American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Examining the role of neighborhood-level sociostructural indices in predicting spontaneous preterm birth in the New York City metropolitan area","authors":"Daniel L. Kuhr MD ,&nbsp;Nicola F. Tavella MPH ,&nbsp;Zahava P. Michaelson MD ,&nbsp;Raina Kishan MD ,&nbsp;Nicole Parkas BS, RDMS ,&nbsp;Rebecca M. Cohen BSE ,&nbsp;Chelsea A. DeBolt MD, MSCR ,&nbsp;Helen Feltovich MD, MS ,&nbsp;Kimberly B. Glazer PhD, MPH","doi":"10.1016/j.ajogmf.2025.101837","DOIUrl":"10.1016/j.ajogmf.2025.101837","url":null,"abstract":"<div><h3>Background</h3><div>Prior predictive models of spontaneous preterm birth that include cervical length and other individual covariates have achieved only moderate discriminative strength. Indices which reflect the sociostructural environment have been associated with preterm birth overall, but the extent to which these measures may improve prediction of spontaneous preterm birth among individuals with measured cervical length has not been tested.</div></div><div><h3>Objectives</h3><div>To determine whether a cervical length model including measures of the neighborhood-level social environment increases spontaneous preterm birth discrimination compared with a cervical length model without such indices.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of all gestations with (1) delivery between January, 2013 and August, 2023 and (2) at least one transvaginal cervical length measurement between 16 weeks and 0 days’ and 24 weeks and 6 days’ gestation. The primary outcome was spontaneous preterm birth. We ascertained neighborhood-level sociostructural determinants of health from the Index of Concentration at the Extremes (ICE) and Child Opportunity Index (COI). We used logistic regression to predict the probability of spontaneous preterm birth in models with (1) cervical length alone, (2) cervical length plus social indices, and (3) cervical length, social indices, and individual characteristics. We examined model discrimination using the area under the receiver operating characteristics curve (AUC) and 95% confidence intervals. We used the net reclassification index (NRI) to quantify the improvement in predictive ability between nested models.</div></div><div><h3>Results</h3><div>1884 pregnancies were included, of which 119 (6.3%) resulted in spontaneous preterm birth. A model with cervical length alone achieved an AUC of 0.66 (0.60, 0.72), increasing to 0.75 (0.70, 0.79) with individual covariates. Adding social indices yielded a model with an AUC of 0.75 (0.71, 0.80). The model with cervical length, individual covariates, and social indices had an NRI of 0.04 (0.01, 0.08), indicating improved performance compared with the previous models.</div></div><div><h3>Conclusions</h3><div>Among individuals with cervical length screening, the inclusion of social indices improved the prediction of spontaneous preterm birth compared to a model with only individual-level covariates.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101837"},"PeriodicalIF":3.1,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482408","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}

{"title":"A systematic review of transvaginal ultrasound assessment of cesarean scar characteristics and prediction of adverse obstetric outcomes","authors":"Amrita Banerjee MBBS ,&nbsp;Roberta Solda MD ,&nbsp;Maria Ivan MBBS ,&nbsp;Charlotte Colley MBBS ,&nbsp;Davor Jurkovic MD ,&nbsp;Anna L. David PhD ,&nbsp;Raffaele Napolitano MD, PhD","doi":"10.1016/j.ajogmf.2025.101839","DOIUrl":"10.1016/j.ajogmf.2025.101839","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to investigate the association between preconception and antenatal ultrasound characteristics of cesarean delivery scars and adverse obstetrical outcomes in subsequent pregnancies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;DATA SOURCES&lt;/h3&gt;&lt;div&gt;Literature searches were performed in MEDLINE, Embase, and Cochrane databases from inception to January 31, 2024.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY ELIGIBILITY CRITERIA&lt;/h3&gt;&lt;div&gt;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).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;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 &lt;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]; &lt;em&gt;P≤&lt;/em&gt;.0001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;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":"2025-11-08","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}

