Austin Oberlin, Katherine Yoh, Eve Overton, Whitney Alexandra Booker, John Ilagan, Dib Sassine, Alexandra Diggs, Sherelle Laifer-Narin, Adela Cimic, Laruence Ring, Maria Sheikh, Caryn St Clair, June Hou, Alexandre Buckley de Meritens, Jason D Wright, Mary D'Alton, Chia-Ling Nhan Chang, Mirella Mourad, Fady Khoury Collado
Objective(s): Traditionally, midline vertical skin incisions have been utilized during surgery for placenta accreta spectrum (PAS), as it is considered to maximize exposure and allow for a uterine incision to avoid the placenta. However, literature directly comparing outcomes of vertical versus transverse incisions in PAS is sparse. Our objective was to compare maternal outcomes between patients who underwent a vertical versus a transverse skin incision for PAS.
Study design: Retrospective review of patients with pathologically confirmed PAS undergoing scheduled surgery at our institution between 09/2019 and 11/2023. Starting in 10/2021, select patients were offered a transverse skin approach. Patients were eligible if the surgery was scheduled, and the placenta was not entirely covering the anterior uterine wall. The transverse skin incision was approximately 18-20cm and used the patient's prior scar. Primary outcomes included rate of maternal transfusion >4 units of packed red blood cells (PRBC), the incidence of surgical complications, and the need for conversion to general anesthesia (GETA).
Results: Seventy patients underwent scheduled surgery for PAS. Thirty-three patients had a vertical skin incision, and 37 had a transverse incision. After initiation of the transverse incision approach, 37/43 (86.0%) had a transverse incision and none required conversion to a vertical incision intraoperatively. The two groups were similar with regard to age, BMI, and severity of PAS. There was no difference in the rate of transfusion of >4 units of PRBC (vertical 12% vs transverse 22%, p=0.29), or in the rate of intraoperative complications (i.e., cystotomy; vertical 3% vs transverse 14%, p= 0.20). In patients with a transverse incision, a significantly lower number of patients required conversion to GETA intraoperatively (vertical 70% vs transverse 24%, p<0.001).
Conclusion: In appropriately selected patients, a transverse skin incision was associated with lower conversion to GETA without any difference in intraoperative outcomes.
目的:传统上,中线垂直皮肤切口被用于胎盘早剥术(PAS),因为这种切口被认为能最大限度地暴露胎盘,并允许子宫切口避开胎盘。然而,直接比较垂直切口与横向切口在 PAS 中的疗效的文献并不多见。我们的目的是比较垂直与横向皮肤切口 PAS 患者的产妇预后:对2019年9月至2023年11月期间在我院接受预定手术的病理确诊PAS患者进行回顾性审查。从 2021 年 10 月开始,我们为部分患者提供了横向皮肤切口。如果手术已排期,且胎盘未完全覆盖子宫前壁,则患者符合条件。横向皮肤切口约 18-20 厘米,使用患者之前的疤痕。主要结果包括产妇输血量大于 4 单位包装红细胞(PRBC)的比率、手术并发症的发生率以及是否需要转为全身麻醉(GETA):70名患者接受了PAS预定手术。33名患者采用垂直皮肤切口,37名患者采用横向切口。在开始采用横向切口方法后,37/43(86.0%)的患者采用了横向切口,没有人需要在术中转为垂直切口。两组患者的年龄、体重指数和 PAS 严重程度相似。两组患者输注大于 4 个单位 PRBC 的比例(纵切口 12% 对横切口 22%,P=0.29)和术中并发症(即膀胱切开术;纵切口 3% 对横切口 14%,P=0.20)没有差异。在采用横切口的患者中,术中需要转为 GETA 的患者人数明显较少(垂直切口 70% 对横切口 24%,P=0.29):在经过适当选择的患者中,横向皮肤切口与较低的 GETA 转归率相关,但术中结果没有任何差异。
{"title":"Transverse versus vertical incision in the surgical management of placenta accreta spectrum.","authors":"Austin Oberlin, Katherine Yoh, Eve Overton, Whitney Alexandra Booker, John Ilagan, Dib Sassine, Alexandra Diggs, Sherelle Laifer-Narin, Adela Cimic, Laruence Ring, Maria Sheikh, Caryn St Clair, June Hou, Alexandre Buckley de Meritens, Jason D Wright, Mary D'Alton, Chia-Ling Nhan Chang, Mirella Mourad, Fady Khoury Collado","doi":"10.1055/a-2479-2604","DOIUrl":"https://doi.org/10.1055/a-2479-2604","url":null,"abstract":"<p><strong>Objective(s): </strong>Traditionally, midline vertical skin incisions have been utilized during surgery for placenta accreta spectrum (PAS), as it is considered to maximize exposure and allow for a uterine incision to avoid the placenta. However, literature directly comparing outcomes of vertical versus transverse incisions in PAS is sparse. Our objective was to compare maternal outcomes between patients who underwent a vertical versus a transverse skin incision for PAS.</p><p><strong>Study design: </strong>Retrospective review of patients with pathologically confirmed PAS undergoing scheduled surgery at our institution between 09/2019 and 11/2023. Starting in 10/2021, select patients were offered a transverse skin approach. Patients were eligible if the surgery was scheduled, and the placenta was not entirely covering the anterior uterine wall. The transverse skin incision was approximately 18-20cm and used the patient's prior scar. Primary outcomes included rate of maternal transfusion >4 units of packed red blood cells (PRBC), the incidence of surgical complications, and the need for conversion to general anesthesia (GETA).</p><p><strong>Results: </strong>Seventy patients underwent scheduled surgery for PAS. Thirty-three patients had a vertical skin incision, and 37 had a transverse incision. After initiation of the transverse incision approach, 37/43 (86.0%) had a transverse incision and none required conversion to a vertical incision intraoperatively. The two groups were similar with regard to age, BMI, and severity of PAS. There was no difference in the rate of transfusion of >4 units of PRBC (vertical 12% vs transverse 22%, p=0.29), or in the rate of intraoperative complications (i.e., cystotomy; vertical 3% vs transverse 14%, p= 0.20). In patients with a transverse incision, a significantly lower number of patients required conversion to GETA intraoperatively (vertical 70% vs transverse 24%, p<0.001).</p><p><strong>Conclusion: </strong>In appropriately selected patients, a transverse skin incision was associated with lower conversion to GETA without any difference in intraoperative outcomes.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachel L Wiley, Suneet P Chauhan, Emily A Johnson, Ipsita Ghose, Hailie N Ciomperlik, Hector Mendez-Figueroa
Objective: This study aimed to compare the composite maternal hemorrhagic outcomes (CMHOs) among term (≥37 weeks) singletons who had scheduled versus unscheduled cesarean deliveries (CDs). A subgroup analysis was done for those without prior uterine surgeries.
