Nulliparous with Class III Obesity at Term: Labor Induction or Cesarean Delivery without Labor.

Objective:  This study aimed to compare maternal and neonatal outcomes between labor induction versus cesarean delivery (CD) without labor among nulliparous individuals with class III obesity (body mass index [BMI] ≥40 kg/m).

Study Design:  A retrospective cohort study of all nulliparous singleton deliveries at ≥37 weeks with a BMI of ≥40 kg/m at delivery between March 2020 and February 2022. We excluded individuals with spontaneous labor, fetal malformations, and stillbirths.

Quantifying placenta accreta spectrum severity and its associated blood loss: a novel transvaginal ultrasound scoring system.

Background: Hemorrhage associated with placenta accreta spectrum (PAS) is a leading cause of maternal morbidity and mortality. Estimating blood loss in these individuals is a critical component of comprehensive preoperative planning.

Objective: A semiquantitative score based on transvaginal ultrasound was developed and tested to predict PAS, estimate its severity, and blood loss in individuals with clinical and ultrasound evidence suggesting PAS.

Aspirin 162 mg vs 81 mg for preeclampsia prophylaxis in high-risk obese individuals: a comparative effectiveness open-label randomized trial (ASPREO).

Background: In the United States, leading medical societies recommend 81 mg of aspirin daily for the prevention of preeclampsia in women at risk, whereas the NICE guidelines in the United Kingdom recommend a dose as high as 150 mg of aspirin. Recent data also suggest that in the obese population, inadequate dosing or aspirin resistance may impact the efficacy of aspirin at the currently recommended doses.

Objective: We evaluated whether daily administration of 162 mg aspirin would be more effective compared with 81 mg in decreasing the rate of preeclampsia with severe features in high-risk obese pregnant individuals.

Well-Child Visits for Early Detection and Management of Maternal Postpartum Hypertensive Disorders.

Importance: Innovative approaches are needed to address the increasing rate of postpartum morbidity and mortality associated with hypertensive disorders.

Objective: To determine whether assessing maternal blood pressure (BP) and associated symptoms at time of well-child visits is associated with increased detection of postpartum preeclampsia and need for hospitalization for medical management.

Design, Setting, And Participants: This is a pre-post quality improvement (QI) study.

Large for Gestational Age and Adverse Outcomes: Stratified By Diabetes Status.

Objective:  To examine the association of adverse outcomes among parturients with large for gestational age (LGA; birth weight ≥ 90) newborns, stratified by diabetes status. Additionally, we described the temporal trends of adverse outcomes among LGA neonates.

Study Design:  This retrospective cohort study used the U.

Pregnancy outcomes among patients with stage 1 chronic hypertension.

In recent years, the American College of Cardiology and the American Heart Association have reduced the thresholds for a hypertension diagnosis among nonpregnant adults. This change has led to more individuals with reproductive potential to be labeled as being chronically hypertensive, and some were started on antihypertensive medications. When these individuals become pregnant, the obstetrical care provider will have to decide whether to manage them as individuals with chronic hypertensive when only a few years ago they would have been managed as normotensive individuals and when the evidence regarding treatment of these patients during pregnancy is limited.

Umbilical-portal-systemic venous shunt and intrauterine growth restriction: an inquiry from a prospective study.

Background: The investigation of the fetal umbilical-portal venous system is based on the premise that congenital anomalies of this system may be related to adverse perinatal outcomes. Several small retrospective studies have reported an association between umbilical-portal-systemic venous shunts and intrauterine growth restriction. However, the prevalence of portosystemic shunts in the fetal growth restricted population is yet to be determined.

Time to Completion of Two-Step Screening for Gestational Diabetes and Adverse Outcomes.

Objective: This study aimed to ascertain whether the length of time to complete the gestational diabetes mellitus (GDM) screening was associated with adverse neonatal outcomes.

Study Design: This was a retrospective cohort study of singleton, nonanomalous individuals who were screened for GDM at ≥24 weeks' gestation at an academic hospital system. We compared outcomes among people who were diagnosed with GDM and completed the 3-hour glucose tolerance test (GTT) ≤14 second versus >14 days from the 1-hour glucose challenge test (GCT).

The association between maternal insurance status on maternal and neonatal outcomes in women with hypertensive disorders of pregnancy.

The objective of this study was to examine the association between maternal insurance status and maternal and neonatal adverse outcomes in women who had hypertensive disorders in pregnancy. A population-based retrospective cohort study was undertaken using the US Vital Statistics dataset on Period Linked Birth-Infant Data from 2016-2020. The study population was restricted to non-anomalous births from women whose pregnancies were complicated by hypertensive disorders.

Fetal malpresentation following mechanical labor induction.

Objective: To evaluate whether the risk of fetal malpresentation following mechanical labor induction could be accurately predicted.

Methods: A retrospective study, including all individuals who underwent labor induction at a single tertiary medical center between March 2011 and May 2021. Cohorts of pharmacological (n = 16 480) and mechanical labor induction (n = 6864) were compared, determining malpresentation rate following induction.

The association between gestational age and maternal adverse outcomes in patients undergoing trial of labor after cesarean.

Background: Although successful trial of labor after cesarean (TOLAC) resulting in vaginal birth after cesarean (VBAC) can lead to improved maternal and neonatal outcomes, an unsuccessful TOLAC is associated with increased risk of uterine rupture, higher blood loss, and increased risk of infection. Data remain limited in terms of whether differences in gestational age of patients who attempt TOLAC affect maternal morbidity. The aim of this study was to examine the association between gestational age and maternal adverse outcomes in women undergoing trial of labor after cesarean.

Postpartum hemorrhage drills or simulations and adverse outcomes: a systematic review and Bayesian meta-analysis.

Objective: To compare the rates of adverse outcomes with postpartum hemorrhage (PPH) before and after implementation of drills or simulation exercises.

Study Eligibility Criteria: We included all English studies that reported on rates of PPH and associated complications during the pre- and post-implementation of interventional exercises.

Study Apprasial And Synthesis Methods: Two investigators independently reviewed the abstracts, and full articles for eligibility of all studies.

Incorporation of randomized controlled trials into organizational guidelines for obstetricians and gynecologists.

Background: The American College of Obstetricians and Gynecologists publishes practice bulletins and committee opinions to serve as clinical guidelines for physicians. The objective of this study was to quantify the frequency that randomized controlled trials become incorporated into the American College of Obstetricians and Gynecologists documents (either practice bulletins or committee opinions).

Methods: Original research articles published in between 2009 and 2014 were examined and randomized controlled trials (RCT) in obstetrics and gynecology were identified.

Obstetrical randomized controlled trials: individuals screened, approached, and enrolled.

Background: The use of randomized clinical trials (RCTs) is predicated on the idea that the study group is representative of the overall clinical population; however, recent studies have suggested that this may not be the case in obstetrics. The generalizability of several seminal obstetrical RCTs, including the A Randomized Trial of Induction Versus Expectant Management trial, has been questioned because of the high ratio of assessed-to-enrolled individuals. Although difficulty in recruitment for obstetrical RCTs is known, it has been postulated that this high ratio increases the likelihood of the study population not being truly representative.

Maternal morbidity following caesarean deliveries with barbed suture for uterine closure.

Purpose: Information regarding the use of barbed suture in gynecologic surgery is limited. Our aim was to compare maternal morbidity following caesarean deliveries performed with barbed compared with non-barbed suture for uterine closure.

Methods: A historical cohort study from a single tertiary institution.