American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Cost-effectiveness of exome sequencing and chromosomal microarray for low-risk pregnancies","authors":"Michal Rosenberg Friedman MD ,&nbsp;Yariv Yogev MD ,&nbsp;Sharon Maslovitz MD ,&nbsp;Moshe Leshno MD ,&nbsp;Lee Reicher MD","doi":"10.1016/j.ajogmf.2024.101512","DOIUrl":"10.1016/j.ajogmf.2024.101512","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Chromosomal microarray analysis (CMA) has been central to prenatal genetic diagnosis, detecting copy number variants with a ∼1% yield in low-risk cases. Next-generation sequencing (NGS), including exome sequencing (ES), enhances diagnostic capabilities with higher yields (8.5–10%) but at greater cost and complexity. While ES's cost-effectiveness is studied in high-risk pregnancies, data for low-risk pregnancies remain lacking. This study evaluates the cost-effectiveness of ES in low-risk pregnancies.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to investigate the cost-effectiveness of exome sequencing compared with chromosomal microarray analysis.</div></div><div><h3>STUDY DESIGN</h3><div>Costs, utilities, and quality-adjusted life years were modeled for prenatal testing with chromosomal microarray analysis or chromosomal microarray analysis + exome sequencing. Average costs and utilities were discounted at 3%. In addition, 2 strategies for screening were compared using the Markovian decision analysis model: (1) chromosomal microarray analysis only (an abnormal result leads to a termination of pregnancy, and a normal test has a 1 to 160 chance of developing into a severe disorder) and (2) exome sequencing after a normal chromosomal microarray analysis (a positive result leads to a termination of pregnancy). Of note, 1-way sensitivity analysis was performed for all variables. The outcome measures included quality-adjusted life years after abortion, costs of chromosomal microarray analysis and exome sequencing, and health expenses of a critically ill infant. The time horizon of the model was 20 years.</div></div><div><h3>RESULTS</h3><div>The total costs were $1348 for chromosomal microarray analysis and $3108 for chromosomal microarray analysis + exome sequencing. The quality-adjusted life years with a time horizon of 20 years were 14.15 for chromosomal microarray analysis and 14.19 for chromosomal microarray analysis + exome sequencing, with an incremental cost-effectiveness ratio of $46,383 per quality-adjusted life years. Sensitivity analysis revealed that the time horizon and the disutility of moderate/severe disability of the genetic disorder have an effect on the incremental cost-effectiveness ratio. For example, the incremental cost-effectiveness ratios are $84,291 per quality-adjusted life years for a relatively small disutility of moderate/severe disability and $94,148 per quality-adjusted life years for a shorter time horizon of 10 years.</div></div><div><h3>CONCLUSION</h3><div>Exome sequencing has the potential to be cost-effective compared with chromosomal microarray analysis alone. Our research provides data regarding the cost-effectiveness of exome sequencing without a specific indication, which will become increasingly important in the near future as whole exome sequencing becomes the first-tier test in prenatal diagnosis.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101512"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476675","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":"Addressing perinatal mood and anxiety disorders in obstetric settings: results of a cluster randomized controlled trial of two approaches","authors":"Nancy Byatt DO ,&nbsp;Martha Zimmermann PhD ,&nbsp;Taber C. Lightbourne MD ,&nbsp;Padma Sankaran MS ,&nbsp;Uruj K. Haider MD ,&nbsp;Radley Christopher Sheldrick PhD ,&nbsp;Misha Eliasziw PhD ,&nbsp;Tiffany A. Moore Simas MD","doi":"10.1016/j.ajogmf.2024.101599","DOIUrl":"10.1016/j.ajogmf.2024.101599","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Mood and anxiety disorders affect one in 5 perinatal individuals and are undertreated. While professional organizations and policy makers recommend that obstetric practices screen for, assess and treat mood and anxiety disorders, multi-level barriers to doing so exist. To help obstetric practices implement the recommended standard of care, we developed implementation assistance, an approach to guide practices on how to integrate screening, assessment, and treatment of mood and anxiety disorders into the obstetric practice workflow. To teach obstetric care clinicians how to treat perinatal mood and anxiety disorders, we also developed an e-learning course and toolkit.