Study design: Retrospectively, we identified all singletons at term who had CDs. The unscheduled CDs included individuals admitted with a plan for vaginal delivery with at least 1 hour of attempted labor. CMHOs included any of the following: estimated blood loss of ≥1,000 mL, use of uterotonics (excluding prophylactic oxytocin) or Bakri balloon, surgical management of hemorrhage, blood transfusion, hysterectomy, thromboembolism, admission to intensive care unit, or maternal death. Multivariable Poisson regression models with robust error variance were used to estimate adjusted relative risks (aRRs) with 95% confidence intervals (CIs).
Results: Of 8,623 deliveries in the study period, 2,691 (31.2%) had CDs at term, with 1,709 (67.3%) scheduled CDs, and 983 (36.5%) unscheduled CDs. Overall, the rate of CMHO was 23.3%, and the rate of blood transfusion was 4.1%. CMHOs were two-fold higher among unscheduled (34.5%) than scheduled CDs (16.9%; aRR = 2.18; 95% CI: 1.81-2.63). The aRRs for blood transfusion and surgical interventions to manage postpartum hemorrhage were three times higher with unscheduled than scheduled CDs. The subgroup analysis indicated that among the cohorts without prior uterine surgery, the rate of the CMHOs was significantly higher when the CD was unscheduled versus scheduled (aRR 1.85; 95% CI 1.45-2.37).
Conclusion: Compared to scheduled CDs, the composite hemorrhagic adverse outcomes were significantly higher with unscheduled CDs.
Key points: · Unscheduled cesareans are at higher risk of hemorrhage.. · Unscheduled cesareans are at higher risk of transfusion.. · Atony treatment is higher in unscheduled cesareans..
{"title":"Postpartum Hemorrhagic Morbidity with Scheduled versus Unscheduled Cesarean Delivery at Term.","authors":"Rachel L Wiley, Suneet P Chauhan, Emily A Johnson, Ipsita Ghose, Hailie N Ciomperlik, Hector Mendez-Figueroa","doi":"10.1055/a-2437-0759","DOIUrl":"https://doi.org/10.1055/a-2437-0759","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to compare the composite maternal hemorrhagic outcomes (CMHOs) among term (≥37 weeks) singletons who had scheduled versus unscheduled cesarean deliveries (CDs). A subgroup analysis was done for those without prior uterine surgeries.</p><p><strong>Study design: </strong> Retrospectively, we identified all singletons at term who had CDs. The unscheduled CDs included individuals admitted with a plan for vaginal delivery with at least 1 hour of attempted labor. CMHOs included any of the following: estimated blood loss of ≥1,000 mL, use of uterotonics (excluding prophylactic oxytocin) or Bakri balloon, surgical management of hemorrhage, blood transfusion, hysterectomy, thromboembolism, admission to intensive care unit, or maternal death. Multivariable Poisson regression models with robust error variance were used to estimate adjusted relative risks (aRRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong> Of 8,623 deliveries in the study period, 2,691 (31.2%) had CDs at term, with 1,709 (67.3%) scheduled CDs, and 983 (36.5%) unscheduled CDs. Overall, the rate of CMHO was 23.3%, and the rate of blood transfusion was 4.1%. CMHOs were two-fold higher among unscheduled (34.5%) than scheduled CDs (16.9%; aRR = 2.18; 95% CI: 1.81-2.63). The aRRs for blood transfusion and surgical interventions to manage postpartum hemorrhage were three times higher with unscheduled than scheduled CDs. The subgroup analysis indicated that among the cohorts without prior uterine surgery, the rate of the CMHOs was significantly higher when the CD was unscheduled versus scheduled (aRR 1.85; 95% CI 1.45-2.37).</p><p><strong>Conclusion: </strong> Compared to scheduled CDs, the composite hemorrhagic adverse outcomes were significantly higher with unscheduled CDs.</p><p><strong>Key points: </strong>· Unscheduled cesareans are at higher risk of hemorrhage.. · Unscheduled cesareans are at higher risk of transfusion.. · Atony treatment is higher in unscheduled cesareans..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V Peter Nagraj, Paige Howard, Karen D Fairchild, Brynne A Sullivan
Objectives: Much attention has been paid to measuring physiological episodes of bradycardia-oxygen desaturation (BDs) in the neonatal intensive care unit (NICU). NICU patients also have spells of tachycardia-desaturation (TDs), but these have not been well-characterized. We hypothesized that TDs would be more common among infants with bronchopulmonary dysplasia (BPD). We aimed to quantify daily TDs compared to BDs in NICU patients across a range of gestational and postmenstrual ages (GA and PMA) and determine whether TDs are associated with BPD.
Study design: We analyzed every 2-second heart rate (HR) and peripheral saturation of oxygen (SpO2) throughout the NICU stay of all infants with 24 to 39 weeks GA admitted to a single, level IV NICU from 2012 to 2015. BDs were defined in our prior work (HR <100 bpm for ≥4 seconds with concurrent SpO2 <80% for ≥10 seconds) and TDs as a 20% increase in HR from the previous 2-hour mean baseline and concurrent SpO2 <80% for ≥10 seconds. We calculated the median daily BDs and TDs across a range of GAs and PMAs. For infants ≤32 weeks GA, we compared TDs for those with and without BPD at 36 weeks PMA and discharge on supplemental oxygen.
Results: We analyzed 782,424 hours of HR and SpO2 data from 1,718 neonates, with a median of 271 hours analyzed per infant. TDs frequency increased with increasing PMA across all GAs. BDs occurred most frequently in infants <29 weeks GA and decreased as infants approached term equivalent age. For infants with ≤32 weeks GA, one or more TD per day from 33 to 35 weeks PMA was associated with BPD and home oxygen.
Conclusion: Episodes of TD at the thresholds defined in this analysis occurred more frequently at later PMA and were more common in infants with BPD and those requiring home oxygen.
