Cases Of Fetal Death Research Articles

Oropouche Virus Infection: Differential Clinical Outcomes and Emerging Global Concerns of Vertical Transmission and Fatal Cases

Oropouche virus (OROV), a member of the Peribunyaviridae family, has emerged as a significant arboviral threat, particularly in South and Central America. Traditionally causing mild febrile illness, recent outbreaks have revealed severe clinical outcomes, including aseptic meningitis, encephalitis, and, more recently, vertical transmission leading to congenital anomalies and fatalities. Environmental changes, including deforestation and climate shifts, have expanded the virus's geographic range, as seen in Brazil, where over 8,000 cases were reported by August 2024, compared to fewer than 831in 2023. For the first time, vertical transmission has been confirmed, with cases of fetal deaths and congenital anomalies such as microcephaly and agenesis of the corpus callosum, drawing parallels to the Zika virus outbreak in 2015–2016. Despite these alarming trends, key mechanisms of placental transmission, maternal immunity, and fetal susceptibility remain poorly understood. This perspective highlights the urgent need for a coordinated global response, focusing on enhanced surveillance in newly affected regions, vector control strategies, and research into the factors driving severe clinical outcomes. Strengthening global efforts will be crucial in mitigating the public health threat posed by OROV, particularly in light of its potential for further geographic expansion and severe clinical manifestations.

Analytical Study of Intrauterine Fetal Death Cases and Associated Maternal Conditions

Analytical Study of Intrauterine Fetal Death Cases and Associated Maternal Conditions

The placenta in fetal death: molecular evidence of dysregulation of inflammatory, proliferative, and fetal protective pathways

BackgroundIt is estimated that over 2 million cases of fetal death occur worldwide every year, but, despite the high incidence, several basic and clinical characteristics of this disorder are still unclear. Placenta is suggested to play a central role in fetal death. Placenta produces hormones, cytokines and growth factors that modulate functions of the placental-maternal unit. Fetal death has been correlated with impaired secretion of some of these regulatory factors. Objective(s)The aim of the present study was to evaluate, in placentas collected from fetal death, the gene expression of inflammatory, proliferative and protective factors. Study designCases of fetal death in singleton pregnancy were retrospectively selected, excluding pregnancies complicated by fetal anomalies, gestational diabetes, intrauterine growth restriction and moderate to severe maternal diseases. A group of placentas collected from healthy singleton term pregnancies were used as controls. Groups were compared regarding maternal and gestational age, fetal sex and birth weight. Placental mRNA expression of inflammatory (IL-6), proliferative (Activin A, TGF-β1) and regulatory (VEGF, VEGFR2, ATP-binding cassette (ABC) transporters ABCB1 and ABCG2, sphingosine 1-phosphate (S1P) signaling pathway) markers was conducted using real-time PCR. Statistical analysis and graphical representation of the data were performed using the GraphPad Prism 5 software. For the statistical analysis, Student’s t-test was used, and P values < 0.05 were considered significant. ResultsPlacental mRNA expression of IL-6 and VEGFR2 resulted significantly higher in the fetal death group compared to controls (P<0.01), while activin A, ABCB1 and ABCG2 expression resulted significantly lower (P<0.01). A significant alteration in the S1P signaling pathway was found in the fetal death group, with an increased expression of the specific receptor isoforms sphingosine 1-phosphate receptor 1, 3 and 4 (S1P1, S1P3, S1P4) and of sphingosine kinase 2 (SK2), one of the enzyme isoforms responsible for S1P synthesis (P<0.01). Conclusion(s): The present study confirmed a significantly increased expression of placental IL-6 and VEGFR2 mRNA, and for the first time showed an increased expression of S1P receptors and SK2 as well as a decreased expression of activin A and of selected ATP-binding cassette transporters, suggesting that multiple inflammatory and protective factors are deranged in placenta of fetal death.

Trends and Rates of Stillbirths: An Observational Study in a Tertiary Level Hospital, Faridpur, Bangladesh

