Obstetrics and Gynecology Commons^™

Less Frequent Versus More Frequent Cervical Examinations In Labor: A Systematic Review And Meta-Analysis, Alessandro Petrecca, Benedetta Bina, Chiara Tersigni, Tullio Ghi, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Digital cervical examinations are central to intrapartum care, yet their optimal frequency remains uncertain and is largely based on consensus rather than high-quality evidence.

OBJECTIVES: To compare less frequent versus more frequent cervical examinations during labor in terms of obstetrical, maternal and neonatal outcomes.

SEARCH STRATEGY: We searched Medline, Cochrane Library, EMBASE, PubMed Central, Scopus and ClinicalTrials.gov from inception to August 2025, without language or geographic restrictions. The review was registered in PROSPERO (CRD420251033729).

SELECTION CRITERIA: Randomized controlled trials comparing different frequencies of cervical examinations in term singleton pregnancies during labor were included.

DATA COLLECTION AND ANALYSIS: Two reviewers …

Progesterone And Cerclage Together For Short Cervix: Evaluating Potential Complementary Effects For Improved Preterm Birth Prevention, Vincenzo Berghella, Ilaria Paladino, Moti Gulersen, Lauren Sayres, Amanda Roman, Rupsa C. Boelig

Department of Obstetrics and Gynecology Faculty Papers

Management of patients with a short cervical length (CL) on transvaginal ultrasound (TVU) often involves therapy with vaginal progesterone and/or cervical cerclage. Although these interventions are frequently viewed as alternative strategies, they may also represent complementary approaches targeting different mechanisms involved in spontaneous preterm birth. As in other areas of medicine, therapies with different mechanisms are often used together rather than as mutually exclusive options. In line with current level 1 evidence from randomized controlled trials (RCTs) and meta-analyses of RCTs on either vaginal progesterone or cerclage, in singleton gestations with no prior spontaneous preterm birth (SPTB), vaginal progesterone is …

Preoperative Considerations For Cervical Cerclage (Part 1), Ilaria Paladino, Moti Gulersen, Amanda Roman, Rupsa C. Boelig, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

Transvaginal cervical cerclage remains a central strategy for preventing spontaneous preterm birth in appropriately selected pregnancies. Although decades of research have clarified which patients benefit most from cerclage, substantial heterogeneity persists in pre-, intra-, and postoperative management. This article, the first in a series on cerclage technique, synthesizes the evidence guiding preoperative decision-making. Cerclage is classified by indication as history-indicated cerclage, ultrasound-indicated cerclage and physical examination-indicated cerclage. History-indicated cerclage is recommended for patients with ≥3 prior early spontaneous preterm births or second-trimester losses < 28 weeks, prior ultrasound-indicated cerclage with delivery at< 32 weeks, or prior physical examination-indicated cerclage; twin gestation alone is not considered an indication. Ultrasound-indicated cerclage should be considered in singletons without prior spontaneous preterm birth with transvaginal ultrasound cervical length ≤20 mm and is recommended in singletons with prior spontaneous preterm birth when cervical length is ≤25 mm before 24 weeks' gestation; in twins, it may be considered when cervical length ≤15 mm before 24 weeks' gestation. Physical examination-indicated cerclage is recommended in singleton or twin gestations with asymptomatic cervical dilation ≥1 cm before 24 weeks' gestation. Timing varies by indication: history-indicated cerclage is typically placed at 12 to 14 weeks' gestation and is not urgent, whereas ultrasound-indicated cerclage and physical examination-indicated cerclage are usually performed between 16 and 23 6/7 weeks' gestation in response to cervical changes, ideally within 72 hours and 24 hours of diagnosis of short transvaginal ultrasound cervical length or dilated cervix, respectively. Preoperative evaluation should include a detailed anatomic ultrasound examination and appropriate genetic screening. Routine urogenital cultures are not indicated in the absence of symptoms. Amniocentesis is not recommended for history-indicated cerclage or ultrasound-indicated cerclage but should be considered before physical examination-indicated cerclage to evaluate for intra-amniotic infection. Adjunctive management remains variable. Progesterone is recommended for a short cervical lenght < =25mm before 24 weeks. Outpatient cerclage appears safe, with no clear benefit to routine inpatient management. Perioperative indomethacin and antibiotics are likely unnecessary for history-indicated cerclage but may be considered in ultrasound-indicated cerclage and are suggested for physical examination-indicated cerclage.

