American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Cervical length nomograms for singleton pregnancies: a large-scale gestational analysis","authors":"Doron Kabiri MD, MPH, Roie Alter MD, Joshua I. Rosenbloom MD, MPH, Ofer Tadmor MD, Einav Kremer MD, MPH","doi":"10.1016/j.ajogmf.2024.101539","DOIUrl":"10.1016/j.ajogmf.2024.101539","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101539"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591740","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":"Vaginal progesterone for prevention of preterm birth in women with a history of preterm birth regardless of cervical length: an argument for use.","authors":"Charlette E Williams, Rupsa C Boelig","doi":"10.1016/j.ajogmf.2024.101565","DOIUrl":"10.1016/j.ajogmf.2024.101565","url":null,"abstract":"<p><p>It is well understood that preterm birth accounts for a substantial amount of poor neonatal outcomes. In 2022, preterm birth affected about 1 of every 10 infants born in the United States with complications ranging from mild respiratory distress syndrome to neonatal death. The complexity of the treatment is secondary to the fact that preterm birth is a multifactorial syndrome with intricate sociocultural factors that influence our racially disproportionate poor outcomes. One of the key risk factors for preterm birth is a history of spontaneous preterm birth. Currently, there are conflicting recommendations regarding the use of vaginal progesterone prophylactically for the prevention of recurrent preterm birth. As described in Practice Bulletin number 234 of the American College of Obstetricians and Gynecologists, the current recommendation is that patients with a singleton pregnancy and previous spontaneous preterm birth should be assessed with serial endovaginal ultrasound cervical length measurements to determine eligibility for vaginal progesterone. In contrast, the Society for Maternal-Fetal Medicine suggests the use of prophylactic vaginal progesterone with patient-centered counseling and shared decision-making. We aimed to present the rationale for the use of prophylactic vaginal progesterone in patients with singleton gestations and a history of spontaneous preterm birth.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101565"},"PeriodicalIF":3.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755436","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":"Nonsevere hypertensive disorders of pregnancy and oral antihypertensive medications: an argument in favor of use.","authors":"Lorena Carolina Martinez-King, Leah M Savitsky, Sherill Rose, Catherine Albright","doi":"10.1016/j.ajogmf.2024.101561","DOIUrl":"10.1016/j.ajogmf.2024.101561","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy are a common complication of pregnancy and a major contributor to both immediate and long-term morbidity and mortality. Recent data support the treatment of chronic hypertension during pregnancy to a blood pressure goal of <140/90 mmHg. Treatment of severe range blood pressures (≥160/110 mmHg) in the setting of gestational hypertension is recommended to prevent severe morbidity and mortality; however, there remains clinical equipoise regarding treatment of gestational hypertension with blood pressures ≥140/90 but <160/110. While there is limited data to support the treatment of gestational hypertension, we believe that treatment of gestational hypertension to a blood pressure of <140/90, similar to the recommendations for chronic hypertension, will lead to a reduction in severe maternal and neonatal morbidity and mortality related to hypertensive disorders of pregnancy. In this expert review, we summarize the available data regarding the treatment of gestational hypertension and offer recommendations for the treatment of gestational hypertension based on our clinical experience.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101561"},"PeriodicalIF":3.8,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740871","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":"Vaginal progesterone for prevention of preterm birth in women with a history of preterm birth regardless of cervical length: an argument against use.","authors":"Anthony Melendez Torres, Sarahn Wheeler","doi":"10.1016/j.ajogmf.2024.101571","DOIUrl":"10.1016/j.ajogmf.2024.101571","url":null,"abstract":"<p><p>Preterm birth, defined as birth before 37 weeks of gestation, has a significant public health effect as the most frequent cause of neonatal-related death and the second most frequent cause of infant-related death at the age of <5 years. Given the unclear and likely multifactorial etiologic nature of preterm birth, interventions to address this condition remain elusive. Progesterone supplementation was once considered a promising strategy for reducing preterm birth among patients with a history of previous preterm birth. However, more recent data suggesting limited efficacy led the United States Food and Drug Administration to revoke approval of 17-alpha hydroxyprogesterone caproate. Vaginal progesterone supplementation remains controversial. Recently published meta-analyses evaluating large, preregistered randomized controlled trials with low risk of bias and selective outcome reporting have found that recurrent preterm birth rates are not significantly reduced by vaginal progesterone supplementation in patients with a singleton pregnancy and previous history of spontaneous preterm birth. Furthermore, studies reporting any benefit from vaginal progesterone in this patient population are noted to have smaller sample sizes, higher risk of bias and selective outcome reporting, and low external validity. Therefore, our study argues against the universal use of vaginal progesterone supplementation for the prevention of recurrent preterm birth.