Journal of Maternal-Fetal & Neonatal Medicine最新文献

Introduction: Bronchopulmonary sequestration (BPS), a rare congenital pulmonary malformation, is characterized by nonfunctional pulmonary parenchyma with aberrant systemic arterial supply (typically from the aorta or its major branches) and absence of communication with the tracheobronchial tree. Large BPS lesions pose significant fetal risks, including hydrops fetalis, mediastinal shift, and polyhydramnios, necessitating timely prenatal intervention to prevent fetal demise.

Case presentation: We present a case of successful ultrasound-guided radiofrequency ablation (RFA) of the feeding artery in a fetus diagnosed with BPS at 22 weeks of gestation. Under ultrasound guidance, a 17-gauge RFA needle was percutaneously inserted into the aberrant feeding artery, achieving complete vascular occlusion without procedural complications. Serial prenatal ultrasounds demonstrated progressive lesion involution. The pregnancy was complicated by cephalopelvic disproportion (CPD), prompting cesarean delivery at 38 weeks. Neonatal computed tomography (CT) confirmed shrinkage of the residual sequestration tissue. Six-month postnatal follow-up revealed normal respiratory function, age-appropriate growth, and developmental milestones.

Conclusion: RFA represents a safe and effective minimally invasive prenatal therapy for BPS. Candidate selection requires comprehensive evaluation of fetal hydrops, lesion size, gestational age, and parental preferences. Amniotic fluid sampling during the procedure is advisable for genetic/ancillary testing. This case highlights the utility of RFA in optimizing fetal outcomes while avoiding open neonatal period surgery. Long-term neonatal follow-up supports the durability of vascular occlusion and functional recovery.

Objectives: To investigate the predictive performance of the second-trimester soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio for composite adverse neonatal outcome (CANO) in preeclampsia (PE).

Methods: This retrospective cohort study enrolled 253 PE women during June 2022-June 2024. Maternal serum levels of sFlt-1 and PlGF were assessed, and their ratio was determined at 13-27 gestational weeks. Subjects were stratified into CANO (n = 80) and non-CANO (n = 173) groups. Baseline characteristics and the sFlt-1/PlGF ratio were compared. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors for CANO. Predictive value was assessed using ROC curve analysis, and a nomogram prediction model was constructed.

Results: The sFlt-1/PlGF ratio was markedly higher in the CANO group than the non-CANO group (p < 0.001). Multivariate analysis identified the sFlt-1/PlGF ratio (OR = 1.040, 95% CI: 1.020-1.060, p < 0.001), serum uric acid level (OR = 1.007, 95% CI: 1.000-1.013, p = 0.043), and history of pre-pregnancy hypertension (OR = 13.51, 95% CI: 2.065-88.36, p = 0.007) as independent risk factors for CANO. Conversely, gestational age at delivery (OR = 0.727, 95% CI: 0.621-0.852, p < 0.001) was a protective factor. The sFlt-1/PlGF ratio predicted CANO with an AUC of 0.799 (95% CI: 0.743-0.855). The integrated nomogram model achieved a C-index of 0.880 (95% CI: 0.836-0.923), indicating excellent discrimination.

Conclusion: The second-trimester sFlt-1/PlGF ratio is an independent predictor for CANO in PE. A model incorporating this biomarker facilitates the early identification of high-risk neonates, informing personalized perinatal management.

Introduction: Pregnancy after bariatric surgery is a high-risk pregnancy. Post-bariatric complications may require emergency surgical intervention. During laparoscopic surgery, anesthetic drugs and formation of pneumoperitoneum influence maternal hemodynamics and may impair the perfusion of the utero-placental unit. Subsequent changes of the fetal heart rate (FHR) might be recognized with intra-operative fetal monitoring and guide maternal positioning and hemodynamic management to maintain fetal wellbeing. However, current fetal monitoring guidelines do not include FHR interpretation during general anesthesia. Furthermore, FHR registration using conventional cardiotocogram (CTG) may be technically difficult due to surgically induced pneumoperitoneum. We developed a multidisciplinary local standard operating procedure based on current literature and guidelines. Intra-operative fetal monitoring using conventional CTG was implemented during laparoscopic surgery for suspected complication after bariatric surgery. We aim to establish whether FHR monitoring during laparoscopy is technically feasible. Secondary, we aim to establish a guideline for interpretation of intra-operative FHR during surgery.