Key points: · Desaturation episodes occur often in preterm infants.. · Bradycardia or tachycardia can coincide with desaturation.. · TD occurs later and with BPD..
{"title":"Tachycardia-Desaturation Episodes in Neonatal Intensive Care Unit Patients with and without Bronchopulmonary Dysplasia.","authors":"V Peter Nagraj, Paige Howard, Karen D Fairchild, Brynne A Sullivan","doi":"10.1055/a-2437-0461","DOIUrl":"10.1055/a-2437-0461","url":null,"abstract":"<p><strong>Objectives: </strong> Much attention has been paid to measuring physiological episodes of bradycardia-oxygen desaturation (BDs) in the neonatal intensive care unit (NICU). NICU patients also have spells of tachycardia-desaturation (TDs), but these have not been well-characterized. We hypothesized that TDs would be more common among infants with bronchopulmonary dysplasia (BPD). We aimed to quantify daily TDs compared to BDs in NICU patients across a range of gestational and postmenstrual ages (GA and PMA) and determine whether TDs are associated with BPD.</p><p><strong>Study design: </strong> We analyzed every 2-second heart rate (HR) and peripheral saturation of oxygen (SpO<sub>2</sub>) throughout the NICU stay of all infants with 24 to 39 weeks GA admitted to a single, level IV NICU from 2012 to 2015. BDs were defined in our prior work (HR <100 bpm for ≥4 seconds with concurrent SpO<sub>2</sub> <80% for ≥10 seconds) and TDs as a 20% increase in HR from the previous 2-hour mean baseline and concurrent SpO<sub>2</sub> <80% for ≥10 seconds. We calculated the median daily BDs and TDs across a range of GAs and PMAs. For infants ≤32 weeks GA, we compared TDs for those with and without BPD at 36 weeks PMA and discharge on supplemental oxygen.</p><p><strong>Results: </strong> We analyzed 782,424 hours of HR and SpO<sub>2</sub> data from 1,718 neonates, with a median of 271 hours analyzed per infant. TDs frequency increased with increasing PMA across all GAs. BDs occurred most frequently in infants <29 weeks GA and decreased as infants approached term equivalent age. For infants with ≤32 weeks GA, one or more TD per day from 33 to 35 weeks PMA was associated with BPD and home oxygen.</p><p><strong>Conclusion: </strong> Episodes of TD at the thresholds defined in this analysis occurred more frequently at later PMA and were more common in infants with BPD and those requiring home oxygen.</p><p><strong>Key points: </strong>· Desaturation episodes occur often in preterm infants.. · Bradycardia or tachycardia can coincide with desaturation.. · TD occurs later and with BPD..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anat Pardo, Shir Nahum Fridland, Or Lee Rak, Emilie Klochendler Frishman, Hadas Zafrir Danieli, Anat Shmueli, Shiri Barbash-Hazan, Arnon Wiznitzer, Asnat Walfisch, Tomer Sela, Leor Wolff, Eran Hadar
Objective: Pulsenmore ES is a self-scanning ultrasound system for remote fetal assessment. It is composed of a hand-held transducer that serves as a smartphone cradle coupled with an application and clinician's web-viewer dashboard. Recently, a novel capability was added to the system allowing for offline fetal heart rate (FHR) and maximal vertical pocket (MVP) measurements. The aim of this study was to evaluate these tools for usability and accuracy.
Study design: A prospective, non-randomized, non-blinded clinical study design was used. Pulsenmore ES scans were obtained by non-professional laypersons in app-guided (AG) mode (user follows video tutorials in the application) or clinician-guided (CG) mode (user is guided by a health-care professional in a real-time telemedicine visit). The scans were stored on a cloud for later interpretation by a health-care professional. Each self-scan was immediately followed by a standard ultrasound scan performed by a clinician. The asynchronous FHR and MVP measurements made on the AG and CG scans through the designated dashboard were analyzed and compared with the real-time, in-clinic, measurements.
Results: The cohort included 28 women. Rates of successful utilization of the Pulsenmore tool for measurement of FHR were 84.7±11.24% of scans made in AG mode and 96.3±6.35% of scans made in CG mode. Corresponding values for MVP were 91.7±2.31% and 95.0±1.73%. FHR accuracy (difference from in-clinic values) was 10.8±7.5 bpm (7.2%) in AG mode and 5.8±5.1 bpm (4%) in CG mode; MVP accuracy was 1.3±1.4cm (22%) and 0.9±0.8cm (14%), respectively. Sensitivity (87.5% and 100%, in AG and CG modes respectively) and specificity (95% and 95.5%, in AG and CG modes, respectively) were established for MVP.
Conclusion: FHR and MVP measurements obtained from scans captured by the self-operated Pulsenmore ES ultrasound platform are highly accurate and reliable for clinical use relative to standard in-clinic measurements.
