Journal of Maternal-Fetal & Neonatal Medicine最新文献

Background: Adrenomedullin (AM) is a potent angiogenic, antioxidant and anti-inflammatory peptide protecting the developing lung from injury due to bronchopulmonary dysplasia (BPD) of the preterm infant. At this stage, no data on the potential effects of chorioamnionitis (CA) occurrence and glucocorticoids (GC) administration on AM in developing lungs are still lacking.

Objective: to investigate, in a sheep-based model, the positive/side-effects of combined exposure to CA and GC on AM concentrations measured in bronchoalveolar lavage fluid (BALF).

Methods: Time-mated ewes were randomly admitted to one of six treatment groups receiving injection: saline (controls); lipopolysaccharide (L) in intra-amniotic fluid treated alone at 7 or 14 d before delivery or associated with betamethasone (B) intramuscularly; B treated alone (7d) or associated with L (14d). Lambs were surgically delivered at 120 days gestation and euthanized. BALF was used for AM measurement in the studied groups.

Results: AM BALF levels significantly (p < 0.05, for all) changed both to B and L exposure in a time-dependent manner. The latter was characterized by AM levels at short term superimposable to controls, whilst significantly (p > 0.05) decreased at long-term. The former showed increased AM at short and decreased at long-term (p < 0.05, for all), respectively.

Conclusions: the present results showing AM BALF changes in a sheep-based model support the AM role in the hemodynamic patterns due to CA and BPD occurrence and open the way to further studies investigating the role of vasoactive agents as trustable markers of lung development/damage.

Objective: To compare the diagnostic value of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in cesarean scar pregnancy (CSP) by a method of meta-analysis.

Methods: Studies on TVS and MRI for CSP were collected from PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang data, and Chinese Scientific Journal Database (VIP database) until April 1, 2024. Stata 15.0 software was used for data analysis. Mann-Whitney U-test was applied to compare the diagnostic efficiency of the TVS and MRI groups.

Results: Nine articles with 713 subjects were involved in this review. The pooled sensitivity (0.96, 95%CI: 0.94-0.97), specificity (0.90, 95%CI: 0.84-0.94), and DOR (197.28, 95%CI: 99.71-390.31) in the MRI group were higher than those (Sensitivity = 0.83, 95%CI: 0.77-0.87; Specificity= 0.74, 95%CI: 0.63-0.83; DOR = 13.66, 95%CI: 7.84-23.79) in the TVS group. The positive likelihood ratio and negative likelihood ratio of the MRI group were 9.56 (95%CI: 8.82-15.72) and 0.05 (95%CI: 0.03-0.07), while those of the TVS group were 3.21 (95%CI:2.18-4.74) and 0.24 (95%CI: 0.18-0.31), respectively. In the MRI and TVS groups, the area under the curve (AUC) of the summary receiver operating characteristic was 0.9497 and 0.86, respectively. The results of Mann-Whitney U-tests of the two groups showed significant differences in the pooled sensitivity (Z= -3.311, p < 0.001), specificity (Z= -2.123, p = 0.034), and DOR (Z= -3.272, p = 0.001).

Conclusion: Both MRI and TVS can effectively diagnose CSP. However, compared with TVS, MRI has better diagnostic accuracy for CSP, with higher sensitivity and specificity. Considering the good diagnostic accuracy of ultrasound, patients with ultrasound suspicion of CSP should be sent to a reference center where MRI can express its full diagnostic potential regarding depth, topography of invasion and myometral residue, which is useful for subsequent management.

Purpose: Cerebral vein thrombosis is a rare, life-threatening condition that has now become more commonly diagnosed due to advancements in imaging techniques. Our purpose is to improve understanding of pathogenesis, diagnosis and pregnancy and IVF management in patients with a history of cerebral thrombosis.

Materials and methods: We present an overview of the modern tactics of anticoagulant therapy for cerebral thrombosis with a focus on pregnancy, the use of hormone therapy, and assisted reproductive technologies.

Results: The most common risk factors for cerebral vein thrombosis are pregnancy, the postpartum period, and the use of oral contraceptives, which explains the high incidence of this pathology in women. The development of cerebral thrombosis is a vivid example of the interaction and synergetic effects of persistent factors that cause an increased risk of thrombotic complications, which include thrombophilia and acquired risk factors. Despite the possible risks, pregnancy after previously suffered cerebral thrombosis is not contraindicated provided adequate anticoagulant therapy.

Conclusions: The most common provoking factors for the development of cerebral thrombosis in women are pregnancy and the use of estrogen-containing drugs. The issue of thromboprophylaxis during pregnancy, when using ART methods and the possibility of using hormonal therapy after cerebral vein thrombosis requires further study.

