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Review some of the top stories from the Contemporary OB/GYN website over the past week and catch up on anything you may have missed.

Contemporary OB/GYN week in review: Cervical screening, US fertility, and more

She joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio, before joining 

 You can reach her at mebert@mjhlifesciences.com.

Preconception hypoglycemia is linked to increased risks of preterm birth, low birth weight, and birth defects, a new study from China finds.

Study finds preconception hypoglycemia tied to adverse pregnancy outcomes

Take a quick look at everything you may have missed last month, including the latest FDA updates, top stories, and exclusive interviews.

Top 5 women's health headlines you missed in July 2025

A new review finds immediate release nifedipine offers comparable safety and efficacy to IV labetalol and hydralazine in managing severe hypertension during pregnancy.

IR nifedipine as effective as IV labetalol for severe hypertension in pregnancy

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Angel Foster, MD, is the founder of The Massachusetts Abortion Access Project.

In the wake of tightening abortion laws, telemedicine and advance provision of abortion pills are emerging as essential, safe, and accessible solutions for reproductive health care.

Angel Foster, MD, highlights the importance of telehealth for abortion care

Kephera Diagnostics has announced the introduction of EndomTest, the first commercially available noninvasive diagnostic test for endometriosis in the United States, according to the company. 

The laboratory-developed test, which requires only a blood sample, is designed to serve as a rule-in tool for the disease and may offer a significant advancement in reducing diagnostic delays commonly experienced by patients.

Endometriosis affects approximately 10% of women of reproductive age, or roughly 6.5 million individuals in the United States, and is associated with pelvic pain, infertility, and reduced quality of life. Diagnosis is often delayed, averaging 7 years from symptom onset, due to reliance on laparoscopy and histologic confirmation as the gold standard. 

“Endometriosis is a serious medical and gynecological condition affecting many women of all ages,” said Michael Krychman, MD, of the University of California Irvine Medical Center. “Currently, our only diagnostic approach is laparoscopic surgery, an invasive procedure that carries inherent risks and [adverse] effects. A simple noninvasive test for endometriosis has the potential to transform patient care.”

The EndomTest is based on more than a decade of academic research and is offered under exclusive license from Exeltis. It utilizes a combination of serum biomarkers—cancer antigen 125 and brain-derived neurotrophic factor—and 6 clinical variables derived from patient history. These include previous surgical history for endometriosis, presence of painful periods leading to referral, severity of menstrual pain, age at first use of painkillers, age at first diagnosis of ovarian cysts, and age at onset of dyspareunia. Results are processed through a diagnostic algorithm to yield a binary outcome: positive or negative.

Validation of the test was conducted using samples from the Oxford Endometriosis CaRe Centre biobank in the United Kingdom. The development study included 204 patients, and the external validation study included 79 patients. Endometriosis diagnoses in both cohorts were based on laparoscopic and histological confirmation.

In the validation study, the test demonstrated a specificity of 100% (95% CI, 86.7%–100%) and a sensitivity of 46.2% (95% CI, 25.5%–66.8%), supporting its utility as a rule-in test. The area under the curve was 0.758. Importantly, the test showed sensitivity of 32% for superficial endometriosis, which is difficult to detect with imaging, and higher sensitivity in cases of deep infiltrating endometriosis and endometrioma, particularly when both lesion types co-occur (sensitivity 69.7%).

Despite the presence of confounding gynecologic conditions such as uterine fibroids, ovarian cysts, and polycystic ovarian syndrome among control participants, the test maintained high specificity. “People are told that their symptoms are normal when they are experiencing disabling pain,” said Caroline Leithner, a patient and advocate. “As a patient who has had a laparoscopy and treatment with 18 months of a [gonadotropin-releasing hormone] agonist, this test would have offered me the option for less invasive testing and more options for earlier treatment of my disease.”

Andrew Levin, PhD, CEO and chief scientific officer at Kephera Diagnostics, stated, “We are proud to be launching the first noninvasive test for endometriosis in the United States. EndomTest leverages Kephera’s scientific expertise in in vitro assays for challenging diseases. With the launch of this test through our CLIA lab, we hope to provide a diagnostic solution that will improve health care for thousands of patients who are affected by endometriosis.”

