Journal of Maternal-Fetal & Neonatal Medicine最新文献

Introduction: The prevalence of breech presentation ranges from 6.9% to 10.0% between weeks 32 and 36 of gestation, gradually declining to 3.0-5.0% by the time an external cephalic version (ECV) can be offered. The primary objective of our study was to identify the factors favoring a spontaneous version between the routine third-trimester ultrasound and the proposal of external cephalic version. We also compared the maternal and neonatal outcomes at delivery between fetuses who spontaneously turned to the cephalic presentation and those who were in the cephalic presentation after external cephalic version.

Method: This retrospective observational study included pregnant women with a breech fetus at their third trimester ultrasound scan (around 32 WG), who were under the care of a tertiary hospital between 2003 and 2022.

Results: A total of 2,439 women were included in the study. The rate of spontaneous version between 32 and 36-37 weeks was 65%. The favoring factors, after adjustment, were multiparity, maternal age under 25 years, polyhydramnios. No difference was found in the incidence of cesarean section (12.6% vs. 13.2% p = 0.32) or assisted vaginal delivery (12.1% vs. 13.0% p = 0.72) for fetuses lying in the cephalic presentation after external cephalic version, compared to those with spontaneous version into the cephalic presentation after third trimester scan.

Conclusion: The risk factors for a fetus remaining in the breech presentation after 32 weeks of gestation were similar to those associated with breech presentation in general. There was no difference in maternal or fetal outcomes between fetuses that were spontaneously or non-spontaneously versed fetuses (after external cephalic version).

Background: Fetal hemoglobin (HbF) plays a critical role in the progressive adaptation to the postnatal oxygen-rich environment in preterm infants due to its peculiar properties and its postnatal decrease has been associated to the combined adverse effects of increasing tissue hyperoxia and decreasing antioxidant defenses in preterm infants.

Purpose: We aimed to assess the association between HbF fractions and the risk of bronchopulmonary dysplasia (BPD) intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP).

Methods: We studied 166 preterm infants with a gestational age of 27.1 ± 1.6 weeks. One hundred and twenty-six infants (74%) had no or mild BPD, and 40 (24%) moderate to severe BPD. One hundred and forty-three infants (86%) had no or grade 1 IVH, and 23 (14%) grade 2-4 IVH. One hundred and thirty (80%) had no ROP, and 32 (20%) had any grade ROP. HbF fractions were recorded during the first seven days of life, at 14, 21, and 28 days of life, and 31, 34, and 36 weeks of postmenstrual age. Mean values during the first week of life (HbF_{1st week}) and at 31, 34, and 36 weeks (HbF_{31-36 weeks}) were calculated.

Results: Logistic regression analysis showed that: HbF_{31-36 weeks} decreased the risk of moderate to severe BPD (OR 0.944, 95% CI 0.911-0.977; p = 0.001); female sex (OR 0.278, 95% CI 0.093-0.832; p = 0.022) and HbF_{1st week} (OR 0.949, 95% CI 0.901-0.999; p = 0.048) decreased the risk of grade 2-4 IVH; and HbF_{1st week} (OR 0.958, 95% Cl 0.919-0.998; p = 0.042) and HbF_{31-36 weeks} (OR 0.956, 95% CI 0.927-0.986; p = 0.004) decreased the risk of any grade ROP.

Conclusion: Low HbF fractions were associated with increased risk of moderate-to severe BPD, grade 2-4 IVH, and any grade ROP. These results confirm previous findings and support the importance of minimizing blood sampling from these fragile patients.

Objective: Limited data informing evidence-based regimens for antibiotic use in neonates undergoing fetal myelomeningocele (fMMC) repair have been published to date, and no standard of care has been established across centers. The goal of this study was to describe current neonatal antibiotic use practices following fMMC repair within the Children's Hospitals Neonatal Consortium (CHNC), a collaborative network of North American institutions with Level IV neonatal intensive care units.

Methods: We conducted a cross-sectional survey of site sponsors at all 48 CHNC centers from April 2024 to January 2025, and invited CHNC Fetal Therapy Focus Group members in May 2024, with one response requested per center.

