Pub Date : 2025-02-01DOI: 10.1016/j.ajogmf.2025.101625
Kevin Y Xu, Lisa M Pappas, Tashalee R Brown, Madeline O Jansen, Vitor S Tardelli, Thiago M Fidalgo, Frances R Levin, Richard A Grucza, Elizabeth A Suarez, Marcela C Smid, Joshua John Horns, Ann M Bruno
{"title":"Attention-deficit Hyperactivity Disorder Medication Discontinuation During Pregnancy and Resumption Postpartum.","authors":"Kevin Y Xu, Lisa M Pappas, Tashalee R Brown, Madeline O Jansen, Vitor S Tardelli, Thiago M Fidalgo, Frances R Levin, Richard A Grucza, Elizabeth A Suarez, Marcela C Smid, Joshua John Horns, Ann M Bruno","doi":"10.1016/j.ajogmf.2025.101625","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101625","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101625"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123802","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 : 2025-02-01DOI: 10.1016/j.ajogmf.2025.101622
Maura Jones Pullins, Kim A Boggess, Ashley N Battarbee
{"title":"Factors associated with reported low-dose aspirin use and its association with adverse outcomes: secondary analysis of the Medical Optimization of Management of Overt Type 2 Diabetes in Pregnancy (MOMPOD) Study.","authors":"Maura Jones Pullins, Kim A Boggess, Ashley N Battarbee","doi":"10.1016/j.ajogmf.2025.101622","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101622","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101622"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123805","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 : 2025-02-01DOI: 10.1016/j.ajogmf.2024.101597
John R. Rees MD, Lisa D. Levine MD, MSCE, Yuli Y. Kim MD, Jennifer A. McCoy MD, MSCE
{"title":"Cardiac and obstetric outcomes among congenital heart disease patients with repeat pregnancies","authors":"John R. Rees MD, Lisa D. Levine MD, MSCE, Yuli Y. Kim MD, Jennifer A. McCoy MD, MSCE","doi":"10.1016/j.ajogmf.2024.101597","DOIUrl":"10.1016/j.ajogmf.2024.101597","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101597"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928362","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}
Preclinical studies have documented the role of alpha-adrenergic agonists in myometrial contraction. Phenylephrine is frequently used to prevent and treat post-spinal hypotension during cesarean delivery. We hypothesized phenylephrine would reduce postpartum blood loss due to alpha-1 receptor-mediated uterine and vascular smooth muscle contraction.
Objectives
This translational study aimed to evaluate the role of phenylephrine in reducing postpartum blood loss due to alpha-1 receptor mediated uterine and vascular smooth muscle contraction.
Methods
This was a prospective, randomized, placebo-controlled, blinded, pilot, clinical trial. Low-risk parturients undergoing cesarean delivery under spinal anesthesia were recruited in this study. The women were randomized to receive phenylephrine or placebo (normal saline) infusion. Each mL of phenylephrine contained 60 micrograms. The study drug began simultaneously with the start of spinal anesthesia, and was stopped at the end of surgery. The infusion rate was started at 50 mcg/min and was titrated to maintain the systolic blood pressure between 80% and 120 % of baseline. The primary outcome measure was postpartum blood loss till 24 hours postpartum, and it was assessed using a surgical swab weighing technique added to suction canister blood contents. The secondary outcomes were incidence of hypertension, hypotension, Apgar score, cord blood gas analysis and neonatal intensive care unit admission (NICU) admission.
Results
One hundred six women received study drugs and were eligible for final analysis. The demographic data, obstetric profiles, and medications were comparable. In the phenylephrine group, the mean postpartum blood loss (median [interquartile range]) was significantly lower ([420 {349–502} vs 494 {397–600} mL; p=.009]). Additionally, a significantly lower number of women had >500 mL of blood loss in the phenylephrine group (26.4% vs 47.1%; p=.02). Furthermore, more women in the control arm needed blood transfusion (37.7% vs 16.9%; p=.01). Six women each had bradycardia and hypertension in the phenylephrine group. NICU admission, Apgar score, and umbilical artery PH were comparable.
