Published by De Gruyter

Volume 46 Issue 1

Issue of Journal of Perinatal Medicine

Contents
Journal Overview

Publicly Available January 9, 2018

Frontmatter

Page range: i-iv

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Review article

March 22, 2017

The assessment of labor: a brief history

Wayne R. Cohen, Emanuel A. Friedman

Page range: 1-8

Abstract

In the 1930s, investigators in the US, Germany and Switzerland made the first attempts to quantify the course of labor in a clinically meaningful way. They emphasized the rupture of membranes as a pivotal event governing labor progress. Attention was also placed on the total number of contractions as a guide to normality. Beginning in the 1950s, Friedman determined that changes in cervical dilatation and fetal station over time were the most useful parameters for the assessment of labor progress. He showed all normal labors had similar patterns of dilatation and descent, differing only in the durations and slopes of their component parts. These observations led to the formulation of criteria that elevated the assessment of labor from a rather arbitrary exercise to one guided by scientific objectivity. Researchers worldwide confirmed the basic nature of labor curves and validated their functionality. This system allows us to quantify the effects of parity, analgesia, maternal obesity, prior cesarean, maternal age, and fetal presentation and position on labor. It permits analysis of outcomes associated with labor aberrations, quantifies the effectiveness of treatments and assesses the need for cesarean delivery. Also, dysfunctional labor patterns serve as indicators of short- and long-term risks to offspring. We still lack the necessary translational research to link the physiologic manifestations of uterine contractility with changes in dilatation and descent. Recent efforts to interpret electrohysterographic patterns hold promise in this regard, as does preliminary exploration into the molecular basis of dysfunctional labor. For now, the clinician is best served by a system of labor assessment proposed more than 60 years ago and embellished upon in considerable detail since.

Original articles – Obstetrics

June 26, 2017

The combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome increases the risk of intraventricular hemorrhage in preterm neonates

Kyung Joon Oh, Jee Yoon Park, JoonHo Lee, Joon-Seok Hong, Roberto Romero, Bo Hyun Yoon

Page range: 9-20

Abstract

Objective: To evaluate the impact of combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome (RDS) on the development of intraventricular hemorrhage (IVH) in preterm neonates. Methods: This retrospective cohort study includes 207 consecutive preterm births (24.0–33.0 weeks of gestation). Intra-amniotic inflammation was defined as an amniotic fluid matrix metalloproteinase-8 concentration >23 ng/mL. According to McMenamin’s classification, IVH was defined as grade II or higher when detected by neurosonography within the first weeks of life. Results: (1) IVH was diagnosed in 6.8% (14/207) of neonates in the study population; (2) IVH was frequent among newborns exposed to intra-amniotic inflammation when followed by postnatal RDS [33% (6/18)]. The frequency of IVH was 7% (8/115) among neonates exposed to either of these conditions – intra-amniotic inflammation or RDS – and 0% (0/64) among those who were not exposed to these conditions; and (3) Neonates exposed to intra-amniotic inflammation and postnatal RDS had a significantly higher risk of IVH than those with only intra-amniotic inflammation [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.1–19.3] and those with RDS alone (OR 5.6, 95% CI 1.0–30.9), after adjusting for gestational age. Conclusion: The combined exposure to intra-amniotic inflammation and postnatal RDS markedly increased the risk of IVH in preterm neonates.

February 10, 2017

Uterine artery Doppler pulsatility index at 11–38 weeks in ICSI pregnancies with egg donation

Annalisa Inversetti, Luca Mandia, Massimo Candiani, Irene Cetin, Alessandro Larcher, Valeria Savasi, Enrico Papaleo, Paolo Cavoretto

Page range: 21-27

Abstract

Background: Uterine artery Doppler pulsatility index (UtA-PI) may be different in pregnancies with egg donation (ICSI-ED) as compared to conceptions with autologous intra-cytoplasmatic sperm injection (autologous ICSI) and to spontaneous conceptions (SC). Methods: One hundred and ninety-four pregnant women with different modes of conception (MC) were prospectively evaluated: 53 ICSI-ED, 36 autologous ICSI and 105 SC. To evaluate the effects of different MC on PI, multivariable linear regression (MLR) models predicting UtA-PI were fitted after adjustment for maternal age, body mass index, race, parity, smoking status and gestational age. Results: In the first trimester, at MLR, autologous ICSI was not associated with a significantly different UtA-PI [estimate (EST) 0.01; 95% confidence interval (CI) −0.19, 0.2; P=0.9] when compared to SC. Conversely, MC by ICSI-ED was associated with lower first trimester UtA-PI (EST −0.32; CI −0.55, −0.08; P=0.01) when compared to SC. At MLR, MC by autologous ICSI and by ICSI-ED were not associated with significant differences in the second and third trimester UtA-PI when compared to SC. Conclusion: ICSI-ED conception presented lower UtA-PI when compared to SC at 11 +0 –13 +6 weeks but not at later assessments. Correction of UtA-PI measurement specifying the origin of oocyte may be useful in first trimester screening.

