AJOG global reports最新文献

{"title":"Safety of quadrivalent recombinant influenza vaccine in pregnant persons and their infants","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.2024.100395","DOIUrl":"10.1016/j.xagr.2024.100395","url":null,"abstract":"<div><h3>Background</h3><div>The Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that all pregnant persons receive any licensed, recommended, and age-appropriate inactivated influenza vaccine (SD-IIV) or recombinant influenza vaccine (RIV) to protect against influenza and influenza-related complications. RIV was safe and efficacious in pre- and postlicensure studies, however there is limited RIV safety data in pregnant persons.</div></div><div><h3>Objective</h3><div>To evaluate the safety of quadrivalent recombinant influenza vaccine (RIV4) versus a quadrivalent standard-dose, inactivated influenza (SD-IIV4) in a large cohort of pregnant persons and their infants.</div></div><div><h3>Study Design</h3><div>This postlicensure observational safety study conducted at Kaiser Permanente Northern California evaluated the subset of pregnant persons vaccinated in routine care as part of a larger cluster-randomized vaccine effectiveness study comparing RIV4 vs. SD-IIV4 (ClinicalTrials.gov NCT03694392). We identified pregnancy (spontaneous abortion, preterm labor, stillbirth/fetal death, congenital/fetal anomalies detected during pregnancy, eclampsia/pre-eclampsia, placental abruption), birth (preterm birth, low birth weight, small for gestational age), and neonatal/infant outcomes (infant death, failure to thrive, congenital anomalies detected after delivery) using diagnostic codes among pregnant persons ≥18 years immunized with RIV4 or SD-IIV4 during the 2018/19 and 2019/20 influenza seasons and their infants. We used conditional logistic regression adjusted for age group, race, ethnicity, trimester of influenza vaccination, comorbidities, and BMI, stratified by gestational age to estimate the odds ratio (OR) of pregnancy outcomes following vaccination with RIV4 vs. SD-IIV4. Using logistic regression, we separately estimated the adjusted OR of birth and neonatal/infant outcomes in the first year of life (eg, death) in infants of RIV4 vs. SD-IIV4 vaccinated pregnant persons.</div></div><div><h3>Results</h3><div>The study population included 48,781 pregnant persons (RIV4 = 14,981; SD-IIV4 = 33,800) and 47,394 live births (RIV4 = 14,538; SD-IIV4 = 32,856). There was no statistical difference in any pregnancy outcome or in birth and neonatal/infant outcome between RIV4 vs. SD-IIV4 vaccinated pregnant persons and their infants.</div></div><div><h3>Conclusion</h3><div>Compared with receipt of a SD-IIV4 during pregnancy, this large study did not identify any pregnancy, birth, or neonatal/infant safety concerns following receipt of a RIV4 during pregnancy and demonstrates that the safety of RIV4 in pregnancy was similar to SD-IIV4. This study provides additional evidence regarding the safety of influenza vaccination in pregnant persons and further supports ACIP and ACOG recommendations that all pregnant persons receive an inactivated or recombinant influenza vaccine.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100395"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535437","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":"Artificial intelligence generates proficient Spanish obstetrics and gynecology counseling templates","authors":"Rachel L. Solmonovich MD ,&nbsp;Insaf Kouba MD ,&nbsp;Oscar Quezada MD ,&nbsp;Gianni Rodriguez-Ayala MD ,&nbsp;Veronica Rojas MD ,&nbsp;Kevin Bonilla MD ,&nbsp;Kevin Espino MD ,&nbsp;Luis A. Bracero MD","doi":"10.1016/j.xagr.2024.100400","DOIUrl":"10.1016/j.xagr.2024.100400","url":null,"abstract":"<div><h3>Background</h3><div>Effective patient counseling in Obstetrics and gynecology is vital. Existing language barriers between Spanish-speaking patients and English-speaking providers may negatively impact patient understanding and adherence to medical recommendations, as language discordance between provider and patient has been associated with medication noncompliance, adverse drug events, and underuse of preventative care. Artificial intelligence large language models may be a helpful adjunct to patient care by generating counseling templates in Spanish.</div></div><div><h3>Objectives</h3><div>The primary objective was to determine if large language models can generate proficient counseling templates in Spanish on obstetric and gynecology topics. Secondary objectives were to (1) compare the content, quality, and comprehensiveness of generated templates between different large language models, (2) compare the proficiency ratings among the large language model generated templates, and (3) assess which generated templates had potential for integration into clinical practice.