American journal of perinatology最新文献

{"title":"Planned Primary Cesarean Delivery versus Attempted Labor in Low-Risk Pregnancies: Associations with Adverse Outcomes.","authors":"Claudia J Ibarra, Han-Yang Chen, Rachel Wiley, Hector Mendez-Figueroa, Suneet P Chauhan","doi":"10.1055/a-2650-1095","DOIUrl":"https://doi.org/10.1055/a-2650-1095","url":null,"abstract":"<p><strong>Objectives: </strong>To compare adverse outcomes among low-risk pregnancies with labor versus planned cesarean delivery (PL-CD).</p><p><strong>Study design: </strong>A population-based, retrospective cohort study used U.S. vital statistic data from 2016-2021 in low-risk individuals delivered at 37 to 41 weeks with non-anomalous, singletons. Labor status was categorized as no labor (PL-CD) or labored. The primary outcome was a composite neonatal adverse outcome (CNAO); secondary outcomes were a composite maternal adverse outcome (CMAO) and infant death. Additional analysis was performed to re-categorize labor status into 3 groups: no labor (PL-CD), labored with vaginal delivery (VD) and labored with intrapartum cesarean (IN-CD). Multivariable Poisson regression models were utilized to estimate adjusted relative risk (aRR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Among 22,685,620 live births during the study period, 13,686,776 (60.3%) were included: 6.0% had PL-CD, and 94.0% labored. The rate of CNAO and CMAO were 7.97 and 3.17 per 1,000 live births, respectively. Compared to PL-CD, the risk of CNAO (aRR 0.58; 95% CI 0.57-0.59), infant death (aRR 0.59; 95% CI 0.57-0.62) and CMAO were lower (aRR 0.62; 95% CI 0.60-0.64) among those that labored overall. Compared to PL-CD by route of delivery, the risk of CNAO (aRR 0.47; 95% CI 0.46-0.48) and CAMO (aRR 0.45; 95% CI 0.44-0.47) was lower among VD, but higher (CANO, aRR 1.24; 95% 1.21-1.26, CAMO aRR 1.75; 95% CI 1.69-1.81) if delivered by IN-CD.</p><p><strong>Conclusions: </strong>Among low-risk pregnancies, those who labored had a lower risk of composite adverse outcomes compared to those with planned cesarean, particularly if delivered vaginally.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582827","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":"Effect of Maternal Body Mass Index on N-Terminal Pro B-Type Natriuretic Peptide Levels in the Third Trimester.","authors":"Upma Saxena, Priyanka Yadav, Abhishek Lachyan, Anita Rani","doi":"10.1055/a-2463-4410","DOIUrl":"10.1055/a-2463-4410","url":null,"abstract":"<p><p>Maternal body mass index (BMI) and cardiac biomarkers, such as N-terminal pro-B-type natriuretic peptide (NT-proBNP), have been subjects of interest in obstetric research due to their potential implications for maternal and fetal health. Previous studies have explored the relationship between maternal BMI and various pregnancy outcomes, but the impact on NT-proBNP levels remains unclear. This study aims to investigate whether maternal BMI influences NT-proBNP levels in the third trimester of pregnancy, which could provide insights into maternal cardiovascular health during late gestation.A total of 234 singleton pregnant women in their third trimester (28-40 weeks) were recruited from Antenatal Care Clinic. Exclusion criteria included preexisting cardiac or renal conditions, hypertension, diabetes mellitus, and other specific medical conditions. Participants were categorized into BMI groups (< 23, 23-24.9, 25-29.9, and ≥30 kg/m²), and their NT-proBNP levels were measured using quantitative enzyme-linked immunosorbent assay kits. Statistical analyses including Spearman correlation, chi-squared test, Kruskal-Wallis test, and regression analysis were performed to assess the association between maternal BMI and NT-proBNP levels.The study population exhibited a range of BMI and NT-proBNP levels within normal ranges. No significant correlation was found between maternal age, parity, and NT-proBNP levels. Similarly, no significant association was observed between maternal BMI and NT-proBNP levels across different BMI categories. Trend analyses showed no consistent relationship between BMI and NT-proBNP levels. Multivariate and univariate regression analyses confirmed the lack of significant association between maternal BMI and NT-proBNP