Fetal Status Research Articles

Clinical assessment of the fetal right Quantitative Lung Index

Objectives We have previously described gestational-age-independent sonographic indices to assess fetal lung size in the right and left lungs: The Quantitative Lung Index for the right lung (QLI-R) and for the left lung (QLI-L), respectively. The purpose of this study was to evaluate the clinical cutoff point of the QLI-R to predict pulmonary hypoplasia and neonatal death. Materials and Methods Retrospective assessment of the QLI-R in patients with left-sided congenital diaphragmatic hernia (CDH-L) and other fetal conditions at risk for fetal pulmonary hypoplasia. Cross-section and longitudinal assessment of the behavior of the QLI-R in untreated and treated patients. ROC curve analysis to determine the optimal cutoff point of the QLI-R in predicting neonatal death. Results One hundred eighteen patients with CDH-L and other fetal conditions at risk for pulmonary hypoplasia had QLI-R measurements done. Seventeen patients were excluded for various reasons. Eleven patients with conditions other than CDH-L but at risk for pulmonary hypoplasia were used for intraclass coefficient measurements of the QLI-R. Ninety patients had CDH-L, of which 78 did not undergo antenatal intervention and in which the cutoff point for pulmonary hypoplasia and neonatal demise was assessed. Stent tracheal occlusion was performed in the remaining 12 patients with CDH-L, in which the behavior of the QLI after surgery was assessed. Analysis of the ICC showed an overall intra-rater reliability of 0.985 (Cronbach’s Alpha-based). There was no correlation between gestational age and QLI-R (-0.73, Pearson correlation, p = .72). Twenty-six of the 78 patients (33%) with CDH-L managed expectantly had a neonatal demise. A QLI-R equal to or less than 0.45 was significantly predictive of neonatal demise (area under the curve 0.64, p = .046, sensitivity 77%). Nine of the 12 patients (75%) that underwent tracheal occlusion had neonatal survival. Of these, 10 had serial assessments of the QLI-R after surgery. An increase in the QLI-R of 0.11 was associated with a tendency for neonatal survival (p = .056). Conclusion Our study confirms that the QLI-R is a gestational-age-independent measurement of fetal lung size, with a high degree of reproducibility. In a population of expectantly managed CDH-L patients, a cutoff value of the QLI-R of 0.45 or lower is predictive of neonatal death from pulmonary hypoplasia. The QLI-R can be used to monitor fetal lung growth after tracheal occlusion, and an increase in the QLI-R is suggestive of neonatal survival. Further prospective studies are needed to confirm these findings and to explore the use of the QLI in other populations at risk for pulmonary hypoplasia and consequent neonatal demise.

Strategies to communicate pregnancy complications: a systematic review and practical points for healthcare professionals.

This systematic review aims to provide an overview of strategies available for healthcare professionals (HCPs) to effectively communicate unexpected news in pregnancy, specifically for the most common pregnancy complications. Three medical databases and grey literature were searched until March 2023 using subject headings and keywords. Snowball techniques were also used. The articles were reviewed at each stage of screening independently by two separate authors. Qualitative, quantitative and mixed methods studies were included. Forty-three studies were included and grouped according to the gestational age of the pregnancy complication - miscarriage, increased risk screening, foetal conditions, stillbirth. The main key points for communication were outlined at each specific complication and eventually the six common themes that emerged from all the categories were included in the acronym PRICES (Preparation - Referral - Individualized care - Clarity - Empowerment - Sensitivity). Given the negative impact of failed communications both in pregnancy outcomes and patients' experience, we advocate that communication training for HCP providing pregnancy care should be mandatory, and skills should be updated at regular intervals. Tools like our acronym PRICES can be used during teaching HCPs how to communicate more effectively.

Validation of a non-invasive prenatal test for fetal RhD, C, c, E, K and Fya antigens