</div></div><div><h3>Study design</h3><div>Cross-sectional study using free open-access large language models to generate counseling templates in Spanish on select obstetrics and gynecology topics. Native Spanish-speaking practicing obstetricians and gynecologists, who were blinded to the source large language model for each template, reviewed and subjectively scored each template on its content, quality, and comprehensiveness and considered it for integration into clinical practice. Proficiency ratings were calculated as a composite score of content, quality, and comprehensiveness. A score of &gt;4 was considered proficient. Basic inferential statistics were performed.</div></div><div><h3>Results</h3><div>All artificial intelligence large language models generated proficient obstetrics and gynecology counseling templates in Spanish, with Google Bard generating the most proficient template (p&lt;0.0001) and outperforming the others in comprehensiveness (<em>P</em>=.03), quality (<em>P</em>=.04), and content (<em>P</em>=.01). Microsoft Bing received the lowest scores in these domains. Physicians were likely to be willing to incorporate the templates into clinical practice, with no significant discrepancy in the likelihood of integration based on the source large language model (<em>P</em>=.45).</div></div><div><h3>Conclusions</h3><div>Large language models have potential to generate proficient obstetrics and gynecology counseling templates in Spanish, which physicians would integrate into their clinical practice. Google Bard scored the highest across all attributes. There is an opportunity to use large language models to try to mitigate the language barriers in health care. Future studies should assess patient satisfaction, understanding, and adherence to clinical plans following receipt of these counseling templates.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100400"},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535960","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":"Use of time-lapse technology on fertilization verification, embryo evaluation, and utilization: A national survey in Japan","authors":"Mitsutoshi Yamada MD, PhD ,&nbsp;Kenji Ezoe PhD ,&nbsp;Satoshi Ueno PhD ,&nbsp;Osamu Yoshino MD, PhD ,&nbsp;Toshifumi Takahashi MD, PhD","doi":"10.1016/j.xagr.2024.100397","DOIUrl":"10.1016/j.xagr.2024.100397","url":null,"abstract":"<div><h3>Background</h3><div>Time-lapse technology (TLT) has emerged as a significant advancement in the field of assisted reproductive technology (ART), providing continuous observation of embryos. However, limited information exists on the adoption of TLT across ART facilities and the clinical implications of its application in embryo evaluation and fertilization verification. The existing literature has not yet comprehensively examined how TLT data are utilized to optimize ART outcomes, particularly in Japan, where ART practices are highly prevalent.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate the adoption rate of TLT and its clinical effects on fertilization verification, embryo evaluation, and utilization of ART in Japan.</div></div><div><h3>Study Design</h3><div>An online survey was conducted from December 23, 2022, to January 16, 2023, in 616 ART facilities <em>with both email and mailed notices</em>. The survey investigated the utilization of TLT in each facility's evaluation of oocyte morphology, fertilization, embryo culture, and morphology.</div></div><div><h3>Results</h3><div>Overall, 345 responses were analyzed. Of these, only 42.6% confirmed fertilization at 16 to 18 hours after insemination. Most facilities defined normally fertilized eggs as 2 pronuclei (2PN; 53.3%) or a combination of a second polar body extrusion and 2PN (44.9%). Overall, 54.6% of the facilities had adopted TLT, and 76.9% to 96.9% of these facilities used TLT images for fertilization verification. At these centers, the use of 0PN embryos decreased, whereas the use of 2.1PN embryos increased. The rates of culture medium supplemented with antioxidants and hyaluronan were significantly higher in facilities with TLT than in those without TLT. TLT images were used for embryo evaluation in 94.3% of the facilities, while 31.0% used a combination of TLT images and artificial intelligence-based scoring systems.</div></div><div><h3>Conclusions</h3><div>While TLT use is widespread in Japan, its application in evaluating fertilization and embryo development stages varies across facilities. Reaching a consensus on the optimal use of the TLT system will enhance the effectiveness, safety, and efficiency of ARTs.