Journal of Maternal-Fetal & Neonatal Medicine最新文献

{"title":"Association between sleep disorders and preeclampsia: a systematic review and meta-analysis.","authors":"Mina Abbasi, Dara Rasoal, Roghieh Kharaghani, Zeinab Khanjari, Zahra Barati, Azadeh Hosseinkhani, Elahe Ahmadnia, Arezoo Haseli","doi":"10.1080/14767058.2024.2419383","DOIUrl":"10.1080/14767058.2024.2419383","url":null,"abstract":"<p><strong>Background: </strong>Sleep disorders are prevalent during pregnancy and are associated with unfavorable outcomes. The meta-analysis evaluated the association between sleep disturbances and preeclampsia.</p><p><strong>Methods: </strong>We systematically searched in English and Persian databases, including Web of Science, Scopus, PubMed, ProQuest, Google Scholar, SID, IRANDOC, and MagIran, for studies published up to September 12, 2024. Eligibility was restricted to observational studies including cohort, case-control, and cross-sectional designs on expectant mothers diagnosed with preeclampsia and sleep disorders. The population studied comprised pregnant mothers with preeclampsia and diagnosed sleep disorders, diagnosed using polysomnography. The common sleep disorders investigated included insomnia, poor sleep quality, breathing problems, sleep apnea, and restless legs syndrome. Two authors independently reviewed and assessed the quality of the studies using the Newcastle-Ottawa Scale. Heterogeneity was evaluated using the I² statistic. Data were analyzed using RevMan 5, presenting results as random effects odds ratios (ORs) and standardized mean differences (SMDs), each with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 25 articles involving 3,992 participants were included in this analysis. Subgroup analysis showed that sleep disturbances significantly increased preeclampsia risk in pregnant women (Qualitative Sleep Disorder Indices OR = 6.79, 95% CI: 3.54-13.71; Quantitative Sleep Disorder Indices SMD = 3.91, 95% CI: 2.11-5.70, <i>p</i> < 0.001). Although high heterogeneity was observed among studies on sleep disorders (I² = 82%, 96%), heterogeneity was low within studies focusing on sleep duration and quality (I² = 0%). The meta-analysis found significantly higher systolic (29.42 mmHg) and diastolic (16.67 mmHg) blood pressure, as well as increased BMI and maternal age, in the preeclampsia group compared to controls (<i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>Sleep disorders, including sleep-disordered breathing, obstructive sleep apnea, insomnia, and poor sleep quality, significantly increase the risk of developing preeclampsia. Prioritizing the diagnosis and treatment of these sleep disorders is crucial for improving pregnancy outcomes.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"37 1","pages":"2419383"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512124","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":"Imaging of the transverse cerebral fissure at three-tesla MR fetal autopsy.","authors":"Luca Caschera, Simone Nava, Valentina Genovese, Francesco Maria Lo Russo, Guido Del Vecchio, Elisa Scola, Silvia Casale, Luciano Lombardi, Giorgio Conte, Fabio Triulzi","doi":"10.1080/14767058.2024.2421289","DOIUrl":"https://doi.org/10.1080/14767058.2024.2421289","url":null,"abstract":"<p><strong>Introduction: </strong>The transverse cerebral fissure of Bichat is a complex anatomic space formed by a median portion (the velum interpositum) and two oblique lateral branches terminating anteriorly at the medial temporal lobes. Its complexity derives from both its embryological development and from its own nature of \"virtual anatomic space\". Previous imaging studies have addressed the issue of its anatomical description by using pneumoencephalography or transcranial ultrasound and magnetic resonance imaging especially in those cases with expansile lesions into its anatomical borders.</p><p><strong>Methods: </strong>We describe the transverse cerebral fissure anatomy in two 20th gestational week fetuses studied with three-tesla MR fetal autopsy with an eye to its embryological development.</p><p><strong>Results: </strong>We were able to define its anatomical borders thanks to the presence of hemosiderin components that spontaneously layered inside its slit-like boundaries as result of postmortem phenomena and that were depica as T2 hypointensity on MR images.</p><p><strong>Conclusions: </strong>This Pictorial essay aims to give a concise and novel description of the transverse cerebral fissure: a deep understanding of the Bichat's fissure embryology and anatomy can help to identify and correctly locate abnormalities arising from this virtual anatomic space in the everyday clinical practice.