Fetal death at any time during pregnancy is a very tragic situation for the parents and treating obstetricians. Pregnancy loss is a distressing problem and retention of dead fetus in utero has its own ill effects on physical, psychological, and social aspects. Mifepristone is commonly used for induction of labour when a fetus dies in the utero. This cross-sectional survey aimed to determine the incidence and trend of intrauterine fetal death and socio-demographic characteristics, maternal obstetric history, health seeking behavior among the women who experience a stillbirth delivery. It will also aim to evaluate the efficacy and safety of using Mifepristone in case of induction of labour. This study was done at the Obstetric &amp; Gynecology department of Bangabandhu Sheikh Mujib Medical College and a total of 219 stillbirth deliveries were recorded out of 4275 total deliveries from January to December 2022, resulting in a stillbirth rate of 51 per thousand live births. The majority of stillbirths were preterm between 28-38 weeks, and more than half were delivered via normal vaginal deliveries. The study revealed poor distribution of prenatal care, with only 9.59% of mothers having had the recommended 4 ante natal care visits, while 29.22% were primiparous. The results underscore the need for effective prenatal care to reduce the incidence of stillbirth and highlight the importance of careful management of intrauterine fetal death cases to mitigate physical, psychological, and social effects. The findings of this study provide valuable information for clinicians, policy makers, and researchers working in the field of obstetrics and gynecology. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):38-43

Echographic Screening for Fetal Malformations at the Gynecological and Obstetric Clinic of the Aristide Le Dantec Hospital: Review from 2016 to 2018

Introduction: Congenital malformations affect around 3% to 4% of live births and 20% of stillbirths. They represent 20 to 30% of the causes of infant mortality in the countries of the European Community. It is estimated that 5 to 10% of malformations are due to exogenous or environmental causes and 12 to 30% to genetic or endogenous causes (gene mutations or chromosomal anomalies). In almost 60% of cases, the actual origin of the malformation remains unknown. Nevertheless, the origin of these anomalies is still being researched, and numerous diagnostic tools are available to practitioners to improve antenatal screening and pregnancy monitoring. However, obstetric ultrasound remains the primary tool for antenatal screening and monitoring of congenital malformations. Methodology: Our main objective was to evaluate the practice of ultrasound screening for foetal malformations at the Gynaecology and Obstetrics Clinic at Hopital Aristide Le Dantec from 1 February 2016 to 31 December 2018. We conducted a retrospective study of ultrasound screening for foetal malformations. Results: At the end of our study, 869 obstetric ultrasounds met our inclusion criteria. We had 837 singleton pregnancies (96.3%), 31 twin pregnancies (3.6%) and 1 trimellar pregnancy (0.1%). We noted 35 cases of foetal malformations, an incidence of 4.02%. All cases of malformations were diagnosed in singleton pregnancies. The average age of the patients was 29 years, with extremes of 18 and 45 years. Primiparous women were the most represented in our study (62.5%). The majority of patients were from Dakar. A history of recurrent miscarriage was found in 7 patients (20%) and there was one case of fetal death in utero during the previous pregnancy. There was no family history of malformations. Consanguinity was found in 11 cases (31.4%). Only 2 patients were found to have taken medication, one for insulin and the other for an unspecified drug. There was no evidence of toxic intake. Fetal malformations were observed in the 3rd trimester in 23 cases (42.9%). There were 11 cases in the 2nd trimester (31.4%) and only 1 case in the 1st trimester. Cranioencephalic malformations were detected in almost half of the cases (42.8%), i.e. 15 cases. There were 8 cases of polymalformative syndromes, i.e. 22.8%. Digestive malformations were represented in 3 cases, i.e. 8.6%, as were cardiac malformations in 3 cases. Pulmonary malformations and limb malformations accounted for 5.7% and 2 cases each. Renal malformations and orofacial malformations also accounted for 1 case each, 2.9% respectively. Among the 15 cases of malformations of the nervous system, ventricular dilatation ranked first with 10 cases representing 66.6%, followed by anencephaly and cystic hygroma with 2 cases each representing 13.3% and finally dolichocephaly with 1 case representing 6.7%. We found 8 different cases of polymalformative syndromes. These syndromes were labelled in 2 cases and unlabelled in the 6 others. There was 1 case of trisomy 21 and 1 case of trisomy 13. The other cases of polymalformative syndromes were not clearly labelled. A combination of cerebral, $cardiac and/or renal malformations were reported. Digestive malformations were noted in 3 cases (8.6%), including 2 dilatations of the coves (megacolon) and 1 case of omphalocele. Pericarditis, atrial septal defect and transposition of the great vessels were the cardiac malformations found in a total of 3 cases (8.6%). Two cases of achondroplasia were found in our series (5.7%). They were all associated with oligohydramnios. There were 2 cases of pulmonary hypoplasia (5.7%). These were associated with anamnios and a medullary syndrome in one of the cases. Cleft lip and palate and polycystic kidney disease were present in one case each (2.9%). The pregnancy resulted in vaginal delivery in 21 cases (60%), caesarean section in 13 cases (37.1%) and in 1 case the mode of delivery was not specified. The main indication for Caesarean section was hydrocephalus (61.5%). The anomaly and the type of malformation were announced in 85.5% of cases. A referral for fetal ultrasound was suggested in 5.7% of patients and fetal MRI in 2.9%. Concordance between antenatal and postnatal diagnosis was achieved in 18 cases (51.4%). The pregnancy resulted in vaginal delivery in 21 cases (60%), caesarean section in 13 cases (37.1%) and in 1 case the mode of delivery was not specified. The main indication for Caesarean section was hydrocephalus (61.5%). The anomaly and the type of malformation were announced in 85.5% of cases. A referral for fetal ultrasound was suggested in 5.7% of patients and fetal MRI in 2.9%. Concordance between antenatal and postnatal diagnosis was achieved in 18 cases (51.4%). Neonatal mortality accounted for 62.9% of the series, with 22 cases. Conclusion: Fetal malformations were detected with a concordance of 51.4% between antenatal and postnatal diagnosis. Neonatal mortality was high. A major preoccupation should be the strengthening of cytogenetic diagnosis and management resources, and raising awareness of the origins of congenital malformations.

