Objective: Preterm births in the late preterm period comprise more than half of all preterm births.However, perinatal outcome evaluation between singleton and multiple pregnancies is limited.This study aimed to compare the perinatal outcomes of preterm pre-labor rupture of membranes (PPROM) between twin and singleton pregnancies at 34 weeks to 36 weeks and 6 days.Methods: This retrospective case-control study included women with preterm births at the Tertiary Hospital between July 2006 and December 2023.We analyzed and compared the maternal and neonatal characteristics, especially intertwined neonatal morbidity and mortality, with those of singletons.Results: There were 52 twin and 317 singleton pregnancies.Women with twin pregnancies had shorter median latencies and fewer cases of histological chorioamnionitis than those with singleton pregnancies.Compared to the ruptured sac babies of twins and singletons, unruptured sac babies of twins had longer hospital stays and were more likely to require respiratory support and resuscitation immediately after delivery.Conclusion: Maternal outcomes of twins and singletons after PPROM differed in latency and histologic chorioamnionitis, whereas neonatal outcomes demonstrated more acute respiratory problems and longer hospital stays in twin babies with unruptured sacs.More cautious respiratory care is needed for infants with an unruptured sac immediately after birth.

Objective:We elucidated the effect of monochorionicity on neonatal and long-term neurologic outcomes on an individual basis in triplets.Methods: We retrospectively reviewed the perinatal outcomes and development and growth at 18 to 24 months corrected age (CA) of triplets born alive between 24 and 32 weeks of gestational age (GA) between 2009 and 2021 from the Seoul National University Hospital database.Neurod evelopmental impairment (NDI) was defined as any delay among the Bayley-III domains (motor and language), cerebral palsy, hearing impairment, or visual loss and was performed at a CA of 18 to 24 months.Results: We included 40 sets of triplets (120 infants), comprising 26, 10, and 4 sets of trichorionic (TC), dichorionic (DC), and monochorionic (MC) triplets, respectively.Ten infants, unaffected by monochorionicity out of 30 DC infants, were included in the non-MC group.Eighty-eight infants were included in the non-MC group, and 32 infants were affected by monochorionicity.In vitro fertilization-embryo transfer was more frequent in the non-MC group (P<0.05), and twin-to-twin transfusion syndrome affected only the MC group (P<0.01).At 24 months of CA, a combined delay of language and cognition in Bayley-III was evident in the MC group (P<0.05).Although NDI did not significantly differ between the 2 groups (P=0.059), the composite outcome of NDI+ postnatal death was significantly different (P<0.05).NDI+ postnatal death correlated with GA, Z-score of birth weight, brain injury, and monochorionicity in the univariate analysis (P<0.05).Multivariate analysis revealed a significant correlation between monochorionicity and NDI+ postnatal death.(P<0.05).Conclusion: Monochorionicity is associated with adverse long-term neurodevelopmental outcomes.

Bronchopulmonary dysplasia (BPD) remains a significant concern in neonatal care despite advance ments in intensive care for preterm infants, as its incidence continues to rise.This chronic complica tion of prematurity not only affects respiratory function but also has impacts on growth and neuro development into childhood and adolescence.The evolution of BPD definitions reflects the changing landscape of neonatal care, aiming to better predict longterm outcomes and guide early interven tions.While the National Institute of Child Health and Human Development (NICHD) 2001 definition set a standard for classifying BPD severity, its limitations in capturing diverse respiratory support and predicting longterm outcomes have prompted the development of newer definitions, such as the NICHD 2018 and Neonatal Research Network 2019 definitions.These updated definitions offer improvements by considering a broader range of respiratory support criteria and enhancing predic tive value for mortality, respiratory morbidity, growth, and neurodevelopmental impairment.The primary goal of defining BPD and grading its severity is to identify highrisk infants early, enabling targeted interventions to improve longterm outcomes.Future efforts should focus on refining BPD definitions to best predict these outcomes and optimize care for this vulnerable population.

Meconium aspiration syndrome (MAS) is defined as respiratory distress in newborn infants born through meconium-stained amniotic fluid whose symptoms cannot be otherwise explained.MAS is characterized by hypoxemia, hypercapnia and acidosis that continues to be associated with significant morbidities and mortality.Worldwide, the incidence has declined due to improved obstetric and perinatal care.The pathophysiological mechanism of MAS include perinatal hypoxia, acute airway obstruction, pulmonary and systemic inflammation, surfactant inactivation and persistent pulmonary hypertension of the newborn (PPHN).Respiratory and hemodynamic supports are main therapies for MAS.Early identification and appropriate management of PPHN is important as it associates with significant mortality and morbidities.This review suggests a comprehensive overview of the epidemiology, diagnosis, management, prognosis and prevention of MAS.

During pregnancy, cervical incompetence has an incidence of approximately 0.5%, accounting for about 8% of mid-trimester miscarriages or stillbirths.Cervical cerclage is a crucial intervention to save fetuses at the periviable period, but it remains a contentious area due to insufficient evidence and susceptibility to selection bias.The American College of Obstetricians and Gynecologists' guidelines from 2014 were not revised, while the United Kingdom updated its recommendations in 2022 based on the 2011 guidelines, and Canada revised its guidelines in 2019 from those issued in 2013.In 2021, the International Federation of Gynecology and Obstetrics emphasized the importance of evidencebased medicine and released recommendations for cervical cerclage surgery.This review aims to examine the evidence for cervical cerclage, focusing on indications, timing of the procedure, its application in twin pregnancies from the four international guidelines, and to update recent metaanalyses and clinical research results about cervical cerclage.

