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New Challenges in Maternal-Fetal Medicine
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New Challenges in Maternal-Fetal Medicine

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 28 November 2025 | Viewed by 2127

Special Issue Editor

Dr. Marzena Laskowska

E-Mail Website
Guest Editor
Department of Obstetrics and Perinatology, Medical University of Lublin, Jaczewskiego 8, 20-950 Lublin, Poland
Interests: preeclampsia; maternal-fetal and neonatal medicine; HELLP; placenta; fetal growth restriction (FGR); pregnancy complications; infection; preterm delivery; PAS; gestational diabetes; gestational cholestasis; postpartum hemorrhage; fetal surgery and neonatal outcomes; metabolic syndrome; prematurity
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Maternal–fetal medicine is a unique field of medicine. It differs from classical obstetrics primarily in the search for an answer to the question of how to provide care for a pregnant woman and her child so as to not only prevent maternal complications and ensure the child is born in good health but to also guarantee that, after several years, the child will develop properly, both physically and mentally.

New imaging modalities and laboratory methodologies have allowed us to diagnose maternal–fetal pathologies early, providing rapid treatment. Studies in this domain continually evolve, and the emerging therapeutic options seem promising. Additionally, various fetal therapy techniques have been established at distinguished centers to treat, for example, open spina bifida or other congenital diseases.

I want to invite you and your co-workers to submit original research articles that address severe issues in perinatal medicine to the Special Issue "New Challenges in Maternal-Fetal Medicine", which sets out to investigate these research areas and the scientific endeavors that are required to improve pregnancy outcomes.

Dr. Marzena Laskowska
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • thrombocytopenia in pregnancy
  • multiple pregnancies
  • placental abruption
  • DIC
  • sepsis
  • chorioamnionitis
  • cholestasis
  • postpartum hemorrhage
  • emergency cervical cerclage
  • problems in pregnancy and labor
  • pregnancy complications
  • spina bifida
  • fetal well-being evaluation

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Published Papers (3 papers)

