ACR Appropriateness Criteria® Multiple Gestations: 2024 Update.

The incidence of twin pregnancies has been rising, largely attributable to increasing use of artificial reproductive techniques. Ultrasound plays a critical role in establishing the chorionicity and amnionicity of multiple gestations, a key predictor of the expected risk and complications, along with guiding future clinical and imaging follow-up examinations and intervals. People carrying multiple gestations will typically undergo more ultrasound examinations (and occasionally fetal MRI) than those carrying singletons, at minimum including a first trimester dating scan, nuchal translucency scan at 11 to 14 weeks, an anatomy scan at 18 to 22 weeks, and other scans in the second and third trimesters for growth and surveillance.

Effect of an Intrapartum Pelvic Dilator Device on Levator Ani Muscle Avulsion During Primiparous Vaginal Delivery: A Pilot Randomized Controlled Trial.

Introduction And Hypothesis: The objective was to evaluate the safety and effectiveness of an intrapartum electromechanical pelvic floor dilator designed to reduce the risk of levator ani muscle (LAM) avulsion during vaginal delivery.

Methods: A multicenter, randomized controlled trial enrolled nulliparous participants planning vaginal delivery. During the first stage of labor, participants were randomized to receive the intravaginal device or standard-of-care labor management.

Taking the Express Lane: Student Attitudes Towards Tracking in Ob/Gyn Residency.

We sought to determine the subspecialty interests of fourth-year medical students (MS4s) matched to Ob/Gyn and evaluate their attitudes towards residency tracking. Matched MS4s completed a survey regarding subspecialization, confidence in that choice, and desire for tracking. A total of 922 MS4s completed the survey.

The golden tickets: impact of preference signaling on obstetrics and gynecology residency applicants.

Background: With the residency selection process becoming more competitive and programs receiving unprecedented numbers of applications, some specialties have introduced preference signaling in an attempt to help applicants target programs of interest. In the 2022-2023 application cycle, obstetrics and gynecology also introduced a 2-tiered system with a limited number of gold signals (n=3) and silver signals (n=15).

Objective: Given the novelty of preference signaling in the obstetrics and gynecology residency application process, this study aimed to (1) assess the effect of signals on interview offers and match and (2) discuss applicant attitudes toward this preference signaling system.

Does the Degree Matter? MD and DO Students Who Match Into OB/GYN Report Different Experiences in US Undergraduate Medical Education.

Background: Although allopathic (MD) and osteopathic (DO) students have similar curricular requirements, little is known about differences in MD and DO preparedness for obstetrics and gynecology (OB/GYN) residency.

Objective: To assess differences in experiences and confidence of MD vs DO students who matched to OB/GYN.

Methods: This cross-sectional survey study was open to all fourth-year medical students who matched to OB/GYN in the United States in April 2021.

The #ObGynInternChallenge: Reach, Adoption, Implementation, and Effectiveness of a Microlearning SMS-Distributed Curriculum.

Problem: While many medical schools have implemented bootcamps or specialized curricula to prepare medical students for residency, these programs are neither universal nor consistent in their content.

Approach: The authors created an electronic, multimodal, short messaging service (SMS)-distributed curriculum, called the #ObGynInternChallenge, to improve learners' medical knowledge, based on the Council on Resident Education in Obstetrics and Gynecology educational objectives. The curriculum was open to all fourth-year medical students who matched into obstetrics and gynecology (Ob/Gyn).

Maternal adverse childhood experiences impact fetal adrenal volume in a sex-specific manner.

Background: The mechanisms by which parental early life stress can be transmitted to the next generation, in some cases in a sex-specific manner, are unclear. Maternal preconception stress may increase susceptibility to suboptimal health outcomes via in utero programming of the fetal hypothalamic-pituitary-adrenal (HPA) axis.

Methods: We recruited healthy pregnant women (N = 147), dichotomized into low (0 or 1) and high (2+) adverse childhood experience (ACE) groups based on the ACE Questionnaire, to test the hypothesis that maternal ACE history influences fetal adrenal development in a sex-specific manner.

Volume, Distribution, and Inequities by Race and Gender of Clinical Experiences Reported by Medical Students Entering Obstetrics and Gynecology Residencies.

Objective: To assess for inequities by race and gender of fourth year medical students' (MS4s) self-reported clinical experience in obstetrics and gynecology (Ob/Gyn).

Design: This was a voluntary, cross-sectional survey. Participants provided demographic data, information regarding their preparation for residency, and self-reported numbers of hands-on clinical experiences.

Counselling, Research Gaps, and Ethical Considerations Surrounding Pregnancy in Solid Organ Transplant Recipients.

Survival after solid-organ transplantation has improved significantly, and many contemporary transplant recipients are of childbearing potential. There are limited data to guide decision-making surrounding pregnancy after transplantation, variations in clinical practice, and significant knowledge gaps, all of which raise significant ethical issues. Post-transplant pregnancy is associated with an increased risk of maternal and fetal complications.

Antepartum Care of the Uterus Transplant Patient: The Experience of 3 Successful US Centers.

We offer consensus recommendations for the antepartum management of the uterus transplant pregnancy based on our experience at 3 US centers. Patient access to accurate information is important to manage expectations and make informed decisions. Unique aspects of medical management include monitoring tacrolimus levels and performing cervical biopsies for rejection.

