The Journal of Maternal-Fetal & Neonatal Medicine最新文献_第3页

Maternal serum interleukin-1β, FoxO1 and Sestrin2 levels in predicting preterm delivery 预测早产的母体血清白细胞介素-1β、FoxO1 和 Sestrin2 水平

The Journal of Maternal-Fetal & Neonatal Medicine

Pub Date : 2023-12-17 DOI: 10.1080/14767058.2023.2295807

Asuman Akkaya Fırat, Aysegül Özel, Ebru Alıcı Davutoğlu, Zeynep Banu Güngör, Rıza Madazlı

The study aimed to investigate whether serum IL-1β, FoxO1and Sesn2 concentrations differed between threatened preterm labor (TPL) and uncomplicated pregnancies. This study was conducted on 54 women...

该研究旨在探讨血清中IL-1β、FoxO1和Sesn2的浓度在受威胁早产（TPL）和无并发症妊娠之间是否存在差异。这项研究对 54 名孕妇进行了...

引用次数: 0

Delivery outcomes associated with maternal congenital heart disease, 2000-2018. 2000-2018年孕产妇先天性心脏病的分娩结局

The Journal of Maternal-Fetal & Neonatal Medicine

Pub Date : 2022-12-01 Epub Date: 2022-06-05 DOI: 10.1080/14767058.2022.2081803

Alice H Linder, Timothy Wen, Jean R Guglielminotti, Lisa D Levine, Yuli Y Kim, Stephanie E Purisch, Mary E D'Alton, Alexander M Friedman

Purpose: To characterize temporal trends and outcomes of delivery hospitalization with maternal congenital heart disease (CHD).

Materials and methods: For this repeated cross-sectional analysis, deliveries to women aged 15-54 years with maternal CHD were identified in the 2000-2018 National Inpatient Sample. Temporal trends in maternal CHD were analyzed using joinpoint regression to estimate the average annual percentage change (AAPC) with 95% CIs. The relationship between maternal CHD and several adverse maternal outcomes was analyzed with log-linear regression models. Risk for adverse outcomes in the setting of maternal CHD was further characterized based on additional diagnoses of cardiac comorbidity including congestive heart failure, arrhythmia, valvular disease, pulmonary disorders, and history of thromboembolism.

Results: Of 73,109,790 delivery hospitalizations, 51,841 had a diagnosis of maternal CHD (7.1 per 10,000). Maternal CHD rose from 4.2 to 10.9 per 10,000 deliveries (AAPC 4.8%, 95% CI 4.2%, 5.4%). Maternal CHD deliveries with a cardiac comorbidity diagnosis also increased from 0.6 to 2.6 per 10,000 from 2000 to 2018 (AAPC 8.4%, 95% CI 6.3%, 10.6%). Maternal CHD was associated with severe maternal morbidity (adjusted risk ratios [aRR] 4.97, 95% CI 4.75, 5.20), cardiac severe maternal morbidity (aRR 7.65, 95% CI 7.14, 8.19), placental abruption (aRR 1.30, 95% 1.21, 1.38), preterm delivery (aRR 1.47, 95% CI 1.43, 1.51), and transfusion (aRR 2.28, 95% CI 2.14, 2.42). Risk for severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) and cardiac severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) increased significantly among women with maternal CHD over the study period. The presence of cardiac comorbidity diagnoses was associated with further increased risk.

Conclusion: Maternal CHD is becoming more common among US deliveries. Among deliveries with maternal CHD, risk for severe morbidity is increasing. These findings support that an increasing burden of risk from maternal CHD in the obstetric population.

目的:探讨产妇先天性心脏病(CHD)分娩住院的时间趋势和结局。材料和方法:对于这项重复的横断面分析，在2000-2018年全国住院患者样本中确定了15-54岁产妇冠心病的分娩情况。使用联结点回归分析产妇冠心病的时间趋势，以95% ci估计平均年百分比变化(AAPC)。采用对数-线性回归模型分析产妇冠心病与几种不良结局的关系。根据其他心脏合并症的诊断，包括充血性心力衰竭、心律失常、瓣膜疾病、肺部疾病和血栓栓塞史，孕妇冠心病的不良结局风险进一步表征。结果:在73,109,790例分娩住院患者中，51,841例诊断为产妇冠心病(7.1 / 10,000)。产妇冠心病发生率从4.2 / 10000上升到10.9 / 10000 (AAPC 4.8%， 95% CI 4.2%， 5.4%)。从2000年到2018年，患有心脏合并症的产妇冠心病分娩也从0.6 / 10,000增加到2.6 / 10,000 (AAPC 8.4%， 95% CI 6.3%， 10.6%)。产妇冠心病与严重产妇发病率(校正风险比[aRR] 4.97, 95% CI 4.75, 5.20)、心脏严重产妇发病率(aRR 7.65, 95% CI 7.14, 8.19)、胎盘早裂(aRR 1.30, 95% CI 1.21, 1.38)、早产(aRR 1.47, 95% CI 1.43, 1.51)和输血(aRR 2.28, 95% CI 2.14, 2.42)相关。在研究期间，母亲患有冠心病的女性严重发病率(AAPC 4.7%， 95% CI 2.5%， 6.9%)和心脏严重发病率(AAPC 4.7%， 95% CI 2.5%， 6.9%)的风险显著增加。心脏合并症诊断的存在与进一步增加的风险相关。结论:产妇冠心病在美国分娩中越来越普遍。在产妇冠心病分娩中，严重发病的风险正在增加。这些发现支持产科人群中孕产妇冠心病风险负担的增加。

