Delivery Of Fetus Research Articles

Optimizing lipid nanoparticles for fetal gene delivery in vitro, ex vivo, and aided with machine learning

There is a clinical need to develop lipid nanoparticles (LNPs) to deliver congenital therapies to the fetus during pregnancy. The aim of these therapies is to restore normal fetal development and prevent irreversible conditions after birth. As a first step, LNPs need to be optimized for transplacental transport, safety on the placental barrier and fetal organs and transfection efficiency. We developed and characterized a library of LNPs of varying compositions and used machine learning (ML) models to delineate the determinants of LNP size and zeta potential. Utilizing different in vitro placental models with the help of a Random Forest algorithm, we could identify the top features driving percentage LNP transport and kinetics at 24 h, out of a total of 18 input features represented by 41 LNP formulations and 48 different transport experiments. We further evaluated the LNPs for safety, placental cell uptake, transfection efficiency in placental trophoblasts and fetal lung fibroblasts. To ensure the integrity of the LNPs following transplacental transport, we screened LNPs for transport and transfection using a high-throughput integrated transport-transfection in vitro model. Finally, we assessed toxicity of the LNPs in a tracheal occlusion fetal lung explant model. LNPs showed little to no toxicity to fetal and placental cells. Immunoglobin G (IgG) orientation on the surface of LNPs, PEGylated lipids, and ionizable lipids had significant effects on placental transport. The Random Forest algorithm identified the top features driving LNPs placental transport percentage and kinetics. Zeta potential emerged in the top driving features. Building on the ML model results, we developed new LNP formulations to further optimize the transport leading to 622 % increase in transport at 24 h versus control LNP formulation. To induce preferential siRNA transfection of fetal lung, we further optimized cationic lipid percentage and the lipid-to-siRNA ratio. Studying LNPs in an integrated placental and fetal lung fibroblasts model showed a strong correlation between zeta potential and fetal lung transfection. Finally, we assessed the toxicity of LNPs in a tracheal occlusion lung explant model. The optimized formulations appeared to be safe on ex vivo fetal lungs as indicated by insignificant changes in apoptosis (Caspase-3) and proliferation (Ki67) markers. In conclusion, we have optimized an LNP formulation that is safe, with high transplacental transport and preferential transfection in fetal lung cells. Our research findings represent an important step toward establishing the safety and effectiveness of LNPs for gene delivery to the fetal organs.

Peri-Operative Complications And Surgical Outcomes In Repeat Cesarean Section: A Retrospective Analysis

Introduction: Repeat cesarean sections are becoming increasingly common due to the global rise in cesarean deliveries. While cesarean sections can be life-saving for both mother and baby, the risks associated with multiple procedures tend to increase. This study aims to evaluate these complications and outcomes to guide safer practices. Methods: This observational cross-sectional study was conducted Department of Obstetrics & Gynaecology, Chittagong Medical College & Hospital, from December 16-June’17. All the pregnant women who underwent repeat Caesarean section in Chittagong Medical College Hospital, Chittagong during the study period were considered as the study population. A total of 100 study subjects were selected by consecutive convenient sampling techniques. Data analysis was done by SPSS (Statistical Package for Social Sciences) 16. In all cases, p-value <05 was considered significant. Result: most repeat cesarean sections (70%) lasted about 1 hour, with 99% utilizing the Pfannenstiel incision. Adhesions were observed primarily with the bladder (8%), peritoneum (5%), and omentum (5%). A lower transverse uterine incision was used in 99% of cases, while 5% experienced scar dehiscence. Challenges during fetal delivery occurred in 5% of cases, and 3% had difficulty entering the peritoneal cavity. Placental abnormalities like placenta previa were noted in 6% of cases, and placental adherence (accreta or percreta) was found in 3%. Urinary bladder injuries occurred in 2% of cases. Blood loss was below 1 liter in 95% of surgeries, but 3% required significant transfusions. Elective tubal ligation was performed in 15% of cases, and some patients underwent additional procedures like Lynch surgeries or uterine artery ligations (3%). Conclusion: Notable complications are observed in repeat cesarean sections, including adhesions with the bladder, scar dehiscence, and challenges during fetal delivery. Additionally, placental abnormalities, such as placenta previa and abnormal adherence, highlight the complexities associated with repeat procedures. Most patients experienced minimal blood loss, with 95% losing less than 1 liter.

Spontaneous Umbilical Cord Vascular Rupture during Labor: A Retrospective Analysis of 12 Cases.

