American Journal Of Perinatology[JOURNAL]
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200 papers
Utility of Serial Cranial Ultrasound in Preterm Infants.
Johnson V, Batt S, Berbari H … +2 more , Mitchell C, Muniraman HK
Am J Perinatol · 2026 Jan · PMID 41468908 · Publisher ↗
This study aimed to describe and evaluate our single-center practice of serial cranial ultrasound (CUS) in preterm infants following the 2020 American Academy of Pediatrics (AAP) clinical report. To evaluate the rate of...
This study aimed to describe and evaluate our single-center practice of serial cranial ultrasound (CUS) in preterm infants following the 2020 American Academy of Pediatrics (AAP) clinical report. To evaluate the rate of cranial abnormalities following the first normal scan and identify risk factors for severe intraventricular hemorrhage (IVH) in the first week of life.A single-center retrospective study over an 8-year study period, from 2016 to 2023. Rates and types of CUS are described and compared over pre- and post-AAP clinical report time epochs. Risk factors associated with severe IVH were analyzed with logistic regression.A total of 727 infants were included. Median number of CUS was 3 (IQR: 2, 4) in both pre- and post-AAP cohort periods. CUS were performed in 289 (39.8%) infants before 7 days of life (DOL), 595 (81.8%) at 7 to 10 DOL, 623 (85.7%) at 4 to 6 weeks, and 361 (49.7%) at term equivalent age (TEA). The rates of abnormal CUS were 139 (48.1%), 364 (61.2%), 401 (64.4%), and 227 (62.9%) of the infants who had CUS at less than 7 days, 7 to 10 days, 4 to 6 weeks, and TEA, respectively. New abnormalities were detected in 13% (48/364) of infants following a normal 7 to 10 DOL scan and 3% (9/290) following a normal 7 to 10 days and 4 to 6 weeks scan. Decreased birth gestational age (odds ratio [OR] = 0.7), advanced resuscitation (OR = 3.4), and birth at outside hospital (OSH; OR = 2.6) were associated with severe IVH before 7 DOL.Our single-center practice of serial CUS was largely consistent with the AAP clinical report. We report that new findings of abnormality following a normal 7 to 10 DOL scan are infrequent and predominantly limited to grade 1 IVH and benign cysts. We identified birth gestation below 25 weeks, birth at an OSH, and advanced resuscitation as risk factors for severe IVH. · Our single center practice of serial cranial ultrasound was largely consistent with the AAP policy statement.. · New abnormal findings after a normal 7-10 cranial ultrasound.. · Lower gestational age and advanced resuscitation at birth and transfer from outside hospital increased risk for severe IVH..
The Ethics of Clinical Research on Diseases of the Fetus and Newborn: Balancing Benefit-Risk, Autonomy, and Maternal-Fetal Interests.
Nelson RM, Childers K, Ling LE … +7 more , Alquier L, Komatsu Y, Schwartz L, Stevens AM, Tjoa ML, Moise KJ, Goldkind SF
Am J Perinatol · 2025 Dec · PMID 41468898 · Publisher ↗
Pregnant persons historically have been excluded from clinical trials. Recently, there has been a shift from exclusion toward inclusion of pregnant persons in research while acknowledging the complexity of reproductive e...
Pregnant persons historically have been excluded from clinical trials. Recently, there has been a shift from exclusion toward inclusion of pregnant persons in research while acknowledging the complexity of reproductive ethics and the intertwined interests of the pregnant person and fetus. Our objective was to use a principle-based approach to review the ethics of clinical research concerning pregnancy-related disorders that predominantly affect fetal well-being.Ethical principles are applied to the design of interventional trials in two rare conditions of pregnancy, hemolytic disease of the fetus and newborn (HDFN) and fetal and neonatal alloimmune thrombocytopenia (FNAIT).Severe HDFN and FNAIT are fetal and neonatal diseases caused by maternal alloantibodies with potential outcomes including maternal and neonatal morbidity, preterm delivery, and fetal or neonatal death. Early-onset severe HDFN was the initial indication for a phase 2 open-label study of nipocalimab in pregnancy, given poor outcomes after prior severe HDFN pregnancy(s). After establishing proof of concept, a phase 3 randomized placebo-controlled study was initiated based on the ethical principles of equipoise and generating socially valuable data to support the efficacy and safety of nipocalimab in severe HDFN. However, off-label use of antenatal intravenous immunoglobulin (IVIg) in standard-risk FNAIT pregnancies made a randomized placebo-controlled study challenging. Thus, the FNAIT clinical program for nipocalimab in pregnant persons with standard-risk FNAIT includes a randomized, placebo-controlled study limited to sites that do not use antenatal IVIg, and a global randomized open-label study of nipocalimab or IVIg.Knowledge of the clinical course and management of severe HDFN and FNAIT, the non-clinical and non-pregnant human clinical evidence, and input from physicians, patients, and health authorities permitted the design of clinical protocols that satisfy the principles of beneficence and non-maleficence in these rare and complex diseases. · Ethical principles apply to pregnancy-related disorders affecting fetal well-being.. · Placebo-controlled randomized trials in HDFN are based on equipoise.. · FNAIT programs must account for the off-label use of IVIg..
Plain Language Summary of Publication: Design of the Phase 3 FREESIA-1 and FREESIA-3 Trials of Nipocalimab in Fetal and Neonatal Alloimmune Thrombocytopenia.
Baker P, Keshinro B, Stegmann B … +5 more , Oey A, Shu C, Heerwegh D, Zaha R, Van Valkenburgh H
Am J Perinatol · 2026 Jul · PMID 41461173 · Full text
This article is a plain language summary of publication (PLSP) of the following articles: "Design of a Phase 3, Multicenter, Randomized, Placebo-Controlled, Double-Blind Study of Nipocalimab in Pregnancies at Risk for Fe...
