AJOG global reports最新文献

{"title":"Assessing supportive needs in pregnant women with substance use, a qualitative study","authors":"S. Heidarifard PhD ,&nbsp;M. Khoshnamrad PhD","doi":"10.1016/j.xagr.2025.100548","DOIUrl":"10.1016/j.xagr.2025.100548","url":null,"abstract":"<div><div>Pregnant women with substance use (SUD), are a vulnerable group with special reproductive health needs. The study aimed to assess the supportive needs of pregnant women with substance use. This study adopted a 3-phase qualitative methodology: (1) qualitative content analysis to identify supportive needs, (2) a 3-round Delphi process involving 20 purposively sampled experts (conducted via email over 6 months), and (3) a nominal group technique session with 10 of the original experts to prioritize critical needs. The focus was on pregnant women with substance use disorder. Five categories of needs emerged: socio-cultural support, health/financial support, consultation services, psychological needs, and access to training. Among these, education on sexual health, sexually transmitted diseases, and harm reduction principles during pregnancy scored highest (mean: 3.95). Expert consensus via the nominal group emphasized developing an educational protocol based on the Theory of Planned Behavior to address behavioral changes aligned with maternal needs. The paramount need for pregnant women with SUD is structured education on sexual health and harm reduction in pregnancy. Findings advocate for tailored, theory-based interventions to provide holistic support, potentially improving maternal and fetal outcomes.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100548"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are the influences on women’s preferences and decision-making when planning mode of birth in high-income countries? A qualitative systematic review","authors":"Moira D. Cruickshank PhD ,&nbsp;Clare Robertson MSc ,&nbsp;Miriam G. Brazzelli PhD ,&nbsp;Aniebiet I. Ekong PhD ,&nbsp;Mo Ade PGCE (Secondary Education) ,&nbsp;Pauline Mcdonagh Hull PGDip (BJTC) ,&nbsp;Paul D. Manson PGDip ,&nbsp;Debra E. Bick PhD ,&nbsp;Denitza O. Williams PhD (Medicine) ,&nbsp;Gillian Taylor Registration Midwife ,&nbsp;Lilla A. Ward Legal Practice Course ,&nbsp;Mary M. Kilonzo MSc ,&nbsp;Tara E. Fairley MBChB ,&nbsp;Siladitya Bhattacharya MD ,&nbsp;Louise Locock PhD ,&nbsp;Magdalena Rzewuska Diaz PhD ,&nbsp;Mairead E. Black PhD","doi":"10.1016/j.xagr.2025.100556","DOIUrl":"10.1016/j.xagr.2025.100556","url":null,"abstract":"<div><h3>Objective</h3><div>In antenatal care in the UK NHS, the concept of choice of mode of birth (MOB) has been recommended for some years but is still poorly operationalised. Proactive, routine provision of balanced and relevant information to women in antenatal care can be supported by using decision aids but such an aid does not currently exist. The objective of this qualitative systematic review was to identify the factors shaping women’s MOB preference and the barriers and facilitators to supported MOB decision-making.</div></div><div><h3>Data sources</h3><div>Seven major electronic databases were searched for articles published in English between 2011 and November 2022. Study eligibility criteria Eligible studies were of any design and provided qualitative data from currently or previously pregnant women in high-income countries, about reasons for MOB preference, and/or barriers or facilitators to women making supported MOB choices. Data were extracted into a pre-designed data extraction form. Identified subthemes were grouped and mapped onto two preestablished global themes. Study quality was assessed using the CASP tool for qualitative research. Confidence in the findings was assessed using GRADECERQual.</div></div><div><h3>Results</h3><div>Women’s preferences for MOB were shaped by perceptions of advantages or disadvantages of each MOB and their own or other women’s previous birth experiences. Barriers to informed MOB decision-making were mainly relating to healthcare professionals’ (HCPs’) negative attitudes, which limited women’s perceived options, and women’s own strong personal beliefs and opinions. Facilitators included having time, support and information on which to make a robust decision.</div></div><div><h3>Conclusions</h3><div>Barriers to supported decision-making about MOB still exist. HCPs are well placed to guide women through the decision-making process. Informed implementation of decision aids has the potential to address barriers in supported decision-making about MOB in routine NHS antenatal care.