American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"The effectiveness of ultrasound-indicated cerclage for the reduction of extreme preterm birth in twin pregnancies with a short cervix: a systematic review and meta-analysis: Short title: Effectiveness of cerclage in twin pregnancies with a short cervix.","authors":"Drs Lissa van-Gils, Renske Dutilh, Ms Nerissa Denswil, Dr Amanda Roman, Dr Marjon A de-Boer, Prof Dr Eva Pajkrt, Prof Dr Martijn A Oudijk","doi":"10.1016/j.ajogmf.2024.101555","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101555","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the effectiveness of cervical cerclage in women with a twin pregnancy and a midpregnancy asymptomatic short cervix (≤25mm), in preventing preterm birth (PTB) and improving neonatal outcomes.</p><p><strong>Data sources: </strong>Systematic searches were conducted in MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library up to April 17 2023, updated in September and February 2024.</p><p><strong>Study eligibility criteria: </strong>Included were RCTs, cohort studies and case-control studies comparing cerclage vs. expectant management in twin pregnancies and an asymptomatic short cervix (≤25mm).</p><p><strong>Study appraisal and synthesis methods: </strong>Risk of bias was assessed with the Newcastle-Ottawa Quality Assessment Scale and the Risk of Bias 2 (RoB 2) tool. Data was analyzed using RevMan 5.4 using a Random-Effects Model.</p><p><strong>Results: </strong>Three RCTs and 13 cohort studies, involving 696 cerclage patients and 595 controls, were analyzed. Combined RCT findings (N=49) found no significant difference in PTB occurrence after adjustment for PTB history and gestational age. Neonates from cerclage-treated mothers exhibited significantly higher rates of RDS (aOR 3.88, 95% CI 1.09-21.03) and very low birth weight (aOR 2.22, 95% CI 1.07-5.73). In contrast, pooled cohort data indicated significantly less PTB rates in women with a cerclage: at 34 weeks (RR 0.75, 95% CI 0.63-0.90), 32 weeks (RR 0.67, 95% CI 0.49-0.90), and 28 weeks (RR 0.572, 95% CI 0.39-0.83). Cerclage also reduced risk for infants <1500g, respiratory distress syndrome, admission at the neonatal intensive care unit and sepsis. Women with cervical length <15mm and a cerclage experienced fewer PTB rates at <37 weeks (RR 0.88, 0.81-0.94), 34 weeks (RR 0.70, 95% CI 0.57-0.87), 32 weeks (RR 0.63, 95% CI 0.50-0.80) and 28 weeks (RR 0.43, 95% CI 0.32-0.59). Perinatal mortality risk was significant lower in neonates born to mothers with a cerclage. For women with cervical length between 16 and 25mm, no significant differences in outcomes were observed.</p><p><strong>Conclusions: </strong>Based on our meta-analysis, cerclage may benefit women with a twin pregnancy with an asymptomatic midpregnancy short cervix <25mm, especially in women with a cervix <15mm, by reducing PTB and improving neonatal outcomes. However, the differences between RCTs and recent cohort studies emphasize the need for well-powered RCTs on neonatal outcomes before introducing cerclage in clinical practice for these women.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101555"},"PeriodicalIF":3.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740532","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":"Comparative effectiveness of Low Molecular Weight Heparin on Live birth for Recurrent Spontaneous Abortion: systematic review and network meta-analysis: Effectiveness of LMWH on Live Birth in RSA.","authors":"Wenrui Huang, Yue Yu, Lei Chen, Xiaoxuan Tang, Xingzi Fang, Xingyan Ou, XueLian Du","doi":"10.1016/j.ajogmf.2024.101572","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101572","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effectiveness and safety of low molecular weight heparins (LMWHs) on live birth rates and adverse pregnancy outcomes in individuals experiencing recurrent spontaneous abortion (RSA).</p><p><strong>Data sources: </strong>PubMed, Web of Science, the Cochrane Library, and Embase from database inception to July 1, 2024.</p><p><strong>Study eligibility criteria: </strong>Eligible randomised controlled trials enrolled women with RSA who received LMWH, with a follow-up duration of at least 12 weeks. The treatment was either monotherapy with LMWH or added LMWH to non-randomised background anticoagulant treatments, with the control group being placebo and other anticoagulant treatments. Trials with a crossover design or involving withdrawn drugs were also excluded.</p><p><strong>Study appraisal and synthesis methods: </strong>We assessed bias using the Risk of Bias 2.0 tool and evaluated evidence quality with the Confidence in Network Meta-Analysis framework. The network meta-analysis employed a Bayesian framework to integrate direct and indirect evidence, calculating risk ratios and 95% confidence intervals. Markov chain Monte Carlo methods generated posterior distributions, allowing comparison and ranking of treatments. Subgroup, regression, and sensitivity analyses assessed the impact of various factors on the results.