Fetal Death Research Articles

Perinatal outcomes according to umbilical artery Doppler assessment among fetuses with congenital heart disease.

To evaluate a cohort of fetuses with congenital heart disease (CHD) who underwent serial umbilical artery (UA) Doppler surveillance and assess perinatal outcome according to UA Doppler assessment. A retrospective cohort study of singleton fetuses with CHD at a single academic center was performed between 2018 and 2020. Fetuses with a chromosomal abnormality or growth restriction were excluded. We compared fetuses with normal versus abnormal UA Doppler assessment at any time in pregnancy. Abnormal UA Doppler assessment was defined as decreased end diastolic flow, determined by an elevated systolic/diastolic ratio >95th percentile for gestational age, or absent/reversed end diastolic flow. Logistic regression assessed the odds of fetuses with CHD and abnormal UA Doppler assessment having a composite adverse perinatal (defined as fetal, neonatal, or infant death), adjusting for relevant covariates. We identified a cohort of 171 fetuses with CHD that met inclusion criteria. Of these, 154 (90%) had normal UA Doppler assessment and 17 (10%) had abnormal UA Doppler assessment throughout pregnancy. Maternal characteristics did not differ between groups except for maternal race and history of preeclampsia. There was no statistically significant difference in primary outcome between groups [14% (21/154) of fetuses with normal UA Doppler assessment had an adverse perinatal outcome compared to 24% (4/17) of those with abnormal UA Doppler assessment, p = 0.28]. UA Doppler assessment is unlikely to predict adverse perinatal outcome in normally grown, euploid singleton fetuses with CHD.

Effectiveness and safety of intravenous labetalol in severe pre-eclampsia and eclampsia at a teaching institution in Chhattisgarh.

Severe hypertension in pregnancy deserves prompt recognition and urgent effective reduction in order to reduce the risk of complications such as eclampsia and HELLP syndrome and to achieve desirable neonatal outcomes. There is a need for effective and safe parenteral antihypertensive treatment. We studied the effectiveness and safety of intravenous labetalol use in severe hypertension in pregnancy and post-partum period in a teaching hospital in Chhattisgarh in 101 women. IV labetalol was given as bolus doses till the blood pressures were controlled. Neonatal outcomes were recorded, and adverse effects such as hypotension, hypoglycemia, and neonatal asphyxia were documented. Intravenous labetalol given as a single bolus of 20 mg was efficacious in controlling blood pressures in 93 out of 101 (93%) women, and the rest were controlled with 1 or 2 additional doses in 1-3 hours. No neonatal deaths happened beyond the 13 intrauterine fetal deaths at presentation. No women developed any episodes of hypotension, tachycardia of more than 100, or nausea or vomiting on labetalol. Intravenous labetalol, even as a single bolus dose, is highly efficacious and is free of any major adverse effects.

A case of intrauterine fetal death associated with chronic premature amniotic under-amniotic syndrome (CAOS)

A case of intrauterine fetal death associated with chronic premature amniotic under-amniotic syndrome (CAOS)

Effectiveness and safety of mifepristone: Misoprotole combination vs misoprostole alone for induction of labour in intrauterine foetal death

Effectiveness and safety of mifepristone: Misoprotole combination vs misoprostole alone for induction of labour in intrauterine foetal death

A Review of Hidradenitis Suppurativa in Special Populations: Considerations in Children, Pregnant and Breastfeeding Women, and the Elderly.

Hidradenitis suppurativa (HS) is a chronic skin condition that significantly impacts patients' quality of life. HS is often challenging to treat. In this review, we discuss the unique characteristics of HS in four special populations: children, the elderly, pregnant individuals, and breastfeeding mothers. In children, diagnosis may be delayed due to atypical and early HS disease presentations. HS management plans must take into consideration the lack of rigorous efficacy and safety data of HS treatments in this population. However, it is important to weigh the risk of treatments against the risk of untreated HS and the morbidity and mortality risk that having HS confers. Pregnancy poses unique challenges for women with HS, with their condition possibly worsening during pregnancy and increased risk of fetal death. Management strategies during pregnancy must consider both maternal and fetal safety. Similarly, breastfeeding mothers require thoughtful medication selection to balance symptom management with infant safety. In the elderly, HS may present more severely and is often complicated by comorbidities. Treating HS in this population should safely accommodate patients' additional health conditions. Furthermore, this review highlights the overall paucity of primary literature addressing management in these populations, underscoring the need for further research to optimize HS care across all stages of life.

