Journal of Maternal-Fetal & Neonatal Medicine最新文献

{"title":"Mode of birth in nulliparous term singleton pregnancies in vertex presentation before and after implementation of an evidence-based intervention: quality-improvement study.","authors":"Petra Psenkova, M Veliskova, D Dzubinska, I Waczulikova, M Tedla, P Peskovicova, J Zahumensky","doi":"10.1080/14767058.2024.2443968","DOIUrl":"https://doi.org/10.1080/14767058.2024.2443968","url":null,"abstract":"<p><strong>Purpose: </strong>The main objective of this study was to assess the impact of a composite quality improvement intervention on mode of birth in nullipara term singleton vertex (NTSVs).</p><p><strong>Material and methods: </strong>This was an ambidirectional study following the implementation of the intervention to reduce cesarean section rate in NSTV by comparing two birth cohorts, pre-composite quality improvement intervention cohort (January 2013-December 2015) and post-composite quality improvement intervention cohort (January 2018-December 2020).</p><p><strong>Results: </strong>In the studied periods, there was a total of 7713 NTSV births. Compared to pre-composite quality improvement intervention, there was a post-composite quality improvement intervention reduction in NTSV cesarean section rate from 30.89% to 13.31% (<i>p</i> < 0.0001). Obstetric and non-obstetric indications for elective cesarean sections decreased from 5.52% to 1.04% (<i>p</i> < 0.0001) and from 4.82% to 0.52% (<i>p</i> < 0.0001), respectively. The frequency of emergency cesarean sections in this group decreased from 20.56% to 11.75% (<i>p</i> < 0.0001), especially those performed for failure to progress in labor (from 13.69% to 7.30%; <i>p</i> < 0.0001). There has been a rising trend with regards to maternal age. However, the proportion of mothers aged 35 years and more giving birth by cesarean section reduced from 46.94% to 20.28%. These reductions in cesarean section rates occurred without any negative impact on core fetal outcomes.</p><p><strong>Conclusions: </strong>This quality improvement study demonstrates that it is feasible to significantly reduce cesarean section rate in NTSV by adopting specific composite measures. However, this requires the understanding of the inherent problems and barriers within the unit and the involvement of all stake holders.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2443968"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923472","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 prediction model for postpartum psychiatric disorders: a retrospective cohort study of 1418 Chinese women from 2020 to 2022.","authors":"Wenxi Chen, Huan Ge, Jing Cong, Wenjie Zhou, Xiaoxia Chang, Xiaojie Quan, Jing Xia, Xincheng Tao, Danhua Pu, Jie Wu","doi":"10.1080/14767058.2024.2438756","DOIUrl":"10.1080/14767058.2024.2438756","url":null,"abstract":"<p><strong>Background: </strong>Postpartum psychiatric disorders (PPDs) have been deemed as a significant public health concern, affecting both maternal health and family dynamics. This study aimed to examine the current status of PPDs, identify the potential risk factors of PPDs, and further develop a clinical nomogram model for predicting PPDs in Chinese women.</p><p><strong>Method: </strong>In this retrospective cohort study, 1418 postpartum women attending the routine postpartum examination at the 42nd day after delivery in Jiangsu Women and Children Health Hospital were recruited as participants from December 2020 to December 2022. The Symptom Checklist-90 (SCL-90) was utilized to assess the status of postpartum psychiatric disorders. A prediction model was constructed by multivariate logistic regression and presented as a nomogram. The performance of nomogram was measured by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). The relationships between predictive factors of PPDs and SCL-90 were also evaluated using Pearson correlation analysis. The relationships between predictive factors of PPDs and SCL-90 were evaluated using Pearson correlation analysis.