Published by De Gruyter

Volume 41 Issue 2

Issue of Journal of Perinatal Medicine

Contents
Journal Overview

Masthead

Publicly Available February 28, 2013

Masthead

Page range: i-iii

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Recommendation and Guidelines for Perinatal Practice

November 15, 2012

Presence of human milk bank is associated with elevated rate of exclusive breastfeeding in VLBW infants

Sertac Arslanoglu, Guido E. Moro, Roberto Bellù, Daniela Turoli, Giuseppe De Nisi, Paola Tonetto, Enrico Bertino

Page range: 129-131

Abstract

Human milk confers health benefits of vital importance for the sick and preterm infants in neonatal intensive care units (NICUs). Mother’s own milk is the first choice in preterm infant feeding, and every effort should be made to promote lactation. When mother’s milk is not available or is insufficient, donor human milk (DHM) is recommended. Yet, occasionally, the concern that the use of DHM might decrease breastfeeding is being raised. The present data collection planned by the Italian Association of Human Milk Banks (AIBLUD) in collaboration with the Italian Neonatal Network (INN) attempted to address this concern. A total of 4277 very low birth weight (VLBW) infants from 83 Italian NICUs were evaluated for this comparative analysis. The 83 Italian NICUs were divided into two groups: centers with a human milk bank (HMB) and centers without a HMB; the available parameters in the network – “any and exclusive breastfeeding rates” and “exclusive formula rate” at discharge – were compared. Exclusive breastfeeding rate at discharge was significantly higher in NICUs with a HMB than in NICUs without (29.6% vs. 16.0%, respectively). Any breastfeeding rate at discharge tended to be higher in the NICUs with HMB (60.4% vs. 52.8%, P=0.09), and exclusive formula rate was lower in the NICUs with HMB (26.5% vs. 31.3%), but this difference was not significant. This report shows that the presence of a HMB and the use of DHM in NICU are associated with increased breastfeeding rate at discharge from the hospital for VLBW infants.

Reviews

December 8, 2012

Bariatric surgery and pregnancy: the magical solution?

Kent Willis, Eyal Sheiner

Page range: 133-140

Abstract

The obesity epidemic is a problem of global importance with a profound impact on maternal-fetal health. Currently, 1 in 5 women, worldwide, are obese at time of conception. Normalizing pregravid weight may significantly reduce obstetrical complications and alter the long-term weight status of mother and child. Bariatric surgery is the most efficient form of weight loss in severely obese women. Surgery has the exciting potential to treat obesity in women of reproductive age and to prevent obesity-related reproductive complications. Pregnancy after bariatric surgery appears to be safe and is effective in reducing complications such as gestational diabetes mellitus, gestational hypertensive disorders and fetal macrosomia, but may result in an increase in neonates born small-for-gestational-age.

December 15, 2012

Placenta accreta and the risk of adverse maternal and neonatal outcomes

Jacques Balayla, Helen Davis Bondarenko

Page range: 141-149

Abstract

Objective: Placenta accreta is an increasingly prevalent and potentially dangerous complication of pregnancy. Although most studies on the subject have addressed the risk factors for the development of this condition, evidence on maternal and neonatal outcomes for these pregnancies is scarce. The objective of the present study is to compile current evidence with regard to risk factors as well as adverse outcomes associated with placenta accreta. Methods: We conducted a complete literature review using PubMed, MEDLINE, Cochrane Database Reviews, UptoDate, DocGuide, as well as Google scholar and textbook literature for all articles on placenta accreta, and any one of the following keywords: “risk factors”, “maternal outcomes”, “neonatal outcomes”, “morbidity”, and “mortality”. Individual case reports were excluded. Results: We reviewed 34 studies conducted between 1977 and 2012. A total number of 508,617 deliveries were studied, with 865 cases of confirmed placenta accreta (average pooled incidence=1/588). The development of placenta accreta appears to be most strongly predicted by a history of cesarean section, low-lying placenta/previa, in vitro fertilization pregnancy, as well as elevated second-trimester levels of α-fetoprotein and β-human chorionic gonadotropin. The most significant maternal outcomes include the need for postpartum transfusion due to hemorrhage and peripartum hysterectomy. Maternal mortality remains rare but significantly higher than among matched, postpartum controls. Important neonatal outcomes include preterm birth, low birth weight, small for gestational age, and reduced 5-min Apgar scores. Whether the need for neonatal intensive care unit admission and steroid administration is iatrogenic and whether an increased risk of perinatal mortality is a clinically significant and independent outcome remain controversial. Conclusion: Although there is a significant shortage of studies on the subject, it appears that placenta accreta is associated with adverse maternal and neonatal outcomes, some of which may be life threatening. Prenatal diagnosis and adequate planning, particularly in high-risk populations, may be indicated for the reduction of these adverse outcomes.

