Matern Fetal Neonatal Med Research Articles

Oral Nifedipine Versus Intravenous Labetalol for Hypertensive Emergencies During Pregnancy: A Systematic Review and Meta-analysis

(Abstracted from J Matern Fetal Neonatal Med 2023;36(2):2235057) Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal death. Severe pregnancy hypertension is defined as 160/110 mm Hg.

Maternal and Neonatal Outcomes of Trial of Labor Compared With Elective Cesarean Delivery According to Predicted Likelihood of Vaginal Delivery

(Abstracted from J Matern Fetal Neonatal Med 2022;35(26):10487–10493 In 2007, the Maternal-Fetal Medicine Unit (MFMU) Network developed the vaginal birth after cesarean (VBAC) calculator to help optimize the likelihood of a successful vaginal delivery. One study found that the risk of maternal and neonatal morbidity is no greater than that of elective repeat cesarean delivery (CD)—specifically when the likelihood of successful VBAC is >70%.

Listeria outbreaks cause maternal and perinatal mortality and morbidity: we must do better.

Listeria outbreaks cause maternal and perinatal mortality and morbidity: we must do better.

EBNEO Commentary: Safety and efficacy of erythropoietin in neonates with hypoxic-ischaemic encephalopathy.

EBNEO Commentary: Safety and efficacy of erythropoietin in neonates with hypoxic-ischaemic encephalopathy.

Mode of Delivery Is an Independent Risk Factor for Maternal Mortality: A Case-Control Study

(Abstracted from J Matern Fetal Neonatal Med 2022;35:1962–1968) In 2014, a systematic analysis by the World Health Organization found that the leading causes of maternal mortality were obstetric hemorrhage, hypertensive disorders, and pregnancy-related sepsis. However, in the United States, the leading causes of maternal death are cardiovascular conditions, noncardiovascular underlying medical conditions, and infection.

Fetal Scalp Blood Sampling During Second Stage of Labor—Analyzing Lactate or pH? A Secondary Analysis of a Randomized Controlled Trial

(Abstracted from J Matern Fetal Neonatal Med 2022;35(6):1100–1107) Cardiotocography (CTG) is widely used in pregnancy as a method to assess the well-being of the fetus. Although CTG has high sensitivity, it also has low specificity.

Increased Rates of Adverse Perinatal Outcomes in Women With Gestational Diabetes and Depression

(Abstracted from J Matern Fetal Neonatal Med 2021;34:3862–3866) Approximately 10% of pregnant women are diagnosed with gestational diabetes mellitus (GDM). Despite interventions such as nutrition education, exercise, and pharmacotherapy, women with GDM continue to have higher rates of adverse perinatal outcomes than those without GDM.

Perinatal Death by Bile Acid Levels in Intrahepatic Cholestasis of Pregnancy: A Systematic Review

(Abstracted from J Matern Fetal Neonatal Med 2021;34(21):3614–3622) Intrahepatic cholestasis of pregnancy (ICP) is characterized by elevated total bile acids (TBAs) and is the most common liver disease during pregnancy. The etiology and pathophysiology of ICP are not well understood, but genetics, ethnicity, hormones, nutrition, and the environment have been cited as risk factors.

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

Cumulative Deceleration Area: A Simplified Predictor of Metabolic Acidemia

(Abstracted from J Matern Fetal Neonatal Med 2021;34:3104–3111) Electronic fetal heart rate (FHR) monitoring is a mainstay of intrapartum clinical care, despite low agreement on the value of key elements of tracing analysis among obstetricians. The degree of heart rate variability and type of deceleration are used as etiologic indicators of the hypoxic injury driving deceleration but rely on subjective interpretation.

Bladder outlet obstruction

Bladder outlet obstruction

Renal agenesis

Renal agenesis

Ovarian cysts

Ovarian cysts

The rising preterm birth rate in China: a cause for concern

The rising preterm birth rate in China: a cause for concern

Does Transvaginal Ultrasound at 13–15 Weeks Improve Anatomic Survey Completion Rates in Obese Gravidas?

(Abstracted from J Matern Fetal Neonatal Med 2021;34:803–809) The fetal anatomic survey is less likely to be completed or is completed at a later gestational age in pregnant women who are obese. This reduces the likelihood of detecting fetal anomalies at an earlier stage of pregnancy.

Pushing the Limits: Perinatal Outcomes Beyond Prolonged Second Stage

(Abstracted from J Matern Fetal Neonatal Med 2021;34:409–415) The management of prolonged second stage (PSS) of labor has been a topic of debate for many years. In nulliparous women, PSS had been defined as 3 hours of labor with epidural and 2 hours without, according to American College of Obstetricians and Gynecologists guidelines for many years.

Use of Gestational Surrogates for Women With Eisenmenger Syndrome: A Cost-Effectiveness Analysis

(Abstracted from J Matern Fetal Neonatal Med 2021;34:526–531) One clear contraindication to pregnancy is Eisenmenger syndrome (ES), a rare complication affecting pulmonary function. Up to 50% of ES cases result in maternal deaths.

Women and babies are dying from inertia: a collaborative framework for obstetrical drug development is urgently needed

Obstetrical complications, often referred to as the "great obstetrical syndromes," are among the most common global causes of mortality and morbidity in young women and their infants. However, treatments for these syndromes are underdeveloped compared with other fields of medicine and are urgently needed. This current paucity of treatments for obstetrical complications is a reflection of the challenges of drug development in pregnancy. The appetite of pharmaceutical companies to invest in research for obstetrical syndromes is generally reduced by concerns for maternal, fetal, and infant safety, poor definition, and high-risk regulatory paths toward product approval. Notably, drug candidates require large investments for development with an unguaranteed return on investment. Furthermore, the discovery of promising drug candidates is hampered by a poor understanding of the pathophysiology of obstetrical syndromes and their uniqueness to human pregnancies. This limits translational extrapolation and de-risking strategies in preclinical studies, as available for other medical areas, compounded with limited fetal safety monitoring to capture early prenatal adverse reactions. In addition, the ethical review committees are reluctant to approve the inclusion of pregnant women in trials, and in the absence of regulatory guidance in obstetrics, clinical development programs are subject to unpredictable regulatory paths. To develop effective and safe drugs for pregnancy complications, substantial commitment, and investment in research for innovative therapies are needed in parallel with the creation of an enabling ethical, legislative, and guidance framework. Solutions are proposed to enable stakeholders to work with a common set of expectations to facilitate progress in this medical discipline. Addressing this significant unmet need to advance maternal and possibly perinatal health requires the involvement of all stakeholders and specifically patients, couples, and clinicians facing pregnancy complications in the dearth of appropriate therapies. This paper focused on the key pharmaceutical research and development challenges to achieve effective and safe treatments for obstetrical syndromes.

Hyperglycemia Recognized in Early Pregnancy Is Phenotypically Type 2 Diabetes Mellitus Not Gestational Diabetes Mellitus: A Case Control Study

(Abstracted from J Matern Fetal Neonatal Med 2020;33:3977–3983) Gestational diabetes mellitus (GDM) is defined as diabetes in pregnancy during the second or third trimester that is not overtly preexisting diabetes mellitus (DM). The time frame during gestation is based on the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, which showed an association between glucose and infants born large for gestational age in women who took a 75-g oral glucose tolerance test (OGTT) at routine testing (24–48 weeks' gestation).

Acetaminophen and the Developing Lung: Could There Be Lifelong Consequences?

Acetaminophen and the Developing Lung: Could There Be Lifelong Consequences?