Cobo T, Boada D, Burgos-Artizzu XP
… +19 more, Goya M, Kacerovsky M, Ferrero S, Filella X, Sellarés A, González B, Mouriz N, Mohedano N, Ampurdanes Q, Roldán E, Del Barco E, Murillo C, Hidalgo J, Garbí S, Musilova I, Fabregat A, Vergara A, Palacio M, Gratacos E
Am J Obstet Gynecol
· 2026 Mar · PMID 41905565
·
Publisher ↗
BACKGROUND: Among women with preterm labor and intact membranes, those with intra-amniotic infection or inflammation represent the group with the highest risk of spontaneous delivery and worse adverse outcomes. Identific...BACKGROUND: Among women with preterm labor and intact membranes, those with intra-amniotic infection or inflammation represent the group with the highest risk of spontaneous delivery and worse adverse outcomes. Identification of this group requires amniocentesis, which is perceived as too invasive by both patients and physicians. OBJECTIVE: This study aimed to develop a minimally invasive prediction model for intra-amniotic infection or early delivery to better stratify patients (low or high risk) and rationalize the use of amniocentesis, limiting the indications to the highest-risk group of spontaneous preterm delivery. STUDY DESIGN: External validation of 4 prediction models was performed using data from 2022 to 2024 of women diagnosed with preterm labor at <34 weeks of gestation who were admitted to the Hospital Clinic, Hospital Sant Joan de Déu, Vall d'Hebron Barcelona University Hospital (Spain), and University Hospital Hradec Kralove (Kradec Kralove, Czech Republic) and underwent amniocentesis to rule in/out intra-amniotic infection or inflammation. Different prediction models, including transvaginal ultrasound cervical length, serum C-reactive protein, vaginal interleukin 6, vaginal pH, vaginal lactic acid, and vaginal Lactobacillus genus, were validated in these patients. RESULTS: Diagnostic performance was performed in 114 women with preterm labor at <34 weeks of gestation, of whom 42 (36.8%) had intra-amniotic infection or spontaneous delivery within 7 days. The areas under the curve of the different models ranged from 84.0% (95% confidence interval, 78.8%-89.2%) to 89.9% (95% confidence interval, 88.4%-91.4%), the sensitivities ranged from 78.6% (33/42) to 90.5% (38/42), and the specificities ranged from 70.8% (51/72) to 84.7% (61/72). The most feasible and efficient model was formed by combining ultrasound cervical length, serum C-reactive protein, and vaginal interleukin 6, showing an area under the curve of 84.0%, a sensitivity of 78.6% (33/42), a specificity of 84.7% (61/72), a positive predictive value of 75.0% (33/44), and a negative predictive value of 87.1% (61/70). CONCLUSION: Minimally invasive models were developed to screen women at high risk of intra-amniotic infection or early delivery and guide the selective use of amniocentesis, thereby improving both antenatal counseling and the clinical management of high-risk patients.
Eyada MF, Clement CG, Segura C
… +5 more, Schoellkopf N, Lewis K, Yaklic J, Kilic GS, Nguyen T
Am J Obstet Gynecol
· 2026 Mar · PMID 41903875
·
Publisher ↗
BACKGROUND: Concerns regarding tissue dissemination during morcellation have led to the adoption of containment systems during minimally invasive hysterectomy. However, the timing and extent of potential myometrial cell...BACKGROUND: Concerns regarding tissue dissemination during morcellation have led to the adoption of containment systems during minimally invasive hysterectomy. However, the timing and extent of potential myometrial cell spillage during contained manual morcellation remain unclear. OBJECTIVE: To evaluate the presence and timing of myometrial cell spillage during minimally invasive hysterectomy with contained sharp morcellation using sequential pelvic washings. STUDY DESIGN: This was a prospective single-center observational study of premenopausal patients undergoing minimally invasive hysterectomy for presumed benign large fibroid uteri requiring contained manual morcellation. Three sequential pelvic washings were collected: baseline after peritoneal entry, posthysterectomy before morcellation, and postmorcellation. Cytologic evaluation with Romanowsky staining and immunohistochemical confirmation with Caldesmon was performed by a blinded pathologist. The primary outcome was detection of myometrial cells; secondary outcomes included timing of detection and associations with clinical variables. RESULTS: Fifty premenopausal patients were included. Myometrial cells were identified in 4 of 50 patients (8%; 95% confidence interval, 2%-19%), and always in only one of the 3 sequential washings. Baseline washings were negative in 98% of cases. Myometrial cells were detected in 4% of posthysterectomy before morcellation and in 2% of postmorcellation samples. All detections were confirmed with Caldesmon immunohistochemistry. Mesothelial cells were present in all washings, confirming sampling adequacy. Final pathology revealed benign disease in all patients. CONCLUSION: Sequential pelvic washings demonstrate that contained manual morcellation is associated with a low rate of myometrial cell spillage, with most spillage occurring before morcellation begins. These findings support the safety and effectiveness of containment systems and highlight that tissue dissemination risk may originate from the hysterectomy itself rather than morcellation alone.
