High-risk Pregnancies Research Articles

478. COVID-19 maternal antibody concentrations in twin infants: impact of multiple pregnancy on transplacental antibody transfer during pregnancy

Abstract Background COVID-19 vaccines in pregnancy protect both pregnant individuals and young infants from severe illness via transplacental transfer of maternally-derived IgG. However, the impact of multiple (e.g. twin) pregnancy on transplacental transfer of SARS-CoV-2 IgG is unknown. We aimed to evaluate anti-Spike (S) antibody transfer among infants from twin pregnancies compared to singleton pregnancies. Methods We conducted a prospective cohort study among individuals with twin and singleton pregnancies who received at least 2 doses of an mRNA COVID-19 vaccine prior to delivery. We tested paired maternal and cord samples for anti-S IgG and used linear regression to evaluate associations between multiple or singleton pregnancy and anti-S antibody. We included as covariates timing of last vaccine dose, gestational age at delivery, number of doses prior to delivery, and small for gestational age (< 10th percentile) birthweight. Results We tested maternal/cord anti-S IgG from 25 twin and 291 singleton pregnancies. The median gestational age at delivery was 36 weeks for twin infants compared to 39 weeks for singleton infants. Median maternal anti-S IgG was 5812 BAU/mL (IQR:754, 16061) and 2971 BAU/mL (IQR:706, 14000) for twin and singleton pregnancies, respectively. Median cord anti-S IgG was 4110 BAU/mL (IQR: 527, 15937) and 3636 BAU/mL (IQR: 1019, 15465) for twin and singleton infants, respectively (Figure 1). Cord:maternal IgG ratios were significantly lower in twin pregnancies compared to singleton pregnancies (p < 0.01; Figure 2). After adjustment for covariates, there was no difference between maternal anti-S IgG concentrations (beta: -0.54; 95% confidence interval [CI]: -1.26,0.18; p=0.14), cord anti-S IgG concentrations (beta: -0.77; 95% CI: -1.68,0.13; p=0.10) or cord:maternal IgG ratios (beta: -0.07; 95% CI: -0.32,0.19; p=0.61) between twin and singleton pregnancies. Conclusion Twin and singleton infants benefit similarly from maternal COVID-19 vaccine during pregnancy. Higher risk pregnancies including multiple pregnancies should be considered in health policy discussions regarding COVID-19 vaccine timing in pregnancy. Disclosures Alisa B. Kachikis, MD, MSc, Merck: Grant/Research Support|Pfizer: Grant/Research Support Mindy Pike, PhD, Merck: Grant/Research Support Alexander L. Greninger, MD, PhD, Cepheid: central contracts|Hologic: central contracts|Janssen: central contracts|Novavax: central contracts|Pfizer: central contracts Janet A. Englund, MD, Ark Biopharma: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant

Different risk-assessment models for prediction of preeclampsia and fetal growth restriction in the first trimester in a high-risk pregnancy – which models are better?

Different risk-assessment models for prediction of preeclampsia and fetal growth restriction in the first trimester in a high-risk pregnancy – which models are better?

Clinical case of high perinatal risk pregnancy with heterozygous Leiden mutation

Clinical case of high perinatal risk pregnancy with heterozygous Leiden mutation

Investigate the relationship between the microbiota awareness in first trimester and high risk pregnancy in Turkish women: cross-sectional study

BackgroundIt is suggested that pregnancy risks may be related to microbial dysbiosis, and it is known that knowledge on this subject is reflected in behaviors. The purpose of this study was to investigate whether microbiota awareness in the first trimester of pregnancy is associated with pregnancy-related risks.MethodsWithin the scope of the study, the microbiota awareness scale was administered to 426 individuals in the first trimester of pregnancy, and information on any diagnosis related to high-risk pregnancy, gestational age, birth weight, and birth height of the newborn was obtained from their file records.ResultsThe mean total microbiota awareness score of individuals was 61.38 ± 11.00 (26.00–91.00). The microbiota awareness score (56.85 ± 11.65) was found to be lower in individuals diagnosed with high-risk pregnancy (p < 0.05) than in healthy subjects (63.64 ± 9.94). Moreover, in individuals with high-risk pregnancies, a positive correlation was found between the microbiota awareness score and newborn birth weight and height (p < 0.05).ConclusionThe poor microbiota awareness level in pregnant women is associated with high-risk pregnancy and neonatal growth status.

