American journal of perinatology最新文献

{"title":"Trends and Contributing Factors Affecting Survival and Neurodevelopmental Outcomes in Infants Born at ≤25 Weeks' Gestation: A Retrospective Single-Center Study.","authors":"Kalsang Dolma, Diksha Shrestha, Ramachandra Bhat, Manimaran Ramani, Fabien Eyal, Michael Zayek","doi":"10.1055/a-2800-3034","DOIUrl":"10.1055/a-2800-3034","url":null,"abstract":"<p><strong>Objective: </strong>Previous data from our institution demonstrated a decline in mortality among infants born at 22 weeks' gestation from 1998 to 2008, alongside a reduction in neurodevelopmental impairment in infants born at 23 to 24 weeks' gestation. This study aimed to analyze temporal trends and identify clinical and perinatal factors associated with survival and neurodevelopmental outcomes in periviable infants (gestational age ≤25 weeks) born between 2009 and 2020.</p><p><strong>Study design: </strong>This retrospective cohort study was conducted at a single level III neonatal intensive care unit. Infants born at ≤25 weeks' gestation were grouped into two epochs: 2009 to 2014 and 2015 to 2020. Survival, major in-hospital morbidities, and neurodevelopmental outcomes at 2 years' corrected age were compared. Clinical practice changes during the study period were evaluated as potential contributors to variations in outcome.</p><p><strong>Results: </strong>A total of 672 infants were included (Epoch 1 [E1]: <i>n</i> = 316; Epoch 2 [E2]: <i>n</i> = 356) during the study period. Survival rates were similar between epochs (E1 vs. E2; 76 vs. 78%; <i>p</i> = 0.42). However, rates of grade 2 or 3 bronchopulmonary dysplasia (41 vs. 57%; <i>p</i> < 0.01) and oxygen use at discharge (23 vs. 47%; <i>p</i> < 0.01) increased significantly in Epoch 2. The prevalence of severe neurodevelopmental impairment also rose substantially (19 vs. 38%; <i>p</i> < 0.01). Follow-up at 2 years declined markedly in Epoch 2 (75 vs. 40%; <i>p</i> < 0.01), limiting confidence in long-term outcome estimates. Notably, a shift in clinical practice toward higher oxygen saturation targets was associated with this increase in pulmonary and neurodevelopmental morbidity.</p><p><strong>Conclusion: </strong>Although survival rates for infants born at ≤25 weeks' gestation have stabilized, the concurrent rise in pulmonary and neurodevelopmental morbidities signals the need for improved care strategies, particularly oxygen management, and emphasizes the importance of long-term monitoring for this vulnerable population.</p><p><strong>Key points: </strong>· Survival rates at ≤25 weeks have plateaued at our single center over the past decade.. · Pulmonary morbidities have increased, likely influenced by evolving care practices.. · Neurodevelopmental outcomes are worsening, highlighting the need to improve intact survival..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1580-1589"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177365","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":"Whole-Body Hypothermia for Hypoxic-Ischemic Encephalopathy and Route of Delivery.","authors":"Sneha Paranandi, Fabrizio Zullo, Kelley Z Kovatis, Anthony C Sciscione, Matthew K Hoffman, Suneet P Chauhan","doi":"10.1055/a-2811-5092","DOIUrl":"10.1055/a-2811-5092","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the antenatal and intrapartum characteristics of newborns at ≥36.0 weeks, who underwent whole-body hypothermia for hypoxic-ischemic encephalopathy (HIE) and had either cesarean or vaginal deliveries.</p><p><strong>Study design: </strong>Retrospectively, we identified all non-anomalous singletons at ≥36.0 weeks who had HIE and underwent whole-body hypothermia at a community teaching hospital. Differences in baseline characteristics and intrapartum factors were compared among the cesarean versus vaginal deliveries using chi-square tests. Multivariable Poisson regression models were used to estimate the association between delivery route and various outcomes with adjustment for potential confounders.</p><p><strong>Results: </strong>Of the 32,765 deliveries during the study period, 132 (0.4%) met the inclusion criteria, and among them, 79 (59.8%) had cesarean deliveries, and the remaining 53 (40.1%) had vaginal births. The prenatal care providers (i.e., private, community hospital faculty, or others) differed significantly between the two groups (<i>p</i> = 0.013). Within 60 minutes of hospitalization, the characteristics of fetal heart rate tracing (FHRT) and its category (I, II, or III) did not differ between the groups. Sentinel events occurred among 25.3% of those who had cesarean and 30.2% of those who delivered vaginally (<i>p</i> = 0.556). FHRT 60 minutes prior to delivery did not differ with regard to the presence of decelerations (<i>p</i> = 0.409), and variability (<i>p</i> = 0.199), but whether it was category I, II, or III (<i>p</i> = 0.030) did vary significantly. The likelihood of neonatal seizure (adjusted incidence rate ratio = 1.03; 95% confidence interval: 0.41-2.58) and mortality (1.10; 0.03-45.5) were similar between the groups.