American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Stage I twin-twin transfusion syndrome with intermittent umbilical artery Doppler abnormalities","authors":"Raphael C. Sun MD ,&nbsp;Andrew H. Chon MD ,&nbsp;Arlyn Llanes ,&nbsp;Lisa M. Korst MD, PhD ,&nbsp;Martha A. Monson MD ,&nbsp;Eftichia V. Kontopoulos MD ,&nbsp;Rubén A. Quintero MD ,&nbsp;Ramen H. Chmait MD","doi":"10.1016/j.ajogmf.2025.101754","DOIUrl":"10.1016/j.ajogmf.2025.101754","url":null,"abstract":"<div><h3>Background</h3><div>Twin-to-twin transfusion syndrome (TTTS) is a rare condition that occurs in approximately 9% to 15% of monochorionic diamniotic twin pregnancies. The Quintero staging system was established to categorize the severity of this disease. Published outcomes for selective laser photocoagulation of communicating vessels demonstrate a significant difference in dual survival outcomes among the different stages of TTTS. Per Quintero staging, Stage I TTTS includes those with donor twin umbilical artery (UA) intermittent, absent, or reversed end diastolic velocity (AREDV), whereas patients with persistent donor twin UA-AREDV are classified as Stage III. This distinction between intermittent and persistent UA-AREDV appears to have been variably interpreted since the original publication.</div></div><div><h3>Objective</h3><div>Our objective was to compare laser-treatment outcomes in Stage I patients with intermittent UA-AREDV vs Stage I patients with a normal UA waveform; Stage III patients with persistent donor twin UA-AREDV were used for comparison. Because arterio-arterial communications (AA) have been associated with postoperative donor demise, the rate of such vascular communications was also assessed within the 3 groups.</div></div><div><h3>Study Design</h3><div>Three groups of monochorionic diamniotic twins with TTTS that was treated with laser surgery (2006–2023) were analyzed for the primary outcome of donor twin intrauterine fetal demise (IUFD): Stage I with preoperative normal donor UA flow (Stage-I Normal); Stage I with preoperative intermittent donor UA-AREDV (Stage-I Intermittent); and Stage III with preoperative persistent donor UA-AREDV (Stage-III).</div></div><div><h3>Results</h3><div>Of 349 study patients, 101 were classified as Stage-I Normal, 36 were Stage-I Intermittent, and 212 were Stage-III. The rate of donor IUFD was lowest in Stage-I Normal vs Stage-I Intermittent and Stage-III groups: 3.0% vs 25.0% vs 29.2%, <em>P</em>&lt;.0001. At least one survival did not differ among the 3 groups; dual survival was highest for Stage-1-Normal (97.0% vs 75.0% vs 66.0%, <em>P</em>&lt;.0001) and differed from both Stage-I Intermittent and Stage-III groups in pairwise comparisons. AA communications were most common in the Stage-I Intermittent group: 27.7% vs 69.4% vs 42.5%, <em>P</em>&lt;.0001. In a multiple logistic regression model, Stage-I Intermittent patients were 7 times more likely to have donor twin IUFD (Odds ratio [OR] 7.23 [1.69–30.82], <em>P</em>=.0075), as were Stage-III patients (OR 7.24 [2.06–25.47], <em>P</em>=.0020), compared to Stage-I Normal patients. In this same model, independently, patients with AA were 3.6 times more likely to have donor IUFD (OR 3.59 [1.95–6.61]; <em>P</em>&lt;.0001).</div></div><div><h3>Conclusion</h3><div>TTTS Stage I patients with intermittent UA-AREDV were at increased risk of donor IUFD after laser surgery.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 10","pages":"Article 101754"},"PeriodicalIF":3.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862526","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":"Outcomes after cerclage and preterm prelabor rupture of membranes: data from the international collaborative for cerclage longitudinal evaluation and research (IC-CLEAR)","authors":"Joanne N. Quiñones-Rivera MD, MSCE ,&nbsp;Joseph Bell MD ,&nbsp;Rupsa C. Boelig MD, MS ,&nbsp;Shirin Azadi MD ,&nbsp;Onyinyech Anosike DO ,&nbsp;Dahiana M. Gallo MD, PhD ,&nbsp;Adam Taylor MD ,&nbsp;Vincenzo Berghella MD ,&nbsp;Leah Carnick Ledford MSN ,&nbsp;Mónica Rincón MD, MCR ,&nbsp;Susana Villegas-Sanchez ,&nbsp;Richard Burwick MD, MPH ,&nbsp;Luisa López-Torres MD ,&nbsp;Jorge E. Tolosa