American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"The association between first trimester physical activity levels and perinatal outcomes.","authors":"Virginia Y Watkins, Peinan Zhao, Antonina I Frolova, Ebony B Carter, Jeannie C Kelly, Anthony O Odibo, Sarah K England, Nandini Raghuraman","doi":"10.1016/j.ajogmf.2024.101534","DOIUrl":"10.1016/j.ajogmf.2024.101534","url":null,"abstract":"<p><strong>Objective: </strong>Physical activity in pregnancy decreases the risk of adverse maternal and neonatal outcomes. This study evaluates the association between first trimester physical activity, assessed by Kaiser Physical Activity Survey (KPAS) scores, and adverse perinatal outcomes.</p><p><strong>Study design: </strong>This is a secondary analysis of a prospective cohort study in which patients were administered the KPAS in each trimester. The primary outcomes were birthweight, large for gestational age (LGA), and small for gestational age (SGA) neonates. Secondary outcomes were composite neonatal morbidity (neonatal acidemia with pH<7.1, hypoxic ischemic encephalopathy, mechanical ventilation, hypoglycemia, and suspected sepsis), gestational diabetes, gestational hypertension, preeclampsia, inadequate and excess gestational weight gain. Outcomes were compared between patients with and without high physical activity levels during early pregnancy, defined as 1st trimester KPAS scores ≥75th percentile and <75th percentile, respectively. Multivariable logistic regression was used to adjust for confounders.</p><p><strong>Results: </strong>A total of 1,045 patients with a complete 1st trimester KPAS were included in this analysis and 262 patients were in the top quartile of physical activity levels in early pregnancy. Higher physical activity levels in the 1st trimester were associated with numerically but not clinically significantly higher birthweights (3191.3±696.1 vs 3076.3±719.8 g, P=.03) with no difference in rates of SGA (10.3% vs 13.3%, P=.25, aRR 0.79; 95% CI 0.52, 1.16) or LGA neonates (8.0% vs 7.3%, P=.80, aRR 1.14; 95% CI 0.68, 1.81). Higher physical activity levels were associated with decreased rates of composite neonatal morbidity (8.4% vs 15%, P<.01, aRR 0.59; 95% CI 0.37, 0.89) and gestational hypertension (6.5% vs 12.9%, P<.01, aRR 0.56; 95% CI 0.33, 0.89). Gestational weight gain and the incidence of gestational diabetes and preeclampsia were similar between groups.</p><p><strong>Conclusion: </strong>Higher levels of physical activity in the first trimester are associated with higher birth weights and lower rates of composite neonatal morbidity and gestational hypertension.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101534"},"PeriodicalIF":3.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569544","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":"How labor induction methods have evolved throughout history, from the Egyptian era to the present day: evolution, effectiveness, and safety.","authors":"Malitha Patabendige, Daniel L Rolnik, Wentao Li, Andrew D Weeks, Ben W Mol","doi":"10.1016/j.ajogmf.2024.101515","DOIUrl":"10.1016/j.ajogmf.2024.101515","url":null,"abstract":"<p><p>Induction of labor (IOL) is currently used for one in 10 pregnancies globally. Methods used for induction have shown major changes over time. Medical interventions trace their origins back to ancient civilizations, with evidence suggesting that they began over 5000 years ago in ancient Egypt. During this era, the Egyptians employed natural remedies such as castor oil and date fruits for the IOL. These early practices highlight the rich history and long-standing tradition of using natural substances in medical treatments, laying the foundation for the development of modern obstetric practices. After that, Hippocrates practiced mammary stimulation and mechanical cervical dilatation about 2500 years ago in Greece. Since then, there has been a marked change, especially over the last century, with the development of safer and more effective methods. Mechanical methods were the main method until the early 20th century, which were then substituted by pharmacological methods with more experiments in the mid to late 20th century. Nowadays, effectiveness, safety, cost, and client satisfaction are the main determinants of the methods used. This review summarizes how labor induction practices have evolved from the Egyptian era to the present-day randomized controlled trials and meta-analysis evidence, paying attention to their effectiveness, safety, and future directions.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101515"},"PeriodicalIF":3.