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Evaluate the extent to which 1) implementation assistance + e-learning/toolkit, and 2) e-learning/toolkit alone improved the rates and quality of care for perinatal mood and anxiety disorders in obstetric practices, as compared to usual care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;We conducted a cluster randomized controlled trial involving 13 obstetric practices across the United States (US). Using 2:2:1 randomization, 13 obstetric practices were assigned to 1) implementation assistance + e-learning/toolkit (n=5), 2) e-learning/toolkit alone (n=5), or 3) usual care (n=3). We measured obstetric care clinicians’ quality of care for perinatal mood and anxiety disorders (as measured by medical record documentation of screening, assessment, treatment initiation, and monitoring) documented in patient charts (n=1040)&lt;em&gt;.&lt;/em&gt; Effectiveness was assessed using multilevel generalized linear mixed models, accounting for clustering of repeated measurements (n=2, i.e., pre and post) within obstetric care clinicians’ patient charts (n=40) nested within practices (n=13). Intention-to-treat and per-protocol analyses were conducted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;At baseline, no significant differences were observed among the 3 groups regarding documented mental health screening. Chart abstraction at 8 months post-training revealed a significant increase in recommended bipolar disorder screening only among the practices that received the implementation plus e-learning/toolkit (from 0.0% to 30.0%; &lt;em&gt;p&lt;/em&gt;=.017). Practices receiving the e-learning/toolkit alone or usual care continued to not screen for bipolar disorder. Documented screening for anxiety also increased in the implementation + e-learning/toolkit group (from 0.5% to 40.2%), however, it did not reach statistical significance when compared to the other groups (&lt;em&gt;P&lt;/em&gt;=.09). A significant increase in documented post-traumatic stress disorder (PTSD) screening was observed among practices receiving the implementation plus e-learning/toolkit (0.0% to 30.0%; &lt;em&gt;P&lt;/em&gt;=.018). The quality-of-care score in the implementation + e-learning toolkit group increased from 20.5 at baseline to 42.8 at follow-up and was significantly different from both the e-learning/toolk","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101599"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932820","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":"Age-specific trends in pregnancy-associated suicide and homicide rates by race/ethnicity, 2005–2021","authors":"Jemar R. Bather PhD ,&nbsp;Marina Mautner Wizentier MS ,&nbsp;Sarah K. Cowan PhD ,&nbsp;Jeffrey F. Peipert MD, PhD ,&nbsp;Debra Furr-Holden PhD ,&nbsp;Melody S. Goodman PhD","doi":"10.1016/j.ajogmf.2025.101607","DOIUrl":"10.1016/j.ajogmf.2025.101607","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101607"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum readmissions among patients with adult congenital heart disease","authors":"Lisa D. Levine MD, MSCE ,&nbsp;Alexander M. Friedman MD, MPH ,&nbsp;Yuli Y. Kim MD ,&nbsp;Stephanie E. Purisch MD ,&nbsp;Timothy Wen MD, MPH","doi":"10.1016/j.ajogmf.2024.101580","DOIUrl":"10.1016/j.ajogmf.2024.101580","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Given the risks associated with congenital heart disease in the postpartum period, epidemiologic data identifying risk factors and timing of complications may be useful in improving postpartum care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to determine the timing of, risk factors for, and complications associated with 60-day postpartum readmissions following deliveries with maternal congenital heart disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;The 