Fetal Status Research Articles

Maternal-Fetal Exposure to Antibiotics: Levels, Mother-to-Child Transmission, and Potential Health Risks.

Due to its widespread applications in various fields, antibiotics are continuously released into the environment and ultimately enter the human body through diverse routes. Meanwhile, the unreasonable use of antibiotics can also lead to a series of adverse outcomes. Pregnant women and developing fetuses are more susceptible to the influence of external chemicals than adults. The evaluation of antibiotic exposure levels through questionnaire surveys or prescriptions in medical records and biomonitoring-based data shows that antibiotics are frequently prescribed and used by pregnant women around the world. Antibiotics may be transmitted from mothers to their offspring through different pathways, which then adversely affect the health of offspring. However, there has been no comprehensive review on antibiotic exposure and mother-to-child transmission in pregnant women so far. Herein, we summarized the exposure levels of antibiotics in pregnant women and fetuses, the exposure routes of antibiotics to pregnant women, and related influencing factors. In addition, we scrutinized the potential mechanisms and factors influencing the transfer of antibiotics from mother to fetus through placental transmission, and explored the adverse effects of maternal antibiotic exposure on fetal growth and development, neonatal gut microbiota, and subsequent childhood health. Given the widespread use of antibiotics and the health threats posed by their exposure, it is necessary to comprehensively track antibiotics in pregnant women and fetuses in the future, and more in-depth biological studies are needed to reveal and verify the mechanisms of mother-to-child transmission, which is crucial for accurately quantifying and evaluating fetal health status.

Association between maternal and cord blood thyroid hormones, and urine iodine concentration with fetal growth.

We planned to evaluate the association of fetal and maternal thyroid hormones and maternal iodine status with neonates' anthropometric parameters. In this cross-sectional study, levels of thyrotropin were measured in maternal serum in the first trimester of pregnancy, and thyrotropin (TSH) and free thyroxin (fT4) were measured in cord blood serum samples at birth. Urinary iodine concentration (UIC) levels in random urine samples of mothers were measured in the third trimester of pregnancy. The relationship between UIC and thyroid hormone levels of mothers with neonates' anthropometric birth parameters of neonates was evaluated. One hundred eighty-eight mother-newborn pairs completed the study. Mean (SD) of cord blood TSH (CB-TSH), cord blood-free thyroxin (CB-FT4) values, and maternal TSH (M-TSH) levels were 8.8 (7.3) mIU/L, 1.01 (0.2) ng/dL, and 2.2 (0.9) mIU/L, respectively. After adjusting for confounders, there was a positive significant association between female neonate length and maternal TSH and log log-transformed CB TSH (LN_CB-TSH) (p<0.05). Median UIC (Q1-Q3) was 157 (53-241) μg/L, and there was no association between birth weight, birth length, and head circumferences of neonates and mothers' UIC (p>0.05). We found a positive correlation between maternal TSH in the first trimester of pregnancy and the birth length of newborns, and a negative correlation was observed between CB-TSH and birth length in girls, but it did not provide conclusive evidence for the relationship between maternal and neonatal thyroid hormone levels and birth weight. There was no association between maternal UIC levels in the third trimester and birth anthropometric parameters.

