To determine whether there is a higher rate of major fetal congenital heart diseases (CHDs) at first-trimester scan in pregnancies conceived by assisted reproductive technology (ART). A retrospective study was conducted from 2014 to 2022. It included 20,009 singleton pregnancies undergoing ultrasound between 11 and 15 weeks for first-trimester aneuploidy screening or referral for suspected fetal abnormality. Fetal heart assessment was performed through sequential analysis. In cases of CHDs, extracardiac malformations, or other risk factors for major aneuploidies, fetal karyotype evaluation was conducted. CHDs were categorized as major or minor. A CHD was diagnosed in 133 (0.7%) of 18,532 natural pregnancies and 14 (0.9%) of 1477 ART pregnancies. The prevalence of major CHDs in natural pregnancies was 0.5%, with no significant difference compared to ART pregnancies (0.7%; p = 0.47). Overall, 48 CHD cases (43.2%) were associated with extracardiac abnormalities, with no differences between natural and ART pregnancies (p = 0.38). The frequency of abnormal karyotype and isolated CHDs (normal karyotype and no extracardiac abnormalities) also did not differ. The rate of major CHDs detectable at the end of the first trimester does not differ between ART and natural pregnancies.

Effects of maternal Mediterranean diet on fetal cardiac function in high-risk pregnancies: a secondary analysis of the IMPACT BCN randomized trial.

To analyze the third trimester uterine artery Dopplers with other tools of fetal surveillance in prediction of in utero cardiac function measures and adverse neonatal outcomes in fetal growth-restricted pregnancies. Pregnancies with severe or non-severe fetal growth restriction (FGR) (per SMFM guidelines) have been analyzed from an ongoing observational FGR study at a University of Colorado high-risk perinatal center. Fetal biometric values, Doppler indices, and cardiac variables were analyzed in both groups. Different Doppler combinations were tested to identify the best predictors for adverse fetal cardiac and neonatal outcomes. In a cohort of 102 FGR pregnancies, the incidence of abnormal uterine artery Dopplers was 27.5% in the non-severe FGR group and 25.8% in the severe FGR group. Abnormal uterine artery pulsatility index (PI) had a strong association with abnormal umbilical artery PI, with an odds ratio (OR) of 4.51 (1.32-16.2) (P = .01), and the cerebroplacental ratio had an inverse association with elevated uterine artery PI (OR 0.11, 0.01-0.69, P = .03). The odds of birthweight being less than 10th percentile with abnormal uterine artery PI was 9.2 (1.93-43.6, P = .005) in the non-severe FGR group. Fetuses in the severe FGR group with abnormal uterine artery PI had a higher incidence of rounder fetal hearts (OR 4.42, 1.09-17.9, P = .03). Although elevated uterine artery Dopplers are significantly associated with lower birthweight and rounder fetal hearts, the lack of strong correlation with other outcome variables indicates that the role of uterine artery Dopplers in fetal growth restriction needs further investigation in studies with a larger sample size.

Assess prenatal ultrasound's diagnostic value in fetal cardiac anomalies using an abnormal number of pulmonary artery (PA) branches as an initial clue. Retrospective analysis of 20 fetuses with an abnormal number of PA branches on ultrasound, comparing prenatal ultrasonic findings with postnatal echocardiography, computed tomography (CT), surgery, autopsy, and genetic tests. Summarized ultrasonographic characteristics and occurrence frequencies in 3-vessel trachea (3VT), 3-vessel PA branch, and innominate artery (INA) coronary section. In total, abnormal PA branches included: 1 branch (15 cases: 7 pulmonary artery sling [PAS], 4 unilateral absence of pulmonary artery [UAPA], 4 anomalous origin of 1 pulmonary artery from ascending aorta [AOPA]); 3 branches (2 cases: 1 isolated left subclavian artery [ILSA], 1 isolated left innominate artery [ILINA], absent right ductus arteriosus); 4 branches (3 cases: 2 ILSA, 1 ILINA, double ductus arteriosus). Associated anomalies: tetralogy of Fallot, persistent left superior vena cava, ventricular septal defect, Berry syndrome, and nasal bone dysplasia. Postnatal confirmations were achieved via autopsy (9 cases), imaging/surgery (10 cases), or lost (1 case). Genetic tests (14 cases) were normal. Detection: 63.2% (3VT section), 100% (3-vessel PA branch section), 57.9% (INA coronary section). The 3VT, 3-vessel PA branch, and INA coronary section are key for the diagnosis of fetal cardiac malformations with abnormal PA branches. The spatiotemporal image correlation with high-definition (STIC-HD) live flow sonography can aid in visualizing the vascular connection linked to these anomalies. Identifying features of 1/3/4 PA branches facilitates a systematic assessment of fetal cardiac defects primarily characterized by aberrant PA branching.

