Postpartum hemorrhage (PPH) is an obstetrical emergency that occurs in 1% to 10% of all deliveries and contributes to nearly one-quarter of all maternal deaths worldwide. Tranexamic acid has been established as an adjunct in the treatment of PPH but its role in its prevention of PPH following vaginal delivery has not been widely studied.
OBJECTIVE
This study aimed to assess the effect of prophylactic tranexamic acid (1 g) along with active management of the third stage of labor in reducing postpartum blood loss and the incidence of postpartum hemorrhage after vaginal delivery.
STUDY DESIGN
In this randomized controlled trial, 650 women with singleton pregnancies at ≥34 weeks of gestation who were undergoing vaginal delivery were included. Eligible women were randomly assigned to receive either 1 g of tranexamic acid or placebo intravenously along with active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the third and fourth stages of labor.
RESULTS
Of 886 women approached for the study, 650 who met the inclusion criteria were enrolled, and 320 in group A and 321 in group B were analyzed. The maternal characteristics were similar between the groups. The mean blood loss did not differ significantly between the intervention and placebo groups (378.5±261.2 mL vs 383.0±258.9 mL; P=.93). The incidence of primary postpartum hemorrhage was comparable in both groups (15.9% in group A and 15.3% in group B; P=.814). The median quantitative decreases in hemoglobin levels within 12 to 24 hours after delivery were 0.60 g% (interquartile range, 0.40–0.90) in group A and 0.60 g% (interquartile range, 0.40–0.80) in group B, which were comparable in both groups (P=.95). The most common adverse effect reported was dizziness, and there was no thromboembolic event at 3 months follow-up in either group.
Conclusion
The use of tranexamic acid as a prophylactic measure along with active management of the third stage of labor does not provide additional benefit in reducing the postpartum blood loss and incidence of postpartum hemorrhage after vaginal delivery.
{"title":"Tranexamic acid in preventing postpartum blood loss in vaginal delivery: a double-blinded randomized controlled trial","authors":"Pratibha Arya MD, Garima Yadav MS, Pratibha Singh MD, Navdeep Kaur Ghuman MD, Charu Sharma MD, Meenakshi Gothwal MD, Priyanka Kathuria MD","doi":"10.1016/j.ajogmf.2024.101450","DOIUrl":"10.1016/j.ajogmf.2024.101450","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Postpartum hemorrhage (PPH) is an obstetrical emergency that occurs in 1% to 10% of all deliveries and contributes to nearly one-quarter of all maternal deaths worldwide. Tranexamic acid has been established as an adjunct in the treatment of PPH but its role in its prevention of PPH following vaginal delivery has not been widely studied.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess the effect of prophylactic tranexamic acid (1 g) along with active management of the third stage of labor in reducing postpartum blood loss and the incidence of postpartum hemorrhage after vaginal delivery.</p></div><div><h3>STUDY DESIGN</h3><p>In this randomized controlled trial, 650 women with singleton pregnancies at ≥34 weeks of gestation who were undergoing vaginal delivery were included. Eligible women were randomly assigned to receive either 1 g of tranexamic acid or placebo intravenously along with active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the third and fourth stages of labor.</p></div><div><h3>RESULTS</h3><p>Of 886 women approached for the study, 650 who met the inclusion criteria were enrolled, and 320 in group A and 321 in group B were analyzed. The maternal characteristics were similar between the groups. The mean blood loss did not differ significantly between the intervention and placebo groups (378.5±261.2 mL vs 383.0±258.9 mL; <em>P</em>=.93). The incidence of primary postpartum hemorrhage was comparable in both groups (15.9% in group A and 15.3% in group B; <em>P</em>=.814). The median quantitative decreases in hemoglobin levels within 12 to 24 hours after delivery were 0.60 g% (interquartile range, 0.40–0.90) in group A and 0.60 g% (interquartile range, 0.40–0.80) in group B, which were comparable in both groups (<em>P</em>=.95). The most common adverse effect reported was dizziness, and there was no thromboembolic event at 3 months follow-up in either group.</p></div><div><h3>Conclusion</h3><p>The use of tranexamic acid as a prophylactic measure along with active management of the third stage of labor does not provide additional benefit in reducing the postpartum blood loss and incidence of postpartum hemorrhage after vaginal delivery.