Fetal Heart Activity Research Articles

Spontaneous Umbilical Cord Vascular Rupture during Labor: A Retrospective Analysis of 12 Cases.

Umbilical cord vascular rupture is a rare and severe condition that can occur during labor, leading to adverse outcomes for the fetus before as well as after delivery. Prompt diagnosis and intervention are crucial for improving the chances of a successful outcome. We aimed to analyze cases of umbilical cord vascular rupture during labor to provide insights into this challenging condition. This retrospective study evaluated the medical records of patients diagnosed with umbilical cord vessel rupture or umbilical cord hematoma at Fujian Maternity and Child Health Hospital from January 1, 2015, to May 31, 2023. The inclusion criteria included gestational age of ≥28 weeks, occurrence during labor, and availability of complete delivery data. Data on fetal heart rate (FHR) changes, delivery intervals, intraoperative findings, placental pathology, and neonatal outcomes were collected and analyzed. A total of 12 cases were analyzed. The incidence of umbilical cord vascular rupture during childbirth was 0.08%. The FHR patterns in umbilical cord rupture during delivery included baseline tachycardia, minimal or absent variability, variable or late deceleration, prolonged deceleration, and undetectable heart rate. The bradycardia-to-delivery interval (BDI) ranged from 6 to 26 minutes. Among the 12 neonates, 9 were discharged well, 2 were stillbirths, and there was 1 neonatal death. Hemorrhagic shock was common in live births. Our study highlights the significance of continuous FHR monitoring during labor and the urgent need for medical teams to respond quickly in cases of umbilical cord vascular rupture. Despite advancements in neonatal resuscitation techniques, managing cases with undetectable fetal heart activity remains clinically challenging, and even with immediate pregnancy termination, poor neonatal outcomes may still occur. · Umbilical cord vascular rupture during labor is a rare event.. · Its clinical management presents significant challenges.. · Advances in neonatal resuscitation have improved rescue success rates.. · In such cases, hemorrhagic shock is common in live births..

Obstetric outcomes in the expectant management of cesarean scar pregnancy with fetal heart activity: a single-center retrospective cohort study.

Cesarean scar pregnancy (CSP) is a high-risk complication characterized by the implantation of a pregnancy within a cesarean scar resulting from a previous delivery. Currently, clinical indicators guiding the expectant management of patients with CSP are lacking. We thus aimed to evaluate pregnancy and neonatal outcomes among women who underwent expectant CSP management and to investigate whether sonographic signs correlated with obstetric outcomes. We retrospective reviewed the electronic medical records and first-trimester transvaginal ultrasonography reports of consecutive patients diagnosed with CSP in the first trimester at the West China Second University Hospital from January 1, 2010 to December 31, 2022. Pregnancy outcomes (emergency surgery, blood loss, and rescue) and neonatal outcomes (gestational age at delivery, neonatal weight, and Apgar scores) were examined. A binary logistic regression analysis was conducted to identify independent risk factors that could predict severe complications. The final analysis included 54 patients. The mean age of the pregnant women was 34±4 years. Among the 54 patients, 14 (25.9%) did not progress to 20 weeks of gestation. Pregnancy continued beyond 20 weeks in 40 patients, with 37 live births (92.5%) and 3 stillbirths (7.5%). Moreover, 7 (17.5%) and 33 (82.5%) patients delivered before and after 34 weeks, respectively. Placenta accreta spectrum (PAS) and placenta previa were confirmed in 29 (72.5%) and 17 (42.5%) patients, respectively. Hysterectomy, emergency cesarean section, and rescue surgery were performed in 5 (12.5%), 15 (37.5%), and 22 (55.5%) patients, respectively. Patients with a visible niche were significantly more likely to have preterm labor, PAS, placenta previa, low-birth-weight newborns, higher blood loss, intraoperative rescue, blood transfusion, and first-trimester vaginal bleeding than were those without one (all P values <0.05). Our study showed that expectant management of CSP to achieve live birth might be feasible. Patients with a visible niche exhibited worse outcomes, with a higher incidence of severe delivery complications.

