Fetal Complications Research Articles

Maternal and fetal outcomes in pregnancy complicated by pre-existing lupus nephritis: Insights from a developing country Pakistan.

Pregnancy in women with systemic lupus erythematosus (SLE) has remained a great challenge for clinicians in terms of maternal and fetal outcomes. The outcomes in women with pre-existing lupus nephritis (LN) are variable. The impact of different classes of LN on maternal and fetal outcomes during pregnancy is not well defined, as data is very scarce, especially from the developing countries. A retrospective analysis was conducted on 52 women with 89 pregnancies. All had biopsy-proven LN. Those women who conceived at least 6months after the diagnosis were included. The analysis was conducted between July 1998 and June 2018 at Sindh Institute of Urology and Transplantation (SIUT), evaluating the outcomes for both the mother and the fetus with a minimum follow-up of 12months after child birth. The mean maternal age at SLE diagnosis was 21.45 ± 6years and at first pregnancy was 26.49 ± 5.63years. The mean disease duration was 14.02 ± 19.8months. At conception, 47 (52.8%) women were hypertensive, 9 (10%) had active disease while 38 (42.7%) and 42 (47.2%) were in complete and partial remission, respectively. A total of 17 (19.1%) were on mycophenolate mofetil (MMF), which was switched to azathioprine (AZA). Out of 89 pregnancies, 56 (62.9%) were successful, while 33 (37.07%) had fetal complications like spontaneous abortion, stillbirth, perinatal death, and intrauterine growth retardation (IUGR). There were more vaginal deliveries (33 [58.92%]) than caesarean sections (23 [41.07%]). Renal flare was observed in 33 (37.1%) women while 15 (16.9%) developed pre-eclampsia. Proliferative LN was found in 56 (62.9%) cases, but no significant differences were found in maternal and fetal outcomes in relation to LN classes (p = .58). However, disease outcomes at 12months were significantly poor in those with active disease at the time of conception (p < .05). There was only one maternal death. A total of 10 (11.2%) women showed deterioration in renal function and 5 (5.6%) were dialysis-dependent at 12months. The maternal and fetal outcomes in pre-existing LN depend on the disease activity at the time of conception. No correlation was found between International Society of Nephrology/Renal Pathology Society (ISN/RPS) classes of LN and adverse disease and pregnancy outcomes.

Evaluation of Maternal and Perinatal Outcomes in Pregnancy with Preeclampsia at Aljala Maternity Hospital

Hypertensive disorders of pregnancy (HDP) accounts for 18% of maternal deaths worldwide, with an estimated number of about 62, 000–77, 000 deaths occur each year. The current study aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Aljala Maternity Hospital. A retrospective, descriptive, case series analysis for four hundred patients was done on the outcome of hypertensive disorder among pregnant women who admitted and were managed at Aljala teaching hospital with preeclampsia during the years 2019 and 2020. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally, delivery route, indications of cesarean section, fetal and maternal complications were determined. The current finding reported high prevalence of perinatal and maternal mortality among pregnant women with preeclampsia. Moreover, other severe maternal and perinatal complications such as Hemolysis Elevated Liver Enzyme Platelet (HELLP) syndrome, placental abruption, eclamptic fits, as well as low birth weight were also commonly reported. The current study showed early onset of preeclampsia was associated with increased risk of developing adverse maternal-fetal/neonatal outcomes compared to late-onset after 36 weeks. Our findings call for special consideration and close surveillance of those women with early-onset diseases.

Prevalence and feto-maternal outcomes of subclinical hypothyroidism in pregnancy among mothers attending a tertiary care hospital of Darjeeling District, West Bengal, India