Results: A neonatologist at 34 centers (center response rate = 71%) completed the survey, of which 30 (88%) reported performing fMMC repair surgery (15/34, 44%) or delivering/receiving fMMC neonates (15/34, 44%) at their center. One-quarter of responding centers (7/30, 23%) reported having an existing clinical protocol for antibiotic management for fMMC neonates after birth. Notably, there was heterogeneity across existing protocols with respect to criteria for antibiotic use, the specific antibiotics used, and the duration of use. Responding centers reported administering antibiotics with guidance from infectious disease, neurosurgery, and fetal specialists. Two responding centers (6%) reported performing beta-2 transferrin testing on dehisced wounds when there is a suspected cerebrospinal fluid (CSF) leak, while the majority did not do so (20/30, 67%), and the remainder did not know their institutional practice (7/30, 23%).

Conclusions: Current antibiotic use in fMMC neonates after birth varies widely between centers in North America, highlighting the need for evidence-based data to inform the development of best practice guidelines.

Background: The growing prevalence of gestational diabetes mellitus (GDM) presents a significant clinical concern. In parallel, obesity has escalated to epidemic levels, and the mental health-GDM connection has been increasingly documented. Against this backdrop, the present study primarily investigates the independent and joint contributions of relative fat mass (RFM) and depression to GDM risk.

Methods: Data were collected from the National Health and Nutrition Examination Survey (NHANES) covering the years 2007-2020. The separate associations of RFM and depression with GDM history were analyzed using a weighted logistic regression model, while interaction analysis was conducted to explore their combined effect. Subgroup analyses were conducted for further validation.

Results: Among 8622 eligible participants, 775 (9.00%) had a history of GDM. The median age at first live birth was 22.00 years (19.00, 26.00). After adjusting for confounding variables, both increased RFM (OR = 1.07; 95% CI: 1.05-1.09) and depression scores (OR = 1.04; 95% CI: 1.02-1.06) were linked to an elevated risk of GDM. The coexistence of obesity (RFM ≥ 40%) and depression yielded a synergistic effect greater than their individual impacts (RERI = 0.87; ROR = 1.33). These findings were consistent across subgroup and sensitivity analyses.

Conclusions: Concurrent elevation in RFM and depressive symptoms significantly heightens the likelihood of GDM history. These results support the integration of metabolic and psychological factors into preventive frameworks targeting GDM history.

Objective: To investigate the relationship between changes in maternal stress hormone levels during labor induction and the occurrence of neonatal hyperbilirubinemia (NNH), and to identify potential independent risk factors.

Methods: A prospective cohort study was conducted involving 1,000 pregnant women who underwent labor induction at our hospital between June 2022 and May 2025. Maternal plasma levels of cortisol, epinephrine (EPI), and norepinephrine (NE) were measured before induction (T₀), during induction (T₁), and 30 min after delivery (T₂). Neonatal total bilirubin concentrations were measured at 24, 48, and 72 h after birth. According to the occurrence of NNH, subjects were divided into the NNH group (n = 95) and the non-NNH group (n = 905). Hormonal and bilirubin changes were compared between the two groups. Point-biserial correlation and multivariate logistic regression analyses were performed to explore associations and identify independent predictors.

Results: Maternal plasma levels of cortisol, EPI, and NE at T₁ and T₂ were significantly higher in the NNH group. All three hormones at T₂ showed moderate positive correlations with the occurrence of NNH (r = 0.28-0.31, p < 0.001). Cortisol, EPI, and NE at T₂ were independently associated with the occurrence of NNH, while gestational age served as a protective factor. Male sex, cephalohematoma, direct antiglobulin test (DAT) positivity, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and exclusive breastfeeding were all associated with a higher risk of NNH. The regression model showed strong discriminatory power and predictive performance.

Conclusion: Elevated maternal stress hormone levels during labor induction may serve as potential predictive indicators for assessing the risk of NNH.

Background: Forceps delivery often leads to increased maternal and neonatal complications, primarily attributed to the rigidity of traditional steel forceps, a major contributor to birth injury.

Aims: This study aims to develop obstetric forceps with reduced rigidity and assess the safety and effectiveness of the newly designed pliant forceps.

Methods: Pliant forceps with varying materials and shapes were produced by three-dimensional printing, and a pilot simulation determined the optimal design. Three fetal mannequins were developed to measure force changes exerted on the fetal head. Simulated births with several resistance intensities, were conducted to compare the real-time force between pliant forceps and Simpson forceps. Perineal distension was assessed by recording maximum perineal distention during a simulated forceps delivery using pliant forceps and Simpson forceps.

