Fetal Activity Research Articles

Feto-Maternal Outcome after Trial of Vaginal Delivery in Women Having the History of Previous Caesarean Section: A Cross-Sectional Study in Pakistan

Aim: To determine the fetus and maternal outcome on the trial of vaginal delivery after a previous single Caesarean Section (CS). Study design: A cross-sectional study Place and Duration: This study was conducted at Bolan Medical Complex Hospital Quetta from January 2021 to December 2021 Methodology: A total of 108 cases were incorporated in the study who had a previous single CS. Patients' vital signs, fetal cardiac activity, pain and tenderness of the lower abdomen, and fetal distress were observed extensively during the labor. Data was collected with pre-designed Performa, and written informed consent was obtained on a consent form. The hospital committee was given authorization, and the data was analyzed for outcomes. Results: A total of71 patients (65.7%) had a successful vaginal delivery, while 37 (34.3%) required a repeat emergency cesarean section. Out of 71 vaginal deliveries, 47 (66.2%) were between the ages of 19 and 30 years, while 24 (33.8%) were between 31 and 45 years. Out of 37 instances, 22 (59.5 %) were between the ages of 19 and 30 years, while 15 (40.5 %) were between 31 and 45 years. The distribution of cases according to fetal distress in emergency cesarean section patients showed that 8 cases (21.6%) experienced fetal distress, and 29 (78.4%) did not develop any fetal complication. Conclusion: This study demonstrates the higher frequency of fetal distress in CS than vaginal delivery. Pregnant patients should be encouraged to have vaginal deliveries to reduce future morbidity related to CS. Keywords: Caesarean Section, Emergency cesarean delivery, Feto-maternal, vaginal delivery

OTUB1: A Key Player in the Adaptive Cardiac Hypertrophy

Deubiquitinases (DUBs), a family enzymes that reverse the process of ubiquitination, participate in diverse cellular processes through regulating protein degradation, intracellular trafficking, cell signaling, and protein‐protein interaction. The functional importance of DUBs in cardiac pathophysiology remains poorly defined. Herein, we report a critical role of OTUB1, one of the most highly expressed DUBs in the heart, in adaptive cardiac remodeling. Analysis of RNA sequencing data revealed that OTUB1 is upregulated in the failing human hearts. OTUB1 is also upregulated and activated in cardiomyocytes (CMs) treated with adrenergic agonists. OTUB1‐deficient CMs were resistant to phenylephrine (PE) ‐ and isoproterenol‐induced CM hypertrophy as characterized by attenuated cell enlargement, decreased fetal gene activation, and diminished protein synthesis. In vivo, CM‐specific deletion of OTUB1 in the developing mouse heart caused dilated cardiomyopathy without a prior development of compensatory cardiac hypertrophy, eventually leading to heart failure and premature lethality of mice by 6 months of age. The severe cardiac phenotype is accompanied by lipid accumulation, ER dilatation, prevalent autophagic vesicles containing ribosomes, as well as dysregulated expression of metabolic and ribosome genes. Delivery of wild‐type OTUB1, but not the enzymatic dead mutant, via AAV9 to OTUB1‐deficient hearts attenuated cardiac dysfunction and prolonged the lifespan of mice. On the molecular level, OTUB1 deficiency blunted mTOR signaling in cultured CMs and mouse hearts. Our findings indicate that OTUB1 is indispensable for the development of adaptive cardiac hypertrophy, possibly through modulating mTOR signaling.

The Effect of Doppler Ultrasonography on Pregnancy Outcomes in Fetal Cardiac Activity Evaluations

Doppler ultrasound is widely used in obstetrics. However, the biological effects of high energy from Doppler ultrasonography have not been clearly revealed. Animal studies have shown negative effects on the fetus, but studies on humans are limited. The aim of this study is to evaluate the effect of Doppler ultrasonography used in early pregnancy weeks (6-12 week) to detect fetal cardiac activity on pregnancy outcomes (number of births and abortions, type of delivery, cesarean indications, birth week, preterm labor rates, birth weights, low-birth-weight infant).

