Efficacy of large language models and their potential in Obstetrics and Gynecology education.

Objective: The performance of large language models (LLMs) and their potential utility in obstetric and gynecological education are topics of ongoing debate. This study aimed to contribute to this discussion by examining the recent advancements in LLM technology and their transformative potential in artificial intelligence. Methods: This study assessed the performance of generative pre-trained transformer (GPT)-3.5 and -4 in understanding clinical information, as well as its potential implications for obstetric and gynecological education. Obstetrics and gynecology residents at three hospitals underwent an annual promotional examination, from which 116 of the 170 questions over 4 years (2020-2023) were analyzed, excluding 54 questions with images. The scores achieved by GPT-3.5, -4, and the 100 residents were compared. Results: The average scores across all 4 years for GPT-3.5 and -4 were 38.79 (standard deviation [SD], 5.65) and 79.31 (SD, 3.67), respectively. For groups R1, R2, and R3, the cumulative annual average scores were 79.12 (SD, 9.00), 80.95 (SD, 5.86), and 83.60 (SD, 6.82), respectively. No statistically significant differences were observed between the scores of GPT-4.0 and those of the residents. When analyzing questions specific to obstetrics, the average scores for GPT-3.5 and -4.0 were 33.44 (SD, 10.18) and 90.22 (SD, 7.68), respectively. Conclusion: GPT-4 demonstrated exceptional performance in obstetrics, different types of data interpretation, and problem solving, showcasing the potential utility of LLMs in these areas. However, acknowledging the constraints of LLMs is crucial and their utilization should augment human expertise and discernment.

What is the impact of simulation on the learning of hysteroscopic skills by residents and medical students? A systematic review.

INTRODUCTION: Hysteroscopy is a critical procedure in gynecology for diagnosing and managing intrauterine pathology. Traditional hands-on training faces ethical and safety challenges, leading to an increased reliance on simulation training. This review systematically assesses the effectiveness of hysteroscopic simulation training in enhancing the technical skills of obstetrics and gynecology residents and medical students. METHODS: A PRISMA-guided literature search was conducted, covering English-language articles from January 2000 to December 2023. Studies were selected based on pre-defined criteria, focusing on the impact of simulation training on the targeted educational group. Metrics for evaluating skill improvement included machine-recorded metrics, Objective Structured Assessment of Technical Skills (OSATS), and global rating scales. RESULTS: The review included nine studies with varied designs, demonstrating significant improvements in hysteroscopic skills following simulation training. Virtual reality (VR) simulators showed substantial benefits in skill acquisition, while physical simulators provided valuable tactile feedback. However, long-term skill retention and the impact on non-technical skills were not adequately assessed. CONCLUSIONS: Simulation-based training effectively enhances hysteroscopic skills in medical students and residents. Further research is needed to explore long-term skill retention and the development of non-technical competencies. Robust studies, including randomized trials, are required for definitive validation.

Are state abortion bans an occupational health hazard for obstetrician-gynaecologists? Findings from a multistate qualitative study.

OBJECTIVES: Since the US Supreme Court's Dobbs v. Jackson decision, 17 states have imposed near-total abortion bans. These bans may negatively impact health and well-being of obstetrician-gynaecologists (OB-GYNs), due to high levels of work-related stress that the laws have created for them. The goal of the present study is to evaluate the impacts of post-Dobbs v. Jackson state abortion bans on occupational health and well-being of OB-GYNs. METHODS: The Study of OB-GYNs in Post-Roe America is a qualitative study of 54 OB-GYNs practising in 13 of the 14 states with near-total abortion bans as of March 2023. Using volunteer sampling methods, participants were recruited for semistructured qualitative interviews via videoconference from March to August 2023. RESULTS: Thematic analysis of interview transcripts identified six major domains of health and well-being impacts of state abortion bans on OB-GYNs: anxiety and depression, burden of negative emotions, burn-out, coping-related health behaviours, sleep disruption and personal relationships. CONCLUSIONS: State abortion bans following the 2022 Dobbs decision may impact the health and well-being not only of pregnant patients but also of their providers. These provider health impacts include mental health and burn-out but also extend to physical health outcomes and the work-life interface.