Findings: The pliant forceps, constructed from polylactic acid with solid blades and angled shanks, featured foam tape on the fetal sides. In simulation studies on term fetal head model, pliant forceps achieved successful assisted vaginal delivery across all resistance levels. Compared to Simpson forceps, pliant forceps consistently exerted lower force on the fetal head during assisted vaginal delivery. The maximum force applied by pliant forceps occurred at RA1 site on fetal head (67.11 ± 4.35 N, Simpson forceps: 99.12 ± 10.53 N, p < 0.001), and Simpson forceps reached its peak at RP2 site (177.37 ± 19.28 N, pliant forceps: 12.87 ± 5.11 N, p < 0.001). Similar results were obtained in simulation experiments on large and small fetal head models. Perineal distension was determined to be smaller in births with pliant forceps compared with that in births with Simpson forceps (lateral perineal distension: 76.6 mm vs. 92.6 mm, p < 0.001).

Conclusions: The three-dimensional-printed pliant forceps demonstrated reduced force on the fetal head and less perineal distension compared to Simpson forceps in simulated births, which holds potential for decreasing birth injuries and maternal birth canal injuries during forceps delivery. Further research is required to ensure the safety and efficacy of pliant forceps before clinical application.

Purpose: To explore the integration of Intrapartum Ultrasound (IUS) into midwifery practice across different regions of Italy, with particular focus on midwives' training, knowledge, clinical use, and perceived barriers to implementation.

Materials and methods: A cross-sectional survey was conducted among 104 midwives working in various Italian regions. The questionnaire assessed participants' formal education and training in IUS, level of knowledge, extent of clinical application, and perceived obstacles to its broader adoption in clinical practice. Descriptive analyses were performed to evaluate regional differences and identify gaps in education and implementation.

Results: Although IUS appears to be widely utilized in clinical settings, a substantial proportion of midwives reported insufficient formal training. Significant barriers to broader implementation included cultural resistance within maternity care settings, limited access to structured educational programs, and regional disparities in clinical practice. Many respondents highlighted the need for improved competencies, particularly in the management of dystocic labor.

Conclusions: This survey highlights the urgent need for standardized and comprehensive training programs to strengthen midwives' competencies in intrapartum ultrasound. Addressing educational gaps, reducing regional inequalities, and promoting cultural change within maternity care environments are essential steps to support the effective and consistent integration of IUS into midwifery practice.

Objective: To compare the efficacy, safety, and reproductive outcomes of hysteroscopic resection versus conventional dilation and curettage (D&C) in the management of retained products of conception (RPOC) following delivery or abortion.

Materials and methods: This retrospective cross-sectional study included 55 patients diagnosed with RPOC at a tertiary care center between January 2015 and December 2025. The surgical intervention selected for each patient was determined by clinical indications, with either hysteroscopic resection or dilation and curettage (D&C) being the preferred option. The diagnosis was confirmed by transvaginal ultrasonography and histopathological examination. A comprehensive analysis encompassing demographic characteristics, clinical manifestations, surgical outcomes, and fertility outcomes was conducted between the two groups.

Results: Hysteroscopy was performed in 28 patients (50.9%). D&C was performed in 27 patients (49.1%). The median time from pregnancy termination to intervention was significantly longer in the hysteroscopy group (28 vs. 7.5 days; p = 0.036). Residual tissue size and operative time were also significantly greater in the hysteroscopy group (p = 0.017 and p < 0.001, respectively). Although not statistically significant, time to conception was shorter in the hysteroscopy group (5 vs. 9.4 months), and the rate of pregnancy desire was significantly higher (82.1% vs. 66.7%; p = 0.021). Pregnancy was observed to be more prevalent in the D&C group during the follow-up period. However, this difference did not attain statistical significance.

Conclusion: Hysteroscopy and dilation and curettage (D&C) have been demonstrated to be both effective and safe options for RPOC. The use of hysteroscopy, with its capacity for direct visualization and targeted removal, is supported by its efficacy in precise intrauterine assessment. The fertility outcomes observed in this cohort were comparable between the study groups.