Outcomes With Cerclage For Short Cervix ≤20.9 Mm Before 24 Weeks In Singletons Without Prior Preterm Birth: A Focused Meta-Analysis Of Randomized Controlled Trials, Rupsa Boelig, Kypros Nicolaides, Orion Rust, Katsufumi Otzuki, Sietske Althuisius, Gabriele Saccone, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

Insurance Type And Menopausal Hormone Therapy Use Among Us Women, Arina Chesnokova, Sunni Mumford, Allison Schachter, Rebecca Hamm, Scott Lorch, Matthew Klebanoff, Sarah Lindley, Erika Harness, Makeba Williams, Marilyn Schapira

Student Papers, Posters & Projects

IMPORTANCE: Access to menopausal hormone therapy (MHT) in the US remains low. Understanding whether insurance type is associated with MHT underuse and racial disparities in menopausal care is critical for designing interventions that increase evidence-based and equitable menopause care.

OBJECTIVE: To examine whether Medicaid compared with private insurance is associated with lower MHT use among US women. A secondary objective explored the degree that payer type is associated with observed racial differences in MHT use.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the 2013-2014, 2015-2016, and 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) to identify …

Cervical Insufficiency Revisited: A Proposal For A New Treatment-Aligned Definition, Vincenzo Berghella, Ilaria Paladino, Moti Gulersen, Rupsa Boelig, Amanda Roman

Department of Obstetrics and Gynecology Faculty Papers

Cervical insufficiency [CI] has traditionally been defined as painless cervical dilation resulting in recurrent second-trimester pregnancy loss in the absence of labor or placental pathology. Definitions from the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynecologists emphasize historical clinical presentation. However, contemporary obstetrics relies increasingly on ultrasound-based cervical length surveillance and evidence-based cerclage indications rather than retrospective diagnosis. The objective of the review was to propose a definition of cervical insufficiency aligned with current evidence-based indications for mechanical prevention of preterm birth, i.e. cervical cerclage. In modern obstetric practice, the operational diagnosis of clinically …

Isolated Polyhydramnios: Diagnosis Should Be Made Based On Both Elevated Afi And Elevated Mvp, Alessandro Petrecca, Vivian Nguyen, Lauren Bracken, Federica Bellussi, Suneet Chauhan, Tullio Ghi, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To evaluate which of the different sonographic definitions of isolated polyhydramnios (elevated amniotic fluid index [AFI] alone, elevated maximum vertical pocket [MVP] alone, or both elevated AFI and MVP) is best associated with adverse perinatal outcomes.

STUDY DESIGN: This retrospective case-control study included singleton pregnancies undergoing sonographic surveillance at a tertiary referral center between February 2021 and January 2026. Cases of isolated polyhydramnios identified during this time-period were compared with pregnancies with normal amniotic fluid volume from 2024. Polyhydramnios was categorized as elevated AFI only (AFI ≥24 cm), elevated MVP only (MVP ≥8 cm), or both elevated AFI and …

Impact Of Maternal Covid-19 Infection Versus Vaccination On Mucosal Immunity In Breastmilk, Mymy Nguyen, Rupsa C. Boelig, Julie Jones, Wathsala Wijayalath, Gregory D. Gromowski, Zubair H. Aghai, Elke S. Bergmann-Leitner

Department of Obstetrics and Gynecology Faculty Papers

Background/Objectives: In the first months of their life, infants rely on maternal antibodies for immune protection. Breastmilk is a major source of these defenses, supplying secretory IgA, IgG, and IgM that help guard mucosal surfaces against pathogens such as SARS-CoV-2. Most studies on breastmilk immunity in the context of COVID-19 have emphasized circulating monomeric IgA, rather than the multimeric secretory IgA (sIgA) that is active at mucosal barriers. This study assessed in-depth the contribution of breastmilk antibody subtypes to SARS-CoV-2 neutralization capacity and how these profiles differ following maternal COVID-19 infection versus vaccination during pregnancy or postpartum.

