American journal of perinatology最新文献

{"title":"Transverse versus vertical incision in the surgical management of placenta accreta spectrum.","authors":"Austin Oberlin, Katherine Yoh, Eve Overton, Whitney Alexandra Booker, John Ilagan, Dib Sassine, Alexandra Diggs, Sherelle Laifer-Narin, Adela Cimic, Laruence Ring, Maria Sheikh, Caryn St Clair, June Hou, Alexandre Buckley de Meritens, Jason D Wright, Mary D'Alton, Chia-Ling Nhan Chang, Mirella Mourad, Fady Khoury Collado","doi":"10.1055/a-2479-2604","DOIUrl":"https://doi.org/10.1055/a-2479-2604","url":null,"abstract":"<p><strong>Objective(s): </strong>Traditionally, midline vertical skin incisions have been utilized during surgery for placenta accreta spectrum (PAS), as it is considered to maximize exposure and allow for a uterine incision to avoid the placenta. However, literature directly comparing outcomes of vertical versus transverse incisions in PAS is sparse. Our objective was to compare maternal outcomes between patients who underwent a vertical versus a transverse skin incision for PAS.</p><p><strong>Study design: </strong>Retrospective review of patients with pathologically confirmed PAS undergoing scheduled surgery at our institution between 09/2019 and 11/2023. Starting in 10/2021, select patients were offered a transverse skin approach. Patients were eligible if the surgery was scheduled, and the placenta was not entirely covering the anterior uterine wall. The transverse skin incision was approximately 18-20cm and used the patient's prior scar. Primary outcomes included rate of maternal transfusion >4 units of packed red blood cells (PRBC), the incidence of surgical complications, and the need for conversion to general anesthesia (GETA).</p><p><strong>Results: </strong>Seventy patients underwent scheduled surgery for PAS. Thirty-three patients had a vertical skin incision, and 37 had a transverse incision. After initiation of the transverse incision approach, 37/43 (86.0%) had a transverse incision and none required conversion to a vertical incision intraoperatively. The two groups were similar with regard to age, BMI, and severity of PAS. There was no difference in the rate of transfusion of >4 units of PRBC (vertical 12% vs transverse 22%, p=0.29), or in the rate of intraoperative complications (i.e., cystotomy; vertical 3% vs transverse 14%, p= 0.20). In patients with a transverse incision, a significantly lower number of patients required conversion to GETA intraoperatively (vertical 70% vs transverse 24%, p<0.001).</p><p><strong>Conclusion: </strong>In appropriately selected patients, a transverse skin incision was associated with lower conversion to GETA without any difference in intraoperative outcomes.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680589","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":"Postpartum Hemorrhagic Morbidity with Scheduled versus Unscheduled Cesarean Delivery at Term.","authors":"Rachel L Wiley, Suneet P Chauhan, Emily A Johnson, Ipsita Ghose, Hailie N Ciomperlik, Hector Mendez-Figueroa","doi":"10.1055/a-2437-0759","DOIUrl":"https://doi.org/10.1055/a-2437-0759","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to compare the composite maternal hemorrhagic outcomes (CMHOs) among term (≥37 weeks) singletons who had scheduled versus unscheduled cesarean deliveries (CDs). A subgroup analysis was done for those without prior uterine surgeries.</p><p><strong>Study design: </strong> Retrospectively, we identified all singletons at term who had CDs. The unscheduled CDs included individuals admitted with a plan for vaginal delivery with at least 1 hour of attempted labor. CMHOs included any of the following: estimated blood loss of ≥1,000 mL, use of uterotonics (excluding prophylactic oxytocin) or Bakri balloon, surgical management of hemorrhage, blood transfusion, hysterectomy, thromboembolism, admission to intensive care unit, or maternal death. Multivariable Poisson regression models with robust error variance were used to estimate adjusted relative risks (aRRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong> Of 8,623 deliveries in the study period, 2,691 (31.2%) had CDs at term, with 1,709 (67.3%) scheduled CDs, and 983 (36.5%) unscheduled CDs. Overall, the rate of CMHO was 23.3%, and the rate of blood transfusion was 4.1%. CMHOs were two-fold higher among unscheduled (34.5%) than scheduled CDs (16.9%; aRR = 2.18; 95% CI: 1.81-2.63). The aRRs for blood transfusion and surgical interventions to manage postpartum hemorrhage were three times higher with unscheduled than scheduled CDs. The subgroup analysis indicated that among the cohorts without prior uterine surgery, the rate of the CMHOs was significantly higher when the CD was unscheduled versus scheduled (aRR 1.85; 95% CI 1.45-2.37).