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Zeitschrift Open Access

Journal of Perinatal Medicine

Official Journal of the International Academy of Perinatal Medicine, the New York P erinatal Society, and the Fetus as a Patient Society

Editor-in-Chief:
Herausgegeben von: , , , , , , , , , , und

Sprache: Englisch

Erstveröffentlichung: 1. Januar 1973

Erscheinungsweise: 9 Hefte pro Jahr

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Objective

The Journal of Perinatal Medicine (JPM) is an international forum covering the entire field of perinatal medicine. For decades, JPM has focused on publications relevant to perinatal medicine, patient care and patient safety. It is an indispensable news source for all obstetricians, neonatologists, perinatologists and other health professionals who want to keep abreast of advances in perinatal and related research. The journal offers statements on themes of topical interest and different views on controversial topics.
JPM is published in 9 issues per year. All contributions submitted for publication in JPM are subject to double-anonymized peer review by at least two experts in the field, selected and invited by the Editor-in-Chief and a dedicated Editorial Team. JPM publishes only English-language a rticles in the categories listed below.

The current volume is open access via Subscribe to Open (S2O). All accepted articles will be published under a Creative Commons license at no cost to authors. Learn more about De Gruyter Bri ll’s Subscribe to Open program.

Topics
Antenatal Care // Chorioamnionitis // Diabetes // Fetal Anomalia // Fetal Diagnosis // Intapartum Care // Maternal Medicine // Multiples // Neonatal Care // Obstetrics // Prematurity // Preterm Labor and Preterm Birth // Ultrasound

Article formats
Original Article, Review, Mini Review, Opinion Paper, Short Communication, Editorial, Letter to the Editor, Commentary, Guidelines and Recommendations

Ihre Vorteile

Specialized, comprehensive and translational research
High quality peer-review
Rapid publication times
No costs for open access publishing (Subscribe-to-Open model)
Authors retain copyright – articles published under the Creative Commons Attribution (CC-BY-4.0) License
Each article easily discoverable because of Search Engine Optimization (SEO) and comprehensive abstracting and indexing services
Secure archiving by De Gruyter and the independent archiving service Portico

Other publications in the field

Open Access
Perinatal determinants of the umbilical cord pH following preterm birth

25. Mai 2026

Theodore Dassios, Allan Jenkinson, Ravindra Bhat, Anne Greenough, Nikos A. Kametas

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Objectives Umbilical cord blood gas analysis captures the fetal acid-base balance at birth. We aimed to investigate the effect of antenatal and perinatal parameters on the cord blood pH and explore the association of cord pH with postnatal outcomes. Methods Retrospective cohort study of preterm infants born and admitted to the Neonatal Unit at King’s College Hospital NHS Foundation Trust. The arterial and venous cord pH and the difference between the venous and the arterial pH were recorded (ΔpH). Results From 2012 to 2023, 1,598 preterm infants (849 male) were included with a median (IQR) gestational age of 33.1 (30.4–35.1) weeks. The median (IQR) cord arterial pH was 7.27 (7.20–7.31) and cord venous pH was 7.32 (7.27–7.36). The arterial pH was significantly associated with the Apgar score at 10 min [unstandardised coefficient 0.021, 95 % CI: 0.015–0.027, adjusted p<0.001], the venous pH with the birth weight z-score [unstandardised coefficient 0.015, 95 % CI: 0.009 to 0.021, p<0.001] and the ΔpH with the administration of intrapartum antibiotics [unstandardised coefficient 0.015, 95 % CI: 0.006 to 0.025, p=0.002]. None of the indices were associated with the duration of invasive ventilation, the duration of stay or with survival to discharge from neonatal care. Conclusions Low arterial cord pH was associated with poor perinatal adaptation, low venous cord pH was associated with decreased fetal growth and a large difference between the two with possible perinatal infection.
Open Access
Forceps, vacuum, and breech extraction for difficult delivery of an unengaged fetal head during cesarean birth: a retrospective cohort study

25. Mai 2026

Marcos Javier Cuerva, Beatriz Garcia, Alicia Ramirez-Castan, Elena Defarges, Marta Cortes, Sara Lopez-Magallon, Carlos Zozaya, Francisco Lopez, José Luis Bartha

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Objectives To compare perinatal outcomes, primarily neonatal transcutaneous bilirubin levels and the need for phototherapy, associated with three fetal extraction techniques used during cesarean birth after difficult or failed manual delivery of an unengaged fetal head: short forceps, vacuum, and breech extraction. Methods A retrospective, single-center analytical study was conducted including all cesarean births performed between July 2022 and July 2025 in which fetal extraction was considered difficult and required the use of short forceps, vacuum, or breech extraction. Only singleton, term, cephalic pregnancies without labor onset were included. Maternal, surgical, and neonatal data were collected and analyzed. Multivariable analyses were adjusted for surgeon experience. Results A total of 98 cesarean births met the inclusion criteria. Short forceps were used in 60 (61.2 %), vacuum extraction in 25 (25.5 %), and breech extraction in 13 (13.3 %) births. Transcutaneous bilirubin levels at 48 h of life did not differ significantly between extraction techniques. Phototherapy was required in 8.3 % of neonates following forceps, in 20.0 % following vacuum, and in none following breech extraction; these differences were not statistically significant. After adjustment for surgeon experience, the use of forceps or vacuum was not independently associated with transcutaneous bilirubin levels or phototherapy requirement. In contrast, procedures performed by highly experienced obstetricians were associated with a significantly lower likelihood of phototherapy requirement. Conclusions In cesarean births complicated by difficult fetal extraction of an unengaged fetal head, neonatal bilirubin levels and phototherapy requirement were not associated with extraction technique but were associated with surgeon experience.
Open Access
Sonographic measurement of placental volume: a comparative analysis of two-dimensional and three-dimensional sonographic techniques

25. Mai 2026

Harvey J. Kliman, Roberto Romero, Arun Meyyazhagan, Cecilia Avila, Tinnakorn Chaiworapongsa, Awoniyi Awonuga, Adi L. Tarca

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Objectives To evaluate the correlation between a simple two-dimensional (2D) sonographic method and the gold-standard three-dimensional (3D) method for estimating placental volume during early to mid-pregnancy. Methods Placental volume was measured using both 2D and 3D ultrasound techniques in 58 pregnant patients between 11 and 22 weeks of gestation. All participants had normal term pregnancy outcomes. The correlation between the two methods was analyzed using Pearson’s correlation coefficient. Results A strong positive correlation was observed between the 2D and 3D placental volume estimates (Pearson’s r=0.93, p<0.001), indicating high agreement between the two measurement approaches. Conclusions The simpler 2D sonographic method shows excellent correlation with the 3D gold-standard technique and may serve as a feasible alternative for placental volume assessment, particularly in low-resource settings where access to advanced equipment is limited.
Open Access
From clamp to care: evidence-based insights to cord management in non-vigorous neonates

25. Mai 2026

Anish Pillai, Sanju Sidaraddi, Ayush Kumar, Prashali Patil, Poonam Sawant, Amit Padmakar Ghawade, Deepak Manhas