Objective: This study aimed to determine the impact of gestational age (GA) cut-off on the clinical outcome of congenital diaphragmatic hernia (CDH) and assess whether prematurity influences the predictive value of fetal lung volume measurement.Methods: We investigated the medical records of infants with CDH between January 2014 and August 2021.We classified the patients into term CDH (TCDH) and preterm CDH (PCDH) groups and compared their clinical characteristics, including fetal lung volume measured by the observed-toexpected lung-to-head ratio (O/E LHR).Results: Among 145 infants with CDH, 23 (15.9%) were preterm.Mean O/E LHR was significantly higher in survivors than in non-survivors with no difference between TCDH and PCDH groups.Mortality rate was significantly higher in infants with GA <34 weeks (80%) than in late preterm infants (16.7%).O/E LHR, rather than GA <34 weeks, was a risk factor predicting mortality in multivariate analyses.Predictive power of O/E LHR was high in the TCDH and PCDH groups, respectively.The incidence of chronic lung disease did not differ between PCDH and TCDH. Conclusion:O/E LHR significantly predicted mortality in preterm infants, suggesting preterm birth alone should not be the determinant of early CDH treatment strategy.

Hydrops fetalis (HF) is a complex fetal complication with diverse etiologies.It is commonly classified into immune and non-immune forms, with well-established etiologies of non-immune HF (NIHF) including cardiovascular, chromosomal, and hematologic abnormalities.However, there have been cases of idiopathic NIHF lacking a clear underlying cause, prompting ongoing research.In this case report, we present a compelling association between the administration of chemotherapeutic agents during pregnancy and the development of NIHF.This report describes a unique case of HF in an infant born to a mother diagnosed with acute myeloid leukemia during pregnancy.The mother received chemotherapy at 26 weeks of gestation.The neonate initially presented with generalized edema, pericardial effusion, and ascites that resolved with appropriate supportive care.Prompt identification of the underlying causes of HF is crucial for prognostic assessment and implementation of effective management strategies.Therefore, considering maternal chemotherapy as a potential contributing factor to NIHF is of importance.

Objective: Hyperuricemia has been described commonly in preeclamptic pregnancies, often prece ding the diagnosis of preeclampsia and historically was used as a diagnostic marker of preeclampsia.The aim of this study was to determine the usefulness of gestation corrected hyperuricemia (GCH) to predict the recurrence of preeclampsia on subsequent pregnancy.Methods: The retrospective study of 64 women who had previous preeclampsia and checked serum uric acid was analyzed.GCH was defined as being one standard deviation above the gestationspecific mean.And we used uric acid zscores ([serum uric acid valuegestation specific mean]/standard deviation of the population) to account for gestationspecific alterations in uric acid and tested this as a continuous variable.The relationship between GCH and recurrence of preeclampsia on subsequent pregnancy was analyzed.Obstetric outcomes were reviewed according to absence or presence of GCH.P<0.05 was considered as significant.Results: Of 64 women, seventeen had the development of recurrent preeclampsia (26.6%).The absence or presence of GCH was not associated with the recurrence of preeclampsia on subsequent pregnancy (P=0.267).And gestationspecific uric acid zscore as a continuous variable did not show any association with the prediction of preeclampsia on subsequent pregnancy (P=0.427).GCH was associated with the small for gestational age (P=0.010).Conclusion: GCH does not predict the recurrence of preeclampsia on subsequent pregnancy.

Objective: Hypoxic-ischemic encephalopathy (HIE) frequently leads to neurological complications, such as seizures and developmental disorders.In addition to these challenges, many infants with HIE experience multi-organ dysfunction, and HIE is a major cause of acute kidney injury (AKI) during the neonatal period.This study aimed to investigate the risk factors for AKI in neonates treated with therapeutic hypothermia (TH) for HIE.Methods: We retrospectively reviewed neonates who received TH for HIE at a single center between January 2015 and August 2024.AKI was defined according to the neonatal modified Kidney Disease Improving Global Outcome criteria.Initial blood gas analysis, seizures, severity of HIE, neurologic studies, and mortality were compared between infants with and without AKI.Results: Among 288 neonates with HIE, TH was performed on 60 neonates, of which 3 were excluded, resulting in a total of 57 neonates.A total of 25 patients (43.9%) developed AKI, of whom 10 had stage 1 AKI, 6 had stage 2 AKI, and 9 had stage 3 AKI.In stage 3 AKI, one patient (1.8%) needed renal replacement therapy.Initial pH (P=0.040) and base excess (BE) (P=0.008) were significantly lower in the AKI group compared to the non-AKI group.AKI patients had a significantly higher rate of severe HIE (P=0.018),convulsions (P=0.022), and mortality (P=0.017).In logistic regression analysis, low initial BE and the presence of convulsion were independently associated with an increased risk of AKI, with odds ratios of 1.16 and 3.95, respectively.Conclusion: AKI remains common in neonates with HIE treated with TH.Low BE and convulsion were identified as independent risk factors for the development of AKI.