Pub Date : 2026-02-01DOI: 10.1016/j.ajogmf.2025.101863
Agustin Conde-Agudelo
{"title":"Letter to the editor regarding \"Cerclage for short cervix ≤20 mm before 24 weeks in singleton gestations without prior spontaneous preterm birth decreases preterm birth: a meta-analysis of randomized controlled trials using individual patient-level data\".","authors":"Agustin Conde-Agudelo","doi":"10.1016/j.ajogmf.2025.101863","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101863","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"101863"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120649","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 : 2026-02-01DOI: 10.1016/j.ajogmf.2025.101847
Manyu Zhang, Mengdi Shi, Pengling Ge
{"title":"Letter to editor regarding \"Sequential use of foley catheter and misoprostol versus misoprostol alone for induction of labor: a multicenter randomized controlled trial\".","authors":"Manyu Zhang, Mengdi Shi, Pengling Ge","doi":"10.1016/j.ajogmf.2025.101847","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101847","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"101847"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120589","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 : 2026-02-01DOI: 10.1016/j.ajogmf.2025.101876
Rebecca Woofter, Rashmi Rao, May Sudhinaraset
{"title":"Prenatal mental health and postpartum care: an analysis of medical records in a California health system.","authors":"Rebecca Woofter, Rashmi Rao, May Sudhinaraset","doi":"10.1016/j.ajogmf.2025.101876","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101876","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"101876"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120672","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 : 2026-01-31DOI: 10.1016/j.ajogmf.2026.101909
Brian A Burnett, Christian M Parobek, Ahmed A Nassr
{"title":"Clinical contexts in the prediction of mirror syndrome.","authors":"Brian A Burnett, Christian M Parobek, Ahmed A Nassr","doi":"10.1016/j.ajogmf.2026.101909","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.101909","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101909"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107800","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 : 2026-01-28DOI: 10.1016/j.ajogmf.2026.101903
Claire Thuillier, Anne-Sophie Boucherie, Juliette François, Anne Rousseau, Patrick Rozenberg, Thibaud Quibel
Background: The optimal timing of delivery after a prior cesarean is debated. Induction of labor may reduce the risk of repeat cesarean delivery, but its safety remains unclear.
Objective: To assess the risks of cesarean delivery and maternal-neonatal morbidity associated with induction of labor versus expectant management from 38 weeks gestation onward in primiparous women with one prior cesarean delivery.
Study design: This secondary analysis of the randomized LUS Trial included primiparous women eligible for a trial of labor after cesarean from 38 weeks and 0 days. Cesarean delivery rates and maternal-fetal morbidity were compared according to the intended management strategy: induction of labor or expectant management. Comparisons were made between women who underwent induction of labor at a specific gestational week and those who remained pregnant at the end of that week (expectant management group). Maternal and neonatal morbidities were assessed using composite criteria. Multivariable logistic regression models were adjusted for maternal characteristics (body mass index, diabetes, hypertensive disorders, suspected macrosomia) and hospital status.
Results: Among the 2,948 LUS Trial participants, 2,267 primiparous women at ≥ 38 weeks of gestation with a prior cesarean delivery were eligible and 1,778 (78.4%) underwent a trial of labor after cesarean. Among them, 372 (20.9%) had an induction of labor and 1,406 (79.1%) had a spontaneous labor. The cesarean delivery rate was 44.2% (1,002/2,267) in the overall population. Cesarean delivery rates were similar in the induction of labor and expectant management groups week-by-week before 40 weeks 0 days. Induction of labor between 40 weeks 0 days and 40 weeks 6 days was associated with a significant lower cesarean delivery risk compared to expectant management beyond 41 weeks 0 days (adjusted OR 0.66, 95% CI 0.30 -0.87). Induction of labor at 39, 40, or 41 weeks was not associated with an increased composite maternal or neonatal morbidity.
Conclusion: In women with one prior cesarean delivery, induction of labor at 40 weeks compared with expectant management beyond 41 weeks reduces the cesarean delivery risk without increasing adverse maternal or neonatal outcomes.
