37th Week Of Gestation Research Articles

Preterm birth and its effects on craniofacial and dentoalveolar growth

Premature or preterm birth is a condition that takes place either before the 37th week of gestation or when the weight of the neonate is lower than 2500 grams (Paulsson et al., 2004; Cortines and Costa, 2016). Several factors that are related to the mother or the fetus have been considered as potential causes for this condition, whereas there is a consensus that there are potential parameters that could lead to premature birth which still remain to be identified (Hohoff et al., 2005; Seow, 1997). Despite the fact that the incidence of neonatal mortality owing to premature birth has been significantly decreased in the recent years, there are yet some side-effects that could affect specific organ systems of the fetus (Paulsson et al., 2004; Hohoff et al., 2005). Moreover, there are reports of possible influence of preterm birth on the development of the cognitive and psychological background of the affected children (Anderson and Doyle, 2008).

Home monitoring of fetal heart rhythm: Lived experiences of women with anti-SSA/Ro52 autoantibodies and their co-parents.

The aim of this study was to explore the parents' experiences of home monitoring of the fetal heart rhythm. Women with anti-SSA/Ro52 autoantibodies carry a 2%-3% risk of giving birth to a child with congenital heart block (CHB), following transplacental transfer and antibody-mediated inflammation in the fetal conduction system during 18th to 24th gestational week. Early detection and subsequent treatment have been reported to decrease morbidity and mortality. Therefore, home monitoring of the fetal heart rhythm by Doppler has been offered at our fetal cardiology center. This study was undertaken to explore the lived experience of the routine. Participants were recruited from a single fetal cardiology center. Consecutive sampling was used. The inclusion criteria were women with SSA/Ro52 antibodies who had undergone Doppler examinations within the last two and a half years at the hospital and had monitored the fetal heartbeat at home. A semi-structured questionnaire was created, and the participants were interviewed individually. The interviews were transcribed verbatim and analyzed according to qualitative content analysis. The overall theme was defined as "walking on thin ice," with six underlying categories: reality, different strategies, gain and loss, healthcare providers, underlying tension, and conducting the examinations again, all with a focus on how to handle the home monitoring during the risk period. Both the mother and the co-parent expressed confidence in their own abilities and that the monitoring provided them with the advantage of growing a bond with the expected child. However, all the participants described a feeling of underlying tension during the risk period. The results show that home monitoring is not experienced as complicated or a burden for the parents-to-be and should be considered a vital part of the chain of care for mothers at risk for giving birth to a child with CHB. However, explaining the teamwork between the different caregivers, for the patients involved, their areas of expertise, and how they collaborate with the patient continues to be a pedagogic challenge and should be developed further.

Muscle strength during pregnancy and postpartum in adolescents and adults.

Adolescent childbirth is associated with worse physical function over the long-term. Differential loss of muscle strength during pregnancy and postpartum for adolescents compared to adults may be one explanation for this, but research examining these differences is lacking. The objective of this study as to assess hand grip strength and hip adduction muscle strength in adolescents and adults during pregnancy and postpartum. A prospective cohort study was carried out with adolescent (13 to 18 years) and adult (23 to 28 years) primigravid women. Assessments were performed at three timepoints: before the 16th gestational week, during the third trimester, and between the fourth and sixth week postpartum. Hand grip strength (continuous and muscle weakness if ≤ 20.67 kgf) and hip adductor measures (continuous and muscle weakness if ≤ 13.8 kgf) were assessed using dynamometry. Generalized estimating equations modelled longitudinal relationships between muscle weakness and age group. More adolescents had hip adductor weakness than adults in the third trimester of pregnancy (62.5% vs. 31.8%, p < 0.005), which was corroborated by the longitudinal analyses. For all women, there were higher odds of hip adductor weakness in the third trimester (OR = 4.35; p< 0.001) and postpartum (OR = 9.45; p < 0.001) compared to the 16th gestational week. No significant difference in HGS was observed between age groups or across the different timepoints. The higher proportion of hip adductor weakness among adolescents may indicate a need for resistance training during and after pregnancy and physical therapy if weakness or injury is noted.