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Background Placental transfusion through delayed cord clamping is the standard of care for vigorous neonates due to its well-established benefits. However, in non-vigorous infants, the immediate need for resuscitation presents significant challenges, making optimal cord management strategies less clear. Optimizing placental transfusion strategies in this population can enhance hemodynamic stability and facilitate smoother postnatal transition. Content This narrative review examines current practices, emerging trends, and available evidence on cord management in non-vigorous neonates. It explores various placental transfusion strategies, including intact umbilical cord milking (I-UCM), cut-cord umbilical cord milking (C-UCM), resuscitation with an intact cord (RIC), and short delayed cord clamping (S-DCC). Evidence suggests that I-UCM enables rapid placental transfusion and improves early hemodynamic parameters in term and near-term neonates. However, its use in extremely premature infants is limited due to safety concerns, particularly the risk of intraventricular haemorrhage. RIC represents a physiologically sound approach by allowing resuscitation while maintaining placental circulation, though its implementation is constrained by logistical and infrastructural challenges. C-UCM offers a practical alternative when intact cord strategies are not feasible. S-DCC provides an intermediate transitional strategy, permitting brief stabilization before cord clamping. Summary Cord management in non-vigorous neonates remains an area of ongoing debate. Alternative strategies such as I-UCM and RIC offer potential advantages, but their use should be individualized based on gestational age, clinical condition, and available resources. Outlook Further high-quality research is required to determine the safest and most effective cord management strategies for non-vigorous neonates across different gestational age groups.
Open Access
Racial and ethnic disparities in birth rates following the Dobbs decision: a retrospective analysis by state abortion policy

20. Mai 2026

Moti Gulersen, Erez Lenchner, Ashley Zimmermann, Marlee Hirsch, Itai Hazan, Eran Bornstein

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Objectives To assess trends in births by maternal race and ethnicity following the Dobbs v. Jackson Women’s Health Organization (Dobbs) decision. Methods Retrospective analysis of the Centers for Disease Control and Prevention Natality Live Birth database with detailed geographical data available (2018–2023). States were classified by abortion policy environment based on the Center for Reproductive Rights’ five-tier framework. For this analysis, states classified as hostile or illegal were grouped as restrictive, while those classified as expanded access or protected access were grouped as protective. We compared rates of births in restrictive vs. protective states before and after the Dobbs ruling on June 24, 2022, stratified by maternal race and ethnicity. The period from July to December 2022 was considered transitional and excluded from the analysis. Results The proportion of births among Hispanic patients in restrictive states increased by 12.8 %, while the proportion in protective states increased by 7.6 % (p<0.01). Rates of births among non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients in restrictive states decreased by 3.8 and 5.6 %, respectively (p<0.001). Rates of births among NHW and NHB patients in protective states also decreased by 2.4 and 6.4 %, respectively (p<0.001). Changes for Asian/Pacific Islander and other racial groups were small (<1 % relative change). Conclusions Following the Dobbs decision, birth rates in restrictive states increased most among Hispanic individuals, while non-Hispanic White and Black populations saw declines. These trends highlight racial and ethnic disparities in the impact of abortion restrictions.
Open Access
Maternal and neonatal outcomes following expectant management of previable preterm premature rupture of membranes: a retrospective cohort study

18. Mai 2026

Dipen Vyas, Lachlan Shiver, Aditya Patel, Jasmine Butler, Collin Crawson, Maher Ajour

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Objectives Previable Preterm Premature Rupture of Membranes (PPPROM), defined as rupture of membrane (ROM) before fetal viability. Currently, it is recommended to counsel the family regarding expectant management (EM) vs. termination of pregnancy (TOP) given the increased maternal morbidity associated with EM. Additionally, there is limited knowledge of outcomes following ROM ≤20 weeks. Given Mississippi’s high-risk obstetric population and all mothers undergoing EM, we aimed to evaluate outcomes following PPPROM at our center. Methods A single-center retrospective cohort study conducted of patients with PPPROM [<24w gestational age (GA)] from 1/1/2014-2/28/2025. Demographic data and primary outcome of composite maternal morbidities and neonatal survival without severe morbidity were reviewed and compared between early (≤20 weeks) vs. late (>20 weeks) ROM. Results Total of 99 mothers (40 early vs. 59 late ROM) were included. 38 % had spontaneous abortion. Composite maternal morbidity was 34 %, with no difference between the groups. Each year increase in maternal age and gravidarum increased maternal morbidity by 10 % and 23 % respectively. Among live births, survival to discharge was 66 %, and survival without severe morbidity was 47.5 %, with no difference between groups. Increase in GA [OR 1.355 (1.095–1.678)], birth weight [OR 1.046 (1.011–1.183)], and 1-min Apgar [OR 1.35 (1.105–1.650)] showed higher survival without morbidity. Survival without morbidity increased with increase in latency period, only for ROM at early GA. Conclusions PPPROM carries a substantial risk of maternal morbidity, which increases with maternal age and gravida. Among live births, neonatal survival without severe morbidity remained unchanged based on timing of ROM.
Open Access
Mental health in the perinatal period: bridging the gaps in care, evidence, and policy

12. Mai 2026

Mochammad Besari Adi Pramono, Wiku Andonotopo, Muhammad Adrianes Bachnas, Wisnu Prabowo, Eric Edwin Yuliantara, Julian Dewantiningrum, Efendi Lukas, I Nyoman Hariyasa Sanjaya, Anak Agung Gede Putra Wiradnyana, Anak Agung Ngurah Jaya Kusuma, Ryan Saktika Mulyana, Khanisyah Erza Gumilar, Ernawati Darmawan, Muhammad Ilham Aldika Akbar, Dudy Aldiansyah, Dovy Djanas, Aloysius Suryawan, Ridwan Abdullah Putra, Anita Deborah Anwar, Cut Meurah Yeni, Nuswil Bernolian, Harry Kurniawan Gondo, Laksmana Adi Krista Nugraha, Waskita Ekamaheswara Kasumba Andanaputra, Wibisana Andika Krista Dharma, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak

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Objectives Perinatal mental health has long been acknowledged as fundamental to the well-being of mothers and infants, yet the recognition of disorders such as postpartum depression, anxiety, and – far less commonly – psychosis still lags behind clinical need. Even where validated screening tools exist, detection remains inconsistent, and many women navigate pregnancy and the postpartum period with symptoms that go unspoken or unnoticed. In some high-income settings, suicide has emerged as a leading contributor to maternal mortality, a reminder that the health consequences of these conditions extend beyond emotional distress and reflect deeper systemic failings. Methods In this opinion paper, we draw on recent developments across epidemiology, neuroscience, psychology, and health-system research to consider why perinatal mental health continues to occupy an uncertain place in routine care. Fragmented service pathways, variability in provider training, and uneven adoption of evidence-supported interventions create persistent gaps between what is known and what is practiced. We highlight examples – stepped-care models, collaborative teams, and digital supports – that illustrate how more coherent systems could function, even if implementation remains uneven. Results Although a wide range of effective interventions exists, their practical reach is limited by sociocultural norms, structural constraints, and resource imbalances. Understanding these influences together – not in isolation – helps clarify why progress has been slower than the evidence might suggest. Conclusions Meaningful improvement will depend on strengthening cross-sector integration, expanding scalable technologies, and tailoring policy responses to local realities. Sustained investment in perinatal mental health offers long-term benefits for families and communities and should be regarded as central to modern maternal care.
Open Access
Association between antenatal corticosteroid exposure and respiratory morbidities in late preterm infants: a population-based study

12. Mai 2026

Hye Won Park, Tae-Eun Kim, Sujin Choi, Sanghyun Park, Ran Lee, Hye Sun Yoon

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Objectives The clinical benefit of antenatal corticosteroids (ACS) in late preterm infants remains uncertain despite guideline expansion after the ALPS trial. This study evaluated the association between ACS exposure and respiratory outcomes in late preterm infants using a nationwide Korean cohort. Methods We performed a population-based cohort study using linked National Health Insurance Service and National Health Screening Program data. Late preterm infants (34 +0 –36 +6 weeks) born between 2014 and 2022 were included. ACS exposure was defined as maternal betamethasone or dexamethasone administered within 7 days before delivery. Propensity scores based on maternal and neonatal characteristics were used to generate inverse probability of treatment weights. Relative risks (RRs) with 95 % confidence intervals (CIs) were estimated for respiratory outcomes. Results Among 53,529 infants, 6,294 (11.8 %) were exposed to ACS. Despite lower birth weight and gestational age in the ACS group, exposure was associated with reduced risks of ventilatory support (RR 0.923; 95 % CI 0.865–0.985), oxygen therapy (RR 0.827; 95 % CI 0.797–0.858), and respiratory distress syndrome (RR 0.908; 95 % CI 0.844–0.978). No significant differences were observed for transient tachypnea of the newborn (TTN) (RR 1.058; 95 % CI 0.991–1.129). Moderate-to-severe bronchopulmonary dysplasia (BPD) was rare and not associated with ACS. Conclusions In this nationwide cohort, ACS exposure was associated with improved acute respiratory outcomes in late preterm infants, except for TTN and moderate-to-severe BPD, providing real-world evidence supporting its effectiveness.
Open Access
Stillbirth as a global public health issue: the need for a coordinated national approach in Germany