Fehér B, Amorim das Virgens IP, Bakony M
… +11 more, Tóth E, Solymosi O, Ütő E, Kói T, Hegyi P, Váncsa S, Ács N, Can G, Gupta N, Biju J, Melczer Z
Am J Obstet Gynecol
· 2026 Mar · PMID 41895366
·
Publisher ↗
OBJECTIVE: Genital mycoplasmas (Mycoplasma genitalium, Mycoplasma hominis, and Ureaplasma species) are highly prevalent in women of reproductive age worldwide. The relevance of cervicovaginal detection in pregnancy remai...OBJECTIVE: Genital mycoplasmas (Mycoplasma genitalium, Mycoplasma hominis, and Ureaplasma species) are highly prevalent in women of reproductive age worldwide. The relevance of cervicovaginal detection in pregnancy remains controversial. This study aimed to assess their associations with adverse pregnancy outcomes. DATA SOURCES: We conducted a systematic review and meta-analysis of observational studies published up to February 1, 2026, in MEDLINE, Embase, and the Cochrane Library. STUDY ELIGIBILITY CRITERIA: Eligible studies reported the presence of any genital mycoplasmas and at least one adverse pregnancy outcome. STUDY APPRAISAL AND SYNTHESIS METHODS: Four reviewers independently selected studies and extracted data. Pooled odds ratios and mean differences with 95% confidence intervals were calculated. Univariate and subgroup analyses were performed for primary and secondary outcomes and multivariate analysis for preterm birth. Sensitivity analyses restricted to cohort studies and cervicovaginal sampling were conducted. RESULTS: Of 11,957 records, 156 studies were included in meta-analysis. In sensitivity analyses excluding amniotic fluid and placental specimens, significant associations with spontaneous preterm birth and low birthweight remained for cervicovaginal samples. Cervicovaginal detection of Ureaplasma parvum was significantly associated with preterm birth (odds ratio, 1.63; confidence interval, 1.36-1.96). For Ureaplasma species, first-trimester detection showed stronger associations compared to second-trimester positivity (P=.044). Cervicovaginal Ureaplasma detection was also associated with low birthweight (odds ratio, 1.56; confidence interval, 1.33-1.83) and small for gestational age (odds ratio, 1.47; confidence interval, 1.19-1.80). Mycoplasma hominis showed significant associations with both preterm birth (adjusted odds ratio, 1.75; confidence interval, 1.21-2.53) and low birthweight (odds ratio, 1.81; confidence interval, 1.51-2.16) when detected in cervicovaginal samples. CONCLUSION: Associations between genital mycoplasmas and adverse pregnancy outcomes are not limited to intra-amniotic presence but are also observed with cervicovaginal detection. Given the observational nature of the available data and residual confounding, these associations should be interpreted cautiously and do not support routine screening or treatment. Cervicovaginal detection should be interpreted within the broader context of the vaginal microbial environment rather than as evidence of an isolated pathogenic effect.