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引用次数: 0

Derivation and assessment of a sex-specific fetal growth standard. 推导和评估性别特异性胎儿生长标准。

The Journal of Maternal-Fetal & Neonatal Medicine

Pub Date : 2022-12-01 Epub Date: 2022-05-22 DOI: 10.1080/14767058.2022.2075696

Nathan R Blue, Amanda A Allshouse, Sarah Heerboth, William Grobman, Brian Mercer, Anthony Shanks, Julia M Bregand-White, Hyagriv Simhan, Uma M Reddy, George Saade, Samuel Parry, Robert M Silver

Purpose: To derive a prescriptive sex-specific fetal growth standard and assess clinical management and outcomes according to sex-specific growth status.

Materials and methods: This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), a prospective observational study of 10,038 nulliparas from eight U.S. centers who underwent ultrasounds at 14-20 and 22-29 weeks with outcomes ascertained after delivery. From these, we selected a nested cohort of lower risk participants (excluded those with chronic hypertension, pre-gestational diabetes, suspected aneuploidy, and preterm delivery) to derive a sex-specific equation for expected fetal growth using fetal weights by ultrasound and at birth. We compared the male-female discrepancy in the rate of weight <10th (small for gestational age [SGA]) and >90th (large for gestational age [LGA]) percentiles between the sex-specific and sex-neutral (Hadlock) standards. Using the full unselected cohort, we then assessed outcomes and clinical management according to sex-specific SGA and LGA status.

Results: Overall, 7280 infants in the lower risk nested cohort were used to derive a sex-specific equation with fetal sex included as an equation intercept. The sex-neutral standard diagnosed SGA more often in female newborns (21% vs. 13%, p < .001) and LGA more often in male newborns (5% vs. 3%, p < .001). The sex-specific standard resolved these disparities (SGA: 9% vs. 10%, p = .23; LGA: 13% vs. 13%, p = .58). To approximate an unselected population, 1059 participants initially excluded for risk factors for abnormal growth were then included for our secondary objective (N = 8339). In this unselected cohort, 39% (95% CI 37.0-42.0%) of the 1498 newborns classified as SGA by the sex-neutral standard were reclassified as appropriate for gestational age (AGA) by the sex-specific standard. These reclassified newborns were more likely to be delivered for growth restriction despite having lower risk of morbidity (females) or comparable risk of morbidity (males) compared to newborns considered AGA by both methods. Of the 6485 newborns considered AGA by the sex-neutral standard, 737 (11.4%, 95% CI 10.6-12.2%) were reclassified as LGA by the sex-specific standard. These reclassified newborns had higher rates of cesarean for arrest of descent, cesarean for arrest of dilation, and shoulder dystocia than newborns considered AGA by both methods. None were reclassified from LGA to AGA by the sex-specific standard.

Conclusion: The Hadlock sex-neutral standard generates sex disparities in SGA and LGA at birth. Our sex-specific standard resolves these disparities and has the potential to improve accuracy of growth pathology risk stratification.

目的：根据胎儿的性别特异性生长状况，得出规定性的胎儿性别特异性生长标准，并评估临床管理和结果：这是对无子宫妊娠结局研究（Nulliparous Pregnancy Outcomes Study：nuMoM2b）的二次分析。该研究是一项前瞻性观察性研究，研究对象是来自美国八个中心的10038名无妊娠期妇女，她们分别在14-20周和22-29周接受了超声波检查，并在分娩后确定了结果。我们从中选择了一个嵌套队列中的低风险参与者（排除了那些患有慢性高血压、妊娠前糖尿病、疑似非整倍体和早产的患者），利用超声和出生时的胎儿体重得出了一个性别特异性的预期胎儿生长方程。我们比较了性别特异性标准和性别中性（Hadlock）标准之间体重第 90 百分位数（胎龄偏大 [LGA]）比率的男女差异。然后，我们使用完整的未入选队列，根据性别特异性 SGA 和 LGA 状态评估了结果和临床管理：总体而言，低风险巢式队列中的 7280 名婴儿被用于推导性别特异性方程，其中胎儿性别被列为方程截距。性别中性标准诊断出的 SGA 多见于女性新生儿（21% 对 13%，p = .23；LGA：13% 对 13%，p = .58）。为了接近未经筛选的人群，我们的次要目标（N = 8339）纳入了最初因发育异常风险因素而被排除在外的 1059 名参与者。在这个未经筛选的队列中，按性别中性标准被归类为 SGA 的 1498 名新生儿中，有 39% （95% CI 37.0-42.0%）按性别特异性标准被重新归类为适合胎龄 (AGA)。与两种方法都认为是 AGA 的新生儿相比，这些被重新分类的新生儿尽管发病风险较低（女性）或发病风险相当（男性），但却更有可能因生长受限而分娩。在按性别中性标准被认为是AGA的6485名新生儿中，有737名（11.4%，95% CI 10.6-12.2%）按性别特异性标准被重新分类为LGA。这些被重新分类的新生儿因胎位下降停止而进行剖宫产、因宫口扩张停止而进行剖宫产以及肩难产的比例均高于两种方法均被视为 AGA 的新生儿。结论：结论：Hadlock 性别中立标准会造成出生时 SGA 和 LGA 的性别差异。结论：Hadlock性别中性标准会造成出生时SGA和LGA的性别差异，而我们的性别特异性标准则解决了这些差异，并有可能提高生长病理学风险分层的准确性。

