American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Obstetrical management and outcomes of female genital mutilations in a high resource expert center","authors":"Audrey Bediat, Konstantinos Chatzistergiou MD, Jean Baptiste Chanier, Gregory Bierry MD, Bruno Renevier MD, Sarah Abramowicz MD , Simon Crequit MD","doi":"10.1016/j.ajogmf.2025.101695","DOIUrl":"10.1016/j.ajogmf.2025.101695","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101695"},"PeriodicalIF":3.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037588","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":"A randomized controlled trial of propranolol in nulliparous patients with prolonged labor","authors":"Yaneve N. Fonge MD ,&nbsp;Helen B. Gomez Slagle MD ,&nbsp;Richard J. Caplan PhD ,&nbsp;Ellen L. Myers MD ,&nbsp;Roxana Portillo ,&nbsp;Anthony C. Sciscione DO","doi":"10.1016/j.ajogmf.2025.101698","DOIUrl":"10.1016/j.ajogmf.2025.101698","url":null,"abstract":"<div><h3>Background</h3><div>Propranolol use has been proposed to shorten the length of labor following prolonged induction.</div></div><div><h3>Objective</h3><div>We sought to determine if administration of propranolol reduces the duration of labor among nulliparous individuals with prolonged latent labor following induction (IOL) at term.</div></div><div><h3>Study Design</h3><div>An open-label randomized clinical trial was conducted from July 2019 through June 2022 comparing 2mg of intravenous propranolol administration to usual care for prolonged latent labor. Nulliparous individuals undergoing IOL at ≥37 weeks with a singleton gestation and cervical dilation ≤2cm were included. Prolonged latent labor was defined as no cervical change ≥8 hours with ruptured membranes and receiving oxytocin. Labor management was standardized among participants. Our primary outcome was time to delivery.</div></div><div><h3>Results</h3><div>80 nulliparous participants (40 propranolol, 40 usual care) were randomized. Propranolol administration did not achieve a significantly faster median time to delivery compared to usual care, (propranolol: 27.7 hrs vs. usual care: 30.4 hrs, <em>P&lt;.</em>52). Equal proportions of individuals delivered vaginally within 24hrs of randomization (propranolol: 27.5% vs. usual care: 27.5%, <em>P&lt;</em>1.0). There was no difference in the cesarean delivery rate between the 2 groups (57.5% versus 55.0%, <em>P</em>=1.0) and no difference in time to active labor (propranolol: 19.5 hrs vs. usual care: 26.0 hrs, <em>P&lt;.</em>22). There were no significant differences in maternal and neonatal outcomes.</div></div><div><h3>Conclusion</h3><div>Propranolol administration did not shorten the time to delivery or increase vaginal delivery in nulliparous individuals with a prolonged latent labor course. Our findings do not support the use of propranolol for prolonged latent labor in nulliparous patients undergoing IOL at term.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101698"},"PeriodicalIF":3.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027611","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":"Diagnosis of hypertensive disorders in pregnancy","authors":"Rebecca Horgan MD ,&nbsp;Yara Hage Diab MD ,&nbsp;Maged Costantine MD ,&nbsp;George Saade MD ,&nbsp;Baha Sibai MD","doi":"10.1016/j.ajogmf.2025.101693","DOIUrl":"10.1016/j.ajogmf.2025.101693","url":null,"abstract":"<div><div>Hypertensive disorders of pregnancy, including chronic hypertension (CHTN), superimposed preeclampsia, gestational hypertension, and preeclampsia, affect 10% to 20% of pregnancies and are a significant cause of maternal and perinatal morbidity and mortality. The incidence of these disorders is increasing because of factors, such as advanced maternal age, obesity, assisted reproductive technology, and increased rates of preexisting comorbidities. Differentiating pregnancy-associated hypertension from preexisting CHTN is challenging, as the overlap between the 2 may be broadening because of the changing demographics of the pregnant population. This review critically evaluated the evidence regarding the current periods recommended to make a diagnosis of a hypertensive disorder of pregnancy. This review does not provide evidence to support the arbitrary 4-hour period or any particular period for the diagnosis of hypertensive disorders in pregnancy. In addition, there is no clear definition of what is considered persistent or sustained blood pressure elevations in blood pressure. Every effort should be made to ensure accurate diagnosis of new-onset elevated blood pressures during pregnancy before labeling the patient with the diagnosis and, thus, recommending serial maternal and fetal testing and delivery at or before 37 weeks of gestation.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101693"},"PeriodicalIF":3.