Umbilical cord vascular rupture is a rare and severe condition that can occur during labor, leading to adverse outcomes for the fetus before as well as after delivery. Prompt diagnosis and intervention are crucial for improving the chances of a successful outcome. We aimed to analyze cases of umbilical cord vascular rupture during labor to provide insights into this challenging condition. This retrospective study evaluated the medical records of patients diagnosed with umbilical cord vessel rupture or umbilical cord hematoma at Fujian Maternity and Child Health Hospital from January 1, 2015, to May 31, 2023. The inclusion criteria included gestational age of ≥28 weeks, occurrence during labor, and availability of complete delivery data. Data on fetal heart rate (FHR) changes, delivery intervals, intraoperative findings, placental pathology, and neonatal outcomes were collected and analyzed. A total of 12 cases were analyzed. The incidence of umbilical cord vascular rupture during childbirth was 0.08%. The FHR patterns in umbilical cord rupture during delivery included baseline tachycardia, minimal or absent variability, variable or late deceleration, prolonged deceleration, and undetectable heart rate. The bradycardia-to-delivery interval (BDI) ranged from 6 to 26 minutes. Among the 12 neonates, 9 were discharged well, 2 were stillbirths, and there was 1 neonatal death. Hemorrhagic shock was common in live births. Our study highlights the significance of continuous FHR monitoring during labor and the urgent need for medical teams to respond quickly in cases of umbilical cord vascular rupture. Despite advancements in neonatal resuscitation techniques, managing cases with undetectable fetal heart activity remains clinically challenging, and even with immediate pregnancy termination, poor neonatal outcomes may still occur. · Umbilical cord vascular rupture during labor is a rare event.. · Its clinical management presents significant challenges.. · Advances in neonatal resuscitation have improved rescue success rates.. · In such cases, hemorrhagic shock is common in live births..

Forceps (Ergonomic Operation): An Effective Aid for Fetal Head Delivery during Cesarean Section

Forceps (Ergonomic Operation): An Effective Aid for Fetal Head Delivery during Cesarean Section

Assessing the Role of Fetal Doppler in High-Risk Obstetrics: Evidence From a Comprehensive Study.

Background Colour Doppler ultrasound is pivotal in modern obstetrics for evaluating maternal and fetal health, especially in high-risk pregnancies. It enhances fetal oxygenation and nutrient delivery assessment, aiding in the early detection of adverse outcomes. However, its effectiveness is influenced by operator skill and the potential for interpretative variability. Aim This study aims to assess the utility of Doppler ultrasound in evaluating fetal status in high-risk pregnancies at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India. Materials and methods A hospital-based observational study was conducted from September 2022 to July 2024, including 145 high-risk pregnant women, of whom 120 delivered at the institute. The study included thorough maternal and fetal assessments, with regular Doppler studies starting at 28 weeks of gestation. The frequency of these studies was adjusted according to the changes and severity observed in the indices. Detailed documentation of both maternal and neonatal outcomes was meticulously maintained. Statistical analyses were performed using MS Excel (Microsoft® Corp., Redmond, WA, USA) and RStudio,Version 2023.08.0-daily+170 (RStudio, Inc., Boston, MA, USA), with a significance threshold of p < 0.05. Results The majority of participants were aged 21-30 years, with multigravida constituting 63.33%. Pregnancy-induced hypertension (PIH) and preeclampsia were the most common high-risk factors (28.33%). Abnormal umbilical artery (UA) flow patterns were observed in 58.33% of cases. Abnormal UA and middle cerebral artery (MCA) Doppler indices correlated significantly with adverse outcomes. Most deliveries were via caesarean section (82.5%), and 63.33% of neonates required Neonatal Intensive Care Unit (NICU) admission. Neonates with abnormal antenatal Doppler studies had significantly lower APGAR (appearance, pulse, grimace, activity, and respiration) scores and higher NICU admission rates. Discussion The study highlights the critical role of Doppler ultrasound in managing high-risk pregnancies, providing essential data for early interventions. Consistent with other studies, abnormal Doppler patterns were significantly associated with adverse neonatal outcomes, necessitating timely caesarean deliveries. Conclusion Fetal Doppler ultrasonography is essential for managing high-risk pregnancies, enabling timely therapeutic interventions and improving perinatal outcomes. Despite its limitations, Doppler technology remains invaluable in identifying at-risk foetuses and guiding clinical decisions for optimal pregnancy management.