levels.Contrary to expectations, this study found no significant effect of maternal BMI on NT-proBNP levels in the third trimester of pregnancy. These findings suggest that factors other than maternal BMI may predominantly influence NT-proBNP levels during late gestation. Further research is warranted to elucidate the complex interactions between maternal physiology, BMI, and cardiovascular biomarkers during pregnancy. · This study aimed to examine the influence of maternal BMI on NT-proBNP.. · No significant correlation between maternal BMI and NT-proBNP levels was found.. · Other factors likely influence NT-proBNP levels, warranting further research..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1141-1151"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779184","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 Outcomes Associated with Progressive Intrahepatic Cholestasis of Pregnancy.","authors":"Minhazur R Sarker, Dana Canfield, Lauren Ferrara, Gladys A Ramos, Chelsea A DeBolt","doi":"10.1055/a-2483-5910","DOIUrl":"10.1055/a-2483-5910","url":null,"abstract":"<p><p>This study aimed to assess the association between increasing bile acid levels in pregnancies with cholestasis and adverse outcomes.This is a retrospective cohort study of singleton, non-anomalous gestations complicated by cholestasis delivered at a single academic medical center from 2005 to 2019. We compared rates of adverse outcomes in pregnancies complicated by mild cholestasis (initial total bile acid [TBA] <40 μmol/L and peak TBA <40 μmol/L), progressive cholestasis (initial TBA <40 μmol/L and peak TBA ≥40 μmol/L), and severe cholestasis (initial TBA ≥40 μmol/L). Our primary outcome was a composite adverse outcome including spontaneous preterm labor and delivery, umbilical artery pH <7.20, 5-minute Apgar <7, cesarean delivery for nonreassuring fetal heart rate tracing, meconium-stained amniotic fluid, and neonatal intensive care unit (NICU) admission. Analyses were performed using mild cholestasis as the base comparator and a second analysis using severe cholestasis as the base comparator.Of the 1,182 pregnancies complicated by cholestasis, 732 (61.9%) had mild cholestasis, 78 (6.6%) had progressive cholestasis, and 372 (31.5%) had severe cholestasis. After adjusting for confounders including gestational age at diagnosis and using mild cholestasis as the base comparator, both progressive and severe cholestasis were associated with the composite adverse outcome (progressive intrahepatic cholestasis of pregnancy [ICP], OR = 1.70; 95% CI: 1.04-2.78 and severe ICP, OR = 1.60; 95% CI: 1.24-2.06). When using progressive cholestasis as the base comparator, there were no statistically significant differences in the primary or secondary outcomes between progressive cholestasis and severe cholestasis.This study highlights the significance of monitoring peak bile acid levels and that some cases of cholestasis may progress in pregnancy and the adverse associations are better reflected by the peak TBA level and not the cholestasis severity at initial diagnosis. · Outcomes with worsening cholestasis severity (progressive) are unknown.. · Retrospective study comparing mild to progressive to severe cholestasis.. · Progressive cholestasis outcomes are more similar to severe cholestasis.. · Clinical utility of trending bile acids warrants further study..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1235-1242"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724732","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":"Changes in Liver Shear Wave Elastography of Preterm Infants during Hospitalization.","authors":"Takahiro Kemmotsu, Tomoyuki Shimokaze, Yusuke Morita, Tomoko Saito, Katsuaki Toyoshima","doi":"10.1055/a-2490-3259","DOIUrl":"10.1055/a-2490-3259","url":null,"abstract":"<p><p>Liver evaluation is essential in preterm infants because of exposure to hepatotoxic drugs, the effects of parenteral nutrition, and their organ immaturity. The clinical significance of shear wave elastography (SWE) which measures tissue elasticity, is unclear in preterm infants. For SWE application to liver evaluation in preterm infants, we examined the postnatal course and factors associated with changes.We prospectively