</p><p><strong>Results: </strong>This network meta-analysis included 22 trials involving 4,773 participants across five different LMWH drugs, with all comparisons made against the control group. Among the five drugs, enoxaparin showed significant benefits. It notably improved live birth rates (LBR) (Risk Ratios 1.19, (95% confidence intervals 1.06 to 1.36), surface under the cumulative ranking curve 73%; moderate confidence of evidence), reduced the risk of pre-eclampsia (0.53, (0.28-0.92), 85%), lowered preterm delivery (0.59, (0.41-0.86), 85%), and decreased pregnancy loss (0.55, (0.38-0.76), 82%). Further analysis of seven different LMWH doses revealed that both enoxaparin 20mg (1.53, (1.08-2.25), 89%) and 40mg (1.18, (1.04-1.38), 59%) significantly improved LBR, with the 20mg dose proving more effective. Both doses also significantly reduced the risk of pregnancy loss.</p><p><strong>Conclusion: </strong>Enoxaparin proved to be the most effective LMWH in increasing LBR compared to the control group. It also significantly lowered the risks of pre-eclampsia, preterm delivery, and pregnancy loss. A dosage-based subgroup analysis showed that both 20mg and 40mg of enoxaparin improved LBR, with the 20mg dose demonstrating greater effectiveness.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101572"},"PeriodicalIF":3.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740870","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":"PPROM in the late preterm period: an argument for expectant management.","authors":"Derek Lee, Tara A Lynch","doi":"10.1016/j.ajogmf.2024.101563","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101563","url":null,"abstract":"<p><p>Preterm prelabor rupture of membranes (PPROM) is associated with significant neonatal risks. When PPROM occurs during the late preterm period (between 34 0/7 and 36 6/7 weeks gestation), the optimal gestational age for delivery is unclear and varies by regional practice. In 2020 the American College of Obstetrician and Gynecologists (ACOG) published guidelines indicating that both expectant management and immediate delivery were considered reasonable options. Historically, studies that examined the topic of expectant management versus immediate delivery of PPROM after 34 weeks supported immediate delivery based on an observed increased risk of infectious complications without any benefit to neonatal outcome. However, these studies were small and were underpowered to detect a meaningful difference in neonatal outcomes. In this review, we examine six randomized controlled trials and two meta-analyses of randomized controlled trials that investigated neonatal and maternal outcomes of expectant management versus immediate delivery of late preterm PROM. Included in this analysis are three recent randomized controlled trials (PPROMEXIL, PPROMEXIL2, and PPROMT) and two meta-analyses that demonstrate a decreased risk of respiratory distress syndrome and NICU admission rate with expectant management. This is counterbalanced by an increased risk of chorioamnionitis with expectant management, but definitions of chorioamnionitis are variable in the trials with unclear generalizability of the outcome across the trials. Additional analysis with a childhood outcome study showed no significant difference in neurodevelopment in infants born to expectant management of late preterm PROM, and an economic analysis found that expectant management was associated with lower delivery and neonatal costs. Overall, we support expectant management of late preterm PROM if maternal and fetal status are stable and there are no contraindications to expectant management but not extending beyond 37 0/7 weeks gestation.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101563"},"PeriodicalIF":3.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739660","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":"Inpatient pharmacological thromboprophylaxis in the antepartum period: an argument for risk-based thromboprophylaxis.","authors":"Jerome J Federspiel","doi":"10.1016/j.ajogmf.2024.101567","DOIUrl":"10.1016/j.ajogmf.2024.101567","url":null,"abstract":"<p><p>Venous thromboembolism (VTE) is a significant cause of maternal morbidity and mortality in the United States. People hospitalized during pregnancy for reasons other than routine birth (ie, during antepartum admissions) are at increased risk of VTE compared with nonhospitalized obstetric patients, but there is no consensus regarding which patients should receive thromboprophylaxis during antepartum hospitalizations as the absolute event rates are low and anticoagulation can complicate antepartum management. We argue that an approach informed by individualized patient risk assessment is likely to produce the greatest net benefit for patients. Such an approach would avoid the pitfalls of universal pharmacologic prophylaxis (potential to interfere with unplanned delivery or receipt of neuraxial anesthesia) among patients for whom the absolute risk of VTE is low. In contrast, approaches that withhold pharmacologic prophylaxis from all antepartum patients likely place some at significant risk of VTE. We outline the arguments against universal pharmacologic thromboprophylaxis and against universal avoidance of pharmacologic thromboprophylaxis and discuss a risk-based approach proposed at our institution. Finally, we outline a research agenda for identification of optimal antepartum anticoagulation strategies.