Pub Date : 2024-08-01DOI: 10.1016/j.ajogmf.2024.101397
{"title":"Sociodemographic factors associated with antenatal steroid use among late preterm births","authors":"","doi":"10.1016/j.ajogmf.2024.101397","DOIUrl":"10.1016/j.ajogmf.2024.101397","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318524","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 : 2024-08-01DOI: 10.1016/j.ajogmf.2024.101426
BACKGROUND
The Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms are designed to help obstetric practices address perinatal depression. The PRogram in Support of Moms includes the statewide Massachusetts Child Psychiatry Access Program for Moms program, plus proactive implementation support.
OBJECTIVE
The goal of this study was to understand the impact of these programs on perinatal generalized anxiety disorder and posttraumatic stress disorder symptoms among individuals screening positive for depression.
STUDY DESIGN
We conducted a secondary analysis of 2017–2022 data from a cluster randomized controlled trial of Massachusetts Child Psychiatry Access Program for Moms vs PRogram In Support of Moms. We included participants completing a generalized anxiety disorder or posttraumatic stress disorder screen at baseline (n=254) with antenatal Edinburgh Postnatal Depression Scale scores ≥10. We assessed changes in generalized anxiety disorder and posttraumatic stress disorder symptoms from pregnancy (4–25 weeks of gestational age or 32–40 weeks of gestational age), 4–12 weeks postpartum, and 11–13 months postpartum. We conducted a difference-in-difference analysis to compare symptom change from pregnancy to postpartum. We used adjusted linear mixed models with repeated measures to examine the impact of the Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms on changes in the Generalized Anxiety Disorder 7 and the Posttraumatic Stress Disorder Checklist.
RESULTS
Mean Generalized Anxiety Disorder 7 scores decreased by 3.6 (Massachusetts Child Psychiatry Access Program for Moms) and 6.3 (PRogram In Support of Moms) points from pregnancy to 4–12 weeks postpartum. Mean Posttraumatic Stress Disorder Checklist scores decreased by 6.2 and 10.0 points, respectively, at 4–12 weeks postpartum among individuals scree ning positive on the Generalized Anxiety Disorder 7 (n=83) or Posttraumatic Stress Disorder Checklist (n=58) in pregnancy. Generalized Anxiety Disorder 7 and Posttraumatic Stress Disorder Checklist scores decreased among both groups at 11–13 months postpartum. These changes were clinically meaningful. PRogram In Support of Moms conferred a statistically significant greater decrease (2.7 points) on the Generalized Anxiety Disorder 7 than the Massachusetts Child Psychiatry Access Program for Moms at 4–12 weeks postpartum. No differences were found between the Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms in Posttraumatic Stress Disorder Checklist or Generalized Anxiety Disorder 7 change at 11–13 months, although both were associated with a reduction in generalized anxiety disorder and posttraumatic stress disorder symptoms at 4–12 weeks and 11–13 months postpartum.
CONCLUSION
Both the Massachusetts Child Psychiatry Access Program f
{"title":"Comparing the effect of two systems-level interventions on perinatal generalized anxiety disorder and posttraumatic stress disorder symptoms","authors":"","doi":"10.1016/j.ajogmf.2024.101426","DOIUrl":"10.1016/j.ajogmf.2024.101426","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>The Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms are designed to help obstetric practices address perinatal depression. The PRogram in Support of Moms includes the statewide Massachusetts Child Psychiatry Access Program for Moms program, plus proactive implementation support.</p></div><div><h3>OBJECTIVE</h3><p>The goal of this study was to understand the impact of these programs on perinatal generalized anxiety disorder and posttraumatic stress disorder symptoms among individuals screening positive for depression.</p></div><div><h3>STUDY DESIGN</h3><p>We conducted a secondary analysis of 2017–2022 data from a cluster randomized controlled trial of Massachusetts Child Psychiatry Access Program for Moms vs PRogram In Support of Moms. We included participants completing a generalized anxiety disorder or posttraumatic stress disorder screen at baseline (n=254) with antenatal Edinburgh Postnatal Depression Scale scores ≥10. We assessed changes in generalized anxiety disorder and posttraumatic stress disorder symptoms from pregnancy (4–25 weeks of gestational age or 32–40 weeks of gestational age), 4–12 weeks postpartum, and 11–13 months postpartum. We conducted a difference-in-difference analysis to compare symptom change from pregnancy to postpartum. We used adjusted linear mixed models with repeated measures to examine the impact of the Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms on changes in the Generalized Anxiety Disorder 7 and the Posttraumatic Stress Disorder Checklist.</p></div><div><h3>RESULTS</h3><p>Mean Generalized Anxiety Disorder 7 scores decreased by 3.6 (Massachusetts Child Psychiatry Access Program for Moms) and 6.3 (PRogram In Support of Moms) points from pregnancy to 4–12 weeks postpartum. Mean Posttraumatic Stress Disorder Checklist scores decreased by 6.2 and 10.0 points, respectively, at 4–12 weeks postpartum among individuals scree ning positive on the Generalized Anxiety Disorder 7 (n=83) or Posttraumatic Stress Disorder Checklist (n=58) in pregnancy. Generalized Anxiety Disorder 7 and Posttraumatic Stress Disorder Checklist scores decreased among both groups at 11–13 months postpartum. These changes were clinically meaningful. PRogram In Support of Moms conferred a statistically significant greater decrease (2.7 points) on the Generalized Anxiety Disorder 7 than the Massachusetts Child Psychiatry Access Program for Moms at 4–12 weeks postpartum. No differences were found between the Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms in Posttraumatic Stress Disorder Checklist or Generalized Anxiety Disorder 7 change at 11–13 months, although both were associated with a reduction in generalized anxiety disorder and posttraumatic stress disorder symptoms at 4–12 weeks and 11–13 months postpartum.</p></div><div><h3>CONCLUSION</h3><p>Both the Massachusetts Child Psychiatry Access Program f","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591610","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 : 2024-08-01DOI: 10.1016/j.ajogmf.2024.101420
{"title":"Letter to the Editor regarding randomized trial of screening for preterm birth in low-risk women—the preterm birth study","authors":"","doi":"10.1016/j.ajogmf.2024.101420","DOIUrl":"10.1016/j.ajogmf.2024.101420","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538754","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 : 2024-08-01DOI: 10.1016/j.ajogmf.2024.101434
Background
In population-based research, pregnancy may be a repeated event. Despite published guidance on how to address repeated pregnancies to the same individual, a variety of approaches are observed in perinatal epidemiological studies. While some of these approaches are supported by the chosen research question, others are consequences of constraints inherent to a given dataset (eg, missing parity information). These decisions determine how appropriately a given research question can be answered and overall generalizability.
