American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Lighting the way: Indocyanine green-guided laparoscopic transabdominal cerclage in pregnancy.","authors":"Matteo Pavone, Chiara Innocenzi, Nicola Macellari, Chiara Cantarini, Nazario Foschi, Angela Botta, Chiara Tersigni, Tullio Ghi, Anna Fagotti, Denis Querleu, Francesco Fanfani, Nicolò Bizzarri","doi":"10.1016/j.ajogmf.2025.101788","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101788","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101788"},"PeriodicalIF":3.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘Outcomes after cerclage and preterm prelabor rupture of membranes: data from the international collaborative for cerclage longitudinal evaluation and research (IC-CLEAR)’ [American Journal of Obstetrics & Gynecology MFM Volume 7, Issue 10, October 2025, 101753]","authors":"Joanne N. Quiñones-Rivera MD, MSCE , Joseph Bell MD , Rupsa C. Boelig MD, MS , Shirin Azadi MD , Onyinyech Anosike DO , Dahiana M. Gallo MD, PhD , Adam Taylor MD , Vincenzo Berghella MD , Leah Carnick Ledford MSN , Mónica Rincón MD, MCR , Susana Villegas Sanchez , Richard Burwick MD, MPH , Luisa López-Torres MD , Jorge E. Tolosa MD, MSCE","doi":"10.1016/j.ajogmf.2025.101786","DOIUrl":"10.1016/j.ajogmf.2025.101786","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 11","pages":"Article 101786"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The immorality of nonconsensual experimentation using the bodies of deceased pregnant women: is stopping life support an abortion?","authors":"Arthur L. Caplan PhD","doi":"10.1016/j.ajogmf.2025.101785","DOIUrl":"10.1016/j.ajogmf.2025.101785","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 11","pages":"Article 101785"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Together or separated in time? Two simultaneous cervical ripening agents perform better than one for labor induction.","authors":"Angela Essa, Salman Ali Jan, Corina N Schoen","doi":"10.1016/j.ajogmf.2025.101770","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101770","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101770"},"PeriodicalIF":3.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of a first-trimester combined screening for preterm preeclampsia in the United States population using the Fetal Medicine Foundation competing risks model.","authors":"Juliana G Martins, Elizabeth Miller, Diana Aboukhater, Michael Bittner, Daniel L Rolnik, Tetsuya Kawakita","doi":"10.1016/j.ajogmf.2025.101803","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101803","url":null,"abstract":"<p><strong>Background: </strong>Preeclampsia complicates 2-8% of pregnancies and is a leading cause of maternal and perinatal morbidity and mortality. In the United States, current guidelines recommend low-dose aspirin based on clinical risk factors, which identify only a minority of those at risk for preterm preeclampsia. The Fetal Medicine Foundation (FMF) competing risks algorithm improves prediction by combining maternal characteristics, biophysical parameters, and biochemical markers. While validated internationally, its performance in the U.S. population remains unclear.</p><p><strong>Objective: </strong>To evaluate the performance of the FMF first-trimester combined screening algorithm for predicting preterm preeclampsia in a diverse U.S. nulliparous population.</p><p><strong>Study design: </strong>We performed a retrospective cohort study using data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). We excluded those with delivery before 20 weeks, missing outcome data, or aspirin use. The FMF model incorporated maternal factors, mean arterial pressure, placental growth factor, pregnancy-associated plasma protein-A, and uterine artery pulsatility index (adjusted from second-trimester values). The primary outcome was preterm preeclampsia, defined as preeclampsia requiring delivery <37 weeks. Model performance was assessed via area under the receiver-operating characteristics curve (AUROC) with 95% confidence interval (CI), with optimal cut-off determined using Liu's method. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), likelihood ratios (LHR), and odds ratios (OR) were calculated using the optimal cut-off. Goodness of fit was evaluated using a calibration plot and decision curve analysis.