Adverse Fetal Outcomes Research Articles

Adverse foetal outcomes in patients with increased risk of preterm preeclampsia in the first trimester of pregnancy: a prospective study

Adverse foetal outcomes in patients with increased risk of preterm preeclampsia in the first trimester of pregnancy: a prospective study

Utilizing Modified Coopland's Scoring System to Identify and Predict the Outcome of High-Risk Pregnancies in Resource-Limited Settings: A Retrospective Review.

Introduction A high-risk pregnancy is associated with adverse maternal and foetal outcomes. Women with high-risk pregnancies are at a greater risk of developing antepartum haemorrhage, miscarriages, and the need for surgical interventions. Neonatal complications include preterm births, low birth weight (LBW), intra-uterine deaths and an increased need for NICU admission. The utilisation of low-cost scoring tools for identifying high-risk women can aid in early diagnosis and timely implementation of therapeutic interventions. Objective The retrospective record-based study sought to calculate the proportion of high-risk pregnancies using modified Coopland's scoring system and compare the maternal and foetal outcomes among high-risk pregnancies. Methods The study retrospectively analysed the records of antenatal women in their third trimester from the years December 2018 to December 2021. Each record was then numerically assessed according to the modified Coopland's scoring system and categorised according to the risk status. Maternal and neonatal outcomes were then compared across the risk groups. Results The data included 300 cases over a three-year period.According to modifiedCoopland's scoring system, we found that the overall proportion of high-risk pregnancies was 18.3%. Adverse maternal and fetal outcomes were increased in high-risk pregnancy groups when compared to low-risk pregnancies, miscarriages (31.6% vs 15.8%) and antepartum haemorrhage (55.6% vs 11.1%). Babies born to high-risk mothers had a higher chance of developing LBW status (52.0%) and respiratory distress (45.5%) when compared to those born to low-risk mothers: 8.0% and 13.6%, respectively. Conclusion A notable portion of pregnant women were classified as high-risk using modified Coopland's scoring tool and would benefit from targeted obstetric care.

Lupus nephritis kidney biopsy characteristics and preterm birth.

Individuals with lupus nephritis (LN) are at high risk of adverse maternal and fetal outcomes in pregnancy. Outside of pregnancy, proliferative lesions on kidney biopsies are associated with disease progression, but these have not been consistently associated with increased risk in pregnancy. This retrospective, single-center study examines how histologic findings, the timing from kidney biopsy to pregnancy, and the clinical features in the first trimester are associated with preterm birth among individuals with LN. Among 35 deliveries in 31 women, the mean gestational age at delivery was 33.8 weeks. The presence of a urine protein-to-creatinine ratio >0.5 g/g in the first trimester was associated with preterm delivery (81% vs. 36%, p = 0.04). Preterm birth was more common in individuals with glomerular crescents on biopsy (89% in those with >20% crescents vs. 50% in those with <20%, p = 0.06). A pregnancy occurring within 2 years after a kidney biopsy was more likely to result in preterm birth than if the biopsy was performed more than 2 years prior to conception (82% vs. 23%, p = 0.01). The time from diagnostic biopsy may be a surrogate for disease activity, and a 2-year delay from biopsy might allow sufficient time to achieve disease remission. Overall, these data could aid family planning discussions and promote preconception disease optimization for patients and their providers.

Association between twin status with cognitive, behavioral development and brain structure in early adolescence: a retrospective cohort analysis based on the Adolescent Brain Cognitive Development Study.

Twin births are related with maternal and fetal adverse outcomes. Little was known about the comparability of the cognitive, behavioral development and brain structure between twins and singletons in early adolescence. This retrospective cohort study was based on data from the United States population-based, prospective, longitudinal observational Adolescent Brain Cognitive Development study. Children with complete twin status information were enrolled, and the exposure variable was twin status. Primary outcomes were cognitive, behavioral development and brain structure in early adolescence. Cognitive and behavioral outcomes were assessed by using the NIH Toolbox and Child Behavioral Checklist, respectively. Brain structure was evaluated by the cortical thickness, area, and volume extracted from the magnetic resonance imaging (MRI) data. Subgroup analyses were conducted by prematurity, birth weight, with sibling, genetic profiles, and twin types (zygosity). From 1st September 2016 to 15th November 2018, 11545 children (9477 singletons and 2068 twins) aged 9-10years were enrolled. Twins showed mildly lower cognitive performance (|t|> 5.104, P-values < 0.001, False Discovery Rate [FDR] < 0.001), better behavioral outcome (|t|> 2.441, P-values < 0.015, FDR < 0.042), such as lower scores for multiple psychiatric disorders and behavioral issues, and smaller cortical volume (t = - 3.854, P-values < 0.001, FDR < 0.001) and cortical area (t = - 3.872, P-values < 0.001, FDR < 0.001). The observed differences still held when stratified for prematurity, birth weight, presence of siblings, genetic profiles, and twin types (zygosity). Furthermore, analyses on the two-year follow-up data showed consistent results with baseline data. Twin status is associated with lower cognitive and better behavioral development in early adolescence accompanied by altered brain structure. Clinicians should be aware of the possible difference when generalizing results from adolescent twin samples to singletons.