</p><p><strong>Conclusion: </strong> Compared to scheduled CDs, the composite hemorrhagic adverse outcomes were significantly higher with unscheduled CDs.</p><p><strong>Key points: </strong>· Unscheduled cesareans are at higher risk of hemorrhage.. · Unscheduled cesareans are at higher risk of transfusion.. · Atony treatment is higher in unscheduled cesareans..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674823","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":"Tachycardia-Desaturation Episodes in Neonatal Intensive Care Unit Patients with and without Bronchopulmonary Dysplasia.","authors":"V Peter Nagraj, Paige Howard, Karen D Fairchild, Brynne A Sullivan","doi":"10.1055/a-2437-0461","DOIUrl":"10.1055/a-2437-0461","url":null,"abstract":"<p><strong>Objectives: </strong> Much attention has been paid to measuring physiological episodes of bradycardia-oxygen desaturation (BDs) in the neonatal intensive care unit (NICU). NICU patients also have spells of tachycardia-desaturation (TDs), but these have not been well-characterized. We hypothesized that TDs would be more common among infants with bronchopulmonary dysplasia (BPD). We aimed to quantify daily TDs compared to BDs in NICU patients across a range of gestational and postmenstrual ages (GA and PMA) and determine whether TDs are associated with BPD.</p><p><strong>Study design: </strong> We analyzed every 2-second heart rate (HR) and peripheral saturation of oxygen (SpO₂) throughout the NICU stay of all infants with 24 to 39 weeks GA admitted to a single, level IV NICU from 2012 to 2015. BDs were defined in our prior work (HR <100 bpm for ≥4 seconds with concurrent SpO₂ <80% for ≥10 seconds) and TDs as a 20% increase in HR from the previous 2-hour mean baseline and concurrent SpO₂ <80% for ≥10 seconds. We calculated the median daily BDs and TDs across a range of GAs and PMAs. For infants ≤32 weeks GA, we compared TDs for those with and without BPD at 36 weeks PMA and discharge on supplemental oxygen.</p><p><strong>Results: </strong> We analyzed 782,424 hours of HR and SpO₂ data from 1,718 neonates, with a median of 271 hours analyzed per infant. TDs frequency increased with increasing PMA across all GAs. BDs occurred most frequently in infants <29 weeks GA and decreased as infants approached term equivalent age. For infants with ≤32 weeks GA, one or more TD per day from 33 to 35 weeks PMA was associated with BPD and home oxygen.</p><p><strong>Conclusion: </strong> Episodes of TD at the thresholds defined in this analysis occurred more frequently at later PMA and were more common in infants with BPD and those requiring home oxygen.</p><p><strong>Key points: </strong>· Desaturation episodes occur often in preterm infants.. · Bradycardia or tachycardia can coincide with desaturation.. · TD occurs later and with BPD..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387323","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 heart rate and amniotic fluid volume measurements with a home ultrasound device.","authors":"Anat Pardo, Shir Nahum Fridland, Or Lee Rak, Emilie Klochendler Frishman, Hadas Zafrir Danieli, Anat Shmueli, Shiri Barbash-Hazan, Arnon Wiznitzer, Asnat Walfisch, Tomer Sela, Leor Wolff, Eran Hadar","doi":"10.1055/a-2469-0887","DOIUrl":"https://doi.org/10.1055/a-2469-0887","url":null,"abstract":"<p><strong>Objective: </strong>Pulsenmore ES is a self-scanning ultrasound system for remote fetal assessment. It is composed of a hand-held transducer that serves as a smartphone cradle coupled with an application and clinician's web-viewer dashboard. Recently, a novel capability was added to the system allowing for offline fetal heart rate (FHR) and maximal vertical pocket (MVP) measurements. The aim of this study was to evaluate these tools for usability and accuracy.</p><p><strong>Study design: </strong>A prospective, non-randomized, non-blinded clinical study design was used. Pulsenmore ES scans were obtained by non-professional laypersons in app-guided (AG) mode (user follows video tutorials in the application) or clinician-guided (CG) mode (user is guided by a health-care professional in a real-time telemedicine visit). The scans were stored on a cloud for later interpretation by a health-care professional. Each self-scan was immediately followed by a standard ultrasound scan performed by a clinician. The asynchronous FHR and MVP measurements made on the AG and CG scans through the designated dashboard were analyzed and compared with the real-time, in-clinic, measurements.