Journal of Perinatal Medicine最新文献

Objectives: To examine the incidence of hypervitaminosis D in very low birth weight (VLBW) infants and any associated maternal or neonatal factors.

Methods: In this single center retrospective study, we studied serum vitamin D (25[OH]D) levels, maternal and neonatal demographic and clinical factors. We included VLBW infants (≤32 weeks gestational age (GA) and ≤1500 g birthweight, n = 130) born between 2021 and 2023. VLBWs receive 400 IU/day cholecalciferol once TPN is discontinued. Hypervitaminosis D was defined as 25[OH]D levels >60 ng/ml. We considered 11 variables with plausibility to influence this outcome. Variables with p < 0.20 in univariate logistic regression were entered into a multivariable logistic model to assess associations with the primary outcome. A linear mixed model assessed the association between calcium and 25[OH]D levels, with time as a fixed effect and subject as a random effect.

Results: 63 VLBWs (48 %) developed hypervitaminosis D. Maternal age > 35 years (OR = 2.2, 95 % CI 0.96-5.06) associated with excess 25[OH]D approached statistical significance (p = 0.06). Our findings indicate that in GA ≥ 28 weeks (OR = 0.77, 95 % CI 0.64-0.92) and maternal hypertension (OR = 0.32, 95 % CI 0.14-0.73) were associated with reduced likelihood of hypervitaminosis D.

Conclusions: 25[OH]D supplementation of 400 IU/day in VLBWs is associated with a high incidence of hypervitaminosis D. The above findings reveal a significant effect of maternal demographic and clinical factors on newborn metabolic health. Further work is needed to identify causes of hypervitaminosis D. Long term prospective studies are needed to understand the impact of hypervitaminosis D in VLBWs.

Objectives: An increasing body of evidence has revealed disrespectful and abusive care in facility-based childbirth as a barrier to maternal and child health. Providers have noted subpar work environments, inadequate staffing, and negative attitudes toward marginalized groups as barriers to respectful care. What has not been studied is the impact of disaster and violence on the delivery of respectful maternity care. The purpose of this study was to evaluate the state of obstetrical care in a maternity hospital in Odessa, Ukraine during a time of military invasion.

Methods: We surveyed 202 maternity care providers who have worked at Odessa City Maternity Hospital № 5 for at least one year. Measurements and topics covered in the questionnaires included respectful care practices performed; types of disrespectful behaviors witnessed; the impact of war on the provision of respectful maternity care; post-traumatic stress; and attitudes about consent in obstetric care.

Results: 50 percent of respondents believed disrespect was an issue in the field of obstetrics. A slight majority (55.0 %) reported that the frequency of disrespect and abuse remained the same before and after the invasion, while 32.2 % reported a lower frequency and 9.4 % reported a higher frequency of disrespect. There was little change in reported performance of respectful maternity care before and after the full-scale invasion.

Conclusions: Reported effects of war on respectful maternity care were minimal. However, the relatively low knowledge of disrespect and the large spread of frequency of reported respectful behavior indicate an opportunity for training.

Objectives: This study aimed to evaluate the predictive value of inflammatory biomarkers fibrinogen/albumin ratio (FAR), platelet/albumin ratio (PAR), and AST/platelet ratio (APRI) in identifying poor neonatal outcomes among pregnancies complicated by IHCP.

Methods: This retrospective comparative study included 165 pregnant women diagnosed with IHCP and 155 healthy pregnant women matched for age and gestational age, who delivered at a tertiary care hospital between January 2023 and January 2025. Demographic, clinical, laboratory, and perinatal characteristics were reviewed. FAR, PAR, and APRI were calculated from standard laboratory data. A composite poor neonatal outcome was defined as the presence of at least one of the following: Apgar score <7 at 5 min, respiratory distress syndrome (RDS), meconium aspiration, neonatal sepsis, or admission to the neonatal intensive care unit (NICU). Diagnostic performance was assessed using receiver operating characteristic (ROC) curves and multivariate logistic regression.

Results: FAR and APRI values were significantly higher in the IHCP group compared to controls (p<0.05). Among neonates with adverse outcomes, only FAR levels were significantly elevated (p = 0.015). However, its discriminative ability was limited (AUC = 0.607; sensitivity: 58 %, specificity: 63 %) and it was not an independent predictor in multivariate analysis.