Objective
To compare common cohort selection and analytic approaches used for perinatal epidemiological research by assessing the prevalence of two perinatal outcomes and their association with a clinical and a social independent variable.
Study Design
Using vital records linked to maternal hospital discharge records for singleton births, we created four cohorts: (1) all-births (2) randomly selected one birth per individual (3) first-observed birth per individual (4) primiparous-births (parity 1). Sampling of births was not conditional on cluster (ie, we did not sample all births by a given mother, but rather sampled individual births). Study outcomes were severe maternal morbidity (SMM) and preeclampsia/eclampsia, and the independent variables were self-reported race/ethnicity (as a social factor) and systemic lupus erythematosus. Comparing the four cohorts, we assessed the distribution of maternal characteristics, the prevalence of outcomes, overall and stratified by parity, and risk ratios (RR) for the associations of outcomes with independent variables. Among all-births, we then compared RR from three analytic strategies: with standard inference that assumes independently sampled births to the same mother in the model, with cluster-robust inference, and adjusting for parity.
Results
We observed minor differences in the population characteristics between the all-birth (N=2736,693), random-selection, and first-observed birth cohorts (both N=2284,660), with more substantial differences between these cohorts and the primiparous-births cohort (N=1054,684). Outcome prevalence was consistently lowest among all-births and highest among primiparous-births (eg, SMM 18.9 per 1000 births among primiparous-births vs 16.6 per 1000 births among all-births). When stratified by parity, outcome prevalence was always the lowest in births of parity 2 and highest among births of parity 1 for both outcomes. RR differed for study outcomes across all four cohorts, with the most pronounced differences between the primiparous-birth cohort and other cohorts. Among all-births, robust inference minimally impacted the confidence bounds of estimates, compared to the standard inference, that is, crude estimates (eg, lupus-SMM association: 4.01, 95% confidence intervals [CI] 3.54–4.55 vs 4.01, 95% CI 3.53–4.56 for crude estimate), wh
背景：在基于人群的研究中，妊娠可能是一个重复事件。尽管已就如何处理同一个体的重复妊娠发布了指导意见，但在围产期流行病学研究中仍可观察到各种不同的方法。其中一些方法得到了所选研究问题的支持，而另一些方法则是特定数据集固有限制的结果（如缺失奇偶信息）。这些决策决定了特定研究问题能得到多恰当的回答以及整体的可推广性：比较围产期流行病学研究中常用的队列选择和分析方法，评估两种围产期结局的发生率及其与临床和社会自变量的关系 研究设计：利用与单胎产妇出院记录相关联的生命记录，我们创建了四个队列：(1) 所有新生儿 (2) 每个个体随机抽取一个新生儿 (3) 每个个体首次观察到的新生儿 (4) 初产妇（奇数 1）。出生抽样不以分组为条件（即我们不抽样某一母亲的所有出生，而是抽样个别出生）。研究结果为严重孕产妇发病率和先兆子痫/子痫，自变量为自我报告的种族/民族（作为社会因素）和系统性红斑狼疮。通过比较四个队列，我们评估了孕产妇特征的分布、总体和按胎次分层的结果发生率，以及结果与自变量相关性的风险比。在所有新生儿中，我们比较了三种分析策略得出的风险比：标准推断（假定模型中同一母亲的新生儿是独立采样的）、聚类分析推断以及根据奇偶性进行调整：我们观察到，所有出生队列（N=2,736,693）、随机选择队列和首次观察到的出生队列（均为 N=2,284,660）之间的人口特征差异较小，而这些队列与初产队列（N=1,054,684）之间的差异更大。在所有新生儿中，结果发生率一直最低，而在初产妇中则最高（例如，初产妇的严重孕产妇发病率为每 1,000 例新生儿中有 18.9 例，而所有新生儿中则为每 1,000 例新生儿中有 16.6 例）。按胎次分层时，在两种结果中，胎次为 2 的新生儿的结果发生率最低，胎次为 1 的新生儿的结果发生率最高。在所有四个组群中，研究结果的风险比都有所不同，其中初产妇组群与其他组群之间的差异最为明显。在所有新生儿中，与标准推断（即粗略估计值）相比，稳健推断对估计值的置信区间影响最小（例如，红斑狼疮与严重孕产妇发病率的关系：4.01，95% CI 3.54-4.55 vs. 4.01，95% CI 3.53-4.56），而根据奇偶性调整则会使估计值略有偏移，在严重孕产妇发病率方面偏向空值，在子痫前期/子痫方面偏离空值：研究人员应考虑其使用的方法、抽样策略和研究问题之间的一致性。结论：研究人员应考虑其使用的方法、抽样策略和研究问题之间的一致性，包括改进研究问题以更好地匹配可用数据的推断、考虑其他数据来源、适当注意数据的局限性和由此产生的偏差以及研究结果的可推广性。如果均等是一个既定的效应调节因子，则应提交分层结果。
{"title":"Considering pregnancies as repeated vs independent events: an empirical comparison of common approaches across selected perinatal outcomes","authors":"","doi":"10.1016/j.ajogmf.2024.101434","DOIUrl":"10.1016/j.ajogmf.2024.101434","url":null,"abstract":"<div><h3>Background</h3><p>In population-based research, pregnancy may be a repeated event. Despite published guidance on how to address repeated pregnancies to the same individual, a variety of approaches are observed in perinatal epidemiological studies. While some of these approaches are supported by the chosen research question, others are consequences of constraints inherent to a given dataset (eg, missing parity information). These decisions determine how appropriately a given research question can be answered and overall generalizability.</p></div><div><h3>Objective</h3><p>To compare common cohort selection and analytic approaches used for perinatal epidemiological research by assessing the prevalence of two perinatal outcomes and their association with a clinical and a social independent variable.