Hulmi J, Virtanen A, Sadeluoto H
… +3 more, Tarkkanen J, Kalliala I, Heinonen A
Am J Obstet Gynecol
· 2026 Mar · PMID 41895365
·
Publisher ↗
BACKGROUND: High-risk human papillomavirus-based screening demonstrates higher sensitivity but lower specificity than cytology for detecting high-grade squamous intraepithelial lesions. This has increased colposcopy refe...BACKGROUND: High-risk human papillomavirus-based screening demonstrates higher sensitivity but lower specificity than cytology for detecting high-grade squamous intraepithelial lesions. This has increased colposcopy referrals and introduced a new group of patients with persistent high-risk human papillomavirus infections and normal cytology. OBJECTIVE: In this population, we aimed to describe colposcopic findings, evaluate the diagnostic performance of systematic colposcopy using Swedescore, and assess the prevalence of high-grade squamous intraepithelial lesions. STUDY DESIGN: In this retrospective cohort study, we included 493 patients referred to colposcopy through the Finnish national cervical cancer screening program in 2021 following high-risk human papillomavirus infection persistence with negative for intraepithelial lesion or malignancy or atypical squamous cells of undetermined significance triage cytology. We described and compared colposcopic findings and histological outcomes across the cohort, stratified by referral cytology, age, and other subgroups. Statistical analyses included descriptive statistics and hypotheses testing with appropriate parametric and nonparametric tests. RESULTS: Altogether, 17.8% (88/493) of patients had a histologically confirmed high-grade squamous intraepithelial lesion. Prevalence was higher (P<.001) in those with atypical squamous cells of undetermined significance triage cytology (26.9%, 42/156) than negative for intraepithelial lesion or malignancy triage cytology (13.6%, 46/337). High-grade squamous intraepithelial lesion prevalence was also higher (P<.001) among those aged less than 50 years (22.3%, 78/345) than among those aged more than 50 years (6.8%, 10/148). Most high-grade squamous intraepithelial lesion cases lacked classic high-grade colposcopic features. Sensitivity and specificity of colposcopic impression for detecting a high-grade squamous intraepithelial lesion were 0.34 (95% confidence interval, 0.26-0.47) and 0.91 (95% confidence interval, 0.88-0.94). Swedescore showed moderate discriminative ability (area under the curve, 0.75) for high-grade squamous intraepithelial lesion detection, with high specificity but poor sensitivity. CONCLUSION: A considerable proportion of individuals with persistent high-risk human papillomavirus infections and normal or low-grade cytology-who would not typically be referred under cytology-based screening-had a high-grade squamous intraepithelial lesion. Younger age and atypical squamous cells of undetermined significance cytology correlated with elevated risk. Colposcopists should adjust their interpretation and maintain a low threshold for biopsy in this population. The clinical significance of detected high-grade squamous intraepithelial lesions remains an open question.
Am J Obstet Gynecol
· 2026 Apr · PMID 41866692
·
Full text
Identifying key factors behind persistently high cesarean rates over the past 15 years is challenging due to inconsistent documentation of primary indications, overlapping risk factors, and evolving clinical standards. T...Identifying key factors behind persistently high cesarean rates over the past 15 years is challenging due to inconsistent documentation of primary indications, overlapping risk factors, and evolving clinical standards. The modified Robson classification helps standardize comparisons across populations. Cesarean rates by modified Robson class were compared using National Vital Statistics data from 2009, when the cesarean rate peaked, to the most recent data available in 2023. In 6 of the 11 categories, the rate of cesarean decreased: nulliparous spontaneous, nulliparous induced, multiparous spontaneous, previous cesarean, twins and higher-order multiples, and unclassified. Cesarean rates increased in 2 categories: breech and other noncephalic presentation and preterm. Cesarean rates stayed the same in 3 categories: nulliparous cesarean, multiparous induced, and multiparous cesarean. Data from the Consortium on Safe Labor highlight 2 major contributors to cesarean rates: women with previous cesareans and nulliparous with induced labor. From 2009 to 2023, intrapartum cesareans in the previous cesarean group declined (31.6% to 26.4%), yet the previous cesarean group remained the highest contributor to the total cesarean rate and its proportion of total cesareans increased (27.5% to 31.2%). Similarly, intrapartum cesareans among nulliparas with induced labor decreased slightly (26.2% to 24.9%), yet its proportion of total cesareans increased (7.7% to 10.4%). Meanwhile, risk factors like advanced maternal age (≥35) and higher body mass index (≥25) became more common. After adjusting for these factors, logistic regression showed a 62% lower odds of cesarean in the previous cesarean group (adjusted odds ratio, 0.38; 95% confidence interval, 0.37-0.38) and an 30% decrease in nulliparous with induced labor (adjusted odds ratio, 0.70; 95% confidence interval, 0.69-0.71) by 2023, suggesting improved risk management. Efforts to reduce unnecessary cesareans-such as promoting vaginal births after cesarean and public reporting-may be working, although further research accounting for maternal comorbidities and in relation to neonatal outcomes is needed. Trends vary by subgroup, with some rates rising, others falling, or remaining stable. Disaggregated data, rather than global rates, offer clearer insights for targeted interventions.
