Specific fetal heart rate (FHR) patterns are associated with fetal compromise. Several placental histopathological findings are associated with neonatal morbidity and adverse neurodevelopment. The relationships between intrapartum FHR patterns and placental histopathology in infants with hypoxic–ischemic encephalopathy (HIE) remain uncertain. This study hypothesized that in infants with HIE, placental histopathology findings are related to abnormal FHR patterns.
This was an observational study performed on a historical cohort from a single tertiary neonatal intensive care unit. Infants were born at ≥36 weeks' gestation with moderate or severe HIE between September 2006 and December 2021. Placental histopathology was assessed by a perinatal pathologist using the Amsterdam Working Group Criteria. FHR, recorded from intrapartum cardiotocography (CTG) was assessed by an obstetrician using a structured proforma. Assessors were blinded to clinical course and outcomes. Duration and type of FHR abnormality were compared across categories of placental histopathology findings.
Fifty infants with moderate or severe HIE (with complete data relating to intrapartum CTG and placental histopathology) were included. Increased duration of FHR abnormality was associated with the presence of histological chorioamnionitis (HCA) (p = 0.013) but not with other placental histopathological lesions. There was no evidence of associations between placental histopathology findings and specific FHR features on intrapartum CTG.
This study demonstrates an association between HCA and increased duration of CTG abnormality in infants with moderate or severe HIE. Intrapartum CTG alone is limited in its ability to identify the presence or absence of placental histopathology. Multimodal intrapartum assessment, such as CTG with placental NIRs or Doppler assessment, may improve the maternal–placental–fetal triad assessment. This could lead to improved intrapartum risk stratification and infant outcomes. Future research should investigate the utility of multimodal assessment to improve risk stratification in labor.
The aim of this study was to assess the effectiveness of fetal fibronectin (fFN) in combination with cervical length for predicting spontaneous preterm birth (sPTB) in women presenting with threatened preterm labor.
This was a prospective study involving singleton pregnancies at 20–36 weeks of gestation with symptoms of threatened preterm labor. Upon admission, cervical length (CL) and fFN test in cervicovaginal secretions were measured. Logistic regression analysis was performed to develop the following models: CL alone, fFN at various thresholds, and their combined models for the prediction of sPTB. Area under the receiver operating characteristic curve (AUROC) was calculated.
A total of 398 cases were analyzed. The median gestational age at recruitment was 30.1 weeks. Among these cases, 55 (13.8%) cases had sPTB at <37 weeks of gestation. A history of preterm birth (HxPTB), shorter CL, and increased fFN level were independently associated with an increased risk of sPTB. AUROC of the fFN test, at ≥50 ng/mL or ≥200 ng/mL, was significantly higher than that of ≥500 ng/mL for predicting sPTB. For the prediction of sPTB, the AUROCs were 0.78 for CL, 0.78 for fFN, and 0.84 for the combination of HxPTB, CL, and fFN ≥50 ng/mL. The ROC curves showed that, at a false-positive rate of 10%, the sensitivities were 53% for CL ≤2.44 cm, 33.9% for fFN ≥50 ng/mL, and 60% for the combination of HxPTB, CL, and fFN ≥50 ng/mL (p < 0.05).
In women symptomatic of threatened preterm labor, a combination of fFN and CL has improved the predictive performance of sPTB compared with either measure alone.
Magnetic resonance (MR) pelvimetry is widely used in planning vaginal breech birth and may support women's informed decision-making regarding their preferred mode of birth. This feasibility study aimed to assess whether transperineal ultrasound (TPU) could measure the maternal pelvis as accurately as MR pelvimetry and thus predict the outcome of vaginal breech birth.
In this prospective cohort study, nulliparous women with a singleton fetus in breech presentation received TPU for the measurement of the anteroposterior mid-pelvic diameter (AMD). These measurements were compared with those in MR pelvimetry to assess agreement and reliability. In women choosing to attempt vaginal breech birth, we additionally examined the association between the AMD (adjusted for possible confounders) and intrapartum cesarean section. The predictive performance of the AMD and traditional pelvic diameters (i.e., obstetric conjugate, interspinous, and intertuberous distance) was compared by means of the area under the receiver operating characteristic curve (AUC).