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509575","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":"Effect of a perineal protection device in vacuum-assisted births-a prospective randomized controlled interventional trial.","authors":"Anna Hoeller, Jana Birri, Nicole Ochsenbein-Koelble, Anne Richter, Roland Zimmermann, Nina Kimmich","doi":"10.1016/j.ajogmf.2024.101532","DOIUrl":"10.1016/j.ajogmf.2024.101532","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Birth tears are common after vaginal birth with a prevalence of up to 85%, especially in vaginal-assisted births. Because birth trauma can cause physical and psychological short-term and long-term maternal morbidity, it is essential to improve maternal outcomes at birth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate the effect of a perineal protection device on the rate of spontaneous birth tears in the posterior compartment in vacuum-assisted births and the feasibility and safety of the device.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;In a prospective, randomized controlled interventional trial from July 2020 to October 2022, we evaluated the application of a perineal protection device in vacuum-assisted vaginal births in a tertiary care center. A total of 1998 patients were asked to participate, and 1574 patients with singletons at ≥36 weeks of gestation gave their informed consent before birth. Ultimately, 209 were included according to a power calculation, performed in advance, with a statistical power of 80% and a significance level of 5% for an expected reduction in the rate of the primary composite outcome of 20%. The primary composite outcome was the rate of low-grade perineal and/or vaginal tears in the posterior compartment. Secondary outcomes were the rate of high-grade perineal tears and episiotomies, the feasibility of the device, and its safety for the mother and child. Descriptive statistics and a logistic regression analysis were performed in an intention-to-treat, a per-protocol, and an as-treated analysis, using SPSS, version 29.0.0.0, and R. A P value of &lt;.05 was considered statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 1574 patients, 249 (15.8%) had an indication for vacuum-assisted vaginal birth, and 217 (13.8%) of those were randomized. An addition 8 patients (0.5%) were excluded because the birth ended without vacuum assistance. Of the remaining 209 patients, 105 formed the intervention group (application of the device), whereas 104 formed the control group (without application of the device). No differences in primary and secondary outcomes were found in the intention-to-treat and per-protocol analysis. In the intention-to-treat analysis, 79 patients (75.2%) in the intervention group and 73 patients (70.2%) in the control group (P=.4) met the primary endpoint. In the per-protocol analysis, the primary composite outcome was seen 53 patients (77.9%) in the intervention group and in 73 patients (70.2%) in the control group (P=.27). For the as-treated analysis, 68 of the 105 patients (65%) remained in the intervention group after exclusion of 37 (35%) patients with failed application of the device. Consequently, 141 formed the control group. In the as-treated analysis, there was also no difference in the primary composite outcome between the 2 groups (53 patients [77.9%] in the intervention group and 99 patients [70.2%] in the control group). However, within the s","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101532"},"PeriodicalIF":3.8,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476676","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":"Antihypertensive therapy and unplanned maternal postpartum healthcare utilization in patients with mild chronic hypertension","authors":"Anna Palatnik MD ,&nbsp;Justin Leach PhD ,&nbsp;Lorie Harper MD, MSCI ,&nbsp;Baha Sibai MD ,&nbsp;Sherri Longo MD ,&nbsp;Lorraine Dugoff MD ,&nbsp;Kirsten Lawrence MD, MSCE ,&nbsp;Brenna L. Hughes MD, MSc ,&nbsp;Joseph Bell MD ,&nbsp;Rodney K. Edwards MD, MS ,&nbsp;Kelly S. Gibson MD ,&nbsp;Caroline Rouse MD ,&nbsp;Lauren Plante MD ,&nbsp;Kara K. Hoppe DO, MS ,&nbsp;Janelle Foroutan MD ,&nbsp;Methodius Tuuli MD ,&nbsp;Hyagriv N. Simhan MD, MS ,&nbsp;Heather Frey MD, MSCI ,&nbsp;Todd Rosen MD ,&nbsp;Torri D. Metz MD, MS ,&nbsp;Alan T.N. Tita MD, PhD","doi":"10.1016/j.ajogmf.2024.101525","DOIUrl":"10.1016/j.ajogmf.2024.101525","url":null,"abstract":"<div><h3>Objective</h3><div>To test whether treatment of mild chronic hypertension (CHTN) in pregnancy is associated with lower rates of unplanned maternal healthcare utilization postpartum.