Published since January 1, 1973

Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine, the International Academy of Perinatal Medicine, the New York Perinatal Society, and the Society for the Fetus as a Patient

ISSN: 1619-3997

Editor-in-chief: Joachim W. Dudenhausen, MD, FRCOG

Edited by: Thorsten Braun, Frank A. Chervenak, Vincenzo D'Addario, Marty Ellington, Mehmet R. Genc, Anne Greenough, Amos Grunebaum, Asim Kurjak, Roberto Romero, Daniel W. Skupski, Ivica Zalud

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

Your Benefits

New results from the clinical and experimental areas
Theoretical and practical aspects of all subdisciplines
Fast transfer of knowledge
Critical, high quality peer-review

Since 2014 the Journal of Perinatal Medicine has been the official journal of the International Academy of Perinatal Medicine and the New York Perinatal Society.

History

Content available since 1973

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Volume 51 Issue 4

May 2023

Publicly Available May 4, 2023

Frontmatter

Page range: i-iv

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Reviews

Open Access October 3, 2022

Placenta Accreta Spectrum Part I: anesthesia considerations based on an extended review of the literature

Rick Enste, Patrick Cricchio, Pierre-Yves Dewandre, Thorsten Braun, Christopher O. Leonards, Phil Niggemann, Claudia Spies, Wolfgang Henrich, Lutz Kaufner

Page range: 439-454

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Abstract

“Placenta Accreta Spectrum” (PAS) describes abnormal placental adherence to the uterine wall without spontaneous separation at delivery. Though relatively rare, PAS presents a particular challenge to anesthesiologists, as it is associated with massive peripartum hemorrhage and high maternal morbidity and mortality. Standardized evidence-based PAS management strategies are currently evolving and emphasize: “PAS centers of excellence”, multidisciplinary teams, novel diagnostics/pharmaceuticals (especially regarding hemostasis, hemostatic agents, point-of-care diagnostics), and novel operative/interventional approaches (expectant management, balloon occlusion, embolization). Though available data are heterogeneous, these developments affect anesthetic management and must be considered in planed anesthetic approaches. This two-part review provides a critical overview of the current evidence and offers structured evidence-based recommendations to help anesthesiologists improve outcomes for women with PAS. This first part discusses PAS management in centers of excellence, multidisciplinary care team, anesthetic approach and monitoring, surgical approaches, patient safety checklists, temperature management, interventional radiology, postoperative care and pain therapy. The diagnosis and treatment of hemostatic disturbances and preoperative prepartum anemia, blood loss, transfusion management and postpartum venous thromboembolism will be addressed in the second part of this series.

Open Access October 3, 2022

Placenta Accreta Spectrum Part II: hemostatic considerations based on an extended review of the literature

Rick Enste, Patrick Cricchio, Pierre-Yves Dewandre, Thorsten Braun, Christopher O. Leonards, Phil Niggemann, Claudia Spies, Wolfgang Henrich, Lutz Kaufner

Page range: 455-467

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Abstract

“Placenta Accreta Spectrum” (PAS) is a rare but serious pregnancy condition where the placenta abnormally adheres to the uterine wall and fails to spontaneously release after delivery. When it occurs, PAS is associated with high maternal morbidity and mortality — as PAS management can be particularly challenging. This two-part review summarizes current evidence in PAS management, identifies its most challenging aspects, and offers evidence-based recommendations to improve management strategies and PAS outcomes. The first part of this two-part review highlighted the general anesthetic approach, surgical and interventional management strategies, specialized “centers of excellence,” and multidisciplinary PAS treatment teams. The high rates of PAS morbidity and mortality are often provoked by PAS-associated coagulopathies and peripartal hemorrhage (PPH). Anesthesiologists need to be prepared for massive blood loss, transfusion, and to manage potential coagulopathies. In this second part of this two-part review, we specifically reviewed the current literature pertaining to hemostatic changes, blood loss, transfusion management, and postpartum venous thromboembolism prophylaxis in PAS patients. Taken together, the two parts of this review provide a comprehensive survey of challenging aspects in PAS management for anesthesiologists.

