Journal of Perinatal Medicine最新文献

{"title":"Epidural anesthesia during labor and delivery and postpartum hemorrhage.","authors":"Maike Katja Sachs, Elisabeth Kapfhammer, Romana Brun, Lukas Kandler, Nicole Ochsenbein, Christian Haslinger","doi":"10.1515/jpm-2024-0567","DOIUrl":"https://doi.org/10.1515/jpm-2024-0567","url":null,"abstract":"<p><strong>Objectives: </strong>Epidural analgesia is widely used for pain management during labor and delivery with inconsistent results regarding its influence on postpartum blood loss. Aim of our study was to investigate blood loss after vaginal delivery in women with epidural analgesia in consideration of established risk factors for postpartum hemorrhage and by using a validated blood measurement technique.</p><p><strong>Methods: </strong>This prospective study was performed at the University Hospital Zurich. Included were 699 women with vaginal deliveries after 34 weeks of pregnancy. Blood loss was assessed by a validated measurement technique. Risk factors for increased blood loss were assessed and stratified by epidural analgesia use. Significant variables were entered into a stepwise multivariate regression analysis.</p><p><strong>Results: </strong>In the univariate analysis, women with epidural analgesia showed a significantly higher blood loss, compared to women without epidural analgesia. However, after multivariate regression analysis no association between increased blood loss and epidural anesthesia was observed. Furthermore, women with epidural analgesia were more often primiparous, experienced more often uterine atony and postpartum hemorrhage, bleeding from perineal laceration, vacuum extraction, longer second stage of labor and bigger neonatal head circumference.</p><p><strong>Conclusions: </strong>Epidural analgesia itself is not associated with increased postpartum blood loss. However, there is a higher incidence of PPH in deliveries with obstetric risk factors, in which more frequent use of epidural analgesia is observed. In other words, not epidural analgesia is the cause of PPH, but difficult obstetric settings are associated with both higher use of epidural analgesia and increased blood loss.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of endometrial multi-vessel blood flow ultrasound parameters in predicting pregnancy outcomes.","authors":"Cai-Cha Yu, Jia-Jia Wang, Yan Jiao, Xiaosi Zhao, Yin-Qing Huang","doi":"10.1515/jpm-2024-0534","DOIUrl":"https://doi.org/10.1515/jpm-2024-0534","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the endometrium using multi-vessel blood flow ultrasound parameters and explore their potential utility in predicting pregnancy outcomes.</p><p><strong>Methods: </strong>A total of 205 women were included in the study. Transvaginal three-dimensional ultrasound was used to evaluate luteal phase endometrial thickness, volume, and three-dimensional power Doppler blood flow parameters of the endometrium (vascularization index [VI], flow index [FI], and vascularization flow index [VFI]), as well as the endometrial microvascular vascularization index (VI_MV). Additionally, the systolic/diastolic ratio (S/D), pulsatility index (PI), and resistance index (RI) of the bilateral uterine arteries were measured. Based on pregnant outcomes, participants were divided into two groups: a clinical pregnancy group and a non-pregnancy group, and ultrasound parameters were compared between these groups.</p><p><strong>Results: </strong>Women in the clinical pregnancy group showed significantly higher levels of endometrial FI, VI, VFI, and VI_MV compared to those in the non-pregnancy group (p<0.05). Conversely, the S/D, PI, RI, and mean levels of bilateral uterine arteries were significantly lower in the pregnancy group than in the non-pregnancy group (p<0.05). VI_MV (area under the ROC curve [AUC] 0.869; sensitivity 92.2 %, specificity 68.8 %), VFI (AUC 0.761; sensitivity 96.9 %, specificity 53.9 %), FI (AUC 0.707; sensitivity 79.7 %, specificity 46.1 %), and VI (AUC 0.637; sensitivity 90.6 %, specificity 51.8 %) all showed a significant strong positive correlation with endometrial thickness (r>0, p<0.05), indicating their role in predicting pregnancy.</p><p><strong>Conclusions: </strong>Multi-vessel blood flow parameters reflect the endometrial blood perfusion state and are closely associated with the likelihood of achieving a successful pregnancy.