Pub Date : 2024-12-01Epub Date: 2024-07-28DOI: 10.1080/14767058.2024.2364249
Karolina Ewa Matuszewska, Ewelina Bukowska-Olech, Michał Piechota, Katarzyna Staniek-Łacna, Krzysztof Drews, Barbara Więckowska, Grzegorz Koczyk, Delfina Popiel, Adam Dawidziuk, Natalia Kochalska, Katarzyna Milanowska, Agnieszka Białek-Prościńska, Jana Skrzypczak, Adam Sebastian Hirschfeld, Aleksandra Wnuk-Kłosińska, Marzena Wiśniewska, Aleksander Jamsheer, Anna Latos-Bieleńska
Objective: To determine the frequency of chromosomal aberrations in chorions after a miscarriage. The second was to examine selected euploid chorions using a next-generation sequencing (NGS) panel designed to assess 43 genes associated with pregnancy loss.
Materials and methods: The 1244 chorions were tested by targeted quantitative fluorescent PCR (QF-PCR, 827 chorions) and microarray-based comparative genomic hybridization (aCGH, 417 chorions). Then, 9 euploid chorions were examined using a designed NGS panel.
Results: Trisomies were the most common chromosomal aberration identified in the spontaneous miscarriage samples. The second chromosomal abnormality in the aCGH group and the third most common in the QF-PCR group was monosomy X. Structural aberrations were the third most common aberration in the samples screened by aCGH (7.7% of chorions). In 19% of 647 couples who submitted chorions for analysis after pregnancy loss, the chromosomal abnormality in the chorion originated from a woman with a balanced chromosomal rearrangement. This discovery was statistically significant compared to patients with normal chorions. Using the designed NGS panel, we identified a potentially pathogenic de novo variant in the F5 gene in two euploid chorions. Additionally, among the patients who experienced miscarriages and were screened using the NGS panel, we identified variants in the MDM, ACE, and NLRP2 genes that could be associated with a predisposition to pregnancy loss.
Conclusion: Numerical aberrations are the most common cause of miscarriages, but structural chromosomal aberrations also account for a significant proportion of abnormal results. Our findings indicate that couples with structural chromosomal abnormalities in material post-miscarriage are at increased risk of carrying balanced chromosomal abnormalities. Moreover, NGS-based analyses can uncover previously unidentified causes of miscarriages in the chorionic villi.
{"title":"From chromosomal aberrations to mutations in individual genes - the significance of genetic studies of chorions after miscarriage in the search for causes of miscarriages.","authors":"Karolina Ewa Matuszewska, Ewelina Bukowska-Olech, Michał Piechota, Katarzyna Staniek-Łacna, Krzysztof Drews, Barbara Więckowska, Grzegorz Koczyk, Delfina Popiel, Adam Dawidziuk, Natalia Kochalska, Katarzyna Milanowska, Agnieszka Białek-Prościńska, Jana Skrzypczak, Adam Sebastian Hirschfeld, Aleksandra Wnuk-Kłosińska, Marzena Wiśniewska, Aleksander Jamsheer, Anna Latos-Bieleńska","doi":"10.1080/14767058.2024.2364249","DOIUrl":"https://doi.org/10.1080/14767058.2024.2364249","url":null,"abstract":"<p><strong>Objective: </strong>To determine the frequency of chromosomal aberrations in chorions after a miscarriage. The second was to examine selected euploid chorions using a next-generation sequencing (NGS) panel designed to assess 43 genes associated with pregnancy loss.</p><p><strong>Materials and methods: </strong>The 1244 chorions were tested by targeted quantitative fluorescent PCR (QF-PCR, 827 chorions) and microarray-based comparative genomic hybridization (aCGH, 417 chorions). Then, 9 euploid chorions were examined using a designed NGS panel.</p><p><strong>Results: </strong>Trisomies were the most common chromosomal aberration identified in the spontaneous miscarriage samples. The second chromosomal abnormality in the aCGH group and the third most common in the QF-PCR group was monosomy X. Structural aberrations were the third most common aberration in the samples screened by aCGH (7.7% of chorions). In 19% of 647 couples who submitted chorions for analysis after pregnancy loss, the chromosomal abnormality in the chorion originated from a woman with a balanced chromosomal rearrangement. This discovery was statistically significant compared to patients with normal chorions. Using the designed NGS panel, we identified a potentially pathogenic de novo variant in the <i>F5</i> gene in two euploid chorions. Additionally, among the patients who experienced miscarriages and were screened using the NGS panel, we identified variants in the <i>MDM</i>, <i>ACE</i>, and <i>NLRP2</i> genes that could be associated with a predisposition to pregnancy loss.</p><p><strong>Conclusion: </strong>Numerical aberrations are the most common cause of miscarriages, but structural chromosomal aberrations also account for a significant proportion of abnormal results. Our findings indicate that couples with structural chromosomal abnormalities in material post-miscarriage are at increased risk of carrying balanced chromosomal abnormalities. Moreover, NGS-based analyses can uncover previously unidentified causes of miscarriages in the chorionic villi.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-02-11DOI: 10.1080/14767058.2024.2313364
Yeon Mi Hwang, Ryan T Roper, Samantha N Piekos, Daniel A Enquobahrie, Mary F Hebert, Alison G Paquette, Priyanka Baloni, Nathan D Price, Leroy Hood, Jennifer J Hadlock
Objective: There is uncertainty around the safety of SSRIs for treating depression during pregnancy. Nevertheless, the use of SSRIs has been gradually increasing, especially during the COVID-19 pandemic period. We aimed to (1) characterize maternal depression rate and use of SSRIs in a recent 10-year period, (2) address confounding by indication, as well as socioeconomic and environmental factors, and (3) evaluate associations of the timing of SSRI exposure in pregnancy with risk for preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) infants among women with depression before pregnancy.
