American journal of perinatology最新文献

{"title":"Transcranial Doppler Evaluation of Cerebral Hemodynamics in Term and Preterm Chinese Neonates Aged < 7 days: A Retrospective Cohort Study.","authors":"Shangwen Shi, Dinghua Wen, Wenjian Zheng, Xiu-Fang Yang","doi":"10.1055/a-2842-1293","DOIUrl":"10.1055/a-2842-1293","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to establish normative transcranial Doppler (TCD)-derived cerebral blood flow values in term and preterm neonates and to assess differences between groups and their associations with gestational age and anthropometric parameters.</p><p><strong>Study design: </strong>A retrospective cohort study was performed on 46 neurologically and hemodynamically stable neonates admitted to the Neonatal Ward of Zhongshan City People's Hospital between April and August 2025. TCD examinations of the anterior (ACA), middle (MCA), and posterior cerebral arteries (PCA) were completed within the first postnatal week in both term and preterm infants. Cerebral hemodynamic parameters-peak systolic velocity, end-diastolic velocity, mean velocity, pulsatility index, and resistance index-were compared between groups and correlated with gestational age, birth weight, and occipitofrontal head circumference.</p><p><strong>Results: </strong>Hemodynamic findings showed that compared with term neonates, preterm neonates showed significantly lower blood flow velocities in the left MCA. In contrast, preterm infants exhibited significantly higher vascular resistance in multiple cerebral arteries, with the increase being more pronounced in the right hemisphere. Standardized linear regression analyses showed that gestational age and birth weight (BW) were positively associated with vascular velocity in both ACA and MCA. Models for left MCA flow velocities demonstrated moderate explanatory power (<i>R</i> ² values ranging from 0.25 to 0.34).</p><p><strong>Conclusion: </strong>Term and preterm neonates exhibited distinct hemodynamic profiles on TCD within the first 7 days of life. The most pronounced difference between the two groups was observed in the MCA. BW demonstrated the strongest association with these hemodynamic differences.</p><p><strong>Key points: </strong>· Normative TCD cerebral flow data established in Chinese neonates <7 days.. · Term neonates showed higher velocities and lower resistance than preterm.. · Birth weight showed the strongest association with MCA flow velocity..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1927-1934"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525279","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":"Pancreas Size and Fat Content Increase during Pregnancy and Correlate with Glycemic Control.","authors":"Elizabeth M Widen, Sara Dube, Ingrid Harris, Madeline van Heukelum, Josephine Do, Aidan Dulaney, Isaiah Janumala, Jeffrey J Luci, Lorie M Harper, Alison G Cahill, John Virostko","doi":"10.1055/a-2831-5762","DOIUrl":"10.1055/a-2831-5762","url":null,"abstract":"<p><strong>Objective: </strong>The pancreas plays a critical role in adapting to the increased metabolic demands and insulin resistance of pregnancy. In rodents, beta cell proliferation during pregnancy induces pancreas growth, but whether similar changes occur in the human pancreas remains unknown. This study characterizes longitudinal changes in the size and composition of the pancreas during pregnancy and postpartum, and examines correlations with breastfeeding, adiposity, and metabolic assays.</p><p><strong>Study design: </strong>Sixty-one pregnant women were followed up to three visits during pregnancy (15, 25, and 35 weeks) and three postpartum (6 weeks, 6 months, and 12 months). MRI was conducted to assess pancreas, spleen, and kidney size as well as pancreas, liver, and whole-body adiposity. Glucose tolerance testing was performed at 24 to 28 weeks' gestation. In a subset of participants (<i>n</i> = 58), additional glucose assays were performed at 15 weeks' gestation. Pancreas size was normalized for concurrently measured body weight to calculate pancreas volume index (PVI).