Untangling the independent effect of endometriosis, adenomyosis, and ART-related factors on maternal, placental, fetal, and neonatal adverse outcomes: results from a systematic review and meta-analysis.

Women with endometriosis may constitute a group at a particularly increased risk of pregnancy-related complications. Furthermore, women selected for assisted reproductive technology (ART) are exposed to additional endocrinological and embryological factors that have been associated with adverse pregnancy outcomes. This study aimed to investigate the independent effect of endometriosis, adenomyosis, and various ART-related factors on adverse maternal, placental, fetal, and neonatal outcomes. Published randomized controlled trials, cohort studies, and case-control studies were considered eligible. PubMed, MEDLINE, ClinicalTrials.gov, Embase, and Scopus were systematically searched up to 1 March 2024. This systematic review and meta-analysis was performed in line with the PRISMA and the MOOSE reporting guidelines. To thoroughly investigate the association between endometriosis/adenomyosis and adverse pregnancy outcomes, sub-analyses were conducted, whenever possible, according to: the method of conception (i.e. ART and non-ART conception), the endometriosis stage/phenotype, the coexistence of endometriosis and adenomyosis, any pre-pregnancy surgical treatment of endometriosis, and the form of adenomyosis. The odds ratio (OR) with 95% CI was used as effect measure. The quality of evidence was assessed using the GRADE approach. We showed a higher risk of placenta previa in women with endometriosis compared to controls (34 studies, OR 2.84; 95% CI: 2.47, 3.26; I2 = 83%, moderate quality). The association was observed regardless of the method of conception and was particularly strong in the most severe forms of endometriosis (i.e. rASRM stage III-IV endometriosis and deep endometriosis (DE)) (OR 6.61; 95% CI: 2.08, 20.98; I2 = 66% and OR 14.54; 95% CI: 3.67, 57.67; I2 = 54%, respectively). We also showed an association, regardless of the method of conception, between endometriosis and: (i) preterm birth (PTB) (43 studies, OR 1.43; 95% CI: 1.32, 1.56; I2 = 89%, low quality) and (ii) cesarean section (29 studies, OR 1.52; 95% CI: 1.41, 1.63; I2 = 93%, low quality). The most severe forms of endometriosis were strongly associated with PTB. Two outcomes were associated with adenomyosis both in the main analysis and in the sub-analysis that included only ART pregnancies: (i) miscarriage (14 studies, OR 1.83; 95% CI: 1.53, 2.18; I2 = 72%, low quality) and (ii) pre-eclampsia (7 studies, OR 1.70; 95% CI: 1.16, 2.48; I2 = 77%, low quality). Regarding ART-related factors, the following associations were observed in the main analysis and confirmed in all sub-analyses conducted by pooling only risk estimates adjusted for covariates: (i) blastocyst stage embryo transfer (ET) and monozygotic twinning (28 studies, OR 2.05; 95% CI, 1.72, 2.45; I2 = 72%, low quality), (ii) frozen embryo transfer (FET) and (reduced risk of) small for gestational age (21 studies, OR 0.59; 95% CI, 0.57, 0.61; P < 0.00001; I2 = 17%, very low quality) and (increased risk of) large for gestational age (16 studies, OR 1.70; 95% CI, 1.60, 1.80; P < 0.00001; I2 = 55%, very low quality), (iii) artificial cycle (AC)-FET and pre-eclampsia (12 studies, OR 2.14; 95% CI: 1.91-2.39; I2 = 9%, low quality), PTB (21 studies, OR 1.24; 95% CI 1.15, 1.34; P < 0.0001; I2 = 50%, low quality), cesarean section (15 studies, OR 1.59; 95% CI 1.49, 1.70; P < 0.00001; I2 = 67%, very low quality) and post-partum hemorrhage (6 studies, OR 2.43; 95% CI 2.11, 2.81; P < 0.00001; I2 = 15%, very low quality). Severe endometriosis (i.e. rASRM stage III-IV endometriosis, DE) constitutes a considerable risk factor for placenta previa and PTB. Herein, we recommend against superimposing on this condition other exposure factors that have a strong association with the same obstetric adverse outcome or with different outcomes which, if coexisting, could determine the onset of an ominous obstetric syndrome. Specifically, we strongly discourage the use of AC regimens for FET in ovulatory women with rASRM stage III-IV endometriosis or DE. We also recommend single ET at the blastocyst stage in this high-risk population. CRD42023401428.

