Pub Date : 2024-10-16DOI: 10.1016/j.ajogmf.2024.101518
John R Soehl, Kathryn Anthony, Chloe N Matovina, L G Ward, Laura R Stroud, Emily S Miller
Background: Postpartum depression affects 14% of pregnant individuals and is a leading cause of preventable maternal mortality. Complications of pregnancy, such as preterm labor or pre-eclampsia, may require hospitalization for close monitoring and management. The impact of an antenatal hospitalization during pregnancy on postnatal depression remains understudied.
Objective: To evaluate whether hospital admission during pregnancy was associated with postpartum depressive symptoms in individuals who were enrolled in a collaborative care model and to evaluate whether enrollment in the collaborative care model during pregnancy mitigated this association.
Study design: This secondary analysis of a prospective cohort study included perinatal people enrolled in a collaborative care model at a quaternary academic center between 2017-2021. The primary outcome was presence of moderately severe or severe postpartum depressive symptoms at 6 weeks postpartum defined as a score of 15 or greater on a PHQ-9. The prevalence of symptoms of this severity was compared between those who experienced an antepartum hospitalization and those who did not using bivariable and multivariable analyses. A Breslow Day test was used to evaluate whether any observed association between antepartum hospitalization and postpartum depressive symptoms differed based on timing of enrollment in the collaborative care model.
Results: During the study period, 1897 individuals met inclusion criteria. Of these, 162 (8.5%) were admitted to the hospital during pregnancy. Of those with an antepartum hospitalization, 20 (12.4%) developed moderately severe to severe postpartum depressive symptoms compared to 136 (7.8%) of those who were not hospitalized (p=0.046). After adjustment for confounders identified through use of a directed acyclic graph, this difference did not persist in multivariable analysis (aOR 1.55, 95% CI [0.87-2.75]). A Breslow Day test demonstrated heterogeneity across enrollment timing, so subgroup analyses were performed for those enrolled during pregnancy (n=930) vs postpartum (n=967). Hospital admission was associated with higher rates of moderately severe to severe postpartum depressive symptoms in those enrolled in the collaborative care model postpartum (19.7% vs 10.6%, p=0.015, aOR 2.25, 95% CI [1.07-4.71]), but not those enrolled antenatally (5.8% vs 5.0%, p=0.735, aOR 1.09, 95% CI [0.38-3.19]).
Conclusions: Antepartum hospital admission was associated with higher rates of moderately severe to severe depressive symptoms. This association did not exist among individuals enrolled in collaborative care model during pregnancy, suggesting a potential protective effect afforded by engagement in a mental health support programming.
背景：产后抑郁症影响到 14% 的孕妇，是可预防的孕产妇死亡的主要原因之一。妊娠并发症，如早产或子痫前期，可能需要住院进行密切监测和治疗。孕期产前住院对产后抑郁症的影响仍未得到充分研究：目的：评估妊娠期入院是否与参加协同护理模式的个体产后抑郁症状有关，并评估妊娠期参加协同护理模式是否会减轻这种关联：这项前瞻性队列研究的二次分析包括2017-2021年间在一家四级学术中心加入协同护理模式的围产期患者。主要结果是产后6周出现中度或重度产后抑郁症状，即PHQ-9评分达到或超过15分。使用二变量和多变量分析比较了产前住院患者和未住院患者中这种严重程度症状的发生率。布雷斯洛日检验用于评估产前住院与产后抑郁症状之间的关联是否因合作护理模式的加入时间而有所不同：在研究期间，共有 1897 人符合纳入标准。其中，162 人（8.5%）在怀孕期间入院。在产前住院的患者中，有 20 人（12.4%）出现了中度至重度产后抑郁症状，而在未住院的患者中，有 136 人（7.8%）出现了中度至重度产后抑郁症状（P=0.046）。通过使用有向无环图对混杂因素进行调整后，这一差异在多变量分析中没有继续存在（aOR 1.55，95% CI [0.87-2.75]）。布雷斯罗日检验显示，不同入院时间的患者存在异质性，因此对孕期入院者（930 人）与产后入院者（967 人）进行了分组分析。在产后加入协同护理模式的患者中，入院与中度至重度产后抑郁症状发生率较高有关（19.7% vs 10.6%，p=0.015，aOR 2.25，95% CI [1.07-4.71]），但在产前加入协同护理模式的患者中，入院与中度至重度产后抑郁症状发生率较低无关（5.8% vs 5.0%，p=0.735，aOR 1.09，95% CI [0.38-3.19]）：产前入院与较高的中度至重度抑郁症状发生率有关。结论：产前入院与中度至重度抑郁症状发生率较高有关，但在孕期参与协作护理模式的患者中并不存在这种关联，这表明参与心理健康支持计划具有潜在的保护作用。