Perinatal outcomes in indian women with Antiphospholipid Antibody Syndrome (APS): Five year experience from a tertiary care centre

BackgroundAntiphospholipid Syndrome (APS) is a systemic autoimmune thrombophilic condition characterized by obstetric manifestations, including pregnancy loss, preeclampsia and fetal growth restriction. Early diagnosis and management are key to improve maternal and neonatal outcomes. ObjectiveThe aim of this study is to assess the perinatal outcomes in APS, the development of various adverse pregnancy outcomes (APO), and their association with specific antibody profiles. Material methodsThis observational study was carried out on booked cases of singleton pregnancy and diagnosed cases of primary APS in our High-Risk Pregnancy (HRP) clinic from January 2018 to December 2022 after approval from institutional ethics committee. Forty-three confirmed cases of primary APS were enrolled and started on low-dose aspirin and low-molecular-weight heparin (LMWH) as per the patient's body weight after confirmation of fetal heart activity radiologically until 36 weeks of gestation as a standard of care. ResultsForty patients (93 %) had obstetric APS, and three patients (7 %) had thrombotic APS. During the course of the current pregnancy, adverse pregnancy outcomes (APO) developed in 12 (30 %) out of 40 cases of obstetric APS and in all 3 patients with thrombotic APS. Preeclampsia was seen in 11 (25.5 %), FGR in 12 (27.9 %), and preterm birth in 7 (16.2 %) cases. Patients with an antibody profile showing the presence of Anti-β2 GP-I positivity and ACL positivity had fewer APOs (20 % and 29 %) in comparison to patients with a LA and triple positive antibody profile (55 % and 50 %). ConclusionTreatment of pregnant women with APS causes significant improvement in the live birth rate. The late pregnancy complications like preeclampsia, FGR, and premature birth, occurring despite treatment still remains a challenge and emphasizes the need for stringent antepartum surveillance and timely delivery.

The Success of Mifepristone and Misoprostol in the Management of Early Pregnancy Loss at a Community Hospital: A Prospective Study

ObjectivesThis prospective single-arm study was conducted to understand the expulsion rate of the gestational sac in the management of early pregnancy loss (EPL). MethodsWe recruited 441 participants; 188 met the eligibility criteria. Participants were 18 years of age and older who experienced a confirmed EPL (<12 weeks gestational age) defined by an intrauterine pregnancy with a non-viable embryonic or anembryonic gestational sac with no fetal heart activity. Participants were given 200 mg of mifepristone pre-treatment orally followed by 2 doses of misoprostol 800 μg vaginally after 24 and 48 hours. Participants were seen in follow-up on day 14 to confirm the absence of a gestational sac, classified as treatment success. For failed treatment (defined by retained gestational sac), we offered expectant management or a third dose of misoprostol and/or dilatation and curettage. We followed all participants for 30 days. We collected data on overtreatment for retained products of conception and hospital admissions for adverse events. ResultsOverall, 181 participants followed the protocol and 169 (93.3%) participants had a complete expulsion of the gestational sac by the second visit (day 14). Twelve (6.6%) failed the treatment and 1 had an adverse event of heavy vaginal bleeding requiring dilatation and curettage. Despite the expulsion of the gestational sac, 29 cases (17.1%) at subsequent follow-up were diagnosed as retained products of conception based on ultrasound assessment of thickened endometrium. ConclusionsPretreatment with mifepristone followed by 2 doses of misoprostol with a 14-day follow-up resulted in a high expulsion rate and is a safe management option for EPL.

Ultrasonography and Pregnancy Outcome in Threatened Abortion: A Prospective Observational Study

Background: Women who experience vaginal bleeding in the early stages of their pregnancy should be extremely worried about the phenomenon of "threatened abortion". Predicting the course of a pregnancy and choosing the best management techniques are critical to providing the best possible care for patients. The purpose of this investigation's prospective observational design was to learn more about the predictive power of ultrasound and how it may affect the medical management of upcoming abortions. Method: For the study, 200 first trimester pregnant women who showed indicators of an imminent abortion were gathered between X and Y. We looked at the fetus's heart, the size of the cervical canal, and a few other parts of the gestational sac using ultrasonography. Furthermore, records pertaining to the existence of extra data, like subchorionic hematoma, were found. Numerous exams were conducted to monitor the pregnancy's development. Results: Of the research's participants, 35% miscarried for unidentified reasons, and 65% were able to bring their pregnancies to term. The pregnancy's outcome could be accurately predicted based on the ultrasonography results. More specifically, there was a significant correlation between the development of a visible gestational sac and the presence of fetal heart activity and a higher chance of a successful pregnancy outcome. This was a strong relationship. On the other hand, women who had a subchorionic hematoma or a shorter cervical length were found to have a significantly higher risk of miscarriage. These findings show the value of ultrasonography as a technique for forecasting the course of pregnancies that are at risk of ending because of difficulties connected to the threat of abortion. Conclusion: Investigation's prospective observational design shows how ultrasound can be used to evaluate the advancement of pregnancy to determine cases where an abortion is likely to occur soon. Clinical decision-making based on ultrasound findings can improve patient management plans, patient counseling, and care for expectant patients. If prompt intervention using ultrasonographic signs improves the results of pregnancy at high risk, more research is needed to make that determination. Keywords: Ultrasonography, Threatened Abortion, Subchorionic Hematoma, and Ultrasound Markers