Características de los casos de óbito fetal en un hospital público de Perú: estudio descriptivo

Objective: To describe the characteristics of fetal death cases reported between 2017 and 2021 in a public hospital in Peru. Methods: Descriptive and cross-sectional study, which was conducted in confirmed cases of fetal death in mothers with gestational age greater than 22 weeks presented at the Vitarte Hospital in Lima, Peru. The sample consisted of 137 cases during the period from 2017 to 2021. Frequencies and percentages were presented. Results: Fetal death had a rate of 14,8 per 1000 live births. Most of the women were between 20 and 24 years old (27%), in addition, 70,1% were cohabiting, 92% were housewives and 83,2% studied up to high school. On the other hand, 50,4% were multigestational and 29,9% had a history of abortion and 16,7% had a history of cesarean section. Prenatal service attendance was the most frequent (67,2%) and 29,2% were overweight. Regarding maternal pathologies, 38% had urinary tract infection, 17,5% had preeclampsia without signs of safety and 2,9% had gestational diabetes. Congenital malformations were present in 19% of cases; in addition, 23,4% of fetal deaths had a maternal cause. Conclusions: The rate of fetal death is high. The cases were characterized mostly by mothers with qualities of social vulnerability, in addition to presenting characteristics of higher obstetric risk. Maternal causes of fetal death were the most frequent. Keywords: Fetal death, pregnancy, delivery, risk factors.

Clinical Characteristics, Laboratory, Maternal and Fetal Outcomes in Pregnancy with Covid-19 at RSUP dr. M. Djamil Padang

Introduction : The data obtained from various studies about covid-19 conducted in severalhospitals in the world are currently considered not sufficient to provide a clinical picture thatoccurs in pregnancies with Covid-19 infection. The aims to provide an overview of the clinical,laboratory, maternal and fetal outcomes in pregnancy with Covid-19 infection at dr. M. DjamilPadang.Methods: This study used a descriptive design with data collection starting from March 01,2020 - March 31, 2021 based on medical record data. Carried out in a single center at RSUPdr. M. Djamil Padang in pregnant patients with confirmed Covid-19 by PCR examination.Results: Total 136 pregnant patients confirmed Covid-19 by PCR examination. Most of thesymptoms were asymptomatic (47.1%) and without any comorbidities (76.5%). There were 3patients who experienced critical symptoms (2.2%). Maternal mortality was found at 2.3% andfetal death 4.7%. The values of d-dimer and NLR were found increasing significantly,2025.35±1392.18 for d-dimer and 6.39±4.43 for NLR. Pregnancy terminations done for 77.9%patients with cesarean section is the most method (83%). There were 4 cases (3.8%) of babiesinfected with Covid-19 from mothers who had pregnancy terminations.Conclusions: Most cases had asymptomatic clinical symptoms (47.1%). There are 2.3%cases of maternal death and 4.7% cases of fetal death. Most of the pregnancy terminationswere performed by cesarean section (88%). On laboratory examination, there was a significantincrease in maternal d-dimer (2,025.35±1.392.18) and NLR (6.39±4.43) in pregnancies withCovid-19.

