American journal of perinatology最新文献

{"title":"Implementation of a Standardized Protocol for Postpartum Anemia: A Prospective Cohort Study.","authors":"Casey A Lower, Emily G Gleason, Asaki Toda, Sindhu K Srinivas, Lisa D Levine, Maggie E Power, Rebecca F Hamm","doi":"10.1055/a-2414-1262","DOIUrl":"10.1055/a-2414-1262","url":null,"abstract":"<p><p>Implementation of standardized protocols for antepartum anemia increases intravenous iron (IVFe) use and improves predelivery hemoglobin (Hb). However, this condition is often overlooked and inadequately treated in postpartum care settings. We aimed to determine if implementation of a standardized protocol for postpartum anemia increases postpartum IVFe use and affects clinical outcomes.We performed a prospective cohort study evaluating implementation of a standardized inpatient protocol for postpartum anemia. This protocol, implemented in December 2021, recommends (1) IVFe for postpartum Hb 7.0 to 8.9 g/dL and (2) oral iron for postpartum Hb 9.0 to 9.9 g/dL. We compared all postpartum inpatients at a single site from April 2021 (preimplementation period [PRE]) to April 2022 (postimplementation period [POST]). The primary outcome was any IVFe use. Secondary outcomes included number of IVFe doses, oral iron supplementation at discharge, postpartum complications, and length of stay.A total of 805 patients were included (PRE = 401; POST = 404). Patients in the PRE and POST groups differed in ethnicity (PRE: 8.2% Hispanic vs. POST: 14.9% Hispanic, <i>p</i> = 0.003). IVFe use significantly increased from PRE to POST (PRE: 6.0% vs. POST: 11.1%, <i>p</i> = 0.009) even when controlling for differences between groups (adjusted odds ratio: 2.48, 95% confidence interval: [1.08-5.67]). Patients receiving IVFe in the POST group were more likely to receive the recommended three doses of IVFe compared with patients receiving IVFe in the PRE group (POST: 29% vs. PRE: 4%, <i>p</i> = 0.04). Patients in the POST group had shorter lengths of stay than in the PRE group (POST: 1.69 days vs. PRE: 1.81 days, <i>p</i> < 0.001). There were no significant differences in blood transfusion, oral iron supplementation, or postpartum complications.Implementation of a standardized protocol for postpartum anemia increased IVFe use without increasing length of stay. · Postpartum anemia is associated with postpartum depression, fatigue, impaired cognition, and altered maternal-infant bonding.. · IVFe is more effective and better tolerated than oral iron.. · Implementation of standardized protocols for antepartum anemia has been shown to increase IVFe use.. · Implementation of a standardized protocol for postpartum anemia increased IVFe use without increasing length of stay..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"660-665"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279081","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":"Social Determinants of Preterm Birth amongst Non-Hispanic Black Individuals.","authors":"Diane N Fru, Elizabeth Kelly, Matthew Orischak, Emily A DeFranco","doi":"10.1055/a-2419-9229","DOIUrl":"10.1055/a-2419-9229","url":null,"abstract":"<p><p>Non-Hispanic Black individuals are disproportionately affected by preterm birth (PTB), a major driver of the racial disparity in infant mortality in the United States. The objective of this study is to identify indicators of social determinants of health (SDoH) that contribute to preterm birth amongst non-Hispanic Black individuals.Population-based retrospective case-control study of U.S. birth records (2012-2016). Factors potentially associated with PTB and considered indicators of SDoH were compared between singleton live births of non-Hispanic Black individuals delivering preterm (<37 weeks of gestation) and term (≥37 weeks of gestation). Logistic regression quantified the association between SDoH and PTB such as insurance, education, and prenatal care visits and reported as odds ratios (ORs; 95% confidence interval, CI).Of 2,763,235 live births to Black individuals, 340,480 (12%) occurred <37 weeks of gestation. Factors most strongly associated with PTB (<i>p</i> < 0.001), presented as OR (95% CI), included no prenatal care 3.0 (95% CI: 2.9-3.1) or insufficient prenatal care 2.7 (95% CI: 2.7-2.8), smoking during pregnancy 1.4 (95% CI: 1.43-1.47), unmarried 1.18 (95% CI: 1.17-1.19), lack of high