Search Results (3,320)

Fetal growth restriction (FGR) remains a significant problem in obstetrics and is a key risk factor for perinatal brain injury. The fetal neuronal vesicles (FNVs) isolated from maternal blood represent an innovative approach—a “fetal brain liquid biopsy”—enabling early diagnostics of neuronal dysfunction in FGR. Western blotting was used to evaluate the protein pattern expression of FNVs isolated from the blood of pregnant women with FGR and uncomplicated pregnancy. Significant changes in the neurotrophic proteins levels (pro-BDNF, pro-NGF) and presynaptic neurotransmission proteins (SYN1, SYP, SYNPO) were identified. New data were obtained on changes in the expression of proteins of sumoylation (SUMO2/3/4) and neddylation (NAE1, UBC12), which differs in early-onset and late-onset FGR. Moreover, increased SUMO2/3/4 levels can be considered as an endogenous neuroprotective response to cerebral hemodynamic reaction in fetuses with late-onset growth restriction. An association has been established between changes in the expression of the studied proteins and intraventricular hemorrhage (IVH) in newborns with late-onset growth restriction. Full article

Doppler assessment of fetal cerebral circulation has become a cornerstone of modern fetal medicine. It is used to evaluate cerebral vascular malformations, brain anomalies, fetal growth restriction due to placental insufficiency, fetal anemia, and hemodynamic complications arising from placental vascular anastomoses in monochorionic pregnancies. Emerging research also explores the predictive value of Doppler parameters for perinatal outcomes and long-term neurodevelopment. To review the anatomy and physiology of fetal cerebral vessels accessible to Doppler evaluation, outline key technical aspects, and summarize current obstetric applications. A PubMed search identified 113 relevant publications, published between 1984 and 2025. Three book chapters by authors recognized internationally within the scientific community were included. A total of 116 publications were critically analyzed in this narrative review. Strong evidence supports the use of Doppler ultrasound in obstetrics, particularly for evaluating fetal cerebral hemodynamics, where it contributes to reducing fetal morbidity and mortality. Doppler assessment of fetal brain circulation is a valuable tool for evaluating brain vascular malformations, other structural abnormalities, and for assessing fetuses with growth restriction, anemia, and twin-to-twin transfusion syndrome. It allows targeted fetal monitoring and timely interventions, providing critical prognostic information and aiding parental counseling. Ongoing advances in Doppler technology and understanding of fetal brain physiology are likely to broaden its clinical uses, improving both perinatal outcomes and long-term neurological health. Full article

Background: Chronically non-healing thoracic wounds after cardiac and non-cardiac thoracotomy, including cases when coronary artery bypass grafting (CABG) is performed, represent a great clinical challenge. It is often that a conservative treatment of the wounds does not provide effective regeneration of the damaged tissues. It is especially critical in patients with infected wounds, in patients owning a systemic infection, and in elderly people. Methods: The article presents a case report of successful treatment of a 63-year-old man with refractory chronic osteomyelitis of the sternum and mediastinitis four years after CABG, complicated by COVID-19 at the time of reconstructive surgery. Due to the low effectiveness of conservative treatment methods, a two-stage approach was applied: radical surgical wound debridement followed by infiltration of the wound with allogenic mesenchymal stromal cells (MSCs) of Wharton’s jelly (WJ-MSCs). Results: This double-stage therapy successfully modulated the inflammatory environment and stimulated granulation, facilitating final thoracoplasty and osteosynthesis. The patient achieved complete healing of the sternum, demonstrating benefits of WJ-MSCs in treating conservative treatment-resistant infections in the surgical wound. Conclusions: The advantages of using perinatal mesenchymal stem cells, with WJ-MSCs as a type of this class of MSCs, were demonstrated in treating chronically infected sternal surgical wounds. We also compared their regenerative properties to other stem cell types like bone marrow MSCs. Full article