Conclusion
Continuous phenylephrine infusion led to a statistically significant but clinically inconsequential reduction in postpartum blood loss in low-risk parturients undergoing cesarean delivery under spinal anesthesia.
背景：临床前研究已经证实了α -肾上腺素能激动剂在子宫肌收缩中的作用。苯肾上腺素常用于预防和治疗剖宫产时脊柱后低血压。我们假设苯肾上腺素可以减少产后因α -1受体介导的子宫和血管平滑肌收缩引起的失血。目的：本转化性研究旨在评估苯肾上腺素在减少产后因α -1受体介导的子宫和血管平滑肌收缩引起的失血中的作用。方法：这是一项前瞻性、随机、安慰剂对照、盲法、先导临床试验。本研究招募脊髓麻醉下剖宫产的低危产妇。这些妇女随机接受肾上腺素或安慰剂（生理盐水）输注。每毫升苯肾上腺素含有60微克。研究药物与脊髓麻醉同时开始，并在手术结束时停止。开始滴注速度为50微克/分钟，并滴定以维持收缩压在基线的80- 120%之间。主要结局指标为产后失血量，直至产后24小时，并使用手术拭子称重技术与吸盘血含量进行评估。次要结局为高血压、低血压发生率、Apgar评分、脐带血气分析及新生儿重症监护病房（NICU）入院情况。结果：106名妇女接受了研究药物，符合最终分析的条件。人口统计数据、产科概况和药物具有可比性。在苯肾上腺素组，平均产后出血量{中位数（四分位数范围）}显著降低{(420 (349-502)vs 494 (397-600) ml；p = 0.009)}。此外，在苯肾上腺素组中，失血量达到500ml的女性人数明显减少(26.4% vs 47.1%；p = 0.02)。此外，对照组中需要输血的妇女更多(37.7% vs 16.9%；p = 0.01)。在使用苯肾上腺素的组中，有6名女性分别出现了心动过缓和高血压。NICU入院、Apgar评分和脐动脉PH具有可比性。结论：持续输注苯肾上腺素可显著降低腰麻下剖宫产低危产妇的产后出血量。
{"title":"Effect of phenylephrine infusion on postpartum blood loss after cesarean delivery: a placebo-controlled, randomized clinical trial","authors":"Sanjeeth Raguramane MBBS , Sandeep Kumar Mishra MBBS, MD , Nivedita Jha MBBS, MS , Satyen Parida MBBS, MD , Ajay Kumar Jha MD, DM","doi":"10.1016/j.ajogmf.2024.101593","DOIUrl":"10.1016/j.ajogmf.2024.101593","url":null,"abstract":"<div><h3>Background</h3><div>Preclinical studies have documented the role of alpha-adrenergic agonists in myometrial contraction. Phenylephrine is frequently used to prevent and treat post-spinal hypotension during cesarean delivery. We hypothesized phenylephrine would reduce postpartum blood loss due to alpha-1 receptor-mediated uterine and vascular smooth muscle contraction.</div></div><div><h3>Objectives</h3><div>This translational study aimed to evaluate the role of phenylephrine in reducing postpartum blood loss due to alpha-1 receptor mediated uterine and vascular smooth muscle contraction.</div></div><div><h3>Methods</h3><div>This was a prospective, randomized, placebo-controlled, blinded, pilot, clinical trial<strong>.</strong> Low-risk parturients undergoing cesarean delivery under spinal anesthesia were recruited in this study. The women were randomized to receive phenylephrine or placebo (normal saline) infusion. Each mL of phenylephrine contained 60 micrograms. The study drug began simultaneously with the start of spinal anesthesia, and was stopped at the end of surgery. The infusion rate was started at 50 mcg/min and was titrated to maintain the systolic blood pressure between 80% and 120 % of baseline. The primary outcome measure was postpartum blood loss till 24 hours postpartum, and it was assessed using a surgical swab weighing technique added to suction canister blood contents. The secondary outcomes were incidence of hypertension, hypotension, Apgar score, cord blood gas analysis and neonatal intensive care unit admission (NICU) admission.</div></div><div><h3>Results</h3><div>One hundred six women received study drugs and were eligible for final analysis. The demographic data, obstetric profiles, and medications were comparable. In the phenylephrine group, the mean postpartum blood loss (median [interquartile range]) was significantly lower ([420 {349–502} vs 494 {397–600} mL; <em>p=.009</em>]). Additionally, a significantly lower number of women had >500 mL of blood loss in the phenylephrine group (26.4% vs 47.1%; <em>p=.02</em>). Furthermore, more women in the control arm needed blood transfusion (37.7% vs 16.9%; <em>p=.01</em>). Six women each had bradycardia and hypertension in the phenylephrine group. NICU admission, Apgar score, and umbilical artery PH were comparable.