American journal of obstetrics and gynecology最新文献

{"title":"Reference ranges for liver function tests in pregnancy controlling for maternal characteristics.","authors":"Hannah R Judah, Robert A Rigby, Mikis D Stasinopoulos, Konstantinos Pateras, Mussarat N Rahim, Michael A Heneghan, Kypros H Nicolaides, Nikos A Kametas","doi":"10.1016/j.ajog.2025.06.056","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.056","url":null,"abstract":"<p><strong>Background: </strong>Liver dysfunction complicates 3% of pregnancies and prompt diagnosis reduces severe maternal and perinatal morbidity and mortality. Recognition of liver dysfunction relies on the creation of reference ranges. Outside pregnancy, factors such as age and gender have been shown to affect liver biomarkers but despite recommendations for age and gender-adjusted reference ranges for liver function tests, these have not been widely adopted clinically. In pregnancy, there are only a few studies that have examined changes of liver function tests (LFTs) with gestation, and none of them have controlled for maternal demographic characteristics.</p><p><strong>Objectives: </strong>The aims of this study are first, to provide reference ranges of LFTs in a large population of uncomplicated pregnancies after adjusting for the effect of gestational age and maternal demographic characteristics on the median and measures of dispersion and shape (skewness and kurtosis) of the distribution of these variables, and second, to create an on-line calculator of z-scores of maternal LFTs using the above-mentioned methodology.</p><p><strong>Study design: </strong>This was a cross-sectional study of healthy women attending for routine antenatal ultrasound scans at 11<sup>+0</sup> to 13<sup>+6</sup> weeks' gestation (visit 1), 19<sup>+0</sup> to 24<sup>+6</sup> weeks (visit 2), 30<sup>+0</sup> to 34<sup>+6</sup> weeks (visit 3), and 35<sup>+0</sup> to 37<sup>+6</sup> weeks (visit 4). Women with a history of liver dysfunction or adverse pregnancy outcome were excluded from the analysis. We measured the following variables: alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), total bilirubin (TBIL) and albumin (ALB). The assessment of the distribution of LFTs across gestational age, (controlling for maternal characteristics) was performed with Generalized Additive Models for Location, Scale, and Shape (GAMLSS), using the GAMLSS R package, which allows the implementation of distributions other than normal distribution.</p><p><strong>Results: </strong>There were 3451 women who agreed to participate in the study and had uncomplicated pregnancies. Women participated only once in the study with 805, 860, 886 and 900 women attending in visits 1, 2, 3 and 4, respectively. The location parameter of the distribution of the LFT variables is independently predicted by gestational age and ethnicity for all variables, by maternal body mass index (BMI) for all variables except ALB, by maternal age for all variables except ALT/AST ratio and GGT, by maternal parity for all variables except TBIL and ALP, by maternal smoking for TBIL and ALB, and by maternal weight for ALP. The scale parameter of the distribution is also independently predicted by gestational age for all variables apart from ALP, maternal BMI for ALT, AST, GGT and ALP, maternal age and ethnicity for GGT and maternal parity for","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemorrhage Management using a Foley Catheter for Uterine Suction.","authors":"Frank I Jackson,Nicholas J Dilena,Sarah H Ableman,Matthew J Blitz,Sharon Gerber","doi":"10.1016/j.ajog.2025.06.061","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.061","url":null,"abstract":"Uterine atony is a common cause of hemorrhage postpartum as well as after a miscarriage, but there are limitations on current approved devices for management. A Foley catheter is inserted into the uterine cavity and attached to suction for vacuum induced hemorrhage control. The technique has been used across trimesters and in the case of mullerian anomaly. Bleeding typically resolves within five minutes of Foley catheter for uterine suction application. Using a readily available Foley catheter for uterine suction offers a practical approach to manage hemorrhage, both in resource-limited settings, or in cases where no alternative device is available.