Journal of Maternal-Fetal & Neonatal Medicine最新文献

Background: Acute Kidney Injury (AKI) is common in neonates admitted to the Neonatal Intensive Care Unit (NICU). Neonatal AKI is associated with multiple comorbid conditions of greater clinical severity, which also increase the neonate's risk of mortality. Understanding the risk of mortality, in addition to the severity of AKI, may be useful in determining alternative treatment options for neonates with AKI.

Methods: Two independent datasets containing neonatal patient data from eleven healthcare centers were filtered, cleaned, and combined to produce a dataset fit for training and testing with seven Machine Learning algorithms. After initial modeling with 34 training features, feature elimination was utilized to isolate the most contributing features and create streamlined models. The models were fine-tuned using Bayesian search before being compared to select the most accurate and interpretable architecture.

Results: A patient cohort of 245 patients included 189 alive and 56 deceased neonates with incidence of AKI. Of the 245 patients included in this study, 73.5% were male and 26.5% were female, alongside a median age at entry of 12 h and interquartile range of 35 h. Three tree-based models, Random Forest, XGBoost, and LightGBM, were found to be the most accurate and interpretable of the seven models tested. Support Vector Machine produced similar results, albeit with less interpretability. The RAMA (Raina, Arnav, Max, Aadi) model followed results of the XGBoost algorithm, with Area under the Receiver Operating Characteristic Curve (AUC-ROC) of 0.882 ± 0.132, Accuracy of 0.878 ± 0.052, and F1 Score of 0.923 ± 0.029.

Conclusion: RAMA utilizes a tree-based decision-making algorithm, allowing it to determine the risk of mortality in neonates susceptible to AKI.

Objective: Labor induction is a common obstetric procedure, with success depending on accurate cervical assessment. The Bishop score, used traditionally, is subjective and limited, while transvaginal sonography (TVS) offers objective cervical length measurement. This systematic review and meta-analysis aimed to compare the accuracy of preinduction TVS and Bishop Score in predicting successful labor induction.

Methods: Following PRISMA guidelines, we searched PubMed, Scopus, Web of Science, and Lens.org for articles from January 2015 to October 2024 for observational studies comparing TVS and Bishop Score in term pregnancies (≥37 weeks). Eligible studies reported diagnostic accuracy metrics for successful vaginal delivery. Data were extracted using a standardized form, and study quality was assessed with QUADAS-2. A random-effects meta-analysis calculated pooled log odds ratios (ORs), with heterogeneity assessed via I² and publication bias via fail-safe N, Kendall's tau, and Egger's regression. A p-value <0.05 was considered significant.

Results: Ten studies (n = 1,612 patients) were included from diverse regions (India, Iran, Türkiye). The pooled OR was 2.1726 (95% CI: 0.9493-4.9706, p = 0.0662), suggesting TVS has 2.17 times higher odds of predicting successful induction than Bishop score, though not statistically significant. TVS achieved a 60.2% success rate versus 48.7% for Bishop score (absolute difference: 11.5%). High heterogeneity (I² = 73.12%, p < 0.001) was observed, with TVS performing better in primigravida and prostaglandin induction settings. No publication bias was detected (Fail-Safe N = 35, Egger's p = 0.944).

Conclusion: TVS shows a moderate, non-significant advantage over Bishop score in predicting successful labor induction. High heterogeneity suggests context-specific performance. Further research should explore whether a combined TVS-Bishop score approach could optimize clinical decision-making. Further research is needed to standardize protocols and assess cost-effectiveness across diverse settings.

Objectives: This study aimed to investigate the independent and synergistic associations of obesity and gestational diabetes mellitus (GDM) with cesarean delivery risk, while comparing body mass index (BMI) and body roundness index (BRI) as indicators of obesity in the National Health and Nutrition Examination Survey (NHANES).

Methods: We analyzed cross-sectional data from 6292 women aged ≥20 years in NHANES 2005-2018. Cesarean delivery history and GDM status were self-reported. Obesity was defined as BMI ≥ 30 kg/m² or BRI > 5.5. Weighted multivariable logistic regression models adjusted for demographics (age, race, education, poverty-income ratio), smoking, and alcohol use were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic spline and subgroup analyses evaluated nonlinear relationships and effect modifications. All analyses were performed using R 4.5.1.

Results: Overall, 47.1% reported cesarean delivery. After full adjustment, obesity (BMI-based: aOR = 1.11, 95% CI: 1.06-1.17; BRI-based: aOR = 1.10, 95% CI: 1.05-1.14) and GDM (aOR = 1.09, 95% CI: 1.03-1.16) independently increased cesarean risk. A significant synergistic effect was observed: women with both obesity and GDM had 24% higher risk (BMI-based aOR = 1.24, 95% CI: 1.15-1.34; BRI-based aOR = 1.22, 95% CI: 1.14-1.30) compared to those without either condition. Subgroup analyses revealed that the obesity-related effect was more significant only among women with GDM. BRI demonstrated greater stability than BMI, showing no interaction with smoking history.