We developed and validated a next generation sequencing-(NGS) based NIPT assay using quantitative counting template (QCT) technology to detect RhD, C, c, E, K (Kell), and Fya (Duffy) fetal antigen genotypes from maternal blood samples in the ethnically diverse U.S. population. Quantitative counting template (QCT) technology is utilized to enable quantification and detection of paternally derived fetal antigen alleles in cell-free DNA with high sensitivity and specificity. In an analytical validation, fetal antigen status was determined for 1061 preclinical samples with a sensitivity of 100% (95% CI 99–100%) and specificity of 100% (95% CI 99–100%). Independent analysis of two duplicate plasma samples was conducted for 1683 clinical samples, demonstrating precision of 99.9%. Importantly, in clinical practice the no-results rate was 0% for 711 RhD-negative non-alloimmunized pregnant people and 0.1% for 769 alloimmunized pregnancies. In a clinical validation, NIPT results were 100% concordant with corresponding neonatal antigen genotype/serology for 23 RhD-negative pregnant individuals and 93 antigen evaluations in 30 alloimmunized pregnancies. Overall, this NGS-based fetal antigen NIPT assay had high performance that was comparable to invasive diagnostic assays in a validation study of a diverse U.S. population as early as 10 weeks of gestation, without the need for a sample from the biological partner. These results suggest that NGS-based fetal antigen NIPT may identify more fetuses at risk for hemolytic disease than current clinical practice, which relies on paternal genotyping and invasive diagnostics and therefore is limited by adherence rates and incorrect results due to non-paternity. Clinical adoption of NIPT for the detection of fetal antigens for both alloimmunized and RhD-negative non-alloimmunized pregnant individuals may streamline care and reduce unnecessary treatment, monitoring, and patient anxiety.

Real-time Classification of Fetal Status Based on Deep Learning and Cardiotocography Data.

This study uses convolutional neural networks (CNNs) and cardiotocography data for the real-time classification of fetal status in the mobile application of a pregnant woman and the computer server of a data expert at the same time (The sensor is connected with the smartphone, which is linked with the web server for the woman and the computer server for the expert).Data came from 5249 (or 4833) cardiotocography traces in Anam Hospital for the mobile application (or the computer server). 150 data cases of 5-minute duration were extracted from each trace with 141,001 final cases for the mobile application and for the computer server alike. The dependent variable was fetal status with two categories (Normal, Abnormal) for the mobile application and three categories (Normal, Middle, Abnormal) for the computer server. The fetal heart rate served as a predictor for the mobile application and the computer server, while uterus contraction for the computer server only. The 1-dimension (or 2-dimension) Resnet CNN was trained for the mobile application (or the computer server) during 800 epochs.The sensitivity, specificity and their harmonic mean of the 1-dimension CNN for the mobile application were 94.9%, 91.2% and 93.0%, respectively. The corresponding statistics of the 2-dimension CNN for the computer server were 98.0%, 99.5% and 98.7%. The average inference time per 1000 images was 6.51 micro-seconds.Deep learning provides an efficient model for the real-time classification of fetal status in the mobile application and the computer server at the same time.

ASSESSMENT OF FACTORS INCREASING THE RISK OF PRELABOUR RUPTURE OF MEMBRANES AND ITS EFFECT ON FETOMATERNAL OUTCOME

Background: Premature rupture of membranes (PROM) refers to a patient who is beyond 37 weeks gestation and has presented with rupture of membranes (ROM) prior to the onset of labor. Patient with PROM presents with leakage of fluid, vaginal discharge and pelvic pressure, but they are not having contraction. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. The risk of intrauterine infection increases with the duration of ROM. Evidence supports the idea that induction of labor, as opposed to expectant management, decreases the risk of chorioamnionitis without increasing the cesarean delivery rate. Methods: - This present observational study was conducted at Obstetrics & Gynecology, Department at Sri Aurobindo Medical College and Post Graduate Institute, Indore and who satisfy the inclusion criteria will be studied from 1st April 2021 to 30th September 2022 (18 months). After were Institutional ethical committee. among the patients diagnosed as premature rupture of membrane with women complain of leaking attending antenatal OPD and antenatal ward. On admission detailed history was taken. General and Systemic examination were done including Per Abdomen, Per Speculum and per vaginum carried out and investigations were done as per protocol. Diagnosis of PROM was confirmed by any of this method. Continuous monitoring of maternal and fetal condition done, antibiotics was given intra/ post natal period. P/ V exam were done when necessary. Investigations done and maternal and fetal outcome were noted. Results: The prevalence of premature rupture of membranes (PROM) was found to be 4.1%, with a corresponding perinatal mortality rate of 0.18 per 1000 deliveries. Approximately 33% of the cases involved pre-term premature rupture of membranes (PROM), while the remaining 67% were term PROM. Among the cases with preterm PROM, 10% of the perinatal deaths occurred. The average age of the female participants was 36.9 years, with a standard deviation of 2.1 years. The median number of children per participant was 1, with a range of 1 to 5 children. A notable correlation was observed between the gestational age at which premature rupture of membranes (PROM) occurred in women and the latency period (p< 0.001). There was a significant association between the gestational age at which premature rupture of membranes (PROM) occurred and foetal birth weight, APGAR score, and Neonatal Intensive Care Unit (NICU) admission (p<0.05). A statistically significant distinction was observed between the implemented intervention and the method of delivery (p=0.009). Conclusion: The incidence of PROM at term was high and conservative/ expectant management was effective. The latency period and fetal outcomes such as birth weight, apgar score and NICU admission were determined by the gestational age at which PROM occurred.