</p><p><strong>Results: </strong>The size of the pancreas increased by approximately 20% from 15 to 35 weeks' gestation (<i>p</i> < 0.001) and declined postpartum. PVI was positively correlated with whole-body fat mass (<i>R</i> ² = 0.12) and fasting blood glucose (<i>R</i> ² = 0.18) at 15 weeks' gestation. Higher pancreas fat content at 15 weeks predicted impaired response to glucose challenge 10 weeks later (<i>R</i> ² = 0.33). PVI was low, and pancreatic fat was high at 15 weeks in two participants who were subsequently diagnosed with gestational diabetes mellitus. Any breastfeeding 1-year postpartum correlated with a smaller decline in PVI from 35 weeks' gestation to 1-year postpartum (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Pancreas size and fat content change dynamically during pregnancy and postpartum, and correlate with glucose levels, prenatal adiposity, and breastfeeding.</p><p><strong>Key points: </strong>· The pancreas adapts to the metabolic demands of pregnancy by increasing in size and shrinking postpartum.. · Small pancreas size and high pancreas fat content early in pregnancy may predict subsequent abnormal glucose tolerance.. · Breastfeeding 1-year postpartum was associated with a smaller decline in pancreas size compared to those who were not breastfeeding..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1786-1794"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502843","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":"Point-of-Care Ultrasound in the Evaluation of Systolic Heart Failure During Pregnancy and Postpartum.","authors":"Juliana G Martins, Antonio Saad, George Saade, Matthew Jones, Luis D Pacheco","doi":"10.1055/a-2820-3207","DOIUrl":"10.1055/a-2820-3207","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) plays a central role in the evaluation of acute and chronic heart failure with reduced ejection fraction, yet its use in obstetric patients remains limited. This expert review outlines a simplified, qualitative-first approach tailored to the physiological and technical challenges of pregnancy. We present a step-by-step guide that prioritizes feasibility and reproducibility using simple and established echocardiographic views, including the E-point septal separation, mitral annular plane systolic excursion, lung B-lines, and inferior vena cava diameter measurements. Most available data are extrapolated from nonpregnant cohorts, and pregnancy-specific outcome evidence remains limited. This framework aims to support maternal-fetal medicine specialists in integrating POCUS into the bedside evaluation of pregnant individuals with suspected systolic heart failure. · Delayed recognition of systolic HF drives maternal morbidity and mortality.. · POCUS enables rapid bedside qualitative assessment when echo is delayed.. · With structured training, POCUS is feasible to support HF care in pregnancy..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1801-1819"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147315964","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":"NEC-Associated Bronchopulmonary Dysplasia and the Gut-Lung Axis in Preterm Infants.","authors":"Nilima Jawale, Jeffrey S Shenberger, Avinash K Shetty, Vignesh Gunasekaran, Parvesh M Garg","doi":"10.1055/a-2821-3458","DOIUrl":"10.1055/a-2821-3458","url":null,"abstract":"<p><p>Prevailing evidence underscores the critical influence of infant gut microbiota on systemic immune responses and intestinal health. The role of functional programming of effector immune cells at extra-intestinal mucosal sites is increasing in interest. Common connections between development of gut and lung microbiomes and reciprocal signaling between the two organ systems has reinforced the concept of a \"gut-lung axis.\" Narrative review of existing literature evaluating mechanistic evidence linking microbial dysbiosis and necrotizing enterocolitis (NEC) to development of preterm acute lung injury and subsequent progression to chronic lung disease or bronchopulmonary dysplasia (BPD). Evidence across animal and human studies indicates that gut-derived microbial ligands and metabolites are foundational in programming respiratory immunity. Conversely, primary pulmonary insults appear to trigger reciprocal shifts in gut microbiome function. This bidirectional signaling likely drives the clinical association between NEC-associated systemic inflammation and the subsequent increased risk of BPD. By focusing on mediators involved in this gut-lung crosstalk, we seek to highlight avenues such as microbiome modulation or targeted anti-inflammatory signaling to prevent or reduce the severity of two of the major morbidities of prematurity. · Gut dysbiosis drives systemic inflammation and mediates pro-inflammatory responses in the lungs.. · The communication between gut and lungs is mediated by microbiome, metabolites and immune cells.. · Modulating the gut microbiome presents a promising strategy for prevention of BPD in preterm infants.