Pregnancy (Hoboken, N.J.)最新文献

{"title":"Outcomes after attempted external cephalic version with two prior cesarean deliveries.","authors":"Emily Schlussel Markovic, Itamar Futterman, Joselle O'Brien, Nelli Fisher, Tirtza Spiegel Strauss, Howard Minkoff, Rodney McLaren","doi":"10.1002/pmf2.70465","DOIUrl":"10.1002/pmf2.70465","url":null,"abstract":"<p><strong>Objective: </strong>American college of obstetricians and gynecologists (ACOG) considers patients with two prior cesarean deliveries (CDs) to be candidates for a trial of labor and separately recommends that external cephalic version (ECV) be offered for malpresentation. However, little is known about the safety, success rate, or effect on maternal and neonatal outcomes of ECV among patients with two prior CDs. This study aimed to evaluate obstetric outcomes after ECV in patients with two prior CDs to guide counseling.</p><p><strong>Study design: </strong>This was a retrospective cohort study of patients with two prior CDs with non-anomalous, singleton births after 36 weeks' gestation utilizing the US Natality Database from 2018 to 2023. Pregnant patients with breech pregnancies who had an ECV attempt were compared with those who did not. The adverse maternal outcomes included blood transfusion, uterine rupture, unplanned hysterectomy, and intensive care unit (ICU) admission. Adverse neonatal outcomes included 5-minute Apgar score < 7, immediate or prolonged assisted ventilation, neonatal ICU (NICU) admission, seizure, and death. ECV success rate and mode of delivery were also assessed. Univariable and multivariable analyses were performed.</p><p><strong>Results: </strong>Among the 16,293 included births, 15,965 (98.0%) had a repeat CD (rCD) for malpresentation without an ECV attempt and 328 (2.0%) had an ECV attempt. Of these 328 ECVs, 223 (68.0%) were successful. Adverse maternal composite outcomes did not differ between births after an ECV attempt and those without (1.8% vs. 1.5%; adjusted odds ratio [aOR], 1.20; 95% confidence interval [CI], 0.53-2.71). Those who had an ECV attempt had a lower risk of adverse neonatal composite outcomes compared to those who did not (9.5% vs. 18.2%; aOR, 0.54; 95% CI, 0.37-0.79). Of the 223 who had a successful ECV, 152 (68.2%) underwent rCD without trial of labor after cesarean (TOLAC) and 71 (31.8%) underwent TOLAC. Among those with a successful ECV, there was no difference in adverse maternal or neonatal morbidities between those who had a TOLAC after successful ECV and those who did not.</p><p><strong>Conclusion: </strong>These data suggest that among patients with two prior CDs, an ECV had a success rate similar to the published rate in the general obstetric population and may be associated with decreased neonatal morbidity compared to patients with no attempted ECV.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 5","pages":"e70465"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Empowerment and Agency through Intrapartum Counseling and Education (PEAICE): A randomized controlled trial.","authors":"Samuel J F Melville, Lorraine Codding, Blake M Lee, Mónica Rincón, Bharti Garg, Katherine Lyons, Fei Cai","doi":"10.1002/pmf2.70458","DOIUrl":"10.1002/pmf2.70458","url":null,"abstract":"<p><strong>Introduction: </strong>As more patients decline evidence-based care from their obstetric providers, effective and accessible antenatal education is essential in reversing this course. This study aimed to assess the effectiveness of a novel low-cost physical intrapartum labor guide on personal perceptions of patient control, labor satisfaction, and obstetric/neonatal outcomes.</p><p><strong>Methods: </strong>This was a single-institution, randomized controlled trial of patients with singleton pregnancies undergoing induction of labor. Participants were randomized at admission for induction to intrapartum guide versus standard of care counseling. Primary outcomes included personal perception of control and satisfaction during labor (assessed via the Labor Agentry Scale [LAS] and a six-question satisfaction survey, administered ≤7 days postpartum). Secondary outcomes included prespecified obstetric and neonatal outcomes. Comparisons between groups were done using Chi-square/Fisher's exact test or two-sample <i>t</i>-test/Wilcoxon rank-sum test. Multiple linear regression analysis was then used to examine the association of intrapartum guide education with LAS scores and neonatal outcomes. Covariate adjustment was performed to improve statistical precision and to protect against residual chance imbalance.