school diploma 1.1 (95% CI: 1.12-1.40), lack of father of baby listed on birth certificate 1.22 (1.21-1.23), and Black paternal race 1.10 (1.08-1.12). Receipt of WIC (women, infants, and children) during the pregnancy had a protective effect on PTB risk in Black individuals, OR = 0.83 (0.83-0.84).Pregnancies in Black individuals who are ≥35 years old, smoke tobacco, utilize Medicaid insurance, have less than a high school education, are unmarried, have little to no prenatal care, Black paternal race, and lack of father of baby listed on birth record had increased risk of PTB. Understanding the lived experience of Black pregnant people and these selected indicators of SDoH that contribute to the risk of PTB may inform development of interventions to address the racial disparity in PTB in the United States. · Preterm birth disproportionately affects Black individuals.. · SDoH are contributors to preterm birth.. · This study investigates social determinant influences on preterm birth among Black individuals..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"781-787"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339316","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":"A Pilot Study Using Continuous Glucose Monitoring among Patients with a Low 1-Hour Glucose Challenge Test Result versus Controls to Detect Maternal Hypoglycemia.","authors":"Jia Jennifer Ding, Lauren Milley, Moeun Son","doi":"10.1055/a-2419-8476","DOIUrl":"10.1055/a-2419-8476","url":null,"abstract":"<p><p>A low 1-hour glucose challenge test (GCT) result (<10th percentile for population) has been associated with neonatal morbidity, including small-for-gestational-age birth weight, and it is hypothesized that underlying maternal hypoglycemia may contribute to this neonatal morbidity. We sought to assess whether eligible patients would undergo continuous glucose monitoring to allow comparison of maternal hypoglycemia between those with a low GCT result versus controls.This exploratory study enrolled patients who completed a GCT between 24 and 30 weeks' gestation from June to September 2022. English- or Spanish-speaking participants aged ≥18 years wore a blinded continuous glucose monitor (CGM) for 10 days. There were 10 participants each in the low GCT (<82 mg/dL) and normal GCT group. Proportions were calculated to determine recruitment rates and describe the low versus normal glycemic groups across clinical and sociodemographic characteristics. Maternal hypoglycemia, defined using various proposed thresholds, was analyzed as continuous data (time duration) with Student's <i>t</i>-tests and categorical data (number of episodes) with chi-square tests and bivariate analyses were performed comparing participants with a low versus normal GCT. Primary outcome measures were recruitment, enrollment, and adherence rates, and overall glycemic values for each group.Of 64 eligible patients, 58 (91%) were approached, and of them, 20 (35%) were enrolled. All 20 participants had CGM data to review with 100% adherence. Average glucose values were similar between participants in the low GCT and normal GCT groups (111.7 ± 18.0 vs. 111.6 ± 11.7 mg/dL, <i>p</i> = 0.99), and participants with a low GCT value did not demonstrate more hypoglycemia than those with a normal GCT value across five proposed thresholds on CGM analysis.In this pilot study, participants wore blinded CGMs to collect glycemic data, and those with a low GCT result did not experience more hypoglycemia than those with a normal GCT on CGM analysis. · Study participants wore continuous glucose monitors in blinded mode to gather glycemic data with 100% adherence.. · Participants with a low GCT result (<82 mg/dL) as compared with those with a normal GCT result were not more likely to demonstrate maternal hypoglycemia using several thresholds on CGM analysis.. · In our cohort, there were few participants in either glycemic group who reported food insecurity or lived in a food desert..