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1714-1722"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13020423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300942","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":"Deferred Cord Clamping and Weight Difference for Very Preterm Infants.","authors":"Mary K Quinn, Anup C Katheria, Jochen Profit, Henry C Lee","doi":"10.1055/a-2815-9816","DOIUrl":"10.1055/a-2815-9816","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to estimate the difference in first-recorded weight associated with deferred cord clamping (DCC) among very preterm infants (< 32 weeks' gestational age) using real-world neonatal intensive care unit data.</p><p><strong>Study design: </strong>Retrospective cohort study using the California Perinatal Care Collaborative data from 2016 to 2023 across 138 hospitals. Infants with gestational ages between 22 and 31^6/7 weeks were included. Exclusions were cord milking, death in the delivery room, or missing data. DCC exposure was defined as a delay in cord clamping of at least 30 seconds. Analyses used linear regression adjusting for gestational age (in days) as a second-order polynomial and intrauterine growth restriction (IUGR).</p><p><strong>Results: </strong>Of 39,013 eligible infants, 6,626 were excluded (cord milking, delivery room deaths, and missing DCC information), leaving 32,387 very preterm infants for the analysis. The mean weight for infants who received DCC was 1,338 g (standard deviation [SD]: 404) compared with 1,290 g (SD: 431) for those who did not. After adjusting for gestational age and IUGR, DCC was associated with 24-g higher first-recorded weight (95% confidence interval: 18-29).</p><p><strong>Conclusion: </strong>In very preterm infants, at least 30 seconds of DCC is associated with a modest increase (24 g) in first-recorded weight. This finding reinforces evidence from small clinical trials showing increased blood volumes and weight gains attributed to DCC.</p><p><strong>Key points: </strong>· DCC of at least 30 seconds is linked to 24 g higher weights in very preterm infants.. · Weight gain from DCC is modest but aligns with prior physiological evidence.. · Real-world evidence on DCC's impact on early weight is limited..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1824-1827"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257015","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":"Rates of Fetal Growth Restriction and Small for Gestational Age Neonates by COVID-19 Epochs: Did the Pandemic Affect Fetal Biometry Measurements?","authors":"Sharon Stortz, Jennifer Culhane, Lisbet Lundsberg, Caitlin Partridge, Molly McAdow","doi":"10.1055/a-2848-3436","DOIUrl":"10.1055/a-2848-3436","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to examine rates of fetal growth restriction (FGR) and small for gestational age (SGA) neonates before, during, and after the COVID-19 pandemic.</p><p><strong>Study design: </strong>We retrospectively evaluated patients with singleton deliveries ≥ 22 weeks of gestation in a single hospital system from March 2018 to December 2022. Patients were assigned to one of three COVID-19 epochs: acute-COVID-19, based on gestational age < 20 weeks on February 3, 2020, and estimated due date before January 1, 2021; pre-COVID-19 and postacute-COVID-19 epochs consisted of patients with matched months 2 years before and after the acute-COVID-19 epoch. Outcomes were FGR and SGA; FGR was defined by International Classification of Diseases-10 codes, and SGA was defined by birthweight < 10th percentile, using the Aris distribution for gestational age and neonatal sex. Patient attributes were compared across COVID-19 epochs, FGR, and SGA separately, using chi-square tests or ANOVA, as appropriate. Crude and adjusted logistic regression models were performed, including covariates associated with each dependent variable.