Measurement of pregnancy rate and foetal loss, and their associations with management practices on reproductive performance of smallholder beef cattle heifers in South Africa.

To determine the impact of early rapid saline bolus during resuscitation on (1) time to achieve return of spontaneous circulation (ROSC), and (2) systemic haemodynamics, oxygenation, myocardial stress markers and pulmonary oedema. Randomised controlled trial. Lamb delivery suite. Term lambs in haemorrhagic, asphyxial cardiac arrest. Fetal lambs were exsanguinated (~45 mL/kg) followed by umbilical cord occlusion to arrest. After 5 min of asystole, ventilation was followed by coordinated chest compressions. Asystolic lambs were randomised to epi-first (intravenous epinephrine, 0.02 mg/kg and if no ROSC, a 10 mL/kg saline bolus over 5 min), or bolus-first (10 mL/kg saline bolus over 2 min and if no ROSC, followed by intravenous epinephrine). Haemodynamics and blood gases were monitored. In the epi-first group, none of the lambs achieved ROSC after epinephrine; ROSC occurred in 11/11 lambs during or immediately after saline bolus. In the bolus-first group, none of the lambs achieved ROSC with bolus alone and 8/9 lambs had ROSC after epinephrine. Mean time to ROSC from start of resuscitation was shorter in epi-first (4.9±1.3 vs 6.6±0.9 min, p=0.004), but time to ROSC from the time of epinephrine administration was shorter with bolus-first (86±43 vs 40±21 s, p=0.004). The fetal heart rate did not change significantly despite fetal blood loss. Our findings support current neonatal resuscitation guidelines of intravenous epinephrine followed by a bolus in neonates with suspected hypovolaemic arrest. Early saline bolus delays epinephrine and ROSC. Careful clinical assessment of haemodynamics in the post-resuscitation phase is critical.

Background: Anemia is common among patients with antiphospholipid syndrome (APS). It can persist alone (primary APS—pAPS) or with another associated disease (secondary APS—sAPS), predominantly systemic lupus erythematosus (SLE). There are no systematic reviews addressing the type of anemia (iron deficiency without anemia—IDWA, iron deficiency—IDA, and anemia of chronic disease—ACD) in these patients. Objectives: This study aimed to assess the type of anemia and to compare the usefulness of common diagnostic anemia parameters and their mutual relations. Methods: A cross-sectional study involving 163 patients was conducted at the University Clinical Center Bezanijska kosa from June 2022 to June 2024, including 79 patients with pAPS, 47 with sAPS and 37 patients diagnosed with SLE. We compared the usefulness of iron metabolism markers (serum iron—Fe; total iron-binding capacity—TIBC; ferritin; hepcidin) in the presence of inflammatory markers such as high-sensitivity (hsCRP) and IL6 in determining the type of anemia. Results: The most common types were IDA (61.9%) and IDWA (64.3%) in pAPS patients. In contrast, ACD was equally distributed across the three groups, with prevalences of 32%, 32%, and 36% (pAPS, sAPS, and SLE, respectively). A higher frequency of thrombosis was significantly associated with a high ferritin level ≥100 (p = 0.017) and high IL6 levels (p = 0.033) as well as fetal losses (p = 0.034 and p = 0.019, respectively). The logistic regression model identified ferritin as the only significant predictor of IDA (p = 0.023). For IDWA, both ferritin (p = 0.017) and hepcidin (p = 0.038) were significant predictors of this type of iron depletion. IL-6 levels were significantly correlated with ferritin and hsCRP levels (p = 0.004 and p = 0.007, respectively). In contrast, hepcidin did not show a statistically significant correlation with inflammatory markers. A total of 40% of patients with IDA had hepcidin levels below 10, and 48% of those with ACD had hepcidin levels above 10 (p = 0.036). Conclusions: It was found that iron deficiency anemia was the most common form in pAPS, while anemia of chronic disease was equally present across all patient groups. Ferritin emerged as an independent marker for identifying iron deficiency anemia in APS patients. Although hepcidin reflects a low-inflammatory state in APS, it proved to be a more valuable tool than ferritin in distinguishing the type of anemia, especially when ferritin levels were inconclusive. Clinical manifestations in APS patients correlated with inflammatory markers. Liver function or any drug used alone or in combination had no impact on anemia type.