First blood test for endometriosis launched by Kephera Diagnostics. News release. Kephera Diagnostics. July 24, 2025. Accessed July 24, 2025. https://kephera.com/first-blood-test-for-endometriosis-launched-by-kephera-diagnostics/

Herranz-Blanco B, Daoud E, Viganò P, García-Velasco JA, Colli E. Development and validation of an endometriosis diagnostic method based on serum biomarkers and clinical variables. 

. 2023;13(7):1052. doi:10.3390/biom13071052

Daoud E, Archer DF, Fabio Parazzini, Bárbara Herranz-Blanco. Validation of an in vitro diagnostic test for endometriosis: impact of confounding medical conditions and lesion location. 

. 2024;25(14):7667-7667. doi:10.3390/ijms25147667

Kephera Diagnostics announced the launch of EndomTest, a noninvasive blood test for endometriosis, promising faster diagnoses and improved patient care.

Noninvasive blood test offers new diagnostic approach for endometriosis

There is a link between early diagnosis of intrahepatic cholestasis of pregnancy (ICP) and adverse outcomes that is not fully driven by peak total bile acid (TBA) levels, according to a recent study published in 

ICP is often reported in the third trimester and has been linked to increased TBA levels. While rare, certain maternal complications have been linked to fat-soluble vitamin deficiency caused by the condition. Adverse fetal outcomes have also been reported, such as stillbirth and preterm birth.

 Peak TBA level is often used to guide management.

“Consequently, there are no current guidelines surrounding whether TBA levels should be repeated, and if so, when this should occur,” wrote investigators. “Given the lack of a management paradigm, diagnosis of ICP prior to late third trimester has limited evidence-based approaches.”

The retrospective cohort study was conducted to assess the impact of early ICP diagnosis on adverse outcomes. Singleton, live gestations complicated by ICP between 2005 and 2019 with prenatal care given were included in the analysis.

At the study center, ICP screening was performed during prenatal visits, and a ursodeoxycholic acid regimen of 300 mg twice per day was provided to patients following ICP diagnosis. Doctors also trended TBA levels every 3 to 4 weeks medically until medically indicated delivery.

Adverse outcomes in pregnancies with an early ICP diagnosis, defined as under 32-weeks’ gestation, were compared to those with a late diagnosis, defined as 32-weeks’ gestation or later. Exclusion criteria included being aged under 18 years and having underlying hepatobiliary pathology.

Comparisons were also made between women diagnosed early or late with severe cholestasis, defined as peak TBAs of 40 µmol/L or higher. The spontaneous preterm birth rate was defined as the primary outcome of the analysis.

Secondary outcomes included iatrogenic preterm birth rates, meconium-stained amniotic fluid, cesarean deliver (CD) for nonreassuring fetal heart tracing (NRFHT), umbilical artery pH under 2.70, and neonatal intensive care unit (NICU) admission.

There were 1247 singleton, live gestations complicated by ICP included in the final analysis. Of these, 19.3% had an early diagnosis and 80.7% had a late diagnosis. Higher peak TBA levels were reported in early ICP diagnosis vs late diagnosis, which was linked to greater ICP severity, prior cholestasis rates, prior preterm birth rates, and delivery at an earlier gestational age.

Rates of spontaneous preterm birth, iatrogenic preterm birth, and NICU admission were higher in patients with early ICP diagnosis, at 14.5%, 32%, and 50.7%, respectively. In comparison, these rates were 6%, 14.8%, and 37%, respectively, in those with late diagnosis.

After adjustments, patients with early ICP diagnoses had odds ratios of 1.81, 1.59, and 1.43, respectively, for these adverse outcomes. No significant associations were reported for umbilical artery pH, meconium-stained amniotic fluid, or CD for NRFHT.

Severe ICP was reported in 36.5% of ICP cases, with 23.7% of these diagnosed early and 76.3% diagnosed late. Greater rates of prior cholestasis, prior preterm birth, and ursodeoxycholic acid treatment were identified in these cases, alongside delivery at an earlier gestational age.

Associations with severe ICP were also reported for spontaneous preterm birth, iatrogenic preterm birth, and NICU admission, with rates of 22.2%, 38%, and 57.6%, respectively. These associations remained when adjusting for peak TBA levels and preterm birth history.