</p></div><div><h3>Study Design</h3><p>Using vital records linked to maternal hospital discharge records for singleton births, we created four cohorts: (1) all-births (2) randomly selected one birth per individual (3) first-observed birth per individual (4) primiparous-births (parity 1). Sampling of births was not conditional on cluster (ie, we did not sample all births by a given mother, but rather sampled individual births). Study outcomes were severe maternal morbidity (SMM) and preeclampsia/eclampsia, and the independent variables were self-reported race/ethnicity (as a social factor) and systemic lupus erythematosus. Comparing the four cohorts, we assessed the distribution of maternal characteristics, the prevalence of outcomes, overall and stratified by parity, and risk ratios (RR) for the associations of outcomes with independent variables. Among all-births, we then compared RR from three analytic strategies: with standard inference that assumes independently sampled births to the same mother in the model, with cluster-robust inference, and adjusting for parity.</p></div><div><h3>Results</h3><p>We observed minor differences in the population characteristics between the all-birth (<em>N</em>=2736,693), random-selection, and first-observed birth cohorts (both <em>N</em>=2284,660), with more substantial differences between these cohorts and the primiparous-births cohort (<em>N</em>=1054,684). Outcome prevalence was consistently lowest among all-births and highest among primiparous-births (eg, SMM 18.9 per 1000 births among primiparous-births vs 16.6 per 1000 births among all-births). When stratified by parity, outcome prevalence was always the lowest in births of parity 2 and highest among births of parity 1 for both outcomes. RR differed for study outcomes across all four cohorts, with the most pronounced differences between the primiparous-birth cohort and other cohorts. Among all-births, robust inference minimally impacted the confidence bounds of estimates, compared to the standard inference, that is, crude estimates (eg, lupus-SMM association: 4.01, 95% confidence intervals [CI] 3.54–4.55 vs 4.01, 95% CI 3.53–4.56 for crude estimate), wh","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601943","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 : 2024-08-01DOI: 10.1016/j.ajogmf.2024.101408
OBJECTIVES
To systematically review randomized controlled trials (RCTs) and perform a meta-analysis comparing early amniotomy with delayed amniotomy in individuals undergoing pre-induction cervical ripening by Foley balloon. The primary outcome was the rate of cesarean delivery. Understanding the impact of the timing of amniotomy on the rate of cesarean delivery is crucial for obstetricians and healthcare providers when making decisions about the management of labor induction.
DATA SOURCES
Data were sourced from electronic databases, including PubMed, OVID, Cochrane Library, Web of Science, and ClinicalTrials.gov through February 2024. The review adhered to Preferred Reporting Item for Systematic Reviews guidelines and registered with PROSPERO (ID CRD42023454520).
STUDY ELIGIBILITY CRITERIA
Inclusion criteria comprised RCTs comparing early amniotomy with delayed amniotomy in individuals undergoing cervical ripening by Foley balloon. Early amniotomy was defined as amniotomy soon after cervical ripening. Delayed amniotomy was defined as withholding amniotomy until after the onset of the active phase of labor, until at least 4 hours from either initiation of oxytocin or Foley balloon removal/expulsion, or until achieving >4 cm of dilation. Participants included nulliparous or multiparous individuals with singleton pregnancies undergoing labor induction at 37 weeks or later.
STUDY APPRAISAL AND SYNTHESIS
A systematic literature search was conducted using defined search terms including “early amniotomy,” “delayed amniotomy,” “induction of labor,” “cervical ripening,” and “Foley balloon,” and “Foley catheter.” The quality of the included trials was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials. The primary outcome was cesarean delivery. Secondary outcomes included outcomes related to labor duration and neonatal outcomes. Pooled relative risks (RR) and weighted mean differences (WMD) with 95% confidence intervals were calculated.
