AJOG global reports最新文献

{"title":"Noninferiority of single-incision laparoscopy vs conventional laparoscopy in salpingectomy or salpingotomy for ectopic pregnancy: a meta-analysis","authors":"Greg J. Marchand MD ,&nbsp;Ahmed Massoud MD ,&nbsp;Hollie Ulibarri BS ,&nbsp;Amanda Arroyo BS ,&nbsp;Daniela Gonzalez Herrera BS ,&nbsp;Brooke Hamilton BS ,&nbsp;Kate Ruffley BS ,&nbsp;Mckenna Robinson BS ,&nbsp;Marissa Dominick BS ,&nbsp;Ali Azadi MD","doi":"10.1016/j.xagr.2024.100435","DOIUrl":"10.1016/j.xagr.2024.100435","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Ectopic pregnancy is an emergency frequently requiring laparoscopic intervention. This study aimed to determine whether single-incision laparoscopic surgery is a safe and effective treatment method compared with conventional laparoscopic surgery with multiple ports.</div></div><div><h3>DATA SOURCES</h3><div>This study searched 6 databases from their inception to May 15, 2024, for articles comparing the safety outcomes of single-incision laparoscopic surgery with conventional laparoscopic surgery in managing women with ectopic pregnancy.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>This study included all studies that evaluated the safety outcomes of single-incision laparoscopic surgery compared with conventional laparoscopic surgery in patients with ectopic pregnancy and included at least 1 of our preselected outcomes. In addition, this study included both randomized controlled trials and observational studies.</div></div><div><h3>METHODS</h3><div>Review Manager (version 5.4.1) and OpenMetaAnalyst software were used to analyze the extracted data. In addition, this study used odds ratios for dichotomous outcomes, mean difference for continuous outcomes, a fixed effects model for homogeneous outcomes, and a random effects model for heterogeneous outcomes. Furthermore, heterogeneity was evaluated using the <em>I²</em> and <em>P</em> values. After removing duplicates, this study identified 83 studies. Using a 2-step screening process, this study excluded non-English and animal studies and included randomized controlled trials and observational studies that included at least 1 of our preselected outcomes. Ultimately, 12 studies were included in the final synthesis.</div></div><div><h3>RESULTS</h3><div>Our analysis showed a significant favoring of the single-incision laparoscopic surgery group in the pain visual analog scale score (median difference=−0.57; <em>P</em>&lt;.01). However, our study found no statistically significant difference between both procedures in the times of analgesic use (median difference=−0.08; <em>P</em>=.19), intraoperative complications (odds ratio=1.17; <em>P</em>=.8), postoperative complications (odds ratio=1.02; <em>P</em>=.96), conversion to laparotomy (odds ratio=1.40; <em>P</em>=.59), bowel injury (odds ratio=1.42; <em>P</em>=.8), and postoperative fever (odds ratio=0.52; <em>P</em>=.42).</div></div><div><h3>CONCLUSION</h3><div>The use of single-incision laparoscopic surgery for treating ectopic pregnancy may reduce postoperative pain with similar rates of analgesic use. The incidences of intraoperative and postoperative complications were comparable. Furthermore, the rates of conversion to laparotomy, bowel injury, and postoperative fever were similar between the 2 techniques. Our results seem to show that single-incision laparoscopic surgery is noninferior to conventional laparoscopic surgery for the safe treatment of ectopic pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100435"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061600","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":"Variations in emergency care for severe pre-eclampsia in Uganda: a national evaluation study","authors":"Annettee Nakimuli MD, PhD ,&nbsp;Jackline Akello MD ,&nbsp;Musa Sekikubo MD, PhD ,&nbsp;Sarah Nakubulwa MD, PhD ,&nbsp;Moses Adroma MD ,&nbsp;Rehema Nabuufu ,&nbsp;Emmanuel Obuya ,&nbsp;John Paul Bagala MD ,&nbsp;Andrew Twinamatsiko MD ,&nbsp;Hadijah Nakatudde ,&nbsp;Patrica Pirio MD ,&nbsp;Grace Latigi ,&nbsp;Baifa Arwinyo MD ,&nbsp;Kenneth Mugabe MD ,&nbsp;Irene Chebet MD ,&nbsp;Richard Mugahi MD ,&nbsp;Isabella Aitchison BA ,&nbsp;Charlotte Patient MD ,&nbsp;Ashley Moffett MD ,&nbsp;Catherine E Aiken MB/BChir, PhD","doi":"10.1016/j.xagr.2024.100424","DOIUrl":"10.1016/j.xagr.2024.100424","url":null,"abstract":"<div><h3>Background</h3><div>Worldwide, 70% of maternal deaths occur in Sub-Saharan Africa. Approximately 10% are attributable to hypertensive disorders of pregnancy, primarily complications of pre-eclampsia. Timely and effective care improves outcomes, but this is not consistently available, particularly in low-resource settings such as Uganda.