Published by De Gruyter

Volume 41 Issue 1 - Special Anniversary Issue: 40 Years of JPM

Issue of Journal of Perinatal Medicine

Contents
Journal Overview

Masthead

Publicly Available January 5, 2013

Masthead

Page range: i-iii

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Editorials

Publicly Available January 5, 2013

A special comment from the Founder of the Journal of Perinatal Medicine on the occasion of the 40^th anniversary of its existence

Erich Saling

Page range: 1-1

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Abstract

No abstract available.

Publicly Available January 5, 2013

40 years of the Journal of Perinatal Medicine

Joachim W. Dudenhausen

Page range: 3-4

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Abstract

No abstract available.

Review Articles

Publicly Available May 12, 2012

To ‘C’ or not to ‘C’?/Caesarean delivery upon maternal request: a review of facts, figures and guidelines

Rohan D’Souza, Sabaratnam Arulkumaran

Page range: 5-15

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Abstract

The last few decades have seen an unrelenting rise in caesarean section (CS) rates. In addition to an increase in numbers of CS performed worldwide, there has also been a change in the indications for CS, a reflection of changing times. A new dilemma facing obstetricians is the increasing demand for CS in the absence of any medical indication (caesarean delivery on maternal request – CDMR). The paucity of evidence either in favour or against, the poor understanding of long-term health and financial implications and the complex ethical issues surrounding CDMR make counselling extremely challenging. Needless to say, CDMR has generated enormous interest both in the media and among health-care providers, and many national and international bodies have now issued guidelines on the topic. In this editorial, we have aimed to explore the factors responsible for the increase in CDMR rates, assess the safety and cost implications of CS and review the recent guidelines and recommendations on CDMR.

Publicly Available August 18, 2012

Perinatal risks after IVF and ICSI

Ursula Zollner, Johannes Dietl

Page range: 17-22

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Abstract

Pregnancies that occur after infertility treatment, particularly after assisted reproduction, constitute high-risk pregnancies. Occurrences of conditions such as high blood pressure, preeclampsia, growth retardations and bleeding are higher in comparison with the norm of spontaneously entered pregnancies. The rate of premature births and the frequency of intrauterine deaths are much higher than the average for all pregnancies. Furthermore, pregnancies resulting from in - vitro fertilisation (IVF) have significantly higher rates of requiring induced labour or caesarean section. However, it is to be assumed that these complications and unfortunate developments are not caused by extracorporeal fertilisation itself, but rather are due to the frequency of multiples and to the risk factors of the women involved. These women are, on average, older and there are often more problems with cycle irregularities, uterine anomalies and obesity than in the total collective of all pregnancies. The methods of modern reproductive medicine often bring a higher rate of multiple pregnancies. The clinical problem of multiple pregnancies is, above all, the raised rate of premature births and intrauterine growth retardations that contribute to the significantly higher rate of morbidity and mortality for these children. The slightly higher rate of congenital defects after IVF and intracytoplasmic sperm injection (ICSI) are also attributed more to the risk profile of the parents and less to the techniques themselves. The most important and easy-to-avoid complication is the multiple pregnancy, and it should be our goal to lower this rate even further.

Publicly Available January 5, 2013

A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix

Roberto Romero, Lami Yeo, Jezid Miranda, Sonia S. Hassan, Agustin Conde-Agudelo, Tinnakorn Chaiworapongsa

Page range: 27-44

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Abstract

Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, and is the most important challenge to modern obstetrics. A major obstacle has been that preterm birth is treated (implicitly or explicitly) as a single condition. Two thirds of preterm births occur after the spontaneous onset of labor, and the remaining one third after “indicated” preterm birth; however, the causes of spontaneous preterm labor and “indicated” preterm birth are different. Spontaneous preterm birth is a syndrome caused by multiple etiologies, one of which is a decline in progesterone action, which induces cervical ripening. A sonographic short cervix (identified in the midtrimester) is a powerful predictor of spontaneous preterm delivery. Randomized clinical trials and individual patient meta-analyses have shown that vaginal progesterone reduces the rate of preterm delivery at <33 weeks of gestation by 44%, along with the rate of admission to the neonatal intensive care unit, respiratory distress syndrome, requirement for mechanical ventilation, and composite neonatal morbidity/mortality score. There is no evidence that 17-α-hydroxyprogesterone caproate can reduce the rate of preterm delivery in women with a short cervix, and therefore, the compound of choice is natural progesterone (not the synthetic progestin). Routine assessment of the risk of preterm birth with cervical ultrasound coupled with vaginal progesterone for women with a short cervix is cost-effective, and the implementation of such a policy is urgently needed. Vaginal progesterone is as effective as cervical cerclage in reducing the rate of preterm delivery in women with a singleton gestation, history of preterm birth, and a short cervix (<25 mm).