{"title":"Physical activity during pregnancy and depression, anxiety and stress: randomized clinical trials","authors":"Miguel Sánchez-Polán PhD ,&nbsp;Maia Brik MD, PhD ,&nbsp;Cristina Silva-Jose PhD ,&nbsp;Dingfeng Zhang PhD ,&nbsp;María Ángeles Díaz-Blanco ,&nbsp;Paloma Hernando López de la Manzanara MD ,&nbsp;Aránzazu Martín Arias MD ,&nbsp;Irune Alzola MD ,&nbsp;Rubén Barakat PhD","doi":"10.1016/j.ajogmf.2025.101835","DOIUrl":"10.1016/j.ajogmf.2025.101835","url":null,"abstract":"<div><h3>Background</h3><div>Pregnancy is not an emotionally stable period; pregnant women could suffer psychological lability influenced by hormonal variation between trimesters of gestation. The COVID-19 pandemic and the lack of social interaction increased this psychological instability, increasing the reported rates of prevalence of depression and anxiety, with its associated maternal and fetal complications. Despite the fact that regular physical activity could help regulate hormonal secretion, during the pandemic, its performance decreased, increasing sedentary rates. Pharmacological treatment could imply potential health risks, so a non-invasive intervention is needed.</div></div><div><h3>Objective</h3><div>To assess the impact of two supervised physical activity programs during pregnancy on prenatal and postnatal depression, anxiety and stress symptoms.</div></div><div><h3>Study design</h3><div>Two randomized clinical trials were developed, with physical activity programs during pregnancy being carried out, randomizing 564 pregnant women in both the Intervention (n=278) and the Control (n=278) groups, of three different regions (and five health centers) from Spain. Three weekly physical activity sessions, online and in-person were performed until the end of pregnancy, measuring depression (measured with CES-D and EPDS), anxiety (STAI) and stress (PSS) symptoms. SPSS software was used, and independent t tests, U Mann Whitney, Pearson Chi-square and one-way ANOVA analyses were used.</div></div><div><h3>Results</h3><div>After intervention, results showed a significant reduction in depression symptoms in the Per Protocol (<em>P=.</em>028) analysis, with also fewer cases of symptoms compatible with depression at the end of gestation, in the Intention to Treat (5.9% / 12.4%) and Per Protocol (3.2% / 12.2%) analyses in the intervention group, in comparison with the control group. Additionally, significantly lower scores were found in pregnant women with more than 90% of program attendance in depression (<em>P=.</em>003) and in state anxiety (<em>P=.</em>035) at the end of pregnancy compared with women that not accomplished protocol criteria (&lt;70% attendance). Analysis per trial, revealed significant lower scores in depression (<em>P=.</em>043), state (<em>P=.</em>015), trait (<em>P=.</em>045) anxiety and in the combination of both (<em>P=.</em>021), in IG of the 2^nd trial, compared with CG. No significant differences were observed in scores of depression, anxiety or stress during and after pregnancy in the Intention to Treat analysis (<em>P&gt;.</em>05).</div></div><div><h3>Conclusion</h3><div>Supervised physical activity during pregnancy could potentially reduce prenatal depression symptoms at the end of gestation and, comparatively, enhance the effects by greater reducing state anxiety and depression symptoms when adherence is greater than 90%.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101835"},"PeriodicalIF":3.1,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482428","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}

