Fetal Status Research Articles

Disorders of cervical maturation under wartime stressful conditions

Pregnancy itself is a prerequisite for stress reactions. Even in the physiological course, pregnancy has a certain impact on a woman’s psyche, and some authors even consider it as a crisis situation or a “period of psychological uncertainty”. Women have different types of reactions to pregnancy: from the absence of any psychological problems to neurotic personality development.All the hardships of wartime affect not only the mother’s organism and her psychological state, but also the state of the unborn fetus, which is programmed with certain physical and mental health characteristics for the rest of its life.To prevent these negative effects, pregnant women during the pregravid period and gestation should take preventive measures aimed at strengthening the organism’s defense reactions in adverse conditions. These include a rational nutritious diet, determination of a woman’s personality type by a perinatal psychologist and appropriate psychological practices, and sufficient supplementation of important vitamins and minerals with antioxidant and other protective properties.Pregnancy under the influence of prolonged chronic stress can be complicated not only by purely obstetric and perinatal problems, but also by disorders of the formation of the labour dominant and preparatory processes in the cervix. As a result, this can lead to miscarriage due to the development of tokophobia as a psychological component of these disorders.Cervical maturation before childbirth is a multifactorial process that includes numerous elements, complex processes at the psychological, systemic, tissue, cellular, gene and molecular levels. Comprehensive preparation of a woman’s organism for childbirth in conditions of chronic stress and certain tokophobia (a woman’s fear of childbirth and uncertainty of the future for her and her child during the war) is not only about preventing stressful effects during pregnancy (magnesium complexes with B vitamins – up to the 36th week), conducting a complex of psychoprophylactic therapy and psychophysiological preparation for childbirth from the 37th week, but also in local impact on the cervical state, taking into account changes in connective tissue and correction of the infectious factor at the same time of pregnancy. For this purpose it is advisable and reasonable to prescribe vaginal suppositories based on hyaluronic acid (HA) to accelerate preparatory changes in the cervical tissues by stimulating the synthesis of its own HA and with antibacterial effects due to a complex of plant extracts.

Implementing K-Nearest Neighbors (k-NN) Algorithm and Backward Elimination on Cardiotocography Datasets

Having a healthy baby is a dream for mothers. Unfortunately, high maternal and fetal mortality has become a vital problem that requires early risk detection for pregnant women. A cardiotocograph examination is necessary to maintain maternal and fetal health. One method that can solve this problem is classification. This research analyzes the optimal use of k values and distance measurements in the k-NN method. This research expects to become the primary reference for other studies examining the same dataset or developing k-NN. A selection feature is needed to optimize the classification method, particularly for improving accuracy results. This study used the cardiotocography dataset from cardiotocograph examinations related to fetal conditions. The cardiotocography dataset consisted of 2,126 records with 22 features and variables. It also had three classification classes, normal, suspect, and pathological, from the Universal Child Immunization Machine Learning Repository website. It employed the K-Nearest Neighbor (k-NN) method and the backward elimination feature with ordinary least squares regression. The test in this research applied the scenarios of three distance calculations, i.e., Euclidean distance, Manhattan distance, and Minkowski distance, as well as four variations of k values. Evaluation of each scenario indicated the accuracy of the confusion matrix and execution time. This study compared K-Nearest Neighbor (k-NN) and Backward Elimination methods with K-nearest neighbor (k-NN) without selection features. The best accuracy of the Backward Elimination and K-Nearest Neighbor (K-NN) methods was 91%, as was the K-Nearest Neighbor (k-NN) method without selection features. Both had similar k values (k = 3) and Manhattan distance. The backward elimination method reduced the number of features from 22 to 14. Meanwhile, the execution times of the Backward Elimination and K-Nearest Neighbor (k-NN) methods got better results as each distance averaged 26.54, 19.23, and 68.09 seconds. K-Nearest Neighbor (k-NN) execution times without selection features were 26.83, 19.39, and 68.84, respectively. In conclusion, backward elimination did not increase accuracy because it yielded the same accuracy. However, backward elimination and K-nearest Neighbor (k-NN) produced faster results, with differences of 29%, 16%, and 75%, respectively.

Intermanufacturer assessment of diagnostic performance of angiogenic ratio vs glycosylated fibronectin in women with suspected pre-eclampsia.