</div></div><div><h3>Objectives</h3><div>We conducted a national evaluation of the provision of prompt and safe care for women with severe pre-eclampsia across all regions of Uganda. We explored the wider health system-related factors, eg supply availability, facilities, and emergency training drills, that may affect the ability of healthcare facilities to deliver optimal pre-eclampsia care.</div></div><div><h3>Study design</h3><div>A multidisciplinary research team carried out in-person, unannounced visits to maternity facilities across Uganda to assess the quality of care provided. Evaluations of facilities, staff interviews, and case notes reviews were performed.</div></div><div><h3>Results</h3><div>75 maternity facilities were included from all regions of Uganda. Of these, 25% were unable to provide correct emergency care for severe pre-eclampsia, and 21% were unable to consistently provide delivery or referral for eclamptic seizure within 12 hours. Factors strongly associated with not providing optimal pre-eclampsia care were lack of staff training, lack of readily available clinical protocols, lack of antenatal education, lack of close postnatal monitoring and care that was not always woman-centered.</div></div><div><h3>Conclusions</h3><div>The key barriers associated with delayed or poor quality pre-eclampsia care across Uganda are potentially modifiable with strengthened clinical governance initiatives. Developing context-specific, standardized, national training and educational programmes could be effective in reducing rates of maternal and neonatal morbidity and mortality from pre-eclampsia.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100424"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104012","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":"Implementation of in utero laparotomy-assisted fetoscopic spina bifida repair in two centers in Latin America: rationale for this approach in this region","authors":"Jezid Miranda PhD ,&nbsp;Miguel A. Parra-Saavedra PhD ,&nbsp;William O. Contreras-Lopez PhD ,&nbsp;Cristóbal Abello MD ,&nbsp;Guido Parra MD ,&nbsp;Juan Hernandez MD ,&nbsp;Amanda Barrero MD ,&nbsp;Isabela Leones MD ,&nbsp;Adriana Nieto-Sanjuanero MD ,&nbsp;Gerardo Sepúlveda-Gonzalez MD ,&nbsp;Magdalena Sanz-Cortes PhD","doi":"10.1016/j.xagr.2025.100442","DOIUrl":"10.1016/j.xagr.2025.100442","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Spina bifida (SB) is a severe congenital malformation that affects approximately 150,000 infants annually, predominantly in low- and middle-income countries, leading to significant morbidity and lifelong disabilities. In Latin America, the birth prevalence of SB is notably high, often exacerbated by limited healthcare resources and poor access to advanced medical care. The implementation of laparotomy-assisted fetoscopic in-utero SB repair programs in Latin America targets reducing prematurity rates and enabling vaginal births while preserving the benefits of decreased need for hydrocephalus treatment and improved mobility in children.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This study evaluated the safety, efficacy, and outcomes of laparotomy-assisted fetoscopic in-utero SB repair in Latin America compared to traditional open-hysterotomy methods.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design&lt;/h3&gt;&lt;div&gt;This retrospective cohort study included 39 cases of laparotomy-assisted fetoscopic in-utero SB repair, with 14 cases from Mexico (2017–2021) and 25 cases from Colombia (2019–2024). These cases were compared to 78 cases from the MOMs trial and 314 from other Latin American centers using traditional open-hysterotomy methods. Statistical analyses included the Student's t-test, Kruskal-Wallis test, and Pearson's chi-square test.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The gestational age (GA) at the time of surgery was significantly higher in fetoscopic centers (26±1.27 weeks) compared to the MOMs trial (23.6±1.42 weeks) and traditional hysterotomy methods (25.4±1 weeks) (&lt;em&gt;P&lt;/em&gt;&lt;.001). Mean GA at delivery was significantly earlier in the hysterotomy-based groups than in our fetoscopic group (MOMs: 34.1 [± 3.1] vs open-repair centers in LATAM: 34 [±3002] vs Fetoscopic: 35.3 [± 3.79] weeks; &lt;em&gt;P&lt;/em&gt; values=.14 and 0004, respectively). Moreover, and the fetoscopic repair group exhibited a significantly lower rate of spontaneous preterm births (&lt;34 weeks) at 15.8%, compared to 46.2% in the MOMs trial group and 49% in the other Latin American centers using traditional open-hysterotomy methods (&lt;em&gt;P&lt;/em&gt;=.004 and .001, respectively). Additionally, the fetoscopic group had higher birthweights (2618±738g) and a lower cesarean