Journal of Perinatal Medicine最新文献

{"title":"Cicero's universal law: a timeless guide to reproductive justice.","authors":"Frank A Chervenak, Susan L Pollet, Renee McLeod-Sordjan, Amos Grünebaum","doi":"10.1515/jpm-2024-0403","DOIUrl":"https://doi.org/10.1515/jpm-2024-0403","url":null,"abstract":"<p><p>Marcus Tullius Cicero's concept of \"ius gentium,\" or universal law, provides a timeless framework for understanding and defending fundamental human rights, particularly in the context of reproductive freedom. Cicero distinguished between \"ius gentium\" and \"ius civile,\" emphasizing that while civil law governs specific communities, universal law, rooted in natural reason, applies to all humanity. This philosophical foundation resonates with modern discussions on reproductive rights, where universal principles of justice and bodily autonomy are at stake. Enlightened by Immanuel Kant's notion of innate freedom, Cicero's philosophy challenges present day's US states' restrictive reproductive laws, which often contradict the universal principles of justice. Applying these concepts to contemporary issues, such as abortion rights, underscores the need to align civil laws with universal ethics, ensuring that individual freedoms are upheld against arbitrary state interventions. By advocating for policies that promote equitable access to reproductive healthcare, Cicero's vision of universal law remains a powerful tool for advancing human dignity and autonomy in modern society.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770034","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":"Incidence and awareness of dysphoric milk ejection reflex (DMER).","authors":"Rachel L Solmonovich, Insaf Kouba, Christine Bailey, Wendi Andria, Kristen Demertzis, Matthew J Blitz, Jolene Muscat","doi":"10.1515/jpm-2024-0299","DOIUrl":"https://doi.org/10.1515/jpm-2024-0299","url":null,"abstract":"<p><strong>Objectives: </strong>To determine Dysphoric Milk Ejection Reflex (DMER) incidence. Secondary objectives were to describe the symptom profiles and patient characteristics of DMER and assess DMER familiarity.</p><p><strong>Methods: </strong>A prospective observational study of people who initiated breastfeeding after delivery between December 2022 and May 2023 at two hospitals in New York. Participants filled out an Initial Survey, assessing prior DMER familiarity, and recurring DMER Symptoms Surveys, assessing symptom presence, severity, and transiency. Medical records were reviewed for patient demographics and clinical history. Descriptive and basic inferential statistics were performed. A p<0.05 was considered statistically significant.</p><p><strong>Results: </strong>Based on the DMER definition utilized, incidence was 26.9 % (n=21), and symptom severity was mostly very mild to moderate. Those with DMER had similar baseline characteristics to those without, apart from a significantly higher rate of having delivered via cesarean section (71.4.0 vs. 33.3 %, p<0.01). Among the 55 patients who completed the initial survey, 61.8 % were unfamiliar with the condition.</p><p><strong>Conclusions: </strong>DMER is described as brief, abrupt, negative emotions experienced by breastfeeding individuals prior to milk letdown. We found that more than 1 in 4 participants screened positive. Future research could better define, quantify, qualify, and publicize this condition to inform clinical practices and facilitate successful breastfeeding relationships.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755185","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":"Viability of Extremely Premature neonates: clinical approaches and outcomes.","authors":"Esin Koc, Sezin Unal","doi":"10.1515/jpm-2024-0432","DOIUrl":"https://doi.org/10.1515/jpm-2024-0432","url":null,"abstract":"<p><p>Viability refers to an infant's ability to survive outside the womb, which is influenced by both developmental maturity and the quality of medical care received. The concept of periviability, which has evolved alongside medical advancements, describes the stage between viability and nonviability, typically spanning from 20^0/7 to 25 ^6/7 weeks of gestation. While the chances of survival are extremely low at the earlier end of this range, the possibility of surviving without significant long-term complications improves towards the later end. The effectiveness of various antenatal and postnatal care practices, particularly those considered to be part of an active approach, plays a crucial role in influencing survival rates and mitigating morbidities. However, the decision to provide such active care is heavily influenced by national guidelines as well as international standards. The variability in guideline recommendations from one country to another, coupled with differences based on gestational age or accompanying risk factors, prevents the establishment of a standardized global approach. This variability results in differing practices depending on the country or institution where the birth occurs. Consequently, healthcare providers must navigate these discrepancies, which often leads to complex ethical dilemmas regarding the balance between potential survival and the associated risks. This review article explores the evolution of the definition of viability, the vulnerabilities faced by periviable infants, and the advancements in medical care that have improved survival rates. Additionally, it examines the viability and periviability definitions, the care and outcomes of periviable infants and recommendations in guidelines.