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Unisex and Sex-Specific Prescriptive Fetal Growth Charts for Improved Detection of Small-for-Gestational-Age Babies in a Low-Risk Population: A post hoc Analysis of a Cluster-Randomized Study. 在低风险人群中改进妊娠期过小婴儿检测的中性和性别特异性胎儿生长指示图:群组随机研究的事后分析。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-26 DOI: 10.1159/000540554
Mariëlle van Roekel, Corine J Verhoeven, Hester D Kamphof, Sanne J Gordijn, Wessel Ganzevoort, Arie Franx, Wessel van Wieringen, Ank de Jonge, Jens Henrichs

Introduction: Our aim was to develop and evaluate the performance of population-based sex-specific and unisex prescriptive fetal abdominal circumference growth charts in predicting small-for-gestational-age (SGA) birthweight, severe SGA (sSGA) birthweight, and severe adverse perinatal outcomes (SAPO) in a low-risk population.

Methods: This is a post hoc analysis of the Dutch nationwide cluster-randomized IRIS study, encompassing ultrasound data of 7,704 low-risk women. IRIS prescriptive unisex and IRIS sex-specific abdominal circumference (AC) fetal growth charts were derived using quantile regression. As a comparison, we used the descriptive unisex Verburg chart, which is commonly applied in the Netherlands. Diagnostic parameters were calculated based on the 34-36 weeks' ultrasound.

Results: Sensitivity rates for predicting SGA and sSGA birthweights were more than twofold higher based on the IRIS prescriptive sex-specific (respectively SGA 43%; sSGA 59%) and unisex (SGA 39%; sSGA 55%) charts, compared to the Verburg chart (SGA 16%; sSGA 23% both p < 0.01). Specificity rates were highest for Verburg (SGA 99%; sSGA 98%) and lowest for IRIS sex-specific (SGA 94%; sSGA 92%). Results for predicting SGA with SAPO were similar for the prescriptive charts (44%), and again higher than the Verburg chart (20%). The IRIS sex-specific chart identified significantly more males as SGA and sSGA (respectively, 42%; 60%, p < 0.001) than the IRIS unisex chart (respectively, 35%; 53% p < 0.01).

Conclusion: Our study demonstrates improved performance of both the IRIS sex-specific and unisex prescriptive fetal growth compared to the Verburg descriptive chart, doubling detection rates of SGA, sSGA, and SGA with SAPO. Additionally, the sex-specific chart outperformed the unisex chart in detecting SGA and sSGA. Our findings suggest the potential benefits of using prescriptive AC fetal growth charts in low-risk populations and emphasize the importance of considering customizing fetal growth charts for sex. Nevertheless, the increased sensitivity of these charts should be weighed against the decrease in specificity.

引言 我们的目的是开发和评估基于人群的性别特异性和单性别规定性胎儿腹围生长曲线图在预测低危人群小于妊娠年龄(SGA)出生体重、严重 SGA(sSGA)出生体重和严重围产期不良结局(SAPO)方面的性能。方法 这是对荷兰全国范围内的分组随机 IRIS 研究进行的一项事后分析,其中包括 7704 名低风险妇女的超声波数据。通过量子回归法得出了 IRIS 规定性单性别和 IRIS 性别特异性腹围(AC)胎儿生长曲线图。作为对比,我们使用了荷兰常用的描述性单性别韦尔堡图表。诊断参数根据 34-36 周超声波检查结果计算得出。结果 根据 IRIS 规定性别的特异性图表(分别为 SGA 43%;sSGA 59%)和中性图表(SGA 39%;sSGA 55%)预测 SGA 和 sSGA 出生体重的灵敏度比 Verburg 图表(SGA 16%;sSGA 23%,均为 p < 0.01)高出两倍多。Verburg 的特异性最高(SGA 99%;sSGA 98%),而 IRIS 性别特异性最低(SGA 94%;sSGA 92%)。用 SAPO 预测 SGA 的结果与处方图表相似(44%),也高于 Verburg 图表(20%)。IRIS 性别特异性图表识别出的 SGA 和 sSGA 男性比例(分别为 42% 和 60%,p<0.001)明显高于 IRIS 单性别图表(分别为 35% 和 53% p<0.01)。结论 我们的研究表明,与 Verburg 描述性图表相比,IRIS 性别特异性和中性胎儿发育描述性图表的性能均有所提高,SGA、sSGA 和 SGA 伴 SAPO 的检出率均增加了一倍。此外,在检测 SGA 和 sSGA 方面,性别特异性图表优于单性别图表。我们的研究结果表明,在低风险人群中使用规定性 AC 胎儿生长图具有潜在的益处,并强调了考虑根据性别定制胎儿生长图的重要性。然而,这些图表灵敏度的提高与特异性的降低应加以权衡。
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引用次数: 0
Pregnancy in Times of War: What Are the Fallouts? A Review. 战时怀孕:后果是什么?回顾。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-24 DOI: 10.1159/000540508
Amine Bouachba, Guillaume Gorincour, Philippe Charlier, Yves Ville

Background: The beginning of the conflict in Ukraine has reminded Europeans of the many and diverse consequences of armed conflicts. Indeed, the ever more sophisticated conflicts have led to the diffusion of numerous chemicals whose consequences spread even after the end of the war. We present through this paper a review of the consequences of pregnancies from the major conflicts that took place since the end of World War II.

