American journal of perinatology最新文献

{"title":"Routine Transvaginal Ultrasound at the Time of the Anatomy Scan: To Do or Not To Do?","authors":"Olivia Grubman, Mackenzie Mitchell, Thomas Owens, Mia Heiligenstein, Elianna Kaplowitz, Guillaume Stoffels, Zainab Al-Ibraheemi, Lois Brustman, Graham Ashmead, Farrah N Hussain","doi":"10.1055/a-2414-0857","DOIUrl":"10.1055/a-2414-0857","url":null,"abstract":"<p><p>There are no universal guidelines for transvaginal ultrasound (TVUS) at the time of the anatomy scan. TVUS can provide information on placental location and cervical length (CL) but may lead to more interventions. As a quality assurance initiative, a universal TVUS (UTVUS) protocol at the time of the anatomy scan was started at our institution. This study was conducted to assess whether there was a decrease in preterm birth (PTB), postpartum hemorrhage (PPH), and neonatal intensive care unit (NICU) admission once UTVUS was implemented.This was a retrospective cohort study performed on singleton gestations from February 2021 to January 2022. In the first 6 months of the study period, patients only had TVUS based on risk factors (pre group). In the second half of the study period, UTVUS was implemented at the time of the anatomy scan (post group).A total of 2,118 patients were included in the study. There were 1,037 patients in the pre group, of which 161 underwent TVUS based on high-risk factors (history of the cervical procedure, history of prior PTB, and placenta appearing low lying or cervix appearing short on abdominal ultrasound). The post group/UTVUS included 1,081 patients. Patients in the pre group had statistically significantly earlier gestational age at first TVUS (<i>p</i> < 0.0001), were less likely to have had a prior PTB <36 weeks (<i>p</i> = 0.03), and were more likely to have a history of cervical procedure (<i>p</i> = 0.0006) than patients in the post group. There was an increased use of vaginal progesterone in the UTVUS with 33 patients (as opposed to 10 patients in the pre group; <i>p</i> = 0.0007). The proportion of patients with PTB, PPH, or NICU admission did not significantly differ between the two groups even after adjusting for cofounders (<i>p</i> > 0.05).Our data show that UTVUS did not decrease the adverse pregnancy outcomes. In addition, the implementation of UTVUS adds more discomfort for a patient, more time to the patient's scan, and is an additional cost. Therefore, surveillance by abdominal ultrasound and adding TVUS based on risk factors may be a reasonable alternative. · UTVUS showed no difference between CLs.. · There is not sufficient evidence to conclude a difference between PTB or PPH in the two groups.. · There was significantly more placenta previa diagnosed in the post group, yet most resolved..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"643-648"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455970","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":"Cost Comparison of a Traditional Didactic versus National Flipped Classroom Curriculum.","authors":"Melissa M Carbajal, Heidi Karpen, AnnaMarie Arias-Shah, Carly Gisondo, Heather M French, Megan M Gray, Susan Izatt, Maria Gillam-Krakauer, Lindsay C Johnston, Allison Payne, Margarita M Vasquez, Elizabeth M Bonachea, Alison J Falck, Patricia R Chess, Rita Dadiz","doi":"10.1055/a-2410-9126","DOIUrl":"10.1055/a-2410-9126","url":null,"abstract":"<p><p>We compared the cost of faculty time preparing educational materials for traditional didactic (TD) education provided at local institutions with that of faculty time preparing National Neonatology Curriculum (NNC) flipped classroom (FC) educational materials shared among institutions for fellow education across the United States.Using survey data and the national average for faculty educators' salaries, we calculated the cost of developing TD versus FC materials. Wilcoxon rank-sum test and comparison of two Poisson rates were utilized to evaluate the time to create versus update TD materials and the cost to create new TD versus FC materials, respectively.FC materials required more time to develop than TD materials (FC, median 17 h, interquartile range [IQR]: 17; TD, median, 5 h, IQR: 5; <i>p</i> < 0.001). However, when the size of individual fellowship programs was factored into the cost analysis, FC materials shared nationally among programs resulted in a 19- to 72-fold cost savings when compared to the creation of new locally used TD materials (FC, $2.49 per fellow; TD $32.05-576.90 per fellow at very large-to-small fellowship programs; <i>p</i> < 0.001).Educational materials developed and disseminated to fellowship programs across the country confer significant savings in faculty educator time and cost per learner. Standardized programs such as the NNC may serve as a model to develop shared peer-reviewed educational resources for other specialties. · Educational materials developed for national use confer time and cost savings.. · Small fellowships benefit greatly from having access to shared resources.. · Shared, peer-reviewed resources promote equity in education.. · Shared resources can free faculty time to focus on other academic interests..