American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Cervical dilation staging and early preterm birth risk after exam-indicated cerclage: A Retrospective Cohort Study with the International Collaborative for Cerclage Longitudinal Evaluation and Research (IC-CLEAR).","authors":"Keely L Robinson, Rupsa C Boelig, Sarah Boudova, Amanda Roman, Julio Mateus, Joanne N Quiñones Rivera, Joseph Bell, Jennifer Tymon, Mónica Rincón, Leonardo Pereira, Richard Burwick, Luisa López-Torres, Jose Bareno-Silve, Catalina Valencia, Jorge E Tolosa","doi":"10.1016/j.ajogmf.2025.101782","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101782","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth is a leading cause of neonatal morbidity and mortality. The risk of preterm birth, especially early preterm birth, and pregnancy loss is significantly increased in patients with premature cervical dilation. An intervention to reduce risk of preterm birth in this setting is cerclage, however, counseling on risk of preterm birth and neonatal outcomes based on different cervical examination findings at time of cerclage placement is difficult given limited data evaluating these differences.</p><p><strong>Objective: </strong>We aimed to determine how the cervical exam staging criteria by Roman et al. (2023) prior to placement of exam-indicated cerclage was associated with risk of very early preterm birth<28 weeks.</p><p><strong>Methods: </strong>This is a retrospective analysis utilizing the International Collaborative-Cerclage Longitudinal Evaluation and Research (IC-CLEAR) database, a multi-center international retrospective database of singleton pregnancies that received a cerclage. Our study included participants who received a physical examination-indicated cerclage. The predictor of interest was cervical stage assessed pre-operatively, evaluated as an ordinal variable with progressive severity indicated by advancing stage- Stage 3 (visually closed, manually dilated with palpable membranes), Stage 4A (visually dilated, membranes seen but not to external os), Stage 4B (visually dilated, membranes at external os), Stage 4C (visually dilated, membranes past external os). The primary outcome was preterm birth <28 weeks gestation. Secondary outcomes included preterm birth <34 weeks, preterm birth <37 weeks, and latency from cerclage placement to delivery. Multivariate analysis was conducted adjusting for study site, prior preterm birth, gestational age at cerclage placement, use of perioperative antibiotics or indomethacin, and progesterone use after cerclage placement.</p><p><strong>Results: </strong>The analysis included 81 patients who had placement of a physical examination-indicated cerclage and met the inclusion criteria. The number of patients in Stages 3, 4A, 4B, and 4C were 17, 27, 25, and 12, respectively. Multivariate analysis revealed advanced cervical stage is significantly associated with preterm birth <28 weeks (overall p-value 0.003). Rates of preterm birth <28 weeks by stage were: 3 (11.7%), 4A (25.9%), 4B (44.0%), 4C (75.0%). Adjusted odds ratio for preterm birth by progressive cervical stage compared to Stage 3 were: Stage 4A (aOR 2.4, 95% CI 2.4 (0.31-19.25), P=0.40), Stage 4B (aOR 8.7, 95% CI (1.2-63.9), P=0.03), Stage 4C (aOR 43.73, 95% CI (3.3-572.2), P=0.004). Latency to delivery after cerclage decreased with increasing Roman stage, although this was only statistically significant for Stage 4C.</p><p><strong>Conclusion: </strong>Cervical staging based on dilation and degree of membrane prolapse helps risk stratify patients presenting with advanced cervical dilation with successful c","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101782"},"PeriodicalIF":3.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081665","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":"Compassion in the face of fear: a clinical imperative for maternal-fetal medicine","authors":"Michael R. Foley MD","doi":"10.1016/j.ajogmf.2025.101778","DOIUrl":"10.1016/j.ajogmf.2025.101778","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 11","pages":"Article 101778"},"PeriodicalIF":3.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065859","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":"Once a multipara, always a multipara? Impact of prolonged inter-delivery interval on induction outcomes.","authors":"Eileen Wang-Koehler, Lisa D Levine, Rebecca F Hamm","doi":"10.1016/j.ajogmf.2025.101780","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101780","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101780"},"PeriodicalIF":3.