{"title":"Association Between Antepartum Admission and Postpartum Depressive Symptoms: Short Title: Antepartum Hospital Admission and Postpartum Depressive Symptoms.","authors":"John R Soehl, Kathryn Anthony, Chloe N Matovina, L G Ward, Laura R Stroud, Emily S Miller","doi":"10.1016/j.ajogmf.2024.101518","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101518","url":null,"abstract":"<p><strong>Background: </strong>Postpartum depression affects 14% of pregnant individuals and is a leading cause of preventable maternal mortality. Complications of pregnancy, such as preterm labor or pre-eclampsia, may require hospitalization for close monitoring and management. The impact of an antenatal hospitalization during pregnancy on postnatal depression remains understudied.</p><p><strong>Objective: </strong>To evaluate whether hospital admission during pregnancy was associated with postpartum depressive symptoms in individuals who were enrolled in a collaborative care model and to evaluate whether enrollment in the collaborative care model during pregnancy mitigated this association.</p><p><strong>Study design: </strong>This secondary analysis of a prospective cohort study included perinatal people enrolled in a collaborative care model at a quaternary academic center between 2017-2021. The primary outcome was presence of moderately severe or severe postpartum depressive symptoms at 6 weeks postpartum defined as a score of 15 or greater on a PHQ-9. The prevalence of symptoms of this severity was compared between those who experienced an antepartum hospitalization and those who did not using bivariable and multivariable analyses. A Breslow Day test was used to evaluate whether any observed association between antepartum hospitalization and postpartum depressive symptoms differed based on timing of enrollment in the collaborative care model.</p><p><strong>Results: </strong>During the study period, 1897 individuals met inclusion criteria. Of these, 162 (8.5%) were admitted to the hospital during pregnancy. Of those with an antepartum hospitalization, 20 (12.4%) developed moderately severe to severe postpartum depressive symptoms compared to 136 (7.8%) of those who were not hospitalized (p=0.046). After adjustment for confounders identified through use of a directed acyclic graph, this difference did not persist in multivariable analysis (aOR 1.55, 95% CI [0.87-2.75]). A Breslow Day test demonstrated heterogeneity across enrollment timing, so subgroup analyses were performed for those enrolled during pregnancy (n=930) vs postpartum (n=967). Hospital admission was associated with higher rates of moderately severe to severe postpartum depressive symptoms in those enrolled in the collaborative care model postpartum (19.7% vs 10.6%, p=0.015, aOR 2.25, 95% CI [1.07-4.71]), but not those enrolled antenatally (5.8% vs 5.0%, p=0.735, aOR 1.09, 95% CI [0.38-3.19]).</p><p><strong>Conclusions: </strong>Antepartum hospital admission was associated with higher rates of moderately severe to severe depressive symptoms. This association did not exist among individuals enrolled in collaborative care model during pregnancy, suggesting a potential protective effect afforded by engagement in a mental health support programming.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101518"},"PeriodicalIF":3.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.ajogmf.2024.101512
Michal Rosenberg Friedman, Yariv Yogev, Sharon Maslovitz, Moshe Leshno, Lee Reicher
Objective: To investigate the cost -effectiveness of exome and genome sequencing (ES), compared to Chromosomal microarray (CMA) METHODS: costs, utility and quality adjusted life years (QALYs) were modeled for prenatal testing with CMA or CMA+ES. Average costs and utilities were discounted at 3%. Two strategies for screening were compared using Markovian decision analysis model: (1) CMA only- abnormal result culminating in termination of pregnancy and normal test has with 1/160 chance for severe disorders. (2) ES after a normal CMA, for positive result a termination of pregnancy (TOP) was conducted. One - way sensitivity analysis for all variables. Outcome measures included the QALYs after abortion, cost of CMA and ES test and the health expenses of a critically ill infant. The time horizon of the model was 20 years.
