Background: Numerous studies have aimed to predict prenatal and neonatal outcomes for pregnancies complicated by congenital cytomegalovirus (CMV). Presently, assessing CMV severity prenatally relies largely on fetal imaging. A controversy exists regarding CMV viral load (VL) and its association with fetal and neonatal sequelae. Objective: To perform a systematic review and meta-analysis investigating the association between CMV DNA VL in amniotic fluid and fetal and neonatal outcomes in pregnancies with congenital CMV. Results: All cohort, case-control and observational studies that compared outcomes of fetuses with congenital CMV and provided information on individual patient CMV VL quantified in copies per milliliter (c/mL) from inception to January 2023 were included, with no geographical or language restrictions. A total of 1251 citations were reviewed with eight studies meeting inclusion criteria and included in meta-analysis. Affected pregnancies had a higher VL in the amniotic fluid compared to those unaffected with a mean difference of 2.2e+7 (range 1.5e+7 to 2.8e+7). In subgroup analysis, the VL was significantly higher in the fetuses, with imaging findings related to CMV compared to asymptomatic fetuses with a mean difference of 4.1e+7 (95% CI 2.8e+7-5.4e+7). However, among babies with congenital CMV, the VL was not significantly different between symptomatic and asymptomatic babies. Conclusions: Amniotic fluid CMV VL is associated with fetal sequalae in congenital CMV, with a higher VL conferring a greater risk for prenatal injury.

BACKGROUND: Preterm labor is caused by multiple etiologies, including intra-amniotic infection and/or intra-amniotic inflammation, vascular disorders, cervical disease, decidual senescence, and breakdown of maternal-fetal tolerance. Accumulating evidence in vivo and in vitro has shown that an allergic reaction, including anaphylaxis, can induce preterm uterine contractions. This report describes a case of a pregnant woman who developed anaphylaxis and regular uterine contractions after the ingestion of a strawberry-coated biscuit. We also review the mechanism of allergic reaction (hypersensitivity)-induced preterm labor. Case presentation A 31-year-old woman (gravida 1, para 0) at 30+2 weeks of gestation was admitted to the labor and delivery unit with regular uterine contractions and anaphylactic symptoms after she ingested a strawberry-coated biscuit as a snack. The uterine contractions resolved after the treatment of anaphylaxis by administering antihistamines and epinephrine. The patient subsequently delivered at 39+3 weeks of gestation. The amniotic fluid profile showed no infection or inflammation. A postpartum skin-prick test confirmed a positive type 1 hypersensitivity reaction to the strawberry-coated biscuit.
CONCLUSIONS: We report a case of anaphylaxis-induced uterine contractility in which uterine contractions subsided after the treatment of anaphylaxis. The absence of intra-amniotic infection and/or intra-amniotic inflammation and the cause of the anaphylaxis were confirmed. Our findings indicate that maternal allergic reactions may be one of the mechanisms of preterm labor.

Although the assessment of the amniotic fluid volume in pregnancy is part of the fetal wellbeing surveillance, the impact of idiopathic polyhydramnios (IP) on maternal and perinatal outcomes in unknown. The aim of this meta-analysis was to investigate the association of IP with different maternal and perinatal outcomes. We screened five electronic databases until December 2023 and performed data extraction and quality assessment using ROBINS-E in duplicates. Pooled risk ratios and 95% confidence intervals (95% CI) were calculated with a random effects model. 38 studies were included. Patients with IP were at increased risk of perinatal complications including preterm delivery (RR 1.96, 95% CI 1.35-2.86; I2 = 92%), placental abruption (RR 3.20, 95% CI 2.20-4.65; I2 = 2%), delivery via caesarean section (RR 1.60, 95% CI 1.39-1.84; I2 = 95%) and postpartum haemorrhage (RR 1.98, 95% CI 1.22-3.22; I2 = 84%). Similarly, IP was associated with increased risk of adverse perinatal outcomes including low APGAR score (RR 3.0, 95% CI 1.23-7.35; I2 = 95%), stillbirth (RR 4.75, 95% CI 2.54-8.86; I2 = 9%) and perinatal mortality (RR 4.75, 95% CI 2.67-8.48; I2 = 37%). This meta-analysis suggests that pregnant women with IP may be at increased risk of perinatal complications and adverse neonatal outcomes. However, data remains inconclusive considering the low quality and high heterogeneity of included studies.PROSPERO registration number: CRD42022359944.