P956 Pregnancy outcomes after maternal or paternal exposure in the tofacitinib ulcerative colitis clinical programme

Abstract Background Pregnant women with ulcerative colitis (UC) have a higher risk of adverse pregnancy outcomes vs age-matched controls.1 Tofacitinib is an oral Janus kinase inhibitor for the treatment of UC. There are no well-controlled studies on tofacitinib use in pregnant women. It was shown to be teratogenic in rats and rabbits at approximately 73 and 6.3 times, respectively, the maximum recommended human dose of 10 mg twice daily. Tofacitinib affects female fertility, parturition and peri/postnatal development in rats and was secreted into the milk of lactating rats; it had no effects on male fertility or sperm motility/concentration. Methods We report pregnancy outcomes in the tofacitinib UC clinical programme: 4 randomised, placebo-controlled Phase (P)2/3 studies (NCT00787202/NCT01465763/NCT01458951/NCT01458574),2,3 an open-label, long-term extension study (NCT01470612)4 and a randomised P3b/4 study (NCT03281304) were analysed.5 Study protocols excluded pregnant women, required females of childbearing potential to use effective contraception and regularly tested for urine β-hCG. Study drug was discontinued in female patients who became pregnant. Pregnancy outcomes after maternal or paternal tofacitinib exposure were identified from Pfizer’s internal safety database up to March 2023 and categorised as healthy newborn, medical termination, foetal death, congenital malformation, spontaneous abortion or lost to follow-up. Results There were 40 pregnancies with exposure to tofacitinib: 16 cases of maternal exposure (median age 29.5 [range: 24−41] years), all during the 1st trimester (10 [62.5%] healthy newborns, 2 [12.5%] medical terminations, 2 [12.5%] spontaneous abortions, 2 [12.5%] lost to followup); and 24 cases of paternal exposure (18 [75.0%] healthy newborns, 2 [8.3%] spontaneous abortions, 4 [16.7%] lost to follow-up). There were no cases of foetal death or congenital malformation. Conclusion Most known outcomes for maternal and paternal tofacitinib exposure were healthy newborns, similar to previous analyses in other tofacitinib clinical study populations and the general UC population.6,7 Limitations included the low number of reported pregnancies and available follow-up. Tofacitinib should not be used during pregnancy unless necessary.

Maternal near miss as a predictor of adverse perinatal outcomes: findings from a prospective cohort study in southwestern Uganda

BackgroundDespite efforts, Uganda has not met the World Health Organization target of < 12 newborn deaths per 1,000 live births. Severe maternal morbidity or ‘near miss’ is a major contributor to adverse perinatal outcomes, particularly in low-resource settings. However, the specific impact of maternal near miss on perinatal outcomes in Uganda remains insufficiently investigated. We examined the association between maternal near miss and adverse perinatal outcomes at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.MethodsWe conducted a prospective cohort study among women admitted for delivery at MRRH’s maternity ward from April 2022 to August 2022. We included mothers at ≥ 28 weeks of gestation with singleton pregnancies, while intrauterine fetal death cases were excluded. For the near-miss group, we consecutively included mothers with any one of the following: antepartum hemorrhage with shock, uterine rupture, hypertensive disorders, coma, and cardiac arrest; those without these complications constituted the non-near-miss group. We followed the mothers until delivery, and their infants until seven days postpartum or death. Adverse perinatal outcomes considered were low birth weight (< 2,500 g), low Apgar score (< 7 at five minutes), intrapartum stillbirths, early neonatal death, or admission to neonatal intensive care unit. Multivariable log-binomial regression was used to determine predictors of adverse perinatal outcomes.ResultsWe enrolled 220 participants (55 maternal near misses and 165 non-near misses) with a mean age of 27 ± 5.8 years. Most of the near misses were pregnancies with hypertensive disorders (49%). Maternal near misses had a four-fold (adjusted risk ratio [aRR] = 4.02, 95% CI: 2.32–6.98) increased risk of adverse perinatal outcomes compared to non-near misses. Other predictors of adverse perinatal outcomes were primigravidity (aRR = 1.53, 95%CI: 1.01–2.31), and gestational age < 34 weeks (aRR = 1.81, 95%CI: 1.19–2.77).ConclusionMaternal near misses, primigravidity, and preterm pregnancies were independent predictors of adverse perinatal outcomes in this study. We recommend implementing maternal near-miss surveillance as an integral component of comprehensive perinatal care protocols, to improve perinatal outcomes in Uganda and similar low-resource settings. Targeted interventions, including specialized care for women with maternal near misses, particularly primigravidas and those with preterm pregnancies, could mitigate the burden of adverse perinatal outcomes.

