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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: gestational diabetes, PCOS dismissal, 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.

A study found no increased risk of vaso-occlusive crises or severe complications from prostaglandin use in pregnancy.

Prostaglandins safe in pregnant patients with sickle cell disease

A study found that women with a family history of diabetes and prior gestational diabetes have the highest polygenic risk scores.

High genetic risk tied to gestational diabetes and family history

New research shows that intravenous iron infusions can be safely administered in outpatient obstetric clinics.

IV iron therapy safe and effective for pregnant patients

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A Psychedelic to Treat Postpartum Depression?

CMV: In the Know

RSV Roundtable

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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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Interventional Ultrasound - An Overview

Ovary (Transvaginal) Ovarian Hyperstimulation

on July 17, 2025, has unveiled next-generation technology capable of identifying HMGB1 in period blood, which may be used as a biomarker for endometriosis.

HMGB1 is a protein linked to endometriosis development and progression. The device, operating similar to pregnancy tests, has displayed a sensitivity of 500% more than existing laboratory methods through the use of a technique synthesizing nanosheets made of borophene.

“Despite the significant potential of menstrual effluent as a diagnostic tool for women’s health, it often faces substantial challenges due to social stigma and limited access to affordable diagnostic methods,” said Dipanjan Pan, PhD, professor at Pennsylvania State University.

A new frontier in endometriosis diagnosis

Current methods of diagnosing endometriosis often require invasive blood tests, laboratory analyses, imaging studies, and extensive patient history collections. According to Pan, these procedures have been linked to delays in endometriosis diagnosis of up to 12 years among US patients.

Borophene is an atomically thin 2D material derivative of graphene but with greater strengths. This allows for earlier identification and treatment, which may allow severe symptoms such as extreme pain and potential infertility to be reduced.

Investigators replaced the alcohol solvent with water, which was used to disperse powdered boron and break down the chemical, restoring it to pristine nanosheets. After this procedure, antibodies capable of identifying HMGB1 were fixed to the nanosheets.

“Think of planting a garden,” Pan said. “The ground—the nanosheets—must be even and clear of weeds before you can fertilize the soil—adding the antibodies. Then, you have the best environment to support the desired vegetables—the HMGB1 proteins.”

Similar to a pregnancy test, one line on the test indicated a negative diagnosis, while 2 lines indicated a positive diagnosis. The test strip is darkened when the blood sample flows over it, and any present HMGB1 proteins bind to the antibodies.

The sensitivity of the device was affirmed by spiking menstrual blood with different HMGB1 concentrations. Successful detection was reported even at low concentrations, highlighting a 5-fold improvement in current tests that take longer to prepare.

A conjugation efficiency of 48% was reported for the borophene nanosheets, and with 25.96 μg/mL of free immunoglobulin G (IgG) remaining, the data indicated 24.04 μg/mL IgG was successfully immobilized on the nanosheet surface.

 In control experiments with nonirradiated antibodies, negligible binding under 5% was measured.

Spectral shifts confirm molecular changes

Investigators also evaluated molecular interactions during UV irradiation of antibodies, observed through surface-enhanced Raman spectroscopy. Significant alterations were found in the intensity of S–S stretching bands among UV-treated IgG vs controls with no treatment.

A trans Ca–S conformation was identified by a unique spectral shift near 517 cm

. Additional shifts were noted at 504, 514, 522, 527, and 544 cm

 in UV-irradiated samples, indicating changes linked to the cleavage or rearrangement of disulfide bonds.

According to Pan, the test may be incorporated into menstrual pads in the future.

 This would allow at-home monitoring of HMGB1 that is discreet and convenient for patients.

“The ability to detect critically important biomarkers via a decentralized platform, like our approach, empowers patients with facilitating widespread use in more rural areas or settings without expansive medical resources,” said Pan. “This study highlights the broader research opportunities essential for realizing next-generation biotechnologies.”

Next-gen tech can detect disease biomarker in period blood. New release. Penn State. July 22, 2025. Accessed August 22, 2025. https://www.eurekalert.org/news-releases/1092104

Natarajan S, Dighe K, Aditya T, et al. Photoinduced immobilization on two-dimensional nano borophene spatially orients capture antibody for highly sensitive biological interactions. 

2025;11(8):1492-1511. doi:10.1021/acscentsci.5c00474

A new device identifies HMGB1 in period blood with 500% greater sensitivity, offering a faster alternative for diagnosing endometriosis.

Clinical

Breakthrough endometriosis test detects biomarker in menstrual blood

This week at Contemporary OB/GYN®, we covered topics ranging from pregnancy complications linked to stroke risk to the adverse effects of abortion bans on pregnancy care. Click the links below to read anything you might have missed from Monday, August 18, to Friday, August 22, 2025.

