Obstetrics & Gynecology

Opioid-Free Discharge Is Noninferior for Pain After Outpatient MIGS

In 103 women undergoing outpatient laparoscopic MIGS, an opioid-free multimodal exit prescription achieved noninferior pain control to restrictive hydromorphone prescribing. Postoperative day 1 mean pain scores were similar (3.1 opioid-free vs 3.5 opioid group), as were day 7 scores and mobility. Patients receiving opioids had more nausea and vomiting than those discharged opioid-free (35.2% vs 14.3%). No opioid-free patients required rescue opioid prescriptions, and most women given opioids consumed none or very few tablets. These findings support routine opioid-free multimodal discharge regimens for appropriately selected outpatient MIGS patients without chronic pain conditions. 1

Endometrium-Free Cesarean Closure Linked to Fewer Scar Defects and Abnormal Implantation

This report describes a cesarean hysterotomy closure technique that excludes endometrium and separately reapproximates the three uterine wall layers. Over 30 years of consecutive use, subsequent pregnancies showed reduced abnormal implantation compared with historical experience with bulk single-layer closure. Sonohysterography demonstrated fewer and smaller cesarean scar defects in women with one or multiple prior cesareans using this technique. The method requires precise anatomic discrimination of endometrium, myometrium, and serosa and is more technically demanding than standard closures. Authors propose that endometrium-free closure may reduce long-term reproductive complications, but randomized comparative trials are still needed. 2

Preventable Severe Early Pregnancy Morbidity Increased After Dobbs

This interrupted time-series at an abortion-restricted tertiary center evaluated severe early pregnancy morbidity among 46,181 pregnancies under 24 weeks from 2017–2023. Investigators identified 407 severe morbidity events using billing codes, transfusion records, and intensive care transfers verified by chart review. Overall severe morbidity rates showed no significant change in level or slope after the Dobbs decision. However, preventable severe morbidity events increased abruptly by 19 per 100 total events, with confidence intervals that excluded zero. Findings suggest post-Dobbs care constraints contributed to additional preventable early pregnancy harm, with implications for counseling and institutional protocols. 3