Original Articles - Obstetrics

August 19, 2012

Correlation between an absence of cervical gland area on transvaginal sonography and cervical mucus hyaluronic acid levels in women with threatened preterm delivery

Naoko Tateyama, Hirobumi Asakura, Toshiyuki Takeshita

Page range: 151-157

Abstract

Purpose: Transvaginal sonographic findings of an absent cervical gland area (CGA) and a short cervical length (CL) are frequently observed in patients with threatened preterm delivery. The present study aimed to clarify whether sonographic findings are due to active production of hyaluronic acid (HA) in the cervix. Methods: Possible relationships between sonographic findings of the presence or absence of the CGA and/or a short CL and cervical mucus HA concentration were investigated in 68 women with threatened preterm delivery at 22–31 weeks’ gestation and 136 women without threatened preterm delivery as controls. Results: HA levels were higher in women with threatened preterm delivery (68.0 ng/mL) than in controls (39.0 ng/mL; P=0.001). Similarly, HA levels were higher in women with preterm labor showing an absent CGA and a short CL than in women with threatened preterm delivery without such findings (P<0.01). Stepwise multivariate logistic regression identified an absent CGA and threatened preterm delivery as independent predictors of high HA levels (P=0.04). HA concentration was not predictive for preterm delivery. Conclusion: A sonographic finding of an absent CGA reflects high HA levels in the cervix with threatened preterm delivery.

September 11, 2012

Adult separation anxiety during pregnancy and its relationship to depression and anxiety

Valsamma Eapen, Deborah Johnston, Alex Apler, Susan Rees, Derrick M. Silove

Page range: 159-163

Abstract

Aims: The current study, the first of its kind, investigated the overlap between adult separation anxiety (ASA) and the symptoms of depression and anxiety in the context of pregnancy. Methods: Women attending an antenatal clinic were screened using the Adult Separation Anxiety Scale (ASA-27). As most perinatal clinics use the Edinburgh Depression Scale (EDS), this study explored the relationship between ASA and the anxiety and depression symptoms by comparing the ASA-27 scores with the scores on the EDS. A subsample including both screen positives and screen negatives on ASA-27 was clinically interviewed using the Mini International Neuropsychiatric Interview (MINI). Results: Women with ASA were significantly more likely to be screened positive for depression (EDS total score) and anxiety (EDS-3A anxiety subscale) than those without ASA. The diagnosis of ASA disorder in this population had only a moderate but significant association with the diagnoses of generalized anxiety disorder [χ 2 (1)=25.9, P=0.000, Φ=0.443] and major depression [χ 2 (1)=16, P=0.000, Φ=0.348] made using the MINI. Conclusion: Adult separation anxiety warrants independent assessment in order to tailor appropriate interventions for the individual subtypes of anxiety in the perinatal period.

September 10, 2012

Value of Doppler sonography near term: can umbilical and uterine artery indices in low-risk pregnancies predict perinatal outcome?

