Background: Spontaneous preterm birth (sPTB) is a major cause of neonatal morbidity and mortality. Women with a short cervix (≤25 mm) are at particularly high risk, prediction based solely on this single measurement is often insufficient. There is an urgent need for more accurate, externally validated tools to stratify risk in this high-risk population.
Objective: To develop and externally validate a dynamic, multivariable nomogram for predicting individualized, time-dependent risks of sPTB in singleton pregnancies with a short cervix.
Study design: We conducted a retrospective training cohort (n=591) of singleton pregnancies with a short cervix identified before 24 weeks of gestation from our Xicheng campus (2016-2022) and a prospective external validation cohort (n=215) from our Daxing campus (2024-2025). A multivariable Cox proportional hazards model was used to identify independent predictors. The model's performance was rigorously evaluated for discrimination (time-dependent AUC), calibration (calibration plots and Brier scores), and clinical utility (decision curve analysis).
Results: Three independent predictors were incorporated into the final nomogram: a history of prior preterm birth (HR=3.94), cervical length (HR=0.91), and the gestational week at diagnosis (HR=1.18). The nomogram demonstrated good discrimination, with time-dependent AUCs for sPTB before 32, 34, and 37 weeks of 0.774, 0.740, and 0.724 in the training cohort, and 0.757, 0.734, and 0.719 in the external test cohort, respectively. The model was well-calibrated in both cohorts, confirmed by low Brier scores and non-significant Hosmer-Lemeshow tests. Decision curve analysis showed a consistent net benefit across a wide range of risk thresholds. The model's performance was maintained despite the validation cohort representing a demographically distinct and higher-risk population.
Conclusion: This study established and externally validated a simple, clinically practical nomogram for predicting spontaneous preterm birth in singleton pregnancies with a short cervix. This robust, clinically applicable tool can aid in patient counseling and the stratification of high-risk pregnancies to guide personalized management strategies.
{"title":"Development and External Validation of a Nomogram for Predicting Spontaneous Preterm Birth in Singleton Pregnancies with a Short Cervix.","authors":"Xinyue Han, Qidi Zhang, Yuli Ke, Yuchun Zhu, Huixia Yang, Yumei Wei","doi":"10.1016/j.ajogmf.2025.101859","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101859","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous preterm birth (sPTB) is a major cause of neonatal morbidity and mortality. Women with a short cervix (≤25 mm) are at particularly high risk, prediction based solely on this single measurement is often insufficient. There is an urgent need for more accurate, externally validated tools to stratify risk in this high-risk population.</p><p><strong>Objective: </strong>To develop and externally validate a dynamic, multivariable nomogram for predicting individualized, time-dependent risks of sPTB in singleton pregnancies with a short cervix.</p><p><strong>Study design: </strong>We conducted a retrospective training cohort (n=591) of singleton pregnancies with a short cervix identified before 24 weeks of gestation from our Xicheng campus (2016-2022) and a prospective external validation cohort (n=215) from our Daxing campus (2024-2025). A multivariable Cox proportional hazards model was used to identify independent predictors. The model's performance was rigorously evaluated for discrimination (time-dependent AUC), calibration (calibration plots and Brier scores), and clinical utility (decision curve analysis).</p><p><strong>Results: </strong>Three independent predictors were incorporated into the final nomogram: a history of prior preterm birth (HR=3.94), cervical length (HR=0.91), and the gestational week at diagnosis (HR=1.18). The nomogram demonstrated good discrimination, with time-dependent AUCs for sPTB before 32, 34, and 37 weeks of 0.774, 0.740, and 0.724 in the training cohort, and 0.757, 0.734, and 0.719 in the external test cohort, respectively. The model was well-calibrated in both cohorts, confirmed by low Brier scores and non-significant Hosmer-Lemeshow tests. Decision curve analysis showed a consistent net benefit across a wide range of risk thresholds. The model's performance was maintained despite the validation cohort representing a demographically distinct and higher-risk population.</p><p><strong>Conclusion: </strong>This study established and externally validated a simple, clinically practical nomogram for predicting spontaneous preterm birth in singleton pregnancies with a short cervix. This robust, clinically applicable tool can aid in patient counseling and the stratification of high-risk pregnancies to guide personalized management strategies.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101859"},"PeriodicalIF":3.1,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606400","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}
Preeclampsia (PE) and fetal growth restriction (FGR) are major causes of maternal and perinatal morbidity. The retina, an accessible and non-invasive window to the systemic microcirculation, offers quantitative biomarkers of maternal endothelial dysfunction that are central to development of PE and FGR. Advances in optical coherence tomography and Optical Coherence Tomography Angiography (OCTA) enable rapid, contrast-free measurement of vessel density, foveal avascular zone geometry and layer-specific thickness with high reproducibility. Emerging studies report reduced superficial capillary plexus density and hypertensive retinopathy signs in hypertensive disorders of pregnancy, with larger effects in early-onset PE. However, evidence remains mostly cross-sectional, heterogeneous and limited by small sample size. We describe potential clinical applications including targeted screening of high-risk women, enhancement of existing risk prediction models, longitudinal disease monitoring and assessment of treatment response. A staged research agenda is proposed, as following: (1) harmonized acquisition and quality standards; (2) prospective, trimester-specific cohorts linking retinal metrics to maternal and perinatal outcomes; (3) conducting mechanistic substudies to relate retinal signatures to systemic hemodynamics; 4) performing implementation trials to evaluate feasibility, equity and the impact on maternal and perinatal outcomes.
