BMC Pregnancy and Childbirth最新文献

Objective: To investigate serum xenopsin-related peptide (XRP) -1 levels in women with hyperemesis gravidarum (HEG) from the onset of pregnancy until the end of week 14.

Materials and methods: This cross-sectional study was conducted at the Antalya Training and Research Hospital Obstetrics Clinic, Türkiye, between July and December 2024. Forty-five pregnant diagnosed with HEG and 45 healthy pregnant were included. Venous blood samples for the XRP-1 test were collected from pregnant women and the collected serum samples were stored at -80 degrees until the day of analysis.

Results: Significant differences were observed between the HEG and healthy groups in terms of serum thyroid-stimulating hormone (1.86 ± 0.54 vs. 1.38 ± 0.67, respectively, p = 0.027), potassium (3.84 ± 0.45 vs. 3.58 ± 0.60, p = 0.010), and XRP-1 (4.33 ± 1.66 vs. 2.38 ± 1.32, p < 0.001) values. At receiver operating characteristic analysis, the area under the curve (AUC: 0.824) was statistically significant for serum XRP-1 (p < 0.001), with a cut-off value of ≥ 2.42 [95% confidence interval 0.731-0.917, 82.2% sensitivity, and 80.0% specificity]. The positive predictive value of serum XRP-1 was 80.0% and the negative predictive value was 81.0%.

Conclusion(s): This study suggests that serum XRP-1 levels are elevated in HEG. Further studies are now needed to validate these findings.

Background: Vitamin D deficiency is prevalent in Indonesia. While dietary vitamin D intake is a potential contributor to 25-hydroxyvitamin D (25(OH)D) concentration, there is limited research on its role in populations with dietary habits rich in fat and spices, such as in the Minangkabau ethnic group. This study investigates the relationship between maternal dietary vitamin D intake and serum 25(OH)D concentrations in Minangkabau pregnant women.

Methods: A cross-sectional study was conducted with 182 pregnant women in their third trimester. Dietary vitamin D intake was assessed using a semi-quantitative food frequency questionnaire (SQ-FFQ), and serum 25(OH)D concentrations were measured by ELISA. Correlation and multiple regression analyses were performed to evaluate associations, adjusting for potential confounders.

Results: The mean dietary vitamin D intake was 9.2 ± 6.8 µg/day, and the mean serum 25(OH)D concentration was 21.0 ± 10.1 ng/mL. Despite higher consumption of vitamin D-rich foods (fish, eggs, and dairy), most participants (88%) had inadequate intake, and 73% had deficient or insufficient vitamin D status. A weak positive correlation between dietary intake and serum 25(OH)D was observed (r = 0.09), but this was not statistically significant (p = 0.25).

Conclusions: While higher consumption of vitamin D-rich foods was associated with greater dietary intake, this did not translate into significantly higher serum 25(OH)D concentration. These findings suggest that dietary intake alone had a limited impact on serum 25(OH)D concentration, with other factors likely playing a more significant role.

Background: Surgical site infection continues to be among the most serious postoperative complications of cesarean delivery, leading to maternal morbidity and additional healthcare cost. Despite the rising trend of cesarean deliveries, evidence on the magnitude and risk factors of surgical site infection in local hospitals in Ethiopia remains limited. This study aimed to assess the magnitude and associated factors of surgical site infection among women who underwent cesarean delivery at Gandhi Memorial Hospital, Addis Ababa, Ethiopia.

Methods: An institution-based retrospective cross-sectional study was conducted from 25 August to 15 September 2025 among women who underwent cesarean delivery at Gandhi Memorial Hospital Addis Ababa, Ethiopia between 1 May 2023 and 30 April 2025. A total of 485 medical records were selected using a systematic sampling technique. Data were collected from women's medical records via a structured checklist and analyzed using Statistical Package for Social Science (SPSS) version 25. Descriptive statistics were used to summarize the data, and bivariable and multivariable logistic regression analyses were performed. Statistical significance was declared at a p- value < 0.05 with a 95% CI.

Results: Among the reviewed records, 31 (6.4%; 95% CI: 4.49-8.36) women developed surgical site infection. Repeated digital vaginal examination (AOR = 2.44 (1.41, 5.19) increases the risk of bacterial introduction; delayed timing of prophylactic antibiotic (AOR = 2.32 (1.23, 4.29) reduces protective coverage at the time of incision; absence of vaginal cleansing right before surgery (AOR = 3.75 (1.26, 11.17) likely increases bacterial load and postoperative hemoglobin level < 11 g/dl (AOR = 5.16 (1.76, 11.19)) may reduce immune capacity. All were significantly associated with surgical site infection.

