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American Journal of Obstetrics and Gynecology
Journal Prestige (SJR): 2.7
Citation Impact (citeScore): 4
Number of Followers: 203  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9378
Published by Elsevier Homepage  [3159 journals]
  • Recurrence patterns of hyperemesis gravidarum
    • Abstract: Publication date: Available online 16 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Miina Nurmi, Päivi Rautava, Mika Gissler, Tero Vahlberg, Päivi Polo-KantolaAbstractBackgroundHyperemesis gravidarum, excessive vomiting in pregnancy, affects approximately 0.3–3.0% of all pregnancies, but the risk is considerably higher in pregnancies following a hyperemetic pregnancy. The reported recurrence rate of hyperemesis gravidarum is wide, ranging from 15% to 81%, depending on study settings. Factors affecting recurrence of hyperemesis gravidarum are as yet insufficiently studied.ObjectiveTo evaluate the recurrence rate of hyperemesis gravidarum in subsequent pregnancies, to elucidate chronological patterns of recurrence of the condition, and to analyze maternal, environmental and pregnancy-related factors associated with recurring hyperemesis gravidarum.Study DesignOut of all pregnancies ending in delivery in Finland between 2004 and 2011, data of women who had at least one pregnancy ending in delivery following a pregnancy diagnosed with hyperemesis gravidarum were retrieved from Hospital Discharge Register and Medical Birth Register (1836 women, 4103 pregnancies; 1836 index pregnancies and 2267 subsequent pregnancies). The first pregnancy with hyperemesis gravidarum diagnosis was chosen as the index pregnancy, and recurrence rate was calculated by comparing the number of hyperemetic pregnancies which followed the index pregnancy to the total number of pregnancies which followed the index pregnancy. Recurrence patters of hyperemesis gravidarum were illustrated by presenting the chronological order of the women’s pregnancies beginning from the index pregnancy to the end of the follow-up period. The associations between recurring hyperemesis and age, parity, pre-pregnancy body mass index, smoking, marital and socioeconomic status, domicile, month of delivery, assisted reproductive technology (ART), sex and number of fetuses were analyzed in both the index pregnancies and in pregnancies following the index pregnancy.ResultsThere were 544 pregnancies with a hyperemesis diagnosis and 1723 pregnancies without a hyperemesis diagnosis following the index pregnancies. The overall recurrence rate of hyperemesis gravidarum in pregnancies following the index pregnancy was 24%. In case of more than one subsequent pregnancy, 11% of women were diagnosed with hyperemesis in all of their pregnancies. In the index pregnancies, recurrence of hyperemesis gravidarum was more common among women with parity of two than parity of one (adjusted OR=1.33, p=0.046). Overweight women (adjusted OR=0.58, p=0.036) or women who smoked after the first trimester (adjusted OR=0.27, p
       
  • Reply
    • Abstract: Publication date: Available online 16 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Oded Langer
       
  • Letter to the Editor in relation to “Pharmacological treatment of
           gestational diabetes mellitus: point/counterpoint” by Oded Langer
    • Abstract: Publication date: Available online 16 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Montserrat Balsells, Apolonia García-Patterson, Rosa Corcoy
       
  • Early cord clamping is the experimental intervention not delayed cord
           clamping
    • Abstract: Publication date: Available online 16 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): David J. Hutchon
       
  • Time to move on from early cord clamping in preterm infants
    • Abstract: Publication date: Available online 16 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): William Tarnow-Mordi, Jon Dorling, Chris Gale
       
  • Prevalence of Endometrial Cancer or Atypical Hyperplasia Diagnosed
           Incidentally in Infertility Clinic
    • Abstract: Publication date: Available online 15 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Yusuf Aytac Tohma, Hulusi Bulent Zeyneloglu, Oner Deniz Aslan, Asuman Nihan Haberal, Gogsen Onalan, Ali Ayhan
       
  • Comparison of the Hadlock and INTERGROWTH 21st formulas for calculating
           estimated fetal weight in a preterm population in France
    • Abstract: Publication date: Available online 14 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Isabelle Monier, Anne Ego, Alexandra Benachi, Pierre-Yves Ancel, François Goffinet, Jennifer ZeitlinAbstractBackgroundAccurate estimation of fetal weight is needed for growth monitoring and decision-making in obstetrics; the INTERGROWTH-21st Project developed an estimated fetal weight formula in order to construct new intrauterine growth standards.ObjectiveTo compare the accuracy of the Hadlock and INTERGROWTH formulas for the estimation of fetal weight among preterm infants.Study designUsing the EPIPAGE 2 population-based study of births between 22 and 34 weeks of gestation, we included 578 non-anomalous singleton fetuses with an ultrasound-to-delivery interval
       
  • "The case for MRI in bowel obstruction during pregnancy : Intussusception
           in a pregnant woman with Roux-en-Y gastric bypass"
    • Abstract: Publication date: Available online 14 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Sebastien Moliere, Victor Cavillon, Yannis Mesli
       
  • Persistence of elevated betaHCG after uterine curettage: unexpected
           diagnosis for a young woman
    • Abstract: Publication date: Available online 14 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Agnese Palmeri, Sergio Costantini, Gloria D'Alessandro
       
  • SMFM Statement on Elective Induction of Labor in Low-Risk Nulliparous
           Women at Term: The ARRIVE Trial
    • Abstract: Publication date: Available online 9 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Society for Maternal-Fetal Medicine (SMFM) Publications Committee
       
  • Vaginal antifungal during pregnancy and risk of spontaneous abortions
    • Abstract: Publication date: Available online 7 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Kejun Xu, Yongming Du
       
