Fetal Care Research Articles

Fatel Medicine in Clinical Practice

Fetal medicine is a specific field of medicine dedicated to the care and management of the expanding blastula during pregnancy. It contains an off-course range of demonstrative and therapeutic methods proposed to guarantee the health and happiness of two together, the future baby and the expectant parent. This abstract investigates the relevance and meaning of the before-birth cure in contemporary dispassionate practice.In the current age, fetal medicine has supported extraordinary advancements on account of contemporary technologies and a deeper understanding of what happens before birth. Ultrasound imaging, for instance, has enhanced the necessary finish for monitoring before birth, detecting irregularities, and assessing the overall energy of the embryo. Non-obtrusive prenatal experimentation (NIPT) has transformed the early detection of ancestral disorders, permissive prompt interventions, and cognizant accountability for persons. Fetal medicine offers further conditions; it offers a spectrum of healing attacks that can significantly impact gestational consequences. Intrauterine before-birth surgeries, such as curing processes for inborn heart defects or spina bifida, elucidate the field’s volume to mediate and improve the value of history for affected babies. Furthermore, before birth, the cure plays an important role in directing extreme-risk pregnancies. It authorizes close monitoring of motherly and prenatal well-being, ensuring that potential problems are recognized and addressed immediately. This is specifically critical in cases of multiple pregnancies, motherly healing environments, or fetal tumor limits. The field’s significance is further underscored by allure skills to foster early sticking between persons and the unborn adolescent. Seeing the embryo through ultrasound scans and engaging in discussions about allure, fitness, and what’s happening can enhance the heated relationship ‘between expectant parents and their babies. In conclusion, before birth, medicine has enhanced a necessary component of new clinical practice. It offers an inclusive approach to fetal care, including diagnostics, healing interventions, and psychological support for expectant parents. As electronics continue to advance and our understanding of before-birth incidents deepens, before-birth medicine’s part in guaranteeing healthy pregnancies and improving neonatal consequences will certainly stretch to expand and develop.

Experiences of fetal care, social support, and emotional functioning during the COVID-19 pandemic in women carrying a fetus with CHD.

To explore how the COVID-19 pandemic affected fetal care, social support, and emotional functioning for women carrying a fetus with CHD. This was a single-centre qualitative study of 31 women who received a prenatal diagnosis of CHD during the pandemic. Patients completed semi-structured interviews about their experiences with fetal care, social support, and perceptions of risk to themselves and their fetus. Consistent themes regarding the impact of the pandemic were identified using an inductive thematic approach. Demographic data were collected via self-report and chart review. Women generally reported consistent access to fetal care throughout the pandemic, with frequent use of telemedicine in addition to in-person care, but negative impacts resulting from restrictions on family support at appointments. Limited access to social support overall and a loss of pregnancy traditions were described. Many women reported feeling isolated and experiencing worries and fears about COVID-19 but also noted feeling supported by their healthcare team. Partner/family support during appointments and connection to peer-to-peer support were identified as recommendations to mitigate negative impacts. Women carrying a fetus with CHD during the COVID-19 pandemic experienced unique stressors that may affect mental health. However, many also experienced unexpected supports that may mitigate effects of pandemic-related stressors. Results can inform efforts to promote positive family outcomes during and following the COVID-19 pandemic.

Pregnancy care for maternal and fetal wellbeing: an ethnography study

Background/Aims In Indonesia, cultural beliefs affect holistic healthcare practices. The aim of this study was to identify the effects of cultural beliefs on maternity care and fetal wellbeing. Methods This study used an ethnographic-qualitative design and was conducted in a community setting in West Java, Indonesia. A total of 16 participants of Sundanese culture were recruited based on information from local health workers and community leaders. Questionnaires, semi-structured interviews and observation sheets were used to collect data on cultural beliefs that impacted pregnant women. Data were analysed using an editing analysis style. Results The seven themes were: dietary practices and restrictions during pregnancy, hygiene practices, managing sleep and drowsiness, sexual intimacy and interactions, cultural beliefs and religious devotion, family participation and challenges monitoring fetal wellbeing. Conclusions To ensure quality pregnancy and fetal care, and facilitate provision of basic needs and parental empowerment, healthcare workers must consider women's cultural beliefs.