MD, MSCE","doi":"10.1016/j.ajogmf.2025.101753","DOIUrl":"10.1016/j.ajogmf.2025.101753","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The literature is conflicting regarding the management of cervical cerclage once patients experience preterm prelabor rupture of membranes (PPROM). While some recommend removal of the cerclage due to the risk of maternal and neonatal infectious morbidity after PPROM, others advocate retention of the cerclage due to the benefit of latency to delivery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Our study objective is to determine the safety of cerclage retention in women who experience PPROM before 34 weeks (w) gestation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study of singleton pregnancies with cerclage for history, ultrasound or physical exam indications between June 2016 and June 2020 at 8 sites across United States and Colombia. The primary exposure of interest was the time from PPROM to cerclage removal (CR) categorized as early &lt; 48 hours (h)– or delayed (≥48 h). Maternal safety outcomes collected as part of the database design included clinical chorioamnionitis, histologic chorioamnionitis, postpartum endometritis, hemorrhage, sepsis, and intensive care unit admission. Neonatal safety outcome was a composite of sepsis, prematurity complications and death. Statistical analysis included bivariate and multivariate techniques. Latency between PPROM and delivery was also compared between the early and delayed CR groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 839 singleton pregnancies managed with cerclage, 135 (16.1%) experienced PPROM before 34 weeks gestation–127 with the cerclage in place. 37 underwent immediate CR for labor, bleeding, chorioamnionitis or cord prolapse and as such, were excluded from further analyses. Eighty-nine patients were included in final analysis–59 early CR (66.3%) and 30 delayed CR (33.7%). Rates of clinical chorioamnionitis and histologic chorioamnionitis were similar between groups (clinical: early CR 22.0% vs delayed CR 40.0%, &lt;em&gt;P=.&lt;/em&gt;08; histologic: early CR 55.1% vs delayed CR 66.7%, &lt;em&gt;P=.&lt;/em&gt;30). Postpartum endometritis rate was higher in delayed CR vs early CR (16.7% vs 1.7%, &lt;em&gt;P=.&lt;/em&gt;008). Composite neonatal outcome and neonatal mortality were similar between groups. Latency from PPROM to delivery was longer with delayed CR by 7 days (&lt;em&gt;P&lt;.&lt;/em&gt;001). In adjusted analyses, clinical chorioamnionitis was not independently associated with cerclage removal timing when controlling for PPROM before 24 weeks (AOR 0.41 [95% CI 0.16, 1.07], &lt;em&gt;P=.&lt;/em&gt;07) and endometritis was lower with early CR (AOR 0.09 [95% CI 0.01, 0.79], &lt;em&gt;P=.&lt;/em&gt;03). We also evaluated the relationship between neonatal outcomes and cerclage removal timing controlling for corticosteroids and PPROM before 24 weeks and found that composite neonatal outcome was not independently associated with cerclage removal timing (AOR 0.36 [95% CI 0.07-1.91], &lt;em&gt;P=.&lt;/em&gt;23). Neonatal mortality was lower with corticosteroid administration (AOR 0.15 [95% CI 0.02, 0.97], &lt;em&gt;P=.&lt;/em&gt;046) and hig","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 10","pages":"Article 101753"},"PeriodicalIF":3.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849273","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":"Placenta previa during second trimester abortion and the risk of adverse outcomes: a systematic review and meta-analysis","authors":"Tomi Kanninen MD,&nbsp;Melissa Figueroa MD,&nbsp;Puja Patel MD,&nbsp;Manuel Alvarez MD,&nbsp;Abdulla Al-Khan MD","doi":"10.1016/j.ajogmf.2025.101746","DOIUrl":"10.1016/j.ajogmf.2025.101746","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 10","pages":"Article 101746"},"PeriodicalIF":3.