Background: Pregnancy is a stressful test for the mother’s thyroid function. The frequency of hypothyroidism in pregnant women is high. However, there are no adequate studies to evaluate the adverse effects of subclinical hypothyroidism (SCH) during pregnancy. Aims and Objectives: This study was carried out to evaluate the prevalence of SCH in pregnancy and its adverse feto-maternal outcomes among mothers attending a tertiary care teaching hospital in Darjeeling district, West Bengal, India. Materials and Methods: The present study was an institution-based observational descriptive study with a prospective longitudinal design conducted for 1 year among pregnant women attending the antenatal clinic of the study institution in the first trimester of their pregnancy. The sample size for the present study was calculated to be 200. A consecutive sampling technique was utilized. The enrolled women were evaluated for thyroid status by assessing serum thyroid stimulating hormone and free T4 level. All the enrolled mothers were kept under close follow-up and they were evaluated for the development of any antenatal, intranatal, and postnatal complications. Results: The mean age was found to be 23.1±4.2 years, most of the women were nulliparous (60%). Of the women, 74% were euthyroid, while the prevalence of SCH was found to be 16%. On follow-up till the termination of their pregnancies, mothers suffering from SCH had statistically significantly higher incidence of maternal complications such as hypertensive disorders in pregnancy (P=0.001), abortion (P&lt;0.001), postpartum hemorrhage (P=0.020) and also fetal adverse outcomes, such as intrauterine growth restriction (P=0.018), fetal premature birth (P=0.035), and low birth weight (P=0.004) when compared with euthyroid mothers. Conclusion: The burden of SCH high in the study population, and it was significantly associated with a number of different maternal as well as fetal complications and adverse outcomes.

Maternal positional therapy for fetal growth and customised birth weight centile benefit in a Bayesian reanalysis of a double-blind, sham-controlled, randomised clinical trial

ObjectivesTo update the Ghana PrenaBelt Trial’s (GPT) primary outcome data with the latest fetal growth standard and reanalyse it. To estimate the posterior probability, under various clinically relevant prior probabilities,...

Assessment of the Level of Knowledge About Risk Factors, Prevention, and Treatment of Gestational Diabetes Mellitus in a Community Sample From Saudi Arabia.

Introduction Gestational diabetes mellitus (GDM) is a common disease affecting pregnant females, and it carries a major risk of short and long-term health problems for both mothers and their offspring. Multiple factors like advanced maternal age, obesity, and unhealthy lifestyle can increase the risk of GDM. The current guidelines recommend screening all pregnant females for risk factors during the first trimester with subsequent testing of the blood glucose level at 24 weeks gestation. Lack of awareness about GDM is a main contributing factor in the delay in screening and diagnosis of GDM with subsequent fetal and maternal complications. This study aims to identify the level of knowledge about GDM among the adult population in the Kingdom of Saudi Arabia (KSA). Material and methods A descriptive cross-sectional questionnaire-based study was conductedto identify the level of knowledge about risk factors, prevention, and treatment of GDM in a community sample from Saudi Arabia. A self-administered electronic questionnaire was designed, tested for validity and reliability, and distributed through social media platforms. It consisted of 18 questions asking about the socio-demographic characteristics, the type of hospital in which the participant receives their medical care, whether the participant heard about GDM or not, and if they knowsomeone with GDM, in addition to questions to assess the level of knowledge about risk factors, complications, prevention, and treatment of GDM. The total score of knowledge was calculated. The multivariate regression analysis test was employed to analyze the relationship between various demographic variables and the level of knowledge about GDM among the study population. A p-value of 0.05 or less was considered statistically significant. Results A total of 539 (100%) participants completed the questionnaire: 263 (48.8%) of them were in the age category (18-25 years), 440 (81.6%) of them were females, 307 (57%) had a bachelor's degree, 275 (51%) were single, 454 (84.2%) had heard about GDM, and 258 (47.9%) of them have or know someone with GDM. The total score of knowledge revealed excellent, good, fair, and poor levels among 334 (62%), 140 (26%), 49 (9%), and 16 (3%) of participants, respectively. The multivariable linear regression model revealed that participants who received health care from governmental hospitals heard about GDMand had or knew someone with GDM were positively associated with a higher level of knowledge. Conclusions The findings revealed that among participants, 62% showed excellent knowledge about GDM, although, the other 38% had non-optimal levels of knowledge. Awareness campaigns are recommended to improve the level of knowledge about this disease, its risk factors, treatment, and complications.

Scrub Typhus During Pregnancy: A Study from Northeast India

Introduction: Scrub typhus is a crucial underrecognized cause of undifferentiated febrile illness in Northeastern India. Scrub typhus in pregnancy is an uncommon entity. In such cases, not initiating effective and safe antibiotics leads to maternal and fetal complications. To reduce complications, it is a must to keep a high index of clinical suspicion. Methodology: The present study was conducted to find the various disease manifestations of scrub typhus during pregnancy from January 2014 to December 2018. It was a retrospective study that included hospitalized patients with a diagnosis of scrub typhus during pregnancy. The scrub typhus was diagnosed based on the clinical presentation and serological test with Weil-Felix test titer for OXK more or equal to 1:160 or immunochromatographic test positive for scrub typhus IgM antibody. Result: During the study period, complete data were obtained from nine patients. The mean age of the patient was 26.5 years. A maximum of five patients presented in the third trimester, and two presented each in the first and second trimesters. Adverse fetal outcome was found in 33.3% of cases. Two patients had multiorgan dysfunction syndrome, and hepatitis was found to be a common occurrence. Conclusion: Scrub typhus during pregnancy presents a unique problem that is associated with high fetal loss and maternal complications. Keeping a high index of suspicion for diagnosis in endemic regions is essential, as prompt initiation of safe and effective antibiotics can prevent complications.