This article is a plain language summary of publication (PLSP) of the following articles: "Design of a Phase 3, Multicenter, Randomized, Placebo-Controlled, Double-Blind Study of Nipocalimab in Pregnancies at Risk for Fetal and Neonatal Alloimmune Thrombocytopenia (FREESIA-1)" by Tiller et al published in on July 28, 2025 (doi:10.1055/a-2666-5642) and "Design of a Phase 3, Multicenter, Randomized, Open-Label Study of Nipocalimab or IVIG and Prednisone in Pregnancies at Risk for Fetal and Neonatal Alloimmune Thrombocytopenia (FREESIA-3)" by Bussel et al published in on November 25, 2025 (doi: 10.1055/a-2753-9323). This PLSP describes the design of the phase 3, placebo-controlled FREESIA-1 and open-label FREESIA-3 trials, which will help researchers understand if nipocalimab, an investigational treatment, can be used to safely treat pregnant individuals who are at risk for fetal and neonatal alloimmune thrombocytopenia (FNAIT). This PLSP will help the general public, including those affected by FNAIT, and health care professionals understand the two studies. It provides information on the eligibility criteria, study design, treatments, and outcomes of interest. An infographic summary of this article is available in the Supplementary Material (available in the online version only).
The Impact of a Protocol on Equitable Labor and Delivery Substance Use Screening: A Retrospective Cohort Study.
Cate JJM, Lunn S, Baffoe-Bonnie A … +7 more , Sugrue R, West P, Truong T, Erkanli A, Gilner J, Hughes B, Wheeler S
Am J Perinatol · 2025 Dec · PMID 41461172 · Publisher ↗
The Society for Maternal-Fetal Medicine (SMFM), the American College of Obstetricians and Gynecologists (ACOG), and the American Society of Addiction Medicine (ASAM) jointly recommend universal substance use screening in...
The Society for Maternal-Fetal Medicine (SMFM), the American College of Obstetricians and Gynecologists (ACOG), and the American Society of Addiction Medicine (ASAM) jointly recommend universal substance use screening in pregnancy with a validated tool. Biologic testing with urine drug screening (UDS) is not recommended unless testing would change medical management. Despite recommendations, racial and socioeconomic differences in substance use screening and biological testing exist. We evaluated the impact of an obstetric substance use screening protocol on validated screening, UDS indication documentation, pre-UDS patient assent, and UDS disparities across race, ethnicity, and payor.This retrospective cohort study used electronic health record data before (July 1, 2020-June 9, 2021) and after (June 10, 2021-May 31, 2022) implementation of an obstetric substance use screening protocol at a tertiary care center. Documented, validated screening, UDS indication, and patient assent were assessed among UDS encounters pre- and postintervention. Association of race, ethnicity, and payor with UDS was assessed using generalized estimating equations models pre- and postintervention. Categorical variables were compared using chi-square and Fisher's exact tests.UDS occurred less frequently postintervention than preintervention (1.9% [124/6,412 encounters] vs. 7.8% [441/5,658 encounters], < 0.001). Adjusting for payor, Black individuals had higher odds of UDS (adjusted odds ratio [aOR] = 2.11, 95% confidence interval [CI]: 1.64-2.70) than White individuals preintervention; however, there were no differences (aOR = 1.23, 95% CI: 0.81-1.87) postintervention. Privately insured individuals had lower odds of UDS preintervention (OR = 0.23, 95% CI: 0.18-0.30) and postintervention (OR = 0.08, 95% CI: 0.04-0.15) than government-insured individuals. Among those with UDS, none (0/441) underwent validated screening preintervention versus 36.3% (45/124) postintervention. Documented UDS indication occurred in 27.9% (123/441) preintervention versus 55.7% (69/124) postintervention ( < 0.001). Documented assent occurred in 0.5% (2/441) of encounters preintervention versus 47.6% (59/124) postintervention ( < 0.001).Implementation of an obstetric substance use screening protocol was associated with decreasing UDS and increasing validated screening, documented UDS indication, and patient assent. Racial disparities in UDS were reduced postintervention; however, suboptimal screening remained, with persistent disparities by payor. · Substance use screening in pregnancy with a validated tool is performed suboptimally.. · There are known disparities in biologic testing for substance use by race and socioeconomic status.. · We evaluated an obstetric substance use screening protocol pre- and postintervention.. · The protocol was associated with validated tool use, patient assent, and screening documentation.. · Racial disparities in substance use screening were reduced postintervention..
Cannabis Use and Intimate Partner Violence During Pregnancy Are Associated with Poorer Postpartum Mental Health.
Marvin MJ, Ballinger AL, Stein SF … +6 more , Fairchild JN, Bogat GA, Lonstein JS, Nuttall AK, Muzik M, Levendosky AA
Am J Perinatol · 2025 Dec · PMID 41412165 · Publisher ↗
Intimate partner violence (IPV) victimization during pregnancy is a pervasive public health problem that is associated with mental health difficulties and increased rates of substance use, including cannabis. Despite bei...
Intimate partner violence (IPV) victimization during pregnancy is a pervasive public health problem that is associated with mental health difficulties and increased rates of substance use, including cannabis. Despite being contraindicated by medical professionals, cannabis use during pregnancy is on the rise. Preliminary research among the general population suggests that cannabis use is associated with later mental health difficulties. While pregnancy IPV is associated with poorer postpartum mental health, less is known about the effects of pregnancy cannabis use on postpartum mental health. This study aims to investigate the combined effects of IPV victimization and cannabis use during pregnancy on postpartum mental health.In this study, 257 women were assessed at three points during pregnancy to measure IPV victimization and cannabis use. Then, at 6 months postpartum, women's posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were assessed.Linear regression analyses revealed that pregnancy IPV victimization was significantly associated with elevated postpartum PTSD (β = 0.21, = 0.005), depression (β = 0.17, = 0.022), and anxiety symptoms (β = 0.21, = 0.008). Pregnancy cannabis use was associated with elevated postpartum PTSD (β = 0.25, < 0.001) and depression (β = 0.25, < 0.001) symptoms. The interaction between pregnancy IPV and cannabis use was not significantly associated with postpartum mental health symptoms.Results suggest that cannabis use during pregnancy, as well as IPV victimization, are independent risk factors for specific postpartum mental health problems. Suggestions for nurses and other medical providers on how to best screen for and counsel pregnant women on cannabis use are discussed. · IPV during pregnancy is associated with elevated postpartum PTSD, depression, and anxiety symptoms.. · Cannabis use during pregnancy is associated with elevated postpartum PTSD and depression symptoms.. · IPV and cannabis use during pregnancy are independent risk factors for postpartum mental health difficulties.. · Medical professionals should screen for and discuss IPV and cannabis use with pregnant women..
Centralized Telemetry Enables Continuous Monitoring to Predict Clinical Deterioration in Infants Hospitalized with Bronchiolitis.
