American journal of perinatology最新文献

{"title":"Association between Maternal Body Mass Index, Skin Incision-to-Delivery Time, and Umbilical Artery pH in Cesarean Deliveries.","authors":"Nadine Sunji, Alyssa M Hernandez, Rachel Schmidt, Amy Y Pan, Nina Ayala, Margaret H Bublitz, Anna Palatnik","doi":"10.1055/a-2622-2743","DOIUrl":"10.1055/a-2622-2743","url":null,"abstract":"<p><p>To estimate the association between maternal body mass index (BMI) at delivery, time from skin incision to infant delivery, and umbilical artery (UA) pH < 7.0.This was a secondary analysis of the Assessment of Perinatal Excellence, a multicenter observational study of an obstetrical cohort of individuals who delivered between 2008 and 2011 in the United States. This analysis included women who delivered via cesarean with known BMI at delivery, skin incision-to-delivery time, and UA pH. Multivariable linear regression assessed the association between BMI and time from skin incision to infant delivery while multivariable logistic regression estimated the associations of BMI and time from skin incision to delivery with UA pH < 7.0. An interaction between BMI and skin incision-to-delivery time was evaluated to examine their combined effect on UA pH < 7.0.A total of 16,723 women were included across five BMI groups. Increasing BMI was associated with longer time intervals from skin incision to delivery and higher rates of UA pH < 7.0. After controlling for potentially confounding factors, all BMI groups ≥25 kg/m² were associated with longer time intervals from skin incision to delivery. Specifically, BMI groups of 40 to 49.9 and ≥50 kg/m² had skin incision-to-delivery times that were 1.30 (95% confidence interval [CI]: 1.23-1.36) and 1.44 (95% CI: 1.34-1.55) times longer, respectively, compared with BMI < 25 kg/m². In the multivariable logistic regression, BMI group ≥50 kg/m² remained associated with higher odds of UA pH < 7.0. There was a significant interaction between BMI and time from skin incision to delivery regarding the risk of UA pH < 7.0 (<i>p</i> for the interaction term = 0.003).Maternal BMI ≥ 50 kg/m² was associated with a longer time from skin incision to infant delivery and higher odds of UA pH < 7.0. BMI differentially impacted UA pH at different skin incision-to-delivery time intervals. · Maternal BMI ≥ 25 kg/m2 was associated with longer skin incision-to-delivery times.. · Maternal BMI ≥ 50 kg/m2 was associated with higher odds of UA pH < 7.0.. · The effect of maternal BMI on UA pH varied at different skin incision-to-delivery time intervals.. · Reducing skin incision-to-delivery time may mitigate the risk of UA pH <7.0 in women with BMI ≥50.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155495","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 Warmer Height (Standard versus Custom) on Neonatal Chest Compression Performance: A Cross-Over Simulation Study.","authors":"Tamara Alexander, Lise DeShea, Leonard W Wilson, William H Beasley, Carol P Dionne, Edgardo Szyld, Birju A Shah","doi":"10.1055/a-2620-7882","DOIUrl":"https://doi.org/10.1055/a-2620-7882","url":null,"abstract":"<p><p>This study aimed to evaluate whether a custom warmer height improves the quality and consistency of chest compressions (CCs) compared with a standard warmer height during simulated neonatal resuscitation.Cross-over study using simulated neonatal resuscitation. A controlled research environment equipped with a 12-camera motion capture system, four in-floor multi-axis force plates, a neonatal manikin, and resuscitation equipment. Biomechanical assessments were recorded every 2 minutes during a 20-minute simulation for each condition. Twenty Neonatal Resuscitation Program (NRP)-trained providers. Each participant performed two 20-minute CC sessions-one with the warmer at the standard 100 cm height and one at a custom height selected by the participant. CC depth, force, and rate; participant back angle, heart rate, and self-reported exertion, were analyzed at 2-minute intervals.Compared with the standard height, the custom height resulted in greater and more consistent CC depth and force while maintaining compression rate. Participants also exhibited a greater back angle, and lower heart rate, and reported reduced exertion under the custom height condition.Allowing NRP-trained providers to adjust warmer heights led to improved CC quality and consistency, suggesting that customizable warmer heights may enhance neonatal resuscitation performance. KEY POINTS: · Custom warmer height chosen by NRP-trained providers resulted in more consistent and greater CC depth and force.. · It also was associated with less provider fatigue, compared with standard height.. · During neonatal resuscitation, frontline healthcare professionals changed.. · Participant heart rate was lower when using the custom versus standard height.. · Our findings support the need for guidelines on adjusting warmer height during neonatal cardiopulmonary resuscitation..