Showing papers in "Journal of Maternal-fetal & Neonatal Medicine in 2012"
TL;DR: 4-D ultrasonography may have an important role in prenatal assessment of fetal neurobehavior and prediction of adverse neurological outcome, however, further large studies are recommended before the test could be recommended for wider clinical practice.
Abstract: Objective. To determine the role of 4-D ultrasonography in prenatal assessment of fetal neurobehavior and in prediction of adverse neurological outcome.Design. Prospective cohort study.Setting. Women Hospital, Hamad Medical Corporation, Qatar.Population. Forty pregnant women between 20 and 38 weeks of gestation with high risk for neurological abnormalities and 40 low risk cases were included.Methods. Prenatal fetal neurological assessment using Kurjak antenatal neurodevelopmental test (KANET). Postnatal neurological assessment was performed using Amiel-Tison’s neurological assessment at term (ATNAT) for all live-borns.Main outcome measures. Prediction of fetuses at neurological risk.Results. The difference in the range of KANET score was significant. A significant difference was shown for isolated head anteflexion, isolated eye blinking, facial expressions, mouth movements, isolated hand movements, hand to face movement, finger movements, and general movements. For isolated leg movement and cranial suture...
285 citations
TL;DR: Large variations in estimated GDM prevalence are found, but direct comparison between countries is difficult due to different diagnostic strategies and subpopulations, and countries need to carefully assess the cost and health impact of scaling up GDM screening and management in order to identify the best policy option for their population.
Abstract: Objective: The association between gestational diabetes mellitus (GDM), perinatal complications and long-term morbidity is gaining increased attention. However, the global burden of GDM and the existing responses are not fully understood. We aimed to assess country prevalence and to summarize practices related to GDM screening and management. Methods: Data on prevalence and country practices were obtained from a survey administered to diabetologists, obstetricians and others working on GDM in 173 countries. Results: GDM prevalence estimates range from 90%. Conclusions: We found large variations in estimated GDM prev...
258 citations
TL;DR: Pregravid overweight or obesity and gaining in excess of the IOM 2009 GWG guidelines strongly increase a woman’s chance of having a larger baby.
Abstract: Objective: To determine the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on large-for-gestational-age (LGA) birth weight (≥90th % ile). Methods: We examined 4321 mother-infant pairs from the Ottawa and Kingston (OaK) birth cohort. Multivariate logistic regression (controlling for gestational and maternal age, pre-pregnancy weight, parity, smoking) were performed and odds ratios (ORs) calculated. Results: Prior to pregnancy, a total of 23.7% of women were overweight and 16.2% obese. Only 29.3% of women met GWG targets recommended by the Institute of Medicine (IOM), whereas 57.7% exceeded the guidelines. Adjusting for smoking, parity, age, maternal height, and achieving the IOM’s recommended GWG, overweight (OR 1.99; 95%CI 1.17–3.37) or obese (OR 2.64; 95% CI 1.59–4.39) pre-pregnancy was associated with a higher rate of LGA compared to women with normal BMI. In the same model, exceeding GWG guidelines was associated with higher rates of LGA (OR 2.86; 95% CI 2.09–...
148 citations
TL;DR: Nearly half of the patients with late-onset PE have placental lesions consistent with maternal underperfusion, which are associated with an imbalance in the maternal concentration of angiogenic/anti-angiogenic factors.
Abstract: Objective: An imbalance between maternal angiogenic/anti-angiogenic factors concentrations has been observed in preeclampsia (PE) and other obstetrical syndromes. However, the frequency of pathologic findings in the placenta and the changes in maternal plasma angiogenic/anti-angiogenic factor concentrations differ between late- and early-onset PE. The aim of this study was to determine if the maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng), and soluble vascular endothelial growth factor receptor-1 and 2 (sVEGFR-1 and sVEGFR-2) are different in late-onset PE with and without placental pathologic findings consistent with maternal underperfusion. Study design: A cross-sectional study was conducted including 64 uncomplicated women and 66 women with late-onset PE (>34 weeks) who had blood samples and placenta available for pathologic examination. Patients with late-onset PE were divided into those with and without placental histologic findings consistent with maternal ...