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065823","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":"Broken-finding strength and value in imperfection: a reflection from a maternal-fetal medicine physician.","authors":"Michael R Foley","doi":"10.1016/j.ajogmf.2025.101777","DOIUrl":"10.1016/j.ajogmf.2025.101777","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101777"},"PeriodicalIF":3.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058681","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":"Longitudinal trends in physical activity and sleep before, during, and after pregnancy using Fitbit and EHR data from the All of Us research program.","authors":"Claire Lo, Jeffrey Annis, Hiral Master, Adnan Cakar, Sarah Osmundson, Douglas Ruderfer, Evan Brittain","doi":"10.1016/j.ajogmf.2025.101744","DOIUrl":"10.1016/j.ajogmf.2025.101744","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101744"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676035","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":"Bridging the gap: why women's health equity benefits everyone.","authors":"Holly Horan, Samantha Martin, Lynda Ugwu, Alan Tita","doi":"10.1016/j.ajogmf.2025.101740","DOIUrl":"10.1016/j.ajogmf.2025.101740","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 9","pages":"101740"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812539","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":"Reproductive outcomes following open maternal–fetal surgery for myelomeningocele closure: analysis of MOMS trial participants","authors":"Julie S. Moldenhauer MD , Cora MacPherson PhD , Elizabeth A. Thom PhD , Amy J. Houtrow MD, PhD, MPH , N. Scott Adzick MD, MMM","doi":"10.1016/j.ajogmf.2025.101765","DOIUrl":"10.1016/j.ajogmf.2025.101765","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>In utero closure of myelomeningocele has become an accepted alternative in the management of prenatally diagnosed spina bifida. Maternal reproductive risk has been previously described on the basis of registry data and institutional outcomes. Herein we aim to provide maternal reproductive outcomes from participants in the Management of Myelomeningocele Study.</div></div><div><h3>OBJECTIVE</h3><div>Open maternal–fetal surgery for in utero closure of myelomeningocele is associated with childhood benefits through school age; however, obstetrical and maternal reproductive risks are also factors to consider. The objective of this analysis was to evaluate reproductive outcomes after open maternal–fetal surgery compared with standard postnatal myelomeningocele closure.</div></div><div><h3>STUDY DESIGN</h3><div>The Management of Myelomeningocele Study was a randomized trial comparing prenatal vs postnatal closure of myelomeningocele. Women in the prenatal closure arm underwent open maternal–fetal surgery at 21 to 26 weeks of gestation and underwent cesarean delivery at 37 weeks if they were not delivered before that. In the postnatal closure arm, cesarean delivery was performed at 37 weeks and neonates underwent surgical closure soon after birth. Families returned for follow-up at 30 months and again at school age between 6 and 10 years. Maternal reproductive questionnaires were administered at the time of the follow-up visits to assess menstruation, fertility, gynecologic issues, and subsequent pregnancy outcomes. We compared continuous variables using the Wilcoxon test and categorical variables using the chi-square or Fisher exact test, as appropriate.</div></div><div><h3>RESULTS</h3><div>A total of 174 randomized women (86 in the prenatal closure group and 88 in the postnatal closure group) completed reproductive questionnaires, with 91 women reporting no subsequent pregnancies since the Management of Myelomeningocele Study. In the prenatal closure group, 36 women reported 60 subsequent pregnancies, of which 45 (75%) progressed ≥20 weeks. In the postnatal closure group, 43 women reported 71 pregnancies, of which 50 (70%) progressed ≥20 weeks. The prenatal closure group was more likely to deliver at <37 weeks (<em>P</em><.001). One uterine rupture (2.2%) and 2 uterine dehiscence cases (4.4%) were reported in the prenatal closure group; none were reported in the postnatal closure group (<em>P</em><.001). The use of fertility treatments or gynecologic surgeries was not different between the groups.