American journal of perinatology最新文献

{"title":"Mortality Trends in Preterm Infants with Birth Weight Less Than 500 Grams in the United States.","authors":"Patrycja Tesmer, Fredrick Dapaah-Siakwan","doi":"10.1055/a-2593-0505","DOIUrl":"https://doi.org/10.1055/a-2593-0505","url":null,"abstract":"<p><p>This study aimed to determine the temporal trends and racial differences in the infant mortality rate (IMR) in preterm infants with birth weight <500 g in the United States from 2005 through 2022.This was a retrospective cross-sectional study of data from the CDC's Wide-ranging Online Data for Epidemiologic Research. Infants with gestational age (GA) 22 to 28 weeks, with birth weight of <500 g, and deaths up to 1 year of age were included. IMR was calculated as deaths per 1,000 live births for each GA and year, and further stratified by maternal race. We evaluated trends with Joinpoint regression and IMR trends were reported using average annual percentage change (AAPC) with 95% confidence intervals (CI). The fetuses-at-risk approach was used to examine racial/ethnic differences in IMR.During the study period, 39,511 out of 50,855 infants born at 22 to 28 weeks GA with birth weight <500 g died within the first year (overall IMR 776.93 per 1,000). The IMR was inversely related to gestational age. The overall IMR decreased significantly from 817.48 to 714.51 (AAPC of -0.8%; CI, -1.0, -0.6) and in all the three racial/ethnic groups. As per the fetuses-at-risk approach, non-Hispanic Black (NHB) infants had the highest IMR of 1.33 per 1,000 fetuses-at-risk compared with 0.39 for non-Hispanic White (NHW) and 0.46 for Hispanic infants (<i>p</i> < 0.01).The IMR in extremely preterm infants weighing <500 g at birth decreased significantly, overall, and in all racial/ethnic groups. However, significant racial/ethnic differences persist. · Infant mortality rate decreased significantly in preterm infants with birth weight <500 g.. · The IMR decreased significantly in the three racial/ethnic groups studied.. · The IMR was significantly higher in non-Hispanic Black infants..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957249","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":"Assessing Racial/Ethnic Variation and Trends in Vaginal Birth after Cesarean in California: A Retrospective Cohort Study Using Linked Birth Certificate and Hospital Discharge Records.","authors":"Nicholas Rubashkin, E Nicole Teal, Rebecca J Baer, Saraswathi Vedam, Miriam Kuppermann, Grace Lanouette, Laura L Jelliffe-Pawlowski, Melissa G Rosenstein","doi":"10.1055/a-2593-0555","DOIUrl":"https://doi.org/10.1055/a-2593-0555","url":null,"abstract":"<p><p>Increasing the vaginal birth after cesarean (VBAC) rate to 18% was a Healthy People 2020 goal. Detailed data on racial/ethnic differences in VBAC rates is lacking and can inform efforts to equitably increase VBAC rates. This study aimed to assess racial/ethnic variation in VBAC rates and to describe group trends in VBAC rates in California between 2011 and 2021.This retrospective cohort study used a database of birth certificates linked to hospital discharge records. We analyzed singleton, term live births among people who had a history of at least one prior cesarean birth, no identified contraindications to a vaginal birth, and self-identified their racial/ethnic group as Hispanic or non-Hispanic (American Indian-Alaskan Native (AIAN), Asian, Black, Hawaiian/Pacific Islander, or white). VBAC births were identified from birth certificate records. Differences between VBAC rates were assessed using univariable and multivariable Poisson log-linear regression while adjusting for potential confounders.A total of 607,808 birthing people were included (2,234 AIAN, 84,899 Asian, 34,217 Black, 2,559 Hawaiian/Pacific Islander, 334,116 Hispanic, 149,783 white). Over the study period, Hawaiian/Pacific Islander birthing people had the highest average VBAC rate at 11.5% (AIAN, 6.5%; Asian, 8.8%; Black, 8.0%; Hispanic, 7.4%; white, 9.5%). In adjusted models, Black (aRR = 1.06, 95% CI: 1.01-1.11) and Hawaiian/Pacific Islander (aRR = 1.43, 95% CI: 1.27-1.61) birthing people were more likely to have a VBAC compared with white birthing people, while Hispanic birthing people were less likely (aRR = 0.96, 95% CI: 0.93-0.98). VBAC rates increased significantly (<i>p</i> < 0.001) over time for all groups except AIAN birthing people.VBAC rates increased for most racial/ethnic groups in California. With the exception of the Hawaiian/Pacific Islander group, there were small and likely not clinically significant differences in the chances for a VBAC across groups. No group in California met the Healthy People 2020 goal VBAC rate of 18%. · VBAC rates increased for most racial/ethnic groups.. · The VBAC rate for AIAN birthing people did not increase.. · No group met the Healthy People 2020 goal VBAC rate of 18%..