American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Cesarean delivery and childhood respiratory outcomes.","authors":"Christine Field, Jessica A DE Voest, Robert A Wise, Alan T N Tita, Sharon A McGrath-Morrow, Elizabeth C Matsui, Sean C Blackwell, Monica Longo, Dwight J Rouse, Torri D Metz, George R Saade, William A Grobman, Kent D Heyborne, John M Thorp, Kelly S Gibson, Geeta K Swamy, Yasser Y El-Sayed, Cynthia Gyamfi-Bannerman","doi":"10.1016/j.ajogmf.2026.102160","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.102160","url":null,"abstract":"<p><strong>Background: </strong>Childhood asthma and respiratory illness are health concerns that result in a significant burden on children, their families, and the healthcare system. Prior research has demonstrated an association between CD and short-term neonatal adverse respiratory outcomes, but less is known about the potential impact of mode of delivery on long-term respiratory outcomes.</p><p><strong>Objective: </strong>To investigate whether there is an association between cesarean delivery (CD) and childhood respiratory outcomes.</p><p><strong>Study design: </strong>Secondary analysis of a prospective, follow-up study of children delivered in the Antenatal Late Preterm Steroids study. Children were included if their mother was enrolled in the follow-up study and had data available for the primary outcome at age 6 or greater. The primary exposure was CD. The primary outcome was a composite of adverse childhood respiratory outcomes: abnormal spirometry, parent-reported diagnosis of asthma or of another chronic respiratory illness, or inpatient admission for respiratory illness. It was planned a priori to assess whether results differed according to whether or not CD occurred after evidence of labor. Log-binomial regression was used to calculate unadjusted and adjusted relative risks (RR), with vaginal delivery as the referent group.</p><p><strong>Results: </strong>Of 1,218 children enrolled in the follow-up study, 833 (68.4%) delivered vaginally and 385 (31.6%) by CD. The median gestational age at delivery was 36.1 (IQR 35.4-36.6) for those born by CD and 36.0 (IQR 35.3-36.7) for children delivered vaginally (p=0.90). Children born by CD had lower birth weight, were more likely to be small-for-gestational-age, have respiratory distress syndrome, and to be admitted to the neonatal intensive care unit, and were less likely to be breastfed. Women of children born by cesarean delivery were older and more likely to have private insurance. The median age at follow-up was 7 years in those born vaginally as well as in those born by CD. There was no difference in the primary outcome between children born by CD and those born vaginally (48.6% vs. 41.5%; adjusted relative risk (aRR) 1.14; 95% confidence interval (CI): 0.99, 1.31), although those born by CD were more likely to have had wheezing or whistling in the chest (49.4% vs. 40.2%; aRR 1.17; 95% CI: 1.02-1.34). There was no evidence that the association between CD and the primary composite outcome differed according to whether or not the CD was performed after labor.</p><p><strong>Conclusion: </strong>Delivery via cesarean in children who were at risk for late preterm delivery was not associated with the primary composite of adverse respiratory outcomes.</p><p><strong>Tweetable statement: </strong>Delivery via cesarean was not associated with a composite of adverse childhood respiratory outcomes.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"102160"},"PeriodicalIF":3.6,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216883","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":"Eucapnic pH versus Arterial Umbilical Cord pH may improve identification of Adverse Postnatal Outcomes in a cohort of non-acidemic newborns.","authors":"Alessandro Petrecca, Elvira Di Pasquo, Silvio Tartaglia, Beatrice Di Marco, Sergio Ferrazzani, Caterina Neri, Carlo Piscicelli, Francesco Pomini, Roberta Rullo, Beatrice Valentini, Giovanni Vento, Tullio Ghi","doi":"10.1016/j.ajogmf.2026.102164","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.102164","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"102164"},"PeriodicalIF":3.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208097","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":"Pregnancy and Offspring Outcomes After Prenatal Stimulant or Atomoxetine Exposure: A Systematic Review and Meta-analysis.","authors":"Rinat Komargodski, Abeer Tillawe, Maya Berlin, Ilan Matok","doi":"10.1016/j.ajogmf.2026.102165","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.102165","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate associations of prenatal exposure to stimulants and atomoxetine for attention-deficit/hyperactivity disorder with pregnancy, congenital, perinatal, and neurodevelopmental outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to March 2026. Protocol was registered in the International Prospective Register of Systematic Reviews (CRD42024506319).