To compare the diagnostic performance of different manufacturers' immunoassays for the soluble fms-like tyrosine kinase-1 (sFlt-1)-to-placental growth factor (PlGF) ratio with that of a point-of-care test for glycosylated fibronectin (GlyFn) in women with suspected pre-eclampsia (PE). This was a prospective, single-center, double-blinded, non-interventional study of East Asian women with a singleton pregnancy who presented with hypertension with or without clinical features of PE after 20 weeks' gestation between January 2020 and March 2022. Maternal serum samples were collected at the time of presentation, and subsequent management followed the departmental protocol, based on gestational age, severity of hypertension, fetal condition and presence of severe PE features. Women diagnosed with PE at presentation were excluded. PE was diagnosed according to the 2018 International Society for the Study of Hypertension in Pregnancy classification. Levels of sFlt-1 and PlGF were measured using the Cobas e411 (Roche Diagnostics), BRAHMS KRYPTOR (ThermoFisher Scientific) and iMAGIN 1800 (Ningbo-Aucheer) platforms. GlyFn levels were measured using the Lumella™ GlyFn PoC test (Diabetomics). The predictive performance of each test to rule out PE within 7 days and rule in PE within 28 days from the date of presentation was assessed. Based on the PROGNOSIS study, a sFlt-1/PlGF ratio of ≤ 38 on the Roche platform was used to predict the absence of PE within 7 days. The sFlt-1/PlGF ratio was classified as high or low using platform-specific thresholds equivalent to a Roche sFlt-1/PlGF ratio of 38, which were derived using Passing-Bablok regression. GlyFn was categorized as high or low using two reported clinical management thresholds (263 μg/mL and 510 μg/mL). Overall, 236 women with suspected PE were included, of whom 70 (29.7%) were diagnosed with PE; 36 (51.4%) and 70 (100%) developed PE within 7 days and 28 days, respectively. Eighty-eight (37.3%) women had a sFlt-1/PlGF ratio of > 38 on the Roche platform, 79 (33.5%) women had a sFlt-1/PlGF ratio of > 55 on the KRYPTOR platform and 96 (40.7%) women had a sFlt-1/PlGF ratio of > 40 on the iMAGIN 1800 platform. Furthermore, 62 (26.3%) and four (1.7%) women had a GlyFn level of > 263 μg/mL and > 510 μg/mL, respectively. The negative predictive value (NPV) of the sFlt-1/PlGF ratio measured on the Roche, KRYPTOR and iMAGIN 1800 platforms to rule out PE within 7 days after presentation was 83.3%, 82.0% and 82.9%, respectively, while that for GlyFn > 263 μg/mL and > 510 μg/mL was 82.6% and 70.4%, respectively. The corresponding positive predictive values (PPV) to rule in PE within 28 days after presentation were 50.5%, 52.3% and 46.7%, respectively, for the sFlt-1/PlGF ratio, and 35.4% and 50.0%, respectively, for GlyFn > 263 μg/mL and > 510 μg/mL. The predictive performance of different manufacturers' assays for the sFlt-1/PlGF ratio to rule in and rule out PE were similar once standardized to a common threshold. Our findings suggest that the sFlt-1/PlGF ratio and GlyFn using a cut-off of 263 μg/mL can both be utilized to rule out PE within 7 days after assessment, with a moderate NPV. The PPV for ruling in PE within 28 days remains poor. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Characterization of blood bank and transfusion medicine practices for pregnant individuals with fetuses at risk of hemolytic disease in the United States.

Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibody-mediated destruction of fetal/neonatal red blood cells (RBCs). While the pathophysiology has been well-characterized, the clinical and laboratory monitoring practices are inconsistent. We surveyed 103 US institutions to characterize laboratory testing practices for individuals with fetuses at risk of HDFN. Questions included antibody testing and titration methodologies, the use of critical titers, paternal and cell-free fetal DNA testing, and result reporting and documentation practices. The response rate was 44% (45/103). Most respondents (96%, 43/45) assess maternal antibody titers, primarily using conventional tube-based methods only (79%, 34/43). Among respondents, 51% (23/45) rescreen all individuals for antibodies in the third trimester, and 60% (27/45) perform paternal RBC antigen testing. A minority (27%, 12/45) utilize cell-free fetal DNA (cffDNA) testing to predict fetal antigen status. Maternal antibody titers are performed even when the fetus is not considered to be at risk of HDFN based on cffDNA or paternal RBC antigen testing at 23% (10/43) of sites that assess titers. There is heterogeneity across US institutions regarding the testing, monitoring, and reporting practices for pregnant individuals with fetuses at risk of HDFN, including the use of antibody titers in screening and monitoring programs, the use of paternal RBC antigen testing and cffDNA, and documentation of fetal antigen results. Standardization of laboratory testing protocols and closer collaboration between the blood bank and transfusion medicine service and the obstetric/maternal-fetal medicine service are needed.

Clinical Implications of HELLP Syndrome in Anesthesia Management of Preeclamptic Pregnant Mothers: A Literature-Based Review

BACKGROUND:Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a serious life-threatening obstetric emergency accompanied with heterogeneous presentation and multisystem dysfunction. It increases the perils of fetal morbidity and mortality and requires complex clinical management during medical and surgical interventions. Hence, it remains a major challenge for anesthesia providers during perioperative management. The current study aimed to explore the main clinical implications of HELLP syndrome in anesthesia management of preeclamptic pregnant mothers who underwent cesarean section.METHODOLOGY:An exhaustive search of the literature was conducted on the available relevant databases, such as PubMed, Google Scholar, and Cochrane Reviews, published from 1990 to 2023, using the terms HELLP syndrome, cesarean section, and anesthetic challenges/complications. All observational studies, randomized controlled trials (RCTs), cohorts, and nonrandomized studies on HELLP syndrome and anesthetic challenges during cesarean section reported in English were included. Nonpregnant mothers with HELLP syndrome and studies with no relevant reports or abstracts, case reports, or case studies were excluded.RESULTS:A systematic search of relevant databases identified 82 studies: 60 from PubMed, 18 from Google Scholar, and 4 from Cochrane Reviews. After removing duplicates, 48 studies were screened and recorded. Eighteen studies were assessed for eligibility after their titles and abstracts were reviewed. Twelve studies were excluded from the current study, as it did not fulfill the inclusion criteria. Finally, six studies, four retrospective studies, one prospective observational study, and one RCT, were included and reviewed.CONCLUSION:Perioperative anesthetic care in patients with HELLP syndrome remains a challenge. Hence, anesthetic techniques should be selected based on the severity of the condition, patient status, urgency surgery, fetal conditions, coagulation status, and safe platelet counts.

Maternal Docosahexaenoic Acid Supplementation Alters Maternal and Fetal Docosahexaenoic Acid Status and Placenta Phospholipids in Pregnancies Complicated by High Body Mass Index.

An optimal fetal supply of docosahexaenoic acid (DHA) is critical for normal brain development. The relationship between maternal DHA intake and DHA delivery to the fetus is complex and is dependent on placental handling of DHA. Little data exist on placental DHA levels in pregnancies supplemented with the recommended dose of 200 mg/d. Our objective was to determine how prenatal DHA at the recommended 200 mg/d impacts maternal, placental, and fetal DHA status in both normal-weight and high-BMI women compared to women taking no supplements. Maternal blood, placenta, and cord blood were collected from 30 healthy pregnant women (BMI 18.9-43.26 kg/m2) giving birth at term. Red blood cells (RBCs) and villous tissue were isolated, and lipids were extracted to determine DHA content by LC-MS/MS. Data were analyzed by supplement group (0 vs. 200 mg/d) and maternal BMI (normal weight or high BMI) using two-way ANOVA. We measured maternal choline levels in maternal and cord plasma samples. Supplementation with 200 mg/d DHA significantly increased (p < 0.05) maternal and cord RBC DHA content only in pregnancies complicated by high BMI. We did not find any impact of choline levels on maternal or cord RBC phospholipids. There were no significant differences in total placental DHA content by supplementation or maternal BMI (p > 0.05). Placental levels of phosphatidylinositol (PI) and phosphatidic acid containing DHA species were higher (p < 0.05) in high-BMI women without DHA supplementation compared to both normal-BMI and high-BMI women taking DHA supplements. Maternal DHA supplementation at recommended doses cord increased RBC DHA content only in pregnancies complicated by higher BMI. Surprisingly, we found that obesity was related to an increase in placental PI and phosphatidic acid species, which was ameliorated by DHA supplementation. Phosphatidic acid activates placental mTOR, which regulates amino acid transport and may explain previous findings of the impact of DHA on placental function. Current recommendations for DHA supplementation may not be achieving the goal of improving fetal DHA levels in normal-weight women.

