Ahead of Publication / Just Accepted

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.

Objectives This study examines the association between fetal macrosomia (>5,000 g) and pregnancy and birth outcomes. Methods This was a retrospective cohort study using data from the perinatal survey of Lower Saxony, Germany (2001–2009). Results Pregnancies complicated by advanced maternal age (>35 years), elevated BMI (>25.0), and excessive gestational weight gain were significantly more likely to result in macrosomic births. Additionally, pregnancies involving macrosomic fetuses were characterized by prolonged gestation and an increased likelihood of cesarean delivery. Neonates with macrosomia exhibited significantly lower Apgar scores at 1, 5, and 10 min (<7) compared to the control group (<5,000 g), though umbilical artery pH values did not differ significantly between groups. Conclusions These findings highlight the need for targeted prenatal monitoring and risk assessment in pregnancies predisposed to fetal macrosomia.

Objectives to describe the risk of early and late fetal loss of a cohort of monochorionic monoamniotic (MCMA) twin pregnancies; secondary objectives are to describe perinatal outcomes of these pregnancies and to identify which obstetric variables mostly influence the incidence of neonatal adverse outcome. Methods retrospective cohort study including MCMA twin pregnancies followed up at the Twin Pregnancy Care Unit of Sant’Anna Hospital in Turin (Italy) between 2005 and 2024. Chorionicity and amnionicity were diagnosed in the first trimester. Results a total number of 53 MCMA twin pregnancies have been included in the study, of which 42 progressed beyond 24 weeks of gestation. The rate of fetal loss before 24 weeks of GA was 19.8 %, after 24 weeks this rate lowered to 3.6 %; the incidence of overall intrauterine losses was 23.6 %; 80.5 % of liveborn twins were female. Around one fourth of the newborn babies had an adverse outcome, the likelihood of which was significantly influenced by gestational age at birth, birthweight and presence of malformations. The incidence of congenital malformations in our sample was 13.4 %. Conclusions most fetal losses occur before 24 weeks of gestation and the rate of fetal demise after this cutoff is quite low. It could be worth to postpone elective delivery to 34 weeks of gestational age or beyond, in order to reduce perinatal complications associated to premature birth.

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.

Objectives To analyse global temporal trends in the incidence of maternal haemorrhage among women of reproductive age, and to assess associations with the sociodemographic index (SDI). Methods Data were obtained from international health databases, including the Global Burden of Disease Study, to extract the number of maternal haemorrhage cases and incidence rates for women aged 15–49 years by country/territory, age group and SDI region over the period 1990–2021. Temporal changes in incidence were quantified using the estimated annual percentage change (EAPC). Correlations between incidence and SDI were analysed. Results Globally, maternal haemorrhage cases declined slightly from 14.1 million in 1990 to 13.9 million in 2021 (EAPC = −1.03). The incidence rate decreased from 1,056.09 to 714.00 per 100,000 women. Marked declines were noted in age groups 15–19 years (EAPC = −1.48), 20–24 years (EAPC = −1.39) and 45–49 years (EAPC = −2.46). The steepest reductions occurred in low-middle SDI regions (EAPC = −2.13), while some high-SDI regions (e.g., Eastern Europe) experienced modest increases. Sub-Saharan Africa remained the region with the highest incidence (>1,000 per 100,000). A significant negative correlation was observed between SDI and maternal haemorrhage incidence. Conclusions Although global incidence of maternal haemorrhage in women of reproductive age has declined over the past three decades, substantial regional and sociodemographic disparities persist. The findings highlight that improvements in obstetric and public health systems have had global impact, yet targeted efforts are needed in low-SDI regions to achieve maternal health equity.

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.

