Journal of Perinatal Medicine最新文献

Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease with high morbidity and mortality that predominantly affects preterm infants. Early diagnosis remains challenging due to nonspecific symptoms and delayed detection of radiological signs.

Content: This systematic review provides an updated overview of the available evidence on serum biomarkers for early NEC detection, focusing on their diagnostic accuracy and clinical utility. A structured search was conducted in MEDLINE, Scopus, and web of science, identifying 40 studies evaluating biomarkers across various categories, including hematological indices, acute phase reactants, immunological markers, tissue damage and tissue repair markers, and metabolic markers.

Summary: Our findings highlight intestinal fatty acid-binding protein (I-FABP) as a promising biomarker for NEC prediction within the first 24 h of life. Ischemia-modified albumin (IMA) and certain multi-marker panels also showed high diagnostic accuracy. Despite these promising results, small sample sizes and heterogeneity in study design, biomarker thresholds, and patient populations limit immediate clinical implementation.

Outlook: Future multicenter studies are essential to validate promising biomarkers, particularly I-FABP and IMA, and establish standardized cut-off values. Integrating biomarkers into multi-marker panels, alongside clinical and non-invasive approaches, may improve early NEC detection, enhance diagnostic accuracy, and guide timely interventions to optimize neonatal outcomes.

Objectives: Preeclampsia is a multisystem syndrome that involves various genetic and environmental factors in its pathogenesis and pathophysiology. Its etiopathogenesis remains to be fully understood. This study aimed to investigate whether the level of pentraxin-3 (PTX3) in maternal peripheral blood during the second and third trimesters can predict its role in the aetiology of preeclampsia.

Methods: This prospective study analysed data from 96 mothers who gave birth between September 2020 and 2021 at the Department of Obstetrics at Umraniye Training and Research Hospital. Blood PTX3 levels were measured for each participant. Of 96, 50 preeclampsia patients were in the study group, and 46 normotensive healthy pregnancies were in the control group. The associations between preeclampsia and PTX3 levels were investigated.

Results: A total of 96 pregnant women were evaluated. The overall mean age was 28.9 ± 6.4years. As compared with mothers with healthy women, preeclampsia women had significantly a higher PTX3 level (5.919 ng/mL vs. 2.828 ng/mL, respectively; p=0.0001) in maternal peripheral blood. In addition, the PTX3 level was similar among varying forms of preeclampsia (p>0.05). In ROC analysis, the cut-off value for Pentraxin-3 to predict preeclampsia was established at 4.16 ng/mL, with a sensitivity of 95.9 %, a specificity of 97.8 %, a PPV of 97.9 % and an NPV of 95.7 %.

Conclusions: Our findings suggest the expression of PTX3 in the peripheral blood was associated with the pathogenesis of PE. The PTX3 may prove useful in predicting preeclampsia in women with a PTX3 level higher than 4.16 ng/mL.

Objectives: To evaluate the incidence of abnormal external genitalia of the fetus and discuss the accuracy of its prenatal diagnosis using two-(2D)/three-(3D) dimensional ultrasound in second- and third-trimester fetal screenings.

Methods: During the 24 months, second- and third-trimester fetal screenings were performed at 18-21+6 and 28-31+6 weeks of gestation, respectively, in 1,623 pregnant women. Fetal external genitalia were assessed using 2D/3D ultrasound. After birth, cross-examination was performed by pediatric experts to check the external genitalia.

Results: Twelve cases of abnormal genitalia (hypospadias: 3; hypospadias with penoscrotal web: 1; micropenis: 3; buried penis: 2; clitoromegaly: 2; genital tumor: 1) were suspected prenatally (0.74 %). In 9 fetuses with suspected abnormal male genitalia, the penile length was below the lower 90th confidence interval. In 2 fetuses with suspected clitoromegaly, the clitoral length was above 6.5 mm. In the 9 fetuses with suspected abnormal male external genitalia, only 6 (hypospadias: 2; penoscrotal web with mild chordee: 1; micropenis: 1; buried penis: 2) were diagnosed postnatally (66.7 %), whereas 3 were diagnosed as normal. Mixed gonadal dysgenesis (45X/46XY) was diagnosed in 1 neonate with hypospadias. One neonate with a micropenis had a right aortic arch and persistent foramen ovale. In 3 fetuses with suspected abnormal female external genitalia, prenatal findings were considered transient, and normality was confirmed after birth.

