AJOG global reports最新文献

{"title":"Maternal serum soluble fms-like tyrosine kinase-1–to–placental growth factor ratio distinguishes growth-restricted from non–growth-restricted small-for-gestational-age fetuses","authors":"Prithi Rajiv MD ,&nbsp;Thomas Cade MD ,&nbsp;Jennifer Dean MD ,&nbsp;Gabriel Davis Jones MD ,&nbsp;Shaun P. Brennecke MD, PhD","doi":"10.1016/j.xagr.2023.100302","DOIUrl":"10.1016/j.xagr.2023.100302","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Fetal growth restriction secondary to chronic placental insufficiency is a major cause of perinatal morbidity and mortality. A significant proportion of fetuses with fetal growth restriction are small for gestational age, defined as a birthweight of ≤10th percentile. However, not all small-for-gestational-age fetuses are growth restricted. Some are constitutionally small and otherwise healthy. It is important to distinguish between small-for-gestational-age fetuses with and without fetal growth restriction to ensure appropriate interventions in small-for-gestational-age fetuses with fetal growth restriction and to minimize unnecessary interventions in healthy small-for-gestational-age fetuses. The maternal serum ratio of soluble fms-like tyrosine kinase-1 and placental growth factor is an indicator of placental insufficiency in the latter half of pregnancy. As such, the soluble fms-like tyrosine kinase-1–to–placental growth factor ratio may be a clinically useful tool to distinguish between small-for-gestational-age fetuses with and without fetal growth restriction.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to determine whether the soluble fms-like tyrosine kinase-1–to–placental growth factor ratio can distinguish between small-for-gestational-age fetuses with and without fetal growth restriction with a birthweight of ≤10th percentile.</p></div><div><h3>STUDY DESIGN</h3><p>A retrospective audit of 233 singleton pregnancies delivering an infant with a birthweight of ≤10th percentile corrected for gestational age with an antenatal maternal serum soluble fms-like tyrosine kinase-1–to–placental growth factor result was performed. Fetal growth restriction was defined as a birthweight of ≤10th percentile with an umbilical artery pulsatility index of &gt;95th percentile, fetal middle cerebral artery pulsatility index of &lt;5th percentile, amniotic fluid index of &lt;6 cm, and/or cerebroplacental ratio of &lt;1st percentile. The soluble fms-like tyrosine kinase-1–to–placental growth factor ratios before delivery between fetuses with and without fetal growth restriction (121 [fetal growth restriction] vs 112 [no fetal growth restriction]) were compared. The Student <em>t</em> test and Fisher exact test were used to compare cases and controls. The Mann-Whitney <em>U</em> test, linear regression analysis, and Spearman correlation coefficient (Rho) were used to examine associations between the soluble fms-like tyrosine kinase-1–to–placental growth factor ratio and fetal outcomes to determine whether the soluble fms-like tyrosine kinase-1–to–placental growth factor ratio served as a prognostic marker of fetal growth restriction severity.</p></div><div><h3>RESULTS</h3><p>The mean soluble fms-like tyrosine kinase-1–to–placental growth factor ratio was increased in fetal growth restriction cases compared with non–fetal growth restriction controls (234.3±25.0 vs 67.4±7.7, respectively; <em>P</em>&lt;.0001). When controlling f","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001442/pdfft?md5=a02ac264edfa56f7b3e38b3f0cd13f07&pid=1-s2.0-S2666577823001442-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457307","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 probiotics and synbiotics on treatment of gestational diabetes: systematic review and meta-analysis","authors":"Arresta Vitasatria Suastika MD ,&nbsp;I Gde Raka Widiana PhD, MD ,&nbsp;Ni Nengah Dwi Fatmawati PhD, MD ,&nbsp;Ketut Suastika PhD, MD ,&nbsp;Ivana Beatrice Paulus MD ,&nbsp;I Nengah Sujaya PhD, M AgrSc, B.Eng","doi":"10.1016/j.xagr.2023.100285","DOIUrl":"10.1016/j.xagr.2023.100285","url":null,"abstract":"<div><h3>OBJECTIVE</h3><p>This review investigated the efficacy of probiotics and/or synbiotics in gestational diabetes mellitus treatment by targeting insulin resistance, lipid metabolism, and anti-inflammatory effects in an updated trial.