Objectives Maternal vascular malperfusion (MVM) refers to dysfunctional uteroplacental circulation and is associated with increased risk of adverse maternal and fetal outcomes. The diagnosis of MVM is one of the most common pathological diagnoses in term placentas. The aim of the study was to test the interrater reliability of the MVM Amsterdam criteria. Methods A group of 12 international perinatal pathologists reviewed digital histological sections of placentas (n=29; 20 MVM/ 9 non-MVM controls), applying published Amsterdam workshop consensus criteria. Kappa statistics were used for interobserver agreement analysis. Results Agreement levels on final MVM diagnosis according to Amsterdam consensus were calculated as slight to fair (K-values of 0.187 and 0.260, p<0.001). Substantial agreement was reached one time for infarcts (K-value of 0.707, p<0.001). Complementary tested criteria achieved none to moderate agreement. Conclusions Our results highlight the need to refine current MVM criteria to support consistent international diagnosis.

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.

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.

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.

Objectives Kangaroo care (KC), involving skin-to-skin contact, early breastfeeding and early discharge, demonstrated benefits in improving outcomes for preterm and low birth weight infants. This systematic review and meta-analysis aimed to evaluate the effectiveness of early KC (initiated within the first 24 h) vs. conventional neonatal care in very preterm infants (≤32 weeks) and/or very low birth weight (VLBW) infants (<1,500 g). Methods A comprehensive search of MEDLINE, SCOPUS, Web of Science, and CENTRAL databases was conducted. Randomized controlled trials (RCTs) comparing early KC to conventional care in very preterm and/or VLBW infants were included. Risk of bias was assessed using the Cochrane Risk of Bias tool . Meta-analysis was conducted using R, with relative risks (RR) and 95 % confidence intervals (CI) calculated. Results Four RCTs, encompassing 1,679 newborns, were included. Meta-analysis revealed a significant reduction in mortality risk (RR=0.81, 95 % CI: 0.67–0.98) with early KC. The pooled RR for infection risk was 0.89 (95 % CI: 0.77–1.02). The impact on hypothermia was mixed, with moderate heterogeneity observed. Conclusions Early KC may reduce mortality and morbidity in very preterm and VLBW infants although its effects on hypothermia vary by severity. Further studies are required to assess its effects on infants weighing <1,000 g or born before 28 weeks of gestation.

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.

Objectives This study aims to analyze the incidence and causes of stillbirth, identify associated risk factors, and explore effective interventions. Methods A retrospective analysis was conducted on 324 stillbirth cases admitted to the Obstetrics Department of Chongqing Health Center for Women and Children from January 2017 to December 2023. A comparison was made with live births in the same period. The study investigated the origins of stillbirth, identified key risk factors, and proposed strategies for the prevention and management of stillbirth. Results The stillbirth rate was 3.2 ‰, with no significant variation over the 7 years (p>0.05). A “U-shaped” relationship was observed between maternal age and stillbirth. The incidence of stillbirth among multiparous women was significantly higher than among primiparous women. The top three maternal factors associated with stillbirth were genital malformations, severe preeclampsia, and infections, with stillbirth rates of 20 , 13, and 13 ‰, respectively. The top three umbilical cord and placental factors associated with stillbirth were identified as umbilical cord shortness, umbilical cord true knot, and placental abruption, with incidence rates of 19 , 17, and 11 ‰, respectively. Twin pregnancies had a stillbirth rate of 17 ‰. Advanced maternal age, multiparity, and twin pregnancies were identified as high-risk groups for stillbirth. Conclusions To reduce stillbirth incidence, essential measures include strengthening pre-conception healthcare and counseling, proactively addressing pregnancy-related complications, improving monitoring methods throughout gestation and delivery, and refining midwifery skills.

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.

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.

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.

