Rate Of Fetal Complications Research Articles

Placental Sonomorphologic Appearance and Fetomaternal Outcome in Fontan Circulation.

Objectives: Pregnancies in women with Fontan circulation are on the rise, and they are known to imply high maternal and fetal complication rates. The altered hemodynamic profile of univentricular circulation affects placental development and function. This study describes placental sonomorphologic appearance and Doppler examinations and correlates these to histopathologic findings and pregnancy outcomes in women with Fontan circulation. Methods: A single-center retrospective analysis of pregnancies in women with Fontan circulation was conducted between 2018 and 2023. Maternal characteristics and obstetric and neonatal outcomes were recorded. Serial ultrasound examinations including placental sonomorphologic appearance and Doppler studies were assessed. Macroscopic and histopathologic findings of the placentas were reviewed. Results: Six live births from six women with Fontan physiology were available for analysis. Prematurity occurred in 83% (5/6 cases) and fetal growth restriction and bleeding events in 66% (4/6 cases) each. All but one placenta showed similar sonomorphologic abnormalities starting during the late second trimester, such as thickened globular shape, inhomogeneous echotexture, and hypoechoic lakes, resulting in a jelly-like appearance. Uteroplacental blood flow indices were within normal range in all women. The corresponding histopathologic findings were non-specific and consisted of intervillous and subchorionic fibrin deposition, villous atrophy, hypoplasia, or fibrosis. Conclusions: Obstetric and perinatal complication rates in pregnancies of women with Fontan circulation are high. Thus, predictors are urgently needed. Our results suggest that serial ultrasound examinations with increased awareness of the placental appearance and its development, linked to the Doppler sonographic results of the uteroplacental and fetomaternal circulation, may be suitable for the early identification of cases prone to complications.

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.

Global epidemiology, natural history, maternal-to-child transmission, and treatment with DAA of pregnant women with HCV: a systematic review and meta-analysis

Pregnant women with hepatitis C virus (HCV) infection represent a special population in which treatment access remains limited despite its increasing prevalence. A reliable estimate of the burden and clinical outcomes of pregnant women with HCV infection is crucial for HCV elimination. We aimed to determine the prevalence, maternal-to-child transmission (MTCT), maternal and fetal complication rates, and direct acting antivirals (DAA) treatment outcomes of chronic HCV infection in pregnant women. We searched PubMed, EMBASE, Scopus, Web of Science from inception until March 1, 2024, for studies reporting on the prevalence, MTCT, complications of HCV infection, and treatment outcomes of DAA in pregnant women. Study quality was assessed using the Newcastle-Ottawa Scale. We performed subgroup analysis based on 9 variables to explore the source of heterogeneity in HCV prevalence. The PROSPERO registration number is CRD42024500023. From a total of 311,905,738 pregnant women from 333 studies, the pooled global seroprevalence of HCV in pregnant women was 2.6% (95% CI: 2.0-3.2, I 2=100%) which increased in patients with intravenous drug use and HIV. Majority of the HCV cases in pregnant women (75%) are diagnosed through universal screening. The pooled MTCT rate was 9.0% (95% CI: 6.6-11.7, I 2=79%), which was higher with HIV co-infection (OR: 3.1, 95% CI: 2.1-4.6, I 2=10%), but was not influenced by the mode of delivery or breastfeeding. Pregnant women with HCV infection had more maternal complications, including intrahepatic cholestasis, preterm delivery, and antepartum hemorrhage. Neonates of mothers with HCV had higher odds of being small for gestational age. The pooled rate of sustained virologic response (SVR12) among the 74 women treated with DAA during pregnancy was 98.4%, with no serious adverse events reported. HCV prevalence in pregnant women varies by geographic region and patient population, while MTCT occurs in almost one in ten viremic mothers. The incidence of both maternal and neonatal complications is significantly higher in patients with HCV infection. Limited data suggest that DAA are safe in pregnant women with HCV infection. None.

