Pub Date : 2022-03-13DOI: 10.1080/14767058.2022.2051006
R. Achiron, E. Kassif, M. Shohat, Z. Kivilevitch
Abstract Background No current data exists regarding the occurrence of pathological results when using Whole Exome Sequencing (WES) analysis in a subgroup of fetuses with minor abnormalities and normal Chromosomal Microarray Analysis (CMA) results. Objective Our study aimed to report our experience with in-utero WES abnormal results, found in fetuses with minor anomalies after a normal CMA result. Methods A retrospective study conducted in a single tertiary center, during four years, included collating data regarding fetuses with minor structural abnormalities, normal CMA results, and abnormal triple WES test results. Results Eleven fetuses were included in the study. Eight were with cardiovascular and lymphatic drainage alterations. Two fetuses developed late third-trimester macrocephaly (head circumference ≥ +2 standard deviations), and one fetus had unilateral mildly short and bowed femur bone. In seven cases (63.6%) the parents opted to terminate the pregnancy as a result of the WES analysis results. Conclusion Our case series raises the possibility that fetuses with even minor structural alterations and normal CMA results can have genetic variants revealable only by WES analysis which can provide critical information regarding pregnancy management.
{"title":"Pathologic whole exome sequencing analysis in fetuses with minor sonographic abnormal findings and normal chromosomal microarray analysis: case series","authors":"R. Achiron, E. Kassif, M. Shohat, Z. Kivilevitch","doi":"10.1080/14767058.2022.2051006","DOIUrl":"https://doi.org/10.1080/14767058.2022.2051006","url":null,"abstract":"Abstract Background No current data exists regarding the occurrence of pathological results when using Whole Exome Sequencing (WES) analysis in a subgroup of fetuses with minor abnormalities and normal Chromosomal Microarray Analysis (CMA) results. Objective Our study aimed to report our experience with in-utero WES abnormal results, found in fetuses with minor anomalies after a normal CMA result. Methods A retrospective study conducted in a single tertiary center, during four years, included collating data regarding fetuses with minor structural abnormalities, normal CMA results, and abnormal triple WES test results. Results Eleven fetuses were included in the study. Eight were with cardiovascular and lymphatic drainage alterations. Two fetuses developed late third-trimester macrocephaly (head circumference ≥ +2 standard deviations), and one fetus had unilateral mildly short and bowed femur bone. In seven cases (63.6%) the parents opted to terminate the pregnancy as a result of the WES analysis results. Conclusion Our case series raises the possibility that fetuses with even minor structural alterations and normal CMA results can have genetic variants revealable only by WES analysis which can provide critical information regarding pregnancy management.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87648586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-10DOI: 10.1080/14767058.2022.2050900
E. Montaguti, L. Cariello, E. Brunelli, A. Youssef, A. Livi, G. Salsi, G. Pilu
Abstract Background Alobar holoprosencephaly (HPE) is easily detected during a first-trimester screening examination, conversely, recognizing the lesser varieties may be difficult even in the second trimester. Objectives To describe the imaging findings of a cohort of fetuses with holoprosencephaly (HPE) and to elucidate the appearances of the different anatomical varieties. Materials and methods We reviewed medical records and stored images of pregnant women referred to our clinic because of a diagnosis or the suspicion of various forms of HPE. We reported the imaging characteristics, the presence of other associated anomalies, magnetic resonance findings, karyotype and autoptic examinations when available. Results Alobar forms show great distortion of normal brain anatomy, with a single ventricle detectable during the first trimester of pregnancy. Extracerebral, face and karyotype abnormalities are often associated. In semilobar and lobar forms the septum pellucidum is typically absent in axial planes, with fused frontal horns, while posterior fossa is often normal. At multiplanar neurosonogram, anomalies involving corpus callosum and cortex development can be detected. Face abnormalities are mild in lobar forms: receding forehead, various degrees of hypotelorism and the presence of a single central maxillary incisor are reported. Conclusions The alobar forms are detectable since the first trimester, with a peculiar single ventricle and extremely frequent extracerebral and karyotype abnormalities. The semilobar and lobar forms are more challenging and the diagnosis is easily missed in a mid-trimester screening exam unless a careful evaluation of both cavum septi pellucidi and frontal horns as well is conducted.