  • Receipt of adjuvant endometrial cancer treatment according to race: An NRG
           Oncology/Gynecologic Oncology Group 210 Study
    • Abstract: Publication date: Available online 7 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Ashley S. Felix, David E. Cohn, Theodore M. Brasky, Richard Zaino, Kay Park, David G. Mutch, William T. Creasman, Premal H. Thaker, Joan L. Walker, Richard G. Moore, Shashikant B. Lele, Saketh R. Guntupalli, Levi S. Downs, Christa I. Nagel, John F. Boggess, Michael L. Pearl, Olga B. Ioffe, Marcus E. Randall, Louise A. Brinton BackgroundBlack women with endometrial cancer are more likely to die from their disease compared to white women with endometrial cancer. These survival disparities persist even when disproportionately worse tumor characteristics among black women are accounted. Receipt of less complete adjuvant treatment among black endometrial cancer patients could contribute to this disparity.ObjectiveWe assessed the hypothesis that black women with endometrial cancer are less likely than their white counterparts to receive adjuvant treatment within subgroups defined by tumor characteristics in the NRG Oncology/Gynecology Oncology Group 210 Study.Study designOur analysis included 615 black and 4,283 white women with endometrial cancer who underwent hysterectomy. Women completed a questionnaire that assessed race and endometrial cancer risk factors. Tumor characteristics were available from pathology reports and central review. We categorized women as low-, intermediate-, or high-risk based on the European Society for Medical Oncology definition. Adjuvant treatment was documented during postoperative visits and was categorized as no adjuvant treatment (54.3%), radiotherapy only (16.5%), chemotherapy only (15.2%), and radiotherapy plus chemotherapy (14.0%). We used polytomous logistic regression to estimate odds ratios and 95% confidence intervals for multivariable-adjusted associations between race and adjuvant treatment in the overall study population and stratified by tumor subtype, stage, or European Society for Medical Oncology risk category.ResultsOverall, black women were more likely to have received chemotherapy-only (odds ratio=1.40, 95% confidence interval=1.04-1.86) or radiotherapy plus chemotherapy (odds ratio=2.01, 95% confidence interval=1.54-2.62) compared to white women in multivariable-adjusted models. No racial difference in receipt of radiotherapy-only was observed. In tumor subtype-stratified models, black women had higher odds of receiving radiotherapy plus chemotherapy than white women when diagnosed with low-grade endometrioid (odds ratio=2.04, 95% confidence interval=1.06-3.93) or serous tumors (odds ratio=1.81, 95% confidence interval=1.07-3.08). Race was not associated with adjuvant treatment among women diagnosed with other tumor subtypes. In stage-stratified models we observed no racial differences in receipt of adjuvant treatment. In models stratified by European Society for Medical Oncology risk group, black women with high-risk cancer were more likely to receive radiotherapy plus chemotherapy compared to white women (odds ratio=1.41, 95% confidence interval=1.03-1.94).ConclusionContrary to our hypothesis we observed higher odds of specific adjuvant treatment regimens among black as compared to white women within specific subgroups of endometrial cancer characteristics.
       
  • Re: Vaginal antifungal during pregnancy and risk of spontaneous abortions
    • Abstract: Publication date: Available online 7 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Sharon Daniel, Reut Rotem, Gideon Koren, Eitan Lunenfeld, Amalia Levy
       
  • Actinomycosis induced adnexal and uterine masses mimicking malignancy on
           FDG PET/CT
    • Abstract: Publication date: Available online 7 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Yiyan Liu
       
  • Early and late preeclampsia are characterized by high cardiac output, but
           in the presence of fetal growth restriction, cardiac output is low:
           insights from a prospective study
    • Abstract: Publication date: Available online 7 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Péter Tamás
       
  • Placenta increta after high-intensity-focused ultrasound for the treatment
           of a uterine leiomyoma
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Chin-Ru Ker, Cheng-Yu Long, Ching-Ju Shen
       
  • Early and late preeclampsia are characterized by high cardiac output, but
           in the presence of fetal growth restriction, cardiac output is low:
           insights from a prospective study
    • Abstract: Publication date: Available online 4 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Christoph Lees, Jasmine Tay, Ian Wilkinson
       
  • A painful erythematous plaque on the right labium majora
    • Abstract: Publication date: Available online 2 August 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Qian-Nan Jia, Sergio Vano-Galvan, Dong-Lai Ma
       
  • Atraumatic Normal Vaginal Delivery: How many women get what they want'
    • Abstract: Publication date: Available online 29 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Jessica Caudwell-Hall, Ixora Kamisan Atan, Rodrigo Guzman Rojas, Susanna Langer, Ka Lai Shek, Hans Peter DietzBackgroundTrauma to the perineum, levator ani complex, and anal sphincters is common during vaginal childbirth, but is often clinically underdiagnosed, and many women are unaware of the potential for long term damage.ObjectivesIn this study we use transperineal ultrasound to identify how many women will achieve a normal vaginal delivery without substantial damage to the levator ani or anal sphincter muscles, and to create a model to predict patient characteristics associated with successful atraumatic normal vaginal delivery.Study DesignThis is a retrospective, secondary analysis of data sets gathered in the context of an interventional perinatal imaging study. 660 primiparas, carrying an uncomplicated singleton pregnancy, underwent an antepartum and postpartum interview, vaginal exam (POP-Q) and 4D translabial ultrasound. Ultrasound data was analysed for levator trauma and/or overdistention and residual sphincter defects. Post-processing analysis of ultrasound volumes was performed blinded against clinical data and analysed against obstetric data retrieved from the local maternity database. Levator avulsion was diagnosed if the muscle insertion at the inferior pubic ramus at the plane of minimal hiatal dimensions and within 5mm above this plane on tomographic ultrasound imaging (TUI) was abnormal. Hiatal overdistensibility (microtrauma) was diagnosed if there was a peripartum increase in hiatal area on Valsalva by>20% with the resultant area =>25cm2. A sphincter deficit was diagnosed if a defect of> 30° was seen in four or more of six TUI slices bracketing the EAS (external anal sphincter). Two models were tested: a first model that defines severe pelvic floor trauma as either OASI (obstetric anal sphincter injury) or levator avulsion, and a second, more conservative model, that also included microtrauma.ResultsA total of 504/660 women (76%) returned for post partum follow-up as described previously. 21 patients were excluded due to inadequate data or concurrent pregnancy, leaving 483 women for analysis. Model 1 defined non-traumatic vaginal delivery as excluding operative delivery, OASIS, and sonographic evidence of levator avulsion or residual sphincter defect. Model 2 also excluded microtrauma. Of 483 women, 112 (23%) had a Caesarean section, 103 (21%) had an operative vaginal delivery, and 17 (4%) had a 3rd/4th degree tear, leaving 251 women who could be said to have had a normal vaginal delivery. On ultrasound, in model 1, 27 women (6%) had an avulsion, and 31 (6%) had a residual defect, leaving 193/483 (40%) who met the criteria for atraumatic normal vaginal delivery. In model 2, an additional 33 women (7%) had microtrauma, leaving only 160/483 (33%) women who met the criteria for atraumatic normal vaginal delivery. On multivariate analysis, younger age and earlier gestation at time of delivery remained highly significant as predictors of atraumatic normal vaginal delivery in both Models, with increased hiatal area on Valsalva also significant in Model 2 (all p ≤ 0.035).ConclusionThe prevalence of significant pelvic floor trauma after vaginal child birth is much higher than generally assumed. Rates of OASI are are often underestimated and levator avulsion is not included as a consequence of vaginal birth in most obstetric text books. In this study less than half (33-40%) of primiparous women can expect to achieve an atraumatic normal vaginal delivery.
       
  • Surgical Variance Between Post-Conceptional and Pre-Conceptional Minimally
           Invasive Trans-Abdominal Cerclage Placement
    • Abstract: Publication date: Available online 29 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Gaby N. Moawad, Paul Tyan, Charbel Awad, Elias D. Abi Khalil Recent data shows that trans-abdominal cerclage placement via laparoscopy carries better obstetrical outcomes in comparison to trans-abdominal cerclage placement via laparotomy (1). In this surgical tutorial, we review the technique for minimally invasive abdominal cerclage and highlight the surgical differences between pre-conceptional and conceptional cerclage.
       
