Background A recent study has suggested that labor epidural analgesia may be associated with increased rates of offspring autism spectrum disorder (ASD). Subsequent replication attempts have lacked sufficient power to confidently exclude the possibility of a small effect and the causal nature of this association remains unknown. Objective To investigate the extent to which exposure to labor epidural

Background SARS-CoV2 infection during pregnancy is associated with adverse pregnancy outcomes including fetal death and preterm birth. It is not known whether that risk occurs only during the time of acute infection or whether risk persists later in pregnancy. Objective The goal of this analysis was to evaluate whether the risk of SARS-CoV-2 infection during pregnancy persists after acute maternal

Background Delayed cord clamping (DCC) and umbilical cord milking (UCM) provide placental transfusion to vigorous newborns. Delayed cord clamping in non-vigorous newborns may not be provided due to perceived need for immediate resuscitation. UCM is an alternative since it can be performed more quickly than DCC and may confer similar benefits. Objective We hypothesized that UCM would reduce admission

Background Intrauterine devices are safe, well tolerated and known to reduce the risk of unwanted pregnancies. At medical abortion, intrauterine devices are placed at a follow-up visit. Patients who miss this visit risk being left without contraception. Objective: To study if placement of an intrauterine device within 48 hours of completed medical abortion up to 63 days’ gestation leads to higher user

The importance of a fully functioning placenta for a good pregnancy outcome is unquestioned. Loss of function can lead to pregnancy complications and is often detected by a thorough placental pathologic examination. Placental pathology has advanced the science and practice of obstetrics and neonatal-perinatal medicine by classifying diseases according to underlying biology and specific patterns of

BACKGROUND Recurrent pregnancy loss negatively affects the reproductive outcomes of natural conception. Preimplantation genetic testing for aneuploidies has been the focus of interventions in women with recurrent pregnancy loss. However, the risk of no embryos being available, high costs, and uncertainties surrounding its effectiveness limit its use. Factors beyond euploidy, such as an appropriate

Background Initiating a progestin-based contraceptive prior to the drop in progesterone required to start lactogenesis stage II (LII) could theoretically impact lactation. Previous studies have shown that initiating progestin-based contraception in the postnatal period prior to birth-hospitalization discharge has no detriment on breastfeeding initiation or continuation compared to interval initiation

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Background Prenatal omega-3 fatty acid supplementation, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), has been associated with greater birthweight in clinical trials; however, its impact on fetal growth throughout gestation is unknown. Objective To examine the association between first trimester DHA/EPA supplementation and growth trajectories of estimated fetal weight and

Objective Chronic hypertension is a major health issue, complicating approximately 0.6-1.5 % of all pregnancies in the United States (US).1 Because kidneys are the first end-organ affected by hypertension, the rate of adverse effects can be related to baseline proteinuria.2, 3 Although the classic cutoff value of urine protein >300 mg/24-hour is widely accepted, it is not based on clinical outcomes

Background DNA cytosine nucleotide methylation (epigenomics/ epigenetics) is an important mechanism for controlling gene expression in cardiac development. Combined Artificial Intelligence (AI) and whole-genome epigenomic analysis of circulating cell free DNA (cfDNA) in maternal blood has the potential for the detection of fetal congenital heart defects (CHD). Objective To use genome-wide DNA cytosine

BACKGROUND The functional maternal-fetal hemodynamic unit includes fetal umbilical vein flow and maternal peripheral vascular resistance. OBJECTIVE We investigated the relationships between maternal and fetal hemodynamics in a population with suspected fetal growth restriction. STUDY DESIGN This was a prospective study of normotensive pregnancies referred to our outpatient clinic for a suspected fetal

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Background Assisted reproductive technology usage is increasing annually; however, data on long-term child health outcomes including hospital admissions is limited. Objectives To examine the potential effects of assisted reproductive technology on any and cause-specific hospital admissions not related to perinatal diagnoses. Study design Population-based record-linkage study utilizing a previously

BACKGROUND The long-term effects of vaginal delivery, parity, and pregnancy on the pelvic floor remain uncertain and controversial issues. In comparison with studies using self-reported symptoms, surgical register data may offer a more valid mean for evaluating the relative influence of these risk factors. OBJECTIVES This study used data from three high-quality nationwide registers, the Swedish National

