American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Stillbirth is associated with postpartum severe maternal morbidity compared with gestational age matched and term live births","authors":"Dante Varotsis MD , Jordan Beacham BS , Julie Gomez MD , Zain Hannan BA , Rupsa C. Boelig MD , Vincenzo Berghella MD , Moti Gulersen MSc","doi":"10.1016/j.ajogmf.2025.101725","DOIUrl":"10.1016/j.ajogmf.2025.101725","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>The rates of severe maternal morbidity in the United States continue to increase. The American College of Obstetricians and Gynecologists recommends close postpartum follow-up for patients at increased risk for severe maternal morbidity and mortality, such as those who suffer from preeclampsia or hypertension. Data on the association between stillbirth and severe maternal morbidity are limited.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to evaluate the association between stillbirth and severe maternal morbidity in comparison with gestational age–matched and term live births.</div></div><div><h3>STUDY DESIGN</h3><div>This was a multicenter, retrospective cohort study that was performed at 3 centers within a hospital system from 2017 to 2023. Severe maternal morbidity was defined with guidance from the indicators outlined by the Centers for Disease Control and Prevention. The inclusion criteria for the stillbirth group were delivery of a fetus that showed no signs of life at 20 weeks’ gestation or later. Cases with antepartum preeclampsia, multiple gestations, maternal age less than 18 years, duplicate records, and voluntary terminations of the pregnancy after 20 weeks’ gestation were excluded. We selected gestational age- and term-matched live births as the control groups. A logistic regression analysis was performed to evaluate the odds of the composite severe maternal morbidity in stillbirths vs gestational age–matched and term-matched live births, separately, with adjustment for potential confounders. The data were presented as the adjusted odds ratios with 95% confidence intervals, and statistical significance was set at a <em>P</em> value of <.05.</div></div><div><h3>RESULTS</h3><div>Of the 29,060 deliveries during the study period, there were 129 (0.44%) stillbirths. Stillbirth was associated with significantly higher odds of severe maternal morbidity than term (adjusted odds ratio, 4.35; 95% confidence interval, 1.75–10.84) and gestational age matched livebirths (adjusted odds ratio, 3.39; 95% confidence interval, 1.72–6.66). There was no significant difference in the rate of postpartum hemorrhage when stillbirths were compared with gestational age–matched live births (10.1% vs 7.3%; <em>P</em>=.42), however, there were significantly more transfusions needed in the stillbirth group (10.1% vs 1.6%; <em>P</em>=.017). When compared with the term live births, there were significantly more transfusions (10.1% vs 1.6%; <em>P</em><.001), intensive care admissions (2.3% vs 0%; <em>P</em>=.007), postpartum preeclampsia (2.3% vs 0%; <em>P</em>=.007), and sepsis (2.3% vs 0%; <em>P</em>=.007).</div></div><div><h3>CONCLUSION</h3><div>Stillbirth is associated with an increased risk for severe maternal morbidity when compared with gestational age- and term-matched live births. Increased postpartum surveillance should be implemented into practice, and preventative interventions, such as tranexamic acid admin","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 9","pages":"Article 101725"},"PeriodicalIF":3.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294999","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 state of residency training in treatment of opioid use disorder in obstetrics and gynecology","authors":"Julia Whitley MD, Karen George MD, MPH, Jeannie C. Kelly MD, MS, Megan L. Lawlor MD, Erika Banks MD, Phillip Ma MD, Jillian Catalanotti MD, MPH","doi":"10.1016/j.ajogmf.2025.101723","DOIUrl":"10.1016/j.ajogmf.2025.101723","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101723"},"PeriodicalIF":3.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276188","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 in reply re: comparative effectiveness of low molecular weight heparin on live birth for recurrent spontaneous abortion: systematic review and network meta-analysis","authors":"Wenrui Huang MD, PhD, Xuelian Du MD, PhD","doi":"10.1016/j.ajogmf.2025.101720","DOIUrl":"10.1016/j.ajogmf.2025.101720","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101720"},"PeriodicalIF":3.