8. Mai 2026

Amira Göpfrich, Peter Bartmann, Joachim W. Dudenhausen, Günther Heller, Brigitte Strizek, Tanja Groten, Lars Hellmeyer, Josefine Königbauer

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Open Access
Understanding stillbirth: a retrospective cohort study using WHO ICD-PM criteria at a tertiary perinatal center in Germany

8. Mai 2026

Celikoez Sidal, Goepfrich Amira, Dudenhausen Joachim, Schröder Julian Nils, Henrich Wolfgang, Hellmeyer Lars, Koenigbauer Josefine Theresia, Rostin Paul

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Objectives The aim of this study was to identify maternal and fetal risk factors associated with stillbirth and to differentiate intrauterine fetal death (IUFD) from late termination of pregnancy (TOP). Methods Analyses were performed on births from 2014 to 2024 at Charité Berlin, characterizing the overall cohort, IUFD, and TOP, respectively. Descriptive characterizations and regressions were applied to evaluate the impact of modifiable risk factors and trends within the overall study cohort and 3rd trimester IUFDs. Results Three hundred and eighty five stillbirths and 58,631 live births were identified (59,016 births, 0.65 % stillbirths). Of these, 177 (46 %) were categorized as IUFD and 208 (54 %) as TOP. The stillbirth rate rose from 0.45 % (2014) to 1.2 % (2024) (odds ratio 1.13, p<0.001). Advanced maternal age, higher maternal BMI before pregnancy, and smoking during pregnancy were associated with stillbirths p<0.01. TOPs and IUFDs differed in their occurrence time (most IUFDs in 28-36+6 weeks of pregnancy [44 %], most TOPs 20-27+6 weeks [75 %; p<0.001]) and in terms of their risk profiles (IUFDs associated with higher gravity, parity and BMI as well as higher rates of multiple gestations compared to TOPs). Differences in disease burden (WHO ICD-PM criteria) were not significant over the year but formed a distinct contrast between IUFD and TOP. 3rd trimester IUFD was associated with higher parity, gravidity and BMI (p<0.05). Conclusions IUFD and TOP cohorts naturally represent different risk profiles. As cohort size and power limited analytical possibilities standardized, differentiated recording and data pooling is crucial to advance stillbirth research and develop effective preventive strategies targeting modifiable risk factors.
Open Access
An audit of delivery plans for babies with antenatal urinary tract abnormalities: the mothers’ perspective

7. Mai 2026

Patrick Green, Agnes Ndzi, Giles Carey, Anthonia Adefolaju, Umber Agarwal, Harriet J. Corbett

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Objectives There is little evidence guiding the delivery of babies who are antenatally detected to have antenatal urinary tract abnormalities (AN-UTA), and some clinicians would deliver early purely because of AN-UTA. With growing evidence of adverse events resulting from early-term delivery this study aimed to assess delivery patterns for babies with AN-UTA. Methods Parents of children referred to our service with AN-UTA from May 2022- Sept 2023 were asked about their recollection of delivery discussions and methods. Data were collected on antenatal scans, delivery timing and method and then subsequent urological investigations and management were assessed. Results Seventy-two babies (53 male) were included. 22 (31 %) were born via spontaneous labour and delivery, 33 underwent planned delivery for non-urological reasons and 17 (24 %) had planned delivery purely because of their AN-UTA. 11/17 of these were before 39 weeks (early-term). 3/17 (18 %) underwent emergency caesarean section for failure to progress during early induction. There was no significant difference between babies born early for AN-UTA with regards to urgent urological investigations (36 % vs. 16 %, p=0.207), nor for early surgery (27 % vs. 10 %, p=0.134). Conclusions 24 % of babies had planned delivery purely for their AN-UTA, without any change to their urological management. The majority of these were <39 weeks gestation. In the absence of other maternal/fetal concerns, delivery <39 weeks should be avoided to optimise global outcomes.
Open Access
Optimal management of pregnancies presenting with membrane prolapse

7. Mai 2026

Dimitris Baroutis, Eleni Katsianou, Antonia Varthaliti, Aikaterini-Gavriela Giannakaki, Konstantinos Koukoumpanis, Nikolaos Sindos, Vasilios Lygizos, Ioannis Fragiskos, Michael Sindos, George Daskalakis, Panagiotis Antsaklis

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Introduction Membrane prolapse represents a severe manifestation of cervical insufficiency, occurring in 0.3–1.0 % of pregnancies and posing significant risks for extreme prematurity and perinatal mortality. Despite decades of clinical experience, optimal management remains controversial. Content This narrative review synthesizes current evidence on pathophysiology, diagnosis, and management of membrane prolapse. We examine biomechanical and inflammatory mechanisms, diagnostic criteria, including cervical length assessment and amniocentesis, as well as therapeutic strategies, such as emergency cerclage and expectant management. Evidence-based perioperative care includes prophylactic antibiotics (cefazolin plus azithromycin), tocolytic therapy for uterine quiescence, antenatal corticosteroids (betamethasone or dexamethasone) between 24 and 34 weeks, and magnesium sulfate for fetal neuroprotection before 32 weeks. Summary Emergency cerclage achieves fetal survival rates of approximately 73 % in carefully selected patients presenting between 16 and 24 weeks with cervical dilation of 2–4 cm and absence of intraamniotic infection. Amniocentesis is critical when cervical dilation exceeds 2–3 cm, as infection represents the strongest predictor of treatment failure. Outcomes vary significantly based on clinical presentation, with negative amniocentesis associated with 70–80 % survival vs. 20–30 % with positive results. Outlook Future research priorities include prospective randomized trials comparing emergency cerclage to expectant management, validation of biomarkers predicting infection and treatment success, optimization of perioperative protocols, and further development of innovative therapeutic strategies such as anti-inflammatory agents.
Open Access
Balloon tamponade use in postpartum hemorrhage due to uterine atony: a retrospective study

4. Mai 2026

Gulcan Okutucu, Duygu Tugrul Ersak, Hakki Serbetci, Ozgecan Ucyildiz, Ayse Gulcin Bastemur, Atakan Tanacan, Fatma Doga Ocal, Dilek Sahin

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Objectives To investigate the influence of technical and clinical variations in uterine balloon tamponade (UBT) procedures on postpartum blood loss and maternal outcomes in women of postpartum hemorrhage (PPH) due to uterine atony. Methods This retrospective cross-sectional study was conducted on 63 patients who underwent UBT for atonic PPH between January 2020 and March 2025. Data collected included demographic characteristics, uterine balloon inflation volume, timing and duration of insertion, and maternal outcomes. The primary outcomes were success of UBT and occurrence of composite adverse maternal outcomes (CAMO). ROC analysis was used to identify optimal threshold values for procedural variables. Results UBT successfully controlled hemorrhage in 74.6 % of women. CAMO occurred in 17.5 % of patients. Severe PPH was observed in 60.3 % of women and was significantly associated with higher maternal shock index, increased transfusion requirements, and longer ICU stays. A delay of ≥45 min from delivery to UBT insertion was strongly associated with increased blood loss and higher CAMO incidence (AUC 0.858, p<0.001). Though not independently indicative of adverse outcomes, balloon volumes greater than 232.5 mL were associated with increased estimated blood loss (p=0.021). Duration of balloon retention and deflation timing had no significant impact on clinical outcomes. Conclusions UBT is an effective intervention for controlling PPH secondary to uterine atony. Early application, within 45 min postpartum, is critical in reducing blood loss and maternal morbidity. Inflation volume may reflect bleeding severity but does not correlate with adverse outcomes. Findings support prompt and standardized application of UBT in PPH protocols.
Open Access
Neonatal units’ visiting policies and parental experience of open-access