{"title":"The eye as a window to placental health: retinal imaging as a novel biomarker for preeclampsia and fetal growth restriction","authors":"Gabriele Saccone MD, PhD , Francesco Matarazzo MD , Mariarosaria Motta MD , Michele Rinaldi MD , Maurizio Guida MD , Ciro Costagliola MD","doi":"10.1016/j.ajogmf.2025.101855","DOIUrl":"10.1016/j.ajogmf.2025.101855","url":null,"abstract":"<div><div>Preeclampsia (PE) and fetal growth restriction (FGR) are major causes of maternal and perinatal morbidity. The retina, an accessible and non-invasive window to the systemic microcirculation, offers quantitative biomarkers of maternal endothelial dysfunction that are central to development of PE and FGR. Advances in optical coherence tomography and Optical Coherence Tomography Angiography (OCTA) enable rapid, contrast-free measurement of vessel density, foveal avascular zone geometry and layer-specific thickness with high reproducibility. Emerging studies report reduced superficial capillary plexus density and hypertensive retinopathy signs in hypertensive disorders of pregnancy, with larger effects in early-onset PE. However, evidence remains mostly cross-sectional, heterogeneous and limited by small sample size. We describe potential clinical applications including targeted screening of high-risk women, enhancement of existing risk prediction models, longitudinal disease monitoring and assessment of treatment response. A staged research agenda is proposed, as following: (1) harmonized acquisition and quality standards; (2) prospective, trimester-specific cohorts linking retinal metrics to maternal and perinatal outcomes; (3) conducting mechanistic substudies to relate retinal signatures to systemic hemodynamics; 4) performing implementation trials to evaluate feasibility, equity and the impact on maternal and perinatal outcomes.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101855"},"PeriodicalIF":3.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589177","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 : 2025-11-19DOI: 10.1016/j.ajogmf.2025.101844
Liat Mor MD, Hadas Ganer Herman MD, Giulia Barda MD, Ilia Kleiner MD, Maya Torem MD, Daniel Tairy MD, Eran Weiner MD, Noa Gonen
BACKGROUND
Induction of labor with an extraamniotic balloon is common but may be lengthy and uncomfortable. Evidence on the impact of maternal mobility during extraamniotic balloon induction is limited.
OBJECTIVE
This study aimed to assess whether a mobility-encouragement protocol using pedometers affects induction-to-delivery time, pain, and maternal satisfaction.
STUDY DESIGN
In this prospective, single-center, randomized controlled trial conducted from February 2019 to July 2020, 189 primi- and multigravidas undergoing inpatient extraamniotic balloon induction of labor with singleton pregnancies at 36 to 42 weeks’ gestation and intact membranes were randomly assigned to a mobility-encouragement protocol group (feedback group, n=92) or a routine care protocol (control group, n=97). The extraamniotic balloon was the sole method of cervical ripening; oxytocin augmentation was administered only after balloon expulsion or removal. The feedback group received digital pedometers and personalized walking encouragement at 2 time points during induction of labor, whereas the control group received standard care. The primary outcome was time from extraamniotic balloon placement to delivery. Sample size was calculated to detect a clinically meaningful 15% reduction in induction-to-delivery time with 80% power and α=0.05. Secondary outcomes included pain scores, labor satisfaction, and labor outcomes. Subanalyses were conducted to examine the effect of different levels of mobility (within the experimental group) and gravidity on primary and secondary outcomes.
RESULTS
No significant differences were found between the feedback and control groups in any of the outcomes assessed, including induction-to-delivery time, pain scores, or labor satisfaction, even after accounting for gravidity. Subanalysis of mobility levels within the feedback group revealed significantly increased extraamniotic balloon insertion–to–expulsion and extraamniotic balloon insertion–to–active labor times among participants with higher mobility levels (P=.002 and P=.008, respectively).
CONCLUSION
Encouraging walking during induction of labor with an extraamniotic balloon is feasible and well tolerated. Although overall mobility did not significantly alter time to delivery or active labor, higher levels of mobility may be associated with longer labor duration.
{"title":"Effect of a mobility-encouragement protocol during induction of labor with an extraamniotic balloon compared with routine care: a randomized controlled trial","authors":"Liat Mor MD, Hadas Ganer Herman MD, Giulia Barda MD, Ilia Kleiner MD, Maya Torem MD, Daniel Tairy MD, Eran Weiner MD, Noa Gonen","doi":"10.1016/j.ajogmf.2025.101844","DOIUrl":"10.1016/j.ajogmf.2025.101844","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Induction of labor with an extraamniotic balloon is common but may be lengthy and uncomfortable. Evidence on the impact of maternal mobility during extraamniotic balloon induction is limited.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to assess whether a mobility-encouragement protocol using pedometers affects induction-to-delivery time, pain, and maternal satisfaction.</div></div><div><h3>STUDY DESIGN</h3><div>In this prospective, single-center, randomized controlled trial conducted from February 2019 to July 2020, 189 primi- and multigravidas undergoing inpatient extraamniotic balloon induction of labor with singleton pregnancies at 36 to 42 weeks’ gestation and intact membranes were randomly assigned to a mobility-encouragement protocol group (feedback group, n=92) or a routine care protocol (control group, n=97). The extraamniotic balloon was the sole method of cervical ripening; oxytocin augmentation was administered only after balloon expulsion or removal. The feedback group received digital pedometers and personalized walking encouragement at 2 time points during induction of labor, whereas the control group received standard care. The primary outcome was time from extraamniotic balloon placement to delivery. Sample size was calculated to detect a clinically meaningful 15% reduction in induction-to-delivery time with 80% power and α=0.05. Secondary outcomes included pain scores, labor satisfaction, and labor outcomes. Subanalyses were conducted to examine the effect of different levels of mobility (within the experimental group) and gravidity on primary and secondary outcomes.</div></div><div><h3>RESULTS</h3><div>No significant differences were found between the feedback and control groups in any of the outcomes assessed, including induction-to-delivery time, pain scores, or labor satisfaction, even after accounting for gravidity. Subanalysis of mobility levels within the feedback group revealed significantly increased extraamniotic balloon insertion–to–expulsion and extraamniotic balloon insertion–to–active labor times among participants with higher mobility levels (<em>P</em>=.002 and <em>P</em>=.008, respectively).</div></div><div><h3>CONCLUSION</h3><div>Encouraging walking during induction of labor with an extraamniotic balloon is feasible and well tolerated. Although overall mobility did not significantly alter time to delivery or active labor, higher levels of mobility may be associated with longer labor duration.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101844"},"PeriodicalIF":3.1,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574736","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 : 2025-11-15DOI: 10.1016/j.ajogmf.2025.101852
Beth L. Pineles MD, PhD , Kyung Hyun Lee PhD , Baha M. Sibai MD
Background
There is inadequate evidence on whether to retain or remove a cervical cerclage after preterm prelabor rupture of the membranes (PPROM). The PROMCerclage trial was the only study to randomize patients to cerclage retention or immediate cerclage removal after PPROM. The trial was terminated early, and results were not statistically significant but the cerclage retention group had shorter latency and more chorioamnionitis. Bayesian post-hoc trial analysis maximizes available clinical trial data by formally integrating information from preexisting studies or prior beliefs into statistical modeling to estimate the probability of a treatment effect.
