OBJECTIVE:We examined whether the addition of GLP-1RA to progestin therapy reduced the risk of hysterectomy in patients with endometrial intraepithelial neoplasia (EIN) and endometrial cancer (EC) in the U.S. managed with fertility-sparing management. METHODS:Women ≤45 years old at EIN/EC diagnosis were identified in the TriNetX Research Collaborative Network (1/1/2017-12/01/2025). Patients initiating GLP-1 RA plus progestins (megestrol acetate, medroxyprogesterone acetate, or levonorgestrel-releasing intrauterine device) formed the GLP-1 RA + progestin group and were compared with the progestin-only group. Groups were 1:1 propensity-score matched (PSM) for demographics, BMI, HbA1c, type 2 diabetes, comorbidities, medication use, healthcare utilization, and EIN/EC. Patients were followed up for 6, 12, and 18 months from treatment initiation until the occurrence of hysterectomy; loss to follow-up; or December 1, 2025. Hazard ratios (HRs) with 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. Analyses for subgroups, head-to-head comparisons were also performed. RESULTS:After 1:1 PSM (n = 432 in each group), hysterectomy occurred in 10.2% of the GLP-1RA + progestin group versus 23.4% in the matched progestin-only group (HR 0.41, 95% CI 0.29-0.58) at 18 months, with significant reductions observed as early as 6 months. This protective association was consistent across subgroups, including younger patients (<40 years), EC diagnosis, progestin type (LNG-IUD or oral progestins), and GLP-1RA type (semaglutide or tirzepatide). CONCLUSION:Adjunct GLP-1 receptor agonist therapy was associated with reduced hysterectomy risk in EIN and EC, supporting prospective fertility-sparing studies.

Introduction:Some phthalates and their replacements are endocrine disrupting chemicals (EDCs) found in consumer products and linked to hypertensive disorders of pregnancy (HDP). Few studies have evaluated associations between EDCs and gestational blood pressure. Objective:To evaluate associations between EDC biomarkers with gestational blood pressure. Methods:The Environmental Reproductive and Glucose Outcomes study (N = 338) measured urinary concentrations of 18 phthalate and replacement metabolites and systolic (SBP) and diastolic (DBP) blood pressure at 3 pregnancy study visits (median: 12, 19, and 26 weeks' gestation). Individual metabolite concentrations and summary measures based on common source or mechanism (eg, ΣPersonal care products [ΣPCP]) were log2-transformed, specific-gravity corrected, and modeled continuously and in quartiles. We estimated covariate-adjusted associations of individual metabolites and, summary measures with blood pressure using linear regression, and with HDP using log-binomial regression, assessing metabolite mixtures using Bayesian Kernel Machine Regression. Results:HDP prevalence was 12.7%. Higher concentrations of monoethyl phthalate (MEP) and ΣPCP were most consistently associated with SBP and DBP elevations at visit 3. Higher concentrations of MEP (Q4 vs Q1) were associated with 4.59 mmHg higher SBP (95% CI: 0.04, 9.15), and higher ΣPCP (Q3 vs Q1) were associated with 5.78 mmHg (95% CI: 1.59, 9.97). Higher MEP and ΣPCP (Q4 vs Q1) were positively linked to DBP elevations of 4.51 to 4.70 mmHg. Other phthalate biomarkers were associated with blood pressure at specific time points. Discussion:Certain urinary phthalate biomarkers, particularly MEP and ΣPCP, were associated with higher blood pressure levels in pregnancy, with implications for HDP.

