Pregnancy (Hoboken, N.J.)最新文献

{"title":"Characterization of the clinical course of early-onset severe hemolytic disease of the fetus and newborn.","authors":"Dick Oepkes, Kenneth J Moise, Enrico Lopriore, Eleonor Tiblad, E J T Joanne Verweij, Rory Windrim, Pranav Pandya, Robert M Silver, Stephen P Emery, John Smoleniec, Olga Ocón-Hernández, Rachel K Morris, Russell S Miller, James B Streisand, Diane D Harrison, Valerie Smith, Lisa B Schwartz, May Lee Tjoa, Leona E Ling, Shumyla Saeed-Khawaja, Yosuke Komatsu","doi":"10.1002/pmf2.70352","DOIUrl":"https://doi.org/10.1002/pmf2.70352","url":null,"abstract":"<p><strong>Introduction: </strong>Severe fetal anemia developing at ≤24 weeks gestational age (GA) in pregnancies complicated by early-onset severe hemolytic disease of the fetus and newborn (EOS-HDFN) is managed by intrauterine erythrocyte transfusions (IUTs). Evidence of off-label intravenous immunoglobulin (IVIG) for preventing/reducing fetal hydrops, fetal anemia, and IUT(s) remains limited to retrospective studies and case series. The prospective, global, multicenter, observational CLARITY study characterized standard-of-care management and outcomes for high-risk pregnancies complicated by EOS-HDFN and their offspring at expert referral centers.</p><p><strong>Methods: </strong>CLARITY enrolled individuals with singleton pregnancies at ≥8 weeks GA and high risk for EOS-HDFN, defined by prior severe fetal anemia, fetal hydrops, or stillbirth at ≤24 weeks GA with indicative fetal/placental HDFN pathology, and current titers ≥32 anti-Rhesus D (RhD) or ≥4 anti-Kell with a confirmed antigen-positive fetus.</p><p><strong>Results: </strong>Of 15 pregnant participants, two (13%) achieved the primary endpoint of a live birth at ≥32 weeks GA without IUT, indicating the absence of clinically relevant fetal anemia and low disease burden. Fourteen (93%) pregnancies resulted in a live birth (median GA, 36^2/7 weeks; range, 31^4/7-38^0/7), including seven (50%) preterm births and 12 (86%) cesarean deliveries. Thirteen (87%) participants required IUTs (median IUTs/pregnancy, 4; range, 1-11), with median GA at first IUT of 24^0/7 weeks (range, 13^0/7-28^2/7). One (7%) fetal death occurred at 16^5/7 weeks, following early IUT (13^0/7 weeks) and serial IVIG treatment (13^1/7-14^6/7 weeks). IUT complications occurred in four (31%) pregnant participants who received IUTs. In an exploratory, post hoc analysis, eight (53%) pregnant participants received IVIG starting between 10^6⁄7 and 19^3⁄7 weeks (median administrations/pregnancy, 12.5; range, 1-20); IVIG-related complications were reported in three (38%), and two (25%) met the primary endpoint. Of 14 live-born neonates followed through 12 weeks of life, three (21%) received exchange transfusion(s), nine (64%) received simple transfusion(s) (one required both types of transfusions), while three (21%) required no transfusions (one required no IUTs during the pregnancy).</p><p><strong>Conclusion: </strong>Outcomes of this prospective study of high-risk EOS-HDFN pregnant participants and their offspring are consistent with previous retrospective studies, indicating a high risk of early IUT, neonatal transfusions, and fetal/neonatal morbidity and mortality. The results underscore the unmet medical need for effective treatments for EOS-HDFN.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03755128.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70352"},"PeriodicalIF":0.0,"publicationDate":"2026-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122620","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":"Bridging care gaps: A qualitative study of postpartum health coaching for hypertensive disorders of pregnancy.","authors":"Kristine Buchholz, Elizabeth Albert, Megan R Knutson Sinaise, Srishti Gupta, Melissa Neal, Scott Hetzel, Kara K Hoppe","doi":"10.1002/pmf2.70354","DOIUrl":"https://doi.org/10.1002/pmf2.70354","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertensive disorders of pregnancy (HDPs) affect approximately one in seven US deliveries and are associated with significant adverse maternal health outcomes. Standard postpartum care, typically a single 6-week visit, is insufficient for ongoing HDP management, education, and support. Combining home blood pressure monitoring with health coaching may enhance self-management, lifestyle change, and engagement with care, yet patient perspectives remain underexplored. This qualitative study examined 1-year postpartum experiences among birthing people with HDPs and explored perceptions of a postpartum health coaching intervention.