</p><p><strong>Results: </strong>A total of 216 patients were enrolled and randomized (108 per arm). Of those enrolled, 189 (87.5%) completed the postpartum survey ≤7 days postpartum and were thus included in the analysis. Compared to standard of care, patients in the intrapartum guide group had significantly higher mean LAS scores (58.36 [95% CI, 56.78-59.94] vs. 54.29 [95% CI, 52.45-56.13]; <i>p</i> = .001) and remained so when adjusting for race, ethnicity, age, insurance, and mode of delivery (<i>β</i> = 3.42; 95% CI, 1.19-5.65). Patients in the intrapartum guide group reported significantly higher birth satisfaction, knowledge of childbirth, and satisfaction with intrapartum education. Finally, neonates of individuals randomized to the intrapartum guide were less likely to receive assisted ventilation (12.5% vs. 23.7%; <i>p</i> = 0.046); however, this difference was not significant when controlling for mode of delivery (adjusted odds ratio [aOR], 0.49; 95% CI, 0.21-1.12).</p><p><strong>Conclusion: </strong>A novel, low-cost intrapartum labor guide administered during induction of labor significantly increased patient-perceived agency and satisfaction. This represents a promising strategy for improving patient adoption and fidelity of labor education regarding evidence for interventions that potentially reduce obstetric/neonatal risk. The findings of this study warrant further study and implementation in obstetric practices.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06787521.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 5","pages":"e70458"},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in low-dose aspirin prescription among patients at risk for preeclampsia.","authors":"Daniella Rogerson, Carolina Thorlund-Díaz, Marni Jacobs, Emily Harnois, Lillian Blank, Leilani Gutierrez-Palominos, Ayelet Ruppin-Pham, Maryam Tarsa, E Nicole Teal","doi":"10.1002/pmf2.70461","DOIUrl":"10.1002/pmf2.70461","url":null,"abstract":"<p><strong>Objective: </strong>Low-dose aspirin (LDA) reduces preeclampsia risk, yet prescribing rates among eligible pregnant patients remain low. This study aims to determine whether there are disparities in LDA prescription to eligible patients based on race/ethnicity, primary language, or insurance after implementation of a standardized electronic health record (EHR) preeclampsia risk screening tool.</p><p><strong>Study design: </strong>This retrospective cohort study included all patients ≥ age 18 with births at a single academic center from September 2022 to July 2025 who had 1 high or ≥2 moderate preeclampsia risk factors. The primary outcome was rate of LDA recommendation/prescription, determined by recommendation documentation in the risk screening tool or prescription in the EHR medication log. Data were extracted from Epic Clinical Data Warehouse. Chi-square or <i>t</i>-tests were used to compare LDA prescribing rates by race/ethnicity, primary language, and insurance, and multivariable regression models were used.</p><p><strong>Results: </strong>Of 5737 LDA-eligible patients, 3995 (69.6%) were recommended/prescribed LDA and 1742 (30.4%) were not. Patients recommended/prescribed LDA were more likely to be older, multiparous, English speaking, and privately insured and/or have pregestational diabetes or chronic hypertension, as well as high-risk factors for preeclampsia (<i>p</i> < 0.001). In an adjusted multivariable analysis for age, race, parity, body mass index, language, diabetes mellitus, chronic hypertension [cHTN], and insurance type, Black/African American patients (adjusted OR [aOR] 1.80, 95% confidence interval [CI] 1.36-2.39) and patients with high-risk factors for preeclampsia (aOR 2.66, 95% CI 2.14-3.31) had higher odds of being prescribed/recommended LDA while non-English speaking (Spanish aOR 0.60, 95% CI 0.46-0.78; another language aOR 0.62, 95% CI 0.45-0.85) and publicly insured (aOR 0.80, 95% CI 0.69-0.93) patients had lower odds. Differences in prescription/recommendations by race and insurance were primarily driven by those with moderate risk factors for preeclampsia, while this was not true for differences in prescription for non-English speaking patients.