Sleep pattern and disorders among pregnant women in Ibadan, Southwest Nigeria

BackgroundSleep is essential for pregnant women’s and the offspring’s health and wellbeing. Poor sleep and disorders have been linked with adverse fetal outcomes and delivery conditions. However, pregnant women often experience several forms of sleep disruption, which has been scarcely reported in low and middle-income countries (LMIC), including Nigeria where the influence of lifestyle factors has also been lacking. We investigated sleep patterns and disorders and the associated factors among pregnant women in Southwest, Nigeria.MethodA cross-sectional study was conducted among five hundred (500) pregnant women attending Adeoyo Maternity Teaching Hospital. A semi-structured questionnaire was used to examine different domains of sleep and associated disorders, namely sleep quality (Pittsburgh Sleep Quality Index (> 5 and ≤ 5)), insomnia (Insomnia Severity Index (> 8 and ≤ 8)), restless leg syndrome (Restless Leg Syndrome Rating Scale (> 10 and ≤ 10). Significant covariates such as physical activity, minimum dietary diversity, smoking and alcohol intake were also assessed. We conducted bivariate and multivariate analysis at p < 0.05 significance level.ResultsThe mean age of participants was 30.4 ± 4.8 years. The pattern of sleep disorder in pregnant were poor sleep quality (50%), restless leg syndrome (58.2%) and insomnia (33.4%). Being currently married (AOR = 6.13; 95% CI: (1.65–22.23)), increasing gestational age: second trimester (AOR = 8.25;95% CI: (1.78–38.17)) to third trimester (AOR = 10.98; 95% CI: (2.44–49.48)) increased the odds of poor sleep quality. Factors associated with restless leg syndrome were marital status [AOR = 3.60; 95% CI; (1.25–10.35)], religion, rigorous physical activities [AOR = 1.52; 95% CI: (1.05–2.21)] and alcohol consumption [AOR = 3.51; 95% CI: (1.00–12.27)]. Factors associated with insomnia were maternal age [AOR = 1.83; 95% CI: (1.11–3.01)], income [AOR = 2.99 (1.26–7.16)] and rigorous physical activity [AOR = 2.55 (1.61–4.02)].ConclusionPoor sleep quality, restless leg syndrome and insomnia were typical among pregnant women in Ibadan, Southwest Nigeria. Thus, awareness and education on the importance of sleep and its risk and protective factors, such as alcohol consumption, smoking, rigorous activity and spousal and family support, should be increased to reduce poor sleep quality and sleep disorders (restless leg syndrome and insomnia) during the pregnancy period.

Assessment of feto-placental oxygenation and perfusion in a rat model of placental insufficiency using T2* mapping and 3D dynamic contrast-enhanced MRI

IntroductionPlacental insufficiency may lead to preeclampsia and fetal growth restriction. There is no cure for placental insufficiency, emphasizing the need for monitoring fetal and placenta health. Current monitoring methods are limited, underscoring the necessity for imaging techniques to evaluate fetal-placental perfusion and oxygenation. This study aims to use MRI to evaluate placental oxygenation and perfusion in the reduced uterine perfusion pressure (RUPP) model of placental insufficiency. MethodsPregnant rats were randomized to RUPP (n = 11) or sham surgery (n = 8) on gestational day 14. On gestational day 19, rats imaged using a 7T MRI scanner to assess oxygenation and perfusion using T2* mapping and 3D-DCE MRI sequences, respectively. The effect of the RUPP on the feto-placental units were analyzed from the MRI images. ResultsRUPP surgery led to reduced oxygenation in the labyrinth (24.7 ± 1.8 ms vs. 28.0 ± 2.1 ms, P = 0.002) and junctional zone (7.0 ± 0.9 ms vs. 8.1 ± 1.1 ms, P = 0.04) of the placenta, as indicated by decreased T2* values. However, here were no significant differences in fetal organ oxygenation or placental perfusion between RUPP and sham animals. DiscussionThe reduced placental oxygenation without a corresponding decrease in perfusion suggests an adaptive response to placental ischemia. While acute reduction in placental perfusion may cause placental hypoxia, persistence of this condition could indicate chronic placental insufficiency after ischemic reperfusion injury. Thus, placental oxygenation may be a more reliable biomarker for assessing fetal condition than perfusion in hypertensive disorders of pregnancies including preeclampsia and FGR.

Acquisition Devices for Fetal Phonocardiography: A Scoping Review.

Timely and reliable fetal monitoring is crucial to prevent adverse events during pregnancy and delivery. Fetal phonocardiography, i.e., the recording of fetal heart sounds, is emerging as a novel possibility to monitor fetal health status. Indeed, due to its passive nature and its noninvasiveness, the technique is suitable for long-term monitoring and for telemonitoring applications. Despite the high share of literature focusing on signal processing, no previous work has reviewed the technological hardware solutions devoted to the recording of fetal heart sounds. Thus, the aim of this scoping review is to collect information regarding the acquisition devices for fetal phonocardiography (FPCG), focusing on technical specifications and clinical use. Overall, PRISMA-guidelines-based analysis selected 57 studies that described 26 research prototypes and eight commercial devices for FPCG acquisition. Results of our review study reveal that no commercial devices were designed for fetal-specific purposes, that the latest advances involve the use of multiple microphones and sensors, and that no quantitative validation was usually performed. By highlighting the past and future trends and the most relevant innovations from both a technical and clinical perspective, this review will represent a useful reference for the evaluation of different acquisition devices and for the development of new FPCG-based systems for fetal monitoring.