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100397"},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441802","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":"Acute Sheehan syndrome following massive postpartum hemorrhage due to vulvar hematoma","authors":"Wataru Saito MD ,&nbsp;Kuniaki Ota MD, PhD ,&nbsp;Toshifumi Takahashi MD, PhD ,&nbsp;Mika Sugihara MD, PhD ,&nbsp;Takehiko Matsuyama MD, PhD ,&nbsp;Yoshiaki Ota MD, PhD ,&nbsp;Koichiro Shimoya MD, PhD","doi":"10.1016/j.xagr.2024.100399","DOIUrl":"10.1016/j.xagr.2024.100399","url":null,"abstract":"<div><div>Acute Sheehan syndrome appearing within 6 weeks postpartum is a rare form of hypopituitarism caused by postpartum hemorrhage. A 37-year-old Japanese woman experienced a vulvar hematoma after spontaneous labor at 40 weeks gestation, leading to massive postpartum hemorrhage (estimated total blood loss of 3,000 mL). Despite successful cesarean delivery and hematoma drainage, she presented 28 days postpartum with anorexia, fatigue, and hyponatremia after initial recovery. MRI revealed a swollen pituitary gland with subacute hemorrhage, confirming the diagnosis. Hormonal replacement therapy with levothyroxine, hydrocortisone, estrogen, and progesterone was initiated. This is the first reported case of acute Sheehan syndrome following a vulvar hematoma, a condition typically not considered a risk factor for this syndrome. The case highlights the importance of considering rare complications like acute Sheehan syndrome in patients with massive postpartum hemorrhage, even when the pathogenesis is clinically common, such as vulvar hematomas.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100399"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424589","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":"Thoughts and opinions about fertility preservation and family building from the transgender community—an interview-based approach","authors":"Zachary W. Walker MD ,&nbsp;Katelin McDilda MD ,&nbsp;Andrea Lanes PhD ,&nbsp;Randi Goldman MD, MBA ,&nbsp;Elizabeth S. Ginsburg MD ,&nbsp;Iris Insogna MD","doi":"10.1016/j.xagr.2024.100398","DOIUrl":"10.1016/j.xagr.2024.100398","url":null,"abstract":"<div><h3>Background</h3><div>When considering the significant prevalence of transgender and gender nonconforming individuals, it is imperative that physicians work to understand the unique needs of this population including paths to family building and fertility preservation.</div></div><div><h3>Objective</h3><div>To understand the thoughts and opinions about fertility preservation and family building within the transgender community.</div></div><div><h3>Study design</h3><div>Survey-based study and qualitative study at a single, large hospital-affiliated fertility center. A 16-question survey followed by a 30-minute virtual interview was utilized. Forty-three participants completed the survey and were used for quantitative analysis, and 40 audio files were used for qualitative analysis.</div></div><div><h3>Results</h3><div>The average age of participants was 27.0±7.3 years old. The majority of participants were assigned female at birth (70.7%); however, most participants’ gender identities were transgender (54.8%) or nonbinary (47.6%). The average age at which participants realized they were transgender and disclosed their identity to a friend, or partner, was 16.2±7.0 (range 3–30) and 20.1±5.6 (range 11–33), respectively. The average age that participants disclosed their gender identity to their parents, siblings, or other family was 22.4±5.9 (range 12–35). Five categories were utilized to summarize the experiences and opinions of the participants: family building and parenthood goals, influences of family background/partner on parenthood goals, awareness and knowledge about fertility preservation, barrier to family building, and recommended healthcare provider communication and education. Sixteen participants (40.0%, <em>n</em>/<em>N</em>=16/40) were interested in having children in the future, 18 (45.0%, <em>n</em>/<em>N</em>=18/40) were unsure/dependent on their partner, and 6 (15.0%, <em>n</em>/<em>N</em>=6/40) were not interested in having children. Of those interested in having children (<em>n</em>/<em>N</em>=16/40), the majority wished to utilize adoption to build their family (68.8%, <em>n</em>/<em>N</em>=11/16). Nine participants (22.5%, <em>n</em>/<em>N</em>=9/40) reported that fertility preservation was never discussed. Most participants agreed that gender dysphoria, cost, inadequate counseling, and improvements in healthcare knowledge about transgender individuals were key influences on their opinions about pursuing fertility preservation or parenthood.</div></div><div><h3>Conclusion</h3><div>Transgender individuals want to build families, and the majority consider adoption the preferred method. There are still transgender individuals who are not counseled about fertility preservation. It is imperative the healthcare system continues to improve the education of healthcare providers about management and care of transgender individuals to provide the best care for this vulnerable population.