P-686 Optimal follicle size for triggering modified natural frozen embryo transfers

Abstract Study question What is the optimal follicle size threshold for performing trigger in modified natural cycle frozen embryo transfers (mNC-FET) cycles Summary answer The optimal follicle size threshold for performing trigger is 16 or 17, depending on the clinic’s preference to risk too early or too late triggering What is known already Recent studies reported higher fetal and maternal obstetrical complication rates are observed in artificial cycles compared to natural cycle frozen embryo transfers (NC-FET), making the natural cycle (NC) the preferred method. The modified natural cycle (mNC) provides a partial solution to overcome the disadvantages of the NC, mostly its repeated visits and inability to conveniently schedule the transfer. In a recently published large RCT, pregnancy rates between NC and mNC were similar, but many patients allocated to the mNC group had an LH surge prior to the hCG injection. Study design, size, duration A retrospective study consisting of 5,862 NC-FET was performed between 2018 and 2023 in a large tertiary hospital. Participants/materials, setting, methods Statistical analysis was conducted to determine the optimal follicle size threshold for triggering, for each threshold between 12-20, under the following assumptions: Clinic is closed on Sundays, ultrasound is initially performed on day 8 of the cycle and every 2 days afterwards, trigger is performed if the follicle size is at or above the threshold, unless clinic is closed 2 days after the current test day in which case no trigger was given. Main results and the role of chance The analysis measured 2 main outcomes for each trigger size threshold: The probability of triggering too early, defined as shifting the ovulation by 3 or more days. The probability of spontaneous LH surge to occur before triggering, possibly leading to transfer cancelation due to clinic closure on the designated transfer day. The traditional follicle size-based algorithm performed as follows: [Follicle size threshold]: ] Early trigger probability], [Closed day transfer probability] 12: 71.9%, 0.1% 13: 61.7%, 0.1% 14: 49.0%, 0.2% 15: 33.9%, 0.6% 16: 21.3%, 1.3% 17: 12.9%, 2.8% 18: 7.3%, 4.5% 19: 3.4%, 6.7% 20: 2.2%, 8.6% As can be seen from the results the optimal trigger threshold is either 16 or 17, depending on whether reducing transfers on days the clinic is closed has a higher importance than preventing a very early trigger day. Limitations, reasons for caution This was a retrospective study that performed statistical analysis to determine the probability of achieving each result based on the described logic. A prospective randomized clinical trial is warranted to validate the algorithm’s performance and consider variables that could not be accounted for, such as the patient’s endometrial width. Wider implications of the findings NC-FET protocols require the ability to adapt the transfer to clinics’ requirements. Given a traditional threshold-based methodology for triggering, a threshold of 16-17 is optimal depending on the risk preference of a clinic. Utilizing more advanced artificial intelligence algorithms based on ovulation prediction can significantly reduce both risk types. Trial registration number Not applicable

A Review of High-Risk Pregnancy Complications in the Resident Clinic

Introduction: A high risk status can develop during a patient’s pregnancy or can be present from conception. These include maternal pre-existing conditions such as hypertension, diabetes, infection such as HIV, and obesity. Fetal complications such as anomaly or multiple gestation also constitute high risk pregnancies. The Corewell Health East Dearborn resident high risk clinic helps to manage these patients’ pregnancies and deliveries. This study aims to analyze the current complications and delivery outcomes of pregnancies from this clinic. Methods: The prenatal care data and pregnancy outcomes from patients in our high-risk resident clinic was collected from Jan 1st 2023 to Jan 1st 2024. The prenatal care data was analyzed for maternal and fetal complications along with delivery outcomes. Results: During the year 2023, 100 patients delivered from the high-risk clinic. Fetal complications were found in 32% of these deliveries. These included 12% twin gestation, 14% growth restriction, 6% fetal anomalies. Maternal complications included 27% with chronic hypertension, 23% with prior cesarean section, 27% with a BMI of 40 or higher, 10% cardiac complications, 4% pre-existing renal complications, 26% with pre-existing diabetes, 3% wtih HIV, and 6% with polysubstance use. The deliveries included 62% cesarean sections and 34% vaginal deliveries. Discussion: The results from our cross-sectional study revealed a high rate of maternal and fetal complications among patients from our high-risk clinic when compared to national averages. There was a high cesarean section rate for these patients. Conclusions: This study allowed us to better understand the patient population that receives care through the resident high-risk clinic. Future studies can explore how to decrease the cesarean section rate.

Aspirin therapy is associated with a lower risk of pregnancy loss in both JAK2- and CALR-mutated essential thrombocythemia-A Mayo Clinic study of 200 pregnancies.

