Antenatal Management Research Articles

573 Does the addition of MRI in antenatal management of suspected PAS impact maternal surgical outcome?

573 Does the addition of MRI in antenatal management of suspected PAS impact maternal surgical outcome?

A multivariable prediction model for intra-amniotic infection in patients with preterm labor and intact membranes including a point of care system that measures amniotic fluid MMP-8.

Among patients with preterm labor and intact membranes (PTL), those with intra-amniotic infection (IAI) present the highest risk of adverse perinatal outcomes. Current identification of IAI, based on microbiological cultures and/or polymerase chain reaction amplification of the 16S ribosomal RNA gene, delay diagnosis and, consequently, antenatal management. The aim to of the study was to assess the performance of a multivariable prediction model for diagnosing IAI in patients with PTL below 34.0weeks using clinical, sonographic and biochemical biomarkers. From 2019 to 2022, we prospectively included pregnant patients admitted below 34.0weeks with diagnosis of PTL and had undergone amniocentesis to rule in/out IAI. The main outcome was IAI, defined by a positive culture and/or 16S ribosomal RNA gene in amniotic fluid. Based on the date of admission, the sample (n=98) was divided into a derivation (2019-2020, n=49) and validation cohort (2021-2022, n=49). Logistic regression models were developed for the outcomes evaluated. As predictive variables we explored ultrasound cervical length measurement at admission, maternal C-reactive protein, gestational age, and amniotic fluid glucose and matrix metalloproteinase-8 (MMP-8) levels. The model was developed in the derivation cohort and applied to the validation cohort and diagnostic performance was evaluated. Clinical management was blinded to the model results. During the study period, we included 98 patients admitted with a diagnosis of PTL. Of these, 10 % had IAI. The final model included MMP-8 and amniotic fluid glucose levels and showed an area under the receiver operating characteristic curve to predict the risk of IAI of 0.961 (95 % confidence interval: 0.860-0.995) with a sensitivity of 75 %, specificity of 93.3 %, positive likelihood ratio (LR) of 11.3 and negative LR of 0.27 in the validation cohort. In patients with PTL, a multivariable prediction model including amniotic fluid MMP-8 and glucose levels might help in the clinical management of patients undergoing amniocentesis to rule in/out IAI, providing results within a few minutes.

Antenatal care management platform

BackgroundPregnancy is a process of developing a fetus in a woman’s womb leading to anatomical and physiological changes. Currently, numerous health facilities offering antenatal services are yet to adopt health informatics. This led to several challenges, including unskilled, early and poor quality antenatal and delivery care, case traffic because many patients are admitted per day, and shy medical professional doctors, nurses, midwives and nursing aids. The main idea of this project was to design and develop a new system for managing maternal health in antenatal care.MethodsThis web-based antenatal care management platform is designed using XAMPP, PHP, HTML and CSS. It involves designing the stoner interface and identifying the inputs, outputs, and processes of the designed system. The configuration involves the use of case diagrams, sequence diagrams and class diagram tools to achieve the physical consummation of the antenatal care management platform and positive living information system. The purpose of this work was to create a web-based platform for managing antenatal care.ResultsThe designed project was tested by using parameters such as WHO guidelines, security, user-friendliness and data storage. Three testing criteria, namely, unit testing, integration testing and system testing, were used to check the efficiency and effectiveness of the antenatal care management platform (ANCMP). The platform that was created met almost all of the criteria that were set out in the design.ConclusionThis project is objectively targeted to develop a web-based antenatal care management system to overcome the complications that occur during and following gestation.It controls the overall conditioning of antenatal care, which includes the enrollment of expectant mothers, shadowing of the listed day and reminding them via email and effectively recording and saving all medical information about the mothers.