Objective: A comprehensive management model called the one-day care clinic has been established and implemented throughout the hospitals as well as maternal and child health care centers for gestational diabetes mellitus (GDM) in China. However, there is still a lack of high-level evidence for this management model. The objective of this study was to describe the one-day outpatient management model and assess its efficacy in managing GDM.

Methods: A retrospective review was performed on patients who were admitted to the obstetrics clinic and diagnosed as GDM at our centers from July 2017 to June 2022. All enrolled patients were divided into two groups: the experimental group that participated in the one-day outpatient management and the control group that only received routine education on gestational diabetes in the outpatient department. Baseline characteristics and clinical data of enrolled patients were reviewed. Blood glucose level before and after attending one-day outpatient management, blood glucose and HbA1c before delivery, weight gain at the end of pregnancy, complications during pregnancy and pregnancy outcomes were collected.

Results: A total of 546 patients were finally included in this study, with 276 in the experimental group and 270 in the control group. There were no significant differences between the two groups in terms of baseline characteristics. The 1h postprandial blood glucose (PBG) and 2h PBG levels were significantly lower after participating in the one-day outpatient management compared to before (all p value < 0.01). Before delivery, the FBG, 2hPBG, and HbA1c levels in the experimental group were significantly lower than those in the control group (all p value < 0.01). The experimental group experienced less weight gain and had a higher rate of achieving weight gain goals compared to the control group. In terms of complications during pregnancy, the incidence of premature rupture of fetal membranes, pregnancy induced hypertension, and hydramnion did not differ significantly between the two groups. In terms of pregnancy outcomes, the incidence of macrosomia and neonatal hypoglycemia in the experimental group was significantly lower than in the control group (all p value < 0.05).

Conclusion: The adoption of the one-day outpatient management is more beneficial for controlling blood glucose levels and weight target during pregnancy in GDM patients. Additionally, this management can decrease the occurrence of adverse pregnancy outcomes, and improve the prognosis of both GDM patients and offspring.

Introduction: Intraamniotic infection (IAI) is one of the main possible complications of preterm prelabor rupture of membranes (PPROM) and can lead to severe consequences for the neonate, such as early onset neonatal sepsis (EONS). Available diagnostic tools for IAI have poor diagnostic performance, which may result in both over- and underdiagnoses of IAI. In a search for better diagnostic tools, we have examined short-term variation (STV) in fetal heart rate. We have previously shown that in IAI exposed pregnancies, the STV was more than 20% lower in the last cardiotocography trace before the start of labor, as compared to those not exposed to IAI. The association between IAI and STV needs further evaluation and we therefore continued by examining the longitudinal change in STV in association with IAI.

Material and methods: We performed a historical cohort study on 628 singleton pregnancies with PPROM, delivering between 24 + 0 to 33 + 6 gestational weeks. The main exposure of the study was IAI, using EONS as a proxy as no easily available method exists for confirming IAI antepartum, and IAI and EONS are strongly associated. The main outcome was STV in fetal heart rate. At least two available cardiotocography traces per fetus were required as a minimum, from PPROM or from seven days before birth, whichever came later, until the start of labor or planned cesarean birth. A total of 9 690 cardiotocography traces were analyzed.

Results: Fetuses exposed to IAI had a 26.5% steeper decline in their STV during the last 24 h before the start of labor when compared to fetuses not exposed (95% CI -32.9% to -19.4%; p < 0.001). After adjustment for antenatal corticosteroids, the decline remained significant. The decline became less prominent but the significance remained when also adjusting for the baseline frequency (-12.7% [95% CI -19.3% to -5.5%], p < 0.001). In the IAI-exposed group, the baseline frequency increased by 11.1 bpm during the last 12 h before the start of labor, beyond those who were not exposed (95% CI 8.3 bpm to 13.8 bpm; p < 0.001).

Conclusions: In pregnancies affected by IAI the STV declines steeper in the last 24 h before the start of labor as compared to pregnancies not affected by IAI, even after adjustment for increasing baseline frequency. The association of STV in relation to IAI needs to be further studied in order to evaluate and establish STVs usefulness in monitoring patients for IAI.

Objectives: To compare the values of ultrasound and clinical parameters for predicting outcomes of induction of labor (IOL) among healthy nulliparous women with a singleton, term cephalic pregnancy.

Methods: The cervical length, cervical strain elastography, posterior cervical angle, head-perineum distance, Bishop score, and maternal parameters were assessed before IOL with a combined method-Foley catheter and Misoprostol perorally. The main outcome was vaginal delivery.