Rising Stillbirth Rates Related to Congenital Syphilis in the United States From 2016 to 2022.

To identify trends in stillbirth rates attributed to congenital syphilis in the United States by describing congenital syphilis-related stillbirths and comparing characteristics of pregnant people who had congenital syphilis-related stillbirths with those of people who had preterm and full-term liveborn neonates with congenital syphilis. Cases of congenital syphilis reported to the Centers for Disease Control and Prevention during 2016-2022 were analyzed and categorized as stillbirth, preterm live birth (before 37 weeks of gestation), or term live birth (37 weeks or later). Cases with unknown vital status or gestational age were excluded. Frequencies were calculated by pregnancy outcome, including pregnant person demographics; receipt of prenatal care; syphilis stage and titer; and timing of prenatal care, testing, and treatment. Overall, 13,393 congenital syphilis cases with vital status and gestational age were reported; of these, 853 (6.4%) were stillbirths. The number of congenital syphilis-related stillbirths increased each year (from 44 to 231); the proportion of congenital syphilis cases resulting in stillbirth ranged from 5.2% to 7.5%. Median gestational age at delivery for stillborn fetuses was 30 weeks (interquartile range 26-33 weeks). People with congenital syphilis-related stillbirths were more likely to have titers at or above 1:32 (78.9% vs 45.5%; P<.001) and to have received no prenatal care (58.4% vs 33.1%; P<.001) than people with liveborn neonates with congenital syphilis. The risk of stillbirth was twice as high in persons with secondary syphilis compared with those with primary syphilis (11.5% vs 5.7%, risk ratio 2.00; 95% CI, 1.27-3.13). Across all congenital syphilis cases, 34.2% of people did not have a syphilis test at their first prenatal visit. Stillbirths occurred in more than 1 in 20 pregnancies complicated by congenital syphilis. Risk factors for stillbirth included high titers, secondary stage, and lack of prenatal care. If the prevalence of congenital syphilis continues to rise, there will be a corresponding increase in the overall stillbirth rate nationally.

North American Fetal Therapy Network: Maternal Outcomes in Fetal Aqueductal Stenosis.

Fetal aqueductal stenosis (AS) affects approximately 1:1,000 pregnancies. Obstruction of cerebral spinal fluid circulation occurs at the aqueduct of Sylvius, leading to progressive hydrocephalus and macrocephaly, which often necessitates cesarean section (CS). The purpose of this study was to describe maternal outcomes associated with fetal AS. This study is conducted through the North American Fetal Therapy Network (NAFTNet). Subjects with a prenatal diagnosis of severe fetal central nervous system ventriculomegaly were recruited and followed longitudinally. Maternal events around the delivery of fetuses with AS were recorded and analyzed. Thirty-seven subjects with fetal AS confirmed by neonatal neuroimaging were analyzed. The average gestational age at delivery was 36.7 weeks. Overall, 86% were delivered by CS, and 62% of these were elective. Ninety-one percent of CSs were performed through a Pfannenstiel abdominal incision. A classical uterine incision was required in 13% of cesarean deliveries. The peripartum complication rate was 27%. Women carrying a fetus with AS were at risk for preterm birth, cesarean delivery, a classical uterine incision, and peripartum complications. These data highlight the maternal morbidity associated with fetal AS and the potential benefit of in utero therapy not only for neonatal outcomes but also for maternal outcomes.

The significance of delivery methods and fetal gender in reducing stillbirth rate: Using the generalized regression model

AimDespite stillbirth being a significant burden for maternal lives, families, and communities worldwide, it is often neglected and overlooked in many countries. The fetal gender and the delivery method are two interaction factors that directly impact the stillbirth rate. This study aimed to identify the impact of fetal gender on stillbirth delivery methods, either cesarean section or vaginal delivery. MethodThe current research analyzed the stillbirths recorded over ten years between January 1st, 2008, and December 31st, 2017, obtained from the Maternity Teaching Hospital in Erbil City, the capital of the Kurdistan Region of Iraq. ResultsThe results showed that stillbirths remain a significant public health concern in the region, with 11.7 stillbirths occurring for every 1000 deliveries. The generalized regression model for each normal, beta, and gamma distribution was used to determine the best fit of the data. The study found that for fetal males, vaginal delivery reduced the stillbirth rate by 4.2 % and the cesarean section rate by 3.6 % while for fetal females, vaginal delivery reduced the stillbirth rate by 4.7 % and the cesarean section rate by 6 %. ConclusionThe findings suggest that healthcare in the region should prioritize reducing the incidence of stillbirths during pregnancy and delivery, considering factors such as fetal gender and delivery mode.