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引用次数: 0

Infant nutrition (donor human milk vs. maternal milk) and long-term neurodevelopmental and growth outcomes in very low birth weight infants 婴儿营养(供体母乳与母乳)与极低出生体重婴儿的长期神经发育和生长结果

The Journal of Maternal-Fetal & Neonatal Medicine

Pub Date : 2022-06-15 DOI: 10.1080/14767058.2022.2086794

Raza U Bajwa, M. Raju, V. Govande, M. Hemingway, Kendall A. P. Hammonds, N. Vora

Abstract Background Human milk, the ultimate source of nutrition for premature infants, enhances host defense mechanism, gastrointestinal maturation, lowers infection rate, improves neurodevelopmental outcomes, and reduces long-term cardiovascular and metabolic disease. Recently, there has been an increase in donor breast milk (DBM) use for premature infants; however, data are limited on the long-term effects of DBM on the infant’s growth and neurodevelopmental outcomes. Objective To determine if there is an association between type of infant nutrition (maternal breast milk (MBM) or DBM) and neurodevelopmental and growth outcomes in very low birth weight (VLBW) infants. Design/methods Retrospective cohort study of VLBW (<1500 g) infants admitted to the Baylor Scott & White Memorial Hospital Neonatal Intensive Care Unit from January 2014 to December 2016. Infants with major congenital anomalies, born at an outside hospital, who were nil per os (NPO) for >15 days, or who died before NICU discharge were excluded. Infants were stratified into two groups (MBM or DBM) based on predominant nutrition (>50%) received in the first month of life. Primary outcomes of neurodevelopmental delay(s) between 2 and 4 years of age identified via ICD 9/10 codes. Growth data (weight, length, and head circumference) were obtained from well-check visits at 12-, 18-, 24-, 36-, and 48-months. Severity of illness was determined using the Clinical Risk Index in Babies-II (CRIB-II) score. Generalized linear models were used to assess the relationship between nutrition and neurodevelopmental delay and trends in growth over time. Results Two hundred and nine infants were included: 146 MBM; 63 DBM. Median gestational age was 28 weeks (range, 23–35) and median birthweight was 1050 g (range, 410–1470). There were no significant differences in birthweight, gestational age, CRIB-II score, or length of stay between the groups. Infants fed DBM had a significantly larger weight z-score (p=.005), length z-score (p=.01), and head circumference z-score (p=.04), on average from birth to 48 months compared to MBM infants, while controlling for NICU length of stay and number of follow-up months; however, this only equated to DBM infants being 0.5 in taller and 0.9 lbs heavier at 48 months. There were no statistically significant differences among type of infant nutrition and long-term neurodevelopmental outcomes, while controlling for CRIB-II score. Conclusions Infants fed DBM have a slightly greater propensity for growth over time compared to infants fed MBM. Longer follow-up is needed to further determine the effect, infant nutrition has on neurodevelopmental outcomes.

摘要背景母乳是早产儿的最终营养来源，可促进宿主防御机制，促进胃肠成熟，降低感染率，改善神经发育结局，减少长期心血管和代谢疾病。最近，早产儿使用供体母乳(DBM)的情况有所增加;然而，关于DBM对婴儿生长和神经发育结果的长期影响的数据有限。目的探讨极低出生体重儿(VLBW)的神经发育和生长结局与婴儿营养类型(母体母乳(MBM)或DBM)是否存在关联。设计/方法回顾性队列研究排除VLBW(15天)或新生儿重症监护病房出院前死亡的患者。根据出生后第一个月的主要营养(>50%)将婴儿分为两组(MBM或DBM)。通过ICD 9/10代码确定的2 - 4岁神经发育迟缓的主要结局。生长数据(体重、体长和头围)分别在12个月、18个月、24个月、36个月和48个月时通过访井获得。使用婴儿临床风险指数- ii (CRIB-II)评分来确定疾病的严重程度。使用广义线性模型来评估营养与神经发育迟缓之间的关系以及随时间的生长趋势。结果纳入新生儿229例:MBM 146例;63 DBM。中位胎龄为28周(范围23-35)，中位出生体重为1050克(范围410-1470)。两组之间的出生体重、胎龄、CRIB-II评分或住院时间均无显著差异。在控制新生儿重症监护病房的住院时间和随访月数的情况下，DBM喂养的婴儿从出生到48个月的平均体重z评分(p= 0.005)、长度z评分(p= 0.01)和头围z评分(p= 0.04)显著高于MBM喂养的婴儿;然而，这只相当于DBM婴儿在48个月时身高增加0.5磅，体重增加0.9磅。在控制CRIB-II评分的情况下，婴儿营养类型和长期神经发育结局无统计学差异。结论:DBM喂养的婴儿随着时间的推移比MBM喂养的婴儿有稍大的生长倾向。需要更长时间的随访来进一步确定婴儿营养对神经发育结果的影响。

