American journal of perinatology最新文献

{"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}

{"title":"Optimizing RhD Immune Globulin Use in Pregnancy.","authors":"Elizabeth Miller, Lana El-Kassis, George Saade, Rebecca Horgan","doi":"10.1055/a-2550-5130","DOIUrl":"10.1055/a-2550-5130","url":null,"abstract":"<p><p>The global shortage of RhD immune globulin, formally acknowledged by the Food and Drug Administration in 2023, is ongoing but has improved in recent months. In response, the American College of Obstetricians and Gynecologists (ACOG) issued guidance in March 2024 on alternative strategies to conserve RhD immune globulin supplies. Our objective is to evaluate strategies for optimizing RhD immune globulin use in pregnancy amidst a global shortage.This clinical opinion reviews guidance on strategies to conserve RhD immune globulin. These include targeted administration based on non-invasive fetal RhD genotyping using cell-free DNA (cfDNA), the use of alternative RhD immune globulin products, and selective withholding of prophylaxis in early pregnancy loss under 12 weeks' gestation. ACOG guidance on the administration of RhD immune globulin in pregnancy differs from many countries worldwide, as well as the World Health Organization and the American Society of Family Planning.Targeted administration and the use of non-invasive cell-free DNA (cfDNA) testing for fetal RhD status have shown promising accuracy and reliability in studies across multiple countries, leading to reduced unnecessary prophylaxis and potential cost savings. Additionally, withholding RhD immune globulin in select early pregnancy losses could further conserve resources without increasing alloimmunization risk.This review underscores the need for evidence-based approaches to manage limited RhD immune globulin supplies effectively and suggests that targeted prophylaxis could benefit both patient outcomes and healthcare resource allocation in the face of global shortages. · Alternative RhD immune globulin strategies are vital amid ongoing global shortages.. · Targeted administration using cfDNA testing reduces unnecessary RhD immune globulin use.. · Consider withholding RhD immune globulin in <12-week pregnancy loss without instrumentation..</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":"143555481","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":"Adverse Perinatal Outcomes Associated with True Knot of the Umbilical Cord: A Multicenter Retrospective Study.","authors":"Maayan Bas Lando, Hen Y Sela, Sarit Helman, Eliel Shapira, Sorina Grisaru-Granovsky, Misgav Rottenstreich","doi":"10.1055/a-2553-9200","DOIUrl":"10.1055/a-2553-9200","url":null,"abstract":"<p><p>This study aimed to estimate the prevalence of true knot of the umbilical cord (TKUC) and identify associated adverse maternal and neonatal outcomes.A multicenter retrospective cohort study was conducted, including all women with singleton pregnancies who delivered between 24 and 42 weeks of gestation from 2005 to 2021 at two large obstetrical centers. Gross pathological examinations of the placenta and umbilical cord were routinely performed immediately after delivery. Women with TKUC detected postpartum were compared with those without TKUC. Maternal and neonatal characteristics, along with adverse outcomes, were compared between the two groups.During the study period, 283,055 deliveries met inclusion and exclusion criteria. The incidence of TKUC was 1.3%, intrauterine fetal death (IUFD) rate was significantly higher in the TKUC group (1.8% vs. 0.3%), with 91% of these deaths occurring after 34 weeks of gestation, and 72% occurring after 37 weeks. Women with TKUC experienced higher rates of preterm premature rupture of membranes, premature rupture of membranes, induction of labor, meconium-stained amniotic fluid, vacuum-assisted vaginal delivery, and postpartum hemorrhage. The rate of intrapartum cesarean deliveries was similar between the groups. Neonatal outcomes revealed similar birth weights, but higher rates of small-for-gestational-age neonates, low Apgar scores, jaundice, hypoglycemia, and intracranial hemorrhage in the TKUC group. Multivariate analysis demonstrated that TKUC was independently associated with IUFD (adjusted odds ratios [aOR]: 6.07; 95% confidence intervals [CI]: 4.68-7.86, <i>p</i> < 0.01).TKUC is not uncommon and is associated with an increased risk of IUFD, particularly in the late third trimester, as well as adverse neonatal outcomes. Early diagnosis in the third trimester followed by delivery in the late preterm or early term period may reduce IUFD rates. · TKUC occurred in 1.3% of approximately 300,000 deliveries.. · It is associated with a sixfold higher risk of IUFD.. · Most IUFDs (91%) occurred > 34 weeks, with 72% occurring > 37.. · Third-trimester ultrasound and delivery at approximately 37 weeks may reduce IUFD..