Histopathological placental findings in antiphospholipid antibody carriers with a fetal loss beyond 12 weeks of pregnancy.

Extra pulmonary Manifestation of Legionella Pneumophila infection in Pregnancy Complicated with Foetal Loss: A Case Report

Spinal Muscular Atrophy (SMA), an autosomal recessive neuromuscular disorder, is primarily caused by homozygous deletions in the SMN1 gene. Although multiplex ligation-dependent probe amplification (MLPA) is the gold standard for SMA diagnosis, invasive prenatal procedures (e.g. amniocentesis or chorionic villus sampling) carry risks, including fetal loss. Non-invasive prenatal testing using digital droplet PCR (ddPCR) to detect SMN1 deletions in cell-free fetal DNA (cffDNA) from maternal plasma presents a safer alternative. This study evaluates the feasibility of ddPCR for non-invasive prenatal detection of SMN1 exon 7 deletions using simulated cffDNA mixtures. Blood samples were collected from two children with SMA (homozygous SMN1 deletions), their carrier mothers, and healthy controls. Genomic DNA was fragmented to simulate fetal (80–160 bp) and maternal (160–300 bp) cfDNA profiles. Simulated mixtures were prepared at varying maternal-to-fetal ratios (1:1 to 64:1). ddPCR was performed using the Bio-Rad SMN1 Copy Number Determination Kit, and *SMN1/RPP30* ratios were calculated. Linear regression analysis assessed quantitative performance. ddPCR accurately distinguished affected (mean ratio ∼0.00), carrier (∼0.46), and healthy (∼0.93) genotypes. A strong linear correlation existed between fetal DNA fraction and *SMN1/RPP30* ratio (*r* = 0.995, *p* < 0.0001). The assay detected affected fetal DNA at fractions as low as 5%, with reliable diagnostic separation at ≥10%. ddPCR exhibits high sensitivity and specificity for detecting SMN1 exon 7 deletions in simulated cffDNA, supporting its potential application in non-invasive prenatal SMA screening. Controlled evaluation under defined maternal-fetal mixture provides a reference for optimizing ddPCR-based prenatal testing for SMA.

Introduction: Acute appendicitis during pregnancy is challenging to diagnose due to anatomical and physiological changes. Delay in diagnosis can increase maternal morbidity and foetal loss. Surgical management is necessary however the use of laparoscopy in pregnancy remains limited despite evidence of safety and advantages. Case Presentation: A 20-year-old primigravida at 19 weeks gestation presented with right-sided abdominal pain and nausea. Clinical examination was equivocal and ultrasound was inconclusive. Had persistence of symptoms despite bowel rest and antibiotics with worsening abdominal pain thus underwent diagnostic laparoscopic which revealed appendicitis thus appendectomy done with appropriate intraoperative precautions. Recovery was uneventful, with no maternal or foetal complications. Discussion: Diagnosis of appendicitis in pregnancy is hampered by altered pain localization, physiological leucocytosis, and limited ultrasound accuracy. Magnetic Resonance Imaging may improve diagnostic accuracy. Persistence of symptoms with clinical suspicion for appendicitis warrants laparoscopic evaluation and laparoscopic appendectomy offers advantages of faster recovery, lower infection risk, and better visualization of displaced anatomy. Despite guideline endorsements, concerns about foetal safety continue to limit its use. Conclusion: This case emphasizes the role of clinical suspicion of appendicitis during pregnancy and supports wider adoption of laparoscopy as a safe and effective surgical option when performed by an experienced team. This case highlights diagnostic complexities however illustrates successful laparoscopic approach in Tanzania.