Corner of Academy

Open Access October 3, 2022

The impact of lateral placenta on preeclampsia and small for gestational age neonates: a systematic review and meta-analysis

Antonios Siargkas, Ioannis Tsakiridis, Petros Grammenos, Aikaterini Apostolopoulou, Sonia Giouleka, Apostolos Mamopoulos, Apostolos Athanasiadis, Themistoklis Dagklis

Page range: 468-476

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Abstract

Objectives We conducted a systematic review and meta-analysis to quantitatively summarize the present data on the association of prenatally identified lateral placenta in singleton pregnancies with small for gestational age (SGA) neonates, preeclampsia and other perinatal outcomes. Methods From inception to November 2021, we searched PubMed/Medline, Scopus and The Cochrane Library for papers comparing the risk of SGA and preeclampsia, as well as other perinatal outcomes in singleton pregnancies with a prenatally identified lateral placenta to those with non-lateral placentas. The revised Newcastle-Ottawa Scale was used to evaluate the quality of eligible papers. The I 2 test was employed to evaluate the heterogeneity of outcomes among the studies. To investigate the possibility of publication bias, funnel plots were constructed. Prospero RN: CRD42021251590. Results The search yielded 5,420 articles, of which 16 were chosen, comprising of 15 cohort studies and one case control study with a total of 4,947 cases of lateral and 96,035 of non-lateral placenta (controls) reported. SGA neonates were more likely to be delivered in cases with a lateral placenta (OR: 1.74; 95% CI: 1.54–1.96; p<0.00001; I 2 =47%). Likewise, placental laterality was linked to a higher risk of fetal growth restriction (OR: 2.18; 95% CI: 1.54–3.06; p<0.00001; I2=0%), hypertensive disorders of pregnancy (OR: 2.39; 95% CI: 1.65–3.51; p=0.0001; I 2 =80%), preeclampsia (OR: 2.92; 95% CI: 1.92–4.44; p<0.0001; I 2 =82%) and preterm delivery (OR: 1.65; 95% CI: 1.46–1.87; p<0.00001; I 2 =0%). Conclusions The prenatal diagnosis of a lateral placenta appears to be associated with a higher incidence of preeclampsia, fetal growth restriction, preterm delivery and SGA. This may prove useful in screening for these conditions at the second trimester anomaly scan.

Original Articles – Obstetrics

Publicly Available December 7, 2022

Fetal intelligent navigation echocardiography (FINE) has superior performance compared to manual navigation of the fetal heart by non-expert sonologists

Katie Swor, Lami Yeo, Adi L. Tarca, Eunjung Jung, Roberto Romero

Page range: 477-491

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Abstract

Objectives Manual and intelligent navigation (i.e. fetal intelligent navigation echocardiography or FINE) by the operator are two methods to obtain standard fetal cardiac views from spatiotemporal image correlation (STIC) volumes. The objective was to compare the performance between manual and intelligent navigation (FINE) of the fetal heart by non-expert sonologists. Methods In this prospective observational study, ten sonologists underwent formal training on both navigational methods. Subsequently, they were tested on their ability to obtain nine cardiac views from five STIC volumes of normal fetal hearts (19–28 gestational weeks) using such methods. The following parameters were determined for both methods: (1) success rate of obtaining nine cardiac views; (2) mean time to obtain nine cardiac views per sonologist; and (3) maximum number of cardiac views successfully obtained for each STIC volume. Results All fetal cardiac images obtained from 100 STIC volumes (50 for each navigational method) were reviewed by an expert in fetal echocardiography. Compared to manual navigation, FINE was associated with a significantly: (1) higher success rate of obtaining eight (excluding the abdomen view) appropriate cardiac views (92–100% vs. 56–88%; all p<0.05); (2) shorter mean time (minute:seconds) to obtain nine cardiac views (2:11 ± 0:37 vs. 15:49 ± 7:44; p<0.0001); and (3) higher success rate of obtaining all nine cardiac views for a given STIC volume (86 vs. 14%; p<0.001). Conclusions When performed by non-expert sonologists, intelligent navigation (FINE) had a superior performance compared to manual navigation of the normal fetal heart. Specifically, FINE obtained appropriate fetal cardiac views in 92–100% of cases.

