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Transverse versus vertical incision in the surgical management of placenta accreta spectrum. 横切与纵切在胎盘早剥手术治疗中的应用。
IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-20 DOI: 10.1055/a-2479-2604
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。
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引用次数: 0
Postpartum Hemorrhagic Morbidity with Scheduled versus Unscheduled Cesarean Delivery at Term. 预产期与非预产期剖宫产的产后出血发病率。
IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-19 DOI: 10.1055/a-2437-0759
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..

研究目的本研究旨在比较足月(≥37周)单胎产妇按计划与非按计划剖宫产(CDs)的综合产妇出血结局(CMHOs)。研究设计:研究设计:通过回顾性分析,我们确定了所有在足月时进行剖宫产的单胎。非计划内分娩包括入院时计划经阴道分娩且至少经过 1 小时尝试性分娩的产妇。CMHOs包括以下任何一种情况:估计失血量≥1,000 mL、使用子宫收缩剂(不包括预防性催产素)或巴克里球囊、手术治疗出血、输血、子宫切除术、血栓栓塞、入住重症监护室或产妇死亡。使用具有稳健误差方差的多变量泊松回归模型来估计调整后相对风险(aRR)及 95% 置信区间(CI):在研究期间的 8,623 例分娩中,2,691 例(31.2%)在临产时发生了子宫内膜异位症,其中 1,709 例(67.3%)为计划内子宫内膜异位症,983 例(36.5%)为计划外子宫内膜异位症。总体而言,CMHO 的发生率为 23.3%,输血率为 4.1%。非计划内 CD 的 CMHO 率(34.5%)是计划内 CD 的两倍(16.9%;aRR = 2.18;95% CI:1.81-2.63)。输血和外科手术治疗产后出血的 aRRs 是计划外 CD 的三倍。亚组分析表明,在未进行过子宫手术的队列中,非计划性产后出血的CMHOs发生率明显高于计划性产后出血(aRR为1.85;95% CI为1.45-2.37):结论:与计划内剖宫产相比,计划外剖宫产的综合出血不良后果明显更高:- 要点:非计划剖宫产的出血风险更高。- 非计划剖宫产的输血风险更高。- 非计划性剖宫产的无子宫治疗率更高。
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引用次数: 0
Tachycardia-Desaturation Episodes in Neonatal Intensive Care Unit Patients with and without Bronchopulmonary Dysplasia. 患有和未患有支气管肺发育不良的新生儿重症监护病房患者的心动过速-失饱和发作。
IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-19 DOI: 10.1055/a-2437-0461
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..

背景:测量新生儿重症监护室(NICU)中心动过缓-氧饱和度(BDs)的生理性发作一直备受关注。新生儿重症监护室的病人也会出现心动过速-氧饱和度降低(TD)的情况,但这些情况还没有得到很好的描述。我们假设 TD 在支气管肺发育不良(BPD)的婴儿中更为常见:我们的目的是量化新生儿重症监护室患者在不同孕龄和月经后年龄(GA、PMA)下的每日TD与BD的比较,并确定TD是否与BPD有关:我们分析了2012年至2015年期间入住一家四级新生儿重症监护室的所有孕龄24-39周的婴儿在整个新生儿重症监护室住院期间的每2秒心率(HR)和血氧饱和度(SpO2)。BD的定义与我们之前的工作(HR 结果)相同:我们分析了 1718 名婴儿 782424 小时的 HR 和 SpO2 数据,每个婴儿的分析时间中位数为 271 小时。在所有 GA 中,TDs 频率随着 PMA 的增加而增加。婴儿出现 BD 的频率最高 结论:在本分析所定义的阈值下,TD 在 PMA 较高时发生得更频繁,在患有 BPD 和需要家庭供氧的婴儿中更为常见。
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引用次数: 0
Fetal heart rate and amniotic fluid volume measurements with a home ultrasound device. 使用家用超声设备测量胎儿心率和羊水量。
IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-19 DOI: 10.1055/a-2469-0887
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}
引用次数: 0
Neurodevelopmental Outcomes in Neonates Surviving Fetomaternal Hemorrhage Compared with a Matched Unexposed Group in a Large Integrated Health Care System. 大型综合医疗系统中孕产妇大出血幸存新生儿的神经发育结果与匹配的未暴露组相比。
IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1055/a-2441-3761
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..