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引用次数: 0

Correlation of clinical outcomes with the application of the 2020 consensus panel on histological classification for Placenta Accreta Spectrum (PAS) 临床结果与应用2020年共识小组对胎盘增生谱(PAS)组织学分类的相关性

The Journal of Maternal-Fetal & Neonatal Medicine

Pub Date : 2022-06-15 DOI: 10.1080/14767058.2022.2086797

J. Munoz, Alixandria F. Pfeiffer, P. Ramsey

Abstract Objective Placenta Accreta Spectrum (PAS) is a range of disorders characterized by placenta adherence to uterine myometrium. The pathologic nomenclature of PAS has varied. In 2020, a consensus panel proposed a system which would parallel the antenatal grading. Our goal was to assess if greater PAS associated morbidity correlated with increasing histopathological grades in this novel system for confirmed cases of PAS. Methods A retrospective cohort analysis was performed of 125 singleton, non-anomalous pregnancies complicated by PAS at the University of Texas Health San Antonio Placenta Accreta program from 2005 to 2020. PAS cases confirmed after cesarean hysterectomy were classified by the new system and outcomes were analyzed including Kaplan-Meier analysis of gestational age at delivery by new pathology categorization. Results Antepartum admission, length of stay and episodes of vaginal bleeding correlated with increasing grades of PAS. In addition, increased PAS grades were associated with deliveries at earlier gestational age and surgical outcomes including operative time, blood loss, ICU admission and post-operative length of stay. Conclusions The grading system proposed by the 2020 consensus panel correlates with antepartum, intra-operative and postoperative outcomes in cases of PAS cesarean hysterectomy and should be implemented for uniformity of reporting.

目的胎盘附着谱(PAS)是一系列以胎盘粘附子宫肌层为特征的疾病。PAS的病理命名多种多样。2020年，一个协商一致的小组提出了一个与产前分级平行的系统。我们的目的是评估在这个新系统中，PAS确诊病例的PAS相关发病率是否与组织病理学分级的增加相关。方法回顾性分析2005年至2020年德克萨斯大学圣安东尼奥分校胎盘增生项目中125例单胎、非异常妊娠合并PAS的病例。对剖宫产子宫切除术后确诊的PAS病例进行分类，并对结果进行分析，包括通过新的病理分类对分娩胎龄进行Kaplan-Meier分析。结果产前入院、住院时间、阴道出血次数与PAS的加重程度相关。此外，PAS评分的增加与早胎龄分娩和手术结果相关，包括手术时间、出血量、ICU入院和术后住院时间。结论2020年共识小组提出的分级制度与PAS剖宫产子宫切除术的产前、术中、术后预后相关，应予以统一报道。

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引用次数: 0

Intrapartum magnesium sulfate exposure and obstetric hemorrhage risk 产时硫酸镁暴露与产科出血风险

The Journal of Maternal-Fetal & Neonatal Medicine

Pub Date : 2022-06-15 DOI: 10.1080/14767058.2022.2086796

Sara Young, Michelle J. Wang, A. Srivastava, D. Abbas, Megan Alexander, Lindsey Claus, S. Tummala, C. Yarrington, A. Comfort