ONTOGENETIC TRANSFORMATIONS OF BONES OF THE HUMAN ORBIT

Introduction. Elucidation of the sources of human orbital bones, clarifi cation of the sequence of their ossifi cation will allow to create a morphological basis for eff ective interpretation of the data of fetal condition monitoring, will contribute to early diagnosis of variants of the structure and possible malformations of the head, organ of vision and related structures.The aim of the study. The aim of this work was to fi nd out the sources of origin, the chronology of ossifi cation, the characteristics of age-related topographic and anatomical changes in the bones of the orbit.Material and methods. 18 series of histological sections of samples of human embryos and pre-fetuses at the age of 4-12 weeks of intrauterine development (4,0-80,0 mm parietal- coccygeal length) and samples of 12 fetuses at the age of 4-9 months of intrauterine development (130,0-450. 0 mm parietal- calcaneal length) using a complex of morphological research methods (anthropometry, morphometry, preparation of histological sections, dissection, three- dimensional reconstruction of series of histological sections and computer tomography, statistical analysis).The study was conducted in accordance with the main provisions of the European Union Convention on Human Rights andBiomedicine (1997), as well as the Helsinki Declaration on Ethical Principles of Medical Research Involving Human Subjects(1964-2008), EU Directive No. 609 (1986), Order of the Ministry of Health of Ukraine dated 23.09.2009 No. 690.The work was carried out within the framework of the initiative research work of the Department of Histology, Cytology andEmbryology of the Bukovinian State Medical University «Structural and functional peculiarities of tissues and organs in ontogenesis, regularities of variant, constitutional, sex and age-related and comparative human morphology». State registration number: 0121U110121. Deadlines: 01.2021-12.2025.The results. The fi rst signs of the appearance of ossifi cation centers around the main nervous and visceral contents of the rudiment of the orbit are determined in 6-week-old embryos in the form of seven cartilaginous bone models, and the fi rst centers of ossifi cation among the rudiments of bones participating in the formation of the orbit are found in the rudiment of the maxilla. In the 6th month of intrauterine development, the processes of ossifi cation of the frontal, sphenoid, ethmoid and maxillary bones begin. At the end of the 8th month of intrauterine development, due to the ossifi cation processes of the lesser wing of the sphenoid and frontal bones, the orbit acquires features of a defi nitive structure.From the beginning of the fetal period of human ontogenesis, ossifi cation of the structures of the sphenoid bone continues, which leads to morphological transformations of the orbit in 5-month fetuses – it is separated from the sphenopalatine and infratemporal fossa by a bone layer, the optic canal is formed, and in 6-month fetuses processes of ossifi cation of the frontal, sphenoid, ethmoid and maxillary bones, and Müller’s orbital muscle changes its structure into a fi brous one.The analysis of the age-related dynamics of the morphometric parameters of the orbit during the fetal period of intrauterine development made it possible to establish the peculiarities of changes in its diameter, circumference and area, which are expressed by mathematical functions: diameter of the orbit, mm = –0. 2285+0.4704*x; circumference of the orbit, mm = –0.2924+1.4595*x; area of the orbit, mm2 = –87.8597+8.0387*x, where x is the age of the human fetus in weeks.Conclusion. The critical periods of the development of the orbit are the 6th month of prenatal ontogenesis, during which there is an uneven growth rate of the horizontal size of the orbit in relation to the vertical one, and its shape returns to the mesoconchal, which was previously observed in fetuses, as well as the 8th month, during which the growth of all parameters of the orbit slows down due to intensive processes of organogenesis of its visceral structures.

Predictors of successful trial of labor after cesarean section (TOLAC) in women with one prior transverse cesarean section at Tertiary Hospitals in northwest Ethiopia: a multicenter study

