Pub Date : 2026-01-01Epub Date: 2025-11-08DOI: 10.1016/j.ajogmf.2025.101839
Amrita Banerjee MBBS , Roberta Solda MD , Maria Ivan MBBS , Charlotte Colley MBBS , Davor Jurkovic MD , Anna L. David PhD , Raffaele Napolitano MD, PhD
<div><h3>OBJECTIVE</h3><div>This study aimed to investigate the association between preconception and antenatal ultrasound characteristics of cesarean delivery scars and adverse obstetrical outcomes in subsequent pregnancies.</div></div><div><h3>DATA SOURCES</h3><div>Literature searches were performed in MEDLINE, Embase, and Cochrane databases from inception to January 31, 2024.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>Eligible studies included studies that evaluated cesarean delivery scar and niche characteristics using transvaginal ultrasound during preconception and/or antenatally and described subsequent adverse obstetrical outcomes (placenta accreta spectrum, preterm birth, uterine dehiscence/rupture, and unsuccessful vaginal birth after cesarean delivery).</div></div><div><h3>METHODS</h3><div>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews registration number: CRD 42019121523). Of note, 2 reviewers independently screened records and assessed eligible articles. The quality of publication was assessed using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. The data were summarized using descriptive statistics.</div></div><div><h3>RESULTS</h3><div>In 19 included studies, the definition of niche, large niche, and cesarean delivery scar assessment timing varied widely. Scar visibility was reported to be between 78% and 100% in the first trimester of pregnancy and between 68% and 91% in the second trimester of pregnancy. The prevalence rates of niche detection were 65% to 97% before conception and 52% to 58% during pregnancy. Uterine dehiscence/rupture was the most common adverse outcome reported (13 studies) and was associated with a large niche, a higher niche depth–to–residual myometrial thickness ratio (≥0.785), a thin residual myometrial thickness, and a higher average decrease in residual myometrial thickness between the first and second trimesters of pregnancy. Owing to methodological study heterogeneity and insufficient description of definitions, optimal cutoffs could not be defined. Of note, 3 studies evaluated the screening for placenta accreta spectrum using first-trimester cesarean delivery scar characteristics. An exposed cesarean delivery scar above the cervicoisthmic canal with placental implantation over the scar or within the niche had high sensitivity (75.0%–100.0%) and negative predictive value (99.6%–100.0%) for placenta accreta spectrum. Of note, 1 study found that a low scar after full dilatation cesarean delivery (a scar within the cervix or <5.0 mm above the internal cervical os) was associated with an increased risk of shortening cervical length and/or spontaneous preterm birth (adjusted odds ratio, 12.7 [95% confidence interval, 4.5–36.0]; <em>P≤</em>.0001).</div></div><div><h3>CONCLUSION</h3><div>This systematic review found that cesarean delivery scar chara
{"title":"A systematic review of transvaginal ultrasound assessment of cesarean scar characteristics and prediction of adverse obstetric outcomes","authors":"Amrita Banerjee MBBS , Roberta Solda MD , Maria Ivan MBBS , Charlotte Colley MBBS , Davor Jurkovic MD , Anna L. David PhD , Raffaele Napolitano MD, PhD","doi":"10.1016/j.ajogmf.2025.101839","DOIUrl":"10.1016/j.ajogmf.2025.101839","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study aimed to investigate the association between preconception and antenatal ultrasound characteristics of cesarean delivery scars and adverse obstetrical outcomes in subsequent pregnancies.</div></div><div><h3>DATA SOURCES</h3><div>Literature searches were performed in MEDLINE, Embase, and Cochrane databases from inception to January 31, 2024.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>Eligible studies included studies that evaluated cesarean delivery scar and niche characteristics using transvaginal ultrasound during preconception and/or antenatally and described subsequent adverse obstetrical outcomes (placenta accreta spectrum, preterm birth, uterine dehiscence/rupture, and unsuccessful vaginal birth after cesarean delivery).</div></div><div><h3>METHODS</h3><div>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews registration number: CRD 42019121523). Of note, 2 reviewers independently screened records and assessed eligible articles. The quality of publication was assessed using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. The data were summarized using descriptive statistics.