Results: Total costs were $1,348 and $3,108 for CMA and CMA+ES strategies respectively. The QALYs with time horizon of 20 years were 14.15 and 14.19 QALYs for CMA and CMA+ES strategies respectively with incremental cost-effectiveness ratio (ICER) of 46,383$/QALYs. Sensitivity analysis revealed that the time horizon and the dis-utility of moderate/severe disability of the genetic disorder has an impact on the ICER. For example, with a relatively small disutility of moderate/sever disability, the ICER is 84,291$/QALYs and for a shorter time horizon of 10 years, the ICER is 94,148$/QALYs.
Conclusion: Exome has the potential to be cost-effective compared with CMA alone. Our research provides data regarding the cost-effectiveness of ES without specific indication that will become increasingly important in the near future as whole exome sequencing becomes the first-tier test in prenatal diagnosis.
{"title":"Cost-effectiveness of exome sequencing and chromosomal microarray for low-risk pregnancies: Cost-effectiveness of Prenatal Exome Sequencing.","authors":"Michal Rosenberg Friedman, Yariv Yogev, Sharon Maslovitz, Moshe Leshno, Lee Reicher","doi":"10.1016/j.ajogmf.2024.101512","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101512","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the cost -effectiveness of exome and genome sequencing (ES), compared to Chromosomal microarray (CMA) METHODS: costs, utility and quality adjusted life years (QALYs) were modeled for prenatal testing with CMA or CMA+ES. Average costs and utilities were discounted at 3%. Two strategies for screening were compared using Markovian decision analysis model: (1) CMA only- abnormal result culminating in termination of pregnancy and normal test has with 1/160 chance for severe disorders. (2) ES after a normal CMA, for positive result a termination of pregnancy (TOP) was conducted. One - way sensitivity analysis for all variables. Outcome measures included the QALYs after abortion, cost of CMA and ES test and the health expenses of a critically ill infant. The time horizon of the model was 20 years.</p><p><strong>Results: </strong>Total costs were $1,348 and $3,108 for CMA and CMA+ES strategies respectively. The QALYs with time horizon of 20 years were 14.15 and 14.19 QALYs for CMA and CMA+ES strategies respectively with incremental cost-effectiveness ratio (ICER) of 46,383$/QALYs. Sensitivity analysis revealed that the time horizon and the dis-utility of moderate/severe disability of the genetic disorder has an impact on the ICER. For example, with a relatively small disutility of moderate/sever disability, the ICER is 84,291$/QALYs and for a shorter time horizon of 10 years, the ICER is 94,148$/QALYs.</p><p><strong>Conclusion: </strong>Exome has the potential to be cost-effective compared with CMA alone. Our research provides data regarding the cost-effectiveness of ES without specific indication that will become increasingly important in the near future as whole exome sequencing becomes the first-tier test in prenatal diagnosis.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101512"},"PeriodicalIF":3.8,"publicationDate":"2024-10-16","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}
Pub Date : 2024-10-11DOI: 10.1016/j.ajogmf.2024.101520
Jennifer M.J. Kidd MD, MPH, Dajana Alku MD, Rosanne Vertichio MS, BSN, Meredith Akerman MS, Lakha Prasannan MD, Devin M. Mann MD, Paul A. Testa MD, Martin Chavez MD, Hye J. Heo MD
{"title":"Comparing users to nonusers of remote patient monitoring for postpartum hypertension","authors":"Jennifer M.J. Kidd MD, MPH, Dajana Alku MD, Rosanne Vertichio MS, BSN, Meredith Akerman MS, Lakha Prasannan MD, Devin M. Mann MD, Paul A. Testa MD, Martin Chavez MD, Hye J. Heo MD","doi":"10.1016/j.ajogmf.2024.101520","DOIUrl":"10.1016/j.ajogmf.2024.101520","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101520"},"PeriodicalIF":3.8,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.ajogmf.2024.101517
Juliana Gevaerd Martins MD , Antonio Saad MD , George Saade MD , Luis D. Pacheco MD
