Healthy Fetuses Research Articles

Molar Twin Deliveries with Coexisting Fetus at Term: Concerning Two Uncomplicated Cases of Gestational Trophoblastic Tumor, From 2015-2021, In Conakry, Guinea

The coexistence of a molar pregnancy with a live fetus is a rare entity of difficult diagnosis and treatment. Continuation of the pregnancy until full-term delivery is possible. We report two cases of twin molar deliveries observed empirically from 2015-2021, in the gynecology-obstetrics department of the Donka national hospital and in the maternity ward of the Jean Paul II hospital in Conakry. The discovery was made on ultrasound of the first trimester of pregnancy and macroscopic examination of the placenta. One of the neonates was alive, a healthy female and the other was polymal formed with facial dysmorphism, omphalocele and sexual ambiguity, fresh stillborn. There was no maternal complication towards a gestational trophoblastic tumor (T.T.G) in both cases. Efforts must be made in the prevention of T.T.G. by screening for twin molar pregnancies with healthy fetuses on transvaginal ultrasound in the first trimester, the dosage of HCG in the face of unexplained metrorrhagia, macroscopic observation of the placenta after each delivery and biopsy sampling of any suspicious placenta.

First Case of Prenatal Diagnostics of Type IV Mucopolysaccharidosis (Morquio Syndrome) in Azerbaijan Republic

In one of the regions of Azerbaijan Republic while clinic examination with doctor-pediatrician, doctor-neurologist and doctor-geneticist a girl of 5 years of age was identified as suspicious of mucopolysaccharidosis. N-acetyl-galactosamin-6-sulfatase enzyme analysis has shown low activity of 0,1 μmol/L at norm of >0,2 μmol/L/h. Molecular-genetic analysis of GALNS gene identified substitution of Adenine nucleotide with Guanine nucleotide in 1283 (с.1283 A>G) position accompanied with amino acid change Gln428Arg (Morquio A; OMIM®: 253000). These results correspond to the presence of MPS IVA type. With the consent of both parents and at the term of 16-17-week pregnancy transabdominal amniocentesis was carried out. At the level of DNA, isolated from fibroblasts from amniotic liquid, we have got heterozygous carriage of a с.1283 A>G mutation of GALNS gene, that says of a healthy fetus. We plan to carry out prenatal diagnostics to all families of reproductive age, who have got affected children diagnosed with MPS.

Abstract 15082: Altered Functional Brain Circuitry in Fetuses With Complex Congenital Heart Disease

Recent reports describing regional alterations involving critical hubs of the developing brain have emerged in neonates with complex CHD prior to surgery. However, the extent to which postnatal brain connectivity disturbances reflect a prenatal onset of aberrant functional circuitry development is unknown. Here, we investigated whether neural connectivity changes are present in fetuses with CHD before birth. We acquired 176 resting state scans from 156 pregnant women who were prospectively enrolled. We analyzed 76 scans from 61 CHD fetuses (mean±sd:33.4±3.1 gestational weeks, GW); which included transposition of the great arteries, n=22; hypoplastic left heart syndrome, n=20; other CHD, n=34) and 103 scans from 95 healthy controls (33.8±3.3 GW). First, we defined 98 anatomic regions ( nodes ) using a fetal atlas. Next, for each fetus, we computed connectivity – the pairwise Fisher- z transformed Pearson correlation, ( z(r) ) – across all 98 nodes. Only the strongest 4% of connections, or 190 edges , were included. Next, we grouped nodes into 16 clusters, or modules , based on a node’s connectivity to other nodes. We then compared (1) the number of connections within ( w-edges ) and between ( b-edges ) modules, and (2) the strength of connectivity within ( w-strength ) and between ( b-strength ) modules. We expected 12/190 w-edges and 177/190 b-edges but observed 55 and 54 w-edges in healthy (H) and CHD fetuses, respectively, 4.5x greater than the expected. Thus, in both cohorts, the normalized w-edges were significantly greater than the normalized b-edges ( p < 0.001); there were no significant between-group differences. However, w-strength (H,1.16±0.26; CHD, 1.14±0.31) and b-strength (H, 1.05±0.19; CHD, 1.04±0.26) were significantly reduced in CHD ( p <0.001). In both, w-strength was greater than b-strength (p<0.001). For the first time, we demonstrated that CHD functional networks follow normative trajectories where within-module connectivity predominates, both in strength and number, in-utero. Fetal CHD connectivity strength, however, was weaker compared to controls suggesting that altered functional brain circuitry in CHD has its origins in-utero. Further studies are needed to assess the surveillance and prognostic potential of these findings.