</p></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 9","pages":"Article 101450"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>BACKGROUND</h3><p>Beyond 18 weeks of gestation, an increased size of the fetal lateral ventricles is reported in most fetuses with open spina bifida. In the first trimester of pregnancy, the definition of ventriculomegaly is based on the ratio of the size of the choroid plexus to the size of the ventricular space or the entire fetal head. However, contrary to what is observed from the midtrimester of pregnancy, in most fetuses with open spina bifida at 11 to 13 weeks of gestation, the amount of fluid in the ventricular system seems to be reduced rather than increased.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to compare the biometry of the lateral ventricles at 11 0/7 to 13 6/7 weeks of gestation between normal fetuses and those with confirmed open spina bifida.</p></div><div><h3>STUDY DESIGN</h3><p>This was a retrospective cohort study that included all cases of isolated open spina bifida detected at 11 0/7 to 13 6/7 weeks of gestation over a period of 5 years and a group of structurally normal fetuses attending at our center over a period of 1 year for the aneuploidy screening as controls. Transventricular axial views of the fetal brain obtained from cases and controls were extracted from the archive for post hoc measurement of cerebral ventricles. The choroid plexus–to–lateral ventricle length ratio, sum of the choroid plexus–to–lateral ventricle area ratio, choroid plexus area–to–fetal head area ratio, and mean choroid plexus length–to–occipitofrontal diameter ratio were calculated for both groups. The measurements obtained from the 2 groups were compared, and the association between each parameter and open spina bifida was investigated.</p></div><div><h3>RESULTS</h3><p>A total of 10 fetuses with open spina bifida were compared with 358 controls. Compared with controls, fetuses with open spina bifida showed a significantly smaller size of the cerebral ventricle measurements, as expressed by larger values of choroid plexus–to–lateral ventricle area ratio (0.49 vs 0.72, respectively; <em>P</em><.001), choroid plexus–to–lateral ventricle length ratio (0.70 vs 0.79, respectively; <em>P</em><.001), choroid plexus area–to–fetal head area ratio (0.28 vs 0.33, respectively; <em>P</em>=.006), and choroid plexus length–to–occipitofrontal diameter ratio (0.52 vs 0.60, respectively; <em>P</em><.001). The choroid plexus–to–lateral ventricle area ratio was found to be the most accurate predictor of open spina bifida, with an area under the curve of 0.88, a sensitivity of 90%, and a specificity of 82%.</p></div><div><h3>CONCLUSION</h3><p>At 11 0/7 to 13 6/7 weeks of gestation, open spina bifida is consistently associated with a reduced amount of fluid in the lateral cerebral ventricles of the fetus, as expressed by a significantly increased choroid plexus–to–lateral ventricle length ratio, choroid plexus–to–lateral ventricle area ratio, choroid plexus area–to–fetal head area ratio, and choroid plexus length–to–occipitofrontal dia
{"title":"First-trimester ultrasound of the cerebral lateral ventricles in fetuses with open spina bifida: a retrospective cohort study","authors":"Nicola Volpe MD, PhD , Alessandra Bovino MD , Elvira Di Pasquo MD , Enrico Corno MD , Michela Taverna MD , Beatrice Valentini MD , Andrea Dall'Asta MD, PhD , Robert Brawura-Biskupsi-Samaha MD , Tullio Ghi MD, PhD","doi":"10.1016/j.ajogmf.2024.101445","DOIUrl":"10.1016/j.ajogmf.2024.101445","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Beyond 18 weeks of gestation, an increased size of the fetal lateral ventricles is reported in most fetuses with open spina bifida. In the first trimester of pregnancy, the definition of ventriculomegaly is based on the ratio of the size of the choroid plexus to the size of the ventricular space or the entire fetal head. However, contrary to what is observed from the midtrimester of pregnancy, in most fetuses with open spina bifida at 11 to 13 weeks of gestation, the amount of fluid in the ventricular system seems to be reduced rather than increased.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to compare the biometry of the lateral ventricles at 11 0/7 to 13 6/7 weeks of gestation between normal fetuses and those with confirmed open spina bifida.</p></div><div><h3>STUDY DESIGN</h3><p>This was a retrospective cohort study that included all cases of isolated open spina bifida detected at 11 0/7 to 13 6/7 weeks of gestation over a period of 5 years and a group of structurally normal fetuses attending at our center over a period of 1 year for the aneuploidy screening as controls. Transventricular axial views of the fetal brain obtained from cases and controls were extracted from the archive for post hoc measurement of cerebral ventricles. The choroid plexus–to–lateral ventricle length ratio, sum of the choroid plexus–to–lateral ventricle area ratio, choroid plexus area–to–fetal head area ratio, and mean choroid plexus length–to–occipitofrontal diameter ratio were calculated for both groups. The measurements obtained from the 2 groups were compared, and the association between each parameter and open spina bifida was investigated.