  • Reply
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): David Peleg
       
  • Response to 17-alpha hydroxyprogesterone caproate
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Anna Frappaolo, Mary Vadnais
       
  • Recurrence of CIN 2 and 3 after treatment in HIV positive patients
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): William Edridge
       
  • Evidence-Based Treatments for Premenstrual Disorders
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Kimberly A. Yonkers, Michael Simoni
       
  • Premenstrual disorders
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): John Studd, Mike Savvas, Neale Watson
       
  • There is insufficient evidence to claim that cerclage is the treatment of
           choice for patients with a cervical length
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Roberto Romero, Agustin Conde-Agudelo, Kypros H. Nicolaides
       
  • Perhaps cerclage is the ideal treatment for the cervix <1 cm
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Yinka Oyelese, Jennifer Powel, Carlos W. Benito
       
  • Reply
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Sukhbir S. Singh, Liane Belland, Nicholas Leyland, Sarah von Riedemann, Ally Murji
       
  • The past, present, and future of selective progesterone receptor
           modulators in the management of uterine fibroids: an alternative
           perspective
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Funlayo Odejinmi, Henry Annan, Rebecca Mallick
       
  • Noninvasive estimation of fetal lung maturity with magnetic resonance
           spectroscopy
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Stefan Bluml, Vidya Rajagopalan
       
  • Needs assessment survey of obstetrics and gynecology subspecialty
           fellowship program directors
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Sylvia M. Botros, Lee A. Learman, Carrie Bell, Anna Marie Connolly, Nancy Schindler, Kim Kenton
       
  • The making of the first loop
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Jack Lippes
       
  • Cyclic transcutaneous bleeding after repeated cesarean section deliveries
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Bastian Czogalla, Fabian Trillsch, Alexander Burges
       
  • February 2018 (vol. 218, no. 2, page 244)
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s):
       
  • September 2017 (vol. 217, no. 3, page 346.e5)
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s):
       
  • Modulation of nuclear factor-κB signaling and reduction of neural tube
           defects by quercetin-3-glucoside in embryos of diabetic mice
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Chengyu Tan, Fantong Meng, E. Albert Reece, Zhiyong ZhaoBackgroundDiabetes mellitus in early pregnancy increases the risk of birth defects in infants. Maternal hyperglycemia stimulates the expression of nitric oxide synthase 2, which can be regulated by transcription factors of the nuclear factor-κB family. Increases in reactive nitrogen species generate intracellular stress conditions, including nitrosative, oxidative, and endoplasmic reticulum stresses, and trigger programmed cell death (or apoptosis) in the neural folds, resulting in neural tube defects in the embryo. Inhibiting nitric oxide synthase 2 can reduce neural tube defects; however, the underlying mechanisms require further delineation. Targeting nitric oxide synthase 2 and associated nitrosative stress using naturally occurring phytochemicals is a potential approach to preventing birth defects in diabetic pregnancies.ObjectiveThis study aims to investigate the effect of quercetin-3-glucoside, a naturally occurring polyphenol flavonoid, in reducing maternal diabetes-induced neural tube defects in an animal model, and to delineate the molecular mechanisms underlying quercetin-3-glucoside action in regulating nitric oxide synthase 2 expression.Study DesignFemale mice (C57BL/6) were induced to develop diabetes using streptozotocin before pregnancy. Diabetic pregnant mice were administered quercetin-3-glucoside (100 mg/kg) daily via gavage feeding, introduction of drug to the stomach directly via a feeding needle, during neurulation from embryonic day 6.5–9.5. After treatment at embryonic day 10.5, embryos were collected and examined for the presence of neural tube defects and apoptosis in the neural tube. Expression of nitric oxide synthase 2 and superoxide dismutase 1 (an antioxidative enzyme) was quantified using Western blot assay. Nitrosative, oxidative, and endoplasmic reticulum stress conditions were assessed using specific biomarkers. Expression and posttranslational modification of factors in the nuclear factor-κB system were investigated.ResultsTreatment with quercetin-3-glucoside (suspended in water) significantly decreased neural tube defect rate and apoptosis in the embryos of diabetic mice, compared with those in the water-treated diabetic group (3.1% vs. 24.7%; P < .001). Quercetin-3-glucoside decreased the expression of nitric oxide synthase 2 and nitrosative stress (P < .05). It also increased the levels of superoxide dismutase 1 (P < .05), further increasing the antioxidative capacity of the cells. Quercetin-3-glucoside treatment also alleviated of endoplasmic reticulum stress in the embryos of diabetic mice (P < .05). Quercetin-3-glucoside reduced the levels of p65 (P < .05), a member of the nuclear factor-κB transcription factor family, but augmented the levels of the inhibitor of κBα (P < .05), which suppresses p65 nuclear translocation. In association with these changes, the levels of inhibitor of κB kinase-α and inhibitor of κBα phosphorylation were elevated (P < .05).ConclusionQuercetin-3-glucoside reduces the neural tube defects rate in the embryos of diabetic dams. Quercetin-3-glucoside suppresses nitric oxide synthase 2 and increases superoxide dismutase 1 expression, leading to alleviation of nitrosative, oxidative, and endoplasmic reticulum stress conditions. Quercetin-3-glucoside may regulate the expression of nitric oxide synthase 2 via modulating the nuclear factor-κB transcription regulation system. Quercetin-3-glucoside, a naturally occurring polyphenol that has high bioavailability and low toxicity, is a promising candidate agent to prevent birth defects in diabetic pregnancies.
       
  • The vaginal eukaryotic DNA virome and preterm birth
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Kristine M. Wylie, Todd N. Wylie, Alison G. Cahill, George A. Macones, Methodius G. Tuuli, Molly J. StoutBackgroundDespite decades of attempts to link infectious agents to preterm birth, an exact causative microbe or community of microbes remains elusive. Culture-independent sequencing of vaginal bacterial communities demonstrates community characteristics are associated with preterm birth, although none are specific enough to apply clinically. Viruses are important components of the vaginal microbiome and have dynamic relationships with vaginal bacterial communities. We hypothesized that vaginal eukaryotic DNA viral communities (the “vaginal virome”) either alone or in the context of bacterial communities are associated with preterm birth.ObjectiveThe objective of this study was to use high-throughput sequencing to examine the vaginal eukaryotic DNA virome in a cohort of pregnant women and examine associations between vaginal community characteristics and preterm birth.Study DesignThis is a nested case-control study within a prospective cohort study of women with singleton pregnancies, not on supplemental progesterone, and without cervical cerclage in situ. Serial midvaginal swabs were obtained at routine prenatal visits. DNA was extracted, bacterial communities were characterized by 16S ribosomal RNA gene sequencing, and eukaryotic viral communities were characterized by enrichment of viral nucleic acid with the ViroCap targeted sequence capture panel followed by nucleic acid sequencing. Viral communities were analyzed according to presence/absence of viruses, diversity, dynamics over time, and association with bacterial community data obtained from the same specimens.ResultsSixty subjects contributed 128 vaginal swabs longitudinally across pregnancy. In all, 24 patients delivered preterm. Participants were predominantly African American (65%). Six families of eukaryotic DNA viruses were detected in the vaginal samples. At least 1 virus was detected in 80% of women. No specific virus or group of viruses was associated with preterm delivery. Higher viral richness was significantly associated with preterm delivery in the full group and in the African American subgroup (P = .0005 and P = .0003, respectively). Having both high bacterial diversity and high viral diversity in the first trimester was associated with the highest risk for preterm birth.ConclusionHigher vaginal viral diversity is associated with preterm birth. Changes in vaginal virome diversity appear similar to changes in the vaginal bacterial microbiome over pregnancy, suggesting that underlying physiology of pregnancy may regulate both bacterial and viral communities.
       