Conclusions: FAR and APRI levels are elevated in pregnancies with IHCP, yet FAR alone demonstrates limited predictive value for adverse neonatal outcomes. It may serve as a supportive, rather than standalone, marker. Further large-scale prospective studies are warranted.

Objectives: To assess the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for clinical chorioamnionitis in term pregnancies complicated by meconium-stained amniotic fluid (MSAF).

Methods: This retrospective case-control study included women with singleton pregnancies at ≥37 weeks with documented MSAF during labor. The NLR was calculated from maternal blood samples collected at admission. Clinical and hematological parameters were compared between women with and without clinical chorioamnionitis. A multivariable logistic regression model was constructed to identify independent predictors, and a predictive risk score was developed.

Results: Among 2,014 women with MSAF, 106 (5.3 %) developed clinical chorioamnionitis. Among those with compared to without clinical chorioamnionitis, the mean NLR was higher (5.0 ± 3.8 vs. 4.3 ± 2.3, p = 0.008) and an NLR >3 was more common (85.8 % vs. 76.9 %, p = 0.042). C-reactive protein and white blood cell levels were comparable between the groups. In multivariable analysis, nulliparity (adjusted odds ratio (aOR) 3.087, 95 % confidence interval (CI):1.808-5.273), longer rupture of membranes (aOR 1.092, 95 % CI:1.092-1.189), and NLR (aOR 1.095, 95 % CI:1.025-1.171) were independently associated with clinical chorioamnionitis. A predictive model incorporating nulliparity, rupture of membranes >10 h, and NLR >3 demonstrated an area under the curve of 0.742 (95 % CI: 0.693-0.791, p < 0.001) for predicting clinical chorioamnionitis.

Conclusions: NLR at admission was independently associated with clinical chorioamnionitis in term pregnancies complicated by MSAF. Incorporating NLR into a predictive model enhanced risk stratification, suggesting that NLR could be a practical biomarker for early identification of increased risk of infection among women with MSAF.

Objectives: To evaluate fetal brain midline structures, cortical structures, and brain volume using sonography in cases of fetal growth restriction (FGR) and to compare these findings with those of fetuses demonstrating normal growth.

Methods: This prospective case-control study included 80 FGR cases and 80 fetuses with normal growth curves between 24 and 37 weeks of gestation. Multiplanar neurosonography was performed in all cases according to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines. The corpus callosum (CC; length, thickness, and fastigium distance), cavum septi pellucidi (CSP), sylvian fissure (SF), parieto-occipital fissure (POF), calcarine fissure (CF), insula, olfactory sulcus (OS), and brain volume were evaluated. Measurements were made using the ultrasound device's electronic calipers, and brain volume was calculated using the Virtual Organ Computer-aided Analysis (VOCAL) application.

Results: In the FGR group, CSP width, CC length, and thickness were significantly increased, while CCFL and POF depths were decreased (p < 0.05, for all). Mean brain volumes were similar in the FGR and control groups (349.30 ± 61.77 vs. 368.42 ± 68.51, p = 0.066). In FGR group, middle cerebral artery peak systolic velocity (MCA PSV) was positively correlated with most brain structures but negatively correlated with CC thickness. There was no relationship between cerebroplacental ratio (CPR) and brain volume or fetal brain structures.

Conclusions: Our findings showed that FGR affects the fetal brain through neuroanatomical structures such as the CC, CSP, CCFL, and POF during the prenatal period. In our cohort, fetal brain volume did not differ significantly in FGR. Furthermore, there was no association between CPR and fetal brain structures.

Objectives: To explore serum vascular endothelial growth factor (VEGF), β-subunit human chorionic gonadotropin (β-hCG), and soluble Fms-like tyrosine kinasereceptor 1 (sFlt-1) levels in pregnant women with placenta accreta spectrum (PAS) and their prognostic implications.