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"555-563"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455952","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":"Does Timing of Diagnosis of Hypertensive Disorders of Pregnancy Impact Blood Pressure Resolution?","authors":"Eric K Broni, Joana Lopes Perdigao, Nathanael Koelper, Jennifer Lewey, Lisa D Levine","doi":"10.1055/a-2419-9343","DOIUrl":"10.1055/a-2419-9343","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy (HDP) can be diagnosed prior to labor, during labor, or postpartum. We evaluated whether the timing of HDP diagnosis impacts postpartum blood pressure (BP) outcomes.Secondary analysis of 384 patients with HDP from a trial evaluating furosemide use on BP outcomes. The timing of HDP diagnosis was categorized into diagnosis in the antepartum period, prior to labor versus diagnosis peripartum (during labor or first day of postpartum). Outcomes included time to resolution of hypertension and persistent hypertension 7 days' postpartum. Logistic and Cox regression models were used.Patients diagnosed in the peripartum period had a shorter median time to postpartum BP resolution after adjusting for severity of HDP, mode of delivery, and furosemide use (5.5 vs. 6.5 days, adjusted hazard ratio: 1.18, 95% confidence interval [1.11-1.25]).Patients diagnosed with HDP in the peripartum period experience a faster BP resolution than those diagnosed in the antepartum period. · HDP can be diagnosed before and during labor and postpartum.. · The timing of HDP diagnosis may have different implications for postpartum BP outcomes.. · Patients diagnosed with HDP in the peripartum period experienced a 24-hour shorter time to BP resolution.. · Timing of HDP diagnosis may provide an added window of opportunity to augment existing modalities of managing postpartum hypertension and related cardiovascular disease complications..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"768-772"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339310","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 Optimal Prediction Model for Successful External Cephalic Version.","authors":"Rahul S Yerrabelli, Peggy K Palsgaard, Priya Shankarappa, Valerie Jennings","doi":"10.1055/a-2419-9146","DOIUrl":"10.1055/a-2419-9146","url":null,"abstract":"<p><p>The majority of breech fetuses are delivered by cesarean birth as few physicians are trained in vaginal breech birth. An external cephalic version (ECV) can prevent cesarean delivery and the associated morbidity in these patients. Current guidelines recommend that all patients with breech presentation be offered an ECV attempt. Not all attempts are successful, and an attempt does carry some risks, so shared decision-making is necessary. To aid in patient counseling, over a dozen prediction models to predict ECV success have been proposed in the last few years. However, very few models have been externally validated, and thus, none have been adopted into clinical practice. This study aims to use data from a U.S. hospital to provide further data on ECV prediction models.This study retrospectively gathered data from Carle Foundation Hospital and used it to test six models previously proposed to predict ECV success. These models were Dahl 2021, Bilgory 2023, López Pérez 2020, Kok 2011, Burgos 2010, and Tasnim 2012 (GNK-PIMS score).A total of 125 patients undergoing 132 ECV attempts were included. A total of 69 attempts were successful (52.2%). Dahl 2021 had the greatest predictive value (area under the curve [AUC]: 0.779), whereas Tasnim 2012 performed the worst (AUC: 0.626). The remaining models had similar predictive values as each other (AUC: 0.68-0.71). Bootstrapping confirmed that all models except Tasnim 2012 had confidence intervals not including 0.5. The bootstrapped 95% AUC confidence interval for Dahl 2021 was 0.71 to 0.84. In terms of calibration, Dahl 2021 was well calibrated with predicted probabilities matching observed probabilities. Bilgory 2023 and López Pérez were poorly calibrated.Multiple prediction tools have now been externally validated for ECV success. Dahl 2021 is the most promising prediction tool. · Prediction models can be powerful tools for patient counseling.. · The odds of ECV success can estimated based on patient factors and clinical findings.. · Of the six tested models, only Dahl 2021 appears to have good predictive value and calibration..