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of the CHTN and pregnancy study, a prospective, open-label, pragmatic, multicenter, randomized treatment trial of pregnant people with mild CHTN. All patients with a postpartum follow-up assessment were included. The primary outcome was unplanned healthcare utilization, defined as unplanned postpartum clinic visits, Emergency Department (ED) or triage visits, or unplanned hospital admissions within 6 weeks postpartum. Differences in outcomes were compared between study groups (Active Group: blood pressure goal of&lt;140/90 mm Hg, and Control Group: blood pressure goal of &lt;160/105 mm Hg), and factors associated with outcomes were examined using logistic regression.</div></div><div><h3>Results</h3><div>A total of 2293 patients were included with 1157 (50.5%) in the active group and 1136 (49.5%) in the control group. Rates of unplanned maternal postpartum healthcare utilization did not differ between treatment and control groups, (20.2% vs 23.3%, <em>P</em>=.07, aOR 0.84, 95% CI 0.69–1.03). However, ED or triage/maternity evaluation unit visits were significantly lower in the Active group (10.2% vs 13.2%, <em>P</em>=.03, aOR 0.76, 95% 0.58–0.99). Higher BMI at enrollment and cesarean delivery were associated with higher odds of unplanned postpartum healthcare utilization.</div></div><div><h3>Conclusion</h3><div>While treatment of mild CHTN during pregnancy and postpartum was not significantly associated with overall unplanned healthcare resource utilization, it was associated with lower rates of postpartum ED and triage visits.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101525"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476663","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":"Timing of the obstetrics and gynecology clerkship and “hands-on” participation in deliveries","authors":"Katherine Lambert MD,&nbsp;Deborah Engle EdD,&nbsp;Melody Baldwin MD, MPH,&nbsp;Lorene Temming MD, MSCI,&nbsp;Sarah K. Dotters-Katz MD, MMHPE","doi":"10.1016/j.ajogmf.2024.101527","DOIUrl":"10.1016/j.ajogmf.2024.101527","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101527"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476680","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":"Elevated B-type natriuretic peptides predict resistant hypertension in patients with postpartum severe preeclampsia: a prospective cohort study","authors":"Walter Annicchiarico MD ,&nbsp;Ángel Vásquez MD ,&nbsp;José Santacruz MD, MS(c) ,&nbsp;Leidy Villamizar MD ,&nbsp;Enrique Ramos-Classon MD, MSc ,&nbsp;José Rojas-Suarez MD, MSc","doi":"10.1016/j.ajogmf.2024.101530","DOIUrl":"10.1016/j.ajogmf.2024.101530","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101530"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476677","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":"Patient perspectives on research participation during labor and delivery","authors":"Melissa Cantave MD,&nbsp;Rachel Paul MPH,&nbsp;Lori Atwood,&nbsp;Brianna Bradley BS,&nbsp;Alicia Collins BS,&nbsp;Jessica Battle BS,&nbsp;Kristina Allen BA,&nbsp;Paige Wilder BS,&nbsp;Jaime R. Strickland MA,&nbsp;Ebony B. Carter MD, MPH,&nbsp;Jeannie C. Kelly MD, MS,&nbsp;Fan Zhang MD,&nbsp;Antonina I. Frolova MD, PhD,&nbsp;Nandini Raghuraman MD, MSCI","doi":"10.1016/j.ajogmf.2024.101531","DOIUrl":"10.1016/j.ajogmf.2024.101531","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101531"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476678","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":"Trends in severe maternal morbidity following an institutional team goal strategy for disparity reduction","authors":"Adina R. Kern-Goldberger MD, MPH, MSCE ,&nbsp;Adi Hirshberg MD ,&nbsp;Abike James MD ,&nbsp;Lisa D. Levine MD, MSCE ,&nbsp;Elizabeth Howell MD, MPP ,&nbsp;Elizabeth Harbuck BSN RN ,&nbsp;Sindhu K. Srinivas MD, MSCE","doi":"10.1016/j.ajogmf.2024.101529","DOIUrl":"10.1016/j.ajogmf.2024.101529","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Racial disparities in maternal pregnancy outcomes, specifically in morbidity and mortality, are persistent in the U.S., and a multifaceted approach to mitigating these disparate outcomes is critical. In 2020, our health system committed to reducing severe maternal morbidity (SMM) in Black patients, employing multiple strategic interventions including implicit bias training, regular reporting of a composite SMM metric stratified by race and ethnicity, standardization of best practices, focused efforts for hemorrhage risk reduction, and system-wide team building.