Cases Of Intrauterine Fetal Death Research Articles

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.

Forensic Analysis of Eighteen Tubal Pregnancy-Related Medical Damage.

To analyze the cases of medical damage after misdiagnosis of tubal pregnancy, to explore the causes of medical damage, the causal relationship between medical malpractice and the damage consequences, as well as the causative potency, in order to provide evaluation ideas for forensic identification of such cases. Eighteen cases of forensic identification of tubal pregnancy related medical damage were collected and retrospectively analyzed from the aspects of age, maternity history, fertility requirements, risk factors, diagnosis and treatment, medical malpractice, damage consequences, and causative potency. All 18 cases were tubal pregnancy, of which 17 cases had medical malpractice, resulting in 14 cases of affected tubal resection, 2 cases of hemorrhagic shock death, 1 case of intrauterine fetal death and affected tubal resection. The other case had the consequence of affected tubal resection, but there was no malpractice in the treatment. Correct diagnosis is helpful to make appropriate treatment plan, prevent disease progression and reduce serious adverse consequences and the occurrence of medical disputes. Scientific and reasonable analysis of the causal relationship between medical malpractice and damage consequences and the causative potency is of great significance to the successful settlement of medical disputes.

Kliniğimizde Gerçekleşen İntra-Uterin Fetal Ölüm Vakalarının Retrospektif Olarak Değerlendirilmesi

The present study aims to retrospectively analyze the frequency, demographic characteristics, affecting risk factors and outcomes of intra-uterine fetal death (IUFD) cases delivered between 2015 and 2022 in our clinic, a tertiary center. Between January 2015 and December 2021, 92 pregnant women between 22-41 weeks of gestational age who gave birth due to IUFD in Muğla University Education and Research Hospital clinic were included in the study. Age at presentation, gravida, parity and body mass index (BMI) data, gestational weeks, and if after birth, birth weight, mode of delivery, infant sex and pathologic examination results were recorded. There were 92 cases of IUFD between the specified dates. The ratio of cases to the number of births was 1.03%. Of the cases, 88 (95.65%) were singleton pregnancies and 4 (4.34%) were multiple pregnancies. The mean age was 29.47±5.71 years. Among the cases, 1 (1.08%) pregnant woman was under 18 years of age and 1 pregnant woman was over 40 years of age. The mean BMI was 25.54±3.90 kg/m2 and 2 (2.16%) pregnant women were morbidly obese (≥40 kg/m2). The mean gestational age was 31.07±4.87 weeks. When the causes of IUFD were evaluated, placental abruptio1n was observed in 12 (13.18%) pregnant women. Hypertensive disorders of pregnancy were present in 6 (50%) of the pregnant women with placental abruption. While 5 (5.49%) pregnant women had diabetes mellitus, 2 (2.19%) had placenta previa. A total of 7 (7.60%) pregnant women had anhydroamniosis, a sign of uteroplacental insufficiency, during hospitalization, while 20 (21.97%) pregnant women had fetal anomaly. One (1.09%) pregnant woman developed disseminated intravascular coagulation. In addition, 3 (3.26%) pregnant women had COVID-19 and were hospitalized. The predictability of IUFD cases is low. But despite this, each center can partially reduce the incidence of IUFD with a pro-active approach by evaluating its own outcomes and identifying risk factors.

Neonatal Outcome of Mothers With COVID-19 in King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia.

This study was conducted to assess the neonatal outcome of mothers with COVID-19 in King Salman Armed Forces Hospital, Tabuk, Saudi Arabia. This was a hospital record-based, retrospective cohort study. The case group included neonates born to mothers who were positive for the COVID-19 virus during pregnancy, whereas the control group included neonates born to mothers who were not infected with the COVID-19 virus during pregnancy. The data were collected from the records and were analyzed using the Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY, USA). This study covered the hospital records of 342 women (114 cases and 228 control). The rates of cesarean sections and small for gestational age were significantly higher among the cases compared to the controls (71.1% versus 43.4%, p < 0.001 and 24.6% versus 11.8%, p = 0.003; respectively). The mean birth weight was significantly lower among the cases group (3.0 ± 0.6 versus 3.3 ± 0.6 kg, p = 0.022). Only the case group reported the occurrence of neonatal COVID-19 infection (7.9%, p < 0.001). The study reported only a single case of intrauterine fetal death and one stillbirth in the cases group, but no neonatal deaths (p> 0.05). Maternal COVID-19 may be associated with undesirable neonatal outcomes. There is a possibility of vertical transmission of COVID-19 from the mother to the neonate, but this cannot be confirmed.

