American journal of perinatology最新文献

Point-of-care ultrasound (POCUS) plays a central role in the evaluation of acute and chronic heart failure with reduced ejection fraction, yet its use in obstetric patients remains limited. This expert review outlines a simplified, qualitative-first approach tailored to the physiological and technical challenges of pregnancy. We present a step-by-step guide that prioritizes feasibility and reproducibility using simple and established echocardiographic views, including the E-point septal separation, mitral annular plane systolic excursion, lung B-lines, and inferior vena cava diameter measurements. Most available data are extrapolated from nonpregnant cohorts, and pregnancy-specific outcome evidence remains limited. This framework aims to support maternal-fetal medicine specialists in integrating POCUS into the bedside evaluation of pregnant individuals with suspected systolic heart failure. · Delayed recognition of systolic HF drives maternal morbidity and mortality.. · POCUS enables rapid bedside qualitative assessment when echo is delayed.. · With structured training, POCUS is feasible to support HF care in pregnancy..

Objective: Our study explores the predictive role of USCOM parameters towards unfavourable maternal and neonatal complications during labour and delivery in a cohort of women followed the high-risk pregnancy clinic of tertiary Italian Hospital.

Study design: A prospective, explorative,monocentric descriptive study was run at Policlinico of Modena. USCOM was implemented in March 2022. Patients in charge of the high-risk pregnancy clinic who received USCOM hemodynamic monitoring during pregnancy were included in the study. By considering the characteristics of labor and delivery, they were divided into two groups (complicated delivery and uncomplicated delivery). Adverse maternal (AMO) and adverse neonatal outcomes (ANO) were prospectively collected from electronic records and analyzed using the R version 4.3.2 statistical software. Continuous variables were presented as means with standard deviations and categorical variables as counts and percentages.

Results: While maternal and perinatal variables, including maternal age, parity, and anthropometric measures, were comparable between groups, significant differences emerged in the USCOM measurements, CO was significantly lower in the group with ANO compared to uneventful neonates (4.35 ± 1.42 L/min vs 4.97 ± 1.44 L/min; aOR 0.79; 95% CI: 0.49, 0.99, p = 0.049). Additionally, VPK was significantly reduced in neonates with ANO comparing with neonates without adverse complications (0.92 ± 0.27 vs 1.08 ± 0.42; aOR = 0.08, 95% CI: 0.01- 0.63, p = 0.016). Finally, CI was lower (2.26 ± 0.67 vs2.54 ± 0.74, aOR 0.49; 95% CI: 0.23- 1.03, p = 0.060) and RVS higher (1800,9±546 vs 1638,2±588,4, aOR 1.00; 95% CI:1.00-1.00, p=0.245) in the ANO group comparing with those without ANO, although both results do not reach statistical significance.

Conclusion: Our findings suggest the implementation of USCOM in clinical practice may enhance the identification of women at increased risk for adverse neonatal outcomes, particularly those presenting with low CO and VPK.