</p><p><strong>Results: </strong>The cohort included 28 women. Rates of successful utilization of the Pulsenmore tool for measurement of FHR were 84.7±11.24% of scans made in AG mode and 96.3±6.35% of scans made in CG mode. Corresponding values for MVP were 91.7±2.31% and 95.0±1.73%. FHR accuracy (difference from in-clinic values) was 10.8±7.5 bpm (7.2%) in AG mode and 5.8±5.1 bpm (4%) in CG mode; MVP accuracy was 1.3±1.4cm (22%) and 0.9±0.8cm (14%), respectively. Sensitivity (87.5% and 100%, in AG and CG modes respectively) and specificity (95% and 95.5%, in AG and CG modes, respectively) were established for MVP.</p><p><strong>Conclusion: </strong>FHR and MVP measurements obtained from scans captured by the self-operated Pulsenmore ES ultrasound platform are highly accurate and reliable for clinical use relative to standard in-clinic measurements.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurodevelopmental Outcomes in Neonates Surviving Fetomaternal Hemorrhage Compared with a Matched Unexposed Group in a Large Integrated Health Care System.","authors":"Bria L Pettway, Marie J Boller, Yun-Yi Hung, Ticara L Onyewuenyi, Miranda Ritterman Weintraub, Michael W Kuzniewicz, Betsy O'Donnell, Anne Regenstein","doi":"10.1055/a-2441-3761","DOIUrl":"https://doi.org/10.1055/a-2441-3761","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to assess short-term neurodevelopmental outcomes for neonates affected by fetomaternal hemorrhage (FMH) and compare them with an unexposed group.</p><p><strong>Study design: </strong> A retrospective cohort analysis was conducted within a large integrated medical system spanning from 2008 to 2018. Neurodevelopmental outcomes of neonatal survivors of FMH were compared with matched controls. Clinically significant FMH in survivors was defined by maternal flow cytometry for fetal hemoglobin result of >0.10% and neonatal transfusion requirement. One unexposed infant was identified for each surviving FMH-exposed infant, matched by gestational age at delivery (±1 week), birth year, sex, and race/ethnicity. The primary outcome was a diagnosis of neurodevelopmental impairment, identified using the International Classification of Diseases (ICD), 9th and 10th Revisions (ICD-9 and ICD-10) codes. Results were presented as proportions, means, medians, and interquartile ranges. Comparisons were performed using chi-square and Fisher's exact tests. A Cox proportional hazards regression model was conducted to examine associations between cognitive and developmental outcomes and FMH exposure.</p><p><strong>Results: </strong> Among 137 pregnancies with clinically significant FMH, 80 resulted in intrauterine demise, 57 neonates required blood transfusion, and 4 neonates requiring transfusion demised during birth hospitalization. No significant difference in rates of neurodevelopmental impairment was found between FMH-exposed and unexposed infants (26.4 vs. 24.6%, <i>p</i> = 0.8). Similar findings were observed in preterm (37 vs. 31.6%, <i>p</i> = 0.7) and term neonates (15.4 vs. 14.8%, <i>p</i> = 1.0). Cox regression showed no significant association between neurodevelopmental outcomes and FMH exposure (1.17 [95% CI: 0.61-2.22]; <i>p</i> = 0.6).</p><p><strong>Conclusion: </strong> Despite the significant perinatal morbidity and mortality associated with FMH, surviving infants did not show a significant difference in neurodevelopmental diagnoses compared to matched unexposed infants. However, definitive conclusions are limited due to the rarity of FMH requiring transfusion and the small exposed sample size, warranting further evaluation in a larger cohort.</p><p><strong>Key points: </strong>· FMH is associated with profound fetal and neonatal morbidity and mortality.. · Impact on neurologic development for infants surviving FMH is unknown.. · Neurodevelopmental outcomes did not differ between survivors of FMH compared to matched controls..