</div></div><div><h3>Conclusion</h3><div>Continuous phenylephrine infusion led to a statistically significant but clinically inconsequential reduction in postpartum blood loss in low-risk parturients undergoing cesarean delivery under spinal anesthesia.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101593"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955920","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 : 2025-02-01DOI: 10.1016/j.ajogmf.2024.101594
Joyce H. Xu BA, Heather N. Czarny MD, Isabella Toledo MD, Carri R. Warshak MD, Emily A. DeFranco DO, MS, Robert M. Rossi MD
<div><h3>Background</h3><div>Chronic kidney disease is a significant cause of adverse obstetric outcomes. However, there are few studies assessing the risk of severe maternal morbidity and mortality among patients with chronic kidney disease and no studies assessing the association between individual indicators of severe maternal morbidity and chronic kidney disease.</div></div><div><h3>Objective</h3><div>To evaluate the risk of severe maternal morbidity and mortality among pregnant patients with chronic kidney disease.</div></div><div><h3>Study Design</h3><div>This was a population-based, retrospective cohort study including U.S. delivery hospitalizations from 2010−2020 utilizing the Healthcare Cost & Utilization Project National Inpatient Sample database. Patients were identified as having a delivery hospitalization, chronic kidney disease, and severe maternal morbidity using International Classification Diagnoses codes (9<sup>th</sup> and 10<sup>th</sup> edition). The primary outcomes were severe maternal morbidity and mortality, as defined according to the Centers for Disease Control and Prevention criteria. Multivariate logistic regression analyses were performed to estimate adjusted relative risk and 95% confidence intervals of severe maternal morbidity and mortality among patients with chronic kidney disease. Subgroup analyses were performed by chronic kidney disease etiology, stage, race and ethnicity, and individual indicators of severe maternal morbidity.</div></div><div><h3>Results</h3><div>Among the 38,374,326 parturients in this study, 95,272 (0.2%) had chronic kidney disease. The risk of severe maternal morbidity was higher for those with chronic kidney disease (12.2% vs 0.7%, aRR 6.4, 95% CI 6.0−6.8) compared to those without. Among severe maternal morbidity indicators, those with chronic kidney disease were at highest risk for acute renal failure (aRR 21.7, 95% CI 19.8−23.7) and sepsis (aRR 9.0, 95% CI 7.6−10.5). Chronic kidney disease was also associated with an increased risk of maternal death (aRR 4.1, 95% CI 2.9−5.8). Black individuals had higher adjusted population attributable fraction (aPAF) between severe maternal morbidity and chronic kidney disease (aPAF 4.0%, 95% CI 3.6−4.3). Increased risk of severe maternal morbidity was associated with all chronic kidney disease subtypes, stages, and a history of renal transplant. Maternal death was significantly associated with diabetic nephropathy, renovascular, and obstructive or unspecified renal disease (aRR 7.3−14.1), as well as stages 3−5 of chronic kidney disease and a history of renal transplant (aRR 15.5−32.6). Risk of severe maternal morbidity and mortality were similar in those with a history of renal transplant and those with stage 1 chronic kidney disease. The number needed to treat with renal transplant to prevent 1 severe maternal morbidity event or maternal death in those with stages 3−5 chronic kidney disease was 2.6 (95% CI 2.4−2.9) and 45.0 (95% CI 31.0−82.0),