RESULTS
Five trials involving 849 participants undergoing induction and cervical ripening by Foley balloon were included. The rate of cesarean delivery did not differ between individuals randomly assigned to the early amniotomy group compared with those assigned to the delayed amniotomy group (22.9% vs. 23.3%; RR 1.00; 95% CI 0.65–1.55). Early amniotomy compared to delayed amniotomy was associated with a higher proportion of delivery within 24 hours (79.9% vs. 67.1%; RR 1.19; 95% CI 1.04–1.36). Early amniotomy compared with delayed amniotomy was associated with a shorter interval from oxytocin to delivery (WMD -1.5 hours; 95% CI -2.1 to -0.8), from Foley expulsion to vaginal delivery (WMD -2.5 hours; 95% CI -4.8 to -0.1), and from the start of oxytocin to vaginal delivery (WMD -1.8 hours; 95% CI -3.2 to -0.4). Other outcomes were not significantly different.
{"title":"Early vs. delayed amniotomy in individuals undergoing pre-induction cervical ripening with transcervical Foley balloon: a meta-analysis","authors":"","doi":"10.1016/j.ajogmf.2024.101408","DOIUrl":"10.1016/j.ajogmf.2024.101408","url":null,"abstract":"<div><h3>OBJECTIVES</h3><p>To systematically review randomized controlled trials (RCTs) and perform a meta-analysis comparing early amniotomy with delayed amniotomy in individuals undergoing pre-induction cervical ripening by Foley balloon. The primary outcome was the rate of cesarean delivery. Understanding the impact of the timing of amniotomy on the rate of cesarean delivery is crucial for obstetricians and healthcare providers when making decisions about the management of labor induction.</p></div><div><h3>DATA SOURCES</h3><p>Data were sourced from electronic databases, including PubMed, OVID, Cochrane Library, Web of Science, and ClinicalTrials.gov through February 2024. The review adhered to Preferred Reporting Item for Systematic Reviews guidelines and registered with PROSPERO (ID CRD42023454520).</p></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><p>Inclusion criteria comprised RCTs comparing early amniotomy with delayed amniotomy in individuals undergoing cervical ripening by Foley balloon. Early amniotomy was defined as amniotomy soon after cervical ripening. Delayed amniotomy was defined as withholding amniotomy until after the onset of the active phase of labor, until at least 4 hours from either initiation of oxytocin or Foley balloon removal/expulsion, or until achieving >4 cm of dilation. Participants included nulliparous or multiparous individuals with singleton pregnancies undergoing labor induction at 37 weeks or later.</p></div><div><h3>STUDY APPRAISAL AND SYNTHESIS</h3><p>A systematic literature search was conducted using defined search terms including “early amniotomy,” “delayed amniotomy,” “induction of labor,” “cervical ripening,” and “Foley balloon,” and “Foley catheter.” The quality of the included trials was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials. The primary outcome was cesarean delivery. Secondary outcomes included outcomes related to labor duration and neonatal outcomes. Pooled relative risks (RR) and weighted mean differences (WMD) with 95% confidence intervals were calculated.</p></div><div><h3>RESULTS</h3><p>Five trials involving 849 participants undergoing induction and cervical ripening by Foley balloon were included. The rate of cesarean delivery did not differ between individuals randomly assigned to the early amniotomy group compared with those assigned to the delayed amniotomy group (22.9% vs. 23.3%; RR 1.00; 95% CI 0.65–1.55). Early amniotomy compared to delayed amniotomy was associated with a higher proportion of delivery within 24 hours (79.9% vs. 67.1%; RR 1.19; 95% CI 1.04–1.36). Early amniotomy compared with delayed amniotomy was associated with a shorter interval from oxytocin to delivery (WMD -1.5 hours; 95% CI -2.1 to -0.8), from Foley expulsion to vaginal delivery (WMD -2.5 hours; 95% CI -4.8 to -0.1), and from the start of oxytocin to vaginal delivery (WMD -1.8 hours; 95% CI -3.2 to -0.4). Other outcomes were not significantly different.</p></div><div><h3>CO","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427867","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 : 2024-08-01DOI: 10.1016/j.ajogmf.2024.101422
Background
Research on the definition of fetal growth restriction (FGR) has focused on predicting adverse perinatal outcomes. A significant limitation of this approach is that the individual outcomes of interest could be related to the condition and the treatment. Evaluation of outcomes that reflect the pathophysiology of FGR may overcome this limitation.
Objective
To compare the diagnostic performance of the FGR definitions established by the International Society for Ultrasound in Obstetrics and Gynecology (ISUOG) and the Society for Maternal-Fetal Medicine (SMFM) to predict placental histopathological findings associated with placental insufficiency and a composite adverse neonatal outcome (ANeO).
Study Design
In this retrospective cohort study of singleton pregnancies, the ISUOG and the SMFM guidelines were used to identify pregnancies with FGR and a corresponding control group. The primary outcome was the prediction of placental histopathological findings associated with placental insufficiency, defined as lesions associated with maternal vascular malperfusion (MVM). A composite ANeO (ie, umbilical artery pH≤7.1, Apgar score at 5 minutes ≤4, neonatal intensive care unit admission, hypoglycemia, respiratory distress syndrome requiring mechanical ventilation, intrapartum fetal distress requiring expedited delivery, and perinatal death) was investigated as a secondary outcome. Sensitivity, specificity, positive and negative predictive values, and the areas under the receiver-operating-characteristics curves were determined for each FGR definition. Logistic regression models were used to assess the association between each definition and the studied outcomes. A subgroup analysis of the diagnostic performance of both definitions stratifying the population in early and late FGR was also performed.
