American journal of perinatology最新文献

{"title":"Maternal Exit from Employment after Premature Birth.","authors":"Katherine D Taylor, Olivia Nieto Rickenbach, Aliba Syed, Dmitry Tumin","doi":"10.1055/a-2715-4524","DOIUrl":"10.1055/a-2715-4524","url":null,"abstract":"<p><p>We sought to evaluate whether infants' preterm birth (PTB) or low birth weight (LBW) were associated with maternal exit from employment after birth.We analyzed data from the National Longitudinal Survey of Youth 1979 cohort, tracking maternal employment after each birth. Births were included if the mother was working at the beginning of the birth month. Time to exit from paid employment (becoming unemployed or leaving the labor force) was tracked up to 2 years after birth.Of 2,647 births to cohort members, 243 infants were born preterm (13%) and 192 were LBW (7%). On multivariable Cox regression, LBW was independently associated with 34% greater hazard of maternal exit from employment (hazard ratio: 1.34; 95% confidence interval: 1.08, 1.66; <i>p</i> = 0.007).LBW, but not PTB, was independently associated with increased risk of maternal exit from employment. · Maternal labor force exit can exacerbate financial concerns associated with preterm birth.. · Low birth weight was independently associated with maternal exit from labor force.. · Controlling for birth weight, preterm birth was not associated with labor force exit..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Morbidity following Periviable Prelabor Rupture of Membranes after Texas Senate Bill 8.","authors":"Danna Ghafir, Emily Fahl, Nancy Ukoh, Han-Yang Chen, Sean C Blackwell, Julie Gutierrez, Irene A Stafford","doi":"10.1055/a-2712-5549","DOIUrl":"10.1055/a-2712-5549","url":null,"abstract":"<p><p>Standard practice prior to Texas Senate Bill 8 (SB 8) for those with periviable prelabor rupture of membranes (PROM) without contraindications to expectant management was to offer termination of pregnancy or expectant management. After SB 8 went into effect, pregnancy termination was only offered for these patients after the development of chorioamnionitis or clinically significant maternal hemorrhage. The aim of this study was to compare maternal outcomes of periviable PROM before and after SB 8 in Houston, TX.This retrospective cohort study compared outcomes of periviable PROM less than 22 weeks of gestational age before and after SB 8 at three tertiary care hospitals from January 1, 2018, to March 31, 2023. Our primary outcome was a composite of adverse maternal outcomes: Sepsis, transfusion, and intensive care unit (ICU) admission. Secondary outcomes included intraamniotic infection, postpartum hemorrhage, abruption, septic shock, hospital length of stay, time from rupture of membranes to delivery, and neonatal survival.Over the 5-year study period, 161 women met the inclusion criteria (96 pre-SB 8 vs. 65 post-SB8). Approximately half (54%) of those with periviable PROM opted for termination prior to SB8. Post-SB8, women were more likely to develop an adverse outcome (22.9 vs. 35.4%; aRR = 1.69, 95% confidence interval [CI]: 1.03-2.78), and were more likely to develop sepsis (9.4 vs. 29.2%; adjusted relative risk [aRR] = 2.97, 95% CI: 1.43-6.17). Five neonates survived to hospital discharge post-SB8, and one survived prior to SB8. Additionally, those expectantly managed post-SB8, compared with those expectantly managed pre-SB8, experienced a longer time from rupture of membranes to delivery (6.5 days post [2-14] vs. 3 days pre [1-7.5]), and a higher rate of sepsis (18 post [30.0%] vs. 6 pre [15.0%]).These results provide evidence that periviable PROM alone is a life-threatening condition with a serious risk of maternal harm. Waiting for maternal infection or hemorrhage to develop before offering pregnancy termination increases the risks of serious maternal morbidity. · Pre-SB8, 54% of women with periviable PROM chose termination.. · Increased rates of sepsis were observed post-SB8.. · Longer rupture of membranes to delivery times were observed post-SB8..