背景：慢性肾脏疾病是不良产科结局的重要原因。然而，很少有研究评估慢性肾脏疾病患者严重产妇发病率和死亡率的风险，也没有研究评估严重产妇发病率和慢性肾脏疾病的个体指标之间的关系。目的：探讨慢性肾脏病孕妇严重孕产妇发病和死亡的风险。研究设计：这是一项基于人群的回顾性队列研究，包括2010-2020年美国分娩住院病例，利用医疗成本和利用项目国家住院患者样本数据库。使用国际分类诊断代码（第9版和第10版）确定患者为分娩住院、慢性肾脏疾病和严重孕产妇发病率。根据疾病控制和预防中心的标准，主要结果是严重的产妇发病率和死亡率。采用多变量logistic回归分析来估计慢性肾病患者严重产妇发病率和死亡率的校正相对危险度和95%置信区间。根据慢性肾脏疾病的病因、分期、种族和民族以及严重产妇发病率的个体指标进行亚组分析。结果：在本研究的38,374,326例产妇中，95272例（0.2%）患有慢性肾脏疾病。慢性肾脏疾病患者发生严重孕产妇发病的风险高于无慢性肾脏疾病患者（12.2% vs 0.7%, aRR 6.4, 95% CI 6.0-6.8）。在严重的孕产妇发病率指标中，慢性肾脏疾病患者发生急性肾功能衰竭（aRR 21.7, 95% CI 19.8-23.7）和脓毒症（aRR 9.0, 95% CI 7.6-10.5）的风险最高。慢性肾脏疾病也与孕产妇死亡风险增加相关（aRR 4.1, 95% CI 2.9-5.8）。黑人在严重产妇发病率和慢性肾脏疾病之间有较高的调整人群归因分数（aPAF） （aPAF 4.0%, 95% CI 3.6-4.3）。重度孕产妇发病风险的增加与所有慢性肾脏疾病亚型、分期和肾移植史相关。产妇死亡与糖尿病肾病、肾血管性疾病、梗阻性或未明确的肾脏疾病（aRR 7.3-14.1）以及慢性肾脏疾病3-5期和肾移植史（aRR 15.5-32.6）显著相关。有肾移植史和1期慢性肾脏病患者的严重产妇发病率和死亡率风险相似。在3-5期慢性肾脏疾病患者中，需要进行肾移植治疗以预防一次严重孕产妇发病事件或孕产妇死亡的人数分别为2.6 （95% CI 2.4-2.9）和45.0 （95% CI 31.0-82.0）。结论：妊娠期慢性肾脏疾病与严重的孕产妇发病率、死亡率和其他不良围产期结局显著相关，需要在妊娠期密切监测和多学科管理。
{"title":"Risk of severe maternal morbidity and mortality among pregnant patients with chronic kidney disease","authors":"Joyce H. Xu BA, Heather N. Czarny MD, Isabella Toledo MD, Carri R. Warshak MD, Emily A. DeFranco DO, MS, Robert M. Rossi MD","doi":"10.1016/j.ajogmf.2024.101594","DOIUrl":"10.1016/j.ajogmf.2024.101594","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease is a significant cause of adverse obstetric outcomes. However, there are few studies assessing the risk of severe maternal morbidity and mortality among patients with chronic kidney disease and no studies assessing the association between individual indicators of severe maternal morbidity and chronic kidney disease.</div></div><div><h3>Objective</h3><div>To evaluate the risk of severe maternal morbidity and mortality among pregnant patients with chronic kidney disease.</div></div><div><h3>Study Design</h3><div>This was a population-based, retrospective cohort study including U.S. delivery hospitalizations from 2010−2020 utilizing the Healthcare Cost & Utilization Project National Inpatient Sample database. Patients were identified as having a delivery hospitalization, chronic kidney disease, and severe maternal morbidity using International Classification Diagnoses codes (9<sup>th</sup> and 10<sup>th</sup> edition). The primary outcomes were severe maternal morbidity and mortality, as defined according to the Centers for Disease Control and Prevention criteria. Multivariate logistic regression analyses were performed to estimate adjusted relative risk and 95% confidence intervals of severe maternal morbidity and mortality among patients with chronic kidney disease. Subgroup analyses were performed by chronic kidney disease etiology, stage, race and ethnicity, and individual indicators of severe maternal morbidity.