American journal of perinatology最新文献

{"title":"Cervical Dilation and Risk of Delivery before 28 Weeks after Physical Exam-Indicated Cerclage.","authors":"Mackenzi McHugh, Corinne Parker, Tetsuya Kawakita","doi":"10.1055/a-2979-5822","DOIUrl":"10.1055/a-2979-5822","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to evaluate the association between the degree of cervical dilation at the time of physical exam-indicated cerclage and delivery before 28 weeks of gestation.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of singleton pregnancies who underwent physical exam-indicated cerclage (painless cervical dilation ≥ 1 cm in the second trimester) at a single academic institution, 2014 to 2022. The primary outcome was delivery before 28 weeks. Cervical dilation was categorized as 1, 2, 3, and 4 to 5 cm. Multivariable logistic regression estimated adjusted odds ratios (aOR) with 95% confidence intervals (CI), adjusting for potential confounders. Kaplan-Meier analysis of the cerclage-to-delivery interval was examined as a sensitivity analysis.</p><p><strong>Results: </strong>Of 107 singleton pregnancies, 31 (29.0%) delivered before 28 weeks. Groups were similar except for body mass index, which was higher among those who delivered before 28 weeks (34.6 ± 8.6 vs. 30.8 ± 7.3 kg/m²; <i>p</i> = 0.026). Cervical dilation was greater in the early-delivery group (median, 1.5 [interquartile range, IQR, 1.0-3.0] vs. 1.0 [IQR, 1.0-2.0] cm; <i>p</i> = 0.016). Compared with 1 cm, dilation of 3 cm (aOR, 8.90; 95% CI, 1.75-45.30) and 4 to 5 cm (aOR, 12.95; 95% CI, 2.20-76.21) were independently associated with delivery before 28 weeks, whereas 2 cm was not (aOR, 0.74; 95% CI, 0.19-2.99); these estimates were imprecise because few patients had dilation of 3 cm or more. Median cerclage-to-delivery latency fell from 16.3 and 14.9 weeks at 1 and 2 cm to 2.4 and 1.5 weeks at 3 and 4 to 5 cm (log-rank <i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>Greater cervical dilation at physical exam-indicated cerclage was associated with delivery before 28 weeks in a dose-dependent manner, with an apparent inflection between 2 and 3 cm. Because the higher-dilation strata contained few patients, these associations should be interpreted with caution.</p><p><strong>Key points: </strong>· Cervical dilation showed a dose-dependent association with delivery before 28 weeks.. · Dilation of 3 and 4 to 5 cm were associated with substantially higher odds of extreme preterm birth.. · Median cerclage-to-delivery latency fell from 15 to 16 weeks at 1 to 2 cm to under 3 weeks at > 3 cm..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179136","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":"Acetaminophen Use in Pregnancy: Evidence, Controversies, and Clinical Counseling.","authors":"Arielle Jourdan Higgs, Karl Edward Seif","doi":"10.1055/a-2984-0938","DOIUrl":"https://doi.org/10.1055/a-2984-0938","url":null,"abstract":"<p><strong>Objective: </strong>To review the current evidence regarding acetaminophen use in pregnancy, evaluate reported associations with adverse neurodevelopmental and reproductive outcomes, and provide an evidence-based framework for clinical counseling and decision-making.</p><p><strong>Study design: </strong>A narrative review of the literature was performed, emphasizing large observational cohort studies, sibling-comparison analyses, pharmacokinetic data, and recent systematic reviews evaluating prenatal acetaminophen exposure and maternal-fetal outcomes.</p><p><strong>Results: </strong>Acetaminophen is the most commonly used analgesic and antipyretic in pregnancy, with 50-65% of pregnant individuals reporting use. Although observational studies have reported associations between prenatal acetaminophen exposure and adverse neurodevelopmental and reproductive outcomes, including attention-deficit/hyperactivity disorder, autism spectrum disorder, and cryptorchidism, these findings remain inconsistent and are subject to substantial confounding, particularly by indication. Large, methodologically rigorous studies incorporating sibling-controlled analyses have demonstrated attenuation or disappearance of these associations, suggesting that underlying maternal conditions may account for the observed risks. Pharmacokinetic studies demonstrate placental transfer of acetaminophen, although fetal metabolism differs because of limited glucuronidation capacity. Current pharmacologic evidence does not support a causal relationship between standard maternal acetaminophen use and premature fetal ductus arteriosus closure.</p><p><strong>Conclusion: </strong>Current evidence does not support a causal relationship between typical prenatal acetaminophen exposure and adverse neurodevelopmental outcomes. Given the known risks of untreated maternal pain and fever, acetaminophen should remain the preferred first-line analgesic and antipyretic during pregnancy when clinically indicated. Patients should receive balanced, evidence-based counseling that acknowledges observational findings while emphasizing the limitations of current data. Use at the lowest effective dose for the shortest necessary duration remains appropriate clinical guidance.