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"37 1","pages":"2421289"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569836","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 meta-analysis of metformin and insulin on maternal outcome and neonatal outcome in patients with gestational diabetes mellitus.","authors":"Rui Wu, Qingqing Zhang, Zuojing Li","doi":"10.1080/14767058.2023.2295809","DOIUrl":"10.1080/14767058.2023.2295809","url":null,"abstract":"<p><strong>Introduction: </strong>The use of metformin for treating gestational diabetes mellitus (GDM) remains controversial because it can pass through the placenta. This meta-analysis aimed to compare the effects of metformin and insulin on maternal and neonatal outcomes in patients with GDM.</p><p><strong>Methods: </strong>We conducted a comprehensive search of the PubMed, Embase, and Cochrane Library databases, focusing on randomized controlled trials (RCTs) that evaluated the impacts of metformin and insulin on both maternal and neonatal outcomes in patients with GDM.</p><p><strong>Results: </strong>Twenty-four RCTs involving 4934 patients with GDM were included in this meta-analysis. Compared with insulin, metformin demonstrated a significant reduction in the risks of preeclampsia (RR 0.61, 95% CI 0.48 to 0.78, <i>p</i> < .0001), induction of labor (RR 0.90, 95% CI 0.82 to 0.98, <i>p</i> = .02), cesarean delivery (RR 0.91, 95% CI 0.85 to 0.98, <i>p</i> = .01), macrosomia (RR 0.67, 95% CI 0.53 to 0.83, <i>p</i> = .0004), neonatal intensive care unit (NICU) admission (RR 0.75, 95% CI 0.66 to 0.86, <i>p</i> < .0001), neonatal hypoglycemia (RR 0.55, 95% CI 0.48 to 0.63, <i>p</i> < .00001), and large for gestational age (LGA) (RR 0.80, 95% CI 0.68 to 0.94, <i>p</i> = .007). Conversely, metformin showed no significant impact on gestational hypertension (RR 0.84, 95% CI 0.67 to 1.06, <i>p</i> = .15), spontaneous vaginal delivery (RR 1.13, 95% CI 1.00 to 1.08, <i>p</i> = .05), emergency cesarean section (RR 0.94, 95% CI 0.77 to 1.16, <i>p</i> = .58), shoulder dystocia (RR 0.65, 95% CI 0.31 to 1.39, <i>p</i> = .27), premature birth (RR 0. 92, 95% CI 0.61 to 1.39, <i>p</i> = .69), polyhydramnios (RR 1.11, 95% CI 0.54 to 2.30, <i>p</i> = .77), birth trauma (RR 0.87, 95% CI 0.54 to 1.39, <i>p</i> = .56), 5-min Apgar score < 7 (RR 1.13, 95% CI 0.76 to 1.68, <i>p</i> = .55), small for gestational age (SGA) (RR 0.93, 95% CI 0.71 to 1.22, <i>p</i> = .62), respiratory distress syndrome (RDS) (RR 0.74, 95% CI 0.50 to 1.08, <i>p</i> = .11), jaundice (RR 1.09, 95% CI 0.95 to 1.25, <i>p</i> = .24) or birth defects (RR 0.80, 95% CI 0.37 to 1.74, <i>p</i> = .57).</p><p><strong>Conclusions: </strong>The findings suggest that metformin can reduce the risk of certain maternal and neonatal outcomes compared with insulin therapy for GDM. However, long-term follow-up studies of patients with GDM taking metformin and their offspring are warranted to provide further evidence.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"37 1","pages":"2295809"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832675","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":"Outcomes in low-risk patients before and after an institutional policy offering 39-week elective induction of labor.","authors":"Gabriella D Cozzi-Glaser, Christina T Blanchard, Jenna N Stanford, Ayamo G Oben, Victoria C Jauk, Jeff M Szychowski, Akila Subramaniam, Ashley N Battarbee, Brian M Casey, Alan T Tita, Rachel G Sinkey","doi":"10.1080/14767058.2023.2295223","DOIUrl":"10.1080/14767058.2023.2295223","url":null,"abstract":"<p><strong>Objective: </strong>Elective induction of labor versus expectant management at 39 weeks gestation in low-risk nulliparous patients was shown in the ARRIVE randomized trial of over 6000 patients to decrease risks of cesarean delivery without significant change in the composite perinatal outcome. We aimed to pragmatically analyze the effect of offering elective induction of labor (eIOL) to all low-risk patients.</p><p><strong>Methods: </strong>Retrospective cohort study of low-risk nulliparous and multiparous patients delivering live, non-anomalous singletons at a single center at greater than or equal to 39 0/7 weeks gestational age. Those with prior or planned cesarean delivery, ruptured membranes, medical comorbidities, or contraindications to vaginal delivery were excluded. Patients were categorized as before (pre-eIOL; 1/2012-3/2014) or after (post-eIOL; 3/2019-12/2021) an institution-wide policy offering eIOL at 39 0/7 weeks. Births occurring April 2014 to December 2018 were allocated to a separate cohort (during-eIOL) given increased exposure to eIOL as our center recruited participants for the ARRIVE trial. The primary outcome was cesarean birth. Secondary outcomes included select maternal (e.g. chorioamnionitis, operative delivery, postpartum hemorrhage) and neonatal morbidities (e.g. birthweight, small- and large-for gestational age, hypoglycemia). Characteristics and outcomes were compared between the pre and during-eIOL, and pre and post-eIOL groups; adjusted OR (95% CI) were calculated using multivariable regression. Subgroup analysis by parity was planned.