American Journal of Obstetrics & Gynecology Mfm最新文献_第4页

Minimizing tearing during vaginal delivery with a perineal protection device: a randomized controlled trial 使用会阴保护装置减少阴道分娩时的撕裂 - 随机对照试验。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm

Pub Date : 2024-09-01 DOI: 10.1016/j.ajogmf.2024.101402

BACKGROUND

There is a growing body of evidence indicating that second-degree tears cause both short- and long-term consequences. Very few preventative measures have been found to reduce the incidence of these tears.

OBJECTIVE

This study aimed to investigate whether the use of a perineal protection device during vaginal birth reduces severe perineal tearing (grade ≥2 tear) in primiparous women compared with routine manual perineal support.

STUDY DESIGN

A single-center randomized controlled trial was conducted in Sweden from 2019 to 2021. Primiparous women at term were randomly allocated to the intervention group (n=43), where a perineal protection device was used, or to the routine care group (n=49). The primary outcome was grade of perineal tear. The secondary outcomes were vaginal and labial tearing. Continuous data were analyzed using the Student t test or Mann-Whitney U test. Dichotomous data were analyzed using the Pearson X² test, Fisher exact test, and ordinal logistic regression.

RESULTS

Women in the intervention group had a significantly lower risk of sustaining more extensive perineal tearing than those in the control group. The use of the perineal protection device decreased the risk of grade ≥2 tears in relation to grade 0 to 1 tears (odds ratio, 0.40; 95% confidence interval, 0.17–0.94). Ordinal logistic regression analyses revealed an odds ratio of 0.36 (95% confidence interval, 0.16–0.81) per incremetn of grade injury using the perineal protection device vs routine care (P=.013). The number needed to treat using the perineal protection device was 4.3 to avoid 1 grade ≥2 tear. Women in the treatment group showed less labial tearing (P=.016). No adverse effect was detected.

CONCLUSION

The use of a perineal protection device reduced the risk of grade ≥2 perineal tearing by 60% and labial tearing.

背景：越来越多的证据表明，二度撕裂会造成短期和长期的后果。但很少有预防措施能降低这种撕裂的发生率：研究设计：研究设计：2019-2021年在瑞典进行了一项单中心随机对照试验。初产妇被随机分配到使用会阴保护装置的干预组（43人）或接受常规护理的干预组（49人）。主要结果是会阴撕裂等级。次要结果是阴道和阴唇撕裂。连续数据采用学生 T 检验或 Mann-Whitney U 检验进行分析。二分法数据采用皮尔逊 X2 检验、费雪精确检验和序数逻辑回归进行分析：结果：与对照组相比，干预组妇女发生更大面积会阴撕裂的风险明显降低。与 0-1 级撕裂相比，使用会阴保护装置可降低≥2 级撕裂的风险（OR 0.40 [95% CI 0.17-0.94]）。顺序逻辑回归分析显示，使用会阴保护装置与对照组相比，一级损伤的增加率为 0.36 (0.16-0.81)（P=0.013）。使用会阴保护装置避免一次≥2 级撕裂所需的治疗次数为 4.3。治疗组妇女的阴唇撕裂较少（P=0.016）。未发现任何不良反应：使用会阴保护装置将会阴撕裂≥2级的风险降低了60%，同时也降低了阴唇撕裂的风险。

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引用次数: 0

Tranexamic acid in preventing postpartum blood loss in vaginal delivery: a double-blinded randomized controlled trial 氨甲环酸预防阴道分娩产后失血--一项双盲随机对照试验。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm

Pub Date : 2024-09-01 DOI: 10.1016/j.ajogmf.2024.101450

BACKGROUND

Postpartum hemorrhage (PPH) is an obstetrical emergency that occurs in 1% to 10% of all deliveries and contributes to nearly one-quarter of all maternal deaths worldwide. Tranexamic acid has been established as an adjunct in the treatment of PPH but its role in its prevention of PPH following vaginal delivery has not been widely studied.

OBJECTIVE

This study aimed to assess the effect of prophylactic tranexamic acid (1 g) along with active management of the third stage of labor in reducing postpartum blood loss and the incidence of postpartum hemorrhage after vaginal delivery.

STUDY DESIGN

In this randomized controlled trial, 650 women with singleton pregnancies at ≥34 weeks of gestation who were undergoing vaginal delivery were included. Eligible women were randomly assigned to receive either 1 g of tranexamic acid or placebo intravenously along with active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the third and fourth stages of labor.

RESULTS

Of 886 women approached for the study, 650 who met the inclusion criteria were enrolled, and 320 in group A and 321 in group B were analyzed. The maternal characteristics were similar between the groups. The mean blood loss did not differ significantly between the intervention and placebo groups (378.5±261.2 mL vs 383.0±258.9 mL; P=.93). The incidence of primary postpartum hemorrhage was comparable in both groups (15.9% in group A and 15.3% in group B; P=.814). The median quantitative decreases in hemoglobin levels within 12 to 24 hours after delivery were 0.60 g% (interquartile range, 0.40–0.90) in group A and 0.60 g% (interquartile range, 0.40–0.80) in group B, which were comparable in both groups (P=.95). The most common adverse effect reported was dizziness, and there was no thromboembolic event at 3 months follow-up in either group.

