American journal of perinatology最新文献

{"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}

{"title":"Association of Active Antenatal Management in the Periviable Period and Parental Morbidity in the United States.","authors":"Katelyn Edel, Whitney Bender","doi":"10.1055/a-2849-7869","DOIUrl":"10.1055/a-2849-7869","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to describe the incidence of parental morbidity with periviable delivery and its relationship to antenatal interventions, including antenatal corticosteroids, antibiotics, and cesarean delivery.</p><p><strong>Study design: </strong>This is a population-based case-control study of the National Center for Health Statistics database of periviable deliveries (20^0/7-25^6/7 weeks) from 2016 to 2021. Subjects were included if they delivered a nonanomalous live singleton gestation in a hospital. To minimize inaccurate dating, subjects were excluded for birthweight > 97% for gestational age. The composite morbidity outcome was defined as parental blood transfusion, intensive care unit (ICU) admission, or unplanned hysterectomy. We assessed this outcome's relationship to parental demographic and clinical characteristics, including the receipt of selected antenatal interventions, including antenatal corticosteroids, antibiotics, and cesarean delivery. Multivariable logistic regression was used to assess the relationship between antenatal intervention and parental morbidity.</p><p><strong>Results: </strong>Of 45,339,472 births during the study period, 93,686 met the inclusion criteria for this study. A total of 2,726 (3.1%) parents experienced parental morbidity. The rate of perinatal morbidity increased over the study period. Black parents were less likely to experience morbidity compared to non-Black parents (2.7 vs. 3.4%, <i>p</i> < 0.001). Parents who received antenatal steroids or antibiotics and those undergoing cesarean delivery had higher rates of morbidity compared to their counterparts who did not receive these interventions.</p><p><strong>Conclusion: </strong>Birthing parents who received steroids or antibiotics prior to periviable delivery and those undergoing cesarean delivery were more likely to experience parental morbidity of transfusion, hysterectomy, or ICU admission. The relationship of these interventions, intended to improve neonatal outcomes or prolong pregnancy, to parental morbidity should be incorporated into the nuanced counseling required for parents at risk of periviable deliveries. Additional research is warranted to understand the institutional, provider, and patient factors underlying these findings.</p><p><strong>Conclusion: </strong>KEY POINTS:  .</p><p><strong>Conclusion: </strong>· Neonatal outcomes after periviable birth are linked to gestational age and receipt of antenatal interventions.. · Parents who received active antenatal interventions were more likely to experience parental morbidity.. · The potential for morbidity following antenatal intervention in the periviable period should be included in the nuanced counseling required in these cases..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1942-1946"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687253","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":"Renal Effects of Aminophylline in Cooled Neonates with Hypoxic-Ischemic Encephalopathy.","authors":"Osman Baştuğ, Arife Canpolat, Dilek Kafadar, Ahmet Özdemir, Funda Baştuğ","doi":"10.1055/a-2847-3290","DOIUrl":"10.1055/a-2847-3290","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the renal effects and safety of adjunct aminophylline therapy in neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH).</p><p><strong>Study design: </strong>This retrospective cohort study included neonates ≥36 weeks and >2,000 g diagnosed with HIE and treated with TH between May 2018 and January 2025. Infants were classified into two groups: those receiving TH alone (TH group) and those given a single intravenous 8 mg/kg dose of aminophylline at the initiation of cooling (TH + A group). Demographic, perinatal, and laboratory characteristics were collected, and serial serum creatinine (sCr) measurements at 24, 48, 72, and 96 hours were analyzed to compare renal and clinical outcomes.