Journal of Maternal-Fetal & Neonatal Medicine最新文献

Background: Factor XII deficiency, a rare inherited coagulation disorder, typically presents with isolated prolonged activated partial thromboplastin tim without spontaneous bleeding. Paradoxically, it is associated with thrombotic events and adverse pregnancy outcomes. Evidence-based guidelines for managing FXII deficiency in pregnancy remain lacking.

Case presentation: A 27-year-old primigravida was incidentally diagnosed with severe FXII deficiency during routine prenatal screening. At 38⁺⁵weeks, she presented with vaginal spotting and spontaneous rupture of membranes. A multidisciplinary team planned a cesarean delivery under general anesthesia. Prophylactic fresh frozen plasma (FFP) 400 mL was administered preoperatively. Postoperative FFP (400 mL) was transfused. No bleeding & thrombotic complications occurred in the mother or neonate.

Systematic review: Analysis of 9 publications (19 pregnancies) revealed.

Conclusions: Successful perinatal outcomes hinge on multidisciplinary collaboration, dynamic risk stratification, and personalized bleeding-thrombosis balance. Prophylactic FFP with selective LMWH demonstrated safety in this case. Further studies are needed to optimize standardized pathways.

Objective: High-risk pregnancies are associated with increased risk of fetal and maternal morbidity and mortality. The non-stress test (NST) is the standard method for antenatal fetal monitoring, while the cerebroplacental ratio (CPR) has emerged as a noninvasive tool for predicting adverse perinatal outcomes. We aimed to evaluate the role of the CPR and NST in predicting adverse perinatal outcomes in high-risk pregnancies.

Methods: A prospective study was conducted with 672 high-risk pregnant women at Haiphong Hospital of Obstetrics and Gynecology in Vietnam from February 2024 to February 2025. All participants had a gestational age of 32 weeks or more. The CPR and an NST were performed on each woman. They were monitored until delivery to identify adverse perinatal outcomes, including cesarean section due to fetal distress, a 5-minute Apgar score below 7, admission to the neonatal intensive care unit, and perinatal death.

Results: There was a significant difference between CPR and NST between groups with adverse and normal perinatal outcomes (p < 0.05). After adjusting for confounding factors, significant associations were found between CPR and adverse perinatal outcomes in women with hypertensive disorders of pregnancy, fetal growth restriction, and hyperglycemia in pregnancy, with OR (95% CI) of 5.92 (1.38-25.45), 11.11 (1.61-76.76), and 6.66 (1.53-28.99), respectively. Similarly, NST results showed significant associations, with ORs (95% CI) of 13.56 (2.59-71.05), 15.44 (2.46-96.98), and 15.35 (3.01-78.33), respectively. While the sensitivity of CPR and NST in high-risk cases is low, their specificity exceeds 90%, and their overall accuracy exceeds 80%. The positive likelihood ratio (LR+) of the NST exceeds that of the CPR in predicting adverse perinatal outcomes across different high-risk groups. Notably, the LR+ for the combined CPR and NST in women with high-risk pregnancies, hypertensive disorders of pregnancy, fetal growth restriction, and hyperglycemia in pregnancy was 5.14, 16.2, 32.14, and 42.4, respectively.

Conclusion: In addition to NST, CPR is a valuable predictor of adverse perinatal outcomes in high-risk pregnancies. The NST shows greater predictive accuracy than the CPR when forecasting adverse perinatal outcomes across different high-risk groups. Combining these two indices provides a stronger prediction for adverse perinatal outcomes.

Objective: Parvovirus B19 infection during pregnancy can cause severe fetal anemia, hydrops fetalis, and fetal death. This study describes our experience managing ten cases of severe fetal anemia due to parvovirus B19 infection during the 2023-2024 national outbreak in Israel.

Methods: This single-center descriptive cohort study included ten singleton pregnancies with fetal anemia (MCA-PSV >1.5 MoM) requiring intrauterine transfusion. Parvovirus B19 infection was confirmed by maternal IgM serology and/or amniotic fluid PCR. For pregnancies <20 weeks of gestation, we implemented a modified intraperitoneal transfusion technique incorporating pre-transfusion ascites drainage. Intravascular transfusions were used for later gestations. Platelet transfusions were administered when thrombocytopenia was present. Serial fetal sonography and neuroimaging were performed throughout the follow-up period.

