Feto-maternal Health Research Articles

The Impact of the Coronavirus Pandemic on Telemedicine Evolution in Obstetrical Care During COVID-19

Abstract: The COVID-19 pandemic has imposed drastic challenges to the health system and resulted in drastic measures to reduce the high morbidity and mortality rates observed among affected individuals. Pregnant women were faced with an unexpected suspension of anti-natal care with the recommendation of indoor confinement. Telemedicine (Tm), defined as the delivery of healthcare via communication, stood up as a valuable tool to address those needs with its convenience of remote monitoring and ease of use. This review aimed to verify the transition of Tm in obstetrical care, define factors and barriers associated with its acceptance, its performance, and how it evolved during the COVID-19 era to guide its role in modern obstetrics. Four electronic repositories were searched: PubMed, Scopus, WOS, and Google Scholar using the keywords (pregnant, telemedicine, COVID- 19, feto-maternal health, outcome, satisfaction, and health care); eligible studies were included in the analysis. Despite the challenges and difficulties faced by Tm during its early implementation in the pandemic, its effectiveness was demonstrated. Looking back to the lessons learned from the pandemic, Tm stood out as a reliable, safe, cost-effective tool for delivering anti-natal care during lockdown. Its role in alleviating anxiety and stress associated with the pandemic was notable. There are still gaps in our knowledge that need to be researched further, practically, the long-term outcome of Tm follow-up for both the mothers and their babies, and from a lower income countries' perspective as Tm services faced digital literacy in those areas. It has been anticipated that Tm will play a crucial role in modern obstetrics, as an integral part of the health service or as a complete part. Moreover, by adopting the 2 models, pregnant women will have the leverage of to aim for better delivery and outcomes in the presented health care.

Recommendations for India-specific multiple micronutrient supplement through expert consultation.

Background & objectives Reducing maternal anaemia and enhancing feto-maternal health to achieve desired birth outcomes is a major health concern in India. Micronutrient deficiencies during pregnancy may impact fetal growth and neonatal outcomes. There is increasing interest in using multiple micronutrient supplement (MMS) during pregnancy. However, the World Health Organization (WHO) recommends use of MMS containing Iron and Folic Acid (IFA) in the context of "rigorous research". Against this backdrop, an Indian Council of Medical Research (ICMR)-led MMS design expert group met over six months to review the evidence and decide on the formulation of an India-specific MMS supplement for pregnant mothers for potential use in a research setting. Methods The India-MMS design expert group conducted a series of meetings to assess the available evidence regarding the prevalence of micronutrient deficiencies in pregnant women in India, the health benefits of supplementing with different micronutrients during pregnancy, as well as nutrient interactions within the MMS formulation. Based on these considerations, the expert group reached a consensus on the composition of the MMS tailored for pregnant women in India. Results The India-specific MMS formulation includes five minerals and 10 vitamins, similar to the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) composition. However, the quantities of all vitamins and minerals except Zinc, Vitamin E, and Vitamin B6 differ. Interpretation & conclusions This report provides an overview of the process adopted, the evidence evaluated, and the conclusions from the expert working group meetings to finalize an MMS supplement in pregnancy for the Indian context to be used in a research setting.

Exploring Barriers to Obstetric Care: A Case Report on High-Risk Pregnancy in a Limited-resource Primary Care Setting in West Bengal, India

Barriers to obstetric care have been under-researched in the Indian context, especially in limited-resource primary care settings. This case study seeks to unravel the barriers that lead to the high-risk pregnancy status of a 26-year-old second gravida, parity one pregnant mother residing in a rural area of West Bengal, India, in her 38 weeks of gestation with several risk factors. The factors that complicate the case include previous history of low birth weight delivery through cesarean section 4 years back, persistent anemia (Hemoglobin <10 g/dL), lately diagnosed hypothyroidism during the third trimester, and suboptimal weight gain of only 6 kg during the pregnancy (significantly below the recommended 9–11 kg gain) posing risks to both the mother and fetus. Ishikawa’s fishbone diagram has been used to illustrate the various categories and factors contributing to barriers to maternal care. Screening for risk factors, addressing the barriers, and timely case management and follow-up could improve fetomaternal health outcome.