</div></div><div><h3>RESULTS</h3><div>In 19 included studies, the definition of niche, large niche, and cesarean delivery scar assessment timing varied widely. Scar visibility was reported to be between 78% and 100% in the first trimester of pregnancy and between 68% and 91% in the second trimester of pregnancy. The prevalence rates of niche detection were 65% to 97% before conception and 52% to 58% during pregnancy. Uterine dehiscence/rupture was the most common adverse outcome reported (13 studies) and was associated with a large niche, a higher niche depth–to–residual myometrial thickness ratio (≥0.785), a thin residual myometrial thickness, and a higher average decrease in residual myometrial thickness between the first and second trimesters of pregnancy. Owing to methodological study heterogeneity and insufficient description of definitions, optimal cutoffs could not be defined. Of note, 3 studies evaluated the screening for placenta accreta spectrum using first-trimester cesarean delivery scar characteristics. An exposed cesarean delivery scar above the cervicoisthmic canal with placental implantation over the scar or within the niche had high sensitivity (75.0%–100.0%) and negative predictive value (99.6%–100.0%) for placenta accreta spectrum. Of note, 1 study found that a low scar after full dilatation cesarean delivery (a scar within the cervix or <5.0 mm above the internal cervical os) was associated with an increased risk of shortening cervical length and/or spontaneous preterm birth (adjusted odds ratio, 12.7 [95% confidence interval, 4.5–36.0]; <em>P≤</em>.0001).</div></div><div><h3>CONCLUSION</h3><div>This systematic review found that cesarean delivery scar chara","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101839"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490360","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 : 2026-01-01Epub Date: 2025-11-05DOI: 10.1016/j.ajogmf.2025.101831
Joyce H. Xu BA , Heather N. Czarny MD , Braxton Forde MD , Carri R. Warshak MD , Emily A. DeFranco DO, MS , Robert M. Rossi MD
Background
Hypertensive disorders in pregnancy (HDP) are increasingly common in the United States and encompass a spectrum of diagnoses, yet the distinct risk profiles of HDP subtypes remain poorly defined.
Objective
To assess the risk of severe maternal morbidity (SMM) and mortality among patients with HDP.
Study Design
This repeated cross-sectional study analyzed U.S. delivery hospitalizations using the 2015–2021 National Inpatient Sample. Patients were identified as having HDP and adverse outcomes using International Classification of Diseases, Tenth Revision (ICD-10) codes. HDP subtypes were classified as chronic hypertension, gestational hypertension, preeclampsia without severe features, preeclampsia with severe features, superimposed preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, and eclampsia. The primary outcomes were SMM and mortality. Temporal trends in the diagnosis of HDP were analyzed using joinpoint regression to estimate the average annual percent change (AAPC). Adjusted multivariate logistic regression and population-attributable fractions (aPAF) were used to examine the association between HDP and SMM outcomes. Additional subgroup analysis were performed to estimate SMM risk by race and ethnicity.
Results
Among the 22,554,997 parturients in this study, 3,423,849 (15.2%) had HDP. From 2015 to 2021, the rate of HDP increased from 12.0% to 18.8% (AAPC +7.8%, 95% CI 7.6–8.0). Compared to those without, HDP was associated with a higher risk of SMM (0.5% vs 2.0%; adjusted odds ratio [aOR] 3.04, 95% CI 2.96–3.12) and maternal death (0.7 vs 2.5 per 10,000 delivery hospitalizations; aOR 2.41, 95% CI 1.97–2.95). Among SMM indicators, those with HDP were at highest risk for cardiovascular (aOR 5.14, 95% CI 4.81–5.49) and renal (aOR 8.30, 95% CI 7.82–8.80) SMM. Among HDP subtypes, HELLP syndrome and eclampsia were associated with high risk for all SMM subcategories (aOR 1.92–158.59). Overall, 26.6% (aPAF, 95% CI 25.9–27.3) of hospitalizations with SMM and 22.3% (aPAF, 95% CI 16.2–28.0) of hospitalizations with maternal death were attributable to HDP. Asian or Pacific Islander patients had the greatest SMM risk (aOR 3.47; 95% CI 3.15–3.83) among racial and ethnic groups. The aPAF between HDP and SMM (34.8%, 95% CI 33.2–36.4) was greater among non-Hispanic Black patients compared to other racial and ethnic groups.