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100398"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424591","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":"The role of the RHOA/ROCK pathway in the regulation of myometrial stages throughout pregnancy","authors":"Jorge A. Carvajal MD, PhD,&nbsp;Jose Galaz MD,&nbsp;Sofía Villagrán MD,&nbsp;Rocío Astudillo MD,&nbsp;Liliana Garmendia MSc,&nbsp;Ana María Delpiano MSc","doi":"10.1016/j.xagr.2024.100394","DOIUrl":"10.1016/j.xagr.2024.100394","url":null,"abstract":"<div><h3>Background</h3><div>Controlling uterine contractile activity is essential to regulate the duration of pregnancy. During most of the pregnancy, the uterus does not contract (i.e., myometrial quiescence). The myometrium recovers its contractile phenotype at around 36 weeks (i.e., myometrial activation) through several mechanisms. The RHOA/ROCK pathway plays a vital role in facilitating muscular contractions by calcium sensitization in humans. Yet, the role of this pathway during different myometrial stages, including quiescence, has not been elucidated.</div></div><div><h3>Objective</h3><div>we aimed to study the role of the RHOA/ROCK pathway in the regulation of the different myometrial stages throughout pregnancy. Specifically, we hypothesized that the inhibition of the components of the RHOA/ROCK pathway play an important role in maintaining uterine quiescence.</div></div><div><h3>Study design</h3><div>Myometrial samples were obtained from pregnant individuals who underwent cesarean section. Pregnant individuals who delivered preterm without labor (myometrial quiescence), preterm with labor (nonphysiological myometrial stimulation), term not in labor (activation), and term in labor (physiological myometrial stimulation) were included. The mRNA and protein expression of RHOA, ROCK I, ROCK II, RND1-3, and ROCK activity through pMYTP1 were evaluated.</div></div><div><h3>Results</h3><div>We found that the human myometrium constitutively expressed RHOA/ROCK pathway components throughout pregnancy. No changes in the components of the RHOA/ROCK pathway were found during quiescence. Moreover, the RHOA protein and ROCK activity increased in the myometrium during labor, supporting the hypothesis that this pathway participates in maintaining the contractile activity of the myometrium. This study provides insight into the role of the RHOA/ROCK pathway in controlling myometrial contractile activity during pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100394"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424590","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":"Guillain-Barré syndrome in pregnancy: a case report and review of the literature","authors":"Corina Iliadi-Tulbure PhD ,&nbsp;Maria Cemortan PhD ,&nbsp;Svetlana Jubirca PhD ,&nbsp;Viorica Cospormac PhD ,&nbsp;Cristina Bubulici ,&nbsp;Maria-Magdalena Vicol","doi":"10.1016/j.xagr.2024.100396","DOIUrl":"10.1016/j.xagr.2024.100396","url":null,"abstract":"<div><div>Guillain-Barré syndrome represents a heterogeneous group of immune-mediated peripheral neuropathies that are characterized by various clinical manifestations. Reporting this clinical case emphasizes the rarity of Guillain-Barré syndrome, the diagnostic challenges faced by healthcare providers, and the risk of delayed diagnosis for both the mother and fetus. A 34-year-old pregnant woman at 33 weeks of gestation presented to the inpatient ward complaining of paresthesia in the lower and upper limbs, muscle pain, balance disturbances, moderate headache, nausea and vertigo, general weakness, and pronounced fatigue. The patient had experienced an acute viral respiratory infection 4 weeks before presenting to the hospital. The patient was admitted to the intensive care unit with a preliminary diagnosis of acute viral respiratory infection and nasopharyngitis. The patient's condition worsened dynamically, manifesting bulbar syndrome (swallowing problems), paresthesia of the anterior abdominal wall, reduced perception of fetal movements, numbness of the tongue, and low fever (37.2°C). A diagnosis of acute inflammatory demyelinating polyradiculopathy (Guillain-Barré syndrome) was established. Despite treatment, the neurologic symptoms worsened. The paravertebral radicular type pains were difficult to manage with administered analgesic therapy, and there was a progression of the bulbar syndrome. Treatment with intravenous immunoglobulin was initiated. Consequently, it was recommended by the multidisciplinary council to perform an emergency cesarean delivery, in the interest of the mother and fetus. Guillain-Barré syndrome is a rare condition that occurs during pregnancy and requires thorough evaluation, prompt multidisciplinary assessment, and individualized management of delivery to improve maternal and fetal prognosis.