American Journal Of Perinatology[JOURNAL]
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200 papers
Predictors of Infection after Cesarean Delivery.
Saad AF, McGee PL, Parry S … +12 more , Thorp JM, Longo M, Tita ATN, Gyamfi-Bannerman C, Chauhan SP, Metz TD, Rood K, Rouse DJ, Bailit JL, Grobman WA, Simhan HN, Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network, Bethesda, Maryland, United States
Am J Perinatol · 2026 Mar · PMID 41850326 · Publisher ↗
Postoperative infections remain a significant complication of cesarean delivery (CD), with rates ranging from 3 to 30%. These infections increase healthcare costs, prolong recovery, and negatively impact maternal outcome...
Postoperative infections remain a significant complication of cesarean delivery (CD), with rates ranging from 3 to 30%. These infections increase healthcare costs, prolong recovery, and negatively impact maternal outcomes. Identifying risk factors for infection might help guide preventative strategies to mitigate this burden. The primary aim of this study was to develop and validate a predictive model for infection after CD using preoperative and perioperative characteristics.This study was a secondary analysis of a multicenter randomized trial comparing tranexamic acid versus placebo to prevent postpartum hemorrhage in individuals undergoing either scheduled or unscheduled CD. The primary outcome of this analysis was a composite of surgical site infection, endometritis, or pelvic abscess diagnosed within 6 weeks postpartum. Univariable and multivariable bootstrapped logistic regression models with stepwise selection were used to identify predictors of infection. Model performance was evaluated using the receiver operator curve area under the curve (AUC).Of the 10,995 participants, 287 (2.6%) developed an infection. Significant predictors included tobacco use (OR: 1.67, 95% CI: 1.21-2.31), BMI at delivery ≥ 30 kg/m (OR: 1.41, 95% CI: 1.04-1.91), labor before cesarean (OR: 1.71, 95% CI: 1.33-2.18), longer surgical duration (OR: 1.01 per minute, 95% CI: 1.01-1.02), uterine incision extension (OR: 1.54, 95% CI: 1.02-2.34), and the use of uterotonics other than oxytocin (OR: 1.48, 95% CI: 1.09-2.02). The predictive model demonstrated modest discrimination with an AUC of 0.64 (95% CI: 0.61-0.68).Multiple modifiable and nonmodifiable factors influence infection after CD. This predictive model offers a framework for assessing individualized risk, though its modest performance indicates that further refinement is necessary before it can be confidently applied in clinical decision-making. Future research should aim to enhance predictive accuracy and explore whether risk stratification meaningfully informs prevention or patient counseling strategies. · This study aimed to create a model to predict postpartum infection after cesarean delivery.. · Several factors were linked to higher infection risk after cesarean delivery. These included tobacco use, obesity, labor before cesarean, longer surgery, uterine incision extension, and uterotonic use.. · The model had moderate accuracy, with an AUC of 0.6.. · Common perioperative factors may help predict infection risk after cesarean delivery..
Device Performance and Parental Perception of the Skincubator 2.0, a Wearable Device to Support Prolonged Skin-to-Skin Care for Preterm Infants.
Nitzan I, Phillips R, Morag I … +4 more , Kipnis O, Shotten T, Hammerman C, Nissimov S
Am J Perinatol · 2026 Mar · PMID 41850325 · Publisher ↗
Early and prolonged skin-to-skin care (SSC) reduces morbidity and mortality in preterm neonates more than intermittent SSC. Extreme preterm neonates generally do not receive early prolonged SSC for several reasons, inclu...
Early and prolonged skin-to-skin care (SSC) reduces morbidity and mortality in preterm neonates more than intermittent SSC. Extreme preterm neonates generally do not receive early prolonged SSC for several reasons, including safety concerns and parental challenges. To facilitate prolonged SSC in this population, we invented the Skincubator, a device to overcome SSC barriers. The Skincubator enables SSC, while safely securing the baby, lines, and tubes and maintaining warmth and humidity. A retractable Transfer Pad enables transfers to and from the caregiver with minimal handling, while keeping baby is safely positioned. Once on the parent, the pad is retracted to allow full SSC. The objective of this study is to assess the Transfer Pad performance and parent satisfaction from the Skincubator.An observational study performed during the learning phase of the Skincubator feasibility study. Success rates of transfer with the retractable pad and humidity within the Skincubator were recorded. Parents were provided with questionnaires to rate (on a Likert scale of 1-5) satisfaction with the safety and convenience of the Skincubator and traditional SSC (t-SSC).Twelve babies were treated in the Skincubator by 18 parents (10 mothers, 8 fathers) for 53 sessions. Two babies were invasively ventilated during Skincubator care. Average Skincubator session time was 146 ± 52 minutes. Humidity within the Skincubator was 71 ± 11%. The retractable pad transfer succeeded in 103 of 106 attempts. Parents were very satisfied with the Skincubator SSC safety and satisfied/neutral with the safety of t-SSC ( = 0.001, Wilcoxon signed-rank test. Parents were satisfied with the Skincubator SSC convenience and neutral with the convenience of t-SSC ( = 0.02).The Skincubator allows transfer to and from SSC within a warm, humidified environment. Parents were more satisfied with the safety and convenience of Skincubator SSC as compared with t-SSC. The Skincubator may support parents in performing longer hours of SSC. · Early prolonged SSC improves preterm infants' outcome but may be challenging.. · To mitigate several SSC barriers, we invented the Skincubator in a wearable incubator for prolonged SSC.. · The Skincubator allows transfer to and from SSC within a warm, humidified environment.. · Compared with t-SSC, parents were more satisfied with the Skincubator safety and convenience.. · The Skincubator may support parents in performing longer hours of SSC..