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

Intrauterine Fetal Death in the Third Trimester of Pregnancy in Kamina, DR Congo: Identification of High-Risk Mothers and Impact of the Periodicity of Antenatal Care

Purpose: Intrauterine fetal death (IUFD) is a problem frequently encountered in obstetrical practice in developing countries. The objectives of this study were to identify maternal risk factors for IUFD in the third trimester of pregnancy and to establish its relationship with the norms of periodicity of antenatal care in Kamina. Materiel and methods: This is a case-control study conducted in 6 health facilities in Kamina from January 2021 to May 2022. The effects of the socio-demographic characteristics and obstetrical history of mothers, number of prenatal attendances, age of pregnancy at the first prenatal attendance and number of consultations in third trimester of pregnancy on the occurrence of IUFD were studied. A total of 78 cases of IUFD were linked to 234 controls. Results: The adjustment allowed us to retain 5 parameters significantly associated with IUFD: residence in a rural environment (aOR=2.25; CI= [1.23-4.48]), absence of a history of abortion (aOR=2.97; CI=[1.21-7.26]), history of stillbirth (aOR=2.97; CI =[1.21-7.26]), non-follow up of prenatal care (aOR=3.69; CI=[1.78-7.68]) and insufficient number of prenatal attendances in the third trimester of pregnancy (aOR= 2.22; CI=[1.04 -4.73]). The values of the area under the ROC curve (AUC) found indicate a good capacity of the model (80.3%). Conclusion: The modifiable maternal determinants and those related to identified ANC should serve providers to reduce the occurrence of IUFD in Kamina and its surroundings.

Early Onset Intrauterine Growth Restriction-Data from a Tertiary Care Center in a Middle-Income Country.

Background and Objectives: In this study, we aimed to describe the clinical and ultrasound (US) features and the outcome in a group of patients suspected of or diagnosed with early onset intrauterine growth restriction (IUGR) requiring iatrogenic delivery before 32 weeks, having no structural or genetic fetal anomalies, managed in our unit. A secondary aim was to report the incidence of the condition in the population cared for in our hospital, data on immediate postnatal follow-up in these cases and to highlight the differences required in prenatal and postnatal care. Materials and Methods: We used as single criteria for defining the suspicion of early IUGR the sonographic estimation of fetal weight < p10 using the Hadlock 4 technique at any scan performed before 32 weeks’ gestation (WG). We used a cohort of patients having a normal evolution in pregnancy and uneventful vaginal births as controls. Data on pregnancy ultrasound, characteristics and neonatal outcomes were collected and analyzed. We hypothesized that the gestational age (GA) at delivery is related to the severity of the condition. Therefore, we performed a subanalysis in two subgroups, which were divided based on the GA at iatrogenic delivery (between 27+0 WG and 29+6 WG and 30+0−32+0 WG, respectively). Results: The prospective cohort study included 36 pregnancies. We had three cases of intrauterine fetal death (8.3%). The incidence was 1.98% in our population. We confirmed that severe cases (very early diagnosed and delivered) were associated with a higher number of prenatal visits and higher uterine arteries (UtA) pulsatility index (PI) centile in the third trimester—TT (compared with the early diagnosed and delivered). In the very early suspected IUGR subgroup, the newborns required significantly more NICU days and total hospitalization days. Conclusions: Patients with isolated very early and early IUGR—defined as ultrasound (US) estimation of fetal weight < p10 using the Hadlock 4 technique requiring iatrogenic delivery before 32 weeks’ gestation—require closer care prenatally and postnatally. These patients represent an economical burden for the health system, needing significantly longer hospitalization intervals, GA at birth and UtA PI centiles being related to it.

The Importance of Post-Mortem Investigations in Stillbirths: Case Studies and a Review of the Literature.