</p><p><strong>Results: </strong>With the SCL-90 cutoff value of 160, the incidence of postpartum psychiatric disorders was 9.17% among Chinese urban women. The univariate and multivariate logistic regression analyses indicated that age ≤ 25 years old (OR = 10.07, 95%CI = 1.83-55.33), prenatal mood disorder (OR = 4.12, 95%CI = 1.99-8.53), invasive prenatal diagnostic procedures (OR = 4.39, 95%CI = 1.16-16.56), poor relationship with husband (OR = 2.86, 95%CI = 1.58-5.16) and poor relationship with mother-in-law (OR = 5.10, 95%CI = 2.70-9.64) were significantly associated with PPDs. A nomogram prediction model for PPDs was further constructed based on these five independent risk factors, and the area under the receiver operating characteristic curve (AUC) of the nomogram model was 0.823 (95% CI = 0.781-0.865). The calibration curves showed remarkable accuracy of the nomogram and the DCA exhibited high clinical net benefit of the nomogram. Besides, we also explored the relationships between the five risk factors and different symptom dimensions of PPDs and found that the five risk factors were almost associated with increased levels of all symptom dimensions.</p><p><strong>Conclusions: </strong>Five psychosocial risk factors for PPDs were identified in Chinese women and the nomogram prediction model constructed based on these five risk factors could predict the risk of PPDs intuitively and individually. Systematic screening these risk factors and further conducting psychosocial interventions earlier during the pregnancy period are crucial to prevent PPDs. For future research, we intend to incorporate additional risk factors, including blood biomarkers and facial expression indicators, to refine our risk model.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2438756"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819873","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":"Statement of Retraction: A sandwich technique (N&H variation technique) to reduce blood loss during cesarean delivery for complete placenta previa: a randomized controlled trial.","authors":"","doi":"10.1080/14767058.2025.2440150","DOIUrl":"https://doi.org/10.1080/14767058.2025.2440150","url":null,"abstract":"","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2440150"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808470","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":"Clinical and demographic factors associated with increased risk of postpartum readmission among patients presenting to the emergency department by 6 weeks postpartum.","authors":"Kate Corry-Saavedra, Aisling Murphy, Jenny Y Mei","doi":"10.1080/14767058.2025.2466210","DOIUrl":"https://doi.org/10.1080/14767058.2025.2466210","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Postpartum emergency department (ED) visits complicate 12% of births and rates of postpartum readmission are on the rise. While there are a wide range of etiologies, prior studies have sought to delineate causes and risk for readmission. Furthering our understanding of risk factors and etiologies for postpartum readmissions may help develop quality metrics and targeted strategies to address the rising rate of readmissions. We aimed to characterize demographic and perinatal characteristics in postpartum ED visits and evaluate risk factors for readmission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort study was performed on all ED visits that took place within 42 days of delivery at a single tertiary care center between 2017 and 2022. Inclusion criteria were age 18 years or above and both delivery and ED visit/readmission at the institution. Exclusion criteria included patients who did not deliver at the study institution, previable deliveries (&lt;24 weeks gestation), intrauterine fetal demise, and termination of pregnancy. Chief complaint was used to determine the main reason for presentation to the ED. Patients who presented with concern for elevated blood pressures had hypertension listed as their chief complaint. Maternal demographics and delivery outcomes were compared between patients who were readmitted to those managed outpatient.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 16162 deliveries, 548 (3.4%) patients presented to the ED for total 616 encounters. 52 (9.5%) patients presented to the ED more than once. Out of the patients who presented to the ED, 221 (40.3%) patients were readmitted, 8 of whom were readmitted twice (1.3%). The majority (63%) of ED visits occurred within 14 days of delivery. Hypertension was the most common reason for presenting to the ED (23.8%), followed by GI complaints (10.8%) and vaginal bleeding (9.7%). Advanced maternal age, higher BMI, Black race, chronic hypertension, maternal medical comorbidity, and longer postpartum length of stay were all associated with higher likelihood of being readmitted. Multivariate logistic regression controlling for potential confounders found higher risk of readmission with hypertensive disorder of pregnancy (adjusted odds ratio [aOR], 2.28; 95% confidence interval [CI], 1.57-3.3; &lt;i&gt;p&lt;/i&gt; &lt; 0.001), preeclampsia with severe features (aOR, 1.91; 95% CI, 1.07-3.42; &lt;i&gt;p&lt;/i&gt; = 