</p><p><strong>Results: </strong>A total of 297 infants were included (TH: 210; TH + A: 87). Baseline demographic and clinical characteristics were similar between the groups. While sCr values at each fixed time point did not significantly differ, repeated-measures analysis demonstrated a significantly steeper decline in sCr over time in the TH + A group (<i>p</i> < 0.001). Convulsions were more frequent in the TH + A group (23.0 vs. 10.5%, <i>p</i> = 0.005), whereas mortality and other major clinical outcomes were comparable.</p><p><strong>Conclusion: </strong>Aminophylline administration at the start of TH was associated with a steeper decline in serum creatinine, suggesting a potential renoprotective effect in neonates with HIE. However, the higher frequency of convulsions emphasizes the need for careful neurological monitoring. Further studies are needed to clarify optimal dosing and the balance between potential renal benefits and neurological risks.</p><p><strong>Key points: </strong>· Aminophylline did not change creatinine at fixed time points in cooled HIE.. · A steeper creatinine decline with aminophylline suggests a more favorable pattern of renal recovery.. · Convulsions were more frequent with aminophylline, requiring close monitoring..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1935-1941"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615509","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":"Early Multimodal Assessment for Prediction of Cerebral Palsy in Neonatal Hypoxic-Ischemic Encephalopathy.","authors":"Fatih Isleyen, Canan Kocaman, Asli Okbay Gunes, Mehmet Fatih Deveci, Celil Yilmaz, Arzu Yilmaz, Gazanfer Ekinci, Ipek Akman","doi":"10.1055/a-2826-4512","DOIUrl":"10.1055/a-2826-4512","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to determine the predictive value of magnetic resonance imaging (MRI), amplitude-integrated electroencephalography (aEEG), the Hammersmith Neonatal Neurological Examination (HNNE), and the General Movements Assessment (GMA) for cerebral palsy (CP) in neonates with hypoxic-ischemic encephalopathy (HIE), and to evaluate whether combining these modalities improves diagnostic accuracy.</p><p><strong>Study design: </strong>In this prospective two-center cohort study, 53 term or late-preterm infants with HIE treated with standardized therapeutic hypothermia (33.5°C for 72 hours) were evaluated. aEEG and MRI findings were compared with concurrent HNNE and GMA results. CP was diagnosed during follow-up by a pediatric neurologist blinded to neonatal data. Diagnostic performance was analyzed using receiver-operating characteristic curves and multivariable logistic regression according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.</p><p><strong>Results: </strong>CP developed in 11 infants (20.8%). aEEG showed the highest predictive accuracy (area under the curve = 0.816 [95% confidence interval: 0.65-0.98]), and abnormal aEEG independently predicted CP (odds ratio = 18.5, <i>p</i> = 0.004). The combined \"MRI or aEEG abnormal\" model achieved the best overall accuracy (86.8%), with sensitivity = 90.9% and negative predictive value = 97.3%. MRI and HNNE had moderate predictive value, whereas GMA showed high specificity but low sensitivity.</p><p><strong>Conclusion: </strong>aEEG emerged as a robust and independent early biomarker for CP prediction after HIE. Combining aEEG with MRI substantially enhanced diagnostic precision, reflecting complementary functional and structural brain injury mechanisms. Although HNNE and GMA add screening value, they are insufficient alone. Standardized multimodal protocols integrating structural (MRI), functional (aEEG), and clinical (HNNE-GMA) assessments should be incorporated into clinical practice to improve early prognostication and guide neuroprotective interventions.</p><p><strong>Key points: </strong>· Early multimodal tools improve CP prediction.. · MRI and aEEG show higher diagnostic accuracy.. · Low HNNE scores indicate increased CP risk.. · Abnormal GMA supports early neurological impairment.. · Combining MRI + GMA + HNNE enhances prediction..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1767-1774"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147368916","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":"Migraines in Pregnancy: A Prospective Study of Symptom Patterns and Obstetric Outcomes.","authors":"Rachel C Schell, Gayathri D Vadlamudi, Sofia S Edwards, Yasmeen Alayli, Devin A Macias, April R Gorman, David Bryan Nelson, Catherine Y Spong, Elaine L Duryea","doi":"10.1055/a-2963-5766","DOIUrl":"10.1055/a-2963-5766","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate the frequency and characteristics of headaches across pregnancy and to examine obstetric and neonatal outcomes among pregnant patients with recurrent migraines.