Five too many! A Case of Incidentally Detected Five Vessel Umbilical Cord Associated with Placental Chorangiosis

Supernumery vessels are defined as presence of four or more vessels present within the umbilical cord. This condition may often accompany a poor pregnancy outcome and presence of congenital anomalies. They may be present in healthy fetuses. Chorangiosis is an adaptive response to in-utero hypoxia and its presence signifies better pregnancy outcomes. Abnormalities that lead to multiple cord vessels are rare with the majority of reported cases highlighting four vessels due to a persistent right umbilical vein. Here, we report a case of a 5-vessel umbilical cord associated with chorangiosis of placenta, detected incidentally after birth.

Spatiotemporal Atlas of the Fetal Brain Depicts Cortical Developmental Gradient.

The fetal brains experience rapid and complex development in utero during the second and third trimesters. In utero MRI of the fetal brain in this period enables us to quantify normal fetal brain development in the spatiotemporal domain. In this study, we established a high-quality spatiotemporal atlas between 23 and 38 weeks gestational age (GA) from 90 healthy Chinese human fetuses of both sexes using a pairwise and groupwise registration pipeline. We quantified the fetal cortical morphology indices and characterized their spatiotemporal developmental pattern. The cortical thickness exhibited a biphasic pattern that first increased and then decreased; the curvature fitted well into the Gompertz growth model; sulcal depth increased linearly, while surface area expanded exponentially. The cortical thickness and curvature trajectories consistently pointed to a characteristic time point around GA of 31 weeks. The characteristic GA and growth rate obtained from individual cortical regions suggested a central-to-peripheral developmental gradient, with the earliest development in the parietal lobe, and we also observed a superior-to-inferior gradient within the temporal lobe. These findings may be linked to biophysical events, such as dendritic arborization and thalamocortical fibers ingrowth. The proposed atlas was also compared with an existing fetal atlas from a white/mixed population. Finally, we examined the structural asymmetry of the fetal brains and found extensive asymmetry that dynamically changed with development. The current study depicted a comprehensive profile of fetal cortical development, and the established atlas could be used as a normative reference for neurodevelopmental and diagnostic purposes, especially in the Chinese population.SIGNIFICANCE STATEMENT We generated a high-quality 4D spatiotemporal atlas of the normal fetal brain development from 23 to 38 gestational weeks in a Chinese population and characterized the spatiotemporal developmental pattern of cortical morphology. According to the cortical development trajectories, the fetal cerebral cortex development follows a central-to-peripheral developmental gradient that may be related to the underlying cellular events. The majority of cortical regions already exhibit significant asymmetry during the fetal period.

Pregnancies complicated by gestational diabetes and fetal growth restriction: an analysis of maternal and fetal body composition using magnetic resonance imaging.

Maternal body composition may influence fetal body composition. The objective of this pilot study was to investigate the relationship between maternal and fetal body composition. Three pregnant women cohorts were studied: healthy, gestational diabetes (GDM), and fetal growth restriction (FGR). Maternal body composition (visceral adipose tissue volume (VAT), subcutaneous adipose tissue volume (SAT), pancreatic and hepatic proton-density fat fraction (PDFF) and fetal body composition (abdominal SAT and hepatic PDFF) were measured using MRI between 30 to 36 weeks gestation. Compared to healthy and FGR fetuses, GDM fetuses had greater hepatic PDFF (5.2 [4.2, 5.5]% vs. 3.2 [3, 3.3]% vs. 1.9 [1.4, 3.7]%, p = 0.004). Fetal hepatic PDFF was associated with maternal SAT (r = 0.47, p = 0.02), VAT (r = 0.62, p = 0.002), and pancreatic PDFF (r = 0.54, p = 0.008). When controlling for maternal SAT, GDM increased fetal hepatic PDFF by 0.9 ([0.51, 1.3], p = 0.001). In this study, maternal SAT, VAT, and GDM status were positively associated with fetal hepatic PDFF.