A Theoretical Exploration of Artificial Intelligence's Impact on Feto-Maternal Health from Conception to Delivery.

The implementation of Artificial Intelligence (AI) in healthcare is enhancing diagnostic accuracy in clinical setups. The use of AI in healthcare is steadily increasing with advancing technology, extending beyond disease diagnosis to encompass roles in feto-maternal health. AI harnesses Machine Learning (ML), Natural Language Processing (NLP), Artificial Neural Networks (ANN), and computer vision to analyze data and draw conclusions. Considering maternal health, ML analyzes vast datasets to predict maternal and fetal health outcomes, while NLP interprets medical texts and patient records to assist in diagnosis and treatment decisions. ANN models identify patterns in complex feto-maternal medical data, aiding in risk assessment and intervention planning whereas, computer vision enables the analysis of medical images for early detection of feto-maternal complications. AI facilitates early pregnancy detection, genetic screening, and continuous monitoring of maternal health parameters, providing real-time alerts for deviations, while also playing a crucial role in the early detection of fetal abnormalities through enhanced ultrasound imaging, contributing to informed decision-making. This review investigates into the application of AI, particularly through predictive models, in addressing the monitoring of feto-maternal health. Additionally, it examines potential future directions and challenges associated with these applications.

LabVIEW-Enabled Synthetic Signal for Empowering Fetal-Maternal Healthcare

Biomedical signal processing has advanced to the point that tools and methods are now available to doctors to diagnose and track medical conditions connected to pregnancy. However, it is extremely difficult for researchers to look into novel procedures and approaches to uncover underlying pathological abnormalities associated with high-risk pregnancies due to the scarcity of high-quality medical databases of pregnant women. In this study, a LabVIEW software environment is used to precisely design a bio-physiological signal generator (BPSG) for use in feto-maternal health assessment applications. McSharry’s dynamical ECG model served as inspiration for the methods utilized to create the proposed time-domain mathematical model. The BPSG is capable of generating various realistic synthetic signals like respiration signal, pulse plethysmography (PPG) signal, phonocardiography (PCG) signal, maternal ECG (MECG) signal, fetal ECG (FECG) signal, abdominal ECG (AECG) signa,l and umbilical blood flow (UBF) velocimetry signals with corresponding Doppler indices. It is possible to create synthetic signals for both healthy and unhealthy conditions. Synthetic signal facilitates the testing and calibration of new diagnostic procedures, denoising algorithms, feature extraction processes, and instrumentation, all of which contribute to the prompt prediction of an overall health state of expectant mother.

FETO/Maternal Complications in Iron Deficiency Anemia during Pregnancy and Labor

Background: Iron deficiency anemia (IDA) is a prevalent nutritional disorder globally, especially in developing countries, impacting both maternal and fetal health. The condition exacerbates the risk of adverse pregnancy outcomes, including increased morbidity and mortality rates. Objective: This study aimed to examine the prevalence and impact of IDA on feto-maternal health during pregnancy and labor, as well as to evaluate the efficacy of antenatal care programs in managing this condition. Methods: A six-month cross-sectional study was conducted at Shaikh Zayad Hospital, Larkana, from October 2021 to March 2022. Fifty pregnant women, ranging from primigravida to multigravida, were recruited through emergency and outpatient departments. Comprehensive data collection included demographic information, clinical history, and a full spectrum of laboratory tests for IDA. The severity of anemia and related complications were assessed, and the collected data were analyzed using SPSS version 25. Results: Of the participants, 74% suffered from moderate anemia, while 12% and 14% had mild and severe anemia, respectively. Serum ferritin levels indicated iron deficiency in 40% of the women, with an elevated total iron-binding capacity (TIBC) in 60% of cases. Maternal complications were prevalent, with 52% encountering unspecified emergency conditions and 16% experiencing postpartum hemorrhage. Fetal complications included intrauterine growth restriction (30%), intrauterine death (18%), and neonatal death (10%). Conclusion: IDA presents a significant health risk during pregnancy, correlated with a high incidence of maternal and fetal complications. This study emphasizes the importance of proactive management and monitoring of iron levels throughout pregnancy. Establishing comprehensive antenatal care that includes nutritional education and iron supplementation is crucial for preventing IDA and improving pregnancy outcomes.