2010–2020 Nationwide Readmissions Database was used for this retrospective cohort study. Postpartum readmissions occurring within 60 days of delivery hospitalization discharge were ascertained. Clinical, demographic, and hospital risk factors associated with postpartum readmission were analyzed using logistic regression models, with unadjusted and adjusted odds ratios as measures of association. Among patients with congenital heart disease, the role of additional cardiac risk factors in the likelihood of readmission was analyzed. Risks for adverse maternal outcomes during readmission were analyzed, including severe maternal morbidity, cardiac severe maternal morbidity, and a critical care composite.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Of an estimated 40,780,439 delivery hospitalizations, 35,242 had an associated congenital heart disease diagnosis (8.6 per 10,000), including 2279 (6.5%) with complex congenital heart disease and 32,963 (93.5%) with noncomplex congenital heart disease. The proportion of deliveries with a maternal congenital heart disease diagnosis increased significantly from 6.7 per 10,000 in 2010 to 11.8 in 2020. Overall risk for 60-day postpartum readmission was 1.6% among women without congenital heart disease and 3.1% among women with congenital heart disease (&lt;em&gt;P&lt;/em&gt;&lt;.01). Among women with congenital heart disease, 36.0% of 60-day postpartum readmissions occurred 1 to 5 days after discharge, 18.0% 5 to 10 days after discharge, and 14.5% 10 to 20 days after discharge. In adjusted models for the entire population, congenital heart disease retained a significant association with 60-day postpartum readmission (adjusted odds ratio, 1.73; 95% confidence interval, 1.55–1.94). When the cohort was restricted to deliveries with congenital heart disease, adjusted analyses demonstrated increased odds associated with additional cardiac risk factors (congestive heart failure: adjusted odds ratio, 1.72; 95% confidence interval, 1.13–2.62; arrhythmia: adjusted odds ratio, 1.68; 95% confidence interval, 1.27–2.21; pulmonary circulation disorders: adjusted odds ratio, 1.57; 95% confidence interval, 1.10–2.24; and chronic hypertension: adjusted odds ratio, 1.88; 95% confidence interval, 1.26–2.80), hypertensive disorders of pregnancy (adjusted odds ratio, 1.97; 95% confidence interval, 1.49–2.61), and cesarean delivery (primary adjusted odds ratio, 1.82; 95% confidence interval, 1.39–2.38; repeat cesarean: adjusted odds ratio, 1.91; 95% confidenc","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101580"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe maternal morbidity contributed by obstetric hemorrhage: Maryland, 2020-2022","authors":"Carrie Wolfson PHD ,&nbsp;Jessica Tsipe Angelson MS, CNM ,&nbsp;Robert Atlas MD ,&nbsp;Irina Burd MD, PHD ,&nbsp;Pamela Chin MS, PA-C ,&nbsp;Cathy Downey BSN, RN ,&nbsp;Jenifer Fahey CNM, PhD ,&nbsp;Susan Hoffman BSN ,&nbsp;Clark T. Johnson MD ,&nbsp;Monica B. Jones MD ,&nbsp;Kimberly Jones-Beatty DNP, MSN, CNM ,&nbsp;Jennifer Kasirsky MD ,&nbsp;Daniel Kirsch MD ,&nbsp;Ichchha Madan MD ,&nbsp;Donna Neale MD ,&nbsp;Joanne Olaku MSN ,&nbsp;Michelle Phillips BSN ,&nbsp;Amber Richter MSN ,&nbsp;Jeanne Sheffield MD ,&nbsp;Danielle Silldorff MS ,&nbsp;Andreea Creanga MD, PHD","doi":"10.1016/j.ajogmf.2024.101589","DOIUrl":"10.1016/j.ajogmf.2024.101589","url":null,"abstract":"<div><h3>Background</h3><div>Obstetric hemorrhage is the leading cause of maternal mortality and severe maternal morbidity (SMM) in Maryland and nationally. Currently, through a quality collaborative, the state is implementing the Alliance for Innovation on Maternal Health (AIM) patient safety bundle on obstetric hemorrhage.</div></div><div><h3>Objective</h3><div>To describe SMM events contributed by obstetric hemorrhage and their preventability in Maryland.