Objective:To measure clinician continuity during pregnancy care and contextualize the findings with patient experiences of clinician continuity and their influence on trust-building. Methods:We conducted a convergent mixed methods study that examined the number of clinicians seen for all patients who gave birth at a large academic medical center between June 2023 and May 2024. Statistical analyses were performed across demographic subgroups with number of clinicians seen during pregnancy care as the primary outcome and the proportion of visits with the most frequently seen clinician as the secondary outcome. Multivariable Poisson regression models were used to control for covariates. Purposive sampling was used to select a subset of English- and Spanish-speaking patients for semi-structured interviews. Participants completed a short sociodemographic survey and interviews exploring perceptions of clinical continuity, factors that build or erode trust, and patients' recommendations for pregnancy care. Interviews were transcribed and analyzed using content analysis. Two researchers met to iteratively refine the codebook, discuss discrepancies, and reach consensus. Results:We identified 2395 patients with eligible visits for the retrospective cohort. Total visits ranged from two to 38 (median 13, interquartile range [IQR] 10-15) with a median of 4 clinicians seen during pregnancy (IQR 3-5). Participants in the resident practice and hospital-based maternal-fetal medicine practice saw more clinicians (7, IQR 6-9 and 5, IQR 3-7, respectively; p < 0.001). Overall, 21.0% of patients had one or more visit with the obstetrician who was present at delivery. The qualitative phase included 14 participants with a median age of 31 years (IQR 28-35). Most participants valued continuity of care; discontinuity of care was a driving factor of patient-clinician trust erosion. Participants recommended clinical continuity as a strategy to improve pregnancy care. Conclusion:Clinician continuity during outpatient pregnancy care varied by clinician type, practice, clinical site, and patient factors. Participants highly valued continuity of care, which was associated with greater trust and improved care experiences.

e23266 Background: Barriers to enrollment and retention of socioeconomically vulnerable patients limit the diversity and generalizability of longitudinal oncology studies. Financial toxicity (FT) may be underestimated if patients who are at highest risk are less likely to complete long-term follow-up (FU). We evaluated socioeconomic and clinical factors associated with non-respondence at 1-year follow-up in a prospective FT survey study of patients undergoing radiation therapy (RT). Methods: All patients ≥18 years that were undergoing RT for any malignancy were eligible. Surveys were completed at baseline (pre-RT), 1-month, and 1-year post-RT, which included the Comprehensive Score for Financial Toxicity (COST) tool and questions regarding demographics and social determinants of health (SDOH). Lower COST scores indicate higher FT. Respondents to the 1-year FU were classified as those who completed the survey between 6-18 months post-RT. Non-respondents were those who did not respond or passed away within the response window. Patients who passed prior to the 1-year FU survey window were ineligible. Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests were used to compare factors associated with respondents and non-respondents. Results: Of 305 patients completing survey, 241 were eligible for analysis: 36% completed the 1-year FU survey, while 64% did not. Non-respondents were more likely to report lower COST scores (higher FT), have a non-English primary language, not be married/partnered, have an educational level of high school or less, hold either private insurance or MassHealth, and have an annual income of < $40,000 (all P< 0.05). Non-respondents also received a greater number of fractions of RT (P< 0.05). When excluding patients who passed during the response window, all variables remained statistically significant except for partnership status. Cancer and treatment characteristics, other than the number of fractions of RT, were not significantly different between the groups. Conclusions: Long-term FU nonresponse was associated with specific SDOH and number of RT fractions. This suggests multiple socioeconomic factors and certain treatment aspects could potentially impact long-term study FU data. As randomized controlled trials follow patients across a longitudinal period, these challenges may similarly affect long-term outcome assessment. These findings can inform strategies to reduce attrition, which will ultimately improve diversity and representativeness in clinical trials.

