Colm P. Travers, Dhuly Chowdhury, Abhik Das, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Nancy Newman, Shirley Cosby, Myra Wyckoff, Alan Tita, Waldemar A. Carlo, For the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Introduction
Cesarean delivery is the most common mode of delivery among extremely preterm infants but there are insufficient data regarding the best mode of delivery among extremely preterm singletons. The objective of this study was to compare the rate of death or severe neurodevelopmental impairment among extremely preterm singletons by actual mode of delivery.
Material and Methods
Observational study using prospectively collected data from 25 US medical centers. We included postnatally-treated singletons with birth weight 401–1000 g, gestational age 22 + 0/7–26 + 6/7 weeks, without a major birth defect, born 2006–2016. Death or severe neurodevelopmental impairment (Bayley Scales of Infant Development-3rd edition cognitive composite score<70, cerebral palsy (Gross Motor Function Classification Scale >3), bilateral blindness, or bilateral hearing loss) at 18–26 month follow-up were compared by mode of delivery (cesarean, vaginal including vertex or breech) using propensity score analysis to adjust for baseline characteristics.
Results
There was no difference in death or severe neurodevelopmental impairment between cesarean and vaginal (vertex or breech) births (42.4% cesarean vs. 47.2% vaginal; adjusted odds ratio (aOR), 95% confidence intervals (CI); 1.03, 0.91–1.17). Both cesarean delivery (26.8% cesarean vs. 51.5% breech vaginal; aOR: 0.71; 95% CI: 0.55–0.92) and vertex vaginal delivery (28.5% vertex vaginal vs. 51.5% breech vaginal; aOR: 0.59; 95% CI: 0.45–0.76) were associated with lower mortality compared with breech vaginal delivery.
Conclusions
Among postnatally-treated extremely preterm singletons, there was no difference in death or severe neurodevelopmental impairment between cesarean or vaginal delivery. Both vertex vaginal and cesarean delivery were associated with lower mortality compared with breech vaginal delivery.
{"title":"Mode of delivery and outcomes among inborn extremely preterm singletons: A cohort study","authors":"Colm P. Travers, Dhuly Chowdhury, Abhik Das, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Nancy Newman, Shirley Cosby, Myra Wyckoff, Alan Tita, Waldemar A. Carlo, For the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network","doi":"10.1111/aogs.15028","DOIUrl":"10.1111/aogs.15028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cesarean delivery is the most common mode of delivery among extremely preterm infants but there are insufficient data regarding the best mode of delivery among extremely preterm singletons. The objective of this study was to compare the rate of death or severe neurodevelopmental impairment among extremely preterm singletons by actual mode of delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Observational study using prospectively collected data from 25 US medical centers. We included postnatally-treated singletons with birth weight 401–1000 g, gestational age 22 + 0/7–26 + 6/7 weeks, without a major birth defect, born 2006–2016. Death or severe neurodevelopmental impairment (Bayley Scales of Infant Development-3rd edition cognitive composite score<70, cerebral palsy (Gross Motor Function Classification Scale >3), bilateral blindness, or bilateral hearing loss) at 18–26 month follow-up were compared by mode of delivery (cesarean, vaginal including vertex or breech) using propensity score analysis to adjust for baseline characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was no difference in death or severe neurodevelopmental impairment between cesarean and vaginal (vertex or breech) births (42.4% cesarean vs. 47.2% vaginal; adjusted odds ratio (aOR), 95% confidence intervals (CI); 1.03, 0.91–1.17). Both cesarean delivery (26.8% cesarean vs. 51.5% breech vaginal; aOR: 0.71; 95% CI: 0.55–0.92) and vertex vaginal delivery (28.5% vertex vaginal vs. 51.5% breech vaginal; aOR: 0.59; 95% CI: 0.45–0.76) were associated with lower mortality compared with breech vaginal delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among postnatally-treated extremely preterm singletons, there was no difference in death or severe neurodevelopmental impairment between cesarean or vaginal delivery. Both vertex vaginal and cesarean delivery were associated with lower mortality compared with breech vaginal delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"408-422"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma Van den Eede, Bart De Keersmaecker, Katrien Lagrou, Lennart Van der Veeken, Sanne Vanwinkel, Maja Vangoitsenhoven, Michael Aertsen, Luc De Catte
Introduction
To investigate the prevalence and timing of prenatal neurosonographic abnormalities after primary cytomegalovirus seroconversion by the first trimester of pregnancy. The additional value of magnetic resonance imaging (MRI) and the correlation between cytomegalovirus viral load in amniotic fluid and adverse neonatal outcomes were evaluated.
Material and Methods
A retrospective study between 2006 and 2022 examined data from 440 women with amniocentesis for periconceptional and first-trimester cytomegalovirus seroconversion. Cases with positive amniocentesis and subsequent follow-up were included. Prenatal neurosonography, MRI, and clinical outcomes were analyzed.
Results
Out of 190 women included, 37% (n = 70) presented with a normal neurosonography. Patients exhibiting abnormal neurosonography findings showed higher viral loads in amniotic fluid compared to those with a normal neurosonography (p = 0.002). In 26% (n = 49) the first abnormal ultrasound sign was already picked up at amniocentesis, and the most common ones were echogenic bowels (49%) and periventricular echogenicity (43%). With increasing gestational age, the likelihood of a new abnormal neurosonography finding decreases. MRI discovered additional abnormalities in 14% (n = 10).
