American journal of perinatology最新文献

{"title":"Evaluating Perceived Control in the Inpatient Antepartum Setting: Development and Validation of a Novel Antepartum Agentry Scale.","authors":"John R Soehl, Nina K Ayala, Laurie B Griffin, Emily S Miller, Melissa A Clark","doi":"10.1055/a-2835-8320","DOIUrl":"10.1055/a-2835-8320","url":null,"abstract":"<p><strong>Objective: </strong>Antepartum hospitalization during pregnancy can compromise patients' sense of control and are associated with higher rates of depression or anxiety. There are no validated scales that measure this sense of control in this hospitalized setting. The authors adapted the Labour Agentry Scale (LAS) to the antepartum inpatient setting by developing and preliminarily validating a novel Antepartum Agentry Scale (AAS).</p><p><strong>Study design: </strong>Fifty-nine candidate statements were derived from the LAS original source material. These statements were iteratively reviewed in three rounds using a content valuation index by Maternal Fetal Medicine providers, resulting in 25 statements that comprised the AAS. The AAS, Patient Health Questionnaire (PHQ-9), and General Anxiety Disorder (GAD-7) scale were administered to 50 individuals hospitalized for a complication during pregnancy. Factor analysis was performed to assess construct validity and evaluate whether the AAS measured a construct distinct from the PHQ-9 or GAD-7. The AAS scores were then classified as \"Low,\" \"Average,\" or \"High\" based on the mean score and standard deviation in the study population. Fisher's exact test was used to evaluate the relation between scores on the AAS and scores of 10 or higher on the PHQ-9 and GAD-7.</p><p><strong>Results: </strong>The AAS had a Cronbach alpha of 0.902. Factor analysis demonstrated minimal overlap between the AAS and items on the PHQ-9 or GAD-7. There was a significant relationship between \"Low,\" \"Average,\" and \"High\" AAS scores and PHQ-9 scores of 10 or more (67 vs. 13 vs. 10%, <i>p</i> = 0.003) and GAD-7 of 10 or more (67 vs. 19 vs. 0%, <i>p</i> = 0.002).</p><p><strong>Conclusion: </strong>Those with higher agentry are less likely to concurrently report clinically significant symptoms of depression or anxiety. Initial results suggest strong internal consistency of the AAS, which may measure a construct distinct from measures of depression or anxiety.</p><p><strong>Key points: </strong>· The LAS is a measure of perception of control during labor and delivery.. · The AAS was adapted from the LAS focusing on antenatal hospitalization.. · Higher scores on the AAS inversely correlated with symptoms of anxiety and depression.. · The AAS has strong internal consistency with a Cronbach's alpha of 0.902.. · The AAS appears to measure a construct distinct from the PHQ-9 or GAD-7..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1848-1857"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479415","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 between Neonatal Hypoglycemia and 30-Day Breastfeeding Outcomes among Gravidas with Type 2 Diabetes.","authors":"Daniella Rogerson, Marni Jacobs, Minhazur Sarker, Kim Boggess, Ashley N Battarbee, Jerrie Refuerzo, Noelia Zork, Gayle Olson, Celeste Durnwald, Kjersti Aagaard, Kedra Wallace, Christina Scifres, Todd Rosen, Sherri Longo, Gladys A Ramos","doi":"10.1055/a-2827-0515","DOIUrl":"10.1055/a-2827-0515","url":null,"abstract":"<p><strong>Objective: </strong>Pregestational diabetes is associated with low prevalence of breastfeeding due to low rates of intent, delayed lactogenesis, and early infant separation. It is hypothesized that the perceived need for formula supplementation due to neonatal hypoglycemia, coupled with maternal low early milk supply, is a barrier to breastfeeding initiation. Whether there is an association between neonatal hypoglycemia and breastfeeding is unknown. We evaluated associations between neonatal hypoglycemia and breastfeeding.</p><p><strong>Study design: </strong>This is a secondary analysis of a randomized controlled trial of metformin versus placebo plus insulin in participants with type 2 diabetes. We included participants who delivered a liveborn neonate, endorsed intention to breastfeed, and had neonatal hypoglycemia data available. A breastfeeding questionnaire was administered at 30-day postpartum, and outcomes were compared between neonates with and without hypoglycemia. The primary outcome was prevalence of exclusive, partial, or no breastfeeding at 30-day postpartum. Secondary outcomes included time to breastfeeding cessation and contributing factors. Characteristics were compared with chi-square, <i>t</i>-tests, or Wilcoxon tests.