Overall, the data indicated an increased risk of adverse outcomes in cases of ICP diagnosed before 32-weeks’ gestation. As these outcomes were consistent even when analyzing early severe ICP, investigators concluded outcomes are also dependent on the duration of time exposed to elevated bile acids.

“While this study better describes the outcomes associated with cholestasis, further studies are needed to determine the mechanism for early ICP associated spontaneous preterm birth and whether trending TBA after early diagnosis can improve outcomes,” wrote investigators.

Sarker MR, Canfield D, Ferrara L, Debolt CA. Earlier diagnosis of intrahepatic cholestasis of pregnancy and adverse pregnancy outcomes. 

Brouwers L, Koster MP, Page-Christiaens GC, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. 

. 2015;212(1):100.e1-7. doi:10.1016/j.ajog.2014.07.026

A new study finds that intrahepatic cholestasis of pregnancy diagnosis before 32-weeks’ gestation increases the risk of adverse outcomes.

Clinical

Early intrahepatic cholestasis of pregnancy linked to adverse outcomes

A standardized protocol for labor induction across racial and ethnic groups is not linked to reduced racial disparities in cesarean section or maternal morbidity, according to a recent study published in 

Significant racial disparities have been observed in obstetric outcomes, including a 10% increase in cesarean delivery risk among Black women vs White women. Data has indicated improved care delivery from interventions designed to reduce these disparities but has not evaluated the impact on morbidity.

“Labor induction is associated with a cesarean delivery rate of around 25% nationally, thereby accounting for approximately 250,000 yearly US cesareans, making induction a critical target for interventions attempting to reduce cesarean rates,” wrote investigators.

Assessing labor induction as a target for intervention

The retrospective study assessed the efficacy of a standardized labor induction protocol for reducing racial disparities in obstetrics. Characteristics of the protocol included frequent cervical examinations, amniotomy for cervical exam of 4 cm or greater, and interventions in patients with labor dystocia.

Pregnant patients receiving labor induction at term, with a singleton gestation and intact membranes, and seeking cervical ripening from their clinician were included in the analysis. Those with prior cesarean delivery were excluded.

Race and ethnicity data were collected from electronic health records alongside additional demographics, labor course, and delivery data. Cesarean delivery for any indication was reported as the primary outcome.

Time to delivery, clinical chorioamnionitis, postpartum hemorrhage, composite maternal morbidity, composite neonatal morbidity, and neonatal intensive care unit (NICU) admission over 48 hours were reported as secondary outcomes.

There were 8386 patients included in the final analysis, 60% of whom identified as people of color (BIPOC) in the preimplementation period vs 58.6% in the postimplementation period. Of these, 76.3% were Black, 11.7% Asian, 7.5% Hispanic White, and 4.4% other racial groups.

Differences in body mass index, insurance status, delivery site, maternal age, parity, gestational age, hypertension, and indication for induction were reported in BIPOC patients vs White patients. Diabetes also differed between these populations in the preimplementation period, but not the postimplementation period.

The risk of cesarean delivery was higher among BIPOC patients vs White patients in both the preimplementation and postimplementation periods, with adjusted risk ratios (aRRs) of 1.36 and 1.55, respectively. Chorioamnionitis and postpartum hemorrhage risks were also increased among BIPOC patients in both periods.

BIPOC patients also reported a higher risk of composite maternal morbidity in both periods, with an aRR of 1.33 in the preimplementation period and 1.46 in the postimplementation period.

Additional risks and lack of protocol impact

A shorter time to delivery was also reported in this population, but this outcome was not significant in adjusted analyses. There were also no differences in neonatal morbidity or NICU admission based on race in either period.

No significant differences in cesarean delivery or other maternal outcomes were linked to the standardized protocol. This highlighted a lack of efficacy of the protocol in reducing racial and ethnic disparities.

Investigators also assessed the impact of the 8 protocol components individually. Most components did not influence the established associations, but the one about leaving a cervical ripening balloon in place for 12 hours after use, followed by initiating or continuing oxytocin, had a greater fidelity for BIPOC patients vs White patients in the postimplementation period.

“Despite implementation of a standardized induction protocol across racial groups, this intervention did not mitigate observed racial disparities in cesarean delivery or maternal morbidity rates,” wrote investigators.