{"title":"Sonography of fetal holoprosencephaly: a guide to recognize the lesser varieties","authors":"E. Montaguti, L. Cariello, E. Brunelli, A. Youssef, A. Livi, G. Salsi, G. Pilu","doi":"10.1080/14767058.2022.2050900","DOIUrl":"https://doi.org/10.1080/14767058.2022.2050900","url":null,"abstract":"Abstract Background Alobar holoprosencephaly (HPE) is easily detected during a first-trimester screening examination, conversely, recognizing the lesser varieties may be difficult even in the second trimester. Objectives To describe the imaging findings of a cohort of fetuses with holoprosencephaly (HPE) and to elucidate the appearances of the different anatomical varieties. Materials and methods We reviewed medical records and stored images of pregnant women referred to our clinic because of a diagnosis or the suspicion of various forms of HPE. We reported the imaging characteristics, the presence of other associated anomalies, magnetic resonance findings, karyotype and autoptic examinations when available. Results Alobar forms show great distortion of normal brain anatomy, with a single ventricle detectable during the first trimester of pregnancy. Extracerebral, face and karyotype abnormalities are often associated. In semilobar and lobar forms the septum pellucidum is typically absent in axial planes, with fused frontal horns, while posterior fossa is often normal. At multiplanar neurosonogram, anomalies involving corpus callosum and cortex development can be detected. Face abnormalities are mild in lobar forms: receding forehead, various degrees of hypotelorism and the presence of a single central maxillary incisor are reported. Conclusions The alobar forms are detectable since the first trimester, with a peculiar single ventricle and extremely frequent extracerebral and karyotype abnormalities. The semilobar and lobar forms are more challenging and the diagnosis is easily missed in a mid-trimester screening exam unless a careful evaluation of both cavum septi pellucidi and frontal horns as well is conducted.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87474850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-10DOI: 10.1080/14767058.2022.2050897
R. Wiley, Han-Yang Chen, S. Wagner, Megha Gupta, S. Chauhan
Abstract Introduction To determine the impact of route of delivery on maternal outcomes among individuals who deliver preterm (before 37 weeks). Materials and methods This was a population-based retrospective cohort study using the U.S. vital statistics datasets on Period Linked Birth-Infant Death Data from 2014 to 2018. The study population was restricted to live births from women with non-anomalous singletons who delivered at 24–36 weeks of gestation. The main explanatory variable for this study was route of delivery, which was categorized as: (i) vaginal delivery, (ii) cesarean delivery with labor, and (iii) cesarean delivery without labor. The primary outcome was composite maternal adverse outcome, which encompassed any of the following: admission to the intensive care unit, maternal blood transfusion, uterine rupture, or unplanned hysterectomy. The results were presented as adjusted relative risk (aRR) with 95% confidence interval (CI). Results Over the study period 1,440,510 live births met the inclusion criteria, and the overall composite maternal adverse outcome was 14.38 per 1,000 live births. After multivariable adjustment, compared to women who underwent a vaginal delivery, the risk of composite maternal adverse outcome was higher in women who had a cesarean delivery with labor (aRR 3.70; 95% CI 3.52–3.90) and those who had a cesarean delivery without labor (aRR 4.79; 95% CI 4.59–4.98). Conclusion With preterm birth, cesarean delivery without labor has higher rate of composite maternal morbidity than cesarean during labor or vaginal delivery.
目的:探讨分娩方式对早产(37周前)孕妇结局的影响。材料和方法这是一项基于人群的回顾性队列研究，使用2014年至2018年期间相关出生-婴儿死亡数据的美国生命统计数据集。研究人群限于在妊娠24-36周分娩的非异常单胎妇女的活产。本研究的主要解释变量是分娩途径，其分类为:(i)阴道分娩，(ii)剖宫产分娩，(iii)剖宫产分娩。主要结局是综合产妇不良结局，包括以下任何一项:入住重症监护病房、产妇输血、子宫破裂或计划外子宫切除术。结果以校正相对危险度(aRR)表示，置信区间为95%。结果在研究期间，1440510例活产符合纳入标准，总体复合产妇不良结局为14.38 / 1000。多变量调整后，与阴道分娩的妇女相比，剖宫产伴分娩的妇女出现综合孕产妇不良结局的风险更高(aRR 3.70;95% CI 3.52-3.90)和无分娩剖宫产(aRR 4.79;95% ci 4.59-4.98)。结论对于早产，无产剖宫产的产妇综合发病率高于顺产剖宫产和阴道分娩。
{"title":"Association between route of delivery and maternal adverse outcomes in pregnancies complicated by preterm birth","authors":"R. Wiley, Han-Yang Chen, S. Wagner, Megha Gupta, S. Chauhan","doi":"10.1080/14767058.2022.2050897","DOIUrl":"https://doi.org/10.1080/14767058.2022.2050897","url":null,"abstract":"Abstract Introduction To determine the impact of route of delivery on maternal outcomes among individuals who deliver preterm (before 37 weeks). Materials and methods This was a population-based retrospective cohort study using the U.S. vital statistics datasets on Period Linked Birth-Infant Death Data from 2014 to 2018. The study population was restricted to live births from women with non-anomalous singletons who delivered at 24–36 weeks of gestation. The main explanatory variable for this study was route of delivery, which was categorized as: (i) vaginal delivery, (ii) cesarean delivery with labor, and (iii) cesarean delivery without labor. The primary outcome was composite maternal adverse outcome, which encompassed any of the following: admission to the intensive care unit, maternal blood transfusion, uterine rupture, or unplanned hysterectomy. The results were presented as adjusted relative risk (aRR) with 95% confidence interval (CI). Results Over the study period 1,440,510 live births met the inclusion criteria, and the overall composite maternal adverse outcome was 14.38 per 1,000 live births. After multivariable adjustment, compared to women who underwent a vaginal delivery, the risk of composite maternal adverse outcome was higher in women who had a cesarean delivery with labor (aRR 3.70; 95% CI 3.52–3.90) and those who had a cesarean delivery without labor (aRR 4.79; 95% CI 4.59–4.98). Conclusion With preterm birth, cesarean delivery without labor has higher rate of composite maternal morbidity than cesarean during labor or vaginal delivery.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89272837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-09DOI: 10.1080/14767058.2022.2050361