Pregnancy complications linked to higher early stroke risk

The risk of stroke before the age of 50 years is increased in women with complications during pregnancy, according to a recent study published in 

 journal of the American Academy of Neurology, on August 6, 2025.

Complications of pregnancy linked to increased stroke risk included preterm birth, gestational diabetes, preeclampsia, miscarriage, and stroke. Investigators noted that while this association was identified, the study did not prove that these complications are responsible for increased stroke risk among pregnant women.

“While the overall risk of stroke is still very low, our study found pregnancy complications may be an early warning sign of stroke risk—even before age 50,” said Frank-Erik De Leeuw, MD, PhD, study author from Radboud University. “Knowing this history could help doctors identify those who may benefit from early prevention and cardiovascular care.”

HPV screening and vaccination accelerate cervical cancer decline

A new modeling study projects that South Korea could eliminate cervical cancer within the next 2 decades, with timelines varying based on screening methods and vaccination coverage. Findings published in 

 demonstrate that adopting high-risk human papillomavirus (hrHPV) testing and increasing vaccination rates could accelerate elimination compared with current practices.

Under the current biennial Pap test program, South Korea is projected to achieve cervical cancer elimination by 2044. Extending the Papanicolaou test (Pap) interval to 5 years delayed elimination by a decade or more, while 3-year Pap testing produced similar outcomes to the current strategy.

Switching to hrHPV testing substantially improved outcomes. Biennial hrHPV testing could reduce cervical cancer cases by 20% to 27% and deaths by 11% to 14% compared with current Pap-based strategies. Under realistic assumptions, elimination could occur as early as 2038 with hrHPV testing, while in the ideal scenario, elimination could be achieved by 2034.

Interventions needed to address trauma in obstetric care

Obstetric patients often face trauma and traumatic stress, indicating a need for interventions that enhance patient-centered care, according to a recent study published in 

Perinatal adverse outcomes linked to traumatic stress include pregnancy loss and infertility, with relative risks of 1.96 and 2.75, respectively, among patients with multiple adverse childhood experiences. Pregnancy complications such as substance use, decreased sleep quality, gestational diabetes, and hypertensive disorders were also more common in these patients.

Adverse effects in offspring were also reported. This included children of mothers with posttraumatic stress disorder (PTSD) having a mean increase of 3.6 points in their Ages and Stages Questionnaire: Social-Emotional score. Attention-deficit/hyperactivity disorder, PTSD, and other psychological disorders were also more common in these children.

OTC oral contraceptives linked to increased initiation among women with barriers to care

The availability of an over-the-counter (OTC) oral contraceptive pill in the United States is significantly improving contraceptive access, particularly among individuals who previously used no method or relied on less-effective options, according to new research published in 

The researchers found a 31.8 percentage point increase in individuals moving from nonuse of contraception to using the OTC pill, compared with prescription users. Similarly, there was a 41.0 percentage point increase in transitions from less-effective methods, such as condoms or emergency contraception, to the OTC pill.

“These findings suggest that removing prescription requirements for [the oral contraceptive pill] can expand contraceptive access, particularly for underserved populations, such as the uninsured and those in rural areas,” the authors concluded.

Katrina Kimport, PhD, highlights how abortion bans are leading to substandard pregnancy care

 Katrina Kimport, PhD, professor in the Advancing New Standards in Reproductive Health program at the University of California, San Francisco, discussed her study evaluating the impact of abortion bans and restrictions implemented in the wake of the US Supreme Court's 

Dobbs v. Jackson Women's Health Organization

Researchers interviewed clinicians who had treated patients affected by these laws, either in states with strict abortion bans or in states where abortion remains legal but received patients from more restrictive regions. The study revealed a stark disconnect between what clinicians were medically trained to do and what they were legally allowed to do under the new restrictions. This gap resulted in patients receiving substandard care, leading to preventable and sometimes severe health consequences.

Abortion bans

Contemporary OB/GYN week in review: Stroke risk, HPV screening, and more

A nationwide study from Denmark found that the use of vaginal estrogen tablets was not associated with an increased risk of recurrent ischemic stroke among postmenopausal women with a prior stroke. The findings were published in 

, a journal of the American Stroke Association, a division of the American Heart Association.

Systemic estrogen replacement therapy, particularly oral formulations, is known to increase the risk of stroke and is contraindicated in women with a history of ischemic stroke. Vaginal estrogen tablets, however, are designed for local absorption to alleviate symptoms of genitourinary syndrome of menopause, such as vaginal dryness and dyspareunia. While previous studies in healthy women suggested that vaginal estrogen does not increase stroke risk, its safety in women with prior ischemic stroke had not been established.