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"580-585"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142144951","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 neonatal outcomes in gestational hypertension for delivery at 37 weeks versus 38-40 weeks.","authors":"Lauren Thompson, Joseph Werthammer, Grace Montgomery, Matthew Nudelman, Jesse Cottrell, David Gozal, Rebekah Fabela, Kennedy Snavely","doi":"10.1055/a-2568-9104","DOIUrl":"https://doi.org/10.1055/a-2568-9104","url":null,"abstract":"<p><strong>Objective: </strong>To compare neonatal and maternal outcomes for mothers with gestational hypertension delivered at 37 weeks' gestation compared with 38-40 weeks.</p><p><strong>Study design: </strong>Single center, retrospective chart review of women with gestational hypertension delivered between 37+0-40+6 weeks' gestation over a 29-month period.</p><p><strong>Results: </strong>337 mother-infant dyads with gestational hypertension were included: 194 delivered at 37 weeks' gestation (cohort 1) and 143 delivered at 38-40 weeks' gestation (cohort 2). Preeclampsia developed in 12% of cohort 1 and 8% of cohort 2 (p=0.242). No significant differences in severe hypertensive-related complications were found between the cohorts. Neonatal outcomes including NICU admission, respiratory support, phototherapy, and length of stay were all more frequent in cohort 1.</p><p><strong>Conclusion: </strong>For women with gestational hypertension, delivery at 38-40 weeks was not associated with increased maternal complications but was associated with fewer neonatal complications when compared to delivery at 37 weeks.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750668","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 Association of Adverse Perinatal Outcomes in Pregnancies with gestational diabetes and excessive gestational weight gain according to obesity status.","authors":"Henry Lesser, Vani Movva, Amanda Young, Celia Gray, Dhanya Mackeen","doi":"10.1055/a-2568-6317","DOIUrl":"https://doi.org/10.1055/a-2568-6317","url":null,"abstract":"<p><strong>Objective: </strong>Obesity, gestational diabetes mellitus (GDM), and excessive gestational weight gain (EGWG) are associated with adverse outcomes. It is unclear which carries the greatest risk. In this study, the relationship of obesity, GDM, and EGWG independently and concomitantly was analyzed to determine if one is a greater risk factor than the other.</p><p><strong>Study design: </strong>A retrospective cohort study of singleton gestations at Geisinger from 10/2007-3/2023 was performed. Exclusion criteria were pregravid BMI <18 kg/m2, gestational age (GA)<34 weeks, pregestational diabetes or chronic hypertension, prior cesarean delivery (CD) or contraindication to vaginal delivery. Patients were grouped by BMI class and the order of groups within each BMI for the test for trend were no GDM/no EGWG, GDM/no EGWG, no GDM/EGWG, and GDM/EGWG. The rates of HDP (hypertensive disorders of pregnancy), severe HDP, CD, large for gestational age (LGA), shoulder dystocia, and neonatal intensive care unit (NICU) admission >35 weeks were evaluated. A test for trend and odds ratios with 95% CIs were reported. P-values were reported across the GDM/EGWG groups per BMI category.</p><p><strong>Results: </strong>42,627 pregnancies were included. At each BMI category, HDP, severe HDP, CD, LGA, and shoulder dystocia generally increased from patients with no GDM/no EGWG to those with GDM/no EGWG to those with no GDM/EGWG to those with GDM/EGWG. NICU admission ≥35 weeks did not follow this progression.</p><p><strong>Conclusions: </strong>EGWG poses a greater risk than GDM regardless of pregravid BMI for HDP, severe HDP, CD, LGA, and shoulder dystocia. Attention should be given to determine the optimal strategy to manage pregnancies experiencing EGWG.