Maternal and fetal outcomes of antiepileptic treatments during pregnancy: A retrospective study

IntroductionEpilepsy is a disease that affects a significant proportion of the female population worldwide. The management of anti-seizure medications during pregnancy and the potential adverse outcomes to both the mother and fetus represent a significant challenge. This retrospective study aimed to evaluate the impact of anti-seizure medications during pregnancy by comparing maternal and fetal outcomes between pregnant women with and without epilepsy. MethodsA total of 242 participants were analysed, including 112 with epilepsy and 130 healthy pregnant controls. Maternal age, medical history, seizure characteristics, use of anti-seizure medications, and pregnancy history were recorded. Maternal and fetal complications, delivery modes, and perinatal outcomes were evaluated. ResultsA total of 242 patients, including 112 (46.3 %) pregnant women with epilepsy and 130 (53.7 %) healthy pregnant women, were included in the study. Among pregnant patients with epilepsy, 4 (3.5 %) did not use anti-seizure medications, 79 (70.5 %) received monotherapy, and 29 (25.8 %) received polytherapy. The rates of pregnancy termination, spontaneous abortion, and maternal and fetal complications were significantly higher in pregnant women with epilepsy (p = 0.045, p = 0.045, p < 0.001, and p = 0.016, respectively). Folic acid use, planned pregnancy rate and postpartum breastfeeding rate were all statistically lower in pregnant women with epilepsy (p < 0.001, p < 0.001, p < 0.001, respectively). The rates of intensive care unit stay, infants with birth weight less than 2500 g, congenital malformations, and preterm births were significantly higher in babies born to pregnant women with epilepsy (p < 0.001, p = 0.047, p = 0.003, and p = 0.051, respectively). Gestational diabetes mellitus was observed in 4 (13.8 %) and congenital malformations in 4 (14.3 %) of the pregnant women with epilepsy who received polytherapy, and in both cases these rates were statistically higher than those of pregnant women with epilepsy who received monotherapy (p = 0.048 and p = 0.004, respectively). DiscussionThis study demonstrated that pregnancies among women affected by epilepsy have significantly higher rates of maternal and fetal complications, spontaneous abortions, and premature births. Polytherapy with anti-seizure medications is associated with an increased risk of gestational diabetes and congenital anomalies. Notably, folic acid use, planned pregnancy, and postpartum breastfeeding were less common in patients with epilepsy. The most commonly prescribed anti-seizure medications were levetiracetam and lamotrigine. Caesarean section is a common mode of delivery in pregnancies of mothers with epilepsy. ConclusionThese results suggest that epilepsy increases both maternal and fetal complications during pregnancy. Furthermore, the use of anti-seizure medications appears to have a significant impact on pregnancy outcomes. Our findings highlight the need for comprehensive management strategies and informed decision making to reduce risks and optimise maternal and fetal outcomes among women with epilepsy.

Extracorporeal Membrane Oxygenation in Amniotic Fluid Embolism: A Systematic Review of Case Reports.

Amniotic fluid embolism (AFE) is an obstetric complication that can result in acute circulatory failure during and after labor. The effectiveness of extracorporeal membrane oxygenation (ECMO) in AFE patients has not been established, especially in the context of coagulopathy. This review aims to evaluate the efficacy of ECMO support in AFE patients. We conducted a systematic review of case reports following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment was performed using a standardized tool. Out of 141 studies screened, 33 studies included 79 AFE patients. The median age was 34 years, and the median gestational age was 37.5 weeks. The majority of AFE cases occurred during cesarean section delivery (55.2%), followed by labor before fetal delivery (26.7%). Extracorporeal membrane oxygenation configurations included venoarterial ECMO (81.3%) and extracorporeal cardiopulmonary resuscitation (CPR, 10.7%). The maternal survival rate was 72%, with 21.2% experiencing minor neurological sequelae and 5.8% having major neurological sequelae. Rescue ECMO to support circulation has demonstrated both safety and efficacy in managing AFE. We suggest early activation of local or mobile ECMO as soon as an AFE diagnosis is established. Further studies are needed to assess the benefits and implications of early ECMO support in AFE patients.