Results: Variation in cervical tissue elasticity, represented by elasticity index (E), was significantly different between outcome groups-vaginal delivery and cesarean section (CS) in internal os, in the anterior lip near the cervical canal and the midpoint of the anterior and posterior lip (p < 0.05). The E was higher-softer in the vaginal delivery group. The overall elasticity was significantly higher in the middle part of the cervix in the vaginal delivery group. However, other ultrasound metrics did not differ significantly across the outcome groups. Overall, women who delivered vaginally were taller and had a lower pre-pregnancy BMI (p = 0.02 for both variables). Univariate and multivariate analyses showed maternal height was the significant independent predictor of CS (AOR 0.91, 95% CI 0.84-0.98). The prognostic value for vaginal delivery, based on cervical length, maternal height, Bishop score, and parameters of cervical strain elastography, was poor (AUC < 0.7).

Conclusion: The study underscores the importance of cervical tissue elasticity in predicting vaginal delivery outcomes, while also highlighting that maternal height is a significant independent predictor of cesarean delivery. However, evaluated metrics in the study have limited prognostic value for predicting vaginal delivery. This suggests a need for further research to identify more reliable predictors of delivery outcomes.

Objective: The objective of this study is to assess the impact of nano platinum-hydrogen saline (Pt NPs + H₂) on oxygen-induced retinopathy (OIR) in neonatal rats, with the goal to contribute new insights into the therapeutic strategies for retinopathy of prematurity.

Methods: Pt NPs + H₂ formulation was synthesized to address OIR in a rat model. Subsequent examination included the assessment of retinal blood vessel distribution and morphology through hematoxylin and eosin (HE) and isolectin B4 (IB4) staining techniques. The levels of reactive oxygen species (ROS), malondialdehyde(MDA), and superoxide dismutase (SOD) were measured to reflect the oxidative stress in rats. Additionally, the protein expression of vascular endothelial growth factor (VEGF) in each experimental group was assessed using western blot analysis, while the gene expression of VEGF in retinal neovascularization tissues was assessed using reverse transcription-polymerase chain reaction (RT-PCR). Furthermore, the extent of retinal cell apoptosis was measured using a TdT-mediated dUTP Nick-End Labeling (TUNEL) apoptosis kit.

Results: HE staining and IB4 staining revealed positive retinal neovascularization in the OIR group, whereas neovascularization in the Pt NPs + H₂ group exhibited reduced severity. Significantly fewer capillary globules and capillary tubules were observed in the Pt NPs + H₂ group compared to the OIR group (p < 0.05). Also, the Pt NPs + H₂ group demonstrated significant reductions in ROS and MDA levels within retinal tissues (p < 0.05, p < 0.001), along with a significant increase in SOD level (p < 0.05). Notably, the MDA level in the Pt NPs + H₂ group was notably lower than that in the OIR group (p < 0.01, p < 0.05), and even lower than that in the H₂ group. Pt NPs + H₂ intervention was associated with decreased protein and mRNA expression of VEGF, with statistical significance (p < 0.05). While the H₂ group exhibited a decreasing trend in apoptotic cell count in the retinal ganglion cell layer (p < 0.05), the Pt NPs + H₂ group demonstrated a more pronounced reduction, with a significant difference (p < 0.01). No significant discrepancy in apoptosis within the inner nuclear layer was observed (p > 0.05).

Conclusions: The synergistic effect of hydrogen saline and nano platinum manifests as enhanced antioxidant, anti-apoptotic, and anti-neovascular properties. Nano platinum-hydrogen saline demonstrates inhibitory effects on OIR in rats.

Objective: To investigate the correlation between the angle of progression (AOP) and maternal surgical complications following a second-stage cesarean delivery.

Methods: We retrospectively evaluated singleton pregnancies at term (≥37 weeks) who underwent cesarean delivery for arrest of descent at the second stage of labor from January 2022 to December 2023. Only cases with recorded AOP were included. The fetal head position was confirmed by transabdominal ultrasound, and the fetal head station was assessed manually by digital examination. The main outcome was defined as a composite adverse maternal outcome, including challenging fetal extraction, uterine extension, requirement for blood transfusions, postpartum fever, ileus, and re-hospitalization due to endometritis or surgical site infection.

Results: Twenty-five cases met the inclusion criteria, of whom 10 (40%) experienced the composite adverse maternal outcome. These patients had wider mean AOP compared to those without maternal morbidity (136.7 ± 7.4 vs. 124.7 ± 12.5, p = .017). Univariate logistic regression analysis showed a significant correlation between measured AOP and composite adverse maternal outcome (OR = 1.15, 95% CI 1.01-1.30, p = .028). The predicted probability for composite adverse maternal outcome by receiver-operating characteristics curve yielded an area under the curve of 0.79 (95% CI 0.60-0.98) for AOP, compared to an area under the curve of 0.53 (95% CI 0.30-0.75) for the manually measured fetal head station.

Conclusions: We found a correlation between the angle of progression and maternal complications following second-stage cesarean delivery. Assessing the angle of progression before surgery may be of help to the obstetrical team to better identify susceptible cases and allow for appropriate preparation.