Fetal Outcomes Research Articles

Maternal, Fetal, and Kidney Outcomes of Viable Pregnancies in Women with Underlying Kidney Disease: Experience from a Single Tertiary Care Center in India

Background There is a dearth of data from resource-limited settings on pregnancy outcomes in women with kidney disease. We investigated the maternal, fetal, and renal outcomes of pregnancies amongst women with kidney disease and compared these outcomes with normal pregnancy outcomes. Materials and Methods This was a single-center retrospective observational study. The maternal, fetal, and renal outcomes of women with kidney dysfunction who delivered at the study center after at least 22 weeks of gestation (viable pregnancy) between January 2012 and December 2021 were analyzed. The study results were also compared with the outcomes of normal pregnancy. Results Two hundred and one deliveries were included in the study, constituting 0.14% of all deliveries during the study period. Lupus nephritis (39.3%) and Immunoglobulin A nephropathy (11.4%) were the most common underlying kidney diseases. The mean (±SD) gestational age at delivery was 34.9 (±3.7) weeks. A higher cesarean section rates (45.3%) were observed in these high-risk pregnancies. Low birth weight was observed in 51.7% of all deliveries. Renal outcome regarding proteinuria and estimated glomerular filtration rate was excellent. Renal transplant patients had unfavorable outcomes. More than 45% of patients had term deliveries with normal birth weight. Conclusion Satisfactory maternal, fetal, and renal outcomes can be achieved with proper pre-pregnancy counseling and multidisciplinary care in women with kidney diseases, even in resource-limited settings.

Abnormal microRNA expression profile at early stages of gestation in pregnancies destined to develop placenta previa

BackgroundPlacenta previa is the abnormal implantation of the placenta into the lower segment of the uterus, is associated with adverse maternal and fetal outcomes such as placenta accreta spectrum disorders, antepartum and postpartum hemorrhage, fetal growth restriction, prematurity, stillbirth and neonatal death, thrombophlebitis, and septicemia. The aim of the study was to assess retrospectively how the later onset of placenta previa affects the microRNA expression profile in the whole peripheral blood during the first trimester of gestation.MethodsRegarding the occurrence of the association between aberrant microRNA expression profiles at early stages of gestation and later onset of various pregnancy-related complications, we selected for the study pregnancies developing placenta previa as the only pregnancy-related disorder. In total, 24 singleton pregnancies diagnosed with placenta previa that underwent first-trimester prenatal screening and delivered on-site within the period November 2012–May 2018 were included in the study. Overall, 80 normal pregnancies that delivered appropriate-for-gestational age newborns after completing 37 weeks of gestation were selected as the control group based on the equality of the length of biological sample storage.ResultsDownregulation of multiple microRNAs (miR-20b-5p, miR-24-3p, miR-26a-5p, miR-92a-3p, miR-103a-3p, miR-130b-3p, miR-133a-3p, miR-145-5p, miR-146a-5p, miR-155-5p, miR-181a-5p, miR-195-5p, miR-210-3p, miR-342-3p, and miR-574-3p) was observed in pregnancies destined to develop placenta previa. The combination of seven microRNAs (miR-130b-3p, miR-145-5p, miR-155-5p, miR-181a-5p, miR-210-3p, miR-342-3p, and miR-574-3p) showed the highest accuracy (AUC 0.937, p < 0.001, 100.0% sensitivity, 83.75% specificity) to differentiate, at early stages of gestation, between pregnancies with a normal course of gestation and those with placenta previa diagnosed in the second half of pregnancy. Overall, 75% of pregnancies destined to develop placenta previa were correctly identified at 10.0% FPR.ConclusionConsecutive large-scale analyses must be performed to verify the reliability of the proposed novel early predictive model for placenta previa occurring as the only pregnancy-related disorder.

Would the utilization of sFlt-1/PlGF ratio in clinical practice prevent unnecessary hospital admissions of cases with preeclampsia?