</p><p><strong>Conclusions: </strong>After implementation of a standardized preeclmapsia risk screening tool, LDA was more often prescribed to eligible Black patients than White, likely reflecting ACOG's inclusion of Black race as a proxy for racism as a preeclmapsia risk factor. However, LDA was less often prescribed to publicly insured or non-English speaking patients, which highlights an opportunity for quality and equity improvement.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 5","pages":"e70461"},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of improved uterotonic availability on postpartum hemorrhage and maternal morbidity after vaginal delivery, review of a single-center quality-improvement initiative.","authors":"Danielle L Chirumbole, Towana Sims, Stacie Denning, Sheena Glover, Lauren Shubert, Michael Jochum, Celeste Green, Courtney Thompson, Adewunmi Babalola, Tara Barrick, Sharon Burks, Manisha Gandhi, Christina Davidson","doi":"10.1002/pmf2.70463","DOIUrl":"10.1002/pmf2.70463","url":null,"abstract":"<p><strong>Introduction: </strong>After implementation of a hemorrhage risk stratification system and management bundle in 2019, our hospital demonstrated a reduction in hemorrhage-related severe maternal morbidity (SMM-H). We then noted a plateau in postpartum hemorrhage (PPH) rates and a gradual increase in SMM-H after 2020, with the majority of PPH after vaginal deliveries (VDs) occurring in those deemed low-risk. Consequently, we implemented a strategy to improve the availability of second-line uterotonics in the delivery room regardless of PPH risk. The objective of this study is to evaluate the effect of this intervention on rates of PPH and SMM-H after VDs.</p><p><strong>Methods: </strong> Through this quality improvement (QI) initiative, we aimed to improve injectable uterotonic availability and use at time of delivery. Our primary outcome measures were rate of PPH and SMM-H in VD. We reviewed all deliveries from the 16 months before and after this intervention (April 2023-July 2024, September 2024-December 2025). Deliveries from August 2024 were excluded to allow for washout. Chi-square was used to determine statistical significance.</p><p><strong>Results: </strong>There were 5365 VDs included in the pre-intervention group with 63.6% designated low-risk for PPH and 4768 included in the post-intervention group with 62.4% designated low-risk. There was no difference in VD PPH pre- versus post-intervention (6.33% vs. 6.61%, <i>p</i> = 0.61). Similarly, there was no significant change in VD SMM-H (22.9% vs. 25.6%, <i>p</i> = 0.40). The rates of PPH and SMM-H in low-risk VD patients were 5.7% and 18.6% pre-intervention compared to 6.1% and 18.8% post-intervention. These differences were not statistically significant. Low-risk patients comprised 57.5% of VDs with PPH after the intervention. Of VDs requiring second-line uterotonics, misoprostol was the most common first agent prior to the intervention (60%) versus methylergonovine after (45%), which was statistically different from prior (<i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong>Improving second-line uterotonic availability in the delivery room did not improve VD PPH rates or SMM-H but did change second-line uterotonic choice.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 5","pages":"e70463"},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Society for Maternal-Fetal Medicine Special Statement: Checklist for initial management of amniotic fluid embolism-Updated 2026\".","authors":"","doi":"10.1002/pmf2.70459","DOIUrl":"https://doi.org/10.1002/pmf2.70459","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1002/pmf2.70364.].