Fetal Presentation Research Articles

Maternal and neonatal factors’ effects on wharton's jelly mesenchymal stem cell yield

As Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) are easily accessible, easy to isolate, and ethically acceptable, they represent a promising source of MSCs for use in regenerative medicine. Considering decisions on WJ-MSCs collection requires extensive knowledge of the factors that impact their yield. This study's aim was to evaluate the influence of parameters related to mothers and newborns on the WJ-MSCs yield. The WJ-MSCs were isolated and expanded after being isolated from 79 umbilical cord (UC) samples. Population doubling time and cell proliferation were assessed. By flow cytometry analysis, WJ-MSCs were identified by positivity of CD105, CD90, and CD73 and negativity of CD45 and CD34. There was a statistically significant negative correlation between UC width and P1 doubling time. Maternal age and WJ-MSC yield were shown to be negatively correlated. Birth weight and gestational age showed a significant positive correlation between WJ-MSCs yield and neonatal variables. No significant correlations were detected between the WJ-MSCs and the mother parity, nor the neonatal sex, fetal presentation, or head circumference. The WJ-MSCs yield increases with younger maternal age, higher gestational age, and increased neonatal birth weight. Hence, consideration should be given to these factors when selecting the ideal donors.

Blended Phenotypes From a SERPINA 11 Pathogenic Variant Over Underlying Immune Fetal Hydrops: A Rare Case Report and Literature Review

Abstract Fetal hydrops can stem from immune or nonimmune causes. Immune causes often involve red cell alloimmunization, whereas nonimmune causes encompass structural malformations, aneuploidy, infections, lymphatic system disorders, genetic syndromes, and more. In a rare and complex case, we encountered a fetal hydrops presentation characterized by blended phenotypes, indicating both a genetic and an underlying immune etiology. The mother, Rhesus negative, presented with a history of adverse obstetric events. At 21 weeks, the current fetus was diagnosed with hydrops. Maternal blood tests unveiled Rhesus alloimmunization, featuring a positive indirect Coombs test at a 1:512 dilution and the presence of anti-D, anti-C, and anti-E antibodies. Fetal blood sampling revealed an O-positive blood group with a hemoglobin level of 10 gm/dL. Despite administering intrauterine transfusion to the fetus, there was no improvement; instead, the fetal hydrops worsened, accompanied by the emergence of nuchal and axillary masses. Exome sequencing of fetal DNA revealed the fetus was homozygous for a pathogenic variant in the SERPINA11 gene and compound heterozygous for a pathogenic variant in the PIEZO1 gene. Furthermore, the combination of pathogenic variants in SERPINA11 and PIEZO1 genes has not been described in cases of fetal hydrops before. This case posed significant challenges in management due to the concurrent presence of both immune and nonimmune hydrops. We describe some of the diagnostic challenges faced in clinical management of this case.

Pregnancy and Neonatal Outcomes in Women Treated for Bowel Endometriosis: A Seven-Year Single-Centre Retrospective Matched Cohort Study