Fetal losses in Morocco: investigating pregnancy history and associated risks

PurposeFetal loss is a significant pregnancy complication that requires further investigation. This study aimed to investigate the characteristics of fetal losses in Settat, Morocco, and assess associated risks. MethodsThis transversal survey utilized data from the medical birth and patient registers of 2282 pregnant women who received antenatal care at the provincial hospital of Settat between 2020 and 2021. Logistic regression was used to analyze the risk of fetal loss, according to pregnancy history. ResultsAmong the 2282 pregnancies, 281 resulted in fetal loss, with 233 cases of early miscarriage, 38 cases of late-term miscarriage, and 10 cases of fetal death in utero. The risk of fetal loss was lowest in women under 30years (10.2%), increased to 18.6% in women aged 30–44years, and was highest at 35.5% in women aged 45years and over. Maternal age (aOR=1.06, 95% confidence interval [CI] 1.03–1.08), number of abortions (aOR=4.91, 95% CI 3.20–7.54), lack of pregnancy monitoring (aOR=5.53, 95% CI 3.39–9.03), cesarean section (aOR=6.39, 95% CI 2.18–18.68), and anemia (aOR=14.27, 95% CI 6.87–29.65) were identified as significant risk factors for fetal loss. ConclusionsMaternal age, pregnancy history, and maternal health status are associated with the risk of fetal loss. Further research is needed to identify key predictors of fetal loss and other pregnancy complications in this population. These findings can aid in developing targeted interventions to reduce the incidence of fetal loss and improve maternal and child health outcomes.

Intrauterine fetal death and associated maternal conditions

Background: Intrauterine fetal death (IUFD) is a cataclysmic event for the parents. It is an important indicator of maternal and perinatal health of a given population. This study was undertaken to study the maternal and fetal factors associated with IUFD. Methods: This was a retrospective study carried out in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, from November 2019 to October 2020 . The details of history, examination findings, investigation reports , mode of delivery and fetal outcome were obtained from records. Results: A total number of 57 intrauterine fetal death were reported amongst 1534 deliveries conducted during the study period. The occurrence of intrauterine fetal death was 37.1/1,000 live births ; Among all these intrauterine fetal death cases, 87.7% deliveries were preterm and 89.4% deliveries were singleton delivery. The other associated maternal conditions were uncontrolled blood glucose in 64.9% cases, hypertensive disorders in 36.8% cases, other medical causes in 10.5% cases. Associated fetal conditions included intrauterine growth retardation of fetus in 28.0% cases, oligohydramnios in 21.0% cases, congenital malformation in 14.0 % cases. Placental condition included antepartum hemorrhage in 3.5% cases. Conclusions: In this study, the occurrence of intrauterine fetal death was associated with high incidence of uncontrolled blood glucose, oligohydramnios and congenital malformations . This emphases the importance of proper antenatal care and identification of risk factors and its proper treatment. BIRDEM Med J 2023; 13(2): 88-91

Pregnancy after kidney transplantation: Ibn Sina Rabat University hospital experience

Kidney transplantation (KT) restores the fertility of women with end-stage kidney disease (ESKD), thus offering them the possibility of having children. However, pregnancy after kidney transplantation is associated with high maternal-fetal morbidity. The purpose of this work is to report the experience of our service in pregnancies in kidney transplant recipients. We retrospectively studied the records of transplant recipients who had one or more pregnancies after KT. We analyzed clinical (blood pressure, weight gain, oedema, duration of pregnancy, obstetric complication) and biological (creatinine, urinary albumin excretion) parameters. Between 1998 and 2020, twenty-one pregnancies occurred in 12 transplant recipients. The average age of patients at the time of conception was 29 ± 5 years with a delay between KT and pregnancy of 43 ± 29 months. Seven pregnancies began with arterial hypertension (HTA) controlled under treatment, proteinuria before conception was negative in all pregnancies and renal function was normal with an average creatinine level of 10.1 ± 1,27 mg/L. Prior to pregnancy, immunosuppression regimens were based on anticalcineurin (n = 21) combined either with mycophenolate mofetil (MMF) (n = 10) or azathioprine (n = 8) or alone (n = 3). Immunosuppression regimens were all associated with corticosteroid therapy. Three months before conception, MMF was relayed by azathioprine in seven pregnancies, on the other hand three other unplanned pregnancies, started under MMF. During pregnancy, the appearance of proteinuria greater than 0,5 g/24 h was noted in three pregnancies in the third trimester. Pregnancy hypertension was found in three pregnancies, one of which progressed to pre-eclampsia. As for renal function, it remained stable with an average creatinine level of 10,3 mg/l in the 3rdtrimester. Two cases of acute pyelonephritis were noted. No episode of acute rejection was noted during and 3 months after pregnancy. The delivery was performed by caesarean section in 44.4%, after an average term of 37 week of amenorrhea ± 2.04 with three cases of prematurity. The average birth weight was 3 110 g ± 450 g. There was one case of spontaneous abortion and two cases of fetal death in utero. After post-partum, renal function remained stable in five patients. In six cases, there was impaired renal function either by acute rejection or secondary to chronic allograft nephropathy. In our department, a quarter of transplant recipients were able to carry a pregnancy with a rate of 89% of successful pregnancies. Pregnancy after KT requires special planning and monitoring. A multidisciplinary collaboration between transplant nephrologist, gynecologist and pediatrician is necessary by referring to the recommendations.