August 31, 2022

Evaluation of fetal middle adrenal artery Doppler and fetal adrenal gland size in pregnancies with fetal growth restriction: a case-control study

Derya Uyan Hendem, Fatma Doga Ocal, Deniz Oluklu, Berhan Besimoglu, Selcan Sinaci, Aysegul Atalay, Dilek Menekse Beser, Atakan Tanacan, Dilek Sahin

Page range: 492-499

Abstract

Objectives This study aims to evaluate sonographic measurements of fetal adrenal gland size and middle adrenal artery Doppler in pregnancies with fetal growth restriction (FGR) and in a healthy control group. Methods This prospective study included 107 singleton pregnancies with FGR between 24 and 42 weeks of gestation and 107 pregnancies with fetuses whose growth was appropriate for gestational age (AGA). Adrenal gland size and Doppler parameters of the adrenal artery were measured and the values and obstetric outcomes were compared between the study and control groups. Results In the study group, the Z-scores of total adrenal width-length and height, fetal zone width-length and middle adrenal artery-peak systolic velocity (MAA-PSV) were significantly higher than those in the control group (p<0.05). The Z-scores of middle adrenal artery-pulsatility index (MAA-PI) were significantly lower in the study group than in the control group (p<0.05). The rate of neonatal intensive care unit admission in fetuses with high adrenal artery PI scores was higher in the FGR group (p<0.05). Conclusions In the present study, we observed decreased adrenal artery PI, increased adrenal blood flow, and increased fetal adrenal volume in fetuses diagnosed with fetal growth restriction, most likely in response to placental insufficiency and chronic hypoxia.

September 23, 2022

First trimester low maternal serum pregnancy associated plasma protein-A (PAPP-A) as a screening method for adverse pregnancy outcomes

Tiina Kantomaa, Marja Vääräsmäki, Mika Gissler, Mikko Sairanen, Jaana Nevalainen

Page range: 500-509

Abstract

Objectives To evaluate different cut-off values of first trimester pregnancy associated plasma protein-A (PAPP-A) in screening for adverse pregnancy outcomes in a retrospective cohort study. Methods During the study period of 1.1.2014–31.12.2018, total of 23,482 women with singleton pregnancies participated in first trimester combined screening for chromosomal abnormalities. Maternal serum PAPP-A multiple of medians (MoM) levels were measured, and study population was divided into three study groups of PAPP-A ≤0.40 (n=1,030), ≤0.35 (n=630) and ≤0.30 (n=363) MoM. Results Small for gestational age (SGA), preterm birth (PTB) and composite outcome (SGA, hypertensive disorder of pregnancy (HDP) and/or PTB) were more frequent in all three PAPP-A MoM study groups and pre-eclampsia in ≤0.40 and ≤0.35 study groups than in their control groups (p < 0.05). The odds ratio (OR) for SGA varied from 3.7 to 5.4 and sensitivity and specificity from 6.9 to 13.8% and from 95.9 to 98.6%, between study groups. Using PAPP-A ≤0.30 MoM as a screening cut-off instead of PAPP-A ≤0.40 MoM, resulted in approximately 50% reduction in screening detection of SGA and PTB. Conclusions PAPP-A ≤0.40 MoM should be considered as a primary screening cut-off for adverse pregnancy outcomes as approximately 23% will develop either SGA, HDP or PTB. It seems to be the best cut-off to screen for SGA.

October 24, 2022

Time interval to delivery in asymptomatic twin pregnancies with a short cervix at 23–28 weeks’ gestation

Moti Gulersen, Matthew J. Blitz, Erez Lenchner, Tara Lal, Burton Rochelson, Eran Bornstein

Page range: 510-516

Abstract

Objectives To evaluate the risk and timing of spontaneous preterm birth (PTB) in asymptomatic twin pregnancies with a short cervical length (CL≤25 mm) at 23–28 weeks of gestation. Methods Multicenter retrospective cohort study of asymptomatic twin pregnancies with a short CL between 23 and 28 weeks’ gestation within a university health system from 1/2012 to 12/2019. Cases were divided into 4 groups based on CL measurement (≤10 mm, 11–15 mm, 16–20 mm, and 21–25 mm). The primary outcome was time interval from presentation to delivery. Secondary outcomes included delivery within one and two weeks of presentation, and delivery prior to 32, 34, and 37 weeks, respectively. Results 104 patients were included. The time interval from presentation to delivery was significantly different among the four groups (p<0.001), with the CL≤10 mm group having the shortest time interval to delivery. Regardless of the CL measurement, spontaneous PTB within one and two weeks was extremely uncommon and occurred in only one patient within the study cohort (1/104, 1.0%). The risk of spontaneous PTB was highest in the shortest CL group (CL ≤ 10 mm; 53.8% PTB<32 weeks, 61.5% PTB<34 weeks, 92.3% PTB<37 weeks). Conclusions Asymptomatic twin pregnancies with a CL ≤ 10 mm had the shortest time interval to delivery and thus represent a specifically high risk group for sPTB. Although all patients were at high risk of sPTB, only one delivered within 1 or 2 weeks of presentation.