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100556"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and outcomes of pregnancies at-risk of hemolytic disease of the fetus and newborn in Sweden, Finland, and Denmark: a population-based register study","authors":"Kelvin H.M. Kwok PhD ,&nbsp;Mika Gissler PhD ,&nbsp;Mette Ø. Thunbo MD, PhD ,&nbsp;Elizabeth C. Hsia MD, MSCE ,&nbsp;May Lee Tjoa PhD ,&nbsp;Shengxin Liu PhD ,&nbsp;Malin Almgren PhD ,&nbsp;Vedran Stefanovic MD, PhD ,&nbsp;Lars H. Pedersen MD, PhD ,&nbsp;Agneta Wikman MD, PhD","doi":"10.1016/j.xagr.2025.100544","DOIUrl":"10.1016/j.xagr.2025.100544","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Red blood cell (RBC) alloimmunization is an immune response where the maternal immune system produces antibodies against fetal RBCs, which can lead to hemolytic disease of the fetus and newborn (HDFN). Despite the significant clinical burden of HDFN, there are few large international cohorts that focus on perinatal care and outcomes of at-risk pregnancies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To describe the maternal characteristics and outcomes of pregnancies affected by RBC alloimmunization, as well as the characteristics and outcomes of neonates from such pregnancies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Utilizing data from nationwide health registers, this population-based cohort study identified all singleton pregnancies in individuals who had ≥1 pregnancy monitored or treated for potential alloimmunization, or ≥1 child with a postnatal diagnosis of HDFN-related conditions, between January 1, 2000, and December 31, 2021, in Sweden and Finland, and between January 1, 1997, and December 31, 2018, in Denmark. Among the identified pregnancies, those with a diagnosis of maternal care for alloimmunization or fetal hydrops, or neonates with a postnatal diagnosis of HDFN-related conditions, were categorized as HDFN pregnancies. The remaining pregnancies—sibling pregnancies that may have been at risk of alloimmunization but did not receive any alloimmunization- or HDFN-related diagnosis—were categorized as non-HDFN pregnancies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;This study included 14,732 singleton pregnancies in Sweden, 5863 in Finland, and 11,964 in Denmark. Among these pregnancies, 7391 (50%) in Sweden, 2885 (49%) in Finland, and 6150 (51%) in Denmark were categorized as HDFN pregnancies. Maternal complications and stillbirth rates were comparable between HDFN and non-HDFN pregnancies. Caesarean deliveries were more frequent in HDFN pregnancies. A total of 14,519 neonates in Sweden, 5827 in Finland, and 11,803 in Denmark were born to all pregnancies identified. Of these, 7289 (50%), 2849 (49%), and 6076 (51%) had HDFN. Among the neonates with HDFN, 27% in Sweden, 38% in Finland, and 12% in Denmark received HDFN-related treatment, including intrauterine transfusion (IUT; data unavailable for Finland), neonatal transfusion, and phototherapy. Compared to non-HDFN neonates, those in the IUT and neonatal transfusion groups had lower gestational age, birth weight and length, and higher rates of neonatal unit admission, and were more frequently diagnosed postnatally with growth disturbances and disorders of the nervous system.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This is a comprehensive overview of perinatal characteristics and outcomes of pregnancies at risk of HDFN in Sweden, Finland, and Denmark. Our findings highlight the significant unmet need in perinatal care among neonates with HDFN, particularly those treated with IUT or neonatal transfusion. Further research is warranted to improve the management of seve","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100544"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘Persistent hypertension at 3 months postpartum among women with hypertensive disorders of pregnancy at a tertiary hospital in Southwestern Uganda’ [AJOG Global Reports Volume 3, Issue 1, February 2023, 100163]","authors":"Henry Mark Lugobe MD ,&nbsp;Musa Kayondo PhD ,&nbsp;Carmel M. Mceniery PhD ,&nbsp;Janet M. Catov PhD ,&nbsp;Ian B. Wilkinson PhD ,&nbsp;Blair J. Wylie MD ,&nbsp;Arthur J. Vaught MD ,&nbsp;Rose Muhindo MD ,&nbsp;Adeline A. Boatin MD","doi":"10.1016/j.xagr.2025.100545","DOIUrl":"10.1016/j.xagr.2025.100545","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100545"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with poor sleep quality on the Pittsburgh Sleep Quality Index among