Journal of Perinatal Medicine最新文献

Objectives: Ventricular disproportion, defined as a ratio of right ventricle (RV) end-diastolic diameter to left ventricle (LV) end-diastolic diameter (RV_D/LV_D) ≥ 1.1 is commonly observed in neonates with congenital diaphragmatic hernia (CDH) and it is independently associated with adverse outcome. Longitudinal postnatal data on ventricular disproportion of CDH neonates are poorly studied and we aimed to evaluate changes in RV_D/LV_D through serial echocardiographic studies at selected timepoints in the neonatal period.

Methods: This retrospective observational study included CDH neonates admitted to the University Children's Hospital of Bonn between January 2011 and March 2021. RV_D/LV_D was measured via apical 4-chamber echocardiographic views at admission, 48 h of life, pre-surgical repair, pre-extubation, and on day 5 of ECMO support, if applicable. Patients receiving palliative care, experiencing early death, or lacking follow-up echocardiographic data were excluded.

Results: Of 248 CDH neonates, 80 were excluded, leaving 168 in the final cohort. At baseline, 41.7 % had an RV_D/LV_D ≥1.1. Mortality (34.3 %) and ECMO rates (62.9 %) were significantly higher in these patients compared to those with RV_D/LV_D <1.1. Ventricular disproportion decreased over time: 41.7 % at admission, 23.1 % at 48 h, 15.7 % pre-repair, and 9.1 % pre-extubation. For ECMO patients, RV_D/LV_D ≥1.1 was found in 62.9 % at admission, decreasing over time. Non-survivors had significantly higher RV_D/LV_D at 48 h (p=0.020) and pre-extubation (p=0.001).

Conclusions: In CDH neonates, ventricular disproportion improves over time, but RV_D/LV_D≥1.1 remains strongly associated with mortality, particularly in ECMO patients, where non-survivors exhibit persistently elevated RV_D/LV_D.

Objectives: The rate of cesarean delivery (CD) in Qatar is rising at an alarming rate. Vaginal birth after cesarean section (VBAC) is associated with lower maternal morbidity and is an important option for younger mothers. This study compared the pregnancy outcomes of second pregnancies in women with prior CD, according to their age groups, with the aim of individualising VBAC counselling.

Methods: This retrospective study divided women in their second pregnancies based on age: young group (YG<25 years), control group (CG, 25-35 years), and advanced age group (AG>35 years). The primary outcome was the mode of delivery.

Results: Out of 2,729 women, 18.2 % had a VBAC (27.4 % in YG vs. 9.5 % in AG). Nearly 48 % agreed to a TOLAC (57.9 % in YG and 41.8 % in AG), 38 % of whom had a successful VBAC. Among those who opted for TOLAC, 47.3 % in YG had a successful VBAC, compared to only 22.8 % in AG (p<0.001). While hypertension, diabetes, macrosomia and preterm birth reduced VBAC, postdated and uncomplicated pregnancies increased the rates. Compared to CG, YG had 35 % lower odds of repeat CD (aOR=0.64, CI=0.49-0.85, p=0.002), while AG had nearly two times higher odds (CI=1.26-2.95, p=0.003), after adjusting for confounders.

Conclusions: Maternal age emerged as an important predictor of repeat cesarean, with younger mothers having a much higher chance of successful VBAC. More than half with uncomplicated pregnancies opted for an elective CD, highlighting the requirement for improving counselling services that motivate women to take up VBAC and improve their confidence in the healthcare system.

Objectives: We aim to explore whether the long inter-pregnancy interval (IPI) modifies the association between previous cesarean section (CS) and adverse maternal and neonatal outcomes in a population with a high rate of CS and a long IPI.

Methods: Adverse maternal and neonatal outcomes were compared between the previous CS and previous vaginal delivery groups. Logistic models were used to adjust for potential confounding factors and calculate the Odds Ratios (ORs) and 95 % confidence intervals (CIs). The interaction model and stratified analyses were used to evaluate the modifications of IPIs on the associations between previous CS and maternal and neonatal outcomes.