Methods: We conducted propensity score-adjusted regression to calculate odds ratios (ORs) of PTB, LBW, and SGA. We accounted for maternal/pregnancy characteristics, comorbidity, depression severity, time of delivery, social vulnerability, and rural residence.
Results: There were 50.3% and 40.3% increases in the prevalence rate of prenatal depression and prenatal SSRI prescription rate during the pandemic. We identified women with depression ≤180 days before pregnancy (n = 8406). Women with no SSRI order during pregnancy (n = 3760) constituted the unexposed group. The late SSRI exposure group consisted of women with an SSRI order after the first trimester (n = 3759). The early-only SSRI exposure group consisted of women with SSRI orders only in the first trimester (n = 887). The late SSRI exposure group had an increased risk of PTB of OR = 1.5 ([1.2,1.8]) and LBW of OR = 1.5 ([1.2,2.0]), relative to the unexposed group. Associations between late SSRI exposure and risk of PTB/LBW were similar among a subsample of patients who delivered during the pandemic.
Conclusions: These findings suggest an association between PTB/LBW and SSRI exposure is dependent on exposure timing during pregnancy. Small for gestational age is not associated with SSRI exposure.
{"title":"Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events: with a consideration of the COVID-19 pandemic period.","authors":"Yeon Mi Hwang, Ryan T Roper, Samantha N Piekos, Daniel A Enquobahrie, Mary F Hebert, Alison G Paquette, Priyanka Baloni, Nathan D Price, Leroy Hood, Jennifer J Hadlock","doi":"10.1080/14767058.2024.2313364","DOIUrl":"10.1080/14767058.2024.2313364","url":null,"abstract":"<p><strong>Objective: </strong>There is uncertainty around the safety of SSRIs for treating depression during pregnancy. Nevertheless, the use of SSRIs has been gradually increasing, especially during the COVID-19 pandemic period. We aimed to (1) characterize maternal depression rate and use of SSRIs in a recent 10-year period, (2) address confounding by indication, as well as socioeconomic and environmental factors, and (3) evaluate associations of the timing of SSRI exposure in pregnancy with risk for preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) infants among women with depression before pregnancy.</p><p><strong>Methods: </strong>We conducted propensity score-adjusted regression to calculate odds ratios (ORs) of PTB, LBW, and SGA. We accounted for maternal/pregnancy characteristics, comorbidity, depression severity, time of delivery, social vulnerability, and rural residence.</p><p><strong>Results: </strong>There were 50.3% and 40.3% increases in the prevalence rate of prenatal depression and prenatal SSRI prescription rate during the pandemic. We identified women with depression ≤180 days before pregnancy (<i>n</i> = 8406). Women with no SSRI order during pregnancy (<i>n</i> = 3760) constituted the unexposed group. The late SSRI exposure group consisted of women with an SSRI order after the first trimester (<i>n</i> = 3759). The early-only SSRI exposure group consisted of women with SSRI orders only in the first trimester (<i>n</i> = 887). The late SSRI exposure group had an increased risk of PTB of OR = 1.5 ([1.2,1.8]) and LBW of OR = 1.5 ([1.2,2.0]), relative to the unexposed group. Associations between late SSRI exposure and risk of PTB/LBW were similar among a subsample of patients who delivered during the pandemic.</p><p><strong>Conclusions: </strong>These findings suggest an association between PTB/LBW and SSRI exposure is dependent on exposure timing during pregnancy. Small for gestational age is not associated with SSRI exposure.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11033706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139718027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-06-05DOI: 10.1080/14767058.2024.2334850
Matthew McGovern, Lynne Kelly, Rebecca Finnegan, Roisin McGrath, John Kelleher, Afif El-Khuffash, John Murphy, Catherine M Greene, Eleanor J Molloy
Objectives: Scientific evidence provides a widened view of differences in immune response between male and female neonates. The X-chromosome codes for several genes important in the innate immune response and neonatal innate immune cells express receptors for, and are inhibited by, maternal sex hormones. We hypothesized that sex differences in innate immune responses may be present in the neonatal population which may contribute to the increased susceptibility of premature males to sepsis. We aimed to examine the in vitro effect of pro-inflammatory stimuli and hormones in neutrophils and monocytes of male and female neonates, to examine the expression of X-linked genes involved in innate immunity and the miRNA profiles in these populations.