Background: Labour is a very short period of life of a fetus but poses physiological stress to all the fetus. Fetal distress is a progressive condition that, if not corrected, can increase the chance of fetal death. So routine and continuous monitoring of fetal heart rate by doing Cardiotocography in labour in high risk pregnancies has become an established obstetric practice. The aim of the study is to evaluate the predictive value of the admission CTG in detecting fetal hypoxia at the time of admission during labour and to correlate its result with fetal outcome in high risk pregnancies. Materials and methods: This prospective observational study was held in ChattogramMaa O Shishu Hospital Medical College from March 2022 to August 2022. A total of 65 gravid women with high risk pregnancies of >37 weeks gestation with cephalic presentation in the first stage of labour were taken. Result was assessed in the form of APGAR SCORE at 5 min, NICU admission, perinatal mortality and mode of delivery. Statistical analysis was done by using SPSS 20. Chi square test was used and p< 0.05 is considered statistically significant. Results: A total of 65 high risk obstetric patients were recruited. The admission CTG were reactive in 45 patients (69.23%) and non-reactive in 20 patients (30.77%). APGAR SCORE <7 at 5 minutes was higher in nonreactive group (60%) as compared to reactive group (60% v/s 17.78%). Occurrence of fetal distress, NICU admission and perinatal mortality was also higher in nonreactive group to reactive group (NICU admission 35% v/s 6.67% and perinatal mortality 15% v/s 0%). Incidence of vaginal delivery vaginal delivery was more common when the test was reactive (64.44% v/s 10%). Sensitivity, specificity, positive predictive value and negative predictive value of Admission CTG for these high risk cases were 68%, 76%, 54% and 85% respectively. Conclusion: Admission CTG is a simple and easy test and an effective screening test to identify groups of women with greater risk of intrapartum fetal hypoxia and to predict fetal outcome and thus prevents unnecessary delay in intervention. Chatt Maa Shi Hosp Med Coll J; Vol.24 (1); Jan 2025; Page 91-95

The association between traffic-related air pollution and risk of non-reassuring fetal heart rate in newborns at birth.

Background: The rising rate of caesarean section (CS) has emerged as a major public health concern worldwide, particularly in tertiary care hospitals managing a high proportion of high-risk pregnancies. The Robson Ten Group Classification System offers a standardized and reproducible method to analyse delivery patterns and identify key contributors to caesarean section rates. Objectives: To categorize all deliveries using the Robson Ten Group Classification System and to evaluate the overall and primary caesarean section rates along with their major contributing groups in a tertiary care hospital. Methods: This prospective observational study was conducted in the labour unit of a tertiary care teaching hospital over a period of two years. All pregnant women aged 18 years and above with a gestational age of 24 weeks or more admitted for delivery were included. Deliveries were categorized into ten groups using the Robson Ten Group Classification System. Data on maternal characteristics, labour onset, mode of delivery, and indications for caesarean section were collected and analysed using descriptive statistics. Results: A total of 600 deliveries were analysed. The overall caesarean section rate was 39.0%, with primary caesarean sections accounting for 62.4% of all caesarean deliveries. Robson Group 1 was the largest group, while Robson Group 5 was the single largest contributor to the overall caesarean section rate, accounting for 38.5% of caesarean deliveries. Nulliparous women in Groups 1 and 2 together contributed significantly to primary caesarean sections. Non-reassuring fetal heart rate pattern and failure to progress in labour were the most common indications for primary caesarean section. Conclusion: The Robson Ten Group Classification System proved to be an effective audit tool for analysing delivery patterns and caesarean section practices in a tertiary care hospital. The high contribution of women with previous caesarean sections and nulliparous women highlights the need for targeted interventions to reduce unnecessary primary caesarean sections and promote evidence-based obstetric care. Keywords: Robson Ten Group Classification System; Caesarean section; Delivery patterns; Tertiary care hospital; Maternal health; Obstetric audit