</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 5","pages":"e70459"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Society for Maternal-Fetal Medicine Special Statement: Considerations for management of high-risk pregnancies when abortion care is restricted.","authors":"Ashish Premkumar, Adam Crosland, Stephanie Dukhovny, Rasha Khoury, Justin R Lappen, Aarti Ramdaney, Allie Sakowicz, Leilah Zahedi-Spung","doi":"10.1002/pmf2.70376","DOIUrl":"10.1002/pmf2.70376","url":null,"abstract":"<p><p>Individuals at high risk for pregnancy-associated morbidity and mortality have unique needs for reproductive health services, including abortion care. Legal restrictions on abortion care in many states make it challenging or impossible for clinicians to practice standard-of-care, evidence-based medicine and for institutions to implement evidence-based clinical guidelines for reproductive healthcare. This Special Statement suggests actions clinicians and institutions can take to build consensus and create systems to ensure patients can receive optimal care. In addition, it addresses counseling about maternal and fetal health that (1) recognizes that risk and patient preferences may change or evolve during pregnancy; (2) incorporates informed patient preferences in a shared decision-making process between the patient and provider; and (3) includes abortion among the options for pregnancy management. We also discuss how abortion restrictions affect training, which will result in shortages of skilled providers who can offer the level of care needed for high-risk pregnancies. Abortion care is a core component of practice for maternal-fetal medicine subspecialists, both to reduce the burden of maternal morbidity and mortality and to operationalize reproductive justice for pregnancy-capable people.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 5","pages":"e70376"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes of monochorionic diamniotic twin pregnancies complicated by selective fetal growth restriction with intermittent absent end diastolic flow.","authors":"Juliana S Gebb, Alekhya Jampa, Violetta Bakunina, Yunliang Zhao, Kiersten Barr, Federica Bellussi, Desiree Fiorentino, Suzanne DeBari, Edward R Oliver, Nahla Khalek, Shelly Soni","doi":"10.1002/pmf2.70464","DOIUrl":"10.1002/pmf2.70464","url":null,"abstract":"<p><strong>Introduction: </strong>Monochorionic diamniotic twins with selective fetal growth restriction (sFGR) are categorized based on the umbilical artery (UA) end diastolic flow (EDF) of the growth-restricted fetus. While persistent flow abnormalities are attributed to placental insufficiency, intermittent flow changes are often attributed to anastomoses. We hypothesized that not all intermittent flow is due to anastomotic fluctuation and sought to determine if pregnancies with intermittent forward and absent EDF may represent a unique cohort of sFGR pregnancy.</p><p><strong>Methods: </strong>Retrospective analysis of prospectively collected data from a monochorionic pregnancy registry. Records of patients with monochorionic diamniotic twins with sFGR evaluated from January 2013 to December 2024 were reviewed. sFGR was defined by the Delphi-based consensus criteria. Pregnancies were grouped by the umbilical artery Doppler of the smaller fetus: (1) Type I: persistent forward EDF (+EDF); (2) Type II: no forward EDF (A/REDF); (3) Type IIIa: intermittent forward and absent EDF (iAEDF); or (4) Type IIIb: intermittent forward, absent, and reversed EDF (iAREDF). Pregnancy characteristics were compared between groups and outcomes were then compared in expectantly managed patients.</p><p><strong>Results: </strong>Of 330 patients with sFGR, 114 (34.5%) had +EDF (Type I), 70 (21.2%) had A/REDF (Type II), 90 (27.3%) had iAEDF (Type IIIa), and 56 (17.0%) had iAREDF (Type IIIb). Gestational age at first evaluation was lower in those with Type II compared to Type IIIb (<i>p</i> = 0.003) and fetal intervention was higher in patients with any absent or reversed EDF compared to those with +EDF (<i>p</i> < 0.001). In expectantly managed patients (<i>n</i> = 189), median gestational age at delivery in weeks was higher in patients with Type I (32.5) and Type IIIa (32.4) compared to those with Type II (27.4) and Type IIIb (29.1) (Type I vs. Type II, <i>p</i> < 0.001; Type I vs. Type IIIa, <i>p</i> = 0.319; Type I vs. Type IIIb, <i>p</i> < 0.001; Type II vs. Type IIIa, <i>p</i> = 0.003; Type II vs. Type IIIb, <i>p</i> = 0.598; Type IIIa vs. Type IIIb, <i>p</i> < 0.001). Additionally, dual survival to discharge was higher in those with Type I compared to Type II (<i>p</i> < 0.001) but not compared to Type IIIa (<i>p</i> = 0.292) or Type IIIb (<i>p</i> = 0.262).