Development and psychometric properties of the Reproductive Health Assessment in Systemic Lupus Erythematosus: Mixed-Methods study.

Systemic lupus erythematosus (SLE) with a high morbidity rate (7% in general and 325/100.000 in reproductive period) was known as "the mother of autoimmune diseases." But healthcare providers hadn't reliable scales to measure the effectiveness of interventions to improve reproductive health. Women with systemic lupus erythematosus (SLE) express concern about a significant gap in their reproductive and sexual health during medical care due to the lack of a specific scale to measure this concept. This study developed psychometrically specific scale to evaluate this concept in Iranian women. The study utilized a sequential-exploratory mixed-methods design, wherein the concept of reproductive health was clarified during the qualitative phase using conventional content analysis (inductive-deductive) to create a pool of RHASLE (Reproductive Health Assessment in SLE) items. During the psychometric process, the face, content, and construct validities of the RHASLE were checked with 650 individuals (320 using exploratory factor analysis [EFA] and 330 using confirmatory factor analysis [CFA]) through interviews and completion of the questionnaire. Convergent and divergent validities were then checked, and the reliability was assessed through stability and internal consistency. Finally, the measurement error, responsiveness, and interpretability of the scale were evaluated and confirmed. The study's findings revealed that the RHASLE consisted of 5 factors (33 items): physical-psychological disorder (13 items), relaxing feeling (6 items), spirituality (3 items), high-risk pregnancies (5 items), and sexual satisfaction (6 items). These factors explained a total of 99.97% of the variance in the concept of reproductive health. Confirmatory factor analysis confirmed the good model fit, and its validity and reliability were deemed acceptable. The RHASLE consisted of 27 items with high internal consistency, stability, responsiveness, and interpretability. That was able to get approval of Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Based on the results, RHASLE is a valid and reliable multidimensional scale that encompasses various aspects of reproductive health (physical, sexual, psychological, social, and spiritual).

Expectations related to home-based telemonitoring of high-risk pregnancies: A qualitative study addressing healthcare providers' and users' views in Norway.

A pregnancy can be evaluated as high-risk for the woman and/or the fetus based on medical history and on previous or ongoing pregnancy characteristics. Monitoring high-risk pregnancies is crucial for early detection of alarming features, enabling timely intervention to ensure optimal maternal and fetal health outcomes. Home-based telemonitoring (HBTM) is a marginally exploited opportunity in antenatal care. The aim of this study was to illuminate healthcare providers' and users' expectations and views about HBTM of maternal and fetal health in high-risk pregnancies before implementation. To address diverse perspectives regarding HBTM of high-risk pregnancies, four different groups of experienced healthcare providers or users were interviewed (n = 21). Focus group interviews were conducted separately with midwives, obstetricians, and women who had previously experienced stillbirth. Six individual interviews were conducted with hospitalized women with ongoing high-risk pregnancies, representing potential candidates for HBTM. None of the participants had any previous experience with HBTM of pregnancies. The study is embedded in a social constructivist research paradigm. Interviews were analyzed using a thematic approach. The participants acknowledged the benefits and potentials of more active roles for both care recipients and providers in HBTM. Concerns were clearly addressed and articulated in the following themes: eligibility and ability of women, availability of midwives and obstetricians, empowerment and patient safety, and shared responsibility. All groups problematized issues crucial to maintaining a sense of safety for care recipients, and healthcare providers also addressed issues related to maintaining a sense of safety also for the care providers. Conditions for HBTM were understood in terms of optimal personalized training, individual assessment of eligibility, and empowerment of an active patient role. These conditions were linked to the importance of competent and experienced midwives and obstetricians operating the monitoring, as well as the availability and continuity of care provision. Maintenance of safety in HBTM in high-risk pregnancies was crucial, particularly so insituations involving emerging acute health issues. HBTM requires new, proactive roles among midwives, obstetricians, and monitored women, introducing a fine-tuned balance between personalized and standardized care to provide safe, optimal monitoring of high-risk pregnancies.