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755214","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":"Shifts in peak month of births and socio-economic factors: a study of divided and reunified Germany 1950-2022.","authors":"Bertram Häussler, Joachim W Dudenhausen","doi":"10.1515/jpm-2024-0526","DOIUrl":"https://doi.org/10.1515/jpm-2024-0526","url":null,"abstract":"<p><strong>Objectives: </strong>The seasonality of conception and birth has intrigued scientists for over 200 years. Since the 1970s, peak birth months in the northern hemisphere have shifted from early spring to late summer, influenced by oral contraceptives and socio-economic factors. The division of Germany from the end of World War II until reunification in 1990 offers a unique opportunity to analyze these influences while both regions had equal access to contraception. This study aims to identify differences in fertility trends and peak birth months between West and East Germany before and after reunification, considering political, socio-economic factors, and contraceptive availability.</p><p><strong>Methods: </strong>A population-based study analyzed overall fertility rates, monthly birth data, peak birth months, and average maternal ages from 1950 to 2022.</p><p><strong>Results: </strong>Fertility patterns were similar in both regions until 1970, showing a sharp increase post-1955 followed by a decline around 1965, likely due to contraception. From 1970 to 1990, East German fertility increased while West Germany's remained lower. After reunification, East German fertility fell sharply but later rose to West German levels. The peak birth month shifted from March to August in West Germany by the mid-1980s, while East Germany experienced this change 20 years later, post-reunification.</p><p><strong>Conclusions: </strong>The 20-year delay in East Germany's shift suggests that oral contraception's impact was influenced by other factors, particularly the age of women at childbirth. Increased control over fertility in the West allowed for more choice in conception timing, a trend adopted in the East after gaining similar autonomy.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770041","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":"Gestational weight gain and obstetric outcomes in women with obesity in an inner-city population.","authors":"Deepali Mathur, Megan Haugland, Megan Leubner, Sara Hovstadius, Dorothy Wakefield, Reinaldo Figueroa","doi":"10.1515/jpm-2024-0193","DOIUrl":"https://doi.org/10.1515/jpm-2024-0193","url":null,"abstract":"<p><strong>Objectives: </strong>To describe maternal and perinatal outcomes in patients with BMI ≥30 kg/m² by BMI class and gestational weight gain.</p><p><strong>Methods: </strong>Retrospective review of singleton pregnancies with pre-pregnancy BMI ≥30 kg/m² who received care at our institution between January 1, 2016 and December 31, 2021. Patients were divided into three categories based on BMI (kg/m²): Class I (BMI 30.0-34.9), Class II (BMI 35-39.9), and Class III (BMI≥40) obesity. For gestational weight gain analysis, pregnancies were stratified into three groups: <11 pounds, 11-20 pounds, and >20 pounds. Maternal demographics and outcomes were compared using chi-square analysis, analysis of variance, nonparametric tests, and multivariable regression analysis.</p><p><strong>Results: </strong>Of 641 patients included, 299 (46.6 %) were in Class I, 209 (32.6 %) in Class II, and 133 (20.7 %) in Class III. Readmission within 6 weeks postpartum, the only outcome found to have a significant difference between BMI categories, was higher in the Class III group (p=0.01). One hundred sixty-two (25.3 %) patients gained <11 pounds, 164 (25.6 %) gained 11-20 pounds, and 313 (48.8 %) gained ≥20 pounds. Greater gestational weight gain was associated with increased rates of cesarean delivery (p<0.001), higher quantitative blood loss (p=0.006), longer length of hospitalization (p=0.03), and higher birthweights (p<0.001).</p><p><strong>Conclusions: </strong>This represents a unique and actionable opportunity for clinicians to counsel and support their patients in adhering to optimal weight gain targets throughout their pregnancy. Future studies are needed to determine the optimal gestational weight gain recommendations for obese patients.