</div></div><div><h3>Results</h3><div>Among the 38,374,326 parturients in this study, 95,272 (0.2%) had chronic kidney disease. The risk of severe maternal morbidity was higher for those with chronic kidney disease (12.2% vs 0.7%, aRR 6.4, 95% CI 6.0−6.8) compared to those without. Among severe maternal morbidity indicators, those with chronic kidney disease were at highest risk for acute renal failure (aRR 21.7, 95% CI 19.8−23.7) and sepsis (aRR 9.0, 95% CI 7.6−10.5). Chronic kidney disease was also associated with an increased risk of maternal death (aRR 4.1, 95% CI 2.9−5.8). Black individuals had higher adjusted population attributable fraction (aPAF) between severe maternal morbidity and chronic kidney disease (aPAF 4.0%, 95% CI 3.6−4.3). Increased risk of severe maternal morbidity was associated with all chronic kidney disease subtypes, stages, and a history of renal transplant. Maternal death was significantly associated with diabetic nephropathy, renovascular, and obstructive or unspecified renal disease (aRR 7.3−14.1), as well as stages 3−5 of chronic kidney disease and a history of renal transplant (aRR 15.5−32.6). Risk of severe maternal morbidity and mortality were similar in those with a history of renal transplant and those with stage 1 chronic kidney disease. The number needed to treat with renal transplant to prevent 1 severe maternal morbidity event or maternal death in those with stages 3−5 chronic kidney disease was 2.6 (95% CI 2.4−2.9) and 45.0 (95% CI 31.0−82.0),","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101594"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928375","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 : 2025-02-01DOI: 10.1016/j.ajogmf.2025.101621
Joanna Sichitiu, Elina Vlachodimitropoulou, Patrick Shannon, E J T Verweij, Shiri Shinar, Greg Ryan, Susan Blaser, Pradeep Krishnan, Tim VAN Mieghem
{"title":"Periventricular echogenicity in fetuses with Hb Bart's disease: a potential sonographic marker: Periventricular Echogenicity in Hb Bart's disease.","authors":"Joanna Sichitiu, Elina Vlachodimitropoulou, Patrick Shannon, E J T Verweij, Shiri Shinar, Greg Ryan, Susan Blaser, Pradeep Krishnan, Tim VAN Mieghem","doi":"10.1016/j.ajogmf.2025.101621","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101621","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101621"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123806","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 : 2025-02-01DOI: 10.1016/j.ajogmf.2024.101592
Thomas P. Kishkovich MD, Abigail M. Kempf MD, Andrea Pelletier MPH, MS, Nicole M. Patton PA-C, Michaela K. Farber MD, MS, Nicole A. Smith MD, MPH
{"title":"Obstetric care consensus criteria are superior to ICD-10 codes for identifying several maternal renal morbidity","authors":"Thomas P. Kishkovich MD, Abigail M. Kempf MD, Andrea Pelletier MPH, MS, Nicole M. Patton PA-C, Michaela K. Farber MD, MS, Nicole A. Smith MD, MPH","doi":"10.1016/j.ajogmf.2024.101592","DOIUrl":"10.1016/j.ajogmf.2024.101592","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101592"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923509","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 : 2025-02-01DOI: 10.1016/j.ajogmf.2024.101595
Sascha Wodoslawsky MD , Kavisha Khanuja MD , Gabriele Saccone MD , Matthew K. Hoffman MD , Vincenzo Berghella MD
Objective
To assess the efficacy of low-dose aspirin in the prevention of adverse outcomes in low-risk, nulliparous singleton pregnancies.
Data Sources
PubMed, Ovid MEDLINE, Scopus, Cochrane Library, clinicaltrials.gov, and ScienceDirect were searched from their inception to August 5, 2023.
Eligibility criteria for selecting studies
Randomized clinical trials comparing low-dose aspirin with placebo or with no treatment in low-risk nulliparous singleton pregnancies were included. High-risk pregnancies, including prior preterm birth, prior preeclampsia, and those affected by maternal diabetes or chronic hypertension were excluded.