Maternal Hemodynamic Assessment at Term for Prediction of Adverse Neonatal Outcomes: The Experience from a Referral Italian Hospital.
Guariglia G, Lecis S, Tramontano AL … +7 more , Cuoghi Costantini R, Bugiolacchi J, Pedrini V, Ciccarone V, Neri I, Marca A, Monari F
Am J Perinatol · 2026 Mar · PMID 41844217 · Publisher ↗
Our study aims to explore the possible predictive role of Ultrasound Cardiac Output Monitoring (USCOM) parameters toward unfavorable maternal and neonatal complications during labor and delivery in a cohort of women foll...
Our study aims to explore the possible predictive role of Ultrasound Cardiac Output Monitoring (USCOM) parameters toward unfavorable maternal and neonatal complications during labor and delivery in a cohort of women followed by the high-risk pregnancy clinic of a tertiary Italian hospital.A prospective, monocentric descriptive study was run at the AOU Policlinico of Modena. USCOM was implemented in March 2022. Patients in charge of the high-risk pregnancy clinic who received USCOM hemodynamic monitoring during their whole pregnancy were included in the study, with the last examination performed around 37 weeks. By considering the characteristics of labor and delivery, they were divided into two groups (complicated delivery and uncomplicated delivery). Adverse maternal outcomes (AMOs) and adverse neonatal outcomes (ANOs) were prospectively collected from electronic records and analyzed using the R version 4.3.2 statistical software. Continuous variables were presented as means with standard deviations, and categorical variables as counts and percentages.While maternal and perinatal variables, including maternal age, parity, and anthropometric measures, were comparable between groups, significant differences emerged in the USCOM measurements. Cardiac output (CO) was significantly lower in the group with ANO compared with uneventful neonates (4.35 ± 1.42 L/min vs. 4.97 ± 1.44 L/min; adjusted odds ratio [aOR] = 0.79; 95% CI: 0.49, 0.99, = 0.049). Additionally, peak velocity of ventricular ejection (VPK) was significantly reduced in neonates with ANO compared with neonates without adverse complications (0.92 ± 0.27 vs. 1.08 ± 0.42; aOR = 0.08, 95% CI: 0.01-0.63, = 0.016). Finally, cardiac index was lower (2.26 ± 0.67 vs. 2.54 ± 0.74, aOR = 0.49; 95% CI: 0.23-1.03, = 0.060) and systemic vascular resistance was higher (1,800.9 ± 546 vs. 1,638.2 ± 588.4, aOR = 1.00; 95% CI: 1.00-1.00, = 0.245) in the ANO group comparing with those without ANO, although both results do not reach statistical significance.Our findings suggest that the implementation of USCOM in clinical practice may enhance the identification of women at increased risk for ANOs, particularly those presenting with low CO and reduced ventricular peak velocity (VPK) before labor. Further studies with larger sample sizes are needed to confirm and strengthen these observations. · USCOM identifies women at increased risk for adverse neonatal outcomes.. · USCOM improves the quality and safety of obstetric care.. · USCOM is applicable across obstetric settings, including labor wards..
Pregnancy Complications and Outcome in Women with a History of Cerebrovascular Events.
Manovitch Z, Perry M, Shust Barequet S … +1 more , Simchen MJ
Am J Perinatol · 2026 Mar · PMID 41839208 · Publisher ↗
Pregnancy induces a hypercoagulable state, heightening the risk of thromboembolic events, particularly for women with prothrombotic tendencies or a history of thromboembolism. Although anticoagulant treatment may improve...
Pregnancy induces a hypercoagulable state, heightening the risk of thromboembolic events, particularly for women with prothrombotic tendencies or a history of thromboembolism. Although anticoagulant treatment may improve outcomes for women with a prior stroke and thrombophilic disorders, the risk of recurrent thromboembolic events during subsequent pregnancies remains unclear. This study aims to assess pregnancy outcomes and the risk of recurrence in women with a history of stroke.This retrospective study analyzed pregnancy outcomes of women with a history of cerebrovascular events who delivered at Sheba Medical Center between 2005 and 2023. Data included cerebrovascular events, pregnancy outcomes, and obstetric complications. Comprehensive thrombophilia screening was performed. Patients were treated with low-molecular-weight heparin (LMWH) or low-dose aspirin (LDA). A control group without cerebrovascular events matched for maternal age, delivery timing, and plurality was used for comparison.A total of 107 women were included, 49 pregnancies with a previous cerebrovascular thrombosis, and 58 with a previous transient cerebrovascular ischemic attack. About 50.4% of the study group women had prothrombotic conditions. Cesarean section rates were higher in the study group (44%) versus controls (14%, < 0.001). Preterm delivery rates were also higher (11 vs. 1.9%, = 0.0057). Other obstetric complications were similar. A subgroup analysis of women without thrombophilia still showed increased risks for cesarean section and preterm delivery. Two women experienced recurrent thromboembolic events during pregnancy, both without maternal thrombophilia.Higher cesarean and preterm delivery rates were observed, regardless of thrombophilia status. The recurrence rate of thromboembolic events was low (2.2%), highlighting that with appropriate prenatal care and tailored prophylactic treatment, women with a history of cerebrovascular events may achieve favorable pregnancy outcomes. · This study analyzed pregnancy outcomes in women with a history of stroke.. · Cesarean section rates were higher in the study group versus controls. Preterm delivery rates were also higher, while other obstetric complication rates were similar.. · The recurrence rate of thromboembolic events was low.. · With appropriate care, women after cerebrovascular events may achieve favorable outcomes..