</p><p><strong>Results: </strong>Of 10,758 patients analyzed, 2521 (23.4%) were pre-eIOL, 5410 (50.3%) during-eIOL, and 2827 (26.3%) post-eIOL. Groups differed with respect to labor type, age, race/ethnicity, marital and payor status, and gestational age at care entry. Post-eIOL was associated with lower odds of cesarean compared to pre-eIOL (aOR 0.83 [95% CI 0.72-0.96]), which was even lower among those specifically undergoing labor induction (aOR 0.58 [0.48-0.70]. During-eIOL was also associated with lower odds of cesarean compared to pre-eIOL (aOR 0.79 [0.69-0.90]). Both during and post-eIOL groups were associated with higher odds of chorioamnionitis, operative delivery, and hemorrhage compared to pre-eIOL. However, only among post-eIOL were there fewer neonates weighing ≥4000 g, large-for-gestational age infants, and neonatal hypoglycemia compared to pre-IOL.</p><p><strong>Conclusion: </strong>An institutional policy offering eIOL at 39 0/7 to low-risk patients was associated with a lower cesarean birth rate, lower birthweights and lower neonatal hypoglycemia, and an increased risk of chorioamnionitis and hemorrhage.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"37 1","pages":"2295223"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10958525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarification on the distinction between congenital vertical talus and oblique talus diagnosis in the intrauterine period.","authors":"Ümran Kılınçdemir Turgut, Necmettin Turgut","doi":"10.1080/14767058.2024.2304280","DOIUrl":"10.1080/14767058.2024.2304280","url":null,"abstract":"","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"37 1","pages":"2304280"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139492573","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":"Adolescent pregnancy - medical, legal and social issues.","authors":"Joanna Pietras, Grażyna Jarząbek-Bielecka, Małgorzata Mizgier, Anna Markowska","doi":"10.1080/14767058.2024.2391490","DOIUrl":"https://doi.org/10.1080/14767058.2024.2391490","url":null,"abstract":"<p><strong>The purpose of the article: </strong>The article aims to indicate the interdisciplinary and complex nature of the problem of adolescent pregnancy.</p><p><strong>Materials and methods: </strong>An analysis of materials contained in the literature on adolescent pregnancy was used.</p><p><strong>Results: </strong>Adolescent pregnancy is both a serious health and social challenge. Lack of proper sex education, regressive age of sexual initiation, emotional immaturity and limited access to contraception are the main reasons for teenage pregnancy. It can also be the result of sexual abuse, which is a punishable offense. Pregnancy in minors is associated with a higher risk of complications for both the mother and the fetus, such as hypertension, preterm birth, low birth weight, fetal growth restriction, and preeclampsia. Pregnancy is a significant psychological burden and a major trauma for girls. Low socioeconomic status and lack of support from the family or partner exacerbate this problem, increasing the risk of depression and substance abuse. As a multidisciplinary problem, it requires action on multiple fronts to prevent it and to reduce the number of adolescent pregnancies. Increasing access to contraception, medical care, and sexual education is crucial in combating this issue. Adolescent pregnant women are a group of women who require special antenatal care. When planning educational activities for these patients, one should remember about the specific needs of said girls related to key nutrients such as iodine, iron, folic acid, and calcium. A poor diet may result from difficult living conditions and conflicts with family and partners. Moreover, this pregnancy is often unplanned.</p><p><strong>Conclusions: </strong>A good solution for pregnant adolescents would be the possibility of specialized assistance not only in gynecology and obstetrics, sexology, but also pedagogical, psychological, sociological and dietary.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"37 1","pages":"2391490"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057162","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":"Performance of five cardiotocography classification templates in labor: a cohort study.","authors":"Denise Kling, Mimmi Rehnström, Andreas Herbst","doi":"10.1080/14767058.2024.2394845","DOIUrl":"https://doi.org/10.1080/14767058.2024.2394845","url":null,"abstract":"<p><strong>Objective: </strong>New guidelines for the interpretation of cardiotocography (CTG) have been presented by FIGO in 2015 (FIGO-15) and by NICE in 2017 (NICE-17) and 2022 (NICE-22) In Sweden, a previous template from 2009 (SWE-09) was replaced in 2017 (SWE-17).The objective of the study was to compare these five different templates for CTG classification regarding sensitivity, specificity, positive and negative predictive values in identifying neonates with acidemia at birth (cord artery pH <7.10).