</p><p><strong>Results: </strong>A total of 420 participants in the primary study (53%) completed an antepartum survey, including a question about intent to breastfeed. After exclusion criteria were applied, 370 (91%) of 405 possible participants reported intention to breastfeed. Among these 370 who met criteria and had intention to breastfeed, 265 (72%) responded to the 30-day postpartum questionnaire. Of these 265, 114 (43%) had neonatal hypoglycemia and 151 (57.0%) did not. Prevalence of not breastfeeding (35 vs. 37%), exclusive breastfeeding (18 vs. 13%), and partial breastfeeding (47 vs. 50%) did not differ between neonates with and without hypoglycemia (<i>p</i> = 0.51). This persisted in a neonatal intensive care unit-admitted subgroup (<i>p</i> = 0.29). Participants who stopped breastfeeding did so on average at 2.6 to 2.8 weeks (<i>p</i> = 0.76).</p><p><strong>Conclusion: </strong>This study found no impact of neonatal hypoglycemia on 30-day postpartum breastfeeding prevalence among participants with diabetes.</p><p><strong>Key points: </strong>· Type 2 diabetes reduces the likelihood of breastfeeding, and the barriers are not fully known.. · Neonatal hypoglycemia is hypothesized to be one barrier to breastfeeding among this population.. · Neonatal hypoglycemia did not impact breastfeeding among diabetic gravidas 30-day postpartum.. · This remained true among neonates admitted to the neonatal intensive care unit.. · Further research examining barriers to breastfeeding among gravidas with diabetes is needed..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1780-1785"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13091607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430060","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":"Maternal Hemodynamic Assessment at Term for Prediction of Adverse Neonatal Outcomes: The Experience from a Referral Italian Hospital.","authors":"Gloria Guariglia, Serena Lecis, Anna L Tramontano, Riccardo Cuoghi Costantini, Jessica Bugiolacchi, Valeria Pedrini, Vittoria Ciccarone, Isabella Neri, Antonio La Marca, Francesca Monari","doi":"10.1055/a-2832-9466","DOIUrl":"10.1055/a-2832-9466","url":null,"abstract":"<p><strong>Objective: </strong>Our study aims to explore the possible predictive role of Ultrasound Cardiac Output Monitoring (USCOM) parameters toward unfavorable maternal and neonatal complications during labor and delivery in a cohort of women followed by the high-risk pregnancy clinic of a tertiary Italian hospital.</p><p><strong>Study design: </strong>A prospective, monocentric descriptive study was run at the AOU Policlinico of Modena. USCOM was implemented in March 2022. Patients in charge of the high-risk pregnancy clinic who received USCOM hemodynamic monitoring during their whole pregnancy were included in the study, with the last examination performed around 37 weeks. By considering the characteristics of labor and delivery, they were divided into two groups (complicated delivery and uncomplicated delivery). Adverse maternal outcomes (AMOs) and adverse neonatal outcomes (ANOs) were prospectively collected from electronic records and analyzed using the R version 4.3.2 statistical software. Continuous variables were presented as means with standard deviations, and categorical variables as counts and percentages.</p><p><strong>Results: </strong>While maternal and perinatal variables, including maternal age, parity, and anthropometric measures, were comparable between groups, significant differences emerged in the USCOM measurements. Cardiac output (CO) was significantly lower in the group with ANO compared with uneventful neonates (4.35 ± 1.42 L/min vs. 4.97 ± 1.44 L/min; adjusted odds ratio [aOR] = 0.79; 95% CI: 0.49, 0.99, <i>p</i> = 0.049). Additionally, peak velocity of ventricular ejection (VPK) was significantly reduced in neonates with ANO compared with neonates without adverse complications (0.92 ± 0.27 vs. 1.08 ± 0.42; aOR = 0.08, 95% CI: 0.01-0.63, <i>p</i> = 0.016). Finally, cardiac index was lower (2.26 ± 0.67 vs. 2.54 ± 0.74, aOR = 0.49; 95% CI: 0.23-1.03, <i>p</i> = 0.060) and systemic vascular resistance was higher (1,800.9 ± 546 vs. 1,638.2 ± 588.4, aOR = 1.00; 95% CI: 1.00-1.00, <i>p</i> = 0.245) in the ANO group comparing with those without ANO, although both results do not reach statistical significance.</p><p><strong>Conclusion: </strong>Our findings suggest that the implementation of USCOM in clinical practice may enhance the identification of women at increased risk for ANOs, particularly those presenting with low CO and reduced ventricular peak velocity (VPK) before labor. Further studies with larger sample sizes are needed to confirm and strengthen these observations.