Journal of Maternal-Fetal & Neonatal Medicine最新文献

{"title":"Maternal and neonatal outcomes with different screening strategies for gestational diabetes mellitus: a retrospective cohort study.","authors":"Shirley J Shao, Lucy J Fu, Llyke Ching, Katelin P Kramer, Nasim C Sobhani","doi":"10.1080/14767058.2025.2467996","DOIUrl":"10.1080/14767058.2025.2467996","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of an expanded gestational diabetes mellitus (GDM) screening strategy on perinatal outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included gravidas screened for GDM at a single academic center. The \"before\" cohort (estimated due dates (EDD) March 2018-April 2019) was screened using the standard 2-step method. The \"after\" cohort (EDD November 2019-July 2023) was screened using an expanded strategy that included the potential for GDM diagnosis based on 1-2 weeks of home glucose monitoring following isolated fasting hyperglycemia on the 3-hour glucose tolerance test (GTT). The primary outcomes were primary cesarean delivery (PCD) and neonatal intensive care unit (NICU) admission. Binomial regression and Kruskal Wallis tests were used to compare perinatal outcomes between the two cohorts in the general population and in a subgroup of those with isolated fasting hyperglycemia.</p><p><strong>Results: </strong>Outcomes for the \"before\" cohort (<i>n</i> = 1,733) were compared with those in the \"after\" cohort (<i>n</i> = 6,280). In the general population, A2GDM incidence increased after expansion of the screening protocol (4.8% vs. 6.4%, RR 1.34, 95% CI 1.07-1.69), but PCD and NICU admission rates were unchanged. In the subgroup of patients with isolated fasting hyperglycemia (<i>n</i> = 233), there was a significant increase in the incidence of any GDM (12.5 vs. 46.0%, RR 3.68, 95% CI 1.95-6.93) and A2GDM (8.3% vs. 37.3%, RR 4.47, 95% CI 2.03-9.87). There was no difference in PCD between cohorts, but NICU admission increased significantly in the \"after\" cohort (8.3% vs 22.4%, RR 2.68, 95% CI 1.18-6.08) in this subgroup.</p><p><strong>Conclusion: </strong>An expanded approach to GDM diagnosis using home blood glucose monitoring following isolated fasting hyperglycemia on 3-hour GTT was associated with increased A2GDM incidence but no improvements in primary maternal or neonatal outcomes. In the absence of clinical benefit, we do not recommend widespread implementation of this expanded strategy.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2467996"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469750","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":"Changes in adrenomedullin in bronchoalveolar lavage fluid with chorioamnionitis in a sheep-based model.","authors":"Adele Fabiano, Daniele Panichi, Simonetta Picone, Giuseppe Lapergola, Gabriella Levantini, Ebe D'Adamo, Mariachiara Strozzi, Danilo Aw Gavilanes, Boris W Kramer, Francesca Gazzolo, Ali Saber Abdelhameed, Diego Gazzolo","doi":"10.1080/14767058.2025.2456502","DOIUrl":"10.1080/14767058.2025.2456502","url":null,"abstract":"<p><strong>Background: </strong>Adrenomedullin (AM) is a potent angiogenic, antioxidant and anti-inflammatory peptide protecting the developing lung from injury due to bronchopulmonary dysplasia (BPD) of the preterm infant. At this stage, no data on the potential effects of chorioamnionitis (CA) occurrence and glucocorticoids (GC) administration on AM in developing lungs are still lacking.</p><p><strong>Objective: </strong>to investigate, in a sheep-based model, the positive/side-effects of combined exposure to CA and GC on AM concentrations measured in bronchoalveolar lavage fluid (BALF).</p><p><strong>Methods: </strong>Time-mated ewes were randomly admitted to one of six treatment groups receiving injection: saline (controls); lipopolysaccharide (L) in intra-amniotic fluid treated alone at 7 or 14 d before delivery or associated with betamethasone (B) intramuscularly; B treated alone (7d) or associated with L (14d). Lambs were surgically delivered at 120 days gestation and euthanized. BALF was used for AM measurement in the studied groups.