Journal of Maternal-Fetal & Neonatal Medicine最新文献

{"title":"Maternal and neonatal outcomes in pregnant women undergoing cardiac surgery: a systematic review and meta-analysis.","authors":"Chaoyou Zhou, Yinjian Zhou, Zhuangzhuang Xu, Lina Mei, Yan Jin","doi":"10.1080/14767058.2025.2451675","DOIUrl":"https://doi.org/10.1080/14767058.2025.2451675","url":null,"abstract":"<p><strong>Objective: </strong>Cardiac diseases that require surgical intervention present a unique challenge during pregnancy and may affect both maternal and neonatal outcomes. This systematic review and meta-analysis aimed to evaluate maternal and neonatal outcomes in pregnant females undergoing cardiac surgery.</p><p><strong>Methods: </strong>A comprehensive manual and electronic search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Sciences databases for studies published up to 31^st May 2024. Eligible studies were required to report maternal and neonatal outcomes of women who underwent cardiac surgery during pregnancy. Random-effects meta-analysis was conducted to estimate pooled maternal and neonatal mortality proportions, and the results were presented as risk ratios (RR) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Seventeen studies met the inclusion criteria, comprising a total sample size of 196 pregnant women who underwent cardiac surgery. Cardiac surgery during pregnancy was significantly (<i>p</i> < 0.001) linked to increased maternal and neonatal mortality, with pooled RR of 4.9% (CI: 2.1%-7.6%) and 26.5% (CI: 19.7%-33.4%), respectively.</p><p><strong>Conclusion: </strong>This study highlights the significant risks associated with cardiac surgery during pregnancy, such as increased risk of maternal and neonatal mortality and higher incidence of preterm labor. Our findings underscore the importance of specialized care and multidisciplinary management for pregnant women with cardiac conditions. Further research is warranted to identify strategies for risk mitigation and improved outcomes in this vulnerable population.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2451675"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030257","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":"Trend, clinical characteristics, and pregnancy outcomes of pregnancy associated venous thromboembolism: a retrospective analysis of nearly 10 years.","authors":"Xiaomei Wang, Shouzhen Chen, Haihua Xu, Rong Zhang, Tenghui Zhan","doi":"10.1080/14767058.2024.2448504","DOIUrl":"https://doi.org/10.1080/14767058.2024.2448504","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy-associated venous thromboembolism (PA-VTE) seriously threatens maternal health. We aimed to investigate the clinical characteristics, risk factors, treatments, and pregnancy outcomes to better prevent and treat PA-VTE.</p><p><strong>Methods: </strong>PA-VTE patients were selected from 171,898 women who were registered in the Department of Obstetrics of Fujian Maternity and Child Health Hospital from January 2014 to August 2023 and delivered to calculate the incidence. Clinical data were collected to retrospectively analyze the clinical characteristics, risk factors, treatments, and pregnancy outcomes of PA-VTE. Descriptive statistical analysis was used.</p><p><strong>Results: </strong>There were 122 cases of PA-VTE with an incidence of 0.71 per 1000 pregnancies; the incidence showed an upward trend and peaked in 2022 (1.24‰). Pregnant women accounted for 28.69% (35/122), the onset were 5-39⁺⁶ weeks and incidence increased with the increase of trimester, reaching the highest level in puerperium with 87 cases (71.31%). VTE was mainly found in the lower extremities (112/122); a few were found in cranial venous sinus (4/122), pelvic vein (1/122), and pulmonary embolism (PE) in five cases. 78.68% (96/122) had clinical manifestations. By Royal College of Obstetricians and Gynaecologists (RCOG) risk assessment scale, 45.71% (16/35) of antepartum patients had risk score ≥3 with a maximum of 9, distributed in eight cases in the first trimester, four cases in the second trimester, and four cases in the third trimester. Patients with risk score <3 all occurred in the second and third trimester. Primary risk factors included advanced maternal age (AMA), thrombophilia. All patients received anticoagulant therapy, and seven patients were placed inferior vena cava (IVC) filter in antepartum period. Except one case of abortion in PPROM, the rest continued pregnancy to 29⁺¹ to 40 weeks, only one case of postpartum hemorrhage and one case of severe neonatal asphyxia. The onset time in puerperium was three hours to 28 days after delivery; 62.07% (54/87) patients were scored ≥2. The main risk factors included elective cesarean section, AMA, and preterm birth. Anticoagulant therapy was given after diagnosis; two cases were placed with IVC filter, one case was placed with left iliac vein stent and thrombolysis.