Journal of Maternal-Fetal & Neonatal Medicine最新文献

Background: Placenta Accreta Spectrum (PAS) disorders has been reported to be associated with a maternal mortality rate of 7-10%, worldwide, and many women who survive, experience life changing morbidity. Triple P procedure (p- perioperative placental localization and incision on the myometrium above the upper border of the placenta; p- pelvic devascularisation; and p-placental non-separation and myometrial excision) was developed in 2010 as a novel conservative alternative to peripartum hysterectomy to avoid severe maternal morbidity and mortality). There have been several modifications to the original Triple P Procedure to achieve "pelvic devascularisation" based on locally available resources.

Objective: To determine the effectiveness of the Triple P Procedure and its modifications on reducing the blood loss and the rate of peripartum hysterectomy in women who were diagnosed to have placental accreta spectrum (PAS) by reviewing the published literature.

Materials and methods: PubMed, Embase and Google Scholar Search searches were made using "Triple P" and "Modified Triple P." Papers selected were assessed independently for content, data extraction and analysis. The following parameters were included for the analysis: total number of cases, total EBL, need for blood transfusion, injury to adjacent pelvic organs (urinary bladder, ureter, bowel), need for embolization, admission to intensive care unit (ICU), post-operative in-patient hospital stay, peripartum Hysterectomy, for "Modified" Triple P Procedure, the nature of the modification.Study characteristics were extracted using a predesigned data extraction table.

Results: The literature search identified 6 articles on the Triple P Procedure and 8 articles on the modified Triple P Procedure which were deemed eligible for analysis and comparison, based on the inclusion criteria. 75 patients had the Triple P procedure with an estimated mean blood loss of 2.31 L and a blood transfusion rate of 52%. The bladder injury rate was only 1.3%. None of the patients had a peripartum hysterectomy. Overall, 654 patients had the Modified Triple P procedure with an estimated mean blood loss of 1.4 L and a blood transfusion rate of 64.5%. The mean hospital stay was 3.86 days and 6.1% had a peripartum hysterectomy.

Conclusion: The Triple P Procedure and the Modified Triple P procedure are associated with lower estimated blood loss as compared to the reported rates with a peripartum hysterectomy. The Triple P Procedure was associated with lower rates of inadvertent injuries to the bladder and ureters as compared to the Modified Triple P Procedure and reported rates with peripartum hysterectomy. Both the Triple P and the Modified Triple P Procedure are associated with very low rates of peripartum hysterectomy (0% and 6.1%, respectively).

Objective: There is an increase in the application data of Extracorporeal Membrane Oxygenation (ECMO) in perinatal women, particularly since the outbreak of coronavirus disease 2019. Therefore, we reviewed publications on the use of ECMO in pregnant and postpartum women and analyzed the maternal and fetal outcomes, updated the progress of ECMO in perinatal women.

Methods: We conducted a systematic literature search across PubMed, EMBASE, Cochrane Library, and the International Clinical Trials Registry (ICTRP), yielding 30 eligible clinical studies that investigated the application of ECMO during pregnancy. A comprehensive data extraction process was implemented to retrieve information from these selected studies. A single rate analysis on material survival, material harmonic compilations, and fetus survival were performed by R software.

Results: Of the 1460 women included, our primary outcome was maternal survival: 74.4% (95% confidence interval [CI]: 67.8%-81.1%). Among them, the survival rate of VV ECMO patients was 83.6% (95% confidence interval [CI]: 76.4%-90.8%); the survival rate of VA ECMO patients was 62.8% (95% confidence interval [CI]: 48.7%-76.8%). The secondary outcomes were maternal hemorrhagic complications: 34.8% (95% [CI]: 24.1%-45.5%), and fetal survival: 73.2% (95% [CI]: 62.0%-84.4%).

Conclusions: Our analysis revealed that the outcomes of ECMO (both type) use in pregnant patients may be comparable or superior to those observed in non-pregnant cohorts. Moreover, patients treated with VV ECMO exhibited a significantly higher survival rate compared to those on VA ECMO.

Details of registration: The protocol for this systematic review was registered on INPLASY (2022110036) in 11 November 2022.

