Obstetrics & Gynecology

Intrapartum cesarean at advanced dilation doubles subsequent spontaneous preterm birth risk

In this single-center cohort of 20,499 term singleton cephalic births with subsequent pregnancies, spontaneous preterm birth occurred in 3.1% of next pregnancies. Compared with vaginal birth, in-labor cesarean was associated with higher spontaneous preterm birth risk at all gestational thresholds examined. Risk rose with cervical dilation at cesarean, reaching a relative risk of 2.0 at full dilation versus vaginal birth. Full-dilation cesarean particularly increased risk of birth before 32 weeks (RR 4.5) and before 28 weeks (RR 7.7). 1

EHR-based machine learning models dynamically predict short-term preeclampsia risk

This multisite retrospective cohort from three NewYork-Presbyterian hospitals included 58,839 pregnancies with routine EHR data. Extreme gradient boosting models predicted preeclampsia onset within 1, 2, and 4 weeks using vital signs, demographics, and routine laboratories. Model performance improved from 28 to 34 weeks’ gestation and peaked around 34 weeks, including in external validation settings. At high sensitivity thresholds, specificity and positive predictive value supported use for targeted surveillance rather than population screening. 2

Racial and ethnic disparities persist in PGT-A IVF outcomes across >430,000 cycles

This SART CORS study included 438,583 primary autologous ART cycles with single blastocyst transfer, of which 150,604 used PGT-A. Among White women, PGT-A was associated with slightly lower live-birth rates than non–PGT-A cycles, whereas rates were similar for Black and Hispanic women. Asian women using PGT-A had higher intrauterine pregnancy and live-birth rates than Asian women not using PGT-A. PGT-A reduced miscarriage across all racial and ethnic groups, but Black and Hispanic women still had higher miscarriage and lower live-birth rates than White women using PGT-A. 3

Antidepressant use near embryo transfer does not reduce clinical pregnancy or live-birth rates

This nationwide Danish cohort included 44,542 women undergoing 123,146 embryo transfers between 2006 and 2019. Current antidepressant users (1,057 women) and recent users (1,580 women) were compared with women without antidepressant exposure. Adjusted relative risks for clinical pregnancy and live birth among current users were 0.96 and 0.96, both close to unity. For recent users, adjusted relative risks for clinical pregnancy and live birth were 0.94 and 1.04, respectively. 4