González Martínez F, Núñez Carretero C, García Fernández L … +4 more , Toledo Del Castillo B, González Sánchez MI, Angulo Chacón AM, Rodríguez Fernández R
Am J Perinatol · 2025 Dec · PMID 41412164 · Publisher ↗
Bronchiolitis is the leading cause of hospitalization in infants, and early detection of clinical deterioration remains a major challenge in pediatric wards. The objective is to analyze continuous longitudinal telemetry...
Bronchiolitis is the leading cause of hospitalization in infants, and early detection of clinical deterioration remains a major challenge in pediatric wards. The objective is to analyze continuous longitudinal telemetry data (heart rate [HR] and oxygen saturation [SpO]) in infants hospitalized with bronchiolitis, and to evaluate whether this monitoring allows early prediction of the need for high-flow nasal cannula (HFNC) therapy or pediatric intensive care unit (PICU) admission.Retrospective, observational study in infants admitted for bronchiolitis (October 2021-January 2022). Clinical, epidemiological, and longitudinal data were collected using minute-by-minute HR and SpO during the first 24 hours of admission using Vital Sync (Medtronic). A mixed model (restricted maximum likelihood; REML) was constructed to model the longitudinal HR and SpO data.About 79 patients with 113,760 longitudinal HR and SpO data were included. A total of 16.5% required HFNC, and 9% were admitted to PICU. A higher HR was observed in the first hours of admission in those patients who required PICU (163 ± 5 vs. 146 ± 4 bpm; < 0.01) and in those who required HFNC (158 ± 6 vs. 144 ± 5 bpm; < 0.01). In the mixed model (REML), we found differences in HR ( < 0.01) between groups (PICU yes/no and HFNC yes/no) and over time ( < 0.01). The mixed model allowed prediction of the mean HR of patients admitted to PICU (162 bpm) and those requiring HFNC (159 bpm).Continuous monitoring of HR in infants hospitalized for bronchiolitis in pediatric wards may be a useful tool to help anticipate clinical deterioration. · Longitudinal continuous telemetry in infants with bronchiolitis may be a useful tool.. · Centralized telemetry monitoring may be promising in pediatric wards outside intensive care units.. · HR monitoring may be useful for the need for admission to the PICU..
Timing and Severity of Fetal Growth Restriction Diagnosis and Association with Perinatal Morbidity.
Bui LN, Ahluwalia S, Ogu NQ … +4 more , Raucher SL, Miller ES, Rajan PR, Fisher SA
Am J Perinatol · 2025 Dec · PMID 41397467 · Publisher ↗
In 2020, the Society of Maternal Fetal Medicine refined fetal growth restriction (FGR) diagnostic criteria by temporal (early-, <32 weeks 0 days [32] weeks; late-onset, ≥32 weeks) and measurement-specific definitions (se...
In 2020, the Society of Maternal Fetal Medicine refined fetal growth restriction (FGR) diagnostic criteria by temporal (early-, <32 weeks 0 days [32] weeks; late-onset, ≥32 weeks) and measurement-specific definitions (severe, estimated fetal weight <3rd; mild, estimated fetal weight 3rd-9th percentile and/or abdominal circumference <10th percentile). Using these updated clinical definitions, we sought to determine the association of timing and severity of FGR diagnosis with, and their discriminatory ability for, adverse pregnancy outcomes.This retrospective cohort study included singleton, non-anomalous pregnancies with sonographic FGR diagnosis at ≥18 weeks' gestation from May 2020 to December 2021. We evaluated four FGR classification exposure groups: (1) early-onset, severe FGR; (2) early-onset, mild FGR; (3) late-onset, severe FGR; and (4) late-onset, mild FGR. Outcomes assessed were hypertensive disorders of pregnancy, preterm birth, and small-for-gestational age. Multivariable logistic regression estimated the odds of each outcome associated with each exposure, adjusted for maternal age, insurance, and parity. Receiver-operating characteristic analysis determined test characteristics for the ability of these FGR classification groups to identify the postnatal outcomes, using late-onset, mild FGR as the reference group.Among 566 eligible pregnancies, early-onset, severe FGR had higher adjusted odds of hypertensive disorders of pregnancy (aOR = 1.3, 95% CI: 1.1-1.7), preterm birth (aOR = 2.1, 95% CI: 1.6-2.6), and small-for-gestational age (aOR = 1.6, 95% CI: 1.3-1.9), compared to late-onset, mild FGR. Late-onset, severe FGR also had higher adjusted odds of preterm birth (aOR = 7.2, 95% CI: 2.9-18.3) and small-for-gestational age (aOR = 5.8, 95% CI: 2.5-13.6). Odds of adverse pregnancy outcomes were similar with early- and late-onset mild FGR. Overall, discriminatory ability of these FGR classification groups for adverse pregnancy outcomes were poor.Early- and late-onset, severe FGR (versus late-onset, mild FGR) are positively associated with, but have poor discriminatory ability for, adverse pregnancy outcomes. · Early-onset, severe FGR (vs. late-onset, mild FGR) is significantly associated with hypertensive disorders of pregnancy.. · Compared to late-onset mild FGR, severe FGR, whether early- or late-onset, has greater odds of preterm birth and small-for-gestational age.. · All FGR classification groups had weak discriminatory ability for identification of these adverse pregnancy outcomes..
Maternal Reticulocyte Hemoglobin as a Predictor of Neonatal Iron Deficiency and Anemia.
Pekar CE, Haischer-Rollo GD, Hansen AP … +2 more , Aden JK, Mu TS
Am J Perinatol · 2025 Dec · PMID 41386283 · Publisher ↗
Anemia in pregnancy affects 30 to 40% of women globally, with iron deficiency (ID) accounting for half of the cases. In the United States, iron-deficiency anemia (IDA) prevalence during pregnancy is approximately 5%. ID...