hospitalized Ghanaian obstetrical patients","authors":"Dhanalakshmi Thiyagarajan MD, MPH ,&nbsp;Astrid Sarfo BA ,&nbsp;Alim Swarray-Deen MBChB, MS ,&nbsp;Promise E. Sefogah MBChB, MPH ,&nbsp;Emma Lawrence MD, MS ,&nbsp;Sarah Compton PhD, MPH","doi":"10.1016/j.xagr.2025.100542","DOIUrl":"10.1016/j.xagr.2025.100542","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Sleep is crucial for overall health, especially during the transformative pregnancy period. However, pregnancy is associated with numerous changes that disrupt sleep patterns and quality. A decrease in sleep quality during the antenatal period is associated with negative fetal and maternal outcomes, including perinatal depression and hypertensive disorders of pregnancy (leading cause of maternal mortality in Ghana). There are limited studies from the sub-Saharan African region, including Ghana, that explored this subject. This study therefore sought to investigate sleep quality and the associated factors among antepartum and postpartum in-patients at the largest tertiary referral center in Ghana.</div></div><div><h3>OBJECTIVE</h3><div>To determine the sleep quality and associated factors among obstetric inpatients in Ghana.</div></div><div><h3>STUDY DESIGN</h3><div>This was a facility-based, cross-sectional study of obstetrical patients who were admitted to the Korle Bu Teaching Hospital in Ghana between November 20 and December 22, 2023. Antenatal and postpartum in-patients who were aged 18 years and older were included. Those critically ill or younger than 18 years were excluded. Using a structured questionnaire, we collected data on the participants’ sociodemographic characteristics, medical and obstetrical history, and current pregnancy or postpartum presentation and outcomes. We subsequently administered the validated Pittsburgh Sleep Quality Index tool to measure sleep quality, followed by pregnancy distress and perinatal depression screening using the Tilburg Pregnancy Distress Scale and the Patient Health Questionnaire-9, respectively. A logistic regression was used to evaluate factors associated with a positive Pittsburgh Sleep Quality Index screen, which indicated poor sleep quality.</div></div><div><h3>RESULTS</h3><div>A total of 416 (99%) of the 420 enrolled participants completed the Pittsburgh Sleep Quality Index questionnaire. Overall, 228 (54.3%) participants screened positive for poor sleep quality on the Pittsburgh Sleep Quality Index, including 88 (53.0%) of the 166 antepartum participants and 140 (56.0%) of the 250 postpartum participants. In the final, multivariable model, antepartum participants who had a shorter duration of admission were less likely to have a positive Pittsburgh Sleep Quality Index (marginal effect, −0.009), and postpartum participants who had an emergency cesarean delivery were more likely to have a positive Pittsburgh Sleep Quality Index (marginal effect, 0.166). In addition, a positive screen for pregnancy distress (Tilburg Pregnancy Distress Scale), and depression (Patient Health Questionnaire-9) were associated with poor sleep quality (<em>P</em>&lt;.01).</div></div><div><h3>CONCLUSION</h3><div>Obstetrics participants with an increased duration of hospital stay, emergency cesarean delivery, and concomitant positive screen for depression or pregnancy distress were more like","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100542"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal imaging diagnosis of iniencephaly apertus associated with heterotaxy syndrome, alobar holoprosencephaly and myelomeningocele: a case report","authors":"Jorge L. Minchola-Vega MD ,&nbsp;Víctor E. Zamora-Mostacero MD ,&nbsp;Claudia I. Lazarte-Rantes MD","doi":"10.1016/j.xagr.2025.100539","DOIUrl":"10.1016/j.xagr.2025.100539","url":null,"abstract":"<div><div>Iniencephaly is a predominantly lethal and rare form of neural tube defect characterized by fixed hyperextension of the head, occipital bone abnormalities, and cervical dysraphism. Its estimated incidence ranges from 0.1 to 10 per 10,000 births and is frequently associated with both neurological and non-neurological developmental anomalies. Here, we present the first documented case of iniencephaly apertus in conjunction with heterotaxy syndrome (HS), alobar holoprosencephaly (HPE) and myelomeningocele. Our report describes a 19-year-old primigravida with no significant medical history, whose ultrasound at 19 weeks of gestation identified findings consistent with iniencephaly apertus associated with alobar HPE and myelomeningocele. Fetal magnetic resonance imaging (MRI) at week 20 confirmed these findings and additionally revealed a centrally positioned liver and asplenia, consistent with HS. The pregnancy was terminated at week 21, resulting in a stillborn female with a normal 46 XX karyotype. The family did not consent to an autopsy. Here, we discuss the prenatal ultrasonographic, fetal MRI, and external macroscopic findings of this unique association. This case highlights the importance of prenatal diagnosis in decisions about pregnancy viability and opens a window for future research on factors contributing to the co-occurrence of these rare conditions.