Journal of Maternal-Fetal & Neonatal Medicine最新文献

Objective: This retrospective analysis evaluates the safety and efficacy of the vaginal use of the chitosan covered gauze ("Celox^™ PPH") in managing lower genital tract trauma with high blood loss, where conventional repair failed.

Methods: Data from patients receiving chitosan covered gauze intravaginally or locally at the vulva due to substantial blood loss because of birth injury were examined retrospectively, using data from a university hospital 2017-2024. Parameters included blood loss, anesthesia, transfusions, length of hospitalization, infection signs, need for intensive care, and tamponade success, defined as bleeding cessation within 5 min and no requirement of further operative intervention.

Results: Use of chitosan covered gauze effectively controlled bleeding in 26 severe birth injury cases except one. Seven women presented with bleeding due to vaginal tears, 2 with cervical tears, 14 with combined vaginal and perineal or cervical tears, 2 with clitoral lacerations and one with a paravaginal hematoma. In the single unsuccessful case the tamponade was applied late after initial suturing because of under-estimated blood loss, and a second subsequent surgery became necessary. In two women of the cohort the gauze was initially used as a bridging concept because of reduced surgical visibility. Median blood loss in the study cohort was 1000 ml resulting in a median hemoglobin-reduction of 3.65 g/dl. Four patients required blood transfusion and intensive care after the bleeding event. Tamponade application duration varied, ranging from 20 min to 24 h, with a median duration of 8.5 h. The median hospital stay was 3 days. Infection parameters were not elevated after gauze application, with no reported cases of postpartum fever nor signs of infection. Removal was uneventful in all patients, expulsion did not occur. Three successful pregnancies after the event have been reported so far.

Conclusion: Vaginal insertion of chitosan covered gauze proved to be safe and effective for the management of severe lacerations after vaginal birth in our retrospective cohort. Shorter application time may be sufficient for birth injuries.

Objectives: Acute leukemia (AL) presents significant health challenges, particularly in children, and iron plays a critical role in cellular processes that could influence cancer development. The study was motivated by the need to clarify the potential role of iron supplementation during pregnancy in influencing the risk of developing childhood leukemia.

Materials and methods: This meta-analysis adhered to PRISMA guidelines and systematically searched PubMed, Scopus, and Web of Science databases up to April 2024 for relevant observational studies. Inclusion criteria focused on case-control studies assessing the relationship between iron supplementation during pregnancy and leukemia risk, reporting odds ratios (ORs) with 95% confidence intervals (CIs). Data extraction and quality assessment were performed independently by two researchers using the Newcastle-Ottawa Scale (NOS). Statistical analysis involved calculating overall relative risk (RR) using a random-effects model and assessing heterogeneity through Cochran's Q test and the I² statistic. Publication bias was evaluated using Egger's and Begg's tests.

Results: The study analyzed data from 9 studies with 12 data sets involving a total of 4281 participants (2327 cases and 1954 controls). The findings indicated no significant association between iron supplementation during pregnancy and the overall risk of childhood leukemia (OR:1.01; 95% CI: 0.84-1.21, I2 = 63.2%). Also, no relationship was found between receiving iron supplements during pregnancy and the risk of AML (OR:1.01; 95% CI: 0.84-1.21, I2 = 56.6%) and ALL (OR:1.00; 95% CI: 0.81-1.24, I2 = 67.3%).

Conclusion: This study found no significant association between iron supplementation during pregnancy and AL risk among case-control studies. Further research is needed to explore the potential influence of genetic and environmental factors on this relationship.

Objective: Vaginal birth after cesarean section (VBAC) is recommended by obstetrical guidelines or expert consensuses. However, no valid tools can exactly predict who can have a vaginal birth among eligible candidates with one prior cesarean section. In recent years, machine learning (ML) is gradually used to develop predictive models in obstetrics and midwifery owing to its excellent performance. This study aimed to develop an explainable ML model to predict the chance of successful VBAC.

Methods: A total of 2438 pregnant women with trial of labor after cesarean (TOLAC) were analyzed from two tertiary hospitals in Guangdong province of China in the final cohort. The data were collected to establish seven predicting models. Training and internal validation data were collected from the First Dongguan Affiliated Hospital of Guangdong Medical University from January 2012 to December 2022. External validation data were collected from Shenzhen Longhua District Central Hospital from January 2011 to December 2017. Seven predicting models based on ML were developed and evaluated by area under the receiver operating characteristic (AUC) curve. The optimal one was picked out from seven models according to its AUC and other indices. The outcome of the predictive model was interpreted by Shapley Additive exPlanations (SHAP).