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149222983","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":"Cyclosporiasis in Pregnancy: A Narrative Review.","authors":"Andrew Elimian, Lili S Wei, Joseph Canterino, Reinaldo Figueroa","doi":"10.1055/a-2979-5863","DOIUrl":"https://doi.org/10.1055/a-2979-5863","url":null,"abstract":"<p><strong>Objective: </strong>Cyclosporiasis, caused by the protozoan parasite Cyclospora cayetanensis, is an emerging foodborne illness of increasing clinical relevance in both endemic and developed countries. Its specific implications during pregnancy remain poorly characterized. Our objective is to synthesize current evidence on the clinical presentation, diagnosis, treatment, and prevention of cyclosporiasis during pregnancy.</p><p><strong>Study design: </strong>This is a narrative review of peer-reviewed literature published between 2012 and 2026, supplemented by guidance from the Centers for Disease Control and Prevention (CDC) and other major health authorities.</p><p><strong>Results: </strong>Cyclosporiasis presents with prolonged watery diarrhea, profound fatigue, and anorexia, all features of heightened concern during pregnancy, given the risks of dehydration, malnutrition, and preterm labor. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the treatment of choice, but its use requires careful consideration of gestational timing, folate supplementation, and the risk of neonatal hyperbilirubinemia. No highly effective alternatives exist for sulfonamide-allergic patients. There is no evidence of vertical transmission.</p><p><strong>Conclusion: </strong>Cyclosporiasis in pregnancy is a clinically challenging condition requiring prompt recognition and tailored management. Prevention through rigorous food and water hygiene is paramount. TMP-SMX can be used safely with appropriate precautions. Further research is needed to define pregnancy-specific outcomes and treatment protocols.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179194","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":"Feasibility and Outcomes of External Cephalic Version among Small for Gestational Age (SGA) births.","authors":"Satjeet K Deol Chauhan, Emily Schlussel Markovic, Rodney A McLaren","doi":"10.1055/a-2979-5919","DOIUrl":"https://doi.org/10.1055/a-2979-5919","url":null,"abstract":"<p><p>OBJECTIVE- The American College of Obstetricians and Gynecologists recommends that external cephalic version (ECV) be offered to patients with malpresentation. The objective of our study was to evaluate the efficacy and perinatal outcomes among births with small for gestational age (SGA) infants after an ECV. STUDY DESIGN- This was a population based, cross sectional study using National Vitality Statistics data of singleton, non-anomalous, neonates born after 36 weeks of gestation, with birthweight of < 2500g between 2021 and 2023. Births with a maternal history of previous cesarean delivery (CD) were excluded. Births were divided into those who had an ECV attempt and those with a breech fetus at CD without a trial of labor. Adverse maternal outcomes (blood transfusion, intensive care unit (ICU) admission, unplanned hysterectomy) and neonatal outcomes (assisted ventilation use, neonatal ICU (NICU) admission, seizures, surfactant use, death) were compared between groups using logistic regression. RESULTS- A total of 8,021 births were included. Of the 8,021 births, 812 (10.1%) had an ECV attempt and 7,209 (89.9%) had a primary breech CD. There were significant differences in baseline characteristics between groups. Among the 812 births who had an ECV attempt, 338 (41.6%) had a successful ECV, of which 233 (68.9%) subsequently delivered vaginally. After adjusting for differences, births that had an ECV attempt had lower odds of neonatal assisted ventilation use (aOR 0.65, 95% CI [0.46-0.92]) and NICU admission (aOR 0.48, 95% CI [0.40-0.58]) than those who had a primary breech CD. There were higher odds of maternal transfusion in breech CD cohort as compared to those who had an ECV attempt (OR 2.81, 95% CI [1.42- 5.56]). CONCLUSION- Although ECV was successful in 41.6% births with SGA infants, there were lower rates of assisted ventilation use and NICU admission among those who underwent an ECV attempt.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163773","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":"Neurodevelopmental Care Utilization among Preterm Infants in the Military Health Care System.","authors":"Amanda Banaag, Zachary Weber, Caitlin Drumm, Genesis James, Tracey Koehlmoos, Rasheda Vereen","doi":"10.1055/a-2817-3566","DOIUrl":"10.1055/a-2817-3566","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate variation in neurodevelopmental care utilization in the Military Health System (MHS) for preterm infants.</p><p><strong>Study design: </strong>Retrospective cohort study of infants born preterm within the MHS from 2017 to 2021. Preterm birth was categorized as extreme preterm, very preterm, moderate preterm, late preterm, or unknown. Patient demographics were extracted. The primary outcome was the use of neurodevelopmental care within 2 years of birth.