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765603","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":"Insight into the abnormal cardiotocographic patterns following neuraxial analgesia for pain management in labor","authors":"Mariachiara Bosco ,&nbsp;Stefano Uccella ,&nbsp;Beatrice De Bellis ,&nbsp;Roberto D’Alessandro ,&nbsp;Rosa Laterza ,&nbsp;Simone Garzon","doi":"10.1016/j.ajogmf.2025.101747","DOIUrl":"10.1016/j.ajogmf.2025.101747","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Neuraxial analgesia (NA) is widely used for pain management in labor but may be associated with abnormal fetal heart rate patterns, including prolonged decelerations.</div></div><div><h3>OBJECTIVE</h3><div>To investigate decelerations and fetal bradycardia following neuraxial analgesia (NA; epidural, combined spinal-epidural, or spinal) in labor, in terms of frequency, associated factors, and outcomes. The primary objective was to determine whether maternal hypotension (SBP&lt;100 mmHg or DBP&lt;60 mmHg), uterine hyperstimulation (ie, exaggerated response to uterine stimulants presenting as a prolonged contractions for over 2 minutes), or other potentially implicated factors are associated with prolonged deceleration (lasting more than 3 minutes) after NA (PDAA).</div></div><div><h3>STUDY DESIGN</h3><div>We retrospectively analyzed data of 898 singletons term pregnant women who underwent NA during labor. Data were retrieved from a prospectively collected database and medical records. All cardiotocographic tracings were manually reviewed from at least 10 minutes before NA to delivery. Univariate and multivariable logistic regression analyses were used to explore the associations between demographic, obstetric, and clinical characteristics and the occurrence of PDAA within 30 minutes after NA.</div></div><div><h3>RESULTS</h3><div>PDAA occurred in 6.57% (59/898; 95% CI 5.08%–8.44%) of women within 30 minutes after NA. Uterine hyperstimulation was significantly more frequent in those with PDAA [39% (23/59) vs 5.4% (45/839); <em>P</em>&lt;.001], who also reported higher preanalgesia pain scores [9.7 (0.94) vs 8.9 (2.04); <em>P</em>=.003]. No significant differences were found between groups in systolic/diastolic blood pressure or the prevalence of maternal hypotension. Nulliparity (OR 2.27, 95% CI 1.01–1.06; <em>P</em>=.048), uterine hyperstimulation (OR 11.4, 95% CI 5.48–23.7; <em>P</em>&lt;.001), and higher pain intensity at time 0 (OR 1.50, 95% CI 1.10–2.30; <em>P</em>=.007) were independently associated with PDAA.</div></div><div><h3>CONCLUSION</h3><div>Uterine hyperstimulation appeared to be the strongest factor associated with PDAA. The role of uterine hyperstimulation due to a rapid drop in catecholamines in the occurrence of PDAA may be further supported by the association with higher preanalgesia pain intensity and nulliparity. Conversely, postanalgesia hypotension did not appear to be a key factor.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 10","pages":"Article 101747"},"PeriodicalIF":3.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761657","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 Pink Journal Club Toolkit: redefining journal clubs in obstetrics and maternal-fetal medicine","authors":"Mariam K. Ayyash MD, MSCR ,&nbsp;Beverly C. Tse MD ,&nbsp;Michelle Joy Wang MD","doi":"10.1016/j.ajogmf.2025.101730","DOIUrl":"10.1016/j.ajogmf.2025.101730","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 9","pages":"Article 101730"},"PeriodicalIF":3.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686990","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":"Visual aids for induction of labor education: a randomized controlled trial","authors":"Halley Staples MD ,&nbsp;Rachel Paul MPH ,&nbsp;Fan Zhang MD ,&nbsp;Bridget Huysman MD, MPH ,&nbsp;Bree Goodman MD ,&nbsp;Rebecca Rimsza MD ,&nbsp;Brianna Bradley BS ,&nbsp;Lori Atwood AAS ,&nbsp;Jeannie C. Kelly MD, MS ,&nbsp;Ebony B. Carter MD, MPH ,&nbsp;Anthony Odibo MD, MSCE ,&nbsp;Antonina Frolova MD, PhD ,&nbsp;Nandini Raghuraman MD, MSCI","doi":"10.1016/j.ajogmf.2025.101743","DOIUrl":"10.1016/j.ajogmf.2025.101743","url":null,"abstract":"<div><h3>Background</h3><div>Approximately 20% of patients in the United States undergo an induction of labor (IOL). Patients undergoing induction are more likely to report lower birth satisfaction, especially Black patients. Visual aids have been shown to improve patient satisfaction in medical decision-making, however, there are few studies investigating the use of visual aids for IOL counseling.