Nora Bolz, Karim D. Kalache, Christina Fotopoulou, Hans Proquitte, Torsten Slowinski, John P. Hartung, Wolfgang Henrich, Christian Bamberg

Page range: 165-170

Abstract

Aim: The goal of this study was to evaluate the umbilical and uterine Doppler velocimetry waveforms for predicting the perinatal outcome of low-risk pregnancies at term. Methods: We prospectively recruited 514 women with low-risk pregnancies and performed umbilical and uterine artery Doppler assessments between 37 and 41 weeks of gestation. Ultrasound measurements (completed in 365 patients) were correlated with the perinatal outcome. Results: The velocimetry waveforms of the umbilical artery were significantly associated with birthweight, placental weight, and postpartal umbilical artery pH. Low pH, placental weight, and birthweight were correlated with increasing pulsatility index (PI) and resistance index (RI). An umbilical artery PI>1.2 and a uterine artery RI>0.5 were associated with statistically higher rates of infants that were small for gestational age (SGA). Also, high cesarean delivery rates were correlated with an umbilical artery PI>1.2. Conclusions: In our low-risk pregnancies population, the elevated umbilical artery indices at term appeared to be associated with the higher rates of infants that were SGA and cesarean deliveries. The Doppler waveforms at term had low prognostic value for predicting neonatal acidosis or decreased Apgar scores.

September 4, 2012

Induction of labor after a prior cesarean delivery: lessons from a population-based study

Lea Shatz, Lena Novack, Moshe Mazor, Ruthy Beer Weisel, Doron Dukler, Tal Rafaeli-Yehudai, Osnat Israeli, Offer Erez

Page range: 171-179

Abstract

Objectives: The aims of this study were (1) to determine the success rate of induction of labor (IOL) in women with a prior cesarean section (CS) and (2) to compare the perinatal outcome of a trial of labor (TOL) in women with one prior CS who had an IOL, spontaneous onset of labor, or an elective repeated CS (ERCS). Material and methods: This study population was divided into three groups: women who had (1) ERCS (n=1916), (2) spontaneous TOL (n=4263), and (3) IOL (n=1576). Results: (1) The rate of IOL in the study cohort was 20.3%; of these, 67.4% had a successful vaginal birth after cesarean (VBAC). (2) Patients in the spontaneous TOL group had a higher VBAC rate than did those who had IOL (P<0.001). (3) The rate of uterine rupture was comparable among all study groups. And (4) a prior vaginal birth increased the likelihood of having a successful induction and a VBAC by 50%. Conclusion: IOL in patients with a previous CS is successful in about two-thirds of the cases. Induction is a safe and useful tool that can serve as an alternative for ERCS and assist to reduce the rate of ERCS.

September 14, 2012

Clinical evaluation of soluble intercellular adhesion molecule-1 and insulin like growth factor-binding protein-1-based rapid immunoassays for the diagnosis of prelabor rupture of membranes

Tao Wang, Rong Zhou, Wei Xiong, Yanyun Wang, Cairong Zhu, Changping Song, Linbo Gao, Lin Zhang, Huaizhong Hu

Page range: 181-185

Abstract

Aims: To evaluate the clinical value of two rapid tests, based on soluble intercellular adhesion molecule-1 (Leakection) and insulinlike growth factor-binding protein-1 (Amnioquick), for the diagnosis of prelabor rupture of membranes. Methods: A total of 200 pregnant women were recruited in this study: 100 pregnant women with membrane rupture and 100 healthy pregnant women as controls. Patients and controls were randomly divided into Leakection and Amnioquick groups, respectively. Sensitivity and specificity were calculated on the basis of the detection results. Results: For the 100 women tested with Leakection, the sensitivity and specificity was 94% and 96%, respectively; the total accuracy was 95%. For the 100 women tested with Amnioquick, the sensitivity and specificity was 80% and 100%, respectively; the total accuracy was 90%. Conclusions: Both Leakection and Amnioquick are non-invasive and inexpensive rapid tests for the diagnosis of premature or prelabor rupture of membranes with high sensitivity and specificity. These tests could greatly help the timely diagnosis of premature or prelabor rupture of membranes in clinical practice.