Publicly Available May 17, 2012

Ethical challenges in the management of multiple pregnancies: the professional responsibility model of perinatal ethics

Frank A. Chervenak, Laurence B. McCullough

Page range: 61-64

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Abstract

Ethics is an essential component for the responsible clinical management of multiple gestation and decision-making about such pregnancies with pregnant women. The ethical concept of the fetus as a patient is presented as the basis for identifying a professionally responsible approach to selective termination, twin-to-twin transfusion syndrome, and to discordant beneficence-based obligations that exist when one or more fetuses are adversely affected by a fetal anomaly or complication of pregnancy. The roles for directive counseling, i.e., making evidence-based recommendations, and for non-directive counseling, i.e., offering evidence-based alternatives but making no recommendations, are described. The professional responsibility model of perinatal ethics creates a practical framework to guide the clinical judgment of perinatologists and the informed process about the clinical management of multiple pregnancies.

Publicly Available July 14, 2012

Therapeutic management of fetal anemia: review of standard practice and alternative treatment options

Nikos Papantoniou, Stavros Sifakis, Aris Antsaklis

Page range: 71-82

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Abstract

Fetal anemia, mainly due to red cell alloimmunization, is still a significant cause of fetal and neonatal mortality and morbidity. The focus of current clinical research has shifted from an invasive approach to non-invasive management and treatment of affected pregnancies, and the progress in this field is associated with a major improvement in perinatal outcome. During the last 50 years, intrauterine red cells transfusion (IUT), first via the intraperitoneal route and later directly to fetal circulation, is the standard practice in most centers, with survival rates that exceed 90%, particularly if anemia is diagnosed early and treated in a timely manner. In addition, plasmapheresis and intravenous administration of high-dose immunoglobulin have been implicated in the treatment of pregnancies complicated with early-onset severe red cell alloimmunization, alone or in combination with IUTs before the 20 th week of pregnancy, but there are still issues to be clarified further. This review article aims to provide an overview of the current standard therapeutic management and alternative treatment modalities in pregnancies complicated by fetal anemia.

Publicly Available June 12, 2012

New perspectives in electronic fetal surveillance

Emily F. Hamilton, Philip A. Warrick

Page range: 83-92

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Abstract

Despite its recognized limitations, fetal heart rate monitoring is a mainstay of intrapartum care. Although the basic technology in standard electronic fetal monitors has changed little in recent decades, clinical behavior in response to heart rate monitoring has changed considerably. In addition to clearly defined nomenclature and clinical guidelines, there is an increased awareness that environmental and human factors can impair clinical judgment, resulting in delayed intervention and, consequently, birth-related injury. This review examines three essential steps that affect clinical outcome: (1) signal acquisition, (2) associations with physiological outcome, and (3) clinical intervention. Only the third step is directly responsible for changing clinical outcome. However, timely initiation of interventions is dependent upon the second step, which is dependent upon the first step. Thus, deficiencies at each step tend to accumulate and contribute to the worsening of overall clinical outcome. This review article summarizes advances occurring at each step. The synergy and convergence of innovations in engineering, mathematics, and behavioral science shows considerable promise in intrapartum fetal surveillance.

Publicly Available July 25, 2012

An overview of central fetal monitoring systems in labour

Inês Nunes, Diogo Ayres-de-Campos, Catarina Figueiredo, João Bernardes

Page range: 93-99

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Abstract

A variety of systems for centralised viewing of fetal signals during labour are currently available, allowing simultaneous monitoring of multiple tracings in one or more locations. Display of maternal vital signs, ST signals and an electronic partogram are available in the majority of these systems. A few of them have incorporated computer analysis of cardiotocographic signals or combined cardiotocographic and ST data analysis. Computer analysis may elicit real-time alerts for healthcare professionals when changes associated with fetal hypoxia are detected. Central fetal monitoring systems have been installed in a large number of maternity hospitals in industrialised countries, but there is still limited evidence of their impact on perinatal indicators, on the behaviour of healthcare professionals and on related health costs.