The Effect of Steroids on Prenatally Diagnosed Lung Lesions

BackgroundOpen fetal resection for large lung lesions has virtually been replaced by maternal steroid administration. Despite this paradigm shift, little is known about the effects steroids have on lung lesion growth in utero. MethodsA 10-year retrospective review of all prenatally diagnosed lung lesions cared for at our fetal care center was performed. We evaluated the effects of prenatal steroids on congenital pulmonary airway malformation (CPAM)-volume-ratio (CVR), distinguishing change in CVR among CPAMs, bronchopulmonary sequestrations (BPS), and bronchial atresias. We also correlated fetal ultrasound and MRI findings with pathology to determine the accuracy of prenatal diagnosis. ResultsWe evaluated 199 fetuses with a prenatal lung lesion. Fifty-four (27 %) were treated with prenatal steroids with a subsequent 21 % mean reduction in the CVR (2.1 ± 1.4 to 1.1 ± 0.4, p = 0.003). Fetuses with hydrops and mediastinal shift who were treated with steroids rarely had resolution of these radiographic findings. Postnatal pathology was available for 91/199 patients (45.7 %). The most common diagnosis was CPAM (42/91, 46 %), followed by BPS (30/91, 33 %), and bronchial atresia (14/91, 15 %). Fetuses who received steroids and had pathology consistent with CPAM were more likely to have a reduction in their CVR (p = 0.02). Fetal ultrasound correctly diagnosed the type of lung lesion in 75 % of cases and fetal MRI in 81 % of cases. ConclusionsPrenatally diagnosed CPAMs are more likely to respond to maternal steroids than BPS or bronchial atresias. Knowing the diagnosis in utero could aid to steward steroid usage, however, fetal imagining modalities are not perfect in distinguishing subtype. Level of evidenceIII.

Midwives' and obstetricians' practice, perspectives and experiences in relation to altered fetal movement: A focused ethnographic study

BackgroundReducing avoidable stillbirth is a global priority. The stillbirth rate in England compares unfavourably to that of some other high-income countries. Poorly-managed episodes of altered fetal movement have been highlighted as a key contributor to avoidable stillbirth, and strategies introduced in England in 2016 to reduce perinatal mortality included recommendations for the management of reduced fetal movement. Despite a downward trend in stillbirth rates across the UK, the effects of policies promoting awareness of fetal movement remain uncertain. ObjectiveTo provide in-depth knowledge of how practice and clinical guidance relating to altered fetal movement are perceived, enacted and experienced by midwives and obstetricians, and explore the relationship between recommended fetal movement care and actual fetal movement care. DesignA focused ethnographic approach comprising over 180 h of observation, 15 interviews, and document analysis was used to explore practice at two contrasting UK maternity units. SettingsAntenatal services at two UK maternity units, one in the Midlands and one in the North of England. ParticipantsThirty-six midwives, obstetricians and sonographers and 40 pregnant women participated in the study across 52 observed care episodes and relevant unit activity. Twelve midwives and three obstetricians additionally participated in formal semi-structured interviews. MethodsFieldnotes, interview transcripts, policy documents, maternity notes and clinical guidelines were analysed using a modified constant comparison method to identify important themes. Resultsfetal movement practice was mostly consistent and in line with guideline recommendations. Notwithstanding, most midwives and obstetricians had concerns about this area of care, including challenges in diagnosis, conflicting evidence about activity, heightened maternal anxiety, and high rates of monitoring and intervention in otherwise low-risk pregnancies. To address these issues, midwives spent considerable time reassuring women through information and regular monitoring, and coaching them to perceive fetal movement more accurately. ConclusionsPractice relating to altered fetal movement might be more uniform than in the past. However, a heightened focus on fetal movement is associated by some midwives and obstetricians with potential harms, including increased anxiety in pregnancy, and high rates of monitoring and intervention in pregnancies where there are no ‘objective concerns’. Challenges in diagnosing a significant change in fetal movement with accuracy might mean that interventions and resources are not being directed towards those pregnancies most at risk. More research is needed to determine how healthcare professionals can engage in conversations about fetal movement and stillbirth to support safe outcomes and positive experiences in pregnancy and birth. RegistrationNot registered. Tweetable abstractMidwives and obstetricians take #reducedfetalmovement seriously but worry this ‘unreliable’ symptom increases anxiety, monitoring and intervention in many ‘low risk’ pregnancies.

