Journal of Maternal-Fetal & Neonatal Medicine最新文献

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.

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.

Objective: Our previous work examined the effect on assessment of fetal well-being when presenting twin fetal heart rate tracings (FHRT) simultaneously on screen. To further examine the potential impact of subconscious perceptual influences on fetal well-being, the current study presented singleton FHRT with and without simultaneous presentation of maternal heart rate in a within-subjects design. Tracings were taken from archival cases with either normal or abnormal Apgar scores to identify differential impact depending on final outcome. All tracings were evaluated for variability, accelerations, decelerations, and overall concern.

Study design: Obstetrical medical professionals (nurses, physician assistants, and physicians; N = 32) assessed FHRTs from 20 singleton gestations that resulted in live births (half with normal Apgar scores (control group), half with a 5-minute Apgar < 7 (at-risk group)) presented either alone or with maternal heart rate on the same tracing. Nurses were naïve to the fact that the fetal heart rate tracings presented in the unpaired condition were the same as those presented in the paired condition. Within-subjects assessments were then compared between the two conditions.

Results: Each nurse participant completed ratings on four metrics for each of 20 singleton gestations across two conditions, plus rated three tracings per condition again to determine test-retest reliability within each condition (52 FHRT assessments, 208 metrics total per participant). The intraobserver impact of visual context was calculated as the frequency of changed opinions regarding an individual metric (e.g. variability) between the paired and unpaired contexts for control versus at-risk FHRT. Participants demonstrated substantial self-agreement when assessing variability, accelerations, and decelerations for control FHRT, but only moderate agreement for the same metrics when assessing at-risk FHRT. In addition, assessment of level of concern demonstrated moderate intraobserver agreement for control FHRT but lowered to only slight agreement for at-risk FHRT.

Conclusions: The simultaneous presentation of fetal heart rate tracings with maternal heart rate tracings introduces both intraobserver and interobserver variances in interpretation of decelerations and overall level of concern, particularly for at-risk FHRT. These changes in interpretation are likely due to the influence of subconscious perceptual decision-making and additional cognitive load in separating multiple streams of information. This may theoretically affect outcomes in cases in which visual information is nuanced. Medical professionals may want to exercise caution when adding more than one tracing to the visual array, as it may affect decision-making.

Objective: To evaluate the effects of Early Essential Newborn Care (EENC) on neonatal hypoglycemia and breastfeeding in late preterm and term cesarean-born infants.

Methods: In this RCT, infants were randomly assigned to the EENC group (immediate skin-to-skin contact and early breastfeeding) or the control group (standard care). Blood glucose was measured at 1, 3, and 6 h post-birth. Breastfeeding outcomes included the onset of lactogenesis II and exclusive breastfeeding at discharge. Time to first breastfeeding was recorded solely as a process fidelity check to confirm intervention adherence. We used multiple imputation as the primary analysis for missing data and conducted pre-specified sensitivity analyses, including a complete-case analysis.

Results: Infants in the EENC group had significantly higher blood glucose levels at 1 h (aMD = 11.56 mg/dL [95%CI: 8.85, 14.27]), 3 h (aMD = 9.06 mg/dL [95%CI: 7.08, 11.04]), and 6 h (aMD = 6.83 mg/dL [95%CI: 5.31, 8.36]) post-birth, compared to the control group (all p < 0.001). The RR for hypoglycemia was significantly lower in the EENC group (RR = 0.88, [95%CI: 0.80, 0.96], p = 0.006). Additionally, mothers in the EENC group experienced earlier onset of lactogenesis II (aMD=-8.82 h [95%CI: -10.23, -7.41], p < 0.001), and had a higher rate of exclusive breastfeeding (RR = 1.31 [95% CI: 1.02, 1.26], p = 0.022). Sensitivity analyses yielded consistent directions for primary glycemic and breastfeeding outcomes.

Conclusion: The EENC improves neonatal glucose regulation and breastfeeding in cesarean-born late preterm and term infants, potentially enhancing neonatal health, maternal-infant bonding, and postpartum transition.

Objective: To investigate fetal intrahepatic umbilical-portal-systemic venous shunts (IHUPSVS).

Methods: The study retrospectively analyzed cases of IHUPSVS at a single center from January 2015 to December 2024. Ultrasonographic features, IHUPSVS types, and postnatal outcomes were recorded and followed up.

Results: Overall, 30 IHUPSVS cases, including 22 Type I (17 Ia and five Ib), two Type II, three Type III, and three Type IV cases, were identified. As gestational age increased, compensatory dilation of the hepatic artery (HA), cardiomegaly, fetal growth restriction (FGR), and abnormal hemodynamics became more prevalent. Type I was mainly linked to FGR. Types II and III showed compensatory dilation of the HA and cardiomegaly. All types were associated with fetal structural malformations, with Type IV being the most prominent. Eleven pregnancies were terminated, and 19 live births occurred, with natural closure.