Data appraisal and synthesis methods
The primary outcome was the incidence of preterm delivery at less than 37 weeks. The summary measures were reported as relative risk (RR) or as mean difference (MD) with a 95% confidence interval (CI).
Results
Ten trials, including 27,075 nulliparous low-risk pregnancies, were included. Overall, low-dose aspirin was associated with no significant differences in preterm birth less than 37 weeks (RR 0.90, 95% CI 0.73−1.09) and less than 34 weeks (RR 0.62, 95% CI 0.37−1.05) compared to control. Patients who took 100 mg daily of aspirin prior to 16 weeks had a significantly lower risk of preterm birth at less than 37 weeks (RR: 0.45, 95% CI: 0.35−0.59), as did, to a lower magnitude, those who began aspirin 100 mg daily after 16 weeks (RR: 0.88, 95% CI: 0.80−0.97). Those who took 100 mg daily of aspirin were at a lower risk of preterm birth at less than 37 weeks than those who took between 60 and 81 mg of daily aspirin (RR: 0.39, 95% CI: 0.31−0.48). No statistically significant differences were found in the incidence of hypertensive disorders of pregnancy, perinatal or neonatal death.
Conclusions
Low-dose aspirin at 100 mg daily reduces the incidence of preterm birth at less than 37 weeks in low-risk, nulliparous pregnancies and may be most helpful if initiated prior to 16 weeks.
目的：评价低剂量阿司匹林预防低危、无产单胎妊娠不良结局的疗效。数据来源：PubMed、Ovid MEDLINE、Scopus、Cochrane Library、clinicaltrials.gov和ScienceDirect，检索时间从网站成立到2023年8月5日。入选标准：纳入了低风险无产单胎妊娠中比较低剂量阿司匹林与安慰剂或不治疗的随机临床试验。排除高危妊娠，包括早产、先兆子痫，以及受母体糖尿病或慢性高血压影响的孕妇。数据评估和综合方法：主要观察指标为小于37周的早产发生率。总结测量结果以相对危险度（RR）或平均差值（MD）报告，置信区间为95%。结果：纳入了10项试验，包括27,075例无产低危妊娠。总体而言，与对照组相比，低剂量阿司匹林与小于37周（RR 0.90, 95% CI 0.73至1.09）和小于34周（RR 0.62, 95% CI 0.37至1.05）的早产无显著差异。16周前每天服用100毫克阿司匹林的患者在37周内早产的风险显著降低（RR 0.45, 95% CI 0.35至0.59），16周后每天服用100毫克阿司匹林的患者的早产风险也显著降低（RR 0.88, 95% CI 0.80至0.97）。与每天服用60-81毫克阿司匹林的孕妇相比，每天服用100毫克阿司匹林的孕妇在37周内早产的风险较低（RR 0.39, 95% CI 0.31至0.48）。妊娠期高血压疾病、围产期高血压疾病和新生儿死亡的发生率差异无统计学意义。结论：低剂量阿司匹林每日100mg可降低低风险、无产妊娠37周以下早产的发生率，如果在16周之前开始服用可能最有帮助。
{"title":"Low-dose aspirin use in low-risk nulliparous pregnancies: a systematic review and meta-analysis of randomized controlled trials","authors":"Sascha Wodoslawsky MD , Kavisha Khanuja MD , Gabriele Saccone MD , Matthew K. Hoffman MD , Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2024.101595","DOIUrl":"10.1016/j.ajogmf.2024.101595","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the efficacy of low-dose aspirin in the prevention of adverse outcomes in low-risk, nulliparous singleton pregnancies.</div></div><div><h3>Data Sources</h3><div>PubMed, Ovid MEDLINE, Scopus, Cochrane Library, clinicaltrials.gov, and ScienceDirect were searched from their inception to August 5, 2023.</div></div><div><h3>Eligibility criteria for selecting studies</h3><div>Randomized clinical trials comparing low-dose aspirin with placebo or with no treatment in low-risk nulliparous singleton pregnancies were included. High-risk pregnancies, including prior preterm birth, prior preeclampsia, and those affected by maternal diabetes or chronic hypertension were excluded.</div></div><div><h3>Data appraisal and synthesis methods</h3><div>The primary outcome was the incidence of preterm delivery at less than 37 weeks. The summary measures were reported as relative risk (RR) or as mean difference (MD) with a 95% confidence interval (CI).</div></div><div><h3>Results</h3><div>Ten trials, including 27,075 nulliparous low-risk pregnancies, were included. Overall, low-dose aspirin was associated with no significant differences in preterm birth less than 37 weeks (RR 0.90, 95% CI 0.73−1.09) and less than 34 weeks (RR 0.62, 95% CI 0.37−1.05) compared to control. Patients who took 100 mg daily of aspirin prior to 16 weeks had a significantly lower risk of preterm birth at less than 37 weeks (RR: 0.45, 95% CI: 0.35−0.59), as did, to a lower magnitude, those who began aspirin 100 mg daily after 16 weeks (RR: 0.88, 95% CI: 0.80−0.97). Those who took 100 mg daily of aspirin were at a lower risk of preterm birth at less than 37 weeks than those who took between 60 and 81 mg of daily aspirin (RR: 0.39, 95% CI: 0.31−0.48). No statistically significant differences were found in the incidence of hypertensive disorders of pregnancy, perinatal or neonatal death.