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Background: It remains unclear whether performing amniocentesis to detect intra-amniotic infection is useful for improving neonatal outcomes., Aims: To determine the efficacy of amniocentesis on the neonatal outcomes in women exhibiting threatened preterm labor and intact membranes., Study Design: Retrospective cohort study, Subjects: A total of 174 women with threatened preterm labor and intact membranes at 22 to 33 weeks of gestation. Women with obvious clinical chorioamnionitis, multifetal pregnancy and/or major anomalies were excluded., Outcome Measures: Neonatal short- and long-term outcomes, Results: Sixty-seven women underwent amniocentesis (Tap group), while the remaining 107 did not. The prevalence of a positive Gram stain or a positive culture result was 10% in the Tap group. The overall outcomes were not statistically different between the two groups, with the exception of borderline significance (p=0.052) in long-term outcomes, favoring the Tap group. We performed a subgroup analysis focusing on infants born at 22-28 weeks of gestation. Consequently, the Tap group had better neonatal outcomes than the no-Tap group with respect to both short-term (OR 0.19, 95%CI 0.07-0.55) and long-term (OR 0.15, 0.05-0.46) outcomes. A multivariate analysis revealed that after adjusting confounding factors, the gestational age at delivery (OR 0.4, 0.3-0.7) and amniocentesis (OR 0.1, 0.02-0.3) remained significantly different., Conclusions: Amniocentesis is useful for improving neonatal outcomes in infants born at 22-28 weeks of gestation to women exhibiting preterm labor and intact membranes., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: Determine the impact of cesarean section (CS) on neonatal outcome of infants born at 23weeks of gestation., Methods: A retrospective study was performed involving 34 infants born at 23weeks and 91 infants born at 24-26weeks. Indications necessitating delivery were severe pregnancy induced hypertension, non-reassuring fetal heart rate patterns (NRFHRs), or intrauterine infection (IUI). Obstetrical indication for CS included NRFHR and breech presentation. Poor outcome included neonatal death or cerebral palsy. Univariate and multiple logistic analyses were performed to determine the effect of CS for obstetrical indications on poor outcome., Results: The incidence of poor outcome was significantly higher at 23weeks (number of poor outcomes/total number: 22/34) compared to that (31/91) at 24-26weeks (p<0.01). The incidence of a poor outcome was significantly higher at 23weeks for infants having NRFHR (11/16) compared to those at 24-26weeks (15/43, p=0.02). However, the incidence of a poor outcome was similar in infants with IUI (6/10 at 23weeks versus 5/11 at 24-26weeks, p=0.41). Vaginal birth in cases of obstetrical indication for CS at 23weeks was associated with higher risk of a poor outcome (odds ratio: 8.2). In contrast, the risk at 24-26weeks was not higher (OR, 0.8). After adjustment using variables of vaginal birth and IUI, vaginal birth significantly affected poor outcome (OR, 13.0)., Conclusion: Poor neonatal outcome was closely related to the mode of delivery, suggesting that CS for obstetrical indication at 23weeks may improve neonatal outcome., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Cases suggestive of non-acidemia related cerebral palsy (CP) are likely misdiagnosed as acidemia related CP because of the presence of nonreasuring fetal heart rate (FHR) patterns., Aims: Our purpose was to compare intrapartum FHR patterns between the cases of neurological damage and the cases without disability after severe metabolic acidemia and neonatal encephalopathy, and also to compare the FHR patterns between cases with CP due to asphyxia and cases with CP of other etiology in infants born after 34 weeks., Study Design: From 1998 to 2003, our peer review conferences determined 136 infants with high-risk factors for neurological impairment in the unselected 65,197 live births. High-risk infants were chosen according to our criteria. Among them 58 were eligible infants because they were born at > or =34 weeks of gestation and also had legible FHR traces., Outcome Measures: Incidence of nonreassuring FHR patterns., Results: Fifteen infants were acidemia related and 43 were non-acidemia related high-risk infants. Ten of the 15 acidemia infants developed CP and all had shown bradycardia > or =13 min with a nadir <80 bpm. In the 43 non-acidemia infants, 35 had CP, mental retardation, epilepsy, or hearing loss and 74% (26/35) of them had shown nonreassuring FHR patterns. Incidence of severe bradycardia was significantly elevated in the acidemia related CP compared with acidotic infants without disability, and those with non-acidemia related CP., Conclusions: Even in infants with non-acidemia related CNS impairments, who were born at > or =34 weeks of gestation, 74% had shown intrapartum nonreassuring FHR patterns.