</p><p><strong>Results: </strong>Of 8,664 nulliparous individuals, 189 (2.2%) had preterm preeclampsia. The FMF model revealed an AUC of 0.75 (95% CI 0.71-0.78), indicating moderate discriminative ability. Using a 0.7% cut-off, sensitivity was 64.0%, specificity 72.5%, PPV 4.9%, and NPV 98.9%. Positive LHR was 2.3, negative LHR 0.5, and OR 4.7. The calibration plot showed the model underestimated risk, while recalibration improved alignment. Decision curve analysis demonstrated net clinical benefit across commonly used thresholds (1-12%).</p><p><strong>Conclusion: </strong>The FMF first-trimester screening algorithm demonstrated moderate predictive performance. Recalibration enhanced risk estimation, and decision curve analysis supported clinical utility, highlighting the need for population-specific adjustment.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101803"},"PeriodicalIF":3.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cell-Free DNA Screening Results by Stage of Maternal Malignancy.","authors":"Emily Zhao, Kristen A Miller, Jonathan Webster, Jamie Perin, Ashley Coggins, Angie C Jelin","doi":"10.1016/j.ajogmf.2025.101804","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101804","url":null,"abstract":"<p><strong>Background: </strong>Cell-free DNA screening is increasingly used for fetal aneuploidy screening. Maternal malignancy is associated with abnormal cell-free DNA results; however, the impact of tumor staging and origin on cell-free DNA results remains unclear.</p><p><strong>Objective: </strong>To characterize the types and stages of malignancies resulting in abnormal cell-free DNA screening results.</p><p><strong>Study design: </strong>This is a single center, retrospective review of cases with a known, suspected, or incidentally diagnosed malignancy during pregnancy from 2015-2023 queried using ICD9/10 codes for malignancy. We extracted maternal medical history, cancer history, aneuploidy screening results and fetal outcomes. We used Fishers exact and Wilcoxon rank sum tests to determine associations between cfDNA screening results and (1) demographic factors, (2) cancer characteristics, and (3) fetal outcomes.</p><p><strong>Results: </strong>We identified 97 cases of malignancy in pregnancy. Thirty-three patients had no aneuploidy screening. Twenty-two underwent first trimester screening and 4 underwent quad screening, all with low-risk results. Among the 38 patients who had cell-free DNA screening, 21.1% (8/38) were hematologic and 78.9% (30/38) were solid tumors. The most common locations were breast (11/38), blood (8/38), and gastrointestinal (5/38). Overall, 31.6% (12/38) of patients had abnormal cell-free DNA results. The fraction of stage 0, I, II, III, and IV solid cancers with abnormal cell-free DNA results was 0/4 (0%), 0/5 (0%), 2/6 (33.3%), 1/4 (25%), and 7/11 (63.6%), respectively. Metastasized status was significantly different between groups: 47.6% (10/21) of patients with stage II-IV solid cancers had abnormal cell-free DNA results, compared to 0% (0/9) of patients with stage 0-I solid cancers (p=0.013). No fetuses had a confirmed aneuploidy.</p><p><strong>Conclusions: </strong>Our data suggest that early stage, solid tumors are less likely to impact cell-free DNA screening results than metastatic tumors. Larger cohorts are needed to further characterize the association between tumor type/stage and cell-free DNA result. Ultimately, cell-free DNA screening may be more likely to incidentally diagnose certain types of maternal malignancy than others.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101804"},"PeriodicalIF":3.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal sonographic predictors of maternal mirror syndrome in hydropic fetuses.","authors":"Brian A Burnett, Christian M Parobek, Matthew A Shanahan, Jessian L Munoz, Romain Corroenne, Kristi Poling, Cara Buskmiller, Amir A Shamshirsaz, Roopali V Donepudi, Magdalena Sanz Cortes, Michael A Belfort, Ahmed A Nassr","doi":"10.1016/j.ajogmf.2025.101787","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101787","url":null,"abstract":"<p><strong>Background: </strong>Mirror syndrome is a rare life-threatening condition in which a pregnant individual develops hypertension, visceral and pulmonary edema, \"mirroring\" the fluid overload of their hydropic fetus. Data is limited to less than 120 cases of mirror syndrome described in the literature.