</div></div><div><h3>CONCLUSION</h3><div>Preterm delivery was more common in subsequent pregnancies after open maternal–fetal surgery. The risk for uterine rupture and dehiscence was higher in the prenatal group than in the postnatal group, but lower than what has been previously reported with open maternal–fetal surgery. Reproductive outcomes were otherwise similar between women undergoing open maternal–fetal surgery for m","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 11","pages":"Article 101765"},"PeriodicalIF":3.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972503","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 watching an educational video on possible obstetric emergencies before labor: a randomized controlled trial","authors":"Eliel Kedar Sade MD ,&nbsp;Ilia Kleiner MD ,&nbsp;Shir Lev MD ,&nbsp;Shiran Rona MD ,&nbsp;Daniel Tairy MD ,&nbsp;Hadas Miremberg MD ,&nbsp;Jacob Bar MD, MSc ,&nbsp;Eran Weiner MD ,&nbsp;Noa Gonen MD","doi":"10.1016/j.ajogmf.2025.101774","DOIUrl":"10.1016/j.ajogmf.2025.101774","url":null,"abstract":"<div><h3>Background</h3><div>While the importance of providing detailed information about potential obstetric emergencies is widely acknowledged, it is often inconsistently addressed in routine care for nulliparous women.</div></div><div><h3>Objective</h3><div>To evaluate the effect of an educational video of possible obstetric emergencies during labor on maternal anxiety and childbirth experience among nulliparous women anticipating vaginal delivery.</div></div><div><h3>Study Design</h3><div>This randomized controlled trial enrolled nulliparous women at term, who were randomly assigned to an intervention group or a control group. The intervention group watched a 5-minute educational video, developed by our department, which covered the management of labor and common obstetric emergencies. The control group received standard obstetric care. Anxiety was evaluated at three distinct time points using the State-Trait Anxiety Inventory (STAI): At recruitment (STAI 1), upon admission to the delivery room (STAI 2), and the postpartum (STAI 3). Both groups completed an 11-item Childbirth Experience Questionnaire (CEQ).</div></div><div><h3>Results</h3><div>A total of 161 participants were approached, with 127 completing the study questionnaires and included in the final analysis (63 intervention, 64 control). Baseline anxiety (STAI 1) and anxiety at admission (STAI 2) were comparable between groups. Immediate postpartum anxiety (STAI 3) was significantly lower in the video group (28 [22–33] vs 33 [26–38]; <em>P</em>=.01), with this reduction remaining significant in multivariable analysis (adjusted coefficient: −5.1; 95% CI: −9.2 to −1.1; <em>P</em>=.01). Greater anxiety reductions were observed in the video group from recruitment to postpartum (Δ STAI 3-1: −15.5 [−24 to −5] vs −9 [−18 to 0]; <em>P</em>=.02) and from admission to postpartum (Δ STAI 3-2: −12.5 [−20 to −3] vs −7 [−12 to 0]; <em>P</em>=.01). CEQ scores were similar between groups.</div></div><div><h3>Conclusion</h3><div>A prelabor educational video significantly reduced postpartum anxiety, highlighting its potential as a simple and scalable intervention to enhance maternal mental health.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 11","pages":"Article 101774"},"PeriodicalIF":3.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972450","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 Simple data-driven dietary pattern associated with lower risk for adverse pregnancy outcomes.","authors":"Andrew Batuure, George I Austin, William A Grobman, Karen L Lindsay, David M Haas, Samuel Parry, George R Saade, Hyagriv N Simhan, Robert M Silver, Uma M Reddy, Aya Brown Kav, Shuang Wang, Natalie A Bello, Tal Korem","doi":"10.1016/j.ajogmf.2025.101773","DOIUrl":"10.1016/j.ajogmf.2025.101773","url":null,"abstract":"<p><strong>Background: </strong>Periconceptional diet has been associated with the risk of adverse pregnancy outcomes (APOs). Various types of diets have been studied to evaluate their potential protective effect against APOs. However, many of these diets are based on regional dietary preferences, are complex, and are composed of many different food categories. A simpler index may increase compliance and facilitate better clinical translation.</p><p><strong>Objective: </strong>Evaluate whether alignment to a parsimonious index derived from periconceptional diet data is associated with reduced risk for APOs.