American journal of perinatology最新文献

{"title":"Delayed versus Early Umbilical Cord Clamping in Preterm Multiple Gestation: A Randomized Controlled Trial.","authors":"Umesh Sharma, Anitha Ananthan, Haribalakrishna Balasubramanian, Prashanth Raghavendra, Muthu Vijayanathan, Padmaja Samant","doi":"10.1055/a-2849-8087","DOIUrl":"10.1055/a-2849-8087","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to evaluate the effects of delayed cord clamping (DCC) on hematocrit at 6 hours and 6 weeks of age, hospital stay, and other clinical outcomes at discharge.</p><p><strong>Study design: </strong>This randomized controlled trial was conducted in a tertiary care center in Western India. Preterm multiple gestations were randomized to DCC at 60 seconds of birth or early cord clamping (ECC) within 30 seconds of birth. The primary outcome was hematocrit at 6 hours of age.</p><p><strong>Results: </strong>A total of 76 mothers and 155 preterm infants of multiple gestation (73 twins and 3 triplets) were randomized. The mean hematocrit at 6 hours was significantly higher in the DCC group (61.9 ± 5.5 vs. 55.8 ± 5.3, <i>N</i> = 155, <i>p</i> < 0.001). Hematocrit at 6 weeks was also significantly higher in the DCC group (55.5 ± 3.8 vs. 49.6 ± 4.5, <i>N</i> = 142, <i>p</i> < 0.001). DCC adherence rate was 88% (<i>n</i> = 70) in the intervention group. Mortality was observed in six infants in the DCC group (7.5%) and eight infants (11%) in the ECC group. Infants in the DCC group had a higher peak bilirubin level, although not statistically significant (13.1 ± 2.3 vs. 11.1 ± 2.5 mg/dL, <i>p</i> = 0.09) and significantly prolonged duration of phototherapy (93.6 ± 32.8 vs. 61.4 ± 38.6 hours, <i>p</i> < 0.001). Other secondary outcomes were similar between the two groups.</p><p><strong>Conclusion: </strong>DCC was feasible in preterm multiple gestation and resulted in improved hematocrit at 6 hours and 6 weeks of life. There was a nonsignificant trend toward higher peak bilirubin levels in infants who received DCC. This trial is registered with the Clinical Trials Registry of India (identifier: CTRI/2023/10/058944).</p><p><strong>Key points: </strong>· DCC increased hematocrit at 6 hours and 6 weeks in preterm multiple gestation.. · DCC increased peak bilirubin levels and prolonged the duration of phototherapy.. · DCC is feasible in preterm multiple gestation..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1969-1975"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759843","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 Utility of Transcutaneous Bilirubin Measurement in Newborns with Hyperbilirubinemia: A Prospective, Observational Study during and after Phototherapy.","authors":"Duygu Besnili Acar, Seda Yilmaz Semerci","doi":"10.1055/a-2841-9781","DOIUrl":"10.1055/a-2841-9781","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the accuracy of transcutaneous bilirubin (TcB) measurements during and after phototherapy (PT) in term and late-preterm infants.</p><p><strong>Study design: </strong>In this prospective, observational study, TcB levels were measured at both the glabela (covered skin) and the lower abdomen (covered by the diaper) during treatment, then 12 and 24 hours after discontinuing the PT. Total serum bilirubin (TSB) levels were simultaneously collected through a blood sample. The agreement between TcB and TSB levels during and after PT was evaluated using Bland-Altman plots.</p><p><strong>Results: </strong>A total of 90 newborn infants and 540 paired bilirubin values were included in this study. The findings indicate that despite a moderate correlation with TSB levels, TcB measurements underestimate TSB levels.</p><p><strong>Conclusion: </strong>This study indicates a moderate correlation and agreement between TcB measurements and TSB levels in term and late-preterm infants undergoing PT, with a tendency to underestimate TSB values and considerable variability between the two methods. Hence, TcB measurements cannot be relied upon as a substitute for TSB measurements during and after PT.</p><p><strong>Key points: </strong>· TcB measurements show moderate correlation with TSB levels.. · Transcutaneous bilirubin measurements tend to underestimate total serum bilirubin levels, which may lead to potential undertreatment.. · Measurements from the lower abdomen are more practical for the evaluation of TcB.. · Transcutaneous bilirubin measurement is not a reliable substitute for total serum bilirubin levels in clinical settings during and after phototherapy.. · Further studies are needed to assess the accuracy of transcutaneous bilirubin measurements beyond 24 hours post-phototherapy..