American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Cerclage in singleton pregnancies with no prior spontaneous preterm birth and short cervix: a randomized controlled trial","authors":"Rupsa C. Boelig MD , Chiara Tersigni MD, PhD , Nicoletta Di Simone MD, PhD , Gabriele Saccone MD , Fabio Facchinetti MD , Giovanni Scambia MD , Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2025.101602","DOIUrl":"10.1016/j.ajogmf.2025.101602","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Preterm birth remains a leading cause of neonatal morbidity and mortality. Cerclage for short cervical length ≤25 mm in patients with singleton pregnancies with a history of spontaneous preterm birth is associated with decreased neonatal morbidity/mortality. Both vaginal progesterone and cerclage individually have level 1 evidence supporting benefit in the prevention of preterm birth in pregnancies complicated by short cervical length. However, there is a paucity of level 1 evidence regarding the potential benefit of cerclage with progesterone relative to progesterone alone for short cervical length ≤25 mm in patients with singleton pregnancies without a history of spontaneous preterm birth.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to conduct a pragmatic randomized controlled trial to evaluate the additional benefit of cerclage with vaginal progesterone relative to vaginal progesterone alone in patients with singleton pregnancies without prior spontaneous preterm birth and with a current midtrimester transvaginal ultrasound cervical length ≤25 mm.</div></div><div><h3>STUDY DESIGN</h3><div>This was a multicenter international randomized controlled trial conducted from September 2017 to September 2023, involving 4 sites in the United States and Italy. Patients with singleton pregnancies without prior spontaneous preterm birth received transvaginal ultrasound cervical length (universal) screening during the midtrimester anatomy ultrasound examination as part of routine care. Inclusion criteria included transvaginal ultrasound cervical length ≤25 mm at 18 0/7 to 23 6/7 weeks. Exclusion criteria included current or planned cerclage, cervical dilation, symptoms of labor, infection, bleeding, and rupture of membranes at screening. Participants were randomized in a 1:1 ratio to cerclage with vaginal progesterone (200-mg vaginal progesterone daily) or vaginal progesterone alone. Randomization was stratified by study site and transvaginal ultrasound cervical length ≤15 mm. The primary outcome was preterm birth <35 weeks, assessed using intention-to-treat analysis. Secondary outcomes included preterm birth <37, 32, 28, and 24 weeks, gestational age at delivery, latency to delivery, and neonatal outcomes. Categorical variables were compared using the Pearson chi-square test and relative risk estimates with 95% confidence intervals. Continuous variables were compared using the Mann–Whitney U test. Latency to delivery and gestational age at delivery were also compared using Kaplan–Meier survival curves. Planned enrollment was set at N=206 on the basis of an estimated 0.54 relative risk with cerclage and a 34% incidence of preterm birth with standard care. The trial was registered on ClinicalTrials.gov (NCT03251729) on June 22, 2017.</div></div><div><h3>RESULTS</h3><div>Enrollment ran from September 22, 2017 to October 31, 2023, and was halted early because of lagging enrollment. A total of 93 participants were ","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101602"},"PeriodicalIF":3.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068385","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":"Postpartum furosemide for accelerating recovery in patients with preeclampsia: a randomized placebo-controlled trial","authors":"Telma Cursino MD, PhD ,&nbsp;Leila Katz MD, PhD ,&nbsp;Isabela Coutinho MD, PhD ,&nbsp;Alex Sandro Rolland de Souza MD, PhD ,&nbsp;Thais Valeria Silva MD, PhD ,&nbsp;Anna Catharina Carneiro da Cunha MD, MS ,&nbsp;Melania Amorim MD, PhD","doi":"10.1016/j.ajogmf.2025.101614","DOIUrl":"10.1016/j.ajogmf.2025.101614","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Preeclampsia is a major hypertensive disorder of pregnancy that may lead to severe complications, particularly in the first 2 weeks of the postpartum period. Blood pressure during the postpartum period remains high and often increases to levels higher than those observed during pregnancy. Furosemide, a fast-acting diuretic, reduces intravascular volume overload and may represent an alternative to accelerate the normalization of blood pressure levels.