Fetoscopic endoluminal tracheal occlusion vs expectant management for fetuses with severe left-sided congenital diaphragmatic hernia

BackgroundThe therapy of fetuses with congenital diaphragmatic hernia (CDH) is challenging, but there is evidence that fetoscopic endoluminal tracheal occlusion (FETO) has a benefit over expectant care. Additionally, standardisation and expertism have a great impact on survival, probably the key of centers relying on expectant management and extracorporeal membrane oxygenation (ECMO) after birth. ObjectiveTo examine the survival and morbidity rates of fetuses with severe isolated left-sided CDH (LCDH) who underwent FETO versus expectant management in high-volume centers. Study DesignThis was a multicenter retrospective study including all consecutive fetuses with severe isolated LCDH who were expectantly managed in a German center or underwent FETO in three other European centers (Belgium, France and Italy). Severe CDH was defined as observed-expected total fetal lung volume (o/e TFLV) ≤35% with intrathoracic position of the liver, using magnetic resonance images (MRI). All MRI were centralized and lung volumes were measured by two experienced operators, who were blinded to the pre- and postnatal data. Multiple logistic regression analyses were performed to examine the effect of the management in the two groups on the short- and long-term outcomes. Results147 patients with expectant management and 47 patients who underwent FETO were analyzed. Fetuses who were expectantly managed had lower o/e TFLV (20.6% ± 7.5% versus 23.7% ± 6.8%, p=0.013), higher gestational age at delivery (median weeks of gestation: 37.4 [IQR: 36.6, 38.00] versus 35.1 [IQR: 33.1, 37.2], p<0.001) and a more frequent use of ECMO (55.8% versus 4.3%, p<0.001) in comparison to the fetuses who underwent FETO. The survival rates at discharge and at two years of age of the expectant management group were higher compared to the survival rates of the FETO group (74.3% versus 44.7%, p=0.001 and 72.8% versus 42.5%, p=0.001, respectively). After adjustment for maternal age, gestational age at birth, o/e TFLV and birthweight Z-score, the odds ratios were 4.65 (95%CI: 1.9-11.9, p=0.001) and 4.37 (95%CI: 1.8-11.0, p=0.001) respectively. The morbidity was comparable between both groups. ConclusionFetuses with severe isolated LCDH had a higher survival rate when treated in an experienced center in Germany with an antenatal expectant management and frequent use of ECMO during the postnatal period in comparison to fetuses treated with FETO in 3 centers in Belgium, France and Italy, without the expense of higher morbidity.

Cardiovascular disease in pregnancy and its outcome: A prospective study.

Prevalence estimates place maternal heart illness anywhere from 0.3 to 3.5 percent. Up to 20.5% of all maternal deaths of non-obstetrical cause are attributable to cardiovascular disease. The aim of the study was the management of patients with the multidisciplinary approach to maternal cardiovascular disease and its influence on maternal and fetal outcomes in a tertiary care centre. 1. To find out the prevalence and spectrum of heart disease in Pregnancy. 2. To find out the outcome of pregnancy with heart disease in a tertiary care centre. This prospective study of one year was done on pregnant with heart disease coming to the Obstetrics and Gynaecology department in collaboration with the cardiology department of IGIMS, Patna. A study was done on 65 pregnant with heart disease between the age group 20 to 35 years were compared to a control group of 65 pregnant women who were hospitalised during the same time period but did not have heart disease. All the pregnant women with heart disease were included in this study. Patients with medical disorders like Kidney disease, Liver disease, Pulmonary Disease, Diabetes Mellitus were excluded from the study. We used IBM's SPSS v23 to analyse the collected data. Prevalence of heart disease in pregnancy was 5.8% in present study and mostly of RHD (62.5%), followed by corrected CHD (12.5%) and CHD (10.9%). Patients of NYHA Class I and II (58.5%), Class III (26.2%), and Class IV (15.4%). The mitral valve was most often impacted by RHD (35.3% of all cases), followed by the tricuspid valve (15.0%). Eight (1.1%) people had cardiac surgery for therapeutic reasons. Six percent of all corrective surgeries included closing an atrial septal defect (ASD). The most common kind of congenital abnormality was a ventricular septal defect (VSD, 3%), followed by atrial septal defect (ASD, 1.5%) and pulmonary ductal atresia (PDA, 1.5%). Patients with heart disease had a higher rate of MTP, emergency LSCS and instrumental births than the controls. Deaths during pregnancy were 4 (6.2%) with cardiac disease and no maternal mortality in control group and all belonged to NYHA Class 4 were anaemic. In patients with a left ventricular ejection fraction of 45% or below, death was high. Two women died intrapartum from RHD, and two died postpartum from Peripartum cardiomyopathy. There were significantly more incidences of low-birth-weight infants (36.4%) compared to the control group (p = 0.001). Cases had a statistically significant greater frequency of obstetric problems, as well as an increased risk of developing anaemia, hypertension, hypothyroidism, cholestasis, FGR, and GDM (p-value 0.017). Multiparity, severe valvular lesion, NYHA function class III or IV, arrhythmia, and low ejection fraction were associated with poor maternal outcome in the current study. Maternal morbidity and mortality due to heart disease can be reduced appreciably by antenatal care, early diagnosis, and management with the help of cardiologists and surgery in selected cases.

