Obstetrics & Gynecology

ACOG reframes endometriosis diagnosis around clinical and imaging criteria

This ACOG Clinical Practice Guideline issues graded recommendations for diagnosing endometriosis in reproductive-aged adults and adolescents. Diagnosis is anchored in history, pelvic examination, and imaging, with selective use of operative evaluation instead of routine diagnostic laparoscopy. A modified GRADE framework classifies recommendation strength and evidence quality, supplemented by Good Practice Points where data are sparse. Recommendations generally extend to adolescents, using limited adolescent data plus extrapolation from adult studies and expert consensus. 1

Aspirin benefit for preterm preeclampsia depends on baseline risk and adherence

This Monte Carlo simulation used 51,024 screened pregnancies to model aspirin’s effect on preterm preeclampsia by risk and adherence. With full adherence, aspirin showed strong protection (relative risk 0.25; 95% CI 0.09–0.66) against preterm preeclampsia. At 50% adherence, benefit was attenuated (relative risk 0.70; 95% CI 0.58–0.98), underscoring counseling around consistent dosing. Absolute risk reduction and number needed to treat were far more favorable at higher baseline risks than at very low risks. Decision-curve analysis favored targeted prophylaxis using the Fetal Medicine Foundation model over universal aspirin for all gravidas. 2

Five-year KEYNOTE-775 data confirm durable benefit of lenvatinib+pembrolizumab

In this phase 3 trial, 827 patients with advanced endometrial cancer previously treated with platinum were randomized to lenvatinib+pembrolizumab or chemotherapy. At 68.8 months median follow-up, 5-year overall survival in all-comers was 19.9% with lenvatinib+pembrolizumab versus 7.7% with chemotherapy. Mismatch repair–deficient tumors derived larger absolute benefit, with 5-year overall survival 36.5% versus 9.8% and higher progression-free survival rates. Treatment-related adverse events caused discontinuation in 32.3% with lenvatinib+pembrolizumab versus 5.9% with chemotherapy, although no new safety signals emerged. Benefits persisted despite more subsequent systemic therapy and crossover in the chemotherapy arm, reinforcing this regimen as standard of care. 3

First-trimester bleeding predicts loss mainly when growth lags by more than 5 days

This prospective cohort followed 5,425 pregnancies with detailed bleeding histories and first-trimester research ultrasound. Bleeding was reported by 25% of participants, and overall pregnancy loss occurred in 12%. Bleeding alone was not associated with loss (hazard ratio 0.89; 95% CI 0.75–1.07). Bleeding plus ultrasound biometry more than 5 days behind LMP substantially increased loss risk (hazard ratio 2.72; 95% CI 2.10–3.53). Patients with bleeding but size-appropriate ultrasound can generally be reassured, while those with lagging growth merit closer surveillance. 4