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"27 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The origin of Hadlock's table: a reply.","authors":"Aaron W Roberts,Vahed Maroufy,Ashley Salazar,Edgar Hernandez-Andrade,Suneet P Chauhan,Patrick Dicker","doi":"10.1016/j.ajog.2025.06.059","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.059","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"20 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comment on Revisiting Hadlock.","authors":"Jessica L Gleason, Zhen Chen, Katherine L Grantz","doi":"10.1016/j.ajog.2025.06.058","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.058","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-pregnancy metformin use associated with lower risk of severe nausea and vomiting of pregnancy and hyperemesis gravidarum","authors":"Neelu Sharma, Kimber W. MacGibbon, Aimee Brecht-Doscher, Victoria K. Cortessis, Marlena S. Fejzo","doi":"10.1016/j.ajog.2025.06.055","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.055","url":null,"abstract":"Severe nausea and vomiting of pregnancy and hyperemesis gravidarum are associated with adverse maternal, fetal, and child outcomes. The recurrence risk is reported to be as high as 89%. Identifying an effective, safe, and affordable method to prevent hyperemesis gravidarum is critical to reducing risk of reoccurrence and improving maternal, fetal, and child health. We recently demonstrated that genetic predisposition to hyperemesis gravidarum is mediated by low pre-pregnancy levels of the emetogenic hormone Growth and Differentiation Factor 15, resulting in hypersensitivity to its rapid rise during pregnancy. Because metformin increases circulating levels of the Growth and Differentiation Factor 15, we hypothesized that use of metformin before pregnancy will desensitize patients to the hormone and lower the risk of severe nausea and vomiting in pregnancy and hyperemesis gravidarum.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"27 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaginal Clamping of Uterine Arteries: A Temporary Intervention to Stop Bleeding in Postpartum Hemorrhage","authors":"Albaro J. Nieto-Calvache, Nicolas Basanta, Jose M. Palacios-Jaraquemada, Luisa F. Rivera-Torres, Francisco Zea","doi":"10.1016/j.ajog.2025.06.060","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.060","url":null,"abstract":"Postpartum hemorrhage, most commonly due to uterine atony, is the leading cause of maternal mortality worldwide. This disproportionately affects centers with limited resources or where transfer to a higher level of care is challenging. Persistent bleeding can lead rapidly to coagulation and metabolic disturbances that are difficult to correct. The primary objective in the management of hemorrhage is to stop bleeding. Temporary measures to control bleeding may be necessary while additional interventions are employed.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"507 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Frequency of Autism by Previous Diagnosis and Screening in Children with Fetal-Neonatal Alloimmune Thrombocytopenia (FNAIT) with and without an Intracranial Hemorrhage (ICH).","authors":"Katherine A Knightly, Eleanore A McFarland, Emilie Vander Haar, Margaret H McKelvy, Thea D Palmer, Stephanie V Volpe, Stacy Corke, James B Bussel","doi":"10.1016/j.ajog.2025.06.052","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.052","url":null,"abstract":"<p><strong>Background: </strong>Fetal-Neonatal AlloImmune Thrombocytopenia (FNAIT) results from parental platelet antigen incompatibility and maternal alloimmunization, most commonly to platelet antigen HPA-1a. De Vos et al. identified mild-moderate neurologic injury in 26% of 31 FNAIT-affected children aged 6-14 without past ICH. Suspicions from NAITbabies members, along with the De Vos observations, led to a survey evaluation of autism in FNAIT-affected children.</p><p><strong>Objective(s): </strong>This study explored the frequency of autism both by previous diagnosis and by screening in FNAIT-affected children with and without having had an ICH.</p><p><strong>Study design: </strong>A de-identified survey was made available to mothers in NAITbabies, assessing risk of autism using four age-specific autism screening scales: Q-CHAT-10 for ages 18-24 months (n=18); M-CHAT-R 2-4 years(n=61); AQ-10-Child 4 -11 years (n=175); and AQ-10-Adolescent for >12 years (n=66). Mothers reported their child's ICH status and pre-screening autism diagnoses. Survey responses were scored using specific questionnaire algorithms.</p><p><strong>Results: </strong>Among 320 FNAIT-affected children, 24 (7.5%) had a previous autism diagnosis and 64 (20%) screened at risk. Among 182 children with known ICH status, that could be linked to an autism questionnaire response, 33 had suffered an ICH and 149 had not. Both pre-existing and screening autism diagnoses increased with age in both ICH and non-ICH groups, peaking in the 12+ age group: 67% with ICH and 36% without ICH. Autism findings were higher among ICH children but were most striking in the non-ICH group. 