Stillbirth has an important economic and social impact, though it remains “inexplicable” in many cases. We report the analysis of 11 cases of intrauterine fetal death carried out through a retrospective study conducted in the period between 2014 and 2017. The purpose of the study is to quantify the contribution of the autopsy and placental examination in identifying the cause of stillbirths. For each case, the medical record was analyzed with the relative maternal and partner data, the results of the external fetal and autopsy examination as well as the macroscopic and histological placental examination. The peak of stillbirth was found in a maternal age group between 30 and 39 years, below the 32nd week and above the 37th week of gestation. The results obtained from the clinical history and external fetal examination make it possible to trace the cause of death in only 18.2% of cases. By adding to these data, the results of the fetal autopsy and the placental examination, it is possible to establish the cause of death in 90.9% of cases. The most frequent abnormalities found in the placenta and cord were short or hypercoiled cord, umbilical cord vascular thrombosis, turns around the neck or stretching of the funiculus, placental infarction and placental insufficiency; also, amniotic fluid abnormalities, such as suspected oligohydramnios and chorioamniositi, were found. The accurate analysis of post-mortem placental and fetal examination is essential to reduce the number of unresponsive intrauterine fetal deaths. Determining the cause of fetal death must help clinicians and parents in better management and care in future pregnancies.

EVALUATION OF THE OUTCOME OF ORAL VERSUS VAGINAL MISOPROSTOL IN TERMINATION OF ALL CASES OF INTRAUTERINE FETAL DEATH

Introduction: Misoprostol a potent uterotropic and uterotonic agent which causes cervical effacement &amp;dilatation and stimulates myometrial contractions, is effective in terminating intrauterine foetal death. The Objective of the study was to compare the effectiveness of oral misoprostol versus vaginal misoprostol in termination of all cases of intrauterine foetal death and its outcome. Details of induction –delivery interval and maternal morbidities were also analysed. A prospective comparative study.Al Methodology: l pregnant women indicated for termination of intrauterine foetal death satisfying both inclusion and exclusion criteria being admitted in our Labour Room during the period of this study were included.Total 60 patients were included out of which 30 receiving oral misoprostol forms the rst group and the other 30 receiving vaginal misoprostol forms the second group. For the rst group, 200 mcg of oral misoprostol tablet was dissolved in 200ml water and 25 mcg, ie. 25ml of the solution was given rst and then every two hours till pain occurs. Second group was given 25 mcg of vaginal misoprostol every 4 hourly. Induction-delivery interval and maternal morbidities were compared in both groups. The me Results: an induction-delivery interval was higher in Oral misoprostol when compared to vaginal route and this difference was found to be statistically signicant (p &lt;0.001). However, the oral route was much easier when compared to vaginal route.The maternal morbidities like diarrhoea, fever, PPH, shivering, vomiting and tachysystole were similar in both groups.There were no cases of uterine rupture in the study. The effe Conclusion: ctiveness of different routes of administration was signicant in our study with signicantly shorter mean induction-delivery interval in vaginal route compared to oral route.Although there were few maternal morbidities seen in both groups, there were no statistically signicant differences between two groups

Neglected listeria infection in pregnancy in China: 93 cases

Objective Listeriosis is a foodborne disease that occurs in immunocompromised patients. Pregnant women are a high-risk group for the disease. Listeria infection during pregnancy is uncommon in China because of dietary habits, with little clinician attention and minimal therapeutic options due to its population-specific nature.This article studies the clinical characteristics of Listeria infection in pregnant women and the improvement of treatment methods. Subjects This study collected clinical data from 16 cases of pregnant patients with laboratory-confirmed Listeria monocytogenes infections at the Women and Children's Hospital of Jiaxing University. These data were combined with 77 cases that were reported in the literature for a total of 93 cases of Listeria monocytogenes infection in pregnancy that occurred in China over a 15-year interval. Methods We collected the clinical data of 16 pregnant patients with listeriosis diagnosed in the laboratory of the Women and Children's Hospital of Jiaxing University from May 2013 to December 2020, and combined it with 77 cases of Listeria monocytogenes during pregnancy in China obtained from a literature search. We summarized the clinical features of listeriosis in pregnancy infection and investigated its treatment methods and prevention. Results Ninety-three cases of Listeria monocytogenes infection in pregnancy occurred in early, middle and late pregnancy in 31, 27, and 35 patients, respectively. The initial clinical presentation was fever in 90 patients, intermittent lower abdominal pain in 50 patients, and abnormal fetal movement and/or abnormal fetal heartbeat in 27 cases. Specimens with a positive bacterial culture included the following: 6 amniotic fluid cultures, 35 blood cultures, 37 maternal placenta and uterine secretion cultures, and 15 neonatal blood cultures. Fifty-seven cases of placental pathology, all showing of neutrophil infiltration, were 100% consistent with acute chorioamnionitis. Fifty-eight patients were initially treated with cephalosporin antibiotics, and only 24 cases were initially treated with broad-spectrum penicillins to cover the pathogenic bacteria. Drug sensitivity tests revealed resistant strains, 15 penicillin G-resistant, 14 oxacillin-resistant, and 13 ampicillin-resistant strains. After penicillin failure, vancomycin or meropenem was given. Maternal outcomes included the following: 20 cases of sepsis, 3 cases of pneumonia, 6 cases of acute pyelonephritis, 28 cases of intrauterine infection, 2 cases of multiple organ dysfunction syndromes, and 1 case of septic shock. The fetal and neonatal outcomes were as follows: 16 cases of abortion, 16 cases of intrauterine fetal death, 22 cases of death after birth, and 39 cases of cure. Conclusion In our study and reported cases, Listeria monocytogenes in pregnancy is associated with fever as the primary manifestation, a high incidence of adverse pregnancy outcomes, and a significant increase in fetal and neonatal mortality. The low coverage of practical use of antimicrobial drugs and the emergence of drug-resistant strains in recent years have increased the difficulty of treatment, suggesting the need for clinicians to raise awareness of the disease and strengthen healthy diet promotion for women in pregnancy.