Methods: Preterm infants (n = 21) and term control (n = 19) infants were recruited from the Coombe Women and Infants University Hospital Dublin with ethical approval and explicit consent. The preterm neonates (eight female, 13 male) were recruited with a mean gestation at birth (mean ± SD) of 28 ± 2 weeks and corrected gestation at the time of sampling was 30 + 2.6 weeks. The mean birth weight of preterm neonates was 1084 ± 246 g. Peripheral blood samples were used to analyze immune cell phenotypes, miRNA human panel, and RNA profiles for inflammasome and inflammatory genes.
Results: Dividing neutrophil results by sex showed no differences in baseline CD11b between sexes among either term or preterm neonates. Examining monocyte CD11b by sex shows, that at baseline, total and classical monocytes have higher CD11b in preterm females than preterm males. Neutrophil TLR2 did not differ between sexes at baseline or following lipopolysaccharide (LPS) exposure. CD11b expression was higher in preterm male non-classical monocytes following Pam3CSK treatment when compared to females, a finding which is unique to our study. Preterm neonates had higher TLR2 expression at baseline in total monocytes, classical monocytes and non-classical monocytes than term. A sex difference was evident between preterm females and term females in TLR2 expression only. Hormone treatment showed no sex differences and there was no detectable difference between males and females in X-linked gene expression. Two miRNAs, miR-212-3p and miR-218-2-3p had significantly higher expression in preterm female than preterm male neonates.
Conclusions: This study examined immune cell phenotypes and x-linked gene expression in preterm neonates and stratified according to gender. Our findings suggest that the responses of females mature with advancing gestation, whereas male term and preterm neonates have very similar responses. Female preterm neonates have improved monocyte activation than males, which likely reflects improved innate immune function as reflected clinically by their lower risk of sepsis. Dividing results by sex showed changes in prete
{"title":"Gender and sex hormone effects on neonatal innate immune function.","authors":"Matthew McGovern, Lynne Kelly, Rebecca Finnegan, Roisin McGrath, John Kelleher, Afif El-Khuffash, John Murphy, Catherine M Greene, Eleanor J Molloy","doi":"10.1080/14767058.2024.2334850","DOIUrl":"https://doi.org/10.1080/14767058.2024.2334850","url":null,"abstract":"<p><strong>Objectives: </strong>Scientific evidence provides a widened view of differences in immune response between male and female neonates. The X-chromosome codes for several genes important in the innate immune response and neonatal innate immune cells express receptors for, and are inhibited by, maternal sex hormones. We hypothesized that sex differences in innate immune responses may be present in the neonatal population which may contribute to the increased susceptibility of premature males to sepsis. We aimed to examine the <i>in vitro</i> effect of pro-inflammatory stimuli and hormones in neutrophils and monocytes of male and female neonates, to examine the expression of X-linked genes involved in innate immunity and the miRNA profiles in these populations.</p><p><strong>Methods: </strong>Preterm infants (<i>n</i> = 21) and term control (<i>n</i> = 19) infants were recruited from the Coombe Women and Infants University Hospital Dublin with ethical approval and explicit consent. The preterm neonates (eight female, 13 male) were recruited with a mean gestation at birth (mean ± SD) of 28 ± 2 weeks and corrected gestation at the time of sampling was 30 + 2.6 weeks. The mean birth weight of preterm neonates was 1084 ± 246 g. Peripheral blood samples were used to analyze immune cell phenotypes, miRNA human panel, and RNA profiles for inflammasome and inflammatory genes.</p><p><strong>Results: </strong>Dividing neutrophil results by sex showed no differences in baseline CD11b between sexes among either term or preterm neonates. Examining monocyte CD11b by sex shows, that at baseline, total and classical monocytes have higher CD11b in preterm females than preterm males. Neutrophil TLR2 did not differ between sexes at baseline or following lipopolysaccharide (LPS) exposure. CD11b expression was higher in preterm male non-classical monocytes following Pam3CSK treatment when compared to females, a finding which is unique to our study. Preterm neonates had higher TLR2 expression at baseline in total monocytes, classical monocytes and non-classical monocytes than term. A sex difference was evident between preterm females and term females in TLR2 expression only. Hormone treatment showed no sex differences and there was no detectable difference between males and females in X-linked gene expression. Two miRNAs, miR-212-3p and miR-218-2-3p had significantly higher expression in preterm female than preterm male neonates.</p><p><strong>Conclusions: </strong>This study examined immune cell phenotypes and x-linked gene expression in preterm neonates and stratified according to gender. Our findings suggest that the responses of females mature with advancing gestation, whereas male term and preterm neonates have very similar responses. Female preterm neonates have improved monocyte activation than males, which likely reflects improved innate immune function as reflected clinically by their lower risk of sepsis. Dividing results by sex showed changes in prete","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-02-07DOI: 10.1080/14767058.2024.2311097
Despina Briana, Ariadne Malamitsi-Puchner, Gian Carlo Di Renzo
{"title":"Using ultrasound instead of X-ray to diagnose neonatal lung disease: an important milestone in the development of neonatal medicine.","authors":"Despina Briana, Ariadne Malamitsi-Puchner, Gian Carlo Di Renzo","doi":"10.1080/14767058.2024.2311097","DOIUrl":"10.1080/14767058.2024.2311097","url":null,"abstract":"","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Participating in physical activity during pregnancy has benefited a lot from maternal and child health. However, there are few longitudinal studies describing activity patterns and related factors during pregnancy. The aim of this study is to investigate longitudinal physical activity changes and the influencing factors of Chinese pregnant women.