Two-hundred pregnancies involving 100 women with essential thrombocythemia (ET) were accessed from Mayo Clinic databases (1990-2023). Median platelet count displayed a decline during pregnancy, nadiring at 48% of baseline, in the third trimester: 704-369 × 109/L. Live birth rate was 72%. Of 53 (27%) unintentional pregnancy losses, 48 (24%) occurred in the first trimester. Other fetal complications included preterm birth 3%, intrauterine growth retardation 3%, and stillbirth 1%. Maternal complications included major hemorrhage (7%), preeclampsia (6%), thrombosis (1%), and placental abruption (0.5%). Antepartum management included no specific therapy in 52 (26%), aspirin alone in 112 (56%), aspirin combined with cytoreductive drugs or systemic anticoagulants in 23 (12%), and other permutations in the remaining. Postpartum systemic anticoagulation was documented in 29 (15%) pregnancies. Unintentional first-trimester loss was predicted by prior fetal loss (43% vs. 18%; p < .01), diabetes mellitus (DM; 67% vs. 23%; p = .02), and absence of aspirin therapy (45% vs. 14%; p < .01); the salutary effect of aspirin therapy was independent of the other two risk factors and apparent in both high (presence of ≥1 risk factor; 33% vs. 61%; p = .07) and low (absence of both risk factors; 10% vs. 34%; p < .01) risk scenarios. The benefit of aspirin therapy, in preventing first-trimester loss, was significant in both JAK2-mutated (18% vs. 50%; p < .01) and CALR-mutated (8% vs. 43%; p < .01) cases. Aspirin use was also associated with a lower risk of venous thrombosis (0% vs. 3%; p = .03). By contrast, the use of systemic anticoagulation, antepartum or postpartum, did not influence fetal or maternal complication rates. CALR mutation and DM predicted maternal hemorrhage (13% vs. 4%; p = .05) and preeclampsia (33% vs. 5%; p = .03), respectively. The current study demonstrates the protective role of aspirin in preventing first-trimester loss in ET, independent of driver mutation status or other risk factors.

Association of preeclampsia, placental pathology, and maternal-fetal features with gestational hypertension before and after 34 weeks of pregnancy

Objective: Evaluating the preeclampsia, placental pathology, maternal and fetal features in women with gestational hypertension (GH) at varying gestational ages. Methods: A series of maternal, fetal, placental pathological, and neonatal variables were prospectively evaluated and compared between two 30-tuple groups of eligible pregnant women with early GH before 34 weeks' gestation and those with late GH after 34 weeks' gestation. Results: Proteinuria and preeclampsia were more prevalent in the early GH group compared with the late GH group (80% vs 20%, P:0.001). The maternal high blood pressure and proteinuria were significantly associated with the early GH and preeclampsia (p&lt;0.05). The percentage of syncytial knots significantly increased as preeclampsia progressed (P&lt;0.05). A significant positive correlation existed between the early GH and the percentage of newborns admitted to NICU, the length of hospitalization, and the levels of the doppler indexes of umbilical and uterine arteries (p&lt;0.05); the newborn Apgar scores were also lower in the early GH group (p&lt;0.05). The mortality rate of newborns born to early hypertensive mothers (13.30%) was insignificantly higher than those delivered by the late hypertensive mothers (3.30%, p:0.16). Conclusion: Maternal high blood pressure and proteinuria may be predicting risk factors for the early GH and/or preeclampsia. The placentas of women with early GH were partially different from those with GH after 34 weeks' gestation. Higher rates of maternal and fetal pregnancy-related complications in the early GH group may be indicative of the different effects of GH and preeclampsia on pregnancy outcomes depending on the gestational age.

Unmet Needs of Immune Thrombotic Thrombocytopenic Purpura (iTTP)-Specific Pregnancy Counseling, Care and Outcomes in Women with Ittp