Pregnancy maintenance and fetal loss assessment in Holstein cows through analyzing pregnancy-associated glycoproteins in milk

Fetal loss (FL) from the 45th day of gestation until calving can impose a significant economic burden on dairy farmers, resulting in lost profits and increased production costs. Pregnancy-associated glycoprotein (PAG) is commonly used for detecting pregnancy in cows. PAG is secreted by binucleated trophoblast cells of the placenta and regulated by more than 24 genes. The purpose of this study was to determine the PAG threshold for FL and a probability of pregnancy maintenance until calving based on milk PAG levels. Our results reveal that primiparous and multiparous cows that maintained pregnancy until the 40th week exhibited higher PAG sample-negative (SN) values in their milk in the 6th week of gestation than did those that experienced FL later in gestation. Pregnant cows with higher PAG SN values in the 6th week of gestation were more likely to maintain their pregnancies. The area under the receiver operating characteristic curve for predicting the probability of pregnancy maintenance was 0.722 for our prediction model. On the other hand, a milk PAG SN value of <0.192 indicated 95 % confidence that FL would occur between the 7th and 40th weeks of gestation. Milk PAG testing is a noninvasive sampling technique that does not induce additional stress in lactating cows. The study reveals that PAG SN values increase significantly in Holstein cows during the 6th week of gestation. The predictive model developed was effective in forecasting pregnancy outcomes up to the 40th week of gestation or calving. The model's performance is moderately good for field application and could be a useful tool for dairy producers.

Physical activity, gestational weight gain in obese patients with early gestational diabetes and the perinatal outcome – a randomised–controlled trial

BackgroundExcessive gestational weight gain, especially among women with gestational diabetes, is associated with several adverse perinatal outcomes. Our study aimed to analyse the impact of the use of pedometers to supervise physical activity on maternal health and the obstetric outcomes of pregnant women with obesity and early gestational diabetes.Methods124 pregnant patients were enrolled in the presented research. Inclusion criteria: singleton pregnancy, age > 18 years, gestational diabetes diagnosed in the first half of pregnancy (< 20th week of pregnancy), obesity according to the American Endocrine Society criteria. Each patient was advised to take at least 5000 steps daily. Patients were randomly assigned to pedometers (N = 62), and were recommended to monitor daily the number of steps. The group without pedometers (N = 62) was not observed. Visit (V1) was scheduled between the 28th and 32nd gestational week (GW), and visit (V2) occurred between the 37th and 39th GW. Anthropometric measurements and blood samples were collected from all patients at each appointment. Foetal and maternal outcomes were analysed at the end of the study.ResultsIn the group supervised by pedometers, there were significantly fewer newborns with macrosomia (p = 0,03). Only 45% of patients satisfied the recommended physical activity guidelines. Patients who walked more than 5000 steps per day had significantly higher body weight at baseline (p = 0,005), but weight gain was significantly lower than in the group that did not exceed 5000 steps per day (p < 0,001). The perinatal outcome in the group of patients performing more than 5000 steps did not demonstrate significant differences with when compared to less active group. ROC curve for weight gain above the guidelines indicated a statistically substantial cut–off point for this group at the level of 4210 steps/day (p = 0.00001).ConclusionsMonitoring the activity of pregnant patients with gestational diabetes and obesity by pedometers did not have a significantly impact on their metabolic control and weight gain. However, it contributed to less macrosomia. Furthermore, physical activity over 5,000 steps per day positively affects weight loss, as well as contributes to improved obstetric and neonatal outcomes.

Prediction by uterine artery Doppler screening of small-for-gestational-age neonates at 19-24 weeks' gestation.

