Pub Date : 2026-04-30DOI: 10.1097/AOG.0000000000006302
Pregnancy options counseling is a person-centered process through which one provides information regarding management options in continuing a pregnancy or not and seeks to understand a patient's values, beliefs, preferences, concerns, and ambivalence regarding pregnancy. In practice, upholding comprehensive person-centered pregnancy options counseling is a nuanced process. A health care professional's ability to enact these ethical principles in their practice may be limited by legal restrictions or institutional culture or both; however, they can use person-centered and shared decision-making frameworks to understand and support their patients. The Society for Family Planning endorses this Committee Statement.
{"title":"Person-Centered Pregnancy Options Counseling.","authors":"","doi":"10.1097/AOG.0000000000006302","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006302","url":null,"abstract":"<p><p>Pregnancy options counseling is a person-centered process through which one provides information regarding management options in continuing a pregnancy or not and seeks to understand a patient's values, beliefs, preferences, concerns, and ambivalence regarding pregnancy. In practice, upholding comprehensive person-centered pregnancy options counseling is a nuanced process. A health care professional's ability to enact these ethical principles in their practice may be limited by legal restrictions or institutional culture or both; however, they can use person-centered and shared decision-making frameworks to understand and support their patients. The Society for Family Planning endorses this Committee Statement.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-24DOI: 10.1097/AOG.0000000000006257
This committee statement announces the American College of Obstetricians & Gynecologists' qualified endorsement of the 2026 Women's Preventive Services Initiative's (WPSI) updated cervical cancer screening guidelines and addresses cervical cancer screening for patients at average risk in the following age categories: 21-29 years, 30-65 years, and older than 65 years. This committee statement discusses specific qualifications to the WPSI guidelines, particularly regarding self-collection for primary high-risk human papillomavirus screening, among other implementation considerations.
{"title":"Screening for Cervical Cancer.","authors":"","doi":"10.1097/AOG.0000000000006257","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006257","url":null,"abstract":"<p><p>This committee statement announces the American College of Obstetricians & Gynecologists' qualified endorsement of the 2026 Women's Preventive Services Initiative's (WPSI) updated cervical cancer screening guidelines and addresses cervical cancer screening for patients at average risk in the following age categories: 21-29 years, 30-65 years, and older than 65 years. This committee statement discusses specific qualifications to the WPSI guidelines, particularly regarding self-collection for primary high-risk human papillomavirus screening, among other implementation considerations.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Forced displacement has profound detrimental consequences on reproductive health, including maternal morbidity and mortality. Pregnant newcomers are a particularly high-risk group and are susceptible to adverse reproductive health outcomes due to the interplay of migration, sexual violence, trauma, disrupted care, racism, and xenophobia. Newcomers have higher rates of preventable pregnancy-related risk factors such as delayed prenatal care, malnutrition, and exposure to infectious diseases, in addition to structural, socioeconomic, language, and cultural barriers to accessing comprehensive pregnancy and abortion care. Perinatal mental health conditions are more prevalent among newcomers (particularly refugees and asylees), but they face greater barriers to accessing mental health care. In this perspective piece, we share two clinical cases that demonstrate how-at the intersection of reproductive justice and migrant justice-dismantling inequities in newcomer reproductive health requires interdisciplinary, trauma-informed, culturally responsive, and linguistically accessible care. We present best practices from an interdisciplinary model for newcomer pregnancy care. We end with a call to action for improving birth outcomes and experiences for newcomer patients.