Results: The categorical boosting (CatBoost) model was selected as the predictive model with the greatest AUC for 0.767 (95% CI: 0.685-0.865), the accuracy for 0.652 (95% CI: 0.602-0.713), sensitivity 0.714 (95% CI: 0.576-0.840), and specificity 0.639 (95% CI: 0.574-0.70). Cervical Bishop score and interpregnancy interval showed the greatest impact on successful vaginal birth, according to SHAP results.

Conclusions: Models based on ML algorithms can be used to predict VBAC. The CatBoost model showed best performance in this study. Based on current evidence-based medical data, clinicians should provide systematic benefit-risk analysis and individualized assessment of VBAC to eligible pregnant women.

Background: Advanced-maternal-age pregnancies carry a heightened risk of pre-eclampsia and fetal growth restriction (FGR), yet current first-trimester screening has limited predictive accuracy. We hypothesized that combining mid-pregnancy placental endocrine biomarkers with a Doppler-based vascular index would improve early identification of women at risk for these complications.

Methods: In a prospective cohort at Zibo Central Hospital (January 2022-June 2024), 420 singleton pregnancies in women ≥35 years (first antenatal visit <14 weeks) underwent serum assays for human chorionic gonadotrophin (hCG), pregnancy-associated plasma protein A (PAPP-A) and the soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFlt-1/PlGF), plus transabdominal Doppler measurement of mean uterine-artery pulsatility index (UtA-PI) at 20-24 weeks. Sequential logistic-regression models-baseline clinical, + vascular (UtA-PI), + endocrine (biomarkers), and an integrated model-were internally validated with 1,000-bootstrap resampling; discrimination (AUC), calibration, net reclassification improvement (NRI) and decision-curve net benefit were assessed. The composite adverse pregnancy outcome (APO) was pre-eclampsia and/or SGA (defined post‑natally by INTERGROWTH‑21st birth‑weight standards).

Results: Eighty-three women (19.8%) developed the APO: 45 PE cases (10.7 %), 51 SGA cases (12.1%; 38 < 3rd centile, 13 3rd-< 10th centile + abnormal Doppler), including 13 concurrent PE +SGA. Compared with unaffected pregnancies, cases showed higher median hCG, lower PAPP-A, higher sFlt-1/PlGF ratio and elevated UtA-PI. Model AUC rose from 0.62 (baseline) to 0.70 (+vascular), 0.78 (+endocrine) and 0.80 (95% CI: 0.75-0.85) for the integrated model, with good calibration and NRI + 0.18. Decision-curve analysis showed the integrated model yielded the greatest net benefit across 5-25% risk thresholds; at a 10% threshold it correctly flagged nine additional high-risk pregnancies and avoided five unnecessary interventions per 100 women screened. Performance remained strong in women ≥40 years (AUC 0.78) and nulliparas (AUC 0.82).

Conclusion: Simultaneous mid-pregnancy assessment of endocrine (hCG, PAPP-A, sFlt-1/PlGF) and vascular (UtA-PI) placental function markedly improves prediction of pre-eclampsia and SGA in women of advanced maternal age, outperforming clinical or single-domain models and demonstrating practical decision-curve gains; integrating this dual-domain profile into routine prenatal care could facilitate targeted surveillance and prophylactic strategies to mitigate adverse outcomes.

Objective: Fetal growth restriction (FGR) is a serious pathological complication associated with perinatal death and adverse pregnancy outcomes, which is largely related to placental dysfunction. This study aimed to identify FGR-related placenta transcriptomic features and provide insight into the pathologic mechanisms of FGR.

Methods: In this research, transcriptomic data were obtained by RNA sequencing on placenta samples from eight FGR patients and eight normal term-pregnant women. Differential expression analysis was used to identify the differentially expressed genes (DEGs) between groups, then function and pathway enrichment analysis by DEGs was performed. After correlation analysis between DEGs and clinical indicators of FGR, validation of DEGs by Gene Expression Omnibus (GEO) dataset was carried out. Receiver operating characteristic (ROC) analysis was used to calculate the diagnostic ability of DEG biomarkers.

Results: We identified seven candidate DEGs. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis revealed candidate DEGs primarily involved in chemokine activities and lymphocyte chemotaxis. Correlation analysis found that the expression level of DPPA4 and CTAG2 gene were significantly positively correlated with neonatal birth weight (p < 0.05). The expression level of IGSF21 was significantly negatively correlated with placenta weight, neonatal birth weight and neonatal birth weight percentile (p < 0.05). The expression level of CXCL11 showed a negative correlation with neonatal birth weight and neonatal birth weight percentile (p < 0.05). Additionally, the expression level of CXCL10 exhibited a negative correlation to neonatal birth weight percentile (p < 0.05). The expression level of HLA-DQA1, CXCL10 and CXCL11 in the GEO dataset were in good agreement with our results. We conducted the ROC analysis and found the area under the curve (AUC) values based on each DEG alone were 80% for HLA-DQA1, 79%f or CXCL11 and 76% for CXCL10, suggesting that the above three DEGs had potential significance for FGR diagnosis.