BabyNet＋＋: Fetal birth weight prediction using biometry multimodal data acquired less than 24 hours before delivery

Accurate prediction of fetal weight at birth is essential for effective perinatal care, particularly in the context of antenatal management, which involves determining the timing and mode of delivery. The current standard of care involves performing a prenatal ultrasound 24 hours prior to delivery. However, this task presents challenges as it requires acquiring high-quality images, which becomes difficult during advanced pregnancy due to the lack of amniotic fluid. In this paper, we present a novel method that automatically predicts fetal birth weight by using fetal ultrasound video scans and clinical data. Our proposed method is based on a Transformer-based approach that combines a Residual Transformer Module with a Dynamic Affine Feature Map Transform. This method leverages tabular clinical data to evaluate 2D+t spatio-temporal features in fetal ultrasound video scans. Development and evaluation were carried out on a clinical set comprising 582 2D fetal ultrasound videos and clinical records of pregnancies from 194 patients performed less than 24 hours before delivery. Our results show that our method outperforms several state-of-the-art automatic methods and estimates fetal birth weight with an accuracy comparable to human experts. Hence, automatic measurements obtained by our method can reduce the risk of errors inherent in manual measurements. Observer studies suggest that our approach may be used as an aid for less experienced clinicians to predict fetal birth weight before delivery, optimizing perinatal care regardless of the available expertise.

Effects of modulator therapies on endocrine complications in adults with cystic fibrosis: a narrative review.

Cystic fibrosis is a monogenic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein, which transports chloride ions in secretory organs. Modulator therapies are small molecules that correct CFTR dysfunction and can lead to a wide range of benefits for both pulmonary and extrapulmonary complications of cystic fibrosis. With advancements in airway, antimicrobial and nutritional therapies and now introduction of modulator therapies, most people living with cystic fibrosis in Australia are now adults. For adults with cystic fibrosis, endocrine manifestations such as cystic fibrosis-related diabetes, metabolic bone disease, and reproductive health are becoming increasingly important, and emerging evidence on the endocrine effects of CFTR modulator therapies is promising and is shifting paradigms in our understanding and management of these conditions. The management of cystic fibrosis-related diabetes will likely need to pivot for high responders to modulator therapy with dietary adaptions and potential use of medications traditionally reserved for adults with type 2 diabetes, but evidence to support changing clinical care needs is currently lacking. Increased attention to diabetes-related complications screening will also be required. Increased exercise capacity due to improved lung function, nutrition and potentially direct modulator effect may have a positive impact on cystic fibrosis-related bone disease, but supporting evidence to date is limited. Fertility can improve in women with cystic fibrosis taking modulator therapy. This has important implications for pregnancy and lactation, but evidence is lacking to guide pre-conception and antenatal management. Provision of multidisciplinary clinical care remains ever-important to ensure the emergence of endocrine and metabolic complications are optimised in adults with cystic fibrosis.