Objective Esophageal atresia is a major anomaly of varying severity. The complexity of surgical correction depends on the presence of a distal fistula. The aim of this study was to determine the feasibility and accuracy of prenatal ultrasound detection of the distal fistula in fetuses diagnosed with esophageal atresia. Methods This was an observational study conducted at a single tertiary care center

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Background The association of pelvic organ prolapse with overactive bladder, other lower urinary tract symptoms (LUTS), and the natural history of those symptoms is not well characterized. Previous cross-sectional studies demonstrated conflicting relationships between prolapse and LUTS. Objectives Primary aims were to determine the baseline association between LUTS and prolapse and to assess longitudinal

Clinical trials to address the COVID-19 public health emergency have broadly excluded pregnant people from participation, illustrating a long-standing trend of clinical trial exclusion that has led to a clear knowledge gap and unmet need in the treatment and prevention of medical conditions experienced during pregnancy or of pregnancy-related conditions. Drugs1 approved for a certain medical condition

Background Among women with symptomatic uterovaginal prolapse undergoing vaginal surgery in the Vaginal hysterectomy with Native Tissue Vault Suspension vs Sacrospinous Hysteropexy with Graft Suspension (Study for Uterine Prolapse Procedures-Randomized Trial (SUPeR) trial, sacrospinous hysteropexy with graft (hysteropexy) resulted in a lower composite surgical failure rate compared to vaginal hysterectomy

Objective Endocervical sampling in women with suspected cervical neoplasia can be obtained by either endocervical brush or endocervical curettage. We aimed to estimate the diagnostic accuracy, discomfort and number of inadequate samples with either test. Data sources Four bibliographic databases were searched on the 9th of June 2022, with no date or language restrictions. Study eligibility criteria

Background Midtrimester sonographic short cervix is a good predictor of preterm birth in singleton pregnancies. Objective To assess the impact on preterm birth rate after implementation of a universal transvaginal cervical length screening program. Study design This study was made up of two parts: a before-and-after multicenter study and a study on the ECHOCOL prospective cohort. We compared the rate

Background For decades, the Apgar scoring system has been used to evaluate neonatal status and determine need for resuscitation or escalation in care, such as admission to a Neonatal Intensive Care Unit. However, variation and accuracy of provider-assigned Apgar scores across neonatal racial groups has yet to be evaluated. Objective To investigate how provider-assigned Apgar scores vary by neonatal

Objective To assess the rate of adverse obstetric and neonatal outcomes in pregnancies diagnosed with confined placental mosaicism vs. unaffected controls. Data sources Web-based databases searched using relevant keywords and retrieved articles published from 1980 to February 2022. Study eligibility criteria Observational studies in English language including at least 10 cases of singleton pregnancies

Objective To evaluate the risk of endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) in asymptomatic postmenopausal women in relation to the endometrial thickness (ET) measured by transvaginal ultrasonography (TVS) stratified by threshold categories used for performing subsequent endometrial sampling and histologic evaluation. Data sources MEDLINE, Scopus, ClinicalTrials.gov, Scielo

Objective The contribution of genetic factors to the presence of overactive bladder (OAB) is recognized. This study aimed to: (1) assemble and synthesize available data from studies assessing differential gene expression in OAB patients compared to non-OAB controls and (2) determine possible correlations and functional pathways between genes. Data sources We searched PubMed, Ovid/Medline, and Wiley

Background Early natural menopause has been regarded as a biomarker of reproductive and somatic aging. Cigarette smoking is the most detrimental factor for lung health and also an established risk factor for early menopause. Understanding the impact of early menopause on health outcomes in mid-life and older female smokers is important to develop preventive strategies. Objective This study aimed to

Background Anti-Mullerian hormone, the most reliable biomarker of ovarian reserve, is widely used in various clinical situations. Anti-Mullerian hormone levels consistently decrease with age. However, there are no standard, age-specific reference values for anti-Mullerian hormone in women of reproductive age, which limits its application. Objective To establish age-specific anti-Mullerian hormone centile

Background Smoking during pregnancy and prenatal secondhand smoke exposure increase risk for preterm birth. As Kentucky has the second highest rate of smoking in the US and no statewide smoke-free law, examination of the impact of municipal smoke-free legislation on preterm birth is warranted. Objective This study used state-level live birth data and county-level municipal smoke-free legislation status

Antenatal steroid (ANS) therapy is standard care for women at imminent risk of preterm delivery. When deliveries occur within seven days of treatment, ANS therapy reduces the risk of neonatal death and improves preterm outcomes by exerting diverse developmental effects on the fetal organs, in particular the preterm lung and cardiovascular system. There is, however, sizable variability in ANS treatment