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"751-757"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339317","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":"Evaluating Nutritional Selection and Outcomes in Neonatal Abstinence Syndrome: A Retrospective Review.","authors":"Juan A Gallegos, Laura Serke, Yana Feygin, Kahir Jawad, Tonya Robinson, Sucheta Telang","doi":"10.1055/a-2418-9886","DOIUrl":"10.1055/a-2418-9886","url":null,"abstract":"<p><p>The rising incidence of neonatal abstinence syndrome (NAS) has amplified the importance of nonpharmacological interventions in its management, which include the selection of feedings. With the goal of obtaining an accurate assessment of the effects of current feeding practices in NAS infants in our neonatal intensive care unit, we conducted a retrospective review of NAS infants at our hospital over a 3-year period to determine their nutritional selections and evaluate their length of stay (LOS), length of treatment (LOT), and growth outcomes.Retrospective chart review of term infants (≥37 weeks of gestation) with NAS. Maternal and infant demographics and characteristics were recorded. Infants were grouped based on majority (>50% of total feeding) nutritional selections and LOS, LOT, and growth parameters were evaluated. Linear regression was used to compare group outcomes. Significance was set at a <i>p</i>-value <0.05.A total of 70 infants were included and grouped based on majority feeds into maternal breast milk (MBM), standard term formula (STF), low lactose formula (LLF), and extensively hydrolyzed formula (EHF) groups. Feeding selections were provider-dependent and infants were placed on MBM or STF as an initial selection. In all infants included in our review, LLF was selected as the first choice following MBM or STF for increased gastrointestinal (GI) disturbance-related Finnegan Neonatal Abstinence Scoring scores and changed to EHF if LLF failed to improve the GI-related symptoms. The STF-fed infants had the shortest LOS, and none of these infants required pharmacological treatment. The LOT and LOS were similar in the MBM- and LLF-fed groups. Infants who were EHF fed had the longest LOT and LOS. All feeding groups demonstrated appropriate growth.Nutritional selections in our NAS infants were modified for the severity of their withdrawal symptoms. All nutritional modifications driven by severity of withdrawal symptoms supported favorable growth outcomes in the infants. · Our NAS infants were fed with multiple types of nutrition.. · Infants with severe NAS required more elemental feeds.. · All formula selections supported favorable growth..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"742-750"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399121","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":"Urinary Neutrophil Gelatinase-Associated Lipocalin Values in Preterm Neonates: A Systematic Review and Meta-analysis.","authors":"Tahagod Mohamed, Robin Alexander, Brielle Davidson, Brett Klamer, Alison Gehred, Michelle C Starr, Cara Slagle, Catherine Krawczeski, Matthew W Harer","doi":"10.1055/a-2417-4087","DOIUrl":"10.1055/a-2417-4087","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is common in hospitalized preterm neonates. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a promising noninvasive AKI biomarker. However, normal values of uNGAL in preterm neonates without AKI are poorly characterized. The objective of this study was to evaluate the current literature to determine normal uNGAL values for preterm neonates without AKI.Systematic review and meta-analysis of all articles published before November 2021 evaluating uNGAL values in preterm neonates without AKI.Of 1,607 studies evaluated for eligibility, 11 were included in the final meta-analysis (210 males, 202 females). uNGAL values were higher in the preterm neonates <29 weeks and ranged between 20.7 and 782.65 ng/mL. Meta mean estimates of gestational age (GA), birthweight, and neutrophil gelatinase-associated lipocalin were 29.4 weeks (95% confidence interval [CI]: 28.8-30.0), 1,241 g (95% CI: 1,111-1,372), and 148.9 ng/mL (95% CI: 48-231), respectively.In limited studies, a wide range of uNGAL values in preterm neonates without AKI are reported. Future studies should identify normal uNGAL values in preterm neonates using larger cohorts by GA and birthweight. · Urinary NGAL is a promising noninvasive biomarker of neonatal AKI.. · A wide range of uNGAL is reported in preterm neonates but the baseline values are not well defined.. · Urine NGAL values are higher in extremely preterm compared with preterm neonates..