Journal of Maternal-Fetal & Neonatal Medicine最新文献

Objective: Even with all the worldwide effort in the care of pregnant women and newborns in the last 10 years, perinatal asphyxia remains a crucial public health problem worldwide, being responsible for the high rates of morbidity and mortality in term and preterm newborns. In this perspective, research was carried out which aimed to investigate the prevalence and analyze the environmental and maternal-fetal risk factors associated with perinatal asphyxia.

Methods: This cohort study (2013-2018), corresponding to six years, was conducted in Fortaleza, Ceará, Brazil. The study involved 480 postpartum women living in a capital in the Northeast of Brazil, whose newborns were admitted to the neonatal intensive care unit of a private referral hospital for high-risk pregnancies. Perinatal asphyxia in live births was taken as the dependent variable. To identify risk factors associated with perinatal asphyxia, bivariate and multivariate analyses were performed.

Results: The research showed a high prevalence of perinatal asphyxia. The final multivariate analysis showed a significant association between perinatal asphyxia and eclampsia and complications in labor (p < 0.05), these being preventable causes of this outcome. The research demonstrated a high prevalence of perinatal asphyxia and a significant association between perinatal asphyxia and complications in labor, eclampsia, and cesarean sections (p < 0.05), being preventable causes of this outcome.

Conclusion: The study gave greater visibility to prenatal care, and understanding complications during pregnancy and childbirth care. The publication of the results signaled to managers the need to implement public and private politics to face this problem, which promoted improvements in the living conditions of the population and the care of pregnant women, to reduce the births of babies with perinatal asphyxia, consequently, reducing neonatal and infant mortality.

Objective: Bronchopulmonary dysplasia (BPD) remains a common pathology in very preterm infants. The risk of complications increases with the severity of the disease.The study aimed to determine the factors affecting the formation of moderate/severe BPD in the modern population of very preterm infants.

Methods: Data from 201 very low birth weight infants < 32 weeks of gestation were used in a retrospective cohort study. Infants were retrospectively divided into two groups based on the type of respiratory support at 36 weeks of postmenstrual age (PMA) - mild BPD (133 infants) and moderate/severe BPD (68 infants). The influence of major perinatal risk factors, neonatal morbidity, and medical interventions on the development of moderate/severe BPD was assessed.

Results: The groups were different in the incidence of intrauterine growth restriction (5% vs. 15%; p = 0.02), maternal hypertension (5% vs. 18%; p = 0.004), cesarean section (29% vs. 43%; p = 0.04), severe intraventricular hemorrhage (9% vs. 19%; p = 0.04), and retinopathy of prematurity (5% vs. 18%; p = 0.002), as well as in need for chest compressions during resuscitation at birth (2% vs. 9%; p = 0.01) for mild and moderate/severe BPD, respectively. Infants in the moderate/severe BPD group had lower Apgar scores at 1 and 5 min, required longer mechanical ventilation (220 (10-1904) hours vs. 72 (1-614) hours; p < 0.0001), CPAP duration (456 (16-1320) hours vs. 278 (10-1200) hours; p = 0.0002), oxygen supply (50 (3-146) days vs. 29 (2-68) days; p < 0.0001), as well as antibacterial therapy (61 (16-177) days vs. 52 (9-121) days; p = 0.0001) and hospital stay (109 (59-321) days vs. 85 (45-205) days; p < 0.0001). Infants with more severe BPD were also significantly more likely to die after reaching the PMA of 36 weeks (12% vs. 1%; p = 0.0003).According to the multivariable logistic regression analysis, the moderate/severe BPD was reliably and independently determined by maternal hypertension (aOR 4.53, 95% CI 1.48-13.91) and genitourinary infections (aOR 4.41, 95% CI 1.41-13.78), as well as the duration of CPAP (aOR 1.002, 95% CI 1.001-1.004) and mechanical ventilation (aOR 1.006, 95% CI 1.004-1.009).

Conclusions: Duration of respiratory support is the main risk factor that determines the development of moderate/severe BPD in the modern population of very preterm infants. Maternal hypertension and genitourinary infections may influence the severity of lung injury.