目的:Pulsenmore ES 是一种用于远程胎儿评估的自扫描超声系统。它由一个手持式传感器、一个智能手机支架、一个应用程序和临床医生的网络浏览器仪表板组成。最近,该系统增加了一项新功能,允许离线测量胎儿心率(FHR)和最大垂直袋(MVP)。本研究旨在评估这些工具的可用性和准确性:研究设计:采用前瞻性、非随机、非盲法临床研究设计。Pulsenmore ES 扫描由非专业人员在应用程序指导(AG)模式(用户按照应用程序中的视频教程操作)或临床医生指导(CG)模式(用户在实时远程医疗访问中由专业医护人员指导)下进行。扫描结果存储在云端,以便日后由专业医护人员进行解读。每次自我扫描后,紧接着由临床医生进行标准超声波扫描。通过指定的仪表板对 AG 和 CG 扫描进行的异步 FHR 和 MVP 测量结果进行了分析,并与在诊所进行的实时测量结果进行了比较:结果:研究对象包括 28 名妇女。使用 Pulsenmore 工具测量 FHR 的成功率在 AG 模式扫描中为 84.7±11.24%,在 CG 模式扫描中为 96.3±6.35%。MVP 的相应值分别为 91.7±2.31% 和 95.0±1.73%。在 AG 模式下,FHR 的准确性(与门诊值的差异)为 10.8±7.5 bpm(7.2%),在 CG 模式下为 5.8±5.1 bpm(4%);MVP 的准确性分别为 1.3±1.4 厘米(22%)和 0.9±0.8 厘米(14%)。MVP的灵敏度(AG和CG模式分别为87.5%和100%)和特异性(AG和CG模式分别为95%和95.5%)均已确定:结论:与标准的门诊测量相比,通过自行操作的 Pulsenmore ES 超声波平台扫描获得的 FHR 和 MVP 测量值在临床应用中高度准确可靠。
{"title":"Fetal heart rate and amniotic fluid volume measurements with a home ultrasound device.","authors":"Anat Pardo, Shir Nahum Fridland, Or Lee Rak, Emilie Klochendler Frishman, Hadas Zafrir Danieli, Anat Shmueli, Shiri Barbash-Hazan, Arnon Wiznitzer, Asnat Walfisch, Tomer Sela, Leor Wolff, Eran Hadar","doi":"10.1055/a-2469-0887","DOIUrl":"https://doi.org/10.1055/a-2469-0887","url":null,"abstract":"<p><strong>Objective: </strong>Pulsenmore ES is a self-scanning ultrasound system for remote fetal assessment. It is composed of a hand-held transducer that serves as a smartphone cradle coupled with an application and clinician's web-viewer dashboard. Recently, a novel capability was added to the system allowing for offline fetal heart rate (FHR) and maximal vertical pocket (MVP) measurements. The aim of this study was to evaluate these tools for usability and accuracy.</p><p><strong>Study design: </strong>A prospective, non-randomized, non-blinded clinical study design was used. Pulsenmore ES scans were obtained by non-professional laypersons in app-guided (AG) mode (user follows video tutorials in the application) or clinician-guided (CG) mode (user is guided by a health-care professional in a real-time telemedicine visit). The scans were stored on a cloud for later interpretation by a health-care professional. Each self-scan was immediately followed by a standard ultrasound scan performed by a clinician. The asynchronous FHR and MVP measurements made on the AG and CG scans through the designated dashboard were analyzed and compared with the real-time, in-clinic, measurements.</p><p><strong>Results: </strong>The cohort included 28 women. Rates of successful utilization of the Pulsenmore tool for measurement of FHR were 84.7±11.24% of scans made in AG mode and 96.3±6.35% of scans made in CG mode. Corresponding values for MVP were 91.7±2.31% and 95.0±1.73%. FHR accuracy (difference from in-clinic values) was 10.8±7.5 bpm (7.2%) in AG mode and 5.8±5.1 bpm (4%) in CG mode; MVP accuracy was 1.3±1.4cm (22%) and 0.9±0.8cm (14%), respectively. Sensitivity (87.5% and 100%, in AG and CG modes respectively) and specificity (95% and 95.5%, in AG and CG modes, respectively) were established for MVP.</p><p><strong>Conclusion: </strong>FHR and MVP measurements obtained from scans captured by the self-operated Pulsenmore ES ultrasound platform are highly accurate and reliable for clinical use relative to standard in-clinic measurements.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bria L Pettway, Marie J Boller, Yun-Yi Hung, Ticara L Onyewuenyi, Miranda Ritterman Weintraub, Michael W Kuzniewicz, Betsy O'Donnell, Anne Regenstein
Objective: This study aimed to assess short-term neurodevelopmental outcomes for neonates affected by fetomaternal hemorrhage (FMH) and compare them with an unexposed group.
Study design: A retrospective cohort analysis was conducted within a large integrated medical system spanning from 2008 to 2018. Neurodevelopmental outcomes of neonatal survivors of FMH were compared with matched controls. Clinically significant FMH in survivors was defined by maternal flow cytometry for fetal hemoglobin result of >0.10% and neonatal transfusion requirement. One unexposed infant was identified for each surviving FMH-exposed infant, matched by gestational age at delivery (±1 week), birth year, sex, and race/ethnicity. The primary outcome was a diagnosis of neurodevelopmental impairment, identified using the International Classification of Diseases (ICD), 9th and 10th Revisions (ICD-9 and ICD-10) codes. Results were presented as proportions, means, medians, and interquartile ranges. Comparisons were performed using chi-square and Fisher's exact tests. A Cox proportional hazards regression model was conducted to examine associations between cognitive and developmental outcomes and FMH exposure.
Results: Among 137 pregnancies with clinically significant FMH, 80 resulted in intrauterine demise, 57 neonates required blood transfusion, and 4 neonates requiring transfusion demised during birth hospitalization. No significant difference in rates of neurodevelopmental impairment was found between FMH-exposed and unexposed infants (26.4 vs. 24.6%, p = 0.8). Similar findings were observed in preterm (37 vs. 31.6%, p = 0.7) and term neonates (15.4 vs. 14.8%, p = 1.0). Cox regression showed no significant association between neurodevelopmental outcomes and FMH exposure (1.17 [95% CI: 0.61-2.22]; p = 0.6).
Conclusion: Despite the significant perinatal morbidity and mortality associated with FMH, surviving infants did not show a significant difference in neurodevelopmental diagnoses compared to matched unexposed infants. However, definitive conclusions are limited due to the rarity of FMH requiring transfusion and the small exposed sample size, warranting further evaluation in a larger cohort.
Key points: · FMH is associated with profound fetal and neonatal morbidity and mortality.. · Impact on neurologic development for infants surviving FMH is unknown.. · Neurodevelopmental outcomes did not differ between survivors of FMH compared to matched controls..