Background: Maternal overweight and obesity, which show a rising trend globally, are associated with adverse pregnancy outcomes and long-term health risks for both mother and child. Awareness and understanding of these risks among women of reproductive age are essential for effective prevention and early intervention. Methods: We conducted a cross-sectional survey among 958 women planning pregnancy, currently pregnant or breastfeeding to assess their knowledge and attitudes regarding overweight and obesity in the perinatal period. The questionnaire covered lifestyle behaviors, breastfeeding practices, and knowledge related to overweight and obesity in pregnancy. Results: Overall knowledge regarding the consequences of maternal overweight and obesity was low, with notable deficits in understanding the associated health risks and frequent misconceptions about dietary recommendations during pregnancy. Awareness gaps were particularly noticeable in domains related to fetal outcomes and recommended energy requirements across pregnancy. Excessive gestational weight gain was reported in over 75% of pregnancies, including among women with normal body mass index. Participation in antenatal classes, current breastfeeding and older age were significantly associated with higher knowledge; however, these factors together explained only 6.2% of variability. Still, several key aspects were not well recognized despite high educational attainment and frequent contact with maternity care services. Conclusions: Our study highlights a clear and urgent need for better, more targeted educational strategies to improve women’s understanding of metabolic health and nutrition before and during pregnancy. The low explained variance indicates that maternal knowledge is influenced by multifactorial and not easily captured determinants, emphasizing the need for comprehensive and individualized educational approaches. Enhancing maternal awareness could support better health outcomes for both mothers and their offspring. Full article

Background/Objectives: Hypertensive disorders of pregnancy (HDP) remain a significant cause of maternal and perinatal morbidity worldwide. In some healthcare settings, access to angiogenic testing is limited, underscoring the need for affordable biomarkers to guide risk assessment. NT-proBNP, a marker of myocardial wall stress and cardio-renal dysfunction, may offer complementary prognostic value to the angiogenic sFlt-1/PlGF ratio. Methods: In this prospective multicenter observational study, we enrolled 180 pregnant women and categorized them into preeclampsia (PE, n = 95), non-PE HDP (gestational or chronic hypertension, n = 25), and healthy controls (n = 60). NT-proBNP and sFlt-1/PlGF levels were measured at enrollment, after 20 weeks of gestation, predominantly during the second and third trimesters. Associations with proteinuria, uric acid, creatinine, and maternal–fetal complications were examined using multivariable logistic regression adjusted for maternal age, BMI, and gestational age. Discrimination was assessed using receiver operating characteristic (ROC) curve analysis, and the incremental value of NT-proBNP beyond the sFlt-1/PlGF ratio was evaluated using ΔAUC and net reclassification improvement (NRI). Results: Median NT-proBNP levels were significantly higher in PE compared with non-PE HDP and controls (p < 0.01). NT-proBNP ≥200 pg/mL independently predicted maternal–fetal complications (adjusted OR 3.12, 95% CI 1.41–6.90, p = 0.005) and correlated with proteinuria (r = 0.47), creatinine (r = 0.43), and uric acid (r = 0.40) (all p < 0.001). sFlt-1/PlGF alone yielded an AUC of 0.84 (95% CI 0.77–0.89), while NT-proBNP alone demonstrated an AUC of 0.78 (0.71–0.84). Combining both biomarkers improved discrimination (AUC 0.88, 95% CI 0.82–0.92), with a ΔAUC of 0.04 (p = 0.02) and a continuous NRI of 0.21 (p = 0.03). The 200 pg/mL threshold for NT-proBNP achieved 80% sensitivity and 71% specificity (p < 0.001). Conclusions: NT-proBNP provides independent and complementary prognostic value to the sFlt-1/PlGF ratio in predicting maternal–fetal complications in HDP. A practical threshold of 200 pg/mL aids risk assessment, and integrating NT-proBNP into angiogenic models improves prediction. Further multicenter studies are needed to validate multimarker strategies and their cost-effectiveness. Full article

Objective: To evaluate the diagnostic utility of antepartum amnioinfusion in cases of severe oligo- and anhydramnios and to descriptively report perinatal outcomes. Methods: This retrospective single-center study analyzed all antepartum amnioinfusions performed between 2009 and 2024 in pregnancies between 16 + 0 and 34 + 0 weeks of gestation. The primary endpoint was diagnostic impact following amnioinfusion. Secondary endpoints were descriptive perinatal outcomes. No inferential statistical analyses were performed. Results: A total of 37 amnioinfusions were performed in 31 patients. Median gestational age at first amnioinfusion was 22 ± 4.3 weeks, with a mean infusion volume of 259 ± 59.4 mL. The most frequent etiologies were preterm prelabor rupture of membranes (PROM, 29%), fetal growth restriction (FGR, 25.8%), and urogenital malformations (22.6%). Amnioinfusion improved sonographic visualization and diagnostic assessment in the majority of cases. Pregnancy prolongation was observed in selected subgroups; however, causal inference regarding therapeutic efficacy cannot be drawn. Conclusions: Antepartum amnioinfusion represents a valuable adjunct for prenatal diagnostic evaluation in severe oligo- and anhydramnios. Observed perinatal outcomes should be interpreted descriptively. Further prospective, controlled studies are required to define the role of amnioinfusion beyond diagnostic feasibility. Full article