Conclusion: This study found lower surgical site infection rates compared to previous Ethiopian studies; however, it remains a critical postoperative concern. Reducing frequent digital vaginal examinations, ensuring timely prophylactic antibiotics, promoting preoperative vaginal cleansing, and maintaining adequate maternal hemoglobin levels are critical to further reduce the risk of SSI. The retrospective nature of the study limits assessment of some factors, including operating room conditions.

Background: Postpartum hemorrhage (PPH) represents ​​one of the most frequent and serious​​ complications in placenta accreta spectrum (PAS), making prenatal risk stratification essential for optimizing obstetric management ​​strategies​​ and maternal outcomes. This study aimed to evaluate a novel prenatal ultrasound ​​method​​ for estimating ​​placenta invasion area​​ and to investigate ​​its association​​ with estimated blood loss (​​EBL in mL​​) during delivery and ​​the​​ adverse maternal outcomes ​​in PAS​​.

Methods: This a retrospective cohort study measured PAS area by determining the length of "tramline sign" obliteration and its distance from the cervical os. Placental invasion was segmented into trapezoidal sections using three-dimensional (3D)-Crystal Vue imaging. Linear and multiple regression analyses were used to assess associations between estimated PAS area and EBL, PPH (EBL ≥ 1000 ml), severe PPH (EBL ≥ 2500 ml) and post-delivery transfusion need.

Results: Among 168 patients, 78 developed PPH and 90 did not. The PPH group > 2-fold higher PAS area vs. non-PPH (17.28 cm² vs. 7.36 cm²; P < 0.001). Linear regression analysis indicated each 1 cm² PAS area increase corresponded to 42.84 mL higher EBL (95% CI, 27.47-55.77; P < 0.001). PAS area independently predicted PPH (adjusted odds ratio (aOR) 1.08, 95% CI 1.04-1.13; P < 0.001) and severe PPH (aOR 1.03, 95% CI 1.02-1.04; P = 0.03). ROC analysis yielded PAS area cutoffs for PPH (10.13 cm²; AUC 0.83 (0.76-0.89); P < 0.001) and severe PPH (10.57cm²; AUC 0.83 (0.76-0.89); P < 0.001). Using these cutoffs, PAS area outperformed classic ultrasound signs in predicting PPH and severe PPH.

Conclusion: 3D-Crystal Vue-derived PAS area estimation is clinically feasible and correlates with EBL and PPH risk in PAS patients.

Background: Postpartum comfort is a critical component of maternal health, influencing both physical and psychological recovery following childbirth. Non-pharmacological interventions offer potential benefits in enhancing postpartum comfort, yet their impact remains inconsistent across studies. This review and meta-analysis aims to evaluate the effectiveness of non-pharmacological interventions in improving postpartum comfort.

Methods: Relevant studies were systematically identified using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and quality was assessed through the Cochrane risk of bias (RoB2) tool. Data synthesis and meta-analytic calculations were conducted using Review Manager (RevMan) software. The intervention effect size was determined based on the standardized mean difference in postpartum comfort scores between intervention and control groups. Heterogeneity was assessed using I² and Q statistics, while publication bias was examined through funnel plot asymmetry and Egger's test.

Results: A total of eight studies met the inclusion criteria. The forest plot of pooled effect size indicated that non-pharmacological interventions significantly improved postpartum comfort, with a standardized mean difference of 1.45 (95% CI: 0.84, 2.05) at the last outcome assessment. Subgroup analyses revealed an effect size of 1.23 (95% CI: 0.52, 1.95) for immediate impact interventions (within the first 48 h postpartum) and 1.59 (95% CI: 0.63, 2.56) for sustained impact interventions (up to two weeks postpartum), with substantial heterogeneity observed across studies (I² > 90%). Publication bias was minimal, although small-study effects were detected.

Conclusions: These findings suggest that non-pharmacological interventions can play a significant role in enhancing postpartum comfort, particularly in the early postpartum period. Further research across diverse populations is recommended to strengthen the evidence base for these interventions.

Objective: Venous thromboembolism (VTE) is a leading cause of maternal mortality, with pregnancy significantly increasing VTE risk due to physiological hypercoagulability. Current risk assessment methods, such as VTE scoring systems and D-dimer testing, have limitations in identifying high-risk individuals, highlighting the need for improved stratification.

Methods: Whole genome sequencing (WGS) was performed on peripheral blood samples collected from 29 pregnant women with clinically diagnosed VTE during routine non-invasive prenatal testin (NIPT). The analysis focused on a curated list of 162 thrombosis-related genes (18 high-risk, 144 moderate/low-risk), incorporating detection of pathogenic variants, copy number variations (CNVs). Genetic risk factors were compared against conventional VTE risk scores and D-dimer levels. Additionally, a control group of 74 healthy pregnant women was included to enable allele frequency analyses.