</p></div><div><h3>RESULTS</h3><p>A total of 10 fetuses with open spina bifida were compared with 358 controls. Compared with controls, fetuses with open spina bifida showed a significantly smaller size of the cerebral ventricle measurements, as expressed by larger values of choroid plexus–to–lateral ventricle area ratio (0.49 vs 0.72, respectively; <em>P</em><.001), choroid plexus–to–lateral ventricle length ratio (0.70 vs 0.79, respectively; <em>P</em><.001), choroid plexus area–to–fetal head area ratio (0.28 vs 0.33, respectively; <em>P</em>=.006), and choroid plexus length–to–occipitofrontal diameter ratio (0.52 vs 0.60, respectively; <em>P</em><.001). The choroid plexus–to–lateral ventricle area ratio was found to be the most accurate predictor of open spina bifida, with an area under the curve of 0.88, a sensitivity of 90%, and a specificity of 82%.</p></div><div><h3>CONCLUSION</h3><p>At 11 0/7 to 13 6/7 weeks of gestation, open spina bifida is consistently associated with a reduced amount of fluid in the lateral cerebral ventricles of the fetus, as expressed by a significantly increased choroid plexus–to–lateral ventricle length ratio, choroid plexus–to–lateral ventricle area ratio, choroid plexus area–to–fetal head area ratio, and choroid plexus length–to–occipitofrontal dia","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 9","pages":"Article 101445"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.ajogmf.2024.101423
<div><h3>BACKGROUND</h3><p>Seven days of antibiotics are recommended in the setting of preterm premature rupture of membranes to promote latency. Azithromycin has generally replaced a 7-day course of erythromycin in current clinical practice. Azithromycin clears from plasma quickly and concentrates in local tissue, which is why daily dosing is not always needed, and local tissue, rather than plasma, concentrations are used to determine dosing. On the basis of limited pharmacokinetic studies in pregnancy, a 1-time dose of 1 g azithromycin may not maintain local (amniotic fluid) drug concentrations above minimum inhibitory concentrations for common genitourinary pathogens (50–500 ng/mL).</p></div><div><h3>OBJECTIVE</h3><p>We aimed to compare the pharmacokinetics of 1-time vs daily dosing of azithromycin in the setting of preterm prelabor rupture of membranes.</p></div><div><h3>STUDY DESIGN</h3><p>This is a randomized clinical trial of singletons with preterm prelabor rupture of membranes randomized to 1 g oral azithromycin once or 500 mg oral azithromycin daily for 7 days. The primary outcome was amniotic fluid azithromycin concentrations over 8 days. Secondary outcomes included plasma azithromycin trough concentrations. Plasma was collected at 1–4 hours and 12–24 hours after the first dose and then every 24 hours through 8 days. Amniotic fluid was collected opportunistically throughout the day noninvasively with Always Flex foam pads. We aimed to enroll 20 participants to achieve n=5 still pregnant through 8 days in each group. Continuous variables were compared using the Mann-Whitney U test, and the relationship between azithromycin concentration and time was assessed using linear regression.</p></div><div><h3>RESULTS</h3><p>The study was halted after 6 enrolled because of lagging enrollment, with 3 in each group. The mean gestational age of enrollment was 27.1±1.7 weeks in the 1 g group and 31.0±1.4 weeks in the 500 mg daily group. One participant in each group had latency to delivery >7 days. Regarding amniotic fluid azithromycin concentration, there was a difference in change in amniotic fluid azithromycin concentration over time between groups (<em>P</em><.001). The amniotic fluid concentration of azithromycin was relatively stable in the 1 g once group (B,−0.07; 95% confidence interval, −0.44 to 0.31; <em>P</em>=.71), whereas amniotic fluid concentration (ng/mL) increased over time (hours) in the 500 mg daily group (B, 1.3; 95% confidence interval, 0.7–1.9; <em>P</em><.001). By ≥96 hours, median amniotic fluid levels of azithromycin were lower in the 1 g once group (median, 11; interquartile, 7–56) compared with 500 mg daily (median, 46; interquartile, 23–196), with a median difference of −27 (interquartile,−154 to −1; <em>P</em>=.03). In plasma, there was higher azithromycin concentration during the first 24 hours with 1 g once vs 500 mg daily (median difference, 637 ng/mL; 101–1547; <em>P</em>=.01); however, by ≥96 hours plasma az