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"683-688"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492905","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":"Development and Evaluation of a Rural Longitudinal Neonatal Resuscitation Program Telesimulation Program (MOOSE: Maine Ongoing Outreach Simulation Education).","authors":"Misty Melendi, Allison E Zanno, Jeffrey A Holmes, Micheline Chipman, Anya Cutler, Henry Stoddard, Leah M Seften, Anna Gilbert, Mary Ottolini, Alexa Craig, Leah A Mallory","doi":"10.1055/a-2421-8486","DOIUrl":"10.1055/a-2421-8486","url":null,"abstract":"<p><p>Neonatal resuscitation is a high-acuity, low-occurrence event and many rural pediatricians report feeling underprepared for these events. We piloted a longitudinal telesimulation (TS) program with a rural hospital's interprofessional delivery room teams aimed at improving adherence to Neonatal Resuscitation Program (NRP) guidelines and teamwork.A TS study was conducted monthly in one rural hospital over a 10-month period from November 2020 to August 2021. TS sessions were remotely viewed and debriefed by experts, a neonatologist and a simulation educator. Sessions were video recorded and assessed using a scoring tool with validity evidence for NRP adherence. Teamwork was assessed using both TeamSTEPPS 2.0 Team Performance Observation Tool and Mayo High-Performance Teamwork Scale.We conducted 10 TS sessions in one rural hospital. There were 24 total participants, who rotated through monthly sessions, ensuring interdisciplinary team composition was reflective of realistic staffing. NRP adherence rate for full code scenarios improved from a baseline of 39 to 95%. Compared with baseline data for efficiency, multiple NRP skills improved (e.g., cardiac lead placement occurred 12× faster, 0:31 seconds vs. 6:21 minutes). Teamwork scores showed improvement in all domains.Our results demonstrate that a TS program aimed at improving NRP and team performance is possible to implement in a rural setting. Our pilot study showed a trend toward improved NRP adherence, increased skill efficiency, and higher-quality teamwork and communication in one rural hospital. Additional research is needed to analyze program efficacy on a larger scale and to understand the impact of training on patient outcomes. · Optimal newborn outcomes depend on skillful implementation of NRP.. · Telesimulation can deliver medical education that circumvents challenges in rural areas.. · A longitudinal NRP TS program is possible to implement in a rural setting.. · A rural NRP telesimulation program may improve interprofessional resuscitation performance.. · A rural NRP telesimulation program may improve interprofessional resuscitation teamwork..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"796-805"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339309","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":"Maternal and Infant Morbidity and Mortality in Relation to Delivery Mode in a Large U.S. Health Care Claims Database in 2019 and 2020.","authors":"Brett T Doherty, Stephanie Lynch, Aneesh Naavaal, Chrissie Li, Kimberly Cole, Leslie MacPhee, Leslie Banning, Anup Sharma, Michael Grabner, Eric Stanek, Tiffany Inglis","doi":"10.1055/a-2419-8916","DOIUrl":"10.1055/a-2419-8916","url":null,"abstract":"<p><p>This study aimed to provide contemporary data on maternal and infant outcomes after delivery to better understand risks of cesarean section (CS).Data for deliveries in 2019 and 2020 were obtained from a large U.S. commercial health care claims database. Maternal morbidity measures included 20 severe maternal morbidity (SMM) outcomes and seven additional obstetric and mental health outcomes. Infant morbidity measures included eight outcomes related to respiratory health, digestive health, atopic dermatitis, and birth trauma. Outcome prevalence was ascertained at 42 days (maternal only) and 360 days after delivery. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for prevalence adjusted for risk factors for delivery mode and each outcome. Analyses were conducted for 2019 and 2020 to assess the influence of the coronavirus disease 2019 pandemic.A total of 436,991 deliveries were identified (145,061 CS; 291,930 vaginal). The prevalence of SMM was 3.3% at 42 days and 4.1% at 360 days. The covariate-adjusted odds of SMM were higher among CS than vaginal deliveries at 42 days (OR: 2.0, 95% CI: 1.9, 2.1) and 360 days (OR: 1.7, 95% CI: 1.7, 1.8). There were 226,983 infants available for analysis of outcomes at 360 days. Most adverse infant outcomes were more prevalent at 360 days among CS than vaginal deliveries, and the covariate-adjusted odds of any adverse infant outcome at 360 days were higher among CS than vaginal deliveries (OR: 1.2; 95% CI: 1.1, 1.3). Respiratory morbidity was most affected by delivery mode. Maternal and infant mortality up to 360 days was rare. Similar trends were observed in the 2019 and 2020 cohorts.This observational study, performed using recent data obtained from a large U.S. commercial claims database, provides contemporary evidence of risks to mothers and infants of CS relative to vaginal delivery. · In a large commercially insured population, one-third of deliveries were by CS.. · Most maternal and infant outcomes were more prevalent among CS deliveries than vaginal deliveries.. · Respiratory conditions were most strongly related to delivery mode among infants.. · Maternal and infant mortality up to 360 days was rare in this population.. · Results were similar in 2019 and 2020, indicating a small impact of the COVID-19 pandemic..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"758-767"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339313","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":"Neonatal Outcomes at 2 Years following Expectant Management of Previable Premature Prelabor Rupture of Membranes at a Single Center.","authors":"Jennifer J M Cate, Allison Chu, Katherine Lambert, Ronan Sugrue, Sarahn Wheeler, Matthew R Grace, William A Adams, Sarah Dotters-Katz","doi":"10.1055/a-2405-3609","DOIUrl":"10.1055/a-2405-3609","url":null,"abstract":"<p><p>Previable premature prelabor rupture of membranes (pPPROM) can lead to significant maternal and neonatal morbidity and mortality. Limited literature exists describing long-term outcomes in neonates surviving pPPROM. Our study describes 2-year survival and outcomes after expectantly managed pPPROM at a single, tertiary, academic center. This is a retrospective review including individuals with pPPROM defined as membrane rupture before 24^0/7 weeks who were candidates and opted for expectant management at a single tertiary academic center between 2013 and 2022. Patients were included if they delivered after 22 weeks. Patients opting for termination, with contraindication to expectant management or who chose expectant management without planned neonatal resuscitation at birth were excluded. Electronic records of patients and associated neonates were reviewed for demographic information, PPROM management, and neonatal outcomes at 2 years including gastrointestinal, respiratory, cognitive, motor, and hearing or vision issues. Descriptive statistical analysis was performed. Of 111 pregnancies with pPPROM, 50(45%) pregnant individuals met inclusion criteria (46 singletons; 4 multiples [3 twins, 1 set of quads]). Of 46 singletons, 31 (67%) survived to 2 years with 1(3%) alive but less than 2 years. In 3/4 (75%) twin gestations, both twins survived to 2 years. A total of 3/4 (75%) quadruplets survived to 2 years. Most surviving infants (95.0%, <i>n</i> = 38) had at least one documented adverse outcome. A total of 55.0% (<i>n</i> = 22) of neonates had gross motor delay, and 77.5% (<i>n</i> = 31) had documented speech delay. Most had respiratory issues with reactive airway disease most common (22.5% <i>n</i> = 9). Gastrointestinal issues were common with gastrostomy tube in 32.5% (<i>n</i> = 13) and short gut syndrome in 15% (<i>n</i> = 6). Over half of neonates with expectantly managed pPPROM survived with high rates of adverse outcomes with over half with documented gross motor and speech delay present at 2 years. Respiratory and gastrointestinal issues were also common. These data provide information for important patient counseling on long-term outcomes in expectantly managed pPPROM. · Adverse outcomes at 2 years after pPPROM were prevalent.. · Speech delay at 2 years was the most common outcome.. · Motor delay occurred in 55% of neonates at 2 years.. · Long-term pPPROM data can guide counseling..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"813-817"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339314","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}