American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Management of cervical cerclage after preterm premature rupture of membranes: an argument for retention","authors":"Allen A. Ghareeb MD ,&nbsp;Alisa Kachikis MD, MSc ,&nbsp;Vy Nguyen BS ,&nbsp;Amanda Roman MD, MPH","doi":"10.1016/j.ajogmf.2024.101569","DOIUrl":"10.1016/j.ajogmf.2024.101569","url":null,"abstract":"<div><div>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. Of note, 1 intervention, the placement of a cervical cerclage, has been shown to reduce the risk of subsequent preterm delivery in appropriate candidates. However, a cerclage does not mitigate the risk of preterm premature rupture of membranes. Preterm premature rupture of membranes 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 after preterm premature rupture of membranes with inconsistent results. This expert review summarized the characteristics of the studies examining the timing of cerclage removal after preterm premature rupture of membranes (Table 1) and current international guidelines (Table 2). In the absence of labor, infection, cervical laceration, or vaginal bleeding, it is recommended that cervical cerclage remains in situ after preterm premature rupture of membranes until 32 to 34 weeks of gestation.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 1","pages":"Article 101569"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","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":"Nonsevere hypertensive disorders of pregnancy and oral antihypertensive medications: an argument against use","authors":"Laurie B. Griffin MD, PhD ,&nbsp;Rachel Sinkey MD ,&nbsp;Alan Tita MD, PhD ,&nbsp;Dwight J. Rouse MD, MSPH","doi":"10.1016/j.ajogmf.2024.101560","DOIUrl":"10.1016/j.ajogmf.2024.101560","url":null,"abstract":"<div><div>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 &lt;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.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 1","pages":"Article 101560"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","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":"“Inpatient pharmacological thromboprophylaxis in the antepartum period: an argument for universal thromboprophylaxis”","authors":"Julia Burd MD,&nbsp;Amanda Zofkie MD","doi":"10.1016/j.ajogmf.2024.101566","DOIUrl":"10.1016/j.ajogmf.2024.101566","url":null,"abstract":"<div><div>Venous thromboembolism (VTE), a largely preventable condition, accounts for almost 15% of maternal mortalities. The physiologic changes of pregnancy, including quantitative changes in coagulation factors and compression of vasculature by the gravid uterus, cause an increase in risk of VTE, including deep vein thromboembolism (DVT), pulmonary embolism, and stroke (CVA). Long term antepartum admission for preeclampsia, preterm prelabor rupture of membranes (PPROM) or other high-risk pregnancy needs present additional risk factors for VTE due to the patient's medical condition and their inpatient status. Given the near-universal support for anticoagulation in patients with a history of venous thromboembolism or high-risk thrombophilia, we will focus this work on patients generally considered low or moderate risk. As outpatients, we do not recommend anticoagulation for this lower risk population. However, with the increase in risk factors for VTE with prolonged admission, it is our general practice to discuss the risks, benefits, and alternatives of chemical VTE prophylaxis 72 hours after admission and recommend administration to all patients unless they have active vaginal bleeding or are at risk for imminent delivery. Here, we will argue why this strategy of universal VTE prophylaxis during antepartum admission with unfractionated heparin (UFH) or low-molecular weight heparin (LMWH) is ultimately in the best interest of patient safety.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 1","pages":"Article 101566"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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 MD,&nbsp;Tara A. Lynch MD, MS","doi":"10.1016/j.ajogmf.2024.101563","DOIUrl":"10.1016/j.ajogmf.2024.101563","url":null,"abstract":"<div><div>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 6 randomized controlled trials and 2 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 3 recent randomized controlled trials (PPROMEXIL, PPROMEXIL2, and PPROMT) and 2 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.