American journal of perinatology最新文献

Objective: Medically complicated pregnancies and deliveries can lead to adverse mental health outcomes, including post-traumatic stress disorder (PTSD). However, few studies have examined mental health outcomes after surgery for placenta accreta spectrum (PAS). Our aim was to identify prevalence of PTSD, anxiety and depression in patients who underwent hysterectomy for PAS. We sought to understand whether more complex or emergent surgery was associated with a higher prevalence of PTSD and whether physical symptoms such as pelvic pain were correlated with patients' mental health outcomes.

Study design: This was a cross-sectional study of patients who underwent a cesarean hysterectomy for PAS between January 2018 and August 2023 at a single urban hospital. Patients were recruited six months or more following surgery. The survey consisted of validated questionnaires (National Stressful Events Survey short scale [NSESSS] for symptoms of PTSD, General Anxiety Disorder [GAD-7], and Patient Health Questionnaire [PHQ-9]) and clinical data were abstracted from the medical record.

Results: During the study period, 100 patients underwent a hysterectomy for PAS, of which 61 completed the survey. Patients most frequently screened positive for PTSD (n/N = 13/61, 21.3%), followed by anxiety (n/N = 10/61, 16.4%), and depression (n/N = 8/61, 13.1%). The prevalence of anxiety and depression were similar to patient self-reported diagnosis prior to surgery. The prevalence of PTSD was not affected by severe maternal morbidity or urgency of the surgical case. However, pelvic floor symptoms, specifically urge incontinence, were associated with PTSD, anxiety and depression.

Conclusion: In patients who undergo cesarean hysterectomy for PAS, nearly a quarter may experience PTSD symptoms, higher than the general postpartum population. Given the high prevalence of symptoms, and the lack of specific patient risk factors associated with PTSD, all patients with PAS should be offered mental health services before and after delivery.

This article is a plain language summary of publication (PLSP) of the following article: "Study Design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM)" by Tjoa et al published by the American Journal of Perinatology on March 20, 2026. This PLSP describes the design of the GERANIUM registry, which will collect data to help researchers understand how doctors manage hemolytic disease of the fetus and newborn (HDFN) in clinical settings. Researchers will also study outcomes related to the health and well-being of pregnant participants affected by HDFN, their children, and their families over time. This PLSP aims to help the general public, including those affected by HDFN, and health care professionals understand the design of the GERANIUM registry. · Data reflecting today's clinical care of HDFN are lacking.. · GERANIUM is a registry collecting real-world data on HDFN.. · Design of the GERANIUM registry is described.. · HDFN-related outcomes are collected during pregnancy.. · Infant outcomes will be recorded up to 2 years after birth..

Objective Operative vacuum delivery is often used to expedite safe vaginal births for various reasons, including maternal exhaustion, which accounts for about 30% of cases. This study identifies risk factors associated with vacuum deliveries for maternal exhaustion and evaluates maternal and neonatal outcomes compared to other indications. Study Design A retrospective cohort study analyzed singleton-term vacuum deliveries from 2011 to 2022 at a tertiary care center, categorizing patients into two groups: those with maternal exhaustion (group 1) and those without (group 2). Statistical analyses included chi-square tests, t-tests, Mann-Whitney tests, and multivariable logistic regression. Results Out of 2,950 vacuum deliveries, 819 (27.8%) were indicated for exhaustion. Exhausted mothers were more likely to be nulliparous (75% vs. 71%, p=0.028), have gestational diabetes (7.7% vs. 5.4%, p=0.047), and use regional anesthesia (92.4% vs. 89.1%, p=0.006). They also experienced longer labor durations, with a second stage averaging 2.86 hours versus 2.54 hours in the non-exhausted group (p<0.001). While postpartum hemorrhage and chorioamnionitis rates were higher in the exhaustion group, neonatal outcomes did not differ significantly. The duration of the second stage was found to increase the odds of maternal exhaustion by 53% for each additional hour (OR 1.53 [95% CI 1.10-1.64]). Conclusion Women in the exhaustion group had distinct characteristics linked to prolonged labor. Despite some complications, vacuum delivery for maternal exhaustion was safe for both mothers and neonates, suggesting a need for targeted interventions to mitigate exhaustion during labor.