From Conception to Delivery: A Comprehensive Review of Thyroid Disorders and Their Far-Reaching Impact on Feto-Maternal Health.

This comprehensive review delves into the multifaceted landscape of thyroid disorders during pregnancy, exploring their impact from conception to postpartum considerations. Key findings highlight the intricate interplay between maternal thyroid health and fetal development, emphasizing the critical importance of timely screening and targeted interventions. The evolving landscape of research and technology suggests a paradigm shift towardpersonalized approaches in clinical practice, emphasizing integrated care models and the integration of telehealth platforms. Postpartum considerations, including postpartum thyroiditis, underscore the necessity for ongoing monitoring and intervention for maternal well-being. Implications for clinical practice encompass healthcare provider education, public awareness campaigns, and policy advocacy for standardized screening guidelines. The call to action resonates for increased research funding to advance understanding and improve outcomes. By fostering awareness, education, and collaborative efforts, this review aims to navigate the complexities of thyroid disorders during pregnancy, ensuring a healthier start for both mothers and their infants.

Electrophoretic Pattern of Serum Proteins in Pregnancy: A Cross-sectional Study

Introduction: Nutritional status during pregnancy is a determining factor for maternal and neonatal health outcomes. Protein is an essential nutrient for foetal development. If pregnancy is associated with an improper diet leading to protein deficiency, the prospects for maternal and foetal outcomes may be catastrophic. An electrophoretic study of serum protein patterns in pregnancy can help identify pregnancy-specific protein markers and facilitate the monitoring of feto-maternal health. Aim: The aim of this study is to assess serum protein levels and their fractions (albumin, alpha-1 globulin, alpha-2 globulin, beta globulin, and gamma globulin) using gel electrophoresis in healthy pregnant women attending an antenatal clinic. Materials and Methods: This cross-sectional study was conducted in the Department of Medical Biochemistry in collaboration with the Department of Obstetrics and Gynecology at Sultania Zanana Hospital, associated with Gandhi Medical College, Bhopal, Madhya Pradesh, India, between January 2021 and February 2021. Fifty normal non-pregnant women of childbearing age and 50 normal pregnant women in the first trimester of pregnancy attending an antenatal clinic were enrolled and followed-up through the second and third trimesters for investigations. Serum total protein, albumin, and globulin levels were estimated using a fully automated chemistry analyser, and the electrophoretic patterns of serum protein fractions were analysed using an automated gel electrophoresis apparatus. EpiInfo statistical software was used for the statistical analysis of data, with p<0.05 considered the statistical significance level. Results: The serum total protein level in non-pregnant women was 6.36±0.40 g/dL, while in pregnant women, it was 8.01±0.40 g/dL, 8.00±0.42 g/dL, and 6.36±0.43 g/dL in the first (T1), second (T2), and third (T3) trimesters, respectively. The serum albumin level was 3.90±0.30 g/dL in non-pregnant women, while in pregnant women it was 4.24±0.38 g/dL, 4.58±0.34 g/dL, and 3.87±0.36 g/dL in T1, T2, and T3, respectively. The globulin level in non-pregnant women was 2.46±0.28 g/dL, while in T1, T2, and T3 it was 3.86±0.22 g/dL, 3.42±0.20 g/dL, and 2.49±0.24 g/dL, respectively. A significant difference was found among the groups for serum total protein, serum albumin, and serum globulin. In non-pregnant women, the protein fractions- albumin, alpha-1 globulin, alpha-2 globulin, beta globulin, and gamma globulindid not show any deviation from normal levels. However, there was a decrease in albumin and beta globulin levels, along with an increase in alpha-2 globulin levels in the first trimester. An increase in beta globulin and a decrease in gamma globulin levels were observed in the second trimester. In the third trimester, all these fractions did not show any significant alterations, except for gamma globulin. Conclusion: Serum total protein, serum albumin, and serum globulin levels showed a significant difference. However, a slight increase in serum globulin levels compensated for the fall in albumin levels during pregnancy. Variations in the levels of beta globulin, alpha-2 globulin, and gamma globulin were observed during pregnancy, while, on the other hand, alpha-1 globulin did not show any alterations in pregnant women during the first, second, and third trimesters, although its level was higher in pregnant women compared to non-pregnant women.