{"title":"Neurodevelopmental Outcomes in Neonates Surviving Fetomaternal Hemorrhage Compared with a Matched Unexposed Group in a Large Integrated Health Care System.","authors":"Bria L Pettway, Marie J Boller, Yun-Yi Hung, Ticara L Onyewuenyi, Miranda Ritterman Weintraub, Michael W Kuzniewicz, Betsy O'Donnell, Anne Regenstein","doi":"10.1055/a-2441-3761","DOIUrl":"https://doi.org/10.1055/a-2441-3761","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to assess short-term neurodevelopmental outcomes for neonates affected by fetomaternal hemorrhage (FMH) and compare them with an unexposed group.</p><p><strong>Study design: </strong> A retrospective cohort analysis was conducted within a large integrated medical system spanning from 2008 to 2018. Neurodevelopmental outcomes of neonatal survivors of FMH were compared with matched controls. Clinically significant FMH in survivors was defined by maternal flow cytometry for fetal hemoglobin result of >0.10% and neonatal transfusion requirement. One unexposed infant was identified for each surviving FMH-exposed infant, matched by gestational age at delivery (±1 week), birth year, sex, and race/ethnicity. The primary outcome was a diagnosis of neurodevelopmental impairment, identified using the International Classification of Diseases (ICD), 9th and 10th Revisions (ICD-9 and ICD-10) codes. Results were presented as proportions, means, medians, and interquartile ranges. Comparisons were performed using chi-square and Fisher's exact tests. A Cox proportional hazards regression model was conducted to examine associations between cognitive and developmental outcomes and FMH exposure.</p><p><strong>Results: </strong> Among 137 pregnancies with clinically significant FMH, 80 resulted in intrauterine demise, 57 neonates required blood transfusion, and 4 neonates requiring transfusion demised during birth hospitalization. No significant difference in rates of neurodevelopmental impairment was found between FMH-exposed and unexposed infants (26.4 vs. 24.6%, <i>p</i> = 0.8). Similar findings were observed in preterm (37 vs. 31.6%, <i>p</i> = 0.7) and term neonates (15.4 vs. 14.8%, <i>p</i> = 1.0). Cox regression showed no significant association between neurodevelopmental outcomes and FMH exposure (1.17 [95% CI: 0.61-2.22]; <i>p</i> = 0.6).</p><p><strong>Conclusion: </strong> Despite the significant perinatal morbidity and mortality associated with FMH, surviving infants did not show a significant difference in neurodevelopmental diagnoses compared to matched unexposed infants. However, definitive conclusions are limited due to the rarity of FMH requiring transfusion and the small exposed sample size, warranting further evaluation in a larger cohort.</p><p><strong>Key points: </strong>· FMH is associated with profound fetal and neonatal morbidity and mortality.. · Impact on neurologic development for infants surviving FMH is unknown.. · Neurodevelopmental outcomes did not differ between survivors of FMH compared to matched controls..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study aimed to examine the trends in the infant mortality rate (IMR) and the trends in the timing of death among periviable preterm infants at 22 to 24 weeks' gestational age (GA) in the United States from 2011 to 2020.
Study design: Retrospective, serial cross-sectional analysis of periviable preterm infants born in the United States at 22 to 24 weeks' GA using the linked birth/infant death records from the Centers for Disease Control and Prevention. Data were analyzed from 2011 to 2020. The exposure was the year of death, and the outcome was the changes over time in the IMR and the timing of death. Further, we evaluated racial differences in the timing of death. We used nonparametric trend analysis to evaluate changes in mortality rate across the study period.
Results: The IMR was inversely related to GA, and for each GA and race/ethnicity, the IMR significantly declined during the study period. The IMR rate was highest in the first 7 days of life for all GAs and races/ethnicities. While Non-Hispanic White infants had a higher infant neonatal mortality rate than non-Hispanic Black infants, non-Hispanic Black infants had a higher postneonatal mortality rate.
Conclusion: The IMR among periviable infants born at 22 to 24 weeks' GA improved for all GAs and races in the United States between 2011 and 2020. However, significant racial differences in the timing of death exist.
Key points: · As expected, the IMR was inversely related to gestational age at 22 to 24 weeks.. · At each gestational age and for each racial/ethnic group, the overall IMR decreased during the study period.. · Non-Hispanic White infants had a higher neonatal mortality rate, whereas non-Hispanic Black infants had a higher postneonatal mortality rate..
{"title":"Trends in the Mortality and Death of Periviable Preterm Infants in the United States, 2011 to 2020.","authors":"Jenil Patel, Omobola Oluwafemi, Tiffany Tang, Angel Sunny, Narendrasinh Parmar, Harshit Doshi, Parth Bhatt, Keyur Donda, Sarah E Messiah, Fredrick Dapaah-Siakwan","doi":"10.1055/a-2435-0908","DOIUrl":"https://doi.org/10.1055/a-2435-0908","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to examine the trends in the infant mortality rate (IMR) and the trends in the timing of death among periviable preterm infants at 22 to 24 weeks' gestational age (GA) in the United States from 2011 to 2020.</p><p><strong>Study design: </strong> Retrospective, serial cross-sectional analysis of periviable preterm infants born in the United States at 22 to 24 weeks' GA using the linked birth/infant death records from the Centers for Disease Control and Prevention. Data were analyzed from 2011 to 2020. The exposure was the year of death, and the outcome was the changes over time in the IMR and the timing of death. Further, we evaluated racial differences in the timing of death. We used nonparametric trend analysis to evaluate changes in mortality rate across the study period.</p><p><strong>Results: </strong> The IMR was inversely related to GA, and for each GA and race/ethnicity, the IMR significantly declined during the study period. The IMR rate was highest in the first 7 days of life for all GAs and races/ethnicities. While Non-Hispanic White infants had a higher infant neonatal mortality rate than non-Hispanic Black infants, non-Hispanic Black infants had a higher postneonatal mortality rate.</p><p><strong>Conclusion: </strong> The IMR among periviable infants born at 22 to 24 weeks' GA improved for all GAs and races in the United States between 2011 and 2020. However, significant racial differences in the timing of death exist.</p><p><strong>Key points: </strong>· As expected, the IMR was inversely related to gestational age at 22 to 24 weeks.. · At each gestational age and for each racial/ethnic group, the overall IMR decreased during the study period.. · Non-Hispanic White infants had a higher neonatal mortality rate, whereas non-Hispanic Black infants had a higher postneonatal mortality rate..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: A recent randomized clinical trial (RCT) showed that listening to music reduces the pain level and anxiety levels in women with spontaneous labor at term. The effect on pregnant women undergoing induction of labor is still unclear.This study aimed to test the hypothesis that in nulliparous women with singleton pregnancies, undergoing induction of labor at term, listening to music would reduce the pain level during labor.
Study design: Parallel group, non-blinded, RCT conducted at a single center in Italy. Nulliparous women with singleton pregnancies and vertex presentation, admitted for induction of labor with either oral or vaginal prostaglandins, between 370/7 and 420/7 weeks, were randomized in a 1:1 ratio to receive music during induction of labor or no music during induction. The endpoints of the trials were the pain level during induction, and in the active phase of labor, recorded using the visual analog scale for pain, ranging from 0 (no pain) to 10 (unbearable pain). The effect of music use on each outcome was quantified as the mean difference (MD) with a 95% confidence interval (CI).