Umbilical cord blood gas (UCBG) sampling provides biochemical data to identify patients who may benefit from encephalopathy screening, but no standardized national guidelines are currently available. We aimed to determine the prevalence of UCBG sampling in high-risk deliveries at a level IV perinatal center in the absence of standardized collection guidelines and to describe subsequent hospital courses among deliveries without UCBG sampling.This was a single-center retrospective cohort study of high-risk deliveries at ≥36 weeks gestation from 2019 to 2021. High-risk deliveries were defined by acute obstetric events, operative delivery, or 5-minute Apgar ≤ 5. UCBG sampling was classified as attempted, obtained (arterial pH documented), or not attempted. Maternal, intrapartum, and neonatal characteristics were compared between attempted and not-attempted groups, and subgroup analyses evaluated infants without UCBG sampling to identify patients who qualified for encephalopathy screening.The study cohort was comprised of 1,144 (11%) high-risk deliveries, of which 1,034 remained after exclusions. UCBG sampling was attempted in 655 (63%) deliveries, and arterial results were obtained in 541 (52%). Among 131 neonatal intensive care unit (NICU) admissions, 105 (80%) had UCBG sampling attempted, and 83 (63%) had arterial results available. Among 41 NICU admissions with respiratory diagnoses and available admission blood gases, 5 met biochemical criteria for encephalopathy screening, and only 1 had a documented comprehensive neurological examination.The lack of standardized guidelines leads to inconsistent UCBG sampling in high-risk deliveries, highlighting the need for standardized UCBG screening criteria and coordinated obstetric-neonatal workflows. · UCBG sampling is the first red flag for hypoxic-ischemic encephalopathy detection.. · Lack of UCBG guidelines leads to inconsistent sampling.. · Establishment of UCBG sampling guidelines can limit practice variation..

The objective of this study is to evaluate the relationship between late and third-trimester ultrasonographic/anthropometric measures of central adiposity and cesarean delivery in patients with body mass index (BMI) ≥ 40 kg/m² and compare their predictive value to BMI alone.Prospective observational cohort study of patients receiving prenatal care and delivering at a single center (2018-2021). Individuals with nonanomalous singleton pregnancies and either BMI ≥ 40 kg/m² or normal BMI between 32 and 36^0/7 weeks were included. In both BMI groups, individuals with delivery < 36 weeks, prior cesarean, and contraindication to vaginal birth were excluded. Patients underwent a study visit > 36 weeks at which 19 central adiposity measures (ultrasonographic and anthropometric), fat distribution indices (e.g., abdominal fat index [aFI]) and BMI (predictive exposures) were obtained by trained research and ultrasound personnel. For our primary analysis (BMI ≥ 40 kg/m²), the primary outcome was cesarean. Measurement exposures were evaluated at alpha = 0.05 using backward selection multivariable logistic regression to generate a parsimonious model. Receiver operator characteristic curves with area under the curve (AUC) assessed the model's predictive ability; AUCs for BMI and the parsimonious model were compared. A planned analysis included women with normal BMI.Of 611 individuals screened, 265 were eligible, 217 consented, and 201 met all study criteria and were analyzed: 149 with BMI ≥ 40 kg/m² (mean BMI: 45.4 ± 5.2; cesarean rate: 21%). A model of maximum preperitoneal fat depth above the umbilicus, below umbilicus aFI, and subxiphoid aFI (all p < 0.05) was significantly more predictive of cesarean (AUC: 0.76; 95% confidence interval [CI]: 0.67-0.86) than BMI alone (AUC: 0.60; 95% CI: 0.49-0.71; p = 0.002). When analyzing the normal BMI group (n = 52), a six-measurement model had outstanding prediction (AUC: 0.97; 95% CI: 0.93-1.00)-exceeding BMI alone (AUC: 0.64; 95% CI: 0.49-0.78; p < 0.001).Select maternal ultrasonographic fat depth measurements near delivery have significantly more predictive ability than BMI alone for cesarean delivery in patients with BMI ≥ 40 kg/m² and should be further explored in those with normal BMI. · Select maternal ultrasound adiposity measurements were more predictive of cesarean than BMI in women with BMI ≥ 40 kg/m2.. · Select adiposity measurements may be more predictive of cesarean than BMI in women with normal BMI ≤ 25 kg/m2.. · There was outstanding prediction of cesarean using these measures in women with normal BMI.. · Select ultrasonographic fat depth measurements near delivery have more predictive ability for cesarean than BMI..