Conclusions
The results highlight the importance of combining diagnostic modalities, from amniocentesis to biweekly ultrasound monitoring and subsequent MRI evaluation, to capture the chronological progression and subsequent outcome of congenital cytomegalovirus.
{"title":"Prevalence and timing of prenatal ultrasound findings in cytomegalovirus-infected pregnancies","authors":"Emma Van den Eede, Bart De Keersmaecker, Katrien Lagrou, Lennart Van der Veeken, Sanne Vanwinkel, Maja Vangoitsenhoven, Michael Aertsen, Luc De Catte","doi":"10.1111/aogs.15018","DOIUrl":"10.1111/aogs.15018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To investigate the prevalence and timing of prenatal neurosonographic abnormalities after primary cytomegalovirus seroconversion by the first trimester of pregnancy. The additional value of magnetic resonance imaging (MRI) and the correlation between cytomegalovirus viral load in amniotic fluid and adverse neonatal outcomes were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A retrospective study between 2006 and 2022 examined data from 440 women with amniocentesis for periconceptional and first-trimester cytomegalovirus seroconversion. Cases with positive amniocentesis and subsequent follow-up were included. Prenatal neurosonography, MRI, and clinical outcomes were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 190 women included, 37% (<i>n</i> = 70) presented with a normal neurosonography. Patients exhibiting abnormal neurosonography findings showed higher viral loads in amniotic fluid compared to those with a normal neurosonography (<i>p</i> = 0.002). In 26% (<i>n</i> = 49) the first abnormal ultrasound sign was already picked up at amniocentesis, and the most common ones were echogenic bowels (49%) and periventricular echogenicity (43%). With increasing gestational age, the likelihood of a new abnormal neurosonography finding decreases. MRI discovered additional abnormalities in 14% (<i>n</i> = 10).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results highlight the importance of combining diagnostic modalities, from amniocentesis to biweekly ultrasound monitoring and subsequent MRI evaluation, to capture the chronological progression and subsequent outcome of congenital cytomegalovirus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"302-308"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hortense Didier-Mathon, Gilles Kayem, Thibault Thubert, Loîc Sentilhes, Charles Garabedian, Thomas Schmitz, Diane Korb, Edouard Lecarpentier, François Goffinet, Cyril Raiffort, Marie-Victoire Senat, Elie Azria, Aude Ricbourg, Alix Defline, Pierre Delorme
Introduction
Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean-related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attempt population.
Material and Methods
This was a 16-year retrospective multicenter case–control cohort study (2002–2018). Eleven French university hospitals participated. Women were included if they had a complete uterine rupture during a VBAC attempt. Two controls, defined as a VBAC attempt without uterine rupture, were randomly included for each case. We analyzed the risk factors of uterine rupture among the overall population and then among women who had labor induction and those who had spontaneous labor. Logistic regression was used to compute crude odds ratios (ORs) and 95% confidence intervals (CIs) for uterine rupture. Multivariable logistic regression was used to calculate adjusted ORs (aORs) and 95% CIs.
Results
Among 48 124 patients with a single prior cesarean section, 31668 (65.8%, 95% CI 65.3–66.2) had a VBAC attempt and 23 086 (72.9% 95% CI 72.4–73.4) had a successful vaginal delivery. The complete uterine rupture frequency was 0.63%. There were 199 cases of complete uterine rupture (0.63%, 95%CI 0.54–0.71) and 396 controls. Among the overall population, the odds of uterine rupture was inversely associated with prior vaginal delivery (adjusted odds ratio [aOR] 0.3, CI 95% 0.2–0.5) and positively with induction of labor (aOR 2.2, 95% CI 1.4–3.4). For women with spontaneous labor, the odds of uterine rupture was positively associated with a Bishop score<6 (aOR 1.8, 95%CI 1.0–3.0), arrest of cervical dilatation of at least 1 hr. (aOR, 1.8 95%CI 1.1–2.9) and oxytocin augmentation (aOR 2.2 95% CI 1.3–3.7). For women undergoing labor induction, no factors were significantly associated with uterine rupture.
Conclusions
Uterine rupture frequency was low among women with high rates of VBAC attempt and successful vaginal delivery and was reduced with previous vaginal birth and increased with induction of labor, regardless of the method used. It was associated with any dystocia during spontaneous labor and suspected macrosomia in induced women, which should be managed with caution.