Objective
To re-analyze published results of the PROMCerclage trial using a Bayesian framework to estimate the probability of benefit and harm for cerclage retention compared to removal on latency and chorioamnionitis in the event of PPROM.
Study Design
We conducted a post-hoc Bayesian analysis of data from the PROMCerclage trial, which included 56 patients with a cerclage in place and subsequent PPROM who had been randomized to cerclage retention vs cerclage removal. Bayesian analysis uses prior information (priors) combined with study data to generate a posterior, or “final” effect size. The primary analysis assumed no association between cerclage management and delivery <1 week after randomization and chorioamnionitis (prior relative risk [RR]=1). Other priors were specified using results of published observational studies. For each outcome, using each prior, we estimated the probability of benefit (RR<1, lower risk of delivery <1 week from randomization / lower risk of chorioamnionitis), RR, and credible interval (CrI).
Results
In the primary analysis comparing cerclage retention to removal, the posterior probability that delivery <1 week from randomization was less likely (ie, RR <1.0) was 21.9%. The posterior probability that chorioamnionitis was less likely with cerclage retention versus removal was 9.5%. Using priors incorporating results of previously published observational studies greatly influenced the results.
Conclusion
A Bayesian re-analysis of the only randomized trial of cerclage retention versus removal after PPROM found that shorter latency and more chorioamnionitis are more likely with cerclage retention than with immediate removal.
{"title":"Bayesian posthoc trial analysis of cerclage management in preterm prelabor rupture of the membranes","authors":"Beth L. Pineles MD, PhD , Kyung Hyun Lee PhD , Baha M. Sibai MD","doi":"10.1016/j.ajogmf.2025.101852","DOIUrl":"10.1016/j.ajogmf.2025.101852","url":null,"abstract":"<div><h3>Background</h3><div>There is inadequate evidence on whether to retain or remove a cervical cerclage after preterm prelabor rupture of the membranes (PPROM). The PROMCerclage trial was the only study to randomize patients to cerclage retention or immediate cerclage removal after PPROM. The trial was terminated early, and results were not statistically significant but the cerclage retention group had shorter latency and more chorioamnionitis. Bayesian post-hoc trial analysis maximizes available clinical trial data by formally integrating information from preexisting studies or prior beliefs into statistical modeling to estimate the probability of a treatment effect.</div></div><div><h3>Objective</h3><div>To re-analyze published results of the PROMCerclage trial using a Bayesian framework to estimate the probability of benefit and harm for cerclage retention compared to removal on latency and chorioamnionitis in the event of PPROM.</div></div><div><h3>Study Design</h3><div>We conducted a post-hoc Bayesian analysis of data from the PROMCerclage trial, which included 56 patients with a cerclage in place and subsequent PPROM who had been randomized to cerclage retention vs cerclage removal. Bayesian analysis uses prior information (priors) combined with study data to generate a posterior, or “final” effect size. The primary analysis assumed no association between cerclage management and delivery <1 week after randomization and chorioamnionitis (prior relative risk [RR]=1). Other priors were specified using results of published observational studies. For each outcome, using each prior, we estimated the probability of benefit (RR<1, lower risk of delivery <1 week from randomization / lower risk of chorioamnionitis), RR, and credible interval (CrI).</div></div><div><h3>Results</h3><div>In the primary analysis comparing cerclage retention to removal, the posterior probability that delivery <1 week from randomization was less likely (ie, RR <1.0) was 21.9%. The posterior probability that chorioamnionitis was less likely with cerclage retention versus removal was 9.5%. Using priors incorporating results of previously published observational studies greatly influenced the results.</div></div><div><h3>Conclusion</h3><div>A Bayesian re-analysis of the only randomized trial of cerclage retention versus removal after PPROM found that shorter latency and more chorioamnionitis are more likely with cerclage retention than with immediate removal.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101852"},"PeriodicalIF":3.1,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145542953","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 : 2025-11-14DOI: 10.1016/j.ajogmf.2025.101845
Elena D’Alberti MD , Daniele Di Mascio MD , Antonella Giancotti MD , Lawrence Impey MD , Guglielmo Stabile PhD , Aris T. Papageorghiou MD , Giuseppe Rizzo MD , Tamara Stampalija PhD
