American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Next-generation sequencing–based approach for fetal DNA quantification and blood antigen detection in alloimmunized pregnancies","authors":"Tesfai Emahazion PhD ,&nbsp;Ahlam Badri MSc ,&nbsp;Elisabeth Jalkesten BSc ,&nbsp;Mari Flodström BSN ,&nbsp;Gunilla Ajne MD, PhD ,&nbsp;Mehmet Uzunel PhD ,&nbsp;Agneta Wikman MD, PhD","doi":"10.1016/j.ajogmf.2025.101694","DOIUrl":"10.1016/j.ajogmf.2025.101694","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Erythrocyte and platelet alloimmunization during pregnancy can be severe and are closely monitored throughout pregnancy. However, the blood type of the fetus and the associated risk are often unknown. Here, fetal erythrocyte and platelet genotype from maternal plasma were determined using next-generation sequencing, providing noninvasive prenatal testing as an alternative to traditional methods for monitoring alloimmunized pregnancies.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to validate an innovative next-generation sequencing method for the detection of specific blood antigens in maternal plasma-derived cell-free DNA, focusing on key antigens associated with immunizations. By analyzing free-circulating fetal DNA across various gestational stages, the study seeks to achieve high-precision identification of clinically relevant erythrocyte and platelet antigens.</div></div><div><h3>STUDY DESIGN</h3><div>Maternal whole blood samples were consecutively collected from 74 immunized and nonimmunized pregnant women at 13 to 27 weeks of gestation in Stockholm County, Sweden. Next-generation sequencing analysis was performed on maternal plasma using a prototype kit from Devyser AB (Stockholm, Sweden). The kit detects several erythrocyte blood group markers, 2 human platelet antigen markers (HPA-1 and HPA-5), XY chromosome markers, and 12 insertions and deletions from different chromosomes to identify and quantify fetal DNA. After birth, genomic DNA from umbilical cord blood samples were genotyped with various methods and compared with noninvasive prenatal testing results obtained during pregnancy.</div></div><div><h3>RESULTS</h3><div>A total of 95 samples from 74 pregnancies were analyzed. Fetal DNA was successfully identified in 72 of 74 cases (97.3%) using insertion and deletion and Y chromosome markers. In 2 cases, fetal DNA could not be detected because of the absence of informative markers. The noninvasive prenatal testing results showed 100% concordance with the genotyped newborns. Among the fetuses of 22 immunized women, 6 were antigen negative, 10 were antigen positive, 5 had antigens not included in the next-generation sequencing panel (3 anti-Cw, 1 anti-M, and 1 anti-Ge2), and 1 had an inconclusive result.</div></div><div><h3>CONCLUSION</h3><div>Our study highlights the feasibility of using next-generation sequencing for comprehensive fetal antigen screening, paving the way for a personalized approach to managing alloimmunized pregnancies. By accurately identifying fetuses expressing antigens corresponding to maternal antibodies and those not at risk, it enhances the precision of targeted care.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101694"},"PeriodicalIF":3.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081059","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":"Achieving water-tight open spina bifida closure through a novel three-port three-layer fetoscopic repair","authors":"Robin Bowman MD ,&nbsp;Amir Alhajjat MD ,&nbsp;Rya Muller BA ,&nbsp;Jonathan Scoville MD, MSPH ,&nbsp;Aimen Shaaban MD","doi":"10.1016/j.ajogmf.2025.101697","DOIUrl":"10.1016/j.ajogmf.2025.101697","url":null,"abstract":"<div><div>About 3,000 individuals in the United States are born with spina bifida each year. Prenatal surgery for open spina bifida has demonstrated improved neurological and functional outcomes compared to postnatal closure. However, open maternal fetal surgery is associated with increased obstetric complications, such as uterine ruptures and need for cesarean deliveries in the current and any subsequent pregnancies. Minimally invasive fetoscopic approaches were subsequently developed to decrease maternal morbidity from large hysterotomies while preserving the fetal benefits of prenatal repair.