Tocolysis after preterm prelabor rupture of membranes and 5-year outcomes: a population-based cohort study

The administration of tocolytics after preterm prelabor rupture of membranes remains a controversial practice. In theory, reducing uterine contractility should delay delivery and allow for optimal antenatal management, thereby reducing the risks for prematurity and adverse consequences over the life course. However, tocolysis may be associated with neonatal death or long-term adverse neurodevelopmental outcomes, mainly related to prolonged fetal exposure to intrauterine infection or inflammation. In a previous study, we showed that tocolysis administration was not associated with short-term benefits. There are currently no data available to evaluate the impact of tocolysis on neurodevelopmental outcomes in school-aged children born prematurely in this clinical setting. This study aimed to investigate whether tocolysis administered after preterm prelabor rupture of membranes is associated with neurodevelopmental outcomes at 5.5 years of age. We used data from a prospective, population-based cohort study of preterm births recruited in 2011 (referred to as the EPIPAGE-2 study) and for whom the results of a comprehensive medical and neurodevelopmental assessment of the infant at age 5.5 years were available. We included pregnant individuals with preterm prelabor rupture of membranes at 24 to 32 weeks' gestation in singleton pregnancies with a live fetus at the time of rupture, birth at 24 to 34 weeks' gestation, and participation of the infant in an assessment at 5.5 years of age. Exposure was the administration of any tocolytic treatment after preterm prelabor rupture of membranes. The main outcome was survival without moderate to severe neurodevelopmental disabilities at 5.5 years of age. Secondary outcomes included survival without any neurodevelopmental disabilities, cerebral palsy, full-scale intelligence quotient, developmental coordination disorders, and behavioral difficulties. A propensity-score analysis was used to minimize the indication bias in the estimation of the treatment effect on outcomes. Overall, 596 of 803 pregnant individuals (73.4%) received tocolytics after preterm prelabor rupture of membranes. At the 5.5-year follow-up, 82.7% and 82.5% of the children in the tocolysis and no tocolysis groups, respectively, were alive without moderate to severe neurodevelopmental disabilities; 52.7% and 51.1%, respectively, were alive without any neurodevelopmental disabilities. After applying multiple imputations and inverse probability of treatment weighting, we found no association between the exposure to tocolytics and survival without moderate to severe neurodevelopmental disabilities (odds ratio, 0.93; 95% confidence interval, 0.55-1.60), survival without any neurodevelopmental disabilities (odds ratio, 1.02; 95% confidence interval, 0.65-1.61), or any of the other outcomes. There was no difference in the neurodevelopmental outcomes at age 5.5 years among children with and without antenatal exposure to tocolysis after preterm prelabor rupture of membranes. To date, the health benefits of tocolytics remain unproven, both in the short- and long-term.

EP21.27: Peculiarities of antenatal diagnosis and management of aneuploidies with the exclusion of Trisomy 21

EP21.27: Peculiarities of antenatal diagnosis and management of aneuploidies with the exclusion of Trisomy 21

Scinтigraphy in Children with Urinary Tract Dilatation (Antenatally Detected Hydronephrosis)

The causes of Antenatal Hydronephrosis/Urinary Tract Dilatation (ANH/UTD) vary from transient benign conditions-transit hydronephrosis, (resolves by birth or during infancy) to conditions that can significantly affect renal function. The outcome of depends on the underlying etiology, so it is very important to determine these causes. The definition and grading of ANH is based on the Anteroposterior Pelvic Diameter (APD) of the fetal renal pelvis. Antenatal management includes antenatal ultrasound monitoring, which is usually repeated every 4-6 weeks. It is recommended that the assessment of the severity of postnatal hydronephrosis is based on the APD of the renal pelvis. Extensive postnatal investigation was proposed to be limited to those with moderate or severe dilatation. Voiding cystourethrography and scintigraphy are usually preserved for children with postnatal APD &lt;15 mm and/or abnormal kidney parenchyma, severe caliyx dilatation ureteral dilatation and bladder pathology. Diuretic renal scintigraphy is important in the postnatal evaluation of infants with ANH, particularly in distinguishing kidneys with poor drainage from nonobstructive hydronephrosis with good drainage. According to our diuretic renography results, we conclude that in the presence of partial or no drainage, the separate renal function may not be significantly impaired. The finding of poor renal emptying is significantly more common among children with increasing renal pelvis APD. Technetium 99m-dimercaptosuccinic acid renal scintigraphy (99mTc-DMSA) has been used in renal imaging to estimate the functional renal mass (damage to the kidney) and relative renal function, especially in pediatric patients. A statistically significant correlation between the degree of hydronephrosis (APD) and DMSA scan finding and between the degree of the VUR and DMSA scan finding was established. Other than VUR, CAKUT (pelvic ureteric junction obstruction, pyelon et ureter duplex, megaureter, posterior urethra valves) were not statistically correlated with pathological findings on the DMSA scan.