  • Reply
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): David B. Nelson, Donald D. McIntire, Kenneth J. Leveno
       
  • Is there a survival advantage in diagnosing endometrial cancer in
           asymptomatic postmenopausal patients' An Israeli Gynecology Oncology
           Group study
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Ofer Gemer, Yakir Segev, Limor Helpman, Nasreen Hag-Yahia, Ram Eitan, Oded Raban, Zvi Vaknin, Sophia Leytes, Alon Ben Arie, Amnon Amit, Tally Levy, Ahmed Namazov, Michael Volodarsky, Inbar Ben Shachar, Ilan Atlas, Ilan Bruchim, Ofer LavieBackgroundIncidental ultrasonographic findings in asymptomatic postmenopausal women, such as thickened endometrium or polyps, often lead to invasive procedures and to the occasional diagnosis of endometrial cancer. Data supporting a survival advantage of endometrial cancer diagnosed prior to the onset of postmenopausal bleeding are lacking.ObjectiveTo compare the survival of asymptomatic and bleeding postmenopausal patients diagnosed with endometrial cancer.Study DesignThis was an Israeli Gynecology Oncology Group retrospective multicenter study of 1607 postmenopausal patients with endometrial cancer: 233 asymptomatic patients and 1374 presenting with postmenopausal bleeding. Clinical, pathological, and survival measures were compared.ResultsThere was no significant difference between the asymptomatic and the postmenopausal bleeding groups in the proportion of patients in stage II–IV (23.5% vs 23.8%; P = .9) or in high-grade histology (41.0% vs 38.4%; P = .12). Among patients with stage-I tumors, asymptomatic patients had a greater proportion than postmenopausal bleeding patients of stage IA (82.1% vs 66.2%; P < .01) and a smaller proportion received adjuvant postoperative radiotherapy (30.5% vs 40.6%; P = .02). There was no difference between asymptomatic and postmenopausal bleeding patients in the 5-year recurrence-free survival (79.1% vs 79.4%; P = .85), disease-specific survival (83.2% vs 82.2%; P = .57), or overall survival (79.7% vs 76.8%; P = .37).ConclusionEndometrial cancer diagnosed in asymptomatic postmenopausal women is not associated with higher survival rates. Operative hysteroscopy/curettage procedures in asymptomatic patients with ultrasonographically diagnosed endometrial polyps or thick endometrium are rarely indicated. It is reasonable to reserve these procedures for patients whose ultrasonographic findings demonstrate significant change over time.
       
  • Preoperative obstructive sleep apnea screening in gynecologic oncology
           patients
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Ross F. Harrison, Erin E. Medlin, Chase B. Petersen, Stephen L. Rose, Ellen M. Hartenbach, David M. Kushner, Ryan J. Spencer, Laurel W. Rice, Ahmed N. Al-NiaimiBackgroundWomen with a gynecologic cancer tend to be older, obese, and postmenopausal, characteristics that are associated with an increased risk for obstructive sleep apnea. However, there is limited investigation regarding the condition’s prevalence in this population or its impact on postoperative outcomes. In other surgical populations, patients with obstructive sleep apnea have been observed to be at increased risk for adverse postoperative events.ObjectiveWe sought to estimate the prevalence of obstructive sleep apnea among gynecologic oncology patients undergoing elective surgery and to investigate for a relationship between obstructive sleep apnea and postoperative outcomes.Study DesignPatients referred to an academic gynecologic oncology practice were approached for enrollment in this prospective, observational study. Patients were considered eligible for study enrollment if they were scheduled for a nonemergent inpatient surgery and could provide informed consent. Enrolled patients were evaluated for a preexisting diagnosis of obstructive sleep apnea. Those without a prior diagnosis were screened using the validated, 4-item STOP questionnaire (ie, Snore loudly, daytime Tiredness, Observed apnea, elevated blood Pressure). All patients who screened positive for obstructive sleep apnea were referred for polysomnography. The primary outcome was the prevalence of women with obstructive sleep apnea or those who screened at high risk for the condition. Secondary outcomes examined the correlation between body mass index (kg/m2) with obstructive sleep apnea and assessed for a relationship between obstructive sleep apnea and postoperative outcomes.ResultsOver a 22-month accrual period, 383 eligible patients were consecutively approached to participate in the study. A cohort of 260 patients were enrolled. A total of 33/260 patients (13%) were identified as having a previous diagnosis of obstructive sleep apnea. An additional 66/260 (25%) screened at risk for the condition using the STOP questionnaire. Of the patients who screened positive, 8/66 (12%) completed polysomnography, all of whom (8/8 [100%]) were found to have obstructive sleep apnea. The prevalence of previously diagnosed obstructive sleep apnea or screening at risk for the condition increased as body mass index increased (P < .001). Women with untreated obstructive sleep apnea and those who screened at risk for the condition were found to have an increased risk for postoperative hypoxemia (odds ratio, 3.5; 95% confidence interval, 1.8–4.7; P = .011) and delayed return of bowel function (odds ratio, 2.1; 95% confidence interval, 1.3–4.5; P = .009).ConclusionThe prevalence of obstructive sleep apnea or screening at risk for the condition is high among women presenting for surgery with a gynecologic oncologist. Providers should consider evaluating a patient’s risk for obstructive sleep apnea in the preoperative setting, especially when risk factors for the condition are present.
       
  • Hormonal contraception and breast cancer
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Carolyn L. Westhoff, Malcolm C. PikeThe recent Danish cohort study reported a 20% increased risk of breast cancer among current and recent hormonal contraception users. These results are largely consistent with previous studies. This study did not report on stage of disease at diagnosis and it is not clear to what extent the apparent increased risk may be due to a small advance in the timing of diagnosis. This study did not report on the risk associated with the use of a 20-μg ethinyl estradiol pill. They did find an increasing risk in current users of longer duration and an increased risk with use of the levonorgestrel intrauterine system–both of these potentially important findings have not been consistently found in previous studies and require further investigation. The breast cancer effects described now in multiple studies wane with time, and in the long-term hormonal contraception use has been found not to be associated with any increased total cancer risk.
       