Anemia in pregnancy affects 30 to 40% of women globally, with iron deficiency (ID) accounting for half of the cases. In the United States, iron-deficiency anemia (IDA) prevalence during pregnancy is approximately 5%. ID and IDA negatively affect the maternal-fetal dyad. Reticulocyte hemoglobin equivalent (RET-He) estimates functional iron stores without additional blood sampling. Monitoring RET-He in pregnant women and neonates may facilitate earlier interventions with iron supplementation. The aim is to evaluate RET-He's utility in identifying pregnant women and neonates at risk for ID and IDA.This prospective, observational study followed pregnant women with anemia. RET-He and hemoglobin (HgB) values were measured during the first and third trimesters and at delivery (umbilical cord blood). Exclusions included preterm birth, monochorionic twin gestations, and conditions complicating cord blood collection.One hundred and seventy-seven dyads were included in the study. Maternal mean HgB was 12.2 ± 1.1 and 10.8 ± 1.2 g/dL, with RET-He values of 32.7 ± 3.2 and 30.5 ± 3.6 pg in the first and third trimesters, respectively. Neonatal mean cord HgB was 15.0 ± 1.6 g/dL with RET-He of 32.9 ± 2.6 pg. Thirteen percent ( = 23) of newborns were anemic (cord HgB < 13.5 g/dL), and 7% ( = 13) of the newborns were iron-deficient (RET-He < 29 pg). Only two of these iron-deficient infants were also anemic. Maternal HgB and RET-He values were not associated with neonatal anemia. Sensitivity and specificity of maternal RET-He for predicting neonatal anemia were not helpful, but improved when predicting neonatal ID, especially in the third trimester. RET-He indicating ID in pregnant women was associated with anemia during their pregnancy.Maternal RET-He does not predict neonatal anemia but may aid in earlier maternal ID diagnoses. Most infants are born with normal HgB and RET-He values. RET-He may be useful for monitoring women with IDA during their pregnancies. · Maternal reticulocyte hemoglobin does not predict neonatal anemia.. · Maternal reticulocyte hemoglobin may aid in diagnosing neonatal ID without anemia.. · Reticulocyte hemoglobin may be used to monitor ID among pregnant women with anemia..
Management of Infants Born to Pregnant Women with Reactive Syphilis Serology: Resource Saving from Using the Current Centers for Disease Control Guidelines.
Lofiego PLF, Tse-Chang A, Gratrix J … +3 more , Smyczek P, Robinson JL, Kumar M
Am J Perinatol · 2025 Dec · PMID 41380725 · Publisher ↗
There has been a marked increase in the number of infants admitted to neonatal intensive care units (NICUs) in Canada for treatment of congenital syphilis. We studied the impact on resource utilization from using the Cen...
There has been a marked increase in the number of infants admitted to neonatal intensive care units (NICUs) in Canada for treatment of congenital syphilis. We studied the impact on resource utilization from using the Centers for Disease Control (CDC) guidelines that allow use of a single-dose intramuscular benzathine penicillin G (BPG), as compared with 10-day course of intravenous penicillin G (PG), in infants considered at low risk for congenital syphilis.This was a retrospective cohort study enrolling infants born to mothers with reactive syphilis serology and admitted for management to two Level 2 NICUs in Edmonton, Alberta, Canada, over a 2-year period. Data were extracted for key NICU resources that are used in managing these infants. We then estimated the resources that would be utilized if the entire cohort was managed per the current CDC guidelines.Forty-nine infants met the study criteria of which 42 were treated with 10-day course of PG. Of these 42 infants, 21 (50%) met the CDC criteria for a single dose of BPG. The use of the CDC criteria to manage this cohort could have avoided 244 hospital days, 128 central line days, 168 antibiotic days related to congenital syphilis treatment, 23 long bones X-rays, and 17 lumbar punctures, for an estimated savings of CDC $ 263,000 to the provincial health system.Using the current CDC guidelines, half of the infants exposed to maternal syphilis and treated with a 10-day course of PG in our cohort could have been managed with a single dose of BPG, resulting in a significant saving of health care resources and in hospital costs. · Cases of congenital syphilis have risen sharply in parts of Canada.. · Frequent admissions of such cases in the Canadian NICUs have aggravated bed capacity challenges.. · Applying the current CDC guidelines could reduce the NICU length of stay, the use of central lines, and other invasive procedures in this population..
Postpartum Hemorrhagic Morbidities with Livebirth versus Stillbirth.
Zullo F, Wiley RL, Ghose I … +5 more , Rizzo G, Giancotti A, Mendez-Figueroa H, Di Mascio D, Chauhan SP
Am J Perinatol · 2025 Dec · PMID 41349585 · Publisher ↗
ACOG publications on stillbirth or postpartum hemorrhage (PPH) do not consider stillbirth as a risk factor for postpartum hemorrhagic morbidity. This study aimed to ascertain the likelihood of composite maternal hemorrha...
ACOG publications on stillbirth or postpartum hemorrhage (PPH) do not consider stillbirth as a risk factor for postpartum hemorrhagic morbidity. This study aimed to ascertain the likelihood of composite maternal hemorrhagic outcome (CMHO) among individuals who delivered vaginally with livebirth versus a stillbirth.This was a retrospective cohort study of all parturients greater than 20 weeks gestation who delivered vaginally at a single level IV site within 24 months. Demographic differences and baseline PPH risks were analyzed. CMHO included any of the following: estimated blood loss ≥1,000 mL, use of uterotonics (beyond prophylactic oxytocin), Bakri balloon, surgical management of PPH, blood transfusion, hysterectomy, venous thromboembolism (VTE), admission to the intensive care unit (ICU), or maternal death. Statistical analysis included chi-squared, Kruskal-Wallis, and Poisson regression with robust error variance for risk ratios, adjusting for gestational age (GA), bleeding on admission, chorioamnionitis, and prior uterine surgery.Of 8,623 consecutive vaginal births ≥20 weeks gestation, 89 (1.9%) were stillbirths. Maternal age, marital status, GA at delivery, and PPH risk stratification at admission differed significantly. Bleeding at admission ( < 0.001), prior uterine surgery ( < 0.001), magnesium sulfate use ( = 0.006), chorioamnionitis ( < 0.001), platelet count <100 ( = 0.001), platelet count <50 ( < 0.001), and retained products of conception ( < 0.001) were different in the two groups. CMHO was significantly higher with a stillbirth delivery (32.6 vs. 16.8%; aRR: 1.56, 95% CI: 1.01-2.46). After adjustment, the components of the CMHO that differed significantly were estimated blood loss ≥1,000 mL and ICU admission. Tamponade, surgical intervention, VTE, hysterectomy, and maternal death did not differ between the two groups.Pregnancies with stillbirth, compared with livebirth, had an increased risk of hemorrhagic related morbidity. In addition to being useful in shared decision-making, our results can be nidus for intervention trials to decrease the hemorrhagic morbidity associated with stillbirth. · The risk of CMHO was significantly higher in the stillbirth group even after adjustment for potential confounders (32.6% vs. 16.8%).. · Stillbirth was associated with a significantly higher risk of blood loss of ≥1,000 mL.. · Stillbirth was also associated with higher likelihood of uterotonic use, transfusion, and admission to ICU..