ABSTRACT Objectives Preeclampsia (PET) is a serious pregnancy complication with potential adverse maternal and fetal outcomes. Recent research has examined the soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio for predicting PET. The study aimed to assess the efficacy of the sFlt-1/PlGF ratio in ruling out unnecessary hospital admission and PET. Methods sFlt-1/PlGF ratio was performed in patients as clinically indicated. Results The sFlt-1/PlGF ratio at a cutoff value of 51 predicted hospital admission with AUC, PPV, NPV, sensitivity, and specificity of 85%, 44%, 98%, 88%, and 85%, respectively. Additionally, at a cutoff value of 38, the sFlt-1/PlGF ratio predicted the short-term development of PET with PPV, NPV, sensitivity, and specificity of 42%, 100%, 100%, and 81%, respectively. The PlGF alone at a cutoff value of 193.36 predicted hospital admission with AUC, PPV, NPV, sensitivity, and specificity of 87%, 80%, 97%, 67%, and 98%, respectively. Moreover, at a cutoff value of 51.35, the PlGF alone predicted the development of PET with PPV, NPV, sensitivity, and specificity of 54%, 98%, 88%, and 90%, respectively. There was a significant association between a high sFlt-1/PlGF ratio and developing PET. Conclusion The sFlt-1/PlGF ratio and PlGF are promising for ruling out PET and hospital admission in pregnant women.

Urinary miRNA Expression in Pre-Eclampsia During Early and Mid-Pregnancy

Background: Pre-eclampsia (PE) is a serious condition affecting 2–8% of pregnancies worldwide, leading to high maternal and fetal morbidity and mortality. MicroRNAs (miRNAs), small non-coding RNA molecules, have emerged as potential biomarkers for various pregnancy-related pathologies, including PE. MiRNAs in plasma and serum have been extensively studied, but urinary miRNAs remain underexplored, especially during early pregnancy. This study aimed to investigate the urinary miRNA expression profiles in women with pre-eclampsia during the first and second trimesters. Materials and Methods: A prospective study was conducted using 48 urine samples from 24 pregnant women (n = 12 pre-eclampsia and n = 12 controls). Urine samples were collected in the first (9–13 weeks) and second (22–24 weeks) trimesters. MiRNA isolation, library preparation, and high-throughput sequencing were performed, followed by differential expression and enrichment analyses. Results: In the first trimester, five miRNAs were dysregulated in PE in comparison with the control group (hsa-miR-184, hsa-miR-203a-3p, hsa-miR-205-5p, hsa-miR-223-3p—downregulated; hsa-miR-1-3p—upregulated). In the second trimester, hsa-miR-205-5p and hsa-miR-223-3p were downregulated, and hsa-miR-9-5p, hsa-miR-1-3p, and hsa-miR-206 were upregulated. Conclusions: Our study identified differentially expressed miRNAs in the urine of pre-eclamptic patients during early pregnancy. These findings suggest that specific urinary miRNAs could serve as non-invasive biomarkers for the early detection and risk assessment of pre-eclampsia. The changes in the level of differential expression of miRNAs during gestation highlight their role in the progression of PE. Further research and validation with a larger cohort are needed to explore their clinical potential for improving maternal and fetal outcomes through early intervention.

Effect of Asymptomatic Bacteriuria During Pregnancy on Maternal and Fetal Outcome

Effect of Asymptomatic Bacteriuria During Pregnancy on Maternal and Fetal Outcome

Use of prenatal ultrasound findings to predict postnatal outcome in fetuses with lower urinary tract obstruction.