7.5% of the 4-11 age group (no ICH) and 18% of the 12+ age group (no ICH) already had been diagnosed with autism. With screening for high risk of autism, these numbers more than doubled to 19% (4-11 age group) and 36% (12+ age group). Positive predictive values of the latter two questionnaires were 0.94 and 0.86, respectively.</p><p><strong>Conclusions: </strong>In FNAIT-affected children without an ICH, rates of autism were surprisingly high and became more apparent with age. These findings highlight the need for early screening and ongoing careful monitoring of children affected by FNAIT, even without known ICH, who can no longer be considered \"consequence-free.\"</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns Regarding \"Effect of Aspirin on Biomarker Profile in Women at High Risk for Preeclampsia\".","authors":"Shiyuan Wei, Jie Chen, Liang Yu","doi":"10.1016/j.ajog.2025.06.054","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.054","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Ibuprofen in Severe Hypertensive Disorders of Pregnancy: a comment.","authors":"Ying Yang, Pei Guo, Ying Liu","doi":"10.1016/j.ajog.2025.06.050","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.050","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Two Different Dosing Regimens of Vaginal Misoprostol for Cervical Priming Among Women Undergoing Vaginoscopic Hysteroscopy: A Non-inferiority Randomized Controlled Trial.","authors":"Raju Govindegowdanadoddi Puttaswamy, Dilip Kumar Maurya, Murali Subbaiah, Avantika Gupta, Marimuthu Sappani, Chitra Thyagaraju, Joseph Beyene, Anish Keepanasseril","doi":"10.1016/j.ajog.2025.06.057","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.057","url":null,"abstract":"<p><strong>Background: </strong>Hysteroscopy is considered the gold standard for diagnosing intrauterine pathology. Pain and discomfort experienced during the procedure may be reduced using vaginoscopic methods and cervical priming. Misoprostol is the agent of choice for cervical priming for transcervical procedures. However, the optimal dose, route and time of administration are debatable. Lower doses may reduce the side effects without reducing the effectiveness of facilitating cervical entry.</p><p><strong>Objectives: </strong>To compare the efficacy of 100mcg with 200mcg of vaginal Misoprostol on ease of cervical entry among women undergoing vaginoscopic hysteroscopy.</p><p><strong>Methods: </strong>This randomised controlled non-inferiority trial was conducted, enrolling 120 women who underwent hysteroscopy at a tertiary-level teaching hospital from November 2020 to June 2022. The intervention included two dosages of vaginal misoprostol - 200mcg (Group-A) and 100mcg (Group-B), administered three hours before the procedure. No analgesia or anaesthesia was used in either group. The primary outcomes measured included assessing the ease of cervical entry on a five-point Likert scale. The secondary outcomes included (i) Pain score assessed using a Visual Analogue Scale (VAS) at three-time points, (ii) time taken for cervical entry and completion of the procedure, and (iv) side effects (drug or procedure-related). A test for non-inferiority was conducted using a one-sided Wald test at a significance level of 0.05.</p><p><strong>Results: </strong>Most cases (77.5%) had \"easy or very easy\" entry through the cervix, which was similar in both groups (Group A: 81.7%, (95% CI: 71.9-91.5) vs Group B: 73.3%, (95% CI: 62.1-84.5)). The difference between the groups was -8.3%, with one-sided 95% CI: -20.9% to 100%, p=0.063 using the intention to treat approach, marginally above the prespecified boundary of 20%, not confirming the noninferiority of the 100 mcg to 200 mcg dose of misoprostol. The median VAS score at three-time points, the mean entry time, and the total procedure duration were comparable between the two groups. Adverse effects were commonly noted among those receiving 200 mcg compared to 100 mcg misoprostol (13(21.7%) vs 6 (10%), p =0.079).</p><p><strong>Conclusion: </strong>Regarding cervical priming during vaginoscopic hysteroscopy, using either 100 mcg of Misoprostol or 200 mcg of Misoprostol facilitated easy or very easy entry in most cases, though this study was not able to establish non-inferiority of the lower dose.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}