February 10, 2017

Violence before pregnancy and the risk of violence during pregnancy

Vislava Globevnik Velikonja, Miha Lučovnik, Tanja Premru Sršen, Vesna Leskošek, Megie Krajnc, Lucija Pavše, Ivan Verdenik, Natasa Tul, Isaac Blickstein

Page range: 29-33

Abstract

Objective: To investigate the relationships among different forms of violence before and during pregnancy. Material and methods: An anonymous questionnaire (adapted NorAQ) was given to 1269 women after childbirth. Results: The response rate was 80% (n=1018). Different forms of violence were experienced by 46.9% of the women; 9.2% reported violence in pregnancy. Suffering from the consequences of violence was reported by 43.8% of the women; sexual (76.6%) and psychological (54.1%) ranked the highest. Past experience of any form of violence increased the risk of violence in pregnancy, violences experienced in adulthood even more than that in childhood [odds ratio (OR) 4.2, 95% confidence interval (CI) 2.7–6.5 vs. OR 1.9, 95% CI 1.2–2.9]. The onset of violence during pregnancy is rare. Violence was most frequently exerted by the intimate partner. Conclusion: Healthcare systems have access to most women of reproductive age, thus they have the unique opportunity to identify and adequately manage violence against women and its consequences.

February 21, 2017

Cancer during pregnancy – clinical characteristics, treatment outcomes and prognosis for mothers and infants

Katarina Jeremic, Aleksandar Stefanovic, Jelena Dotlic, Sasa Kadija, Olivera Kontic, Miroslava Gojnic, Jelena Jeremic, Vesna Kesic

Page range: 35-45

Abstract

Objective: To assess which obstetrical characteristics and treatment improved outcomes and prognosis of pregnant women with malignancy. Methods: A prospective study, undertaken between 2005 and 2014, involving 35 pregnant women who were diagnosed with malignant tumors during pregnancy. Patients were followed-up for 1 year after delivery. The pregnancy course and outcome and parameters that could influence the condition of mother and fetus were evaluated. Results: Most malignancies were hematological, diagnosed in the second trimester and treated with combined therapy (surgery/adjuvant) after pregnancy. Most fetuses were in good state throughout pregnancy, but were delivered by caesarean section (CS) before term. Adjuvant therapy during pregnancy mostly caused transitory deterioration of fetal conditions. The majority of both mothers and infants were in a good state 12 months postpartum, although numerous mothers were still ill and on therapy. Surviving pregnancy and preventing tumors progression during pregnancy were the best predictors of mothers’ future condition (P=0.022). High birthweight and term delivery were the most important factors for good outcome of the infants (P=0.001). Conclusions: If the tumor is not progressing, pregnancy should be continued as long as possible to obtain adequate birthweight of the infant. Second trimester surgery is safe, while other therapies should preferably be applied after delivery.

Publicly Available February 28, 2017

The effect of attending a prenatal childbirth preparedness course on labor duration and outcomes

David Yohai, Debi Alharar, Ruthi Cohen, Zohar Kaltian, Barak Aricha-Tamir, Saviona Ben Aion, Zehava Yohai, Adi Y. Weintraub

Page range: 47-52

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Abstract

Objective: To evaluate the effect of attending a prenatal childbirth preparation course (CPC) on labor duration and outcomes. Methods: A cross sectional study of 53 primiparous women who attended and 54 women who did not attend a CPC was conducted. The state-trait anxiety inventory (STAI) score was used to diagnose anxiety. Clinical and obstetrical data were collected from the perinatal database of our center. Through post-partum interviews, coping strategies were assessed, patients graded their childbirth experience and breastfeeding was evaluated. Data were analyzed using description analyses and a P-value <0.05 was considered statistically significant. Results: The STAI score was significantly lower in the study group compared with controls (P=0.025). The first stage and the entire duration of labor were significantly shorter (P=0.036 and P=0.026, respectively) in women who attended the CPC. No significant differences were found with regard to the mode of delivery, rate of episiotomy, use of analgesics and neonatal outcomes between the groups. Women in the study group rated their labor experience significantly higher (P=0.016) and exhibited significantly higher rates of breastfeeding (P<0.001) than controls. Conclusions: The knowledge acquired in the CPC has positive effects on the course of labor and delivery outcomes as well as higher rates of breastfeeding.

