American journal of perinatology最新文献

{"title":"What Is Culture Made of? An Exploratory Study of Ethical Cultures and Provider Perspectives on the Care of Periviable Neonates.","authors":"Shannon Y Adams, Jessica T Fry, Natalia Henner","doi":"10.1055/a-2405-3336","DOIUrl":"10.1055/a-2405-3336","url":null,"abstract":"<p><strong>Objective: </strong> Studies examining intercenter variation in neonatal intensive care unit practices at the limits of fetal viability have hypothesized that institutional \"culture\" can be one of many factors that impact patient care. This study aimed to describe institutional culture at a single, large academic center with regard to the antenatal consultation, resuscitation, and postnatal management of periviable neonates.</p><p><strong>Study design: </strong> Members of six clinical groups-attending and fellow maternal-fetal medicine physicians, attending and fellow neonatal-perinatal medicine physicians, neonatal nurses, advanced practiced neonatal nurses, pediatric hospitalist physicians, and neonatal respiratory therapists-were invited to complete qualitative, semi-structured interviews. All audio recordings were transcribed. Dedoose software was used to complete team-based coding and thematic analysis.</p><p><strong>Results: </strong> Twenty-two interviews were completed. Thematic analysis revealed three central themes described by participants as contributory to institutional culture: <i>Perception</i>, referring to factors based on individual attitudes and insights, <i>Statements of Information</i>, referring to factors anchored in more objective concepts such as outcomes data and institutional policy, and <i>Dynamic Factors</i>, referring to the relatively fluid factors of institutional culture that interact with both <i>Perception</i> and <i>Statements of Information</i>. Participants were more likely to mention factors in the <i>Perception</i> category (<i>n</i> = 430) compared with factors in the <i>Information</i> category (<i>n</i> = 225), and although the latter were described as critical components of antenatal counseling and perinatal management, the philosophy of our unit appeared to be more heavily rooted in institutional memory and individual belief systems.</p><p><strong>Conclusion: </strong> Our data demonstrate a personal undertone to institutional culture at the limits of viability, with an emphasis on individual attitudes and subjective interpretations of fact rather than empirical data. As the landscape of neonatology continues to change, understanding those factors that contribute to culture remains a necessary step toward deconstructing institutional belief systems and optimizing clinical care.</p><p><strong>Key points: </strong>· Institutional culture is the collective norms and attitudes that help guide organizational behavior.. · Institutional culture may be one of many factors that impact the care of periviable neonates.. · Deconstructing culture helps us better understand our clinical environment and optimize patient care..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"502-510"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279082","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":"Deimplementation of Routine Maternal Oxygen Supplementation for Intrauterine Fetal Resuscitation: A Retrospective Cohort Study.","authors":"Sarah E Chisholm, Mariella Gastanaduy, Adrem Elmayan, Frank B Williams","doi":"10.1055/a-2405-1687","DOIUrl":"10.1055/a-2405-1687","url":null,"abstract":"<p><strong>Objective: </strong> Current practice guidelines for laboring patients with category II intrapartum tracings recommend maternal oxygen supplementation despite emerging randomized data challenging its benefit and utility. We aim to validate that de-implementing maternal oxygen supplementation for fetal resuscitation did not increase the risk of neonatal acidemia in a real-world setting.</p><p><strong>Study design: </strong> This is a retrospective observational study conducted at a single tertiary care center from January 2019 to June 2021. All laboring deliveries during the study period were reviewed and eligible participants included singleton or twin pregnancies between 23 and 42 weeks gestational age with persistent category II tracings. Known major fetal anomalies, contraindications to labor, and maternal indication for O₂ supplementation, including active coronavirus disease 2019, were excluded. Cohorts were allocated based on the time of delivery. Those occurring prior to our hospital policy change were identified as historical controls and deliveries after April 1, 2020, as the postdeimplementation cohort. The primary outcome was fetal acidemia, defined as umbilical cord pH < 7.2. Secondary outcomes included severe acidemia (pH < 7.0), 5-minute Apgar score <4, and neonatal intensive care admission. Regression analyses controlling for known variables associated with neonatal acidemia generated adjusted odds ratios (aORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong> Among 9,088 deliveries during the study period, 1,162 tracings were flagged as persistent category II, including 681 (59%) in the postintervention group. The two cohorts had comparable baseline and obstetric characteristics. No difference in neonatal acidemia was observed between the postdeimplementation group and historical controls (13.8 vs. 15.4%, aOR = 0.87, 95% CI: 0.62, 1.22). Severe acidemia, 5-minute Apgar <4, and neonatal intensive care admission were not increased in the postdeimplementation group.