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemorrhagic placental lesions on ultrasound: a continuum of placental abruption.","authors":"Yinka Oyelese, Ethan Litman, Jonathan L Hecht, Edgar Hernandez-Andrade, Wendy L Kinzler","doi":"10.1515/jpm-2024-0564","DOIUrl":"https://doi.org/10.1515/jpm-2024-0564","url":null,"abstract":"<p><p>Placental abruption has classically been defined as the premature separation of a normally located placenta before delivery of the fetus. Traditionally, this diagnosis was based on clinical symptoms, including vaginal bleeding, pain, and fetal distress. This definition, however, preceded the advent of obstetric ultrasound. Ultrasound frequently identifies various hemorrhagic lesions, such as retroplacental, subchorionic, intraamniotic, intraplacental, and preplacental hematomas in both symptomatic and asymptomatic patients. These variable ultrasound findings lead to new challenges as to what to define as an abruption, particularly in the absence of symptoms. This ambiguity in defining placental abruption affects clinical decision-making and hinders our understanding of the pathophysiology of abruption, presenting challenges in studying abruption. It is likely that these varying sonographic findings may precede the classic presentation of vaginal bleeding and pain and therefore are often concealed abruptions. This commentary highlights the importance of developing clear diagnostic guidelines for placental abruption, given its association with severe outcomes including a high rate of perinatal mortality and maternal morbidity. We aim to elucidate the complexities of ultrasound diagnosis in placental abruption, advocating for precise criteria to better guide clinical practice. We propose that these ultrasound findings of hemorrhagic placental lesions after 20 weeks of gestation in asymptomatic patients should be considered part of the spectrum of abruption, while in symptomatic patients should be taken as confirmation of the diagnosis of abruption.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intervention using the Robson classification as a tool to reduce cesarean section rates in six public hospitals in Brazil.","authors":"Alberto Jorge de Sousa Guimarães, Nelson Sass, Adalberto Kiochi Aguemi, Eliana Bonilha, Eneida Ramos Vico, Marina de Freitas, Mirna Namie Okamura, Edward Araujo Júnior, Liliam Cristine Rolo, Maria Regina Torloni","doi":"10.1515/jpm-2024-0580","DOIUrl":"https://doi.org/10.1515/jpm-2024-0580","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze the effectiveness and safety of a multifaceted intervention to reduce cesarean section (CS) rates.</p><p><strong>Methods: </strong>This interrupted time series study involved six public hospitals with pre-intervention CS rates>35 %. We collected monthly data on overall and Robson group CS rates of 37,031 women who gave birth at the six hospitals during 30 months in the pre-intervention (12 months, n=14,836 women), intervention (6 months, n=6,431 women), and post-intervention (12 months, n=15,764 women) study periods. The intervention bundle included six components: audit and feedback using the Robson classification, goal setting for overall CS rate, distribution of evidence-based guidelines, informative meetings with hospital coordinators, newsletters, and inter-hospital mentoring.</p><p><strong>Results: </strong>There were no significant changes in mean overall CS rates between the three periods. However, five of the six hospitals had a significant decrease in CS rates in at least one Robson group during the study period: groups 1 and 5a (2 hospitals), group 2a (1 hospital), groups 4 and 4a (1 hospital), and group 5b (1 hospital). There were no significant increases in adverse events (maternal and perinatal mortality, neonatal asphyxia) in any of the hospitals with reductions in CS rates.</p><p><strong>Conclusions: </strong>The multifaceted intervention did not significantly reduce the overall CS rate in the participating hospitals. However, five of the six hospitals had significant reductions in CS rates in at least one Robson group, without increasing adverse maternal or perinatal outcomes.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient management of prelabour rupture of membranes (PROM) at term - a re-evaluation and contribution to the current debate.","authors":"Magdalena Kittelmann, Rama Kiblawi, Martina Gisin, Andreas Schötzau, Irene Hoesli, Thabea Musik","doi":"10.1515/jpm-2024-0604","DOIUrl":"https://doi.org/10.1515/jpm-2024-0604","url":null,"abstract":"<p><strong>Objectives: </strong>Our study aims to underpin the safety of ambulatory management for 24 h after PROM at term. Patient data from 2021 were compared with data from 2010 to 2013, when ambulatory management was first introduced at the Women's Clinic of the University Hospital of Basel.</p><p><strong>Methods: </strong>In this retrospective study with historical control groups, we compared a cohort of women who underwent outpatient management of PROM at term in 2021, n=78 with two previous cohorts with inpatient management in 2010-2012, n=202 and outpatient management in 2013, n=37, respectively.