measured liver SWE values every other week in 37 preterm infants born at 23 to 35 weeks gestation and 12 term infants born after 36 weeks gestation.The median early postnatal liver SWE value was 1.22 (interquartile range, 1.19-1.26) m/s. The correlations of liver SWE values with gestational age and birth weight were <i>r</i> = -0.18 (<i>p</i> = 0.23) and <i>r</i> = -0.21 (<i>p</i> = 0.157), respectively. The median liver SWE values from birth to 36 to 38 postmenopausal weeks were 1.22 (1.17-1.24) m/s at <28 weeks gestation (<i>n</i> = 9), 1.21 (1.18-1.25) m/s at 28 to 29 weeks gestation (<i>n</i> = 11), 1.24 (1.21-1.28) m/s at 30 to 31 weeks gestation (<i>n</i> = 8), and 1.21 (1.20-1.24) m/s at ≥32 weeks gestation (<i>n</i> = 9). There was no change over time in any gestational age group (<i>p</i> = 0.158). The median liver SWE values were 1.22 (1.17-1.25) m/s (<i>n</i> = 10) and 1.22 (1.19-1.25) m/s (<i>n</i> = 27) for small- and appropriate-for-gestational-age infants, respectively (<i>p</i> = 0.93). The correlations of abnormally high serum concentrations of direct bilirubin (>1.0 mg/dL) and alanine aminotransferase (>12 IU/L) with liver SWE values were <i>r</i> = 0.37 (<i>p</i> = 0.041) and <i>r</i> = 0.21 (<i>p</i> = 0.35), respectively.Liver SWE values may be useful for the evaluation of liver damage with cholestasis in preterm infants because they remain constant regardless of gestational age and birth weight and do not change over time or with a deviation of body size. · Liver SWE was prospectively performed in preterm infants.. · Liver SWE was constant until term regardless of gestational age or birth weight.. · Liver SWE values of preterm infants ranged from 1.2 to 1.3 m/s.. · For preterm infants, elevation of liver SWE values reflected cholestasis.. · Liver SWE may become the new standard for liver evaluation in preterm infants..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1318-1324"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749738","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 between Perinatal Complications and Adverse Childhood Experiences: Findings from a Nationwide Online Survey.","authors":"Yousuke Imanishi, Ichiro Wada, Takahiro Tabuchi","doi":"10.1055/a-2464-3665","DOIUrl":"10.1055/a-2464-3665","url":null,"abstract":"<p><p>This study aimed to evaluate the association between maternal adverse childhood experiences (ACEs) levels and the risk of perinatal complications.This is a retrospective cohort study of 5,693 mother-child pairs born between 2019 and 2021, who completed questionnaires on maternal ACE scores and perinatal complications such as preterm birth, low birth weight infants, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), and premature rupture of membrane (PROM). Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression according to the three ACE score groups after adjusting for confounding factors such as maternal age, child's sex, household income, and maternal education.Maternal ACEs have a significant positive correlation with preterm birth (OR: 1.42, 95% CI: 1.09-1.86, <i>p</i> for trend = 0.009), PIH (OR: 1.55, 95% CI: 1.17-2.07, <i>p</i> for trend = 0.002), and PROM (OR: 1.42, 95% CI: 1.09-1.84, <i>p</i> for trend = 0.01). These associations remained unchanged when stratified according to smoking, alcohol consumption, and obesity.Maternal ACEs were associated with the risk of perinatal complications such as preterm birth, PIH, and PROM. · Maternal ACEs are linked to higher risks of preterm birth, PIH, and PROM.. · Parental divorce, emotional abuse, and neglect were the most common ACEs among Japanese mothers.. · Mothers with ACEs score ≥ 2 had a higher risk of perinatal complications..