Results: During the study period, 30 women agreed to take part in the study, underwent randomization, and were enrolled and followed up. Fifteen women were randomized in the music group and 15 in the control group. No patients were lost to follow-up for the primary outcome. Pain level during the induction procedure was 8.8 ± 0.9 in the music group, and 9.8 ± 0.3 in the control group (MD -2.60 points, 95% CI -3.94 to -1.26; p < 0.01). Music during labor and delivery was also associated with decreased anxiety during the induction procedure (MD -3.80 points, 95% CI -5.53 to -2.07; p < 0.01).
Conclusion: In nulliparous women, listening to music during the induction of labor reduces pain and anxiety levels.
Key points: · Music listening has a modulatory effect on the human stress response.. · Music listening may generate beneficial changes in the autonomic nervous system and the HPA axis activity that should be conducive to the stress recovery process.. · Listening to music during induction of labor resulted in a significant lower pain..
{"title":"Effect of Listening Music on Nulliparous Singleton Pregnancies Who Underwent Induction of Labor: A Randomized Clinical Trial.","authors":"Gabriele Saccone, Maria Chiara Malferà, Lucia D'Antonio, Pasquale Gallo, Alessandra Ammendola, Giorgia Buonomo, Dario Colacurci, Rosanna Zapparella, Mariavittoria Locci","doi":"10.1055/a-2437-0524","DOIUrl":"10.1055/a-2437-0524","url":null,"abstract":"<p><strong>Objective: </strong> A recent randomized clinical trial (RCT) showed that listening to music reduces the pain level and anxiety levels in women with spontaneous labor at term. The effect on pregnant women undergoing induction of labor is still unclear.This study aimed to test the hypothesis that in nulliparous women with singleton pregnancies, undergoing induction of labor at term, listening to music would reduce the pain level during labor.</p><p><strong>Study design: </strong> Parallel group, non-blinded, RCT conducted at a single center in Italy. Nulliparous women with singleton pregnancies and vertex presentation, admitted for induction of labor with either oral or vaginal prostaglandins, between 37<sup>0/7</sup> and 42<sup>0/7</sup> weeks, were randomized in a 1:1 ratio to receive music during induction of labor or no music during induction. The endpoints of the trials were the pain level during induction, and in the active phase of labor, recorded using the visual analog scale for pain, ranging from 0 (no pain) to 10 (unbearable pain). The effect of music use on each outcome was quantified as the mean difference (MD) with a 95% confidence interval (CI).</p><p><strong>Results: </strong> During the study period, 30 women agreed to take part in the study, underwent randomization, and were enrolled and followed up. Fifteen women were randomized in the music group and 15 in the control group. No patients were lost to follow-up for the primary outcome. Pain level during the induction procedure was 8.8 ± 0.9 in the music group, and 9.8 ± 0.3 in the control group (MD -2.60 points, 95% CI -3.94 to -1.26; <i>p</i> < 0.01). Music during labor and delivery was also associated with decreased anxiety during the induction procedure (MD -3.80 points, 95% CI -5.53 to -2.07; <i>p</i> < 0.01).</p><p><strong>Conclusion: </strong> In nulliparous women, listening to music during the induction of labor reduces pain and anxiety levels.</p><p><strong>Key points: </strong>· Music listening has a modulatory effect on the human stress response.. · Music listening may generate beneficial changes in the autonomic nervous system and the HPA axis activity that should be conducive to the stress recovery process.. · Listening to music during induction of labor resulted in a significant lower pain..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fagen Xie, Michael J Fassett, Jiaxiao M Shi, Vicki Y Chiu, Theresa M Im, Sunhea Kim, Nana A Mensah, Nehaa Khadka, Daniella Park, Carol Mao, Matthew Molaei, Iris Lin, Darios Getahun
Objective: This study aims to identify hemolytic disease of the fetus and newborn (HDFN) pregnancies using electronic health records (EHRs) from a large integrated health care system.
Study design: A retrospective cohort study was performed among pregnant patients receiving obstetrical care at Kaiser Permanente Southern California health care system between January 1, 2008, and June 30, 2022. Using structured (diagnostic/procedural codes, medication, and laboratory records) and unstructured (clinical notes analyzed via natural language processing) data abstracted from EHRs, we extracted HDFN-specific "indicators" (maternal positive antibody test and abnormal antibody titer, maternal/infant HDFN diagnosis and blood transfusion, hydrops fetalis, infant intravenous immunoglobulin [IVIG] treatment, jaundice/phototherapy, and first administrated Rho[D] Immune Globulin) to identify potential HDFN pregnancies. Chart reviews and adjudication were then performed on select combinations of indicators for case ascertainment. HDFN due to ABO alloimmunization alone was excluded. The HDFN frequency and proportion of each combination were fully analyzed.
Results: Among the 464,711 eligible pregnancies, a total of 136 pregnancies were confirmed as HDFN pregnancies. The percentage of the HDFN-specific indicators ranged from 0.02% (infant IVIG treatment) to 34.53% (infant jaundice/phototherapy) among the eligible pregnancies, and 32.35% (infant IVIG treatment) to 100% (maternal positive antibody test) among the 136 confirmed HDFN pregnancies. Four combination groups of four indicators, four combination groups of five indicators, and the unique combination of six indicators showed 100% of HDFN pregnancies, while 80.88% of confirmed HDFN pregnancies had the indicator combination of maternal positive antibody test, maternal/infant HDFN diagnosis, and infant jaundice/phototherapy.
Conclusion: We successfully identified HDFN pregnancies by leveraging a combination of medical indicators extracted from structured and unstructured data that may be used in future pharmacoepidemiologic studies. Traditional indicators (positive antibody test results, high titers, and clinical diagnosis codes) alone did not accurately identify HDFN pregnancies, highlighting an unmet need for improved practices in HDFN coding.
Key points: · A case ascertainment method was developed to identify HDFN from structured and unstructured data.. · The method used in this study may be used in future pharmacoepidemiologic studies.. · The study highlighted an unmet need for improved practices in HDFN coding..
