Objective This systematic review and meta-analysis aims to compare the perinatal outcomes of complicated monochorionic (MC) pregnancies after selective reduction by radiofrequency ablation (RFA), bipolar cord coagulation (BCC) and interstitial laser (IL). Data sources We searched PubMed, Scopus, and Web of Science, from inception of the database until 26 April 2021. Study eligibility criteria Studies

Background Observational studies among older women have associated vitamin D insufficiency with greater prevalence and incidence of urinary incontinence than older women with adequate vitamin D status. Less is known about the effect of vitamin D supplementation on reducing incontinence. Objective To evaluate the effects of vitamin D supplementation for reducing urinary incontinence frequency in older

Background Contraceptives are used to prevent unwanted pregnancies and treat certain gynecological conditions, but many women report non-use or inconsistent use due to method dissatisfaction. The sexual acceptability of contraception—how birth control methods affect users’ sexual wellbeing—is likely an important component of contraceptive satisfaction but has yet to be systematically examined. Objective

Background National guidelines recommend that maternity systems provide patient-centered access to immediate postpartum long-acting reversible contraception (i.e., insertion of an intrauterine device or implant during the delivery hospitalization). Hospitals face significant barriers to offering these services, and efforts to improve peripartum contraception care quality have met with mixed success

Severe hypertension in pregnancy is a medical emergency. Although expeditious treatment within 30 to 60 minutes is recommended to reduce the risk of maternal death or severe morbidity, treatment is often delayed by more than 1 hour. In this statement, we propose a quality metric that facilities can use to track their rates of timely treatment of severe hypertension. We encourage facilities to adopt

Objective To assess perinatal outcomes of first pregnancies following remission from gestational trophoblastic neoplasia (GTN), as well as the impact of the time between the end of chemotherapy and the subsequent pregnancy. Data sources The Medical Subject Headings related to perinatal outcomes, chemotherapy and GTN were used alone or in combination to retrieve relevant articles. We searched in EMBASE

Background Cesarean rates have been used as obstetrical quality indicators. However, these approaches do not take into consideration the accompanying maternal and neonatal morbidity. A challenge in the field of obstetrics has been to establish a valid outcomes quality measure that encompasses pre-existing high-risk maternal factors, as well as associated maternal and neonatal morbidity that is universally

Background The rate of cesarean delivery has increased in the United States over the last several decades. The rate of cesarean delivery on maternal request (CDMR) however remains uncertain and recent data on CDMR are lacking. Objectives The objectives of this study were to describe the prevalence and temporal trends of CDMR in the United States, and to characterize the population of women who elect

Background Antenatal corticosteroid (ACS) therapy is standard of care for women at imminent risk of preterm labour. Despite this, much remains to be understood regarding an optimal (maximum benefit, minimal risk of side effects) ACS dosing strategy. Although conveying overall benefit when given to the right patient at the right time, ACS treatment efficacy is highly variable, and is not risk-free.

Background Despite the importance of prenatal care, quality measurement efforts have focused on the number of prenatal visits, or prenatal care adequacy, rather than the services received. It is unknown whether receiving more prenatal visits is associated with receiving more guideline-based prenatal care services. The relationship between guideline-based prenatal care and patients’ clinical and sociodemographic

Background Prospective longitudinal cohorts assessing women’s health and gynecologic conditions have been historically limited. Objectives The Apple Women’s Health Study was designed to gain a deeper understanding of the relationship between menstrual cycles, health, and behaviors. This paper describes the design and methods of the ongoing Apple Women’s Health Study and provides demographic characteristics

Advancement of women leaders in obstetrics and gynecology does not reflect the changes in the physician workforce seen over the last 50 years. A core value of our culture in obstetrics and gynecology must be gender equity. Departmental, institutional, and professional society efforts should explicitly prioritize and demonstrate a commitment to gender equity with tangible actions. This commentary from

Objective To assess the efficacy of mechanical strategies to avoid recurrence of intrauterine adhesions and to evaluate the impact on subsequent fertility after hysteroscopic adhesiolysis. To rank the available antiadhesive options. Data sources MEDLINE, Scopus, ClinicalTrials.gov, CINAHL, Scielo, EMBASE, PROSPERO, Cochrane Library, conference proceedings and international controlled trials registries

Background In recent years, there has been growing recognition of the financial burden of severe illness, including associations with higher rates of non-employment, uninsurance and catastrophic out-of-pocket health spending. Gynecologic cancer patients often require expensive and prolonged treatments, potentially disrupting employment and insurance coverage access, and putting patients and their families

Objective To assess the efficacy and safety of prophylactic tranexamic acid administration in comparison with standard uterotonic agents alone among women undergoing cesarean delivery. Data sources Medline, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov and Google Scholar were systematically searched from inception to June 30, 2021. Study eligibility criteria

Background Pregnant women are at increased risk of mortality and morbidity due to coronavirus disease 2019 (COVID-19). Many studies reported on the association of COVID-19 with pregnancy specific adverse outcomes but prediction models utilizing large cohort of pregnant women are still lacking for estimating the risk of maternal morbidity and other adverse events. Objective The main aim of this study

Background Opportunistic bilateral salpingo-oophorectomy (BSO) is often offered to patients undergoing benign hysterectomy to prevent ovarian cancer, but the magnitude of risk reduction obtained with BSO in this population remains unclear, and must be weighed against potential risks of ovarian hormone deficiency. Objective To quantify the relative and absolute risk reduction in ovarian cancer incidence