Impact of the COVID-19 pandemic on teaching and research activities in obstetrics and gynecology: a national two-stage, stratified, cluster sampling survey in China.

BACKGROUND: Few studies quantified the influence of the coronavirus disease 2019 (COVID-19) pandemic on medical teaching and scientific research activities in China. This is the first national study to investigate such topics from the viewpoint of physicians practicing obstetrics and gynecology in China. METHODS: This is a national questionnaire survey with online interviews for respondents. This two-stage, stratified, cluster sampling method was applied based on city categories (categories 1 to 3 correspond to < 10,000, 10,000 to 30,000, and > 30,000 beds, respectively), hospital levels (primary, secondary, and tertiary), and hospital types (general and specialized) in China among physicians practicing obstetrics and gynecology. Physicians documented notable alterations in both overall and specialized teaching and research engagements. Comparative analyses were conducted across diverse municipal and hospital attributes. RESULTS: Data were collected from a representative sample of 11,806 physicians from 779 hospitals across 157 cities and 31 provinces. Notably, except for online seminars, a minimum reduction of 20% in both overall and specialized teaching and research activities was observed among physicians. Up to 61.7% (95% confidence interval 59.3-64.0) of physicians reported either a complete termination or a > 50% decline in resident training. Compared with category 1 cities and primary hospitals, category 3 cities and tertiary hospitals experienced greater reductions in items of resident or graduate education, visiting scholar, clinical trials, and laboratory studies (adjusted p values < 0.05), coupled with notable increases in online seminar participation (adjusted p values of 0.002 and < 0.001, respectively). CONCLUSIONS: Amidst the COVID-19 pandemic in China, activities requiring direct, face-to-face communication were more affected in resource-rich cities and general hospitals compared to resource-limited areas and specialized hospitals. Residency training experienced the most significant decline. Conversely, participation in online seminars increased, providing additional opportunities for continuing medical education.

Exploring the Efficacy of Artificial Intelligence: A Comprehensive Analysis of CHAT-GPT's Accuracy and Completeness in Addressing Urinary Incontinence Queries.

BACKGROUND: Artificial intelligence models are increasingly gaining popularity among patients and healthcare professionals. While it is impossible to restrict patient's access to different sources of information on the Internet, healthcare professional needs to be aware of the content-quality available across different platforms. OBJECTIVE: To investigate the accuracy and completeness of Chat Generative Pretrained Transformer (ChatGPT) in addressing frequently asked questions related to the management and treatment of female urinary incontinence (UI), compared to recommendations from guidelines. METHODS: This is a cross-sectional study. Two researchers developed 14 frequently asked questions related to UI. Then, they were inserted into the ChatGPT platform on September 16, 2023. The accuracy (scores from 1 to 5) and completeness (score from 1 to 3) of ChatGPT's answers were assessed individually by two experienced researchers in the Women's Health field, following the recommendations proposed by the guidelines for UI. RESULTS: Most of the answers were classified as "more correct than incorrect" (n = 6), followed by "incorrect information than correct" (n = 3), "approximately equal correct and incorrect" (n = 2), "near all correct" (n = 2, and "correct" (n = 1). Regarding the appropriateness, most of the answers were classified as adequate, as they provided the minimum information expected to be classified as correct. CONCLUSION: These results showed an inconsistency when evaluating the accuracy of answers generated by ChatGPT compared by scientific guidelines. Almost all the answers did not bring the complete content expected or reported in previous guidelines, which highlights to healthcare professionals and scientific community a concern about using artificial intelligence in patient counseling.

Bilateral Pregnancy Luteoma Presenting as Acute Abdomen in a Young Female: A Case Report.

Pregnancy luteoma (PL) is a rare, non-neoplastic ovarian lesion that can mimic malignant ovarian tumors, posing significant diagnostic challenges. PL typically presents as asymptomatic, unilateral, or bilateral ovarian masses and is often discovered incidentally. Its development is linked to hormonal fluctuations during pregnancy, particularly elevated human chorionic gonadotropin (hCG) levels. While PL generally resolves postpartum, complications such as torsion may necessitate surgical intervention. We report the case of a 23-year-old primigravida presenting with acute abdominal pain, vomiting, and abdominal distention at 13 weeks gestation. Imaging revealed large, bilateral multicystic ovarian masses. Elevated CA-125 levels raised suspicion for malignancy, leading to a laparotomy and bilateral oophorectomy. Histopathological analysis confirmed the diagnosis of pregnancy luteoma.