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-Like Peptide-1 Receptor Agonists among Pregnancies with Pregestational Diabetes and Its Relationship with Congenital Malformations.","authors":"Zoe Lewin, Shani Snow, Jung Ae Lee, Gianna Wilkie","doi":"10.1055/a-2716-1639","DOIUrl":"10.1055/a-2716-1639","url":null,"abstract":"<p><p>Pregestational diabetes is a common complication seen in pregnancy, with significant increase seen in the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for diabetes management in reproductive-age individuals. The objective of this study was to describe the perinatal outcomes and prevalence of congenital malformations associated with the use of GLP-1 RA in individuals with pregestational diabetes using a national dataset.This study was a retrospective cohort study of patients with pregestational diabetes and pregnancies using data obtained from the Epic Cosmos database between May 1, 2022 and April 30, 2025. Demographics, perinatal outcomes, and prevalence of congenital malformations were compared by GLP-1 RA exposure in pregnancy. Categorical variables were compared with Chi-square and continuous variables were compared using student <i>t</i>-tests for two comparisons. No individual level data were available, so covariate adjustment was not performed.The total sample population was 143,593 patients with pregestational diabetes, with 24.4% (<i>n</i> = 35,083) of patients using a GLP-1 RA at some time point in pregnancy. Patients with GLP-1 RA usage were more likely to develop pre-eclampsia (13.1% versus 11.9%, <i>p</i> < 0.00001), have a cesarean delivery (44.4 vs. 38.9%, <i>p</i> < 0.0001), have a first trimester pregnancy loss/termination (9.8 vs. 7.5%, <i>p</i> < 0.00001), and a preterm delivery (23.1 vs. 20.8%, <i>p</i> < 0.0001) when compared with patients without GLP-1 RA use. There was no statistically significant difference in the overall rate of any congenial malformation by GLP-1 RA use (3.3% in both groups, <i>p</i> = 0.63). However, patients with GLP-1 RA usage were more likely to have fetuses with genital malformations (0.7 vs. 0.6%, <i>p</i> = 0.02) and urinary malformations (0.5 vs. 0.4%, <i>p</i> = 0.01) compared with patients without GLP-1 RA use.GLP-1 RA therapy in a large cohort of pregnant patients with pregestational diabetes was associated with an overall low rate of malformations but found to have a possible increase in genital and urinary malformations. Counseling of patients prior to use of this medication in the preconception period is required. · GLP-1 receptor agonist therapy exposure is common in pregnancy among patients with diabetes.. · GLP-1 receptor agonist therapy was not associated with an increased risk of overall malformations.. · GLP-1 receptor agonist therapy was associated with increased genital and urinary malformations..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition Pattern and Adverse Pregnancy Outcomes in Nulliparous Individuals: A Cluster Analysis.","authors":"Tetsuya Kawakita, Yara H Diab, Kazuma Onishi, George Saade","doi":"10.1055/a-2712-5518","DOIUrl":"10.1055/a-2712-5518","url":null,"abstract":"<p><p>This study aimed to develop a k-means clustering algorithm to identify distinct food intake patterns through cluster analysis.This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), including nulliparous individuals with singleton pregnancies. Dietary intake data from the 3 months preceding pregnancy were collected using a validated questionnaire. The primary outcome was a composite measure including preterm birth, stillbirth, preeclampsia, eclampsia, gestational diabetes, and small for gestational age. Clusters were formed using a k-means clustering algorithm with Euclidean distance, based on 335 dietary variables. The association between dietary clusters and adverse pregnancy outcomes (APOs) was assessed. Relative risks with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for predefined confounders. A random forest model was also employed to identify features predictive of cluster allocation.The analysis included 7,599 participants, distributed across three clusters: Cluster 1 (<i>n</i> = 4,243, 55.8%), Cluster 2 (<i>n</i> = 2,768, 36.4%), and Cluster 3 (<i>n</i> = 588, 7.7%). Cluster 2, which serves as the referent cluster, is characterized by a higher intake of vitamin