Ectopic splenosis is a disorder caused by the overflow of splenic myeloid cells or intravascular migration after splenic trauma or splenectomy. It is often asymptomatic and detected incidentally during imaging evaluation. Splenosis lacks specificity on clinical imaging examinations such as ultrasound, computed tomography, and magnetic resonance imaging and is often confused with tumors. We report the case of a primigravida (G1P0) in her early 30s with multiple hypoechoic masses in her upper abdomen that were detected during routine prenatal ultrasound at 23 + 1 weeks of gestation, with a recommendation for follow-up monitoring. Tumor marker analysis showed normal results. The patient remained asymptomatic without abdominal pain or fever, and monitoring showed normal fetal heart rate. The patient was admitted to our hospital, and we conducted a multidisciplinary consultation. We used misoprostol and a Cook balloon to induce labor; the patient delivered vaginally successfully. In this case report, we aimed to highlight the significance of taking detailed medical history and using the “minimal intervention” approach for managing pregnancy-complicated splenosis, highlighting the pivotal role of multimodal imaging evaluation.

Epidural analgesia has shown high maternal-fetal safety and satisfactory analgesia. Sufentanil is associated with a high risk of pruritus, nausea, and vomiting for epidural labor analgesia. Alfentanil is characterized by a rapid onset and is also used for labor analgesia. The study aimed to compare the analgesic efficacy and adverse effects of epidural ropivacaine combined with equipotent doses of alfentanil or sufentanil for labor analgesia, and to provide evidence for optimizing obstetric analgesic regimens. In this multicenter, randomized, controlled, single-blind trial conducted at four tertiary hospitals in China between June 2023 and June 2024, 442 nulliparous women with singleton, term pregnancies were enrolled. Participants were randomly assigned (1:1) to receive epidural 0.075% ropivacaine combined with either 4μg/ml alfentanil (group A) or 0.2μg/ml sufentanil (group S). Analgesia was delivered via a programmed intermittent epidural bolus (PIEB) plus patient-controlled epidural analgesia (PCEA) regimen (10ml bolus, 50-min interval, 3ml/h background infusion, 8-ml patient-controlled bolus, 20-min lockout). The onset of analgesia, defined as the median time from drug administration to the first recording of a visual analogue scale (VAS) score ≤ 3 within 30min was the primary outcome. Hemodynamic parameters, labor characteristics, analgesic consumption, maternal satisfaction, neonatal outcomes, and adverse events were recorded as secondary outcomes. The median onset time of analgesia was significantly shorter in the alfentanil group compared with the sufentanil group (8.0min vs. 10.0min, P < 0.001). No significant differences were observed between groups in blood pressure, heart rate, SpO₂, fetal heart rate, Bromage scores, VAS scores at subsequent time points, uterine pressure, sensory block level, body temperature, duration of analgesia, labor duration, mode of delivery, oxytocin use, total drug consumption, maternal satisfaction, or neonatal Apgar scores (all P > 0.05). Adverse events such as pruritus, nausea, vomiting, urinary retention, and lower limb numbness were infrequent and comparable between groups. Both alfentanil and sufentanil, when combined with 0.075% ropivacaine, provide effective and safe epidural labor analgesia. However, alfentanil offers the advantage of a faster onset of analgesia, making it a valuable alternative to sufentanil in clinical practice. Chinese Clinical Trial Registry, ChiCTR2300072104, Date of registration: June 2, 2023.

Fetal acidemia, caused by impaired gas exchange between the fetus and the mother, is a leading cause of stillbirth and neurologic complications. Early prediction is therefore essential to guide timely clinical intervention. Several strategies rely on cardiotocography (CTG), which combines fetal heart rate (fHR) with uterine contractions and has led to development of clinical guidelines for CTG interpretation and the introduction of different fHR features. Additionally, ST event analysis, investigating changes in the ST segments of the fetal electrocardiogram (fECG), has been proposed as a complementary tool. This narrative review adopts a systematic approach, with comprehensive searches in Embase and PubMed to ensure full coverage of the available literature, and summarizes findings from 30 studies. Clinical guidelines for CTG interpretation frequently lead to intermediate risk level annotations, leaving the final decision regarding fetal management to clinical experience. In contrast, various fHR features can successfully discriminate between fetuses developing acidemia and healthy controls. Evidence regarding the added value of ST events derived from the scalp electrode remains conflicting, due to concerns about invasiveness. Recent studies on machine learning models highlight their ability to integrate multiple fHR features and improve predictive performance, suggesting a promising direction for enhancing acidemia prediction during labor.