{"title":"Centering Reproductive and Migrant Justice: Dismantling Inequities in Newcomer Pregnancy Care.","authors":"Marisol Granillo Arce,Audrey Montgomery,Kristin Koo,Luca Koritsanszky,Thamarah Crevecoeur,Emily Fox,Rasha Khoury,Kettie Louis,Maithri Ameresekere,Samantha Q Truong","doi":"10.1097/aog.0000000000006289","DOIUrl":"https://doi.org/10.1097/aog.0000000000006289","url":null,"abstract":"Forced displacement has profound detrimental consequences on reproductive health, including maternal morbidity and mortality. Pregnant newcomers are a particularly high-risk group and are susceptible to adverse reproductive health outcomes due to the interplay of migration, sexual violence, trauma, disrupted care, racism, and xenophobia. Newcomers have higher rates of preventable pregnancy-related risk factors such as delayed prenatal care, malnutrition, and exposure to infectious diseases, in addition to structural, socioeconomic, language, and cultural barriers to accessing comprehensive pregnancy and abortion care. Perinatal mental health conditions are more prevalent among newcomers (particularly refugees and asylees), but they face greater barriers to accessing mental health care. In this perspective piece, we share two clinical cases that demonstrate how-at the intersection of reproductive justice and migrant justice-dismantling inequities in newcomer reproductive health requires interdisciplinary, trauma-informed, culturally responsive, and linguistically accessible care. We present best practices from an interdisciplinary model for newcomer pregnancy care. We end with a call to action for improving birth outcomes and experiences for newcomer patients.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"48 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-23DOI: 10.1097/aog.0000000000006303
Emily K Guernsey,Valeria Hernandez,John Cursio,L Phillip Schumm,Debra Stulberg,Manoradhan Murugesan,Annie Dude
OBJECTIVETo evaluate whether there is an association between state-level Medicaid expansion and severe maternal morbidity (SMM) among Medicaid enrollees who delivered between 2010 and 2018.METHODSThis is a secondary analysis of Medicaid claims that uses national Medicaid analytic files. We included Medicaid enrollees with delivery hospitalizations between 2010 and 2018 in all states that expanded Medicaid under the Affordable Care Act (ACA) by July 2016. The primary outcome was SMM, defined using the Centers for Disease Control and Prevention's validated list of 21 indicators. The primary exposure was whether the enrollee's state of residence had expanded Medicaid 21 months before their delivery under the ACA, to allow for 1 year of expansion before a 9-month pregnancy. We also included analyses that allowed for a 9-month lag after expansion so that Medicaid expansion was in place at the start of a pregnancy. We calculated annual rates of SMM by Medicaid expansion status and analyzed trends across time. We used logistic regression to estimate the association between timing of deliveries relative to Medicaid expansion and SMM at the delivery encounter.RESULTSData for 6,976,586 individuals were available for analysis in 30 of the 31 states that expanded Medicaid by July 2016. Rates of SMM trended downward after Medicaid expansion in these states. Individuals who delivered at least 21 months after state Medicaid expansions were significantly less likely to experience SMM relative to those who delivered before Medicaid expansion (including blood transfusion: odds ratio [OR] 0.79; 95% CI, 0.68-0.90; excluding blood transfusion: OR 0.76; 95% CI, 0.65-0.88).CONCLUSIONMedicaid expansion was associated with decreased odds of SMM.
{"title":"Medicaid Expansion and Severe Maternal Morbidity.","authors":"Emily K Guernsey,Valeria Hernandez,John Cursio,L Phillip Schumm,Debra Stulberg,Manoradhan Murugesan,Annie Dude","doi":"10.1097/aog.0000000000006303","DOIUrl":"https://doi.org/10.1097/aog.0000000000006303","url":null,"abstract":"OBJECTIVETo evaluate whether there is an association between state-level Medicaid expansion and severe maternal morbidity (SMM) among Medicaid enrollees who delivered between 2010 and 2018.METHODSThis is a secondary analysis of Medicaid claims that uses national Medicaid analytic files. We included Medicaid enrollees with delivery hospitalizations between 2010 and 2018 in all states that expanded Medicaid under the Affordable Care Act (ACA) by July 2016. The primary outcome was SMM, defined using the Centers for Disease Control and Prevention's validated list of 21 indicators. The primary exposure was whether the enrollee's state of residence had expanded Medicaid 21 months before their delivery under the ACA, to allow for 1 year of expansion before a 9-month pregnancy. We also included analyses that allowed for a 9-month lag after expansion so that Medicaid expansion was in place at the start of a pregnancy. We calculated annual rates of SMM by Medicaid expansion status and analyzed trends across time. We used logistic regression to estimate the association between timing of deliveries relative to Medicaid expansion and SMM at the delivery encounter.RESULTSData for 6,976,586 individuals were available for analysis in 30 of the 31 states that expanded Medicaid by July 2016. Rates of SMM trended downward after Medicaid expansion in these states. Individuals who delivered at least 21 months after state Medicaid expansions were significantly less likely to experience SMM relative to those who delivered before Medicaid expansion (including blood transfusion: odds ratio [OR] 0.79; 95% CI, 0.68-0.90; excluding blood transfusion: OR 0.76; 95% CI, 0.65-0.88).CONCLUSIONMedicaid expansion was associated with decreased odds of SMM.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-23DOI: 10.1097/aog.0000000000006315