Publicly Available April 27, 2012

Fetal growth and developmental programming

Sander Galjaard, Roland Devlieger, Frans A. Van Assche

Page range: 101-105

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Abstract

The environment in utero and in early neonatal life may induce a permanent response in the fetus and the newborn, leading to enhanced susceptibility to later diseases. This review concentrates on the role and mechanisms of events during the antenatal and immediate postnatal period resulting in later life diseases, concentrating on abnormal growth patterns of the fetus. Fetal overgrowth is related to exposure to a diabetic intra uterine environment, increasing the vulnerability to transgenerational obesity and hence an increased sensitivity to more diabetic mothers. This effect has been supported by animal data. Fetal growth restriction is complex due to malnutrition in utero , catch up growth due to a high caloric intake and low physical activity in later life. Metabolic changes and a transgenerational effect of intra uterine malnutrition has been supported by animal data. In recent years the discovery of alterations of the genome due to different influences during embryonic life, called epigenetics, has led to the phenomenon of fetal programming resulting in changing transgenerational metabolic effects.

Publicly Available July 14, 2012

Role of automation in neonatal respiratory support

Nelson Claure, Eduardo Bancalari

Page range: 115-118

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Abstract

Premature infants frequently present with respiratory instability, which is associated with fluctuations in ventilation and gas exchange. Adjustment of respiratory support to the infant’s needs is limited by staff availability and workload. Hence, automation is being explored as a way to improve the care of the premature infants. New modes of automatic respiratory support are being developed and becoming available for clinical use in preterm infants. These modes are expected to compensate for some of the limitations that presently exist in the conventional forms of respiratory support. Available evidence and preliminary findings are promising, but further investigation is needed to determine the effects of these modalities on the long-term outcome of preterm infants.

Publicly Available August 19, 2012

Perinatal prevention of bronchopulmonary dysplasia

Anne Greenough, Na’eem Ahmed

Page range: 119-126

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Abstract

Bronchopulmonary dysplasia (BPD), defined as oxygen dependency for at least 28 days after birth, is a common adverse outcome of very premature birth. Affected children require frequent readmissions to hospital in the first 2 years, and although lung growth and remodelling results in progressive improvement in lung function, airflow abnormalities may remain. Indeed, the most severely affected experience troublesome respiratory symptoms as adolescents and young adults. As a consequence, many potential preventative strategies have been investigated, and some have resulted in a reduction in BPD but with a negative risk/benefit ratio, for example, postnatal corticosteroids. Others therapies, namely antenatal corticosteroids and postnatal surfactant, have resulted in significant benefits to infants, including reductions in respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and neonatal death, but have not impacted favourably on the incidence of BPD, perhaps due to the increased survival of very immature infants. In one major trial, it has been shown that BPD can be reduced without adverse effects by caffeine administration. Avoidance of high oxygen concentrations at resuscitation is also a promising approach to reduce BPD.

Opinion Paper

Publicly Available November 3, 2011

Optimization of women’s health before conception when pregnancy has been postponed

Joachim W. Dudenhausen, Amos Grunebaum, Ursula M. Staudinger

Page range: 23-25

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Abstract

Objectives: In the industrialized world, the mean age at which mothers give birth to their first child has increased. The purpose of this article was to review the available evidence in order to optimize preconception care in women who have postponed childbearing to the later years of the reproductive life cycle. Methods: Review of literature. Results: There is a paucity of evidence and rigorous studies to advise mothers on the potential interventions for optimizing pregnancy outcome. Conclusions: Evidence-based guidelines for advising women who postponed childbearing are scant, and further research in this important area is urgently needed.