0.03), and presenting for hypertension (aOR, 5.69; 95% CI, 3.56-9.09; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). There were also higher odds of readmission with any delivery complication (aOR, 1.77; 95% CI, 1.24-2.52; &lt;i&gt;p&lt;/i&gt; = 0.002) and having more than one ED visit (aOR, 3.42; 95% CI, 1.86 to 6.28; &lt;i&gt;p&lt;/i&gt; &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Most ED visits took place within 2 weeks of delivery, and postpartum hypertension was the leading cause. Risk of readmission after an ED visit was higher for patients with medical comorbidities, hypertensive disorders of pregnancy, and delivery complica","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2466210"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434149","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":"Assessment of the clinical significance of a UGT1A1 gene variant in affecting phototherapy response and long-term outcomes in neonatal hyperbilirubinemia.","authors":"Shuai Fu, Xue Yang, Lin Pei, Xiaoman Wan, Yue Jiang, Yingying Kang, Hesheng Chang","doi":"10.1080/14767058.2025.2457005","DOIUrl":"https://doi.org/10.1080/14767058.2025.2457005","url":null,"abstract":"<p><strong>Objective: </strong>Phototherapy is the standard treatment, but its efficacy can vary among neonates, prompting interest in genetic factors, particularly UGT1A1 gene variants. This study aims to evaluate the clinical significance of the UGT1A1 gene variant in influencing phototherapy response and long-term outcomes in neonatal hyperbilirubinemia.</p><p><strong>Methods: </strong>This retrospective study included 104 neonates with neonatal hyperbilirubinemia, of whom 63 carried the normal UGT1A1 gene, and 41 had the homozygous UGT1A1 Gly71Arg variant. Genetic testing for the UGT1A1 gene Gly71Arg locus had been previously conducted as part of their clinical care using DNA extraction and sequencing. Parameters such as phototherapy duration, complications, and long-term outcomes were analyzed to assess the correlation between the UGT1A1 gene variant and clinical results. Furthermore, the impact of the UGT1A1 gene variant was evaluated using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Neonates with the UGT1A1 gene variant showed prolonged phototherapy duration, extended time to bilirubin normalization, increased phototherapy complications, higher phototherapy intensity, and more excellent rehospitalization rates for hyperbilirubinemia. The presence of the UGT1A1 gene variant correlated with specific complications, including dehydration, hypoglycemia, and hyperbilirubinemia. Additionally, infants with the UGT1A1 gene variant had significantly higher rates of developmental delay, cerebral palsy, hearing impairment, neurodevelopmental disorders, and severe hyperbilirubinemia-related morbidities. Mean peak bilirubin levels were significantly higher in the variant compared with the normal group. ROC analysis demonstrated moderate to strong sensitivities and specificities with area under the curve (AUC) values ranging from 0.693 to 0.830.</p><p><strong>Conclusion: </strong>We found that a UGT1A1 gene variant significantly affects phototherapy response and can impact long-term outcomes in neonatal hyperbilirubinemia, highlighting the potential of genetic testing for personalized risk assessment and management of hyperbilirubinemia in newborns.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2457005"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469820","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":"Pregnancy in ACHD women: crucial role of multidisciplinary clinical roadmap.","authors":"M Grandinetti, S Salvi, A Olimpieri, S Fruci, E Portinaro, K Corigliano, R Lillo, M C Meucci, F Graziani, A B Delogu, M L Narducci, S De Carolis, G Vento, D Arduini, A Amodeo, A Lanzone, M Massetti","doi":"10.1080/14767058.2025.2470411","DOIUrl":"https://doi.org/10.1080/14767058.2025.2470411","url":null,"abstract":"<p><strong>Purpose: </strong>Pregnancy in women with adult congenital heart disease (ACHD), whether in its natural history or after surgical correction, represents a unique pathophysiological model that requires careful, multidisciplinary management to ensure favorable maternal, fetal and neonatal outcomes. Investigating the impact of congenital cardiac conditions on maternal and feto-neonatal health, the effect of pregnancy-related cardiovascular changes on maternal cardiac health, and the outcomes for offspring born from ACHD mothers is highly relevant, due to the increasing number of ACHD women reaching adulthood and the significant burden these pregnancies can pose. The aim of this article is to provide food for thought to those who have always been involved in ACHD and pregnancy, but also to provide a training tool for young doctors who are approaching at this wonderful world for the first time.