背景：剖宫产后的最佳分娩时间是有争议的。引产可以降低再次剖宫产的风险，但其安全性尚不清楚。目的：评估有一次剖宫产史的初产妇在妊娠38周后剖宫产的风险和与引产相关的母婴发病率。研究设计：这项随机LUS试验的二级分析纳入了符合剖宫产后分娩试验条件的38周零0天的初产妇。根据预期的管理策略：引产或待产，比较剖宫产率和母胎发病率。对在特定妊娠周进行引产的妇女和在妊娠周结束时仍怀孕的妇女（待产管理组）进行比较。使用综合标准评估孕产妇和新生儿发病率。多变量logistic回归模型调整了产妇特征（体重指数、糖尿病、高血压疾病、疑似巨大儿）和医院状况。结果：在2,948名LUS试验参与者中，2,267名妊娠≥38周且有剖宫产史的初产妇符合条件，1,778名（78.4%）接受了剖宫产后的分娩试验。其中引产372例（20.9%），自然分娩1406例（79.1%）。剖宫产率为44.2%（1,002/2,267）。引产组和待产组在40周0天前各周剖宫产率相似。与41周0天以上的孕妇相比，40周0天至40周6天的引产与剖宫产风险显著降低相关（调整OR 0.66, 95% CI 0.30 -0.87）。39、40或41周引产与孕产妇或新生儿综合发病率增加无关。结论：对于有过一次剖宫产史的妇女，40周引产与41周以上的准产相比，可降低剖宫产的风险，且不会增加产妇或新生儿的不良结局。
{"title":"Impact of labor induction on cesarean risk and maternal-fetal outcomes by gestational age in primiparas with a previous cesarean delivery: LUSTrial secondary analysis.","authors":"Claire Thuillier, Anne-Sophie Boucherie, Juliette François, Anne Rousseau, Patrick Rozenberg, Thibaud Quibel","doi":"10.1016/j.ajogmf.2026.101903","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.101903","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing of delivery after a prior cesarean is debated. Induction of labor may reduce the risk of repeat cesarean delivery, but its safety remains unclear.</p><p><strong>Objective: </strong>To assess the risks of cesarean delivery and maternal-neonatal morbidity associated with induction of labor versus expectant management from 38 weeks gestation onward in primiparous women with one prior cesarean delivery.</p><p><strong>Study design: </strong>This secondary analysis of the randomized LUS Trial included primiparous women eligible for a trial of labor after cesarean from 38 weeks and 0 days. Cesarean delivery rates and maternal-fetal morbidity were compared according to the intended management strategy: induction of labor or expectant management. Comparisons were made between women who underwent induction of labor at a specific gestational week and those who remained pregnant at the end of that week (expectant management group). Maternal and neonatal morbidities were assessed using composite criteria. Multivariable logistic regression models were adjusted for maternal characteristics (body mass index, diabetes, hypertensive disorders, suspected macrosomia) and hospital status.</p><p><strong>Results: </strong>Among the 2,948 LUS Trial participants, 2,267 primiparous women at ≥ 38 weeks of gestation with a prior cesarean delivery were eligible and 1,778 (78.4%) underwent a trial of labor after cesarean. Among them, 372 (20.9%) had an induction of labor and 1,406 (79.1%) had a spontaneous labor. The cesarean delivery rate was 44.2% (1,002/2,267) in the overall population. Cesarean delivery rates were similar in the induction of labor and expectant management groups week-by-week before 40 weeks 0 days. Induction of labor between 40 weeks 0 days and 40 weeks 6 days was associated with a significant lower cesarean delivery risk compared to expectant management beyond 41 weeks 0 days (adjusted OR 0.66, 95% CI 0.30 -0.87). Induction of labor at 39, 40, or 41 weeks was not associated with an increased composite maternal or neonatal morbidity.</p><p><strong>Conclusion: </strong>In women with one prior cesarean delivery, induction of labor at 40 weeks compared with expectant management beyond 41 weeks reduces the cesarean delivery risk without increasing adverse maternal or neonatal outcomes.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101903"},"PeriodicalIF":3.1,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094388","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 : 2026-01-28DOI: 10.1016/j.ajogmf.2026.101905
Jamie A Green, Frank I Jackson, Sarah H Abelman, Nathan A Keller, Matthew J Blitz
<p><strong>Background: </strong>Racial and ethnic disparities in preterm birth persist despite advances in prevention. Cervical length screening and cerclage placement are established strategies for reducing recurrent spontaneous preterm birth (sPTB), yet it remains unclear whether access to and use of these interventions differ by race and ethnicity or contribute to observed disparities in outcomes.</p><p><strong>Objective: </strong>To evaluate racial and ethnic differences in early cervical length screening, cerclage placement, and preterm birth outcomes among patients with a history of sPTB.</p><p><strong>Study design: </strong>This retrospective cohort study included patients with two deliveries between January 2019 and December 2024 within a large academic health system. The first delivery resulted in an sPTB, and the second was used to evaluate preventive care and outcomes. The primary exposures were self-reported race and ethnicity; the primary outcomes were early cervical length screening, cerclage placement, and sPTB in the subsequent pregnancy. Early cervical length screening was defined as having at least one cervical length measurement obtained via transvaginal ultrasound between 16 0/7 and 18 6/7 weeks of gestation. Multivariable logistic regression was used to assess associations after adjustment for sociodemographic and clinical factors, including obstetric comorbidity index score, prior sPTB <34 weeks, public insurance, and preferred language.