Fetal Health Research Articles

Dietary diversity and preferences among pregnant women and its association with anaemia

Purpose This study aims to assess dietary choices of pregnant women and its relationship with their anaemia status. Design/methodology/approach A mixed-method study comprising a survey and three focus group discussions (FGDs). The survey included 380 adult pregnant women with data collected on food choices, preferences and haemoglobin (Hb) status. Findings More than 50% of women in the study had Hb concentration < 11.0 g/dl; mean Hb was 10.24 g/dl (SD = 1.59). Univariate analysis was used to generate descriptive tabulations for socio-demographic characteristics of respondents, dietary choices for women and anaemia status. T-test and bivariate analysis between dietary diversity score of the women among the food groups consumed as well as their anaemia (Hb) status. This showed that women with high dietary diversity score had improved Hb status (P = 0.003), and those who consumed meat and fish as well as dark leafy vegetables had significantly high diversity scores (P = 0.031 and P = 0.049). Thematic analysis was used for analysing qualitative data. Research limitations/implications The sample used in the study is unlikely to be fully representative of pregnant women in the Accra Metropolis. In addition, this study used a cross-sectional study design, making it difficult to establish causal associations between nutritional status and food choice of pregnant women. It does not also show variation in dietary practices by seasons of the year. The scope of the study did not allow for a detailed analysis, and this should be considered in future studies. Also, the study did not explore an obstetric factor like past bleeding history as well as the menstrual cycle of these pregnant women, as these factors are likely to interfere with the anaemia status of the pregnant women. Originality/value This paper contributes significant value by specifically focusing on and clarifying the complex relationship between dietary choices and aneamia among pregnant women. It also provides insights into the distinct dietary patterns and preferences of pregnant women, which may be contributing to the high prevalence of aneamia. The results of the study can inform the development of localized, evidence-based interventions to address this critical public health concern, ultimately leading to improved maternal and foetal health outcomes.

Histopathological changes in the placentas of pregnant women with Gestational Diabetes Mellitus

Objectives: Placental damage might be the primary underlying cause of the high rates of fetal adverse outcomes in cases with gestational diabetes mellitus (GDM). Histopathological changes were considered to be associated with GDM in the literature. However, there are also studies showing no changes in the placenta in some gestational diabetic women. The pathophysiology of these placental alterations remains elusive. Therefore, this study aimed to examine the histopathological changes in the placentas of patients with GDM and compare them with the placentas of the healthy control group.
 Material and methods: This experimental non-randomized case-control study was conducted with 40 GDM patients and 40 healthy pregnant women at Dicle University Faculty of Medicine between March 2023 and December 2023. Placental tissues obtained following cesarean delivery were subjected to routine tissue processing. Placental samples were stained with hematoxylin-eosin and examined histopathologically using a light microscope.
 Results: When histopathological findings were compared between the GDM and control groups, villous degeneration, congestion in blood vessels, fibrinoid accumulation, inflammation and intervillous hemorrhage were higher in the GDM group than in the control group (p<0.001).
 Conclusion: The intricate relationship between GDM and placental pathology underscores the profound impact of metabolic changes on placental structure and function throughout pregnancy. Understanding these pathological changes is crucial for elucidating the progression of GDM and its implications for maternal and fetal health, highlighting the importance of comprehensive placental analysis in managing pregnancies complicated by GDM.
 Keywords: Gestational diabetes, hematoxylin-eosin staining, histopathological examination

Fetal Hypoxia Detection Using Machine Learning: A Narrative Review

Fetal hypoxia is a condition characterized by a lack of oxygen supply in a developing fetus in the womb. It can cause potential risks, leading to abnormalities, birth defects, and even mortality. Cardiotocograph (CTG) monitoring is among the techniques that can detect any signs of fetal distress, including hypoxia. Due to the critical importance of interpreting the results of this test, it is essential to accompany these tests with the evolving available technology to classify cases of hypoxia into three cases: normal, suspicious, or pathological. Furthermore, Machine Learning (ML) is a blossoming technique constantly developing and aiding in medical studies, particularly fetal health prediction. Notwithstanding the past endeavors of health providers to detect hypoxia in fetuses, implementing ML and Deep Learning (DL) techniques ensures more timely and precise detection of fetal hypoxia by efficiently and accurately processing complex patterns in large datasets. Correspondingly, this review paper aims to explore the application of artificial intelligence models using cardiotocographic test data. The anticipated outcome of this review is to introduce guidance for future studies to enhance accuracy in detecting cases categorized within the suspicious class, an aspect that has encountered challenges in previous studies that holds significant implications for obstetricians in effectively monitoring fetal health and making informed decisions.