Pregnancy induces a hypercoagulable state, heightening the risk of thromboembolic events, particularly for women with prothrombotic tendencies or a history of thromboembolism. Although anticoagulant treatment may improve outcomes for women with a prior stroke and thrombophilic disorders, the risk of recurrent thromboembolic events during subsequent pregnancies remains unclear. This study aims to assess pregnancy outcomes and the risk of recurrence in women with a history of stroke.This retrospective study analyzed pregnancy outcomes of women with a history of cerebrovascular events who delivered at Sheba Medical Center between 2005 and 2023. Data included cerebrovascular events, pregnancy outcomes, and obstetric complications. Comprehensive thrombophilia screening was performed. Patients were treated with low-molecular-weight heparin (LMWH) or low-dose aspirin (LDA). A control group without cerebrovascular events matched for maternal age, delivery timing, and plurality was used for comparison.A total of 107 women were included, 49 pregnancies with a previous cerebrovascular thrombosis, and 58 with a previous transient cerebrovascular ischemic attack. About 50.4% of the study group women had prothrombotic conditions. Cesarean section rates were higher in the study group (44%) versus controls (14%, p < 0.001). Preterm delivery rates were also higher (11 vs. 1.9%, p = 0.0057). Other obstetric complications were similar. A subgroup analysis of women without thrombophilia still showed increased risks for cesarean section and preterm delivery. Two women experienced recurrent thromboembolic events during pregnancy, both without maternal thrombophilia.Higher cesarean and preterm delivery rates were observed, regardless of thrombophilia status. The recurrence rate of thromboembolic events was low (2.2%), highlighting that with appropriate prenatal care and tailored prophylactic treatment, women with a history of cerebrovascular events may achieve favorable pregnancy outcomes. · This study analyzed pregnancy outcomes in women with a history of stroke.. · Cesarean section rates were higher in the study group versus controls. Preterm delivery rates were also higher, while other obstetric complication rates were similar.. · The recurrence rate of thromboembolic events was low.. · With appropriate care, women after cerebrovascular events may achieve favorable outcomes..

Antenatal counseling (AC) is vital in neonatal-perinatal medicine (NPM) to support families and align care plans. NPM fellows report gaps in communication and AC training, and current literature offers little on effective teaching methods. Standardized recommendations to assess AC skills are lacking. To create effective training programs, we must first understand how AC is currently being taught and evaluated in clinical education. Our aim was to assess the national landscape through an environmental scan of AC curriculum in NPM fellowship to establish a baseline of current educational practices and identify areas for improvement.Survey was developed based on a literature review and expert collaboration, with pilot testing performed on a subset of program leadership and fellows. It was distributed via email listserv nationally to NPM fellows and fellowship program leadership in 2024 to 2025. Survey included select-all, multiple-choice, and Likert-scale questions.Thirty-three percent of programs (33/102) and 18% of fellows (146/815) completed the survey. Most institutions use various methods to teach AC, though some report no formal training. Over 80% of fellows want more AC training. Only 39% of fellows reported being observed more than three times during their fellowship regardless of year in fellowship, whereas 79% noted they typically perform four or more consults per month while on service. Most programs (85%) lack formal assessment methods.While diverse educational modalities are employed in AC training, fellows desire more training. Limited observation and assessment highlight a need for improved curricula and formal feedback to better support skill development. · Fellows want more antenatal counseling training.. · Antenatal counseling observation and feedback are rare despite volume.. · Most programs lack formal assessment of fellows performing antenatal consults..

The objective is to present stepwise refinements to HomeSafe, an Epic-tethered, population-health-coordinated postpartum pathway for blood pressure (BP) surveillance after hypertensive disease of pregnancy (HDP). HomeSafe was designed for HDP people identified during their delivery hospitalization. The program incorporated prepopulated orders for home BP measurement and submission through a smartphone application linked to the electronic health record (Epic). A population health coordinator (PHC) was integrated at Year 2 to support registry tracking, expanded digital support and metric-driven reviews. Study data were managed using REDCap (Research Electronic Data Capture); a secure, web-based application hosted by the Massachusetts General Brigham Digital Research Applications team. Year-to-year analyses were performed for BP submission and route, predictors of timely BP return (≥1 BP in 7 days), 6-week postpartum visit attendance, and clinical and demographic variables.Across 24 months, 640 postpartum HDP individuals were enrolled; 68.6% (439/640) submitted BP in a timely fashion. In Year 1, 44.9% of BPs submission was by Epic (44.9%), portal (8.2%), or phone (15.5%). No BP was submitted by 31.4%. With a PHC (Year 2), Epic-routed capture increased to 56.5%, and phone/portal-dependent routes decreased to 11.6% (p = 0.0006). Program enrollment increased from 245 to 485 (p < 0.001) without changes in delivery volume. Independent negative predictors of BP return were Black non-Hispanic race, public insurance, and multiparity; HDP subtype, delivery mode, antihypertensive use, and neonatal intensive care unit admission were not predictive. HomeSafe engagement strongly predicted 6-week postpartum visit attendance (89.9 vs. 65.4%, p < 0.0001). HomeSafe, an EHR-tethered, postpartum BP surveillance pathway, when partnered with a population health management approach and a coordinator provides significant improvements in BP ascertainment, enrollment scalability, and 6-week postpartum engagement. Persistent disparities by race and insurance status highlight a need for equity-focused approaches. · HomeSafe-Epic-linked monitoring of postpartum blood pressure.. · Population health tenets improve postpartum surveillance.. · Gaps in postpartum surveillance of high-risk person remain..