IMPORTANCE:Postoperative urinary retention (POUR) is a frequent and burdensome complication following urogynecologic surgery. Studies in other specialties suggest intraoperative glycopyrrolate may increase POUR risk; however, this association has not been explored in prolapse surgery, where baseline rates of POUR are higher and same-day surgery is now standard. OBJECTIVE:The objective of this study was to evaluate the association between intraoperative glycopyrrolate and POUR among patients undergoing laparoscopic prolapse repair with same-day discharge. STUDY DESIGN:We conducted a retrospective cohort study of patients undergoing outpatient laparoscopic sacrocolpopexy, sacrocervicopexy, or sacrohysteropexy surgery from June 2017 through January 2024. All patients underwent a standardized postoperative voiding trial with 300 mL of saline instilled through a transurethral catheter, followed by a void within 15 minutes. The exposure was intraoperative glycopyrrolate; the primary outcome was POUR, defined as voiding <200 mL. Log-binomial regression was used to estimate relative risk (RR) and 95% CI, adjusting for age, body mass index, surgeon, concomitant sling, and perioperative scopolamine use. RESULTS:Among 321 patients, 77% received glycopyrrolate. After adjusting for confounders, patients who received glycopyrrolate had an increased risk of POUR (RR: 1.93, 95% CI; 1.16 to 3.22) compared with those who did not receive glycopyrrolate. This relationship may be dose-dependent: patients who received a low dose had an RR of 1.28 (95% CI; 0.70 to 2.33), while those receiving a high dose had an RR of 2.57 (95% CI; 1.51 to 4.38). CONCLUSIONS:Intraoperative glycopyrrolate was associated with a significantly increased POUR risk, particularly at higher doses commonly used during neuromuscular blockade reversal. Surgeons should engage with anesthesiologists to discuss the potential effect of drugs on postoperative outcomes.

Background With improvements in in vitro culture techniques, there has been a steady shift in practice to transfer in vitro fertilisation (IVF) embryos at the blastocyst-stage to increase pregnancy rates per embryo transfer (ET) and reduce the risk of multiple pregnancy. In patients with fewer embryos (≤5 zygotes), fresh cleavage-stage ET is still commonly performed to reduce the risk of cycle cancellation if no embryo survives to the blastocyst-stage in vitro. However, evidence for improved outcomes with cleavage-stage embryo transfer in this subgroup of patients is lacking. We will compare blastocyst-stage to cleavage-stage ET with regard to cumulative live birth rates (CLBR) per oocyte retrieval and other patient-centred cycle outcomes in patients with ≤5 zygotes. Methods and analysis Multicentre, randomised pragmatic comparative effectiveness trial with superiority design comparing blastocyst-stage to cleavage-stage ET in patients with ≤5 zygotes. This trial will enrol and randomise 1126 women aged 18–44 undergoing IVF to either fresh cleavage-stage or blastocyst-stage ET at eleven IVF centres. Surplus embryos will be vitrified at the blastocyst-stage. The primary outcome is the CLBR per oocyte retrieval. Secondary outcomes include: multiple pregnancy, pregnancy loss <20 weeks and cycle cancellation. Exploratory outcomes include: live birth per fresh ET, ectopic pregnancy, time to pregnancy, stillbirth, preterm birth, financial burden, patient distress and facilitators and barriers for patient involvement and implementation. All primary analyses will be conducted according to the intent-to-treat principle. We also will report per-protocol analyses as a sensitivity analysis. A multidisciplinary stakeholder team, including a 5-patient stakeholder panel, will participate in study design, conduct and oversight. Ethics and dissemination The Institutional Review Board at Beth Israel Deaconess Medical Center (BIDMC) provides central regulatory oversight. Results will inform timing of embryo transfer in patients with ≤5 zygotes and will be disseminated through academic publications, meeting presentations and communications to advocacy groups and patient participants. Trial registration number NCT06746129 .