Current Practices and Gaps in Antenatal Counseling Training in United States Neonatal-Perinatal Medicine Fellowships.
Bartlett M, Yang K, Frost M
Am J Perinatol · 2026 Mar · PMID 41839207 · Publisher ↗
Antenatal counseling (AC) is vital in neonatal-perinatal medicine (NPM) to support families and align care plans. NPM fellows report gaps in communication and AC training, and current literature offers little on effectiv...
Antenatal counseling (AC) is vital in neonatal-perinatal medicine (NPM) to support families and align care plans. NPM fellows report gaps in communication and AC training, and current literature offers little on effective teaching methods. Standardized recommendations to assess AC skills are lacking. To create effective training programs, we must first understand how AC is currently being taught and evaluated in clinical education. Our aim was to assess the national landscape through an environmental scan of AC curriculum in NPM fellowship to establish a baseline of current educational practices and identify areas for improvement.Survey was developed based on a literature review and expert collaboration, with pilot testing performed on a subset of program leadership and fellows. It was distributed via email listserv nationally to NPM fellows and fellowship program leadership in 2024 to 2025. Survey included select-all, multiple-choice, and Likert-scale questions.Thirty-three percent of programs (33/102) and 18% of fellows (146/815) completed the survey. Most institutions use various methods to teach AC, though some report no formal training. Over 80% of fellows want more AC training. Only 39% of fellows reported being observed more than three times during their fellowship regardless of year in fellowship, whereas 79% noted they typically perform four or more consults per month while on service. Most programs (85%) lack formal assessment methods.While diverse educational modalities are employed in AC training, fellows desire more training. Limited observation and assessment highlight a need for improved curricula and formal feedback to better support skill development. · Fellows want more antenatal counseling training.. · Antenatal counseling observation and feedback are rare despite volume.. · Most programs lack formal assessment of fellows performing antenatal consults..
Association of Prepregnancy Obesity and Excessive Gestational Weight Gain with Perinatal Outcomes among Patients with Pregestational Diabetes.
Markovic ES, Ward H, Khanuja K … +1 more , McLaren R
Am J Perinatol · 2026 Jun · PMID 41825476 · Publisher ↗
OBJECTIVE: Prepregnancy obesity, excessive gestational weight gain (GWG), and pregestational diabetes (PGDM) are individually associated with adverse maternal and neonatal outcomes. However, little is known about the int...
OBJECTIVE: Prepregnancy obesity, excessive gestational weight gain (GWG), and pregestational diabetes (PGDM) are individually associated with adverse maternal and neonatal outcomes. However, little is known about the intersection of these comorbidities. This study aimed to determine if patients with PGDM and excessive GWG or prepregnancy obesity had worse obstetric outcomes. STUDY DESIGN: This was a population-based cohort study using data from the 2021 to 2023 National Vital Statistics System of singleton, nonanomalous, live births at 23 to 41 weeks with a history of maternal PGDM. Births were divided into four groups based on prepregnancy body mass index (pBMI) and GWG: (1) normal pBMI and GWG, (2) normal pBMI and excessive GWG; (3) obese pBMI and normal GWG, and (4) obese pBMI and excessive GWG. The primary outcome, a composite of maternal and neonatal adverse outcomes, was compared with group 1 (births from parents with normal pBMI and GWG) as the referent using logistic regression to adjust for confounders. RESULTS: Of the 53,631 births that met the inclusion criteria, 6.3, 15.1, 21.5, 57.0% were in groups 1 to 4, respectively. After adjusting for maternal age, nulliparity, chronic hypertension, and previous preterm birth, compared with group 1 (normal pBMI-normal GWG), births in groups 2 ( normal pBMI-excess GWG; adjusted odds ratio [aOR]: 1.93, 95% confidence interval [CI]: 1.77-2.09), 3 ( obese pBMI-normal GWG; aOR: 1.63, 95% CI: 1.51-1.77), and 4 ( obese pBMI-excess GWG aOR: 2.54, 95% CI: 2.36-2.73) had higher odds of composite adverse pregnancy outcomes. CONCLUSION: Both prepregnancy obesity and excessive GWG are associated with adverse perinatal outcomes in pregnancies complicated by PGDM. Excessive GWG was a stronger driver of these outcomes. These findings highlight the importance of prepregnancy weight optimization and gestational weight management to reduce associated risks. KEY POINTS: · Prepregnancy obesity and excessive GWG are associated with adverse perinatal outcomes in pregnancies complicated by PGDM.. · Excessive GWG and obese BMI had the worst perinatal outcomes.. · Excessive GWG was a stronger predictor of adverse perinatal outcomes than obese prepregnancy BMI.. · Class III prepregnancy obesity (BMI ≥ 40) with normal GWG had similar rates of composite adverse pregnancy outcomes as those with normal BMI and excessive GWG..
Association between Neonatal Hypoglycemia and 30-Day Breastfeeding Outcomes among Gravidas with Type 2 Diabetes.
Rogerson D, Jacobs M, Sarker M … +13 more , Boggess K, Battarbee AN, Refuerzo J, Zork N, Olson G, Durnwald C, Aagaard K, Wallace K, Scifres C, Rosen T, Longo S, Ramos GA, MOMPOD Study Consortium
Am J Perinatol · 2026 Mar · PMID 41806854 · Full text
Pregestational diabetes is associated with low prevalence of breastfeeding due to low rates of intent, delayed lactogenesis, and early infant separation. It is hypothesized that the perceived need for formula supplementa...
