Risky Baby Rehabilitation

BackgroundLow back pain is the most common musculoskeletal problem which negatively affects functional capasity and quality of life during pregnancy (1). So, from the beginning of pregnancy, pregnant women should...

This study aimed to determine the effect on pregnant women's prenatal attachment of a nursing practice using the first and second Leopold's maneuvers. This experimental, randomized and controlled study was conducted in a pregnancy class of a training and research hospital in Kocaeli, Turkey from September 2016 to September 2017. Its sample included 100 pregnant women, 50 in the experimental group and 50 in the control group (https://www.random.org, accessed: 09.20.2016). Data were collected using a personal information form, the Prenatal Attachment Inventory (PAI) and the Fetal Position Awareness Scale (FPAS). The study offered education that included fetal development, the first and second Leopold's maneuvers, and Leopold's maneuvers were administered in the 28th week of the women's pregnancy and re-administered in the 32nd and 36th weeks of pregnancy. No intervention was administered to the control group in these weeks, but the scales were administered. The sociodemographic, obstetric, social support and baby-related characteristics of the groups were similar (p > .05). There were no statically significant differences between their mean PAI and FPAS scores in the 28th week of pregnancy (p > .05). The experimental group's mean PAI and the FPAS scores in the 32nd and 36th weeks of pregnancy were significantly higher than those of the control group (p < .01). The study concluded that Leopold's maneuvers affected the pregnant women's prenatal attachment levels.

A cause of pre-eclampsia?

Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by erythrocyte allo‑antibodies present in the maternal plasma dur‑ing pregnancy, which cross the placental barrier and enter the fetal bloodstream, bind to fetal erythrocyte antigens and cause destruction of fetal erytrhocytes. Hemolysis leads to fetal anemia, which can cause fetal death if not treated. Case report: We report a case of HDFN in a multiparous female with multiple erythrocyte alloantibodies of anti‑C+G, anti‑E, anti‑Kp(a) and anti‑Kn(a) specificity. In her third preg‑nancy we found erythrocyte alloantibodies of anti‑C+G and anti‑Kp(a) specificity for the first time. Erythrocyte alloantibodies titers were low and fetal hemolysis was not expected. However, in the 30th week of pregnancy obstetricians observed rapid development of fetal anemia, which was due to hemolysis. The pregnancy was ter‑minated. Despite an exchange transfusion, the newborn died a few days after birth because of HDFN. In the following pregnancy, titers of al‑ready known erythrocyte alloantibodies were high and very severe hemolysis was predicted. In the 22nd week obstetricians found fetal hydrops. Despite intrauterine transfusion (IUT), the preg‑nancy ended with intrauterine fetal death. The fifth pregnancy ended with miscarriage in the 11th week of pregnancy. In the last pregnancy, titers of known erythrocyte alloantibody were high and again very severe hemolysis was predicted. In the 17th and 20th week of pregnancy, erythrocyte alloantibody titers increased. In the 22nd week of pregnancy, obstetricians observed fetal anemia and decided to perform an IUT. The fetus received seven IUTs. After the second IUT, additional erythrocyte alloantibodies of anti‑E and anti‑Kn(a) specificity were found in the ma‑ternal plasma. In the 34th week of pregnancy, ob‑stetricians terminated the pregnancy with elec‑tive caesarean section. The child was born with no signs of hemolytic anemia. Conclusion: HDFN is still considered an unpredictable disease. By the help of modern pro‑cedures for monitoring of immunised pregnant women also those pregnant women with mulip‑le, clinically significant erythrocyte alloantibod‑ies can be successfully managed in the course of pregnancy.

