Journal of Perinatal Medicine最新文献

Objectives: Maternal vascular malperfusion (MVM) refers to dysfunctional uteroplacental circulation and is associated with increased risk of adverse maternal and fetal outcomes. The diagnosis of MVM is one of the most common pathological diagnoses in term placentas. The aim of the study was to test the interrater reliability of the MVM Amsterdam criteria.

Methods: A group of 12 international perinatal pathologists reviewed digital histological sections of placentas (n=29; 20 MVM/ 9 non-MVM controls), applying published Amsterdam workshop consensus criteria. Kappa statistics were used for interobserver agreement analysis.

Results: Agreement levels on final MVM diagnosis according to Amsterdam consensus were calculated as slight to fair (K-values of 0.187 and 0.260, p<0.001). Substantial agreement was reached one time for infarcts (K-value of 0.707, p<0.001). Complementary tested criteria achieved none to moderate agreement.

Conclusions: Our results highlight the need to refine current MVM criteria to support consistent international diagnosis.

Objectives: To explore the association between postpartum pain and discharge readiness after delivery, and examine the mediating effects of social support and quality of discharge guidance.

Methods: This study included puerperae who delivered and were discharged from a tertiary hospital affiliated to Peking University between April and July 2021 by the convenience sampling method. The Chinese versions of the OB-RHDS, OB-QDTS, PSQ, and VAS were used to evaluate discharge readiness, quality of discharge guidance, social support, and postpartum pain, respectively. The path analysis was performed based on the Andersen model.

Results: A total of 306 questionnaires were distributed in this study, and 276 (90.20 %) valid questionnaires were collected. The postpartum pain at discharge was 2.62±1.89 (possible range: 0-10). The average score of postpartum social support (importance) was 210.98±30.08, and the average score of postpartum social support (actually received) was 201.17±34.21, respectively. The postpartum pain at discharge significantly affected maternal discharge readiness. The path analysis showed that the quality of discharge guidance had the mediating effect of the association between pain at discharge and discharge readiness, and postpartum social support was a moderator for the association between pain at discharge and quality of discharge guidance, and the association between quality of discharge guidance and discharge readiness.

Conclusions: The postpartum pain at discharge was associated with discharge readiness, and the quality of discharge guidance and postpartum social support might mediate the association.

Objectives: Maternal hemorrhage is a leading cause of maternal morbidity and mortality worldwide, with significant regional disparities. This study utilizes the most recent Global Burden of Disease (GBD) 2021 data to examine global and regional trends in maternal hemorrhage from 1990 to 2021.

Methods: We analyzed the incidence, mortality, and disability-adjusted life years (DALYs) attributable to maternal hemorrhage across 204 countries and territories. We calculated the Estimated Annual Percentage Change (EAPC) for key indicators and projected future trends using Bayesian age-period-cohort models.

Results: From 1990 to 2021, global maternal hemorrhage incidence declined from 14.17 million to 13.96 million cases, and age-standardized incidence rate (ASIR) decreased from 245.34 to 176.89 per 100,000 (EAPC: -0.835 %), with particularly high rates in Central and Western Sub-Saharan Africa. DALYs attributed to maternal hemorrhage dropped from 7.1 million to 2.96 million, with the age-standardized DALYs rate (ASDR) falling from 125.29 to 37.47 per 100,000 (EAPC: -3.975 %). Mortality also decreased from 114,112 to 46,874 deaths, and the age-standardized mortality rate (ASMR) declined from 2.04 to 0.59 per 100,000 (EAPC: -4.055 %), with the largest reductions in East Asia and South Asia. Regions with lower socio-demographic index experienced high incidence, DALYs, and mortality rates. Projections to 2050 suggest a continued global decline in all indicators.

Conclusions: Despite overall reductions in the global burden of maternal hemorrhage, significant regional disparities persist, particularly in low-resource settings. Targeted interventions in high-burden regions, such as Sub-Saharan Africa, are crucial to further reduce maternal morbidity and mortality.

Objectives: to describe the risk of early and late fetal loss of a cohort of monochorionic monoamniotic (MCMA) twin pregnancies; secondary objectives are to describe perinatal outcomes of these pregnancies and to identify which obstetric variables mostly influence the incidence of neonatal adverse outcome.

Methods: retrospective cohort study including MCMA twin pregnancies followed up at the Twin Pregnancy Care Unit of Sant'Anna Hospital in Turin (Italy) between 2005 and 2024. Chorionicity and amnionicity were diagnosed in the first trimester.

Results: a total number of 53 MCMA twin pregnancies have been included in the study, of which 42 progressed beyond 24 weeks of gestation. The rate of fetal loss before 24 weeks of GA was 19.8 %, after 24 weeks this rate lowered to 3.6 %; the incidence of overall intrauterine losses was 23.6 %; 80.5 % of liveborn twins were female. Around one fourth of the newborn babies had an adverse outcome, the likelihood of which was significantly influenced by gestational age at birth, birthweight and presence of malformations. The incidence of congenital malformations in our sample was 13.4 %.

Conclusions: most fetal losses occur before 24 weeks of gestation and the rate of fetal demise after this cutoff is quite low. It could be worth to postpone elective delivery to 34 weeks of gestational age or beyond, in order to reduce perinatal complications associated to premature birth.