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612356","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":"Trends in the Mortality and Death of Periviable Preterm Infants in the United States, 2011 to 2020.","authors":"Jenil Patel, Omobola Oluwafemi, Tiffany Tang, Angel Sunny, Narendrasinh Parmar, Harshit Doshi, Parth Bhatt, Keyur Donda, Sarah E Messiah, Fredrick Dapaah-Siakwan","doi":"10.1055/a-2435-0908","DOIUrl":"https://doi.org/10.1055/a-2435-0908","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to examine the trends in the infant mortality rate (IMR) and the trends in the timing of death among periviable preterm infants at 22 to 24 weeks' gestational age (GA) in the United States from 2011 to 2020.</p><p><strong>Study design: </strong> Retrospective, serial cross-sectional analysis of periviable preterm infants born in the United States at 22 to 24 weeks' GA using the linked birth/infant death records from the Centers for Disease Control and Prevention. Data were analyzed from 2011 to 2020. The exposure was the year of death, and the outcome was the changes over time in the IMR and the timing of death. Further, we evaluated racial differences in the timing of death. We used nonparametric trend analysis to evaluate changes in mortality rate across the study period.</p><p><strong>Results: </strong> The IMR was inversely related to GA, and for each GA and race/ethnicity, the IMR significantly declined during the study period. The IMR rate was highest in the first 7 days of life for all GAs and races/ethnicities. While Non-Hispanic White infants had a higher infant neonatal mortality rate than non-Hispanic Black infants, non-Hispanic Black infants had a higher postneonatal mortality rate.</p><p><strong>Conclusion: </strong> The IMR among periviable infants born at 22 to 24 weeks' GA improved for all GAs and races in the United States between 2011 and 2020. However, significant racial differences in the timing of death exist.</p><p><strong>Key points: </strong>· As expected, the IMR was inversely related to gestational age at 22 to 24 weeks.. · At each gestational age and for each racial/ethnic group, the overall IMR decreased during the study period.. · Non-Hispanic White infants had a higher neonatal mortality rate, whereas non-Hispanic Black infants had a higher postneonatal mortality rate..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612358","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":"Effect of Listening Music on Nulliparous Singleton Pregnancies Who Underwent Induction of Labor: A Randomized Clinical Trial.","authors":"Gabriele Saccone, Maria Chiara Malferà, Lucia D'Antonio, Pasquale Gallo, Alessandra Ammendola, Giorgia Buonomo, Dario Colacurci, Rosanna Zapparella, Mariavittoria Locci","doi":"10.1055/a-2437-0524","DOIUrl":"10.1055/a-2437-0524","url":null,"abstract":"<p><strong>Objective: </strong> A recent randomized clinical trial (RCT) showed that listening to music reduces the pain level and anxiety levels in women with spontaneous labor at term. The effect on pregnant women undergoing induction of labor is still unclear.This study aimed to test the hypothesis that in nulliparous women with singleton pregnancies, undergoing induction of labor at term, listening to music would reduce the pain level during labor.</p><p><strong>Study design: </strong> Parallel group, non-blinded, RCT conducted at a single center in Italy. Nulliparous women with singleton pregnancies and vertex presentation, admitted for induction of labor with either oral or vaginal prostaglandins, between 37^0/7 and 42^0/7 weeks, were randomized in a 1:1 ratio to receive music during induction of labor or no music during induction. The endpoints of the trials were the pain level during induction, and in the active phase of labor, recorded using the visual analog scale for pain, ranging from 0 (no pain) to 10 (unbearable pain). The effect of music use on each outcome was quantified as the mean difference (MD) with a 95% confidence interval (CI).</p><p><strong>Results: </strong> During the study period, 30 women agreed to take part in the study, underwent randomization, and were enrolled and followed up. Fifteen women were randomized in the music group and 15 in the control group. No patients were lost to follow-up for the primary outcome. Pain level during the induction procedure was 8.8 ± 0.9 in the music group, and 9.8 ± 0.3 in the control group (MD -2.60 points, 95% CI -3.94 to -1.26; <i>p</i> < 0.01). Music during labor and delivery was also associated with decreased anxiety during the induction procedure (MD -3.80 points, 95% CI -5.53 to -2.07; <i>p</i> < 0.01).