Risk factors for stillbirth at term: an Italian area-based, prospective cohort study

Stillbirth at term has great emotional impact on both parents and professionals. In developed countries, efforts to identify risk factors are mandatory to plan area-specific prevention strategies. The aim of the study was to identify independent risk factors that contribute to stillbirth at 37 weeks' gestation or later. This was an area-based, prospective cohort study on pregnancy at term with enrolled from 2014 to 2021 in Emilia-Romagna, a north Italian region. Data were retrieved from both birth certificates and the Stillbirth Surveillance system database. To identify independent risk factors, a multivariate analysis using logistic regression was performed. A descriptive analysis of the causes of stillbirth is also reported. In the observation period, 246,437 babies born at term (including 260 stillbirths, giving a rate of 1.06/1000) were considered. The risk factors independently associated with stillbirth were small for gestational age babies (odds ratio, 2.58; 95% confidence interval, 1.88-3.53), pregnancy achieved though fertility treatments (odds ratio, 2.01; 95% confidence interval, 1.15-3.51), and delayed access to pregnancy services (odds ratio, 1.56; 95% confidence interval, 1.10-2.22). In multipara, the presence of a previous stillbirth (odds ratio, 3.91; 95% confidence interval, 1.98-7.72) was also associated with an increased risk for recurrence. Early- rather than late-term was an additional risk factor. The most frequent causes of death were placental and cord disorders (61/260 and 56/260, respectively). However, 28.1% of cases remain unexplained. The risks for stillbirth at term are known early in pregnancy or could be identified through tailored antenatal management, allowing effective preventive strategies to reduce preventable cases.

Fetal Abdominal Cyst as a Stage of Meconium Peritonitis after Fetoscopic Laser Photocoagulation

AbstractFetal meconium peritonitis (FMP) is a rare form of sterile chemical peritonitis occurring in utero due to the perforation of the fetal intestine, sometimes after fetoscopic laser photocoagulation (FLP) in twin-to-twin transfusion syndrome, with the broad spectrum of prenatal ultrasound manifestations including abdominal cyst. We report a unique presentation of FMP following FLP with ascites, pseudocyst formation, and the cyst resolving probably of a fistula formation. This case report highlights unusual FMP development and gives a novel clue to antenatal diagnosis and management.

Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families.

Congenital anomalies of the kidney and urinary tract are collectively one of the most commonly diagnosed antenatal conditions. Clinicians have several tools available to diagnose anomalies, including imaging, biomarkers, family history and genetic studies. In certain cases, antenatal interventions such as vesico-amniotic shunting may be considered to improve postnatal outcomes.Congenital kidney anomalies detected antenatally can vary in clinical significance from almost no impact postnatally to significant morbidity and perinatal mortality. Prognosis broadly depends on kidney size, structure and amount of amniotic fluid, alongside genetics and family history, and progression on subsequent scans. It is important to counsel parents appropriately using a parent-focused and personalised approach. The use of a multidisciplinary team should always be considered.