4. Mai 2026

Charlotte Neske, Carolina Zorro, Valentina Fragala, Sandeep Shetty, Ana Serrano-Llop, Laura De-Rooy, Nicola Crowley, Ravindra Bhat, Rashmi Gandhi, Anne Greenough

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Objectives A survey of visiting policies in neonatal units in the UK and Ireland was conducted and parental experiences with open-access were examined across two neonatal units (one recently introduced it; another has had it in place for five years). Methods Units were contacted by email or telephone to complete the survey. Parents at two units prospectively completed a questionnaire. Results Eighty percent (169/212) of units participated in the survey. Among these, 88 % implemented complete open-access for parents, 7 % partial and 5 % restricted. 141/169 units (83.4 %) allowed parents during bedside ward rounds. Of these, 26 (18.4 %) required use of noise-cancelling headphones. Two persons per patient were allowed in 106 units (63 %), three in 44 (26 %) and four or more in 19 (11 %). Visitors must be accompanied by a parent. Siblings could visit at any time in 112 units (66 %), 48 during fixed hours (28 %) and 9 never allowed them (5 %); two units allowed siblings during summer months (1 %). In the two units, 87 % of 15 and 89 % of 20 parents were satisfied with the level of access. Concerns about confidentiality were expressed by 13 % and 20 % reported feeling a little worried about overhearing others’ information or vice versa. Parents benefitted from open-access by feeling more welcome, less stressed and able to plan their visits more seamlessly. Open-access was perceived to improve the babies’ quality of care through greater parental involvement and time spent together. Conclusions Visiting policies varied between units; open-access was regarded as beneficial to parent and infant wellbeing.
Open Access
Maternal vaccination in the immunization era: implementation, uptake, and emerging vaccines

27. April 2026

Antônio Braga, Susana Cristina Aidé Viviani Fialho, Caroline Alves de Oliveira Martins, Karine Mello Duvivier, Gustavo Yano Callado, Edward Araujo Júnior, Jorge de Rezende-Filho

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Maternal immunization has ascended as a cornerstone of contemporary strategies aimed at safeguarding pregnant women, fetuses, and children in early childhood against vaccine-preventable diseases. The profound physiological and immunological adaptations inherent to gestation heighten maternal susceptibility to infectious morbidity, while several pathogens, including influenza, pertussis, COVID-19, rubella, and respiratory syncytial virus (RSV), pose significant risks of adverse maternal, fetal, and neonatal outcomes. Although an extensive body of evidence attests to the safety and effectiveness of maternal vaccines, global uptake among pregnant people remains markedly uneven and, in many settings, critically suboptimal. A nuanced understanding of national and international immunization programs, along with their structural and sociocultural challenges, is imperative to strengthen perinatal health protection. This narrative review synthesizes evidence drawn from peer-reviewed scientific literature, global health agency publications, and official national immunization guidelines. Extracted data were complemented by analyses of the immunological landscape of pregnancy, current vaccine recommendations, established safety profiles, and maternal immunization schedules across high-, middle-, and low-income countries. Particular emphasis was placed on the vaccines most consistently recommended during pregnancy, namely influenza, Tdap, COVID-19, and RSV, as well as on contextual determinants influencing vaccine hesitancy, access barriers, and global disparities in coverage.
Open Access
Development of a Z-score for the ductal flow pulsatility index in normal fetuses using two-dimensional Doppler echocardiography

27. April 2026

Luciane Alves da Rocha Amorim, Julia Castro Rodrigues, Paulo Zielinsky, Antonio Braga, Gustavo Yano Callado, Pedro Teixeira Castro, Edward Araujo Júnior

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Objectives To determine gestational age-specific reference ranges and develop a Z-score equation for the fetal ductal pulsatility index (PI), between 24 and 33 + 6 weeks of gestation. Methods A prospective cross-sectional study conducted from 2023 to 2024, 226 singleton fetuses between 24 and 33 + 6 weeks were enrolled. The ductus arteriosus (DA) was assessed in the longitudinal plane of the fetus using color Doppler to confirm its course and flow direction, and pulsed Doppler sampling was placed at the proximal DA with an insonation angle <15°. Three consecutive measurements of PI were recorded and averaged. Z-scores were derived from predicted means and standard deviations and reference percentiles (5th, 50th, and 95th) were computed for gestational age groups using quantile regression. Intraobserver reproducibility was evaluated in 30 randomly selected cases with an interval ≥2 weeks using the intraclass correlation coefficient (ICC). Results The mean gestational age was 28.2 ± 3.1 weeks. The ductal PI showed a mean of 2.4 ± 0.26 with normal distribution (p=0.2525). The Z-score equation for PI was successfully derived Z-score = (Measured PI − 2.4)/0.26. Reference ranges for PI were: 24–27 weeks (5th=2.0; 50th=2.4; 95th=2.7), 28–31 weeks (5th=2.1; 50th=2.5; 95th=2.9), and 32–34 weeks (5th=2.2; 50th=2.4; 95th=2.5). Intraobserver reproducibility for PI was excellent (ICC >0.90). Conclusions We established gestational age-specific reference ranges and a Z-score equation for the ductal PI in normal fetuses between 24 and 33 + 6 weeks. These findings provide a standardized tool for fetal cardiologists to identify subtle ductal flow abnormalities and support perinatal risk stratification.
Open Access
Intrapartum risk factors for neonatal intensive care unit admission in pregnancies with grade III meconium-stained amniotic fluid

21. April 2026

Cen Cao, Haiyan Sun, Runrun Feng, Junling Fei, Min Zhang, Yihan Lu, Xinxin Zhu, Zhiping Ge, Ziyan Jiang

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Objectives To analyze the high-risk factors of neonatal intensive care unit (NICU) admission in grade III meconium-stained amniotic fluid (MSAF) pregnancies and offer recommendations for clinical practice. Methods Clinical data from 517 women with grade III MSAF during delivery were gathered for analysis. Two groups were examined using multivariable logistic regression in order to identify high-risk factors associated with NICU admission. The area under the receiver operating characteristic curve (ROC) was calculated to assess the relationship between NICU admission and blood tests during delivery. Results The NICU admission group displayed a higher prevalence of thick meconium-stained amniotic fluid, a greater number of balloon catheter usage, worse routine blood test results during delivery, and higher 24 h vaginal bleeding volume, while lower rate of spontaneous membrane rupture. Logistic regression analysis identified abnormal fetal heart rate, maternal fever, and thick amniotic fluid as risk factors for NICU admission. Furthermore, ROC curve showed white blood cell (WBC) count and neutrophil percentage had a certain value of prediction for NICU admission. Conclusions When grade III MSAF was found during delivery, if there is concurrent abnormal fetal heart monitoring, maternal fever and thick AF, a more cautious perinatal observation, a reasonable selection of delivery methods, and timely early resuscitation of newborns should be employed.
Open Access
Association between oral glucose tolerance test (OGTT) glucose levels and fetal macrosomia in non-diabetic women

