American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Periventricular echogenicity in fetuses with hemoglobin Bart disease: a potential sonographic marker","authors":"Joanna Sichitiu MD, Elina Vlachodimitropoulou MD, PhD, Patrick Shannon MD, Joanne Verweij MD, PhD, Shiri Shinar MD, Greg Ryan MB, Susan Blaser MD, Pradeep Krishnan MD, Tim Van Mieghem MD, PhD","doi":"10.1016/j.ajogmf.2025.101621","DOIUrl":"10.1016/j.ajogmf.2025.101621","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101621"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123806","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":"Obstetric care consensus criteria are superior to ICD-10 codes for identifying several maternal renal morbidity","authors":"Thomas P. Kishkovich MD, Abigail M. Kempf MD, Andrea Pelletier MPH, MS, Nicole M. Patton PA-C, Michaela K. Farber MD, MS, Nicole A. Smith MD, MPH","doi":"10.1016/j.ajogmf.2024.101592","DOIUrl":"10.1016/j.ajogmf.2024.101592","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101592"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923509","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":"Low-dose aspirin use in low-risk nulliparous pregnancies: a systematic review and meta-analysis of randomized controlled trials","authors":"Sascha Wodoslawsky MD ,&nbsp;Kavisha Khanuja MD ,&nbsp;Gabriele Saccone MD ,&nbsp;Matthew K. Hoffman MD ,&nbsp;Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2024.101595","DOIUrl":"10.1016/j.ajogmf.2024.101595","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the efficacy of low-dose aspirin in the prevention of adverse outcomes in low-risk, nulliparous singleton pregnancies.</div></div><div><h3>Data Sources</h3><div>PubMed, Ovid MEDLINE, Scopus, Cochrane Library, clinicaltrials.gov, and ScienceDirect were searched from their inception to August 5, 2023.</div></div><div><h3>Eligibility criteria for selecting studies</h3><div>Randomized clinical trials comparing low-dose aspirin with placebo or with no treatment in low-risk nulliparous singleton pregnancies were included. High-risk pregnancies, including prior preterm birth, prior preeclampsia, and those affected by maternal diabetes or chronic hypertension were excluded.</div></div><div><h3>Data appraisal and synthesis methods</h3><div>The primary outcome was the incidence of preterm delivery at less than 37 weeks. The summary measures were reported as relative risk (RR) or as mean difference (MD) with a 95% confidence interval (CI).</div></div><div><h3>Results</h3><div>Ten trials, including 27,075 nulliparous low-risk pregnancies, were included. Overall, low-dose aspirin was associated with no significant differences in preterm birth less than 37 weeks (RR 0.90, 95% CI 0.73−1.09) and less than 34 weeks (RR 0.62, 95% CI 0.37−1.05) compared to control. Patients who took 100 mg daily of aspirin prior to 16 weeks had a significantly lower risk of preterm birth at less than 37 weeks (RR: 0.45, 95% CI: 0.35−0.59), as did, to a lower magnitude, those who began aspirin 100 mg daily after 16 weeks (RR: 0.88, 95% CI: 0.80−0.97). Those who took 100 mg daily of aspirin were at a lower risk of preterm birth at less than 37 weeks than those who took between 60 and 81 mg of daily aspirin (RR: 0.39, 95% CI: 0.31−0.48). No statistically significant differences were found in the incidence of hypertensive disorders of pregnancy, perinatal or neonatal death.</div></div><div><h3>Conclusions</h3><div>Low-dose aspirin at 100 mg daily reduces the incidence of preterm birth at less than 37 weeks in low-risk, nulliparous pregnancies and may be most helpful if initiated prior to 16 weeks.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101595"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928365","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":"Association of omega-3 fatty acid supplementation with recurrent preterm birth by obesity status","authors":"Stephanie A. Fisher MD, MPH,&nbsp;Alan M. Peaceman MD,&nbsp;Lynn M. Yee MD, MPH","doi":"10.1016/j.ajogmf.2025.101603","DOIUrl":"10.1016/j.ajogmf.2025.101603","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101603"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013214","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":"Tugging the Foley catheter balloon every three hours in induction of labor after one previous cesarean: a randomized controlled trial","authors":"Krishnan Yunesh MBBS,&nbsp;Aizura Syafinaz