A. Tiselko, R. Kapustin, Yuliya P. Milyutina, N. Borovik, E. Abashova, M. Yarmolinskaya
Abstract Objective To analyze glucose variability and investigate its role as a predictor for preeclampsia development in pregnant women with type 1 diabetes mellitus (T1DM) with various insulin therapy regimens. Methods A total of 200 pregnant women with T1DM were included in the study. A hundred women used continuous subcutaneous insulin infusion (CSII), and the rest of the group was administered with multiple daily insulin injections (MDI). Continuous glucose monitoring (CGM), index calculation of glucose variability (MAGE, MODD, CONGA, and CV), assessment of preeclampsia frequency and severity were conducted. Results The work results show the link between the severity rate of preeclampsia and the duration of T1DM as well as the level of HbA1c before and during pregnancy. The rate of preeclampsia in the group of women, using CSII comprises 26.8% of cases that appear less than in the group of those, administered with MDI that is 46.6% (χ 2 = 5.45; р < .05). A negative correlation is defined between pathological glucose variability and gestational age when preeclampsia occurs. A negative correlation was also revealed between MODD, CV, and the time for the detection of preeclampsia: r = −0.30, r = −0.24, respectively. The study illustrates the correlation obtained between preeclampsia and glucose variability and the value of MAGE, MODD, CV, and SD. Preeclampsia development is affected by the duration of hyperglycemic conditions in the third trimester of pregnancy. The data in the group of women using MDI marks the early development of preeclampsia on the 33.0 [32–34] week of pregnancy compared to the group of women practicing CSII on 35.5 [33–36] week of pregnancy (Z = 5.4; p < .001). The increase of risk of preeclampsia development is proved in pregnant patients with T1DM when the hyperglycemic condition lasts more than 25% of a 24-h period according to the rate of CGM and measurements of glucose variability MODD > 1.07 and CONGA > 3.39. Conclusion Comprehensive evaluation of the glycemic profile while using CGM revealed a correlation between pathological glucose variability and the frequency and severity of preeclampsia thus proving the benefits of CSII in pregnant patients with T1DM to perform glycemic targets and decrease glucose variability, which eventually led to the decrease of preeclampsia frequency in this group of women.
{"title":"Glucose variability as the risk factor of preeclampsia in pregnant patients with type 1 diabetes mellitus","authors":"A. Tiselko, R. Kapustin, Yuliya P. Milyutina, N. Borovik, E. Abashova, M. Yarmolinskaya","doi":"10.1080/14767058.2022.2050361","DOIUrl":"https://doi.org/10.1080/14767058.2022.2050361","url":null,"abstract":"Abstract Objective To analyze glucose variability and investigate its role as a predictor for preeclampsia development in pregnant women with type 1 diabetes mellitus (T1DM) with various insulin therapy regimens. Methods A total of 200 pregnant women with T1DM were included in the study. A hundred women used continuous subcutaneous insulin infusion (CSII), and the rest of the group was administered with multiple daily insulin injections (MDI). Continuous glucose monitoring (CGM), index calculation of glucose variability (MAGE, MODD, CONGA, and CV), assessment of preeclampsia frequency and severity were conducted. Results The work results show the link between the severity rate of preeclampsia and the duration of T1DM as well as the level of HbA1c before and during pregnancy. The rate of preeclampsia in the group of women, using CSII comprises 26.8% of cases that appear less than in the group of those, administered with MDI that is 46.6% (χ 2 = 5.45; р < .05). A negative correlation is defined between pathological glucose variability and gestational age when preeclampsia occurs. A negative correlation was also revealed between MODD, CV, and the time for the detection of preeclampsia: r = −0.30, r = −0.24, respectively. The study illustrates the correlation obtained between preeclampsia and glucose variability and the value of MAGE, MODD, CV, and SD. Preeclampsia development is affected by the duration of hyperglycemic conditions in the third trimester of pregnancy. The data in the group of women using MDI marks the early development of preeclampsia on the 33.0 [32–34] week of pregnancy compared to the group of women practicing CSII on 35.5 [33–36] week of pregnancy (Z = 5.4; p < .001). The increase of risk of preeclampsia development is proved in pregnant patients with T1DM when the hyperglycemic condition lasts more than 25% of a 24-h period according to the rate of CGM and measurements of glucose variability MODD > 1.07 and CONGA > 3.39. Conclusion Comprehensive evaluation of the glycemic profile while using CGM revealed a correlation between pathological glucose variability and the frequency and severity of preeclampsia thus proving the benefits of CSII in pregnant patients with T1DM to perform glycemic targets and decrease glucose variability, which eventually led to the decrease of preeclampsia frequency in this group of women.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80372436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-09DOI: 10.1080/14767058.2022.2048813
X. Yang, Yihui Liu, Hai-yin Jiang, Xian Ying
Abstract Objective Epidemiologic findings are inconsistent concerning the association between cesarean section (C-section) and celiac disease in offspring. Methods We performed a systematic literature search of PubMed and Embase databases until July 2021. A meta-analysis was performed for each outcome in which a summary odds ratio (OR) was calculated while taking heterogeneity into account. Results A total of 11 observational were identified for the literature review. We found that C-section was not associated with an increase in the risk of CD (OR = 1.03, 95% CI, 0.95–1.12; p = .501). In subgroup analyses, the association remained insignificant for both infants born after elective C-section (OR 1.05; 0.95–1.16; p = .329) and emergency C-section (OR 1.06; 1–1.13; p = .051). Conclusions Our results indicate that C-section is not associated with CD in offspring.