<div><h3>OBJECTIVE</h3><div>This study aimed to evaluate the role of fetal growth velocity in predicting small-for-gestational-age at birth and adverse perinatal outcomes.</div></div><div><h3>DATA SOURCES</h3><div>A systematic review and meta-analysis was conducted through an electronic search of PubMed, Embase, and CINAHL, including studies published between January 2000 and February 2025.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>Both prospective and retrospective studies of pregnancies undergoing longitudinal growth assessment, from the second to the third trimester or within the third trimester, were included.</div></div><div><h3>METHODS</h3><div>This study was registered with PROSPERO (International Prospective Register of Systematic Reviews) (CRD42025642750). Pooled sensitivity and pooled specificity with 95% confidence interval and pooled risk estimates were synthesized using random- and fixed-effects models, respectively. Risk of bias was assessed using the Newcastle–Ottawa scale and the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies), whereas certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.</div></div><div><h3>RESULTS</h3><div>The electronic search yielded 5.440 citations. Following full-text review of the potentially eligible studies, 21 studies were included. The predictive and risk stratification value of fetal growth velocity for small-for-gestational-age at birth and adverse perinatal outcomes was assessed across cohorts of 185.441 and 164.341 singleton pregnancies, respectively. Slowing fetal growth velocity showed suboptimal predictive performance for small-for-gestational-age at birth, with pooled sensitivity and specificity for abdominal circumference and estimated fetal weight growth velocity (defined as z-scores divided by interval time in days) of 0.22 (95% CI, 0.09–0.44) and 0.92 (95% CI, 0.92–0.95), and 0.55 (95% CI, 0.53–0.56) and 0.96 (95% CI, 0.96–0.96), respectively (GRADE: low). Slowing fetal growth velocity showed a moderate association with adverse perinatal outcomes: abdominal circumference growth velocity <10<sup>th</sup> centile was associated with composite adverse perinatal outcome among fetuses predicted to be small-for-gestational-age (pooled odds ratio, 2.47; 95% CI, 1.69–3.82), whereas a fixed centile drop in abdominal circumference/estimated fetal weight ≥50 significantly increased the risk of perinatal death, irrespective of estimated fetal weight (pooled odds ratio, 3.92; 95% CI, 2.03–7.58) (GRADE: moderate).</div></div><div><h3>CONCLUSION</h3><div>Fetal growth velocity might be considered a moderate risk factor for adverse outcomes, but it did not improve prediction over cross-sectional biometry, either at 32 or 36 weeks of gestation, even when implemented in multivariable models. Its clinical utility may lie in complementing third-trimester biometry and maternal/fetal Dopplers in risk stratific
目的：探讨胎儿生长速度（FGV）在预测出生时小胎龄（SGA）和围产期不良结局（APO）中的作用。数据来源：通过PubMed， EMBASE， CINAHL的电子检索进行系统回顾和荟萃分析，包括2000年1月至2025年2月发表的研究。研究资格标准：对妊娠进行纵向生长评估的前瞻性和回顾性研究，包括妊娠中期至妊娠晚期或妊娠晚期。研究评价和综合方法：本研究已在国际前瞻性系统评价数据库注册（PROSPERO: CRD42025642750）。分别使用随机效应模型和固定效应模型合成具有95%置信区间（95% CI）的合并敏感性和合并特异性，以及合并风险估计。使用纽卡斯尔-渥太华量表（NOS）和诊断准确性研究质量评估（QUADAS-2）评估偏倚风险，通过GRADE方法评估证据的确定性。结果：电子检索得到5440条引文。在对可能符合条件的研究进行全文审查后，纳入了21项研究。FGV对出生时SGA和APO的预测和风险分层价值分别在185,441和164,341单胎妊娠队列中进行了评估。缓慢的FGV显示出出生时SGA的次优预测性能，腹部围（AC）和估计胎儿体重（EFW）生长速度的综合敏感性和特异性，定义为z分数除以间隔时间（天），分别为0.22 （95% CI 0.09 - 0.44）和0.92 (95% CI 0.92 - 0.95), 0.55 （95% CI 0.53 - 0.56）和0.96 (95% CI 0.96 - 0.96)（等级：低）。FGV减慢与APO表现出中等风险相关性：预测为SGA的胎儿中，ACGV < 10与复合APO相关，合并OR为2.47 (95% CI, 1.69 - 3.82)，而AC/EFW≥50的固定下降百分位数被发现显著增加围产期死亡的风险，与EFW无关，合并OR为3.92 (95% CI, 2.03 - 7.58) （GRADE: moderate）。结论：FGV可能被认为是不良结局的中等危险因素，但即使在多变量模型中实施，它也不能提高横断面生物测定法在32周或36周时的预测。它的临床应用可能在于补充妊娠晚期生物测量和母/胎儿多普勒风险分层，但迫切需要标准化的定义和公式，以提高可重复性和指导产前保健的实施。
{"title":"Fetal growth velocity as a predictor of small for gestational age at birth and adverse perinatal outcomes: systematic review and meta-analysis","authors":"Elena D’Alberti MD , Daniele Di Mascio MD , Antonella Giancotti MD , Lawrence Impey MD , Guglielmo Stabile PhD , Aris T. Papageorghiou MD , Giuseppe Rizzo MD , Tamara Stampalija PhD","doi":"10.1016/j.ajogmf.2025.101845","DOIUrl":"10.1016/j.ajogmf.2025.101845","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study aimed to evaluate the role of fetal growth velocity in predicting small-for-gestational-age at birth and adverse perinatal outcomes.</div></div><div><h3>DATA SOURCES</h3><div>A systematic review and meta-analysis was conducted through an electronic search of PubMed, Embase, and CINAHL, including studies published between January 2000 and February 2025.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>Both prospective and retrospective studies of pregnancies undergoing longitudinal growth assessment, from the second to the third trimester or within the third trimester, were included.</div></div><div><h3>METHODS</h3><div>This study was registered with PROSPERO (International Prospective Register of Systematic Reviews) (CRD42025642750). Pooled sensitivity and pooled specificity with 95% confidence interval and pooled risk estimates were synthesized using random- and fixed-effects models, respectively. Risk of bias was assessed using the Newcastle–Ottawa scale and the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies), whereas certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.