Fetal states identification in cardiotocographic tracings through discrete emissions multivariate hidden Markov models

Background and objectivesComputerized Cardiotocography (cCTG) allows to analyze the Fetal Heart Rate (FHR) objectively and thoroughly, providing valuable insights on fetal condition. A challenging but crucial task in this context is the automatic identification of fetal activity and quiet periods within the tracings. Different neural mechanisms are involved in the regulation of the fetal heart, depending on the behavioral states. Thereby, their correct identification has the potential to increase the interpretability and diagnostic capabilities of FHR quantitative analysis. Moreover, the most common pathologies in pregnancy have been associated with variations in the alternation between quiet and activity states. MethodsWe address the problem of fetal states clustering by means of an unsupervised approach, resorting to the use of a multivariate Hidden Markov Models (HMM) with discrete emissions. A fixed length sliding window is shifted on the CTG traces and a small set of features is extracted at each slide. After an encoding procedure, these features become the emissions of a multivariate HMM in which quiet and activity are the hidden states. After an unsupervised training procedure, the model is used to automatically segment signals. ResultsThe achieved results indicate that our developed model exhibits a high degree of reliability in identifying quiet and activity states within FHR signals. A set of 35 CTG signals belonging to different pregnancies were independently annotated by an expert gynecologist and segmented using the proposed HMM. To avoid any bias, the physician was blinded to the results provided by the algorithm. The overall agreement between the HMM's predictions and the clinician's interpretations was 90%. ConclusionsThe proposed method reliably identified fetal behavioral states, the alternance of which is an important factor in the fetal development. One key strength of our approach lies in the ease of interpreting the obtained results. By utilizing a small set of parameters that are already used in cCTG and possess clear intrinsic meanings, our method provides a high level of explainability. Another significant advantage of our approach is its fully unsupervised learning process. The states identified by our model using the Baum-Welch algorithm are associated with the “Active” and “Quiet” states only after the clustering process, removing the reliance on expert annotations. By autonomously identifying the clusters based solely on the intrinsic characteristics of the signal, our method achieves a more objective evaluation that overcomes the limitations of subjective interpretations. Indeed, we believe it could be integrated in cCTG systems to obtain a more complete signal analysis.

Improving Nurse Management of the Second Stage of Labor

ObjectiveTo develop, implement, and evaluate an educational program to improve nurses’ management of the second stage of labor. DesignEvidence-based practice project guided by the Iowa Model–Revised. SettingAcute care teaching hospital in central California averaging 2,100 births/year with 12 labor, delivery, and recovery rooms and a Level III nursery. ParticipantsEighteen registered nurses participated in the educational intervention. InterventionAn instructional course addressed contemporary labor management guidelines and delayed and open/closed glottis pushing. Assessment/documentation of maternal–fetal status, progress/fetal descent, and nurse/provider communication were discussed. Participants engaged in an interactive experience regarding maternal positions. MeasurementsData collected from the electronic health record included the number of position changes, nurse/provider communication interactions, and minutes from 10 cm to birth and minutes in delayed pushing. ResultsSecond-stage labor outcomes for nulliparous patients at term with a singleton in vertex presentation improved with more position changes and percentage of spontaneous vaginal births. Patients of nurses who participated in the educational intervention (n = 18) had a vaginal birth rate of 87.5% and a surgical birth rate of 6.2%. Patients of nurses who did not participate in the educational intervention (n = 31) had a vaginal birth rate of 81.8% and a surgical birth rate of 9.1%. ConclusionBased on the positive response to the intervention and improved clinical outcomes, regularly scheduled interactive nursing education focused on strategies to improve the second stage of labor may be beneficial.