Summary: MEDLINE, Web of Science, and Embase were screened for articles linking perinatal death (PD) or birth defects (BD) to wartime. A total of 50 papers treating 8 countries and 4 major and medically documented conflicts were included in the final analysis. An increase in BD and PD during and after the end of the conflicts was reported through all the conflicts analyzed.

Key message: While more data are needed to conclude, maternal-fetal medicine specialists ought to be wary when dealing with exposed populations.

乌克兰冲突的开始提醒了欧洲人武装冲突带来的多种多样的后果。事实上,日益复杂的冲突导致了许多化学品的扩散,其后果甚至在战争结束后仍在蔓延。我们在本文中回顾了自第二次世界大战结束以来发生的主要冲突对妊娠的影响。我们在 MEDLINE、Web of science 和 Embase 中筛选了将围产期死亡或出生缺陷与战争相关联的文章。最终分析共纳入了 50 篇论文,涉及 8 个国家和 4 个有医学记录的重大冲突。在分析的所有冲突中,都有出生缺陷和围产期死亡在冲突期间和冲突结束后增加的报道。虽然还需要更多的数据才能得出结论,但孕产妇胎儿医学专家在处理受冲突影响的人群时应保持警惕。
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引用次数: 0
Predictive Value of the sFlt-1/PlGF Ratio and Interleukin-6 for the Presence of Placental Lesions in Spontaneous Preterm Labor with Intact Membranes with Delivery within 7 Days. sFlt-1/PlGF比值和白细胞介素-6对胎膜完整且在七天内分娩的自发性早产儿胎盘病变的预测价值。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-22 DOI: 10.1159/000540203
Marian Kacerovsky, Helena Hornychova, Magdalena Holeckova, Ladislava Pavlikova, Jitka Rezabkova Chloubova, Bo Jacobsson, Ivana Musilova

Introduction: The aim of the study was to identify predictive values of the soluble fms-like tyrosine kinase/placental growth factor (sFlt-1/PlGF) ratio and interleukin (IL)-6, assessed with a clinically available method in a large-volume biochemistry laboratory, in maternal blood, amniotic fluid, and umbilical cord blood for the presence of the placental lesions consistent with maternal vascular malperfusion (MVM) and acute histological chorioamnionitis (HCA), respectively.

Methods: This retrospective study included 92 women with preterm labor with intact membranes (PTL) delivered within 7 days of admission with gestational ages between 22+0 and 34+6 weeks. The sFlt-1/PlGF ratio and IL-6 were assessed in stored samples of maternal serum, amniotic fluid, and umbilical cord serum using Elecsys® sFlt-1, PlGF, and IL-6 immunoassays.

Results: Women with MVM had a higher sFlt-1/PlGF ratio in the maternal serum, compared to those without MVM (19.9 vs. 4.6; p < 0.0001), but not in the amniotic fluid or umbilical cord blood. A cut-off value of 8 for the sFlt-1/PlGF ratio in maternal serum was identified as optimal for predicting MVM in patients with PTL. Women with HCA had higher concentrations of IL-6 in maternal serum, compared to those without HCA (11.1 pg/mL vs. 8.4 pg/mL; p = 0.03), amniotic fluid (9,216 pg/mL vs. 1,423 pg/mL; p < 0.0001), and umbilical cord blood (20.7 pg/mL vs. 10.7 pg/mL, p = 0.002). Amniotic-fluid IL-6 showed the highest predictive value. A cut-off value of IL-6 concentration in the amniotic fluid of 5,000 pg/mL was found to be optimal for predicting HCA in PTL.

Conclusion: Maternal serum sFlt-1/PlGF and amniotic fluid IL-6 concentrations can be used for liquid biopsy to predict placental lesions in women with PTL who deliver within 7 days.

