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

Objective: To evaluate the safety and effectiveness of intermittent bolus administration of ephedrine, norepinephrine, and phenylephrine in the treatment of maternal hypotension during spinal anesthesia for cesarean sections in preeclamptic women.

Methods: This PRISMA-based systematic review included English random control trails (RCTs) of women with singleton preeclampsia (American College of Obstetricians and Gynecologists (ACOG) criteria) undergoing cesarean delivery with spinal anesthesia, excluding chronic hypertension or systemic disease. Interventions were intermittent bolus phenylephrine, norepinephrine, or ephedrine, with outcomes on maternal hemodynamics, neonatal status, and adverse events. Searches of PubMed, ScienceDirect, Google Scholar, and Cochrane (to December 2024) plus reference screening identified eligible studies. Two reviewers independently selected studies, extracted data, and assessed risk of bias (Cochrane RoB 2.0). Due to heterogeneity in vasopressor regimens and outcome measures, results were synthesized narratively.

Results: Of 2333 records screened, six RCTs (sample sizes 20-166) were included, all in preeclamptic women undergoing cesarean delivery. Overall risk of bias was low. Norepinephrine better preserved maternal hemodynamics than phenylephrine or ephedrine, with higher cardiac output (6.31 ± 1.08 vs. 5.45 ± 1.21 L/min; P = 0.009) and lower uteroplacental resistance (0.04 ± 0.02 vs. 0.06 ± 0.03; P = 0.002). Ephedrine caused higher heart rates (84.9 ± 7.1 vs. 76.6 ± 6.9 bpm; P < 0.05) and more nausea/vomiting. Neonatal umbilical artery pH was higher with norepinephrine or phenylephrine than ephedrine (7.32 ± 0.02 vs. 7.31 ± 0.03; P < 0.050), while Apgar scores did not differ. Adverse events favored norepinephrine, which reduced bradycardia versus phenylephrine (5.1% vs. 20.5%; relative risk (RR) = 0.25; P = 0.042) and tachycardia versus ephedrine (16.1% vs. 36.4%; RR = 0.54; P = 0.020).

Conclusion: Intermittent bolus administration of norepinephrine offers superior maternal cardiac output and neonatal safety, making it optimal for preeclamptic cesarean deliveries. Phenylephrine is effective for blood pressure control but may induce bradycardia, while the use of ephedrine is limited by its association with neonatal acidosis. Tailored vasopressor selection is thus essential for optimal outcomes.

Registration: PROSPERO; CRD42024565007.

Objective: To evaluate the early pregnancy loss (EPL) rates in women with and without low molecular weight heparin (LMWH) treatment during early pregnancy.

Methods: A retrospective, non-randomized study was conducted at Guangzhou Women and Children's Medical Center between June 2019 and March 2022, involving women diagnosed with polycystic ovary syndrome (PCOS). All participants conceived following standard preconception care and voluntarily chose either the control group or the LMWH intervention group during the first month of pregnancy. The intervention was administered throughout the entire first trimester. Early and final pregnancy outcomes were recorded, with a particular focus on EPL rates. In addition, venous blood samples and clinical data were collected to compare hormonal profiles, blood lipid levels, and anthropometric parameters between the two groups. Statistical analyses included the two-tailed unpaired Student's t-test, Mann-Whitney U test, Chi-square test, and Kaplan-Meier survival analysis. A value of P < 0.050 was considered statistically significant.

Results: Thirty-eight women in the LMWH group and 102 women in the control group were included. The EPL rates in the LMWH and control groups were 5.3% (2/38) and 26.5% (27/102), respectively (χ ² = 7.582, P = 0.006, odds ratio (OR) = 0.154, 95% confidence interval (CI): 0.035-0.685). The age (P = 0.005), PCOS subtype (P = 0.012), and levels of total cholesterol (P = 0.003), and high-density lipoprotein (P = 0.018) were significantly different between these two groups. Continued follow-up was performed to observe the long-time effects of LMWH treatment in early pregnancy. Seventy-three patients were successfully delivered, 23 patients in the LMWH group and 50 patients in the control group. There was no significant difference between the LMWH and control groups in gestation length, bleeding during delivery, birth weight, gender of the newborn, or mode of delivery. In addition, Kaplan-Meier curve analysis revealed that LMWH treatment may decrease the risk of EPL in PCOS patients in the first trimester (χ ² = 4.144, P = 0.040).