IMPORTANCE:Tobacco smoking is linked to poor surgical outcomes, leading many physicians to avoid synthetic implants like mesh in smokers due to concerns about impaired healing. While long-term outcomes for smokers have been studied, the effect of smoking on 30-day postoperative complications, especially related to surgical mesh, is less understood. OBJECTIVES:This study aimed to quantify the association between tobacco smoking and risk of postoperative infection, readmission, and reoperation within 30 days of minimally invasive apical prolapse repair. We also examined whether these associations differed based on whether mesh was used. STUDY DESIGN:We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database for patients who underwent minimally invasive apical pelvic organ prolapse repair from 2012 to 2022. Smoking in the last year was the exposure. Outcomes included postoperative infection, unplanned readmission, and reoperation within 30 days. We calculated adjusted risk ratios for complications and stratified results based on mesh use. RESULTS:Of 67,235 cases, 5,518 (8.2%) patients smoked in the past year. Smokers had a significantly higher likelihood of infection and unplanned readmission. Smoking did not increase the risk of unplanned reoperation. The association between smoking and 30-day complications did not differ based on mesh use (all P for interaction ≥0.24). CONCLUSIONS:Tobacco use was associated with an increase in postoperative complications within 30 days, though the absolute risk was low. There was no evidence of effect modification by mesh use; suggesting that mesh-augmented repairs could be considered in smokers who receive appropriate counseling.

Objective: To evaluate the impact of ART duration and CD4 count on risk for high grade cervical dysplasia in women with HIV (WWH) compared to women without HIV in the treat-all era with integrase strand inhibitors (INSTIs). Design: Prospective longitudinal cohort study in Botswana Methods: From February 2021 to August 2022, baseline HPV self-sampling was offered to women with and without HIV. Those HPV+ underwent biopsy for histopathological diagnosis. Using women without HIV as reference, risk ratios (RRs) were calculated for HPV, cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+), and CIN3+, stratified by ART duration and CD4 cell counts. Results: Of 3000 women enrolled, 2953(98.4%) underwent HPV testing, which was positive in 823(55.7%) WWH and in 654(44.3%) women without HIV. Histopathology was available for analysis in 1291(87.4%) women (709 WWH, 582 women without HIV). Over 99% of WWH had detectable HIV viral load and 94.4% were on a dolutegravir-based ART regimen. WWH had a higher risk of HPV (RR1.27,95%CI:1.18,1.37), CIN2+ (RR1.52,95%CI:1.16,1.98) and CIN3+ (RR1.75,95%CI:1.25,2.45) compared to women without HIV. There was attenuation of risk for CIN2+ with higher recent CD4 cell count, and those with higher nadir CD4 count had similar risk to those without HIV (nadir CD4≥500 CIN2+ RR1.15[95%CI:0.56,2.37], CIN3+ RR1.81[95% CI:0.86,3.79]; nadir CD4 350-499 CIN2+ RR1.23[95% CI:0.71,2.12], CIN3+ RR1.34[95%CI:0.68,2.64]). Conclusion: Although some attenuation of risk for CIN2+ was observed with higher recent and nadir CD4 cell counts, WWH continue to have a higher risk of CIN2+/CIN3+ compared to women without HIV. These findings support tailored cervical screening algorithms for WWH.

BACKGROUND:Personal care products frequently contain endocrine disrupting chemicals (EDCs) including parabens and phthalates, which can alter glucose metabolism. The postpartum period is a time of rapid metabolic change, but whether EDC-associated product use impacts postpartum glucose metabolism is unknown. METHODS:We included 270 participants from the Boston, MA-based Environmental Reproductive and Glucose Outcomes (ERGO) pregnancy cohort with data on self-reported personal care product use at ≤4 pregnancy visits (median: 11, 19, 26, 36 weeks of gestation) and 1 postpartum visit (median: 9 weeks). We quantified postpartum hemoglobin A1c (HbA1c), fasting insulin, fasting- and 2-h glucose post-75-g oral glucose tolerance test, and calculated homeostatic model assessment for insulin sensitivity (HOMA2-S) and beta-cell function (HOMA2-B). Using covariate-adjusted linear regression, we estimated visit-specific associations of product use with postpartum glycemic outcomes. RESULTS:Associations of product use with postpartum glycemic measures were mixed. Users of certain hair products had lower postpartum insulin sensitivity compared to non-users (e.g., Visit1 hair gel/spray: 22.8% difference [95% CI: 39.2, -1.9] in mean HOMA2-S). Conversely, users of products like deodorant, liquid- and bar soap, had higher insulin sensitivity and lower glucose levels (e.g., postpartum deodorant: 32.1% difference [95% CI: 7.0, 63.1] in mean HOMA2-S; -3.1 mg/dL [95% CI: 6.3, -0.04] mean fasting glucose). Associations with other products were inconsistent across timepoints or null. CONCLUSION:Use of certain personal care products during the perinatal period was associated with altered postpartum glucose metabolism. Larger studies are needed to understand the impacts of product use patterns on glycemic outcomes.