141 citations
TL;DR: This massively parallel sequencing-based approach, combined with the improved z-score test methodology, enables the prenatal diagnosis of most common aneuploidies with a high degree of accuracy, even in the first trimester of pregnancy.
Abstract: Objective: To develop a new bioinformatic method in the noninvasive prenatal identification of common fetal aneuploidies using massively parallel sequencing on maternal plasma. Methods: Massively parallel sequencing was performed on plasma DNA samples from 108 pregnant women (median gestation: 12+5 week) immediately before chorionic villus sampling (CVS) or amniocentesis. Data were analysed using a novel z-score method with internal reference chromosome. The diagnostic accuracies of the fetal karyotyping status were compared against two previously reported z-score methods – one without adjustment and the other with GC correction. Results: A total of 32 cases with fetal aneuploidy were confirmed by conventional karyotyping, including 11 cases of Trisomy 21, 10 cases of Trisomy 18, 2 cases of Trisomy 13, 8 cases of Turner syndrome (45, XO) and one case of Klinefelter syndrome (47, XXY). Using the z-score method without reference adjustment, the detection rate for Trisomy 21, Trisomy 18, Trisomy 13, Turner s...
122 citations
TL;DR: A profound change in the first-trimester metabolite profile was noted in women who had subsequently developed early-onset PE, and preliminary algorithms appeared highly sensitive for first trimester prediction of early onset PE.
Abstract: Objective: To evaluate the use of metabolomics for the first-trimester detection of maternal metabolic dysfunction and prediction of subsequent development of early-onset preeclampsia (PE). Study design: This was a case-control study of maternal plasma samples collected at 11–13 weeks’ gestation from 30 women who had subsequently developed PE requiring delivery before 34 weeks and 60 unaffected controls. Nuclear magnetic Resonance (NMR) spectroscopy was used to identify and quantify metabolomic changes in cases versus controls. Both genetic computing and standard statistical analyses were performed to predict the development of PE from the metabolite concentrations alone as well as the combination of metabolite concentrations with maternal characteristics and first-trimester uterine artery Doppler pulsatility index (PI). Results: Significant differences between cases and controls were found for 20 metabolites. A combination of four of these metabolites (citrate, glycerol, hydroxyisovalerate, and methionin...
108 citations
TL;DR: A supervised program of moderate-intensity exercise performed throughout pregnancy was associated with a reduction in the rate of cesarean, instrumental deliveries and can be recommended for healthy women in pregnancy.
Abstract: Objective: In this study, the authors assessed the effects of a structured, moderate-intensity exercise program during the entire length of pregnancy on a woman’s method of delivery. Methods: A randomized controlled trial was conducted with 290 healthy pregnant Caucasian (Spanish) women with a singleton gestation who were randomly assigned to either an exercise (n = 138) or a control (n = 152) group. Pregnancy outcomes, including the type of delivery, were measured at the end of the pregnancy. Results: The percentage of cesarean and instrumental deliveries in the exercise group were lower than in the control group (15.9%, n = 22; 11.6%, n = 16 vs. 23%, n = 35; 19.1%, n = 29, respectively; p = 0.03). The overall health status of the newborn as well as other pregnancy outcomes was unaffected. Conclusions: Based on these results, a supervised program of moderate-intensity exercise performed throughout pregnancy was associated with a reduction in the rate of cesarean, instrumental deliveries and can be recomm...
108 citations
TL;DR: Preterm birth is associated with brain tissue volume alterations that become more pronounced in the presence of perinatal risk factors and white matter injury, and associations between volumetric alterations as early as TEA and long-term neurodevelopmental impairments are scarce.
Abstract: Objective: To evaluate the clinical value of neonatal brain tissue segmentation in preterm infants according to the literature. Methods: A structured literature search was undertaken in MEDLINE/Pubmed. This included all publications on volumetric brain tissue assessment in preterm infants at term-equivalent age (TEA) compared to brain tissue volumes of term-born infants, related to perinatal risk factors or related to neurodevelopmental outcome. Results: Sixteen prospective cohort studies, described in 30 articles, fulfilled the criteria. Preterm infants displayed total and regional brain tissue alterations compared to healthy, term-born controls. These alterations seemed more prominent with decreasing gestational age. White matter injury, intraventricular haemorrhage, postnatal corticosteroid therapy, intra-uterine growth retardation and chronic lung disease were frequently associated with volume changes. Associations between volume alterations at TEA and neurodevelopmental outcome in early childhood wer...