Hysteroscopic resection vs dilation and evacuation for treatment of caesarean scar pregnancy: study protocol for a randomised controlled trial.

Caesarean scar pregnancy (CSP) is a type of ectopic pregnancy where the fertilised egg is implanted in the muscle or fibrous tissue of the scar after a previous caesarean section. Management options for women who opted for termination of CSP include sharp curettage, dilation and evacuation (D&E), excision of trophoblastic tissues, local or systemic administration of methotrexate, bilateral hypogastric artery ligation, and selective uterine artery embolisation with curettage and/or methotrexate administration. Recently hysteroscopic resection has also been proposed as an alternative option. To compare the surgical outcome of hysteroscopic resection with dilation and evacuation (D&E) for the treatment of caesarean scar pregnancy (CSP). Parallel-group, non-blinded, randomised clinical trial conducted at a single centre in Italy. Eligible women are those with singleton gestations at less than 9 weeks of gestation, and with thickness of myometrial layer ≥1 mm at the level of the ectopic. Inclusion criteria are women with CSP with positive embryonic/fetal heart activity who opted for termination of pregnancy. Patients will be randomised 1:1 to receive either hysteroscopic resection (i.e. intervention group) or D&E (i.e. control group). In both groups, 50 mg/m2 (based on DuBois formula for body surface area) of methotrexate (MTX) will be injected intramuscularly at the time of randomisation (day 1) and another dose at day 3. A third dose of MTX is planned in case of persistence of fetal heart activity on day 5. Participants will receive either D&E or hysteroscopic resection from 3 to 7 days after the last dose of MTX. A sample size of 54 women is planned. The primary outcome is the success rate of the treatment protocol, defined as no requirement for further treatment until complete resolution of the CSP as demonstrated by negative beta hCG levels and absence of residual gestational material on ultrasound examination.. Hysteroscopic surgery is superior to D&E for the treatment of CSP. The results of the trial will provide information on the best treatment for CSP.

Facteurs associés à l’échec du traitement médical de la grossesse extra-utérine: cas de l’Hôpital Gyneco-Obstétrique et Pédiatrique de Yaoundé

Introductionl´objectif de notre travail était d´identifier les facteurs associés à l´échec du traitement médical de la grossesse extra-utérine (GEU) chez les femmes à l´Hôpital Gynéco- Obstétrique et Pédiatrique de Yaoundé.Méthodesil s´agissait d´une étude cas-témoins avec collecte rétrospective des données, sur une période de 10 ans, du 1er janvier 2008 au 31 décembre 2017. Les cas étaient toutes les patientes prises en charge pour GEU avec échec du traitement médical et les témoins celles chez qui le traitement médical de la GEU avait réussi. Les variables étudiées étaient: les caractéristiques sociodémographiques, cliniques, paracliniques et thérapeutiques. L´échantillonnage était consécutif et exhaustif. Nous avons réalisé une analyse multivariée.Résultatsnous avons recruté 92 patientes dont 23 cas et 69 témoins. Les variables associées à l´échec du traitement médical de la GEU après analyse univariée étaient: un taux de β-HCG initial > 10000UI/L (OR=3,05;P=0,031), un taux de β-HCG à J4 > 10000UI/L (OR=7,15;P=0,000), un taux de β-HCG à J7 > à 10000UI/L (OR=20;P=0,000), un score de Fernandez ≥ 13 (OR=3,09;P=0,020), la présence d´activité cardiaque de l´embryon (OR=2,8;P=0,036), l´antécédent d´interruption volontaire de grossesse (OR=2,67;P=0,043) et le niveau de scolarisation primaire (P=0,013). Après analyse multivariée, les facteurs prédictifs étaient: un taux de β-HCG initial >10000 UI/L (OR=8,97; P=0,004), un taux de β-HCG à J4 >10000 UI/L (OR=8,44;P= 0,007), un score de Fernandez ≥ 13 (OR=1,12;P=0,005) et la présence de l´activité cardiaque de l´embryon (OR=6,09;P=0,026).Conclusionles facteurs prédictifs de l´échec du traitement médical de la GEU à HGOPY sont liés au taux de β-HCG initial et la viabilité embryonnaire.