Conclusions: Prenatal diagnosis of abnormal external genitalia may still be difficult even with 3D ultrasound. Postnatal cross-examination by pediatric experts should be mandatory when abnormal external genitalia are suspected prenatally.

Objectives: Fetal responses to auditory stimuli remain a relatively understudied area in prenatal care. This study investigates the effects of personalized fetal music therapy by employing Doppler ultrasound to assess fetal cardiac and hemodynamic responses to specific musical stimuli. By integrating AI-based pattern recognition, we aim to establish a novel framework for prenatal acoustic stimulation that may support neurological development and enhance maternal-fetal bonding.

Methods: Thirty pregnant participants between 32 and 37 weeks of gestation underwent Doppler ultrasound recordings while exposed to two distinct musical pieces: Brahms' Lullaby (representing slow, soothing stimuli) and Mozart's Symphony No. 40 (representing fast, dynamic stimuli). Each session included baseline fetal heart rate (FHR) and Doppler waveform measurements - peak systolic velocity (PS), end-diastolic velocity (ED), and time-averaged maximum velocity (TAMax) - recorded before, during, and after music exposure. AI-driven analysis was used to evaluate heart rate variability and blood flow dynamics, and statistical methods (paired t-tests and ANOVA) were applied to identify significant variations in fetal responses.

Results: Fetal heart rate significantly decreased during Brahms' Lullaby, indicating a calming effect, and increased during Mozart's Symphony, suggesting arousal. Corresponding changes in Doppler waveform metrics reflected stimulus-dependent modulation of fetal cardiovascular function.

Conclusions: AI-assisted Doppler ultrasound analysis confirms that fetal music therapy modulates cardiac responses based on musical characteristics. These findings establish a foundation for personalized prenatal music interventions with potential benefits for in utero neurological priming and stress reduction.

Surrogacy is a complex and evolving practice that sits at the intersection of reproductive medicine, ethics, law, and social policy. This comprehensive review traces the historical, medical, and ethical foundations of surrogacy, from its roots in early IVF experiments to its current global practice. It explores the distinctions between traditional and gestational surrogacy, outlines medical and social indications, and evaluates associated perinatal and psychological outcomes. Central to the analysis is the debate between altruistic and commercial surrogacy, highlighting the ethical tensions surrounding compensation, autonomy, and potential exploitation. The review examines global legal frameworks, with detailed attention to Israel's uniquely regulated system, which balances reproductive liberty with strict oversight. The paper also considers religious perspectives, showing how cultural and theological differences shape national policy. The experiences of gestational carriers, commissioning couples, and children born through surrogacy are examined to underscore the psychological and social implications. While surrogacy offers hope to many, it raises profound questions about the commodification of reproduction, the fragmentation of motherhood, and the responsibilities of professionals involved in care. Ultimately, the review argues for nuanced, culturally sensitive regulation that protects all parties particularly the child, whose interests must remain central throughout the surrogacy process.

Objectives: To develop predictive models for gestational diabetes mellitus (GDM) using maternal clinical and ultrasonographic parameters, as well as fetal ultrasonographic measurements obtained during routine second-trimester obstetric examination.

Methods: Our prospective case-control study included 80 pregnant participants (32 with GDM and 48 healthy controls) between 24 and 28 weeks of gestation. We evaluated maternal parameters including anthropometric measurements such as neck circumference and waist-hip ratio, ultrasonographic measurements like maternal adipose thickness, as well as fetal ultrasonographic parameters including pancreatic hyperechogenicity, soft tissue measurements, and cardiac parameters. Following ultrasonographic examination, all participants underwent a 75-g oral glucose tolerance test (OGTT). Two separate logistic regression models were developed for maternal and fetal parameters to evaluate their association with the presence or absence of GDM.