</p><p><strong>Conclusion: </strong> In nulliparous women, listening to music during the induction of labor reduces pain and anxiety levels.</p><p><strong>Key points: </strong>· Music listening has a modulatory effect on the human stress response.. · Music listening may generate beneficial changes in the autonomic nervous system and the HPA axis activity that should be conducive to the stress recovery process.. · Listening to music during induction of labor resulted in a significant lower pain..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387319","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 Hemolytic Disease of the Fetus and Newborn within a Large Integrated Health Care System.","authors":"Fagen Xie, Michael J Fassett, Jiaxiao M Shi, Vicki Y Chiu, Theresa M Im, Sunhea Kim, Nana A Mensah, Nehaa Khadka, Daniella Park, Carol Mao, Matthew Molaei, Iris Lin, Darios Getahun","doi":"10.1055/a-2444-2314","DOIUrl":"https://doi.org/10.1055/a-2444-2314","url":null,"abstract":"<p><strong>Objective: </strong> This study aims to identify hemolytic disease of the fetus and newborn (HDFN) pregnancies using electronic health records (EHRs) from a large integrated health care system.</p><p><strong>Study design: </strong> A retrospective cohort study was performed among pregnant patients receiving obstetrical care at Kaiser Permanente Southern California health care system between January 1, 2008, and June 30, 2022. Using structured (diagnostic/procedural codes, medication, and laboratory records) and unstructured (clinical notes analyzed via natural language processing) data abstracted from EHRs, we extracted HDFN-specific \"indicators\" (maternal positive antibody test and abnormal antibody titer, maternal/infant HDFN diagnosis and blood transfusion, hydrops fetalis, infant intravenous immunoglobulin [IVIG] treatment, jaundice/phototherapy, and first administrated Rho[D] Immune Globulin) to identify potential HDFN pregnancies. Chart reviews and adjudication were then performed on select combinations of indicators for case ascertainment. HDFN due to ABO alloimmunization alone was excluded. The HDFN frequency and proportion of each combination were fully analyzed.</p><p><strong>Results: </strong> Among the 464,711 eligible pregnancies, a total of 136 pregnancies were confirmed as HDFN pregnancies. The percentage of the HDFN-specific indicators ranged from 0.02% (infant IVIG treatment) to 34.53% (infant jaundice/phototherapy) among the eligible pregnancies, and 32.35% (infant IVIG treatment) to 100% (maternal positive antibody test) among the 136 confirmed HDFN pregnancies. Four combination groups of four indicators, four combination groups of five indicators, and the unique combination of six indicators showed 100% of HDFN pregnancies, while 80.88% of confirmed HDFN pregnancies had the indicator combination of maternal positive antibody test, maternal/infant HDFN diagnosis, and infant jaundice/phototherapy.</p><p><strong>Conclusion: </strong> We successfully identified HDFN pregnancies by leveraging a combination of medical indicators extracted from structured and unstructured data that may be used in future pharmacoepidemiologic studies. Traditional indicators (positive antibody test results, high titers, and clinical diagnosis codes) alone did not accurately identify HDFN pregnancies, highlighting an unmet need for improved practices in HDFN coding.</p><p><strong>Key points: </strong>· A case ascertainment method was developed to identify HDFN from structured and unstructured data.. · The method used in this study may be used in future pharmacoepidemiologic studies.. · The study highlighted an unmet need for improved practices in HDFN coding..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612351","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":"Differences in Time of Birth between Spontaneous and Operative Vaginal Births.","authors":"Christopher X Hong, Mariana Masteling, Clarice G Zhou, Matthew K Janssen, Jourdan E Triebwasser","doi":"10.1055/a-2442-7396","DOIUrl":"10.1055/a-2442-7396","url":null,"abstract":"<p><strong>Objective: </strong> Previous studies have identified an association between obstetric interventions and the time of day in which they are performed; however, they do not account for granular variations in the temporality of delivery interventions, which is influenced by both health care providers and resource availability. We sought to assess differences in time of birth among spontaneous vaginal births (SVBs) versus operative (forceps- and vacuum-assisted) vaginal births (OVBs).