Background: Cardiotocography (CTG) is a globally used intrapartum monitoring tool to assess the foetal heart rate and the related responses to the physiology of the uterine action. The intrapartum foetal monitoring is the primary responsibility of the midwives caring for the woman in labour. Midwives’ knowledge and understanding of CTG traces and interpretation ensure timely responses to pathological findings, thus ensuring positive foetal and neonatal outcomes. Aim: The study aimed to assess the midwives’ knowledge of cardiotocograph interpretation and documentation in a selected hospital in Gauteng. Setting: The data were collected in a selected secondary hospital, a referral hospital for the midwife-led obstetric units and district hospitals in the Gauteng province. Methods: The study employed a quantitative retrospective research design, utilising a checklist to analyse patients’ past medical records – this retrospective analysis aimed to evaluate midwives’ knowledge in interpreting CTG. Results: A review of 336 CTG case records analysed five criteria: baseline heart rate, variability, decelerations, accelerations, and overall trace assessment. Significant discrepancies in record-keeping were found between midwives and researchers. Researchers maintained complete records and interpretations for all criteria, whereas midwives exhibited considerable gaps, ranging from 31% to 100% across the CTG criteria. Conclusion: Analysis indicates a substantial gap in CTG documentation by midwives compared to researchers. Contribution: Midwives exhibiting significant data omissions that may affect intrapartum care quality and clinical decisions.

Purpose: Present a unique case of a large umbilical cord pseudocyst with a two-vessel cord associated with fetal heterotaxy and extensive congenital vascular malformations. Introduction: Umbilical pseudocysts found during the first trimester are a rare anomaly, occurring in 0.4%-3.4% of pregnancies and are most commonly transient. An umbilical cord cyst is one that communicates with the urachus, while a pseudocyst is composed of Wharton’s jelly. The prevalence of a pseudocyst in the third trimester, however, is unknown due to insufficient data. In literature reviews, the prevalence of fetal anomalies with a third trimester umbilical cyst is reported to be 38-100%. It is worth noting that this data is likely biased by the tendency to report abnormal and unique cases in literature. Case Description: The patient was a 23-year-old G3P2 who desired a trial of labor after cesarean (TOLAC) under the care of a midwife. She had an anatomy ultrasound at 30 weeks’ gestation which demonstrated fetal heart defects and an umbilical cyst. The fetal echocardiogram showed a double outlet right ventricle (DORV) with mild pulmonary stenosis, right aortic arch, large ventricular septal defect, and visceral situs inversus with levocardia. A two-vessel umbilical cord with umbilical cyst measuring 4.1 x 3.1 x 2.8cm with absent flow within was also noted. The parents decided at this time to do cell-free DNA which was low risk. On repeat ultrasound at 37 weeks’ gestation, the azygous vein was noted coursing into the inferior vena cava. The abdominal anatomy was also clarified – the stomach and spleen were on the right side and liver and gallbladder on the left side. Upon discovery of the DORV on fetal echo, consultation with pediatric cardiology was initiated with close monitoring of the degree of pulmonic stenosis (PS) of the fetus. It was discussed whether the fetus could be delivered at our center, a level III NICU – or need immediate cardiac surgery upon delivery. It was determined the PS was mild, and the fetus would be well-supported by our NICU. Additionally, no additional complications were anticipated for the patient’s planned TOLAC. The patient presented in latent labor at 39+0 weeks’ gestation with a VBAC success calculated score of 73.4%. During labor, the patient was monitored using external tocodynamometry and fetal doppler. She opted for no epidural and delivered a viable baby girl. After 60 seconds, delayed cord clamping was performed, and the neonate was passed to a NICU team for standard resuscitation. The neonate had APGAR’s of 7 and 8 at 1 and 5 minutes, respectively. She initially required NCPAP but was quickly transitioned to room air. The cord was tied off distal to the umbilical pseudocyst and secured to the neonate for transfer to the NICU. In the NICU, the umbilical cord pseudocyst was noted to have minimal bleeding but was clamped, cut, and sent for pathology. The neonate spent 11 days in the NICU and was discharged to home with close cardiology follow up and referral to pediatric cardiothoracic surgery. Pathology noted a 5.3 cm diameter 2-vessel umbilical cord consistent with a pseudocyst – segmental myxoid degeneration and edematous Wharton’s jelly. Also sent to pathology was the placenta, which showed both maternal and vascular malperfusion. Comments included findings consistent with increased resistance to blood flow in the umbilical vein, probably secondary to congenital vascular alterations due to heterotaxy and congenital heart anomalies. Conclusions: While data is very limited on the prevalence and comorbidities of umbilical cord cysts and pseudocysts, the presence of an umbilical cyst on prenatal ultrasound should warrant advanced imaging and referral to a tertiary care center.