Role of Ultrasound in the Assessment and Differential Diagnosis of Pelvic Pain in Pregnancy.

Pelvic pain (PP) is common in pregnant women and can be caused by several diseases, including obstetrics, gynaecological, gastrointestinal, genitourinary, and vascular disorders. Timely and accurate diagnosis as well as prompt treatment are crucial for the well-being of the mother and foetus. However, these are very challenging. It should be considered that the physiological changes occurring during pregnancy may confuse the diagnosis. In this setting, ultrasound (US) represents the first-line imaging technique since it is readily and widely available and does not use ionizing radiations. In some cases, US may be conclusive for the diagnosis (e.g., if it detects no foetal cardiac activity in suspected spontaneous abortion; if it shows an extrauterine gestational sac in suspected ectopic pregnancy; or if it reveals a dilated, aperistaltic, and blind-ending tubular structure arising from the cecum in suspicious of acute appendicitis). Magnetic resonance imaging (MRI), overcoming some limits of US, represents the second-line imaging technique when an US is negative or inconclusive, to detect the cause of bowel obstruction, or to characterize adnexal masses.

The effect of formal fetal movement counting on maternal psychological outcomes: A systematic review and meta-analysis.

INTRODUCTIONFormally counting fetal movements in pregnancy is one of the oldest methods to assess fetal well-being. Although not routinely recommended in contemporary maternity care, due to a lack of evidence of its effectiveness, formal fetal movement counting is still practiced in many birth settings. Requesting women to formally count their fetal movements in a structured, objective way that can potentially improve maternal subjective outcomes such as worry or concern. The aim of this study was to evaluate the effect of formal fetal movement counting versus no formal counting, on maternal worry, concern or anxiety, and maternal–fetal attachment (MFA). Secondary outcomes were compliance with the intervention (counting method) and hospital admission/attendance for fetal activity concerns.METHODSCINAHL, MEDLINE and EMBASE were searched systematically for eligible studies from inception dates to June 2020, supplemented by searches of trial databases, grey literature and the reference lists of included studies. Randomized controlled and quasi-randomized trials were included in the review.RESULTSNine studies reported across 15 publications were included involving 70824 pregnant women. The results showed that MFA levels were significantly higher in women who formally counted fetal movements than those who did not (standardized mean difference=0.72; 95% CI: 0.10–1.33, five studies, 1565 women). There were no differences between the groups in maternal anxiety or worry/concern outcomes. Attendance or admission rates for reduced fetal movements, or concern for fetal activity, did not differ between the groups (OR=1.36; 95% CI: 0.97–1.91, three studies, 1947 women). Compliance in completing fetal movement charts varied, ranging 45–90%, although definitions of compliance differed across studies, which may have affected rates.CONCLUSIONSThis review has found that formal fetal movement counting in pregnancy has no detrimental effects on maternal psychological or emotional status and positively affects maternal–fetal attachment. Although current evidence does not support the use of formal fetal movement counting for improving perinatal outcomes, such as stillbirth and neonatal death, the results of this review are helpful for clinicians in discussing fetal movements in pregnancy and in discussing the optional methods available to women who may be advised to or choose to objectively assess fetal movements using a formal fetal movement counting method.