{"title":"Cesarean section is not associated with increased risk of celiac disease in the offspring: a meta-analysis","authors":"X. Yang, Yihui Liu, Hai-yin Jiang, Xian Ying","doi":"10.1080/14767058.2022.2048813","DOIUrl":"https://doi.org/10.1080/14767058.2022.2048813","url":null,"abstract":"Abstract Objective Epidemiologic findings are inconsistent concerning the association between cesarean section (C-section) and celiac disease in offspring. Methods We performed a systematic literature search of PubMed and Embase databases until July 2021. A meta-analysis was performed for each outcome in which a summary odds ratio (OR) was calculated while taking heterogeneity into account. Results A total of 11 observational were identified for the literature review. We found that C-section was not associated with an increase in the risk of CD (OR = 1.03, 95% CI, 0.95–1.12; p = .501). In subgroup analyses, the association remained insignificant for both infants born after elective C-section (OR 1.05; 0.95–1.16; p = .329) and emergency C-section (OR 1.06; 1–1.13; p = .051). Conclusions Our results indicate that C-section is not associated with CD in offspring.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77669696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-09DOI: 10.1080/14767058.2022.2047925
Li Xu, Yuhai Du, Yan Wu
Abstract Objective Listeriosis is a foodborne disease that occurs in immunocompromised patients. Pregnant women are a high-risk group for the disease. Listeria infection during pregnancy is uncommon in China because of dietary habits, with little clinician attention and minimal therapeutic options due to its population-specific nature.This article studies the clinical characteristics of Listeria infection in pregnant women and the improvement of treatment methods. Subjects This study collected clinical data from 16 cases of pregnant patients with laboratory-confirmed Listeria monocytogenes infections at the Women and Children's Hospital of Jiaxing University. These data were combined with 77 cases that were reported in the literature for a total of 93 cases of Listeria monocytogenes infection in pregnancy that occurred in China over a 15-year interval. Methods We collected the clinical data of 16 pregnant patients with listeriosis diagnosed in the laboratory of the Women and Children's Hospital of Jiaxing University from May 2013 to December 2020, and combined it with 77 cases of Listeria monocytogenes during pregnancy in China obtained from a literature search. We summarized the clinical features of listeriosis in pregnancy infection and investigated its treatment methods and prevention. Results Ninety-three cases of Listeria monocytogenes infection in pregnancy occurred in early, middle and late pregnancy in 31, 27, and 35 patients, respectively. The initial clinical presentation was fever in 90 patients, intermittent lower abdominal pain in 50 patients, and abnormal fetal movement and/or abnormal fetal heartbeat in 27 cases. Specimens with a positive bacterial culture included the following: 6 amniotic fluid cultures, 35 blood cultures, 37 maternal placenta and uterine secretion cultures, and 15 neonatal blood cultures. Fifty-seven cases of placental pathology, all showing of neutrophil infiltration, were 100% consistent with acute chorioamnionitis. Fifty-eight patients were initially treated with cephalosporin antibiotics, and only 24 cases were initially treated with broad-spectrum penicillins to cover the pathogenic bacteria. Drug sensitivity tests revealed resistant strains, 15 penicillin G-resistant, 14 oxacillin-resistant, and 13 ampicillin-resistant strains. After penicillin failure, vancomycin or meropenem was given. Maternal outcomes included the following: 20 cases of sepsis, 3 cases of pneumonia, 6 cases of acute pyelonephritis, 28 cases of intrauterine infection, 2 cases of multiple organ dysfunction syndromes, and 1 case of septic shock. The fetal and neonatal outcomes were as follows: 16 cases of abortion, 16 cases of intrauterine fetal death, 22 cases of death after birth, and 39 cases of cure. Conclusion In our study and reported cases, Listeria monocytogenes in pregnancy is associated with fever as the primary manifestation, a high incidence of adverse pregnancy outcomes, and a significant increase in fetal and neonatal mortal
{"title":"Neglected listeria infection in pregnancy in China: 93 cases","authors":"Li Xu, Yuhai Du, Yan Wu","doi":"10.1080/14767058.2022.2047925","DOIUrl":"https://doi.org/10.1080/14767058.2022.2047925","url":null,"abstract":"Abstract Objective Listeriosis is a foodborne disease that occurs in immunocompromised patients. Pregnant women are a high-risk group for the disease. Listeria infection during pregnancy is uncommon in China because of dietary habits, with little clinician attention and minimal therapeutic options due to its population-specific nature.This article studies the clinical characteristics of Listeria infection in pregnant women and the improvement of treatment methods. Subjects This study collected clinical data from 16 cases of pregnant patients with laboratory-confirmed Listeria monocytogenes infections at the Women and Children's Hospital of Jiaxing University. These data were combined with 77 cases that were reported in the literature for a total of 93 cases of Listeria monocytogenes infection in pregnancy that occurred in China over a 15-year interval. Methods We collected the clinical data of 16 pregnant patients with listeriosis diagnosed in the laboratory of the Women and Children's Hospital of Jiaxing University from May 2013 to December 2020, and combined it with 77 cases of Listeria monocytogenes during pregnancy in China obtained from a literature