Pregestational diabetes is associated with low prevalence of breastfeeding due to low rates of intent, delayed lactogenesis, and early infant separation. It is hypothesized that the perceived need for formula supplementation due to neonatal hypoglycemia, coupled with maternal low early milk supply, is a barrier to breastfeeding initiation. Whether there is an association between neonatal hypoglycemia and breastfeeding is unknown. We evaluated associations between neonatal hypoglycemia and breastfeeding.This is a secondary analysis of a randomized controlled trial of metformin versus placebo plus insulin in participants with type 2 diabetes. We included participants who delivered a liveborn neonate, endorsed intention to breastfeed, and had neonatal hypoglycemia data available. A breastfeeding questionnaire was administered at 30-day postpartum, and outcomes were compared between neonates with and without hypoglycemia. The primary outcome was prevalence of exclusive, partial, or no breastfeeding at 30-day postpartum. Secondary outcomes included time to breastfeeding cessation and contributing factors. Characteristics were compared with chi-square, -tests, or Wilcoxon tests.A total of 420 participants in the primary study (53%) completed an antepartum survey, including a question about intent to breastfeed. After exclusion criteria were applied, 370 (91%) of 405 possible participants reported intention to breastfeed. Among these 370 who met criteria and had intention to breastfeed, 265 (72%) responded to the 30-day postpartum questionnaire. Of these 265, 114 (43%) had neonatal hypoglycemia and 151 (57.0%) did not. Prevalence of not breastfeeding (35 vs. 37%), exclusive breastfeeding (18 vs. 13%), and partial breastfeeding (47 vs. 50%) did not differ between neonates with and without hypoglycemia ( = 0.51). This persisted in a neonatal intensive care unit-admitted subgroup ( = 0.29). Participants who stopped breastfeeding did so on average at 2.6 to 2.8 weeks ( = 0.76).This study found no impact of neonatal hypoglycemia on 30-day postpartum breastfeeding prevalence among participants with diabetes. · Type 2 diabetes reduces the likelihood of breastfeeding, and the barriers are not fully known.. · Neonatal hypoglycemia is hypothesized to be one barrier to breastfeeding among this population.. · Neonatal hypoglycemia did not impact breastfeeding among diabetic gravidas 30-day postpartum.. · This remained true among neonates admitted to the neonatal intensive care unit.. · Further research examining barriers to breastfeeding among gravidas with diabetes is needed..
Early Multimodal Assessment for Prediction of Cerebral Palsy in Neonatal Hypoxic-Ischemic Encephalopathy.
Isleyen F, Kocaman C, Gunes AO … +5 more , Deveci MF, Yilmaz C, Yilmaz A, Ekinci G, Akman I
Am J Perinatol · 2026 Mar · PMID 41791421 · Publisher ↗
The objective of this study is to determine the predictive value of magnetic resonance imaging (MRI), amplitude-integrated electroencephalography (aEEG), the Hammersmith Neonatal Neurological Examination (HNNE), and the...
The objective of this study is to determine the predictive value of magnetic resonance imaging (MRI), amplitude-integrated electroencephalography (aEEG), the Hammersmith Neonatal Neurological Examination (HNNE), and the General Movements Assessment (GMA) for cerebral palsy (CP) in neonates with hypoxic-ischemic encephalopathy (HIE), and to evaluate whether combining these modalities improves diagnostic accuracy.In this prospective two-center cohort study, 53 term or late-preterm infants with HIE treated with standardized therapeutic hypothermia (33.5°C for 72 hours) were evaluated. aEEG and MRI findings were compared with concurrent HNNE and GMA results. CP was diagnosed during follow-up by a pediatric neurologist blinded to neonatal data. Diagnostic performance was analyzed using receiver-operating characteristic curves and multivariable logistic regression according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.CP developed in 11 infants (20.8%). aEEG showed the highest predictive accuracy (area under the curve = 0.816 [95% confidence interval: 0.65-0.98]), and abnormal aEEG independently predicted CP (odds ratio = 18.5, = 0.004). The combined "MRI or aEEG abnormal" model achieved the best overall accuracy (86.8%), with sensitivity = 90.9% and negative predictive value = 97.3%. MRI and HNNE had moderate predictive value, whereas GMA showed high specificity but low sensitivity.aEEG emerged as a robust and independent early biomarker for CP prediction after HIE. Combining aEEG with MRI substantially enhanced diagnostic precision, reflecting complementary functional and structural brain injury mechanisms. Although HNNE and GMA add screening value, they are insufficient alone. Standardized multimodal protocols integrating structural (MRI), functional (aEEG), and clinical (HNNE-GMA) assessments should be incorporated into clinical practice to improve early prognostication and guide neuroprotective interventions. · Early multimodal tools improve CP prediction.. · MRI and aEEG show higher diagnostic accuracy.. · Low HNNE scores indicate increased CP risk.. · Abnormal GMA supports early neurological impairment.. · Combining MRI + GMA + HNNE enhances prediction..
Maternal, Obstetric, and Perinatal Outcomes in Late Preterm and Term Births with Gestational Diabetes versus Normoglycemia.
Grantz KL, Gleason JL, Yeung E … +5 more , Tekola-Ayele F, Putnick DL, Ma Y, Scifres CM, Chen Z
Am J Perinatol · 2026 Jun · PMID 41791420 · Publisher ↗
OBJECTIVE: The objective of this study was to evaluate obstetric, maternal, and perinatal outcomes by delivery week for pregnancies with gestational diabetes mellitus (GDM) and without diabetes. STUDY DESIGN: We conducte...