Background/Objectives: The majority of chromosome 22q11.2 deletions are de novo, resulting from meiotic non-allelic homologous recombination (NAHR). While 22q11.2 deletion syndrome (22q11.2DS)-associated phenotypes are well characterized, risk factors leading to NAHR are poorly understood, including the possible relationship with assisted reproductive technology (ART). Here we examined the prevalence of ART conceptions and medical comorbidities in patients with 22q11.2DS vs. spontaneously conceived (SC) patients with 22q11.2DS. Methods: Retrospective analysis, under IRB approval, of medical records on 1184 patients with laboratory-confirmed de novo chromosome 22q11.2 deletions was performed. ART conceptions included IVF with and without ICSI. Deletion size and obstetric, family, and medical histories were examined. Results: We identified 30 pregnancies conceived using ART (2.57%) compared with the U.S. general population rate of 2.3% (p-value = 0.6603). ART and SC sub-cohorts demonstrated no significant differences in deletion size or perinatal outcomes, including preterm birth, multiples, polyhydramnios, or congenital heart disease. Controlling for these factors, neonates conceived via ART were more likely to be admitted to the ICU (aOR = 6.3). Conclusions: Pregnancies conceived via ART, and later found to have 22q11.2DS, demonstrated no significant differences in prevalence or perinatal outcomes compared with the U.S. general population. Moreover, NAHR is unrelated to ART in this population. Likewise, associated phenotypic features are unrelated. These data will be reassuring to those families where ART was employed to conceive children who were later found to have 22q11.2DS. Full article

Mpox is an emerging zoonotic infection caused by the Monkeypox virus, an Orthopoxvirus with increasing global relevance following the 2022 multinational outbreak. Historically endemic to Central and West Africa, the disease has evolved from sporadic zoonotic transmission to sustained human-to-human spread, particularly through close physical and intimate contact. Clinical manifestations typically include fever, lymphadenopathy, and progressive mucocutaneous lesions, although severity varies according to viral clade, immune status, and comorbidities. The 2022 outbreak, predominantly associated with the Clade IIb variant, was characterized by milder disease, localized lesions, and reduced mortality compared with the more virulent Clade I variant. Despite this, severe outcomes remain possible, particularly in vulnerable groups such as children, pregnant individuals, immunocompromised patients, and persons with extensive dermatological disorders. Diagnosis relies primarily on polymerase chain reaction testing from lesion-derived samples, with genomic sequencing serving as a complementary tool for epidemiological surveillance. Management is largely supportive, though antivirals such as tecovirimat may be considered in severe cases or in high-risk populations. Data regarding therapeutic safety in pregnancy are limited; however, tecovirimat appears to have the most favorable profile, whereas cidofovir and brincidofovir remain contraindicated. Prevention strategies include targeted vaccination with the non-replicating Modified Vaccinia Ankara–Bavarian Nordic vaccine, used for both pre- and post-exposure prophylaxis, particularly in individuals at elevated risk. Given the evolving epidemiological profile, the potential for vertical transmission, and the risk of adverse perinatal outcomes, Mpox infection during pregnancy poses unique clinical challenges. This review synthesizes current evidence on virology, clinical presentation, diagnosis, prevention, and management, with an emphasis on obstetric considerations and public health implications. Full article

(1) Background: Perinatal loss is a deeply painful and often invisible experience, with a significant impact on mental health. This study aimed to assess levels of psychopathological symptoms, shame, and perceived social support according to the type of perinatal loss; explore the relationships between these variables; and analyze the mediating effect of perceived social support on the relationship between shame and symptoms, as well as the moderating effect of the type of loss. (2) Methods: A total of 501 Portuguese women who had experienced perinatal loss participated in the study, recruited through an online questionnaire. Psychopathological symptoms, shame, perceived social support, and type of loss were assessed. Analyses included descriptive statistics, Spearman correlations, normality and homogeneity of variances tests, and mediation and moderation models with PROCESS. (3) Results: The results revealed high levels of anxiety and depression, and moderate levels of shame. Perceived social support, especially from partners and family members, was high. Shame correlated positively with symptoms and negatively with social support. Only social support from friends significantly mediated the relationship between shame and psychological distress. (4) Conclusions: These results reinforce the protective role of support networks and the importance of clinical interventions focused on reducing shame. Full article