search. We summarized the clinical features of listeriosis in pregnancy infection and investigated its treatment methods and prevention. Results Ninety-three cases of Listeria monocytogenes infection in pregnancy occurred in early, middle and late pregnancy in 31, 27, and 35 patients, respectively. The initial clinical presentation was fever in 90 patients, intermittent lower abdominal pain in 50 patients, and abnormal fetal movement and/or abnormal fetal heartbeat in 27 cases. Specimens with a positive bacterial culture included the following: 6 amniotic fluid cultures, 35 blood cultures, 37 maternal placenta and uterine secretion cultures, and 15 neonatal blood cultures. Fifty-seven cases of placental pathology, all showing of neutrophil infiltration, were 100% consistent with acute chorioamnionitis. Fifty-eight patients were initially treated with cephalosporin antibiotics, and only 24 cases were initially treated with broad-spectrum penicillins to cover the pathogenic bacteria. Drug sensitivity tests revealed resistant strains, 15 penicillin G-resistant, 14 oxacillin-resistant, and 13 ampicillin-resistant strains. After penicillin failure, vancomycin or meropenem was given. Maternal outcomes included the following: 20 cases of sepsis, 3 cases of pneumonia, 6 cases of acute pyelonephritis, 28 cases of intrauterine infection, 2 cases of multiple organ dysfunction syndromes, and 1 case of septic shock. The fetal and neonatal outcomes were as follows: 16 cases of abortion, 16 cases of intrauterine fetal death, 22 cases of death after birth, and 39 cases of cure. Conclusion In our study and reported cases, Listeria monocytogenes in pregnancy is associated with fever as the primary manifestation, a high incidence of adverse pregnancy outcomes, and a significant increase in fetal and neonatal mortal","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91383235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-08DOI: 10.1080/14767058.2022.2048814
Alexander J Gould, Olivia Recabo, Phinnara Has, E. Werner, M. Clark, A. Lewkowitz
Abstract Objective As induction of labor (IOL) becomes more common, hospitals must adjust to accommodate longer length of stays on labor and delivery. An alternative to reduce the length of time spent on labor and delivery during an IOL is to perform cervical ripening on an antepartum unit. However, this may affect patient satisfaction and knowledge about the birthing process. This study aimed to evaluate whether cervical ripening conducted in an antepartum unit, rather than on a labor and delivery unit, was associated with changes in patient satisfaction with birth experience and baseline knowledge about IOL. Additionally, the study aimed to understand how patients would prefer to receive education on the IOL process. Methods This prospective observational study recruited English and Spanish-speaking patients at or after 39 weeks and 0 days gestation who were admitted for IOL. Consenting patients completed a preliminary survey containing sociodemographic and obstetric information as well as a previously validated survey on IOL knowledge on admission. Within 48 h of delivery, patients completed a follow-up survey including a validated birth satisfaction survey, the Birth Satisfaction Scale-Revised, and questions eliciting their preferred IOL education method. Data analyses compared patients who were admitted to antepartum for IOL to those admitted directly to labor and delivery. Multivariate analyses adjusted for sociodemographic and obstetric differences between the two groups. The primary outcomes were scores on the Birth Satisfaction Scale-Revised and on a test examining IOL knowledge. Secondary outcomes included preferred method of IOL education, obstetric outcomes, and neonatal outcomes. Results A total of 277 eligible patients were approached from October 2020 to March 2021. Of the 216 (78%) that consented, 159 (74%) completed the follow-up survey and were subsequently included in this analysis. Individuals admitted directly to antepartum (n = 122) more commonly self-identified as Latina, Latin American, or Hispanic (27.9% vs. 8.1%, p = .01) and were nulliparous (68.0% vs. 21.6%, p < .001) compared to participants admitted to labor and delivery for IOL (n = 37). Patients admitted to labor and delivery were more likely to undergo elective induction (29.7% vs. 9.8%, p = .006). Admission unit was not associated with differences in birth satisfaction scores or obstetric or neonatal outcomes. However, after controlling for potential confounders, patients admitted to the antepartum unit correctly answered a greater percentage of questions assessing IOL knowledge compared to patients admitted to labor and delivery (73.9% vs. 62.3%, adjusted mean difference (aMD) 12.6 [95% CI 7.2, 18.0]). Patients in both groups indicated preference for reviewing an induction checklist with a provider during prenatal care (59.1%) or using a technology-based intervention (37.1%) over attending in-person classes (3.1%) to learn more about IOL. Conclusion Unit of admi
摘要目的随着人工引产(IOL)越来越普遍，医院必须调整以适应更长的产程和分娩时间。另一种减少人工晶状体产程和分娩时间的方法是在产前进行宫颈成熟。然而，这可能会影响患者的满意度和对分娩过程的了解。本研究旨在评估在产前病房而非产房进行的宫颈成熟是否与患者对分娩经验的满意度和对人工晶状体的基线知识的变化有关。此外，该研究旨在了解患者如何接受有关人工晶状体过程的教育。方法本前瞻性观察研究招募了妊娠39周0天或之后接受人工晶状体手术的英语和西班牙语患者。同意的患者完成了一项初步调查，其中包括社会人口统计学和产科信息，以及先前确认的关于入院时人工晶体知识的调查。在分娩48小时内，患者完成随访调查，包括有效的分娩满意度调查，分娩满意度量表-修订，并询问他们首选的人工晶状体教育方法。数据分析比较了产前因人工晶状体入院的患者和直接因分娩入院的患者。多变量分析调整了两组之间的社会人口统计学和产科差异。主要结果是出生满意度量表-修订和检查人工晶状体知识的测试得分。次要结局包括首选的人工晶状体教育方法、产科结局和新生儿结局。结果从2020年10月至2021年3月，共接触了277例符合条件的患者。在同意的216人(78%)中，159人(74%)完成了随访调查，随后被纳入本分析。直接入院的产前患者(n = 122)比因人工晶体而入院的分娩患者(n = 37)更普遍地认为自己是拉丁裔、拉丁美洲人或西班牙裔(27.9%对8.1%，p = 0.01)和未产(68.0%对21.6%，p < 0.001)。入院分娩的患者更有可能进行择期引产(29.7% vs. 9.8%， p = 0.006)。入院单位与分娩满意度评分或产科或新生儿结局的差异无关。然而，在控制了潜在的混杂因素后，与分娩住院的患者相比，入住产前病房的患者正确回答评估IOL知识的问题的百分比更高(73.9%对62.3%，调整平均差(aMD) 12.6 [95% CI 7.2, 18.0])。两组患者在产前护理期间(59.1%)或使用基于技术的干预(37.1%)比参加面对面的课程(3.1%)了解更多关于人工晶状体的知识更倾向于与提供者一起审查诱导清单。结论人工晶状体的住院单位与分娩满意度无关，但与患者对人工晶状体的了解程度有关。这表明，IOL可以在不改变分娩经验的情况下，在较不急症的单位开始，并可能增加患者的知识。此外，人工晶状体检查表或基于技术的教育可能有助于进一步提高患者对人工晶状体的认识。