</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":"143596118","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":"Letter to the Editor in Response to \"Fetal Growth Restriction: A Pragmatic Approach\".","authors":"Allan Nadel","doi":"10.1055/a-2547-4322","DOIUrl":"10.1055/a-2547-4322","url":null,"abstract":"","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":"143522410","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":"Comparison of Outpatient Mechanical Cervical Ripening Methods to Standard Inpatient Ripening.","authors":"Mary P Goering, Whitney L Wunderlich, Marc C Vacquier, David A Watson, Kelly A Drake, Sandra I Hoffman, Anna Schulte, Laura C Colicchia, Abbey C Sidebottom","doi":"10.1055/a-2553-9258","DOIUrl":"https://doi.org/10.1055/a-2553-9258","url":null,"abstract":"<p><p>This study aimed to assess clinical efficiency and maternal and neonatal outcomes for patients who underwent outpatient cervical ripening using mechanical methods (osmotic dilators and Foley balloon) compared with patients who underwent inpatient ripening.A retrospective cohort study from March 2020 to March 2022 compared patients with low-risk, term, singleton pregnancies who underwent outpatient cervical ripening to clinically similar patients who had inpatient ripening. Inverse probability of treatment weighting for analysis of outcomes to account for differences in groups and comparisons of outcomes are reported as mean differences with 95% confidence intervals (CIs).The cohort included 391 patients (116 outpatient, 275 inpatient). Among the outpatient group, half used only mechanical devices, and all others received additional pharmacological methods after admission for labor induction. Among the inpatient group, the most common cervical ripening method was pharmacological only (66.2%), followed by both pharmacological and mechanical (25.8%), and 8% used only mechanical. After outpatient cervical ripening, patients had significantly higher cervical dilation (mean difference 1.9 cm, 95% CI: 1.6, 2.3) and simplified bishop scores (mean difference 1.6, 95% CI: 1.2, 2.1) on admission compared with the inpatient group. The average time from admission to delivery was 5.8 hours shorter (95% CI: -8.6, -2.9) for the outpatient group compared with the inpatient group, and the average total length of stay was 7.1 hours shorter (95% CI: -12.1, -2.1) for the outpatients among patients with vaginal deliveries. Both groups had similar hours of oxytocin use, and mode of delivery, and did not differ for maternal complications or neonatal outcomes.Outpatient cervical ripening using multiple mechanical methods was associated with significantly higher cervical dilation, shorter average time from patient admission to delivery, and shorter total length of stay for vaginal deliveries. Outpatient cervical ripening may be an important option for easing resource utilization for induced labor. · Outpatient cervical ripening resulted in superior cervical dilation and Bishop scores.. · Hospital length of stay was shorter for those receiving outpatient cervical ripening.. · Maternal complications and neonatal outcomes did not differ by setting..</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":"143741823","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":"Head Ultrasound Findings in Infants with Birth Weight >1,500 g and Gestational Age >32 Weeks Exposed to Prenatal Opioids.","authors":"Rishika P Sakaria, Divya Rana, Mimily Harsono, Harris L Cohen, Massroor Pourcyrous","doi":"10.1055/a-2552-0715","DOIUrl":"https://doi.org/10.1055/a-2552-0715","url":null,"abstract":"<p><p>This study aimed to evaluate the effects of prenatal exposure to opioids on head ultrasound (HUS) and to determine the need for routine HUS evaluation in infants exposed to prenatal opioids.This is a retrospective cohort study performed at a level III NICU. Infants >32 weeks gestational age and >1,500 g birth weight with prenatal opioid exposure (<i>n</i> = 127) were included in this study. Data including demographic information and HUS results were recorded.Twenty (16%) infants were exposed to opioids only whereas the rest of the infants (84%) were exposed to opioids plus other drugs (polysubstance) in utero. Sixteen of 127 infants (13%) had abnormal initial HUS. Sub-ependymal hemorrhage or grade 1 intraventricular hemorrhage was the most common abnormal finding. Absent septum pellucidum was seen in three infants.A relatively large proportion (13%) of infants in this study had abnormal HUS findings; however, further studies are required to correlate HUS findings with a specific drug of exposure, duration of exposure, polysubstance use, umbilical cord drug concentration levels, and neurodevelopmental outcomes. · Limited data exists regarding HUS findings in infants with prenatal opioid exposure.. · A relatively large proportion of infants exposed to opioids in utero had abnormal HUS.. · Subependymal hemorrhages or grade I intraventricular hemorrhage was the most common abnormal finding..