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Data showed that fracture risk rises briefly after menopausal hormone therapy discontinuation, then falls below never-users.

Study shows persistent bone protective effect of menopausal hormone therapy

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.

A new study highlights the strong prognostic value of the 100-g oral glucose tolerance test in identifying pregnant women at high risk for developing diabetes mellitus.

100-g OGTT found to predict future diabetes risk in pregnant women

A study found that increased mid-pregnancy uterine artery resistance may slightly impair executive function in offspring.

Uterine artery resistance in pregnancy linked to reduced offspring cognitive flexibility

Sarah Raifman, PhD, MSc, is a Project Director and social epidemiologist at Advancing New Standards in Reproductive Health.

A new study using advanced pregnancy preference measures reveals that heavy alcohol use significantly increases the risk of unintended pregnancy, highlighting the need for personalized contraceptive support.

Sarah Raifman, PhD, MSc, highlights the link between heavy drinking and pregnancy

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A Psychedelic to Treat Postpartum Depression?

CMV: In the Know

RSV Roundtable

STIs

Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

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Jeff Andrews, MD, FRCSC, is Vice President Medical Affairs, Diagnostic Solutions, at BD.

A new FDA-submitted self-collection HPV test aims to improve cervical cancer screening access for underserved women by offering a convenient, non-invasive at-home option.

Jeff Andrews, MD, FRCSC, discusses BD's new HPV self-collection device

These are 3D ultrasound images of a 14-week fetus. What is your diagnosis?

occipital meningocele and umbilical hernia

Clinical

DailyDx: 3D Images of a 14-week fetus

The risks of significant birth complications such as stillbirth, preterm birth, and babies born smaller than expected are increased by the presence of sexually transmitted infection (STI) during pregnancy, according to a recent study published in 

The Lancet Regional Health–Western Pacific.

The data included nearly 60,000 births between 2005 and 2020. Examples of associations discovered include a 3-fold increased risk of preterm birth from congenital syphilis, a 2-fold increased risk of stillbirth from gonorrhea, and higher odds of small for gestational age babies from chlamydia, gonorrhea, and trichomoniasis.

“This research shows STIs during pregnancy may lead to potentially devastating outcomes,” said Jennifer Dunne, PhD, epidemiologist and statistician at Curtin University in Australia. “Current STI screenings happen early in pregnancy, but we need additional checks later in pregnancy, especially in high-risk areas.”

Investigators conducted a retrospective population-based cohort study to evaluate the link between STIs during pregnancy and adverse pregnancy outcomes.

 Data from the Northern Territory in Australia were obtained from the Northern Territory Perinatal Data Collection.

Live and stillbirths between July 1, 2005, and December 31, 2020, were included in the analysis. Exclusion criteria included gestational age under 20 weeks or at least 45 weeks, multiple births, maternal age under 16 years or over 45 years, and birth weight under 400 g or over 6000 g.

Indications of prenatal chlamydia, gonorrhea, trichomoniasis, and syphilis were included in the dataset. The notification date was reported as the date of diagnosis, with data linkage keys used to map these dates to prenatal periods.

Infant STI cases were also reported. When these cases occurred without a maternal diagnosis, investigators concluded the infection was present during pregnancy.

Pre-labor rupture of membranes, small for gestational age, preterm birth, and stillbirth were reported as primary outcomes. Categories of preterm birth included spontaneous and provider-initiated. Covariates included maternal age, smoking and alcohol consumption during pregnancy, Aboriginal ethnicity, parity, and year of delivery.

There were 59,465 births included in the final analysis, with 31% of mothers aged 30 to 34 years, 40% primiparous, 79.5% not smoking during pregnancy, and 97.5% not consuming alcohol during pregnancy. Chlamydia was reported in 2.6% of cases, gonorrhea in 1.4%, trichomoniasis in 4%, and syphilis in 0.2%.

Small for gestational age had the greatest associations, with a relative risk (RR) of 1.86 for maternal chlamydia, 1.76 for gonorrhea, and 1.10 for trichomoniasis vs no maternal STI. An RR of 1.97 was reported for stillbirth in women with gonorrhea and 1.23 for preterm birth in those with trichomoniasis, highlighting additional associations.

Maternal STIs were not linked to spontaneous preterm birth or premature rupture of membranes. Small cell counts caused data linking maternal syphilis with premature rupture of membranes and stillbirth to be suppressed.

RRs of 3.34 and 2.22 were reported for preterm birth and small for gestational age, respectively, for cases of congenital syphilis. However, there was no link between congenital chlamydia and small for gestational age, and all other associations were suppressed because of small cell counts.