Lower urinary tract obstruction (LUTO) is a chronic condition with a spectrum of outcomes. It is usually suspected prenatally based on ultrasound features (USFs). Given the unknown postnatal trajectory and the potential for significant morbidity and mortality, many families choose termination of pregnancy (TOP), often based on USFs alone. Herein, we sought to develop a tool that can be used to predict postnatal outcome based on combinations of USFs, which can aid prenatal counseling and parental decision-making. This was a retrospective study of cases with suspected fetal LUTO that were seen at a high-risk fetal center and a tertiary pediatric center in Canada. Data were collected on USFs, prenatal/postnatal death and postnatal need for transplantation and/or dialysis. USFs from pregnancies with a gestational age of 13-26 weeks on initial ultrasound at the high-risk fetal center that underwent TOP were collected and matched to fetuses with comparable prenatal USFs that were not terminated, which had a known postnatal outcome, to build a random forest model. The random forest model was fitted for each outcome (death, dialysis or transplantation) and tested for accuracy using leave-one-out cross-validation. Each predictor was assessed independently with combined importance when accounting for other predictors. The model was used to predict the most likely postnatal outcomes for cases of TOP had the pregnancy been continued. USF data from 85 cases of TOP and 125 cases of expectantly managed pregnancy with prenatally suspected LUTO were retrieved. For expectantly managed cases, there was a median follow-up duration of 5.7 (interquartile range, 0.2-14.5) years among the liveborn infants. There were 14 prenatal and 22 postnatal deaths in the expectantly managed cohort. The random forest model demonstrated the highest predictive accuracy for transplantation (77% accuracy, 50% sensitivity, 80% specificity), followed by death (72% accuracy, 83% sensitivity, 67% specificity) and dialysis (71% accuracy, 70% sensitivity, 71% specificity). For the TOP cohort, had the pregnancies been continued, the model predicted transplantation and dialysis in 21/85 (25%) and 37/85 (44%) cases, respectively; pre- or postnatal death was predicted in 69/85 (81%) cases. Our data suggest that it is possible to predict death and postnatal transplantation and/or dialysis from USFs in fetuses with suspected LUTO with acceptable accuracy. Predictive accuracy will improve with continued follow-up of more patients, enabling more personalized prenatal counseling and more informed decision-making for families. © 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.

Adverse Fetomaternal Outcomes in Obese Pregnant Women with Gestational Hypertension

Objective: To determine the incidence of adverse fetomaternal outcomes of gestational hypertension in pregnant obese women. Methodology: The six-month descriptive observational study at Liaqat Memorial Hospital, Kohat, with 127obesepregnantwomenaged15-45.Participantswere selectedbasedonsingletonpregnancy more than 24 weeks gestation according to scan or LMP and a blood pressure of >140/90 mmHg on two different occasions without proteinuria, or a single reading of BP of 160/110mmHg with a BMI over 30 kg/m². Baseline data (maternal age, parity, BMI gestational age, education, socioeconomic status, family income, and residence) were collected. Fetomaternal complications were recorded by following up the patients till delivery. Results: The study included obese pregnant women with an average age of 33.2± 1.5 years and a mean BMI of 31.2 ± 5.6. Most participants had a median parity of 3, with a majority belonging to urban areas (51.1%) , having middle socioeconomic status (48.8% ). The adverse fetal outcomes ranged from preterm birth (16.4%),fetal growth restriction (12.6%),fetal hypoxia (8.9%)andlastlyperinataldeath(5.2%).Theadversematernaloutcomeswerepostpartumhemorrhage (16.4%), placental abruption (8.3%) , ecclempsia (7.2%) , HELLPsyndrome (4.1%) and maternal mortality (3.1%). Adverse maternal and fetal outcomes preterm labor postpartum hemorrhage, eclampsia, and placental abruption, fetal growth restriction and intrauterine fetal death outcomes being significantly higher in moderate gestational hypertension compared to mild gestational hypertension p=0.023, p=0.030, p=0.020, p=0.011, p=0.035 and p=0.022) respectively and adverse outcome placental abruption, eclampsia, and fetal growth restriction being significantly higher in class II obesity when compared to class I (p value= p=0.045 p=0.041 p=0.038)respectively Conclusion: Adverse fetomaternal outcomes are significantly affected by the severity of gestational hypertension andclass of obesity.Prenatal identification ofrisk factors in these women couldlowermaternal and fetal morbidity and mortality rates, underscoring the importance of an effective prenatal care system. Keywords: Obesity, Maternal Health, Fetal Growth Retardation, Pre- Eclampsia, Premature Birth

Pregnancy in patients with chronic kidney disease undergoing dialysis.