E as α-tocopherol, vitamin A retinol activity equivalents, vegetables, and fruits, aligning most closely with a healthy diet pattern. Compared with Cluster 2, Cluster 1, characterized by a lower intake of the same nutrients, did not show a significant association with increased odds of APOs (22.7 vs. 25.4%; adjusted relative risk [aRR], 1.07 [95% CI: 0.98-1.18]). In contrast, Cluster 3, characterized by higher intake of trans fats, dietary polyunsaturated fatty acids 20:4, red meat, and sugary beverages, was significantly associated with APOs compared with Cluster 2 (31.0 vs. 22.7%; aRR, 1.19 [95% CI: 1.01-1.39]).A dietary pattern characterized by a high intake of trans fats, polyunsaturated fatty acids, red meat, and sugary beverages is significantly associated with an increased risk of APOs. · Diets high in trans fats, polyunsaturated fatty acids, red meat, and sugary beverages are associated with increased APOs.. · Diets rich in vitamin E, vitamin A, vegetables, and green salads are linked to a lower risk of these outcomes.. · This study underscores the significant role of nutrition in influencing APOs..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeat versus Single Course of Antenatal Corticosteroid in Management of Preterm Premature Rupture of Membranes: A Systematic Review and Meta-analysis.","authors":"Yosteline Da Costa, Veena Ramanathan, Juliana Almeida Oliveira, Joaquim Brito, Abdelrahman Yousif","doi":"10.1055/a-2708-5314","DOIUrl":"https://doi.org/10.1055/a-2708-5314","url":null,"abstract":"<p><p>A single course of antenatal corticosteroids is standard for women at risk of preterm birth, including those with ruptured membranes. The benefit of repeat courses in the setting of preterm premature rupture of membranes (PPROM) remains uncertain. This study aimed to assess the safety and effectiveness of repeat versus single course of corticosteroid in women with PPROM.We searched PubMed, Cochrane, and Embase databases from inception to September 17, 2025, with no language restrictions, using the terms related to PPROM and corticosteroids. Randomized and non-randomized clinical trials enrolling women with PPROM and comparing repeat with single course were included. Studies without PPROM or comparator group were excluded. Screening and quality assessment were performed by two authors, with a third author participation in case of disagreements. Statistical analysis used Review Manager 5.4 and R studio 4.5.0, with risk ratio (RR), random effects, Cochran Q test and I-squared statistics, and sensitivity analysis. This study was registered with PROSPERO (identifier: CRD420251069007).Six studies comprising 2,434 patients were included. Sensitivity analysis showed that repeat course of corticosteroids increased the risk of endometritis compared to a single course (RR = 1.63; 95% CI: 1.10 to 2.43). In the subgroup analysis the mixed hours corticosteroid favored the outcome of chorioamnionitis (RR = 1.62; 95% CI: 1.12 to 2.36; <i>p</i> = 0.001) with no overall subgroup difference. No difference was observed for the outcomes of respiratory distress syndrome, neonatal sepsis, necrotizing enterocolitis, and intraventricular hemorrhage.Repeat corticosteroid courses in PPROM may increase maternal infections morbidity without clear neonatal benefit. Further large, well-designed randomized trials are needed to clarify safety. · Repeat course of corticosteroid might increase maternal infections morbidity.. · A cautious approach due to potential increase in maternal morbidity related to repeat corticoid use.. · No significant neonatal benefit was observed with repeat courses of antenatal corticosteroids..