The severity of intrahepatic cholestasis during pregnancy increases risks of adverse outcomes beyond stillbirth: evidence from 15,826 patients

BackgroundWhat kinds of fetal adverse outcomes beyond stillbirth directly correlate to the severity of intrahepatic cholestasis during pregnancy (ICP) remained tangled. Herein, we conducted a retrospective cohort study and a dose-response meta-analysis to speculate the association between the severity of ICP and its adverse outcomes.MethodsWe retrospectively collected a cohort of ICP patients from electronic records from Guangzhou Women and Children’s Medical Center between Jan 1st, 2018, and Dec 31st, 2022. Also, we searched PubMed, Cochrane, Embase, Scopus, and Web of Science to extract prior studies for meta-analysis. The Kruskal-Wallis test, a one-way or two-way variants analysis (ANOVA), and multi-variant regression are utilized for cohort study. One stage model, restricted cubic spline analysis, and fixed-effect model are applied for dose-response meta-analysis. The data analysis was performed using the R programme.ResultsOur cohort included 1,289 pregnant individuals, including 385 mild ICP cases, 601 low moderate ICP cases, 282 high moderate ICP cases, and 21 severe ICP cases. The high moderate bile acid levels were correlated to preterm birth [RR = 2.14, 95%CI 1.27 to 3.62), P < 0.01], and preterm premature rupture of membranes [RR = 0.34, 95%CI 0.19 to 0.62), P < 0.01]. We added our cases to cases reported by other studies included in the meta-analysis. There were 15,826 patients included in dose-response meta-analysis. The severity of ICP was associated with increased risks of stillbirth, spontaneous preterm birth, iatrogenic preterm birth, preterm birth, admission to neonatal intensive care unit, and meconium-stained fluid (P < 0.05).ConclusionsOur study shows the correlation between the severity of ICP and the ascending risks of stillbirth, preterm birth, and meconium-stained fluid, providing new threshold TBA levels.Prospero registration numberCRD42023472634.

The effect of a digital intervention on symptoms of depression in pregnant women exposed to Intimate partner violence in Denmark and Spain (STOP study)

Introduction and objectiveIntimate Partner Violence (IPV) during pregnancy is a significant public health concern associated with adverse maternal and fetal health outcomes, including increased risk of depression. This study aimed to assess the effectiveness of a digital empowerment-based intervention in reducing symptoms of depression among IPV-exposed pregnant women. Study designThis intervention study was nested within a cohort study conducted in Denmark and Spain. Pregnant women attending antenatal care were digital screened for IPV using the Abuse Assessment Screen (AAS) and the Women’s Abuse Screening Tool (WAST). Those screening positive were offered a digital intervention comprising 3–6 video consultations with trained IPV counsellors and access to a safety planning app. Changes in depression scores from baseline to follow-up were evaluated using mixed model regression. ResultsFrom February 2021-October 2022, 1,545 pregnant women (9.6 %) screened positive for IPV within our population (8.5 % in Denmark and 17.0 % in Spain) with 485 (31.4 %) meeting the criteria for the intervention. Of those eligible, 104 (21.4 %) accepted the intervention, and 55 completed it (13.1 %). Post-intervention, a significant reduction in Edinburgh Postnatal Depression Scale (EPDS) was found, with a mean difference of −3.9 (95 % CI: −5.3; −2.4), compared to the average pre-intervention score of 11.3. Stratifying the analyses across sociodemographic variables did not alter the overall result, indicating a reduction in EPDS scores irrespective of setting or sociodemographic factors. Notably, the intervention was most effective for women initially presenting with EPDS scores above the depression cut-off. ConclusionThe findings suggest that a brief digital intervention is associated with a reduction in depression symptoms among pregnant women exposed to IPV, particularly among those with high depressive scores. This highlights the potential of digital interventions in delivering counseling and shows efficacy when administered by both midwives and psychologists in diverse settings. However, the absence of a control group underscores the need for caution in interpreting the results.

Lack of Serological Response by Delivery to Syphilis Treatment Does Not Impact Pregnancy Outcomes.

Objectives: Maternal syphilis can lead to serious adverse pregnancy outcomes, including neonatal death. A 4-fold decline in blood non-treponemal titer at six months after the treatment of syphilis compared to the baseline is considered as an adequate serological response. However, the duration of normal human gestation does not allow the ascertainment of an adequate serological response. Aim: The aim of this study was to assess correlations between the lack of a 4-fold decrease in non-treponemal titer by delivery after syphilis treatment and fetal and newborns' condition and serological outcomes. Methods: Fourteen pregnant patients (gestational age 16-22 weeks) diagnosed with early syphilis (secondary or latent) were treated with intramuscular benzathine penicillin and subsequently monitored clinically, serologically, and ultrasonographically at monthly intervals. Based on the non-treponemal test results at delivery, patients were stratified into two groups: those with a 4-fold decline in titers and those without such a decline. All newborns were clinically and serologically assessed for congenital syphilis at birth and then monitored until serological tests became negative. Results: Fifty percent of the included women did not achieve a 4-fold decline in non-treponemal titer by delivery. Patients from the group showing a 4-fold decline in RPR titer at delivery and those without such a decline did not differ in basic demographic and clinical characteristics or in ultrasound parameters used for fetal assessment. Based on the clinical and laboratory assessments of newborns on the day of delivery and during a 6-month follow-up, none were diagnosed with congenital syphilis or required treatment for syphilis. Conclusions: The lack of an adequate serological response to syphilis therapy by delivery among patients treated between 16 and 22 weeks of pregnancy does not appear to be associated with adverse fetal and neonatal outcomes.

ITRAQ proteomics analysis of placental tissue with gestational diabetes mellitus.