</p><p><strong>Conclusion: </strong> De-implementation of routine maternal oxygen supplementation for fetal resuscitation did not increase the likelihood of neonatal acidemia in a real-world setting, validating guidelines recommending against the intervention.</p><p><strong>Key points: </strong>· De-implementation of maternal O2 supplementation for fetal resuscitation did not increase acidemia.. · Real-world experience validates experimental findings regarding maternal oxygenation.. · Other perinatal outcomes reflected no difference in fetal acidemia..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"471-477"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103489","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":"Corrigendum: Impact of Patient Safety Bundle and Team-Based Training on Obstetric Hypertensive Emergencies.","authors":"Laura Grogan, Erika Peterson, Megan Flatley, Amy Domeyer-Klenske","doi":"10.1055/a-2522-3118","DOIUrl":"10.1055/a-2522-3118","url":null,"abstract":"","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"e1-e2"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370115","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":"Association of Parental Interactions and Therapies with Cerebral Oxygenation Variability in the Neonatal Intensive Care Unit.","authors":"Presley Volkema, Lisa Letzkus, Michael Spaeder, Santina Zanelli","doi":"10.1055/a-2435-1066","DOIUrl":"10.1055/a-2435-1066","url":null,"abstract":"<p><strong>Objective: </strong> This study evaluated the association of parental interactions and therapies with cerebral oxygenation (rScO₂) and rScO₂ variability in infants using near-infrared spectroscopy.</p><p><strong>Study design: </strong> Prospective pilot study in clinically stable infants admitted to the neonatal intensive care unit (NICU). Infants were monitored continuously for 48 hours, and rScO₂ during parental interactions and therapies was compared with periods of no activity. rScO₂ variability was derived using the root mean of successive squared differences of averaged 1-minute rScO₂ values. Wilcoxon matched-pairs signed-rank test was used to compare baseline and activity periods.</p><p><strong>Results: </strong> Data analysis included 23 infants. rScO₂ variability increased during periods of parental interaction (<i>p</i> = 0.04) and during combined parental interaction and therapies (<i>p</i> = 0.04).</p><p><strong>Conclusion: </strong> We observed that routine NICU interventions are associated with increased rScO₂ variability in clinically stable NICU patients. rScO₂ variability may represent a useful biomarker for the early determination of the safety and efficacy of NICU interventions.</p><p><strong>Key points: </strong>· Low rScO2 variability is linked to poor outcomes.. · Parental interactions increase rScO2 variability.. · rScO2 variability may be a useful biomarker.. · rScO2 variability may predict outcomes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"533-537"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387317","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":"Placenta and Intestinal Injury in Preterm Infants.","authors":"Padma Garg, Jörn-Hendrik Weitkamp, Anna G McDonald, Sarah N Cilvik, Imran Mir, Jeffrey S Shenberger, Oluwabunmi Olaloye, Liza Konnikova, Suhas G Kallapur, Parvesh M Garg","doi":"10.1055/a-2347-4135","DOIUrl":"10.1055/a-2347-4135","url":null,"abstract":"<p><p>Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal conditions affecting 6 to 10% of low-birth-weight infants and remains a leading cause of death. The risk factors associated with NEC are complex and multifactorial, including preterm birth and intrauterine exposure to inflammation and hypoxia. Chorioamnionitis has been associated with intestinal injury in animal and human clinical studies. This review presents current evidence about the clinical impact of the intrauterine environment on intestinal injury during pregnancy and postpregnancy. We present information from our own clinical and laboratory research in conjunction with information collected from an extensive search in the databases PubMed, EMBASE, and Scopus. Prospective multicenter studies, including accurate and precise clinical, maternal, and laboratory predictors (e.g., inflammatory biomarkers), will help identify the mechanisms associated with the placental pathology, the development of NEC, and the impact of in utero-triggered inflammation on the clinical outcomes. Filling the knowledge gap to link the inflammatory surge to postnatal life will aid in identifying at-risk infants for NEC in a timely manner and facilitate the development of novel immunomodulatory treatments or interventions to improve the outcomes of these vulnerable infants. KEY POINTS: · Placental inflammatory and vascular lesions are associated with NEC severity.. · Higher grade chorioamnionitis with a fetal response is associated with an increased risk of surgical NEC.. · There is a need for routine bedside utilization of placenta pathology in clinical decision-making..