</p><p><strong>Results: </strong>Compared with late preterm births, total use of specialty care was significantly higher (<i>p</i> < 0.05) in moderate, very, and extreme preterm births. Black infants had fewer total visits than White infants (-1.54, <i>p</i> < 0.05). Disparities by region of birth were noted, with lower utilization in the Pacific and West South-Central census divisions (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>There are differences in neurodevelopmental care utilization among preterm infants in the MHS, driven by gestational age, race, and geography. These findings support the need for a standardized policy on neurodevelopmental follow-up.</p><p><strong>Key points: </strong>· Neurodevelopmental utilization varies by sociodemographic factors.. · Despite universal access to care, neurodevelopmental care utilization varies in the military health care system.. · Standardized neurodevelopmental follow-up is needed to ensure equitable access to care..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1739-1745"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343343","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":"Severe Maternal Morbidity with the Inclusion of Events after Delivery Hospitalization.","authors":"Karen L Schneider, Keri L Calkins, Patrick S Romano, Judy George, Whitney Schott, Leanna S Sudhof","doi":"10.1055/a-2817-3616","DOIUrl":"10.1055/a-2817-3616","url":null,"abstract":"<p><strong>Objective: </strong>Severe maternal morbidity (SMM) is a growing public health concern in the United States. While existing measures capture SMM-related complications during the delivery hospitalization, patients may also experience serious complications after discharge that affect long-term health, mortality, and health care utilization. We aimed to assess the frequency of SMM events occurring after hospital discharge and identify the appropriate postdischarge window for measurement.</p><p><strong>Study design: </strong>We analyzed 2019 to 2021 delivery hospitalizations among women aged 12 to 55 years using the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases from 17 states, with follow-up through 2021. SMM was identified per AHRQ measure specifications in inpatient and emergency department encounters. We calculated overall SMM rates as well as specific SMM-related complications, during delivery hospitalization and after discharge.</p><p><strong>Results: </strong>The SMM rate during delivery hospitalization was 87.1 per 10,000 deliveries. Extending the measurement period through 42 days' postdischarge increased the cumulative SMM rate by 32.1% to 115.0 per 10,000 deliveries. More than 80% of SMM events observed within 90 days occurred in the first 42 days after discharge, and 78.6% of these were treated in inpatient settings. Coagulopathy (26.0 per 10,000), acute renal failure (21.4 per 10,000), and sepsis (25.3 per 10,000) had the highest cumulative rates through 42 days' postdischarge. Coagulopathy was the most common complication during the delivery hospitalization (27.7%), whereas sepsis emerged as the most frequent condition treated in the 42 days after discharge (34.4%).</p><p><strong>Conclusion: </strong>Our study highlights the importance of including the postpartum period when measuring SMM. Most events were treated in an inpatient setting, and the majority occurred within 42 days after delivery. To address SMM, research and policy warrants focus on maternal health during and after the delivery hospitalization.</p><p><strong>Key points: </strong>· Including events through 42 days' postdischarge increased the cumulative SMM rate by 32.1%.. · Over 80% of SMM events observed within 90 days of delivery discharge occurred in the first 42 days.. · Coagulopathy (including disseminated intravascular coagulation), acute renal failure, and sepsis had the highest cumulative rates through 42 days' postdischarge..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1834-1838"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Determinants of Health, Perceived Stress Scores, and Adverse Pregnancy Outcomes.","authors":"Kevin Saiki, Eunjung Lim, Jonathan Riel, Paula Benny, Anna Gragas, Megan Stevenson, Jaime Stevens, Men Jean Lee, Kelly Yamasato","doi":"10.1055/a-2848-3471","DOIUrl":"10.1055/a-2848-3471","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate self-reported first-trimester perceived stress and social needs and their associations with subsequent pregnancy adverse outcomes in a cohort in Hawai'i.</p><p><strong>Study design: </strong>In this single-center prospective cohort study, patients with singleton pregnancies were recruited from 2021 to 2022 at the time of routine first trimester genetic screening. Participants completed surveys assessing social needs and perceived stress. Pregnancy adverse outcomes, including preterm birth, hypertensive disease of pregnancy, small for gestational age, large for gestational age, and gestational diabetes, were obtained through chart review. Associations between reported social needs, perceived stress, and adverse outcomes were evaluated using multivariable logistic regressions, adjusting for demographic factors.