Background/Objectives: Antepartum computerized cardiotocography (cCTG) represents an essential tool for assessing fetal well-being. This study aimed to comparatively evaluate antepartum cCTG-derived indices across high-risk pregnancies to identify distinctive fetal autonomic and reactivity profiles. Methods: A comparative analysis of antepartum cCTG parameters was conducted. The cohort included pregnancies beyond 28 weeks of pregnancy, 169 cases of hypertensive disorders of pregnancy (HDP), 146 of gestational diabetes mellitus (GDM), 86 of intrahepatic cholestasis (ICP), and 87 low-risk pregnancies as controls. Results: Baseline FHR remained within the physiological range across all groups (110–160 bpm; p > 0.05). Dynamic cCTG parameters exhibited clear pathology-dependent alterations. Short-term variability (STV) showed a stepwise decline from controls to ICP and GDM, reaching its lowest values in HDP (mean 1.08 bpm; p < 0.00001), accompanied by an increased proportion of epochs with STV < 1 bpm. Long-term variability suppression (LTV < 5 bpm) was significantly higher in GDM and HDP (p = 0.0077). Acceleration frequency decreased across all pathological groups, with the most pronounced reduction observed in HDP, whereas fetal movements were paradoxically elevated in both GDM and HDP. Total decelerations were more frequent in ICP and HDP; however, repetitive, late, prolonged, and >5 min decelerations remained rare and did not differ significantly between groups. Conclusions: HDP showed the most unfavorable cCTG profiles, consistent with impaired fetal autonomic regulation and chronic subclinical hypoxemia. GDM and ICP had moderate changes, suggesting milder adaptive responses. These findings emphasize the value of quantitative cCTG in differentiating fetal autonomic patterns in high-risk pregnancies and the importance of tailored surveillance strategies.

Total anomalous pulmonary venous connection (TAPVC) is one of the most severe congenital heart defects; however, prenatal diagnosis remains suboptimal. A normal fetal heart has a junction between the pulmonary venous (PV) and left atrium (LA). In contrast, no junctions are observed in patients with TAPVC. In the present study, we attempted to visualize and detect fetal PV-LA connections using artificial intelligence (AI) trained on the fetal cardiac ultrasound videos of 100 normal cases and six TAPVC cases. The PV-LA aggregate area was segmented using the following three-dimensional (3D) segmentation models: SegResNet, Swin UNETR, MedNeXt, and SegFormer3D. The Dice coefficient and 95% Hausdorff distance were used to evaluate segmentation performance. The mean values of the shortest PV-LA distance (PLD) and major axis angle (PLA) in each video were calculated. These methods demonstrated sufficient performance in visualizing and detecting the PV-LA connection. In terms of TAPVC screening performance, MedNeXt-PLD and SegResNet-PLA achieved mean area under the receiver operating characteristic curve values of 0.844 and 0.840, respectively. Overall, this study shows that our approach can support unskilled examiners in capturing the PV-LA connection and has the potential to improve the prenatal detection rate of TAPVC.