Ahmad Adlan MObGyn,&nbsp;Thai Ying Wong MRCOG,&nbsp;Farah Gan MObGyn,&nbsp;Mukhri Hamdan MObGyn, PhD,&nbsp;Peng Chiong Tan FRCOG, PhD","doi":"10.1016/j.ajogmf.2024.101579","DOIUrl":"10.1016/j.ajogmf.2024.101579","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Induction of labor after 1 previous cesarean delivery with an unripe cervix have an especially high risk for unplanned cesarean delivery and uterine rupture. Mechanical balloon ripening is often preferred over prostaglandin-based ripening during induction of labor after 1 previous cesarean delivery, because uterine rupture has been associated with prostaglandin use. The transcervical Foley balloon can be dislodged past the ripened cervix and be retained comfortably in the vagina during passive placement. Tugging of the Foley catheter can be a noninvasive and tolerated method for timelier retrieval of the retained balloon; expediting discovery of a ripened cervix would permit an earlier follow-on amniotomy and oxytocin infusion, thereby hastening birth.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to evaluate the effect of tugging of the Foley balloon for 30 seconds every 3 hours during 12 hours of scheduled placement in comparison with standard care (no tugging) on the induction to birth interval and patient satisfaction.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;This randomized controlled trial, conducted at a university hospital in Malaysia, recruited participants from April 2023 to March 2024. Eligible participants admitted for Foley balloon induction of labor who had 1 previous cesarean were recruited. After balloon insertion, participants were randomized to tugging or standard care. Following balloon displacement, a vaginal examination was performed to check the cervix. The examination findings then dictated the follow-on management of induction of labor after 1 previous cesarean according to standard practice. The primary outcomes were the induction (Foley insertion) to delivery interval and participants’ satisfaction with the birthing process. Secondary outcomes were largely derived from the core outcome set for trials on induction of labor. Based on a superiority hypothesis, it was calculated that a sample size of 126 would be required to detect a 4-hour reduction in the induction-to-delivery interval and a 1.5 point increase in the satisfaction score based on a 0 to 10 numerical rating scale with the level of significance set at 0.05, power at 80%, and a 10% drop out rate. Comparative analyses using an intention-to-treat approach were conducted using &lt;em&gt;t&lt;/em&gt; tests, Mann-Whitney U tests, chi square tests, and Fisher exact tests as appropriate.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 126 participants were randomized with 63 in each trial arm. The induction to birth interval was (mean ± standard deviation) 29.7±9.6 hours for those in the 3-hourly tugging group and 29.8±9.1 hours for those under standard care (&lt;em&gt;P&lt;/em&gt;=.950), and maternal satisfaction with the induction of labor after 1 previous cesarean delivery birth process, assessed using a 0 to 10 numerical rating scale, was (median [interquartile range]) 8 [7–9] and 8 [7–9] (&lt;em&gt;P&lt;/em&gt;=.936), respectively. The cesarean delivery rate ","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101579"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824647","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":"Cost-effectiveness of exome sequencing and chromosomal microarray for low-risk pregnancies","authors":"Michal Rosenberg Friedman MD ,&nbsp;Yariv Yogev MD ,&nbsp;Sharon Maslovitz MD ,&nbsp;Moshe Leshno MD ,&nbsp;Lee Reicher MD","doi":"10.1016/j.ajogmf.2024.101512","DOIUrl":"10.1016/j.ajogmf.2024.101512","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Chromosomal microarray analysis (CMA) has been central to prenatal genetic diagnosis, detecting copy number variants with a ∼1% yield in low-risk cases. Next-generation sequencing (NGS), including exome sequencing (ES), enhances diagnostic capabilities with higher yields (8.5–10%) but at greater cost and complexity. While ES's cost-effectiveness is studied in high-risk pregnancies, data for low-risk pregnancies remain lacking. This study evaluates the cost-effectiveness of ES in low-risk pregnancies.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to investigate the cost-effectiveness of exome sequencing compared with chromosomal microarray analysis.