</div></div><div><h3>Study Design</h3><div>This cross-sectional study used data from hospital-based SMM surveillance and review program in Maryland. Hospital-based SMM criteria include admission to an intensive care unit and/or transfusion of 4 or more units of blood products (of any type) during pregnancy or within 42 days postpartum. A total of 193 obstetric hemorrhage events that met the surveillance definition were identified in hospitals participating in SMM surveillance since inception on August 1, 2020 until December 31, 2022. We compared patient and delivery characteristics, practices done well, and recommendations for care improvement among patients with severe obstetric hemorrhage deemed preventable and non-preventable by hospital-based review committees. For obstetric hemorrhage events deemed preventable, we further identified factors that contributed to the SMM outcome at the provider, system, and patient levels.</div></div><div><h3>Results</h3><div>Uterine atony was the leading cause of obstetric hemorrhage events (37.8%), followed by uterine rupture, laceration and intra-abdominal bleeding (23.8%). Sixty-six (34.2%) obstetric hemorrhage events were preventable. Patients with preventable obstetric hemorrhage were significantly more likely to have an emergency than planned cesarean delivery and less likely to have a placental complication or &gt;1500 mL blood loss volume. Hospital-based review committees determined that 81.8%, 30.3%, and 22.7% of preventable events could have been prevented or made less severe through changes to provider, system, or patient factors, respectively. Recommendations following event reviews aligned with the Alliance for Innovation on Maternal Health Obstetric Hemorrhage Patient Safety Bundle, particularly regarding elements in the Recognition and Prevention and Response domains.</div></div><div><h3>Conclusion</h3><div>About one-third of SMM events contributed by obstetric hemorrhages were deemed preventable. Of AIM bundle elements, assessing hemorrhage risk on admission to labor and delivery, peripartum, and upon transition to postpartum care together with rapid, unit-standardized management of hemorrhage are likely to benefit more than half of patients with preventable SMM contributed by obstetric hemorrhage.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101589"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928380","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":"Combined vaginal progesterone and cervical cerclage in the prevention of preterm birth: A systematic review and meta-analysis","authors":"Anne-Marie Aubin MD ,&nbsp;Liam McAuliffe MD ,&nbsp;Kimberley Williams MD ,&nbsp;Ashad Issah MD ,&nbsp;Rosanna Diacci MD ,&nbsp;Jack E. McAuliffe BSc ,&nbsp;Salma Sabdia MD ,&nbsp;Jason Phung MD ,&nbsp;Carol A. Wang BSc(Hons) ,&nbsp;Craig E. Pennell PhD","doi":"10.1016/j.ajogmf.2024.101553","DOIUrl":"10.1016/j.ajogmf.2024.101553","url":null,"abstract":"<div><h3>Background</h3><div>Vaginal progesterone and cervical cerclage are both effective interventions for reducing preterm birth (PTB). It is currently unclear whether combined therapy offers superior effectiveness compared to single therapy.</div></div><div><h3>Objective</h3><div>To determine the efficacy of combining cervical cerclage and vaginal progesterone in the prevention of PTB.</div></div><div><h3>Data sources</h3><div>We searched Medline (Ovid), EMBASE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Cochrane Library (Wiley) and Scopus (from their inception to 2020).</div></div><div><h3>Study eligibility criteria</h3><div>The review accepted randomized and pseudo-randomized control trials, non-randomized experimental control trials, and cohort studies. High risk patients (shortened cervical length &lt;25mm or prior PTB) who were assigned cervical cerclage, vaginal progesterone, or both for the prevention of PTB were included. Only singleton pregnancies were assessed.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>The primary outcome was birth &lt;37 weeks. Secondary outcomes included birth &lt;28, &lt;32 and &lt;34 weeks, gestational age (GA) at delivery, days between intervention and delivery, preterm premature rupture of membranes, neonatal mortality, neonatal intensive care unit admission, intubation and birthweight. Following title and full-text screening, eight papers were included in the final analysis. Risk of bias was assessed using the Cochrane Collaboration tool for assessing the risk of bias (ROBINS-I and RoB-2). Quality of evidence was assessed using the GRADE tool.