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953205","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":"National Survey of Neonatal-Perinatal Medicine Fellows on Postresuscitation Debriefing.","authors":"Lily Guo, Nicole K Sather, Nadia Khan, Lauren E Zinns, Vinod Havalad, Gillian Brennan","doi":"10.1055/a-2591-8200","DOIUrl":"https://doi.org/10.1055/a-2591-8200","url":null,"abstract":"<p><p>Debriefing can be a powerful tool to facilitate improvement of performance after a resuscitation event. This study characterizes the debriefing experience of neonatal-perinatal medicine (NPM) fellows in the neonatal intensive care unit (NICU), operating room, and delivery room in the United States.An anonymous 13-item electronic survey was distributed to NPM program directors across the United States, who were asked to forward it to their respective NPM fellows. The survey addressed the frequency and timing of debriefings, access to formal training, and comfort levels with debriefing.Ninety-five responses were collected, with all participants having taken part in at least one medical resuscitation. Debriefings occurred approximately 25% of the time following a resuscitation, typically within 6 hours. Twenty percent of respondents reported feeling somewhat or very uncomfortable leading a debriefing, while 84% believed debriefings improve team performance. Despite 72% reporting no formal debriefing training, 94% expressed interest in receiving such training.This national survey on NPM fellows highlights inconsistent debriefing practices despite recognized benefits. Limited formal training remains a barrier, but a strong interest in further education presents an opportunity to improve training through the incorporation of structured debriefing frameworks into fellowship curricula. · Although NPM fellows often debrief resuscitations, 72% reported no formal training.. · Formal debriefing training can improve debriefing quality and enhance patient outcomes.. · NPM programs should implement structured debriefing to better prepare their fellows..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959564","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":"Neonatal Outreach Training: Identifying Needs in the Community.","authors":"Michael Andrew Assaad, Yasmine Khouzam","doi":"10.1055/a-2586-3520","DOIUrl":"https://doi.org/10.1055/a-2586-3520","url":null,"abstract":"<p><p>This study aimed to identify the neonatal training needs of levels I and II community health centers (CHCs).We conducted a mixed-methods study involving a questionnaire, focus groups (FG), and an audit of neonatal transport data. The questionnaire assessed the felt needs of CHC staff, FGs identified normative needs with an expert neonatal transport team, and the audit captured expressed needs using data from the Canadian neonatal transport network.A total of 158 respondents from 12 CHCs completed the questionnaire (98% completeness rate). Key findings indicated significant challenges in human resources, procedural training, management of critical situations including neonatal resuscitation, nutrition, and neurodevelopmental care (NDC), and crisis resource management. Simulation emerged as the preferred training modality. FGs (three sessions, 17 participants) emphasized the importance of regular, multidisciplinary simulation-based training and stress management. The audit (947 means of transport, 2017-2020) revealed frequent respiratory, neurological, and surgical diagnoses, reinforcing the need for advanced training in respiratory support, neonatal resuscitation, and select high-acuity-specific pathologies.Targeted outreach education is essential to address the identified training needs in neonatal care at CHCs. Key components should include simulation-based training, comprehensive procedural modules, and specialized modules on extreme prematurity, pneumothorax, hypoxic-ischemic encephalopathy/seizures, and surgical conditions. Enhanced training in nutrition and NDC is also critical for community health practitioners. · CHC lack neonatal care training.. · In situ simulation training is the preferred modality of CHC.. · Key training gaps include resuscitation and ventilation.. · Crisis resource management and stress management are key team training components.. · Training must cover prematurity, respiratory, neurological, and surgical conditions..