October 24, 2022

Hepatic arterial buffer response in monochorionic diamniotic pregnancies with twin-to-twin transfusion syndrome

Jader de Jesus Cruz, Joana Bernardeco, Alvaro Cohen, Fatima Serrano

Page range: 517-523

Abstract

Objectives Hepatic arterial buffer response (HABR) is an important regulatory process for hepatic blood flow. Its activity has been described in some fetal adverse conditions but in twin-to-twin transfusion syndrome (TTTS) it is unknown if such response is present. The aim of this study is to test the hypothesis that HABR operates in monochorionic diamniotic twins (MCDA) with TTTS. Methods Hepatic artery pulsatility index (PI) and peak systolic velocity (PSV) were measured prospectively in 64 MCDA pregnancies. 43 without TTTS (group 1) and in 21 pregnancies with TTTS (group 2). We calculated ratios for PI (HAPI-ratio) and PSV (HAV-ratio) between recipient and donor in group 2 or bigger and smaller fetus in group 1 and compared groups. The association of HAV-ratio and HAPI ratio with TTTS, relation with other fetal Dopplers and reliability of measurement by a single operator were investigated. Results HAV-ratio and HAPI-ratio appears to be independent from fetal Dopplers, estimated weight and gestational age. In group 2, HAV-ratio is lower than group 1 (p<0.001, 95% CI 0.443–0.643). In group 1 the mean HAV-ratio is 1.014 (±0.021) while in group 2 is 0.47 (±0.035). HAPI-ratio is lower in group 2 than in group 1 although this difference was not significant (p=0.066, 95% CI −0.007–0.231). A good reliability of measurements of hepatic artery PSV and PI was demonstrated by intraclass correlation coefficient analysis (ICC 0.971 95% CI 0.963–0.977, p<0.001 and ICC 0.694 95% CI 0.596–0.772, p<0.001, respectively). Conclusions Monochorionic pregnancies with TTTS are associated with lower HAV-ratios. This could be explained by an active HABR.

Publicly Available November 21, 2022

Healthcare of pregnant women with diabetes during the COVID-19 pandemic: a Southern Brazilian cross-sectional panel data

Roberta de Pádua Borges, Georgia Oliveira Avila, Amanda Cunha Ritter, Janine Alessi, Angela Jacob Reichelt, Maria Lucia da Rocha Oppermann, Gabriela Heiden Telo, Beatriz D. Schaan

Page range: 524-530

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Abstract

Objectives To evaluate the indirect effects of the COVID-19 pandemic on the care of women with pregnancies complicated by gestational or pre-existing diabetes, and their maternal-fetal outcomes. Methods A cross-sectional panel data conducted in a University Hospital in Southern Brazil. Maternal-fetal outcomes and predictors of care from 235 pregnant women with type 1, type 2, or gestational diabetes were evaluated. Two time periods were compared: six months preceding the pandemic, in 2019, and the COVID-19 period from September 2020 to March 2021. Comparisons were performed using analysis of variance, Mann–Whitney U, Fisher’s exact and T-tests. Risks were calculated using the Poisson regression with robust estimates. Results Maternal age was lower (32.1 ± 6.8 vs. 34.4 ± 6.6, p=0.009) and rates of depression/anxiety were higher (16.5 vs. 7.4%, p=0.046) in the group evaluated during the COVID-19. Neonatal hypoglycemia (RR 4.04; 95% CI 1.37–11.98, p=0.012), and SGA rates (RR 4.29; 95% CI 1.93–9.54, p<0.001) were higher in the group assessed before the pandemic. Conclusions Despite economic, social and structural impacts of the pandemic, parameters of maternal care were similar; diabetes control improved, and neonatal hypoglycemia and SGA rates were lower among pregnant women with diabetes during the pandemic.

