Journal of Perinatal Medicine最新文献

Introduction: Recent advancements in four-dimensional (4D) ultrasonography have enabled detailed observation of fetal behavior in utero, including facial movements, limb gestures, and stimulus responses. These developments have prompted renewed inquiry into whether such behaviors are merely reflexive or represent early signs of integrated neural function. However, the relationship between fetal movement patterns and conscious awareness remains scientifically uncertain and ethically contested.

Content: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Four databases (PubMed, Scopus, Embase, Web of Science) were searched for English-language articles published from 2000 to 2025, using keywords including "fetal behavior," "4D ultrasound," "neurodevelopment," and "consciousness." Studies were included if they involved human fetuses, used 4D ultrasound or functional imaging modalities, and offered interpretation relevant to neurobehavioral or ethical analysis. A structured appraisal using AMSTAR-2 was applied to assess study quality. Data were synthesized narratively to map fetal behaviors onto developmental milestones and evaluate their interpretive limits.

Summary: Seventy-four studies met inclusion criteria, with 23 rated as high-quality. Fetal behaviors such as yawning, hand-to-face movement, and startle responses increased in complexity between 24-34 weeks gestation. These patterns aligned with known neurodevelopmental events, including thalamocortical connectivity and cortical folding. However, no study provided definitive evidence linking observed behaviors to conscious experience. Emerging applications of artificial intelligence in ultrasound analysis were found to enhance pattern recognition but lack external validation.

Outlook: Fetal behavior observed via 4D ultrasound may reflect increasing neural integration but should not be equated with awareness. Interpretations must remain cautious, avoiding anthropomorphic assumptions. Ethical engagement requires attention to scientific limits, sociocultural diversity, and respect for maternal autonomy as imaging technologies continue to evolve.

Objectives: Obesity in pregnancy is associated with several risks during vaginal delivery. Several guidelines advise early epidural placement. This systematic review summarizes evidence on the maternal and perinatal outcome of epidural analgesia (EA) for vaginal delivery in obese women.

Methods: A systematic literature search was conducted to identify studies reporting EA during vaginal delivery in obese women. Study information, baseline characteristics, and outcomes were extracted.

Results: Eleven studies (31,325 patients total) were included. Newcastle-Ottawa Scale quality scores ranged from 2/8 to 7/8. Studies varied in study group choice, baseline characteristics, and outcome measures. Five studies reported patient-oriented outcomes, nine reported technical outcomes regarding catheter placement. One study compared obese women with early vs. late vs. no EA and reported similar incidence of instrumental deliveries (5.3 vs. 1.8 % vs. 0 %, p=0.315) and similar Apgar scores (8.37 ± 1.17 vs. 8.43 ± 1.28 vs. 8.08 ± 2.02, p=0.519). Other studies used a comparison of obese with non-obese women, both receiving EA. Incidence of instrumental deliveries was similar, but the incidence of cesarean delivery and several other outcomes was increased in obese women.

Conclusions: The selected literature predominantly reports on technical difficulties regarding EA. In many studies but one, we found a sub-optimal comparison of obese and non-obese women with EA. Side effects of EA in obese women are suggested in some studies, but we believe that the true influence of EA in obese parturients is insufficiently reported. To fully understand associated risks and benefits for these women, this population should be studied separately, and more evidence is needed.

Objectives: Intraamniotic infection is a major cause of preterm labor. While ascending infection from the urogenital tract is well recognized, hematogenous transmission in which pathogens travel from the maternal circulation to the intraamniotic environment has been proposed. Listeria monocytogenes is a common bacterium causing Listeriosis and is believed to cause intraamniotic infection via the maternal bloodstream. However, molecular evidence supporting this route is limited.

Methods: A complete microbiologic workup was performed, including cultures from amniotic fluid, vagina, maternal and neonatal blood, and the placenta in a patient with intraamniotic infection. Whole genome hybrid sequencing was utilized to characterize the genomic features including virulence factors and antimicrobial resistance. Placental pathology, Brown-Hopps, Warthin-Starry staining, and calorimetric in situ hybridization were performed to detect the presence of Listeria in the placenta.