Conclusion

The use of tranexamic acid as a prophylactic measure along with active management of the third stage of labor does not provide additional benefit in reducing the postpartum blood loss and incidence of postpartum hemorrhage after vaginal delivery.

目的评估在积极处理第三产程的同时，预防性使用氨甲环酸（1 克）对减少产后失血和阴道分娩后 PPH 发生率的效果：在这项随机对照试验中，共纳入了 650 名妊娠期≥ 34 周、经阴道分娩的单胎孕妇。符合条件的产妇被随机分配到在积极处理第三产程的同时静脉注射1克氨甲环酸或安慰剂。使用校准采血袋测量第三和第四产程的产后失血量：在接受研究的 886 名产妇中，有 650 名符合纳入标准，A 组有 320 名，B 组有 321 名。两组产妇的特征相似。干预组和安慰剂组的平均失血量无明显差异（378.5±261.2 毫升 vs. 383±258.9 毫升；P = 0.93）。两组的原发性产后出血发生率相当（A 组：15.9%，B 组：15.3%，P = 0.814）。A 组产后 12-24 小时内血红蛋白定量下降的中位数（四分位间）为 0.60 g%（0.40-0.90），B 组为 0.60 g%（0.40-0.80），两组数据相当（P=0.95）。最常见的不良反应是头晕，两组随访三个月均未发生血栓栓塞事件：结论：使用氨甲环酸作为预防措施，同时积极处理第三产程，并不能在减少产后失血量和阴道分娩后 PPH 的发生率方面带来额外的益处。

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引用次数: 0

First-trimester ultrasound of the cerebral lateral ventricles in fetuses with open spina bifida: a retrospective cohort study 开放性脊柱裂胎儿头三个月大脑侧脑室超声：一项回顾性队列研究。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm

Pub Date : 2024-09-01 DOI: 10.1016/j.ajogmf.2024.101445

<div><h3>BACKGROUND</h3><p>Beyond 18 weeks of gestation, an increased size of the fetal lateral ventricles is reported in most fetuses with open spina bifida. In the first trimester of pregnancy, the definition of ventriculomegaly is based on the ratio of the size of the choroid plexus to the size of the ventricular space or the entire fetal head. However, contrary to what is observed from the midtrimester of pregnancy, in most fetuses with open spina bifida at 11 to 13 weeks of gestation, the amount of fluid in the ventricular system seems to be reduced rather than increased.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to compare the biometry of the lateral ventricles at 11 0/7 to 13 6/7 weeks of gestation between normal fetuses and those with confirmed open spina bifida.</p></div><div><h3>STUDY DESIGN</h3><p>This was a retrospective cohort study that included all cases of isolated open spina bifida detected at 11 0/7 to 13 6/7 weeks of gestation over a period of 5 years and a group of structurally normal fetuses attending at our center over a period of 1 year for the aneuploidy screening as controls. Transventricular axial views of the fetal brain obtained from cases and controls were extracted from the archive for post hoc measurement of cerebral ventricles. The choroid plexus–to–lateral ventricle length ratio, sum of the choroid plexus–to–lateral ventricle area ratio, choroid plexus area–to–fetal head area ratio, and mean choroid plexus length–to–occipitofrontal diameter ratio were calculated for both groups. The measurements obtained from the 2 groups were compared, and the association between each parameter and open spina bifida was investigated.</p></div><div><h3>RESULTS</h3><p>A total of 10 fetuses with open spina bifida were compared with 358 controls. Compared with controls, fetuses with open spina bifida showed a significantly smaller size of the cerebral ventricle measurements, as expressed by larger values of choroid plexus–to–lateral ventricle area ratio (0.49 vs 0.72, respectively; <em>P</em><.001), choroid plexus–to–lateral ventricle length ratio (0.70 vs 0.79, respectively; <em>P</em><.001), choroid plexus area–to–fetal head area ratio (0.28 vs 0.33, respectively; <em>P</em>=.006), and choroid plexus length–to–occipitofrontal diameter ratio (0.52 vs 0.60, respectively; <em>P</em><.001). The choroid plexus–to–lateral ventricle area ratio was found to be the most accurate predictor of open spina bifida, with an area under the curve of 0.88, a sensitivity of 90%, and a specificity of 82%.</p></div><div><h3>CONCLUSION</h3><p>At 11 0/7 to 13 6/7 weeks of gestation, open spina bifida is consistently associated with a reduced amount of fluid in the lateral cerebral ventricles of the fetus, as expressed by a significantly increased choroid plexus–to–lateral ventricle length ratio, choroid plexus–to–lateral ventricle area ratio, choroid plexus area–to–fetal head area ratio, and choroid plexus length–to–occipitofrontal dia