Perinatal depression (PND) is a severe mood disorder affecting mothers during pregnancy and postpartum, with implications for both maternal and neonatal health. Emerging evidence suggests that gut microbiota-derived metabolites play a critical role in neuroinflammation and neurotransmission. In this study, we employed an in silico approach to evaluate the pharmacokinetic and therapeutic potential of metabolites produced by Lactobacillus helveticus and Bifidobacterium longum in targeting key proteins implicated in PND, including BDNF, CCL2, TNF, IL17A, IL1B, CXCL8, IL6, IL10. The ADMET (Absorption, Distribution, Metabolism, Excretion, and Toxicity) profiles of selected microbial metabolites, including acetate, lactate, formate, folic acid, riboflavin, kynurenic acid, γ-aminobutyric acid, and vitamin B12 were assessed using computational tools to predict their bioavailability and safety. Enrichment analysis was performed to identify biological pathways and molecular mechanisms modulated by these metabolites, with a focus on neuroinflammation, stress response, and neurogenesis. Additionally, molecular docking studies were conducted to evaluate the binding affinities of these metabolites toward the selected PND-associated targets, providing insights into their potential as neuroactive agents. Our findings suggest that specific microbial metabolites exhibit favorable ADMET properties and strong binding interactions with key proteins implicated in PND pathophysiology. These results highlight the therapeutic potential of gut microbiota-derived metabolites in modulating neuroinflammatory and neuroendocrine pathways, paving the way for novel microbiome-based interventions for perinatal depression. Further experimental validation is warranted to confirm these computational predictions and explore the clinical relevance of these findings. Full article

Background: The World Health Organization (WHO) has recently focused much attention on physical activity recommendations. Regular physical activity offers broad health benefits, reducing the risk of some chronic diseases and improving bone structure and muscle strength. Although the scientific literature provides numerous recommendations for physical activity during pregnancy and the postpartum period, there are no official recommendations for lifestyle-related physical activity. Objectives: This narrative review aimed to review the current knowledge on physical activity during pregnancy and the postpartum period, specifically focusing on lifestyle-related physical activity. The review was based on the definition of lifestyle-related physical activity proposed by Dunn et al. in 1998, which is at least 30 min of self-selected activity per day, encompassing all recreational, occupational, or household activities, as well as planned and unplanned activities that are part of daily life. Methods: A number of databases were analyzed, including PubMed, the Cochrane Library, Embase, and Web of Science. Results: The most valuable reports and recommendations regarding physical activity during the perinatal period were identified. Conclusions: Moderate physical activity during pregnancy is safe and offers benefits, such as reducing the risk of gestational diabetes, preeclampsia, and excessive weight gain, as well as improving mental health. The most common benefits of continuing physical activity after delivery include weight control, reduced risk of depression, and improved quality of life. Lifestyle-based physical activity is easier to implement and more achievable than structured exercise. Further research is needed to establish recommendations regarding lifestyle-based physical activity during the perinatal period. Full article

Background: Preterm birth, affecting more than 13.4 million infants worldwide each year, remains one of the leading causes of neonatal morbidity and mortality. Among its complications, respiratory distress syndrome and bronchopulmonary dysplasia are predominant contributors to prolonged hospitalization and respiratory support needs. As advances in perinatal care have improved survival, attention has increasingly turned to optimizing respiratory function and reducing complications through non-pharmacological interventions. Respiratory physiotherapy has therefore gained recognition as a valuable adjunct to medical management in this population. Purpose: To provide a comprehensive synthesis of the current clinical evidence regarding respiratory physiotherapy techniques used in preterm neonates with respiratory distress syndrome or bronchopulmonary dysplasia. Summary of Evidence: The available literature describes several physiotherapeutic modalities—including prolonged slow expiration, postural treatment, Vöjta therapy, and gentle mechanical techniques—aimed at improving ventilation, gas exchange, and secretion clearance. Across diverse studies, these interventions have been associated with better oxygenation, improved heart and respiratory rates, shorter mechanical ventilation time, and reduced hospital stay, while showing no relevant adverse effects. Although methodological heterogeneity persists, the consistency of beneficial trends supports their integration into multidisciplinary neonatal care. Conclusions: Respiratory physiotherapy represents a safe and promising therapeutic complement for preterm neonates with respiratory distress syndrome or bronchopulmonary dysplasia. Techniques that combine postural control and controlled expiratory maneuvers appear particularly effective in enhancing pulmonary mechanics and recovery. Future research should focus on standardizing intervention protocols, identifying optimal timing and dosing, and evaluating the long-term respiratory and developmental outcomes of these physiotherapeutic strategies. Full article