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"415-419"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141417301","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":"Vascular Placental Pathology and Cardiac Structure in Stillborn Fetuses.","authors":"Alexa A Freedman, Tess E K Cersonsky, Halit Pinar, Robert L Goldenberg, Robert M Silver, Linda M Ernst","doi":"10.1055/a-2405-1621","DOIUrl":"10.1055/a-2405-1621","url":null,"abstract":"<p><strong>Objective: </strong> Adverse pregnancy outcomes, including preterm birth and preeclampsia, are associated with worse cardiovascular outcomes for offspring. Examination of the placenta is important for understanding how the prenatal period shapes long-term cardiovascular health. We sought to investigate the association between placental vascular malperfusion and fetal cardiac structure.</p><p><strong>Study design: </strong> Data obtained from the Stillbirth Collaborative Research Network included stillbirths with placental pathology and autopsy. Stillbirths were classified in two ways: based on the severity of placental maternal vascular malperfusion (MVM) and based on the cause of death (MVM, fetal vascular malperfusion [FVM], or acute infection/controls). Organ weight and heart measures were standardized by gestational age (GA) and compared across groups.</p><p><strong>Results: </strong> We included 329 stillbirths in the analysis by MVM severity and 76 in the analysis by cause of death (COD). While <i>z</i>-scores for most organ weights/heart measures were smaller when COD was attributed to MVM as compared with FVM or controls, heart weight and brain weight <i>z</i>-scores did not differ by COD (<i>p</i> > 0.05). In analyses accounting for body size, the difference between heart and body weight z-score was -0.05 (standard deviation [SD]: 0.53) among those with MVM as a COD and -0.20 (SD: 0.95) among those with severe MVM. Right and left ventricle thicknesses and tricuspid, pulmonary, mitral, and aortic valve circumferences were consistently as expected or larger than expected for GA and body weight. In the analysis investigating the severity of MVM, those with the most severe MVM had heart measures that were as expected or larger than expected for body weight while those with only mild to moderate MVM had heart measures that were generally small relative to body weight.</p><p><strong>Conclusion: </strong> When assessed as COD or based on severity, MVM was associated with heart measures that were as expected or larger than expected for GA and body weight, indicating possible heart sparing.</p><p><strong>Key points: </strong>· Fetal deaths with MVM show smaller organ weights.. · Heart weight sparing is seen with fetal death attributed to MVM.. · Heart weight sparing is more pronounced with severe MVM..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"462-470"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103509","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":"Impact of Inpatient Patient-Provider Language Concordance on Exclusive Breastfeeding Rates Postpartum.","authors":"Alexandra M Abbate, Alexander M Saucedo, Jeny Ghartey, Julia López, Miriam Alvarez, Emily Hall, Elaine Avshman, Odera Okafor, Megan Olshavsky, Lorie M Harper, Alison G Cahill","doi":"10.1055/s-0044-1789587","DOIUrl":"10.1055/s-0044-1789587","url":null,"abstract":"<p><strong>Objective: </strong> Studies outside of obstetrics suggest that patient-provider language concordance may impact the efficacy of educational interventions and overall patient satisfaction. Many pregnant patients who present to the hospital for delivery with initial plans to exclusively breastfeed ultimately leave the hospital supplementing with formula. We aim to examine the impact of language concordance between patients and their primary bedside nurse during the delivery hospitalization period on the relationship between intended and actual feeding practices for term newborns of primiparous patients at a single institution.</p><p><strong>Study design: </strong> This is a single-center, prospective cohort of primiparous patients with term, singleton gestations admitted for delivery between February 2022 and January 2023. Participants completed a predelivery survey on arrival and a postpartum survey before hospital discharge. The primary outcome was the association between nurse-patient language concordance and postpartum exclusive breastfeeding. Multiple logistic regression analysis was performed to assess the primary outcome, and <i>p</i>-values < 0.05 were considered significant.