</div></div><div><h3>RESULTS</h3><div>The electronic search yielded 5.440 citations. Following full-text review of the potentially eligible studies, 21 studies were included. The predictive and risk stratification value of fetal growth velocity for small-for-gestational-age at birth and adverse perinatal outcomes was assessed across cohorts of 185.441 and 164.341 singleton pregnancies, respectively. Slowing fetal growth velocity showed suboptimal predictive performance for small-for-gestational-age at birth, with pooled sensitivity and specificity for abdominal circumference and estimated fetal weight growth velocity (defined as z-scores divided by interval time in days) of 0.22 (95% CI, 0.09–0.44) and 0.92 (95% CI, 0.92–0.95), and 0.55 (95% CI, 0.53–0.56) and 0.96 (95% CI, 0.96–0.96), respectively (GRADE: low). Slowing fetal growth velocity showed a moderate association with adverse perinatal outcomes: abdominal circumference growth velocity <10<sup>th</sup> centile was associated with composite adverse perinatal outcome among fetuses predicted to be small-for-gestational-age (pooled odds ratio, 2.47; 95% CI, 1.69–3.82), whereas a fixed centile drop in abdominal circumference/estimated fetal weight ≥50 significantly increased the risk of perinatal death, irrespective of estimated fetal weight (pooled odds ratio, 3.92; 95% CI, 2.03–7.58) (GRADE: moderate).</div></div><div><h3>CONCLUSION</h3><div>Fetal growth velocity might be considered a moderate risk factor for adverse outcomes, but it did not improve prediction over cross-sectional biometry, either at 32 or 36 weeks of gestation, even when implemented in multivariable models. Its clinical utility may lie in complementing third-trimester biometry and maternal/fetal Dopplers in risk stratific","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101845"},"PeriodicalIF":3.1,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534809","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}
<div><h3>Objective</h3><div>Oxytocin remains the mainstay for induction and for the management of labor arrest during trial of labor after cesarean (TOLAC). Therefore, the clinical question should be not whether to use oxytocin, but how to optimize its administration. This meta-analysis aimed to assess which oxytocin protocol, in terms of initial dose, amount of increase, timing to next increase, and maximum dose, may minimize the risk of uterine rupture (UR) during TOLAC.</div></div><div><h3>Data sources</h3><div>PubMed, Embase and Clinicaltrials.gov were searched up to September 21, 2024.</div></div><div><h3>Study eligibility criteria</h3><div>Randomized and nonrandomized studies evaluating the association between induction and/or augmentation with oxytocin and UR during TOLAC versus spontaneous TOLAC were eligible. To be included, studies had to report at least one parameter of the oxytocin protocol used (ie, initial dose, amount of increase, timing to next increase, or maximum dose). The primary outcome was UR.</div></div><div><h3>Methods</h3><div>Effect measures were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) and pooled using the Mantel-Haenszel method under a random-effects model. Oxytocin exposure was categorized to perform three separate meta-analyses, ie, any use (for induction and/or augmentation), for induction only, and for augmentation only. In all three comparisons, subgroup analyses assessed differences based on oxytocin initial dose (≤2 vs >2 mU/min), amount of increase (≤2 vs >2 mU/min), timing to next increase (<30 vs ≥ 30 minutes), and maximum dose (≤20 vs >20 mU/min).</div></div><div><h3>Results</h3><div>Twenty-one observational studies with 51,511 patients undergoing TOLAC were included. Oxytocin use during TOLAC was consistently associated with a significantly higher risk of UR across all analyses (any use: OR 1.94, 95% CI 1.36–2.77, <em>P=</em>.0003; induction only: OR 2.07, 95% CI, 1.28–3.36, <em>P=</em>.003; augmentation only: OR 2.03, 95% CI 1.22–3.38; <em>P=</em>.007). Among oxytocin protocol parameters, the initial oxytocin dose showed no relationship with UR risk. A significant association was found in some analyses only for increments ≤2 mU/min, though the >2 mU/min subgroup was consistently underpowered. A higher risk of UR was uniformly observed when dose escalations were performed at intervals <30 minutes. Both moderate (≤20 mU/min) and high (>20 mU/min) maximum doses were significantly associated with increased odds, with a greater risk at higher doses.</div></div><div><h3>Conclusions</h3><div>These findings showed an association between oxytocin dosing during TOLAC and an increased risk of UR. Specifically, they suggest that both the timing and cumulative exposure of oxytocin, rather than the initial or incremental dose alone, may critically influence UR risk during TOLAC. Protocols adopting longer escalation intervals (≥30 minutes) and limiting maximum doses (≤20 mU/