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to evaluate the effectiveness of furosemide compared with a placebo for blood pressure control in the postpartum period in women with severe preeclampsia.</div></div><div><h3>STUDY DESIGN</h3><div>In a triple-masked placebo-controlled randomized clinical trial, postpartum women with de novo preeclampsia with severe features or eclampsia diagnosed during pregnancy and adequate diuresis who had received magnesium sulfate were randomized to receive furosemide (40 mg/d orally for 5 days) or a placebo. The primary outcome was mean blood pressure. The secondary outcomes were frequency of severe hypertensive episodes, continued need for antihypertensives, number of antihypertensives used to control blood pressure, length of hospital stay, adverse effects, and maternal complications. A sample size of 120 patients was estimated, 60 in each arm of the study, based on the estimated difference between the mean systolic pressure of 142±12 mm Hg for the furosemide group and 153±19 mm Hg for the placebo group.</div></div><div><h3>RESULTS</h3><div>Between June 20, 2014, and November 30, 2014, 271 women were screened, and 120 were randomized to the furosemide or placebo groups, of which 118 were included in the final analysis (58 in the furosemide group and 60 in the placebo group). Most characteristics were similar between the groups. The mean daily systolic and diastolic pressures were lower in the furosemide group (<em>P</em>&lt;.001), and there were fewer episodes of severe hypertension on the second (<em>P</em>=.04) and fifth (<em>P</em>=.04) days of the postpartum period. In addition, a shorter time was required until blood pressure was controlled (<em>P</em>=.01) in the furosemide group.</div></div><div><h3>CONCLUSION</h3><div>Compared with placebo, 40 mg/d of oral furosemide in patients with preeclampsia reduced the mean daily systolic blood pressure in the first and fifth days of the postpartum period and mean daily diastolic blood pressure in the first, second, and fifth days of the postpartum period and the time required for blood pressure control.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101614"},"PeriodicalIF":3.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053864","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":"Novel machine learning applications in peripartum care: a scoping review","authors":"Shani Steinberg MD ,&nbsp;Melissa Wong MD, MHDS ,&nbsp;Eyal Zimlichman MD, MSc ,&nbsp;Abraham Tsur MD, MBA","doi":"10.1016/j.ajogmf.2025.101612","DOIUrl":"10.1016/j.ajogmf.2025.101612","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Machine learning (ML), a subtype of artificial intelligence (AI), presents predictive modeling and dynamic diagnostic tools to facilitate early interventions and improve decision-making. Considering the global challenges of maternal, fetal, and neonatal morbidity and mortality, ML holds the potential to enable significant improvements in maternal and neonatal health outcomes. We aimed to conduct a comprehensive review of ML applications in peripartum care, summarizing the potential of these tools to enhance clinical decision-making and identifying emerging trends and research gaps.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Sources&lt;/h3&gt;&lt;div&gt;We conducted a scoping review on MEDLINE, Cochrane Library, and EMBASE databases from inception to April 2024. We gathered additional relevant studies through snowball sampling. We meticulously screened titles and abstracts and chose full-text articles for further analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Eligibility Criteria&lt;/h3&gt;&lt;div&gt;We included primary research articles and abstracts focusing on pregnant individuals, employing ML methods for peripartum care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Appraisal and Synthesis Methods&lt;/h3&gt;&lt;div&gt;No formal quality assessment was performed. Data were extracted using a custom template to capture study characteristics and ML models. Findings were synthesized using summary tables and figures to highlight key trends and results.