Seminars in perinatology最新文献

Hypertensive disorders of pregnancy are major contributors to adverse maternal, fetal and neonatal outcomes. This review summarizes pivotal clinical and translational studies that have shaped the clinical approach to the prevention and treatment of preeclampsia. Early preclinical trails established the pathophysiological basis and rationale for prevention strategies culminating in the standard use low dose aspirin and the emerging potential of statins. Recent randomized trials have also demonstrated that treatment of mild chronic hypertension reduces the risk preeclampsia and associated complications. Furthermore, clinical studies examining the use of magnesium sulfate for seizure prophylaxis and the optimal delivery timing have defined key aspects of evidence-based preeclampsia management. Further research to identify novel therapeutic targets and refine management strategies to mitigate the persistent burden of preeclampsia is urgently needed.

Landmark trials impact how we care for patients. These studies often have convincing data that lead to new or updated practice guidelines by professional societies and other organizations. In this review, we present four such studies of maternal interventions that defined standards of care and continue to influence what we do today. The first found that the rate of perinatal HIV transmission was reduced in women with HIV in pregnancy with treatment of zidovudine in the antepartum, intrapartum, and neonatal periods. The second found that postoperative infections and use of resources were reduced in women who received a single intravenous dose of azithromycin in addition to their standard preoperative antibiotics for cesarean delivery. The third study did not find any benefit in treating subclinical hypothyroidism or hypothyroxinemia in pregnancy preventing routine use of levothyroxine for these patients. The fourth showed that the treatment of non-severe chronic hypertension in pregnancy safely resulted in improved pregnancy outcomes.

Over the past few decades, multiple landmark studies investigating interventions for perinatal benefit have determined best practices for obstetricians worldwide. In this review, we will highlight trials that have demonstrated the effects of maternal intervention for perinatal benefit, including latency antibiotics, antenatal steroids, fetal neuroprotective measures, intrapartum group B streptococcus (GBS) prophylaxis, and delivery timing.

Fetal therapy has continued to expand in treatable conditions and surgical approaches. To maintain the evidence-based approach to optimizing patient care and outcomes, clinical trials investigating these interventions is essential. All trials must take in consideration both the potential benefit to the fetus or fetuses with the maternal and perinatal risks. In this review we discuss clinical trials in fetal therapy which have changed the field and provided the highest level of evidence possible. Large-scale trials have been performed in the management of Twin-to-Twin Transfusion Syndrome (TTTS), Spina bifida, Lower Urinary Tract Obstruction (LUTO) and Congenital Diaphragmatic Hernia (CDH). As molecular biology and advanced prenatal diagnostics continues to develop, future trials in gene and enzyme therapy remain on the horizon.

Spontaneous preterm birth remains a leading global cause of neonatal morbidity and mortality, with lasting health socioeconomic consequences. Despite substantial research efforts over the past decades, preterm birth rates are not declining.Large cohort studies have shown that measurement of cervical length by transvaginal ultrasound is the best predictor for identifying women at risk of preterm birth, although sensitivity stays limited. While this has guided randomised clinical trials, preventive strategies remain suboptimal. Progestogens trials have long dominated the research landscape, and evidence synthesis though individual participant data indicates a potential reduction in preterm birth of approximately 30 % for women with a singleton pregnancy and a short cervix.Relative to progestogens, other potentially effective interventions, such as cervical cerclage and pessary have received limited attention, and were evaluated later or not at all. The optimal management of twin pregnancies, an important cause of preterm birth, remains uncertain. Our knowledge base on the prevention of preterm birth can be improved by research with greater uniformity in outcome measures, better prioritization, better evidence synthesis, more balanced resource allocation, and enhanced global collaboration.

Preterm birth is the leading cause of neonatal morbidity and mortality worldwide and contributes to substantial long-term health and economic burdens. Despite decades of research, overall rates remain largely unchanged, highlighting the urgent need for more effective predictive and preventative strategies. Traditional approaches, including risk-factor scoring, cervical length measurement, and fetal fibronectin testing, provide limited predictive value. Given the limitations of traditional approaches, emerging technologies provide new opportunities to elucidate mechanisms and improve prediction. Proteomic analyses have identified pathways, such as inflammation and angiogenesis, while metabolomics has revealed small-molecule alterations reflecting biochemical and microbial processes. Genetic investigations highlight complex contributions from both maternal and fetal genomes. Artificial intelligence and machine learning are being applied to integrate multi-omics data with clinical variables with early studies suggesting improved predictive accuracy compared with conventional models. Despite these advancements, significant challenges remain. Many prediction studies are constrained by heterogeneous definitions of preterm birth, small sample sizes, and lack of validation across diverse populations. Beyond research limitations, system-level factors such as social determinants of health, environmental exposure, and inequities in access to prenatal care contribute to disparities in both risk and outcomes. These realities underscore the need for predictive tools that are not only scientifically robust but also applicable across diverse populations and care settings. Although clinical translation of novel approaches remains limited, continued innovation, longitudinal research, and commitment to equity will be essential to achieving meaningful improvements in the prediction of preterm birth. Understanding the pathophysiology and applying proven interventions is essential to improving perinatal health outcomes.