Methods: From January to August 2020, 240 pregnant women were recruited in Hangzhou, China. Physical activity during pregnancy was assessed in the first, second, and third trimesters of pregnancy by using the Pregnancy Physical Activity Questionnaire.
Results: The daily energy consumption during first, second, and third trimesters was 20.55, 20.76, 17.19 METs-h/d. The results of repeated-measure analysis of variance and pairwise comparison showed that the total daily energy consumption of physical activity in the third trimester was significantly lower than that in the first and second trimesters, with statistical significance (p < 0.001). The generalized estimation equation showed that education level, pre-pregnancy BMI, gravidity, unnaturally conceived and pre-pregnancy exercise habits were the influencing factors of physical activity during pregnancy (p < 0.05).
Conclusion: Physical activity levels of pregnant women during different trimester were not optimistic. In order to improve physical activity during pregnancy and promote the health status of both mother and the developing baby, more attention should be paid on pregnant women with low education level, high BMI before pregnancy, primipara, unnaturally conceived and no good exercise habits before pregnancy.
{"title":"Physical activity changes and influencing factors among Chinese pregnant women: a longitudinal study.","authors":"Le Zhang, Jinlan Piao, Wei Zhang, Ningning Liu, Xuesong Zhang, Yu Shen, Ying Jin, Fangfang Wang, Suwen Feng","doi":"10.1080/14767058.2024.2306190","DOIUrl":"10.1080/14767058.2024.2306190","url":null,"abstract":"<p><strong>Objective: </strong>Participating in physical activity during pregnancy has benefited a lot from maternal and child health. However, there are few longitudinal studies describing activity patterns and related factors during pregnancy. The aim of this study is to investigate longitudinal physical activity changes and the influencing factors of Chinese pregnant women.</p><p><strong>Methods: </strong>From January to August 2020, 240 pregnant women were recruited in Hangzhou, China. Physical activity during pregnancy was assessed in the first, second, and third trimesters of pregnancy by using the Pregnancy Physical Activity Questionnaire.</p><p><strong>Results: </strong>The daily energy consumption during first, second, and third trimesters was 20.55, 20.76, 17.19 METs-h/d. The results of repeated-measure analysis of variance and pairwise comparison showed that the total daily energy consumption of physical activity in the third trimester was significantly lower than that in the first and second trimesters, with statistical significance (<i>p</i> < 0.001). The generalized estimation equation showed that education level, pre-pregnancy BMI, gravidity, unnaturally conceived and pre-pregnancy exercise habits were the influencing factors of physical activity during pregnancy (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Physical activity levels of pregnant women during different trimester were not optimistic. In order to improve physical activity during pregnancy and promote the health status of both mother and the developing baby, more attention should be paid on pregnant women with low education level, high BMI before pregnancy, primipara, unnaturally conceived and no good exercise habits before pregnancy.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-01-25DOI: 10.1080/14767058.2024.2306189
Oyoung Kim, Subeen Hong, In Yang Park, Hyun Sun Ko
Objective: The relationship between placental location in pregnancies without previa and adverse pregnancy outcomes has not been well studied. Additionally, the impact of abnormal cord insertion sites remains controversial. Therefore, the objective of this study was to explore the adverse outcomes associated with placental location and abnormal cord insertion in nulliparous women and to assess their impact on pregnancy outcomes.
Methods: This retrospective cohort study was conducted at a single tertiary hospital between January 2019 and June 2022. The study included nulliparous women with singleton pregnancies who delivered live infants and had available data on placental location and umbilical cord insertion site from a second- or third-trimester ultrasound. Placental location was categorized as anterior or posterior using transabdominal ultrasonography. The association between placental location/cord insertion site and pre-eclampsia was evaluated using multivariate logistic regression analysis. We compared the area under the curve to evaluate the impact of placental location and cord insertion site on pre-eclampsia.
Results: A total of 2219 pregnancies were included in the study. Pre-eclampsia occurred significantly more frequently in the anterior group than in the posterior group (8.21% vs. 3.04%, p < .001). In multivariate analysis investigating the association between placental location and pre-eclampsia, anterior placenta and marginal cord insertion showed increased odds ratios for pre-eclampsia of 3.05 (95% confidence interval [CI] 1.68-6.58) and 3.64 (95% CI 1.90-6.97), respectively. Receiver operating characteristic (ROC) curves were constructed to predict pre-eclampsia using independent factors from multivariate analyses. Model I, including maternal age, pre-pregnancy body mass index, in vitro fertilization, chronic hypertension, overt diabetes, kidney disease, and hematologic diseases, achieved an area under the ROC curve of 0.70 (95% CI 0.65-0.75). Adding cord insertion site and placental location to the model (Model II) improved its predictive performance, resulting in an area under the ROC curve of 0.749 (95% CI 0.70-0.79, p = .02).