{"title":"Azithromycin dosing and preterm premature rupture of membranes treatment (ADAPT): a randomized controlled Phase I trial","authors":"","doi":"10.1016/j.ajogmf.2024.101423","DOIUrl":"10.1016/j.ajogmf.2024.101423","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Seven days of antibiotics are recommended in the setting of preterm premature rupture of membranes to promote latency. Azithromycin has generally replaced a 7-day course of erythromycin in current clinical practice. Azithromycin clears from plasma quickly and concentrates in local tissue, which is why daily dosing is not always needed, and local tissue, rather than plasma, concentrations are used to determine dosing. On the basis of limited pharmacokinetic studies in pregnancy, a 1-time dose of 1 g azithromycin may not maintain local (amniotic fluid) drug concentrations above minimum inhibitory concentrations for common genitourinary pathogens (50–500 ng/mL).</p></div><div><h3>OBJECTIVE</h3><p>We aimed to compare the pharmacokinetics of 1-time vs daily dosing of azithromycin in the setting of preterm prelabor rupture of membranes.</p></div><div><h3>STUDY DESIGN</h3><p>This is a randomized clinical trial of singletons with preterm prelabor rupture of membranes randomized to 1 g oral azithromycin once or 500 mg oral azithromycin daily for 7 days. The primary outcome was amniotic fluid azithromycin concentrations over 8 days. Secondary outcomes included plasma azithromycin trough concentrations. Plasma was collected at 1–4 hours and 12–24 hours after the first dose and then every 24 hours through 8 days. Amniotic fluid was collected opportunistically throughout the day noninvasively with Always Flex foam pads. We aimed to enroll 20 participants to achieve n=5 still pregnant through 8 days in each group. Continuous variables were compared using the Mann-Whitney U test, and the relationship between azithromycin concentration and time was assessed using linear regression.</p></div><div><h3>RESULTS</h3><p>The study was halted after 6 enrolled because of lagging enrollment, with 3 in each group. The mean gestational age of enrollment was 27.1±1.7 weeks in the 1 g group and 31.0±1.4 weeks in the 500 mg daily group. One participant in each group had latency to delivery >7 days. Regarding amniotic fluid azithromycin concentration, there was a difference in change in amniotic fluid azithromycin concentration over time between groups (<em>P</em><.001). The amniotic fluid concentration of azithromycin was relatively stable in the 1 g once group (B,−0.07; 95% confidence interval, −0.44 to 0.31; <em>P</em>=.71), whereas amniotic fluid concentration (ng/mL) increased over time (hours) in the 500 mg daily group (B, 1.3; 95% confidence interval, 0.7–1.9; <em>P</em><.001). By ≥96 hours, median amniotic fluid levels of azithromycin were lower in the 1 g once group (median, 11; interquartile, 7–56) compared with 500 mg daily (median, 46; interquartile, 23–196), with a median difference of −27 (interquartile,−154 to −1; <em>P</em>=.03). In plasma, there was higher azithromycin concentration during the first 24 hours with 1 g once vs 500 mg daily (median difference, 637 ng/mL; 101–1547; <em>P</em>=.01); however, by ≥96 hours plasma az","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 9","pages":"Article 101423"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>The increase in the use of induction of labor is a worldwide phenomenon in the current management of labor and delivery in Western societies, with approximately one out of every 4 pregnancies undergoing this procedure This has led women to seek various methods for stimulation of the onset of labor. Some data suggest that the use of acupuncture for favoring spontaneous labor onset could reduce the number of inductions of labor procedures. However, good quality evidence in this respect is not yet available.</div></div><div><h3>Objective</h3><div>The aim of this study was to evaluate the effectiveness of acupuncture using a filiform needle to induce spontaneous onset of labor in women with a scheduled induction of labor date and assess the safety and satisfaction of women undergoing acupuncture.</div></div><div><h3>Study Design</h3><div>We conducted a multicenter, randomized, controlled, parallel-arm, unmasked trial in 3 hospitals in Spain. Eligible participants were women older than 18 years with a singleton pregnancy and a cephalic presentation, scheduled for induction of labor following center-specific protocols. Participants were randomly allocated to one of 2 groups: the intervention group, which underwent acupuncture sessions for a maximum of 4 days prior to the scheduled induction of labor, or the control group, which received no specific prelabor intervention. The primary study outcome was the proportion of women admitted because of spontaneous onset of labor or premature rupture of membranes before or the day of the scheduled induction of labor.