Women with chronic kidney disease are less likely to become pregnant and are more susceptible to pregnancy complications when compared to patients with normal kidney function. As a result, these are considered high-risk pregnancies, both maternal and fetal. Over the years, there has been an increase in the incidence of pregnancies in dialysis patients, and an improvement in maternal and fetal outcomes. It is believed that the optimization of obstetric and neonatal care, the adjustment of dialysis treatment (particularly the increase in the number of hours and weekly frequency of dialysis sessions), and the use of erythropoiesis-stimulating agents have provided better metabolic, volume, blood pressure, electrolyte, and anemia control. This review article aims to analyze pregnancy outcomes in chronic kidney disease patients undergoing dialysis and to review nephrological medical management in this scenario. Due to the growing interest in the subject, clinical recommendations for care practice have become more consistent in both drug and dialysis management, aspects that are addressed in this review.

Novel maternal risk factors for preeclampsia prediction using machine learning algorithms

<div align="center"><table width="590" border="1" cellspacing="0" cellpadding="0"><tbody><tr><td valign="top" width="387"><p>Preeclampsia and eclampsia are the most common obstetric disorders associated with poor outcomes for women, fetuses, and newborns throughout the perinatal period. The study’s primary objective was to assess the accuracy of novel high-risk factors using MLA in predicting preeclampsia. The study included 400 pregnant women and used 27 novel high-risk factors to predict preeclampsia. The target variables for predicting preeclampsia are systolic and diastolic blood pressures. Various algorithms, including DT, RF, Gradient Boosting, SVM, K-Neighbors, LGBM, MLP, Ada Boost Classifier, and Extra Trees Classifier are used in the analysis. The accuracy and precision of the LGBM Classifier (0.85 and 0.9583 with F1 0.7188), Support Vector Classifier (0.8417 and 0.92 with F1 0.7077), Decision Tree (0.825 and 0.913 with F1 0.6667), and Extra Trees (0.8167 and 0.9091 with F1 0.6452) are found to be better algorithms for prediction of preeclampsia than those of the other models used in the study. According to the novel high-risk factors score, 17.5% of pregnant women were identified as being at high risk for preeclampsia during the first trimester, which increased to 18.7% in 3rd trimester; in addition, 16% of pregnant women had a BP of 140/90 mmHg and the above. Novel, high-risk scores and MLA can effectively predict preeclampsia at an early period.</p></td></tr></tbody></table></div>

How have the triplet pregnancies baseline characteristic and its outcomes changed over the last two decades?

Triplet pregnancies are high-risk pregnancies, and baseline characteristics and gestational care protocols have changed over years. The objective of this study is to compare the baseline characteristics and the prevalence of maternal, fetal, obstetric, and perinatal outcomes in triplet pregnancies between 2013 and 2024 (PII) and 2000 and 2012 (PI). This is a single-center, observational retrospective case-control study that includes all triplet pregnancies followed up at the La Paz University Hospital between 2000 and 2024. Univariate and multivariate statistical studies were performed. 234 triplet pregnancies were analyzed: 140 (PI group) and 94 (PII group). Maternal age (P = 0.04) and nulliparous women (P < 0.01) were higher in PII group, although ART pregnancies were more frequent in PI (P = 0.04). The dichorionic triamniotic pregnancies percentage was significantly higher (P < 0.01) in PII group and the trichorionic triamniotic percentage was significantly higher (P < 0.01) in PI group. Preeclampsia (P < 0.01), intrauterine growth restriction (P < 0.01), fetal death (P < 0.01), neonatal death (P = 0.04), and small for gestational age (P < 0.01) were significantly more frequent in PII group. Threatened preterm labour (P < 0.01) and extreme premature births (P < 0.01) were significantly more frequent in the PI group. After adjusting for confounders, premature birth was the only one that remained significant (P = 0.01). The baseline characteristics of the PII group (higher maternal age, more nulliparous women, and higher rate of dichorionic triamniotic) might be associated with a higher rate of obstetric and fetal complications during this period. Premature births and threatened preterm labour have decreased over the years, probably related to the advances in gestational care.

