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Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions
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Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions

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

Deadline for manuscript submissions: 20 December 2025 | Viewed by 3911

Special Issue Editor

Dr. Jessian Munoz

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Division of Fetal Intervention, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA
Interests: maternal–fetal medicine; pregnancy; newborn; obstetrics; high-risk pregnancy; mother-to-child infection; spontaneous abortion; recurrent spontaneous abortion
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is well known that despite the huge advances in genomics, immunology, ultrasonography, pharmacology, and other fields—they all serve complex pregnancies—the incidence of pathology and the patient care outcomes have continued to be suboptimal. For example, preterm birth is an ongoing challenge for both obstetricians and neonatologists due to limitations in predicting such births. This requires the establishment of a personalized strategy and a clear direction of treatment that takes into account the underlying mechanisms of the condition. Additional complexities include understanding that preterm births can be caused by preterm labor, preterm pre-labor rupture of membranes (PPROM), cervical insufficiency, and iatrogenic preterm delivery due to pregnancy or maternal complications.

As cesarean delivery rates continue to increase worldwide, the morbidity associated with repeat hysterotomies has become a global problem. The placenta accreta spectrum, uterine dehiscence, cesarean scar ectopic pregnancies, and peripartum hysterectomies have also increased in incidence, each with their own morbidity and mortality risks.

As part of the maternal–fetal dyad, infants are also significantly impacted by the intricacies of perinatology. The morbidity and mortality of premature newborns are higher than those of full-term infants.Analysis of this issue has highlighted the importance of the projection of fetal development in utero, continuing with the neonatal period, childhood, and even adulthood. In addition, the advancements in fetal surgery (in utero) interventions have allowed for the earlier treatment of complex fetal conditions.

Future research in the field of maternal–fetal medicine has many complexities to address surrounding the various aspects of care for both the mother and child.

Dr. Jessian Munoz
Guest Editor

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Keywords

  • maternal–fetal medicine
  • preterm delivery
  • preterm birth management
  • newborn
  • obstetrics
  • high-risk pregnancy
  • perinatal outcome
  • placenta accreta, fetal surgery

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Published Papers (3 papers)

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Research

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9 pages, 367 KB  
Article
Risk Factors and Clinical Significance of Urologic Injury in Cesarean Hysterectomy for Placenta Accreta Spectrum
by J. Connor Mulhall, Kayla E. Ireland, John J. Byrne, Patrick S. Ramsey, Georgia A. McCann and Jessian L. Munoz
J. Clin. Med. 2025, 14(20), 7199; https://doi.org/10.3390/jcm14207199 - 13 Oct 2025
Viewed by 777
Abstract
Background/Objectives: Placenta accreta spectrum (PAS) is an obstetric condition with placental adherence to the underling myometrium characterized by significant surgical morbidity at time of delivery. PAS delivery is most commonly performed by cesarean hysterectomy. The most common morbidities associated with PAS cesarean [...] Read more.
Background/Objectives: Placenta accreta spectrum (PAS) is an obstetric condition with placental adherence to the underling myometrium characterized by significant surgical morbidity at time of delivery. PAS delivery is most commonly performed by cesarean hysterectomy. The most common morbidities associated with PAS cesarean hysterectomy are blood transfusion, intensive care unit admission and urinary tract injuries. This requires interdisciplinary team management including obstetricians and urologists. Our objective was to identify pre- and intra-operative risk factors for urologic injury in this high-risk condition. Methods: A retrospective cohort study was performed at a single tertiary center with the Center for the Management of Placenta Accreta Spectrum disorders from 2012 to 2022. Urologic injuries were considered as injury to either the bladder or ureters. Furthermore, bladder injuries were subdivided into those inherent to the procedure (intentional cystotomy) and those considered unplanned complications (incidental cystotomy). Inclusion criteria required complete antenatal documentation for assessment, and these were accessed by electronic medical records. Multivariate analysis was performed for significant variables on univariate analysis. Results: During the 11-year study period, 146 cases of PAS were managed by our team. Of these, 39 (26.7%) were complicated by urologic injury. Intentional cystotomies were performed in 28.2% (11/39) of cases. There were 28 (28/39, 71.8%) incidental cystotomies and 5 (5/39, 12.8%) ureteral injuries were encountered. Of note, all 5 patients with ureteral injuries also had cystotomies. Upon univariate analysis, anterior placentation (OR 2.96 [1.94, 4.67], p = 0.04), percreta by antenatal ultrasound (OR 2.59 [1.13, 5.9], p = 0.02) and >2 pre-delivery vaginal bleeding episodes (OR 4.27 [1.54, 12.16], p = 0.005) were associated with urologic injury. Multivariate analysis revealed the independent significance of these variables. Of note, the presence of zero, one, two, and all three risk factors were associated with urologic injury rates of 11.1%, 22.5%, 41.9%, and 71.4%, respectively. Conclusions: Urologic injury during cesarean hysterectomy occurs in almost one-third of cases. Pre-operative risk factors may be used to identify those at greater risk for this surgical complication. Determining patient risk allows for the use of resources such as formal urology consultation, surgical planning, and intraoperative assistance, as well as detailed patient counseling. Full article
(This article belongs to the Special Issue Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions)
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10 pages, 478 KB  
Article
Association Between Body Mass Index and Uterotonic Use in Postpartum Hemorrhage: A Retrospective Cohort Study
by CeCe Cheng, Bryce T. Munter, Michaela Y. Lee, Claire D. Sundjaja, Natasha D. Paul, Margaret M. Klausmeyer, Nastassia A. Yammine, Patrick S. Ramsey and John J. Byrne
J. Clin. Med. 2025, 14(17), 6283; https://doi.org/10.3390/jcm14176283 - 5 Sep 2025
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Abstract
Background/Objectives: Our primary objective was to determine whether patients with a higher body mass index (BMI) who experienced postpartum hemorrhage (PPH) required ≥2 uterotonics more often than those with lower BMI. Methods: We conducted a retrospective cohort study that included all patients who [...] Read more.
Background/Objectives: Our primary objective was to determine whether patients with a higher body mass index (BMI) who experienced postpartum hemorrhage (PPH) required ≥2 uterotonics more often than those with lower BMI. Methods: We conducted a retrospective cohort study that included all patients who experienced a PPH between 1 August 2020 and 31 July 2022. Extracted data included patient demographics, PPH risk factors, details regarding the labor course and hemorrhage management, and maternal and neonatal outcomes, such as mode of delivery, etiology of hemorrhage, need for nonpharmacological management, neonatal Apgar scores, requirement for phototherapy, neonatal intensive care unit (NICU) admission, and NICU length of stay. All variables were compared between four BMI classes: non-obese and classes I, II, and III obesity. Possible confounding factors were assessed with a logistic regression analysis. Results: Of the 6732 deliveries that occurred during the study period, a total of 891 (13.2%) patients had PPH. Differences were noted in the number of uterotonics used, although no direct correlation was found between increasing BMI class and the use of ≥2 uterotonics. Patients with higher BMIs were more likely to require cesarean delivery, have a classical hysterotomy incision, and have a hysterotomy extension, and were less likely to need a blood transfusion (p < 0.05 for all). There was no difference in the rate of uterine atony or other etiologies of hemorrhage, and no difference was observed in the non-pharmacologic management of hemorrhage between groups. Conclusions: In our study population, BMI alone does not appear to be directly associated with the use of ≥2 uterotonics. Full article
(This article belongs to the Special Issue Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions)
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Other