</div><div>Single and 2-layer fetoscopic closure techniques have been described, but concerns remain regarding the ability to achieve water-tight closure via minimally invasive approaches. Water-tight closure is critical for preventing postoperative complications, particularly cerebrospinal fluid (CSF) leakage and wound dehiscence.</div><div>This report describes a novel 3-port, 3-layer fetoscopic repair technique. The accompanying video demonstrates the technique and procedural steps in detail. This method may facilitate higher rates of water-tight dural closure via the fetoscopic approach, potentially reducing postoperative complications.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101697"},"PeriodicalIF":3.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081119","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":"Severe maternal morbidity and risk of transplant rejection in pregnant patients with a history of solid-organ transplant","authors":"Anna Jarvis MD ,&nbsp;Miriam Sheetz BS ,&nbsp;Shriddha Nayak MD ,&nbsp;Arthur Vaught MD ,&nbsp;Marika Toscano MD ,&nbsp;Kristin Darwin MD","doi":"10.1016/j.ajogmf.2025.101696","DOIUrl":"10.1016/j.ajogmf.2025.101696","url":null,"abstract":"<div><h3>Background</h3><div>In 2023, 18,078 US women underwent solid organ transplants; over a third (n = 5547) were of reproductive age, receiving kidney (69.6%), liver (23.7%), or heart (9.0%) transplants. Successful pregnancies are feasible for transplant recipients, but these patients often face elevated pregnancy risks, including hypertension, gestational diabetes, pre-eclampsia, and preterm birth.</div></div><div><h3>Objective</h3><div>To determine rates of severe maternal morbidity (SMM) associated with prior kidney, liver, or heart transplant.</div></div><div><h3>Study Design</h3><div>This descriptive study was conducted using the TriNetX Research Network, a health research network with data from 95 health care organizations spanning 1/1/2010−10/29/2024. Patients aged 12-55 years were included if they underwent single solid organ transplant prior to pregnancy and had no prior history of transplant rejection. Pregnancy was defined by delivery CPT code indicating presence of a pregnancy. SMM was defined using Centers for Disease Control (CDC) ICD-10 codes for 21 indicators of SMM. The primary outcome was composite SMM during delivery hospitalization or within one year postpartum. Secondary outcomes included comparison of SMM in individuals with and without solid organ transplant history, as well as estimation of rates of individual indicators of SMM and postpartum transplant rejection over time.</div></div><div><h3>Results</h3><div>A total of 421 kidney, 192 liver, and 59 heart transplant recipients met inclusion criteria. Rates of composite SMM were greatest for heart transplant recipients (40.7%), with morbidity most often from pulmonary edema/acute heart failure (28.8%). This was followed by kidney transplant recipients (composite SMM 11.48%), with acute renal failure occurring in 9% of patients. Liver transplant recipients had the lowest composite SMM (7.48%). Rates of postpartum solid organ transplant rejection progressively increased at 1-, 2-, and 5-years post-delivery for all cohorts. Solid organ transplant rejection at 5-years was highest for heart transplant recipients (25.4%), followed by kidney (11.48%), and liver (7.48%).</div></div><div><h3>Conclusion</h3><div>Solid organ transplant recipients have significantly higher odds of composite SMM compared to pregnant non-transplant recipients. Among transplant recipients, patients with a history of heart transplant had the highest prevalence of composite non-transfusion SMM and highest rates of transplant rejection 5 years post-delivery. The impact of pregnancy on long-term outcomes in transplant recipients requires further study.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101696"},"PeriodicalIF":3.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986596","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":"Obstetrical management and outcomes of female genital mutilations in a high resource expert center","authors":"Audrey Bediat,&nbsp;Konstantinos Chatzistergiou MD,&nbsp;Jean Baptiste Chanier,&nbsp;Gregory Bierry MD,&nbsp;Bruno Renevier MD,&nbsp;Sarah Abramowicz MD ,&nbsp;Simon Crequit MD","doi":"10.1016/j.ajogmf.2025.101695","DOIUrl":"10.1016/j.ajogmf.2025.101695","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101695"},"PeriodicalIF":3.