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Economic Evaluation Alongside the Telephone-Based Nurse-Delivered Interpersonal Psychotherapy for Postpartum Depression Trial.","authors":"Susanne Hay, Cindy-Lee Dennis, Paula Ravitz, Sophie Grigoriadis, Elise Maddalone, Dmitry Dukhovny, John Zupancic","doi":"10.1055/a-2708-5194","DOIUrl":"https://doi.org/10.1055/a-2708-5194","url":null,"abstract":"<p><p>In a previously reported, multi-site, randomized controlled trial in women with postpartum depression (PPD), telephone-based, nurse-delivered, interpersonal psychotherapy (IPT) compared with standard postpartum care showed a reduction of 24% in the incidence of PPD (Dennis et al, <i>British Journal of Psychiatry</i>, 2020). The economic implications of this therapy have not been explored. We aimed to determine the cost-effectiveness of telephone-based, nurse-delivered IPT compared with standard postpartum care, using resource utilization data collected alongside the clinical study.We conducted a prospectively planned economic evaluation using patient-level data from the IPT trial, which enrolled 241 mothers with PPD. We considered costs from a societal perspective, measuring direct medical costs from study logs and secondary sources, as well as evaluating costs borne by the mother and family (including both medical and non-medical expenditures) and wage losses through questionnaires. We used a time horizon of 12 weeks post-randomization, corresponding to the endpoint of the clinical trial. Costs are reported in (2022) Canadian dollars.Patients in the IPT group had more phone calls with public health nurses external to those provided by the study protocol (IPT 73% versus control 55%, <i>p</i> = 0.007) and fewer visits to psychiatrists (9% versus 22%, <i>p</i> = 0.008). However, there were no statistically significant differences in any of the cost categories or total societal expenditures (IPT group $6,653, control group $5,336, <i>p</i> = 0.234). When costs and effects were combined, the societal expenditure was $5,397 for each additional patient without PPD.Telephone-based, nurse-delivered IPT, as employed in this trial, showed no statistically significant differences in costs compared with standard care but resulted in improved clinical outcomes. Although associated with moderate uncertainty, the resulting incremental cost-effectiveness was well within the acceptable range for medical interventions in this population, and telephone-based, nurse-delivered IPT should be considered for patients with PPD. · Telephone-based, nurse-delivered IPT is effective in treating PPD.. · We performed an economic evaluation alongside a randomized controlled trial of IPT, using patient-level data and considering costs from a societal perspective.. · Patients in the IPT group had more phone calls with public health nurses and fewer visits to psychiatrists, with overall similar costs between the two groups.. · The societal expenditure was $5,397 for each additional patient without PPD, which is well within the acceptable range for medical interventions in this population.. · Telephone-based, nurse-delivered IPT should be considered for cost-effective care of patients with PPD..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association between Maternal-Fetal Medicine Physician Density and Pregnancy Outcomes.","authors":"Tetsuya Kawakita, Rula Atwani, Misa Hayasaka, Lindsay Speros Robbins, George Saade","doi":"10.1055/a-2717-3951","DOIUrl":"https://doi.org/10.1055/a-2717-3951","url":null,"abstract":"<p><strong>Objective: </strong>We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level.</p><p><strong>Study design: </strong>This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state categorized into three groups: (1) low density (<30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models.</p><p><strong>Results: </strong>Overall, there were 14,771,547 live births, 3,440 maternal mortality, 4,980 pregnancy-related mortality, and 90,848 stillbirths included. The median MFM density across states was 31.6 per 100,000 live births (interquartile range: 21.9-42.5). States with high MFM density had a reduced risk of maternal mortality (aIRR 0.70; 95% CI 0.58-0.85) and pregnancy-related mortality (aIRR 0.83; 95% CI 0.71-0.98) compared to states with low MFM density, corresponding to 7.29 (AME 95% CI 3.58-11.00) and 5.57 (AME 95% CI 0.74-10.40) less mortality per 100,000 live births, respectively. States with moderate MFM density had a similar risk of maternal mortality compared to low MFM density states (aIRR 1.02; 95% CI 0.87-1.20).</p><p><strong>Conclusions: </strong>High MFM-density states have a decreased risk of maternal mortality compared to low MFM-density states, suggesting a critical role of MFM in reducing maternal mortality.