Original Articles - Fetus

September 28, 2012

The clinical value of KANET in studying fetal neurobehavior in normal and at-risk pregnancies

Ulrich Honemeyer, Amira Talic, Alya Therwat, Litty Paulose, Rheka Patidar

Page range: 187-197

Abstract

Objectives: The aim of this study was to evaluate the clinical value of Kurjak’s Antenatal Neurodevelopmental Test (KANET), a new test for fetal neurodevelopment. Methods: One hundred seventeen prenatal neurological tests were performed by the KANET scoring system between 28 and 38 weeks of gestation in 24 low-risk (24 fetuses) and 26 at-risk pregnancies (32 fetuses). The study was completed within 12 months from July 2011 onward. All 56 babies were assessed for early neurological outcome at birth by neonatologists. Results: There were no abnormal KANET scores. Two thirds of all borderline scores were found in the at-risk group. Because KANET was performed more than once in most pregnancies, we introduced the average KANET score. Only one fetus of the “at-risk group” had a borderline average score. This fetus had the only abnormal early neurological outcome of all 56 fetuses. When we compared all 18 borderline KANET scores with fetal diurnal rhythm based on maternal observation, we found that 89% of the borderline scores of the “at-risk” group were at times characterized by the mother as usually “active” periods compared with 33.3% in the low-risk group. Conclusion: KANET is suggestive of expressing the risk for neurodevelopmental fetal disorders. Studies designed to investigate the potential connectivity of fetal diurnal rhythm and pregnancy risk status should follow.

Original Articles - Newborn

September 5, 2012

Effect of maternal vitamin A deficiency during pregnancy on neonatal kidney size

Ehab K. El-Khashab, Ahmad M. Hamdy, Karima M. Maher, Mohamed A. Fouad, Ghada Z. Abbas

Page range: 199-203

Abstract

Background and aims: In animal studies, vitamin A deficiency (VAD) during pregnancy has been shown to be associated with a decrease in nephron number and kidney weight of the offspring. At present, it is unclear whether these observations are pertinent to humans. Thus, this study was performed to assess the vitamin A status of a cohort of Egyptian pregnant women and their newborns and to determine the potential effect of maternal VAD during pregnancy on the neonatal kidney size. Methods: The maternal and cord blood samples were collected for the measurement of serum retinol concentration. Within the first 3 days after delivery, an abdominal ultrasound was performed in all newborns to determine the renal dimensions and volume. Results: Sixteen (20%) mothers had VAD. The newborns delivered to VAD mothers had significantly lower mean values of cord retinol concentrations and dimensions of both kidneys than the newborns delivered to mothers with vitamin A sufficiency. The maternal serum retinol concentrations were positively correlated with the cord retinol concentrations, the dimensions of both kidneys, and the combined renal volume of their respective newborns. Conclusion: Maternal VAD during pregnancy may decrease renal size in the infant at birth. The functional implications of this effect warrant further study.

August 28, 2012

Polymorphism 1936A>G in the AKAP10 gene (encoding A-kinase-anchoring protein 10) is associated with higher cholesterol cord blood concentration in Polish full-term newborns

Beata Łoniewska, Mariusz Kaczmarczyk, Jeremy Simon Clark, Agnieszka Kordek, Andrzej Ciechanowicz

Page range: 205-210

Abstract

Aims: A-Kinase anchoring proteins (AKAPs) coordinate the specificity of protein kinase A signaling by localizing the kinase to subcellular sites. The 1936G (V646) AKAP10 allele has been associated with adults with low cholinergic/vagus nerve sensitivity and with newborns with increased blood pressure. Decreased activity of the parasympathetic system is associated with risk of metabolic syndrome. The aim of this study was to answer the question of whether 1936A>G AKAP10 polymorphism is associated with metabolic changes in full-term newborns that are predictive factors for the metabolic phenotype in adulthood. Methods: The study included 114 consecutive healthy Polish newborns born after the end of the 37 th week of gestation to healthy women with uncomplicated pregnancies. At birth, cord blood of neonates was obtained for isolation of genomic DNA and cholesterol as well as triglyceride concentration. Results: The cholesterol level in homozygotes GG was significantly higher than that in 1936A variant carriers (AG+AA, recessive mode of inheritance). Conclusions: Our results demonstrate a possible association between the 1936G AKAP10 variant and the total cholesterol level in the cord blood of the Polish newborn population.