</div></div><div><h3>Results</h3><div>Between November 2017 and June 2023, 212 women were recruited and included in the analysis (106 in the acupuncture group and 106 in the control group). There were no significant differences between the 2 groups in the baseline demographic characteristics. Regarding the primary outcome, 65.1% (69/106) of women in the acupuncture group and 39.6% (42/106) in the control group were admitted for spontaneous onset of labor or premature rupture of membranes (<em>P</em><.001). Overall, women in the intervention group were admitted 1.25 days before (SD 1.4) their scheduled induction of labor date compared to 0.67 days (SD 1.15) for those in the control group (<em>P</em>=.001). The median time from recruitment to hospitalization was 4.48 days for the acupuncture group and 5.33 days for the control group (HR 0.52, 95% CI 0.35-0.77, <em>P</em>=.001). There were no significant differences between the 2 groups regarding the time from admission to delivery or the cesarean delivery rate. Nor were there differences in the rates of maternal or neonatal outcomes, and no maternal or fetal deaths occurred in either group.</div></div><div><h3>Conclusion</h3><div>Acupuncture with filiform needles, administered 4 days prior to scheduled induction of labor increased admission for spontaneous onset of labor and premature rupture of membranes before the indu
{"title":"Acupuncture before planned admission for induction of labor (ACUPUNT study): a randomized controlled trial","authors":"Montserrat Zamora-Brito BSc , Federico Migliorelli PhD , Raquel Pérez-Guervós BSc , Rosa Solans-Oliva BSc , Angela Arranz-Betegón PhD , Montse Palacio PhD","doi":"10.1016/j.ajogmf.2024.101477","DOIUrl":"10.1016/j.ajogmf.2024.101477","url":null,"abstract":"<div><h3>Background</h3><div>The increase in the use of induction of labor is a worldwide phenomenon in the current management of labor and delivery in Western societies, with approximately one out of every 4 pregnancies undergoing this procedure This has led women to seek various methods for stimulation of the onset of labor. Some data suggest that the use of acupuncture for favoring spontaneous labor onset could reduce the number of inductions of labor procedures. However, good quality evidence in this respect is not yet available.</div></div><div><h3>Objective</h3><div>The aim of this study was to evaluate the effectiveness of acupuncture using a filiform needle to induce spontaneous onset of labor in women with a scheduled induction of labor date and assess the safety and satisfaction of women undergoing acupuncture.</div></div><div><h3>Study Design</h3><div>We conducted a multicenter, randomized, controlled, parallel-arm, unmasked trial in 3 hospitals in Spain. Eligible participants were women older than 18 years with a singleton pregnancy and a cephalic presentation, scheduled for induction of labor following center-specific protocols. Participants were randomly allocated to one of 2 groups: the intervention group, which underwent acupuncture sessions for a maximum of 4 days prior to the scheduled induction of labor, or the control group, which received no specific prelabor intervention. The primary study outcome was the proportion of women admitted because of spontaneous onset of labor or premature rupture of membranes before or the day of the scheduled induction of labor.</div></div><div><h3>Results</h3><div>Between November 2017 and June 2023, 212 women were recruited and included in the analysis (106 in the acupuncture group and 106 in the control group). There were no significant differences between the 2 groups in the baseline demographic characteristics. Regarding the primary outcome, 65.1% (69/106) of women in the acupuncture group and 39.6% (42/106) in the control group were admitted for spontaneous onset of labor or premature rupture of membranes (<em>P</em><.001). Overall, women in the intervention group were admitted 1.25 days before (SD 1.4) their scheduled induction of labor date compared to 0.67 days (SD 1.15) for those in the control group (<em>P</em>=.001). The median time from recruitment to hospitalization was 4.48 days for the acupuncture group and 5.33 days for the control group (HR 0.52, 95% CI 0.35-0.77, <em>P</em>=.001). There were no significant differences between the 2 groups regarding the time from admission to delivery or the cesarean delivery rate. Nor were there differences in the rates of maternal or neonatal outcomes, and no maternal or fetal deaths occurred in either group.</div></div><div><h3>Conclusion</h3><div>Acupuncture with filiform needles, administered 4 days prior to scheduled induction of labor increased admission for spontaneous onset of labor and premature rupture of membranes before the indu","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101477"},"PeriodicalIF":3.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1016/j.ajogmf.2024.101476
Subeen Hong MD , Seon Ui Lee MD , Sangeun Won MD , Byung Soo Kang MD , Oyoung Kim MD , In Yang Park PhD, MD , Hyun Sun Ko PhD, MD
Background
Short cervical length in the mid-trimester is a powerful predictor of preterm birth (PTB). However, clinical significance of cervical length in the third trimester for predicting PTB has not been established yet.