The role of maternal age on adverse pregnancy outcomes among primiparous women with singleton birth: a retrospective cohort study in urban areas of China

Background Both young and advanced maternal age pregnancies have strong associations with adverse pregnancy outcomes; however, there is limited understanding of how these associations present in an urban environment in China. This study aimed to analyze the associations between maternal age and pregnancy outcomes among Chinese urban women. Methods We performed a population-based study consisting of 60,209 singleton pregnancies of primiparous women whose newborns were delivered after 20 weeks’ gestation between January 2012 and December 2015 in urban areas of China. Participants were divided into six groups (19 or younger, 20–24, 25–29, 30–34, 35–39, 40 or older). Pregnancy outcomes include gestational diabetes mellitus (GDM), preeclampsia, placental abruption, placenta previa, premature rupture of membrane (PROM), postpartum hemorrhage, preterm birth, low birthweight, small for gestational age (SGA), large for gestational age (LGA), fetal distress, congenital microtia, and fetal death. Logistic regression models were used to assess the role of maternal age on the risk of adverse pregnancy outcomes with women aged 25–29 years as the reference group. Results The risks of GDM, preeclampsia, placenta previa, and postpartum hemorrhage were decreased for women at a young maternal age and increased for women with advanced maternal age. Both young and advanced maternal age increased the risk of preterm birth and low birthweight. Young maternal age was also associated with increased risk of SGA (aOR 1.64, 95% CI 1.46–1.83) and fetal death (aOR 2.08, 95% CI 1.35–3.20). Maternal age over 40 years elevated the odds of placental abruption (aOR 3.44, 95% CI 1.47–8.03), LGA (aOR 1.47, 95% CI 1.09–1.98), fetal death (aOR 2.67, 95% CI 1.16–6.14), and congenital microtia (aOR 13.92, 95% CI 3.91–49.57). There were positive linear associations between maternal age and GDM, preeclampsia, placental abruption, placenta previa, PROM, postpartum hemorrhage, preterm birth, LGA and fetal distress (all P for linear trend < .05), and a negative linear association between maternal age and SGA (P for linear trend < .001). The analysis of the associations between maternal age and adverse fetal outcomes showed U-shape for preterm birth, low birth weight, SGA, fetal death and congenital microtia (all P for quadratic trend < .001). Conclusions Advanced maternal age predisposes women to adverse obstetric outcomes. Young maternal age manifests a bidirectional effect on adverse pregnancy outcomes. The findings may contribute to improving women’s antenatal care and management.

Hyperechogenic fetal bowel: Current evidence-based prenatal diagnosis and management.

Echogenic fetal bowel (EB) is a prenatal ultrasound finding (0.2%-1.4% of all pregnancies) defined as bowel of similar or greater echogenicity than surrounding bone. In fact, the ultrasound assessment is strongly subjective with inter-observer variability. The pathophysiology depends on the underlying condition, apparently related with meconium stasis and hypercellularity. It is often an isolated finding, with possible association with other structural anomalies. About the origin, it was observed in fetuses with cystic fibrosis, congenital infections, thalassemia, intraamniotic bleeding, fetal growth restriction. Fetuses with EB are at increased risk of adverse perinatal outcome, such as intrauterine growth restriction, placental dysfunction and perinatal death, highlighting the need for a thorough antenatal management and post-natal follow-up. It seems to be associated with a plenty of conditions, such as a poor fetal outcome, fetal growth restriction and placental dysfunction. Therefore management requires a multidisciplinary approach with different specialties' involvement and the prognosis is influenced by the underlying pathophysiology. In this complex scenario, the present review aims to define the clinical pathway which should be offered to pregnant women in case of finding of fetal EB ultrasound marker, to rule out any suspected pathological cause.

Antenatal Diagnosis and Management of Fetal Intestinal Volvulus: Case Series and Literature Review.