Accelerations were initially chosen as the basis for non-stress test (NST) interpretation against a background of significant artifact present in the first-generation, non-autocorrelated fetal monitors that made the interpretation of variability with external fetal heart rate (FHR) monitoring unreliable. Since moderate variability and accelerations are both physiologically similar and equally indicative of a non-acidemic fetus, we hypothesized that interpreting NSTs based on variability rather than accelerations would produce similar results.We performed a retrospective cohort study of singleton fetuses undergoing antenatal testing in our system between 2011 and 2022. Data regarding the interpretation of NSTs were extracted and non-reactive tests were identified. For patients with non-reactive NSTs, data regarding follow-up testing were collected.Our cohort included 76,232 total NSTs performed on 22,619 patients at increased risk of fetal demise, of which 1,662 (2%) were found to be non-reactive. Of the non-reactive tests, 1,499 (90%) were interpreted as having moderate variability, 114 (7%) had minimal or absent variability, and in 49 (3%), the variability was uncertain. Data regarding follow-up testing were available for 1,480 of the 1,499 non-reactive tests with moderate variability. In this group, 1,476 (99%) went on to have either reassuring follow-up testing. The four infants (0.3%) who failed to have a reassuring follow-up test all had major anomalies.In nonanomalous fetuses, moderate variability in an otherwise non-reactive NST was invariably followed by a reassuring test of fetal well-being. These data confirm basic science observations regarding FHR regulation and suggest that, in the presence of moderate variability during an otherwise non-reactive NST, additional follow-up testing may not be necessary. Such an approach would avoid the need for additional testing in 90% of fetuses with non-reactive NSTs. · A clinical distinction between moderate variability and an acceleration represents historical artifact.. · Nonanomalous fetuses with a nonreactive nonstress test but moderate variability invariably had reassuring subsequent testing.. · These clinical observations confirm known basic science physiology.. · In the antepartum evaluation of fetal well- being, moderate variability and accelerations are clinically equivalent..

Anterior placentation is a risk factor for hemorrhage during cesarean delivery in patients with a resolved placenta previa or low-lying placenta. As anterior placentas are sometimes incised at the time of hysterotomy, it is possible that, even in the absence of low-lying placenta or placenta previa, anterior placentation may be associated with higher blood loss at the time of nonlaboring, primary cesarean delivery. Therefore, we sought to identify if there is an association between anterior placentation and peripartum hemorrhage (PPH) in parturients undergoing primary cesarean delivery.This is a retrospective cohort study that included parturients from a tertiary care center who underwent primary cesarean delivery from 2016 to 2022. Patients with known risk factors for PPH (known placenta accreta spectrum, placenta previa, etc.) were excluded from primary analyses. Primary analyses assessed the association via logistic regression between PPH (defined as estimated blood loss [EBL] ≥ 1,000 mL) and anterior placentation. We then assessed if this risk was present in higher risk subgroups (patients using anticoagulation at the time of delivery and patients who underwent vaginal trial of labor prior to primary cesarean) and a lower risk subgroup (those undergoing nonlaboring primary cesarean).The primary cohort consisted of 996 parturients. Of those, 501 had an anterior placenta. Odds ratio of EBL ≥ 1,000 according to anterior placentation was 1.12 (95% confidence interval: 0.80-1.56) in multivariate regression. Risk of PPH was not associated with anterior placentation in higher- and lower-risk subgroups.Anterior placentation alone is not associated with higher EBL in patients undergoing primary cesarean delivery, even in patients using anticoagulation or those requiring intrapartum cesarean. · Anterior placenta and previa increase hemorrhage risk.. · Anterior placentation alone does not increase hemorrhage risk.. · The risk is not increased among those with additional risk factors.. · Placenta location may impact hemorrhage risk..