Risks and pregnancy outcome after fetal reduction in dichorionic twin pregnancies: a Danish national retrospective cohort study

Twin pregnancies carry a higher risk of congenital and structural malformations, and pregnancy complications including miscarriage, stillbirth, and intrauterine fetal death, compared with singleton pregnancies. Carrying a fetus with severe malformations or abnormal karyotype places the remaining healthy fetus at an even higher risk of adverse outcome and pregnancy complications. Maternal medical conditions or complicated obstetrical history could, in combination with twin pregnancy, cause increased risks for both the woman and the fetuses. To our knowledge, no previous studies have evaluated and compared the outcomes of all dichorionic twin pregnancies and compared the results of reduced twins with those of nonreduced and primary singletons in a national cohort. These data are important for clinicians when counseling couples about fetal reduction and its implications. This study aimed to describe and compare the risks of adverse pregnancy outcomes, including the risk of pregnancy loss, in a national cohort of all dichorionic twins-reduced, nonreduced, and primary singletons. In addition, we examined the implications of gestational age at fetal reduction on gestational age at delivery. This was a retrospective cohort study of all Danish dichorionic twin pregnancies, including pregnancies undergoing fetal reduction and a large proportion of randomly selected primary singleton pregnancies with due dates between January 2008 and December 2018. The primary outcome measures were adverse pregnancy outcomes (defined as miscarriage before 24 weeks, stillbirth from 24 weeks, or single intrauterine fetal death in nonreduced twin pregnancies), preterm delivery, and obstetrical pregnancy complications. Outcomes after fetal reduction were compared with those of nonreduced dichorionic twins and primary singletons. In total, 9735 dichorionic twin pregnancies were included, of which 172 (1.8%) were reduced. In addition, 16,465 primary singletons were included. Fetal reductions were performed between 11 and 23 weeks by transabdominal needle-guided injection of potassium chloride, and outcome data were complete for all cases. Adverse pregnancy outcome was observed in 4.1% (95% confidence interval, 1.7%-8.2%) ofreduced twin pregnancies, and 2.4% (95% confidence interval, 0.7%-6.1%) were delivered before 28 weeks, and 4.2% (95% confidence interval, 1.7%-8.5%) before 32 weeks. However, when fetal reduction was performed before 14 weeks, adverse pregnancy outcomes occurred in only 1.4% (95% confidence interval, 0.0%-7.4%), and delivery before 28 and 32 weeks diminished to 0% (95% confidence interval, 0.0%-5.0%) and 2.8% (95% confidence interval, 0.3%-9.7%), respectively. In contrast, 3.0% (95% confidence interval, 2.7%-3.4%) of nonreduced dichorionic twins had an adverse pregnancy outcome, and 1.9% (95% confidence interval, 1.7%-2.1%) were delivered before 28 weeks, and 7.3% (95% confidence interval, 6.9%-7.7%) before 32 weeks. Adverse pregnancy outcomes occurred in 0.9% (95% confidence interval, 0.7%-1.0%) of primary singletons, and 0.2% (95% confidence interval, 0.1%-0.3%) were delivered before 28 weeks, and 0.7% (95% confidence interval, 0.6%-0.9%) before 32 weeks. For reduced twins, after taking account of maternal factors and medical history, it was demonstrated that the later the fetal reduction was performed, the earlier the delivery occurred (P<.01). The overall risk of pregnancy complications was significantly lower among reduced twin pregnancies than among nonreduced dichorionic twin pregnancies (P=.02). In a national 11-year cohort including all dichorionic twin pregnancies, transabdominal fetal reduction by needle guide for fetal or maternal indication was shown to be safe, with good outcomes for the remaining co-twin. Results were best when the procedure was performed before 14 weeks.

The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography.