</p><p><strong>Key points: </strong>· USCOM identifies women at increased risk for adverse neonatal outcomes.. · USCOM improves the quality and safety of obstetric care.. · USCOM is applicable across obstetric settings, including labor wards..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1795-1800"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472348","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":"Where's the Cord Gas? Variation in Umbilical Cord Blood Gas Sampling in High-Risk Deliveries.","authors":"Isabella T Eiler, Jian Zhang, Ke Yan, Erwin Cabacungan, Garrett Fitzgerald, Brock E Polnaszek, Susan S Cohen","doi":"10.1055/a-2824-7217","DOIUrl":"10.1055/a-2824-7217","url":null,"abstract":"<p><strong>Objective: </strong>Umbilical cord blood gas (UCBG) sampling provides biochemical data to identify patients who may benefit from encephalopathy screening, but no standardized national guidelines are currently available. We aimed to determine the prevalence of UCBG sampling in high-risk deliveries at a level IV perinatal center in the absence of standardized collection guidelines and to describe subsequent hospital courses among deliveries without UCBG sampling.</p><p><strong>Study design: </strong>This was a single-center retrospective cohort study of high-risk deliveries at ≥36 weeks gestation from 2019 to 2021. High-risk deliveries were defined by acute obstetric events, operative delivery, or 5-minute Apgar ≤ 5. UCBG sampling was classified as attempted, obtained (arterial pH documented), or not attempted. Maternal, intrapartum, and neonatal characteristics were compared between attempted and not-attempted groups, and subgroup analyses evaluated infants without UCBG sampling to identify patients who qualified for encephalopathy screening.</p><p><strong>Results: </strong>The study cohort was comprised of 1,144 (11%) high-risk deliveries, of which 1,034 remained after exclusions. UCBG sampling was attempted in 655 (63%) deliveries, and arterial results were obtained in 541 (52%). Among 131 neonatal intensive care unit (NICU) admissions, 105 (80%) had UCBG sampling attempted, and 83 (63%) had arterial results available. Among 41 NICU admissions with respiratory diagnoses and available admission blood gases, 5 met biochemical criteria for encephalopathy screening, and only 1 had a documented comprehensive neurological examination.</p><p><strong>Conclusion: </strong>The lack of standardized guidelines leads to inconsistent UCBG sampling in high-risk deliveries, highlighting the need for standardized UCBG screening criteria and coordinated obstetric-neonatal workflows.</p><p><strong>Key points: </strong>· UCBG sampling is the first red flag for hypoxic-ischemic encephalopathy detection.. · Lack of UCBG guidelines leads to inconsistent sampling.. · Establishment of UCBG sampling guidelines can limit practice variation..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1761-1766"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484564","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":"Anterior Placentation as a Risk Factor for Hemorrhage at the Time of Primary Cesarean Delivery.","authors":"Tess E K Cersonsky, Camila Cabrera, Elizabeth Cochrane, Henri M Rosenberg, Sara Edwards, Angela Bianco, Luciana A Vieira, Chelsea A Debolt","doi":"10.1055/a-2823-4753","DOIUrl":"10.1055/a-2823-4753","url":null,"abstract":"<p><strong>Objective: </strong>Anterior placentation is a risk factor for hemorrhage during cesarean delivery in patients with a resolved placenta previa or low-lying placenta. As anterior placentas are sometimes incised at the time of hysterotomy, it is possible that, even in the absence of low-lying placenta or placenta previa, anterior placentation may be associated with higher blood loss at the time of nonlaboring, primary cesarean delivery. Therefore, we sought to identify if there is an association between anterior placentation and peripartum hemorrhage (PPH) in parturients undergoing primary cesarean delivery.</p><p><strong>Study design: </strong>This is a retrospective cohort study that included parturients from a tertiary care center who underwent primary cesarean delivery from 2016 to 2022. Patients with known risk factors for PPH (known placenta accreta spectrum, placenta previa, etc.) were excluded from primary analyses. Primary analyses assessed the association via logistic regression between PPH (defined as estimated blood loss [EBL] ≥ 1,000 mL) and anterior placentation. We then assessed if this risk was present in higher risk subgroups (patients using anticoagulation at the time of delivery and patients who underwent vaginal trial of labor prior to primary cesarean) and a lower risk subgroup (those undergoing nonlaboring primary cesarean).