Abstract MP27: Pregnant Women of Advanced Maternal Age Have Higher Central Artery Stiffness Than Younger Pregnant Women

The frequency of women undergoing pregnancy at advanced maternal age (AMA, ≥35 years) is increasing in developed countries, including the United States. AMA is associated with an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia, and preterm birth. Increased risk for adverse pregnancy outcomes at AMA may be mediated in part by altered arterial structure and function or inadequate maternal arterial adaptations during pregnancy. Therefore, we examined central artery stiffness and endothelial function across healthy pregnancy (i.e. no comorbid maternal or fetal conditions, born at term) in women who had enrolled in a longitudinal study between March 2015 and January 2020. We hypothesized that women at AMA (age ≥35 years, mean±SE: 36±0 years, n=18) would have higher arterial stiffness and lower endothelial function compared with younger women (age 21-30 years, mean±SE: 27±0 years, n=51) across pregnancy. Hemodynamic and arterial function measures were collected in the first (6-13 weeks), second (18-26 weeks), and third (27-37 weeks) trimesters and postpartum (4-14 weeks after the delivery). Brachial artery blood pressure was assessed in the supine position and central artery stiffness was assessed via carotid-femoral (aortic) pulse wave velocity (cfPWV) and carotid β-stiffness index. Endothelial function was determined via brachial artery flow-mediated dilation (FMD). Brachial artery systolic, diastolic, and mean blood pressures were not different between AMA and younger women across pregnancy or postpartum (all P &gt;0.05). The AMA group had higher cfPWV ( P &lt;0.01) and carotid β-stiffness index ( P &lt;0.01) across pregnancy and postpartum compared to the younger group. cfPWV decreased among younger women at the second and third trimesters compared with the first trimester ( P &lt;0.01), while cfPWV among women of AMA did not change ( P =0.07). There were no differences in FMD between AMA and younger women across pregnancy or postpartum ( P =0.96). These results demonstrate that healthy women of AMA have increased central artery stiffness, but no difference in endothelial function, compared to younger pregnant women across pregnancy, and that the normal decrease in aortic stiffness is blunted in pregnant women of AMA compared to younger women. The sustained higher central artery stiffness throughout pregnancy among women of AMA may contribute to increased risk of pregnancy complications and future CVD risk in these women.

Determination of the Normative Value of Fetal Left Brachiocephalic Vein Diameter Using Ultrasound in a Tertiary Care Hospital in Eastern India.

Fetal ultrasound plays a vital role in prenatal care by offering key insights into fetal growth and facilitating the early identification of congenital abnormalities. Among various anatomical structures, the fetal left brachiocephalic vein (FLBCV) plays a significant role in fetal circulation, yet normative data for FLBCV dimensions are limited, particularly in diverse populations. This study aims to establish normative values for FLBCV diameter in fetuses between 18 and 23 weeks of gestation in a tertiary care hospital in Eastern India. Such data are essential for accurate clinical assessment and early diagnosis of potential congenital anomalies. This descriptive study was conducted at the College of Medicine and Sagore Dutta Hospital, Kolkata, India, from January to December 2022. The study included 287 singleton pregnancies between 18 and 23 weeks of gestation, excluding cases with maternal or fetal conditions that could affect the measurements. LBCV diameter was measured using transabdominal ultrasound, and the normative values were established using percentile charts. Correlation analyses were performed to assess the relationship between FLBCV diameter and various fetal and maternal parameters. Linear regression analysis was done to identify significant predictors of FLBCV diameter. FLBCV diameter showed a consistent increase with gestational age, ranging from a median of 1.87 mm at 18 completed weeks to 2.27 mm at 22 completed weeks. The 95th percentile values exhibited more pronounced growth, particularly between 18 and 20 weeks. Significant positive correlations were observed between FLBCV diameter and fetal biometric parameters such as biparietal diameter, head circumference, abdominal circumference, and femur length. Head circumference emerged as the most significant predictor (p=0.007) of FLBCV diameter in the linear regression model. This study provides essential normative data on FLBCV diameter for the Indian population, offering a valuable reference for clinicians in prenatal diagnostics. The incorporation of FLBCV measurement in basic fetal echocardiography, which is a part of the second-trimester fetal anomaly scan, could enhance the detection of congenital anomalies, contributing to improved prenatal care.