</p><p><strong>Results: </strong>AM BALF levels significantly (<i>p</i> < 0.05, for all) changed both to B and L exposure in a time-dependent manner. The latter was characterized by AM levels at short term superimposable to controls, whilst significantly (<i>p</i> > 0.05) decreased at long-term. The former showed increased AM at short and decreased at long-term (<i>p</i> < 0.05, for all), respectively.</p><p><strong>Conclusions: </strong>the present results showing AM BALF changes in a sheep-based model support the AM role in the hemodynamic patterns due to CA and BPD occurrence and open the way to further studies investigating the role of vasoactive agents as trustable markers of lung development/damage.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2456502"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030255","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 analysis of maternal fetal neonatal outcomes in patients with chronic hypertension needs pathological examination of the placenta.","authors":"L Carbillon","doi":"10.1080/14767058.2025.2487071","DOIUrl":"https://doi.org/10.1080/14767058.2025.2487071","url":null,"abstract":"","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2487071"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052060","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":"Research waste among randomized controlled trials in preterm infants: a Cross-sectional study.","authors":"Cuncun Shen, Jingjing Qiu, Yanxia Qiao, Huifen Chen, Yaya Qin, Junran Li, Tao Fan, Jing Ma, Xinrong Zhang, Feng Zhou","doi":"10.1080/14767058.2025.2498559","DOIUrl":"https://doi.org/10.1080/14767058.2025.2498559","url":null,"abstract":"<p><strong>Objective: </strong>Randomized controlled trials (RCTs) are the gold standard for evaluating efficacy; however, they may contribute to research waste. This study examined the extent of research waste in RCTs involving preterm infants over the past two decades.</p><p><strong>Methods: </strong>This cross-sectional study searched ClinicalTrials.gov between 2001 and 2020 to identify RCTs involving preterm infants. Research waste was defined as the occurrence of any of the following: non-publication, poor reporting, or avoidable design deficiencies. We searched PubMed, Embase, and Google Scholar databases to determine publication status. The CONSORT checklist was used to evaluate the reporting adequacy. Design deficiency was identified based on the risk of bias, evaluated using the Cochrane tool, and the presence of a relevant systematic review.</p><p><strong>Results: </strong>A total of 100 RCTs were eligible for inclusion. The primary research focus was pulmonary diseases (28%), followed by nutritional (15%) and ophthalmological diseases. Seventy-eight of the 100 RCTs were published and these were likelier to have an enrollment size greater than 300 (26% vs. 5%, <i>p</i> = .038). Inadequate reporting was observed in 25 published RCTs, while 47 had design deficiencies. Overall, 69 of the 100 RCTs exhibited at least one feature of research waste. Having a primary investigator from North America or Europe (odds ratio [OR] 0.168, 95% confidence interval [CI] 0.040-0.711, <i>p</i> = .015) and an enrollment size greater than 300 (OR 0.074, 95% CI 0.018-0.304, <i>p</i> < .001) were independently associated with reduced research waste.</p><p><strong>Conclusion: </strong>Nearly 70% of RCTs involving preterm infants exhibited features of research waste. However, large-scale RCTs conducted in North America and Europe were less likely to contribute to this issue.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2498559"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041154","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":"Labor epidural analgesia and autism spectrum disorder in 3-year-old offspring based on data from the Japan Environment and Children's Study: a prospective cohort study.","authors":"Toma Fukuda, Hyo Kyozuka, Tsuyoshi Murata, Shun Yasuda, Akiko Yamaguchi, Akiko Sato, Yuka Ogata, Hayato Go, Mitsuaki Hosoya, Seiji Yasumura, Koichi Hashimoto, Keiya Fujimori, Hidekazu Nishigori","doi":"10.1080/14767058.2025.2509147","DOIUrl":"https://doi.org/10.1080/14767058.2025.2509147","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between labor epidural analgesia (LEA) and autism spectrum disorder (ASD) in 3-year-old offspring in Japan.