Acute confusion in pregnancy

If a woman is acutely confused in pregnancy, she will most likely present to an unscheduled care setting outside of maternity services. It is therefore essential that all clinicians working within general medicine are comfortable assessing pregnant women in this context. Useful resources are available to support assessing pregnant women that present acutely, however confusion is beyond them. This article discusses important aspects to consider when assessing pregnant women and places emphasis on a systematic approach to ensure obstetric and non-obstetric causes of confusion have been considered. Certain life-threatening diagnosis’ have been further discussed in more detail (Wernicke's encephalopathy, hyponatreamia, hypercalcamia, acute fatty liver of pregnancy and thrombotic thrombocytopenia purpura). These conditions have been chosen as there is a significant risk of maternal mortality and morbidity as well as poor fetal outcomes if not recognised and treated early.

Maternal and fetal outcomes in those with autoimmune connective tissue disease.

Autoimmune CTDs like systematic lupus erythematosus (SLE), systemic sclerosis (SSc), and rheumatoid arthritis (RA)predominantly affect women during reproductive years and are linked to maternal and fetal complications. We conducted a population-based, retrospective cohort study using the national inpatient data sample to compare maternal and fetal outcomes in patients with and without CTD delivering between October 2015 and December 2020. Regression analysis was performed and adjusted for multiple patient characteristics to compare outcomes. Our study comprised of 18,866,050 deliveries, of which 50,450 (0.02%) had autoimmune CTD, including 25,340 with SLE, 23,945 with RA, and 1,165 with SSc. Patients with CTDs had significantly higher odds of maternal death (aOR 3.898; 95% CI: 1.462-10.389, p = 0.007), hypertensive disorders (aOR 1.554; 95% CI: 1.456-1.659, p < 0.001), acute kidney injury (aOR 4.886; 95% CI: 3.934-6.069, p < 0.001), blood transfusions (aOR 1.853; 95% CI: 1.628-2.109, p < 0.001), peripartum cardiomyopathy (aOR 2.709; 95% CI: 1.492-4.917, p = 0.001), sepsis (aOR 2.112; 95% CI: 1.430-3.119, p < 0.001), and ARDS (aOR 1.623; 95% CI: 1.076-2.449, p = 0.021). Fetal outcomes were also worse, with higher odds of small for gestational age fetuses (aOR 1.926; 95% CI: 1.779-2.086, p < 0.001), stillbirth (aOR 1.644; 95% CI: 1.352-2.000, p < 0.001), and preterm labor (aOR 1.702; 95% CI: 1.574-1.841, p < 0.001). Patients with RA, SS, and SLE experience varying degrees of complications. Our study shows that pregnant patients with autoimmune CTDs have worse maternal and fetal outcomes compared to those without CTDs. The rates of adverse outcomes varies among CTD subtypes. Comprehensive preconception counseling and tailored management strategies are essential for optimizing outcomes in these patients. Key Points • Increased Maternal Complications: Patients with autoimmune CTDs had significantly higher odds of maternal death, hypertensive disorders, acute kidney injury, blood transfusions, peripartum cardiomyopathy, sepsis, and ARDS. • Adverse Fetal Outcomes: Higher odds of small for gestational age fetuses, stillbirth, and preterm labor were observed in patients with CTDs compared to those without. • CTD Subtype Variations: Complication rates varied among CTD subtypes, with SLE, RA, and SSc each presenting varying risks and outcomes.

