Zeitschrift fur Geburtshilfe und Neonatologie最新文献

Adverse perinatal outcomes have been linked to alterations in vitamin D-binding protein (VDBP) levels. We assessed the predictive value of serum and cervicovaginal fluid VDBP for preterm birth, as well as to measure VDBP in threatened preterm labor (TPL) and preterm premature rupture of membranes (PPROM).A total of 138 pregnant women were divided into three groups in this prospective case-control study: TPL(n=59), PPROM (n=43) and control (n=36). Also, all patients were divided into two groups according to whether the latency period was shorter (n=48) or longer than 48 hours (n=90). The VDBP levels were measured using an enzyme-linked immunosorbent assay kit and compared between groups.Cervicovaginal fluid and serum VDBP levels were lower in the TPL and PPROM groups than controls. Cervicovaginal fluid VDBP<0.63ng/ml predicted preterm birth with 81.58% sensitivity and 53.23% specificity (AUC=0.713, p<0.001). Serum VDBP≤ 0.26ng/ml predicted preterm birth with 61.84% sensitivity and 64.52% specificity (AUC=0.629, p=0.008). No significant difference was detected between serum and cervicovaginal fluid VDBP levels for predicting preterm birth (p=0.018). Moreover, cervicovaginal fluid VDBP>0.44ng/ml predicted latency period≤48 hours with 43.75% sensitivity and 94.44% specificity (AUC=0.694, p<0.001), while serum VDBP did not predict a latency period shorter than 48 hours (AUC=0.515, p=0.771).Both serum and cervicovaginal VDBP may be valuable markers for predicting preterm birth. Although no difference was found between serum and cervicovaginal VDBP in terms of predictive role, cervicovaginal fluid VDBP may be one step ahead of serum VDBP with the ability to predict a short latency period.

Neonatal shock has a high mortality rate in neonates. New treatment approaches are being researched. Methylene blue (MB) may have the ability to enhance blood pressure but is rarely used on newborns. MB usage in a newborn with catecholamine-resistant shock who needed renal replacement therapy (RRT) due to hyperammonemia from an underlying urea cycle defect is presented here. A 3050-g female neonate, born at 38 weeks' gestation, was admitted to our neonatal intensive care unit on the fourth postnatal day due to hyperammonemia and encephalopathy. She was in shock but did not have sepsis, and her cardiological evaluation was normal. Upon detection of severe hyperammonemia, protein intake was ceased and ammonia-reducing medications were initiated. She required RRT due to persistent severe hyperammonemia, but despite receiving fluid resuscitation, vasopressors, and hydrocortisone, her blood pressure remained low until starting MB. Afterwards, RRT waseffectively performed. After continuous RRT, the patient's ammonia level decreased. Unfortunately, the patient died on the tenth day following delivery due to multiple organ failure. Catecholamine-resistant shock is a significant factor in neonatal mortality. In neonates with decompensated catecholamine-resistant shock and normal cardiac function, MB might be a novel therapeutic alternative. However, more studies are required to examine the efficacy, dose, and use.

Advances in perinatal medicine have contributed to significantly improved survival of newborns. While some infants die despite extensive medical treatment, a larger proportion dies after a decision to withdraw life-sustaining therapy is made. The approaches to these decisions have significantly changed over the years, and their practical implementation still varies greatly between different neonatal intensive care units. The aim of this study was to evaluate the circumstances surrounding all neonatal deaths in a university neonatal setting in Germany over a ten-year period and to document changes over time. During the 10-year study period, 41,543 children were born at the LMU university hospital Munich, while 348 children died during this time. Of these, 248 children passed away in the delivery room. A total of 10,908 children received medical care in the neonatal wards (two level III NICUs and two intermediate care units). Of these, more than half (56%) were term infants, and only about 1% wereat the border of viability. On the neonatal intensive care unit, a total of 97 newborns died. A more proactive approach has led to primary palliative care for extremely preterm infants being increasingly replaced by attempts at therapy at the threshold of viability. Since there was no change in the guidelines for the management of preterm infants at the border of viability during the data collection period, this shift could be attributed more likely to the interaction of parental preferences and expectations and medical decision-making.

Cilia are thin extensions on the cells of eukaryotic organisms. They are formed by a special protein transport mechanism - the intraflagellar transporter (IFT). The IFT consists of two proteins: complex A and complex B. Mutations in the genes of the IFT-A complex (IFT43, IFT121, IFT122, IFT139, IFT140, and IFT144) lead to the development of skeletal ciliopathies. These include Sensenbrenner, Jeune, and short-rib polydactyly syndrome [1,2]. We report two cases of different ciliopathies in a non-related family; both parents are heterozygous carriers of a pathogenic mutation in the IFT122 gene.

Background and purpose: Mandala is recognized as an art therapy that provides psychological support and healing. This study aimed to determine the effects of mandala art therapy on blood glucose levels, mood, and anxiety in pregnant women with abnormal oral glucose tolerance test (OGTT) values.

Materials and methods: This experimental study, designed as a pre-test post-test control group trial, was conducted in a public hospital in eastern Türkiye. The study involved 68 pregnant women (intervention group=34, control group=34). In the intervention group, the pregnant women received mandala art therapy twice: once at 0 hour after fasting plasma glucose (FPG) and once at 1 hour after plasma glucose (PG). Data collection tools included a Personal Information Form, the State-Trait Anxiety Inventory (STAI), and the Brief Mood Introspection Scale (BMIS), while glucose levels were obtained from patient records. Statistical analysis included frequency, percentage, mean, standard deviation,chi-square test, independent samples t-test, paired t-test, and ANCOVA.