{"title":"Association of admission unit and birth satisfaction during induction of labor","authors":"Alexander J Gould, Olivia Recabo, Phinnara Has, E. Werner, M. Clark, A. Lewkowitz","doi":"10.1080/14767058.2022.2048814","DOIUrl":"https://doi.org/10.1080/14767058.2022.2048814","url":null,"abstract":"Abstract Objective As induction of labor (IOL) becomes more common, hospitals must adjust to accommodate longer length of stays on labor and delivery. An alternative to reduce the length of time spent on labor and delivery during an IOL is to perform cervical ripening on an antepartum unit. However, this may affect patient satisfaction and knowledge about the birthing process. This study aimed to evaluate whether cervical ripening conducted in an antepartum unit, rather than on a labor and delivery unit, was associated with changes in patient satisfaction with birth experience and baseline knowledge about IOL. Additionally, the study aimed to understand how patients would prefer to receive education on the IOL process. Methods This prospective observational study recruited English and Spanish-speaking patients at or after 39 weeks and 0 days gestation who were admitted for IOL. Consenting patients completed a preliminary survey containing sociodemographic and obstetric information as well as a previously validated survey on IOL knowledge on admission. Within 48 h of delivery, patients completed a follow-up survey including a validated birth satisfaction survey, the Birth Satisfaction Scale-Revised, and questions eliciting their preferred IOL education method. Data analyses compared patients who were admitted to antepartum for IOL to those admitted directly to labor and delivery. Multivariate analyses adjusted for sociodemographic and obstetric differences between the two groups. The primary outcomes were scores on the Birth Satisfaction Scale-Revised and on a test examining IOL knowledge. Secondary outcomes included preferred method of IOL education, obstetric outcomes, and neonatal outcomes. Results A total of 277 eligible patients were approached from October 2020 to March 2021. Of the 216 (78%) that consented, 159 (74%) completed the follow-up survey and were subsequently included in this analysis. Individuals admitted directly to antepartum (n = 122) more commonly self-identified as Latina, Latin American, or Hispanic (27.9% vs. 8.1%, p = .01) and were nulliparous (68.0% vs. 21.6%, p < .001) compared to participants admitted to labor and delivery for IOL (n = 37). Patients admitted to labor and delivery were more likely to undergo elective induction (29.7% vs. 9.8%, p = .006). Admission unit was not associated with differences in birth satisfaction scores or obstetric or neonatal outcomes. However, after controlling for potential confounders, patients admitted to the antepartum unit correctly answered a greater percentage of questions assessing IOL knowledge compared to patients admitted to labor and delivery (73.9% vs. 62.3%, adjusted mean difference (aMD) 12.6 [95% CI 7.2, 18.0]). Patients in both groups indicated preference for reviewing an induction checklist with a provider during prenatal care (59.1%) or using a technology-based intervention (37.1%) over attending in-person classes (3.1%) to learn more about IOL. Conclusion Unit of admi","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84836218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-06DOI: 10.1080/14767058.2022.2047927
A. Malvasi, A. Vimercati
In the last 40 years, intrapartum ultrasound (IU) has been a technique often used in the delivery ward. Many studies are reported in literature about it. According to literature, the IU improves especially the diagnosis of fetal head position (FHP) during the labor, in comparison with traditional digital vaginal examination (DVE). ISUOG practice guidelines highlighted high levels of evidence and grades of recommendation, in particular for the sonographic confirmation of FHP in the pelvis before OVD [1]. IU is currently used in the delivery room for FHP labor diagnosis with VE [2]. The caput succedaneum in labor limits the DVE of FHP diagnosis because reduces the digital examinations of sutures and fontanels. Some authors demonstrate that angle of progression (AOP), head-perineal distance (HPD), and head-symphysis distance (HSD) are important to determine fetal head station during labor. Despite the literature reports many studies on the issue, just a few studies about the IU use in delivery ward are referred to midwives. The role of midwives in delivery ward is various during the labor and delivery in different countries in the world because there are different legislative rules. Although these institutional differences, literature confirm the importance of IU: therefore it is time for midwives to utilize IU. The study wants to establish the role of midwives in valuating all these parameters (AOP, HSD, and HPD), compared to VDE fetal head progression diagnosis [3] while other studies demonstrate that ultrasound measurement of the AOP reliability is similar in experienced operators and midwives [4]. While some authors report that midwives were concerned about the fact that the use of IU is an excessive medicalization of the birth, pregnant women found valuable the non-intrusive nature and accuracy of ultrasound [5]. Another study demonstrates the importance of ultrasound