</p><p><strong>Conclusion: </strong>Occurring in approximately 4 per 1,000 deliveries at a community teaching hospital, the majority of singletons who had whole-body cooling had cesarean delivery. While the category of FHRT did not differ significantly within 60 minutes of admission, it did differ 60 minutes before birth.</p><p><strong>Key points: </strong>· Whole-body hypothermia (WBH) occured in 4/1,000 births.. · About 60% of newborns with WBH had cesarean delivery.. · Neither braddycardia nor tachycardia was noted with 132 cases of WBH.. · Categories of fetal heart rate tracing differed significantly among those delivered vaginal versus cesarean..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1665-1672"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206395","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":"Assessment of Kidney Function and Acute Kidney Injury following Transcatheter Patent Ductus Arteriosus Closure in Preterm Infants.","authors":"Dipen Vyas, Timothy Martin, Aditya Patel, Andrew Michael South, Parvesh Mohan Garg","doi":"10.1055/a-2798-8294","DOIUrl":"10.1055/a-2798-8294","url":null,"abstract":"<p><strong>Objective: </strong>Transcatheter patent ductus arteriosus closure (TCPC) has been increasingly used in preterm infants. Hemodynamically significant patent ductus arteriosus (hsPDA) owing to ductal steal and changes in kidney perfusion is associated with the risk of acute kidney injury (AKI) and changes in kidney function. There is limited evidence describing changes in kidney function following TCPC and factors affecting the same. We conducted this study with aim of reviewing the prevalence of AKI and changes in kidney function following TCPC in preterm infants.</p><p><strong>Study design: </strong>A single-center retrospective cohort study was conducted to collect data from January 1, 2017, to February 29, 2024. Preterm infants born <29 w of gestational age (GA) receiving TCPC were included in the study. The primary outcome was AKI prevalence and kidney function following TCPC. AKI was defined as per the modified neonatal kidney disease: Improving Global Outcomes (KDIGO) criteria using serum creatinine (SCr) and urine output.</p><p><strong>Results: </strong>A total of 89 infants fulfilled inclusion criteria. Included infants were predominantly female (50, 59.7%), had median GA of 25 w (IQR: 24-27), and median birth weight of 700 g (IQR: 600-863). AKI developed in five infants (5.6%) following TCPC using SCr criteria. Four infants (4.5%) had stage 1 and one (1.1%) had stage 2 AKI. Overall, 14% reduction in SCr levels was seen following TCPC (median pre-TCPC, 0.28 mg/dL [IQR: 0.21-0.35], median, 5 to 7 days post-TCPC, 0.24 mg/dL [IQR: 0.18-0.29], <i>p</i> < 0.001). Infants who developed AKI had an initial rise in SCr followed by 37% reduction by 5 to 7 days (pre-TCPC: 0.41 mg/dL [IQR: 0.27-0.51]; median, 24 hours post, 0.57 mg/dL [IQR: 0.29-1.22]; median, 5 to 7 days post, 0.26 mg/dL [IQR: 0.19-0.67], <i>p</i> = 0.07).</p><p><strong>Conclusion: </strong>In preterm infants undergoing TCPC, a small percentage of infants developed mild AKI which improved quickly within 1 week post-TCPC. Overall, there was a significant and persistent improvement in kidney function following TCPC.</p><p><strong>Key points: </strong>· Incidence of AKI following transcatheter PDA closure is low (5%) and majority had grade 1 AKI.. · Serum Cr levels reduced by 14% within 48 hours of TCPC; reduction was higher in infants with AKI.. · Each day increase in age at time of TCPC was associated with 18% lower odds of developing AKI..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1572-1579"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12883097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083792","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":"Utility of Prenatal Nutrition Consult in Achieving Recommended Weight Gain in Diamniotic Twin Pregnancies.","authors":"Elena Lands, Rachel Wood, Andrea Pelletier, Carolina Bibbo","doi":"10.1055/a-2937-2740","DOIUrl":"10.1055/a-2937-2740","url":null,"abstract":"<p><strong>Objective: </strong>Nutritional education in twin gestations improves perinatal outcomes. Our objective was to determine if a prenatal nutrition consultation led to more patients with diamniotic twin pregnancies achieving adequate weight gain according to Institute of Medicine (IOM) guidelines.