First-Trimester Soluble fms-like Tyrosine Kinase 1 (sFlt-1) for the Prediction of Preterm Preeclampsia.

While soluble fms-like tyrosine kinase 1 (sFlt-1) is used to predict preeclampsia (PE) and its severity in late pregnancy, we aimed to clarify its role in early pregnancy. Using prospective cohorts, we estimated the association between sFlt-1, adjusted for gestational age, and preterm PE. sFlt-1 was significantly decreased in the first trimester, mostly before the 13th week, and significantly increased in the third trimester in those who developed preterm PE and particularly early-onset PE.

First-Trimester PLGF and PAPP-A and the Risk of Placenta-Mediated Complications: PREDICTION Prospective Study.

Objectives: To estimate the association between low first-trimester maternal serum placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) and the risk of placenta-mediated complications.

Methods: We performed a secondary analysis of PREDICTION study including nulliparous participants recruited at 11-14 weeks of pregnancy. First-trimester PlGF and PAPP-A were reported in multiples of the median (MoM) adjusted for maternal characteristics and gestational age.

Lower uterine segment thickness to predict uterine rupture: a secondary analysis of PRISMA cluster randomized trial.

Background: Third-trimester lower uterine segment thickness (LUST) is associated with uterine rupture during trial of labor after cesarean (TOLAC) but threshold values vary according to the approach used (lower values with vaginal ultrasound, higher values with abdominal ultrasound).

Objective: To estimate the optimal LUST cut-off value combining vaginal and abdominal ultrasound to predict uterine rupture during TOLAC.

Study Design: We performed a secondary analysis of PRISMA cluster randomized trial including women with a single previous cesarean who underwent ultrasound LUST measurement at 34-38 weeks using the thinnest measurement obtained by combining transvaginal and transabdominal measurements.

Prospective Validation of First-Trimester Screening for Preterm Preeclampsia in Nulliparous Women (PREDICTION Study).

Background: Fetal Medicine Foundation (FMF) studies suggest that preterm preeclampsia can be predicted in the first trimester by combining biophysical, biochemical, and ultrasound markers and prevented using aspirin. We aimed to evaluate the FMF preterm preeclampsia screening test in nulliparous women.

Methods: We conducted a prospective multicenter cohort study of nulliparous women recruited at 11 to 14 weeks.

Comparison of National Factor-Based Models for Preeclampsia Screening.

Objective:  This study aimed to compare the predictive values of the American College of Obstetricians and Gynecologists (ACOG), the National Institute for Health and Care Excellence (NICE), and the Society of Obstetricians and Gynecologists of Canada (SOGC) factor-based models for preeclampsia (PE) screening.

Study Design:  We conducted a secondary analysis of maternal and birth data from 32 hospitals. For each delivery, we calculated the risk of PE according to the ACOG, the NICE, and the SOGC models.

Perinatal morbidity among women with a previous caesarean delivery (PRISMA trial): a cluster-randomised trial.

Background: Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery.

Methods: We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis.

Impact of COVID-19 and Vaccination During Pregnancy on Placenta-Mediated Complications (COVIGRO Study).

Objectives: COVID-19 has been associated with preterm birth (PTB) and placental-mediated complications, including fetal growth restriction and preeclampsia (PE). This study aimed to estimate the impact of COVID-19 and vaccination on adverse pregnancy outcomes and markers of placental function.

Methods: We performed a study on a prospective cohort of women recruited in the first trimester of pregnancy during the early COVID-19 pandemic period (December 2020 to December 2021).

Clinical Risk Factors for Placenta Accreta or Placenta Percreta: A Case-Control Study.

Objectives: Uterine scarring is a risk factor for placenta accreta spectrum (PAS) disorder. We aimed to determine the factors related to PAS in women who had previously undergone a cesarean.

Methods: We performed a case-control study where women who underwent postpartum hysterectomy for placenta accreta/percreta (cases) were matched to all women with a previous cesarean who delivered in the week before each case (controls).

Guideline No. 442: Fetal Growth Restriction: Screening, Diagnosis, and Management in Singleton Pregnancies.

Objective: Fetal growth restriction is a common obstetrical complication that affects up to 10% of pregnancies in the general population and is most commonly due to underlying placental diseases. The purpose of this guideline is to provide summary statements and recommendations to support a clinical framework for effective screening, diagnosis, and management of pregnancies that are either at risk of or affected by fetal growth restriction.

Target Population: All pregnant patients with a singleton pregnancy.

[Directive clinique n 442 : Retard de croissance intra-utérin : Dépistage, diagnostic et prise en charge en contexte de grossesse monofœtale].

Objectif: Le retard de croissance intra-utérin est une complication obstétricale fréquente qui touche jusqu'à 10 % des grossesses dans la population générale et qui est le plus souvent due à une pathologie placentaire sous-jacente. L'objectif de la présente directive clinique est de fournir des déclarations sommaires et des recommandations pour appuyer un protocole clinique de dépistage, diagnostic et prise en charge du retard de croissance intra-utérin pour les grossesses à risque ou atteintes.

Population Cible: Toutes les patientes enceintes menant une grossesse monofœtale.

COVID-19 Proactive Disease Management Using COVID Virtual Hospital in a Rural Community.

Purpose: A community teaching hospital serving a rural population established an intensive "hospital at home" program for patients with COVID-19 utilizing disease risk stratification and pulse oximeter readings to dictate nurse and clinician contact. Herein, we report patient outcomes and provider experiences resulting from this "virtual" approach to triaging pandemic care.

Methods: COVID-19-positive patients appropriate for outpatient management were enrolled in our COVID Virtual Hospital (CVH).

Comparing aspirin 75 to 81 mg vs 150 to 162 mg for prevention of preterm preeclampsia: systematic review and meta-analysis.

Objective: This study aimed to compare 2 aspirin dosage regimens for the prevention of preterm preeclampsia (PE): 75 to 81 mg vs 150 to 162 mg taken daily starting in the first trimester of pregnancy.

Data Sources: A systematic search was performed using PubMed, Embase, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials from January 1985 to April 2023.

Study Eligibility Criteria: The inclusion criteria were randomized controlled trials that compared the effect of 2 aspirin dosage regimens during pregnancy for the prevention of PE initiated in the first trimester of pregnancy.

Educational initiative in an NCATS TL1 training program to address the impact of systemic racism on human health, biomedical research, and the translational scientist.

Introduction: The goal of clinical and translational science (CTS) is to fill gaps in medical knowledge toward improving human health. However, one of our most pressing challenges does not reside within the biological map we navigate to find sustainable cures but rather the moral compass to recognize and overcome racial and ethnic injustices that continue to influence our society and hinder diverse research rigor. The Georgetown-Howard Universities Center for Clinical and Translational Science includes an inter-institutional TL1-funded training program for predoctoral/postdoctoral trainees in Translational Biomedical Science (TBS).