剖宫产后阴道分娩（VBAC）的尝试被提倡以减少剖宫产相关的发病率，但它有子宫破裂的风险，对孕产妇和新生儿造成重大风险。本研究评估子宫破裂发生率和危险因素在高VBAC尝试人群。材料和方法：这是一项为期16年的回顾性多中心病例对照队列研究（2002-2018）。11家法国大学医院参与了研究。如果女性在VBAC尝试期间子宫完全破裂，则包括在内。两个对照组，定义为VBAC尝试没有子宫破裂，随机纳入每个病例。我们分析了所有人群中子宫破裂的危险因素以及引产和自然分娩的妇女。采用Logistic回归计算子宫破裂的粗优势比（ORs）和95%可信区间（CIs）。采用多变量logistic回归计算调整后的or （aORs）和95% ci。结果：48124例有过一次剖宫产史的患者中，31668例（65.8%,95% CI 65.3-66.2）尝试过VBAC， 23086例（72.9%,95% CI 72.4-73.4）成功阴道分娩。子宫完全破裂发生率为0.63%。子宫完全破裂199例（0.63%,95%CI 0.54 ~ 0.71），对照组396例。在总体人群中，子宫破裂的几率与既往阴道分娩呈负相关（调整优势比[aOR] 0.3, 95% CI 0.2-0.5），与引产呈正相关（aOR 2.2, 95% CI 1.4-3.4）。对于自然分娩的妇女，子宫破裂的几率与Bishop评分呈正相关。结论：在VBAC尝试率高和阴道分娩成功率高的妇女中，子宫破裂的频率较低，无论使用何种方法，阴道分娩的妇女子宫破裂频率降低，引产的妇女子宫破裂频率增加。它与自然分娩时的难产和引产妇女的疑似巨大儿有关，应谨慎处理。
{"title":"Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery","authors":"Hortense Didier-Mathon, Gilles Kayem, Thibault Thubert, Loîc Sentilhes, Charles Garabedian, Thomas Schmitz, Diane Korb, Edouard Lecarpentier, François Goffinet, Cyril Raiffort, Marie-Victoire Senat, Elie Azria, Aude Ricbourg, Alix Defline, Pierre Delorme","doi":"10.1111/aogs.15017","DOIUrl":"10.1111/aogs.15017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean-related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attempt population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a 16-year retrospective multicenter case–control cohort study (2002–2018). Eleven French university hospitals participated. Women were included if they had a complete uterine rupture during a VBAC attempt. Two controls, defined as a VBAC attempt without uterine rupture, were randomly included for each case. We analyzed the risk factors of uterine rupture among the overall population and then among women who had labor induction and those who had spontaneous labor. Logistic regression was used to compute crude odds ratios (ORs) and 95% confidence intervals (CIs) for uterine rupture. Multivariable logistic regression was used to calculate adjusted ORs (aORs) and 95% CIs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 48 124 patients with a single prior cesarean section, 31668 (65.8%, 95% CI 65.3–66.2) had a VBAC attempt and 23 086 (72.9% 95% CI 72.4–73.4) had a successful vaginal delivery. The complete uterine rupture frequency was 0.63%. There were 199 cases of complete uterine rupture (0.63%, 95%CI 0.54–0.71) and 396 controls. Among the overall population, the odds of uterine rupture was inversely associated with prior vaginal delivery (adjusted odds ratio [aOR] 0.3, CI 95% 0.2–0.5) and positively with induction of labor (aOR 2.2, 95% CI 1.4–3.4). For women with spontaneous labor, the odds of uterine rupture was positively associated with a Bishop score<6 (aOR 1.8, 95%CI 1.0–3.0), arrest of cervical dilatation of at least 1 hr. (aOR, 1.8 95%CI 1.1–2.9) and oxytocin augmentation (aOR 2.2 95% CI 1.3–3.7). For women undergoing labor induction, no factors were significantly associated with uterine rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Uterine rupture frequency was low among women with high rates of VBAC attempt and successful vaginal delivery and was reduced with previous vaginal birth and increased with induction of labor, regardless of the method used. It was associated with any dystocia during spontaneous labor and suspected macrosomia in induced women, which should be managed with caution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"380-388"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142764772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yan Wang, Yuan Lv, Jia Yao, Hao Ding, Gang Li, Jianmin Li, Lizhu Chen
Introduction: Fetal skeletal abnormalities can be caused by various factors and genetic cause plays an important role. Prenatal exome sequencing (ES) has been shown to be a powerful approach for accurate prenatal molecular diagnoses. Diagnostic yield of ES in fetal skeletal abnormalities varies significantly across studies. This study aimed to perform a systematic review of the literature and meta-analysis to assess the incremental yield of ES in fetuses with different kinds of skeletal abnormalities and a negative result on chromosome microarray or karyotyping.
Material and methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched up to November 26, 2022. Relevant data were collected from observational studies containing five or more cases of skeletal abnormalities who underwent ES. The incremental yield of ES was evaluated by single proportion analysis and 95% confidence interval (CI), both according to the article features and individual phenotypes. This study was registered on PROSPERO as CRD42022382800.
Results: Twenty-six studies including 524 individuals met the inclusion criteria. The pooled incremental yield was 60.2% (95% CI, 53.4%-66.9%) for all fetuses with skeletal abnormalities. In subgroup analysis, the additional diagnostic yield was 83.9% (95% CI, 76.4%-90.4%) in isolated dysplasia cases (group I), 52.0% (95% CI, 32.9%-70.9%) in dysplasia with non-skeletal abnormalities cases (group II), 33.3% (95% CI, 19.3%-48.6%) in isolate dysostoses cases (group III), 47.8% (95 % CI, 35.8%-60.0%) in dysostoses with non-skeletal abnormalities cases (group IV), 83.0% (95% CI, 63.7%-97.1%) in combination of the two phenotypes without non-skeletal abnormalities cases (group V), 74.5% (95% CI, 54.9%-90.9%) in combination of the two phenotypes with non-skeletal abnormalities cases (group VI). The origin of the pathogenic variations differed among the groups. Most causative variants were de novo in groups I (97/133, 72.9%), V (14/23, 60.9%), and VI (15/26, 57.7%). Meanwhile, pathogenic variations in III (18/25, 72.0%) and IV (37/67, 55.2%) were more often inherited from a parent.