IntroductionHypertriglyceridemia-related pancreatitis (HIP) in pregnancy is associated with higher risks of organ dysfunction, intensive care requirement, and complications including fetal death, preterm birth, and placental abruption. We present a case with high mortality risk and unexpected long-term sequelae.Clinical CaseA 34-year-old woman, 25 weeks pregnant, had four prior HIP episodes causing two miscarriages and two intrauterine fetal deaths between weeks 20–25. She presented with severe nausea, vomiting, and epigastric pain radiating to the back for 10 hours. History included type 2 diabetes; she was on insulin detemir 10 U/day and fenofibrate 267 mg/day, though recent compliance was poor.On physical examination: Blood pressure was 135/80 mmHg, pulse was 109/min regular, temperature was 36.7°C, respiratory rate was 22/min. Laboratory results showed Lipase:179 U/L (0–67) Amylase:49 U/L (28–100) Triglycerides:8652 mg/dL (0–150) WBC:10.9×10³/µL, NEU:8.9×10³/µL CRP:9 mg/dL. Renal and liver function tests, LDH could not be measured due to lipemic serum. (Table-1) HIP was diagnosed; oral intake stopped. IV insulin 8 U/h, 0.9% NaCl 200 mL/h, and 5% dextrose 50 mL/h were started. Fetal heart activity was normal initially.After six hours, the patient developed fever 38.5°C, hypotension 80/50 mmHg, and confusion. She was transferred to ICU, intubated, and underwent 2 days of lipoprotein apheresis (Table-2). Meropenem and vasopressors were initiated. By Day 1’s end, obstetric reassessment revealed absent fetal heart activity. On Day 5, labor was induced, and she delivered a stillborn. Abdominal CT showed necrotizing pancreatitis. After 3 weeks of treatment, she was discharged. Outpatient triglycerides at 3 and 6 months were 346 and 228 mg/dL, respectively.At 6 months post-ICU, she presented with fatigue, amenorrhea, muscle weakness, 30 kg weight loss, slow speech, and alopecia. Examination revealed myxedematous facies, dry skin, alopecia, bone tenderness; pulse 44/min. TSH: 0.9 mU/L (0.5–4) Free T4: < 0.25 ng/dL (0.58–1.38) Free T3: < 0.88 ng/dL (2.1–4.5) Morning cortisol: < 0.4 µg/dL (5–22.6) ACTH: 11 pg/mL (<46) FSH: 6.6 IU/L, LH: 2.3 IU/L, estradiol: < 15 ng/L IGF-1: 37 µg/L (92–222) Panhypopituitarism secondary to septic shock and hypotension was diagnosed. Pituitary MRI showed partial empty sella.(Figure-1)Hydrocortisone 100 mg IV loading, followed by 50 mg q6h, was initiated; on Day 3, levothyroxine 100 mcg/day was added. Muscle strength and skin color improved rapidly. A week later, Free T4 0.50 ng/dL and Free T3 1.27 ng/dL normalized partially. She was discharged on prednisolone 5 mg AM+2.5 mg PM and combined oral contraceptives.ConclusionLipopheresis is an effective treatment for HIP but does not always prevent catastrophic outcomes. Severe hypotension can cause irreversible damage, particularly panhypopituitarism, in pregnant women with an enlarged pituitary gland.Figure 1:Partial Empty Sella Table 1:Laboratory ResultsWorsening acidosis on arterial blood gas analysis and a marked elevation in pancreatitis markers are observed. Table 2:Effect of Therapeutic Lipid Apheresis on Triglyceride Levels

Alternative splicing dynamics during human cardiac development in vivo and in vitro.

Variations in fetal heart rate variability (HRV) may serve as early indicators of risk for later psychopathology. These individual differences could further interact with the postpartum environment to shape developmental outcomes. The present study investigated the relation between fetal HRV and toddler psychopathology in the context of postnatal parenting stress as an index of infants' early parenting environment. Mother-infant dyads (N = 159) were followed from the third trimester through 18 months postpartum. Fetal HRV was collected remotely during a 20-minute baseline at 34-40 weeks' gestation. Parents reported on parenting stress at 7 months, and toddler socioemotional outcomes at 18 months using questionnaires. Fetal HRV was not significantly associated with internalizing or externalizing problems alone. Parenting stress was positively associated with internalizing problems, but no interaction with fetal HRV was found. However, a significant interaction emerged for externalizing problems: lower fetal HRV predicted greater externalizing symptoms at higher levels of parenting stress. This study is among the first to investigate if interactions between fetal HRV and the postpartum caregiving environment associate with toddler transdiagnostic risk. These results highlight parenting stress as a promising intervention target, especially for babies with lower fetal HRV who may be at greater risk for psychopathology.