Acute right ventricular failure is a critical condition in pregnancy that can lead to severe maternal and fetal complications. This expert review discusses the instrumental role of point-of-care ultrasound in diagnosing and managing ARVF in pregnant patients, highlighting its benefits for immediate clinical decision-making in obstetric emergencies. The unique physiological changes during pregnancy, such as increased blood volume and cardiac output, can exacerbate underlying or latent cardiac issues, making pregnant patients particularly susceptible to acute right ventricular failure. Common causes during pregnancy include pulmonary embolism, peripartum cardiomyopathy, and congenital heart diseases, each presenting distinct challenges in diagnosis and management. The real-time capability of point-of-care ultrasound allows for the immediate assessment of right ventricular size and function, evaluation of fluid status via the inferior vena cava, and identification of potential pulmonary embolism, offering a non-invasive, rapid, and dynamic diagnostic tool right at the bedside. The expert review details specific point-of-care ultrasound techniques adapted for pregnant patients, including the parasternal long and short axis and apical 4-chamber view, essential for evaluating right heart function and guiding acute management strategies. These include fluid management, adjustment of pharmacological treatment, and immediate interventions to support cardiac function and reduce ventricular overload. Point-of-care ultrasound enhances clinical outcomes by allowing clinicians to make informed decisions quickly, reducing the time to intervention, and tailoring management strategies to individual patient needs. However, despite its apparent advantages, the adoption of point-of-care ultrasound requires specialized training and familiarity with obstetric-specific protocols. This review advocates for the integration of point-of-care ultrasound into standard obstetric care protocols, emphasizing the need for clear guidelines and structured protocols that equip healthcare providers with the skills necessary to utilize this technology effectively. Future research should aim to refine these protocols and expand the evidence base to solidify the role of point-of-care ultrasound in improving maternal and fetal outcomes in acute right ventricular failure.
{"title":"A practical approach to the diagnosis and initial management of acute right ventricular failure during pregnancy using point-of-care ultrasound","authors":"Juliana Gevaerd Martins MD , Antonio Saad MD , George Saade MD , Luis D. Pacheco MD","doi":"10.1016/j.ajogmf.2024.101517","DOIUrl":"10.1016/j.ajogmf.2024.101517","url":null,"abstract":"<div><div>Acute right ventricular failure is a critical condition in pregnancy that can lead to severe maternal and fetal complications. This expert review discusses the instrumental role of point-of-care ultrasound in diagnosing and managing ARVF in pregnant patients, highlighting its benefits for immediate clinical decision-making in obstetric emergencies. The unique physiological changes during pregnancy, such as increased blood volume and cardiac output, can exacerbate underlying or latent cardiac issues, making pregnant patients particularly susceptible to acute right ventricular failure. Common causes during pregnancy include pulmonary embolism, peripartum cardiomyopathy, and congenital heart diseases, each presenting distinct challenges in diagnosis and management. The real-time capability of point-of-care ultrasound allows for the immediate assessment of right ventricular size and function, evaluation of fluid status via the inferior vena cava, and identification of potential pulmonary embolism, offering a non-invasive, rapid, and dynamic diagnostic tool right at the bedside. The expert review details specific point-of-care ultrasound techniques adapted for pregnant patients, including the parasternal long and short axis and apical 4-chamber view, essential for evaluating right heart function and guiding acute management strategies. These include fluid management, adjustment of pharmacological treatment, and immediate interventions to support cardiac function and reduce ventricular overload. Point-of-care ultrasound enhances clinical outcomes by allowing clinicians to make informed decisions quickly, reducing the time to intervention, and