American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Glucose Time in Range Trajectories During Pregnancy and Association with Adverse Perinatal Outcomes: A Joint Latent-Class Trajectory Modeling Approach.","authors":"Sara M Sauer, Isabel Fulcher, Ayodeji Sanusi, Ashley N Battarbee","doi":"10.1016/j.ajogmf.2025.101669","DOIUrl":"10.1016/j.ajogmf.2025.101669","url":null,"abstract":"<p><strong>Background: </strong>While time in range (TIR) summarized over pregnancy is associated with adverse outcomes among individuals with preexisting type 1 or 2 diabetes, the impact of TIR trajectories with advancing gestation is unknown.</p><p><strong>Objective: </strong>To identify glucose TIR trajectories across pregnancy and evaluate their association with perinatal outcomes among patients with preexisting diabetes.</p><p><strong>Study design: </strong>Retrospective, single-center cohort study of pregnant patients with type 1 or 2 diabetes who used continuous glucose monitoring and delivered in 2019-2023. Weekly TIR (65-140 mg/dL) was computed starting at 10 weeks' gestation, and joint latent-class trajectory modeling identified discrete TIR trajectory groups. Patients were classified into groups, and multivariable logistic regression estimated the associations between groups and perinatal outcomes.</p><p><strong>Results: </strong>Of 179 pregnant patients, 91 had type 1 and 88 had type 2 diabetes. We identified four TIR trajectory groups using data from over 5.1 million CGM measurements: 1) good control, stable (n=48), 2) moderate control, initial improvement and late decline (n=22), 3) moderate control, late improvement (n=63), and 4) poor control, initial worsening and late improvement (n=46). All perinatal outcomes differed by TIR trajectory. Groups 2, 3, and 4 with suboptimal control in early pregnancy were associated with higher odds of preterm birth, indicated preterm birth, and NICU admission, compared to group 1. Groups 3 and 4, which had the lowest TIR during second and early third trimesters, were associated with higher odds of LGA. Only group 4 was associated with higher odds of preeclampsia and neonatal hypoglycemia.</p><p><strong>Conclusions: </strong>Achieving glycemic control in the second and early third trimesters during fetal and placental growth and development is important to reduce the risk of adverse pregnancy outcomes, particularly LGA. Third trimester TIR decline may impact risk of preterm birth and NICU admission.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101669"},"PeriodicalIF":3.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651199","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 impact of an Informative video on anxiety levels in women undergoing term induction of labor: A randomized controlled trial.","authors":"Matan Friedman, Liat Mor, Irit Segman, Yossi Mizrachi, Noa Ben Shushan, Hagit Eisenberg, Tamar Shieldkrot, Eran Weiner, Giulia Barda","doi":"10.1016/j.ajogmf.2025.101667","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101667","url":null,"abstract":"<p><strong>Background: </strong>Induction of labor (IOL) is frequently performed worldwide. While IOL is often medically necessary to improve maternal and neonatal outcomes, the process can be associated with considerable anxiety, particularly for nulliparous women.</p><p><strong>Objective: </strong>To evaluate the impact of an informative educational video on anxiety levels among women undergoing term induction of labor (IOL).</p><p><strong>Methods: </strong>This randomized controlled trial included 167 women who underwent term IOL at a single medical center between April 2024 and August 2024. Participants in the 'video group' (n=81) watched an 8-minute animated video detailing IOL methods and risks in addition to standard counselling. Participants in the control group (n=86) only received standard counselling. Anxiety levels were measured using the State-Trait Anxiety Inventory (STAI) before and after the procedure. The primary outcome was the change in STAI scores. Secondary outcomes including patient satisfaction, as reported on a scale of one to five.</p><p><strong>Results: </strong>Baseline STAI scores before receiving any counselling regarding IOL were similar between the study groups. Post-procedure, women allocated to the video group demonstrated lower anxiety levels compared to women in the control group (38.9 ± 11.0 vs 44.1 ± 11.3, p=0.002). Moreover, the decrease in STAI scores was greater in the video group (4.4 ± 7.9 vs 0.6 ± 10.0, p=0.007). Multivariate analysis confirmed that the video intervention was independently associated with reduced anxiety (β -7.8, 95% CI -15.1 to -0.5). Finally, Patient satisfaction was also higher in the video group (4.4 ± 0.6 vs 4.1 ± 0.9, p=0.018).