NULLIPAROUS WOMEN: EXAMINING FETAL AND MATERNAL OUTCOMES IN INDUCED VERSUS SPONTANEOUS LABOR

Introduction: The goal of modern obstetrics is to enhance feto-maternal health. In certain cases, interventions are required to safe-guard it. The most frequent interventional procedure is currently in-duction of labour. This study was conducted to assess feto-maternal outcome in induced women in comparison to spontaneous labour in nullipara. Methodology: This was a prospective study conducted among 55 nulliparous pregnant women at or beyond 37 weeks of gestation who were in need of induction. Progress of labour was monitored with modified WHO partograph. All consecutive patients who entered into spontaneous labour (n=55) were also included. Results: Mean cervical dilatation in ‘spontaneous labour’ group was 4.48 (± 0.65) cm and in ‘induction labour’ group was 4.4 (± 0.62) cm. In ‘spontaneous labour’ group, 36.4% required augmentation whereas in ‘induction labour’ group 67.3% required. In former, 81.8% had normal vaginal deliveries, whereas 63.6% in the later group. Mean du-ration of first stage of labour in ‘spontaneous labour’ group was 11.42 (± 2.32) hours and in ‘induction labour’ group was 10.36 (± 2.78) hrs. The rate of maternal complication was significantly more in ‘in-duction labour’ group compared to ‘spontaneous labour’ group. There was no significant difference in neonatal outcome in new-born in both the study groups. Conclusion: Induction of labour is associated with higher rate of LSCS. Duration of first stage of labour is significantly shorter in in-duced women, however duration of second and third stage of labour was almost similar to spontaneous labour. Induction of labour is a safe procedure.

Successful Outcome of Pregnancy in two Cases of Takayasu Arteritis

Introduction : Takayasu arteritis is a vasculitis of unknown cause. It is a disease of involvement of vessels of branches of the aortic arch. It can affect women of reproductive age and may present with pregnancy. Pregnancy may have a favorable outcome if diagnosed and appropriately managed from the onset of the disease and enter pregnancy in the remission phase and with medication. But, if it is diagnosed for the first time during pregnancy outcome might be worse. Case reports: Here presented two case reports of diagnosed Takahashi Arteritis with term pregnancy; who entered pregnancy in remission phase and on medication. The prior preparation leads the pregnancy to a successful outcome without any residual effect on feto-maternal health. Conclusion: Early diagnosis of the disease and proper management of the progress of the disease by intervention is essential for a good prognosis. A close follow-up and multidisciplinary approach during pregnancy make pregnancy a safer journey for a woman with Takahashi Arteritis. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 63-67

Antenatal Care - How to ensure quality!

Antenatal Care - How to ensure quality!

Immune Thrombocytopenic Purpura in Pregnancy: A Case Report in a Health Institution in Benin City, Nigeria

In comparison with reports among Caucasians, immune thrombocytopaenic purpura (ITP) is thought to be uncommon in native black Africans and persons of African ancestry worldwide. The uncommon presentation of these instances provides the information required for the collection of data for prospective research and as a foundation for improving illness management techniques aimed at promoting feto-maternal health. This paper offers a retrospective review of a 32-year-old woman who was diagnosed with ITP in her first trimester of pregnancy following a two-day history of nasal bleeding. Four years prior to her presentation, the patient had similar bleeding event, but was undiagnosed; however, it was managed by unorthodox means, with resolution of symptoms. Thereafter, she had recurrent episodes at this index presentation and a year earlier. For the treatment of this condition, corticosteroids such as oral prednisolone, intravenous methylprednisolone and dexamethasone were used in curtailing the bleeding episodes, despite the recurrence. The effectiveness of these medications was striking. She gave birth to a live female neonate through spontaneous vaginal delivery, and overall, the outcome was excellent in both the mother and neonate.

Maternal hypertensive traits and adverse outcome in pregnancy: a Mendelian randomization study.