Conclusions: ES had a favorable incremental yield in fetuses with skeletal abnormalities. The common pathogenic variations and genetic patterns of skeletal abnormalities vary among different subtypes. Interpreting this difference is beneficial for personalized clinical consultation.
{"title":"Incremental yield of prenatal exome sequencing in fetuses with skeletal system abnormalities: A systematic review and meta-analysis.","authors":"Yan Wang, Yuan Lv, Jia Yao, Hao Ding, Gang Li, Jianmin Li, Lizhu Chen","doi":"10.1111/aogs.15025","DOIUrl":"https://doi.org/10.1111/aogs.15025","url":null,"abstract":"<p><strong>Introduction: </strong>Fetal skeletal abnormalities can be caused by various factors and genetic cause plays an important role. Prenatal exome sequencing (ES) has been shown to be a powerful approach for accurate prenatal molecular diagnoses. Diagnostic yield of ES in fetal skeletal abnormalities varies significantly across studies. This study aimed to perform a systematic review of the literature and meta-analysis to assess the incremental yield of ES in fetuses with different kinds of skeletal abnormalities and a negative result on chromosome microarray or karyotyping.</p><p><strong>Material and methods: </strong>The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched up to November 26, 2022. Relevant data were collected from observational studies containing five or more cases of skeletal abnormalities who underwent ES. The incremental yield of ES was evaluated by single proportion analysis and 95% confidence interval (CI), both according to the article features and individual phenotypes. This study was registered on PROSPERO as CRD42022382800.</p><p><strong>Results: </strong>Twenty-six studies including 524 individuals met the inclusion criteria. The pooled incremental yield was 60.2% (95% CI, 53.4%-66.9%) for all fetuses with skeletal abnormalities. In subgroup analysis, the additional diagnostic yield was 83.9% (95% CI, 76.4%-90.4%) in isolated dysplasia cases (group I), 52.0% (95% CI, 32.9%-70.9%) in dysplasia with non-skeletal abnormalities cases (group II), 33.3% (95% CI, 19.3%-48.6%) in isolate dysostoses cases (group III), 47.8% (95 % CI, 35.8%-60.0%) in dysostoses with non-skeletal abnormalities cases (group IV), 83.0% (95% CI, 63.7%-97.1%) in combination of the two phenotypes without non-skeletal abnormalities cases (group V), 74.5% (95% CI, 54.9%-90.9%) in combination of the two phenotypes with non-skeletal abnormalities cases (group VI). The origin of the pathogenic variations differed among the groups. Most causative variants were de novo in groups I (97/133, 72.9%), V (14/23, 60.9%), and VI (15/26, 57.7%). Meanwhile, pathogenic variations in III (18/25, 72.0%) and IV (37/67, 55.2%) were more often inherited from a parent.</p><p><strong>Conclusions: </strong>ES had a favorable incremental yield in fetuses with skeletal abnormalities. The common pathogenic variations and genetic patterns of skeletal abnormalities vary among different subtypes. Interpreting this difference is beneficial for personalized clinical consultation.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samson Nivins, Parvin Kumar, Xinxia Chen, Mika Gissler, Catharina Lavebratt
Introduction
Hypertensive disorders of pregnancy (HDP) or prepregnancy overweight/obesity are independently associated with the risk for certain neurodevelopmental and psychiatric disorders in offspring. These two conditions often co-exist but the risk from combined exposure is unknown. We investigated whether specific subtypes of maternal HDP, along with prepregnancy overweight/obesity, were associated with the distinct risk of neurodevelopmental and psychiatric disorders in offspring during childhood.
Material and Methods
This prospective, population-based cohort study used data from 652 732 singleton children born alive in Finland between 2004 and 2014 and followed until 2018. The Cox proportional hazards model was used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI).
Results
Children exposed to both chronic hypertension and obesity exhibited a 2.4–3.5-fold higher risk for mood disorders, specific developmental disorder, autism spectrum disorders, and attention-deficit/hyperactivity disorders. Similarly, exposure to both gestational hypertension and overweight increased the risk for anxiety disorders and attention-deficit hyperactivity disorders by 2.4-fold. Meanwhile, combined exposure to preeclampsia and overweight increased the risk of mood and anxiety disorders, specific developmental disorders, and other behavioral disorders, by 1.8–2.2-fold. The effect size of combined exposure to HDP and overweight/obesity was greater than that of the individual exposure to HDP subtypes or overweight/obesity. Furthermore, overweight/obesity synergistically modified these associations between the HDP subtype exposure and offspring mental disorders, except for specific developmental disorders.
Conclusions
Our findings suggest that combined exposure to different subtypes of HDP and higher prepregnancy BMI have distinct impacts on the mental health of offspring. Notably, a more pronounced effect was observed in cases where chronic hypertension and obesity coexisted. Future research should focus on exploring dose-related relationships rather than amalgamating maternal HDP for investigating the offspring outcomes.