Does surgery to preserve fertility in Sertoli-Leydig cell tumours increase the likelihood of spontaneous conception?

A nulligravida in her 30s presented with primary infertility and secondary amenorrhoea. General examination revealed virilisation; sonological examination detected a right ovarian solid mass. International Ovarian Tumour Analysis (IOTA) was suggestive of malignancy and serum testosterone was raised. A strong clinical suspicion and negative tumour markers pointed towards androgen producing sex cord stromal ovarian neoplasm. MRI excluded pelvic lymphadenopathy. Given the patient's desire for conception, fertility sparing staging laparotomy was done. Histopathology confirmed Sertoli-Leydig cell tumour (SLCT) International Federation of Gynaecology and Obstetrics stage IA. Serum testosterone fell drastically by day 10. Spontaneous menstruation resumed within 30 days. The significance of SLCTs as a differential diagnosis in young women with secondary amenorrhoea and virilising features underscores the role of fertility-preserving surgery in certain circumstances. Here we discuss the clinical features, diagnostic challenges and management strategies for SLCTs, emphasising the need for multidisciplinary collaboration and option of fertility preservation in early stages.

A Practical Approach to the Diagnosis and Initial Management of Acute Right Ventricular Failure during Pregnancy using Point-of-Care Ultrasound.

Acute right ventricular failure is a critical condition in pregnancy that can lead to severe maternal and fetal complications. This expert review discusses the instrumental role of Point-of-Care Ultrasound in diagnosing and managing ARVF in pregnant patients, highlighting its benefits for immediate clinical decision-making in obstetric emergencies. The unique physiological changes during pregnancy, such as increased blood volume and cardiac output, can exacerbate underlying or latent cardiac issues, making pregnant patients particularly susceptible to acute right ventricular failure. Common causes during pregnancy include pulmonary embolism, peripartum cardiomyopathy, and congenital heart diseases, each presenting distinct challenges in diagnosis and management. The real-time capability of point-of-care ultrasound allows for the immediate assessment of right ventricular size and function, evaluation of fluid status via the inferior vena cava, and identification of potential pulmonary embolism, offering a non-invasive, rapid, and dynamic diagnostic tool right at the bedside. The expert review details specific point-of-care ultrasound techniques adapted for pregnant patients, including the parasternal long and short axis and apical four-chamber view, essential for evaluating right heart function and guiding acute management strategies. These include fluid management, adjustment of pharmacological treatment, and immediate interventions to support cardiac function and reduce ventricular overload. Point-of-care ultrasound enhances clinical outcomes by allowing clinicians to make informed decisions quickly, reducing the time to intervention, and tailoring management strategies to individual patient needs. However, despite its apparent advantages, the adoption of point-of-care ultrasound requires specialized training and familiarity with obstetric-specific protocols. This review advocates for the integration of point-of-care ultrasound into standard obstetric care protocols, emphasizing the need for clear guidelines and structured protocols that equip healthcare providers with the skills necessary to utilize this technology effectively. Future research should aim to refine these protocols and expand the evidence base to solidify the role of point-of-care ultrasound in improving maternal and fetal outcomes in acute right ventricular failure.

Evaluating the accuracy and reliability of non-piezo portable ultrasound devices in postpartum care.