Background/Objectives: Deep infiltrating endometriosis has been linked to worsened maternal and neonatal outcomes. However, reports regarding bowel endometriosis are still scanty. We aimed to evaluate pregnancy, delivery, and newborn adverse outcomes in women after laparoscopic-assisted surgery for bowel endometriosis. Methods: A single-center retrospective cohort study was conducted at a tertiary-care university hospital. From January 2015 to December 2021, pregnant women who were diagnosed and treated for bowel endometriosis were matched using a 1:3 ratio with pregnant women with no history of endometriosis. Patients were matched using the Cox proportional hazards model to determine parity, age, BMI and gestational age-adjusted relative risk (aRR) with a 95% confidence interval (CI). Co-primary outcomes were the incidence of labor abnormalities and cesarean section (CS) rate. Co-secondary outcomes were incidence of complications related to pregnancy, delivery, and newborn. Results: A total of 71 pregnancies among women treated for bowel endometriosis and 213 from healthy controls were included. Patients requiring IVF/ET for getting pregnant were in the bowel endometriosis group relative to controls (43.7% vs. 11.7%; p < 0.001). Increased risk of labor abnormalities was present for bowel endometriosis relative to controls (21.1% vs. 17.4%; p = 0.040; aRR 1.39 [95% CI 1.06–2.05]). Risk of non-cephalic fetal presentation (14.1% vs. 6.1%; p = 0.016; aRR 3.08 [95% CI 2.03–4.68]), CS rate (43.7% vs. 24.9%; p = 0.003; aRR 1.75 [95% CI 1.23–2.49]), and emergent CS rate (19.7% vs. 8.5%; p = 0.009; aRR 2.21 [95% CI 1.55–3.16]) were significantly higher in women treated for colorectal endometriosis compared with controls. Moreover, placenta previa (9.9% vs. 0.0%; p < 0.001; aRR 21.82 [95% CI 2.19–116.40]), second-trimester hemorrhage (5.6% vs. 0.9%; p = 0.017; aRR 6.00 [95% CI 1.12–32.06]), postpartum hemorrhage (15.5% vs. 3.3%; p < 0.001; aRR 4.71 [95% CI 1.90–11.70]), and the need for transfusion during labor (5.6% vs. 0.5%; p = 0.004; aRR 12.00 [95% CI 1.36–105.60]) were increased in treatments vs. controls. Concerning neonatal outcomes, an increased risk for neonatal intensive care unit admission was seen in postsurgical endometriotic women relative to healthy controls (26.0% vs. 6.9%; p < 0.001; aRR 3.75 [2.04–3.86]). Conclusions: Women treated for bowel endometriosis seem more exposed to adverse pregnancy and neonatal outcomes relative to healthy controls. However, additional prospective and comparative studies are needed to validate the available evidence.

Cesarean delivery in a tertiary institution of the Republic of Moldova: analysis using the Robson classification

BackgroundThe worldwide rise in cesarean section rate is a major public health concern and cause of significant debate. Despite multiple studies showing that higher cesarean rates may be associated with adverse maternal and perinatal outcomes, the number of cesarean births increases continuously. In the Republic of Moldova, the cesarean section has increased from 15.75% in 2012 to 27.42% in 2022, however, the perinatal mortality remains unchanged - constituting 11.6‰. In order to understand the factors that determine the increasing trend of cesarean section and to approach new strategies to reduce unnecessary surgical delivery, a standardized tool is needed to assess and compare cesarean section rates. ObjectiveTo assess changes in cesarean section rates and trends and to evaluate the contribution of different obstetrical populations to overall cesarean rates in Municipal Clinical Hospital using the Robson Classification. Study DesignA cohort study conducted at the Municipal Clinical Hospital in Chisinau. The study includes 13882 women who gave birth in 2017, 2019, and 2022 in this hospital. All births were classified into 10 Robson groups, using six basic variables (parity, cesarean section delivery in medical history, labor onset, number of fetuses, gestational age, and fetal presentation). Statistical data were collected and analyzed using the Epi INFO program. ResultsThe overall cesarean section rate was 20.02% (2779/13882) with a significant increase from 18.59% (809/4351) to 21.59% (1134/5252), P=0.0003. Approximately one-third 39.55% (1099/2279) of all cesarean deliveries were performed before the labor onset. The main contributor in all study years is Group 5 - 34.44% (957/2779). The next valuable group as a contributor to the overall cesarean rate are the women from Group 2 representing 14.14% (393/2779), followed by women of Group 1 with 11.98% (333/2779). ConclusionsThe use of the Robson Ten-groups classification offers a clear and detailed record of the cesarean section trends, and due to its simplicity and exclusivity, it can be implemented in the Republic of Moldova as well. The main contributors to the overall cesarean rate are women with a previous cesarean delivery - Group 5, followed by nulliparous women of Group 2 and Group 1.