Gestational diabetes mellitus is an endocrine and metabolic disorder that appears for the first time during pregnancy and causes varying degrees of short- and/or long-term effects on the mother and child. The etiology of the disease is currently unknown and isobaric tags for relative and absolute quantitation proteomics approach, the present study attempted to identify potential proteins in placental tissues that may be involved in the pathogenesis of GDM and adverse foetal pregnancy outcomes. Pregnant women with GDM hospitalised were selected as the experimental group, and pregnant women with normal glucose metabolism as the control group. The iTRAQ protein quantification technology was used to screen the differentially expressed proteins between the GDM group and the normal control group, and the differentially expressed proteins were analysed by GO, KEGG, PPI, etc., and the key proteins were subsequently verified by western blot. Based on the proteomics of iTRAQ, we experimented with three different samples of placental tissues from GDM and normal pregnant women, and the total number of identified proteins were 5906, 5959, and 6017, respectively, which were similar in the three different samples, indicating that the results were reliable. Through the Wayne diagram, we found that the total number of proteins coexisting in the three groups was 4475, and 91 differential proteins that could meet the quantification criteria were strictly screened, of which 32 proteins were up-regulated and 59 proteins were down-regulated. By GO enrichment analysis, these differential proteins are widely distributed in extracellular membrane-bounded organelle, mainly in extracellular exosome, followed by intracellular vesicle, extracellular organelle. It not only undertakes protein binding, protein complex binding, macromolecular complex binding, but also involves molecular biological functions such as neutrophil degranulation, multicellular organismal process, developmental process, cellular component organization, secretion, regulated exocytosis. Through the analysis of the KEGG signaling pathway, it is found that these differential proteins are mainly involved in HIF-1 signaling pathway, Glycolysis/Gluconeogenesis, Central carbon metabolism in cancer, AMPK signaling pathway, Proteoglycans in cancer, Protein processing in endoplasmic reticulum, Thyroid cancer, Alcoholism, Glucagon signaling pathway. This preliminary study helps us to understand the changes in the placental proteome of GDM patients, and provides new insights into the pathophysiology of GDM.

P-448 Placental histopathology in frozen embryo transfer HRT induced IVF pregnancies and non-IVF pregnancies and its correlation with maternal and fetal outcomes: a prospective case-control study

Abstract Study question Is Placental histopathology altered in Frozen Embryo transfer, HRT induced IVF pregnancies when compared to non-IVF pregnancies; if yes,any implications on maternal and fetal outcome? Summary answer Pathological placental lesions and adverse maternal outcomes were found to be significantly higher in IVF pregnancies compared to non-IVF pregnancies. What is known already Studies on placental histopathology in IVF pregnancies suggest that there may be differences compared to naturally conceived pregnancies. Some research indicates an increased risk of certain placental abnormalities such as changes in vascularization and structure (Uroka Belak, et al., 2023). Additionally, alterations in gene expressions and epigenetic modifications in placenta have been observed in IVF pregnancies. However, it is essential to note that findings can vary, and more research is needed to fully understand the implications and potential long-term effects. Study design, size, duration Prospective, single centre, comparative clinical study, including 100 pregnancies between November, 2022 and November, 2023; 50 FET HRT induced IVF pregnancies, 50 non-IVF pregnancies. Participants/materials, setting, methods Patients aged 32-45 years, &amp;gt;34 weeks gestation, with no associated maternal and obstetrical complications were recruited after proper screening and informed consent. Among 100 pregnancies, we compared placental HPE using the Amsterdam Placental Workshop Group Consensus and feto-maternal outcomes between FET HRT induced IVF pregnancies and non-IVF pregnancies. We used Chi-square test to compare groups(p &amp;lt; 0.05). Main results and the role of chance Out of 100 participants, 50 were frozen embryo transfer, HRT induced IVF pregnancies and 50 were non-IVF pregnancies. Out of 50 IVF pregnancies; 27(54%) had pathological placental lesions, of which 17(63%) were noted to have adverse maternal outcomes and 6(22.2%) had adverse fetal outcomes. Out of 50 non-IVF pregnancies, 4(8%) had pathological placental lesions; of which 1(25%) were noted to have adverse maternal outcomes and 1(25%) had adverse fetal outcomes. On comparing these 2 groups, our result was found to be statistically significant(p &amp;lt; 0.05). Limitations, reasons for caution This study has some limitations owing to it being a single centered comparative trial, possibility of observer bias in histopathological examination and that the study is restricted to HRT induced IVF pregnancies. Wider implications of the findings This study reveals valuable insights into potential differences in placental and fetal development. Understanding these variances could influence clinical practices, patient counseling, and contribute to advancements in assisted reproductive technologies. Additionally, insights into long-term health outcomes for both mothers and babies may emerge, guiding future research and healthcare strategies. Trial registration number Not applicable

P-752 Association between obesity in women with multiple gestations and adverse obstetric outcomes: a study of an American population database with over 136,000 unique deliveries