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1168-1178"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821822","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":"COVID-19 Serostatus Does Not Affect the Intrauterine Transfer of Micronutrients and Fatty Acids or Maternal-Fetal Lymphocyte Cell Composition: An Observational Study.","authors":"Mullapudi V Surekha, Gargi Meur, Nadimpalli Suneetha, Nagalla Balakrishna, Putcha U Kumar, Bhukya Tulja, K Suryam Reddy, Ahmed Ibrahim, Pratha Sunitha","doi":"10.1055/a-2480-5329","DOIUrl":"10.1055/a-2480-5329","url":null,"abstract":"<p><p>Studies on the effects of coronavirus disease 2019 (COVID-19) on pregnant mothers and their newborns, specifically in relation to their micronutrient status, fatty acids (FAs), and inflammatory status are sparse. We hypothesized that COVID-19 infection would adversely affect the transfer of nutrients, and FAs from mothers to their fetuses via the umbilical cord and maternal-fetal distribution of inflammatory cells. This study aimed to determine the effect of COVID-19 on micronutrients, inflammatory markers, and FAs profiles in pregnant mothers and their newborns' cord blood.This was a cross-sectional study of 212 pregnant mothers in the third trimester and their newborns, recruited after testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serostatus. Peripheral blood of mothers and cord blood were collected at birth and analyzed for vitamin B12 (Vit B12), folic acid, 25(OH)D3, FAs, and peripheral blood mononuclear cells. Student's <i>t</i>-test or analysis of variance (ANOVA) was used to express statistical significance. Non-normal data were tested using the Mann-Whitney <i>U</i> test and Kruskal-Wallis test, with proportions compared with the chi-square test.Vit B12 levels were significantly low and adrenic acid levels significantly high in COVID-19 seropositive mothers while 25(OH)D3 was significantly low in seropositive cord blood. Irrespective of COVID-19 serostatus, folate, vit B12, saturated FA levels were significantly high in cord blood indicating their increased transfer from mothers to the fetus. However, monounsaturated (MUFA) and polyunsaturated fatty acid (PUFA) levels were significantly lower in cord blood. Irrespective of COVID-19 serostatus, CD4⁺ T helper cells (percentage of lymphocytes) were significantly higher in cord blood, while NK cells, NK-T cells, and CD8⁺ T-cytotoxic cells-percentage of lymphocytes-were significantly lower in cord blood when compared with corresponding mother's blood.The results indicate that while COVID-19 did not impede the transfer of essential nutrients such as MUFA and PUFA from mother to fetus, or affect maternal-fetal immune cell responses, it did appear to affect the levels of vit B12, vitamin D, and adrenic acid. · COVID-19 did not impede essential fatty acids transfer through cord blood.. · COVID-19 affected maternal-fetal immune responses.. · COVID-19 affected vitB12, vitamin D and adrenic acid levels..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1213-1222"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885233","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":"Individual and County-Level Factors Associated with Severe Maternal Morbidity at Delivery: An Investigation of a Privately Insured Population in the United States, 2008 to 2018.","authors":"Jennifer L Matas, Laura E Mitchell, Jason L Salemi, Cici X Bauer, Cecilia Ganduglia Cazaban","doi":"10.1055/a-2483-5842","DOIUrl":"10.1055/a-2483-5842","url":null,"abstract":"<p><p>Few studies have explored the impact of county-level variables on severe maternal morbidity (SMM) subtypes. To address this gap, this study used a large commercial database to examine the associations between individual- and county-level factors and SMM.This retrospective cohort study used data from the Optum's deidentified Clinformatics Data Mart Database from 2008 to 2018. The primary outcomes of this study were any SMM, nontransfusion SMM, and nine specific SMM subtypes. Temporal trends in the prevalence of SMM and SMM subtypes were assessed using Joinpoint Regression. Multilevel logistic regression models were used to investigate the association of individual- and county-level factors with SMM.Between 2008 and 2018, there was not a significant change in the prevalence of any SMM (annual percent change [APC]: -0.9, 95% confidence interval [CI]: -2.2, 0.5). Significant increases in prevalence were identified for three SMM subtypes: other obstetric (OB) SMM (APC: 10.3, 95% CI: 0.1, 21.5) from 2013 to 2018, renal SMM (APC: 8.5, 95% CI: 5.5, 11.6) from 2008 to 2018, and sepsis (APC: 23.0, 95% CI: 6.5, 42.1) from 2014 to 2018. Multilevel logistic regression models revealed variability in individual and county risk factors