</p><p><strong>Results: </strong>A total of 9,692 patients were included; differences across COVID-19 epochs were observed for advanced maternal age, body mass index ≥ 30 at delivery, smoking, chronic hypertension, hypertensive disorders of pregnancy, number of prenatal care visits, and ultrasounds. Patients in the acute- and post-COVID-19 epochs had an increased odds of FGR (aOR: 1.76, 95% CI: 1.44-2.16 and aOR: 1.64, CI: 1.38-1.94, respectively) compared with the pre-COVID-19 epoch. Compared with the pre-COVID-19 epoch, patients in the acute-COVID-19 epoch had reduced odds of SGA (aOR: 0.80, 95% CI: 0.65-0.98).</p><p><strong>Conclusion: </strong>During the acute-COVID-19 epoch, FGR diagnosis increased compared with pre-COVID-19, while SGA at birth decreased. This highlights the limitation of prenatal ultrasound for precisely identifying fetuses at the highest risk of FGR, which may be due to confirmation bias or broad diagnostic criteria for FGR.</p><p><strong>Key points: </strong>· We found no significant difference in the number of prenatal visits across COVID-19 epochs.. · The rate of FGR increased during the acute-COVID-19 epoch, while the rate of SGA decreased.. · Incongruence of FGR and SGA rates highlights the limitation of ultrasound to precisely identify at-risk fetuses..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1858-1863"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632259","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":"Gabapentin and Opioid Coexposure During Pregnancy and Adverse Perinatal Outcomes: A Population-Based Study, 2020-2024.","authors":"Amna Umer, James H Berry, Christa Lilly, Nicholas Davis, Maria Ganoe, Candice Lefeber, Janine Breyel, Collin John, Umer Najib","doi":"10.1055/a-2849-7756","DOIUrl":"10.1055/a-2849-7756","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to examine the association between prenatal gabapentin exposure, with and without opioid coexposure, and adverse perinatal outcomes.</p><p><strong>Study design: </strong>We conducted a retrospective, population-based cohort study of all live singleton births in West Virginia from January 2020 to July 2024 (<i>n</i> = 77,059). Exposure was categorized as no exposure to gabapentin or opioids, gabapentin alone, opioids alone, or both. Outcomes included birth weight, gestational age, 5-minute APGAR, low birth weight (LBW, <2,500 g), preterm birth, small for gestational age (SGA), neonatal abstinence syndrome (NAS), NICU admission, and congenital anomalies. Logistic and linear regression models were adjusted for maternal age, race, nicotine, and other substance use.</p><p><strong>Results: </strong>Of 77,059 births, 177 infants (0.23%) were exposed to gabapentin and 2,868 (3.72%) to opioids. Notably, 105 gabapentin-exposed infants (59.3%) were also exposed to opioids. Compared with the group with no exposure to gabapentin or opioid, exposure to gabapentin alone was associated with lower mean birth weight (AMD = -372.6 g, 95% CI: -500.0, -245.2), lower gestational age (AMD = -0.67 weeks, 95% CI: -1.10, -0.23), and higher odds of LBW (AOR = 3.77, 95% CI: 2.23, 6.34), SGA (AOR = 2.93, 95% CI: 1.74, 4.94), and NICU admission (AOR = 5.59, 95% CI: 3.47, 9.01). Coexposure with opioids was associated with a higher risk of preterm birth (AOR = 3.97, 95% CI: 2.64, 5.97), lower 5-minute APGAR (AMD = -0.23, 95% CI: -0.38, -0.07), and higher NAS incidence (89 vs. 43% with gabapentin alone and 77% with opioids alone). Gabapentin use alone was not significantly associated with preterm birth, 5-minute APGAR scores, or congenital abnormalities.</p><p><strong>Conclusion: </strong>These findings highlight the pattern of gabapentin use during pregnancy, including frequent co-use with opioids. Due to data limitations, causal inferences cannot be drawn. Further research with detailed exposure information and maternal comorbidities is needed to clarify risks and inform clinical care and long-term outcomes.</p><p><strong>Key points: </strong>· Prenatal gabapentin exposure occurred in 2.3 per 1,000 live births (2020-2024).. · Two-thirds of the gabapentin-exposed infants were also exposed to opioids.. · Co-exposed infants had higher rates of adverse outcomes than those with single-substance exposure..