Retracted Dilapan-s in a multiparous woman at term on induction of labour

The use of Dilapan-S as an agent of induction of labour has recently gained a lot of attention for its efficiency, safety profile and lack of foetal complications. However, one of its known complications is the retraction of the rods into the uterus. Fortunately, the incidence is very rare, but the mechanisms remain elusive and poorly understood. This paper is about a multiparous woman at 39 weeks with unfavourable cervix and a multiparous os who was admitted for IOL using Dilapan-S. During the digital insertion of the 5th rod, she spontaneously ruptured her membranes with retraction of four of the rods into the uterus. Soon after, she developed uterine contractions and was transferred into the delivery suite with an improved Bishop score and a cervical dilatation of 3 cm. An augmentation of labour was commenced with oxytocin but was later discontinued due to a suspicious CTG trace. She had an emergency caesarean section for maternal request with the delivery of a healthy baby and retrieval of the four Dilapan-S rods intra-operative.

Maternal And Fetal Outcome in Placenta Previa: A Multicenter Prospective Observational Study

Objective: To find out the frequency of placenta previa and maternal and fetal outcomes in cases of placenta previa in our population. Methods: All women with an age range from 18-40 years diagnosed with placenta previa based on ultrasound were recruited with the study. Data including patient age, parity, previous normal deliveries, previous caesarian sections, grade of the placenta previa and history of previous pregnancies was recorded. Maternal complications including post-partum haemorrhage, hysterectomy and death were also recorded. Fetal complications including low APGAR score at five minutes, low birth weight and death were also recorded. Results: The age group between 26-35 years seems to have the highest incidence of placenta previa (62.58%). Post-partum haemorrhage was seen in 57 (38.77%) patients. Post-partum haemorrhage was strongly associated with the grade of placenta previa. Emergency obstetric hysterectomy was done in 7 (4.76%) patients. Two (1.36%) patients died of complications. Out of 147, 38 (25.85%) had low APGAR scores, 52 (35.37%) had low birth weight and 12 (8.16%) died of various complications. Conclusion: Placenta previa has become a very common condition which may be attributable to higher rates of caesarians. It may lead to increased morbidity and mortality of the mother and the baby if not diagnosed and managed properly. These cases should be managed by experienced multidisciplinary teams in a tertiary care centre to minimize the rate of complications. Keywords: APGAR score, Intrauterine growth retardation,Neonatal, Placenta previa, Postpartum haemorrhage

Guidelines for Treatment of Hyperemesis Gravidarum and Implementation in Clinical Practice in Norway: A Descriptive Study

Background. The severe pregnancy complication hyperemesis gravidarum (HG) requires intravenous fluids, antiemetics, and nutrition to prevent maternal and fetal complications. Several guidelines exist for the treatment of HG within and across countries. The aim of this study was to investigate whether the guideline issued by the Norwegian Society for Obstetrics and Gynecology (NGF) was implemented in clinical practice by comparing department treatment protocols and assessing provided treatment. Methods. Department protocols for the treatment of HG were requested from all Norwegian gynecology departments and compared to the NGF guideline regarding the use of Pregnancy Unique Quantification of Emesis (PUQE-24) score, antiemetics, thiamine, and fluid and nutritional therapy. Additionally, we performed a retrospective chart review of provided treatment during 2017–2019 at four hospitals. Results. In all, 28 of 39 (72%) departments replied, of which 11 reported using the NGF guidelines unaltered. Of the 17 local department protocols in use, 16 closely resembled the NGF guidelines regarding the use of PUQE score, fluid therapy, nutritional treatment, and thiamine. Eight department protocols differed slightly from the NGF guidelines regarding the antiemetic medication treatment pathway, and two recommended antiemetic medication not supported by national or international guidelines. The retrospective chart review of 343 patients at four hospitals showed that the provided care aligned with the guidelines regarding intravenous fluids and the use of PUQE score, and the use of antiemetics mostly aligned with the treatment pathway provided in the NGF guideline. However, the proportion of patients receiving ondansetron varied between 32% and 79% and thiamine from 38 to 86% between hospitals. Overall, few patients were provided with nutritional treatment by partial peripheral nutrition (14%), enteral tube feeding (8%), or total parenteral nutrition (1.5%). Conclusion. The NGF guideline was used unaltered or largely integrated in department protocols. Treatment data suggest that the guideline was implemented in clinical practice, but differences in the provision of ondansetron and thiamine suggest geographical inequality of care. Infrequent use of nutritional treatment by parenteral nutrition or enteral feeding tube could suggest improvements in pharmacological symptom management or undertreatment of malnutrition.