Original Articles

Publicly Available August 18, 2012

Preterm Birth Genome Project (PGP) – validation of resources for preterm birth genome-wide studies

Craig E. Pennell, Felipe Vadillo-Ortega, David M. Olson, Eun-Hee Ha, Scott Williams, Tim M. Frayling, Siobhan Dolan, Michael Katz, Mario Merialdi, Preterm Birth Genome Project (PGP) Consortium, Ramkumar Menon

Page range: 45-49

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Abstract

We determined a series of quality control (QC) analyses to assess the usability of DNA collected and processed from different countries utilizing different DNA extraction techniques prior to genome-wide association studies (GWAS). The quality of DNA collected utilizing four different DNA extraction techniques and the impact of shipping DNA at different temperatures on array performance were evaluated. Fifteen maternal-fetal pairs were used from four countries. DNA was extracted using four approaches: whole blood, blood spots with whole genome amplification (WGA), saliva and buccal swab. Samples were sent to a genotyping facility, either on dry ice or at room temperature and genotyped using Affymetrix SNP array 6.0. QC measured included extraction techniques, effect of shipping temperatures, accuracy and Mendelian concordance. Significantly fewer (50%) single nucleotide polymorphisms (SNPs) passed QC metrics for buccal swab DNA (P<0.0001) due to missing genotype data (P<0.0001). Whole blood or saliva DNA had the highest call rates (99.2 0.4% and 99.3 0.2%, respectively) and Mendelian concordance. Shipment temperature had no effect. DNA from blood or saliva had the highest call rate accuracy, and buccal swabs had the lowest. DNA extracted from blood, saliva and blood spots were found suitable for GWAS in our study.

Publicly Available October 12, 2012

Reduction of cesarean delivery rates after implementation of a comprehensive patient safety program

Amos Grunebaum, Joachim Dudenhausen, Frank A. Chervenak, Daniel Skupski

Page range: 51-55

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Abstract

Aims: The objective of this paper was to review our institution’s cesarean delivery rates starting in 2004 prior to the full implementation of a patient safety program including a uniform oxytocin policy until 2012 when the oxytocin policy and the safety program had been fully implemented. Results: Cesarean delivery rates at our institution decreased incrementally from 41.6% in 2004 to 32.7% in 2012. The decrease in cesarean delivery rates was observed for each of the five age groups. Conclusion: Concerns about an increase in cesarean delivery rates after implementation of a comprehensive patient safety program including a standardized oxytocin protocol may be unfounded. Despite the increase of US national cesarean delivery rates, our study shows that it is possible to safely lower cesarean delivery rates without concomitant concerns of litigations.

Publicly Available August 25, 2012

How safe is preterm operative vaginal delivery and which is the instrument of choice?

Siobhan Corcoran, Niamh Daly, Maeve Eogan, Mary Holohan, Tom Clarke, Michael Geary

Page range: 57-60

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Abstract

Objective: The objective of this study was to determine neonatal outcomes in preterm operative vaginal delivery given the current paucity of data available to guide clinicians. Study design: A retrospective review of 64 cases was conducted, and neonatal outcomes were compared to spontaneous vaginal deliveries in similar gestations. The primary outcomes studied were death and occurrence of intraventricular haemorrhage. Secondary outcomes included admission to NICU, Apgar <3 at 5 min, ventilation requirement, jaundice requiring treatment, culture-proven sepsis and necrotising enterocolitis. The study was conducted in a stand-alone maternity unit of approximately 9000 deliveries per year. Results and conclusions: We concluded that although vacuum delivery is avoided in preterm infants, outcomes were similar to forceps deliveries of similar gestations.

Publicly Available June 30, 2012

Single fetal death in twin gestations

Isaac Blickstein, Sharon Perlman

Page range: 65-69

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Abstract

Twin pregnancies are at higher risk for fetal mortality when compared with singleton pregnancies. Single fetal demise occurs in 3.7–6.8% of all twin pregnancies and considerably increases the complication rate in the co-twin including fetal loss, premature delivery, and end-organ damage. In this review, we summarize the current information on the etiology of single twin demise, the pathophysiology of injury to the surviving twin, and the preventive and secondary management strategies.

Publicly Available March 21, 2012

Comparison between antenatal neurodevelopmental test and fetal Doppler in the assessment of fetal well being