Hidden in plain sight: role of residual myometrial thickness to predict outcome of Cesarean scar pregnancy.

Ultrasound in Obstetrics & GynecologyAccepted Articles Opinion Hidden in plain sight: role of residual myometrial thickness to predict outcome of Cesarean scar pregnancy I. E. Timor-Tritsch, Corresponding Author I. E. Timor-Tritsch [email protected] orcid.org/0000-0001-9774-3107 Department of Obstetrics and Gynecology, New York University, New York, NY, USACorrespondence to: Prof. I. E. Timor-Tritsch, Department of Obstetrics and Gynecology, New York University, New York, NY, USA, E-mail: [email protected]Search for more papers by this authorA. Monteagudo, A. Monteagudo Icahn School of Medicine, Carnegie Maternal–Fetal Associate's, NY, USASearch for more papers by this authorG. Calỉ, G. Calỉ Department of Obstetrics and Gynecology, Maternal–Fetal Medicine Unit, Azienda Ospedaliera Villa Sofia-Cervello, Palermo, Italy Maternal–Fetal Unit, Candela Clinic, Palermo, ItalySearch for more papers by this authorA. Kaelin Agten, A. Kaelin Agten orcid.org/0000-0002-3344-0315 Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. M. Palacios Jaraquemada, J. M. Palacios Jaraquemada Department of Obstetrics and Gynecology, CEMIC University Hospital, Buenos Aires, ArgentinaSearch for more papers by this authorF. D'Antonio, F. D'Antonio orcid.org/0000-0002-7546-8025 Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, ItalySearch for more papers by this author I. E. Timor-Tritsch, Corresponding Author I. E. Timor-Tritsch [email protected] orcid.org/0000-0001-9774-3107 Department of Obstetrics and Gynecology, New York University, New York, NY, USACorrespondence to: Prof. I. E. Timor-Tritsch, Department of Obstetrics and Gynecology, New York University, New York, NY, USA, E-mail: [email protected]Search for more papers by this authorA. Monteagudo, A. Monteagudo Icahn School of Medicine, Carnegie Maternal–Fetal Associate's, NY, USASearch for more papers by this authorG. Calỉ, G. Calỉ Department of Obstetrics and Gynecology, Maternal–Fetal Medicine Unit, Azienda Ospedaliera Villa Sofia-Cervello, Palermo, Italy Maternal–Fetal Unit, Candela Clinic, Palermo, ItalySearch for more papers by this authorA. Kaelin Agten, A. Kaelin Agten orcid.org/0000-0002-3344-0315 Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. M. Palacios Jaraquemada, J. M. Palacios Jaraquemada Department of Obstetrics and Gynecology, CEMIC University Hospital, Buenos Aires, ArgentinaSearch for more papers by this authorF. D'Antonio, F. D'Antonio orcid.org/0000-0002-7546-8025 Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, ItalySearch for more papers by this author First published: 09 May 2023 https://doi.org/10.1002/uog.26246 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.26246. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

The Impact of Comprehensive Fetal Care on Mortality of Children With Congenital Diaphragmatic Hernia when Delivery is Co-located in a Pediatric Hospital