</p><p><strong>Methods: </strong>This qualitative study was embedded within the STAC-MyHEARTp randomized trial (NCT05685251), which compared home blood pressure monitoring plus health coaching to usual care. Using an explanatory sequential design, semi-structured interviews were conducted posttrial and analyzed thematically. Self-Determination Theory and Self-Regulation Theory guided coding and interpretation, with comparison across intervention and control arms.</p><p><strong>Results: </strong>Thirty-two participants (16 per arm) completed interviews. Four themes were identified: (1) postpartum experiences were emotionally and medically challenging, characterized by fear, anxiety, and hypervigilance; (2) participants strongly desired education and support, with coaching filling gaps unmet by standard care; (3) coaching provided behavioral, emotional, and healthcare benefits, including enhanced motivation, confidence, self-monitoring, lifestyle change, and self-advocacy; (4) persistent gaps, particularly in mental health support and continuity of care, remained across groups. Control participants recognized the potential value of structured support.</p><p><strong>Conclusions: </strong>Health coaching offers meaningful, multidimensional support for individuals with HDP, promoting self-efficacy, engagement, and lifestyle change. Integrating structured coaching into comprehensive postpartum care can address persistent gaps, improve patient experience, and potentially enhance long-term cardiovascular and psychosocial outcomes, underscoring the need for sustained, person-centered postpartum care.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70354"},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122557","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":"Placenta accreta spectrum care has moved beyond subspecialty identity: A call to refocus the field on individualized, expertise-driven systems of care.","authors":"Brett D Einerson, Yalda Afshar, Daniela A Carusi, John C Markley, J Newton, Christine Warrick, Lisa Zuckerwise, Jennifer Gilner, Sebastian R Hobson, Karin A Fox, Alireza A Shamshirsaz","doi":"10.1002/pmf2.70355","DOIUrl":"https://doi.org/10.1002/pmf2.70355","url":null,"abstract":"","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70355"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122633","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":"Pregnancy and postpartum cannabis and alcohol use among people with HIV in the United States.","authors":"Jecca R Steinberg, Deborah Kacanek, Carly Broadwell, Jennifer Jao, Kathleen M Powis, Tzy-Jyun Yao, Emily A Barr, Lisa B Haddad, Suzanne Siminski, Ellen G Chadwick, Lynn M Yee","doi":"10.1002/pmf2.70350","DOIUrl":"https://doi.org/10.1002/pmf2.70350","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate patterns of alcohol and cannabis use in pregnancy and postpartum and identify associated factors in a large, diverse cohort of people with HIV.</p><p><strong>Methods: </strong>We analyzed data on cannabis and alcohol use from the Surveillance Monitoring for ART Toxicities study, which enrolled pregnant people with HIV at 22 United States sites. We included participants who completed a questionnaire about substance use during pregnancy and postpartum between 2007 and 2019. Postpartum cannabis and alcohol use patterns were categorized as: (1) never (in pregnancy or postpartum), (2) initiation/resumption (no use in pregnancy, any use postpartum), (3) continuation (any use in pregnancy and postpartum), or (4) discontinuation (any use in pregnancy, no use postpartum). Multivariable log-binomial or Poisson models were fit using generalized estimating equations among pregnancies without use during pregnancy to determine factors associated with cannabis or alcohol initiation/resumption.</p><p><strong>Results: </strong>Among 1765 pregnancies with alcohol data, 8% reported alcohol use during pregnancy and 44% postpartum. Among 1772 pregnancies with cannabis data, cannabis use during pregnancy was also less frequent (8%) than postpartum (14%). The adjusted relative risk (aRR) of postpartum alcohol initiation/resumption was lower for each additional year of age (aRR, 0.98; 95% confidence interval [CI], 0.97, 0.99), for those with less annual household income (≤$10,000 vs. >$30,000; aRR, 0.77; CI, 0.65, 0.91), and for those with less than high school education (vs. greater; aRR, 0.84; CI, 0.72, 0.99). It was greater for those from a Midwest versus Northeast location (aRR, 1.44; CI, 1.16, 1.80), for participants with a cesarean birth (aRR, 1.14; CI, 1.01, 1.30), and for those who used tobacco during pregnancy (aRR, 1.19; CI, 1.00, 1.40). Factors associated with postpartum cannabis initiation/resumption included younger age (aRR, 0.94; CI, 0.91, 0.97), lower household income (aRR, 1.90; CI, 1.06, 3.40), more recent delivery year (aRR, 1.10 per year; CI, 1.02, 1.18), psychiatric diagnosis during pregnancy (aRR, 1.71; CI, 1.02, 2.86), and tobacco use during pregnancy (aRR, 1.94; CI, 1.29, 2.94).