OBJECTIVE: The objective of this study was to evaluate obstetric, maternal, and perinatal outcomes by delivery week for pregnancies with gestational diabetes mellitus (GDM) and without diabetes. STUDY DESIGN: We conducted a secondary analysis of electronic medical record data from 9,696 (5.3%) GDM pregnancies and 173,323 pregnancies without any diabetes delivered at 34 to 40 weeks. Composite and individual outcomes included maternal (e.g., death, hypertensive disorders, hemorrhage); primary neonatal morbidity and perinatal mortality (e.g., death, ventilation use, sepsis, seizures, injury); secondary neonatal (e.g., shoulder dystocia, hypoglycemia); and neonatal respiratory support/morbidity from chart review. Modified Poisson regression with generalized estimating equations calculated adjusted relative risks (RR) for differences in outcome rates by GDM status and fetus at risk model for outcomes at delivery compared with ongoing pregnancies. RESULTS: A higher proportion of GDM pregnancies delivered at each week prior to 39 weeks compared with no diabetes (2.5, 3.9, 7.4, 17.2, 32, and 36.9% for GDM and 1.4, 2.3, 5.0, 11.0, 24.6, and 38.4% for no diabetes, at 34, 35, 36, 37, 38, and 39 weeks, respectively, < 0.001). Among GDM, compared with ongoing pregnancy, risk of maternal composite was higher for delivery at 37 weeks, 20.5 versus 11.6% (RR: 1.71; 95% confidence interval [CI]: 1.51-1.92) and 38 weeks, 14.9 versus 9.4% (RR: 1.62; 95% CI: 1.42-1.84) driven by hypertensive disorders (18.3% at 37 and 23.5% at 38 vs. 10.1% at 39 weeks); and risk of primary neonatal composite was higher at 37 weeks, 2.3 versus 1.1% (RR: 2.00; 95% CI: 1.33-3.00). Risk of stillbirth was higher at 37 weeks, 0.41 versus 0.11% (RR: 3.62; 95% CI: 1.22-10.75) among GDM, suggesting that it was an indication for earlier delivery. CONCLUSION: For GDM-complicated pregnancies, earlier delivery at 37 and 38 weeks compared with ongoing pregnancy was associated with higher risk of maternal morbidity likely due to having hypertensive disorders and delivery at 37 weeks with higher risk for serious neonatal morbidity. KEY POINTS: · Assessed outcomes in GDM pregnancies by delivery week.. · Maternal morbidity risk increased at 37 and 38 weeks.. · Neonatal death was rare and unrelated to GDM status.. · Neonatal morbidity risk increased at 37 weeks..
Corrigendum: Impact of Postnatal Heart Rate Assessment on Delayed Cord Clamping in Neonatal Resuscitation.
Yum SK, Galindo RB, Pineda L … +1 more , Yamada NK
Am J Perinatol · 2026 Mar · PMID 41791408 · Publisher ↗
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Hypertensive Disorders of Pregnancy: Factors Associated with Multiple Postpartum Blood Pressure Visits.
Dyre LJ, Falde DL, Branda ME … +3 more , Theiler RN, Butler Tobah YS, Rivera-Chiauzzi EY
Am J Perinatol · 2026 Mar · PMID 41776841 · Publisher ↗
Patients with hypertensive disorders of pregnancy (HDPs) are recommended to attend an early postpartum follow-up visit for blood pressure monitoring. Follow-up frequency for patients with HDPs can vary widely, with some...
Patients with hypertensive disorders of pregnancy (HDPs) are recommended to attend an early postpartum follow-up visit for blood pressure monitoring. Follow-up frequency for patients with HDPs can vary widely, with some patients requiring multiple office visits. We sought to determine factors associated with multiple postpartum blood pressure visits among patients with HDPs.We retrospectively identified patients with HDPs who delivered at our maternity center in 2019 and compared factors between patients who attended a single blood pressure follow-up appointment without requiring further clinical evaluation for hypertension and patients who required multiple postpartum clinical evaluations for persistent hypertension. Univariate logistic regression models were used to identify factors associated with increased odds of having multiple clinically indicated postpartum visits for blood pressure monitoring.We identified 328 patients with HDPs, of whom 260 (79.3%) attended an initial postpartum blood pressure follow-up appointment and were included in further analyses. Of the 260 patients, 70 (26.9%) had multiple blood pressure visits. Factors associated with multiple blood pressure visits included delivery between 34 and less than 37 weeks of gestation (odds ratio [OR], 3.62; 95% CI, 1.07-12.30), systolic blood pressure before discharge of 140 mm Hg or higher (OR, 5.02; 95% CI, 2.57-9.82), and discharge with blood pressure medication (OR, 3.42; 95% CI, 1.82-6.41).Patients with HDPs who deliver preterm, have persistent hypertension before discharge, or are discharged with antihypertensive medication require continued close postpartum observation and continuity of care. · Postpartum follow-up care for patients with HDPs should be tailored to the patient.. · Preterm delivery, persistence of hypertensive blood pressure at discharge, and discharge with antihypertensive medication are associated with multiple postpartum ambulatory office visits.. · High-risk patients should be diligently monitored with postpartum continuity of care..
Anterior Placentation as a Risk Factor for Hemorrhage at the Time of Primary Cesarean Delivery.
Cersonsky TEK, Cabrera C, Cochrane E … +5 more , Rosenberg HM, Edwards S, Bianco A, Vieira LA, Debolt CA
Am J Perinatol · 2026 Mar · PMID 41771501 · Publisher ↗
Anterior placentation is a risk factor for hemorrhage during cesarean delivery in patients with a resolved placenta previa or low-lying placenta. As anterior placentas are sometimes incised at the time of hysterotomy, it...