</p><p><strong>Materials and methods: </strong>This article was conceived and structured as an \"educational and debate\". In this article we describe our experience in the ACHD outpatient clinic and the High-Risk Pregnancies Division of Fondazione Policlinico A. Gemelli Hospital IRCCS from 2013 and now includes over 100 patients evaluated over a 10-year period.</p><p><strong>Results: </strong>In this article we describe our clinical pathway and the clinical history of our first patient, a 30-year-old woman with univentricular heart (criss-cross heart, double outlet right ventricle and pulmonary stenosis) who underwent a Glenn operation as a child. Our plan included scheduled cardiological and obstetrical follow-ups, as well as planned hospitalizations. An elective C-section was carried out at 38 gestational weeks under spinal anesthesia, with Extracorporeal Membrane Oxygenation and the heart surgery team stand by. It was an uncomplicated delivery. As a result, we developed a specific clinical pathway named \"ACHD Pregnancy Pink Pathway.\"</p><p><strong>Conclusions: </strong>The strength of this idea dwells in the synergy between different experts in deciding for the best decision regarding the required monitoring strictness and the more appropriate obstetric surveillance and delivery plan for the patient. The lesson we learned over the years is that to ensure the best diagnosis and treatment for our young unique patients, we must create a detailed \"ROADMAP\" for them. We propose a pioneering pathway divided into the three essential phases: maternal, obstetrics and fetal-neonatal.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2470411"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587949","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":"Diagnostic significance of combined two-dimensional ultrasound and three-dimensional tomographic ultrasound imaging for cleft palate in fetus of 11-13 + 6 weeks: a prospective study.","authors":"Xiaoliu Shao, Na Li, Lihua Liang, Yingfeng Liu, Juan Yan, Yanyan Peng, Pei Ma","doi":"10.1080/14767058.2025.2463396","DOIUrl":"https://doi.org/10.1080/14767058.2025.2463396","url":null,"abstract":"<p><strong>Purpose: </strong>Clinical screening for cleft palate in fetus currently focuses on weeks 20-24. It has been shown that cleft palate can be detected by ultrasound in first-trimester anatomy scan, but there are no large-scale samples to validate. This study was to confirm the ability of combined two-dimensional(2D)-ultrasound and three-dimensional(3D)-tomographic ultrasound imaging (TUI) to safely detect an fetal cleft palate at 11-13 + 6 weeks <i>via</i> large-scale samples.</p><p><strong>Methods: </strong>A prospective study was designed, involving 6870 pregnant women applying 2D-ultrasound transabdominal sweeps of the fetal face in the median sagittal and coronal views of the retronasal triangle with abnormalities of the palatal line detected, followed by an axial view of the superior alveolar eminence and 3D-TUI evaluation. The endpoints were the results of the fetal facial profile assessment for delivery and induction of labor. The accuracy, sensitivity, and specificity of ultrasound for diagnosing a cleft palate at 11-13 + 6 weeks were analyzed.</p><p><strong>Results: </strong>Among 6870 fetus, a total of 43 different cleft palate types were diagnosed by 2D-ultrasound in three-sections at the 11-13 + 6 weeks, and a total of 6827 cases were diagnosed of negative for cleft palate. Of the 43 cases diagnosed of positive for cleft palate, three cases were false positives compared to endpoint results, with a correct positive predictive value of 93.0%. Of the 6827 cases diagnosed of negative for cleft palate, five cases were false negatives compared to endpoint results, with a correct negative predictive value of 99.0%. The sensitivity and specificity of 2D-ultrasound screening for cleft palate were 84.4%, and 99.9%, respectively. The 43 cases received 3D-TUI scans, and the results showed that 37 cases of cleft palate detected, with a positive predictive value of 86.0%, which was lower than that of 2D ultrasonography (93.0%) (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>It may be feasible and accurate to diagnose cleft palate in fetus at 11-13 + 6 weeks by using combined 2D three sections ultrasound and 3D-TUI scans.