Minimally invasive abdominal curettage for an intramural twin pregnancy: a new twist to the traditional D&C

Less than 1% of ectopic pregnancies are intramural and are located within the myometrium without connection to the fallopian tubes or endometrial cavity. Known risk factors include prior hysterotomy, uterine instrumentation, and myometrial pathology such as adenomyosis. The timely diagnosis and treatment of intramural pregnancies is important to reduce patient morbidity. This video demonstrates the laparoscopic removal of a twin intramural pregnancy in a 32-year-old primiparous patient with a history of myomectomy eight months prior to presentation. Two gestational sacs were visualized in the right fundal myometrium surrounded by only 4-6 millimeters of myometrial tissue. One sac was empty and the other with a live embryo measuring eight weeks gestation with fetal cardiac activity. After extensive counseling, the patient desired to proceed with surgical intervention. To safely excise the pregnancy without inadvertent injury to the fallopian tubes, a reverse U-shaped incision was made with electrosurgery. Dilute vasopressin was utilized to minimize blood loss and hydro-dissection was performed to assist with myometrial separation from the gestational sac. Finally, sharp curettage was performed laparoscopically to remove any remaining products of conception from the myometrium. This unique approach to curettage laparoscopically decreases the risk of endometrial disruption and perforation of a fresh hysterotomy repair, rather than if performed vaginally. We repaired the myometrial defect in multiple layers with barbed suture to avoid uterine wall weakness, which can be associated with spontaneous uterine rupture in future pregnancy. In conclusion, this video demonstrates a minimally invasive approach to the surgical treatment of an intramural pregnancy with laparoscopic resection and curettage.

COVID-19 in pregnancy: implications for fetal brain development.

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy on the developing fetal brain is poorly understood. Other antenatal infections such as influenza have been associated with adverse neurodevelopmental outcomes in offspring. Although vertical transmission has been rarely observed in SARS-CoV-2 to date, given the potential for profound maternal immune activation (MIA), impact on the developing fetal brain is likely. Here we review evidence that SARS-CoV-2 and other viral infections during pregnancy can result in maternal, placental, and fetal immune activation, and ultimately in offspring neurodevelopmental morbidity. Finally, we highlight the need for cellular models of fetal brain development to better understand potential short- and long-term impacts of maternal SARS-CoV-2 infection on the next generation.

Vanishing twin after 12 gestational weeks is associated with adverse perinatal outcomes in in vitro fertilization cycles

Background: To assess the associations between vanishing gestational age and the adverse perinatal outcomes following in vitro fertilization cycles. Methods: This is a retrospective cohort study conducted in Guangzhou Women and children hospital from January 2011 to January 2019. We identified 350 vanishing twin pregnancies including 54 secondary fetal deaths and 296 singleton deliveries compared to 2080 infants from single gestations. The children detected by transvaginal ultrasonography in gestational week 6. By linking with the hospital’s registries, the main endpoints were gestational age (weeks), birth weight (g), low birth weight (LBW), preterm birth and neonatal malformation rate. Perinatal outcomes were compared among study groups and controls. Results: Of the 350 vanishing twin, there were 15.4% (54) secondary fetal death. Of the 2376 singleton deliveries, 12.5% (296) originated from a twin gestation. In the assessment of perinatal outcome, there were no significant differences between the singleton cohort and vanishing twin before the presence of fetal cardiac activity cohort (VT before CA) and early vanishing cohort. The late vanishing twin group had a higher risk of preterm delivery (P < 0.001) and LBW (P < 0.001). There were no significant differences between all cohorts in assessing neonatal malformation rate (P > 0.05). Conclusion: Vanishing twin after 12 weeks is a predictor of adverse perinatal outcome. The couples with a viable fetus or a non-viable fetus and an empty gestational sac in early pregnancy (<12 weeks) have a similar outcome as the baby from a singleton delivery without vanishing.

Interventional Challenges in Non-Tubal Ectopic Pregnancy.