Unmet needs of iTTP-specific pregnancy counseling, care and outcomes in women with iTTP INTRODUCTION: Pregnancy is a known trigger for an initial episode or relapse of immune thrombotic thrombocytopenic purpura (iTTP) and outcomes of pregnancy in women with iTTP have historically been suboptimal with high rates of recurrent iTTP, fetal loss, preeclampsia and HELLP syndrome. More recent data suggest that prophylactic immunosuppression to normalize ADAMTS13 levels before conception, and ADAMTS13 monitoring and prophylactic steroids or plasma exchange during pregnancy can improve maternal and fetal outcomes. However, it is not clear whether women with iTTP are routinely counseled regarding these options. We conducted this study to understand the experiences of women with iTTP with reproductive healthcare, how iTTP has impacted their reproductive decisions, and outcomes of pregnancy. METHODS: We developed a web-based (RedCap) survey focused on the reproductive healthcare experiences of women with iTTP with in three major sections: (1) counseling and education around pregnancy that was provided to them, (2) the impact of iTTP on their reproductive decisions, and (3) outcomes of any pregnancies they had experienced. The survey was distributed through social media and email mailing lists of a patient advocacy organization and was kept open for one month (January 2023). Survey data were summarized using counts and percentages. The focus of the analysis was to identify gaps in patient education and care where efforts could be focused on educating clinicians or providing information to patients though patient advocacy groups. RESULTS: Seventy-five females with iTTP responded to the survey. The median age of the respondents was 44 years (range 23 - 65). Sixty-five (74.7%) identified as White, 13 (14.9%) as Black, 6 (6.9%) as Asian and 3 (3.4%) identified as other/prefer not to say. Nearly all (94.6%) were followed by a hematologist or hematologist-oncologist and 82.9% reported being monitored regularly for iTTP. Only 26.7% (20 of 75) reported that their doctor talked to them about measures that may help achieve a successful pregnancy. These included ADAMTS13 monitoring (n=15), plasma exchange treatments (n=10), rituximab (n=10), and aspirin (n=3) (options are not mutually exclusive so total is &amp;gt; 20). Moreover, 30.0% (21 of 70) reported that they were advised by their doctor to not get pregnant due to their iTTP. Some patients (36.0%) avoided pregnancy out of fear of the consequences of iTTP and 28.4% (21 of 74) responded that their iTTP diagnosis has affected their ability to get into a relationship, which impacts their quality of life (Figure 1). Fifty-three patients reported that they had had at least one pregnancy. Of these, 35 had pregnancies before iTTP diagnosis, 10 with the initial presentation of iTTP, and 8 women had a total of 11 pregnancies following the diagnosis of iTTP. Consistent with prior reports, there was a high rate of maternal and fetal complications in pregnancies that occurred in the setting of a first iTTP episode complicating pregnancy, or pregnancies after an iTTP diagnosis (Table 1). iTTP relapse occurred in 27.3% (3 of 11) pregnancies in women with prior iTTP. Fetal loss occurred in 30% of pregnancies with first TTP diagnosis and 9% of pregnancies after iTTP. In both groups, approximately 20% were small for gestational age. Preeclampsia or HELLP syndrome occurred in 50% and 18.2% of pregnancies complicated by initial TTP diagnosis or after iTTP diagnosis, respectively. CONCLUSION: Though pregnancy in women with iTTP is high risk, close monitoring and prophylactic interventions can improve outcomes. While many women with iTTP are counseled regarding the risks of pregnancy, few receive counseling regarding their options to potentially improve pregnancy outcomes. This limits their reproductive choices and impacts their relationships. Educating clinicians and providing information to patients though patient advocacy groups may help address these healthcare gaps.

Diagnostic et prise en charge d’hyperparathyroïdie primaire pendant la grossesse : revue de la littérature autour d’un cas

ObjectiveThere is no specific recommendation for management in pregnant women: the aim of this review, based on a clinical case study, is to clarify its development, complications, risk factor and treatment. MethodsA review of the literature was performed by consulting the Pubmed, Cochrane Library, and Science Direct databases. ResultsPrimary hyperparathyroidism is defined as excessive production of parathyroid hormone resulting in hypercalcemia. The prevalence of primary hyperparathyroidism during pregnancy is not known. Indeed, the symptomatology, related to hypercalcemia, is not very specific and easily confused with the clinical manifestations of pregnancy. The physiological changes specific to the pregnant state frequently lead to a slight hypocalcemia which may complicate the diagnosis of primary hyperparathyroidism. Primary hyperparathyroidism results from a parathyroid adenoma in the majority of cases and is detected by ultrasound during pregnancy. Primary hyperparathyroidism in pregnancy causes significant risks to both mother and fetus. The maternal complication rate is 14–67%, however, the most serious complication is hypercalcemic crisis, which requires increased surveillance in the postpartum period. Obstetrical complications are also induced by primary hyperparathyroidism, such as acute polyhydramnios, or intrauterine growth retardation. The fetal complication rate can reach 45–80% of cases with neonatal hypocalcemia as the main complication. If medical treatment is based on hyperhydration, only surgical treatment is curative. ConclusionSurgery should be proposed to symptomatic patients or those with high blood calcium levels, discussed in interdisciplinary committee and should be organized ideally in the second trimester to avoid maternal and fetal complications.