Anterior placentation is a risk factor for hemorrhage during cesarean delivery in patients with a resolved placenta previa or low-lying placenta. As anterior placentas are sometimes incised at the time of hysterotomy, it is possible that, even in the absence of low-lying placenta or placenta previa, anterior placentation may be associated with higher blood loss at the time of nonlaboring, primary cesarean delivery. Therefore, we sought to identify if there is an association between anterior placentation and peripartum hemorrhage (PPH) in parturients undergoing primary cesarean delivery.This is a retrospective cohort study that included parturients from a tertiary care center who underwent primary cesarean delivery from 2016 to 2022. Patients with known risk factors for PPH (known placenta accreta spectrum, placenta previa, etc.) were excluded from primary analyses. Primary analyses assessed the association via logistic regression between PPH (defined as estimated blood loss [EBL] ≥ 1,000 mL) and anterior placentation. We then assessed if this risk was present in higher risk subgroups (patients using anticoagulation at the time of delivery and patients who underwent vaginal trial of labor prior to primary cesarean) and a lower risk subgroup (those undergoing nonlaboring primary cesarean).The primary cohort consisted of 996 parturients. Of those, 501 had an anterior placenta. Odds ratio of EBL ≥ 1,000 according to anterior placentation was 1.12 (95% confidence interval: 0.80-1.56) in multivariate regression. Risk of PPH was not associated with anterior placentation in higher- and lower-risk subgroups.Anterior placentation alone is not associated with higher EBL in patients undergoing primary cesarean delivery, even in patients using anticoagulation or those requiring intrapartum cesarean. · Anterior placenta and previa increase hemorrhage risk.. · Anterior placentation alone does not increase hemorrhage risk.. · The risk is not increased among those with additional risk factors.. · Placenta location may impact hemorrhage risk..
Sedation-Analgesia Management in Neonates with Hypoxic-Ischemic Encephalopathy under Therapeutic Hypothermia: Feedback from a Local Study on 51 Patients.
Basse C, Boukhris MR, Chaton L … +3 more , Storme L, Bourel-Ponchel E, Flamein F
Am J Perinatol · 2026 Mar · PMID 41771287 · Publisher ↗
The objective of this study is to explore real-world practices in managing sedation-analgesia in a population of neonates with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia.Retrospective data from ne...
The objective of this study is to explore real-world practices in managing sedation-analgesia in a population of neonates with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia.Retrospective data from neonates admitted with hypoxic-ischemic encephalopathy to the neonatal intensive care unit of Lille University Hospital were collected, between December 31, 2018, and July 15, 2022. Drug and dosage of sedation-analgesia during the 96 hours following therapeutic hypothermia initiation were collected. Neonates were divided into four subgroups for principal component analysis, according to neurological examination at discharge: death, severe sequelae, moderate sequelae, no sequelae.Neonates with a favorable outcome were exposed to higher cumulative doses. They were more likely to be exposed to polypharmacy, midazolam, and dexmedetomidine, and increasing doses of these. Daily doses of opioids did not vary significantly. Newborns with acute renal failure had lower cumulative doses. There was no significant difference between newborns with and without hepatic cytolysis.Practice assessments highlight heterogeneity regarding sedation-analgesia, especially within patient groups. Findings indicate that sedation-analgesia is not reassessed as often as it should be to account for specific pharmacokinetic parameters and the physiologic course of recovery. · Although sedation-analgesia is considered standard of care during therapeutic hypothermia, its use may be iatrogenic; therefore, we evaluated our practices to move toward optimized, personalized management.. · Neonates with a favorable outcome were more likely to have been exposed to a higher cumulative dose; increasing doses; polypharmacy; midazolam; and dexmedetomidine.. · Findings indicate that sedation-analgesia is not reassessed as often as it should be..
Neurodevelopmental Care Utilization among Preterm Infants in the Military Health Care System.
Banaag A, Weber Z, Drumm C … +3 more , James G, Koehlmoos T, Vereen R
Am J Perinatol · 2026 Mar · PMID 41771286 · Publisher ↗
This study aims to evaluate variation in neurodevelopmental care utilization in the Military Health System (MHS) for preterm infants.Retrospective cohort study of infants born preterm within the MHS from 2017 to 2021. Pr...
This study aims to evaluate variation in neurodevelopmental care utilization in the Military Health System (MHS) for preterm infants.Retrospective cohort study of infants born preterm within the MHS from 2017 to 2021. Preterm birth was categorized as extreme preterm, very preterm, moderate preterm, late preterm, or unknown. Patient demographics were extracted. The primary outcome was the use of neurodevelopmental care within 2 years of birth.Compared with late preterm births, total use of specialty care was significantly higher ( < 0.05) in moderate, very, and extreme preterm births. Black infants had fewer total visits than White infants (-1.54, < 0.05). Disparities by region of birth were noted, with lower utilization in the Pacific and West South-Central census divisions ( < 0.05).There are differences in neurodevelopmental care utilization among preterm infants in the MHS, driven by gestational age, race, and geography. These findings support the need for a standardized policy on neurodevelopmental follow-up. · Neurodevelopmental utilization varies by sociodemographic factors.. · Despite universal access to care, neurodevelopmental care utilization varies in the military health care system.. · Standardized neurodevelopmental follow-up is needed to ensure equitable access to care..
Point-of-Care Ultrasound in the Evaluation of Systolic Heart Failure During Pregnancy and Postpartum.
Martins JG, Saad A, Saade G … +2 more , Jones M, Pacheco LD
Am J Perinatol · 2026 Mar · PMID 41760135 · Publisher ↗
Point-of-care ultrasound (POCUS) plays a central role in the evaluation of acute and chronic heart failure with reduced ejection fraction, yet its use in obstetric patients remains limited. This expert review outlines a...