Seasonal variation in newborn hip dysplasia: Unraveling the impact of weather on hip development

BackgroundBabies born in winter have greater incidence of developmental dysplasia of the hip (DDH) and related surgeries. How weather conditions impact hip development and how screening program reacts weather issue remain unknown. This study tests a hypothesis that winter born babies have more newborn acetabular dysplasia and laxity that is responsible of later DDH. MethodsRetrospective data from newborns who had hip ultrasonography in the first 3 days of life were analyzed. The Graf type IIc, III, IV (shallow acetabulum) and type D (laxity) were classified as abnormal. The association and risks of an abnormal hip were analyzed with gender, gestational age, fetal presentation, parity and external temperature of birth month and the last 3 months before birth using the Pearson chi-square test and logistic regression. ResultsA total of 10962 newborns participated in hip ultrasound exams voluntarily in nurseries from 2016 to 2022. Distribution of babies with Graf type I, IIa, IIc, D, III/IV hips were 88.8%, 10%, 0.5%, 0.6%, and 0.1%, respectively. Female was the most significant factor for congenital shallow acetabulum (3.8x) and hip laxity (4x) compared to male (p <0.001). Preterm babies had a borderline lower risk of abnormal hips (0.4x, p = 0.05). Winter season is not associated with newborn abnormal hips (p = 0.36, statistical power = 80%), but a positive correlation was noted between external temperature and incidence of abnormal hips (r = 0.62, p = 0.03). Cold weather does not have a direct internal effect in acetabular dysplasia or hip laxity at birth. ConclusionsBabies who were born in winter were not associated with acetabular dysplasia and hip laxity at birth but had greater risks of late-diagnosed DDH and surgeries. The postnatal effects from weather should be addressed by a public awareness campaign, and hip screening may not be limited on the neonatal stage. Level of evidencelevel III, diagnostic

Next-generation monitoring in obstetrics: Assessing the accuracy of non-piezo portable ultrasound technology.

The emergence of handheld ultrasound devices capable of connecting to cell phones or tablets heralds a significant advancement in medical technology, particularly within the field of obstetrics. These devices offer the promise of immediate bedside ultrasound examinations, potentially revolutionizing patient care by enabling fetal assessments in diverse settings. This prospective study aimed to validate the reliability of non-piezo, chip-based handheld ultrasound devices in clinical obstetric practice. Conducted in a university hospital obstetric ward, the study included 100 pregnant women between 17 and 41 weeks of gestation. Participants underwent ultrasound examinations using both conventional and portable point-of-care ultrasound (POCUS) devices to compare the accuracy in estimating fetal weight and other parameters, such as cardiac activity, fetal presentation, placental location, and amniotic fluid volume. The reliability and agreement between the devices were assessed using intraclass correlation coefficients, Bland-Altman plots, and Pearson correlation coefficients. The results show a near-perfect agreement (0.98) and correlation (r = 0.98, p < 0.001) for estimated fetal weight and most biometry measurements between the two types of ultrasound devices, with slight deviations in head circumference and amniotic fluid index measurements. Subgroup analysis revealed variations in agreement and correlation rates with higher BMI and advanced gestational age, indicating areas for further refinement. These findings affirm the high reliability of handheld ultrasound devices for basic obstetric ultrasound evaluations, supporting their integration into daily clinical practice. This technology improves the flexibility and immediacy of prenatal care, although further research is needed to optimize its application across patient populations and treatment settings.

Unintended Upper Uterine Wall Extensions at the Time of Cesarean Delivery: Risk Factors and Associated Adverse Maternal and Neonatal Outcomes.