背景：大多数开放性脊柱裂的胎儿在妊娠 18 周后，其侧脑室会增大。在妊娠头三个月，脑室肥大的定义是基于脉络丛与脑室间隙或整个胎儿头部的大小之比。然而，与孕中期的情况相反，大多数开放性脊柱裂胎儿在 11-13 周时脑室系统的液体量似乎减少而非增加：比较正常胎儿与确诊开放性脊柱裂胎儿在 11+0-13+6 周时侧脑室的生物测量值：研究设计：回顾性队列研究，包括5年内所有在妊娠11+0-13+6周发现的孤立性开放性脊柱裂病例，以及1年内在本中心参加非整倍体筛查的一组结构正常胎儿作为对照。我们从档案中提取了病例和对照组胎儿大脑的经室轴切面，用于事后测量脑室。计算两组的脉络丛与侧脑室长度（CPVLr）和面积（CPVAr）之比、脉络丛面积之和与胎儿头部面积之比（CPHAr）以及脉络丛长度平均值与枕额径之比（CPHLr）。比较两组的测量结果，并研究各参数与开放性脊柱裂的关系：结果：10 名开放性脊柱裂胎儿与 358 名对照组胎儿相比，脑室测量值明显较小（CPVAr 值较大，0.72 vs 0.49，pConclusions）：在妊娠 11+0-13+6 周时，开放性脊柱裂始终与胎儿侧脑室积液量减少有关，CPVLr、CPVAr、CPHAr 和 CPHLr 均明显增加。

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引用次数: 0

Azithromycin dosing and preterm premature rupture of membranes treatment (ADAPT): a randomized controlled Phase I trial 阿奇霉素剂量与早产胎膜早破治疗（ADAPT）：随机对照 I 期试验。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm

Pub Date : 2024-09-01 DOI: 10.1016/j.ajogmf.2024.101423

<div><h3>BACKGROUND</h3><p>Seven days of antibiotics are recommended in the setting of preterm premature rupture of membranes to promote latency. Azithromycin has generally replaced a 7-day course of erythromycin in current clinical practice. Azithromycin clears from plasma quickly and concentrates in local tissue, which is why daily dosing is not always needed, and local tissue, rather than plasma, concentrations are used to determine dosing. On the basis of limited pharmacokinetic studies in pregnancy, a 1-time dose of 1 g azithromycin may not maintain local (amniotic fluid) drug concentrations above minimum inhibitory concentrations for common genitourinary pathogens (50–500 ng/mL).</p></div><div><h3>OBJECTIVE</h3><p>We aimed to compare the pharmacokinetics of 1-time vs daily dosing of azithromycin in the setting of preterm prelabor rupture of membranes.</p></div><div><h3>STUDY DESIGN</h3><p>This is a randomized clinical trial of singletons with preterm prelabor rupture of membranes randomized to 1 g oral azithromycin once or 500 mg oral azithromycin daily for 7 days. The primary outcome was amniotic fluid azithromycin concentrations over 8 days. Secondary outcomes included plasma azithromycin trough concentrations. Plasma was collected at 1–4 hours and 12–24 hours after the first dose and then every 24 hours through 8 days. Amniotic fluid was collected opportunistically throughout the day noninvasively with Always Flex foam pads. We aimed to enroll 20 participants to achieve n=5 still pregnant through 8 days in each group. Continuous variables were compared using the Mann-Whitney U test, and the relationship between azithromycin concentration and time was assessed using linear regression.</p></div><div><h3>RESULTS</h3><p>The study was halted after 6 enrolled because of lagging enrollment, with 3 in each group. The mean gestational age of enrollment was 27.1±1.7 weeks in the 1 g group and 31.0±1.4 weeks in the 500 mg daily group. One participant in each group had latency to delivery >7 days. Regarding amniotic fluid azithromycin concentration, there was a difference in change in amniotic fluid azithromycin concentration over time between groups (<em>P</em><.001). The amniotic fluid concentration of azithromycin was relatively stable in the 1 g once group (B,−0.07; 95% confidence interval, −0.44 to 0.31; <em>P</em>=.71), whereas amniotic fluid concentration (ng/mL) increased over time (hours) in the 500 mg daily group (B, 1.3; 95% confidence interval, 0.7–1.9; <em>P</em><.001). By ≥96 hours, median amniotic fluid levels of azithromycin were lower in the 1 g once group (median, 11; interquartile, 7–56) compared with 500 mg daily (median, 46; interquartile, 23–196), with a median difference of −27 (interquartile,−154 to −1; <em>P</em>=.03). In plasma, there was higher azithromycin concentration during the first 24 hours with 1 g once vs 500 mg daily (median difference, 637 ng/mL; 101–1547; <em>P</em>=.01); however, by ≥96 hours plasma az