Small-for-gestational-age (SGA) neonates are at increased risk of perinatal mortality and morbidity. We aimed to investigate the performance of uterine artery pulsatility index (UtA-PI) at 19-24 weeks' gestation to predict the delivery of a SGA neonate in a Chinese population. This was a retrospective cohort study using data obtained between January 2010 and June 2018. Doppler ultrasonography was performed at 19-24 weeks' gestation. SGA was defined as birth weight below the 10th centile according to the INTERGROWTH-21st fetal growth standards. The performance of UtA-PI to predict the delivery of a SGA neonate was assessed using receiver-operating-characteristics (ROC)-curve analysis. We included 6964 singleton pregnancies, of which 748 (11%) delivered a SGA neonate, including 115 (15%) women with preterm delivery. Increased UtA-PI was associated with an elevated risk of SGA, both in neonates delivered at or after 37 weeks' gestation (term SGA) and those delivered before 37 weeks (preterm SGA). The areas under the ROC curve (AUCs) for UtA-PI were 64.4% (95% CI, 61.5-67.3%) and 75.8% (95% CI, 69.3-82.3%) for term and preterm SGA, respectively. The performance of combined screening by maternal demographic/clinical characteristics and estimated fetal weight in the detection of term and preterm SGA was improved significantly by the addition of UtA-PI, although the increase in AUC was modest (2.4% for term SGA and 4.9% for preterm SGA). This is the first Chinese study to evaluate the role of UtA-PI at 19-24 weeks' gestation in the prediction of the delivery of a neonate with SGA. The addition of UtA-PI to traditional risk factors improved the screening performance for SGA, and this improvement was greater in predicting preterm SGA compared with term SGA. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Feasibility of Spectral Analysis as a Tool in Nursing Research to Quantify Patterns of Respiration in Premature Infants.

Respiratory difficulties are a common concern in preterm infants, and they can lead to long-term health problems. Few studies have investigated the use of spectral analysis as a biomarker to quantify respiration patterns in preterm infants. To evaluate the feasibility of using spectral analysis of heart rate variability as a biomarker for the quantification of respiratory patterns in very-low-birth-weight preterm infants compared to direct observation. In a comparative, small-scale feasibility study, 18 preterm infants born during their 27th to 28th gestational week (weighing <1500 grams) participated by convenience. Respiratory patterns (regular or irregular; shallow or deep) were directly observed on the 28th week during playback of speech recording. Heart rate variability was simultaneously measured using spectral analysis of heart periods, from which the mean values influenced by respiratory sinus arrhythmia (frequencies of 0.30-1.0 Hz) were compared to each observed respiratory pattern. The magnitudes of respiratory sinus arrhythmia and the area under the curve were determined. The magnitude of respiratory sinus arrhythmia (frequencies of 0.30-1.0 Hz) in infants observed to be displaying irregular shallow respiration was greater than that in infants with regular deep respiration. Further, there was a shift from lower frequencies (frequency peak = 0.30 Hz) to higher frequencies (peak = 0.70 Hz). In contrast with direct observation, spectral analysis allowed for the quantification of respiratory patterns in a vulnerable population of preterm infants of interest to the nursing scientific and practice community. Future directions include applying this biomarker to evaluate both developmental and pathological trends in the respiratory patterns of preterm infants.

Uzrok prevremenog porođaja kao prognostički faktor neonatalnog ishoda i načina završavanja porođaja

Introduction: Premature birth, occurring before the 37th gestational week, is commonly attributed to uterine contractions, premature rupture of the amniotic sac, or placental abruption. In 20% - 30% cases involving maternal or fetal complications, premature birth may be induced, often due to conditions such as preeclampsia, fetal growth retardation, or severe maternal heart disease. Aim: The study aims to determine whether the cause and time of preterm birth affect the neonatal outcome. Material and methods: This retrospective study analyzes patients prematurely born at the Obstetrics and Gynecology Clinic Narodni Front in 2020, the cause of their premature birth, as well as the status of the fetus after birth. In the study, we compared the neonatal outcome in spontaneously induced preterm birth. Results: Among all the births (n = 4,211), in the period between July and December 2020, there were 498 preterm births, i.e., 11.83%. Based on the data on the status of the premature infants' vital signs, the percentage of stillborn preterm infants was 8.9% while the percentage of live births was 91.1%. The Apgar score was the highest in neonates born by vaginal birth after the 34th week of gestation, with intact fetal membranes and spontaneous contractions. According to the study, 54.1% of preterm births ended in cesarean section due to gestational age younger than 28 weeks and with a predominantly pelvic presentation of the fetus. Conclusion: The high rate of premature births highlights a serious problem and suggests a continued rising trend, despite preventive efforts. Improved outcomes are seen in pregnancies reaching later gestational weeks, particularly after the 34th week of gestation, with intact fetal membranes and no signs of infection. Spontaneously born premature infants tend to have higher Apgar scores and better neonatal outcomes, as compared to induced births.