Enhancing Maternal Health Surveillance in the United States Through Natural Language Processing.
Horgan R, Kawakita T, Saade G
Am J Perinatol · 2025 Dec · PMID 41349584 · Publisher ↗
Maternal health outcomes are essential indicators of overall health care quality and societal well-being. However, in the United States, the maternal health surveillance is often inaccurate, restricting the clinical util...
Maternal health outcomes are essential indicators of overall health care quality and societal well-being. However, in the United States, the maternal health surveillance is often inaccurate, restricting the clinical utility of the data gathered. The limits imposed by these inaccuracies restrict timely policy responses and hinder effective innovations, despite the increasing availability of electronic health records. This paper explores the potential use of natural language processing in improving maternal health surveillance. By combining rule-based linguistic processing with machine learning, natural language processing can transform narrative text into structured, analyzable data, allowing it to be used for predictive purposes, as well as the development of real-time public health surveillance systems. · Maternal health surveillance is often inaccurate, restricting the clinical utility of the data.. · Natural language processing can extract key insights from unstructured clinical notes.. · Artificial intelligence-driven surveillance in obstetrics may improve data accuracy and timeliness.. · Ethical use of natural language processing needs to ensure privacy, bias control, and validation..
Servo-Controlled versus Manual Cooling for Therapeutic Hypothermia in Neonatal Hypoxic-Ischemic Encephalopathy: A Retrospective Comparative Study.
Magalhães M, Leandro DMK, de Azevedo SS … +4 more , Teixeira JQ, Hiratzuka HA, Mimica MJ, Variane GFT
Am J Perinatol · 2025 Dec · PMID 41349575 · Publisher ↗
This study aimed to compare temperature control during therapeutic hypothermia (TH) in neonates with moderate or severe hypoxic-ischemic encephalopathy (HIE) using manual cooling (MC) or a servo-controlled (SC) system.Re...
This study aimed to compare temperature control during therapeutic hypothermia (TH) in neonates with moderate or severe hypoxic-ischemic encephalopathy (HIE) using manual cooling (MC) or a servo-controlled (SC) system.Retrospective cohort study including neonates with ≥ 35 weeks' gestation with moderate or severe HIE who were treated with TH between 2018 and 2020, using MC with ice packs or a SC system. Temperature curves and clinical outcomes were compared between the two methods of cooling. Data were summarized using descriptive statistics. Groups were compared with appropriate parametric or nonparametric tests. Temperature stability and rewarming variability were evaluated, and secondary outcomes were analyzed using risk ratios with 95% confidence intervals and logistic regression adjusted for encephalopathy severity.During the study period, 56 neonates with moderate or severe HIE were cooled, 31 (55.4%) with MC and 25 (44.6%) with a SC system. Baseline characteristics and time to target temperature were similar. SC achieved more stable hypothermia, with less variability ( = 0.014) and reduced time outside the therapeutic range (2.7 vs. 8.1%, = 0.005). Extreme temperature deviations occurred only in the MC group. Rewarming rates were comparable, although variability was greater with MC. Clinical outcomes showed lower risk of hypotension (RR: 0.647, 95% CI: 0.409-1.02; = 0.044), inotrope use (RR: 0.647, 95% CI: 0.409-1.02; = 0.044), and abnormal magnetic resonance imaging (MRI) findings (12.0 vs. 46.2%; RR: 0.26, 95% CI: 0.08-0.81; = 0.013) in the SC group. After adjusting for clinical encephalopathy severity, SC remained independently protective against abnormal MRI (aOR: 0.19; 95% CI: 0.04-0.865; = 0.03) and hypotension (aOR: 0.27; 95% CI: 0.08-0.95; = 0.04). Mortality occurred only in the MC group.While both methods were effective, the SC system offered more stable temperature control and may reduce complications during and after TH. · Temperature stability is critical for the effectiveness of TH.. · SC cooling provided more stable temperature control than MC.. · SC cooling and MC were feasible in a neonatal intensive care unit setting.. · SC cooling may reduce neurological complications during and after TH..
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 · 2025 Dec · PMID 41344345 · Publisher ↗
OBJECTIVE: This study aimed to determine whether immediate postnatal heart rate (HR) assessment during delayed cord clamping (DCC) influences the clinical decision-making of neonatal resuscitation providers. STUDY DESIGN...
OBJECTIVE: This study aimed to determine whether immediate postnatal heart rate (HR) assessment during delayed cord clamping (DCC) influences the clinical decision-making of neonatal resuscitation providers. STUDY DESIGN: The decision to perform or defer DCC primarily relies on subjective parameters, potentially leading to variations in subsequent steps of the resuscitation algorithm. In this study, HR, a numerical parameter, was introduced during DCC. Ten subjects completed a total of 60 short scenarios simulating DCC for a 27-week preterm manikin. Each subject experienced two consecutive sets (control vs. test) of three scenarios with predefined HR ranges (<60, 60-99, and ≥ 100/minute) presented in random order. In control scenarios, subjects participated in the DCC procedure per usual practice. In test scenarios, they manually measured HR during DCC. Objective variables and subjective questionnaire responses were collected. RESULTS: The mean DCC duration significantly increased for HR 60 to 99/minute (45.4 vs. 55.3 seconds, = 0.035) and HR ≥ 100/minute (37.1 vs. 63.7 seconds, = 0.011) scenarios in the test group compared with the control. For the HR < 60/minute scenario, mean DCC duration and time to ECG attachment tended to be shorter in the test group (45.4 vs. 34.6 and 89.7 vs. 56.3 seconds, respectively). In this HR range, initiation of respiratory support occurred significantly earlier in the test group (mean 72.7 vs. 47.6 seconds, = 0.020). According to the questionnaire, 2 (20%) subjects believed tone and respiratory effort were sufficient for DCC decision-making. Seven (70%) subjects perceived that HR assessment during DCC had a "strong" or "very strong" impact on the decision to delay or proceed with cord clamping, with confidence levels rising from a median of 3 to 4 on a 5-point Likert scale. CONCLUSION: Assessing immediate postnatal HR during DCC appears to impact clinical decision-making for providers, implying the potential for enhancing uniformity of decisions among healthcare professionals surrounding DCC. KEY POINTS: · The decision to perform or defer DCC primarily relies on subjective parameters.. · HR assessment during DCC appears to impact clinical decision-making for providers.. · Assessing HR during DCC may potentially enhance uniformity of decisions among HCPs..