Tesfai F, Xu J, Anastasiou D
… +9 more, He R, Boal M, Aranan Y, Lingam G, Shah D, Stoyanov D, Chandrasekaran D, Mazomenos E, Francis N
Am J Obstet Gynecol
· 2026 Mar · PMID 41864316
·
Publisher ↗
BACKGROUND: To support surgical education, an increasing focus has been on integrating surgical data, including surgical motion and activity and process understanding, to develop predictive models to assess surgical skil...BACKGROUND: To support surgical education, an increasing focus has been on integrating surgical data, including surgical motion and activity and process understanding, to develop predictive models to assess surgical skills. OBJECTIVE: This study aimed to develop deep learning models based on fine-grained analysis to predict technical errors and generic surgical skills during robotic-assisted vaginal cuff closures as part of a hysterectomy. STUDY DESIGN: This was a multicenter prospective observational cohort study of robotic-assisted total hysterectomy performed between 2023 and 2025. Vaginal cuff closure video segments, recorded on the Touch Surgery video platform via the DS1 computer, were extracted and double-annotated by 2 trained surgeons: errors via Objective Clinical Human Reliability Analysis and global skill via Modifiable Global Evaluative Assessment of Robotic Skills. Of note, 3 deep learning pipelines were developed: 2 crucial surgical tasks (surgical video error detection via temporal modeling models and surgical skill assessment via few-shot surgical skill assessment) and multimodal learning. RESULTS: A total of 40 videos, including 667 minutes (1,201,654 frames), from 2 centers were analyzed. Of note, 11 surgeons performed vaginal cuff closure (3 beginners, 5 intermediates, and 3 experts). Interrater reliability was good for both Modifiable Global Evaluative Assessment of Robotic Skills (intraclass correlation coefficient, 0.807; P=.001) and Objective Clinical Human Reliability Analysis error counts (intraclass correlation coefficient, 0.712; P=.010). The median Modifiable Global Evaluative Assessment of Robotic Skills score was 21.0 (interquartile range, 19.1-24.6), and the median error was 25.0 (interquartile range, 16.3-31.5). Level of experience showed a significant correlation to Modifiable Global Evaluative Assessment of Robotic Skills: the Kruskal-Wallis test was <0.002. Significant correlations were found between operative time and Modifiable Global Evaluative Assessment of Robotic Skills and Objective Clinical Human Reliability Analysis (r=-0.534 [P<.001] and r=0.421 [P=.007], respectively). Few-shot experiments showed that the model achieves a performance of 81.70% accuracy and 81.30% F1 score in the 5-shot setting. The multimodal skill assessment model achieved excellent agreement with manual assessment ratings (r=0.85±0.02; mean absolute error=1.85±0.16). CONCLUSION: This proof of concept shows that deep learning can objectively score generic surgical skill and initial flag frame-level errors in vaginal cuff closure videos, aligning with validated objective assessment tools. Although larger, multicenter datasets remain essential, these results lay the groundwork for artificial intelligence-driven quality monitoring and evidence-based credentialing in minimally invasive gynecologic surgery.