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754957","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":"Hemolytic disease of the fetus and newborn: pregnant person's and fetal immune systems interaction.","authors":"Liliana Voto, Carlos Alberto Gonzalez, Silvana Gonzalez","doi":"10.1515/jpm-2024-0438","DOIUrl":"https://doi.org/10.1515/jpm-2024-0438","url":null,"abstract":"<p><p>There exists a need to research new diagnostic and therapeutic approaches that consider hemolytic disease of fetus and newborn (HDFN)'s physiopathology and focus not only on the pregnant person's immune system but also on the fetal immune system. This implies, in the final sense, to view the fetus as our patient. In spite of having found a safe and efficient method of prevention of HDFN more than 50 years ago, HDFN continues to be a relevant cause of perinatal morbidity and mortality, due to lack of access to immunoprophylaxis. In light of the above, we should strive to prevent sensitization and HDFN by ensuring certain health policies across the globe, especially in countries and regions of high morbidity and mortality.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755050","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":"Placental fetal vascular malperfusion in maternal diabetes mellitus.","authors":"Jerzy Stanek","doi":"10.1515/jpm-2024-0370","DOIUrl":"https://doi.org/10.1515/jpm-2024-0370","url":null,"abstract":"<p><strong>Objectives: </strong>To study the clinical and placental correlations in diabetic pregnancies in which placental histopathology included routine double E cadherin/CD34 immunostaining.</p><p><strong>Methods: </strong>Retrospective study of 229 cases of diabetic pregnancies, mostly with gestational diabetes mellitus. The cases were individually matched for gestational age at delivery with non-diabetic pregnancies to yield a comparative group of 229 cases. 23 independent clinical and 50 placental phenotypes (variables) were statistically compared by analysis of variance or Chi-square with application of the Bonferroni correction for multiple comparisons.</p><p><strong>Results: </strong>The study group showed statistically significantly more common gestational hypertension, chronic hypertension, polyhydramnios, umbilical cord compromise, cesarean sections, macerated stillbirths, neonatal deaths, and fetal malformations. About a third of cases in each group showed lesions of maternal and fetal vascular malperfusion (FVM), the latter more common than reported in literature. The CD34 component of the double immunostaining increased the sensitivity of placental examination by highlighting clustered endothelial fragmentation of recent fetal vascular malperfusion or increasing the grade of fetal vascular malperfusion (on-going distal villous fetal vascular malperfusion with temporal heterogeneity).</p><p><strong>Conclusions: </strong>With the double immunostaining, FVM is as common as maternal vascular malperfusion pattern of placental injury in diabetic pregnancies with high prevalence of fetal congenital malformations. This is likely due to umbilical cord compression evoked by mass-forming fetal anomalies. Recognizing placental FVM may sensitize to the increased risk of neonatal systemic thrombotic pathology. However, several hypoxic lesions and patterns as well as those of shallow placental implantation were also seen with increased frequencies in diabetic pregnancies.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716533","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":"Effects of a respiratory function indicator light on visual attention and ventilation quality during neonatal resuscitation: a randomised controlled crossover simulation trial.","authors":"Yasuhisa Ikuta, Fumihiko Takatori, Shoichiro Amari, Ai Ito, Akira Ishiguro, Tetsuya Isayama","doi":"10.1515/jpm-2024-0251","DOIUrl":"https://doi.org/10.1515/jpm-2024-0251","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the effectiveness of placing an indicator light indicating inadequate ventilation near the face mask during positive-pressure ventilation with respiratory function monitors (RFMs) in neonatal resuscitation. The study is a three-group, randomised, controlled, crossover simulation trial.</p><p><strong>Methods: </strong>Paediatrics residents, neonatology fellows, and attending neonatologists at a single neonatal intensive care unit. A ventilation simulation with a manikin was performed three times consecutively using the same scenario with three different ventilation evaluation methods (A) RFM plus indicator light and conventional methods (heart rate and chest rise) (B) RFM and conventional methods, and (C) conventional methods alone.</p><p><strong>Results: </strong>The ratio of gaze duration on the manikin to the total trial duration was recorded using an eye-tracking device. The proportion of trials with adequate ventilation (expiratory tidal volume [VTe], 4-10 mL/kg; peak inspiratory pressure <30 cm H₂O; leak <40 %) was determined. After excluding incomplete data, 63 simulations (22 participants) were analysed. The ratios of the gaze duration on the manikin to the total trial duration were significantly different among settings A (0.60 [95 % confidence interval: 0.52-0.67] sec/sec), B (0.51 [0.43-0.59] sec/sec), and C (0.80 [0.76-0.84] sec/sec). Ventilation with adequate VTe and less leakage was more frequent in settings A and B than in setting C (adequate VTe: A, 91 %; B, 91 %; and C, 83 %; less leak: A, 76 %; B, 78 %; and C, 57 %).