Zeitschrift fur Geburtshilfe und Neonatologie最新文献

This study aimed to systematically characterize the features and drug distribution of neonatal adverse drug reactions using data from the FAERS, with a focus on exposure-specific patterns and stratified analyses by sex and clinical outcomes.Reports submitted to FAERS from the first quarter of 2004 to the fourth quarter of 2024 were utilized. Patients experienced the ADR at an age of no more than 28 days. Four quantitative disproportionality analysis methods, including ROR, PRR, BCPNN, and MGPS, were used to detect signals of adverse drug events.A total of 15,456 neonatal cases exposed to the target drugs were included, yielding 60,611 adverse event reports, 95.45% of which were classified as serious. The median time to onset of ADRs was 264 days for intrauterine drug exposure, compared to 1-3 days for extrauterine exposure. The most affected SOCs were injury and procedural complications (19.53%), congenital disorders (15.96%), and pregnancy/perinatal conditions (8.65%). Transplacental exposure accounted for the highest proportion (52.47%), followed by intravenous (9.34%), oral (6.77%), breastfeeding (1.80%), intramuscular (1.48%), and inhalation (1.29%). The top maternal exposure drugs included venlafaxine, sertraline, quetiapine, lamotrigine, and levetiracetam. For intravenous use, levetiracetam, zidovudine, indomethacin, ibuprofen, and vancomycin were most common. Female neonates had higher risks of microcephaly, ventricular septal defect, and growth restriction, while male neonates were more prone to hypospadias, cryptorchidism, and agitation. Serious AEs were mainly linked to maternal drug exposure during pregnancy.These results showed that the use of antidepressants, antiepileptics, and antivirals during pregnancy represents a significant risk factor for neonatal adverse reactions, particularly congenital malformations. Consequently, it is imperative to implement precise prevention strategies tailored to specific exposure stages and to advocate for the establishment of an international pharmacovigilance network for neonates.

This study aims to contribute to investigating the potential impact of the SARS-CoV-2 pandemic and lockdown measures on perinatal care.A statistical analysis of diagnoses (ICD-10) of 21,393 newborns born between 2019 and 2021 from three Level 1 perinatal centers was conducted. During the study period, a statistical decrease in full-term births and very early preterm births (VLBW), coupled with an increase in infants born between 28 and 37.0 weeks of gestation, was observed in 2020 and 2021. Likewise, a significantly higher number of infants were born after 42.0 weeks of gestation. Neonatal morbidity, characterized by increased rates of asphyxiated newborns and umbilical artery pH values<7.1 as well as infant damage due to maternal pregnancy complications increased significantly. Furthermore, a statistically significant increase in the number of IUGR/SGA births was observed.While the reduction in the number of very premature infants observed in many places can be interpreted as a positive result of the lockdown measures, our data demonstrate an increase in pathological perinatal parameters. An increase in perinatally depressed newborns and a significantly increased postnatal morbidity of the children can possibly be indicators for an inadequate prenatal and/or intranatal care. Implications for similar, anticipated situations should be drawn.

Fetal intra-abdominal cystic lesions are relatively common. The morphological assessment of the cyst, determination of the fetal sex, and evaluation of its relationship with adjacent structures can guide the differential diagnosis. The aims of this study were to evaluate the diagnostic accuracy of ultrasound in detecting fetal intra-abdominal cysts and to develop a predictive model for spontaneous regression or persistence.We retrospectively reviewed 61 fetuses with intra-abdominal cystic lesions between October 2020 and November 2024. Maternal-fetal characteristics, ultrasonographic features of cystic lesions, and postnatal outcomes were collected. A total of 61 fetuses with intra-abdominal cysts were analyzed. Spontaneous regression occurred in 15 cases (24.6%) during the prenatal period, while 46 (75.4%) persisted postnatally. Mean cyst size was 24.1 mm (+/- 11.2) in the regression group and 40 mm (- 16.5) in the persistent group. Cysts that regressed were diagnosed at a median of 25 weeks, whereas persistent cases were diagnosed at 30 weeks. In univariate logistic regression analyses, gestational age at diagnosis and initial cyst diameter were identified as significant predictors of spontaneous prenatal regression (p=0.006, 0.003, respectively). Prenatal US is an effective tool to accurately diagnose fetal intra-abdominal cysts. The combination of a lower gestational age at diagnosis and a smaller initial cyst diameter is associated with a higher likelihood of spontaneous prenatal regression. An evaluation based on gestational age at diagnosis and ultrasound characteristics with a primary focus on the largest diameter of the cystic lesions may help to guide parental counseling.

We report a rare case of peripartum pontine stroke in a 34-year-old primipara initially attributed to an episode of severe transient hypotension caused by the subdural spread of local anesthetic during epidural analgesia for delivery. The rapid intrapartum intervention by the obstetric team because of spinal shock clinical pictures and fetal bradycardia using high vacuum extraction prevented the risk of fetal ischemic-hypoxic damage. A healthy child was born with an Apgar score of 8/10, 3790 grams /53 cm, with a normal neonatal course. On the third postpartum day, because of persistent neurologic symptoms (headache, urinary, and fecal incontinence), brain magnetic resonance imaging indicated a pontine ischemic lesion. The symptoms gradually regressed with acetylsalicylic acid and physical therapy, and on the 17th day, the patient was discharged home. After puerperium and recovery, thrombophilia were detected. The case indicates the importance of rapid intervention by the obstetric team in case of sudden peripartum maternal and fetal complications.