</p><p><strong>Study design: </strong>This was a single-site prospective observational study of pregnant patients evaluated for recurrent headaches during prenatal visits from December 2020 through September 2022. Standardized questions were used at each visit to assess headache type, frequency, and associated symptoms. Obstetric and neonatal outcomes were recorded. Statistical analyses included mixed effects logistic regression, independent <i>t</i>-tests, and chi-square tests to compare baseline characteristics and outcomes between groups.</p><p><strong>Results: </strong>During the study period, 858 pregnant patients were evaluated for recurrent headaches. Of these, 546 (63.6%) patients were diagnosed with migraine headaches and 312 (36.4%) with tension-type headaches. Migraine frequency was highest in the second trimester. Nausea, vomiting, and photophobia were the most commonly reported associated symptoms. In the first trimester, 58.7% of patients reported nausea, 59.4% photophobia, and 31.0% vomiting. The frequency of these symptoms decreased with advancing gestation. The composite outcome of preterm delivery, preeclampsia with severe features, abruption, and stillbirth did not significantly differ between patients with migraines and matched controls without headache disorders (25.4 vs. 21.1%, <i>p</i> = 0.12). There were no significant differences in individual components of the composite outcome or in neonatal outcomes, including birthweight < 3%ile, birthweight < 10%ile, and need for neonatal respiratory support.</p><p><strong>Conclusion: </strong>Migraines were the most common headache diagnosis among pregnant patients with recurrent headaches, and migraine frequency and associated symptoms changed across gestation. After adjustment for comorbid conditions, obstetric and neonatal outcomes were similar between patients with recurrent migraines and those without headache disorders.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015232","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":"Late-Onset Neonatal Sepsis: Contemporary Epidemiology, Diagnosis, Prevention, and Precision Therapeutics.","authors":"Shweta Dixit, Shilpa Dixit, Yashwant Kumar Rao, Anirudha Das","doi":"10.1055/a-2938-3600","DOIUrl":"10.1055/a-2938-3600","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Late-onset neonatal sepsis (LOS) remains a major challenge in modern neonatal intensive care units (NICUs), disproportionately affecting very low birth weight (VLBW) and extremely preterm infants. Despite advances in perinatal care, LOS continues to contribute to high mortality, prolonged hospitalization, and long-term neurodevelopmental impairment. Emerging trends-including evolving pathogen profiles, increased antimicrobial resistance (AMR), and widespread microbiome disruption-highlight persistent clinical and public health concerns. This review synthesizes current evidence on the epidemiology, pathophysiology, diagnosis, and management of LOS, with emphasis on evolving diagnostics, antimicrobial stewardship, prevention strategies, and emerging precision approaches. Key gaps and research priorities are highlighted to inform future clinical practice and neonatal health policy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This narrative review synthesizes contemporary literature, including multicenter cohort studies, national registries, and emerging diagnostic and predictive technologies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;LOS arises from the complex interplay between neonatal immune immaturity, invasive NICU interventions, and microbial exposure. Gram-positive organisms predominate in high-income settings, whereas multidrug-resistant Gram-negative pathogens are increasingly reported in low- and middle-income countries, contributing to higher morbidity and mortality. Early-life antibiotic exposure and dysbiosis compromise the gut microbiome, further increasing susceptibility. Clinical recognition remains challenging due to nonspecific signs, often leading to delayed or excessive empiric antibiotic therapy. Rapid molecular diagnostics, emerging predictive tools, including early-warning models, and serial biomarker monitoring offer opportunities for pathogen-directed therapy, individualized pharmacokinetic