Abstract Background The gold standard intrapartum treatment for preeclampsia with severe features is magnesium sulfate in order to provide prophylaxis against eclampsia. However, though magnesium sulfate is known to have a relaxant effect on uterine muscle, there have been variable reports in the literature in regard to the association between magnesium and obstetric hemorrhage (OBH). Objective We aim to compare OBH incidence in patients with hypertensive disease of pregnancy (HDP) with or without exposure to intrapartum magnesium sulfate. Methods We performed a retrospective cohort study of all deliveries at our institution associated with a diagnosis of hypertensive disease of pregnancy (HDP) (e.g. chronic and gestational hypertension, preeclampsia with or without severe features, eclampsia, or HELLP) from January 1, 2018 to December 31, 2019. The category of HDP diagnosis was determined by a detailed chart review by trained chart abstractors. The primary outcome was total quantitative blood loss (QBL) and the rate of obstetric hemorrhage. Secondary outcomes included a composite of obstetric hemorrhage-related maternal morbidity outcomes (OBH-M), the individual composite components and the incidence of additional hemorrhage-related interventions (e.g. uterotonics and surgical interventions). We also examined the same primary and secondary outcomes in a stratified analysis based on delivery mode (i.e. vaginal deliveries only and cesarean deliveries only). Results Of 791 patients with a diagnosis of HDP, 411 patients received magnesium sulfate for eclampsia prophylaxis and 380 patients did not receive magnesium sulfate. For all delivery modes, there was a significantly higher QBL (p < .01), increased rate of OBH (p = .04) and increased OBH-M (p < .01) in deliveries associated with intrapartum exposure to magnesium compared to those without. However, our stratified analysis by delivery mode demonstrated that magnesium-related hemorrhage risk only persisted for vaginal deliveries (QBL p < .01; OBH aOR 1.47, 95% CI: 0.75–2.85; OBH-M aOR 1.47, 95% CI 1.00–7.55) with no significant hemorrhage-related differences among cesareans with or without magnesium exposure (QBL p = .51; OBH aOR 1.45, 95% CI: 0.85–2.47; OBH-M 1.50 95% CI: 0.70–3.23). Conclusion Intrapartum exposure to magnesium sulfate use was associated with an increase in QBL and risk of OBH-M in vaginal deliveries, but not associated with any hemorrhage-related outcome differences in cesarean deliveries. More research is needed to explore the effects of hypertensive disease, magnesium exposure, and delivery mode on obstetric hemorrhage risk.

背景为了预防子痫的发生，重度子痫前期产时治疗的金标准是硫酸镁。然而，虽然已知硫酸镁对子宫肌肉有松弛作用，但关于镁与产科出血(OBH)之间的关系，文献中有不同的报道。目的比较产时接触硫酸镁或不接触硫酸镁的妊娠高血压病(HDP)患者OBH的发生率。方法:我们对2018年1月1日至2019年12月31日在我院分娩的所有与妊娠高血压疾病(HDP)(如慢性和妊娠高血压、伴有或不伴有严重特征的先兆子痫、子痫或HELLP)诊断相关的分娩进行了回顾性队列研究。HDP诊断的类别是由训练有素的图表抽象者通过详细的图表审查确定的。主要观察指标为总定量失血量(QBL)和产科出血率。次要结局包括产科出血相关产妇发病率结局(OBH-M)、个别复合成分和额外出血相关干预措施(如子宫强直和手术干预)的发生率。我们还在基于分娩方式(即仅阴道分娩和仅剖宫产分娩)的分层分析中检查了相同的主要和次要结局。结果在诊断为HDP的791例患者中，411例患者接受了硫酸镁预防子痫，380例患者未接受硫酸镁治疗。对于所有分娩方式，产时暴露于镁的分娩与未暴露于镁的分娩相比，QBL (p < 0.01)、OBH率(p = 0.04)和OBH- m (p < 0.01)均显著升高。然而，我们对分娩方式的分层分析显示，镁相关出血风险仅在阴道分娩时持续存在(QBL p < 0.01;OBH or 1.47, 95% CI: 0.75-2.85;ohh - m aOR为1.47,95% CI为1.00-7.55)，在有或没有镁暴露的剖宫产者中无显著的出血相关差异(QBL p = 0.51;OBH or 1.45, 95% CI: 0.85-2.47;Obh-m 1.50 (95% ci: 0.70-3.23)。结论:产时暴露于硫酸镁与阴道分娩中QBL和OBH-M风险的增加有关，但与剖宫产中任何出血相关的结局差异无关。需要更多的研究来探讨高血压疾病、镁暴露和分娩方式对产科出血风险的影响。

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引用次数: 1

Trauma in pregnancy clinical practice guidelines: systematic review 妊娠创伤临床实践指南:系统综述