delivery rate (65.8%) compared to the other groups (&lt;em&gt;P&lt;/em&gt;&lt;.001). Hydrocephalus treatment requirements at 12 months were similar across all groups. No maternal deaths or other outcomes such as pulmonary edema or need for maternal transfusion were noted in the fetoscopic SB repair group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The laparotomy-assisted fetoscopic SB repair offers a feasible and safer alternative to traditional hysterotomy-based techniques in Latin America. This approach significantly reduces the rates of prematurity and cesarean deliveries, facilitating vaginal births and minimizing maternal morbidity. These findings support the broader adoption of fetoscopic SB repair in regions with a high p","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100442"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377869","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":"Patients’ acceptance toward elective induction of labor at 39th week of gestation among low-risk pregnancies in a tertiary hospital in Vietnam: the PALI study","authors":"Ha Thi Thu Nguyen PhD ,&nbsp;Giang Thi Tra Duong MD ,&nbsp;Thanh Hoang Luong MD ,&nbsp;Dat Tuan Do PhD ,&nbsp;Thuong Thi Huyen Phan PhD ,&nbsp;Toan Khac Nguyen MD ,&nbsp;Anh Duy Nguyen PhD","doi":"10.1016/j.xagr.2025.100452","DOIUrl":"10.1016/j.xagr.2025.100452","url":null,"abstract":"<div><h3>Background</h3><div>The term “elective induction of labor (eIOL)” refers to the practice of inducing labor before the due date in the absence of medical indication. In 2022, the American College of Obstetricians and Gynecologists (ACOG) recommended that eIOL be considered for healthy women at 39 weeks of gestation. However, the acceptance of eIOL among pregnant women is crucial. Understanding pregnant women's perspectives on this issue is essential for developing strategies to shift public perceptions of eIOL.</div></div><div><h3>Objective</h3><div>To evaluate the opinion and acceptance of low-risk pregnant women regarding elective induction of labor at 39^th week of gestation.</div></div><div><h3>Materials and Methods</h3><div>From January 2022 to January 2023, we conducted a survey of low-risk pregnant women attending routine obstetrics at Hanoi Obstetrics and Gynecological Hospital, Hanoi, Vietnam, at 2 intervals: 36 weeks and 39 weeks of gestation. The first survey included questions regarding basic demographics, obstetric history, and participants' opinions and acceptance of labor induction, with a particular focus on eIOL at 39 weeks of gestation in the absence of medical indications. The women's acceptance was asked for a second time at 39 weeks, and in-depth interviews were conducted with those who changed their minds between the 2 surveys.</div></div><div><h3>Results</h3><div>For 200 pregnant women who participated in the study at 36 weeks, the 3 most common reasons for IOL prior to the due date were maternal indications, fetal indications, and a convenient day for pregnant women, about 88%, 87%, and 80%, respectively. Women not opting for eIOL were concerned about the risk of harm to the fetus (53%) and increasing infection complications (33%). Among 177 pregnant women who completed the second survey, the rate of eIOL acceptance was decreased compared to the first time (40.1% vs 54.5%, respectively). Twenty-eight women altered their decision from acceptance to rejection of eIOL due to apprehension about the risk associated with labor induction (43%) or impacts from others, including medical staff (25%) and relatives (21%). Four out of 8 women conversed to accept eIOL at the 39th week of gestation to choose a date of birth.</div></div><div><h3>Conclusion</h3><div>Awareness of the induction of labor among pregnant women in Vietnam remains limited. More than half of women who do not support eIOL believe it could be harmful to the fetus. The acceptance rate for eIOL declines as the pregnancy approaches the due date because of adverse impacts from relatives and medical staff. These findings underscore the importance of comprehensive medical counseling for pregnant women and their families, as well as improving the healthcare providers’ awareness regarding the advantages and disadvantages of induction of labor.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100452"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419875","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":"Construct validation of a complete postpartum health and well-being patient reported outcome measure: prospective cohort study","authors":"Laura J. O'Byrne BMBS, MSc, PhD ,&nbsp;Gillian M. Maher PhD ,&nbsp;Jill M. Mitchell MB, BCh, BAO ,&nbsp;Ali S Khashan PhD ,&nbsp;Richard M. Greene MB, BCh, BAO ,&nbsp;John P. Browne PhD ,&nbsp;Fergus P. McCarthy MB, BCh, BAO, PhD","doi":"10.1016/j.xagr.2025.100440","DOIUrl":"10.1016/j.xagr.2025.100440","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Despite a focus on patient-reported outcome measures (PROM) in maternity care, a standardized tool is lacking. Current existing measures often focus on a single dimension of postpartum health.