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Zargarzadeh N, Haddadi M, Abiad M, Javinani A, Krispin E, Shainker S, Aagaard K, Shamshirsaz AA. Amnioreduction safety in singleton pregnancies; systematic review and meta-analysis. J Perinat Med 2025:jpm-2024-0605. [PMID: 40254983 DOI: 10.1515/jpm-2024-0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 03/26/2025] [Indexed: 04/22/2025]
Abstract
OBJECTIVES Prenatal ultrasound identifies polyhydramnios in approximately 0.7 % of pregnancies. Polyhydramnios (defined as amniotic fluid index >24 cm) is associated with maternal symptoms and preterm delivery. However, amnioreduction (AR) can effectively alleviate symptoms and reduce preterm delivery risks; its advantages remain controversial. This study aims to assess maternal safety following AR in singleton pregnancies systematically. METHODS Databases searched included PubMed, Embase, Scopus, and Web of Science until April 2024. Pregnant patients with singleton pregnancy and polyhydramnios undergo AR included in our study. Statistical analyses were conducted using R software. RESULTS From 574 initially identified articles, seven studies with 390 singleton pregnancies who underwent AR were included. The primary outcomes showed low odds of placental abruption 0.04 (95 % CI: 0.02-0.09, I 2 =12 %) and chorioamnionitis 0.03 (95 % CI: 0.01-0.08, I 2 =0 %). Secondary outcomes indicated a mean gestational age at birth of almost 36 weeks (95 % CI: 35.51-36.41, I 2 =49 %) and low odds of cesarean delivery 0.45 (95 % CI: 0.30-0.61, I2=58 %), preterm delivery within 48 h after AR 0.10 (95 % CI: 0.07-0.15, I 2 =9 %) and PPROM within 48 h after AR 0.03 (95 % CI: 0.02-0.04, I 2 =0 %). CONCLUSIONS This study demonstrates that maternal complications are expected to be low following the AR procedure. However, given the lack of evidence for fetal benefit and pregnancy prolongation, future studies should directly compare the effects of AR with expectant management. Additionally, fetal survival is likely influenced more by the underlying fetal diagnosis or the etiology of polyhydramnios rather than AR itself. The current meta-analyses will serve as a guide for shared decision-making, and highlight the need for continued clinical trials powered to establish superiority or benefit with AR for singleton pregnancies.
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Affiliation(s)
- Nikan Zargarzadeh
- Division of Fetal Medicine and Surgery, Maternal Fetal Care Center (MFCC), Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohammad Haddadi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - May Abiad
- Division of Fetal Medicine and Surgery, Maternal Fetal Care Center (MFCC), Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Javinani
- Division of Fetal Medicine and Surgery, Maternal Fetal Care Center (MFCC), Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eyal Krispin
- Division of Fetal Medicine and Surgery, Maternal Fetal Care Center (MFCC), Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott Shainker
- Division of Fetal Medicine and Surgery, Maternal Fetal Care Center (MFCC), Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kjersti Aagaard
- Division of Fetal Medicine and Surgery, Maternal Fetal Care Center (MFCC), Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- HCA Healthcare and HCA Healthcare Research Institute, Nashville, TN, USA
- HCA Texas Maternal Fetal Medicine, Houston, TX, USA
| | - Alireza A Shamshirsaz
- Division of Fetal Medicine and Surgery, Maternal Fetal Care Center (MFCC), Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Sun X, Jing R, Li Y. Predicting purulent meningitis in very preterm infants: a novel clinical model. BMC Pediatr 2025; 25:3. [PMID: 39755624 DOI: 10.1186/s12887-024-05349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 12/20/2024] [Indexed: 01/06/2025] Open
Abstract
BACKGROUND Purulent meningitis (PM) is a commonly encountered infectious condition in newborns, which unfortunately can result in infant mortality. Newborns with PM often present nonspecific symptoms. The success of lumbar puncture, an invasive test, relies on the operator's expertise. Preterm infants pose diagnostic challenges compared to full-term babies. The objective of this study is to establish a convenient and effective clinical prediction model based on perinatal factors to assess the risk of PM in very preterm infants, thereby assisting clinicians in developing new diagnostic and treatment strategies. METHODS This study involved very preterm infants (gestational age < 32 weeks) admitted to the Qilu Hospital of Shandong University from January 2020 to December 2023. All included infants underwent lumbar puncture. We gathered comprehensive data that included information on maternal health conditions and the clinical features of very preterm infants. The PM was diagnosed according to the diagnostic criteria. This study conducted data analysis and processing using R version 4.1.2. A stepwise regression method was applied for multivariate Logistic regression analysis to select the best predictors for PM and to develop a predictive model. Differences were considered statistically significant at P < 0.05. RESULTS This study enrolled a total of 201 preterm infants, including 117 boys and 84 girls. The gestational age was 28.7 ± 1.7 weeks, and the weight was 1166.2 ± 302.7 g. Ninety infants were diagnosed with PM, while 111 did not have PM. The influencing factors include birth weight, PCT within 24 h after birth, cesarean delivery, and premature rupture of membranes. These were used to construct a risk prediction nomogram and verified its accuracy. The Brier score was 0.157, the calibration slope was 1.0, and the concordance index was 0.849. CONCLUSIONS We developed and validated a personalized nomogram to identify high-risk individuals for early prediction of purulent meningitis in very preterm infants. This practical predictive model may help reduce unnecessary lumbar puncture procedures.