Timing of planned cesarean delivery among patients with two previous cesarean sections.

The timing of planned repeat cesarean delivery (CD) is debateful in clinical practice. Planned repeat CD is typically scheduled before the spontaneous onset of labor to minimize the risk of uterine rupture during labor and the associated risk for fetal compromise. This timing should be balanced with the potential risk of delivering an infant who could benefit from additional maturation in utero. We aim to study the influence of gestational age at the time of repeat CD on maternal and fetal complications. A population-based retrospective cohort study including all term singleton third CDs (≥ 37weeks of gestation), between February-2020 and January-2022 at a tertiary medical center was conducted. Maternal and neonatal adverse outcomes were compared by gestational age at the time of the CD. A logistic regression models were constructed to adjust forconfounders. The study population included624 third CDs. Among them, two study groups were defined: 199 were at 37 + 0 to 37 + 6weeks of gestation, and 44 were at ≥ 39weeks of gestation at the time of delivery. 381 were at 38 + 0 to 38 + 6weeks. Since our routine practice is to schedule elective CD at 38 + 0 to 38 + 6weeks of gestation, we defined this group as the comparison group. In a multivariate analysis, both study groups were associated with significantly higher rates of emergent CDs after adjusting for maternal age, parity, ethnicity, premature rapture of membranes, spontaneous onset of labor and birthweight. After adjusting also for emergent CDs, CDs at 37 + 0 to 37 + 6weeks of gestation were significantly associated with maternal and neonatal length of stay exceeding 4days. Additionally, CDs at 37 + 0 to 37 + 6weeks of gestation were also associated with composite of adverse neonatal and maternal outcomes. Our study demonstrated that scheduling third CD at 38 + 0 to 38 + 6weeks is associated with reduced risk of emergent CD, as well as beneficial maternal and neonatal outcomes.

Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: Our 15-Year Experience in a Tertiary-Level Center.

Introduction: The goal of this study was to evaluate the effect of chorionicity on maternal, fetal and neonatal morbidity and mortality in triplet pregnancies in our environment. Methods: A retrospective observational study was carried out on triplet pregnancies that were delivered in a tertiary center between 2006 and 2020. A total of 76 pregnant women, 228 fetuses and 226 live newborns were analyzed. Of these triplet pregnancies, half were non-trichorionic. We analyzed maternal characteristics and obstetric, fetal, perinatal and neonatal complications based on their chorionicity, comparing trichorionic vs. non-trichorionic triplet pregnancies. Prematurity was defined as <34 weeks. We measured perinatal and neonatal mortality, composite neonatal morbidity and composite maternal morbidity. Results: Newborns with a monochorionic component had a lower gestational age at birth, presented greater prematurity under 34 weeks, lower birth weight, greater probability of birth weight under 2000 g and an APGAR score below 7 at 5 min after birth, more respiratory distress syndrome and, overall, higher composite neonatal morbidity. The monochorionic component of triple pregnancies may entail the development of complications intrinsic to shared circulation and require premature elective termination. This greater prematurity is also associated with a lower birth weight and to the main neonatal complications observed. These findings are in line with those that were previously published in the meta-analysis by our research group and previous literature. Discussion: Triplet gestations with a monochorionic component present a higher risk of obstetric, fetal and neonatal morbidity and mortality.