</p><p><strong>Conclusions: </strong>The incidence of PA-VTE showed an increasing trend over the past decade, predominantly occurring postpartum. Main risk factors included AMA, thrombophilia, preterm birth, and elective cesarean section. Higher risk scores correlated with earlier onset. Early risk assessment, appropriate prophylaxis, and standardized anticoagulation therapy resulted in favorable maternal and fetal outcomes, with temporary IVC filter placement being beneficial in selected cases.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2448504"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985348","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":"Some comments on \"Maternal hemoglobin A1c and left ventricular hypertrophy in infants of mothers with pregestational diabetes\".","authors":"Jeong Sook Kim, Soo-Jeong Lee","doi":"10.1080/14767058.2024.2434060","DOIUrl":"https://doi.org/10.1080/14767058.2024.2434060","url":null,"abstract":"","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2434060"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774343","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":"Second trimester cervical length screening, in a low-risk European population.","authors":"Francesca Ferrari, Beatrice Melis, Laura Basile, Enrica Perrone, Giuseppe Chiossi, Nicola Volpe, Carla Verrotti, Fabio Facchinetti","doi":"10.1080/14767058.2024.2436099","DOIUrl":"10.1080/14767058.2024.2436099","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this work is to assess cervical length (CL) distribution in a low-risk population in order to evaluate the applicability of a possible universal CL screening in the second trimester, aimed at preventing preterm birth (PTB).</p><p><strong>Methods: </strong>In a multicentric, prospective cohort study, singleton pregnant women attending second trimester anatomy scan between 18 + 0 to 22 + 6 weeks of gestation were eligible. Teenage pregnancy and women with previous PTB were excluded. The recruitment occurred from February 2020 to December 2022. TVU CL was measured by expert sonographers, in 12 National Health Service (NHS) care clinics of Modena and Parma districts (Emilia-Romagna Region, Italy). Internal quality check of images was performed. Personal and obstetric history, as well as gestational age were collected. Primary outcomes were to define CL curves and the incidence of CL ≤25 mm in low-risk pregnant women Secondary outcomes were the incidences of PTB <37, <34, and <32 weeks.</p><p><strong>Results: </strong>Among 3226 screened women, mean and median CL were 40.8 and 40 mm, respectively. The 10th centile was equal to 33 mm while 25 mm represented the 2nd centile of the distribution. The incidence of CL ≤25 mm (short cervix) was 1.25%. Among those women, 7.5% were shorter than 150 cm, opposed to 2.1% in the normal CL group (<i>p</i> = .02); in addition there were more nullipara, women ≥ 40 and smokers (<i>p</i> = .03). Women with short cervix were at higher risk of PTB (23.6 vs 4.3%; RR: 4.6, 95%CI 2.49-8.48). At multivariate analysis, both CL ≤ 25 mm (RR: 5.51, 95%CI: 2.45-12.3) and stature ≤150 cm (RR: 2.54, 95%CI: 1.11-5.79) resulted independent predictors for PTB, once adjusted for other risk factors (fibroids, cervical surgery, obesity, low education, older age, smoking habit).</p><p><strong>Conclusion: </strong>Although our study confirmed that women with short cervix are more likely to deliver preterm, the low incidence of such risk factor means that most of the preterm births occurred among women with normal cervical length. Thus, in a low-risk Italian population, ineffectiveness of universal screening is forecast.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2436099"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848126","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":"Unveiling the potential role of the shock index in maternal sepsis: reality or fantasy?","authors":"María Fernanda Escobar, Isabella Ramos, Ketty Marta Guerra, Natalia Soto Franco, Juan Sebastián Galindo-Sánchez, Laura Libreros-Peña, Evelyn E Peña-Zárate, Lizbeth A Guevara-Calderón, Hernán Gómez-Moreno, María Paula Echavarría","doi":"10.1080/14767058.2025.2453999","DOIUrl":"https://doi.org/10.1080/14767058.2025.2453999","url":null,"abstract":"<p><strong>Objective: </strong>Maternal sepsis continues to be a maternal health problem associated with 75,000 deaths per year worldwide, representing a greater burden in low- and middle-income countries (LMICs). Although the Shock Index (SI) has been widely studied in postpartum hemorrhage and in non-obstetric populations, it has not yet been widely studied in sepsis. We aimed to identify the relationship between Shock Index and suspected sepsis in pregnant and postpartum patients to explore the use of Shock index in the context of maternal sepsis and its relationship with sepsis-related outcomes.