Alex Vosooney,Catherine T Witkop,Amy G Cantor,Heidi D Nelson,Carla Picardo,Sarah Son,Nancy Byatt,Linda L Humphrey,May Lau,Francisco Garcia,Susan M Kendig,Amir Qaseem,Diana Ramos,Alina Salganicoff,Margot L Savoy,Nancy O'Reilly,Julie K Wood,Christopher Zahn,Ilana Moyer,Megan Palacios,Kimberly D Gregory,
The Women's Preventive Services Initiative (WPSI) expanded its previous cervical cancer screening recommendation for average-risk women by including patient-collected high-risk human papillomavirus (hrHPV) screening tests and additional follow-up testing needed to complete the screening process. To update the previous recommendation, the WPSI identified new evidence demonstrating that primary hrHPV screening increases detection of precancerous lesions compared with cytology screening. New studies indicate that patient-collected hrHPV testing has similar test accuracy for precancer detection compared with clinician-collected samples and may reduce barriers to screening. Consistent with the previous recommendation, the WPSI recommends cervical cancer screening for average-risk women aged 21-65 years. For women aged 21-29 years, screening using cervical cytology (Pap test) every 3 years is recommended; co-testing with cytology and hrHPV testing is not recommended for those younger than 30 years. For women aged 30-65 years, primary hrHPV testing (preferred method) or co-testing (cytology with hrHPV) every 5 years is recommended; if hrHPV testing cannot be performed, cytology every 3 years is acceptable. Women at average risk should not be screened more than once every 3 years. Patient-collected hrHPV is an appropriate screening method for average-risk women aged 30-65 years. The new recommendation-including additional testing to follow up on findings on the initial screening-was recently approved by the Health Resources & Services Administration, U.S. Department of Health and Human Services, for coverage without co-pay or deductible charges for most eligible women beginning in 2027.
{"title":"Screening for Cervical Cancer: A Recommendation From the Women's Preventive Services Initiative.","authors":"Alex Vosooney,Catherine T Witkop,Amy G Cantor,Heidi D Nelson,Carla Picardo,Sarah Son,Nancy Byatt,Linda L Humphrey,May Lau,Francisco Garcia,Susan M Kendig,Amir Qaseem,Diana Ramos,Alina Salganicoff,Margot L Savoy,Nancy O'Reilly,Julie K Wood,Christopher Zahn,Ilana Moyer,Megan Palacios,Kimberly D Gregory, ","doi":"10.1097/aog.0000000000006315","DOIUrl":"https://doi.org/10.1097/aog.0000000000006315","url":null,"abstract":"The Women's Preventive Services Initiative (WPSI) expanded its previous cervical cancer screening recommendation for average-risk women by including patient-collected high-risk human papillomavirus (hrHPV) screening tests and additional follow-up testing needed to complete the screening process. To update the previous recommendation, the WPSI identified new evidence demonstrating that primary hrHPV screening increases detection of precancerous lesions compared with cytology screening. New studies indicate that patient-collected hrHPV testing has similar test accuracy for precancer detection compared with clinician-collected samples and may reduce barriers to screening. Consistent with the previous recommendation, the WPSI recommends cervical cancer screening for average-risk women aged 21-65 years. For women aged 21-29 years, screening using cervical cytology (Pap test) every 3 years is recommended; co-testing with cytology and hrHPV testing is not recommended for those younger than 30 years. For women aged 30-65 years, primary hrHPV testing (preferred method) or co-testing (cytology with hrHPV) every 5 years is recommended; if hrHPV testing cannot be performed, cytology every 3 years is acceptable. Women at average risk should not be screened more than once every 3 years. Patient-collected hrHPV is an appropriate screening method for average-risk women aged 30-65 years. The new recommendation-including additional testing to follow up on findings on the initial screening-was recently approved by the Health Resources & Services Administration, U.S. Department of Health and Human Services, for coverage without co-pay or deductible charges for most eligible women beginning in 2027.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"7 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inequalities in severe maternal morbidity (SMM) and mortality in high-income countries are persistent, socially patterned, and evident across multiple dimensions, including socioeconomic deprivation, race and ethnicity, and migration status. These inequalities are not fully explained by individual clinical risk factors but arise from the interaction of structural disadvantage, intermediate social conditions, and health systems. Many determinants of risk are established before pregnancy; however, variation in access to care, quality of care, and responsiveness to symptoms during pregnancy and childbirth can either mitigate or exacerbate vulnerability. Identifying social and structural determinants, ensuring equitable access to care, providing culturally responsive care, and promoting timely, unbiased clinical decision making are essential components of clinician efforts to reduce inequalities in SMM and mortality.