Assessing the Role of Fetal Doppler in High-Risk Obstetrics: Evidence From a Comprehensive Study.

Background Colour Doppler ultrasound is pivotal in modern obstetrics for evaluating maternal and fetal health, especially in high-risk pregnancies. It enhances fetal oxygenation and nutrient delivery assessment, aiding in the early detection of adverse outcomes. However, its effectiveness is influenced by operator skill and the potential for interpretative variability. Aim This study aims to assess the utility of Doppler ultrasound in evaluating fetal status in high-risk pregnancies at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India. Materials and methods A hospital-based observational study was conducted from September 2022 to July 2024, including 145 high-risk pregnant women, of whom 120 delivered at the institute. The study included thorough maternal and fetal assessments, with regular Doppler studies starting at 28 weeks of gestation. The frequency of these studies was adjusted according to the changes and severity observed in the indices. Detailed documentation of both maternal and neonatal outcomes was meticulously maintained. Statistical analyses were performed using MS Excel (Microsoft® Corp., Redmond, WA, USA) and RStudio,Version 2023.08.0-daily+170 (RStudio, Inc., Boston, MA, USA), with a significance threshold of p < 0.05. Results The majority of participants were aged 21-30 years, with multigravida constituting 63.33%. Pregnancy-induced hypertension (PIH) and preeclampsia were the most common high-risk factors (28.33%). Abnormal umbilical artery (UA) flow patterns were observed in 58.33% of cases. Abnormal UA and middle cerebral artery (MCA) Doppler indices correlated significantly with adverse outcomes. Most deliveries were via caesarean section (82.5%), and 63.33% of neonates required Neonatal Intensive Care Unit (NICU) admission. Neonates with abnormal antenatal Doppler studies had significantly lower APGAR (appearance, pulse, grimace, activity, and respiration) scores and higher NICU admission rates. Discussion The study highlights the critical role of Doppler ultrasound in managing high-risk pregnancies, providing essential data for early interventions. Consistent with other studies, abnormal Doppler patterns were significantly associated with adverse neonatal outcomes, necessitating timely caesarean deliveries. Conclusion Fetal Doppler ultrasonography is essential for managing high-risk pregnancies, enabling timely therapeutic interventions and improving perinatal outcomes. Despite its limitations, Doppler technology remains invaluable in identifying at-risk foetuses and guiding clinical decisions for optimal pregnancy management.

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

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

Study of Number of Cotyledons of Placenta in Different Gestational Age Groups of Healthy Pregnant Mother of Bangladesh

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: The placenta has drawn attention as an important indicator of intrauterine condition of fetus and maternal diseases. The study of number of cotyledons of placenta in different gestational age groups of healthy pregnant mother of Bangladesh is cross sectional descriptive study. &amp;lt;i&amp;gt;Aim of the study&amp;lt;/i&amp;gt;: The aim of the study was to study the variation of number of cotyledons of placenta in deferent state of gestational ages of healthy pregnant mother. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: This cross sectional descriptive study was conducted in the Department of Anatomy, Mymensingh Medical College, Mymensingh, from January 2018 to December 2018. This study was performed on 80 human placentae. &amp;lt;i&amp;gt;Result&amp;lt;/i&amp;gt;: The mean (± SD) number of cotyledon of the placenta was 18.56 (±2.15) in group A, 21.21 (±3.11) in group B and 23.75 (±3.45) in group C. The mean number of cotyledon of the placenta was maximum in group C (23.75) and was minimum in group A (18.56). It was also observed that the mean number of cotyledon of the placenta increased with gestational age. The mean difference of the number of placental cotyledons between groups A and C was statistically moderately significant (p &amp;lt; 0.05) but between A and B and B and C was statistically non-significant (p &amp;gt; 0.05). &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: The placental examination becomes important as it will help in understanding the specific etiologies of adverse outcome. This study has shown that the mean number of cotyledon of the placenta increased with gestational age.

