American journal of perinatology最新文献

The objective of this study was to examine the effect of coronavirus disease 2019 (COVID-19) infection during pregnancy on birth outcomes, including the relationship between the trimester of COVID-19 infection and newborn size. Findings could be used to better inform appropriate management of COVID-19 during pregnancy.This retrospective chart review study included patients diagnosed with COVID-19 who received care at a single university-affiliated obstetrics practice. Pregnant patients with a diagnosis of COVID-19 between April 2022 and April 2023 were included in this study. Participant demographics and birth outcomes were extracted and analyzed.Our sample included 141 women who had COVID-19 during pregnancy, grouped based on the trimester of COVID-19 infection. In analyses adjusted for confounding background factors, those with a COVID-19 infection during the second trimester (n = 57) and third trimester (n = 50) had newborns with significantly decreased head circumference at birth compared with those infected during the first trimester (p < 0.05). In addition, compared with those with a COVID-19 infection during the first trimester, those who had COVID-19 during the third trimester had an average 1.3 cm decreased birth length.In the current study, COVID-19 infection later in pregnancy, especially in the third trimester, significantly predicted decreased birth weight, length, and head circumference. · COVID-19 infection may impact newborn size.. · Third-trimester infection was most detrimental.. · Late-term monitoring may be warranted..

Low-dose aspirin is an established preventive strategy for reducing the risk of preeclampsia in patients with designated risk factors.This prospective observational study evaluated trends in aspirin prescription rates in a multihospital health system over a 10-month period during which a policy to offer low-dose aspirin universally was instituted.A total of 11,382 patients were included and an interrupted time series was used to analyze rates of aspirin prescriptions ordered by 16 weeks, before and after implementation of the universal policy. There were statistically significant increases in aspirin prescription rates for the entire cohort (incidence rate ratio [IRR]: 2.93; 95% confidence interval [CI]: 2.13-4.04) and for a high-risk subcohort including patients with chronic hypertension, pregestational diabetes, and/or multiple gestation (IRR: 1.48; 95% CI: 1.26-1.76).Instituting a policy to offer universal low dose aspirin during pregnancy resulted in significantly increased utilization among patients with high-risk indications for aspirin. · A universal aspirin policy led to a significant increase in aspirin use across the cohort.. · There were also significant increases among high-risk patients including those with hypertension and diabetes.. · Universal aspirin may lower risk more broadly and improve usage among high-risk patients..

The relationship between body mass index (BMI) ≥ 30 in pregnancy and postpartum hemorrhage (PPH) has been unclear. While some risk stratification protocols classify elevated BMI as a moderate risk factor others do not. This study aimed to examine the effect of elevated BMI on PPH in a contemporary population.This retrospective cohort study included all singletons ≥14 weeks with recorded BMI who delivered at a Level IV center for two consecutive years. The exposure group was sub-categorized into BMI of 30 to 39.9 and BMI ≥ 40 kg/m², with a planned subgroup by mode of delivery. Data was collected by clinicians, and the composite maternal hemorrhagic outcome (CMHO) was defined as: blood loss ≥ 1,000 mL, interventions for atony including use of uterotonics (excluding prophylactic oxytocin), mechanical tamponade, surgical intervention, venous thromboembolism, admission to the intensive care unit, hysterectomy, or maternal death. Adjusted relative risks (aRR) with 95% confidence intervals (CI) were calculated using multivariate Poisson regression with robust error variance.Of 8,623 deliveries in the study period, 8,340 (96.7%) met inclusion criteria, with 2,943 (35%) with BMI < 30.0, 3,900 (46%) with BMI of 30 to 39.9 kg/m², and 1,497 (17%) with BMI of ≥40 kg/m². CHMO was increased for BMI of 30 to 39.9 (aRR: 1.16; 95% CI: 1.04-1.29) and ≥40.0 (aRR: 1.19; 95% CI: 1.04-1.36), largely due to increased risk of blood loss ≥ 1,000 and uterotonic use. A subgroup analysis by mode of delivery noted that increased risk for CHMO was only present in BMI ≥ 40 for vaginal deliveries (aRR: 1.35; 95% CI: 1.10-1.65) and only for BMI of 30 to 39.9 in cesarean delivery (aRR: 1.28; 95% CI: 1.10-1.50).Parturients with BMI ≥ 30 had a higher risk of hemorrhage-related morbidity compared with patients with BMI < 30, however, clinical management and impact need further investigation. · Patients with an elevated BMI had a higher risk of hemorrhage-related morbidity.. · Individuals with BMI ≥ 40 kg/m2 are at increased risk of hemorrhage with vaginal deliveries.. · With rising BMI rates, research on perinatal risks and targeted interventions is crucial for better..