Преконцептивное облучение матерей: Риск фетоинфантильных потерь

Safety of female personnel exposed to occupational radiation is still a topical issue of radiation epidemiology. Mayak Production Association is the first Russian atomic enterprise and women made a quarter of its personnel. Fetal and infant losses (FILs) that include stillbirths and infant mortality could be used as an important criterion for assessing the effects of maternal preconception (prior to conception) exposure. The aim of this study was to assess FILs risk among the offspring of female Mayak PA workers exposed to occupational preconception external gamma-radiation. A retrospective analysis was performed among 15307 children born in 1949–1973; mothers of 4880 of them were Mayak PA workers. FILs were analyzed taking into account sex of the offspring, period of their birth, nosologies, parental age, and dose categories of preconception exposure. Methods of non-parametrical statistics were used and calculation of relative risk was performed with 95 % confidence interval. In general, fetal and infant losses demonstrated no statistical differences, 44.5 for 103 in the main group, 38.7 for 103 in the reference group, χ2 =2.79, p = 0.95. A statistically significant increase of FILs, stillbirths and infantile mortality was detected among the offspring with only their mothers working at Mayak PA. Dynamics analysis established the period from 1949 to 1953, in which FILs, stillbirths and infantile mortality were higher among the offspring of exposed mothers. Statistically significant differences in the FILs structure were obtained for fetal death that was more often registered in the main group, 3.48 vs 1.34 for 103, χ2 = 7.54, p = 0.006. FILs risk among mothers working at Mayak PA aged under 20 was statistically significantly higher for girls, 2.42 (1.25–4.67), and for both sexes, 2.16 (1.37–3.4). FILs were associated with the dose range of preconception external gamma-radiation of mothers from 0.16 mGy to 3006 mGy. The study also established certain categories of preconception exposure of the ovaries with significantly higher stillbirth risk in the main group as opposed to the reference one.

Preconception maternal exposure: Risk of fetal and infant losses

Safety of female personnel exposed to occupational radiation is still a topical issue of radiation epidemiology. Mayak Production Association is the first Russian atomic enterprise and women made a quarter of its personnel. Fetal and infant losses (FILs) that include stillbirths and infant mortality could be used as an important criterion for assessing the effects of maternal preconception (prior to conception) exposure. The aim of this study was to assess FILs risk among the offspring of female Mayak PA workers exposed to occupational preconception external gamma-radiation. A retrospective analysis was performed among 15307 children born in 1949–1973; mothers of 4880 of them were Mayak PA workers. FILs were analyzed taking into account sex of the offspring, period of their birth, nosologies, parental age, and dose categories of preconception exposure. Methods of non-parametrical statistics were used and calculation of relative risk was performed with 95 % confidence interval. In general, fetal and infant losses demonstrated no statistical differences, 44.5 for 103 in the main group, 38.7 for 103 in the reference group, χ2 =2.79, p = 0.95. A statistically significant increase of FILs, stillbirths and infantile mortality was detected among the offspring with only their mothers working at Mayak PA. Dynamics analysis established the period from 1949 to 1953, in which FILs, stillbirths and infantile mortality were higher among the offspring of exposed mothers. Statistically significant differences in the FILs structure were obtained for fetal death that was more often registered in the main group, 3.48 vs 1.34 for 103, χ2 = 7.54, p = 0.006. FILs risk among mothers working at Mayak PA aged under 20 was statistically significantly higher for girls, 2.42 (1.25–4.67), and for both sexes, 2.16 (1.37–3.4). FILs were associated with the dose range of preconception external gamma-radiation of mothers from 0.16 mGy to 3006 mGy. The study also established certain categories of preconception exposure of the ovaries with significantly higher stillbirth risk in the main group as opposed to the reference one.