Objective: Non-tubal ectopic pregnancies (EPs) are rare and potentially life threatening. The number is rising due to various risk factors and there are no uniform guidelines in the management of EPs. This study was done to assess risk factors and challenges in the management of EPs. Materials and methods: This is a retrospective observational descriptive study that was done at SDM College of Medical Sciences & Hospital, Shri Dharmasthala Manjunatheshwara University Dharwad, Karnataka India. Data was collected from the medical records section of all the patients of non-tubal ectopic pregnancies managed in our hospital from January 2020 to June 2021. The collected data were analyzed for demographic characteristics, risk factors and management. Results: The incidence of ectopic pregnancies in our institute was 6-7 per 1000 pregnancies, of which 20% of the ectopic pregnancies were non-tubal. The incidence was higher than the other studies, which could be due to our center being a tertiary care referral center. Cesarean scar ectopic pregnancies were the most common accounting for 60% of cases. The management varied from conservative to minimally invasive surgery to hysterectomy hysterectomy with bilateral internal iliac artery ligation, depending upon the clinical presentation, duration of gestation, presence of fetal cardiac activity and hemodynamic stability. The other non-tubal ectopic pregnancies were cervical, ovarian, corneal and heterotopic. Cervical pregnancy beyond 12 weeks of gestation was rare which was managed by conserving the uterus. Conclusion: Non-tubal ectopic pregnancies are rare. Early diagnosis requires a high index of suspicion if missed can lead to an array of complications leading to loss of fertility, morbidity, and mortality. The key step to avert the complications is early diagnosis and individualized treatment.

PLACENTALABRUPTION AND FETAL DEATH FOLLOWING VEHICLE COLLISION: A CASE REPORT AND LITERATURE REVIEW

AIM: We present a case of placental abruption and fetal death following a motor vehicle accident, associated with air bag activation, and a short literature review of this important issue. Case report:A27-year-old women at 32nd gestational week presented after a head-on motor vehicle collision. Patient was restrained and air-bag deployed. Upon admission patient had stable vital signs, no visible major physical injuries, but was complaining of lower abdominal and the right leg pain. Physical examination revealed ecchymosis of the lower abdomen consistent with seatbelt trauma. Initial obstetric ultrasound examination showed no fetal cardiac activity, and the retro placental hematoma was identied. The labor was induced. Massive hemorrhage occurred after delivery of the placenta. Uterus atonia could not be managed conservatively with uterotonic agents or surgically, so hysterectomy had to be performed. The patient recovered and was discharged on the night postoperative day. Pathologic examination conrmed placental abruption. CONCLUSION:In conclusion all pregnant women who had a vehicle accident should be sent to the medical center with the possibility to take care of both trauma patients - the pregnant woman and fetus. Utmost attention should be paused to such patients as even the slightest trauma can have grave consequences on both the mother and fetus.

Are There Postnatal Benefits to Prenatal Kick Counting? A Quasi-Experimental Longitudinal Study.

Mild signs of postpartum depression or anxiety are present in up to half of all new mothers. However, the impact of having the “baby blues” on infant development remains largely unknown. The current study explores a potential relation between mother’s self-reported depression or anxiety symptoms and infant’s motor development in a longitudinal sample of 50 mother-infant dyads. Further, we examine whether engaging in fetal kick counting during pregnancy may reduce maternal psychopathology symptoms and thereby positively influence infant motor development and parent-child engagement during the first months of life. We hypothesized that subclinical maternal psychopathology would negatively impact infant motor development, and that completing a fetal kick count activity during the third trimester would reduce overall signs of maternal psychopathology. Results only partially support these hypotheses. Postpartum maternal anxiety seems to negatively affect the emergence of infants’ fine motor skills. However, engaging in fetal kick counting during pregnancy did not reduce maternal depression or anxiety symptoms. Nevertheless, preliminary evidence suggests that engaging in fetal kick counting may impact early child development by altering the mother’s attitudes toward the child. Future research is needed to examine the value of this low-cost intervention strategy more closely.