Conclusion: LMWH treatment during early pregnancy may reduce the EPL rate in women with PCOS.

Objective: To evaluate the diagnostic efficacy and clinical application of the Obstetrical Chinese Disseminated Intravascular Coagulation (DIC) Scoring System (OCDSS).

Methods: This study is a retrospective study that collected 1063 cases from Wuhan Union Hospital, Yichang Central People's Hospital, and the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture between July 2017 and June 2024. These cases were divided into DIC and non-DIC groups based on score standard. Diagnosis of DIC, the rate of hysterectomy, neonatal mortality, and severe asphyxia are the main outcome measures. All the laboratory indicators are all determined by clinical laboratory department of the hospital. Data were expressed as mean ± standard deviation or median (interquartile range) and frequencies. Independent sample t-test or non-parametric test were used to compare measurement data, while the chi-square test was used for count data. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to test the predictive accuracy. Using univariate and multivariate logistic regression analysis to study the high-risk factors. P < 0.050 indicates a statistical significance.

Results: Of 1063 participants in this study, 29 participants (2.73%) were diagnosed with obstetrical DIC by OCDSS score standard, and all the participants were diagnosed as DIC with underlying disease. When the Takao, Clark, and Erez score standard is the "gold standard", the OCDSS score standard always shows good sensitivity and specificity, with all the AUC over 0.75. OCDSS score standard also has better predictive of hysterectomy (68.18%, 91.07%, 0.872), severe neonatal asphyxia and death (79.17%, 75.07%, 0.842) than the other three score standards. All the indicators included in the OCDSS score standard contributed to the DIC diagnosis (all the P < 0.001). The indicators in the DIC group were more abnormal than the non-DIC group (all the P < 0.001).

Conclusion: OCDSS is a first score standard, especially for pregnancies, it considers the underlying disease, clinical symptoms, and laboratory results. This score system shared a good diagnosis performance for DIC in the Chinese population and may help clinicians make timely decisions.

Objective: To assess the impact of maternal physiological and pathological factors on fetal birth weight in pregnancies in Kazakhstan.

Methods: This retrospective cross-sectional study was conducted from January 2016 to December 2021 at Aksu City Hospital, Atyrau Regional Perinatal Center, Altai Interdistrict Hospital, Abay Regional Perinatal Center of the Health Department, and Astana Multidisciplinary City Hospital No. 3, in the Republic of Kazakhstan using the stratified randomization grouping method. The study involved two maternal ethnicity groups, Asian (5101; 77.91%) and European (1446; 22.09%). All statistical analyses were performed using Stat Tech version 3.0.9 and SPSS 26.0.

Results: This study involved 6547 pregnant women. Fetuses weighing < 2500 g were more common in the Asian group than in the European one (P = 0.001), while large fetuses (> 4000 g) were more common in the European group (P = 0.001). Multiple linear regression analyses revealed that a history of arterial hypertension and preeclampsia leads to decreased fetal weight, while gestational diabetes mellitus (GDM) was associated with increased fetal weight. In the Asian ethnic group, maternal physiological factors and a history of arterial hypertension, preeclampsia, and GDM significantly influenced fetal birth weight. In the European group, a history of hypertension and GDM did not affect birth weight.

Conclusion: Stillbirth and perinatal death were more likely among women of the Asian ethnic group when compared with women of the European ethnic group. Therefore, it is necessary to account for the maternal physiological and pathological factors that may influence fetal birth weight when assessing optimal fetal birth weight.