10. März 2026

Taha Yasin Bayram, Reyhan Aslancan Bayram, Osman Murat Guler, Burak Yucel

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Objectives Foetal macrosomia is a significant obstetric problem that can lead to serious maternal/neonatal complications. The aim of this study was to determine which of the 75 g oral glucose tolerance test (OGTT) glucose values – fasting, first-hour, or second-hour – most strongly predicts foetal macrosomia in non-diabetic patients. Methods This cross-sectional study prospectively screened 1,047 pregnant women who underwent a 75 g OGTT. Women with pregestational or gestational diabetes mellitus (GDM) were excluded from the main analysis. A total of 185 non-diabetic women were included. Among the included patients, those who delivered macrosomic foetuses constituted Group 1 (n=16), while those who delivered normal birth weight infants constituted Group 2 (n=169). Fasting, first-hour, and second-hour glucose values from the 75 g OGTT were compared between the groups. Results No statistically significant differences were found between the two groups in terms of demographic variables (p>0.05). The mean fasting glucose values in Groups 1 and 2 were 77.75 and 76.11 mg/dL, respectively (p=0.42), the mean first-hour glucose values were 116.25 and 111.51 mg/dL, respectively (p=0.43), and the mean second-hour glucose values were 104.38 and 95.19 mg/dL, respectively (p=0.04). Receiver operating characteristic (ROC) curve analysis was performed for the second-hour glucose concentration, with an AUC of 0.675, and a threshold of 99.5 mg/dL was established. Conclusions The second-hour glucose value of the 75 g OGTT may be a marker for foetal macrosomia in nondiabetic patients. These findings suggest that when the second-hour glucose value exceeds 99.5 mg/dL, foetal macrosomia may develop.
Open Access
Algorithm for RhD immune globulin shortage yields over 50 % dosage savings

6. März 2026

Gillian Piltch, Frank Jackson, Sarika Arora, Burton Rochelson, Matthew J. Blitz, Jennifer Kidd

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Objectives Our institution developed an evidence-based algorithm to guide administration of RhD immune globulin (RhIG) to RhD-negative pregnant and postpartum people in periods of shortage. This study aims to quantify potential RhIG dosage savings with implementation of this algorithm. Methods This was a quality improvement study that incorporated all dosages of RhIG administered in the inpatient and outpatient settings of a large metropolitan health system in 2023. We calculated potential dosage savings by applying the algorithm to the 2023 RhIG data. Results We estimated that implementation of this algorithm would result in a greater than 50 % RhIG dosage savings. Omitting RhIG for threatened, spontaneous, or induced abortion prior to 12 weeks gestation could result in up to 85 % dosage savings in the first trimester; incorporating non-invasive prenatal screening for fetal RhD status into clinical care would lead to a 39 % dosage savings in the second and third trimesters; and administering 150 µg (750 IU) RhIG to postpartum people would save 50 % of postpartum dosages. Conclusions This algorithm can help healthcare systems maintain RhIG reserves during shortages while balancing patient safety.
Open Access
Maternal and neonatal outcomes among pregnant women with eating disorders

6. März 2026

Asmaa El Mouden, Ethan Bendayan, Haim Arie Abenhaim

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Objectives Eating disorders (ED), most prevalent among women of reproductive age, may negatively impact both maternal and fetal health during pregnancy. However, their effects remain inadequately explored. This study aimed to evaluate the associations between maternal ED and perinatal outcomes. Methods A retrospective population-based cohort study of all delivery admissions from 2016 to 2021 was conducted using the United States’ Healthcare Cost and Utilization Project-National Inpatient Sample. Pregnancies complicated by maternal ED were identified using ICD-10 codes F50.x. Associations between antenatal ED and adverse maternal and neonatal outcomes were assessed using multivariable logistic regression. Potential confounders adjusted for include baseline maternal demographics and relevant clinical factors. Results Among 4,337,612 delivery admissions, 1,262 involved an ED diagnosis, with prevalence increasing from 23.9 to 37.6/100,000 (p<0.0001) over the study period. Patients with an ED were more likely to use tobacco, cannabis, and alcohol. Anxiety disorders, bipolar affective disorder, and depression were also more common among the ED group. Maternal ED was associated with higher risks of anemia (aOR 2.8, 95 % CI 2.6–3.3), preterm labor (1.4, 1.1–1.7), disseminated intravascular coagulation (6.2, 1.5–24.7), postpartum hemorrhage (1.9, 1.6–2.4), uterine rupture (4.4, 1.6–11.6), genitourinary tract infection (1.9, 1.1–3.3), and prolonged hospitalization (2.3, 1.7–3.1). Neonates of affected mothers were more likely to present with congenital anomalies (2.3, 1.6–3.4), IUGR (1.7, 1.4–2.1), fetal distress (1.3, 1.1–1.5), and preterm birth (1.4, 1.2–1.7). Conclusions Pregnant individuals with ED constitute a high-risk group with elevated susceptibility to maternal and neonatal complications. Early recognition and integrated multidisciplinary care are crucial to improve outcomes.
Open Access
Antenatal fetal surveillance and iatrogenic delivery

3. März 2026

Hannah S. Foster, Jessica Wu, Markolline Forkpa, Jesse Chittams, Nehemiah Weldeab, Jennifer McCoy, Nadav Schwartz

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Objectives Antenatal testing is routinely recommended for high-risk pregnancies to reduce the risk of stillbirth, yet limited data guide counseling about likelihood of unscheduled iatrogenic delivery. We explored factors associated with clinical recommendations for unscheduled iatrogenic delivery prompted by antenatal testing and examined variables that influence obstetric outcomes. Methods In this retrospective cohort study, we identified singleton pregnancies undergoing serial testing in an academic system from January 2022-May 2023. Indications for testing, recommendations made at the final testing visit before delivery, and obstetric outcomes were obtained. Primary outcomes were unscheduled iatrogenic delivery <39 weeks and unscheduled iatrogenic delivery <37 weeks recommended at the final visit. Stepwise regression models assessed associations between demographics, testing indications, and outcomes. Results A total of 3,959 patients were included. 11.3 % (n=447) were recommended for delivery based on findings identified at their final testing visit. Of these, 352 patients (8.9 %) underwent unscheduled iatrogenic term delivery <39 weeks, and 156 (3.9 %) underwent unscheduled iatrogenic preterm delivery <37 weeks. After adjustment for confounders, chronic hypertension, hypertensive disorders of pregnancy, fetal growth restriction, and other fetal indications were associated with both primary outcomes. Only 40 % of delivery recommendations were triggered by an abnormal test (NST, mBPP, BPP); most were prompted by other clinical concerns identified during testing encounters. Conclusions Patients undergoing antenatal testing should be counseled about the meaningful likelihood of an unscheduled iatrogenic delivery recommendation. Because most recommendations arise from clinical issues unrelated to the testing results themselves, our findings may help clinicians guide shared decision-making around testing frequency and protocols.
Open Access
In vivo therapy for prenatal repair of the ovine fetal myelomeningocele model using human umbilical cord-derived mesenchymal stem cells: proof of principle

23. Februar 2026

Christian Bamberg, Christian Tomuschat, Kurt Hecher, Mario Rüdiger, Marius A. Möbius, Christian Hagel, Aline Reitmeier, Marie-Luise Schröder, Anke Diemert, Konrad Reinshagen

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Objectives Animal models suggest that combining mesenchymal stromal cells (MSCs) with prenatal myelomeningocele (MMC) repair may help preserve spinal cord function. This study assessed the feasibility of administration human umbilical cord-derived MSCs during prenatal repair of MMC in a sheep model. Methods MMC (L1–L5) were surgically created in 11 fetal lambs at 75 days. Seven underwent repair 25 days later – five with and two without MSCs. A high-dose, ready-to-use MSCs product (Desacell ® ), derived from healthy human neonatal umbilical cord tissue was administered in five cases. Each received 1 mL of Desacell ® gel containing 30 million MSCs directly to the spinal cord. All fetuses underwent multilayer dural myofascial patching and skin closure. Results Of the seven treated lambs, three (two with MSCs, one without) survived to term (144–147 days gestation). Motor function was evaluated using the sheep locomotor rating scale before euthanasia. MMC sites were excised en-bloc. Mean large neuron densities in gray matter were 20.4, 15, and 13.1 per mm 2 , respectively. Conclusions This is the first report of successful local administration of MSCs during in utero MMC repair in a sheep model using Desacell ® , a ready-to-use stem cell product. MSCs administration was feasible in all intended cases, however, the limited sample size restricted comparative outcomes analyses.
Open Access
Fighting preterm birth with the scalpel: lessons from a decade of total cervical occlusion