Conclusion: This study gives an insight into transcriptional features in FGR mechanism and discovers novel genes that may provide evidence for predicting and managing FGR.

Background: Therapeutic hypothermia (TH) is standard of care for neonates ≥36 weeks with hypoxic-ischemic encephalopathy (HIE). Although intravenous fluid restriction is common, optimal strategies for parenteral and enteral nutrition remain unclear. This study evaluated the tolerance of parenteral nutrition (PN) and enteral feeding in neonates undergoing TH, as well as the impact of these interventions on clinical outcomes.

Methods: We retrospectively reviewed charts from the Florida Neonatal Neurologic Network (FN3) of neonates who underwent TH for HIE between 2012 and 2020. Collected data included demographics, neurologic assessments, nutritional strategies, laboratory values, and MRI findings. Statistical analysis was performed using one-way ANOVA, with results expressed as Kruskal-Wallis p-values.

Results: Of 170 neonates, 163 met inclusion criteria. Participants were categorized by nutritional approach: intravenous fluids (IVF), PN, or both. Neonates receiving PN had significantly higher blood urea nitrogen (BUN) during TH (p <  0.05), although values remained within acceptable limits. Lipid tolerance did not differ between groups. PN administration was associated with improved glucose regulation at 12 h (p <  0.05). Enteral feeding correlated with reduced brain injury on MRI and improved neurodevelopmental outcomes, including cognitive (p <  0.05) and motor (p <  0.05) function. Neonates receiving both PN and enteral feeding demonstrated significant recovery from malnutrition by the first outpatient follow-up (p <  0.05) and achieved full enteral feeds sooner (p <  0.05).

Conclusions: Early nutritional support, including PN and enteral feeding, appears to be well-tolerated in neonates undergoing TH for HIE. These findings suggest that providing early nutrition may enhance neurodevelopmental outcomes and promote growth during TH.

Background: Postpartum psychiatric disorders (PPDs) have been deemed as a significant public health concern, affecting both maternal health and family dynamics. This study aimed to examine the current status of PPDs, identify the potential risk factors of PPDs, and further develop a clinical nomogram model for predicting PPDs in Chinese women.

Method: In this retrospective cohort study, 1418 postpartum women attending the routine postpartum examination at the 42nd day after delivery in Jiangsu Women and Children Health Hospital were recruited as participants from December 2020 to December 2022. The Symptom Checklist-90 (SCL-90) was utilized to assess the status of postpartum psychiatric disorders. A prediction model was constructed by multivariate logistic regression and presented as a nomogram. The performance of nomogram was measured by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). The relationships between predictive factors of PPDs and SCL-90 were also evaluated using Pearson correlation analysis. The relationships between predictive factors of PPDs and SCL-90 were evaluated using Pearson correlation analysis.

Results: With the SCL-90 cutoff value of 160, the incidence of postpartum psychiatric disorders was 9.17% among Chinese urban women. The univariate and multivariate logistic regression analyses indicated that age ≤ 25 years old (OR = 10.07, 95%CI = 1.83-55.33), prenatal mood disorder (OR = 4.12, 95%CI = 1.99-8.53), invasive prenatal diagnostic procedures (OR = 4.39, 95%CI = 1.16-16.56), poor relationship with husband (OR = 2.86, 95%CI = 1.58-5.16) and poor relationship with mother-in-law (OR = 5.10, 95%CI = 2.70-9.64) were significantly associated with PPDs. A nomogram prediction model for PPDs was further constructed based on these five independent risk factors, and the area under the receiver operating characteristic curve (AUC) of the nomogram model was 0.823 (95% CI = 0.781-0.865). The calibration curves showed remarkable accuracy of the nomogram and the DCA exhibited high clinical net benefit of the nomogram. Besides, we also explored the relationships between the five risk factors and different symptom dimensions of PPDs and found that the five risk factors were almost associated with increased levels of all symptom dimensions.

Conclusions: Five psychosocial risk factors for PPDs were identified in Chinese women and the nomogram prediction model constructed based on these five risk factors could predict the risk of PPDs intuitively and individually. Systematic screening these risk factors and further conducting psychosocial interventions earlier during the pregnancy period are crucial to prevent PPDs. For future research, we intend to incorporate additional risk factors, including blood biomarkers and facial expression indicators, to refine our risk model.