Results: Seventy percent of fetuses presented with anemia and hydrops before 20 weeks of gestation. The modified intraperitoneal transfusion technique doubled the mean transfused packed red blood cell volumes compared to the standard technique (40 mL vs. 20 mL; p = 0.009). We performed 15 intraperitoneal transfusions (mean 2.14 per fetus) and 11 intravascular transfusion procedures. One fetal death occurred following intraperitoneal transfusion. Complications included one iatrogenic abdominal wall defect post-intraperitoneal transfusion (successfully repaired postnatally) and one case of transient ascites with hemosiderin deposits (resolved after birth). Two fetuses required platelet transfusions. All surviving infants demonstrated normal neuroimaging. Mean gestational age at delivery was 37 weeks 5 days, with 88% delivered at term. One preterm delivery occurred at 27 weeks due to cervical shortening and contractions, resulting in neonatal complications of prematurity.

Conclusion: Intensive intrauterine intervention, including ascites drainage and repeated red blood cell and platelet transfusions, may improve fetal outcomes in severe parvovirus B19 anemia. The modified intraperitoneal transfusion technique with pre-transfusion ascites drainage enabled larger transfusion volumes. Early, aggressive intervention appears crucial for optimal outcomes in these challenging cases.

Objective: The benefit of interventions to improve neonatal outcomes of preterm birth (PTB) must be balanced with the associated fetal and maternal risks. Artificial intelligence (AI) could be used to assess uterine contractions and consequently help to predict PTB. This paper aims to assess the predictive accuracy and applicability of AI models currently using uterine contractions in PTB prediction.

Methods: A systematic Embase, Medline, Pubmed and Web of Science review was conducted using PRISMA guidelines. Eligible studies assessed EHG or time-series data using AI methods, including deep learning/machine learning/neural networks to predict PTB. Data on AI model performance measures, validity, and applicability were collected. Results are reported as a narrative review due to study heterogeneity. Bias was assessed using the PROBAST framework.

Results: The studies used various Electrohysterography (EHG) contractility features and/or classifiers for AI analysis and varying performance measures to assess predictive accuracy for PTB. A wide range of EHG features were assessed included temporal, spectral, entropy and topological features. A total of 53 records were identified for inclusion. Of these, 18 examined EHG features, 22 assessed AI classifiers, and 3 tested both. Excellent classification performance (ACC and/or AUC ≥0.9) were reported by 38.8% (7/18) of studies examining EHG features and 86.3% (19/22) of studies assessing AI classifiers. Non-linear features outperformed linear features, and deep-learning models such as neural networks were the highest-performing classifiers. Bias assessment showed 86.7% (46/53) had an unclear or high risk of bias. Key concerns include unbalanced data, small sample size and lack of validity outside of sampled datasets.

Conclusion: Non-linear features and DL models offer superior results. However, we did not find evidence of external validation, thus the applicability of models in uterine contraction assessment for the prediction of PTB remains limited. Future research requires an emphasis on clinical data integration within high-quality studies, as well as more more studies focusing on early PTB detection.

Background: To evaluate the feasibility and safety of performing myomectomy during cesarean delivery using a novel bleeding-reducing suture technique.

Methods: This retrospective cohort study included pregnant women with intramural uterine fibroids. A total of 120 patients were divided into two groups: Group A consisted of women who underwent myomectomy during cesarean section between January 2020 and June 2024, and Group B included women who underwent cesarean section alone without myomectomy. The following data were obtained from hospital records and compared between the groups: maternal age, gravidity, parity, myoma size, gestational age at time, preoperative and postoperative hemoglobin (Hb) levels, need for blood transfusion, hospital stay, and duration of surgery. The primary outcome of the study was the change in Hb levels before and after the operation.