</p><p><strong>Conclusion: </strong>An informative educational video prior to IOL is an effective, low-cost intervention for reducing patient anxiety and improving satisfaction during labor induction.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101667"},"PeriodicalIF":3.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651227","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":"Letter to the Editor regarding 'Oxytocin Regimen Used for Induction of Labor and Pregnancy Outcomes': A Call for Refined Dosing Strategies in Nulliparous Labor Induction.","authors":"Binglin Li, Yueqi Feng, Ruijuan Chen","doi":"10.1016/j.ajogmf.2025.101670","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101670","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101670"},"PeriodicalIF":3.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651216","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":"Reduced Odds of Severe Maternal Morbidity Associated with the US Affordable Care Act Dependent Coverage Provision.","authors":"Jean Guglielminotti, Jamie R Daw, Alexander M Friedman, Goleen Samari, Guohua Li","doi":"10.1016/j.ajogmf.2025.101668","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101668","url":null,"abstract":"<p><strong>Background: </strong>Continuous perinatal health insurance coverage is a policy intervention that may help reduce severe maternal morbidity (SMM) and racial and ethnic disparities in SMM in the United States. The Affordable Care Act Dependent Coverage Provision (DCP) allowed young adults to remain on their parent's private health insurance plan until their 26^th birthday but its effectiveness in reducing SMM has not been evaluated.</p><p><strong>Objective: </strong>To assess the association of the DCP with SMM during delivery hospitalization.</p><p><strong>Study design: </strong>Difference-in-differences analysis of US delivery hospitalizations from January 2006 to September 2015, stratified according to maternal race and ethnicity. The outcome was SMM exclusive of blood transfusion only, as defined by the Centers for Disease Control and Prevention criteria. The exposure was maternal age categorized into 21 to 25 years (covered by the DCP) and 27 to 31 years (not covered the DCP). The intervention was the DCP categorized into pre- and post-DCP periods (January 2006-September 2010 and October 2010-September 2015, respectively).</p><p><strong>Results: </strong>Of the 4,007,937 delivery hospitalizations in the sample, 22,540 (56.2 per 10,000) recorded SMM. For birthing people aged 21-25 years (covered by the DCP), the mean SMM rate was 48.9 per 10,000 during the pre-DCP period and 58.2 per 10,000 during the post-DCP period (crude difference: 9.3 per 10,000). For birthing people aged 27-31 years (not covered the DCP), the mean SMM rate was 53.4 per 10,000 during the pre-DCP period and 63.6 per 10,000 during the post-DCP period (crude difference: 10.2 per 10,000). Implementation of DCP was associated with a 1.2% (95% CI: -3.6, 1.3) relative decrease in the mean SMM rate (adjusted odds ratio (aOR): 0.988; 95% CI: 0.964, 1.013). For non-Hispanic White people, the DCP was associated with a 10.7% (95% CI: 7.1, 14.2) relative decrease in the mean SMM rate (aOR: 0.893; 95% CI: 0.858, 0.929). The DCP was associated with an increase in the proportion of privately insured (aOR: 1.225; 95% CI: 1.220, 1.231), a decrease in the proportion of Medicaid beneficiaries (aOR: 0.853; 95% CI: 0.849, 0.856), and a decrease in the proportion of uninsured (aOR: 0.807; 95% CI: 0.798, 0.816).</p><p><strong>Conclusions: </strong>Maternal health benefit of the DCP appears to be limited to non-Hispanic White birthing people.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101668"},"PeriodicalIF":3.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626409","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":"Letter to the editor on: \"The essential role of the nurse in childbirth support\".","authors":"Tatiana Isabel Vásquez Figueroa, Doris Mariela Morales Córdova, Lilia Jannet Saldarriaga Sandoval","doi":"10.1016/j.ajogmf.2025.101664","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101664","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101664"},"PeriodicalIF":3.