During routine prenatal antibody screening, maternal reactivity is sometimes detected for which the clinical significance is unclear. As a result, the strategy for monitoring these antibodies during pregnancy, to mitigate the risk of hemolytic disease of the fetus and newborn (HDFN), may be uncertain. This review focuses on four such immune responses in obstetrics: anti-G, anti-M, warm reactive autoantibodies, and apparent nonspecific immune responses that cannot be further classified. The relationship of these antibodies to HDFN is a primary focus. Related concerns, including maternal and neonatal transfusion considerations and candidacy for Rh immune globulin, are also addressed. · Pregnant patients with anti-G who lack anti-D are candidates for Rh immune globulin.. · Anti-M is a rare cause of HDFN.. · Warm reactive autoantibodies in pregnancy are unlikely to be clinically significant..

The primary objective was to ascertain if the proportion of time in category II fetal heart rate tracing (FHRT) prior to birth among term (≥ 37 weeks) singletons in labor was associated with composite adverse neonatal outcomes (CANO).The inclusion criteria for this retrospective cohort study were nonanomalous singletons at term, whose FHRT was reviewed by obstetricians blinded to the maternal characteristics and neonatal outcomes. According to ACOG's criteria, the last 20 to 120 minutes of the tracing were reviewed in 20-minute epochs. The cohorts were divided into three groups: group A, category II for < 33% of the available tracing; group B, for ≥ 33 and <66%; and, group C, for ≥ 66% of the FHRT. CANO was any of the following: Apgar score < 7 at 5 minutes, mechanical ventilation, hypoxic-ischemic encephalopathy, neonatal seizure, confirmed sepsis, or neonatal death. Group A was compared with groups B and C, using an adjusted odds ratio (aOR).FHRT for 5,160 consecutive deliveries was reviewed, and 2,780 (53.8%) met the inclusion criteria. Of the 321,980 minutes of FHRT reviewed, 223,000 minutes (69.2%) were category II. The overall CANO among the cohorts was 1.4% (38/2,780), and it did not vary significantly between group A versus B (aOR: 1.11; 95% confidence interval [CI]: 0.35-3.48), or between group A versus C (aOR: 0.80; 95% CI: 0.27-2.35). The overall rate of cesarean delivery for nonreassuring FHRT was 9.7% (270/2,780), and it did not differ between group A versus B (aOR: 0.86; 95% CI: 0.51-1.47) or group A versus C (aOR: 1.18; 95% CI: 0.73-1.91).Among term deliveries, in the last 20 to 120 minutes before birth, 70% of the time FHRT was category II, and the proportion of time in Category II did not significantly influence adverse neonatal outcomes. · In the last 20 to 120 minutes before birth, 69.2% of FHRT were category II.. · In 2,780 parturients with category II FHRT, CANO occurred in 1.4%.. · Category II FHRT, for 20 to 120 min before birth, was not assocated with adverse outcomes.