16. Februar 2026

Franka Lindel, Lena Steinkasserer, Vivien Dütemeyer, Alexandros Rahn, Peter Hillemanns, Lars Brodowski, Constantin von Kaisenberg

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Objectives Preterm birth remains a leading cause of neonatal morbidity and mortality worldwide. Despite medical advances, effective prevention remains challenging. Surgical interventions like total cervix occlusion (TCO) show promise in high-risk groups. Methods This was a retrospective study including patients with singleton pregnancies who had undergone Saling’s TCO at the Medical School of Hannover from 2011 to 2021. Data on maternal characteristics, obstetric history, intervention details, and outcomes were collected. Patients were stratified into two groups: classic Saling indication (≥2 late miscarriages or preterm births <32 weeks) and extended indication (1 such event). Primary outcomes were live birth and preterm birth after 28 + 0 weeks. Results The analysis is based on a sample of 99 pregnant women, pregnancy and outcome data was available of 67 patients. The median delivery time was 36 weeks. 92.5 % of the neonates were born alive, with 88.1 % of these births occurring after the 28th week of gestation. Patients with extended indication showed longer gestation than those with classic indication. Maternal age, BMI, and conception mode had no impact. Higher parity increased chances of live birth, prior preterm birth lowered it. Previous late abortions raised the risk of delivery before 28 weeks. Conclusions TCO may prolong gestation and improve outcomes, independent of maternal factors. Women with extended indications appear to benefit as well. Given the lack of prospective data and varied international practices, further randomized, multicenter trials are urgently needed to better define indications and assess efficacy.
Open Access
Declining but uneven: global evolution of maternal hemorrhage burden and its future trajectory

28. Januar 2026

Hongqiao Wang

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Objectives Maternal hemorrhage is a leading cause of maternal morbidity and mortality worldwide, with significant regional disparities. This study utilizes the most recent Global Burden of Disease (GBD) 2021 data to examine global and regional trends in maternal hemorrhage from 1990 to 2021. Methods We analyzed the incidence, mortality, and disability-adjusted life years (DALYs) attributable to maternal hemorrhage across 204 countries and territories. We calculated the Estimated Annual Percentage Change (EAPC) for key indicators and projected future trends using Bayesian age-period-cohort models. Results From 1990 to 2021, global maternal hemorrhage incidence declined from 14.17 million to 13.96 million cases, and age-standardized incidence rate (ASIR) decreased from 245.34 to 176.89 per 100,000 (EAPC: −0.835 %), with particularly high rates in Central and Western Sub-Saharan Africa. DALYs attributed to maternal hemorrhage dropped from 7.1 million to 2.96 million, with the age-standardized DALYs rate (ASDR) falling from 125.29 to 37.47 per 100,000 (EAPC: −3.975 %). Mortality also decreased from 114,112 to 46,874 deaths, and the age-standardized mortality rate (ASMR) declined from 2.04 to 0.59 per 100,000 (EAPC: −4.055 %), with the largest reductions in East Asia and South Asia. Regions with lower socio-demographic index experienced high incidence, DALYs, and mortality rates. Projections to 2050 suggest a continued global decline in all indicators. Conclusions Despite overall reductions in the global burden of maternal hemorrhage, significant regional disparities persist, particularly in low-resource settings. Targeted interventions in high-burden regions, such as Sub-Saharan Africa, are crucial to further reduce maternal morbidity and mortality.
Open Access
Revisiting KANET in the context of fetal connectomics: defining optimal gestational windows for neurodevelopmental screening

26. November 2025

Wiku Andonotopo, Muhammad Adrianes Bachnas, Julian Dewantiningrum, Mochammad Besari Adi Pramono, I Nyoman Hariyasa Sanjaya, Ernawati Darmawan, Muhammad Ilham Aldika Akbar, Dudy Aldiansyah, Cut Meurah Yeni, Nuswil Bernolian, Sri Sulistyowati, Waskita Ekamaheswara Kasumba Andanaputra, Milan Stanojevic, Asim Kurjak

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Objectives To introduce the KANET-connectome matrix (KANET-Con) as a conceptual framework linking fetal behaviors observed on four-dimensional (4D) ultrasound to underlying neural network maturation, and to evaluate optimal gestational timing for functional neurodevelopmental screening. Methods A narrative review was conducted using a PRISMA-guided literature identification and screening process. PubMed, Scopus, and Web of Science were searched (January 2000–March 2025) for studies addressing fetal connectomics, fetal neurobehavior, KANET scoring, and developmental neuroimaging. Forty-two peer-reviewed studies met inclusion criteria. Observed fetal behaviors—including facial mimicry, eye blinking, limb movement, and overall gestalt coordination—were aligned with their most plausible neural substrates using evidence from developmental neuroscience and imaging. Results Findings demonstrated clear temporal associations between specific fetal behaviors and neural circuit development. Eye blinking and facial expressions (24–26 weeks) correlated with brainstem-cortical integration; hand-to-face gestures (26–30 weeks) reflected emerging interhemispheric pathways; and complex limb coordination (28–32 weeks) was linked to corticospinal and basal ganglia maturation. Collectively, these data indicate that 24–32 weeks of gestation represents an optimal window for KANET-based neurobehavioral screening. Additionally, emerging artificial intelligence applications show potential to enhance scoring objectivity by detecting subtle movement features such as behavioral entropy, asymmetry, and latency. Conclusions KANET, interpreted through a fetal connectomic lens, provides a functional window into early neural integration. The KANET-Con offers a clinically relevant, globally accessible conceptual model to support early detection of neurodevelopmental deviations and inform risk stratification, particularly in resource-limited settings.
Open Access
The intrauterine microbiome–neurodevelopment axis: decoding the prenatal microbial imprint on lifelong mental health

26. November 2025

Wiku Andonotopo, Muhammad Adrianes Bachnas, Julian Dewantiningrum, Mochammad Besari Adi Pramono, I Nyoman Hariyasa Sanjaya, Ernawati Darmawan, Muhammad Ilham Aldika Akbar, Dudy Aldiansyah, Cut Meurah Yeni, Nuswil Bernolian, Waskita Ekamaheswara Kasumba Andanaputra, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak

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Introduction The traditional view of a sterile intrauterine environment has been challenged by sequencing studies detecting low-biomass microbial DNA in placenta, amniotic fluid, and fetal tissues. These findings suggest that maternal microbiota-derived signals may contribute to fetal brain development and influence long-term neuropsychiatric outcomes. Content This narrative review synthesizes evidence from over 90 preclinical and clinical studies examining maternal microbiota–fetal brain interactions. Maternal immune activation – characterized by elevated cytokines such as interleukin (IL)-6 and IL-17A – has been shown in mouse models to disrupt cortical layering and synaptic organization, while human cohort studies involving more than 250,000 pregnancies link maternal inflammatory markers to increased autism spectrum disorder (ASD) risk. Microbial metabolites, including short-chain fatty acids (butyrate, acetate, propionate), bile acids, and tryptophan derivatives, regulate microglial maturation, blood–brain barrier integrity, and hippocampal neurogenesis. Epigenetic mechanisms – DNA methylation, histone acetylation, and chromatin remodeling – have been observed in placenta and cord blood from pregnancies affected by obesity or dysbiosis. Large-scale epidemiological studies also associate prenatal infection and antibiotic exposure with higher rates of ASD and attention-deficit/hyperactivity disorder (ADHD). Summary Collectively, the evidence indicates that maternal microbiota influence fetal brain development through converging immune, metabolic, epigenetic, and hormonal pathways. Strong mechanistic insights come from animal models, whereas human data remain largely observational, limiting causal interpretation. Outlook Recognizing the maternal microbiome as a modifiable prenatal factor highlights opportunities for prevention. Early translational approaches – including maternal microbiota profiling, dietary optimization, and probiotic supplementation – are under investigation, but require rigorous clinical validation before integration into prenatal care.
Open Access
Integrating mental health into obstetric practice: a review of collaborative care models for perinatal anxiety