Purpose: Placenta accreta (PA) significantly increases the risk of life-threatening maternal outcomes, and its rising prevalence, driven by the increase in cesarean deliveries, underscores the need for precise diagnostic tools to improve clinical management and outcomes. This study aims to evaluate the advanced diagnostic capabilities of prenatal ultrasound and magnetic resonance imaging (MRI) in the detection of PA, a severe obstetric complication characterized by abnormal adherence of the placenta to the myometrium.

Materials and methods: The study utilized a review of current literature and clinical studies to assess the diagnostic accuracy and clinical utility of ultrasound and MRI in identifying PA. Both imaging modalities were evaluated for their ability to assess the depth and extent of placental invasion, as well as their complementary roles in prenatal diagnosis. The experimental system included detailed imaging protocols for ultrasound and MRI, focusing on placental and uterine structures, and their application in real-world clinical settings.

Results: The findings demonstrate that ultrasound and MRI are highly effective in diagnosing PA, with each modality offering unique advantages. Ultrasound is widely accessible and serves as the first-line diagnostic tool, providing detailed visualization of placental adherence and vascular patterns. MRI, on the other hand, offers superior soft tissue contrast and is particularly valuable in complex cases or when ultrasound findings are inconclusive. Together, these imaging techniques enable accurate evaluation of placental invasion, facilitating timely and targeted prenatal interventions. The study also highlights the potential for improved maternal and fetal outcomes through early diagnosis and optimized pregnancy management.

Conclusions: Prenatal ultrasound and MRI are indispensable tools in the diagnosis and management of placenta accreta, offering complementary insights that enhance diagnostic precision. Their combined use allows for detailed assessment of placental and uterine structures, guiding clinical decision-making and improving outcomes for both mothers and infants. Future advancements in imaging technology and research hold promise for further enhancing diagnostic accuracy and expanding clinical applications, ultimately contributing to safer and more effective care for patients with PA.

Background: Placenta accreta spectrum disorders (PAS), a devastating obstetric complication, has increased dramatically in recent decades along with the growing rate of cesarean worldwide. Various conservative management techniques, aimed to avoid hysterectomy and potentially preserve fertility, have been implemented in the management of PAS. However, reports on subsequent pregnancy outcomes following conservative management for PAS are limited.

Objective: To systematically evaluate the subsequent pregnancy outcomes in PAS patients undergoing conservative management.

Methods: This was a single-center, ambispective cohort study conducted between January 2013 to March 2021. Follow-ups were conducted annually, extending until March 2023. Eligible patients were PAS patients who underwent successful conservative treatment and had intentions for future fertility. Baseline characteristics, conservative management strategies, and subsequent pregnancy outcomes were collected and analyzed. Primary outcome was the subsequent pregnancy outcomes, including interpregnancy interval, conceive method, pregnancy success rate, pregnancy and delivery outcomes, and major maternal morbidities.

Results: A total of 40 patients with conservatively managed PAS and attempting subsequent pregnancies were included. These patients were further divided into the subsequent pregnancy group (n = 28) and non-pregnancy group (n = 12). There were no significant differences in term of baseline characteristics, conservative management, and delivery outcome between the two groups(All p < 0.05). The menstrual resumption time was 4.5 (2.25-6.00) months, and the interpregnancy interval was 39.7 ± 26.4 months. In the subsequent pregnancy, 28 patients experienced at least one pregnancy, with a total of 43 subsequent pregnancies. Ultimately, 60% (24/40) of patients successfully delivered but with a PAS recurrence of 33.3% (8/24). Major maternal morbidity included postpartum hemorrhage (PPH) (25%), disseminated intravascular coagulation (12.5%), uterine rupture (4.2%) and hysterectomy (4.2%). Furthermore, the incidence of composite adverse delivery outcomes was 45.8% (11/24). Neonatal outcomes were generally favorable, with a full-term birth rate of 87.5% and live birth rate of 95.8% (23/24).

Conclusion: Our findings reveal that while conservative management for PAS does not compromise subsequent fertility, it does pose substantial risks in subsequent pregnancies, including high recurrence rates of PAS, significant PPH, and increased incidence of composite adverse delivery outcomes. Patients should be thoroughly informed of the related risks and subsequent pregnancies necessitate comprehensive preconception counseling, meticulous antenatal care and individualized management strategies to minimize these risks.