</div></div><div><h3>Results</h3><div>Combined therapy was associated with lower risk of PTB &lt;37 weeks compared to progesterone alone (RR 0.75, 95% CI 0.58, 0.96). Compared to cerclage only, combined therapy was associated with less PTB &lt;32 weeks, decreased neonatal mortality, increased GA and a longer interval between intervention and delivery. Compared to progesterone alone, combined therapy was associated with less PTB &lt;32 weeks, less PTB&lt;28 weeks, increased GA, decreased neonatal mortality and decreased neonatal intensive care unit admissions.</div></div><div><h3>Conclusions</h3><div>Combined treatment of cervical cerclage and vaginal progesterone could potentially result in a greater reduction in PTB compared to single therapy. Further well-conducted and adequately powered randomized controlled trials are needed to assess these promising findings.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101553"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428213","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":"Cesarean Delivery Classification System.","authors":"Clodagh Mullen, Marcos Izquierdo, Nicolas Mario Mas D Alessandro, Matthew Sikora","doi":"10.1016/j.ajogmf.2025.101624","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101624","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101624"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123803","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":"Prevalence of GLP-1 medication exposure prior to, during, and after pregnancy using state-wide data from 2017 to 2023","authors":"Katherine A. Ahrens MPH, PhD,&nbsp;Kristin Palmsten ScD,&nbsp;Heather S. Lipkind MD, MS,&nbsp;Christina M. Ackerman-Banks MD","doi":"10.1016/j.ajogmf.2024.101596","DOIUrl":"10.1016/j.ajogmf.2024.101596","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101596"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928371","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":"Comparative effectiveness of low molecular weight heparin on live birth for recurrent spontaneous abortion: systematic review and network meta-analysis","authors":"Wenrui Huang PhD ,&nbsp;Yue Yu BD ,&nbsp;Lei Chen MD ,&nbsp;Xiaoxuan Tang MD ,&nbsp;Xingzi Fang MD ,&nbsp;Xingyan Ou MD ,&nbsp;XueLian Du PhD","doi":"10.1016/j.ajogmf.2024.101572","DOIUrl":"10.1016/j.ajogmf.2024.101572","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the effectiveness and safety of low molecular weight heparins (LMWHs) on live birth rates and adverse pregnancy outcomes in individuals experiencing recurrent spontaneous abortion (RSA).</div></div><div><h3>Data sources</h3><div>PubMed, Web of Science, the Cochrane Library, and Embase from database inception to July 1, 2024.</div></div><div><h3>Study eligibility criteria</h3><div>Eligible randomized controlled trials enrolled women with RSA who received LMWH, with a follow-up duration of at least 12 weeks. The treatment was either monotherapy with LMWH or added LMWH to nonrandomized background anticoagulant treatments, with the control group being placebo and other anticoagulant treatments. Trials with a crossover design or involving withdrawn drugs were also excluded.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>We assessed bias using the Risk of Bias 2.0 tool and evaluated evidence quality with the Confidence in Network Meta-Analysis framework. The network meta-analysis employed a Bayesian framework to integrate direct and indirect evidence, calculating risk ratios and 95% confidence intervals. Markov chain Monte Carlo methods generated posterior distributions, allowing comparison and ranking of treatments. Subgroup, regression, and sensitivity analyses assessed the impact of various factors on the results.</div></div><div><h3>Results</h3><div>This network meta-analysis included 22 trials involving 4773 participants across five different LMWH drugs, with all comparisons made against the control group. Among the five drugs, enoxaparin showed significant benefits. It notably improved live birth rates (LBR) (Risk Ratios 1.19, (95% confidence intervals 1.06 to 1.36), surface under the cumulative ranking curve 73%; moderate confidence of evidence), reduced the risk of pre-eclampsia (0.53, (0.28–0.92), 85%), lowered preterm delivery (0.59, [0.41–0.86], 85%), and decreased pregnancy loss (0.55, [0.38–0.76], 82%). Further analysis of 7 different LMWH doses revealed that both enoxaparin 20mg (1.53, [1.08–2.25], 89%) and 40mg (1.18, [1.04–1.38], 59%) significantly improved LBR, with the 20mg dose proving more effective. Both doses also significantly reduced the risk of pregnancy loss.