UNASSIGNED: The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the reduction of amniotic fluid.
UNASSIGNED: Electronic databases were searched (PubMed, Medline, and Scopus). Selection criteria included studies reporting the relationship between oligohydramnios and use of NSAID during pregnancy. We analyzed the median age of women, weeks of pregnancy at the beginning of the drug administration, kind of medication, period of exposure and dosage, deepest vertical pocket (DVP), and amniotic fluid index (AFI).
UNASSIGNED: Of the 68 records identified, we analyzed 29 studies investigating the administration of NSAIDs, including 11 studies examined the administration of the Indomethacin, four articles have focused on the use of Nimesulide, and only two manuscripts considered the use of Diclofenac. We found a strict correlation between the development of oligohydramnios and the use of NSAIDs. The oligohydramnios is reversible, and the normal amount of amniotic fluid is restored after the interruption of the treatment.
UNASSIGNED: The use of NSAIDs should be considered when maternal benefits outweigh the potential fetal risk, at the lowest effective dose for shortest duration. Beyond 48 h of NSAIDs treatment, we consider ultrasound monitoring of amniotic fluid, and we suggest stopping therapy if a decline AFI is present.

The objective is to summarize the current use of artificial intelligence (AI) in obstetric ultrasound. PubMed, Cochrane Library, and ClinicalTrials.gov databases were searched using the following keywords \"neural networks\", OR \"artificial intelligence\", OR \"machine learning\", OR \"deep learning\", AND \"obstetrics\", OR \"obstetrical\", OR \"fetus\", OR \"foetus\", OR \"fetal\", OR \"foetal\", OR \"pregnancy\", or \"pregnant\", AND \"ultrasound\" from inception through May 2022. The search was limited to the English language. Studies were eligible for inclusion if they described the use of AI in obstetric ultrasound. Obstetric ultrasound was defined as the process of obtaining ultrasound images of a fetus, amniotic fluid, or placenta. AI was defined as the use of neural networks, machine learning, or deep learning methods. The authors\' search identified a total of 127 papers that fulfilled our inclusion criteria. The current uses of AI in obstetric ultrasound include first trimester pregnancy ultrasound, assessment of placenta, fetal biometry, fetal echocardiography, fetal neurosonography, assessment of fetal anatomy, and other uses including assessment of fetal lung maturity and screening for risk of adverse pregnancy outcomes. AI holds the potential to improve the ultrasound efficiency, pregnancy outcomes in low resource settings, detection of congenital malformations and prediction of adverse pregnancy outcomes.

The benefits of routine gastric suctioning or lavage in neonates remain uncertain, despite the common practice worldwide. To investigate the potential advantages and harms, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effects of these procedures in healthy or meconium-stained neonates at birth. We systematically searched PubMed, Scopus, Embase, Ovid, and the Cochrane Library databases from inception to February 9, 2023. We included only RCTs assessing the outcomes of gastric suction or lavage in neonates at birth. We calculated risk ratio (RR) and weighted mean differences with 95% confidence intervals (CIs) using a random-effects model. The primary outcomes were gastrointestinal symptoms including vomiting, retching, feeding intolerance, and secondary aspiration. The secondary outcomes included time to initiation of breastfeeding and potential adverse procedure-related events. Twelve RCTs with a total of 4,122 neonates were analyzed. All the studies compared neonates who received gastric suction or lavage with those who received usual care. Gastrointestinal symptoms were significantly reduced in neonates receiving gastric suction or gastric lavage compared with the control group (RR, 0.75; 95% CI, 0.63-0.89). Gastric lavage was beneficial for infants with meconium-stained amniotic fluid (RR 0.71; 95% CI, 0.60-0.84), while gastric suction had no significant benefit in reducing gastrointestinal symptoms in infants without meconium-stained amniotic fluid (RR 0.91; 95% CI, 0.61-1.37). Our findings suggest that gastric suction or lavage may reduce gastrointestinal symptoms in neonates; however, these procedures may only benefit infants born with meconium-stained amniotic fluid. Vigorous newborns without meconium-stained amniotic fluid may not benefit from these procedures. Furthermore, gastric suction may lead to adverse outcomes such as apnea and bradycardia. Registration: This study was registered in the PROSPERO International prospective register of systematic reviews in health and social care (CRD42023247780).

This study aimed to reassess the effect of prophylactic transcervical amnioinfusion for intrapartum meconium-stained amniotic fluid on meconium aspiration syndrome and other adverse neonatal and maternal outcomes.
From inception to November 2021, a systematic search of the literature was performed in PubMed, Embase, Web of Science, and Scopus databases and gray literature sources.
We identified randomized controlled trials of patients with intrapartum moderate to thick meconium-stained amniotic fluid that evaluated the effect of amnioinfusion on adverse neonatal and maternal outcomes.
Of note, 2 reviewers independently abstracted data and gauged study quality by assigning a modified Jadad score. Meconium aspiration syndrome constituted the primary outcome. The secondary outcomes were meconium below the cords, Apgar scores of <7 at 5 minutes, neonatal acidosis, cesarean delivery, cesarean delivery for fetal heart rate abnormalities, neonatal intensive care unit admission, and postpartum endometritis. This study calculated the odds ratios with 95% confidence intervals for categorical outcomes and weighted mean differences with 95% confidence intervals for continuous outcomes.
A total of 24 randomized studies with 5994 participants met the inclusion criteria. The overall odds of meconium aspiration syndrome was reduced by 67% in the amnioinfusion group (pooled odds ratio, 0.33; 95% confidence interval, 0.21-0.51). Except for postpartum endometritis, amnioinfusion was associated with a significant reduction in all secondary outcomes.
Our study found that the use of intrapartum amnioinfusion in the setting of meconium-stained amniotic fluid significantly reduces the odds of meconium aspiration syndrome and other adverse neonatal outcomes.

