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

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.

Objective: To compare pregnancy terminations for two reasons: intrauterine fetal death (IUFD) and fetal anomaly, focusing on obstetric data and termination processes to optimize clinical management.

Methods: This retrospective, single-center study included singleton pregnancies terminated for intrauterine fetal death or fetal anomaly (≥ 10 weeks' gestation) between January 2020 and December 2021. Demographic, obstetric, and procedural data were collected. Termination methods included misoprostol, balloon catheter, curettage, and hysterotomy, following FIGO guidelines. Feticide was performed when indicated. Statistical analysis was conducted using t-test, chi-square test, and Pearson correlation; significance was set at P < 0.050.

Results: A total of 173 termination cases (104 IUFD, 69 fetal anomalies) were analyzed. Mean gestational age was 16.6 ± 4.2 weeks. Termination and hospitalization times were longer in anomaly cases (P < 0.001). Gravida and parity were lower in the anomaly group (P = 0.005, P = 0.011). Misoprostol use showed a positive correlation with termination time (r = 0.251, P = 0.001); parity was negatively correlated (r = -0.175, P = 0.021). Balloon, curettage, and feticide rates were higher in anomaly cases (all P < 0.001). Complications occurred in 4 patients (2.3%).

Conclusion: Clinical approaches to pregnancy termination differ based on the underlying condition. Obstetric history and fetal pathology influence the methods and timing of the procedure, emphasizing the need for individualized care to improve patient outcomes.

Advances in prenatal screening have significantly improved the early detection of fetal anomalies and chromosomal abnormalities. Among these, first-trimester soft markers have emerged as valuable indicators of potential adverse outcomes. This review explores the clinical relevance of key markers-including increased nuchal translucency (NT), nasal bone hypoplasia, tricuspid regurgitation, aberrant right subclavian artery, and abnormal ductus venosus flow-and their associations with aneuploidy, structural malformations, and pregnancy complications such as preeclampsia and fetal growth restriction. We emphasize the importance of interpreting soft markers within a comprehensive clinical context, rather than in isolation, and examine their underlying pathophysiological mechanisms and associated statistical risks. Particular attention is given to the integration of soft marker findings with advanced screening techniques, including cell-free DNA (cfDNA) testing and maternal serum biochemistry, to improve diagnostic accuracy. In addition, we review current recommendations for clinical management, such as the use of follow-up diagnostic procedures like chorionic villus sampling or amniocentesis, and the role of multidisciplinary counselling in high-risk pregnancies. Future research should aim to validate novel soft markers and promote the standardization of screening protocols to enhance maternal and fetal outcomes.

Objective: To validate and compare the performance of four risk stratification tools-the DEVI (Adverse Cardiac Events in Valvular Rheumatic Heart Disease in Pregnancy) score, Zwangerschap bij Aangeboren Hartafwijking (ZAHARA) score, Cardiac Disease in Pregnancy II (CARPREG II), and modified WHO (mWHO) classification-in predicting adverse cardiac events during pregnancy in women with valvular heart disease (VHD).

Methods: This retrospective cohort study was conducted at Fernandez Hospital, a tertiary care referral center in Hyderabad, India, utilizing clinical data from pregnancies managed between January 2011 and December 2023. The primary outcome was the development of composite adverse cardiac events. Discriminative ability was assessed using the area under the receiver operating characteristic curve (AUC), calibration was evaluated via calibration plots, and clinical utility was determined by decision curve analysis (DCA). Categorical variables were reported as frequencies and percentages and continuous variables were presented as means with standard deviations or medians with interquartile ranges. Individual risk assessment was conducted using both the CARPREG II and DEVI risk stratification models, while the ZAHARA score was calculated by aggregating weighted parameters according to established scoring criteria.

Results: The study enrolled 176 women and analyzed 205 pregnancies with adverse cardiac events in 19 pregnancies (9.3%). The DEVI score demonstrated superior discrimination (AUC = 0.846, 95% CI: 0.765-0.927, P < 0.001), followed by mWHO (AUC = 0.826, 95% CI: 0.736-0.917, P < 0.001), CARPREG II (AUC = 0.762, 95% CI: 0.652-0.872, P < 0.001), and ZAHARA (AUC = 0.716, 95% CI: 0.628-0.803, P < 0.001). Calibration plots revealed an overestimation of risk at higher probabilities for DEVI and CARPREG II. DCA indicated net clinical benefit for both tools at 10-30% threshold probabilities.

Conclusion: The DEVI score showed the highest discriminative performance, though its calibration and clinical utility were comparable to CARPREG II. These findings support its use for risk stratification in pregnant women with VHD, particularly in resource-limited settings where rheumatic VHD predominates.

Preterm birth (PTB), predominantly induced by intraamniotic inflammation, stands as the foremost contributor to neonatal morbidity and mortality globally. Fetal inflammatory response syndrome, stemming from the activation of the innate immune system, signifies the occurrence of funisitis or chorionic vasculitis. Maternal-fetal complications associated with infection-related PTB encompass maternal sepsis, fetal demise, neonatal sepsis, neonatal neurological impairment, and chronic lung disease. The inflammatory cascade is initiated when Toll-like receptors present on immune cells within the fetal membranes and the female reproductive tract encounter pathogen-associated molecular patterns derived from infectious agents. Subsequently, the nuclear factor kappa-light-chain-enhancer of activated B cells facilitates the transcription of cytokines. The accumulation of neutrophils compromises the tissue integrity of the fetal membranes, leading to membrane rupture via the secretion of matrix metalloproteinases. Elevated prostaglandin levels prompt uterine contractions and cervical remodeling, resulting in progressive cervical effacement and dilation, ultimately culminating in fetal delivery. The diagnosis of PTB should encompass three pivotal criteria: gestational age, uterine activity, and the consequences of that uterine activity. The diagnosis of chorioamnionitis is established through a combination of clinical manifestations, laboratory findings, identification of infectious microorganisms, and placental pathology. Fetal monitoring involves antenatal ultrasonography and non-stress testing. The management of infection-related PTB involves controlling and treating the infection, timing delivery to coincide with optimal fetal lung maturity, and optimizing outcomes for both the mother and neonate. Current preventive strategies for PTB primarily focus on inhibiting myometrial contractions that arise from the inflammatory cascade initiating PTB. An understanding of these pathways serves as the cornerstone for the development of therapeutic interventions aimed at preventing PTB.