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101567"},"PeriodicalIF":3.8,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717313","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":"Nonsevere hypertensive disorders of pregnancy and oral antihypertensive medications: an argument against use.","authors":"Laurie B Griffin, Rachel Sinkey, Alan Tita, Dwight J Rouse","doi":"10.1016/j.ajogmf.2024.101560","DOIUrl":"10.1016/j.ajogmf.2024.101560","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, affect approximately 13% of all pregnancies and are a major cause of maternal and neonatal morbidity and mortality worldwide. Although the treatment of preeclampsia with severe features has been well established on the basis of randomized controlled data, international society guidelines vary on the treatment of gestational hypertension and preeclampsia without severe features. The American College of Obstetricians and Gynecologists recommends against the use of antihypertensive agents for nonsevere hypertension (blood pressure of <160/110 mm Hg) in both gestational hypertension and preeclampsia without severe features given a lack of level 1 evidence in support of treatment and the theoretical risk of masking of disease progression or causing adverse fetal effects, such as growth restriction. However, with the publication of the Chronic Hypertension in Pregnancy trial, (CHAP) which demonstrated the benefit of treatment of nonsevere chronic hypertension, \"indication creep\" or the application of a treatment outside the population of proven benefit is being observed with the use of antihypertensive medication for the treatment of nonsevere hypertension in gestational hypertension and preeclampsia without severe features. The use of antihypertensive treatment in this population without a definitive trial and no clearly defined safety protocols is potentially dangerous and could, at worst, lead to maternal and fetal harm or, at best, provide benefit in ways that are hard to assess and, thus, interfere with efforts to generate definitive evidence to change practice guidelines, denying many pregnant patients optimal care. It is imperative that a definitive trial be performed performed prior to the widespread use of antihypertensive treatment for gestational hypertension or preeclampsia without severe features.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101560"},"PeriodicalIF":3.8,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716693","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":"Aspirin dosage for preeclampsia prophylaxis: an argument for 81 mg dosing.","authors":"Kimen S Balhotra, Baha M Sibai","doi":"10.1016/j.ajogmf.2024.101568","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101568","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101568"},"PeriodicalIF":3.8,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717308","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 Cervical Cerclage after Premature Preterm Rupture of Membranes: An argument for removal: Immediate removal of cerclage after PPROM.","authors":"Fabrizio Zullo, Daniele DI Mascio","doi":"10.1016/j.ajogmf.2024.101570","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101570","url":null,"abstract":"<p><p>Cervical cerclage is a widely used intervention to prevent PTB in high-risk pregnancies. However, cerclage carries risks, including preterm prelabor rupture of membranes (PPROM) and subsequent complications such as chorioamnionitis. Our review evaluates the evidence for immediate removal (i.e. removal at time of diagnosis) versus retention of cervical cerclage (i.e. removal when clinically indicated) following PPROM, focusing on optimizing neonatal outcomes and minimizing maternal and fetal complications. A meta-analysis on the topic that included 169 patients in the \"removal\" group and 208 in the \"retention\" group showed that the rate of pregnancy prolongation > 48 hours was significantly lower in the group undergoing immediate removal of cerclage (47% vs 85%; OR 0.15), as well as the rate of pregnancy prolongation > 7 days (33% vs 57%; OR 0.30). Pregnancy latency was also significantly lower despite the absolute mean difference was only 2.84 days. However, the rate of chorioamnionitis was significantly lower in the immediate removal compared to the retention group (29% vs 41%; OR 0.57), as well as the rate of Apgar score < 7 at 5 minutes (16% vs 43%; OR 0.22). A proposed balanced approach involves retaining the cerclage for approximately 24 hours post-PROM to permit steroid administration (initial dose followed by a second dose after 24 hours) before removal. This strategy aims to maximize steroid benefits while minimizing the risks of prolonged cerclage retention, potentially achieving a correct timing that optimizes neonatal outcomes without significantly increasing complications This management approach could be beneficial in situations where immediate removal may preclude full steroid benefits. Our recommendations support a protocol balancing appropriate timing for steroid administration with the risks of extended cerclage retention, namely chorioamnionitis, unless further randomized controlled trials will show the proper evidence based management in this clinical scenario.