</div></div><div><h3>STUDY DESIGN</h3><div>Costs, utilities, and quality-adjusted life years were modeled for prenatal testing with chromosomal microarray analysis or chromosomal microarray analysis + exome sequencing. Average costs and utilities were discounted at 3%. In addition, 2 strategies for screening were compared using the Markovian decision analysis model: (1) chromosomal microarray analysis only (an abnormal result leads to a termination of pregnancy, and a normal test has a 1 to 160 chance of developing into a severe disorder) and (2) exome sequencing after a normal chromosomal microarray analysis (a positive result leads to a termination of pregnancy). Of note, 1-way sensitivity analysis was performed for all variables. The outcome measures included quality-adjusted life years after abortion, costs of chromosomal microarray analysis and exome sequencing, and health expenses of a critically ill infant. The time horizon of the model was 20 years.</div></div><div><h3>RESULTS</h3><div>The total costs were $1348 for chromosomal microarray analysis and $3108 for chromosomal microarray analysis + exome sequencing. The quality-adjusted life years with a time horizon of 20 years were 14.15 for chromosomal microarray analysis and 14.19 for chromosomal microarray analysis + exome sequencing, with an incremental cost-effectiveness ratio of $46,383 per quality-adjusted life years. Sensitivity analysis revealed that the time horizon and the disutility of moderate/severe disability of the genetic disorder have an effect on the incremental cost-effectiveness ratio. For example, the incremental cost-effectiveness ratios are $84,291 per quality-adjusted life years for a relatively small disutility of moderate/severe disability and $94,148 per quality-adjusted life years for a shorter time horizon of 10 years.</div></div><div><h3>CONCLUSION</h3><div>Exome sequencing has the potential to be cost-effective compared with chromosomal microarray analysis alone. Our research provides data regarding the cost-effectiveness of exome sequencing without a specific indication, which will become increasingly important in the near future as whole exome sequencing becomes the first-tier test in prenatal diagnosis.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101512"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476675","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":"Combined vaginal progesterone and cervical cerclage in the prevention of preterm birth: A systematic review and meta-analysis","authors":"Anne-Marie Aubin MD ,&nbsp;Liam McAuliffe MD ,&nbsp;Kimberley Williams MD ,&nbsp;Ashad Issah MD ,&nbsp;Rosanna Diacci MD ,&nbsp;Jack E. McAuliffe BSc ,&nbsp;Salma Sabdia MD ,&nbsp;Jason Phung MD ,&nbsp;Carol A. Wang BSc(Hons) ,&nbsp;Craig E. Pennell PhD","doi":"10.1016/j.ajogmf.2024.101553","DOIUrl":"10.1016/j.ajogmf.2024.101553","url":null,"abstract":"<div><h3>Background</h3><div>Vaginal progesterone and cervical cerclage are both effective interventions for reducing preterm birth (PTB). It is currently unclear whether combined therapy offers superior effectiveness compared to single therapy.</div></div><div><h3>Objective</h3><div>To determine the efficacy of combining cervical cerclage and vaginal progesterone in the prevention of PTB.</div></div><div><h3>Data sources</h3><div>We searched Medline (Ovid), EMBASE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Cochrane Library (Wiley) and Scopus (from their inception to 2020).</div></div><div><h3>Study eligibility criteria</h3><div>The review accepted randomized and pseudo-randomized control trials, non-randomized experimental control trials, and cohort studies. High risk patients (shortened cervical length &lt;25mm or prior PTB) who were assigned cervical cerclage, vaginal progesterone, or both for the prevention of PTB were included. Only singleton pregnancies were assessed.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>The primary outcome was birth &lt;37 weeks. Secondary outcomes included birth &lt;28, &lt;32 and &lt;34 weeks, gestational age (GA) at delivery, days between intervention and delivery, preterm premature rupture of membranes, neonatal mortality, neonatal intensive care unit admission, intubation and birthweight. Following title and full-text screening, eight papers were included in the final analysis. Risk of bias was assessed using the Cochrane Collaboration tool for assessing the risk of bias (ROBINS-I and RoB-2). Quality of evidence was assessed using the GRADE tool.