107 citations
TL;DR: The preliminary results of this study suggest that metabolomics may provide a promising tool to study aspects related to the nutrition and health of preterm infant.
Abstract: Objective: The aim of the present study was to investigate the metabolic profile of preterm human breast milk (HBM) by using a metabolomic approach. Methods: NMR spectroscopy and GC/MS were used to analyze the water-soluble and lipid fractions extracted from milk samples obtained from mothers giving birth at 26–36 weeks of gestation. For the sake of comparison, preterm formula milk was also studied. Results: The multivariate statistical analysis of the data evidenced biochemical variability both between preterm HBM and commercial milk and within the group of HBM samples. Conclusions: The preliminary results of this study suggest that metabolomics may provide a promising tool to study aspects related to the nutrition and health of preterm infant.
104 citations
TL;DR: Preliminary evidence for short-term improvements in the physiological stability of NICU infants using MSS is provided, suggesting an effective therapeutic window for MSS when the infant’s auditory brain development is most intact.
Abstract: Objective: Preterm infants experience frequent cardiorespiratory events (CREs) including multiple episodes of apnea and bradycardia per day. This physiological instability is due to their immature ...
95 citations
TL;DR: Autophagy can be part of an integrated pro-survival signalling which includes the PI3K-Akt- mTOR axis and its activation seems be crucial for pharmacological and ischemic preconditioning.
Abstract: Autophagy is an endogenous tightly regulated process responsible for the degradation of damaged and dysfunctional cellular organelles and protein aggregates. Emerging data indicate a strong and complex interaction among autophagy, apoptosis and necrosis. We studied these interactions in a neonatal model of hypoxia-ischemia (HI). Autophagy was assessed by evaluating the expression of the two autophagy proteins beclin 1 and LC3, and by "in vivo" autophagic vesicles formation and clearance using monodansylcadaverine (MDC). Both autophagy and apoptosis pathways were increased in the same neurons at short times after HI. Neuroprotective drugs also increased autophagy. Interestingly, pharmacological inhibition of autophagy switched cell death phenotypes from apoptosis to necrosis. Rapamycin, that enhances autophagy by inhibition of mTOR and previously shown to be neuroprotective in our animal model of HI when administered before the ischemic insult, was used to study the potential interaction between autophagy and survival pathways. Rapamycin, besides inducing autophagy, also increased Akt and CREB (cAMP response element-binding protein) phosphorylation in the same cells. The pharmacological inhibition of the phosphatidylinositol 3-kinase (PI3K)/Akt axis reduced the neuroprotective effect of rapamycin without affecting autophagy. Conversely, pharmacological inhibition of autophagy reduced the neuroprotective effect of rapamycin without affecting Akt phosphorylation. Both treatments, however, caused a rapid switch towards necrotic cell death. Thus, autophagy can be part of an integrated pro-survival signalling which includes the PI3K-Akt- mTOR axis and its activation seems be crucial for pharmacological and ischemic preconditioning.
TL;DR: Evaluation of the fetal behavior in fetuses with cerebral VM using KANET test has the potential to detect Fetuses with abnormal behavior, and to add the dimension of CNS function to the morphological criteria of VM.
Abstract: Objective: To assess differences in fetal behavior in both normal fetuses and fetuses with cerebral ventriculomegaly (VM). Methods: In a period of eighteen months, in a longitudinal prospective cohort study,Kurjak Antenatal NeuorogicalTest (KANET) was applied to assess fetal behavior in both normal pregnancies and pregnancies with cerebral VM using four-dimensional ultrasound (4D US). According to the degree of enlargement of the ventricles, VM was divided into three groups: mild, moderate and severe. Moreover fetuses with isolated VM were separated from those with additional abnormalities. According to the KANET, fetuses with scores ≥14 were considered normal, those with scores 6–13 borderline and abnormal if the score was ≤5. Differences between two groups were examined by Fisher’s exact test. Differences within the subgroups were examined by Kruskal–Wallis test and contingency table test. Results: KANET scores in normal pregnancies and pregnancies with VM showed statistically significant differences. M...