We performed this study to evaluate uterine artery Doppler velocimetry (UADV) measurement of unilateral or bilateral abnormalities as a predictor of complications in pregnancy during the mid-second trimester (20-24 weeks). We enrolled 1,090 pregnant women who had undergone UADV twice: once between the 20th and 24th week (1st stage) and again between the 28th and 32nd week (2nd stage) of pregnancy, and then delivered at Yonsei Medical Center. UADV was performed bilaterally. Follow-up UADV was performed between the 28th and 32nd week, and the frequencies of pregnancy-induced hypertension (PIH), fetal growth restriction (FGR), and preterm delivery (before 34 weeks of gestation) were determined. Chi-squared and t-tests were used where appropriate, with p < .05 considered significant. According to the results of UADV performed between 20-24 weeks of gestation, 825 women (75.7%) were included in the normal group, 196 (18.0%) in the unilateral abnormality group, and 69 (6.3%) in the bilateral abnormality group. The incidences of FGR were 8.0%, 10.2%, and 26.1%, and the incidences of PIH were 0.1%, 3.6%, and 14.5%, respectively. The incidence of PIH was significantly lower in the normal group. The incidences of preterm delivery were 2.2%, 5.6%, and 8.7%, respectively. PIH developed in 46.7% of patients with bilateral abnormal findings in both the 1st and 2nd stage tests, and developed in none of the patients with normal findings in both tests. Abnormal results found by UADV performed between the 20-24th weeks of pregnancy, such as high S/D ratios regardless of placental location and the presence of an early diastolic notch, were associated with significant increases in the incidences of intrauterine growth restriction (IUGR) and PIH. This was true for both bilateral and unilateral abnormalities. Abnormal findings in bilateral UADV during the second trimester especially warrant close follow up for the detection of subsequent development of pregnancy complications.

Retinopathy of prematurity (RoP) is a cause of newborn blindness. Several predisposing factors have been reported to contribute to the disease process. The current study aimed to compare serum vitamin D levels in infants with and without RoP. This case-control study was conducted on 154 very low birth weight (VLBW) infants admitted to Ghaem hospital, Mashhad, Iran, during 2016-2019. Retinal examination for RoP was done at the 32nd week of pregnancy and vitamin D level was determined using the infants' first-day serum samples. A researcher-made questionnaire including maternal, infant, laboratory, and retinal examination information was used as the data collection tool. Out of 154 infants in the study, 56 (36.4%) were normal while 98 (63.6%) had RoP. Based on the severity of retinopathy, 43 infants (43.9%) were at stage I, 48 (49%) at stage II, and 7 (7.1%) at stage III. Significant differences in neonatal (P<0.001) and maternal (P=0.015) vitamin D levels, first and fifth minute Apgar scores (P=0.034 and P=0.001, respectively), and weight (P=0.014) were found between the infants with and without RoP. The incidence of RoP was higher in infants with lower gestational age, lower birth weight, low first and fifth minutes Apgar scores, and male sex. Low serum levels of vitamin D in premature infants and their mothers were associated with incidence of RoP. The higher the stage of RoP, the greater was the severity of vitamin D deficiency. Thus, controlling the maternal vitamin D level during pregnancy, consumption of vitamin D supplements, and investigation of serum vitamin D levels in premature infants are recommended. Early correction of vitamin D deficiency may lead to reduction of RoP.

A total of 2771 pregnant women with gestational age estimated by ultrasound measurement of the fetal biparietal diameter (BPD) before the 22nd week of gestation were re-examined by ultrasound in the 32nd and 37th week of pregnancy at which time the fetal BPD and abdominal diameter (AD) were measured. An additional examination was performed at 34 weeks if the fetal weight in the 32nd week was estimated to be less than 95% of the expected mean weight. Light-for-gestational age (LGA) was suspected if the estimated birth-weight was less than 85% of the expected mean birthweight. This applied to 186 uncomplicated pregnancies in which there was no clinical suspicion of poor intrauterine growth. These pregnancies were randomly allocated to a treatment group (AD and estimated weight reported) or to a control group (AD and estimated weight withheld). Induction of labour was significantly more common in the treatment group (41%) than in the control group (15%). No statistically significant difference was found in the use of instrumental vaginal delivery or caesarean section. There was a suggestion of marginal benefit in terms of neonatal morbidity but this was not statistically significant.