Utility of placental biomarkers and fetoplacental Dopplers in predicting likely placental pathology in early and late fetal growth restriction – A prospective study

IntroductionThe aim of this study was to evaluate the association between placental abnormalities, placental biomarkers, and fetoplacental Dopplers in a cohort of pregnancies complicated by fetal growth restriction (FGR). We also ascertained the risk of perinatal mortality, severe neurological morbidity, and severe non-neurological morbidity by type of placental abnormality. MethodsThis was a prospective cohort study. Multivariable logistic regression was used to evaluate the effect of early vs. late FGR, placental biomarkers and fetoplacental Dopplers on Maternal Vascular Malperfusion (MVM) which was the commonest placental abnormality identified. ResultsThere were 161 (53.5 %) early FGR and 140 (46.5 %) late FGR cases. MVM abnormalities were present in 154 (51.2 %), VUE in 45 (14.6 %), FVM in 16 (5.3 %), DVM in 14 (4.7 %) and CHI in 4 (1.3 %) cases. The odds of MVM were higher in early compared to late FGR cohort (OR 1.89, 95%CI 1.14, 3.14, p = 0.01). Low maternal PlGF levels <100 ng/L (OR 2.34, 95%CI 1.27,4.31, p = 0.01), high sFlt-1 level (OR 2.13, 95%CI 1.35, 3.36, p = 0.001) or elevated sFlt-1/PlGF ratio (OR 3.48, 95%CI 1.36, 8.91, p = 0.01) were all associated with MVM. Increased UA PI > 95th centile (OR 2.91, 95%CI 1.71, 4.95, p=<0.001) and mean UtA PI z-score (OR 1.74, 95%CI 1.15, 2.64, p = 0.01) were associated with higher odds of MVM. Rates of severe non-neurological morbidity were highest in the MVM, FVM, and CHI cohorts (44.8 %, 50 %, and 50 % respectively). ConclusionMVM was the commonest placental abnormality in FGR, particularly in early-onset disease. Low maternal PlGF levels, high sFlt-1 levels, elevated sFlt-1/PlGF ratio, and abnormal fetoplacental Dopplers were also significantly associated with MVM. MVM, FVM, and CHI abnormalities were associated with lower median birthweight, higher rates of preterm birth, operative birth for non-reassuring fetal status, and severe neonatal non-neurological morbidity.

Temporalities of oxytocin for labour augmentation: a mixed-methods study of time factors shaping labour practices in a busy maternity unit in Tanzania

BackgroundHigh rates of labour augmentation with oxytocin have been found in some low- and lower-middle-income countries, causing potential perinatal harm. It is critical to understand the reasons for this overuse. Aim was to explore factors that shape practices around using oxytocin for labour augmentation in a high-volume labour ward in Dar es Salaam, Tanzania.MethodsMixed-methods data collection was conducted from March 2021 to February 2022, including structured observations of 234 births, 220 h of unstructured labour ward observations and 13 individual in-depth interviews with birth attendants. Thematic network analysis and descriptive statistics were used to analyse data. We used a time-lens to understand practices of oxytocin for labour augmentation in time-pressured labour wards.ResultsBirth attendants constantly had to prioritise certain care practices over others in response to time pressure. This led to overuse of oxytocin for augmentation to ensure faster labour progression and decongestion of the, often overburdened, ward. Simultaneously, birth attendants had little time to monitor foetal and maternal condition. Surprisingly, while oxytocin was used in 146 out of 234 (62.4%) structured labour observations, only 9/234 (4.2%) women had active labour lasting more than 12 h. Correspondingly, 21/48 (43.8%) women who were augmented with oxytocin in the first stage of labour had uncomplicated labour progression at the start of augmentation. While the partograph was often not used for decision-making, timing of starting oxytocin often correlated with natural cycles of ward-rounds and shift-turnovers instead of individual women’s labour progression. This resulted in co-existence of ‘too early’ and ‘too late’ use of oxytocin. Liberal use of oxytocin for labour augmentation was facilitated by an underlying fear of prolonged labour and low alertness of oxytocin-related risks.ConclusionsTime scarcity in the labour ward often made birth attendants deviate from clinical guidelines for labour augmentation with oxytocin. Efforts to navigate time pressure resulted in too many women with uncomplicated labour progression receiving oxytocin with little monitoring of labour. Fear of prolonged labour and low alertness to oxytocin-mediated risks were crucial drivers. These findings call for research into safety and benefits of oxytocin in low-resource settings and interventions to address congestion in labour wards to prevent using oxytocin as a time-management tool.