Anesthetic Management of Carcinoma Breast during Third Trimester of Pregnancy: a Case Report

Although malignancy during pregnancy is uncommon, if occurs, it adds challenge to ensure safety of both the mother and fetus. A 36-year lady was diagnosed with carcinoma breast and scheduled for modified radical mastectomy at 29 weeks of gestation. The case was conducted under general anesthesia with intraoperative pectoralis nerve block for postoperative analgesia. Care was taken to avoid hypotension, tachycardia and hypercarbia so that the placental perfusion was not hampered. The trachea was extubated and immediate postoperative obstetrician review revealed no abnormality in the fetal heart rate and activity. Postoperative course was uneventful. Pregnancy was continued till 34 weeks of gestation when elective cesarean section was done under subarachnoid block. A healthy baby was delivered without any adverse consequences. Anesthesia during last trimester of pregnancy can be safely performed, when precautions are taken with involvement of proper teamwork, and the benefit of surgery outweighs the risk of postponing it.

Primary Hepatic Ectopic Pregnancy: Diagnosis and Laparoscopic Management

To demonstrate and discuss a case of primary hepatic ectopic pregnancy and laparoscopic management. Case presentation with demonstration of surgical hepatic wedge resection. Tertiary referral center in Manchester, United Kingdom. A 33-year-old women gravida 13 para 2 with a body mass index of 55 kg/m2 and previous 2 cesarean sections and a laparoscopic cholecystectomy presented to the emergency services after a private ultrasound scan showing a pregnancy of unknown location and a serum human chorionic gonadotropin (hCG) of 18 336 IU/mL. A diagnostic laparoscopy was performed but fallopian tubes were normal with no signs of ectopic pregnancy seen. An abdominal ultrasound scan was performed but did not identify the ectopic pregnancy. Owing to worsening symptoms of pain and rising hCG levels, she underwent a further laparoscopy converted to laparotomy and a left salpingo-oophorectomy for suspected left ovarian pregnancy. However, serum hCG levels continued to rise after the surgery, reaching 36 960 IU/mL. An magnetic resonance imaging scan of her abdomen and pelvis was arranged that showed a 4 cm cystic lesion in the segment V of the liver. Further ultrasound correlation showed a hyperechoic lesion with echogenic components suspicious of an ectopic pregnancy with a fetal pole. Fetal heart action was not visualized. A multidisciplinary team approach was adopted with involvement of the hepatobiliary surgical team, and the option of medical management with methotrexate and surgical excision was considered. A decision was made for surgical excision based on the accessible location of the ectopic pregnancy on segment V and the more controlled and predictable outcome with surgical excision. A preoperative computed tomography scan confirmed the lesion in segment V of liver in keeping with liver capsular implantation of ectopic pregnancy (Video still 1). At laparoscopy the ectopic pregnancy was visualized on the inferior surface of liver close to the inferior margin with a band of overlying omental adhesion (Video still 2). The overlying omental adhesions were sealed and cut with advanced bipolar diathermy, keeping a safe margin from the ectopic pregnancy to minimize any bleeding. The liver capsule was then opened with monopolar diathermy, and the small segment of liver with the ectopic pregnancy was excised using a combination of Bowa-Lotus liver blade (Bowa Medical Ltd). Hemostasis was controlled using Floseal hemostatic matrix and applied pressure laparoscopically. Total operating time was 80 minutes with an estimated blood loss of 500 mL. The patient was discharged on day 3 postoperatively, and follow-up serum hCG excluded residual trophoblastic disease. On review of the clinical case, earlier imaging of the upper abdomen when confronted by a persistent pregnancy of unknown location with high levels of serum hCG would have prevented the second laparoscopy, laparotomy, and salpingo-oophorectomy. In similar cases, it would also help exclude poorly differentiated malignancies as a source of serum hCG. Only 27 cases of ectopic pregnancy on the liver have been identified in English literature since 1952, based on a MEDLINE and Embase enquiry and further review of all case reports by the authors to avoid duplicates. Estimated incidence of hepatic implantation is 1 in 15 000 pregnancies; 4 case reports of laparoscopic liver resection have been identified and another case managed by suction from the liver surface [1,2]. The key principle demonstrated is to resect the ectopic pregnancy with a safe margin of liver tissue and any adhesions to avoid catastrophic bleeding from direct handling of the ectopic pregnancy.

Biomarkers at 6 weeks' gestation in the prediction of early miscarriage in pregnancy following assisted reproductive technology.