ABSTRACTVeterinarians should be vigilant in limiting embryonic, foetal and neonatal losses through appropriate reproductive programs and management strategies following natural mating and artificial insemination, especially after embryo transfer (ET) procedures, due to their high associated costs in Elite Hanwoo breeding programs. To establish a breeding population of Hanwoo cows with top 1% genomic estimated breeding values (GEBVs) for carcass weight and compare reproductive outcomes between OPU‐IVF and MOET. Elite donor cows were assigned to either OPU‐IVF or MOET groups, and the resulting embryos were transferred to synchronized recipient cows. Pregnancy rate, calving success, abortion, birth weight, sex ratio and dystocia were evaluated. The MOET group showed 100% calving success with no abortions; the OPU group had a 68.2% calving rate and 31.8% abortion rate. The sex ratio of the resulting offspring was similar between the groups, with female calves accounting for 37.5%–40.0% and male calves for 60.0%–62.5% of total calves. While the mean birth weights of female calves did not significantly differ between the groups (32.0–32.8 kg), male calves from the OPU group exhibited a significantly higher average birth weight (36.9 kg) than those from the MOET group, with a mean difference of 4.9 kg (p < 0.05). Spontaneous calving was more frequent in MOET (62.5%), while induced parturition was common in OPU (56.7%). Dystocia incidence was higher in OPU, especially with early induction. OPU‐IVF was linked to higher abortion and dystocia risks, while MOET showed more favourable calving outcomes. Appropriate embryo production strategy and careful periparturient management are crucial for successful Hanwoo reproduction.

Structural Basis of HPA-1a Alloimmunization in FNAIT and Allosteric Regulation of Integrin Conformation.

Perspective on postoperative hormone replacement therapy and fertility preservation in Swyer syndrome with dysgerminoma: a case series and literature review.

Background.Listeria monocytogenes is a common foodborne organism identified as a causative agent of multiple clinical conditions in unique circumstances such as pregnancy and immunocompromise. It is a Gram-positive rod and a facultative anaerobic organism. This paper presents a study over a timeline of 5 years in retrospect and explores the incidence of listeriosis amongst patients of different age groups, along with its associated risk factors and clinical outcomes.Materials and methods. This study was conducted in retrospect from June 2019 to June 2024 at Shifa International Hospital, Islamabad. Ninety-seven cases of listeriosis were identified. These cases were culture-positive listeriosis where the pathogen was isolated from various samples such as blood and cerebrospinal fluid. Important risk factors associated with the clinical presentations were also documented, which included diabetes mellitus, chronic kidney disease and malignancy. The mean±sd was calculated for the continuous variable. Frequency and percentage were calculated for categorical variables. Chi-square tests were performed to assess associations with mortality and foetal outcomes.Results. A total of 97 culture-confirmed listeriosis cases, comprising 44 (45.5%) males and 53 (54.6%) females, were obtained. Fifteen of the females were pregnant. Fever was the most common presenting symptom across all groups, with pregnant patients also reporting abdominal pain, vomiting and foetal complications, while non-pregnant patients showed a wider range, including neurological, respiratory and gastrointestinal complaints. Of the 97 patients, 86 had comorbidities – most commonly hypertension and diabetes – while 15 total adult deaths occurred. Eight pregnancies resulted in foetal losses. Descriptive trends in pregnant patients suggested worse foetal outcomes with higher C-reactive protein, total leukocyte count and maternal comorbidities. Ampicillin-based regimens were the most frequently used treatments, and all isolates were sensitive to the tested antibiotics.Conclusion. This study highlights how listeriosis poses substantial morbidity and mortality risk, especially in pregnant cases. There is also a critical data gap, emphasizing the need for better diagnostic strategies, timely and targeted interventions, awareness of the clinical team and public health surveillance to reduce the burden of this often-overlooked infection in Pakistan.

Risk factors for failure of transvaginal cervico-isthmic cerclage: a retrospective cohort study.

to describe the risk of early and late fetal loss of a cohort of monochorionic monoamniotic (MCMA) twin pregnancies; secondary objectives are to describe perinatal outcomes of these pregnancies and to identify which obstetric variables mostly influence the incidence of neonatal adverse outcome. retrospective cohort study including MCMA twin pregnancies followed up at the Twin Pregnancy Care Unit of Sant'Anna Hospital in Turin (Italy) between 2005 and 2024. Chorionicity and amnionicity were diagnosed in the first trimester. a total number of 53 MCMA twin pregnancies have been included in the study, of which 42 progressed beyond 24weeks of gestation. The rate of fetal loss before 24weeks of GA was 19.8 %, after 24weeks this rate lowered to 3.6 %; the incidence of overall intrauterine losses was 23.6 %; 80.5 % of liveborn twins were female. Around one fourth of the newborn babies had an adverse outcome, the likelihood of which was significantly influenced by gestational age at birth, birthweight and presence of malformations. The incidence of congenital malformations in our sample was 13.4 %. most fetal losses occur before 24weeks of gestation and the rate of fetal demise after this cutoff is quite low. It could be worth to postpone elective delivery to 34weeks of gestational age or beyond, in order to reduce perinatal complications associated to prematurebirth.