This study aims to estimate the frequency of unintended upper uterine wall extensions during cesarean delivery (CD) and identify associated risk factors and adverse outcomes. A multicenter retrospective cohort study was conducted, including patients who underwent CD between 2005 and 2021. Demographic factors, obstetric history, CD indications, delivery and surgical characteristics, adverse maternal and neonatal outcomes were compared between those with unintended upper uterine wall extensions during CD and those without extensions. Crude and adjusted estimates (odds ratios [ORs] and 95% confidence intervals [CIs]) were used. Among 30,517 patients meeting inclusion criteria, 117 (0.4%) had an unintended upper uterine wall extension. In univariate analysis, upper uterine wall extensions were associated with higher rates of intrapartum CD, second-stage CD, unplanned or emergency CD, CD following failed vacuum delivery or trial of labor after CD, chorioamnionitis, prolonged labor, increased vaginal exams, lower fetal head station, and higher birth weight. During surgery, higher rates of general anesthesia, significant intraperitoneal adhesion, fetal malpresentation, and fetal extraction by the leg were observed. Multivariable analysis identified fetal extraction not by head (adjusted OR [aOR]: 9.17, 95% CI: 5.35-15.73), vertex fetal presentation (aOR: 3.65, 95% CI: 1.81-7.35), second-stage CD (aOR: 3.07, 95% CI: 1.24-7.59), and trial of labor after cesarean (aOR: 2.04, 95% CI: 1.08-3.84) as significant risk factors for unintended upper uterine wall extensions. Additionally, upper uterine wall extensions were associated with higher rates of maternal and neonatal complications, including longer operating times, excessive bleeding, postpartum hemorrhage, intraperitoneal drainage, blood product transfusion, puerperal fever, paralytic ileus, Apgar score < 7 at 1 and 5 minutes, and fetal intracranial hemorrhage. Our study identifies risk factors for unintended upper uterine wall extensions during CD. While these extensions are infrequent, their occurrence is associated with increased maternal and neonatal morbidity. · Unintended upper uterine wall extensions occur in 0.4% of cesarean deliveries.. · Significant risk factors include fetal extraction not by head and second-stage CD.. · Extensions are associated with increased maternal complications like excessive bleeding and prolonged surgery.. · Neonatal complications include lower Apgar scores and intracranial hemorrhage.. · Awareness of these risks is critical for improving cesarean delivery outcomes..

Limb-girdle muscular dystrophy in pregnancy: a narrative review.

Limb-girdle muscular dystrophy (LGMD) poses unique challenges for women during pregnancy, necessitating comprehensive care and tailored management strategies. The present narrative review aims to examine the unique challenges and management strategies required for women with LGMD during pregnancy. With over 30 genetic subtypes identified and the potential for additional discoveries through advanced diagnostic techniques, preconception counseling plays a crucial role in informing prospective parents about reproductive risks and available options. Baseline assessments, including cardiac and pulmonary evaluations, are essential to guide antenatal care, alongside genetic testing for precise diagnosis and counseling. Optimizing maternal health through respiratory exercises, cardiac monitoring, and individualized exercise and nutrition plans is paramount to avoid potential complications. During pregnancy, close monitoring of maternal and fetal well-being is important, with collaborative care between obstetricians and specialists. An individualized approach to delivery mode considering factors such as muscle strength, pelvic size, and fetal presentation is crucial. While vaginal delivery has been proven to be possible, the need for an emergency cesarean delivery should always be kept in mind. Regional anesthesia is preferred, with proactive planning for potential respiratory support. Bupivacaine has been shown to be effective with epidural catheters that may be used for prolonged relief with opioids like morphine and fentanyl, while also evaluating the patients' respiratory function. Postpartum considerations include pain management, mobility support, breastfeeding assistance, and emotional support. Early mobilization and tailored physiotherapy regimens may promote optimal recovery, while comprehensive breastfeeding guidance is needed to address challenges related to muscle weakness. Access to mental health resources and support networks is essential to helping individuals cope with the emotional demands of parenthood alongside managing LGMD. By addressing the unique needs of pregnant individuals with LGMD, healthcare providers can optimize maternal and fetal outcomes while supporting individuals in their journey to parenthood.

Comparison of facial features in foetuses and newborns following natural delivery with cephalic presentation: a pilot study.

Malocclusions are usually diagnosed around 3-4 years of age according to specific criteria. The purpose of this protocol is to validate a method to understand how the type of delivery can influence the development of malocclusions. This pilot study, conducted at the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan, evaluated the relationship between the type of delivery, foetal presentation, and the presence of malocclusions in children. The sample included 5 healthy term newborns, all born to healthy mothers with uncomplicated pregnancies by vaginal delivery or C-section. Measurements were taken at the 37th week of gestation (T0) and on the second day of life (T1), including head circumference, lower facial angle, frontonasal angle, labial fissure length, and interpupillary distance. The results suggest that further research is necessary to better understand the influence of delivery mode and fetal presentation on the development of malocclusions. This study represents an important first step, highlighting the need for larger samples and more in-depth investigation methods to obtain more conclusive results.