INTRODUCTION: The early diagnosis of hemorrhage via postpartum ultrasound is crucial to initiate therapy and, thus, prevent maternal death. In these critical situations rapid availability and simple transport of ultrasound devices is vital, paving the way for a  new generation of portable handheld ultrasound devices (PUD) consisting of transducers and tablets or smart phones. However, evidence to confirm the diagnostic accuracy of these new devices is still scarce. METHODS: The accuracy and reliability of these new devices in relation to established standard ultrasound devices is analyses in this pilot study by comparing diagnoses and by applying statistical analysis via Bland-Altman plots, intraclass correlation coefficients (ICC), and Pearson correlation coefficients (PCC). One hundred patients of a university hospital were included in this study. RESULTS: In all cases, the same diagnosis was made regardless of the applied ultrasound device, confirming high accuracy. There was a high correlation (PCC 0.951) and excellent agreement (ICC 0.974) in the assessment of the cavum, while the assessment of the diameters of the uterus showed only a good correlation and a good agreement. Subgroup analysis for maternal weight, mode of delivery and day after delivery was performed  CONCLUSION: The same diagnosis independent of the used devices and excellent results of the cavum assessment promote the use of PUDs in a clinical setting. The slightly lower accuracy in the measurement of the uterus may be caused by the PUD's small acoustic window, reflecting one of its weaknesses. Therefore, the patient may benefit from the short time to diagnosis and the unbound location of examination, either in the delivery room, on the ward, or at home.

Use of Long-Acting Injectables for Severe Mental Illness in the Peripartum Period: A Case Report and a Scoping Review.

The management of acute mania during pregnancy poses a complex clinical task, necessitating careful consideration of treatment options and demanding a delicate balance between the risks associated with medication use and the adverse impacts of untreated severe mental illness on the fetus. Medication nonadherence stands out as a significant factor contributing to relapse, with rates potentially reaching 40%. The pharmacokinetic profile of long-acting injectable (LAI) risperidone contrasts with that of oral risperidone, characterized by a gradual and consistent release from the depot, mitigating fluctuations between peak and trough concentrations. Clinically, this sustained plasma profile of LAI risperidone has been linked to a reduction in adverse events, such as extrapyramidal side effects, metabolic syndrome, and hyperprolactinemia. Numerous studies have indicated that LAI antipsychotic therapy correlates with reduced mortality rates and decreased number of hospitalizations. This case report illustrates the effective management of acute mania in a pregnant 32-year-old through the utilization of LAI risperidone. This case underscores the significance of individualized treatment strategies and emphasizes the potential utility of LAI antipsychotics as a viable therapeutic option for managing acute mania in pregnancy. Further research is warranted to delineate the long-term outcomes and safety profile of LAI antipsychotics in this population.

Artificial Intelligence in Predicting the Mode of Delivery: A Systematic Review.

The integration of artificial intelligence (AI) into obstetric care offers significant potential to enhance clinical decision-making and optimize maternal and neonatal outcomes. Traditional prediction methods for mode of delivery often rely on subjective clinical judgment and limited statistical models, which may not fully capture complex patient data. This systematic review aims to evaluate the current state of research on AI applications in predicting the mode of delivery, comparing the performance of AI models with traditional methods, and identifying gaps for future research. A comprehensive literature search was conducted across PubMed, Google Scholar, Web of Science, and Scopus databases, covering publications from January 2010 to July 2024. Inclusion criteria were studies employing AI techniques to predict the mode of delivery, published in peer-reviewed journals, and involving human subjects. Studies were assessed for quality using the Prediction Model Risk of Bias Assessment Tool (PROBAST), and data were synthesized narratively due to heterogeneity. In total, 18 studies met the inclusion criteria, employing various AI models such as logistic regression, random forest, gradient boosting, and neural networks. Sample sizes ranged from 40 to 94,480 participants across diverse geographic settings. AI models demonstrated high accuracy rates, often exceeding 90%, and strong predictive metrics (area under the curve (AUC) values from 0.745 to 0.932). Key predictors included maternal age, gravidity, parity, gestational age, labor induction type, and fetal weight. Notable models like the Adana System and Categorical Boosting (CatBoost, Yandex LLC, Moscow, Russia) highlighted the effectiveness of AI in enhancing prediction accuracy and supporting clinical decisions. AI models significantly outperform traditional statistical methods in predicting the mode of delivery, providing a robust tool for obstetric care. Future research should focus on standardizing data collection, improving model interpretability, addressing ethical concerns, and ensuring fairness in AI predictions to enhance clinical trust and application.

Predicting collaborative practice between midwives and obstetricians: A regression analysis.