</p><p><strong>Objective(s): </strong>We sought to determine if a cardiogenic versus non-cardiogenic etiology for hydrops fetalis was associated with mirror syndrome. We also examined whether there are sonographic predictors for progression from hydrops to mirror syndrome.</p><p><strong>Study design: </strong>This is a retrospective cohort study of all singleton pregnancies evaluated at our fetal center from 2012-2023 with a prenatal diagnosis of hydrops fetalis, including both immune and nonimmune etiologies. Participant history, pregnancy outcome, and ultrasound data were obtained. Cases were classified as having mirror syndrome if they presented with fetal hydrops, new or worsening hypertension and significant maternal edema. Participants were further classified by the fetal condition causing hydrops, either cardiogenic or non-cardiogenic. A cardiogenic etiology was defined as the presence of high cardiac output heart failure or other evidence of fetal cardiac compromise. Bivariate analyses were performed comparing those with and without mirror syndrome, and logistic regression was used to evaluate etiology of hydrops as well as the predictive value of affected fetal fluid compartments and placental thickness with mirror syndrome.</p><p><strong>Results: </strong>Among 182 cases of hydrops, mirror syndrome was diagnosed in 29/182 (16%). Hydrops due to a cardiogenic etiology was more common in mirror syndrome, 18/29 (62%) compared to 56/153 (37%) without, p = .01. A cardiogenic etiology for hydrops (OR, 2.83; 95% CI, 1.27-6.61) and placental thickening (OR, 7.20; 95% CI, 2.54-20.6) were significantly associated with mirror syndrome.</p><p><strong>Conclusions: </strong>Cardiogenic hydrops was significantly associated with progression to mirror syndrome, suggesting a potential common pathophysiology between fetal cardiovascular compromise and mirror syndrome. Fluid collection within the placenta (thickening) was also significantly associated with mirror syndrome.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101787"},"PeriodicalIF":3.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A data-driven approach produced a more efficient, pragmatic periconception dietary index.","authors":"Valene Garr Barry, Nandini Raghuraman","doi":"10.1016/j.ajogmf.2025.101772","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101772","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101772"},"PeriodicalIF":3.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subsequent pregnancy outcomes of excisional surgery vs conservative surgery for cesarean scar pregnancy.","authors":"Ning Wang, Feng Qi, Jianwei Zhou, Xiaocen Niu, Xingmiao Li, Mengjia Yu, Yanan Yang, Xuelu Zhu, Xiuxiu Jiang","doi":"10.1016/j.ajogmf.2025.101776","DOIUrl":"10.1016/j.ajogmf.2025.101776","url":null,"abstract":"<p><strong>Background: </strong>Recurrent cesarean scar pregnancy (CSP) presents a significant clinical challenge for gynecologists. A thinner residual myometrium is an independent risk factor for CSP recurrence. There is limited evidence regarding which treatment modalities effectively reduce the risk of CSP recurrence.</p><p><strong>Objective: </strong>This study compared subsequent pregnancy outcomes between excisional and conservative surgical treatments in CSP patients with a thin residual myometrium.</p><p><strong>Study design: </strong>This was a multicenter retrospective observational cohort study of CSP patients hospitalized in China. The participants were recruited from January 1, 2019, to December 31, 2021, and data on pregnancy outcomes were collected up to January 31, 2025. Data were collected from CSP patients with a residual myometrium thickness ≤3 mm who underwent surgical management through either excisional surgery (ES) (CSP excision and hysterotomy closure) or conservative surgery (CS) (vacuum aspiration and surgical hysteroscopy). Patients with a residual myometrium >3 mm, those with a gestational age greater than 12 weeks, those with incomplete medical records or follow-up data, those who did not undergo surgical management, and those without fertility requirements were excluded. Data were obtained from the health system's electronic health records and telephone follow-up. The primary outcome was the subsequent pregnancy outcome of CSP. Survival analysis was performed to evaluate the risk of CSP recurrence.