Objective
To examine the predictive role of a shortened cervix in the third trimester for PTB in women who had a normal cervical length in the second trimester
Study design
This retrospective cohort study included women who underwent cervical length measured at least once in both the second trimester (16+0 weeks to 27+6weeks) and the early third trimester (28+0 weeks to 33+6 weeks). Women with short cervical length in the second trimester, those with multiple pregnancies, those who underwent cerclage operation, and those who had iatrogenic PTB were excluded. The study population was divided into two groups based on cervical length in the third trimester: a short cervix (≤25 mm) group and a control group (>25 mm). Rates of PTB (<37 weeks) were compared between two groups. Predictive performances of cervical length in the third trimester for PTB were assessed.
Results
Women with a short cervical length at 28+0 to 33+6 weeks accounted for 12.6% (n=717) of the total study population (n=5682). PTB rate was 9.5% in the short cervix group, which was significantly higher than that (3.2%) in the control group (P<.001). The adjusted odds ratio for short cervical length on PTB was 2.73 (95% CI: 1.96–3.79). A short cervix in the third trimester had a sensitivity of 30.1%, a specificity of 88.1%, a positive predictive value of 9.5%, and a negative predictive value (NPV) of 96.8% in predicting PTB. The addition of third-trimester cervical length to the predictive model significantly increased the area under the curve from 0.64 (95% CI: 0.60–0.68) to 0.67 (95% CI: 0.63–0.71) (P=.002), demonstrating improved predictive performance.
Conclusion
Approximately 13% of women with normal cervical length in the mid-trimester had a short cervical length after 28 weeks, which increased the risk of PTB. The high specificity and NPV of third-trimester cervical length measurements underscore their critical utility in identifying women at low risk for preterm delivery.
{"title":"Predictive value of short cervix in early third trimester for preterm birth in women with normal mid-trimester cervical length","authors":"Subeen Hong MD , Seon Ui Lee MD , Sangeun Won MD , Byung Soo Kang MD , Oyoung Kim MD , In Yang Park PhD, MD , Hyun Sun Ko PhD, MD","doi":"10.1016/j.ajogmf.2024.101476","DOIUrl":"10.1016/j.ajogmf.2024.101476","url":null,"abstract":"<div><h3>Background</h3><div>Short cervical length in the mid-trimester is a powerful predictor of preterm birth (PTB). However, clinical significance of cervical length in the third trimester for predicting PTB has not been established yet.</div></div><div><h3>Objective</h3><div>To examine the predictive role of a shortened cervix in the third trimester for PTB in women who had a normal cervical length in the second trimester</div></div><div><h3>Study design</h3><div>This retrospective cohort study included women who underwent cervical length measured at least once in both the second trimester (16+0 weeks to 27+6weeks) and the early third trimester (28+0 weeks to 33+6 weeks). Women with short cervical length in the second trimester, those with multiple pregnancies, those who underwent cerclage operation, and those who had iatrogenic PTB were excluded. The study population was divided into two groups based on cervical length in the third trimester: a short cervix (≤25 mm) group and a control group (>25 mm). Rates of PTB (<37 weeks) were compared between two groups. Predictive performances of cervical length in the third trimester for PTB were assessed.</div></div><div><h3>Results</h3><div>Women with a short cervical length at 28+0 to 33+6 weeks accounted for 12.6% (<em>n</em>=717) of the total study population (<em>n</em>=5682). PTB rate was 9.5% in the short cervix group, which was significantly higher than that (3.2%) in the control group (<em>P</em><.001). The adjusted odds ratio for short cervical length on PTB was 2.73 (95% CI: 1.96–3.79). A short cervix in the third trimester had a sensitivity of 30.1%, a specificity of 88.1%, a positive predictive value of 9.5%, and a negative predictive value (NPV) of 96.8% in predicting PTB. The addition of third-trimester cervical length to the predictive model significantly increased the area under the curve from 0.64 (95% CI: 0.60–0.68) to 0.67 (95% CI: 0.63–0.71) (<em>P</em>=.002), demonstrating improved predictive performance.