Results: Following the intervention, pregnant women in the intervention group had significantly lower post-test STAI total and BMIS-negative mood subscale mean scores compared to those in the control group (p<0.05). Additionally, those in the intervention group scored higher on the positive mood and overall mood subscales of BMIS compared to those in the control group (p<0.05). There was no statistically significant difference between the groups' FPG(0-hour), PG(1-hour), and PG(2-hour) measurements (p>0.05).

Conclusion: Mandala art therapy was found to reduce anxiety and negative mood while positively affecting positive mood and overall emotional well-being in pregnant women with abnormal OGTT values.

In recent years, the role of healthy dietary patterns-particularly the Mediterranean diet-has been increasingly investigated in the prevention and management of gestational diabetes mellitus (GDM) and its associated complications.To evaluate the effects of adherence to the Mediterranean dietary pattern (MedDiet) adopted prior to conception or early in gestation on GDM and its association with maternal and fetal outcomes.A systematic literature search was conducted, including randomized and non-randomized clinical trials. Data were collected from Biblioteca Virtual em Saúde (BVS), PubMed, Embase, and Google Scholar databases for articles published between 2015 and 2025. The review protocol was registered in PROSPERO under the registration number CRD420251008611. The average incidence of GDM was lower in the MedDiet group (15.2%) compared to the control group (18.5%), suggesting a beneficial effect of the intervention. There was also a reduction in urinary tract infection rates (6.8% vs. 14.9%) and in the incidence of hypertension/preeclampsia (6.9% vs. 9.5%) in the intervention group. Cesarean section rates were similar between groups, with minor variations. Regarding neonatal outcomes, birthweight was slightly higher in the MedDiet group, and the incidence of small-for-gestational-age newborns was lower, reflecting an overall favorable effect on neonatal growth patterns. The rate of preterm birth was also lower in the intervention group, as was perinatal mortality in some studies. The need for neonatal intensive care unit admission varied across studies, with a trend toward reduction in the MedDiet group.The Mediterranean diet appears to be effective in reducing the incidence of GDM and improving maternal and fetal outcomes.

Anti-Müllerian hormone (AMH) is commonly used in artificial reproductive treatments. Unfortunately, there is only limited data about AMH in adverse pregnancy outcomes. Here, we searched the role of first-trimester AMH to predict adverse pregnancy outcomes in women without polycystic ovary syndrome (PCOS).A total of 240 pregnant women were enrolled in this prospective study. The inclusion criteria were being in the first trimester of pregnancy, having AMH levels measured, not having PCOS, and having had regular antenatal visits. Adverse outcomes were preeclampsia, gestational hypertension, gestational diabetes, preterm birth, pregnancy loss, and stillbirth. Demographic features, obstetric outcomes, and AMH levels were recorded and compared for each adverse outcome. AMH levels were lower in preeclampsia, gestational hypertension, gestational diabetes, and pregnancy loss compared to the control group. In ROC analysis, a cut-off value of 2.14 ng/mL for predicting preeclampsia yielded a sensitivity of 84.2% and specificity of 55.5% (p=0.027, AUC=0.658). For gestational hypertension, a threshold of 2.65 ng/mL resulted in a sensitivity of 94.4% and specificity of 41.2% (p=0.004, AUC=0.662). In predicting gestational diabetes, a cut-off of 1.98 ng/mL achieved a sensitivity of 83.3% and specificity of 59.7% (p<0.001, AUC=0.723). For pregnancy loss, a cut-off value of 2.94 ng/mL showed a sensitivity of 93.8% and specificity of 33.6% (p=0.001, AUC=0.660). The study provides initial indications about the role of AMH in predicting adverse pregnancy outcomes in pregnant women without PCOS. We believe that our study, when supported by randomized controlled studies with a large population, could confirm first-trimester AMH as a biomarker that can be used to predict adverse pregnancy outcomes. By using this marker, patients can be informed about the complications that will develop in the later period of pregnancy and can be referred to appropriate centers.

There are limited number of randomized controlled studies on the effectiveness of perineal massage and warm compresses in reducing perineal trauma.To evaluate the effectiveness of massage and warm compresses implemented by nurses and midwives on perineal trauma, volume of hemorrhage, length of episiotomy, and pain.The single-center, single-blind randomized controlled trial (RCT) included 120 pregnant women in labor. Women were randomly divided into four groups: receiving massage only, warm compress only, both massage and warm compress, and the control group.The application of warm compresses and massage was effective for reducing perineal trauma (p<0.001). Warm compress application was found to be effective to decrease first-degree trauma (p<0.001). The hemorrhage volume and length of episiotomy for the intervention groups were lower than in the control group (p<.001). Massage and warm compress interventions were effective for reducing pain (p<0.05).Massage and warm compress methods are effective in reducing trauma, pain, hemorrhage, and episiotomy length. Furthermore, the use of the two methods together does not provide an advantage.

Brucellosis is one of the most common zoonotic diseases in the world, causing high morbidity in animals and humans. The aim of this study was to investigate the effects of Brucella infection during pregnancy on the fetus and neonate.In our study, fetal and neonatal characteristics of women with positive Brucella agglutination tests during pregnancy between January 2017 and January 2023 were evaluated retrospectively. Included were all pregnant women with a tube agglutination test>1:160 for Brucella melitensis during pregnancy. Maternal characteristics, intrauterine abortion, intrauterine growth retardation, and neonatal findings were recorded.A total of 23 patients were included in the study. The most common complaints of pregnant women were fever (69.6%), malaise (78.3%), and myalgia (47.8%). A total of 21.7% of the pregnancies ended in abortion. Ten (55.6%) babies had low birth weight. Two babies had congenital brucellosis, and one baby had brucella infection due to transmission through breast milk.Brucella infections in pregnancy cause adverse effects in pregnant women, the fetus and newborn. Especially in endemic areas, it should be considered in the differential diagnosis.