A rare case of alpha-methyldopa-induced hepatitis in pregnancy

Introduction. There are three groups of disorders during pregnancy: disorders specific for pregnancy that resolve spontaneously or soon after delivery, acute hepatic disorders coinciding with pregnancy, and chronic disorders. Drug-induced liver disease prevails among women and it is estimated to be a leading cause of acute liver injury. Drug-induced hepatitis is rare in pregnancy with only a few cases reported in literature. Alpha-methyldopa is one of the commonly used drugs in pregnancy that could cause hepatotoxicity with different clinical presentations and possible adverse effects on normal course of pregnancy. Case outline. We reported a rare case of hepatotoxicity caused by alpha-methyldopa in 26 gestational weeks pregnancy in a 35-year-old patient admitted because of jaundice and elevated liver function tests. She had been using antihypertensive drug, alpha-methyldopa, from 12th gestational week, and no other medication or supplementation was recorded. Ultrasound of the abdomen excluded obstruction or any other abnormalities. Autoimmune panel was done. Biochemical analyses were indicative of toxic acute liver injury caused by alpha-methyldopa according to values of transaminase. After 13 days, patient was discharged recovered from the hospital. Conclusion. Diagnosis of alpha-methyldopa hepatotoxicity is challenging since the low incidence, unpredictability, diverse symptomatology and absence of specific biomarkers. That is why timely diagnosis is crucial for the well-being of both future mother and child.

Analysis of fetal renal cortex development: Cortical maturation index as a new potential guide in fetal renal cortex assessment

Background/Aim. To date, most of the scientific attention has been aimed at the morphometric analysis of the nephrogenic zone (NZ) of the fetal renal cortex, while the quantification and analysis of the maturation zone (MZ) and other indicators of renal maturity were missing. The aim of the study was to examine the characteristics of fetal kidney cortex maturation, as well as to propose the development of a new cortical maturity index (CMI). Methods. The study included 42 paraffin molds of the fetal kidney, divided into three groups according to gestational age (GA). After hematoxylin and eosin staining, tissue sections were analyzed through the following parameters: the thickness of the NZ and MZ, the renal corpuscles area (RCa) and the glomerular capillary tuft area (GCTa), and the maturation stages of the glomeruli. In addition, a new parameter, CMI, was formed as a ratio of NZ and MZ thickness. The collected data were statistically processed. Results. Changes in NZ and MZ thickness were statistically significant, and they correlated with GA. A value of CMI higher than 0.2 was recorded in the kidney samples of fetuses younger than the 20th gestational week (GW), while a value lower than 0.1 was recorded in the samples older than the 30th GW. With an increase in GA in all zones of the renal cortex, RCa and GCTa decreased. A statistically significant reduction of GCTa was observed in the oldest group in the juxtamedullary and intermediate zones of the cortex (p &lt; 0.01). Glomeruli located in the deeper parts of the cortex were more mature than the superficial ones. Conclusion. The measured parameters can serve as a starting point for future studies that would analyze the histomorphological characteristics of the fetal kidney cortex. In the absence of clinical data, a newly formed parameter CMI can represent assistance with the determination of GA, as it significantly correlates with GA (p &lt; 0.01).

Pregnancy termination indications and outcomes before 24 weeks of gestation - a case series.