</div></div><div><h3>Objective</h3><div>To compare standard counseling for IOL to standard counseling plus a patient-informed visual aid and evaluate differences in patient knowledge of IOL and satisfaction with counseling.</div></div><div><h3>Study design</h3><div>This was a randomized controlled trial of patients with singleton gestations ≥37 weeks admitted for IOL. Patients who were &lt;18 years old, non-English speaking, with prior cesareans, fetal anomalies, intrauterine fetal demise, or whose induction agent had already been determined were excluded. We developed a visual aid handout on induction methods with input from patients that had recently undergone an induction. On admission, patients were randomized to routine counseling or counseling with the visual aid. The primary outcome was patient knowledge, using questions adapted from a published IOL knowledge assessment. Our secondary outcome was satisfaction with IOL counseling, rated on 0 to 10 scale. Eighty-four patients (42 in each arm) were required to detect a 25% difference in knowledge scores with 85% power. We used an intention-to-treat approach for our analyses; we compared the percentage of correct answers on the IOL knowledge assessment and satisfaction with IOL counseling using Wilcoxon rank sum. We conducted planned stratified analyses by historically marginalized race, level of education, and insurance type.</div></div><div><h3>Results</h3><div>Eighty-four patients were randomized; 39% self-identified as Asian, Black, or Hispanic. The percentage of correct IOL knowledge answers were similar between the visual aid group and the standard counseling group: median 80 (IQR: 60–90) versus 70 (60–90), <em>P</em>=.23. We observed no significant differences between groups after stratifying by historically marginalized race and ethnicity, insurance type, or level of education. Satisfaction with counseling scores were similar between participants receiving the visual aid compared to regular counseling: 9 (8–10) versus 10 (9–10), <em>P</em>=.08.</div></div><div><h3>Conclusion</h3><div>The introduction of a patient-informed visual aid did not change IOL knowledge or satisfaction with counseling compared to standard counseling. Future directions include modifying the visual aid using patient feedback and evaluating its implementation earlier in antenatal care.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 10","pages":"Article 101743"},"PeriodicalIF":3.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676037","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 feasibility and effectiveness of using an adhesion barrier in preventing dysmenorrhea, pain, and niche-related problems after cesarean sections: a multicenter randomized pilot study","authors":"Britt L. Post MD ,&nbsp;Carry Verberkt MD, PhD ,&nbsp;Danique van Veen MD ,&nbsp;Lucet van der Voet MD, PhD ,&nbsp;Marlies Y. Bongers Prof, MD, PhD ,&nbsp;Marjon A. de Boer MD, PhD ,&nbsp;Esther J. Wortelboer MD, PhD ,&nbsp;Judith A.F. Huirne Prof, MD, PhD ,&nbsp;Robert A. de Leeuw MD, PhD","doi":"10.1016/j.ajogmf.2025.101742","DOIUrl":"10.1016/j.ajogmf.2025.101742","url":null,"abstract":"<div><h3>Background</h3><div>A cesarean scar can lead to various gynecological complaints, including abdominal pain, dysmenorrhea, postmenstrual spotting, and unexplained secondary infertility. The ethiology of the development of a niche is currently not clear. A possible hypothesis is the involvement of vesicouterine adhesions formed after the cesarean section.</div></div><div><h3>Objective</h3><div>This study explores the feasibility of a randomized controlled trial assessing the effectiveness of an adhesion barrier on the uterine wound in women undergoing their first cesarean section on gynecological symptoms and the presence of adhesions evaluated by transvaginal ultrasound (TVUS).