This Week in Obstetrics & Gynecology — May 14, 2026

Welcome to This Week in Obstetrics & Gynecology. This week we're covering 10 notable papers spanning optimizing perinatal outcomes, assessing long-term health risks, and new data on cancer genetics and physician wellbeing. Let's dive in.

We begin this week in obstetrics, with several papers focused on managing risks during pregnancy and delivery.

First, a large study in the *American Journal of Obstetrics and Gynecology* challenges the one-size-fits-all approach to the duration of the second stage of labor [10]. Investigators from Norway analyzed over 120,000 births to estimate the probability of spontaneous delivery based on parity, epidural use, and fetal position. They found that these factors significantly alter expected timelines. For nulliparous women with a fetus in the occiput anterior position and no epidural, 98% delivered within two hours of pushing, with marginal benefit to pushing longer. However, for those with an epidural, the rate was 84% at two hours, but pushing for another 30 minutes increased the probability to 90%. The picture changes dramatically for a persistent occiput posterior position. In nulliparous women, the spontaneous delivery rate at two hours was just under 80% without an epidural, and plummeted to only 45% with an epidural, with little benefit to pushing past 120 minutes. For parous women, timelines were shorter, with most delivering within 60 minutes without an epidural, or 90 minutes with one. The authors note that active pushing for more than 30 minutes was associated with higher rates of adverse maternal and neonatal outcomes. The clinical takeaway is clear: the clock on the second stage should be individualized, using this data to inform discussions about when to consider operative delivery.

Staying with high-risk obstetrics, a paper in *Ultrasound in Obstetrics & Gynecology* explores the best way to diagnose selective fetal growth restriction, or sFGR, in monochorionic twin pregnancies [4]. This retrospective study compared the traditional ISUOG criteria with the newer, broader Delphi consensus definition. The Delphi criteria were more sensitive, identifying about 30% of pregnancies as having sFGR, compared to only about 15% using the ISUOG criteria. However, the outcomes for the additional cases identified solely by the Delphi criteria were significantly better—with higher rates of intact survival of both twins and lower neonatal morbidity—compared to those meeting the stricter ISUOG definition. While each individual component of the Delphi criteria was independently associated with adverse outcomes, the findings suggest the broader definition may be capturing a group of less severely affected pregnancies. This study highlights a diagnostic conundrum and underscores the need for more research to refine our tools for diagnosing and managing this complex condition.

Next, a population-based study from Hungary published in *BJOG* sheds light on the rising prevalence of gestational diabetes [7]. Analyzing data from a universal screening program between 2010 and 2017, researchers found that the prevalence of GDM increased from 15% to 20%. While factors like pre-pregnancy BMI are known contributors, this study uncovered a more nuanced driver. After adjusting for multiple factors, the investigators found that BMI gain during the first two trimesters of pregnancy—measured at the time of the oral glucose tolerance test—explained a significant portion of the increase in both GDM diagnoses and fasting glucose levels. This suggests that weight gain during pregnancy is a more important determinant of the current GDM epidemic than early-pregnancy BMI alone. The findings call for a dual focus in prevention, targeting both pre-conception weight and appropriate weight gain during pregnancy.

Finally in this section, a follow-up study published in *Obstetrics and Gynecology* provides a definitive answer on a potential therapy for birth asphyxia [1]. This was a neurodevelopmental follow-up of the A-PLUS trial, which had randomized laboring mothers to a single 2-gram dose of azithromycin or placebo. This analysis focused on infants born at 34 weeks or later who experienced birth asphyxia. At two years of age, there was no difference whatsoever in neurodevelopmental outcomes. The mean cognitive, language, and motor scores on the Bayley Scales were nearly identical between the azithromycin and placebo groups. This negative finding is important: while the original trial showed a benefit for maternal sepsis, we now know this intervention does not confer any neuroprotective benefit to neonates with birth asphyxia. Azithromycin should not be used for this indication.

Next, we turn to long-term health risks and medication safety, with important data on NSAIDs, PCOS, and the link between endometriosis and ovarian cancer.

First, a large, population-based study in *PLoS Medicine* offers reassuring evidence on the safety of nonsteroidal anti-inflammatory drugs, or NSAIDs, during the first trimester [2]. With recent concerns raised about acetaminophen, clinicians and patients are often uncertain about pain and fever management in early pregnancy. This Israeli registry study included over 264,000 singleton pregnancies. After extensive statistical adjustment, exposure to NSAIDs like ibuprofen, diclofenac, or naproxen in the first trimester was not associated with an increased risk of major congenital malformations, either overall or in any specific organ system. Furthermore, there was no evidence of a dose-response relationship. This robust data provides a strong basis for counseling patients that indicated or inadvertent use of NSAIDs in early pregnancy is unlikely to be harmful to the fetus.