</p><p><strong>Study design: </strong>We collected data of a retrospective cohort of diamniotic twin pregnancies cared for by maternal-fetal medicine specialists at one academic institution from January 2021 to December 2022. Patients were grouped based on whether they received at least one outpatient nutrition consult, and these groups were compared based on whether they met weight gain guidelines or not and other perinatal outcomes. Analyses were performed with Chi-square, <i>t</i>-tests, and multivariable logistic regression adjusted for characteristics that were significantly associated with each outcome.</p><p><strong>Results: </strong>Nutrition consultation was associated with a significantly higher rate of meeting IOM goals (59 vs. 29%, <i>p</i> = 0.003) and a significantly higher mean total weight gain (17.9 vs. 13.4 kg, <i>p</i> < 0.001). Mean gestational age at delivery was 5.6 days later in the nutrition group (<i>p</i> = 0.04). When adjusted for age, race, parity, marital status, pre-gravid BMI, and chorionicity, those who did not receive a nutrition consult had over doubled odds of delivery before 34 weeks (aOR 2.65, 95% CI: 1.12-6.23).</p><p><strong>Conclusion: </strong>One prenatal nutrition consult in diamniotic twin pregnancies resulted in a significantly higher proportion of patients meeting IOM weight gain goals and significantly fewer births before 34 weeks.</p><p><strong>Key points: </strong>· A single prenatal nutrition consult helps appropriate weight gain in diamniotic twin pregnancies.. · Nutrition consult is associated with fewer preterm births.. · Nutrition consult should be routine for twin pregnancies and is paid for by most U.S. payors..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761407","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":"Hypertensive Disorders of Pregnancy: Factors Associated with Multiple Postpartum Blood Pressure Visits.","authors":"Lillian J Dyre, Danielle L Falde, Megan E Branda, Regan N Theiler, Yvonne S Butler Tobah, Enid Y Rivera-Chiauzzi","doi":"10.1055/a-2809-6441","DOIUrl":"10.1055/a-2809-6441","url":null,"abstract":"<p><strong>Objective: </strong>Patients with hypertensive disorders of pregnancy (HDPs) are recommended to attend an early postpartum follow-up visit for blood pressure monitoring. Follow-up frequency for patients with HDPs can vary widely, with some patients requiring multiple office visits. We sought to determine factors associated with multiple postpartum blood pressure visits among patients with HDPs.</p><p><strong>Study design: </strong>We retrospectively identified patients with HDPs who delivered at our maternity center in 2019 and compared factors between patients who attended a single blood pressure follow-up appointment without requiring further clinical evaluation for hypertension and patients who required multiple postpartum clinical evaluations for persistent hypertension. Univariate logistic regression models were used to identify factors associated with increased odds of having multiple clinically indicated postpartum visits for blood pressure monitoring.</p><p><strong>Results: </strong>We identified 328 patients with HDPs, of whom 260 (79.3%) attended an initial postpartum blood pressure follow-up appointment and were included in further analyses. Of the 260 patients, 70 (26.9%) had multiple blood pressure visits. Factors associated with multiple blood pressure visits included delivery between 34 and less than 37 weeks of gestation (odds ratio [OR], 3.62; 95% CI, 1.07-12.30), systolic blood pressure before discharge of 140 mm Hg or higher (OR, 5.02; 95% CI, 2.57-9.82), and discharge with blood pressure medication (OR, 3.42; 95% CI, 1.82-6.41).</p><p><strong>Conclusion: </strong>Patients with HDPs who deliver preterm, have persistent hypertension before discharge, or are discharged with antihypertensive medication require continued close postpartum observation and continuity of care.</p><p><strong>Key points: </strong>· Postpartum follow-up care for patients with HDPs should be tailored to the patient.. · Preterm delivery, persistence of hypertensive blood pressure at discharge, and discharge with antihypertensive medication are associated with multiple postpartum ambulatory office visits.. · High-risk patients should be diligently monitored with postpartum continuity of care..