{"title":"Inequalities in Severe Maternal Morbidity and Mortality in High-Income Countries: Patterns, Drivers, and Pathways to Action.","authors":"Nicola Vousden,Elie Azria,Dorothea Geddes-Barton,Catherine Deneux-Tharaux","doi":"10.1097/aog.0000000000006298","DOIUrl":"https://doi.org/10.1097/aog.0000000000006298","url":null,"abstract":"Inequalities in severe maternal morbidity (SMM) and mortality in high-income countries are persistent, socially patterned, and evident across multiple dimensions, including socioeconomic deprivation, race and ethnicity, and migration status. These inequalities are not fully explained by individual clinical risk factors but arise from the interaction of structural disadvantage, intermediate social conditions, and health systems. Many determinants of risk are established before pregnancy; however, variation in access to care, quality of care, and responsiveness to symptoms during pregnancy and childbirth can either mitigate or exacerbate vulnerability. Identifying social and structural determinants, ensuring equitable access to care, providing culturally responsive care, and promoting timely, unbiased clinical decision making are essential components of clinician efforts to reduce inequalities in SMM and mortality.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"139 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-16DOI: 10.1097/aog.0000000000006299
Elliott K Main,Emily K McCormick,Mark W Tomlinson,Chen Ma,Andrew M Carpenter,Stephanie A Leonard,Maria Alcazar,Terri Deeds,Susan Dragoo,Laurel Durham,David C Lagrew,Deirdre J Lyell,Kisha Semenuk,Christa Walzak,Suzan L Carmichael
OBJECTIVEThe Centers for Disease Control and Prevention's (CDC) severe maternal morbidity (SMM) index is a list of major complications, but it does not identify underlying causes. Our objectives were to create a hierarchical algorithm to identify a primary underlying condition for each SMM case and calculate the frequencies of underlying conditions that lead to SMM in large administrative datasets.METHODSA hierarchical algorithm using International Classification of Diseases, Tenth Revision codes was developed using a combination of medical record reviews and iterative analyses of large datasets over an 8-year period, 2016-2024. To assess validity, the algorithm's assignment of primary underlying conditions for SMM cases was compared with detailed medical record abstraction. The developed algorithm was then applied to 2016-2020 California and National Inpatient Sample (NIS) hospital discharge datasets. A nonhierarchical approach, which allowed the assignment of multiple diagnosis codes to identify comorbidities, was also evaluated. Frequencies of underlying conditions among SMM cases were compared with causes of pregnancy-related mortality by using the CDC's Pregnancy Mortality Surveillance System data (2017-2019). Total SMM and nontransfusion SMM were examined for each analysis.RESULTSIn the 604 SMM cases used to assess validity, the primary underlying condition that resulted in SMM based on the algorithm had 94.5% concordance with a detailed medical record review. When applied to California discharge data (2016-2020) (n=43,897) hemorrhage (combined placental and other) was the most frequent primary underlying condition that resulted in SMM (50.5%) and nontransfusion SMM (38.3%). Severe hypertensive disorders and infection were also common-together accounting for 31.2% of SMM and 44.9% of nontransfusion SMM. Other medical conditions accounted for 12.9% of SMM and 19.8% of nontransfusion SMM. Rates of cardiovascular conditions as the primary underlying conditions were 2.4% of SMM and 4.3% of nontransfusion SMM. Results were similar for NIS data (n=63,880). Causes of maternal mortality in the United States (2017-2019) substantially differed from underlying conditions that resulted in SMM: rates for hemorrhage (12.1%), hypertensive disorders (6.3%), and infection (14.3%) were lower, and rates for cardiovascular conditions (26.6%) were higher.CONCLUSIONThe hierarchical algorithm provides a method to assign a primary underlying condition to population SMM cases by using administrative codes. Hemorrhage, hypertensive disorders, and infection dominate underlying conditions for SMM, whereas cardiovascular disease, the most common cause of maternal death, is an uncommon SMM underlying condition.