Novel fetal phenotype of TAF8 deficiency.

TAF8 is part of the transcription factor TFIID complex. TFIID is crucial for recruiting the transcription factor complex containing RNA polymerase II. TAF8 deficiency was recently reported as causing a severe neurodevelopmental disorder in eight patients. We have ascertained three Muslim Arab couples with fetal brain malformations. Clinical, imaging, pathological, biochemical, and molecular analyses were performed. Pre-natal ultrasound performed in four pregnancies revealed massive cerebellar atrophy, microcephaly, cerebral and corpus callosum (CC) anomalies. Pre-natal MRI studies of two of the affected fetuses confirmed microcephaly, small vermis, abnormal sulcation pattern with malformation, and shortening of CC. The fetuses were found to carry a novel likely pathogenic homozygous variant (c.45 + 5 G > A) of TAF8, predicted to affect splicing and presenting autosomal recessive inheritance. Post-mortem examinations confirmed the imaging studies in one fetus. Dysmorphic features including hypertelorism, wide nasal bridge, clinodactyly, and hirsutism were present. Western blotting analysis in fibroblasts of an affected fetus demonstrated a significant reduction of TAF8 protein. We determined high expression levels of TAF8 which progressively diminish in fetal brains of WT mice. We report for the first time the fetal presentation of TAF8 deficiency due to a novel genetic variant, and study TAF8 presence during fetal and neonatal periods in mouse brains. Our study may contribute to understanding the role of TAF8 in the developing human brain.

Outcomes of Fetal Malpresentation Beyond 28 Weeks of Gestation at a Tertiary-Level Hospital

Background: The term malpresentation encompasses any fetal presentation other than vertex, including breech, face, brow, shoulder, and compound presentations. Both fetal and maternal factors contribute to the occurrence of malpresentation. Objective: To determine the outcomes of fetal malpresentation beyond 28 weeks of gestation at a tertiary-level hospital. Material and Methods: It was a cross sectional descriptive type of observational study carried out in the Department of Obstetrics &amp; Gynaecolgy, Mymensingh Medical College Hospital, Mymensingh during the period of March 2019 to August 2019.Structured questionnaire including history and physical examination of pregnant women were included in data collection sheet-and analysis was done by computer software SPSS version 20. Results: This study shows majority of the women 20(40%) were in the age group of 26-30 years. The average age was 29.9 years. The common fetal malpresentation was breech presentation 35(70%) followed by5(10%) was brow presentation, 5(10%) was shoulder presentation and 3(6%) was compound presentation and maximum seen in multiparity 20(40%) Regarding mode of delivery, 15(30%) delivered vaginally and 35(70%) had to do caesarean section. 13(26%) women suffered from complication during labour. Most common fetal morbidity were birth asphyxia 10(20%) and perinatal mortality was 2(4%). Conclusion: It was observed that major fetal morbidities were low birth weight, birth asphyxia and perinatal infection. Majority patients were delivered by caesarean section. Identification of the cases that require caesarean section, and allowing appropriate and safe trial of labour and vaginal delivery (if no contraindication) require clinical experience and technical skill. The obstetricians should acquire and maintain such knowledge through clinical exposure and attending obstetric emergency skill courses.

Whole Exome Sequencing Revealing a Novel PBX1 Gene Variant in a Chinese Family Causing Recurrent Neonatal Death.

Causative mutations of PBX1 are associated with congenital abnormalities of the kidney and urinary tract (CAKUT), often accompanied by hearing loss, abnormal ear morphology, or developmental delay. The aim of the present investigation was to introduce a novel variant in the PBX1 gene identified in a Chinese family, leading to recurrent neonatal mortality. A pregnant woman (gravida 5, para 0), who had experienced recurrent neonatal deaths, sought genetic etiology diagnosis. Whole exome sequencing (WES) was conducted to identify sequence variants and copy number variants in the fetus presenting with posterior nuchal cystic hygroma and fetal hydrops. A novel NM_002585.4:c.694G>C(p.D232H) in PBX1 was identified in the fetus through trio whole exome sequencing (WES), revealing a paternal mosaic PBX1 variant in blood at 11.54% (6/52 variants reads). Subsequent parental Sanger sequencing confirmed the variant detected by WES. Ultimately, the variant was classified as likely pathogenic, leading the family to elect pregnancy termination at 17 weeks gestation. The novel variant in the PBX1 gene appears to be a significant factor contributing to recurrent neonatal deaths in the Chinese family. Such findings expand the spectrum of PBX1 gene variants and provide valuable perinatal guidance for diagnosing fetuses with PBX1 mutations.