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597943","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":"Increasing dialogue surrounding controversies in antepartum management among trainees.","authors":"Sarah Boudova, Laurie Griffin, Carolina Martinez-King, John Soehl, Virginia Watkins, Tiffany Yang","doi":"10.1016/j.ajogmf.2025.101617","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101617","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101617"},"PeriodicalIF":3.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587594","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":"External Cephalic Version in Twin Pregnancies with Non-Vertex Presenting Twin.","authors":"Zvi Ehrlich, Vladimir Plotkin, Shirly Shapira, Ari Weiss, Alexander Ioscovich, Sorina Grisaru-Granovsky, Misgav Rottenstreich, Hen Y Sela","doi":"10.1016/j.ajogmf.2025.101663","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101663","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Objective Mode of delivery in twin pregnancies is primarily based on the presentation of the leading twin&lt;sup&gt;1&lt;/sup&gt;. When the leading twin is vertex, the recommendation is to attempt vaginal delivery, otherwise the recommended mode of delivery is cesarean delivery (CD)&lt;sup&gt;2&lt;/sup&gt;. In singleton pregnancies, external cephalic version (ECV) is a widely accepted procedure for non-vertex presentation, with a success rate of 50-70%&lt;sup&gt;3&lt;/sup&gt;. However, there is limited data on the safety and success of ECV in twin pregnancies&lt;sup&gt;4&lt;/sup&gt;. Thus, the goal of our study was to assess success rates of ECVs in twin pregnancies with a non-vertex leading twin as well as safety and rates of subsequent vaginal deliveries, in a prospective clinical trial and to further evaluate whether ECV influences the mode of delivery and associated maternal and neonatal outcomes. Study Design This was a prospective interventional trial with a historical control group conducted at a large tertiary medical center. The study included women with (DCDA) twin pregnancy with a non-vertex presenting twin, who were at a gestational age ≥ 37+0 weeks at the time of the planned elective CD or ECV, were 18 years or older, multiparous, with no previous CD and no contraindication for vaginal delivery. After obtaining informed consent, ECVs were performed in a controlled setting, in an operating room, under combined spinal-epidural anesthesia (CSE) by two obstetricians experienced in ECVs. Women with successful ECV underwent immediate induction of Labor (IOL), while those with unsuccessful ECV proceeded directly to CD. Maternal and neonatal outcomes of study participants were compared to an historical comparison group, retrospectively identified among women with DCDA twin pregnancies and similar characteristics, who were scheduled to undergo a planned elective CD. The primary outcome of the study was a composite adverse maternal and neonatal outcome. Secondary outcomes measured included individual maternal and neonatal adverse outcomes. A secondary analysis was conducted on the study group to identify factors associated with successful ECV in this group. Results A total of 55 women who met inclusion criteria agreed to undergo an ECV attempt (Study group). Of these, 4 (7.2%) had spontaneous onset of labor before scheduled ECV and underwent urgent CD. Of the remaining 51 women, twenty-nine (56.8%) had a successful ECV attempt and of these 25 (86.2%) had a successful vaginal delivery of both twins, while 22 (43.2%) had failed ECV attempt and underwent immediate CD. Maternal and neonatal characteristics of the study and control groups were similar (Table 1). There was no difference in rate of the composite adverse maternal & neonatal outcome between the groups (23.1% vs. 20%. P-value=0.69) (Table 2). CD rates were 54 % vs. 100% in the study and control group, respectively (P-value&lt;0.01). There was no increase in maternal or neonatal adverse outcomes between the groups. Length of stay w","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101663"},"PeriodicalIF":3.