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750671","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":"Predicting Clinical Outcomes of Severe Bronchopulmonary Dysplasia through New Definitions and Phenotypes.","authors":"Susan McAnany, Gangaram Akangire, Ashley Sherman, Venkatesh Sampath, Winston Manimtim","doi":"10.1055/a-2550-5306","DOIUrl":"10.1055/a-2550-5306","url":null,"abstract":"<p><p>This study aimed to compare the accuracy of three newly proposed definitions of bronchopulmonary dysplasia (BPD) in predicting outcomes, and to investigate the impact of large airway versus parenchymal versus vascular BPD phenotypes on BPD outcomes.Retrospective chart review of 100 infants with severe BPD discharged from a Children's hospital between 2020 and 2021. Multivariable models evaluated the associations between BPD definitions and phenotypes with tracheostomy and death at 6 months and 1 year after NICU discharge. Secondary outcomes included the need for respiratory support, the use of pulmonary medications, and the need for long-term gastrostomy feeding.Neonatal research network (NRN) and BPD collaborative criteria best-predicted outcomes associated with tracheostomy and/or death (<i>p</i> < 0.001). Among the three BPD phenotypes, large airway disease was independently associated with death or tracheostomy (odds ratios [OR]: 10.5; 95% confidence interval [CI]: 1.6, 68.1). The combination of all three phenotypes was also associated with death or tracheostomy (OR: 9.8; 95% CI: 1.0, 93.5). Both NRN and BPD collaborative definitions showed an association with the need for respiratory support, medication use, and need for long-term gastrostomy tube feeding. Among the 29 infants for whom complete information was available, 18 (62%), 20 (69%), and 18 (62%) had parenchymal, central airway and pulmonary vascular phenotype, respectively.Our results indicate that newer definitions of BPD may better predict the severity of BPD and the need for long-term invasive ventilation support compared with the 2001 National Institute of Health definition of BPD phenotypes impacting mortality and short-term outcomes. These data may be useful for counseling families and developing phenotype-based individualized treatment plans. · The current definition of BPD has limitations.. · New definitions of BPD better predict outcomes.. · BPD phenotypes can better predict outcomes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555484","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":"Needs of Parents and Neonates in the Intensive Care Unit: A Literature Review.","authors":"Brandon W Qualls","doi":"10.1055/a-2552-9008","DOIUrl":"10.1055/a-2552-9008","url":null,"abstract":"<p><p>The admission of a neonate to the neonatal intensive care unit (NICU) presents unique and complex needs for both the infant and their parents. This literature review aims to synthesize existing research to comprehensively understand these needs, focusing on parental psychosocial well-being, practical requirements, and the neonate's developmental necessities. Understanding these needs is crucial for optimizing clinical outcomes and fostering healthy parent-infant relationships. A nonsystematic literature review was conducted using PubMed, Google Scholar, and PsycINFO databases. Search criteria focused on \"neonatal intensive care\" and \"parental needs.\" Articles published in English between 2011 and 2022 were included. The review analyzed 123 articles, primarily focusing on research conducted in Western countries. Parental needs were categorized into seven areas: mental health/psychosocial well-being, practical needs (physical, safety, monetary), parental involvement, relationships (infant, staff, peers), information, spiritual needs, and help with other responsibilities. Neonatal needs included parental involvement, skin-to-skin contact, breastfeeding, and reduced length of stay. Key findings highlighted the prevalence of parental anxiety and depression, the importance of practical support, and the critical role of parental involvement in both parent and infant well-being. This review underscores the interconnectedness of parental and neonatal needs within the NICU environment. Parental involvement is essential for both groups, and factors such as hospital policies, community resources, and socioeconomic status significantly influence fulfilling these needs. The limitation of the review indicates the need for more diverse global research. Future studies should address these limitations and explore effective interventions to meet the identified needs, improving outcomes for NICU families. · The review identifies seven key parental needs in the NICU and four neonatal needs.. · It is important to provide support for the well-being of both parents and infants.. · Hospital policies, community resources, and socioeconomic status impact the ability to meet these..