TL;DR: The increase in PTB rates may be explained by medical indications at late preterm gestations, primarily in older, Caucasian women requiring fertility assistance, and interventions to reduce the rate of PTB need to be targeted to this high-risk population.
Abstract: Objectives: To (1) investigate the current distribution of PTB phenotypes; (2) identify factors associated with spontaneous preterm labour (SPTL), PPROM, and indicated PTB; (3) investigate the relationship of gestational age (ga) with each PTB phenotype. Methods: Retrospective review of all live, singleton births 23+0 to 36+6 weeks ga at an obstetric referral centre 2004–2008. Results: A total of 4,522 PTBs were included (SPTL 31.7%, PPROM 27.4%, indicated 40.8%). PTB phenotype distribution differed between ga groups (<27 weeks: SPTL 45%, PPROM 32%, indicated 23%; 27–33 weeks: SPTL 30%, PPROM 32%, indicated 39%; 34–36 weeks: SPTL 32%, PPROM 24%, indicated 44%, p < 0.001). Between 34–36 weeks’, demographic factors were significantly different between PTB phenotypes (age ≥35: SPTL 13.8%, PPROM 15.4%, indicated 21.6%; Caucasian ethnicity: SPTL 61.6%, PPROM 69.0%, indicated 70.2%; Assisted Reproductive Technology (ART): SPTL 2.8%, PPROM 1.9%, indicated 9.3%; all p < 0.001). Between 27–33 weeks’ PTB phenotype ...
TL;DR: This finding provides evidence that an alarmin, HMGB1, and one of its receptors, sRAGE, are engaged in the process of clinical chorioamnionitis at term, quite different from those observed in cases of intra-amniotic infection/ inflammation in preterm gestations.
Abstract: Objective: High mobility group box-1 (HMGB1) protein is an alarmin, a normal cell constituent, which is released into the extracellular environment upon cellular stress/damage and capable of activating inflammation and tissue repair. The receptor for advanced glycation end products (RAGE) can bind HMGB1. RAGE, in turn, can induce the production of pro-inflammatory cytokines; this may be modulated by the soluble truncated forms of RAGE, including soluble RAGE (sRAGE) and endogenous secretory RAGE (esRAGE). The objectives of this study were to determine whether: 1) clinical chorioamnionitis at term is associated with changes in amniotic fluid concentrations of HMGB1, sRAGE and esRAGE; and 2) the amniotic fluid concentration of HMGB1 changes with labor or as a function of gestational age. Methods: Amniotic fluid samples were collected from the following groups: 1) mid-trimester (n = 45); 2) term with (n = 48) and without labor (n = 22) without intra-amniotic infection; and 3) term with clinical chorioamnioni...
TL;DR: Sleep duration and quality of sleep can affect the type of delivery, length of labor stages, as well as neonates’ Apgar score and birth weight.
Abstract: Background: Sleep disturbance is common during pregnancy. The aim of this study was to assess the effects of sleep duration and its quality on labor and fetal outcome. Method: In a cross sectional study, primigravida women with singleton pregnancy (gestational age > 37 weeks) were recruited. Women with hypertension, diabetes mellitus, or those who needed emergency cesarean section were excluded. Data regarding the type and length of delivery, the quality of sleep as well as the neonates’ weight and Apgar scores were recorded. Results: Totally, 457 participants were recruited. There was a significant correlation between the sleep duration and length of delivery stages. In most participants with more than 8 hours sleep, the first stage of delivery lasted between 6 and 10 hours. They had normal vaginal delivery with induction, and their neonates’ Apgar score was > 9 (p = 0.029, p = 0.018, and p = 0.001, respectively). Most mothers with refreshing sleep had normal vaginal delivery with induction, their neonat...
TL;DR: Transabdominal measurement overestimated cervical LOA by 8 mm among women with a short cervix and resulted in the underdiagnosis of 57% of cases.