Methods: …

Text Messaging Support For Patients Diagnosed With Impaired Glucose Tolerance During Pregnancy: Nonrandomized Pre-Post Implementation Study Assessing Impact On Postpartum Transitions Of Care, Natasha R. Kumar, Whitney Bender, Celeste Durnwald

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Patients with impaired glucose tolerance (IGT) identified during pregnancy who do not develop gestational diabetes mellitus (GDM) often do not receive additional interventions for their long-term metabolic risks.

OBJECTIVE: This nonrandomized pre-post implementation study reports the design process and initial program evaluation for Better Follow-up of Impaired Glucose Tolerance (BRIDGE), a 12-week text-based postpartum support program promoting hemoglobin A1c (HbA1c) completion and primary care provider (PCP) visit scheduling for patients diagnosed with IGT during pregnancy, assessing improvement in desired postpartum transition milestones. The 19-month program was divided into 2 arms lasting 9.5 months each, BRIDGE- (SMS text messaging support …

Midwives' Self-Efficacy In Perimenopause Care: An Educational Intervention, Yinka Sokunbi

Doctor of Midwifery Advances in Midwifery Projects

Study Purpose: This project evaluated the effectiveness of an asynchronous continuing education (CE) webinar in improving midwives’ self-efficacy to provide comprehensive perimenopause care.

Research Questions

1. What is the impact of a targeted CE webinar on midwives’ self-efficacy in providing comprehensive perimenopause care?

2. How do participants perceive the impact and acceptability of a pilot CE webinar?

Significance/Background: Despite midwifery’s defined role in lifespan care, engagement in perimenopause management remains limited. Gaps in formal education and continuing professional development contribute to low confidence in this area. Guided by Social Cognitive Theory, this project targeted self-efficacy as a modifiable factor influencing …

Aspirin And Preterm Birth Among Pregnant People With Increased Heat Exposure: Secondary Analysis Of A Randomized Clinical Trial, Gabriella Meltzer, Luke Duttweiler, Sarah Saleem, Kartik Shankar, Manolo Mazariegos, Antoinette Tshefu, Jackie Patterson, Elwyn Chomba, Waldemar Carlo, Shivaprasad Goudar, Richard Derman, Archana Patel, Patricia Hibberd, Edward Liechty, Fabian Essamai, Edwin Asturias, Denise Babineau, Janet Moore, Cascade Tuholske, Andrew Zimmer, Brent Coull, Elizabeth Mcclure, Robert Goldenberg, Nancy Krebs, Matthew Hoffman, Blair Wylie

Global Health Articles

IMPORTANCE: Scalable interventions are urgently needed to mitigate the adverse effects of heat on pregnancy and newborn health.

OBJECTIVE: To evaluate whether low-dose aspirin modifies the association between heat exposure and preterm birth.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of the Global Network for Women's and Children's Health Research Aspirin Supplementation for Pregnancy Indicated Risk Reduction in Nulliparas (ASPIRIN) randomized, double-blinded, placebo-controlled clinical trial was conducted from March 2016 to June 2018. Statistical analyses were performed from June 2024 to June 2025. The study settings included the Democratic Republic of Congo, Zambia, Kenya, Guatemala, Pakistan, and Belagavi and Nagpur, …

Response Of Reticulocyte And Red Blood Cell Indices To Single-Dose Intravenous Iron In Pregnant Women With Moderate Iron Deficiency Anemia: Secondary Analysis Of The Rapidiron Trial, Manjunath S. Somannavar, Sudhir Mehta, Dharmesh Kumar Sharma, Seema Mehta, Yogeshkumar S, Umesh Charantimath, Benjamin E. Leiby, Michael K. Georgieff, Zubair H. Aghai, Ashalata Mallapur, Umesh Ramadurg, Radha Sangavi, Praveen Patil, J. P. Akshaykirthan, Rupsa C. Boelig, Mrutyunjaya B. Bellad, Richard J. Derman

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Iron deficiency anemia in pregnancy is a significant health concern. Reticulocyte hemoglobin equivalent (Ret-He) and immature reticulocyte fraction (IRF) are emerging as early markers, yet their response to different iron therapies in pregnancy is underexplored.