</p><p><strong>Design: </strong>We analyzed prospective data from 7,798 pregnant individuals from the USA in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) study. We applied a sparse regression model to data from food frequency questionnaires and used it to select a small number of food categories that were jointly associated with low risk. We validated this index internally in the nuMoM2b cohort and externally on similar data on 2,240 participants from the Environmental influences on Child Health Outcomes (ECHO) study.</p><p><strong>Results: </strong>The data-driven dietary index (DDI) included legumes, citrus fruits, dark green vegetables, and whole grains as food categories associated with lower risk for APOs versus processed meats, potatoes, and refined grains as associated with higher risk. High alignment with the DDI was associated with 22% relative risk (RR) reduction for 1 or more APO (adjusted RR (aRR) [CI] of 0.78 [0.70,0.87]), preeclampsia (0.74 [0.56,0.99]), and gestational hypertension (0.81 [0.67,0.98]). Validation in the ECHO dataset showed that high alignment to the DDI was associated with a 31% reduction in APOs (crude RR of 0.69 [0.50,0.89]).</p><p><strong>Conclusions: </strong>We demonstrated an approach for devising a simple data-driven dietary index, showed that it is associated with reduced APO risk when accounting for confounders, and validated it in an independent dataset. Future studies could validate the DDI for prospective interventions, as well as apply our approach to other populations or clinical settings.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101773"},"PeriodicalIF":3.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972531","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":"Sequential use of foley catheter and misoprostol versus misoprostol alone for induction of labor: a multicenter randomized controlled trial.","authors":"Saule Issenova, Dilfuza Sultanmuratova, Gulzhan Issina, Zhupar Nakhanova, Anel Kenzhegaliyeva, Rukset Attar","doi":"10.1016/j.ajogmf.2025.101769","DOIUrl":"10.1016/j.ajogmf.2025.101769","url":null,"abstract":"<p><strong>Background: </strong>Labor induction is a critical intervention used when prolonging pregnancy poses risks to maternal or fetal health. While combined methods of cervical ripening have been studied, evidence specifically regarding sequential use (as opposed to simultaneous administration) remains limited.</p><p><strong>Objective: </strong>To compare the efficacy and safety of a sequential labor induction method (Foley catheter followed by misoprostol) versus misoprostol alone in term pregnancies.</p><p><strong>Study design: </strong>This multicenter, randomized controlled trial (NCT06249815) was conducted at 2 hospitals in Almaty, Kazakhstan. A total of 400 women with singleton term pregnancies, cephalic presentation, and unfavorable cervices (Modified Bishop Score ≤6) requiring labor induction were enrolled. Participants were randomly assigned to: PRIMARY OUTCOME: Vaginal delivery.</p><p><strong>Secondary outcomes: </strong>Cesarean delivery, uterine hyperstimulation, fetal distress, Apgar scores, postpartum hemorrhage, chorioamnionitis, perineal trauma, operative vaginal birth, blood transfusion, and labor augmentation.</p><p><strong>Results: </strong>The sequential method significantly increased the probability of vaginal delivery compared to misoprostol alone (77.5% vs 69.5%; adjusted RR=1.16; 95% CI: 1.04-1.29; P=.009). The total dose of misoprostol required was significantly lower in the sequential group (P<.001). A higher incidence of chorioamnionitis was observed in the sequential group (OR=3.82; 95% CI: 1.05-13.9; P=.03).</p><p><strong>Conclusion: </strong>The sequential method increases the probability of vaginal delivery while requiring a lower total misoprostol dose, without increasing the rate of major maternal or neonatal complications. However, it may be associated with a higher risk of chorioamnionitis, which warrants further investigation. These findings support its consideration as a clinically effective and pharmacologically conservative alternative for labor induction in women with an unfavorable cervix.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101769"},"PeriodicalIF":3.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972506","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}