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100539"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart failure in pregnancy and postpartum: a nationwide study over 6.3 million of pregnancies in France between 2010 and 2018","authors":"Amélie Gabet PhD ,&nbsp;Lise Legrand MD ,&nbsp;Richard Isnard MD, PhD ,&nbsp;Françoise Pousset MD ,&nbsp;Jacques Blacher MD, PhD ,&nbsp;Valérie Olié PhD","doi":"10.1016/j.xagr.2025.100540","DOIUrl":"10.1016/j.xagr.2025.100540","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular diseases became the first cause of maternal death in France, but only scarce epidemiological data have been published about heart failure (HF) in pregnancy/postpartum.</div></div><div><h3>Objective</h3><div>The aim of the present study was to describe the epidemiology of HF in pregnancy or until 6 weeks postpartum in France.</div></div><div><h3>Study Design</h3><div>This is an observational cohort study. Using the French National Health Insurance Information System database (Système National des Données de Santé), all women who gave birth in France after 22 weeks of gestation between January 1, 2010, and December 31, 2018, were selected. HF hospitalizations occurring during the pregnancies or 6 weeks postpartum were identified.</div></div><div><h3>Results</h3><div>On 6293,367 deliveries analyzed, 2241 (35.6/100,000) had at least one hospitalization for HF. This rate remained quite stable between 2010 and 2018. A total of 22.6% of these cases had heart disease history, including HF before pregnancy, and 49.0% had preceding or concomitant heart disease. Compared to women without HF, those with HF were older (32.0 [6.1] vs 29.9 [5.3] years), had more frequently multiple pregnancy (14.6% vs 1.7%), history of medically assisted reproduction (7.9% vs 3.2%), cardiovascular risk factors (arterial hypertension [17.0% vs 1.7%], gestational diabetes [15.5% vs 9.6%], obesity [14.9% vs 4.7%], tobacco smoking [12.4% vs 9.4%]), and had a lower socio-economic level with 23.4% living in the French most deprived area against 18.1% living in the least deprived area. The most frequent cardiac condition found were cardiomyopathy (29.5%), arrhythmias (14.0%), and valvulopathy (8.5%). The rate of pre-eclampsia reached 29.4% in pregnancies with HF against 2.0% in pregnancies without HF. Fetal complications were much higher in pregnancies with HF than without HF, with 11.5% vs 0.9% very/extremely preterm birth, and 5.3% vs 0.8% fetus/child death. One year after delivery, maternal death was observed in 2.2% of women with HF against &lt;0.01% in those without HF.</div></div><div><h3>Conclusion</h3><div>Despite occurring in only 1 in 2808 pregnancies, HF during pregnancy or the postpartum period has a significant impact on maternal and fetal outcomes.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100540"},"PeriodicalIF":0.0,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual behavior and its influencing factors among Uruguayan adolescents: a cross-sectional study","authors":"Tonmoy Alam Shuvo MSc,&nbsp;Kabir Hossain MSc,&nbsp;Arifur Rahman MSc","doi":"10.1016/j.xagr.2025.100538","DOIUrl":"10.1016/j.xagr.2025.100538","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate the factors influencing adolescent sexual behavior in Uruguay, with a focus on socio-demographics, substance use, psychological distress, and protective factors.</div></div><div><h3>Methods</h3><div>We analyzed data from the 2019 Uruguay Global School-based Student Health Survey (GSHS). Chi-square tests identified variables significantly associated with sexual behavior. Mixed-effects logistic regression models estimated odds ratios, and a fully adjusted model provided adjusted odds ratios for all significant factors. All analyses were performed using R programming.