导言目的:在大容量生化实验室中使用临床可用的方法评估母体血液、羊水和脐带血中的可溶性酪氨酸激酶/胎盘生长因子(sFlt-1/ PlGF)比率和白细胞介素(IL)-6,以确定它们分别对母体血管灌注不良(MVM)和急性组织学绒毛膜羊膜炎(HCA)胎盘病变的预测值。研究方法 这项回顾性研究纳入了 92 名在入院七天内分娩的胎膜未破早产(PTL)产妇,她们的胎龄在 22+0 到 34+6 周之间。使用 Elecsys sFlt-1、PlGF 和 IL-6 免疫测定法对储存的母体血清、羊水和脐带血清样本中的 sFlt-1/PlGF 比率和 IL-6 进行了评估:结果:与没有 MVM 的妇女相比,患有 MVM 的妇女的母体血清中 sFlt-1/PlGF 比率较高(19.9 对 4.6;p <;0.0001),但羊水或脐带血中的 sFlt-1/PlGF 比率不高。母体血清中 sFlt-1/PlGF 比率的临界值为 8,是预测 PTL 患者 MVM 的最佳值。与未患 HCA 的妇女相比,患 HCA 的妇女在母体血清(11.1 pg/mL vs. 8.4 pg/mL;p = 0.03)、羊水(9,216 pg/mL vs. 1,423 pg/mL;p < 0.0001)和脐带血(20.7 pg/mL vs. 10.7 pg/mL,p = 0.002)中的 IL-6 浓度较高。羊水 IL-6 的预测价值最高。羊水中 IL-6 浓度的临界值为 5,000 pg/mL,是预测 PTL 中 HCA 的最佳值:结论:母体血清sFlt-1/PlGF和羊水IL-6浓度可用于液体活检,以预测七天内分娩的PTL产妇的胎盘病变。
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引用次数: 0
North American Fetal Therapy Network: Maternal Outcomes in Fetal Aqueductal Stenosis. 北美胎儿治疗网络:胎儿导水管狭窄的产妇结局。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-22 DOI: 10.1159/000540196
Stephen P Emery, Samia Lopa, Erika Peterson, Jena L Miller, Marjorie C Treadwell, Juliana Gebb, Henry Galan, Eric P Bergh, Amanda Criebaum, Amelia McLennan, Joseph B Lillegard, Yair J Blumenfeld, Ozhan M Turan, David C Streitman

Introduction: Fetal aqueductal stenosis (AS) affects approximately 1:1,000 pregnancies. Obstruction of cerebral spinal fluid circulation occurs at the aqueduct of Sylvius, leading to progressive hydrocephalus and macrocephaly, which often necessitates cesarean section (CS). The purpose of this study was to describe maternal outcomes associated with fetal AS.

Methods: This study is conducted through the North American Fetal Therapy Network (NAFTNet). Subjects with a prenatal diagnosis of severe fetal central nervous system ventriculomegaly were recruited and followed longitudinally. Maternal events around the delivery of fetuses with AS were recorded and analyzed.

Results: Thirty-seven subjects with fetal AS confirmed by neonatal neuroimaging were analyzed. The average gestational age at delivery was 36.7 weeks. Overall, 86% were delivered by CS, and 62% of these were elective. Ninety-one percent of CSs were performed through a Pfannenstiel abdominal incision. A classical uterine incision was required in 13% of cesarean deliveries. The peripartum complication rate was 27%.

Conclusion: Women carrying a fetus with AS were at risk for preterm birth, cesarean delivery, a classical uterine incision, and peripartum complications. These data highlight the maternal morbidity associated with fetal AS and the potential benefit of in utero therapy not only for neonatal outcomes but also for maternal outcomes.

导言:胎儿导水管狭窄(AS)约影响 1:1 000 名孕妇。脑脊液(CSF)循环受阻发生在西尔维乌斯导水管,导致进行性脑积水,通常需要通过传统的子宫切口进行剖宫产(CS)。本研究旨在描述与胎儿导水管狭窄相关的产妇结局:本研究通过北美胎儿治疗网络(NAFTNet)进行。受试者在确诊为重度中枢神经系统脑室肥大时被招募,并接受纵向随访。对患有强直性脊柱炎的胎儿分娩前后的母体事件进行了记录和分析:结果:对37名经新生儿神经影像学检查确诊的胎儿强直性脊柱炎患者进行了分析。平均妊娠期为 36.7 周。总体而言,86%的受试者通过剖宫产(CS)分娩,其中62%为选择性剖宫产。62%为选择性剖宫产。86%为剖宫产。91%的剖腹产是通过普芬恩斯蒂尔腹部切口进行的。13%的剖宫产需要传统的子宫切口。围产期并发症发生率为27%:结论:怀有强直性脊柱炎胎儿的妇女有早产、剖宫产、传统子宫切口和围产期并发症的风险。这些数据凸显了与胎儿强直性脊柱炎相关的孕产妇发病率,以及宫内治疗不仅对新生儿而且对孕产妇的潜在益处。
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引用次数: 0
Elevated Middle Cerebral Artery Peak Systolic Velocity in Non-Anemic Fetuses: Providing a Better Understanding of Enigmatic Middle Cerebral Artery Peak Systolic Velocity. 非贫血胎儿大脑中动脉峰值收缩速度升高--更好地理解神秘的大脑中动脉峰值收缩速度。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-18 DOI: 10.1159/000540342
Saja Anabusi, Tim Van Mieghem, Greg Ryan, Shiri Shinar

Introduction: Our aim was to investigate the incidence, comorbidities, and outcomes of fetuses with an elevated middle cerebral artery peak systolic velocity (MCA-PSV) >1.5 multiples of median (MoM), despite normal hemoglobin (Hgb) levels on fetal blood sampling (FBS).