Subpartum fetal monitoring is a debated topic in obstetrics. Studies have shown that CTG monitoring can lead to not always necessary interventions such as C-sections and vaginal-operative deliveries. Therefore, the 2021 AWMF S3 guideline "Vaginal Birth at Term" recommends structured intermittent auscultation instead of CTG monitoring in low-risk pregnancies for the first time.In a retrospective cross-sectional study, all German maternity clinics (n=616) were asked using an online questionnaire whether they use intermittent auscultation for low-risk pregnancies as well as reasons for and against it. The response rate was 16% (n=96). RESULTS:  22% (n=21) of clinics reported using intermittent auscultation always or sometimes. A significant correlation was found if changes had occurred and the application of intermittent auscultation (X2=12.95, df=2, p=0.001). Other factors such as the availability of one-to-one care (>95%), midwife-led delivery rooms, and differentiation between high- and low-risk pregnancies had no significant influence on the use of intermittent auscultation.The guideline has not led to the use of intermittent auscultation for monitoring in low-risk pregnancies. Clear low-risk definition, one-to-one care, qualified staff and updated studies on intermittent auscultation vs. CTG are needed.

Search for laboratory markers that can predict adverse fetal pregnancy outcomes in patients with cholestasis of pregnancy.This was an observational case-control study conducted from December 2016 to December 2019. Pregnancy outcome data and maternal antenatal laboratory markers were collected in the intrahepatic cholestasis of pregnancy (ICP) (N=117) and normal pregnancy controls (N=100), laboratory indictors including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γ-GT), total bilirubin (TB), direct bilirubin (DB), total bile acids (TBA), cholyglycine (CG), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), etc. The ICP group was divided into an adverse outcome and normal outcome group according to fetal pregnancy outcomes. Descriptive statistics and regression analysis were performed on the prenatal indicators of the two groups to evaluate the association between prenatal laboratory indicators in ICP patients and adverse neonatal outcomes.ALT, TBA, CG, PT, APTT, hemoglobin, red blood cell distribution width, hematocrit, mean platelet volume, and platelet distribution width in ICP patients differed significantly from those in the normal control group, which led to premature birth, amniotic fluid pollution, low birth weight and other adverse outcomes. In terms of fetal outcomes, TBA [(39.16±35.70) μmol/L vs. (24.17±18.76) μmol/L], CG [(22.17±19.42) μg/mL vs. ( 13.91±13.18) μg/mL], DB [(22.17±19.42) μg/mL vs. (13.91±13.18) μg/mL] were higher than those in the normal outcome group, while fibrinogen was lower [(4.16±1.30) g/L vs. (4.78±0.91) g/L]; the difference was statistically significant. Multivariate logistic regression analysis showed that CG(OR=1.06, 95%CI:1.01~1.12, P=0.02, FIB(OR=0.54, 95%CI:0.31~0.92, P=0.02) was independently associated with the occurrence ofadverse fetal outcomes in ICP.Prenatal CG and FIB levels were independently associated with adverse fetal outcomes in patients with ICP.

Considering that the incisions made during cesarean delivery may damage subcutaneous tissue and fascia, and pelvic floor muscle contractions are effective in femoral head movements, it is hypothesized that the mode of delivery may have an impact on balance and kinesiophobia. This study aimed to investigate the effect of cesarean delivery on balance, kinesiophobia, and body awareness.A total of 70 women participated in the study. Demographic and obstetric data of the participants were recorded. Thoracolumbar fascia was assessed using a goniometric platform, trunk flexibility with the Modified Schober test, static balance with the Flamingo Balance test, and dynamic balance with the Y Balance Test. The Tampa Scale of Kinesiophobia was used to evaluate movement fear, and the Body Awareness Questionnaire was used to assess body awareness.No significant differences were found between cesarean and vaginal deliveries in terms of thoracolumbar fascia assessment, static balance, or dynamic balance measurements (p>0.05). In women who delivered vaginally, dynamic balance was observed to decrease with advancing age (p<0.05). Moreover, in vaginal deliveries, a shorter time since last birth was associated with improved anterior dynamic balance, while an increased number of deliveries was linked to impaired anterior dynamic balance (p<0.05). Regardless of the mode of delivery, all women experienced a decline in static balance and reduced anterior reach with increasing age. Additionally, an increased number of deliveries was associated with impaired static balance, and shorter postpartum duration was linked to decreased dynamic balance (p<0.05). No significant difference was found between vaginal and cesarean deliveries in terms of kinesiophobia (p>0.05). However, in women who delivered vaginally, body awareness decreased with age (p<0.05). In conclusion, the study found that cesarean scars had no adverse effects on balance, kinesiophobia, or body awareness. Nevertheless, further research focusing on balance is recommended.