Pregnant women's knowledge related to integrated ANC services

Complications of pregnancy and childbirth as the highest cause of maternal death can be prevented by regular pregnancy checks through Integrated Antenatal Care (ANC). Integrated Antenatal Services provided by trained and professional health personnel can prevent and detect complications in fetuses and pregnant women early so that undesirable things do not happen in the future. WHO data shows that the importance of Integrated ANC visits has not become a top priority for some pregnant women during their pregnancies in Indonesia. This scoping review aims to review the importance of Integrated ANC knowledge for pregnant women and the needs of Integrated ANC providers. The method in this review uses a scoping review technique. The scoping review research design was chosen because the reference sources used in the research were varied, originating from several articles. The results of this study showed that after carrying out the chi-square test, it was concluded that there was a relationship between knowledge and attitudes of pregnant women regarding Integrated Pregnancy Visits (ANC) with a p value of 0.02 (p &lt; 0.05). The study conducted provides evidence to support the need for pregnant women in Integrated ANC services so that maternal and infant mortality rates are reduced.

A Systematic Review of NT-proBNP as Prognostic Biomarker for Preeclampsia Complications

Background: Preeclampsia can lead to maternal and fetal complications due to its ability to cause multiple organ disorders. Interestingly, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels were higher in preeclampsia than in non-preeclampsia, representing cardiovascular mal¬function as the potential cause. Moreover, NT-proBNP also has a potential role in predicting complications that will arise in preeclampsia. This systematic review was performed to determine the role of NT-proBNP plasma levels in predicting maternal and fetal complications in preeclampsia.Subjects and Method: This systematic review was conducted based on PRISMA-P by previous observational study from scientific databases, namely Hinari, Cochrane Library, ScienceDirect, Scopus, and grey literature in OCLC’s OAISTER between 2006 and 2021. The search keyword used were ((NTproBNP) OR (NT-proBNP) OR (N-terminal pro-BNP) OR (N-terminal pro-Brain Natriuretic Peptide)) AND ((preeclampsia) OR (pre-eclampsia)) AND (pregnancy complications). Newcastle - Ottawa Quality Assessment Scale (NOS) was used to assess quality of included studies.Results: After study selection, five studies from 156 studies were considered eligible and selected in this systematic review. The results showed that pre-eclampsia complications occurred with NT-proBNP levels above 500 mg/dL, which cardiovascular complications may occurred above 700 mg/dL. NT-proBNP levels were higher in women with maternal complications such as placental abruption, HELLP (Hemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, eclampsia, pulmonary oedema, congestive heart failure, cerebrovascular accident, renal dysfunction, and hypertensive retinopathy. Furthermore, increased NT-proBNP levels were associated with fetal growth restriction, resulting in low birth weight. NT-proBNP was significantly higher in pregnant women due to a combination of pre-existing volume overload and NT-proBNP clearance dysfunction in kidney. Conclusion: NT-proBNP levels were associated with adverse outcomes in preeclampsia. NT-proBNP serum levels could be used to predict maternal-fetal complications in preeclampsia. Keywords: preeclampsia, fetal, maternal, complications, NT-proBNP Correspondence: Aiman Hilmi Asaduddin. Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. E-mail: aimanhilmi02@student.uns.ac.id. Phone number: +62 85726562060.

Hemodynamic, ventilatory and gas exchange responses to exercise using a cycle ergometer and the incremental shuttle walk test in pregnant women