The Importance of Therapeutic Nutrition in Pregnancy: A Comprehensive Review

Pregnancy is a critical period in a woman's life where proper nutrition plays a pivotal role in maternal and foetal health. Therapeutic nutrition interventions during pregnancy have gained increasing attention due to their potential to prevent complications and promote optimal outcomes for both the mother and the developing foetus. This review aims to explore the importance of therapeutic nutrition in pregnancy by examining its impact on maternal health, foetal development, and long-term outcomes. Key aspects such as macronutrient and micronutrient requirements, dietary interventions, and their effects on pregnancy outcomes will be discussed. Additionally, the review will address the significance of nutritional counselling and education in prenatal care. Understanding the role of therapeutic nutrition in pregnancy is essential for healthcare providers to optimize maternal and foetal health outcomes.

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.

Clinical Application of Reticulocyte Maturity Indices in Early Diagnosis of Iron Deficiency Anemia in the First Trimester of Pregnancy

Background: Iron deficiency anemia (IDA) is a prevalent global health issue, particularly affecting pregnant females due to increased iron demands during pregnancy. In Pakistan, IDA remains a significant concern, posing challenges to maternal and child health. Early detection and management of iron deficiency are crucial for improving pregnancy outcomes.
 Objective: This study aims to investigate the iron status and associated hematological parameters among pregnant females during the first trimester in Islamabad, Pakistan.
 Methodology : This cross-sectional study, conducted in collaboration with the Pakistan Atomic Energy Commission (PAEC) and the Pakistan Institute of Medical Sciences (PIMS), aimed to investigate the iron status among first-trimester pregnant females in Islamabad, Pakistan.Laboratory investigations encompassed hemoglobin and serum ferritin assays, reticulocyte counts, and other red blood cell parameters. Participants were categorized into distinct iron status groups based on these evaluations. Utilizing SPSS version 25, statistical analysis followed ethical protocols, striving to uncover discrepancies in hematological parameters across the various iron status groups.
 Results : Among 340 first-trimester pregnant women, three iron status groups were identified. Group 1 (n = 102) had low ferritin despite normal Hb, with elevated immature reticulocytes. Group 2 (n = 150) showed normal iron parameters, while Group 3 (n = 88) had high reticulocyte counts. Group 2 exhibited superior erythrocyte indices and higher ferritin levels than Groups 1 and 3. Group 3 displayed the poorest indices and elevated immature reticulocytes. These findings highlight variations in iron status and reticulocyte maturation among pregnant women.
 Conclusion: This study underscores the high prevalence of iron deficiency anemia among first-trimester pregnant females in Islamabad, Pakistan. Variations in red blood cell parameters and serum ferritin levels highlight the importance of early iron status assessment for optimizing maternal and foetal health outcomes.

A Study of Frequency of Anemia in Pregnant Females in Tertiary Care Hospital, Islamabad

