B oth delayed clamping and milking of the umbilical cord have separately been shown to have positive effects for neonates. Delayed clamping improves neonatal anemia, lowers the need for transfusion, lowers the incidence of necrotizing enterocolitis, and decreases the incidence of intraventricular hemorrhage. While milking has also been associated with improved neonatal outcomes, there is a lack of studies comparing the 2 techniques. This study aimed to compare delayed clamping and umbilical cord milking in terms of effect on the initial hematocrit concentrations in preterm infants. This randomized controlled trial included singleton infants between 23 weeks 0 days gestation and 34 weeks 6 days gestation that were born at a single hospital between April 18, 2014, and June 5, 2018. Patients were excluded with known congenital anomalies, precipitous delivery, placental abruption, uterine rupture, or infants with risk factors for anemia. Patients were randomized to either the delayed cord clamping group or milking group using 1:1 block randomization. Delayed cord clamping lasted for 60 seconds and infants were held at the level of the maternal abdomen during cesarean delivery and at the perineum for vaginal delivery. For the milking group, the cord was milked 4 times before clamping, from ∼20 cm from the placental end of the cord to the infant’s umbilicus, with time for cord refill in between milking. An intent-to-treat approach was used in analysis. The sample size was calculated to create an 80% probability value of .05 for the primary outcome measure of a hematocrit difference of 3%. Of 282 patients who were randomized, 204 were included in the analysis. Of those, 100 were assigned to the milking group and 104 were assigned to the delayed clamping group. The milking procedure took, on average, 6 seconds. The cord clamping group had an average delayed cord clamping of 30 to 60 seconds. The clamping and milking groups were similar in terms of delivery mode, birth weight, cord blood arterial, and venous pH and Apgar scores. The median gestational age for delivery was 32 weeks. While there was a trend toward higher initial hematocrit concentration in the milking group compared with the delayed clamping group, this difference was not statistically significant (51.8 vs. 49.9; P=0.07). The 2 groups were similar in terms of transfusion (15.5% in the delayed clamping group vs. 9.1% in the milking group; P=0.24), intraventricular hemorrhage (delayed clamping group, 15.5% vs. milking group, 10.1%; P=0.35), and necrotizing enterocolitis (delayed clamping group, 5.8% vs. milking group, 3.0%; P=0.49). While the differences did not reach statistical significance, all these outcomes were lower in the milking group. Compared with delayed clamping, cord milking yielded similar effects on hematocrit concentrations, rates of necrotizing enterocolits, and intraventricular hemorrhage, and need for neonatal transfusions, and did not carry any increased risk of complications. There may be certain clinical situations where a 30to 60-second delay in cord clamping may delay necessary resuscitation by the neonatal team and milking the umbilical cord may be an acceptable alternative. These outcomes support the use of milking as a method for increasing infant blood volume. Subsequent Pregnancy Outcomes After Open Maternal-Fetal Surgery for Myelomeningocele

Subsequent Pregnancy Outcomes After Open Maternal-Fetal Surgery for Myelomeningocele

Studying how the fetal spinal cord regenerates in an ex vivo model of spina bifida repair may provide insights into the development of new tissue engineering treatment strategies to better optimize...

https://journals.sagepub.com/doi/pdf/10.1177/2041731420943833

Hydrogel and neural progenitor cell delivery supports organotypic fetal spinal cord development in an ex vivo model of prenatal spina bifida repair.

There is growing evidence that levels of fear and anxiety have increased during the COVID-19 pandemic. However, given regular epidemic prevention and control measures, longitudinal changes and causal factors in the incidence of fear and anxiety need to be measured and explored. College students completed online surveys in two wave studies a year apart. The participants who completed both of the surveys numbered 22,578. The online surveys were completed at the pandemic’s normalization/prevention stage (T1, from June 1 to 15, 2020) and during a phase of new local transmission of the disease in Guangdong Province (T2, from June 10 to 18, 2021). Multiple linear regressions were used to examine fear and anxiety predictors from demographic characteristics. Fear related to COVID-19 had significantly decreased at T2 (t = 66.64, p < 0.001), however, anxiety had significantly increased at T2 (t = -5.03, p < 0.001). In particular, not implementing preventive measures (e.g., handwashing) during the COVID-19 pandemic had the greatest impact in predicting the change in fear levels. By contrast, prior poor mental health status contributed the most in predicting the change in degree of anxiety. These results suggest different changes in anxiety levels (deterioration) and degree of fear (mitigation) occurred as the COVID-19 pandemic progressed. These findings have implications for planning mental health crisis provisions and have long-term impact beyond this pandemic. 