Abstract: Objective: To assess the diagnostic performance of transabdominal sonographic measurement of cervical length in identifying patients with a short cervix. Methods: Cervical length was measured in 220 pregnant women using transabdominal and transvaginal ultrasound (US). Reproducibility and agreement between and within both methods were assessed. The diagnostic accuracy of transabdominal US for identifying cases with a cervical length <25 mm was evaluated. Results: Twenty-one out of 220 cases (9.5%) had a cervical length <25 mm by transvaginal US. Only 43% (n = 9) of patients with a short cervix were correctly identified by transabdominal US. In patients with a cervical length of <25 mm by transvaginal US, transabdominal measurement of the cervix overestimated this parameter by an average of 8 mm (95% LOAs, −26.4 to 10.5 mm). Among women without a short cervix, transabdominal US underestimated cervical length on average (LOA) by 1.1 mm (95% LOAs, −11.0 to 13.2 mm). Transvaginal US was also more reproducible ...
TL;DR: Endoscopic MIA is a feasible and potentially more acceptable approach to perinatal autopsy and provides an additional option for parents who do not agree to a traditional PM examination and could result in increased utilization of investigations after death in this group of patients.
Abstract: Objective: Perinatal autopsy provides additional diagnostic information in a significant proportion of cases but parents and relatives frequently decline traditional postmortem (PM) examination, pa...
TL;DR: During scheduled caesarean section for placenta previa multifocally accreta or increta, IABO can prevent hysterectomy in many cases and improves perioperative outcome as it gives the operator time to achieve the haemostasis via curettage and oversewing of the implantation site with acceptable blood loss.
Abstract: Objective: To evaluate whether aorta balloon occlusion decreases the rate of hysterectomies and maternal morbidity during extirpative surgery of placenta previa accreta or increta. Methods: We prospectively assessed 33 consecutive patients with placenta praevia and MRI diagnosis of multifocal accreta or increta. Manual removal of the placenta was performed during a scheduled caesarean delivery. In 15 patients, surgery was preceded by balloon catheterization of the abdominal aorta (Intra Abdominal Balloon Occlusion: IABO); 18 patients refusing IABO were considered as controls. We used Fisher’s exact test for categorical variables and Mann–Whitney test for continuous variables. Results: In the IABO group we observed significant decreases in incidence of hysterectomy, estimated blood loss, number of transfused units of red blood cells, postoperative stay and admission to Intensive Care Unit. No IABO-related complications were reported. Conclusions: During scheduled caesarean section for placenta previa multi...
TL;DR: Considering its shorter induction process and lower cost, Foley catheter with extra-amniotic saline infusion is superior to the Cook cervical ripening balloon for initiating cervical ripened.
Abstract: Objective: To compare the efficacy of two mechanical devices for cervical ripening: Foley catheter with extra-amniotic saline infusion and the Cook cervical ripening balloon. Methods: Women at term with a singleton pregnancy who presented for labor induction were randomly assigned to the Foley catheter or the Cook cervical ripening balloon (costs $3 and $41, respectively). The main outcome measures included time from device insertion to delivery, rates of successful vaginal delivery and occurrence of adverse events. Results: The study was completed by 188 women. Time from balloon insertion to expulsion and from insertion to delivery was significantly shorter in the Foley catheter group when compared with the Cook cervical ripening balloon group (6.9 ± 4.2 vs. 10.1 ± 4.7 hours, p = .001 and 19.6 ± 11.4 vs. 23.4 ± 15.5 hours, p = .03, respectively). There were no significant differences in other outcomes. Conclusions: Considering its shorter induction process and lower cost, Foley catheter with extra-amniot...
TL;DR: It is suggested that improving immunization safety/efficacy awareness among obstetricians as the most likely method to improve flu immunization during pregnancy.
Abstract: Introduction: Pregnant women and infants are at increased risk of vaccine-preventable complications due to influenza. In Switzerland, immunization was first recommended to all pregnant women in 2009. We assessed the acceptability of this recommendation and its determinants two seasons later. Methods: Women having delivered in the University Hospitals of Geneva during March 2011 were asked to fill in a questionnaire assessing their knowledge, beliefs and acceptability of influenza vaccination during pregnancy. Results: The questionnaire was completed by 261/323 (80%) women. Out of 261, 213 (82%) were aware of increased risks of influenza during pregnancy, and 119/261 (46%) knew that immunization was recommended during pregnancy. Only 110/261 (42%) recalled an immunization advise during their pregnancy and only 47/261 (18%) had been immunized. A direct recommendation was the main predictor of immunization, associated with a 107-fold increased likelihood of vaccination. Factors identified by multivariate ana...