Vers une généralisation du diagnostic prénatal non-invasif des maladies monogéniques ? État des lieux et perspectives

The screening of fetal aneuploidies and non-invasive prenatal diagnosis of monogenic diseases (NIPD-MD) both rely on the study of free fetal DNA in maternal circulation, but their respective rise was unequal. Development of NIPD-MD has taken longer as it represents a less attractive commercial dynamic for industry, but also because it usually involves the development of tailored tests specific to each pathogenic variant. We have carried out a review of the literature on the various indications and technologies involved in the use of NIPD-MM. We present its current implementation and its development in France. To date, NIPD-MD has been routinely offered in France for several years by the laboratories of the French NIPD-MD network but remains mostly limited to the exclusion of paternal or de novo variants, the exclusion DPNI-MD. Indeed, it is still difficult to study the transmission of maternal variants from circulating free DNA analysis, due to its biological complexity: coexistence and predominance of similar DNA sequences of maternal origin. Different strategies, either direct or indirect, are being evaluated to establish fetal status regardless of the parental origin of the disease or its transmission mode. The emergence of commercial screening solutions for monogenic diseases complements the arsenal of prenatal exploration tools for these diseases. The multitude of existing technologies and protocols may complicate the information provided during antenatal consultations, but mastery of know-how and knowledge of ethical issues of NIPD-MD will ensure optimal service and better management of pregnancies at risk of transmitting monogenic disease.

Clinical analysis of 31 cases of fetal umbilical artery thrombosis

Objective: To analyze the ultrasonic manifestations, clinical features, high risk factors and key points of pregnancy management in prenatal diagnosis of umbilical artery thrombosis (UAT). Methods: The data of 31 pregnant women of UAT diagnosed by prenatal ultrasonography and confirmed after birth from July 2017 to July 2022 at the Women's Hospital, Zhejiang University School of Medicine were retrospectively analyzed, including the maternal characteristics, pregnancy outcomes and fetal complications. In addition, the baseline data and pregnancy outcomes were compared in 21 patients who continued pregnancy after diagnosis of UAT. Of the 21 UAT cases that continued pregnancy, 10 cases were treated with low molecular weight heparin (LMWH; LMWH treatment group), while the other 11 patients had expectant treatment(expectant treatment group). Results: The age of the 31 pregnant women was (30.2±4.7) years, of which 5 cases (16%,5/31) were advanced age pregnant women. The gestational age at diagnosis was (32.9±4.0) weeks, and the gestational age at termination of pregnancy was (35.6±2.9) weeks. In 31 fetuses with UAT, 15 cases (48%) had fetal distress, 11 cases (35%) had fetal growth restriction, and 3 cases (10%) had intrauterine stillbirth. There were 28 cases of live births, including 26 cases by cesarean section and 2 cases by vaginal delivery. There were also 3 stillbirths, all delivered vaginally. Four neonates had mild asphyxia and two newborns had severe asphyxia. Among the 31 cases, 10 cases were terminated immediately after diagnosis, the gestational age at diagnosis was (35.9±2.9) weeks. Another 21 pregnancies continued, and their gestational age at diagnosis was (31.4±3.7) weeks. The median prolonged gestational age in LMWH treatment group was 7.9 weeks (4.6-9.4 weeks), and all were live births. The median prolonged gestational age in the expectant treatment group was 0.6 weeks (0.0-1.0 weeks), and 2 cases were stillbirths. There was a statistically significant difference in prolonged gestational age (P=0.002). Conclusions: Ultrasound is the preferred method for prenatal detection of UAT. Clinicians need to be vigilant for UAT when a newly identified single umbilical artery is detected by ultrasound in the second or third trimesters. The decision to continue or terminate the pregnancy depends on the gestational age and the condition of fetus. Attention should be paid to fetal movements as the pregnancy continues. The treatment of LMWH as soon as possible after diagnosis of UAT may improve the pregnancy outcome.

A wearable fetal movement detection system for pregnant women.

A wearable device-based fetal movement detection system for pregnant women is proposed to resolve the problems of low accuracy of fetal movement detection by fetal heart monitor, difficulties of fetal movement monitoring by pregnant women in person, and inability to monitor for long periods of time by ultrasonic Doppler imaging device. The overall software design flow of the system is proposed after determining the overall structure of the system based on symmetric sensor. The application circuit of the three-axis acceleration sensor MC3672 and its supporting sensor data collection program are designed, and the application circuit of the main control chip NRF52840 with Cortex-M4 core is analyzed. The function of data collection and algorithm recognition result transfer to a smartphone is realized through the fetal movement recognition and algorithm design and Bluetooth communication design. Finally, the system test scheme is introduced, which involves performing functional tests on four healthy pregnant volunteers and analyzing the results. The experimental results show that the average recognition rate and correct rate of this system to recognize fetal movement is 89.74% when using the real fetal movement actively perceived by pregnant women as the standard, achieving a domestic and wearable design of fetal movement monitoring device for pregnant women that can be used to analyze and predict the fetal health condition.