21. November 2025

Julian Dewantiningrum, Wiku Andonotopo, Efendi Lukas, Mochammad Besari Adi Pramono, Wisnu Prabowo, Muhammad Adrianes Bachnas, I Nyoman Hariyasa Sanjaya, Anak Agung Gede Putra Wiradnyana, Anak Agung Ngurah Jaya Kusuma, Khanisyah Erza Gumilar, Ernawati Darmawan, Muhammad Ilham Aldika Akbar, Dudy Aldiansyah, Aloysius Suryawan, Ridwan Abdullah Putra, Anita Deborah Anwar, Laksmana Adi Krista Nugraha, Waskita Ekamaheswara Kasumba Andanaputra, Wibisana Andika Krista Dharma, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak

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Objective Perinatal anxiety is one of the most common yet least systematically addressed complications of preg- nancy and childbirth. Despite abundant evidence that collaborative and integrated care models improve maternal outcomes, obstetric practice still lacks a defined operational standard for addressing anxiety alongside routine obstetric care. Fragmented screening, insufficient referral systems, and financing barriers continue to delay intervention, widening inequities across populations and settings. Methods This opinion article synthesizes recent evidence (2010–2025) from PubMed, Google Scholar, and professional guidelines to propose a practical framework for embedding mental health care within obstetric workflows. Drawing upon studies from high- and low-resource contexts, we outline a ten-point minimum standard for perinatal-anxiety management and a three-tier maturity model that describes the progressive integration of collaborative care—from basic screening to digitally supported, team-based systems. The model identifies measurable implementation metrics and policy levers that enable sustainability and equity. Results Rather than advocating new research, this article translates two decades of findings into a clinically actionable standard. It emphasizes the central role of ob- stetric teams in early detection, stepped care, and follow-up through coordination with mental-health professionals. Conclusions Integrating mental health into obstetric practice is both a moral and operational imperative. By adopting the proposed minimum standard and maturity model, health systems can transform perinatal anxiety care from discre- tionary innovation to routine expectation—achieving faster response, broader access, and better maternal–infant out- comes worldwide.
Open Access
Artificial wombs in perinatal medicine: a transformative frontier in neonatal care and bioethics

13. Oktober 2025

Wiku Andonotopo, Muhammad Adrianes Bachnas, Julian Dewantiningrum, Mochammad Besari Adi Pramono, Ernawati Darmawan, Muhammad Ilham Aldika Akbar, I Nyoman Hariyasa Sanjaya, Dudy Aldiasnyah, Cut Meurah Yeni, Nuswil Bernolian, Waskita Ekamaheswara Kasumba Andanaputra, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak

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Objectives To evaluate the current state and translational readiness of artificial womb technology (AWT), focusing on its technical feasibility, preclinical validation, and ethical, legal, and clinical implications for perinatal medicine. Methods We conducted an integrative narrative review of the scientific literature from January 2000 to May 2025. Searches were performed in PubMed, Scopus, and Web of Science using terms such as “artificial womb,” “extrauterine fetal incubation,” “artificial placenta,” “preterm birth,” and “bioethics.” A total of 65 peer-reviewed studies were included, spanning domains of bioengineering, preclinical models, clinical frameworks, and normative analysis. Data were synthesized thematically, with supplemental visual mapping and comparative tables to illustrate platform characteristics and ethical considerations. Results Advanced AWT systems, including EXTEND and the Perinatal Life Support (PLS) platform, have demonstrated success in sustaining extremely preterm lambs and goat fetuses, preserving physiological development in fluid-based environments. Key innovations include pumpless oxygenators, modular system architecture, and AI-assisted monitoring. Despite progress, unresolved challenges include umbilical cannulation, sterility, endocrine simulation, and long-term neurodevelopmental outcomes. Ethical tensions surround maternal autonomy, fetal personhood, informed consent, and global equity in access. Conclusions Artificial wombs represent a paradigm shift in neonatal care, offering the potential to extend viability and reduce preterm morbidity. As AWT approaches clinical translation, interdisciplinary coordination across medicine, ethics, and law will be essential to guide responsible integration. This analysis provides a foundational roadmap for advancing AWT from preclinical innovation to ethical clinical application.
Open Access
Antenatal shunting and outcomes in fetuses with non-immune hydrops fetalis

26. August 2025

Valentina Fragala, Sanjeev Sabale, Ghalia Ashoor, Christopher Harris, Carolina Zorro, Anne Greenough

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Objectives Hydrops fetalis is associated with high morbidity and perinatal mortality. The aim of our study was to compare the outcomes of infants who had non-immune hydrops fetalis (NIHF) who did or did not undergo antenatal shunting . Methods Between January 2014 and June 2023, 20 infants with the diagnosis of NIHF were admitted to the neonatal intensive care unit (NICU) at King’s College Hospital NHS Foundation Trust. The criteria for antenatal shunt placement were development of hydrops fetalis, polyhydramnios due to oesophageal compression by a pleural effusion that would likely result in preterm labour or a large pleural effusion (no hydrops at presentation) resulting in likely inferior vena cava compression and significant risk of development of hydrops. Results The 20 infants had a median gestational age of 34 (27–40) weeks of gestation at delivery and were diagnosed at a median gestational age of 29 (17–40) weeks. Eight infants had a shunt inserted antenatally (six pleuro amniotic and two abdominal amniotic) and they delivered at a significantly later median gestational age (36 vs. 32.5 weeks, p=0.025). After adjustment for gestational age at delivery and antenatal severity, those who had a shunt placed were not more likely to be oxygen dependent at 36 weeks post menstrual age (PMA) and had a lower length of stay (23 vs. 95 days, p=0.019). Conclusions Infants who had NIHF and had antenatal shunting had favourable outcomes compared to those who did not, despite a more severe antenatal presentation.
Open Access
Amniotic Fluid Embolism: a comprehensive review of diagnosis and management

22. August 2025

Wiku Andonotopo, Muhammad Adrianes Bachnas, Julian Dewantiningrum, Mochammad Besari Adi Pramono, Caroline Setiawan, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak

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Introduction Amniotic Fluid Embolism (AFE) is a rare but catastrophic obstetric emergency characterized by the sudden entry of amniotic fluid or fetal debris into the maternal circulation. This triggers acute cardiopulmonary collapse, disseminated intravascular coagulation (DIC), and multi-organ failure. Despite its low incidence, AFE remains a significant contributor to maternal mortality worldwide. The pathophysiology is poorly understood, involving immune-mediated anaphylactoid reactions and mechanical vascular obstruction. Content This review provides a comprehensive synthesis of current knowledge on AFE, examining its epidemiology, pathophysiology, risk factors, clinical manifestations, diagnostic challenges, and management strategies. A systematic literature review was conducted following PRISMA guidelines, incorporating peer-reviewed articles and clinical protocols published from 2000 to 2024. Clinical tools such as diagnostic algorithms and resuscitation frameworks were developed from aggregated evidence and thematic analysis. Summary AFE typically presents intrapartum or in the immediate postpartum period with sudden hypoxia, hypotension, and coagulopathy. Diagnosis is clinical, as no single confirmatory biomarker currently exists. Management is primarily supportive, focusing on rapid resuscitation, hemodynamic stabilization, and aggressive coagulopathy correction. Emerging strategies such as the A-OK regimen (Atropine, Ondansetron, Ketorolac) are discussed as investigational approaches under consideration. Outlook AFE continues to challenge obstetric and critical care teams due to its abrupt onset and high fatality. Future priorities include the development of validated diagnostic biomarkers, refinement of therapeutic interventions, and establishment of standardized multidisciplinary response protocols to improve maternal and neonatal outcomes.
Open Access
Sonographic surveillance and perinatal outcomes among pregnancies with periviable fetal growth restriction