  • Lippes loop and the first IUDs: lessons from a bygone era
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Jeffrey F. Peipert
       
  • Information for Readers
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s):
       
  • A randomized clinical trial of knotless barbed suture vs conventional
           suture for closure of the uterine incision at cesarean delivery
    • Abstract: Publication date: August 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 2Author(s): Cynthia Abraham
       
  • Successful in utero transesophageal pacing for severe drug-resistant
           tachyarrhythmia
    • Abstract: Publication date: Available online 25 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Julien Stirnemann, Alice Maltret, Ayman Haydar, Bertrand Stos, Damien Bonnet, Yves Ville Sustained fetal tachyarrhythmia can evolve into a life-threatening condition in 40% of cases when hydrops develops, with a 27% risk of perinatal mortality. Several antiarrhythmic drugs can be given solely or in combination to the mother to achieve therapeutic transplacental concentrations. Therapeutic failure could lead to progressive cardiac insufficiency, and restrict therapeutic options to either elective delivery or direct fetal administration of anti-arrhythmic drugs which may increase the risk of death.We report for the first time successful fetal transesophageal pacing to treat hydropic fetus with drug resistant tachyarrhythmia.
       
  • Best Practice Guidelines regarding Prenatal Evaluation and Delivery of
           Patients with Skeletal Dysplasia
    • Abstract: Publication date: Available online 23 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Ravi Savarirayan, Judith P. Rossiter, Julie E. Hoover-Fong, Melita Irving, Viviana Bompadre, Michael J. Goldberg, Michael B. Bober, Tae-Joon Cho, Shawn E. Kamps, William G. Mackenzie, Cathleen Raggio, Samantha S. Spencer, Klane K. White, Skeletal Dysplasia Management ConsortiumStructured BackgroundSkeletal dysplasia comprises a heterogeneous and collectively common group of inherited disorders of development, growth, and maintenance of the human skeleton. There is potential for increased perinatal morbidity and mortality in pregnant women who themselves have skeletal dysplasia, and for affected fetuses where skeletal dysplasia is suspected in utero.ObjectivesTo establish guidelines for perinatal health care professionals who should be aware of these risks, in order to optimize maternal and child health pregnancy outcomes through “best” prenatal and delivery management practices.Study DesignA panel of 13 multidisciplinary international experts participated in a Delphi process, which comprised consideration of thorough literature review and a list of 54 possible care recommendations subject to two rounds of anonymous voting and a face to face meeting. Those recommendations with more than 80% agreement were considered as consensual.ResultsDuring the first round, consensus was reached to support 30 out of the 54 statements. After the panel discussion, the group reached consensus on 40 statements. These statements include guidelines for the evaluation and treatment of pregnant women with skeletal dysplasia and for the unborn child with or suspected to have skeletal dysplasia.ConclusionsConsensus based best practice guidelines provided as a minimum of standard care to minimize associated health risks, and improve clinical outcomes for patients with skeletal dysplasia.
       
  • Society for Maternal-Fetal Medicine (SMFM) Consult Series #46 : Evaluation
           and Management of Polyhydramnios
    • Abstract: Publication date: Available online 23 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Society for Maternal-Fetal Medicine (SMFM), Jodi S. Dashe, Eva K. Pressman, Judith U. Hibbard Polyhydramnios, or hydramnios, is an abnormal increase in the volume of amniotic fluid. Identification of polyhydramnios should prompt a search for an underlying etiology. Although most cases of mild polyhydramnios are idiopathic, the two most common pathologic causes are maternal diabetes mellitus and fetal anomalies, some of which are associated with genetic syndromes. Other causes of polyhydramnios include congenital infection and alloimmunization. The purpose of this document is to provide guidance on the evaluation and management of polyhydramnios. The following are SMFM recommendations: (1) we suggest that polyhydramnios in singleton pregnancies be defined as either a DVP of >8 cm or an amniotic fluid index of >24 cm (GRADE 2C); (2) we recommend that amnioreduction be considered only for the indication of severe maternal discomfort, dyspnea, or both in the setting of severe polyhydramnios (GRADE 1C); (3) we recommend that indomethacin should not be used for the indication of polyhydramnios for the sole purpose of decreasing amniotic fluid (GRADE 1B); (4) we suggest that antenatal fetal surveillance is not required for the sole indication of mild idiopathic polyhydramnios (GRADE 2C); (5) we recommend that labor should be allowed to occur spontaneously at term for women with mild idiopathic polyhydramnios; that induction, if planned, should not occur prior to 39 weeks of gestation in the absence of other indications; and that mode of delivery should be determined based on usual obstetric indications (GRADE 1C); (6) we recommend that women with severe polyhydramnios deliver at a tertiary center (GRADE 1C).
       
  • Surgery is Not Superior to Dilation for the Management of Vaginal Agenesis
           in MRKH Syndrome: A Multicenter Comparative Observational Study in 131
           Patients
    • Abstract: Publication date: Available online 21 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Alaa Cheikhelard, Maud Bidet, Amandine Baptiste, Magali Viaud, Christine Fagot, Naziha Khen-Dunlop, Christine Louis-Sylvestre, Jean-Luc Brun, Emile Darai, Philippe Descamps, P. Leguevaque, P. Lopes, Claude Louis-Borrione, Karine Morcel, Bernard-Jean Paniel, Aline Ranke, Romain Rouzier, Catherine Pienkowski, Sabine Sarnacki, Philippe Touraine BackgroundVaginal agenesis in Mayer-Rokitanski-Küster-Hauser (MRKH) syndrome can be managed either by various surgeries or dilation. The choice still depends on surgeon’s preferences rather than on quality comparative studies and validated protocols.Objective(s)To compare dilation and surgical management of vaginal agenesis in MRKH syndrome, in terms of quality of life, anatomical results and complications in a large multicenter population.Study DesignOur multicenter study included 131 patients older than 18, at least one year after completing vaginal agenesis management. All had an independent gynecological evaluation including a normalized pelvic exam, and filled World Health Organization Quality of Life (WHOQOL-BREF) (general quality of life), Female Sexual Function Index and Female Sexual Distress Scale-Revised (sexual quality of life) scales. Groups were: Surgery (N=84), Dilation therapy (N=26), Intercourse (N=20). Statistics: data were compared using ANOVA, Student, Kruskal-Wallis, Wilcoxon and Student's exact test.ResultsMean age was 26.5 +/- 5.5 years at inclusion.In all groups, World Health Organization Quality of Life (WHOQOL-BREF) scores were not different between patients and the general population except for lower psychosocial health and social relationship scores (which were not different between groups). Global Female Sexual Function Index scores were significantly lower in the surgery and dilation therapy groups (median 26 [2.8-34.8] and 24.7 [2.6-34.4], respectively) than the intercourse group (30.2 [7.8-34.8]), p=0.044), who had a higher score only in the Satisfaction dimension (p=0,004). However, the scores in the other dimensions of Female Sexual Function Index were not different between groups. The Female Sexual Distress Scale-Revised scores were respectively 17 [0-52], 20 [0-47] and 10 [10-40] in the surgery group, dilation therapy group, and intercourse group (p=0.38), with a sexual distress in 71% of patients.Vaginal depth was shorter in dilatation therapy group (9.6 cm [5.5-12]) compared to surgery group (11 cm [6-15]) and intercourse group (11 cm [6-12.5]) (p=0.039), but remained within normal ranges. One bias in the surgery group was the high number of sigmoidovaginoplasties (57/84, 68%), but no differences were observed between surgeries. Only 4 patients achieved vaginas shorter than 6,5 cm.Delay between management and first intercourse was 6 months (not significant). Seventy patients (53%) had dyspareunia (not significant), and 17 patients all from the surgery group had an abnormal pelvic exam.In the surgery group, 34 patients (40.5%) had complications, requiring 20 secondary surgeries in 17 patients, and 35 (42%) needed postoperative dilation. In the dilation therapy group, 13 (50%) needed maintenance dilation.Conclusion(s)Surgery is not superior to therapeutical or intercourse dilation, bears more complications, and should therefore be only a second-line treatment. Psychological counseling is mandatory at diagnosis and during therapeutical management.
       