Point-of-care ultrasound (POCUS) plays a central role in the evaluation of acute and chronic heart failure with reduced ejection fraction, yet its use in obstetric patients remains limited. This expert review outlines a simplified, qualitative-first approach tailored to the physiological and technical challenges of pregnancy. We present a step-by-step guide that prioritizes feasibility and reproducibility using simple and established echocardiographic views, including the E-point septal separation, mitral annular plane systolic excursion, lung B-lines, and inferior vena cava diameter measurements. Most available data are extrapolated from nonpregnant cohorts, and pregnancy-specific outcome evidence remains limited. This framework aims to support maternal-fetal medicine specialists in integrating POCUS into the bedside evaluation of pregnant individuals with suspected systolic heart failure. · Delayed recognition of systolic HF drives maternal morbidity and mortality.. · POCUS enables rapid bedside qualitative assessment when echo is delayed.. · With structured training, POCUS is feasible to support HF care in pregnancy..
Severe Maternal Morbidity with the Inclusion of Events after Delivery Hospitalization.
Schneider KL, Calkins KL, Romano PS … +3 more , George J, Schott W, Sudhof LS
Am J Perinatol · 2026 Mar · PMID 41748099 · Publisher ↗
Severe maternal morbidity (SMM) is a growing public health concern in the United States. While existing measures capture SMM-related complications during the delivery hospitalization, patients may also experience serious...
Severe maternal morbidity (SMM) is a growing public health concern in the United States. While existing measures capture SMM-related complications during the delivery hospitalization, patients may also experience serious complications after discharge that affect long-term health, mortality, and health care utilization. We aimed to assess the frequency of SMM events occurring after hospital discharge and identify the appropriate postdischarge window for measurement.We analyzed 2019 to 2021 delivery hospitalizations among women aged 12 to 55 years using the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases from 17 states, with follow-up through 2021. SMM was identified per AHRQ measure specifications in inpatient and emergency department encounters. We calculated overall SMM rates as well as specific SMM-related complications, during delivery hospitalization and after discharge.The SMM rate during delivery hospitalization was 87.1 per 10,000 deliveries. Extending the measurement period through 42 days' postdischarge increased the cumulative SMM rate by 32.1% to 115.0 per 10,000 deliveries. More than 80% of SMM events observed within 90 days occurred in the first 42 days after discharge, and 78.6% of these were treated in inpatient settings. Coagulopathy (26.0 per 10,000), acute renal failure (21.4 per 10,000), and sepsis (25.3 per 10,000) had the highest cumulative rates through 42 days' postdischarge. Coagulopathy was the most common complication during the delivery hospitalization (27.7%), whereas sepsis emerged as the most frequent condition treated in the 42 days after discharge (34.4%).Our study highlights the importance of including the postpartum period when measuring SMM. Most events were treated in an inpatient setting, and the majority occurred within 42 days after delivery. To address SMM, research and policy warrants focus on maternal health during and after the delivery hospitalization. · Including events through 42 days' postdischarge increased the cumulative SMM rate by 32.1%.. · Over 80% of SMM events observed within 90 days of delivery discharge occurred in the first 42 days.. · Coagulopathy (including disseminated intravascular coagulation), acute renal failure, and sepsis had the highest cumulative rates through 42 days' postdischarge..
NEC-Associated Bronchopulmonary Dysplasia and the Gut-Lung Axis in Preterm Infants.
Jawale N, Shenberger JS, Shetty AK … +2 more , Gunasekaran V, Garg PM
Am J Perinatol · 2026 Mar · PMID 41748098 · Full text
Prevailing evidence underscores the critical influence of infant gut microbiota on systemic immune responses and intestinal health. The role of functional programming of effector immune cells at extra-intestinal mucosal...
Prevailing evidence underscores the critical influence of infant gut microbiota on systemic immune responses and intestinal health. The role of functional programming of effector immune cells at extra-intestinal mucosal sites is increasing in interest. Common connections between development of gut and lung microbiomes and reciprocal signaling between the two organ systems has reinforced the concept of a "gut-lung axis." Narrative review of existing literature evaluating mechanistic evidence linking microbial dysbiosis and necrotizing enterocolitis (NEC) to development of preterm acute lung injury and subsequent progression to chronic lung disease or bronchopulmonary dysplasia (BPD). Evidence across animal and human studies indicates that gut-derived microbial ligands and metabolites are foundational in programming respiratory immunity. Conversely, primary pulmonary insults appear to trigger reciprocal shifts in gut microbiome function. This bidirectional signaling likely drives the clinical association between NEC-associated systemic inflammation and the subsequent increased risk of BPD. By focusing on mediators involved in this gut-lung crosstalk, we seek to highlight avenues such as microbiome modulation or targeted anti-inflammatory signaling to prevent or reduce the severity of two of the major morbidities of prematurity. · Gut dysbiosis drives systemic inflammation and mediates pro-inflammatory responses in the lungs.. · The communication between gut and lungs is mediated by microbiome, metabolites and immune cells.. · Modulating the gut microbiome presents a promising strategy for prevention of BPD in preterm infants.
Fetal and Neonatal Heart Rate Trends in Preterm Delivery: A Clinical Study from the Week before to the Week after Birth.
Eenkhoorn C, Goos TG, Franx A … +4 more , Dankelman J, Taal HR, Willemsen SP, Eggink AJ
Am J Perinatol · 2026 Feb · PMID 41730274 · Publisher ↗
This study aimed to explore the fetal heart rate trend in the week before birth, the transition from fetal to neonatal heart rate, and the neonatal heart rate trend in the week after birth in preterm neonates admitted to...