Abstract Study question The purpose of this study is to compare obese and non-obese women with multiple pregnancies to determine the effects on pregnancy, delivery, and neonatal outcomes. Summary answer Obesity and multiple gestations are independent risk factors for adverse obstetric outcomes. Combined, obesity in multiple gestation increases risk of maternal, delivery, and neonatal complications. What is known already Obesity is a pandemic and multiple pregnancies are a known consequence of assisted reproductive technologies. Obese women (body mass index [BMI] &amp;gt;30kg/m2) are at higher risk of hypertensive disorders, gestational diabetes, fetal growth complications, stillbirth, preterm birth, labour complications, caesarean deliveries, wound infection, venous thromboembolism, and adverse neonatal outcomes. Multiple gestation is associated with greater obstetric risks, including miscarriage, preterm birth, gestational diabetes, hypertensive disorders, operative delivery, postpartum hemorrhage, congenital anomalies, and fetal growth restriction. The combined effects are not well-established. Study design, size, duration We conducted a retrospective population-based study utilizing data collected between 2004 and 2014 inclusively, from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. We evaluated deliveries using the international classification of diseases [ICD], ninth edition, clinical modification codes for delivery-related discharge diagnosis and birth-related procedural diagnosis. All women with a diagnosis of multiple pregnancies were selected. They were subsequently divided based on the ICD-9 code for obesity. A total of 137,303 multiple pregnancies were analyzed. Participants/materials, setting, methods Within the 137,303 multiple pregnancies, 130,542 (95%) were non-obese, while 6,761 (5%) were obese. An initial analysis was performed to identify the prevalence of obesity in women with multiple pregnancies. We then compared baseline clinical and demographic characteristics between women with obesity to those without obesity using chi-squared tests. Subsequently, binary logistic regression analyses were conducted to explore comparisons between the obese and non-obese groups while adjusting for the potential confounding effects. Main results and the role of chance Over the 11-year study period, there was a statistically significant increase in prevalence of obesity for women with multiple gestations (p &amp;lt; 0.0001). The obese group was at higher risk of pregnancy-induced hypertension (adjusted odd’s ratio [aOR]=1.89, 95% confidence interval [CI]=1.77-2.02), gestational hypertension (aOR=1.84, CI = 1.65-2.05), preeclampsia (aOR=1.68, CI = 1.55-1.81), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR=1.86, CI = 1.58-2.20), gestational diabetes mellitus (aOR=2.65, CI = 2.44-2.87), and placenta previa (aOR=0.57, CI = 0.39-0.85). They were more likely to have preterm premature rupture of membranes (aOR=1.19, CI = 1.06-1.34), chorioamnionitis (aOR=1.24, CI = 1.03-1.51), caesarean sections (aOR=1.28, CI = 1.18-1.38), wound complications (aOR=1.65, CI = 1.31-2.08), and transfusions (aOR=0.77, CI = 0.67-0.89). They were less likely to have small for gestational age neonates (aOR=0.88, CI = 0.79-0.97), though more likely to have neonates with congenital anomalies (aOR=1.56, CI = 1.16-2.10). Conversely, for certain factors, the outcomes were similar between obese and non-obese women with multiple gestation including rates of eclampsia (p = 0.07), abruptio placenta (p = 0.82), hysterectomy (p = 0.36), postpartum hemorrhage (p = 0.08), maternal death (p = 0.98), maternal infection (p = 0.10), deep vein thrombosis (p = 0.17), pulmonary embolism (p = 0.75), venous thromboembolism (p = 0.15), disseminated intravascular coagulation (p = 0.85) and intrauterine fetal demise (p = 0.52). Limitations, reasons for caution The database is retrospective and relies on hospitals reporting elevated body mass index, which may not always be consistently recognized, potentially resulting in an underestimation of the total number of obese women. However, this only stands to support the increased risks detected in this study as being legitimate. Wider implications of the findings We addresses a significant gap in the literature by simultaneously exploring the impacts of multiple pregnancies and maternal obesity on obstetric complications. This can guide clinical practice, encouraging single embryo transfer in obese women undergoing in-vitro fertilization and tailored care for obese patients with multiple pregnancies, anticipating the associated risks. Trial registration number not applicable

Comparison of intravenous bolus phenylephrine, ephedrine and mephentermine for maintenance of arterial blood pressure during spinal anaesthesia in caesarean section

Background: Subarachnoid block, although being highly efficient, often has limitation such as hypotension which can result in adverse maternal and fetal outcome, continues to be a matter of concern to the Anesthesiologist. The study was to compare the effect of phenylephrine, ephedrine and mephentermine, for maintenance of arterial pressure during spinal anaesthesia for caesarean section. Methodology: A prospective randomized double blinded study involving 90 patients with hypotension after subarachnoid block under spinal anesthesia was conducted, dividing them into three groups: P (Phenylephrine) 100 mcg, E (Ephedrine) 6 mg, and M (Mephentermine) 6 mg. Patients were compared based on age, weight, height, hemodynamic parameters, complications, and neonatal APGAR scores. Results: On inter-group comparison rise in systolic, diastolic and mean arterial blood pressure at 1,2,4 and 6min after drug administration were significantly high in phenylephrine group (p &lt;0.01) compared to ephedrine and mephentermine group. Thereafter the differences narrowed off. Heart rate was raised during episodes of hypotension. The mean heart rate was decreased significantly (p&lt;0.05) in phenylephrine group compared to other two groups. The neonatal APGAR score were &gt;/= 7 in the three groups at the 1st and 5th min. Conclusion: The study found that phenylephrine, ephedrine, and mephentermine effectively maintained arterial blood pressure in intravenous bolus form during subarachnoid block for caesarean section. Phenylephrine, a fast-acting, short-lived normotensive drug, significantly reduced heart rate compared to ephedrine and mephentermine, but did not cause significant adverse effects on mother and fetus. Keywords: hypotension; ephedrine; mephentermine; phenylephrine; subarachnoid block