</p><p><strong>Results: </strong>The primary cohort consisted of 996 parturients. Of those, 501 had an anterior placenta. Odds ratio of EBL ≥ 1,000 according to anterior placentation was 1.12 (95% confidence interval: 0.80-1.56) in multivariate regression. Risk of PPH was not associated with anterior placentation in higher- and lower-risk subgroups.</p><p><strong>Conclusion: </strong>Anterior placentation alone is not associated with higher EBL in patients undergoing primary cesarean delivery, even in patients using anticoagulation or those requiring intrapartum cesarean.</p><p><strong>Key points: </strong>· Anterior placenta and previa increase hemorrhage risk.. · Anterior placentation alone does not increase hemorrhage risk.. · The risk is not increased among those with additional risk factors.. · Placenta location may impact hemorrhage risk..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1746-1752"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343318","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":"Labor Length Differences in Combination Ripening with 60 versus 30-mL Foley Inflation Volume: A Propensity Score-Matched Study.","authors":"Rebecca F Hamm, Jennifer Mccoy, Antoilyn Nguyen, Lisa D Levine","doi":"10.1055/a-2815-3677","DOIUrl":"10.1055/a-2815-3677","url":null,"abstract":"<p><strong>Objective: </strong>Data support shorter time to delivery with 60 versus 30-mL Foley inflation for labor induction. Similarly, combination cervical ripening has a shorter time to delivery compared with single agents. To date, no study has evaluated incremental benefit of higher Foley volume in the setting of combination ripening methods.</p><p><strong>Study design: </strong>This is a secondary analysis of a prospective cohort study evaluating standardized induction management at two sites. Any cervical ripening method could be used. Site no. 1 used 60-mL Foley inflation, whereas Site no. 2 used 30 mL. For this analysis, patients were included if they underwent a term (≥37 weeks) induction from 2020 to 2022 with a singleton, intact membranes, and received combination methods of Foley and another agent. A 1:1 propensity score matching balanced baseline parameters.</p><p><strong>Results: </strong>Of 4,295 inductions, 2,117 (49.3%) utilized combination cervical ripening methods. After propensity score matching, 1,480 were included. Even in the context of combined ripening and standardized induction, Foley inflation to 60 mL was associated with a 3-hour shorter labor length than 30 mL (14.6 [10.4-21.3] vs. 17.7 hours [12.4-24.4], <i>p</i> < 0.001). When censored for cesarean, patients who received 60-mL Foley inflation delivered 70% faster than those who received 30 mL (hazard ratio: 1.73 [1.36-2.21]). There was no difference in cesarean, maternal morbidity, or neonatal morbidity.</p><p><strong>Conclusion: </strong>Even when using combined cervical ripening methods, 60-mL Foley inflation is associated with reduced time to delivery as compared with 30 mL without increasing morbidity.</p><p><strong>Key points: </strong>· No prior study has evaluated incremental benefit of higher Foley volume.. · Combined cervical ripening with 60-mL Foley is associated with reduced time to delivery.. · Combined cervical ripening with 60-mL Foley is not associated with differences in morbidity..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1820-1823"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225174","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 Pathophysiological Approach for Early Detection and Prevention of AKI in the NICU.","authors":"Vignesh Gunasekaran, Soowan Woo, Parvathy Krishnan, Andrew M South, Jeffrey Shenberger, David Askenazi, Parvesh M Garg","doi":"10.1055/a-2816-0051","DOIUrl":"10.1055/a-2816-0051","url":null,"abstract":"<p><p>This study aimed to summarize contemporary evidence on the definition, epidemiology, risk factors, and prevention of acute kidney injury (AKI) in critically ill and preterm infants in the neonatal intensive care unit (NICU), and to highlight prevention-focused strategies to improve outcomes. Narrative review of current literature evaluating AKI burden, diagnostic criteria, modifiable and nonmodifiable risk factors, and preventive interventions in neonatal intensive care settings. AKI is common in critically ill and preterm infants and is associated with increased mortality, prolonged hospitalization, neurodevelopmental impairment, and progression to chronic kidney disease. Modified Kidney Disease: Improving Global Outcomes criteria have improved diagnostic