Assessment of Knowledge Regarding Antenatal Care among Men in Selected Rural Areas of Himachal Pradesh

Background: WHO defined health as the state of complete physical, mental, and social well-being and not merely an absence of disease or infirmity, but it includes ability to lead socially and economically productive life.1 Being a man or women has a significant impact on health, as a result of both biological as well as gender related differences. Antenatal care (ANC) is most important aspect of women‘s reproductive health. The antenatal care is the care provided by skilled health care professionals to pregnant women and adolescent girls to ensure best health conditions for mother and baby during pregnancy. It reduces maternal and perinatal morbidity and mortality both directly, through detections and indirectly, through the identification of women and girls at increased risk of developing complications during labour, delivery and ensuring appropriate level of care.1 As per NFHS- 4, the 21% of pregnant women utilised full ANC, ranging from 2.3–65.9% across states. Overall, 51.6% had 4 or more ANC visits, 30.8% consumed IFA for at least 100 days and 91.1% had one or more doses of tetanus toxoid. Full ANC utilisation was inequitable across place of residence, caste, and maternal education. Registration of pregnancy, utilisation of government‘s Integrated Child Development Services (ICDS) and health insurance coverage were associated with higher odds of full ANC utilisation. Lower maternal education, lower wealth quintile, lack of father‘s participation during antenatal visits, higher birth order, teenage and unintended pregnancy were associated with lower odds of full ANC utilisation. This study assesses the knowledge about the antenatal care among married and unmarried men of 18-35 years age in selected rural areas of Himachal Pradesh. Methods: The study was an unmatched case and control design where married men were considered as a case and unmarried men as comparator group. This study was a part of large study for which sample size of 268 men in each group was calculated assuming prevalence of female contraceptives 70% in unmarried men and 85% in married men. This was carried out by cluster-based sampling in villages of Nagrota Bagwan and Shahpur health blocks of DRPGMC Tanda at Kangra. Results: The 93.3% participants among case group are aware of anaemia in pregnancy while only 64.9% among control group are aware of anaemia in pregnancy. The knowledge about all three causes of anaemia was statistically more in case group (61.9%) as compared to control group (38.8%). Assessment about high-risk pregnancy, about 72.4% participants among case group were aware about the risk factors in pregnancy as compared to 43.3% in control group with statistically significant differences (P=0.000). All the causes of high-risk pregnancy were reported by the participants of case group (44.0% vs 29.9%) with statistically significant differences. Conclusions: Married men had significantly more knowledge about various components of antenatal care. The awareness approach for unmarried men needs to be designed regarding antenatal care.

Effect of Internet + continuous midwifery service model on psychological mood and pregnancy outcomes for women with high-risk pregnancies