</div></div><div><h3>Results</h3><div>Combined therapy was associated with lower risk of PTB &lt;37 weeks compared to progesterone alone (RR 0.75, 95% CI 0.58, 0.96). Compared to cerclage only, combined therapy was associated with less PTB &lt;32 weeks, decreased neonatal mortality, increased GA and a longer interval between intervention and delivery. Compared to progesterone alone, combined therapy was associated with less PTB &lt;32 weeks, less PTB&lt;28 weeks, increased GA, decreased neonatal mortality and decreased neonatal intensive care unit admissions.</div></div><div><h3>Conclusions</h3><div>Combined treatment of cervical cerclage and vaginal progesterone could potentially result in a greater reduction in PTB compared to single therapy. Further well-conducted and adequately powered randomized controlled trials are needed to assess these promising findings.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101553"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428213","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":"Addressing perinatal mood and anxiety disorders in obstetric settings: results of a cluster randomized controlled trial of two approaches","authors":"Nancy Byatt DO ,&nbsp;Martha Zimmermann PhD ,&nbsp;Taber C. Lightbourne MD ,&nbsp;Padma Sankaran MS ,&nbsp;Uruj K. Haider MD ,&nbsp;Radley Christopher Sheldrick PhD ,&nbsp;Misha Eliasziw PhD ,&nbsp;Tiffany A. Moore Simas MD","doi":"10.1016/j.ajogmf.2024.101599","DOIUrl":"10.1016/j.ajogmf.2024.101599","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Mood and anxiety disorders affect one in 5 perinatal individuals and are undertreated. While professional organizations and policy makers recommend that obstetric practices screen for, assess and treat mood and anxiety disorders, multi-level barriers to doing so exist. To help obstetric practices implement the recommended standard of care, we developed implementation assistance, an approach to guide practices on how to integrate screening, assessment, and treatment of mood and anxiety disorders into the obstetric practice workflow. To teach obstetric care clinicians how to treat perinatal mood and anxiety disorders, we also developed an e-learning course and toolkit.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Evaluate the extent to which 1) implementation assistance + e-learning/toolkit, and 2) e-learning/toolkit alone improved the rates and quality of care for perinatal mood and anxiety disorders in obstetric practices, as compared to usual care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;We conducted a cluster randomized controlled trial involving 13 obstetric practices across the United States (US). Using 2:2:1 randomization, 13 obstetric practices were assigned to 1) implementation assistance + e-learning/toolkit (n=5), 2) e-learning/toolkit alone (n=5), or 3) usual care (n=3). We measured obstetric care clinicians’ quality of care for perinatal mood and anxiety disorders (as measured by medical record documentation of screening, assessment, treatment initiation, and monitoring) documented in patient charts (n=1040)&lt;em&gt;.&lt;/em&gt; Effectiveness was assessed using multilevel generalized linear mixed models, accounting for clustering of repeated measurements (n=2, i.e., pre and post) within obstetric care clinicians’ patient charts (n=40) nested within practices (n=13). Intention-to-treat and per-protocol analyses were conducted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;At baseline, no significant differences were observed among the 3 groups regarding documented mental health screening. Chart abstraction at 8 months post-training revealed a significant increase in recommended bipolar disorder screening only among the practices that received the implementation plus e-learning/toolkit (from 0.0% to 30.0%; &lt;em&gt;p&lt;/em&gt;=.017). Practices receiving the e-learning/toolkit alone or usual care continued to not screen for bipolar disorder. Documented screening for anxiety also increased in the implementation + e-learning/toolkit group (from 0.5% to 40.2%), however, it did not reach statistical significance when compared to the other groups (&lt;em&gt;P&lt;/em&gt;=.09). A significant increase in documented post-traumatic stress disorder (PTSD) screening was observed among practices receiving the implementation plus e-learning/toolkit (0.0% to 