PREGNANCY-RELATED COMPLICATIONS IN PRIMARY ALDOSTERONISM: A EUROPEAN SURVEY

Objective: Hypertensive pregnancy disorders, affecting 4 - 25% of pregnancies according to countries’ income, represent a major cause of maternal and fetal morbidity and mortality. Data on pregnancy's complications in patients with primary aldosteronism (PA) are scarce, despite PA being the most frequent cause of secondary hypertension. We did an international survey to collect maternal and fetal pregnancy-related complications in a cohort of women with PA recruited from 5 Hypertension Excellence Centers in Europe. Design and method: We included consecutive women aged 18 - 45 years who were pregnant either after or &lt;1-year before diagnosis of PA and excluded those who were pregnant after unilateral adrenalectomy for PA. PA diagnosis was made in each center according to guidelines. Information on maternal and fetal issues was obtained through medical records and patients’ interviews. Results: We included 78 women aged 30 ± 6 years, 33% nulliparous, 14% with past pre-eclampsia, 53% with hypokalemia, 4% smokers, 7% with type II diabetes, 4% with chronic kidney disease. They had 97 pregnancies, of which 43 occurred &lt;1 year before PA diagnosis and 54 after a median of 18 months from PA diagnosis. All women had either chronic or new onset gestational hypertension (12%). Excluding 7 spontaneous miscarriages, pregnancy-related complications occurred during 43 out of 90 pregnancies (44%), including proteinuria in 36 (40%), pre-eclampsia in 27 (30%), placental abruption in 2 (2%) and intrauterine fetal death in 6 pregnancies (7%). There was a high rate of delivery morbidity including 30% of pre-term births occurring at a median of 34 weeks of gestational age, and 35% of cesareans sections. A total of 23 out of 84 (27%) newborns had a low birth weight (&lt;2500 g) and 22 (26%) underwent neonatal intensive care. When compared to historical control cases from a systematic review, women with PA showed similar rates of maternal complications vs women with essential chronic hypertension, but higher rates of fetal complications (Figure 1). Conclusions: Our data emphasize the importance of PA screening in young hypertensive women prior pregnancy, to ensure 1) appropriate and early treatment of PA, and 2) strict follow-up during pregnancy.

Membrane Sweeping to Induce Labor in Post-term Pregnant Women: Success Rate and Outcomes.

Introduction Membrane sweeping is a mechanical technique by which a clinician inserts one or two fingers into the cervix and detaches the inferior pole of the membranes from the lower uterine segment using a continuous circular sweeping motion. This produces hormones that promote effacement and dilatation, potentially promoting labor. This study aimed to determine the success rate and the outcome of membrane sweeping in postdate pregnant women in Alhasahesa Teaching Hospital. Methods This prospectivedescriptive cross-sectional study conducted at Alhashesa Teaching Hospital, Alhashesa, Sudan, between May and October 2022 included all pregnant women at 40 or more weeks of gestation who underwent membrane sweeping to induce labor. We recorded the number of sweeps needed, sweeping-to-delivery interval, mode of delivery, maternal outcome, and fetal outcome (including birth weight, Apgar score at delivery, and the need for neonatal intensive care unit admission [NICU]). Data were collected through patient interviews using a specially designed questionnaire and analyzed using Statistical Package for Social Sciences (SPSS®) software for Windows, Version 26.0 (Armonk, NY: IBM Corp.), Results Membrane sweeping induced labor in 127 postdate women (86.4%). Most of the women in the study (n=138; 93.9%) had no complications, seven (4.8%) had postpartum hemorrhage, one (0.7%) had sepsis, and one (0.7%) was admitted to the intensive care unit. All neonates were alive, and most (n=126; 85.8%) birth weights ranged from 2.5 kg to 3.5 kg. Thirteen (8.8%) neonates weighed less than 2.5 kg, and eight (5.4%) weighed more than 3.5 kg. One hundred thirty-three (90.5%) had Apgar scores <7, eight (5.4%) had Apgar scores under five, and six (4.1%) had Apgar scores of five to six. Seven neonates (4.8%) were admitted to the NICU. Conclusions Membrane sweeping to induce labor has a high success rate, and it can be safe for both the mother and the baby, as it is associated with a low rate of maternal and fetal complications. Additionally, no maternal and/or fetal deaths were reported. A large, controlled study is required to compare its benefits over other methods of induction of labor.