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Affiliation(s)
- Xiaowei Sun
- Department of Pediatrics, Qilu Hospital, Shandong University, No.107, West Culture Road, Lixia District, Jinan City, Shandong Province, 250000, China
| | - Rui Jing
- Department of Pediatrics, Weifang People's Hospital, No.151 Guangwen Street, Kuiwen District, Weifang City, Shandong Province, 261000, China
| | - Yang Li
- Department of Pediatrics, Qilu Hospital, Shandong University, No.107, West Culture Road, Lixia District, Jinan City, Shandong Province, 250000, China.
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Wu FT, Chen CP. Too Much of a Good Thing: Updated Current Management and Perinatal Outcomes of Polyhydramnios. J Med Ultrasound 2024; 32:285-290. [PMID: 39801544 PMCID: PMC11717093 DOI: 10.4103/jmu.jmu_83_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 01/16/2025] Open
Abstract
Amniotic fluid assessment is crucial in prenatal ultrasound to monitor fetal conditions, with polyhydramnios, characterized by excessive amniotic fluid, affecting 1%-2% of pregnancies. Polyhydramnios is linked to complications such as placental abruption, preterm labor, congenital anomalies, and postpartum hemorrhage, emphasizing the need for early detection and management. While idiopathic causes account for 60%-70% of cases, other causes include impaired fetal swallowing and increased urine production due to maternal, fetal, and placental conditions. Accurate amniotic fluid volume (AFV) assessment and surveying the underlying cause are important, with ultrasound methods such as deep vertical pocket (DVP) and amniotic fluid index (AFI) preferred. Polyhydramnios is defined by an AFV exceeding 2000 ml, an AFI over 24 cm, or DVP more than 8 cm. Management typically targets underlying causes, with treatments such as amnioreduction and indomethacin for severe cases. Antepartum monitoring includes detailed fetal ultrasound, genomic and genetic examinations, and tests for maternal diabetes and infections. Intrapartum management addresses complications such as malpresentation and shoulder dystocia, whereas postpartum care involves monitoring for uterine atony and hemorrhage. Perinatal outcomes in idiopathic polyhydramnios are generally poorer, with increased risks of fetal demise, preterm delivery, and neonatal complications, but these results may need further stratification and verification.
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Affiliation(s)
- Fang-Tzu Wu
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Institute of Clinical and Community Health Nursing, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
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Ibarra C, Bergh E, Tsao K, Johnson A. Prenatal diagnostic and intervention considerations in congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151436. [PMID: 39018717 DOI: 10.1016/j.sempedsurg.2024.151436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
Congenital diaphragmatic hernia (CDH) is a life-threatening birth defect with significant morbidity and mortality. The prenatal management of a pregnancy with a fetus affected with CDH is complex and requires a multi-disciplinary team approach. An improved understanding of prenatal diagnosis and management is essential to developing strategies to optimize outcomes for these patients. In this review, we explore the current knowledge on diagnosis, severity stratification, prognostic prediction, and indications for fetal intervention in the fetus with CDH.
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Affiliation(s)
- Claudia Ibarra
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, United States
| | - Eric Bergh
- Department of Obstetrics and Gynecology, Division of Fetal Intervention, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, United States.
| | - Kuojen Tsao
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, United States
| | - Anthony Johnson
- Department of Obstetrics and Gynecology, Division of Fetal Intervention, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, United States
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Laoreti A, Sala V, Casati D, Faiola S, Spaccini L, Cetin I, Lanna MM. Amnioreduction for Polyhydramnios in a Consecutive Series at a Single Center: Indications, Risks and Perinatal Outcomes. CHILDREN (BASEL, SWITZERLAND) 2024; 11:502. [PMID: 38671719 PMCID: PMC11048928 DOI: 10.3390/children11040502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
Pregnancies complicated by severe polyhydramnios are associated with a high rate of underlying fetal anomaly. Amnioreduction may be offered to alleviate maternal symptoms. This is a retrospective study of amnioreductions performed on singleton and twin gestations complicated by symptomatic polyhydramnios between 2010 and 2023 at our tertiary referral center. The indications, procedural techniques and pregnancy and neonatal outcomes were retrieved from an archive database and reviewed with the use of the maternal and child medical record chart, the hospital electronic clinical discharge report and telephone recalls. Our study comprised 86 pregnancies, 65 singletons and 21 twin pregnancies. Fetal anomalies were identified in 79% of cases, mainly gastrointestinal obstructive anomalies; 9.3% of cases were idiopathic. The median gestational age at first amnioreduction was 32.5 weeks, and peri-procedural complications were rare (1 case of placental abruption and 2 cases of preterm delivery). The median gestational age at delivery was 36.5 weeks, with a median prolongation of the pregnancy from the time of first drain until birth of 30 days. Preterm labor < 37 weeks occurred in 48.8% of procedures, with 26.7% of patients delivering before 34 weeks and pPROM < 36 weeks recorded in 23.2% of cases. In conclusion, amnioreduction offered to alleviate maternal symptoms is a reasonably safe procedure with a low complication rate. These pregnancies necessitate management in a tertiary referral center because of their need for a multidisciplinary approach both prenatally and postnatally.
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Affiliation(s)
- Arianna Laoreti
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Valentina Sala
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Daniela Casati
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Stefano Faiola
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Luigina Spaccini
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
- Clinical Genetic Service, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
| | - Irene Cetin
- Fondazione IRCCS Ca’ Granda, Hospital Maggiore Policlinico, University of Milan, 20122 Milan, Italy;
| | - Mariano M. Lanna
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
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