</div></div><div><h3>Study design</h3><div>A multicenter randomized pilot study was performed on women undergoing their first cesarean section. They were randomly allocated to the application of the adhesion barrier 4DryField® PH after uterine closure or no adhesion barrier. They were followed for 9 months using TVUS and questionnaires. The primary outcome measure was feasibility (protocol compliance, loss-to-follow-up, data collection). Secondary outcomes were perioperative outcomes, menstrual outcomes, Quality of Life, and sexual function at 9 months, as well as ultrasound findings such as vesicouterine adhesion and niche measurements at 3 months.</div></div><div><h3>Results</h3><div>One hundred and seventeen participants (58 intervention, 59 control) were enrolled. Protocol adherence was 94.8% to 100%, and follow-up loss was 3% to 12%. Difficulties in feasibility included ultrasound evaluation, ultrasound storage, and participant recall bias. At 9 months, 40% of participants had amenorrhea and/or gave breastfeeding or used hormonal contraceptives. There was no apparent difference in dysmenorrhea, but postmenstrual spotting was less in the intervention group (0% vs 18.4%, <em>P</em>=.04). Furthermore, there was a trend toward fewer adhesions and niches in the intervention group.</div></div><div><h3>Conclusion</h3><div>The study showed no clear limitations, feasible execution of the procedure, and a low drop-out rate. Spotting was less in the intervention group. Nevertheless, a larger sample size is needed to draw solid conclusions concerning the beneficial effect of reducing niches, adhesions, dysmenorrhea, and chronic pelvic pain. Our findings are encouraging and support the design of a comparatively large randomized controlled trial with a refined methodology to enhance feasibility and accuracy.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 10","pages":"Article 101742"},"PeriodicalIF":3.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676036","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":"Early wound dressing (soft gauze/tape dressing) removal after cesarean delivery: a meta-analysis of randomized trials","authors":"Leshae A. Cenac MD ,&nbsp;Serena Guerra MD ,&nbsp;Alicia Huckaby DO ,&nbsp;Gabriele Saccone MD, PhD ,&nbsp;Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2025.101739","DOIUrl":"10.1016/j.ajogmf.2025.101739","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether removing the wound dressing within 24 hours after a cesarean delivery leads to any negative effects on wound healing and to recommend the best time for dressing removal.</div></div><div><h3>Data sources</h3><div>Science Direct, PubMed, Cochrane Library, and Scopus as the electronic databases from their inception until December 2024.</div></div><div><h3>Criteria for study eligibility</h3><div>Randomized controlled trials (RCTs) were incorporated in the databases, irrespective of their publication language, sample size, publication date, use of blinding, or study setting/location.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>A systematic review of RCTs was conducted to compare wound outcomes in cesarean delivery patients with early dressing removal vs standard care. Utilizing an intent-to-treat approach, the analysis evaluated wound complication rates through both objective wound scores and subjective patient-reported complaints. The primary outcome of the study was postoperative wound complications, defined as any of the following: infection, disruption (skin dehiscence or deeper), or seroma/hematoma. The summary measures were reported as odds ratio (OR) or as mean difference with 95% of confidence interval (CI), using the random effects model of DerSimonian and Laird.</div></div><div><h3>Results</h3><div>Four trials, including 2130 participants, were included in the meta-analysis. Most of them defined early dressing removal as 24 hours after cesarean, and late removal as 48 hours after cesarean. All trials used soft gauze/tape dressing. Pooled data showed that early removal did not increase the incidence of wound complications (17.9% vs 19.4%; OR 0.90, 95% CI 0.72–1.14), and was associated with higher maternal satisfaction.</div></div><div><h3>Conclusion</h3><div>Early dressing removal (≤24 hours) after cesarean delivery appears to be safe and preferable compared to later removal, since it is associated with higher maternal satisfaction.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 9","pages":"Article 101739"},"PeriodicalIF":3.