</p><p><strong>Study design: </strong> This cross-sectional study used birth certificate data from the National Vital Statistics System from 2016 to 2021, which includes the time of birth and delivery method for recorded U.S. births. The number of SVBs and OVBs at each minute was normalized relative to the total births within each delivery group to facilitate balanced comparisons between groups. Logistic regression analysis assessed the odds of OVBs per time of day.</p><p><strong>Results: </strong> A total of 15,412,129 subjects who underwent vaginal birth were included in this analysis, 690,905 (4.5%) of whom underwent OVBs. Compared to births at other time intervals, those between 4:30 and 7:30 p.m. were more likely to be OVBs (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.12-1.14). Conversely, births between 3:00 and 6:00 a.m. were less likely to be OVBs (OR = 0.87, 95% CI: 0.86-0.88). After adjusting for adjusting for maternal age, gestational age, and induction of labor, births between 4:30 and 7:30 p.m. remained more likely to be OVBs (adjusted odds ratio [aOR] = 1.09, 95% CI: 1.08-1.10) and births between 3:00 and 6:00 a.m. remained less likely to be OVBs (aOR = 0.91, 95% CI: 0.90-0.92).</p><p><strong>Conclusion: </strong> In this population-based study, we identified temporal differences between SVBs and OVBs with increased use of instrumentation during the late afternoon and reduced use in the early morning. These findings prompt further investigation into the indications for OVBs and root causes of these temporal variations, which are likely multifactorial and involve provider and resource availability.</p><p><strong>Key points: </strong>· This study identifies temporal differences between SVBs and OVBs.. · Compared to SVBs, operative births are more likely in the late afternoon.. · OVBs are also less likely in the early morning.. · These temporal trends suggest the influence of provider and resource availability..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455954","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":"Incidence of new, non-physiologic maternal findings on fetal magnetic resonance imaging.","authors":"Shirley J Shao, Andrew Grimes, Marley Rashad, Liina Poder, Dorothy Shum, Nasim Camillia Sobhani","doi":"10.1055/a-2466-1319","DOIUrl":"https://doi.org/10.1055/a-2466-1319","url":null,"abstract":"<p><strong>Objective: </strong>Fetal magnetic resonance imaging (MRI) is increasingly used for evaluation of fetal anomalies, and rates of incidental maternal findings are not well characterized. Our objective was to evaluate the rate of incidental maternal findings at the time of antenatal MRI performed for fetal indications.</p><p><strong>Study design: </strong>This was a retrospective cohort study that included all fetal MRIs performed between 2018-2023 at a single tertiary care institution with a multidisciplinary fetal diagnosis and treatment center. The electronic medical record was reviewed to identify all documented maternal findings and any new, non-physiologic maternal findings. The latter was defined as previously unknown abnormalities of maternal structures unrelated to normal physiology.</p><p><strong>Results: </strong>Our study included 834 imaging events, performed at an average gestational age of 23 weeks. The most common indication for imaging was fetal anomaly (81.1%). The most common imaging type was fetal brain MRI (81.4%). Overall, 16.2% reported a maternal finding and 7% reported a new, non-physiologic finding. The most common new, non-physiologic findings were renal cysts (n=11), liver cysts (n=6), and gallstones or gallbladder sludge (n=5). Compared to imaging events that included a fetal brain MRI, imaging events that included a fetal body MRI had a significantly higher rate of any maternal findings (53.0% vs 10.4%, p< 0.001) and new, non-physiologic maternal findings (26.9% vs 3.7%, p< 0.001).</p><p><strong>Conclusion: </strong>Our results suggest that the risk of identifying new, non-physiologic maternal findings on fetal MRI is low. The rate of any maternal and new, non-physiologic maternal findings may differ by fetal MRI type due to differences in imaging depth and extent of radiology subspecialist review. These data should be incorporated into pre-test counseling for patients planning to have fetal MRI.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612353","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}