Peripartum Cardiomyopathy: An Analysis of Clinical Profiles and Outcomes from a Tertiary Care Center in Northern India

Objective: The present study was conducted to evaluate the clinical profile, and risk factors of peripartum cardiomyopathy (PPCM) and its association with maternal and fetal outcomes from a tertiary care center in Northern India. Methods: An observational cohort study was conducted on 19 pregnant females showing features of heart failure in the last month of pregnancy or 5 months postpartum. We analyzed the clinical profiles and outcomes in these women with PPCM. Results: The mean age of presentation was 27.9 years with a mean gestational age of 34.9 weeks. 68.4% were primigravida. The most commonly associated comorbidities were anemia and preeclampsia/eclampsia. Breathlessness was present in all women with maximum presenting with class IV breathlessness. The mean baseline ejection fraction (EF) was 34%. A significant change (P &lt; 0.05) was observed in various echo parameters (left ventricular [LV] end diastolic volume; LV end systolic volume; LV strain; EF; right ventricular systolic excursion velocity; left atrial diameter) from baseline to 3 months. Maternal and fetal deaths occurred in 5.2% and 31.5% of subjects, respectively. Cardiogenic shock and significantly reduced EF were associated with adverse fetal and maternal outcomes. Conclusion: The majority of the study participants were young primigravidas with preeclampsia and anemia being strongly associated risk factors. PPCM with poor LVEF and shock is associated with adverse fetal and maternal outcomes. Larger studies with a higher number of patients are needed to study PPCM in detail in the Indian subset.

Adverse foetal outcomes in patients with increased risk of preterm preeclampsia in the first trimester of pregnancy: a prospective study

Adverse foetal outcomes in patients with increased risk of preterm preeclampsia in the first trimester of pregnancy: a prospective study

Height Adjusted Dose versus Height-Weight Adjusted Dose of Intrathecal Hyperbaric Bupivacaine for Caesarean Delivery for Preventing Maternal Hypotension: A Prospective, Double-Blinded, Randomized Controlled Study

Background: Spinal anesthesia for cesarean section is associated with significant hypotension due to sympathetic blockade and can cause adverse maternal and fetal outcomes. Although hypotension is considered to be dose-dependent, choosing a dose of bupivacaine to achieve an adequate level of blockade without causing hypotension is a challenge. Methods: Ninety-six eligible parturients posted for elective cesarean section under spinal anesthesia were divided into two groups. Group H received intrathecal bupivacaine dose calculated as per patients’ height and Group HW received intrathecal bupivacaine dose calculated as per patients’ height and weight chart. Heart rate and mean blood pressure were monitored in both groups. Time required to achieve sensory block up to T6, complete motor block, the dose of ephedrine required to treat hypotension, the incidence of complications, and neonatal appearance, pulse, grimace, activity, respiration (APGAR) scores were noted. Results: Hypotension occurred in 35.56% of parturients in Group H and 16.28% of parturients in Group HW, which was statistically significant. The mean dose of 0.5% bupivacaine was 9.12 mg in Group HW and 9.4 mg in Group H (P value = 0.02). The mean dose of Ephedrine was 12 ± 5.8 mg in Group H compared to 6.0 mg in Group HW, which was statistically significant. The time needed to achieve sensory and complete motor block were comparable in both groups. Conclusion: Height-weight-adjusted intrathecal hyperbaric bupivacaine achieved comparable sensory and motor block with lesser incidence and severity of hypotension compared to height-adjusted dose.

Comparison of a Two (32/38 Weeks) versus One (36 Weeks) Ultrasound Protocol for the Detection of Decreased Fetal Growth and Adverse Perinatal Outcome.

Third-trimester ultrasound has low sensitivity to small for gestational age (SGA) and adverse perinatal outcomes (APOs). The objective of this study was to compare, in terms of cost-effectiveness, two routine third-trimester surveillance protocols for the detection of SGA and evaluate the added value of a Doppler study for the prediction of APO. This was a retrospective observational study of low-risk pregnancies that were followed by a two growth scans protocol (P2) at 32 and 38 weeks or by a single growth scan at 36 weeks (P1). Ultrasound scans included an estimated fetal weight (EFW) in all cases and a Doppler evaluation in most cases. A total of 1011 pregnancies were collected, 528 with the P2 protocol and 483 with the P1 protocol. While the two models presented no differences for the detection of SGA in terms of sensitivity (47.89% vs. 50% p = 0.85) or specificity (94.97 vs. 95.86% p = 0.63), routine performance of two growth scans (P2) led to a 35% cost increase. The accuracy of EFW for the detection of SGA showed a noteworthy improvement when reducing the interval to labor, and the only parameter with predictive capacity of APO was the cerebroplacental ratio at 38 weeks. In low-risk pregnancies, the higher costs of a two-scan growth surveillance protocol at the third trimester are not justified by an increase in diagnostic effectivity.