Conclusions: Anterior placenta and marginal cord insertion were associated with an increased risk of pre-eclampsia. Further studies on prospective cohorts are necessary to validate these findings.
目的:关于无前置胎盘妊娠中胎盘位置与不良妊娠结局之间的关系,目前还没有很好的研究。此外,异常脐带插入部位的影响仍存在争议。因此,本研究旨在探讨与无前置胎盘妇女的胎盘位置和异常脐带插入有关的不良妊娠结局,并评估其对妊娠结局的影响:这项回顾性队列研究于 2019 年 1 月至 2022 年 6 月在一家三甲医院进行。研究对象包括单胎妊娠、分娩过活产婴儿且有第二或第三孕期超声检查胎盘位置和脐带插入部位数据的无子宫妊娠妇女。胎盘位置通过经腹超声波检查分为前置胎盘和后置胎盘。使用多变量逻辑回归分析评估了胎盘位置/脐带插入部位与先兆子痫之间的关系。我们比较了曲线下面积,以评估胎盘位置和脐带插入部位对子痫前期的影响:结果:本研究共纳入 2219 例妊娠。子痫前期在前置胎盘组的发生率明显高于后置胎盘组(前置胎盘组为 8.21%,后置胎盘组为 3.04%,P<0.05),前置胎盘组包括体外受精、慢性高血压、明显糖尿病、肾脏疾病和血液病,ROC 曲线下面积为 0.70(95% CI 0.65-0.75)。在模型(模型 II)中加入脐带插入部位和胎盘位置可提高其预测性能,使 ROC 曲线下面积达到 0.749 (95% CI 0.70-0.79, p = .02):结论:前置胎盘和边缘脐带插入与先兆子痫风险增加有关。结论:前置胎盘和边缘脐带插入与先兆子痫风险增加有关,有必要对前瞻性队列进行进一步研究,以验证这些发现。
{"title":"Association between placental location and cord insertion site with pre-eclampsia: a retrospective cohort study.","authors":"Oyoung Kim, Subeen Hong, In Yang Park, Hyun Sun Ko","doi":"10.1080/14767058.2024.2306189","DOIUrl":"10.1080/14767058.2024.2306189","url":null,"abstract":"<p><strong>Objective: </strong>The relationship between placental location in pregnancies without previa and adverse pregnancy outcomes has not been well studied. Additionally, the impact of abnormal cord insertion sites remains controversial. Therefore, the objective of this study was to explore the adverse outcomes associated with placental location and abnormal cord insertion in nulliparous women and to assess their impact on pregnancy outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a single tertiary hospital between January 2019 and June 2022. The study included nulliparous women with singleton pregnancies who delivered live infants and had available data on placental location and umbilical cord insertion site from a second- or third-trimester ultrasound. Placental location was categorized as anterior or posterior using transabdominal ultrasonography. The association between placental location/cord insertion site and pre-eclampsia was evaluated using multivariate logistic regression analysis. We compared the area under the curve to evaluate the impact of placental location and cord insertion site on pre-eclampsia.</p><p><strong>Results: </strong>A total of 2219 pregnancies were included in the study. Pre-eclampsia occurred significantly more frequently in the anterior group than in the posterior group (8.21% vs. 3.04%, <i>p</i> < .001). In multivariate analysis investigating the association between placental location and pre-eclampsia, anterior placenta and marginal cord insertion showed increased odds ratios for pre-eclampsia of 3.05 (95% confidence interval [CI] 1.68-6.58) and 3.64 (95% CI 1.90-6.97), respectively. Receiver operating characteristic (ROC) curves were constructed to predict pre-eclampsia using independent factors from multivariate analyses. Model I, including maternal age, pre-pregnancy body mass index, <i>in vitro</i> fertilization, chronic hypertension, overt diabetes, kidney disease, and hematologic diseases, achieved an area under the ROC curve of 0.70 (95% CI 0.65-0.75). Adding cord insertion site and placental location to the model (Model II) improved its predictive performance, resulting in an area under the ROC curve of 0.749 (95% CI 0.70-0.79, <i>p</i> = .02).</p><p><strong>Conclusions: </strong>Anterior placenta and marginal cord insertion were associated with an increased risk of pre-eclampsia. Further studies on prospective cohorts are necessary to validate these findings.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-22DOI: 10.1080/14767058.2024.2352790
Jianxin Ma, Mengna Wang, Qianqian Zuo, Hong Ma, Shangqing Wu
Objective: To compare the number of oocytes retrieved and clinical outcomes of ovulation induction in an older population treated with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) (IVF/ICSI) using different rFSH options and the effectiveness of antagonist treatment to induce ovulation using gonadotropin-releasing hormone agonists (GnRH-a) in combination with an human chorionic gonadotropin (HCG) trigger.