tailoring management strategies to individual patient needs. However, despite its apparent advantages, the adoption of point-of-care ultrasound requires specialized training and familiarity with obstetric-specific protocols. This review advocates for the integration of point-of-care ultrasound into standard obstetric care protocols, emphasizing the need for clear guidelines and structured protocols that equip healthcare providers with the skills necessary to utilize this technology effectively. Future research should aim to refine these protocols and expand the evidence base to solidify the role of point-of-care ultrasound in improving maternal and fetal outcomes in acute right ventricular failure.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101517"},"PeriodicalIF":3.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.ajogmf.2024.101524
Nadim Chaarani MD , Sara Sorrenti MD , Antonio Sasanelli MD , Daniele Di Mascio MD , Vincenzo Berghella MD
<div><h3>Objective</h3><div>The aim of this systematic review and meta-analysis was to assess whether early discharge from hospital after cesarean delivery (CD) affects the rate of maternal readmission.</div></div><div><h3>Data source</h3><div>The research was conducted using PubMed, Embase, Web of Sciences, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials as electronic databases, from the inception of each database to August 2023 with RCT as publication type. No restrictions for language or geographic location were applied.</div></div><div><h3>Study eligibility criteria</h3><div>Selection criteria included only RCTs comparing the effect of earlier versus later hospital discharge after CD.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>The primary outcome was the rate of maternal readmission. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% confidence intervals (CI) using the random effects model of Mentel–Haenszel. I-squared (Higgins I<sup>2</sup>) greater than 0% was used to identify heterogeneity. “Early” and “late” hospital discharge was first considered according to each study's definition and then a subgroup analysis was performed including only studies defining as “early” a discharge within 24–28 hours and “late” a discharge at ≥48 hours after CD. The study was registered on PROSPERO (CRD 42024529885).</div></div><div><h3>Results</h3><div>Seven RCTs including 4,267 individuals, of which 2,125 (49.8%) randomized in the early discharge and 2,142 (50.2%) in the late discharge group were included. There was no difference between the two groups in the rate of maternal readmission (3.6% vs. 3.4%, RR 1.10; 95% CI 0.80–1.52). There was no significant difference in both maternal complications diagnosed within 6 weeks after CD and neonatal complications. Early discharge after CD was associated with improved psychological wellbeing and was cost-effective. The subgroup analysis of the primary outcomes only in high-quality studies showed similar results: no difference in the rate of maternal readmission was observed (3.8% vs. 3.2%, RR 1.20; 95% CI 0.63–2.30) between the two groups. When focusing only on studies comparing 24–28-hour versus ≥ 48-hour hospital discharge, the rate of maternal readmission did not differ between the two groups, while the rates of neonatal readmission and neonatal jaundice were significantly higher in the early discharge group.</div></div><div><h3>Conclusions</h3><div>There is no increase in the rate of maternal readmission following early hospital discharge at 24–28 hours as opposed to later hospital discharge after a CD. The rates of neonatal readmission and neonatal jaundice were significantly higher in the early discharge group. Patients undergoing uncomplicated CDs might be discharged from the hospital at 24–28 hours postpartum, as long as close neonatal outpatient follow-up is done in 1–2 days; if this is unfeasible, discha