  • Postpartum intrauterine devices: Clinical and programmatic review
    • Abstract: Publication date: Available online 19 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Lisa M. Goldthwaite, Erica P. Cahill, Amy J. Voedisch, Paul D. Blumenthal The immediate postpartum period is a critical moment for contraceptive access and an opportunity to initiate long acting reversible contraception, including insertion of an intrauterine device (IUD). The use of the IUD in the postpartum period is a safe practice with few contraindications and many benefits. While an IUD placed during the postpartum period is more likely to expel compared to one placed at the postpartum visit, women initiating IUDs at the time of delivery are also more likely to continue to use an IUD compared to women planning to follow up for an interval IUD insertion. This review will focus on the most recent clinical and programmatic updates on postpartum IUD practice. We discuss postpartum IUD expulsion and continuation, eligibility criteria and contraindications, safety in regards to breastfeeding, and barriers to access. Our aim is to summarize evidence related to postpartum IUDs and encourage those involved in the health care system to remove barriers to this worthwhile practice.
       
  • Expanding Phenotypes of Intrauterine Growth Restriction
    • Abstract: Publication date: Available online 17 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Christie L. Walker, Audrey A. Merriam, Cynthia Gyamfi-Bannerman, Kristina M. Adams Waldorf
       
  • Response to Letter to the Editor for: Racial difference in postpartum
           hemorrhage outcome: Pathophysiological, clinical, and social
           significance'
    • Abstract: Publication date: Available online 11 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Alexander Friedman, Cynthia Gyamfi-Bannerman
       
  • Vaginal delivery within 24 hours of labor induction as a primary outcome
           – what's the rush'
    • Abstract: Publication date: Available online 11 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Lena Sagi-Dain, Shlomi Sagi
       
  • Do Pregnant Inmates have a Constitutional Right to Opioid Replacement
           Therapy'
    • Abstract: Publication date: Available online 11 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Joseph B. Williams Changes in the national drug laws have resulted in a marked increase in the number of individuals incarcerated in the US over the past several decades, and women have not been exempt from this trend. Incarcerated women who are pregnant and at risk of experiencing opioid withdrawal often lack access to opioid replacement therapy while in jails and prisons, and this treatment is necessary to prevent significant acute withdrawal which can be detrimental to maternal-fetal health. I contend that pregnant inmates who are at risk of experiencing opioid withdrawal possess a constitutional right to receive opioid replacement therapy while incarcerated, and failure to provide this treatment represents a violation of the Eighth Amendment’s protection against cruel and unusual punishment.
       
  • Sexual response in women with Mayer-Rokitansky-Küster-Hauser syndrome
           with a non-surgical neo-vagina
    • Abstract: Publication date: Available online 11 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Stephanie Both, Kirsten Kluivers, Marianne Ten Kate-Booij, Philomeen Weijenborg BackgroundSexual dysfunction is prevalent in women with Mayer-Rokitansky-Küster-Hauser syndrome after creation of a neo-vagina. Insight into the physiological response of the neo-vagina during sexual arousal is lacking, while this would help in the understanding of sexual function of these patients. The physiological sexual response of the vagina can be objectively measured by vaginal photoplethysmography assessing vaginal blood flow.Objective(s)Testing whether the physiological and subjective sexual response in women with Mayer-Rokitansky-Küster-Hauser syndrome with a neo-vagina differs from the response in women with a natal vagina.Study designVaginal blood flow (Vaginal Pulse Amplitude) and subjective sexual responses during neutral and erotic film viewing were assessed in pre-menopausal Mayer-Rokitansky-Küster-Hauser women with a non-surgically created neo-vagina (n = 15), and were compared with responses of an age-matched control group (n = 21).ResultsAll Mayer-Rokitansky-Küster-Hauser women had created their neo-vagina themselves by dilation. Mayer-Rokitansky-Küster-Hauser women showed a significantly smaller vaginal pulse amplitude compared to controls during neutral film viewing (p = .002). In both groups, vaginal pulse amplitude increased significantly during erotic film viewing, but this increase was significantly smaller in the Mayer-Rokitansky-Küster-Hauser group (p’s < .005). Levels of subjective sexual arousal did not significantly differ between the two groups (p’s> .2).ConclusionsMayer-Rokitansky-Küster-Hauser women with a non-surgically created neo-vagina showed a weaker vaginal blood flow response during visual sexual stimulation, and poorer basal blood flow compared to controls. The differences in vaginal blood flow may be related to less vascularization and innervation of the neo-vagina compared to the natal vagina. The weaker vaginal sexual response can play a role in sexual dysfunction, although, despite the weaker vaginal response, Mayer-Rokitansky-Küster-Hauser women did not differ in their level of subjective sexual arousal. Future studies may compare vaginal blood flow and subjective sexual response of Mayer-Rokitansky-Küster-Hauser women with non-surgically and surgically created vaginas.
       
  • Sexism in Obstetrics & Gynecology: Not just a “women’s
           issue”
    • Abstract: Publication date: Available online 11 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Francine Hughes, Peter S. Bernstein Women in medicine have made strides towards equality and yet the gender gap continues to exist. Despite being the specialty dedicated to the promotion of women’s health, Obstetrics and Gynecology is also marred by gender disparity. Obstetrician-gynecologists who are women continue to face barriers to advancement to leadership positions and earn $36,000 per year less than men in Obstetrics and Gynecology according to a recent study. Similarly, men in Obstetrics and Gynecology may be negatively affected by unconscious bias and socially prescribed roles for men and women, resulting in patient preferences for providers who are women. Both men and women have a vested interest in promoting greater gender parity in Obstetrics and Gynecology, and participation of men is critical for realization of this goal. For the obstetrician-gynecologist, sexism is not just a “women’s issue”.
       