</p></div><div><h3>DATA SOURCES</h3><p>The literature review was performed using the key words “Probiotics,” “Synbiotics,” and “Gestational Diabetes” in several databases, including PubMed, ScienceDirect, and the Cochrane Central Register of Controlled Trials.</p></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><p>Eligible publication was screened independently by 2 reviewers. Studies included provided at least 1 of the following outcomes: (1) blood glucose marker, including fasting blood glucose level, fasting serum insulin level, and homeostasis model assessment insulin resistance; (2) blood lipid profiles, including triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol; and (3) nitric oxide and C-reactive protein.</p></div><div><h3>METHODS</h3><p>All studies were reviewed using the critical appraisal Cochrane risk-of-bias tool for randomized trials. The descriptions of the extracted data were guided by the Preferred Reporting Items for Systematic Reviews 2020 statement with the Grading of Recommendations Assessment, Development, and Evaluation approach. This study was registered on the International Prospective Register of Systematic Reviews database (identification number: CRD42022375665).</p></div><div><h3>RESULTS</h3><p>From 13 randomized controlled trials involving 896 patients, individuals with probiotic had significant reduction on homeostasis model assessment insulin resistance (mean difference, −0.72; 95% confidence interval, −1.07 to −0.38; <em>I²</em>, 96%; <em>P</em>=.00), fasting blood glucose level (mean difference, −3.79; 95% confidence interval, −6.24 to −1.34; <em>I²</em>, 93%; <em>P</em>=.00), and insulin level (mean difference, −2.43 mg/dL; 95% confidence interval, −3.37 to −1.48; <em>I²</em>, 54%; <em>P</em>=.00). Meanwhile for profile lipid, significant reduction of the mean difference was observed in the triglyceride (mean difference, −17.73 mg/dL; 95% confidence interval, −29.55 to − 5.9; <em>P</em>=.003) and C-reactive protein (mean difference, −1.93 dL; 95% confidence interval, −2.3 to −1.56; <em>P</em>=.00).</p></div><div><h3>CONCLUSION</h3><p>Probiotic and synbiotic supplementations reduced the risk of insulin resistance and improved glycemic control, blood lipid profiles, and inflammation in women with gestational diabetes mellitus. Probiotics may be a viable option for gestational diabetes mellitus treatment; however, large-scale, well-designed randomized controlled trials with longer follow-up periods are required before they can be recommended to patients.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001272/pdfft?md5=91f43a5548f993ce18222e5e41e2e6a2&pid=1-s2.0-S2666577823001272-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136160624","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":"Maternal satisfaction with group care: a systematic review","authors":"Fitim Sadiku BS ,&nbsp;Hana Bucinca PharmD ,&nbsp;Florence Talrich PhD ,&nbsp;Vlorian Molliqaj MS ,&nbsp;Erza Selmani MS ,&nbsp;Christine McCourt PhD ,&nbsp;Marlies Rijnders PhD ,&nbsp;George Little MD ,&nbsp;David C. Goodman MD, MS ,&nbsp;Sharon Schindler Rising CNM, MSN ,&nbsp;Ilir Hoxha MD, PhD","doi":"10.1016/j.xagr.2023.100301","DOIUrl":"10.1016/j.xagr.2023.100301","url":null,"abstract":"<div><h3>OBJECTIVE</h3><p>This review examined the quantitative relationship between group care and overall maternal satisfaction compared with standard individual care.</p></div><div><h3>DATA SOURCES</h3><p>We searched CINAHL, Clinical Trials, The Cochrane Library, PubMed, Scopus, and Web of Science databases from the beginning of 2003 through June 2023.</p></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><p>We included studies that reported the association between overall maternal satisfaction and centering-based perinatal care where the control group was standard individual care. We included randomized and observational designs.