BackgroundTrials of labor after cesarean section is the preferred strategy to decrease the cesarean delivery rate and reducing complications associated with multiple cesarean sections. The success rate of trials of labor after cesarean section and associated factors have not been well documented in Ethiopia. Hence, this study was aimed to determine the success rate and factors associated with the trial of labor after one cesarean section in five Comprehensive Specialized Hospitals located in northwest Ethiopia.MethodsAn institutional-based cross-sectional study was conducted among 437 women who came for the trial of labor from December 1, 2021, to March 30, 2022. All women who fulfilled the eligibility criteria were included to this study. Data was collected using structured and pre-tested questionnaire. Then, the data was entered into Epi Data 4.6 software and exported to SPSS version 26 for analysis. To identify the variables influencing the outcome variable, bivariable and multivariable logistic regression analyses were conducted. The model’s fitness was checked using the Hosmer-Lemeshow goodness of fit test, and an adjusted odds ratio with a 95% confidence interval was used to declare the predictors that are significantly associated with TOLAC.ResultsThe success rate of the trial of labor after one cesarean section was 56.3% (95% CI, 51.3%, 61.2%). Maternal age ≥ 35 years (AOR: 3.3, 95% CI 1.2, 9.3), the fetal station at admission ≤ zero (AOR: 5. 6, 95% CI 3.3, 9.5), vaginal delivery before cesarean section (AOR: 1.9, 95% CI 1.2, 3.2), and successful vaginal birth after cesarean delivery (AOR 2.2, 95% CI 1.2, 4.1) were found to have a significant association with the success rate of trial of labor after cesarean section.ConclusionsIn this study, the success rate of the trial of labor after a cesarean section was low as compared to the ACOG guideline and other studies in different countries. Therefore, the clinicians ought to offer counsel during antenatal and intrapartum period, encourage the women to make informed decision on the mode of delivery, and the practitioners need to follow fetal and maternal conditions strictly to minimize adverse birth outcomes.

The iPREFACE score is useful for predicting fetal acidemia: A retrospective cohort study of 113 patients who underwent emergency cesarean section for non-reassuring fetal status during labor

The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future. This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor. This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography score. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of <7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and -removal of cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0 and neonatal intensive care unit admissions for neonatal asphyxia. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia and facilitation of timely intervention hold promise for enhancing the outcomes of mothers and newborns during childbirth. Prospective studies are warranted to establish precise cutoff values and to validate the clinical application of these scores.

COVID-19 lockdowns affected birthing outcomes in a regional New South Wales Health District.

The 400 000 residents of the Illawarra Shoalhaven Local Health District (ISLHD) experienced two distinct lockdowns aimed at mitigating the transmission of severe acute respiratory syndrome coronavirus 2 infection. Analysing effects of these lockdowns on maternal and neonatal outcomes presents a valuable opportunity to assess the impact of pandemic-level restrictions on maternal and neonatal outcomes. Evaluate the impacts of restrictions from two lockdown periods on maternal, birthing, and neonatal outcomes within a regional local health district. The study included 22 166 women who gave birth within ISLHD between 2017 and 2022. Groups included for analysis: Control Group - mothers pregnant before the pandemic (conception before 3 April 2019); Exposure Group 1 - mothers pregnant during the first lockdown (conception date 22 January 2020 to 5 May 2020); and Exposure Group 2 - mothers pregnant during the second lockdown (conception date 30 April 2021 to 13 Sep 2021). Odds of adverse birthing outcomes including non-reassuring fetal status (odds ratio (OR) 1.34; 95% CI 1.14-1.56 and OR 1.20; 95% CI 1.03-1.40), and postpartum haemorrhage (OR 2.04; 95% CI 1.73-2.41 and OR 1.74; 95% CI 1.48-2.05) were substantially increased in Exposure Groups 1 and 2, respectively. Gestational diabetes, gestational hypertension, low birth weight and admission to neonatal intensive care rates improved. Pregnant women exposed to pandemic restrictions within ISLHD had decreased odds of adverse antenatal and neonatal outcomes, but increased odds of poor peripartum outcomes.

Machine learning model based on RCA-PDCA nursing methods and differentiating factors to predict hypotension during cesarean section surgery