Results: Compared with previous vaginal delivery, previous CS was associated with increased risks of uterine-related complications (a OR=1.57, 95 % CI 1.25-1.98), but with decreased risks of preterm birth (a OR=0.73, 95 % CI 0.63-0.85) and severe neonatal adverse outcomes (a OR=0.59, 95 % CI 0.46-0.78). There are synergistic biological interaction effects of previous CS and a long IPI (>60 months) on the risks of placental-related complications (RERI=0.32, 95 % CI 0.05-0.58; AP=0.39, 95 % CI 0.03-0.76) but an antagonistic biological interaction effect on the risk of preterm birth (RERI=-0.35, 95 % CI -0.68 to -0.01; AP=-0.09, 95 % CI -0.68 to -0.03).

Conclusions: Previous CS was associated with increased risks of adverse maternal outcomes but decreased risks of certain adverse neonatal outcomes. Prolonged IPIs might not attenuate the adverse effects of previous CS on mothers, and might adversely exert harm on newborns.

Objectives: Community births in the United States - including planned home and freestanding birth center deliveries - have increased in recent years. Understanding how these patterns have evolved across racial and ethnic groups, particularly in the post-pandemic period, is essential for clinical practice and health policy. Objective: To analyze national trends in community births from 2016 through 2024 by race and ethnicity, and to discuss clinical, ethical, and policy implications.

Methods: Birth certificate data from the CDC natality database were examined for 2016-2024. Community births were defined as intended home or freestanding birth center births. Trends were assessed overall and stratified by race/ethnicity, with relative changes indexed to 2016.

Results: From 2016 to 2024, community births increased overall but diverged by group. Non-Hispanic White and Hispanic women demonstrated sustained increases relative to 2016, while non-Hispanic Black women showed an increase during the pandemic followed by decline, and non-Hispanic Asian women displayed a modest upward trend. These shifts occurred against the backdrop of declining total births in some groups, affecting proportional comparisons. International comparisons are limited by the distinctive U.S. context, where midwifery is less integrated and credentialing standards are variable.

Conclusions: Community birth patterns since the pandemic reveal both growth and divergence across racial and ethnic groups. These findings highlight the need for policy interventions to address maternity care deserts and harmonize midwifery credentialing. Clinically, professional responsibility requires fully informed consent leading to directive counseling, which should not be misinterpreted as paternalism but as an ethical duty to recommend hospital birth as the safest option while respecting patient autonomy.

Objectives: Preterm birth (PTB), defined as delivery before 37 weeks of gestation, is a leading cause of neonatal mortality and long-term developmental impairment. Its complex etiology, spanning environmental, genetic, psychosocial, and socio-economic domains, limits effective prediction and prevention. We systematically synthesized evidence on how environmental exposures influence PTB risk through multi-omic disruptions within a fetal exposome framework.

Methods: A comprehensive literature search was conducted in major biomedical databases, following PRISMA guidelines. Ninety-five human studies published through May 2025 were included, encompassing exposures such as ambient air pollution, endocrine-disrupting chemicals, maternal stress, nutrition, occupational hazards, climate variability, and microbiome alterations. Two reviewers independently extracted data (exposure type, omics platform, biospecimen, PTB subtype) with inter-rater reliability assessment, and study quality was evaluated using the Newcastle-Ottawa Scale. Findings were narratively stratified by exposure category, study design, and spontaneous vs. indicated PTB.

Results: Environmental exposures were consistently associated with disruptions in oxidative stress, inflammation, immune regulation, hormonal signaling, placental aging, and microbial ecology, mediated by multi-omic signatures in maternal, placental, and fetal tissues. Candidate biomarkers show promise for early risk stratification but lack validation and population-level predictive performance due to heterogeneous exposure assessment and study design.