</div></div><div><h3>Conclusion</h3><div>Approximately 13% of women with normal cervical length in the mid-trimester had a short cervical length after 28 weeks, which increased the risk of PTB. The high specificity and NPV of third-trimester cervical length measurements underscore their critical utility in identifying women at low risk for preterm delivery.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101476"},"PeriodicalIF":3.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-24DOI: 10.1016/j.ajogmf.2024.101472
Kenechukwu Odenigbo BA, Melissa Bauer DO, Yen-Ling Lai MS, Hsou-Mei Hu PhD, Chad M. Brummett MD, Brian T. Bateman MD, MSc, Jennifer F. Waljee MD, MPH, MS, Alex F. Peahl MD, MSc
{"title":"Patterns of opioid prescription fills in birthing people undergoing vaginal and cesarean birth in the United States","authors":"Kenechukwu Odenigbo BA, Melissa Bauer DO, Yen-Ling Lai MS, Hsou-Mei Hu PhD, Chad M. Brummett MD, Brian T. Bateman MD, MSc, Jennifer F. Waljee MD, MPH, MS, Alex F. Peahl MD, MSc","doi":"10.1016/j.ajogmf.2024.101472","DOIUrl":"10.1016/j.ajogmf.2024.101472","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101472"},"PeriodicalIF":3.8,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1016/j.ajogmf.2024.101471
Alyssa C. Savelli Binsted MD, MS , George Saade MD , Tetsuya Kawakita MD, MS
Background
Severe maternal morbidity (SMM) is increasing in the United States. Several tools and scores exist to stratify an individual's risk of SMM.
Objective
We sought to examine and compare the validity of four scoring systems for predicting SMM.
Study Design
This was a retrospective cohort study of all individuals in the Consortium on Safe Labor dataset, which was conducted from 2002 to 2008. Individuals were excluded if they had missing information on risk factors. SMM was defined based on the Centers for Disease Control and Prevention excluding blood transfusion. Blood transfusion was excluded due to concerns regarding the specificity of International Classification of Diseases codes for this indicator and its variable clinical significance. Risk scores were calculated for each participant using the Assessment of Perinatal Excellence (APEX), California Maternal Quality Care Collaborative (CMQCC), Obstetric Comorbidity Index (OB-CMI), and modified OB-CMI. We calculated the probability of SMM according to the risk scores. The discriminative performance of the prediction score was examined by the areas under receiver operating characteristic curves and their 95% confidence intervals (95% CI). The area under the curve for each score was compared using the bootstrap resampling. Calibration plots were developed for each score to examine the goodness-of-fit. The concordance probability method was used to define an optimal cutoff point for the best-performing score.
Results
Of 153, 463 individuals, 1115 (0.7%) had SMM. The CMQCC scoring system had a significantly higher area under the curve (95% CI) (0.78 [0.77–0.80]) compared to the APEX scoring system, OB-CMI, and modified OB-CMI scoring systems (0.75 [0.73–0.76], 0.67 [0.65–0.68], 0.66 [0.70–0.73]; P<.001). Calibration plots showed excellent concordance between the predicted and actual SMM for the APEX scoring system and OB-CMI (both Hosmer–Lemeshow test P values=1.00, suggesting goodness-of-fit).
Conclusion
This study validated four risk-scoring systems to predict SMM. Both CMQCC and APEX scoring systems had good discrimination to predict SMM. The APEX score and the OB-CMI had goodness-of-fit. At ideal calculated cut-off points, the APEX score had the highest sensitivity of the four scores at 71%, indicating that better scoring systems are still needed for predicting SMM.