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2463396"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484538","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":"Perspective in diagnostic accuracy of prenatal ultrasound and MRI for placenta accreta.","authors":"Qiu-Min Yang, Chu Zhang, Yun-Yun Zhang, Cai-Ning Liu","doi":"10.1080/14767058.2025.2463401","DOIUrl":"https://doi.org/10.1080/14767058.2025.2463401","url":null,"abstract":"<p><strong>Purpose: </strong>Placenta accreta (PA) significantly increases the risk of life-threatening maternal outcomes, and its rising prevalence, driven by the increase in cesarean deliveries, underscores the need for precise diagnostic tools to improve clinical management and outcomes. This study aims to evaluate the advanced diagnostic capabilities of prenatal ultrasound and magnetic resonance imaging (MRI) in the detection of PA, a severe obstetric complication characterized by abnormal adherence of the placenta to the myometrium.</p><p><strong>Materials and methods: </strong>The study utilized a review of current literature and clinical studies to assess the diagnostic accuracy and clinical utility of ultrasound and MRI in identifying PA. Both imaging modalities were evaluated for their ability to assess the depth and extent of placental invasion, as well as their complementary roles in prenatal diagnosis. The experimental system included detailed imaging protocols for ultrasound and MRI, focusing on placental and uterine structures, and their application in real-world clinical settings.</p><p><strong>Results: </strong>The findings demonstrate that ultrasound and MRI are highly effective in diagnosing PA, with each modality offering unique advantages. Ultrasound is widely accessible and serves as the first-line diagnostic tool, providing detailed visualization of placental adherence and vascular patterns. MRI, on the other hand, offers superior soft tissue contrast and is particularly valuable in complex cases or when ultrasound findings are inconclusive. Together, these imaging techniques enable accurate evaluation of placental invasion, facilitating timely and targeted prenatal interventions. The study also highlights the potential for improved maternal and fetal outcomes through early diagnosis and optimized pregnancy management.</p><p><strong>Conclusions: </strong>Prenatal ultrasound and MRI are indispensable tools in the diagnosis and management of placenta accreta, offering complementary insights that enhance diagnostic precision. Their combined use allows for detailed assessment of placental and uterine structures, guiding clinical decision-making and improving outcomes for both mothers and infants. Future advancements in imaging technology and research hold promise for further enhancing diagnostic accuracy and expanding clinical applications, ultimately contributing to safer and more effective care for patients with PA.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2463401"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484566","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":"Subsequent pregnancy outcomes following conservative management for placenta accreta spectrum disorders: an ambispective cohort study.","authors":"Kai Chen, Yulu Bai, Youliang Ma, Junyao Chen, Yan Huang, Fang Yang, Yu Long","doi":"10.1080/14767058.2025.2477782","DOIUrl":"https://doi.org/10.1080/14767058.2025.2477782","url":null,"abstract":"<p><strong>Background: </strong>Placenta accreta spectrum disorders (PAS), a devastating obstetric complication, has increased dramatically in recent decades along with the growing rate of cesarean worldwide. Various conservative management techniques, aimed to avoid hysterectomy and potentially preserve fertility, have been implemented in the management of PAS. However, reports on subsequent pregnancy outcomes following conservative management for PAS are limited.</p><p><strong>Objective: </strong>To systematically evaluate the subsequent pregnancy outcomes in PAS patients undergoing conservative management.</p><p><strong>Methods: </strong>This was a single-center, ambispective cohort study conducted between January 2013 to March 2021. Follow-ups were conducted annually, extending until March 2023. Eligible patients were PAS patients who underwent successful conservative treatment and had intentions for future fertility. Baseline characteristics, conservative management strategies, and subsequent pregnancy outcomes were collected and analyzed. Primary outcome was the subsequent pregnancy outcomes, including interpregnancy interval, conceive method, pregnancy success rate, pregnancy and delivery outcomes, and major maternal morbidities.