Hypertensive disorders of pregnancy are associated with adverse feto-maternal outcomes. Existing evidence is mostly limited to observational studies, which are liable to confounding and bias. This study investigated the causal relevance of component hypertensive indices on multiple adverse pregnancy outcomes using Mendelian randomization. Uncorrelated (r2 < 0.001) genome-wide significant (P < 5 × 10-8) single-nucleotide polymorphisms associated with SBP, DBP and pulse pressure (PP) were selected as instrumental variables. Genetic association estimates for outcomes of preeclampsia or eclampsia, preterm birth, placental abruption and hemorrhage in early pregnancy were extracted from summary statistics of genome-wide association studies in the FinnGen cohort. Two-sample, inverse-variance weighted Mendelian randomization formed the primary analysis method. Odds ratios (OR) are presented per-10 mmHg higher genetically predicted hypertensive index. Higher genetically predicted SBP were associated with higher odds of preeclampsia or eclampsia [OR 1.81, 95% confidence interval (CI) 1.68-1.96, P = 5.45 × 10-49], preterm birth (OR 1.09, 95% CI 1.03-1.16, P = 0.005) and placental abruption (OR 1.33, 95% CI 1.05-1.68, P = 0.016). Higher genetically-predicted DBP was associated with preeclampsia or eclampsia (OR 2.54, 95% CI 2.21-2.92, P = 5.35 × 10-40). Higher genetically predicted PP was associated with preeclampsia or eclampsia (OR 1.68, 95% CI 1.47-1.92, P = 1.9 × 10-14) and preterm birth (OR 1.18, 95% CI 1.06-1.30, P = 0.002). This study provides genetic evidence to support causal associations of SBP, DBP and PP on multiple adverse outcomes of pregnancy. SBP and PP were associated with the broadest range of adverse outcomes, suggesting that optimized management of blood pressure, particularly SBP, is a key priority to improve feto-maternal health.

Comparative predictive power of serum vs plasma proteomic signatures in feto-maternal medicine

Blood proteins are frequently measured in serum or plasma, because they provide a wealth of information. Differences in the ex vivo processing of serum and plasma raise concerns that proteomic health and disease signatures derived from serum or plasma differ in content and quality. However, little is known about their respective power to predict feto-maternal health outcomes. Predictive power is a sentinel characteristic to determine the clinical use of biosignatures. This study aimed to compare the power of serum and plasma proteomic signatures to predict a physiological pregnancy outcome. Paired serum and plasma samples from 73 women were obtained from biorepositories of a multinational prospective cohort study on pregnancy outcomes. Gestational age at the time of sampling was the predicted outcome, because the proteomic signatures have been validated for such a prediction. Multivariate and cross-validated models were independently derived for serum and plasma proteins. A total of 1116 proteins were measured in 88 paired samples from 73 women with a highly multiplexed platform using proximity extension technology (Olink Proteomics Inc, Watertown, MA). The plasma proteomic signature showed a higher predictive power (R=0.64; confidence interval, 0.42-0.79; P=3.5×10-6) than the serum signature (R=0.45; confidence interval, 0.18-0.66; P=2.2×10-3). The serum signature was validated in plasma with a similar predictive power (R=0.58; confidence interval, 0.34-0.75; P=4.8×10-5), whereas the plasma signature was validated in serum with reduced predictive power (R=0.53; confidence interval, 0.27-0.72; P=2.6×10-4). Signature proteins largely overlapped in the serum and plasma, but the strength of association with gestational age was weaker for serum proteins. Findings suggest that serum proteomics are less informative than plasma proteomics. They are compatible with the view that the partial ex-vivo degradation and modification of serum proteins during sample processing are an underlying reason. The rationale for collecting and analyzing serum and plasma samples should be carefully considered when deriving proteomic biosignatures to ascertain that specimens of the highest scientific and clinical yield are processed. Findings suggest that plasma is the preferred matrix.

Comparison of Feto-maternal Outcomes Among Various BMI Groups As Per Asia Pacific Standards: An Observational Retrospective Comparative Study in a Private Tertiary Care Center in Delhi.