</div></div><div><h3>Conclusion</h3><div>Enoxaparin proved to be the most effective LMWH in increasing LBR compared to the control group. It also significantly lowered the risks of pre-eclampsia, preterm delivery, and pregnancy loss. A dosage-based subgroup analysis showed that both 20mg and 40mg of enoxaparin improved LBR, with the 20mg dose demonstrating greater effectiveness.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101572"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740870","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":"High- vs low-dose oxytocin regimens for labor augmentation: a systematic review and meta-analysis","authors":"Teresa C. Logue MD, MPH ,&nbsp;Fabrizio Zullo MD ,&nbsp;Fiamma van Biema MA ,&nbsp;Moeun Son MD, MSCI ,&nbsp;Lauren London MD ,&nbsp;Sneha Paranandi MD ,&nbsp;Anthony C. Sciscione DO ,&nbsp;Giuseppe Rizzo MD ,&nbsp;Daniele Di Mascio MD ,&nbsp;Suneet P. Chauhan MD, Hon DSc","doi":"10.1016/j.ajogmf.2025.101604","DOIUrl":"10.1016/j.ajogmf.2025.101604","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study aimed to assess whether high- vs low-dose oxytocin regimens for labor augmentation are associated with differential risk of low Apgar score, neonatal acidosis, and other adverse labor outcomes.</div></div><div><h3>DATA SOURCES</h3><div>We searched electronic databases (MEDLINE, Embase, the Cochrane Library, CINAHL, Scopus, ClinicalTrials.gov) from inception up to March 2024 using combinations of the following key words: “oxytocin,” “oxytocin regimen,” “oxytocin protocol,” “oxytocin dosage,” “active management,” “high dose protocol,” “low dose protocol,” and “augmentation of labor.”</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>We included quasi-randomized and randomized controlled trials comparing continuous oxytocin infusion with high-dose regimens (intervention group) vs low-dose regimens (control group) in nulliparous or multiparous patients undergoing labor augmentation. High-dose regimens were defined as a starting oxytocin dose of ≥4 mU/min, increasing in increments of 3 to 7 mU/min every 15 to 40 minutes. Low-dose regimens were defined as a starting oxytocin dose of &lt;4 mU/min, increasing in increments of 1 to 2 mU/min every 15 to 40 minutes (PROSPERO CRD42024500197).</div></div><div><h3>METHODS</h3><div>The coprimary outcomes were incidence of Apgar score &lt;7 at 5 minutes and umbilical arterial pH &lt;7.00. The secondary outcomes included cesarean delivery and chorioamnionitis. We performed random-effects head-to-head meta-analyses to compare high-dose with low-dose strategies, and reported summary risk ratios with 95% confidence intervals.</div></div><div><h3>RESULTS</h3><div>Ten randomized and quasi-randomized controlled trials of 5508 pregnancies met the inclusion criteria and were included in this meta-analysis. There was no difference in risk for the coprimary outcomes of Apgar score &lt;7 at 5 minutes (relative risk, 0.94; 95% confidence interval, 0.60–1.46) and umbilical arterial pH &lt;7.00 (relative risk, 0.77; 95% confidence interval, 0.50–1.20). There was also no difference in risk for cesarean delivery (relative risk, 0.83; 95% confidence interval, 0.67–1.02). High-dose oxytocin regimens were associated with significantly lower risk of chorioamnionitis (relative risk, 0.70; 95% confidence interval, 0.57–0.84; number needed to treat=25) and higher risk of tachysystole (relative risk, 1.32; 95% confidence interval, 1.21–1.43; <em>P</em>&lt;.001).</div></div><div><h3>CONCLUSION</h3><div>When used for labor augmentation, high-dose oxytocin regimens decreased the risk of chorioamnionitis compared with low-dose regimens without affecting the risk of low Apgar scores, neonatal acidosis, or cesarean delivery.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101604"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956172","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}