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250052","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 in Reply Re: Quantifying placenta accreta spectrum severity and its associated blood loss: a novel transvaginal ultrasound scoring system","authors":"Neha Agarwal MD, Edgar Hernandez-Andrade MD, PhD, Baha M. Sibai MD, Farah H. Amro MD, Jennie O. Coselli MD, Michal F. Bartal MD, Dejian Lai PhD, Eleazar E. Soto-Torres MD, Sami Backley MD, Anthony Johnson DO, Jimmy Espinoza MD, MSc, Eric P. Bergh MD, Sen Zhu PhD, Ashley Salazar DNP, Sean C. Blackwell MD, Ramesha Papanna MD, MPH","doi":"10.1016/j.ajogmf.2025.101722","DOIUrl":"10.1016/j.ajogmf.2025.101722","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101722"},"PeriodicalIF":3.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250053","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 \"Breast stimulation vs low-dose oxytocin for labor augmentation in women with a previous cesarean delivery: a randomized controlled trial\".","authors":"Songjie Liao, Di Xiao, Yaling Li, Liqiu Kou","doi":"10.1016/j.ajogmf.2025.101717","DOIUrl":"10.1016/j.ajogmf.2025.101717","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101717"},"PeriodicalIF":3.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250057","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 re: \"impact of prenatal vaccination counseling on nonbirthing partners' vaccination rates\".","authors":"Umama Muskan, Iftikhar Khan, Maryam Karim, Jamal Shah, Sozen Rehman","doi":"10.1016/j.ajogmf.2025.101716","DOIUrl":"10.1016/j.ajogmf.2025.101716","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101716"},"PeriodicalIF":3.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250054","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":"Unwanted pregnancies are associated with preterm birth, but not low birth weight","authors":"Annie Dude MD, PhD ,&nbsp;Jocelyn Wascher MD","doi":"10.1016/j.ajogmf.2025.101713","DOIUrl":"10.1016/j.ajogmf.2025.101713","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies indicate that unintended and unwanted pregnancies can be associated with poor obstetric outcomes.</div></div><div><h3>Objective</h3><div>This study examined whether an unintended or unwanted pregnancy was associated with a preterm delivery and with low birth weight.</div></div><div><h3>Study design</h3><div>We conducted a secondary analysis of the 2017 to 2019 cycle of the National Survey of Family Growth, a nationally-representative population- based survey of reproductive-aged people identifying as female in the United States. The sample consisted of respondents who had at least one prior live birth. Respondents were asked whether their most recent pregnancy was wanted (either at that time or prior to that time), unintended (wanted, but too soon, or unwanted at any time), or unwanted (did not want to be pregnant at any time). The primary outcomes were preterm delivery, defined as a live birth prior to 37 weeks’ gestation, and low birth weight, defined as a birthweight less than 2500 grams. We also examined early preterm delivery (defined as a live birth prior to 34 weeks’ gestation) as a secondary outcome, as well as restricting the sample to term deliveries only to examine low birth weight. We used chi square and Wilcoxon rank sum analysis for bivariable comparisons and logistic regression for multivariable models.</div></div><div><h3>Results</h3><div>Our sample consisted of 3299 unique deliveries, 35.4% of which resulted from unintended pregnancies and 16.9% of which resulted from unwanted pregnancies. Overall, 12.7% of respondents had any preterm delivery, including 11.3% of those with intended pregnancies, 15.4% of those with unintended pregnancies (<em>p</em>=.02), 11.9% of those with wanted pregnancies and 16.9% of those with unwanted pregnancies (<em>p</em>=.01). Of the overall sample, 3.7% had a preterm delivery prior to 34 weeks gestation, including 3.0% of those with an intended pregnancy, 4.9% of those with an unintended pregnancy (<em>p</em>=.10), 