simulation-based training, as an adjunct to ultrasound clinical training, improving obstetrical ultrasound skills in midwives [6]. Another trial analyzes the learning curve of IU in a midwife student for the determination of FHP in labor, comparing the results with DVE. Transabdominal sonography gives an easier learning and a higher accuracy in the determination of FHP in labor, compared to digital examination [7]. The IU plays an important role in the delivery ward also for the midwives, but the guidelines do not mention who they are referred to. However, in some cases, midwives prefer the traditional DVE respect to IU, but reproducibility of IU in non-experienced operators is good [8]. In literature the use of IU by midwives has been reported as a useful experience to improve the diagnosis of FHP and its progression in labor. However, the fetal head progression evaluation requires a longer learning curve. In our experience and in literature, the IU improves the FHP diagnosis in the birth canal, compared to DVE and this learning curve is simple and short. Other authors determine
{"title":"Is it time for midwives to do intrapartum ultrasound in the delivery ward?","authors":"A. Malvasi, A. Vimercati","doi":"10.1080/14767058.2022.2047927","DOIUrl":"https://doi.org/10.1080/14767058.2022.2047927","url":null,"abstract":"In the last 40 years, intrapartum ultrasound (IU) has been a technique often used in the delivery ward. Many studies are reported in literature about it. According to literature, the IU improves especially the diagnosis of fetal head position (FHP) during the labor, in comparison with traditional digital vaginal examination (DVE). ISUOG practice guidelines highlighted high levels of evidence and grades of recommendation, in particular for the sonographic confirmation of FHP in the pelvis before OVD [1]. IU is currently used in the delivery room for FHP labor diagnosis with VE [2]. The caput succedaneum in labor limits the DVE of FHP diagnosis because reduces the digital examinations of sutures and fontanels. Some authors demonstrate that angle of progression (AOP), head-perineal distance (HPD), and head-symphysis distance (HSD) are important to determine fetal head station during labor. Despite the literature reports many studies on the issue, just a few studies about the IU use in delivery ward are referred to midwives. The role of midwives in delivery ward is various during the labor and delivery in different countries in the world because there are different legislative rules. Although these institutional differences, literature confirm the importance of IU: therefore it is time for midwives to utilize IU. The study wants to establish the role of midwives in valuating all these parameters (AOP, HSD, and HPD), compared to VDE fetal head progression diagnosis [3] while other studies demonstrate that ultrasound measurement of the AOP reliability is similar in experienced operators and midwives [4]. While some authors report that midwives were concerned about the fact that the use of IU is an excessive medicalization of the birth, pregnant women found valuable the non-intrusive nature and accuracy of ultrasound [5]. Another study demonstrates the importance of ultrasound simulation-based training, as an adjunct to ultrasound clinical training, improving obstetrical ultrasound skills in midwives [6]. Another trial analyzes the learning curve of IU in a midwife student for the determination of FHP in labor, comparing the results with DVE. Transabdominal sonography gives an easier learning and a higher accuracy in the determination of FHP in labor, compared to digital examination [7]. The IU plays an important role in the delivery ward also for the midwives, but the guidelines do not mention who they are referred to. However, in some cases, midwives prefer the traditional DVE respect to IU, but reproducibility of IU in non-experienced operators is good [8]. In literature the use of IU by midwives has been reported as a useful experience to improve the diagnosis of FHP and its progression in labor. However, the fetal head progression evaluation requires a longer learning curve. In our experience and in literature, the IU improves the FHP diagnosis in the birth canal, compared to DVE and this learning curve is simple and short. Other authors determine ","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78316870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-06DOI: 10.1080/14767058.2022.2047924
R. Mclaren, Maureen Clark, S. Narayanamoorthy, S. Rastogi
Abstract Objective The objective of this study was to evaluate for antenatal risk factors for neonatal seizures among late preterm births. Study design This was a case control study which included late preterm births without anomaly from the United States Natality database. Cases were infants with neonatal seizures, while the controls consisted of infants without neonatal seizures. Maternal and pregnancy characteristics were compared. Multivariable logistic regression was performed to investigate risk factors for neonatal seizures. Results Of the 943,580 late preterm births, 512 (0.05%) developed neonatal seizures. Significant risk factors associated with neonatal seizures among late preterm births included number of prenatal visits (adjusted odds ratio [aOR] 0.94, 95% CI [0.92–0.96]), smoking history (aOR 1.78, 95% CI [1.41–2.25]), chorioamnionitis (aOR 4.37, 95% CI [2.65–7.21]), non-Hispanic White race (aOR 1.41, 95% CI [1.13–1.76]), and cesarean birth (aOR 2.31, 95% CI [1.91–2.80]). Conclusion Number of prenatal visits, history of smoking, chorioamnionitis, non-Hispanic white race, and cesarean birth are risk factors for neonatal seizures at late preterm gestation.