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956235","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":"Neonatal and Maternal Outcomes following Shoulder Dystocia Resolution Utilizing ≥ versus < 3 Maneuvers.","authors":"Fabrizio Zullo, Teresa C Logue, Daniele Di Mascio, Giuseppe Rizzo, Antonella Giancotti, Matthew K Hoffman, Hector Mendez Figueroa, Anthony C Sciscione, Suneet P Chauhan","doi":"10.1055/a-2589-3709","DOIUrl":"https://doi.org/10.1055/a-2589-3709","url":null,"abstract":"<p><p>Most shoulder dystocia (SD) cases do not have associated adverse outcomes. The objective was to assess whether SD relieved with ≥3 maneuvers, compared with fewer, is associated with a higher likelihood of adverse outcomes. The secondary objective was to examine if postpartum hemorrhage is associated with SD managed with ≥3 maneuvers versus fewer.This was a secondary analysis of the assessment of perinatal excellence (APEX) study, an observational cohort of over 115,000 deliveries in 25 U.S. hospitals from 2008 to 2011. We included individuals with singleton, vertex, and nonanomalous fetuses at ≥34 weeks who had SD requiring at least one maneuver. We stratified participants according to if ≥3 maneuvers, versus fewer, were utilized to resolve the SD. The primary outcome was the incidence of a neonatal composite adverse outcome including APGAR <5 at 5 minutes, fetal fractures, intracranial hemorrhage, brachial plexus palsy, facial nerve palsy, hypotension treated, hypoxic-ischemic encephalopathy, or neonatal death. Using modified-Poisson-regression, we calculated adjusted incidence relative risk (aIRR) with 95% confidence intervals (CI).The rate of SD in APEX was 1.9% (2,138/118,422). Of 2,138 cases of SD, 96% met the inclusion criteria. ≥3 maneuvers were utilized in 18.9% (391/2,062) of SD cases. The composite neonatal adverse outcome occurred in 8.1% (168/2,062) of cases, and in adjusted models, the risk for the composite outcome was significantly higher with SD requiring ≥3 maneuvers (15.1%) versus <3 maneuvers (6.5%; aIRR: 2.08; 95% CI: 1.50-2.89). Additionally, APGAR <5 at 5 minutes (aIRR: 4.10; 95% CI: 1.18-14.25), neonatal brachial plexus palsy (aIRR: 2.58; 95% CI: 1.45-4.60), and hypoxic-ischemic encephalopathy (aIRR: 2.83; 95% CI: 1.36 and 5.89) were significantly more likely when ≥3 were used. No significant difference was noted for postpartum hemorrhage (PPH) by number of maneuvers (aIRR: 0.74; 95% CI: 0.44 and 1.21).SD relieved by ≥3 maneuvers, compared with <3, was associated with a 2-fold-increased risk for the composite neonatal adverse outcome, with no difference in risk for PPH. · ≥3 Maneuvers increase neonatal adverse outcomes.. · With ≥3 maneuvers, higher risk of low APGAR and HIE.. · PPH rates similar for ≥3 versus <3 maneuvers..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship between Hip Ultrasound Result and the Diagnosis of Developmental Dysplasia of the Hip in Premature Infants.","authors":"Ahmed Osman, Sara Conroy, Jonathan L Slaughter","doi":"10.1055/a-2592-0430","DOIUrl":"https://doi.org/10.1055/a-2592-0430","url":null,"abstract":"<p><p>The study objective was to evaluate the relationship between the first hip ultrasound (HUS) result and developmental dysplasia of the hip (DDH) diagnosis in preterm infants. Additionally, we report the types of treatment for preterm infants diagnosed with DDH.This is a retrospective chart review of infants born between January 1, 2009, and December 31, 2018, at <37 weeks of gestation who had HUS in the first year of life. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity for abnormal and normal HUS results were calculated.From 2,397 infants analyzed, 71 (3%) infants were diagnosed with DDH. The majority (<i>n</i> = 2,140; 89%) of patients had normal HUS, with only 5 (0.2%) infants later diagnosed with DDH. The sensitivity of HUS was 0.91 PPV 0.8, the specificity was 0.99 and NPV was 0.99. Of the 196 (8%) infants with equivocal results, 17 (9%) had subsequent DDH diagnoses.For infants diagnosed with DDH, the majority (<i>n</i> = 41; 58%) were treated nonoperatively with Pavlik harness. Surgical correction was performed in 26 (36%) patients.A normal first HUS result in preterm infants has an excellent NPV for the diagnosis of DDH. Abnormal first HUS has a good PPV. Those with an equivocal result may need close follow-up. · A normal HUS in preterm infants strongly rules out DDH.. · An abnormal HUS result in preterm infants has a good PPV for DDH.. · Most preterm infants with developmental DDH are managed nonsurgically..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953453","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":"Obstetrics and Gynecology Resident Comfort in Caring for Pregnant People with Physical Disabilities.","authors":"Susan Carlson, Audrey Aitelli, Sarah Dotters-Katz, Claire Kalpakjian","doi":"10.1055/a-2588-4900","DOIUrl":"https://doi.org/10.1055/a-2588-4900","url":null,"abstract":"<p><p>Pregnant people with disabilities face higher complication rates, yet few guidelines exist on caring for this population. This study evaluates obstetrics and gynecology (OBGYN) residents' comfort in caring for pregnant people with physical disabilities.A 19-question e-survey was developed and piloted for content and face validation. Likert scale was used to assess comfort in caring for pregnant patients