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273979","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":"Hospital Costs of Severe Maternal Morbidity Hospitalizations in the United States from 2014 to 2019: A Nationwide Cross-Sectional Study.","authors":"Mohammad A Salameh, Megan E Branda, Bijan J Borah, Vanessa E Torbenson","doi":"10.1055/a-2618-7331","DOIUrl":"10.1055/a-2618-7331","url":null,"abstract":"<p><p>The objective of this study was to estimate the average hospitalization cost (AHC) for deliveries affected by severe maternal morbidity (SMM) and analyze trends from 2014 to 2019. The study also aimed to explore cost stratification based on patient, delivery, and hospital characteristics.Using the National Inpatient Sample dataset, all delivery hospitalizations from 2014 to 2019 were identified. Deliveries affected by SMM were determined based on the Centers for Disease Control definition. Deliveries were categorized into three groups: no SMM (nSMM), any SMM (aSMM), and SMM excluding cases with blood transfusion as the only indicator (SMMeBTo). A regression model accounting for survey design and adjusting for variables including age, race/ethnicity, primary payer, income, delivery method, hospital location/teaching status, and hospital region was used to test the trends in incidence. Hospital charges were adjusted using cost-to-charge ratios and presented in 2022 U.S. dollars ($). A regression model adjusting for the same variables was used to assess costs.From 2014 to 2019, 4,444,957 deliveries were identified, with a weighted estimate of 22,224,775. The rates of aSMM and SMMeBTo were 1.9 and 0.7%, respectively. AHC was $5,218 (95% confidence intervals [CI]: $5,200-5,235) for nSMM, $11,101 (95% CI: $11,038-11,165) for aSMM, and $11,541 (95% CI: $114,330-11,650) for SMMeBTo. Hospitalization costs across all SMM categories rose annually from 2014 to 2017, decreased in 2018, and peaked in 2019. All races had significantly higher costs than non-Hispanic Whites across all SMM categories. SMM costs were higher for cesarean deliveries. The highest cost was in deliveries involving a temporary tracheostomy. Urban teaching hospitals and those in the Northeast had the highest SMM costs.Deliveries affected by SMM incur significantly higher costs, with these costs increasing over time. Understanding disparities across patient factors, delivery methods, and hospital characteristics can inform interventions aimed at addressing inequities. · Costs of SMM hospitalizations are rising, even after adjusting for inflation.. · The escalating cost burden is disproportionately shouldered by different racial groups.. · Factors in delivery and hospital settings contribute to the variation in cost..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126432","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":"Application of Generative AI to Enhance Obstetrics and Gynecology Research.","authors":"Tetsuya Kawakita, Melissa S Wong, Kelly S Gibson, Megha Gupta, Alexis C Gimovsky, Hind N Moussa, Heo J Hye","doi":"10.1055/a-2616-4182","DOIUrl":"10.1055/a-2616-4182","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The rapid evolution of large-language models such as ChatGPT, Claude, and Gemini is reshaping the methodological landscape of obstetrics and gynecology (OBGYN) research. This narrative review provides a comprehensive account of generative AI capabilities, key use cases, and recommended safeguards for investigators. First, generative AI expedites hypothesis generation, enabling researchers to interrogate vast corpora and surface plausible, overlooked questions. Second, it streamlines systematic reviews by composing optimized search strings, screening titles and abstracts, and identifying full-text discrepancies. Third, AI assistants can draft reproducible analytic code, perform preliminary descriptive or inferential analyses, and create publication-ready tables and figures. Fourth, the models support scholarly writing by suggesting journal-specific headings, refining prose, harmonizing references, and translating technical content for multidisciplinary audiences. Fifth, they augment peer-review and editorial workflows by delivering evidence-focused critiques. In educational settings, these models can create adaptive curricula and interactive simulations for trainees, fostering digital literacy and evidence-based practice early in professional development among clinicians. Integration into clinical decision-support pipelines is also foreseeable, warranting proactive governance. Notwithstanding these opportunities, responsible use demands vigilant