</p><p><strong>Conclusion: </strong>Patients with sFGR and intermittent absent EDF may represent a unique cohort with outcomes more similar to those with +EDF than those with intermittent forward, absent, and reversed EDF.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 5","pages":"e70464"},"PeriodicalIF":0.0,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between breastfeeding and neurodevelopmental outcomes after late preterm birth.","authors":"Anna Palatnik, Jessica A de Voest, Alan T N Tita, Sean C Blackwell, Monica Longo, T Michael O'Shea, Dwight J Rouse, Torri D Metz, George R Saade, Kara M Rood, Kent D Heyborne, John M Thorp, Geeta K Swamy, Kelly S Gibson, Yasser Y El-Sayed, Cynthia Gyamfi-Bannerman","doi":"10.1002/pmf2.70384","DOIUrl":"10.1002/pmf2.70384","url":null,"abstract":"<p><strong>Objective: </strong>To test the hypothesis that breastfeeding is associated with improved neurodevelopmental outcomes among children delivered late preterm.</p><p><strong>Study design: </strong>Secondary analysis of a prospective, follow-up study of ≥6-year-old children enrolled in the Antenatal Late Preterm Steroid (ALPS) Trial, a multicenter study that assessed betamethasone administration in pregnancies deemed to be at imminent risk of late preterm birth (34-36 weeks). Term births and those with missing breastfeeding data were excluded. The primary exposure was breastfeeding (exclusive or partial) at 3 months of life collected via maternal interviews. Any breastfeeding at 6 months was examined as a secondary exposure. The primary outcome was cognitive function at age ≥6, measured by the Differential Ability Scales, 2nd Edition (DAS-II) core components of the General Conceptual Ability (GCA) that includes verbal, non-verbal reasoning, and spatial abilities. Secondary outcomes included Gross Motor Function Classification System level, Social Responsiveness Scale, and Child Behavior Checklist scores. Multivariable analyses were adjusted for prespecified baseline characteristics (maternal age and education, gestational age at birth, child age, sex, tobacco use in pregnancy, ALPS study group, study center).</p><p><strong>Results: </strong>Of 797 mothers included in the analysis, 414 (51.9%) were breastfeeding 3 months after giving birth. Participants who breastfed were older, of lower body mass index (BMI), and were more likely to be White, have a college degree, be married, have private insurance, and less likely to have used tobacco in pregnancy. Children of participants who breastfed were also older at follow-up. There were no differences in birth weight or gestational age at birth by breastfeeding status. The primary outcome, DAS-II GCA, was higher among children who were breastfed at 3 months, 100.5 ± 13.7 vs. 93.2 ± 13.2, mean difference of 7.27 (95% confidence interval [CI], 5.32, 9.22; adjusted mean difference, 2.54; 95% CI, 0.70, 4.37). In secondary analyses, differences in the overall GCA appeared to be driven by increased scores for spatial ability and nonverbal reasoning. There were no differences in secondary outcomes.</p><p><strong>Conclusions: </strong>Among children born late preterm at 34-36 weeks, breastfeeding (exclusive or partial) at 3 months of life was associated with improved neurodevelopmental outcomes at age 6 or older. Breastfeeding for ≥3 months was associated with a modest increase in GCA score (2.5 points; 0.17 SD), the clinical significance of which is likely greater at the population than individual level.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 5","pages":"e70384"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13565325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrauterine transfusion in monochorionic twins with parvovirus B19 infection: Evidence of intertwin blood exchange.","authors":"Ninon Dupuis, Blandine Hervy, Marlène Sohier-Lépine, Louise Paret, Christophe Vayssière","doi":"10.1002/pmf2.70460","DOIUrl":"10.1002/pmf2.70460","url":null,"abstract":"<p><strong>Background: </strong>Parvovirus B19 infection can cause severe fetal anemia. Management in monochorionic twin pregnancies is challenging due to placental vascular connections.