{"title":"Postpartum health-care utilization and blood pressure control by antihypertensive agent in hypertensive disorders of pregnancy","authors":"Carrie Bennett MD ,&nbsp;Lara Lemon PharmD, PhD ,&nbsp;Kripa Venkatakrishnan MPH ,&nbsp;Sanjana Ghosh BS ,&nbsp;Hyagriv Simhan MD, MS ,&nbsp;Alisse Hauspurg MD, MS","doi":"10.1016/j.ajogmf.2025.101836","DOIUrl":"10.1016/j.ajogmf.2025.101836","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Hypertensive disorders of pregnancy are a significant contributor to maternal morbidity and mortality in the postpartum period and are the leading cause of postpartum readmission following delivery hospitalization. At present, there remains uncertainty regarding differences in postpartum health care utilization for individuals discharged on specific antihypertensive agents while enrolled in an institutional remote blood pressure (BP) monitoring program.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;To evaluate rates of postpartum hospital readmission and emergency room (ER) utilization for individuals with a hypertensive disorder of pregnancy (HDP) enrolled in remote BP monitoring after discharge on labetalol vs nifedipine.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;We performed a retrospective cohort study to evaluate outcomes associated with the type of antihypertensive medication at discharge in postpartum individuals delivering between April 2019 and June 2023 at a single institution. The exposure of interest was discharge on single-agent labetalol vs nifedipine. Individuals were included who were diagnosed with hypertension (HTN) in pregnancy (including pre-pregnancy HTN) and were enrolled in our institution’s remote BP management program. Our institution’s remote program monitors BP up to 6 months postpartum. Individuals were excluded if they were prescribed antihypertensives antenatally. We compared demographics, clinical outcomes, and home BP measures between groups. The primary outcome was postpartum hospital readmission and ER visits within 8 weeks of delivery. Multivariate logistic regression models adjusted for severity of HDP, TIS, race, and BMI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;1507 individuals were included; 488 (32.4%) were discharged on labetalol and 1019 (67.6%) on nifedipine. Those discharged on labetalol had higher BMIs and higher rates of pre-pregnancy HTN. Compared to individuals discharged on labetalol, those discharged on nifedipine were less likely to have a postpartum hospital readmission (9.2% vs 3.9%, &lt;em&gt;P&lt;.&lt;/em&gt;001). In multivariate logistic regression models, discharge on labetalol was associated with a significant increased odds of postpartum hospital readmission [aOR 2.70 (95% CI 1.57–4.65)] but not ED visits [aOR 1.01 (95% CI 0.67–1.52)] compared with discharge on nifedipine. These findings were similar with stratification by pre-pregnancy HTN. Upon analysis of home postpartum BP data, we found that the proportion of blood pressures in the severe range by each postpartum day was higher in the first ten days postpartum for those discharged on labetalol as compared to nifedipine.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;Discharge on labetalol was associated with an increased odds of postpartum hospital readmission following a HDP compared with discharge on nifedipine. Our findings suggest this may be driven by more severe hypertension on home monitoring by each day postpartum in the first","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101836"},"PeriodicalIF":3.1,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482841","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}

{"title":"Selective fetal growth restriction type II: IIb or not IIb","authors":"Ariane C. Youssefzadeh MD,&nbsp;Ramen H. Chmait MD","doi":"10.1016/j.ajogmf.2025.101833","DOIUrl":"10.1016/j.ajogmf.2025.101833","url":null,"abstract":"<div><div>Monochorionic diamniotic twins have distinct risk profiles because of their single shared placenta. Selective fetal growth restriction complicates monochorionic diamniotic twin pregnancies by up to 25% because of unequal placental share, vascular anastomoses (aberrant sizes, quantities, and types), and discrepant cord insertion sites. Since 2007, the Gratacos classification system has been used to better understand the risk of selective fetal growth restriction based on the umbilical artery Doppler findings of the selective fetal growth restriction fetus, where type I has forward diastolic flow, type II has persistent absent or reversed end-diastolic flow, and type III has intermittent absent or reversed end-diastolic flow. Type I has an excellent prognosis, and type III is characterized by its unpredictable clinical course. This review focuses on early selective fetal growth restriction type II, which is generally considered to predict the worst outcome, with high rates of perinatal morbidity and mortality. Despite selective fetal growth restriction being relatively common, the optimal management remains controversial. Management strategies include expectant management, cord occlusion of the smaller twin to protect the appropriate grown twin, and selective laser photocoagulation of communicating vessels to unlink the fates of the twins. The clinical course of selective fetal growth restriction type II is not uniform, and a nuanced approach plays a role. Our study describes the management dilemma associated with early selective fetal growth restriction type II overall and the justification for the subclassification into type IIa vs type IIb, which may help stratify patients’ prognoses and management plans.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101833"},"PeriodicalIF":3.1,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477136","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}

