Proceedings of the XIIth World Congress of Perinatal Medicine, Madrid, Spain, 3–6 November 2015

Abstract

The World Association of Perinatal Medicine convened its XIIth meeting in Madrid, Spain, 3–6 November 2015. More than 3000 health professionals from the world over and 200 speakers presented up-to-date clinical and basic material related to the care of pregnant women, fetus and neonate. Preceding the formal Congress several individual mini courses were offered. They were well attended and the audience had the opportunity to relate very closely to the speakers, an issue of great importance for young clinicians to share relevant clinical information. The identification and alternative treatments of threatened preterm birth and the care of the growth restricted newborn occupied significant amount of the speakers' efforts. Obesity, postpartum hemorrhage, maternal infections and morbidly adherent placenta were also addressed. 4 days of intensive learning and experience sharing were the result.

The XIIth Congress of the World Association of Perinatal Medicine convened in Madrid, Spain, 3–6 November 2015. More than 3000 healthcare professionals from around the world attended; over 200 speakers provided a wide spectrum of up-to-date basic research and clinical knowledge applied to the care of pregnant women and their babies. The program attempted to strike a balance between issues strictly related to the care of pregnant women and those covering an array of clinical situations that affect both the maternal health and the course of the pregnancy and/or its effects on perinatal and neonatal outcomes, short and long terms.

This report centers on discussions regarding maternal health. A significant amount of time was devoted to the issue of noninvasive prenatal diagnosis, fetal growth restriction, chemical markers, risk assessment, delivery timing and new developments in the care of the neonates born prematurely and growth restricted.

Several precongress courses were offered, where specifically the worldwide obesity epidemic and its effects on women's health were addressed by J Dudenhausen as part of the course entitled ‘The fetus as a patient’. Women are advised and encouraged to achieve the recommended BMI prior to conception. The importance of maternal nutrition on fetal development providing the mother with the indicated micronutrients supplementation such as folic acid to prevent certain fetal anomalies like open neural tube defects and congenital heart defects was discussed by A Vereczkey following the seminal work of Czeizel and his team. Efforts to limit gestational weight gaining to decrease or avoid gestational complications, increasing the chances of a physiologic labor and a vaginal delivery and decreasing the neonate chances of long-term metabolic effects of maternal obesity were described. Maternal nutrition occupied an important part of the discussions in association with optimal maternal health and perinatal outcome, fetal and neonatal health programming.

The critical need to continue efforts to identify accurately and effectively ways to assess and forecast idiopathic preterm labor with its ominous impact on neonatal intact survival was emphasized in presentations by Romero and DiRenzo, the Congress Scientific chairpersons, in several sessions who also chaired a number of sessions during the Congress. They addressed the multiple and complex issues related to preterm birth, the use of chemical markers such as PAMG-1 in cervical–vaginal tissue, the use of cervical length by a detailed transvaginal ultrasound evaluation and its very high negative predictive value and maternal chemical markers for inflammation infection. The study of the vaginal environment by the simple traditional measurement of its acidity level to the increasing use of the vaginal microbiome may assist in deciding the individual treatment approach. The diagnosis, possible etiologic agents, acute or chronic presence and treatment of chorioamnionitis is an integral part of the efforts at elucidating the complex mechanisms involved in preterm labor–preterm birth. This issue always brings a renewed discussion on the proper and timely use and arguably effectiveness of tocolytic agents emphasize by B Serra in tandem with the most effective use of steroids to strengthened fetal lung maturity and agents to protect the immature fetal brain, such as magnesium sulphate, melatonin and others in the horizon, by JL Bartha and A Conde-Agudelo. As it is recognized that preterm labor–preterm birth is a multifactorial entity, there is a critical need to understand the importance of properly determining the most likely trigger factor and therefore the most logical therapeutic approach. Within this context, it was emphasized that rapid turnaround time in the spectrum of diagnostic tests employed is an imperative if we are to be effective and efficient in the treatment plan. It is to be noted that some of the tests discussed are not available to practitioners in many areas of the world or are considered experimental and investigational and not approved for clinical use in the human.

The treatment of increased risk for preterm labor–preterm birth continues to include the use of local vaginal progesterone, systemic progesterone, cervical cerclage placed under a variety of indications or the utilization of a vaginal pessary as discussed by L Cabero Roura. Work continues unabated searching for the best approach that will accomplish the goal of prolonging the pregnancy. Indeed these treatments vary with the locale and means available to the women. The approval processes that these treatments must go through vary with the different national certifying bodies such as the US FDA in USA and the sister institutions in EU or other countries. Some of the devices are only available for clinical research and therefore not yet widely employed. This represents a very important issue at these international meetings where the clinical treatments are liable to have limited access as it relates to the environment where the presenters practice medicine and the different professional practice scope of the audience.

