Tranexamic Acid to Prevent Obstetrical Hemorrhage after Cesarean Delivery

N Engl J Med, April 13, 2023

Luis D. Pacheco, M.D., Rebecca G. Clifton, Ph.D., George R. Saade, M.D., Steven J. Weiner, M.S., Samuel Parry, M.D., John M. Thorp, Jr., M.D., Monica Longo, M.D., Ph.D., Ashley Salazar, R.N., M.S.N., W.H.N.P., Wendy Dalton, R.N., Alan T.N. Tita, M.D., Ph.D., Cynthia Gyamfi-Bannerman, M.D., Suneet P. Chauhan, M.D., et al., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network*

April 13, 2023
N Engl J Med 2023; 388:1365-1375
DOI: 10.1056/NEJMoa2207419

Background: Prophylactic use of tranexamic acid at the time of cesarean delivery has been shown to decrease the calculated blood loss, but the effect on the need for blood transfusions is unclear.

Cardiovascular risk factors in women and the impact of race and ethnicity contribution.

AHA Scientific Statement, April 10, 2023

Nonbiological variables need to be incorporated into the cardiovascular risk assessment of women.

Cardiovascular Disease Risk Factors in Women: The Impact of Race and Ethnicity: A Scientific Statement From the American Heart Association

Mehta LS, Velarde GP, Lewey J, Sharma G, Bond RM, Navas-Acien A, Fretts AM, Magwood GS, Yang E, Blumenthal RS, Brown RM, Mieres JH;
American Heart Association Cardiovascular Disease and Stroke in Women and Underrepresented Populations Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Hypertension; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council.

Circulation . 2023 Apr 10. doi: 10.1161/CIR.0000000000001139. Online ahead of print. PMID: 37035919 .

Does risk for heart disease start before birth?

American Heart Association, Newsroom, February 13, 2023

Sadiya S. Khan, MD, MSc
Sadiya S. Khan, M.D., M.Sc., FAHA

A new American Heart Association scientific statement summarizes the intergenerational impact of prepregnancy heart health

DALLAS, Feb. 13, 2023 — Preventing heart disease starts much earlier than you may realize, according to a new American Heart Association scientific statement published today in a Go Red For Women spotlight issue of the Association’s flagship, peer-reviewed journal Circulation.

Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association
Sadiya S. Khan et al.
Originally published13 Feb 2023 | https://doi.org/10.1161/CIR.0000000000001124 |Circulation. 2023;147:e76–e91

Single dose of azithromycin reduces maternal sepsis or death

UAB News, by Hannah Echols, February 9, 2023

A-PLUS co-leads Alan Tita, M.D., Ph.D. and Waldemar A. Carlo, M.D. Photography: Andrea Mabry
A-PLUS co-leads Alan Tita, M.D., Ph.D. and Waldemar A. Carlo, M.D.
Photography: Andrea Mabry.

Ten percent of maternal deaths are caused by infections that occur shortly before, during or after delivery. Maternal infections and sepsis, which is a serious complication of infections, are among the top five causes of maternal mortality worldwide. Maternal infection also increases the risk of neonatal sepsis, which accounts for 16 percent of newborn deaths.

A new study published today in the New England Journal of Medicine provides evidence that a single oral dose of azithromycin, a common antibiotic, reduced the risk of maternal sepsis or death by 33 percent in women who delivered vaginally. The results from the Azithromycin Prevention in Labor Use Study, or A-PLUS, trial led by investigators at the University of Alabama at Birmingham enhances information from previous UAB-led trials, which showed azithromycin administered before cesarean delivery reduced maternal infections.

The multi-country, randomized trial was conducted at eight sites in seven low- and middle-income countries in Africa, Asia and Latin America. The study was funded by the National Institutes of Health and the Bill & Melinda Gates Foundation and conducted by the NICHD Global Network for Women’s and Children’s Health Research. Published results were presented simultaneously at the Society for Maternal-Fetal Medicine’s annual meeting in San Francisco, California.

“The World Health Organization and others have prioritized reducing maternal sepsis to reduce maternal deaths,” said Alan Tita, M.D., Ph.D., professor in the UAB Department of Obstetrics and Gynecology and director of the UAB Center for Women’s Reproductive Health and Mary Heersink Institute for Global Health, and associate dean for Global and Women’s Health. “Studies confirming the effectiveness of azithromycin for vaginal delivery, which is the most common mode of delivery, were lacking. We wanted to find a low-cost intervention that could be used globally to address this problem.”

CHAP trial named a Notable Article of 2022 by the NEJM

The Heersink School of Medicine, Written by Shawna Masters, January 25, 2023

Pregnancy

The UAB-led Chronic Hypertension and Pregnancy (CHAP) trial has been named one of the New England Journal of Medicine’s (NEJM) Notable Articles of 2022.

Each year, NEJM editors select a collection of articles to be recognized as “notable” from the previous year. Many of the 2022 articles selected received extensive news coverage, one being the CHAP trial.

The CHAP trial, led by principal investigator Alan Tita, M.D., Ph.D., was initially published in the NEJM in April 2022. The study provides, for the first time, evidence that treating mild chronic hypertension with medications is both safe and beneficial for the mother and the baby.

Obstetrics & Gynecology – Call for Submissions!

Obstetrics & Gynecology, January 4, 2023

Special Issue: Racism & Reproductive Health: Paving a Path to Health Equity

Obstetrics & Gynecology will dedicate an entire issue to explore the influence of racism in obstetrics and gynecology and promising strategies to advance health equity.

Deadline: The submission window is January 20, 2023 to February 1, 2023.

Preventing Maternal Mortality and Morbidity

Northwestern University, News Center, By Haleigh Ehmsen, October 18, 2022

This was originally published in October 2022 Breakthroughs.

A recent report by the CDC found that four out of five deaths during pregnancy, delivery or even up to a year postpartum could have been prevented. The U.S. has the highest maternal death rate of any high-income country, and research is needed to pinpoint why as well as determine how to prevent maternal deaths.
…..

Discovering Patterns and Risk Factors

Through research into women’s heart health and experience during pregnancy, Northwestern scientists have learned the ways women’s health is impacted by social determinants, including what part of the country they live in.
…..