{"title":"Early pregnancy depressive symptoms and severe maternal morbidity","authors":"T. Caroline Bank MD ,&nbsp;Janet Catov PhD ,&nbsp;Jiqiang Wu MSc ,&nbsp;Lynn M. Yee MD, MPH ,&nbsp;Michelle L. Miller PhD ,&nbsp;Rebecca McNeil PhD ,&nbsp;Lara S. Lemon PhD, PharmD ,&nbsp;Uma M. Reddy MD ,&nbsp;Robert M. Silver MD ,&nbsp;Kelly Zafman MD ,&nbsp;George Saade MD ,&nbsp;Judith Chung MD ,&nbsp;Courtney D. Lynch PhD ,&nbsp;William A. Grobman MD, MBA ,&nbsp;Kartik K. Venkatesh MD, PhD","doi":"10.1016/j.ajogmf.2025.101830","DOIUrl":"10.1016/j.ajogmf.2025.101830","url":null,"abstract":"<div><h3>Background</h3><div>Maternal mental health conditions are common in pregnancy; suboptimal maternal mental health is associated with numerous adverse pregnancy outcomes, including preterm birth, hypertensive disorders of pregnancy, and maternal mortality.</div></div><div><h3>Objective</h3><div>The relationship between maternal mental health during early pregnancy and subsequent severe maternal morbidity (SMM) remains to be investigated. We examined whether depressive symptoms in early pregnancy were associated with SMM at delivery hospitalization.</div></div><div><h3>Study Design</h3><div>This was a secondary analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study. In this prospective cohort, nulliparous individuals were followed from the first trimester through delivery at eight centers in the United States. The Edinburgh Postnatal Depression Scales (EPDS) was administered at 6-13 weeks’ gestation and assessed categorically at thresholds (≥10 and ≥13) that are commonly used in clinical practice. The primary outcome was SMM at delivery hospitalization, and secondarily, SMM without transfusion. Relative risk regression using a modified Poisson model with robust error variance was used and adjusted for baseline age, insurance status, tobacco use, and residential Area Deprivation Index. In secondary analyses, we further adjusted for preexisting psychiatric diagnosis and psychotropic medication exposure in early pregnancy.</div></div><div><h3>Results</h3><div>Among 8,784 nulliparas enrolled in early pregnancy (median gestational age: 12.0 weeks; interquartile range [IQR] 11.0, 13.0), 17.2% and 7.1% of individuals had an EPDS score ≥10 and ≥13, respectively. 2.3% experienced SMM and 0.5% experienced non-transfusion SMM. Having an EPDS ≥10 was associated with a greater frequency of SMM in comparison to having an EPDS &lt;10 (3.0% vs 2.1%; relative risk [RR] 1.42; 95% confidence interval [CI] 1.02, 1.96). However, the relative risk was not significant after adjustment (adjusted relative risk [aRR] 1.17; 95% CI: 0.77, 1.77). Individuals who met the higher EPDS threshold of ≥13 had an increased risk of SMM without transfusion in unadjusted (1.1% vs 0.4%, RR 2.53, 95% CI: 1.13, 5.67) and adjusted analyses (1.1% vs 0.4%, aRR: 3.12; 95% CI: 1.11, 8.81). The above associations were similar after further adjustment for a psychiatric diagnosis and psychotropic medication exposure in early pregnancy.</div></div><div><h3>Conclusion</h3><div>In a prospective US cohort of nulliparous individuals, severe early pregnancy depressive symptoms were associated with an increased risk of SMM without transfusion. Further data about whether intervention for depression in early pregnancy can affect SMM are needed.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101830"},"PeriodicalIF":3.1,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472204","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}