</p><p><strong>Methods: </strong>Prospective cohort study utilizing the Japan Environment and Children's Study, the largest nationwide birth cohort study. A total of 65,742 live singleton offspring were enrolled between January 2011 and March 2014. Offspring born <i>via</i> cesarean delivery or with confirmed chromosomal abnormalities were excluded. Multivariate logistic regression analyses were conducted to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), accounting for maternal, paternal, and perinatal covariates. Subgroup analyses were performed based on the sex of the offspring. The primary outcome was the diagnosis of ASD at age 3.</p><p><strong>Results: </strong>Among the 65,742 offspring (33,684 boys [51.2%]; mean maternal age, 31.1 [4.9] years), 1,324 (2.0%) were exposed to LEA. ASD was diagnosed in 14 (1.1%) offspring exposed to LEA and 257 (0.4%) not exposed to LEA by age 3. After adjusting for potential confounders, multivariate logistic regression revealed that LEA was associated with an increased risk of ASD (aOR: 2.23; 95% CI: 1.28-3.87). Subgroup analysis indicated that the association was significant in male offspring (aOR: 2.55; 95% CI: 1.40-4.65), but not in female offspring (aOR: 1.41; 95% CI: 0.34-5.91).</p><p><strong>Conclusion: </strong>This study suggests a mild association between LEA and ASD in 3-year-old male offspring. However, the findings should be cautiously interpreted given the limited number of ASD cases in this study. Causal relationships cannot be established since this was an observational study.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2509147"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144185","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":"Causal relationship between citrate and gestational diabetes mellitus: a two-sample Mendelian randomization analysis.","authors":"Yuhan He, Yanqiong Gan, Jing Mao, Qi Shi","doi":"10.1080/14767058.2025.2509160","DOIUrl":"https://doi.org/10.1080/14767058.2025.2509160","url":null,"abstract":"<p><strong>Background: </strong>Diabetes Mellitus (GDM) is a common metabolic disease during pregnancy, mainly manifested as impaired glucose tolerance in the middle and late stages of pregnancy. As a key intermediate product in the tricarboxylic acid cycle, citrate has been widely recognized for its role in regulating blood glucose levels. However, the potential association between citrate and impaired glucose tolerance during pregnancy needs further research, The aim of this study is to investigate the relationship between citrate levels in the human body and the incidence of gestational diabetes mellitus.</p><p><strong>Method: </strong>This study adopts a two-sample Mendelian randomization approach, using genetic variants of citrate as instrumental variables, to investigate the causal relationship between citrate and gestational diabetes mellitus (GDM). The research data is derived from the OpenGWAS and FinnGen databases, with single nucleotide polymorphisms (SNPs) related to citrate levels and the incidence of GDM selected as analytical tools. Citrate is designated as the exposure factor, and GDM as the outcome variable. Comprehensive assessments of the causal relationship between the instrumental variables and GDM are conducted using methods such as Inverse Variance Weighted (IVW), MR Egger, Simple Mode, Weighted Median, and Weighted Mode. Additionally, Cochran's Q and I^2 statistics are utilized to evaluate heterogeneity, with visualization provided through funnel plots. To test the robustness of the results, a leave-one-out sensitivity analysis method is employed. Furthermore, the potential pleiotropy in this study is detected using MR Egger.</p><p><strong>Result: </strong>In this study, a total of 6 SNPs related to citrate were included. The MR causal analysis revealed that the relevant genes of citrate had a significant impact on gestational diabetes mellitus in both the Inverse Variance Weighted method (OR = 0.170, 95% CI: 0.032 to 0.896, <i>p</i> = 0.037) and the Weighted Median method (OR = 0.116, 95% CI: 0.016 to 0.844, <i>p</i> = 0.033). The tests for heterogeneity, pleiotropy, and sensitivity used in this experiment all indicated that there were no special interfering factors in this experiment.</p><p><strong>Conclusion: </strong>This study found that there is a negative correlation between the level of citrate in pregnant women and gestational diabetes mellitus.