{"title":"Prenatal exposure to maternal hypertension and higher body mass index and risks of neurodevelopmental and psychiatric disorders during childhood","authors":"Samson Nivins, Parvin Kumar, Xinxia Chen, Mika Gissler, Catharina Lavebratt","doi":"10.1111/aogs.15021","DOIUrl":"10.1111/aogs.15021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hypertensive disorders of pregnancy (HDP) or prepregnancy overweight/obesity are independently associated with the risk for certain neurodevelopmental and psychiatric disorders in offspring. These two conditions often co-exist but the risk from combined exposure is unknown. We investigated whether specific subtypes of maternal HDP, along with prepregnancy overweight/obesity, were associated with the distinct risk of neurodevelopmental and psychiatric disorders in offspring during childhood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This prospective, population-based cohort study used data from 652 732 singleton children born alive in Finland between 2004 and 2014 and followed until 2018. The Cox proportional hazards model was used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children exposed to both chronic hypertension and obesity exhibited a 2.4–3.5-fold higher risk for mood disorders, specific developmental disorder, autism spectrum disorders, and attention-deficit/hyperactivity disorders. Similarly, exposure to both gestational hypertension and overweight increased the risk for anxiety disorders and attention-deficit hyperactivity disorders by 2.4-fold. Meanwhile, combined exposure to preeclampsia and overweight increased the risk of mood and anxiety disorders, specific developmental disorders, and other behavioral disorders, by 1.8–2.2-fold. The effect size of combined exposure to HDP and overweight/obesity was greater than that of the individual exposure to HDP subtypes or overweight/obesity. Furthermore, overweight/obesity synergistically modified these associations between the HDP subtype exposure and offspring mental disorders, except for specific developmental disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that combined exposure to different subtypes of HDP and higher prepregnancy BMI have distinct impacts on the mental health of offspring. Notably, a more pronounced effect was observed in cases where chronic hypertension and obesity coexisted. Future research should focus on exploring dose-related relationships rather than amalgamating maternal HDP for investigating the offspring outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"319-330"},"PeriodicalIF":3.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gernot Hudelist, Ezgi Darici Kurt, Gábor Szabó, Dominika Miklos, Theresa Hudelist, Attila Bokor
<div> <section> <h3> Introduction</h3> <p>Surgical resection of sacral plexus endometriosis (SPE) is contemplated in severely symptomatic patients not responding to medical or hormonal therapy. However, there is only limited data on the effects of surgery on pain and neurological symptoms. This study aims to report on the surgical outcomes in terms of pain and neurological symptom reduction in women undergoing surgical resection of SPE.</p> </section> <section> <h3> Material and Methods</h3> <p>Thirty premenopausal patients with histologically confirmed SPE who underwent surgical resection of the disease between 2018 and 2024 were included in this multicenter prospective analysis. The primary outcome was the change in neurological symptoms reflected by sacral radiculopathy including dysaesthesia, paraesthesia, hyperaesthesia, and pain. The secondary outcome was post-surgical morbidity reflected by rates of major intra- and postoperative complications.</p> </section> <section> <h3> Results</h3> <p>All patients exhibited DE affecting the sacral roots S1-S4, whereas no case of isolated supracardinal sciatic nerve involvement was observed. Out of 30 patients, one was lost to follow-up leaving 29 patients for final analysis. Six (20%) of the 30 patients underwent partial resection of the sacral root because of endometriotic infiltration of the nerval tissue. In all other patients, dissection and shaving with cold scissors were sufficient to remove DE affecting the sacral root. Dysaesthesia was observed in 13/30 (43.3%), paraesthesia in 16/30 (53.3%), hyperaesthesia in 5/30 (16.7%), and secondary motor dysfunction in 4/30 (13.3%), preoperatively. The mean follow-up interval was 25.5 ± 20.2 months showing an overall improvement in sacral radiculopathy in 93.1% (27/29) of the patients. A significant decrease in numeric rating scale (NRS) scores of dysaesthesia (<i>p</i> = 0.003), paraesthesia (<i>p</i> ≤ 0.001) and hyperaesthesia (<i>p</i> = 0.068) were observed post-surgically. Equally, reduced pain symptoms including dysmenorrhea, dyspareunia and dyschezia (all <i>p</i> ≤ 0.001) with a relevant increase in post-surgical quality of life scores (<i>p</i> ≤ 0.001) were recorded. De novo hyperaesthesia and paraesthesia occurred in 6.8% (2/29) and 3.4% (1/29) of the patients, respectively. Major Clavien-Dindo grade III complications occurred in 13.3% (4/30) of the cases.</p> </section> <section> <h3> Conclusions</h3> <p>Radical resection of symptomatic deep endometriosis affecting the sacral plexus reduces neurological and pain symptoms and leads to an increa