The Journal of Maternal-Fetal & Neonatal Medicine

Pub Date : 2022-06-15 DOI: 10.1080/14767058.2022.2078190

M. De Vito, Giulia Capannolo, Sara Alameddine, R. Fiorito, A. Lena, L. Patrizi, Francesco D’ Antonio, G. Rizzo

Abstract Purpose To objectively evaluate the methodological quality and clinical heterogeneity robustness of the published clinical practice guidelines (CPGs) on the management of trauma in pregnancy. Materials and methods Pubmed, Google Scholar, UpToDate, and Scopus Database were searched. The risk of bias and quality assessment of the included CPGs were performed using “The Appraisal Of Guidelines for Research and Evaluation (AGREE II)” tool. The following points relating to the management of trauma during pregnancy were addressed: quality of evidence assessment, classification of recommendations, main causes of trauma in pregnancy, importance of correct use of seat belts, ultrasound scans and/or pregnancy test in every female of reproductive age, description of physiological changes in pregnancy, classification in primary and secondary survey, primary survey based on ABCD Approach, fetus viable based on the weeks, radiographic studies for maternal evaluation, duration of fetal monitoring, use of anti-D immunoglobulin in rhesus-D-negative pregnant trauma patients, description of dose of RhD-Ig, the way to define gestational age if it was undetermined, descriptions of obstetrical complications, use of tetanus vaccination, and timing to perimortem cesarean section (CS). Results Six CPGs were included. Quality of evidence assessment was described in 16.7% of CPGs (1/6), while it was not reported in 83.3% (5/6). Classification of recommendations was reported in 50% (3/3) of the CPGs. Motor vehicle crash was reported as the main cause of trauma in pregnancy in all the CPGs included in the present review, despite that the importance of a correct use of seat belts was described only in the 50% (3/6). Definition of fetal viability was also different among the included CPGs; in 50% (3/6) defined a fetus viable when it from 23 weeks, 33.3% (2/6) from 24 weeks, and 16.7% (1/6) from 20 weeks of gestation. Regarding the type of fetal monitoring, 33.3% (2/6) CPGs recommended CTG assessment at least every 4 h, 16.7% (1/6) at least every 6 h, 33.3% for 24 h if there are not reassuring signs and 16.7% (1/6) did not specify the duration of monitoring. Recommendations about the use of anti-D-immunoglobulin in rhesus-D-negative pregnant were also heterogeneous: 50% (3/6) of the CPGs suggested administration in all rhesus-D-negative pregnant women, 16.7% (1/6) only according to gestational age at trauma or in case of significant abdominal trauma, and 16.7% (1/6) only in case of positive Kleihauer test while 16.7% (1/6) did not specify it. Administration of tetanus vaccination was suggested in in 33.3% (2/6) of CPGs. Finally, there were different descriptions of timing to perimortem CS: 33.3% (2/6) of CPGs claims to do CS no later than 4 min, 50% (3/6) no later than 5 min, and 16.7% (1/6) does not describe timing for CS. The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 69%. Only three CPGs scored more than 60% and revealed

目的客观评价已出版的临床实践指南(CPGs)妊娠创伤处理的方法学质量和临床异质性稳健性。检索Pubmed、Google Scholar、UpToDate、Scopus数据库。使用“研究与评价指南评估(AGREE II)”工具对纳入的cpg进行偏倚风险和质量评估。讨论了下列与怀孕期间创伤处理有关的问题:证据质量评估、建议分类、孕期创伤的主要原因、正确使用安全带的重要性、每个育龄女性的超声扫描和/或妊娠试验、孕期生理变化的描述、一级和二级调查的分类、基于ABCD方法的一级调查、基于周的胎儿存活率、用于母体评估的x线检查、胎儿监测的持续时间。抗d免疫球蛋白在恒河猴d阴性妊娠创伤患者中的使用，RhD-Ig剂量描述，未确定胎龄的定义方法，产科并发症描述，破伤风疫苗的使用，以及剖宫产术(CS)的时机。结果共纳入6个cpg。16.7%的cpg(1/6)报告了证据质量评估，83.3%(5/6)未报告证据质量评估。50%(3/3)的cpg报告了建议分类。尽管只有50%(3/6)的孕妇提到了正确使用安全带的重要性，但在本综述中所有的CPGs中，机动车碰撞被报道为妊娠期创伤的主要原因。所纳入的cpg对胎儿生存能力的定义也不同;50%(3/6)的人认为23周为可存活胎儿，33.3%(2/6)的人认为24周为可存活胎儿，16.7%(1/6)的人认为20周为可存活胎儿。关于胎儿监测的类型，33.3%(2/6)的cpg建议至少每4小时评估一次CTG, 16.7%(1/6)的cpg建议至少每6小时评估一次CTG, 33.3%(1/6)的cpg建议如果没有令人放心的体征，则建议24小时评估一次CTG, 16.7%(1/6)的cpg未规定监测的持续时间。关于抗d免疫球蛋白在rh - d阴性孕妇中的使用的建议也存在差异:50%(3/6)的CPGs建议在所有rh - d阴性孕妇中使用抗d免疫球蛋白，16.7%(1/6)仅根据创伤时的胎龄或严重腹部创伤，16.7%(1/6)仅在Kleihauer试验阳性的情况下使用，16.7%(1/6)未明确说明。33.3%(2/6)的CPGs建议接种破伤风疫苗。最后，对死前CS的时间有不同的描述:33.3%(2/6)的cpg声称不迟于4分钟进行CS, 50%(3/6)不迟于5分钟，16.7%(1/6)没有描述CS的时间。第一次全面评估(OA1)的AGREE II标准化领域得分的平均值为69%。只有三个cpg评分超过60%，并且显示了审稿人在推荐使用这些cpg方面的共识。结论创伤孕妇的处理在一些最相关的方面存在临床异质性。这一系统综述的结果强调，需要由主要团体推动的最新和共享的指南，以便使创伤孕妇的管理同质化。

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引用次数: 1

The reduced serum concentrations of β-arrestin-1 and β-arrestin-2 in pregnancies complicated with gestational diabetes mellitus 妊娠合并妊娠期糖尿病患者血清β-骤停素1和β-骤停素2浓度降低