BackgroundAntenatal treatment with nipocalimab, a neonatal Fc receptor (FcRn) blocker, delayed or prevented fetal anemia, as compared with a historical benchmark, in a phase 2 study of early-onset severe hemolytic disease of the fetus and newborn (HDFN). We report on the fetal and neonatal pharmacokinetics of nipocalimab and infant immunity through 96 weeks after birth.MethodsThe UNITY study was a single-group, open-label study assessing pregnant individuals at high risk of early-onset severe HDFN treated with weekly intravenous nipocalimab (30 or 45 mg/kg) from 14 to 35 weeks’ gestation, unless discontinued for safety-related stopping criteria or intrauterine transfusion initiation. Pharmacokinetics were assessed in maternal, fetal, and infant blood and colostrum or breast milk; FcRn receptor occupancy and immunoglobulin G (IgG) were measured in neonatal and maternal blood; and infant IgG and safety were monitored through 96 weeks after birth.ResultsSafety analysis included 12 live-born infants from 13 pregnancies (one fetal loss occurred following intrauterine transfusion complications). Nipocalimab concentrations were maintained in maternal participants at pharmacologically active concentrations (greater than 10 μg/ml) during the weekly dosing intervals, but were observed at low concentrations (10 μg/ml or less) in one of four fetal cordocenteses (0.04 μg/ml), one of 11 cord blood samples (0.7 μg/ml), three of seven colostrum samples (less than 4 μg/ml), and two of nine breast milk samples (less than 2 μg/ml). Low infant IgG at birth (cord blood median, 175 mg/dl; range, 92–941) reached levels consistent with a physiologic nadir by 24 weeks after birth (median, 273 mg/dl; range, 153–429) and recovered to normal range (with one exception) between 16 and 96 weeks (median, 762 mg/dl; range, 407–925). Infectious adverse events were primarily mild to moderate and typical for early childhood. Protective titers to age-appropriate vaccinations (diphtheria and tetanus) were observed in six of seven infants at or before 96 weeks.ConclusionsIn this cohort of 12 live-born infants, antenatal treatment with nipocalimab resulted in low levels of detectable drug in fetal, neonatal, and infant samples. Treatment was associated with low IgG levels at birth; however, unusual or unexpected childhood illnesses or impaired vaccine responses were not observed. (Funded by Johnson & Johnson; ClinicalTrials.gov number, NCT03842189.)

Introduction and objective: Edwards Syndrome, also known as Trisomy 18, is the second most common autosomal trisomy following Down Syndrome. This chromosomal disorder is characterized by the presence of a third copy of chromosome 18, in contrast to the usual two. The condition is associated with a wide spectrum of severe congenital anomalies, significant developmental delays, and a high rate of fetal loss and infant mortality. Therefore, a comprehensive synthesis of these associated developmental anomalies is crucial for accurate prenatal counseling, clinical guidance, and postnatal management. The primary objective of this comprehensive review is to systematically identify, collate, and synthesize the existing literature regarding the range and prevalence of congenital heart defects in children diagnosed with Edwards Syndrome. Recognizing that cardiac anomalies are a cardinal feature and a leading cause of mortality in this condition, this review aims to provide a detailed, evidence-based overview of these specific manifestations. Ultimately, this focused analysis seeks to enhance clinical understanding of the cardiovascular complications in Edwards Syndrome and inform targeted management strategies. Brief description of the state of knowledge: Edwards Syndrome (Trisomy 18) is characterized by a high burden of congenital anomalies, with cardiac defects affecting the vast majority of patients and serving as a primary determinant of survival. Historically regarded as a uniformly lethal condition requiring only palliative care, the clinical perspective is evolving. Recent data indicate that cardiac interventions may offer survival benefits, challenging traditional non-interventional paradigms and necessitating an updated understanding of the cardiovascular phenotype. Methods: A systematic literature review was performed by searching major biomedical databases (PubMed, Google Scholar, Elicit) using a combination of keywords and MeSH terms, including "Edwards Syndrome" and "congenital abnormalities." Inclusion criteria prioritized peer-reviewed articles such as case series, observational studies, and systematic reviews. Data extraction focused on the types, frequency, and systemic impact of anomalies, as well as postnatal developmental outcomes. The collected data were then synthesized to create a comprehensive syndrome profile. Conclusions: The clinical paradigm for Edwards Syndrome is shifting from a uniform designation of lethality toward a personalized, multidisciplinary model. Accurate prenatal diagnosis via fetal echocardiography is essential for early risk stratification. Contemporary management requires a balanced approach integrating palliative care with the option of active cardiac intervention. Consequently, parental counseling must emphasize shared decision-making, providing families with evidence-based data on potential surgical outcomes to optimize the quality of life for the affected child.