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study eligibility criteria: &lt;/strong&gt;Randomized trials and observational studies comparing pregnancies or offspring exposed to stimulant medications, methylphenidate- or amphetamine-based agents, or atomoxetine with unexposed comparators and reported outcomes were eligible.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study appraisal and synthesis methods: &lt;/strong&gt;Reporting guidance for systematic reviews and observational meta-analyses was followed. Two reviewers screened studies, extracted data, and assessed quality with the Newcastle-Ottawa Scale. Random-effects meta-analyses pooled unadjusted and adjusted estimates separately. For neurodevelopmental outcomes, comparators restricted to attention-deficit/hyperactivity disorder populations were prioritized when available.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-five studies were included; 23 contributed to quantitative analyses. Exposure windows included periconceptional, first-trimester, early-, late-, or continued-pregnancy exposure. Exposure was associated with major congenital malformations in unadjusted analyses (risk ratio, 1.25; 95% confidence interval, 1.14-1.37), but not after adjustment (adjusted risk ratio, 1.04; 95% confidence interval, 0.97-1.12). No adjusted association was observed with cardiovascular malformations (adjusted risk ratio, 1.20; 95% confidence interval, 0.88-1.63), although methylphenidate showed a modest increase (adjusted risk ratio, 1.33; 95% confidence interval, 1.01-1.74). In adjusted analyses, exposure was not associated with miscarriage, preterm birth, low birth weight, small for gestational age, neonatal intensive care unit admission, neurodevelopmental disorders, autism spectrum disorder, or offspring attention-deficit/hyperactivity disorder. Low 5-minute Apgar score remained associated with exposure after adjustment (adjusted risk ratio, 1.21; 95% confidence interval, 1.03-1.42). Lower adjusted autism spectrum disorder risk with stimulants was not replicated in methylphenidate-specific analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Prenatal exposure to stimulants or atomoxetine for attention-deficit/hyperactivity disorder was not associated with increased adjusted risk of major congenital malformations or most adverse pregnancy, perinatal, and neurodevelopmental outcomes. Attenuation of crude associations after adjustment suggests confounding by indication, residual confounding, and maternal characteristics. The observed associations between methylphenidate and cardiovascular malformations and between exposure and low 5","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"102165"},"PeriodicalIF":3.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208100","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":"Transabdominal Cerclage: Who, When, How.","authors":"Shivani Rao, Patrick Teefey, Stefania Crovella, Vincenzo Berghella","doi":"10.1016/j.ajogmf.2026.102161","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.102161","url":null,"abstract":"<p><p>Transabdominal cerclage (TAC) was devised over 60 years ago with several controlled studies and a randomized controlled trial (RCT) evaluating its safety and efficacy. TAC has biologic rationales for being more effective than transvaginal cerclage (TVC) given its sterile placement higher in the cervix at the level of the internal os. TAC decreases recurrent preterm birth (PTB) in patients with a prior spontaneous PTB (SPTB) < 28 weeks despite a transvaginal (TV) history-indicated cerclage (HIC) or ultrasound-indicated cerclage (UIC), as supported by level 1 data, and should be offered to these patients. The supportive data are on open TAC (OTAC) or laparoscopic TAC (LTAC), done pre-pregnancy or in-pregnancy in the 1st trimester in patients with a normal (not short or dilated) cervix. The data on other indications are too limited to recommend TAC for other clinical scenarios. Pregnancy outcomes are excellent with both pre-pregnancy and in-pregnancy TAC. For both LTAC and OTAC, there is some evidence that pre-pregnancy timing is associated with better pregnancy outcomes and lower complications than