BackgroundIntraoperative hypotension during cesarean section has become a serious complication for maternal and fetal healthy. It is commonly encountered by subarachnoid anesthesia. However, currently used control methods have varying degrees of side effects, such as drugs. The Root Cause Analysis (RCA) - Plan, Do, Check, Act (PDCA) is a new model of care that identifies the root causes of problems. The study aimed to demonstrate the usefulness of RCA-PDCA nursing methods in preventing intraoperative hypotension during cesarean section and to predict the occurrence of intraoperative hypotension through a machine learning model. MethodsPatients who underwent cesarean section at Traditional Chinese Medicine of Southwest Medical University from January 2023 to December 2023 were retrospectively screened, and the data of their gestational times, age, height, weight, history of allergies, intraoperative vital signs, fetal condition, operative time, fluid out and in, adverse effects, use of vasopressor drugs, anxiety-depression-pain scores, and satisfaction were collected and analyzed. The statistically different features were screened and five machine learning models were used as predictive models to assess the usefulness of the RCA-PDCA model of care. Results(1) Compared with the general nursing model, the RCA-PDCA nursing model significantly reduces the incidence of intraoperative hypotension and postoperative complications in cesarean delivery, and the patient experience is comfortable and satisfactory. (2) Among the five machine learning models, the RF model has the best predictive performance, and the accuracy of the random forest model in preventing intraoperative hypotension is as high as 90%. ConclusionThrough computer machine learning model analysis, we prove the importance of the RCA-PDCA nursing method in the prevention of intraoperative hypotension during cesarean section, especially the Random Forest model which performed well and promoted the application of artificial intelligence computer learning methods in the field of medical analysis.

Multicentric intelligent cardiotocography signal interpretation using deep semi-supervised domain adaptation via minimax entropy and domain invariance

Background and ObjectiveObstetricians use Cardiotocography (CTG), which is the continuous recording of fetal heart rate and uterine contraction, to assess fetal health status. Deep learning models for intelligent fetal monitoring trained on extensively labeled and identically distributed CTG records have achieved excellent performance. However, creation of these training sets requires excessive time and specialist labor for the collection and annotation of CTG signals. Previous research has demonstrated that multicenter studies can improve model performance. However, models trained on cross-domain data may not generalize well to target domains due to variance in distribution among datasets. Hence, this paper conducted a multicenter study with Deep Semi-Supervised Domain Adaptation (DSSDA) for intelligent interpretation of antenatal CTG signals. This approach helps to align cross-domain distribution and transfer knowledge from a label-rich source domain to a label-scarce target domain. MethodsWe proposed a DSSDA framework that integrated Minimax Entropy and Domain Invariance (DSSDA-MMEDI) to reduce inter-domain gaps and thus achieve domain invariance. The networks were developed using GoogLeNet to extract features from CTG signals, with fully connected, softmax layers for classification. We designed a Dynamic Gradient-driven strategy based on Mutual Information (DGMI) to unify the losses from Minimax Entropy (MME), Domain Invariance (DI), and supervised cross-entropy during iterative learning. ResultsWe validated our DSSDA model on two datasets collected from collaborating healthcare institutions and mobile terminals as the source and target domains, which contained 16,355 and 3,351 CTG signals, respectively. Compared to the results achieved with deep learning networks without DSSDA, DSSDA-MMEDI significantly improved sensitivity and F1-score by over 6%. DSSDA-MMEDI also outperformed other state-of-the-art DSSDA approaches for CTG signal interpretation. Ablation studies were performed to determine the unique contribution of each component in our DSSDA mechanism. ConclusionsThe proposed DSSDA-MMEDI is feasible and effective for alignment of cross-domain data and automated interpretation of multicentric antenatal CTG signals with minimal annotation cost.

Hypoxia modulates P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) drug transporters in brain endothelial cells of the developing human blood-brain barrier

P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) multidrug resistance (MDR) transporters are localized at the luminal surface of the blood-brain barrier (BBB). They confer fetal brain protection against harmful compounds that may be circulating in the peripheral blood. The fetus develops in low oxygen levels; however, some obstetric pathologies such as pre-eclampsia, placenta accreta/previa may result in even greater fetal hypoxic states. We investigated how hypoxia impacts MDR transporters in human fetal brain endothelial cells (hfBECs) derived from early and mid-stages of pregnancy. Hypoxia decreased BCRP protein and activity in hfBECs derived in early pregnancy. In contrast, in hfBECs derived in mid-pregnancy there was an increase in P-gp and BCRP activity following hypoxia. Results suggest a hypoxia-induced reduction in fetal brain protection in early pregnancy, but a potential increase in transporter-mediated protection at the BBB during mid-gestation. This would modify accumulation of various key physiological and pharmacological substrates of P-gp and BCRP in the developing fetal brain and potentially contribute to the pathogenesis of neurodevelopmental disorders commonly associated with in utero hypoxia.