Miscarriage is a major concern in early pregnancy among women having conceived with assisted reproductive treatments. This study aimed to examine potential miscarriage-related biophysical and biochemical markers at 6 weeks' gestation among women with confirmed clinical pregnancy following in vitro fertilization (IVF)/embryo transfer (ET) and evaluate the performance of a model combining maternal factors, biophysical and biochemical markers at 6 weeks' gestation in the prediction of first trimester miscarriage among singleton pregnancies following IVF/ET. A prospective cohort study was conducted in a teaching hospital between December 2017 and January 2020 including women who conceived through IVF/ET. Maternal mean arterial pressure, ultrasound markers including mean gestational sac diameter, fetal heart activity, crown rump length and mean uterine artery pulsatility index (mUTPI) and biochemical biomarkers including maternal serum soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), kisspeptin and glycodelin-A were measured at 6 weeks' gestation. Logistic regression analysis was carried out to determine significant predictors of miscarriage prior to 13 weeks' gestation and performance of screening was estimated by receiver-operating characteristics curve analysis. Among 169 included pregnancies, 145 (85.8%) pregnancies progressed to beyond 13 weeks' gestation and had live births whereas 24 (14.2%) pregnancies resulted in a miscarriage during the first trimester. In the miscarriage group, compared to the live birth group, maternal age, body mass index, and mean arterial pressure were significantly increased; mean gestational sac diameter, crown rump length, mUTPI, serum sFlt-1, glycodelin-A, and the rate of positive fetal heart activity were significantly decreased, while no significant differences were detected in PlGF and kisspeptin. Significant prediction for miscarriage before 13 weeks' gestation was provided by maternal age, fetal heart activity, mUTPI, and serum glycodelin-A. The combination of maternal age, ultrasound (fetal heart activity and mUTPI), and biochemical (glycodelin-A) markers achieved the highest area under the curve (AUC: 0.918, 95% CI 0.866-0.955), with estimated detection rates of 54.2% and 70.8% for miscarriage before 13 weeks' gestation, at fixed false positive rates of 5% and 10%, respectively. A combination of maternal age, fetal heart activity, mUTPI, and serum glycodelin-A at 6 weeks' gestation could effectively identify IVF/ET pregnancies at risk of first trimester miscarriage.

Hysteroscopic resection vs ultrasound-guided dilation and evacuation for treatment of cesarean scar ectopic pregnancy: a randomized clinical trial

Cesarean scar ectopic pregnancy is a type of ectopic pregnancy in which the fertilized egg is implanted in the muscle or fibrous tissue of the scar after a previous cesarean delivery. The condition can be catastrophic if not managed on time and can lead to significant morbidity and mortality. Several approaches have been studied for the management of cesarean scar ectopic pregnancy in women who opted for termination of pregnancy with no consensus on the best treatment modality reached so far. This study aimed to compare the success rate of hysteroscopic resection vs ultrasound-guided dilation and evacuation for the treatment of cesarean scar ectopic pregnancy. This was a parallel group, nonblinded, randomized clinical trial conducted at a single center in Italy. Women with singleton gestations at <8 weeks and 6 days of gestation were included in the study. Inclusion criteria were women with a cesarean scar ectopic pregnancy with positive embryonic heart activity who opted for termination of pregnancy. Patients were randomized 1:1 to receive either hysteroscopic resection (ie, intervention group) or ultrasound-guided dilation and evacuation (ie, control group). Both groups received 50 mg/m2 of methotrexate intramuscularly at the time of randomization (day 1) and another dose at day 3. A third dose of methotrexate was planned in case of persistence of positive fetal heart activity at day 5. Participants received either ultrasound-guided dilation and evacuation or hysteroscopic resection from 1 to 5 days after the last dose of methotrexate. Hysteroscopic resection was performed under spinal anesthesia using a 15 Fr bipolar mini-resectoscope. Dilation and evacuation were performed by vacuum aspiration with a Karman cannula, followed by sharp curettage, if necessary, under ultrasound guidance. The primary outcome was the success rate of the treatment protocol, defined as no further treatment required until the complete resolution of the cesarean scar ectopic pregnancy. Resolution of the cesarean scar ectopic pregnancy was evaluated based on decline of beta-hCG and the absence of residual gestational material in the endometrial cavity. Treatment failure was defined as the necessity for further treatment required until the complete resolution of the cesarean scar ectopic pregnancy. A sample size calculation indicated that 54 participants were required to test the hypothesis RESULTS: A total of 54 women were enrolled and randomized. Number of previous cesarean deliveries ranged from 1 to 3. Overall, 10 women received a third dose of methotrexate with 7 of 27 (25.9%) participants in the hysteroscopic resection group and 3 of 27 (11.1%) in the dilation and evacuation group. The success rate was 100% (27/27) in the hysteroscopic resection group and 81.5% (22/27) in the dilation and evacuation group (relative risk, 1.22; 95% confidence interval, 1.01-1.48). Additional procedures were required in 5 cases of the control group, namely 3 hysterectomies, 1 laparotomic uterine segmental resection, and 1 hysteroscopic resection. The length of stay in the hospital was 9.0±2.9 days in the intervention group and 10.0±3.5 days in the control group (mean difference,-1.00 days; 95% confidence interval,-2.71 to 0.71). No cases of admission to intensive care unit or maternal death were reported. Hysteroscopic resection was associated with an increased success rate in the treatment of cesarean scar ectopic pregnancy when compared with ultrasound-guided dilation and evacuation.