oversight. Large-language models occasionally fabricate citations or misinterpret domain-specific data (\"hallucinations\"), potentially propagating misinformation. Outputs are highly prompt-dependent, creating a reliance on informed prompt engineering that may disadvantage less technical clinicians. Moreover, uploading protected health information or copyrighted text raises privacy, security, and intellectual property concerns. We outline best-practice recommendations: maintain human verification of all AI-generated content; cross-validate references with primary databases; employ privacy-preserving, on-premises deployments for sensitive data; document prompts for reproducibility; and disclose AI involvement transparently. In summary, generative AI offers a powerful adjunct for OBGYN scientists by accelerating topic formulation, evidence synthesis, data analysis, manuscript preparation, and peer review. When coupled with rigorous oversight and ethical safeguards, these tools can enhance productivity without compromising scientific integrity. Future studies should quantify accuracy, bias, and downstream patient impact. · Generative AI supports various research stages in OBGYN, such as hypothesis generation, systematic review assistance, data analysis, and scientific writing, demonstrating its potential to streamline research workflows and improve research efficiency.. · Generative AI has notable limitations, including the risk of generating inaccurate references (\"hallucinations\") and the need for care","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Practice of Kidney Support Therapy in the NICU: Results from a CHNC Survey.","authors":"Christine Stoops, Sofia I Perazzo, Jennifer A Rumpel, Tahagod Mohamed, Andrew M South, Mona Khattab, Catherine Joseph, Matthew W Harer, Cara L Slagle, Mary Revenis, John Daniel","doi":"10.1055/a-2608-0889","DOIUrl":"10.1055/a-2608-0889","url":null,"abstract":"<p><p>In a survey conducted within the Children's Hospital Neonatal Consortium (CHNC), the Kidney Focus Group aimed to describe the resource and practice variations among participating level IV neonatal intensive care units.A 24-question survey was developed by neonatologists and pediatric nephrologists who belong to the Kidney Support Therapy (KST) subgroup of the CHNC Kidney Focus Group.The majority (89.5%) of responding centers offered some form of KST, with > 90% centers offered prenatal consultations. The most common KST modality offered were peritoneal dialysis (PD) and continuous renal replacement therapy (CRRT) while on ECMO. Prismaflex was the most common device used for stand-alone CRRT. The most common indication for KST initiation was fluid overload and body weight was indicated as the most common limiting factor with the majority of centers reporting weight limitation ≤ 1.5-2 kg.Advances in technology have made it possible to offer KST to a wider neonatal population than before. However, the availability of such technologies can vary significantly among institutions in addition to diversity of clinical experience and standardized protocols. This survey provides valuable insights into current KST practices across 19 level IV NICUs within the CHNC demonstrating expected practice variations amongst centers that may be dependent on location, center resources, and subspecialty providers, among others. · Considerable practice variation exists in KST among NICUs.. · Majority of NICUs utilize multi-disciplinary involvement, but subspecialties vary widely.. · The most common indication for KST initiation was fluid overload..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Hemorrhage Morbidity in Deliveries Complicated by Elevated Body Mass Index.","authors":"Hailie Ciomperlik, Rachel L Wiley, Ipsita Ghose, Anna Whelan, Hector Mendez-Figueroa, Suneet P Chauhan","doi":"10.1055/a-2600-7069","DOIUrl":"10.1055/a-2600-7069","url":null,"abstract":"<p><p>The relationship between body mass index (BMI) ≥ 30 in pregnancy and postpartum hemorrhage (PPH) has been unclear. While some risk stratification protocols classify elevated BMI as a moderate risk factor others do not. This study aimed to examine the effect of elevated BMI on PPH in a contemporary population.This retrospective cohort study included all singletons ≥14 weeks with recorded BMI who delivered at a Level IV center for two consecutive years. The exposure group was sub-categorized into BMI of 30 to 39.9 and BMI ≥ 40 kg/m², with a planned subgroup by mode of delivery. Data was collected by clinicians, and the composite maternal hemorrhagic outcome (CMHO) was defined as: blood loss ≥ 1,000 mL, interventions for atony including use of uterotonics (excluding prophylactic oxytocin), mechanical tamponade, surgical intervention, venous thromboembolism, admission to the