Post Natal Mothers Satisfied and Happy with the Outcomes of their Deliveries after Individualized Precision Maternal Monitoring using 3D-Printing Technology in a Maternity Unit in the Developing World - A Case Study of Jaramogi Oginga Odinga Teaching and Referral Hospital in Western Kenya

Background: In the low and middle income countries’ healthcare system for medicine and surgery training and service provision, the use of computing technologies would be of great help in creating faster and transformational solutions by creating software applications and hardware fabrications for faster diagnosis, which are absent currently, hence leading to efficient treatment interventions in the developing world. Objective: The objective of this study was to assess the potential of using computing innovation of 3-D printing technology in producing medical solutions using 3-D printing of fetoscopes to solve the challenge of the frequency of monitoring fetal heart rates in the maternity department. Methodology: A randomized case-control study was used to analyze the impact of having one fetoscope per mother on shortening the frequency of monitoring of fetal heart rates and promptly intervening in case of non-reassuring fetal status. This was done by 3-D printing fetoscopes increasing the numbers at the Maternity department of Jaramogi Oginga Odinga Teaching and Referral Hospital. Findings: The frequency of monitoring heart rates increased to hourly instead of 3 hourly in 24 hours, leading to timely interventions, as compared to previous days when there was only one fetoscope serving the whole unit. Mothers with a 3-D printed Fetoscope reported a lower proportion of emergency caesarean section done compared to mothers who were sharing a 3-D printed Fetoscope (13% vs. 38%, p = 0.021). No fetal death was reported among mothers with a 3-D printed Fetoscope each, while maternal satisfaction was higher among mothers with a 3-D printed Fetoscope as compared to those who were sharing (94% vs. 63%, p = 0.002). Conclusion: We concluded that computing technology is useful in designing and fabricating medical equipment and parts, which help save lives in the maternity, emergency room and the operating room in low and middle income countries.

Hearing loss in children with congenital heart disease

Background : Congenital heart disease (CHD) is a dangerous disease, about 50% of deaths will occur in the first month of life. In developed countries almost all types of congenital heart disease have been detected in infancy even at less than 1 month of age, whereas in developing countries many are only detected after the child is older, so in some severe CHD types may have died before being detected. Rubella infection in pregnancy or congenital rubella syndrome (CRS) can cause miscarriage, fetal death, or congenital abnormalities after birth. CRS is characterized by sensorineural hearing loss (SNHL), congenital cataracts or glaucoma, congenital heart disease, and developmental delays. Purpose : This case report was submitted in order to find out how to properly treat patients with hearing loss with sensory deafness and congenital heart disease. Case : Reported a 3-year-old 6-month-old boy diagnosed with very severe degree sensorineural deafness and congenital heart disease based on anamnesis, physical examination and examination of OAE, BERA and ASSR for examination of auditory function) and echocardiography examination for examination of cardiac function. Conclusion : From the history, physical examination and examination of OAE, BERA, ASSR showed patients with very severe sensorineural hearing loss of the left and right ear and congenital heart disease, planned use of hearing aids or cochlear implantation and cardiac consul for CHD treatment.

Acupuncture before planned admission for induction of labor (ACUPUNT study): a randomized controlled trial

The increase in the use of induction of labor is a worldwide phenomenon in the current management of labor and delivery in Western societies, with approximately one out of every 4 pregnancies undergoing this procedure This has led women to seek various methods for stimulation of the onset of labor. Some data suggest that the use of acupuncture for favoring spontaneous labor onset could reduce the number of inductions of labor procedures. However, good quality evidence in this respect is not yet available. The aim of this study was to evaluate the effectiveness of acupuncture using a filiform needle to induce spontaneous onset of labor in women with a scheduled induction of labor date and assess the safety and satisfaction of women undergoing acupuncture. We conducted a multicenter, randomized, controlled, parallel-arm, unmasked trial in 3 hospitals in Spain. Eligible participants were women older than 18 years with a singleton pregnancy and a cephalic presentation, scheduled for induction of labor following center-specific protocols. Participants were randomly allocated to one of 2 groups: the intervention group, which underwent acupuncture sessions for a maximum of 4 days prior to the scheduled induction of labor, or the control group, which received no specific prelabor intervention. The primary study outcome was the proportion of women admitted because of spontaneous onset of labor or premature rupture of membranes before or the day of the scheduled induction of labor. Between November 2017 and June 2023, 212 women were recruited and included in the analysis (106 in the acupuncture group and 106 in the control group). There were no significant differences between the 2 groups in the baseline demographic characteristics. Regarding the primary outcome, 65.1% (69/106) of women in the acupuncture group and 39.6% (42/106) in the control group were admitted for spontaneous onset of labor or premature rupture of membranes (P<.001). Overall, women in the intervention group were admitted 1.25 days before (SD 1.4) their scheduled induction of labor date compared to 0.67 days (SD 1.15) for those in the control group (P=.001). The median time from recruitment to hospitalization was 4.48 days for the acupuncture group and 5.33 days for the control group (HR 0.52, 95% CI 0.35-0.77, P=.001). There were no significant differences between the 2 groups regarding the time from admission to delivery or the cesarean delivery rate. Nor were there differences in the rates of maternal or neonatal outcomes, and no maternal or fetal deaths occurred in either group. Acupuncture with filiform needles, administered 4 days prior to scheduled induction of labor increased admission for spontaneous onset of labor and premature rupture of membranes before the induction of labor date.