The risk factors for Group B Streptococcus colonization during pregnancy and influences of intrapartum antibiotic prophylaxis on maternal and neonatal outcomes

BackgroundGroup B Streptococcus (GBS), also referred as Streptococcus agalactiae, is one of the leading causes of life-threatening invasive diseases such as bacteremia, meningitis, pneumonia and urinary tract infection in pregnant women and neonates. Rates of GBS colonization vary by regions, but large-sample studies on maternal GBS status are limited in southern China. As a result, the prevalence of GBS among pregnant women and its associated risk factors and the efficacy of intrapartum antibiotic prophylaxis (IAP) intervention in preventing adverse pregnancy and neonatal outcomes remain poorly understood in southern China.MethodsTo fill this gap, we retrospectively analyzed demographic and obstetrical data of pregnant women who have undergone GBS screening and delivered between 2016 and 2018 in Xiamen, China. A total of 43,822 pregnant women were enrolled and only a few GBS-positive women did not receive IAP administration. Possible risk factors for GBS colonization were assayed by univariate and multivariate logistic regression analysis. Generalized linear regression model was applicated to analyze whether IAP is one of the impact factors of the hospital length of stay of the target women.ResultsThe overall GBS colonization rate was 13.47% (5902/43,822). Although women > 35 years old (P = 0.0363) and women with diabetes mellitus (DM, P = 0.001) had a higher prevalence of GBS colonization, the interaction between ages and GBS colonization was not statistically significant in Logistic Regression analysis (adjusted OR = 1.0014; 95% CI, 0.9950, 1.0077). The rate of multiple births was significantly dropped in GBS-positive group than that of GBS-negative group (P = 0.0145), with no significant difference in the rate of fetal reduction (P = 0.3304). Additionally, the modes of delivery and the incidences of abortion, premature delivery, premature rupture of membranes, abnormal amniotic fluid and puerperal infection were not significantly different between the two groups. The hospitalization stays of the subjects were not influenced by GBS infection. As for neonatal outcomes, the cases of fetal death in maternal GBS-positive group did not statistically differ from that in maternal GBS-negative group.ConclusionOur data identified that pregnant women with DM are at high risk of GBS infection and IAP is highly effective in prevention of adverse pregnancy and neonatal outcomes. This stressed the necessity of universal screening of maternal GBS status and IAP administration to the target population in China, and women with DM should be considered as priorities.

Proteomic profile of extracellular vesicles in maternal plasma of women with fetal death

Objectives Fetal death is a complication of pregnancy caused by multiple etiologies rather than being the end-result of a single disease process. Many soluble analytes in the maternal circulation, such as hormones and cytokines, have been implicated in its pathophysiology. However, changes in the protein content of extracellular vesicles (EVs), which could provide additional insight into the disease pathways of this obstetrical syndrome, have not been examined. This study aimed to characterize the proteomic profile of EVs in the plasma of pregnant women who experienced fetal death and to evaluate whether such a profile reflected the pathophysiological mechanisms of this obstetrical complication. Moreover, the proteomic results were compared to and integrated with those obtained from the soluble fraction of maternal plasma. Methods This retrospective case-control study included 47 women who experienced fetal death and 94 matched, healthy, pregnant controls. Proteomic analysis of 82 proteins in the EVs and the soluble fractions of maternal plasma samples was conducted by using a bead-based, multiplexed immunoassay platform. Quantile regression analysis and random forest models were implemented to assess differences in the concentration of proteins in the EV and soluble fractions and to evaluate their combined discriminatory power between clinical groups. Hierarchical cluster analysis was applied to identify subgroups of fetal death cases with similar proteomic profiles. A p-value of <.05 was used to infer significance, unless multiple testing was involved, with the false discovery rate controlled at the 10% level (q < 0.1). All statistical analyses were performed by using the R statistical language and environment-and specialized packages. Results Nineteen proteins (placental growth factor, macrophage migration inhibitory factor, endoglin, regulated upon activation normal T cell expressed and presumably secreted (RANTES), interleukin (IL)-6, macrophage inflammatory protein 1-alpha, urokinase plasminogen activator surface receptor, tissue factor pathway inhibitor, IL-8, E-Selectin, vascular endothelial growth factor receptor 2, pentraxin 3, IL-16, galectin-1, monocyte chemotactic protein 1, disintegrin and metalloproteinase domain-containing protein 12, insulin-like growth factor-binding protein 1, matrix metalloproteinase-1(MMP1), and CD163) were found to have different plasma concentrations (of an EV or a soluble fraction) in women with fetal death compared to controls. There was a similar pattern of change for the dysregulated proteins in the EV and soluble fractions and a positive correlation between the log2-fold changes of proteins significant in either the EV or the soluble fraction (ρ = 0.89, p < .001). The combination of EV and soluble fraction proteins resulted in a good discriminatory model (area under the ROC curve, 82%; sensitivity, 57.5% at a 10% false-positive rate). Unsupervised clustering based on the proteins differentially expressed in either the EV or the soluble fraction of patients with fetal death relative to controls revealed three major clusters of patients. Conclusion Pregnant women with fetal death have different concentrations of 19 proteins in the EV and soluble fractions compared to controls, and the direction of changes in concentration was similar between fractions. The combination of EV and soluble protein concentrations revealed three different clusters of fetal death cases with distinct clinical and placental histopathological characteristics.