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Research

11 pages, 869 KiB  
Article
Comparison of Perinatal Outcomes Following Elective and Emergency Cerclage Insertion: A Ten-Year Retrospective Cohort Study
by Franciszek Ługowski, Julia Babińska, Kamil Jasak, Karolina Pastwa, Ewelina Litwińska-Korcz, Magdalena Litwińska, Zoulikha Jabiry-Zieniewicz and Monika Szpotańska-Sikorska
J. Clin. Med. 2025, 14(10), 3515; https://doi.org/10.3390/jcm14103515 - 17 May 2025
Viewed by 283
Abstract
Background: Cervical insufficiency (CI) is a painless cervix dilation in the second or early third trimester due to a structural or functional defect. However, CI is often diagnosed retrospectively. A cervix with CI cannot retain the fetus. This condition significantly increases the [...] Read more.
Background: Cervical insufficiency (CI) is a painless cervix dilation in the second or early third trimester due to a structural or functional defect. However, CI is often diagnosed retrospectively. A cervix with CI cannot retain the fetus. This condition significantly increases the morbidity associated with extreme prematurity. Women diagnosed with cervical incompetence and dilatation in the mid-second trimester are offered interventions to prolong the duration of pregnancy, with the mainstay of therapy being emergency cerclage. A prophylactic cerclage may be offered to women with a history of extremely preterm birth due to isthmic cervical incompetence. Aim: The aim of this study was to evaluate the perinatal outcomes of elective and emergency cerclages. Materials and Methods: A 10-year retrospective analysis, from 1 January 2015 to 29 February 2024 of pregnancies with indications for cervical cerclage, was conducted. Obstetric and neonatal outcomes were assessed. Results: Prophylactic cervical cerclage was performed in 43 (57%) and emergency cerclage in 32 (43%) of all analyzed cases. The mean prolongation of gestation (measured as the period between cerclage insertion and delivery) was higher in the elective cerclage group compared with the emergency cerclage group (18.6 ± 5.4 vs. 12.2 ± 6.4 weeks; p < 0.0001). The mean gestational week at cerclage removal was also higher in the elective group (36.1 ± 2.2 vs. 31.4 ± 5.6 weeks; p < 0.001). Deliveries in the extreme prematurity period (before 28 completed weeks of gestation) were five times more often in the rescue cerclage group. A significantly higher mean birthweight was reported in the elective cerclage group, at 2920.4 ± 946.8 g vs. 2078.8 ± 1147.8 g (p = 0.0004). Emergency cerclage insertion was associated with a higher need for NICU hospitalization (28% vs. 5%, p = 0.003), continuous positive airway pressure (38% vs. 2%, p < 0.0001), and intubation (22% vs. 0%, p = 0.003). Conclusions: While elective cerclage is associated with more favorable perinatal and neonatal outcomes, this likely reflects earlier intervention in lower-risk pregnancies rather than inherent superiority of the approach. Emergency cerclage, performed under urgent and often suboptimal conditions, remains a critical and effective intervention capable of prolonging gestation and improving neonatal survival in high-risk cases. Full article
(This article belongs to the Special Issue New Challenges in Maternal-Fetal Medicine)
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17 pages, 1464 KiB  
Article
Compliance with the European Pregnancy Prevention Programme in Isotretinoin Treatment: Safety Outcomes and Dose-Related Correlations
by Piotr Brzeziński, Igor Jarosław Feszak, Janusz Śmigielski, Piotr Kawczak and Tomasz Bączek
J. Clin. Med. 2025, 14(10), 3497; https://doi.org/10.3390/jcm14103497 - 16 May 2025
Viewed by 136
Abstract
Background: Isotretinoin is a highly effective treatment for moderate-to-severe acne, but strict contraceptive measures are required because of its teratogenicity. The European Pregnancy Prevention Programme (PPP) aims to minimise foetal exposure through structured protocols. However, real-world data on patient compliance and treatment outcomes [...] Read more.
Background: Isotretinoin is a highly effective treatment for moderate-to-severe acne, but strict contraceptive measures are required because of its teratogenicity. The European Pregnancy Prevention Programme (PPP) aims to minimise foetal exposure through structured protocols. However, real-world data on patient compliance and treatment outcomes are limited. Methods: This retrospective study included 569 female patients aged 14–25 years treated with isotretinoin in Poland (2021–2022). Patients were assigned to three groups based on PPP compliance: full (Group I), partial (Group IIA), and minimal (Group IIB). Data on contraception, cumulative dose, treatment duration, adverse events, laboratory monitoring, and therapy discontinuation were analysed using non-parametric statistical tests (p < 0.05). Results: No pregnancies occurred during treatment. Overall compliance with PPP requirements was high: 100% of the patients used contraception or declared abstinence. The majority (92.79%) used condoms, 1.93% used oral contraceptives, and 7.21% reported abstinence. Significant differences in cumulative isotretinoin dose were observed between the groups (Kruskal–Wallis H = 19.89, p < 0.001), with Group I receiving a lower mean dose than those in Groups IIA (p < 0.001) and IIB (p < 0.01). Notably, all therapy discontinuations (4.75%) occurred in Group I (full compliance), which may reflect stricter monitoring and an earlier identification of adverse effects or patient concerns. These discontinuations were associated with lower cumulative dosing (Mann–Whitney Z = 7.81, p < 0.001) than that seen in the other groups. An inverse correlation between age and cumulative dose was also found (H = 13.09, p = 0.0004), with younger patients (≤17 years) more likely to reach therapeutic targets. Conclusions: Isotretinoin therapy under structured PPP protocols is safe and effective, with no pregnancies reported and excellent contraceptive compliance. Significant differences in dosing and adherence patterns highlight the need for flexible patient-centred approaches to optimise safety and outcomes. Full article
(This article belongs to the Special Issue New Challenges in Maternal-Fetal Medicine)
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15 pages, 1304 KiB  
Article
The Role of Accurate Estimations of Blood Loss and Identification of Risk Factors in the Management of Early Postpartum Hemorrhage in Women Undergoing a Cesarean Section
by Zofia Włodarczyk, Aleksandra Śliwka, Hanna Maciocha, Szymon Paruszewski, Julia Wyszyńska, Maja Kłopecka, Gabriela Afrykańska, Marta Śliwińska, Artur Ludwin and Paweł Jan Stanirowski
J. Clin. Med. 2025, 14(6), 1861; https://doi.org/10.3390/jcm14061861 - 10 Mar 2025
Viewed by 1171
Abstract
Objective: This study aimed to analyze and compare three different methods of estimated blood loss (EBL) assessment in conjunction with the exploration of risk factors associated with early postpartum hemorrhage (PPH) among women undergoing a cesarean section (CS). Methods: Women with a singleton [...] Read more.
Objective: This study aimed to analyze and compare three different methods of estimated blood loss (EBL) assessment in conjunction with the exploration of risk factors associated with early postpartum hemorrhage (PPH) among women undergoing a cesarean section (CS). Methods: Women with a singleton pregnancy who underwent an elective/emergency CS were recruited for this prospective cross-sectional study. Early PPH was defined as a cumulative blood loss ≥1000 mL within the 24 h period following the delivery. Methods of EBL assessment included the following: (1) visual estimation by the surgeon (sEBL), (2) the evaluation of blood-soaked dressings (dEBL), and (3) implementation of a mathematical formula (fEBL). Results: In the study period, 21 cases of early PPH were identified and compared with 452 controls. Among the patients with a PPH, a significant increase in the surgery time (60 min. vs. 46 min., p = 0.001), fetal birthweight (3780 g vs. 3417.5 g, p < 0.01), the occurrence of uterine atony (61.9% vs. 2.2%, p < 0.001), and myomas (9.5% vs. 1.1%, p < 0.05) was noted. In both groups, dEBL and sEBL provided the highest and the lowest EBL values, respectively (PPH dEBL: 1230 mL vs. fEBL: 1173.3 mL vs. sEBL 1000 mL, p < 0.001; control dEBL: 652 mL vs. fEBL 604 mL vs. sEBL 600 mL, p < 0.001). A patient age of 31–34 years (OR 1.71; 95%CI: 1.19–2.44), overweight (OR 2.65; 95%CI: 1.87–3.76), obesity (OR 2.68; 95%CI: 1.71–4.21), emergency mode of CS (OR 4.06; 95%CI: 2.94–5.62), surgeon experience (resident OR 1.86; 95%CI: 1.27–2.7; assistant specialist OR 3.13; 95%CI: 2.15–4.55) and fetal macrosomia (OR 3.19; 95%CI: 2.14–4.74) were selected as significant risk factors of the PPH. Conclusions: In women with early PPH following a CS, both dEBL and fEBL provide comparable estimations of blood loss. An emergency-mode CS and fetal macrosomia are the strongest contributors to PPH among women undergoing a CS. A combination of different methods of EBL with the proper identification of risk factors of a PPH can lead to improvement in the clinical management of obstetric hemorrhage following the CS. Full article
(This article belongs to the Special Issue New Challenges in Maternal-Fetal Medicine)
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