Results
Both societies’ definitions showed a similar diagnostic performance as well as a significant association with the primary (ISUOG adjusted odds ratio 3.01 [95% confidence interval 2.42, 3.75]; SMFM adjusted odds ratio 2.85 [95% confidence interval 2.31, 3.51]) and secondary outcomes (ISUOG adjusted odds ratio 1.95 [95% confidence interval 1.56, 2.43]; SMFM adjusted odds ratio 2.12 [95% confidence interval 1.70, 2.65]). Furthermore, both FGR definitions had a limited discriminatory capacity for placental histopathological findings of MVM and the composite ANeO (area under the receiver-operating-characteristics curve ISUOG 0.63 [95% confidence interval 0.61, 0.65], 0.59 [95% confidence interval 0.56, 0.61]; area under the receiver-operating-characteristics SMFM 0.63 [95% confidence interval 0.61, 0.66], 0.60 [95% confidence interval 0.57, 0.62]).
Conclusion
The ISUOG and the SMFM FGR definitions have limited dis
背景：有关胎儿生长受限定义的研究主要集中在预测围产期不良结局方面。这种方法的一个重要局限是，所关注的个别结果可能与病情和治疗有关。对反映胎儿生长受限病理生理学的结果进行评估可能会克服这一局限性：目的：比较国际妇产科超声学会（International Society for Ultrasound in Obstetrics and Gynecology）和母胎医学会（Society for Maternal-Fetal Medicine）制定的胎儿生长受限定义的诊断性能，以预测与胎盘功能不全相关的胎盘组织病理学结果和新生儿综合不良结局：在这项针对单胎妊娠的回顾性队列研究中，采用了国际妇产科超声学会和母胎医学会的指南来识别胎儿生长受限的妊娠和相应的对照组。主要结果是预测与胎盘功能不全相关的胎盘组织病理学结果，即与母体血管灌注不良相关的病变。新生儿综合不良结局（即脐动脉pH值≤7.1、5分钟Apgar评分≤4、入住新生儿重症监护室、低血糖、需要机械通气的呼吸窘迫综合征、需要加速分娩的产时胎儿窘迫和围产期死亡）作为次要结局进行研究。确定了每种胎儿生长受限定义的敏感性、特异性、阳性预测值和阴性预测值，以及受体操作特征曲线下的面积。逻辑回归模型用于评估每个定义与研究结果之间的关联。此外，还对两种定义的诊断性能进行了亚组分析，对早期和晚期胎儿生长受限的人群进行了分层：结果：两个学会的定义都显示出相似的诊断性能以及与主要结果的显著相关性（国际妇产科超声学会调整后的比值比为 3.01 [95% 置信区间为 2.42 - 3.75]；母胎医学会调整后的比值比为 2.85 [95% 置信区间为 2.75]）。85[95%置信区间2.31，3.51])和次要结局(国际妇产科超声学会调整后的几率比1.95[95%置信区间1.56，2.43]；母胎医学会调整后的几率比2.12[95%置信区间1.70，2.65])。此外，两种胎儿生长受限定义对母体血管灌注不良的胎盘组织病理学结果和新生儿综合不良结局的判别能力有限（国际妇产科超声学会接收者操作特征曲线下面积为 0.63[95%置信区间0.61，0.65]，0.59[95%置信区间0.56，0.61]；母胎医学会接收器操作特征曲线下面积0.63[95%置信区间0.61，0.66]，0.60[95%置信区间0.57，0.62]）：国际妇产科超声学会和母胎医学会的胎儿生长受限定义对胎盘组织病理学发现与胎盘功能不全和新生儿综合不良结局相关的判别能力有限。
{"title":"Placental pathology lesions: International Society for Ultrasound in Obstetrics and Gynecology vs Society for Maternal-Fetal Medicine fetal growth restriction definitions","authors":"","doi":"10.1016/j.ajogmf.2024.101422","DOIUrl":"10.1016/j.ajogmf.2024.101422","url":null,"abstract":"<div><h3>Background</h3><p>Research on the definition of fetal growth restriction (FGR) has focused on predicting adverse perinatal outcomes. A significant limitation of this approach is that the individual outcomes of interest could be related to the condition and the treatment. Evaluation of outcomes that reflect the pathophysiology of FGR may overcome this limitation.</p></div><div><h3>Objective</h3><p>To compare the diagnostic performance of the FGR definitions established by the International Society for Ultrasound in Obstetrics and Gynecology (ISUOG) and the Society for Maternal-Fetal Medicine (SMFM) to predict placental histopathological findings associated with placental insufficiency and a composite adverse neonatal outcome (ANeO).</p></div><div><h3>Study Design</h3><p>In this retrospective cohort study of singleton pregnancies, the ISUOG and the SMFM guidelines were used to identify pregnancies with FGR and a corresponding control group. The primary outcome was the prediction of placental histopathological findings associated with placental insufficiency, defined as lesions associated with maternal vascular malperfusion (MVM). A composite ANeO (ie, umbilical artery pH≤7.1, Apgar score at 5 minutes ≤4, neonatal intensive care unit admission, hypoglycemia, respiratory distress syndrome requiring mechanical ventilation, intrapartum fetal distress requiring expedited delivery, and perinatal death) was investigated as a secondary outcome. Sensitivity, specificity, positive and negative predictive values, and the areas under the receiver-operating-characteristics curves were determined for each FGR definition. Logistic regression models were used to assess the association between each definition and the studied outcomes. A subgroup analysis of the diagnostic performance of both definitions stratifying the population in early and late FGR was also performed.</p></div><div><h3>Results</h3><p>Both societies’ definitions showed a similar diagnostic performance as well as a significant association with the primary (ISUOG <em>adjusted odds ratio</em> 3.01 [95% <em>confidence interval</em> 2.42, 3.75]; SMFM <em>adjusted odds ratio</em> 2.85 [95% <em>confidence interval</em> 2.31, 3.51]) and secondary outcomes (ISUOG <em>adjusted odds ratio</em> 1.95 [95% <em>confidence interval</em> 1.56, 2.43]; SMFM <em>adjusted odds ratio</em> 2.12 [95% <em>confidence interval</em> 1.70, 2.65]). Furthermore, both FGR definitions had a limited discriminatory capacity for placental histopathological findings of MVM and the composite ANeO (<em>area under the receiver-operating-characteristics curve</em> ISUOG 0.63 [95% <em>confidence interval</em> 0.61, 0.65], 0.59 [95% <em>confidence interval</em> 0.56, 0.61]; <em>area under the receiver-operating-characteristics</em> SMFM 0.63 [95% <em>confidence interval</em> 0.61, 0.66], 0.60 [95% <em>confidence interval</em> 0.57, 0.62]).</p></div><div><h3>Conclusion</h3><p>The ISUOG and the SMFM FGR definitions have limited dis","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589933324001484/pdfft?md5=4b87263cd4ffc3005d327f9e332d7224&pid=1-s2.0-S2589933324001484-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajogmf.2024.101425
BACKGROUND
Both short and long interpregnancy intervals are associated with adverse pregnancy outcomes; however, the impact of interpregnancy intervals on labor progression is unknown.