August 28, 2012

Defining hypoxic ischemic encephalopathy in newborn infants: benchmarking in a South African population

Alan R. Horn, George H. Swingler, Landon Myer, Michael C. Harrison, Lucy L. Linley, Candice Nelson, Lloyd Tooke, Natasha R. Rhoda, Nicola J. Robertson

Page range: 211-217

Abstract

Objectives: There are few population-based studies of hypoxic ischemic encephalopathy (HIE) in sub-Saharan Africa, and the published criteria that are used to define and grade HIE are too variable for meaningful comparisons between studies and populations. Our objectives were (1) to investigate how the incidence of HIE in our region varies with different criteria for intrapartum hypoxia and (2) to determine how encephalopathy severity varies with different grading systems. Method: We reviewed the records of infants with a diagnosis of HIE born between September 2008 and March 2009 in public facilities in the Southern Cape Peninsula, South Africa. The incidence of HIE was calculated according to four definitions of intrapartum hypoxia and graded according to three methods. Results: Depending on which defining criteria were applied, the incidence of HIE varied from 2.3 to 4.3 per 1000 live births, of mild HIE ranged from 0.4 to 1.3 per 1000 live births, and of moderate-severe HIE ranged from 1.5 to 3.7 per 1000 live births. Ninety-seven of the 110 (88%) infants reviewed had at least one intrapartum-related abnormality. Only 62 (56%) infants had a blood gas performed in the first hour of life. Conclusion: The incidence and grade of HIE can vary more than 2-fold in the same population, depending on which defining criteria are used. Consensus definitions are needed for benchmarking.

September 5, 2012

Comparison of left ventricular cardiac dimensions between small and appropriate for gestational age preterm infants below 30 weeks of gestation

Christoph Czernik, Stefanie Rhode, Boris Metze, Christoph Bührer, Lothar Schmitz

Page range: 219-226

Abstract

Objective: The development of the left cardiac structures in the early life of small for gestational age (SGA) preterm infants has been inadequately studied. The aim of the study was to compare the left ventricular cardiac dimensions between SGA and appropriate for gestational age (AGA) preterm infants. Methods: Echocardiography was performed on day 2 (T1) and at age 1 month (T2) in 19 SGA preterm infants (birthweight <3 rd percentile) and 21 AGA controls (P25-50) matched for gestational age (<30 weeks). Results: The left ventricular cardiac dimensions did not differ significantly between SGA and AGA infants at either T1 or T2 after correction for body length. The left ventricular mass was similar for SGA and AGA infants at T1 and T2 after correction for body weight or body length. The left ventricular output increased significantly from T1 to T2 in both SGA and AGA infants [SGA: 350 (T1)–640 (T2) mL/kg/min, P<0.05; AGA: 300 (T1)–510 (T2) mL/kg/min, P<0.05]. Conclusions: The left cardiac structures related to body length are comparable between SGA and AGA preterm infants in the first month of life and show similar development.

Letter to the Editor

August 19, 2012

Vegan carriage of group B streptococcus: a questionnaire study utilising social media

Abdul Qader Ismail, Raveem Ismail, Mark Anthony

Page range: 227-227

Abstract

No abstract available.

Book Review

February 28, 2013

I hear a song in my head. A memoir in stories of love, fear, doctoring and flight

A. Gerald Shaper

Page range: 229-229

Abstract

No abstract available.

Congress Calendar

February 28, 2013

Congress Calendar

Page range: 231-231

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)

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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