Perinatal outcomes of antenatally diagnosed omphalocele and gastroschisis: a survey from a university hospital.

To evaluate the clinical features and perinatal outcomes of antenatally diagnosed fetuses with omphalocele and gastroschisis. This was a retrospective, single-center, cohort study of prenatally diagnosed fetuses with omphalocele and gastroschisis followed-up and delivered at a university hospital. Demographic, pregnancy, birth and perinatal outcomes were compared between gastroschisis and omphalocele. A total of 75 fetuses with omphalocele and 21 cases with gastroschisis were evaluated. The mean maternal age of women carrying a fetus with omphalocele was significantly higher than the women with gastroschisis (p=0.001). Associated structural anomalies were found in 53.3% and 4.7% of fetuses with omphalocele and gastroschisis, respectively (p<0.001). The rate of chromosomal anomaly was 8.3% in pregnancies with omphalocele. In liveborn pregnancies, the mean gestational age at delivery and birth weight did not differ between the study groups. Time to postoperative oral intake, duration of parenteral nutrition and length of hospital stay were significantly longer in babies with gastroschisis than omphalocele (p<0.01). Rates of termination, intrauterine, neonatal and infant death of fetuses with omphalocele were 25.3%, 6.7%, 10.7% and 2.7% respectively. Time to postoperative oral intake, duration of parenteral nutrition and duration of hospitalization were significantly longer in babies with complex compared to simple gastroschisis (p<0.01). Survival rates were 95.2%, 82.9% and 20% in fetuses with gastroschisis, isolated and non-isolated omphalocele, respectively. Associated structural and chromosomal anomalies were significantly more common in fetuses with omphalocele compared to those with gastroschisis. Prognosis of fetuses with omphalocele depended on the associated structural and chromosomal anomalies, whereas bowel compromise was the main determining factor in gastroschisis.

Fetoscopic laser photocoagulation: a medically reasonable treatment option in the management of types II and III vasa previa.

Vasa previa is a condition where unprotected fetal vessels cross the cervix within the membranes, posing a considerable risk of fetal death or severe morbidity if the membranes rupture before or during delivery. There has not been a definitive in utero treatment for this condition. Patients are typically closely monitored and hospitalized in the early third trimester and scheduled for cesarean delivery before term. This approach poses considerable physical, social, psychological, and financial challenges for pregnant patients and their families. Furthermore, fetal vessel rupture may lead to severe hypoxic-ischemic injury and consequent neurodevelopmental impairment. Finally, babies delivered early due to vasa previa may face both the short- and long-term consequences of prematurity. Recently, fetoscopic laser photocoagulation using a single-port fetoscope has emerged as a potential therapeutic option for patients with types II and III vasa previa. This innovative approach aims to reduce hospital stays, increases the chance of successful vaginal delivery, and potentially allows pregnancies to reach full term, providing lifelong benefits for the infant. Preliminary clinical studies on human subjects have demonstrated promising results concerning the feasibility, safety, and efficacy of this intervention for a subset of patients with types II and III vasa previa. After reviewing the current state of the art, we argued that offering fetoscopic laser photocoagulation in specialized centers under IRB supervision meets the ethical obligations of beneficence and non-maleficence for both pregnant and fetal patients, as well as the autonomy-based obligations for pregnant patients.

Antibody profiles in the mosaic of 'seronegative' APS syndrome.