OBJECTIVE:This study aimed to evaluate maternal outcomes in a large cohort with high prevalence of human immunodeficiency virus (HIV) infection in Botswana after implementation of a treat-all policy.METHODS:In this retrospective cohort study, data were collected from the medical record at the time of discharge from November 2021 to December 2023. Outcomes were recorded in the Tsepamo Birth Outcomes Surveillance and Safe Birth studies at Princess Marina Hospital in Botswana. We evaluated maternal mortality and obstetric morbidities by HIV status, including preeclampsia, eclampsia, hemorrhage, infection, and acute pulmonary or cardiac conditions at the time of hospital discharge.RESULTS:We included 11,754 participants; 2,201 (18.7%) were pregnant people with HIV infection. Ninety-seven percent (2,135) were on antiretroviral therapy (ART) at time of delivery; 1,996 (93.5%) of those with a known ART regimen were on dolutegravir, tenofovir disoproxil fumarate, and lamivudine. Of the 1,090 people with HIV infection with known CD4 counts, 757 (69.4%) had more than 500 cells/microliter, and only 42 (3.9%) had fewer than 200 cells/microliter. Of 1,524 people with HIV infection with known viral loads, 1,436 (94.2%) were undetectable on initial testing. There were no statistically significant differences in incidence of hemorrhage (90 [4.1%] vs 370 [3.9%], adjusted risk ratio [RR] 0.93, 95% CI, 0.73-1.17), infection (38 [1.7%] vs 126 [1.3%], adjusted RR 1.56, 95% CI, 0.97-2.51), eclampsia (6 [0.3%] vs 28 [0.3%], adjusted RR 1.12, 95% CI, 0.50-2.53), acute pulmonary or cardiac conditions (15 [0.7%] vs 43 [0.4%], adjusted RR 1.22, 95% CI, 0.65-2.27), transfusion of 2 or more units of packed red blood cells (33 [36.7%] vs 110 [29.8%], P=.21), additional uterotonics (48 [53.3%] vs 173 [47.1%], P=.29), use of tranexamic acid (31 [ 34.4%] vs 106 [29.0%], P=.31), intensive care unit admission (4 [0.2%] vs 10 [0.1%], P=.31), mechanical ventilation (3 [0.1%] vs 6 [0.1%], P=.38), pressor support (2 [0.1%] vs 2 [0.0%], P=.16), or mortality (5 [0.2%] vs 11 [0.1%], adjusted RR 1.44, 95% CI, 0.46-4.57) in people with HIV infection compared with those without HIV infection. There were few notable differences, including a slightly reduced risk of preeclampsia (184 [8.4%] vs 818 [8.6%], adjusted RR 0.84, 95% CI, 0.71-0.98) and, although rare, an increased risk of uterine rupture (12 [0.5%] vs 8 [0.1%], adjusted RR 6.54, 95% CI, 2.33-18.33) in people with HIV infection compared with those without HIV infection.CONCLUSION:There was little difference in adverse maternal obstetric outcomes between people with and those without HIV infection in the treat-all era with integrase strand inhibitors (primarily dolutegravir); notable exceptions included a slightly reduced risk of preeclampsia and, although rare, an increased risk of uterine rupture in those with HIV infection.