Methods: A single-center observational retrospective cohort study of all fetuses undergoing FBS and MCA-PSV >1.5 MoM. Only those fetuses with no or mild anemia were included. Indications for Doppler assessment, associated anomalies, and neonatal outcomes were collected.

Results: Overall, 383 fetuses had an MCA-PSV >1.5 MoM and underwent FBS. Twenty-three (6%) fetuses met our inclusion criteria and had no or only mild anemia. Associations with elevated MCA-PSV were elucidated in 12 of the 23 cases (52.2%) and included mild anemia (n = 2), intracranial hemorrhage (n = 3), genetic disease (n = 1), idiopathic nonimmune hydrops (NIH, n = 1), hypoxic-ischemic encephalopathy (n = 1), maternal and or fetal acidosis (n = 3), and fetal growth restriction (n = 1). Favorable perinatal outcomes were observed in truly unexplained 11 cases with no additional anomalies (47.8%).

Conclusion: Elevated MCA-PSV >1.5 MoM with normal Hgb levels is seen in 6% of pregnancies undergoing FBS and is often associated with other significant maternal or fetal problems. Those with unexplained and isolated MCA-PSV elevation have normal outcomes.

引言 我们的目的是研究在胎儿血液采样(FBS)中血红蛋白(Hgb)水平正常,但大脑中动脉收缩峰值速度(MCA-PSV >1.5倍中位数(MoM))升高的胎儿的发病率、并发症和结局。方法 对所有接受 FBS 和 MCA-PSV 为 1.5 倍中位数的胎儿进行单中心观察性回顾性队列研究。仅纳入无贫血或轻度贫血的胎儿。研究收集了多普勒评估的指征、相关畸形和新生儿结局。结果 总体而言,383 个胎儿的 MCA-PSV 为 1.5 MoM,并接受了 FBS。23名(6%)胎儿符合我们的纳入标准,没有贫血或仅有轻度贫血。23例中有12例(52.2%)与MCA-PSV升高有关,包括轻度贫血(2例)、颅内出血(3例)、遗传病(1例)、特发性非免疫性水肿(NIH,1例)、缺氧缺血性脑病(HIE,1例)、母体或胎儿酸中毒(3例)和胎儿生长受限(1例)。在真正原因不明的 11 例病例中,未发现其他异常,围产期结局良好(47.8%)。结论 在接受 FBS 检查的孕妇中,有 6% 出现 MCA-PSV >1.5 MoM 升高但血红蛋白水平正常的情况,而且往往与其他重大的母体或胎儿问题相关。那些原因不明的、孤立的 MCA-PSV 升高孕妇的预后正常。
{"title":"Elevated Middle Cerebral Artery Peak Systolic Velocity in Non-Anemic Fetuses: Providing a Better Understanding of Enigmatic Middle Cerebral Artery Peak Systolic Velocity.","authors":"Saja Anabusi, Tim Van Mieghem, Greg Ryan, Shiri Shinar","doi":"10.1159/000540342","DOIUrl":"10.1159/000540342","url":null,"abstract":"<p><strong>Introduction: </strong>Our aim was to investigate the incidence, comorbidities, and outcomes of fetuses with an elevated middle cerebral artery peak systolic velocity (MCA-PSV) &gt;1.5 multiples of median (MoM), despite normal hemoglobin (Hgb) levels on fetal blood sampling (FBS).</p><p><strong>Methods: </strong>A single-center observational retrospective cohort study of all fetuses undergoing FBS and MCA-PSV &gt;1.5 MoM. Only those fetuses with no or mild anemia were included. Indications for Doppler assessment, associated anomalies, and neonatal outcomes were collected.</p><p><strong>Results: </strong>Overall, 383 fetuses had an MCA-PSV &gt;1.5 MoM and underwent FBS. Twenty-three (6%) fetuses met our inclusion criteria and had no or only mild anemia. Associations with elevated MCA-PSV were elucidated in 12 of the 23 cases (52.2%) and included mild anemia (n = 2), intracranial hemorrhage (n = 3), genetic disease (n = 1), idiopathic nonimmune hydrops (NIH, n = 1), hypoxic-ischemic encephalopathy (n = 1), maternal and or fetal acidosis (n = 3), and fetal growth restriction (n = 1). Favorable perinatal outcomes were observed in truly unexplained 11 cases with no additional anomalies (47.8%).</p><p><strong>Conclusion: </strong>Elevated MCA-PSV &gt;1.5 MoM with normal Hgb levels is seen in 6% of pregnancies undergoing FBS and is often associated with other significant maternal or fetal problems. Those with unexplained and isolated MCA-PSV elevation have normal outcomes.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fetal Strain and Strain Rate Measured with Speckle Tracking Echocardiography in Maternal Diabetes: Systematic Review. 用斑点追踪超声心动图测量母体糖尿病患者的胎儿应变和应变率:系统综述。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-17 DOI: 10.1159/000538413
Chantelle de Vet, Hossy Zamani, Daisy van der Woude, Sally-Ann Clur, Guid Oei, Judith van Laar, Noortje van Oostrum

Introduction: The aim of this systematic review and meta-analysis was to evaluate fetal cardiac function in fetuses of mothers with diabetes compared to those of mothers without diabetes using 2D-STE.