</p></div><div><h3>METHODS</h3><p>Screening and independent data extraction were carried out by 4 researchers. We extracted data on study characteristics, population, design, intervention characteristics, satisfaction measurement, and outcome. Quality assessment was performed using the Cochrane tools for Clinical Trials (RoB2) and observational studies (ROBINS-I). We summarized the study, intervention, and satisfaction measurement characteristics. We presented the effect estimates of each study descriptively using a forest plot without performing an overall meta-analysis. Meta-analysis could not be performed because of variations in study designs and methods used to measure satisfaction. We presented studies reporting mean values and odds ratios in 2 separate plots. The presentation of studies in forest plots was organized by type of study design.</p></div><div><h3>RESULTS</h3><p>A total of 7685 women participated in the studies included in the review. We found that most studies (ie, 17/20) report higher satisfaction with group care than standard individual care. Some of the noted results are lower satisfaction with group care in both studies in Sweden and 1 of the 2 studies from Canada. Higher satisfaction was present in 14 of 15 studies reporting CenteringPregnancy, Group Antenatal Care (1 study), and Adapted CenteringPregnancy (1 study). Although indicative of higher maternal satisfaction, the results are often based on statistically insignificant effect estimates with wide confidence intervals derived from small sample sizes.</p></div><div><h3>CONCLUSION</h3><p>The evidence confirms higher maternal satisfaction with group care than with standard care. This likely reflects group care methodology, which combines clinical assessment, facilitated health promotion discussion, and community-building opportunities. This evidence will be helpful for the implementation of group care globally.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001430/pdfft?md5=3f2fb0a80315614f9f68ea666d355b74&pid=1-s2.0-S2666577823001430-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139195809","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 use of bubble charts in analyzing the global second-stage cesarean delivery rates: a systematic review","authors":"Lin Tai Linus Lee MRCOG ,&nbsp;Christopher Pak Hey Chiu MRCOG ,&nbsp;Man Kee Teresa Ma MRCOG ,&nbsp;Lee Ting Kwong MRCOG ,&nbsp;Man Wai Catherine Hung MRCOG ,&nbsp;Yuen Yee Yannie Chan MRCOG ,&nbsp;Eunice Joanna Wong MBBS ,&nbsp;Theodora Hei Tung Lai MRCOG ,&nbsp;Oi Ka Chan MSc ,&nbsp;Po Lam So MMedSc ,&nbsp;Wai Lam Lau FRCOG ,&nbsp;Tak Yeung Leung MD ,&nbsp;Hong Kong College of Obstetricians and Gynaecologists Research Group","doi":"10.1016/j.xagr.2024.100312","DOIUrl":"10.1016/j.xagr.2024.100312","url":null,"abstract":"<div><h3>OBJECTIVE</h3><p>This study aimed to systematically review the worldwide second-stage cesarean delivery rate concerning pre–second-stage cesarean delivery and assisted vaginal birth rates.</p></div><div><h3>DATA SOURCES</h3><p>PubMed, Medline Ovid, EBSCOhost, Embase, Scopus, and Google Scholar were queried from inception to February 2023, with the following terms: “full dilatation,” “second stage,” and “cesarean,” with their word variations. Furthermore, an additional cohort of 353,434 cases from our recently published study was included.</p></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><p>Only original studies that provided sufficient information on the number of pre–second-stage cesarean deliveries, second-stage cesarean deliveries, and vaginal births were included for the calculation of different modes of delivery. Systemic reviews, meta-analyses, or case reports were excluded.</p></div><div><h3>METHODS</h3><p>Study identification and data extraction were independently performed by 2 authors. Selected studies were categorized on the basis of parity, study period, and geographic regions for comparison.</p></div><div><h3>RESULTS</h3><p>A total of 25 studies were included. The overall pre–second-stage cesarean delivery rate, the second-stage cesarean delivery rate, and the second-stage cesarean delivery–to–assisted vaginal birth ratio were 17.94%, 2.65%, and 0.19, respectively. Only 5 studies described singleton, term, cephalic presenting pregnancies of nulliparous women, and their second-stage cesarean delivery rates were significantly higher than those studies with cohorts of all parity groups (4.50% vs 0.83%; <em>P</em>&lt;.05). In addition, the second-stage cesarean delivery rate showed a secular increase across 2009 (0.70% vs 1.05%; <em>P</em>&lt;.05). Moreover, it was the highest among African studies (5.14%) but the lowest among studies from East Asia and South Asia (0.94%). The distributions of second-stage cesarean delivery rates of individual studies and subgroups were shown with that of pre–second-stage cesarean delivery and assisted vaginal birth using the bubble chart.