30.0%; &lt;em&gt;P&lt;/em&gt;=.018). The quality-of-care score in the implementation + e-learning toolkit group increased from 20.5 at baseline to 42.8 at follow-up and was significantly different from both the e-learning/toolk","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101599"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932820","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":"Age-specific trends in pregnancy-associated suicide and homicide rates by race/ethnicity, 2005–2021","authors":"Jemar R. Bather PhD ,&nbsp;Marina Mautner Wizentier MS ,&nbsp;Sarah K. Cowan PhD ,&nbsp;Jeffrey F. Peipert MD, PhD ,&nbsp;Debra Furr-Holden PhD ,&nbsp;Melody S. Goodman PhD","doi":"10.1016/j.ajogmf.2025.101607","DOIUrl":"10.1016/j.ajogmf.2025.101607","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101607"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972437","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 readmissions among patients with adult congenital heart disease","authors":"Lisa D. Levine MD, MSCE ,&nbsp;Alexander M. Friedman MD, MPH ,&nbsp;Yuli Y. Kim MD ,&nbsp;Stephanie E. Purisch MD ,&nbsp;Timothy Wen MD, MPH","doi":"10.1016/j.ajogmf.2024.101580","DOIUrl":"10.1016/j.ajogmf.2024.101580","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Given the risks associated with congenital heart disease in the postpartum period, epidemiologic data identifying risk factors and timing of complications may be useful in improving postpartum care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to determine the timing of, risk factors for, and complications associated with 60-day postpartum readmissions following deliveries with maternal congenital heart disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;The 2010–2020 Nationwide Readmissions Database was used for this retrospective cohort study. Postpartum readmissions occurring within 60 days of delivery hospitalization discharge were ascertained. Clinical, demographic, and hospital risk factors associated with postpartum readmission were analyzed using logistic regression models, with unadjusted and adjusted odds ratios as measures of association. Among patients with congenital heart disease, the role of additional cardiac risk factors in the likelihood of readmission was analyzed. Risks for adverse maternal outcomes during readmission were analyzed, including severe maternal morbidity, cardiac severe maternal morbidity, and a critical care composite.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Of an estimated 40,780,439 delivery hospitalizations, 35,242 had an associated congenital heart disease diagnosis (8.6 per 10,000), including 2279 (6.5%) with complex congenital heart disease and 32,963 (93.5%) with noncomplex congenital heart disease. The proportion of deliveries with a maternal congenital heart disease diagnosis increased significantly from 6.7 per 10,000 in 2010 to 11.8 in 2020. Overall risk for 60-day postpartum readmission was 1.6% among women without congenital heart disease and 3.1% among women with congenital heart disease (&lt;em&gt;P&lt;/em&gt;&lt;.01). Among women with congenital heart disease, 36.0% of 60-day postpartum readmissions occurred 1 to 5 days after discharge, 18.0% 5 to 10 days after discharge, and 14.5% 10 to 20 days after discharge. In adjusted models for the entire population, congenital heart disease retained a significant association with 60-day postpartum readmission (adjusted odds ratio, 1.73; 95% confidence interval, 1.55–1.94). When the cohort was restricted to deliveries with congenital heart disease, adjusted analyses demonstrated increased odds associated with additional cardiac risk factors (congestive heart failure: adjusted odds ratio, 1.72; 95% confidence interval, 1.13–2.62; arrhythmia: adjusted odds ratio, 1.68; 95% confidence interval, 1.27–2.21; pulmonary circulation disorders: adjusted odds ratio, 1.57; 95% confidence interval, 1.10–2.24; and chronic hypertension: adjusted odds ratio, 1.88; 95% confidence interval, 1.26–2.80), hypertensive disorders of pregnancy (adjusted odds ratio, 1.97; 95% confidence interval, 1.49–2.61), and cesarean delivery (primary adjusted odds ratio, 1.82; 95% confidence interval, 1.39–2.38; repeat cesarean: adjusted odds ratio, 1.91; 95% confidenc","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101580"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855678","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}