</p><p><strong>Methods: </strong>This is a historical cohort study including singleton births in Lund November 2015-February 2016, after spontaneous or induced labor at ≥34 completed gestational weeks with validated umbilical cord acid-base samples.Characteristics of cardiotocographic traces during the last hour before birth were reviewed by two independent assessors blinded to outcome. Each template was then used to classify the CTG as normal, suspicious, or pathological. Traces for which classification differed between the two assessors for any of the templates were assessed by a third assessor. The classification by majority (at least 2 of 3) was used for analyses.Main outcome measures were the sensitivity, specificity, and positive and negative predictive values for each template to identify neonates with cord artery pH <7.10 by the classification pathological. In a secondary analysis, these outcome measures were calculated for the classifications suspicious + pathological together.</p><p><strong>Results: </strong>SWE-09 and NICE-22 had significantly higher sensitivity (both 92%; 95% CI 79-98%) than NICE-17 (68%; 51-82%), FIGO-15 (42%; 26-59%) and SWE-17 (39%; 24-57%) to identify neonates with acidemia by the classification pathological. Specificity was significantly higher for SWE-17 (91%; 88-93%), FIGO-15 (90%; 88-93%) and NICE-17 (78%; 74-81%) than for NICE-22 (63%; 59-67%) and SWE-09 (62%; 58-66%). The positive predictive value of a pathological pattern ranged between 15% (SWE-09 and NICE-22) and 24% (FIGO-15), and negative predictive values between 95% (SWE-17) and 99% (SWE-09 and NICE-22). Combining suspicious and pathological patterns increased the sensitivity and decreased the specificity for all templates.</p><p><strong>Conclusions: </strong>Current CTG interpretation templates either have low sensitivity to identify fetal acidemia or low specificity. Among current guidelines, NICE 2022 had the highest sensitivity to identify neonates with acidemia and is considered the safest current classification system. Efforts to further improve diagnostic precision are warranted.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"37 1","pages":"2394845"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094125","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":"The value of fetal left ventricular global longitudinal strain in predicting neonatal complications in pregnant women with hypertensive disorders.","authors":"Guodong Wu, Daoling Yang, Yingying Yu, Xiaoying Tao","doi":"10.1080/14767058.2024.2404985","DOIUrl":"https://doi.org/10.1080/14767058.2024.2404985","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy-induced hypertension remains one of the important types of diseases that affect maternal and infant outcomes; prenatal and perinatal ultrasound examination is an important tool for evaluating fetal development. So, this study aimed to explore the clinical value of applying fetal heart quantification (fetal HQ) measuring left ventricular global longitudinal strain (LVGLS) and left ventricular ejection fraction (LVEF) in mid-to-late fetuses to predict neonatal complications in patients with gestational hypertension.</p><p><strong>Methods: </strong>A retrospective summary of 146 pregnant women with gestational hypertension diagnosed from August 2020 to October 2023 into JinHua Maternal and Child Health Care Hospital was performed. Fetal HQ measured the fetal global spherical index (GSI), left and right ventricular spherical index (SI), left and right ventricular fractional shortening (FS), LVGLS and RVGLS, LVEF, and fractional area change (FAC) of the left and right ventricles. They were divided into complication group and non-complication group based on whether fetal complications occurred 28 days after birth. Multivariate logistic regression was used to screen risk factors to neonatal complications.</p><p><strong>Results: </strong>The 146 neonates were divided into 39 of the complication group and 107 of the non-complication group. Compared with the latter group, pregnant women in the former group had a higher incidence of preeclampsia and eclampsia, increased mean systolic and diastolic blood pressure, significantly lower estimated fetal weight (EFW), left ventricular 24-segment SI, LVGLS, LVEF, and left ventricular FAC values (<i>p</i> < .05). Logistic regression showed higher of LVGLS (adjusted OR = 2.281, <i>p</i> < .001) was risk factors for neonatal complications, while higher LVEF (adjusted OR = 0.600, <i>p</i> < .001) and left ventricular FAC (adjusted OR = 0.784, <i>p</i> = .035) were protective factors. Spearman's correlation analysis showed a significant negative correlation between LVGLS and LVEF (<i>r</i> = -0.368, <i>p</i> < .001). Receiver operating curves (ROCs) showed the area under the curve (AUC) for predicting overall neonatal complications was 0.880 for LVGLS and 0.878 for LVEF (<i>p</i> < .001).</p><p><strong>Conclusions: </strong>Fetal HQ for fetal LVGLS and LVEF in mid-to-late pregnancy with gestational hypertension helps to assess the overall neonatal complications risk.