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 406 studies, 78% were published within the last five years. Most studies originated from high-income or well-resourced countries, with 27% from North America (including 24% from the United States) and 34% from Asia, predominantly China (18%). Studies from low- and middle-income regions were notably scarce, reflecting significant regional disparities. Predictive modeling tasks were the most prevalent (59%), followed by classification tasks (29%). Supervised learning dominated (90%), with algorithms such as Support Vector Machines, Random Forests, and Logistic Regression most commonly used. Key topics included fetal distress and acidemia (32%), preterm birth (22%), mode of delivery (13%), and birth weight (13%). Notably, Explainable AI methods were utilized in only 19% of studies, and external validation was performed in just 5%. Despite these advancements, only 1% of models resulted in accessible clinical tools, and none were fully integrated into healthcare systems.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;ML holds significant potential to enhance peripartum care by improving diagnostic accuracy and predictive capabilities. However, realizing this potential requires responsible AI practices, including robust validation with external datasets, prospective investigations across diverse populations, and the development of digital and data infrastructure for seamless integration into electronic health records. Additionally, transparent AI that provides insights into risk stratification logic is essential for clinician ","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 3","pages":"Article 101612"},"PeriodicalIF":3.8,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cochrane update: news and reviews from the Cochrane US network","authors":"Erin Plummer BS ,&nbsp;Shayesteh Jahanfar PhD ,&nbsp;Tiffany Duque MPH, RDN ,&nbsp;Jeanne-Marie Guise MD, MPH, MBA ,&nbsp;David M. Haas MD, MS","doi":"10.1016/j.ajogmf.2025.101611","DOIUrl":"10.1016/j.ajogmf.2025.101611","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 3","pages":"Article 101611"},"PeriodicalIF":3.8,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042182","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":"Treatment for anxiety, depression, and stress in pregnant people experiencing antepartum hospitalization: a systematic review and meta-analysis","authors":"John R. Soehl MD ,&nbsp;Kathryn Anthony MD ,&nbsp;Adam K. Lewkowitz MD, MPHS ,&nbsp;Lauren Fletcher MLIS, MA ,&nbsp;L.G. Ward PhD ,&nbsp;Emily S. Miller MD, MPH","doi":"10.1016/j.ajogmf.2025.101613","DOIUrl":"10.1016/j.ajogmf.2025.101613","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically evaluate inpatient interventions to reduce symptoms of anxiety, depression, or stress in pregnant individuals during antepartum hospitalization.</div></div><div><h3>Data Sources</h3><div>Searches were conducted in Ovid MEDLINE, Embase, CINAHL Plus, Cochrane CENTRAL, and PsycINFO from database inception through April 2023.</div></div><div><h3>Study eligibility criteria</h3><div>Randomized controlled trials and cohort studies were eligible for inclusion if an intervention was compared to treatment as usual (TAU) to reduce symptoms of anxiety, depression, or stress among pregnant individuals admitted to a hospital's antepartum unit.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>Two authors independently screened all abstracts for eligibility and reviewed all potentially eligible full-text articles for inclusion. The primary outcome was the score on the assessment for symptoms of anxiety, depression, or stress after the intervention. The Hedges method was used to detect standardized mean difference (SMD) in studies using different psychometric scales, and weighted mean differences (WMD) were used in studies using the same psychometric scales. Risk of bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions.</div></div><div><h3>Results</h3><div>Of 1185 articles originally identified, 19 full-text manuscripts were reviewed, and 3 studies (all randomized controlled studies)—corresponding to 226 patients randomized to an intervention and 263 patients randomized to TAU—were included. Compared to TAU, interventions significantly reduced mean scores on validated scales assessing symptoms of anxiety (SMD –0.65 [95% Confidence Interval (CI) –0.83, –0.46]), depression (WMD –0.52 [95% CI –0.76, –0.28]), and stress (WMD -0.57 [95% CI –0.82, –0.31]).</div></div><div><h3>Conclusion</h3><div>Though data are limited, interventions given to birthing people who experience antepartum hospitalization modestly—but significantly—reduce symptoms of anxiety, depression, and stress. These data highlight a need for further high-quality trials to support the mental health needs of this high-risk population.</div></div><div><h3>Funding</h3><div>This project was supported by the Department of Maternal Fetal Medicine at the Alpert School of Medicine of Brown University. AKL was supported by NICHD (K23HD103961). ESM was supported by NICHD (R01HD105499) and NINR (R01NR021126-01). LGW was supported by K23HD107296-01A1 and P20GM139767.