</p><p><strong>Conclusions: </strong>Risk factors differ for alcohol versus cannabis initiation or resumption after pregnancy among people with HIV. Understanding the clinical and obstetric characteristics associated with postpartum alcohol and/or cannabis use may enhance tailoring of interventions to optimize health among postpartum people with HIV.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70350"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122610","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":"Validation of the Gothenburg obstetric triage system.","authors":"Linnéa Lindroos, Erica Ginström Ernstad, Staffan Nilsson, Verena Sengpiel","doi":"10.1002/pmf2.70358","DOIUrl":"https://doi.org/10.1002/pmf2.70358","url":null,"abstract":"<p><strong>Introduction: </strong>Obstetric emergency triage is a relatively new form of emergency triage and not yet fully implemented within obstetric emergency care. In addition to assessing both the pregnant patient and fetus, obstetric triage systems require adaptation to the physiological changes of pregnancy. Without adapted triage systems, obstetric patients are known to receive unequal care compared to non-obstetric emergency patients, resulting in avoidable adverse outcomes. This study aims to validate the Gothenburg obstetric triage system, a five-level obstetric emergency system based on symptom presentations and vital sign parameters.</p><p><strong>Materials and methods: </strong>Consecutive medical charts from the obstetric emergency department at Sahlgrenska University Hospital between January 1-17 and June 1-17, 2021 were reviewed. Triage levels were dichotomized into urgent (red/orange) and nonurgent (yellow/green/blue) and assessed in relation to 31 previously established acuity outcome measures reflecting acuity in the moment of triage. Sensitivity and specificity as well as over- and undertriage were assessed for Gothenburg obstetric triage system (GOTS) in general and individual chief complaints. For undertriaged patients, deepened chart reviews were performed.</p><p><strong>Results: </strong>Of 1280 patient visits, the appropriate triage level had been assigned in 96% of the patient visits; 2.3% (29/1280) were undertriaged. Sensitivity and specificity were 0.62 (confidence interval [CI], 0.50-0.73) and 0.98 (CI, 0.97-0.99), respectively. Subjective symptom descriptions such as pain and dyspnea were prone to under- and overtriage.</p><p><strong>Conclusion: </strong>We suggest a two-phase validation process with standardized acuity outcome measures and deepened chart reviews to assess validity of obstetric triage systems in a given obstetric context. We found that GOTS is a valid triage system in the studied context but also identified areas of further improvement.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70358"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761477","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":"Scaling the collaborative care model in obstetrics: Multilevel determinants to guide implementation.","authors":"Alexandra Turco, Andrea Chu, Emily Feinberg, L G Ward, A Rani Elwy, Emily S Miller","doi":"10.1002/pmf2.70356","DOIUrl":"10.1002/pmf2.70356","url":null,"abstract":"<p><strong>Objectives: </strong>The Collaborative Care Model (CCM) is an evidence-based approach to care that improves health outcomes in primary care settings by integrating mental health into routine medical care. While recent adaptations have tailored the CCM for use in obstetric settings to address perinatal mental health (PMH) concerns, real-world implementation remains limited. Bridging this gap between research and practice requires an understanding of contextual factors influencing adoption and sustainment. As a sub-study of the Collaborative Care Model for Perinatal Wellness Support Services-Population-Level Upstream Systems Change (COMPASS+) Randomized Trial, our objective was to identify key factors modifying the implementation of the perinatal CCM (pCCM).</p><p><strong>Study design: </strong>We conducted a qualitative implementation study guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to evaluate facilitators and barriers of pCCM implementation during the Preparation phase of pre-implementation. Using purposive sampling, we recruited clinical and administrative key informants from five obstetric clinics and one birthing hospital, all affiliated with COMPASS+ Trial. Semi-structured interviews were designed to elicit determinants at multiple contextual levels. Data were analyzed using the Rapid Qualitative Analysis process. Coding and thematic analysis were guided by the EPIS domains-inner context, outer context, bridging factors, and innovation characteristics.