目的本系统综述和荟萃分析旨在评估剖宫产（CD）后提前出院是否会影响产妇再入院率：研究使用 PubMed、Embase、Web of Sciences、Scopus、ClinicalTrials.gov 和 Cochrane Central Register of Controlled Trials 等电子数据库，研究时间从各数据库建立之初至 2023 年 8 月，研究类型为 RCT。研究资格标准：研究评估和综合方法：主要结果是产妇再入院率。采用 Mentel-Haenszel 随机效应模型，以相对风险（RR）或平均差（MD）及 95% 置信区间（CI）报告总结指标。I 平方（Higgins I2）大于 0% 用于识别异质性。首先根据每项研究的定义考虑 "较早 "和 "较晚 "出院的情况，然后进行亚组分析，其中只包括定义为 "较早 "在 CD 后 24-28 小时内出院和 "较晚 "在 CD 后 48 小时内出院的研究。该研究已在 PROSPERO（CRD 42024529885）上注册：结果：共纳入了七项 RCT 研究，包括 4267 名患者，其中 2125 人（49.8%）被随机分入早期出院组，2142 人（50.2%）被随机分入晚期出院组。两组产妇的再入院率没有差异（3.6% vs 3.4%，RR 1.10；95% CI 0.80-1.52）。分娩后 6 周内诊断出的产妇并发症和新生儿并发症没有明显差异。剖宫产后尽早出院与心理健康的改善有关，而且具有成本效益。仅对高质量研究的主要结果进行的亚组分析显示了相似的结果：两组间的产妇再入院率无差异（3.8% vs 3.2%，RR 1.20；95% CI 0.63-2.30）。如果只关注比较 24-28 小时出院与 48 小时出院的研究，则两组产妇的再入院率没有差异，而较早出院组的新生儿再入院率和新生儿黄疸率明显较高：结论：与 CD 后较晚出院相比，24-28 小时提前出院的产妇再入院率没有增加。较早出院组的新生儿再入院率和新生儿黄疸率明显较高。接受无并发症产前诊断的患者可在产后24-28小时出院，只要在1-2天内进行密切的新生儿门诊随访即可；如果不可行，48小时出院似乎对母婴都安全有效。分娩后尽早出院与心理健康的改善有关，而且具有成本效益。
{"title":"Early hospital discharge after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials","authors":"Nadim Chaarani MD , Sara Sorrenti MD , Antonio Sasanelli MD , Daniele Di Mascio MD , Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2024.101524","DOIUrl":"10.1016/j.ajogmf.2024.101524","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this systematic review and meta-analysis was to assess whether early discharge from hospital after cesarean delivery (CD) affects the rate of maternal readmission.</div></div><div><h3>Data source</h3><div>The research was conducted using PubMed, Embase, Web of Sciences, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials as electronic databases, from the inception of each database to August 2023 with RCT as publication type. No restrictions for language or geographic location were applied.</div></div><div><h3>Study eligibility criteria</h3><div>Selection criteria included only RCTs comparing the effect of earlier versus later hospital discharge after CD.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>The primary outcome was the rate of maternal readmission. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% confidence intervals (CI) using the random effects model of Mentel–Haenszel. I-squared (Higgins I<sup>2</sup>) greater than 0% was used to identify heterogeneity. “Early” and “late” hospital discharge was first considered according to each study's definition and then a subgroup analysis was performed including only studies defining as “early” a discharge within 24–28 hours and “late” a discharge at ≥48 hours after CD. The study was registered on PROSPERO (CRD 42024529885).</div></div><div><h3>Results</h3><div>Seven RCTs including 4,267 individuals, of which 2,125 (49.8%) randomized in the early discharge and 2,142 (50.2%) in the late discharge group were included. There was no difference between the two groups in the rate of maternal readmission (3.6% vs. 3.4%, RR 1.10; 95% CI 0.80–1.52). There was no significant difference in both maternal complications diagnosed within 6 weeks after CD and neonatal complications. Early discharge after CD was associated with improved psychological wellbeing and was cost-effective. The subgroup analysis of the primary outcomes only in high-quality studies showed similar results: no difference in the rate of maternal readmission was observed (3.8% vs. 3.2%, RR 1.20; 95% CI 0.63–2.30) between the two groups. When focusing only on studies comparing 24–28-hour versus ≥ 48-hour hospital discharge, the rate of maternal readmission did not differ between the two groups, while the rates of neonatal readmission and neonatal jaundice were significantly higher in the early discharge group.</div></div><div><h3>Conclusions</h3><div>There is no increase in the rate of maternal readmission following early hospital discharge at 24–28 hours as opposed to later hospital discharge after a CD. The rates of neonatal readmission and neonatal jaundice were significantly higher in the early discharge group. Patients undergoing uncomplicated CDs might be discharged from the hospital at 24–28 hours postpartum, as long as close neonatal outpatient follow-up is done in 1–2 days; if this is unfeasible, discha","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101524"},"PeriodicalIF":3.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.ajogmf.2024.101522
Stephanie Jarvi BSc, Amir Aviram MD, Courtney Jolliffe MD, Sophie Wortsman BSc, Grace Liu MD, Anne Berndl MD, Jon Barrett MD, Jamie Kroft MD