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This study evaluated the construct validity of using a suite of PROMs based on the top psychometrically validated tools available. They were combined to achieve coverage of all important aspects of postpartum well-being outlined by the International Consortium of Health Outcomes (ICHOM).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Recruitment took place in a tertiary university maternity hospital between April 3&lt;sup&gt;rd&lt;/sup&gt; 2023, and October 28&lt;sup&gt;th&lt;/sup&gt; 2023, with final responses collected in January 2024. Postnatal women were recruited before hospital discharge and consented to completing the PROM tool which consisted of the Postpartum Quality of Life (PQoL) tool, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and 2 additional questions on pelvic pain with sexual intercourse. The PROM was administered at T1=first week postpartum, T2=6 weeks and T3=12 weeks postpartum. We evaluated the construct validity of these tools through hypothesis testing, proposing that: (1) the instrument should differentiate between groups with and without morbidity, (2) the instrument should differentiate between groups based on delivery type, and (3) should detect change over the postpartum period. Statistical analyses, including chi-square tests, repeated measures ANOVA, and independent t-tests, were used for data analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;534 women were recruited, with an average age of 32 years (±5.0), 90.6% (n=484) had term deliveries, 59% (n=316) were multiparous, 40% (n=216) had spontaneous vaginal deliveries (SVD), 12% (n=63) had operative vaginal deliveries and 47.7% (n= 255) had caesarean sections. Examining the tools’ ability to detect changes based on morbidity found no significant differences in PQoL, ICIQ-UI SF or pelvic pain scores between groups with and without maternal morbidity. There were also no differences found in the scores of mothers who had babies admitted to the Neonatal Unit (NNU). Examining score differences based on delivery type, found no variations in total PQoL scores across all timepoints. There were no score differences at other time points in the ICIQ-UI SF or pelvic pain question scores. The PQoL, ICIQ-UI SF and the pelvic pain with sexual intercourse questions had statistically significant difference in their overall scores over the 3 timepoints of the study. The PQoL scores were T1: 128 [&lt;span&gt;&lt;math&gt;&lt;mo&gt;±&lt;/mo&gt;&lt;/math&gt;&lt;/span&gt;9.67], T2: 125 [&lt;span&gt;&lt;math&gt;&lt;mo&gt;±&lt;/mo&gt;&lt;/math&gt;&lt;/span&gt;8.47], and T3: 126 [&lt;span&gt;&lt;math&gt;&lt;mo&gt;±&lt;/mo&gt;&lt;/math&gt;&lt;/span&gt;8.51] &lt;em&gt;P=&lt;/em&gt;.002. The ICIQ-UI SF had a median score and interquartile ranges of T1: 7.7 (IQR=6), T2: 9 (IQR=7), and T3: 9 (IQR=7), &lt;em&gt;P=&lt;&lt;/em&gt;.001. The pelvic pain","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100440"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375853","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":"Characterization of severity of hemolytic disease of the fetus and newborn due to Rhesus antigen alloimmunization","authors":"Alexis A. Krumme ScD ,&nbsp;Robert Y. Suruki ScD ,&nbsp;Clair Blacketer MPH ,&nbsp;Jill Hardin PhD ,&nbsp;Joel N. Swerdel PhD ,&nbsp;May Lee Tjoa PhD ,&nbsp;Kara B. Markham MD","doi":"10.1016/j.xagr.2024.100439","DOIUrl":"10.1016/j.xagr.2024.100439","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Clinical manifestations of hemolytic disease of the fetus and newborn include anemia, hyperbilirubinemia, hydrops fetalis, kernicterus, and fetal or neonatal demise. More than 50 antibodies are linked to hemolytic disease of the fetus and newborn, with Rhesus (including D and c) and Kell antigens carrying the highest risk of disease. To date, a multicenter, comprehensive evaluation of hemolytic disease of the fetus and newborn due to Rhesus antigen alloantibodies in the United States has not been undertaken.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to implement a novel severity index to characterize the real-world disease spectrum of hemolytic disease of the fetus and newborn due to alloantibodies from the Rhesus class.