Only 1 association was reported for STI coinfections with adverse perinatal outcomes. This association was for small for gestational age in women co-infected with gonorrhea and trichomoniasis, with an RR of 1.81. Overall, the trial highlighted significant associations between STIs during pregnancy and adverse perinatal outcomes.

“Many of these infections are common, preventable, and treatable; we just need to be able to catch them in time to treat them as early as possible,” said Dunne.

Research reveals STIs during pregnancy linked to adverse birth complications. Curtin University. July 21, 2025. Accessed July 28, 2025. 

https://www.eurekalert.org/news-releases/1092014

Dunne J, Tessema GA, Legge M, et al. The association between sexually transmitted infections and pregnancy outcomes in the Northern Territory, Australia: a population-based cohort study. 

2025;60:101610. doi:10.1016/j.lanwpc.2025.101610

A new study finds that infections such as chlamydia, gonorrhea, and syphilis during pregnancy significantly increase the risk of stillbirth, preterm birth, and low birth weight.

STIs during pregnancy linked to higher risk of birth complications

New evidence-based guidelines have been published by the World Health Organization (WHO) for treating sickle-cell disease (SCD) in pregnant women, according to an article published in 

Nearly 7.74 million individuals worldwide are impacted by SCD, often leading to severe anemia, opportunistic infections, cerebrovascular disease, vaso-occlusive crises, and premature death.

 The guidelines were designed to support providers in providing high-quality care that improves outcomes in affected women, alongside highlighting the complex link between SCD and pregnancy.

“Although their pregnancies are deemed to be high-risk, there is little guidance available to support optimal care for pregnant women with SCD in moderate- and high-prevalence contexts,” wrote the authors.

When developing the new guideline, investigators noted only 5 guidelines had recommendations about managing SCD in pregnant women. The WHO guidelines are the first to provide comprehensive, evidence-based recommendations that can be applied in all contexts worldwide.

The guidelines, in particular, consider low- and middle-income countries (LMICs), where SCD has a greater impact. They were developed through a comprehensive appraisal of scientific evidence and can be used to inform policymaking alongside supporting health care workers.

Investigators developed the guidelines by addressing 8 questions relating to pressing issues faced by women with SCD and their caregivers. Alongside reducing these burdens, the guidelines aim to address the efficacy, safety, feasibility, and cost-effectiveness of interventions. Eight systematic reviews were assessed.

The guideline development group created 20 recommendations about managing SCD in pregnancy. This included treatment through dietary supplements, medications, and prophylactic blood transfusions.

Treatment was also discussed through fluid management, pain management, and thromboprophylaxis. Pregnant women with SCD may present with additional risk factors for thromboembolism, such as prior venous thromboembolism, requiring clinicians to follow local recommendations for thromboprophylaxis initiation.

Pain medication includes nonsteroidal anti-inflammatory drugs, oral paracetamol, and the lowest effective dose of opioids. Iron supplementation was not recommended unless patients present with iron deficiency.

Interpregnancy care, fetal monitoring, and mode and timing at birth were also highlighted. Authors noted the importance of remarks accompanying these recommendations, explaining the rationale behind them and providing contextual considerations.

Considerations included acknowledgement of vital issues experienced by women with SCD and their families throughout the reproductive cycle. This is vital for women residing in LMICs, where 95% of maternal mortality was reported in 2020. Applicable WHO guidance that already exists was also recommended to provide a positive pregnancy experience.

These new recommendations provide more focus on SCD and its influence during pregnancy, bringing vital support to care providers that may improve maternal and infant outcomes. Investigators recommended well-planned, consensus-driven implementation of evidence-based policies to improve SCD management.

Further research was also suggested to fill evidence gaps about improving outcomes in pregnant women with SCD and their infants. This research may lead to future WHO recommendations about prenatal SCD with a stronger evidence base.

“Pregnant women with SCD deserve skillful care that effectively manages the risks associated with their pregnancy, while supporting as positive an experience of pregnancy, childbirth, and the postnatal period as possible,” wrote investigators.

Williams MJ, Ramson JA, Afolabi BB, Chou D. New WHO recommendations on the management of sickle-cell disease in pregnancy. 

 Published online July 15, 2025. doi:10.1002/pmf2.70069

Ware RE, de Montalembert M, Tshilolo L, Abboud MR. Sickle cell disease. 

 2017;390(10091):311-323. doi:10.1016/S0140-6736(17)30193-9

The World Health Organization’s evidence-based recommendations aim to improve care and outcomes for pregnant women with sickle cell disease.