Cardiac and obstetric outcomes of pregnancies for women after cardiotoxic therapy in childhood: a single center observational study

BackgroundChildhood cancer survivors (CCS) are at increased risk of cardiomyopathy during pregnancy if they have prior cardiotoxic exposure. Currently, there is no consensus on the necessity, timing and modality of cardiac monitoring during and after pregnancy. Therefore, we examined cardiac function using contemporary echocardiographic parameters during pregnancy in CCS with cardiotoxic treatment exposure, and we observed obstetric outcomes in CCS, including in women without previous cardiotoxic treatment exposure.MethodA single-center retrospective cohort study was conducted among 39 women enrolled in our institution’s cancer survivorship outpatient clinic. Information on potential cardiotoxic exposure in childhood, cancer diagnosis and outcomes of all pregnancies were collected through interviews and review of health records. Echocardiographic exams before and during pregnancy were retrospectively analyzed for left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) if available. The primary outcomes were (i) left ventricular dysfunction (LVD) during pregnancy, defined as LVEF < 50% or a decline of ≥ 10% in LVEF below normal (< 54%), and (ii) symptomatic heart failure (HF). Rate of obstetric and fetal complications was compared to the general population through the national perinatal registry (PERINED).ResultsAll pregnancies (91) of 39 women were included in this study. The most common malignancy was leukemia (N = 17, 43.6%). In 22 patients, echocardiograms were retrospectively analyzed. LVEFbaseline was 55.4 ± 1.2% and pre-existing subnormal LVEF was common (7/22, 31.8/%). The minimum value of LVEF during pregnancy was 3.8% lower than baseline (p = 0.002). LVD occurred in 9/22 (40.9%) patients and HF was not observed. When GLS was normal at baseline (< -18.0%; N = 12), none of the women developed LVD. Nine of out ten women with abnormal GLS at baseline developed LVD later in pregnancy. In our cohort, the obstetric outcomes seemed comparable with the general population unless patients underwent abdominal irradiation (N = 5), where high rates of preterm birth (only 5/18 born at term) and miscarriage (6/18 pregnancies) were observed.ConclusionOur study suggests that women with prior cardiotoxic treatment have a low risk of LVD during pregnancy if GLS at baseline was normal. Pregnancy outcomes are similar to the healthy population except when patients underwent abdominal irradiation.

Open and endoscopic fetal myelomeningocele surgeries display similar in-hospital safety profiles in a large, multi-institutional database

Open intrauterine fetal myelomeningocele repair has demonstrated decreased ventriculoperitoneal shunting and improved motor outcomes despite maternal and fetal risks. Few data directly compare the safety of open vs endoscopic approaches. This study aimed to analyze in-hospital maternal and fetal outcomes of pregnant patients undergoing open vs endoscopic fetal myelomeningocele repair using a large, multi-center database. This was a review of the Pediatric Health Information System database from October 1, 2015, to December 31, 2021. All patients who underwent open or endoscopic fetal myelomeningocele repair according to the International Classification of Diseases, Tenth Revision, were identified. Demographics, gestational age, and outcomes were analyzed. Descriptive and univariate statistics were used. A total of 378 pregnant patients underwent fetal myelomeningocele repair. The approach was endoscopic in 143 cases (37.8%) and open in 235 cases (62.2%). Overall postprocedural outcomes included no maternal in-hospital mortalities or intensive care unit admissions, a median length of stay of 4 days (interquartile range, 4-5), 14 cases (3.7%) of surgical and postoperative complications, 6 cases (1.6%) of intrauterine infections, 12 cases (3.2%) of obstetrical complications (including preterm premature rupture of membranes), 3 cases (0.8%) of intrauterine fetal demise, and 16 cases (4.2%) of preterm delivery. Compared with an open approach, the endoscopic approach occurred at a later gestational age (25 weeks [interquartile range, 24-25] vs 24 weeks [interquartile range, 24-25]; P<.001) and had an increased rate of intrauterine infection (6 [4.2%] cases vs 0 [0%] case; P=.002). There was no difference between approaches in the rates of surgical complications, obstetrical complications, intrauterine fetal demise, or preterm deliveries. Compared with an open approach, endoscopic fetal myelomeningocele repair displays a comparable rate of fetal complications, including intrauterine fetal demise and preterm delivery, and a similar in-hospital maternal safety profile despite an association with increased intrauterine infection.

Risk factors associated with adverse pregnancy outcomes and postpartum exacerbation in women with myasthenia gravis.