</p><p><strong>Methods: </strong>A single-center, retrospective, case-control study was conducted, including pregnant and postpartum patients attended between June 2015 and December 2020 in a high-complexity university hospital. This study was conducted in a High Obstetric Complexity Unit (UACO) in the southwest region of Colombia. Pregnant or postpartum women with infectious processes of obstetric or non-obstetric origins were included. Cases had sepsis diagnosis; controls showed infection process and systemic inflammatory response signs without confirmed sepsis. Those with unconfirmed infections and preterm conditions were excluded. A logistic regression model was conducted to examine the association between maternal factors and sepsis diagnosis, and significant variables were determined through univariate analysis and included in a multivariate model.</p><p><strong>Results: </strong>A total of 640 patients were included (343 cases and 297 controls), sepsis was significantly associated with a higher shock index at admission SI ≥ 0.9 (85.4% vs 75%, <i>p</i> = 0.001). No correlation was found between the Shock Index and C-reactive protein (CRP), leukocyte count, or ICU length of stay. The area under the receiver operating characteristic curve (AUROC) analysis identified a Shock Index of 1 as the optimal cutoff point, while the cutoff point of 0.9 demonstrated the highest sensitivity (85%). An SI ≥ 0.9 increased the risk of sepsis 1.94 times (95% CI 1.31-2.91, <i>p</i> = 0.001) and remained significant in the adjustment model (OR_adj 2.18, 95% CI 1.42-3,32, <i>p</i> < 0.001). Incidence of maternal sepsis, incidence of maternal complications, and perinatal outcomes were measured with a SI ≥ 0.9.</p><p><strong>Conclusion: </strong>Our findings underscore the importance of using the Shock Index with a cutoff point of 0.9 as a predictive tool for sepsis in pregnant patients, emphasizing the need for timely intervention and continuous monitoring of patients.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2453999"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030271","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":"Relationship between ApoA-1, ApoB/ApoA-1 ratio, and preterm birth in patients with gestational diabetes mellitus in the third trimester.","authors":"Min Xiao, Ying-Ying Chen, Juan Yu","doi":"10.1080/14767058.2025.2458596","DOIUrl":"https://doi.org/10.1080/14767058.2025.2458596","url":null,"abstract":"<p><strong>Objective: </strong>The research on Apolipoprotein A-1 (ApoA-1), Apolipoprotein B/Apolipoprotein A-1 (ApoB/ApoA-1) ratio, and preterm birth was limited to the first and second trimesters. No studies have been conducted in the third trimester, and thus this study aimed to investigate the association between ApoA-1, ApoB/ApoA-1 ratio, and preterm birth in patients with gestational diabetes mellitus (GDM) in the third trimester.</p><p><strong>Methods: </strong>This study collected the data of single pregnant women of age at pregnancy 16-49 years with GDM who were in the third trimester and gave birth in the Obstetrics department, Hangzhou Linping District Women & Children Hospital from December 1, 2023, to April 20, 2024. The patients were divided into preterm birth group and term birth group according to whether they had preterm birth or not. The restricted cubic spline analysis was used to explore whether there was a linear relationship between ApoA-1, ApoB/ApoA-1 ratio, and preterm birth. The relationship between ApoA-1, ApoB/ApoA-1 ratio, and preterm birth in patients with GDM was explored using trend analysis. The receiver operating characteristic and Decision Curve Analysis were conducted to evaluate the predictive efficacy and clinical benefits of ApoA-1, ApoB/ApoA-1 ratio in predicting preterm birth in patients with GDM.</p><p><strong>Results: </strong>There was a linear relationship between ApoA-1, ApoB/ApoA-1 ratio, and preterm birth. The higher the ApoA-1 level, the lower the risk of preterm birth; the higher the ApoB/ApoA-1 ratio, the higher the risk of preterm birth.</p><p><strong>Conclusion: </strong>ApoA-1, ApoB/ApoA-1 ratio in pregnant women with GDM in the third trimester were associated with preterm birth.