Background: Anemia is among the most public hematological disorders, especially in pregnancy. It is a nutritional deficiency disorder that affects pregnant women, mainly in underdeveloped countries. Pregnant women who suffer from anemia often have bad pregnancy outcomes and may lead to difficulties that endanger both the mother's and the fetus's health. This study aimed was to determine the frequency of anemia among pregnant women in tertiary care hospitals in Islamabad. Material and Methods: This cross-sectional investigation was carried out in the Dr. Akbar Niazi Teaching Hospital's pathology and gynecology department in Islamabad. All the pregnant women who visited for antenatal check-ups from January 2021 to December 2021 were involved in the study. Data was taken through a specially designed proforma and statistical analysis was accomplished using SPSS version 21. Results: A total number of 93 pregnant females were enrolled in the study. The average age of pregnant women was 30.6 ± 6.0 (20-43). The average hemoglobin in our study population was 11.1± 1.4 (8-13 g/dL). The mean range of WBC counts was 11,304/mm3 ±7722 (4100/mm3 - 81000/mm3), the mean value of RBC count was 4.1 mil/mm3 ± 0.6 (2-5 mil/mm3). The overall prevalence of anemia in pregnant females was 45% (n=42). Out of 42 pregnant anemic women, 25 (59%) had normocytic normochromic type of anemia, 15 (36%) had microcytic type of anemia, and 2 (5%) had macrocytic type of anemia. Mild anemia was recorded in 26 (30%) of the pregnant females, while moderate anemia was recorded in 16 (17%) of the pregnant females, and 51 (55%) of the pregnant females had no anemia. Conclusion: Anemia was found in the majority of pregnant females visiting tertiary care teaching hospitals. The frequency of mild anemia was high and also according to severity. The most common morphological type of anemia was normocytic normochromic. The overall prevalence of anemia in pregnancy was 45% (n=42).55% of pregnant women were non-anemic and new severe anemia was detected.

Machine Learning Approaches Predicting the Best Features of Child Birth Using Support Vector Machine (SVM) Algorithm

Cesarean childbirth, though often necessary for medical reasons, carries inherent risks and impacts maternal and neonatal health. Predicting the likelihood of cesarean delivery can assist healthcare providers in making informed decisions and optimizing maternal care. In this study, we propose an ensemble machine learning approach to predict cesarean childbirth based on maternal and fetal health data. First, we collect comprehensive data including maternal age, BMI, gestational age, fetal weight, previous cesarean history, and other relevant factors. After preprocessing the data to handle missing values and encode categorical variables, we select informative features using correlation analysis and domain expertise. Next, we employ various ensemble machine learning methods, including Voting Classifiers, Bagging, Random Forest, Boosting, and Stacking. These methods combine predictions from multiple base learners, leveraging their diverse strengths to enhance predictive accuracy.

Reviewing the art of safe prescription practices: A checklist for the use of psychotropic drugs during pregnancy

Half of the women diagnosed with a mental health condition requiring regular medication have previously given birth to children. A dilemma arises when deciding whether to continue medication to treat the mother’s illness or potentially cease or replace medication in the interests of their child. This study endeavors to examine the challenges associated with prescribing psychotropic medications to pregnant women experiencing mental health disorders. Its primary objective is to furnish a checklist delineating essential considerations for prescribers in such cases. The investigation underscores the pivotal equilibrium required in addressing the mental health of the mother while mitigating risks to the developing fetus. The paper delves into the nuances of decision-making within this framework, highlighting the importance of a collaborative health-care approach coupled with personalized treatment strategies. These strategies may encompass modifications in medication regimens and the incorporation of non-pharmacological interventions. The prescription of psychotropic medications to pregnant women with mental health conditions presents complex challenges and demands consideration. Striking a critical balance is imperative, as it entails managing the mother’s mental health while minimizing potential risks to the developing fetus. The decision-making process is nuanced, influenced by factors such as the teratogenic potential of specific medications, the risk of neonatal withdrawal syndrome, and the potential for adverse outcomes in maternal and fetal health if psychiatric conditions remain untreated. Pre-conception counseling and maternal-fetal medicine services are beneficial tools in navigating this balance. Predictors of the necessity for medication during pregnancy include the patient’s diagnosis, severity of prior episodes, and responsiveness to treatment. The dynamic landscape of pharmaceutical research underscores the importance for prescribers to actively engage with evolving literature, ensuring the provision of accurate and up-to-date advice. Effective shared decision-making is of paramount significance in instilling confidence and assuring the patient.

Dilation of Pregnant Rat Uterine Arteries with Phenols from Extra Virgin Olive Oil Is Endothelium-Dependent and Involves Calcium and Potassium Channels.