Introduction Neonatal jaundice is a common condition characterized by elevated serum bilirubin levels. Although usually benign, inadequate management may result in severe complications such as bilirubin encephalopathy and kernicterus. Phototherapy is the standard treatment; however, concerns regarding potential short- and long-term adverse effects have motivated the investigation of oral adjuvants as complementary therapies to accelerate bilirubin clearance and reduce phototherapy exposure. Content This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251071886). Randomized controlled trials published between 2010 and 2025 were included, evaluating full-term neonates (35–42 weeks, 2–4 kg) without Rh incompatibility. Searches were conducted in PubMed, Cochrane Central, Embase, and Web of Science. Of 193 identified records, 18 RCTs met eligibility criteria. The oral adjuvants assessed included probiotics, phenobarbital, ursodeoxycholic acid (UDCA), oral calcium, zinc sulfate, fenofibrate, and clofibrate. Lactobacillus reuteri demonstrated greater 24-hour reductions in total serum bilirubin (TSB) compared to controls, whereas Bifidobacterium strains primarily reduced phototherapy duration. Phenobarbital did not outperform phototherapy alone and was associated with longer hospitalization. UDCA showed substantial bilirubin reductions, although findings were heterogeneous. Zinc supplementation did not demonstrate consistent significant benefit. Fenofibrate produced statistically significant decreases in TSB across trials and showed the most consistent efficacy. Clofibrate also reduced bilirubin levels but with methodological variability and limited comparative data. Summary Oral adjuvants combined with phototherapy may enhance bilirubin reduction in term neonates, particularly fenofibrate. Outlook However, heterogeneity and potential bias limit definitive conclusions, emphasizing the need for large, multicenter randomized trials.

Objectives To explore the association between postpartum pain and discharge readiness after delivery, and examine the mediating effects of social support and quality of discharge guidance. Methods This study included puerperae who delivered and were discharged from a tertiary hospital affiliated to Peking University between April and July 2021 by the convenience sampling method. The Chinese versions of the OB-RHDS, OB-QDTS, PSQ, and VAS were used to evaluate discharge readiness, quality of discharge guidance, social support, and postpartum pain, respectively. The path analysis was performed based on the Andersen model. Results A total of 306 questionnaires were distributed in this study, and 276 (90.20 %) valid questionnaires were collected. The postpartum pain at discharge was 2.62±1.89 (possible range: 0–10). The average score of postpartum social support (importance) was 210.98±30.08, and the average score of postpartum social support (actually received) was 201.17±34.21, respectively. The postpartum pain at discharge significantly affected maternal discharge readiness. The path analysis showed that the quality of discharge guidance had the mediating effect of the association between pain at discharge and discharge readiness, and postpartum social support was a moderator for the association between pain at discharge and quality of discharge guidance, and the association between quality of discharge guidance and discharge readiness. Conclusions The postpartum pain at discharge was associated with discharge readiness, and the quality of discharge guidance and postpartum social support might mediate the association.

Objectives This study aimed to establish reference values for heart rate frequency and variability indices in preterm neonates admitted to a neonatal intensive care unit of a tertiary care hospital during their first week of life. Methods In this retrospective cohort study, the Generalized Additive Models for Location Scale and Shape framework was employed to establish reference values for heart rate indices across time-domain, frequency-domain and nonlinear-domain in neonates considering gestational age, postnatal age, sex and birth weight. Results Heart rate tracings of 594 neonates (45 % female; median gestational age at birth 29 0 (IQR 26 6 –30 5 ); 38 % birth weight <p10, 6 % birth weight >p90) were analyzed. Reference values were established for 25 heart rate indices. Nearly all heart rate indices were significantly influenced by gestational age, postnatal age and sex. Baseline heart rate decreased with gestational age, increased with postnatal age and was higher in females. Heart rate standard deviation increased with gestational age and postnatal age and was lower in female. Inclusion of birth weight significantly improved model fit for all HRV indices. Conclusions This study highlights the importance of considering gestational and postnatal age, sex and birth weight when interpreting neonatal heart rate frequency and variability in preterm neonates. These findings support the need for personalized approaches for neonatal monitoring and interpretation. Future research should validate these values in larger, more diverse populations, including additional clinical factors such as neonatal complications and medication administration, to determine their clinical relevance.

