Journal of Maternal-Fetal & Neonatal Medicine最新文献

Onset of uterine contractions which become progressively more frequent, intense and last for longer durations as the labor progresses is expected to cause a gradually evolving hypoxic stress to human fetuses. This is because of the repeated constriction of maternal spiral arterioles supplying the placental bed and compression of the umbilical cord as the labor advances. The majority of fetuses are able to mount physiological compensatory responses to protect their high priority central organs by maintaining aerobic metabolism. However, fetuses who are exposed to preexisting compromise such as chronic utero-placental insufficiency, chorioamnionitis or chronic fetal anemia and acidosis may not have sufficient reserves to withstand further hypoxic stress, leading to rapid decompensation and neurological injury or death. Physiological interpretation of fetal heart rate changes involves recognition of specific features of both hypoxic and non-hypoxic stresses on the cardiotocograph (CTG) and determining the fetal compensatory responses to ongoing stress. This approach which is based on the cardinal principle of individualization of care will enable frontline clinicians to differentiate features of compensation from decompensation. Timely interventions to improve intrauterine environment and/or to accomplish urgent birth will help avoid hypoxic ischemic encephalopathy (HIE) and its long term sequalae (cerebral palsy or learning difficulties) and perinatal deaths. Conversely, continuation of labor with careful observation in fetuses with compensated gradually evolving hypoxic stress will help avoid unnecessary intrapartum operative interventions. Emerging evidence suggests reduction in the rates of both HIE and emergency cesarean sections following the implementation of principles of physiological interpretation of CTG.

Objective: To investigate maternal and neonatal outcomes and influencing factors in pregnant women with borderline hypertension.

Methods: This prospective cohort study consecutively enrolled 600 pregnant women receiving prenatal care at two hospitals between January 1 and December 31, 2024. Participants were divided into a normotensive control group (n = 300) and a borderline hypertension group (systolic 130-139 mmHg and/or diastolic 80-89 mmHg, n = 300). The primary outcome was progression to hypertensive disorders of pregnancy (HDP). Maternal and neonatal outcomes were compared, and influencing factors were analyzed.

Results: Women with borderline hypertension exhibited significantly higher rates of cesarean delivery (63.0% vs. 42.0%; p < 0.001), HDP progression (27.0% vs. 0.0%; p < 0.001), fetal growth restriction (15.7% vs. 2.7%; p < 0.001), and NICU admission (13.7% vs. 4.0%; p < 0.001) compared to normotensive controls. Notably, later gestational age at onset of borderline hypertension was identified as a protective factor against HDP progression (OR = 0.785 per week; 95% CI: 0.724-0.851; p < 0.001), corresponding to a 21.5% risk reduction for each delayed week of onset.

Conclusion: Borderline hypertension is associated with markedly increased adverse perinatal outcomes. Early detection and intervention-especially for women developing borderline elevation before 20 weeks-may help mitigate HDP progression. Integrating blood pressure trajectory monitoring into routine prenatal care is recommended.

Objective: To analyze and evaluate the efficacy of different blue light therapy methods and provide evidence-based recommendations for their selection in clinical practice.

Methods: Clinical randomized controlled trials (RCTs) evaluating the efficacy of various blue light therapy methods for neonatal jaundice were retrieved from both domestic and international databases. The search period covered the inception of each database until November 2023. After screening, the quality of the included studies was assessed using the Cochrane Risk of Bias tool. Literature management was conducted with NoteExpress 3.2, while data collection and extraction were performed using Excel 2003. Statistical analysis was carried out using RevMan 5.4.1. Heterogeneity was assessed using the Q test (p value), and the OR value of the combined effect was calculated using either a fixed-effects or random effects model, depending on the presence of heterogeneity. A forest plot was generated to visualize the results. Sensitivity analysis was performed by excluding the largest-weighted study, and the potential for bias in outcome indicators was assessed using a funnel plot.

Results: A total of 652 articles were retrieved, with 16 clinical RCTs meeting the inclusion criteria. The meta-analysis results indicated that, compared to continuous blue light therapy in the control group, intermittent blue light therapy achieved a higher total effective rate (OR = 1.82, 95%CI (1.25-2.64), p = .002), significantly lower serum bilirubin levels post-treatment (OR = -14.59, 95%CI (-26.11 to -3.08), p = .01), and a shorter time to jaundice resolution (OR = -2.35, 95%CI (-3.83 to -0.87), p = .002). Additionally, the incidence of adverse reactions was lower in the intermittent therapy group compared to the control group (OR = 0.27, 95%CI (0.19-0.36), p < .00001). Sensitivity analysis confirmed that the combined effect size was stable and reliable (OR (95%CI) = -16.23 (-28.67 to -3.79), p = .01). The funnel plot suggested potential publication bias.