Green-top Guidelines (GTGs) by the Royal College of Obstetrics and Gynecology (RCOG) guide clinical practices similar to Practice Bulletins (PBs) by the American College of Obstetrics and Gynecology (ACOG). Previous analyses reveal that most recommendations lack Grade A evidence and are not based on randomized clinical trials (RCTs). This descriptive study evaluates the quality of evidence supporting RCOG Obstetrical recommendations.We reviewed obstetrical RCOG GTGs available as of September 2024, checking each citation in PubMed for RCT status. Quality assessments were not made independently. The senior author verified a random 10% of the data (B.J.F.H.). Data were recorded and summarized in Excel.RCOG lists 37 obstetrical GTGs with 1,861 recommendations. About 1,288 (69%) of recommendations are supported by 3,674 references. A total of 43% of GTGs rely on consensus and expert opinion. When omitting recommendations based on expert opinion, 98 (9%) of RCOG recommendations are Grade A (based on high-quality evidence), and of the cited references, 5% of GTGs are Evidence Level 1 + + (highest quality), while 7% are RCTs.Among the recommendations, 69% of GTGs have identifiable references. However, 43% of GTG references are nonanalytical studies or expert opinions. Our findings highlight the need for more high-quality evidence in guidelines and suggest further research in evidence-based obstetrical care. · Of 1,861 obstetrical recommendations, 69% cite references, but 43% rely on expert opinion.. · Only 9% of the GTGs meet Grade A standards, showing limited high-quality references.. · About 43% of the guidelines are based on clinical experience, with 5% having the highest evidence strength.. · Only 7% of references come from RCTs.. · The research highlights the need for stronger, evidence-based guidelines..

Preeclampsia remains one of the leading causes of perinatal mortality worldwide. Little is known about the modifiable risk factors that can be identified and addressed early in pregnancy to reduce the risk of preeclampsia and its associated adverse outcomes. We sought to determine if there is a synergistic effect of prepregnancy body-mass index and obstructive sleep apnea (OSA) on the risk of preeclampsia.We conducted a retrospective cohort study of singleton pregnancies delivered in Kaiser Permanente Southern California hospitals between January 1, 2010, and December 31, 2020 (n = 342,349). Preeclampsia and sleep apnea were ascertained using clinical diagnosis codes. Body mass index (BMI) in kg/m² measured during prenatal care visits was categorized as normal (18.5-24.9), overweight (25-29.9), and obese (≥30). Multivariable logistic regression was used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI).Compared with normal weight in pregnancy, overweight (aRR : 1.6; 95% CI: 1.5, 1.7) and obese BMI (aRR: 2.5; 95% CI: 2.4, 2.6) were associated with an increased risk of preeclampsia. Independent of prepregnancy body-mass index, a pregnancy with OSA was associated with an increased risk of preeclampsia (aRR: 2.2; 95% CI: 1.8, 2.6). Compared with normal weight without the diagnosis of OSA in a pregnancy, overweight (aRR: 4.6; 95% CI: 2.9, 7.4) and obese BMI (aRR: 3.8; 95% CI: 3.2, 4.6) with the diagnosis of OSA were associated with an increased risk of preeclampsia.OSA and elevated body-mass index have an independent and additive relationship with preeclampsia. Overweight women at risk of preeclampsia should be advised of a higher likelihood of developing preeclampsia when both conditions occur together and may benefit from close monitoring and early interventions for these modifiable risk factors. · There is a dose-dependent association between BMI and the risk of preeclampsia.. · Coexistent obesity and OSA resulted in a stronger risk for preeclampsia.. · The combined effect of obesity and OSA on preeclampsia risk is additive rather than synergistic..