OBJECTIVE: To determine whether intravenous single-dose iron administration produces a more favorable effect on reticulocyte indices than oral iron therapy in anemic pregnant women.

METHODS: This is a secondary analysis of the RAPIDIRON Trial, a multicenter, three-arm randomized controlled trial comparing ferric carboxymaltose (FCM), ferric derisomaltose (FDM) and standard oral ferrous sulfate. Reticulocyte hemoglobin equivalent (Ret-He), Immature Reticulocyte Fraction (IRF) and other red blood …

Health Professional Education Associations: What Other Professions Teach Us About Building Resources, Community, And Advocacy For Midwifery Educators, Kim Q. Dau, Ms, Cnm

Doctor of Midwifery Advances in Midwifery Projects

In response to a looming health care workforce deficit, several health professions have experienced recent rapid workforce growth. These professions are supported by specialized health professional associations designed to promote educational excellence in the face of rapid growth. In contrast, the midwifery profession does not have dedicated professional organizations to support education programs. The purpose of this study is to better understand the various strategies used by selected health professional education associations and their value to the profession. This can be adapted to promote the growth and excellence of midwifery education in the United States, responding to the need for …

Patterns Of Recurrent Preterm Birth: An Individual Patient Data Meta-Analysis, Charlotte E. Van Dijk, Annemijn A. De Ruigh, Benjamin Y. Gravesteijn, Brenda M. Kazemier, Vincenzo Berghella, John Owen, Roberto Eduardo Bittar, Rashmi Bagga, Joan M. G. Crane, Andrew H. Shennan, Birgit Arabin, Ben Willem Mol, Eva Pajkrt, C. Emily Kleinrouweler

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: Pregnant patients with a previous spontaneous preterm birth are at high risk for recurrent (spontaneous) preterm birth. We investigated whether the number of previous spontaneous preterm births, gestational age of the previous birth and cervical length could stratify patients into different risk groups for recurrence to investigate whether there is a risk group that does not require additional interventions.

DATA SOURCES: A systematic search of MEDLINE and EMBASE was conducted from 1995 until April 2025.

STUDY ELIGIBILITY CRITERIA: Studies that were included were prospective studies with original individual patient data available that reported on asymptomatic pregnant individuals with ≥1 …

Repair Of Uterine Rupture With Placenta Accreta At 22 Weeks, Followed By Cesarean Hysterectomy Delivery Of Healthy Neonate At 32 Weeks, Molly Dickinson, Thomas Jefferson University, Marco Goldberg, Mae Florendo, Andrew Chau, Corrado Minimo, Kate Stampler, Jay Goldberg

Einstein Health Papers

Introduction: Uterine rupture at previable gestational ages is almost always treated with evacuation of the pregnancy, followed by uterine repair or hysterectomy. Case Presentation: A 40-year-old woman with one prior cesarean section presented at 22 weeks of gestation with an acute abdomen. Imaging noted hemoperitoneum with areas of bulging in the anterior uterine wall. Laparoscopy converted to a laparotomy through a midline incision, noted an actively bleeding 2 cm area of uterine rupture with protruding placental tissue. The uterine rupture was surgically closed with sutures. The patient was kept in the hospital for the remainder of her pregnancy. At 32 …

Identification Of De Novo Variants From Parent-Proband Duos Via Long-Read Sequencing, Leandros Boukas, Emmanuèle C. Délot, Georgia Pitsava, Christine Lambert, Cairbre Fanslow, Primo Baybayan, Sami Belhadj, Bojan Losic, John Harting, Krista Bluske, Jonathan Lotempio, Huda B. Al-Kouatly, Rachid Karam, William J. Rowell, Changrui Xiao, Eric Vilain, Seth I. Berger

Department of Obstetrics and Gynecology Faculty Papers

While de novo variants cause many Mendelian disorders, their detection currently requires sequencing of the proband and both biological parents. This is not feasible when only one parent is available, a limitation for millions of families. Here, we develop duoNovo, which identifies de novo variants from parent-proband duos using long-read sequencing followed by haplotype reconstruction and detection of identical-by-descent haplotype blocks. We sequenced 104 trios with PacBio HiFi sequencing and applied duoNovo to each of the 208 duos constructed by masking one parent, classifying over 55 million variants according to their de novo status. We evaluated duoNovo's performance against classifications …