Conclusion
HDP was significantly associated with an increased risk of SMM and mortality, with eclampsia and HELLP syndrome posing the highest risks.
背景：妊娠期高血压疾病（HDP）在美国越来越普遍，包括一系列诊断，但HDP亚型的独特风险特征仍不明确。目的：评价妊高征孕妇重度孕产妇发病（SMM）及死亡风险。研究设计：这项重复的横断面研究利用2015-2021年全国住院患者样本分析了美国分娩住院情况。使用国际分类诊断代码（第10版）确定患者为HDP和不良结局。HDP亚型分为慢性高血压、妊娠期高血压、无严重特征子痫前期、有严重特征子痫前期、叠加性子痫前期、HELLP（溶血、肝酶升高、低血小板）综合征和子痫。主要结局是SMM和死亡率。使用连接点回归分析HDP诊断的时间趋势，以估计平均年百分比变化（AAPC）。采用校正多元逻辑回归和人群归因分数（aPAF）来检验HDP和SMM结果之间的关系。另外进行亚组分析以估计按种族和民族划分的SMM风险。结果：在本研究的22,554,997例产妇中，3,423,849例（15.2%）患有HDP。从2015年到2021年，HDP率从12.0%上升到18.8% （AAPC +7.8%, 95% CI 7.6-8.0）。与没有妊娠的孕妇相比，HDP与更高的SMM风险相关（0.5% vs. 2.0%；调整优势比[aOR] 3.04, 95% CI 2.96-3.12）和孕产妇死亡（每10,000例住院分娩中0.7 vs 2.5; aOR 2.41, 95% CI 1.97-2.95）。在SMM指标中，HDP患者发生心血管（aOR 5.14, 95% CI 4.81-5.49）和肾脏（aOR 8.30, 95% CI 7.82-8.80） SMM的风险最高。在HDP亚型中，HELLP综合征和子痫与所有SMM亚型的高风险相关（aOR为1.92-158.59）。总体而言，因SMM住院的26.6% （aPAF, 95% CI 25.9-27.3）和因产妇死亡住院的22.3% （aPAF, 95% CI 16.2-28.0）可归因于HDP。亚洲或太平洋岛民患者在种族和族裔群体中SMM风险最高（aOR 3.47; 95% CI 3.15-3.83）。与其他种族和民族相比，非西班牙裔黑人患者中HDP和SMM之间的aPAF （34.8%, 95% CI 33.2-36.4）更高。结论：HDP与SMM和死亡风险增加显著相关，其中子痫和HELLP综合征的风险最高。
{"title":"Severe maternal morbidity and mortality across subtypes of hypertensive disorders in pregnancy","authors":"Joyce H. Xu BA , Heather N. Czarny MD , Braxton Forde MD , Carri R. Warshak MD , Emily A. DeFranco DO, MS , Robert M. Rossi MD","doi":"10.1016/j.ajogmf.2025.101831","DOIUrl":"10.1016/j.ajogmf.2025.101831","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive disorders in pregnancy (HDP) are increasingly common in the United States and encompass a spectrum of diagnoses, yet the distinct risk profiles of HDP subtypes remain poorly defined.</div></div><div><h3>Objective</h3><div>To assess the risk of severe maternal morbidity (SMM) and mortality among patients with HDP.</div></div><div><h3>Study Design</h3><div>This repeated cross-sectional study analyzed U.S. delivery hospitalizations using the 2015–2021 National Inpatient Sample. Patients were identified as having HDP and adverse outcomes using International Classification of Diseases, Tenth Revision (ICD-10) codes. HDP subtypes were classified as chronic hypertension, gestational hypertension, preeclampsia without severe features, preeclampsia with severe features, superimposed preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, and eclampsia. The primary outcomes were SMM and mortality. Temporal trends in the diagnosis of HDP were analyzed using joinpoint regression to estimate the average annual percent change (AAPC). Adjusted multivariate logistic regression and population-attributable fractions (aPAF) were used to examine the association between HDP and SMM outcomes. Additional subgroup analysis were performed to estimate SMM risk by race and ethnicity.