Methods: Embase, MEDLINE, and CENTRAL were searched for observational studies on 2D-STE fetal left and right ventricular global longitudinal strain and strain rate that included singleton, non-anomalous pregnancies complicated by pregestational or gestational diabetes mellitus compared to uncomplicated pregnancies. The strain values were pooled per 4 weeks of gestation for meta-analysis using random-effects models.

Results: Fifteen studies met the criteria, including 990 fetuses of diabetic mothers and 1,645 control fetuses. The study design was cross-sectional in fourteen studies and longitudinal in one study. Gestational age, type of diabetes, ultrasound device, and 2D-STE software varied between the studies. Glycemic control and type of treatment were often lacking. In fetuses of diabetic mothers versus healthy mothers, left ventricular strain was significantly decreased (7 studies), increased (1 study), or not significantly different (7 studies). Right ventricular strain was decreased (7 studies), increased (1 study), or not different (2 studies). Left ventricular strain rate was decreased (3 studies), increased (1 study), or not different (2 studies). Right ventricular strain rate was increased (1 study) or not different (2 studies).

Conclusion: Fetuses of mothers with diabetes show evidence of systolic dysfunction, which is more visible in the right ventricle. Contradictory results are probably due to suboptimal study designs and variation in gestational age, diabetes severity, image acquisition, and software. Large prospective longitudinal studies are needed to assess fetal myocardial function with 2D-STE in pregestational diabetes mellitus type 1 and 2 and gestational diabetes mellitus pregnancies. The influence of glycemic control, BMI, and treatment should be evaluated.

简介:这项系统性综述和荟萃分析的目的是利用 2D-STE 评估糖尿病母亲与非糖尿病母亲胎儿的胎儿心脏功能:方法: 通过Embase、MEDLINE和CENTRAL检索了有关二维STE胎儿左心室和右心室整体纵向应变和应变率的观察性研究,这些研究包括单胎、因妊娠前或妊娠期糖尿病而并发的非异常妊娠与非并发妊娠的比较。使用随机效应模型对每4周妊娠的应变值进行汇总,以进行荟萃分析:15项研究符合标准,包括990名糖尿病母亲的胎儿和1645名对照组胎儿。14 项研究的研究设计为横断面研究,1 项研究为纵断面研究。不同研究的妊娠年龄、糖尿病类型、超声设备和 2D-STE 软件各不相同。血糖控制和治疗类型往往缺失。与健康母亲相比,糖尿病母亲的胎儿左心室应变显著降低(7 项研究)、增加(1 项研究)或无显著差异(7 项研究)。右心室应变减少(7 项研究)、增加(1 项研究)或无差异(2 项研究)。左心室应变率降低(3 项研究)、升高(1 项研究)或无差异(2 项研究)。右心室应变率增加(1 项研究)或无差异(2 项研究):结论:母亲患有糖尿病的胎儿会出现收缩功能障碍,这在右心室更为明显。结论:患有糖尿病的母亲所怀的胎儿有收缩功能障碍的迹象,右心室更为明显。出现矛盾的结果可能是由于研究设计不够理想,以及妊娠年龄、糖尿病严重程度、图像采集和软件的不同造成的。需要进行大型前瞻性纵向研究,用二维STE评估妊娠前1型和2型糖尿病妊娠及妊娠期糖尿病妊娠的胎儿心肌功能。应评估血糖控制、体重指数和治疗的影响。
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引用次数: 0
Effect of Maternal Ursodeoxycholic Acid Treatment on Fetal Atrioventricular Conduction in Patients with Intrahepatic Cholestasis of Pregnancy. 母体熊去氧胆酸治疗对妊娠肝内胆汁淤积症患者胎儿房室传导的影响
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-16 DOI: 10.1159/000540261
Ömer Gökhan Eyisoy, Oya Demirci, Ümit Taşdemir, Mucize Özdemir, Aydın Öcal, Özge Kahramanoğlu

Introduction: The aim of this study was, first, to investigate the difference in fetal atrioventricular conduction in patients with and without intrahepatic cholestasis of pregnancy (ICP) by measuring the fetal PR interval; second, to evaluate the altering effect of ursodeoxycholic acid (UDCA) treatment on the fetal PR interval in ICP patients.