Effect Of Dental Treatments On Reduction Of Preterm Birth: A Systematic Review And Meta-Analysis, Camille Thomas, Shakil Ahmed, Vincenzo Berghella, Romina Brignardello-Petersen, Mohamed El-Rabbany, Catherine Devion, Stefania Ronzoni

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: Periodontal disease is associated with increased risk of preterm birth. Effective management during pregnancy may reduce preterm birth, though clinical trial evidence has been inconsistent. This study aimed to assess whether treating dental disease during pregnancy reduces preterm birth.

DATA SOURCES: A systematic search was performed of EMBASE, MEDLINE, PubMed, Cochrane Library, and trial registries up to December 2023 and re-run in January 2025.

STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs) enrolling pregnant persons with any dental disease randomized to receive dental treatment vs no treatment were included. No language restriction was applied.

STUDY APPRAISAL AND SYNTHESIS METHODS: Data …

Molecular Profiling And Tumor Biomarker Analysis Of Gog281/Logs: A Positive Late-Phase Trial Of Trametinib For Recurrent/Persistent Low-Grade Serous Ovarian Carcinoma, Robert L. Hollis, Austin Miller, Heather A. Lankes, Kwong-Kwok Wong, William Rodgers, David Millan, Karen Carty, Robert L. Coleman, Kathleen N. Moore, Angeles Alvarez Secord, David M. O'Malley, John K. Chan, Andrea R. Hagemann, Stephanie Gaillard, Saketh R. Guntupalli, Mitchell I. Edelson, Peter G. Rose, Oliver Dorigo, Susana Banerjee, Ailith Ewing, Michael Churchman, Anil K. Sood, C. Simon Herrington, Charlie Gourley, David M. Gershenson

Abington Jefferson Health Papers

PURPOSE: Low-grade serous ovarian carcinoma (LGSOC) is a distinct form of ovarian cancer characterized by younger patient age and relative chemoresistance. The GOG281/LOGS trial (NCT02101788) investigated the efficacy of the MEK inhibitor trametinib compared with physician's choice standard-of-care (SOC) in patients with LGSOC with persistent/recurrent disease. The study demonstrated significantly improved progression-free survival (PFS) in the trametinib-treated arm.

EXPERIMENTAL DESIGN: Two hundred and sixty patients with recurrent/persistent LGSOC were enrolled and randomly assigned in GOG281. We performed molecular analysis of 170 patients with available tumor specimens, comprising whole-exome sequencing and phospho-ERK (pERK) IHC, to identify biomarkers of clinical benefit from …

Exploring Physician Views On Birth Method And Route Of Delivery, Vivian Nguyen, Vincenzo Berghella, Md

Alpha Omega Alpha Research Symposium Posters

Purpose: In the United States, rates of cesarean deliveries (CD) have been increasing. Despite recommendations from the American College of Obstetrics and Gynecology to prevent increasing rates of CDs, planned CD has been associated with lower rates of perinatal deaths and better maternal outcomes when compared to planned vaginal delivery (VD). However, the data is limited, so it is important that we conduct randomized controlled trials (RCTs) comparing maternal and perinatal outcomes in planned CD vs planned vaginal delivery (VD) for nulliparous, term, single, vertex pregnancies. The purpose of study is to survey obstetricians and gynecologists (ob/gyns) on their …

Impact Of Prophylactic Oral Azithromycin During Labor On Azithromycin Resistance (Amr) In Nasal Staphylococcus Aureus And Streptococcus Pneumoniae In Women And Infants In The Multi-Country Azithromycin Prevention In Labor Use Study (A-Plus)., Patricia L. Hibberd, Jean H. Kim, Marissa Trotta, Sixto M. Leal, Anna Aceituno, Doyle V. Ward, Archana Patel, Akila Subramaniam, Waldemar A. Carlo, Imran Ahmed, Sarah Saleem, Sk Masum Billah, Rashidun Haque, Manolo Mazariegos, Fabian Esamai, Manjunath S. Somannavar, Shivaprasad S. Goudar, Elwyn Chomba, Muska Mwenchanya, Adrien Lokangaka, Antoinette Tshefu, Robert L. Goldenberg, Melissa Bauserman, Nancy F. Krebs, Sherri Bucher, Richard J. Derman, William A. Petri, Marion Koso-Thomas, Denise C. Babineau, Elizabeth M. Mcclure, Alan T. N. Tita