</div></div><div><h3>Conclusions</h3><div>Low-dose aspirin at 100 mg daily reduces the incidence of preterm birth at less than 37 weeks in low-risk, nulliparous pregnancies and may be most helpful if initiated prior to 16 weeks.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101595"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928365","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 : 2025-02-01DOI: 10.1016/j.ajogmf.2025.101603
Stephanie A. Fisher MD, MPH, Alan M. Peaceman MD, Lynn M. Yee MD, MPH
{"title":"Association of omega-3 fatty acid supplementation with recurrent preterm birth by obesity status","authors":"Stephanie A. Fisher MD, MPH, Alan M. Peaceman MD, Lynn M. Yee MD, MPH","doi":"10.1016/j.ajogmf.2025.101603","DOIUrl":"10.1016/j.ajogmf.2025.101603","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101603"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013214","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 : 2025-02-01DOI: 10.1016/j.ajogmf.2024.101579
Krishnan Yunesh MBBS, Aizura Syafinaz Ahmad Adlan MObGyn, Thai Ying Wong MRCOG, Farah Gan MObGyn, Mukhri Hamdan MObGyn, PhD, Peng Chiong Tan FRCOG, PhD
<div><h3>BACKGROUND</h3><div>Induction of labor after 1 previous cesarean delivery with an unripe cervix have an especially high risk for unplanned cesarean delivery and uterine rupture. Mechanical balloon ripening is often preferred over prostaglandin-based ripening during induction of labor after 1 previous cesarean delivery, because uterine rupture has been associated with prostaglandin use. The transcervical Foley balloon can be dislodged past the ripened cervix and be retained comfortably in the vagina during passive placement. Tugging of the Foley catheter can be a noninvasive and tolerated method for timelier retrieval of the retained balloon; expediting discovery of a ripened cervix would permit an earlier follow-on amniotomy and oxytocin infusion, thereby hastening birth.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to evaluate the effect of tugging of the Foley balloon for 30 seconds every 3 hours during 12 hours of scheduled placement in comparison with standard care (no tugging) on the induction to birth interval and patient satisfaction.</div></div><div><h3>STUDY DESIGN</h3><div>This randomized controlled trial, conducted at a university hospital in Malaysia, recruited participants from April 2023 to March 2024. Eligible participants admitted for Foley balloon induction of labor who had 1 previous cesarean were recruited. After balloon insertion, participants were randomized to tugging or standard care. Following balloon displacement, a vaginal examination was performed to check the cervix. The examination findings then dictated the follow-on management of induction of labor after 1 previous cesarean according to standard practice. The primary outcomes were the induction (Foley insertion) to delivery interval and participants’ satisfaction with the birthing process. Secondary outcomes were largely derived from the core outcome set for trials on induction of labor. Based on a superiority hypothesis, it was calculated that a sample size of 126 would be required to detect a 4-hour reduction in the induction-to-delivery interval and a 1.5 point increase in the satisfaction score based on a 0 to 10 numerical rating scale with the level of significance set at 0.05, power at 80%, and a 10% drop out rate. Comparative analyses using an intention-to-treat approach were conducted using <em>t</em> tests, Mann-Whitney U tests, chi square tests, and Fisher exact tests as appropriate.</div></div><div><h3>RESULTS</h3><div>A total of 126 participants were randomized with 63 in each trial arm. The induction to birth interval was (mean ± standard deviation) 29.7±9.6 hours for those in the 3-hourly tugging group and 29.8±9.1 hours for those under standard care (<em>P</em>=.950), and maternal satisfaction with the induction of labor after 1 previous cesarean delivery birth process, assessed using a 0 to 10 numerical rating scale, was (median [interquartile range]) 8 [7–9] and 8 [7–9] (<em>P</em>=.936), respectively. The cesarean delivery rate