Background: Some of the perinatal deaths are preventable., Aims: To examine with accuracy perinatal deaths and their clinically relevant conditions to further reduce perinatal mortality rates., Study Design: Population-based study., Subjects: 356 perinatal deaths in Miyazaki Prefecture from 1998 to 2005., Outcome Measures: Causes and clinically associated risk factors of perinatal deaths in infants with congenital abnormalities and those of the non-malformed infants., Methods: We performed a population-based study of 87,593 deliveries in Miyazaki from 1998 to 2005, where 356 perinatal deaths were reported. We also held peer-review audit conference twice a year to investigate causes and clinically associated risk factors of the perinatal deaths, where at least 7 obstetricians and 7 neonatologists congregated., Results: Our perinatal mortality rate was 4.1/1000. 99% of the neonatal deaths and 85% of the stillbirths were examined by the peer-review audit conferences to validate the accuracy of causes. Three fourths were non-malformed perinatal deaths, in which stillbirths represented twice the number of neonatal deaths. Prematurity is the major factor attributable to neonatal deaths. Half of stillbirths were unexplainable but associated with overt or subtle fetal growth restriction. Intrapartum asphyxia after 32 weeks of gestation resulted in 10% of perinatal deaths. The audit conferences concluded that 13% (28/222) of the non-malformed infants had a potential of avoiding death., Conclusion: In the advanced region of perinatal medicine in Japan, we still have room to improve perinatal mortality. Most prevalent factors were fetal growth restriction, intrapartum asphyxia after 32 weeks of gestation, and sudden fetal deaths of undiagnosed diabetes near-term.

Background: Intrauterine bacterial infection is important as a high risk factor associated with subsequent brain damage of the newborn., Aims: To see if mature fetuses require both hypoxia and intrauterine infection to lead to cerebral palsy, while premature fetuses need infection alone., Study Design: A retrospective cohort study., Subjects: 230 singleton live-born infants of 22 to 32 weeks of gestation, exposed to intrauterine infection during labor and delivery, from 1995 to 2002., Methods: Mortality and incidence of cerebral palsy at 2 years old were compared among the 3 groups; immature (n=89, 22-27 weeks), premature (n=73, 28-33 weeks) and mature (n=68, >34 weeks). The relationship between cerebral palsy and fetal pH values was examined., Outcome Measures: Mortality and cerebral palsy., Results: Mortality and cerebral palsy were significantly decreased with advancing gestation. Mortality was significantly decreased after 28 weeks of gestation while cerebral palsy was significantly decreased after 34 weeks of gestation. Acidosis was associated with cerebral palsy in mature infants, but not in less mature infants., Conclusions: : Premature infants were more susceptible to intrauterine infection to cause death or cerebral palsy than mature infants. Mature infants may require exposures to both infection and hypoxia but less mature infants need infection alone to cause cerebral palsy, suggesting different pathogenesis during the developmental stage.

Background: It is still controversial that intrapartum exposure to magnesium may or may not reduce brain damage in premature infants in human and animal models., Aims: We investigated the effect of hypoxemia alone under magnesium exposure on fetal cardiovascular changes in chronically catheterized goat fetuses., Study Design: We performed a 3-day experimental protocol with control (10% glucose) on day 1, recovery on day 2, and magnesium on day 3. Magnesium sulfate was directly infused to fetuses in a bolus dose of 270 mg/kg followed by 80 mg/kg/h. Hypoxemia was induced by maternal inhalation of nitrogen gas on day 1 and on day 3. Cerebral blood flow was measured by colored microsphere techniques. Repeated measure ANOVA and Bonferroni's/Dunn's test were used for comparison., Subjects: Six Japanese Saanen goats at 0.85 gestation., Outcome Measures: Fetal heart rate, blood pressure, and cerebral blood flow., Results: Ionized magnesium concentrations were significantly increased. Fetal PO2 decreased significantly from 30 mmHg to 14 mmHg without acidemia. Magnesium exposure significantly attenuated hypoxemia-induced bradycardia but did not affect blood pressure. Hypoxemia significantly increased fetal brain blood flow from the pre-hypoxic levels on day 1. Magnesium exposure further increased hypoxemia-induced brain blood flow on day 3, but statistical significance was limited to the cerebral cortex., Conclusion: In near-term, initially healthy goat fetuses, brain blood flow during acute hypoxemia was significantly increased with magnesium sulfate exposure.