Impacts of COVID-19 on Pregnancy Outcomes: A Retrospective Study

Background: This study compared outcomes of pregnant females with and without COVID-19 and their fetuses/newborns. Methods: This is a retrospective study from 2020 to 2023 utilizing the United States Collaborative Network of the TriNetX Database. We compared the outcomes of pregnant females with COVID-19 and pregnant females without COVID-19. Maternal outcomes evaluated were death, intubation, intensive care unit (ICU) admission, and premature rupture of membranes (PROM) within 9 months of the diagnosis of pregnancy. Fetal outcomes included preterm birth and intrauterine death (IUD). A subgroup analysis of outcomes was performed based on the mother’s vaccine status. Results: The risks of maternal death (RR = 1.97), maternal intubation (RR = 3.33), and maternal (ICU) admission (RR = 1.76) were significantly higher in pregnant females with COVID-19. For the neonate, there was a higher risk of preterm birth (RR = 1.12). When the confounders were eliminated with propensity matching, there was still an increase in maternal intubation (RR = 3.24) and maternal ICU admission (RR = 1.60). For the neonate/fetus, there was a decreased risk of PROM (RR = 0.83) and IUD (RR = 0.74) for the fetuses of the mothers with COVID-19. For the subgroup analysis, the mother was at an increased risk of ICU admission (RR = 0.04) when unvaccinated. Conclusions: There is an increased risk of poor outcomes for pregnant women infected with COVID-19; however, fetal outcomes are generally favorable. When unvaccinated, there was an increased risk of ICU admission for the mother.

Effects of Maternal Age on Fetus and Perinatal Outcomes in a Tertiary Care Center: An Observational Study

Introduction: The early and late pregnancy both can be hazardous for mother and child. The study aims to explore the maternal age group among Nepalese women who delivered in Tribhuvan University Teaching Hospital and its effects on perinatal outcomes.Methods: An observational cross-section study was carried out from February to September, 2023 with the records of maternity cases at a tertiary care hospital after receiving ethical approval from the Institutional Review Committee [Reference number: 130(6-11) E2-2 079/080]. The records of maternity cases of four years duration from April, 2018 onwards were included. Data was entered in Microsoft Excel 2016 and descriptive analysis was done.Results: Out of 13062 maternity cases, the prevalence of pregnancy in normal reproductive age was 12035 (92.13%). A total of 882 (6.67%) maternity cases were in advanced age and 145 (1.11%) were in teen age. The alive newborns which were more in normal reproductive age was 12008 (99.77%) and stillbirth which was more in teen age pregnancy was 4 (2.75%). The low-birth-weight newborns distributed more in teen age pregnancy was 44 (30.34%) and high birth weight newborns distributed more in advanced age pregnancy was 18 (2.04%).Conclusions: The abnormal birth weight and stillbirths were common in teen age and advanced age pregnancy.

Serial evaluation of morphological and biophysical placental attributes in women with normal outcome and preeclampsia.

The study's aim was to perform serial placental biometry and Doppler assessments in antenatal women and compare the characteristics of preeclampsia (PE) and normal outcome. This prospective cohort study was carried out after ethical clearance. Placental length (PL), thickness, and plavental volume (PV), along with the uterine artery (Ut), middle cerebral artery (MCA), and umbilical artery (UA) blood flow were evaluated serially at 11-14, 20-24, and 28-32 weeks of gestation. The women were followed until delivery, those with PE were considered cases, and those with no other adverse outcome were controls. The placental attributes between cases and controls were compared. A total of 135/1008 (13.4%) had hypertensive disorders of pregnancy (HDP) and 44/1008 (4.4%) had PE, and no maternal or fetal adverse outcomes were seen in 600 (59.5%) women. The PL and PV were significantly less in those with PE (P = 0.005) than in controls. The ratios of PL/Ut A PI and PV/Ut A PI were significantly lower in cases than in controls in all trimesters (P <0.001). In the first trimester, the area under the curve (AUC), sensitivity, and specificity of PV/Ut A PI for PE prediction were 0.801, 81.8%, and 70.5%, respectively. The sensitivity and specificity of the PL/Ut PI ratio was 81.8% and 70.5%, whereas that at 28-32 weeks was 73.3% & 70.7%. Placental parameters were significantly lower in PE than in normal outcome, and the ratios of PL/Ut A PI and PV/Ut A PI proved to be promising markers.

Remote blood pressure monitoring in women at risk of or with hypertensive disorders of pregnancy: A systematic review and meta-analysis.