Hamm RF, Mumford SL, Forkpa M, et al. The impact of implementing a standardized protocol for labor induction on obstetric disparities: secondary analysis of a type I hybrid effectiveness-implementation trial. 

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

. Racial and ethnic differences in utilization of labor management strategies intended to reduce cesarean delivery rates. 

 2017;130(6):1285-1294. doi:10.1097/AOG.0000000000002343

A study finds that a uniform labor induction protocol did not reduce racial disparities in cesarean deliveries or maternal health outcomes.

Labor induction protocol fails to reduce disparities in c-section rates

The FDA granted priority review to an application for flibanserin 100 mg (Addyi; Sprout Pharmaceuticals), utilized in women with low sexual desire, to expand its use to women who have undergone menopause, according to Sprout Pharmaceuticals on July 24, 2025.

Flibanserin is the first and only pill approved by the FDA for the treatment of low sexual desire in women, highlighting a landmark in managing hypoactive sexual desire disorder (HSDD). No other FDA treatments have been approved, despite nearly 40% of women reporting low sexual desire within their lifetimes.

"Sexual desire is ageless. Access to care should be too,” said Cindy Eckert, founder and CEO of Sprout Pharmaceuticals. “Priority review brings us closer to expanding access and empowering more women with a science-backed, FDA-approved solution for their sexual wellness."

More than 25,000 health care professionals in the United States have prescribed flibanserin to treat HSDD in their patients. It is a nonhormonal treatment, influencing key neurotransmitters that play a key role in sexual response.

The original FDA approval for the use of flibanserin in premenopausal women occurred following results from the largest clinical trials in women’s sexual health. Health Canada approved the medication for use in menopausal women as well, following a review of its robust safety and efficacy profile.

The FDA now may also approve the use of flibanserin in this population. This would highlight a shift toward life-stage-spanning sexual health innovations, providing women access to multiple treatment options regardless of their age.

Current risks associated with flibanserin include severe low blood pressure and fainting among women who drink alcohol close to the time of dosage, take certain medications with flibanserin, or have liver problems. Experts recommend waiting at least 2 hours after drinking 1 or 2 standard alcoholic drinks before taking flibanserin to reduce risks.

Doctors should also consult with their patients to encourage safety when taking flibanserin, ensuring their patients do not administer the treatment if they have liver problems or take a contraindicating medication. Allergic reactions should also be assessed before prescribing flibanserin.

Alongside these adverse events, drowsiness has been noted as a common and potentially serious adverse effect of flibanserin. Additional adverse effects include difficulty falling asleep or staying asleep, dizziness, nausea, and dry mouth.

"This is about expanding access, expanding awareness, and expanding agency for women who have been overlooked for far too long," said Eckert.

Testosterone therapy as an alternative treatment

Prior data have shown variations in duration, route, and coadministration with estrogen patterns when using testosterone therapy (TTh) in women with HSDD.

 This method has been recommended for HSDD treatment previously, but unlike flibanserin, it has not received FDA approval.

Data about TTh use in women with HSDD was obtained from patients aged 18 to 70 years using TriNetX Diamond. The final analysis included 33,418 women aged a mean 44.2 plus or minus 10.8 years at HSDD diagnosis.

TTh was given to 850 individuals, 461 of whom were prescribed injectable testosterone, 257 topical testosterone, and 119 pellets. Coprescription estrogen was reported in 162. Based on this variety, investigators concluded that further research about the efficacy and long-term outcomes of this method is needed.

FDA grants priority review for Addyi (flibanserin) paving the way for expanded access to treat low sexual desire in postmenopausal women. Sprout Pharmaceuticals. July 24, 2025. Accessed July 24, 2025. https://www.prnewswire.com/news-releases/fda-grants-priority-review-for-addyi-flibanserin-paving-the-way-for-expanded-access-to-treat-low-sexual-desire-in-postmenopausal-women-302512883.html

Krewson C. Variations found in testosterone therapy for women with HSDD. Contemporary OB/GYN. May 7, 2024. Accessed July 24, 2025. https://www.contemporaryobgyn.net/view/variations-found-in-testosterone-therapy-for-women-with-hsdd

The FDA has granted priority review to expand flibanserin (Addyi; Sprout Pharmaceuticals) use to postmenopausal women, potentially broadening access to treatment for hypoactive sexual desire disorder.