Objective: To examine the association between sociodemographic factors and utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate. Design: Retrospective cohort. Exposure: Initial infertility evaluation and treatment utilization. Main Outcome Measures: The prevalence of reproductive-aged women who reside in Massachusetts presenting for initial consult vs. census-based estimates was calculated for each racial and ethnic group. Age at initial consult, insurance coverage, drive time to nearest affiliated center, and neighborhood deprivation as measured by Area Deprivation Index (ADI) were considered determinants of treatment utilization in regression analysis. Results: A total of 16,160 women presenting for an infertility consult from 2010-2021 met inclusion criteria. Compared with census estimates, Non-Hispanic (NH) Asian and NH White individuals were overrepresented in initial consults, whereas the NH Black and Hispanic populations were underrepresented throughout the study period. Mean age at presentation was higher in NH Black women compared with the NH Asian reference group (35.7 +/- 5.1 vs. 34.6 +/- 4.4 years old). A lower proportion of Hispanic and NH Black women had private insurance (78% and 79%, respectively) compared with 86% of NH Asian women. Over a fifth of Hispanic and NH Black women lived in the most disadvantaged ADI quintile (23% and 21%, respectively) compared with 6% of the reference population. Overall, the absence of private insurance, greater neighborhood disadvantage, and increased driving distance were associated with lower treatment utilization (odds ratio [OR]: 0.79 [95% confidence interval 0.71-0.87], for other vs. private insurance; OR: 0.62 [0.53-0.72], for ADI quintile 5 vs. 1, OR: 0.84 [0.72-0.97] for drive time 15-30 vs. <15 minutes), whereas age was not (OR: 0.96 [0.93-1.00] for each 5-year increase). Conclusions: Relative to their numbers in the broader population of reproductive-aged women in Massachusetts, the NH Black and Hispanic populations were the most underrepresented racial and ethnic groups seen for infertility evaluation at our center. These individuals were less likely to have private insurance coverage and more likely to live in disadvantaged neighborhoods, which are variables that negatively impact infertility treatment utilization. (Fertil Steril (R) 2025;123:709-17. (c) 2024 by American Society for Reproductive Medicine.)

OBJECTIVE:The aim of this study was to evaluate the performance of HPV type restriction and cycle threshold (Ct)-limit setting to optimize detection of cervical intraepithelial neoplasia (CIN) with primary HPV testing. METHODS:Baseline cervical screening at time of entry into a prospective longitudinal cohort of women with and without HIV was conducted from February 2021 to July 2022 in Botswana. All women underwent HPV testing of 15 individual types using the AmpFire assay; all HPV-positive and a random subset of HPV negative had histopathology collected. Performance parameters of HPV type restriction groupings were calculated, and sensitivity by individual HPV type Ct-value limits were plotted. RESULTS:Among 2964 women who underwent primary HPV screening, 1293 (43.6%) tested HPV-positive. Among women with HIV (WWH), HPV types 16/18/33 were associated with the greatest burden of CIN2+/CIN3+ (53%/56%). In WWH, grouping by HPV types separately reported in commercial assays (16/18/45) had low sensitivity (44% [CI: 36%-52%]) but high specificity (86% [CI: 84%-88%]) for CIN2+; 8-type HPV restriction (16/18/31/33/35/45/52/58) improved sensitivity (79% [CI: 72%-86%]) and maintained reasonable specificity (67% [CI: 65%-70%]) for CIN2+. Similar results were seen in women without HIV. Ct-limit setting for medium oncogenic HPV types (31,33,35,52,58) maintained a sensitivity of 72% in WWH while reducing over-detection of non-pathogenic HPV. CONCLUSION:Eight-type HPV restriction and Ct-limit setting are promising strategies for improving the performance of primary HPV screening. A potential strategy to improve 8-type HPV restriction would be to treat all with HPV 16/18/45; treat HPV 31/33/35/52/58 if below the type-specific Ct limit and repeat HPV testing in 1-year for other positive HPV results.

