Journal of Perinatal Medicine最新文献

{"title":"Social vulnerability and triage acuity among pregnant people seeking unscheduled hospital care.","authors":"Lakha Prasannan, Alejandro Alvarez, Disha Shahani, Matthew J Blitz","doi":"10.1515/jpm-2025-0095","DOIUrl":"https://doi.org/10.1515/jpm-2025-0095","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines the association between census tract-linked social vulnerability index (SVI) and maternal-fetal triage index (MFTI), a standardized score used to classify obstetric triage visit acuity.</p><p><strong>Methods: </strong>This retrospective cohort study included patients at 20 weeks of gestational age or greater presenting to a New York City obstetric triage unit from March 2019 to April 2021, analyzing only the first pregnancy per patient. Exclusions included missing SVI or MFTI data and MFTI-5 (scheduled services). The primary exposure was SVI, and the primary outcome was MFTI score at the first triage visit. Multinomial logistic regression modeled the odds of MFTI-1 (stat) and MFTI-2 (urgent) visits relative to prompt/non-urgent visits, adjusting for potential confounders.</p><p><strong>Results: </strong>Among 11,388 pregnant patients, most triage visits were classified as prompt or non-urgent (61.5 %), while 35.1 % were urgent, and 3.4 % were stat. Patients from neighborhoods with very high SVI had increased odds of an urgent visit (aOR 1.22, 95 % CI 1.06-1.41), as did those with chronic hypertension (aOR 1.46, 95 % CI 1.18-1.81), though SVI was not associated with stat visits. Stat visits were more likely during the COVID-19 pandemic (aOR 5.42, 95 % CI 4.04-7.28) and among patients with chronic hypertension (aOR 1.84, 95 % CI 1.15-2.94), while nulliparity and term presentation were associated with lower odds of a stat visit.</p><p><strong>Conclusions: </strong>Patients living in areas with a very high SVI score had increased odds of urgent triage visits but not stat visits. No racial or ethnic disparities were observed.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159755","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":"Correlation between macronutrient content and donation characteristics in Croatian human milk bank.","authors":"Vladimira Rimac, Jurjana Novoselac, Branka Golubić Ćepulić, Ines Bojanić","doi":"10.1515/jpm-2024-0361","DOIUrl":"https://doi.org/10.1515/jpm-2024-0361","url":null,"abstract":"<p><strong>Objectives: </strong>Optimal macronutrient (protein, fat, carbohydrate) values in human milk (HM) are essential for the healthy growth of infants, particularly those with very low birth weight. This study aimed to investigate the correlations between macronutrient content in HM and the characteristics of donations in the Croatian HM bank.</p><p><strong>Methods: </strong>A total of 211 pools of HM from 51 donors were included. Analysis of HM was performed on MIRIS Human Milk Analyzer (Miris AB, Uppsala, Sweden). Prior to routine use, a brief verification of MIRIS was performed (between-run and within-run precision).</p><p><strong>Results: </strong>In precision study the coefficients of variation were all below 10 %, as well as bias, with the exception of the between-run for crude proteins high control level (bias was 12 %). Storage temperature in the donor's home positively correlated with fat (p=0.004) and energy content (p=0.009) and negatively correlated with carbohydrates (p=0.003). The duration of lactation (p<0.001) and the duration of HM storage (in donor's home p=0.022; in the bank p=0.001; total duration of HM storage p<0.001) negatively correlated with proteins in HM. Statistically significant difference was obtained for all components (fat p=0.008, proteins p=0.006, carbohydrates p<0.001, energy content p=0.002) when comparing infant's sex and milk macronutrients, with male infants having higher values.</p><p><strong>Conclusions: </strong>This study demonstrates that various factors can affect the macronutrient content of donated HM. It is important to monitor all factors that may impact on the quality of HM.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172902","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":"Risk factors and awareness of tobacco smoking and second-hand smoke exposure among pregnant women in Taiwan.","authors":"Ching-Feng Chang, Lin-Hua Wang, Hsin-Yi Kuo, Ching-Chiang Lin","doi":"10.1515/jpm-2024-0516","DOIUrl":"https://doi.org/10.1515/jpm-2024-0516","url":null,"abstract":"<p><strong>Objectives: </strong>Tobacco smoking during pregnancy is a significant public health concern, posing serious risks to both maternal and fetal health. This study aimed to identify factors associated with smoking, second-hand smoke (SHS) exposure, and knowledge of smoking hazards and cessation counseling services during pregnancy.