Implementing a Digital Neurocritical Care Unit for Neonates in Brazil: A 4-Year Experience.
de Azevedo SS, Leandro DMK, Santos TS … +9 more , Mimica MJ, Rodrigues PG, Teixeira JQ, Belém TMLOU, Medina CG, Fernandes ACPB, Sugahara FBP, Magalhães M, Variane GFT
Am J Perinatol · 2025 Dec · PMID 41344344 · Publisher ↗
This study aimed to describe neuromonitoring findings and short-term outcomes after the implementation of a digital health strategy comprising continuous, real-time, tele-based video-aEEG/EEG monitoring in a publicly fun...
This study aimed to describe neuromonitoring findings and short-term outcomes after the implementation of a digital health strategy comprising continuous, real-time, tele-based video-aEEG/EEG monitoring in a publicly funded NICU in Brazil.Prospective, observational cohort study conducted between July 2017 and June 2021, analyzing neuromonitoring data of high-risk newborns and correlating it with clinical and imaging outcomes.A total of 116 newborns, with a median gestational age of 37 weeks (interquartile range [IQR]: 32-39) and a median birth weight of 2,800 g (IQR: 1,472-3,305), were enrolled with more than 8,000 hours of monitoring. The main indication was suspected seizure ( = 49, 42.2%). A total of 43 (37.1%) neonates presented pathological background activity, and sleep-wake cycle (SWC) was absent in 68 (58.6%). Seizures were identified in 36 (31.0%) neonates, predominantly within the first 12 hours of life ( = 14, 38.9%), electrographic-only ( = 29, 80.6%), and repetitive ( = 24, 66.7%). A total of 47 (40.5%) neonates received antiseizure medications, with phenobarbital being the most frequently used (46; 97.9%). Only one patient (2.1%) was discharged receiving antiseizure medication. Cranial ultrasound (cUS) was performed in 94 (81.0%) infants, with abnormal findings in 34 (36.2%) infants. Pathological background activity, absence of SWC, and seizures were significantly associated with severe abnormalities on cUS, and increased risk of death before discharge.The implementation of a digital health strategy incorporating real-time and continuous video-aEEG/EEG monitoring demonstrated potential to improve diagnostic accuracy for electrographic seizures, optimize antiseizure medication stewardship, and inform early neuroprotective interventions. · Brain monitoring improves seizure diagnosis.. · aEEG/EEG supported antiseizure medication discontinuation.. · Abnormal aEEG/EEG findings are associated with poor outcomes.. · Remote aEEG/EEG monitoring is feasible in LMIC..
Antenatal Anemia and Perinatal Outcomes for Patients with Cardiac Disease in Pregnancy.
Jones SI, Xu A, Truong T … +9 more , Snow SC, Ward CC, Meng ML, Denoble A, Goldstein SA, Peek E, Zahn KM, Igbinosa II, Federspiel JJ
Am J Perinatol · 2026 Jul · PMID 41314252 · Full text
OBJECTIVE: This study aimed to assess whether pregnant patients with antenatal anemia in the setting of cardiac disease experience an increased risk of severe maternal morbidity (SMM) and other adverse pregnancy outcomes...
OBJECTIVE: This study aimed to assess whether pregnant patients with antenatal anemia in the setting of cardiac disease experience an increased risk of severe maternal morbidity (SMM) and other adverse pregnancy outcomes. STUDY DESIGN: This retrospective cohort study used the 2016-2021 National Readmissions Database to identify patients with cardiac disease delivering a singleton infant between 24 and 41 weeks gestation. Cardiac disease was identified by diagnosis codes and categorized based on modified World Health Organization (mWHO) criteria. Modified Poisson regression was used to assess the association between anemia and severe maternal morbidity, stratified by mWHO criteria. In a secondary analysis, iron deficiency anemia alone was considered the exposure of interest. Models were adjusted for age, median household income by ZIP code, primary payer, hospital size, hospital teaching status, delivery mode, and other comorbid conditions. RESULTS: Cardiac disease was identified in 61,542 patients in our cohort (47,767 [77.6%] with mWHO I-II disease and 13,775 [22.4%] with mWHO II/III+ disease). Of these patients, 10,257 (16.7%) had anemia. Weighted to provide national estimates, this sample results in a national estimate of 115,347 deliveries complicated by cardiac disease during the study period in the United States, of which 19,439 (16.7%) also had anemia. Anemia was associated with higher odds of SMM/mortality in people with mWHO I-II (aRR = 1.90, 95% CI: 1.73, 2.09) and mWHO II/III+ (aRR = 1.24, 95% CI: 1.18, 1.31) cardiac disease. Antenatal anemia was also associated with blood product transfusion, non-transfusion SMM/mortality, cardiac SMM, preterm birth, and cesarean delivery. This relationship persisted for the subgroup of patients with iron deficiency anemia. CONCLUSION: Antenatal anemia, including iron deficiency anemia, adversely impacts pregnancy outcomes in pregnant patients with cardiac disease. Identifying and treating this modifiable risk factor potentially offer an opportunity to reduce morbidity in this high-risk population. KEY POINTS: · SMM is observed in nearly half of patients with severe cardiac disease and anemia in pregnancy.. · Antenatal anemia is associated with SMM or mortality for patients of all mWHO cardiac risk groups.. · Anemia is associated with other adverse pregnancy outcomes for patients with cardiac disease..
Reducing Golden Hour Admission Times for Extremely Preterm Infants: An Improvement Science Initiative.
Heitkamp NM, Fox H, Elliott M … +4 more , Swanson JR, Lepore S, Zanelli SA, Wiggins JB
Am J Perinatol · 2025 Nov · PMID 41314251 · Publisher ↗
The Golden Hour is the first 60 minutes of life for extremely preterm infants and represents a critical window where timely stabilization can reduce morbidity such as intraventricular hemorrhage and bronchopulmonary dysp...