Results: L. monocytogenes was detected in both the amniotic fluid and chorioamniotic membranes but not in the vaginal fluid. Whole genome sequencing identified the two isolates as L. monocytogenes sequence type 1, clonal complexes 1, and serotype 4b. Placental pathology demonstrated extensive acute intervillositis with intracellular rod-shaped bacteria in the intervillous space of the placenta identified by Brown-Hopps and Warthin-Starry staining. Calorimetric in situ hybridization confirmed the presence of L. monocytogenes in the intervillous space.

Conclusions: This study provides the first molecular evidence supporting a hematogenous route of intraamniotic infection by L. monocytogenes Evidence in support includes the presence of acute intervillositis and the detection of L. monocytogenes in the amniotic fluid and intervillous space of the placenta combined with the absence of this organism in the vagina.

Introduction: Obstructed labor is a serious obstetric emergency that can lead to uterine rupture, and significant maternal and perinatal morbidity and mortality. Bandl first described this condition, of abnormal retraction of the uterus occurring during obstructed labor, characterized by a constriction between the thinned lower uterine segment and the thick, retracted upper uterine portion. To determine the incidence and the maternal and perinatal outcome in pregnancies showing Bandl's ring by reviewing the published literature.

Content: PubMed, Embase and Google Scholar Search searches were made using "Bandl's ring." Papers selected were assessed independently for content, data extraction and analysis. The following parameters were included for the analysis: total number of reported cases, use of ultrasound, fetal position and station, labor augmentation, modality of delivery, indications for cesarean section, neonatal complications.

Summary and outlook: The literature search identified nine articles that met the established inclusion criteria and were deemed eligible for analysis and comparison, encompassing a total of 23 clinical cases. Ultrasound was used 21 % of the cases. The fetal occiput was posterior in 93 % of the cases, augmentation of labor in 39 %, cesarean section was necessary in 95.6 % of cases and there were three cases of severe neonatal complications (13 %). Bandl's ring represents a rare yet clinically significant intrapartum pathology. This study highlights the importance of early recognition and appropriate management of Bandl's ring. Incorporating ultrasound into the assessment of obstructed labor may enhance obstetricians' ability to accurately identify this condition, thereby minimizing the risks associated with delayed or inappropriate intervention.

Objectives: The aim of this study was to assess the effect of low-dose nicotine on the expression of brain-derived neurotrophic factor (BDNF) mRNA, its antisense alternative splice form brain-derived neurotrophic factor antisense (BDNF-AS), and its protein levels after global hypoxia in newborn piglets. This study also sought to explore the regulatory role of BDNF-AS on BDNF mRNA.

Methods: A total of 41 newborn piglets were randomised after hypoxia to one of two different infusions of nicotine (18 or 46 μg/kg/h, respectively) or to a control group receiving saline. After 4 h of infusion, the piglets were euthanized and brain samples from the hippocampus and temporal cortex were collected for quantification of BDNF mRNA, BDNF-AS and BDNF protein.

Results: In the hippocampus, significant lower expression of BDNF mRNA was observed in the animals treated with 46 μg/kg/h of nicotine compared to the group receiving 18 μg/kg/h (p=0.047) and the control group (p=0.017). The BDNF mRNA and BDNF-AS showed a strong correlation (r=0.63, p<0.001) in the hippocampus samples and moderate, but significant, correlation (r=0.36, p=0.021) in the samples from the cortex. We found no differences in BDNF mRNA between the groups in the cortex samples. Protein levels of BDNF were similar in all three groups in both the hippocampus and cortex samples.

Conclusions: Our results suggest that low concentrations of nicotine might have a short-term effect on the expression of BDNF mRNA. However, the BDNF protein levels remained unchanged at the same time point and the long-term impact on the nervous system remains unclear.

Objectives: To assess the predictive value of combining the Kurjak Antenatal Neurodevelopmental Test (KANET) with Doppler indices for early detection of neurodevelopmental delays in pregnancies of varying risk levels.