Open Access November 18, 2022

Attitudes toward COVID-19 vaccination of pregnant and lactating women in Hungary

Ivett Szalma, Tamás Bitó

Page range: 531-537

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Abstract

Objectives This study has three purposes. First, we explore the percentage of the population that is vaccinated and the factors that contribute to whether or not an individual takes up COVID-19 vaccination. Second, we also look at how pregnant and lactating women (PLW) take up vaccination. Third, we reveal what the public think about PLW receiving vaccines. Methods Questionnaire data collection was carried out online using the quota method among Hungarians aged 18–65 with Internet access. The survey was carried out between 29th November and 11th December 2021. A total of 1,000 participants completed the questionnaire. Results A total of 66.4% of the respondents aged 18–65 received vaccination. There were significant differences across sociodemographic variables in vaccination: men and individuals with more education, better perceived financial status, and personal experience with COVID-19 were more likely to be vaccinated. PLW were less likely to be vaccinated, partly due to their fear of vaccines’ side-effects. More than one third of the participants do not agree with PLW having COVID-19 vaccination. In general, attitudes toward vaccination of PLW differed significantly by social group. Men and individuals with tertiary education and better financial situation, who knew somebody who had died of COVID-19 infection, and who had been vaccinated were more likely to accept vaccination for both pregnant women and lactating mothers. Conclusions Acceptance of receiving COVID-19 vaccination depends on social status; thus, targeted campaigns are required. In addition, PLW are afraid of vaccines’ side effects, so they should be provided information, just as there is a need to increase public information on this topic.

November 28, 2022

Maternal vitamin D levels correlate with fetal weight and bone metabolism during pregnancy: a materno-neonatal analysis of bone metabolism parameters

Lian-mei Luo, Nan Wu, Jun Zhang, Dong Yang

Page range: 538-545

Abstract

Objectives Vitamin D plays an essential role in neonatal skeletal development and maternal weight gain during pregnancy. We aim to study the association between vitamin D status, maternal weight, and materno-neonatal bone metabolism parameters. Methods From January to June 2017, we conducted this cross-sectional study among 103 pregnant women (21–42 years old) and their singletons. The levels of serum 25-(OH)D, PTH, P1NP, OC, and CTX were measured for mothers and neonates (cord blood). Serum vitamin D and OC were measured using chemiluminescence and two-site immunoradiometric assay, respectively. Meanwhile, P1NP, CTX, and PTH were measured by ELISA. Results The average serum vitamin D levels from mothers were 15.1 ng/mL during pregnancy and 16.2 ng/mL in the umbilical cord. At baseline, vitamin D deficient mothers were more likely to have higher PTH (36.4 vs. 18 pg/mL; p=0.029) and lower P1NP levels (90 vs. 92.5 ng/mL; p=0.026). Also, vitamin D deficient status was associated with lower fetal weight (3,293 vs. 3,358 g ; p=0.019). Maternal weight was significantly correlated with P1NP (65.86 vs. 109.35; p=0.001) and OC (14.52 vs. 18.24; p=0.038), as well as cord vitamin D level (13.31 vs. 18.46; p=0.039) among normal vs. overweight women. No significant differences were found for the correlation between maternal weight and fetal parameters except for fetal weight which significantly increased with the increase in maternal weight (overweight vs. obese women=3,280 vs. 3,560; p=0.06). Conclusions Maternal vitamin D status is associated with maternal and neonatal bone metabolism parameters as well as maternal and neonatal weight.

November 24, 2022

Removal of pregnancy categories and likelihood of prescribing: a randomized trial

Angela Robinson, Itamar D. Futterman, Fouad Atallah, Jeremy Weedon, Yi-Ju Amy Chen, Radu Apostol, Howard Minkoff

Page range: 546-549

Abstract

Objectives To assess the degree to which removal of FDA’ Pregnancy Categories (PC) of medications (A, B, C, and D) from labeling, affects the likelihood that providers will prescribe those medications. Methods Over a one-year period a convenience sample of providers was recruited into a randomized, survey-based, study. Two versions of the survey were randomly distributed; version 1 presented clinical vignettes, drug information, and PC, while version 2, presented the identical information without the PC. Respondents were asked to estimate their likelihood of prescribing the drug. A mixed linear model was constructed, with likelihood of prescription as the dependent variable, treated as interval-scaled. Results Out of 169 surveys given out, 162 (96%) were returned. Simple effects analysis showed that the presence of PC letter significantly affected the decision to prescribe category B (p<0.001) and C drugs (p=0.008) but not the A or D. Participants were significantly less likely to prescribe class B and C drugs when the letters were not available for review. These findings remained significant even when controlling for covariates (p=0.001). Conclusions When a PC letter is absent on labeling, physicians were less likely to use category B and C drugs, the most common medications prescribed in pregnancy.