February 28, 2017

Serum fibrinogen levels could be an index of successful use of balloon tamponade in postpartum hemorrhage

Ayaka Nakashima, Kazuhide Ogita, Masaya Chita, Takeshi Yokoi

Page range: 53-57

Abstract

Objective: The object of our study was to determine whether serum fibrinogen levels could be used to predict the success rates of balloon tamponade and decrease the use of invasive methods. Methods: This retrospective study, conducted at Rinku General Medical Center, was aimed to identify factors associated with high success rates in balloon tamponade. Forty-six patients with postpartum hemorrhage (PPH), non-responsive to uterotonics and treated with balloon tamponade between April 2008 and March 2015, were included. Results: Forty-six women were included, of which 34 underwent vaginal delivery and 12 underwent cesarean delivery. There were no complications from balloon tamponade and its success rate was 73.3%. Seven women required additional procedures: One used gauze packing, three used uterine artery embolization, and five underwent peripartum hysterectomy. The cut-off line of serum fibrinogen level was 172.5 mg/dL (P=0.002) with its 77.4% sensitivity and 66.7% specificity. Conclusion: We recommend measuring serum fibrinogen level for predicting whether the balloon tamponade can be used successfully or not.

July 8, 2017

Impact factors on cervical dilation rates in the first stage of labor

Jana Juhasova, Martina Kreft, Roland Zimmermann, Nina Kimmich

Page range: 59-66

Abstract

Aims: To assess cervical dilation rates of nulliparous and multiparous women in the active first stage of labor and to evaluate significant impact factors. Methods: In a retrospective cohort study between January 2007 and July 2014 at the University Hospital of Zurich in Switzerland, we analyzed 8378 women with singleton pregnancies in vertex presentation with a vaginal delivery at 34+0 to 42+5 gestational weeks. Median cervical dilation rates were calculated and different impact factors evaluated. Results: Cervical dilation rates increase during labor progress with faster rates in multiparous compared with nulliparous women (P<0.001). Dilation rates exceed 1 cm/h at a dilatation of 6–7 cm, but are very individual. Accelerating impact factors are multiparity, a greater amount of cervical dilation and fetal occipitoanterior position, whereas the use of epidural anesthesia, a higher fetal weight and head circumference decelerate dilation (P<0.001). Conclusion: Cervical dilation is a hyperbolic increasing process, with faster dilation rates in multiparous compared to nulliparous women and a reversal point of labor around 6–7 cm, respectively. Besides, cervical dilation is highly individual and affected by several impact factors. The diagnosis of labor arrest or prolonged labor should therefore be based on such rates and on the individual evaluation of every woman.

Publicly Available March 13, 2017

Feasibility and acceptability of text messaging to support antenatal healthcare in Iraqi pregnant women: a pilot study

Taghreed Alhaidari, Nazar Amso, Taqi Mohammed Jawad, Ulfat Alnakkash, Faris Khazaal, Ahmed Alnaaimi, Timothy Pickles, Rebecca Playle, Robert Istepanian, Nada Philip, John W. Gregory, Thamer Al Hilfi

Page range: 67-74

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Abstract

Objective: To determine the feasibility and acceptability of mobile health technology and its potential to improve antenatal care (ANC) services in Iraq. Methods: This was a controlled experimental study conducted at primary health care centers. One hundred pregnant women who attended those centres for ANC were exposed to weekly text messages varying in content, depending on the week of gestation, while 150 women were recruited for the unexposed group. The number of ANC visits in the intervention and control groups, was the main outcome measure. The Mann-Whitney test and the Poisson regression model were the two main statistical tests used. Results: More than 85% of recipients were in agreement with the following statements: “the client recommends this program for other pregnant women”, “personal rating for the message as a whole” and “obtained benefit from the messages”. There was a statistically significant increase in the median number of antenatal clinic visits from two to four per pregnancy, in addition to being relatively of low cost, and could be provided for a larger population with not much difference in the efforts. Conclusions: Text messaging is feasible, low cost and reasonably acceptable to Iraqi pregnant women, and encourages their ANC visits.

