Zeitschrift fur Geburtshilfe und Neonatologie最新文献

Agouti-related peptide (AgRP) is an orexigenic neuropeptide secreted by the hypothalamus that plays a key role in stimulating appetite and increasing food intake. This study aimed to evaluate circulating AgRP levels in pregnant women diagnosed with hyperemesis gravidarum (HG).This cross-sectional case-control study compared serum AgRP levels between two groups of pregnant women. The first group included 44 women aged 18-40 years who were hospitalized during the first trimester due to HG, while the control group consisted of 44 healthy pregnant women without HG, matched for age, body mass index (BMI), and gestational age.Both groups were similar in terms of age, BMI, gravida, parity, and gestational week at which blood samples were taken (p > 0.05 for all). Median serum AgRP level was 211.67 ng/L in the HG group and 182.14 ng/L in the control group (p=0.073). There was a significant positive correlation between AgRP level and maternal BMI as well as urinary ketone positivity (r=0.326, r=0.334, r=0.536, r=0.335; p<0.05, respectively).In this study, serum AgRP levels did not differ significantly between the HG and control groups. Although these findings should be interpreted with caution due to the limited sample size, they suggest that AgRP may not play a central role in the pathogenesis of HG. Further prospective studies with larger cohorts are warranted to better elucidate this potential association.

The emotional bond between parents and their fetus is critical for parenting during pregnancy and after birth. Parental knowledge and experiences can influence this bond. Online breastfeeding education may provide informational and psychological support that could contribute to parental bonding.To evaluate the effect of online breastfeeding education for primiparous women and their partners on prenatal maternal bonding and paternal antenatal bonding.This randomized controlled study was conducted online via Google Meet between January 1 and April 1, 2025. The sample included 101 primiparous pregnant women (experimental: 52; control: 49) and their partners. Participants were recruited using snowball sampling and completed the Personal Information Form, Prenatal Attachment Scale, and Paternal Antenatal Attachment Scale before and after the intervention.Post-intervention, prenatal attachment scores were higher in the experimental group than the control group (p<0.05), but within-group pre-post changes were not significant. Differences were observed in curiosity, excitement, and hope subdimensions (p<0.05). Fathers showed slight increases in antenatal attachment scores, with no significant changes within or between groups (p>0.05).Online breastfeeding education did not significantly improve prenatal attachment within the intervention group or paternal antenatal bonding. Post-test maternal attachment was higher in the experimental group, but the overall effect on parent-fetus bonding was limited. Targeted, theory-based educational interventions are needed to strengthen prenatal bonding, especially for fathers. Future studies with larger samples and longer follow-up are recommended to evaluate sustained effects.

This study aimed to determine the proportion of pathological results in the early 75-g OGTT among women with a history of late miscarriage or preterm birth after prophylactic cerclage. The effects of early-diagnosed gestational diabetes on pregnancy outcome, neonatal parameters, preconceptional BMI, and mode of delivery were also analyzed. In 140 pregnant women, a primary cerclage and a 75-g OGTT were performed between 16 and 21 weeks of gestation. Analysis was based on OGTT results (physiological vs. pathological). The primary endpoint was pregnancy outcome; secondary endpoints included neonatal parameters, preconceptional BMI, and mode of delivery. Eighty-nine women (63%) showed a pathological OGTT result substantially higher than in the general population. This was not significantly associated with late miscarriage or preterm birth (OR 2.18; p=0.13) but showed a trend toward increased risk. Neonatal outcomes were similar between groups. A preconceptional BMI>35 kg/m² was significantly related to a pathological OGTT (p=0.04). Women with a pathological OGTT had more cesarean deliveries (55.8% vs. 35.3%; p=0.02). In this high-risk cohort with a history of late miscarriage or preterm birth, 63% had a pathological early 75-g OGTT, indicating increased susceptibility to glucose metabolism disorders. Early glucose screening and individualized metabolic management are essential to improve pregnancy and perinatal outcomes.

To create a new scoring system for predicting preterm birth by incorporating second-trimester sonographic measurements, including cervical length, uterocervical angle, and lower uterine segment myometrial thickness, along with cervical dilation.This prospective study included 252 pregnant women who were admitted to a university-affiliated research hospital between 16 and 24 gestational weeks. Participants were followed and categorized into two groups: preterm birth group (n=40) and term birth group (n=212). Cervical length, uterocervical angle, and myometrial thickness were measured and the predictive role of these parameters for preterm birth was evaluated. A new scoring system was developed based on the identified cut-off values.A cervical length≤36.3 mm predicted preterm birth with 85% sensitivity and 73.1% specificity (p<0.001, AUC=0.831), while a uterocervical angle>102.1 degrees predicted it with 92.5% sensitivity and 54.3% specificity (p<0.001, AUC=0.767). Additionally, a myometrial thickness≤5.7 mm predicted preterm birth with 90% sensitivity and 37.4% specificity (p=0.002, AUC=0.634). A new scoring system score≥2 predicted preterm birth with 75% sensitivity and 89.6% specificity (p<0.001, AUC=0.871). In the validation group, a total score≥2 predicted preterm birth with 70.6% sensitivity and 90.4% specificity (p<0.001, AUC=0.826).This scoring system, incorporating cervical length, uterocervical angle, myometrial thickness, and cervical dilatation, offers a potential alternative to digital cervical examination, a subjective method for predicting preterm birth.