目的：在剖宫产后分娩试验（TOLAC）中，催产素仍然是诱导和处理阵痛骤停的主要药物。因此，临床问题不应该是是否使用催产素，而是如何优化其管理。本荟萃分析旨在评估哪种催产素方案，在初始剂量、增加量、下一次增加的时间和最大剂量方面，可以最大限度地减少TOLAC期间子宫破裂（UR）的风险。数据来源：PubMed， Embase和Clinicaltrials.gov检索截止到2024年9月21日。研究资格标准：随机和非随机研究评估在TOLAC期间诱导和/或增强催产素和UR与自发TOLAC之间的关系是合格的。要纳入研究，研究必须报告至少一个使用催产素方案的参数（即，初始剂量、增加量、下一次增加的时间或最大剂量）。主要结局为UR。方法：效应测量以95%置信区间（ci）的优势比（ORs）表示，并在随机效应模型下使用Mantel-Haenszel方法进行汇总。催产素暴露被归类为三个独立的荟萃分析，即任何用途（用于诱导和/或增强），仅用于诱导和仅用于增强。在所有三个比较中，亚组分析评估了催产素初始剂量（≤2 vs >2 mU/min）、增加量（≤2 vs >2 mU/min）、下一次增加时间（20 mU/min）的差异。结果：21项观察性研究纳入51,511例接受TOLAC的患者。在所有分析中，TOLAC期间催产素的使用始终与UR风险显著升高相关（任何使用：OR 1.94, 95% CI 1.36-2.77, p = 0.0003；仅诱导：OR 2.07, 95% CI 1.28-3.36, p = 0.003；仅增强：OR 2.03, 95% CI 1.22-3.38; p = 0.007）。在催产素方案参数中，初始催产素剂量与尿路风险无关。在一些分析中，仅在增量≤2 mU/min时发现了显著的关联，尽管bb0 2 mU/min亚组的动力一直不足。当剂量以20 μ mU/min的间隔增加时，一致观察到UR的风险较高，最大剂量与增加的几率显著相关，剂量越高风险越大。结论：这些发现表明TOLAC期间催产素剂量与尿路风险增加之间存在关联。具体来说，他们认为催产素的时间和累积暴露，而不是单独的初始或增量剂量，可能对TOLAC期间尿路风险产生关键影响。采用较长的升级间隔（≥30分钟）和限制最大剂量（≤20 mU/min）的方案可提高TOLAC期间的安全性。需要可靠的证据，例如来自随机试验的证据，来证实这些结果并确定TOLAC管理的最佳催产素方案。
{"title":"Oxytocin dosing during trial of labor after cesarean to minimize the risk of uterine rupture: a systematic review and meta-analysis","authors":"Pierpaolo Nicolì MD , Moti Gulersen MD , Jordan Beacham , Hila Hochler MD , Alessandra Familiari MD , Anna Locatelli MD , Cynthia Abraham MD , Ettore Cicinelli MD, PhD , Amerigo Vitagliano MD, PhD , Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2025.101846","DOIUrl":"10.1016/j.ajogmf.2025.101846","url":null,"abstract":"<div><h3>Objective</h3><div>Oxytocin remains the mainstay for induction and for the management of labor arrest during trial of labor after cesarean (TOLAC). Therefore, the clinical question should be not whether to use oxytocin, but how to optimize its administration. This meta-analysis aimed to assess which oxytocin protocol, in terms of initial dose, amount of increase, timing to next increase, and maximum dose, may minimize the risk of uterine rupture (UR) during TOLAC.</div></div><div><h3>Data sources</h3><div>PubMed, Embase and Clinicaltrials.gov were searched up to September 21, 2024.</div></div><div><h3>Study eligibility criteria</h3><div>Randomized and nonrandomized studies evaluating the association between induction and/or augmentation with oxytocin and UR during TOLAC versus spontaneous TOLAC were eligible. To be included, studies had to report at least one parameter of the oxytocin protocol used (ie, initial dose, amount of increase, timing to next increase, or maximum dose). The primary outcome was UR.</div></div><div><h3>Methods</h3><div>Effect measures were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) and pooled using the Mantel-Haenszel method under a random-effects model. Oxytocin exposure was categorized to perform three separate meta-analyses, ie, any use (for induction and/or augmentation), for induction only, and for augmentation only. In all three comparisons, subgroup analyses assessed differences based on oxytocin initial dose (≤2 vs >2 mU/min), amount of increase (≤2 vs >2 mU/min), timing to next increase (<30 vs ≥ 30 minutes), and maximum dose (≤20 vs >20 mU/min).</div></div><div><h3>Results</h3><div>Twenty-one observational studies with 51,511 patients undergoing TOLAC were included. Oxytocin use during TOLAC was consistently associated with a significantly higher risk of UR across all analyses (any use: OR 1.94, 95% CI 1.36–2.77, <em>P=</em>.0003; induction only: OR 2.07, 95% CI, 1.28–3.36, <em>P=</em>.003; augmentation only: OR 2.03, 95% CI 1.22–3.38; <em>P=</em>.007). Among oxytocin protocol parameters, the initial oxytocin dose showed no relationship with UR risk. A significant association was found in some analyses only for increments ≤2 mU/min, though the >2 mU/min subgroup was consistently underpowered. A higher risk of UR was uniformly observed when dose escalations were performed at intervals <30 minutes. Both moderate (≤20 mU/min) and high (>20 mU/min) maximum doses were significantly associated with increased odds, with a greater risk at higher doses.</div></div><div><h3>Conclusions</h3><div>These findings showed an association between oxytocin dosing during TOLAC and an increased risk of UR. Specifically, they suggest that both the timing and cumulative exposure of oxytocin, rather than the initial or incremental dose alone, may critically influence UR risk during TOLAC. Protocols adopting longer escalation intervals (≥30 minutes) and limiting maximum doses (≤20 mU/","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101846"},"PeriodicalIF":3.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530977","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}
To investigate the impact of lidocaine patches use after cesarean delivery on postoperative pain and document adverse reactions
Study eligibility criteria
Meta-analysis of randomized controlled trials (RCTs). We included all RCTs comparing lidocaine patch use after cesarean delivery with placebo. The primary outcome was pain at 24 hours postoperative measured through Visual Analogue Scale (VAS). Secondary outcomes were: pain at 12, 36, 48 hours and 72 hours measured through VAS scale; opioid consumption; and adverse reactions. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% of confidence interval (CI).