背景：在早产胎膜早破（PPROM）的情况下，建议使用七天的抗生素以促进潜伏期。在目前的临床实践中，阿奇霉素已普遍取代了红霉素的七天疗程。阿奇霉素能迅速从血浆中清除，并在局部组织中浓缩，这就是为什么不一定需要每天用药，而是使用局部组织而不是血浆浓度来确定用药剂量的原因。根据有限的妊娠期药代动力学研究，一次性服用 1 克阿奇霉素可能无法使局部（羊水）药物浓度维持在常见泌尿生殖系统病原体的最低抑菌浓度（MIC50）（50-500ng/ml）以上：我们旨在比较在早产胎膜早破（PPROM）情况下一次性服用阿奇霉素与每日服用阿奇霉素的药代动力学。主要结果是 8 天内羊水中阿奇霉素的浓度。次要结果包括血浆阿奇霉素谷浓度。在首次用药后1-4小时和12-24小时采集血浆，然后在8天内每24小时采集一次血浆。全天使用 Always Flex 发泡垫无创收集羊水。我们的目标是每组招募 20 名参与者，使每组在 8 天后仍有 5 名孕妇。连续变量用曼-惠特尼 U 检验进行比较，阿奇霉素浓度与时间之间的关系用线性回归进行评估：结果：由于入组人数滞后，研究在入组 6 人后停止，每组 3 人。1克组的平均妊娠年龄为（27.1±1.7）周，每日500毫克组的平均妊娠年龄为（31.0±1.4）周。每组均有一人的分娩潜伏期超过 7 天。关于羊水中阿奇霉素的浓度，各组间羊水中阿奇霉素浓度随时间的变化存在差异（p结论：在PPROM的情况下，每天服用500毫克的阿奇霉素与每天服用1克的阿奇霉素相比，能在8天内维持更高的羊水浓度，且更稳定地高于常见的MICs。

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引用次数: 0

Virtual reality training for postpartum uterine balloon insertion—a multi-center randomized controlled trial 产后子宫球囊置入术的虚拟现实训练 - 一项多中心随机对照试验。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm

Pub Date : 2024-09-01 DOI: 10.1016/j.ajogmf.2024.101429

引用次数: 0

The effects of proton pump inhibitors during pregnancy on treatment of preeclampsia, and related outcomes: a systematic review and meta-analysis. 孕期质子泵抑制剂对治疗子痫前期的影响及相关结果：系统回顾和荟萃分析。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm

Pub Date : 2024-08-31 DOI: 10.1016/j.ajogmf.2024.101478

Kate Mills, Annie R A McDOUGALL, Annie Tan, Maureen Makama, Phi-Yen Nguyen, Elizabeth Armari, Zoe Bradfield, Roxanne Hastie, A Metin Gulmezoglu, Anne Ammerdorffer, Joshua P Vogel

Objective: This systematic review evaluated the available evidence of the effects of PPIs during pregnancy on preeclampsia and related maternal, fetal and neonatal outcomes.

Data sources: Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, and Global Medicus Index) were searched on 17 November 2023.

Study eligibility criteria: Randomized controlled trials involving pregnant women, using any class or dose of PPIs, were eligible.

Study appraisal and synthesis methods: Meta-analysis was conducted for all outcomes of interest, with random-effects models. Results were presented as risk ratios or mean difference. Quality assessment was performed using the Risk of Bias 2 tool, and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was completed to evaluate the certainty of the evidence. The study was registered on PROSPERO (CRD42023423673).

Results: Our search identified 3,879 records, which were screened by two authors independently. Nine reports (describing eight trials) met our eligibility criteria, however six trials were ultimately excluded from our analysis as women were only given PPIs immediately prior to Cesarean section for acid aspiration prevention. The two trials included in the meta-analysis evaluated the treatment of 177 women with diagnosed preeclampsia. For the primary outcomes, moderate-certainty evidence showed there is likely no effect of the use of PPIs on risk of HELLP syndrome (RR 1.21, 95% CI 0.37 - 3.99, I² = 0%) or perinatal mortality (RR 0.81, 95% CI 0.36 - 1.79, I² = 0%), while there were insufficient data to meta-analyse all other primary outcomes, including eclampsia and neonatal mortality. No trials investigated PPIs for preventing preeclampsia.

Conclusions: Given the limited outcome data we are uncertain of the effect of PPIs in women with preeclampsia. Further trials are required to determine what (if any) effects PPIs might have for preeclampsia prevention or treatment.

目的：这是一篇系统性综述：本系统综述评估了孕期服用 PPIs 对子痫前期及相关孕产妇、胎儿和新生儿结局影响的现有证据：数据来源：2023 年 11 月 17 日检索了五个电子数据库（MEDLINE、Embase、CINAHL、Cochrane CENTRAL 和 Global Medicus Index）：研究评估和综合方法：采用随机效应模型对所有相关结果进行 Meta 分析。结果以风险比或平均差表示。使用 "偏倚风险2 "工具进行了质量评估，并完成了 "建议、评估、发展和评价分级"（GRADE）评估，以评价证据的确定性。该研究已在 PROSPERO（CRD42023423673）上注册：结果：我们的检索发现了 3,879 条记录，这些记录由两位作者独立筛选。有九份报告（描述了八项试验）符合我们的资格标准，但最终有六项试验被排除在我们的分析之外，因为妇女仅在剖腹产前立即服用 PPIs 以预防酸吸入。纳入荟萃分析的两项试验评估了 177 名确诊子痫前期妇女的治疗情况。在主要结果方面，中度确定性证据显示，使用 PPIs 对 HELLP 综合征（RR 1.21，95% CI 0.37 - 3.99，I² = 0%）或围产期死亡率（RR 0.81，95% CI 0.36 - 1.79，I² = 0%）的风险可能没有影响，而对所有其他主要结果（包括子痫和新生儿死亡率）进行荟萃分析的数据不足。没有试验研究了预防子痫前期的PPIs：鉴于结果数据有限，我们无法确定PPIs对子痫前期妇女的影响。需要进行更多试验，以确定 PPIs 对子痫前期的预防或治疗有哪些影响（如果有的话）。