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036842","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 care in the neonatal intensive care unit, PeliCaN: a randomized controlled trial","authors":"Heather H. Burris MD, MPH ,&nbsp;Niesha Darden ,&nbsp;Maggie Power BSN,CNM ,&nbsp;Laura Walker BA ,&nbsp;Rachel Ledyard MPH ,&nbsp;Joseph Reiter MS ,&nbsp;Jennifer Lewey MD, MPH ,&nbsp;Kimberly K. Trout PhD, RN, CNM ,&nbsp;Marie Tan BA ,&nbsp;Emily F. Gregory MD, MPH ,&nbsp;Sara B. DeMauro MD, MSCE ,&nbsp;Scott A. Lorch MD, MSCE ,&nbsp;Lori Christ MD ,&nbsp;Sara C. Handley MD, MSCE ,&nbsp;Diana Montoya-Williams MD, MSHP ,&nbsp;Celeste Durnwald MD","doi":"10.1016/j.ajogmf.2025.101689","DOIUrl":"10.1016/j.ajogmf.2025.101689","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Postpartum parents of hospitalized infants in neonatal intensive care units have higher rates of chronic disease and pregnancy complications than parents of well newborns. Neonatal intensive care unit parents may prioritize remaining at their infants’ bedsides over their healthcare.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to determine whether embedding doulas and certified nurse midwives for postpartum care in the neonatal intensive care unit (PeliCaN) would reduce the time to receive postpartum healthcare, with the hypothesis that the intervention would shorten the time and improve the comprehensiveness of postpartum care.</div></div><div><h3>STUDY DESIGN</h3><div>This was a parallel randomized controlled trial from November 29, 2022, to November 7, 2023, in a single-center, level 3 neonatal intensive care unit in a tertiary hospital in Philadelphia, Pennsylvania, with approximately 4200 births annually. Postpartum parents of infants who were born at &lt;34 weeks of gestation, &lt;2 weeks old, and anticipated to remain in the neonatal intensive care unit ≥1 week, were eligible. Of the 135 potentially eligible parents, the staff screened 78 for eligibility (constrained by access to just 4 hours per week of midwifery care), contacted 52 of 71 eligible parents, and enrolled 37 by 2 weeks after delivery. There were 20 parents randomized to the intervention group and 17 parents randomized to the control group via block randomization stratified by gestational age (&lt;29 and ≥29 weeks) and insurance (public and private). The intervention consisted of postpartum doula support and midwifery clinical care in the neonatal intensive care unit for the duration of the infant’s hospitalization. Participants in the control group received usual care. The outcomes were measured at 12 weeks after delivery. All participants had complete follow-up data. The primary outcome was days to receive any postpartum care and to completion of 3 care components: blood pressure measurement and treatment if needed; depression screening and referral and treatment if indicated; and contraception counseling (if no sterilization procedure had been performed) and provision if patients desired. Planned secondary analyses included stratification by gestational age and insurance as well as assessing the rates of any postpartum care receipt.</div></div><div><h3>RESULTS</h3><div>Six participants (30.0%) in the intervention group and 6 participants (35.0%) in the control group were parents of infants born at &lt;29 weeks of gestation, and 16 participants (80.0%) in the intervention group and 15 participants (88.2%) in the control group were publicly insured. The median times to the first postpartum visit were 11 days (interquartile range, 10–12) in the intervention group and 31 days (interquartile range, 26–37) in the control group (<em>P</em>&lt;.001). In addition, 1 participant (5%) in the intervention group and 6 participants (35%) in the co","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101689"},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042280","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":"Impact of iron deficiency without anemia on pregnancy outcomes: a pilot study","authors":"Madison R. Klavans MD,&nbsp;Emily Fronk MD,&nbsp;Laura Parsons MD,&nbsp;Christian Chisholm MD","doi":"10.1016/j.ajogmf.2025.101687","DOIUrl":"10.1016/j.ajogmf.2025.101687","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101687"},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032493","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":"Vascular effects of a hypertensive disorder of pregnancy antepartum and postpartum: the EPOCH study","authors":"Mark A. Hlatky MD,&nbsp;Jonathan A. Mayo MPH,&nbsp;Seda Tierney MD,&nbsp;Hayley E. Miller MD,&nbsp;Oshra Sedan PhD,&nbsp;Marcia L. Stefanick PhD,&nbsp;Mads Melbye MD, DrMed,&nbsp;Heather A. Boyd PhD,&nbsp;David K. Stevenson MD,&nbsp;Gary M. Shaw DrPH,&nbsp;Virginia D. Winn MD, PhD","doi":"10.1016/j.ajogmf.2025.101692","DOIUrl":"10.1016/j.ajogmf.2025.101692","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101692"},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044391","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":"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}