{"title":"Development and Application of an Algorithm to Identify the Primary Underlying Condition for Cases of Severe Maternal Morbidity.","authors":"Elliott K Main,Emily K McCormick,Mark W Tomlinson,Chen Ma,Andrew M Carpenter,Stephanie A Leonard,Maria Alcazar,Terri Deeds,Susan Dragoo,Laurel Durham,David C Lagrew,Deirdre J Lyell,Kisha Semenuk,Christa Walzak,Suzan L Carmichael","doi":"10.1097/aog.0000000000006299","DOIUrl":"https://doi.org/10.1097/aog.0000000000006299","url":null,"abstract":"OBJECTIVEThe Centers for Disease Control and Prevention's (CDC) severe maternal morbidity (SMM) index is a list of major complications, but it does not identify underlying causes. Our objectives were to create a hierarchical algorithm to identify a primary underlying condition for each SMM case and calculate the frequencies of underlying conditions that lead to SMM in large administrative datasets.METHODSA hierarchical algorithm using International Classification of Diseases, Tenth Revision codes was developed using a combination of medical record reviews and iterative analyses of large datasets over an 8-year period, 2016-2024. To assess validity, the algorithm's assignment of primary underlying conditions for SMM cases was compared with detailed medical record abstraction. The developed algorithm was then applied to 2016-2020 California and National Inpatient Sample (NIS) hospital discharge datasets. A nonhierarchical approach, which allowed the assignment of multiple diagnosis codes to identify comorbidities, was also evaluated. Frequencies of underlying conditions among SMM cases were compared with causes of pregnancy-related mortality by using the CDC's Pregnancy Mortality Surveillance System data (2017-2019). Total SMM and nontransfusion SMM were examined for each analysis.RESULTSIn the 604 SMM cases used to assess validity, the primary underlying condition that resulted in SMM based on the algorithm had 94.5% concordance with a detailed medical record review. When applied to California discharge data (2016-2020) (n=43,897) hemorrhage (combined placental and other) was the most frequent primary underlying condition that resulted in SMM (50.5%) and nontransfusion SMM (38.3%). Severe hypertensive disorders and infection were also common-together accounting for 31.2% of SMM and 44.9% of nontransfusion SMM. Other medical conditions accounted for 12.9% of SMM and 19.8% of nontransfusion SMM. Rates of cardiovascular conditions as the primary underlying conditions were 2.4% of SMM and 4.3% of nontransfusion SMM. Results were similar for NIS data (n=63,880). Causes of maternal mortality in the United States (2017-2019) substantially differed from underlying conditions that resulted in SMM: rates for hemorrhage (12.1%), hypertensive disorders (6.3%), and infection (14.3%) were lower, and rates for cardiovascular conditions (26.6%) were higher.CONCLUSIONThe hierarchical algorithm provides a method to assign a primary underlying condition to population SMM cases by using administrative codes. Hemorrhage, hypertensive disorders, and infection dominate underlying conditions for SMM, whereas cardiovascular disease, the most common cause of maternal death, is an uncommon SMM underlying condition.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"138 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-16DOI: 10.1097/AOG.0000000000006297
Lisa D Levine, Catherine Klammer, Jennifer Lewey
Cardiovascular disease (CVD) is the leading cause of pregnancy-related death in the United States and disproportionately affects Black women. In this review, we address the major contributors to cardiovascular-related maternal deaths, focusing on the importance of both preconception and postpartum care. Risk factors such as hypertension, diabetes, dyslipidemia, and obesity contribute to cardiovascular risk during and after pregnancy. As prepregnancy optimization of these factors has been shown to mitigate this risk, we discuss evidence-based approaches to cardiovascular risk management in reproductive-aged women. Women with pre-existing CVD should undergo preconception counseling and risk assessment using validated tools such as the modified World Health Organization 2.0 classification. We review common presenting symptoms of CVD in pregnancy, such as shortness of breath, and we discuss how tools such N-terminal pro-B-type natriuretic peptide testing can help distinguish dyspnea of pregnancy from symptoms of heart failure. We also review the evidence-based management of the leading causes of cardiovascular-related maternal deaths, including cardiomyopathy, myocardial infarction, and hypertensive disorders of pregnancy. Importantly, the implementation of standardized care, such as perinatal CVD risk assessment algorithms, and postpartum remote monitoring programs may improve disparities in cardiovascular risk assessment and diagnosis.