BackgroundCardiovascular disease, including hypertension, in pregnant women is a leading cause of morbidity and mortality globally. The development of reference intervals for cardiovascular responses using exercising testing to measure oxygen utilisation (V̇O2) with cardiopulmonary exercise testing (CPET), and distances walked using the incremental shuttle walk test (ISWT), may be promising methods to assess and stratify pregnant women regarding their risk of adverse pregnancy outcomes, to encourage exercise during pregnancy, and to improve exercise prescriptions during pregnancy. We aimed to determine the reference intervals for V̇O2 at rest, anaerobic threshold (AT) and submaximal exercise using CPET, and the reference interval for the ISWT, to develop a correlation equitation that predicts submaximal V̇O2 from the distance walked in the ISWT, and to explore the relationship between hemoglobin (Hb) and ferritin concentration and V̇O2 at AT in women in second trimester. MethodsAfter prospective IRB approval (HREC 15/23) and clinical trials registration (ANZCTR ACTRN12615000964516), and informed written consent, we conducted CPET and the ISWT according to international guidelines in a university associated tertiary referral obstetric and adult medicine hospital, in healthy pregnant women in second trimester (14 to 27 gestational weeks). Hemoglobin and ferritin concentrations were recorded from pathology results in the participants’ medical records at the time of exercise testing. Adverse events were recorded. Results90 participants undertook CPET, 28 of which also completed the ISWT. The mean ± SD age and body mass index (BMI) were 32 ± 3.2 years, and 25 ± 2.7 kg/m2. Median (IQR) gestation was 23 (22,24) weeks. One in four women were 24 weeks or greater gestation. The reference intervals for V̇O2 at rest, AT and submaximal exercise were 2.9 to 5.3, 8.1 to 20.7 and 14.1 to 30.5 mL/kg/min respectively. The reference interval for the ISWT was 218 to 1058 meters.metres. The correlation equation to predict submaximal V̇O2 from the distance walked in the ISWT was submaximal V̇O2 (mL/kg/min) = 0.012*distance walked in ISWT (m) + 14.7 (95% CI slope 0.005 to 0.070, Pearson r = 0.5426 95% CI 0.2126 to 0.7615, P=0.0029). Hemoglobin concentration was positively correlated with V̇O2 at AT (AT V̇O2 (mL/kg/min) = 0.08*Hb (g/L) + 4.9 (95% CI slope 0.0791 to 0.143, Pearson r = 0.2538 95% CI 0.049 to 0.438, P=0.016). There was no linear association between ferritin and submaximal V̇O2 (Pearson r = 0.431 P=0.697). There were no maternal or fetal complications. ConclusionsCPET and ISWT are safe and feasible in women in second trimester including those at or beyond 24 weeks gestation. We have established the reference interval for V̇O2 at rest, AT and submaximal exercise by CPET, the reference interval for the distance walked for the ISWT, and a correlation equation to predict submaximal V̇O2 for use in clinical practice and research. Hemoglobin rather than ferritin is likely correlated with exercise capacity in pregnancy suggesting vigilance to correct lower hemoglobin levels may positively impact maternal health. Clinical trials registryThe study was prospectively registered with the Australian and New Zealand Clinical Date of registration – 15/9/2015; Date of initial participant enrolment - 4/11/2015; Clinical trial identification number; ACTRN12615000964516; URL of the registration site - https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369216 Prior presentation and published abstract“Oxygen utilization and anaerobic threshold measured using cardiopulmonary exercise testing in healthy pregnant women.” Obstetric Anaesthetists Association Meeting Edinburgh May 2023 Traer E, Ismail H, Leeton L, Bernhard R, Dennis AT. Oxygen utilisation and anaerobic threshold measured using cardiopulmonary exercise testing in healthy pregnant women. International Journal of Obstetric Anesthesia 2023;54: Supplement 1. Article 103659 O7 Traer E, Ismail H, Leeton L, Bernhard R, Dennis AT. “Oxygen utilization and anaerobic threshold measured using cardiopulmonary exercise testing in healthy pregnant women.” Poster presentation, iPOETTS abstract competition. Evidence Based Perioperative Medicine EPBOM World Congress of Perioperative Medicine, July 2023, London, U.K.

The hair tales of women of color in Northern Manhattan: a qualitative analysis.

Exposure to endocrine disrupting chemicals (EDCs), such as phthalates, can negatively impact maternal and child health, contributing to impaired fetal growth, preterm birth, and pregnancy complications, as well as increased downstream risks of cardiometabolic disease and breast cancer. Notably, women of color (WOC) are the largest consumers of personal care products, which are a common source of EDC exposure. The Let's Reclaim Our Ancestral Roots (Let's R.O.A.R) Pilot Study developed an educational intervention delivered during pregnancy to promote reduced use of phthalate-containing hair care products (HCPs). This mixed-methods study included: (1) a quantitative analysis and (2) a qualitative analysis of the educational sessions and the semi-structured focus groups to evaluate the factors that influenced the hair care practices and product choices of WOC at various stages of life, including their current pregnancy (hereafter referred to as the hair journey). During the sessions, participants learned about EDCs (with a focus on phthalates), the unequal burden of exposure for WOC, adverse implications of exposure, and exposure reduction strategies. Focus group sessions provided insight into participants' hair journeys from childhood to the current pregnancy and explored factors during their hair product selection process. All sessions were transcribed and imported into NVivo Version 12 for coding and thematic analysis. A total of 46 individuals were enrolled in the study, and 31 participated in an educational session. This current work synthesizes the qualitative analysis of this study. We identified two important life stages (before and after gaining agency over hair care practices and product choices) and three dominant themes related to HCP use: (1) products that impacted the hair journey, which involved all mentions of hair products, (2) factors that influenced the hair journey, which included individuals or entities that shaped participants' hair experiences, and (3) the relationship between hair and sense of self, where sense of self was defined as the alignment of one's inner and outer beauty. The themes intersected and impacted the participants' hair journey. Cultural integration was a sub-theme that overlapped within the dominant themes and participants discussed the effect of traditions on their hair experiences.