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting dexamethasone-associated extubation success in preterm infants.","authors":"Kelly A Denhard, Karen Fairchild, Brynne A Sullivan","doi":"10.1055/a-2717-3994","DOIUrl":"https://doi.org/10.1055/a-2717-3994","url":null,"abstract":"<p><strong>Objective: </strong>Dexamethasone improves respiratory status in some preterm infants with lung disease. Dexamethasone increases heart rate variability, which decreases the heart rate characteristics index (HRCi), a sepsis risk score that reflects inflammation. Respiratory improvement can be measured by the ability to wean support, quantified by a respiratory severity score (RSS). We hypothesized that HRCi and RSS early in dexamethasone treatment are associated with respiratory improvement marked by successful extubation.</p><p><strong>Study design: </strong>We retrospectively reviewed NICU patients born at <32 weeks gestational age (GA) admitted from 2012-2022 who received >3 days of dexamethasone for lung disease while on mechanical ventilation. Daily mean FiO2, HRCi, and RSS (Mean Airway Pressure x FiO2) were calculated for the dexamethasone start day and two days before and after. Successful extubation was defined as occurring during the dexamethasone course without reintubation within 7 days. We compared variables between infants with and without successful extubation.</p><p><strong>Results: </strong>A total of 65 infants (mean GA 25±1 weeks) were included. HRCi, FiO2, and RSS significantly decreased by Day 3 of dexamethasone. Successful extubation (n=38) was associated with higher postmenstrual age (PMA), lower FiO2 and RSS, and being on conventional rather than high-frequency ventilation (all p<0.05). Multivariable analysis found that RSS and PMA, but not HRCi, predicted successful extubation.</p><p><strong>Conclusion: </strong>Dexamethasone treatment decreased the HRCi, but this was not associated with extubation success. Higher PMA and lower respiratory support were associated with successful extubation during dexamethasone treatment.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antihypertensive Treatment in the Postpartum Care of Preeclampsia: A Hemodynamic-Based Approach.","authors":"Ifeoma Ogamba-Alphonso, Erin Miller, Tudi-Max Brown-Thomas, Ioanna Katehis, Saige Gitlin, Delphina Maldonado, Gabriella Fernandez De Salvo, Tony Asfour, Izzy Ginsberg, Silpaa Gunabalan, Anand Rajan, Keya Shah, Mehak Kapoor, George Gubernikoff, Wendy Kinzler, Martin Chavez, Hye Heo, Patricia Rekawek","doi":"10.1055/a-2708-5020","DOIUrl":"https://doi.org/10.1055/a-2708-5020","url":null,"abstract":"<p><p>Labetalol and nifedipine are first-line antihypertensives for hypertensive disorders of pregnancy. However, there is limited research comparing their effectiveness based on hemodynamic profiles seen in preeclampsia, such as high cardiac output (CO) and high systemic vascular resistance (SVR). This study assesses whether concordance of antihypertensive treatment with the hemodynamic status on echocardiogram reduces time to achieve target postpartum blood pressure (BP) before discharge.This retrospective cohort study included patients with preeclampsia with severe features who received a postpartum echocardiography, excluding patients with cardiac etiology. Antihypertensive choices were provider-dependent. The CO and SVR were calculated retrospectively from the echocardiogram in collaboration with cardiology. Concordance was defined as patients with high CO (>6 L/min) started on labetalol and high SVR (>1,200 dynes·sec·cm⁵) started on nifedipine; opposite pairings were discordant. The primary outcome was time to achieve target BP, defined as the period from the start of antihypertensive therapy to when no titration was needed to sustain BPs of less than 140/90 mm Hg. Chi-square and Fisher's tests were used for categorical variables, and Mann-Whitney U test for continuous variables.Of 298 patients, 155 (52%) received concordant therapy and 143 (48%) discordant. Of the cohort, 229 (76.8%) had high SVR and 69 (23.2%) had high CO. Median time to target BP was not significantly