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587592","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":"Breast Stimulation vs. Low Dose Oxytocin for Labor Augmentation in Women with a Previous Cesarean Delivery, a Randomized Controlled Trial.","authors":"Raneen Abu Shqara, Gabriela Goldilfield, Tikva Assulyn, Inshirah Sgayer, Nadir Ganem, Lior Lowenstein, Maya Frank Wolf","doi":"10.1016/j.ajogmf.2025.101658","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101658","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Oxytocin and breast stimulation are methods used for labor augmentation in women with a previous cesarean delivery (CD). Compared to spontaneous labor, labor augmentation has been shown to increase the risk of uterine rupture in women with a previous CD. The optimal method of labor augmentation for women with a prior CD has not been established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;In a cohort of patients with one previous CD, we aimed to compare maternal and neonatal outcomes according to the method of labor augmentation; breast stimulation or intravenous oxytocin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This randomized controlled trial (RCT) was conducted at a single, tertiary, university-affiliated hospital. The participants had one previous CD and a cervical dilatation of 2-6 cm, had inadequate uterine contractions, defined as less than 3 per 10 minutes, and were candidates for labor augmentation. They were randomized for augmentation by breast stimulation using a breast pump, or by intravenous low-dose oxytocin starting at 0.5-2 milliunits/minutes, and increasing incrementally by 1-2 milliunits/minutes every 15-40 minutes.. An intrauterine pressure catheter was inserted. Both augmentation treatments were continued for a maximum of 12 hours. If active labor did not occur within 12 hours, the intervention was deemed a failure. An intention-to-treat analysis was performed. The co-primary outcomes were the time from augmentation to delivery, and uterine contraction intensity as measured by Montevideo units. Secondary outcomes included intervention failure, meconium-stained amniotic fluid, vaginal delivery after cesarean section, uterine rupture, infectious outcomes, postpartum hemorrhage, and maternal hospitalization length. The neonatal outcomes included: Apgar score at 5 minutes, umbilical cord pH&lt;7.1, neonatal intensive care unit admission, asphyxia, and perinatal death.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The breast stimulation and the intravenous oxytocin groups included 33 and 34 patients, respectively. The participants' demographic and obstetric characteristics were similar. The median time from augmentation to delivery was longer in the breast stimulation than the oxytocin group: 10.9 hours (total range 1.5-63.2) vs. 5.1 hours (0.8-30), p&lt;0.001. The median (range) contraction intensity as measured by Montevideo units was similar between the groups in the first stage of labor, 125 (70-270) vs. 180 (80-280), p=0.110; and in the second stage of labor, 145 (30-280), vs. 175 (50-290), p=0.164. The tachysystole rate was lower, with statistical significance, in the breast stimulation than the oxytocin group, 6% vs. 27%, p=0.044; while the rates of tachysystole-associated non-reassuring fetal heart rates did not differ significantly, 6% vs. 21%, p=0.427. . Similar proportions of patients delivered within 24 hours of intervention. Uterine rupture occurred in two patients in the oxytocin group (5.6%) and in none in the breast","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101658"},"PeriodicalIF":3.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587579","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":"Letter to Editor regarding 'Does combining warm perineal compresses with perineal massage during the second stage of labor reduce perineal trauma? A randomized controlled trial':Reevaluating Perineal Protection: The Impact of Warm Compresses and Perineal Massage during the Second Stage of Labor.","authors":"Ruijuan Chen, Jingni Zhao, Binglin Li","doi":"10.1016/j.ajogmf.2025.101662","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101662","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101662"},"PeriodicalIF":3.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574146","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":"Warm Compresses During Labor: Addressing Clinical Considerations.","authors":"Raneen Abu Shqara, Lior Lowenstein, Susana Mustafa Mikhail","doi":"10.1016/j.ajogmf.2025.101661","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101661","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101661"},"PeriodicalIF":3.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574149","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}