研究目的本研究旨在评估受孕产妇出血(FMH)影响的新生儿的短期神经发育结果,并将其与未受影响组进行比较:在一个大型综合医疗系统内进行了一项回顾性队列分析,时间跨度为2008年至2018年。新生儿FMH幸存者的神经发育结果与匹配对照组进行了比较。通过母体流式细胞术检测胎儿血红蛋白结果>0.10%和新生儿输血需求来定义存活者中具有临床意义的FMH。每个暴露于 FMH 的存活婴儿都有一个未暴露的婴儿,这些婴儿按分娩时的胎龄(±1 周)、出生年份、性别和种族/民族进行配对。主要结果是神经发育障碍的诊断,使用国际疾病分类(ICD)第 9 次和第 10 次修订版(ICD-9 和 ICD-10)代码确定。结果以比例、平均值、中位数和四分位数间距表示。比较采用卡方检验和费雪精确检验。采用 Cox 比例危险度回归模型研究认知和发育结果与接触氟甲烷之间的关系:结果:在137例临床症状明显的FMH孕妇中,80例胎死腹中,57例新生儿需要输血,4例需要输血的新生儿在出生住院期间死亡。暴露于 FMH 的婴儿与未暴露于 FMH 的婴儿的神经发育受损率无明显差异(26.4% 对 24.6%,P = 0.8)。早产儿(37% vs. 31.6%,p = 0.7)和足月儿(15.4% vs. 14.8%,p = 1.0)中也观察到类似的结果。Cox回归结果显示,神经发育结果与FMH暴露之间无明显关联(1.17 [95% CI: 0.61-2.22]; p = 0.6):结论:尽管 FMH 会导致严重的围产期发病率和死亡率,但与匹配的未暴露婴儿相比,存活婴儿的神经发育诊断结果并无明显差异。然而,由于需要输血的FMH非常罕见,且暴露样本量较小,因此最终结论有限,需要在更大的群体中进行进一步评估:- 要点:FMH 与胎儿和新生儿的严重发病率和死亡率有关。- FMH对存活婴儿神经系统发育的影响尚不清楚。- 与匹配的对照组相比,FMH幸存者的神经发育结果没有差异
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引用次数: 0
Trends in the Mortality and Death of Periviable Preterm Infants in the United States, 2011 to 2020. 2011-2020 年美国围产期早产儿死亡率和死亡趋势。
IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1055/a-2435-0908
Jenil Patel, Omobola Oluwafemi, Tiffany Tang, Angel Sunny, Narendrasinh Parmar, Harshit Doshi, Parth Bhatt, Keyur Donda, Sarah E Messiah, Fredrick Dapaah-Siakwan

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..

研究目的本研究旨在探讨 2011 年至 2020 年期间美国胎龄 22-24 周可活早产儿的婴儿死亡率(IMR)趋势和死亡时间趋势:研究设计:利用美国疾病控制和预防中心的出生/婴儿死亡关联记录,对美国胎龄 22-24 周的围活产早产儿进行回顾性、序列横断面分析。数据分析期为 2011 年至 2020 年。暴露是死亡年份,结果是 IMR 和死亡时间随时间的变化。此外,我们还评估了死亡时间的种族差异。我们使用非参数趋势分析来评估研究期间死亡率的变化:IMR与GA成反比,在研究期间,每个GA和种族/人种的IMR都显著下降。在所有性别和种族/族裔中,出生头 7 天的 IMR 率最高。虽然非西班牙裔白人婴儿的新生儿死亡率高于非西班牙裔黑人婴儿,但非西班牙裔黑人婴儿的新生儿后期死亡率更高:2011年至2020年期间,美国所有性别和种族在22至24周出生的围产期婴儿的新生儿死亡率都有所改善。然而,在死亡时间上存在明显的种族差异:- 正如预期的那样,婴儿死亡率与 22-24 周的胎龄成反比。- 在研究期间,每个胎龄和每个种族/族裔群体的总体IMR都有所下降。- 非西班牙裔白人婴儿的新生儿死亡率较高,而非西班牙裔黑人婴儿的新生儿后期死亡率较高。
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引用次数: 0
Effect of Listening Music on Nulliparous Singleton Pregnancies Who Underwent Induction of Labor: A Randomized Clinical Trial. 听音乐对接受引产手术的单胎妊娠的影响:随机临床试验。
IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1055/a-2437-0524
Gabriele Saccone, Maria Chiara Malferà, Lucia D'Antonio, Pasquale Gallo, Alessandra Ammendola, Giorgia Buonomo, Dario Colacurci, Rosanna Zapparella, Mariavittoria Locci

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..

背景最近的一项随机临床试验显示,听音乐可以减轻自然临产孕妇的疼痛和焦虑程度。但对引产孕妇的影响尚不清楚:研究设计:研究设计:在意大利的一个中心进行的平行组非盲法随机临床试验。在 37 0/7 - 42 0/7 周之间入院接受口服或阴道前列腺素引产的单胎顶位妊娠无阴道产妇,按 1:1 的比例随机分配在引产过程中听音乐或在引产过程中不听音乐。试验的终点是引产过程中和分娩活跃期的疼痛程度,采用疼痛视觉模拟量表(VAS)记录,从0(无痛)到10(疼痛难忍)不等。音乐使用对每种结果的影响以平均差(MD)和 95% 置信区间(CI)进行量化:在研究期间,有 30 名妇女同意参加研究,并接受了随机分配和随访。音乐组和对照组各随机分配了 15 名妇女。在主要结果方面,没有患者失去随访机会。在引产过程中,音乐组的疼痛程度为(8.8±0.9)分,对照组为(9.8±0.3)分(MD -2.60分,95% CI -3.94至-1.26;p试验注册:试验注册:Clinicaltrials.gov NCT04662424。
{"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}
引用次数: 0
Identifying Hemolytic Disease of the Fetus and Newborn within a Large Integrated Health Care System. 在大型综合医疗保健系统中识别胎儿和新生儿溶血病。
IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1055/a-2444-2314
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..