FDA grants priority review to flibanserin for treating postmenopausal HSDD

What is your diagnosis based on these images of the ovary?

Challenge your diagnostic skills with this image quiz: Is this ovarian lesion cystic in nature or something else?

Image IQ: Ovarian Cyst or Something Else?

The odds of never breastfeeding and of breastfeeding cessation are increased among women with hypertensive disorders of pregnancy (HDPs), according to a recent study published in 

HDPs have been reported as the leading cause of maternal and infant morbidity and mortality in the United States.

 However, these risks may be reduced through breastfeeding, based on data from previous studies.

 Breastfeeding is performed by 83% of US women at delivery, but only 25% exclusively through 6 months.

“Though other maternal comorbidities, including gestational diabetes, have been seen to negatively influence breastfeeding outcomes, little is known about breastfeeding outcomes for the 16% of US pregnant women with HDP compared with women without HDP,” wrote investigators.

Assessing breastfeeding duration and HDP diagnosis

The cross-sectional study was conducted to determine the impact of HDP exposure on never breastfeeding and breastfeeding cessation among US women. Data was obtained from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System.

Women with complete HDP data and a live infant at survey completion, alongside noninitiation or cessation of breastfeeding, were included in the analysis. Deliveries between 2016 and 2021 were eligible, with never breastfeeding and time to breastfeeding cessation in weeks reported as dependent variables.

Breastfeeding less than 1 week was categorized as cessation at 0.5 weeks. Other responses for breastfeeding included the exact breastfeeding duration in weeks and a response of “still breastfeeding.” HDP was defined as self-reported high blood pressure or hypertension, preeclampsia, or eclampsia before or during pregnancy.

Maternal age, insurance, race and ethnicity, household income, enrollment in the Women, Infants and Children program, educational level, and marital status were reported as covariates. Health-related covariates included preterm birth, singleton live birth, cesarean delivery, smoking in pregnancy, body mass index over 30, and gestational diabetes.

There were 205,247 women across 43 US states included in the final analysis, 0.8% of whom were American Indian, 5.3% Asian, 15% Black, 18% Hispanic, 50.8% White, 2.3% multiracial, and 0.7% other. Ninety-nine percent of samples were from first-time mothers, with 54% having private insurance and 91% delivering at term.

An HDP diagnosis was reported in 17% of participants, with women aged under 18 years or at least 35 years more likely to be diagnosed. Additional groups with an increased HDP prevalence included American Indian or Black women, not married, insured by Medicaid, and with a household income of $40,000 or less.

Women with HDP were also more likely to have a body mass index of 30 or higher, gestational diabetes, and to smoke. Infants of these women were more often born preterm, had a low birth weight, and were admitted to a hospital for over 5 days after delivery.

Breastfeeding initiation was reported in 85% of women with HDP vs 88% without. When adjusted for covariates, an odds ratio of 1.11 was reported for never breastfeeding among women with HDP. Race and ethnicity did not significantly influence this link.

The odds of breastfeeding cessation were also increased among women with HDP, with an adjusted HR of 1.17. The median time to breastfeeding cessation was 17 weeks among this population, vs 34 weeks among women without HDP. Since over 25% of the population was still breastfeeding at the last observation, an upper quartile was not obtained.

Race and ethnicity influenced the association between HDP and breastfeeding cessation. Asian, non-Hispanic Black, and American Indian patients had increased risks, with HRs of 1.34, 1.19, and 1.18, respectively. Overall, the data highlighted increased risks of never breastfeeding and breastfeeding cessation among women with HDP.

“Further analyses could inform tailored approaches to promote breastfeeding for dyads experiencing higher cardiometabolic risk and promote health equity for US women and infants,” wrote investigators.

Nardella D, Canavan ME, Taylor SN, Sharifi M. Hypertensive disorders of pregnancy and breastfeeding among US women. 

. 2025;8(7):e2521902. doi:10.1001/jamanetworkopen.2025.21902

Women with hypertensive disorders of pregnancy are more likely to never start or stop breastfeeding early, according to a recent study.

Angel Foster, MD

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