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 3,052 pregnant women receiving prenatal care from 2016 to 2022. Maternal characteristics, smoking status, SHS exposure, and knowledge of smoking risks and cessation services were analyzed using multivariable logistic regression models.</p><p><strong>Results: </strong>Approximately 5.6 % of participants were current smokers. Smoking was more prevalent among unmarried women, those with low income, multigravida, and women with overweight/obesity (p<0.05). SHS exposure was reported by 19.9 % of participants, with higher rates among women with low income and immigrant status (p<0.05). While 99.2 % of participants were aware of the risks of smoking to maternal and infant health, awareness was significantly lower among immigrant women (p<0.05). Additionally, 96.3 % of participants were aware of smoking cessation counseling services, but lower awareness levels were observed in women aged≥35 years, unmarried women, and immigrant women (p<0.05).</p><p><strong>Conclusions: </strong>Sociodemographic factors such as low income and immigrant status are strongly associated with smoking and SHS exposure during pregnancy. To address these disparities, hospitals should prioritize tailored prenatal education and counseling services. Emphasizing the risks of smoking to maternal and infant health can promote healthier pregnancies, especially in underserved rural areas.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173143","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":"Improving the accuracy of screening for large-for-gestational-age fetuses: a multicenter observational study.","authors":"Benjamin Birene, Alexandre Ferreira, Emilie Raimond, Olivier Graesslin, Uzma Ishaque, René Gabriel","doi":"10.1515/jpm-2025-0015","DOIUrl":"https://doi.org/10.1515/jpm-2025-0015","url":null,"abstract":"<p><strong>Objectives: </strong>Large-for-gestational-age (LGA) fetuses present significant maternal and neonatal risks. However, prenatal screening is prone to inaccuracies, leading to potentially unnecessary interventions. This study aims to evaluate the factors influencing the accuracy of third-trimester screening for LGA fetuses to improving diagnostic accuracy.</p><p><strong>Methods: </strong>A prospective, multicenter cohort study was conducted involving low-risk pregnancies from three hospitals. Screening was analyzed using ultrasound-based fetal weight estimation (EFW), abdominal circumference (AC) and symphysial fundal height (SFH) measurements. EFW and AC were assessed either during the routine third-trimester ultrasound or during an additional growth ultrasound when available. Newborns were classified as LGA based on AUDIPOG growth curves. Screening performance was assessed using sensitivity, specificity, predictive values, diagnostic odds ratios (DOR), Youden's index and accuracy. We also evaluated composite screening tests combining biometric parameters with maternal clinical risk factors and influence of gestational age at the time of growth ultrasound to identify the optimal timing for screening.</p><p><strong>Results: </strong>Among 2,217 women, risk factors such as high BMI and gestational diabetes increased suspicion of LGA fetuses, contributing to both true and false positive results (p<0.001). No single ultrasound parameter demonstrated superior diagnostic performance. Third-trimester ultrasound showed a sensitivity of 37 % [31-44 %] and a specificity of 94 % [93-95 %], while growth ultrasound improved sensitivity to 65 % [57-74 %] but reduced specificity to 82 % [79-85 %]. SFH measurements did not enhance screening performance. Overestimation of fetal weight was observed in 56.89 % (95/167) of cases, with errors exceeding 10 % in 26.95 % (122/167) of newborns. Combined screening using fetal biometry and maternal clinical risk factors showed high specificity but poor sensitivity, limiting their utility as standalone tools for detecting macrosomia.</p><p><strong>Conclusions: </strong>This study underscores the impact of operator bias in LGA screening, with risk factors influencing measurements. The modest performance of ultrasound-based screening highlights the inherent limitations of current methods. These findings call for cautious labeling of LGA fetuses and development of management strategies to address the challenges of imprecise screening.</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":"144150669","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":"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":"Copy number variation sequencing detection technology for identifying fetuses with abnormal soft indicators: a comprehensive study.","authors":"Guangting Lu, Weiwu Liu","doi":"10.1515/jpm-2024-0449","DOIUrl":"10.1515/jpm-2024-0449","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to assess the value of copy number variation sequencing (CNV-seq) in prenatal diagnosis of abnormal ultrasound markers to reduce fetal birth defects.