Objective: Fetal cerebellar abnormalities are associated with neurodevelopmental disorders and structural brain malformations. Accurate and early diagnosis is crucial for prenatal counseling and planning postnatal interventions. While prenatal ultrasound is a key tool for detecting fetal brain abnormalities, variations in diagnostic accuracy across studies necessitate a systematic evaluation of its effectiveness in diagnosing cerebellar abnormalities.

Methods: A comprehensive literature search was conducted across major databases to identify relevant studies on prenatal ultrasound for diagnosing cerebellar anomalies. Inclusion criteria included studies with clear diagnostic outcomes, diverse patient populations, and standardized ultrasound protocols. Meta-analytic techniques were employed to assess overall diagnostic accuracy, sensitivity, specificity, and heterogeneity using Meta Disk. The quality of the included studies was evaluated using the QUADAS-2 tool.

Results: The meta-analysis included fifteen studies involving 1,902 fetuses with suspected cerebellar abnormalities. The pooled sensitivity and specificity of prenatal ultrasound were 0.83 (95% CI: 0.80-0.86) and 0.97 (95% CI: 0.96-0.98), respectively. The positive likelihood ratio was 7.96 (95% CI: 3.23-19.64), the negative likelihood ratio was 0.18 (95% CI: 0.09-0.36), and the odds ratio was 46.76 (95% CI: 14.06-155.53). The combined area under the curve (AUC) reached 0.93, indicating robust diagnostic performance. Heterogeneity was observed, influenced by factors such as gestational age at screening, operator expertise, and ultrasound equipment quality.

Conclusions: Prenatal ultrasound is a reliable tool for detecting cerebellar abnormalities with high sensitivity and specificity. However, variability in diagnostic performance suggests the need for standardized protocols and advanced imaging techniques to enhance accuracy. Future research should focus on integrating multiple imaging modalities to optimize prenatal screening outcomes.

Purpose: This review aims to identify and analyze the risk factors associated with recurrent pregnancy loss (RPL) and to evaluate the effectiveness of various predictive models in estimating the risk of RPL. The review also explores recent advancements in machine learning algorithms that can enhance the accuracy of these predictive models. The ultimate goal is to provide a comprehensive understanding of how these tools can aid in the personalized management of women experiencing RPL.

Materials and methods: The review synthesizes current literature on RPL, focusing on various risk factors such as chromosomal abnormalities, autoimmune conditions, hormonal imbalances, and structural uterine anomalies. It also analyzes different predictive models for RPL risk assessment, including genetic screening tools, risk scoring systems that integrate multiple clinical parameters, and machine learning algorithms capable of processing complex datasets. The effectiveness and limitations of these models are critically evaluated to provide insights into their clinical application.

Results: Key risk factors for RPL were identified, including chromosomal abnormalities (e.g. translocations and aneuploidies), autoimmune conditions (e.g. antiphospholipid syndrome), hormonal imbalances (e.g. thyroid dysfunction and luteal phase defects), and structural uterine anomalies (e.g. septate or fibroid-affected uteri). Predictive models such as genetic screening tools and risk scoring systems were shown to be effective in estimating RPL risk. Recent advancements in machine learning algorithms demonstrate potential for enhancing predictive accuracy by analyzing complex datasets, which may lead to improved personalized management strategies.

Conclusions: The integration of risk factors and predictive modeling offers a promising approach to improving outcomes for women affected by RPL. A comprehensive understanding of these factors and models can aid clinicians and researchers in refining risk assessment and developing targeted interventions. The review underscores the need for further research into specific pathways involved in RPL and the potential of novel treatments aimed at mitigating risk.

Introduction: The Jada System^® is an FDA-cleared vacuum-induced hemorrhage-control device for the control and treatment of abnormal postpartum uterine bleeding or hemorrhage when conservative management is warranted. The instructions for use for Jada contain a warning stating that the safety and effectiveness of the Jada System in delivery at a gestational age less than 34 weeks or, if multiples, uterus judged less than 34 weeks size, have not been established. While the primary analysis of the RUBY registry, an 800 subject post-approval RWE study of the usage of Jada, included 50 individuals who had preterm births less than 34 weeks gestational age (wGA), the safety and outcomes were not evaluated specifically for less than 28 wGA and 28 to less than 34 wGA subgroups.

Methods: We conducted a descriptive subgroup analysis of the real-world RUBY registry to assess the safety and effectiveness of Jada for postpartum hemorrhage management in preterm births less than 34 weeks (less than 28 wGA and 28 to less than 34 wGA). Of the 50 individuals treated, 24 had vaginal births and 26 had cesarean births.