{"title":"Surgical outcomes of women undergoing radical resection of deep endometriosis of the sacral plexus: A prospective cohort study","authors":"Gernot Hudelist, Ezgi Darici Kurt, Gábor Szabó, Dominika Miklos, Theresa Hudelist, Attila Bokor","doi":"10.1111/aogs.15015","DOIUrl":"10.1111/aogs.15015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Surgical resection of sacral plexus endometriosis (SPE) is contemplated in severely symptomatic patients not responding to medical or hormonal therapy. However, there is only limited data on the effects of surgery on pain and neurological symptoms. This study aims to report on the surgical outcomes in terms of pain and neurological symptom reduction in women undergoing surgical resection of SPE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Thirty premenopausal patients with histologically confirmed SPE who underwent surgical resection of the disease between 2018 and 2024 were included in this multicenter prospective analysis. The primary outcome was the change in neurological symptoms reflected by sacral radiculopathy including dysaesthesia, paraesthesia, hyperaesthesia, and pain. The secondary outcome was post-surgical morbidity reflected by rates of major intra- and postoperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All patients exhibited DE affecting the sacral roots S1-S4, whereas no case of isolated supracardinal sciatic nerve involvement was observed. Out of 30 patients, one was lost to follow-up leaving 29 patients for final analysis. Six (20%) of the 30 patients underwent partial resection of the sacral root because of endometriotic infiltration of the nerval tissue. In all other patients, dissection and shaving with cold scissors were sufficient to remove DE affecting the sacral root. Dysaesthesia was observed in 13/30 (43.3%), paraesthesia in 16/30 (53.3%), hyperaesthesia in 5/30 (16.7%), and secondary motor dysfunction in 4/30 (13.3%), preoperatively. The mean follow-up interval was 25.5 ± 20.2 months showing an overall improvement in sacral radiculopathy in 93.1% (27/29) of the patients. A significant decrease in numeric rating scale (NRS) scores of dysaesthesia (<i>p</i> = 0.003), paraesthesia (<i>p</i> ≤ 0.001) and hyperaesthesia (<i>p</i> = 0.068) were observed post-surgically. Equally, reduced pain symptoms including dysmenorrhea, dyspareunia and dyschezia (all <i>p</i> ≤ 0.001) with a relevant increase in post-surgical quality of life scores (<i>p</i> ≤ 0.001) were recorded. De novo hyperaesthesia and paraesthesia occurred in 6.8% (2/29) and 3.4% (1/29) of the patients, respectively. Major Clavien-Dindo grade III complications occurred in 13.3% (4/30) of the cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Radical resection of symptomatic deep endometriosis affecting the sacral plexus reduces neurological and pain symptoms and leads to an increa","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"95-101"},"PeriodicalIF":3.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tallhage, S, Årestedt, K, Schildmeijer, Oscarsson M. Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: a Swedish nationwide register study. Acta Obstet Gynecol Scand. 2024; 103: 304–312. doi:10.1111/aogs.14717.
There is an error in Table 4, Country of origin, Born outside Sweden but in the EU, SROM. The current numbers are 247 (7.8), but the correct values are 24 (7.8). A total of 24 women with SROM were born outside of Sweden but in the EU.
We apologize for this error.
{"title":"Correction to “Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: A Swedish nationwide register study”","authors":"","doi":"10.1111/aogs.15027","DOIUrl":"10.1111/aogs.15027","url":null,"abstract":"<p>\u0000 \u0000 <span>Tallhage, S</span>, <span>Årestedt, K</span>, <span>Schildmeijer, Oscarsson M</span>. <span>Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: a Swedish nationwide register study</span>. <i>Acta Obstet Gynecol Scand</i>. <span>2024</span>; <span>103</span>: <span>304</span>–<span>312</span>. doi:10.1111/aogs.14717.\u0000 </p><p>There is an error in Table 4, Country of origin, Born outside Sweden but in the EU, SROM. The current numbers are 247 (7.8), but the correct values are 24 (7.8). A total of 24 women with SROM were born outside of Sweden but in the EU.</p><p>We apologize for this error.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"245"},"PeriodicalIF":3.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Detection and surveillance of fetal growth restriction (FGR) is well established, but there is still room for improvement. Animal studies indicate that compromised fetuses increase adrenal blood flow. Modern ultrasound equipment allows us to measure vascular impedance in the fetal adrenal arteries despite their modest size. However, extensive anatomical variance is a challenge to standardizing measurements. We set out to improve this.
Material and Methods
We included 75 low-risk pregnant women in a prospective cross-sectional study aiming to develop a reliable technique to visualize and measure flow velocity in human fetal adrenal arteries. We used commercially available ultrasound equipment: a GE Voluson 10 2019 with a C2-9 probe (GE Healthcare, Zipf, Austria), and a Philips Epiq Elite with a V9-2 probe (Philips Medical Systems International B.V., Best, The Netherlands), exploiting the modern sensitive power Doppler modes in both scanners to visualize small vessels.
Results
Among 72 fetuses, the inferior adrenal artery was the most consistently visualized and measured artery to the gland. Doppler velocimetry was achieved in 66 (92%) participants. We found the anatomical variation described previously but were able to develop visualization strategies to identify the common arteries and use a consistent Doppler technique for the second half of pregnancy.
Conclusions
It is possible to visualize and measure flow velocity in the adrenal arteries of human fetuses. The success rate was highest for the inferior adrenal artery making this vessel a candidate for clinical studies.