</div></div><div><h3>Result</h3><div>Our analysis included a total of 2495 participants. Older adolescents (≥15 years) had a significantly higher likelihood of engaging in sexual behavior (AOR: 3.69, 95% confidence intervals [CI]: 2.92–4.66). Tobacco (AOR: 2.60, 95% CI: 1.91–3.55) and alcohol use (AOR: 2.09, 95% CI: 1.71–2.56) were strong risk factors, along with alcohol-related behavioral issues (AOR: 2.08, 95% CI: 1.65–2.62). Anxiety (AOR: 1.51, 95% CI: 1.09–2.08) and involvement in physical fights (AOR: 1.84, 95% CI: 1.42–2.40) increased the odds, while loneliness showed a protective effect (AOR: 0.62, 95% CI: 0.46–0.83). Parental bonding (OR: 0.54, 95% CI: 0.45–0.65), attachment (OR: 0.70, 95% CI: 0.59–0.82), and supervision (OR: 0.64, 95% CI: 0.54–0.77) showed significant effects before adjustment, but after adjustment, they became insignificant. Sedentary behavior reduced the likelihood, while truancy increased the possibility of sexual behavior among adolescents.</div></div><div><h3>Conclusion</h3><div>Interventions should aim to reduce adolescent sexual risk behaviors by promoting healthy practices and addressing factors such as substance use, mental health, and parental involvement to encourage safer sexual behaviors.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100538"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘Safety of quadrivalent recombinant influenza vaccine in pregnant persons and their infants’ [AJOG Global Reports Volume 4, Issue 4, November 2024, 100395]","authors":"Amber Hsiao PhD, MPH ,&nbsp;Arnold Yee MBA ,&nbsp;Ruvim Izikson MD, MPH ,&nbsp;Bruce Fireman MA ,&nbsp;John Hansen MPH ,&nbsp;Ned Lewis MPH ,&nbsp;Sonja Gandhi-Banga PhD ,&nbsp;Alexandre Selmani PhD ,&nbsp;Oxana Talanova MD, MPH ,&nbsp;Heidi Kabler MD ,&nbsp;Ajinkya Inamdar MBBS, MS, MBA ,&nbsp;Nicola P. Klein MD, PhD","doi":"10.1016/j.xagr.2025.100536","DOIUrl":"10.1016/j.xagr.2025.100536","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100536"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communicating uncertainty with perinatal counseling: a randomized controlled trial of a multimodal curriculum for obstetrical trainees","authors":"Melissa Spiel DO ,&nbsp;Eve M. Roth MD ,&nbsp;Allison A. Merz-Herrala MD ,&nbsp;Anna Modest PhD, MPH ,&nbsp;Brett C. Young MD","doi":"10.1016/j.xagr.2025.100535","DOIUrl":"10.1016/j.xagr.2025.100535","url":null,"abstract":"<div><h3>Background</h3><div>Effective communication of uncertain prognoses is a critical skill in obstetrics. Yet few curricula exist to prepare graduate medical education trainees for these high-stakes conversations.</div></div><div><h3>Objective</h3><div>To design and evaluate a multimodal curriculum for improving obstetric trainees' communication skills when conveying uncertain prognoses.</div></div><div><h3>Methods</h3><div>In this blinded, randomized controlled trial, obstetrics residents at an academic medical center were assigned to either a standard didactic session or an intervention group receiving a structured, multimodal curriculum. The intervention included a reading assignment on the SPIKES protocol and physician empathy, an instructional video, and facilitated small-group discussion. Two weeks post-intervention, all participants engaged in a standardized patient encounter simulating a periviable diagnosis of preterm prelabor rupture of membranes. Communication performance was assessed using a structured rubric, and stress levels before and after the encounter.</div></div><div><h3>Results</h3><div>Twenty-three obstetric trainees completed the study. The intervention group demonstrated significantly higher communication scores (mean score 19.5 vs 15.5; <em>P=.</em>02) and greater use of patient-centered techniques such as acknowledging anxiety and minimizing jargon. They also reported lower stress levels during the simulation (mean 3.2 vs 4.0 on a 5-point scale, <em>P=.</em>003). Post-intervention surveys revealed improved comfort with delivering complex prognoses and responding to emotional cues.</div></div><div><h3>Conclusion</h3><div>This structured SPIKES-based curriculum significantly enhanced obstetric trainees’ communication performance and confidence in simulated counseling scenarios involving uncertain prognoses. The curriculum is feasible for integration into graduate medical education and aligns with ACGME communication competencies. These findings support broader implementation of structured communication training in obstetrics to improve both learner outcomes and patient-centered care.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100535"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}