The objective of this study is to determine the predictive value of magnetic resonance imaging (MRI), amplitude-integrated electroencephalography (aEEG), the Hammersmith Neonatal Neurological Examination (HNNE), and the General Movements Assessment (GMA) for cerebral palsy (CP) in neonates with hypoxic-ischemic encephalopathy (HIE), and to evaluate whether combining these modalities improves diagnostic accuracy.In this prospective two-center cohort study, 53 term or late-preterm infants with HIE treated with standardized therapeutic hypothermia (33.5°C for 72 hours) were evaluated. aEEG and MRI findings were compared with concurrent HNNE and GMA results. CP was diagnosed during follow-up by a pediatric neurologist blinded to neonatal data. Diagnostic performance was analyzed using receiver-operating characteristic curves and multivariable logistic regression according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.CP developed in 11 infants (20.8%). aEEG showed the highest predictive accuracy (area under the curve = 0.816 [95% confidence interval: 0.65-0.98]), and abnormal aEEG independently predicted CP (odds ratio = 18.5, p = 0.004). The combined "MRI or aEEG abnormal" model achieved the best overall accuracy (86.8%), with sensitivity = 90.9% and negative predictive value = 97.3%. MRI and HNNE had moderate predictive value, whereas GMA showed high specificity but low sensitivity.aEEG emerged as a robust and independent early biomarker for CP prediction after HIE. Combining aEEG with MRI substantially enhanced diagnostic precision, reflecting complementary functional and structural brain injury mechanisms. Although HNNE and GMA add screening value, they are insufficient alone. Standardized multimodal protocols integrating structural (MRI), functional (aEEG), and clinical (HNNE-GMA) assessments should be incorporated into clinical practice to improve early prognostication and guide neuroprotective interventions. · Early multimodal tools improve CP prediction.. · MRI and aEEG show higher diagnostic accuracy.. · Low HNNE scores indicate increased CP risk.. · Abnormal GMA supports early neurological impairment.. · Combining MRI + GMA + HNNE enhances prediction..

Severe maternal morbidity (SMM) is a growing public health concern in the United States. While existing measures capture SMM-related complications during the delivery hospitalization, patients may also experience serious complications after discharge that affect long-term health, mortality, and health care utilization. We aimed to assess the frequency of SMM events occurring after hospital discharge and identify the appropriate postdischarge window for measurement.We analyzed 2019 to 2021 delivery hospitalizations among women aged 12 to 55 years using the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases from 17 states, with follow-up through 2021. SMM was identified per AHRQ measure specifications in inpatient and emergency department encounters. We calculated overall SMM rates as well as specific SMM-related complications, during delivery hospitalization and after discharge.The SMM rate during delivery hospitalization was 87.1 per 10,000 deliveries. Extending the measurement period through 42 days' postdischarge increased the cumulative SMM rate by 32.1% to 115.0 per 10,000 deliveries. More than 80% of SMM events observed within 90 days occurred in the first 42 days after discharge, and 78.6% of these were treated in inpatient settings. Coagulopathy (26.0 per 10,000), acute renal failure (21.4 per 10,000), and sepsis (25.3 per 10,000) had the highest cumulative rates through 42 days' postdischarge. Coagulopathy was the most common complication during the delivery hospitalization (27.7%), whereas sepsis emerged as the most frequent condition treated in the 42 days after discharge (34.4%).Our study highlights the importance of including the postpartum period when measuring SMM. Most events were treated in an inpatient setting, and the majority occurred within 42 days after delivery. To address SMM, research and policy warrants focus on maternal health during and after the delivery hospitalization. · Including events through 42 days' postdischarge increased the cumulative SMM rate by 32.1%.. · Over 80% of SMM events observed within 90 days of delivery discharge occurred in the first 42 days.. · Coagulopathy (including disseminated intravascular coagulation), acute renal failure, and sepsis had the highest cumulative rates through 42 days' postdischarge..

Background: Postoperative infections remain a significant complication of cesarean delivery, with rates ranging from 3% to 30%. These infections increase healthcare costs, prolong recovery, and negatively impact maternal outcomes. Identifying risk factors for infection might help guide preventative strategies to mitigate this burden.

Objective(s): The primary aim of this study was to develop and validate a predictive model for infection after cesarean delivery using preoperative and perioperative characteristics.

Study design: This study was a secondary analysis of a multicenter randomized trial comparing tranexamic acid (TXA) versus placebo to prevent postpartum hemorrhage in individuals undergoing either scheduled or unscheduled cesarean delivery. The primary outcome of this analysis was a composite of surgical site infection, endometritis, or pelvic abscess diagnosed within 6 weeks postpartum. Univariable and multivariable bootstrapped logistic regression models with stepwise selection were used to identify predictors of infection. Model performance was evaluated using the receiver operator curve (ROC) area under the curve (AUC).