Konecke N, Jackson TL, Angeles I
… +13 more, Sigman II, Ware CF, Benson AE, Shatzel JJ, Raghuraman N, Stout MJ, Bruno AM, Fein S, Webster C, Auerbach M, Lo JO, Tuuli MG, Lewkowitz AK
Am J Obstet Gynecol
· 2026 Mar · PMID 41864313
·
Publisher ↗
Pritchard NL, Hiscock RJ, Hastie R
… +10 more, Roddy Mitchell A, Vollenhoven BJ, Stern C, Green MP, Wilkinson D, Tong S, Walker SP, Gordon HG, Kennedy AL, Lindquist AC
Am J Obstet Gynecol
· 2026 Mar · PMID 41861980
·
Publisher ↗
BACKGROUND: Cesarean deliveries are one of the most common obstetric interventions globally. It is important all risks are fully understood. OBJECTIVE: This study aimed to investigate the impact of first birth by cesarea...BACKGROUND: Cesarean deliveries are one of the most common obstetric interventions globally. It is important all risks are fully understood. OBJECTIVE: This study aimed to investigate the impact of first birth by cesarean delivery on subsequent reproductive outcomes. STUDY DESIGN: We conducted a retrospective cohort study of all women who gave birth to their first spontaneously conceived, singleton infant in Victoria, Australia from January 2005 to December 2015, with follow-up for second births until December 2017. The exposure was first birth by cesarean delivery, compared with vaginal birth. Primary outcomes included (1) a second live birth occurring within the study time frame and (2) conception via in vitro fertilization or other assisted reproductive technologies among those for whom a second birth was reported. Secondary outcomes included interpregnancy interval and miscarriage rates. Statistical analyses included Cox proportional hazards regression, Poisson regression, or quantile regression depending on the outcome. Outcomes were adjusted for maternal age (at both first and second pregnancy), Socio-Economic Indexes for Areas quintile at the time of pregnancy, preexisting hypertension, and preexisting diabetes. RESULTS: There were 298,241 women who met the inclusion criteria, of whom 184,061 (61.7%) had both their first and second birth during the 12-year study period. A total of 205,164 had a vaginal birth and 93,077 gave birth by cesarean delivery. Having a first birth by cesarean delivery was associated with an 11% reduction in the likelihood of having a second live birth (adjusted hazard ratio, 0.89; 95% confidence interval, 0.88-0.90). Among the cohort reporting a second live birth, there was a 28% increase in the use of in vitro fertilization for conception among those who had a prior cesarean delivery (adjusted risk ratio, 1.28; 95% confidence interval, 1.15-1.43) and a 28% increase in the probability of any assisted reproductive technology use (adjusted risk ratio, 1.28; 95% confidence interval, 1.18-1.40). No difference in miscarriage rates was observed (adjusted risk ratio, 1.01; 95% confidence interval, 0.98-1.03). CONCLUSION: First birth by cesarean delivery was associated with an 11% reduced likelihood of a second live birth within the 12-year study period and a 28% increase in the use of assisted reproductive technologies to achieve a second birth. Factors leading to a cesarean delivery may also be associated with subsequent reproductive outcomes and warrant further study.