Conclusion: Prenatal ultrasound is useful for diagnosing IHUPSVS, monitoring fetal growth and hemodynamics, and predicting prognosis by IHUPSVS types.

Background: Intra-uterine adhesion (IUA) frequently recurs after hysteroscopic adhesiolysis, undermining menstruation and fertility. We aimed to determine whether baseline serum anti‑Müllerian hormone (AMH)‑to-follicle‑stimulating hormone (FSH) ratio and menstrual pattern independently and jointly predict IUA severity transitions after adhesiolysis using a multi‑state Markov model.

Methods: We conducted a single-center prospective study of 210 women (18-45 years) undergoing first adhesiolysis for moderate-to-severe IUA. Baseline serum AMH and FSH were measured and menstrual pattern was classified as normal, hypomenorrhea, or amenorrhea. Hysteroscopy at 3, 6, 12, and 24 months defined four severity states (none, mild, moderate, severe) and two absorbing outcomes (pregnancy ≥ 12 weeks, repeat surgery). Continuous-time multi-state Markov models estimated transition-specific adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), controlling for age, body-mass index (BMI), baseline adhesion severity, and adjuvant therapy. Internal validation used 200-bootstrap c-index and calibration.

Results: Of 210 participants, 83 women (39.5%) had any recurrence and 28 (13.3%) progressed to severe adhesions. Pregnancy ≥ 12 weeks occurred in 54 (25.7%) and repeat surgery in 36 (17.1%). Each one-standard-deviation decrease in AMH/FSH increased hazards from mild to moderate (adjusted HR 1.81, 95% CI 1.29-2.54) and from moderate to severe (HR 2.15, 95% CI 1.41-3.28), with a non-significant trend from none to mild (HR 1.20, 95% CI 0.95-1.52). Amenorrhea versus normal was associated with higher hazards for none to mild (HR 1.88, 95% CI 1.23-2.99) and mild to moderate (HR 1.55, 95% CI 1.10-2.18). An interaction suggested that amenorrhea amplified the adverse effect of a low AMH/FSH ratio on progression to severe disease (HR 1.39, 95% CI 1.03-1.88). The model showed good performance, with bootstrap‑corrected C‑index 0.78 (95% CI 0.74-0.82), optimism‑corrected C‑index 0.76, and optimism‑corrected calibration slope 0.94.

Conclusions: Baseline endocrine status summarized by the AMH/FSH ratio and menstrual pattern independently and jointly predict IUA dynamics after adhesiolysis. A biomarker-based, multi-state risk tool may help personalize severity-anchored surveillance and re-intervention after adhesiolysis.

Objectives: To explore the changes in needs among postpartum women and provide a reference for the development of scientific and effective targeted nursing interventions.

Methods: We conducted a longitudinal qualitative study of 18 postpartum women who initially experienced normal vaginal deliveries in China. Participants were selected using a purposive sampling method, and semi-structured interviews were conducted at twenty-four hours, three days, two weeks, and forty-two days during the postpartum period. The study was designed using a phenomenological approach and the data were analyzed using a social-ecological framework.

Results: The study extracted three main themes and eleven subthemes: the micro system (including needs for scientific newborn care guidance, needs for nursing of maternal physiological discomfort, needs for breastfeeding guidance, and Needs for dynamic psychological care of Postpartum), the meso system (including needs for single - room of the ward environment, needs for online consultation after discharge, needs for health education for family members), and the macro system (including needs for birth certificate policy optimization, needs for comprehensive guidance on vaccination, needs for home visit to optimize, and needs for standardized education implementation and personalized, dynamic learning).

Conclusion: This study indicates that the needs of women who have undergone normal vaginal delivery undergo a dynamic change process. Consequently, clinical medical staff should develop health education programs and provide personalized and precise interventions based on varying needs at different stages of the postpartum period.

Objectives: Prevalence, outcome and causal implication of neonatal survival-associated major morbidities remain the central focus of quality improvement of maternal-fetal and neonatal medicine. We aimed to estimate baseline information of neonatal intensive and critical care by analyzing surviving data of all hospitalized neonates from livebirth population.

Subjects and methods: We prospectively collected a datafile consisting of 10,840 (13.72%) cases as all hospitalized neonates from 79,012 livebirths in Handan in 2020, a sub-provincial region with 9.41 million population and intermediate-to-high level of socioeconomic development in north China. The diagnoses of diseases requiring intensive and/or critical care, and causes of deaths, were categorized, and perinatal and disease-specific risks of death were estimated by multivariable logistic regression models.