This study aimed to assess termination of pregnancy (TOP) indications and obstetric outcomes before the 24th gestational week. This is a retrospective study that includes terminations performed in singleton pregnancies between December 2021 and December 2022 in the Perinatology Clinic of Necmettin Erbakan University Meram Medical Faculty. According to the reasons for TOP, all patients were divided into three groups: maternal, fetal, and obstetric reasons. The termination approach and outcomes were evaluated in all cases. A total of 210 patients were included in the study. Considering termination indications, 18 (8.5%) patients had maternal causes, 127 (60.5%) had fetal causes, and 65 (31%) had obstetric causes. Maternal causes were significantly higher in the 1st trimester and fetal causes in the 2nd trimester (P = 0.001). In the maternal group, 77.8% dilatation and curettage were used, 70.1% misoprostol and 29.9% misoprostol + Foley catheter in the fetal group, and 66.2% misoprostol in the obstetric group (P = 0.0001). The length of hospital stay and recurrent revision curettage were not statistically different between the fetal, maternal, and obstetric groups (P = 0.099, P = 0.8, respectively). Termination options should be offered for complicated pregnancies due to fetal, maternal, or obstetric reasons. Pregnancy termination week and indication affect morbidity.

Disease activity and neonatal outcomes after exposure to natalizumab throughout pregnancy

BackgroundAfter natalizumab discontinuation severe relapses can occur despite pregnancy, but third trimester exposure is associated with neonatal haematological abnormalities (HA). The best time point for stopping natalizumab during pregnancy is...

Особенности развития и клинического течения глаукомного процесса у детей, рожденных на разных сроках гестации

Material and methods. 147 children (242 eyes) aged from 1 to 18 months with different stages of glaucoma. The main group consisted of 106 patients (170 eyes) born before the 37th week of gestation (29.1±2.4 weeks). The comparison group consisted of 41 children (72 eyes) with primary congenital glaucoma, born from 37 to 42 weeks of gestation (38.6±1.0 weeks). Results. The manifestation of the glaucoma process in the group of prematurely born children in most cases occurred at 5–6 months. The «classic» increase in the size of the eye was significantly more often observed in patients with primary congenital glaucoma (29 children, 51 eyes, 70.8%). At the same time, corneal edema was noted more often in the group of children with glaucoma and ROP (55 children, 91 eyes, 53.5%). In the group of children born at term, the horizontal corneal diameterwas 13.51±1.19 mm. In the group of preterm infants with glaucoma, this figure was 12.53±0.89 mm. Axial length of the eye in children with glaucoma born at term also significantly exceeded the age norm: 23.22±2.83 mm. On average, axial length of the eyes with glaucoma in premature babies was 22.74±2.76 mm. IOP in the group of premature babies averaged 25.94±4.5 mm Hg, while the indicator in the group of full-term babies was 24, 31±4.9 mm Hg. Conclusion. Thus, the manifestation, clinical course, and outcome of the glaucoma process in children born at different gestational ages can be very variable. Key words: retinopathy of prematurity, glaucoma, corneal diameter, axial length, intraocular pressure

Risk for fetal malformations and unfavorable neonatal outcomes in early-onset gestational diabetes mellitus.

