Journal of Perinatal Medicine最新文献

Objectives: To elucidate the effects of the timing of fetal head rotation on the labor progress and outcomes.

Methods: A paired ultrasound measurement was performed at each of the three stages of labor: latency stage, active stage, and full-cervical-dilatation stage. The measurements included fetal head position, head-perineum distance (HPD) and the angle of progression (AOP).

Results: A total of 46 pregnancy women were included and a total of 102 effective measurements were collected. The cases in occipital anterior position were all eutocia. The rate of cesarean section in the left transverse occipital group was the highest (15.7 %, 3/19). There were 13 cases (37.1 %) with fetal head rotation occur during active phase, changing from occipital transverse to anterior. Ten cases (28.6 %) rotated in the second stage of labor. The average rotation degree of occipital transverse to anterior position was 62.6°. When AoP <95°, 100 % of the women were occipital transverse; When AoP ≥125°, 66.7 % was occipital anterior. The rate of oxytocin utilization and epidural analgesia in the occipital posterior group was higher than that in the other groups (71.4 and 85.7 %, respectively).

Conclusions: Occipital transverse is the most common fetal head position in the early stage of labor and fetal head rotation occurs mostly in the active phase and the second stage of labor. Sufficient time should be given in labor management for women that who tried vaginal delivery without contraindications.

Objectives: The purpose of the study is to estimate factors affecting survival in prenatally diagnosed hypoplastic left heart syndrome (HLHS) and echocardiographic features predicting poor prognosis and early neonatal death.

Methods: This study was designed as a retrospective cohort study. Cases of hypoplastic left heart syndrome diagnosed in the prenatal period between 2014 and 2023 were extracted from electronic medical records. Demographic data, echocardiographic features, results of genetic testing, pregnancy outcomes, and postnatal outcomes were analyzed.

Results: Eighty-three prenatally diagnosed fetal HLHS cases were analyzed. Overall, survival during the study period was 26.5 %, and survival among live births was 35.4 %. Survival analysis has shown that the majority of deaths occurred during the neonatal period. Out of 62 live births, 47 had Norwood procedures, six had balloon procedures and three had hybrid procedures. Eleven out of 47 who had the Norwood procedures went on to have a Glenn operation, and only three had full Fontan palliation. The presence of additional extra-cardiac anomaly, need for extracorporeal membrane oxygenation (ECMO), bidirectional flow at pulmonary veins on color Doppler, and low birth weight are associated with survival and early neonatal death. Tricuspid regurgitation, restrictive foramen ovale, and fetal growth restriction (FGR) are not associated with survival. HLHS evolved from critical aortic stenosis has better survival rates.

Conclusions: Extra-cardiac anomaly, need for ECMO, bidirectional flow at pulmonary veins, and low birth weight were negatively associated with survival and early neonatal death. The survival rate was higher among HLHS cases that had evolved from critical aortic stenosis.

The retention of academic faculty, particularly in the field of Obstetrics and Gynecology (OB/GYN), has become a growing challenge in the post-COVID era. The healthcare landscape has been dramatically altered, leading to a "Great Exit" where a large number of faculty members are resigning or retiring early. This phenomenon is not just a financial burden as recruitment costs have skyrocketed, but also poses a threat to the stability and reputation of academic institutions. In this review article, we explore the underlying causes of faculty attrition, the predictors of resignation, and propose comprehensive strategies to retain talented faculty members. We highlight the importance of mentorship, career development opportunities, and fostering a supportive work environment that aligns with both institutional and individual values. The goal is to create a sustainable framework for faculty engagement that strengthens the academic mission and improves clinical outcomes.

Objectives: To assess the sonographic visualization of the fetal optic chiasm (OC) and optic tracts (OTs), establish mid-trimester reference values, and assess the relationship between OC and OT dimensions and cavum septum pellucidum (CSP) measurements.