</div></div><div><h3>Results</h3><div>Among the 22,554,997 parturients in this study, 3,423,849 (15.2%) had HDP. From 2015 to 2021, the rate of HDP increased from 12.0% to 18.8% (AAPC +7.8%, 95% CI 7.6–8.0). Compared to those without, HDP was associated with a higher risk of SMM (0.5% vs 2.0%; adjusted odds ratio [aOR] 3.04, 95% CI 2.96–3.12) and maternal death (0.7 vs 2.5 per 10,000 delivery hospitalizations; aOR 2.41, 95% CI 1.97–2.95). Among SMM indicators, those with HDP were at highest risk for cardiovascular (aOR 5.14, 95% CI 4.81–5.49) and renal (aOR 8.30, 95% CI 7.82–8.80) SMM. Among HDP subtypes, HELLP syndrome and eclampsia were associated with high risk for all SMM subcategories (aOR 1.92–158.59). Overall, 26.6% (aPAF, 95% CI 25.9–27.3) of hospitalizations with SMM and 22.3% (aPAF, 95% CI 16.2–28.0) of hospitalizations with maternal death were attributable to HDP. Asian or Pacific Islander patients had the greatest SMM risk (aOR 3.47; 95% CI 3.15–3.83) among racial and ethnic groups. The aPAF between HDP and SMM (34.8%, 95% CI 33.2–36.4) was greater among non-Hispanic Black patients compared to other racial and ethnic groups.</div></div><div><h3>Conclusion</h3><div>HDP was significantly associated with an increased risk of SMM and mortality, with eclampsia and HELLP syndrome posing the highest risks.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101831"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472173","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}
To compare maternal and neonatal outcomes following selective fetal reduction versus expectant management in dichorionic-diamniotic twin pregnancies complicated by mid-trimester preterm premature rupture of membranes in 1 sac.
Data sources
A systematic literature search of PubMed, Embase, and Scopus was conducted through March 2025.
Study eligibility criteria
Included studies were observational (case series or cohort studies) comparing selective fetal reduction versus expectant management in twin pregnancies with mid-trimester preterm premature rupture of membranes (prior to 24+0 weeks). Only studies reporting relevant maternal or neonatal outcomes were included.
Study appraisal and synthesis methods
Studies were assessed using the Newcastle-Ottawa Scale. Meta-analyses were performed using random- or fixed-effects models based on heterogeneity. Outcomes included perinatal survival, neonatal survival, latency period, gestational age at delivery, delivery ≥32 weeks, and other maternal and neonatal complications.
Results
Five retrospective studies met eligibility criteria, and 4 were included in the meta-analysis. Neonatal survival was higher with selective fetal reduction (74% vs 69%), though not statistically significant (OR=1.72, 95% CI=0.96–4.25). Perinatal survival was significantly lower with selective fetal reduction (33% vs 69%), when the reduced fetuses were included (OR=0.40, 95% CI=0.19–0.8). Selective fetal reduction significantly increased odds of delivery ≥32 weeks (67.4% vs 11.3%; OR=15.34, 95% CI=3.86–61.03). Latency and mean gestational age at delivery trended higher in the reduction group but did not reach statistical significance. Maternal and neonatal complications - including chorioamnionitis, cesarean delivery and respiratory morbidity - were less frequent following selective reduction, except for pulmonary hypoplasia, which was higher.
Conclusions
Selective fetal reduction after mid-trimester rupture in 1 sac of dichorionic-diamniotic twins increases the likelihood of delivery ≥32 weeks. Although most other outcome differences were not significant, these findings suggest that fetal reduction may be an alternative to expectant management when termination of the entire pregnancy is not optional.