Methods: A total of 132 fresh cycles were selected for this study, which were treated with IVF/ICSI in our hospital from March 2022 to December 2022. Observations were made according to different subgroups and the effects of different triggering methods on the number of oocytes obtained, embryo quality, and clinical outcomes.
Results: The initial gonadotropin (Gn) dose, the number of oocytes, and the number of MII oocytes were higher in group A than in group B (p < .05), and the clinical pregnancy rate was 29.41% in group A. Group B had a clinical pregnancy rate of 27.5%. The double-trigger group was superior to the HCG-trigger group in terms of the number of 2PN, the number of viable embryos, and the number of high-quality embryos (p < .05). The use of a double-trigger regimen (OR = 0.667, 95%CI (0.375, 1.706), p = .024) was a protective factor for the clinical pregnancy rate, whereas AFC (OR = 0.925, 95%CI (0.867, 0.986), p = .017) was an independent factor for the clinical pregnancy rate.
Conclusions: The use of a dual-trigger regimen of GnRH-a in combination with HCG using an appropriate antagonist improves pregnancy outcomes in fresh embryo transfer cycles in older patients.
目的比较高龄人群体外受精(IVF)/卵胞浆内单精子显微注射(ICSI)(IVF/ICSI)治疗中使用不同的rFSH方案所获得的卵母细胞数量和诱导排卵的临床效果,以及使用促性腺激素释放激素激动剂(GnRH-a)联合人绒毛膜促性腺激素(HCG)触发剂进行拮抗剂治疗诱导排卵的效果:本研究选取了2022年3月至2022年12月在我院接受IVF/ICSI治疗的132个新鲜周期。根据不同的亚组,观察不同的触发方法对获得卵母细胞数量、胚胎质量和临床结果的影响:结果:A组的初始促性腺激素(Gn)剂量、卵母细胞数量和MII卵母细胞数量均高于B组(p p = .024),是临床妊娠率的保护因素,而AFC(OR = 0.925,95%CI (0.867,0.986),p = .017)是临床妊娠率的独立因素:结论:在高龄患者的新鲜胚胎移植周期中,使用GnRH-a联合HCG的双触发方案,并使用适当的拮抗剂,可改善妊娠结局。
{"title":"Analysis of use of different rFSHs during IVF/ICSI-assisted conception in elderly population and effect of double trigger on clinical outcomes.","authors":"Jianxin Ma, Mengna Wang, Qianqian Zuo, Hong Ma, Shangqing Wu","doi":"10.1080/14767058.2024.2352790","DOIUrl":"https://doi.org/10.1080/14767058.2024.2352790","url":null,"abstract":"<p><strong>Objective: </strong>To compare the number of oocytes retrieved and clinical outcomes of ovulation induction in an older population treated with <i>in vitro</i> fertilization (IVF)/intracytoplasmic sperm injection (ICSI) (IVF/ICSI) using different rFSH options and the effectiveness of antagonist treatment to induce ovulation using gonadotropin-releasing hormone agonists (GnRH-a) in combination with an human chorionic gonadotropin (HCG) trigger.</p><p><strong>Methods: </strong>A total of 132 fresh cycles were selected for this study, which were treated with IVF/ICSI in our hospital from March 2022 to December 2022. Observations were made according to different subgroups and the effects of different triggering methods on the number of oocytes obtained, embryo quality, and clinical outcomes.</p><p><strong>Results: </strong>The initial gonadotropin (Gn) dose, the number of oocytes, and the number of MII oocytes were higher in group A than in group B (<i>p</i> < .05), and the clinical pregnancy rate was 29.41% in group A. Group B had a clinical pregnancy rate of 27.5%. The double-trigger group was superior to the HCG-trigger group in terms of the number of 2PN, the number of viable embryos, and the number of high-quality embryos (<i>p</i> < .05). The use of a double-trigger regimen (OR = 0.667, 95%CI (0.375, 1.706), <i>p</i> = .024) was a protective factor for the clinical pregnancy rate, whereas AFC (OR = 0.925, 95%CI (0.867, 0.986), <i>p</i> = .017) was an independent factor for the clinical pregnancy rate.</p><p><strong>Conclusions: </strong>The use of a dual-trigger regimen of GnRH-a in combination with HCG using an appropriate antagonist improves pregnancy outcomes in fresh embryo transfer cycles in older patients.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-03-14DOI: 10.1080/14767058.2024.2327573
Shi Tian, Li Wang, Yi-Wei Han, Yan-Nan Liu, Feng-Qiu Li, Xiao-Hua Jin
Objective: This study aims to compare the safety and efficacy of misoprostol administered orally and vaginally in obese pregnant women at term with either gestational hypertension or diabetes.
Methods: A total of 264 pregnant women were enrolled and categorized into two groups based on their primary condition: hypertension (134 cases) or diabetes mellitus (130 cases) and were further divided into subgroups for misoprostol administration: orally (Oral group) or vaginally (Vaginal group). The primary outcomes measured were changes in the Bishop score following treatment, induction of labor (IOL) success rates, requirement for oxytocin augmentation, duration of labor, mode of delivery, and cesarean section rates.