Myasthenia gravis (MG), an autoimmune neuromuscular disease affecting women of childbearing age, exerts an impact on pregnancy, and vice versa. The purposes of the study were to evaluate adverse pregnancy outcomes and postpartum exacerbation in a cohort of Asian MG women, and to explore the predictors for these outcomes. Thirty-seven MG pregnancies of 33 women followed in Xiangya and the second Xiangya hospitals between January 2012 and January 2022, were included in this study. Baseline maternal data, maternal complications, and neonatal outcomes were extracted from medical records. MG courses were evaluated during pregnancy and postpartum 1 year. In 5.4% of cases, MG exacerbation was reported during gestation, mostly in the third trimester, and in 38.9% in the postpartum period. Maternal complications were measured in 59.5% of women, gestational diabetes mellitus (GDM) taking the lead (29.7%) followed by premature rupture of membranes (PROMs) (18.9%). Transient neonatal MG (TNMG) and hyperbilirubinemia (HB) were seen in 24.3% of newborns. Body mass index (BMI) was the only independent predictor for maternal obstetric complications (p=.017), while thyroid disorders for GDM (p=.006). Younger mothers tended to give birth to babies with TNMG (p=.015). Primipara was the only risk factor for HB (p=.015). Higher gestational BMI gain (GBG) (p=.049) and without thyroid disorder (p=.017) were independent risk factors for puerperal exacerbation. Activated partial thromboplastin time and thyroid-stimulating hormone levels could be reliable to predict puerperal exacerbation. Most MG patients have unaffected courses during pregnancy but face a higher rate of maternal and fetal complications. Risk factors identified in our study aid the management of pregnancy in MG women.

Second pregnancy following kidney transplantation is not associated with an increased risk of graft loss in a single center retrospective cohort study.

Previous studies on first pregnancy following kidney transplantation (KT) show no association with decreased graft survival. This study examined patients with multiple gestations compared to a single pregnancy following KT and evaluated the risk of graft function deterioration. A retrospective cohort study on fertile female kidney transplant recipients (KTRs) from Rabin Medical Center between January 2001 and December 2017 was performed. Data were collected on patients' comorbidities, pregnancy complications, graft loss, mortality, and lab results. Time-varying COX analysis was performed - second pregnancy being the time-related variable. Fifty-two KTRs split into 30 single pregnancy and 22 multiple pregnancy patients following KT. Single pregnancy patients were older during their first pregnancy and had a higher caesarian section rate. During a median follow-up period of 5.6 years, multiple pregnancies, compared to a single pregnancy, were not associated with an increased rate of graft loss. No significant difference was seen between first and second pregnancy in gestational age, birth weight, graft function, and proteinuria rates. Second pregnancy following KT was not shown to be associated with a decreased graft survival. In addition, obstetrical, maternal, and fetal complication rates are not increased in second compared to first pregnancy following KT.

Maternal Obesity in Twin Pregnancy: The Role of Nutrition to Reduce Maternal and Fetal Complications.

There are more and more obese mothers with twin gestations. For a long time before, the responses of lymphocytes and platelets in obese women can cause a low-grade inflammation. In addition, a proper control of gestational weight gain would improve the outcomes in mothers with high pre-gestational body mass index (BMI). In women with high pre-gestational BMI and twin pregnancy, our aims were to explore the biochemical and hematological parameters and to study the rate of obstetric adverse outcomes. This was an observational and retrospective study conducted in the Hospital Universitario La Paz (Madrid, Spain). We included 20 twin pregnancies as the lean group (BMI = 18.5–24.9 kg/m2), homogeneous in the maternal age and ethnicity, and having parity with other 20 twin pregnancies as the obese group (BMI ≥ 30 kg/m2). The maternal data and maternal, fetal, obstetric, and neonatal complications were collected from the medical records. In the first and third trimester of pregnancy, the biochemical and hematological parameters of the blood were assayed. In this cohort, gestational weight gain was significantly lower in the obese than lean group. In the first trimester, the hemoglobin levels in obese women (12.1 ± 0.8 g/dL) were lower than lean women (12.6 ± 0.7 g/dL; p-Value = 0.048). In addition, the tendency of glucose levels, TSH levels and platelets was to increase in obese compared to lean women. In the third trimester, the TSH levels were higher in obese (3.30 ± 1.60 mUI/L) than lean women (1.70 ± 1.00 mUI/L; p-Value = 0.009). Furthermore, there was a tendency for levels of platelets and lymphocytes to increase in obese compared to lean women. No significant differences were detected in the rate of maternal, fetal, obstetrical, and neonatal complications between the groups. The hemoglobin, platelets, lymphocytes and TSH levels need further investigation to understand potential subclinical inflammation in obese women. Furthermore, obese women with twin pregnancies should follow-up with a specialist nutritionist, to help them control their gestational weight gain with appropriate dietary measures.

Umbilical Cord Entanglement.

Umbilical Cord Entanglement.

The use of metformin in women with polycystic ovary syndrome: an updated review.