Clinical manifestations, as distinct from thrombotic and obstetric morbidity, were recently included in the update of classification criteria of the antiphospholipid syndrome (APS). However, the existence of several patients with clinical manifestations suggestive of APS, but negative for criteria antiphospholipid antibodies (aPLs) [anti-cardiolipin antibodies (aCL), anti-β2-glycoprotein I antibodies (aβ2-GPI), and lupus anticoagulant] may suggest an update of diagnostic criteria. In this study, we analysed the prevalence of six non-criteria aPLs in a large monocentric cohort of patients with seronegative APS (SN-APS), to investigate their possible diagnostic role. aCL IgA, aβ2-GPI IgA, and aβ2-GPI Domain 1 antibodies were detected by chemiluminescence, anti-phosphatidylserine/prothrombin (aPS/PT) IgG, anti-vimentin/cardiolipin (aVim/CL) IgG, and anti-carbamylated-β2-glycoprotein I (aCarb-β2-GPI) IgG by ELISA in sera from 144 SN-APS patients. In SN-APS patients, aCL IgA was detected in 4/144 (2.77%), aβ2-GPI IgA in 2/144 (1.39%), aβ2-GPI-Domain 1 in 1/144 (0.69%), aPS/PT in 16/144 (11.11%), aVim/CL in 37/144 (25.69%), and aCarb-β2-GPI in 43/144 patients (29.86%). Patients negative for all non-criteria aPL assays were 77/144 (53.47%). Notably, the Venn diagram showed that aCarb-β2-GPI together with aVim/CL represented the prevalent combination of positive antibodies. In SN-APS patients, aCL IgA were associated with recurrent thrombosis (OR 11.48; P = 0.03); in obstetric SN-APS patients, aPS/PT were significantly associated with foetal deaths (OR 4.84; P = 0.01), aVim/CL with spontaneous abortions (OR 2.71; P = 0.016). This study indicates that aPS/PT, aVim/CL and aCarb-β2-GPI antibodies may represent useful tools to identify 'seronegative' APS patients, who are negative for criteria aPLs, supporting the need to make testing for non-criteria aPLs more accessible in patients with SN-APS.

New ZNHIT3 Variants Disrupting snoRNP Assembly Cause Prenatal PEHO Syndrome with Isolated Hydrops.

ZNHIT3 (zinc finger HIT type containing protein 3) is an evolutionarily conserved protein required for ribosome biogenesis by mediating the assembly of small nucleolar RNAs (snoRNAs) of class C/D into ribonucleoprotein complexes (snoRNPs). Missense mutations in the gene encoding ZNHIT3 protein have been previously reported to cause PEHO syndrome, a severe neurodevelopmental disorder typically presenting after birth. We discuss here the case of two fetuses from a single family who presented with isolated hydrops during the early second trimester of pregnancy, resulting in intrauterine demise. Autopsy revealed no associated malformation. Through whole-genome quartet analysis, we identified two novel variants within the ZNHIT3 gene, both inherited from healthy parents and occurring as compound heterozygotes in both fetuses. The c.40T>C p.Cys14Arg variant originated from the father, while the c.251_254delAAGA variant was of maternal origin. Analysis of the variants in human cell culture models reveals that both variants reduce cell growth, albeit to different extents, and impact the protein's stability and function in distinct ways. The c.251_254delAAGA results in production of a stable form of ZNHIT3 that lacks a domain required for mediating snoRNP biogenesis, whereas the c.40T>C p.Cys14Arg variation behaves similarly to the previously described PEHO-associated ZNHIT3 variants that destabilize the protein. Interestingly, both variations lead to a marked decrease in specific box C/D snoRNA levels, reduced rRNA levels and cellular translation. Analysis of rRNA methylation pattern in fetus samples reveals distinct sites of hypo 2'-O-methylation. RNA-seq analysis of undifferentiated and differentiated SHSY5Y cells transfected with the ZNHIT3 variants reveals differential expression of a set of genes, many of which are associated with developmental processes and RNA binding compared to cells expressing wild-type ZNHIT3. In summary, this work extends the phenotype of PEHO syndrome to include antenatal manifestations and describe the molecular defects induced by two novel ZNHIT3 variants.

Prevention and management of anaemia in pregnancy: Community perceptions and facility readiness in Ghana and Uganda.