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101571"},"PeriodicalIF":3.8,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740568","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":"\"Inpatient pharmacological thromboprophylaxis in the antepartum period: an argument for universal thromboprophylaxis\".","authors":"Julia Burd, Amanda Zofkie","doi":"10.1016/j.ajogmf.2024.101566","DOIUrl":"10.1016/j.ajogmf.2024.101566","url":null,"abstract":"<p><p>Venous thromboembolism (VTE), a largely preventable condition, accounts for almost 15% of maternal mortalities. The physiologic changes of pregnancy, including quantitative changes in coagulation factors and compression of vasculature by the gravid uterus, cause an increase in risk of VTE, including deep vein thromboembolism (DVT), pulmonary embolism, and stroke (CVA). Long term antepartum admission for preeclampsia, preterm prelabor rupture of membranes (PPROM) or other high-risk pregnancy needs present additional risk factors for VTE due to the patient's medical condition and their inpatient status. Given the near-universal support for anticoagulation in patients with a history of venous thromboembolism or high-risk thrombophilia, we will focus this work on patients generally considered low or moderate risk. As outpatients, we do not recommend anticoagulation for this lower risk population. However, with the increase in risk factors for VTE with prolonged admission, it is our general practice to discuss the risks, benefits, and alternatives of chemical VTE prophylaxis 72 hours after admission and recommend administration to all patients unless they have active vaginal bleeding or are at risk for imminent delivery. Here, we will argue why this strategy of universal VTE prophylaxis during antepartum admission with unfractionated heparin (UFH) or low-molecular weight heparin (LMWH) is ultimately in the best interest of patient safety.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101566"},"PeriodicalIF":3.8,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740869","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":"PPROM in the late preterm period: an argument for expectant management.","authors":"Derek Lee, Tara A Lynch","doi":"10.1016/j.ajogmf.2024.101563","DOIUrl":"10.1016/j.ajogmf.2024.101563","url":null,"abstract":"<p><p>Preterm prelabor rupture of membranes (PPROM) is associated with significant neonatal risks. When PPROM occurs during the late preterm period (between 34 0/7 and 36 6/7 weeks gestation), the optimal gestational age for delivery is unclear and varies by regional practice. In 2020 the American College of Obstetrician and Gynecologists (ACOG) published guidelines indicating that both expectant management and immediate delivery were considered reasonable options. Historically, studies that examined the topic of expectant management versus immediate delivery of PPROM after 34 weeks supported immediate delivery based on an observed increased risk of infectious complications without any benefit to neonatal outcome. However, these studies were small and were underpowered to detect a meaningful difference in neonatal outcomes. In this review, we examine 6 randomized controlled trials and 2 meta-analyses of randomized controlled trials that investigated neonatal and maternal outcomes of expectant management versus immediate delivery of late preterm PROM. Included in this analysis are 3 recent randomized controlled trials (PPROMEXIL, PPROMEXIL2, and PPROMT) and 2 meta-analyses that demonstrate a decreased risk of respiratory distress syndrome and NICU admission rate with expectant management. This is counterbalanced by an increased risk of chorioamnionitis with expectant management, but definitions of chorioamnionitis are variable in the trials with unclear generalizability of the outcome across the trials. Additional analysis with a childhood outcome study showed no significant difference in neurodevelopment in infants born to expectant management of late preterm PROM, and an economic analysis found that expectant management was associated with lower delivery and neonatal costs. Overall, we support expectant management of late preterm PROM if maternal and fetal status are stable and there are no contraindications to expectant management but not extending beyond 37 0/7 weeks gestation.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101563"},"PeriodicalIF":3.8,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739660","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":"Aspirin dosage for preeclampsia prophylaxis: an argument for 81-mg dosing.","authors":"Kimen S Balhotra, Baha M Sibai","doi":"10.1016/j.ajogmf.2024.101568","DOIUrl":"10.1016/j.ajogmf.2024.101568","url":null,"abstract":"<p><p>Research conducted over the past few decades has shown that low-dose aspirin can effectively reduce the risk of developing preeclampsia. Consequently, numerous prominent organizations have adopted the recommendation to use low-dose aspirin during pregnancy to prevent preeclampsia. However, the optimal dosage of low-dose aspirin (81mg versus 162mg) remains a subject of debate. Currently, there is insufficient high-quality data to justify the use of a higher dosage of low-dose aspirin. In this review, we review the existing evidence that supports the continued use of 81mg of aspirin over a higher dose and emphasize the need for high-quality research to alter current recommendations.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101568"},"PeriodicalIF":3.8,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717308","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":"Inpatient pharmacological thromboprophylaxis in the antepartum period: an argument for risk-based thromboprophylaxis.","authors":"Jerome J Federspiel","doi":"10.1016/j.ajogmf.2024.101567","DOIUrl":"10.1016/j.ajogmf.2024.101567","url":null,"abstract":"<p><p>Venous thromboembolism (VTE) is a significant cause of maternal morbidity and mortality in the United States. People hospitalized during pregnancy for reasons other than routine birth (ie, during antepartum admissions) are at increased risk of VTE compared with nonhospitalized obstetric patients, but there is no consensus regarding which patients should receive thromboprophylaxis during antepartum hospitalizations as the absolute event rates are low and anticoagulation can complicate antepartum management. We argue that an approach informed by individualized patient risk assessment is likely to produce the greatest net benefit for patients. Such an approach would avoid the pitfalls of universal pharmacologic prophylaxis (potential to interfere with unplanned delivery or receipt of neuraxial anesthesia) among patients for whom the absolute risk of VTE is low. In contrast, approaches that withhold pharmacologic prophylaxis from all antepartum patients likely place some at significant risk of VTE. We outline the arguments against universal pharmacologic thromboprophylaxis and against universal avoidance of pharmacologic thromboprophylaxis and discuss a risk-based approach proposed at our institution. Finally, we outline a research agenda for identification of optimal antepartum anticoagulation strategies.