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2509160"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144233","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":"Adjunctive pessary therapy after emergency cervical cerclage in patients with protruding fetal membranes - a multicenter cohort study.","authors":"Michał Kostrzanowski, Katarzyna Kosińska-Kaczyńska, Katarzyna Chaberek, Anna Wójcikiewicz, Paweł Rybicki, Piotr Sieroszewski","doi":"10.1080/14767058.2025.2477075","DOIUrl":"10.1080/14767058.2025.2477075","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to compare the perinatal outcomes in women with cervical dilatation with fetal membranes visible before 26 weeks of gestation managed with an adjunctive pessary after emergency cervical cerclage or emergency cerclage alone.</p><p><strong>Methods: </strong>We performed a retrospective analysis of women with singleton gestation, diagnosed with cervical dilatation accompanied by fetal membranes visible at or beyond the external os, who underwent emergency cervical cerclage. The participants were recruited at 3 tertiary perinatal centers. Adjunctive pessary treatment depended on the choice of the attending physician. The primary outcomes included preterm delivery before 34 weeks of gestation and a live infant discharged home.</p><p><strong>Results: </strong>Emergency cerclage alone was performed in 35 women, and 39 underwent emergency cerclage and adjunctive pessary therapy. Women in the adjunctive pessary group delivered significantly later (median 36, IQR 32-38 weeks vs 34, IQR 24-37 weeks of gestation; <i>p</i> = 0.03). No statistically significant differences were observed in rates of deliveries <34 weeks and rates of live infants discharged home. A significant prolongation of pregnancy (median 107, interquartile range 52-134 vs median 69, interquartile range 27-99 days; <i>p</i> = 0.02) and reduction in the rates of preterm deliveries <28 (7.7% vs 28.6%; <i>p</i> = 0.03) and <30 weeks of gestation (12.8% vs 34.3%; <i>p</i> = 0.05) were observed in adjunctive pessary group, despite more advanced cervical insufficiency. Adjunctive pessary significantly reduced the risk of delivery <30 weeks (aOR 0.2, 95% CI 0.06-0.7) and <34 weeks of gestation (aOR 0.2, 95% CI 0.05-0.81).</p><p><strong>Conclusion: </strong>The use of a pessary as an adjunctive therapy after emergency cervical cerclage may be effective in lowering the risk of delivery <30 weeks and may offer a new option for managing women with advanced cervical insufficiency.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2477075"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607059","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":"Validation of the clinical efficacy of one-day outpatient management of patients with gestational diabetes mellitus.","authors":"Jingwen Xu, Qian Jing, Huixia Shi, Hui Qian, Li Shi","doi":"10.1080/14767058.2024.2436086","DOIUrl":"https://doi.org/10.1080/14767058.2024.2436086","url":null,"abstract":"<p><strong>Objective: </strong>A comprehensive management model called the one-day care clinic has been established and implemented throughout the hospitals as well as maternal and child health care centers for gestational diabetes mellitus (GDM) in China. However, there is still a lack of high-level evidence for this management model. The objective of this study was to describe the one-day outpatient management model and assess its efficacy in managing GDM.</p><p><strong>Methods: </strong>A retrospective review was performed on patients who were admitted to the obstetrics clinic and diagnosed as GDM at our centers from July 2017 to June 2022. All enrolled patients were divided into two groups: the experimental group that participated in the one-day outpatient management and the control group that only received routine education on gestational diabetes in the outpatient department. Baseline characteristics and clinical data of enrolled patients were reviewed. Blood glucose level before and after attending one-day outpatient management, blood glucose and HbA1c before delivery, weight gain at the end of pregnancy, complications during pregnancy and pregnancy outcomes were collected.