Spontaneous massive fetomaternal hemorrhage: two case reports and a literature review of placental pathology

BackgroundMassive fetomaternal hemorrhage (FMH) is a rare event during pregnancy that may cause severe fetal anemia or death.Case presentationThis paper reports two cases of fetomaternal hemorrhage with unexplained reasons. Both cases required emergency caesarean sections for non-reassuring fetal status and were treated with neonatal blood transfusion. Fetomaternal hemorrhage was confirmed via maternal Kleihauer-Betke test.ConclusionWe found parenchymal pallor, increased nucleated red blood cells (nRBCs), and syncytial knots (SKs) in the placentas, which are compatible with fetal anemia. Immunohistochemical staining indicated VEGF, CD34, and CD31 expression in the endothelial cells of the capillaries, characteristic of massive FMH placenta. This article also reviews the particular histopathological changes in FHM placenta according to the placental lesion classification system.

Screening Preeclampsia and the Role of Low Dose Aspirin for the Prevention of Preeclampsia

Preeclampsia is one of the leading causes of maternal morbidity and can affect fetal conditions such as inhibition of intrauterine growth, premature labor, placental abruption, fetal distress, and, worst of all, intrauterine fetal death. In contrast to the decreasing incidence of pregnancies with infection, preeclampsia did not decrease significantly during the past two decades. Prevention of preeclampsia is an effort that is currently being intensively carried out to reduce morbidity and mortality of pregnant women. Prophylactic administration of low-dose aspirin (81 mg/day) is recommended in women with a high risk of preeclampsia. It should be started between 12 weeks of gestation to 18 weeks (optimal before 16 weeks). Aspirin has been shown to be safe for the mother and the fetus during pregnancy. Treatment with aspirin also did not increase the risk of developing congenital malformations and had no adverse effect on fetal development or bleeding complications during the neonatal period.

Childbirth on a Moderately Shrinked Pelvis at the Institut D’hygiene Sociale Hospital in Dakar

Objectives: To assess the frequency of moderately narrowed pelvises, to specify the epidemiological and clinical profile of parturients, the mode of childbirth and to evaluate the maternal and neonatal prognosis in patients who underwent a trial of labour at the IHS hospital between the January 1st, 2019 and December 31st, 2020. Patients and Methods: This was a descriptive and analytical retrospective study of all patients who underwent a trial of labour at the Gynaecology-Obstetrics Department of the IHS Hospital in Dakar between January 1st and December 31st, 2020, i.e. a period of 12 months. Data were collected from birth records. Data entry was performed with EPI INFO 7 software and analysis with SPSS 21 software. Results: During the study period, we performed 101 labour trials among the 2156 childbirths, a frequency of 4.6% of childbirths. The epidemiological profile of the patients was that of a primiparous woman (73.3%) with an average age of 24, married (96.9%), having carried out at least 3 prenatal consultations (90%) and carrying a pregnancy at term (97%). Clinically, the average fundal height was 33 cm with extremes of 27 and 40 cm. The majority of patients (73.3%) had a borderline pelvis while the transversely narrowed pelvis accounted for only 26.7% of cases. The introductory palpation was only performed in 17 patients (16.8%) and it was doubtful in 11 of them (10.9%). The trial of labour ended in vaginal childbirth in 34.7% of cases or in caesarean section in 65.3% of patients. Failure of the trial of labour was more frequent in nulliparous (76.9%) compared to primiparous (64.9%), pauciparous (72.7%) (p=0.082) and in patients with borderline pelvis (79.5%) compared to those who had a transversely narrowed pelvis (68.7%) (p=0.392). In our series, 12 new-borns (11.9%) had benefited from neonatal resuscitation and eleven of them, that is a rate of 10.8%, were transferred to a neonatology unit. These were cases of non-reassuring fetal status occurring during the expulsive phase. Their evolution was favourable in all cases. One early neonatal death (1%) was recorded. No maternal complication had been notified. Conclusion: Childbirths on a moderately narrowed pelvis are not uncommon in our practice. They require a prior clinical evaluation of the parturients, particularly with the introducer palpation in order to increase the chances of a favourable outcome and to avoid maternal and perinatal complications.