Breast milk induced immune haemolytic disease of newborn due to anti-c: A case report

BackgroundHemolytic disease of fetus and newborn is a major risk factor for anemia and hyperbilirubinemia in newborns. Early identification and diagnosis can significantly improve neonatal health. Case reportThis report documents a case of hemolytic disease of fetus and newborn presenting as persistent neonatal anemia requiring frequent transfusion support. The underlying cause was determined to be the passive acquisition of hemolytic alloantibodies (anti-c) via breast milk. ConclusionImportance of antenatal screening for red cell antibodies is gradually being recognized and adopted in developing countries to minimize the burden of HDFN. Breast milk should be considered as a potential source of hemolysing alloantibodies in newborns and may require evaluation in mothers with alloantibodies in her serum.

Caesarean section rates in a tertiary teaching hospital in northern Uganda: a retrospective analysis using the robson ten group classification system

BackgroundThe Robson Ten Groups Classification System (RTGCS) is increasingly used to assess, monitor, and compare caesarean section (CS) rates within and between healthcare facilities. We evaluated the major contributing groups to the CS rate at Gulu Regional Referral Hospital (GRRH) in Northern Uganda using the RTGCS.MethodsWe conducted a retrospective analysis of all deliveries from June 2019 through July 2020 at GRRH, Gulu city, Uganda. We reviewed files of mothers and collected data on sociodemographic and obstetric variables. The outcome variables were Robson Ten Groups (1–10) based on parity, gestational age, foetal presentation, number of foetuses, the onset of labour, parity and lie, and history of CS.ResultsWe reviewed medical records of 3,183 deliveries, with a mean age of 24.6 ± 5.7 years. The overall CS rate was 13.4% (n = 427). Most participants were in RTGCS groups 3 (43.3%, n = 185) and 1 (29.2%, n = 88). The most common indication for CS was prolonged labour (41.0%, n = 175), followed by foetal distress (19.9%, n = 85) and contracted pelvis (13.6%, n = 58).ConclusionOur study showed that GRRH patients had a low-risk obstetric population dominated by mothers in groups 3 and 1, which could explain the low overall CS rate of 13.4%. However, the rates of CS among low-risk populations are alarmingly high, and this is likely to cause an increase in CS rates in the future. We recommend group-specific interventions through CS auditing to lower group-specific CS rates.

Neighborhood deprivation is not associated with abortion consideration or completion in patients with fetal myelomeningocele.

The objective of this study was to evaluate whether patient-level neighborhood deprivation index (NDI) was associated with termination of pregnancy consideration and completion in patients presenting with fetal myelomeningocele. This was a retrospective cohort analysis of patients with fetal myelomeningocele presenting to a fetal treatment center (FTC) in Illinois between 2018 and 2024. The exposure was NDI calculated from patient zip codes. The NDI was analyzed as both a dichotomous and ordinal exposure. The co-primary outcomes were abortion consideration prior to FTC consultation, ascertained by nurse intake, and abortion completion after consultation. Bivariate and log-binomial regression analyses were performed. Covariates were selected based on p<0.10 on bivariate analyses. Otherwise, p<0.05 indicated statistical significance. A total of 157 participants were included. Evaluation of neighborhood deprivation as a dichotomous exposure revealed no association with abortion consideration or completion. AdditionallLy, no association was found on log binomial modeling after controlling for gestational age at presentation to the FTC and maternal race or ethnicity for abortion consideration (aRR 0.87, 95% CI 0.59-1.28) or completion (aRR 0.86, 95% CI 0.59-1.28). These results were similar when treating the NDI as an ordinal exposure. Contrary to our hypothesis, NDI is not associated with abortion consideration or completion in patients with fetal myelomeningocele.