optimization, and safe antimicrobial stewardship. Prevention through central-line bundles, human milk feeding, probiotics, strict hand hygiene, and context-specific infection-control strategies remains central to reducing LOS incidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;LOS represents a multifactorial syndrome with profound implications for survival and neurodevelopment in preterm and VLBW infants. Effective management requires integration of precision diagnostics, individualized therapy, microbiome-preserving strategies, neuroprotective interventions, and equitable implementation of prevention and stewardship programs. Bridging mechanistic understanding with scalable, context-sensitive approaches is critical to improving survival, reducing morbidity, and optimizing long-term outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;· LOS remains a major NICU burden.. · AMR reshapes neonatal pathogen epidemiology.. · Early diagnosis remains challenging.. · Biomarkers and artificial intelligence improve risk stratification.. · Prevention","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758621","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":"Persistent Adverse Perinatal Outcomes among Pregnancies with Gestational Diabetes in the United States.","authors":"Amy M Valent, Bharti Garg, Aaron B Caughey, Teri L Hernandez","doi":"10.1055/a-2957-5259","DOIUrl":"10.1055/a-2957-5259","url":null,"abstract":"<p><p>This study aimed to evaluate the prevalence of large-for-gestational age (LGA) births and hypertensive disorders of pregnancy (HDP) among pregnant individuals with gestational diabetes mellitus (GDM) following the 2014 U.S. Preventive Services Task Force (USPSTF) universal screening recommendation. We analyzed linked U.S. birth and infant death datasets for singleton, non-anomalous births delivered between 23^0/7 and 42^6/7 weeks' gestation from 2014 to 2022. Multivariate Poisson regression models estimated the independent association between GDM and LGA, small for gestational age (SGA), or HDP. Among the 31,791,459 total births included in the analysis, 6.8% had GDM, and the LGA prevalence declined from 17.9% in 2014 to 14.9% in 2022 (risk ratio [RR] 0.83; 95% confidence interval [CI] 0.82-0.84; rate difference - 3.06%) without an increase in rates of SGA infants. However, the overall frequency of LGA among pregnancies complicated by GDM was higher than in pregnancies that were not complicated by GDM in the United States during this study period ([GDM] 16.2% vs. [non-GDM] 10.8%, <i>p</i> < 0.001; RR 1.53 [95% CI 1.52-1.54]). In contrast, HDP prevalence increased from 11.1 to 15.5% during the same period among pregnancies complicated by GDM (RR 1.40; 95% CI 1.38-1.42; rate difference 4.46%). GDM remained independently associated with LGA (adjusted RR [aRR] 1.34 [95% CI 1.33-1.34]) and HDP (aRR 1.67 [1.66-1.68]). While universal GDM screening and current management strategies have reduced LGA at the population level, LGA still remains persistently higher than in non-GDM pregnancies, and HDP rates continue to rise. Future studies should focus on innovative interventions to improve outcomes. · Rates of GDM and HDP are increasing annually.. · Despite a decrease in LGA since universal GDM screening, rates remain elevated.. · Rates of hypertensive disorders are higher in GDM, similarly in each body mass index class..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954597","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 Time from Neuraxial Anesthesia to Delivery among Non-Labor Cesarean.","authors":"Minhazur Sarker, Dana Canfield, Gladys A Ramos, Angela T Bianco, Chelsea A DeBolt","doi":"10.1055/a-2957-5324","DOIUrl":"10.1055/a-2957-5324","url":null,"abstract":"<p><strong>Objective: </strong>Prior studies showing an inverse association between time from spinal anesthesia to delivery and umbilical artery (UA) pH were relatively small cohorts or included only spinal anesthesia. In a large cohort of unlabored cesarean deliveries, we further investigated this association.</p><p><strong>Study design: </strong>This is a secondary analysis of a retrospective cohort study of singleton, term, non-anomalous pregnancies delivered by non-labor cesarean with neuraxial anesthesia, inclusive of spinal, epidural, or combined spinal-epidural. We assessed outcomes with time intervals from neuraxial placement to delivery: < 20, 20-39, 40-59, and ≥ 60 minutes. The primary outcome was UA pH < 7.1. We further analyzed the time intervals for surgical procedural steps among neonatal UA pH cohorts: ≤ 7.00, 7.01-7.10, 7.11-7.20, 7.21-7.30, and ≥ 7.31. Multivariable logistic regression adjusting for baseline confounders was used to determine the strength of association.