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037588","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":"A randomized controlled trial of propranolol in nulliparous patients with prolonged labor","authors":"Yaneve N. Fonge MD ,&nbsp;Helen B. Gomez Slagle MD ,&nbsp;Richard J. Caplan PhD ,&nbsp;Ellen L. Myers MD ,&nbsp;Roxana Portillo ,&nbsp;Anthony C. Sciscione DO","doi":"10.1016/j.ajogmf.2025.101698","DOIUrl":"10.1016/j.ajogmf.2025.101698","url":null,"abstract":"<div><h3>Background</h3><div>Propranolol use has been proposed to shorten the length of labor following prolonged induction.</div></div><div><h3>Objective</h3><div>We sought to determine if administration of propranolol reduces the duration of labor among nulliparous individuals with prolonged latent labor following induction (IOL) at term.</div></div><div><h3>Study Design</h3><div>An open-label randomized clinical trial was conducted from July 2019 through June 2022 comparing 2mg of intravenous propranolol administration to usual care for prolonged latent labor. Nulliparous individuals undergoing IOL at ≥37 weeks with a singleton gestation and cervical dilation ≤2cm were included. Prolonged latent labor was defined as no cervical change ≥8 hours with ruptured membranes and receiving oxytocin. Labor management was standardized among participants. Our primary outcome was time to delivery.</div></div><div><h3>Results</h3><div>80 nulliparous participants (40 propranolol, 40 usual care) were randomized. Propranolol administration did not achieve a significantly faster median time to delivery compared to usual care, (propranolol: 27.7 hrs vs. usual care: 30.4 hrs, <em>P&lt;.</em>52). Equal proportions of individuals delivered vaginally within 24hrs of randomization (propranolol: 27.5% vs. usual care: 27.5%, <em>P&lt;</em>1.0). There was no difference in the cesarean delivery rate between the 2 groups (57.5% versus 55.0%, <em>P</em>=1.0) and no difference in time to active labor (propranolol: 19.5 hrs vs. usual care: 26.0 hrs, <em>P&lt;.</em>22). There were no significant differences in maternal and neonatal outcomes.</div></div><div><h3>Conclusion</h3><div>Propranolol administration did not shorten the time to delivery or increase vaginal delivery in nulliparous individuals with a prolonged latent labor course. Our findings do not support the use of propranolol for prolonged latent labor in nulliparous patients undergoing IOL at term.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101698"},"PeriodicalIF":3.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027611","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":"Diagnosis of hypertensive disorders in pregnancy","authors":"Rebecca Horgan MD ,&nbsp;Yara Hage Diab MD ,&nbsp;Maged Costantine MD ,&nbsp;George Saade MD ,&nbsp;Baha Sibai MD","doi":"10.1016/j.ajogmf.2025.101693","DOIUrl":"10.1016/j.ajogmf.2025.101693","url":null,"abstract":"<div><div>Hypertensive disorders of pregnancy, including chronic hypertension (CHTN), superimposed preeclampsia, gestational hypertension, and preeclampsia, affect 10% to 20% of pregnancies and are a significant cause of maternal and perinatal morbidity and mortality. The incidence of these disorders is increasing because of factors, such as advanced maternal age, obesity, assisted reproductive technology, and increased rates of preexisting comorbidities. Differentiating pregnancy-associated hypertension from preexisting CHTN is challenging, as the overlap between the 2 may be broadening because of the changing demographics of the pregnant population. This review critically evaluated the evidence regarding the current periods recommended to make a diagnosis of a hypertensive disorder of pregnancy. This review does not provide evidence to support the arbitrary 4-hour period or any particular period for the diagnosis of hypertensive disorders in pregnancy. In addition, there is no clear definition of what is considered persistent or sustained blood pressure elevations in blood pressure. Every effort should be made to ensure accurate diagnosis of new-onset elevated blood pressures during pregnancy before labeling the patient with the diagnosis and, thus, recommending serial maternal and fetal testing and delivery at or before 37 weeks of gestation.