</p><p><strong>Results: </strong>A total of 20 individuals were interviewed prior to thematic saturation. Determinants influencing adoption and sustainability of the pCCM were mapped across EPIS domains. Several cross-cutting barriers emerged on the clinic level related to limited office space and workflow changes to accommodate the pCCM, at the population level including societal stigma regarding the use of psychotropic medications during pregnancy, and among bridging factors such as need for mental health referral networks. Participants also identified multiple facilitators that support integration of the CCM into obstetric settings, such as increased medical touchpoints during pregnancy, staff and leadership buy-in, and preexisting comfort with obstetric clinicians. The need for site-level adaptation was an underlying theme, underscoring the opportunity to tailor implementation strategies to local contexts.</p><p><strong>Conclusion: </strong>The CCM is well suited to obstetric care but requires context-specific adaptation to support adoption and sustainability. Implementation strategies must address multilevel barriers and leverage existing facilitators to bridge the gap between research and practice.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70356"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766195","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":"Codes, care, and consequence: A viewpoint on CPT valuation in obstetric practice.","authors":"Brian K Iriye","doi":"10.1002/pmf2.70359","DOIUrl":"https://doi.org/10.1002/pmf2.70359","url":null,"abstract":"<p><p>In 2027, obstetric care in the United States will be billed differently than it has been for nearly half a century. Long-standing maternity global codes will be retired and replaced by new and revised codes that separately report antepartum, labor management, delivery, and postpartum care. The valuation of these codes, and of the broader obstetric ultrasound family, is determined through the AMA/Specialty Society Relative Value Scale Update Committee (RUC) process and is constrained by statutory budget neutrality within the Medicare Physician Fee Schedule. This viewpoint argues that CPT valuation in obstetrics has consequences at the bedside and is supported by two arguments. First, valuation latency-the interval between a code's last survey and the current state of the work it describes-is itself a clinical problem, and the obstetric ultrasound family, in which expanding guideline content has outpaced formal revaluation, is the clearest current example. Second, the rigor of the specialty-society survey process is the proximate determinant of whether new and revised codes are valued accurately, and that rigor depends directly on the time and care physicians invest in their responses. The viewpoint is directed at maternal-fetal medicine and obstetric clinicians, providing background on the CPT valuation process and underscoring that thoughtful participation in specialty-society RUC surveys is a meaningful contribution to accurate valuation.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70359"},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764696","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":"Hypertension-related morbidity after delivery discharge: A comparison of nifedipine versus labetalol.","authors":"Sonya Fabricant, Matthew Cervantes, Glenda Marshall, Natalie Bello, Emily Seet, Sarah Kilpatrick, Mariam Naqvi","doi":"10.1002/pmf2.70357","DOIUrl":"10.1002/pmf2.70357","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate rates of hypertension-related morbidity after delivery discharge among individuals on nifedipine versus labetalol monotherapy.</p><p><strong>Methods: </strong>This was a retrospective cohort study of individuals who delivered at a level IV obstetric hospital from January 1, 2021 to January 20, 2024, had a hypertensive disorder of pregnancy, and were discharged on nifedipine or labetalol monotherapy. The primary outcome was hypertension-related post-discharge morbidity, defined as any of the following within 30 days of delivery discharge: severe hypertension, de novo preeclampsia lab abnormalities, or new-onset clinical morbidity (hemolysis, elevated liver enzymes and low platelets [HELLP] syndrome, eclampsia, pulmonary edema/acute heart failure, cerebrovascular disorders, myocardial infarction/cardiac arrest, liver hematoma, or acute renal failure). Secondary outcomes included hypertension-related hospital return and hospital return length of stay. Data were abstracted from the medical record. Logistic regression and bivariate analysis were used to compare groups. Multivariable logistic regression was used to adjust for baseline characteristics and readmission risk factors from the literature.