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"37 1","pages":"2404985"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299824","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":"Effect of intravenous esketamine in emergency cesarean deliveries: a retrospective analysis of maternal and neonatal outcomes.","authors":"Xiao-Mei Huang, Hong-Xia Qiu","doi":"10.1080/14767058.2024.2413855","DOIUrl":"https://doi.org/10.1080/14767058.2024.2413855","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the effects of administering intravenous esketamine at a dose of 0.25 mg/kg to pregnant patients receiving epidural anesthesia for emergency cesarean section on both maternal and neonatal outcomes.</p><p><strong>Methods: </strong>Medical records of pregnant patients transitioning from labor analgesia to epidural anesthesia for emergency cesarean sections between January 2020 and December 2022 were analyzed. The patients were categorized based on whether they received esketamine infusions during the incision-to-delivery interval. The variables compared between the groups included hemodynamic parameters, perioperative and postoperative adverse reactions, and neonatal outcomes (gender, weight, Apgar scores at 1 and 5 min, need for neonatal intensive care, and umbilical artery/vein blood gas analysis).</p><p><strong>Results: </strong>For maternal outcomes, the systolic blood pressure (SBP) in the esketamine group showed a significant increase at 5 and 10 min' post-administration, and the diastolic blood pressure (DBP) significantly increased at 5 min, compared to the control group (<i>p</i> < 0.01). No significant differences were observed in heart rate (HR) and oxygen saturation (SpO₂) at any time point (<i>p</i> > 0.05). The esketamine group experienced a significant rise in the incidence of arrhythmias, dizziness, and nystagmus during the perioperative period, a notable decrease in hypotension incidence, and an increase in postoperative nausea and dizziness. Regarding neonatal outcomes, there were no significant differences in gender, weight, Apgar scores ≤7 at 1 and 5 min, and the need for neonatal intensive care. However, the pH level in the umbilical artery blood of the esketamine group was significantly higher. The levels of PCO₂ and PO₂ in umbilical artery and venous blood did not show significant differences between the groups.</p><p><strong>Conclusions: </strong>In pregnant women undergoing emergency cesarean section, intravenous administration of 0.25 mg/kg esketamine is correlated with favorable maternal and neonatal outcomes.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"37 1","pages":"2413855"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479415","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 epidural analgesia on intrapartum maternal fever and maternal outcomes: an updated systematic review and meta-analysis.","authors":"Rui Lu, Lijuan Rong, Li Ye, Ying Xu, Hao Wu","doi":"10.1080/14767058.2024.2357168","DOIUrl":"https://doi.org/10.1080/14767058.2024.2357168","url":null,"abstract":"<p><strong>Objective: </strong>Epidural-related maternal fever in women is a common clinical phenomenon that leads to adverse consequences for mothers and neonates. The meta-analysis aimed to quantify the risk for intrapartum maternal fever after epidural analgesia (EA) stratified according to parity. The secondary objective was to investigate the association between EA and maternal outcomes.</p><p><strong>Methods: </strong>An electronic literature search of the Medline/PubMed, Embase, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure databases was performed to identify studies reporting the occurrence of intrapartum fever in parturients. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and meta-analysis was performed using Review Manager version 5.3.</p><p><strong>Results: </strong>Seventeen randomized controlled trials (RCTs) (5959 parturients) were included. Odds ratios for maternal fever in the analysis were 4.17 (95% confidence interval (CI) 2.93-5.94) and 5.83 (95% CI 4.96-6.87), respectively. Results of subgroup analysis according to parity were consistent. EA significantly prolonged the length of the first stage of labor (MD 34.52 [95% CI 12.13-56.91]) and the second stage of labor (MD 9.10 [95% CI 4.51-13.68]). Parturients who received EA were more likely to undergo instrumental delivery (OR 2.03 [95% CI 1.44-2.86]) and oxytocin augmentation (OR 1.45 [95% CI 1.12-1.88]). There were no differences in cesarean delivery rates between the EA and non-EA groups.</p><p><strong>Conclusions: </strong>Parturients who received EA exhibited a higher incidence of intrapartum fever. Credibility of the subgroup analyses was low because the mixed group did not effectively represent multiparas.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"37 1","pages":"2357168"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175567","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}