Ultrasonographic Diagnosis of Fetal Hemodynamic Parameters in Pregnant Women with Diabetes Mellitus in the Third Trimester of Pregnancy

ObjectiveIt was to investigate the diagnosis of fetal hemodynamics in pregnant women with diabetes mellitus in the third trimester of pregnancy by color Doppler ultrasonography. Methods55 women with gestational diabetes mellitus (GDM) in the third trimester of pregnancy who were clinically diagnosed and treated in Haian City People’s Hospital of Jiangsu Province were selected as the observation group, and 55 pregnant women with normal prenatal examination results were selected as the controls. The hemodynamic parameters of fetal middle cerebral artery (MCA), umbilical artery (UA), and renal artery (RA) were detected, including the ratio of maximum systolic blood flow velocity to end-diastolic blood flow velocity (S/D), resistance index (RI) and arterial pulsation index (PI). Fasting serum levels of maternal patients were collected for detecting Cystain C (Cys C) and homocysteine (Hcy) to analyze the predictive value of serological indexes and target arterial hemodynamics parameters for adverse pregnancy outcome (APO). ResultsThe results showed that compared with controls, in the observation group, RI, PI, and S/D of MCA and RA increased significantly, while RI, PI and S/D of UA decreased obviously (P < 0.05), the levels of serum Cys C and Hcy were clearly increased (P < 0.05). The APO rate of controls and observation group was 10.91% and 25.45%, respectively. It was found that the area under the curve of serum Cys C, Hcy, and the APO predicted by the hemodynamic parameters of fetal MCA, UA, and RA were all greater than 0.75 (P < 0.05). Multiple Logistic regression analysis showed that serum Cys C and Hcy, and the hemodynamic parameters of fetal MCA, UA and RA were correlated with APO (P < 0.05). ConclusionIn summary, maternal blood glucose level can affect fetal hemodynamic parameters. In the third trimester of pregnancy, the changes of blood flow parameters of fetal MCA, UA, RA, and maternal serum Cys C and Hcy levels are helpful to understand fetal status in utero, and can be used to predict APO.

Labor management and neonatal outcomes in cardiotocography categories II and III (Review).

The safe care of both mothers and fetuses during labor is a primary goal of all health professionals. The assessment of fetal oxygenation and well-being is a key aspect of perinatal care provided. Fetal heart rate (FHR) auscultation became part of daily obstetric practice in a number of countries during the 20th century and remains a key method of fetal monitoring, particularly in low-risk pregnancies. Cardiotocography (CTG) is the continuous monitoring and recording of the FHR and uterine myometrial activity, making it possible to assess the fetal condition. It therefore plays a critical role in the detection of fetal hypoxia during labor, a condition directly related to short- and long-term complications in the newborn. Herein, particular reference is made to the management of CTG category II and III standards, as well as to the handling of childbirth. In addition, specific FHR patterns are associated with immediate neonatal outcomes based on updated studies conducted worldwide. Finally, the prognostic significance of CTG and its potential as a prospective avenue for further investigation are also highlighted herein. Given that the misinterpretation of CTG findings is the most common cause of medical-legal responsibility, this knowledge field requires more emphasis and attention. The aim of the present review was to further deepen the knowledge on issues that mainly concern the safety and monitoring of pregnant women and fetuses during childbirth.

Association between intrapartum fetal pulse oximetry and adverse perinatal and long-term outcomes: a systematic review and meta-analysis protocol.

Current methods of intrapartum fetal monitoring based on heart rate, increase the rates of operative delivery but do not prevent or accurately detect fetal hypoxic brain injury. There is a need for more accurate methods of intrapartum fetal surveillance that will decrease the incidence of adverse perinatal and long-term neurodevelopmental outcomes while maintaining the lowest possible rate of obstetric intervention. Fetal pulse oximetry (FPO) is a technology that may contribute to improved intrapartum fetal wellbeing evaluation by providing a non-invasive measurement of fetal oxygenation status. This systematic review and meta-analysis aims to synthesise the evidence examining the association between intrapartum fetal oxygen saturation levels and adverse perinatal and long-term outcomes in the offspring. We will include randomised control trials (RCTs), cohort, cross-sectional and case-control studies which examine the use of FPO during labour as a means of measuring intrapartum fetal oxygen saturation and assess its effectiveness at detecting adverse perinatal and long-term outcomes compared to existing intrapartum surveillance methods. A detailed systematic search of PubMed, EMBASE, CINAHL, The Cochrane Library, Web of Science, ClinicalTrials.Gov and WHO ICTRP will be conducted following a detailed search strategy until February 2024. Three authors will independently review titles, abstracts and full text of articles. Two reviewers will independently extract data using a pre-defined data extraction form and assess the quality of included studies using the Risk of Bias tool for RCTs and Newcastle-Ottawa Scale for observational studies. The grading of recommendations, assessment, development, and evaluation (GRADE) approach will be used to evaluate the certainty of the evidence. We will use random-effects meta-analysis for each exposure-outcome association to calculate pooled estimates using the generic variance method. This systematic review will follow the Preferred Reporting Items for Systematic reviews and Meta-analyses and MOOSE guidelines. CRD42023457368 (04/09/2023).