consistency and revealed particularly high AKI prevalence in extremely low birth weight infants. Key modifiable risk factors include hemodynamic instability, patent ductus arteriosus, nephrotoxic drug exposure, fluid overload, and sepsis, while preventive strategies span optimized antenatal management, therapeutic hypothermia for hypoxic ischemic encephalopathy, careful postnatal hemodynamic and fluid management, nephrotoxic drug stewardship, early infection control, individualized ductus arteriosus therapy, and potential use of caffeine, alongside emerging urinary biomarkers for earlier detection. Given limited therapeutic options once AKI occurs, prevention through structured surveillance, timely identification of high-risk states, and rigorous implementation of kidney protective practices is essential. Integrating quality improvement, protocolized care pathways, and educational outreach within NICUs offers the greatest promise for improving short and long-term outcomes in infants with AKI. · Structured post-AKI monitoring and quality improvement protocols reduce AKI incidence.. · Nephrotoxic medication protocols reduce AKI through proactive monitoring and dose optimization.. · Neonatal AKI is common and serious; prevention via fluids, hemodynamics, and med stewardship is key..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1701-1713"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225198","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":"The Association of Maternal Body Fat Distribution with Cesarean Delivery, Spontaneous Labor, and Perinatal Morbidity in Women with Body Mass Index ≥ 40 kg/m2.","authors":"Akila Subramaniam, John Owen, Christina Blanchard, Victoria Jauk, Paula Chandler-Laney, Jeff Szychowski, Alan Tita","doi":"10.1055/a-2824-4137","DOIUrl":"10.1055/a-2824-4137","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to evaluate the relationship between late and third-trimester ultrasonographic/anthropometric measures of central adiposity and cesarean delivery in patients with body mass index (BMI) ≥ 40 kg/m² and compare their predictive value to BMI alone.</p><p><strong>Study design: </strong>Prospective observational cohort study of patients receiving prenatal care and delivering at a single center (2018-2021). Individuals with nonanomalous singleton pregnancies and either BMI ≥ 40 kg/m² or normal BMI between 32 and 36^0/7 weeks were included. In both BMI groups, individuals with delivery < 36 weeks, prior cesarean, and contraindication to vaginal birth were excluded. Patients underwent a study visit > 36 weeks at which 19 central adiposity measures (ultrasonographic and anthropometric), fat distribution indices (e.g., abdominal fat index [aFI]) and BMI (predictive exposures) were obtained by trained research and ultrasound personnel. For our primary analysis (BMI ≥ 40 kg/m²), the primary outcome was cesarean. Measurement exposures were evaluated at alpha = 0.05 using backward selection multivariable logistic regression to generate a parsimonious model. Receiver operator characteristic curves with area under the curve (AUC) assessed the model's predictive ability; AUCs for BMI and the parsimonious model were compared. A planned analysis included women with normal BMI.</p><p><strong>Results: </strong>Of 611 individuals screened, 265 were eligible, 217 consented, and 201 met all study criteria and were analyzed: 149 with BMI ≥ 40 kg/m² (mean BMI: 45.4 ± 5.2; cesarean rate: 21%). A model of maximum preperitoneal fat depth above the umbilicus, below umbilicus aFI, and subxiphoid aFI (all <i>p</i> < 0.05) was significantly more predictive of cesarean (AUC: 0.76; 95% confidence interval [CI]: 0.67-0.86) than BMI alone (AUC: 0.60; 95% CI: 0.49-0.71; <i>p</i> = 0.002). When analyzing the normal BMI group (<i>n</i> = 52), a six-measurement model had outstanding prediction (AUC: 0.97; 95% CI: 0.93-1.00)-exceeding BMI alone (AUC: 0.64; 95% CI: 0.49-0.78; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Select maternal ultrasonographic fat depth measurements near delivery have significantly more predictive ability than BMI alone for cesarean delivery in patients with BMI ≥ 40 kg/m² and should be further explored in those with normal BMI.</p><p><strong>Key points: </strong>· Select maternal ultrasound adiposity measurements were more predictive of cesarean than BMI in women with BMI ≥ 40 kg/m2.. · Select adiposity measurements may be more predictive of cesarean than BMI in women with normal BMI ≤ 25 kg/m2.. · There was outstanding prediction of cesarean using these measures in women with normal BMI.. · Select ultrasonographic fat depth measurements near delivery have more predictive ability for cesarean than BMI..