Comparative Efficacy of Intermittent Bolus Doses of Phenylephrine and Norepinephrine in Preventing Maternal Bradycardia during Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

Background and Aims: Maternal hypotension is a common concern during cesarean sections (CS) with spinal anesthesia and can have adverse consequences for both the mother and fetus. This study aimed to investigate the prophylactic effectiveness of intermittent boluses of phenylephrine and norepinephrine in preventing maternal bradycardia during maintenance of systolic blood pressure (SBP) within 90–100% of baseline. Material and Methods: Two hundred American Society of Anesthesiologists physical status -II parturients scheduled for CS with subarachnoid block (SAB) were randomly assigned to Group A (phenylephrine, 50 µg) or Group B (norepinephrine, 4 µg). The primary goal was to assess the incidence of maternal bradycardia (≤50 bpm) whilst SBP maintenance at 90-100% of baseline. The secondary objectives encompassed total boluses administered, episodes of hypertension (≥120% of baseline), Intraoperative nausea and vomiting (IONV), and neonatal APGAR scores. The time from intrathecal injection to fetal delivery (induction–delivery interval) was also evaluated. Results: Both norepinephrine and phenylephrine groups effectively prevented spinal-induced hypotension, with similar outcomes However, Group A (phenylephrine) experienced a significantly higher incidence of bradycardia (18%) compared to Group B (norepinephrine) with only 5% (P=0.016). Episodes of hypertension, IONV, and neonatal APGAR scores were comparable between the two groups. Conclusion: Intermittent boluses of norepinephrine and phenylephrine demonstrated equivalent efficacy in preventing spinal-induced hypotension during CS. However, norepinephrine exhibited an advantage over phenylephrine by significantly reducing the incidence of bradycardia. These findings support the consideration of norepinephrine as an effective alternative vasopressor for maintaining maternal hemodynamics during CS under SAB.

Effect of intravenous palonosetron on hypotension induced by spinal anesthesia for cesarean section: A randomized controlled trial.

The aim of this study was to evaluate the impact of intravenous palonosetron compared to ondansetron on hypotension induced by spinal anesthesia in women undergoing cesarean section. Fifty-four women scheduled for elective cesarean section were, randomly allocated to ondansetron group (n = 27) or palonosetron group (n = 27). Ten minutes prior to the administration of spinal anesthesia, participants received an intravenous injection of either ondansetron or palonosetron. A prophylactic phenylephrine infusion was initiated immediately following the intrathecal administration of bupivacaine and fentanyl. The infusion rate was titrated to maintain adequate blood pressure until the time of fetal delivery. The primary outcome was total dose of phenylephrine administered. The secondary outcomes were nausea or vomiting, the need for rescue antiemetics, hypotension, bradycardia, and shivering. Complete response rate, defined as the absence of postoperative nausea and vomiting and no need for additional antiemetics, were assessed for up to 24 hours post-surgery. No significant differences were observed in the total dose of phenylephrine used between the ondansetron and palonosetron groups (387.5 μg [interquartile range, 291.3-507.8 μg versus 428.0 μg [interquartile range, 305.0-507.0 μg], P = 0.42). Complete response rates also showed no significant differences between the groups both within two hours post-spinal anesthesia (88.9% in the ondansetron group versus 100% in the palonosetron group; P = 0.24) and at 24 hours post-surgery (81.5% in the ondansetron group versus 88.8% in the palonosetron group; P = 0.7). In addition, there was no difference in other secondary outcomes. Prophylactic administration of palonosetron did not demonstrate a superior effect over ondansetron in mitigating hemodynamic changes or reducing phenylephrine requirements in patients undergoing spinal anesthesia with bupivacaine and fentanyl for cesarean section.

Chronic endometritis - a constantly discussed issue in infertile women.