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1913-1919"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519596","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":"Sedation-Analgesia Management in Neonates with Hypoxic-Ischemic Encephalopathy under Therapeutic Hypothermia: Feedback from a Local Study on 51 Patients.","authors":"Clement Basse, Mohamed Riadh Boukhris, Laurence Chaton, Laurent Storme, Emilie Bourel-Ponchel, Florence Flamein","doi":"10.1055/a-2815-9871","DOIUrl":"10.1055/a-2815-9871","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to explore real-world practices in managing sedation-analgesia in a population of neonates with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia.</p><p><strong>Study design: </strong>Retrospective data from neonates admitted with hypoxic-ischemic encephalopathy to the neonatal intensive care unit of Lille University Hospital were collected, between December 31, 2018, and July 15, 2022. Drug and dosage of sedation-analgesia during the 96 hours following therapeutic hypothermia initiation were collected. Neonates were divided into four subgroups for principal component analysis, according to neurological examination at discharge: death, severe sequelae, moderate sequelae, no sequelae.</p><p><strong>Results: </strong>Neonates with a favorable outcome were exposed to higher cumulative doses. They were more likely to be exposed to polypharmacy, midazolam, and dexmedetomidine, and increasing doses of these. Daily doses of opioids did not vary significantly. Newborns with acute renal failure had lower cumulative doses. There was no significant difference between newborns with and without hepatic cytolysis.</p><p><strong>Conclusion: </strong>Practice assessments highlight heterogeneity regarding sedation-analgesia, especially within patient groups. Findings indicate that sedation-analgesia is not reassessed as often as it should be to account for specific pharmacokinetic parameters and the physiologic course of recovery.</p><p><strong>Key points: </strong>· Although sedation-analgesia is considered standard of care during therapeutic hypothermia, its use may be iatrogenic; therefore, we evaluated our practices to move toward optimized, personalized management.. · Neonates with a favorable outcome were more likely to have been exposed to a higher cumulative dose; increasing doses; polypharmacy; midazolam; and dexmedetomidine.. · Findings indicate that sedation-analgesia is not reassessed as often as it should be..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1723-1730"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343303","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 Role of Birth Plan in Shaping Maternal and Neonatal Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Giovanna Cristina de Castro Martin, Ana Clara Pimenta Servidoni, Guilherme Franceschini Machado, Lucas Habiro Alves, Bruna Benigna Sales Armstrong, Cainã Gonçalves Rodrigues, Maria Julia Lemos, Marcio Delascio Lopes, Marcelo Zugaib","doi":"10.1055/a-2849-7990","DOIUrl":"10.1055/a-2849-7990","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis discuss how birth plans impact maternal and infant outcomes. Our main objective is to analyze maternal fear of childbirth, labor phases duration, delivery method, neonatal admission, and early breastfeeding initiation.</p><p><strong>Study design: </strong>We systematically searched PubMed, Embase, and Cochrane Central for studies published from inception until July 2025. Only randomized controlled trials involving pregnant individuals in labor that compared birth plan use (written or verbal) to standard care without a plan were included. A random-effects meta-analysis was conducted through RStudio version 4.4.1 to pool prevalences and rates. Heterogeneity and sensitivity analyses were performed with leave-one-out analysis. We used version 2 of the Cochrane Risk-of-Bias Tool for quality assessment.</p><p><strong>Results: </strong>Birth plans were associated with a higher likelihood of normal vaginal delivery (risk ratio [RR]: 3.22; 95% confidence interval [CI]: 1.49-6.95; <i>p</i> = 0.003) and increased odds of early breastfeeding (RR: 3.68; 95% CI: 1.48-9.15; <i>p</i> = 0.005). No significant benefits were observed for episiotomy rates (RR: 0.47; 95% CI: 0.02-10.49; <i>p</i> = 0.636) or labor augmentation (RR: 0.65; 95% CI: 0.30-1.41; <i>p</i> = 0.274). Risk of bias was low across all studies.</p><p><strong>Conclusion: </strong>Birth plans may be associated with improved maternal outcomes, including increased rates of vaginal delivery, and early breastfeeding. The overall evidence suggests birth plans as a strategy to promote a more respectful childbirth.</p><p><strong>Key points: </strong>· Birth plans were associated with increased likelihood of vaginal delivery.. · Birth plan increased rates of early breastfeeding.. · The overall evidence suggests birth plans as a strategy to promote a more respectful childbirth..