目的：比较双绒毛膜-双羊膜双胎妊娠合并中期胎膜早破的产妇和新生儿结局。数据来源：截至2025年3月，对PubMed、Embase和Scopus进行了系统的文献检索。研究资格标准：纳入的研究是观察性的（病例系列或队列研究），比较选择性胎位减少与准产管理在双胎妊娠中期胎膜早破（24+0周之前）。仅纳入报告相关孕产妇或新生儿结局的研究。研究评价和综合方法：使用纽卡斯尔-渥太华量表对研究进行评估。采用基于异质性的随机或固定效应模型进行meta分析。结局包括围产期生存、新生儿生存、潜伏期、分娩胎龄、分娩≥32周以及其他孕产妇和新生儿并发症。结果：5项回顾性研究符合入选标准，4项纳入meta分析。选择性胎位减少的新生儿存活率更高（74%对69%），但没有统计学意义（OR=1.72, 95% CI=0.96-4.25）。当包括减少的胎儿时，选择性减少胎儿的围产期生存率显著降低（33%对69%）（OR=0.40, 95% CI=0.19-0.8）。选择性胎位减少显著增加≥32周分娩的几率（67.4% vs. 11.3%； OR=15.34, 95% CI=3.86-61.03）。减少组的分娩潜伏期和平均胎龄增高，但未达到统计学意义。产妇和新生儿并发症——包括绒毛膜羊膜炎、剖宫产和呼吸系统疾病——在选择性减量后发生率较低，但肺发育不全发生率较高。结论：双绒毛膜-双羊膜双胞胎妊娠中期单囊破裂后选择性胎位减少可增加≥32周分娩的可能性。虽然大多数其他结果差异不显著，但这些发现表明，当不能选择终止整个妊娠时，胎儿减少可能是一种替代妊娠管理的方法。
{"title":"Expectant management versus selective fetal reduction in dichorionic-diamniotic twins following mid-trimester, preterm premature rupture of membranes in 1 twin: Review of literature and meta-analysis","authors":"Nissim Arbib MD , Anat Shmueli MD , Shiri Barbash-Hazan MD , Keren Tzadikevitch-Geffen MD , Hadas Miremberg MD , Shany Kolp-Asis MD , Kinneret Tenenbaum-Gavish MD , Yuval Gielchinsky MD , Eran Hadar MD","doi":"10.1016/j.ajogmf.2025.101824","DOIUrl":"10.1016/j.ajogmf.2025.101824","url":null,"abstract":"<div><h3>Objective</h3><div>To compare maternal and neonatal outcomes following selective fetal reduction versus expectant management in dichorionic-diamniotic twin pregnancies complicated by mid-trimester preterm premature rupture of membranes in 1 sac.</div></div><div><h3>Data sources</h3><div>A systematic literature search of PubMed, Embase, and Scopus was conducted through March 2025.</div></div><div><h3>Study eligibility criteria</h3><div>Included studies were observational (case series or cohort studies) comparing selective fetal reduction versus expectant management in twin pregnancies with mid-trimester preterm premature rupture of membranes (prior to 24+0 weeks). Only studies reporting relevant maternal or neonatal outcomes were included.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>Studies were assessed using the Newcastle-Ottawa Scale. Meta-analyses were performed using random- or fixed-effects models based on heterogeneity. Outcomes included perinatal survival, neonatal survival, latency period, gestational age at delivery, delivery ≥32 weeks, and other maternal and neonatal complications.</div></div><div><h3>Results</h3><div>Five retrospective studies met eligibility criteria, and 4 were included in the meta-analysis. Neonatal survival was higher with selective fetal reduction (74% vs 69%), though not statistically significant (OR=1.72, 95% CI=0.96–4.25). Perinatal survival was significantly lower with selective fetal reduction (33% vs 69%), when the reduced fetuses were included (OR=0.40, 95% CI=0.19–0.8). Selective fetal reduction significantly increased odds of delivery ≥32 weeks (67.4% vs 11.3%; OR=15.34, 95% CI=3.86–61.03). Latency and mean gestational age at delivery trended higher in the reduction group but did not reach statistical significance. Maternal and neonatal complications - including chorioamnionitis, cesarean delivery and respiratory morbidity - were less frequent following selective reduction, except for pulmonary hypoplasia, which was higher.</div></div><div><h3>Conclusions</h3><div>Selective fetal reduction after mid-trimester rupture in 1 sac of dichorionic-diamniotic twins increases the likelihood of delivery ≥32 weeks. Although most other outcome differences were not significant, these findings suggest that fetal reduction may be an alternative to expectant management when termination of the entire pregnancy is not optional.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101824"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472232","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 : 2025-12-01Epub Date: 2025-12-03DOI: 10.1016/j.ajogmf.2025.101792