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引用次数: 0

Six versus 12-Hours Balloon Catheter Placement for the Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials. 球囊导管置入引产6小时与12小时：随机对照试验的系统回顾和元分析》。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm

Pub Date : 2024-08-31 DOI: 10.1016/j.ajogmf.2024.101474

Attyia Rashid, Muhammad Imran, Shujaat Ali, Areeba Mariam Mehmood, Saba Khalil, Dawood Azam Farooq, Ateeba Kamran, Shamaila Zamir, Ubaid Khan, Mohamed Abuelazm

Objective: Balloon catheters have shown promising results in the induction of labor (IOL); however, evidence regarding the optimal time of balloon catheter placement is still lacking. Thus, this study aims to evaluate the efficacy and safety of six-hour placement compared to 12 hours.

Data source: We conducted a comprehensive search through a search strategy across "Embase, SCOPUS, PubMed (via MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL)" from inception until April 20, 2024.

Study eligibility criteria: We included the randomized controlled trials (RCTs) evaluating the efficacy and safety of six-hour balloon catheter placement compared with 12 hours for cervical ripening in IOL. Covidence was used to screen eligible articles.

Methods: All relevant outcome data were synthesized using risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CIs) in meta-analysis models within RevMan 5.4.

Prospero id: CRD42024540935 RESULTS: We included five RCTs with 960 women undergoing the IOL with balloon catheter placement. Six-hour placement was associated with significant lower insertion to overall delivery interval (MD: -4.25, 95% CI [-5.34, -3.15], P< 0.00001) and insertion to vaginal delivery interval (MD: -4.65, 95% CI [-6.08, -3.23], P< 0.00001) without significant difference in BISHOP score change (MD: -0.02, 95% CI [-0.23, 0.20], P= 0.88), catheter removal to delivery interval (MD: 0.72, 95% CI [-0.39, 1.83], P= 0.20) and total duration of oxytocin infusion (MD: -0.36, 95% CI [-0.85, 0.14], P= 0.16) compared to twelve hours. Also, significantly lower overall cesarean delivery (CD) rate (RR: 0.81, 95% CI [0.68, 0.96], P= 0.01) and CD due to malpresentation (RR: 0.39, 95% CI [0.16, 0.93], P= 0.03) were observed with six-hour placement.

Conclusion: A planned six-hour balloon catheter placement reduced insertion to delivery intervals and CD rate and has equal efficacy in BISHOP score change and catheter removal to delivery interval compared to twelve hours.

目的：球囊导管在引产（IOL）中显示出了良好的效果；然而，关于球囊导管置入的最佳时间仍缺乏证据。因此，本研究旨在评估 6 小时置管与 12 小时置管相比的有效性和安全性：数据来源：我们通过检索策略在 "Embase、SCOPUS、PubMed（通过 MEDLINE）和 Cochrane 对照试验中央注册中心（CENTRAL）"进行了全面检索，检索时间从开始到 2024 年 4 月 20 日：我们纳入了评估 6 小时球囊导管置入与 12 小时宫颈成熟 IOL 的有效性和安全性的随机对照试验 (RCT)。研究采用Covidence筛选符合条件的文章：在RevMan 5.4的荟萃分析模型中，使用风险比（RR）或平均差（MD）及95%置信区间（CI）对所有相关结果数据进行综合：CRD42024540935 结果：我们纳入了五项研究，960 名妇女接受了球囊导管置入人工晶体手术。6小时置管与明显较低的插入到总分娩间隔（MD：-4.25，95% CI [-5.34，-3.15]，P< 0.00001）和插入到阴道分娩间隔（MD：-4.65，95% CI [-6.08，-3.23]，P< 0.00001），而BISHOP评分变化（MD：-0.02，95% CI [-0.23，0.20]，P= 0.88）、导管拔除到分娩间隔（MD：0.72，95% CI [-0.39，1.83]，P= 0.20）和输注催产素总时间（MD：-0.36，95% CI [-0.85，0.14]，P= 0.16）与12小时相比无明显差异。此外，六小时置管可明显降低总体剖宫产率（RR：0.81，95% CI [0.68，0.96]，P= 0.01）和因胎位不正导致的剖宫产率（RR：0.39，95% CI [0.16，0.93]，P= 0.03）：结论：与 12 小时相比，计划中的 6 小时球囊导管置入缩短了插入到分娩的时间间隔，降低了 CD 率，在 BISHOP 评分变化和导管拔出到分娩的时间间隔方面具有同等疗效。