Remote blood pressure monitoring refers to an organized framework that either allows clinicians to review home-based blood pressure readings and institute management, or provide participants with clear instructions for contacting care teams when blood pressure readings are out of prespecified targets. With widespread uptake of telemonitoring and mobile health in recent years, such models of care have been increasingly described in the literature. This study aimed to review remote blood pressure monitoring in pregnant and postpartum women who are at high-risk for or have an established diagnosis of hypertensive disorders of pregnancy, and its effect on maternal and fetal outcomes, healthcare utilization and psychosocial outcomes. PubMed, Medline, Embase, Cochrane Library, Web of Science and CINAHL databases were searched electronically in June 2024 to their inception. Included studies compared remote blood pressure monitoring with standard care. Remote blood pressure monitoring was pre-defined as any framework for measuring blood pressure remotely in pregnancy, with organized review by clinicians. Published full-text and study abstracts describing randomized controlled trials and observational studies were included. The study population was pregnant women at high-risk for developing pre-eclampsia or postpartum (<6 weeks) women with an established diagnosis of a hypertensive disorder of pregnancy. Remote blood pressure monitoring undertaken in the antenatal and postnatal periods were analyzed separately. This systematic review was conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement. Screening of records and data extraction were independently performed. Data were extracted and analyzed using Review Manager software (version 5.4; Cochrane Collaboration, Copenhagen, Denmark). Risk of bias and quality assessment was performed independently using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) assessment tool and the Cochrane Risk of Bias 2 (RoB2) tool. A total of 18 studies with 28 094 patients were included. Antenatal remote blood pressure monitoring reduces antenatal outpatient visits, antenatal hospital admissions for any cause, and antenatal hospital admissions specifically for hypertension. Importantly, there was no increase in adverse maternal and fetal outcomes, including the likelihood of cesarean section deliveries or induction of labor due to hypertension, composite maternal outcome, growth restriction, neonatal intensive care unit admissions, gestational age at delivery and the composite fetal outcome. Psychosocial outcomes were also not significantly different between the remote blood pressure monitoring and usual care groups. Postpartum remote blood pressure monitoring in women with an established hypertensive disorder of pregnancy led to greater compliance with blood pressure follow-up within 10 days, with no increase in unscheduled hypertension-related presentations, postpartum readmissions or outpatient antihypertensive prescription. Utilizing a model of remote blood pressure monitoring which incorporates organized review and management by clinicians, may reduce antenatal outpatient visits and admissions, without increasing adverse fetal and maternal outcomes, in pregnant women who require frequent monitoring of their blood pressure. In postpartum women with a hypertensive disorder of pregnancy, remote blood pressure monitoring can improve guideline recommended follow-up within 10 days. However, the meta-analysis was hampered by study heterogeneity and a paucity of high-quality evidence. Further randomized controlled trials are needed to confirm the findings of this review and provide recommendations.

Implementation of a crash cesarean section policy and its impact on maternal and neonatal outcomes at King Abdulaziz University Hospital: A retrospective study.

A typical surgical technique for pregnant women with potentially fatal problems affecting the mother or fetus is an emergency cesarean section (ECS). The decision-to-delivery interval (DDI) for ECS should be within 30 minutes. The objective of this study was to investigate crash ECS indications and effects on maternal and neonatal outcomes. In this retrospective study, all women undergoing crash cesarean section (CS) at Obstetrics and Gynecology department at King Abdulaziz University hospital, Jeddah, Saudi Arabia during 2022 and 2023 were evaluated. Data about demographic and obstetric characteristics of mother, ECS indications, DDI, and outcomes for mothers and newborns was gathered from the patient's sheet. One hundred 3 crash CS were performed during study period. Crash CS indications were fetal bradycardia (64.1%), prolapsed cord (24.3%), uterine rupture (6.8%), and severe antepartum hemorrhage (4.9%). D-D time range from 2 to 30 minutes. DDI was ≤15 minutes in 90 patients (87.4%) and >15 minutes in 13 patients (12.6%). Gestational age was <32 weeks (16.7%), between 32 and <37 weeks (15.5%), and ≥37 weeks (68.0%). Good maternal outcome was reported in 89 (86.4%), while 24 (13.6%) had complications. Intensive care unit maternal admission was significantly higher in gestational age 32 to <37 weeks versus <32 weeks and ≥37 weeks of gestation (18.8% vs 5.9% and 2.9%, P = .050). Fetal outcome was good in 69 (67.0%), while 34 (33.0%) had complications. Neonatal body weights, Apgar score at 1, 5, 10 minutes, and umbilical cord arterial pH were significantly decreased in preterm versus termed neonates (P < .0001, P < .0001, P < .0001, P = .014, and P = .003). Moreover, respiratory distress syndrome, jaundice, intubation, neonatal deaths, and sepsis were significantly higher in preterm versus term deliveries (P < .0001, P = .029, P < .0001, P = .010, and P = .031). Good neonatal outcome was significantly higher (P < .0001); while respiratory distress syndrome was significantly lower (P = .007) in deliveries with DDI ≤ 15 minutes versus > 15 minutes. The 30-minute standard for DDI time interval may be a feasible guideline at least for level-3 hospitals. Crash CS indication was mostly due to fetal bradycardia. The maternal and neonatal outcomes were better in term than preterm deliveries. The positive effect of very short intervals on neonatal outcome still needs to be proven.