</div></div><div><h3>Systematic Review Registration</h3><div>PROSPERO, CRD42023444189</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 3","pages":"Article 101613"},"PeriodicalIF":3.8,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042202","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":"Effect of a perineal protection device in vacuum-assisted births: a prospective randomized controlled interventional trial","authors":"Knut Haadem MD, PhD","doi":"10.1016/j.ajogmf.2025.101615","DOIUrl":"10.1016/j.ajogmf.2025.101615","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101615"},"PeriodicalIF":3.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029918","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":"Author reply to the letter to the editor regarding “Effect of a perineal protection device in vacuum-assisted births - a prospective randomized controlled interventional trial”","authors":"Nina Kimmich MD","doi":"10.1016/j.ajogmf.2025.101616","DOIUrl":"10.1016/j.ajogmf.2025.101616","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101616"},"PeriodicalIF":3.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029980","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":"Paracetamol prior to catheter balloon insertion for labor induction—A randomized controlled trial","authors":"Maya Frank Wolf MD ,&nbsp;Inshirah Sgayer MD ,&nbsp;Raneen Abu Shqara MD ,&nbsp;Karina Naskovica MD ,&nbsp;Fatina Kassis MA ,&nbsp;Nataly Kushnir MA ,&nbsp;Miri Lavinsky MA ,&nbsp;Nasra Idilbi PhD ,&nbsp;Lior Lowenstein MD","doi":"10.1016/j.ajogmf.2025.101610","DOIUrl":"10.1016/j.ajogmf.2025.101610","url":null,"abstract":"<div><h3>Background</h3><div>Assessing maternal pain and satisfaction following administration of paracetamol vs. placebo prior to catheter balloon placement.</div></div><div><h3>Methods</h3><div>Primiparous women at term admitted for medically-indicated labor induction were randomized to receive intravenous paracetamol 1 gram in 100cc normal saline (N=71) or placebo of 100cc normal saline (N=70) prior to catheter balloon insertion. The women were blinded to the intervention allocation. Primary outcomes were visual analog scale (VAS) scores and maternal satisfaction, assessed via questionnaire.</div></div><div><h3>Results</h3><div>Pre-induction maternal pain did not differ between the paracetamol and placebo groups. Median VAS scores at 2, 30, and 60 minutes after catheter insertion were comparable between the groups: 6.46±2.77 vs. 6.66±2.78, <em>P=.</em>68; 5.53±3.20 vs. 5.93±3.01, <em>P=.</em>46; and 5.83±3.25 vs. 6.49±2.88, <em>P=.</em>26, respectively. For the paracetamol vs. placebo group, the mean sum of VAS scores was lower (4.39 vs. 5.37, <em>P=.</em>045) and the proportion with a mean VAS score &lt;5 was higher (65.2% vs. 44.1%, <em>P=.</em>016). This difference persisted in a multivariate logistic regression analysis adjusted for maternal age (OR=2.2, 95% CI 1.1–4.5, <em>P=.</em>036). After balloon insertion, relatively fewer women in the paracetamol vs. placebo group showed immobility (33.8% vs 50.0%, <em>P=.</em>037) and needed analgesics (31.3% vs. 66.1%, <em>P</em>&lt;.001). Maternal satisfaction score was similar between the groups (<em>P=.</em>877). Cervical ripening, duration from catheter insertion to delivery, and labor and neonatal outcomes did not differ significantly between the groups.</div></div><div><h3>Conclusions</h3><div>The administration of paracetamol compared with placebo prior to catheter balloon insertion was associated with lower VAS score and less analgesic use and maternal immobility.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101610"},"PeriodicalIF":3.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030001","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":"Cervical balloon catheter versus Dilapan-S for outpatient cervical ripening: A randomized controlled trial.","authors":"Rachel L Wood, Clarissa Bluemm, Sarah C Lassey, Sarah E Little","doi":"10.1016/j.ajogmf.2025.101608","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101608","url":null,"abstract":"<p><strong>Background: </strong>As induction of labor increases in the United States, safe, effective outpatient cervical ripening has been explored as a method to decrease the inpatient time burden. The most effective method of outpatient mechanical cervical ripening remains unclear.</p><p><strong>Objective: </strong>To evaluate if Dilapan-S is non-inferior to cervical balloon for outpatient cervical ripening (CR) based on change in Bishop score.