different (concordant: 32 hours [interquartile range, IQR: 0-61], discordant: 41 hours [IQR: 4-75], <i>p</i> = 0.13). The concordant group needed fewer titrations to achieve target BP (1 [IQR: 0-2] vs. 2 [IQR: 1-3]; <i>p</i> = 0.008) and were less likely to be discharged home on multiple antihypertensive medications compared with the discordant group (28.9 vs. 42.7%, <i>p</i> = 0.014). Maternal demographics were similar between groups.While time to target BP did not differ, concordance of antihypertensive therapy to postpartum hemodynamics in patients with severe preeclampsia reduced medication adjustments and increased the likelihood of discharge on a single-agent regimen. · Echocardiography can be used to assess maternal hemodynamics.. · Aligning BP meds to hemodynamics cuts the need for a second agent.. · Aligning BP meds to hemodynamics reduces dose adjustments..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histologic Features Suggestive of Shallow Placental Implantation: Maternal-Placental Relevance and Site-Specific Implications.","authors":"Gayatri Ravikumar, Padmavathi S Kamath, Chandrakala Bada Shekharappa","doi":"10.1055/a-2708-5263","DOIUrl":"10.1055/a-2708-5263","url":null,"abstract":"<p><p>Shallow placental implantation (SPI) contributes to adverse pregnancy outcomes. Identification of histopathological features of SPI and its clinical associations with site-specific implications remains under-explored, which forms the basis for this study.This retrospective study included 182 singleton placentas over 25 weeks of gestation submitted for histopathological examination. Features of SPI was identified based on extravillous trophoblast (EVT) persistence in the decidua, parenchyma, or membranes/chorionic disc. Associations of features of SPI (any SPI, multiple SPI when more than one SPI lesion was present, and site-specific features of SPI) with clinical and placental outcomes were analyzed.At least one feature of SPI was present in 58.8% placentas, with multiple features in 26.9%. The most common site was membranes/chorionic disc (40%). Features of SPI was present in parenchyma in 24.2% and in decidua in 20.3%. Presence of SPI features was significantly associated with preeclampsia (<i>p</i> = 0.0001), fetal growth restriction (FGR; <i>p</i> = 0.012), Cesarean delivery (<i>p</i> = 0.007), and chronic hypertension (<i>p</i> = 0.014) and negatively with PROM (<i>p</i> = 0.0009). Placental findings with significant association were lower placental weight (<i>p</i> = 0.042), infarction (<i>p</i> = 0.015), significant fibrin (<i>p</i> = 0.005), maternal (<i>p</i> < 0.001) and fetal (<i>p</i> = 0.014) vascular malperfusion. The birth weight was significantly lower when SPI features were present (<i>p</i> = 0.013), though no significant difference was observed in major neonatal morbidities. Basal plate myometrial fibers showed association with multiple SPI (<i>p</i> = 0.023).Site-specific analysis revealed SPI features in parenchyma to be significantly associated with oligohydramnios and increased neonatal morbidities (hematological, gastrointestinal, and overall), in addition to other adverse outcomes associated with SPI. Decidual features of SPI were additionally associated with maternal diabetes, but showed limited neonatal impact beyond low birth weight.SPI features correlate significantly with major obstetric conditions, birth weight, and placental vascular pathology. Site-specific analysis shows parenchymal SPI has the greatest clinical impact, particularly on neonatal morbidities. Recognition and site-specific documentation enhance its value as an additional parameter within the maternal vascular malperfusion (MVM) spectrum. · Histologic features of SPI were present in 58.8% of high-risk placentas.. · Chronic hypertension (HTN), preeclampsia, FGR, and low birth weight associated with features of SPI.. · Lower placental weight, MVM, and fetal vascular malperfusion (FVM) significantly associated with features of SPI.. · Basal plate myometrial fibers were associated with multiple SPI.. · Parenchymal SPI features are associated with adverse neonatal outcomes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}