Conclusions: Intermittent blue light therapy is effective and demonstrates significant clinical benefits, making it a valuable treatment option for neonatal jaundice in clinical practice.

Objective: To investigate the diagnostic efficacy and detection value of matrix metalloproteinase-9 (MMP-9) and VEGF in menacing pernicious placenta previa (PPP).

Method: Among all the cases of PPP, a critical condition within the Placenta Accreta Spectrum (PAS) caused by aberrant implantation of the placenta in the uterine wall, which were analyzed between April 2021 and March 2023, there were sixty-three cases. The control group consisted of those sixty-three women who had a normal placenta. Serum levels of MMP-9 and VEGF were measured and compared in both groups. The expression levels of MMP-9 and VEGF were analyzed along with ultrasound scores related to different degrees of placental implantation. Comparisons between groups were performed using t-tests and one-way ANOVA. The diagnostic efficacy of each of the indicators was determined using receiver operating characteristic (ROC) curves by calculating the area under the curve (AUC) and Youden's index.

Results: MMP-9, VEGF expression, and ultrasound scores of pregnant women in the PPP group were significantly higher than those in the control group (p < 0.05). Logistic regression analysis demonstrated that MMP-9, VEGF, and ultrasound scores were significantly associated with PPP (p < 0.05). ROC curves indicated that serum MMP-9, VEGF, and ultrasound scores predicted the AUC of 0.802, 0.817, and 0.983 for PPP, respectively. The Youden's index values were 0.492, 0.540, and 0.826, respectively.

Conclusion: MMP-9, VEGF, and ultrasound scores help predict placental implantation in PPP, which, in turn, provides significant support for clinical understanding.

Objective: To evaluate the diagnostic accuracy of combined vaginal and abdominal color Doppler ultrasonography for ovarian cyst torsion.

Methods: In a cross-sectional diagnostic study from January 2019 to October 2023, 86 patients suspected of ovarian cyst torsion were assessed using vaginal and abdominal ultrasonography. Pathological findings were the gold standard. Diagnostic performances were analyzed using ROC curves.

Results: Vaginal ultrasonography had a sensitivity of 76%, specificity of 61%, and AUC of 0.686. Abdominal ultrasonography showed a sensitivity of 72%, specificity of 50%, and AUC of 0.610. Combined use resulted in improved sensitivity (84%), specificity (72.2%), and the highest AUC (0.781). The combined method significantly outperformed abdominal ultrasonography in accuracy and AUC.

Conclusion: Vaginal ultrasonography alone is more accurate than abdominal ultrasonography for diagnosing ovarian cyst torsion. The combination of both methods enhances diagnostic precision, offering significant benefits for early diagnosis and treatment planning.

Introduction: Following the implementation of the universal two-child policy in China, many multiparous women who had a history of induced abortion gave birth again. However, there is a lack of studies exploring the associations between induced abortion for nonmedical reasons and maternal and neonatal perinatal complications.

Methods: In this retrospective cohort study, the participants were multiparous women who gave birth to singleton babies at or after 28 weeks of gestation between 1 December 2015, and 1 December 2020. The exposure factor was a maternal history of induced abortion for nonmedical reasons. Logistic regression models were used to adjust for potential confounding factors, and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for maternal and neonatal perinatal outcomes. The dose-effect relationships between the number of induced abortions for nonmedical reasons and adverse outcomes were tested by the Cochran-Armitage trend test (p for trend). Stratified analyses were conducted to test the robustness of the results in subgroups with different maternal ages or interpregnancy intervals.

Results: There were 3985 multiparous women with a history of induced abortion for nonmedical reasons and 1823 multiparous women without such a history. Compared to women without such a history, women with a history of induced abortion for nonmedical reasons had increased risks of cesarean section (adjusted OR, 1.44; 95% CI: 1.23 - 1.69), placenta-related complications (adjusted OR, 2.14; 95% CI: 1.68 - 2.72), uterine-related complications (adjusted OR, 1.24; 95% CI: 0.97 - 1.59), HDP (adjusted OR, 1.49; 95% CI: 1.16 - 1.93), and preterm birth (adjusted OR, 1.24; 95% CI: 1.05 - 1.48) in subsequent pregnancy. In addition, there were dose-effect relationships between the number of induced abortions and the number of cesarean sections (P_trend <.001), placenta-related complications (P _trend <.001), uterine-related complications (P_trend =.016), HDP (P_trend =.0003), and preterm birth (P _trend =.0006). Similar trends were observed in most subgroups with different maternal ages or interpregnancy intervals.

Conclusions: A history of induced abortion for nonmedical reasons was associated with increased risks of maternal and neonatal perinatal complications. Furthermore, dose-effect relationships were observed for these associations.