Cesarean section is frequently performed for breech presentation; however, external cephalic version (ECV) is recommended as an alternative strategy to increase the likelihood of vaginal birth. Tocolytics agents are commonly administrated to improve ECV success, yet the comparative effectiveness of different regimes remains inadequately characterized. To systematically evaluate and compare the efficacy and safety of various tocolytic agents in facilitating successful ECV through a Bayesian network meta-analysis. Bayesian network meta-analysis. Bayesian network meta-analysis was performed using the "gemtc" package in R 4.1.1. Treatment effects were quantified by calculating odds ratios (ORs) with corresponding 95% credible intervals (CrIs). Surface under the cumulative ranking curve values were used to rank tocolytic agents according to ECV success rates, maternal outcomes, and adverse events. A total of sixteen RCTs encompassing 2,817 participants and six distinct tocolytic agents met the inclusion criteria. Compared with placebo, terbutaline (OR: 2.7, 95% CrI: 1.1-6.4) and ritodrine (OR: 2.2, 95% CrI: 1.4-3.9) were associated with significantly higher ECV success rates. Additionally, terbutaline was linked to an increased likelihood of vaginal delivery (OR: 2.0, 95% CrI: 1.0-2.9). Maternal adverse effects, including tachycardia, palpitations, hypotension, nausea, dizziness, and flushing, were more frequently reported with terbutaline, nifedipine, and nitroglycerin than with placebo. No statistically significant differences in fetal heart rate abnormalities were detected among the elevated interventions. Terbutaline and ritodrine appear to offer superior efficacy in improving ECV success compared with alternative tocolytic agents, albeit with a higher incidence of maternal side effects. Consequently, clinical decision-making regarding tocolytic use should be informed by a comprehensive assessment of the associated benefits and potential risks.

Pregestational diabetes (PGD) increases congenital heart defect (CHD) risk over 5-fold. Maternal exercise enhances eNOS (endothelial nitric oxide synthase) activity, benefiting embryos, though its causal role remains unclear. This study investigated the role of eNOS in maternal exercise-mediated protection of fetal heart development in a PGD mouse model. PGD was induced in eNOS+/- or wild-type female mice via streptozotocin before breeding with wild-type or eNOS+/- males. Pregnant females had access to a running wheel for voluntary exercise or remained sedentary. Fetuses were collected at embryonic day 18.5 for genotyping and CHD assessment. Embryonic day 12.5 hearts were analyzed for proliferation, apoptosis, oxidative stress, and eNOS protein levels. Maternal exercise normalized litter size and mortality rates in offspring of diabetic eNOS+/- females but did not reduce CHD incidence in offspring of wild-type or eNOS+/- females with PGD. CHDs included septal defects, double outlet right ventricle, and valve defects. Exercise increased coronary artery density but not capillary density. Proliferation deficits at embryonic day 12.5 were restored by exercise, yet oxidative stress remained elevated. Maternal exercise in eNOS+/- dams during PGD did not significantly change eNOS protein or phosphorylation levels in both eNOS+/+ and eNOS+/- fetal hearts. Offspring genotype did not affect CHD incidence, cell proliferation, apoptosis, or oxidative stress. Maternal exercise does not prevent CHDs in PGD offspring of eNOS+/- mice. Its ability to mitigate PGD-induced oxidative stress is eNOS dependent and essential for improving heart morphology.

A woman in her mid-20s with repaired congenital heart disease (CHD) delivered a 33-week neonate in 2024 following preterm labor and a 24-week neonate in 2025 for non-reassuring fetal heart tones. Placental examination in both cases revealed grossly abnormal, red-brown discolored membranes with a circumvallate insertion. Histologic evaluation demonstrated diffuse chorioamniotic hemosiderosis (DCH) in both cases. This report describes a novel case of recurrent DCH in a mother with CHD and proposes that Fontan physiology may contribute to impaired uteroplacental perfusion, increasing the risk for marginal hemorrhage.