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100396"},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424592","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":"Experiences of Midwestern obstetric clinicians during the Coronavirus disease 2019 pandemic","authors":"Drishti D. Sinha MD, MPHS ,&nbsp;Megan Foeller MD ,&nbsp;Abigail S. Bell BA ,&nbsp;Anthony J. Nixon Jr. MPH ,&nbsp;Darrell Hudson PhD, MPH ,&nbsp;Aimee S. James PhD, MPH ,&nbsp;Amy R. Scheffer ,&nbsp;Ana A. Baumann PhD ,&nbsp;Emily Diveley RN ,&nbsp;Ebony B. Carter MD, MPH ,&nbsp;Nandini Raghuraman MD, MSCI ,&nbsp;Indira U. Mysorekar PhD ,&nbsp;Jeannie C. Kelly MD, MS","doi":"10.1016/j.xagr.2024.100392","DOIUrl":"10.1016/j.xagr.2024.100392","url":null,"abstract":"<div><h3>Background</h3><div>The Coronavirus disease 2019 (COVID-19) pandemic led to healthcare system changes aimed at minimizing disease transmission that impacted experiences with obstetric healthcare.</div></div><div><h3>Objective</h3><div>To explore experiences of clinicians providing obstetric care during the COVID-19 pandemic.</div></div><div><h3>Study Design</h3><div>Qualitative, in-depth, semi-structured interviews were conducted with five nurse practitioners and 16 obstetrical physicians providing a mix of outpatient and inpatient obstetric care during the COVID-19 pandemic in a mid-sized, Midwestern city in the United States. Interviews elucidated challenges and facilitators of obstetric care provision and vaccination of pregnant patients against COVID-19 during the pandemic. Transcripts were coded inductively then deductively using the Health Equity Implementation Framework (HEIF), which integrates a disparities framework and implementation framework to highlight multilevel factors that influence obstetric care. Thematic analysis was conducted, and thematic saturation was reached.</div></div><div><h3>Results</h3><div>We interviewed 21 clinicians. Clinicians recounted personal challenges such as social isolation and burnout that could be countered by social support. Challenges within the clinical encounter included implementation of infection mitigation efforts, vaccine counseling, and limitations of telehealth. However, when successfully implemented, telehealth facilitated care and circumvented barriers. Clinicians cited challenges at the healthcare system level such as rapidly evolving knowledge and recommendations, restrictive visitor policies, personnel shortage, and inadequate institutional resources to support pandemic-related stressors. However, interdisciplinary care and guidelines available for clinicians facilitated care. Clinicians reported that challenges at the societal level included financial strain, lack of childcare, medical mistrust, politicization of medicine, misinformation, and racism. Societal-level facilitators included insurance access, community outreach, positive policy changes, and fostering trust in medicine.</div></div><div><h3>Conclusion</h3><div>The pandemic produced unique stressors and exacerbated existing challenges for clinicians providing obstetric care. Applying the HEIF to the findings emphasizes the influence of societal factors on all other levels. Identified facilitators can inform interventions to address stressors in obstetric care that have resulted from the changed sociopolitical landscape of the pandemic.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100392"},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441801","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":"Using machine learning to predict the risk of developing hypertensive disorders of pregnancy using a contemporary nulliparous cohort","authors":"Jonathan S. Schor PhD ,&nbsp;Adesh Kadambi BEng ,&nbsp;Isabel Fulcher PhD ,&nbsp;Kartik K. Venkatesh MD, PhD ,&nbsp;Mark A. Clapp MD, MPH ,&nbsp;Senan Ebrahim MD, PhD ,&nbsp;Ali Ebrahim PhD ,&nbsp;Timothy Wen MD, MPH","doi":"10.1016/j.xagr.2024.100386","DOIUrl":"10.1016/j.xagr.2024.100386","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive disorders of pregnancy (HDP) are significant drivers of maternal and neonatal morbidity and mortality. Current management strategies include early identification and initiation of risk mitigating interventions facilitated by a rules-based checklist. Advanced analytic techniques, such as machine learning, can potentially offer improved and refined predictive capabilities.</div></div><div><h3>Objective</h3><div>To develop and internally validate a machine learning prediction model for hypertensive disorders of pregnancy (HDP) when initiating prenatal care.