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Prophylactic oral azithromycin vs. placebo reduced maternal, but not neonatal, mortality/sepsis in the A-PLUS Randomized Trial. While prophylactic intrapartum azithromycin reduces maternal mortality/sepsis, it may promote antimicrobial resistance (AMR) in commensal bacteria,.

METHODS: Randomly selected women and their infants participating in A-PLUS were enrolled in a longitudinal cross-sectional sub-study to assess the presence of azithromycin resistance in selected bacteria in nasal cultures. Staphylococcus aureus and Streptococcus pneumoniae were cultured on selective agar, then azithromycin-containing agar to select for azithromycin resistant bacteria, identified biochemically. Azithromycin susceptibility was assessed by E-test. Nasal cultures were collected from women and infants between August …

Oxytocin Dosing During Trial Of Labor After Cesarean To Minimize The Risk Of Uterine Rupture: A Systematic Review And Meta-Analysis, Pierpaolo Nicolì, Moti Gulersen, Jordan Beacham, Hila Hochler, Alessandra Familiari, Anna Locatelli, Cynthia Abraham, Ettore Cicinelli, Amerigo Vitagliano, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: Oxytocin remains the mainstay for induction and for the management of labor arrest during trial of labor after cesarean (TOLAC). Therefore, the clinical question should be not whether to use oxytocin, but how to optimize its administration. This meta-analysis aimed to assess which oxytocin protocol, in terms of initial dose, amount of increase, timing to next increase, and maximum dose, may minimize the risk of uterine rupture (UR) during TOLAC.

DATA SOURCES: PubMed, Embase and Clinicaltrials.gov were searched up to September 21, 2024.

STUDY ELIGIBILITY CRITERIA: Randomized and nonrandomized studies evaluating the association between induction and/or augmentation with oxytocin …

The Association Between Gestational Body Mass Index Change, Cesarean Section, And Other Pregnancy Outcomes: Research Protocol: Retrospective Cohort Analysis, Kirsten I. Black, Owen Streeter, Arianne Sweeting, Pejman Adily, Mark Lauer, Adrienne Gordon, Vincenzo Berghella, Belinda R. Bruce, Lauren Ferris, Bradley De Vries

Department of Obstetrics and Gynecology Faculty Papers

Increasingly the value of gestational weight gain (GWG) as a useful measure to predict obstetric outcomes including cesarean section is being questioned. We will undertake a retrospective cohort study of recorded births in 2023 from 24 to 42 weeks' gestation for women aged from 16 to 49 years in the United States. Using multivariable Robust Poisson Regression, maternal body mass index (BMI) and BMI gain will be modelled on the primary outcome of cesarean delivery. The primary analysis will be restricted to nulliparous women if there is interaction between parity and BMI or BMI gain. A sample of 716,392 births …

Bladder Prolapse (Cystocele) Among African, Asian, And Middle Eastern Women: A Clinical And Socio-Cultural Perspective, Gayathri Delanerolle, Vindya Pathiraja, Tharanga Mudalige, Nirmala Rathnayake, Abirame Sivakumar, Wijamunige Nimesha Prashadini, Nihal Mohamed Al Riyami, Lamiya Al-Kharusi, Mohammad Haddadi, Fred Tweneboah-Koduah, Om Kurmi, George Uchenna Eleje, Peter Phiri, Lauri Romanzi, Sohier Elneil