BackgroundWe evaluated the impact of delivery at a comprehensive fetal care center co-located in a pediatric hospital on extracorporeal membrane oxygenation (ECMO) exposure and survivorship of children with CDH. MethodsThis retrospective study includes maternal–fetal dyads with a prenatal diagnosis of isolated CDH who received any prenatal care at a single fetal center between February 2006 and March 2021. The principal variables included: (1) delivery setting (children born in the pediatric hospital [“inborn”] vs. children who were delivered elsewhere [“outborn”]), (2) exposure to ECMO (yes vs. no), and (3) survival-at-discharge from birth hospitalization (yes vs. no). Multivariable logistic regression was used to evaluate the association between delivery setting and ECMO cannulation, and whether delivery setting moderates the association between exposure to ECMO and survival-at-discharge. ResultsAmong 418 maternal–fetal dyads, 77.0% of children were inborn and 32.0% of children were exposed to ECMO during their index hospitalization. Inborn children had more severe prenatal prognostic indicators but had a 57% lower odds of extracorporeal than outborn children. In multivariable logistic regression, delivery setting moderated the association between exposure to ECMO and survival-at-discharge. Although there was no statistically significant difference in mortality between inborn and outborn children who were not exposed to ECMO, inborn children exposed to ECMO had a 6.86 (1.98, 23.74) increased odds of death and outborn children exposed to ECMO had a 17.71 (4.69, 66.87) increased odds of death when both were compared to non-cannulated outborn children. ConclusionsComprehensive fetal care with delivery co-located in a pediatric hospital was associated with decreased exposure to ECMO and a survivorship advantage among children with CDH who required extracorporeal support. Level of EvidenceLevel III.

Development and validation of the 23-item preterm birth risk assessment scale-Korean version

BackgroundPreterm birth (PTB) is a complex and significant challenge in obstetrics. Thus, clinicians and researchers have paid a keen interest in the identification of women at a high risk for PTB. This study aimed to develop a PTB risk assessment scale based on the preliminary 32-item Preterm Birth Risk Assessment Scale-Korean version (PBRAS-K).MethodsWe enrolled 298 participants (167 in the exploratory factor analysis group from March 3, 2021 to August 31, 2021 and 131 in the confirmatory factor analysis group from December 3, 2021 to February 14, 2022) who delivered before 37+0 weeks after experiencing preterm symptoms and were admitted to high-risk pregnancy maternal–fetal intensive care units (MFICUs). After an item-reduction process in the exploratory factor analysis, the psychometric property scales were assessed using SPSS Statistics version 27.0, and the confirmatory factor analysis was conducted using AMOS version 27.0.ResultsThe Kaiser–Meyer–Olkin (KMO) test and Bartlett’s χ2 test of sphericity confirmed the adequacy of the sample for factor analysis (KMO = .81 (> .80), χ2 = 1841.38, p < .001). The final version of the PBRAS-K comprised 23 items within seven dimensions. Factor analysis identified items explaining 65.9% of the total variance. The PBRAS-K achieved a mean score of 35.58 (± 10.35) and showed high internal consistency and satisfactory reliability (Cronbach’s alpha = .85). Regarding concurrent validity, the PBRAS-K exhibited a low-to-moderate correlation with the PTB risk (r = .45, p < .001). As for criterion validity and convergent validity, the PBRAS-K showed a positive and high correlation with the Somatic Awareness Scale with Spontaneous Preterm Labor (SPL-SAS) (r = .65, p < .001) and pregnancy-related stress (r = .57, p < .001), respectively. Risk scoring for preterm delivery and SPL-SAS were moderately correlated (r = .53, p < .001).ConclusionsPBRAS-23-K is a valid and reliable instrument for assessing the risk for PTB in pregnant women. Clinical nurses are encouraged to apply and obtain information regarding effective interventions in MFICUs. This scale provides meaningful results and reflects the opinions of women who had experienced PTB. The PBRAS-23-K should be evaluated for standardization and cut-off scores using larger sample sizes in the future.

Prenatally Diagnosed Large Lung Lesions: Timing of Resection and Perinatal Outcomes

