What's new in maternal-fetal medicine: October 24, 2026

Committee Statement No. 32 recommends opt-out lifetime HIV screening, with more frequent testing for ongoing risk, inclusive sexual histories and discussion of PrEP. It recommends prescribing PrEP for increased acquisition risk and for any person who requests it. Pregnancy still requires HIV screening during each pregnancy.

Review routine prenatal screening, risk-based retesting, counseling, PrEP referral/prescribing and medication-specific monitoring. ACOG notes good pregnancy and lactation safety data for oral PrEP; do not generalize those data to every newer formulation.

Darakamas and colleagues reported complete or partial treatment response in 22 of 24 pregnancies (91.7%). The authors observed conversion in 9 of 9 fetuses with supraventricular tachycardia treated with flecainide alone; among seven atrial-flutter cases treated with flecainide, five had rate control and two converted. These small, nonrandomized subgroups should not be used to rank first-line therapies.

The 2024 AHA scientific statement (endorsed by PACES) differentiates supraventricular tachycardia (SVT) from atrial flutter (AFL) and considers whether hydrops is present. Its Figure 2 lists flecainide for SVT without hydrops, flecainide plus digoxin for SVT with hydrops, sotalol for AFL without hydrops, and sotalol plus digoxin for AFL with hydrops as first-line approaches. This does not mean all fetal tachyarrhythmias should receive flecainide or digoxin.

Among 17 fetuses with sonographically enlarged thyroid glands, 14 had a maternal risk factor - frequently current or previous Graves disease - and 6 had additional sonographic abnormalities. Some fetuses improved with altered maternal treatment; others were observed or received specialized fetal treatment.

A suspected fetal goiter should prompt detailed neck assessment, fetal heart rate and growth review, maternal thyroid studies, thyroid-stimulating immunoglobulin / receptor antibody history and medication review. Therapy depends on whether fetal thyroid function is excessive or deficient.

A meta-analysis including 28,035 observations (5,516 balloon exposures) found lower odds of complete rupture with balloon-based induction than prostaglandin induction (OR 0.43, 95% CI 0.26-0.72), but no statistically detected difference versus spontaneous labor or oxytocin alone. Certainty was very low.

Mechanical ripening remains a reasonable option in appropriately selected TOLAC candidates with continuous monitoring and rapid cesarean capability. Findings cannot isolate the effect of the balloon, because oxytocin and/or amniotomy usually followed.

Among 5.6 million singleton deliveries, coded low-lying placenta was associated with hemorrhage in 21.1% versus 4.0% with normal placentation, and severe maternal morbidity in 4.5% versus 1.8%. This was an administrative-data analysis, not a gestational-age-specific delivery-planning study.

Verify placental edge-to-os distance and interval resolution on ultrasound. Plan intrapartum hemorrhage preparedness based on current imaging and clinical factors; these associations do not establish a new cesarean threshold.

In a secondary analysis of 2,302 nulliparous patients with neuraxial anesthesia, each estimated 100-mU increase in second-stage oxytocin exposure was associated with increased postpartum hemorrhage risk (adjusted RR 1.027, 95% CI 1.015-1.038).

Reassess ongoing indication, titration and documentation in prolonged second stage. Do not stop indicated oxytocin based on an observational association; total dose is strongly related to labor duration and indication.

SMFM distinguishes universal, validated questionnaire-based screening from indiscriminate universal biological testing, and describes disparities in who undergoes testing. It proposes stratified quality measures for standardized screening at birth admission.

Review consent and notification, the clinical indications for urine or other biological testing, use of validated tools, equitable implementation and clear links to treatment rather than punitive responses.

An AJOG Clinical Opinion argues that AI-assisted clinical work requires independent verification of sources, awareness of hallucinations and bias, protection of confidentiality and ongoing physician accountability. It is a professional framework, not a validated tool efficacy study.

For calculators and EMR-ready summaries, require tested formulas, traceable original citations, clear version dates, documented limitations and clinician review. Avoid entering identifiable clinical details into unapproved services.