across different SMM subtypes. Adolescent mothers (odds ratio [OR]: 2.10, 95% CI: 1.29, 3.40) and women in the 40 to 55 (OR: 1.67, 95% CI: 1.12, 2.51) age group were found to be at significant risk of other OB SMM and renal SMM, respectively. For every increase in rank within a county's socioeconomic social vulnerability index (SVI), the risk of respiratory SMM increased 2.8-fold, whereas an increase in rank in the racial/ethnic minority SVI was associated with a 1.6-fold elevated risk of blood transfusion.This study underscores the complex association between individual and county factors associated with SMM, emphasizing the need for multifaced approaches to improve maternal care. · No increase in composite SMM rates from 2008 to 2018.. · Increases in obstetric SMM subtypes and sepsis.. · Risk factor profiles may differ across SMM subtypes.. · Key risk factors: age, comorbidities, prenatal care.. · County socioeconomic status associated with respiratory SMM risk..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1257-1271"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715051","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":"Placenta Accreta Spectrum: Risk Factors for Unplanned Immediate Hysterectomy in Planned Uterine Preservation Surgery.","authors":"Lior Friedrich, Nitzan Mor, Alina Weissmann-Brenner, Eran Kassif, Shakad Noah Friedrich, Tal Weissbach, Elias Castel, Gabriel Levin, Raanan Meyer","doi":"10.1055/a-2486-9070","DOIUrl":"10.1055/a-2486-9070","url":null,"abstract":"<p><p>Placenta accreta spectrum (PAS) is a term used to describe trophoblast invasion into the uterine wall. The condition can be fatal at labor due to a lack of spontaneous separation of the placenta from the uterine wall, leading to severe hemorrhage. In this study, we aim to evaluate preoperative risk factors for unplanned immediate hysterectomy in PAS uterine-preserving surgeries.Preoperative parameters of women who underwent successful uterine-preserving surgery were retrospectively compared with those who underwent an unplanned immediate hysterectomy during these surgeries. A multivariable regression analysis was conducted to identify independent factors associated with unplanned immediate hysterectomy.Overall, 238 were included in the study's cohort. A total of 86.2% underwent successful uterine-preserving surgery, and 13.8% underwent an unplanned immediate hysterectomy. The number of previous cesarean deliveries (CDs) and the proportion of women with grade 3 preoperative PAS was significantly lower among the successful uterine-preserving group. The proportion of preoperative ultrasound lacunae detection, the number of lacunae observed, loss of clear zone detection, the length of clear zone loss, the proportion of retroplacental hypervascularity, bridging vessels detection, and bladder involvement were significantly lower in the successful uterine-preserving group. In a multivariable regression analysis, the presence of lacunae and loss of clear zone were independently associated with unplanned cesarean hysterectomy (adjusted odds ratio [aOR] = 3.18 [95% confidence interval (CI): 1.11-11.6], <i>p</i> = 0.047, and aOR = 3.67 [95% CI: 1.3-13.2], <i>p</i> = 0.025, respectively].Preoperative assessment of the applicability of a uterine-preserving surgery may be performed using the ultrasound parameters reported in this study. · Applicability of a uterine-preserving surgery may be performed using sonographic parameters.. · Sonographic presence of lacunae is associated with an unplanned hysterectomy.. · Sonographic loss of clear zone is associated with an unplanned hysterectomy..