</p><p><strong>Conclusions: </strong>An indicator light close to the facemask with an RFM directed the eyesight towards the manikin without compromising the ventilation quality during the simulation of neonatal resuscitation.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710344","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":"External validation of a non-invasive vaginal tool to assess the risk of intra-amniotic inflammation in pregnant women with preterm labor and intact membranes.","authors":"Teresa Cobo, Xavier P Burgos-Artizzu, Silvia Ferrero, Judith Balcells, Jordi Bosch, Amadeu Gené, Clara Murillo, Claudia Rueda, David Boada, Maria Teresa Sánchez-Antón, Marian Kacerovsky, Bo Jacobsson, Montse Palacio","doi":"10.1515/jpm-2024-0178","DOIUrl":"10.1515/jpm-2024-0178","url":null,"abstract":"<p><strong>Objectives: </strong>To prospectively validate the diagnostic performance of a non-invasive point-of-care tool (Rapid IAI System), including vaginal alpha-fetoprotein and interleukin-6, to predict the occurrence of intra-amniotic inflammation in a Spanish cohort of patients admitted with a diagnosis of preterm labor and intact membranes.</p><p><strong>Methods: </strong>From 2017 to 2022, we prospectively evaluated a cohort of pregnant women diagnosed with preterm labor and intact membranes admitted below 34+0 weeks who underwent amniocentesis to rule-in/out intra-amniotic infection and/or inflammation. Vaginal sampling was performed at the time of amniocentesis or within 24-48 h. Amniotic fluid IL-6, vaginal alpha-fetoprotein and vaginal IL-6 concentrations were measured using a point-of-care tool provided by Hologic Inc., \"Rapid IAI System\". We defined intra-amniotic inflammation when amniotic fluid IL-6 values were greater than 11.3 ng/mL. During recruitment, clinicians were blinded to the results of the point-of-care tool. The original prediction model proposed by Hologic Inc. to predict intra-amniotic inflammation was validated in this cohort of patients.</p><p><strong>Results: </strong>We included 151 patients diagnosed with preterm labor and intact membranes. Among these, 29 (19.2 %) had intra-amniotic inflammation. The algorithm including vaginal IL-6 and alpha-fetoprotein showed an area under curve to predict intra-amniotic inflammation of 80.3 % (±5.3 %) with a sensitivity of 72.4 %, specificity of 84.6 %, positive predictive valuve (PPV) of 52.5 %, negative predictive value (NPV) of 92.9 %, and a positive likelihood ratio (LR+) of 4.6 and negative likelihood ratio (LR-) of 0.33.</p><p><strong>Conclusions: </strong>External validation of a non-invasive rapid point-of-care tool, including vaginal alpha-fetoprotein and IL-6, showed very good diagnostic performance for predicting the absence of intra-amniotic inflammation in women with preterm labor and intact membranes.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687289","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 family-centric, comprehensive nurse-led home oxygen programme for neonatal chronic lung disease: home oxygen policy evaluation (HOPE) study.","authors":"Nele Legge, Dominic Fitzgerald, Jacqueline Stack, Himanshu Popat","doi":"10.1515/jpm-2024-0319","DOIUrl":"https://doi.org/10.1515/jpm-2024-0319","url":null,"abstract":"<p><strong>Objectives: </strong>Considerable variation and little objective evidence exists to guide the use of supplemental oxygen therapy in infants with neonatal chronic lung disease (nCLD) after hospital discharge. We developed a new policy utilizing regular oximetry downloads to help determine commencement and titration of low flow oxygen. The aim of this policy is to improve safety and uniformity in practice and potentially lead to improvements in outcomes including the number of infants being discharged on home oxygen therapy (HOT) and length of stay (LOS).</p><p><strong>Methods: </strong>This single-centre pre- and post-implementation study included 86 and 94 infants <32 weeks' gestation (pre- vs. post-implementation) meeting definition of nCLD. The primary outcomes were (1) successful implementation of the new policy, (2) changes in number of patients discharged on HOT and (3) in LOS. Secondary outcomes were changes in feeding mode at discharge, total length of HOT, readmission to hospital within the first year of life and neurodevelopmental outcomes at 8 months post menstrual age amongst infants treated with HOT.</p><p><strong>Results: </strong>The policy was successfully implemented with 100 % of infants with nCLD receiving downloads in the post-implementation epoch. Pre-implementation 36 % (31 of 85) of infants with nCLD were treated with HOT vs. 17 % (16 of 94) post-implementation (p=0.03). There was no significant difference in LOS or any of the secondary outcomes.</p><p><strong>Conclusions: </strong>A protocolised approach to decision making using predetermined parameters regarding the need for supplemental oxygen in neonates with nCLD is practical and achievable and may result in fewer neonates requiring HOT.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682067","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}