Methods: This prospective cross-sectional study included 154 morphologically normal fetuses between 19 and 23 weeks of gestation. The diameters of the fetal OC and OTs were measured using two-dimensional transabdominal ultrasound in a transventricular axial section angled approximately 20-40° caudally. CSP length as well as anterior, middle, and posterior widths were measured by placing the cursor on the inner surfaces in the transventricular section. The average CSP width was included in the analysis.

Results: The OC and OTs were successfully visualized in 109 fetuses and included in the analysis. Visualization success in transabdominal axial sections at 19-23 weeks was 70.8 %, with high intraobserver and interobserver reproducibility. Additionally, visualization rates were higher in advanced gestational weeks and in fetuses with breech presentation (p=0.007 and p=0.017, respectively). OC and OT dimensions were positively correlated with CSP length and width, biparietal diameter (BPD), head circumference (HC), and gestational age (p<0.05, for all).

Conclusions: The OC and OTs were successfully visualized transabdominally in axial sections with high intraobserver and interobserver reproducibility. Additionally, OC and OT dimensions were positively correlated with gestational age, as well as with BPD, HC, and CSP measurements.

Marcus Tullius Cicero's concept of "ius gentium," or universal law, provides a timeless framework for understanding and defending fundamental human rights, particularly in the context of reproductive freedom. Cicero distinguished between "ius gentium" and "ius civile," emphasizing that while civil law governs specific communities, universal law, rooted in natural reason, applies to all humanity. This philosophical foundation resonates with modern discussions on reproductive rights, where universal principles of justice and bodily autonomy are at stake. Enlightened by Immanuel Kant's notion of innate freedom, Cicero's philosophy challenges present day's US states' restrictive reproductive laws, which often contradict the universal principles of justice. Applying these concepts to contemporary issues, such as abortion rights, underscores the need to align civil laws with universal ethics, ensuring that individual freedoms are upheld against arbitrary state interventions. By advocating for policies that promote equitable access to reproductive healthcare, Cicero's vision of universal law remains a powerful tool for advancing human dignity and autonomy in modern society.

Viability refers to an infant's ability to survive outside the womb, which is influenced by both developmental maturity and the quality of medical care received. The concept of periviability, which has evolved alongside medical advancements, describes the stage between viability and nonviability, typically spanning from 20^0/7 to 25 ^6/7 weeks of gestation. While the chances of survival are extremely low at the earlier end of this range, the possibility of surviving without significant long-term complications improves towards the later end. The effectiveness of various antenatal and postnatal care practices, particularly those considered to be part of an active approach, plays a crucial role in influencing survival rates and mitigating morbidities. However, the decision to provide such active care is heavily influenced by national guidelines as well as international standards. The variability in guideline recommendations from one country to another, coupled with differences based on gestational age or accompanying risk factors, prevents the establishment of a standardized global approach. This variability results in differing practices depending on the country or institution where the birth occurs. Consequently, healthcare providers must navigate these discrepancies, which often leads to complex ethical dilemmas regarding the balance between potential survival and the associated risks. This review article explores the evolution of the definition of viability, the vulnerabilities faced by periviable infants, and the advancements in medical care that have improved survival rates. Additionally, it examines the viability and periviability definitions, the care and outcomes of periviable infants and recommendations in guidelines.

Objectives: To determine Dysphoric Milk Ejection Reflex (DMER) incidence. Secondary objectives were to describe the symptom profiles and patient characteristics of DMER and assess DMER familiarity.

Methods: A prospective observational study of people who initiated breastfeeding after delivery between December 2022 and May 2023 at two hospitals in New York. Participants filled out an Initial Survey, assessing prior DMER familiarity, and recurring DMER Symptoms Surveys, assessing symptom presence, severity, and transiency. Medical records were reviewed for patient demographics and clinical history. Descriptive and basic inferential statistics were performed. A p<0.05 was considered statistically significant.