Shifting to long-term health, a massive nationwide study from Sweden, published in *Human Reproduction*, sounds an alarm about the cardiovascular risks associated with Polycystic Ovary Syndrome [5]. Following nearly 300,000 women for up to 20 years, researchers found that a diagnosis of PCOS more than doubled the risk of developing hypertension and tripled the risk of developing dyslipidemia, even after adjusting for obesity. The risk was starkly higher for women with the hyperandrogenic phenotype of PCOS. These women faced a more than five-fold increased risk of hypertension and a nearly eight-fold increased risk of dyslipidemia compared to controls. These findings are a powerful reminder that PCOS is a profound metabolic and cardiovascular condition, not just a reproductive disorder. The study underscores the urgent need for early, aggressive cardiovascular risk assessment and preventive care for all women with PCOS, especially those with evidence of hyperandrogenism.

Rounding out this section, a systematic review in *Gynecologic Oncology* provides critical perspective on the link between endometriosis and ovarian cancer [6]. The review confirms that epidemiological studies consistently show a modest but statistically significant increase in the relative risk of ovarian cancer in women with endometriosis, particularly for the endometrioid and clear cell subtypes. Relative risks ranged from 1.3 to 4.2. However, the authors stress a crucial point for patient counseling: the absolute lifetime risk of ovarian cancer for a woman with endometriosis remains low, generally under 2 to 5 percent. The review concludes that current evidence does not justify routine oncologic surveillance or prophylactic surgery based on a diagnosis of endometriosis alone. The key clinical implication is the need for nuanced communication, acknowledging the relative risk increase while reassuring patients about the low absolute risk to avoid unnecessary anxiety and overtreatment.

Our final section covers new findings in hereditary cancer genetics, a look at cervical cancer screening, and a novel intervention for physician burnout.

First, from *Gynecologic Oncology*, a study analyzing real-world genetic testing data challenges our assumptions about hereditary cancer in older women [8]. Researchers examined a registry of over 113,000 ovarian cancer patients and focused on the nearly 23,000 who were diagnosed at age 70 or older. They found that 6.6% of these older patients harbored an actionable pathogenic or likely pathogenic variant in an established ovarian cancer susceptibility gene. Critically, these older patients were one-and-a-half times less likely to report a family history of cancer that would typically trigger testing. The study also noted that in this older cohort, BRCA2 variants were more common than BRCA1. The takeaway is that relying on family history is an insensitive screening tool for genetic risk in older ovarian cancer patients. These findings strongly support current guidelines for universal genetic testing for all patients with ovarian cancer, regardless of age or family history.

Next, a commentary in *JAMA Internal Medicine* urges the specialty to prepare for the responsible implementation of self-collected HPV testing for cervical cancer screening [9]. While this article has no abstract, its title and source signal an important discussion. With the recent FDA approval of self-collection kits, there is enormous potential to reduce health disparities by reaching under-screened women. However, the authors implicitly caution that implementation must be thoughtful. Key challenges will include creating robust systems for linking patients with positive self-tests to appropriate follow-up care, providing clear patient education, and ensuring that access to this new technology is equitable. The piece serves as a call to action for clinicians and health systems to ensure this innovation closes, rather than widens, the screening gap.

Finally, a randomized clinical trial in *JAMA* offers a hopeful, evidence-based strategy to combat physician burnout [3]. The study focused on pregnant and postpartum residents and fellows, a group at high risk for burnout. 156 trainees were randomized to either usual support or a pragmatic parental support package, which included a smart bassinet, a wearable breast pump, virtual perinatal support, and formal faculty mentorship. The results were significant. From pregnancy to 24 weeks postpartum, the group receiving the support package experienced a significantly smaller increase in burnout scores compared to the control group. This effect, which was rated as medium-to-large, was driven primarily by a reduction in interpersonal disengagement. This trial demonstrates that tangible, structural support—not just wellness lectures or resilience training—can make a real difference in mitigating burnout during a critical life and career transition.

If you only have time for one paper this week, make it the study on PCOS and cardiovascular risk from *Human Reproduction* [5]. It provides powerful, population-level evidence quantifying the massive long-term risk of hypertension and dyslipidemia, especially in the hyperandrogenic phenotype. This paper fundamentally reframes a common reproductive issue as a lifelong metabolic and cardiovascular threat that demands our proactive management.

Here are the key takeaways from this week in Obstetrics & Gynecology.

First, individualize second-stage pushing times based on parity, epidural use, and fetal position; new data from the *American Journal of Obstetrics and Gynecology* provides specific timeframes to guide this decision-making [10].

Second, women with PCOS, particularly the hyperandrogenic type, have a dramatically increased long-term risk of hypertension and dyslipidemia, with risk ratios as high as five- to eight-fold. This finding from *Human Reproduction* mandates early and aggressive cardiovascular risk screening and prevention [5].

Third, first-trimester exposure to common NSAIDs does not appear to increase the risk of major congenital malformations, according to a large cohort study in *PLoS Medicine*, providing reassuring data for patient counseling [2].

Fourth, for childbearing physician trainees, a pragmatic support package including tools like a smart bassinet and wearable pump can significantly mitigate postpartum burnout, highlighting the value of tangible, institutional support [3].

And fifth, universal genetic testing for ovarian cancer patients is crucial, as a study in *Gynecologic Oncology* shows a significant number of women diagnosed over age 70 carry actionable mutations, often without a corresponding family history [8].

That's your roundup for This Week in Obstetrics & Gynecology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.