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2458596"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081902","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 prospective observational multicenter cohort study of maternal serum sFlt-1 and PlGF concentration in prediction of adverse neonatal outcomes in small for gestational age newborns delivered ≥34 weeks of gestation.","authors":"Katarzyna Kosińska-Kaczyńska, Katarzyna Chaberek, Natalia Szymecka-Samaha, Agnieszka Czapska, Kinga Żebrowska, Norbert Dera, Jan Modzelewski, Jakub Góra, Kacper Borawski, Weronika Włoch, Anna Scholz, Robert Brawura- Biskupski-Samaha","doi":"10.1080/14767058.2025.2456983","DOIUrl":"https://doi.org/10.1080/14767058.2025.2456983","url":null,"abstract":"<p><strong>Introduction: </strong>Small-for-gestational age (SGA) newborns are at increased risk of adverse neonatal outcomes and the risk is related to the etiology of growth restriction: highest in placental insufficiency, lowest in constitutional SGA. The aim of this study was to investigate if placental growth factor (PlGF), soluble fms-like tyrosine kinase-1(sFlt-1) or sFlt-1/PlGF ratio are efficient in prediction of adverse neonatal outcomes in SGA newborns delivered ≥34 weeks of gestation.</p><p><strong>Methods: </strong>A prospective observational multicenter cohort study was performed. Women in singleton gestation had serum PlGF, sFlt-1 and sFlt-1/PlGF ratio measured at the time of SGA diagnosis and included if they delivered ≥34 weeks. The primary outcome was adverse neonatal outcome, diagnosed in case of any of the following: Neonatal Intensive Care Unit hospitalization, mechanical ventilation, continuous positive airway pressure, sepsis, necrotizing enterocolitis, intraventricular hemorrhage grade III or IV and neonatal death before discharge. The Mann-Whitney test and the Fisher's exact test were used for the statistical analysis. Cutoff points for adverse outcome prediction were calculated based on ROC curves. Multivariate logistic regression analysis was performed to adjust for confounding factors.</p><p><strong>Results: </strong>A total of 102 women were included in the study. Serum PlGF concentration of 137 pg/mL had a sensitivity of 75% (95% CI 58.8 - 87.3), specificity of 56.45% (95% CI 43.3 - 69.0), positive likelihood ratio of 1.72 (95% CI 1.23 - 2.41) and negative likelihood ratio of 0.44 (95% CI 0.25 - 0.79) in prediction of adverse outcomes. Serum sFlt-1 level of 2018 pg/mL had a sensitivity of 82.05% (95% CI 66.5 - 92.5), specificity of 50% (95% CI 37.0 - 63.0), positive likelihood ratio of 1.64 (95% CI 1.23 - 2.19) and negative likelihood ratio of 0.36 (95% CI 0.18 - 0.73), while sFlt-1/PlGF ratio of 18.9 had a sensitivity of 79.92% (95% CI 60.7 - 88.9), specificity of 56.45% (95% CI 43.3 - 69.0), positive likelihood ratio of 1.77 (95% CI 1.27 - 2.46) and negative likelihood ratio of 0.41 (95% CI 0.22 - 0.75) in prediction of adverse outcomes. In logistic regression analysis only birth weight was an independent risk factors for adverse outcome.</p><p><strong>Conclusion: </strong>In pregnancies with SGA, fetuses measurements of maternal serum sFlt-1 or PlGF provide poor prediction of adverse neonatal outcomes.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2456983"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068711","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":"Letter to editor with regard to the article \"levels of agreement between clinical examination and transabdominal ultrasound evaluation of fetal head position in the second stage of labor\".","authors":"Alev Esercan","doi":"10.1080/14767058.2024.2434056","DOIUrl":"https://doi.org/10.1080/14767058.2024.2434056","url":null,"abstract":"","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2434056"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899715","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":"Association of serum N,N,N-trimethyl-5-aminovaleric acid, trimethylamine N-oxide, and trimethyllysine levels with gestational diabetes mellitus.","authors":"Pei Cai, Yi Zheng, Lulu Chen, Qing Fang, Yingjuan Lei, Zhihua She","doi":"10.1080/14767058.2025.2467999","DOIUrl":"https://doi.org/10.1080/14767058.2025.2467999","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association of serum N,N,N-trimethyl-5-aminovaleric acid (TMAVA), trimethylamine N-oxide (TMAO), and trimethyllysine (TML) levels with gestational diabetes mellitus (GDM).</p><p><strong>Methods: </strong>Seventy pregnant women from the Hunan Provincial Maternal and Child Health Care Hospital (March 2021 to October 2023) were enrolled in this study. Forty GDM patients with GDM were included in the GDM group (GDM), and 30 healthy controls were included (Con). Participants were further categorized into adverse and good outcome groups based on pregnancy outcomes. Serum TMAVA, TMAO, and TML levels were quantified using ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Correlations between biomarker levels and clinical indicators were assessed using Pearson and Spearman analyses. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate risk factors and predictive value.