</p><p><strong>Results: </strong>The maternal and foetal outcomes of our cohort were comparable to those of the previous cohorts. The expected difference in shorter hospital stay was confirmed.</p><p><strong>Conclusions: </strong>The study confirms the safety of an outpatient approach in the management of PROM at term. Further studies, especially RCTs, are needed for a definitive evaluation.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breastfeeding in HIV-positive mothers under optimized conditions: 'real-life' results from a well-resourced healthcare setting.","authors":"Cornelia Feiterna-Sperling, Renate Krüger, Hannah Bethke, Jan-Peter Siedentopf, Katharina von Weizsäcker, Michaela Heinrich-Rohr, Irena Rohr","doi":"10.1515/jpm-2025-0170","DOIUrl":"https://doi.org/10.1515/jpm-2025-0170","url":null,"abstract":"<p><strong>Objectives: </strong>Global guidelines increasingly support breastfeeding among women living with HIV (WLWH) under optimized conditions. However, outcome data from high-resource settings remain limited.</p><p><strong>Methods: </strong>We retrospectively analyzed WLWH who delivered at Charité - Universitätsmedizin Berlin between 2017 and 2023. Eligibility for breastfeeding required VL<50 cop/mL.</p><p><strong>Results: </strong>Of 409 WLWH, 365 (89.2 %) were eligible and 77 (18.8 %) initiated breastfeeding. No case of mother-to-child transmission (MTCT) was observed. Sustained viral suppression and ART adherence were key. Exclusive breastfeeding was associated with longer duration (p=0.001), midwifery care promoted exclusivity (p=0.009), and vaginal delivery was linked to longer duration (p=0.005).</p><p><strong>Conclusions: </strong>Breastfeeding with VL<50 cop/mL appears safe in high-resource settings. Findings support individualized counseling, close monitoring, and multidisciplinary care. The increasing breastfeeding trend reflects a shift in clinical practice.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amnioreduction safety in singleton pregnancies; systematic review and meta-analysis.","authors":"Nikan Zargarzadeh, Mohammad Haddadi, May Abiad, Ali Javinani, Eyal Krispin, Scott Shainker, Kjersti Aagaard, Alireza A Shamshirsaz","doi":"10.1515/jpm-2024-0605","DOIUrl":"https://doi.org/10.1515/jpm-2024-0605","url":null,"abstract":"<p><strong>Objectives: </strong>Prenatal ultrasound identifies polyhydramnios in approximately 0.7 % of pregnancies. Polyhydramnios (defined as amniotic fluid index >24 cm) is associated with maternal symptoms and preterm delivery. However, amnioreduction (AR) can effectively alleviate symptoms and reduce preterm delivery risks; its advantages remain controversial. This study aims to assess maternal safety following AR in singleton pregnancies systematically.</p><p><strong>Methods: </strong>Databases searched included PubMed, Embase, Scopus, and Web of Science until April 2024. Pregnant patients with singleton pregnancy and polyhydramnios undergo AR included in our study. Statistical analyses were conducted using R software.</p><p><strong>Results: </strong>From 574 initially identified articles, seven studies with 390 singleton pregnancies who underwent AR were included. The primary outcomes showed low odds of placental abruption 0.04 (95 % CI: 0.02-0.09, <i>I</i> ^<i>2</i> =12 %) and chorioamnionitis 0.03 (95 % CI: 0.01-0.08, <i>I</i> ^<i>2</i> =0 %). Secondary outcomes indicated a mean gestational age at birth of almost 36 weeks (95 % CI: 35.51-36.41, <i>I</i> ^<i>2</i> =49 %) and low odds of cesarean delivery 0.45 (95 % CI: 0.30-0.61, I2=58 %), preterm delivery within 48 h after AR 0.10 (95 % CI: 0.07-0.15, <i>I</i> ^<i>2</i> =9 %) and PPROM within 48 h after AR 0.03 (95 % CI: 0.02-0.04, <i>I</i> ^<i>2</i> =0 %).</p><p><strong>Conclusions: </strong>This study demonstrates that maternal complications are expected to be low following the AR procedure. However, given the lack of evidence for fetal benefit and pregnancy prolongation, future studies should directly compare the effects of AR with expectant management. Additionally, fetal survival is likely influenced more by the underlying fetal diagnosis or the etiology of polyhydramnios rather than AR itself. The current meta-analyses will serve as a guide for shared decision-making, and highlight the need for continued clinical trials powered to establish superiority or benefit with AR for singleton pregnancies.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Positive Airway Pressure vs. High Velocity Nasal Cannula for weaning respiratory support of preterm infants.","authors":"Erin Cicalese, Heather Howell, Tatiana A Nuzum, Natalia Mavrogiannis, Gurpreet Kaur, Kristyn Pierce, Sarah Fleishaker, Purnahamsi V Desai","doi":"10.1515/jpm-2025-0033","DOIUrl":"https://doi.org/10.1515/jpm-2025-0033","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the rates of Chronic Lung Disease (CLD) between premature infants weaned with either Continuous Positive Airway Pressure (CPAP) or High Velocity Nasal Cannula (HVNC).