  • Femur-Sparing Pattern of Fetal Growth After Maternal Zika Virus Infection
    • Abstract: Publication date: Available online 11 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Sora Yasri, Viroj Wiwanitkit
       
  • Cervical Cerclage for Singleton Pregnant Patients on Vaginal Progesterone
           with Progressive Cervical Shortening
    • Abstract: Publication date: Available online 11 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Christopher A. Enakpene, Laura DiGiovanni, Tiffany N. Jones, Megan Marshalla, Dimitrios Mastrogiannis, Micaela Della Torre
       
  • Racial difference in postpartum hemorrhage outcome: Pathophysiological,
           clinical, and social significance'
    • Abstract: Publication date: Available online 11 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Shigeki Matsubara, Hironori Takahashi, Akihide Ohkuchi
       
  • Reply to Letter # L18-061AR1
    • Abstract: Publication date: Available online 11 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Alison M. Bauer, Justin R. Lappen, David N. Hackney
       
  • December 2017 (vol. 217, no. 6, page 725, Abstract 8)
    • Abstract: Publication date: Available online 3 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s):
       
  • Implementation and Validation of a Retroperitoneal Dissection Curriculum
    • Abstract: Publication date: Available online 3 July 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Aisha A. Yousuf, Helena Frecker, Abheha Satkunaratnam, Eliane M. Shore BackgroundCompetency-based education requires educators to use simulation training for the purposes of education and assessment of resident trainees. Research demonstrates that improvement in surgical skills acquired in a simulated environment is transferrable to the operative environment. Laparoscopic retroperitoneal dissection (LRD), opening the retroperitoneal space and identifying the ureter, is a fundamental skill for gynecologists. Integrating simulation models into a formal and comprehensive curriculum for teaching ureterolysis could translate to increased surgical competency.ObjectivesOur goal was to validate a comprehensive curriculum for LRD for the purpose of identification of the ureter by evaluating intraoperative performance.Study DesignA comprehensive curriculum, encompassing didactic and technical skills components and using a previously developed pelvic model, was designed to teach laparoscopic ureterolysis. Novice surgeons (PGY 3-5) were recruited. Participants completed pre- and post- curriculum multiple-choice questionnaires (MCQ) to evaluate a didactic component. Pre- and post- performance on the model was video-recorded. As part of the technical component, participants received constructive feedback from expert surgeons on how to perform LRD using the simulation model. Participants were then video-recorded performing LRD in the operating room (OR) within 3 months of the curriculum. All videos were blindly assessed by an expert using the objective structured assessment of technical skills (OSATS) tool. At the conclusion of the study, participants completed a course evaluation.ResultsThirty novice gynecologic surgeons were recruited. High baseline knowledge of ureteric anatomy and injury (MCQ score median and interquartile (IQR)) still significantly increased from 7 (5-7.25) pre-curriculum to 8 (7-9) post-curriculum (p < 0.001). The median (IQR) technical OSATS score increased significantly from 24.5 (23-28.25) pre-curriculum to 30 (29.75-32) post-curriculum (p < 0.001). Video recordings were completed for 23 participants performing LRD in the OR. Intraoperative OSATS scores (median of 29 (27-32)) correlated with post-curriculum OSATS scores on the model (r=0.53, p = 0.01). The ureter was identified intraoperatively by 91% (n=21/23) of participants. The majority of residents (81%, n=21/26) were more comfortable completing a supervised retroperitoneal dissection as a result of participating in the curriculum. Residents felt that this model would be useful to enhance skills acquisition prior to performing the skill in the OR (65%, n=17/26).ConclusionA comprehensive retroperitoneal dissection curriculum showed improvement in cognitive knowledge and technical skills, which also translated to competent performance in the OR. In addition to the objective measures, residents felt that their skills acquisition was improved following course completion.
       
  • Retraction notice to 647: Compliance of federally-funded maternal fetal
           medicine and neonatology studies to federally-mandated trial registration
           requirements: Am J Obstet Gynecol 2018;218:S385.
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Vanessa C. Nunes, Alexandria Wells, Germaine Y. Noukelak, Menachem Miodovnik, Tonse N.K. RajuThis article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal).This abstract has been retracted at the request of the
      Authors .All authors did not have the opportunity to review and approve the abstract prior to submission. As a result, the abstract was published with errors.
       
  • Reply
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Lindsey J. Graham, Brendan C. Graham, Carl H. Rose, Jeffrey L. Winters
       
  • SMFM Divider Page
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s):
       
  • How shall we transfuse Hippolyta' The same way whether on or off the
           battlefield
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Mark H. Yazer, Shawn C. Nessen, Andrew P. Cap
       
  • Reply
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Alison Paquette, Nathan D. Price, Stephen J. Lye
       
  • The preterm labor associated ADAMTS2 gene is induced by
           glucocorticoids
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Alasdair W. Jubb, Thomas P. Hofer, David A. Hume, Loems Ziegler-Heitbrock
       
  • Genitourinary syndrome of menopause: corrections and comments by a
           gynecologist
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Karen L. Miller
       
  • Reply
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Spencer G. Kuper, Alan T. Tita
       
  • Prevention of adverse pulmonary, neurological, and ocular perinatal
           outcomes by supplementing omega-3 fatty acids during pregnancy
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Lorenzo Ferro Desideri, Fabio Barra, Simone Ferrero
       
  • Reply
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Maria P. Ruiz, Yongmei Huang, Cande V. Ananth, Jason D. Wright
       
  • All-cause death in young women with endometrial cancer who receive
           progesterone therapy
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Andreas Obermair, Monika Janda, Val Gebski
       
  • Optimal aspirin dosing for preeclampsia prevention
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Anna Lene Seidler, Lisa Askie, Joel G. Ray
       