The Journal of Maternal-Fetal & Neonatal Medicine

Pub Date : 2022-06-08 DOI: 10.1080/14767058.2022.2083495

Süleyman Cemil Oğlak, A. Yavuz, F. Olmez, Z. Özköse, Sema Süzen Çaypınar

Abstract Objective This study aimed to analyze maternal serum β-arrestin-1 and β-arrestin-2 concentrations in pregnant women complicated with gestational diabetes mellitus (GDM) and compare them with the normoglycemic uncomplicated healthy control group. Methods A prospective case-control study was conducted, including pregnant women complicated with GDM between 15 February 2021, and 31 July 2021. We recorded serum β-arrestin-1 and β-arrestin-2 concentrations of the participants. Receiver operating characteristic (ROC) curves were used to describe and compare the performance of diagnostics value of variables β-arrestin-1, and β-arrestin-2. Results The mean β-arrestin-1 and β-arrestin-2 levels were found to be significantly lower in the GDM group (41.0 ± 62.8 ng/mL, and 6.3 ± 9.9 ng/mL) than in the control group (93.1 ± 155.4 ng/mL, and 12.4 ± 17.7, respectively, p < .001). When we analyze the area under the ROC curve (AUC), maternal serum β-arrestin-1 and β-arrestin-2 levels can be considered a statistically significant parameter for diagnosing GDM. β-arrestin-1 had a significant negative correlation with fasting glucose (r = −0.551, p < .001), plasma insulin levels (r = −0.522, p < .001), HOMA-IR (r = −0.566, p < .001), and HbA1C (r = −0.465, p < .001). β-arrestin-2 was significantly negatively correlated with fasting glucose (r = −0.537, p < .001), plasma insulin levels (r = −0.515, p < .001), HOMA-IR (r = −0.550, p < .001), and HbA1C (r = −0.479, p < .001). Conclusion β-arrestin 1 and β-arrestin 2 could be utilized as biomarkers in the diagnosis of GDM. The novel therapeutic strategies targeting these β-arrestins may be designed for the GDM treatment.

摘要目的分析合并妊娠期糖尿病(GDM)孕妇血清β-arrestin-1和β-arrestin-2浓度，并与血糖正常的健康对照组进行比较。方法采用前瞻性病例对照研究，纳入2021年2月15日至2021年7月31日期间合并GDM的孕妇。我们记录了受试者血清中β-arrestin-1和β-arrestin-2的浓度。采用受试者工作特征(ROC)曲线描述和比较变量β-arrestin-1和β-arrestin-2的诊断价值表现。结果GDM组β-arrestin-1、β-arrestin-2平均水平(41.0±62.8 ng/mL、6.3±9.9 ng/mL)明显低于对照组(93.1±155.4 ng/mL、12.4±17.7 ng/mL, p < 0.001)。当我们分析ROC曲线下面积(AUC)时，母体血清β-arrestin-1和β-arrestin-2水平可以被认为是诊断GDM的统计学意义参数。β-arrestin-1与空腹血糖(r = - 0.551, p < 0.001)、血浆胰岛素水平(r = - 0.522, p < 0.001)、HOMA-IR (r = - 0.566, p < 0.001)、HbA1C (r = - 0.465, p < 0.001)呈显著负相关。β-arrestin-2与空腹血糖(r = - 0.537, p < 0.001)、血浆胰岛素水平(r = - 0.515, p < 0.001)、HOMA-IR (r = - 0.550, p < 0.001)、HbA1C (r = - 0.479, p < 0.001)呈显著负相关。结论β-抑制素1和β-抑制素2可作为诊断GDM的生物标志物。针对这些β-抑制因子的新治疗策略可能被设计用于GDM的治疗。

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引用次数: 4

Effects of selenium levels on placental oxidative stress and inflammation during pregnancy: a prospective cohort study 硒水平对妊娠期间胎盘氧化应激和炎症的影响:一项前瞻性队列研究

The Journal of Maternal-Fetal & Neonatal Medicine

Pub Date : 2022-06-05 DOI: 10.1080/14767058.2022.2078963

Jianqing Wang, C. Liang, Ya-bin Hu, Xun Xia, Zhi-juan Li, Hui Gao, J. Sheng, Kun Huang, Sufang Wang, P. Zhu, Jia-hu Hao, F. Tao