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;This retrospective cohort study was conducted in neonates with commercial insurance available through Optum's deidentified Clinformatics® Data Mart Database (Clinformatics®) and Merative MarketScan® Commercial Claims and Encounters (CCAE) Database from 2000 to 2022. Neonatal and maternal records were linked algorithmically by shared family identifier. A hierarchical severity index was developed for neonates with a Rhesus antigen hemolytic disease of the fetus and newborn diagnosis code in the first 30 days of life, using antenatal and neonatal diagnoses and treatments: &lt;em&gt;Severe&lt;/em&gt; (neonatal death, hydrops fetalis, intrauterine transfusion); &lt;em&gt;Moderate&lt;/em&gt; (neonatal exchange transfusion); &lt;em&gt;Mild&lt;/em&gt; (neonatal simple transfusion); &lt;em&gt;Minimal&lt;/em&gt; (neonatal phototherapy or hyperbilirubinemia). Maternal, antenatal, and perinatal demographic and clinical characteristics were summarized descriptively by severity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;In Clinformatics® and Commercial Claims and Encounters Database, respectively, 1927 and 1268 neonates met the inclusion criteria. Most (93.1% Clinformatics®; 93.5% CCAE Database) displayed minimal severity, although in both databases nearly 40% of these neonates still required phototherapy. More neonates were mildly affected (3.3% Clinformatics®; 2.2% Commercial Claims and Encounters Database) than moderately (1.0% Clinformatics®; 1.1% Commercial Claims and Encounters Database). In Clinformatics® and Commercial Claims and Encounters Database, respectively, severe hemolytic disease of the fetus and newborn affected 2.6% and 3.2% of neonates, 54% and 46% of whom received exchange or simple transfusions. Severely affected neonates were more commonly delivered by cesarean delivery and at a lower gestational age (34.1 weeks Clinformatics®; 35.4 weeks Commercial Claims and Encounters Database) than those minimally affected (38.5 weeks Clinformatics®; 38.4 weeks Commercial Claims and Encounters Database).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;Results across 2 real-world US databases found that although most neonates affected by hemolytic disease of the fetus and newborn due to Rhesus antigen alloantib","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100439"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419873","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":"Utilizing machine learning to predict the risk factors of episiotomy in parturient women","authors":"Mojdeh Banaei PhD,&nbsp;Nasibeh Roozbeh PhD,&nbsp;Fatemeh Darsareh PhD,&nbsp;Vahid Mehrnoush MD,&nbsp;Mohammad Sadegh Vahidi Farashah PhD,&nbsp;Farideh Montazeri BSc","doi":"10.1016/j.xagr.2024.100420","DOIUrl":"10.1016/j.xagr.2024.100420","url":null,"abstract":"<div><h3>Background</h3><div>Episiotomy has specific indications that, if properly followed, can effectively prevent women from experiencing severe lacerations that may result in significant complications like anal incontinence. However, the risk factors related to episiotomy has been the center of much debate in the medical field in the past few years.</div></div><div><h3>Objective</h3><div>The present study used a machine learning model to predict the factors that put women at the risk of having episiotomy using intrapartum data.</div></div><div><h3>Study design</h3><div>This was a retrospective cohort study design. Factors such as age, educational level, residency place, medical insurance, nationality, attendance at prenatal education courses, parity, gestational age, onset of labor, presence of a doula during labor, maternal health conditions like anemia, diabetes, preeclampsia, prolonged rupture of membrane, placenta abruption, presence of meconium in amniotic fluid, intrauterine growth retardation, intrauterine fetal death, maternal body mass index, and fetal distress were extracted from the electronic health record system of a tertiary-care medical center in Iran, from January 2022 to January 2023. The criteria for inclusion were vaginal delivery of a single pregnancy. Deliveries done through scheduled/emergency cesarean section or at the mother's request were excluded. The participants were divided into two groups: those who had vaginal deliveries with episiotomy and those who had vaginal deliveries without episiotomy. The significant variables, as determined by their <em>P</em>-values, were selected as features for the eight machine-learning models. The evaluation of performance included area under the curve (AUC), accuracy, precision, recall, and F1-Score.