Fetal and perinatal periods are critical phases for long-term development. Early diagnosis of maternal complications is challenging due to the great complexity of these conditions. In recent years, amniotic fluid has risen in a prominent position in the latest efforts to describe and characterize prenatal development. Amniotic fluid may provide real-time information on fetal development and metabolism throughout pregnancy as substances from the placenta, fetal skin, lungs, gastric fluid, and urine are transferred between the mother and the fetus. Applying metabolomics to monitor fetal well-being, in such a context, could help in the understanding, diagnosis, and treatment of these conditions and is a promising area of research. This review shines a spotlight on recent amniotic fluid metabolomics studies and their methods as an interesting tool for the assessment of many conditions and the identification of biomarkers. Platforms in use, such as proton nuclear magnetic resonance (1H NMR) and ultra-high-performance liquid chromatography (UHPLC), have different merits, and a combinatorial approach could be valuable. Metabolomics may also be used in the quest for habitual diet-induced metabolic signals in amniotic fluid. Finally, analysis of amniotic fluid can provide information on exposure to exogenous substances by detecting the exact levels of metabolites carried to the fetus and associated metabolic effects.

Throughout pregnancy, fetuses are exposed to a range of chemosensory inputs influencing their postnatal behaviors. Such prenatal exposure provides the fetus with continuous sensory information to adapt to the environment they face once born. This study aimed to assess the chemosensory continuity through a systematic review and meta-analysis of existing evidence on chemosensory continuity from prenatal to first postnatal year. Web of Science Core. Collections, MEDLINE, PsycINFO, EBSCOhost ebook collection was searched from 1900 to 2021. Studies identified from the search were grouped according to type of stimuli the fetuses were exposed to prenatally that the neonatal infants\' responses to were being evaluated, namely flavors transferred from the maternal diet, and the odor of their own amniotic fluid. Of the 12 studies that met the eligibility criteria for inclusion (k = 6, k = 6, respectively in the first and the second group of studies), and eight studies (k = 4, k = 4, respectively) provided sufficient data suitable for meta-analysis. Infants, during their first year of life, oriented their heads for significantly longer durations in the direction of the prenatally experienced stimuli with large pooled effect sizes (flavor stimuli, d = 1.24, 95% CI [0.56, 1.91]; amniotic fluid odor, d = 0.853; 95% CI [.632, 1.073]). The pooled effect size for the duration of mouthing behavior was significant in response to prenatal flavor exposure through maternal diet (d = 0.72; 95% CI [0.306, 1.136]), but not for the frequency of negative facial expressions (d = -0.87, 95% CI [-2.39, 0.66]). Postnatal evidence suggests that there is a chemosensory continuity from fetal to the first year of postnatal life.

Data on the ability of anticonvulsants and lithium to enter fetal and newborn circulation has become increasingly available; here we estimated penetration ratios in a series of matrices from combined samples of pregnant/breastfeeding women treated with anticonvulsants or lithium.
We conducted a systematic literature search in PubMed/EMBASE for studies with concentrations of anticonvulsants/lithium from maternal blood, amniotic fluid, umbilical cord blood and/or breast milk. Penetration ratios were calculated by dividing the concentrations in amniotic fluid, umbilical cord plasma or breast milk by the maternal concentrations. When data from multiple studies were available, we calculated combined penetration ratios, weighting studies\' mean by study size.
Ninety-one eligible studies for brivaracetam, carbamazepine, clonazepam, ethosuximide, gabapentin, lacosamide, lamotrigine, levetiracetam, lithium, oxcarbazepine, perampanel, phenobarbital, phenytoin, pregabalin, primidone, topiramate, valproate, vigabatrin and zonisamide were identified. For amniotic fluid, the highest penetration ratios were estimated for levetiracetam (mean 3.56, range 1.27-5.85, n = 2) and lowest for valproate (mean 0.11, range 0.02-1.02, n = 57). For umbilical cord plasma, oxcarbazepine had the highest ratio (mean 1.59, range 0.11-4.33, n = 12) with clonazepam having the lowest (mean 0.55, range 0.52-0.59, n = 2). For breast milk, the highest ratios were observed for oxcarbazepine (mean 3.75, range 0.5-7.0, n = 2), whereas the lowest were observed for valproate (mean 0.04, range 0.01-0.22, n = 121).
We observed substantial variability between anticonvulsants and lithium regarding their ability to enter fetal/newborn circulation. Assessing concentrations of anticonvulsants and lithium in maternal samples can provide a surrogate of fetal/infant exposure, although patterns of concentration-dependent effects for maternal/neonatal safety are lacking.