American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Effectiveness of a cervical pessary in prolongation of pregnancy after an arrested episode of preterm labor: a systematic review and individual patient data meta-analysis","authors":"Sofie H. Breuking MD, PhD ,&nbsp;Annemijn A. De Ruigh MD, PhD ,&nbsp;Carme Merced MD ,&nbsp;Rik Van Eekelen PhD ,&nbsp;Madelon Van Wely PhD ,&nbsp;Charlotte E. Van Dijk MD ,&nbsp;Laia Pratcorona MD, PhD ,&nbsp;Elena Carreras MD, PhD ,&nbsp;Ben W. Mol MD, PhD ,&nbsp;Gabriele Saccone PhD, MD ,&nbsp;Eva Pajkrt MD, PhD ,&nbsp;Maria Goya MD, PhD ,&nbsp;Frederik J. Hermans MD, PhD","doi":"10.1016/j.ajogmf.2025.101690","DOIUrl":"10.1016/j.ajogmf.2025.101690","url":null,"abstract":"<div><h3>Background</h3><div>Randomized controlled Trials (RCTs) show conflicting results on the effectiveness of a cervical pessary after an arrested episode of preterm labor (PTL) aiming to prolong pregnancy.</div></div><div><h3>Objective</h3><div>To assess the effectiveness of a cervical pessary in prolongation of pregnancy after an arrested episode of PTL by utilizing individual participant data (IPD) meta-analysis.</div></div><div><h3>Data sources</h3><div>Databases Central, Embase, Medline, and clinical trial databases (ClinicalTrials.gov, ISRCTN, EU-CTR) were searched from inception until January 2024.</div></div><div><h3>Study Eligibility Criteria</h3><div>Randomized controlled trials investigating individuals between 24⁺⁰ and 34⁺⁰ weeks of gestation with an arrested episode of PTL and who were subsequently randomized to cervical pessary or no intervention.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>Studies were assessed for data integrity and risk of bias. Main outcomes were prolongation of pregnancy &gt;7 days, interval between randomization and delivery, and a composite of adverse neonatal outcome. A one-step meta-analysis approach was employed, and the intention-to-treat principle was applied.</div></div><div><h3>Results</h3><div>Four RCTs had IPD available. In singleton pregnancies (total <em>N</em>=546; 275 individuals in the pessary group, 271 individuals in the control group), pessary placement did not decrease delivery risk within 7 days (relative risks [RR] 0.87; 95% confidence intervals [CI] 0.40–1.9), prolong pregnancy (mean differences 4.5 days; 95% CI –0.08 to 9.0), nor reduce the risk of adverse neonatal outcomes (RR 0.95; 95% CI 0.53–1.7). The incidence of readmissions for a new episode of PTL was significantly less frequent in the cervical pessary group (RR 0.66, 95% CI 0.50–0.85). Two studies investigating multiple pregnancies (<em>N</em>=167, 84 individuals in the pessary group, 83 individuals in the control group) were identified, showing contradictory results that could not be explained by study differences. Therefore, merging IPD and pooling of was uninformative.</div></div><div><h3>Conclusion</h3><div>In individuals with a singleton pregnancy with an episode of PTL between 24 and 34 weeks of gestational age, pessary placement does not prevent delivery within 7 days, preterm birth, or neonatal outcomes. A pessary might reduce the probability of readmissions for PTL.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101690"},"PeriodicalIF":3.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High- vs low-dose oxytocin protocols for labor induction: a systematic review and meta-analysis","authors":"Jennifer L. Grasch MD ,&nbsp;Maged M. Costantine MD, MBA ,&nbsp;Alison G. Cahill MD, MSCI ,&nbsp;Akila Subramaniam MD, MPH ,&nbsp;Moeun Son MD, MSCI ,&nbsp;Nandini Raghuraman MD, MSCI ,&nbsp;William A. Grobman MD, MBA ,&nbsp;Heather A. Frey MD, MSCI","doi":"10.1016/j.ajogmf.2025.101691","DOIUrl":"10.1016/j.ajogmf.2025.101691","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review aimed to synthesize available literature reporting maternal and neonatal outcomes of induction of labor using high- vs low-dose oxytocin protocols.</div></div><div><h3>Data Sources</h3><div>PubMed, Embase, Scopus, CINAHL, and Cochrane databases, and ClinicalTrials.gov were searched from inception to January 17, 2023.</div></div><div><h3>Study Eligibility Criteria</h3><div>Studies with the following criteria were included: randomized or observational studies conducted with pregnant individuals, published in English, that compared low-dose (starting dose 0.5–2 milliunits/min increased by 1–2 milliunits/min every 15–40 minutes) vs high-dose (≥4 milliunits/min increased by 3–6 milliunits/min every 15–40 minutes) oxytocin infusion protocols for induction of labor. Studies of individuals with fetal death were excluded.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>Two reviewers independently extracted data and appraised study quality following the PRISMA guidelines and using the Cochrane risk of bias assessment tools. The primary outcome was cesarean delivery. Secondary outcomes included spontaneous vaginal delivery, operative vaginal delivery, duration of labor induction, uterine tachysystole, and maternal and neonatal morbidity outcomes. Pooled relative risks (RR) with 95% confidence intervals (CI) were calculated using random-effects models. Heterogeneity was assessed statistically using the Higgins’ <em>I</em>² test and visually using a funnel plot.