WHO issues new global guidelines for managing sickle cell disease in pregnancy

The American College of Obstetricians and Gynecologists (ACOG) has issued updated clinical guidance on the management of umbilical cord clamping in preterm neonates. This Clinical Practice Update, developed in collaboration with expert clinicians and endorsed by leading professional organizations, is based on recent data from 2 systematic reviews and individual participant data meta-analyses published in November 2023.

The update revises Committee Opinion No. 814 from 2020 and includes recommendations regarding short, medium, and long deferral of cord clamping, umbilical cord milking, and immediate cord clamping in neonates born before 37 weeks of gestation.

The newly reviewed data include 2 meta-analyses of randomized controlled trials comparing deferred cord clamping or cord milking with immediate clamping in preterm births. The analyses incorporated data from 48 and 47 trials, involving 6367 and 6094 neonates, respectively. The median gestational age in both analyses was 29 weeks.

Deferred umbilical cord clamping, defined in the studies as a delay ranging from 30 to 180 seconds, was associated with a statistically significant reduction in neonatal death before hospital discharge compared with immediate clamping (within 15 seconds). The odds ratio (OR) was 0.68 (95% CI, 0.51–0.91). In contrast, umbilical cord milking did not show a statistically significant difference in mortality (OR 0.73, 95% CI, 0.44–1.20).

When stratified by timing, long deferral (120 seconds or more) was associated with a more pronounced reduction in neonatal death (OR 0.31, 95% CI, 0.11–0.80). However, short (15–<45 seconds) and medium (45–<120 seconds) deferrals, as well as cord milking, did not demonstrate a statistically significant mortality benefit compared with immediate clamping.

There were no differences across groups in the incidence of any grade of neonatal intraventricular hemorrhage. For neonates born before 32 weeks’ gestation, both deferred clamping (OR 0.59, 95% CI, 0.47–0.73) and cord milking (OR 0.69, 95% CI, 0.51–0.93) were associated with lower rates of red blood cell transfusion.

The findings prompted a re-evaluation by the International Liaison Committee on Resuscitation (ILCOR). The committee noted limitations in the evidence supporting long deferral of 120 seconds or more, including small sample sizes, adherence issues (as low as 67%), and the controlled nature of clinical trial settings. A post hoc ILCOR analysis comparing deferred clamping of 60 seconds or more with immediate clamping found reduced odds of neonatal death (OR 0.63, 95% CI, 0.44–0.88), based on broader trial data with better adherence.

Given these findings, ACOG now recommends the following for obstetric care professionals:

Defer umbilical cord clamping for at least 60 seconds in preterm neonates born before 37 weeks of gestation who do not require immediate resuscitation.

In neonates born between 28 0/7 and 36 6/7 weeks of gestation, when deferred clamping is not performed, umbilical cord milking is a reasonable alternative to immediate clamping to improve hematologic outcomes.

The document emphasized that deferred clamping should be individualized in certain clinical situations, including the need for immediate resuscitation, multiple gestations, congenital anomalies, placenta previa, antepartum hemorrhage, and others. These considerations align with the exclusion criteria in the systematic reviews.

ACOG highlighted the need for careful, multidisciplinary collaboration before adopting long deferral protocols of 120 seconds or more. The authors note, “More evidence is needed before recommending the routine practice of long deferral of cord clamping for 120 seconds or more in preterm newborns.”

This guidance reflects ACOG’s ongoing effort to incorporate the most current evidence into clinical practice and to support improved outcomes in neonatal care.

An update to clinical guidance for delayed umbilical cord clamping after birth in preterm neonates. 

. Published online July 24, 2025. doi:10.1097/aog.0000000000006020

Seidler AL, Aberoumand M, Hunter KE, et al; 

. Deferred cord clamping, cord milking, and immediate cord clamping at preterm birth: a systematic review and individual participant data meta-analysis. 

 2023;402(10418):2209-2222. doi:10.1016/S0140-6736(23)02468-6

Seidler AL, Libesman S, Hunter KE, et al; 

. Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth: a systematic review and network meta-analysis with individual participant data. 

 2023;402(10418):2223-2234. doi:10.1016/S0140-6736(23)02469-8

A new ACOG clinical guidance offers updated recommendations on umbilical cord management for preterm births based on recent evidence and analysis.

ACOG updates clinical guidance on delayed umbilical cord clamping in preterm neonates

A comprehensive approach to physical, visual, and emotional well-being in women's health care

As obstetricians and gynecologists, we spend our careers caring for others, yet we often neglect our own health. The irony isn't lost on us; we counsel patients about posture during pregnancy while hunching over our desks or advise about stress management while burning the candle from both ends. It's time we apply the same attention to detail we give to our patients' well-being to our own professional health through comprehensive ergonomic practices.