Objective: To study value of one-on-one midwifery and music therapy combined program for natural childbirth.

Methods: This retrospective study analyzed the medical records of 82 women who gave birth spontaneously in our hospital between January 2020 and February 2022. They were grouped based on midwifery nursing programs. The control group received routine care, while the study group received one-to-one midwifery combined with music therapy. Maternal and infant outcomes, pelvic floor muscle function, progress of labor, and neonatal health were compared between two groups, degree of pain and anxiety during delivery, degree of perineal injury, and amount of 2-hour postpartum hemorrhage in two groups were analyzed.

Results: The incidence of adverse maternal and infant outcomes in study group was lower than that in control group, duration of labor was shorter than that in control group, and degree of perineal damage was lighter than that in control group, with p < 0.05. Values of pelvic floor muscle function indicators in study group were higher than those in control group, and pain and anxiety scores at time of delivery were lower than those in control group, with p < 0.05. Apgar score of newborns in study group was higher than that in control group, postpartum 2h bleeding volume of pregnant women was less than that in control group, with p < 0.05.

Conclusion: Application of one-to-one midwifery combined with music therapy in natural childbirth can relieve pain and anxiety of parturients during childbirth, at same time, reduce occurrence risk of maternal-infant-related complications, promote improvement of pelvic floor function of parturients.

Objective: Phototherapy is the standard treatment, but its efficacy can vary among neonates, prompting interest in genetic factors, particularly UGT1A1 gene variants. This study aims to evaluate the clinical significance of the UGT1A1 gene variant in influencing phototherapy response and long-term outcomes in neonatal hyperbilirubinemia.

Methods: This retrospective study included 104 neonates with neonatal hyperbilirubinemia, of whom 63 carried the normal UGT1A1 gene, and 41 had the homozygous UGT1A1 Gly71Arg variant. Genetic testing for the UGT1A1 gene Gly71Arg locus had been previously conducted as part of their clinical care using DNA extraction and sequencing. Parameters such as phototherapy duration, complications, and long-term outcomes were analyzed to assess the correlation between the UGT1A1 gene variant and clinical results. Furthermore, the impact of the UGT1A1 gene variant was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: Neonates with the UGT1A1 gene variant showed prolonged phototherapy duration, extended time to bilirubin normalization, increased phototherapy complications, higher phototherapy intensity, and more excellent rehospitalization rates for hyperbilirubinemia. The presence of the UGT1A1 gene variant correlated with specific complications, including dehydration, hypoglycemia, and hyperbilirubinemia. Additionally, infants with the UGT1A1 gene variant had significantly higher rates of developmental delay, cerebral palsy, hearing impairment, neurodevelopmental disorders, and severe hyperbilirubinemia-related morbidities. Mean peak bilirubin levels were significantly higher in the variant compared with the normal group. ROC analysis demonstrated moderate to strong sensitivities and specificities with area under the curve (AUC) values ranging from 0.693 to 0.830.

Conclusion: We found that a UGT1A1 gene variant significantly affects phototherapy response and can impact long-term outcomes in neonatal hyperbilirubinemia, highlighting the potential of genetic testing for personalized risk assessment and management of hyperbilirubinemia in newborns.

Purpose: Clinical screening for cleft palate in fetus currently focuses on weeks 20-24. It has been shown that cleft palate can be detected by ultrasound in first-trimester anatomy scan, but there are no large-scale samples to validate. This study was to confirm the ability of combined two-dimensional(2D)-ultrasound and three-dimensional(3D)-tomographic ultrasound imaging (TUI) to safely detect an fetal cleft palate at 11-13 + 6 weeks via large-scale samples.

Methods: A prospective study was designed, involving 6870 pregnant women applying 2D-ultrasound transabdominal sweeps of the fetal face in the median sagittal and coronal views of the retronasal triangle with abnormalities of the palatal line detected, followed by an axial view of the superior alveolar eminence and 3D-TUI evaluation. The endpoints were the results of the fetal facial profile assessment for delivery and induction of labor. The accuracy, sensitivity, and specificity of ultrasound for diagnosing a cleft palate at 11-13 + 6 weeks were analyzed.