To compare the feto-maternal outcomes among various BMI groups as per Asia Pacific Standards. This is a retrospective non-interventional observational study on 1396 antenatal women with singleton pregnancy. Their BMI based on pre-pregnancy weight was calculated and the women were divided into various groups as per Asia Pacific standards for BMI classification. Details of associated morbidities and delivery outcomes were noted in a pre-structured proforma and a comparison was made among the various groups using Chi square test. A p value of < 0.05 was taken as significant. Among the 1396 women under study, 10.6% were underweight, 36% had normal weight, 21% were overweight while 32% were obese or very obese. There was a significant association of low BMI with preterm labor (p value 0.03) and fetal growth restriction (p value < 0.01). Overweight and obese women were found to be more prone to hypertensive disorders of pregnancy (p value- 0.002), gestational diabetes (p value- 0.003) and overweight women were more prone to cholestasis of pregnancy (p value 0.03). The women with higher BMI had a significantly higher requirement of induction of labor (p value-0.0002). There was significant increased number of babies more than 90th percentile in overweight and obese women (p value 0.003). However, there was no change in Neonatal ICU admissions (p value 0.85) or neonatal mortality. Asia Pacific references should be used for studies related to all studies on BMI and pregnancy. All women having BMI outside the normal BMI spectrum are at increased risk of antenatal and postnatal complications. Early identification of such women will enable careful evaluation and counseling to improve the reproductive outcome and feto-maternal health.

A prospective study on prevalence of thalassemic gene disorder and hemoglobinopathies in pregnancy: Antenatal and intranatal outcome in a hospital-based population of Eastern India

Background: Thalassemia syndromes are autosomal recessive disorders and the most commonly inherited hemoglobinopathies in the world. Among these, β-thalassemia is the most common type of thalassemia in Eastern India and in West Bengal. Thalassemic mothers are more predisposed to maternal complications such as hypertensive disorders, gestational diabetes mellitus (GDM), and adverse neonatal outcome in terms of low birth weight, prematurity, etc. This study was to assess the effect of thalassemia gene disorder and hemoglobinopathies (thal-hbpathy) on fetomaternal health. Aims and Objectives: This study was done to evaluate the effect of thal-hbpathy on fetomaternal health and to compare their antenatal, intranatal outcome with control unaffected mothers, and with anaemic non-thalassemic mothers. Materials and Methods: This is a prospective and observational study of 150 women who attended tertiary care hospital during 18 months, fulfilling pre-defined inclusion and exclusion criteria. All women were evaluated during antenatal and intranatal period. Observations were recorded and interpreted. Results: Among 150 participants, 80(53.3%) were having normal hemoglobin (Hb) level and normal hemoglobin high performance liquid chromatography(Hb-HPLC), 54(36.7%) had anemia (Hb &lt;10.9g/dl) with normal Hb pattern on HPLC, and 16(10.66%) had thal-hbpathy. Hb-HPLC revealed β-thalassemia trait in 7.3%, E β-thalassemia trait in 0.7%, whereas HbE heterozygous 2.7% in our study population. Majority (15/16) of thal-hbpathy patients were anemic. Oligo-hydramnios was detected in 18.7% of thalassemic women as compared to anemic (3.7%) and normal group (3.7%), which were significant. Obstetric cholestasis (OC) 12.5%(2/16) and intrauterine growth restriction (IUGR) were observed in thal-hbpathy group antenatal patients which were statistically significant P&lt;0.05. Conclusion: Overall prevalence of thalassemia was 10.7%. The important fetomaternal complications observed were prematurity, IUGR, OC, oligohydramnios, OC(PIH), and GDM.

Impact of COVID-19 on pathophysiological changes on feto-maternal health and treatment strategies: A literature review

Aim: During the coronavirus disease 2019 (COVID-19) pandemic, physiological changes in pregnancy have placed both the mother and the fetus at potential risk of infection. Particularly, changes in cardiovascular function, the coagulation cascade, the immune system, and the respiratory system may be instrumental in the COVID-19 disease progression. Since this is a novel virus, the management, treatment, and prevention of COVID-19 is still evolving in general and obstetric patients as well. Therefore, it has become very crucial to study its effect on pregnancy and how providers adapted new practices pragmatically without prior scientific data. Our goal is to focus on addressing these issues systematically. Methods: We selected all the peer-reviewed articles on pregnancy-related to COVID-19 infection. Search terms were COVID-19, coronavirus, pregnancy, and maternal health using google scholar, Centers for Disease Control and Prevention (CDC), and PubMed. Results: We demonstrated the direct and indirect impact of COVID-19 on maternal health, including physical, mental, and social effects. We primarily highlighted case series and cohort studies discussing the clinical course, management, pathophysiological (immunological) changes, and the outcomes of COVID-19 infection in pregnant women. Conclusion: We discussed the physiological, pathological, and mental health changes in pregnant women with COVID-19 infection and the current evolving management plans, treatment approaches, and preventive measures to combat the disease. A global effort in further research is essential to determine and minimize the impact of COVID-19 on pregnant women and their outcomes.