Background: Monozygotic twin pregnancies are at increased risk of congenital abnormalities compared to singletons. In 20% of cases, both fetuses are affected (concordance), while in 80% of cases, only one fetus is affected (discordance). This study examines the prevalence of discordance for structural defects in monochorionic (MC) twins, with normal aCGH comparative genomic hybridization (aCGH), reporting the types of detected abnormalities and their possible impact on perinatal outcomes, including the rate of single and double fetal loss before 24 weeks’ gestation and the rate of preterm birth (PB) before 32 weeks’ gestation. Methods: This was a retrospective study of discordant structural fetal anomalies in MC twin pregnancies detected at first-trimester scanning in three fetal medicine centers in Poland. Results: In the study population of 381 monochorionic twin pregnancies examined at 11–13 weeks’ gestation, 21 (5.5%) pregnancies showed discordant structural defects with normal aCGH result. The most common were cardiac defects (n = 8), followed by central nervous system (CNS) (n = 6) defects and facial anomalies (n = 3). Single or double fetal loss before 28 weeks occurred in four (19%) and two (9%) cases, respectively, and was associated with intertwin crown–rump length (CRL) discordance greater than 20% (p = 0.046). PB before 32 weeks’ gestation occurred in nine cases (47%) and was strongly associated with polyhydramnios (p = 0.001), which occurred mainly in CNS and facial defects. Conclusions: The prevalence of discordant structural defects with normal aCGH results among monochorionic twins is approximately 5%. In pregnancies with discordant defects, cardiac defects are the most common. Intertwin discordance greater than than 20% is associated with an increased risk of fetal demise.

ObjectiveTo compare preconception disease-activity indices—systemic lupus erythematosus Disease Activity Score low disease activity (SLE-DAS LDA), lupus low disease activity state (LLDAS) and SLE-DAS remission—with Definitions of Remission in SLE (DORIS) remission in predicting adverse maternal and fetal outcomes among pregnant women with SLE.MethodsThis retrospective cohort study included 202 pregnancies in 196 women with SLE managed at Shenzhen People’s Hospital between January 2017 and December 2024. Preconception disease activity was categorised using SLE-DAS, LLDAS and DORIS remission criteria. Main outcomes were maternal flares and fetal outcomes, including spontaneous abortion, therapeutic abortion, total fetal loss, preterm delivery and small for gestational age (SGA). Predictive accuracies of indices were compared.ResultsPreconceptionally, 127 pregnancies (62.8%) met LLDAS, 131 (64.9%) met SLE-DAS LDA and 78 (38.6%) achieved DORIS remission. Compared with higher disease activity, SLE-DAS LDA was associated with fewer maternal flares (22.1% vs 45.1%) and therapeutic abortions (6.4% vs 15.7%). LLDAS was associated with lower rates of flare (21.3% vs 45.3%), therapeutic abortion (7.9% vs 17.3%), total fetal loss (19.7% vs 34.2%) and preterm delivery (22.0% vs 25.3%). SLE-DAS and DORIS remission performed similarly for maternal outcomes, while DORIS remission correlated more strongly with favourable fetal outcomes, including lower total fetal loss (15.4% vs 31.5%), preterm delivery (15.4% vs 28.2%) and SGA (9.0% vs 19.4%). Multivariable analyses confirmed that achieving these disease-activity states preconception independently protected against total fetal loss, maternal flare and therapeutic abortion. LLDAS was the best overall predictor, while SLE-DAS LDA was the most attainable and predictive for maternal complications.ConclusionSLE-DAS LDA effectively predicts maternal complication, while LLDAS better identifies fetal risk. Remission offers similar protection but is less attainable, suggesting LDA suffices for conception planning. Optimising preconception disease control remains essential and warrants multicentre validation.