</p><p><strong>Results: </strong>Among the 464 CSP patients (median [interquartile range] age, 34.0 [31.0-37.0] years), 32 (6.9%) underwent ES, and 432 (93.1%) underwent CS. The pregnancy rate in the excisional group was significantly greater than that in the conservative group (20 [62.5%, 95% confidence interval (95% CI): 45.7%-79.3%] vs 130 [30.1%, 95% CI: 25.8%-34.4%], P<.001). The CSP recurrence rate in the excisional group was significantly lower than that in the conservative group (1 [5.0%, 95% CI: 0%-14.6%] vs 41 [31.5%, 95% CI: 23.6%-39.5%], P=.014). After the postsurgical pregnancy interval were considered, the CSP recurrence rate in the excisional group was lower than that in the conservative group according to time-dependent Cox regression analysis (hazard ratio, 0.34; 95% CI: 0.14-0.82; P=.01).</p><p><strong>Conclusion: </strong>For CSP patients with a thinner residual myometrium, ES improves the pregnancy rate while effectively reducing the risk of CSP recurrence.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101776"},"PeriodicalIF":3.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-fidelity trainer for fetoscopic spina bifida repair.","authors":"Claudio V Schenone, Sofia Musi, Weston T Northam, Michael Silver, Jeremiah Egolf, Eric Dennis, Saja Traoui, Jennifer Arnold, Alireza A Shamshirsaz, Eyal Krispin","doi":"10.1016/j.ajogmf.2025.101784","DOIUrl":"10.1016/j.ajogmf.2025.101784","url":null,"abstract":"<p><strong>Background: </strong>Fetoscopic spina bifida repair requires a well-trained, dedicated team to perform the surgery. However, the paucity of cases and limited training resources limit the approach's widespread adoption. Therefore, high-fidelity simulators are essential to fill these gaps.</p><p><strong>Objective: </strong>We sought to create a synthetic, low-cost, high-fidelity simulator for appropriate training in fetoscopic spina bifida repair.</p><p><strong>Study design: </strong>We designed a disposable, single-use, multi-layer silicone pad resembling a myelomeningocele attached to a 3D-printed fetal mannequin mounted on a positioning base. The mannequin is housed in a 3D-printed cylindrical enclosure with a removable, puncturable silicone locking lid representing the uterus. We assessed the model's realism and educational value using a 5-point Likert scale survey administered after the simulation sessions. We used the criteria proposed by Tun et al, a multidimensional tool that incorporates the patient, the healthcare facility or environment, and the clinical scenario, with specific definitions stratified by fidelity levels (low, intermediate, and high), as a reference to ascertain a trainer's fidelity.</p><p><strong>Results: </strong>A multidisciplinary team, comprising a maternal-fetal medicine-trained fetal surgeon, a pediatric neurosurgeon, and simulation development engineers, developed a low-cost synthetic fetoscopic spina bifida repair simulation model that enables practicing the essential neurosurgical steps of fetoscopic spina bifida repair using a three-port approach, including fetoscopic placode and fascial dissection, patch suturing to the fascial layer, and skin closure. Nine clinicians with different levels of expertise tested the final version of the trainer. Most rated the simulator's realism as \"very good\" or \"excellent\" on all surgical steps. All study participants rated the educational value as \"very good\" or \"excellent\". The model is classified as high-fidelity according to prespecified criteria.</p><p><strong>Conclusion: </strong>We developed a high-fidelity, inexpensive synthetic simulator that includes all essential surgical steps for fetoscopic spina bifida repair.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101784"},"PeriodicalIF":3.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}