White P, Choi-Klier JI, Greer H
… +4 more, Lozano A, Barbour T, Hanlon A, Armbruster SD
Am J Obstet Gynecol
· 2026 Mar · PMID 41856225
·
Publisher ↗
BACKGROUND: Cancer survivorship in the United States is rapidly rising, with a projected 50% increase by 2050, driven by improvements in treatment and increased incidence of cancers such as endometrial cancer. Along with...BACKGROUND: Cancer survivorship in the United States is rapidly rising, with a projected 50% increase by 2050, driven by improvements in treatment and increased incidence of cancers such as endometrial cancer. Along with this growth, long-term side effects create significant burdens, yet survivorship research, particularly for female-organ cancers, remains limited and imbalanced - with breast cancer studies far outnumber those for gynecologic cancers. To understand these disparities, funding patterns for survivorship research between disease sites, while accounting for differences in disease prevalence were undertaken. OBJECTIVE: To evaluate the distribution of National Institutes of Health funding for breast and gynecologic cancer survivorship research in relation to survivor populations. STUDY DESIGN: A retrospective cohort study was conducted on National Institutes of Health funded grants for breast and gynecologic cancer survivorship from fiscal years 2017 to 2021 using an existing dataset from the National Institutes of Health Office of Cancer Survivorship. Grant characteristics, including funding amount, study design, and research focus, were extracted from National Institutes of Health Reporter and ClinicalTrials.gov. Total funding and per-survivor funding were calculated using prevalence data from the Surveillance, Epidemiology, and End Results program. Descriptive statistics were applied to compare breast and gynecologic cancer survivorship research. RESULTS: Among 160 National Institutes of Health-funded grants for female organ-related cancer survivorship, 144 (90%) focused on breast cancer and 16 (10%) on gynecologic cancers. Breast cancer survivorship research received more funding ($188.35 million for 4,100,000 survivors) compared to gynecologic cancer survivorship research ($15.41 million for 796,000 survivors). Per-survivor funding was also higher for breast cancer ($9.69 per survivor) than for gynecologic cancers ($2.15 per survivor). Overall, most survivorship studies were interventional (60%), with randomized controlled trials as the predominant design. The primary study focus was on late and long-term effects of cancer treatment (53%), followed by health promotion (21%) and care delivery (16%). CONCLUSION: National Institutes of Health funding for gynecologic cancer survivorship research is substantially lower than that for breast cancer, even when accounting for survivor prevalence. The findings highlight the need for equitable resource allocation to ensure comprehensive survivorship support for gynecologic cancer survivors. Increased funding and gynecology-related research efforts are necessary to address the unique challenges faced by this population and to optimize long-term outcomes.
Pardo N, Kingdom J, Nevo O
… +2 more, Pardo A, Melamed N
Am J Obstet Gynecol
· 2026 Mar · PMID 41833703
·
Publisher ↗
BACKGROUND: Umbilical artery Doppler plays a central role in the diagnosis and management of placenta-mediated early-onset fetal growth restriction. However, interpreting available data on the rate of umbilical artery Do...BACKGROUND: Umbilical artery Doppler plays a central role in the diagnosis and management of placenta-mediated early-onset fetal growth restriction. However, interpreting available data on the rate of umbilical artery Doppler progression remains challenging, primarily because many prior studies included patients with varying degrees of fetal growth restriction severity. Consequently, the aggregated data resulted in estimates of umbilical artery Doppler progression that are often too broad for clinical use. Therefore, there is a need for more robust data to define the deterioration rate of umbilical artery Doppler abnormalities in more homogeneous patient cohorts with definitive evidence of severe placenta-mediated early-onset fetal growth restriction. OBJECTIVE: To quantify the rate of progression of umbilical artery Doppler abnormalities, time to delivery, and risk of fetal death in a homogeneous cohort of singleton pregnancies with severe placenta-mediated early-onset fetal growth restriction that ultimately progressed to late umbilical artery Doppler abnormalities (defined as intermittent or persistent absent or reversed end-diastolic flow). STUDY DESIGN: We conducted a retrospective descriptive study of singleton pregnancies with severe early-onset fetal growth restriction that ultimately progressed to late umbilical artery Doppler abnormalities in a single tertiary center (2014-2024). Umbilical artery Doppler findings at each visit were categorized according to the following order of progression: normal (umbilical artery pulsatility index <95th percentile), elevated umbilical artery-pulsatility index (>95th percentile), intermittent absent end-diastolic flow, persistent absent end-diastolic