Anaemia is one of the most common conditions in low- and middle-income countries, with prevalence increasing during pregnancy. The highest burden is in Sub-Saharan Africa and South Asia, where the prevalence of anaemia in pregnancy is 41.7% and 40%, respectively. Anaemia in pregnancy can lead to complications such as prematurity, low birthweight, spontaneous abortion, and foetal death, as well as increasing the likelihood and severity of postpartum haemorrhage. Identifying and mitigating anaemia in pregnancy is a public health priority. Here we present a mixed-methods situational analysis of facility readiness and community understanding of anaemia in Ghana and Uganda. Quantitative health assessments (adapted from service availability and readiness assessments) and qualitative key informant interviews (KIIs) with district-level stakeholders, in-depth interviews (IDIs) with maternity staff, and focus group discussions (FGDs) with community members were held in 2021. We carried out facility assessments in nine facilities in Ghana and seven in Uganda. We carried out seven KIIs, 23 IDIs, and eight FGDs in Ghana and nine, 17, and five, respectively, in Uganda. Many good practices and general awareness of anaemia in pregnancy were identified. In terms of bottlenecks, there was broad consistency across both countries. In health facilities, there were gaps in the availability of haemoglobin testing-especially point-of-care testing-staffing numbers, availability of standard operating procedures/guidelines for anaemia in pregnancy, and poor staff attitudes during antenatal care. Amongst community members, there was a need for improved sensitisation around malaria and helminth infections as potential causes of anaemia and provision of education around the purpose of iron and folic acid supplementation for preventing or managing anaemia in pregnancy. Anaemia in pregnancy is a persistent challenge, but one with clear opportunities to intervene to yield improvements.

Biallelic NEXN variants and fetal onset dilated cardiomyopathy: two independent case reports and revision of literature

BackgroundDilated cardiomyopathy (DCM) is an etiologically heterogeneous group of diseases of the myocardium. With the rapid evolution in laboratory investigations, genetic background is increasingly determined including many genes with variable penetrance and expressivity. Biallelic NEXN variants are rare in humans and associated with poor prognosis: fetal and perinatal death or severe DCMs in infants.Case presentationWe describe two male infants with prenatal diagnosis of dilated cardiomyopathy with impaired ventricular contractility. One of the patients showed hydrops and polyhydramnios. Postnatally, a DCM with severely reduced systolic function was confirmed and required medical treatment. In patient 1, Whole Exome Sequencing (WES) revealed a homozygous NEXN variant: c.1156dup (p.Met386fs) while in patient 2 a custom Next Generation Sequencing (NGS) panel revealed the homozygous NEXN variant c.1579_1584delp. (Glu527_Glu528del). These NEXN variants have not been previously described. Unlike the unfavorable prognosis described for biallelic NEXN variants, we observed in both our patients a favorable clinical course over time.ConclusionThis report might help to broaden the present knowledge regarding NEXN biallelic variants and their clinical expression. It might be worthy to consider the inclusion of the NEXN gene sequencing in the investigation of pediatric patients with DCM.

Nutrition Education and Nutritional Status of Chronic Lack of Energy Pregnant Women in PUSKESMAS Work Areas Throughout Kupang City

One of the indirect causes of preventable maternal and child mortality is the health status of pregnant women. Pregnant women with SEZ conditions are at risk of experiencing decreased muscle strength, which is needed in the process of labor so that it can result in fetal death, premature birth, birth defects, low birth weight babies, short birth babies and even infant death. The design used is quantitative with a cross sectional approach with univariate and bivariate analysis using the Chi-Square test. The population of this study were all pregnant women who did pregnancy checks at the Puskesmas in Kupang City in 2022. Sample technique using purposive sampling technique. This study was conducted from January to December 2022. The results showed that of all pregnant women who were given nutrition education in the form of counseling and provision of additional food, most experienced weight gain. In contrast to the increase in LiLA, although there is a change in the size of LiLA after being given education, there are still pregnant women who do not experience changes in LiLA. The statistical test results obtained a p-value &lt;0.005, which means that there is a relationship between the provision of nutrition education and the improvement of the nutritional status of pregnant women with SEZ. It is expected for health workers to carry out special monitoring of pregnant women at risk of SEZ in conducting health checks and consuming additional nutritionally balanced foods.