with physical disabilities. The e-survey was sent to U.S. OBGYN residents via CREOG-coordinator listserv, a listserv to all U.S. OBGYN residency coordinators, in February 2024, with three reminder emails. Descriptive statistics were used to analyze the data, and variables with clinical and statistical significance were considered for adjustment in regression models.Eighty-eight residents completed the survey. The mean age was 29 years; 88% identified as female. All ACOG regions were represented. Eight and 44% reported formal education on disability care in residency and medical school, respectively. Seventy-three percent felt uncomfortable positioning disabled patients for a pelvic examination, 59% felt uncomfortable discussing sexual health practices, and 89% felt uncomfortable making recommendations regarding the mode of delivery. Those without education in residency were 91% less likely to be comfortable making recommendations regarding the mode of delivery (absolute risk reduction [aRR]: 0.09; 95% confidence interval [CI]: 0.01 and 0.59). Only 30% were comfortable discussing lactation/breastfeeding with patients with physical disabilities; residents without personal experience including caring for family members or friends or other caretaking experiences were 66% less likely to be comfortable (aRR: 0.34; 95% CI: 0.12 and 0.99). A total of 92.5% of residents wanted more education in this space. Of those 83, 71, and 82% desired didactics, patient panels, and simulations, respectively.Among responding residents, comfort in caring for pregnant people with physical disabilities is low. Additional training is necessary to adequately care for this population. · OBGYN resident comfort with disability care is low.. · Few residents receive formal disability training.. · Formal education improves disability care comfort..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960828","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":"External Validation of the Clinical Obstetric Comorbidity Index across a Diverse Health System.","authors":"Adina R Kern-Goldberger, Sindhu K Srinivas, Michael O Harhay, Lisa D Levine","doi":"10.1055/a-2572-1727","DOIUrl":"10.1055/a-2572-1727","url":null,"abstract":"<p><p>The clinically-modified obstetric comorbidity index (OB-CMI) is a comorbidity-based scoring system that has been validated to predict severe maternal morbidity (SMM) in a single tertiary, academic hospital using an internal SMM definition. We aimed to validate the OB-CMI for the prediction of SMM as defined by the CDC during delivery admissions across a diverse health system.This is a retrospective cohort study evaluating all deliveries in a large health system encompassing academic and community hospitals. Data from 2019 to 2021 were extracted from the electronic health record (EHR) and validated with chart review. An OB-CMI score was calculated for each patient using established diagnosis codes and EHR data. The primary outcome was nontransfusion SMM (defined by the CDC) during the delivery admission. Patient characteristics were evaluated by the hospital, and hospital-specific receiver-operator characteristic (ROC) curves were constructed and compared.In total, 42,130 deliveries were included with significant differences in all demographic, clinical, and obstetric characteristics across the hospitals including age, BMI, race/ethnicity, insurance type, preterm birth, and preeclampsia rates. Median OB-CMI score and rate of elevated OB-CMI score (≥6) were also significantly different. ROC curves for OB-CMI and SMM for each hospital are noted in the figure with an area under the curve range from 0.77 to 0.83, and no significant differences across hospitals (<i>p</i> = 0.32).In a large cohort of patients delivering across a diverse hospital system, the clinical OB-CMI score similarly predicted SMM despite differences in demographic and clinical characteristics among the hospitals. This validation of the OB-CMI supports the use of this scoring system in variegated clinical settings, which can inform widescale uptake and clinical integration of OB-CMI scoring to improve obstetric risk stratification. · The clinically-modified OB-CMI consistently predicted nontransfusion SMM across multiple hospitals.. · This OB-CMI can be used for obstetric risk stratification across different clinical settings.. · Future research should explore the impact of using the OB-CMI to mitigate risk in clinical practice..