/pdf/longitudinal-changes-in-fear-and-anxiety-among-chinese-35ch2e8t.pdf

Longitudinal changes in fear and anxiety among Chinese college students during the COVID-19 pandemic: a one-year follow-up study

PURPOSE
We compared placental-derived and amniotic fluid-derived mesenchymal stem cells (pMSCs and afMSCs, respectively) in transamniotic stem cell therapy (TRASCET) for experimental spina bifida.


METHODS
Pregnant dams (n=29) exposed to retinoic acid for the induction of fetal spina bifida were divided into four groups. Three groups received volume-matched intraamniotic injections of either saline (n=38 fetuses) or a suspension of 2×10(6) cells/mL of syngeneic, labeled afMSCs (n=73) or pMSCs (n=115) on gestational day 17 (term=21-22days). Untreated fetuses served as controls. Animals were killed before term. Statistical comparisons were by Fisher's exact test (p<0.05).


RESULTS
Survival was similar across treatment groups (p=0.08). In fetuses with isolated spina bifida (n=100), there were higher percentages of defect coverage (either partial or complete) in both afMSC and pMSC groups compared with saline and untreated groups (p<0.001-0.03 in pairwise comparisons). There were no differences in coverage rates between afMSC and pMSC groups (p=0.94) or between saline and untreated groups (p=0.98).


CONCLUSIONS
Both pMSC and afMSC can induce comparable rates of coverage of experimental spina bifida after concentrated intraamniotic injection in the rodent model. This broadens the options for timing and cell source for TRASCET as a potential alternative in the prenatal management of spina bifida.

A Comparison Between Placental and Amniotic Mesenchymal Stem Cells for Trans-Amniotic Stem Cell Therapy (TRASCET) in Experimental Spina Bifida

Maternal-fetal surgery (MFS) encompasses a range of innovative procedures aiming to treat fetal illnesses and anomalies during pregnancy. Their development and gradual introduction into healthcare raise important ethical issues concerning respect for pregnant women's bodily integrity and autonomy. This paper asks what kind of ethical framework should be employed to best regulate the practice of MFS without eroding the hard-won rights of pregnant women. I examine some existing models conceptualising the relationship between a pregnant woman and the fetus to determine what kind of framework is the most adequate for MFS, and conclude that an ecosystem or maternal-fetal dyad model is best suited for upholding women's autonomy. However, I suggest that an appropriate framework needs to incorporate some notion of fetal patienthood, albeit a very limited one, in order to be consistent with the views of healthcare providers and their pregnant patients. I argue that such an ethical framework is both theoretically sound and fundamentally respectful of women's autonomy, and is thus best suited to protect women from coercion or undue paternalism when deciding whether to undergo MFS.

/pdf/maternal-fetal-surgery-does-recognising-fetal-patienthood-50g0ycbyb3.pdf

Maternal–Fetal Surgery: Does Recognising Fetal Patienthood Pose a Threat to Pregnant Women’s Autonomy?

Purpose of review To review the advance of maternal--fetal surgery, the research of stem cell transplantation and tissue engineering in prenatal management of fetal meningomyelocele (fMMC). Recent findings Advance in the imaging study provides more accurate assessment of fMMC in utero. Prenatal maternal--fetal surgery in fMMC demonstrates favourable postnatal outcome. Minimally invasive fetal surgery minimizes uterine wall disruption. Endoscopic fetal surgery is performed via laparotomy-assisted or entirely percutaneous approach. The postnatal outcome for open and endoscopic fetal surgery shares no difference. Single layer closure during repair of fMMC is preferred to reduce postnatal surgical intervention. All maternal--fetal surgeries impose anesthetic and obstetric risk to pregnant woman. Ruptured of membrane and preterm delivery are common complications. Trans-amniotic stem cell therapy (TRASCET) showed potential tissue regeneration in animal models. Fetal tissue engineering with growth factors and dura substitutes with biosynthetic materials promote spinal cord regeneration. This will overcome the challenge of closure in large fMMC. Planning of the maternal--fetal surgery should adhere to ethical framework to minimize morbidity to both fetus and mother. Summary Combination of endoscopic fetal surgery with TRASCET or tissue engineering will be a new vision to achieve to improve the outcome of prenatal intervention in fMMC.

Chen-Ai Sung

Papers

Fetal surgery and stem cell therapy for meningomyelocele.

The application of clinical ultrasound in fetal therapy