Extra-Corporeal Membrane Oxygenation in Pregnancy.

Extracorporeal membrane oxygenation (ECMO) is a cardiac or pulmonary function support system that is used in cases of refractory organ failure in addition to conventional treatment. Currently, Level I evidence is not yet available, which reflects improved outcomes with ECMO in pregnant women, the use in pregnancy should be indicated in selected cases and only in specialized centers. We searched articles in the most important scientific databases from 2009 until 31 December 2023 consulting also the site ClinicalTrials.com to find out about studies that have been recently conducted or are currently ongoing. We matched the combination of the following keywords: "ECMO and pregnancy", "H1N1 and pregnancy", "COVID-19 and pregnancy", "ARDS and pregnancy", "ECMO and pregnancy AND (cardiac arrest)". We selected the following number of articles for each keyword combination: "ECMO and pregnancy" (665 articles); "ECMO and influenza H1N1" (384 articles); "pregnancy and influenza H1N1" (1006 articles); "pregnancy and ARDS" (2930 articles); "ECMO and pregnancy and ARDS and influenza H1N1" (24 articles); and "[ECMO and pregnancy AND (cardiac arrest)]" (74 articles). After careful inspection, only 43 papers fitted our scope. There are two types of ECMO: venous-venous (VV-ECMO) and venous-arterial (VA-ECMO). The first-one is necessary to cope with severe hypoxia: oxygen-depleted blood is taken from the venous circulation, oxygenated, and carbon dioxide removed from the extracorporeal circuit and returned to the same venous system. The VA-ECMO is a type of mechanical assistance to the circulatory system that allows to put the failing organ at rest by ensuring adequate oxygenation and systemic de-oxygenation, avoiding multi-organ failure. The main indications for ECMO support in pregnant women are cardiogenic shock, acute respiratory distress syndrome (ARDS), pulmonary embolism, and eclampsia. There are also fetal indications for ECMO, and they are fetal distress, hypoxic-ischemic encephalopathy (HIE), and twin-to-twin transfusion syndrome (TTTS). Until now, based on the outcomes of the numerous clinical studies conducted, ECMO has been shown to be a successful therapeutic strategy in cases where medical treatment has been unsuccessful. In well-selected pregnant patients, it appears to be safe and associated with a low risk of maternal and fetal complications. The aim of this review is to report the main properties of ECMO (VV and VA) and the indications for its use in pregnant women.

FETO/Maternal Complications in Iron Deficiency Anemia during Pregnancy and Labor

Background: Iron deficiency anemia (IDA) is a prevalent nutritional disorder globally, especially in developing countries, impacting both maternal and fetal health. The condition exacerbates the risk of adverse pregnancy outcomes, including increased morbidity and mortality rates. Objective: This study aimed to examine the prevalence and impact of IDA on feto-maternal health during pregnancy and labor, as well as to evaluate the efficacy of antenatal care programs in managing this condition. Methods: A six-month cross-sectional study was conducted at Shaikh Zayad Hospital, Larkana, from October 2021 to March 2022. Fifty pregnant women, ranging from primigravida to multigravida, were recruited through emergency and outpatient departments. Comprehensive data collection included demographic information, clinical history, and a full spectrum of laboratory tests for IDA. The severity of anemia and related complications were assessed, and the collected data were analyzed using SPSS version 25. Results: Of the participants, 74% suffered from moderate anemia, while 12% and 14% had mild and severe anemia, respectively. Serum ferritin levels indicated iron deficiency in 40% of the women, with an elevated total iron-binding capacity (TIBC) in 60% of cases. Maternal complications were prevalent, with 52% encountering unspecified emergency conditions and 16% experiencing postpartum hemorrhage. Fetal complications included intrauterine growth restriction (30%), intrauterine death (18%), and neonatal death (10%). Conclusion: IDA presents a significant health risk during pregnancy, correlated with a high incidence of maternal and fetal complications. This study emphasizes the importance of proactive management and monitoring of iron levels throughout pregnancy. Establishing comprehensive antenatal care that includes nutritional education and iron supplementation is crucial for preventing IDA and improving pregnancy outcomes.

