Maternal-fetal medicine (Wolters Kluwer Health, Inc.)最新文献

Objective: To assess the association between delayed fusion of the amniotic and chorion diagnosed at 16 weeks of gestation and maternal-fetal outcomes.

Methods: This prospective cohort study was conducted at Tianjin Central Hospital of Gynaecology Obsterics, China, from February 2022 to March 2024. A total of 331 singleton pregnant women with low risk of fetal chromosomal abnormalities were enrolled. Ultrasound examinations at 16 weeks' gestation identified cases of delayed fusion of amnion and chorion. Maternal and fetal outcomes were compared between the delayed fusion group and the timely fusion group.

Results: Delayed fusion occurred in 28.00% (91/325) of cases. Post-delivery fetal membrane histopathology revealed no structural abnormalities attributable to delayed fusion. No significant differences were observed in maternal complications (gestational diabetes mellitus, hypertensive disorders, obesity, anemia) and 5-minute Apgar scores between groups. In addition, miscarriage rates were unaffected by delayed fusion. Notably, the delayed fusion group had a significantly higher incidence of preterm births (8.79% (8/91) vs. 2.56% (6/234), P = 0.028). After adjustment for confounders, infants in the delayed fusion group had a significantly lower mean birth weight (172.05 g less) than those in the timely fusion group.

Conclusion: Delayed fusion at 16 weeks did not alter fetal membrane structure after delivery and was not associated with most maternal or neonatal complications in this cohort. However, it may be an independent risk factor for preterm birth and reduced birth weight, warranting further investigation.

Objective: To investigate the impact of the second division timing on pregnancy outcome after in vitro fertilization.

Methods: In this unpaired retrospective study, 16,696 embryos from 6571 patients were analyzed. Patients were divided into four groups according to the number of blastomeres observed on day 2 (44 ± 1 h) and day 3 (68 ± 1 h) of development. Blastocyst formation rates and pregnancy outcomes were compared among the groups. Propensity Score Matching was applied to eliminate discrepancies among the baseline data of the different groups.

Results: The blastocyst formation rates in Group A (delayed second cleavage) and Group B (delayed second cleavage and early compaction) were significantly lower than that of Group C (normal cleavage) (P < 0.001). For both day 3 single embryo transfer and frozen single blastocyst transfer, the clinical pregnancy and live birth rates in Group A were comparable to those of Group C. For day 3 double embryo transfer, the biochemical pregnancy, clinical pregnancy, and live birth rates following the combined transfer of embryos from Groups A and C were significantly lower than those obtained when two embryos from Group C were transferred.

Conclusion: Embryos with delayed second cell cleavage exhibited reduced blastocyst formation rates and resulted in poorer pregnancy outcomes even when the third cleavage was completed on time. These findings indicate that the kinetics of embryo development are closely associated with developmental competence and pregnancy outcomes.

Objective: To evaluate the effectiveness of prophylactic tranexamic acid in reducing postpartum hemorrhage (PPH) in high-risk populations, specifically pregnant women with placenta previa, by conducting multicenter randomized controlled trials with sufficient statistical power, in order to establish high-quality evidence for its widespread use in PPH prevention.

Methods: This multicenter randomized, double-blind, placeto-controlled trial with two parallel groups will enroll 1680 patients undergoing cesarean delivery with placenta previa. Participants will be randomly assigned to receive either tranexamic acid (1 g) or placebo intravenously immediately after birth. The primary outcome will be the incidence of PPH, defined as a calculated estimated blood loss exceeding 1000 mL or the need for red blood cell transfusion before postpartum day 2. With 80% statistical power, this study aims to detect a 20% reduction in the incidence of PPH, from 33.0% to 26.4%.

Discussion: Tranexamic acid is a cost-effective and easily accessible medication that shows promise in reducing the risk of PPH during cesarean delivery in high-risk patients, such as those with placenta previa. This large-scale, adequately powered, multicenter randomized placebo-controlled trial is designed to determine whether the routine prophylactic use of tranexamic acid during cesarean delivery in patients with placenta previa will offer clinical benefits that outweigh the associated risks.

Trial registration: ClinicalTrials.gov NCT05811676 (March 15, 2023).

Objective: To determine whether rheumatoid arthritis (RA) contributes to the increased risk of preeclampsia (PE) and to identify potential underlying biological mechanisms.

Methods: We performed an integrated bidirectional two-sample Mendelian randomization (MR) and transcriptomic analysis to elucidate the potential relationship between RA and PE. Instrumental variables (IVs) were selected from large-scale GWAS summary datasets from openGWAS and FinnGen databases. Primary analysis used inverse-variance weighted (IVW) method, supplemented by MR-Egger and weighted median. The odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the causal effect of the exposure on the outcome. Transcriptomic profiling of disease-relevant tissues (RA synovium and PE placenta from GEO datasets) identified shared differentially expressed genes (DEGs), which were subsequently characterized through Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and protein-protein interaction network reconstruction.

Results: The forward MR analysis revealed a significant causal effect of RA on PE risk (OR _meta = 1.05, 95% CI _meta: 1.02-1.07, P _meta < 0.001), while reverse analysis showed directionally inconsistent associations (OR _meta = 0.99, 95% CI _meta: 0.84-1.17, P _meta = 0.89). Transcriptomic analysis of diseased tissues identified 98 shared DEGs enriched in calcium signaling (GO, P < 0.001) and FoxO pathways (KEGG, P = 0.003), with protein-protein interaction networks highlighting ACTN2 and EGF as central nodes. Disease-specific DEG profiles revealed upregulated MMP13 in RA and IL5 in PE.

Conclusion: This study confirms that RA is a significant risk factor for developing PE during pregnancy. Identifying crucial genes presents opportunities for targeted interventions. Future work should focus on validating these findings and exploring the functional implications of the identified biomarkers.

The advent of liquid biopsy technologies has revolutionized the non-invasive monitoring of various medical conditions, including complications during pregnancy. Fetal and placental health are crucial to maternal and neonatal outcomes, yet many of the conventional diagnostic techniques for detecting placental dysfunction and perinatal complications, such as preeclampsia, preterm birth, and fetal growth restriction, are invasive or pose a risk to the fetus. Liquid biopsy offers a promising alternative by using biomarkers such as cell-free DNA, cell-free RNA, and extracellular vesicles to provide a non-invasive, real-time, and dynamic assessment of placental and fetal health. This review discusses the advancements in liquid biopsy technologies, with a focus on their potential for early detection, monitoring, and understanding of placental dysfunction and perinatal complications.