Interactions with families are essential to successful recruitment conversations that promote informed decision-making about clinical research enrollment. However, there is little evidence about how to implement communication-oriented recruitment training among pediatric clinical research teams. Our objective was to evaluate the feasibility and acceptability of Better Research Interactions for Every Family (BRIEF), a multipart educational intervention to improve relationship-based conversations about clinical trial enrollment with families in the neonatal setting.We piloted BRIEF in partnership with a neonatal clinical research team. Research team members completed surveys following the BRIEF intervention's online module and the BRIEF group training session. They completed self-assessments after consent discussions before and after the BRIEF intervention, in which they rated their achievement of recruitment skills taught in BRIEF. Research team members also completed a final study interview to provide feedback on the intervention components, training content, and use of skills in practice.All nine research team members completed all components of BRIEF. Survey responses showed moderate to low satisfaction with previous recruitment training before BRIEF and high satisfaction with the BRIEF training. Self-assessments showed significant increases in reported partnership with bedside nursing (p = 0.02) and confirmation of family names (p = 0.05) after BRIEF training. Interviews provided further evidence of overall satisfaction with the BRIEF training, its content, and the skills learned, as well as opportunities for improvement, particularly in supporting challenging conversations.This pilot study demonstrated the feasibility and acceptability of the BRIEF intervention, as well as opportunities for improvement in future training. · It was feasible to implement the BRIEF researcher training in a single-site NICU trial.. · BRIEF training was acceptable to research team members.. · BRIEF training shows potential to improve relationship-based research communication..

Background Pregestational diabetes is associated with low prevalence of breastfeeding due to low rates of intent, delayed lactogenesis, and early infant separation. It is hypothesized that the perceived need for formula supplementation due to neonatal hypoglycemia, coupled with maternal low early milk supply, is a barrier to breastfeeding initiation. Whether there is an association between neonatal hypoglycemia and breastfeeding is unknown. We evaluated associations between neonatal hypoglycemia and breastfeeding. Methods This is a secondary analysis of a randomized control trial of metformin versus placebo plus insulin in participants with type 2 diabetes. We included participants who delivered a liveborn neonate, endorsed intention to breastfeed, and had neonatal hypoglycemia data available. A breastfeeding questionnaire was administered at 30-days postpartum, and outcomes were compared between neonates with and without hypoglycemia The primary outcome was prevalence of exclusive, partial or no breastfeeding at 30-days postpartum. Secondary outcomes included time to breastfeeding cessation and contributing factors. Characteristics were compared with Chi-square, t-tests or Wilcoxon tests. Results 420 participants in the primary study (53%) completed an antepartum survey including a question about intent to breastfeed. After exclusion criteria were applied, 370 (91%) of 405 possible participants reported intention to breastfeed. Among these 370 who met criteria and had intention to breastfeed, 265 (72%) responded to the 30-day postpartum questionnaire. Of these 265, 114 (43%) had neonatal hypoglycemia and 151 (57.0%) did not. Prevalence of not breastfeeding (35% vs 37%), exclusive breastfeeding (18% vs 13%), and partial breastfeeding (47% vs 50%) did not differ between neonates with and without hypoglycemia (p = 0.51). This persisted in a NICU admitted subgroup (p = 0.29). Participants who stopped breastfeeding did so on average at 2.6-2.8 weeks (p = 0.76). Conclusions This study found no impact of neonatal hypoglycemia on 30-day postpartum breastfeeding prevalence among participants with diabetes.