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1976-1983"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637749","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":"Diagnostic and Clinical Outcomes of Sex Chromosome Abnormalities Detected on Noninvasive Prenatal Screening.","authors":"Ifeoma Ogamba-Alphonso, Annie Rozenblyum, Teresa Dunn, Xiwei Yang, Nicole Cacace, Anju Suhag","doi":"10.1055/a-2849-7834","DOIUrl":"10.1055/a-2849-7834","url":null,"abstract":"<p><strong>Objective: </strong>Noninvasive prenatal screening (NIPS) screens for aneuploidy, but its positive predictive value for sex chromosome aneuploidies (SCA) is variable. NIPS reports include \"atypical sex chromosome findings,\" which may indicate fetal/maternal SCAs or mosaicism, although sensitivity is unknown. Previous studies are limited by small cohorts and insufficient maternal testing and ultrasound data. This study evaluates confirmation rates and outcomes for screen-positive SCAs, including \"atypical sex chromosome\" on NIPS.</p><p><strong>Study design: </strong>This retrospective study included singleton pregnancies that underwent diagnostic testing for screen-positive SCAs or atypical sex chromosome findings on NIPS from 2019 to 2024. Data collected included demographics, ultrasound findings, cytogenetics, maternal karyotype, and perinatal outcomes. The primary outcome was diagnostic confirmation, defined as proportion of NIPS screen-positive SCA and \"atypical sex chromosome\" confirmed by diagnostic testing. Secondary outcomes included fetal/placental mosaicism, incidental genetic findings, and maternal genetic results. Chi-squared and Kruskal-Wallis tests were used for categorical and continuous variables, respectively.</p><p><strong>Results: </strong>Of 510 patients who underwent diagnostic testing, 91 met inclusion criteria. Overall, 41.8% (<i>n</i> = 38) of NIPS-predicted SCAs were confirmed. Confirmation rates varied by SCA type: monosomy X (32.1%), XXY (80%), XYY (100%), XXX (66.7%), and atypical findings (26.2%) (<i>p</i> < 0.001). Mosaicism was present in 31.6% of confirmed cases. Incidental genetic findings, including fetal copy number variants, occurred in 11 cases. Maternal karyotype was normal in 100% of confirmed cases versus 54.2% of nonconfirmed (<i>p</i> = 0.033). Perinatal outcomes were generally favorable.</p><p><strong>Conclusion: </strong>Fewer than half of NIPS-predicted SCAs were confirmed, with low confirmation rates for monosomy X and atypical findings. Mosaicism accounted for nearly one-third of confirmed cases. False-positive results often included incidental fetal and maternal findings, which may contribute to high false-positive rates. These findings emphasize the need for comprehensive pretest counseling and standardized testing guidelines, given the risk of unexpected maternal SCAs and fetal copy number variants.</p><p><strong>Key points: </strong>· Less than half of NIPS-predicted SCAs were true-positive.. · Nearly one-third of confirmed SCAs involved mosaicism.. · Abnormal maternal karyotype may drive false-positive rates..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1954-1960"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759831","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":"Preserving Access to Evidence-Based Preventive Services in Pregnancy and Postpartum: The Impact of Kennedy v. Braidwood Supreme Court Decision.","authors":"Natasha R Kumar, A Mark Fendrick, Kara Zivin, Vanessa K Dalton","doi":"10.1055/a-2849-7918","DOIUrl":"10.1055/a-2849-7918","url":null,"abstract":"","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1843-1847"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637714","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":"Study Design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM).","authors":"May Lee Tjoa, Ashley Orillion, Raymond Mankoski, Nida Imran, Carol Mao, Alexis Krumme, Sylvie Van Hoorde, Blanca Linares-Rivas Rico, Yosuke Komatsu","doi":"10.1055/a-2816-3361","DOIUrl":"10.1055/a-2816-3361","url":null,"abstract":"<p><strong>Objective: </strong>Hemolytic disease of the fetus and newborn (HDFN) is a rare and serious immune-mediated condition that can result in poor fetal and neonatal outcomes. During pregnancy, monitoring with middle cerebral artery Doppler ultrasound and intrauterine transfusions (IUTs) are the current standard of care, although intravenous immunoglobulin (IVIg) has been adopted in some centers to attempt to delay the onset of fetal anemia. Significant gaps remain in understanding the safety and effectiveness of current HDFN management, both during pregnancy and in neonates and children. We present the design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM; ClinicalTrials.gov Identifier: NCT07194070), a study that will provide real-world, prospective, longitudinal data on management, clinical course, and outcomes of HDFN from the antenatal period up to 2 years after birth.