An organoid-based CRISPR-Cas9 screen for regulators of intestinal epithelial maturation and cell fate

Generation of functionally mature organs requires exquisite control of transcriptional programs governing cell state transitions during development. Despite advances in understanding the behavior of adult intestinal stem cells and their progeny, the transcriptional regulators that control the emergence of the mature intestinal phenotype remain largely unknown. Using mouse fetal and adult small intestinal organoids, we uncover transcriptional differences between the fetal and adult state and identify rare adult-like cells present in fetal organoids. This suggests that fetal organoids have an inherent potential to mature, which is locked by a regulatory program. By implementing a CRISPR-Cas9 screen targeting transcriptional regulators expressed in fetal organoids, we establish Smarca4 and Smarcc1 as important factors safeguarding the immature progenitor state. Our approach demonstrates the utility of organoid models in the identification of factors regulating cell fate and state transitions during tissue maturation and reveals that SMARCA4 and SMARCC1 prevent precocious differentiation during intestinal development.

The role of perinatal protection of a fetus in preservation of the health of the nation

This review examines the international role of perinatal protection of a fetus in preservation of the health of the nation. Historical perspectives, present-day developments, and future priorities of perinatal medical science are given. The etiology of decompensated placental insufficiency and intrauterine growth restriction is considered. The authors also considered the epidemiology of premature delivery and perinatal outcomes, the problem of development, diagnosis and obstetric management in critical fetal condition is covered in detail. The current review of literature was conducted in order to advance the theoretical knowledge of specialists on modern complex issues of perinatal medicine. The considered practical aspects will contribute to the improvement of interdisciplinary interaction between clinicians of various specialties in the field of perinatal protection of a fetus and, through this, to the preservation of the health of the nation and the multiplication of future generations.

Transcriptional and epigenomic profiling identifies YAP signaling as a key regulator of intestinal epithelium maturation

During intestinal organogenesis, equipotent epithelial progenitors mature into phenotypically distinct stem cells that are responsible for lifelong maintenance of the tissue. While the morphological changes associated with the transition are well characterized, the molecular mechanisms underpinning the maturation process are not fully understood. Here, we leverage intestinal organoid cultures to profile transcriptional, chromatin accessibility, DNA methylation, and three-dimensional (3D) chromatin conformation landscapes in fetal and adult epithelial cells. We observed prominent differences in gene expression and enhancer activity, which are accompanied by local changes in 3D organization, DNA accessibility, and methylation between the two cellular states. Using integrative analyses, we identified sustained Yes-Associated Protein (YAP) transcriptional activity as a major gatekeeper of the immature fetal state. We found the YAP-associated transcriptional network to be regulated at various levels of chromatin organization and likely to be coordinated by changes in extracellular matrix composition. Together, our work highlights the value of unbiased profiling of regulatory landscapes for the identification of key mechanisms underlying tissue maturation.

A prospective study on neonatal ophthalmic injuries associated with forceps delivery

Assisted delivery by forceps is needed to expedite vaginal delivery in certain maternal and fetal conditions. The aim of this study was to evaluate the incidence and the extent of ophthalmological injuries in neonates after forceps delivery. Women with cephalic fetuses delivered vaginally by forceps from July 2020 to June 2022 were recruited prospectively. Ophthalmologists would be consulted when there were signs of external ophthalmic injuries, such as periorbital forceps marks or facial bruising. Demographic data, pregnancy characteristics, delivery details, and perinatal outcomes were evaluated to identify any associated risk factors for neonatal ophthalmological injuries. A total of 77 forceps deliveries were performed in the study period, in which 20 cases (26%) required ophthalmological consultations. There were more right or left occipital fetal head positions in the group requiring ophthalmological assessment than those that did not require assessment (35% vs 12.3% [P = 0.023]). The degree of moulding of the fetal head was more marked in the former group (65% vs 28% [P = 0.001]). The overall incidence of detectable ophthalmological lesions was 16.9% (13/77). All ophthalmic injuries were mild, and most resolved with conservative management. In our study cohort, external ophthalmic injuries were common after forceps delivery. We recommended ophthalmological consultation in newborns delivered by forceps with evidence of compressive trauma to rule out serious ophthalmological trauma.