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.

Objectives To characterize national trends in prepregnancy body mass index from 2016 to 2024 across U.S. racial and ethnic groups, with particular attention to normal weight prevalence at pregnancy entry. Methods We conducted a retrospective population-based analysis of 32,726,128 live births using CDC National Vital Statistics System Natality data from 2016 through 2024. Prepregnancy BMI was calculated from self-reported height and weight on birth certificates. Obesity was defined as BMI ≥30.0 kg/m 2 for all groups except Asian mothers, for whom BMI ≥25.0 kg/m 2 was applied per established ethnicity-specific metabolic risk thresholds. Results By 2024, normal weight prevalence had fallen below 50 % for all racial and ethnic groups except Asian mothers, who nonetheless demonstrated the steepest downward trajectory. Obesity prevalence increased steadily across all groups while normal weight declined universally. Non-Hispanic Native Hawaiian or Other Pacific Islander mothers had the highest absolute obesity prevalence at 51.6 %. Applying ethnicity-appropriate thresholds, obesity among Asian mothers reached 41.4 % – exceeding Non-Hispanic White and Hispanic mothers – representing the largest relative increase between 2016 and 2024. Conclusions Between 2016 and 2024, the U.S. obstetric population experienced broad metabolic deterioration characterized by rising obesity and erosion of normal weight as the normative baseline at pregnancy entry. Ethnicity-specific BMI thresholds reveal Asian mothers as a rapidly emerging high-risk population, underscoring the need for system-level interventions and recalibrated preconception metabolic strategies.

Objectives The safety and efficacy of peripartum transfusion support depends on a comprehensive risk analysis, the provision of substantiated criteria for ordering blood products, and surveillance of outcomes over time. We aimed to determine bleeding frequencies and volumes of blood loss, associated patient risk factors, and the effectiveness of our transfusion support scheme. Methods Birth records of 12,255 pregnant women who gave birth at our hospital were screened for haemorrhage volumes, mode of delivery, bleeding aetiology, accompanying risk factors as well as outcome. Transfusion related data was extracted from the electronic blood product database. Results A total of 204 (1.6 %) women who gave birth within the 5-year study period received at least one RBC transfusion within 48 h after delivery. Differences in haemorrhage volumes in all women compared to those receiving RBC transfusion confirmed an increased probability of RBC transfusion with larger haemorrhage volumes. Uterus atony bleeding (UAB) was the most common cause associated with transfusions. Six risk factors for RBC transfusion among transfused patients were identified that showed a probability of >10 %: Adherent placenta (31.4 %), preterm rupture of membranes (PROM) (25.5 %), age over 35 (25.0 %), a previous caesarean section (19.6 %), gestational diabetes mellitus (15.2 %), and a twin pregnancy (11.8 %). An overall crossmatch-to-transfusion (C/T) ratio of 2.75:1 was reached and no patient with major haemorrhage-related morbidity or mortality was recorded. Conclusions Evaluation of peripartum haemorrhage and associated RBC transfusion using the described methodology revealed RBC transfusions in 1.6 % of all women who gave birth within the study period. The described blood ordering scheme demonstrates a safe and efficient utilisation of blood products.

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.

Background Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality, driven by oxidative stress, endothelial dysfunction, and systemic inflammation. Current preventive strategies, such as low-dose aspirin, offer modest benefit, highlighting the need for alternative approaches. Medicinal plants with antioxidant and anti-inflammatory properties, long used in maternal health traditions, may provide biological pathways relevant to preeclampsia prevention. Summary This review synthesizes human clinical and mechanistic evidence on four medicinal plants with documented antioxidant activity –  Curcuma longa , Moringa oleifera , Orthosiphon aristatus , and Centella asiatica . These botanicals demonstrate potential mechanisms of action including redox modulation, preservation of endothelial function, and suppression of pro-inflammatory pathways, all of which are implicated in preeclampsia pathophysiology. Content A PRISMA-guided systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library (2000–2025) identified human studies evaluating these plants’ effects on oxidative stress and vascular health. Evidence was synthesized narratively due to heterogeneous study designs and outcomes. Most studies were small, often not pregnancy-specific, and used non-standardized botanical formulations. Outlook These medicinal plants offer biologically plausible pathways to reduce preeclampsia risk. However, pregnancy-focused randomized trials, dose optimization, pharmacokinetic profiling, and safety evaluations are essential before clinical integration into maternal care.