Methods: The study consisted of 42 ICP patients and 48 healthy pregnant women. Fetal echocardiography was performed to measure the mechanical PR interval. The fetal PR interval and the clinical characteristics were compared between the two groups. The effect of UDCA treatment on the fetal PR interval in ICP patients was evaluated.

Results: In ICP patients, significantly longer fetal PR intervals were observed than in the control group (123.21 ± 8.54 vs. 115.13 ± 5.95 ms, p < 0.001). In the ICP group, there was a positive correlation between the fetal PR interval and maternal fasting total bile acid (TBA) levels (r = 0.514, p = 0.001). After 1 week of treatment with UDCA in patients with ICP, the PR interval was shorter than before, although the reduction was not statistically significant (120.98 ± 6.70 vs. 123.21 ± 8.54 ms, p = 0.095). In patients with severe ICP (TBA >40 mmol/L, n = 10), a significant reduction in the fetal PR interval was observed after treatment with UDCA (127.5 ms [IQR, 118.0-134.75] before vs. 122 ms [IQR, 109.5-126.5] after, p = 0.037).

Conclusion: Fetal PR interval increased in ICP patients in correlation with maternal serum TBA concentration. Treatment with UDCA may have limited positive effects on the fetal AV conduction system. The beneficial effects of UDCA on the fetal PR interval may be more pronounced in patients with higher bile acid levels.

简介本研究的目的首先是通过测量胎儿PR间期,研究妊娠肝内胆汁淤积症(ICP)患者和非ICP患者胎儿房室传导的差异;其次是评估熊去氧胆酸(UDCA)治疗对ICP患者胎儿PR间期的改变作用:研究对象包括 42 名 ICP 患者和 48 名健康孕妇。胎儿超声心动图测量机械性 PR 间期。比较两组孕妇的胎儿 PR 间期和临床特征。评估了 UDCA 治疗对 ICP 患者胎儿 PR 间期的影响:ICP患者的胎儿PR间期明显长于对照组(123.21±8.54 vs. 115.13±5.95 ms,p<0.001)。在 ICP 组中,胎儿 PR 间期与母体空腹总胆汁酸水平(TBA)呈正相关(r=0.514,p=0.001)。ICP患者使用UDCA治疗一周后,PR间期比治疗前缩短,但缩短幅度无统计学意义(120.98±6.70 vs. 123.21±8.54ms,p=0.095)。在重度 ICP(TBA>40 mmol/L,n=10)患者中,观察到 UDCA 治疗后胎儿 PR 间期显著缩短(治疗前 127,5ms [IQR, 118,0-134,75] vs. 治疗后 122ms [IQR, 109,5-126,5], p=0,037):结论:ICP 患者的胎儿 PR 间期延长与母体血清 TBA 浓度相关。使用 UDCA 治疗可能对胎儿房室传导系统产生有限的积极影响。UDCA 对胎儿 PR 间期的有利影响在胆汁酸水平较高的患者中可能更为明显。
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引用次数: 0
Middle Cerebral Artery Doppler before and after Fetal Spina Bifida Repair: An Indirect Sign of Hindbrain Compression and Decompression? 胎儿脊柱裂修复前后的大脑中动脉多普勒:后脑受压和减压的间接标志?
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-06-14 DOI: 10.1159/000539773
Ladina Vonzun, Ladina Ruegg, Julia Zepf, Nele Strübing, Patrice Grehten, Martin Meuli, Luca Mazzone, Ueli Moehrlen, Nicole Ochsenbein-Koelble

Introduction: Reduced middle cerebral artery resistance indices (MCA-RI) in fetuses with spina bifida (fSB) are commonly observed. Compression of neuronal pathways in the brainstem due to hindbrain herniation (HH) and disturbed cerebrospinal fluid circulation likely cause an imbalance of the autonomic nervous system. This may increase systemic vasoconstriction and compensatory increase cerebral vasodilation (like brain sparing). The aim of this study was to systematically analyze all fetal MCA-RI before and after fSB repair and to compare their correlation with the presence and postsurgical resolution of HH.

Methods: 173 patients were included. Standardized ultrasound examinations including MCA and umbilical artery (UA) Doppler as well as assessment of HH presence and regression were performed. Fetuses with MCA-RI <5th percentile (P) before fetal surgery were compared to the group with normal MCA-RI and correlated to the presence of HH before and its regression after fSB repair.

Results: 30% (49/161) fetuses showed RI's <5th P before fSB repair. All fetuses had normal UA-RI. 99.4% of fetuses (160/161) showed normal of MCA-RI before delivery. Normalization occurred within a mean of 1.3 ± 1.2 weeks. HH regression was observed in 97% in the group with normal MCA-RI and in 96% in the group with MCA-RI <5th P before surgery (p = 0.59). Time lapse to HH regression after fSB repair was 1.8 ± 1.7 and 1.9 ± 1.6 weeks, respectively.

