Obstetrics and gynecology最新文献

The objectives of our study were to estimate trends in severe early pregnancy morbidity in pregnant individuals at less than 24 weeks of gestation at a referral center in an abortion-restricted environment and to assess differences after the Dobbs v. Jackson Women's Health Organization decision. We measured severe early pregnancy morbidity from January 2017 to December 2023 using billing codes, transfusion records, and intensive care transfers. We verified events and assessed preventability using chart review. We performed an interrupted time series analysis evaluating whether the level or slope of the severe early pregnancy morbidity rate varied with the Dobbs decision. We identified 407 severe early pregnancy morbidity events among 46,181 pregnancies. We noted no significant changes in the rate of total severe early pregnancy morbidity before and after the Dobbs decision, but we did note a significant level increase of 19 events per 100 total events (95% CI, 8.9-29.8) in the rate of preventable severe early pregnancy morbidity.

Objective: To describe demographic and clinical characteristics, preventability, Maternal Mortality Review Committee (MMRC)-determined contributing factors, and example recommendations for pregnancy-related deaths due to infection using data from MMRCs.

Methods: We used pregnancy-related death data from MMRCs in 29 states occurring during 2017-2019 with MMRC-determined underlying cause of death of infection. We describe the distribution of demographic and clinical characteristics, present the most frequent contributing factor classes, and provide example MMRC prevention recommendations.

Results: Ninety-one pregnancy-related infection deaths were identified, and MMRCs determined that 86.4% of deaths were preventable among 88 deaths for which MMRCs determined preventability. Most deaths occurred within 42 days of delivery (69.3%). Additional clinical information was available for many deaths. Group A streptococci were the most frequently identified pathogen (34.0%, 18/53) and genital tract was the most frequently identified source (47.9%, 35/73) of the infection. The most frequent health care encounter before death was hospitalization (50.7%, 36/71). More than half of decedents (69.1%, 47/68) had a health care encounter less than 7 days before death. The five most frequent contributing factor classes were clinical skill/quality of care (18.6%), delay (10.1%), knowledge (10.1%), lack of continuity of care (9.6%), and lack of access/financial resources (7.8%). The MMRC prevention recommendations occur at multiple levels, addressing frequent contributing factor classes.

Conclusion: Most pregnancy-related deaths due to infection are preventable. Example MMRC recommendations highlight prevention opportunities, including improving patient and clinician knowledge regarding clinical signs and symptoms of serious infections, implementing obstetric sepsis protocols, and enhancing care coordination within and across systems.

Objective: To evaluate the association between psychostimulant continuation, compared with discontinuation, and postpartum mental health outcomes in pregnant people with attention-deficit/hyperactivity disorder (ADHD) who had consistent psychostimulant prescriptions before pregnancy.

Methods: This was a retrospective cohort study that used the Merative MarketScan Commercial Claims Database (2011-2021). Included individuals were aged 13-50 years with singleton pregnancies, had delivered at or after 20 weeks of gestation, and had an ADHD diagnosis and psychostimulant adherence. Psychostimulant use during pregnancy was classified as no refills, the proportion of days covered below 80%, or the proportion of days covered at or above 80%. The primary outcomes were mental health events that occurred within 1 year postpartum, such as emergency department or inpatient mental health-related admissions, and new diagnoses of mood or anxiety disorders. Adjusted event rate ratios were estimated using Poisson regression, controlling for maternal age, gestational age at delivery, maternal comorbidities, and preexisting mental health diagnoses.

Results: Among 3,676 eligible patients, 1,521 (41.4%) had no psychostimulant prescriptions during pregnancy (discontinued), 1,899 (51.7%) had a proportion of days covered below 80%, and 256 (7.0%) maintained a proportion of days covered at or above 80%. Overall, 3.3% (95% CI, 2.7-4.0%) experienced postpartum mental health-related admissions and 16.2% (95% CI, 14.6-18.0%) received new postpartum mood or anxiety disorder diagnoses. Although unadjusted analyses suggested a higher incidence of postpartum mood or anxiety disorders among patients continuing psychostimulants than those who discontinued (19.3% vs 12.8%; rate ratio 1.46, 95% CI, 1.17-1.83), this association was no longer observed after controlling for confounders. In adjusted analyses, continuation of psychostimulants during pregnancy was not associated with differences in postpartum mental health-related admissions (rate ratio 1.01, 95% CI, 0.59-1.71) or new mood or anxiety disorder diagnoses (rate ratio 1.30, 95% CI, 0.97-1.74). Preexisting mental health diagnoses (rate ratio 2.60, 95% CI, 1.76-3.90) and medical comorbidities (rate ratio 1.98, 95% CI, 1.33-2.93) were the strongest predictors of postpartum admissions.

Conclusion: Among individuals with ADHD adherent to psychostimulants before pregnancy, the continuation of medication during pregnancy was not associated with adverse postpartum mental health outcomes when compared with discontinuation of medication.

Objective: To evaluate the diagnostic performance of an artificial intelligence (AI) system for detecting eight abnormal fetal ultrasound findings across cephalic, thoracic, and abdominal regions in routine, unfiltered, multicenter images.