</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":"143741902","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":"Psychosocial, Behavioral, and Medical Drivers of Gestational Diabetes among Racial-Ethnic Groups.","authors":"Austin B Gardner, Macie L Champion, Teresa Janevic, Lynn M Yee, Ashley N Battarbee","doi":"10.1055/a-2554-0925","DOIUrl":"https://doi.org/10.1055/a-2554-0925","url":null,"abstract":"<p><p>Certain racial and ethnic groups have historically been labeled \"high-risk\" for the development of gestational diabetes mellitus (GDM). Our objective was to identify the psychosocial, behavioral, and medical factors associated with GDM and determine if they differ by race/ethnicity.Secondary analysis of a multicenter, prospective cohort study of pregnant nulliparous individuals with singleton gestations (2010-2013). The primary outcome was GDM. Psychosocial, behavioral, and medical characteristics were compared by self-reported race/ethnicity. Multivariable logistic regression with backward selection identified factors associated with GDM. Interaction terms between race/ethnicity and risk factors were tested.Of 8,672 pregnant individuals, 61% were non-Hispanic White, 13% non-Hispanic Black, 17% Hispanic, 4% Asian, and 5% other. The incidence of GDM differed by race/ethnicity with 4% non-Hispanic White, 3% non-Hispanic Black, 5% Hispanic, 11% Asian, and 5% other (<i>p</i> < 0.001). Of 34 psychosocial, behavioral, and medical factors, those associated with GDM were parent with history of diabetes (adjusted odds ratio [aOR]: 1.72; 95% confidence interval [CI]: 1.33-2.23), non-English language (aOR: 2.57; 95% CI: 1.14-5.79), daily calorie intake (aOR: 1.18; 95% CI: 1.08-1.29), daily fiber intake (aOR: 0.84; 95% CI: 0.75-0.94), maternal age (aOR: 1.53; 95% CI: 1.37-1.70), prepregnancy BMI (aOR: 1.21; 95% CI: 1.02-1.44), and waist circumference (aOR: 1.21; 95% CI: 1.03-1.43). These associations did not differ based on race/ethnicity (interaction <i>p</i>-values > 0.1).Replacing race/ethnicity as a risk factor for GDM with significant upstream psychosocial, behavioral, and medical factors should be considered. · GDM varies in incidence based on race.. · GDM was linked to a parent with various factors.. · These factors are the history of diabetes, non-English language, and daily calorie intake.. · These factors also include lower daily fiber intake, maternal age, prepregnancy BMI, and waist circumference.. · The psychosocial, behavioral, and medical factors associated with GDM did not differ based on race/ethnicity..</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":"143742005","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":"Leadership Challenges in Neonatal Services during the COVID-19 Pandemic.","authors":"Kanekal Suresh Gautham, Lakshmi Katakam, Jens Eickhoff, Ryan McAdams","doi":"10.1055/a-2551-5143","DOIUrl":"10.1055/a-2551-5143","url":null,"abstract":"<p><p>This study aimed to identify key challenges, barriers, personal experiences, coping mechanisms, and lessons learned by neonatal health care leaders during the COVID-19 pandemic, because they are not well documented.Voluntary, anonymous, online survey of leaders in perinatal care systems.A total of 154 leaders responded. The exact number of survey recipients could not be enumerated because the survey was sent via email distribution lists (listservs). The key challenges reported included managing patient and family-centered care, staffing shortages, education and training, resource allocation, communication, support systems, and maintaining trust in a time of uncertainty. Common self-care techniques included exercise, sleep, meditation, social support, and taking time off. Respondents highlighted lessons such as the critical importance of effective communication, flexibility, teamwork, resilience, and the prioritization of self-care for sustainable leadership.These findings underscore the need for structured crisis management strategies and proactive support systems to strengthen resilience in neonatal health care leaders, enhancing preparedness for future systemic crises. · Leaders in perinatal care faced significant challenges during the COVID-19 pandemic.. · Key challenges were managing patient/family-centered care, staffing shortages, communication, and trust.. · Structured crisis management strategies and proactive support systems for resilience are required..</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":"143571839","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}