Intrauterine fetal death in a COVID positive pregnant woman.

SARS-CoV-2 disease mechanisms are not yet fully understood, especially in cases affecting pregnant women. In fact, although they suffer from the same symptoms as non-pregnant women, they are more susceptible to-adverse outcomes of COVID-19 as well as pregnancy complications leading to stillbirth, premature rupture of membrane, or intrauterine fetal demise (IUFD). The consequences on pregnancy are not clearly correlated with the severity of the infection. We present a case of fetal death in a 30-year-old woman with a confirmed SARS-CoV-2 infection without any other significant clinical or obstetric disorders. A histopathological examination of the placenta indicated massive and diffuse intervillar fibrinoid deposits associated with chronic histiocytic intervillositis that can be associated with SARS-CoV-2 placentitis. Given the high rates of SARS-CoV-2 infections in pregnancy, it is important to understand the factors that determine negative pregnancy outcomes, regardless of the severity of the patient's symptoms.

"Unusual cases of foetal death in Pitbull bitches: Foetal mummification and maceration "

"Unusual cases of foetal death in Pitbull bitches: Foetal mummification and maceration "

Detection rate and clinical significance of regions of homozygosity in prenatal genetic diagnosis

Objective: To detect the incidence and analyze the clinical significance of regions of homozygosity (ROH) through the single nucleotide polymorphism array (SNP array). Methods: The SNP array detection results of 5 116 pregnant women in the Third Affiliated Hospital of Guangzhou Medical University from January 2016 to December 2020 were retrospectively analyzed. The pregnant women with ROH (5 Mb as the threshold) were followed up to analyze the relationship between ROH and abnormal fetal phenotype. Whole exon sequencing was performed in 4 cases of consanguineous marriage to detect potential recessive causative genes in the ROH region. Results: (1) A total of 39 cases of ROH were detected, with a positive rate of 0.76% (39/5 116). Among them, 25 cases (64%, 25/39) were detected only on single chromosome, and chromosome 11 had the highest detection rate, suggesting the risk of uniparental disomy; fourteen cases (36%,14/39) were detected on multiple chromosomes, most commonly on chromosomes 11, 1, 3, 4 and 8. (2) The number of cases and detection rate of ROH detected by different prenatal diagnosis indicators were as follows: 12 cases (1.78%, 12/676) in pregnant women with abnormal non-invasive prenatal testing result, 12 cases (0.37%, 12/3 284) in pregnant women with ultrasound abnormality, 4 cases (4/4) in pregnant women with consanguineous marriage, 3 cases (0.92%, 3/326) in pregnant women with previous adverse pregnancy, 2 cases (1.15%, 2/174) in pregnant women with high risk of serology in screening, 2 cases (4.00%, 2/50) in pregnant women with abnormal fetal chromosomal karyotype, 2 cases (0.79%, 2/253) in pregnant women with advanced maternal age, 1 case (0.56%, 1/178) in pregnant women with related parental genetic factors and 1 case (0.58%, 1/171) in pregnant women with the other factors. (3) The follow-up results of 39 cases of prenatal ROH showed that there were 16 cases of term birth, 15 cases of termination of pregnancy, 2 cases of preterm births, 1 case of fetal death and 5 cases lost to follow-up. Conclusions: Chromosomal ROH phenomenon is not rare. By analyzing the detection rate of ROH in prenatal diagnosis, combined with the results of fetal phenotype and postpartum follow-up, the clinical characteristics of ROH are discussed, so as to better understand the relationship between ROH and its phenotype.