Conclusions: Integrating fetal exposome concepts with multi-omics enhances mechanistic insight into PTB risk and may support biomarker discovery and precision-guided prenatal interventions. Clinical translation requires standardized exposure measurement, biomarker validation, and equity-focused implementation.

Objectives: To investigate the implications of maternal anemia in term neonates.

Methods: In a population-based retrospective cohort study, standard demographic and clinical variables noted during post-birth hospitalization in term neonates were compared across groups stratified by maternal anemia in a racially diverse population.

Results: Of 474 maternal-neonatal dyads, 66.03 % were Hispanic (H), 15.8 % Black (B), 7.3 % non-hispanic white (NHW), and 10.7 % Asian/pacific islanders (AP). 39.6 % of H, 57.3 % of B, 65.7 % of NHW, and 37 % of AP mothers were anemic, with significantly higher prevalence in NHW and B compared to H. 12.8 % of all anemia cases had moderately severe anemia (Hematocrit<30 %). Body mass index was lower, and gravidity, hypertension, and Cesarean-section rates were higher in anemic mothers, while feeding difficulty, hospitalization duration, and Neonatal intensive care unit admission rate were higher in the neonates born to them. Mothers with moderately severe anemia were younger, had higher parity, and a higher prevalence of antepartum hemorrhage compared to the mild anemia group. Their offspring, although not small for gestational age, had lower birth weights. The adverse maternal-neonatal outcomes associated with anemia were less common in the Hispanic mother-infant dyads compared to the B and NHW.

Conclusions: Maternal anemia is associated with significant complications in term neonates and their mothers. There is a racial disparity in its prevalence and associated maternal-neonatal complications. The cultural-biological etiopathogenesis of this observation warrants further investigation. Optimization of antenatal care and targeted interventions could improve the outcomes and prevalence in at-risk populations.

Objectives: To evaluate the comparative effectiveness of four pharmacologic regimens - oxytocin, carbetocin, oxytocin plus tranexamic acid (TXA), and carbetocin plus TXA - for postpartum hemorrhage (PPH) prophylaxis in cesarean deliveries.

Methods: This prospective cohort study was conducted at a tertiary center in Istanbul, Turkey, between March 2024 and January 2025. A total of 400 women undergoing cesarean delivery at 34+0-39+6 weeks of gestation were sequentially assigned to one of four prophylactic intervention groups (n=100 each): oxytocin, oxytocin+TXA, carbetocin, or carbetocin+TXA. Medications were administered post-placental delivery. Third-stage labor management was standardized. Primary outcomes included estimated blood loss (EBL), 24-h hemoglobin change (ΔHb), and need for transfusion or intravenous iron. Baseline neonatal characteristics, including birthweight and Apgar scores, were recorded to ensure comparability across groups.

Results: Baseline characteristics were similar across groups. Hemoglobin decline differed significantly (p=0.015), being lowest in the carbetocin+TXA group (7.73 ± 6.68 %) and highest in the oxytocin group (10.70 ± 7.23 %). Although mean EBL was lowest in the carbetocin+TXA group, the difference was not statistically significant (p=0.172). Transfusion and iron supplementation rates were low and comparable. No adverse neonatal outcomes were observed.

Conclusions: Carbetocin combined with TXA was associated with the most favorable hematologic profile. These findings support the use of multimodal pharmacologic strategies for PPH prevention in cesarean births and may inform future protocol development.

Objectives: To evaluate the maternal and neonatal outcomes of pregnant patients who underwent ultrasound-guided percutaneous nephrostomy for the management of symptomatic hydronephrosis.

Methods: This retrospective cohort study evaluated 85 pregnant patients with symptomatic hydronephrosis (≥ Grade 2) managed at a tertiary center between January 2020 and February 2025. Participants were stratified into ultrasound-guided PCN (n=43) and conservative management (n=45) groups. The primary outcome of this study was to evaluate the safety and efficacy of ultrasound-guided PCN in pregnant patients with symptomatic hydronephrosis.