A review of current knowledge on the pathophysiology, diagnostic and treatment options for chronic endometritis in infertile women. One of the major causes of failed in vitro fertilization (IVF) is undiagnosed intrauterine pathologies, including chronic inflammation of the uterine mucosa - chronic endometritis. However, some authors relativize the negative impact of chronic endometritis on reproductive outcomes. The etiopathogenesis of chronic endometritis is due to qualitative and quantitative changes in the endometrial microbiome with abnormal multiplication of microorganisms naturally occurring in the uterine cavity or vagina. There is no uniform consensus on the most common pathogen causing chronic endometritis. It is characterized by infiltration of plasma cells into the endometrial stroma outside the menstrual cycle, accompanied by hyperaemia and endometrial oedema. Clinical symptoms are very mild or absent. The diagnosis of chronic endometritis is often difficult because there is no specific clinical or laboratory diagnostic method. The following investigative options are commonly used for the diagnosis of chronic endometritis: diagnostic hysteroscopy, histopathological examination of the endometrium including CD 138 immunohistochemistry and culture from the uterine cavity. However, standardised international hysteroscopic and histopathological criteria for accurate diagnosis of chronic endometritis are still lacking. Empirically administered antibiotic therapy improves the success rate of pregnancy and delivery of a viable foetus in infertile patients with proven chronic endometritis. In addition to reviewing the current knowledge of chronic endometritis, this article discusses the importance of hysteroscopy in the diagnostic process. Chronic endometritis is often a clinically silent disease with negative impact on reproduction in infertile women. Although there are still many unresolved issues, the introduction of hysteroscopy into the diagnostic process is important for clinical practice; however, hysteroscopy even in combination with histological examination of the endometrium, often does not allow an unequivocal diagnosis of chronic endometritis. Further prospective randomised studies in a selected group of women with proven chronic endometritis and repeated failure to implant proven euploid embryos should refine this knowledge.

Acute-on-chronic: using magnetic resonance imaging to disentangle the haemodynamic responses to acute and chronic fetal hypoxaemia.

The fetal haemodynamic response to acute episodes of hypoxaemia are well characterised. However, how these responses change when the hypoxaemia becomes more chronic in nature such as that associated with fetal growth restriction (FGR), is less well understood. Herein, we utilised a combination of clinically relevant MRI techniques to comprehensively characterize and differentiate the haemodynamic responses occurring during acute and chronic periods of fetal hypoxaemia. Prior to conception, carunclectomy surgery was performed on non-pregnant ewes to induce FGR. At 108-110 days (d) gestational age (GA), pregnant ewes bearing control (n = 12) and FGR (n = 9) fetuses underwent fetal catheterisation surgery. At 117-119 days GA, ewes underwent MRI sessions where phase-contrast (PC) and T2 oximetry were used to measure blood flow and oxygenation, respectively, throughout the fetal circulation during a normoxia and then an acute hypoxia state. Fetal oxygen delivery (DO2) was lower in FGR fetuses than controls during the normoxia state but cerebral DO2 remained similar between fetal groups. Acute hypoxia reduced both overall fetal and cerebral DO2. FGR increased ductus venosus (DV) and foramen ovale (FO) blood flow during both the normoxia and acute hypoxia states. Pulmonary blood flow (PBF) was lower in FGR fetuses during the normoxia state but similar to controls during the acute hypoxia state when PBF in controls was decreased. Despite a prevailing level of chronic hypoxaemia, the FGR fetus upregulates the preferential streaming of oxygen-rich blood via the DV-FO pathway to maintain cerebral DO2. However, this upregulation is unable to maintain cerebral DO2 during further exposure to an acute episode of hypoxaemia. The haemodynamic alterations required at the level of the liver and lung to allow the DV-FO pathway to maintain cerebral DO2, may have lasting consequences on hepatic function and pulmonary vascular regulation after birth.

Severe fetal distress and acute maternal pancreatitis secondary to severe hypertriglyceridemia: a case report

BackgroundAcute pancreatitis (AP) during pregnancy is a rare condition and a potential cause of maternal–fetal mortality. Its diagnosis can be challenging. Hypertriglyceridemia (HTG) is one of the causes. We describe a case of severe fetal distress in the third trimester of pregnancy, associated with severe HTG complicated by AP.Case presentationA 35-year-old pregnant patient at 36-week gestation presented to the emergency department with acute epigastric pain. After excluding preeclampsia and initially challenging laboratory analyses, a diagnosis of AP was made based on a lipase level 12 times the normal range. The etiology was HTG at 40 times the normal level. Despite initial conservative management, the patient deteriorated rapidly clinically, and severe fetal distress (SFD) necessitated an emergency cesarean section. Lactescent blood appearance was observed intraoperatively. We suspect that the severe and rapid HTG may have caused acute fetal hypoxia.ConclusionsAP during pregnancy is a rare condition, with significant maternal–fetal mortality. Early diagnosis remains challenging. A multidisciplinary approach is necessary for optimal management, with special consideration for rapid fetal delivery in cases of AP secondary to HTG due to the increased risk of fetal mortality.

Preterm Birth, Low Birth Weight, and Medical Comorbidities Are Risk Factors for Severe Laryngomalacia in Children.