</p><p><strong>Results: </strong>In total, 924 patients were included for analysis. Overall, 31.5% (n=291) of patients underwent early cervical length screening, and 8.0% (n=74) received a cerclage. Non-Hispanic Black patients were more likely to receive early screening than non-Hispanic White patients (aOR 1.84, 95% CI 1.17-2.87) and had higher odds of cerclage placement (aOR 5.67, 95% CI 2.69-12.74). Patients with an index sPTB <34 weeks were significantly more likely to undergo early screening (aOR 2.85, 95% CI 2.07-3.93) and cerclage placement (aOR 10.76, 95% CI 5.83-21.27). Non-Hispanic Black patients also had higher odds of short cervix compared with non-Hispanic White patients (aOR 3.23, 95% CI 1.17-9.91). Across the full cohort, preterm birth occurred in 26.1% of deliveries, with higher rates among non-Hispanic Black than non-Hispanic White patients (33.6% vs 17.4%; aOR 1.70, 95% CI 1.05-2.43). However, among patients who received early cervical length screening, rates of preterm and spontaneous preterm birth were similar across racial and ethnic groups.</p><p><strong>Conclusions: </strong>Racial and ethnic differences were identified in early cervical length screening and cerclage placement among patients with a history of sPTB. These differences did not translate into disparities in preterm birth outcomes when early screening and indicated intervention were performed. Consistent and equitable implementation of evidence-based screening and treatment may help reduce racial and ethnic
背景：尽管在预防早产方面取得了进展，但种族和民族差异仍然存在。宫颈长度筛查和环切放置是减少复发性自发性早产（sPTB）的既定策略，但尚不清楚这些干预措施的获取和使用是否因种族和民族而异，或者是否会导致观察到的结果差异。目的：评价sPTB患者早期宫颈长度筛查、环扎术放置和早产结局的种族和民族差异。研究设计：这项回顾性队列研究纳入了一个大型学术卫生系统中2019年1月至2024年12月期间两次分娩的患者。第一次分娩导致sPTB，第二次用于评估预防保健和结果。主要暴露是自我报告的种族和民族；主要结局是早期宫颈长度筛查、环扎术放置和妊娠后的sPTB。早期宫颈长度筛查定义为在妊娠16 0/7周至18 6/7周期间通过经阴道超声获得至少一次宫颈长度测量。采用多变量logistic回归对社会人口学和临床因素（包括产科合并症指数评分、既往sPTB）进行校正后的相关性进行评估。结果：共纳入924例患者进行分析。总体而言，31.5% （n=291）的患者接受了早期宫颈长度筛查，8.0% （n=74）的患者接受了环扎术。非西班牙裔黑人患者比非西班牙裔白人患者更有可能接受早期筛查（aOR 1.84, 95% CI 1.17-2.87），并且有更高的环扎置入几率（aOR 5.67, 95% CI 2.69-12.74）。结论：在有sPTB病史的患者中，在早期宫颈长度筛查和环扎术中发现了种族和民族差异。当进行早期筛查和指示性干预时，这些差异并没有转化为早产结局的差异。一致和公平地实施循证筛查和治疗可能有助于减少高危患者中早产的种族和民族差异。
{"title":"Racial and Ethnic Disparities in Early Cervical Length Screening and Spontaneous Preterm Birth.","authors":"Jamie A Green, Frank I Jackson, Sarah H Abelman, Nathan A Keller, Matthew J Blitz","doi":"10.1016/j.ajogmf.2026.101905","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.101905","url":null,"abstract":"<p><strong>Background: </strong>Racial and ethnic disparities in preterm birth persist despite advances in prevention. Cervical length screening and cerclage placement are established strategies for reducing recurrent spontaneous preterm birth (sPTB), yet it remains unclear whether access to and use of these interventions differ by race and ethnicity or contribute to observed disparities in outcomes.</p><p><strong>Objective: </strong>To evaluate racial and ethnic differences in early cervical length screening, cerclage placement, and preterm birth outcomes among patients with a history of sPTB.</p><p><strong>Study design: </strong>This retrospective cohort study included patients with two deliveries between January 2019 and December 2024 within a large academic health system. The first delivery resulted in an sPTB, and the second was used to evaluate preventive care and outcomes. The primary exposures were self-reported race and ethnicity; the primary outcomes were early cervical length screening, cerclage placement, and sPTB in the subsequent pregnancy. Early cervical length screening was defined as having at least one cervical length measurement obtained via transvaginal ultrasound between 16 0/7 and 18 6/7 weeks of gestation. Multivariable logistic regression was used to assess associations after adjustment for sociodemographic and clinical factors, including obstetric comorbidity index score, prior sPTB <34 weeks, public insurance, and preferred language.