Covid-19 as a possible risk factor of intrauterine fetal death.

To summarize information about possible effects of covid-19 on intrauterine fetal death and present three cases of intrauterine fetal death in women with recent covid-19 infection. Review of available information about pregnancy with covid-19 and comparison with own observation of cases during spring 2021. Covid-19 influences risk of intrauterine fetal death, preeclampsia/eclampsia or HELLP syndrome. Coagulation changes and drop of platelets is considered as one of the causes of intrauterine fetal death due to fetal vascular malperfusion.

Association between fetal vascular malperfusion and gestational diabetes.

Diabetes mellitus (DM) is a major complication in pregnancy. Placental lesions with DM remain unclear and controversial. Recently, the terms of placental pathological findings, such as maternal and fetal vascular malperfusions (MVM and FVM, respectively) were introduced by the Amsterdam Placental Workshop Group Consensus Statement (APWGCS). FVM cases were classified as the partial obstruction type (global FVM) and the complete obstruction type (segmental FVM). The aim of this study was to clarify the pathological characteristics of the placenta with pregestational DM/gestational DM; GDM according to APWGCS. We studied the placentas of 182 DM women (27 pregestational DM and 155 GDM) and control placentas of 460 women without DM during 2011-2018. We excluded cases of intrauterine fetal death or multiple pregnancies. We reviewed microscopical findings including, MVM, FVM, chorioamnionitis with the slides according to the APWGCS. Microscopically, the incidence of FVM was significantly higher in GDM patients than control (17% vs. 10%, p=0.0138), but not significant in pregestational DM (11%, p=0.7410). Segmental FVM (complete obstruction) was significantly more observed in GDM than control group (5% vs. 0.4%, p=0.0013). Segmental FVM in GDM showed high incidence of light-for-dates infant (three of seven cases, 43%, p=0.0288). In addition, several segmental FVM findings (villous stromal-vascular karyorrhexis and stem vessel occlusion) were frequently noted in 2 or 3 points positive of 75 g oral glucose tolerance test than 1 point positive GDM. Our placental findings suggest disorder of carbohydrate metabolism might affect the fetal vascular damage, especially complete fetal vascular obstruction.

VP19.05: Telemedicine for maternal care during COVID‐19 pandemic and its impact on fetal outcome

The COVID 19 pandemic has affected maternity services worldwide. In Qatar, maternity outpatient services were maintained by telemedicine during the peak of the pandemic to ensure continuity of care, patient safety, and quality. As a consequence, a significant decline in face-to-face visits was observed. We decided to conduct a review to determine the effects of telemedicine on pregnancy outcomes in non-COVID-19 infected women. We conducted a retrospective review at a Secondary Hospital in Qatar. Electronic records of the women who delivered between Feb-July 2020 were evaluated. Women infected by COVID 19, were excluded. Pregnancy outcomes like miscarriages, preterm labour and cases of intrauterine fetal death were noted. A comparative analysis was conducted with women who delivered in the preceding year in the same time frame. Odd's ratio was evaluated using online Medcal online software. There was an increase in the number of women delivering during the pandemic (n = 4436) as compared to the pre-pandemic period (n = 3154). The prevalence of preterm birth was similar, 7.55% and 7.29% (OR-0.91,95% CI-0.758 -1.08, P > 0.05) in the pre and during the pandemic respectively. The incidence of miscarriages was alike, 22.10% and 21.32% (OR-1.07,95% CI-0.96-1.1892, P > 0.05). A higher incidence of intrauterine fetal death was recorded at a rate of 0.58% during the pandemic compared to 0.095% in the pre-pandemic (OR-6.09,95% CI-0.1.83 -20.19 P < 0.05). The COVID 19 pandemic has impacted care provision in maternity services across the world strained pregnant women and maternity services. In our review, there was an increased incidence in cases of IUD. The reasons are unclear. The importance of patient education becomes even more critical with provision for face to face reviews when indicated.