Results: Livebirth-based incidence of major perinatal comorbidities were 19.7‰ for congenital pneumonia/early onset sepsis, 12.1‰ intraventricular hemorrhage, 8.7‰ birth asphyxia, 8.7‰ respiratory distress syndrome (RDS), 7.7‰ sepsis and 6.8‰ congenital anomalies (CA). Case-fatality rate (cause-specific mortality rate referring to livebirths) of major diseases were 47.1% (0.2‰) pulmonary hemorrhage, 26.9% (0.1‰) necrotizing enterocolitis, 15.6% (0.2‰) late onset sepsis, 14.1% (1.2‰) RDS, 11.3% (0.8‰) CA, and 11% (1.0‰) asphyxia. There were 242 (2.2%) died in hospital (3.1‰ of all livebirths), 52.1% being in the preterm, 49.2% in low birthweight, and <40% in those <28 weeks of gestation, or <1000 g birthweight, respectively. Death risks associated with the perinatal and neonatal morbidities were markedly declined with variable magnitudes as estimated by multivariable logistic regression models.

Conclusions: The incidence rates of major perinatal comorbidities, neonatal mortality rates, and major risks to the overall and specific outcome of all the hospitalized neonates in Handan, denote baseline characteristics and efficiency of the regional perinatal-neonatal care system.

Objectives: To explore the genetic value and clinical management strategies for subsequent pregnancies in women with a history of adverse obstetric outcomes.

Methods: 204 pregnant women with a history of adverse obstetric outcomes, including spontaneous abortions and/or offspring with developmental anomalies, were retrospectively enrolled. The subjects were categorized into four groups based on the adverse characteristics of previous obstetric histories: inborn developmental anomalies group (IDAG, n = 53), genetic anomalies group (GAG, n = 35), composite group (CG, n = 52), and unknown etiology group (UEG, n = 64). In the subsequent pregnancy, the following strategies were conducted: ① All the fetuses underwent standardized ultrasound screening; ② Invasive fetal prenatal diagnosis were performed, including karyotyping (n = 204), copy number variation sequencing (CNV-seq, n = 161) and whole exome sequencing (WES, n = 11); ③ Dynamic ultrasound assessments and clinical follow-ups of pregnancy outcomes ranging from six months to six years were carried; ④ Fetal outcomes and maternal clinical characteristics among the different groups were further compared.

Results: ① Mean maternal age was not significant among four groups, however, the median gravidity and the median number of spontaneous abortion in UEG were the highest (p < 0.05). ② 8.33% (17/204) fetal genetic anomalies in subsequent pregnancy were found with abnormal chromosomes and 13.04% (21/161) anomalies were found by CNV-seq, among which 12 were investigated additionally. However, no significant difference was in the detection rate (DR) of karyotypes or CNVs among four groups. ③ 13 (6.37%, 13/204) fetuses presented abnormal ultrasonic manifestations accompanied with CNVs or pathogenic genes, and the DR of 9.38% (6/64) in abnormal manifestations of UEG was the highest. ④ 17 (8.33%, 17/204) chose termination and the survivors' growth and development were normal in the follow-ups from six months to six years.

Conclusion: Prenatal genetic diagnosis should be recommended for all subsequent pregnancies of families with adverse obstetric history. In addition, dynamic ultrasound and follow-up management are essential for clinicians to optimize neonatal outcomes.

Objective: To evaluate the contribution of the Causes of Death and Associated Condition (CODAC) classification system in reducing the proportion of nonspecific and unspecified causes of stillbirths compared to the ICD-10 system and to assess maternal and pregnancy-related factors associated with stillbirth in Brazil.

Methods: A retrospective cross-sectional study was conducted in ten tertiary obstetric care facilities in Brazil, including cases of stillbirths 2009 to 2018. Data were obtained from medical records, death certificates, and postmortem investigations. The CODAC system was applied to identify specific causes of death, and maternal and pregnancy characteristics were evaluated to find associations with stillbirth. Agreement between the two systems was assessed using the kappa coefficient, and McNemar's test was used to evaluate differences in the prevalence of unspecified causes.

Results: Of the 3390 initially assessed cases, 2545 were included in the final analysis. The CODAC system reduced the proportion of unspecified stillbirths from 40.79% (ICD-10) to 22.00%. Regional disparities were evident. Cases with unspecified causes (ICD-10 P20/P95) were more prevalent in the northeast (56.4%), whereas other specific ICD-10 causes were predominant in the southeast (47.9%). Maternal conditions such as preeclampsia (24.0% vs. 18.6%, p = 0.004) and placental abruption (20.6% vs. 10.0%, p < 0.001) were significantly associated with cases in which a specific cause of stillbirth was assigned. The agreement between the classification systems was low (kappa = 0.376), and McNemar's test showed a significant difference (p < 0.001).

Conclusion: The CODAC improves the understanding of causes of death over the ICD-10 classification system currently used in Brazil. The CODAC was able to decrease the proportion of unexplained cases, which could potentially contribute to better informing maternal and perinatal health policies.