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771101","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":"Analysis of Hysterotomy Extension at Unscheduled Cesarean Delivery.","authors":"Jason G Bunn, Albert Tang, Kristen Warncke, Saron Gilazgi, Donald D Mcintire, David B Nelson, Catherine Y Spong, J Seth Hawkins","doi":"10.1055/a-2586-3568","DOIUrl":"https://doi.org/10.1055/a-2586-3568","url":null,"abstract":"<p><p>This study aimed to determine if the rate of hysterotomy extensions increases with increasing cervical dilation in unscheduled cesarean deliveries, and to develop a measure of the severity of hysterotomy extension for quantifying morbidity.This is a retrospective study of unscheduled cesarean deliveries relating to labor dystocia and/or nonreassuring tracings from January 1, 2021, to December 31, 2021. Severe extension was defined as bilateral or adjacent to a structure such as the uterine artery, broad ligament, or cervix, and was compared with uterine artery extensions alone.There were 990 unscheduled cesarean deliveries included. Extensions (<i>n</i> = 233) significantly increased with increasing cervical dilation (<i>p</i> < 0.0001), complicating more than 30 and 50% at 6 and 10 cm of cervical dilation, respectively. Apart from this trend, a logistic regression analysis indicated cervical dilation was an independent risk factor for extension. Transfusions of at least 2 units of blood were five times (26 vs. 5%) more likely for patients with severe extensions than no extension (<i>p</i> < 0.0001).Hysterotomy extensions significantly increase with increasing cervical dilation, and cervical dilation is an independent risk factor for extension. A composite measure of severity accounts for different types of extension when quantifying morbidity, but uterine artery extension is the primary driver of maternal morbidity in cases without hysterectomy. · We report higher than previously published rates of extension, in our study of unscheduled cesareans.. · Extension rates rise with cervical dilation-33% at 6 cm, over 50% at 10 cm.. · Cervical dilation is an independent risk factor for extension.. · Severe extensions were fivefold more likely to be transfused two units than no extension.. · The composite measure for severity was driven by uterine artery extensions..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957247","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":"Maternal Morbidity in Singleton versus Twin Gestations Undergoing Cesarean Delivery.","authors":"Mia Heiligenstein, Nathan Fox","doi":"10.1055/a-2565-9208","DOIUrl":"https://doi.org/10.1055/a-2565-9208","url":null,"abstract":"<p><p>As the prevalence of twin pregnancies rises, and because of the high cesarean rate in twin pregnancies, it is imperative to estimate the maternal morbidity in twin pregnancies undergoing cesarean delivery. This study aims to clarify whether twin gestations undergoing cesarean delivery are at increased risk for maternal morbidity compared with singleton pregnancies undergoing cesarean delivery.This study was a retrospective cohort study of all singleton and twin gestations who underwent cesarean delivery in a single maternal fetal medicine and obstetrical practice from 2005 to 2023. All patients who underwent a cesarean delivery with a liveborn were included with the exception of patients with a history of a prior myomectomy, known placenta previa, or known placenta accreta spectrum. An electronic medical record was used to obtain baseline characteristics and maternal outcomes. Our primary outcome was a composite outcome for maternal morbidity. We first compared all patients undergoing primary cesarean delivery and performed subgroup analyses of patients laboring prior to cesarean delivery, scheduled primary cesarean section without labor, and repeat cesarean section. Chi-squared test, Fisher exact test, and student's <i>t</i>-test were utilized for statistical analysis.Of the 2,872 women meeting inclusion criteria, 2,250 had singleton pregnancies while 622 had twin pregnancies. Baseline characteristics were largely similar between groups, except for higher body mass index and incidence of preeclampsia in twin gestations. In patients undergoing primary cesarean delivery, the composite outcome for maternal morbidity did not significantly differ between singleton and twin pregnancies (0.8 vs. 1.4%; <i>p</i> = 0.172). However, secondary outcomes revealed higher blood loss in twin pregnancies, evidenced by both elevated estimated blood loss (EBL) and increased rate of blood transfusion (4.7 vs. 1.8%; <i>p</i> < 0.001). These findings remained consistent across all subgroup analyses.We observed no differences in major maternal morbidities between patients undergoing cesarean delivery for singleton or twin gestations. However, we did find significant differences in EBL and transfusion requirements for women with twin gestations. · There are no differences in major maternal morbidities.. · This is between patients undergoing cesarean delivery for singleton versus twin gestations.. · This includes with the exception of higher EBL and transfusion requirements in twin gestations..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956208","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}