Fetal loss, the spontaneous termination of pregnancy between day 42 and 260 of gestation, is poorly understood. Impacts of fetal loss include loss of production, increased health risk, and economic loss. The aims of this study were to identify loci associated with fetal loss in Holstein heifers and primiparous cows to facilitate the selection of reproductively efficient cattle and identify the genetic causes of fetal loss. A genome-wide association analysis (GWAA) compared 5714 heifers that calved at term (controls) to 416 heifers that experienced fetal loss (cases), and for primiparous cows, 2519 controls were compared to 273 cases. The efficient mixed-model association eXpedited approach in the SNP and Variation Suite (v 9.1) statistical software was used with additive, dominant, and recessive inheritance models for the GWAA. In heifers, 16 loci were associated (FDR < 0.05) with fetal loss in the recessive model. In primiparous cows, there were 44 loci associated (FDR < 0.05) with fetal loss in the recessive model. No loci associated with fetal loss were shared between cows and heifers or in the additive and dominant models. These results improve the characterization of genetic factors contributing to fetal loss in Holstein heifers and primiparous cows and provide targets for genomic selection.

Maternal and neonatal outcomes after infection with monkeypox virus clade I during pregnancy in DR Congo: a pooled, prospective cohort study.

This is a case report of a 23 year old primiparous female with past medical history of antiphospholipid syndrome, unprovoked deep venous thromboses and venous thromboembolisms, chronic hypertension and class III obesity. She presented to us at 20 weeks and 1 day gestation with known left sided pulmonary embolism who was being managed on the antepartum service. She was taking therapeutic anticoagulation; however, her clinical picture worsened when she then had worsening bilateral pulmonary embolisms and was subsequently diagnosed with superimposed preeclampsia with severe features at 23 weeks and 1 day gestation. She had acutely worsening proteinuria and difficult to control hypertension despite multiple medications. Management included a multidisciplinary approach including maternal fetal medicine, hematology, neonatology, anesthesia and interventional radiology in addition to routine obstetrical care inpatient. As she desired full neonatal resuscitation, she received betamethasone for fetal lung maturity and magnesium sulfate for fetal neuroprotection (in addition to maternal seizure prophylaxis). Fetus was diagnosed with fetal growth restriction at 23 weeks and 5 days gestation, with elevated umbilical artery Dopplers. Patient was ultimately delivered at 24 weeks gestation for worsening preeclampsia via an uncomplicated primary classical cesarean section utilizing perioperative heparin drip, with no excessive bleeding noted intraoperatively or thrombotic events. Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by circulating antiphospholipid antibodies Lupus Anticoagulant, Anticardiolipin Antibody (IgG/IgM), or Anti-B2 Glycoprotein I (IgG/IgM). Diagnostic criteria include one laboratory finding with positive antiphospholipid antibodies on two occasions at least 12 weeks apart as well as one clinical finding (2). Clinical findings include vascular thrombosis, unexplained death of a morphologically normal fetus &gt; 10 weeks gestation, premature birth of a morphologically normal neonate &lt;34 weeks gestation due to preeclampsia, eclampsia or placental insufficiency, or &gt; 3 unexplained pregnancy losses &lt; 10 weeks gestation (with maternal hormonal, anatomic, chromosomal and paternal chromosomal causes excluded) (2). Pregnancy complications can include venous and arterial thrombosis, fetal loss, fetal growth restriction, preeclampsia and preterm delivery. Pregnancy management of APS can include daily low dose aspirin and prophylactic anticoagulation in addition to treating any complications in pregnancy. The APS complications seen in our patient included pulmonary embolism, fetal growth restriction, preterm preeclampsia with severe features, preterm delivery, placental insufficiency, livedo reticularis, autoimmune hemolytic anemia, and a false positive RPR. Multidisciplinary approach to this patient including played a crucial role to the success of this delivery and should be considered in delivery planning in all high-risk obstetric patients with multi-system compromise and high risk for maternal and fetal morbidity and mortality from medical condition.