Results: Significant enhancements in Bishop scores, decreased cesarean section rates and increased success rates of IOL were noted in both administration groups. The incidence of vaginal delivery within 24 h was significantly higher in the Vaginal group compared to the Oral group. Adverse effects, including nausea, uterine overcontraction, hyperfrequency of uterine contraction and uterine hyperstimulation without fetal heart rate deceleration, were significantly more prevalent in the Vaginal group than in the Oral group.
Conclusion: Misoprostol administration, both orally and vaginally, proves effective for labor induction in obese pregnant women with hypertension or diabetes. However, the oral route presents a lower risk of adverse maternal and neonatal outcomes, suggesting its preference for safer labor induction in this demographic.
{"title":"Efficacy and safety of oral and vaginal administration of misoprostol for induction of labor in high-risk obese pregnant women with hypertension or diabetes mellitus.","authors":"Shi Tian, Li Wang, Yi-Wei Han, Yan-Nan Liu, Feng-Qiu Li, Xiao-Hua Jin","doi":"10.1080/14767058.2024.2327573","DOIUrl":"10.1080/14767058.2024.2327573","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to compare the safety and efficacy of misoprostol administered orally and vaginally in obese pregnant women at term with either gestational hypertension or diabetes.</p><p><strong>Methods: </strong>A total of 264 pregnant women were enrolled and categorized into two groups based on their primary condition: hypertension (134 cases) or diabetes mellitus (130 cases) and were further divided into subgroups for misoprostol administration: orally (Oral group) or vaginally (Vaginal group). The primary outcomes measured were changes in the Bishop score following treatment, induction of labor (IOL) success rates, requirement for oxytocin augmentation, duration of labor, mode of delivery, and cesarean section rates.</p><p><strong>Results: </strong>Significant enhancements in Bishop scores, decreased cesarean section rates and increased success rates of IOL were noted in both administration groups. The incidence of vaginal delivery within 24 h was significantly higher in the Vaginal group compared to the Oral group. Adverse effects, including nausea, uterine overcontraction, hyperfrequency of uterine contraction and uterine hyperstimulation without fetal heart rate deceleration, were significantly more prevalent in the Vaginal group than in the Oral group.</p><p><strong>Conclusion: </strong>Misoprostol administration, both orally and vaginally, proves effective for labor induction in obese pregnant women with hypertension or diabetes. However, the oral route presents a lower risk of adverse maternal and neonatal outcomes, suggesting its preference for safer labor induction in this demographic.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-08-04DOI: 10.1080/14767058.2024.2386081
Xiao Liu, Yan Kang, Nannan Cao, Xiaomei Sun, Yongzhong Gu, Xietong Wang, Hongmei Wang
Objective: This study examined the efficacy of pulling down the cervix and packing it in the vaginal fornix (PC-PVF) on postpartum hemorrhage in the lower uterine segment (PPH-LUS).
Methods: All cases of PPH-LUS after vaginal delivery at two tertiary hospitals between January 2019 and December 2022 were retrospectively investigated. Patients treated successfully with conservative measures were divided into routine treatment only (40 patients), routine treatment + early PC-PVF (33 patients), and routine treatment + late PC-PVF (51 patients) groups. Routine treatment consisted of uterine massage, uterotonics, and tranexamic acid administration. The therapeutic effect was evaluated by comparing the volume and rate of bleeding within 24 h after delivery.
Results: A total of 124 patients were treated conservatively, except for three patients who underwent laparotomy for hemostasis after PC-PVF failed for incomplete rupture of the lower uterine segment. The efficacy of treatment was 44% (40/91) for routine treatment only and 100% when combined with PC-PVF for PPH-LUS. There was no significant difference in maternal age, gestational week, neonatal weight, and Apgar score. But the total blood loss in the conventional treatment + early PC-PVF group (657.27 ml ± 131.61 ml) was significantly lower than that in the other two groups, which was 847.13 ml ± 250.37 ml(p < .01) and 1040.78 ml ± 242.70 ml (p < .01), respectively. The bleeding rate in the routine treatment + early PC-PVF group decreased significantly after tamponade.
Conclusions: PC-PVF is a safe and effective treatment for PPH-LUS. Early identification of PPH-LUS and prompt application of PC-PVF can effectively reduce blood loss after vaginal delivery.