</p><p><strong>Methods: </strong>This was a retrospective, observational cohort study at a level IV NICU including infants <34 weeks gestational age (GA) on NIV (noninvasive ventilation) for at least 5 days. Maternal and infant demographics and clinical data from the infant's hospital course were collected. Infants were assigned to CPAP (n=175) and HVNC (n=48) cohorts based on which modality they were treated with for most of their time on NIV.</p><p><strong>Results: </strong>Demographics and clinical characteristics were similar between the CPAP group and the HVNC group. The rates of CLD were significantly higher in the HVNC group as compared to the CPAP group (58.3 vs. 24.6 %, p<0.001). After logistic regression analysis was performed accounting for GA, invasive respiratory support requirement, sepsis and administration of antenatal corticosteroids, the HVNC group was found to be almost 4 times more likely to develop CLD. Further analysis using propensity score matching yielded similar results.</p><p><strong>Conclusions: </strong>When used as the primary modality of noninvasive support, preterm infants on HVNC were more likely to develop CLD than those on CPAP.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombotic thrombocytopenic purpura in pregnancy: a comprehensive review.","authors":"Eman Alsulmi","doi":"10.1515/jpm-2024-0527","DOIUrl":"https://doi.org/10.1515/jpm-2024-0527","url":null,"abstract":"<p><p>Thrombotic thrombocytopenic purpura (TTP) is a rare but life-threatening hemolytic disorder with severe implications during pregnancy, characterized by microangiopathic hemolytic anemia (MAHA), severe thrombocytopenia, and systemic microvascular thrombosis. The condition arises from a severe deficiency in the ADAMTS13 enzyme, whether congenital or acquired, leading to the accumulation of ultra-large von Willebrand factor (vWF) multimers and widespread platelet aggregation. Pregnancy itself exacerbates TTP due to physiological reductions in ADAMTS13 activity, necessitating a high degree of clinical vigilance. This review addresses the etiology, diagnostic challenges, clinical presentation, and management of TTP in pregnancy, focusing on clinical relevance and emphasizing the importance of prompt therapeutic plasma exchange (TPE) and interdisciplinary care to optimize maternal and fetal outcomes.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Looking for a needle in a haystack: a case study of rare disease care in neonatology.","authors":"Natalia Czaplińska, Bozena Kociszewka-Najman, Przemyslaw Kosiński, Milan Stanojević","doi":"10.1515/jpm-2025-0090","DOIUrl":"https://doi.org/10.1515/jpm-2025-0090","url":null,"abstract":"<p><strong>Objectives: </strong>Rare diseases (RDs) collectively affect approximately 400 million individuals globally, including newborns and children. These conditions often involve genetic, metabolic, or congenital disorders and are challenging to diagnose and manage due to their subtle or non-specific symptoms. Aim is to emphasize the need for specialized, multidisciplinary, and technology-driven approaches to improve outcomes for neonates with RD.</p><p><strong>Methods: </strong>A comprehensive review of the infrastructure, diagnostic approaches, and clinical care strategies for RDs in neonates was conducted. The Department of Neonatology and Rare Diseases at the Medical University of Warsaw was analyzed as a model for centralized care, integrating prenatal consultations, advanced diagnostics, and multidisciplinary treatment.</p><p><strong>Results: </strong>The department offers specialized care for neonates with RDs, including intensive care, advanced diagnostic tools, and personalized therapies such as pharmacological interventions and surgery. Collaboration with a perinatology center ensures prenatal consultations, delivery planning, and early interventions, while the proximity of operating rooms to neonatal units enhances outcomes. Genetic counseling plays a pivotal role in supporting families and expanding newborn screening programs with emerging osmic technologies which can significantly improve early diagnosis and management.</p><p><strong>Conclusions: </strong>Centralized, multidisciplinary care and advancements in diagnostic technologies are essential for improving outcomes for neonates with RD. The integration of clinical care, genetic counseling, and innovative screening programs highlights the importance of specialized centers in addressing the unique challenges of these conditions.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}