Asim Kurjak, Amira Talic, Ulrich Honemeyer, Milan Stanojevic, Ivica Zalud

Page range: 107-114

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Abstract

Aims: The primary aim of this study was to compare circulatory changes in the fetal brain under certain pathological conditions with alterations in fetal behavior. Patients and methods: A prospective longitudinal cohort study on fetal behavior of fetuses from singleton pregnancies between the 28 th and 38 th gestational week in the period from March 2009 to October 2011 was undertaken. There were 596 fetuses in the high-risk group and 273 fetuses in the low-risk group. Elevated umbilical artery Doppler pulsatility index and reduced middle cerebral artery pulsatility index obtained in the absence of fetal movements were considered abnormal. The Kurjak Antenatal Neurodevelopmental Test (KANET) was used to assess fetal behavior. Results: Statistically significant differences in the distribution of normal, abnormal, and borderline KANET scores between low-risk and high-risk groups were found. Furthermore, 596 fetuses from the high-risk group were subdivided into subgroups according to the risk factor. The largest proportion of abnormal KANET scores (23.9%) was in the subgroup of fetuses whose mothers had an offspring diagnosed with cerebral palsy (23.9%), followed by the proportion of borderline KANET scores in the subgroup of fetuses from febrile mothers (12.7%). Fetal behavior was significantly different between the normal group and the following subgroups of fetuses: fetal growth restriction (FGR), gestational diabetes mellitus, threatened preterm birth, antepartal hemorrhage, maternal fever, sibling with cerebral palsy, and polyhydramnios. Conclusions: A new clinical application of the KANET test in early identification of fetuses at risk for adverse neurological outcome was demonstrated.

Congress Calendar

Publicly Available January 5, 2013

Congress Calendar

Page range: 127-127

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Abstract

No Abstract available.

About this journal

Journal of Perinatal Medicine: Happy 50th Anniversary
The Journal of Perinatal Medicine (JPM) is celebrating its 50th anniversary. The first issue was published in January 1973, making it the first scientific journal in the field of perinatal medicine. JPM was founded by Erich Saling of Berlin (Germany), the father of perinatal medicine, and Roberto Caldeyro Barcia of Uruguay, an expert in uterine contractility, Edward Hon from the USA, who pioneered electronic heart rate monitoring of the fetus, and Stanley James, one of the most outstanding neonatologists. Over the past 50 years, JPM has grown with the increasing number of annual submissions and readers, as well as increasing impact within the scientific community.
Enjoy reading the Special Anniversary Issue we published on the occasion of JPM's milestone birthday!

Objective
The Journal of Perinatal Medicine (JPM) is a truly international forum covering the entire field of perinatal medicine. It is an essential news source for all those obstetricians, neonatologists, perinatologists and allied health professionals who wish to keep abreast of progress in perinatal and related research. Ahead-of-print publishing ensures fastest possible knowledge transfer. The Journal provides statements on themes of topical interest as well as information and different views on controversial topics. It also at informs about the academic, organisational and political aims and objectives of the World Association of Perinatal Medicine (WAPM)

Please submit your manuscript here

Topics
JPM covers the entire field of perinatal medicine, obstetrics and neonatology. It is published in 9 issues per year.

Article formats
Research Articles, Reviews, Mini Reviews and Opinion Papers, Short Communications, Editorials, Letters to the Editor, WAPM-Newsletters

Volume 41 Issue 1 - Special Anniversary Issue: 40 Years of JPM

Issue of Journal of Perinatal Medicine

Masthead

A special comment from the Founder of the Journal of Perinatal Medicine on the occasion of the 40th anniversary of its existence

Abstract

40 years of the Journal of Perinatal Medicine

Abstract

To ‘C’ or not to ‘C’?/Caesarean delivery upon maternal request: a review of facts, figures and guidelines

Abstract

Perinatal risks after IVF and ICSI

Abstract

A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix

Abstract

Ethical challenges in the management of multiple pregnancies: the professional responsibility model of perinatal ethics

Abstract

Therapeutic management of fetal anemia: review of standard practice and alternative treatment options

Abstract

New perspectives in electronic fetal surveillance

Abstract

An overview of central fetal monitoring systems in labour

Abstract

Fetal growth and developmental programming

Abstract

Role of automation in neonatal respiratory support

Abstract

Perinatal prevention of bronchopulmonary dysplasia

Abstract

Optimization of women’s health before conception when pregnancy has been postponed

Abstract

Preterm Birth Genome Project (PGP) – validation of resources for preterm birth genome-wide studies

Abstract

Reduction of cesarean delivery rates after implementation of a comprehensive patient safety program

Abstract

How safe is preterm operative vaginal delivery and which is the instrument of choice?

Abstract

Single fetal death in twin gestations

Abstract

Comparison between antenatal neurodevelopmental test and fetal Doppler in the assessment of fetal well being

Abstract

Congress Calendar

Abstract

A special comment from the Founder of the Journal of Perinatal Medicine on the occasion of the 40^th anniversary of its existence