American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Feb 2021
Fetal growth velocity standards from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.
Human growth is susceptible to damage from insults, particularly during periods of rapid growth. Identifying those periods and the normative limits that are compatible with adequate growth and development are the first key steps toward preventing impaired growth. ⋯ The fetal skeleton and abdomen have different velocity growth patterns during intrauterine life. Accordingly, we have produced international Fetal Growth Velocity Increment Standards to complement the INTERGROWTH-21st Fetal Growth Standards so as to monitor fetal well-being comprehensively worldwide. Fetal growth velocity curves may be valuable if one wants to study the pathophysiology of fetal growth. We provide an application that can be used easily in clinical practice to evaluate changes in fetal size as conditional velocity for a more refined assessment of fetal growth than is possible at present (https://lxiao5.shinyapps.io/fetal_growth/). The application is freely available with the other INTERGROWTH-21st tools at https://intergrowth21.tghn.org/standards-tools/.
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Am. J. Obstet. Gynecol. · Feb 2021
A Chronicle of the 17OHP-C Story to Prevent Recurrent Preterm Birth.
Preterm birth is a substantial public health concern. In 2019, the US preterm birth rate was 10.23%, which is the fifth straight year of increase in this rate. Moreover, preterm birth accounts for approximately 1 in 6 infant deaths, and surviving children often suffer developmental delay or long-term neurologic impairment. ⋯ Importantly, the themes of the 17-alpha hydroxyprogesterone caproate story are not limited to obstetrics. It can also serve as a microcosm of issues within the US healthcare system, which ultimately contributes to the high cost of healthcare. In our opinion, the answer to the question is clear-the facts speak for themselves-and we believe 17-alpha hydroxyprogesterone caproate should not be endorsed for use to prevent recurrent preterm birth in the United States.
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Am. J. Obstet. Gynecol. · Feb 2021
Birth hospital and racial and ethnic differences in severe maternal morbidity in the state of California.
Birth hospital has recently emerged as a potential key contributor to disparities in severe maternal morbidity, but investigations on its contribution to racial and ethnic differences remain limited. ⋯ In California, excess odds of severe maternal morbidity among racially and ethnically minoritized women were not fully explained by birth hospital. Structural causes of racial and ethnic disparities in severe maternal morbidity may vary by region, which warrants further examination to inform effective policies.
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Am. J. Obstet. Gynecol. · Feb 2021
A specific bacterial DNA signature in the vagina of Australian women in midpregnancy predicts high risk of spontaneous preterm birth (the Predict1000 study).
Intrauterine infection accounts for a quarter of the cases of spontaneous preterm birth; however, at present, it is not possible to efficiently identify pregnant women at risk to deliver preventative treatments. ⋯ We have identified a vaginal bacterial DNA signature that identifies women with a singleton pregnancy who are at increased risk of spontaneous preterm birth and may benefit from targeted antimicrobial therapy.
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Am. J. Obstet. Gynecol. · Feb 2021
Assessment of evidence underlying guidelines by the Society for Maternal-Fetal Medicine.
The Society for Maternal-Fetal Medicine, sometimes together with the American College of Obstetricians and Gynecologists, publishes guidelines utilizing the Grading of Recommendations, Assessment, Development, and Evaluation system to rate the quality of evidence and assign the strength of its recommendations. The strength of recommendations is determined by the quality of evidence and 3 other strength determinants that are defined in this system. ⋯ Recommendations by the Society for Maternal-Fetal Medicine assessed by the Grading of Recommendations, Assessment, Development, and Evaluation system were supported by high-quality evidence in 15% of cases. This suggests that well-designed, high-quality clinical trials remain a priority in obstetrics. Strong recommendations were often made on the basis of Grading of Recommendations, Assessment, Development, and Evaluation strength determinants other than quality of evidence. Increased transparency of the Society for Maternal-Fetal Medicine's determination of strong recommendations based on strength determinants other than quality of the evidence may be useful to practicing clinicians.