Obstetrics & Gynecology

Cervical Length After 24 Weeks Still Predicts Spontaneous Preterm Birth

This meta-analysis pooled 16 cohort and cross-sectional studies including 26,776 asymptomatic singleton pregnancies with transvaginal cervical length (TVCL) measured after 24 weeks. Women who later had spontaneous preterm birth before 37 or 34 weeks had significantly shorter TVCL at 24–28+6 and 27–32+6 weeks than term controls. Differences were consistent regardless of preterm birth risk status, gestational-age window, or TVCL measurement technique, and iatrogenic preterm births were excluded. A TVCL cutoff near 25.5–26.0 mm after 24 weeks yielded a high positive likelihood ratio and moderate sensitivity for predicting spontaneous preterm birth. 1

Telemedicine Medication Abortion Matches Clinic Outcomes Up to 77 Days

This retrospective cohort from a California academic system compared telemedicine (n=165) versus clinic-based (n=411) medication abortion up to 77 days’ gestation. After adjustment, attendance at at least one follow-up visit did not differ significantly by modality, with high follow-up in both groups. Successful abortion without surgical intervention occurred in about 90% of telemedicine and 88% of clinic patients, with no significant adjusted difference. Serious adverse events were rare in both groups, each under 1%, and mainly required intravenous antibiotics or transfusion. 2

Pelvic Floor Botulinum Toxin Reduces Endometriosis-Associated Chronic Pelvic Pain

This double-masked phase 2 trial randomized 29 women with refractory endometriosis-associated chronic pelvic pain and pelvic floor spasm to 100 Units onabotulinumtoxinA or saline injections. At one month, more women receiving botulinum toxin reported benefit than placebo (73% vs 29%), with greater percent benefit and longer duration of relief. Among participants with at least moderate baseline pain, toxin led to significantly lower pain scores compared with placebo. By one year, most patients used less pain medication, particularly those who had received botulinum toxin, although this difference approached but did not reach conventional significance. 3

Multiple Maternal Chronic Conditions Raise Severe Neonatal Morbidity–Mortality Risk

This Ontario population-based cohort included 1,018,968 live births, classifying maternal chronic conditions from records in the two years before conception. Compared with no chronic conditions, adjusted relative risks for severe neonatal morbidity or mortality rose progressively with one, two, and three or more conditions (aRRs 1.26, 1.58, 2.01). Complex multimorbidity, cardiometabolic clusters, and severe multimorbidity defined by prenatal hospitalization further increased risk, with aRRs up to 3.11. Models adjusted for maternal age, parity, immigration status, income, and rurality, supporting a robust dose–response association. 4