</p></div><div><h3>CONCLUSION</h3><p>The overall worldwide pre–second-stage cesarean delivery rate was 17.94%, the second-stage cesarean delivery rate was 2.65%, and the second-stage cesarean delivery–to–assisted vaginal birth ratio was 0.19. The African studies had the highest second-stage cesarean delivery rate (5.14%) and second-stage cesarean delivery–to–assisted vaginal birth ratio (1.88), whereas the studies from East Asia and South Asia were opposite (0.94% and 0.11, respectively).</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000066/pdfft?md5=06548b59767e86ce9a61871ae0394310&pid=1-s2.0-S2666577824000066-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139637388","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":"Preeclampsia prevention: a survey study on knowledge and practice among prenatal care providers in Ethiopia","authors":"Delayehu Bekele MD, MPH,&nbsp;Wondimu Gudu MD, MPH,&nbsp;Lemi Belay Tolu MD, MPH,&nbsp;Malede Birara MD, MPH,&nbsp;Abraham Fessehaye Sium MD","doi":"10.1016/j.xagr.2023.100300","DOIUrl":"10.1016/j.xagr.2023.100300","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Knowledge and practice gaps among providers have been cited as factors behind the underuse of aspirin for preeclampsia prevention globally.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to determine the knowledge and practice levels of prenatal care providers at a national tertiary referral hospital in Ethiopia and its catchment health institutions.</p></div><div><h3>STUDY DESIGN</h3><p>This was a cross-sectional survey on the knowledge and practice of preeclampsia prevention through aspirin prophylaxis among prenatal care providers at St. Paul's Hospital Millennium Medical College (Ethiopia) and its catchment health institutions. Data were collected prospectively using a structured questionnaire on ODK (Get ODK Inc, San Diego, CA). The primary objective of our study was to determine the knowledge and practice levels among prenatal care providers. Data were analyzed using SPSS software (version 23; IBM, Chicago, IL). Simple descriptive analyses were performed to analyze the data. Proportions and percentages were used to present the results.</p></div><div><h3>RESULTS</h3><p>A total of 92 prenatal care providers working at 17 health institutions were approached, and 80 of them agreed to participate in the study, constituting a response rate of 87%. The mean scores of knowledge and practice of preeclampsia prevention using aspirin were 42.90 (±0.13) and 45.8 (±0.07), respectively. Most of the providers had poor knowledge (score of &lt;50%) and poor practice (score of &lt;50%). Among the 80 prenatal care providers, only 19 (23.8%) had good knowledge, and only 29 (36.3%) had good practice. More than half of the respondents (49/80 [61.3%]) mentioned “lack of national guidelines for use of aspirin in pregnancy” as the main factor that affected their practice of aspirin prophylaxis for preeclampsia prevention in pregnant women. Among the resources used as a reference for the practice of aspirin prophylaxis for preeclampsia prevention, International Federation of Gynecology and Obstetrics or World Health Organization guidelines (45/80 [56.3%]) were the most frequently used resources, followed by American College of Obstetricians and Gynecologists guidelines (36/80 [45.0%]) and clinical judgment (36/80 [45.0%]).</p></div><div><h3>CONCLUSION</h3><p>Our results support previous reports of significant knowledge-to-practice gaps in the use of aspirin prophylaxis for preeclampsia prevention among prenatal care providers. Moreover, the results underscore the need for immediate action in narrowing this gap among providers by availing practical national guidelines for preeclampsia prevention and in-service trainings.