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引用次数: 0

Expedited versus standard postpartum discharge in patients with hypertensive disorders of pregnancy and its effect on the postpartum course. 妊娠期高血压疾病患者产后快速出院与标准出院的对比及其对产后过程的影响。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm

Pub Date : 2024-08-30 DOI: 10.1016/j.ajogmf.2024.101475

Alina Tvina, Anna Palatnik

Background: Hospital stay after an uncomplicated delivery is typically 2 days for vaginal birth and 3 days for cesarean birth. Health maintenance organizations and third-party payers have encouraged shorter maternity stays. The safety of earlier discharge is unclear particularly when it comes to patients diagnosed with hypertensive disorders of pregnancy (HDP).

Objective: To examine whether expedited discharge amongst patients with HDP will have a negative effect on postpartum readmission rate and blood pressure related complications.

Study design: This was a single academic center retrospective cohort study of patients with HDP (gestational hypertension, preeclampsia, or chronic hypertension) for 2 epochs: 2015-2018, prior to implementation of an expedited discharge policy, and 2019-2020 after hospital wide implementation of expedited postpartum discharge. The expedited discharge policy entailed patients being discharged home as soon as day 1 after a vaginal delivery and day 2 after a cesarean delivery. The primary outcome was unplanned health care utilization postpartum, defined as emergency department (ED) visits, unscheduled clinic visits, and hospital readmission. Secondary outcomes were planned postpartum visits attendance, antihypertensive medication initiation after discharge, and blood pressure control throughout the first year. Bivariable and multivariable logistic regression analyses were run to evaluate the association between expedited discharge and primary and secondary outcomes.

Results: A total of 1,441 patients were included in the analysis. There were no statistically significant differences in the rate of unplanned health care utilization (11.3% in the standard postpartum discharge group vs. 13.8% in the expedited discharge group, P=.17). Systolic and diastolic blood pressures did not differ between the groups at 1-2 weeks, six weeks, and one year postpartum. Patients in the expedited discharge group were more likely to attend the 1-2-week postpartum blood pressure check (58.7% vs. 51.7%, P=.02, adjusted OR 1.33, 95% CI 1.08-1.77). Other secondary outcomes did not differ between the two cohort groups.

Conclusion: In this single academic center study, expedited discharge after delivery in patients with HDP was not associated with a higher rate of unplanned healthcare utilization postpartum.

背景：顺产的住院时间一般为 2 天，剖宫产为 3 天。健康维护组织和第三方支付机构鼓励缩短产妇的住院时间。提前出院的安全性尚不明确，尤其是对妊娠高血压疾病（HDP）患者而言：研究设计：这是一项单一学术中心的回顾性队列研究，研究对象为两个时期的HDP（妊娠高血压、子痫前期或慢性高血压）患者：2015-2018年，实施快速出院政策之前；2019-2020年，在全院范围内实施产后快速出院政策之后。快速出院政策要求患者在阴道分娩后第 1 天和剖宫产后第 2 天尽快出院回家。主要结果是产后非计划医疗使用情况，即急诊室就诊、计划外就诊和再次入院。次要结果是产后计划内就诊人次、出院后开始服用降压药以及第一年的血压控制情况。我们进行了二变量和多变量逻辑回归分析，以评估快速出院与主要和次要结果之间的关联：共有 1,441 名患者参与了分析。产后标准出院组和快速出院组的非计划医疗使用率差异无统计学意义（标准产后出院组为 11.3%，快速出院组为 13.8%，P=0.17）。两组患者在产后 1-2 周、6 周和 1 年的收缩压和舒张压没有差异。快速出院组患者更有可能参加产后 1-2 周的血压检查（58.7% 对 51.7%，P=0.02，调整 OR 1.33，95% CI 1.08-1.77）。其他次要结果在两组之间没有差异：在这项单一学术中心研究中，HDP 患者产后加速出院与产后非计划医疗使用率较高无关。