OBJECTIVE
We examined the impact of interpregnancy intervals on the labor curve, hypothesizing that those with a longer interpregnancy intervals would have slower labor progression.
STUDY DESIGN
This is a retrospective cohort study of patients with a history of one prior vaginal delivery admitted for induction of labor or spontaneous labor with a singleton gestation ≥37 weeks at an academic medical center between 2004 and 2015. Repeated measures regression was used to construct labor curves, which were compared between patients with short interpregnancy intervals, defined as <3 years since the last delivery, and long interpregnancy intervals, defined as >3 years since the last delivery. We chose this interval as it approximates the median birth interval in the United States. Interval-censored regression was used to estimate the median duration of labor after 4 centimeters of dilation, stratified by type of labor (spontaneous vs induced). Multivariate analysis was used to adjust for potential confounders.
RESULTS
Of the 1331 patients who were included in the analysis, 544 (41%) had a long interpregnancy interval. Among the entire cohort, there were no significant differences in first or second-stage progression between short and long interpregnancy interval groups. In the stratified analysis, first-stage progression varied between groups on the basis of labor type: long interpregnancy interval was associated with a slower active phase among those being induced and a quicker active phase among those in spontaneous labor. The second-stage duration was similar between cohorts regardless of labor type.
CONCLUSION
Multiparas with an interpregnancy interval >3 years may have a slower active phase than those with a shorter interpregnancy interval when undergoing induction of labor. Interpregnancy interval does not demonstrate an effect on the length of the second stage.
{"title":"Association between interpregnancy interval and the labor curve","authors":"","doi":"10.1016/j.ajogmf.2024.101425","DOIUrl":"10.1016/j.ajogmf.2024.101425","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Both short and long interpregnancy intervals are associated with adverse pregnancy outcomes; however, the impact of interpregnancy intervals on labor progression is unknown.</p></div><div><h3>OBJECTIVE</h3><p>We examined the impact of interpregnancy intervals on the labor curve, hypothesizing that those with a longer interpregnancy intervals would have slower labor progression.</p></div><div><h3>STUDY DESIGN</h3><p>This is a retrospective cohort study of patients with a history of one prior vaginal delivery admitted for induction of labor or spontaneous labor with a singleton gestation ≥37 weeks at an academic medical center between 2004 and 2015. Repeated measures regression was used to construct labor curves, which were compared between patients with short interpregnancy intervals, defined as <3 years since the last delivery, and long interpregnancy intervals, defined as >3 years since the last delivery. We chose this interval as it approximates the median birth interval in the United States. Interval-censored regression was used to estimate the median duration of labor after 4 centimeters of dilation, stratified by type of labor (spontaneous vs induced). Multivariate analysis was used to adjust for potential confounders.</p></div><div><h3>RESULTS</h3><p>Of the 1331 patients who were included in the analysis, 544 (41%) had a long interpregnancy interval. Among the entire cohort, there were no significant differences in first or second-stage progression between short and long interpregnancy interval groups. In the stratified analysis, first-stage progression varied between groups on the basis of labor type: long interpregnancy interval was associated with a slower active phase among those being induced and a quicker active phase among those in spontaneous labor. The second-stage duration was similar between cohorts regardless of labor type.</p></div><div><h3>CONCLUSION</h3><p>Multiparas with an interpregnancy interval >3 years may have a slower active phase than those with a shorter interpregnancy interval when undergoing induction of labor. Interpregnancy interval does not demonstrate an effect on the length of the second stage.</p></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589933324001514/pdfft?md5=a05077c6a1d570fa65cf060239ae0017&pid=1-s2.0-S2589933324001514-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.ajogmf.2024.101433
Background
Improved pain control after cesarean section remains a challenging objective. Although both the lateral quadratus lumborum block (L-QLB) and acupuncture have been reported to provide superior postoperative analgesia after cesarean section when compared to placebo, the efficacy of these techniques has never been compared head-to-head.