in-pregnancy OTAC. After meticulous pre-operative planning ensuring proper TAC indication and an experienced surgeon, the LTAC, possibly robotically, technique should be preferred. LTAC has been associated with the best outcomes when performed pre-pregnancy. This outpatient procedure does not usually require other peri-operative interventions and has a very quick recovery period. Complications of TAC are uncommon (<5%), and lower with LTAC compared to OTAC. Fertility rates after pre-pregnancy TAC are excellent and compare well to the general population or appropriate controls. During pregnancy, patients with TAC in place should be started on vaginal progesterone at 16 weeks. In cases of early pregnancy loss, an MVA or D&E can usually be feasible through the TAC. Planned CD at 38 weeks is usually recommended with TAC left in situ. Transvaginal removal of a TAC is feasible, especially when the suture has been placed using a technique that anchors the knot vaginally, and may be considered in patients who desire vaginal birth and have completed childbearing. TAC can usually be safely left in place after pregnancy, helping prevent PTB in multiple future pregnancies.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"102161"},"PeriodicalIF":3.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208184","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":"Is earlier better? Revisiting the timing of aspirin for the prevention of preeclampsia.","authors":"Piya Chaemsaithong, Liona C Poon","doi":"10.1016/j.ajogmf.2026.102133","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.102133","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"102133"},"PeriodicalIF":3.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196575","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 REMOAT Feasibility Study: Remote Electronic Monitoring for Antenatal Testing.","authors":"Marta Perez, Miriam Alvarez, Vaishnavi Kankate, Alison Cahill, Lorie Harper","doi":"10.1016/j.ajogmf.2026.102163","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.102163","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"102163"},"PeriodicalIF":3.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196659","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":"Secondary analysis of the Lower Uterine Segment Trial: a pragmatic hypothesis-generating study, methodological relevance, and response to further considerations (reply to letter to the editor).","authors":"Jeremy Boujenah, Patrick Rozenberg","doi":"10.1016/j.ajogmf.2026.102155","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.102155","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"102155"},"PeriodicalIF":3.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196510","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":"Improvement of pregnancy outcome following primary CMV infection after the introduction of valacyclovir in the clinical practice in Italy, updated data from a large real-life multicenter study.","authors":"Lorenzo Zammarchi, Anna Beltrami, Giuseppina Liuzzi, Federica Ciccone, Filippo Lagi, Beatrice Borchi, Lucia Pasquini, Elisabetta Venturini, Luisa Galli, Nigritella Brianese, Lina Rachele Tomasoni, Sofia Lovatti, Vania Spinoni, Serena Messali, Antonella Vimercati, Francesco Di Gennaro, Sara Daleno, Maria Teresa Tassone, Daniele Lilleri, Milena Furione, Piera d'Angelo, Alessia Arossa, Giuseppe Maria Maruotti, Laura Letizia Mazzarelli, Serena Salomè, Francesco Raimondi, Sara Ornaghi, Francesca Arienti, Federica Fernicola, Mariateresa Sinelli, Carolina Saffioti, Erica Ricci, Alessio Mesini, Francesca Ippolita Calò Carducci, Leonardo Caforio, Giulia Lorenzetti, Carlo Torti, Maria Merelli, Paolo Fusco, Licia Bordi, Gabriella Rozera, Antonella Giancotti, Stefano Ghirardello, Maria Grazia Capretti, Alessandro Bartoloni, Anna Seidenari, Camilla Dionisi, Giuliana Simonazzi, Michele Trotta, Tiziana Lazzarotto","doi":"10.1016/j.ajogmf.2026.102156","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.102156","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Congenital cytomegalovirus infection (cCMV) is a leading cause of neurodevelopmental impairment and congenital sensorineural hearing loss (SNHL). Since December 2020, valacyclovir (VCV) is reimbursed by the Italian National Health System to reduce maternal-fetal CMV transmission following primary CMV maternal infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study is to evaluate the effectiveness of VCV in preventing fetal CMV infection, termination of pregnancy, miscarriage, congenital CMV infection at birth and presence of signs/symptoms of cCMV in newborns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;The current study provides an update on previously published data from a large multicenter observational Italian study including women with primary CMV infection acquired during the periconceptional period and up to 24 gestational weeks between January 2010 and June 2025. Primary outcomes are CMV transmission at amniocentesis, termination of pregnancy, miscarriage, transmission at birth (positive CMV DNA on newborn's urine), symptomatic cCMV, and a composite outcome (occurrence of transmission at amniocentesis or at birth or termination of pregnancy or miscarriage).