Overall, 67 nulliparous women with breech presentation received both TPU and MR pelvimetry, of which 47 chose a vaginal breech birth (30 successful vaginal births and 17 intrapartum cesarean sections). The repeatability coefficients and intraclass correlation coefficient for the AMD were 0.38 cm and 0.97 (95% CI 0.96–0.98), respectively. Bland–Altman analysis between the AMD measured in TPU and MR pelvimetry yielded a mean difference of −0.0052 cm (95% CI −0.066 to 0.056 cm) with upper and lower limits of agreement of 0.48 cm (95% CI 0.38–0.59 cm) and −0.49 cm (95% CI −0.6 cm to −0.39 cm), respectively. In the subgroup of women who attempted vaginal breech birth, AMD was significantly associated with intrapartum cesarean section (adjusted odds ratio 0.25; 95% CI 0.06–0.81; AUC 0.77), while the obstetric conjugate, interspinous, and intertuberous distances were not.
TPU can accurately and reliably measure the AMD, a novel pelvic diameter in breech presentation. Importantly, a smaller AMD was associated with an increased risk of intrapartum cesarean section if vaginal breech birth was attempted. Consequently, TPU could represent an alternative to MR pelvimetry and support women in deciding their preferred mode of birth in breech presentation.
Gestational diabetes mellitus (GDM) is associated with various health risks in offspring. We investigated the effect of GDM exposure on offspring morbidity in a population-based cohort, assessed by the utilization of specialized health care services up to 12 years of age.
This register-based study, part of the Finnish Gestational Diabetes (FinnGeDi) study, included all singleton children born in Finland in 2009, captured from the Medical Birth Registry. Mothers of children in the study cohort underwent comprehensive screening for GDM. The study cohort included 6235 (11.1%) GDM-exposed children and 49 484 unexposed children. Utilization of specialized health care services was measured as the number of outpatient visits and inpatient treatment episodes (including duration in days). Data were obtained from the Finnish Care Register for Health Care up to 12 years of age and were analyzed separately for early childhood (0–2 years), preschool age (3–6 years), and school age (7–12 years) also. Maternal, birth, and child-related factors were considered, including maternal age, pre-pregnancy body mass index (BMI), parity, maternal hypertensive disorders, socioeconomic status (SES), smoking status, mode of delivery, preterm birth, small for gestational age, and child sex in the adjustment model.
Children exposed to maternal GDM had a higher incidence of outpatient visits than unexposed children (adjusted incidence rate ratio [IRR] 1.10, 95% confidence interval [CI] 1.07–1.13). Among children with multiple outpatient care visits (the highest quartile), GDM-exposed children were overrepresented in early childhood (adjusted odds ratio [aOR] 1.08, 95% CI: 1.00–1.15), preschool age (aOR 1.12, 95% CI: 1.05–1.19), and school age (aOR 1.11, 95% CI: 1.04–1.19). Children exposed to GDM were also more likely to require inpatient treatment than unexposed children (adjusted IRR 1.14, 95% CI: 1.10–1.19). The difference was not explained by shorter episodes (adjusted IRR 1.20, 95% CI: 1.16–1.24 for inpatient treatment days).
Children exposed to maternal GDM required more specialized health care services than unexposed children, with increased utilization of specialized health care observed across all age categories up to 12 years of age.
The aim was to evaluate whether SARS-CoV-2 infection during pregnancy was associated with severe postpartum hemorrhage (PPH), as SARS-CoV-2 infection has been shown to affect the coagulation system.
In this national register-based cohort study in Sweden, Denmark, and Norway, we studied the association between severe PPH according to a registered positive test for SARS-CoV-2 during pregnancy between March 1, 2020 and March 31, 2023 using logistic regression analyses to estimate odds ratios (ORs) with 95% confidence intervals (CI). Country-specific estimates of association were combined in random effects meta-analyses. The primary outcome was severe PPH, defined as a blood loss >1500 mL and/or receiving a blood transfusion.
We included 542 394 singleton deliveries (264 804 in Sweden, 143 775 in Denmark, and 133 815 in Norway), of which 62 606 women (11%) had a positive SARS-CoV-2 test during pregnancy, and 20 786 (3.8%) deliveries were registered with a severe PPH. Overall, we observed no association between testing positive for SARS-CoV-2 during pregnancy and severe PPH (combined adjusted OR 1.04; 95% CI: 0.96–1.12). The results were similar for different calendar periods corresponding to dominant SARS-CoV-2 variants. We did, however, observe an association between severe PPH and women testing positive within 7 days before delivery (combined adjusted OR 1.30; 95% CI: 1.10–1.53).
There was no association identified between SARS-CoV-2 test positivity and PPH of >1500 mL and/or blood transfusion in pregnant women from three Scandinavian countries. However, we observed a 30% higher odds of severe PPH among pregnant women who tested positive within one week before delivery.
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