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1657-1664"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347086","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 Equivalence of Fetal Heart Rate Variability and Accelerations in the Interpretation of Non-Stress Tests.","authors":"Grace J Johnson, Alison N Goulding, Stacie G Denning, Steven L Clark","doi":"10.1055/a-2814-9328","DOIUrl":"10.1055/a-2814-9328","url":null,"abstract":"<p><strong>Objective: </strong>Accelerations were initially chosen as the basis for non-stress test (NST) interpretation against a background of significant artifact present in the first-generation, non-autocorrelated fetal monitors that made the interpretation of variability with external fetal heart rate (FHR) monitoring unreliable. Since moderate variability and accelerations are both physiologically similar and equally indicative of a non-acidemic fetus, we hypothesized that interpreting NSTs based on variability rather than accelerations would produce similar results.</p><p><strong>Study design: </strong>We performed a retrospective cohort study of singleton fetuses undergoing antenatal testing in our system between 2011 and 2022. Data regarding the interpretation of NSTs were extracted and non-reactive tests were identified. For patients with non-reactive NSTs, data regarding follow-up testing were collected.</p><p><strong>Results: </strong>Our cohort included 76,232 total NSTs performed on 22,619 patients at increased risk of fetal demise, of which 1,662 (2%) were found to be non-reactive. Of the non-reactive tests, 1,499 (90%) were interpreted as having moderate variability, 114 (7%) had minimal or absent variability, and in 49 (3%), the variability was uncertain. Data regarding follow-up testing were available for 1,480 of the 1,499 non-reactive tests with moderate variability. In this group, 1,476 (99%) went on to have either reassuring follow-up testing. The four infants (0.3%) who failed to have a reassuring follow-up test all had major anomalies.</p><p><strong>Conclusion: </strong>In nonanomalous fetuses, moderate variability in an otherwise non-reactive NST was invariably followed by a reassuring test of fetal well-being. These data confirm basic science observations regarding FHR regulation and suggest that, in the presence of moderate variability during an otherwise non-reactive NST, additional follow-up testing may not be necessary. Such an approach would avoid the need for additional testing in 90% of fetuses with non-reactive NSTs.</p><p><strong>Key points: </strong>· A clinical distinction between moderate variability and an acceleration represents historical artifact.. · Nonanomalous fetuses with a nonreactive nonstress test but moderate variability invariably had reassuring subsequent testing.. · These clinical observations confirm known basic science physiology.. · In the antepartum evaluation of fetal well- being, moderate variability and accelerations are clinically equivalent..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1673-1677"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218347","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":"Fetal and Neonatal Heart Rate Trends in Preterm Delivery: A Clinical Study from the Week before to the Week after Birth.","authors":"Chantal Eenkhoorn, Tom G Goos, Arie Franx, Jenny Dankelman, H Rob Taal, Sten P Willemsen, Alex J Eggink","doi":"10.1055/a-2806-2923","DOIUrl":"10.1055/a-2806-2923","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore the fetal heart rate trend in the week before birth, the transition from fetal to neonatal heart rate, and the neonatal heart rate trend in the week after birth in preterm neonates admitted to a tertiary care hospital, considering maternal and neonatal factors.</p><p><strong>Study design: </strong>A retrospective cohort study was conducted, including neonates born between 24 and 34 weeks of gestation. Baseline heart rate, average deceleration capacity, standard deviation, skewness, and sample entropy were assessed using interrupted time series and difference-in-differences analyses. Subgroup analyses were performed according to gestational age at birth, sex, birth weight, mode of delivery, Apgar score at 5 minutes, umbilical cord pH, and neonatal medication.