{"title":"Identifying Hemolytic Disease of the Fetus and Newborn within a Large Integrated Health Care System.","authors":"Fagen Xie, Michael J Fassett, Jiaxiao M Shi, Vicki Y Chiu, Theresa M Im, Sunhea Kim, Nana A Mensah, Nehaa Khadka, Daniella Park, Carol Mao, Matthew Molaei, Iris Lin, Darios Getahun","doi":"10.1055/a-2444-2314","DOIUrl":"https://doi.org/10.1055/a-2444-2314","url":null,"abstract":"<p><strong>Objective: </strong> This study aims to identify hemolytic disease of the fetus and newborn (HDFN) pregnancies using electronic health records (EHRs) from a large integrated health care system.</p><p><strong>Study design: </strong> A retrospective cohort study was performed among pregnant patients receiving obstetrical care at Kaiser Permanente Southern California health care system between January 1, 2008, and June 30, 2022. Using structured (diagnostic/procedural codes, medication, and laboratory records) and unstructured (clinical notes analyzed via natural language processing) data abstracted from EHRs, we extracted HDFN-specific \"indicators\" (maternal positive antibody test and abnormal antibody titer, maternal/infant HDFN diagnosis and blood transfusion, hydrops fetalis, infant intravenous immunoglobulin [IVIG] treatment, jaundice/phototherapy, and first administrated Rho[D] Immune Globulin) to identify potential HDFN pregnancies. Chart reviews and adjudication were then performed on select combinations of indicators for case ascertainment. HDFN due to ABO alloimmunization alone was excluded. The HDFN frequency and proportion of each combination were fully analyzed.</p><p><strong>Results: </strong> Among the 464,711 eligible pregnancies, a total of 136 pregnancies were confirmed as HDFN pregnancies. The percentage of the HDFN-specific indicators ranged from 0.02% (infant IVIG treatment) to 34.53% (infant jaundice/phototherapy) among the eligible pregnancies, and 32.35% (infant IVIG treatment) to 100% (maternal positive antibody test) among the 136 confirmed HDFN pregnancies. Four combination groups of four indicators, four combination groups of five indicators, and the unique combination of six indicators showed 100% of HDFN pregnancies, while 80.88% of confirmed HDFN pregnancies had the indicator combination of maternal positive antibody test, maternal/infant HDFN diagnosis, and infant jaundice/phototherapy.</p><p><strong>Conclusion: </strong> We successfully identified HDFN pregnancies by leveraging a combination of medical indicators extracted from structured and unstructured data that may be used in future pharmacoepidemiologic studies. Traditional indicators (positive antibody test results, high titers, and clinical diagnosis codes) alone did not accurately identify HDFN pregnancies, highlighting an unmet need for improved practices in HDFN coding.</p><p><strong>Key points: </strong>· A case ascertainment method was developed to identify HDFN from structured and unstructured data.. · The method used in this study may be used in future pharmacoepidemiologic studies.. · The study highlighted an unmet need for improved practices in HDFN coding..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher X Hong, Mariana Masteling, Clarice G Zhou, Matthew K Janssen, Jourdan E Triebwasser
Objective: Previous studies have identified an association between obstetric interventions and the time of day in which they are performed; however, they do not account for granular variations in the temporality of delivery interventions, which is influenced by both health care providers and resource availability. We sought to assess differences in time of birth among spontaneous vaginal births (SVBs) versus operative (forceps- and vacuum-assisted) vaginal births (OVBs).
Study design: This cross-sectional study used birth certificate data from the National Vital Statistics System from 2016 to 2021, which includes the time of birth and delivery method for recorded U.S. births. The number of SVBs and OVBs at each minute was normalized relative to the total births within each delivery group to facilitate balanced comparisons between groups. Logistic regression analysis assessed the odds of OVBs per time of day.
Results: A total of 15,412,129 subjects who underwent vaginal birth were included in this analysis, 690,905 (4.5%) of whom underwent OVBs. Compared to births at other time intervals, those between 4:30 and 7:30 p.m. were more likely to be OVBs (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.12-1.14). Conversely, births between 3:00 and 6:00 a.m. were less likely to be OVBs (OR = 0.87, 95% CI: 0.86-0.88). After adjusting for adjusting for maternal age, gestational age, and induction of labor, births between 4:30 and 7:30 p.m. remained more likely to be OVBs (adjusted odds ratio [aOR] = 1.09, 95% CI: 1.08-1.10) and births between 3:00 and 6:00 a.m. remained less likely to be OVBs (aOR = 0.91, 95% CI: 0.90-0.92).
Conclusion: In this population-based study, we identified temporal differences between SVBs and OVBs with increased use of instrumentation during the late afternoon and reduced use in the early morning. These findings prompt further investigation into the indications for OVBs and root causes of these temporal variations, which are likely multifactorial and involve provider and resource availability.
Key points: · This study identifies temporal differences between SVBs and OVBs.. · Compared to SVBs, operative births are more likely in the late afternoon.. · OVBs are also less likely in the early morning.. · These temporal trends suggest the influence of provider and resource availability..
{"title":"Differences in Time of Birth between Spontaneous and Operative Vaginal Births.","authors":"Christopher X Hong, Mariana Masteling, Clarice G Zhou, Matthew K Janssen, Jourdan E Triebwasser","doi":"10.1055/a-2442-7396","DOIUrl":"10.1055/a-2442-7396","url":null,"abstract":"<p><strong>Objective: </strong> Previous studies have identified an association between obstetric interventions and the time of day in which they are performed; however, they do not account for granular variations in the temporality of delivery interventions, which is influenced by both health care providers and resource availability. We sought to assess differences in time of birth among spontaneous vaginal births (SVBs) versus operative (forceps- and vacuum-assisted) vaginal births (OVBs).</p><p><strong>Study design: </strong> This cross-sectional study used birth certificate data from the National Vital Statistics System from 2016 to 2021, which includes the time of birth and delivery method for recorded U.S. births. The number of SVBs and OVBs at each minute was normalized relative to the total births within each delivery group to facilitate balanced comparisons between groups. Logistic regression analysis assessed the odds of OVBs per time of day.</p><p><strong>Results: </strong> A total of 15,412,129 subjects who underwent vaginal birth were included in this analysis, 690,905 (4.5%) of whom underwent OVBs. Compared to births at other time intervals, those between 4:30 and 7:30 p.m. were more likely to be OVBs (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.12-1.14). Conversely, births between 3:00 and 6:00 a.m. were less likely to be OVBs (OR = 0.87, 95% CI: 0.86-0.88). After adjusting for adjusting for maternal age, gestational age, and induction of labor, births between 4:30 and 7:30 p.m. remained more likely to be OVBs (adjusted odds ratio [aOR] = 1.09, 95% CI: 1.08-1.10) and births between 3:00 and 6:00 a.m. remained less likely to be OVBs (aOR = 0.91, 95% CI: 0.90-0.92).</p><p><strong>Conclusion: </strong> In this population-based study, we identified temporal differences between SVBs and OVBs with increased use of instrumentation during the late afternoon and reduced use in the early morning. These findings prompt further investigation into the indications for OVBs and root causes of these temporal variations, which are likely multifactorial and involve provider and resource availability.</p><p><strong>Key points: </strong>· This study identifies temporal differences between SVBs and OVBs.. · Compared to SVBs, operative births are more likely in the late afternoon.. · OVBs are also less likely in the early morning.. · These temporal trends suggest the influence of provider and resource availability..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shirley J Shao, Andrew Grimes, Marley Rashad, Liina Poder, Dorothy Shum, Nasim Camillia Sobhani
Objective: Fetal magnetic resonance imaging (MRI) is increasingly used for evaluation of fetal anomalies, and rates of incidental maternal findings are not well characterized. Our objective was to evaluate the rate of incidental maternal findings at the time of antenatal MRI performed for fetal indications.