During pregnancy, uterine vasculature undergoes significant circumferential growth to increase uterine blood flow, vital for the growing feto-placental unit. However, this process is often compromised in conditions like maternal high blood pressure, particularly in preeclampsia (PE), leading to fetal growth impairment. Currently, there is no cure for PE, partly due to the adverse effects of anti-hypertensive drugs on maternal and fetal health. This study aimed to investigate the vasodilator effect of extra virgin olive oil (EVOO) phenols on the reproductive vasculature, potentially benefiting both mother and fetus. Isolated uterine arteries (UAs) from pregnant rats were tested with EVOO phenols in a pressurized myograph. To elucidate the underlying mechanisms, additional experiments were conducted with specific inhibitors: L-NAME/L-NNA (10-4 M) for nitric oxide synthases, ODQ (10-5 M) for guanylate cyclase, Verapamil (10-5 M) for the L-type calcium channel, Ryanodine (10-5 M) + 2-APB (3 × 10-5 M) for ryanodine and the inositol triphosphate receptors, respectively, and Paxilline (10-5 M) for the large-conductance calcium-activated potassium channel. The results indicated that EVOO-phenols activate Ca2+ signaling pathways, generating nitric oxide, inducing vasodilation via cGMP and BKCa2+ signals in smooth muscle cells. This study suggests the potential use of EVOO phenols to prevent utero-placental blood flow restriction, offering a promising avenue for managing PE.

Seroprevalence of Syphilis among Pregnant Women Attending Antenatal Care in Yaqshiid District, Mogadishu, Somalia

Background: The prevalence of syphilis among pregnant women in Somalia has been poorly studied, despite its significant impact on maternal and fetal health. In Somalia, the last syphilis study was conducted approximately 30 years ago, leaving a critical knowledge gap regarding the current epidemic of syphilis among pregnant women. Materials and methods: From January 2023 to April 2023, a hospital-based cross-sectional study was conducted on maternal and child health. A total of 300 pregnant women were included in the study, and the seroprevalence of syphilis was determined using the Venereal Disease Research Laboratory. This one-step quick diagnostic test cassette was used as the preliminary screening tool, and Positive results were confirmed using the full chemiluminescence immunoassay (CLIA) analyzer MAGLUMI. A structured questionnaire was used to collect demographic characteristics and knowledge regarding syphilis transmission and mother-to-child transmission. SPSS Version 27.0 was used to analyze the gathered data. Statistical significance was set at p < 0.05. Results:  Overall, 5.3% (16/300) of pregnant women had syphilis seroprevalence. Seroprevalence rates were higher in women aged 24-34 (50.0%). There were significant relationships between syphilis infection and education (p < 0.000), occupation (p < 0.000), and residence (p = 0.002). Furthermore, a significant majority of pregnant women (78%) were unaware of syphilis transmission routes and its correlation to HIV risk (81.7%). Stillbirths constituted 23.3% of pregnancy-related problems, whereas 17% of pregnant women had a prior record of blood transfusions. Conclusions: The study found an alarming syphilis seroprevalence in pregnant women, especially in certain demographic groups. The lack of knowledge of syphilis transmission and its effects highlights the necessity for targeted education. Improved prenatal care, health awareness, and effective prevention should lessen the effects of syphilis on mother and newborn health.

SCUBE1 Promotes Gestational Diabetes Mellitus: A Bioinformatics and Experimental Investigation.