</div></div><div><h3>Results</h3><div>During the study period, out of 1775 vaginal deliveries, 629 (35.4%) required an episiotomy. Each model had an AUC value assigned to it: linear regression (0.85), deep learning (0.82), support vector machine (0.79), light gradient-boosting (0.79), logistic regression (0.78), XGBoost classification (0.77), random forest classification (0.76), decision tree classification (0.75), and permutation classification—knn (0.70). Linear regression had a better diagnostic performance among all the models with the area under the ROC curve (AUC): 0.85, accuracy: 0.80, precision: 0.74, recall: 0.86, and F_1 score: 0.79). Parity, labor onset, gestational age, body mass index, and doula support were the leading clinical factors related to episiotomy, according to their importance rankings.</div></div><div><h3>Conclusions</h3><div>Utilizing a clinical dataset and various machine learning models to assess the risk factors of episiotomy resulted in promising results. Further research, focusing on intrapartum clinical data and perspectives of the birth attendant, is necessary to enhance the accuracy of predictions.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100420"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885705","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":"Immediate postplacental intrauterine device placement: retrospective cohort study of expulsion and associated risk factors","authors":"Emily Leubner MD,&nbsp;Brooke A. Levandowski PhD, MPA,&nbsp;Sage Mikami MD ,&nbsp;Theresa Green PhD, MBA,&nbsp;Sarah Betstadt MD, MPH","doi":"10.1016/j.xagr.2024.100421","DOIUrl":"10.1016/j.xagr.2024.100421","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Postpartum contraception is typically provided during postpartum visits. When desired and accessible, the immediate postpartum period provides an additional opportunity to increase the use of more effective contraceptive methods to potentially reduce subsequent unintended pregnancies and improve pregnancy outcomes. In New York State, recent policy changes expanded Medicaid coverage to include immediate postplacental intrauterine device insertion.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to investigate clinically documented intrauterine device expulsion within 12 months of placement in patients who depend on state-funded health insurance.</div></div><div><h3>STUDY DESIGN</h3><div>This retrospective cohort study included Medicaid patients with an immediate postplacental intrauterine device placed after third-trimester delivery, who delivered between March 2, 2017 and September 2, 2019. Current Procedural Terminology code billing data were used to identify 238 patients who underwent intrauterine device placement during their delivery admission. Electronic medical record data were analyzed using chi-squared tests, <em>t</em> tests, and multivariable logistic regression.</div></div><div><h3>RESULTS</h3><div>There were 17.6% (42/238) documented intrauterine device expulsions within the first year after placement. Among patients with vaginal deliveries, 22.1% (29/131) of intrauterine devices placed had a documented expulsion, whereas the expulsion rate was 12.2% (13/107) among patients who had cesarean deliveries (<em>P</em>=.04). After controlling for body mass index, parity, intrauterine device type, and gestational age, patients who delivered vaginally were more likely to experience intrauterine device expulsion within 1 year compared with those who had cesarean delivery (adjusted odds ratio, 2.71; 95% confidence interval, 1.27–5.80). Patients with a documented intrauterine device expulsion within 1 year were more likely to have a subsequent pregnancy before October 2020 (35.7% [15/42] vs 15.3% [30/196] in the no-expulsion group; <em>P</em>=.002).</div></div><div><h3>CONCLUSION</h3><div>The overall percentage of documented intrauterine device expulsion within 1 year following immediate postplacental placement was 17.6%, with a greater percentage of expulsion in patients who underwent vaginal delivery. Patients with a documented intrauterine device expulsion within 1 year of placement were significantly more likely to experience a subsequent pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100421"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907743","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 maternal beta-blocker treatment on mean fetal heart rate","authors":"Sarah Hautier MD ,&nbsp;Thi Minh Thu Nguyen MD ,&nbsp;Arane Kim MD ,&nbsp;Tiphaine Barral MD ,&nbsp;Dominique Luton PhD","doi":"10.1016/j.xagr.2024.100423","DOIUrl":"10.1016/j.xagr.2024.100423","url":null,"abstract":"<div><h3>Background</h3><div>During pregnancy, the prescription of beta-blockers to the mother may be necessary for pre-existing chronic conditions. Their use raises concerns due to potential effects on the fetus.