Achieving adequate pain relief is crucial for intradetrusor onabotulinumtoxinA treatments for idiopathic overactive bladder in office settings. The objective of this study was to determine whether buffered lidocaine bladder instillation provides better pain control than standard lidocaine prior to intradetrusor onabotulinumtoxinA injections. We conducted a prospective, double-blind, randomized controlled trial comparing two protocols. The standard protocol used a pre-procedure instillation of 50 ml of 1

Financial toxicity is an adverse outcome of cancer care and is often quantified by patient-reported validated survey tools, such as The Comprehensive Score for Financial Toxicity (COST). We aimed to examine the association of objective financial measures of hospital out-of-pocket (OOP) expenses and write-offs with the patient derived COST scores in patients with gynecologic cancer. We identified individuals who completed our cross-sectional survey in discrete periods between 2017 and 2021. Response rates for these periods ranged from 75 to 95

Importance Despite the importance of patient trust in health care, there are no patient-reported outcome measures (PROMs) for trust in their clinician that have been developed empirically in Spanish, which is the second most common language in the US. Objective To develop and validate a Spanish-language PROM for trust in pregnancy care clinician. Design, Setting, and Participants This cross-sectional study used a national online panel of patients who reported a Spanish language preference and had limited English proficiency and were currently pregnant or had given birth within the 12 months before the survey. Participants resided in the United States, and data were collected from January to May 2024. Exposures Participants had clinical interactions during pregnancy and/or postpartum care. Data collected included demographics, Confianza (Trust) Scale candidate items, and 4 measures for concurrent validity evidence: the Trust in Physician Scale (TPS), the Mothers on Respect Index, the Edinburgh Postpartum Depression Scale (EPDS), and the Patient-Reported Outcomes Measurement Information System Global 10. Main Outcomes and Measures The main outcomes were psychometric properties of the Confianza scale and its association with validated scales (validity coefficients). Item response theory (IRT) analyses were conducted to evaluate the psychometric properties of the candidate items, select the best item subset for the Confianza scale, examine its correlation with other measures, and compare scores according to demographic characteristics. Results Of the included 204 participants (mean [SD] age, 26 [7] years; 62 participants from South America [30%]; 32 participants from Mexico [16%]), 117 participants were pregnant (57%), and 87 were within 1-year post partum (43%) at the time of survey completion. Four items were removed based on exploratory factor analysis. Using results from IRT analysis on the remaining 12 items, 5 items were selected to represent communication, caring, competency, accompaniment, and overall trust for the final measure. The 5-item Confianza scale had high measurement precision, with reliability above 0.90 across a wide range of the trust continuum. The Confianza scale (mean [SD] score, 21.5 [4.6] out of 25) was positively correlated with the TPS ( r = 0.47; 95% CI, 0.36 to 0.57; P < .001) and negatively correlated with the EPDS ( r = −0.41; 95% CI, −0.52 to −0.29; P <.001). Higher trust scores were obtained when there was language concordance with clinicians (mean [SD], 23.6 [2.3] vs 20.0 [5.3]; P < .001) and care continuity (mean [SD], 22.3 [3.8] vs 20.9 [5.3]; P = .001). Conclusions and Relevance In this cross-sectional study of pregnant and postpartum Spanish-speaking individuals, a Spanish-language PROM for trust in pregnancy care clinician had initial validity.