Results: The maternal model achieved 90.0 % accuracy through a stepwise integration of suprapubic subcutaneous adipose tissue thickness (OR=1.35, 95 % CI: 1.11-1.64), visceral adipose tissue (OR=1.68, 95 % CI: 1.18-2.40), gravidity (OR=2.09, 95 % CI: 1.32-3.33), and family history of diabetes. The fetal model reached 82.5 % accuracy using two parameters: pancreatic hyperechogenicity (OR=0.02, 95 % CI: 0.00-0.14) and fetal abdominal subcutaneous tissue thickness (OR=5.09, 95 % CI: 1.75-14.78). The maternal model demonstrated excellent discriminative ability with an AUC of 0.95.

Conclusions: Both maternal and fetal ultrasonographic parameters can serve as effective predictors of GDM when combined with clinical risk factors. These models, which can be easily incorporated into routine second-trimester ultrasound examinations, offer potential for early identification of high-risk patients without additional patient visits or invasive testing.

Objectives: This study aims to assess the value of copy number variation sequencing (CNV-seq) in prenatal diagnosis of abnormal ultrasound markers to reduce fetal birth defects.

Methods: Between June 2021 and December 2022, Yulin Maternal and Child Health Care Hospital examined 295 pregnant women with abnormal ultrasound indicators. We were categorized by the number of abnormalities and age. Karyotype analysis and CNV-seq were conducted, and the CNV-seq detection rate was statistically analyzed.

Results: CNV-seq detected abnormal chromosomes in 43 out of 295 pregnant women with abnormal fetal ultrasound soft indicators, resulting in a detection rate of 14.58 %, compared to 5.76 % with traditional karyotype analysis. CNV-seq identified all aneuploidy abnormalities found by karyotype analysis and an additional 5 abnormalities, increasing the detection rate by 1.69 %. However, CNV-seq missed one case of chromosome equilibrium translocation. The detection rate of CNV-seq in fetuses with Several abnormal soft indexes was 29.41 %, significantly higher than individual soft indexes (p<0.05). The study compared abnormality rates of single and multiple ultrasound soft markers in two age groups. Abnormal detection rates were 12.38 % for the younger group and 13.73 % for the older group, with no significant difference. However, the younger group had a significantly higher detection rate for multiple soft markers compared to the older group (χ²=5.517, p<0.05).

Conclusions: CNV-seq technology is valuable for identifying fetuses with abnormal soft markers, guiding its future use in perinatal diagnosis and aiding clinical genetic counseling.

The development of facial musculature and expressions in the human fetus represents a critical intersection of developmental biology, neurology, and evolutionary anthropology, offering insights into early neurological and social development. Fetal facial expressions, shaped by Cranial Nerve VII, reflect evolutionary adaptations for nonverbal communication and exhibit minimal asymmetry in universal expressions. Advancements in 4D ultrasound imaging and artificial intelligence (AI) have introduced innovative methods for analyzing these movements, revealing their potential as diagnostic tools for neurodevelopmental disorders like Bell's Palsy and Ramsay Hunt Syndrome before birth. These technologies promise early interventions that could significantly improve neonatal outcomes. By integrating imaging, AI, and longitudinal studies, researchers propose a multidisciplinary approach to establish diagnostic criteria for fetal facial movements. However, translating these advancements into clinical practice requires addressing ethical and practical challenges, refining imaging and AI methodologies, and fostering interdisciplinary collaboration. The review highlights the universality of fetal expressions while emphasizing the importance of distinguishing typical variability from pathological markers. In conclusion, these findings suggest transformative potential for maternal-fetal medicine, paving the way for proactive strategies to manage neurodevelopmental risks. Focused research is essential to fully harness these innovations and establish a new frontier in perinatal science.