American Journal of Obstetrics and Gynecology

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BACKGROUND: Persistent pregnancies of unknown location (PUL) are defined by abnormally trending serum human chorionic gonadotropin with nondiagnostic ultrasound. There is no consensus on optimal management. OBJECTIVE: This study was designed to assess the cost-effectiveness between three primary management strategies for persistent pregnancies of unknown location: (1) expectant management, (2) empirical two-dose methotrexate, (3) uterine evacuation followed by methotrexate, if indicated...

BACKGROUND: Postpartum depression affects 10-20% of birthing people and is associated with changes in healthcare utilization. Little is known about the association between postpartum depressive symptoms and choice to use contraception, however both un- or under-treated depression and short interpregnancy intervals pose significant perinatal health risks. OBJECTIVE: To evaluate whether postpartum depressive symptoms are associated with changes in decisions to use any method of contraception...

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Cefazolin is the most common antibiotic used for prophylaxis in obstetrics and gynecology. Among those with a penicillin allergy, alternative antibiotics are often chosen for prophylaxis given fears of cross-reactivity between penicillin and cefazolin. Alternative antibiotics in this setting are associated with adverse sequalae including surgical site infection, induction of bacterial resistance, higher costs to the healthcare system, and possible Clostridium difficile infection. Given the difference in R1 side chains between the penicillin and cefazolin, cefazolin use is safe and should be recommended for penicillin allergic patients including those who experience IgE-mediated reactions such as anaphylaxis...

BACKGROUND: Continuous glucose monitoring (CGM) has facilitated the evaluation of dynamic changes in glucose throughout the day and their effect on fetal growth abnormalities in pregnancy. However, studies of multiple CGM metrics combined and their association with other adverse pregnancy outcomes are limited. OBJECTIVE: Our goals were to 1) use machine-learning techniques to identify discrete glucose profiles based on weekly CGM metrics in pregnant individuals with pregestational diabetes and, 2) investigate their association with adverse pregnancy outcomes...

BACKGROUND: A consensus standardized definition of success after stress urinary incontinence surgical treatment is lacking, which precludes comparisons between studies and affects patient counseling. OBJECTIVES: To identify optimal patient-centric definition(s) of success after stress urinary incontinence surgical treatment and to compare the identified "more accurate" treatment success definitions with a commonly used composite definition of success (ie, no reported urine leakage, negative cough stress test result, and no retreatment)...

BACKGROUND: In recent years, perinatal viability has shifted from 24 to 22 weeks of gestation at many institutions after improvements in survival in neonates delivered at the limit of viability. Monitoring these fetuses is essential since antenatal interventions with resuscitation efforts are available for patients at risk of delivery at the limit of viability. However, fetal monitoring as biophysical profile has not been extensively studied in very preterm pregnancies, particularly in the periviable period (20 weeks 0 days - 23 weeks 6 days)...

BACKGROUND: Cytomegalovirus is responsible for the most common congenital infection, affecting 0.5-1% of live births in Europe. Congenital CMV infection can be diagnosed during pregnancy by viral DNA amplification in the amniotic fluid, but the prognosis of fetuses without severe brain abnormalities remains difficult to establish based on prenatal imaging alone. OBJECTIVES: To identify predictors of moderate to severe symptomatic CMV infection among fetal blood parameters, and to propose an algorithm based on these parameters and on prenatal imaging that would provide the best positive and negative predictive values...

BACKGROUND: Assessing the umbilical artery pulsatility index (UA PI) via Doppler measurements plays a critical role in evaluating fetal growth impairment. This study aims to investigate perinatal outcomes associated with discordant PIs of umbilical arteries (UAs) in growth-restricted fetuses. METHODS: In this retrospective cohort study, all singleton pregnancies were included if their estimated fetal weight (EFW) and/or abdominal circumference (AC) fell below the 10th percentile for gestational age (2017-2022)...

BACKGROUND: Recently the potential detrimental effect that the duration of storage time may have on vitrified samples has raised some concern, especially when some studies found an association between cryo-storage length and decreased clinical results. OBJECTIVE: This study aimed to evaluate the effects of the storage time length of day-5 vitrified blastocysts in two study groups: freeze-all cycles and non elective frozen embryo transfers (FET). STUDY DESIGN: This was a retrospective study including 58001 vitrified/warmed day-5 blastocysts from two different populations according to the reason for FET...

BACKGROUND: The prevalence of metabolic syndrome is rapidly increasing in the United States. We hypothesized that prediction models using data obtained during pregnancy can accurately predict the future development of metabolic syndrome. OBJECTIVE: To develop machine-learning models to predict the development of metabolic syndrome using factors ascertained in nulliparous pregnant individuals. STUDY DESIGN: This was a secondary analysis of a prospective cohort study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study [nuMoM2b HHS])...

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No abstract text is available yet for this article.

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BACKGROUND: Contemporary guidance for preoperative feeding allows solids up to six hours and clear fluid up to two hours before anesthesia. Clinical trial evidence to support this approach for cesarean section is lacking. Many medical practitioners continue to follow conservative policies of no intake from midnight to the time of surgery, especially in pregnant women. OBJECTIVE: To evaluate the pragmatic approach of permitting free access to water to the point when the operating theater call to dispatch the woman compared to fasting from midnight in preoperative oral intake restriction for planned cesarean under spinal anesthesia on perioperative vomiting and maternal satisfaction...