Conclusion: In fetuses with MCA-RIs <5 P before fSB repair, a parallel timely course of MCA-RI normalization and HH regression was noted. To suggest common pathogenic factor(s), more studies are needed. However, normalization of the fetal cerebral circulation could be a further benefit of fSB repair.

导言:脊柱裂胎儿的大脑中动脉阻力指数(MCA-RI)降低是常见现象。后脑疝(HH)和脑脊液循环障碍导致脑干神经元通路受压,很可能造成自主神经系统失衡。这可能会增加全身血管收缩和代偿性增加脑血管扩张(如脑疏通)。本研究的目的是系统分析 fSB 修复前后的所有胎儿 MCA-RI,并比较其与 HH 存在和手术后缓解的相关性。方法:共纳入 173 例患者,进行了包括 MCA 和脐动脉(UA)多普勒在内的标准化超声检查,并评估了 HH 的存在和消退情况。将胎儿手术前MCA-RI<第5百分位数(P.)的胎儿与MCA-RI正常的胎儿组进行比较,并将两者与胎儿手术前是否存在HH及手术后HH是否消退进行比较:结果:30%(49/161)的胎儿在FSB修补术前显示出RI的第5百分位数。所有胎儿的 UA-RI 均正常。99.4%的胎儿(160/161)在分娩前显示 MCA-RI 正常。正常化平均发生在 1.3±1.2 周内。术前MCA-RI正常组中有97%的胎儿HH消退,MCA-RI<5thP.组中有96%的胎儿HH消退(P = 0.59)。FSB修复后HH消退的时间分别为1.8±1.7周和1.9±1.6周:结论:在fSB修复前MCA-RIs为5.P的胎儿中,MCA-RI正常化与HH消退的时间进程是平行的。要提出共同的致病因素,还需要更多的研究。然而,胎儿脑循环正常化可能是 fSB 修复的另一个益处。
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引用次数: 0
Comparison of Serial Amnioinfusion Strategies for Isolated Early-Onset Fetal Renal Anhydramnios. 针对孤立性早发性胎儿肾性无羊水症的连续无羊水灌注策略比较。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-06-10 DOI: 10.1159/000539732
Joyce M Cheng, Ahmet A Baschat, Meredith A Atkinson, Mara Rosner, Michelle L Kush, Denise Wolfson, Sarah Olson, Kristin Voegtline, Lindsey Goodman, Angie C Jelin, Jena L Miller

Introduction: The optimal protocol for serial amnioinfusions to maintain amniotic fluid in pregnancies with early-onset fetal renal anhydramnios before 22 weeks is not known. We compared the performance of two different approaches.

Methods: A secondary analysis was conducted of serial amnioinfusions performed by a single center during the external pilot and feasibility phases of the Renal Anhydramnios Fetal Therapy (RAFT) trial. During the external pilot, higher amnioinfusion volumes were given less frequently; in the feasibility study, smaller volume amnioinfusions were administered more frequently. Procedural details, complications, and obstetric outcomes were compared between the two groups using Pearson's χ2 or Fisher's exact tests for categorical variables and Student's t tests or Wilcoxon rank-sum tests for continuous variables. The adjusted association between procedural details and chorioamniotic separation was obtained through a multivariate repeated measure logistic regression model.

Results: Eleven participants underwent 159 amnioinfusions (external pilot: 3 patients, 21 amnioinfusions; feasibility: 8 patients, 138 amnioinfusions). External pilot participants had fewer amnioinfusions (7 vs. 19.5 in the feasibility group, p = 0.04), larger amnioinfusion volume (750 vs. 500 mL, p < 0.01), and longer interval between amnioinfusions (6 [4-7] vs. 4 [3-5] days, p < 0.01). In the external pilot, chorioamniotic separation was more common (28.6% vs. 5.8%, p < 0.01), preterm prelabor rupture of membranes (PPROM) occurred sooner after amnioinfusion initiation (28 ± 21.5 vs. 75.6 ± 24.1 days, p = 0.03), and duration of maintained amniotic fluid between first and last amnioinfusion was shorter (38 ± 17.3 vs. 71 ± 19 days, p = 0.03), compared to the feasibility group. While delivery gestational age was similar (35.1 ± 1.7 vs. 33.8 ± 1.5 weeks, p = 0.21), feasibility participants maintained amniotic fluid longer.

Conclusion: Small volume serial amnioinfusions performed more frequently maintain normal amniotic fluid volume longer because of delayed occurrence of PPROM.