</p><p><strong>Methods: </strong>Between June 2021 and December 2022, Yulin Maternal and Child Health Care Hospital examined 295 pregnant women with abnormal ultrasound indicators. We were categorized by the number of abnormalities and age. Karyotype analysis and CNV-seq were conducted, and the CNV-seq detection rate was statistically analyzed.</p><p><strong>Results: </strong>CNV-seq detected abnormal chromosomes in 43 out of 295 pregnant women with abnormal fetal ultrasound soft indicators, resulting in a detection rate of 14.58 %, compared to 5.76 % with traditional karyotype analysis. CNV-seq identified all aneuploidy abnormalities found by karyotype analysis and an additional 5 abnormalities, increasing the detection rate by 1.69 %. However, CNV-seq missed one case of chromosome equilibrium translocation. The detection rate of CNV-seq in fetuses with Several abnormal soft indexes was 29.41 %, significantly higher than individual soft indexes (p<0.05). The study compared abnormality rates of single and multiple ultrasound soft markers in two age groups. Abnormal detection rates were 12.38 % for the younger group and 13.73 % for the older group, with no significant difference. However, the younger group had a significantly higher detection rate for multiple soft markers compared to the older group (χ²=5.517, p<0.05).</p><p><strong>Conclusions: </strong>CNV-seq technology is valuable for identifying fetuses with abnormal soft markers, guiding its future use in perinatal diagnosis and aiding clinical genetic counseling.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"338-349"},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468219","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":"AI and early diagnostics: mapping fetal facial expressions through development, evolution, and 4D ultrasound.","authors":"Wiku Andonotopo, Muhammad Adrianes Bachnas, Julian Dewantiningrum, Mochammad Besari Adi Pramono, Milan Stanojevic, Asim Kurjak","doi":"10.1515/jpm-2024-0602","DOIUrl":"10.1515/jpm-2024-0602","url":null,"abstract":"<p><p>The development of facial musculature and expressions in the human fetus represents a critical intersection of developmental biology, neurology, and evolutionary anthropology, offering insights into early neurological and social development. Fetal facial expressions, shaped by Cranial Nerve VII, reflect evolutionary adaptations for nonverbal communication and exhibit minimal asymmetry in universal expressions. Advancements in 4D ultrasound imaging and artificial intelligence (AI) have introduced innovative methods for analyzing these movements, revealing their potential as diagnostic tools for neurodevelopmental disorders like Bell's Palsy and Ramsay Hunt Syndrome before birth. These technologies promise early interventions that could significantly improve neonatal outcomes. By integrating imaging, AI, and longitudinal studies, researchers propose a multidisciplinary approach to establish diagnostic criteria for fetal facial movements. However, translating these advancements into clinical practice requires addressing ethical and practical challenges, refining imaging and AI methodologies, and fostering interdisciplinary collaboration. The review highlights the universality of fetal expressions while emphasizing the importance of distinguishing typical variability from pathological markers. In conclusion, these findings suggest transformative potential for maternal-fetal medicine, paving the way for proactive strategies to manage neurodevelopmental risks. Focused research is essential to fully harness these innovations and establish a new frontier in perinatal science.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"263-285"},"PeriodicalIF":1.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414619","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":"Trisomy 18 mosaicism - are we able to predict postnatal outcome by analysing the tissue-specific distribution?","authors":"Iris Dressler-Steinbach, Miriam Kinzel, Holger Janke, Rainer Wimmer, Alexander Weichert, Rabih Chaoui, Lars Garten, André Weber, Stefan Verlohren, Wolfgang Henrich, Markus Stumm","doi":"10.1515/jpm-2024-0543","DOIUrl":"10.1515/jpm-2024-0543","url":null,"abstract":"","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"407-409"},"PeriodicalIF":1.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414621","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":"A crisis in U.S. maternal healthcare: lessons from Europe for the U.S.","authors":"Amos Grünebaum, Joachim Dudenhausen, Frank A Chervenak","doi":"10.1515/jpm-2024-0606","DOIUrl":"10.1515/jpm-2024-0606","url":null,"abstract":"","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"297-304"},"PeriodicalIF":1.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256072","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}