Gestational diabetes mellitus (GDM) is one of the most common metabolic diseases in pregnant women, posing significant risks to the life and health of both mothers and fetuses. With improving living standards, the incidence of GDM is increasing rapidly. Therefore, understanding the underlying mechanism of GDM is of paramount importance. We downloaded two datasets from the Gene Expression Omnibus (GEO) database, containing sequencing data specifically related to "gestational diabetes" and "placenta". By merging these two datasets, a mRNA expression dataset was obtained and subjected to bioinformatics analyses. To screen out corresponding genes, differential analysis and weighted correlation network analysis (WGCNA) were carried out. Lasso, support vector machine and random forest analyses were subsequently performed for identifying key genes from the differentially expressed genes (DEGs) jointly screened out through differential analysis and WGCNA. Afterwards, immunoinfiltration and correlation analysis were performed to screen immune cells that play a role in disease progression and explore the correlation between the screened key genes and immune cells, after which Western Blot, quantitative real-time polymerase chain reaction, Immunohistochemistry, methyl thiazolyl tetrazolium, flow cytometry, scratch and Transwell assays were, respectively, performed for verification. For further verification, we found that the expression levels of MAP6D1 and SCUBE1 in embryonic tissues of GDM patients was higher compared to those of healthy pregnant women, which was consistent with the results of bioinformatics analysis. Consequently, SCUBE1 was selected for follow-up experiment. In order to explore the role of SCUBE1 in the development of GDM, we treated the trophoblastic cells HTR-8/SVneo with high glucose, and on this basis downregulated the expression of SCUBE1. Through further analysis, we observed that SCUBE1 had a role in reducing cell activity, migration and invasion, and promoting cell apoptosis. In summary, SCUBE1 promotes the development of GDM by increasing cell apoptosis and reducing cell activity, migration, and invasion.

It is time to explore the impact of length of gestation and fetal health on the human lifespan.

A recently proposed principal law of lifespan (PLOSP) proposes to extend the whole human lifespan by elongating different life stages. As the preborn stage of a human being, gestation is the foundation for the healthy development of the human body. The antagonistic pleiotropy (AP) theory of aging states that there is a trade-off between early life fitness and late-life mortality. The question is whether slower development during the gestation period would be associated with a longer lifespan. Among all living creatures, the length of the gestation period is highly positively correlated to the length of the lifespan, although such a correlation is thought to be influenced by the body sizes of different species. While examining the relationship between lifespan length and body size within the same species, dogs exhibit a negative correlation between lifespans and body sizes, while there is no such correlation among domestic cats. For humans, most adverse gestational environments shorten the period of gestation, and their impacts are long-term. While many issues remain unsolved, various developmental features have been linked to the conditions during the gestation period. Given that the length of human pregnancies can vary randomly by as long as 5 weeks, it is worth investigating whether a slow steady healthy gestation over a longer period will be related to a longer and healthier lifespan. This article discusses the potential benefits, negative impacts, and challenges of the relative elongation of the gestation period.

Investigating causal relationships between extensive peripheral immune cell phenotypes and preeclampsia: A bi-directional Mendelian randomization analysis.

Preeclampsia, a multifaceted condition during pregnancy characterized by hypertension and organ dysfunction, poses significant risks to both maternal and fetal health. This study aims to investigate the bidirectional causal relationship between peripheral immune cell phenotypes and preeclampsia using a two-sample Mendelian randomization (MR) approach. Genetic data from two sizable cohorts were utilized: 3757 individuals from Sardinia, providing information on 731 immune traits, and 200929 Finnish adult females, encompassing 6663 preeclampsia cases. Single-nucleotide polymorphisms served as instrumental variables. The MR analyses employed the inverse variance-weighted (IVW) method as the primary tool, supplemented by MR-Egger, weighted median, and weighted mode methods to enhance reliability and address potential heterogeneity and horizontal pleiotropy. Among the 731 immune cell phenotypes studied, 18 displayed a suggestive positive association (IVW p<.05) with heightened preeclampsia risk, while 20 exhibited a suggestive negative association linked to reduced risk. Following false discovery rate (FDR) adjustment, four immune phenotypes showed significant associations with decreased preeclampsia risk: CD27 on CD24+ CD27+ B cells (B-cell panel) (odds ratio [OR]=0.927, PFDR=0.061), CD33+ HLA DR+ CD14- absolute count (OR=0.963, PFDR=0.061), CD80 on plasmacytoid dendritic cells (OR=0.923, PFDR=0.061); and CD80 on CD62L+ plasmacytoid dendritic cells (OR=0.923, PFDR=0.061). In the reverse-direction MR analysis, no significant causal effects of preeclampsia on immune cell phenotypes were observed. This study provides quantifiable evidence linking specific immune cell phenotypes to the risk of developing preeclampsia. This novel understanding of the immunological aspects underlying preeclampsia's pathogenesis could lead to innovative therapeutic strategies centered on immune modulation.