flow, intermittent reversed end-diastolic flow, and persistent reversed end-diastolic flow. The primary outcomes were the timing of progression between successive umbilical artery Doppler abnormalities and the interval from each Doppler abnormality to either delivery or fetal death. RESULTS: A total of 241 patients met the study criteria and underwent 1835 Doppler assessments. The mean gestational age at which late umbilical artery Doppler abnormalities were first observed was 27.5±3.2 weeks, and the mean gestational age at birth was 28.6±3.1 weeks. Fetal death was observed in 11 pregnancies (4.6%), although the majority of these cases (10/11) were either previable (4/11) or occurred because the parents declined intervention due to poor prognosis (6/11). The mean±standard deviation time of umbilical artery Doppler progression was 7±8 days from elevated umbilical artery-pulsatility index to intermittent absent end-diastolic flow, 6±6 days from intermittent absent end-diastolic flow to absent end-diastolic flow, 6±6 days from absent end-diastolic flow to intermittent reversed end-diastolic flow, and 4±5 days from intermittent reversed end-diastolic flow to reversed end-diastolic flow. The time to delivery was greatest in cases of elevated umbilical artery-pulsatility index >95th percentile (median 6 [interquartile range, 3-12] days) or abnormal cerebral Doppler (5 [2-11] days) and was shorter for intermittent absent end-diastolic flow (4 [2-10] days), absent end-diastolic flow (3 [1-8] days), intermittent reversed end-diastolic flow (0 [0-3] days), and reversed end-diastolic flow (0 [0-1] days). The risk of observed fetal death increased progressively with the severity of umbilical artery Doppler abnormalities, from 0.6% in cases with intermittent absent end-diastolic flow to 11.5% in cases with reversed end-diastolic flow. All cases of observed fetal death showed evidence of either reversed end-diastolic flow in the umbilical artery or abnormal ductus venosus Doppler at the examination preceding fetal death. CONCLUSION: In this study, we provided estimates of umbilical artery Doppler deterioration rate, stage-specific fetal death risk, and time to delivery. Given the high-risk case mix, these intervals likely represent worst-case timelines and can therefore guide the minimum surveillance frequency, the timing of antenatal corticosteroid administration, and delivery timing planning. Patients and care providers can be reassured that the risk of fetal growth restriction-related fetal death between visits is low when neither reversed end-diastolic flow in the umbilical artery nor abnormal ductus venosus Doppler is present.
Meislin R, Bianco A, Wang JG
… +8 more, Kravitz E, Ponce J, Hanson C, Katz D, Choo E, Shaz D, Que LG, Bose S
Am J Obstet Gynecol
· 2026 Mar · PMID 41833702
·
Publisher ↗
Asthma affects 8% to 13% of pregnancies and is associated with adverse maternal and fetal outcomes. The evidence consistently demonstrates that uncontrolled asthma in pregnancy is the primary driver of this pregnancy ris...Asthma affects 8% to 13% of pregnancies and is associated with adverse maternal and fetal outcomes. The evidence consistently demonstrates that uncontrolled asthma in pregnancy is the primary driver of this pregnancy risk rather than the diagnosis alone. Compared with controlled disease, uncontrolled asthma has been associated with higher rates of preterm birth (adjusted odds ratio: 1.3 vs 1.6), hypertensive disorders of pregnancy (adjusted odds ratio: 1.2 vs 1.5), and impaired fetal growth or small-for-gestational-age neonates (adjusted odds ratio: 1.2 vs 1.4). This study aimed to review the biologic pathways linking active asthma to adverse pregnancy outcomes, including airway inflammation, oxidative stress, placental dysfunction, and maternal hypoxemia. Building on modern understanding of asthma heterogeneity, this review integrated phenotype- and endotype-informed principles with pregnancy-specific immunologic shifts, highlighting how a Th2-predominant state may exacerbate disease activity and modify risk in susceptible patients. Multiple modifiable contributors, including viral infections, air pollution, indoor exposures, obesity, allergic rhinitis, gastroesophageal reflux disease, and obstructive sleep apnea, further influence disease activity and underscore the importance of active management. This study synthesized updated, practical guidance aligned with international asthma guidelines emphasizing proactive monitoring, routine assessment of symptoms and objective measures, and continuation or escalation ("step-up") of controller therapy to maintain control throughout pregnancy. In addition, this study reviewed contemporary strategies for asthma management, including antireliever therapy and maintenance and reliever therapy, and highlighted nonpharmacologic interventions. Across this review, the emphasis lies on the importance of asthma control, with a goal of complete remission of symptoms, to optimize maternal-fetal outcomes. This study highlighted areas of future research, including the implementation of precision-guided asthma care in pregnancy and the use of biologic therapies to prevent active disease.