</p><p><strong>Results: </strong>In total, 924 patients were included for analysis. Overall, 31.5% (n=291) of patients underwent early cervical length screening, and 8.0% (n=74) received a cerclage. Non-Hispanic Black patients were more likely to receive early screening than non-Hispanic White patients (aOR 1.84, 95% CI 1.17-2.87) and had higher odds of cerclage placement (aOR 5.67, 95% CI 2.69-12.74). Patients with an index sPTB <34 weeks were significantly more likely to undergo early screening (aOR 2.85, 95% CI 2.07-3.93) and cerclage placement (aOR 10.76, 95% CI 5.83-21.27). Non-Hispanic Black patients also had higher odds of short cervix compared with non-Hispanic White patients (aOR 3.23, 95% CI 1.17-9.91). Across the full cohort, preterm birth occurred in 26.1% of deliveries, with higher rates among non-Hispanic Black than non-Hispanic White patients (33.6% vs 17.4%; aOR 1.70, 95% CI 1.05-2.43). However, among patients who received early cervical length screening, rates of preterm and spontaneous preterm birth were similar across racial and ethnic groups.</p><p><strong>Conclusions: </strong>Racial and ethnic differences were identified in early cervical length screening and cerclage placement among patients with a history of sPTB. These differences did not translate into disparities in preterm birth outcomes when early screening and indicated intervention were performed. Consistent and equitable implementation of evidence-based screening and treatment may help reduce racial and ethnic ","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101905"},"PeriodicalIF":3.1,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094440","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 : 2026-01-28DOI: 10.1016/j.ajogmf.2026.101895
Andrea Henkel, Amythis Soltani, Samantha Kay Wagner, Kate A Shaw
{"title":"The impact of lactation after loss on reproductive grief: a planned secondary analysis of a randomized trial.","authors":"Andrea Henkel, Amythis Soltani, Samantha Kay Wagner, Kate A Shaw","doi":"10.1016/j.ajogmf.2026.101895","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.101895","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101895"},"PeriodicalIF":3.1,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094348","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 : 2026-01-28DOI: 10.1016/j.ajogmf.2026.101904
Amir Snir, Omri Zamstein, Tamar Wainstock, Eyal Sheiner
{"title":"Small for Gestational Age and Autism Spectrum Disorder in Childhood: Investigating a Potential Contributory Association.","authors":"Amir Snir, Omri Zamstein, Tamar Wainstock, Eyal Sheiner","doi":"10.1016/j.ajogmf.2026.101904","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.101904","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101904"},"PeriodicalIF":3.1,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094374","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 : 2026-01-25DOI: 10.1016/j.ajogmf.2026.101902
Daniel R Liesman, Steven T Papastefan, Manmeet Singh, Amir M Alhajjat, Aimen F Shaaban, Ashish Premkumar
{"title":"Factors Associated with the Uptake of Prenatal Repair for Fetal Myelomeningocele.","authors":"Daniel R Liesman, Steven T Papastefan, Manmeet Singh, Amir M Alhajjat, Aimen F Shaaban, Ashish Premkumar","doi":"10.1016/j.ajogmf.2026.101902","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.101902","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101902"},"PeriodicalIF":3.1,"publicationDate":"2026-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146067362","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 : 2026-01-24DOI: 10.1016/j.ajogmf.2026.101901
Maurizio Di Serio, Enrico Corno, Sara dell'Omo, Patrizia Melioli, Giorgia Contardi, Adriane Nigro, Serena Neri, Tullio Ghi, Andrea Dall'Asta
Objective: To evaluate the correlation between levator ani muscle (LAM) coactivation and labor outcome in a cohort of nulliparous women with singleton gestation at term.
Methods: Single-centre prospective observational study including nulliparous women with low-risk term pregnancy with cephalic presenting fetus enrolled between 39 and 40 weeks of gestation. At routine term obstetric assessment, trained midwives performed transperineal ultrasound on the midsagittal plane to evaluate the antero-posterior diameter of the LAM. The minimal distance between the postero-inferior border of the pubic symphysis and the anterior border of the puborectalis muscle was evaluated at rest and at the acme of a pushing effort. LAM coactivation was defined as a reduction of the antero-posterior diameter of the levator hiatus during the pushing efforts. The primary outcome was to compare the duration of the second stage of labor between coactivating versus non-coactivating women and evaluate the occurrence of composite adverse labor outcome (CAO) as defined by the occurrence of any among episiotomy, vacuum or cesarean delivery for second stage dystocia, obstetric anal sphincter inury (OASI) and severe post-partum hemorrhage.