Methods: We performed a multicenter, retrospective evaluation of an AI software that detects eight abnormal ultrasound findings on still images. Ground truth was established by a multidisciplinary panel (board-certified reviewers with 5 or more years of experience) using a three-step process (view identification, structure visibility, sign presence or absence) with majority consensus. The software evaluated eight findings on six standard views: absence of the cavum septum pellucidum, absence of the corpus callosum, malposition of the great vessels, absence or unusual size of one of the three vessels, disequilibrium or absence of at least one of the two ventricles, thoracic situs inversus, abdominal situs inversus, and nonvisibility of a single stomach bubble or abnormally big stomach. For thoracic and abdominal situs, an evaluability step preceded classification. Primary end points were sensitivity and specificity per finding on evaluable images, with subgroup analyses by geography, device manufacturer, trimester, body mass index (BMI), demographics, anatomy, indication, and finding status. Cluster bootstrap accounted for within-patient clustering; multiplicity was controlled with Bonferroni or Hochberg correction.

Results: We analyzed 6,452 images from 1,115 examinations (11-41 weeks of gestation) from approximately 1,000 pregnancies in 942 patients across 75 international sites over five countries; 6,094 images contributed to performance estimates. Mean sensitivity for AI detection was 93.2% (95% CI, 91.6-94.6%) and mean specificity was 90.8% (95% CI, 89.5-92.0%) across the eight findings. Sensitivity was superior to 87% and specificity was superior to 81% for all findings. Abdominal situs inversus had the highest performance (sensitivity 99.3%, 95% CI, 97.6-100%; specificity 99.3%, 95% CI, 98.4-100%). Among thoracic findings, sensitivity was lowest for malposition of the great vessels (87.7%), and specificity was lowest for absence or unusual size of at least one of the three vessels (81.5%). Subgroup performance was generally consistent across manufacturers, regions, BMI categories, and trimesters.

Conclusion: In a heterogeneous, multicenter dataset, the software reliably identified predefined ultrasound findings suggestive of congenital malformations. These results support its potential as a real-time assistant to standardize interpretation and to flag suspicious findings.

Measles is a highly contagious infectious disease caused by the measles virus. Recent declines in population-level immunity and outbreaks linked to imported cases have led to the highest U.S. incidence of measles since its elimination in 2000. Measles infection during pregnancy is associated with increased risk of pneumonia, need for respiratory support and mortality, prematurity, and stillbirth. Although perinatal transmission is rare, congenital measles is linked to higher infant mortality. No licensed antiviral therapies or curative treatments exist, making prevention critical. Measles-containing vaccines are safe and 97% effective in preventing infection when two doses are administered. Measles vaccination is contraindicated during pregnancy; obstetricians and gynecologists should strongly recommend vaccination to all nonpregnant susceptible patients.

Objective: To assess the safety of the respiratory syncytial virus prefusion F protein (RSVpreF) vaccine in pregnant women during the 2024-2025 French immunization campaign, with a particular focus on the risk of preterm birth.

Methods: Using the national health care database, which covers almost 99% of the population in France, we included all women who gave birth after 22 weeks of gestation between September 16 and December 31, 2024. Women vaccinated with RSVpreF were matched 1:1 with unvaccinated women on the basis of gestational age at vaccination, maternal age at pregnancy onset, region of residence, week of conception, history of preterm birth, influenza vaccination during the same pregnancy, and multiple pregnancy. Outcomes included preterm birth, delivery within 1 and 3 weeks after vaccination, stillbirth, small-for-gestational-age (SGA) birth weight, cesarean delivery, hemorrhage, preeclampsia, and major cardiovascular events, including maternal death. Time-to-event analyses were conducted with Poisson regression models with robust variance to estimate weighted incidence rate ratios (IRRs) and their 95% CIs for each outcome.

Results: Among the 29,032 women vaccinated during the study period, 24,891 (85.7%) were successfully matched to 24,891 unvaccinated women in a control group. In the matched cohort, the mean±SD maternal age was 30.9±5.0 years, 3.2% had a history of preterm birth, 0.6% had multiple pregnancies, and 21.8% had received influenza vaccination. No significant increase in the risk of the following outcomes was observed: preterm birth (weighted IRR 0.97, 95% CI, 0.89-1.06), delivery within 1 week (weighted IRR 0.81, 95% CI, 0.72-0.90) or within 3 weeks (weighted IRR 0.97, 95% CI, 0.93-1.00), stillbirth (weighted IRR 0.77, 95% CI, 0.45-1.32), cesarean delivery (weighted IRR 1.00, 95% CI, 0.96-1.03), SGA birth weight (weighted IRR 1.01, 95% CI, 0.96-1.07), postpartum hemorrhage (weighted IRR 1.03, 95% CI, 0.97-1.10), preeclampsia (weighted IRR 1.02, 95% CI, 0.85-1.22), or major adverse cardiovascular event (weighted IRR 0.60, 95% CI, 0.26-1.40) outcomes. Among women vaccinated at or before 32 weeks of gestation, no significant increase in the risk of preterm birth was observed (weighted IRR 1.13, 95% CI, 0.98-1.31).

Conclusion: This large observational study found no major safety concerns associated with RSVpreF vaccination during pregnancy. Further research, including international comparisons and evaluations of effectiveness relative to monoclonal antibodies against RSV, will be needed to fully characterize the benefit-risk balance of RSVpreF. Ongoing surveillance remains essential, particularly to monitor rare adverse events.