Fetal intestinal volvulus is a rare condition that can lead to hemorrhage, bowel necrosis, and urgent surgical treatment after birth. Thus, prompt diagnosis and treatment are essential to avoiding fetal or neonatal demise. Prenatal ultrasound is a keystone tool in the diagnostic course. However, sonographic findings tend to be non-specific, with limited understanding of the pathophysiology behind their atypical presentation. With a literature review and a case series, we aim to optimize the antenatal diagnosis and management of this rare but life-threatening condition. Six cases from our institution were retrospectively analyzed over 12 years. A literature review was conducted until December 2022. A total of 300 articles matched the keyword "Fetal volvulus", and 52 studies were eligible for the review. Our 6 cases are added to the 107 cases reported in the literature of fetal intestinal volvulus with antenatal ultrasound assessment and without associated gastroschisis or omphalocele. Several prenatal symptoms and ultrasound markers, even if not specific, were more frequently reported. Different experiences of management were described regarding follow-up, the timing of delivery, the mode of delivery, and surgery outcomes. This paper highlights the importance of suspecting and assessing fetal volvulus at routine ultrasound scans, describing the most frequent antenatal presentations and management in order to improve fetal and neonatal outcomes.

Why do Women Use Midazolam in the Third Stage of Labor? An Exploratory Study

Aims: The aims of this study were to report women’s reasons for using midazolam in the third stage of labor after the delivery of the fetal head, and report their knowledge of, attitudes toward, and satisfaction with its use.&#x0D; Methods and Materials: This prospective study was conducted between November 1, 2019 and November 1, 2020. Inclusion criteria were age 18 years or more, admitted into labor or for induction of labor, and having knowledge of midazolam. The women’s reasons, knowledge, attitudes, perceptions, and satisfaction were recorded and analyzed.&#x0D; Results: We recruited 200 women, mean age 29.4 years, 61% of whom knew about midazolam. Their reasons for choosing to have midazolam were relief of pain associated with the delivery of the fetal head, fear of delivery of the fetal head, and a desire to forget delivery details in 74%, 15%, and 11%, respectively. The factors that correlated positively with the women’s reasons for choosing midazolam included younger age, higher parity, and source of information due to being used in previous deliveries (all p-values were &lt;0.05). Satisfaction was high in 88.5% of women. The factors that correlated positively with higher satisfaction included the women’s positive feeling about not recalling delivery details, and positive attitude toward the use of midazolam (all p-values were &lt;0.05).&#x0D; Conclusion: The women chose to have midazolam for relief of pain associated with the delivery of the fetal head, fear of delivery of the fetal head, or a desire to forget delivery details. This reflects deficiencies in antenatal pain management counseling and the presence of barriers against the use of epidural analgesia.

Second trimester abnormal uterine artery Dopplers and adverse obstetric and neonatal outcomes when PAPP-a is normal

Objectives To explore the association between abnormal uterine artery Dopplers (combined PI > 2.5) - with normal PAPP-A - and adverse obstetric/neonatal outcomes. Methods This was a retrospective cohort study of 800 patients between 1 March 2019 − 23 November 2021 in a tertiary UK hospital, where it is routine to measure uterine artery Dopplers of all pregnancies during their anomaly scans. 400 nulliparous women/birthing people with complete data were included. 400 nulliparous controls scanned in the same time frame (1.5 years) with normal PAPP-A and uterine artery Dopplers were matched for age and BMI. Outcomes included: mode of birth, postpartum complications, birth weight/centile, Apgar score, gestational age at delivery, neonatal unit admission, and clinical neonatal hypoglycemia. Multivariable analysis was used. Results Compared to controls, pregnancies with abnormal uterine artery Dopplers and normal PAPP-A were at increased risk of induction (46.5% vs 35.5%, p = .042), cesarean section (46.0% vs 38.0%, p = .002), emergency cesarean section (35.0% vs 26.5%, p = .009), and pre-eclampsia 5.8% vs 2.5%, p = .021). Their babies were more likely to be admitted to the neonatal unit – mostly for prematurity (15.3% vs 6.3%, p = .0004), hypoglycemia (4.0% vs 1.0%, p = .007), be small for gestational age (26.5% vs 11.5%, p = .0001), had intrauterine growth restriction (10.8% vs 1.3%, p = .0001), and be born prematurely (10.0% vs 3.5%, p = .002). Routine measurement of uterine artery Dopplers increased the detection rate of small for gestational age fetuses by 15.1%. Over half of the babies admitted with neonatal hypoglycemia in pregnancies with abnormal uterine artery Dopplers had an unexplained cause. Conclusions Pregnancies with abnormal uterine Dopplers are not only at increased risk of pre-eclampsia and small for gestational age fetuses/intrauterine growth restriction, but are also at increased risk of emergency cesarean section and adverse neonatal outcomes. The increased incidence of neonatal hypoglycemia is likely driven to some degree by prematurity and placental complications, but possibly also by undiagnosed glucose dysmetabolism. This may warrant routine measurement of uterine artery Dopplers in all pregnancies (regardless of risk), where feasible, to aid antenatal management and counseling.