Department of Obstetrics and Gynecology Faculty Papers

Bladder prolapse, also known as cystocoele, is the most common form of pelvic organ prolapse (POP), significantly affecting women's physical, sexual, and psychosocial health, particularly in low- and middle-income countries (LMICs). Despite its widespread prevalence and disabling consequences, bladder prolapse remains under-recognised and inadequately addressed in global health strategies. Prevalence estimates vary widely across regions, from 3%-64.6%, influenced by diagnostic methods and cultural reporting biases. Common risk factors include high parity, early childbirth, prolonged labour, poor postpartum care, malnutrition, obesity, and ageing. Clinical diagnosis often relies on simplified grading systems in resource-limited settings. Conservative treatments like pelvic floor muscle training …

Whole-Blood Cellular Responses: A Promising Indicator Of Sars-Cov-2 Immunity Compared To Serology, Lucas M. Zhou, Elizabeth H. Duncan, Rupsa C. Boelig, Margaret Costanzo, Jeffrey R. Currier, Elke S. Bergmann-Leitner

Department of Obstetrics and Gynecology Faculty Papers

Background: Currently available immunological tests for SARS-CoV-2 assess only antibody responses. Despite the growing evidence that T cells play a crucial role in protection, especially against emerging viral variants, no routine test is available to determine T cell immunity. The prognostic value of SARS-CoV-2-specific antibodies for determining whether individuals are immune and protected against disease remains uncertain. This is in part due to the following: (a) specificity and limitations such as the sensitivity of antibody tests, and (b) the lack of correlation between antibody titers (quantity) and the antiviral function of antibodies (quality). Approximately a quarter of SARS-CoV-2-infected patients with …

Corrigendum To "Trustworthiness Criteria For Meta-Analyses Of Randomized Controlled Studies: Obgyn Journal Guidelines" [Ejogrb 305 (2025) 416-418], Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

Participating members of the OBGYN Editors’ Integrity Group (OGEIG) All OGEIG members who participated in meetings discussing the manuscript ‘Trustworthiness criteria for meta-analyses of randomized controlled studies’ are listed here, with their affiliated journal/organization in parentheses: Jason Abbott (J Minim Invasive Gynecol), Ganesh Acharya (Acta Obstet Gynecol Scand), Amir Aviram (Am J Obstet Gynecol MFM), Kurt Barnhart (Fertil Steril), Vincenzo Berghella (Am J Obstet Gynecol MFM), Catherine S. Bradley (Am J Obstet Gynecol), Nancy Chescheir (COPE), Thomas D'Hooghe (Gynecol Obstet Invest), Michael Geary (Int J Gynecol Obstet), Janesh Gupta (Eur J Obstet Gynecol), Karl Oliver Kagan (Arch Gynecol Obstet), Anthony …

Can Artificial Intelligence Models Provide Reliable Medical Counselling To Fertility Patients?, Idan Alcalay, Ariel Weissman, Hadas Ganer Herman, Avi Tsafrir, Matan Friedman, Eran Weiner, Raoul Orvieto, Nikolaos P. Polyzos, Michael H. Dahan, Alex Polyakov, Robert Fischer, Sandro C. Esteves, Baris Ata, Jason M. Franasiak, Yossi Mizrachi

Department of Obstetrics and Gynecology Faculty Papers

RESEARCH QUESTION: Can generative artificial intelligence (AI) models provide reliable counselling to fertility patients regarding real-world clinical questions?

DESIGN: In this cross-sectional study, 12 clinical questions were developed to reflect common, real-life dilemmas encountered during fertility workup and treatment. Responses to each question were generated by two experienced fertility specialists, and two AI models - ChatGPT and Gemini. Eight leading internationally recognized fertility experts, blinded to the source of each reply, independently rated all the responses on a scale from 1 (strongly disagree) to 10 (strongly agree). Ratings were compared across all four repliers using non-parametric statistical tests.