导言：胎儿生长受限（FGR）的检测和监控已得到广泛认可，但仍有改进的余地。动物实验表明，胎儿发育受限会增加肾上腺血流量。尽管胎儿肾上腺动脉的体积不大，但现代超声设备可让我们测量其血管阻抗。然而，解剖学上的广泛差异是标准化测量的一个挑战。材料和方法：我们在一项前瞻性横断面研究中纳入了 75 名低风险孕妇，旨在开发一种可靠的技术来观察和测量胎儿肾上腺动脉的流速。我们使用了市售的超声设备：配有 C2-9 探头的 GE Voluson 10 2019（GE Healthcare，奥地利齐普夫）和配有 V9-2 探头的 Philips Epiq Elite（Philips Medical Systems International B.V.，荷兰贝斯特），利用这两种扫描仪的现代灵敏功率多普勒模式来观察小血管：结果：在 72 个胎儿中，肾上腺下动脉是最常被观察和测量到的通往腺体的动脉。有 66 名（92%）胎儿进行了多普勒测速。我们发现了之前描述过的解剖变异，但能够制定可视化策略来识别总动脉，并在妊娠后半期使用一致的多普勒技术：结论：观察和测量人类胎儿肾上腺动脉的流速是可能的。肾上腺下动脉的成功率最高，因此该血管可用于临床研究。
{"title":"Ultrasound visualization and blood flow velocity measurements of the adrenal arteries in the fetus","authors":"Øystein Bergøy, Torvid Kiserud, Jørg Kessler, Ingvild Dalen, Kristine Moi Økland, Ragnar Kvie Sande","doi":"10.1111/aogs.15011","DOIUrl":"10.1111/aogs.15011","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Detection and surveillance of fetal growth restriction (FGR) is well established, but there is still room for improvement. Animal studies indicate that compromised fetuses increase adrenal blood flow. Modern ultrasound equipment allows us to measure vascular impedance in the fetal adrenal arteries despite their modest size. However, extensive anatomical variance is a challenge to standardizing measurements. We set out to improve this.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We included 75 low-risk pregnant women in a prospective cross-sectional study aiming to develop a reliable technique to visualize and measure flow velocity in human fetal adrenal arteries. We used commercially available ultrasound equipment: a GE Voluson 10 2019 with a C2-9 probe (GE Healthcare, Zipf, Austria), and a Philips Epiq Elite with a V9-2 probe (Philips Medical Systems International B.V., Best, The Netherlands), exploiting the modern sensitive power Doppler modes in both scanners to visualize small vessels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 72 fetuses, the inferior adrenal artery was the most consistently visualized and measured artery to the gland. Doppler velocimetry was achieved in 66 (92%) participants. We found the anatomical variation described previously but were able to develop visualization strategies to identify the common arteries and use a consistent Doppler technique for the second half of pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>It is possible to visualize and measure flow velocity in the adrenal arteries of human fetuses. The success rate was highest for the inferior adrenal artery making this vessel a candidate for clinical studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"102-108"},"PeriodicalIF":3.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Malene Møller Jørgensen, Rikke Bæk, Jenni K. Sloth, Rami Sammour, Adi Sharabi-Nov, Manu Vatish, Hamutal Meiri, Marei Sammar
<div> <section> <h3> Introduction</h3> <p>Placental-derived extracellular vesicles (EVs) are nano-organelles that facilitate intercellular communication between the feto-placental unit and the mother. We evaluated a novel Multiple Microarray analyzer for identifying surface markers on plasma EVs that predict preterm delivery and preeclampsia compared to term delivery controls.</p> </section> <section> <h3> Material and Methods</h3> <p>In this prospective exploratory cohort study pregnant women between 24 and 40 gestational weeks with preterm delivery (<i>n</i> = 16), preeclampsia (<i>n</i> = 19), and matched term delivery controls (<i>n</i> = 15) were recruited from Bnai Zion Medical Center, Haifa, Israel. Plasma samples were tested using a multiple microarray analyzer. Glass slides with 17 antibodies against EV surface receptors - were incubated with raw plasma samples, detected by biotinylated secondary antibodies specific to EVs or placental EVs (PEVs), and labeled with cyanine 5–streptavidin. PBS and whole human IgG served as controls. The fluorescent signal ratio to negative controls was log 2 transformed and analyzed for sensitivity and specificity using the area under the receiver operating characteristics curves (AUROC). Best pair ratios of general EVs/PEVs were used for univariate analysis, and top pairs were combined for multivariate analysis. Results were validated by comparison with EVs purified using standard procedures.</p> </section> <section> <h3> Results</h3> <p>Heatmaps differentiated surface profiles of preeclampsia, preterm delivery, and term delivery receptors on total EVs and PEVs. Similar results were obtained with enriched EVs and EVs from raw plasma. Univariate analyses identified markers predicting preterm delivery and preeclampsia over term delivery controls with AUC >0.6 and sensitivity >50% at 80% specificity. Combining the best markers in a multivariate model, preeclampsia prediction over term delivery had an AUC of 0.89 (95% CI: 0.72–1.0) with 90% sensitivity and 90% specificity, marked by inflammation (TNF RII), relaxation (placenta protein 13 (PP13)), and immune-modulation (LFA1) receptors. Preterm delivery prediction over term delivery had an AUC of 0.97 (0.94–1.0), 84% sensitivity, and 90% specificity, marked by cell adhesion (ICAM), immune suppression, and general EV markers (CD81, CD82, and Alix). Preeclampsia prediction over preterm delivery had an AUC of 0.91 (0.79–0.99) with 80% sensitivity and 90% specificity with markers for complement activation (C1q) and autoimmunity markers.</p> </section> <section> <h3> Conclusions</h3>