IntroductionFetuses with large lung lesions including congenital cystic adenomatoid malformations (CCAMs) are at risk for cardiopulmonary compromise. Prenatal maternal betamethasone and cyst drainage for micro- and macrocystic lesions respectively have improved outcomes yet some lesions remain large and require resection before birth (open fetal surgery, OFS), at delivery via an Ex Utero Intrapartum Treatment (EXIT), or immediately post cesarean section (section-to-resection, STR). We sought to compare prenatal characteristics and outcomes in fetuses undergoing OFS, EXIT, or STR to inform decision-making and prenatal counseling. MethodsA single institution retrospective review was conducted evaluating patients undergoing OFS, EXIT, or STR for prenatally diagnosed lung lesions from 2000 to 2021. Specimens were reviewed by an anatomic pathologist. Lesions were divided into “CCAMs” (the largest pathology group) and “all lung lesions” since pathologic diagnosis is not possible during prenatal evaluation when care decisions are made. Prenatal variables included initial, greatest, and final CCAM volume-ratio (CVR), betamethasone use/frequency, cyst drainage, and the presence of hydrops. Outcomes included survival, ECMO utilization, NICU length of stay (LOS), postnatal nitric oxide use, and ventilator days. ResultsSixty-nine percent (59 of 85 patients) of lung lesions undergoing resection were CCAMs. Among patients with pathologic diagnosis of CCAM, the initial, largest, and final CVRs were greatest in OFS followed by EXIT and STR patients. Similarly, the incidence of hydrops was significantly greater and the rate of hydrops resolution was lower in the OFS group. Although the rate of cyst drainage did not differ between groups, maternal betamethasone use varied significantly (OFS 60.0%, EXIT 100.0%, STR 74.3%; p = 0.0378). Notably, all OFS took place prior to 2014. There was no difference in survival, ventilator days, nitric oxide, NICU LOS, or ECMO between groups. In multiple variable logistic modeling, determinants of survival to NICU discharge among patients undergoing resection with a pathologic diagnosis of CCAM included initial CVR <3.5 and need for <3 maternal betamethasone doses. ConclusionFor CCAMs that remain large despite maternal betamethasone or cyst drainage, surgical resection via OFS, EXIT, or STR are viable options with favorable and comparable survival between groups. In the modern era there has been a shift from OFS and EXIT procedures to STR for fetuses with persistently large lung lesions. This shift has been fueled by the increased use of maternal betamethasone and introduction of a Special Delivery Unit during the study period and the appreciation of similar fetal and neonatal outcomes for STR vs. EXIT and OFS with reduced maternal morbidity associated with a STR. Accordingly, efforts to optimize multidisciplinary perinatal care for fetuses with large lung lesions are important to inform patient selection criteria and promote STR as the preferred surgical approach in the modern era. Level of EvidenceLevel IV.

Fear of childbirth: prevalence and associated factors in pregnant women of a maternity hospital in southern Brazil

BackgroundThe fear of childbirth (FOC) harms maternal and fetal health, however it has been little studied in Brazil. This research aimed to determine the prevalence of FOC in a maternity hospital in southern Brazil and identify its associated factors.MethodsThe Wijma Delivery Expectancy Questionnaire – W-DEQ(A) was used to assess the prevalence of FOC, and its relationship with sociodemographic variables, gestational history, aspects of the current pregnancy, knowledge about childbirth, anxiety symptoms (Beck Anxiety Inventory), depressive symptoms (Edinburgh Postnatal Depression Scale), and perception of social support (Multidimensional Scale of Perceived Social Support) was investigated. Questionnaires about the content of FOC and information sources regarding childbirth were also applied.ResultsWe interviewed 125 pregnant women between 28 and 36 weeks of pregnancy between July and September of 2021, and 12% of them scored ≥ 85 on the W-DEQ(A), indicating severe FOC. There was a significant correlation between FOC and anxiety symptoms (r = 0.50, p < 0.001), depressive symptoms (r = 0.34, p < 0.001), and poor social support (r = -0.23, p = 0.008). FOC was lower in pregnant women with complete elementary education when compared to those with higher education (p = 0.003), however, those with negative experiences in previous deliveries had more FOC than those who had had positive experiences (p = 0.001). More than 85% of them fear fetal distress.ConclusionsFOC is a prevalent condition that impacts the mental health of pregnant women. Therefore, health professionals should recognize and address it during prenatal care to provide integral maternal–fetal care and improve the childbirth experience.