TL;DR: The aim of this study was to determine the frequencies of abnormal pregnancy outcomes in a Chinese cohort and to identify clinical and laboratory factors predicting adverse fetal and maternal outcomes in Chinese women with systemic lupus erythematosus.
Abstract: Objective. The impact of pregnancy on lupus activity has been controversial especially in Chinese women. Research looking at predictive factors in this population are sparse. The aim of this study was therefore twofold: to determine the frequencies of abnormal pregnancy outcomes in a Chinese cohort and to identify clinical and laboratory factors predicting adverse fetal and maternal outcomes in Chinese women with systemic lupus erythematosus. Study design. Data of 111 pregnancies of 105 systemic lupus erythematosus (SLE) patients from January 1990 to December 2008 in Peking Union Medical College Hospital in Beijing were analyzed retrospectively. Univariate analysis using chi-square test and logistic regression was used to assess the predictive value of each variable on binary outcomes. Lupus activity was based on SLE Disease Activity Index (SLEDAI) criteria. Results. There were 23 elective, 2 spontaneous abortions, and 5 stillbirths, with 81 pregnancies resulting in live births including two multi...
TL;DR: An intraamniotic inflammatory response to bacteria in pregnancies complicated by PPROM seems to be different below and above 32 weeks of gestation.
Abstract: Objective: To analyse whether intraamniotic inflammation in response to bacteria is different below and above gestational age 32 weeks in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). Methods: A prospective study was performed, and 115 women with singleton pregnancies complicated by PPROM at gestational ages between 240/7 and 366/7 weeks were included in the study. Transabdominal amniocenteses were performed. Amniotic fluid was analysed using polymerase chain reactions for genital mycoplasmas and cultured for aerobic and anaerobic bacteria. The concentrations of 26 proteins in the amniotic fluid were determined simultaneously using multiplex technology. Results: Bacteria were found in the amniotic fluid of 43% (49/115) of the women. The women were stratified into two subgroups according to gestational age 32 weeks. The amniotic fluid levels of four (interleukin-6, interleukin-10, CC chemokine ligands 2, and 3) and one specific (CC chemokine ligands 2) proteins were higher in wo...
TL;DR: Nearly one in four California women experienced complications during childbirth hospitalization during 2005–2007, and non-white women were more likely to suffer morbidity.
Abstract: Objective: To determine the incidence and risk factors for maternal morbidity during childbirth hospitalization. Methods: Maternal morbidities were determined using ICD9-CM and vital records codes from linked hospital discharge and vital records data for 1,572,909 singleton births in California during 2005–2007. Socio-demographic, obstetric and hospital volume risk factors were estimated using mixed effects logistic regression models. Results: The maternal morbidity rate was 241/1000 births. The most common morbidities were episiotomy, pelvic trauma, maternal infection, postpartum hemorrhage and severe laceration. Preeclampsia (adjusted odds ratio [AOR]: 2.96; 95% confidence interval 2.8,3.13), maternal age over 35 years, (AOR: 1.92; 1.79,2.06), vaginal birth after cesarean, (AOR: 1.81; 1.47,2.23) and repeat cesarean birth (AOR: 1.99; 1.87,2.12) conferred the highest odds of severe morbidity. Non-white women were more likely to suffer morbidity. Conclusions: Nearly one in four California women experienced...
TL;DR: Type 2 diabetic patients have a higher incidence of adverse perinatal outcomes than nondiabetic patients independent of obesity, and diabetes remained a significant predictor of adverse delivery, fetal and neonatal composite outcomes.