RESULTS: The …

Updates In Contemporary Management Of Singleton Pregnancies Complicated By A Short Cervix, Moti Gulersen, Vincenzo Berghella, Eran Bornstein

Department of Obstetrics and Gynecology Faculty Papers

Singleton pregnancies complicated by a short cervical length (≤25 mm) are at significantly increased risk for spontaneous preterm birth. Several treatment strategies aimed at reducing this risk and improving perinatal outcomes have been evaluated, including vaginal progesterone, cervical cerclage, and cervical pessary. This review summarizes the latest evidence regarding the efficacy of these interventions. Vaginal progesterone and/or cervical cerclage have been identified as proven evidence-based practices for preterm birth prevention and improve neonatal outcomes. Vaginal progesterone reduces the risk of preterm birth < 35 weeks by 27% (relative risk 0.73, 95% confidence interval 0.58-0.90). Cervical cerclage has been shown to reduce the risk of preterm birth < 35 weeks by 30% (relative risk 0.70, 95% confidence interval 0.55-0.89) in patients with a short cervical length and prior preterm birth. In contrast, recent data suggest that cervical pessary should no longer be considered a management option for these patients. A continued focus on individualized, evidence-based approaches remains essential to optimizing outcomes in this high-risk population.

The Effect Of Hcv On Methadone Dose During Pregnancy, Sarah Boudova, Neel S. Iyer, Danielle M. Tholey, Jonathan M. Fenkel, Rupsa C. Boelig

Department of Obstetrics and Gynecology Faculty Papers

Pregnancy is a time of high patient motivation to initiate treatment for opioid use disorder (OUD). Hepatic drug metabolism can be altered by pregnancy and hepatitis C virus (HCV) infection. We aimed to examine the impact of HCV during pregnancy on methadone dosing. Retrospective chart review of all pregnant patients with OUD admitted for initiation of methadone from 1/2020-6/2022. Associations were examined using Student's T-tests, chi-squared tests, Fisher's exact tests and univariate and multivariate linear regression. We identified 191 pregnancies initiated on methadone, of which 188 were screened for HCV. 111 (59.0%) were HCV Antibody (Ab)+, of whom 108 were …

Utility Of The Us Preventive Services Task Force For Preeclampsia Risk Assessment And Aspirin Prophylaxis, Thomas Mcelrath, Arun Jeyabalan, Arkady Khodursky, Alison Moe, Manfred Lee, Maneesh Jain, Laura Goetzl, Elizabeth Sutton, Pamela Simmons, George Saade, Antonio Saad, Luis Pacheco, Esther Park-Hwang, Antonina Frolova, Ebony Carter, Ai-Ris Collier, Daniel Kiefer, Vincenzo Berghella, Rupsa Boelig, Michal Elovitz, Cynthia Gyamfi-Bannerman, Joseph Biggio, Kara Rood, William Grobman, Carrie Haverty, Morten Rasmussen

Department of Obstetrics and Gynecology Faculty Papers

IMPORTANCE: The US Preventive Services Task Force (USPSTF) guidelines on preeclampsia risk assessment and aspirin prophylaxis (AP) have not been evaluated for clinical utility.

OBJECTIVE: To evaluate which characteristics in the USPSTF guidelines identify risk status and the association of preeclampsia risk with AP recommendations.

DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study enrolled from July 2020 to March 2023 with data analysis performed from October to December 2024. Enrollment occurred at 11 centers throughout the US or via direct-to-participant recruitment. Pregnant participants aged 18 years or older with a singleton pregnancy less than 22 weeks' gestation were selected via …

Priority Ir: Protocol For Implementation Research On Single-Dose Postpartum Iv Iron To Treat Iron-Deficiency Anemia Among Women In India And Pakistan, Valerie L. Flax, Narjis Rizvi, Umesh Charantimath, Saleem Jessani, Avinash Kavi, Sarah Saleem, Manjunath Somannavar, Shivaprasad S. Goudar, Anika Hannan, Elizabeth M. Mcclure, Simal Thind, Rosemary Frasso, Richard Derman

Global Health Articles

BACKGROUND: Anemia among women of reproductive age has remained highly prevalent globally. Intravenous (IV) iron is well tolerated and proven effective for treating postpartum iron deficiency anemia in high-income countries, but evidence from LMICs, where oral iron is standard treatment, is limited. The PRIORITY trial will test the effectiveness of IV iron compared to oral iron for postpartum women with moderate anemia in eight LMIC sites. An implementation research (IR) study will be conducted alongside the PRIORITY trial in India and Pakistan to gather information on the intervention characteristics and the implementation process, and to assess feasibility, acceptability, fidelity, and …