Pregnancy Curriculum: Advocating for a Healthier Pregnancy in General Surgery Residency

With an increasing number of women entering surgical careers, pregnancy amongst surgical residents is anecdotally rising. There is no single resource to inform expectant surgical residents of potential occupational risks, or to help them optimize workplace safety during and after pregnancy. The aim of this initiative is to provide surgical residents with an overview of residency occupational risks applicable to maternal-fetal health, propose systemic and situational modifications, and to empower pregnant residents to better plan and advocate for a healthy pregnancy. Surgery department staff were invited to contribute to the pregnancy curriculum at the authors' institution. Feedback was received from attending physicians and surgical residents (N = 12), as well as all female residents having experienced in-training pregnancy or early child-rearing from 2017 to 2022 (N = 6). After identifying workplace hazard and compiling staff feedback, the authors developed a set of recommendations for the protection of pregnant and early-parenting female trainees. Five areas of process improvements were identified for the protection of pregnant residents: culture, ergonomics, exposure, maternal & fetal care, and fourth trimester support. Specific recommendations ranged from widespread institutional support emphasizing psychological safety and zero-retaliation policies, to healthcare-related hazard exposure protections, as well as tangible postpartum and lactation support. Out of this initiative came the pregnancy curriculum. Widespread and decisive institutional support is paramount to cultural shifts surrounding in-training pregnancy. The guidelines proposed in this project are intended to be enforced by surgical residency leadership with the precise goal of removing the cultural burden from the expectant resident. Only the resident herself can thereafter chose to adopt or decline the protective measures. Through our recommendations, we hope to offer a foundation upon which individual residents and program leaders can build tailored, pregnancy-specific interventions, with the ultimate goal of improving the antenatal outcomes of our trainees and their growing families without compromising surgical training.

The Role of the Neonatologist in Fetuses Diagnosed with Congenital Heart Disease.

Prenatal diagnosis of congenital heart disease (CHD) can decrease preoperative morbidity and mortality. Delivery room planning can improve cardiac hemodynamics and time to critical catheter and surgical interventions. Care algorithms have defined lesion-specific level-of-care assignments and delivery room action plans that can facilitate team-based approaches to safe deliveries. Neonatologists play critical roles in the care of fetuses diagnosed with CHD, from the time of diagnosis through the postnatal intensive care unit (ICU) stays. Prenatally, neonatologists are members of the multidisciplinary counseling teams, with expertise to counsel expectant parents about what to expect during the ICU stay, which is especially valuable in CHD associated with extracardiac or genetic anomalies. Neonatologists' role in delivery planning includes identification of the optimal delivery location and allocation of appropriate personnel and resources. After delivery, postnatal care considerations include hemodynamic stability, optimization of end-organ function, genetics consultation, developmentally appropriate care practices to encourage caregiver bonding, and optimization of care to improve neurodevelopmental outcomes of neonates with CHD.

Establishing a Fetal Center in a Freestanding Pediatric Hospital.

Advances in antenatal imaging have allowed early and accurate diagnosis of many fetal anomalies. This, together with the increasing understanding of the natural history of many fetal diseases, has opened the door to the possibility of offering timely fetal interventions in progressive or life-threatening conditions with the intention of improving perinatal outcomes. These interventions can occur at an adult hospital with obstetrical services (with or without pediatric care) or at a freestanding pediatric hospital. In this article, we provide an overview of the approach to develop a comprehensive fetal care center in a freestanding pediatric hospital. Services included prenatal consultation, advanced diagnostics, innovative fetal therapy, research, and special delivery services. We also review the importance of continuous improvement in achieving this goal.

Fetal Heart Rate < 3rd Percentile for Gestational Age Can Be a Marker of Inherited Arrhythmia Syndromes.

Repeated fetal heart rates (FHR) < 3rd percentile for gestational age (GA) with 1:1 atrioventricular conduction (sinus bradycardia) can be a marker for long QT syndrome. We hypothesized that other inherited arrhythmia syndromes might present with fetal sinus bradycardia. We reviewed pregnancies referred with sinus bradycardia to the Colorado Fetal Care Center between 2013 and 2023. FHR/GA data, family history, medication exposure, normalized isovolumic contraction times (n-IVRT), postnatal genetic testing, and ECGs at 4-6 weeks after birth were reviewed. Twenty-nine bradycardic subjects were evaluated by fetal echocardiography. Five were lost to follow-up, one refused genetic testing, and one had negative genetic testing for any inherited arrhythmia. Six had non-genetic causes of fetal bradycardia with normal prenatal n-IVRT and postnatal QTc. Thirteen carried pathogenic variants in RYR2 (n = 2), HCN4 (n = 2), KCNQ1 (6), and other LQTS genes (n = 4). The postnatal QTc was <470 ms in subjects with RYR2, HCN4, and two of those with KCNQ1 mutations, and >470 ms in subjects with CALM 2, KCNH2, SCN5A, and four of those with KCNQ1 mutations. LQTS and RYR2 mutations were associated with prolonged n-IVRT, but HCN4 was not. Two fetuses died in utero with variants of uncertain significance (CACNA1 and KCNE1). Cascade testing uncovered six affected but undiagnosed parents and confirmed familial inheritance in five. In addition to heralding LQTS, repeated FHR < 3rd percentile for GA is a risk factor for other inherited arrhythmia syndromes. These findings suggest that genetic testing should be offered to infants with a history of FHR < 3rd percentile for GA even if the postnatal ECG demonstrates a normal QTc interval.