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13 pages, 725 KB  
Systematic Review
Impact of Perioperative Antibiotic Prophylaxis in Caesarean Section on the Maternal Gut Microbiome: A Systematic Review
by Elisabeth AL Feles, Claudio Neidhöfer, Christina Wessels, Rosalie Gruber and Frauke Mattner
J. Clin. Med. 2025, 14(14), 5104; https://doi.org/10.3390/jcm14145104 - 18 Jul 2025
Cited by 1 | Viewed by 1522
Abstract
Background/Objectives: Caesarean section (CS) accounts for over 20% of global births and routinely involves perioperative antibiotic prophylaxis (PAP) to reduce surgical site infections. While the impact of such prophylaxis on neonatal microbiome development is well described, effects on the maternal gut microbiome remain [...] Read more.
Background/Objectives: Caesarean section (CS) accounts for over 20% of global births and routinely involves perioperative antibiotic prophylaxis (PAP) to reduce surgical site infections. While the impact of such prophylaxis on neonatal microbiome development is well described, effects on the maternal gut microbiome remain underexplored. This systematic review synthesizes current evidence on how antibiotic prophylaxis during CS affects maternal gut microbiome composition and diversity—an underrepresented, but clinically relevant aspect of maternal–fetal medicine. Methods: A systematic literature search was conducted in Medline (PubMed), the Cochrane Library, and the WHO International Clinical Trials Registry Platform (ICTRP) through November 2024. Inclusion criteria were defined according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies used molecular techniques to report maternal gut microbiome outcomes (alpha- and beta-diversity). The search concentrated on beta-lactam antibiotics. Reference lists were screened, but no additional grey literature was searched. Synthesis followed the Synthesis Without meta-analysis (SWiM) approach. No review protocol was registered. The review received no external funding. Results: Out of 1011 records, three studies (total 286 mothers) met the inclusion criteria. All reported maternal microbiome outcomes secondarily to infant-focused research. Only one study provided pre- and post-birth stool samples. Applied antibiotic regimens, sequencing methods, and reported microbiome metrics for alpha- and beta-diversity varied considerably, thus limiting comparability of results. Due to high heterogeneity, no formal risk of bias was assessed. While taxonomic diversity changes were inconsistent, significant shifts in functional diversity metrics were observed postpartum. Conclusions: Evidence on maternal microbiome disruption following perioperative antibiotic prophylaxis in CS is methodologically fragmented and limited by small sample sizes and inconsistent antibiotic protocols. Nonetheless, functional diversity appears sensitive to antibiotic exposure. To improve clinical understanding and safety, maternal-focused studies using standardized protocols are urgently needed. The maternal microbiome may play a key role in both recovery and shaping the newborn’s early microbial environment. Full article
(This article belongs to the Special Issue Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions)
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