Jesrine Hong MObGyn, Mukhri Hamdan PhD, Peng Chiong Tan PhD
{"title":"Reply to: Regarding “Antenatal dexamethasone versus betamethasone on glycemic control in mild gestational diabetes: A randomized clinical trial”","authors":"Jesrine Hong MObGyn, Mukhri Hamdan PhD, Peng Chiong Tan PhD","doi":"10.1016/j.ajogmf.2025.101792","DOIUrl":"10.1016/j.ajogmf.2025.101792","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 12","pages":"Article 101792"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680765","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 : 2025-12-01Epub Date: 2025-12-03DOI: 10.1016/j.ajogmf.2025.101810
Alisse Hauspurg MD, MS, Rodolfo Fernandez Criado MD, Tracy L. Jackson PhD, Scott Machado, Nicole Konecki, Samantha E. Parker PhD, Kerrie P. Nelson PhD, Danielle Simmons NP, Maria Mejia Castillo BA, William Hunt, Nina K. Ayala MD, ScM, Methodius G. Tuuli MD, MPH, MBA, Adam K. Lewkowitz MD, MPHS
{"title":"Outcomes and engagement among Spanish- versus English-speaking participants in a remote postpartum blood pressure monitoring program","authors":"Alisse Hauspurg MD, MS, Rodolfo Fernandez Criado MD, Tracy L. Jackson PhD, Scott Machado, Nicole Konecki, Samantha E. Parker PhD, Kerrie P. Nelson PhD, Danielle Simmons NP, Maria Mejia Castillo BA, William Hunt, Nina K. Ayala MD, ScM, Methodius G. Tuuli MD, MPH, MBA, Adam K. Lewkowitz MD, MPHS","doi":"10.1016/j.ajogmf.2025.101810","DOIUrl":"10.1016/j.ajogmf.2025.101810","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 12","pages":"Article 101810"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681294","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 : 2025-12-01Epub Date: 2025-12-03DOI: 10.1016/j.ajogmf.2025.101764
Grace E. Fuller BA, Timothy Wen MD, MPH, Fiamma van Biema MA, Suneet P. Chauhan MD, Hon DSc, Alexander M. Friedman MD, MPH, Teresa C. Logue MD, MPH
{"title":"Severe maternal morbidity among births to American Indians and Alaska Natives, 2000–2021","authors":"Grace E. Fuller BA, Timothy Wen MD, MPH, Fiamma van Biema MA, Suneet P. Chauhan MD, Hon DSc, Alexander M. Friedman MD, MPH, Teresa C. Logue MD, MPH","doi":"10.1016/j.ajogmf.2025.101764","DOIUrl":"10.1016/j.ajogmf.2025.101764","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 12","pages":"Article 101764"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681295","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 : 2025-12-01Epub Date: 2025-09-29DOI: 10.1016/j.ajogmf.2025.101803
Juliana G. Martins MD , Elizabeth Miller MD , Diana Aboukhater MD , Michael Bittner MPH , Daniel L. Rolnik MD, PhD , Tetsuya Kawakita MD
Background
Preeclampsia complicates 2% to 8% of pregnancies and is a leading cause of maternal and perinatal morbidity and mortality. In the United States, current guidelines recommend low-dose aspirin based on clinical risk factors, which identify only a minority of those at risk for preterm preeclampsia. The Fetal Medicine Foundation (FMF) competing risks algorithm improves prediction by combining maternal characteristics, biophysical parameters, and biochemical markers. While validated internationally, its performance in the U.S. population remains unclear.
Objective
To evaluate the performance of the FMF first-trimester combined screening algorithm for predicting preterm preeclampsia in a diverse U.S. nulliparous population.