</p><p><strong>Study design: </strong>This was a single-blind, randomized controlled trial at a single tertiary hospital. Term patients, both nulliparous and multiparous, aged 18-50 with a singleton, cephalic fetus and no prior c-section who were scheduled for outpatient CR per pre-existing hospital policy were eligible. Participants were randomized to single balloon cervical ripening with a Cook catheter with 60mL in the intrauterine balloon or placement of 3 to 5 Dilapan-S hydroscopic dilators and were then discharged home. On return to the hospital, the CR agent was removed, a blinded cervical exam performed, and participants completed a satisfaction survey. Further induction proceeded per their obstetrical provider. The primary outcome was change in Bishop score. Secondary outcomes included patient satisfaction, mode of delivery, induction time, adverse maternal and neonatal outcomes and a cervical ripening failure composite (failure to place randomized cervical ripening agent, prelabor rupture of membranes prior to scheduled return to hospital, significant vaginal bleeding, or need for further cervical ripening after the initial agent is removed) .We had 80% power to show non-inferiority in change in Bishop score with a margin of 2 and standard deviation of 3.</p><p><strong>Results: </strong>From May 2022 to June 2023, 80 participants were randomized with no difference in baseline demographic data, starting dilation, or Bishop score. 70% of participants in each arm were nulliparous. There was no difference in change in Bishop score between Dilapan-S and cervical balloon (median change 3 (interquartile range (IQR) 2-5) vs 3 (IQR2-4.5) respectively, p=0.91). There was no difference in time to delivery, mode of delivery, or maternal or neonatal outcomes. Participants randomized to Dilapan-S were more satisfied with their experience (satisfaction scale 0-10, median 9 (IQR 8-10) vs 8 (IQR 5-9), p<0.01) and were less likely to experience cervical ripening failure (7(17.5%) vs 18(45%), p<0.01) compared to participants who were randomized to cervical balloon.</p><p><strong>Conclusions: </strong>Dilapan-S was non-inferior to cervical balloon catheter for outpatient cervical ripening based on change in Bishop score. Participants were more satisfied with Dilapan-S and less likely to experience cervical ripening failure compared to a cervical catheter with single balloon inflation.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101608"},"PeriodicalIF":3.8,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013215","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":"Nitroglycerine for retained placenta: a meta-analysis of randomized controlled trials","authors":"Alessandro Petrecca MD ,&nbsp;Gabriele Saccone MD ,&nbsp;Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2025.101605","DOIUrl":"10.1016/j.ajogmf.2025.101605","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effect of nitroglycerine on placenta delivery after retained placenta.</div></div><div><h3>Design</h3><div>Systematic review with meta-analysis.</div></div><div><h3>Data Sources</h3><div>MEDLINE, PROSPERO, Scopus, ClinicalTrials.gov, EMBASE, Sciencedirect, the Cochrane Library, Scielo were searched from their inception until February 2024.</div></div><div><h3>Eligibility criteria for selecting studies</h3><div>We included all randomized clinical trials comparing use of nitroglycerine (i.e. intervention group) with placebo or with no treatment (i.e. control group) given for retained placenta after vaginal delivery.</div></div><div><h3>Data synthesis</h3><div>The primary outcome was rate of manual removal of the placenta. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% of confidence interval (CI).</div></div><div><h3>Results</h3><div>Four trials, including 1,279 pregnancies, were analyzed. The quality of the RCTs included was moderate. Pooled results showed that administration of nitroglycerine in women with retained placenta after vaginal delivery was associated with similar incidence of manual removal compared to control (89% vs 90%; RR 0.94, 95% CI 0.74 to 1.20). We also found similar mean postpartum blood loss, and no significant differences in the incidence of drop of hb &gt; 15 or 30%, need for uterotonics.</div></div><div><h3>Conclusions</h3><div>Use of nitroglycerine in women with retained placenta after vaginal delivery did not reduce the use of manual removal of the placenta</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 6","pages":"Article 101605"},"PeriodicalIF":3.8,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013238","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}