Objectives To evaluate current evidence on prenatal neurobehavioural assessment using four-dimensional ultrasound (4D-US), structured scoring systems, and emerging artificial intelligence (AI) platforms, and to develop an integrated framework for early identification of neurodevelopmental vulnerability. Methods A narrative review of the literature from 2000 to 2025 was conducted following PRISMA-guided organisational principles to enhance transparency. Studies were eligible if they used 3D/4D ultrasound to assess fetal neurobehaviour, including spontaneous motor activity, facial expressions, or behavioural transitions. Specific tools examined included the Kurjak Antenatal Neurodevelopmental Test (KANET), prenatal General Movements Assessment (GMA), and AI-assisted behavioural analysis systems. Methodological quality was appraised using the Newcastle–Ottawa Scale and the Joanna Briggs Institute checklist. Data extraction focused on imaging protocols, behavioural parameters, scoring systems, and associations with neonatal neurological outcomes. Results Fifty eligible studies demonstrated that fetal motor sequences, movement variability, and facial expressions exhibit hierarchical maturation consistent with developmental progression of brainstem, subcortical, and cortical neural circuits. KANET parameters showed reproducible scoring and meaningful correlation with neonatal neurodevelopment, particularly in high-risk pregnancies. Prenatal general movement patterns displayed continuity with postnatal repertoires and contributed to early neurological prediction. AI-based classifiers provided objective quantification of fetal movement and facial activity, supporting automated or semi-automated assessment workflows. Conclusions Functional neurobehavioural assessment using 4D-US, structured scoring tools, and AI-enhanced analysis is feasible, reproducible, and clinically informative. Integrating behavioural markers with neurosonographic findings and computational modelling may strengthen early detection of neurological risk and improve long-term neurodevelopmental care pathways.

Objectives Crohn’s disease, which typically affects individuals of reproductive age, has risen in prevalence over the past decades. The study objective was to determine the impact of maternal Crohn’s disease on maternal and neonatal adverse outcomes. Methods A retrospective cohort study was performed using the Healthcare Cost and Utilization Project-National Inpatient Sample from the United States. International Classification of Diseases, 10th edition (ICD-10) codes were used to identify individuals who delivered between 2016 and 2021, and then those with Crohn’s disease were identified (ICD-10 code K50). The effect of Crohn’s disease on pregnancy was estimated using multivariable logistic regression adjusted for baseline maternal characteristics. Results There were 4,337,612 births between 2016 and 2021, of which 5,671 were associated with maternal Crohn’s disease, for an overall period prevalence of 13.1/10,000 births. There was an upward trend in prevalence from 10.2/10,000 deliveries in 2016 to 15.6/10,000 deliveries in 2021 (p<0.0001). Individuals with Crohn’s disease were at increased risk of preeclampsia (odds ratio 1.6, 95 % CI 1.4–1.7), chorioamnionitis (1.3, 1.1–1.5), placental abruption (1.4, 1.1–1.7), instrumental delivery (1.3, 1.1–1.4), cesarean delivery (1.6, 1.5–1.7), postpartum hemorrhage (1.3, 1.2–1.5), sepsis (2.0, 1.5–2.7), and venous thromboembolic events (2.1, 1.1–3.8). Neonates born to these mothers were more likely to be premature (1.6, 1.5–1.7), suffer from congenital anomalies (1.5, 1.2–1.8) and intrauterine growth restriction (1.7, 1.5–1.9). Conclusions Crohn’s disease in pregnancy was associated with adverse maternal and neonatal outcomes. Pregnant patients with Crohn’s disease should therefore be closely monitored throughout their pregnancy to minimize these adverse outcomes.