{"title":"Tugging the Foley catheter balloon every three hours in induction of labor after one previous cesarean: a randomized controlled trial","authors":"Krishnan Yunesh MBBS, Aizura Syafinaz Ahmad Adlan MObGyn, Thai Ying Wong MRCOG, Farah Gan MObGyn, Mukhri Hamdan MObGyn, PhD, Peng Chiong Tan FRCOG, PhD","doi":"10.1016/j.ajogmf.2024.101579","DOIUrl":"10.1016/j.ajogmf.2024.101579","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Induction of labor after 1 previous cesarean delivery with an unripe cervix have an especially high risk for unplanned cesarean delivery and uterine rupture. Mechanical balloon ripening is often preferred over prostaglandin-based ripening during induction of labor after 1 previous cesarean delivery, because uterine rupture has been associated with prostaglandin use. The transcervical Foley balloon can be dislodged past the ripened cervix and be retained comfortably in the vagina during passive placement. Tugging of the Foley catheter can be a noninvasive and tolerated method for timelier retrieval of the retained balloon; expediting discovery of a ripened cervix would permit an earlier follow-on amniotomy and oxytocin infusion, thereby hastening birth.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to evaluate the effect of tugging of the Foley balloon for 30 seconds every 3 hours during 12 hours of scheduled placement in comparison with standard care (no tugging) on the induction to birth interval and patient satisfaction.</div></div><div><h3>STUDY DESIGN</h3><div>This randomized controlled trial, conducted at a university hospital in Malaysia, recruited participants from April 2023 to March 2024. Eligible participants admitted for Foley balloon induction of labor who had 1 previous cesarean were recruited. After balloon insertion, participants were randomized to tugging or standard care. Following balloon displacement, a vaginal examination was performed to check the cervix. The examination findings then dictated the follow-on management of induction of labor after 1 previous cesarean according to standard practice. The primary outcomes were the induction (Foley insertion) to delivery interval and participants’ satisfaction with the birthing process. Secondary outcomes were largely derived from the core outcome set for trials on induction of labor. Based on a superiority hypothesis, it was calculated that a sample size of 126 would be required to detect a 4-hour reduction in the induction-to-delivery interval and a 1.5 point increase in the satisfaction score based on a 0 to 10 numerical rating scale with the level of significance set at 0.05, power at 80%, and a 10% drop out rate. Comparative analyses using an intention-to-treat approach were conducted using <em>t</em> tests, Mann-Whitney U tests, chi square tests, and Fisher exact tests as appropriate.</div></div><div><h3>RESULTS</h3><div>A total of 126 participants were randomized with 63 in each trial arm. The induction to birth interval was (mean ± standard deviation) 29.7±9.6 hours for those in the 3-hourly tugging group and 29.8±9.1 hours for those under standard care (<em>P</em>=.950), and maternal satisfaction with the induction of labor after 1 previous cesarean delivery birth process, assessed using a 0 to 10 numerical rating scale, was (median [interquartile range]) 8 [7–9] and 8 [7–9] (<em>P</em>=.936), respectively. The cesarean delivery rate ","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101579"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824647","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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