Objectives: To evaluate current evidence on prenatal neurobehavioural assessment using four-dimensional ultrasound (4D-US), structured scoring systems, and emerging artificial intelligence (AI) platforms, and to develop an integrated framework for early identification of neurodevelopmental vulnerability.

Methods: A narrative review of the literature from 2000 to 2025 was conducted following PRISMA-guided organisational principles to enhance transparency. Studies were eligible if they used 3D/4D ultrasound to assess fetal neurobehaviour, including spontaneous motor activity, facial expressions, or behavioural transitions. Specific tools examined included the Kurjak Antenatal Neurodevelopmental Test (KANET), prenatal General Movements Assessment (GMA), and AI-assisted behavioural analysis systems. Methodological quality was appraised using the Newcastle-Ottawa Scale and the Joanna Briggs Institute checklist. Data extraction focused on imaging protocols, behavioural parameters, scoring systems, and associations with neonatal neurological outcomes.

Results: Fifty eligible studies demonstrated that fetal motor sequences, movement variability, and facial expressions exhibit hierarchical maturation consistent with developmental progression of brainstem, subcortical, and cortical neural circuits. KANET parameters showed reproducible scoring and meaningful correlation with neonatal neurodevelopment, particularly in high-risk pregnancies. Prenatal general movement patterns displayed continuity with postnatal repertoires and contributed to early neurological prediction. AI-based classifiers provided objective quantification of fetal movement and facial activity, supporting automated or semi-automated assessment workflows.

Conclusions: Functional neurobehavioural assessment using 4D-US, structured scoring tools, and AI-enhanced analysis is feasible, reproducible, and clinically informative. Integrating behavioural markers with neurosonographic findings and computational modelling may strengthen early detection of neurological risk and improve long-term neurodevelopmental care pathways.

Objectives: Post-mortem magnetic resonance imaging (pmMRI) has emerged as a promising, non-invasive alternative to conventional autopsy for detecting cardiac anomalies in fetal and perinatal deaths and we aimed to systematically evaluate the diagnostic accuracy of pmMRI in detecting cardiac anomalies in fetal and perinatal deaths.

Methods: A systematic search of electronic databases and grey literature was conducted following PRISMA 2020 guidelines to analyse studies comparing pmMRI findings to conventional autopsy. Data extraction and quality assessment were independently performed by two reviewers using the QUADAS-2 tool. Meta-analysis was conducted using a bivariate random-effects model to calculate pooled sensitivity, specificity, and diagnostic odds ratios (DOR).

Results: Sixteen studies were included in the systematic review, and 12 studies (n=1810 fetuses) were meta-analyzed. The pooled sensitivity and specificity of pmMRI for detecting cardiac anomalies were 76 % (95 % CI: 71-80 %) and 96 % (95 % CI: 95-97 %), respectively. The diagnostic odds ratio was 55.35 (95 % CI: 22.73-134.79), with an area under the SROC curve of 0.89, indicating excellent diagnostic performance. Subgroup analyses showed comparable sensitivity between 1.5 and 3 T scanners, though specificity was slightly higher for 1.5 T. Diagnostic accuracy was generally better in larger fetuses and when higher field strength MRI (9.4 T) was used.

Conclusions: pmMRI demonstrates high specificity and moderate sensitivity for detecting cardiac anomalies in fetal and perinatal deaths and may serve as a valuable non-invasive adjunct to conventional autopsy. Standardization of imaging protocols and further research into high-field pmMRI integration are recommended to optimize diagnostic reliability.

Objectives: The sFlt-1/PlGF ratio is a predictive biomarker for preeclampsia (PE)-related outcomes. In women with signs of PE at ≤34 weeks, it may guide the timing of antenatal corticosteroid (ACS) administration.

Methods: We retrospectively analyzed 702 women presenting with signs of PE and/or fetal growth restriction (FGR) between 22+0- and 33+6-weeks. High risk was defined as an sFlt-1/PlGF ratio ≥85. The predictive accuracy of the ratio for PE-related preterm birth at ≤34+0 weeks was assessed using receiver operating characteristic (ROC) analysis. Differences in remaining pregnancy duration and gestational age at delivery between risk groups were analyzed using the log-rank test (p<0.05).

Results: Among 702 patients, 165 (23.5 %) had a PE-related delivery ≤34+0 weeks. A high sFlt-1/PlGF ratio (≥85) was observed in 128 (18.2 %) women who received ACS and in 44 (6.3 %) who didn't. The sFlt-1/PlGF ratio predicted PE-related delivery at ≤34+0 weeks - and thus the need for ACS with an AUC of 0.95 (95 % CI 0.93-0.97), yielding an optimal cut-off of 52.5 with sensitivity 87.9 % (95 % CI 82.0-92.0) and specificity 87.9 % (95 % CI 84.9-90.4). The median remaining pregnancy duration was 7.0 days (IQR 3.0-17.8), with delivery at 29+5 weeks (IQR 26+6-32+0) in women with ACS and a ratio ≥85, vs. 60.0 days (IQR 42.0-80.0) and delivery at 38+1 weeks (IQR 37+0-39+3) in women with a ratio <85 and no ACS.

Conclusions: In women with signs of PE and FGR <34 weeks of gestation, the sFlt-1/PlGF ratio is a strong predictor of PE-related preterm delivery and may support clinical decision-making regarding timely ACS administration.