Methods: A prospective study was conducted on 111 pregnant women (71 low-risk, 40 high-risk) between 28 and 36 weeks of gestation. KANET was performed using 4D ultrasound. Doppler assessments included resistance indices of the middle cerebral artery (MCA) and umbilical artery (UA), and ductus venosus (DV) velocity parameters: systolic (S), diastolic (D), and S/D ratio. High-risk cases with abnormal findings underwent repeat KANET. Postnatal neurodevelopment was evaluated at 3 and 6 months using the Denver Developmental Screening Test II (DDST II). Statistical analyses included regression and ROC curve analysis.

Results: High-risk pregnancies showed significantly lower KANET scores (mean 13.4 ± 2.3) than low-risk pregnancies (mean 16.9 ± 1.5; p<0.001). Abnormal DV Doppler findings were present in 42 % of high-risk cases and correlated with lower KANET scores (r=0.82, p<0.01). Follow-up KANET identified progressive neurodevelopmental delays in 25 % of high-risk cases. The combined KANET-Doppler approach demonstrated superior predictive accuracy (AUC=0.89, p<0.001) compared to either method alone.

Conclusions: Integrating KANET with Doppler indices, particularly DV parameters, offers an effective strategy for early identification of neurodevelopmental risks in high-risk pregnancies. This approach supports more targeted prenatal monitoring and early intervention strategies.

Objectives: To establish and verify the prediction model of recurrent preeclampsia (PE) in pregnant women with a history of PE.

Methods: Totally 130 pregnant women with a history of PE from Jan 2021 to Jan 2023 were selected retrospectively. The patients were randomly matched according to the proportion of 1:4 to establish a verification group (nasty 26) and a modeling group (nasty 104). The modeling patients were divided into two groups according to the occurrence of preeclampsia: recurrent group (nasty 50) and non-recurrent group (nasty 54). Multivariate logistic regression analysis of influencing factors was established. Calibration curve was performed to verify, decision curve analysis (DCA) was used to evaluate the clinical practicability of the prediction model, and ROC analysis was used to show the prediction value of the model.

Results: Multivariate logistic regression analysis showed that there were significant differences in age, gestational age, gestational interval, systolic blood pressure and diastolic blood pressure of previous pregnancy. (p<0.05) According to the results of logistic regression analysis, a prediction model was constructed. Logit(P)=(0.910Age)+(0.987Age of onset of previous pregnancy)+(1.167Gestational interval)+(1.186Systolic blood pressure in previous pregnancy)+(0.970Diastolic blood pressure in previous pregnancy).The slope of the calibration curve was close to one in the training set and verification set. The results showed that the prediction of recurrent PE risk of pregnant women with history of eclampsia was consistent with the actual risk. ROC analysis showed that the area under curve was 0.991. The results of DCA analysis showed that the model had good clinical practicability.

Conclusions: In this study, a prediction model is successfully established and verified according to the influencing factors.

Objectives: Depending on risk profile, pregnant women can freely choose their preferred birthplace, especially in the case of a normal pregnancy. In addition to obstetric maternity units in a hospital, options may include out-of-hospital births (such as births at home or in a freestanding midwifery unit. To our knowledge, there is no study comparing the outcomes of peripartum transfers from different places.

Methods: Between 2020 and 2021, all births transferred internally from the AMU of the University Hospital of Leipzig (n=74) were retrospectively analyzed and compared with births transferred from external (home or an FMU; n=72). The main outcome measures were morbidity and interventions.

Results: 86.1 % were transfers from an FMU and 13.9 % were transfers of planned home births. There were significantly less spontaneous vaginal births in planned OH births (55.6 %) compared to planned AMU births (73.7 %, p<0.001). For the FMU births, we found a significantly higher rate of caesarean section (20.8 %, to 6.6 %, p<0.001) and postpartum neonatal transfers (8.3-4.1 %, p=0.025). The duration of labor was significantly longer in transferred OH (p<0.001).

Conclusions: In case of an intrapartum transfer, there was a decreased likelihood of spontaneous vaginal birth and increased likelihood of secondary caesarean section compared to internally transferred AMU births. Furthermore, OH transfers were associated with a higher morbidity. Hence, pregnant women should be given an informed choice of birthplace, including the likelihood of intrapartum transfer. Out-of-hospital deliveries are associated with a higher rate of adverse perinatal outcome.