Conclusions: Both obesity and GDM independently elevate cesarean delivery risk, with a pronounced synergistic effect when coexisting. BRI performs comparably to BMI but exhibits superior stability in risk prediction. Integrated prenatal screening for metabolic risks and targeted weight management may reduce avoidable cesarean deliveries.

Background: Hysteroscopic tubal occlusion serves as an effective minimally invasive treatment, aiming to improve the efficacy of assisted reproductive technologies by preventing hydrosalpinx fluid from entering the uterine cavity. This study aims to investigate the specific alterations in the intrauterine microenvironment associated with this surgery and its positive impact on the success rate of in vitro fertilization and embryo transfer (IVF-ET).

Methods: This retrospective study included 158 patients with hydrosalpinx who underwent hysteroscopic tubal occlusion between January 2019 and December 2021. Pre- and postoperative evaluations included endometrial total protein levels, cytokines (TNF-α, bFGF, IL-10), immune markers (CD138, CD38, CD68), hormone receptors (ER, PR), uterine microbial composition, postoperative recovery, and IVF-ET pregnancy outcomes.

Results: Postoperative total protein levels in endometrial tissues significantly increased (p < 0.05). Protein levels of CD138, CD38, CD68, ER, and PR were all significantly reduced postoperatively (p < 0.05). The abundance of Lactobacillus increased significantly from 81.56% to 91.71% (χ²=4.153, p = 0.042), while other microbial species showed no significant differences. Pain scores decreased significantly from 3.24 ± 0.68 to 1.36 ± 0.31, and the mean time to return to daily activities was 1.08 ± 0.26 days. IVF-ET outcomes showed a clinical pregnancy rate of 39.87%, ongoing pregnancy rate of 32.91%, live birth rate of 29.75%, and a miscarriage rate of 6.96%, with no ectopic pregnancies reported.

Conclusions: Hysteroscopic tubal occlusion effectively alters the uterine microenviron-ment by modulating immune, hormonal, and microbial profiles, while improving patient recovery and supporting favorable pregnancy outcomes in IVF-ET.

Objective: To describe risk factors for declining antepartum vaccination, including the novel COVID-19 vaccine during the COVID-19 pandemic.

Methods: Retrospective cohort study including women delivering at a single center in the fall and winter of 2021. Patients without vaccine data were excluded. Baseline characteristics collected from the electronic medical record included maternal age, nulliparity, body mass index, insurance, and self-identified race/ethnicity. Those who accepted the COVID-19 vaccine were compared to those who declined. Separate comparisons were done to assess those who accepted and those who declined influenza and tetanus, diphtheria, pertussis (Tdap) vaccines as well. Statistical analysis was performed using Student's t-test, Fisher's exact test, chi square, and logistic regression. The regression model assessed the impact of patient characteristics on vaccine acceptance and was adjusted for age, nulliparity, body mass index, insurance, and race/ethnicity.

Results: Vaccine data was available for 772 patients. The rate of acceptance was 46.1% for COVID-19 vaccine, 58.0% for influenza vaccine, and 80.8% for Tdap vaccine. Those who accepted the COVID-19 vaccine were older (34.3 ± 3.8 years vs 33.0 ± 4.8 years, p < 0.001) and more frequently nulliparous (8.7% vs 2.9%, p < 0.001) than those declining it. Those accepting Tdap were also older (33.8 ± 4.3 vs 32.7 ± 4.9 years, p = 0.006). Insurance type differed across groups for all three vaccines (p < 0.001). Race differed between acceptance and refusal of the influenza and Tdap vaccines, but not the COVID-19 group. In the adjusted analysis, public insurance remained independently associated with reduced acceptance for COVID-19 (aOR 0.28, 95% CI 0.14-0.55) and influenza (aOR 0.38, 95% CI 0.20-0.73), but not for Tdap. Older age and nulliparity were independently associated with increased acceptance of COVID-19.

Conclusion: Public insurance in pregnancy is associated with a decreased likelihood of vaccine acceptance for the COVID-19 and influenza vaccines. Specific efforts for understanding the motivations for declining vaccination are needed to develop strategies to improve uptake in this population.

Objective: To determine the predictive value of serum IGFBP-3 in combination with transvaginal ultrasonography cervical length in singleton pregnancies during the 18-23⁺⁶ weeks' gestational period for the prediction of preterm birth.

Methods: This prospective observational study included singleton pregnant women who received antenatal care at King Chulalongkorn Memorial Hospital at 18-23⁺⁶ weeks' gestation between December 2022 and April 2024. Cervical length was determined by transvaginal ultrasound and serum was collected to measure IGFBP-3 levels. Demographic data and pregnancy outcomes were recorded.