intensive care unit, hysterectomy, or maternal death. Adjusted relative risks (aRR) with 95% confidence intervals (CI) were calculated using multivariate Poisson regression with robust error variance.Of 8,623 deliveries in the study period, 8,340 (96.7%) met inclusion criteria, with 2,943 (35%) with BMI < 30.0, 3,900 (46%) with BMI of 30 to 39.9 kg/m², and 1,497 (17%) with BMI of ≥40 kg/m². CHMO was increased for BMI of 30 to 39.9 (aRR: 1.16; 95% CI: 1.04-1.29) and ≥40.0 (aRR: 1.19; 95% CI: 1.04-1.36), largely due to increased risk of blood loss ≥ 1,000 and uterotonic use. A subgroup analysis by mode of delivery noted that increased risk for CHMO was only present in BMI ≥ 40 for vaginal deliveries (aRR: 1.35; 95% CI: 1.10-1.65) and only for BMI of 30 to 39.9 in cesarean delivery (aRR: 1.28; 95% CI: 1.10-1.50).Parturients with BMI ≥ 30 had a higher risk of hemorrhage-related morbidity compared with patients with BMI < 30, however, clinical management and impact need further investigation. · Patients with an elevated BMI had a higher risk of hemorrhage-related morbidity.. · Individuals with BMI ≥ 40 kg/m2 are at increased risk of hemorrhage with vaginal deliveries.. · With rising BMI rates, research on perinatal risks and targeted interventions is crucial for better..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952314","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":"Surgical Bundle to Reduce Infectious Morbidity after Cesarean Delivery in Individuals with Morbid Obesity.","authors":"Martina Benuzzi, Misa Hayasaka, Alyssa Savelli, George Saade, Emily Peters, Tetsuya Kawakita","doi":"10.1055/a-2620-7831","DOIUrl":"10.1055/a-2620-7831","url":null,"abstract":"<p><p>This study aimed to evaluate whether the implementation of a surgical bundle reduces surgical site infections (SSI), hospital readmission rates, and emergency department (ED) visits within 6 weeks in individuals with a body mass index (BMI) of 40 kg/m² or greater after cesarean delivery.This was a retrospective study including individuals with morbid obesity undergoing cesarean delivery at 23 weeks of gestation or greater. The preintervention period spanned from January 2017 to December 2020. The postintervention period extended from January 2021 to April 2023. The surgical bundle included standard preprocedure prophylactic antibiotics and a 48-hour course of oral cephalexin and metronidazole. The primary outcome was SSIs while secondary outcomes included hospital readmission or ED visits within 6 weeks postpartum or wound complications (dehiscence, seroma, or hematoma). Adjusted relative risks (aRR) with 95% confidence intervals (95% CI) were calculated using modified Poisson regression, adjusting for potential confounders.Of 2,105 pregnancies, 1,308 (62.1%) underwent cesarean in the preintervention period and 797 (37.9%) in the postintervention period. Compared to the preintervention period, the postintervention period had increased use of azithromycin (30.6 vs. 35.9%; <i>p</i> = 0.012), cephalexin (1.8 vs. 52.8%; <i>p</i> < 0.001), and metronidazole (3.1 vs. 60.4%; <i>p</i> < 0.001). However, compared to the preintervention period, the postintervention period had a similar risk of SSIs (6.6 vs. 5.9%; aRR: 0.92; 95% CI: 0.66-1.28), readmission or ED visits (19.8 vs. 19.8%; aRR: 0.94; 95% CI: 0.80-1.11), and wound complications (4.7 vs. 6.4%; aRR: 1.37; 95% CI: 0.96-1.96). In individuals with labor or ruptured membranes, the postintervention period had increased use of azithromycin (74.9 vs. 82.3%; <i>p</i> = 0.022), cephalexin (2.5 vs. 56.1%; <i>p</i> < 0.001), and metronidazole (4.3 vs. 63.8%; <i>p</i> < 0.001). In this subgroup, outcomes remained insignificant.A morbid obesity surgical bundle increased antibiotic use but did not reduce SSIs, hospital readmission, ED department visits, and wound complications. · A surgical bundle for individuals with morbid obesity increased the use of postoperative antibiotics.. · The surgical bundle did not significantly reduce SSIs.. · The surgical bundle did not significantly reduce hospital readmissions and ED visits..