Results: Based on the DMER definition utilized, incidence was 26.9 % (n=21), and symptom severity was mostly very mild to moderate. Those with DMER had similar baseline characteristics to those without, apart from a significantly higher rate of having delivered via cesarean section (71.4.0 vs. 33.3 %, p<0.01). Among the 55 patients who completed the initial survey, 61.8 % were unfamiliar with the condition.

Conclusions: DMER is described as brief, abrupt, negative emotions experienced by breastfeeding individuals prior to milk letdown. We found that more than 1 in 4 participants screened positive. Future research could better define, quantify, qualify, and publicize this condition to inform clinical practices and facilitate successful breastfeeding relationships.

Objectives: The seasonality of conception and birth has intrigued scientists for over 200 years. Since the 1970s, peak birth months in the northern hemisphere have shifted from early spring to late summer, influenced by oral contraceptives and socio-economic factors. The division of Germany from the end of World War II until reunification in 1990 offers a unique opportunity to analyze these influences while both regions had equal access to contraception. This study aims to identify differences in fertility trends and peak birth months between West and East Germany before and after reunification, considering political, socio-economic factors, and contraceptive availability.

Methods: A population-based study analyzed overall fertility rates, monthly birth data, peak birth months, and average maternal ages from 1950 to 2022.

Results: Fertility patterns were similar in both regions until 1970, showing a sharp increase post-1955 followed by a decline around 1965, likely due to contraception. From 1970 to 1990, East German fertility increased while West Germany's remained lower. After reunification, East German fertility fell sharply but later rose to West German levels. The peak birth month shifted from March to August in West Germany by the mid-1980s, while East Germany experienced this change 20 years later, post-reunification.

Conclusions: The 20-year delay in East Germany's shift suggests that oral contraception's impact was influenced by other factors, particularly the age of women at childbirth. Increased control over fertility in the West allowed for more choice in conception timing, a trend adopted in the East after gaining similar autonomy.

Objectives: To describe maternal and perinatal outcomes in patients with BMI ≥30 kg/m² by BMI class and gestational weight gain.

Methods: Retrospective review of singleton pregnancies with pre-pregnancy BMI ≥30 kg/m² who received care at our institution between January 1, 2016 and December 31, 2021. Patients were divided into three categories based on BMI (kg/m²): Class I (BMI 30.0-34.9), Class II (BMI 35-39.9), and Class III (BMI≥40) obesity. For gestational weight gain analysis, pregnancies were stratified into three groups: <11 pounds, 11-20 pounds, and >20 pounds. Maternal demographics and outcomes were compared using chi-square analysis, analysis of variance, nonparametric tests, and multivariable regression analysis.

Results: Of 641 patients included, 299 (46.6 %) were in Class I, 209 (32.6 %) in Class II, and 133 (20.7 %) in Class III. Readmission within 6 weeks postpartum, the only outcome found to have a significant difference between BMI categories, was higher in the Class III group (p=0.01). One hundred sixty-two (25.3 %) patients gained <11 pounds, 164 (25.6 %) gained 11-20 pounds, and 313 (48.8 %) gained ≥20 pounds. Greater gestational weight gain was associated with increased rates of cesarean delivery (p<0.001), higher quantitative blood loss (p=0.006), longer length of hospitalization (p=0.03), and higher birthweights (p<0.001).

Conclusions: This represents a unique and actionable opportunity for clinicians to counsel and support their patients in adhering to optimal weight gain targets throughout their pregnancy. Future studies are needed to determine the optimal gestational weight gain recommendations for obese patients.

There exists a need to research new diagnostic and therapeutic approaches that consider hemolytic disease of fetus and newborn (HDFN)'s physiopathology and focus not only on the pregnant person's immune system but also on the fetal immune system. This implies, in the final sense, to view the fetus as our patient. In spite of having found a safe and efficient method of prevention of HDFN more than 50 years ago, HDFN continues to be a relevant cause of perinatal morbidity and mortality, due to lack of access to immunoprophylaxis. In light of the above, we should strive to prevent sensitization and HDFN by ensuring certain health policies across the globe, especially in countries and regions of high morbidity and mortality.