Peripartum Torpor: A Chilling Case Report and Review of the Literature

Purpose: To report a rare case of peripartum maternal hypothermia and bradycardia. Methods: Case report. Results: Torpor is a transient state of hibernation with hypothermia and bradycardia. Hypothermia is defined as an abnormally low core body temperature less than 36°C.1 Sinus bradycardia is defined as less than 60 beats/min. While occasionally hypothermia or bradycardia is seen in obstetric patients undergoing vaginal delivery, when combined together, it can be a rare, life-threatening state that requires prompt intervention to prevent adverse maternal and fetal outcomes. A 23 year-old G2P0102 at 33+3 weeks of gestation was admitted to the high risk obstetric service for preterm labor complicated by fetal growth restriction. She had a history of preeclampsia in a previous pregnancy, but otherwise denied any chronic medical problems. Upon arrival, her vital signs showed a temperature of 37°C, a pulse of 53 bpm, and blood pressure of 126/62 mmHg. Her white blood cell count was 12.4 x 109/L and hemoglobin was 11.3 g/dL. She received betamethasone for fetal lung maturity and penicillin for Group B streptococcus prophylaxis. As her cervix continued to dilate, she received an epidural for pain management. Once she was in active labor, she became bradycardic with a pulse in the 30s-40s bpm, as confirmed by EKG. She was completely asymptomatic at this time, and fetal heart tones were reassuring with a baseline between 110’s-130’s bpm. She delivered vaginally with 150 mL of estimated blood loss, and her bradycardia continued postpartum even after the epidural was discontinued. When she complained of feeling cold, multiple attempts with different oral and axillary thermometers could not obtain a reading. She was warmed with forced-air warming blankets, warmed blankets, and hot packs in her groin and axilla. During this time, discussion with the NICU staff revealed that her baby was also hypothermic at 33.3°C and hypoglycemic at 28 mg/dL at birth. Other than feeling cold, the patient continued to be asymptomatic despite hypotension and bradycardia. She appeared somnolent but was responsive to questions. Her uterus was firm with minimal vaginal bleeding and no purulent or foul-smelling vaginal discharge. Repeat laboratory testing revealed a white blood count of 19 x 109/L and lactate was 3.3 mmol/L. Her comprehensive metabolic panel was unremarkable. A chest x-ray was clear. A C-reactive protein was &lt; 0.3 mg/dL and sedimentation rate was 14 mm/h. A rectal continuous thermometer was placed, which eventually recorded a temperature at 33.3°C and upon recheck was 31.7°C. A multidisciplinary team, including Anesthesia, Internal Medicine, and Neurology, evaluated the patient due to concern for a central nervous system insult. She received fluid resuscitation and broad-spectrum antibiotics for sepsis protocol. Due to the concern for potential septic shock, the decision was made to transport her to the Medical ICU for further management. As she was leaving Labor &amp; Delivery, her temperature had increased to 36.9°C and her pulse to 61. Thyroid studies the next day revealed a normal Free T4 of 1.00 ng/dL and a high thyroid stimulating hormone level of 9.55 uIU/mL. However, despite an extensive workup, no clear etiology of her hypothermia and bradycardia was identified. Intervention with fluids and application of forced-air warming system resolved the hypothermia in less than 6 hours without relapse. Antibiotics were discontinued after one day due to low suspicion for systemic infection. She remained vitally stable and was discharged on postpartum day 2 without further complications. Conclusions: Maternal hypothermia is relatively common during cesarean delivery; however, very few cases report maternal hypothermia during vaginal delivery. An English language literature search for maternal hypothermia during vaginal delivery yielded less than 10 case reports – few of which identified a cause of the hypothermia – and none of which reported simultaneous maternal bradycardia. While our case is a very rare presentation and the etiology is still unknown, it highlights the importance of prompt recognition of vital sign derangements in peripartum patients as well as multidisciplinary attention.

Ultrasonic convex array probe applied to increase success rate of external cephalic version without anesthesia