22. August 2025

Felicia V. LeMoine, Angela C. Ranzini, Marisa R. Imbroane, Esha V. Ghosalkar, David N. Hackney, Emily J. Hamburg-Shields

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Objectives This study compared adverse perinatal outcomes between pregnancies complicated by periviable fetal growth restriction (pFGR) that underwent weekly sonographic surveillance vs. serial growth surveillance. Methods In this retrospective cohort study, pFGR was defined as a 22 0/7–27 6/7-week singleton, <500 g, and ≤10 % for gestational age. The surveillance group initiated weekly Doppler surveillance while the serial growth (SG) group underwent growth assessment every 3–4 weeks between 22 and 27 6/7 weeks. Adverse perinatal outcomes were compared. Results Eighty-one (36.2 %) underwent weekly Doppler surveillance. Chronic hypertension (18.5 % vs. 9.1 %, p=0.04), a prior history of fetal demise (8.6 % vs. 2.1 %, p=0.02), and an estimated fetal weight <3 % (22.2 % vs. 10.5 %, p=0.02) and any abnormal umbilical artery Doppler pattern at diagnosis (25.8 % vs. 12.9 %, p=0.046) occurred more frequently in the weekly Doppler surveillance group than the SG group. Despite no difference in perinatal death, the surveillance group demonstrated a higher rate of obstetric (65.4 % vs. 42.7 %, p<0.05) and neonatal (60.8 % vs. 28.4 %, p<0.05) adverse outcome composites compared to the SG group. Conclusions The surveillance group experienced increased rates of obstetric and neonatal morbidity without difference in perinatal death though interpretation is limited by the observational nature of this study.
Open Access
Correlation of serum miR-203a-3p with the severity of neonates with necrotizing enterocolitis and analysis of its molecular mechanism

8. August 2025

Fengna Zhu, Zhengjiang Jin, Weiyu Liu, Hongyan Liu

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Objectives The objective of this study was to examine the role of microRNA-203a-3p (miR-203a-3p) in the pathogenesis of necrotizing enterocolitis (NEC). Methods Quantitative real-time polymerase chain reaction (qRT-PCR) and receiver operating characteristic (ROC) curve analysis were employed to evaluate the relative abundances of miR-203a-3p as well as its diagnostic capacity. Logistic regression was applied to search for influential risk factors associated with NEC in neonates. Cell behaviors were assessed with flow cytometry and CCK-8 detection. The target genes of miR-203a-3p and its potential biological functions were analyzed via bioinformatic analysis. Results A significant reduction in serum levels of miR-203a-3p was observed in neonates with NEC. Notably, this miRNA exhibited exceptional diagnostic precision for differentiating NEC from non-NEC cases, as evidenced by an area under the curve (AUC) of 0.928. Furthermore, miR-203a-3p was established as an independent indicator for assessing the severity of NEC. In an NEC cell model, levels of miR-203a-3p were distinctly diminished; however, this decrease was significantly reversed following transfection with miR-203a-3p (p<0.001). Correspondingly, findings were noted regarding cell apoptosis, cell viability, inflammatory indicators, and antioxidant enzyme activities. MiR-203a-3p-related genes predominantly clustered within inflammatory-associated signaling pathways and proteins, particularly ataxia telangiectasia mutated (ATM). Notably, miR-203a-3p was found to directly target ATM. Importantly, heightened levels of ATM were detected in both neonates with NEC and LPS-triggered fetal human colon (FHC) cells (p<0.001). Conclusions MiR-203a-3p alleviates LPS-induced inflammatory damage in FHC cells through regulating ATM, thereby presenting a promising avenue for the development of novel therapeutic strategies for neonates with NEC.
Open Access
Generative artificial intelligence for counseling of fetal malformations following ultrasound diagnosis

31. Juli 2025

Amos Grünebaum, Frank A. Chervenak

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Objectives To explore the potential role of generative artificial intelligence (GenAI) in enhancing patient counseling following prenatal ultrasound diagnosis of fetal malformations, with an emphasis on clinical utility, patient comprehension, and ethical implementation. Background The detection of fetal anomalies during the mid-trimester ultrasound is emotionally distressing for patients and presents significant challenges in communication and decision-making. Generative AI tools, such as GPT-4 and similar models, offer novel opportunities to support clinicians in delivering accurate, empathetic, and accessible counseling while preserving the physician’s central role. Methods We present a narrative review and applied framework illustrating how GenAI can assist obstetricians before, during, and after the fetal anomaly scan. Use cases include lay summaries, visual aids, anticipatory guidance, multilingual translation, and emotional support. Tables and sample prompts demonstrate practical applications across a range of anomalies.
Open Access
Measurements of the fetal heart and prenatal biomarkers in children born with an isolated ventricular septum defect – a large, prospective, multicenter cohort study

25. Juli 2025

Cathrine Vedel, Christian Pihl, Finn Stener Jørgensen, Olav Bjørn Petersen, Line Rode, Karin Sundberg, Helle Zingenberg, Henning Bundgaard, Kasper Iversen, Anne-Sophie Sillesen, Anna Axelsson Raja, Niels Vejlstrup, Ann Tabor, Charlotte Kvist Ekelund

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Objectives To compare 2nd-trimester cardiac and fetal biometries, 1st-trimester biomarkers, and obstetric outcome between children with an isolated ventricular septum defect (iVSD) and healthy children in a large cohort of children with neonatal echocardiography. Methods The Copenhagen Baby Heart Study offered all neonates born in Copenhagen an echocardiography within the 60 days of life between 2016 and 2018. The mothers were recruited at the 2nd-trimester scan (18+0 to 22+6). The documentation from the 2nd-trimester anomaly scan was supplemented with the four-chamber view with Doppler flow, the sagittal view of the aortic arch, the mid-umbilical artery flow, and the ductus venosus flow. All prenatal images were evaluated and cardiac biometries measured by two blinded investigators. VSDs were classified as muscular or as “other type” (perimembranous, inlet, and outlet VSDs). We compared cardiac biometries, biomarkers, and pregnancy outcome between fetuses with a neonatally diagnosed iVSD and controls. Results We included 25,556 neonates for an echocardiography, of which 9,155 fetuses were scanned in the period with extended cardiac imaging prenatally. We identified 294 fetuses with a postnatal VSD. Fetal measurements were similar between those with an iVSD compared to those without, and obstetric outcome were similar. Conclusions Our results indicate that children diagnosed with an iVSD through neonatal echocardiography in an unselected population have an otherwise structurally normal heart prenatally and a normal pregnancy outcome.
Open Access
Feasibility and reproducibility of speckle tracking echocardiography in routine assessment of the fetal heart in a low-risk population: a letter reply

7. Juli 2025

Adalina Sacco, Ayisha Kazi, Diane Lambo, Victoria Jowett, Pranav Pandya

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Journal Impact Factor	1.4	2024, Journal Citation Reports (Clarivate, 2025)
5-year Journal Impact Factor	1.8	2024, Journal Citation Reports (Clarivate, 2025)
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CiteScore	3.5	2024, Scopus (Elsevier B.V., 2025)
SCImago Journal Rank	0.592	2024, SJR (Scimago Lab, 2025; Data Source: Scopus)
Source Normalized Impact per Paper	0.733	2024, CWTS Journal Indicators (CWTS B.V., 2025; Data Source: Scopus)

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