Objective: To analyze the clinical characteristics and the risk factors associated with severe laryngomalacia in children. Methods: In this study, the clinical data of children (0-18 years), including gender, age at presentation, preterm delivery, low birth weight, delivery mode, feeding mode, fetal delivery, medical comorbidities, maternal gestational age at presentation, and calcium supplementation during pregnancy, diagnosed with laryngomalacia between January 2013 and January 2023 were retrospectively analyzed. The children were divided into mild-moderate and severe groups. Several risk factors were compared and analyzed between the 2 groups. The statistically significant risk factors were included in the logistic regression analysis. Results: A total of 224 children with severe laryngomalacia were enrolled in this study. The ratio of male to female patients was 1.55:1. All patients had severe laryngomalacia manifested by inspiratory laryngeal stridor. The average age of patients at symptom presentation was 2.7 (1.5-5.2) months. There were significant differences between the 2 groups in the age at presentation, premature delivery, low birth weight, medical comorbidities, and calcium supplementation during pregnancy (P < .05). Multivariate logistic regression analysis showed that premature delivery [odds ratio (OR) = 3.177, 95% confidence interval (CI): 2.329-4.334], low birth weight (OR = 3.188, 95% CI: 2.325-4.370), and medical comorbidities (OR = 1.434, 95% CI: 1.076-1.909) were independent risk factors for severe laryngomalacia (P < .05). Conclusion: Children with severe laryngomalacia exhibited persistent stridor at an earlier age at presentation. Premature delivery, low birth weight, and medical comorbidities were potential risk factors for severe laryngomalacia in children.

Maternal Outcomes of Placental Abruption With Intrauterine Fetal Death and Delivery Routes: A Nationwide Observational Study

(Acta Obstet Gynecol Scand. 2023;102:708–715) Both maternal and neonatal morbidity and mortality are associated with placental abruption (PA), a condition where the placenta prematurely separates from the uterine wall before or during labor. PA and intrauterine fetal death (IUFD) can co-occur, making a delivery more complex as well as high risk, as shown through increased maternal morbidity rates. Worldwide, delivery for mothers with PA and IUFD varies between vaginal delivery (VD) and cesarean delivery (CD), although various sources cite VD as the preferred method. Frequent complications of VD for PA with IUFD includes a longer delivery time, uterine rupture, and substantial blood loss. CD is associated with hemorrhagic shock and hematoma formation due to a greater increase in blood loss. Limited, small-scale studies have been performed comparing VD and CD and the effect on maternal morbidity in cases with IUFD and PA; however, this study uses a large data set to understand the relationship between delivery method and morbidity in cases of PA with IUFD.

Simulation of Uterus Active Contraction and Fetus Delivery in ls-dyna.

Vaginal childbirth is the final phase of pregnancy when one or more fetuses pass through the birth canal from the uterus, and it is a biomechanical process. The uterine active contraction, causing the pushing force on the fetus, plays a vital role in regulating the fetus delivery process. In this project, the active contraction behaviors of muscle tissue were first modeled and investigated. After that, a finite element method (FEM) model to simulate the uterine cyclic active contraction and delivery of a fetus was developed in ls-dyna. The active contraction was driven through contractile fibers modeled as one-dimensional truss elements, with the Hill material model governing their response. Fibers were assembled in the longitudinal, circumferential, and normal (transverse) directions to correspond to tissue microstructure, and they were divided into seven regions to represent the strong anisotropy of the fiber distribution and activity within the uterus. The passive portion of the uterine tissue was modeled with a Neo Hookean hyperelastic material model. Three active contraction cycles were modeled. The cyclic uterine active contraction behaviors were analyzed. Finally, the fetus delivery through the uterus was simulated. The model of the uterine active contraction presented in this paper modeled the contractile fibers in three-dimensions, considered the anisotropy of the fiber distribution, provided the uterine cyclic active contraction and propagation of the contraction waves, performed a large deformation, and caused the pushing effect on the fetus. This model will be combined with a model of pelvic structures so that a complete system simulating the second stage of the delivery process of a fetus can be established.

Gene expression of iron transporters, markers of vascularization and structural integrity in placenta of mothers with and without anemia.