A maternal ketogenic diet alters oviduct fluid nutrients and embryo histone acetylation in mice.

A ketogenic diet elevates blood β-hydroxybutyrate to concentrations that perturb the development, metabolism, histone acetylation (H3K27ac) and viability of preimplantation mouse embryos in vitro. However, whether a ketogenic diet alters β-hydroxybutyrate concentrations within female reproductive fluid is unknown. This study aimed to quantify glucose and β-hydroxybutyrate within mouse blood and oviduct fluid following standard diet and ketogenic diet consumption and to assess whether a maternal periconceptional ketogenic diet impacts in vivo embryo development and blastocyst H3K27ac. Female C57BL/6 x CBA mice were fed a standard or ketogenic diet (n=24 each) for 24-27 days. Glucose and β-hydroxybutyrate were quantified in blood via an electronic monitoring system, and in oviduct fluid via ultramicrofluorescence. The developmental grade of flushed blastocysts was recorded, and blastocyst cell number and H3K27ac was assessed via immunofluorescence. A maternal ketogenic diet elevated β-hydroxybutyrate in day 24 blood (P<0.001) and oviduct fluid (P<0.05) compared with a standard diet, whereas glucose was unchanged. A periconceptional ketogenic diet did not impact blastocyst cell number, however, significantly delayed blastocyst development (P<0.05) and reduced trophectoderm-specific H3K27ac (P<0.05) compared with standard diet-derived embryos. Maternal ketogenic diet consumption is therefore associated with reproductive tract nutrient changes and altered embryonic development and epigenetics in vivo. Future studies to assess whether periconceptional/gestational ketogenic diet consumption impacts human preimplantation, fetal, and long-term offspring development and health are warranted.

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.

Velocity-selective arterial spin labeling perfusion measurements in 2nd trimester human placenta with varying BMI

IntroductionProper placental development is crucial to fetal health but is challenging to functionally assess non-invasively and is thus poorly characterized in populations. Body mass index (BMI) has been linked with adverse outcomes, but the causative mechanism is uncertain. Velocity-selective arterial spin labeling (VS-ASL) MRI provides a method to non-invasively measure placental perfusion with robustness to confounding transit time delays. In this study, we report on the measurement of perfusion in the human placenta in early pregnancy using velocity-selective arterial spin labeling (VS-ASL) MRI, comparing non-obese and obese participants. MethodsParticipants (N = 97) undergoing routine prenatal care were recruited and imaged with structural and VS-ASL perfusion MRI at 15 and 21 weeks gestation. Resulting perfusion images were analyzed with respect to obesity based on BMI, gestational age, and the presence of adverse outcomes. ResultsAt 15 weeks gestation BMI was not associated with placental perfusion or perfusion heterogeneity. However, at 21 weeks gestation BMI was associated with higher placental perfusion (p < 0.01) and a decrease in perfusion heterogeneity (p < 0.05). In alignment with past studies, perfusion values were also higher at 21 weeks compared to 15 weeks gestation. In a small cohort of participants with adverse outcomes, at 21 weeks lower perfusion was observed compared to participants with uncomplicated pregnancies. DiscussionThese results suggest low placental perfusion in the early second trimester may not be the culpable factor driving associations of obesity with adverse outcomes.