</div></div><div><h3>Study Design</h3><div>We developed a prediction model using data from the prospective multisite cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) among low-risk individuals without a prior history of aspirin utilization for preeclampsia prevention. The primary outcome was the development of HDP. Random forest modeling was utilized to develop predictive models. Recursive feature elimination (RFE) was employed to create a reduced model for each outcome. Area under the curve (AUC), 95% confidence intervals (CI), and calibration curves were utilized to assess discrimination and accuracy. Sensitivity analyses were conducted to compare the sensitivity and specificity of the reduced model compared to existing risk factor-based algorithms.</div></div><div><h3>Results</h3><div>Of 9,124 assessed low risk nulliparous individuals, 21% (n=1,927) developed HDP. The prediction model for HDP had satisfactory discrimination with an AUC of 0.73 (95% CI: 0.70, 0.75). After RFE, a parsimonious reduced model with 30 features was created with an AUC of 0.71 (95% CI: 0.68, 0.74). Variables included in the model after RFE included body mass index at the first study visit, pre-pregnancy weight, first trimester complete blood count results, and maximum systolic blood pressure at the first visit. Calibration curves for all models revealed relatively stable agreement between predicted and observed probabilities. Sensitivity analysis noted superior sensitivity (AUC 0.80 vs 0.65) and specificity (0.65 vs 0.53) of the model compared to traditional risk factor-based algorithms.</div></div><div><h3>Conclusion</h3><div>In cohort of low-risk nulliparous pregnant individuals, a prediction model may accurately predict HDP diagnosis at the time of initiating prenatal care and aid employment of close interval monitoring and prophylactic measures earlier in pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100386"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000807/pdfft?md5=1d72d5b9a6a289e9fc9dc49b95536460&pid=1-s2.0-S2666577824000807-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314470","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":"Preferences for induction of labor methods in India: a qualitative study of views and experiences of women, clinicians, and researchers","authors":"Lydia A. Hawker MBChB ,&nbsp;Shuchita Mundle MD ,&nbsp;Jaya P. Tripathy MD ,&nbsp;Pradeep Deshmukh MD ,&nbsp;Beverly Winikoff MD ,&nbsp;Andrew D. Weeks MD ,&nbsp;Carol Kingdon PhD ,&nbsp;Kate Lightly PhD","doi":"10.1016/j.xagr.2024.100389","DOIUrl":"10.1016/j.xagr.2024.100389","url":null,"abstract":"<div><h3>Background</h3><p>Induction of labor (IOL) is an increasingly common intervention, but experiences and preferences of induction methods are under-researched particularly in low -and middle-income countries. Understanding these perspectives is important to improve the childbirth experience.</p></div><div><h3>Objective</h3><p>To explore the experiences and preferences of IOL methods for women, clinicians, and researchers in the “Misoprostol or Oxytocin for Labour Induction” (MOLI) study.</p></div><div><h3>Study Design</h3><p>This qualitative study was based in two government hospitals in the city of Nagpur, India—one tertiary referral hospital and one women's hospital. Fifty-three semi-structured interviews with women before and after induction (between days 1 and 5 postnatal), with women recruited to the “Misoprostol or Oxytocin for Labour Induction (MOLI)” randomized controlled trial (NCT03749902). Eight focus group discussions with doctors, nurses, and trial research assistants before and during trial delivery were conducted. Thematic analysis was conducted using the Framework approach.</p></div><div><h3>Results</h3><p>Four themes emerged: (1) <em>IOL methods,</em> (2) <em>impact of the study,</em> (3) <em>IOL and childbirth as one small part of the wider experiences in life</em>, and (4) <em>key moments in the childbirth experience.</em> For women, the safety of their baby was more important than any IOL method. Clinicians had apprehensions over misoprostol use which could affect protocol implementation; they reported that changing perception is difficult as usual practice feels “comfortable.” Women wanted to share their experiences and reported key moments during childbirth including vaginal examinations, “trying for normal,” bearing the pain, waiting, and relationships with staff.</p></div><div><h3>Conclusion</h3><p>Women did not have a strong preference for the IOL method and viewed childbirth positively when maternal and neonatal outcomes were good. Labor pain, vaginal examinations, a normal birth, and interactions with staff impacted women's experiences.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100389"},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000832/pdfft?md5=e76f967d42d729e7b9d67da589f19285&pid=1-s2.0-S2666577824000832-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164565","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}