</p><p><strong>Results: </strong>A total of 546 patients were finally included in this study, with 276 in the experimental group and 270 in the control group. There were no significant differences between the two groups in terms of baseline characteristics. The 1h postprandial blood glucose (PBG) and 2h PBG levels were significantly lower after participating in the one-day outpatient management compared to before (all <i>p</i> value < 0.01). Before delivery, the FBG, 2hPBG, and HbA1c levels in the experimental group were significantly lower than those in the control group (all <i>p</i> value < 0.01). The experimental group experienced less weight gain and had a higher rate of achieving weight gain goals compared to the control group. In terms of complications during pregnancy, the incidence of premature rupture of fetal membranes, pregnancy induced hypertension, and hydramnion did not differ significantly between the two groups. In terms of pregnancy outcomes, the incidence of macrosomia and neonatal hypoglycemia in the experimental group was significantly lower than in the control group (all <i>p</i> value < 0.05).</p><p><strong>Conclusion: </strong>The adoption of the one-day outpatient management is more beneficial for controlling blood glucose levels and weight target during pregnancy in GDM patients. Additionally, this management can decrease the occurrence of adverse pregnancy outcomes, and improve the prognosis of both GDM patients and offspring.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2436086"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774360","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":"Proof of concept testing of a vascular closure device for use in fetal surgery.","authors":"Braxton Forde, Samuel Martin, Marc Oria, Jordan Kapke, Eyal Krispin, Jose L Peiro","doi":"10.1080/14767058.2024.2435468","DOIUrl":"https://doi.org/10.1080/14767058.2024.2435468","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Prior clinical findings have demonstrated that maternal laparotomy with trans-amniotic trans-uterine suturing of the fetoscopic port site during in utero myelomeningocele repair reduces the risk of membrane rupture. However, due to laparotomy-associated morbidity, we aimed to explore the feasibility of using a vascular closure device for percutaneous trans-amniotic trans-uterine suturing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This IRB and IACUC-exempt study utilized 2 strategies for proof-of-concept testing of using the Abbott Perclose&lt;sup&gt;™&lt;/sup&gt; ProStyle&lt;sup&gt;™&lt;/sup&gt; Device for suture placement; 1. Ultrasound guided application on a high fidelity maternal abdominal uterus model used for fetal procedures and 2. Placement under direct visualization with sheep undergoing cesarean delivery for other research purposes. In the high-fidelity uterus model, the Abbott Perclose&lt;sup&gt;™&lt;/sup&gt; ProStyle&lt;sup&gt;™&lt;/sup&gt; device was used to place a transuterine/transamniotic stitch with accompanying video recording of the approach (https://go.screenpal.com/watch/cZfhoDVsYvW password: perclose). Regarding the second approach, at the time of a cesarean section, 12 French Checkflo&lt;sup&gt;®&lt;/sup&gt; cannulas were inserted into the sheep amniotic space &lt;i&gt;via&lt;/i&gt; different approaches: (1) Seldinger technique, (2) Seldinger technique insertion of Checkflo&lt;sup&gt;®&lt;/sup&gt; cannula and subsequent use of the Abbott Perclose&lt;sup&gt;™&lt;/sup&gt; ProStyle&lt;sup&gt;™&lt;/sup&gt; device to suture the port site after check flow removal, (3) Abbott Perclose&lt;sup&gt;™&lt;/sup&gt; ProStyle&lt;sup&gt;™&lt;/sup&gt; device utilized in what is described as a \"pre-close\" technique, where prior to cannula placement, trans-uterine trans-amniotic stitches are placed followed by the insertion of a 12 French Checkflo&lt;sup&gt;®&lt;/sup&gt; cannula over the same guidewire. Samples of the sutured uterine wall were sent to pathology and H&E staining was performed to assess uterine hole closure and amnion-to-uterus fixation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The high-fidelity model confirmed that the Perclose&lt;sup&gt;™&lt;/sup&gt; ProStyle&lt;sup&gt;™&lt;/sup&gt; Device was easily visualized by ultrasound and suture