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 832 women were included (826 singletons and 8 sets of twin pregnancies, total 842 fetuses); 588 fetuses received prenatal VCV (576 singletons and 6 twins) and 254 were untreated (248 singletons and 4 twins). CMV-positive amniocentesis occurred in 17.2% (64/373) of VCV-treated fetuses compared with 27.9% (38/136) of untreated one (p=0.007, aOR 0.53 [95%CI 0.34, 0.85]).Termination of pregnancy and miscarriage occurred in 4.7% (26/555) and 0.7% (4/555) of treated fetuses versus 10.0% (25/250) and 1.6% (4/250) of untreated one, respectively (p=0.004, aOR 0.46 [95%CI 0.25, 0.78] and p=0.24, aOR 0.45 [95%CI 0.11, 1.80]). Neonatal CMV DNA in urine was detected in 23.7% (124/525) and 27.1% (60/221) of newborns from treated and untreated pregnancies, respectively (p=0.31, aOR 0.83 [95%CI 0.58, 1.19]). The prevalence of symptomatic congenital infection at birth was significantly less frequent in the VCV group (3.6% 19/525 vs. 9.9% 22/221, p=0.001, aOR 0.34 [95%CI 0.18, 0.64]). The composite outcome occurred less frequently in treated pregnancies (27.2% vs. 35.8%, p = 0.012, aOR 0.67 [95%CI 0.49, 0.91]). VCV-related adverse events were reported in 6.7% of cases and were mild or moderate. The diagnosis of cCMV infection at birth following a negative amniocentesis was not significantly different among treated and untreated pregnancies (12.9%, 36/280 versus 7.3%, 7/96; p = 0.139). In the group of treated pregnancies with negative amniocentesis the proportion of newborn with cCMV diagnosed at birth was 23.2% (19 of 63), 10.9% (11 of 90) and 6.3% (6 of 90) among those with seroconversion, positive lgG-IgM and low IgG avidity and positive lgG-IgM and intermediate IgG avidity and positive molecular test respectively (p=0.003).&lt;","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"102156"},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184386","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":"Limits of Machine Learning for Predicting Stillbirth at Term: A Population-Based Cohort of 302,192 Pregnancies in Northern Italy.","authors":"M Benuzzi, T Kawakita, F Monari, B Melis, G Guariglia, A La Marca, I Neri, G Saade, F Facchinetti, I El Moudden","doi":"10.1016/j.ajogmf.2026.102148","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.102148","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Stillbirth at term is a major public-health concern. In high-income settings, the most commonly identifiable causes are unrecognised fetal growth restriction (about 14%) and placental abruption (about 12%), but 20 to 40% of term stillbirths remain unexplained. Whether modern machine learning can substantively improve prediction over established clinical risk-factor models is unresolved.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the predictive performance of three machine-learning models, elastic-net logistic regression, random forest, and extreme gradient boosting, for stillbirth at term in a population-based cohort, and to quantify the achievable ceiling using static registry variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Secondary analysis of 302,192 term pregnancies (322 stillbirths; rate 1.07 per 1,000), recorded in the Emilia-Romagna \"Certificato di Assistenza al Parto\" birth registry between 2014-2023. Three machine-learning models were trained on a stratified 80% training set with class rebalancing by Random Over-Sampling Examples applied within each cross-validation fold. Logistic-regression predicted probabilities were rescaled to natural prevalence by intercept-only Platt-style recalibration on a held-out training slice. Performance was evaluated on the held-out 20% test set (n=60,438; 66 stillbirths) using area under the receiver operating characteristic curve (AUC-ROC), area under the precision-recall curve (AUC-PR), sensitivity, specificity, predictive values (Wilson 95% CIs), calibration intercept and slope, observed:expected (O:E) ratio, and decision curve analysis. Sensitivity analyses included a head-to-head comparison with the previously published Salerno (2023) logistic regression specification, complete-case and missing-as-zero analyses, feature ablation, refitting without class rebalancing, bootstrap optimism correction, and temporal validation (training 2014-2021; test 2022-2023).