{"title":"Care utilization and clinical outcomes among high-risk patients enrolled in a postpartum navigation program: a retrospective matched cohort study","authors":"Alyssa M. Hernandez,&nbsp;Mackenzie O’Connell,&nbsp;Natasha Griffin,&nbsp;Abbey Kruper,&nbsp;Kristine Graettinger,&nbsp;Anna Palatnik,&nbsp;Jacqueline Peebles","doi":"10.1016/j.ajogmf.2025.101829","DOIUrl":"10.1016/j.ajogmf.2025.101829","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The postpartum period represents the highest risk time for maternal morbidity and mortality. Patient navigation is a promising intervention to improve maternal outcomes during this high-risk period.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To compare care utilization and clinical outcomes pre- and post-implementation of a postpartum navigation program in a retrospective, matched cohort analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Pregnant patients &gt;32 weeks’ gestation at risk for postpartum morbidity were invited to participate in a postpartum navigation program between October 2023 and September 2024. Qualifying criteria included intrapartum complications, hypertensive disorders of pregnancy, diabetes, and/or risk factors for perinatal mood and anxiety disorders. The navigator conducted regular check-ins with enrolled patients at delivery, 2, 6, and 12 weeks postpartum to assess physical recovery and psychological health. A matched cohort was created with similarly high-risk patients who delivered in the 18 months before program implementation and received standard care. Subjects were matched 1:1 according to race, ethnicity, parity, delivery method, and high-risk criteria. We compared adherence to standard postpartum care recommendations and clinical outcomes between the matched groups. Program feasibility and acceptability were assessed using retention and patient satisfaction as endpoints.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 365 patients who met the eligibility criteria, 167 agreed to participate. Five patients withdrew from the program prior to starting any program activities, and one did not have outcome data available. The 161 patients who remained enrolled were matched to historical controls, totaling a final sample size of 322 patients. All demographic and clinical characteristics were similar between the two groups except for gestational age at delivery, which was earlier in the control group (38.7 weeks, IQR 37.4–39.3) than the intervention group (39.0, IQR 37.7–39.6, &lt;em&gt;P=.&lt;/em&gt;047). Total attendance at a comprehensive postpartum visit within 12 weeks of birth did not differ (93.8% vs. 90.1%, &lt;em&gt;P=.&lt;/em&gt;22). After adjusting for gestational age at delivery, the intervention group was more likely to complete postpartum depression screening (AOR 1.65, 95% CI 1.02–2.67) and continue breastfeeding at 6 weeks postpartum (AOR 2.17, 95% CI 1.46–5.01). The intervention group had higher rates of enrollment in a remote hypertension monitoring program (98.5% vs. 89.1%, &lt;em&gt;P=.&lt;/em&gt;027), which recommends once-daily blood pressure (BP) monitoring for two weeks postpartum. Intervention participants also recorded a higher total number of BP measurements using the monitoring program (12 BPs [IQR 0–26] vs. 0 [IQR 0–2], &lt;em&gt;P&lt;.&lt;/em&gt;001). However, enrollment in remote monitoring did not remain statistically significant in the multivariate model. Regarding intervention retention, 80.7% of participants atte","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101829"},"PeriodicalIF":3.1,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472178","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}

{"title":"Severe maternal morbidity and mortality across subtypes of hypertensive disorders in pregnancy","authors":"Joyce H. Xu BA ,&nbsp;Heather N. Czarny MD ,&nbsp;Braxton Forde MD ,&nbsp;Carri R. Warshak MD ,&nbsp;Emily A. DeFranco DO, MS ,&nbsp;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":"2025-11-05","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}

{"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 ,&nbsp;Anat Shmueli MD ,&nbsp;Shiri Barbash-Hazan MD ,&nbsp;Keren Tzadikevitch-Geffen MD ,&nbsp;Hadas Miremberg MD ,&nbsp;Shany Kolp-Asis MD ,&nbsp;Kinneret Tenenbaum-Gavish MD ,&nbsp;Yuval Gielchinsky MD ,&nbsp;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":"2025-11-05","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}

{"title":"Pushing the limit: antenatal corticosteroids at 22 weeks’ gestation","authors":"Moti Gulersen MD, MSc","doi":"10.1016/j.ajogmf.2025.101812","DOIUrl":"10.1016/j.ajogmf.2025.101812","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 12","pages":"Article 101812"},"PeriodicalIF":3.1,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453370","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}