Debriefing can be a powerful tool to facilitate improvement of performance after a resuscitation event. This study characterizes the debriefing experience of neonatal-perinatal medicine (NPM) fellows in the neonatal intensive care unit (NICU), operating room, and delivery room in the United States.An anonymous 13-item electronic survey was distributed to NPM program directors across the United States, who were asked to forward it to their respective NPM fellows. The survey addressed the frequency and timing of debriefings, access to formal training, and comfort levels with debriefing.Ninety-five responses were collected, with all participants having taken part in at least one medical resuscitation. Debriefings occurred approximately 25% of the time following a resuscitation, typically within 6 hours. Twenty percent of respondents reported feeling somewhat or very uncomfortable leading a debriefing, while 84% believed debriefings improve team performance. Despite 72% reporting no formal debriefing training, 94% expressed interest in receiving such training.This national survey on NPM fellows highlights inconsistent debriefing practices despite recognized benefits. Limited formal training remains a barrier, but a strong interest in further education presents an opportunity to improve training through the incorporation of structured debriefing frameworks into fellowship curricula. · Although NPM fellows often debrief resuscitations, 72% reported no formal training.. · Formal debriefing training can improve debriefing quality and enhance patient outcomes.. · NPM programs should implement structured debriefing to better prepare their fellows..

This study aimed to examine the correlations between pairs of maternal, infant, and maternal-infant dyad quality measures to provide a comprehensive assessment of perinatal care.In a retrospective cohort study using birth and fetal death certificates linked to hospital discharge data from Michigan, Oregon, Pennsylvania, and South Carolina (2016-2018), we examined correlations between pairs of maternal, infant, and maternal-infant dyad quality measures. Maternal quality measures included nulliparous term singleton vertex (NTSV) cesarean birth, nontransfusion severe maternal morbidity (SMM), and a composite maternal outcome. Infant quality was assessed with a composite outcome measure, whereas the dyad measure combined maternal and infant outcomes.Among 955,904 dyads across 266 hospitals, 25.9% had NTSV, 0.7% had nontransfusion SMM, 12.3% had the composite infant measure, and 19.3% had the dyad measure. The correlation between nontransfusion SMM and the dyad measure was 0.12, whereas the correlation between the composite infant measure and the dyad measure was 0.86, which was higher than the correlation between the composite maternal measure and the dyad measure (0.47).We observed minimal correlations among these perinatal quality measures, especially when aggregated beyond individual outcomes. · There are minimal correlations among different perinatal quality measures.. · Quality is multifaceted, and hospitals vary in the level of quality they achieve.. · Assessing hospital care for pregnant patients and infants requires multiple quality measures..

This study aimed to evaluate the diagnostic yield of fetal echocardiography (f-Echo) in detecting significant congenital heart disease (CHD) in pregnancies with a first-degree relative with a history of bicuspid aortic valve (BAV) and a normal level II obstetric ultrasound.A retrospective review was conducted of all f-Echos performed between 2019 and 2023 for the sole indication of family history of BAV. Cases with additional indications or affected nonfirst-degree relative were excluded. Postnatal transthoracic echocardiography (t-Echo) data were reviewed when available. Significant CHD was defined as requiring catheter or surgical intervention in the first year of life.Sixty-five f-Echos were included (mean gestational age: 26.6 ± 3.7 weeks). No significant CHD was identified prenatally. Postnatal t-Echo was performed in 41 (63%) cases, with no significant CHD detected. Two (5%) infants were diagnosed postnatally with BAV, neither requiring intervention during the study interval. Minor findings included one case each of pulmonary valve stenosis and atrial septal defect.In pregnancies with a first-degree relative with BAV and a normal obstetric ultrasound, f-Echo showed no added diagnostic value for detecting significant CHD. Based on the state's birth rate (approximately 35,000/year), BAV prevalence (1-2%), and an average family size of 3.08, an estimated 733 to 1,466 pregnancies annually in Arkansas could qualify for f-Echo under current guidelines. At a cost of $1,000 to 5,000 per study, this translates to an annual healthcare expenditure ranging from $733,000 to 7.33 million. These findings support more targeted screening and the need for multicenter studies. · No significant CHD detected with f-Echo.. · Postnatal t-Echo remains definitive.. · Routine f-Echo may add limited value.. · Cost implications warrant reconsideration.