March 15, 2017

Clinical characteristics and outcome of twin pregnancies complicated by single intrauterine death

Qiong Luo, Xiujun Han

Page range: 75-79

Abstract

Abstract: Aim: To investigate the clinical characteristics and outcome of twin pregnancies complicated by single intrauterine death and how to improve the outcomes of surviving twins. Three thousand three hundred and eighty-four women who delivered twin pregnancies at Women’s Hospital, Zhejiang University, School of Medicine were included. Clinical and demographic data on gestational age, etiology, morbidity and mortality for mothers and fetuses were collected. Results: The median gestational age for detecting a single intrauterine death in twin pregnancy was 29 weeks and the average gestational age of pregnancy termination was 32 weeks. At least one complication occurred in 93 of 134 mothers (69.4%). The leading causes of a single intrauterine death were umbilical cord abnormality (21.6%), congenital anomalies (17.9%), twin-twin transfusion syndrome (TTTS) (8.2%) and velamentous placenta (7.4%). Of the 134 cases, in 115 cases the remaining twin survived. The birth weight of the surviving twin was significantly higher in pregnancies that continued for more than 1 week after single intrauterine death compared to that ended within 1 week after intrauterine death. Conclusions: Extension of gestation for the surviving twin fetus as long as possible in ensuring the health of the surviving twin and mother, will improve the prognosis of surviving twin after a single intrauterine death.

August 14, 2017

Utility of routine urine CMV PCR and total serum IgM testing of small for gestational age infants: a single center review

Michael M. Espiritu, Sean Bailey, Elena V. Wachtel, Pradeep V. Mally

Page range: 81-86

Abstract

Background: Due to the extremely low incidence of TORCH (toxoplasmosis, rubella, CMV, herpes simplex virus) infections, diagnostic testing of all small for gestational age (SGA) infants aimed at TORCH etiologies may incur unnecessary tests and cost. Objective: To determine the frequency of urine CMV PCR and total IgM testing among infants with birth weight <10% and the rate of test positivity. To evaluate the frequency of alternative etiologies of SGA in tested infants. Methods: Retrospective chart review of SGA infants admitted to the neonatal intensive care unit (NICU) at NYU Langone Medical Center between 2007 and 2012. Subjects were classified as being SGA with or without intrauterine growth restriction (IUGR). The IUGR subjects were then further categorized as having either symmetric or asymmetric IUGR utilizing the Fenton growth chart at birth. Initial testing for TORCH infections, which included serum total IgM, CMV PCR and head ultrasound, were reviewed and analyzed. Results: Three hundred and eighty-six (13%) infants from a total of 2953 NICU admissions had a birth weight ≤10 th percentile. Of these, 44% were IUGR; 34% being symmetric IUGR and 10% asymmetric. A total of 32% of SGA infants had urine CMV PCR and total IgM tested with no positive results. As expected, significantly higher percentage of symmetric IUGR infants were tested compared to asymmetric IUGR and non-IUGR SGA infants, (64% vs. 47% vs. 19%) P≤0.01. However, 63% of infants with a known cause for IUGR had same testing done aimed at TORCH infections. We calculated additional charges of $64,065 that were incurred by such testing. Conclusions: The majority of infants in our study who received testing for urine CMV PCR and total IgM aimed at TORCH infections had one or more other known non-infectious etiologies for IUGR. Because the overall yield of such testing is extremely low, we suggest tests for possible TORCH infections may be limited to symmetric IUGR infants without other known etiologies. Improved guidelines testing for TORCH infections can result in reducing hospital charges and unnecessary studies.

February 17, 2017

The association between pre-pregnancy obesity and screening results of depression for all trimesters of pregnancy, postpartum and 1 year after birth: a cohort study

Hanieh Salehi-Pourmehr, Sakineh Mohammad-Alizadeh, Nayyer Jafarilar-Agdam, Somayyeh Rafiee, Azizeh Farshbaf-Khalili

Page range: 87-95

Abstract

Objective: To determine the relationship between pre-pregnancy obesity and screening results of gestational and post-delivery depression in women referred to the health centers of Tabriz, Iran. Methods: In this cohort study, 62 and 245 pregnant women with class 2–3 obesity [body mass index (BMI)≥35 kg/m 2 ] and normal-weight (BMI 18.5–24.9 kg/m 2 ) were enrolled, respectively, in the first trimester of pregnancy from December 2012 to January 2016. For matching of groups, nulliparous and multiparous mothers aged 18–35 years were selected with the ratio of 1:4 in obese and normal BMI groups from the same recruitment center and to controlling the confounder factors, inclusion criteria were considered. The Edinburgh Postnatal Depression Scale (EPDS) was completed in five time points, the first, second, third trimester of pregnancy, 6–8 weeks and 12 months after delivery. Independent t -test, Mann-Whitney, chi-square, Fisher’s exact tests and multivariate logistic and linear regression adjusted for confounders were used. P<0.05 was considered as statistically significant. Results: Based on the EPDS, 12.7% of normal weight women in first, 13.5% in second, 10.2% in third trimester of pregnancy, 7.8% in 6–8 weeks of postpartum and 10.6% in 1 year after delivery screened positive for depression. This proportion was greater in class 2–3 obese women (32.3%, 33.3%, 28.8% in trimesters of pregnancy and 35.4%, 19.4% in postpartum period, respectively) (P<0.05). The results of multivariate logistic regression adjusted for confounding factors showed that the risk of depression in the first trimester of pregnancy for class 2–3 obesity was 3.25-fold greater than normal weight group [adjusted odds ratio (aOR) 3.25, 95% confidence interval (CI) 1.68–6.28]. This risk was 3.29-fold in the second (aOR 3.29, 95% CI 1.67–6.47), 4-folds in the third trimester (aOR 4.003, 95% CI 1.84–8.70 for third), 7.5-fold in the 6–8 weeks of postpartum (aOR 7.46, 95% CI 3.30–16.89) and 1.83-fold (aOR 7.46, 95% CI 3.30–16.89) for 1 year after birth. Conclusions: Pre-pregnancy obesity was associated with probability of gestational and post-delivery depression. Therefore, training and planning to conduct required interventions to resolve obesity seem be helpful in this regard.