Study design: This was a retrospective cohort study that included all fetal MRIs performed between 2018-2023 at a single tertiary care institution with a multidisciplinary fetal diagnosis and treatment center. The electronic medical record was reviewed to identify all documented maternal findings and any new, non-physiologic maternal findings. The latter was defined as previously unknown abnormalities of maternal structures unrelated to normal physiology.
Results: Our study included 834 imaging events, performed at an average gestational age of 23 weeks. The most common indication for imaging was fetal anomaly (81.1%). The most common imaging type was fetal brain MRI (81.4%). Overall, 16.2% reported a maternal finding and 7% reported a new, non-physiologic finding. The most common new, non-physiologic findings were renal cysts (n=11), liver cysts (n=6), and gallstones or gallbladder sludge (n=5). Compared to imaging events that included a fetal brain MRI, imaging events that included a fetal body MRI had a significantly higher rate of any maternal findings (53.0% vs 10.4%, p< 0.001) and new, non-physiologic maternal findings (26.9% vs 3.7%, p< 0.001).
Conclusion: Our results suggest that the risk of identifying new, non-physiologic maternal findings on fetal MRI is low. The rate of any maternal and new, non-physiologic maternal findings may differ by fetal MRI type due to differences in imaging depth and extent of radiology subspecialist review. These data should be incorporated into pre-test counseling for patients planning to have fetal MRI.
目的:胎儿磁共振成像(MRI)越来越多地用于评估胎儿畸形,而母体偶然发现的比例却没有得到很好的描述。我们的目的是评估因胎儿适应症而进行产前磁共振成像时母体意外发现的比率:这是一项回顾性队列研究,纳入了一家拥有多学科胎儿诊断和治疗中心的三级医疗机构在 2018-2023 年期间进行的所有胎儿 MRI。研究人员查阅了电子病历,以确定所有记录在案的母体检查结果以及任何新的、非生理性的母体检查结果。后者被定义为与正常生理无关的先前未知的母体结构异常:我们的研究包括 834 例造影,平均孕周为 23 周。最常见的造影适应症是胎儿异常(81.1%)。最常见的成像类型是胎儿脑部磁共振成像(81.4%)。总体而言,16.2%报告了母体发现,7%报告了新的非生理学发现。最常见的非生理性新发现是肾囊肿(11 例)、肝囊肿(6 例)和胆结石或胆囊淤血(5 例)。与包括胎儿脑部核磁共振成像的造影事件相比,包括胎儿身体核磁共振成像的造影事件的任何母体发现率(53.0% vs 10.4%,P< 0.001)和新的非生理性母体发现率(26.9% vs 3.7%,P< 0.001)都明显更高:我们的结果表明,在胎儿磁共振成像中发现新的、非生理性母体发现的风险很低。由于成像深度和放射学亚专科审查范围的差异,不同类型胎儿磁共振成像的任何母体和新的、非生理性母体发现率可能不同。这些数据应纳入计划进行胎儿核磁共振成像检查的患者的检查前咨询中。
{"title":"Incidence of new, non-physiologic maternal findings on fetal magnetic resonance imaging.","authors":"Shirley J Shao, Andrew Grimes, Marley Rashad, Liina Poder, Dorothy Shum, Nasim Camillia Sobhani","doi":"10.1055/a-2466-1319","DOIUrl":"https://doi.org/10.1055/a-2466-1319","url":null,"abstract":"<p><strong>Objective: </strong>Fetal magnetic resonance imaging (MRI) is increasingly used for evaluation of fetal anomalies, and rates of incidental maternal findings are not well characterized. Our objective was to evaluate the rate of incidental maternal findings at the time of antenatal MRI performed for fetal indications.</p><p><strong>Study design: </strong>This was a retrospective cohort study that included all fetal MRIs performed between 2018-2023 at a single tertiary care institution with a multidisciplinary fetal diagnosis and treatment center. The electronic medical record was reviewed to identify all documented maternal findings and any new, non-physiologic maternal findings. The latter was defined as previously unknown abnormalities of maternal structures unrelated to normal physiology.</p><p><strong>Results: </strong>Our study included 834 imaging events, performed at an average gestational age of 23 weeks. The most common indication for imaging was fetal anomaly (81.1%). The most common imaging type was fetal brain MRI (81.4%). Overall, 16.2% reported a maternal finding and 7% reported a new, non-physiologic finding. The most common new, non-physiologic findings were renal cysts (n=11), liver cysts (n=6), and gallstones or gallbladder sludge (n=5). Compared to imaging events that included a fetal brain MRI, imaging events that included a fetal body MRI had a significantly higher rate of any maternal findings (53.0% vs 10.4%, p< 0.001) and new, non-physiologic maternal findings (26.9% vs 3.7%, p< 0.001).</p><p><strong>Conclusion: </strong>Our results suggest that the risk of identifying new, non-physiologic maternal findings on fetal MRI is low. The rate of any maternal and new, non-physiologic maternal findings may differ by fetal MRI type due to differences in imaging depth and extent of radiology subspecialist review. These data should be incorporated into pre-test counseling for patients planning to have fetal MRI.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}