Objective
This study was conducted to investigate the comparative analgesic efficacy of L-QLB and acupuncture following elective cesarean section.
Study Design
In this prospective, randomized, controlled clinical trial, a total of 190 patients with singleton-term pregnancies scheduled for cesarean section under spinal-epidural anesthesia were enrolled. Patients were randomized 1:1 to acupuncture group or L-QLB group. L-QLB group received bilateral L-QLB with 0.33% ropivacaine and sham acupuncture, acupuncture group received transcutaneous electrical acupoint stimulation and press needle therapy, and sham L-QLB. All patients received the standard postoperative pain treatment. The primary outcome was pain scores on movement at 24 hours. Secondary endpoints included pain scores in the first 48 hours postoperatively, patient-controlled intravenous analgesia (PCIA) demands, analgesia-related adverse effects, postoperative complications, QoR-15, the time to mobilization, and gastrointestinal function.
Results
Median (interquartile range [range]) pain scores at 24 hours on movement were similar in patients receiving acupuncture or L-QLB (3 [2–4] vs 3 [2–4], respectively; P=.40). PCIA consumption and pain scores within 48 hours postoperatively also showed no difference between the two groups. The acupuncture improved QoR-15 scores at 24 and 48 hours postoperatively (P<.001), as well as shortened the time to first flatus (P=.03) and first drinking (P<.001) compared to L-QLB. In addition, the median time to mobilization in the L-QLB group was markedly prolonged compare with acupuncture group (17.0 [15.0–19.0] hours vs 15.3 [13.3–17.0] hours, estimated median difference, 1.5; 95% CI, 1–2; P<.001).
Conclusion
As a component of multimodal analgesia regimen after cesarean section, acupuncture did not lower postoperative pain scores or reduce analgesic medication consumption compared to L-QLB.
{"title":"Lateral quadratus lumborum block vs acupuncture for postcesarean analgesia: a randomized clinical trial","authors":"","doi":"10.1016/j.ajogmf.2024.101433","DOIUrl":"10.1016/j.ajogmf.2024.101433","url":null,"abstract":"<div><h3>Background</h3><p>Improved pain control after cesarean section remains a challenging objective. Although both the lateral quadratus lumborum block (L-QLB) and acupuncture have been reported to provide superior postoperative analgesia after cesarean section when compared to placebo, the efficacy of these techniques has never been compared head-to-head.</p></div><div><h3>Objective</h3><p>This study was conducted to investigate the comparative analgesic efficacy of L-QLB and acupuncture following elective cesarean section.</p></div><div><h3>Study Design</h3><p>In this prospective, randomized, controlled clinical trial, a total of 190 patients with singleton-term pregnancies scheduled for cesarean section under spinal-epidural anesthesia were enrolled. Patients were randomized 1:1 to acupuncture group or L-QLB group. L-QLB group received bilateral L-QLB with 0.33% ropivacaine and sham acupuncture, acupuncture group received transcutaneous electrical acupoint stimulation and press needle therapy, and sham L-QLB. All patients received the standard postoperative pain treatment. The primary outcome was pain scores on movement at 24 hours. Secondary endpoints included pain scores in the first 48 hours postoperatively, patient-controlled intravenous analgesia (PCIA) demands, analgesia-related adverse effects, postoperative complications, QoR-15, the time to mobilization, and gastrointestinal function.</p></div><div><h3>Results</h3><p>Median (interquartile range [range]) pain scores at 24 hours on movement were similar in patients receiving acupuncture or L-QLB (3 [2–4] vs 3 [2–4], respectively; <em>P</em>=.40). PCIA consumption and pain scores within 48 hours postoperatively also showed no difference between the two groups. The acupuncture improved QoR-15 scores at 24 and 48 hours postoperatively (<em>P</em><.001), as well as shortened the time to first flatus (<em>P</em>=.03) and first drinking (<em>P</em><.001) compared to L-QLB. In addition, the median time to mobilization in the L-QLB group was markedly prolonged compare with acupuncture group (17.0 [15.0–19.0] hours vs 15.3 [13.3–17.0] hours, estimated median difference, 1.5; 95% CI, 1–2; <em>P</em><.001).</p></div><div><h3>Conclusion</h3><p>As a component of multimodal analgesia regimen after cesarean section, acupuncture did not lower postoperative pain scores or reduce analgesic medication consumption compared to L-QLB.</p></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634816","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 : 2024-07-31DOI: 10.1016/j.ajogmf.2024.101440