The hidden epidemic: Work-related musculoskeletal disorders in ob-gyn

Work-related musculoskeletal disorders (WMSDs) have become an occupational hazard that's as common in operating rooms as surgical masks. Research indicates that WMSDs are prevalent among surgeons but have received little attention because of the underreporting of injuries and the logistical constraints of studying surgical ergonomics.

Research also indicates that surgeons require mental acuity, physical dexterity, and situational awareness similar to high-performance athletes. They are also manual laborers facing physically arduous work and long periods of ergonomic strain. In our specialty, the problem is compounded by the unique demands of gynecologic surgery, from the awkward positioning required for vaginal and laparoscopic procedures to the physical strain of lengthy cesarean sections.

The contributing factors are multifaceted and include increasing patient body mass index (BMI), smaller surgeon hand size, noninclusive design of instruments and energy devices, and improper positioning of surgical equipment.

Each surgical approach, whether laparoscopic, robotic, or vaginal, brings its own ergonomic challenges that we must address proactively rather than reactively.

Musculoskeletal disorders are the No. 1 reason physicians leave the practice of medicine. We can work to prevent these disabilities.

Physical ergonomics: The foundation of sustainable practice

Operating room positioning: Getting the basics right

The cornerstone of surgical ergonomics begins with proper positioning. Surgeons and operating room (OR) staff should maintain a neutral body posture, which includes keeping the neck in a neutral position, the back straight, and avoiding rotation or tilt of the torso. Shoulders should be relaxed, and elbows kept close to the body. This may sound elementary, but watch any busy OR and you will see surgeons contorting themselves like yoga instructors attempting advanced poses, except these "poses" last for hours and lack the mindful breathing component.

For optimal positioning, consider these key recommendations:

: Proper chair position allowing for 90-degree flexion at the knee, forearm placement parallel to the ground with elbows tucked at the side, and head flexion less than 20 degrees forms the foundation of ergonomic positioning.

The operating table should be adjusted to allow the surgeon to work with minimal shoulder elevation and wrist deviation. The table should be adjusted to the tallest surgeon, with step stools for the other team members.

: Monitor placement is crucial in laparoscopic surgery. Screens should be positioned directly in front of the surgeon, at eye level, and at an appropriate distance to prevent neck strain. The days of craning our necks to see a monitor mounted high on the wall should be relegated to medical history alongside bloodletting.

: Often overlooked, proper foot positioning with both feet flat on the floor or a footrest helps maintain spinal alignment and reduces lower back strain. Antifatigue mats can provide additional support during lengthy procedures.

The evolution of surgical instruments has been remarkable, yet many tools remain poorly designed for prolonged use. Many were not designed with women’s hands in mind. When selecting instruments, consider the following:

: Ergonomic handles with appropriate diameter and texture reduce grip force requirements and hand fatigue.

: Balanced instruments reduce wrist strain and allow more precise movements.

: Instruments requiring excessive force for activation contribute to hand and forearm fatigue.

Research supports the effectiveness of intraoperative breaks and stretching in reducing surgeon discomfort. Implementing structured microbreaks during lengthy procedures isn't a sign of weakness; it's a sign of wisdom. Simple neck rolls, shoulder shrugs, and hand stretches can be performed between surgical steps, significantly reducing cumulative strain.

The American College of Surgeons has an excellent resource for intraoperative breaks and stretches.

Visual ergonomics: Seeing clearly without strain

Visual ergonomics in ob-gyn extends beyond having good lighting in the OR. Our specialty demands close, detailed work that puts significant strain on our visual system, from examining cervical biopsies under magnification to performing surgical procedures.

Proper lighting is essential for both surgical and clinical work. When your screen is much brighter than your surroundings, your eyes must work harder to see. Adjusting your environmental lighting can reduce eye strain.

In clinical settings, this means the following:

: Avoid extreme contrasts between task lighting and ambient lighting.

: Position monitors and workstations to minimize glare from windows and overhead lights.

: Use lighting that provides good color rendition for accurate tissue assessment.

With the increasing digitization of medical records and imaging, we spend countless hours staring at screens. When people are exposed to glare or have uncorrected vision problems, they tend to lean forward or backward in an attempt to compensate. An awkward body position leads to eye strain and accelerates postural fatigue. This creates a cascade effect where visual problems lead to postural issues, compounding our ergonomic challenges.

: Position screens at arm's length (approximately 20 to 26 inches) with the top of the screen at or slightly below eye level. This reduces neck flexion and allows for natural downward gaze.

Stephanie Pearson, MD, provides some tips for ergonomics within obstetrics and gynecology.

Jeff Andrews, MD, FRCSC

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