INTRODUCTION: Effective collaborative practice between midwives and obstetricians improves patient safety and obstetrical outcomes, but its implementation remains challenging. Therefore, its determinants need to be better understood. This study examined factors impacting collaborative practice (CP) between these professional groups. METHODS: This study was a cross-sectional survey that took place in Swiss hospital labor wards in 2021. Collaborative practice perceptions of 70 midwives (57.4% response rate) and 44 obstetricians (29.0% response rate) were assessed using the Interprofessional Collaboration Scale, with the score serving as the main outcome. A total of 13 individual, behavioral, and organizational predictors were analyzed by multiple linear regression. RESULTS: Participants rated collaborative practice with a median score of 3.1 (IQR: 2.8-3.4) out of a maximum score of 4.0. Results showed that five predictors significantly influenced collaborative practice: type of profession (ß= -0.180; 95% CI: -0.296 - -0.040, p=0.011), trust/respect (ß=0.343; 95% CI: 0.085-0.040, p=0.000), shared visions/goals (ß=0.218; 95% CI: 0.030-0.204, p=0.009), workplace (ß=0.253; 95% CI: 0.089-0.445, p=0.004) and shared power (ß=0.163; 95% CI: 0.042-0.222, p=0.015). The model explained 66% of the variance (adjusted R2) in collaborative practice in labor wards. CONCLUSIONS: This study has identified key factors influencing CP in Swiss labor wards: workplace characteristics that require tailored CP models, and a power-sharing culture that fosters trust, respectful interactions and shared goals, requiring active exchange between midwives and obstetricians.

Improving birth experiences and provider interactions: Expert opinion on critical links in Maternity care.

This article explores the Quality of Provider Interaction (QPI) within maternity care, spotlighting its crucial role in positive childbirth experiences. It emphasizes the need for trust-based relationships between women and their care providers, a necessity amplified by the profound neurohormonal sensitivities experienced during labor. Drawing from the 'Optimizing the birth environment' COST DEVOTION CA18211 Working Group, this article aims to provide insights and stimulate discussion on how to mitigate birth trauma and improve childbirth experiences. The study evolved through discussions on QPI, engagement with the group, a review of COST Action research, and conference contributions, leading to essential recommendations. From our dialogue and evaluation of existing literature, we identified four pivotal aspects critical to enhancing QPI: 1) Empathy and emotional availability, 2) Trauma-informed maternity care, 3) Integrating woman-centered individual and institutional attitudes, and 4) Empowering language use. We examine how these elements influence women's emotional and psychological well-being throughout childbirth and beyond, underscoring their critical contribution. This article proposes a framework to improve maternity care by enhancing the Quality of Provider Interaction (QPI). It offers practical recommendations for refining care protocols and language guidelines, emphasizing the importance of respectful, secure birthing environments. Adopting care models that prioritize high-quality provider interactions is crucial for the well-being of women and their families.

Rare complications of complete hydatidiform molar pregnancy: the 'hook effect' and thyrotoxicosis.

A multiparous woman in her 40s presented with a positive pregnancy test, vaginal bleeding, abdominal distention and shortness of breath, 8 weeks after her last menstrual period. A serum human chorionic gonadotrophin (hCG) was reported 900 mIU/ml, and a transvaginal ultrasound (TVUS) diagnosed a pregnancy of unknown location. The patient deteriorated re-presenting 6 days later with features of thyrotoxicosis. TVUS demonstrated a 198×110×165-mm intrauterine mass with features of a complete hydatidiform mole (CHM), and a serum hCG was reported as 440 mIU/ml. Due to the discrepancy between hCG level and suspicion of CHM, the hCG was thought to be falsely low secondary to the 'hook effect'. Following appropriate dilution, the hCG was reported as 4 573 344 mIU/mL. She underwent an uncomplicated surgical evacuation of molar pregnancy and was discharged 3 days postoperatively with resolution of her symptoms and follow-up in a regional gestational trophoblastic disease centre.

Content and timing of the 6-8 week maternal postnatal check: a mixed methods study.