{"title":"Myomectomy at the time of cesarean delivery is not a predictor of transfusion among pregnant individuals with fibroids: a retrospective cohort study","authors":"Stephanie Jarvi BSc, Amir Aviram MD, Courtney Jolliffe MD, Sophie Wortsman BSc, Grace Liu MD, Anne Berndl MD, Jon Barrett MD, Jamie Kroft MD","doi":"10.1016/j.ajogmf.2024.101522","DOIUrl":"10.1016/j.ajogmf.2024.101522","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101522"},"PeriodicalIF":3.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.ajogmf.2024.101521
Alison M. Hoffer MD, LT, MC, USN, Brianne W. Morrow MD, LT, MC, USN, Andrea F. McGlynn MS, Jonathan T. Hunt MD, MBA, Maj, USAF, MC, Study conducted in Portsmouth, Virginia
{"title":"Screening for developmental dysplasia of the hip following external cephalic version","authors":"Alison M. Hoffer MD, LT, MC, USN, Brianne W. Morrow MD, LT, MC, USN, Andrea F. McGlynn MS, Jonathan T. Hunt MD, MBA, Maj, USAF, MC, Study conducted in Portsmouth, Virginia","doi":"10.1016/j.ajogmf.2024.101521","DOIUrl":"10.1016/j.ajogmf.2024.101521","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101521"},"PeriodicalIF":3.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.ajogmf.2024.101496
Erin S. Huntley MD, Edgar Hernandez-Andrade MD, Eleazar Soto-Torres MD, Baha M. Sibai MD, Donatella Gerulewicz-Vannini MD, Sean C. Blackwell MD
<div><h3>BACKGROUND</h3><div>In asymptomatic women with cervical length ≤10 mm, vaginal progesterone has a limited effect in reducing the rate of preterm delivery.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to estimate the rate of preterm delivery and mean latency period to delivery in asymptomatic women with no history of preterm delivery and a cervical length of ≤10.0 mm undergoing or not undergoing cerclage and who were not treated with vaginal progesterone.</div></div><div><h3>STUDY DESIGN</h3><div>This was a retrospective analysis of asymptomatic patients with singleton pregnancies and no history of preterm delivery with an incidental finding of a cervical length of ≤10.0 mm measured by transvaginal ultrasound during midtrimester scan. Of note, 56 patients (63.6%) underwent cerclage placement and 32 patients (36.4%) did not, none of them received vaginal progesterone. Patients with evidence of advanced dilation, prolapsing membranes, ruptured membranes, or positive signs of infection were not candidates for cerclage placement and were excluded from the analysis. Differences in the prevalence of preterm delivery, mean gestational age at delivery, and mean latency from very short cervix identification to delivery between the 2 groups were calculated. Associations between cerclage and preterm delivery adjusted for maternal characteristics and fetal weight were estimated.</div></div><div><h3>RESULTS</h3><div>The median gestational ages at the time of cervical length measurement were 20 6/7 weeks (interquartile range, 17 5/7 to 23 3/7) in the cerclage group and 21 5/7 weeks (interquartile range, 17 6/7 to 23 6/7) in the no-cerclage group (<em>P</em>=.02). No difference in cervical length was observed between patients who had a cerclage (5.9±3.1 mm) and those who did not have a cerclage (6.5±3.2 mm) (<em>P</em>=.4). The prevalence of preterm delivery in women with cerclage vs women without cerclage was as follows: PTD at <37 weeks of gestation (31/56 [55.3%] in the cerclage group vs 28/32 [87.5%] in the no-cerclage group; adjusted odds ratio, 0.17; 95% confidence interval, 0.05–0.62; <em>P</em>=.008), PTD at ≤34 weeks of gestation (27/56 [48.2%] in the cerclage group vs 24/32 [75.0%] in the no-cerclage group; adjusted odds ratio, 0.16; 95% confidence interval, 0.05–0.55; <em>P</em>=.02), and PTD at ≤28 weeks of gestation (19/56 [33.9%] in the cerclage group vs 22/32 [68.7%] in the no-cerclage group; adjusted odds ratio, 0.15; 95% confidence interval, 0.05–0.51; <em>P</em>=.002). The median gestational ages at delivery were 32 6/7 weeks (interquartile range, 19 1/7 to 40 1/7) in the cerclage group and 28 1/7 weeks (interquartile range, 20 1/7 to 40 2/7) in the no-cerclage group (<em>P</em>=.001). The median latencies from the time of cervical length measurement to delivery were 84 days (interquartile range, 8–144) in the cerclage group and 43 days (interquartile range, 1–146) in the no-cerclage group (<em>P</em>=.003).</div></div><d