Results: Treatment success rates were 85.7% at less than 28 wGA (81.8% vaginal [9/11], 100% cesarean [3/3]) and 88.9% at 28 to less than 34 wGA (100% vaginal [13/13], 82.6% cesarean [19/23]). No maternal deaths, uterine perforations, device expulsions, or serious adverse device effects (ADEs) were reported in either subgroup. Two nonserious ADEs were reported in 1 individual (endometritis and bacterial vaginosis); 2 individuals required hysterectomy (1 vaginal, 1 cesarean).

Conclusion: Results for the less than 28 wGA and 28 to less than 34 wGA subgroups were consistent with the overall less than 34 wGA subgroup, which was previously shown to be consistent with births ≥34 wGA; however, continued attention to uterine size is warranted before device placement in births less than 34 wGA.

Clinical trial registration: ClinicalTrials.gov; NCT04995887.

Objective: This study aimed to assess the relationship between increased body mass index (BMI) with severe maternal morbidity (SMM).

Study design: We obtained data for a retrospective cohort of singleton live births using an electronic birth certificate database from 2010 to 2022 in Central New York. Institutional review board exemption was obtained. Pre-pregnancy BMI was assessed as a continuous variable and a categorical variable with groups of BMI <18.5 kg/m², 30-39.9 kg/m², 40-49.9 kg/m², and ≥50 kg/m² compared to patients with BMI 18.5-29.9 kg/m². Primary outcomes were maternal intensive care unit (ICU) admission and composite SMM defined as ICU admission, unplanned hysterectomy, reoperation, eclampsia, and blood transfusion. Secondary outcomes were the individual SMM components, 5-minute APGAR score <7, and neonatal intensive care unit (NICU) admission. ANOVA and χ² were used to compare continuous and categorical variables respectively, and logistic regression was used to obtain adjusted odds ratios for primary and secondary outcomes.

Results: There were 223,837 patients with singleton live births with mean BMI 27.86 kg/m². 54,385 (24.3%) had BMI 30-39.9 kg/m², 13,299 (5.9%) had BMI 40-49.9 kg/m², and 1,958 (0.87%) had BMI ≥50 kg/m². 3,203 (1.4%) patients experienced SMM, and 423 (0.2%) patients were admitted to ICU. For each 1-point increase in BMI the adjusted odds ratio (aOR) of SMM increased by 0.8% (aOR 1.008, 95% CI 1.002-1.013) and ICU admission increased by 2.0% (aOR 1.02, 95% CI 1.005-1.034). Odds of ICU admission for those with BMI 40-49.9 kg/m² increased by 69% (aOR 1.69, 95% CI 1.16-2.47); BMI ≥50 kg/m² increased by 300% (aOR 3.01, 95% CI 1.53-5.91), but those with BMI 30-39.9 kg/m² did not have significantly higher odds of ICU admission (aOR 1.09, 95% CI 0.84-1.42).

Conclusion: Increasing BMI was significantly associated with increased SMM and maternal ICU admission.

Background: Pregnancy gingivitis is a common oral health issue that affects both maternal and fetal health. This study aims to evaluate the effectiveness of periodontal treatment in preventing pregnancy gingivitis, preterm birth, and low birth weight through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive literature search was performed across CINAHL, Scopus, Cochrane, and PubMed/Medline databases from 2000 to the present. Study selection and data extraction were independently carried out by two reviewers. Statistical analyses, including heterogeneity tests, sensitivity analysis, and publication bias assessment, were conducted using RevMan 5.4 and R software.

Results: A total of 13 studies were included. The meta-analysis indicated that periodontal treatment might have a potential effect on preventing pregnancy gingivitis, but this was not statistically significant (OR = 0.85, 95% CI [0.68, 1.06], I² = 51%). Subgroup analysis revealed that periodontal treatment significantly reduced the rates of preterm birth and low birth weight in lower-quality studies, but no significant effects were observed in higher-quality studies. Sensitivity analysis and publication bias tests confirmed the stability and reliability of the results.

Conclusion: While lower-quality studies suggest that periodontal treatment may positively impact pregnancy gingivitis, preterm birth, and low birth weight, these effects were not supported by higher-quality evidence. Further well-designed RCTs are needed to confirm these findings and ensure their reliability. Periodontal treatment could potentially be considered as part of prenatal care to improve maternal oral health and pregnancy outcomes.