ObjectivesTo determine if the electrical heart axis in different types of congenital heart defects (CHD) differs from that of a healthy cohort at mid-gestation.MethodsNon-invasive fetal electrocardiography (NI-fECG) was performed in singleton pregnancies with suspected CHD between 16 and 30 weeks of gestation. The mean electrical heart axis (MEHA) was determined from the fetal vectorcardiogram after correction for fetal orientation. Descriptive statistics were used to determine the MEHA with corresponding 95% confidence intervals (CI) in the frontal plane of all fetuses with CHD and the following subgroups: conotruncal anomalies (CTA), atrioventricular septal defects (AVSD) and hypoplastic right heart syndrome (HRHS). The MEHA of the CHD fetuses as well as the subgroups was compared to the healthy control group using a spherically projected multivariate linear regression analysis. Discriminant analysis was applied to calculate the sensitivity and specificity of the electrical heart axis for CHD detection.ResultsThe MEHA was determined in 127 fetuses. The MEHA was 83.0° (95% CI: 6.7°; 159.3°) in the total CHD group, and not significantly different from the control group (122.7° (95% CI: 101.7°; 143.6°). The MEHA was 105.6° (95% CI: 46.8°; 164.4°) in the CTA group (n = 54), -27.4° (95% CI: -118.6°; 63.9°) in the AVSD group (n = 9) and 26.0° (95% CI: -34.1°; 86.1°) in the HRHS group (n = 5). The MEHA of the AVSD and the HRHS subgroups were significantly different from the control group (resp. p = 0.04 and p = 0.02).The sensitivity and specificity of the MEHA for the diagnosis of CHD was 50.6% (95% CI 47.5% - 53.7%) and 60.1% (95% CI 57.1% - 63.1%) respectively.ConclusionThe MEHA alone does not discriminate between healthy fetuses and fetuses with CHD. However, the left-oriented electrical heart axis in fetuses with AVSD and HRHS was significantly different from the control group suggesting altered cardiac conduction along with the structural defect.Trial registrationClinical trial registration number: NL48535.015.14.

The fascinating microbes and their impact on neonatal dogs and cats - A review.

Recent literature data indicate that canine and feline neonates are not born in a sterile environment as it was stated previously. The acquisition, colonisation and maintenance of the early life microbiota of healthy fetuses is a rapidly developing research area. In humans, the natural healthy infant microbiome plays an essential role in health and its assembly is determined by the maternal-offspring exchanges of microbes. Even though this topic is becoming more and more important in dogs and cats, the exact role of the neonatal microbiome is not yet fully known in animals. This review summarises the current knowledge of the normal physiological neonatal microbiome in healthy puppies and kittens.

Early functional analysis on the pulmonary hemodynamic effects of Transamniotic Stem Cell Therapy (TRASCET) in the nitrofen model of congenital diaphragmatic hernia

PurposeTransamniotic stem cell therapy (TRASCET) with mesenchymal stem cells (MSCs) has been shown to impact pulmonary vascular development and remodeling in experimental congenital diaphragmatic hernia (CDH), with secondary structural cardiac effects. We sought to determine whether TRASCET has any functional impact on term fetal pulmonary hemodynamics in the nitrofen model. MethodsTime-dated pregnant rat dams (n = 13) received nitrofen on gestational day 9 (E9) to induce fetal CDH. Fetuses (n = 155) were divided into three groups: untreated (n = 45), and two groups receiving volume-matched intra-amniotic injections on E17 of either saline (sham; n = 46), or a suspension of amniotic fluid-derived MSCs (afMSCs) (TRASCET; n = 64). Donor afMSCs were syngeneic, phenotyped by flow cytometry, and “primed” by exposure to interferon-gamma and interleukin-1beta prior to administration in vivo. At term (E21), fetuses underwent Doppler flow assessment at the mid-pulmonary artery and 4-chamber echocardiogram. Pulmonary vascular resistance was estimated by pulmonary artery acceleration time (PAAT), max velocity (MaxV) and velocity time integral (VTI). Cardiac function was assessed by global longitudinal strain (GLS) and ejection fraction (EF) using speckle analyses. Healthy fetuses (n = 11) served as additional controls. Statistical analysis was by the Mann-Whitney U test ResultsHigh resolution ultrasound data could be obtained from 8 to 13 fetuses per group. The PAAT and the PAAT normalized to cardiac cycle time were significantly improved by TRASCET compared to both untreated and sham-treated CDH (p = 0.004 to <0.001 in all pairwise comparisons). The flow profile sharpness (MaxV:VTI) was increased in untreated (p = 0.06) and sham (p = 0.01) groups but normalized by TRASCET (p<0.01). There was no difference in GLS between TRASCET and either the untreated or sham groups (p = 0.25 to p = 0.93). ConclusionTransamniotic stem cell therapy improves pulmonary vascular resistance in early term fetuses in the Nitrofen model of congenital diaphragmatic hernia. Further focus on the functional pulmonary hemodynamic impact of this therapy is justified. Level of EvidenceN/A (animal and laboratory study)

Fetal Wellbeing Monitoring: A Review Article.