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101570"},"PeriodicalIF":3.8,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717315","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 Cervical Cerclage after Premature Preterm Rupture of Membranes: An argument for retention: Retention vs Removal of Cerclage after Premature Preterm Rupture of Membranes.","authors":"Allen A Ghareeb, Alisa Kachikis, Vy Nguyen, Amanda Roman","doi":"10.1016/j.ajogmf.2024.101569","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101569","url":null,"abstract":"<p><p>Preterm birth remains the leading cause of infant morbidity and mortality worldwide. Efforts aimed at reducing preterm birth rates have largely focused on mitigating risks in those who have already experienced a preterm delivery. One intervention, the placement of a cervical cerclage, has been shown to reduce the risk of subsequent preterm delivery in the appropriate candidate. However, a cerclage does not mitigate the risk of premature preterm rupture of membranes (PPROM). PPROM is a significant contributor to the incidence of preterm births and can occur with a cerclage in place. Many studies have examined the outcomes associated with immediate vs delayed cerclage removal following PPROM with inconsistent results. In this expert review, we summarize the characteristics of the studies examining timing of cerclage removal following PPROM (Table 1), and current international guidelines (Table 2). In the absence of labor, infection, cervical laceration or vaginal bleeding, we recommend that cervical cerclage remain in situ following PPROM until 32-34 weeks gestation.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101569"},"PeriodicalIF":3.8,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716641","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":"Evidence-based obstetric guidance in the setting of a global intravenous fluid shortage","authors":"Sarah Heerboth MD ,&nbsp;Paulina M. Devlin MD, MS ,&nbsp;Savvy Benipal MD ,&nbsp;Emma Trawick MD ,&nbsp;Nandini Raghuraman MD, MSCI ,&nbsp;Elizabeth Coviello DO ,&nbsp;Erin E. Brown PharmD ,&nbsp;Johanna Quist-Nelson MD","doi":"10.1016/j.ajogmf.2024.101556","DOIUrl":"10.1016/j.ajogmf.2024.101556","url":null,"abstract":"<div><div>Intravenous fluid (IVF) administration is a ubiquitous medical intervention. Although there are clear benefits to IVF in certain obstetric scenarios, IVF is often given in unindicated circumstances; the ongoing IVF shortage highlights an opportunity to reduce unindicated IVF in obstetrics. This document provides evidence-based recommendations to reduce IVF use within general obstetric practice. The three sections address IVF use within (1) antepartum care, (2) intrapartum care, and (3) postpartum care, including postpartum hemorrhage (PPH) risk reduction. Using the GRADE framework, we provide a summary of the available evidence surrounding use of IVF in obstetrics and recommend strategies to reduce IVF. We recommend transitioning intravenous (IV) antibiotics to IV push or oral when possible, discontinuing IVF bolus prior to neuraxial anesthesia or for the treatment of preterm labor, and avoiding unnecessary continuous IVF infusions. There may be further opportunities for fluid conservation with IV medications that could be given intramuscularly. These suggestions for IVF use reduction should be evaluated based on local need and capabilities as well as the characteristics and risk factors of the population. Patients with sepsis, PPH, burns, diabetic ketoacidosis, and hemodynamic instability should not have a reduction in IVF administration as these diagnoses have evidence-based resuscitation guidelines that include IVF. The recommendations presented may be applicable beyond the immediate IVF shortage and should be considered as an area for future research.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101556"},"PeriodicalIF":3.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693721","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 Process of Developing a Comprehensive Maternal-Fetal Surgery Center.","authors":"Andrew H Chon, Amanda J H Kim, Roya Sohaey, Leonardo Pereira, Aaron B Caughey, Amy C Hermesch, Alireza A Shamshirsaz, Gretchen McCullough, Mounira A Habli, Stephanie E Dukhovny, Mubeen Jafri, Ramesha Papanna, Kenneth Azarow, Monica Rincon, Eryn Hughey, Erin J Madriago, Mary Beth Martin, Mariaelena Galie, Ramen H Chmait, Raphael C Sun","doi":"10.1016/j.ajogmf.2024.101557","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101557","url":null,"abstract":"<p><p>The scope of fetal therapy has evolved over the last several decades to include interventions intended to treat or mitigate morbidities of complex fetal disorders. As a result, maternal-fetal surgery centers have been established across the country to better meet the needs of this patient population. Centers offering fetal interventions need to utilize a multidisciplinary approach to optimally balance the pregnant patient's autonomy and safety while striving to optimize fetal health. Although there is literature highlighting the components that an experienced maternal-fetal surgery center should contain, there are limited publications illustrating the process of creating a maternal-fetal surgery center. The journey of building a maternal-fetal surgery center is often as complex as the care delivered. The convergence of resources from both adult and pediatric medicine along with extensive hospital executive support are necessary. As a group of centers with diverse experience and geographic locations, we present a staged approach to building a comprehensive maternal-fetal surgery center and the lessons learned along the way.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101557"},"PeriodicalIF":3.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695877","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}