November 24, 2022

Prenatal prediction of Shone’s complex. The role of the degree of ventricular disproportion and speckle-tracking analysis

Patrizio Moras, Luciano Pasquini, Giuseppe Rizzo, Cosimo Marco Campanale, Marco Masci, Luca Di Chiara, Giulio Falasconi, Pietro Bagolan, Alessandra Toscano

Page range: 550-558

Abstract

Objectives Shone’s complex (SC) is characterized by sequential obstructions of left ventricular (LV) inflow and outflow. It can be associated with poor long-term prognosis when compared to Simple-Aortic Coarctation (S-CoA). We aimed to assess whether the degree of ventricular disproportion and 2D-speckle-tracking echocardiography (2D-STE) could improve the accuracy of prenatal prediction of SC. Methods 75 consecutive fetuses were retrospectively enrolled from January 2010 to June 2021. Fetuses were divided into 4 groups (Group 1: SC; Group 2: S-CoA; Group 3: False Positive-Coarctation of the Aorta [FP-CoA]; group 4: controls). Comparisons for echocardiographic measures and myocardial deformation indices were performed. A receiver operating characteristic (ROC) analysis was performed on the MV/TV (mitral valve/tricuspid valve ratio) and LV GLS (global longitudinal strain) values to identify cut-offs to separate group 1 and 2 fetuses. Results SC fetuses showed a significant reduction in MV/TV when compared to S-CoA and FP-CoA fetuses (p<0.001). LV GLS in SC fetuses was significantly reduced compared to S-CoA fetuses (−13.3 ± 2.1% vs. −17.0 ± 2.2%, p=0.001). A cut-off value of 0.59 for MV/TV and −15.35% for LV GLS yielded a sensitivity of 76 and 82% and a specificity of 71 and 83% respectively in separating SC vs. S-CoA fetuses. Conclusions SC fetuses showed a more severe degree of ventricular disproportion and a lower LV GLS compared to S-CoA, FP-CoA and control fetuses. MV/TV and GLS are both predictors of SC. These findings may improve the quality of prenatal parental counselling.

Original Article – Fetus

October 26, 2022

The effect of middle cerebral artery peak systolic velocity on prognosis in early and late-onset fetal growth restriction

Hale Cetin Arslan, Aytul Corbacıoglu Esmer, Aysu Akca, Kadir Arslan

Page range: 559-563

Abstract

Objectives We aim to investigate the utility of middle cerebral artery peak systolic velocity (MCA PSV) Doppler in determining the perinatal mortality and morbidity in serial Doppler measurements from the time of diagnosis to the delivery of complicated cases with fetal growth restriction (FGR). Methods At 24–38 weeks of gestation, 65 pregnant women diagnosed with FGR were included in the study. The fetal biometry measurements, MCA pulsatility index (PI), and MCA PSV Doppler evaluation of the cases formed at the diagnosis and the delivery were recorded. Gestational weeks, birth weights, APGAR scores, cord pH values, NICU (neonatal intensive care unit) admission, NICU duration of stay, and perinatal morbidity parameters such as RDS (respiratory distress syndrome), BPD (bronchopulmonary dysplasia), NEC (necrotizing enterocolitis), sepsis and perinatal mortality were compared. The patients were divided into two groups: early and late-onset fetal growth restriction. Perinatal morbidity and mortality were accepted as adverse perinatal outcomes. Results MCA PSV above the 95th percentile at the diagnosis and delivery time was seen at a significantly higher rate with adverse perinatal outcomes. Conclusions This study shows that evaluating MCA PSV with Doppler can be a helpful diagnostic method for early diagnosis of restriction and hypoxic fetuses. Also, it may be used in clinics as a noninvasive method to predict neonatal prognosis.