Study Design
We performed a retrospective cohort study using data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). We excluded those with delivery before 20 weeks, missing outcome data, or aspirin use. The FMF model incorporated maternal factors, mean arterial pressure, placental growth factor, pregnancy-associated plasma protein-A, and uterine artery pulsatility index (adjusted from second-trimester values). The primary outcome was preterm preeclampsia, defined as preeclampsia requiring delivery <37 weeks. Model performance was assessed via area under the receiver-operating characteristics curve (AUROC) with 95% confidence interval (CI), with optimal cut-off determined using Liu’s method. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), likelihood ratios (LHR), and odds ratios (OR) were calculated using the optimal cut-off. Goodness of fit was evaluated using a calibration plot and decision curve analysis.
Results
Of 8,664 nulliparous individuals, 189 (2.2%) had preterm preeclampsia. The FMF model revealed an AUC of 0.75 (95% CI 0.71–0.78), indicating moderate discriminative ability. Using a 0.7% cut-off, sensitivity was 64.0%, specificity 72.5%, PPV 4.9%, and NPV 98.9%. Positive LHR was 2.3, negative LHR 0.5, and OR 4.7. The calibration plot showed the model underestimated risk, while recalibration improved alignment. Decision curve analysis demonstrated net clinical benefit across commonly used thresholds (1%–12%).
Conclusion
The FMF first-trimester screening algorithm demonstrated moderate predictive performance. Recalibration enhanced risk estimation, and decision curve analysis supported clinical utility, highlighting the need for population-specific adjustment.
背景：子痫前期并发症2-8%的妊娠，是产妇和围产期发病率和死亡率的主要原因。在美国，目前的指南建议基于临床风险因素使用低剂量阿司匹林，这只确定了少数有早产子痫前期风险的人。胎儿医学基金会（FMF）竞争风险算法通过结合母体特征、生物物理参数和生化标志物来改进预测。虽然在国际上得到了认可，但它在美国人口中的表现仍不明朗。目的：评价FMF早期妊娠联合筛查算法在美国不同的未产人群中预测早产子痫前期的性能。研究设计：我们进行了一项回顾性队列研究，使用了来自未分娩妊娠结局研究：监测准妈妈（nuMoM2b）的数据。我们排除了在20周前分娩、缺少结局数据或使用阿司匹林的患者。FMF模型纳入了母体因素、平均动脉压、胎盘生长因子、妊娠相关血浆蛋白-a和子宫动脉脉搏指数（根据妊娠中期值调整）。主要结局是早产子痫前期，定义为需要分娩的子痫前期。结果：8664例未产个体中，189例（2.2%）发生早产子痫前期。FMF模型显示AUC为0.75 (95% CI 0.71-0.78)，表明判别能力中等。采用0.7%的临界值，敏感性为64.0%，特异性为72.5%，PPV为4.9%，NPV为98.9%。阳性LHR为2.3，阴性LHR为0.5，OR为4.7。校准图显示模型低估了风险，而重新校准改善了对齐。决策曲线分析表明，临床净收益超过常用阈值（1-12%）。结论：FMF早期妊娠筛查算法具有中等的预测性能。重新校准增强了风险评估，决策曲线分析支持临床效用，强调了针对特定人群进行调整的必要性。
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Pub Date : 2025-12-01Epub Date: 2025-09-26DOI: 10.1016/j.ajogmf.2025.101804
Emily Zhao BA , Kristen A. Miller MGC , Jonathan Webster MD , Jamie Perin PhD, MS , Ashley Coggins MD , Angie C. Jelin MD
Background
Cell-free DNA (cfDNA) screening is increasingly used for fetal aneuploidy screening. Maternal malignancy is associated with abnormal cfDNA results; however, the impact of tumor staging and origin on cfDNA results remains unclear.
Objective
To characterize the types and stages of malignancies resulting in abnormal cfDNA screening results.
Study Design
This is a single-center, retrospective review of cases with a known, suspected, or incidentally diagnosed malignancy during pregnancy from 2015 to 2023, queried using ICD9/10 codes for malignancy. We extracted maternal medical history, cancer history, aneuploidy screening results, and fetal outcomes. We used Fisher’s exact and Wilcoxon rank sum tests to determine associations between cfDNA screening results and (1) demographic factors, (2) cancer characteristics, and (3) fetal outcomes.