Influence of Light Intensity exercise During Pregnancy on Fetal Echocardiographic and Maternal Cardiovascular Measures

Background: Although moderate intensity maternal exercise is recommended during pregnancy, most women do not achieve this level. Objective: This study aimed to determine the effects of supervised maternal light-intensity exercise on fetal cardiovascular measures in the 3rd trimester. Materials and Methods: We compared women participating in light-intensity (LI) stretching/breathing or no exercise (CON) across 24+ weeks of pregnancy Women with singleton pregnancies (<16 weeks), between 18-40 years, 18.5-34.99 kg/m2 BMI, and having no chronic health conditions were eligible. LI did 150 minutes light-intensity weekly exercise; CON did normal daily activities, but no exercise. Maternal measures included resting heart rate (HR) and blood pressure (BP). Fetal measures included estimated fetal weight (EFW), ponderal index (PI), HR, along with right and left ventricular measures (e.g., stroke volume, cardiac output, ejection fraction) at 36 weeks’ gestation. T-tests compared differences between groups; partial spearman rank correlations and regressions were performed to find relationships and predict fetal echocardiographic outcomes, controlling for fetal activity state. Results: Of 50 pregnant women (n=26 in LI, n=24 in CON), we found maternal exercise intensity influences fetal left ventricular heart flow, while maternal exercise duration influences fetal right ventricular outcomes. There were no differences (p>0.05) in fetal cardiac anatomical measures. Lastly, light intensity exercise and duration of exercise lower maternal blood pressure in late pregnancy. Conclusions:Light-intensity exercise is associated with improved fetal cardiac measures. Women benefit from light intensity exercise during pregnancy. Cardiovascular benefits from exercise for mother and child are dose dependent.

Effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester abortion past 20 weeks at a tertiary Hospital in Ethiopia: A retrospective review

BackgroundCurrent literature recommends inducing fetal demise prior to second trimester medication abortion beyond 20 weeks of gestation. There is inadequate literature regarding the practice and effectiveness of this procedure in low-income countries. This study aimed at documenting the effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester medication abortion in an Ethiopian setting. MethodsThis is a retrospective chart review conducted at St. Paul's Hospital Millennium Medical College, in Ethiopia. A total of 65 cases of feticide administration before 2nd trimester medication abortion between 20 and 28 weeks of gestation (From April 1, 2021 to September 30, 2021) were reviewed. The primary outcome was cessation of fetal cardiac activity the day after the first feticide injection. Data were extracted by reviewing maternal charts using a data extraction tool prepared in English. Data were analyzed using SPSS version 23. Simple descriptive statistics were used to analyze baseline characteristics and fetal demise outcomes. Results were presented in percentages and frequencies. ResultsMore than three quarters of the feticide injections were with intra-amniotic digoxin, while the rest (24.6%, 16/65) were with intra-cardiac lidocaine. Injection of digoxin or lidocaine was effective at inducing fetal demise the day after administration in 92.3% (60/65) of the cases. Intracardiac lidocaine administration was 100% (16/16) effective at inducing fetal demise within the day after the injection while the effectiveness of digoxin within the same period was 89.8%. ConclusionIn this study, both intra-amniotic digoxin and intra-cardiac lidocaine were effective at inducing fetal demise, which is in support of findings from similar previous studies. ImplicationsIn an Ethiopian setting, both intra-amniotic digoxin and intra-cardiac lidocaine injections are effective at inducing fetal demise before second trimester abortion beyond 20 weeks of gestation within the next day after feticide administration.

Applying Artificial Intelligence to Understand Fluctuation of Fetal Brain Activity by Recognizing Facial Expressions of Japanese Fetuses

Applying Artificial Intelligence to Understand Fluctuation of Fetal Brain Activity by Recognizing Facial Expressions of Japanese Fetuses

An Implantable Electronic Device for Monitoring Fetal Lung Pressure in a Lamb Model of Congenital Diaphragmatic Hernia