{"title":"Cardiovascular-Related Maternal Mortality.","authors":"Lisa D Levine, Catherine Klammer, Jennifer Lewey","doi":"10.1097/AOG.0000000000006297","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006297","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) is the leading cause of pregnancy-related death in the United States and disproportionately affects Black women. In this review, we address the major contributors to cardiovascular-related maternal deaths, focusing on the importance of both preconception and postpartum care. Risk factors such as hypertension, diabetes, dyslipidemia, and obesity contribute to cardiovascular risk during and after pregnancy. As prepregnancy optimization of these factors has been shown to mitigate this risk, we discuss evidence-based approaches to cardiovascular risk management in reproductive-aged women. Women with pre-existing CVD should undergo preconception counseling and risk assessment using validated tools such as the modified World Health Organization 2.0 classification. We review common presenting symptoms of CVD in pregnancy, such as shortness of breath, and we discuss how tools such N-terminal pro-B-type natriuretic peptide testing can help distinguish dyspnea of pregnancy from symptoms of heart failure. We also review the evidence-based management of the leading causes of cardiovascular-related maternal deaths, including cardiomyopathy, myocardial infarction, and hypertensive disorders of pregnancy. Importantly, the implementation of standardized care, such as perinatal CVD risk assessment algorithms, and postpartum remote monitoring programs may improve disparities in cardiovascular risk assessment and diagnosis.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-16DOI: 10.1097/aog.0000000000006275
This Clinical Practice Update provides revised guidance on the use of transvaginal ultrasonography to triage patients with postmenopausal bleeding. This document is a focused update of related content in Committee Opinion No. 734, The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding (Obstet Gynecol 2018;131:e124-9).
{"title":"Updated Guidance Regarding The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Individuals With Postmenopausal Bleeding.","authors":"","doi":"10.1097/aog.0000000000006275","DOIUrl":"https://doi.org/10.1097/aog.0000000000006275","url":null,"abstract":"This Clinical Practice Update provides revised guidance on the use of transvaginal ultrasonography to triage patients with postmenopausal bleeding. This document is a focused update of related content in Committee Opinion No. 734, The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding (Obstet Gynecol 2018;131:e124-9).","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"66 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVETo assess pain during office operative hysteroscopy with or without inhaled nitrous oxide (N2O).METHODSA prospective, randomized, double-blind, placebo-controlled trial was conducted at a single university-affiliated tertiary care hospital. Women undergoing office operative hysteroscopy were randomized in 1:1 ratio to receive either inhaled N2O or ambient air through a self-administered face mask. Pain was assessed using a 10-point visual analog scale at three timepoints: uterine entry, during the procedure, and postprocedure.RESULTSBetween July and November 2025, a total of 214 women were randomized to receive either N2O (n=110) or ambient air (n=104). Baseline demographics and procedural characteristics were comparable between groups. Intraprocedural pain was significantly lower in the N2O group (2.23±3.29 vs 3.96±3.31, P<.001). Among postmenopausal women, the analgesic effect of N2O was more pronounced, with significantly lower pain both at uterine entry (5.47±3.38 vs 8.00±2.72, P=.013) and during the procedure (2.42±3.86 vs 6.56±2.79, P=.002). Procedure completion rates were higher in the N2O group (93.6% vs 83.7%, P=.021), and patient satisfaction was significantly greater (80.9% vs 47.1%, P<.001).CONCLUSIONInhaled N2O significantly reduces pain during office operative hysteroscopy, improves patient satisfaction, and decreases the rate of incomplete procedures, with a low incidence of adverse events. These findings support its use as an effective and well-tolerated analgesic option for outpatient hysteroscopic procedures.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov, NCT07074795.