</p><p><strong>Results: </strong> Overall, 108 participants were surveyed, of which 84 (77.8%) noted language concordance with their primary nurse and 24 (22.2%) reported language discordance. The race/ethnicity, language spoken at home, reported plans to return to work, WIC (special supplemental nutrition program for women, infants, and children) enrollment, and prenatal feeding plan variables revealed significant differences in reported language concordance. Following adjustment for patient-reported prenatal feeding plan, patients who reported language concordance with their primary nurse were significantly more likely to exclusively breastfeed in the immediate postpartum period (adjusted odds ratio, 5.60; 95% confidence interval, 2.06-16.2).</p><p><strong>Conclusion: </strong> Patients who reported language concordance with their primary nurse were significantly more likely to breastfeed exclusively in the immediate postpartum period. These findings highlight that language concordance between patients and bedside health care providers may contribute to initiating and continuing exclusive breastfeeding during the peripartum period.</p><p><strong>Key points: </strong>· Patients who reported language concordance with their primary nurse were more likely to breastfeed.. · Patient-Provider language concordance may impact infant feeding decisions in the postpartum period.. · More research is needed to further explore the impact of language concordance with other providers..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"435-441"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103493","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":"Identifying Elective Induction of Labor among a Diverse Pregnant Population from Electronic Health Records within a Large Integrated Health Care System.","authors":"Fagen Xie, Michael J Fassett, Theresa M Im, Daniella Park, Vicki Y Chiu, Darios Getahun","doi":"10.1055/a-2405-3703","DOIUrl":"10.1055/a-2405-3703","url":null,"abstract":"<p><strong>Objective: </strong> Distinguishing between medically indicated induction of labor (iIOL) and elective induction of labor (eIOL) is a daunting process for researchers. We aimed to develop a Natural Language Processing (NLP) algorithm to identify eIOLs from electronic health records (EHRs) within a large integrated health care system.</p><p><strong>Study design: </strong> We used structured and unstructured data from Kaiser Permanente Southern California's EHRs of patients who were <35 years old and had singleton deliveries between 37 and 40 gestational weeks. Induction of labor (IOL) pregnancies were identified if there was evidence of an IOL diagnosis code, procedure code, or documentation in a delivery flowsheet or progress note. A comprehensive NLP algorithm was developed and refined through an iterative process of chart reviews and adjudications, where IOL-associated reasons (medically indicated vs. elective induction) were reviewed. The final algorithm was applied to discern the indications of IOLs performed during the study period.</p><p><strong>Results: </strong> A total of 332,163 eligible pregnancies were identified between January 1, 2008, and December 31, 2022. Of these eligible pregnancies, 68,541 (20.6%) were IOL, of which 6,824 (10.0%) were eIOL. Validation of the NLP process against 300 randomly selected pregnancies (100 eIOL, iIOL, and non-IOL cases each) yielded a positive predictive value of 83.0% and 88.0% for eIOL and iIOL, respectively. The rates of eIOL among the maternal age groups ranged between 9.6 and 10.3%, except for the <20 years group (12.2%). Non-Hispanic White individuals had the highest rate of eIOL (13.2%), while non-Hispanic Asian/Pacific Islanders had the lowest rate of eIOL (7.8%). The rate of eIOL increased from 1.0% in the 37-week gestational age (GA) group to 20.6% in the 40-week GA group.</p><p><strong>Conclusion: </strong> Findings suggest that the developed NLP algorithm effectively identifies eIOL. It can be utilized to support eIOL-related pharmacoepidemiological studies, fill in knowledge gaps, and provide content more relevant to researchers.</p><p><strong>Key points: </strong>· An NLP algorithm was developed to identify indications of IOL.. · The study algorithm was successfully implemented within a large integrated health care system.. · The study algorithm can be utilized to support eIOL-related studies..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"495-501"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103492","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":"Expanded Fetal Growth Restriction Definition Identifies High Proportion of Umbilical Artery Doppler Anomalies.","authors":"Angela Nakahra, Miranda Long, Ardem Elmayan, Joseph R Biggio, Frank B Williams","doi":"10.1055/a-2435-0468","DOIUrl":"10.1055/a-2435-0468","url":null,"abstract":"<p><strong>Objective: </strong> Fetal growth restriction (FGR) increases the risk for perinatal morbidity and mortality. The Society for Maternal-Fetal Medicine expanded the definition of FGR to independently include abdominal circumference (AC) < 10th percentile for gestational age (GA), regardless of estimated fetal weight (EFW). While studies have shown increased detection of small for GA neonates with expanded definition, no studies have evaluated the likelihood of abnormal umbilical artery Dopplers (UAD) detection with expanded definition. The objective of this study was to compare the likelihood of identifying UAD abnormalities in fetuses with normal EFW and restricted AC versus those by EFW alone.