Methods: Serum levels were measured in PAS patients and non-PAS controls. Depending on the depth of placental penetration into the uterine wall, PAS patients were further classified into placenta accreta, placenta increta and placenta percreta subgroups. Diagnostic efficacy of individual biomarkers and combined indices was evaluated using receiver operating characteristic curves. Correlations between biomarker levels, disease severity, and prognosis were analyzed.

Results: Serum levels of VEGF and β-hCG showed significant positive correlations with the extent of PAS invasion, whereas sFlt-1 levels were inversely associated with disease progression. Combined pregnancy complications, elevated serum VEGF levels and decreased serum sFlt-1 levels were risk factors for poor prognosis in patients with PAS. The AUC values of the indicators combined to predict the diagnosis and prognosis of patients with PAS were greater than serum VEGF, hCG, and sFlt-1 levels alone.

Conclusions: Serum levels of VEGF, β-hCG, and sFlt-1 demonstrate the potential to differentiate between women with and without PAS, and further exhibit a correlation with the depth of myometrial invasion in PAS cases. The combined use of these serum markers enhances both the sensitivity and specificity of prenatal diagnosis and prognostic assessment for PAS compared to individual markers, thereby offering valuable guidance for clinical diagnosis and management of PAS.

Objectives: To determine the genetic causes of miscarriage by analyzing products of conception (POC).

Methods: Chromosomal microarray (CMA) using the Affymetrix Cytoscan HD array was performed in 172 POC specimens from women experiencing spontaneous miscarriage before 20 weeks of gestation to detect aneuploidies, copy number variants (CNVs), and loss of heterozygosity (LOH). Whole exome sequencing (WES) with Roche KAPA HyperExome V2 probes was used for cases where CMA results were normal.

Results: Common clinical indications included recurrent pregnancy loss, first-time miscarriage, absence of cardiac activity, intrauterine death, and fetal growth restriction (FGR), making up 72.55 % of cases. CMA identified chromosomal abnormalities in 38.37 % of samples, with numerical anomalies in 16.86 % and structural anomalies in 21.51 %. Turner syndrome (5.8 %) and various trisomies (5.8 %) were frequent numerical anomalies. Mosaicism and LOH were observed in 11.04 and 2.91 % of cases. WES detected pathogenic or likely pathogenic mutations in 21 genes (e.g., KCNQ1, KCNE1, COL1A2, ROBO1) in 18 cases, adding a 10.46 % diagnostic yield. K-means clustering grouped 17 of these genes into three pathways: chondrocyte differentiation, fibrin clot formation, and Ehlers-Danlos syndrome.

Conclusions: Combining CMA and WES provides a diagnostic yield of 48.83 %, offering a powerful approach to uncover genetic causes of pregnancy loss and guide clinical care.

Objectives: There is much debate about the best mode of delivery for the macrosomic fetus. This study compares maternal and neonatal outcomes of macrosomic in prelabor cesareans (PLC) vs. in trials of labor (TOL).

Methods: Retrospective cohort including neonates with birthweight of 4,000 g or more delivered in a public teaching hospital between October 2019 and December 2024. Exclusions: preterm, non cephalic, multiples, fetal death and malformed. Created three composite outcomes: "any serious adverse neonatal outcome", "any adverse maternal outcome", "neonatal respiratory morbidity". Considered significant a value of p<0.05.

Results: Included 611 births. There was no maternal death and, in the group of TOL, one neonatal death; 37.7 % had vaginal births and 62.3 % had cesareans. Were conducted 341 (56 %) TOL's; from these, 32.8 % failed. Among 231 vaginal births, we had 61 (26.4 %) cases of shoulder dystocia, among which 9 neonates were discharged with brachial plexus injury (3.9 % of vaginal births; 1/25). We found a greater frequency of "any neonatal adverse outcome" in TOL, adjusted Odss Ratio (aOR) 6.68; p=0.037. No significant difference in "respiratory morbidity". In TOL, the frequency of "any maternal adverse outcome" was higher: aOR 3.53; p=0.009. A sensivity analysis excluding birthweights of 4,500 g or more had basically the same results.

Conclusions: We had a high frequency of infants discharged with brachial plexus injury. Higher maternal morbidity in TOL could be because of the high rate of failed TOL. Not accessed in this work, there is still some difficulty in correctly identifiying the macrosomic antenatally.