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001429/pdfft?md5=d7577baa3ee2bd5d627434f4b1f2ae36&pid=1-s2.0-S2666577823001429-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139188994","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":"Clandestine abortion resulting in uterine perforation and a retained foreign body led to generalized peritonitis: a case report from Lilongwe, Malawi","authors":"Jennifer Draganchuk MD ,&nbsp;Stellah Ashley Lungu MBBS ,&nbsp;Tulsi Patel MD ,&nbsp;Mtisunge Chang'ombe MBBS, MMED","doi":"10.1016/j.xagr.2024.100328","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100328","url":null,"abstract":"<div><p>Abortion is criminalized in Malawi in the absence of a life-threatening condition. Consequently, women often undergo unsafe abortions. A large proportion of abortions performed in Malawi require subsequent treatment at a healthcare facility. We describe the case of a 17-year-old who presented with generalized peritonitis and was found intraoperatively to have a necrotic and perforated uterus with a stick retained in her abdominopelvic cavity from a clandestine abortion. This case demonstrates the need for awareness and vigilance among healthcare providers in all specialties to suspect surgical abortion complications as a cause of generalized peritonitis and points to the need for further studies on the optimal management of such patients.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000224/pdfft?md5=1aa225d9999eca68cf3af112378ffc3e&pid=1-s2.0-S2666577824000224-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140041738","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":"Tranexamic acid to reduce blood loss in women at high risk of postpartum hemorrhage undergoing cesarean delivery—a randomized controlled trial","authors":"Bethany G. Neumann MD ,&nbsp;Mrityunjay C. Metgud MD ,&nbsp;Matthew K. Hoffman MD, MPH ,&nbsp;Kamal Patil MD ,&nbsp;Mahadevi Savanur MD ,&nbsp;Vinutha Hanji MD ,&nbsp;Madiwalayya S. Ganachari MD ,&nbsp;Manjunath Somannavar MD ,&nbsp;Shivaprasad S. Goudar MD, MPH","doi":"10.1016/j.xagr.2024.100316","DOIUrl":"10.1016/j.xagr.2024.100316","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Postpartum hemorrhage is a leading cause of maternal morbidity and mortality. Tranexamic acid has proven to be useful in treating hemorrhage from acute blood loss. However, its role in preventing blood loss in women at high risk of postpartum hemorrhage undergoing cesarean delivery is not well studied.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess the role of tranexamic acid in reducing blood loss during elective and unscheduled cesarean deliveries in women at high risk of postpartum hemorrhage.</p></div><div><h3>STUDY DESIGN</h3><p>This was a prospective, placebo-controlled, randomized controlled trial from March 2021 to February 2022 at the Karnatak Lingayat Education Society Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, India. Women at a high risk of postpartum hemorrhage undergoing cesarean delivery were recruited and randomized to receive either tranexamic acid or placebo (1:1) at least 10 minutes before skin incision. High-risk factors for postpartum hemorrhage included obesity, hypertension, multiparity, previous cesarean delivery, multiple pregnancy, abnormally implanted placenta, placenta previa, abruption, uterine leiomyomas, polyhydramnios, and fetal macrosomia. The primary outcome was blood loss, calculated by a formula using pre- and postoperative hematocrit levels. In addition, gravimetrically measured blood loss was measured and compared between the 2 groups.</p></div><div><h3>RESULTS</h3><p>A total of 212 women met the inclusion criteria and were randomized (tranexamic acid [n=106] and placebo [n=106]). The mean blood loss estimates were 400.9 mL in the tranexamic acid group and 597.9 mL in the placebo group (<em>P</em>&lt;.001). The mean gravimetrically measured blood loss estimates were 379.2 mL in the tranexamic acid group and 431.1 mL in the placebo group (<em>P</em>&lt;.001). In addition, there was a significant difference in the fall in hemoglobin levels (1.04 vs 1.61 g/dL) and change in hematocrit levels (3.20% vs 4.95%) from the pre- to postoperative period between the 2 groups (<em>P</em>&lt;.001). No difference in the need for additional uterotonics (<em>P</em>=.26) or the need for postoperative parental iron (<em>P</em>=.18) was noted. No woman was transfused in either group.