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;The goal of this study is to investigate trends in SMM by race across this period of concentrated interventions to improve maternal outcomes overall, and specifically for Black patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;This is a retrospective cohort study evaluating all delivery admissions at an academic, urban, tertiary-care hospital in Philadelphia—one site of a health system encompassing five delivery hospitals—over a 3-year period from 2019 to 2021. Data including patient demographics, clinical features, and outcomes were extracted from the electronic medical record (EMR). Self-reported race was categorized as Black vs non-Black as documented in the EMR. SMM was defined according to established CDC indicators as well as additional codes identified by Vizient for common sources of SMM including hemorrhage, infection, and embolism. Data were analyzed by year with a multivariable logistic regression model including insurance type and obstetric comorbidity index (OB-CMI), a weighted scoring system accounting for numerous chronic medical conditions and antepartum pregnancy complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In total, 12,339 deliveries were included, 64.6% (&lt;em&gt;N&lt;/em&gt;=8012) of which were to Black patients. Median OB-CMI score was higher for Black patients at 3 (interquartile range [IQR] 1–5) compared to 2 (IQR 1–4) for non-Black patients, &lt;em&gt;P&lt;/em&gt;&lt;.01. There was a significant decrease in SMM for the entire cohort over the study period (8.5% in 2019 to 6.5% in 2021, &lt;em&gt;P&lt;/em&gt;=.001), driven by a decreased rate specifically among Black patients (8.9% in 2019 to 6.6% in 2021, &lt;em&gt;P&lt;/em&gt;=.005) with a nonsignificant decrease for non-Black patients (7.8% in 2019 to 6.3% in 2021, &lt;em&gt;P&lt;/em&gt;=.21). The adjusted model similarly demonstrated decreased risk of SMM over time for Black patients (2020 vs 2019 adjusted odds ratio [aOR] = 0.81, 95% confidence interval [CI] 0.69–0.96; 2021 vs 2019 aOR 0.73, 95% CI 0.62–0.86).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Dedicated efforts to improve equity in maternal outcomes over a 2-year period (2020–2021) in this hospital serving a Black patient majority were associated with a significant decline in SMM, especially among Black patients. This finding demonstrates the success of a high-level, coordinated, and systematic approach in reducing SMM and associated dispa","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101529"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476681","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":"Cohen vs Pfannenstiel cesarean skin incision for body mass index ≥35 kg/m²: a randomized controlled trial.","authors":"Rebekah J McCurdy, Siani Harding, Laura Felder, Anita Beáta, Peter Schnatz, Vincenzo Berghella","doi":"10.1016/j.ajogmf.2024.101528","DOIUrl":"10.1016/j.ajogmf.2024.101528","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Maternal obesity is recognized as a significant risk factor for adverse pregnancy outcomes, including increased cesarean delivery rates and heightened surgical complications. It is unclear whether the Cohen or Pfannenstiel skin incisions for cesarean delivery are associated with different outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate the effect of a Cohen or Pfannenstiel cesarean skin incision on maternal morbidity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Pregnant individuals with a body mass index of ≥35 kg/m&lt;sup&gt;2&lt;/sup&gt;, carrying either singleton or multiple pregnancies, were consented prenatally and in labor. Eligible participants who underwent a cesarean delivery between 24 and 41 weeks of gestation were randomized to either the Pfannenstiel or Cohen skin incision group at Thomas Jefferson University Hospital from October 2016 to March 2020. This study aimed to recruit 284 participants based on a sample size calculation, assuming a 50% reduction in wound complications with Cohen vs Pfannenstiel incisions (80% power; α=.05). However, recruitment was terminated early after 72 participants were randomized. The primary outcome was a composite maternal morbidity within 6 weeks, which consisted of the following: wound infection, hematoma, seroma, separation of skin of ≥1 cm, readmission for wound complications, endometritis, and postpartum hemorrhage. Statistical analyses included bivariate tests, t tests, and nonparametric analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 331 pregnant individuals who consented prenatally and in labor, 72 eventually underwent cesarean delivery and were randomized, 34 to the Cohen skin incision group and 38 to the Pfannenstiel skin incision group. The mean body mass index was &gt;42 kg/m&lt;sup&gt;2&lt;/sup&gt;. Approximately two-thirds of the patients had a pannus, 56% of the patients were Black, 47% of the patients had diabetes mellitus, and 56% of the patients had hypertensive disorders. The primary outcome of composite maternal morbidity occurred in 47.1% of patients in the Cohen incision group and 36.8% of patients in the Pfannenstiel incision group (risk