Original Articles – Neonates

October 24, 2022

Assessment of salivary cortisol concentrations for procedural pain monitoring in newborns

Marta Olszewska, Stephanie Pointinger-Tomasik, Przemko Kwinta

Page range: 564-572

Abstract

Objectives The study aimed to evaluate the usefulness of salivary cortisol (SC) for the assessment of procedural pain intensity in preterm and term newborns. Methods Three groups of neonates (term, 37 0 –41 6 weeks; moderate to late preterm, 32 0 –36 6 ; and very preterm, <32 0 ) hospitalized in neonatal intensive care unit were assessed for the study. Response to nappy change, lung ultrasound (LUS), and blood sampling was analyzed. The intensity of pain was evaluated using continuous heart rate and blood oxygen saturation (SpO 2 ) monitoring, Neonatal Infant Pain Scale (NIPS), and SC concentrations. Saliva samples were collected before and 20 min after the procedure’s end. Results Seventy-one infants were examined: 30 term, 21 moderate to late preterm, and 20 very preterm. SC has increased significantly in response to nappy change only in very preterm newborns (2.13 ng/mL [1.55–3.68] vs. 2.84 ng/mL [1.93–9.06], p = 0.01). LUS did not affect concentrations of SC in any group. Significant increase in SC was observed after blood sampling in term and very preterm infants (2.2 ng/mL [1.45–2.92] vs. 4.29 ng/mL [3.88–5.73], p = 0.002, and 1.88 ng/mL [1.47–4.13] vs. 5.3 ng/mL [3.42–8.02], p = 0.002, respectively). A significant correlation between values of SC increase and NIPS scores was found (Spearman’s rank correlation coefficient [r s ] = 0.31, p = 0.001). Conclusions We observed the increase in SC concentrations in response to painful stimulus. The presence of a correlation between NIPS scores and SC increase suggests that SC can be used as an objective parameter to assess pain in neonates.

November 3, 2022

Impact on neonatal morbidities after a change in policy to administer antenatal corticosteroids to mothers at risk for late preterm delivery

Pradeep Mally, Julia Katz, Sourabh Verma, Sheryl Purrier, Elena V. Wachtel, Rebecca Trillo, Kiran Bhutada, Sean M. Bailey

Page range: 573-579

Abstract

Objectives Antenatal corticosteroids (ACS) administered to mothers at risk for preterm delivery before 34 weeks has been standard care to improve neonatal outcomes. After introducing a new obstetric policy based on updated recommendations advising the administration of ACS to pregnant women at risk for late preterm (LPT) delivery (34–36 6/7 weeks), we set out to determine the short-term clinical impact on those LPT neonates. Methods Retrospective chart review of LPT neonates delivered at NYU Langone Medical Center both one year before and after the policy went into place. We excluded subjects born to mothers with pre-gestational diabetes, multiple gestations, and those with congenital/genetic abnormalities. We also excluded subjects whose mothers already received ACS previously in pregnancy. Subjects were divided into pre-policy and post-policy groups. Neonatal and maternal data were compared for both groups. Results 388 subjects; 180 in the pre-policy and 208 in the post-policy group. This policy change resulted in a significant increase in ACS administration to mothers who delivered LPT neonates (67.3 vs. 20.6%, p<0.001). In turn, there was a significant reduction in LPT neonatal intensive care unit (NICU) admissions (44.2 vs. 54.4%, p=0.04) and need for respiratory support (27.9 vs. 42.8%, p<0.01). However, we also found an increased incidence of hypoglycemia (49.5 vs. 28.3%, p<0.001). Conclusions This LPT ACS policy appears effective in reducing the need for LPT NICU level care overall. However, clinicians must be attentive to monitor for adverse effects like hypoglycemia, and there remains a need for better understanding of potential long-term impacts.

Open Access November 23, 2022

The Apgar score in clinical research: for what, how and by whom it is used

Henry J. Rozycki, Miheret Yitayew

Page range: 580-585

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Abstract

Objectives To review how the Apgar score is used in published clinical research as well as who uses it, and how this may have changed between 1989–90 and 2018–19. Methods Pubmed search for English publications using MeSH Terms “apgar score” OR “apgar” AND “score” AND “humans” for epochs 1989–90 & 2018–19. The location and specialty of first author, primary purpose and how the Apgar score was used was recorded. Results There was a 61% increase in number of publications in 2018–19 compared to 1989–90, from all regions except North America. The most common purpose for using the Apgar was to assess newborn status after pregnancy/delivery interventions. There were 50 different definitions of a significant score. Definition of significance was influenced by specialty in 2018–19 and by study purpose in both epochs. Conclusions Most studies using the Apgar score are focused on the mother. There is no consistent definition of a significant score. Development of any future newborn assessment tools should account for the multiple purposes for which the Apgar score is used.