</p></div><div><h3>CONCLUSION</h3><p>High-risk women receiving tranexamic acid had significantly less blood loss than women receiving placebo during cesarean delivery.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000108/pdfft?md5=6f3f3185702dac2f21e61e8d267dfe4e&pid=1-s2.0-S2666577824000108-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139637898","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":"Hemoglobin A1c in early pregnancy to identify preexisting diabetes mellitus and women at risk of hyperglycemic pregnancy complications","authors":"Ka Wang Cheung MD ,&nbsp;Tiffany Sin-Tung Au BSc ,&nbsp;Chi-Ho Lee MD ,&nbsp;Vivian Wai Yan Ng MBBS ,&nbsp;Felix Chi-Kin Wong MBBS ,&nbsp;Wing-Sun Chow MBBS ,&nbsp;Pui Wah Hui MD ,&nbsp;Mimi Tin Yan Seto MBBS","doi":"10.1016/j.xagr.2024.100315","DOIUrl":"10.1016/j.xagr.2024.100315","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Unrecognized diabetes mellitus during pregnancy could pose serious maternal and neonatal complications. A hemoglobin A1c level of ≥6.5% was used to diagnose both diabetes mellitus in nonpregnant individuals and diabetes in pregnancy. As the hemoglobin A1c level could be influenced by maternal physiological changes, the optimal cutoff in early pregnancy to detect women with diabetes in pregnancy and associated complications remains unclear.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to evaluate the diagnostic performance of various hemoglobin A1c levels and the optimal hemoglobin A1c cutoff to identify mothers with diabetes in pregnancy diagnosed by the gold standard 75 g oral glucose tolerance test before 24 weeks of gestation. In addition, the pregnancy and neonatal outcomes were compared using the optimal hemoglobin A1c cutoff.</p></div><div><h3>STUDY DESIGN</h3><p>A retrospective cohort study was conducted between 2004 and 2019. Women with at least 1 risk factor of gestational diabetes mellitus received an oral glucose tolerance test before 24 weeks of gestation. Terminology of hyperglycemia first detected during pregnancy by oral glucose tolerance test was classified as either diabetes in pregnancy or gestational diabetes mellitus following the World Health Organization's recommendation. Women who met the diagnostic criteria of diabetes in pregnancy and early-onset gestational diabetes mellitus (ie, before 24 weeks of gestation) and had a paired hemoglobin A1c measurement within 4 weeks of their early oral glucose tolerance test were studied. Sensitivity, specificity, and positive and negative predictive values at various hemoglobin A1c cutoffs were calculated for the detection of diabetes in pregnancy. The optimal hemoglobin A1c level was identified from the constructed receiver operating characteristic curves. Multivariate binary logistic regression analyses were performed to calculate the unadjusted and adjusted odds ratios for pregnancy complications.</p></div><div><h3>RESULTS</h3><p>There were 63,111 deliveries, and 22,949 women underwent an oral glucose tolerance test before 24 weeks of gestation. A total of 157 and 3210 women met the diagnostic criteria of diabetes in pregnancy and early-onset gestational diabetes mellitus using an oral glucose tolerance test, respectively. Only 346 participants had a paired hemoglobin A1c and oral glucose tolerance test measurement (82 cases with diabetes in pregnancy and 264 cases with early-onset gestational diabetes mellitus). The receiver operating characteristic curve identified an optimal hemoglobin A1c cutoff of 5.7% to diagnose diabetes in pregnancy, with a sensitivity of 64.6%, specificity of 81.1%, positive predictive value of 51.5%, and negative predictive value of 88.1%. A hemoglobin A1c cutoff of either 5.9% or 6.5% could miss 47.6% or 73.2% of women with diabetes in pregnancy. In multivariate logistic regression analysis, a hemoglobin A1c level of ≥5.7","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000091/pdfft?md5=59cf5c7a41abd4867edfeec81c1fd0ff&pid=1-s2.0-S2666577824000091-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539161","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":"Training