Results: Demographic characteristics were similar between groups. Abdominal pain was more common in the conservative group (45.5 % vs. 26.8 %, p=0.062), while other clinical and laboratory parameters showed no significant differences. Antibiotic use differed significantly (p=0.016), though urine culture results were comparable. Pregnancy and neonatal outcomes, including gestational age at delivery, birth weight, Apgar scores, cesarean delivery rates, and neonatal intensive care unit (NICU) admission rates, did not differ significantly between groups (all p>0.05). Kaplan-Meier survival analysis demonstrated no statistically significant difference in cumulative live birth rates between the PCN and conservative treatment groups (log-rank test, p=0.665), with hazard ratios indicating comparable reproductive outcomes over time.

Conclusions: This study demonstrates that ultrasound-guided PCN is a safe and effective intervention for managing symptomatic hydronephrosis during pregnancy, with favorable maternal and neonatal outcomes. Further prospective studies with larger cohorts are warranted to validate these findings and refine clinical guidelines.

Objectives: To determine the incidence and outcome of perinatal asphyxia (PA) in spontaneous extreme preterm birth (PTB) between 24 and 28 weeks gestation.

Methods: We conducted a retrospective cohort study (2010-2019) at a Dutch tertiary center, including singleton spontaneous PTBs with active neonatal management. PA was defined as a 5-min Apgar score ≤5, umbilical artery pH≤7.00, base deficit >12 mmol/L, and need for ongoing resuscitation. Cases were classified as proven PA (all criteria met), suspected PA (Apgar≤5 only if blood gas data missing), or no PA. Neurodevelopment was assessed at 2 years corrected age. Multiple imputation addressed missing data. Logistic regression, adjusted for gestational age (GA), was used to evaluate associations with infant mortality, cerebral injury, and neurodevelopmental impairment (NDI).

Results: Among 138 neonates, 84 % had no PA, 12.3 % suspected PA, and 3.6 % proven PA. After imputation, the estimated incidence of PA was 5.0 %. PA was not significantly associated with infant mortality (aOR 1.07; 95 % CI 0.13-8.87; p=0.95) or intraventricular hemorrhage (aOR 1.62; 95 % CI 0.26-10.39; p=0.61). NDI occurred in two infants with PA.

Conclusions: PA occurred more frequently in this extreme preterm cohort than in term neonates, yet did not independently influence mortality or morbidity. A major limitation is the use of ACOG criteria, originally developed for term births, which may have led to over- or underestimation of PA's true incidence and impact. Although based on few confirmed cases, findings suggest PA, may not be a major independent predictor of adverse outcome in extreme PTB.

Objectives: This study evaluates the diagnostic yield of prenatal whole exome sequencing (WES) and its impact on outcome, such as termination of pregnancy (TOP) or neonatal management.

Methods: A retrospective analysis of more than 4 years of prenatal WES at a single genetic center was performed. Inclusion criteria included normal genome-wide deletion/duplication analysis and ≥1 ultrasound anomaly. Trio analysis was performed, filtering for de novo, compound heterozygous, homozygous, and hemizygous variants, complemented by a genome-wide phenotype-driven analysis.

Results: (Likely) pathogenic variants fitting the phenotype were identified in 36 of 171 cases (21.1 %), of which 19 were de novo, 14 autosomal recessive, one autosomal dominant, and 2 X-linked dominant. Median turnaround time was 16 days. Parents opted for TOP in 21 cases, three resulted in intrauterine death, 11 were carried to term and one was lost to follow-up. Among the neonates, the diagnosis led to optimized postnatal management in 8/11 (72.7 %), abstinence of care in two (18.2 %) and exclusion of syndromic disorders in one (9.1 %).

Conclusions: Our findings indicate that in 1/5 pregnancies with ultrasound anomalies and normal deletion/duplication analysis, a (likely) pathogenic variant explaining the phenotype can be identified. The high proportion (17/36 or 47.2 %) of inherited variants highlights the importance of WES for recurrence risk assessment.