Spontaneous echo contrast and decreased umbilical vein blood flow may predict thrombus formation in fetal intra-abdominal umbilical vein varix.

Fetal intra-abdominal umbilical vein varix (FIUVV) can cause thrombosis, fetal growth restriction (FGR), and intrauterine fetal death (IUFD). However, its management and evaluation to avoid fetal risks have not been elucidated. The aim of this study was to develop a novel method to evaluate fetal risks, including FGR and fetal dysfunction via frequent ultrasound examinations. A 28-year-old pregnant woman was diagnosed with FIUVV via ultrasound at 26weeks of gestation and admitted to our hospital. Ultrasound examinations were performed two to three times weekly to evaluate size and shape of the FIUVV and umbilical vein blood flow at the inflow and outflow sites of the FIUVV. The outflow site of the FIUVV was constricted and collapsed, and the blood flow velocity at the inflow site of the FIUVV was decreased. At 32weeks of gestation, spontaneous echo contrast (SEC), which indicates increased echogenicity, appeared. At 35weeks of gestation, the patient noticed decreased fetal movement, and CTG showed non-reassuring fetal status. SEC in the FIUVV was remarkable. Fetal movement could not be confirmed at ultrasound. Cesarean section was performed and a 1,854-g healthy infant was delivered with an umbilical cord arterial pH of 7.266. The echographic changes, such as decreased umbilical vein blood flow and SEC, in FIUVV observed in this case could indicate thrombus formation, which can lead to fetal dysfunction. Frequent ultrasound examinations can help determine the timing of delivery and improve the neonatal prognosis.

Machine Learning Prediction of Fetal Health Status from Cardiotocography Examination in Developing Healthcare Contexts

Reducing neonatal mortality is a critical global health objective, especially in resource-constrained developing countries. This study employs machine learning (ML) techniques to predict fetal health status based on cardiotocography (CTG) examination findings, utilizing a dataset from the Kaggle repository due to the limited comprehensive healthcare data available in developing nations. Features such as baseline fetal heart rate, uterine contractions, and waveform characteristics were extracted using the RFE wrapper feature engineering technique and scaled with a standard scaler. Six ML models—Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Gradient Boosting (GB), Categorical Boosting (CB), and Extended Gradient Boosting (XGB)—are trained via cross-validation and evaluated using performance metrics. The developed models were trained via cross-validation and evaluated using ML performance metrics. Eight out of the 21 features selected by GB returned their maximum Matthews Correlation Coefficient (MCC) score of 0.6255, while CB, with 20 of the 21 features, returned the maximum and highest MCC score of 0.6321. The study demonstrated the ability of ML models to predict fetal health conditions from CTG exam results, facilitating early identification of high-risk pregnancies and enabling prompt treatment to prevent severe neonatal outcomes.

Increased Maternal BMI at Time of Delivery Associated with Poor Maternal and Neonatal Outcomes.