</p><p><strong>Results: </strong>Of 360 patients meeting inclusion criteria, 67.2% were discharged on nifedipine and 32.8% were discharged on labetalol. Nifedipine recipients had lower body mass index and were less likely to have chronic hypertension compared to labetalol recipients. Post-discharge morbidity occurred less frequently among individuals discharged on nifedipine compared to labetalol (1.7% vs. 10.2%; adjusted odds ratio [aOR], 0.1; 95% confidence interval [CI], 0.05-0.5). Individuals on nifedipine were less likely to return to the hospital in the 30 days following discharge (4.6% vs. 12.7%; aOR, 0.3; 95% CI, 0.1-0.7) and less likely to have a hospital return lasting ≥24 h (1.7% vs. 6.8%; OR, 0.2; 95% CI, 0.07-0.8).</p><p><strong>Conclusion: </strong>Among individuals on antihypertensive monotherapy at delivery discharge, nifedipine was associated with significantly reduced odds of post-discharge morbidity compared to labetalol.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70357"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763686","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":"Closing a critical gap in perinatal mental health: The case for posttraumatic stress disorder screening in obstetric care.","authors":"Abigail Powers, Briana Woods-Jaeger","doi":"10.1002/pmf2.70351","DOIUrl":"https://doi.org/10.1002/pmf2.70351","url":null,"abstract":"","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70351"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765861","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":"Delivery outcomes associated with resolved first-trimester low placentation.","authors":"Rachel Feiner, Rachel Wiley, Leah Lamale-Smith, E Nicole Teal, Minhazur Sarker","doi":"10.1002/pmf2.70368","DOIUrl":"10.1002/pmf2.70368","url":null,"abstract":"<p><strong>Introduction: </strong>The majority of low placentation identified on first-trimester transabdominal ultrasound resolves; however, whether this resolution is associated with adverse outcome remains poorly understood. This investigation aimed to determine whether patients with resolved first-trimester low placentation had different delivery outcomes compared to patients who never had low placentation.</p><p><strong>Methods: </strong>This is a retrospective cohort study of singleton pregnancies with low placentation, defined as low-lying placenta or placenta covering the internal os, on first-trimester transabdominal ultrasound between 12+0 weeks and 13+6 weeks, delivering at a single tertiary care center from January to December 2022. We compared outcomes stratified by first-trimester low placentation that resolved by the second trimester, or those without low placentation at any point. The primary outcome was quantitative blood loss at delivery by volumetric measurement. Secondary outcomes included postpartum hemorrhage (PPH) defined as blood loss ≥1000 cc, unplanned cesarean delivery, preterm birth, 5-min Apgar < 7, and composite maternal adverse outcomes including the use of atony device, retained products of conception, blood transfusion, peripartum hysterectomy, intensive care unit admission, or death.</p><p><strong>Results: </strong>This cohort included 437 low placentation patients and 491 patients without low placentation. Resolved first-trimester low placentation was associated with a significant increase in quantitative blood loss at delivery (405 ± 369 cc vs. 331 ± 253 cc, <i>p</i> < 0.01) but no difference in incidence of PPH (6.4% vs. 4.7%, <i>p</i> = 0.25). Resolved first-trimester low placentation was also associated with increased tranexamic acid (TXA) administration (11.9% vs. 7.7%, <i>p</i> = 0.03), blood transfusion (1.8% vs. 0.4%, <i>p</i> = 0.04), and unplanned cesarean delivery (15.3% vs. 9.2%, <i>p</i> < 0.01) without differences in the indications for unplanned cesarean delivery. In our multivariable regression, resolved first-trimester low placentation remained associated with TXA administration (adjusted odds ratio [OR], 1.70; 95% confidence interval [CI], 1.07-2.70) and unplanned cesarean delivery (adjusted OR 1.73; 95% CI, 1.12-2.68). There were no associations with adverse neonatal outcomes or composite maternal outcome.</p><p><strong>Conclusion: </strong>Resolved first-trimester low placentation is not associated with clinically significant adverse outcomes. However, given changes in unplanned cesarean delivery rate, resolved low placentation may indicate altered uterine physiology. Future research would be valuable to better understand the relationship between resolved low placentation and unplanned cesarean deliveries.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698726","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}