ratio, 1.24; 95% confidence interval, 0.71-2.08) and was similar regardless of the presence of a pannus or degree of obesity. Surgical site infection, hematoma, seroma, wound separation/dehiscence, endometritis, and postpartum hemorrhage were similar between the Cohen and Pfannenstiel groups. In addition, neonatal outcomes were similar between the Cohen and Pfannenstiel groups, except that the Cohen incision group was found to have a statistically significantly lower Apgar score at 5 minutes and a higher need for respiratory support than the Pfannenstiel incision group, possibly related to the trend for a longer time from skin incision to delivery. Physicians were found to be significantly less satisfied with the Cohen incision than the Pfannenstiel incision.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In pregnant patients with a bod","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101528"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476673","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":"Practical Resources for Effective Postpartum Parenting (PREPP): a randomized controlled trial of a novel parent-infant dyadic intervention to reduce symptoms of postpartum depression: RCT of the PREPP intervention for postpartum depression.","authors":"Myrriam D Grubb, Claire A Wilson, Lydia Zhang, Grace Liu, Seonjoo Lee, Catherine Monk, Elizabeth A Werner","doi":"10.1016/j.ajogmf.2024.101526","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101526","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is little known about the effectiveness of psychological interventions to prevent postpartum depression that focus on the birthing parent and infant dyad. Risk factors for PPD include depression during pregnancy, low parenting self-efficacy, and disrupted parental nocturnal sleep. The brief Practical Resources for Effective Postpartum Parenting (PREPP) intervention is designed for pregnant individuals at-risk for postpartum depression, providing them with 1) caregiving strategies aimed at reducing infant fuss and cry behavior and increasing infant sleep, 2) self-reflection and mindfulness skills and 3) psychoeducation about the postpartum period and infant behavior. The aims are to set more realistic postpartum expectations, enhance parenting confidence and sleep via supporting infant regulatory behavior, improve parental affect regulation and ultimately reduce the risk of postpartum depression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Assess the effectiveness of PREPP compared to enhanced treatment as usual in reducing symptoms of depression and anxiety and episodes of infant fuss and cry behavior and improving parental and infant sleep in the early postpartum.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A randomized controlled trial was conducted of 175 pregnant individuals. Inclusion criteria were standard prenatal care for a singleton pregnancy, aged 18 to 45 and at increased risk of PPD as determined by a score of ≥19 on the Predictive Index of Postnatal Depression or ≥7 on the Edinburgh Postnatal Depression Scale. Participants assigned to the PREPP group (n=88) received three coaching sessions and two phone check-ins. Participants assigned to the enhanced treatment as usual group (n=87) received three sessions which included psychoeducation, mood assessments, and clinical referral and follow-up as indicated. Assessments were conducted at 28 to 32 weeks and 34 to 39 weeks gestation, and at six, 12 and 16 weeks postpartum and included measures of parental depression, anxiety and sleep (Edinburgh Postnatal Depression Scale, Patient Health Questionnaire (PHQ-9), Hamilton Rating Scales of Depression and Anxiety and Pittsburgh Sleep Quality Index) and infant sleep and fuss and cry behavior (Baby Day Diary).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared to enhanced treatment as usual, PREPP significantly reduced depressive symptoms at six, 12 and 16 weeks postpartum with medium to large effect sizes (d=0.7-0.98). Compared to enhanced treatment as usual, participants receiving PREPP reported less of a decline in sleep quality at six weeks postpartum (p=0.035) and the effect size was large (d=0.83). Moreover, parents receiving the PREPP intervention reported less infant fussing and crying, with the largest effect for morning crying (p&lt;0.001; d=-1.48).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The results provide evidence that PREPP, initiated during pregnancy, reduced symptoms of parental depression and infant fuss and cry behavior in ","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101526"},"PeriodicalIF":3.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476679","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}