Results: 201 women were included, of whom 42 (20.9%) had LAM coactivation. Women with LAM coactivation showed longer active second stage duration when compared to the non-coactivation group (84±50 minutes vs 64±45, p=0.02) and higher rates of CAO (31.0% vs 12.5%, p<0.01) and OASI (5.4% vs 0%, p<0.01). LAM coactivation only was associated with composite adverse labor outcome (34.3% vs 18.1%, p<0.01).
Conclusions: Within a population of singleton term pregnancies at low risk the antepartum demonstration of LAM coactivation at TP ultrasound is associated with an increased duration of the second stage of labor and higher frequency of CAO including OASIs.
目的：探讨未生育足月单胎妊娠妇女提肛肌（LAM）协同激活与分娩结局的关系。方法：单中心前瞻性观察研究，纳入孕39 ~ 40周的低危足月未生育且胎儿头位的妇女。在常规的产科评估中，训练有素的助产士在正中矢状面进行经会阴超声来评估LAM的前后直径。耻骨联合后下边界和耻骨直肠肌前边界之间的最小距离在休息和推力的顶点时进行评估。LAM共激活被定义为推入过程中提上睑肌裂孔前后直径减小。主要结局是比较共激活与非共激活妇女的第二阶段分娩持续时间，并评估复合不良分娩结局（CAO）的发生情况，其定义为在会阴切开术、真空或剖宫产中发生任何第二阶段难产、产科肛门括约肌损伤（OASI）和严重产后出血。结果：纳入201例妇女，其中42例（20.9%）发生LAM共激活。与非共激活组相比，LAM共激活组的活跃第二阶段持续时间更长（84±50分钟vs 64±45分钟，p=0.02）， CAO发生率更高（31.0% vs 12.5%）。结论：在低风险单胎足月妊娠人群中，产前超声显示LAM共激活与第二产程持续时间增加和CAO（包括OASIs）频率更高有关。
{"title":"Antepartum two-dimensional sonographic evaluation of levator ani muscle coactivation and correlation with labor outcomes in nulliparous women at term gestation.","authors":"Maurizio Di Serio, Enrico Corno, Sara dell'Omo, Patrizia Melioli, Giorgia Contardi, Adriane Nigro, Serena Neri, Tullio Ghi, Andrea Dall'Asta","doi":"10.1016/j.ajogmf.2026.101901","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2026.101901","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the correlation between levator ani muscle (LAM) coactivation and labor outcome in a cohort of nulliparous women with singleton gestation at term.</p><p><strong>Methods: </strong>Single-centre prospective observational study including nulliparous women with low-risk term pregnancy with cephalic presenting fetus enrolled between 39 and 40 weeks of gestation. At routine term obstetric assessment, trained midwives performed transperineal ultrasound on the midsagittal plane to evaluate the antero-posterior diameter of the LAM. The minimal distance between the postero-inferior border of the pubic symphysis and the anterior border of the puborectalis muscle was evaluated at rest and at the acme of a pushing effort. LAM coactivation was defined as a reduction of the antero-posterior diameter of the levator hiatus during the pushing efforts. The primary outcome was to compare the duration of the second stage of labor between coactivating versus non-coactivating women and evaluate the occurrence of composite adverse labor outcome (CAO) as defined by the occurrence of any among episiotomy, vacuum or cesarean delivery for second stage dystocia, obstetric anal sphincter inury (OASI) and severe post-partum hemorrhage.</p><p><strong>Results: </strong>201 women were included, of whom 42 (20.9%) had LAM coactivation. Women with LAM coactivation showed longer active second stage duration when compared to the non-coactivation group (84±50 minutes vs 64±45, p=0.02) and higher rates of CAO (31.0% vs 12.5%, p<0.01) and OASI (5.4% vs 0%, p<0.01). LAM coactivation only was associated with composite adverse labor outcome (34.3% vs 18.1%, p<0.01).</p><p><strong>Conclusions: </strong>Within a population of singleton term pregnancies at low risk the antepartum demonstration of LAM coactivation at TP ultrasound is associated with an increased duration of the second stage of labor and higher frequency of CAO including OASIs.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101901"},"PeriodicalIF":3.1,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053739","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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