Abstract: Objective: Given that both type 2 diabetes and obesity are associated with adverse pregnancy outcomes and often coexist, we sought to determine if outcomes in type 2 diabetic patients are related to the presence of diabetes or to maternal obesity. Methods: This retrospective cohort study examined perinatal outcomes of type 2 diabetic and nondiabetic patients matched by prepregnancy body mass index January 2000 to July 2008. Chi-square, Fisher’s exact test, Mann-Whitney U and t-tests were used to compare groups. The association between type 2 diabetes and adverse perinatal outcomes was evaluated through logistic regression with adjustment for potential confounders. Results: 213 pairs of type 2 and non-diabetic patients were compared. Diabetic patients had overall worse composite pregnancy, delivery, fetal, and neonatal outcomes. Specifically, diabetic patients had higher rates of preeclampsia, poly- and oligohydramnios, cesarean delivery, shoulder dystocia, postpartum hemorrhage, preterm delivery, LGA infa...
TL;DR: In this paper, a review summarizes current knowledge concerning the role for melatonin in human pregnancy and in the newborn and concludes that short-term melatonin therapy is highly effective in reducing complications during pregnancy and during the neonatal period.
Abstract: Reactive oxygen species (ROS) play a critical role in the pathogenesis of various diseases during pregnancy and the perinatal period. Newborns are more prone to oxidative stress than individuals later in life. During pregnancy, increased oxygen demand augments the rate of production of ROS and women, even during normal pregnancies, experience elevated oxidative stress compared with non-pregnant women. ROS generation is also increased in the placenta during preeclampsia. Melatonin is a highly effective direct free-radical scavenger, indirect antioxidant, and cytoprotective agent in human pregnancy and it appears to be essential for successful pregnancy. This suggests a role for melatonin in human reproduction and in neonatal pathologies (asphyxia, respiratory distress syndrome, sepsis, etc.). This review summarizes current knowledge concerning the role for melatonin in human pregnancy and in the newborn. Numerous studies agree that short-term melatonin therapy is highly effective in reducing complications during pregnancy and in the neonatal period. No significant toxicity or treatment-related side effects with long-term melatonin therapy in children and adults have been reported. Treatment with melatonin might result in a wide range of health benefits, including improved quality of life and reduced healthcare costs.
TL;DR: The NIFTY test was a highly specific test that could be avoided in almost all women who have a normal fetus and would recommend the test to their friends.
Abstract: Objective: To report the initial experience of noninvasive prenatal diagnosis of fetal Down syndrome (The NIFTY test) in a clinical setting. Methods: The NIFTY test was offered as a screening test for fetal Down syndrome to pregnant women with a singleton pregnancy at 12 weeks of gestation or beyond. A satisfaction questionnaire was sent to the first 400 patients. Results: During a 6-month period, 567 NIFTY tests were performed. Over 90% of those studied were ethnic Chinese, and the mean age of the women studied was 36 years. The test was performed at 12–13 weeks of gestation in 49.21%. The median reporting time was 9 days. The test was positive for trisomy 21 in eight cases, and for trisomy 18 in 1 case; all were confirmed by fetal karyotyping. There was no false-positive result. Of the questionnaires, 182 completed responses were received. Over 95% had complete or almost complete resolution of anxiety. Except for one, all were satisfied with the NIFTY test, and all indicated that they would recommend the test to their friends. Conclusion: The NIFTY test was a highly specific test. Unnecessary invasive tests and associated fetal losses could be avoided in almost all women who have a normal fetus.
TL;DR: Support is affirm for the recommendations of the IADPSG Consensus Panel on diagnosis and classification of hyperglycemia in pregnancy after careful consideration of these issues.
Abstract: The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study showed significant perinatal risks at levels of maternal hyperglycemia below values that are diagnostic for diabetes. A Consensus Panel of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) reviewed HAPO Study results and other work that examined associations of maternal glycemia with perinatal and long-term outcomes in offspring and published recommendations for diagnosis and classification of hyperglycemia in pregnancy in 2010. Subsequently, some commentaries and debate challenged the IADPSG recommendations. In this review, we provide details regarding some points that were considered by the IADPSG Consensus Panel but not published and address the following issues: 1) what should be the frequency of gestational diabetes mellitus (GDM); 2) were appropriate outcomes and odds ratios used to define diagnostic thresholds for GDM; 3) to improve perinatal outcome, should the focus be on GDM, obesity, or both; 4) should results of randomized controlled trials of treatment of mild GDM influence recommendations for diagnostic thresholds; and, 5) other issues related to diagnosis of GDM. Other groups are independently considering strategies for the diagnosis of GDM. However, after careful consideration of these issues, we affirm our support for the recommendations of the IADPSG Consensus Panel.