Results: Of the 10,995 participants, 287 (2.6%) developed an infection. Significant predictors included tobacco use (OR: 1.67, 95% CI: 1.21-2.31), BMI at delivery ≥ 30 kg/m2 (OR: 1.41, 95% CI: 1.04-1.91), labor before cesarean (OR: 1.71, 95% CI: 1.33-2.18), longer surgical duration (OR: 1.01 per minute, 95% CI: 1.01-1.02), uterine incision extension (OR: 1.54, 95% CI: 1.02-2.34), and the use of uterotonics other than oxytocin (OR: 1.48, 95% CI: 1.09-2.02). The predictive model demonstrated modest discrimination with an AUC of 0.64 (95% CI: 0.61-0.68).

Conclusion(s): Multiple modifiable and non-modifiable factors influence infection after cesarean delivery. This predictive model offers a framework for assessing individualized risk, though its modest performance indicates that further refinement is necessary before it can be confidently applied in clinical decision-making. Future research should aim to enhance predictive accuracy and explore whether risk stratification meaningfully informs prevention or patient counseling strategies.

Background: Early and prolonged skin-to-skin care (SSC) reduces morbidity and mortality in preterm neonates more than intermittent SSC. Extreme preterm neonates generally do not receive early prolonged SSC for several reasons, including safety concerns and parental challenges. To facilitate prolonged SSC in this population we invented the Skincubator, a device to overcome SSC barriers. The Skincubator enables SSC, while safely securing the baby, lines, and tubes and maintaining warmth and humidity. A retractable transfer pad enables transfers to and from the caregiver with minimal handling, while keeping baby is safely positioned . Once on the parent, the pad is retracted to allow full SSC.

Objectives: To assess the transfer pad performance and parent satisfaction from the Skincubator.

Methods: An observational study performed during the learning phase of the Skincubator feasibility study. Success rates of transfer with the retractable pad and humidity within the Skincubator were recorded. Parents were provided with questionnaires to rate (on a Likert scale of 1-5) satisfaction with the safety and convenience of the Skincubator and traditional SSC (t-SSC).

Results: Twelve babies were treated in the Skincubator by 18 parents (10 mothers, 8 fathers) for 53 sessions. Two babies were invasively ventilated during Skincubator care. Average Skincubator session time was 146±52 minutes. Humidity within the Skincubator was 71±11%. The retractable pad transfer succeeded in 103 of 106 attempts. Parents were very satisfied with the Skincubator SSC safety and satisfied/neutral with the safety of t-SSC (p=0.001, Wilcoxon Signed Rank Test (WSRT). Parents were satisfied with the Skincubator SSC convenience and neutral with the convenience of t-SSC (p=0.02).

Conclusions: The Skincubator allows transfer to and from SSC within a warm, humidified, environment. Parents were more satisfied with the safety and convenience of Skincubator SSC as compared to t-SSC. The Skincubator may support parents in performing longer hours of SSC.

Background: Antepartum hospitalization during pregnancy can compromise patients' sense of control and are associated with higher rates of depression or anxiety. There are no validated scales that measure this sense of control in this hospitalized setting.

Objective: The authors adapted the Labour Agentry Scale (LAS) to the antepartum inpatient setting by developing and preliminarily validating a novel Antepartum Agentry Scale (AAS).

Methods: Fifty-nine candidate statements were derived from the LAS original source material. These statements were iteratively reviewed in three rounds using a content valuation index by Maternal Fetal Medicine providers, resulting in 25 statements that comprised the AAS. The AAS, Patient Health Questionnaire (PHQ-9), and General Anxiety Disorder (GAD-7) scale were administered to 50 individuals hospitalized for a complication during pregnancy. Factor analysis was performed to assess construct validity and evaluate whether the AAS measured a construct distinct from the PHQ-9 or GAD-7. The AAS scores were then classified as "Low," "Average," or "High" based on the mean score and standard deviation in the study population. Fisher's exact test was used to evaluate the relation between scores on the AAS and scores of 10 or higher on the PHQ-9 and GAD-7.

Results: The AAS had a Cronbach alpha of 0.902. Factor analysis demonstrated minimal overlap between the AAS and items on the PHQ-9 or GAD-7. There was a significant relationship between Low", "Average", and "High" AAS scores and PHQ-9 scores of 10 or more (67% vs 13% vs 10%, p = 0.003) and GAD-7 of 10 or more (67% vs 19% vs 0%, p = 0.002).

Conclusions: Those with higher agentry are less likely to concurrently report clinically significant symptoms of depression or anxiety. Initial results suggest strong internal consistency of the AAS, which may measure a construct distinct from measures of depression or anxiety.