“It is well known that taking systemic hormone replacement therapy, such as oral estrogen tablets, may increase the risk of stroke after menopause. While other studies have not detected an increased risk of stroke associated with the use of vaginal estrogen in healthy postmenopausal women, there is no data on whether vaginal estrogen tablets pose an increased risk for women who have already had a stroke,” said lead author Kimia Ghias Haddadan, MD, of Copenhagen University Hospital – Herlev and Gentofte.

The investigation utilized data from Danish national registries, which provide comprehensive information on health, prescriptions, and demographics. Researchers identified 56,642 women who experienced a first ischemic stroke between January 2008 and December 2017. After excluding women younger than 45 years, those with prior vaginal estrogen use, and those using systemic hormone therapy in the year before their stroke, 34,274 women remained eligible.

Among these, 3353 women developed a recurrent ischemic stroke. Each case was matched by birth year with a control who had not experienced recurrence, resulting in 3353 matched pairs. The median age was 75 years. Vaginal estrogen use was categorized as current (within 3 months), recent (3-24 months), or past (>24 months).

The analysis demonstrated that use of vaginal estrogen tablets was not associated with increased recurrence of ischemic stroke. Adjusted HRs showed no significant difference in risk between users and nonusers: current use (0.79; 95% CI, 0.52-1.20), recent use (1.09; 95% CI, 0.73-1.63), and past use (1.48; 95% CI, 0.95-2.30).

No differences were observed between high-dose and low-dose users, nor was there an association with cumulative exposure. “We were cautiously hopeful about the findings, and it was reassuring to discover that the use of vaginal estrogen did not raise the risk of recurrent stroke in this high-risk population,” Haddadan said.

She added, “US-based studies, such as the Women’s Health Initiative and the Nurses’ Health Study, have shown no increased stroke risk with vaginal estrogen in healthy women. Our study extends this reassurance to women with a history of stroke.”

The investigators emphasized that the results should not be interpreted as evidence of a protective effect. “It is important to note that these findings suggest that vaginal estrogen is likely safe for this high-risk group of women who have already had a stroke; however, they do not imply that vaginal estrogen prevents strokes,” Haddadan said.

Samar R. El Khoudary, PhD, MPH, FAHA, professor of epidemiology at the University of Pittsburgh and chair of the American Heart Association’s 2020 statement on menopause transition and cardiovascular disease risk, commented on the study. “As an epidemiologist, I see this study as a valuable contribution because it focuses on a population often excluded from hormone therapy research, midlife women with a prior stroke, and examines an increasingly used route of administration: vaginal tablets,” she said. “While the study did not find a statistically significant association with stroke recurrence, the findings should be interpreted with caution. Real-world data can’t account for all clinical and behavioral factors, and prescription fill records don’t confirm whether the medication was actually used.”

The authors noted several limitations, including reliance on prescription data, lack of information on medication adherence, and restriction to vaginal tablets as the predominant mode of administration in Denmark. Data on stroke subtypes and patient lifestyle factors were also unavailable.

Despite these limitations, the study provides important evidence for clinical practice. “We hope our findings reassure health professionals caring for postmenopausal women with a history of stroke. For these women, especially those with troubling menopause symptoms, the study shows that this type of therapy may be a safe choice. It could improve their quality of life without raising the risk of another stroke,” Haddadan said.

Vaginal estrogen tablets may be safe for postmenopausal women who have had a stroke. American Heart Association. August 21, 2025. Accessed August 22, 2025. https://newsroom.heart.org/news/vaginal-estrogen-tablets-may-be-safe-for-postmenopausal-women-who-have-had-a-stroke?preview=22a2&preview_mode=True

Haddadan KG, Eckert-Lind C, Meaidi A, et al. Recurrent ischemic stroke and vaginal estradiol in women with prior ischemic stroke: a nationwide nested case-control study. 

. August 21, 2025. doi:10.1161/STROKEAHA.125.050986

Vaginal estrogen tablets were not associated with increased risk of recurrent ischemic stroke in postmenopausal women with prior stroke.

Vaginal estrogen tablets not linked to recurrent stroke risk in postmenopausal women

Katrina Kimport, PhD, professor in the Advancing New Standards in Reproductive Health program at the University of California, San Francisco, discussed her study evaluating the impact of abortion bans and restrictions implemented in the wake of the US Supreme Court's 

Kimport outlined 3 key categories of patients who were particularly harmed by these restrictions, as follows:

Patients with preexisting medical conditions

: These individuals had serious health issues, such as heart disease, that were managed at the time but were expected to worsen with continued pregnancy. Although doctors knew that these patients would likely reach a life-threatening point, the fact that they were not in immediate danger meant clinicians were legally barred from intervening, leading to worsening health outcomes.