Kliniğimizde Tedavi Edilen Tubal Ektopik Gebelik Olgularında Hemoperitonyumun Önemi ve Retrospektif Analizi

Aim: The purpose of this study is to present the importance of hemoperitoneum and retrospective analysis of tubal ectopic pregnancy cases treated in our clinic.&#x0D; Material and Methods: This study respectively included 86 women who were diagnosed and treated for tubal ectopic pregnancy (EP) in our single-centre clinic between January 2012 and August 2013. Age, date of last menstrual period, human chorionic gonadotropin (β-hCG) level, the size and the presence of tubal EP masses, fetal cardiac activity and treatment procedures were evaluated and compared. The presence of hemoperitoneum for predictive treatment methods and factors that affecting the success of treatment methods were investigated.&#x0D; Results: The mean age of the patients was 29.1±5.7 (16-41) years. Mean β-hCG level was 4448,5±8351,9 IU/L. Laparatomy was performed to 14 patients (16.3%), laparoscopy to 5 patients (5.8%), expectant management to 15 patients (17.4%). Methotrexate (MTX) treatment was given to 46 patients (53.5%) and laparoscopy was performed to 1 patient (1.2%) and laparatomy to 5 patients (5.8%) due to MTX treatment failure in 6 patients. Compared with the MTX treatment of tubal EP, the possible factors that affecting surgical management, such as the initial β-hCG level (p=0.004), whether there is hemorrhage in the abdominal cavity (p=0.03), the size of ectopic pregnancy mass (p=.005) and the presence of fetal heart activity (p

A lethal and rare cause of arthrogryposis: Glyt1 encephalopathy

Glycine encephalopathy with normal serum glycine (MIM #617301), also known as GLYT1 encephalopathy, is an extremely rare disorder caused by biallelic variants in SLC6A9 and characterised by facial dysmorphic features, skeletal findings including contractures, knee hyperextension, and joint dislocations and seizures. To date, only ten patients from five families have been reported and only two of them could survive until childhood. In this study, we report on a consanguineous Turkish couple with a history of six pregnancies with three habitual abortions and three postpartum exitus. While in three pregnancies the babies were born prematurely at 32nd gestational week by emergency ceserean section due to hydrops and fetal distress, the other pregnancy was medically terminated at 16th gestational week due to absent fetal heart activity. The product of all these three pregnancies exhibited similar phenotype including short neck, thoracic kyphosis, hypertrichosis, joint contractures and dislocations, hypertonia, knee hyperextension and facial dysmorphic features. Trio exome sequencing was performed prenatally during the last pregnancy and a novel VUS variant in SLC6A9 and a likely pathogenic variant in MTOR gene were detected. DNA isolation was performed from frozen muscle and adrenal tissue of previously autopsied fetuses with similar clinical features, and the same variants were confirmed in both of them. Our data suggest that SLC6A9 and MTOR variants may be responsible for this extremely lethal phenotype in this family.

Caesarean scar pregnancy: diagnosis, natural history and treatment.

This review aims at summarizing the latest evidence on diagnosis, natural history and management of caesarean scar pregnancy (CSP). CSP can result in maternal morbidity from major haemorrhage, uterine rupture, placenta accreta spectrum disorders and hysterectomy. Classification of the CSP types, presence of fetal heart activity, gestational age and residual myometrial thickness seem to influence rates of ongoing pregnancy, subsequent development of placenta accreta with expectant management, as well as success and complication rates associated with various methods of pregnancy termination. Expectant management may be appropriate in certain good prognosis cases, such as absent fetal heart activity or when the myometrial layer at the implantation site is relatively thick. Surgical treatments are typically associated with higher success rates, but seem to result in severe haemorrhage more frequently than medical treatments, which have higher failure rates. Although other treatment modalities are available, in general, the size and quality of evidence to guide care provision in CSP is very poor. CSP can be associated with severe maternal morbidity but can also lead to a livebirth. There is currently a lack of good-quality evidence to predict the outcome of CSP and provide informed and evidence-based care.