</p><p><strong>Study design: </strong>GERANIUM is a prospective, observational study enrolling alloimmunized pregnant individuals (aged ≥18 years) before 24 weeks of gestational age who are at high risk for HDFN based on previous obstetric history. This study will enroll approximately 175 participants across multiple global sites. Data collected during pregnancy include fetal loss, frequency and severity of HDFN, treatment patterns, as well as effectiveness and adverse outcomes of IUTs and other interventions. Following birth, infants will be followed for the first 2 years of life, with documentation of HDFN sequelae, including treatments, growth, and development. Impact on the parents and children will be assessed using validated participant- and observer-reported outcome measures.</p><p><strong>Conclusion: </strong>The GERANIUM registry will provide prospective, contemporaneous data on current management of HDFN and associated outcomes.</p><p><strong>Key points: </strong>· HDFN can result in fetal loss or poor long-term outcomes.. · IUT and IVIg can be associated with serious complications.. · Impacts of HDFN on patients' quality of life are unclear.. · GERANIUM will provide contemporaneous data on HDFN care.. · Prospective data for mothers/infants will be collected..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1731-1738"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Device Performance and Parental Perception of the Skincubator 2.0, a Wearable Device to Support Prolonged Skin-to-Skin Care for Preterm Infants.","authors":"Itamar Nitzan, Raylene Phillips, Iris Morag, Olga Kipnis, Tova Shotten, Cathy Hammerman, Sagee Nissimov","doi":"10.1055/a-2834-0694","DOIUrl":"10.1055/a-2834-0694","url":null,"abstract":"<p><strong>Objectives: </strong>Early and prolonged skin-to-skin care (SSC) reduces morbidity and mortality in preterm neonates more than intermittent SSC. Extreme preterm neonates generally do not receive early prolonged SSC for several reasons, including safety concerns and parental challenges. To facilitate prolonged SSC in this population, we invented the Skincubator, a device to overcome SSC barriers. The Skincubator enables SSC, while safely securing the baby, lines, and tubes and maintaining warmth and humidity. A retractable Transfer Pad enables transfers to and from the caregiver with minimal handling, while keeping baby is safely positioned. Once on the parent, the pad is retracted to allow full SSC. The objective of this study is to assess the Transfer Pad performance and parent satisfaction from the Skincubator.</p><p><strong>Study design: </strong>An observational study performed during the learning phase of the Skincubator feasibility study. Success rates of transfer with the retractable pad and humidity within the Skincubator were recorded. Parents were provided with questionnaires to rate (on a Likert scale of 1-5) satisfaction with the safety and convenience of the Skincubator and traditional SSC (t-SSC).</p><p><strong>Results: </strong>Twelve babies were treated in the Skincubator by 18 parents (10 mothers, 8 fathers) for 53 sessions. Two babies were invasively ventilated during Skincubator care. Average Skincubator session time was 146 ± 52 minutes. Humidity within the Skincubator was 71 ± 11%. The retractable pad transfer succeeded in 103 of 106 attempts. Parents were very satisfied with the Skincubator SSC safety and satisfied/neutral with the safety of t-SSC (<i>p</i> = 0.001, Wilcoxon signed-rank test. Parents were satisfied with the Skincubator SSC convenience and neutral with the convenience of t-SSC (<i>p</i> = 0.02).</p><p><strong>Conclusion: </strong>The Skincubator allows transfer to and from SSC within a warm, humidified environment. Parents were more satisfied with the safety and convenience of Skincubator SSC as compared with t-SSC. The Skincubator may support parents in performing longer hours of SSC.</p><p><strong>Key points: </strong>· Early prolonged SSC improves preterm infants' outcome but may be challenging.. · To mitigate several SSC barriers, we invented the Skincubator in a wearable incubator for prolonged SSC.. · The Skincubator allows transfer to and from SSC within a warm, humidified environment.. · Compared with t-SSC, parents were more satisfied with the Skincubator safety and convenience.. · The Skincubator may support parents in performing longer hours of SSC..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1872-1883"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479452","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":"Current Practices and Gaps in Antenatal Counseling Training in United States Neonatal-Perinatal Medicine Fellowships.","authors":"Michelle Bartlett, Kesi Yang, Mackenzie Frost","doi":"10.1055/a-2826-4610","DOIUrl":"10.1055/a-2826-4610","url":null,"abstract":"<p><strong>Objective: </strong>Antenatal counseling (AC) is vital in neonatal-perinatal medicine (NPM) to support families and align care plans. NPM fellows report gaps in communication and AC training, and current literature offers little on effective teaching methods. Standardized recommendations to assess AC skills are lacking. To create effective training programs, we must first understand how AC is currently being taught and evaluated in clinical education. Our aim was to assess the national landscape through an environmental scan of AC curriculum in NPM fellowship to establish a baseline of current educational practices and identify areas for improvement.