midwives to determine fetal presentation using a handheld portable ultrasound device—need of the hour?","authors":"Smriti Prasad MRCOG,&nbsp;Borna Poljak MRCOG,&nbsp;Yana Richens PhD,&nbsp;Chelone Lee-Wo MSc,&nbsp;Asma Khalil FRCOG","doi":"10.1016/j.xagr.2024.100314","DOIUrl":"10.1016/j.xagr.2024.100314","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266657782400008X/pdfft?md5=b5bad106a23ae8377a57f56b8c5c3428&pid=1-s2.0-S266657782400008X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539181","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":"Hepatitis C virus detection and management after implementation of universal screening in pregnancy","authors":"Sarah Boudova MD, PhD ,&nbsp;Danielle M. Tholey MD ,&nbsp;Elizabeth Ferries-Rowe MD","doi":"10.1016/j.xagr.2024.100317","DOIUrl":"10.1016/j.xagr.2024.100317","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Accurately identifying cases of hepatitis C virus has important medical and public health consequences. In the setting of rising hepatitis C virus prevalence and highly effective treatment with direct-acting antivirals, the Society for Maternal-Fetal Medicine guidelines recently changed to recommend universal screening for hepatitis C virus during pregnancy. However, there is little data on the influence of this policy change on case identification and management.</p></div><div><h3>OBJECTIVE</h3><p>We aimed to examine the influence of universal hepatitis C virus screening on our patient population. Our primary objective was to determine if there was a difference in the detected hepatitis C virus prevalence after the policy change. Our secondary objectives were to determine which factors were associated with a positive test for hepatitis C virus and to examine postpartum management of pregnant patients living with hepatitis C virus, including the (1) gastroenterology referral rate, (2) treatment rate, (3) infantile hepatitis C virus screening rate, and (4) factors associated with being referred for treatment.</p></div><div><h3>STUDY DESIGN</h3><p>We conducted a single-center, retrospective cohort study of deliveries that occurred before (July 2018–June 2020) and after (July 2020–December 2021) the implementation of universal hepatitis C virus screening. Information on hepatitis C virus and HIV status, if patients were screened for hepatitis C virus, history of intravenous drug use, and basic demographic information were abstracted from the electronic medical records. A subset of patients was administered a questionnaire regarding hepatitis C virus risk factors. For all patients who tested positive for hepatitis C virus, information on if they were referred for treatment in the postpartum period and if their infant was screened for hepatitis C virus were abstracted from the electronic medical records.</p></div><div><h3>RESULTS</h3><p>A total of 8973 deliveries occurred during this study period. A total of 71 (0.79%) patients had a detectable viral load. With implementation of universal screening, hepatitis C virus screening rates increased from 5.78% to 77.25% of deliveries (<em>P</em>&lt;.01). The hepatitis C virus prevalence rates before and after universal screening was implemented were 0.78% and 0.81%, respectively (<em>P</em>=.88). There were significant demographic shifts in our pregnant population over this time period, including a reduction in intravenous drug use. A subset of 958 patients completed a hepatitis C virus risk factor questionnaire, in addition to undergoing universal hepatitis C virus screening. Ten patients screened positive with universal screening; only 8 of these individuals would have been identified with risk-based screening. Among the patients with a detectable viral load, 67.61% were referred for treatment and 18.75% were treated. A multivariate logistic regression model indicated that intrav","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266657782400011X/pdfft?md5=83530edefc388a52d37464272399a139&pid=1-s2.0-S266657782400011X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139820281","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}