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Different Risk Assessment Models for Predicting Postdischarge Phototherapy Requirement in Term and Late Preterm Neonates.","authors":"Selma Aktas, Enes Dursun, Irem Yasa, Bala Ascıoglu","doi":"10.1055/a-2616-4116","DOIUrl":"10.1055/a-2616-4116","url":null,"abstract":"<p><p>This study was conducted to compare the Bhutani nomogram and the difference between the total serum bilirubin measurement at discharge and the AAP phototherapy threshold at the time of measurement (Δ-TSB) for predicting the postdischarge bilirubin level that will exceed the phototherapy threshold.Healthy neonates born at ≥35 weeks of gestation, followed in the newborn nursery, who did not receive phototherapy during hospital stay after birth, and who followed up in the outpatient clinic at least for 1 month from 2019 to 2024 were included in the study. Four logistic models were compared (D-TSB-plus,which encompassed additional variables such as gestational age, delivery type, and blood incompatibility, and DAT positivity, the Bhutani risk zones, and Bhutani-plus which encompassed additional variables such as gestational age, delivery type, and blood incompatibility) to predict postdischarge phototherapy requirement.Of the 2,040 neonates included in the study, 208 were readmitted for phototherapy treatment after discharge. ABO and/or Rh incompatibility, Bhutani risk zone, lower gestational age, and being born vaginally increased the need for phototherapy. Δ-TSB was the strongest predictor of postdischarge phototherapy requirement (<i>p</i> < 10^-50). Among the logistic models, the Δ-TSB-plus model had the highest predictive power (AUC: 0.83), followed by Δ-TSB alone (AUC: 0.82), Bhutani-plus (AUC: 0.80) and Bhutani alone (AUC: 0.74) models, respectively.Δ-TSB models had higher predictive ability regarding postdischarge phototherapy requirement compared with Bhutani models. Combining Bhutani risk zones with risk factors, especially with gestational age, increased the discrimination but did not reach the success of Δ-TSB models. · It is important to predict neonates likely to develop jaundice to start treatment in a timely manner.. · Combining bilirubin measurement with hemolysis findings and clinical parameters improves the prediction of postdischarge phototherapy.. · Δ-TSB model appears to be the strongest model for the prediction of postdischarge phototherapy requirement..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109293","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":"Comment on \"Head Ultrasound Findings in Infants with Birth Weight >1,500 g and Gestational Age >32 Weeks Exposed to Prenatal Opioids\".","authors":"Shubham Kumar, Rachana Mehta, Ranjana Sah","doi":"10.1055/a-2616-4091","DOIUrl":"10.1055/a-2616-4091","url":null,"abstract":"","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109310","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":"Evaluation of Cesarean Delivery Risk by Physician Sex.","authors":"Yuki Joyama, Misa Hayasaka, Lindsay Robbins, George Saade, Tetsuya Kawakita","doi":"10.1055/a-2615-5055","DOIUrl":"10.1055/a-2615-5055","url":null,"abstract":"<p><p>This study aimed to examine the association between physician sex, cesarean delivery, and neonatal complications.We analyzed the Consortium on Safe Labor database including 228,437 deliveries from 2002 to 2008. The study focused on singleton pregnancies with cephalic presentations, excluding cases with contraindications to vaginal delivery, elective cesarean deliveries, and nonobstetricians and gynecologists or maternal-fetal medicine physician management. The primary outcome of this study was cesarean delivery; secondary outcomes were cesarean delivery due to arrest of dilation or descent, cesarean delivery for nonreassuring fetal heart tracings (NRFHT), cesarean delivery for other indications, and a composite of neonatal complications. To estimate average marginal effects (AMEs) in percentage points (pp) with 95% confidence intervals (95% CI) of cesarean delivery between male and female physicians, we performed generalized estimating equations with Poisson distribution and exchange-correlation structure, adjusting for maternal, physician-level characteristics, and hospital-fixed effects.Of 108,004 individuals, 46,779 (43.3%) were attended by 183 female physicians, and 61,225 (56.7%) were attended by 250 male physicians. Female physicians were associated with a lower overall adjusted cesarean delivery proportion (11.93 vs. 13.47%; AME -1.54 pp [95% CI: -2.35, -0.73]), cesarean delivery for failure to progress (5.72 vs. 6.48%; AME -0.76 pp [95% CI: -1.24, -0.27]), and cesarean delivery for indications except for failure to progress or NRFHT (1.68 vs. 2.01%; AME -0.33 pp [95% CI: -0.56, -0.10]). There were no significant differences in cesarean outcomes for NRFHT or composite neonatal complications between male and female physicians.Compared with male physicians, female physicians had a lower rate of cesarean delivery. Further research is needed to understand the underlying mechanisms and develop targeted interventions. · Compared with male physicians, female physicians had a lower rate of cesarean delivery.. · This reduction was particularly evident for cesarean deliveries due to failure to progress.. · The reduction was not associated with an increased risk of neonatal complications..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101179","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}