Methods and analysis: Prospective, observational, feasibility study in a tertiary care hospital with a national referral function for post-bariatric complications in pregnancy. We will collect data from pregnant women with a gestational age of ≥ 24 weeks with a suspicion of a complication after bariatric surgery requiring surgical exploration. Non-Dutch speaking women and women with multiple gestation will be excluded. Data will be collected in Research Manager and analyzed using IBM SPSS Statistics for Windows, version 22.

Discussion: The available literature on intra-operative fetal monitoring is scarce. However, despite ambiguity in current international guidelines FHR monitoring is performed in various clinics. To avoid unnecessary caesareans during surgery it is important that FHR monitoring is of sufficient registration quality and that there are guidelines for interpretation of CTG during general anesthesia. However, the technique of intra-operative CTG has not been validated and hence the relevance of our standard operating procedure on intra-operative fetal monitoring during surgery for complications after bariatric surgery.

Objective: To investigate maternal and neonatal outcomes and influencing factors in pregnant women with borderline hypertension.

Methods: This prospective cohort study consecutively enrolled 600 pregnant women receiving prenatal care at two hospitals between January 1 and December 31, 2024. Participants were divided into a normotensive control group (n = 300) and a borderline hypertension group (systolic 130-139 mmHg and/or diastolic 80-89 mmHg, n = 300). The primary outcome was progression to hypertensive disorders of pregnancy (HDP). Maternal and neonatal outcomes were compared, and influencing factors were analyzed.

Results: Women with borderline hypertension exhibited significantly higher rates of cesarean delivery (63.0% vs. 42.0%; p < 0.001), HDP progression (27.0% vs. 0.0%; p < 0.001), fetal growth restriction (15.7% vs. 2.7%; p < 0.001), and NICU admission (13.7% vs. 4.0%; p < 0.001) compared to normotensive controls. Notably, later gestational age at onset of borderline hypertension was identified as a protective factor against HDP progression (OR = 0.785 per week; 95% CI: 0.724-0.851; p < 0.001), corresponding to a 21.5% risk reduction for each delayed week of onset.

Conclusion: Borderline hypertension is associated with markedly increased adverse perinatal outcomes. Early detection and intervention-especially for women developing borderline elevation before 20 weeks-may help mitigate HDP progression. Integrating blood pressure trajectory monitoring into routine prenatal care is recommended.

Background: During the immediate postpartum period, breastfeeding could be challenge for many women due nipple pain and trauma. Non-pharmacological therapeutic strategies that reduce pain and accelerate healing are essential to prevent early weaning and support successful lactation.

Objective: This study aimed to evaluate the effectiveness of low-level laser therapy (LLLT) in reducing pain and promoting healing of nipple trauma in postpartum women, as well as to assess participants satisfaction with the intervention.

Methods: This multicentric, controlled, randomized, double-blind clinical trial included 60 women equally divided into an experimental group (2 J of red light at the nipple's central point and 4 J of infrared light in a cross pattern over the areolar region) and a sham group. Pain intensity was measured using the Numeric Rating Scale before, during, and up to 7 days after the intervention, and healing was assessed using a validated instrument. Intention-to-treat analysis was conducted.

Results: We found a significant reduction in pain in the experimental group, with relief observed 30 min (p = 0.0439) after the LLLT application. Pain diary analyses indicated that, compared to the sham group, the experimental group reported lower pain intensity at 1h (p = 0.0485), 6h (p = 0.0194), 12h (p = 0.0033), and 7 days after the intervention (p = 0.0085). There was no significant difference in the level of satisfaction between groups (p = 0.652), and no adverse effects were identified.