</p><p><strong>Results: </strong>Of the 5,255 cesarean deliveries, 645 (12.3%) delivered within 20 minutes, 4,067 (77.4%) delivered between 20 and 39 minutes, 468 (8.9%) delivered between 40 and 59 minutes, and 75 (1.4%) delivered in ≥ 60 minutes from neuraxial anesthesia. Increased time from neuraxial placement to delivery was associated with UA pH < 7.1 and < 7.2, UA base deficit > 8, and meconium-stained amniotic fluid (all <i>p</i> < 0.05). After adjusting for confounders and using < 20 minutes as the reference, increased time from neuraxial placement to delivery was no longer associated with adverse outcomes. There was an inverse relationship with pH and time from neuraxial placement to delivery, skin incision to uterine incision, and uterine incision to delivery (all <i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>Our study suggests that although increased time from neuraxial anesthesia to delivery is associated with lower UA pH, these findings are significantly affected by clinical factors such as body mass index (BMI), hypertension, or diabetic disorders, type of neuraxial anesthesia, number of prior cesarean deliveries, and surgical factors such as duration of procedural steps.</p><p><strong>Key points: </strong>· Our study is inclusive of spinal, epidural, and combined spinal-epidural anesthesia.. · Our findings reveal an association between time from neuraxial placement and low UA pH, which is confounded by numerous clinical factors.. · When assessing duration of each step, only increased duration of surgical steps is associated with lower UA pH and not presurgical preparation..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954668","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":"Perinatal Risk and Outcomes Among Individuals Insured by Medicare.","authors":"Osinakachukwu Mbata, Ayodamope Fawole, Armand Zimmerman, Muskaan Toshniwal, Evan Myers, Maria Small, Osondu Ogbuoji","doi":"10.1055/a-2954-5263","DOIUrl":"https://doi.org/10.1055/a-2954-5263","url":null,"abstract":"<p><strong>Objective: </strong>Pregnant Medicare beneficiaries are typically individuals with chronic conditions causing disability or end-stage organ disease, which may increase obstetric risk. Few studies have examined this population. We compared medical comorbidities and perinatal outcomes between Medicare-insured and non-Medicare-insured obstetric patients.</p><p><strong>Study design: </strong>We performed a cross-sectional analysis of the 2019 Healthcare Cost and Utilization Project National Inpatient Sample, including singleton deliveries (Major Diagnostic Category 14). Using discharge weights, strata, and hospital clusters, we compared Medicare with all other payers across maternal demographics, chronic conditions, and perinatal outcomes, including severe maternal morbidity (SMM). Relative risks (RR) were estimated from survey-weighted log-link quasi-Poisson models; a two-sided α < 0.05 indicated significance.</p><p><strong>Results: </strong>Of 3,697,605 deliveries, 28,855 were Medicare-insured. Medicare beneficiaries were more likely to be Black (33.3 vs. 9.5%) and of advanced maternal age (25.4 vs. 23.4%) and had higher rates of chronic kidney disease, prepregnancy hypertension and diabetes, cesarean delivery (37.7 vs. 35.1%), and preterm birth (13.6 vs. 7.5%) than privately insured patients (all <i>p</i> < 0.001). Relative to Medicare, privately insured patients had lower risk of SMM (RR: 0.28; 95% confidence interval: 0.25-0.32).</p><p><strong>Conclusion: </strong>Pregnant Medicare beneficiaries enter pregnancy with a higher chronic disease burden and experience worse maternal and perinatal outcomes, highlighting the need for targeted support of this vulnerable population.</p><p><strong>Key points: </strong>· Pregnant Medicare beneficiaries enter pregnancy with a higher chronic disease burden.. · Pregnant Medicare beneficiaries experience worse maternal and perinatal outcomes.. · Perinatal racial disparities in the general population persisted within the Medicare cohort..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987675","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}