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584280","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":"Racial Disparities in the Adherence to an Enhanced Recovery After Cesarean Protocol (ERAC): A Retrospective Observational Study at Two NYC Hospitals, 2016-2020.","authors":"Abbey T Gilman, Jessica Kim, Silis Y Jiang, Sharon E Abramovitz, Robert S White","doi":"10.1055/a-2548-0737","DOIUrl":"https://doi.org/10.1055/a-2548-0737","url":null,"abstract":"<p><p>Enhanced recovery after surgery programs for cesarean deliveries (ERAC) aim to optimize the quality of care for all patients. Race is not routinely monitored in ERAC programs. Given the extensive reports of racial disparities in obstetrical care, the goal of this study was to investigate racial differences in adherence rates to individual ERAC protocol elements.A cohort study was performed among cesarean delivery patients enrolled in an ERAC program at two hospitals from October 2016 to September 2020. Compliance with anesthesia-specific ERAC metrics, including ketorolac, ondansetron, and active warming methods, were compared by race. Race was self-reported by all patients. Logistic regression models stratified by pre- and post-ERAC status were used to assess relationships.The sample consisted of 7,812 cesarean delivery patients, of which 4,640 were pre-ERAC (59.4%) and 3,172 were post-ERAC (40.6%). There were no racial differences found in overall ERAC protocol adherence, active warming methods, or ondansetron administration in the pre- and post-ERAC groups. The odds of ketorolac administration in Black patients (adjusted odds ratio [aOR]: 0.72; 95% confidence interval [CI]: 0.55-0.95; <i>p</i> = 0.020) and Asian patients (aOR: 0.81; 95% CI: 0.68-0.98; <i>p</i> = 0.027) pre-ERAC were significantly lower compared with white patients. In the post-ERAC group, this disparity persisted in Black (aOR: 0.80; 95% CI: 0.65-0.99; <i>p</i> = 0.042) and Asian patients (aOR: 0.85; 95% CI: 0.73-0.98; <i>p</i> = 0.023).Appropriate implementation and adherence to all elements of the ERAC program may provide a practical approach to reducing disparities in outcomes and ensuring equitable treatment for all patients. · No racial differences were found in ondansetron administration pre- and post-ERAC.. · No racial differences were found in active warming methods pre- and post-ERAC.. · Black patients had significantly lower odds of ketorolac administration pre- and post-ERAC.. · Asian patients had significantly lower odds of ketorolac administration pre- and post-ERAC.. · ERAC metrics must be routinely monitored by race to resolve any observed inequities..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Maternal Serum Retinol-Binding Protein Levels with Adverse Pregnancy Outcomes: A Retrospective Cohort Study.","authors":"Wenjing Dong, Xuelian Chu, Yanan Wang, Linyuan Gu, Yiming Chen","doi":"10.1055/a-2544-9158","DOIUrl":"10.1055/a-2544-9158","url":null,"abstract":"<p><p>This study aimed to determine the correlation between decreased or increased retinol-binding protein (RBP) levels during pregnancy and adverse pregnancy outcomes.A retrospective cohort study was conducted to analyze the data of 16,094 pregnant women who participated in serum RBP level detection during pregnancy. The chi-square test or Mann-Whitney U test was used for the univariate analysis of qualitative or quantitative data. Multiple logistic regression analysis, odds ratio (OR), and 95% confidence interval were used to evaluate the effect of RBP levels on adverse pregnancy outcomes.The groups showed a significant difference in RBP levels (<i>p</i> < 0.001). The results of multiple logistic regression analysis revealed that twins (OR = 2.631), upper respiratory tract infection (URTI, OR = 2.596), premature delivery (OR = 1.833), and macrosomia (OR = 1.524) were correlated with low retinol-binding protein (L-RBP), while preeclampsia (PE, OR = 0.147), intrahepatic cholestasis of pregnancy (OR = 1.654), gestational hypertension (GH, OR = 1.646), oligohydramnios (OR = 1.487), and advanced maternal age (OR = 1.470) were correlated with high retinol-binding protein (H-RBP). Decreased or increased RBP levels were correlated with hyperlipidemia (OR = 1.738, 2.857), Antenatal anemia (OR = 1.378, 0.791), gestational diabetes mellitus (GDM, OR = 1.272, 0.796), and small infant size (OR = 0.664, 1.444). L-RBP may indicate an increased risk of antenatal anemia and GDM, whereas H-RBP may indicate a decreased risk of antenatal anemia and GDM. Pregnant women with H-RBP were more likely to give birth to smaller infants, whereas those with L-RBP had a lower risk of this outcome. Additionally, mothers with H-RBP were not likely to give birth to male infants.Hyperlipidemia, URTI, GH, PE, and GDM affect serum RBP levels, and these exposure factors can lead to different degrees of adverse pregnancy outcomes. · To study the effect of adverse exposure factors on pregnancy outcome and the relationship with RBP.. · RBP may be a new biomarker that can be used to help stratify pregnancy risk.. · This study included 16,094 participants and a high number of variables in the analysis..