To compare the mRNA expression of placental iron transporters (TfR-1 and FPN), markers of placental vascularization (VEGF and sFLT1) and marker of structural integrity (LMN-A) in term women with and without iron deficiency anemia. A total of 30 pregnant women were enrolled; 15 cases of iron deficiency anemia (Hb 7-10.9 gm/dL) and 15 gestational age matched healthy controls (Hb ≥ 11 gm/dL). Peripheral venous blood was collected for assessment of hemoglobin levels and serum iron profile. Placental tissue was used for assessing the mRNA expression of TfR-1, FPN, VEGF, sFLT-1 and LMN-A via real time PCR. Placental expression of TfR-1, VEGF and LMN-A was increased in pregnant women with anemia compared to healthy pregnant controls. Placental expression of sFLT-1 was decreased in pregnant women with anemia compared to healthy pregnant controls. There was no change in the placental expression of FPN. The increased expression of TfR-1, VEGF and LMN-A in cases of iron deficiency anemia are most likely to be compensatory in nature to help maintain adequate fetal iron delivery. Compensatory changes in the placenta aimed at buffering transport of iron to the fetus are seen in pregnant women with anemia compared to healthy pregnant controls.

Defining Architectural Changes in Mouse Pelvic Floor Muscles During Pregnancy to Withstand Physiological Distension Associated with Parturition

Pelvic floor disorders (PFDs), which are present in ~25% of women, profoundly impact quality of life. During childbirth, pelvic floor muscles (PFMs) endure substantial mechanical strain, which can lead to PFM dysfunction. As such, vaginal childbirth is a major risk factor for PFDs. Previous studies in rats demonstrate important structural adaptations in the PFMs that help to withstand the mechanical strain of childbirth, including muscle fiber lengthening by sarcomerogenesis. However, it is diffcult to establish a comprehensive understanding of the molecular mechanisms underlying PFM dysfunction during childbirth in rat models. Here, our objective was to determine if mouse PFMs undergo similar adaptations to rats during pregnancy and vaginal distension. We hypothesized that, akin to rats, PFMs in mice would undergo muscle fiber elongation through sarcomerogenesis during pregnancy. The PFMs (coccygeus [C], iliocaudalis [ICa], pubocaudalis [PCa]) and a non-pelvic floor muscle (tibialis anterior [TA]) were collected from late-pregnant (E16.5) and non-pregnant C57BL/6NJ (3 months old) mice. These animals were subjected or not subjected to physiological vaginal distension to mimic vaginal parturition (N = 4/group); in anesthetized mice, a 6F transurethral catheter was inserted into the vagina, and it was inflated with 0.3 mL (which best approximated fetal head circumference), and a 13 g weight was attached to the catheter creating circumferential and downward strains similar to parturition. Following this, the animals were euthanized, and the pelvis was fixed in situ for assessment of muscle architectural parameters; muscle fibers length was determined using digital calipers and sarcomere length was measured by light microscopy. Pregnancy induced a significant increase in normalized muscle fiber length in all PFMs compared to non-pregnant animals (Pregnant vs. not pregnant — C: 4.71±0.06 mm vs. 3.37±0.15 mm, p&lt;0.0001; ICa 8.74±0.14 mm vs. 7.50±0.27 mm, p=0.004; PCa 7.13±0.09 mm vs. 6.28±0.34 mm, p=0.04); TA muscle fiber length was unchanged (6.92±0.17 mm vs. 6.73 ± 0.19 mm, p=0.28). Sarcomere length was not affected by pregnancy in any muscle (C: 2.44±0.002 μm vs. 2.45 ± 0.003 μm, p=0.55; ICa: 2.26±0.003 μm vs. 2.26±0.004 μm, p=0.64; PCa: 2.16±0.01 μm vs. 2.16±0.003 μm, p=0.74; TA: 2.55±0.004 μm vs. 2.54±0.003 μm, p=0.28). Balloon-mediated vaginal distention resulted in significantly longer sarcomere lengths in non-pregnant compared to pregnant animals in all PFMs (C: 2.98±0.01 μm vs. 2.43±0.01 μm, p&lt;0.0001; ICa: 2.54±0.004 μm vs. 2.24±0.005 μm, p&lt;0.0001; PCa: 2.85±0.001 μm vs. 2.17±0.001 μm, p&lt;0.0001), indicating protection against sarcomere elongation in pelvic floor muscles of pregnant animals. This study shows that, similar to rats, pregnancy causes architectural changes in mouse pelvic floor muscles, which prevent excessive sarcomere stretching during physiologic vaginal distension that is comparable to fetal delivery. This work was funded by NIH grant #K12 HD000849 (Reproductive Scientist Development Program) to LAB and UC San Diego Senate Grant to LAB. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.