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;On the test set, elastic-net logistic regression achieved AUC 0.658 (0.589-0.726), XGBoost AUC 0.617 (0.544-0.690), and random forest AUC 0.534 (0.470-0.597). All three fell below the AUC of 0.70 threshold for clinical screening. Logistic regression significantly outperformed random forest (DeLong p=0.001). Positive predictive values at Youden-optimal thresholds were within Wilson-interval distance of the population baseline (0.106%). Decision curve analysis showed no model produced net benefit superior to a treat-all strategy at clinically plausible thresholds. After intercept recalibration, the logistic regression was well calibrated in the large (observed:expected ratio 1.12, 95% CI 0.88 to 1.43). Gestational age, particularly early-term delivery, was the most influential predictor across models. Temporal validation degraded all three AUCs to 0.57 to 0.58. The previously published Salerno (2023) logistic regression specification achieved AUC 0.637 on the same test set, only 0.0","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"102148"},"PeriodicalIF":3.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167009","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 perineal warm compress implementation on obstetric anal sphincter injury: initial evaluation of a quality improvement project.","authors":"Yannay Khaikin, Olivia Smith, Melissa G Walker, Kellie E Murphy, Kuan Liu, Sebastian R Hobson","doi":"10.1016/j.ajogmf.2026.102150","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.102150","url":null,"abstract":"<p><strong>Background: </strong>Obstetric anal sphincter injury (OASI) is a severe complication of vaginal birth. Perineal warm compress during the second stage of labor has been shown to decrease the rate of OASI in randomized controlled trials.</p><p><strong>Objectives: </strong>This retrospective study evaluated the outcomes of a Quality Improvement (QI) project whose aim was to increase the use of warm compress on a labor and delivery unit at a tertiary-care center.</p><p><strong>Study design: </strong>We included all vaginal births ≥24+0 weeks' gestation occurring on the labor and delivery unit in the thirteen months before (June 2023 to June 2024) and after initiation of a QI project (July 2024 to July 2025). The primary outcomes were warm compress use and the OASI rate. A run chart was utilized to plot the monthly use of warm compress. The OASI proportion was compared before and after the QI project using a chi-squared test. The impact of warm compress exposure with covariate adjustment, either before or during the QI project, was evaluated using inverse probability of treatment weighting. Relative risk (RR) of OASI with 95%CI and p-values were reported. The analysis was repeated for a high risk subgroup: primiparous births occurring at term.</p><p><strong>Results: </strong>8415 vaginal births were included: 4272 before and 4143 during the QI project. Covariates were similar between the two periods. 4299 (51%) of births were among primiparous participants delivering at term. Warm compress documentation increased during the project (mean: 17.9% vs. 45.6%); however, there was consistent rise in the year prior to project start. Warm compress use was higher among term primiparous births throughout the study. OASI proportion was lower during the QI project, but this was not statistically significant (all vaginal births: 4.6% vs. 4.0%, p=.2; term primiparous births: 7.8% vs. 6.3%, p=.06). After Adjusting for covariates, warm compress exposure was associated with a lower risk of OASI among term primiparous births (aRR=0.77, 95% CI 0.59 to 0.99, p=.04), but not all vaginal births (aRR=0.88, 95% CI 0.70 to 1.10, p=.26).</p><p><strong>Conclusion: </strong>Initial implementation of perineal warm compress did not significantly reduce the rate of OASI. Adjusted analysis showed that warm compress exposure modestly reduced the risk of OASI among first vaginal births at term, but not all vaginal births.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"102150"},"PeriodicalIF":3.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168338","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}