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497974","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":"Telemedicine Consultations in Community Hospitals Improve Neonatal Encephalopathy Assessment.","authors":"Anya Cutler, Leah Marie Seften, Alexa Craig","doi":"10.1055/a-2541-3763","DOIUrl":"10.1055/a-2541-3763","url":null,"abstract":"<p><p>We aimed to determine if the implementation of teleconsults in the community hospital would decrease the time to initiation of therapeutic hypothermia (TH).We compared neonates treated with TH prior to implementation of the teleconsult program (pretele) to those treated after (posttele) for the outcomes of time to initiation of TH, seizures, and death/severe injury on brain MRI. We controlled for confounders using multivariable linear and logistic regression models.There were 52 pretele neonates and 49 posttele who were all born in community hospitals and treated with TH. Mothers in the posttele group were older and had higher rates of gestational diabetes. Fewer neonates with mild encephalopathy were cooled in the posttele period (13 [25.0%] pretele vs. 2 [4.1%] posttele). After controlling for gestational diabetes, maternal age, and severity of encephalopathy, there was no difference in time to TH initiation (<i>p</i> = 0.445), brain injury or death (<i>p</i> = 0.136), or seizure (<i>p</i> = 0.433) between the pre-and posttele groups. In the sub-analysis of the posttele group, the time to initiation was 4.50 hours (3.75, 5.00) for those with teleconsults versus 3.25 (2.12, 4.00) hours (<i>p</i> = 0.007) for those without.When comparing pre- to posttele groups, teleconsults in the community hospital did not significantly change the time to initiate TH or result in more adverse short-term outcomes of seizures or death/brain injury. In the sub-analysis of the posttele group, teleconsults did result in delayed initiation of TH but also possibly improved patient selection with fewer mildly encephalopathic neonates treated. · Telemedicine did not reduce the time to initiate TH.. · Fewer mild NE neonates received TH posttele.. · Multiple NE exams increased for the posttele group.. · No short-term adverse outcome differences were found..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456789","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 Uterine Artery Doppler Indices when Leaving the Placenta In Situ for Placenta Accreta Spectrum.","authors":"Elias Kassir, Edgar A Hernandez-Andrade, Baha M Sibai, Ramesha Papanna, Eleazar E Soto-Torres, Jennie O Coselli, Sarah T Mehl, Donatella Gerulewicz-Vannini, Abigail S Zamorano, Sean C Blackwell, Farah H Amro","doi":"10.1055/a-2553-9323","DOIUrl":"https://doi.org/10.1055/a-2553-9323","url":null,"abstract":"<p><p>This study aimed to evaluate longitudinal changes in uterine artery (UtA) Doppler velocimetry in patients with placenta accreta spectrum (PAS) managed by leaving the placenta in situ (LPIS) postpartum.This is a prospective cohort study of patients with PAS managed by LPIS for either planned interval hysterectomy or uterine preservation who underwent serial postpartum ultrasounds. We included patients who had Doppler velocimetry of the UtA obtained before delivery and postpartum. Left, right, and mean (m) peak systolic velocity (PSV), end-diastolic velocity (EDV), and pulsatility index (PI) were recorded. Our goal is to describe changes in these Doppler indices over time and to make comparisons with normal postpartum reference values.A total of 34 patients were included: 19 planned for uterine-sparing management and 15 planned for interval hysterectomy. No significant differences in mUtA PI, mPSV, and mEDV were documented between predelivery values and those obtained within the first eight weeks postpartum, however after 8 weeks there was a significant increase in mUtA PI (0.80-1.49; <i>p</i> < 0.001), while mUtA PSV (103.8-58.6 cm/s; <i>p</i> = 0.002) and mEDV (53.5-15.8 cm/s; <i>p</i> < 0.001) decreased significantly. Patients opting for uterine-sparing management who successfully retained their uterus showed a trend for higher mUtA PI, PSV, and EDV than those who underwent an interval hysterectomy. mUtA PI postpartum values were lower in our study group compared to those reported from postpartum patients without PAS.In comparison to patients without PAS, mUtA PI is markedly lower in LPIS patients in the first 8 weeks. In patients undergoing LPIS for PAS, UtA Doppler indices start to show significant changes at ≥ 8 weeks postpartum compared to predelivery values, with a significant increase in mUtA PI and a reduction in mUtA PSV and EDV. Future studies are needed to evaluate the clinical utility of these findings. · UtA PI is lower when the placenta is left in situ.. · UtA PI increases and velocities decrease after 8 weeks.. · Those who retain their uterus have higher UtA PI..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741906","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}