Automated prediction of early spontaneous miscarriage based on the analyzing ultrasonographic gestational sac imaging by the convolutional neural network: a case-control and cohort study

BackgroundIt is challenging to predict the outcome of the pregnancy when fetal heart activity is detected in early pregnancy. However, an accurate prediction is of importance for obstetricians as it helps to provide appropriate consultancy and determine the frequency of ultrasound examinations. The purpose of this study was to investigate the role of the convolutional neural network (CNN) in the prediction of spontaneous miscarriage risk through the analysis of early ultrasound gestational sac images.MethodsA total of 2196 ultrasound images from 1098 women with early singleton pregnancies of gestational age between 6 and 8 weeks were used for training a CNN for the prediction of the miscarriage in the retrospective study. The patients who had positive fetal cardiac activity on their first ultrasound but then experienced a miscarriage were enrolled. The control group was randomly selected in the same database from the fetuses confirmed to be normal during follow-up. Diagnostic performance of the algorithm was validated and tested in two separate test sets of 136 patients with 272 images, respectively. Performance in prediction of the miscarriage was compared between the CNN and the manual measurement of ultrasound characteristics in the prospective study.ResultsThe accuracy of the predictive model was 80.32% and 78.1% in the retrospective and prospective study, respectively. The area under the receiver operating characteristic curve (AUC) for classification was 0.857 (95% confidence interval [CI], 0.793–0.922) in the retrospective study and 0.885 (95%CI, 0.846–0.925) in the prospective study, respectively. Correspondingly, the predictive power of the CNN was higher compared with manual ultrasound characteristics, for which the AUCs of the crown-rump length combined with fetal heart rate was 0.687 (95%CI, 0.587–0.775).ConclusionsThe CNN model showed high accuracy for predicting miscarriage through the analysis of early pregnancy ultrasound images and achieved better performance than that of manual measurement.

Hysteroscopic resection vs dilation and evacuation for treatment of caesarean scar pregnancy: study protocol for a randomised controlled trial.

Caesarean scar pregnancy (CSP) is a type of ectopic pregnancy where the fertilised egg is implanted in the muscle or fibrous tissue of the scar after a previous caesarean section. Management options for women who opted for termination of CSP include sharp curettage, dilation and evacuation (D&E), excision of trophoblastic tissues, local or systemic administration of methotrexate, bilateral hypogastric artery ligation, and selective uterine artery embolisation with curettage and/or methotrexate administration. Recently hysteroscopic resection has also been proposed as an alternative option. To compare the surgical outcome of hysteroscopic resection with dilation and evacuation (D&E) for the treatment of caesarean scar pregnancy (CSP). Parallel-group, non-blinded, randomised clinical trial conducted at a single centre in Italy. Eligible women are those with singleton gestations at less than 9 weeks of gestation, and with thickness of myometrial layer ≥1 mm at the level of the ectopic. Inclusion criteria are women with CSP with positive embryonic/fetal heart activity who opted for termination of pregnancy. Patients will be randomised 1:1 to receive either hysteroscopic resection (i.e. intervention group) or D&E (i.e. control group). In both groups, 50 mg/m2 (based on DuBois formula for body surface area) of methotrexate (MTX) will be injected intramuscularly at the time of randomisation (day 1) and another dose at day 3. A third dose of MTX is planned in case of persistence of fetal heart activity on day 5. Participants will receive either D&E or hysteroscopic resection from 3 to 7 days after the last dose of MTX. A sample size of 54 women is planned. The primary outcome is the success rate of the treatment protocol, defined as no requirement for further treatment until complete resolution of the CSP as demonstrated by negative beta hCG levels and absence of residual gestational material on ultrasound examination.. Hysteroscopic surgery is superior to D&E for the treatment of CSP. The results of the trial will provide information on the best treatment for CSP.