</p><p><strong>Results: </strong>Serum TMAVA, TMAO, and TML levels were significantly higher in the GDM group. TMAVA levels were positively correlated with fasting plasma glucose (FPG), fasting insulin (FINS), creatinine (Cr), TMAO, and TML. TMAO and TML positively correlated with FPG, 2-h postprandial glucose (2h PG), FINS, Cr, and uric acid (UA) levels, while TMAO negatively correlated with triglyceride (TG). Combined TMAVA, TMAO, and TML predicted GDM with an area under the curve (AUC) of 0.940 (95% CI: 0.883-0.997). Elevated TMAVA levels were associated with adverse pregnancy outcomes in GDM, with an AUC of 0.757 (95% CI: 0.612-0.902).</p><p><strong>Conclusions: </strong>Elevated serum levels of TMAVA, TMAO, and TML were significantly associated with the occurrence of GDM and adverse pregnancy outcomes. The combined detection of these three biomarkers demonstrated superior accuracy in predicting GDM. Among them, TMAVA demonstrated the highest predictive efficiency for adverse pregnancy outcomes in women with GDM. These findings provide new biomarkers for early screening and risk assessment of GDM, offering promising applications in clinical practice.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2467999"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460398","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":"Factors contributing to clinical misdiagnosis of fetal head position: an ultrasound based cohort study from Tanzania.","authors":"Kenneth Bagandanshwa, Bariki Mchome, Upendo Kibona, Ibrahim Salum, Glory Mangi, Gileard Masenga, Adelaida Kavishe, Cecilia Mushi, Signe Egenberg, Torbjørn Moe Eggebø","doi":"10.1080/14767058.2025.2480186","DOIUrl":"https://doi.org/10.1080/14767058.2025.2480186","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Accurate determination of fetal head position is essential for managing labor, particularly in cases of slow progress or before operative vaginal interventions. Several studies have shown that ultrasound examinations are more accurate than clinical examinations, but few ultrasound studies are done in sub-Saharan Africa. Clinical vaginal assessment of fetal position remains the standard in most African settings, but its accuracy is limited by examiner skills and labor conditions. This study aimed to compare clinical and ultrasound assessments of fetal position during active labor, to identify factors contributing to clinical misdiagnosis, and to evaluate the impact of misdiagnosis on delivery mode.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methodology: &lt;/strong&gt;An observational cohort study was conducted at Kilimanjaro Christian Medical Centre in Moshi, Tanzania, from 19&lt;sup&gt;th&lt;/sup&gt; November 2023 to 13&lt;sup&gt;th&lt;/sup&gt; April 2024. Fetal position was categorized as a clock; 10 to 2 o'clock as occiput anterior (OA) position, 3 o'clock as left occiput transverse (LOT) position, 4 to 8 o'clock as occiput posterior (OP) position, and 9 o'clock as right occiput transverse (ROT) position. Three trained doctors conducted ultrasound examinations, while midwives performed clinical assessments recording position, station, cervical dilatation, caput succedaneum, and molding. Fetal station ranged from -5 to +5. Caput succedaneum was first graded as 0, +1, +2, or +3 and recategorized as none (0), slight (grade +1), and huge (grade +2 and +3). Molding was categorized as absent or present. Clinical misdiagnosis of position was defined as any discrepancy between clinical and ultrasound assessments using ultrasound examinations as the gold standard. Misdiagnosis included cases where the fetal head position could not be determined clinically, as well as those that were incorrectly assessed through vaginal examination. Blinded comparisons evaluated agreement and clinical misdiagnosis. Factors contributing to clinical misdiagnosis were assessed using logistic regression and potential confounders included maternal age, gestational age, body mass index (BMI), station during the second stage, caput succedaneum, and molding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The final study population comprised 215 women, 204 were examined in the active first labor stage and 210 in the second stage. Fetal position could not be determined clinically in 40/204 (19.6%) women in the active first stage, but ultrasound successfully determined position in all cases. The overall agreement rate in the active first stage was 101/164 (61.6%), with 60/76 (78.9%) agreement in OA position and 41/88 (46.6%) agreement in non-OA positions. Agreement in classifying position into four categories (OA, LOT, OP, and ROT) was moderate (Cohen's kappa, &lt;i&gt;k&lt;/i&gt; = 0.41, 95% CI 0.31-0.52). In the second stage, clinical assessment failed in 11/210 (5.2%) cases, while ultrasound failed in 5/210 (2.4%). The overall agr","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2480186"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671514","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}