</p><p><strong>Results: </strong>The fetal and neonatal heart rate of 123 patients was analyzed. After birth, step change of baseline (2.23 bpm, <i>p</i> < 0.05), average deceleration capacity (0.43 bpm, <i>p</i> < 0.001), and skewness (0.47 nu, <i>p</i> < 0.001) increased, while sample entropy (-0.68 bits, <i>p</i> < 0.001) and standard deviation (-1.15 bpm, <i>p</i> < 0.001) decreased. Postnatally, baseline increased in linear slope and decreased in quadratic slope (both <i>p</i> < 0.001). Average deceleration capacity decreased in linear slope (<i>p</i> < 0.001). Sample entropy and standard deviation increased in linear slopes (both <i>p</i> < 0.001). Skewness increased in quadratic slope (<i>p</i> < 0.05). Subgroup analyses revealed that delivery mode, medication, and birth weight modulated these trends.</p><p><strong>Conclusion: </strong>This study provides unique insights into heart rate frequency and variability trends during the period around preterm birth. It highlights the dynamic physiological adaptation that occurs during the transition from intrauterine to extrauterine life in preterm infants and may help inform future research on fetal and neonatal monitoring and clinical management.</p><p><strong>Key points: </strong>· Heart rate frequency and variability dynamics were assessed around preterm birth in a NICU cohort.. · After birth, heart rate frequency increased while variability measures decreased.. · Heart rate frequency and variability differed by gestational age, birth weight, medication, and delivery mode..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1613-1620"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275408","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":"Perinatal and Maternal Outcomes by Indication for Delivery in the Second Trimester.","authors":"Kristen A Cagino, Paula L McGee, Maged M Costantine, Michael W Varner, Alan T N Tita, Monica Longo, Barbara J Stoll, John M Thorp, Uma M Reddy, William A Grobman, Dwight J Rouse, Hyagriv N Simhan, Jennifer L Bailit, Lorraine Dugoff, George R Saade, Baha M Sibai","doi":"10.1055/a-2800-3108","DOIUrl":"10.1055/a-2800-3108","url":null,"abstract":"<p><strong>Objective: </strong>Perinatal and maternal morbidity in the setting of preterm birth may differ by delivery indication. We compared perinatal and maternal outcomes of second-trimester (24^0/7-27^6/7 weeks of gestation) deliveries indicated for preeclampsia with severe features (PE-SF), with those following preterm premature rupture of membranes (PPROM).</p><p><strong>Study design: </strong>Secondary analysis of an observational cohort study of singleton and twin preterm deliveries before 35 weeks' gestation at 33 hospitals across the United States. Singletons without congenital anomalies who were delivered due to PE-SF or PPROM from 24^0/7 to 27^6/7 weeks of gestation were included. The primary outcome was a composite of perinatal morbidity or death, defined as fetal or neonatal death, severe bronchopulmonary dysplasia (BPD) grade III, intraventricular hemorrhage (IVH) grade III to IV, necrotizing enterocolitis (NEC) stage IIA or greater, periventricular leukomalacia (PVL), retinopathy of prematurity (ROP) stage III to IV, or culture-proven sepsis. Secondary outcomes included components of the primary outcome, small-for-gestational-age (SGA) birth, and a composite of maternal morbidity. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>Among the 7,515 in the original cohort, 164 deliveries for PE-SF and 119 deliveries following PPROM were included. Individuals with PE-SF were more likely to have a BMI of ≥30 kg/m², hypertensive disorder of pregnancy in a prior pregnancy, chronic hypertension, and cesarean birth (<i>p</i> < 0.05) compared with those who delivered following PPROM. Composite perinatal morbidity or death did not differ between groups (aOR = 1.60, 95% CI: 0.89, 2.85, <i>p</i> = 0.11), but fetal death was significantly higher in the PE-SF group (aOR = 6.04, 95% CI: 1.42, 25.71). Neonates delivered for PE-SF were more likely to be SGA (aOR = 13.45, 95% CI: 2.92, 61.94). Composite maternal morbidity did not differ between groups (aOR = 1.18, 95% CI: 0.62, 2.26).</p><p><strong>Conclusion: </strong>Second-trimester preterm birth indicated for PE-SF was associated with a higher rate of fetal death than birth for PPROM. Composite neonatal and maternal morbidity did not differ by indication.</p><p><strong>Key points: </strong>· Fetal death occurred more frequently in individuals with PE-SF compared with PPROM in the second trimester.. · Composite perinatal and maternal outcomes were similar between groups.. · Our findings can be used for risk stratification and survival prediction rates..