Background/Objectives: The optimal anesthetic technique for category 2 and 3 cesarean deliveries remains debated, with concerns about impacts on decision-to-delivery interval (DDI) and perinatal outcomes. This study examined the influence of epidural, spinal, and general anesthesia on DDI, surgical and postoperative complications, and neonatal outcomes. Methods: This prospective cohort study at a tertiary perinatology center enrolled parturient women undergoing category 2 and 3 cesarean deliveries. Three DDI phases were assessed for each anesthetic modality: transfer time (decision for cesarean section to admission in the operation room), anesthetic time (admission to incision), and delivery time (incision to delivery of the neonate). The surgical procedure time (incision to closure), neonatal (5 min Apgar score, umbilical artery pH/base excess, neonatal intensive care unit (NICU) admission) and maternal (blood loss, surgical and postoperative complications) outcomes were also analyzed for each group. Results: There were 215 women (122 category 2 and 93 category 3) included. The use of epidural and general anesthesia was associated with significantly shortened DDI compared to spinal anesthesia (p &lt; 0.001). This difference was due prolonged transfer (p &lt; 0.05) and anesthetic times (p &lt; 0.001), respectively. No cases of umbilical artery pH below 7 were observed in any group. No significant differences were observed in the incidence of umbilical artery pH between 7 and 7.10 or in base excess below −12 nmol/L (p = 0.416 and p = 0.865, respectively). NICU admission was higher with both general and spinal anesthesia (p = 0.021), but mainly due to a higher proportion of preterm births, both before the 32nd week (p = 0.033) and between the 32nd and 37th week of pregnancy (p &lt; 0.001). General anesthesia was associated with higher maternal blood loss (p = 0.026) and a higher rate of postoperative complications (p = 0.006). Conclusions: In category 2 and 3 cesarean deliveries, general and epidural anesthesia were associated with shorter DDI compared to spinal anesthesia with no differences in neonatal outcomes. General anesthesia was associated with a higher risk of maternal complications compared to neuraxial anesthetic techniques.

Extremely early premature babies (i.e. those born before the 32nd week of pregnancy) constitute a group at high risk of development of the perceptive forms of hearing impairment represented mostly by chronic sensorineural hearing loss (CSNHL) and hearing neuropathy (HN). The timely diagnostics of these hearing disorders in premature children and, accordingly, their early and adequate rehabilitation provide a basis for the prevention of hearing and speech problems. At the same time, the hearing function in prematurely born babies is known to be highly unstable and can undergo substantial changes with age; these changes are most frequently observed during the early childhood. This paper was designed to report the results of observations of the hearing function dynamics in a cohort of the extremely early premature children. A total of 186 babies were available for the examination. It was shown that 14 (7.5%) of them had hearing problems. They disappeared by the 12th and 24th months of life in 3 children. Three other babies experienced transformation of NH into CSNHL at the age of 12, 14, and 18 months. NH transformed into CSNHL in three children by the age of 12, 24, and 48 months. Five children developed delayed CSNHL by the 10th, 15th, 24th, 28th, and 36th months of the actual life. These findings give evidence that the extremely premature children may experience both the improvement of the hearing function due largely to the processes of maturation in the auditory system and its deterioration or delayed formation of hearing impairment. It is concluded that the extremely early premature children born before the 32nd week of pregnancy should remain under the dynamic audiological observation at least as long as the third or fourth years of life.