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101693"},"PeriodicalIF":3.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036842","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":"Postpartum care in the neonatal intensive care unit, PeliCaN: a randomized controlled trial","authors":"Heather H. Burris MD, MPH ,&nbsp;Niesha Darden ,&nbsp;Maggie Power BSN,CNM ,&nbsp;Laura Walker BA ,&nbsp;Rachel Ledyard MPH ,&nbsp;Joseph Reiter MS ,&nbsp;Jennifer Lewey MD, MPH ,&nbsp;Kimberly K. Trout PhD, RN, CNM ,&nbsp;Marie Tan BA ,&nbsp;Emily F. Gregory MD, MPH ,&nbsp;Sara B. DeMauro MD, MSCE ,&nbsp;Scott A. Lorch MD, MSCE ,&nbsp;Lori Christ MD ,&nbsp;Sara C. Handley MD, MSCE ,&nbsp;Diana Montoya-Williams MD, MSHP ,&nbsp;Celeste Durnwald MD","doi":"10.1016/j.ajogmf.2025.101689","DOIUrl":"10.1016/j.ajogmf.2025.101689","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Postpartum parents of hospitalized infants in neonatal intensive care units have higher rates of chronic disease and pregnancy complications than parents of well newborns. Neonatal intensive care unit parents may prioritize remaining at their infants’ bedsides over their healthcare.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to determine whether embedding doulas and certified nurse midwives for postpartum care in the neonatal intensive care unit (PeliCaN) would reduce the time to receive postpartum healthcare, with the hypothesis that the intervention would shorten the time and improve the comprehensiveness of postpartum care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;This was a parallel randomized controlled trial from November 29, 2022, to November 7, 2023, in a single-center, level 3 neonatal intensive care unit in a tertiary hospital in Philadelphia, Pennsylvania, with approximately 4200 births annually. Postpartum parents of infants who were born at &lt;34 weeks of gestation, &lt;2 weeks old, and anticipated to remain in the neonatal intensive care unit ≥1 week, were eligible. Of the 135 potentially eligible parents, the staff screened 78 for eligibility (constrained by access to just 4 hours per week of midwifery care), contacted 52 of 71 eligible parents, and enrolled 37 by 2 weeks after delivery. There were 20 parents randomized to the intervention group and 17 parents randomized to the control group via block randomization stratified by gestational age (&lt;29 and ≥29 weeks) and insurance (public and private). The intervention consisted of postpartum doula support and midwifery clinical care in the neonatal intensive care unit for the duration of the infant’s hospitalization. Participants in the control group received usual care. The outcomes were measured at 12 weeks after delivery. All participants had complete follow-up data. The primary outcome was days to receive any postpartum care and to completion of 3 care components: blood pressure measurement and treatment if needed; depression screening and referral and treatment if indicated; and contraception counseling (if no sterilization procedure had been performed) and provision if patients desired. Planned secondary analyses included stratification by gestational age and insurance as well as assessing the rates of any postpartum care receipt.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Six participants (30.0%) in the intervention group and 6 participants (35.0%) in the control group were parents of infants born at &lt;29 weeks of gestation, and 16 participants (80.0%) in the intervention group and 15 participants (88.2%) in the control group were publicly insured. The median times to the first postpartum visit were 11 days (interquartile range, 10–12) in the intervention group and 31 days (interquartile range, 26–37) in the control group (&lt;em&gt;P&lt;/em&gt;&lt;.001). In addition, 1 participant (5%) in the intervention group and 6 participants (35%) in the co","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101689"},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042280","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 iron deficiency without anemia on pregnancy outcomes: a pilot study","authors":"Madison