While assessing maternal health is relatively easy, assessing fetal well-being has always been tricky. This has led to tremendous technological development in fetal well-being assessment, thus bridging the gap between biotechnology and antenatal medicine. It is broadly divided into early pregnancy, late pregnancy, and during labour assessment. While the early assessment involves genetic check-ups and malformations, the late pregnancy check-ups aim at delivering a healthy fetus at term by normal vaginal delivery. The early tests can be invasive or non-invasive. Non-invasive include cell-free fetal DNA assessment and fetal cell-based assessment. Invasive tests include amniocentesis and chorionic villous sampling. These are followed by chromosomal microarray and next-generation sequencing. Under this procedure, exome sequencing is done, which is either clinical or whole. Sequencing of the whole genome can also be done. A recent advancement is pre-implantation genetic testing. These are mainly useful in identifying monogenic disorders for which the locus causing disease is identified beyond any doubt. In late pregnancy, the most commonly used test is biophysical. It works on the principle that an increase in the fetal heart rate occurs in conjugation with fetal movements. The next widely employed technology is Doppler, which is used to know fetal heart rates, valve timing intervals, and umbilical artery waveforms. Cardiotocography is also widely used both during pregnancy and during labour. It measures the fetal heart rate while correlating it with uterine contractions. Wireless fetal and maternal heart monitoring and telemonitoring are recent upcoming fields.

Evaluation of the Effectiveness of Supportive Group Therapy on Fear of Delivery in Pregnant Women, 2021

Background and Objective: Fear of childbirth is one of the major problems in delivery and the postpartum period. In most women, fear of childbirth is associated with increased pain, prolonged labor and unpleasant labor experience, and increased rate of elective cesarean section Materials and Methods: This interventional study was conducted on 90 pregnant women referred to health centers in Kordkuy, Iran. They were randomly assigned to two groups: intervention and control. The inclusion criteria entailed a wish for cesarean delivery or being doubtful about the mode of delivery, primigravida, singleton pregnancy, the age range of 18-35 years, reading and writing literacy, gestational age of 22-30 weeks at the beginning of the study, and a healthy fetus based on ultrasound examinations in the first trimester. The exclusion criteria were as follows: clear and identifiable obstacles to natural childbirth at the time of sampling, mental and neurological disorders, smoking, drug, and alcohol addiction, repeated abortions, and a history of infertility. The data collection tools included the Wijma Delivery Expectancy/Experience Questionnaire (version A) and the demographic information form. The intervention in the experimental group was performed in five one-hour sessions, while the control group received routine pregnancy care. The data were analyzed in SPSS software using independent chi-square and independent t-tests. Results: Before the intervention, demographic variables, such as age, occupation, and education, were homogeneous between the intervention and control groups. At the end of the support group therapy sessions, the mean fear of childbirth score in the intervention group was 69.22, which was significantly lower than that in the control group (84.58) (P&lt;0.001). Conclusion: Midwifery counseling in the form of supportive group therapy is effective in reducing the fear of childbirth. Considering that some pregnant women were compelled to undergo a cesarean section due to the opposition of their husbands, it is necessary to conduct studies on the effects of support group therapy on the fear of childbirth in groups consisting of pregnant women, as well as their spouses and families.