Objective: To explore the feasibility of using ultrasonic convex array probe compressing abdominal wall to increase success rate of external cephalic version (ECV) without anesthesia in full-term and near-term pregnancy. Methods: Totally 190 singleton and non-cephalic presentation pregnant women in 36-39+4 weeks of gestation performed ECV from April 2019 to August 2023 in the First Affiliated Hospital of Nanjing Medical University were analyzed. According to whether use the ultrasound probe compressing fetal breech or not, the pregnant women were divided into two groups: 81 cases in the probe-compressing group (including primipara 61 cases and multipara 20 cases) and 109 cases in the non-probe-compressing group(including primipara 72 cases and multipara 37 cases). Clinical data, ECV related factors and complications were analyzed and compared between the two groups. Results: (1) The overall success rate of ECV was 64.2% (122/190). There was no significant difference in the success rate of ECV between probe-compressing group and non-probe-compressing group [69.1% (56/81) vs 60.6% (66/109), χ2=1.490, P=0.222]. The total vaginal delivery rate after successful ECV was 81.1% (99/122), while 71.1% (54/76) in primipara and 97.8% (45/46) in multipara, respectively. (2) Compare to the non-probe-compressing group, the success rate of ECV in primipara was significantly higher in the probe-compressing group [45.8% (33/72) vs 70.5% (43/61)], but the gestational age was shorter and the height was higher in the probe-compressing group (all P<0.05). The success rate of ECV of multipara in the probe-compressing group (65.0%, 13/20) was lower than that in the non-probe-compressing group (89.2%, 33/37), but there was no significant difference between the two groups (P>0.05). (3) Multivariate logistic regression analysis showed that abdominal wall compressed by ultrasound probe (OR=2.601, 95%CI: 1.113-6.075; P=0.027) and amniotic fluid index (AFI; OR=1.010, 95%CI: 1.001-1.020; P=0.028) were positive factors for the successful rate of ECV in primipara pregnant women. (4) The main complication of ECV was transient fetal heart rate reduction (8.9%,17/190), the incidence in the probe-compressing group was significantly higher than that in the non-probe-compressing group [14.8% (12/81) vs 4.6% (5/109); χ2=5.967, P=0.015]. No statistical differences were found in rates of complications between the ECV successful and unsuccessful pregnant women, and between probe-compressing and non-probe-compressing groups (all P>0.05). No adverse maternal and neonatal outcomes related to ECV were observed. Conclusions: The ultrasonic convex array probe compressing could significantly improve the success rate of ECV in primipara without increasing the incidence of adverse maternal and fetal outcomes. The success rate of ECV in primipara is influenced by AFI and operation mode.

Prevalence, Determinants, and Antibiotic Resistance Patterns of Urinary Tract Infections in Antenatal Women in an Urban Resettlement Colony and Slum in Delhi, India: A Cross-sectional Study

Abstract Background: Urinary tract infection (UTI) is the most common bacterial infection occurring in pregnant women with untreated, recurrent, and inadequately treated bacteriuria accentuating the risk of multiple adverse fetal and maternal health outcomes. The study objective was to determine the proportion of UTIs and their predictors along with antibiotic resistance patterns of causative organisms in pregnant women. Materials and Methods: This cross-sectional study was conducted among 348 pregnant women in an urban resettlement and slum colony. Urine samples were examined through semi-quantitative culture on plated Mac Conkey and blood agar. Antibiotic susceptibility testing was done on Muller Hinton agar using the modified Stokes’ disc diffusion method. Results: At least one symptom related to UTI was reported by 35.7% (95% CI: 30.7-41.1) of the participants. The proportion of pregnant women detected having UTI on urine culture was 7.4% (n = 24, 95% CI: 5.1-10.8) with 13 (54.2%) asymptomatic and 11 (45.8%) symptomatic cases. Overcrowding was a significant predictor of UTI. The most common organisms detected were Escherichia coli (n = 12), Klebsiella pneumoniae (n = 7), Staphylococcus aureus (n = 3), and Acinetobacter species (n = 2). Conclusions: The use of individual toilets and active screening for UTI through culture and sensitivity testing in pregnant women should be promoted in low-resource settings irrespective of symptoms. The initiation of presumptive antibiotic therapy for UTI cases in pregnant women should be restricted to painful micturition due to high false positivity of other symptoms with Nitrofurantoin being a likely preferred drug for empirical administration due to its low resistance pattern among isolated organisms.

Cargo exchange between human and bacterial extracellular vesicles in gestational tissues: a new paradigm in communication and immune development

Host-bacteria and bacteria-bacteria interactions can be facilitated by extracellular vesicles (EVs) secreted by both human and bacterial cells. Human and bacterial EVs (BEVs) propagate and transfer immunogenic cargos that may elicit immune responses in nearby or distant recipient cells/tissues. Hence, direct colonization of tissues by bacterial cells is not required for immunogenic stimulation. This phenomenon is important in the feto-maternal interface, where optimum tolerance between the mother and fetus is required for a successful pregnancy. Though the intrauterine cavity is widely considered sterile, BEVs from diverse sources have been identified in the placenta and amniotic cavity. These BEVs can be internalized by human cells, which may help them evade host immune surveillance. Though it appears logical, whether bacterial cells internalize human EVs or human EV cargo is yet to be determined. However, the presence of BEVs in placental tissues or amniotic cavity is believed to trigger a low-grade immune response that primes the fetal immune system for ex-utero survival, but is insufficient to disrupt the progression of pregnancy or cause immune intolerance required for adverse pregnancy events. Nevertheless, the exchange of bioactive cargos between human and BEVs, and the mechanical underpinnings and health implications of such interactions, especially during pregnancy, are still understudied. Therefore, while focusing on the feto-maternal interface, we discussed how human cells take up BEVs and whether bacterial cells take up human EVs or their cargo, the exchange of cargos between human and BEVs, host cell (feto-maternal) inflammatory responses to BEV immunogenic stimulation, and associations of these interactions with fetal immune priming and adverse reproductive outcomes such as preeclampsia and preterm birth.