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 1","pages":"Article 101563"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","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":"Increasing dialogue surrounding controversies in antepartum management among trainees","authors":"Sarah Boudova MD, PhD ,&nbsp;Laurie Griffin MD, PhD ,&nbsp;Carolina Martinez-King MD, MAS ,&nbsp;John Soehl MD ,&nbsp;Virginia Watkins MD ,&nbsp;Tiffany Yang MD","doi":"10.1016/j.ajogmf.2025.101617","DOIUrl":"10.1016/j.ajogmf.2025.101617","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 1","pages":"Article 101617"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587594","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":"Delivering insights through new perspectives, mentorship, and academic debate","authors":"Emily S. Miller MD, MPH,&nbsp;Suneet P. Chauhan MD,&nbsp;Karin A. Fox MD, MEd,&nbsp;Adam K. Lewkowitz MD, MPHS,&nbsp;Tracy A. Manuck MD, MSCI,&nbsp;Molly J. Stout MD, MS,&nbsp;Terri-Ann Bennett MD,&nbsp;Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2025.101618","DOIUrl":"10.1016/j.ajogmf.2025.101618","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 1","pages":"Article 101618"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477103","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 pelvic artery embolization on anti-Müllerian hormone levels in patients with postpartum hemorrhage: a prospective cohort study","authors":"Hyeon Ji Kim MD, MSc,&nbsp;Eunjeong Ji PhD,&nbsp;Jee Yoon Park MD, PhD","doi":"10.1016/j.ajogmf.2025.101649","DOIUrl":"10.1016/j.ajogmf.2025.101649","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101649"},"PeriodicalIF":3.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516954","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":"Results of cardiovascular testing among pregnant and postpartum persons undergoing standardized cardiovascular risk assessment","authors":"Afshan B. Hameed MD, MBA, FACOG, FACC ,&nbsp;Maryam Tarsa MD, MAS ,&nbsp;Ashten Waks MD, MSPH ,&nbsp;Anna Grodzinsky MDMS ,&nbsp;Karen L. Florio DO, MPH ,&nbsp;Jenny Chang MPH ,&nbsp;Marni B. Jacobs PhD, MPH ,&nbsp;Omotayo I. Balogun MPH ,&nbsp;Heike Thiel de Bocanegra PhD, MPH","doi":"10.1016/j.ajogmf.2025.101656","DOIUrl":"10.1016/j.ajogmf.2025.101656","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States, accounting for one in three pregnancy-related deaths. A standardized CVD Risk Assessment can guide clinicians in identifying patients at risk for CVD.</div></div><div><h3>Objective</h3><div>The objective of this study was to evaluate whether a standardized CVD risk assessment yields more abnormal findings on follow-up CVD testing among pregnant and postpartum patients compared to assessments based on clinician judgment alone.</div></div><div><h3>Study Design</h3><div>A retrospective chart review was performed across three geographically and ethnically diverse hospital networks that had implemented the CVD Risk Assessment algorithm. The analysis included a total of 31,232 pregnant and postpartum patients who had presented for obstetric care visit from September 2020 to August 2024. We calculated the proportion of patients with abnormal composite brain natriuretic peptide (BNP), electrocardiogram (EKG), and/or echocardiogram test results by risk assessment group, and a two Proportion Z-Test was conducted to compare proportions. We then calculated the odds of having abnormal tests for each risk assessment group.</div></div><div><h3>Results</h3><div>Standardized CVD risk assessment yielded more abnormal composite test results than clinician judgment alone (6.9% vs. 4.2%; <em>p</em>&lt;.0001). There was a greater proportion of abnormal test results among the risk-positive than the risk-negative group (23.4% vs. 6.6%; <em>P</em>&lt;.0001). Patients assessed for CVD had 1.69 times the odds of having an abnormal test than those tested based on clinician judgment alone (<em>P</em>&lt;.0001). Risk-positive patients had 4.31 times the odds of having an abnormal test than risk-negative patients (<em>P</em>&lt;.0001).</div></div><div><h3>Conclusion</h3><div>Implementing a standardized CVD Risk Assessment algorithm may enhance the detection of cardiovascular disease in pregnant and postpartum patients with previously unknown CVD or at risk of developing CVD, providing a valuable tool that complements clinician judgment for improved perinatal outcomes.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101656"},"PeriodicalIF":3.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amniotic fluid extracellular vesicle and cell-free RNA profiling reveals fetal adaptations in twin-twin transfusion syndrome","authors":"Jacqueline G. Parchem MD,&nbsp;Huihui Fan MBBS, PhD,&nbsp;Lovepreet K. Mann MBBS,&nbsp;Kadeshia M. Campbell PhD,&nbsp;Sujuan Yang MS,&nbsp;Wencai Ma PhD,&nbsp;Jong H. Won PhD,&nbsp;Jing Wang PhD,&nbsp;Ramesha Papanna MD,&nbsp;Raghu Kalluri MD, PhD","doi":"10.1016/j.ajogmf.2025.101655","DOIUrl":"10.1016/j.ajogmf.2025.101655","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101655"},"PeriodicalIF":3.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493882","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, Nur Eva, Lanny Wijayaningsih, Kriswandani Kriswandani, Rizky Andana Pohan, Riza Amalia, 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":" ","pages":"101641"},"PeriodicalIF":3.8,"publicationDate":"2025-02-21","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}