<div><h3>Background</h3><p>Although it is well-known that the presence of fetal anomalies is associated with maternal morbidity, granular information on these risks by type of anomaly is not available.</p></div><div><h3>Objective</h3><p>To examine adverse maternal outcomes according to the type of fetal anomaly.</p></div><div><h3>Study Design</h3><p>This was a repeated cross-sectional analysis of US vital statistics Live Birth/Infant Death linked data from 2011 to 2020. All pregnancies at 20 weeks or greater were included. Our primary outcome was severe maternal morbidity (SMM), defined as any maternal intensive care unit admission, transfusion, uterine rupture, or hysterectomy. Outcomes were compared between pregnancies with a specific type of fetal anomaly and pregnancies without any fetal anomaly. Fetal anomalies that were available in the dataset included anencephaly, meningomyelocele/spina bifida, cyanotic congenital heart disease, congenital diaphragmatic hernia, omphalocele, gastroschisis, cleft lip and/or palate, hypospadias, limb anomaly, and chromosomal disorders. If a fetus had more than one anomaly, it was classified as multiple anomalies. Adjusted relative risks (aRR) with 99% confidence intervals (99% CI) were calculated using modified Poisson regression. Adjusted risk differences (aRDs) were calculated using the marginal standardization form of predictive margins.</p></div><div><h3>Results</h3><p>Of 35,760,626 pregnancies included in the analysis, 35,655,624 pregnancies had no fetal anomaly and 105,002 had isolated or multiple fetal anomalies. Compared to pregnancies without fetal anomaly, all fetal anomalies were associated with an increased risk of SMM except for gastroschisis and limb anomaly in order of aRRs (99% CI): 1.58 (1.29–1.92) with cleft lip and/or palate; 1.75 (1.35–2.27) with multiple anomalies; 1.76 (1.18–2.63) with a chromosomal disorder; 2.19 (1.82–2.63) with hypospadias; 2.20 (1.51–3.21) with spina bifida; 2.39 (1.62–3.53) with congenital diaphragmatic hernia; 2.66 (2.27–3.13) with congenital heart disease; 3.15 (2.08–4.76) with omphalocele; and 3.27 (2.22–4.80) with anencephaly. Compared to pregnancies without fetal anomaly, all fetal anomalies were associated with an increased absolute risk of SMM except for gastroschisis and limb anomaly in order of aRDs (99% CI): 0.26 (0.12–0.40) with cleft lip and/or palate, 0.34 (0.13–0.55) with multiple anomalies, 0.34 (0.02–0.66) with a chromosomal disorder, 0.54 (0.36–0.72) with hypospadias, 0.54 (0.17–0.92) with spina bifida, 0.63 (0.21–1.05) with congenital diaphragmatic hernia, 0.75 (0.56–0.95) with congenital heart disease, 0.97 (0.38–1.56) with omphalocele, and 1.03 (0.46–1.59) with anencephaly.</p></div><div><h3>Conclusion</h3><p>The presence of fetal anomalies is associated with adverse maternal health outcomes. The risk of SMM varies according to the type of fetal anomaly. Counseling mothers about the maternal implications of fetal anomalies is paramount to help t
{"title":"Maternal implications of fetal anomalies: a population-based cross-sectional study","authors":"","doi":"10.1016/j.ajogmf.2024.101440","DOIUrl":"10.1016/j.ajogmf.2024.101440","url":null,"abstract":"<div><h3>Background</h3><p>Although it is well-known that the presence of fetal anomalies is associated with maternal morbidity, granular information on these risks by type of anomaly is not available.</p></div><div><h3>Objective</h3><p>To examine adverse maternal outcomes according to the type of fetal anomaly.</p></div><div><h3>Study Design</h3><p>This was a repeated cross-sectional analysis of US vital statistics Live Birth/Infant Death linked data from 2011 to 2020. All pregnancies at 20 weeks or greater were included. Our primary outcome was severe maternal morbidity (SMM), defined as any maternal intensive care unit admission, transfusion, uterine rupture, or hysterectomy. Outcomes were compared between pregnancies with a specific type of fetal anomaly and pregnancies without any fetal anomaly. Fetal anomalies that were available in the dataset included anencephaly, meningomyelocele/spina bifida, cyanotic congenital heart disease, congenital diaphragmatic hernia, omphalocele, gastroschisis, cleft lip and/or palate, hypospadias, limb anomaly, and chromosomal disorders. If a fetus had more than one anomaly, it was classified as multiple anomalies. Adjusted relative risks (aRR) with 99% confidence intervals (99% CI) were calculated using modified Poisson regression. Adjusted risk differences (aRDs) were calculated using the marginal standardization form of predictive margins.</p></div><div><h3>Results</h3><p>Of 35,760,626 pregnancies included in the analysis, 35,655,624 pregnancies had no fetal anomaly and 105,002 had isolated or multiple fetal anomalies. Compared to pregnancies without fetal anomaly, all fetal anomalies were associated with an increased risk of SMM except for gastroschisis and limb anomaly in order of aRRs (99% CI): 1.58 (1.29–1.92) with cleft lip and/or palate; 1.75 (1.35–2.27) with multiple anomalies; 1.76 (1.18–2.63) with a chromosomal disorder; 2.19 (1.82–2.63) with hypospadias; 2.20 (1.51–3.21) with spina bifida; 2.39 (1.62–3.53) with congenital diaphragmatic hernia; 2.66 (2.27–3.13) with congenital heart disease; 3.15 (2.08–4.76) with omphalocele; and 3.27 (2.22–4.80) with anencephaly. Compared to pregnancies without fetal anomaly, all fetal anomalies were associated with an increased absolute risk of SMM except for gastroschisis and limb anomaly in order of aRDs (99% CI): 0.26 (0.12–0.40) with cleft lip and/or palate, 0.34 (0.13–0.55) with multiple anomalies, 0.34 (0.02–0.66) with a chromosomal disorder, 0.54 (0.36–0.72) with hypospadias, 0.54 (0.17–0.92) with spina bifida, 0.63 (0.21–1.05) with congenital diaphragmatic hernia, 0.75 (0.56–0.95) with congenital heart disease, 0.97 (0.38–1.56) with omphalocele, and 1.03 (0.46–1.59) with anencephaly.</p></div><div><h3>Conclusion</h3><p>The presence of fetal anomalies is associated with adverse maternal health outcomes. The risk of SMM varies according to the type of fetal anomaly. Counseling mothers about the maternal implications of fetal anomalies is paramount to help t","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876195","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号