Probe motion during mid-trimester fetal anomaly scan in the clinical setting: A prospective observational study

IntroductionThis study aims to investigate probe motion during full mid-trimester anomaly scans. MethodsWe undertook a prospective, observational study of obstetric sonographers at a UK University Teaching Hospital. We collected prospectively full-length video recordings of routine second-trimester anomaly scans synchronized with probe trajectory tracking data during the scan. Videos were reviewed and trajectories analyzed using duration, path metrics (path length, velocity, acceleration, jerk, and volume) and angular metrics (spectral arc, angular area, angular velocity, angular acceleration, and angular jerk). These trajectories were then compared according to the participant level of expertise, fetal presentation, and patient BMI. ResultsA total of 17 anomaly scans were recorded. The average velocity of the probe was 12.9 ± 3.4 mm/s for the consultants versus 24.6 ± 5.7 mm/s for the fellows (p = 0.02), the average acceleration 170.4 ± 26.3 mm/s2 versus 328.9 ± 62.7 mm/s2 (p = 0.02), and the average jerk 7491.7 ± 1056.1 mm/s3 versus 14944.1 ± 3146.3 mm/s3 (p = 0.02), the working volume 9.106 ± 4.106 mm3 versus 29.106 ± 11.106 mm3 (p = 0.03), respectively. The angular metrics were not significantly different according to the participant level of expertise, the fetal presentation, or to patients BMI. ConclusionSome differences in the probe path metrics (velocity, acceleration, jerk and working volume) were noticed according to operator’s level.

Safety and Efficacy of Oral Mifepristone for Cervical Ripening and Induction of Labor.

Background Labor induction, a common practice to prevent maternal and fetal complications from prolonged labor, involves stimulating contractions before they begin naturally. This can be achieved through medications, mechanical methods, or surgical interventions. Cervical ripening is crucial for successful delivery. When the cervix is not sufficiently ripe, drugs are often used to augment this process chemically. Objective To evaluate the safety and efficacy of mifepristone for cervical ripening and induction of labor. Method A sample size of 200 was used in this single-blind randomized control trial. Primarily, pregnant women with term pregnancies, Bishop scores <6, and cephalic fetal presentation were included in the study. The study population was randomly divided into test and control groups. The test group (n=100) was administered 200 mg of mifepristone orally, while the control group (n=100) received a placebo. The Bishop score was reassessed 24 hours after mifepristone administration. Patients were taken for labor induction if their Bishop score was >6. For individuals with a Bishop score of <6, 1 mg of dinoprostone gel was administered intracervically once every six hours. Safety and efficacy were assessed by analyzing several parameters associated with labor progression, maternal outcomes, and fetal outcomes. Results The mean age of patients in the test group was 26±4.5 years, while in the control group, it was 26±5 years. The induction-to-delivery interval was notably shorter in the test group (18.8±2.3 hours) than in the control group (19.24±1.8 hours, p<0.0001). After the administration of 200 mg mifepristone, the mean Bishop score in the test group was 5.74±0.8, compared to 5.13±0.76 in the control group. The increase in the Bishop score after mifepristone treatment was significantly higher in the test group than in the control group (p-value=0.013). In the study, 73 (73%) patients in the test group had a normal vaginal delivery (NVD), whereas NVD accounted for 64 (64%) patients in the control group. Instrumental deliveries were less frequent in the test group, accounting for 14 (14%) patients, compared to 16 (16%) patients in the control group. The frequency of lower segment cesarean section (LSCS) was also lower in the mifepristone-treated group at 13 (13%) compared to the control group at 20 (20%). Fetal distress in five (38%) patients and non-progression of labor in 11 (55%) patients were the most frequent indications for LSCS in the test and control groups, respectively. There was no significant difference in neonatal outcomes between the test and control groups. Meconium-stained liquor was the most frequent complication in both the test group(10, 10%) and the control group (5, or 5%). Conclusion Administration of mifepristone effectively increased the Bishopscores and reduced the induction-to-delivery interval compared to controls, highlighting its potential as a cervical ripening agent.