  • Maternal pomegranate juice attenuates maternal inflammation–induced
           fetal brain injury by inhibition of apoptosis, neuronal nitric oxide
           synthase, and NF-κB in a rat model
    • Abstract: Publication date: July 2018Source: American Journal of Obstetrics and Gynecology, Volume 219, Issue 1Author(s): Yuval Ginsberg, Nizar Khatib, Noor Saadi, Michael G. Ross, Zeev Weiner, Ron BelooseskyBackgroundMaternal inflammation is a risk factor for neonatal brain injury and future neurological deficits. Pomegranates have been shown to exhibit anti-inflammatory, anti-apoptotic and anti-oxidant activities.ObjectiveWe hypothesized that pomegranate juice (POM) may attenuate fetal brain injury in a rat model of maternal inflammation.Study DesignPregnant rats (24 total) were randomized for intraperitoneal lipopolysaccharide (100 μg/kg) or saline at time 0 at 18 days of gestation. From day 11 of gestation, 12 dams were provided ad libitum access to drinking water, and 12 dams were provided ad libitum access to drinking water with pomegranate juice (5 mL per day), resulting in 4 groups of 6 dams (saline/saline, pomegranate juice/saline, saline/lipopolysaccharide, pomegranate juice/lipopolysaccharide). All dams were sacrificed 4 hours following the injection and maternal blood and fetal brains were collected from the 4 treatment groups. Maternal interleukin-6 serum levels and fetal brain caspase 3 active form, nuclear factor-κB p65, neuronal nitric oxide synthase (phosphoneuronal nitric oxide synthase), and proinflammatory cytokine levels were determined by enzyme-linked immunosorbent assay and Western blot.ResultsMaternal lipopolysaccharide significantly increased maternal serum interleukin-6 levels (6039 ± 1039 vs 66 ± 46 pg/mL; P < .05) and fetal brain caspase 3 active form, nuclear factor-κB p65, phosphoneuronal nitric oxide synthase, and the proinflammatory cytokines compared to the control group (caspase 3 active form 0.26 ± 0.01 vs 0.20 ± 0.01 U; nuclear factor-κB p65 0.24 ± 0.01 vs 0.1 ± 0.01 U; phosphoneuronal nitric oxide synthase 0.23 ± 0.01 vs 0.11 ± 0.01 U; interleukin-6 0.25 ± 0.01 vs 0.09 ± 0.01 U; tumor necrosis factor-α 0.26 ± 0.01 vs 0.12 ± 0.01 U; chemokine (C-C motif) ligand 2 0.23 ± 0.01 vs 0.1 ± 0.01 U). Maternal supplementation of pomegranate juice to lipopolysaccharide-exposed dams (pomegranate juice/lipopolysaccharide) significantly reduced maternal serum interleukin-6 levels (3059 ± 1121 pg/mL, fetal brain: caspase 3 active form (0.2 ± 0.01 U), nuclear factor-κB p65 (0.22 ± 0.01 U), phosphoneuronal nitric oxide synthase (0.19 ± 0.01 U) as well as the brain proinflammatory cytokines (interleukin-6, tumor necrosis factor-α and chemokine [C-C motif] ligand 2) compared to lipopolysaccharide group.ConclusionMaternal pomegranate juice supplementation may attenuate maternal inflammation–induced fetal brain injury. Pomegranate juice neuroprotective effects might be secondary to the suppression of both the maternal inflammatory response and inhibition of fetal brain apoptosis, neuronal nitric oxide synthase, and nuclear factor-κB activation.
       
  • Six-month expulsion of postplacental copper intrauterine devices placed
           after vaginal delivery
    • Abstract: Publication date: Available online 2 June 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Elizabeth P. Gurney, Sarita Sonalkar, Arden Mcallister, Mary D. Sammel, Courtney A. Schreiber BackgroundImmediate placement of an intrauterine device (IUD) after vaginal delivery is safe and convenient, but longitudinal data describing clinical outcomes have been limited.ObjectivesTo determine the proportion of TCu380A (copper) IUDs devices expelled, partially expelled, malpositioned, and retained, as well as contraceptive use by 6 months postpartum. To determine risk factors for expulsion and partial expulsion.Study DesignIn this prospective, observational study, women who received a postplacental TCu380A IUD at vaginal delivery were enrolled postpartum. Participants returned for clinical follow-up at 6 weeks, and for a research visit with a pelvic exam and ultrasound at 6 months. We recorded IUD outcomes and 6-month contraceptive use. Partial expulsion was defined as an IUD protruding from the external cervical os, or a transvaginal ultrasound showing the distal end of the IUD below the internal os of the cervix. Multinomial logistic regression models identified risk factors associated with expulsion and partial expulsion by 6 months. The area under the receiver-operating characteristics (ROC) curve was used to assess the ability of a string check to predict the correct placement of a postplacental IUD. The primary outcome was the proportion of IUDs expelled at 6 months.ResultsWe enrolled 200 women. Of 162 participants with follow-up data at 6 months, 13 (8.0%, 95% CI 4.7%-13.4%), experienced complete expulsion and 26 (16.0%, 95% CI 11.1%-22.6%) partial expulsion (see Figure 1). Of 25 malpositioned IUDs (15.4%, 95% CI 10.2%-21.9%), 14 were not at the fundus (8.6%, 95% CI 5.2%-14.1%) and 11 were rotated within the uterus (6.8%, 95% CI 3.8%-11.9%). Multinomial logistic regression modeling indicated that higher parity (OR 2.05; 95% CI 1.21-3.50, p=0.008) was associated with expulsion. Provider specialty (Obstetrics vs. Family Medicine; OR 5.31, 95% CI 1.20-23.59; p=0.03) and gestational weight gain (normal vs. excess; OR 9.12, 95% CI 1.90-43.82; p=0.004) were associated with partial expulsion. Long-acting reversible contraceptive method use at 6 months was 80.9% (95% CI 74.0%-86.6%).At 6 weeks postpartum, 35 of 149 (23.5%, 95% CI 16.9%-31.1%) participants had no IUD strings visible. Sensitivity of a string check to detect an incorrectly positioned intrauterine device was 36.2%, and specificity of the string check to predict a correctly positioned intrauterine device was 84.5%. This corresponds to an area under the ROC curve of 0.5.ConclusionThis prospective assessment of postplacental TCu380A intrauterine device placement, with ultrasound to confirm device position, finds a complete intrauterine device expulsion proportion of 8.0% at 6 months. The association of increasing parity with expulsion is consistent with prior research. The clinical significance of covariates associated with partial expulsion (provider specialty and gestational weight gain) is unclear. Due to the observational study design, any associations cannot imply causality.The proportion of partially expelled and malpositioned IUDs was high, and the area under the ROC curve of 0.5 indicates that a string check is a poor test for assessing device position. Women considering a postplacental IUD should be counseled about the risk of position abnormalities, as well as the possibility of non-visible strings, which may complicate clinical follow-up. The clinical significance of IUD position abnormalities is unknown; future research should evaluate the influence of malposition and partial expulsion on contraceptive effectiveness and side effects.
       
  • A prospective cohort study of meat and fish consumption and endometriosis
           risk
    • Abstract: Publication date: Available online 2 June 2018Source: American Journal of Obstetrics and GynecologyAuthor(s): Ayae Yamamoto, Holly R. Harris, Allison F. Vitonis, Jorge E. Chavarro, Stacey A. Missmer BackgroundOnly two case-control studies have examined the associations between consumption of meat products and endometriosis risk with inconsistent results. Consumption of animal products has the potential to influence endometriosis risk through effects on steroid hormones levels.ObjectivesTo determine whether higher intake of red meat, poultry, fish, and seafood are associated with risk of laparoscopically-confirmed endometriosisStudy Design81,908 participants of the prospective Nurses’ Health Study II were followed from 1991-2013. Diet was assessed via food frequency questionnaire every 4 years. Cox proportional hazards models were used to calculate rate ratios (RR) and 95% confidence intervals (CIs).ResultsDuring 1,019,294 person-years of follow-up, 3,800 cases of incident laparoscopically-confirmed endometriosis were reported. Women consuming>2 servings/day of red meat/day had a 56% higher risk in endometriosis (95% CI=1.22-1.99; Ptrend
       
 
 
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