Conclusion: LLLT proved to be a safe, effective, and feasible approach for managing pain associated with nipple trauma in the early postpartum, providing maternal comfort and supporting the continuation of exclusive breastfeeding.

Onset of uterine contractions which become progressively more frequent, intense and last for longer durations as the labor progresses is expected to cause a gradually evolving hypoxic stress to human fetuses. This is because of the repeated constriction of maternal spiral arterioles supplying the placental bed and compression of the umbilical cord as the labor advances. The majority of fetuses are able to mount physiological compensatory responses to protect their high priority central organs by maintaining aerobic metabolism. However, fetuses who are exposed to preexisting compromise such as chronic utero-placental insufficiency, chorioamnionitis or chronic fetal anemia and acidosis may not have sufficient reserves to withstand further hypoxic stress, leading to rapid decompensation and neurological injury or death. Physiological interpretation of fetal heart rate changes involves recognition of specific features of both hypoxic and non-hypoxic stresses on the cardiotocograph (CTG) and determining the fetal compensatory responses to ongoing stress. This approach which is based on the cardinal principle of individualization of care will enable frontline clinicians to differentiate features of compensation from decompensation. Timely interventions to improve intrauterine environment and/or to accomplish urgent birth will help avoid hypoxic ischemic encephalopathy (HIE) and its long term sequalae (cerebral palsy or learning difficulties) and perinatal deaths. Conversely, continuation of labor with careful observation in fetuses with compensated gradually evolving hypoxic stress will help avoid unnecessary intrapartum operative interventions. Emerging evidence suggests reduction in the rates of both HIE and emergency cesarean sections following the implementation of principles of physiological interpretation of CTG.

Introduction: Cardiotocography (CTG) is used for fetal surveillance to prevent asphyxia related neonatal outcomes during pregnancy and delivery. In Sweden, all delivery wards have transitioned from CTG registered and printed on paper inside the delivery room, to digital central fetal monitoring where CTG is visible both in the delivery room and on distance for multiple observers. We aimed to evaluate whether the transition from CTG on paper to central fetal monitoring has affected neonatal morbidity.

Material and methods: The study was conducted as a retrospective cohort study. Data from 8577 deliveries in Östersund, Sweden were extracted from medical records. The study population was divided into two cohorts, one where the CTG registration during delivery had been printed on paper (Cohort I, January 2012-December 2015), and one where digital central fetal monitoring was used (Cohort II, July 2016-December 2019). The cohorts were compared regarding the incidence of neonatal metabolic acidosis (umbilical artery pH <7.05 and base deficit >12 mmol/L) as the main outcome, and secondary outcomes such as Apgar score at 5 min of age, the incidence of neonatal resuscitation, and the incidence of emergency cesarean and instrumental vaginal birth due to suspected fetal hypoxia.

Results: The incidence of metabolic acidosis was 0.5% in Cohort I and 0.6% in Cohort II, odds ratio (OR) 1.27, 95% confidence interval (CI) 0.67-2.40, p = 0.46. There were no statistically significant differences in any of the secondary neonatal outcomes. Adjustment for potential confounders did not alter the estimates. The cohorts differed in the incidence of inductions of labor; 18.8% in Cohort I vs 23.2% in Cohort II, p < 0.0001, and the use of oxytocin; 50.2% vs 60.0%, p < 0.0001, both of which were more frequent in Cohort II. The incidence of instrumental vaginal births due to suspected fetal hypoxia was lower in the cohort with digital CTG; 3.6% vs 2.6%, p = 0.01.

Conclusion: We observed no difference regarding the incidence of neonatal metabolic acidosis or other neonatal outcomes between the cohort that had CTG registered and printed on paper, and the cohort with digital central fetal monitoring.