Gastrointestinal congenital anomalies requiring surgery: diagnosis, counselling, and management

Key content Congenital anomalies affect more than 2% of fetuses in the UK, with 70% noncardiac in origin. Around 10% are gastrointestinal anomalies such as abdominal wall defects and intestinal atresias. Most gastrointestinal anomalies require postnatal surgical management. Obstetricians must understand the key features of diagnosis and management of common gastrointestinal anomalies. Clinically relevant and evidence‐based information helps facilitate parental reproductive autonomy through timely and informed counselling, planning for delivery and optimising perinatal outcomes. Management of pregnancies complicated by congenital gastrointestinal anomalies requires a multidisciplinary approach with specialist input. Learning objectives To be familiar with the antenatal diagnosis of gastrointestinal anomalies, associated conditions and potential obstetric complications To understand the antenatal and postnatal management of gastrointestinal anomalies including the approach to surgery To appreciate the role of multidisciplinary counselling in fetal medicine Ethical issues Antenatal counselling in the context of diagnostic and outcome uncertainties Consideration of termination of pregnancy for fetal anomaly, including grounds for, and timing of, decision‐making

New therapeutic opportunities in improving the antenatal management of obese women

Research objectives: to assess the effectiveness of the developed treatment complex on the course of pregnancy and childbirth in obese women.Materials and methods. 135 pregnant women were examined depending on the degree of obesity and received treatment. The women were examined and treated in the Department of Pathology of Pregnancy and Childbirth, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine” during 2019–2021.The developed medical complex included: Miofolic 2 sachets/day 3 months before pregnancy and throughout the gestation period; in case of insufficiency or deficiency of vitamin D, this vitamin was prescribed in a dose of 4000 IU/day; magnesium citrate 250–300 mg/day during pregnancy; micronized progesterone vaginally 200–400 mg/day in the II phase of the menstrual cycle before conception and up to 34 weeks of gestation (if necessary); individual programs of prenatal psychological rehabilitation using psychophysical exercises were used depending on the psychosomatic disorders.Results. it was found that the number of pregnant women of older reproductive age is increasing. There was a decrease in pre-pregnancy weight (which was positively reflected in the subsequent course of pregnancy) at the 3 months before the onset of pregnancy in women with lifestyle modification (diet therapy, dosed physical activities) and who intake a developed treatment complex at the pre-gravid stage.A peculiarity of the somatic morbidity of pregnant women was the combination of various types of extragenital diseases. Significant differences were found between chronic diseases of the cardiovascular system and diseases of the gastrointestinal tract and liver compared to the control group. The course of pregnancy largely depended on the reproductive system status before fertilization – an increase in the frequency of infertility was noted with an increase in the woman’s body mass index.Pregnant women who received the developed treatment complex had fewer pregnancy complications, the frequency of which was not significantly different from the control group. At the same time, against the background of the treatment, their lipid profile and vitamin and mineral supply improved. All this had a positive effect on the pregnancy outcomes.Conclusions. Developed medical complex including myo-inositol, starting from the pre-gravid period and throughout pregnancy, helps to reduce insulin resistance in obese women, improve the lipid profile and normalize the leptin level, which has a positive effect on the course of pregnancy and childbirth and improves perinatal outcomes.