</p><p><strong>Case: </strong>We report a case of severe fetal anemia in both fetuses of a monochorionic diamniotic twin pregnancy following maternal parvovirus B19 infection. Elevated middle cerebral artery peak systolic velocity (MCA-PSV) was first detected at 16 weeks in twin A and reached 2.32 multiples of the median (MoM) in twin A and 2.30 MoM in twin B at 21+6 weeks. These findings were associated with polyhydramnios in both fetuses and ascites in twin B. Intrauterine transfusion was performed at 22+1 weeks, revealing hemoglobin levels of 3 g/dL in both fetuses. Transfusion of twin B resulted in an unexpected spontaneous increase in hemoglobin in twin A, suggesting intertwin blood transfer.</p><p><strong>Results: </strong>Following minimal additional transfusion in twin A, MCA-PSV normalized in both fetuses. The pregnancy was subsequently complicated by preeclampsia without severe features, and vaginal delivery occurred at 36+3 weeks. Both neonates had normal and identical hemoglobin levels at birth. Placental examination after delivery, with dye injection, demonstrated a single large arterio-arterial anastomosis that had not been visualized prenatally.</p><p><strong>Conclusion: </strong>Transfusion of one twin was followed by an immediate rise in hemoglobin in the co-twin, indicating major intertwin blood exchange through a large arterio-arterial anastomosis. Because such exchange cannot be predicted prenatally, both fetuses require individual assessment before and after transfusion.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 5","pages":"e70460"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13565334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning curve analysis for competency assessment in fetoscopic laser photocoagulation for twin-twin transfusion syndrome: A model for middle-resource settings.","authors":"Vajiheh Marsoosi, Laleh Eslamian, Sotoudeh Mohammadi, Lida Mohamadpour, May Abiad, Ali Javinani, Fatemeh Shojaeian, Aliakbar Rasekhi, Alireza A Shamshirsaz","doi":"10.1002/pmf2.70462","DOIUrl":"10.1002/pmf2.70462","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the learning curve (LC) and skill acquisition for selective fetoscopic laser photocoagulation (sFLP) using cumulative analysis for twin-twin transfusion syndrome (TTTS) treatment in middle-resource settings.</p><p><strong>Method: </strong>Two novices with prior expertise in maternal-fetal medicine and minimally invasive procedures underwent a four-phase training program for sFLP. The program included literature reviews, observational fellowships, hands-on simulator training, and surgeries performed under direct supervision at a large tertiary referral center in Iran. Between October 2018 and May 2023, they independently managed and performed sFLP on 230 patients with TTTS. Performance was evaluated using cumulative sum (CUSUM) and learning curve CUSUM (LC-CUSUM) analyses.</p><p><strong>Results: </strong>At birth, among the 228 pregnancies included in the birth survival analysis, 81.5% had at least one surviving twin, including 109 patients (47.8%) with survival of both twins, whereas 42 pregnancies (18.5%) resulted in double fetal demise. The learning curve analysis estimated an overall failure probability of 0.18 (95% confidence interval [CI], 0.13-0.23), with a survival probability of 0.82 (95% CI, 0.77-0.87). For outcomes with at least one survivor, the predefined competency threshold was achieved after the 80th patient, after which acceptable performance was maintained throughout the remainder of the study. For double-twin survival, the probability of failure was 0.52 (95% CI, 0.41-0.54). The predefined competency threshold was achieved after the 110th procedure, after which acceptable performance was similarly maintained throughout the remainder of the study. These findings demonstrate progressive skill acquisition and operational consistency through structured training and continuous quality control.</p><p><strong>Conclusion: </strong>Structured training enabled acquisition of procedural competency after 80 procedures for outcomes with at least one survivor and 110 procedures for double-twin survival. LC-CUSUM and CUSUM analyses provide an objective framework for monitoring implementation of new fetal therapy programs and may support safe expansion of fetoscopic laser photocoagulation in resource-constrained settings.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 5","pages":"e70462"},"PeriodicalIF":0.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}