Background: Preterm birth, a significant global health concern, has been associated with alterations in the gut microbiota. However, the causal nature of this relationship remains uncertain due to the limitations inherent in observational studies.

Purpose: To investigate the potential causal relationship between gut microbiota imbalances and preterm birth.

Methods: We conducted a two-sample Mendelian randomization (MR) study using genome-wide association study (GWAS) data from the MiBioGen consortium focusing on microbiota and preterm birth. Single nucleotide polymorphisms (SNPs) associated with the microbiota were selected as instrumental variables. The inverse variance weighting (IVW) method was used to estimate causality. We confirmed pleiotropy and identified and excluded outlier SNPs using MR-PRESSO and MR-Egger regression. Cochran's Q test was applied to assess heterogeneity among SNPs, and a leave-one-out analysis was performed to evaluate the influence of individual SNPs on overall estimates.

Results: Our findings provide evidence for a causal link between specific components of the gut microbiota and preterm birth, with the identification of relevant metabolites.

Conclusion: This study highlights the causal role of gut microbiota imbalances in preterm birth, offering novel insights into the development of preterm birth and potential targets for prevention strategies.

Objectives: Intrahepatic cholestasis of pregnancy (ICP), a condition exclusive to pregnancy, necessitates prompt identification and intervention to improve the perinatal outcomes. This study aims to develop suitable machine-learning models for predicting ICP based on clinical and laboratory indicators.

Methods: This study retrospectively analyzed data from 1092 pregnant women, with 537 diagnosed with ICP and 555 healthy cases as a control. Two study schemes were devised. For scheme 1, 62 indicators from the first period of gestation were utilized to establish predictive models. For scheme 2, 62 indicators from at least two periods of gestation were utilized to establish predictive models. Under each scheme, three different machine-learning models were developed based on the Arya Privacy Computing Platform, encompassing Support Vector Machine (SVM), Deep Neural Network (DNN), and Xgboost for Scheme 1, and Recurrent Neural Network (RNN), Long Short-Term Memory Network (LSTM), and Gated Recurrent Unit (GRU) for Scheme 2. The predictive efficacy of each model on ICP was evaluated and compared.

Results: Under Scheme 1, the cohort comprised 1092 pregnant women (537 with ICP, 555 healthy). The SVM model exhibited a sensitivity, specificity, and accuracy of 85.5%, 47.50%, and 67.90%, respectively, while DNN showed 65.70%, 92.70%, and 79.40%, respectively, and Xgboost achieved 65.60%, 81.90%, and 73.40%, respectively. In Scheme 2, 899 pregnant women were analyzed (466 with ICP, 433 healthy). RNN demonstrated a sensitivity, specificity, and accuracy of 97.60%, 82.10%, and 90.50%, respectively; LSTM presented 90.70%, 81.70%, and 86.60%, respectively; and GRU achieved 89.90%, 83.80%, and 89.40%, respectively.

Conclusion: DNN and RNN are the two most suitable models to predict ICP in a convenient and available way. It provides flexible choice for medical staff and helps them optimize the therapeutic strategies to meet different clinical setting and improve the clinical prognosis of ICP.

Objective: To assess the neonatal survival rates, maternal complications, neonatal complications, and factors associated with survival rates following periviable premature rupture of membranes (PROM) between 15 and 23⁺⁶ weeks of gestation.

Materials and methods: The retrospective study included patients with periviable PROM between 15 and 23⁺⁶ weeks of gestation from January 1, 2008, to December 31, 2022. Multivariate regression analysis was performed to identify factors influencing neonatal survival.

Results: A total of 71 cases of periviable PROM between 15 and 23⁺⁶ weeks of gestation were included in the study, and the neonatal survival rate was found to be 26.8%. Maternal complications occurred in 59.2% of cases. Of the 19 surviving newborns, 89.5% experienced neonatal complications. Univariate analysis showed that gestational age at delivery, duration of latency and antenatal steroid administration were the factors significantly associated with increased survival rates after periviable PROM before 24 weeks of gestation.

Conclusion: The survival rate of periviable PROM between 15 and 23⁺⁶ weeks of gestation was 26.8% with neonatal complications of 89.5%. This information may be useful for counseling pregnant women experiencing periviable PROM.