Obstetrics & Gynecology

Hospitals serving more Black births had higher TOLAC and VBAC rates, but Black‑White VBAC gap persisted

In 1,734,919 low‑risk deliveries with prior cesarean (2017–2019), hospitals in the top 5% of births to Black patients had higher adjusted odds of TOLAC (aOR 1.51) and VBAC (aOR 1.24). Overall, only 19.7% attempted TOLAC and 81.4% of attempts resulted in VBAC. Black patients remained less likely than White patients to achieve VBAC (aOR 0.88), though probabilities were higher at high Black‑serving hospitals. This retrospective, propensity‑matched analysis suggests institutional factors influence TOLAC/VBAC rates but cannot prove causation. 1

Baseline vaginal Lactobacillus modestly improves IVF outcome prediction when combined with clinical factors

In 475 IVF couples, positive vaginal cultures occurred in 25.5% and positive semen cultures in 29%, with partner pathogen concordance <3%. Clinical pregnancy rates were similar between women with positive versus negative vaginal cultures (36% vs 39%, not significant). Machine‑learning models found maternal age the dominant predictor; microbial features, especially Lactobacillus presence, added modest predictive value. Baseline partner microbiology rarely overlapped, so treating presumed sexual transmission is unsupported by these data. 2

Natural‑cycle endometrial preparation associated with higher pregnancy rates after IUA separation surgery in women ≤35

Among women ≤35 with prior intrauterine adhesion separation, natural cycle (NC) FET had higher clinical pregnancy (47.5%) than HRT (30.9%) and higher biochemical pregnancy (50.5% vs 35.1%). Adjusted analyses showed NC versus HRT clinical pregnancy aOR 1.627 (95% CI 1.079–2.453) and biochemical aOR 1.532 (95% CI 1.020–2.301). Live birth and early miscarriage rates did not differ significantly between NC and HRT after adjustment. This retrospective cohort supports considering NC in this subgroup but is limited by nonrandomized design and potential residual confounding. 3