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

Objective: To determine whether an association exists between group B Streptococcus (GBS) colonization and preeclampsia among pregnant Black women.

Methods: This retrospective cross-sectional study involved Black women who gave birth at State University of New York Downstate Hospital between January 2010 and December 2017. Data were collected from the Obstetric Department, including delivery date, time, mode of delivery, age of the mother, weeks of gestation at delivery, and antepartum complications. The GBS test results were originally determined using the eSwab transport system. Preeclampsia was defined based on the American College of Obstetricians and Gynecologists criteria for the periods 2010-2012 and 2013-2017. The primary outcome was whether GBS was associated with the outcome of preeclampsia in the population of Black women. Covariates, including smoking status, gestational age, parity, body mass index, maternal age, and presence of herpes simplex virus (HSV) and human immunodeficiency virus (HIV) were examined as potential confounders. Chi-squared test and logistic regression model were used, presenting odds ratios with 95% confidence intervals (P < 0.050), analyzed with SAS on Demand for Academics (SAS Institute, Inc., NY).

Results: Among the 8,019 Black women included in this study, GBS-positive women (n = 977) had a 53% reduction in the likelihood of being diagnosed with preeclampsia compared to GBS-negative women (adjusted odds ratio, 0.47; 95% confidence interval, 0.32-0.70). We did not find evidence of differences in the distribution of smoking habits (P = 0.783) or maternal age (P = 0.107) between GBS-positive and GBS-negative women. However, the GBS-positive women tended to be less likely to have a preterm delivery (9.62% (94/977) vs. 24.24% (1707/7042), P < 0.001), less likely to be nulliparous (33.37% (326/977) vs. 37.87% (2667/7042), P = 0.006), and less likely to be obese (51.38% (502/977) vs. 55.30% (3894/7042), P < 0.001) compared with GBS-negative women. In contrast, GBS-positive women were more likely to have a comorbid infection than their counterparts: HSV (5.94% (58/977) vs. 2.63% (185/7042), P < 0.001) and HIV (1.54% (15/977) vs. 0.82% (58/7042), P = 0.028).

Conclusion: We found a reduced likelihood of preeclampsia among women who were positive for GBS at delivery. Given the cross-sectional nature of our study, more research is needed to further explore this association.

The care of obstetrics patients has improved dramatically over the past few decades. Unfortunately, rates of cesarean section remain high, and decreasing this rate requires close care and follow-up in the prenatal outpatient setting. Counseling regarding cesarean delivery and vaginal delivery is imperative. Opportunities still exist in helping patients objectively weigh the decision for cesarean delivery versus vaginal delivery. Additional developments have occurred in the intrapartum and the postpartum setting, with an aim to improve patient and neonatal outcomes. Changes have been implemented for patients undergoing cesarean delivery including preoperative and intraoperative treatment of pain, nausea, and vomiting, as well as postoperative care bundles that improve patient outcomes. Innovations have also occurred in the care of postpartum patients after vaginal delivery, again with improvements in patient outcomes. This article summarizes the current evidence, provides care recommendations, and identifies the next steps in improving obstetrics care.

With the advances in fetal medicine, there will be more cases of congenital hypothyroidism (CH) diagnosed in the fetal period. However, there is no consensus on the management protocol. We present a successful case of conservatively managed fetal goitrous hypothyroidism due to compound heterozygous TG mutations. Goiter was observed in a fetus at 23 weeks of gestation. Because there was no evidence of transplacental passage of antithyroid antibody and drugs, iodine overload, and iodine deficiency, the fetus was highly suspected to have CH. Considering the potential risks of amniocentesis/cordocentesis, and lack of available parenteral levothyroxine in China, the fetus was closely monitored thereafter. A male neonate was delivered vaginally without complications at 39 weeks of gestation. We verified severe hypothyroidism in the infant and immediately initiated levothyroxine therapy. His growth and mental development were normal at the age of 8 month. Whole-exome sequencing showed that the neonate had two compound heterozygous mutations in the TG gene. We also performed a literature review of the prognosis of postnatal treatment of CH due to TG mutations and the result showed that postnatal treatment of CH due to TG mutations has a favorable prognosis. However, further prospective studies are warranted to verify this conclusion.