Клініко-анамнестичні характеристики та медикаментозний супровід вагітних жінок із обтяженим акушерським анамнезом і тромбофіліями

The purpose of the study was to determine the clinical and anamnestic features (age characteristics of women and anamnestic features of previous pregnancies) of pregnant women with burdened obstetric history and thrombophilia with the establishment of the main pharmacological mechanisms of therapeutic support. Materials and methods. The study was performed at the Department of Clinical Laboratory Diagnostics of Kharkiv National Medical University and at the Kharkiv Clinical Laboratory Center in the period from 2017 to 2021. We examined 137 pregnant women: the main group (101 women – pregnant women with a burdened obstetric history and thrombophilia aged 29.0 to 37.0 years) and the control group (36 women – pregnant women with a burdened obstetric history without thrombophilia aged 26.0 to 30.0 years). In general, the predominance of one (35.8 %) and two (46.7 %) pregnancies in the history of women with a burdened obstetric history compared to three (17.5 %) was noted. Results and discussion. An increase (U = 706.0; p &lt;0.001) in the chances of developing negative consequences of pregnancy in thrombophilia with increasing age due to negative idiopathic thromboembolic effects due to thrombophilia was noted. A higher mean age of pregnant women with a burdened obstetric history in the presence of thrombophilia (33.0 [29.0; 37.0] years) was determined compared with the control (28.0 [26.0; 30.0] years). The maximum negative manifestations of idiopathic thromboembolic effects due to thrombophilia in the first pregnancy were found. The predominance of cases of fetal death in the first pregnancy of women with two (94.1 %) and three (78.3 %) pregnancies was determined. In general, the need for antiplatelet therapy in thrombophilia was stated. Its use (χ2 = 46,950; p &lt;0.001) was determined in 85.1 % of cases, the majority (65.3 %) of one drug (probably (χ2 = 164.54; p &lt;0.001) more often (52.5 %) acetylsalicylic acid compared with dipyridamole (5.9 %)). It was found that anti aggregate therapy, which included two drugs (combination: acetylsalicylic acid, dipyridamole or klexan) was most often used in the first (40.7%) pregnancy in contrast to the second (11.8%) and third (13.0 %). Conclusion. The study found that antiplatelet therapy with only one drug (acetylsalicylic acid, dipyridamole or klexan) was more commonly used in the second (74.5%) and third (73.9%) pregnancies than in the first one (40.7%). It was naturally determined that the absence of any medication was noted most often by pregnant women in the first (18.5%) pregnancy in contrast to the second (13.7%) and third (13.0%)

Infantile survival and neurodevelopment at three years of age on delivery by the intended delivery mode in extremely preterm infants

ObjectiveTo elucidate the impact of the intended delivery mode on long-term outcomes among extremely preterm infants. Materials and methodsWomen who delivered singletons between 23 0/7 and 25 6/7 weeks of gestation from January 2010 to March 2014 and their infants were included in this study. The cases of fetal growth restriction and those with a chromosomal or major structural abnormality were excluded. The cases of fetal death that was diagnosed before labor onset and cases of non-reassuring fetal status, placental abruptions or umbilical cord prolapse that was diagnosed at labor onset were also excluded. The primary outcome was the incidence of composite adverse events, including death, cerebral palsy, or neurodevelopmental delay, at the age of three years. The composite adverse events, including death, grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, necrotizing enterocolitis, focal intestinal perforation, and sepsis of neonatal period, were assessed as short-term outcomes. The association between the intended delivery mode and primary outcome, short-term outcome, and each component was analyzed using a multivariate logistic regression model. ResultsEighty cases were included in the analyses. Primary outcomes could be assessed in 72 cases. Infantile composite adverse events before discharge were observed in 19 cases (24%). The prevalence of primary outcomes was 40% (29 cases). The intended delivery mode was not associated with primary and short-term outcomes and each component complication. ConclusionAn advantage of intended cesarean delivery in terms of prognosis at three years of age in extremely preterm infants was not observed.

Fatal Cowpox Virus Infection in Human Fetus, France, 2017.

Cowpox virus (CPXV) has an animal reservoir and is typically transmitted to humans by contact with infected animals. In 2017, CPXV infection of a pregnant woman in France led to the death of her fetus. Fetal death after maternal orthopoxvirus (smallpox) vaccination has been reported; however, this patient had not been vaccinated. Investigation of the patient’s domestic animals failed to demonstrate prevalence of CPXV infection among them. The patient’s diagnosis was confirmed by identifying CPXV DNA in all fetal and maternal biopsy samples and infectious CPXV in biopsy but not plasma samples. This case of fetal death highlights the risk for complications of orthopoxvirus infection during pregnancy. Among orthopoxviruses, fetal infection has been reported for variola virus and vaccinia virus; our findings suggest that CPXV poses the same threats for infection complications as vaccinia virus.