</p><p><strong>Results: </strong>A total of 40 patients with conservatively managed PAS and attempting subsequent pregnancies were included. These patients were further divided into the subsequent pregnancy group (<i>n</i> = 28) and non-pregnancy group (<i>n</i> = 12). There were no significant differences in term of baseline characteristics, conservative management, and delivery outcome between the two groups(All <i>p</i> < 0.05). The menstrual resumption time was 4.5 (2.25-6.00) months, and the interpregnancy interval was 39.7 ± 26.4 months. In the subsequent pregnancy, 28 patients experienced at least one pregnancy, with a total of 43 subsequent pregnancies. Ultimately, 60% (24/40) of patients successfully delivered but with a PAS recurrence of 33.3% (8/24). Major maternal morbidity included postpartum hemorrhage (PPH) (25%), disseminated intravascular coagulation (12.5%), uterine rupture (4.2%) and hysterectomy (4.2%). Furthermore, the incidence of composite adverse delivery outcomes was 45.8% (11/24). Neonatal outcomes were generally favorable, with a full-term birth rate of 87.5% and live birth rate of 95.8% (23/24).</p><p><strong>Conclusion: </strong>Our findings reveal that while conservative management for PAS does not compromise subsequent fertility, it does pose substantial risks in subsequent pregnancies, including high recurrence rates of PAS, significant PPH, and increased incidence of composite adverse delivery outcomes. Patients should be thoroughly informed of the related risks and subsequent pregnancies necessitate comprehensive preconception counseling, meticulous antenatal care and individualized management strategies to minimize these risks.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2477782"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651649","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":"An integrative approach to identifying <i>NPC1</i> as a susceptibility gene for gestational diabetes mellitus.","authors":"Yuping Shan, Hong Hu, Anning Yang, Wendi Zhao, Yijing Chu","doi":"10.1080/14767058.2024.2445665","DOIUrl":"https://doi.org/10.1080/14767058.2024.2445665","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to identify a novel gene and its potential mechanisms associated with susceptibility to gestational diabetes mellitus (GDM) through an integrative approach.</p><p><strong>Methods: </strong>We analyzed data from genome-wide association studies (GWAS) of GDM in the FinnGen R11 dataset (16,802 GDM cases and 237,816 controls) and Genotype Tissue Expression v8 expression quantitative trait locus data. We used summary-data-based Mendelian randomization to determine associations between transcript levels and phenotypes, transcriptome-wide association studies to provide insights into gene-trait associations, multi-marker analysis of genomic annotation to perform gene-based analysis, genome-wide complex trait analysis-multivariate set-based association test-combo to determine gene prioritization, and polygenic priority scores to prioritize the causal genes to screen candidate genes. Subsequent Mendelian randomization analysis was performed to infer causality between the candidate genes and GDM and phenome-wide association study (PheWAS) analysis was used to explore the associations between selected genes and other characteristics. Furthermore, to gain a deeper understanding of the functional implications of these susceptibility genes, GeneMANIA analysis was used to determine the fundamental biological functions of the therapeutic targets and protein-protein interaction network analysis was performed to identify intracellular protein interactions.</p><p><strong>Results: </strong>We identified two novel susceptibility genes associated with GDM: <i>NPC1</i> and <i>KIAA1191</i>. Magnetic resonance imaging revealed a strong correlation between <i>NPC1</i> expression levels and a lower incidence of GDM (odds ratio: 0.922, 95% confidence interval: 0.866-0.981, <i>p</i> = 0.011). PheWAS at the gene level indicated that <i>NPC1</i> was not associated with any other trait. The biological significance of this gene was evidenced by its strong association with sterol metabolism.</p><p><strong>Conclusion: </strong>Our study identified <i>NPC1</i> as a novel gene whose predicted expression level is linked to a reduced risk of GDM, providing new insights into the genetic framework of this disease.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2445665"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922194","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}