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1753-1760"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484586","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":"Post-Traumatic Stress Disorder, Anxiety, and Depression in Patients after Undergoing Cesarean Hysterectomy for Placenta Accreta Spectrum Disorder.","authors":"Austin Oberlin, Fady Khoury Collado, Catherine Monk, Kristina D'Antonio, Helai Hesham, Meghan Angley, Eve Overton, John G Ilagan, Laurence E Ring, Alexandre Buckley De Meritens, Mirella Mourad","doi":"10.1055/a-2837-4940","DOIUrl":"10.1055/a-2837-4940","url":null,"abstract":"<p><strong>Objective: </strong>Medically complicated pregnancies and deliveries can lead to adverse mental health outcomes, including post-traumatic stress disorder (PTSD). However, few studies have examined mental health outcomes after surgery for placenta accreta spectrum (PAS). Our aim was to identify prevalence of PTSD, anxiety, and depression in patients who underwent hysterectomy for PAS. We sought to understand whether more complex or emergent surgery was associated with a higher prevalence of PTSD and whether physical symptoms such as pelvic pain were correlated with patients' mental health outcomes.</p><p><strong>Study design: </strong>This was a cross-sectional study of patients who underwent a cesarean hysterectomy for PAS between January 2018 and August 2023 at a single urban hospital. Patients were recruited 6 months or more following surgery. The survey consisted of validated questionnaires (National Stressful Events Survey short scale for symptoms of PTSD, General Anxiety Disorder, and Patient Health Questionnaire) and clinical data were abstracted from the medical record.</p><p><strong>Results: </strong>During the study period, 100 patients underwent a hysterectomy for PAS, of which 61 completed the survey. Patients most frequently screened positive for PTSD (<i>n</i>/<i>N</i> = 13/61, 21.3%), followed by anxiety (<i>n</i>/<i>N</i> = 10/61, 16.4%) and depression (<i>n</i>/<i>N</i> = 8/61, 13.1%). The prevalence of anxiety and depression was similar to the patients' self-reported diagnosis prior to surgery. The prevalence of PTSD was not affected by severe maternal morbidity or urgency of the surgical case. However, pelvic floor symptoms, specifically urge incontinence, were associated with PTSD, anxiety, and depression.</p><p><strong>Conclusion: </strong>In patients who undergo cesarean hysterectomy for PAS, nearly a quarter may experience PTSD symptoms, higher than the general postpartum population. Given the high prevalence of symptoms and the lack of specific patient risk factors associated with PTSD, all patients with PAS should be offered mental health services before and after delivery.</p><p><strong>Key points: </strong>· Patients who undergo hysterectomy for PAS experience high prevalence of PTSD.. · Emergent surgery and severe morbidity are not associated with postpartum PTSD, anxiety, or depression.. · Adverse mental health outcomes are associated with pelvic floor symptoms, such as incontinence..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1898-1903"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490592","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":"Plain Language Summary of Publication: 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-2815-9970","DOIUrl":"10.1055/a-2815-9970","url":null,"abstract":"<p><p>This article is a plain language summary of publication (PLSP) of the following article: \"Study Design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM)\" by Tjoa et al published by the <i>American Journal of Perinatology</i> on March 20, 2026. This PLSP describes the design of the GERANIUM registry, which will collect data to help researchers understand how doctors manage hemolytic disease of the fetus and newborn (HDFN) in clinical settings. Researchers will also study outcomes related to the health and well-being of pregnant participants affected by HDFN, their children, and their families over time. This PLSP aims to help the general public, including those affected by HDFN, and health care professionals understand the design of the GERANIUM registry. · Data reflecting today's clinical care of HDFN are lacking.. · GERANIUM is a registry collecting real-world data on HDFN.. · Design of the GERANIUM registry is described.. · HDFN-related outcomes are collected during pregnancy.. · Infant outcomes will be recorded up to 2 years after birth..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1828-1833"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490562","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}