{"title":"Expedited versus standard postpartum discharge in patients with hypertensive disorders of pregnancy and its effect on the postpartum course.","authors":"Alina Tvina, Anna Palatnik","doi":"10.1016/j.ajogmf.2024.101475","DOIUrl":"10.1016/j.ajogmf.2024.101475","url":null,"abstract":"<p><strong>Background: </strong>Hospital stay after an uncomplicated delivery is typically 2 days for vaginal birth and 3 days for cesarean birth. Health maintenance organizations and third-party payers have encouraged shorter maternity stays. The safety of earlier discharge is unclear particularly when it comes to patients diagnosed with hypertensive disorders of pregnancy (HDP).</p><p><strong>Objective: </strong>To examine whether expedited discharge amongst patients with HDP will have a negative effect on postpartum readmission rate and blood pressure related complications.</p><p><strong>Study design: </strong>This was a single academic center retrospective cohort study of patients with HDP (gestational hypertension, preeclampsia, or chronic hypertension) for 2 epochs: 2015-2018, prior to implementation of an expedited discharge policy, and 2019-2020 after hospital wide implementation of expedited postpartum discharge. The expedited discharge policy entailed patients being discharged home as soon as day 1 after a vaginal delivery and day 2 after a cesarean delivery. The primary outcome was unplanned health care utilization postpartum, defined as emergency department (ED) visits, unscheduled clinic visits, and hospital readmission. Secondary outcomes were planned postpartum visits attendance, antihypertensive medication initiation after discharge, and blood pressure control throughout the first year. Bivariable and multivariable logistic regression analyses were run to evaluate the association between expedited discharge and primary and secondary outcomes.</p><p><strong>Results: </strong>A total of 1,441 patients were included in the analysis. There were no statistically significant differences in the rate of unplanned health care utilization (11.3% in the standard postpartum discharge group vs. 13.8% in the expedited discharge group, P=.17). Systolic and diastolic blood pressures did not differ between the groups at 1-2 weeks, six weeks, and one year postpartum. Patients in the expedited discharge group were more likely to attend the 1-2-week postpartum blood pressure check (58.7% vs. 51.7%, P=.02, adjusted OR 1.33, 95% CI 1.08-1.77). Other secondary outcomes did not differ between the two cohort groups.</p><p><strong>Conclusion: </strong>In this single academic center study, expedited discharge after delivery in patients with HDP was not associated with a higher rate of unplanned healthcare utilization postpartum.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112973","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}

引用次数: 0

Acupuncture before planned admission for induction of labor (ACUPUNT study): a randomized controlled trial 计划入院引产前的针灸（ACUPUNT 研究）：随机对照试验：AJOG 一览。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm

Pub Date : 2024-08-30 DOI: 10.1016/j.ajogmf.2024.101477

<div><h3>Background</h3><div>The increase in the use of induction of labor is a worldwide phenomenon in the current management of labor and delivery in Western societies, with approximately one out of every 4 pregnancies undergoing this procedure This has led women to seek various methods for stimulation of the onset of labor. Some data suggest that the use of acupuncture for favoring spontaneous labor onset could reduce the number of inductions of labor procedures. However, good quality evidence in this respect is not yet available.</div></div><div><h3>Objective</h3><div>The aim of this study was to evaluate the effectiveness of acupuncture using a filiform needle to induce spontaneous onset of labor in women with a scheduled induction of labor date and assess the safety and satisfaction of women undergoing acupuncture.</div></div><div><h3>Study Design</h3><div>We conducted a multicenter, randomized, controlled, parallel-arm, unmasked trial in 3 hospitals in Spain. Eligible participants were women older than 18 years with a singleton pregnancy and a cephalic presentation, scheduled for induction of labor following center-specific protocols. Participants were randomly allocated to one of 2 groups: the intervention group, which underwent acupuncture sessions for a maximum of 4 days prior to the scheduled induction of labor, or the control group, which received no specific prelabor intervention. The primary study outcome was the proportion of women admitted because of spontaneous onset of labor or premature rupture of membranes before or the day of the scheduled induction of labor.</div></div><div><h3>Results</h3><div>Between November 2017 and June 2023, 212 women were recruited and included in the analysis (106 in the acupuncture group and 106 in the control group). There were no significant differences between the 2 groups in the baseline demographic characteristics. Regarding the primary outcome, 65.1% (69/106) of women in the acupuncture group and 39.6% (42/106) in the control group were admitted for spontaneous onset of labor or premature rupture of membranes (<em>P</em><.001). Overall, women in the intervention group were admitted 1.25 days before (SD 1.4) their scheduled induction of labor date compared to 0.67 days (SD 1.15) for those in the control group (<em>P</em>=.001). The median time from recruitment to hospitalization was 4.48 days for the acupuncture group and 5.33 days for the control group (HR 0.52, 95% CI 0.35-0.77, <em>P</em>=.001). There were no significant differences between the 2 groups regarding the time from admission to delivery or the cesarean delivery rate. Nor were there differences in the rates of maternal or neonatal outcomes, and no maternal or fetal deaths occurred in either group.</div></div><div><h3>Conclusion</h3><div>Acupuncture with filiform needles, administered 4 days prior to scheduled induction of labor increased admission for spontaneous onset of labor and premature rupture of membranes before the indu