An Imperative Role of Fetal Autopsy in Previable Fetuses - ADAM Complex Revisited

Abstract Objective To identify the occurrence of the amniotic deformity adhesions, mutilation (ADAM) complex and imperative role of fetal autopsy in diagnosing this condition. Methods A retrospective descriptive study spanning nine years, from January 2014 to January 2022, was conducted at the Department of Pathology within a tertiary care hospital in South India. The study focused on analyzing the clinical presentation, prenatal ultrasonogram, and morphological features of fetuses with the ADAM complex, limb body wall complex, or amniotic bands. Results Among the 438 fetuses assessed during the study period, five fetuses showed features of the ADAM complex (0.01%). The most frequent gestational age observed was 12–18 weeks and most fetuses were female. The common anomaly encountered was limb defects, followed by abdominal and cranial anomalies. Conclusion The diagnosis of the ADAM complex relies primarily on fetal autopsy to differentiate it from similar conditions like anencephaly or body-stalk anomalies. The pathologist plays a crucial role in understanding the complexities of the ADAM complex. Advanced antenatal imaging and therapies offer potential for prevention through improved counseling.

Factors infl uencing delivery in women with multiple fetus pregnancy.

This paper aims to analyze the factors that can influence the method of childbirth in women with multiple pregnancies. Retrospective analysis of selected parameters in women with multiple pregnancies who gave birth at the 2nd Clinic of Gynecology and Obstetrics of the Faculty of Medicine (FM), Comenius University (CU) and University Hospital (UH) Bratislava in the years 2010-2022. Between 2010 and 2022, at the 2nd Clinic of Gynecology and Obstetrics of the FM CU and UH in Bratislava, 1.13% of births were multiple pregnancies. After statistical data processing, primiparity appeared statistically significant as a risk of acute caesarean section (C-section); multiparous women had a higher probability to give birth vaginally. Since 2017, the clinic has had a decreasing trend in the number of caesarean sections. Women with an acute caesarean section, in turn had on average a lower pH of both fetuses compared to vaginal delivery. However, the incidence of asphyxia in fetuses was not statistically significantly different. We found no risk factor increasing the likelihood of acute caesarean section for fetus B in twins. Multiple pregnancy has a higher morbidity not only for the woman but also for the fetuses. The incidence of multiple pregnancies is influenced by assisted reproduction. Delivery method depends on various factors such as chorionicity, fetal presentation, and history of a previous caesarean section.

Malpresentation and autism spectrum disorder in the study to explore early development.

An infant's presentation at delivery may be an early indicator of developmental differences. Non-vertex presentation (malpresentation) complicates delivery and often leads to caesarean section, which has been associated with neurodevelopmental delays, including autism spectrum disorder (ASD). However, malpresentation could be an early sign of an existing developmental problem that is also an upstream factor from caesarean delivery. Little research has been done to investigate the association between malpresentation and ASD. We examine the association between malpresentation at delivery and ASD and whether this association differs by gestational age. We used data from the Study to Explore Early Development (SEED), a multi-site, case-control study of children with ASD compared to population controls. The foetal presentation was determined using medical records, birth records and maternal interviews. We defined malpresentation as a non-vertex presentation at delivery, then further categorised into breech and other malpresentation. We used multivariable logistic regression to estimate the adjusted odds ratio (aOR) for the association between malpresentation and ASD. We included 4047 SEED participants, 1873 children with ASD and 2174 controls. At delivery, most infants presented vertex (n = 3760, 92.9%). Malpresentation was associated with higher odds of ASD (aOR 1.31, 95% confidence interval [CI] 1.02, 1.68) after adjustment for maternal age, poverty level, hypertensive disorder and smoking. The association was similar for breech and other types of malpresentation (aOR 1.28, 95% CI 0.97, 1.70 and aOR 1.40, 95% CI 0.87, 2.26, respectively) and did not differ markedly by gestational age. Malpresentation at delivery was modestly associated with ASD. Early monitoring of the neurodevelopment of children born with malpresentation could identify children with ASD sooner and enhance opportunities to provide support to optimise developmental outcomes.