</p><p><strong>Results: </strong>Out of 351 participants, 141 (40.2%) experienced at least one adverse pregnancy outcome. For the composite adverse outcome, participants who reported food insecurity had lower odds of the composite outcome than those who did not (odds ratio = 0.47, 95% confidence interval = 0.23-0.92). No associations were observed between social needs and individual adverse outcomes. High perceived stress scores were also not associated with composite or individual adverse outcomes.</p><p><strong>Conclusion: </strong>In this socially and medically high-risk Pacific-Island cohort, self-reported first trimester social needs and perceived stress scores overall were not associated with subsequent adverse pregnancy outcomes, with the exception of decreased adverse outcomes in those reporting food insecurity. These findings add to the limited data on the complex interactions between social needs, psychological stress, and pregnancy outcomes, and suggest that alternative pathways for evaluation are needed. The manifestations of perceived stress in this culturally unique population appear to differ from other Western cohorts.</p><p><strong>Key points: </strong>· Food insecurity is associated with decreased adverse outcome.. · Perceived stress score is not associated with adverse outcomes.. · Interactions among social needs, stress, and outcomes are complex..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1864-1871"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632264","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":"Harnessing Large Language Models in Neonatal Intraventricular Hemorrhage: Exploring Retrieval Augmented Generation Methodology for Prognostic Variable Discovery.","authors":"Tanima Arora, Kristyn Beam","doi":"10.1055/a-2838-5446","DOIUrl":"10.1055/a-2838-5446","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to evaluate whether large language models (LLMs) can autonomously synthesize existing literature and accurately extract prognostic variables for neonatal intraventricular hemorrhage (IVH) and its outcomes while assessing their capability for clinical feature ranking and risk stratification.</p><p><strong>Study design: </strong>This pilot study employed a systematic literature review combined with retrieval-augmented generation (RAG) methodology. GPT 4 (OpenAI) and Claude Sonnet (4.0, Anthropic) were prompted to identify peer-reviewed studies utilizing machine learning and deep learning to predict IVH outcomes in preterm neonates. Data extraction was prompted to follow TRIPOD artificial intelligence (AI) guidelines, capturing study design, population characteristics, predictor variables, and outcome measures. Semi-automated RAG extraction was performed with manual validation to mitigate hallucination risk.</p><p><strong>Results: </strong>LLMs initially identified 39 studies, with 28 meeting some or all the validation criteria after excluding references that were hallucinated. From these, 14 distinct prognostic predictors were extracted across four outcome domains: mortality, progression, complications, and resolution. Universal high-impact predictors included gestational age (13 mentions; 41%), birth weight (8 mentions, 25%), and Apgar scores (11 mentions, 34%). Variables were categorized into three clinical tiers based on frequency, outcome breadth, and modifiability. A preliminary risk stratification model demonstrated high-risk neonates (<28 weeks, <1,000g, Apgar <3) with estimated progression risk >70%, and mortality >50%, while low-risk neonates (>32 weeks, >1,500 g, Apgar > 5) showed favorable trajectories.</p><p><strong>Conclusion: </strong>This study demonstrates that LLMs can synthesize medical literature and extract clinically relevant prognostic variables for neonatal IVH outcomes. However, LLM outputs were susceptible to hallucinations and incomplete data synthesis, underscoring the need for rigorous clinical oversight and human validation to ensure reliability. The identified universal predictors provide a foundation for developing AI-assisted clinical decision support tools. Notable research gaps include the complete absence of resolution prediction studies and limited investigation of complication predictors, highlighting opportunities for future investigation in precision neonatology.</p><p><strong>Key points: </strong>· LLMs can synthesize medical literature. · LLMs can assist in creating a prognostic ontology. · Human oversight is critical when using LLMs for healthcare.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1904-1912"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502855","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":"Characteristics and Outcomes Associated with the Attempt of External Cephalic Version in U.S. Birth Certificate Data.","authors":"Alison Verster, Easha Patel, Ronald Ramus, Amanda Robinson, Edward Springel","doi":"10.1055/a-2849-7694","DOIUrl":"10.1055/a-2849-7694","url":null,"abstract":"<p><strong>Objectives: </strong>Malpresentation is the indication for approximately 17% of primary cesarean deliveries (CD). External cephalic version (ECV) is a safe and effective procedure to reduce CD. Our primary objective is to identify associations between patient demographics and rate of ECV attempt. Secondary objectives include determining the rate of ECV attempt in the United States, and assessing neonatal and maternal outcomes associated with ECV attempt.