What Do Your Neighbors Think About You? How Perceived Neighbor Attitudes Toward Latinos Influence Mental Health Among a Pregnant Latina Cohort

Latina women living in the USA experience disproportionately higher rates of psychological distress compared to their non-Latina White counterparts. Poor maternal mental health during pregnancy can contribute to intergenerational mental health disparities. Through this pathway, mothers’ experiences, environments, and exposures (henceforth “exposures”) during pregnancy become biologically embodied and can negatively affect the fetus and life-long developmental trajectories of her child. One of the exposures that can affect mother–offspring dyads is the neighborhood. With the goal of integrating anthropological and sociological theories to explain mental health disparities among pregnant Latina women, we explored how perceptions of neighbor attitudes may influence mental health during pregnancy. We analyzed self-reported responses from 239 pregnant Latina women in Southern California (131 foreign-born, 108 US-born) on their mental health and perceived attitudes of their neighbors using multiple linear regression models. Among foreign-born Latina women, living in neighborhoods with more favorable views of Latinos was associated with lower depression scores (pooled β = − .70, SE = .29, p = .019) and lower pregnancy-related anxiety scores (pooled β = − .11, SE = .05, p = .021), but greater state anxiety scores (pooled β = .09, SE = .04, p = .021). Among US-born women, there were no associations between neighbor attitudes and mental health. Overall, results suggest that social environments are correlated with mental health and that foreign-born and US-born Latinas have varied mental health experiences in the USA. Our findings highlight the importance of improving aspects of neighborhood cohesion as part of maternal–fetal care management.

News from the European Journal of Therapeutics: A new issue and a new editorial board

News from the European Journal of Therapeutics: A new issue and a new editorial board

Fetal Care Nursing—The Birth of a Specialty

With the rapid growth of specialized fetal care centers (FCCs) across the United States, a new area of nursing practice has emerged. Fetal care nurses provide care in FCCs to pregnant persons experiencing complex fetal conditions. This article describes the unique practice of fetal care nurses necessitated by the complexity of perinatal care and the provision of maternal–fetal surgery in FCCs. The Fetal Therapy Nurse Network has played a significant role in the evolution of this nursing practice and will serve as a platform for the generation of core competencies and the development of a potential specialty certification for fetal care nurses.

Death Is Sacred: Being and Non-Being in Sarah Hall’s “Theatre 6”

Abstract The short story “Theatre 6” is one of three post-apocalyptic short stories included in Sarah Hall’s collection Madame Zero, first broadcast on BBC Radio 4 in 2013. The story is inspired by the real-life case of Savita Halappanavar, who died of septic shock at Galway University Hospital in 2012 because of being denied an abortion on grounds of septic miscarriage. The text paints a dystopian vision of a not so far away future where the Hunter fetal care act legislatively places the life of unborn babies higher than the one of mothers. The protagonists are a genderless anaesthesiologist, Dr. Rosinski, and a nameless patient, brought to a London hospital in septic shock, following a denied abortion in spite of a miscarriage suffered several days before. The time of narration is uncertain; however, the story is generally taken to be placed in a future where present-day anti-abortion tendencies have taken over the British judicial system. The story discusses the being/non-being dichotomy from a variety of perspectives: life-death, morals-hypocrisy, religion-secularism, male-female, empathy-bureaucracy, truth-duplicity. The ultimate question the text raises is what or whose life is sacred in a world that has jettisoned all semblance of sanity?