</div></div><div><h3>Results</h3><div>Six studies (two randomized controlled trials, four observational studies) were included, encompassing 7850 deliveries (3957 in the high-dose group and 3893 in the low-dose group). Overall, there was no difference in the risk of cesarean delivery following induction of labor with a high-dose oxytocin protocol compared with a low-dose protocol (26.0% vs 28.4%, pooled RR 1.02, 95% CI 0.85–1.21). There were also no differences in the likelihood of cesarean delivery for nonreassuring fetal status or neonatal morbidity, or in the duration of labor. Induction with high-dose oxytocin was associated with a lower frequency of postpartum hemorrhage, compared with a low-dose protocol (7.6% vs 9.9%, RR 0.78, 95% CI 0.66–0.92). Details of high- and low-dose protocols varied widely between studies, which all were at medium or high risk of bias. There was moderate heterogeneity (<em>I</em>²=45.5%), and no evidence of publication bias (Harbord test, <em>P</em>=.74).</div></div><div><h3>Conclusions</h3><div>A synthesis of the existing literature demonstrates no difference in the frequency of cesarean delivery following induction of labor using a high- vs low-dose oxytocin protocol. However, this review highlights the methodological limitations of the few available published studies and the need for high-quality trials to guide optimal oxytocin dosing for labor induction.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101691"},"PeriodicalIF":3.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053232","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 it not time to propose a maternal-fetal definition of fetal growth restriction specifically linked to maternal vascular malperfusion of the placenta?","authors":"Lionel Carbillon MD, PhD","doi":"10.1016/j.ajogmf.2025.101629","DOIUrl":"10.1016/j.ajogmf.2025.101629","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101629"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433721","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":"Preference on sources of obstetric and mental health education among perinatal people with Medicaid insurance: a qualitative study","authors":"Liana Lum BA,&nbsp;Katrina Ursinobared BA,&nbsp;Melissa Guillen BA,&nbsp;Crystal F. Ware BSN, CCRP,&nbsp;Nina K. Ayala MD, ScM,&nbsp;Melissa L. Russo MD,&nbsp;Margaret M. Thorsen MD,&nbsp;Kate M. Guthrie PhD,&nbsp;Emily S. Miller MD, MPH,&nbsp;Adam K. Lewkowitz MD, MPHS","doi":"10.1016/j.ajogmf.2025.101640","DOIUrl":"10.1016/j.ajogmf.2025.101640","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101640"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433741","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 “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 MD,&nbsp;Jingni Zhao MD,&nbsp;Binglin Li MD","doi":"10.1016/j.ajogmf.2025.101662","DOIUrl":"10.1016/j.ajogmf.2025.101662","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101662"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","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":"Letter to Editor regarding “The association between perinatal depressive symptoms and child neurodevelopment”","authors":"Ajeng Ayu Widiastuti,&nbsp;Nur Eva,&nbsp;Lanny Wijayaningsih,&nbsp;Kriswandani Kriswandani,&nbsp;Rizky Andana Pohan,&nbsp;Riza Amalia,&nbsp;Margaretta Erna Setianingrum","doi":"10.1016/j.ajogmf.2025.101641","DOIUrl":"10.1016/j.ajogmf.2025.101641","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101641"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484499","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 MD,&nbsp;Lior Lowenstein MD,&nbsp;Susana Mustafa Mikhail MD","doi":"10.1016/j.ajogmf.2025.101661","DOIUrl":"10.1016/j.ajogmf.2025.101661","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101661"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","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}

{"title":"Obstetrics and gynecology: a beautiful paradox","authors":"Sara Sereno MD","doi":"10.1016/j.ajogmf.2025.101651","DOIUrl":"10.1016/j.ajogmf.2025.101651","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101651"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469335","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":"Reply: Enhancing diagnostic approaches for placental dysfunction in fetal growth restriction","authors":"Maria J. Rodriguez-Sibaja MD,&nbsp;Jimena Lopez-Diaz MD,&nbsp;Mario I. Lumbreras-Marquez MD, MMSc","doi":"10.1016/j.ajogmf.2025.101630","DOIUrl":"10.1016/j.ajogmf.2025.101630","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101630"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374895","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":"Oxytocin regimen used for induction of labor and pregnancy outcomes","authors":"Parker G. Allan MD,&nbsp;Kailee N. May MD,&nbsp;Amir L. Butt MD, MPH,&nbsp;Christine T. Vo MD","doi":"10.1016/j.ajogmf.2025.101645","DOIUrl":"10.1016/j.ajogmf.2025.101645","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101645"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433733","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}