Early-onset gestational diabetes mellitus (GDM) is diagnosed before the 24th gestational week. Since early GDM is associated with first trimester hyperglycemia, many clinicians treat these women as having pre-GDM. However, whether early GDM increases the risk for unfavorable pregnancy outcomes and particularly for fetal malformations to a greater extent than late-onset GDM were not studied sufficiently. We aimed to examine the effect of early-onset GDM on unfavorable pregnancy outcomes. A retrospective cohort study of women with GDM delivering singletons during 2005-2018 was conducted. Women were divided into GDM diagnosed at the first (Trimester1; up to 13.6weeks; N = 117), the second (Trimester2; up to 23.6weeks; N = 126), and the third trimester (Trimester3; N = 2334). The primary outcomes were neonatal malformations and a composite of large-for-age newborns, hypoglycemia and hyperbilirubinemia treated with phototherapy. Comparisons were made between early- (Trimester1 + Trimester2-groups) and late-onset GDM (Trimester3-group), and between the three trimesters. Fetal malformations were low and comparable between the trimester1, trimester2, trimester3 groups (2 (1.7%), 3 (2.4%), and 110 (4.7%), respectively).The composite neonatal complications was similar between the groups (68 (58%), 58 (46%), and 1087 (47%), respectively). In early-onset, the rates of neonatal hypoglycemia and shoulder dystocia were higher than in the late-onset GDM group (OR 95% CI 3.5 [2.0-6.1] and 10.3 [2.4-44.6], respectively). Macrosomia was higher in trimester1 compared with trimester2 and trimester3 cohorts (OR 95% CI 5.3 [1.7-16.9] and 2.8 [1.5-5.2], respectively). The risk for fetal malformations was low and comparable between the first, second and third trimester GDM. Since the risks for macrosomia, shoulder dystocia, and neonatal hypoglycemia are higher in early-onset GDM, these women should undergo strict glycemic control, intensive monitoring, and careful neonatal evaluation.

Management of fetal supraventricular tachyarrhythmia - case report

The conduction system of the fetal heart is defined by the16th week of gestation when it matures and normally produces a regular rhythm and rate between 110 and 160 beats per minute (bpm) for the remainder of the pregnancy. Deviations from these parameters are fetal arrhythmias. They are diagnosed in 2% of unselected pregnancies. They are mostly benign and transient but some of them are persistent and associated with structural defects or can cause heart failure, fetal hydrops and intrauterine death. Routine prenatal care includes screening for fetal arrhythmias in the second and third trimester with fetal ultrasound examinations which include a view of the four cardiac chambers and both ventricular outflow tracts. The fetal outcomes are improved upon appropriate antepartum diagnosis and care. Here we present a pregnancy and multidisciplinary management, prenatal evaluation and intervention with maternal transplacental treatment of a 28-year-old female, gravida II, para II, in 28+5 weeks of gestation with fetal arrhythmia, in tertiary university hospital. She had a history of previous caesarean section, in the 40th week of gestation due to an infection of the synus pylonidalis. We confirmed suspected fetal arrhythmia as supraventricular tachyarrhythmia without fetal hydrops, based on the ultrasound doppler M mode imaging, and started transplacental administration of antiarrhythmyc agent, digoxin. It has been considered the first line agent for treatment of fetal supraventricular tachycardia but higher maternal doses are required to maintain a therapeutic serum level. We converted fetal heartbeat into normal sinus rhythm after three days of administration of digoxin. We continued to monitor the fetus once a week with controlling levels of digoxin and electrolytes in maternal blood until the end of the pregnancy at 38+6 weeks of gestation.

Individual ambient ozone exposure during pregnancy and adverse birth outcomes: Exploration of the potentially vulnerable windows

BackgroundAmbient ozone (O3) exposure during pregnancy might be associated with preterm birth (PTB) and low birth weight (LBW); however, existing evidence remains inconclusive. It is necessary to explore the relationships and potential susceptible periods further. MethodsTo explore the relationship between O3 exposure and adverse birth outcomes, a study using records of 34,122 singleton live births in Beijing between 2016 and 2019 was conducted. The O3 exposure in each gestational week of pregnant women was estimated, and Cox proportional hazard models were used to estimate the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Distributed lag nonlinear model (DLNM) incorporated in Cox proportional hazard models were used to explore potential critical windows. ResultsAn increase of 10 μg/m3 in O3 exposure was associated with a 3.9% (95%CI: 0.6–7.3%) higher risk of PTB. Additionally, this increase in O3 exposure was positively linked to PTB during the 2nd − 7th, 22nd − 29th, and 37th gestational weeks, and LBW during the 2nd − 7th, 24th − 29th, and 37th gestational weeks. ConclusionsThis study demonstrates a positive correlation between O3 exposure and PTB, and identified specific sensitive periods during pregnancy when the risk was higher.

