American Journal of Obstetrics & Gynecology Mfm最新文献

{"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":"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":"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":"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}

{"title":"Maternal blood lipoprotein cholesterol prior to and at the time of diagnosis of preeclampsia: a systematic review","authors":"Sally Yang ,&nbsp;Wei Zhou PhD ,&nbsp;Evdokia Dimitriadis PhD ,&nbsp;Ellen Menkhorst PhD","doi":"10.1016/j.ajogmf.2025.101654","DOIUrl":"10.1016/j.ajogmf.2025.101654","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;Wide-spread endothelial dysfunction is thought to underlie the maternal symptoms of preeclampsia. Endothelial dysfunction is strongly associated with abnormal circulating lipoprotein cholesterol levels. This systematic review aimed to assess whether maternal circulating high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very-low-density lipoprotein cholesterol levels were altered before or at the time of preeclampsia diagnosis. This may provide an understanding of the pathogenesis of preeclampsia and the predictive and diagnostic utility of lipoprotein cholesterol levels in distinguishing pregnancies complicated by preeclampsia from normal pregnancies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;DATA SOURCES&lt;/h3&gt;&lt;div&gt;Literature searches were conducted in Ovid MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, and Google Scholar from inception to April 2024 for studies reporting high-density lipoprotein, low-density lipoprotein, and very-low-density lipoprotein levels in normal pregnancies and pregnancies complicated by preeclampsia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY ELIGIBILITY CRITERIA&lt;/h3&gt;&lt;div&gt;The selected studies included the following: population of pregnant women, exposure to preeclampsia, blood samples collected during a specific trimester of pregnancy, and at least 1 primary outcome (high-density lipoprotein, low-density lipoprotein, or very-low-density lipoprotein). Of note, 2 reviewers were involved in the study selection. The excluded studies included pregnancies complicated by other risk factors for preeclampsia (eg, preexisting hypertension, diabetes mellitus, and obesity) and other pregnancy-related hypertensive disorders (pregnancy-induced hypertension, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;The quality of the included studies was evaluated using the Newcastle-Ottawa Scale for case-control, cohort, and cross-sectional studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 41 studies were included. The quality of the studies was generally good. However, 59% of the studies did not control for the gestational age at which the blood samples were collected. No consistent change in high-density lipoprotein or low-density lipoprotein levels was found before preeclampsia diagnosis in the first, second, or third trimesters of pregnancy. Very-low-density lipoprotein was significantly elevated in 2 of 2 studies that reported levels before preeclampsia diagnosis in the late second (&gt;23 weeks of gestation) or third trimester of pregnancy. After preeclampsia diagnosis in the third trimester of pregnancy, very-low-density lipoprotein levels were significantly elevated in 9 of 11 studies, and high-density lipoprotein levels were significantly decreased in 15 of 19 studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;Very-low-density lipoprotein is highly atherogenic, and its elevation before and at the time of preeclampsia diagn","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 5","pages":"Article 101654"},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477104","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":"The association between perinatal depressive symptoms and child neurodevelopment: a response.","authors":"Emily S Miller, Lisa Mele, Maged M Costantine","doi":"10.1016/j.ajogmf.2025.101642","DOIUrl":"10.1016/j.ajogmf.2025.101642","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101642"},"PeriodicalIF":3.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473068","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}