BACKGROUND: Since 2020, the General Medical Services contract requires GP practices in England to offer women a GP appointment 6-8 weeks after birth: the '6-8 week postnatal check' or 'consultation'. Historically, provision of checks was variable, and women still frequently report poor experiences. AIM: To explore GPs' and women's perspectives of the 6-8 week postnatal check, including key components and timing. DESIGN & SETTING: Mixed methods study: focus groups of GPs and women, and an online survey of GPs in England. METHOD: Focus groups explored GPs' and women's experiences of postnatal consultations. An online survey explored GPs' clinical approach, organisation, and improvement potential. Quantitative analysis examined associations between demographics and clinical approach. Thematic framework analysis was used for qualitative data. RESULTS: 18 women and 14 GPs participated in focus groups. 671 GPs completed the survey. Mental wellbeing and contraception were reported as important topics, although some women were not asked about mental health. GP survey responses indicated most recommendations from national guidance were 'always' or 'very often' covered by most, but not all GPs. Clinical coverage was higher for GPs who used clinical templates, had awareness of guidance, were female or a parent. Many GPs (n=326, 49%) needed more time than was allocated for the consultation: (n=524, 78% allocated<15 minutes; n=351, 52% completed in<15 minutes). CONCLUSION: This study suggests GPs are allocated insufficient time for postnatal consultations, with substantial variation in practice. Specifying consultation duration and consideration of template usage in policy may improve care and outcomes for women.

Early prediction of gestational diabetes mellitus using first trimester maternal serum pregnancy-associated plasma protein-a: A cross-sectional study.

Background and Aims: The oral glucose tolerance test with 75 g glucose is commonly regarded as the gold standard (GS) for the detection of gestational diabetes mellitus (GDM). However, one limitation of this test is its administration in the late second trimester of pregnancy in some countries (e.g., Iran). This study aimed to evaluate the accuracy of pregnancy-associated plasma protein-A (PAPP-A) for predicting GDM in the early first trimester of pregnancy using a novel statistical modeling technique. Methods: The study population consisted of 344 pregnant women who participated in the first trimester screening program for GDM. Maternal serum PAPP-A levels were measured between 11 and 13 gestational weeks for all participants. A Bayesian latent profile model (LPM) under the skew-t (ST) distribution was employed to estimate the diagnostic accuracy measures of PAPP-A in the absence of GS test outcomes. Results: The mean (standard deviation) age of the participants was 28.87 ± 5.20 years. The median (interquartile range (IQR)) PAPP-A MoM was 0.91 (0.69-1.34). Utilizing the LPM under the ST distribution while adjusting for covariates, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of PAPP-A were 92% (95% credible interval [CrI]: 0.89, 0.98), 81% (95% CrI: 0.76, 0.91), and 0.91 (95% CrI: 0.83, 0.97), respectively. Notably, the pregnant women with GDM had significantly lower PAPP-A values ( ß = -0.52, 95% CrI [-0.61, -0.46]). Conclusion: Generally, our findings confirmed that PAPP-A could serve as a potential screening tool for the identification of GDM in the early stages of pregnancy.

'Are you pregnant? If not, why not?': artificial reproductive technology and the trauma of infertility.

The article scrutinises Rohini S. Rajagopal's work, what's a lemon squeezer doing in my vagina (2021), to illustrate the escalating medicalisation of infertile bodies. In a cultural context where reproductive concerns are construed as medical disorders demanding treatment and surveillance, medical professionals and pharmaceutical companies exploit these sociocultural dynamics to provide infertile couples with immediate solutions through Assisted Reproductive Technologies. Consequently, the study contributes a critical perspective to the field of medical humanities, initiating a nuanced discourse that interrogates the impact of terms such as 'living laboratories', 'baby machine', 'mother machine' and 'hope technology' on our comprehension of future motherhood. Drawing on feminist critiques of medicalisation, the article argues that biotechnology perpetuates the eighteenth-century biomedical metaphor of the body as a machine with replaceable parts. Notably, contemporary advancements in reproductive medicine allow for the replacement of perceived 'flawed' body parts, further objectifying them within this framework.

Severe Maternal Morbidity: The Impact of Race on Tricare Beneficiaries.