deployment was without complication. In the animal model, the Perclose&lt;sup&gt;™&lt;/sup&gt; ProStyle&lt;sup&gt;™&lt;/sup&gt; device effectively sutured the amnion to the uterus in both the pre- and post-close approach. The pre-close technique achieved better amnion-to-uterus approximation and more appropriate uterine hole closure. H&E staining revealed that without suturing, amnion separation from the chorion layer occurred, and the uterine hole persisted. The post-close technique showed partial connection between the amnion and chorion, but inadequate uterine hole closure with amnion shift into the defect. Optimal closure, with secure amnion-to-chorion fixation and uterine closure, was achieved through the pre-close technique.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The Abbott Perclose&lt;sup&gt;™&lt;/sup&gt; ProStyle&lt;sup&gt;™&lt;/sup&gt; Device seems to be a feasible device for use of uterin","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2435468"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796253","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":"Changes in short-term variation of antenatal cardiotocography to identify intraamniotic infection: a historical cohort study.","authors":"Brynhildur Tinna Birgisdottir, Tomas Andersson, Ingela Hulthén Varli, Sissel Saltvedt, Ke Lu, Farhad Abtahi, Ulrika Åden, Malin Holzmann","doi":"10.1080/14767058.2024.2434059","DOIUrl":"https://doi.org/10.1080/14767058.2024.2434059","url":null,"abstract":"<p><strong>Introduction: </strong>Intraamniotic infection (IAI) is one of the main possible complications of preterm prelabor rupture of membranes (PPROM) and can lead to severe consequences for the neonate, such as early onset neonatal sepsis (EONS). Available diagnostic tools for IAI have poor diagnostic performance, which may result in both over- and underdiagnoses of IAI. In a search for better diagnostic tools, we have examined short-term variation (STV) in fetal heart rate. We have previously shown that in IAI exposed pregnancies, the STV was more than 20% lower in the last cardiotocography trace before the start of labor, as compared to those not exposed to IAI. The association between IAI and STV needs further evaluation and we therefore continued by examining the longitudinal change in STV in association with IAI.</p><p><strong>Material and methods: </strong>We performed a historical cohort study on 628 singleton pregnancies with PPROM, delivering between 24 + 0 to 33 + 6 gestational weeks. The main exposure of the study was IAI, using EONS as a proxy as no easily available method exists for confirming IAI antepartum, and IAI and EONS are strongly associated. The main outcome was STV in fetal heart rate. At least two available cardiotocography traces per fetus were required as a minimum, from PPROM or from seven days before birth, whichever came later, until the start of labor or planned cesarean birth. A total of 9 690 cardiotocography traces were analyzed.</p><p><strong>Results: </strong>Fetuses exposed to IAI had a 26.5% steeper decline in their STV during the last 24 h before the start of labor when compared to fetuses not exposed (95% CI -32.9% to -19.4%; <i>p</i> < 0.001). After adjustment for antenatal corticosteroids, the decline remained significant. The decline became less prominent but the significance remained when also adjusting for the baseline frequency (-12.7% [95% CI -19.3% to -5.5%], <i>p</i> < 0.001). In the IAI-exposed group, the baseline frequency increased by 11.1 bpm during the last 12 h before the start of labor, beyond those who were not exposed (95% CI 8.3 bpm to 13.8 bpm; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>In pregnancies affected by IAI the STV declines steeper in the last 24 h before the start of labor as compared to pregnancies not affected by IAI, even after adjustment for increasing baseline frequency. The association of STV in relation to IAI needs to be further studied in order to evaluate and establish STVs usefulness in monitoring patients for IAI.</p>","PeriodicalId":50146,"journal":{"name":"Journal of Maternal-Fetal & Neonatal Medicine","volume":"38 1","pages":"2434059"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774340","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}