Background and Objectives: Antiretroviral therapy used during pregnancy in HIV infected women effectively reduces vertical transmission, though concerns about potential adverse newborn outcomes persists. This study focused on prematurity and low birth weight in antiretroviral HIV-exposed children in two major Romanian centers, Bucharest and Constanța, in the context of free access to antiretroviral treatment for pregnant women in Romania since 2001. Materials and Methods: A retrospective observational study was performed including couples of HIV-infected women and their live singleton newborns from 2006 and 2012. Preterm delivery was defined as birth before week 37 and low birth weight was defined as birth weight less than 2500 g in full-term babies. Results: A total number of 352 children and 313 women were enrolled. Mean maternal age at delivery was 23.1 years. Mean newborn birth weight was 2726 g. In the children group, 191 (54.2%) were boys, and the rate of HIV transmission was 13.9%. The prematurity rate was 21.5% and low birth weight rate was 25.56%. Preterm birth was associated with high HIV RNA in the third trimester, HIV-positive final status in infants, and vaginal delivery. Low birth weight was associated with lack of antiretroviral treatment during pregnancy and HIV-positive status in infants. No association was found between prematurity and low birth weight in full-term newborns and exposure to any antiretroviral class, any specific antiviral drug, or with any number of maternal regimens, duration of antiretroviral treatment prior to conception, or maternal exposure during puberty. Conclusions: In our study, preterm birth was significantly associated with HIV vertical transmission in newborns and with exposure to high maternal viral replication during the last trimester of pregnancy. Low birth weight in full-term babies was significantly associated with lack of antiretroviral exposure in utero in our analysis. Full article

Adequate nutrition and healthy behaviours during pregnancy are essential to maternal and neonatal health. Evidence from Greece on maternal dietary and lifestyle practices remains limited, despite global guidelines promoting supplementation, physical activity (PA) and abstinence from harmful substances. This review evaluates micronutrient intake, supplementation practices, PA and substance exposure among pregnant women in Greece, based on studies from 2010 to 2025. The results reveal widespread use of supplements, but frequent deviations from clinical guidelines. Suboptimal intake of key micronutrients remains common, and unsupervised supplementation raises concerns about excessive intake. Caffeine and tobacco use persist during pregnancy and lactation, while alcohol consumption shows a declining trend. PA is generally below international recommendations, with most pregnant women engaging in sedentary or low-intensity activities. These findings underscore systemic gaps in antenatal care in Greece, including inconsistent counselling, lack of structured screening and the absence of coordinated national strategies. Culturally tailored public health interventions, with a focus on equitable access and behaviour change support, are urgently needed to enhance nutritional adequacy, reduce behavioural risks and promote evidence-based care across the perinatal period. Full article

Background: Neonatal myocytes rely predominantly on glycolytic metabolism for survival during hypoxic conditions. During asphyxia, metabolic pathway dysregulation impairs cardiac myocyte contractility. Co-administration of dextrose and insulin may help restore metabolic homeostasis and improve cardiac function. Methods: Following blinded randomization and instrumentation, near-term lambs (138–140 days gestational age) were asphyxiated by umbilical cord occlusion until complete cardiac arrest, followed by 7 min of continued arrest to model severe asphyxia. Return of spontaneous circulation (ROSC) was defined as heart rate ≥ 100 beats per minute (bpm) and diastolic blood pressure ≥ 20 mmHg. Results: The incidence of ROSC was 3/6 in the control group compared to 5/5 in the experimental group receiving dextrose–insulin therapy, although this difference did not reach statistical significance. Conclusions: In this proof-of-concept study using a near-term ovine model of prolonged asphyxial cardiac arrest, dextrose and insulin co-administered with epinephrine were associated with improved ROSC rates although could be an association. Larger studies are needed to confirm these findings and evaluate clinical translation Full article