导言 22 周前早发胎儿肾性羊水过少的孕妇进行连续羊水灌注以维持羊水的最佳方案尚不清楚。我们比较了两种不同方法的效果。方法 在肾性无水胎儿治疗(Renal Agenesis Fetal Therapy,RAFT)试验的外部试验和可行性阶段,我们对单个中心进行的连续羊水灌注进行了二次分析。在外部试验阶段,大容量羊膜腔注射的频率较低;在可行性研究阶段,小容量羊膜腔注射的频率较高。对两组的手术细节、并发症和产科结果进行了比较,对分类变量采用皮尔逊卡方检验或费雪精确检验,对连续变量采用学生 t 检验或 Wilcoxon Rank-Sum 检验。程序细节与绒毛膜羊膜分离之间的调整关联是通过多变量重复测量逻辑回归模型得出的。结果 11名参与者接受了159次羊膜腔注射(外部试点:3名患者,21次羊膜腔注射;可行性:8名患者,138次羊膜腔注射)。外部试点参与者的羊膜腔注射次数较少(可行性组为 7 次对 19.5 次,p = 0.04),羊膜腔注射量较大(750 毫升对 500 毫升,p < 0.01),羊膜腔注射间隔时间较长(6 [4-7] 天对 4 [3-5] 天,p < 0.01)。在外部试验中,绒毛膜羊膜分离更常见(28.6% vs. 5.8%,p < 0.01),早产胎膜早破(PPROM)在羊膜腔注射开始后更早(28 ± 21.5 对 75.6 ± 24.1 天,p = 0.03),与可行性组相比,首次和最后一次羊膜腔注射之间的羊水维持时间更短(38 ± 17.3 对 71 ± 19 天,p=0.03)。虽然分娩胎龄相似(35.1 ± 1.7 对 33.8 ± 1.5 周,p=0.21),但可行性组的羊水维持时间更长。结论 小容量连续羊水灌注更频繁地维持正常羊水量的时间更长,因为PPROM发生的时间会推迟。
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引用次数: 0
Needle Fetal Thoracoscopy: A Technique to Assist with Ultrasound-Guided Placement of Challenging Thoracoamniotic Shunts. 针式胎儿胸腔镜检查:一种在超声引导下辅助进行高难度胸羊膜分流术的技术。
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-05-15 DOI: 10.1159/000539274
Steven T Papastefan, Daniel R Liesman, Katherine C Ott, Federico Scorletti, Xavier F Pombar, Aimen F Shaaban, Amir M Alhajjat

Introduction: Fetal thoracoamniotic shunts are common lifesaving interventions but frequently require replacement. Needle fetal thoracoscopy is a technique that uses standard thoracoamniotic shunt introducer sheaths to permit direct visualization and even instrument manipulation during shunt deployment to facilitate optimal positioning and primary shunt function in the most challenging cases.

Case presentation: In this study, 5 patients who underwent needle fetal thoracoscopy-assisted thoracoamniotic shunt placement were reviewed. Three patients with large, macrocystic congenital pulmonary airway malformations (CPAMs) with evidence of worsening mediastinal shift and/or hydrops and 2 patients with large chylothorax with fetal hydrops were treated. Four cases had previous shunts that failed due to poor sonographic visualization during initial placement, cyst septations, shunt obstruction, or dislodgment. Needle fetal thoracoscopy was used to disrupt cyst walls and septations, clear hematoma, and confirm the optimal initial position of the shunt. In this series, 1 severe CPAM patient with a short cervix developed preterm labor postoperatively resulting in neonatal demise. The remaining 4 patients experienced resolution of hydrops and progressed to successful delivery with excellent neonatal outcomes.

Conclusion: Needle fetal thoracoscopy is a procedure that may be selectively deployed in challenging thoracoamniotic shunt cases impacted by recurrent failure, poor sonographic windows, and challenging fetal positioning.

引言胎儿胸羊膜分流术是常见的救生措施,但经常需要更换。针式胎儿胸腔镜是一种使用标准羊膜腔分流导管鞘的技术,可在分流管部署过程中直接观察甚至操作器械,从而在最具挑战性的病例中实现最佳定位和主要分流功能:本研究回顾了五例接受针式胎儿胸腔镜辅助羊膜腔分流术的患者。其中三例患者患有巨大囊性先天性肺气道畸形(CPAM),并伴有纵隔移位和/或水肿恶化的证据;两例患者患有巨大乳糜胸,并伴有胎儿水肿。四例患者之前曾进行过分流术,但因初次置入时声像图显示不清、囊肿隔膜、分流术阻塞或移位而失败。使用针式胎儿胸腔镜破坏囊壁和隔膜、清除血肿并确认分流管的最佳初始位置。在该系列手术中,一名宫颈短的重度 CPAM 患者术后出现早产,导致新生儿死亡。其余四名患者的水肿得到缓解,并顺利分娩,新生儿预后良好:结论:针刺胎儿胸腔镜手术可有选择性地应用于受反复失败、声像图窗口不佳和胎位困难影响的高难度胸羊膜腔分流术病例。
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引用次数: 0
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Fetal Diagnosis and Therapy
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