Clinicians’ criteria for fetal moral status: viability and relationality, not sentience

The antiabortion movement is increasingly using ostensibly scientific measurements such as ‘fetal heartbeat’ and ‘fetal pain’ to provide ‘objective’ evidence of the moral status of fetuses. However, there is little...

Management of Red Cell Alloimmunization in Pregnancy.

Rhesus immune globulin has resulted in a marked decrease in the prevalence of RhD alloimmunization in pregnancy; however, antibody formation to other red cell antigens continues to occur. Evaluation for the presence of anti-red cell antibodies should be routinely undertaken at the first prenatal visit. If anti-red cell antibodies are detected, consideration of a consultation or referral to a maternal-fetal medicine specialist with experience in the monitoring and treatment of these patients is warranted. Cell-free DNA can be used to determine fetal red cell antigen status to determine whether the pregnancy is at risk of complications from the red cell antibodies. First-time sensitized pregnancies are followed up with serial maternal titers, and, when indicated, serial Doppler assessment of the peak systolic velocity in the middle cerebral artery should be initiated by 16 weeks of gestation. When there is a history of an affected fetus or neonate, maternal titers are less predictive of fetal risk; if the fetus is antigen positive, serial peak systolic velocity in the middle cerebral artery measurements should be initiated by 15 weeks of gestation because intraperitoneal intrauterine blood transfusions can be used at this gestation if needed. The mainstay of fetal therapy involves intrauterine transfusion through ultrasound-directed puncture of the umbilical cord with the direct intravascular injection of red cells. A perinatal survival rate exceeding 95% can be expected at experienced centers. Neonatal phototherapy and "top-up" transfusions attributable to suppressed reticulocytosis often are still required for therapy after delivery.

Role and efficacy of vasopressors in post-spinal hypotension in cesarean section. Is norepinephrine a newer choice?

In elective cesarean section, spinal anesthesia-related hypotension is routinely prevented or treated with fluids and vasopressors. From the use of fluid preloading to co-loading and different vasopressors, Phenylephrine remains the vasopressor of choice in the management of hypotension during cesarean section under spinal anesthesia for a long time. However, in recent studies, Norepinephrine has also been found as effective as phenylephrine but its routine use has not been recommended till now for the same as a vasopressor agent, and among all the vasopressors, phenylephrine has emerged as the recommended one. Phenylephrine is chosen as a vasopressor over mephenteramine, metaraminol, and ephedrine due to the lack of conclusive evidence about the clinical benefits of one over the other, especially in emergency and high-risk Cesarean sections, and is determined by indirect evidence on fetal acid-base status. Norepinephrine is preferable to phenylephrine, according to recent studies, the present recommendations are mostly based on studies done in elective Cesarean sections. Further studies are warranted in elective, emergency, and high-risk Cesarean sections to use phenylephrine over other vasopressors.

Nursing care in threatened preterm labor in the Obstetrics and Gynecology Department of a hospital

The threat of preterm labor, a pathology endangering the lives of both mother and baby, affects one in ten births and is a serious public health issue. This research aimed to manage the nursing care process for a 35-year-old pregnant woman with a threat of preterm labor, using a purely qualitative approach in a single case study, applying the five stages of the nursing care process. In the assessment stage, Maryori Gordon's 11 functional patterns guide was used, identifying 10 nursing diagnoses based on NANDA-I Taxonomy II, prioritizing: labor pain, risk of maternal/fetal dyad alteration, and infection control. The care plan was developed using NOC and NIC classifications. During the implementation stage, nursing care focused on pain management, prenatal fetal status, and infection control. These were evaluated by comparing baseline scores with achievement scores, resulting in an updated care plan with changes scored at+1, 0, and +2. In conclusion, the nursing care process was managed, providing quality and humanized care to the patient.