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1590-1596"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146091740","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":"Expectant Management Beyond 34 Weeks' Gestation Should Be Offered for Preterm Premature Rupture of Membranes.","authors":"Minhazur Sarker, Jeffrey D Sperling, Ukachi N Emeruwa, Elizabeth N Teal","doi":"10.1055/a-2809-6494","DOIUrl":"10.1055/a-2809-6494","url":null,"abstract":"<p><p>Delivery timing for preterm prelabor rupture of membranes (PPROM) was historically recommended at 34 weeks' gestation. Recent studies have shown expectant management of PPROM beyond 34 weeks is associated with increased antepartum or intrapartum hemorrhage and intrapartum fever and decreased risk of newborn respiratory distress, admission to neonatal intensive care unit, and cesarean delivery. Despite the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) embracing expectant management as an option to consider for PPROM, widespread uptake and implementation of this management and the nuanced discussion remain mixed. With this clinical opinion, we highlight the outcomes associated with expectant management of PPROM beyond 34 weeks, summarize the current state of the controversy, review the nationally published guidelines, and discuss our opinion on the controversy as well as future directions for research endeavors. Given the data present at this time, we believe that providers should at least routinely offer, but not necessarily recommend, the option of expectant management for PPROM beyond 34 weeks in the absence of contraindications. Foregoing this discussion limits patients' ability to make informed decisions and, worse, if not universally offered in the absence of contraindications to expectant management, may be an area of inequitable or biased care. · Recent studies have characterized outcomes with expectant management of PPROM after 34 weeks.. · There remains controversy regarding delivery timing for pregnancies complicated by PPROM.. · Expectant management should be routinely offered for PPROM in the absence of contraindications..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1688-1692"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12950273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146163475","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":"Iron Deficiency Screening with Reticulocyte-Hemoglobin Content and 2-Year Neurodevelopmental Outcomes in Extremely Low Birth Weight Infants.","authors":"Whitley N Hulse, Timothy M Bahr, Betsy Ostrander, Sarah Winter, Robin K Ohls, Tara L DuPont","doi":"10.1055/a-2806-3017","DOIUrl":"10.1055/a-2806-3017","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to assess reticulocyte-hemoglobin (RET-He) and daily iron dosing with 2-year cognitive outcomes.</p><p><strong>Study design: </strong>A multicenter retrospective cohort study of 78 infants born between 2014 and 2018 at less than 28 weeks' gestation or less than 1,250 g birth weight throughout level III or IV neonatal intensive care units (NICUs). RET-He measurement, iron supplementation, and the Bayley Scales of Infant and Toddler Development-III (Bayley-III) test were analyzed using multiple linear regression models.</p><p><strong>Results: </strong>For every 1 mg/kg increase in mean total daily iron supplementation, the Bayley-III cognitive score increased by 2.9 points (95% confidence interval [CI]: 0.4-5.4, <i>p</i> = 0.023). No associations were identified between minimum or maximum RET-He and Bayley-III cognitive outcomes. Infants with a RET-He value < 29 pg tended to be 2.53 times more likely to have a Bayley-III language score below 70 (odds ratio: 2.53, 95% CI: 0.92-6.95, <i>p</i> = 0.071). Thirty-eight out of 78 (38.4%) infants were iron-deficient during their NICU hospitalization, with at least one RET-He < 29 pg.</p><p><strong>Conclusion: </strong>An association was identified between a higher mean daily iron dose and improved cognitive outcomes for infants, but not between the iron index RET-He and neurodevelopmental outcomes. Iron deficiency remains common among NICU patients undergoing follow-up, suggesting that standard iron dosing may be inadequate for high-risk neonates.</p><p><strong>Key points: </strong>· Higher daily iron dose improves cognitive outcomes.. · Reticulocyte-hemoglobin level is not associated with neurodevelopmental outcomes.. · Iron deficiency is common in very low birth weight infants, affecting 38.4%..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1621-1625"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257048","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}