The study aims to determine whether the time of day influences these parameters compared to normotensive pregnancies.This prospective, single-center study included 60 pregnant women diagnosed with hypertensive disorders (gestational hypertension, chronic hypertension, or preeclampsia) and 60 normotensive controls, all between 30 and 37 weeks of gestation. Umbilical artery Doppler measurements were performed twice daily, between 08:00-10:00 and 20:00-22:00, by the same experienced operator. Measurements were taken at both the fetal and placental ends of the umbilical artery, recording systolic/diastolic ratios, pulsatility index, and resistance index values.In Doppler measurements, the morning and evening evaluations revealed that S/D, PI, and RI values near the fetus and placenta were significantly higher in the study group compared to the control group. Notably, in the preeclampsia subgroup, the morning S/D values (3.3±1.1 vs. 2.3±0.5, p<0.001) were found to reach the highest levels. Regarding neonatal outcomes, the study group demonstrated significantly higher rates of cesarean delivery (71.7% vs. 33.3%, p<0.001) and neonatal intensive care unit admission (36.7% vs. 6.7%, p<0.001), while birth weight was significantly lower (2724.9±759.1 g vs. 3241.1±422.7 g, p<0.001).This study demonstrates that hypertensive disorders during pregnancy have a significant adverse effect on umbilical artery Doppler measurements and neonatal outcomes. These findings underscore the importance of early diagnosis and meticulous monitoring.

Thanks to enormous medical advances, the survival rate of seriously ill newborns and premature babies improved significantly at the end of the last century. However, stagnation has been observed in recent decades. Neonatal palliative care therefore remains an important part of care for seriously ill preterm and newborn infants in neonatology. Parents who experience the loss of a newborn are at an increased risk of developing mental health disorders. As a result, bereaved families face unique emotional and psychological challenges. To date, Germany has not implemented a comprehensive, structured, hospital-initiated, outreach-based aftercare service for parents experiencing early bereavement. This contrasts with the support services provided to parents of ill or premature newborns during and after hospital care. In order to address this gap in care and bridge the gap between inpatient support and outpatient follow-up, the Support Team for Early Bereaved Parents (SAVE) was established at our institution in 2019. Here, we report on our experience of running this new program in its first years.

Omodysplasia type II (autosomal dominant) is a very rare skeletal dysplasia with facial dysmorphism and urogenital abnormalities. Causal are alterations in the FZD2 gene. We describe a prenatally detected case with shortened upper extremities, cleft lip and palate and suspected genital hypoplasia. The de novo mutation in the FZD2 gene in the affected fetus, which has not been described yet, was found in the literature and is most likely the cause of the symptoms. To our knowledge, it is the first publication of the de novo mutation in the FZD2 gene.

While international studies highlight the positive impact on birth outcomes associated with caseload midwives, no comprehensive assessment of the Swiss situation has been performed.This study aimed to assess birth outcomes in Swiss hospitals and in low-risk pregnancies in relation to birth care provided by hospital-based staff midwives compared to attending caseload midwives.For this retrospective cohort study, we used data of n=55,518 low-risk births collected between 2018 and 2021 through voluntary data collection in Swiss hospitals. We performed a descriptive analysis as well as non-parametric correlative and logistic regression analysis using SPSS.Women with caseload midwives were more often multiparous than women with hospital-based staff midwives. The adjusted regression analysis showed that care by attending caseload midwives increased the ratio of spontaneous delivery compared to hospital-based staff midwives (83.1% vs. 70.2%, aOR 1.97, p<0.001). The C-section rate was lower in women in the caseload care system (9.2% vs. 16.6%, aOR 0.55, p<0.001) as well as the rate of vacuum extractions (7.6% vs. 13.0%, aOR 0.63, p<0.001). Care by a caseload midwife was associated with fewer interventions during labour and birth in general. Caseload midwives commonly improve birth outcomes compared to hospital-based staff midwives with respect to mitigating presumably unnecessary interventions.

The objective of this study was to assess the link between postpartum blood loss and placental elastography in multiparous pregnancies.In this prospective study, multiparous women who delivered at term between 2020 and 2024 were included. During the obstetric ultrasonography procedure, placental elastography was evaluated through the utilization of the shear wave elastography (SWE) technique. Elastographic measurements were performed at three distinct sites within the anteriorly positioned placentas via the abdominal route. The mean value of these three sites was subsequently calculated to derive the Z score. The difference (Δ) between prepartum and postpartum hemoglobin values was calculated, and cases with ΔHB below 2 g/dl were considered as the control group, and those with ΔHB above 2 g/dl were considered as the study group. Z scores were then compared between the two groups.A total of 109 cases was included in the study, 88 (80.7%) of which were assigned to the control group, and 21 (19.3%) to the study group. Maternal age (30.4±4.82 vs. 31.7±6.68) and BMI (28.7±3.96 vs. 28.1±4.77 kg/m2) were similar in both groups (p>0.05). A positive relationship was identified between ΔHB levels and Z score (r=0.521, p<0.001). The optimal cut-off value for the Z score was determined to be 5.64 kPa, exhibiting 76.2% sensitivity and 52.3% specificity (AUC: 0.709, p=0.003, 95% CI 0.586-0.833).The elastographic evaluation of the prepartum placenta has the potential to serve as a valuable tool in estimating postpartum hemoglobin decline.