Abstract Background Studies on the impact of Se levels in different pregnancy periods on placental function are limited. Aim This cohort study sought to investigate the levels of the trace element Se and to assess their effects on placental oxidative stress (OS) and mRNA expression of inflammatory genes during pregnancy. Methods The study population consisted of 2519 pregnant women from the Ma’anshan birth cohort. Se levels were measured in the first and second trimesters of pregnancy and in cord blood using inductively coupled plasma-mass spectrometry (ICP-MS). Placental stress and mRNA expression of inflammatory genes were assessed using RT-PCR. Results A statistically significant negative association was noted between Se levels in the second trimester of pregnancy and mRNA expression of placental HO-1(β = −0.009, p < .01), HIF1α (β = −0.005, p = .010), GRP78 (β = −0.011, p < .001), CRP (β = −.007, p = .033) and CD68 (β = −0.006, p = .019). A negative association was noted between Se levels in cord blood and mRNA expression of placental HO-1 (β = −0.007, p = .004), HIF1α (β = −0.006, p = .005) and GRP78 (β = −0.009, p = .004). We found that prenatal Se status was associated with placental stress and mRNA expression of inflammatory genes. Conclusion Se deficiency during pregnancy, especially in the second trimester, leads to the production of OS and an increase in inflammatory mediators, affecting the growth and development of the fetus. Monitoring of pregnant women’s nutritional status is necessary to prevent nutritional imbalances and deficiencies in important micronutrients in the fetal.

背景不同妊娠期硒水平对胎盘功能影响的研究有限。目的本队列研究旨在探讨妊娠期微量元素硒水平对胎盘氧化应激(OS)和炎症基因mRNA表达的影响。方法研究人群为来自马鞍山出生队列的2519名孕妇。采用电感耦合血浆质谱法(ICP-MS)测定妊娠前、中期和脐带血中的硒水平。采用RT-PCR检测胎盘应激和炎症基因mRNA表达。结果妊娠中期硒水平与胎盘HO-1(β = - 0.009, p < 0.01)、HIF1α (β = - 0.005, p = 0.010)、GRP78 (β = - 0.011, p < 0.001)、CRP (β = - 0.09, p < 0.01) mRNA表达呈显著负相关。007, p = 0.033)和CD68 (β = - 0.006, p = 0.019)。脐带血硒水平与胎盘HO-1 (β = - 0.007, p = 0.004)、HIF1α (β = - 0.006, p = 0.005)、GRP78 (β = - 0.009, p = 0.004) mRNA表达呈负相关。我们发现产前硒水平与胎盘应激和炎症基因mRNA表达有关。结论妊娠期特别是妊娠中期缺硒可导致OS的产生和炎症介质的增加，影响胎儿的生长发育。监测孕妇的营养状况是必要的，以防止胎儿营养失衡和重要微量营养素的缺乏。

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引用次数: 0

Abnormal vaginal flora and spontaneous preterm birth in high-risk singleton pregnancies with cervical cerclage 高危单胎妊娠伴宫颈环扎术后阴道菌群异常与自发性早产

The Journal of Maternal-Fetal & Neonatal Medicine

Pub Date : 2022-06-05 DOI: 10.1080/14767058.2022.2081802

Wallace Jin, K. Hughes, Shirlene Sim, S. Shemer, P. Sheehan

Abstract Objective To investigate abnormal vaginal and suture-based bacterial flora for associations with spontaneous preterm birth in high-risk singleton pregnancies with an ultrasound-indicated or emergency cervical cerclage. Materials and methods A retrospective study of 196 singleton pregnancies with an ultrasound-indicated or emergency cerclage at the Royal Women’s Hospital, Australia, from 2004 to 2018. High vaginal swabs were collected regularly between 14 and 26 weeks’ gestation, including pre- and post-cerclage insertion, and sent for microscopy and culture. Cervical suture was cultured upon removal. Primary outcomes were spontaneous preterm birth <37, <34 and <30 weeks. Results 43.4% (85/196) of women delivered preterm. The acquisition and persistence of vaginal Escherichia coli following cerclage insertion were independently associated with spontaneous preterm birth <37 weeks (p = .0225, p = .0477). Escherichia coli growth from the cervical suture upon removal was associated with spontaneous preterm birth <34 weeks (p = .0458). The acquisition of vaginal mixed anaerobes post-cerclage was independently associated with spontaneous preterm birth <34 weeks (p = .0480) Conclusion For singleton pregnancies with an ultrasound-indicated or emergency cerclage, the presence of vaginal or suture-based Escherichia coli following cerclage insertion yields increased risk of cerclage failure and spontaneous preterm birth.

目的探讨超声指示或急诊宫颈环切术高危单胎妊娠患者阴道及缝合线菌群异常与自发性早产的关系。材料与方法回顾性研究了2004年至2018年澳大利亚皇家妇女医院196例超声指示或紧急结扎的单胎妊娠。在妊娠14至26周期间定期收集高阴道拭子，包括环扎前后，并送去显微镜和培养。取出后进行宫颈缝线培养。主要结局为自发性早产<37周、<34周和<30周。结果早产率为43.4%(85/196)。阴道环扎术后大肠杆菌的获得和持续存在与自发性早产<37周独立相关(p =。0225, p = .0477)。取出宫颈缝线后大肠杆菌的生长与自发性早产<34周相关(p = 0.0458)。结扎术后阴道混合厌氧菌的获得与自发性早产<34周独立相关(p = 0.0480)结论对于超声指示或紧急结扎术的单胎妊娠，结扎术插入后阴道或缝合线上存在大肠杆菌会增加结扎失败和自发性早产的风险。

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引用次数: 1