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1288-1294"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724779","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":"Impact of Cannabis Legalization on Umbilical Cord Tissue Tetrahydrocannabinol Levels.","authors":"Kimberly Spence, Sarah Milota, Paula Buchanan, Nirja Acharya, Amit M Mathur","doi":"10.1055/a-2480-3163","DOIUrl":"10.1055/a-2480-3163","url":null,"abstract":"<p><p>This study aimed to assess the impact of cannabis legalization on both qualitative and quantitative umbilical cord tissue tetrahydrocannabinol (THC) rates and concentrations as a proxy for fetal exposure.This is a retrospective, observational study of umbilical cord tissue THC levels in a single center, comparing THC exposure rates and concentration levels before and after cannabis legalization in the state of Illinois, Epoch 1 (October 1, 2018-June 30, 2019, pre-legalization) and Epoch 2 (July 1, 2019-August 31, 2021, post-legalization).A total of 811 umbilical cords were analyzed during epoch 1 and 2,170 during epoch 2. A higher percentage of umbilical cord tissue tested positive for THC in Epoch 2 compared with Epoch 1 (46.2 vs. 40.6%; <i>p</i> < 0.01). Mean THC levels were 51% higher in umbilical cord tissue in Epoch 2 versus Epoch 1 (6.2 ng/g vs. 4.1 ng/g; <i>p</i> < 0.001).Legalization of recreational cannabis was associated with more fetuses exposed to THC and in higher concentrations. · THC concentration can be measured in umbilical cord tissue after birth.. · THC positivity in umbilical cord tissue can be used as a proxy for fetal exposure to cannabis.. · Umbilical cord tissue THC concentration and rates of positivity increased with the legalization of cannabis..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1206-1212"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685849","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":"Transverse versus Vertical Incision in the Surgical Management of Placenta Accreta Spectrum.","authors":"Austin Oberlin, Katherine Yoh, Eve Overton, Whitney A Booker, John G Ilagan, Dib Sassine, Alexandra Diggs, Sherelle Laifer-Narin, Adela Cimic, Laurence E Ring, Maria Sheikh, Caryn St Clair, June Hou, Alexandre Buckley De Meritens, Jason D Wright, Mary D'Alton, Chia-Ling Nhan Chang, Mirella Mourad, Fady Khoury-Collado","doi":"10.1055/a-2479-2604","DOIUrl":"10.1055/a-2479-2604","url":null,"abstract":"<p><p>Traditionally, midline vertical skin incisions have been utilized during surgery for placenta accreta spectrum (PAS), as it is considered to maximize exposure and allow for a uterine incision to avoid the placenta. However, literature directly comparing outcomes of vertical versus transverse incisions in PAS is sparse. Our objective was to compare maternal outcomes between patients who underwent a vertical versus a transverse skin incision for PAS.Retrospective review of patients with pathologically confirmed PAS undergoing scheduled surgery at our institution between September 2019 and November 2023. Starting in October 2021, select patients were offered a transverse skin approach. Patients were eligible if the surgery was scheduled, and the placenta was not entirely covering the anterior uterine wall. The transverse skin incision was approximately 18 to 20 cm and used the patient's prior scar. Primary outcomes included the rate of maternal transfusion >4 units of packed red blood cells (PRBCs), the incidence of surgical complications, and the need for conversion to general anesthesia (GETA).Seventy patients underwent scheduled surgery for PAS. Thirty-three patients had a vertical skin incision, and 37 had a transverse incision. After initiation of the transverse incision approach, 37/43 (86%) had a transverse incision and none required conversion to a vertical incision intraoperatively. The two groups were similar with regard to age, body mass index (BMI; kg/m²), and severity of PAS. There was no difference in the rate of transfusion of >4 units of PRBCs (vertical 12% vs. transverse 22%, <i>p</i> = 0.29), or in the rate of intraoperative complications (i.e., cystotomy; vertical 3% vs. transverse 14%, <i>p</i> = 0.20). In patients with a transverse incision, a significantly lower number of patients required conversion to GETA intraoperatively (vertical 70% vs. transverse 24%, <i>p</i> < 0.001).In appropriately selected patients, a transverse skin incision was associated with lower conversion to GETA without any difference in intraoperative outcomes. · Transverse incision for PAS has equivalent surgical outcomes.. · Fewer patients require GETA with a transverse incision.. · Transverse incision for PAS may need fewer narcotics..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1200-1205"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680589","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}