Distribution of Polybrominated Diphenyl Ethers (PBDEs) in Placental Tissues of Maternal and Fetal Origin in Exposed Wistar Rats and Associations with Thyroid Hormone Levels.

In utero exposure to polybrominated diphenyl ethers (PBDEs) is linked to adverse pregnancy and fetal health outcomes, including altered thyroid hormone (TH) levels. Despite their phase out, PBDEs are still commonly detected in newborn cord blood. While PBDEs can cross the placenta, few studies have separately assessed PBDEs or THs in the maternal and fetal placental tissues. Additionally, no studies have separately assessed THs in these tissues across mid- and late gestation, during the onset of fetal TH synthesis. To address these gaps, we conducted a study with Wistar rats and examined PBDE accumulation in the maternal and fetal placenta. Pregnant dams were exposed daily to sesame oil vehicle, a low dose, or high dose PBDE mixture. At GD15 and 20, dams were sacrificed and placental tissues were collected. Tissues were analyzed for PBDEs, T3, rT3, and T4 using mass spectrometry. BDE-47, -99, -100, and -209 were frequently detected in both the fetal and maternal placenta. At GD15, higher concentrations of BDE-99, -100, and -209 were measured in the fetal placenta; however, this trend reversed by GD20, with higher maternal placental concentrations. Placental T3 and T4 were significantly impacted by exposure, tissue, and exposure x tissue at GD15, with significant reductions in both THs following low dose exposure in the maternal placenta. By GD20, maternal placental T3 was only significantly reduced in the high exposure groups and there was no effect on placental T4. Overall, these results highlight the rapid developmental changes that occur throughout gestation between the maternal and fetal placenta, and the differential impacts of gestational PBDE exposure on placental T3 and T4 across mid- and late-gestation.

Fetal Outcome Associated with COVID-19; Correlation between Ultrasound and Birth Measures in COVID-19 Pregnant Women

Fetal Outcome Associated with COVID-19; Correlation between Ultrasound and Birth Measures in COVID-19 Pregnant Women

Relationship Between Clinical and Laboratory Parameters at Admission and Pregnancy Outcomes in Cases of Preterm Premature Rupture of Membranes

Abstract Background: Preterm premature rupture of membranes (PPROM) is a significant complication in pregnancy, often associated with adverse maternal and fetal outcomes. Understanding the relationship between clinical and laboratory parameters at admission and pregnancy outcomes in PPROM cases is essential for effective management and intervention. Methods The study was conducted retrospectively to examine the relationship between clinical and laboratory parameters at the time of admission and the latent period in pregnant women with PPROM. Records of pregnant women diagnosed with PPROM between 2015-2017 in the obstetrics department of a university hospital were reviewed. The patients were grouped according to gestational weeks, clinical parameters at admission were recorded, and their relationships with the latent period were analyzed. Results When the data obtained in the study were analyzed, it was shown that cervical length (p = 0.008) and the gestational week at the time of admission had an effect on the latent period (p