OBJECTIVE:To conduct a systematic review and meta-analysis of treatments for female sexual desire, arousal, and orgasmic dysfunction in patients without sexual pain conditions. DATA SOURCE:MEDLINE, Embase, Web of Science, Cochrane Library, PsycINFO, and ClinicalTrials.gov. METHODS OF STUDY SELECTION:Following the initial search in December 2024, a total of 8994 abstracts were screened, 278 full-text articles were reviewed, and 36 studies met criteria for data abstraction including a patient population with female sexual dysfunction (FSD) of desire, arousal, and/or orgasm (DAO) and outcome measures including the Female Sexual Function Index (FSFI), its DAO subscales, and the Female Sexual Distress Scale (FSDS). Studies including patients with sexual pain conditions were excluded. Two reviewers independently conducted each phase. TABULATION, INTEGRATION, AND RESULTS:Of the 36 studies, 26 were RCTs and 10 were single-arm trials. Ten studies evaluated cognitive behavioral therapy (CBT), 24 investigated medication therapy, and 2 investigated devices. Meta-analyses were conducted for mindfulness-based CBT, flibanserin, and bremelanotide. Mindfulness-based CBT significantly improved total FSFI and subscales of desire, arousal, and orgasm. Conversely, flibanserin improved total FSFI and desire while bremelanotide improved total FSFI and its desire and arousal subscales. No studies directly compared CBT to pharmacotherapy. CONCLUSION:In this systematic review of treatments of females with sexual DAO dysfunctions without pain, we found that CBT improves DAO; flibanserin improves desire; and bremelanotide improves both desire and arousal; and all 3 treatments reduce distress. Our findings align with previous literature and expand upon it to include multiple treatment modalities. This broader perspective offers a starting point for clinicians, including gynecologists, who frequently serve as the first point of care for FSD. Conclusions regarding most other treatments could not be drawn due to limited numbers of studies of FSD excluding pain, heterogeneous terminology for DAO disorders, and varying outcome measures across studies.

OBJECTIVE:Loop electrosurgical excision (LEEP) is the standard of care for high-grade cervical intraepithelial neoplasia. The primary aim of this study was to compare patient-reported outcomes among patients who received local anesthesia (LA) during LEEP with those who received GA. METHODS:PubMed, Embase, and Cochrane databases were searched for studies comparing GA with LA in LEEP. Primary outcomes were postprocedure pain and satisfaction, including the likelihood of choosing the same anesthesia method again. Statistical analysis used Review Manager 5.4, heterogeneity was assessed with I2 , and a random-effects model was applied. RESULTS:Six studies (2,169 patients; 1,536 LA, 633 GA) met inclusion criteria. Postprocedure pain was slightly lower with GA than LA (standardized mean difference: -0.49, 95% CI = -1.88, 0.89), but this was not statistically significant. Satisfaction was higher for GA (odds ratio: 1.62; 95% CI = 0.94, 2.79), though not significantly. GA patients had larger cone volumes (mean difference: 0.46 cm 3 ; 95% CI = 0.29, 0.62), and deeper excisions, though depth was not statistically significant (mean difference: 0.75 mm; 95% CI = -0.23, 1.74). CONCLUSIONS:While GA was associated with minimally lower pain and greater satisfaction, these differences were not statistically or clinically meaningful. GA was also linked to larger cone volumes, potentially increasing risks for future pregnancies. Given the higher risks and costs of GA, LA may be preferable for LEEP.

Importance Improving patients' recall and understanding of their planned surgery is essential for fully informed consent. Objective The objective of this study was to assess if the addition of an information handout to the standard preoperative consent process for the transobturator midurethral sling procedure improved patient understanding, recall, and satisfaction. Study Design This is a randomized controlled trial of adult women undergoing a transobturator midurethral sling procedure for the treatment of stress urinary incontinence. After standard counseling, participants were randomly assigned to either the control or the intervention group, with the latter receiving an extra informational handout detailing surgical information. Before surgery, all participants filled out a questionnaire assessing key points discussed during the surgical consent, which was used to calculate a knowledge score, the primary endpoint. Secondary outcomes included perception of the consent process and patient satisfaction. Results Of 98 randomized participants (50 control, 48 intervention), knowledge scores were 43% for controls and 57% for the intervention group (P = 0.015). Despite low scores, high self-rated understanding and satisfaction were noted across both groups (78% control, 71% intervention, P = 0.4). Notably, younger individuals, those with some college education, and patients undergoing additional prolapse surgery benefited most from the handout. Conclusions The informational handout improved knowledge scores, though overall knowledge scores were low in both groups. High satisfaction and perceived understanding of the planned procedure persisted, but the addition of a handout was not associated with a significant difference in knowledge scores.