引言胎盘源性细胞外囊泡（EVs）是一种纳米细胞器，可促进胎盘和母体之间的细胞间交流。我们评估了一种新型多重微阵列分析仪，该分析仪可识别血浆 EVs 表面标记物，与足月分娩对照组相比，该标记物可预测早产和子痫前期：在这项前瞻性探索性队列研究中，以色列海法市 Bnai Zion 医疗中心招募了 24 至 40 孕周的早产孕妇（n = 16）、子痫前期孕妇（n = 19）和匹配的足月分娩对照组孕妇（n = 15）。使用多重微阵列分析仪对血浆样本进行检测。将含有 17 种针对 EV 表面受体的抗体的玻璃载玻片与原始血浆样本孵育，用针对 EV 或胎盘 EV（PEV）的生物素化二抗检测，并用 5-链霉亲和素标记。PBS 和全人 IgG 作为对照。荧光信号与阴性对照的比率经对数2转换，并用接收者操作特征曲线下面积（AUROC）分析灵敏度和特异性。一般 EVs/PEVs 的最佳配对比率用于单变量分析，最佳配对组合用于多变量分析。结果通过与使用标准程序纯化的 EVs 进行比较得到验证：结果：热图可区分子痫前期、早产和足月分娩受体在总 EVs 和 PEVs 上的表面特征。富集的EV和原始血浆中的EV也得到了类似的结果。单变量分析确定了预测早产和子痫前期的标记物，其AUC大于0.6，灵敏度大于50%，特异性为80%。在多变量模型中结合最佳标记物，预测子痫前期高于足月分娩的AUC为0.89（95% CI：0.72-1.0），灵敏度为90%，特异性为90%，标记物为炎症（TNF RII）、松弛（胎盘蛋白13（PP13））和免疫调节（LFA1）受体。早产预测比足月产预测的 AUC 为 0.97 (0.94-1.0)，灵敏度为 84%，特异性为 90%，以细胞粘附 (ICAM)、免疫抑制和一般 EV 标记（CD81、CD82 和 Alix）为标志。与早产相比，子痫前期预测的AUC为0.91（0.79-0.99），灵敏度为80%，特异性为90%，标记物为补体激活（C1q）和自身免疫标记物：新的、强大的 EV 多阵列分析仪和方法提供了一种简单、快速的诊断工具，可揭示主要产科综合征的新型表面标记物。
{"title":"A novel multiple marker microarray analyzer and methodology to predict major obstetric syndromes using surface markers of circulating extracellular vesicles from maternal plasma","authors":"Malene Møller Jørgensen, Rikke Bæk, Jenni K. Sloth, Rami Sammour, Adi Sharabi-Nov, Manu Vatish, Hamutal Meiri, Marei Sammar","doi":"10.1111/aogs.15020","DOIUrl":"10.1111/aogs.15020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Placental-derived extracellular vesicles (EVs) are nano-organelles that facilitate intercellular communication between the feto-placental unit and the mother. We evaluated a novel Multiple Microarray analyzer for identifying surface markers on plasma EVs that predict preterm delivery and preeclampsia compared to term delivery controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this prospective exploratory cohort study pregnant women between 24 and 40 gestational weeks with preterm delivery (<i>n</i> = 16), preeclampsia (<i>n</i> = 19), and matched term delivery controls (<i>n</i> = 15) were recruited from Bnai Zion Medical Center, Haifa, Israel. Plasma samples were tested using a multiple microarray analyzer. Glass slides with 17 antibodies against EV surface receptors - were incubated with raw plasma samples, detected by biotinylated secondary antibodies specific to EVs or placental EVs (PEVs), and labeled with cyanine 5–streptavidin. PBS and whole human IgG served as controls. The fluorescent signal ratio to negative controls was log 2 transformed and analyzed for sensitivity and specificity using the area under the receiver operating characteristics curves (AUROC). Best pair ratios of general EVs/PEVs were used for univariate analysis, and top pairs were combined for multivariate analysis. Results were validated by comparison with EVs purified using standard procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Heatmaps differentiated surface profiles of preeclampsia, preterm delivery, and term delivery receptors on total EVs and PEVs. Similar results were obtained with enriched EVs and EVs from raw plasma. Univariate analyses identified markers predicting preterm delivery and preeclampsia over term delivery controls with AUC >0.6 and sensitivity >50% at 80% specificity. Combining the best markers in a multivariate model, preeclampsia prediction over term delivery had an AUC of 0.89 (95% CI: 0.72–1.0) with 90% sensitivity and 90% specificity, marked by inflammation (TNF RII), relaxation (placenta protein 13 (PP13)), and immune-modulation (LFA1) receptors. Preterm delivery prediction over term delivery had an AUC of 0.97 (0.94–1.0), 84% sensitivity, and 90% specificity, marked by cell adhesion (ICAM), immune suppression, and general EV markers (CD81, CD82, and Alix). Preeclampsia prediction over preterm delivery had an AUC of 0.91 (0.79–0.99) with 80% sensitivity and 90% specificity with markers for complement activation (C1q) and autoimmunity markers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"151-163"},"PeriodicalIF":3.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Strong evidence of an association between hysterectomy and urinary incontinence.","authors":"Karen Ruben Husby, Niels Klarskov","doi":"10.1111/aogs.15024","DOIUrl":"https://doi.org/10.1111/aogs.15024","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号