An innovative obstetrical device was again addressed by Argentinian investigators (J Schwartzman and H Krupitzki). The instrument is presented as the first new obstetrical instrument for decades. The International Federation of Obstetrics and Gynecology is in support of its use by mid level providers in developing countries. It is said to need very little training on its use and it is of low cost. In essence, it is a disposable (one time use) modified vacuum extractor that surrounds the fetal head once applied and facilitates the extraction as indicated. It is recommended to be used only on term, vertex, occiput anterior presentations at birth canal levels similar to the traditional obstetrical forceps application. The inventor, an Argentinian car mechanic, is supported by a large manufacturer of medical instrumentation, conducting simulation and limited clinical human studies in developing countries. The instrument has been presented previously in several international meetings. It is known as the Odon device.

The early identification and risk assessment of postpartum hemorrhage, recognized in many parts of the world as the number one cause of pregnancy-related deaths, was discussed both in the context of the medical and surgical treatments by Z Papp and D Farine. The increasing prevalence of cesarean births in certain environments brings with it an increasing frequency of morbidly adherent placentas and the need to identify them early and accurately to plan the woman's delivery. Obstetrical units ready, equipped and experienced to provide all the necessary maternal and neonatal services was discussed by M Kurtser. It is critical to have access to different levels of care with structured perinatal regionalization to insure that patients identified at increased risk for peripartum hemorrhage are proactively transferred to institutions with the ability to care for these often dramatic clinical situations.

Preeclampsia, still the nemesis of all those that provide care for pregnant women all over the world, occupied an important segment of the conversations during the meeting. From the possible early recognition of defective placenta implantation via ultrasound exploration of maternal vascular supply, to novel biomarkers in maternal serum, like glycosylated fibronectin discussed by M Gravett, to the use of agents given to the mother to promote adequate angiogenesis such as placenta growth factor, or the ASPRE trial of aspirin by K Nicolaides. Genetics, immune and angiogenic imbalance continue to be studied in a concerted effort to elucidate this complex clinical entity. A collaborative approach to create a global pregnancy biobank is ongoing. Other emerging biomarkers may appear through the use of transcriptomics, proteomics and metabolomics. It is noted that the enthusiasm for the use of angiogenic markers in preeclampsia have been generated in Europe since these assays are not approved by the FDA so the experience is limited. Some of the laboratory techniques are not readily available and the use of some of the proposed newer markers is considered experimental in some locations.

The interest in the subject of maternal hypertension–preeclampsia was clearly demonstrated by the fact that two independent sessions were offered. The need for early identification of this disease was emphasized by all presenters, discussing the bio and hemodynamic markers of their preference to differentiate early from late disease followed by the use of anticoagulants, angiogenic drugs and HMG CoA reductase inhibitors. Indeed the etiology of preeclampsia continue to evade its accurate description through generations of basic scientists and clinicians.

The universal increment in the prevalence of obesity in many areas of the world and its association with maternal and long-term neonatal and infant morbidities. Parental obesity, as emphasized by G Visser in one of his multiple presentations, has deleterious long-term effects on the offspring. Evidence was presented regarding the association of maternal obesity and increased risk for pregnancy-related deaths by F Mariona. Some of the studies are preliminary and further analysis is ongoing.

The President's session featured Prof E Saling considered by many the father of perinatal medicine. He made an impassioned presentation addressing the evolution of perinatal medicine. Aspects of home birth and early discharge of preterm newborns were addressed by F Chervenak and X Carbonell.

A number of national and regional organizations held special meetings with presentations associated with their individual approach to diagnosis and treatment of gestational and neonatal diseases. To note some, the Natural Family Planning Teachers Association of Spain, the Spanish Society of Neonatal Nursing, the Indian Society for Prenatal Diagnosis and Treatment, Gestosis, Scientific Society of Neonatal Nursing, the Latin American Federation of Perinatal Medicine Associations, the Spanish National Societies of Perinatology, Neonatology and Obstetrics, the International Society of the fetus as a patient, the Sociedad Ibero-Americana de Neonatologia, the South East European Society of Perinatal Medicine and the Parents Association of Menudos Corazones, electronic poster sessions were on going through the duration of the meeting with ample time for the audience to review and provide feedback on the content. Industry supported sessions were provided by Ginevri, Maquet, Dräger, Nestlé Nutrition Institute, Bayer, Philips, Abbvie and Toshiba.

Throughout the meeting, there was plenty of opportunity to share clinical and laboratory experiences and results with experts from many corners of the world.

These were 4 days of very active learning and participation from professionals involved in the care of pregnant women and their babies. This report centers mostly on issues related to maternal health. An equally loaded calendar was associated with preconception, prenatal diagnosis, fetal, neonatal and infant presentations.