This study aimed to explore the fetal heart rate trend in the week before birth, the transition from fetal to neonatal heart rate, and the neonatal heart rate trend in the week after birth in preterm neonates admitted to a tertiary care hospital, considering maternal and neonatal factors.A retrospective cohort study was conducted, including neonates born between 24 and 34 weeks of gestation. Baseline heart rate, average deceleration capacity, standard deviation, skewness, and sample entropy were assessed using interrupted time series and difference-in-differences analyses. Subgroup analyses were performed according to gestational age at birth, sex, birth weight, mode of delivery, Apgar score at 5 minutes, umbilical cord pH, and neonatal medication.The fetal and neonatal heart rate of 123 patients was analyzed. After birth, step change of baseline (2.23 bpm, < 0.05), average deceleration capacity (0.43 bpm, < 0.001), and skewness (0.47 nu, < 0.001) increased, while sample entropy (-0.68 bits, < 0.001) and standard deviation (-1.15 bpm, < 0.001) decreased. Postnatally, baseline increased in linear slope and decreased in quadratic slope (both < 0.001). Average deceleration capacity decreased in linear slope ( < 0.001). Sample entropy and standard deviation increased in linear slopes (both < 0.001). Skewness increased in quadratic slope ( < 0.05). Subgroup analyses revealed that delivery mode, medication, and birth weight modulated these trends.This study provides unique insights into heart rate frequency and variability trends during the period around preterm birth. It highlights the dynamic physiological adaptation that occurs during the transition from intrauterine to extrauterine life in preterm infants and may help inform future research on fetal and neonatal monitoring and clinical management. · Heart rate frequency and variability dynamics were assessed around preterm birth in a NICU cohort.. · After birth, heart rate frequency increased while variability measures decreased.. · Heart rate frequency and variability differed by gestational age, birth weight, medication, and delivery mode..
Deferred Cord Clamping and Weight Difference for Very Preterm Infants.
Quinn MK, Katheria AC, Profit J … +1 more , Lee HC
Am J Perinatol · 2026 Mar · PMID 41720473 · Publisher ↗
The objective of this study is to estimate the difference in first-recorded weight associated with deferred cord clamping (DCC) among very preterm infants (< 32 weeks' gestational age) using real-world neonatal intensive...
The objective of this study is to estimate the difference in first-recorded weight associated with deferred cord clamping (DCC) among very preterm infants (< 32 weeks' gestational age) using real-world neonatal intensive care unit dataRetrospective cohort study using the California Perinatal Care Collaborative data from 2016 to 2023 across 138 hospitals. Infants with gestational ages between 22 and 31 weeks were included. Exclusions were cord milking, death in the delivery room, or missing data. DCC exposure was defined as a delay in cord clamping of at least 30 seconds. Analyses used linear regression adjusting for gestational age (in days) as a second-order polynomial and intrauterine growth restriction (IUGR).Of 39,013 eligible infants, 6,626 were excluded (cord milking, delivery room deaths, and missing DCC information), leaving 32,387 very preterm infants for the analysis. The mean weight for infants who received DCC was 1,338 g (standard deviation [SD]: 404) compared with 1,290 g (SD: 431) for those who did not. After adjusting for gestational age and IUGR, DCC was associated with 24-g higher first-recorded weight (95% confidence interval: 18-29).In very preterm infants, at least 30 seconds of DCC is associated with a modest increase (24 g) in first-recorded weight. This finding reinforces evidence from small clinical trials showing increased blood volumes and weight gains attributed to DCC. · DCC of at least 30 seconds is linked to 24 g higher weights in very preterm infants.. · Weight gain from DCC is modest but aligns with prior physiological evidence.. · Real-world evidence on DCC's impact on early weight is limited..
Acceptability and Feasibility of an Educational Intervention to Improve Researcher-Participant Interactions in a Neonatal Intensive Care Unit Clinical Trial: Research Team Feedback on the BRIEF Intervention.
Kraft SA, Duenas DM, Kelsh A … +5 more , Oslin E, Gray MM, Juul SE, Weiss EM, BRIEF-DIVI Collaborative
Am J Perinatol · 2026 Mar · PMID 41720472 · Full text
Interactions with families are essential to successful recruitment conversations that promote informed decision-making about clinical research enrollment. However, there is little evidence about how to implement communic...
Interactions with families are essential to successful recruitment conversations that promote informed decision-making about clinical research enrollment. However, there is little evidence about how to implement communication-oriented recruitment training among pediatric clinical research teams. Our objective was to evaluate the feasibility and acceptability of Better Research Interactions for Every Family (BRIEF), a multipart educational intervention to improve relationship-based conversations about clinical trial enrollment with families in the neonatal setting.We piloted BRIEF in partnership with a neonatal clinical research team. Research team members completed surveys following the BRIEF intervention's online module and the BRIEF group training session. They completed self-assessments after consent discussions before and after the BRIEF intervention, in which they rated their achievement of recruitment skills taught in BRIEF. Research team members also completed a final study interview to provide feedback on the intervention components, training content, and use of skills in practice.All nine research team members completed all components of BRIEF. Survey responses showed moderate to low satisfaction with previous recruitment training before BRIEF and high satisfaction with the BRIEF training. Self-assessments showed significant increases in reported partnership with bedside nursing ( = 0.02) and confirmation of family names ( = 0.05) after BRIEF training. Interviews provided further evidence of overall satisfaction with the BRIEF training, its content, and the skills learned, as well as opportunities for improvement, particularly in supporting challenging conversations.This pilot study demonstrated the feasibility and acceptability of the BRIEF intervention, as well as opportunities for improvement in future training. · It was feasible to implement the BRIEF researcher training in a single-site NICU trial.. · BRIEF training was acceptable to research team members.. · BRIEF training shows potential to improve relationship-based research communication..
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