3.1% of those with wanted pregnancies, and 6.3% of those with unwanted pregnancies (<em>p</em>=.01). Unwanted pregnancies remained associated with preterm delivery and early preterm delivery after adjusting for confounders (adjusted odds ratio 1.42, 95% confidence interval 1.02 to 1.98 for any preterm delivery, adjusted odds ratio 1.84, 95% confidence interval 1.10 to 3.08 for early preterm delivery). In our sample, 8.0% of respondents had a low birth weight neonate, including 6.6% of those with an intended pregnancy, 10.5% of those with an unintended pregnancy (<em>p</em>=.02), 7.4% of those with wanted and 10.5% of those with unwanted pregnancies (<em>p</em>=.10). These results were insignificant among those with term deliveries and after adjusting for confounders.</div></div><div><h3>Conclusion</h3><div>Unwanted pregnancies are associated with an increased risk of preterm delivery, but not low birth weight.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101713"},"PeriodicalIF":3.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250059","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 “Comparative effectiveness of low-molecular-weight heparin (LMW-Heparin) on live birth for recurrent spontaneous abortion: systematic review and network meta-analysis”","authors":"Paul Claman MD","doi":"10.1016/j.ajogmf.2025.101719","DOIUrl":"10.1016/j.ajogmf.2025.101719","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101719"},"PeriodicalIF":3.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250055","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":"Intrapartum continuous glucose monitor metrics and neonatal hypoglycemia","authors":"Gianna Wilkie MD, MSCI,&nbsp;Shani Snow BS,&nbsp;Nillani Anandakugan MS,&nbsp;Heidi Leftwich DO","doi":"10.1016/j.ajogmf.2025.101712","DOIUrl":"10.1016/j.ajogmf.2025.101712","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101712"},"PeriodicalIF":3.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250050","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 twin‐to‐twin transfusion syndrome: update and current challenges","authors":"Hanane Bouchghoul MD, PhD ,&nbsp;Hugo Madar MD, PhD ,&nbsp;Aurélien Mattuizzi MD ,&nbsp;Frédéric Coatleven MD ,&nbsp;Marie Vincienne MD ,&nbsp;Perrine Prier MD ,&nbsp;Alizée Froeliger MD ,&nbsp;Loïc Sentilhes MD, PhD","doi":"10.1016/j.ajogmf.2025.101714","DOIUrl":"10.1016/j.ajogmf.2025.101714","url":null,"abstract":"<div><div>Since a 2004 randomized trial established fetoscopy as the gold standard for the treatment for twin-to-twin transfusion syndrome (TTTS), advancements in surgical technique and expert training have considerably improved survival rates to 89% for at least one fetus and 65% for both fetuses. However, many challenges remain. This review provides an update on the current principles, issues, and debates. The Solomon technique has helped improve neonatal outcomes by reducing the risks of postoperative twin anemia-polycythemia sequence and TTTS recurrence. Nevertheless, fetoscopic laser photocoagulation is associated with significant obstetrical risks, including preterm premature rupture of membranes, preterm delivery, and even placental abruption. Additionally, fetal growth restriction, observed in 30% to 50% of cases, may adversely affect double survival rates following fetoscopy, particularly when abnormal Doppler indices are present. Gestational age (GA) at the time of fetoscopy is a critical prognostic factor, as earlier GA is associated with lower survival rates. This consideration raises questions about the optimal timing of the procedure after TTTS diagnosis. Emerging evidence supports expectant management with close ultrasound monitoring for asymptomatic patients with stage I TTTS. In stage III and IV TTTS, laser photocoagulation should not be delayed, whereas stage II TTTS diagnosed at very early GAs might benefit from expectant management until 16 to 17 weeks of gestation. Further advancements, such as flexible video fetoscopy and computer-assisted fetal laser surgery, represent the next frontier in addressing these challenges.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101714"},"PeriodicalIF":3.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250058","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}