Prevalence and Pregnancy Outcomes of Intrahepatic Cholestasis of Pregnancy.

Intrahepatic cholestasis of pregnancy is a common pregnancy-specific liver disease associated with increased risk of adverse fetal and maternal outcomes. We sought to determine its prevalence, risk factors and feto-maternal outcomes. A retrospective review of data of 164 pregnant women diagnosed with intrahepatic cholestasis of pregnancy at Chitwan Medical College, Nepal from August 2018 to September 2020 was done. Socio-demographic data, clinic-laboratory profile and feto-maternal outcomes were obtained from clinical audit books and electronic records. A multivariate logistic regression analysis was used to evaluate the predictors of adverse neonatal outcome. The prevalence of intrahepatic cholestasis of pregnancy was 2.5% (164 out of 6539 deliveries). The mean age was 27.5 ± 4.4 years and 51.2% were multigravida. The preterm delivery rate was 15.2% and Caesarean delivery rate was 69.5%. 22% of the neonates needed intensive care admission out of which Respiratory Distress Syndrome or Transient Tachypnea of Newborn was seen in half of them. There were 2 cases of Intrauterine Fetal Death. In multivariate analysis, delivery <34 weeks of gestation was only found to be a significant independent predictor of adverse neonatal outcome Conclusion: The prevalence of intrahepatic cholestasis of pregnancy among pregnant women is significant in our setting which is associated with adverse fetal outcome. Early diagnosis and timely intervention is necessary in order to reduce associated perinatal morbidity.

Clinical characteristics, CT features and perinatal outcome of COVID-19 pneumonia in pregnant women and comparison with non-pregnant women

Background and Objective: To evaluate the clinical course and CT findings of pregnant womenMethods: Fourthy (25 pregnant and 15 non-pregnant) patients were entered to the study. Chest CT features and clinical findings were evaluated between two groups. Data related to pregnancy and fetal status evaluated in the pregnant group.Result: The average age of pregnant patients was 33.1±5.75 years and the non-pregnant group was 35.4±6.88 years. The gestational age ranged from 7 weeks to 39weeks+2days (mean =31weeks+5days). No significant difference was seen between the two groups about clinical findings except the duration of symptoms before CT which was more in pregnant patients (6.71 ± 5.5 days vs 3.53 ± 1.92 days). Two mortalities in pregnant and one in non-pregnant patients , 2(8%) cases of premature rupture of membranes (PROM), 3 (12%) cases of intra-uterine fetal death (IUFD), 3 (12%) cases of fetal distress and 2 (8%) cases of IUGR in pregnant group. Fifteen pregnant patients gave birth .No positive PCR result was detected in newborns. Unlike the control group, the common CT findings were ground-glass pattern.Conclusion: In summary, although we found the clinical findings in pregnant and control group were similar but pattern of CT involvement was different in pregnant patients and rate of ICU admission and mortality rate were more than control group. This viral pneumonia was associated with some important complications such as IUFD in severely involved mothers. CT could be an efficient tool for the early detection and severity assessment in the pregnant patients with COVID-19 pneumonia.