Comparison of the feeding habits of breastfeeding and non-breastfeeding mothers and the sociodemographic factors influencing breastfeeding

Breastfeeding is the most ideal form of infant feeding, the biological norm that affects the mother's nutrition as well as certain sociodemographic factors. The aim of this research is to compare the nutritional habits of breastfeeding and non-breastfeeding mothers during the postpartum period, and to further examine the correlations of sociodemographic factors with breast milk feeding. Our quantitative, cross-sectional study was conducted between 26. 03. 2021 and 18. 07. 2021. During the non-random, targeted, expert sample selection, the target group included those biological mothers who raised at least one child born alive after the 37th gestational week in their own care. Exclusion criteria included adoption, pregnancy with the first child, inadequate completion of the mandatory questions, and reports of a congenital and/or acquired physical or mental illness that makes breastfeeding impossible. 2008 people met the inclusion and exclusion criteria. The survey was carried out anonymously via a self-filled questionnaire online. The statistical analysis was performed using the IBM SPSS 25 program, the significance level was determined at p<0.05. There was a significant difference between the group of breastfeeding mothers and non-breastfeeding mothers in terms of age (p<0.001), place of residence (p<0.001), marital status (p<0.001), education (p<0.001), income status (p<0.001), the number of children (p = 0.005), the method of delivery (p = 0.018), how many children completed the questionnaire (p = 0.021). Varied nutrition was characteristic in a significantly higher proportion during the postpartum period among breastfeeding mothers (p = 0.006). There was a relationship between the two groups in terms of energy intake (p = 0.002) and daily vitamin/mineral/trace element intake (p = 0.044). During the period of childbirth, breastfeeding mothers pay more attention to their nutrition than non-breastfeeding mothers. Breastfeeding can be significantly influenced by certain sociodemographic factors. Orv Hetil. 2023; 164(43): 1693-1700.

Evaluation of carotid artery Doppler measurements in late-onset fetal growth restriction: a cross-sectional study

Background/Aim: It has been reported that both the internal carotid artery (ICA) and the common carotid artery (CCA) are associated with hypoxia, also observed in late-onset fetal growth restriction (FGR). However, it has not yet been investigated whether these Doppler measurements differ in cases of late-onset FGR. This study evaluated the ICA and the CCA Doppler parameters in late-onset FGR fetuses and compared these measurements with those of healthy fetuses. Methods: This cross-sectional observational study comprised 75 singleton pregnancies diagnosed with late-onset FGR between the 32nd and 37th weeks of gestation, alongside 75 healthy fetuses paired 1:1 based on obstetric history and gestational age between June 2022 and May 2023. The Delphi consensus of 2016 was used for the definition of late-onset FGR. The exclusion criteria were congenital anomalies, presence of any additional disease, maternal body mass index over 35 kg/m2, abdominal scars hindering ultrasound visualization, use of medications such as antenatal steroids, sympathomimetics, and indomethacin that affect vascular function, drug use, smoking during pregnancy, concurrent preeclampsia, and multiple pregnancies. Upon the patients' admission to the hospital, their demographic characteristics were documented, and ultrasonographic examinations and Doppler measurements were subsequently performed. The Doppler velocimetry of the umbilical artery (UA) encompassed measurements of the systolic to diastolic ratio (S/D), pulsatility index (PI), and peak systolic velocity (PSV). The carotid artery Doppler velocimetry of the middle cerebral artery (MCA), ICA, and CCA encompassed measurements of the PI, resistance index (RI), and PSV. We assessed the diagnostic performance of Doppler measurements for late-onset FGR through receiver operating characteristic (ROC) analysis. Results: In the late-onset FGR group, the mean UA-SD was higher (2.7 [0.6] vs. 2.5 [0.5], P=0.006), and the mean UA-PI (0.8 [0.2] vs. 0.9 [0.2], P=0.011) and mean PSV (35.6 [8.2] vs. 41.1 [7.1], P&lt;0.001) were lower compared to the control group. In the late-onset FGR group, carotid Doppler measurements were more pronounced than UA Doppler measurements. Moreover, ICA Doppler measurements exhibited superior diagnostic performance in predicting late-onset FGR compared to other Doppler measurements (Area under the curve [AUC]=0.777, P&lt;0.001 for ICA-PI; AUC=0.751, P&lt;0.001 for ICA-RI; AUC=0.749, P&lt;0.001 for ICA-PSV). Conclusion: In fetuses with late-onset FGR, UA Doppler measurements showed minimal differences compared to healthy fetuses, but differences in carotid Doppler measurements, especially in the ICA, were more pronounced. Therefore, in the management of fetuses suspected of having late-onset FGR, a more detailed Doppler examination might be required.