Results
Three RCTs, including 219 pregnancies, were analyzed. The quality of the RCTs included was moderate. Overall, there was some clinical heterogeneity among RCTs. Lidocaine patches, compared to the placebo patches, were associated with a significant reduction in VAS pain score at 12 hours (1.58 vs 2.24, P value=.0006), 24 hours (1.8 vs 2.4, P value< .0001) and 36 hours (0.48 vs 1.68 P value<.00001), respectively. Lidocaine patches, compared with placebo, was associated with similar VAS scores at 48 and 72 hours, as well as similar opioid consumption and adverse reactions.
Conclusion
The use of lidocaine patches after cesarean delivery is associated with a significant decrease in pain scores at 12, 24 and 36 hours, as well as similar pain scores at 48 and 72 hours, opioid consumption, and adverse reactions. Based on these data, the use of lidocaine patches may be considered as part of a multimodal analgesia strategy after cesarean delivery.
目的：探讨剖宫产术后使用利多卡因贴片对术后疼痛及不良反应的影响。研究资格标准：随机对照试验（RCTs）荟萃分析。我们纳入了所有比较剖宫产后利多卡因贴片使用与安慰剂使用的随机对照试验。主要观察指标为术后24小时视觉模拟评分（VAS）。次要结局为：通过VAS量表测量12、36、48、72小时疼痛；阿片样物质消费;还有不良反应。总结测量结果以相对危险度（RR）或95%可信区间（CI）的平均差值（MD）报告。结果：分析了3项随机对照试验，包括219例妊娠。纳入的随机对照试验质量一般。总的来说，随机对照试验中存在一些临床异质性。与安慰剂贴片相比，利多卡因贴片分别在12小时（1.58 vs 2.24， p值 = 0.0006）、24小时（1.8 vs 2.4， p值< 0.0001）和36小时（0.48 vs 1.68 p值< 0.00001）显著降低VAS疼痛评分。与安慰剂相比，利多卡因贴片在48小时和72小时的VAS评分相似，阿片类药物消耗和不良反应相似。结论：剖宫产术后使用利多卡因贴剂可显著降低12、24、36小时疼痛评分，降低48、72小时疼痛评分，降低阿片类药物消耗，减少不良反应。基于这些数据，利多卡因贴片的使用可能被认为是剖宫产后多模式镇痛策略的一部分。
{"title":"Lidocaine patches after cesarean delivery: a meta-analysis of randomized controlled trials","authors":"Nadia Parisi MD , Alessandro Petrecca MD , Whitney Bender MD , Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2025.101832","DOIUrl":"10.1016/j.ajogmf.2025.101832","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the impact of lidocaine patches use after cesarean delivery on postoperative pain and document adverse reactions</div></div><div><h3>Study eligibility criteria</h3><div>Meta-analysis of randomized controlled trials (RCTs). We included all RCTs comparing lidocaine patch use after cesarean delivery with placebo. The primary outcome was pain at 24 hours postoperative measured through Visual Analogue Scale (VAS). Secondary outcomes were: pain at 12, 36, 48 hours and 72 hours measured through VAS scale; opioid consumption; and adverse reactions. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% of confidence interval (CI).</div></div><div><h3>Results</h3><div>Three RCTs, including 219 pregnancies, were analyzed. The quality of the RCTs included was moderate. Overall, there was some clinical heterogeneity among RCTs. Lidocaine patches, compared to the placebo patches, were associated with a significant reduction in VAS pain score at 12 hours (1.58 vs 2.24, <em>P</em> value=.0006), 24 hours (1.8 vs 2.4, <em>P</em> value< .0001) and 36 hours (0.48 vs 1.68 <em>P</em> value<.00001), respectively. Lidocaine patches, compared with placebo, was associated with similar VAS scores at 48 and 72 hours, as well as similar opioid consumption and adverse reactions.</div></div><div><h3>Conclusion</h3><div>The use of lidocaine patches after cesarean delivery is associated with a significant decrease in pain scores at 12, 24 and 36 hours, as well as similar pain scores at 48 and 72 hours, opioid consumption, and adverse reactions. Based on these data, the use of lidocaine patches may be considered as part of a multimodal analgesia strategy after cesarean delivery.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101832"},"PeriodicalIF":3.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530979","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 : 2025-11-13DOI: 10.1016/j.ajogmf.2025.101840
Rupsa C. Boelig MD, MS , Eshika Agarwal MD , Jenani Jayakumaran MD , Vincenzo Berghella MD , Julio Mateus MD, PhD , Joanne Quiñones-Rivera MD, MSCE , Jennifer Tymon MD , José Bareño-Silva MD , Mónica Rincón MD, MCR , Richard Burwick MD , Luisa López-Torres MD , Catalina Valencia MD , Jorge E. Tolosa MD, MSCE , IC-CLEAR Collaborative (Supplement)
<div><h3>BACKGROUND</h3><div>There was a randomized trial that suggested a benefit with indomethacin and antibiotics in the setting of an examination-indicated cerclage. However, there is little evidence to guide the use of perioperative indomethacin and/or antibiotics in the setting of an ultrasound-indicated cerclage.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to determine whether perioperative antibiotics and/or indomethacin at the time of ultrasound-indicated cerclage placement reduces the rate of spontaneous preterm birth at <37 weeks of gestation.</div></div><div><h3>STUDY DESIGN</h3><div>This was a multicenter retrospective cohort study of women with singleton pregnancies who received a transvaginal cervical cerclage from June 2016 to July 2021. This study aimed to evaluate whether perioperative antibiotics and/or indomethacin at the time of cerclage was superior to no antibiotics/indomethacin in the prevention of spontaneous preterm birth. Of note, 10 sites were involved, 8 in the United States and 2 in Colombia. Because this was an observational cohort, a few propensity score–based analyses were performed to adjust for potential confounding or assignment bias. First, the propensity score for each treatment group comparison (indomethacin vs none, perioperative antibiotics vs none, and indomethacin and perioperative antibiotics vs neither) was determined using multivariate logistic regression taking into consideration study country (United States or Colombia), previous preterm birth history (yes or no), body mass index, cervical length before placement, cervical dilation, gestational age at placement, use of postoperative progestogen (yes vs no), and use of other perioperative interventions (indomethacin or perioperative antibiotics). This propensity score was used for a weighted analysis (1/propensity score). The primary outcome was spontaneous preterm birth at <37 weeks of gestation. The secondary outcomes include rates of spontaneous preterm birth at <34 weeks of gestation and <28 weeks of gestation and latency (weeks) from randomization to delivery for the outcome of spontaneous preterm birth at <37 weeks. Data were weighted using the propensity score for the primary and secondary outcomes, with the respective predictors being indomethacin vs none, perioperative antibiotics vs none, or perioperative indomethacin and antibiotics vs neither in bivariate regression analysis. A 2-sided alpha level of 0.05 was considered statistically significant for all analyses.