Therapeutic Aspects, Maternal and Fetal Prognosis of Eclampsia in the Gynecology and Obstetrics Department of Sikasso Hospital

Objective: To study the therapeutic aspects, the maternal and fetal prognosis of eclampsia from January 1, 2016 to December 31, 2017 in the gyneco-obstetrics department of Sikasso hospital. Methodology: We have carried out a prospective and descriptive study of cases of eclampsia. It concerned pregnant women, parturients and admitted mothers with signs of hypertension during pregnancy. Results: Nicardipine and Magnesium Sulfate were the most commonly used antihypertensives. Caesarean section was performed in 63.3% of cases. Stillbirth rate was 30.3% of stillbirths, maternal lethality was 11%. Conclusion: Eclampsia is a very common pathology in young women and before childbirth. Maternal and fetal care remains multidisciplinary. Nicardipine and magnesium sulfate were the most commonly used antihypertensives. Vaginal delivery and caesarean were performed. The majority of newborns had a normal weight and more than half were alive 69.7%.

Role of Ultrasonography and Color Doppler in the Assessment of High-Risk Pregnancies and Their Accuracy in Predicting Fetal Outcome.

Introduction Various methods are employed to evaluate the well-being of the fetus in high-risk pregnancies which consists of a biophysical profile (BPP), a non-stress test (NST), and daily fetal movements. Detection of aberrant blood flow in fetoplacental beds has been revolutionized by recent developments in ultrasound technology, such as color Doppler flow velocimetry. The cornerstone of maternal and fetal care is lowering maternal and perinatal mortality and morbidity is antepartum fetal surveillance. Doppler ultrasound is a non-invasive way of obtaining a qualitative and quantitative evaluation of maternal and fetal circulation and is utilized to investigate complications like fetal growth restriction (FGR) and fetal distress.Thus, it is useful in making distinctions between fetuses that are truly growth restricted and small for gestational age and healthy fetuses. The aim of the current study was to determine the role of Doppler indices in high-risk pregnancies and their accuracy in predicting fetal outcomes. Material and methods This prospective cohort studyincluded 90 high-risk pregnancies in the III trimester (after 28 weeks of gestation) on whom ultrasonography and Doppler were performed.Ultrasonography was performed using PHILIPS EPIQ 5, a curvilinear probe of frequency 2-5MHz. Gestational age was determined with a biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femoral length (FL). Placental grading and position werenoted. Estimated fetal weight and the amniotic fluid index were calculated. BPP scoring was done. Doppler study was conducted and the findings of Doppler indices that is pulsatility index (PI) and resistive index (RI) of the middle cerebral artery (MCA), umbilical artery (UA), and uterine artery (UTA), and cerebroplacental (CP) ratio in these high-risk pregnancies were documented and compared with standard. The flow patterns in MCA, UA, and UTA were also assessed. These findings were correlated with fetal outcomes. Results Among 90 cases, the common high-risk factor in pregnancy was preeclampsia without severe features (30%). Growth lag was present in 43 (47.8%) participants. Among the study population, HC/AC ratio was increased in 19 (21.1%) participants which indicatesasymmetrical intrauterine growth restriction. Adverse fetal outcomes were seen in 59 (65.6%) of the subjects. CP ratioand UA PIhad better sensitivity (83.05% and 79.66%, respectively) and positive predictive value (PPV) (87.50% and 90.38%, respectively) in identifying the adverse fetal outcomes. Diagnostic accuracy of CP ratio and UA PI (Accuracy=81.11%) was highest in predicting adverse outcomes than all the other parameters. Conclusion CP ratio and UA PI had better sensitivity, PPV, and diagnostic accuracy in identifying adverse fetal outcomes than other parameters. The study's findings support that the use of color Doppler imaging in high-risk pregnancies will help in the early identification of adverse fetal outcomes and aid in early intervention. This study is non-invasive, simple, safe, and reproducible. This study can also be performed bedside in high risk and unstable patients.This study is required to accurately assess fetal well-being in all high-risk pregnancies in order to improve fetal outcomes and to incorporate this procedure as a part of the protocol for the assessment of fetal well-being in these patients.