Influence of indications on perinatal outcomes after radio frequency ablation in complicated monochorionic pregnancies: a retrospective cohort study

BackgroundRadiofrequency ablation (RFA) is recommended to prevent potential neurological injury or intrauterine foetal death (IUFD) of the co-twin(s) in complicated monochorionic (MC) pregnancies. However, the impacts of various indications on the pregnancy outcome following RFA remain unclear. This study aimed to determine how the indications influence the perinatal outcomes in complicated MC pregnancies undergoing radiofrequency ablation.MethodsThis was a retrospective cohort study performed in a single centre. All consecutive MC pregnancies treated with RFA between July 2011 and July 2019 were included. The adverse perinatal outcomes and the survival rate were analysed based on various indications. The continuous variables with and without normal distribution were compared between the groups using Student’s t-test and Mann–Whitney U test, respectively, and for categorical variables, Chi-square and Fisher’s exact tests were used. P < 0.05 indicated a significant difference.ResultsWe performed 272 RFA procedures in 268 complicated MC pregnancies, including 60 selective intrauterine growth restriction (sIUGR), 64 twin–twin transfusion syndrome (TTTS), 12 twin reversed arterial perfusion sequence (TRAPs), 66 foetal anomaly and 66 elective foetal reduction (EFR) cases. The overall survival rate of the co-twin was 201/272 (73.9%). The overall technical successful rate was determined at 201/263 (76.7%). The IUFD rate in the co-twin was 20/272 (7.4%). The TTTS group had recorded the lowest survival rate (37/64, 57. 8%), and the survival rate was significantly correlated with Quintero stages (P = 0.029). Moreover, the sIUGR III subgroup had a lower survival rate compared with sIUGR II (55.6%, versus 84.3%). The subgroup of foetal anomaly of gastroschisis or exomphalos had the highest IUFD rate (4/10, 40%), followed by sIUGR III (2/9, 22.2%) and dichorionic triamniotic (DCTA) subgroup (8/46, 17.9%). In EFR group, eight IUFD cases were all coming from the DCTA subgroup and received RFA before 17 weeks.ConclusionsThe perinatal outcome of RFA was correlated with the indications, with the lowest survival rate in TTTS IV and the highest IUFD incidence in abdominal wall defect followed by sIUGR III. Elective RFA after 17 weeks may prevent IUFD in DCTA pregnancies.

Group B Streptococcus serotypes associated with different clinical syndromes: Asymptomatic carriage in pregnant women, intrauterine fetal death, and early onset disease in the newborn.

ObjectivesTo study Group B Streptococcus (GBS) isolates associated with different clinical syndromes: asymptomatic carriage in pregnant women, intrauterine fetal death (IUFD), and early onset disease (EOD) in the newborn.MethodsGBS isolates were collected from asymptomatic pregnant women admitted for labor, IUFD cases, and neonates with EOD. Serotypes and antibiotic susceptibilities were determined. Multilocus sequence typing (MLST) was performed to assess genetic epidemiology.ResultsGBS carriage rate was 26.1% (280/1074). The dominant serotype among asymptomatic pregnant women was VI [98/240 women (40.8%)], followed by serotypes III, V and IV in 42/240 (17.5%), 30/240 (12.5%) and 28/240 (11.7%) women, respectively. The dominant serotype in IUFD cases was serotype VI [10/13 (76.9%)]. In contrast the prevalent serotype among EOD cases was III [16/19 (84.2%)]. ST-1 was associated with IUFD [7/13 (53.8%)], ST-17 was associated with serotype III and EOD in the newborn 14/19 (73.7%)]. Erythromycin and clindamycin resistance reached 36.8%, 7.7% and 20.0%among EOD, vaginal carriage and IUFD, respectively.ConclusionsSerotypes VI and ST-1 were dominant among asymptomatic pregnant women and in IUFD cases while EOD was associated with serotype III and ST-17. Invasive mechanisms thus may differ between IUFD and EOD in the newborn and virulence may be related to capsule serotype. Resistance rates to erythromycin and clindamycin were high in EOD cases.

Alternative Hysterotomy Technique for the Reduction of Prenatal Complications of Intrauterine Myelomeningocele Repair