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1947-1953"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637728","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":"Composite Biometry versus Head Circumference Alone in Second Trimester Dating of Twin Gestations: A Retrospective Cohort Study.","authors":"Raegan A Chunn, Sorana Raiciulescu, Tracey H DeYoung, Sharon K Stortz, Monica A Lutgendorf, Andrew S Thagard","doi":"10.1055/a-2846-3581","DOIUrl":"10.1055/a-2846-3581","url":null,"abstract":"<p><strong>Objective: </strong>To establish the due date in a singleton gestation in the second trimester, U.S. societal guidelines recommend using a composite of the fetal biparietal diameter, head circumference, abdominal circumference, and femur length. In twin pregnancies, evidence supports using either the head circumference or composite biometry of the larger twin. Our objective was to compare the accuracy of these two approaches in determining the true gestational age of twin gestations.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of dichorionic, diamniotic gestations conceived with assisted reproductive technologies between 2006 and 2016, excluding fetuses with major anomalies that could impact accurate dating, pregnancies complicated by loss of one or both twins, or higher-order multiple gestations reduced to twins. The earliest second-trimester ultrasound study for each subject was reviewed and the gestational age was calculated using head circumference alone and composite biometry based on Hadlock's formulas. Paired sample statistics were used to calculate the mean difference in days from the observed versus true gestational age to assess the accuracy of each strategy and represented graphically using Bland-Altman plots.</p><p><strong>Results: </strong>A total of 179 subjects with a second-trimester ultrasound were identified that met criteria over the 10-year period. Ultrasounds were performed at a mean gestational age of 19.9 days (range: 14.43-26.14). Use of head circumference alone resulted in a mean absolute difference of 3.11 days from the true gestational age (standard deviation [SD]: 4.51, standard error mean [SEM]: 0.34). Composite biometry resulted in a mean absolute difference of 1.74 days (SD: 3.60; SEM: 0.27). The difference of approximately 1 to 2 days was significant (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>In our twin population, the use of composite biometry of the larger twin more accurately approximates gestational age compared with head circumference alone, though the difference between the two approaches is modest.</p><p><strong>Key points: </strong>· Head circumference or composite biometry is used to date twins.. · In our study, composite biometry improved accuracy.. · The difference between the two was modest (1-2 days)..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1984-1986"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147588981","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":"When Pushing Is Not Enough: A Novel Description of Maternal Characteristics and Delivery Outcome.","authors":"Naama Farago, Gal Bachar, Avia Amir, Yoav Siegler, Dana Vitner, Nizar Khatib, Ron Beloosesky, Zeev Weiner, Yaniv Zipori","doi":"10.1055/a-2837-0136","DOIUrl":"10.1055/a-2837-0136","url":null,"abstract":"<p><strong>Objective: </strong>Operative vacuum delivery (VD) is often used to expedite safe vaginal births for various reasons, including maternal exhaustion (MEX), which accounts for about 30% of cases. This study identifies risk factors associated with vacuum deliveries for MEX and evaluates maternal and neonatal outcomes compared to other indications.</p><p><strong>Study design: </strong>A retrospective cohort study analyzed singleton-term vacuum deliveries from 2011 to 2022 at a tertiary care center, categorizing patients into two groups: Those with MEX (group 1) and those without (group 2). Statistical analyses included chi-square tests, <i>t</i>-tests, Mann-Whitney tests, and multivariable logistic regression.</p><p><strong>Results: </strong>Out of 2,950 vacuum deliveries, 819 (27.8%) were indicated for exhaustion. Exhausted mothers were more likely to be nulliparous (75 vs. 71%, <i>p</i> = 0.028), have gestational diabetes (7.7 vs. 5.4%, <i>p</i> = 0.047), and use regional anesthesia (92.4 vs. 89.1%, <i>p</i> = 0.006). They also experienced longer labor durations, with a second stage averaging 2.86 hours versus 2.54 hours in the non-exhausted group (<i>p</i> < 0.001). While postpartum hemorrhage and chorioamnionitis rates were higher in the exhaustion group, neonatal outcomes did not differ significantly. The duration of the second stage was found to increase the odds of MEX by 53% for each additional hour (OR = 1.53 [95% CI: 1.10-1.64]).