Eradication of cervical canal colonization associated with prophylactic cervical cerclage: the look further study.

The perioperative management of the cervical cerclage procedure is not unified. In general population controlling microbiome cervical status does not affect obstetric outcomes, but it might be beneficial in patients with cervical insufficiency. The aim of our study was to present the obstetric, neonatal and pediatric outcomes of patients undergoing the cervical cerclage placement procedure in our obstetric department using a regimen of care that includes control of the microbiological status of the cervix and elimination of the pathogens detected. Thirty-five patients undergoing cervical cerclage in the 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, were included in the study. The procedure was performed only after receiving a negative culture from the cervical canal. Thirty-one (88.6%) patients delivered after the 34th and twenty-eight (80.0%) after the 37th week of gestation. The colonization of the genital tract was present in 31% of patients prior to the procedure, in 42% of patients - during the subsequent pregnancy course and in 48% of patients - before delivery. A total of 85% of patients who had miscarriage or delivered prematurely had abnormal cervical cultures. In patients with normal cervical cultures, and 91.7% of women delivered at term. No abnormalities in children's development were found. Controlling microbiological status of the cervical canal results in better or similar outcomes to those reported by other authors in terms of obstetric and neonatal outcomes. Active eradication of the reproductive tract colonization potentially increases the effectiveness of the cervical cerclage placement.

The prevalence of congenital anomalies: nationwide study in 2020 in Estonia

Objective To assess the prevalence of congenital anomalies (CAs), chromosomal abnormalities and monogenic diseases among births and terminated pregnancies due to fetal anomalies (TOPFA) in 2020 in Estonia. Up to 2020 no data on prevalence of CAs in Estonia is reported. Methods For retrospective observational study data of all births and terminations of pregnancies after 12th gestational week from (i) the Estonian Medical Birth Registry, (ii) Abortion Registy, (iii) Health Insurance Fund and (iv) hospital records were linked. To calculate the total, live birth, stillbirth and TOPFA prevalence of CAs with 95% confidence intervals (CI), guidelines issued by EUROCAT, European network for the epidemiological surveillance of CAs, https://eu-rd-platform.jrc.ec.europa.eu/eurocat_en were followed. Results In 2020 the total prevalence of CAs, chromosomal abnormalities and monogenic diseases in Estonia was 378.6 per 10,000 births (95% CI 346.0, 413.5). The most prevalent CAs were heart defects, 163.7 cases per 10,000 births (95%CI 142.5, 187.2). The prevalence of chromosomal abnormalities and genetic diseases was 92.6 per 10,000 births (95%CI 76.8, 110.6), 80% of cases were among TOPFAs. No newborns with major aneuploidies (Trisomy 21, 18, 13, polyploidy) were reported in 2020. Live birth prevalence of CAs, including chromosomal abnormalities and genetic diseases was 258.4 per 10,000 live births (95%CI 231.5, 287.5) and stillbirth prevalence of CAs 0.8 per 10,000 births. Conclusions The prevalence of CAs and genetic disorders in Estonia is one of the highest compared to prevalence reported by other European regions. It indicates to high population coverage with prenatal diagnostics in Estonia. Low number of major aneuploidies among live births may reflect good detection rate of major chromosomal abnormalities and cultural preferences.