Steroid hormones, including progestagens, estrogens, androgens, corticosteroids, and their precursor cholesterol, perform essential functions in the successful establishment and maintenance of pregnancy and normal fetal development. As the core endocrine organ at the prenatal stage, the human placenta is involved in the biosynthesis, metabolism, and delivery of steroid hormones. Steroidogenic pathways are tightly regulated by placenta-intrinsic cytochrome P450 and hydroxysteroid dehydrogenase. However, the relationship between placental steroidogenic enzyme expression and adverse pregnancy outcomes is controversial. In this review, we summarize the possible upstream regulatory mechanisms of placental steroidogenic enzymes in physiologic and pathophysiologic states. We also describe the human placental barrier model and examine the potential of single-cell sequencing for evaluating the primary functions and cellular origin of steroidogenic enzymes. Finally, we examine the existing evidence for the association between placental steroidogenic enzyme dysregulation and adverse pregnancy outcomes.

Objective: To assess the relationship between ovarian hyperstimulation syndrome (OHSS) and adverse outcomes using population-based data in the United States. The hypothesis is that patients with OHSS were more likely to deliver preterm and more likely to have hypertensive disorders.

Methods: This retrospective cohort study identified 94 patients with OHSS and 183 matched referents in eight counties in Minnesota. Data were collected regarding pregnancy history, infertility treatment, and pregnancy outcomes. Using the Rochester Epidemiology Project, study subjects were identified from female patients, aged 18 to 49 years, who were diagnosed with infertility from January 2, 1995 to December 1, 2017, and had a pregnancy greater than 20 weeks' gestation. The primary outcome was preterm delivery or hypertensive disorder of pregnancy incidence in the OHSS group when compared with control patients. Chi-squared test, t test, and multivariate logistic models were used where appropriate.

Results: Patients with OHSS were more likely to deliver preterm (odds ratio, 2.14; 95% confidence interval, 1.26-3.65; P < 0.01), and their neonates were more likely to be small for gestational age (odds ratio, 4.78; 95% confidence interval, 1.61-14.19; P < 0.01). No significant differences between the groups were observed in any other outcome. Patients with OHSS are more likely to deliver preterm if they undergo fresh transfer compared with a freeze all and subsequent frozen transfer (odds ratio, 3.03, 95% confidence interval, 1.20-7.66, P = 0.02).

Conclusion: OHSS may lead to preterm birth and small-for-gestational-age neonates, which changes patient counseling and leads to arranging specialized obstetrical care for these patients with OHSS.

Objective: This study aimed to determine the most pertinent factors responsible for placenta accreta spectrum disorders in patients without any history of pregnancy and evaluate their prognostic implications.

Methods: This retrospective cohort study included 1009 patients diagnosed with placenta accreta spectrum disorders based on standardized diagnostic criteria across 10 tertiary hospitals in China between January 1, 2018, and December 31, 2018; 45 patients without a history of pregnancy were selected. The collected data mainly included demographic characteristics (including age, operative history, and ultrasound findings) and maternal-fetal outcomes (including any history of intraoperative bleeding, blood transfusion details, maternal-fetal complications, and fetal Apgar scores). SPSS 24.0 was used for statistical analyses. The Mann-Whitney U test and logistic regression were performed; a two-tailed P < 0.050 was considered statistically significant.

Results: Ultrasound-based detection of placenta previa (χ ² = 9.911, P = 0.003) showed a strong association with placenta accreta spectrum types. The severity of placenta accreta spectrum was directly proportional to the likelihood of having coexistent complete placenta previa (χ ² = 11.626, P = 0.009) and being diagnosed by ultrasound (χ ² = 5.449, P = 0.047). Blood transfusion also impacted placenta accreta spectrum types in relation to maternal prognosis (χ ² = 8.785, P = 0.004). On univariate analysis, older age led to more complications (U = 82.000, P = 0.011), and in vitro fertilization-embryo transfer caused more intraoperative bleeding (U = 91.500, P = 0.007). Although the 1- and 5-minute Apgar scores were statistically significant, the rates of neonatal asphyxia did not differ (P > 0.050). Endometrial damage led to lower Apgar scores on both univariate (1 minute: U = 29.500, P = 0.027; and 5 minutes: U = 33.500, P = 0.031) and multivariate (1 minute: β = -1.510, 95% confidence interval, -2.639 to 0.381, P = 0.010; and 5 minutes: β = -0.968, 95% confidence interval, -1.779 to 0.157, P = 0.021) analyses.

Conclusion: In patients who had no history of pregnancy, placenta previa was a strong risk factor for severe placenta accreta spectrum disorders. Endometrial damage led to lower Apgar scores; this warrants greater consideration in the clinic.