Introduction: The main aim of the fetal surgery of myelomeningocele (MMC) is the improvement in prognosis for children with this defect and at the same time high safety of the procedure for mother and fetus. Objective: The aim of the study was to determine the effectiveness of alternative hysterotomy technique for fetal surgery of MMC in prevention of essential perinatal complications. Methods: Forty-nine pregnant women diagnosed with fetal MMC (fMMC) who underwent classic hysterotomy without the use of stapler formed the study cohort. Two cases of intrauterine fetal death or neonatal death in the immediate perioperative period in the study group (SG) were excluded from further analyses. In the historical control group (46 patients) from our center hysterotomy was performed according to Management of Myelomeningocele Study (MOMS) protocol. The study cohort’s outcomes were compared with the historical controls and with post-MOMS results in Children’s Hospital of Philadelphia (CHOP) and Vanderbilt University Medical Center (VUMC). Results: In the SG we did not observe delivery before 30 weeks of gestation (0/47; 0%) and the incidence of chorionamniotic membrane separation (CMS, 3/47; 6%) and preterm premature rupture of membranes (PPROM, 7/47; 15%) was lower compared to the other groups. Preterm delivery as a result of uterine contractions occurred significantly less frequently in the SG (8/47; 17%). Fetal surgery with classic hysterotomy resulted in rare use of magnesium sulfate (3/47; 6%). Conclusions: The alternative hysterotomy technique for fetal surgery of MMC results in low occurrences of CMS, PPROM, preterm delivery, and the rare use of tocolytics.

Sonographic Assessment of Umbilical Cord Diameter as an Indicator of Fetal Growth and Perinatal Outcome

Objective: To determine whether the assessment of umbilical cord diameter (UCD) is a viable indicator of fetal growth and perinatal outcome. Material and Methods: A total of 652 singleton pregnancies between 10 and 40 weeks of gestation were reviewed for this study. The UCD was measured vertically in the longitudinal section, adjacent to its insertion at the fetal abdomen. Other fetal biometrics were measured according to standard measurement protocols. The perinatal outcome of each patient case was also recorded. Result: The UCD ranged between 0.73 and 1.68 cm, and correlated positively with gestational age, estimated fetal weight ( r = 0.779, r = 0.639, P &lt; .05), and other fetal biometrics. The UCD of 50 subjects was 2 standard deviations below the mean and correlated significantly ( r = 0.712, P &lt; .05) with poor fetal outcome in the first and second trimester. Observational studies of 50 subjects, whose UCD was 2 standard deviations below the mean, resulted in 21 cases of intrauterine fetal death, 10 cases of preeclampsia, 8 cases of oligohydramnios, and 11 cases of intrauterine growth restriction. Conclusion: The UCD has the potential to serve as an important indicator of fetal growth, well-being, and perinatal outcome.

The correlation between the number of vaginal examinations during active labor and febrile morbidity, a retrospective cohort study

BackgroundThe association between the number of vaginal examinations (VEs) performed during labor and the risk of infection is unclear. The literature regarding this issue is not consensual, and the available studies are relatively small. Therefore, we aimed to study the association between the number of VEs during labor, and maternal febrile morbidity, in a very large cohort.MethodsThis is a retrospective cohort study. All women who delivered vaginally ≥37 weeks, at our institute, between 2008 and 2017 were included. Patients who underwent cesarean delivery or who were treated with prophylactic antibiotics, or had a fever ≥38.0 °C prior to the first VE were excluded. Cases of intrauterine fetal death, known malformations, or missing data were excluded as well. The cohort was divided according to the number of VEs performed: up to 4 VEs (n = 9716), 5–6 VEs (n = 4624), 7–8 VEs (n = 2999), and 9 or more VEs (n = 4844). The rates of intrapartum febrile morbidity (intrapartum fever and chorioamnionitis), postpartum febrile morbidity (postpartum fever and endometritis), and peripartum febrile morbidity (any of the mentioned complications) were compared.ResultsOverall, 22,183 women were included in the study. On multivariate analysis, we found that performing 5 VEs or more during labor was independently associated with intrapartum febrile morbidity (5–6 VEs: aOR = 1.83, 95% CI (1.29–2.61), 7–8 VEs: aOR = 2.65 95% CI (1.87–3.76), 9 or more VEs aOR = 3.47 95% CI (2.44–4.92)), postpartum febrile morbidity (5–6 VEs: aOR = 1.29, 95% CI (1.09–1.86), 7–8 VEs: aOR = 1.94 95% CI (1.33–2.83), 9 or more VEs aOR = 1.91 95% CI (1.28–2.82)), and peripartum morbidity (5–6 VEs: aOR = 1.48, 95% CI (1.15–1.91), 7–8 VEs: aOR = 2.15 95% CI (1.66–2.78), 9 or more VEs: aOR = 2.57 95% CI (1.97–3.34)).ConclusionThe number of VEs performed during labor is directly correlated with febrile morbidity. Performing five or more VEs during labor is independently associated with febrile morbidity; For intrapartum and peripartum febrile morbidity the risk rises as more VEs are performed.