Real-time pre-eclampsia prediction model based on IoT and machine learning

Pre-eclampsia (PET) is a hypertensive disease that occurs during pregnancy or in the postpartum period. It complicates 2% to 8% of all pregnancies and is one of the causes of more than 50,000 maternal deaths and over 500,000 fetal deaths worldwide annually. Adverse birth outcomes due to pregnancy complications have been associated with three delays: delay in recognizing the complication, delay in reaching an appropriate facility, and delay in receiving adequate care when the facility is reached. Thus prevention, timely detection, and care of pregnancy complications can prevent maternal deaths and morbidity. The Internet of Things (IoT) and machine learning (ML) technologies have become the new revolution of research in the field of healthcare. These technologies can be utilized to interconnect various sensors, monitor the health status of a patient, and predict the occurrence of an ailment. This study has designed and prototyped a pre-eclampsia monitoring model based on IoT and machine learning for remotely monitoring the health status of an expectant woman and her unborn child, to enhance early diagnosis of pre-eclampsia and improve birth outcomes. The study involved researching the on most appropriate biosensors and then designing and prototyping the pre-eclampsia watch. To build the pre-eclampsia prediction model the best ML algorithm was empirically analysed. A Naïve Bayes pre-eclampsia prediction model was found to perform better in identifying pregnant women who are at risk of pre-eclampsia after evaluation of various pre-eclampsia models built using decision trees, Naïve Bayes, K Nearest Neighbor (KNN), logistic regression, support vector machines (SVM) and Artificial neural networks (ANN). Lastly, the predictive model was integrated with the pre-eclampsia model to assist in early diagnosis of pre-eclampsia. The prototype generates alerts when the expectant woman is at risk of Pre-eclampsia. The pre-eclampsia watch model can securely capture and transmit expectant women's vital to the cloud for processing and provide timely alerts when the woman is at risk. Further research on the performance and efficacy of the model in a real environment will be done by experimenting with it in a purposively selected sample.

Intrapericardial Teratoma and Associated 3q29 Deletion in a Fetus: Case Report.

Depending on its location, size, and proximity to the cardiac structures, an intrapericardial teratoma may lead to severe circulatory disturbances and even fetal demise. A 34-year-old G2P1 presented at 20w5d with a solid cystic mass in the right thorax of the fetus, originating from the right atrium or lung, with signs of non-immune fetal hydrops, soon resulting in intrauterine fetal death. Detailed post-mortem autopsy revealed signs of hydrops fetalis universalis due to a spherical tumor mass originating from the aortic root. Histologic examination of the tumor showed the characteristic morphology of a teratoma. A 1.6-Mb microdeletion at 3q29 was identified by single nucleotide polymorphism array. This is the first report presenting the diagnosis of an intrapericardial teratoma in a fetus with a microdeletion of 3q29. Intrapericardial teratoma has a poor prognosis and the fetal outcome relies on the development of hydrops. A post-mortem examination is essential in order to make a definitive diagnosis, which underlines the status of the fetal pathologist and the need for interdisciplinary cooperation.

Impact of the ARRIVE Trial on Stillbirth Rates in Nulliparous Individuals.

We aim to examine the population-level rates of induction, stillbirth, perinatal mortality, and neonatal death before and after the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial. This study was a cross-sectional analysis of publicly available U.S. Live Birth data linked with Infant Death and Fetal Death certificate data from National Vital Statistics Online. We limited analyses to nulliparous individuals with singleton pregnancy and cephalic presentation who delivered at 39 weeks or greater. The pre- and post-ARRIVE periods spanned from August 2016 to July 2018, and from January 2019 to December 2020, respectively. Our primary outcome was a stillbirth. Secondary outcomes included induction of labor, perinatal mortality, and neonatal death. Outcomes were compared between the pre- and post-ARRIVE periods. Modified Poisson regression was used to calculate adjusted relative risks (aRRs). Of 2,817,071 births, there were 1,454,346 births in the pre-ARRIVE period and 1,362,725 in the post-ARRIVE period; there were 1,196 and 1,062 stillbirths in the pre- and post-ARRIVE periods, respectively. Compared to the pre-ARRIVE period, the post-ARRIVE period was not associated with a significant decrease in the risk of stillbirth at 39 weeks or greater (aRR 0.92 [95% confidence interval {95% CI} 0.85-1.00]) and stillbirth at 40 weeks or greater (aRR 0.92 [95% CI 0.82-1.04]). Compared to the pre-ARRIVE trial period, the post-ARRIVE trial was associated with increased rates of induction of labor at 39 weeks (aRR 1.37 [95% CI 1.37-1.38]) and 40 weeks (aRR 1.24 [95% CI 1.24-1.25]. Similar to stillbirth, there was no significant decrease in the risk of perinatal mortality at 39 weeks or greater or 40 weeks or greater. There was also no statistically significant change in neonatal death rates at 39 weeks or greater or at 40 weeks or greater. The increase in induction of labor at 39 weeks was not large enough to impact the stillbirth rate at 39 weeks or greater. · Post-ARRIVE trial, rate of induction of labor increased at 39 and 40 weeks.. · Post-ARRIVE trial, stillbirth and perinatal mortality rates remained unchanged.. · Induction rate rise post-ARRIVE trial did not impact neonatal death rates..