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.

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.

Objectives Preterm birth is associated with a higher risk of mortality. In 2020, the global incidence of preterm births was reported at 9.9 per 100 live births. This meta-analysis was undertaken to evaluate the effect of preterm birth on mortality among various age groups. Methods A thorough search was done on four electronic databases: “PubMed, Scopus, Web of Science, and Embase”. Adhering to PRISMA 2020 guidelines, observational analytical studies published till 4th December 2024 were included. Screening of the studies was done by two independent reviewers in two stages: title/abstract, followed by full text review of the advanced articles. It was followed by data extraction. Study quality was assessed with the Newcastle Ottawa Scale. Meta-analysis using a random-effects model was done in R Studio. PROSPERO ID: CRD42024622282. Results Database search yielded 1775 unique studies. 23 studies met the final predefined eligibility criteria. Preterm babies showed an increased risk of mortality compared to term babies with a pooled relative risk of 6.12 (95 % CI: 3.16–11.84) for neonatal mortality, 11.84 (95 % CI: 6.88–20.37) for infant mortality and 1.88 (95 % CI: 1.24–2.83) for 1–5 year. However, it was similar in adult mortality with a pooled relative risk of 1.21 (95 % CI: 0.07–20.12). Conclusions Preterm birth is strongly associated with increased risks of childhood mortality, especially in extreme and very preterm infants, but the risk persists even for late preterms.

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.

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.

Objectives We aimed to explore the incidence rate of and risk factors for anorectal diseases in primiparae in the first 6 weeks following delivery, and to establish a risk evaluation model for the early identification of high-risk groups and precise intervention. Methods Subjects (350 in total) in this prospective observational cohort study were recruited from eligible primiparae who delivered between January 2023 and January 2025. The pregnancy data, intrapartum data and postpartum follow-up (completed at 1 week, 3 weeks and 6 weeks following delivery) data were acquired. Relevant variables were identified using univariate analysis plus Least Absolute Shrinkage and Selection Operator regression, and a machine learning Logistic regression prediction model was constructed. Results Finally, 326 of the enrolled 350 primiparae finished the follow-up, with a completion rate of 93.14 %. The incidence rate of anorectal diseases in the first 6 weeks after delivery was 29.14 %. Prolonged second stage of labor, elevated fetal birth weights, increased pre-pregnancy body mass index (BMI), a history of gestational constipation, and epidural anesthesia served as independent risk factors (p<0.001). The area under the curve (AUC) of the prediction model was 0.928, which was well calibrated, and the mean AUC by 5-fold cross-validation was 0.865, implying good discrimination and generalization ability. The constructed nomogram realized individualized risk assessment. Conclusions Prolonged second stage of labor, large fetal weights, high pre-pregnancy BMI, gestational constipation, and epidural anesthesia are considered independent risk factors. The model supports screening high-risk groups and improving postpartum anorectal health management.

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.

Introduction The surgical technique for ex utero intrapartum treatment (EXIT) has been well-established for fetuses in cephalic presentation. EXIT for a fetus in a breech lie presents surgical challenges and requires modification. Summary We describe EXIT on a fetus in a breech lie and with multiple congenital anomalies, including micrognathia, bilateral cleft lip, and a sizeable neural tube defect at 36 + 3 weeks of gestation when the mother presented after preterm prelabor rupture of membranes (PPROM). Conclusions Hysterotomy in the uterine fundus is feasible for partial delivery of a breech fetus for EXIT if the placental margin is >2 cm away from the incision site. A power surgical stapler is an effective tool to perform a hysterotomy in the uterine fundus. Timely simulation-based training is a valuable tool to prepare for infrequent but high-stakes procedures.