EP27.06: Diagnostic clarification of sonographic malformations or abnormal NIPT by early amniocentesis before 15 +0 weeks: experiences from our practice

Early detailed ultrasound diagnostics can be performed with high detection rates in the first trimester. In addition, NIPT is now routinely used to screen for aneuploidies. In Germany, the inclusion of NIPT in the catalogue of services of the health insurance companies is imminent, so that an expansion of such tests is to be expected. The question arises how abnormalities should be diagnostically clarified to obtain a diagnosis quickly, safely and reliably. We offer early amniocentesis (AC) before 15+0 weeks for confirmation with a quickly available FISH test in distinction to CVS, which only reflects the placenta. We looked at the rate of diagnosis by AC, ultrasound/NIPT discrepancies, time of diagnosis and abortion rate. In all out of 95 cases a FISH result was obtained within 24 hours and a complete genotype within 14 days. In all out of 50 cases with additional NIPT there was no false-positive NIPT. In cases with planned termination of pregnancy, a one-stage procedure was possible after diagnosis in most of the cases. There were no complications in the sense of premature rupture of membranes in the first 5 days. Early AC is a powerful tool in cases when poor prognosis must be assumed by ultrasound and NIPT to get an early and reliable diagnosis. In contrast to chorionic villus sampling or NIPT, there is no risk of misdiagnosis due to placental mosaics. The decision to perform early AC after abnormal NIPT should always depend on the result of a qualified ultrasound. If NIPT is conspicuous and ultrasound is unremarkable or mild, AC should be performed after 16+0 weeks to avoid miscarriage of a healthy fetus.

Sono-fetal tibial length evaluation as a predictor of gestational age: A case of Nigerian population

Background: Accurate pregnancy dating is essential for guiding patients about the option of termination of pregnancy or in analysis of biochemical serum screening test and to ensure adequate management of pregnant women with the intention to reduce maternal morbidity and mortality, especially when considering the best parameter for estimating gestational age, it is important that the structure has little biological variation, and can be measured with high degree of reproducibility. This study was designed to evaluate the use of fetal tibia length as a tool for the estimation of gestational age among the Nigerian population. Materials and Methods: This was a cross-sectional study, which involved 215 pregnant women selected using convenient sampling technique based on the inclusion criteria in a single private diagnostic centre in Port Harcourt. Ultrasound scan was done on each subject and fetal biometric parameters (Biparietal diameter, femur length and tibial length) and gestational age were assessed and documented. Data obtained were analyzed using descriptive and inferential statistics. Results: The majority (n = 12) of the pregnant women had gestational age of 25 weeks. The mean values for BPD, FL and TL of those with 17th week GA were 36.70±1 0.35, 23.65±0.7 and 22.28±1.42 as the least mean values while the highest mean values were identified in patients that had 41 weeks of GA, which were 95.20±0.00, 79.40±0.00 and 58.00±0.00 for BPD, FL and TL respectively. There were no statistically significance mean differences between BPD (t = 225.17, p = 0.001), FL (t = 100.84, p = 0.001) and TL (t = -33.38, p = 0.001) and the estimated gestational age of 17 weeks. Conclusion: The fetal tibial length (FTL) increases with advancing gestational age in apparently healthy fetus. The FTL can be strongly use as a tool for the prediction of fetal gestational age, where other parameters cannot be evaluated.

Correlation of liver and kidney indicators with foetal vital organ function

This study aimed to investigate the correlation between indicators of liver and kidney function and foetal vital organ function. One hundred and eighty-five pregnant women who underwent cordocentesis and whose foetuses were diagnosed with abnormal foetal organ function were enrolled. The indicators of liver and kidney function were compared between foetuses with abnormal vital organ function and healthy foetuses. There was a significant difference between foetuses with and those without normal cardiovascular systems in terms of total protein, albumin, total bile acid, and creatinine levels (P < .05). A significant difference in aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) levels was observed in foetuses with and those without normal foetal urinary systems (P < .05). A difference between foetuses with normal and those without normal musculoskeletal systems was noted when comparing LDH levels. Further, there was a significant difference in gestational age and AST, alanine aminotransferase, albumin, total bilirubin, alkaline phosphatase, LDH, adenosine dehydrogenase, fibronectin, and creatinine levels between foetuses with normal versus abnormal blood systems (P < .05). Thus, hepatic and renal function indicators may be associated with abnormal foetal vital organ function. Impact statement What is already known on this subject? Foetal cardiac function is currently evaluated using colour Doppler ultrasound and magnetic resonance imaging in clinical practice, but there are few predictive indicators of the function of other vital organs. It is difficult to determine whether children have abnormalities in the urinary system, digestive system, nervous system, or other vital organs. What do the results of this study add? In this study, it was found that total protein, albumin, total bile acid, creatinine, aspartate aminotransferase, lactate dehydrogenase, fibronectin, alanine aminotransferase, total bilirubin, alkaline phosphatase, adenosine dehydrogenase, and other liver and kidney function indicators may be associated with foetal vital organ dysfunction. However, the forecast range of specific indicators must be further improved upon. What are the implications of these findings for clinical practice and/or further research? This study provides an additional reference for predicting foetal cardiac function.