Results: Pathogenic/likely pathogenic variants were identified in 58.6% of cases (17/29), with TUBB1 and vWF as key contributors. 17 pathogenic CNVs were detected in 41.4% (12/29), involving PRSS1, C4A, etc. Allele frequency analysis highlighted 9 loci across 4 genes, indluding HLA-B, PRSS1, ACE, C4A linked to VTE susceptibility. Traditional VTE risk scores and D-dimer levels showed limited predictive ability, particularly in cases with low clinical risk scores but high genetic risk. Notably, among the 11 women with a pre-delivery VTE score of 0, 7 had genetic predispositions. Similarly, among the 15 women with low pre-delivery D-dimer levels, 9 had genetic risk, and among the 5 women with low D-dimer levels at 24 h postpartum, 3 had genetic risk. These findings collectively highlight the inability of traditional markers to capture hidden genetic risk in pregnancy-associated VTE.

Conclusions: The dual use of NIPT samples for VTE genetic assessment reduces invasive procedures and costs, offering a novel approach to optimize risk stratification, particularly for individuals with low traditional risk scores but high genetic susceptibility. These findings support integrating genetic screening into prenatal care to enable personalized prevention.

Clinical Decision Support Systems (CDSS) powered by machine learning (ML) are increasingly recognized as valuable tools for improving maternal healthcare, particularly in the prevention of high-risk pregnancies. However, their adoption in real-world settings remains limited due to concerns about transparency, reproducibility, and integration into clinical workflows. Interpretable ML methods offer a promising solution by enhancing the usability and trustworthiness of these systems. This scoping review maps interpretable CDSS for maternal high-risk pregnancy prevention and intrapartum management, including both ML and rule-based systems. We examined model characteristics, implementation and validation approaches, and interpretability methods. We searched PubMed and supplemented results with targeted screening in Google Scholar. Included studies reported interpretable outputs and clinical performance. Key data extracted encompassed study design, CDSS type, validation strategies, interpretability techniques, and clinical outcomes. Nineteen studies met the inclusion criteria. Most ML studies used Random Forests or Support Vector Machines. non-ML systems commonly implemented standardized rules, scoring systems with early-warning alerts. Post hoc methods such as SHAP and LIME were frequently used. Reporting of code/data availability was variably documented, which may limited reproducibility. Most evaluations were retrospective, constraining generalizability. Future work should prioritize transparent, prospective, and open science practices, with interpretable outputs aligned to clinical reasoning for successful integration.

Background: The efficacy of antenatal corticosteroids (ACS) in late-preterm birth remains uncertain, with benefits of repeated courses not well established. The aim of this study was to assess real-world effectiveness of antenatal dexamethasone in late-preterm births and identify optimal dosing, timing, and beneficiary subgroups.

Methods: This retrospective cohort study utilized data from all deliveries occurring between January 1, 2018, and June 30, 2025 at a Chinese tertiary center. 3,703 individuals with singleton or multiple gestations who delivered during the late preterm period were included. The primary outcome was the incidence of neonatal respiratory distress syndrome (RDS, defined as requiring clinical signs, radiography, ≥ 24-hour persistence, and respiratory support or oxygen). The association between antenatal dexamethasone exposure and pregnancy outcomes was evaluated using propensity score matching (PSM) to balance baseline characteristics, and multivariate logistic regression to adjust for potential confounders.

Results: Of 3,703 eligible late-preterm births, 1,279 (34.5%; mean [standard deviation] maternal age, 30.6 [4.0] years) were exposed to ACS. After PSM (n = 820 per group), ACS showed no significant association with neonatal RDS [OR (odds ratio) 0.97; 95% CI (confidence interval): 0.70-1.35; P = 0.867] but was associated with an increased risk of neonatal hypoglycemia (OR 1.49; 95% CI: 1.17-1.91; P = 0.011). Administration of a complete course 36 h to 7 days before delivery was associated with a reduced risk of RDS (OR 0.44; 95% CI: 0.24-0.80; P = 0.008). Repeated courses were also associated with reduced RDS risk (OR 0.40; 95% CI: 0.18-0.90; P = 0.026) but with an increased risk of hypoglycemia (OR 2.93; 95% CI: 1.56-5.49; P = 0.001). In singletons, treatment prevented 24 RDS cases per 1000 but resulted in 26 additional chorioamnionitis and 110 hypoglycemia cases. No benefit was observed in twins. The relative excess risk due to interaction test was - 1.08 (95% CI: -3.91, 0.23), suggesting a potential non-significant antagonistic interaction between ACS and twin pregnancy.

Conclusions: Among late-preterm births, ACS exposure was associated with a reduction in neonatal RDS for singleton pregnancies when administered in optimally timed or repeated courses; however, it was also associated with an increased risk of neonatal hypoglycemia. In twin pregnancies delivering late-preterm, no significant respiratory benefit was observed. These findings highlight that both treatment timing and pregnancy type are critical considerations when administering ACS.