Polycystic ovary syndrome (PCOS) is a major cause of female infertility, being present in up to 20% of women of childbearing age. Insulin resistance (IR) plays an important role in the pathophysiology of PCOS; therefore, its treatment may benefit women with the syndrome. The main drug used for IR management is metformin (MT). We aim to review the literature on the use of metformin in women with PCOS. Using the terms "metformin" and "polycystic ovary syndrome," we conducted a search the PubMed, EMBASE, and Google Scholar databases. The research was restricted to articles published in English. Initially, only published meta-analyses were included, in the absence of meta-analyzes, RCT and well-designed prospective studies were used. Metformin increases success rates and decreases complication rates when used as an adjunctive medication for ovulation induction during low complexity assisted reproduction treatments and during ovarian stimulation for in vitro fertilization in women with PCOS. Evidence about the effect of metformin on fetal and obstetric complication rates is conflicting. Metformin is associated with high incidence of gastrointestinal symptoms; however, serious adverse effects are rare and there is no evidence of teratogenicity. For women with PCOS, metformin is a good adjunctive medication for ovulation induction/stimulation for high and low complexity assisted reproduction therapies. The adverse effects are mostly mild, and there is no risk of teratogenicity, but the risk of long-term complications for the offspring is not yet defined. High heterogeneity of the studies limits extrapolation of findings, and further research is needed to determine which women will benefit most from the medication.

Effects of the Zishen Yutai Pill Compared With Placebo on Live Births Among Women in a Fresh Embryo Transfer Cycle: A Randomized Controlled Trial.

To assess the efficacy of the Zishen Yutai Pill compared with placebo on live birth rates among women after fresh embryo transfer cycles. We conducted a double-blind, multicenter, placebo-controlled, randomized trial to investigate whether administration of the Zishen Yutai Pill would improve pregnancy outcomes among women undergoing fresh embryo transfer after in vitro fertilization or intracytoplasmic sperm injection. The primary outcome was live birth rate. Secondary outcomes were rates of implantation, biochemical pregnancy, clinical pregnancy, pregnancy loss, cycle cancellation, and maternal, fetal, and neonatal complications. A total sample size of 2,265 women (1:1 in two groups) was used to detect a live birth rate difference between the Zishen Yutai Pill and placebo. Participants were enrolled and randomized to receive 5 g of the Zishen Yutai Pill or placebo orally, three times per day during the study. Recruitment was completed between April 2014 and June 2017, with 2,580 patients screened. Two thousand two hundred sixty-five patients were randomized: 1,131 to the Zishen Yutai Pill and 1,134 to placebo. Characteristics were similar between groups. In intention-to-treat analysis, the rates of live birth in the Zishen Yutai Pill (ZYP) group and placebo group were 26.8% and 23.0% (rate ratio [RR], 1.16; 95% CI 1.01-1.34; P=.038), respectively. The implantation rates were 36.8% and 32.6% in the ZYP and placebo groups, respectively (RR 1.13; 95% CI 1.01-1.25; P=.027). The biochemical pregnancy rate for the ZYP group was 35.5% compared with 31.1% in the placebo group (RR 1.14; 95% CI 1.02-1.28; P=.026). The rates of clinical pregnancy in the ZYP and placebo groups were 31.2% compared with 27.3%, respectively (RR 1.14; 95% CI 1.00-1.30; P=.043). There were no significant between-group differences in the rates of pregnancy loss, maternal, or neonatal complications (all P>.05). The Zishen Yutai Pill increased the rate of live birth after fresh embryo transfer compared with placebo. Chictr.org.cn, Chictr-TRC-14004494.

Pregnancy in physicians: A scoping review

BackgroundThe personal health and professional impact of physician pregnancy requires further study. We performed a comprehensive scoping review of physician pregnancy to synthesize and assess the evidence to aid decision-making for relevant stakeholders. MethodsA search of 7 databases resulted in 3733 citations. 407 manuscripts were included and scored for evidence level. Data were extracted into themes using template analysis. ResultsPhysician pregnancy impacted colleagues through perceived increased workload and resulted in persistent stigmatization and discrimination despite work productivity and academic metrics being independent of pregnancy events. Maternity leave policies were inconsistent and largely unsatisfactory. Women physicians incurred occupational hazard risk and had high rates of childbearing delay, abortion, and fertility treatment; obstetric and fetal complication rates compared to controls are conflicting. ConclusionsComprehensive literature review found that physician pregnancy impacts colleagues, elicits negative perceptions of productivity, and is inadequately addressed by current parental leave policies. Data are poor and insufficient to definitively determine the impact of physician pregnancy on maternal and fetal health. Prospective risk-matched observational studies of physician pregnancy should be pursued.