Postpartum urinary retention is a relatively common condition that can have a significant impact on women in the immediate days following childbirth. If left untreated, postpartum urinary retention can lead to repetitive overdistention injury that may damage the detrusor muscle and the parasympathetic nerve fibers within the bladder wall. In rare circumstances, postpartum urinary retention may even

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Syphilis is a treponemal infection that can be acquired sexually, hematogenous or via vertical transmission from mother to infant. Despite evidence-based curative treatment options with penicillin, it remains a public health threat with increasing prevalence over recent years. Congenital syphilis, a condition where a fetus acquires the infection during pregnancy, can lead to stillbirth, miscarriage

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Background With the increasing rates of same day discharge following minimally invasive surgery for endometrial cancer, the need for and value of routine postoperative testing is unclear. Objective To determine whether routine postoperative labs following minimally invasive hysterectomy for endometrial cancer leads to clinically significant changes in postoperative care. Study Design This is a single-institution

Background Fetal growth restriction is strongly associated with impaired placentation and abnormal utero-placental blood flow. NO-donors like PETN are strong vasodilators and protect the endothelium. Recently, we demonstrated in a randomized controlled pilot-study a 38% relative risk reduction for the development of fetal growth restriction or perinatal death, following administration of PETN to pregnant

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Background Acute funisitis, the histologic diagnosis of inflammation within the umbilical cord, represents fetal inflammatory response to infection. While acute funisitis has been associated with an increased risk of adverse outcomes among preterm neonates, there are limited and conflicting data with term deliveries. Objective We aim to evaluate the association between acute funisitis and neonatal

Background Antenatal corticosteroids (ACS) improve neonatal outcomes when administered to infants who are at risk of preterm delivery. Many women who receive ACS for threatened preterm labor go on to deliver at term. Thus, long-term outcomes should be evaluated for term-born infants who were exposed to ACS in-utero Objective The objective of this study was to compare the long-term outcomes of term-born

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Background The extravillous trophoblast expresses each of the non-classical MHC class I antigens - HLA-E, F, and G and a single classical class I antigen HLA-C. We recently demonstrated dynamic expression patterns of HLA-C, G and F during early EVT invasion and placentation. Objective In this study we investigate the hypothesis that the immune inflammatory mediated complications of pregnancy such as

Background Among women with preterm labor, those with intra-amniotic infection present the highest risk of early delivery and the most adverse outcomes. Identification of intra-amniotic infection requires amniocentesis, perceived as too invasive by women and physicians. Non-invasive methods for identifying intra-amniotic infection and/or early delivery are critical to focus early efforts on high-risk

BACKGROUND While emerging data during the SARS-CoV-2 pandemic have demonstrated robust mRNA vaccine-induced immunogenicity across populations, including pregnant and lactating individuals, the rapid waning of vaccine-induced immunity and the emergence of variants of concern motivated the use of mRNA vaccine booster doses. Whether all populations, including pregnant and lactating individuals, will mount

Background Spontaneous preterm birth accounts for the majority of preterm births and results in significant morbidity in the newborn and childhood period. This subtype of preterm birth represents an increasing proportion of all preterm births compared to medically indicated preterm birth, yet is understudied in ‘Omics analyses. The placenta is a key regulator of fetal and newborn health, and the placental

Background Nineteen states passed legislation mandating insurance coverage of assisted reproductive technology (ART), and out-of-pocket costs associated with in vitro fertilization (IVF) vary significantly depending on the region. Consequently, it has been observed that ART utilization differs regionally and is associated with the presence of an insurance mandate. However, it is unknown whether regional

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Background There is no consensus on an optimal strategy for managing the active phase of the second stage of labor. Intensive pushing could reduce pushing duration, but also increase abnormal fetal heart rate due to cord compression and to the reduced placental perfusion and oxygenation resulting from the combination of uterine contractions and maternal expulsive forces. It may therefore increase the

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Background Recurrent vulvovaginal candidiasis (RVVC) affects nearly 138 million women globally each year. In the US, fluconazole is considered standard of care for acute vulvovaginal candidiasis (VVC), but there are currently no US Food and Drug Administration–approved drugs for the treatment of RVVC. Oteseconazole is a novel oral selective inhibitor of fungal lanosterol demethylase (CYP51, an enzyme

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