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650800","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":"Keep your candle lit: a story for maternal-fetal medicine physicians","authors":"Michael R. Foley MD","doi":"10.1016/j.ajogmf.2025.101741","DOIUrl":"10.1016/j.ajogmf.2025.101741","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 9","pages":"Article 101741"},"PeriodicalIF":3.1,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638321","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":"Randomized controlled trial of the impact of ursodeoxycholic acid on glycemia in gestational diabetes mellitus: the GUARDS trial","authors":"Catalina de Paco Matallana PhD ,&nbsp;Jose E. Blanco-Carnero PhD ,&nbsp;Ana Company Calabuig MD ,&nbsp;Manuela Fernandez PhD ,&nbsp;Monika Lewanczyk MD ,&nbsp;Matilda Burton MBChB ,&nbsp;Xi Yang PhD ,&nbsp;Alice L. Mitchell PhD ,&nbsp;Anita Lovgren-Sandblom BSc ,&nbsp;Hanns-Ulrich Marschall PhD ,&nbsp;David Wright MD ,&nbsp;Caroline Ovadia PhD ,&nbsp;Kypros H. Nicolaides MD ,&nbsp;Catherine Williamson MD","doi":"10.1016/j.ajogmf.2025.101732","DOIUrl":"10.1016/j.ajogmf.2025.101732","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Gestational diabetes mellitus is a pregnancy complication that can be associated with increased risks of adverse maternal and neonatal outcomes. Optimal glycemic control remains challenging for many patients despite the existing management strategies. Ursodeoxycholic acid is commonly used for cholestasis of pregnancy and has shown potential metabolic benefits, including improved insulin sensitivity and reduced inflammation. We hypothesize that ursodeoxycholic acid may improve glycemic control in gestational diabetes mellitus.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to compare treatment with ursodeoxycholic acid vs placebo for improving maternal glycemia in gestational diabetes mellitus.</div></div><div><h3>STUDY DESIGN</h3><div>This was a single-site, randomized, double-blind, placebo-controlled trial of ursodeoxycholic acid in 113 women with gestational diabetes mellitus at 24 to 28 weeks’ gestation. The primary outcome was maternal fasting blood glucose concentration at 35⁺⁰ to 37⁺⁶ weeks’ gestation.</div></div><div><h3>RESULTS</h3><div>The primary outcome did not differ significantly between groups when evaluated by intention to treat analysis (treatment effect, 0.98; 95% confidence interval, 0.92–1.05; <em>P</em>=.61). There were no differences in maternal or fetal secondary outcomes, including maternal weight change, need for insulin treatment, birthweight centile, proportion of large or small for gestational age infants, neonatal hypoglycemia, or admission to the neonatal unit. A prespecified secondary analysis measured serum concentrations of ursodeoxycholic acid using ultra-performance liquid chromatography–tandem mass spectrometry and showed that participants taking larger numbers of tablets had higher serum concentrations of ursodeoxycholic acid. Post hoc analysis revealed no difference in the rate of fasting blood glucose concentrations at or above the recommended target of 90 mg/dL according to intention to treat analysis (5/50 [10.0%] vs 8/53 [15.1%]; risk ratio, 0.66; 95% confidence interval, 0.23–1.89; <em>P</em>=.557). However, among patients with serum ursodeoxycholic acid ≥0.5 µmol/L (indicating adherence), fewer patients had fasting glucose levels above the target (2/42 [4.8%] vs 11/57 [19.3%]; risk ratio, 0.25; 95% confidence interval, 0.06–1.06; <em>P</em>=.039).</div></div><div><h3>CONCLUSION</h3><div>This trial demonstrated no difference in fasting glycemia between women with gestational diabetes mellitus treated with ursodeoxycholic acid and those treated with placebo. However, those with elevated serum ursodeoxycholic acid concentrations were more likely to have fasting blood glucose concentrations below the recommended thresholds, suggesting potential benefit of further investigation.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 9","pages":"Article 101732"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620828","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}