R. Klavans MD,&nbsp;Emily Fronk MD,&nbsp;Laura Parsons MD,&nbsp;Christian Chisholm MD","doi":"10.1016/j.ajogmf.2025.101687","DOIUrl":"10.1016/j.ajogmf.2025.101687","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101687"},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032493","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":"Vascular effects of a hypertensive disorder of pregnancy antepartum and postpartum: the EPOCH study","authors":"Mark A. Hlatky MD,&nbsp;Jonathan A. Mayo MPH,&nbsp;Seda Tierney MD,&nbsp;Hayley E. Miller MD,&nbsp;Oshra Sedan PhD,&nbsp;Marcia L. Stefanick PhD,&nbsp;Mads Melbye MD, DrMed,&nbsp;Heather A. Boyd PhD,&nbsp;David K. Stevenson MD,&nbsp;Gary M. Shaw DrPH,&nbsp;Virginia D. Winn MD, PhD","doi":"10.1016/j.ajogmf.2025.101692","DOIUrl":"10.1016/j.ajogmf.2025.101692","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101692"},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044391","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":"Effectiveness of a cervical pessary in prolongation of pregnancy after an arrested episode of preterm labor: a systematic review and individual patient data meta-analysis","authors":"Sofie H. Breuking MD, PhD ,&nbsp;Annemijn A. De Ruigh MD, PhD ,&nbsp;Carme Merced MD ,&nbsp;Rik Van Eekelen PhD ,&nbsp;Madelon Van Wely PhD ,&nbsp;Charlotte E. Van Dijk MD ,&nbsp;Laia Pratcorona MD, PhD ,&nbsp;Elena Carreras MD, PhD ,&nbsp;Ben W. Mol MD, PhD ,&nbsp;Gabriele Saccone PhD, MD ,&nbsp;Eva Pajkrt MD, PhD ,&nbsp;Maria Goya MD, PhD ,&nbsp;Frederik J. Hermans MD, PhD","doi":"10.1016/j.ajogmf.2025.101690","DOIUrl":"10.1016/j.ajogmf.2025.101690","url":null,"abstract":"<div><h3>Background</h3><div>Randomized controlled Trials (RCTs) show conflicting results on the effectiveness of a cervical pessary after an arrested episode of preterm labor (PTL) aiming to prolong pregnancy.</div></div><div><h3>Objective</h3><div>To assess the effectiveness of a cervical pessary in prolongation of pregnancy after an arrested episode of PTL by utilizing individual participant data (IPD) meta-analysis.</div></div><div><h3>Data sources</h3><div>Databases Central, Embase, Medline, and clinical trial databases (ClinicalTrials.gov, ISRCTN, EU-CTR) were searched from inception until January 2024.</div></div><div><h3>Study Eligibility Criteria</h3><div>Randomized controlled trials investigating individuals between 24⁺⁰ and 34⁺⁰ weeks of gestation with an arrested episode of PTL and who were subsequently randomized to cervical pessary or no intervention.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>Studies were assessed for data integrity and risk of bias. Main outcomes were prolongation of pregnancy &gt;7 days, interval between randomization and delivery, and a composite of adverse neonatal outcome. A one-step meta-analysis approach was employed, and the intention-to-treat principle was applied.</div></div><div><h3>Results</h3><div>Four RCTs had IPD available. In singleton pregnancies (total <em>N</em>=546; 275 individuals in the pessary group, 271 individuals in the control group), pessary placement did not decrease delivery risk within 7 days (relative risks [RR] 0.87; 95% confidence intervals [CI] 0.40–1.9), prolong pregnancy (mean differences 4.5 days; 95% CI –0.08 to 9.0), nor reduce the risk of adverse neonatal outcomes (RR 0.95; 95% CI 0.53–1.7). The incidence of readmissions for a new episode of PTL was significantly less frequent in the cervical pessary group (RR 0.66, 95% CI 0.50–0.85). Two studies investigating multiple pregnancies (<em>N</em>=167, 84 individuals in the pessary group, 83 individuals in the control group) were identified, showing contradictory results that could not be explained by study differences. Therefore, merging IPD and pooling of was uninformative.</div></div><div><h3>Conclusion</h3><div>In individuals with a singleton pregnancy with an episode of PTL between 24 and 34 weeks of gestational age, pessary placement does not prevent delivery within 7 days, preterm birth, or neonatal outcomes. A pessary might reduce the probability of readmissions for PTL.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101690"},"PeriodicalIF":3.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019224","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}