</p><p><strong>Conclusion: </strong>Women in the exhaustion group had distinct characteristics linked to prolonged labor. Despite some complications, VD for MEX was safe for both mothers and neonates, suggesting a need for targeted interventions to mitigate exhaustion during labor.</p><p><strong>Key points: </strong>· Maternal exhaustion accounts for 30% of vacuum births.. · Higher maternal morbidity is observed in the exhaustion group.. · Neonatal outcomes are comparable between groups.. · Vacuum delivery for exhaustion remains a safe option.. · An intervention to reduce exhaustion is needed..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1892-1897"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484597","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":"Predictors of Infection after Cesarean Delivery.","authors":"Antonio F Saad, Paula L McGee, Samuel Parry, John M Thorp, Monica Longo, Alan T N Tita, Cynthia Gyamfi-Bannerman, Suneet P Chauhan, Torri D Metz, Kara Rood, Dwight J Rouse, Jennifer L Bailit, William A Grobman, Hyagriv N Simhan","doi":"10.1055/a-2835-1796","DOIUrl":"10.1055/a-2835-1796","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative infections remain a significant complication of cesarean delivery (CD), with rates ranging from 3 to 30%. These infections increase healthcare costs, prolong recovery, and negatively impact maternal outcomes. Identifying risk factors for infection might help guide preventative strategies to mitigate this burden. The primary aim of this study was to develop and validate a predictive model for infection after CD using preoperative and perioperative characteristics.</p><p><strong>Study design: </strong>This study was a secondary analysis of a multicenter randomized trial comparing tranexamic acid versus placebo to prevent postpartum hemorrhage in individuals undergoing either scheduled or unscheduled CD. The primary outcome of this analysis was a composite of surgical site infection, endometritis, or pelvic abscess diagnosed within 6 weeks postpartum. Univariable and multivariable bootstrapped logistic regression models with stepwise selection were used to identify predictors of infection. Model performance was evaluated using the receiver operator curve area under the curve (AUC).</p><p><strong>Results: </strong>Of the 10,995 participants, 287 (2.6%) developed an infection. Significant predictors included tobacco use (OR: 1.67, 95% CI: 1.21-2.31), BMI at delivery ≥ 30 kg/m² (OR: 1.41, 95% CI: 1.04-1.91), labor before cesarean (OR: 1.71, 95% CI: 1.33-2.18), longer surgical duration (OR: 1.01 per minute, 95% CI: 1.01-1.02), uterine incision extension (OR: 1.54, 95% CI: 1.02-2.34), and the use of uterotonics other than oxytocin (OR: 1.48, 95% CI: 1.09-2.02). The predictive model demonstrated modest discrimination with an AUC of 0.64 (95% CI: 0.61-0.68).</p><p><strong>Conclusion: </strong>Multiple modifiable and nonmodifiable factors influence infection after CD. This predictive model offers a framework for assessing individualized risk, though its modest performance indicates that further refinement is necessary before it can be confidently applied in clinical decision-making. Future research should aim to enhance predictive accuracy and explore whether risk stratification meaningfully informs prevention or patient counseling strategies.</p><p><strong>Key points: </strong>· This study aimed to create a model to predict postpartum infection after cesarean delivery.. · Several factors were linked to higher infection risk after cesarean delivery. These included tobacco use, obesity, labor before cesarean, longer surgery, uterine incision extension, and uterotonic use.. · The model had moderate accuracy, with an AUC of 0.6.. · Common perioperative factors may help predict infection risk after cesarean delivery..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1884-1891"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479441","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}