TL;DR: Utilization of management modifications identified in this review may reduce urologic injury due to INPLAT, as antenatal diagnosis is paramount to minimize UT injury.
Abstract: Objective. A systematic review of the literature was conducted to answer the following question: are there enhancements to standard peripartum hysterectomy technique that minimize unintentional urinary tract (UT) injury in pregnancies complicated by invasive placental attachment (INPLAT)?Methods. A PubMed search of English language articles on INPLAT published by June 2010 was conducted. Data regarding the following parameters was required for inclusion in the quantitative analysis of the review’s objective: (1) type of INPLAT, (2) details pertaining to medical and surgical management of INPLAT, and (3) complications, if any, associated with management. An attempt was made to identify approaches that may lower the risk of unintentional UT injury.Results. Most cases (285 of 292) were managed by hysterectomy. There were 83 (29%) cases of unintentional UT injury. Antenatal diagnosis of INPLAT lowered the rate of UT injury (39% vs. 63%; P = 0.04). Information regarding surgical technique or medical management...
TL;DR: Severe or morbid obesity were associated with an increased risk of adverse perinatal outcome and mortality and should be managed as high-risk pregnancies.
Abstract: Objective. The objective of this study is to examine the effects of abnormal maternal body mass index (BMI), either underweight or severe or morbid obesity (BMI 435), on obstetrical and neonatal outcomes. Methods. A three-year period (2.007–2.009) observational retrospective study was carried out in Granada (Spain). Women were categorized by first ten weeks of pregnancy BMI, according to World Health Organization (WHO) into three groups: underweight (518.5), normal (20–24.9), and severe or morbid obese (435). Obstetrical and neonatal outcomes were evaluated using normal group as reference after suitable adjustments for confounding factors. Results. 3.016 patients out of 12.781 single births were included. Maternal BMI classified 168 women (5.5 %) as underweight, 2.597 (86.1%) as normal, and 251 (8.3%) as severe or morbidly obese. As compared to normal women, underweight women were younger, and class II or III obese showed higher parity and higher incidence of hypertension disorders and Diabetes Mellitus. After controlling for these confounders, underweight women showed increased adjusted risk of oligohydramnios and low birth weight babies, and severe or morbidly obese women had an increased adjusted risk of Streptococcus Group B colonization, induction of labour, elective and emergency cesarean section, fetal macrosomia, fetal acidosis at birth, and perinatal mortality. Conclusions. Severe or morbid obesity were associated with an increased risk of adverse perinatal outcome and mortality and should be managed as high-risk pregnancies.
TL;DR: Melatonin reduces OS and inflammatory cells recruitment and glial cells activation in cerebral cortex after neonatal HI damage, which lays the groundwork for future clinical studies in infants.
Abstract: Objective: Oxidative stress (OS) plays a key role in perinatal brain damage. The aim of this study is to evaluate the effectiveness of melatonin as a neuroprotective drug by investigating the influence of melatonin on OS and inflammation biomarkers in an animal model of cerebral hypoxia-ischemia. Methods: Five minutes after hypoxic-ischemic (HI) injury melatonin was administered to 28 rats (HI-Mel group). At the same time, 28 hypoxic-ischemic rats were vehicle-treated (V-HI group). Five rats were used as sham operated controls (CTL). OS biomarkers: isoprostanes (IsoPs), neuroprostanes (NPs) and neurofurans (NFs), and microglial activation markers (glial fibrillary acidic protein [GFAP] and monoclonal antirat CD68 [ED1]) were measured in the cerebral cortex of the two lobes. Results: A significant increase of IsoPs on the left lobe was observed in V-HI after 1 hour (h) from HI injury (p < 0.001); a significant increase of NPs on both side (p < 0.05) and a significant increase of NFs on the left (p < 0.05) ...