Patients with pregnancy-related complications

: This group included individuals experiencing conditions such as preeclampsia or preterm premature rupture of membranes, where the only effective treatment is to end the pregnancy. In both cases, waiting could result in life-threatening infections or dangerously high blood pressure, but clinicians were often forced to wait until the patient’s condition became emergent, by which point the risk of serious harm or death had greatly increased.

Patients facing inevitable fetal or infant death

: In these situations, prenatal testing clearly indicated that the fetus would not survive birth or would die shortly afterward. Despite this prognosis, clinicians were unable to intervene because the fetus still had a detectable heartbeat, which legally prevented any action unless the pregnant person was also in immediate danger. These laws forced individuals to carry doomed pregnancies to term, exacerbating emotional and physical distress.

Overall, the study highlighted how restrictive post-

 abortion laws have significantly compromised pregnancy care, limiting clinicians' ability to prevent suffering and protect patient health, even in nonelective, medically necessary situations.

This video is part 1 of a 2-part series. Check back tomorrow for part 2.

Kimport K, Kaller S. Not actively dying: an inductive categorization of obstetric cases negatively affected by post-Dobbs abortion bans. 

Published online July 25, 2025. doi:10.1016/j.contraception.2025.111043

A new study reveals that restrictive post-Dobbs abortion laws are preventing doctors from providing necessary care, resulting in avoidable harm to pregnant patients.

Investigators of a study published in August 2025 have highlighted a need for increased instrumentation or ultrasound guidance in approximately 11% of intrauterine device (IUD) removal cases, influenced by race and ethnicity, age, and primary language.

An increase in long-acting reversible contraception use has been observed in US patients over time, from 6 per 10,000 patients in 2010 to 14.1 per 10,000 in 2020. These include IUDs, which may have complications during removal, such as missing strings, perforation, malposition, or uterine wall embedment.

“Few large studies report the incidence of complicated removals; two smaller studies found that approximately 80% of cases were uncomplicated,” wrote investigators.

Defining complicated vs uncomplicated IUD removal

The retrospective chart review was conducted to evaluate complicated IUD removal rates in a large health care system and determine how these rates are influenced by sociodemographic factors. Successful IUD removals from January 1, 2017, to December 31, 2020, in patients aged 15 to 25 years were included in the analysis.

Participants were identified from diagnosis codes within inpatient and outpatient records. Investigators defined uncomplicated removals as office-based procedures with visible strings not requiring imaging or specialized instrumentation.

Conditions of complicated removal included ultrasound guidance, additional instrumentation, hysterectomy, and surgical removal in an operating room. Two independent reviewers performed a chart review.

There were 1803 IUD removals included in the final analysis, 11.4% of which were considered complicated. This indicated an incidence of 113.7 per 1000 IUD removals. Independent associations for age and race with operating room were reported, though age was the only variable with a significant link to complicated removal.

Of complicated removals, 69.8% were performed in the office while 30.2% required intervention within the operating room. Additionally, 50.2% of complicated removals involved hysterectomy, and 21% involved ultrasonography.

While race, ethnicity, and body mass index were not associated with complicated IUD removal, an increase in prevalence was reported in Spanish-speaking patients, with a rate of 17.8% vs 11.2% in English-speaking patients. In patients speaking other languages, the rate was 4.8%.

Operating room removals were also more common in Spanish-speaking patients, with a rate of 6.9% vs 3.4% in English-speaking patients. Overall, the data highlighted the incidence and factors linked to IUD. Investigators concluded this information may be used to inform patient counseling and clinical decision-making.

“The higher rates of complicated and operating room removals among Spanish-speaking patients may reflect disparities in health care access, communication barriers, delayed follow-up, or clinician biases, all of which warrant further investigation,” wrote investigators.

Increased long-acting contraceptive use has also been observed following the Supreme Court’s 

Dobbs v. Jackson Women's Health Organization 

period, a 1% increase in IUD use has been observed, from 47% to 48%.

In comparison, permanent contraception methods have significantly increased in prevalence. This includes a rise in salpingectomy rates of 9% and a rise in vasectomy rates of 49%. Rising rates of salpingectomy were also reported in nulliparous women, from 4.88% pre-

These increases in long-acting contraception use have been linked to reductions in rates of childbirth. While women receiving salpingectomy reported having the most children, rates decreased from a mean of 2.87 pre-

Investigators concluded that more invasive and longer-lasting contraception is being used post-

Coles M, Dedhia D, Alvarez A, Sanghani S, Blitz M, Gerber S. Incidence of complicated intrauterine device removal in a large health care system. 

 2025;2(4):e105. doi:10.1097/og9.0000000000000105

A study found that 11% of intrauterine device removals have complications, with higher rates among Spanish-speaking patients.

R. Udayakumar

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