Results: A total of 176 pregnant women were analyzed. Twelve cases (6.8%) of preterm births were identified. Preterm birth prediction, when using serum IGFBP-3 values greater than 6.9 ng/ml, had a sensitivity of 75%, a specificity of 61.5%, a positive predictive value (PPV) of 12.3% and a negative predictive value (NPV) of 97.1%. When cervical length values less than 37 mm were used, the prediction had a sensitivity of 66.7%, a specificity of 44.6%, a PPV of 8%, and a NPV of 94.9%. When serum IGFBP-3 or cervical length was used to predict preterm birth, sensitivity, specificity, PPV and NPV were 83.3%, 27.1%, 7.6% and 95.7%, respectively.

Conclusions: The use of serum IGFBP-3 levels in combination with cervical length had a good sensitivity to predict preterm birth. While NPV is high, the low PPV limits its standalone use to predict preterm birth.

Purpose: The aim of this study was to compare the time to delivery between early (within 2 h) and late (after 2 h) amniotomy and oxytocin initiation in patients undergoing cervical ripening with a cervical ripening balloon (CRB).

Methods: Secondary analysis of data collected from a previous parallel randomized controlled trial comparing CRB removal after 6 versus 12 h. For our study, the full cohort from the original trial was divided into patients who had amniotomy and oxytocin infusion within 2 h of CRB removal (study group) and patients who hadamniotomy and oxytocin more than 2 h after CRB removal (control group). Inclusion criteria were age > 18 years, ≥ 37 gestational weeks, Bishop score < 5, singleton vertex presentation, intact membranes, and no contraindication for vaginal delivery. Primary outcome for the current study was the time from CRB removal to delivery. Secondary outcomes included the rate of cesarean delivery and adverse maternal and neonatal outcomes.

Results: A total of 197 patients were analyzed, 34 in the study group and 163 in the control group. The study and control groups did not differ in baseline characteristics but differences were observed in the treatment characteristics stemming from the division into the two groups for the analysis. Time from CRB removal to delivery was significantly shorter in the study group vs control (9 ± 6.7 vs.17 ± 11.9 h, p < 0.001) respectively. The rate of cesarean deliveries and other maternal and neonatal outcomes were similar in the two groups.

Conclusion: Our findings suggest that early amniotomy and oxytocin infusion combination in patients undergoing labor induction with a CRB is associated with a shorter duration of labor and similar cesarean deliveries rate. Latent confounding remains possible.

Background: Early-onset hypoglycemia is a frequent metabolic complication in preterm infants and may lead to adverse neurodevelopmental outcomes. Accurate risk prediction is essential for timely clinical intervention.

Methods: A retrospective study was conducted on 436 preterm infants admitted to a tertiary hospital in Guangzhou from January 2022 to November 2023. The dataset was randomly divided into a training set (n = 305) and a validation set (n = 131). Univariate analysis and LASSO logistic regression were used to screen predictive variables. A multivariate logistic regression model was developed and visualized as a nomogram. Internal validation was performed using calibration plots, ROC curves, and decision curve analysis (DCA).

Results: A retrospective cohort of 436 preterm infants was analyzed, among whom 124 cases (28.44%) experienced hypoglycemia within 48 h after birth. Multivariate logistic regression identified six independent risk factors: reduced gestational age, multiple births, cesarean delivery, maternal gestational diabetes, gestational hypertension, and abdominal distension observed on the second postnatal day. The predictive model exhibited solid discriminative power, with an AUC of 0.802 in the training group and 0.829 in the validation group. Model calibration was satisfactory across datasets. DCA further supported the model's clinical utility, indicating consistent net benefit over a wide spectrum of risk thresholds.

Conclusion: The model demonstrated promising predictive ability for early-onset hypoglycemia in preterm infants and could potentially serve as a preliminary tool to inform risk stratification strategies. However, its clinical translation requires confirmation through external validation in prospective, multicenter studies before any consideration of widespread implementation.

Objective: Listeria monocytogenes is a pathogenic Gram-positive bacterium that poses a serious threat to pregnant women and their fetuses. This case report aims to highlight the management and outcomes of such an infection in a pregnancy with multiple complications.

Methods: We describe the clinical management of a 33-year-old woman who conceived via in vitro fertilization (IVF) and presented in the third trimester with Listeria monocytogenes infection, complicated by complete placenta previa, a succenturiate placenta, and breech presentation.

Results: Despite prompt medical intervention, intrauterine fetal demise occurred. Following prophylactic uterine artery embolization (UAE), successful vaginal delivery was achieved. Three months postpartum, her menstrual cycle returned to normal. After monitoring her follicles during natural cycles, she successfully conceived again within one cycle, experienced a smooth pregnancy, and ultimately delivered a healthy baby boy at term.

Conclusions: This case underscores the importance of increased awareness regarding the risk of Listeria monocytogenes infection during pregnancy. It discusses the potential of applying next-generation sequencing (NGS) to amniotic fluid samples obtained via amniocentesis for early diagnosis and highlights that performing uterine artery embolization when necessary can help maximize the preservation of fertility.