The own observation of pregnancy and tuberculosis after COVID-19 in a patient who was treated in the pulmonary tuberculosis department N 2 of the Zaporizhia Regional Phthisiopulmonology Clinical Medical Diagnostic Center is presented. According to the presented clinical case, a woman, who had pulmonary tuberculosis 9 years ago, underwent mild COVID-19 at the 20th week of pregnancy and did not receive any treatment. The patient had of the dispensary observation in the phthisiatrician and regularly underwent preventive check-­up, because of her previous tuberculosis. However, the patient was hospitalized in the intensive care unit of the PNE «Regional Perinatal Center» ZRC with moderate preeclampsia, signs of intrauterine fetal hypoxia, in which the mother needed medical care, at the 32nd week of pregnancy. Three days after hospitalization, in view of the fetal distress and preeclampsia, it was made a decision to perform assisted delivery by cesarean section. The child was born alive, vertical transmission of COVID-19 was not diagnosed. Taking into account the history of tuberculosis in anamnesis, the woman underwent X-­ray examination of the thoracic cavity organs, where the reactivation of a specific process, on the background of metatuberculous changes, were revealed. The woman was diagnosed of multidrug­-resistant tuberculosis (MDR-­TB) with a destructive process in the lungs by further examination, that’s why, she was hospitalized to Zaporizhia Regional Clinical and Diagnostic Center of Phthysiatry and Pulmonology» of Zaporizhia Regional Council for further treatment. A course of antimycobacterial therapy (AMBT), according to the modified short­-term treatment regimen, was prescribed to the patient. Against the background of AMBT, rapid positive dynamics was determined: stable cessation of bacterial excretion was determined after 1 month of AMBT, and healing of destruction with the formation of residual post-­tuberculosis changes — after 2 months. The presented clinical case demonstrates the negative impact of COVID-19 both on the course of pregnancy (moderate preeclampsia, which led to cesarean section at 32nd weeks of pregnancy) and on the reactivation of the tuberculous process, with its course in the form of MDR­-TB.

Womb at work: The missing impact of maternal employment on newborn health

Parental leave policies across the globe have become much more generous than they used to be. This is also true for prenatal maternal leave. While this may be costly in the short run, little is known about the effect of maternal employment during pregnancy on newborn health. In this paper, I exploit three sharp policy changes on the duration of paid parental leave in Austria that strongly affected the share of mothers who work up to the 32nd week of pregnancy. I use administrative data from Austria on the working history of women linked to the full Austrian birth register and coupled with a regression discontinuity framework to identify the effect of prenatal employment on their offspring. Maternal employment during pregnancy with the second child reacts strongly to these policy changes. The share of employed mothers sharply declined in 1990 by 19.1 percentage points, increased in 1996 by 7.2 percentage points and declined again by 6.4 percentage points in 2000. None of these changes in prenatal employment translated into effects on newborn health measured via birth weight, gestational length, and Apgar scores. This result holds true for mothers of different socioeconomic backgrounds and across industries. The effect is precisely estimated, which suggests that prenatal employment prior to the 32nd week of pregnancy does not causally affect the fetus for measures visible at birth.

A transplacental hemorrhage of approximately 10 ml occurred at the 29th week of the first pregnancy of a woman carrying twins. The administration of 400 μg Rh immunoglobulin 96 hours later failed to prevent primary immunization. Traces of saline‐reacting anti‐Rh0 (D) were detectable by the 32nd week, increasing to a titer of 1: 64 by the 37th week of pregnancy. The possibility that antenatal administration of Rh immunoglobulin may enhance the risk of primary immunization is considered.

Delayed interval delivery and survival of the two fetuses after second trimester loss of one triplet

The authors present their renal tumor cases observed during pregnancy and review the literature related to this topic. Between January 1, 2000 and January 1, 2015, altogether 3 patients were treated for renal tumor during pregnancy. Two of them had surgery performed during pregnancy, while in the other, premature birth of the baby preceded surgery. In the first case, a laparoscopic tumor resection was performed in the 29th week of the patient's pregnancy. In the second case, a transperitoneal radical nephrectomy was carried out during the 10th week of pregnancy. In the case of the third patient, a caesarean section was performed during the 32nd week of gestation, and then followed later by surgery for the metastatic renal tumor. However, the tumor was found to be inoperable.