Maternal morbidity and mortality rates in the United States have increased in the last two decades with a disproportionate impact on women of color. While numerous factors contribute to the inequities in pregnancy-related mortality, access to health insurance is among the most significant. Military Tricare models universal health care access; however, in studies looking at births in military treatment facilities, disparities still exist for women of color. This study analyzed maternal delivery outcomes for all women with Tricare coverage, including deliveries in the civilian sector. We analyzed data from 6.2 million births in the Centers for Disease Control (CDC) Wide-ranging Online Data for Epidemiology Research (WONDER) Linked Birth/Infant Death Records for 2017-2019. Data included all-cause morbidity (transfusions, perineal lacerations, uterine rupture, unplanned hysterectomy, and ICU admissions), severe maternal morbidity (SMM) excluding lacerations, and SMM excluding transfusion. Risk ratios were calculated by comparing overall maternal morbidity rates between Tricare, Medicaid, self-pay, and private insurance. In addition, risk ratios were calculated between insurance types stratified by race. In conclusion, there is an increased risk for women identifying as racial minorities for SMM and SMM excluding transfusion. While Tricare coverage seems to decrease the risk, the decrease is not significant and disparities in outcomes persist among women identifying as minorities. The risk of severe maternal morbidity remains elevated for women of color despite access to Tricare health insurance.

Universal Cardiovascular Disease Risk Assessment in Pregnancy: Call to Action JACC: Advances Expert Panel.

The United States has the highest maternal mortality rate among developed countries, with cardiovascular disease (CVD) being one of the leading causes of maternal deaths. Diagnosing CVD during pregnancy may be challenging as symptoms of normal pregnancy overlap with those of CVD. Delays in recognition and response to the diagnosis of CVD is a missed opportunity for timely intervention to improve maternal outcomes. Implementing universal CVD risk assessment for all pregnant and postpartum patients across clinical care settings presents a pivotal opportunity to address this issue. Integrating a validated risk assessment tool into routine obstetric care, clinicians, including obstetricians, primary care, and emergency healthcare providers, can enhance awareness of cardiovascular risk and facilitate early CVD diagnosis. Consensus among stakeholders underscores the importance of screening and education on cardiovascular health strategies for pregnant and postpartum patients to reduce CVD-related maternal mortality. This comprehensive approach offers a pathway to identify at-risk individuals and intervene promptly, potentially saving lives and advancing maternal healthcare equity.

Digital versus Speculum-Based Balloon Catheter Insertion for Labor Induction: A Systematic Review and Meta-Analysis: Digital vs speculum-based balloon IOL.

OBJECTIVES: Induction of labor is commonly undertaken when ongoing pregnancy poses risk to either mother or fetus. Often cervical preparation is required with mechanical methods increasingly popular due to their improved safety. This study evaluates the efficacy, safety, and acceptability of digital versus speculum-based balloon insertion for cervical preparation, aiming to identify gaps and inform future research. DATA SOURCE: PubMed, Ovid MEDLINE, EMBASE, and Scopus were searched from database inception until 30 June 2023. STUDY ELIGIBILITY CRITERIA: Included studies were randomized controlled trials comparing digital versus speculum-based insertion of catheter-related balloons for labor induction in individuals with viable singleton pregnancies, in both inpatient and outpatient settings, written in English. Exclusions included studies not using cervical balloons, comparisons to non-balloon methods, non-human studies, and non-primary literature like guidelines, reviews, commentaries, and opinion pieces. METHODS: Title and abstract screening were performed by four authors. Full-text articles were assessed against inclusion criteria. Selection was agreed upon by consensus among three authors, with a fourth consulted for disputes. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for randomized trials. A meta-analysis was also performed. RESULTS: Out of 3397 studies, four met the inclusion criteria, all being randomized controlled trials with some concerns in at least one domain but no high risk of bias. Two studies found digital insertion significantly less painful than speculum-based insertion (p<0.001), while one reported no difference (p=0.72). Maternal satisfaction was comparable, with one study favouring digital insertion (p=0.011). Meta-analysis findings for other outcome measures suggest no difference between speculum or digital insertion. However, due to substantial heterogeneity, findings for procedural time, time from induction-to-delivery, and epidural rate should be cautiously interpreted. CONCLUSIONS: Digital insertion for cervical preparation appears associated with reduced pain and higher patient acceptability compared to speculum-based insertion. Additionally, efficacy and safety were comparable, indicating it is a preferable option for clinical use. There was no difference in other procedural, obstetric, or neonatal outcomes, however, more rigorous research employing standardised outcome measures is needed to facilitate a clinically meaningful interpretation.