Evaluation of Congenital Cytomegalovirus Infection in Pregnant Women Admitted to a University Hospital in Istanbul.

Cytomegalovirus (CMV) can cause serious complications in immunocompromised individuals and fetuses with congenital infections. These can include neurodevelopmental impairments and congenital abnormalities in newborns. This paper emphasizes the importance of concurrently evaluating ultrasonography findings and laboratory parameters in diagnosing congenital CMV infection. To examine the prenatal characteristics of CMV DNA-positive patients, we assessed serum and amniotic fluid from 141 pregnant women aged 19-45 years, each with fetal anomalies. ELISA and PCR tests, conducted in response to these amniocentesis findings, were performed at an average gestational age of 25 weeks. Serological tests revealed that all 141 women were CMV IgG-positive, and 2 (1.41%) had low-avidity CMV IgG, suggesting a recent infection. CMV DNA was detected in 17 (12.05%) amniotic fluid samples using quantitative PCR. Of these, 82% exhibited central nervous system abnormalities. Given that most infections in pregnant women are undetectable and indicators non-specific, diagnosing primary CMV in pregnant women using clinical findings alone is challenging. We contend that serological tests should not be the sole means of diagnosing congenital CMV infection during pregnancy.

Pregnancy outcomes in patients complicated with pre-excitation syndrome

IntroductionPregnant women with pre-excitation syndrome are more likely to develop supraventricular tachycardia (SVT) during pregnancy and delivery, leading to an increased risk of adverse events.MethodThis was a retrospective study of 309 pregnancies in 280 women (29 women had two pregnancies in this series) with pre-excitation syndrome who delivered at West China Second University Hospital from June 2011 to October 2021. All the 309 pregnant women with pre-excitation syndrome were divided into SVT and non-SVT groups to analyze the cardiac and obstetric complications.ResultsAmong the included pregnant women in the past 10 years, the prevalence of pre-excitation syndrome was 0.24% (309/127725). There were 309 cases with pre-excitation syndrome in all hospitalized pregnant women. Among them, 62 (20.1%, 62/309) had a history of SVT. In the 62 cases with SVT during pregnancy, 22 (35.5%) cases had a history of SVT. Gestational diabetes mellitus was associated with SVT during pregnancy. The cesarean section rate was 88.7% in the SVT group, which was significantly higher than that in the non-SVT group (64.8%) (P < 0.001). Cases with SVT during pregnancy had more cardiac and obstetric complications. Four fetal deaths were recorded in the SVT group. Additionally, 29 women experienced two pregnancies during the study period, among whom, five received radiofrequency ablation after the first delivery and obtained better outcomes in the second pregnancy.ConclusionThe adverse outcomes such as cardiac complications, maternal and fetal complications (PROM, prematurity, SGA, fetal distress, etc.) in pregnant women with pre-excitation syndrome were closely related to SVT, with possible risk factors including history of SVT before pregnancy, cardiac function, heart organic abnormalities, and gestational diabetes mellitus.

Hubungan Perilaku Ibu, Peran Nakes, Dan Motivasi Keluarga Terhadap Kejadian Anemia Pada Ibu Hamil Di Desa Permis

Introduction: Anemia in pregnancy is a problem in the health sector because it is an indicator of poor nutritional status and health status. Anemia during pregnancy is defined as Hb less than 10 g/dL. If Hb is below 12 g/dL in early pregnancy, pregnant women may need to be given prophylactic drugs because of hemodilution which reduces Hb levels to less than 10 g/dL. The purpose of this study was to determine the relationship between maternal behavior, the role of health workers, and family motivation on the incidence of anemia in pregnant women in Permis Village in 2022. Methods: This type of research is an analytical descriptive study using a quantitative method with a cross-sectional approach. Results: The statistical test results show that there is a relationship between the role of midwives and the incidence of anemia in pregnant women in Permis Village in 2022 with a p-value of 0.006. there is a relationship between family motivation and the incidence of anemia in pregnant women in Permis Village in 2022 with a p-value of 0,021. there is a relationship between anemia prevention behavior and the incidence of anemia in pregnant women in Permis Village in 2022 with a p-value of 0.013. Discussion: The conclusion is the relationship between maternal behavior, the role of health workers, and family motivation toward the incidence of anemia in pregnant women in Permis Village in 2022. The suggestion for this research is to apply healthy behavior on how to prevent and treat anemia during pregnancy to prevent complications in pregnant women and fetuses.