Facteurs associés à l’échec du traitement médical de la grossesse extra-utérine: cas de l’Hôpital Gyneco-Obstétrique et Pédiatrique de Yaoundé

Introductionl´objectif de notre travail était d´identifier les facteurs associés à l´échec du traitement médical de la grossesse extra-utérine (GEU) chez les femmes à l´Hôpital Gynéco- Obstétrique et Pédiatrique de Yaoundé.Méthodesil s´agissait d´une étude cas-témoins avec collecte rétrospective des données, sur une période de 10 ans, du 1er janvier 2008 au 31 décembre 2017. Les cas étaient toutes les patientes prises en charge pour GEU avec échec du traitement médical et les témoins celles chez qui le traitement médical de la GEU avait réussi. Les variables étudiées étaient: les caractéristiques sociodémographiques, cliniques, paracliniques et thérapeutiques. L´échantillonnage était consécutif et exhaustif. Nous avons réalisé une analyse multivariée.Résultatsnous avons recruté 92 patientes dont 23 cas et 69 témoins. Les variables associées à l´échec du traitement médical de la GEU après analyse univariée étaient: un taux de β-HCG initial > 10000UI/L (OR=3,05;P=0,031), un taux de β-HCG à J4 > 10000UI/L (OR=7,15;P=0,000), un taux de β-HCG à J7 > à 10000UI/L (OR=20;P=0,000), un score de Fernandez ≥ 13 (OR=3,09;P=0,020), la présence d´activité cardiaque de l´embryon (OR=2,8;P=0,036), l´antécédent d´interruption volontaire de grossesse (OR=2,67;P=0,043) et le niveau de scolarisation primaire (P=0,013). Après analyse multivariée, les facteurs prédictifs étaient: un taux de β-HCG initial >10000 UI/L (OR=8,97; P=0,004), un taux de β-HCG à J4 >10000 UI/L (OR=8,44;P= 0,007), un score de Fernandez ≥ 13 (OR=1,12;P=0,005) et la présence de l´activité cardiaque de l´embryon (OR=6,09;P=0,026).Conclusionles facteurs prédictifs de l´échec du traitement médical de la GEU à HGOPY sont liés au taux de β-HCG initial et la viabilité embryonnaire.

Machine Learning Techniques for Identifying Fetal Risk During Pregnancy

Cardiotocography (CTG) is a biophysical method for assessing fetal condition that primarily relies on the recording and automated analysis of fetal heart activity. The quantitative description of the CTG signals is provided by computerized fetal monitoring systems. Even though effective conclusion generation methods for decision process support are still required to find out the fetal risk such as premature embryo, this proposed method and outcome data can confirm the assessment of the fetal state after birth. Low birth weight is quite possibly the main attribute that significantly depicts an unusual fetal result. These expectations are assessed in a constant experimental decision support system, providing valuable information that can be used to obtain additional information about the fetal state using machine learning techniques. The advancements in modern obstetric practice enabled the use of numerous reliable and robust machine learning approaches in classifying fetal heart rate signals. The Naïve Bayes (NB) classifier, support vector machine (SVM), decision trees (DT), and random forest (RF) are used in the proposed method. To assess these outcomes in the proposed method, some of the metrics such as precision, accuracy, F1 score, recall, sensitivity, logarithmic loss and mean absolute error have been taken. The above mentioned metrics will be helpful to predict the fetal risk.

Hysteroscopic Resection vs Blind Dilation and Curettage (D&C) for Treatment of Cesarean Scar Pregnancy: A Randomized Clinical Trial

<h3>Study Objective</h3> To compare the success rate of hysteroscopic resection vs dilation and curettage (D&C) for treatment of cesarean scar pregnancy (CSP). <h3>Design</h3> Parallel-group randomized clinical trial conducted from February 2020 to February 2021 (Clinicaltrials.gov NCT04205292) <h3>Setting</h3> Women admitted with diagnosis of CSP at a single center in Italy. <h3>Patients or Participants</h3> Inclusion criteria were women with singleton CSP and positive embryonic/fetal heart activity, gestational age <8 weeks and 6 days at the time of randomization, and thickness of myometrial layer ≥1mm. Patients were randomized 1:1 to receive either hysteroscopic resection or D&C. A sample size of 54 women was planned. After one year of enrollment an interim analysis was performed, and 17 women were included. <h3>Interventions</h3> In both groups, 50mg/m2 (based on DuBois formula for body surface area) of methotrexate (MTX) was injected intramuscularly at the time of randomization (day 1) and another dose at day 3. A third dose of MTX was planned in case of persistence of positive fetal heart activity at day 5. Women received D&C or hysteroscopic resection using 15 Fr bipolar mini resectoscope from 3 to 7 days after the second or third dose of MTX. Ultrasound guidance was used in both groups, if needed. <h3>Measurements and Main Results</h3> The primary outcome was the success rate of the treatment protocol, defined as no further treatment required until the complete resolution of the CSP. Success rate was 100% in the hysteroscopic resection group and 75.0% in the D&C group (OR 7.31, 95% CI 0.30-178.57) (Table). <h3>Conclusion</h3> Hysteroscopic resection was associated with increase in success rate of treatment of CSP, even if the statistical significance was not reached in this preliminary analysis.