背景：引产是目前西方社会分娩管理中的一个世界性现象，大约每四名孕妇中就有一名需要接受引产手术。一些数据表明，使用针灸促进自然分娩可以减少引产的次数。然而，目前还没有这方面的高质量证据：本研究的目的是评估使用丝状针针灸诱导预定引产日期的妇女自然临产的有效性，并评估接受针灸的妇女的安全性和满意度：我们在西班牙的三家医院开展了一项多中心、随机对照、平行臂、无掩蔽试验。符合条件的参试者均为 18 岁以上的单胎妊娠头位妊娠妇女，并按照各中心的具体方案安排引产。参与者被随机分配到两组中的一组：干预组，在预定引产前接受最多四天的针灸治疗；对照组，不接受特定的产前干预。主要研究结果是在预定引产前或当天因自然临产或胎膜早破而入院的妇女比例：2017年11月至2023年6月期间，共招募了212名妇女并纳入分析（针灸组106人，对照组106人）。两组的基线人口统计学特征无明显差异。在主要结果方面，针灸组有 65.1%（69/106）的产妇因自然临产或胎膜早破入院，对照组有 39.6%（42/106）的产妇因自然临产或胎膜早破入院（P < 0.001）。总体而言，干预组妇女在预定引产日期前 1.25 天（标准差 1.4）入院，而对照组妇女在预定引产日期前 0.67 天（标准差 1.15）入院（P=0.001）。从招募到住院的中位时间，针灸组为 4.48 天，对照组为 5.33 天（HR 0.52，95% CI 0.35 - 0.77，P=0.001）。在从入院到分娩的时间或剖宫产率方面，两组之间没有明显差异。两组产妇和新生儿的结局也无差异，均无产妇或胎儿死亡：结论：在计划引产前 4 天针刺丝状针，可增加引产日期前自然临产和胎膜早破的入院率。

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引用次数: 0

Predictive value of short cervix in early third trimester for preterm birth in women with normal mid-trimester cervical length 妊娠中期宫颈长度正常的妇女在妊娠早期三个月宫颈过短对早产的预测价值。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm

Pub Date : 2024-08-30 DOI: 10.1016/j.ajogmf.2024.101476

Background

Short cervical length in the mid-trimester is a powerful predictor of preterm birth (PTB). However, clinical significance of cervical length in the third trimester for predicting PTB has not been established yet.

Objective

To examine the predictive role of a shortened cervix in the third trimester for PTB in women who had a normal cervical length in the second trimester

Study design

This retrospective cohort study included women who underwent cervical length measured at least once in both the second trimester (16+0 weeks to 27+6weeks) and the early third trimester (28+0 weeks to 33+6 weeks). Women with short cervical length in the second trimester, those with multiple pregnancies, those who underwent cerclage operation, and those who had iatrogenic PTB were excluded. The study population was divided into two groups based on cervical length in the third trimester: a short cervix (≤25 mm) group and a control group (>25 mm). Rates of PTB (<37 weeks) were compared between two groups. Predictive performances of cervical length in the third trimester for PTB were assessed.

Results

Women with a short cervical length at 28+0 to 33+6 weeks accounted for 12.6% (n=717) of the total study population (n=5682). PTB rate was 9.5% in the short cervix group, which was significantly higher than that (3.2%) in the control group (P<.001). The adjusted odds ratio for short cervical length on PTB was 2.73 (95% CI: 1.96–3.79). A short cervix in the third trimester had a sensitivity of 30.1%, a specificity of 88.1%, a positive predictive value of 9.5%, and a negative predictive value (NPV) of 96.8% in predicting PTB. The addition of third-trimester cervical length to the predictive model significantly increased the area under the curve from 0.64 (95% CI: 0.60–0.68) to 0.67 (95% CI: 0.63–0.71) (P=.002), demonstrating improved predictive performance.

Conclusion

Approximately 13% of women with normal cervical length in the mid-trimester had a short cervical length after 28 weeks, which increased the risk of PTB. The high specificity and NPV of third-trimester cervical length measurements underscore their critical utility in identifying women at low risk for preterm delivery.

背景妊娠中期宫颈长度过短是早产的有力预测指标。然而，妊娠三个月宫颈长度对预测早产的临床意义尚未确定：研究设计：：这项回顾性队列研究包括在妊娠后三个月（16+0 周至 27+6 周）和妊娠早期三个月（28+0 周至 33+6 周）至少测量过一次宫颈长度的妇女。第二孕期宫颈长度短的妇女、多胎妊娠妇女、接受过宫颈环扎手术的妇女以及先天性早产的妇女被排除在外。研究对象根据怀孕三个月时的宫颈长度分为两组：短宫颈组（≤ 25 毫米）和对照组（> 25 毫米）。两组的早产率（< 37 周）进行了比较。评估了怀孕三个月时宫颈长度对早产的预测性：宫颈长度短于 28+0 至 33+6 周的妇女占总研究人数（5682 人）的 12.6%（717 人）。短宫颈组的早产率为 9.5%，明显高于对照组的 3.2%（P < 0.001）。宫颈长度过短与早产的调整后几率比为 2.73（95% CI：1.96-3.79）。在预测早产方面，第三孕期宫颈短的敏感性为 30.1%，特异性为 88.1%，阳性预测值为 9.5%，阴性预测值为 96.8%。在预测模型中加入第三孕期宫颈长度后，曲线下面积从 0.64 (95% CI: 0.60-0.68) 显著增加到 0.67 (95% CI: 0.63-0.71) (p = 0.002)，显示预测性能有所提高：结论：在孕中期宫颈长度正常的妇女中，约有 13% 在 28 周后宫颈长度变短，这增加了早产的风险。第三孕期宫颈长度测量的高特异性和阴性预测值强调了其在识别早产低风险妇女方面的重要作用。

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引用次数: 0