{"title":"Early identification and conservative treatment of postpartum hemorrhage in the lower uterine segment after vaginal delivery.","authors":"Xiao Liu, Yan Kang, Nannan Cao, Xiaomei Sun, Yongzhong Gu, Xietong Wang, Hongmei Wang","doi":"10.1080/14767058.2024.2386081","DOIUrl":"https://doi.org/10.1080/14767058.2024.2386081","url":null,"abstract":"<p><strong>Objective: </strong>This study examined the efficacy of pulling down the cervix and packing it in the vaginal fornix (PC-PVF) on postpartum hemorrhage in the lower uterine segment (PPH-LUS).</p><p><strong>Methods: </strong>All cases of PPH-LUS after vaginal delivery at two tertiary hospitals between January 2019 and December 2022 were retrospectively investigated. Patients treated successfully with conservative measures were divided into routine treatment only (40 patients), routine treatment + early PC-PVF (33 patients), and routine treatment + late PC-PVF (51 patients) groups. Routine treatment consisted of uterine massage, uterotonics, and tranexamic acid administration. The therapeutic effect was evaluated by comparing the volume and rate of bleeding within 24 h after delivery.</p><p><strong>Results: </strong>A total of 124 patients were treated conservatively, except for three patients who underwent laparotomy for hemostasis after PC-PVF failed for incomplete rupture of the lower uterine segment. The efficacy of treatment was 44% (40/91) for routine treatment only and 100% when combined with PC-PVF for PPH-LUS. There was no significant difference in maternal age, gestational week, neonatal weight, and Apgar score. But the total blood loss in the conventional treatment + early PC-PVF group (657.27 ml ± 131.61 ml) was significantly lower than that in the other two groups, which was 847.13 ml ± 250.37 ml(<i>p</i> < .01) and 1040.78 ml ± 242.70 ml (<i>p</i> < .01), respectively. The bleeding rate in the routine treatment + early PC-PVF group decreased significantly after tamponade.</p><p><strong>Conclusions: </strong>PC-PVF is a safe and effective treatment for PPH-LUS. Early identification of PPH-LUS and prompt application of PC-PVF can effectively reduce blood loss after vaginal delivery.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To determine cardiotocographic patterns in newborns with metabolic acidosis, based on clinical signs of neurological alteration (NA) and the need for hypothermic treatment.
Methods: All term newborns with metabolic acidosis in a single center from 2016 to 2020 were included in the study. Three segments of intrapartum CTG (cardiotocography) were considered (first 30 min of active labor, 90 to 30 min before birth, and last 30 min before delivery) and a longitudinal analysis of CTG pattern was performed according to the 2015 FIGO classification.
Results: Three hundred and twenty-four neonates with metabolic acidosis diagnosed at birth were divided into three groups: the first group included all neonates with any clinical sign of neurological alteration, requiring hypothermia according to the recommendation of the Italian Society of Neonatology (group TNA-Treated neurological Alteration, n = 17), the second encompassed neonates with any clinical sign of neurological alteration not requiring hypothermia (group NTNA-Not Treated neurological Alteration, n = 83), and the third enclosed all neonates without any sign of clinical neurological involvement (group NoNA-No neurological Alteration, n = 224). The most frequent alterations of CTG in TNA group were late decelerations, reduced variability, bradycardia, and tachysystole. Unexpectedly, from the longitudinal analysis of the CTG, 49% of all cases with metabolic acidosis never showed a pathological CTG with normal trace at the beginning of labor followed by normal or suspicious trace in the final part of labor, the same as in TNA and NTNA groups (10 and 39%, respectively).
Conclusions: CTG has limited specificity in identifying cases of acidosis at birth, even in babies who will develop NA.
{"title":"Analysis of CTG patterns in cases with metabolic acidosis at birth with and without neonatal neurological alterations.","authors":"Rossella Attini, Benedetta Montersino, Elisabetta Versino, Alessandro Messina, Emmanuele Mastretta, Silvia Parisi, Chiara Germano, Martina Quattromani, Viola Casula, Ilenia Mappa, Alberto Revelli, Bianca Masturzo","doi":"10.1080/14767058.2024.2377718","DOIUrl":"https://doi.org/10.1080/14767058.2024.2377718","url":null,"abstract":"<p><strong>Objective: </strong>To determine cardiotocographic patterns in newborns with metabolic acidosis, based on clinical signs of neurological alteration (NA) and the need for hypothermic treatment.</p><p><strong>Methods: </strong>All term newborns with metabolic acidosis in a single center from 2016 to 2020 were included in the study. Three segments of intrapartum CTG (cardiotocography) were considered (first 30 min of active labor, 90 to 30 min before birth, and last 30 min before delivery) and a longitudinal analysis of CTG pattern was performed according to the 2015 FIGO classification.</p><p><strong>Results: </strong>Three hundred and twenty-four neonates with metabolic acidosis diagnosed at birth were divided into three groups: the first group included all neonates with any clinical sign of neurological alteration, requiring hypothermia according to the recommendation of the Italian Society of Neonatology (group TNA-Treated neurological Alteration, <i>n</i> = 17), the second encompassed neonates with any clinical sign of neurological alteration not requiring hypothermia (group NTNA-Not Treated neurological Alteration, <i>n</i> = 83), and the third enclosed all neonates without any sign of clinical neurological involvement (group NoNA-No neurological Alteration, <i>n</i> = 224). The most frequent alterations of CTG in TNA group were late decelerations, reduced variability, bradycardia, and tachysystole. Unexpectedly, from the longitudinal analysis of the CTG, 49% of all cases with metabolic acidosis never showed a pathological CTG with normal trace at the beginning of labor followed by normal or suspicious trace in the final part of labor, the same as in TNA and NTNA groups (10 and 39%, respectively).</p><p><strong>Conclusions: </strong>CTG has limited specificity in identifying cases of acidosis at birth, even in babies who will develop NA.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}