Predictive Assessment of Fetus Features Using Scanned Image Segmentation Techniques and Deep Learning Strategy

Fetus weight at various stages of pregnancy is a critical component in determining the health of the baby. Abnormalities arising early in the pregnancy may be prevented by preventive measures. A variety of techniques suggested to predict foetus weight. Computer vision is a capability that can estimate the weight of a baby based on ultra-sonograms taken at various stages of pregnancy. Using the scanned data, one may train an advanced convolutional neural network that helps in accurately forecasting the fetus's size, weight, and overall health. The research utilizes computer vision techniques with image clustering methods for preprocessing, to predict the foetus's health, training datasets defective foetus datasets and healthy foetus datasets. Developing an integrated computer vision and a deep neural network is the hour which decrease the cost of operations and manual processes This study estimate the fetus's weight with optimal accuracy range at varying gestation age.

A deep learning mixed-data type approach for the classification of FHR signals.

The Cardiotocography (CTG) is a widely diffused monitoring practice, used in Ob-Gyn Clinic to assess the fetal well-being through the analysis of the Fetal Heart Rate (FHR) and the Uterine contraction signals. Due to the complex dynamics regulating the Fetal Heart Rate, a reliable visual interpretation of the signal is almost impossible and results in significant subjective inter and intra-observer variability. Also, the introduction of few parameters obtained from computer analysis did not solve the problem of a robust antenatal diagnosis. Hence, during the last decade, computer aided diagnosis systems, based on artificial intelligence (AI) machine learning techniques have been developed to assist medical decisions. The present work proposes a hybrid approach based on a neural architecture that receives heterogeneous data in input (a set of quantitative parameters and images) for classifying healthy and pathological fetuses. The quantitative regressors, which are known to represent different aspects of the correct development of the fetus, and thus are related to the fetal healthy status, are combined with features implicitly extracted from various representations of the FHR signal (images), in order to improve the classification performance. This is achieved by setting a neural model with two connected branches, consisting respectively of a Multi-Layer Perceptron (MLP) and a Convolutional Neural Network (CNN). The neural architecture was trained on a huge and balanced set of clinical data (14.000 CTG tracings, 7000 healthy and 7000 pathological) recorded during ambulatory non stress tests at the University Hospital Federico II, Napoli, Italy. After hyperparameters tuning and training, the neural network proposed has reached an overall accuracy of 80.1%, which is a promising result, as it has been obtained on a huge dataset.

Study protocol for a randomized trial on timely delivery versus expectant management in late preterm small for gestational age pregnancies with an abnormal umbilicocerebral ratio (UCR): the DRIGITAT study