{"title":"Antenatal factors for neonatal seizures among late preterm births**","authors":"R. Mclaren, Maureen Clark, S. Narayanamoorthy, S. Rastogi","doi":"10.1080/14767058.2022.2047924","DOIUrl":"https://doi.org/10.1080/14767058.2022.2047924","url":null,"abstract":"Abstract Objective The objective of this study was to evaluate for antenatal risk factors for neonatal seizures among late preterm births. Study design This was a case control study which included late preterm births without anomaly from the United States Natality database. Cases were infants with neonatal seizures, while the controls consisted of infants without neonatal seizures. Maternal and pregnancy characteristics were compared. Multivariable logistic regression was performed to investigate risk factors for neonatal seizures. Results Of the 943,580 late preterm births, 512 (0.05%) developed neonatal seizures. Significant risk factors associated with neonatal seizures among late preterm births included number of prenatal visits (adjusted odds ratio [aOR] 0.94, 95% CI [0.92–0.96]), smoking history (aOR 1.78, 95% CI [1.41–2.25]), chorioamnionitis (aOR 4.37, 95% CI [2.65–7.21]), non-Hispanic White race (aOR 1.41, 95% CI [1.13–1.76]), and cesarean birth (aOR 2.31, 95% CI [1.91–2.80]). Conclusion Number of prenatal visits, history of smoking, chorioamnionitis, non-Hispanic white race, and cesarean birth are risk factors for neonatal seizures at late preterm gestation.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74747173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-06DOI: 10.1080/14767058.2022.2047923
Chang Liu, Huihui Chen, Junzhao Zhao, Yufeng Chen, Boyun Xu
Abstract Objective To investigate whether high estrogen (E2) levels caused by controlled ovarian hyperstimulation affect the birth defect rate in singleton assisted reproductive technology (ART) birth after conceived by fresh embryo transfer and frozen embryo transfer (FET). Methods This was a retrospective cohort study. A total of 581 women with singletons, as well as those who have become pregnant and have had an unwanted abortion under high E2 levels on trigger day were divided into three groups. Group A received FET and the E2 levels on trigger day were higher than 5000 pg/ml. Group B received fresh embryo transfer and the E2 levels were between 3000 and 5000 pg/ml. Group C received FET and the E2 levels were between 3000 and 5000 pg/ml. Results There were no significant differences in birth weight, delivery mode, preterm birth rate, and fetal sex between the three groups (p > .05). Birth defect rate in Group B was higher than that in Group A and C, and the rate between Group B and C had significant differences (p < .05). After adjusting for maternal age, BMI, and type of infertility, only a FET cycle is significantly associated with decreased birth defect rate. Conclusion Fresh embryo transfer under supraphysiological level of estrogen exposure may increase the birth defect rate of ART singletons. Even after prenatal screening and diagnosis, a part of birth defect could not be detected during pregnancy. When the estrogen levels on trigger day were no lower than 3000 pg/ml, FET should be advocated to reduce the occurrence of such risk.
{"title":"Comparative study on risk of birth defects in singleton ART birth under high levels of estrogen after fresh embryo transfer and frozen embryo transfer","authors":"Chang Liu, Huihui Chen, Junzhao Zhao, Yufeng Chen, Boyun Xu","doi":"10.1080/14767058.2022.2047923","DOIUrl":"https://doi.org/10.1080/14767058.2022.2047923","url":null,"abstract":"Abstract Objective To investigate whether high estrogen (E2) levels caused by controlled ovarian hyperstimulation affect the birth defect rate in singleton assisted reproductive technology (ART) birth after conceived by fresh embryo transfer and frozen embryo transfer (FET). Methods This was a retrospective cohort study. A total of 581 women with singletons, as well as those who have become pregnant and have had an unwanted abortion under high E2 levels on trigger day were divided into three groups. Group A received FET and the E2 levels on trigger day were higher than 5000 pg/ml. Group B received fresh embryo transfer and the E2 levels were between 3000 and 5000 pg/ml. Group C received FET and the E2 levels were between 3000 and 5000 pg/ml. Results There were no significant differences in birth weight, delivery mode, preterm birth rate, and fetal sex between the three groups (p > .05). Birth defect rate in Group B was higher than that in Group A and C, and the rate between Group B and C had significant differences (p < .05). After adjusting for maternal age, BMI, and type of infertility, only a FET cycle is significantly associated with decreased birth defect rate. Conclusion Fresh embryo transfer under supraphysiological level of estrogen exposure may increase the birth defect rate of ART singletons. Even after prenatal screening and diagnosis, a part of birth defect could not be detected during pregnancy. When the estrogen levels on trigger day were no lower than 3000 pg/ml, FET should be advocated to reduce the occurrence of such risk.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84078156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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