Original articles – Fetus

February 25, 2017

Causes of intrauterine fetal death are changing in recent years

Hiroko Takita, Junichi Hasegawa, Masamitsu Nakamura, Tatsuya Arakaki, Tomohiro Oba, Ryu Matsuoka, Akihiko Sekizawa

Page range: 97-101

Abstract

Objective: To investigate, how causes of intrauterine fetal death (IUFD) have changed in recent years with the advancement of prenatal diagnosis at a single perinatal center in Japan. Methods: Medical records were retrospectively reviewed for all cases of IUFDs that occurred between 2001 and 2014. The most commonly associated causes of fetal deaths were compared between 2001–2007 and 2008–2014. Results: The number of IUFD after 20 weeks’ gestation/all deliveries in our center was 38/6878 cases (0.53%) in 2001–2007 and 35/7326 (0.48%) in 2008–2014. The leading cause of IUFD in 2001–2007 was fetal abnormalities (43.2%), the prevalence of which was only 8.6% in 2008–2014 (P<0.01). Meanwhile, the prevalence of umbilical cord abnormalities was relatively increased from 30.0% in 2001–2007 to 54.5% in 2008–2014 (P=0.06). In 2001–2007, chromosomal abnormalities were frequently observed (56% of IUFDs due to fetal abnormalities). Hyper-coiled cord (HCC) and umbilical ring constrictions were the most frequent cause of IUFD in both periods. The relatively decreased prevalence of IUFD due to velamentous cord insertion and umbilical cord entanglement, HCC and umbilical cord constriction was increased. Conclusions: The prevalence of IUFD due to fetal abnormalities was reduced, but IUFD associated with umbilical cord abnormalities tended to increase relatively.

Original articles – Newborn

March 27, 2017

Proactive approach at the limits of viability improves the short-term outcome of neonates born after 23 weeks’ gestation

Patrik Šimják, Jan Smíšek, Michal Koucký, Tereza Lamberská, Richard Plavka, Zdeněk Hájek

Page range: 103-111

Abstract

Objective: The aim of this single-center study was to identify factors that affect the short-term outcome of newborns delivered around the limits of viability. Methods: A group of 137 pregnant women who gave birth between 22+0/7 and 25+6/7 weeks of gestation was retrospectively studied. The center supports a proactive approach to infants around the limits of viability. Perinatal and neonatal characteristics were obtained and statistically evaluated. Results: A total of 166 live-born infants were enrolled during a 6-year period; 162 (97.6%) of them were admitted to the neonatal intensive care unit (ICU) and 119 (73.5%) survived until discharge. The decrease in neonatal mortality was associated with an advanced gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Neonatal morbidities were common among infants of all gestational ages. The incidence of severe intraventricular hemorrhage significantly depended on gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Survival without severe neonatal morbidities was 39.5% and occurred mostly after 24+0/7 weeks of gestation. Conclusion: The short-term outcome of newborns delivered around the limits of viability is mostly affected by gestational age and antenatal corticosteroid treatment. A consistently proactive approach improves the survival of infants at the limits of viability. This is most pronounced in cases where the delivery is delayed beyond 24 completed gestational weeks.

Letter to the Editor

December 30, 2017

Exact days of gestation necessary for infants at borderline viability: reply to Proactive approach at the limits of viability improves the short-term outcome of neonates born after 23weeks’ gestation. P. Šimják, J. Smíšek, M. Koucký, T. Lamberská, R. Plavka and Z. Hájek. J Perinat Med 2017

Shilpi Chabra

Page range: 113-114

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