The Golden Hour is the first 60 minutes of life for extremely preterm infants and represents a critical window where timely stabilization can reduce morbidity such as intraventricular hemorrhage and bronchopulmonary dysplasia. At the University of Virginia, average Golden Hour admission times for infants <28 weeks' gestation were 117 minutes, indicating a major opportunity for improvement. This study aimed to reduce admission time by 25% (to ≤87 min) for infants <28 weeks' gestational age within 1 year of implementation.Using the Institution for Healthcare Improvement methodology, a multidisciplinary team identified key drivers of delay and implemented two Plan-Do-Study-Act (PDSA) cycles. PDSA 1 introduced a designated admission coordinator, structured flowsheet, and visible timer to enhance team awareness. PDSA 2 focused on line-placement efficiency, adding an auditory time, team huddles after 15 minutes, and earlier isolette closure to promote thermoregulation. Statistical process control (SPC) charts (XbarS, XmR) were used to evaluate changes. The outcome measure was time from admission to isolette closure. Process measures were time to glucose, IV dextrose, X-ray, and surfactant administration. Balancing measures were admission temperature, glucose levels, and severe intraventricular hemorrhage (IVH) rates.Among 106 infants, the average admission time decreased from 117 to 59 minutes, resulting in a 50% reduction. The proportion of admissions meeting the SMART aim (<87 min) improved from 8 to 100%. Process variability decreased on both XbarS and XmR charts. Balancing measures remained stable.Two sequential PDSA cycles achieved and sustained a 50% reduction in Golden Hour admission time without adverse effects. Structured team roles, real-time feedback, and workflow redesign produced a more efficient and stable process. This initiative demonstrates that systematic QI can meaningfully optimize Golden Hour care and may be replicable across NICUs. · This is the first reported quality improvement initiative to use admission time as a primary outcome within the neonatal Golden Hour framework.. · The results show a significant and sustained 50% reduction in admission time-from 117 minutes to 59 minutes-exceeding the SMART aim.. · Key drivers of change included defined team roles, visual and auditory cues, and standardization of the umbilical line placement workflow, which can be readily adapted for use in other NICUs seeking to test improvements during Golden Hour admissions..
Design of a Phase 3, Multicenter, Randomized, Open-Label Study of Nipocalimab or IVIG and Prednisone in Pregnancies at Risk for Fetal and Neonatal Alloimmune Thrombocytopenia.
Bussel J, Stegmann B, Baker P … +5 more , Oey A, Jiang Y, Zaha R, Van Valkenburgh H, Keshinro B
Am J Perinatol · 2025 Dec · PMID 41290206 · Publisher ↗
Nipocalimab, a neonatal Fc receptor blocker, showed evidence of efficacy and safety in preventing or delaying fetal anemia in a phase 2 study of early-onset severe hemolytic disease of the fetus and newborn, demonstratin...
Nipocalimab, a neonatal Fc receptor blocker, showed evidence of efficacy and safety in preventing or delaying fetal anemia in a phase 2 study of early-onset severe hemolytic disease of the fetus and newborn, demonstrating potential for treatment of other maternal immunoglobulin G alloantibody-mediated fetal diseases. The phase 3 FREESIA-3 study aims to evaluate the efficacy and safety of nipocalimab or intravenous immunoglobulin (IVIG) with prednisone in pregnancies with a previous occurrence of fetal and neonatal alloimmune thrombocytopenia (FNAIT) with or without intracranial hemorrhage or severe fetal/neonatal bleeding (high- or standard-risk, respectively).FREESIA-3 is a phase 3, open-label, randomized, multicenter study in pregnant individuals at risk for FNAIT. Participants are randomized 4:1 to receive either weekly 45 mg/kg intravenous nipocalimab or weekly IVIG with prednisone starting at 13 to 18 weeks of gestational age (standard-risk) or 12 weeks of gestational age (high-risk) until delivery. During treatment, pregnant participants will receive ultrasound monitoring every 2 weeks for fetal bleeding, growth, and development. Postnatal follow-up is 24 weeks for maternal participants and 104 weeks for neonates/infants.The primary endpoint is an adverse outcome of death or adjudicated severe bleeding in utero up to 1 week postbirth, or platelet count at birth of < 30 × 10/L in a fetus/neonate. Secondary endpoints include fetal/neonatal death, neonatal platelet count at birth, nadir neonatal platelet count over 1 week postbirth, neonate requiring platelet transfusion(s), adjudicated fetal and neonatal bleeding up to 1 week postbirth, neonate receiving IVIG for thrombocytopenia, safety in maternal participants and neonates/infants, and immunogenicity of nipocalimab. Exploratory endpoints include patient- and caregiver-reported outcome assessments and nipocalimab pharmacokinetics and pharmacodynamics.FREESIA-3, an open-label, multicenter, randomized, phase 3 study, will evaluate the efficacy and safety of nipocalimab in both standard- and high-risk pregnancies for FNAIT. · FNAIT is a transplacental alloantibody-driven disease.. · Nipocalimab blocks IgG recycling, lowering IgG levels.. · Nipocalimab blocks IgG placental transfer to the fetus.. · Nipocalimab reduced adverse outcomes in EOS-HDFN.. · FREESIA-3 studies nipocalimab efficacy/safety in FNAIT..
Low Molecular Weight Heparin Thromboprophylaxis or No Treatment following Cesarean Delivery: A Pilot Randomized Controlled Trial.
Bruno AM, Allshouse AA, Branch DW … +2 more , Silver RM, Metz TD
Am J Perinatol · 2025 Dec · PMID 41290205 · Full text
This study aimed to evaluate the feasibility of randomizing patients to weight-based low molecular weight heparin (LMWH) versus no pharmacologic thromboprophylaxis following cesarean delivery (CD).Single-center, open-lab...