Tracheal occlusion (TO) is a fetal treatment option for congenital diaphragmatic hernia. It aims to reduce lung hypoplasia and hypertension by occluding the trachea with a subsequent increase in pulmonary pressure. However, how TO affects lung pressure is unknown, and no devices are available for its measurement. We developed an implantable device for real-time wireless monitoring and long-term logging of lung pressure in ovine fetuses. The device comprised a microcontroller unit, two pressure sensors, an inertial measurement unit (IMU), a radio frequency unit, and an antenna. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">In vitro</i> and <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">in vivo</i> tests were performed to evaluate device performances. A diaphragmatic hernia was created in ovine fetuses via hysterotomy. Nine devices were implanted at 100 days of gestation and remained until delivery (~142 d). One pressure sensor measured pressure in the amniotic sac and the other in the fetal trachea. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">In vitro</i> pressure accuracy was median (interquartile range) 0.31% (0.1%). <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">In vitro</i> device lifetime was ~60 days. The <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">in vivo</i> device recording time was 26.0 (3.9) days and it was well tolerated by the fetus and the ewe. Data telemetry operated throughout the device lifetime. At delivery, amniotic fluid, device encapsulation, and lamb skin did not present evidence of damages. Pressure data in four lambs were analyzed. Fast pressure changes due to the spontaneous fetal activity and long-term mean pressure changes resulting from TO were detected. The IMU allowed for the assessment of changes in fetal position. This device allows long-term monitoring of mean lung pressure, spontaneous breathing activity, and movements in physiological and pathological ovine fetal models.

Features of functional maturation of the central nervous system in fetuses with multiple pregnancies

The study was undertaken to detect some peculiarities of fetal rest activity cycle formation in multiple pregnancy. 86 fetuses (43 twins) were observed with the following assessment of the newbornsneurological status. The rest activity cycle parameters and haemodynamic indices of fetoplacental system were examined. Also there was considered the influence of IUGR and twins birth weight discordance on CNSfunctionalformation. The results showed that twins comparing with single pregnancies are characterized by the retardation of rest activity cycle formation that is manifested in shortening оf the quite and prolongation оf the intermediate states, lowering of cardiac rhythm variability and motorcardial reflex. These findings substantiate the necessity of including twins into high-risk group concerning neurological disorders in the newborns. The IUGR appears an additional factor increasing this risk.

Birth of a Healthy Baby 9 Years After a Surgically Successful Deceased Donor Uterus Transplant.

To describe surgical procedures, previous failed pregnancies, methods for overcoming pregnancy failure and, most importantly, birth of a healthy infant, in a uterus transplantation from a deceased donor. Majority of uterus transplants have involved live donors, but several advantages make deceased donor transplantation a practicable option, principally by eliminating surgical risks to the live donor. Uterus transplantation from a deceased donor was performed in September 2011 in Turkey. After 5 miscarriages, perfusion computed tomography revealed an obstructed blood-outflow. To overcome this blood flow obstruction, a saphenous vein graft was anastomosed between utero-ovarian and left ovarian vein with laparotomy. Follow-up computed tomography confirmed resolution of venous congestion and a decrease in uterine volume. Following vascular augmentation surgery, fetal cardiac activity were observed 28 days after the first embryo transfer attempt. Preterm premature rupture of the membranes was diagnosed at 19 weeks' gestation. Cesarean section was planned at 28 weeks' gestation due to intrauterine growth restriction and suspected preeclampsia. A healthy 760 g male baby was delivered. The baby was discharged from the neonatal intensive care unit 79 days after delivery in good condition weighing 2475 g. Deceased donor uterus transplantation is a reasonable approach for treating uterine factor-related infertility. In case of recurrent miscarriages, regional vascular augmentation by arterial or venous supercharging may be required to overcome regional misperfused regions determined by imaging studies.

Call to Action: Healthcare Providers Must Speak Up for Adolescent Abortion Access

On September 1, 2021, Texas Senate Bill 8 (S.B. 8) took effect as the most restrictive ban on abortion in the United States (U.S.) since its legalization in 1973. S.B. 8 prohibits abortion after detection of fetal cardiac activity, at around 6 weeks of pregnancy, which creates a nearly impossible window for a person to discover a pregnancy, make an appointment, comply with Texas’s other medically unnecessary abortion restrictions, and receive abortion care. To circumvent judicial review, S.B. 8 deputizes private citizens to enforce the law through civil lawsuits against anyone assisting with or providing abortion care in violation of the law.