{"title":"External validation and comparison of four prediction scores for severe maternal morbidity","authors":"Alyssa C. Savelli Binsted MD, MS , George Saade MD , Tetsuya Kawakita MD, MS","doi":"10.1016/j.ajogmf.2024.101471","DOIUrl":"10.1016/j.ajogmf.2024.101471","url":null,"abstract":"<div><h3>Background</h3><p>Severe maternal morbidity (SMM) is increasing in the United States. Several tools and scores exist to stratify an individual's risk of SMM.</p></div><div><h3>Objective</h3><p>We sought to examine and compare the validity of four scoring systems for predicting SMM.</p></div><div><h3>Study Design</h3><p>This was a retrospective cohort study of all individuals in the Consortium on Safe Labor dataset, which was conducted from 2002 to 2008. Individuals were excluded if they had missing information on risk factors. SMM was defined based on the Centers for Disease Control and Prevention excluding blood transfusion. Blood transfusion was excluded due to concerns regarding the specificity of International Classification of Diseases codes for this indicator and its variable clinical significance. Risk scores were calculated for each participant using the Assessment of Perinatal Excellence (APEX), California Maternal Quality Care Collaborative (CMQCC), Obstetric Comorbidity Index (OB-CMI), and modified OB-CMI. We calculated the probability of SMM according to the risk scores. The discriminative performance of the prediction score was examined by the areas under receiver operating characteristic curves and their 95% confidence intervals (95% CI). The area under the curve for each score was compared using the bootstrap resampling. Calibration plots were developed for each score to examine the goodness-of-fit. The concordance probability method was used to define an optimal cutoff point for the best-performing score.</p></div><div><h3>Results</h3><p>Of 153, 463 individuals, 1115 (0.7%) had SMM. The CMQCC scoring system had a significantly higher area under the curve (95% CI) (0.78 [0.77–0.80]) compared to the APEX scoring system, OB-CMI, and modified OB-CMI scoring systems (0.75 [0.73–0.76], 0.67 [0.65–0.68], 0.66 [0.70–0.73]; <em>P</em><.001). Calibration plots showed excellent concordance between the predicted and actual SMM for the APEX scoring system and OB-CMI (both Hosmer–Lemeshow test <em>P</em> values=1.00, suggesting goodness-of-fit).</p></div><div><h3>Conclusion</h3><p>This study validated four risk-scoring systems to predict SMM. Both CMQCC and APEX scoring systems had good discrimination to predict SMM. The APEX score and the OB-CMI had goodness-of-fit. At ideal calculated cut-off points, the APEX score had the highest sensitivity of the four scores at 71%, indicating that better scoring systems are still needed for predicting SMM.</p></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101471"},"PeriodicalIF":3.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1016/j.ajogmf.2024.101452
Mechmet Impis Oglou MD , Petya Chaveeva PhD , Catalina De Paco Matallana PhD, Maria del Mar Gil Mira PhD, Antonios Siargkas MD, Isabel Puig PhD, Juan Luis Delgado PhD, Vasil Kalev MD, Lorena Gonzalez-Gea MD, Irene Fernandez-Buhigas PhD, Ioannis Tsakiridis PhD, Themistoklis Dagklis PhD
{"title":"Association of uterine fibroids with perinatal outcomes: a multicenter cohort study","authors":"Mechmet Impis Oglou MD , Petya Chaveeva PhD , Catalina De Paco Matallana PhD, Maria del Mar Gil Mira PhD, Antonios Siargkas MD, Isabel Puig PhD, Juan Luis Delgado PhD, Vasil Kalev MD, Lorena Gonzalez-Gea MD, Irene Fernandez-Buhigas PhD, Ioannis Tsakiridis PhD, Themistoklis Dagklis PhD","doi":"10.1016/j.ajogmf.2024.101452","DOIUrl":"10.1016/j.ajogmf.2024.101452","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101452"},"PeriodicalIF":3.8,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1016/j.ajogmf.2024.101468
Annabelle L. van Gils MD, Martijn A. Oudijk MD, Eva Pajkrt MD
{"title":"Reply to “Contractions of the lower uterine segment during transvaginal ultrasound cervical length: incidence, significance, proper measurement, and management”","authors":"Annabelle L. van Gils MD, Martijn A. Oudijk MD, Eva Pajkrt MD","doi":"10.1016/j.ajogmf.2024.101468","DOIUrl":"10.1016/j.ajogmf.2024.101468","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101468"},"PeriodicalIF":3.8,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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