The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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J. Matern. Fetal. Neonatal. Med. · May 2020
Observational StudyRisk factors associated with neonatal thrombocytopenia in pregnant women with immune thrombocytopenic purpura.
Objectives: To characterize the risk factors associated with neonatal thrombocytopenia among pregnant women with immune thrombocytopenic purpura (ITP). Methods: We reviewed the records of ITP patients who delivered during 2006-2016 at our medical center. Results: Of 253 pregnancies, median maternal age at diagnosis was 29 [25-33] years, 222 (87.7%) had previously-diagnosed ITP and 31 (12.3%) were diagnosed with new-onset ITP during pregnancy. ⋯ Conclusion: Neonatal thrombocytopenia presented following almost one-tenth of pregnancies with ITP. New pregnancy-onset disease was the only prognostic marker for neonatal thrombocytopenia. This finding could contribute to risk stratification and individualized patient management.
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J. Matern. Fetal. Neonatal. Med. · May 2020
Meta AnalysisThe impact of omega-3 fatty acid supplementation on glycemic control in patients with gestational diabetes: a systematic review and meta-analysis of randomized controlled studies.
Background: Omega-3 fatty acid supplementation shows some treatment efficacy for gestational diabetes. This systematic review and meta-analysis is conducted to investigate the efficacy of omega-3 fatty acid supplementation for glycemic control in patients with gestational diabetes. Methods: The databases including PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases are systematically searched for collecting the randomized controlled trials (RCTs) regarding the efficacy of omega-3 fatty acid versus placebo for gestational diabetes. ⋯ However, notably decreased high sensitivity C-reactive protein (hs-CRP) is revealed after omega-3 fatty acids supplementation (std. MD = -1.14; 95% CI = -2.0 to -0.29; p = .009). Conclusions: Omega-3 fatty acids supplementation can provide substantially beneficial effects on glycemic control and inflammatory response for gestational diabetes.
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J. Matern. Fetal. Neonatal. Med. · May 2020
Comparative StudyOutcomes associated with trial of labor after cesarean in women with one versus two prior cesarean deliveries after a change in clinical practice guidelines in an academic hospital.
Objective: In 2010, the American College of Obstetricians & Gynecologists (ACOG) published a new clinical practice guideline on trial of labor after cesarean (TOLAC) that was considered less restrictive. It allowed for offering TOLAC to women with two prior cesarean deliveries, even without a prior vaginal delivery, and for labor induction. As a result, our hospital, a public tertiary care academic center, updated our TOLAC practice guideline to reflect ACOG's new recommendations. ⋯ There were no differences in neonatal outcomes. Vaginal birth after cesarean (VBAC) success rates were similar between groups (78.9% in women with 1 prior cesarean versus 74.0% in women with 2 prior cesareans, p=.33), even when only analyzing women without a prior vaginal delivery (69.4% in women with 1 prior cesarean versus 71.4% in women with 2 prior cesareans, p = .78). Conclusion: Adoption of ACOG's TOLAC practice changes, specifically offering TOLAC to women with two prior cesareans even without a prior vaginal delivery, and offering induction of labor regardless of cervical favorability, may increase VBAC rates without increasing maternal or neonatal morbidity from TOLAC.
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J. Matern. Fetal. Neonatal. Med. · May 2020
Case ReportsNIRS improves hemodynamic monitoring and detection of risk for cerebral injury: cases in the neonatal intensive care nursery.
Near-infrared spectroscopy (NIRS) monitoring provides a noninvasive, bedside measure of cerebral and somatic oxygenation in neonates at risk for hemodynamic instability and brain injury. This technology has been increasingly utilized in the neonatal intensive care unit, however, clinicians perceive a lack of evidence for the added value of NIRS monitoring. We present six clinical scenarios illustrating the value of NIRS monitoring for the diagnosis and management of critically ill newborns.