</p><p><strong>Study design: </strong>Survey was developed based on a literature review and expert collaboration, with pilot testing performed on a subset of program leadership and fellows. It was distributed via email listserv nationally to NPM fellows and fellowship program leadership in 2024 to 2025. Survey included select-all, multiple-choice, and Likert-scale questions.</p><p><strong>Results: </strong>Thirty-three percent of programs (33/102) and 18% of fellows (146/815) completed the survey. Most institutions use various methods to teach AC, though some report no formal training. Over 80% of fellows want more AC training. Only 39% of fellows reported being observed more than three times during their fellowship regardless of year in fellowship, whereas 79% noted they typically perform four or more consults per month while on service. Most programs (85%) lack formal assessment methods.</p><p><strong>Conclusion: </strong>While diverse educational modalities are employed in AC training, fellows desire more training. Limited observation and assessment highlight a need for improved curricula and formal feedback to better support skill development.</p><p><strong>Key points: </strong>· Fellows want more antenatal counseling training.. · Antenatal counseling observation and feedback are rare despite volume.. · Most programs lack formal assessment of fellows performing antenatal consults..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1775-1779"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466371","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 Clinical Benefit of Adding Weight of Blood-Soaked Materials to Quantification of Postpartum Blood Loss.","authors":"Rachel L Wiley, Ipsita Ghose, Hector Mendez-Figueroa, Suneet P Chauhan","doi":"10.1055/a-2831-5846","DOIUrl":"10.1055/a-2831-5846","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to evaluate whether full quantitative blood loss (FBL), which incorporates the weight of blood soaked materials, improves the prediction of hemorrhage-related clinical decision-making compared with volumetric blood loss (VBL) using calibrated drapes alone.</p><p><strong>Study design: </strong>We performed a secondary analysis of an IRB-approved retrospective cohort including all deliveries over 2 years at a large, urban academic center. During the study period, a quantitative blood loss protocol was introduced without other changes to hemorrhage management. VBL consisted of calibrated drape measurement with visual estimation of laps and clots, while FBL additionally included weighing of soaked materials. The primary outcome was hemorrhage intervention, defined as transfusion, surgical management of atony, balloon tamponade, ICU admission, or hysterectomy. Predictive performance of VBL and FBL was compared using receiver operating characteristic curves and area under the curve (AUC). Secondary outcomes included uterotonic use, correlation with peripartum hemoglobin change, and a subgroup analysis of vaginal deliveries with blood loss of 500 to 1,000 mL.</p><p><strong>Results: </strong>Among 8,359 deliveries, 1,524 (18.4%) had both VBL and FBL recorded, allowing direct comparison. Overall, hemorrhage intervention occurred in 5.4% of deliveries. There was no significant difference in predicting intervention in either the direct-comparison group or the full cohort. In the paired sample, VBL better predicted uterotonic use than FBL (AUC: 0.713 vs. 0.680, p¼0.02). FBL identified more deliveries as having abnormal blood loss and more cases meeting PPH criteria; however, this did not translate into higher intervention rates. Both methods correlated modestly with hemoglobin change, explaining <13% of variance, with no meaningful difference between approaches.</p><p><strong>Conclusion: </strong>When calibrated drapes are used, adding weighing of blood-soaked materials provides minimal additional clinical value in predicting hemorrhage interventions or physiologic impact. These findings support streamlined blood loss quantification strategies, particularly in low-resource settings where simplicity and efficiency are critical.</p><p><strong>Key points: </strong>· Full quantification of blood loss increases rate of PPH classification without increase in severe morbidity.. · The addition of weighing blood soaked materials does not better detect hemorrhage related morbidity.. · Volumetric assessment of blood loss alone may be sufficient..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1839-1842"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525281","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}