研究目的本研究旨在利用大型综合医疗保健系统的电子健康记录(EHR)来识别胎儿和新生儿溶血病(HDFN)孕妇:研究设计:对 2008 年 1 月 1 日至 2022 年 6 月 30 日期间在南加州凯泽医疗保健系统接受产科护理的孕妇进行了一项回顾性队列研究。利用从电子病历中抽取的结构化(诊断/手术代码、用药和实验室记录)和非结构化(通过自然语言处理分析的临床笔记)数据,我们提取了 HDFN 特异性 "指标"(母体抗体检测阳性和抗体滴度异常、母婴 HDFN 诊断和输血、胎儿水肿、婴儿静脉注射免疫球蛋白 [IVIG] 治疗、黄疸/光疗和首次注射 Rho[D] 免疫球蛋白),以确定潜在的 HDFN 妊娠。然后根据选定的指标组合进行病历审查和判定,以确定病例。仅由ABO异体免疫引起的HDFN被排除在外。对每种组合的 HDFN 频率和比例进行了全面分析:结果:在 464 711 名符合条件的孕妇中,共有 136 名孕妇被确认为 HDFN 孕妇。在符合条件的孕妇中,HDFN特异性指标的比例从0.02%(婴儿IVIG治疗)到34.53%(婴儿黄疸/光疗)不等;在136例确诊的HDFN孕妇中,HDFN特异性指标的比例从32.35%(婴儿IVIG治疗)到100%(母体抗体检测阳性)不等。由四项指标组成的四组组合、由五项指标组成的四组组合以及由六项指标组成的独特组合显示了100%的HDFN妊娠,而80.88%的确诊HDFN妊娠具有母体抗体检测阳性、母婴HDFN诊断和婴儿黄疸/光疗的指标组合:我们利用从结构化和非结构化数据中提取的医疗指标组合,成功识别了 HDFN 孕妇,这些指标组合可用于未来的药物流行病学研究。传统指标(阳性抗体检测结果、高滴度和临床诊断代码)本身并不能准确识别 HDFN 妊娠,这凸显了在 HDFN 编码方面有待改进的需求:- 要点:本研究开发了一种病例确定方法,可从结构化和非结构化数据中识别 HDFN。- 本研究中使用的方法可用于未来的药物流行病学研究。- 这项研究强调了改进HDFN编码实践的需求尚未得到满足。
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引用次数: 0
Differences in Time of Birth between Spontaneous and Operative Vaginal Births. 自然分娩和阴道手术分娩在分娩时间上的差异。
IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1055/a-2442-7396
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..

目的 以往的研究发现,产科干预与一天中进行干预的时间有关;但是,这些研究并没有考虑到分娩干预时间上的细微差别,而这种细微差别受到医疗服务提供者和资源可用性的影响。我们试图评估自然阴道分娩(SVB)与手术(产钳和真空辅助)阴道分娩(OVB)在分娩时间上的差异。研究设计 这项横断面研究使用了 2016-2021 年美国国家生命统计系统(National Vital Statistics System)中的出生证明数据,其中包括有记录的美国新生儿的出生时间和分娩方式。每分钟 SVB 和 OVB 的数量相对于每个分娩组的总出生人数进行了归一化处理,以便于在组间进行平衡比较。逻辑回归分析评估了每天不同时间发生 OVB 的几率。结果 共有15,412,129名经阴道分娩的受试者参与了此次分析,其中690,905人(4.5%)进行了OVB。与其他时间段的分娩相比,下午 4:30-7:30 之间的分娩更有可能是经阴道分娩(几率比 [OR] 1.13,95% CI 1.12-1.14)。相反,在凌晨 3:00-6:00 之间出生的婴儿不太可能是 OVB(OR 0.87,95% CI 0.86-0.88)。在对产妇年龄、胎龄和引产进行调整后,下午 4:30-7:30 之间的分娩仍然更有可能是 OVB(调整后的几率比 [aOR] 1.09,95% CI 1.08-1.10),而凌晨 3:00-6:00 之间的分娩仍然不太可能是 OVB(aOR 0.91,95% CI 0.90-0.92)。结论 在这项基于人群的研究中,我们发现了自然分娩和手术阴道分娩之间的时间差异,在傍晚时使用器械的情况增多,而在清晨时使用的情况减少。这些发现促使我们进一步研究 OVB 的适应症以及这些时间差异的根本原因,这些原因可能是多因素的,涉及到提供者和资源的可用性。
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引用次数: 0
Incidence of new, non-physiologic maternal findings on fetal magnetic resonance imaging. 胎儿磁共振成像中母体非生理性新发现的发生率。
IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1055/a-2466-1319
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。
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American journal of perinatology
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