Evaluation of feto-maternal outcomes among pregnant women with co-existence of ureteric stones and urinary tract infections.

Objective: To determine the fetal and maternal outcome among pregnant women who are diagnosed positive for co-occurrence of Ureteric Stones and Urinary Tract Infections during their third trimester. Study Design: Cross Sectional Analytical study. Setting: Urology and Gynecology Department of Mukhtar A Sheikh Hospital Multan. Period: 6th February 2020 to 6th July 2020. Material &amp; Methods: Pregnant women in their third trimester were confirmed for the presence of ureteric stones and urinary tract infections through imaging and urine culture studies. Cases confirmed for the disorders were then evaluated for any complications during the remaining gestational period. The diseased group was compared with healthy pregnant women. Results: Out of 200 selected women, 60 (27.7%) were positive for comorbidity of two illnesses. Among pregnancy outcomes, Preterm Labor (46.6%) has the highest rate of incidence followed by Preeclampsia (41.6%), Oligohydramnios (10.6%), Abortion (1.6%), Operative Intervention (cesarean section) (36.6%), Acute Renal Failure (5%), Acute Respiratory Distress Syndrome (11.6%), and Septicemia (1.6%) among the study group. Similarly, fetal outcomes such as fetal demise (1.6%), Low birth weight babies (58.3%), and premature babies (51.3%) were statistically significant in the study group than the control group. Conclusion: The coexistence of ureteric stones and UTIs is largely affecting pregnant population and this co-morbid condition has a significant impact on fetomaternal health.

Clinically relevant DNA viruses in pregnancy.

Infections by DNA viruses during pregnancy are associated with increased health risks to both mother and fetus. Although not all DNA viruses are related to an increased risk of complications during pregnancy, several can directly infect the fetus and/or cause placental dysfunction. During Non-Invasive Prenatal Testing analysis, the presence of viral DNA can be detected, theoretically allowing screening early in pregnancy. Although treatment options are currently limited, this might rapidly change in the near future. It is therefore important to be aware of the potential impact of these viruses on feto-maternal health. In this manuscript we provide a brief introduction into the most commonly detected DNA viruses in human cell-free DNA sequencing experiments and their pathogenic potential during pregnancy.

Positive Impacts of the COVID-19 Pandemic and Public Health Measures on Healthcare

In the midst of the COVID-19 pandemic, several unexpected positive outcomes have surfaced. The WHO public health measures have positively transformed people’s behaviour and lifestyles. The pandemic has prompted more focus on self-care and health awareness. Hand hygiene practice has been greatly emphasised. The acceptance rate for the use of personal protective equipment, such as face masks, has been remarkable. People with co-morbid conditions are paying more attention to their primary illnesses by improving diets and exercise methods. People are more willing to accept and act on public health messages. The pandemic lockdowns have not only successfully mitigated the transmission of coronavirus, but they have also indirectly reduced the hospital admission rates for endemic community respiratory infections and trauma-related emergencies like motor vehicle accidents. Fetomaternal health and wellness have significantly improved during the pandemic. The abrupt emergence of COVID-19 has also led to a massive societal shift on tobacco smoking cessation. Smokers are compelled to reflect on the harmful effects of cigarette smoking in relation to COVID-19. Issues of mental, relational and sexual health are put in the spotlight during the pandemic. People are investing more time in themselves, family and relationships. The world has seen an unprecedented global race in healthcare innovation and technology development in tackling the same global issue. Artificial intelligence, including robots and drones, have been rapidly developed and employed for healthcare as well as food and delivery services in order to minimise human physical contact. This article discusses several unforeseen positive impacts on healthcare that emerged from the COVID-19 public health measures that have been implemented. The positive impacts of the COVID-19 pandemic should be highlighted in order to provide hope to our community.