目的：估算无症状、无早产史、宫颈长度（CL）≤10.0 mm、接受或未接受宫颈环扎术、未使用阴道黄体酮治疗的妇女的早产率（PTD）和平均分娩潜伏期：对无症状单胎妊娠且无早产史的患者进行回顾性分析，这些患者在中期妊娠扫描时偶然发现经阴道超声测量的宫颈长度（CL）≤10.0 mm，其中56人（63.6%）接受了宫颈环扎术，32人（36.4%）未接受宫颈环扎术，他们均未使用阴道黄体酮。有证据显示胎盘晚期扩张、胎膜脱垂、胎膜破裂或感染阳性体征的孕妇不适合进行宫颈环扎术，这些孕妇被排除在分析之外。计算了两组间早产发生率、平均分娩胎龄和极短宫颈鉴定至分娩的平均潜伏期的差异。在对产妇特征和胎儿体重进行调整后，估计了宫颈环扎与早产之间的关系：结果：在测量CL时，宫颈环扎组的中位胎龄（范围）为（周/天）20w6d（17w5d-23w3d），而未进行宫颈环扎组的中位胎龄为21w5d（17w6d-23w6d）（P=0.02）。进行了宫颈环扎的产妇（5.9 mm (SD 3.1 mm)）与未进行宫颈环扎的产妇（6.5 mm (SD 3.2 mm)；P=0.4）的CL没有差异。使用宫颈环扎术的产妇与未使用宫颈环扎术的产妇的早产（PTD）发生率分别为PTD 结论：在中期妊娠扫描中宫颈很短（≤10.0 mm）的低风险无症状妇女中，与期待疗法相比，采用宫颈环扎术的妇女分娩潜伏期更长，早产发生率更低。
{"title":"Rate of preterm delivery and latency period in asymptomatic patients undergoing cerclage for very short cervix ≤10.0 mm","authors":"Erin S. Huntley MD, Edgar Hernandez-Andrade MD, Eleazar Soto-Torres MD, Baha M. Sibai MD, Donatella Gerulewicz-Vannini MD, Sean C. Blackwell MD","doi":"10.1016/j.ajogmf.2024.101496","DOIUrl":"10.1016/j.ajogmf.2024.101496","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>In asymptomatic women with cervical length ≤10 mm, vaginal progesterone has a limited effect in reducing the rate of preterm delivery.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to estimate the rate of preterm delivery and mean latency period to delivery in asymptomatic women with no history of preterm delivery and a cervical length of ≤10.0 mm undergoing or not undergoing cerclage and who were not treated with vaginal progesterone.</div></div><div><h3>STUDY DESIGN</h3><div>This was a retrospective analysis of asymptomatic patients with singleton pregnancies and no history of preterm delivery with an incidental finding of a cervical length of ≤10.0 mm measured by transvaginal ultrasound during midtrimester scan. Of note, 56 patients (63.6%) underwent cerclage placement and 32 patients (36.4%) did not, none of them received vaginal progesterone. Patients with evidence of advanced dilation, prolapsing membranes, ruptured membranes, or positive signs of infection were not candidates for cerclage placement and were excluded from the analysis. Differences in the prevalence of preterm delivery, mean gestational age at delivery, and mean latency from very short cervix identification to delivery between the 2 groups were calculated. Associations between cerclage and preterm delivery adjusted for maternal characteristics and fetal weight were estimated.</div></div><div><h3>RESULTS</h3><div>The median gestational ages at the time of cervical length measurement were 20 6/7 weeks (interquartile range, 17 5/7 to 23 3/7) in the cerclage group and 21 5/7 weeks (interquartile range, 17 6/7 to 23 6/7) in the no-cerclage group (<em>P</em>=.02). No difference in cervical length was observed between patients who had a cerclage (5.9±3.1 mm) and those who did not have a cerclage (6.5±3.2 mm) (<em>P</em>=.4). The prevalence of preterm delivery in women with cerclage vs women without cerclage was as follows: PTD at <37 weeks of gestation (31/56 [55.3%] in the cerclage group vs 28/32 [87.5%] in the no-cerclage group; adjusted odds ratio, 0.17; 95% confidence interval, 0.05–0.62; <em>P</em>=.008), PTD at ≤34 weeks of gestation (27/56 [48.2%] in the cerclage group vs 24/32 [75.0%] in the no-cerclage group; adjusted odds ratio, 0.16; 95% confidence interval, 0.05–0.55; <em>P</em>=.02), and PTD at ≤28 weeks of gestation (19/56 [33.9%] in the cerclage group vs 22/32 [68.7%] in the no-cerclage group; adjusted odds ratio, 0.15; 95% confidence interval, 0.05–0.51; <em>P</em>=.002). The median gestational ages at delivery were 32 6/7 weeks (interquartile range, 19 1/7 to 40 1/7) in the cerclage group and 28 1/7 weeks (interquartile range, 20 1/7 to 40 2/7) in the no-cerclage group (<em>P</em>=.001). The median latencies from the time of cervical length measurement to delivery were 84 days (interquartile range, 8–144) in the cerclage group and 43 days (interquartile range, 1–146) in the no-cerclage group (<em>P</em>=.003).</div></div><d","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101496"},"PeriodicalIF":3.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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