目的评价吸入或不吸入氧化亚氮（N2O）时宫腔镜手术时的疼痛。方法在一所大学附属三级医院进行前瞻性、随机、双盲、安慰剂对照试验。接受宫腔镜手术的妇女按1:1的比例随机分配，通过自我给药面罩吸入二氧化氮或周围空气。在三个时间点：子宫进入、手术中和手术后，使用10分视觉模拟量表评估疼痛。结果在2025年7月至11月期间，共有214名女性随机接受N2O （n=110）或环境空气（n=104）。组间基线人口统计学和程序特征具有可比性。N2O组术中疼痛明显降低（2.23±3.29 vs 3.96±3.31，P< 0.001）。在绝经后妇女中，N2O的镇痛效果更为明显，子宫入口疼痛（5.47±3.38 vs 8.00±2.72，P= 0.013）和手术过程中疼痛（2.42±3.86 vs 6.56±2.79，P= 0.002）均明显减轻。N2O组手术完成率较高（93.6% vs 83.7%， P= 0.021），患者满意度显著高于N2O组（80.9% vs 47.1%， P< 0.001）。结论吸入N2O可明显减轻宫腔镜手术疼痛，提高患者满意度，降低手术不完成率，不良事件发生率低。这些发现支持其作为门诊宫腔镜手术有效且耐受性良好的镇痛选择。临床试验注册：clinicaltrials .gov, NCT07074795。
{"title":"Nitrous Oxide for Pain Management in Office Hysteroscopy: A Randomized Placebo-Controlled Trial.","authors":"Sabina Razdolsky,Rina Yaniv-Tamir,Merav Raz,Shanny Kolp-Asis,Tova Katz,Loren Elbaz,Tamar Tzur","doi":"10.1097/aog.0000000000006282","DOIUrl":"https://doi.org/10.1097/aog.0000000000006282","url":null,"abstract":"OBJECTIVETo assess pain during office operative hysteroscopy with or without inhaled nitrous oxide (N2O).METHODSA prospective, randomized, double-blind, placebo-controlled trial was conducted at a single university-affiliated tertiary care hospital. Women undergoing office operative hysteroscopy were randomized in 1:1 ratio to receive either inhaled N2O or ambient air through a self-administered face mask. Pain was assessed using a 10-point visual analog scale at three timepoints: uterine entry, during the procedure, and postprocedure.RESULTSBetween July and November 2025, a total of 214 women were randomized to receive either N2O (n=110) or ambient air (n=104). Baseline demographics and procedural characteristics were comparable between groups. Intraprocedural pain was significantly lower in the N2O group (2.23±3.29 vs 3.96±3.31, P<.001). Among postmenopausal women, the analgesic effect of N2O was more pronounced, with significantly lower pain both at uterine entry (5.47±3.38 vs 8.00±2.72, P=.013) and during the procedure (2.42±3.86 vs 6.56±2.79, P=.002). Procedure completion rates were higher in the N2O group (93.6% vs 83.7%, P=.021), and patient satisfaction was significantly greater (80.9% vs 47.1%, P<.001).CONCLUSIONInhaled N2O significantly reduces pain during office operative hysteroscopy, improves patient satisfaction, and decreases the rate of incomplete procedures, with a low incidence of adverse events. These findings support its use as an effective and well-tolerated analgesic option for outpatient hysteroscopic procedures.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov, NCT07074795.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"276 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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