OP01.04: Non‐surgical treatment of Caesarean scar pregnancy

Case 1 is of a 33-year-old woman with a history of one previous Caesarean section (CS) presented with spotting. Transvaginal sonography showed a 33mm gestation sac, 3mm live fetal pole with heart beat at lower segment of uterus at the location of previous CS scar. The first β-hcG titer of the patient was 58000 IU/L. Her second set of β-hcG increased to 110500 IU/L. Two doses of MTX with 48 hours' interval was prescribed for her. The fetus was reducted with KCL injection with sonography guidance transadominally. The patient was observed for one more week and then discharged with weekly checking of β-hcG titer. At the third week of follow-up, her β-hcG level was under 1000 IU/L. The level of β-HcG became negative after 4 weeks and pregnancy mass in Caesarean scar disappeared after 5 months. Case 2 is of a 34-year-old woman with a history of one previous CS who was presented with spotting. Transvaginal sonography showed an 18x20 mm gestation sac with fetal heart and yolk sac at lower segment of uterus at the location of the previous CS scar. The patient's first set of serum β-hcG titer was 14480IU/L. Two doses of MTX were prescribed for her. In follow up, the repeated transvaginal sonography showed similar findings with fetal heart activity. The patient did not experience any symptom of pain or bleeding at this point and was clinically stable. She was offered the option of Intra sac MTX injection with sonography guidance. In her follow-up after injection, the fetal heart was not detected. She was discharged with weekly checking of β-hcG titer. At the second month of follow-up, her β-hcG level was undetectable. Caesarean scar mass disappeared after 6 months and she became pregnant with normal implantation of pregnancy after 2 years.

The Relationship between Gestational Diabetes Metabolic Control and Fetal Autonomic Regulation, Movement and Birth Weight

(1) Background: Maternal metabolic control in gestational diabetes is suggested to influence fetal autonomic control and movement activity, which may have fetal outcome implications. We aimed to analyze the relationship between maternal metabolic control, fetal autonomic heart rate regulation, activity and birth weight. (2) Methods: Prospective noninterventional longitudinal cohort monitoring study accompanying 19 patients with specialist clinical care for gestational diabetes. Monthly fetal magnetocardiography with electro-physiologically-based beat-to-beat heart rate recording for analysis of heart rate variability (HRV) and the ‘fetal movement index’ (FMI) was performed. Data were compared to 167 healthy pregnant women retrieved from our pre-existing study database. (3) Results: Fetal vagal tone was increased with gestational diabetes compared to controls, whereas sympathetic tone and FMI did not differ. Within the diabetic population, sympathetic activation was associated with higher maternal blood-glucose levels. Maternal blood-glucose levels correlated positively with birth weight z scores. FMI showed no correlation with birth weight but attenuated the positive correlation between maternal blood-glucose levels and birth weight. (4) Conclusion: Fetal autonomic control is altered by gestational diabetes and maternal blood-glucose level, even if metabolic adjustment and outcome is comparable to healthy controls.

Mobile Self-Operated Home Ultrasound System for Remote Fetal Assessment During Pregnancy.

Background: Mobile medical devices for self-patient use are a rapidly evolving section of telehealth. We examined the INSTINCT® ultrasound system, a portable, self-operated ultrasound device attached to a commercial smartphone for remote fetal assessment. We aimed to evaluate whether it is feasible to use remote fetal assessment during pregnancy. Materials and Methods: This is an observational noninterventional trial. We included women with a singleton fetus at 14 + 0 to 39 + 6 gestational weeks. Each participant received the device for a self-use period of 7-14 days and was instructed to perform one to three scans a day. Participants completed a self-assessment questionnaire to evaluate safety and usability (i.e., user experience and satisfaction). Each scan was evaluated for fetal heart activity, amniotic fluid volume, fetal tone, fetal body, and breathing movements. Results: One hundred women, completing 1,360 self scans, used the device for 8.1 ± 1.5 days, performing an average of 13.6 ± 6.2 scans each. There were no device-related serious adverse events. Success in detection was 95.3% for fetal heart activity, 88.3% for body movements, 69.4% for tone, 92.2% for normal amniotic fluid volume, and 23.8% for breathing movements. Interobserver agreement was 94.4% for fetal heart rate activity, 85.9% for body movements, 69.5% for fetal tone, 86.9% for amniotic fluid volume, and 94.0% for breathing movements. Self-assessed user experience was rated at 4.4/5, whereas device satisfaction was rated at 3.9/5. Conclusion: The INSTINCT ultrasound system is a feasible solution for remote sonographic fetal assessment. Further studies are needed to assess its role and impact in telehealth antenatal care and fetal surveillance.