Results: The demographic and laboratory characteristics of 120 pregnant women with intramural leiomyomas who underwent either cesarean myomectomy or cesarean section alone were analyzed. Of these, 60 underwent cesarean section alone, while 60 underwent cesarean section with myomectomy. No statistically significant difference was found between the two groups in terms of preoperative Hb, postoperative 24-hour Hb, or Hb decrease (p = .240, p = .270, and p = .420, respectively). Similarly, there was no significant difference in operation duration (p = .160). A weak but statistically significant negative correlation was observed between myoma size and gestational age at delivery (r = -0.21, p = .0009). No statistically significant correlations were found between myoma size and either operation time or hospital stay.

Conclusion: Cesarean myomectomy appears to be a feasible and safe option when performed using the bleeding-reducing uterine isthmic circumferential suture technique. However, further multicenter studies with larger sample sizes are required to confirm these findings before recommending cesarean myomectomy as a routine approach.

Introduction: A traumatic birth experience can have profound and enduring negative consequences on both maternal and neonatal health and well-being. Although Maternal Empowerment Training (MET) has been applied in other maternal contexts, its specific efficacy on the combination of maternal-infant attachment, breastfeeding self-efficacy, and delivery preference among mothers experiencing a traumatic birth remains unclear. This study aimed to evaluate the effectiveness of MET on these outcomes in this population.

Materials and methods: This randomized controlled trial was conducted in 2023 at Payambar-e Azam and Afzalipour hospitals in Kerman, Iran. Seventy mothers with a history of birth trauma were enrolled, with 35 participants assigned to the intervention group and 35 to the control group. Convenience sampling was used, and participants were randomly allocated using block randomization. Assessors were blinded to group allocation during data collection and analysis. Research tools included a demographic questionnaire, the Mother-to-Infant Bonding Scale (MIBS), the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), and a checklist assessing preference for cesarean delivery; all instruments are valid and reliable. Data were collected at baseline and two weeks after the last intervention session. The intervention group attended four sessions of Motivational Enhancement Therapy (one face-to-face and three online individual sessions), while the control group received routine postpartum care. Data were analyzed using SPSS-21.

Results: After controlling for baseline differences using ANCOVA, the MET group showed a significant improvement in mother-infant attachment (lower MIBS score), a significant increase in breastfeeding self-efficacy, and a significant reduction in the preference for cesarean delivery compared to the control group (p < 0.0001 for all).

Conclusion: Given the effectiveness of MET, its application is recommended for mothers with traumatic birth experiences to improve breastfeeding self-efficacy and maternal-infant attachment, and to decrease preference for Ce-section.

Introduction: The importance of prenatal determination of chorionicity for the management of twin pregnancies is well recognized. However, research on the contribution of prenatal evaluation of zygosity to the management of twins is limited. We assessed the utility of adding SNP-based cell-free DNA (cfDNA) zygosity testing to ultrasound chorionicity assessment for the clinical management of twin pregnancies.

Methods: Prospective observational study involving 13 United States practices with proficiency in prenatal ultrasound. Patients diagnosed by ultrasound with twins in the first trimester were assessed with cfDNA screening for zygosity. Ultrasound assessment of chorionicity was performed prior to cfDNA results. Placental pathology was used as the gold standard for chorionicity assessment. Gestational age at delivery and standardized birthweights were compared, based on chorionicity and zygosity.

Results: 110 twin pregnancies were included. Among 79 dichorionic (DC) cases confirmed by placental pathology, one (1.3%) was misclassified as monochorionic (MC) by ultrasound, but was dizygous (DZ) by cfDNA, consistent with DC. Of 31 monozygotic (MZ) twins by cfDNA, confirmed as MC by pathology, ultrasound misclassified one (3.6%) as DC. Median gestational age at delivery was earlier for MZ twin pregnancies (35.0 weeks) compared to DZ (36.9 weeks, p = 0.02). After adjusting for fetal sex and gestational age at birth, MZDC twins had significantly lower birthweights (p = 0.006) and birthweight percentiles (p = 0.004) than DZDC twins.

Conclusions: Based on postpartum placental pathology as the reference standard for determining MC versus DC, cfDNA zygosity testing appears to aid in the prenatal assignment of chorionicity. Larger studies are needed to confirm the value of zygosity testing in the management of twin pregnancies.