</p><p><strong>Study design: </strong>Data were obtained from the National Center for Health Statistics birth certificate data from 2014 to 2021. We analyzed live, singleton, non-anomalous births at term (37-42 weeks). Observations lacking complete information on the mode of delivery, presentation at delivery, or whether an ECV was attempted were excluded. We reasoned that subjects who either had an ECV attempt or were non-cephalic at the time of delivery constituted an ECV-eligible cohort. The association between patient characteristics and ECV attempts was examined using logistic regression to obtain odds ratios and 95% confidence intervals.</p><p><strong>Results: </strong>A total of 30,656,644 deliveries were recorded in the database from 2014 to 2021, and 925,082 subjects met inclusion criteria and were considered ECV-eligible. Only 7.9% of the ECV-eligible population had an ECV attempt. Non-Hispanic Black and Hispanic race/ethnicity, unmarried status, lack of a college degree, non-private insurance, delayed prenatal care, increased age, lower parity, one prior CD, and increased BMI were associated with decreased rates of ECV attempt. In regards to neonatal and maternal outcomes, differences were statistically significant but absolute differences were small.</p><p><strong>Conclusion: </strong>Our findings are limited by the quality of data collection, but strongly suggest that ECV is underutilized and not uniformly offered to patients. We identified patient characteristics including race and other demographics that were associated with decreased rates of ECV attempt, and found no clinically significant differences in neonatal or maternal outcomes with ECV attempt other than decreased CD rate.</p><p><strong>Key points: </strong>· External cephalic version (ECV) is underutilized.. · Disparities exist in receiving an ECV attempt.. · ECV is safe for neonates and pregnant people..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1961-1968"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between NT-proBNP and Persistent Postpartum Hypertension among Individuals with Hypertensive Disorders of Pregnancy.","authors":"Rosemary Shay, Carrie Bennett, Caroline Smith, Janet Catov, Arun Jeyabalan, Robin Gandley, Malamo Countouris, Alisse Hauspurg","doi":"10.1055/a-2842-1208","DOIUrl":"10.1055/a-2842-1208","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the association of N-terminal pro B-type natriuretic peptide (NT-proBNP) concentration during the delivery hospitalization with persistence of postpartum hypertension and postpartum blood pressure (BP) trajectory among individuals with hypertensive disorders of pregnancy (HDP).</p><p><strong>Study design: </strong>This was a single-site cohort study including individuals with new-onset HDP who participated in a remote BP monitoring program and an obstetric biobank. Postpartum BP data were collected from the delivery hospitalization, remote monitoring program, and outpatient visits. Correlations between log(NT-proBNP) and BP values were assessed, and outcomes were compared between low-NT-proBNP (defined as less than 150 pg/mL based on previously published reference intervals in pregnancy) and high-NT-proBNP (greater than or equal to 150 pg/mL) groups.</p><p><strong>Results: </strong>A total of 111 individuals were included, with 31 (27.9%) in the low-NT-proBNP group and 80 (72.1%) in the high-NT-proBNP group. Log(NT-proBNP) had a weakly positive correlation with maximum postpartum systolic (SBP) and diastolic BP (DBP) during the delivery hospitalization. Persistent postpartum hypertension, defined as antihypertensive medication or stage two hypertension at 6 weeks postpartum, occurred in 40.0% of the high-NT-proBNP group versus 19.4% of the low-NT-proBNP group (<i>p</i> = 0.04). The high-NT-proBNP group also had significantly different maximum postpartum DBP during the delivery hospitalization (101 vs. 94 mm Hg, <i>p</i> = 0.01), maximum SBP during remote monitoring (145 vs. 139 mm Hg, <i>p</i> = 0.049), and likelihood of being on antihypertensive medication at 6 weeks postpartum (31.3 vs. 12.9%, <i>p</i> = 0.048) and at any time between delivery and 6 weeks postpartum (48.8 vs. 22.6%, <i>p</i> = 0.01) compared with the low-NT-proBNP group. The high- versus low-NT-proBNP groups had significantly different SBP trajectories over the first 14 days postpartum, with the greatest difference noted in the first 3 to 4 days.</p><p><strong>Conclusion: </strong>NT-proBNP measurement among individuals with HDP at the time of delivery may be useful in assessing risk for persistent postpartum hypertension.</p><p><strong>Key points: </strong>· This study examined the association between NT-proBNP and postpartum blood pressure (BP) outcomes.. · High NT-proBNP was associated with persistent postpartum hypertension.. · Postpartum SBP trajectory differed between high- and low-NT-proBNP groups.. · NT-proBNP may be useful in assessing risk for persistent postpartum hypertension..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1920-1926"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653553","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}