Short Communication

Publicly Available October 4, 2022

Visitor restriction during the COVID-19 pandemic did not impact rates of Staphylococcus aureus colonization in the NICU patients

Hailey Zie Evans, Sean Bailey, Sourabh Verma, Erin Cicalese

Page range: 586-589

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Abstract

Objectives In our neonatal intensive care unit (NICU), patients are screened for colonization with Staphylococcus aureus (S. aureus) and decolonized if positive. During the COVID-19 pandemic, our NICU significantly limited its visitor policy. We assessed for a difference between S. aureus colonization rates before and after the visitor policy change, which coincided with the exponential rise of COVID-19 cases in New York City (NYC). Methods We calculated rates of newly S. aureus colonized NICU patients during January to June 2020 and compared rates pre- and post-implementation of the new visitor policy. Additionally, we obtained the weekly incidence of COVID-19 in NYC and assessed for a correlation between COVID-19 rates and S. aureus colonization. Results The number of newly colonized patients per thousand patient days was 4.65 pre- and 3.95 post-implementation of the new visitor policy. The difference was not statistically significant (p=0.66). Furthermore, there was no correlation between the incidence of COVID-19 in NYC and the rates of S. aureus colonization in our NICU (R 2 =0.02). Conclusions Our results suggest that limiting visitation of patients is not associated with a decrease in S. aureus colonization rate. Hospital unit leaders may need to focus on other strategies in order to reduce colonization.

Letter to the Editor

Publicly Available November 17, 2022

Knowledge and attitudes of pregnant women on maternal immunization against COVID-19: correspondence

Won Sriwijitalai, Viroj Wiwanitkit

Page range: 590-590

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Ahead of Print / Just Accepted

Ahead of Print / Just Accepted

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5-year Journal Impact Factor	2.322
CiteScore	3.7
Journal Impact Factor	2.716
Journal Citation Indicator	0.93
SCImago Journal Rank	0.620
Source Normalized Impact per Paper	1.032

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Editorial

Editor-in-Chief
Joachim W. Dudenhausen, Berlin, Germany

Founding Editor
Erich Z. Saling, Berlin, Germany

Coordinating Editor for the WAPM
Frank A. Chervenak, New York, US

Coordinating Editor for the IAPM
Asim Kurjak, Zagreb, Croatia

Associate Editors Obstetrics
Thorsten Braun, Berlin, Germany
Vincenzo D’Addario, Bari, Italy
Mehmet Genc, Gainesville, US
Amos Grunebaum, New York, US
Roberto Romero, Detroit, US
Daniel W. Skupski, New York, US
Ivica Zalud, Honolulu, US

Associate Editors Neonatology
Marty Ellington, New York, NY, US
Anne Greenough, London, UK

Editorial Board
Haim Abenhaim, Montreal, Canada
João F. Bernardes, Porto, Portugal
Jonathan Blau, Staten Island, NY, US
Eran Bornstein, New York, US
Luis Cabero, Barcelona, Spain
Xavier Carbonell-Estrany, Barcelona, Spain
Erich Cosmi, Padua, Italy
Mary E. D’Alton, New York, US
Dan Farine, Toronto, Canada
Sonia S. Hassan, Detroit, US
Roland Hentschel, Freiburg, Germany
Wolfgang Holzgreve, Bonn, Germany
Ben Lee, Doha, Quartar
Jorge C. Martinez, Buenos Aires, Argentina
Zoltan Papp, Budapest, Hungary
Ranjan K. Pejaver, Bangalore, India
Ritsuko K. Pooh, Osaka, Japan
Giuseppe Rizzo, Rome, Italy
Ola D. Saugstad, Oslo, Norway
Joseph Schenker, Jerusalem, Israel
Klaus Vetter, Berlin, Germany
Alexander Weichert, Berlin, Germany
Hung N. Winn, Columbia, US
Bruce K. Young, New York, US
Roland Zimmermann, Zurich, Switzerland

Social Media Editor
Nicola Volpe, Parma, Italy

Statistical Advice
Wolfgang Köpcke, Münster, Germany

Ethical Advice
Frank A. Chervenak, New York

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Tel.: +49-30-26005-220
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(Deutsch)

Online ISSN: 1619-3997
Print ISSN: 0300-5577
Type: Journal
Language: English
Publisher: De Gruyter
First published: January 1, 1973
Publication Frequency: 9 Issues per Year
Audience: researchers and health professionals in the field of perinatal and related research