Utilization of Antenatal Care Services among Patients Presenting in Ayub Teaching Hospital

Regular use of antenatal care services during pregnancy has a positive impact on maternal and fetal health and serves as a tool to reduce maternal morbidity and mortality. Objective: To assess the utilization of antenatal care services among pregnant women at Ayub Teaching Hospital in Abbottabad, Pakistan. Methods: This descriptive study was conducted in Ayub Teaching Hospital in Abbottabad, KPK province, Pakistan. Data were collected on paper-based questionnaires and analyzed using SPSS. A total of 208 patients participated. Results: Key findings from the study indicated that the average age of participants was 28 years. The majority of women came from lower-middle-class backgrounds. The study also revealed a wide range of educational backgrounds among participants. Most women had prior pregnancy experience. The study found that a significant percentage of women initiated antenatal visits during the first trimester with drop in visits during the third trimester. Understanding the reasons for seeking care is crucial, with various medical concerns and routine check-ups cited. Barriers to utilization included lack of awareness, family issues, and geographical distance. Additionally, only 72% of women reported taking recommended supplements during pregnancy. Conclusions: The study identified that women from middle income group with previous experience of pregnancy seek antenatal care in first trimester with various pregnancy problems but visits were not consistent. Major reason for non-utilization of services was unawareness about the services.  

Assessment of fetal resistance to hypoxia using the Stange test as an adjunct to Apgar scale assessment of neonatal health status

It has been established that the cause of biological death of fetuses in stillbirths and the cause of neonatal encephalopathies in live births is hypoxic brain cell damage in fetuses. Timely cesarean section remains the most effective way to preserve fetal life and health in the face of lethal intrauterine hypoxia. However, there is no universally recognized methodology for assessing fetal adaptation reserves to hypoxia and no methodology for selecting the type of delivery in order to perform a timely cesarean section if necessary. The Apgar score, which has been used since 1952, allows assessment of neonatal health at 1 and 5 minutes after birth, but this assessment is made without taking into account the health of the fetus before delivery. In recent years, it has been established that the outcome of fetal hypoxia is determined not only by its duration, but also by the amount of adaptive reserves available in the fetus to hypoxia. It was found that the duration of fetal immobility during apnea of a pregnant woman is an indicator of fetal resistance to hypoxia. In 2011, a method of assessing fetal resistance to intrauterine hypoxia based on the Stange test was developed in Russia. It has been found that the maximum duration of fetal immobility during maternal apnea is normally more than 30 seconds, while in the presence of fetal signs of fetoplacental insufficiency it does not reach 30 seconds, and in the presence of signs of severe fetoplacental insufficiency it does not reach 10 seconds. Therefore, it was proposed to consider good fetal resistance to hypoxia as an indication for vaginal delivery, and poor fetal resistance to hypoxia as an indication for cesarean section. A technique for assessing fetal resistance to hypoxia is described that has been developed for independent use by every pregnant woman. It is shown that it is sufficient for her to have a stopwatch and to be able to record the maximum period of fetal immobility during voluntary apnea. It is hoped that a measure of fetal resistance to hypoxia could be a meaningful complement to the Apgar score of neonatal health. It is envisioned that the use of a modified Stange test could help physicians prevent stillbirths and neonatal encephalopathies.

PREVALENCE AND MANAGEMENT OF MATERNAL DEATHS DUE TO ECLAMPSIA AND HELLP SYNDROME: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Eclampsia and HELLP syndrome, are serious complications during pregnancy, and pose significant risks to both mother and fetus. Early management of eclampsia and HELLP syndrome before delivery may improve the outcomes for patients. This study aims to systematically review the literature on the prevalence and management of eclampsia and HELLP syndrome regarding maternal deaths in the last 10 years. Methods: This systematic review used the PRISMA 2020 guidelines and focused on full-text English literature published between 2014 and 2024. Editorials and review papers from the same journal, as well as submissions without a DOI, were not considered. Literature was gathered from online databases such as PubMed, SagePub, and ScienceDirect. Result: In the initial stages, our research team retrieved a total of 9400 articles from reputable sources such as PubMed, SagePub, and Science Direct. After a meticulous three-level screening process, only six articles were deemed directly relevant to our ongoing systematic review and were selected for further analysis through thorough full-text reading. Conclusion: Eclampsia and HELLP syndrome are both conditions that require treatment. Pregnancy termination and magnesium supplementation prevent eclampsia, while glucocorticoids are crucial for treating HELLP syndrome. Treatment should consider baseline features and long-term implications to address maternal and fetal health and well-being.