Prenatal Manifestation of Transient Abnormal Myelopoiesis: Case Report and Review of the Literature.

Background: Congenital malignancies are unusual fetal conditions, and therefore, the data on their prenatal manifestation are limited. Transient abnormal myelopoiesis (TAM) is a hematologic disorder characteristic for babies with trisomy 21 and based on the transient appearance of blast cells in peripheral blood. Methods: This paper presents prenatal manifestation of congenital TAM in a newborn with normal karyotype and reviews the literature on prenatal manifestation of this disorder. Results: A pregnant woman in her third pregnancy referred herself to the hospital for reduced fetal movements at 30 weeks of gestation. Admission's ultrasound scan showed an increased middle cerebral artery peak systolic velocity together with hepatomegaly. The patient was admitted to the labor ward for cardiotocography monitoring which showed acute fetal distress with repeated unprovoked decelerations. An emergency cesarean section was conducted and a phenotypically normal female newborn with low Apgar score was delivered. Further examination of the peripheral blood revealed anemia and leukocytosis with high blast proportion. A bone marrow aspirate revealed 70.2% of blasts in a sample with an abnormal karyotype of 47 XX+21. Cytogenetic analysis of the blasts with later microarray comparative genomic hybridization confirmed the presence of GATA1 mutation. However, the buccal smear showed a normal karyotype in the infant. The disease was classified as TAM. Conclusions: Our study demonstrates a rare case of prenatal manifestation of TAM in a neonate with a normal karyotype. Obstetricians should pay attention to symptoms like high MCA PSV and hepatosplenomegaly as possible causes of fetal hematological disorders and differentiate it with infection or isoimmunization.

Dynamic regulation of innate lymphoid cell development during ontogeny

The helper-like ILC contains various functional subsets, such as ILC1, ILC2, ILC3 and LTi cells, mediating the immune responses against viruses, parasites, and extracellular bacteria, respectively. Among them, LTi cells are also crucial for the formation of peripheral lymphoid tissues, such as lymph nodes. Our research, along with others’, indicates a high proportion of LTi cells in the fetal ILC pool, which significantly decreases after birth. Conversely, the proportion of non-LTi ILCs increases postnatally, corresponding to the need for LTi cells to mediate lymphoid tissue formation during fetal stages and other ILC subsets to combat diverse pathogen infections postnatally. However, the regulatory mechanism for this transition remains unclear. In this study, we observed a preference for fetal ILC progenitors to differentiate into LTi cells, while postnatal bone marrow ILC progenitors preferentially differentiate into non-LTi ILCs. Particularly, this differentiation shift occurs within the first week after birth in mice. Further analysis revealed that adult ILC progenitors exhibit stronger activation of the Notch signaling pathway compared to fetal counterparts, accompanied by elevated Gata3 expression and decreased Rorc expression, leading to a transition from fetal LTi cell-dominant states to adult non-LTi ILC-dominant states. This study suggests that the body can regulate ILC development by modulating the activation level of the Notch signaling pathway, thereby acquiring different ILC subsets to accommodate the varying demands within the body at different developmental stages.

Being Exposed to Covid-19 During Pregnancy

Introduction: Pregnant women are vulnerable to COVID-19 due to reduced partial immunity commonly occurring during pregnancy. Rarely has research reported how pregnant women deal with COVID-19. This study explores the experiences of pregnant women confirmed with COVID-19. Methods: This qualitative study utilized a phenomenological approach. Six postpartum mothers living in North Halmahera, Mollucas, participated in the research. Data analysis was carried out using the Colaizzi method. Results: The participants were positively confirmed with COVID-19 in the third trimester of pregnancy. The perceived symptoms included cough, cold, fever, shortness of breath, headache, dizziness, and loss of smell and taste. The perceived feelings varied among participants. One participant reported worries about her fetus's condition, and another felt disappointed because she could not care for herself, leading to infection. Two participants did not feel panic or fear because the symptoms were mild, and they had previously treated other family members infected with COVID-19. Conclusion: To improve their healing, the research participants tried to remain strong, adhere to health protocols, maintain a healthy diet, take medicine, think positively, and practice dhikr and sholawat. These findings can be used to improve the quality of care.