BACKGROUND Mental health conditions during delivery hospitalizations are not well characterized. OBJECTIVE To characterize prevalence of maternal mental health condition diagnoses and associated risk during United States delivery hospitalizations METHODS The 2000-2018 Nationwide Inpatient Sample was used for this repeated-cross sectional analysis. Delivery hospitalizations to women age 15-54 with and

Background Bacterial vaginosis– a condition defined by a shift from Lactobacillus dominance to a polymicrobial, anaerobic bacterial community - increases the risk of acquiring sexually transmitted infections and other complications of the female reproductive tract . Antibiotic treatment frequently fails to return the microbiome to an optimal Lactobacillus-dominated state. No criteria currently exist

Background Women are more likely to present with genitourinary complaints immediately after exposure to interpersonal violence, but little is known about long-term effects on women’s urologic health such as their susceptibility to bladder pain and infections. Objective To determine whether lifetime interpersonal violence exposure and current post-traumatic stress disorder (PTSD) symptoms are associated

BACKGROUND Guidelines for managing abnormal cervical cancer screening tests changed from a results-based approach in 2012 to a risk-based approach in 2019. We estimated the cost-effectiveness and changes in resource utilization of the 2012 and 2019 guidelines. METHODS We utilized a previously published model of cervical cancer natural history and screening to estimate and compare the lifetime costs

With recent advances in gene editing with systems such as CRISPR-Cas9, precise genome editing in utero is on the horizon. Sickle cell disease is an excellent candidate for in utero fetal gene therapy, as it is monogenic, causes irreversible harm, and has life-limiting morbidity. Gene therapy recently has been proven effective in an adolescent patient. Several hurdles still impede progress for fetal

Background The discovery of the Fallopian tube epithelium as origin of high grade serous ovarian cancer has brought a new option for ovarian cancer prevention. As the Fallopian tubes have no known function after completion of childbearing, they can be removed to reduce the life-time risk of ovarian cancer. Although the lifetime risk in the general population does not justify preventive surgery in itself

Background Postpartum hemorrhage causes a quarter of global maternal deaths. WHO recommends oxytocin as the first line agent to prevent hemorrhage at cesarean delivery. However, some randomized controlled trials suggest other uterotonics are superior. Objective We conducted a network meta-analysis comparing pharmacological agents in reducing blood loss and minimizing need for additional uterotonics

BACKGROUND A number of retrospective and prospective studies have documented significant rates of regression in cervical intraepithelial neoplasia grade 2 (CIN2) lesions in young women. The initial observational management of CIN2 is increasingly accepted as appropriate for women under 25 years of age with screen detected abnormalities, and is included in a number of clinical guidelines. However, there

Physiologic, mechanical and immunologic alterations in pregnancy could potentially affect susceptibility to and severity of COVID-19 during pregnancy. Due to lack of comparable incidence data and challenges with disentangling differences in susceptibility from different exposure risks, data are insufficient to determine whether pregnancy increases susceptibility to SARS-CoV-2 infection. Data support

Background There are approximately 1.2 million cesarean deliveries performed each year, and while traditional postoperative pain management strategies previously relied heavily on opioids, practitioners are now moving toward opioid-sparing protocols using multiple classes of non-narcotic analgesics. Multimodal pain management systems have been adopted by other surgical specialties, including gynecology

Viral hepatitis in pregnancy can be caused by a list of viruses that cause systemic infection or target hepatocytes in their pathogenesis. Since viral hepatitis during pregnancy may represent acute, chronic or reactivation of a prior infection, a high clinical suspicion, medical history review, and awareness of risk factors for acquisition of infection are important management principles. The route

Background There is debate about the safety and effectiveness of surgical treatments for stress urinary incontinence. Controversy about the use of synthetic mesh sling insertion has led to increased uptake of retropubic colposuspension and autologous sling procedures. Comparative evidence on long-term outcomes from these procedures is needed. Objective To compare risk of reoperation at 10 years between

Background Studies in several fields demonstrate gender and racial differences in descriptions of applicants in letters of recommendation. However, gender and racial bias in obstetrics and gynecology residency letters of recommendation are understudied. Objective This analysis aimed to determine if there are differences in the letters of recommendation written for medical students applying for obstetrics

BACKGROUND Cesarean scar pregnancies (CSP) are at high risk of pregnancy complications including placenta previa with antepartum hemorrhage, placenta accreta spectrum (PAS) and uterine rupture. OBJECTIVE To evaluate the development of the utero-placental circulation in the first half of pregnancy in ongoing CSP and compare it to pregnancies implanted in the lower uterine segment above a prior cesarean

Objective To assess the efficacy of ultrasound assessment of fetal occiput position prior to operative vaginal delivery (OVD) in decreasing failed OVD. Data sources The search was conducted using MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library as electronic databases from the inception of each database to April 2021. No restrictions for language or geographic

Background It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study

Background Intraoperative evaluation of ureteral patency is often performed in gynecologic and urogynecologic surgery. There are many agents used to help assess patency, each with its own associated cost, ease of use, and adverse reactions. Some agents, such as dextrose, are used as instillation fluid to create a viscosity difference and aid visualization of a ureteral jet. Others, such as oral phenazopyridine