</p><p><strong>Study design: </strong> Single-institution retrospective cohort study of fetal growth ultrasounds meeting criteria for FGR either by EFW < 10th percentile or AC < 10th percentile with normal EFW. Those with FGR by AC alone were compared with those with FGR by EFW. Primary outcome was prevalence of UAD abnormalities, including elevated systolic/diastolic ratio, and absent and/or reversed end diastolic velocity. Receiver operator characteristic curves were generated to compare predictive value of UAD abnormalities by FGR definition.</p><p><strong>Results: </strong> A total of 619 scans met criteria for FGR between November 2020 and June 2021, with 441 (71%) meeting definition by EFW and 178 (29%) by AC criteria alone. Baseline characteristics were similar between groups. FGR by AC alone was identified earlier (30.4 ± 3.3 vs. 35.4 ± 3.0 weeks' gestation, <i>p</i> < 0.001) with higher proportion identified before 32 weeks (70 vs. 11%, <i>p</i> < 0.001). Proportion of abnormal UAD were similar between groups (15 vs. 15%, adjusted odds ratio: 1.12, 95% confidence interval: 0.61-2.23). Use of EFW alone would have failed to identify 29% of abnormal UAD. A combined definition of FGR had the highest detection of abnormal UAD (area under curve: 0.78 vs. AC alone 0.73 vs. EFW alone 0.69).</p><p><strong>Conclusion: </strong> A definition of FGR that considers both EFW and AC improves detection of abnormal UAD.</p><p><strong>Key points: </strong>· Fetuses with restricted AC are equally likely to exhibit abnormal UAD indices compared with those that meet criteria by EFW.. · Earlier GA of FGR detection and improved detection of abnormal UAD with expanded growth definition.. · Expanded definition of FGR significantly improves detection of abnormal UAD as compared with those diagnosed with EFW criteria alone.. · Expanded growth restriction definition improves Doppler identification..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"526-532"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387320","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":"Association between induction start time and labor duration in nulliparous women undergoing elective induction of labor.","authors":"Francesca Lucia Facco, Cora MacPherson, Uma Reddy, Alan Tita, Robert M Silver, Yasser El-Sayed, Ronald Wapner, Dwight J Rouse, George Saade, John M Thorp, Suneet P Chauhan, Maged M Costantine, Edward Chien, Kent Heyborne, Sindhu K Srinivas, Geeta K Swamy, William A Grobman","doi":"10.1055/a-2547-4196","DOIUrl":"https://doi.org/10.1055/a-2547-4196","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between elective induction of labor (EIOL) start time and labor duration among nulliparous women Methods: The ARRIVE trial was a multi-center randomized controlled trial of induction of labor at 39 weeks 0 days to 39 weeks 4 days versus expectant management in low-risk nulliparous women. In this secondary analysis, we included participants randomized to the induction group who had an EIOL without spontaneous labor or rupture of membranes prior to the induction start. Start time of EIOL was categorized as: early AM (midnight to 5:59 AM), late AM (6 AM-11:59 AM), early PM (noon-5:59 PM), or late PM (6 PM-11:59 PM). The primary outcome was labor duration. Cesarean delivery rates by induction start time were also examined. Multivariable analysis was conducted controlling for age, body mass index, insurance status, and modified Bishop score on admission (< 5 or ≥5).</p><p><strong>Results: </strong>Of 3,062 women randomized to EIOL, 2,197 were included in this analysis. EIOL occurred in the early AM in 13%, in late AM in 28%, in early PM in 13%, and in late PM in 45%. Participants induced in the late AM had the shortest mean labor durations (21.5 ±11.3 hours) and the highest frequency of delivery at < 24 hours (68%). In adjusted analyses, induction in the late AM (vs. grouped other time periods) remained significantly associated with shorter labor duration (-1.5 hrs, 95% CI -2.5, -0.4, p=0.006), and there was no interaction between Bishop score and time of EIOL. Cesarean delivery rates did not differ by start time.</p><p><strong>Conclusions: </strong>Induction of labor starting between 6AM and 11:59 AM was associated with shorter labor durations, independent of baseline maternal characteristics including cervical status on admission.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522405","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}