BackgroundThe clinical inability to correctly identify late fetal growth restriction (FGR) within a group of fetuses who are identified as small for gestational age (SGA) is an everyday problem for all obstetrician-gynecologists. This leads to substantial overtreatment of healthy small fetuses but also inadequate detection of the growth-restricted fetuses that may benefit from timely delivery. Redistribution of the fetal circulation, signaled by an abnormal ratio of the Doppler velocity flow profiles of the umbilical artery and the middle cerebral artery, more specifically an increased umbilicocerebral ratio (UCR) (or its inverse: a decreased cerebroplacental ratio (CPR)), is an adaptation to chronic hypoxemia and nutritional scarcity with long-term consequences in survivors. The relevance of an abnormal UCR has been signaled extensively, and there is a general consensus that it is a signal of FGR, independent of size, with a strong association with poor outcomes. Yet, in the current literature, no comparisons of a monitoring-delivery strategy based on unfavorable UCR have been published. The objective of the Doppler Ratio In fetal Growth restriction Intervention Trial At (near) Term (DRIGITAT) is to evaluate if the timing of the delivery based on an abnormal UCR in late preterm fetuses identified as SGA improves neurodevelopmental outcomes at 2 years of age.MethodsThe DRIGITAT study is a national multicenter cohort study of women with singleton pregnancies between 32 and 37 weeks of gestation identified as SGA, with a nested randomized controlled trial (RCT) in case of an abnormal UCR (> 0.8). Recruiting centers are in The Netherlands. In the nested RCT, women are randomized to either immediate induction of labor or expectant management from 34 weeks in case of severely abnormal size (EFW or FAC < p3) and from 36 weeks in case of mildly abnormal size (EFW or FAC p3–p10). The primary outcome measure is the 7-point average difference in the composite cognitive score (CCS) and composite motor score (CMS) on the Bayley-3 at 2 years. Secondary outcome measures include a composite outcome of neonatal morbidity, perinatal mortality, mode of delivery, maternal quality of life, costs, and predictive value of serum biomarkers. Analyses will be by intention to treat. The required sample size is determined for the nested RCT as 185 patients.DiscussionThis study will provide insight into the diagnostic efficacy of UCR measurement in the evaluation of SGA fetuses in order to differentiate the healthy SGA fetus from the growth-restricted fetus and to determine if a fetus with abnormal UCR benefits from early delivery.Trial registrationHealthcare Evaluation Netherlands NTR6663. Registered on 14 August 2017.

Fetal congenital heart disease - mode of delivery and obstetrical complications

BackgroundThe optimal mode of delivery in cases of fetal congenital heart disease (CHD) is not established. The few relevant studies did not address operative vaginal delivery. The aim of this study was to assess the impact of fetal CHD on mode of delivery during a trial of labor, and to secondarily describe some obstetric complications.MethodsThe database of a tertiary medical center was searched for women who gave birth to a singleton, liveborn neonate in 2015–2018. Mode of delivery was compared between women carrying a fetus with known CHD and women with a healthy fetus matched 1:5 for maternal age, parity, body mass index, and gestational age.ResultsThe cohort included 616 women, 105 in the CHD group and 511 in the control group. The rate of operative vaginal delivery was significantly higher in the CHD group (18.09% vs 9.78%, OR 2.03, 95% CI 1.13–3.63, p = 0.01); the difference remained significant after adjustment for nulliparity and gestational age at delivery (aOR 2.58, 95% CI 1.36–4.9, p < 0.01). There was no difference between the CHD and control group in rate of intrapartum cesarean delivery (9.52% vs 10.76%, respectively, OR 0.97, 95% CI 0.47–1.98, p = 0.93). The most common indication for operative vaginal delivery was non-reassuring fetal heart rate (78.94% vs 64%, respectively). Median birth weight percentile was significantly lower in the CHD group (45th vs 53rd percentile, p = 0.04).ConclusionsOur findings suggest that operative vaginal delivery, performed mostly because of non-reassuring fetal heart rate, is more common in pregnancies complicated by a prenatal diagnosis of CHD than non-anomalous pregnancies.

Normograms in Prenatal Life of Stomach and Urinary Bladder in the Second and Third Trimesters of Pregnancy.

The aim of this study was to prepare normograms for the fetal stomach, urinary bladder, and stomach to urinary bladder index in healthy fetuses. The study was conducted based on the data extracted from the database of our tertiary center in the years 2016-2019. The study group, comprising 867 fetuses, demonstrated normal biometry and normal heart structure, normal heart function, no extracardiac malformations, and no extracardiac anomalies. The stomach to urinary bladder index was analyzed in the study group. The examinations were performed with the use of the following ultrasound machines: Voluson E10, Philips and Voluson Expert, with convex transabdominal transducers. Linear regression analysis based on Microsoft Excel was used for statistical analysis. The average size of the stomach in healthy fetuses between the 14-40th week of gestation was 18 mm (8-40 mm), the average urinary bladder measurement was 17 mm (15-42 mm), and the fetal stomach to urinary bladder index was constant: 1.26 (0.09-3.93). The normograms for the stomach, urinary bladder and the stomach to urinary bladder index prepared based on our study group can contribute to an improvement in the accuracy of examination and provide an unified organization of the description of fetuses. These normograms constitute an additional marker for the assessment of fetal condition. A clear disproportion in the size of the urinary bladder and stomach can be helpful in terms of paying more attention to fetuses with untypical features in screening centers.