</div></div><div><h3>RESULTS</h3><div>The database included cerclages placed in women with singleton pregnancies from March 2016 to July 2021. Overall, 340 cases of ultrasound-indicated cerclage were included in this study. Of note, 29.4% of cases had documented cervical dilation at the time of surgery, 28.5% of cases did not have documented cervical dilation at the time of surgery, and 42.1% of cases did not have examination findings recorded. There wer
{"title":"Evaluation of perioperative antibiotics and indomethacin with cerclage for short cervix: a retrospective cohort study with the International Collaborative for Cerclage Longitudinal Evaluation and Research","authors":"Rupsa C. Boelig MD, MS , Eshika Agarwal MD , Jenani Jayakumaran MD , Vincenzo Berghella MD , Julio Mateus MD, PhD , Joanne Quiñones-Rivera MD, MSCE , Jennifer Tymon MD , José Bareño-Silva MD , Mónica Rincón MD, MCR , Richard Burwick MD , Luisa López-Torres MD , Catalina Valencia MD , Jorge E. Tolosa MD, MSCE , IC-CLEAR Collaborative (Supplement)","doi":"10.1016/j.ajogmf.2025.101840","DOIUrl":"10.1016/j.ajogmf.2025.101840","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>There was a randomized trial that suggested a benefit with indomethacin and antibiotics in the setting of an examination-indicated cerclage. However, there is little evidence to guide the use of perioperative indomethacin and/or antibiotics in the setting of an ultrasound-indicated cerclage.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to determine whether perioperative antibiotics and/or indomethacin at the time of ultrasound-indicated cerclage placement reduces the rate of spontaneous preterm birth at <37 weeks of gestation.</div></div><div><h3>STUDY DESIGN</h3><div>This was a multicenter retrospective cohort study of women with singleton pregnancies who received a transvaginal cervical cerclage from June 2016 to July 2021. This study aimed to evaluate whether perioperative antibiotics and/or indomethacin at the time of cerclage was superior to no antibiotics/indomethacin in the prevention of spontaneous preterm birth. Of note, 10 sites were involved, 8 in the United States and 2 in Colombia. Because this was an observational cohort, a few propensity score–based analyses were performed to adjust for potential confounding or assignment bias. First, the propensity score for each treatment group comparison (indomethacin vs none, perioperative antibiotics vs none, and indomethacin and perioperative antibiotics vs neither) was determined using multivariate logistic regression taking into consideration study country (United States or Colombia), previous preterm birth history (yes or no), body mass index, cervical length before placement, cervical dilation, gestational age at placement, use of postoperative progestogen (yes vs no), and use of other perioperative interventions (indomethacin or perioperative antibiotics). This propensity score was used for a weighted analysis (1/propensity score). The primary outcome was spontaneous preterm birth at <37 weeks of gestation. The secondary outcomes include rates of spontaneous preterm birth at <34 weeks of gestation and <28 weeks of gestation and latency (weeks) from randomization to delivery for the outcome of spontaneous preterm birth at <37 weeks. Data were weighted using the propensity score for the primary and secondary outcomes, with the respective predictors being indomethacin vs none, perioperative antibiotics vs none, or perioperative indomethacin and antibiotics vs neither in bivariate regression analysis. A 2-sided alpha level of 0.05 was considered statistically significant for all analyses.</div></div><div><h3>RESULTS</h3><div>The database included cerclages placed in women with singleton pregnancies from March 2016 to July 2021. Overall, 340 cases of ultrasound-indicated cerclage were included in this study. Of note, 29.4% of cases had documented cervical dilation at the time of surgery, 28.5% of cases did not have documented cervical dilation at the time of surgery, and 42.1% of cases did not have examination findings recorded. There wer","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101840"},"PeriodicalIF":3.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530993","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 : 2025-11-08DOI: 10.1016/j.ajogmf.2025.101838
Alana Davidson BS, Stephanie Ros Saposnik MD, Matthew Grace MD, Brett Einerson MD, MPH, Anthony Shanks MD, MEd, Sarah K. Dotters-Katz MD
{"title":"Implementation of the SLOE for MFM applications—insights from its first year in practice","authors":"Alana Davidson BS, Stephanie Ros Saposnik MD, Matthew Grace MD, Brett Einerson MD, MPH, Anthony Shanks MD, MEd, Sarah K. Dotters-Katz MD","doi":"10.1016/j.ajogmf.2025.101838","DOIUrl":"10.1016/j.ajogmf.2025.101838","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 1","pages":"Article 101838"},"PeriodicalIF":3.1,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490352","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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