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate the impact of beta-blockers on mean fetal heart rate in pregnant women treated with these medications compared to an untreated patient group.</div></div><div><h3>Study Design</h3><div>This was a retrospective case-control study involving 90 patients, divided into two groups: 45 patients on beta-blockers and 45 untreated patients. Included patients delivered singleton pregnancies after 24 weeks of gestational age at two university hospitals in Île-de-France between 2009 and 2021. They were matched based on age, parity, and gestational age at delivery. Fetal heart rate and maternal heart rate were recorded on the day of delivery. Pregnancy outcomes were studied secondarily.</div></div><div><h3>Results</h3><div>There was no significant difference in mean fetal heart rate between the two groups: 87% of fetuses from mothers treated with beta-blockers had a heart rate between 110 and 150 bpm, compared to 93% of fetuses in the second group (<em>P</em>=.71). Among patients taking beta-blockers, the most commonly used treatment was bisoprolol.</div></div><div><h3>Conclusion</h3><div>The study did not reveal a significant effect of beta-blockers on fetal heart rate. However, close monitoring and appropriate clinical management are still necessary for pregnant patients on beta-blocker treatment due to other potential implications like intra-uterine growth restriction for both the mother and the fetus.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100423"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933828","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":"Scoping review of climate drivers on maternal health: current evidence and clinical implications","authors":"Claire Masters MHP ,&nbsp;Chuhan Wu MS ,&nbsp;Dara Gleeson MPH ,&nbsp;Michaela Serafica RN, MSN ,&nbsp;Jordan L. Thomas PhD ,&nbsp;Jeannette R. Ickovics PhD","doi":"10.1016/j.xagr.2025.100444","DOIUrl":"10.1016/j.xagr.2025.100444","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically review the literature on associations between climate drivers and health outcomes among pregnant people. This review fills a gap by synthesizing evidence for a clinician audience.</div></div><div><h3>Data Sources</h3><div>Systematic scoping review of articles published in PubMed and clinicaltrials.gov from January 2010 through December 2023.</div></div><div><h3>Study Eligibility Criteria</h3><div>Empirical studies published in English-language peer-reviewed journals, assessing associations between select climate drivers and adverse maternal and birth outcomes. The review included studies examining heat, storms, sea level rise, flooding, drought, wildfires, and other climate-related factors. Health outcomes included preterm birth, low birthweight, small for gestational age, gestational diabetes, pre-eclampsia/eclampsia, miscarriage/stillbirth and maternal mortality.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>The scoping review protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202410004, January 3, 2024) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Data were extracted by 2 authors; quality and risk of bias was assessed independently.</div></div><div><h3>Results</h3><div>Total of 966 references were screened; 16.35% (<em>k</em>=158) met inclusion criteria. The majority of studies (146/158; 92.4%) documented statistically significant and clinically meaningful associations between climate drivers and adverse perinatal health outcomes, including risk of preterm birth, low birthweight, and stillbirth as well as preeclampsia, gestational diabetes, miscarriage, and maternal death. Among the most durable findings: extreme heat exposure in early and late pregnancy were associated with increased risk of preterm birth and stillbirth. Driven in part by large (often population-based) studies and objective outcomes from surveillance data or medical record reviews, studies in this scoping review were evaluated as high quality (scoring 7-9 on the Newcastle-Ottawa Scale). Risk of bias was generally low.</div></div><div><h3>Conclusions</h3><div>Climate drivers are consistently associated with adverse health outcomes for pregnant people. Continuing education for clinicians, and clinician-patient communications should be expanded to address risks of climate change and extreme weather exposure, especially risks of extreme heat in late-pregnancy. Results from this review should inform multilevel interventions to address adverse health effects of climate during pregnancy as well as practice advisories, protocols, checklists, and clinical guidelines in obstetrics.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100444"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378043","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}