Comparison of Inflammatory Factors of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Maternal Platelet Count in Patients with and Without Chorioamnionitis and with Premature Preterm Rupture of Membrane

Background: The present study aimed to compare inflammatory markers of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and maternal platelet count in patients with and without chorioamnionitis with premature preterm rupture of membrane (PPROM). Methods: Women with PPROM and gestational age less than 34 weeks were enrolled in this cohort study. PPROM was confirmed with sterile speculum examination or the AmniSure test. A blood sample was drawn from mothers for complete blood count (CBC) and differential count (Diff) before administering antibiotics and corticosteroids. Another blood sample was drawn for CBC-Diff tests at the time of pregnancy termination. The status of mothers and fetuses was carefully monitored during hospitalization through the following indicators: Vital signs, daily abdominal examination, uterus discharge, daily non-stress test, and weekly ultrasonography. All samples were collected in one year. Results: A total of 110 patients were examined. The reason for pregnancy termination was gestational age of 34 weeks in 30 patients (27.3%), chorioamnionitis in 19 cases (17.3%), pain and dilation in 32 cases (29.1%), and miscellaneous in 29 cases (26.4%). Among the study parameters, only NLR was significantly different between groups, and the order of values from highest to lowest was in the chorioamnionitis, pain and dilatation, miscellaneous, and gestational age of 34 weeks groups. We found that NLR at a cut-off point of 3.2 - 3.5 had an acceptable sensitivity and low specificity to detect the cases of chorioamnionitis. Raised NLR was associated with (95% CI) histological chorioamnionitis with a sensitivity of 86% and a specificity of 43%. Conclusions: According to the findings of our study, NLR can be a suitable indicator for predicting chorioamnionitis in women who deliver preterm without clinical signs and symptoms of infection. It can be used for expectant management for PPROM after 34 weeks.

Intestinal obstruction in pregnancy—a rare presentation of uterine perforation

BackgroundIntestinal obstruction is an uncommon non-obstetric condition during pregnancy which may cause maternal and fetal mortality. Clinicians are confronted with challenges in diagnosis and treatment of intestinal obstruction due to the overlapping symptoms, concerns over radiological evaluation, and surgical risks.Case presentationWe reported a 39-year old, gravida 7, para 2, woman who suffered from acute intestinal obstruction at 34 weeks of gestation. Ultrasonography and abdominal computed tomography were applied for intestinal obstruction diagnose. Conservative treatment was initially attempted. But following ultrasound found the absence of fluid in the amniotic sac and the patient showed no improvement in clinical symptoms. An emergency caesarean section was then performed. Intra-operative assessment showed dense adhesion between the left wall of uterus and omentum, descending colon, and sigmoid colon. After adhesion dialysis, uterine rupture with complete opening of the uterine wall at the site of left uterine cornua was found without active bleeding. The uterine rupture was then repaired.ConclusionsAlthough uncommon during pregnancy, clinical suspicion of bowel obstruction is necessary especially in women with a history of abdominal surgery. Surgical intervention is indicated when conservative therapy fails and when there are signs of abnormal fetal conditions and worsened symptoms.

The Special Delivery Unit: A Novel Concept for Mother-Baby Continuity for Major Fetal Abnormalities.

This article describes the experience in the planning and development of a special delivery unit (SDU) at our free-standing children's hospital in Austin, Texas. Description of various aspects of the development of the SDU. In addition, telephone surveys were obtained from five other institutions regarding the planning and current status of their SDUs. Since the advent of the SDU at Children's Hospital of Philadelphia in 2008, several free-standing children's hospitals have opened similar units at their institutions. Developing an obstetrical unit in a children's hospital can be a daunting task on many fronts. The costs of providing 24-hour obstetrical, nursing, and anesthesiology coverage must be considered. Although most SDUs are associated with a fetal center and fetal surgery/interventions, some units function exclusively for the delivery of pregnancies complicated by major fetal conditions where the neonate will require immediate surgical care or other interventions. Research on the cost-effectiveness and the effect of SDUs on clinical outcome, teaching, and patient satisfaction is warranted. · Specialized delivery units are becoming more common at free-standing children's hospitals.. · The primary aim of the SDU is to maintain mother-baby continuity in cases of congenital anomalies.. · Developing an obstetrical unit at a pediatric hospital is a daunting task..