Genetic Screening and Teratogenic Exposures: Considerations in Caring for the Uterus Transplant Patient.

Counseling the uterus transplant patient requires an enhanced knowledge of unique genetic challenges that include an understanding of the spectrum of Mayer-Rokitansky-Küster-Hauser syndrome. Patients should understand their options for genetic screening and testing including preimplantation genetic testing for aneuploidy, genetic screening, and diagnostic testing. This patient population is potentially at risk for fetal anomalies due to the increased susceptibility to infections, such as cytomegalovirus.

Implementation of a protocol for management of antepartum iron deficiency anemia: a prospective cohort study.

Background: In randomized trials, antepartum intravenous iron sucrose is effective at improving predelivery hemoglobin in iron deficiency anemia. Yet, there is a gap between this knowledge and its implementation into care.

Objective: We aimed to determine if the implementation of a standardized protocol for the management of antepartum anemia outside of a clinical trial improves intravenous iron sucrose utilization and clinical outcomes.

Association Between Race and Hemoglobin at Delivery or Need for Transfusion When Using Race-Based Definitions for Treatment of Antepartum Anemia.

With race-based definitions of antepartum anemia, Black women are at significant increased odds of delivery admission hemoglobin<11g/dL than non-Black women with the same antepartum hemoglobin.

ACR Appropriateness Criteria® Second and Third Trimester Screening for Fetal Anomaly.

The Appropriateness Criteria for the imaging screening of second and third trimester fetuses for anomalies are presented for fetuses that are low risk, high risk, have had soft markers detected on ultrasound, and have had major anomalies detected on ultrasound. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios.

ACR Appropriateness Criteria® Second and Third Trimester Vaginal Bleeding.

Vaginal bleeding can occur throughout pregnancy with varied etiologies. Although history and physical examination can identify many etiologies, imaging, in particular ultrasound (US), is the backbone of current medical practice. US pregnant uterus transabdominal, US pregnant uterus transvaginal, and US duplex Doppler velocimetry are usually appropriate for the evaluation of women with painless vaginal bleeding, those with painful vaginal bleeding, and also for those with second or third trimester vaginal bleeding with suspicion of or known placenta previa, low-lying placenta, or vasa previa.

Single-unit vs multiple-unit transfusion in hemodynamically stable postpartum anemia: a pragmatic randomized controlled trial.

Background: The American Academy of Blood Banks recommends single-unit red cell transfusion protocols across medicine to reduce transfusion complications and the use of a scarce resource. There are minimal data regarding single-unit protocols in obstetrics.

Objective: We aimed to compare single-unit vs multiple-unit transfusion protocols for treatment of hemodynamically stable postpartum anemia.

ACR Appropriateness Criteria® Placenta Accreta Spectrum Disorder.

Placenta accreta spectrum disorder (PASD) is the current terminology recommended by the International Federation of Obstetrics and Gynecology (FIGO) and should replace terms such as abnormally adherent/invasive placenta or morbidly adherent placenta. PASD refers to a variety of potential clinical complications, which may result from abnormal placental implantation. More specifically, placenta accreta refers to a defect in the decidua basalis where the chorionic villi adhere directly to the myometrium with trophoblastic invasion.

Effectiveness of antepartum intravenous iron sucrose: dose timing and impact on outcomes.

Objective: Studies have demonstrated that antepartum intravenous iron sucrose infusion (IVFe) is safe and improves predelivery hemoglobin (Hb). Yet, there is little data guiding timing of administration or number of doses required to be impactful. We sought to determine if timing of antepartum IVFe and number of doses provided impacts efficacy.

Assessing reVITALize: Should the Definition of Postpartum Hemorrhage Differ by Mode of Delivery?

 Obstetrical hemorrhage is a leading cause of morbidity and mortality, yet is inconsistently defined. In 2014, the American Congress of Obstetricians and Gynecologists (ACOG) reVITALize program redefined postpartum hemorrhage (PPH) as greater than 1,000 mL blood loss regardless of the mode of delivery (MOD).  We sought to assess the reVITALize definition's validity by understanding whether the definition of PPH should, as proposed by ACOG, be one value regardless of MOD.

Interleukin-6 and tumor necrosis factor alpha as predictors of success after emergent cerclage.

Serum levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) were measured in patients requiring an emergent cerclage to determine if they are predictive of successful pregnancy outcome. Women with a clinical diagnosis of cervical incompetence requiring an emergent cerclage between 15 and 24 weeks gestation were enrolled. Asymptomatic women of the same gestational age range were recruited as controls.

Relationship between tumor necrosis factor-alpha genotype and success of emergent cerclage.

The guanine to adenine substitution at the -308 position in the tumor necrosis factor-alpha (TNF-alpha) gene promoter region results in a 5-fold greater cytokine response to an inciting event. We investigated whether this polymorphism is associated with cervical incompetence and adverse pregnancy outcome after emergent cerclage. Women with a diagnosis of cervical incompetence requiring an emergent cerclage between 15 and 24 weeks were enrolled.

Follistatin-free activin A is not associated with preterm birth.

Objective: The purpose of this study was to determine whether follistatin-free activin A (an inhibin-related protein with rising serum levels before term labor) is associated with spontaneous preterm birth in an outpatient population.

Study Design: From 10 centers, 2929 women were enrolled in the Preterm Prediction Study. Plasma was isolated from blood samples obtained at 24 and 28 weeks of gestation and stored.