Results: Among 6870 fetus, a total of 43 different cleft palate types were diagnosed by 2D-ultrasound in three-sections at the 11-13 + 6 weeks, and a total of 6827 cases were diagnosed of negative for cleft palate. Of the 43 cases diagnosed of positive for cleft palate, three cases were false positives compared to endpoint results, with a correct positive predictive value of 93.0%. Of the 6827 cases diagnosed of negative for cleft palate, five cases were false negatives compared to endpoint results, with a correct negative predictive value of 99.0%. The sensitivity and specificity of 2D-ultrasound screening for cleft palate were 84.4%, and 99.9%, respectively. The 43 cases received 3D-TUI scans, and the results showed that 37 cases of cleft palate detected, with a positive predictive value of 86.0%, which was lower than that of 2D ultrasonography (93.0%) (p < 0.05).

Conclusion: It may be feasible and accurate to diagnose cleft palate in fetus at 11-13 + 6 weeks by using combined 2D three sections ultrasound and 3D-TUI scans.

Intrauterine resuscitation includes different interventions which aim to improve fetal oxygenation when intrapartum fetal hypoxic stress leading to abnormal CTG features is suspected. Based on the etiology of the hypoxic stress, prompt institution of specific conservative measures, aiming to restore fetal oxygenation and normalize the features of the CTG trace, may reduce the incidence of unnecessary operative deliveries. However, there is paucity of evidence supporting the effectiveness of intrauterine resuscitation measures: based on available data, routine administration of fluid boluses is not recommended and should be limited only to volume-depleted patients, in which intravenous hydration has been associated with potential benefits. Similarly, amnioinfusion and maternal oxygen administration cannot be recommended as previous studies on their efficacy reported conflicting results, and some have suggested that these measures may be potentially harmful. On the other hand, changing maternal position seems to be a potentially useful maneuver with no side effects in cases of supine hypotension syndrome or in cases of suspected sustained umbilical cord compression. Administration of tocolytics for ongoing excessive uterine activity is associated with fetal heart rate improvement; within the most used tocolytic drugs, terbutaline (a beta-agonist) is often recommended as the first-choice agent to be administered for intrapartum acute tocolysis due to its efficacy, ease of administration and side effect profile.

Purpose: Pregnancy in women with adult congenital heart disease (ACHD), whether in its natural history or after surgical correction, represents a unique pathophysiological model that requires careful, multidisciplinary management to ensure favorable maternal, fetal and neonatal outcomes. Investigating the impact of congenital cardiac conditions on maternal and feto-neonatal health, the effect of pregnancy-related cardiovascular changes on maternal cardiac health, and the outcomes for offspring born from ACHD mothers is highly relevant, due to the increasing number of ACHD women reaching adulthood and the significant burden these pregnancies can pose. The aim of this article is to provide food for thought to those who have always been involved in ACHD and pregnancy, but also to provide a training tool for young doctors who are approaching at this wonderful world for the first time.

Materials and methods: This article was conceived and structured as an "educational and debate". In this article we describe our experience in the ACHD outpatient clinic and the High-Risk Pregnancies Division of Fondazione Policlinico A. Gemelli Hospital IRCCS from 2013 and now includes over 100 patients evaluated over a 10-year period.

Results: In this article we describe our clinical pathway and the clinical history of our first patient, a 30-year-old woman with univentricular heart (criss-cross heart, double outlet right ventricle and pulmonary stenosis) who underwent a Glenn operation as a child. Our plan included scheduled cardiological and obstetrical follow-ups, as well as planned hospitalizations. An elective C-section was carried out at 38 gestational weeks under spinal anesthesia, with Extracorporeal Membrane Oxygenation and the heart surgery team stand by. It was an uncomplicated delivery. As a result, we developed a specific clinical pathway named "ACHD Pregnancy Pink Pathway."

Conclusions: The strength of this idea dwells in the synergy between different experts in deciding for the best decision regarding the required monitoring strictness and the more appropriate obstetric surveillance and delivery plan for the patient. The lesson we learned over the years is that to ensure the best diagnosis and treatment for our young unique patients, we must create a detailed "ROADMAP" for them. We propose a pioneering pathway divided into the three essential phases: maternal, obstetrics and fetal-neonatal.