Current literature on the risks and outcomes of obesity in pregnancy almost exclusively utilizes prepregnancy body mass index (BMI). Given the rising obesity rate across the United States along with a paucity of available information on the relationship between delivery BMI and maternal and neonatal outcomes, our study aimed to determine the association of maternal BMI at delivery with antepartum, intrapartum, and neonatal complications at an academic referral hospital. This study is a secondary analysis of data collected for a prospective cohort study of Coronavirus Disease-2019 (COVID-19) in pregnancy. This analysis included all patients who delivered term singleton infants between May 1, 2020, and April 30, 2021, at the University of Iowa Hospitals and Clinics. Demographic and clinical data were obtained from the electronic medical record. The relationship between maternal BMI and maternal and neonatal characteristics of interest was assessed using logistic regression models. A statistical significance threshold of 0.05 was used for all comparisons. There were 1,996 women who delivered term singleton infants during the study period. The median BMI at delivery was 31.7 kg/m2 (interquartile range 27.9, 37.2), with 61.1% of women having a BMI ≥ 30.0 kg/m2. Increasing BMI was significantly associated with nonreassuring fetal status, unscheduled cesarean birth, overall cesarean birth rate, postpartum hemorrhage, prolonged postpartum stay, hypertensive diseases of pregnancy, neonatal hypoglycemia, neonatal intensive care unit admission, decreased APGAR score at 1 minute, and increasing neonatal birth weight. Even when controlling for preexisting hypertension in a multivariate model, increasing BMI was associated with gestational hypertension and preeclampsia. Increased maternal BMI at delivery was associated with adverse perinatal outcomes. These findings have implications for clinical counseling regarding risks of pregnancy and delivery for overweight and obese patients and may help inform future studies to improve safety, especially by examining reasons for high cesarean rates. · Sixty-one percent of delivering patients had a BMI330 kg/m2 at delivery.. · There was a higher cesarean rate with increasing delivery BMI.. · For every 5-unit increase in maternal BMI, neonatal weight increased by 0.47 g..

Association of maternal obesity with growth of fetal fractional limb volume

BackgroundMaternal obesity influences birth weight and newborn adiposity. Fetal fractional limb volume has recently been introduced as a useful parameter for the proxy of fetal adiposity. However, the association between maternal adiposity and the growth of fetal fractional limb volume has not been examined. AimsTo investigate the association of maternal pre-pregnancy BMI with the growth of fetal fractional limb volume. Study designProspective cohort study. SubjectsWomen with singleton uncomplicated pregnancies enrolled between July 2017 and June 2020. Outcome measuresFetal fractional limb volume was assessed between 20 and 40 weeks' gestation, measured as cylindrical limb volume based on 50 % of the total diaphysis length. The measured fractional limb volume at each gestational week were converted to z-scores based on a previous report. The association between pre-pregnancy BMI and fetal fractional limb volume was examined. Maternal age, parity, gestational weight gain and fetal sex were considered as potential confounding variables. ResultsUltrasound scans of 455 fractional arm volume and thigh volume were obtained. Fractional limb volume increased linearly until the second trimester of gestation, then increased exponentially in the third trimester. Maternal pre-pregnancy BMI was significantly correlated with z-scores of fractional arm volume and thigh volume across gestation. The post-hoc analysis showed the association between pre-pregnancy BMI and fractional arm volume was significant especially between 34 and 40 weeks. ConclusionsMaternal obesity influences the growth pattern of fetal fractional limb volume. Fractional arm volume may potentially provide a useful surrogate marker of fetal nutritional status in late gestation.

Association between the socio-demographic variables of women admitted for delivery to a Tertiary Care Hospital and their maternal and neonatal outcome - A cross-sectional study

The adverse outcome of pregnancy, either on the mother or fetus, remains to be still high despite improvements in healthcare services. This is due to various factors, including medical, environmental or socioeconomic factors. A cross-sectional study was conducted among 300 women admitted for delivery to a tertiary care hospital at Belagavi to find the association between socio-demographic variables and their maternal and neonatal outcomes. Data was collected using tools on socio-demographic profiles and questionnaires on Maternal and neonatal health outcomes. Descriptive statistics, Chi-square test and multiple logistic regression analysis analyzed data. Majority (47%) of the mothers belonged to the age group of 24 to 29 years, 79% are Hindu, 48.67% completed Pre-University course, 98.33% are homemakers, 67.33% had a non-consanguineous marriage and 62.33% are non-vegetarian. In the study, 62.33% had a vaginal delivery, 58% were primipara and 52.67% of them were pregnant for the first time. There was a significant association between the mother’s age and education level and maternal and neonatal outcome, and there was no significant association between the preterm and term with demographic characteristics. Multiple logistic regression analysis showed that women who had delivered vaginally, those pregnant for the third time had good maternal outcomes and women who had 11 to 13 antenatal visits have good neonatal outcomes. Also, women with either maternal or fetal conditions have an equal chance of undergoing Cesarean section. Birth weight and length of the baby is associated with the mother’s gestational age at the time of delivery