Results
We identified 97 cases of malignancy in pregnancy. Thirty-three patients had no aneuploidy screening. Twenty-two underwent first-trimester screening, and 4 underwent quad screening, all with low-risk results. Among the 38 patients who had cfDNA screening, 21.1% (8/38) were hematologic, and 78.9% (30/38) were solid tumors. The most common locations were breast (11/38), blood (8/38), and gastrointestinal (5/38). Overall, 31.6% (12/38) of patients had abnormal cfDNA results. The fraction of stage 0, I, II, III, and IV solid cancers with abnormal cfDNA results was 0/4 (0%), 0/5 (0%), 2/6 (33.3%), 1/4 (25%), and 7/11 (63.6%), respectively. Metastasized status was significantly different between groups: 47.6% (10/21) of patients with stage II to IV solid cancers had abnormal cfDNA results, compared to 0% (0/9) of patients with stage 0 to I solid cancers (P=.013). No fetuses had a confirmed aneuploidy.
Conclusion
Our data suggest that early-stage, solid tumors are less likely to impact cfDNA screening results than metastatic tumors. Larger cohorts are needed to further characterize the association between tumor type/stage and cfDNA result. Ultimately, cfDNA screening may be more likely to incidentally diagnose certain types of maternal malignancy than others.
{"title":"Cell-free DNA screening results by stage of maternal malignancy","authors":"Emily Zhao BA , Kristen A. Miller MGC , Jonathan Webster MD , Jamie Perin PhD, MS , Ashley Coggins MD , Angie C. Jelin MD","doi":"10.1016/j.ajogmf.2025.101804","DOIUrl":"10.1016/j.ajogmf.2025.101804","url":null,"abstract":"<div><h3>Background</h3><div>Cell-free DNA (cfDNA) screening is increasingly used for fetal aneuploidy screening. Maternal malignancy is associated with abnormal cfDNA results; however, the impact of tumor staging and origin on cfDNA results remains unclear.</div></div><div><h3>Objective</h3><div>To characterize the types and stages of malignancies resulting in abnormal cfDNA screening results.</div></div><div><h3>Study Design</h3><div>This is a single-center, retrospective review of cases with a known, suspected, or incidentally diagnosed malignancy during pregnancy from 2015 to 2023, queried using ICD9/10 codes for malignancy. We extracted maternal medical history, cancer history, aneuploidy screening results, and fetal outcomes. We used Fisher’s exact and Wilcoxon rank sum tests to determine associations between cfDNA screening results and (1) demographic factors, (2) cancer characteristics, and (3) fetal outcomes.</div></div><div><h3>Results</h3><div>We identified 97 cases of malignancy in pregnancy. Thirty-three patients had no aneuploidy screening. Twenty-two underwent first-trimester screening, and 4 underwent quad screening, all with low-risk results. Among the 38 patients who had cfDNA screening, 21.1% (8/38) were hematologic, and 78.9% (30/38) were solid tumors. The most common locations were breast (11/38), blood (8/38), and gastrointestinal (5/38). Overall, 31.6% (12/38) of patients had abnormal cfDNA results. The fraction of stage 0, I, II, III, and IV solid cancers with abnormal cfDNA results was 0/4 (0%), 0/5 (0%), 2/6 (33.3%), 1/4 (25%), and 7/11 (63.6%), respectively. Metastasized status was significantly different between groups: 47.6% (10/21) of patients with stage II to IV solid cancers had abnormal cfDNA results, compared to 0% (0/9) of patients with stage 0 to I solid cancers (<em>P</em>=.013). No fetuses had a confirmed aneuploidy.</div></div><div><h3>Conclusion</h3><div>Our data suggest that early-stage, solid tumors are less likely to impact cfDNA screening results than metastatic tumors. Larger cohorts are needed to further characterize the association between tumor type/stage and cfDNA result. Ultimately, cfDNA screening may be more likely to incidentally diagnose certain types of maternal malignancy than others.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 12","pages":"Article 101804"},"PeriodicalIF":3.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186970","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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