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101567"},"PeriodicalIF":3.8,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717313","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":"Management of cervical cerclage after preterm premature rupture of membranes: an argument for removal.","authors":"Fabrizio Zullo, Daniele Di Mascio","doi":"10.1016/j.ajogmf.2024.101570","DOIUrl":"10.1016/j.ajogmf.2024.101570","url":null,"abstract":"<p><p>Cervical cerclage is a widely used intervention to prevent preterm birth in high-risk pregnancies. However, cerclage is associate with risks, including preterm premature rupture of membranes and subsequent complications, such as chorioamnionitis. Our review evaluates the evidence for immediate removal (ie, removal at the time of diagnosis) vs retention of cervical cerclage (ie, removal when clinically indicated) after preterm premature rupture of membranes, focusing on optimizing neonatal outcomes and minimizing maternal and fetal complications. A meta-analysis on the topic that included 169 patients in the \"removal\" group and 208 in the \"retention\" group showed that the rates of pregnancy prolongation >48 hours and >7 days were significantly lower in the group who underwent immediate removal of cerclage than in the group who had delayed removal of cerclage (pregnancy prolongation >48 hours: 47% vs 85%, respectively; odds ratio, 0.15; pregnancy prolongation >7 days: 33% vs 57%, respectively; odds ratio, 0.30). In addition, pregnancy latency was significantly lower, despite the absolute mean difference being only 2.84 days. However, the rates of chorioamnionitis and Apgar score <7 at 5 minutes were significantly lower in the immediate removal group than in the retention group (chorioamnionitis: 29% vs 41%, respectively; odds ratio, 0.57; Apgar score <7 at 5 minutes: 16% vs 43%, respectively; odds ratio, 0.22). A proposed balanced approach involves retaining the cerclage for approximately 24 hours after premature rupture of membranes (PROM) to permit steroid administration (initial dose followed by a second dose after 24 hours) before removal. This strategy aims to maximize steroid benefits while minimizing the risks of prolonged cerclage retention, potentially achieving a correct timing that optimizes neonatal outcomes without significantly increasing complications This management approach could be beneficial in situations where immediate removal may preclude full steroid benefits. Our recommendations support a protocol balancing appropriate timing for steroid administration with the risks of extended cerclage retention, namely, chorioamnionitis, unless further randomized controlled trials will show the proper evidence-based management in this clinical scenario.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101570"},"PeriodicalIF":3.8,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717315","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":"Nonsevere hypertensive disorders of pregnancy and oral antihypertensive medications: an argument against use.","authors":"Laurie B Griffin, Rachel Sinkey, Alan Tita, Dwight J Rouse","doi":"10.1016/j.ajogmf.2024.101560","DOIUrl":"10.1016/j.ajogmf.2024.101560","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, affect approximately 13% of all pregnancies and are a major cause of maternal and neonatal morbidity and mortality worldwide. Although the treatment of preeclampsia with severe features has been well established on the basis of randomized controlled data, international society guidelines vary on the treatment of gestational hypertension and preeclampsia without severe features. The American College of Obstetricians and Gynecologists recommends against the use of antihypertensive agents for nonsevere hypertension (blood pressure of <160/110 mm Hg) in both gestational hypertension and preeclampsia without severe features given a lack of level 1 evidence in support of treatment and the theoretical risk of masking of disease progression or causing adverse fetal effects, such as growth restriction. However, with the publication of the Chronic Hypertension in Pregnancy trial, (CHAP) which demonstrated the benefit of treatment of nonsevere chronic hypertension, \"indication creep\" or the application of a treatment outside the population of proven benefit is being observed with the use of antihypertensive medication for the treatment of nonsevere hypertension in gestational hypertension and preeclampsia without severe features. The use of antihypertensive treatment in this population without a definitive trial and no clearly defined safety protocols is potentially dangerous and could, at worst, lead to maternal and fetal harm or, at best, provide benefit in ways that are hard to assess and, thus, interfere with efforts to generate definitive evidence to change practice guidelines, denying many pregnant patients optimal care. It is imperative that a definitive trial be performed performed prior to the widespread use of antihypertensive treatment for gestational hypertension or preeclampsia without severe features.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101560"},"PeriodicalIF":3.8,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716693","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}