This study aimed to evaluate the feasibility of randomizing patients to weight-based low molecular weight heparin (LMWH) versus no pharmacologic thromboprophylaxis following cesarean delivery (CD).Single-center, open-label pilot randomized controlled trial of individuals aged 18+ undergoing CD at the University of Utah Health from November 2023 to June 2024. Those with a contraindication to anticoagulation, a plan for therapeutic anticoagulation, or considered at highest risk for postpartum venous thromboembolism (VTE; i.e., undergoing cesarean-hysterectomy, high-risk thrombophilia, personal history of thromboembolism) were excluded. Enrolled individuals were randomized in a 1:1 ratio utilizing block randomization with randomly varying block sizes to receive weight-based LMWH for 14 days or no pharmacologic thromboprophylaxis. The primary outcome was feasibility, defined as ≥35% enrollment of eligible individuals and retention of ≥85% of enrolled individuals through all study procedures. Secondary feasibility outcomes included the number of eligible patients per month, approach rate, enrollment rate, and retention rate. Additional outcomes included VTE, wound hematoma, patient-reported symptoms, or a bleeding complication within 6 weeks postpartum. Baseline characteristics were compared between those approached and enrolled and those not enrolled. The proportion meeting each of the outcomes was reported with 95% confidence intervals (CI).Over the 6-month study period, 694 patients were screened and found eligible for an average of 106 eligible patients per month. There were 611 patients approached (88%, 95% CI: 85.6-90.5), of which 64 enrolled (10.5%, 95% CI: 8-12.9), and 61 participants were retained through all study procedures (95.3%, 95% CI: 90-100). Thus, the overall primary outcome feasibility parameters were not met. Among the 64 individuals enrolled and randomized, the mean age was 31.0 years (standard deviation: 5.5 years), and the majority were non-Hispanic White (56%). Baseline characteristics were similar between those who were approached and enrolled compared with those not enrolled. There were no differences in additional clinical outcomes (VTE, wound hematoma, patient-reported symptoms, or bleeding complications) by prophylaxis group.In this pilot trial, individual patient randomization to weight-based LMWH or no pharmacologic thromboprophylaxis after CD was not feasible due to low enrollment rates. Future trials addressing postpartum thromboembolism prevention should consider alternative study designs. · Individual patient randomization to enoxaparin or no therapy after CD was not feasible.. · The approach rate, enrollment rate, and retention rate were 88, 11, and 95%, respectively, in this single-center pilot.. · Future prospective studies may need to consider alternative designs..
A Uterine Suction Device to Prevent Postpartum Hemorrhage in Scheduled Cesarean Delivery: A Pilot Study.
Kawakita T, Ray N, Brennan M … +2 more , Rosen M, Saade G
Am J Perinatol · 2026 Jul · PMID 41285413 · Publisher ↗
OBJECTIVE: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality, with cesarean delivery posing a heightened risk. While interventions such as prophylactic tranexamic acid and balloon ta...
OBJECTIVE: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality, with cesarean delivery posing a heightened risk. While interventions such as prophylactic tranexamic acid and balloon tamponade have limitations-especially when the cervix is not dilated-vacuum-assisted uterine tamponade may offer a novel intraoperative approach. This prospective pilot study evaluated the feasibility of the Daisy catheter, a cervical drain device developed by Raydiant Oximetry, Inc., designed to evacuate blood and promote uterine contraction through continuous negative-pressure suction. STUDY DESIGN: We enrolled ten pregnant individuals scheduled for cesarean delivery at a tertiary care center, all of whom had at least one PPH risk factor. Following fetal and placental delivery, the Daisy catheter was inserted trans-hysterotomically, advanced through the cervix, and connected to wall suction (-90 to -100 mm Hg) for 2 hours. Quantitative blood loss, perioperative hemoglobin change, ultrasound findings, and adverse events were recorded. RESULTS: Device placement succeeded in 9 of 10 cases; one failure was due to an undiagnosed cervical cerclage. Eight participants completed the full suction protocol. Mean hemoglobin decline from preoperative baseline to postoperative day 1 was 1.36 ± 0.47 g/dL, significantly lower than the 1.9 ± 1.1 g/dL observed in a historical cohort from 31 U.S. hospitals ( = 0.019). Ultrasound at 2 hours postpartum confirmed correct device placement, absence of intrauterine clot, and no evidence of trauma. Device removal was uncomplicated, and no adverse events were reported. CONCLUSION: These preliminary findings suggest that intraoperative use of the Daisy device is feasible, well-tolerated, and may reduce blood loss after cesarean delivery. Larger, randomized trials are warranted to evaluate its impact on transfusion rates, reoperation, and overall maternal outcomes, particularly in settings where alternative tamponade methods are limited. The ClinicalTrials.gov identifier is NCT06219538. KEY POINTS: · Vacuum tamponade used during cesarean delivery.. · Daisy device showed safe, feasible deployment.. · Hemoglobin drop was lower than the historical average..
Induction Time to Vaginal Delivery: A Comparison of Obstetric Coverage Models.
Lao A, Sommers T, Kim J … +7 more , Maldonado D, Drohan L, Kantorowska A, Vahanian S, Rekawek P, Suhag A, Wat K
Am J Perinatol · 2025 Dec · PMID 41285412 · Publisher ↗
Induction of labor (IOL) and hospitalist coverage are becoming more common. While hospitalist coverage has been associated with improved maternal outcomes and lower cesarean delivery rates, its impact on IOL remains uncl...
Induction of labor (IOL) and hospitalist coverage are becoming more common. While hospitalist coverage has been associated with improved maternal outcomes and lower cesarean delivery rates, its impact on IOL remains unclear. The objective of this study was to compare the induction time to vaginal delivery across three obstetric coverage models: hospitalists, faculty generalists, and private practice generalists.This single-site retrospective cohort study analyzed singleton, term (≥39 weeks), vertex patients undergoing IOL at NYU Langone Hospital-Long Island from January 1, 2022, to September 30, 2022. Hospitalists at this institution managed high-risk obstetric patients, including those under maternal-fetal medicine care, resident clinic, and unregistered patients who presented to labor and delivery, along with serving as labor and delivery safety officer on the labor floor. Faculty and private practice generalists managed their respective groups. Outcomes included induction time to vaginal delivery, mode of delivery, induction methods, and maternal and neonatal complications. Statistical analyses included chi-square, ANOVA, and multivariable linear regression. A -value of < 0.05 was statistically significant.Among 403 patients, 92 (22.8%) were managed by hospitalists, 115 (28.5%) by faculty, and 196 (48.6%) by private generalists. Median (IQR) induction-to-delivery times were similar across groups: hospitalists 20.5 (15.3-27.5) hours, faculty 23.4 (16.5-31.1) hours, and private 19.7 (14.1-25.6) hours ( = 0.004). However, when limited to vaginal deliveries, no significant difference was observed in induction-to-vaginal-delivery time ( = 0.17). Private generalists had the shortest induction-to-cesarean time and time to membrane rupture leading to cesarean. There were no differences in intrapartum or postpartum complications. Hospitalists had more NICU admissions after vaginal delivery, mostly unrelated to labor.Induction-to-vaginal delivery times and complication rates were similar across coverage models, but differences in NICU admissions and cesarean delivery times highlight care variations. Collaboration and evidence-based standardized induction protocols may optimize outcomes across coverage models. · Induction to vaginal delivery time can be similar across obstetric groups.. · Labor and delivery units with high induction rates may benefit from hospitalists.. · An evidence-based induction protocol may optimize maternal and fetal outcomes..
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