BACKGROUND There are many drawbacks to the traditional midwifery service management model, which can no longer meet the needs of the new era. The Internet + continuous midwifery service management model extends maternal management from prenatal to postpartum, in-hospital to out-of-hospital, and offline to online, thereby improving maternal and infant outcomes. Applying the Internet + continuous midwifery service management model to manage women with high-risk pregnancies (HRP) can improve their psycho-emotional opinion and, in turn, minimize the risk of adverse maternal and/or fetal outcomes. AIM To explore the effectiveness of a midwife-led Internet + continuous midwifery service model for women with HRP. METHODS We retrospectively analyzed the clinical data of 439 women with HRP who underwent prenatal examination and delivered at Shanghai Sixth People's Hospital (affiliated to the Shanghai Jiao Tong University School of Medicine) from April to December 2022. Among them, 239 pregnant women underwent routine obstetric management, and 200 pregnant women underwent Internet + continuous midwifery service mode management. We used the State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, and analysis of delivery outcomes to compare psychological mood and the incidence of adverse delivery outcomes between the two groups. RESULTS The data showed that in early pregnancy, the anxiety and depression levels of the two groups were similar; the levels gradually decreased as pregnancy progressed, and the decrease in the continuous group was more significant [31.00 (29.00, 34.00) vs 34.00 (32.00, 37.00), 8.00 (6.00, 9.00) vs 12.00 (10.00, 13.00), P &lt; 0.05]. The maternal self-efficacy level and strategy for weight gain management were better in the continuous group than in the traditional group, and the effective rate of midwifery service intervention in the continuous group was significantly higher than in the control group [267.50 (242.25, 284.75) vs 256.00 (233.00, 278.00), 74.00 (69.00, 78.00) vs 71.00 (63.00, 78.00), P &lt; 0.05]. The incidence of adverse delivery outcomes in pregnant women and newborns and fear of maternal childbirth were lower in the continuous group than in the traditional group, and nursing satisfaction was higher [10.50% vs 18.83%, 8.50% vs 15.90%, 24.00% vs 42.68%, 89.50% vs 76.15%, P &lt; 0.05]. CONCLUSION The Internet + continuous midwifery service model promotes innovation through integration and is of great significance for improving and promoting maternal and child health in HRP.

Effectiveness of Self-Instructional Module on knowledge regarding High-Risk Pregnancy among Antenatal mothers

A high-risk pregnancy is one in which there is or will be an increased risk of morbidity or mortality for the mother, the fetus, or the baby before or after delivery. Between 20–30% of pregnancies in India are high-risk. Consequently, the purpose of the current study is to evaluate the impact of a self-instruction module on prenatal mothers' understanding about high-risk pregnancies. The study's pre-experimental research design was chosen. For this study, 63 prenatal mothers were chosen using the purposive sample method. Result: revealed that majority of the respondents (65.08%) had poor knowledge regarding high-risk pregnancy, (30.16%) had average knowledge and only (4.76%) had good level of knowledgepre-test. Whereas in post-test majority of the respondents (82.53%) had good knowledge and (17.46%) had average knowledge regarding high-risk pregnancy. The Paired‘t’ test value was 26.86 whichwas greater than table value at .05 level of significance. This shows that there is significant difference between the pre-test and post-test level of knowledge regardinghigh-risk pregnancyamong antenatal mothers. There was significant association found between the pre-test knowledge score regarding high-risk pregnancy among antenatal mothers with demographic variableslike educational status, type of family, previous knowledge and source of information regarding high-risk pregnancy. Conclusion: Study concluded with strong need for proper health education in improving knowledge regarding high-risk pregnancy among antenatal mothers.

Intravitreal anti-vascular endothelial growth factor injections in pregnancy and breastfeeding: a case series and systematic review of the literature

IntroductionAnti-vascular endothelial growth factor (anti-VEGF) agents may occasionally need to be considered for sight-threatening macular pathology in pregnant and breastfeeding women. This is controversial due to the dearth of data on systemic side effects for mother and child. We aimed to expand the evidence base to inform management.MethodsRetrospective case series of pregnant and breastfeeding women treated with intravitreal anti-VEGF injections at Oxford Eye Hospital between January 2015 and December 2022. In addition, we conducted a systematic review and combined eligible cases in a narrative synthesis.ResultsWe treated six pregnant women with anti-VEGF for diabetic macular oedema(DMO) (n = 5) or choroidal neovascularisation (CNV) (n = 1). Four received ranibizumab whilst two (not known to be pregnant) received aflibercept. Patients known to be pregnant underwent counselling by an obstetric physician. Five pregnancies resulted in live births. Combining our cases with those previously published, treatment of 41 pregnant women (42 pregnancies) are reported. Indications for treatment included CNV (n = 28/41,68%), DMO (n = 7/41,17%) and proliferative diabetic retinopathy (n = 6/41,15%). Bevacizumab (n = 22/41,54%) and ranibizumab (n = 17/41,41%) were given more frequently than aflibercept (n = 2/41,5%). Many (n = 16/41,40%) were unaware of their pregnancy when treated. Most pregnancies resulted in live births (n = 34/42,81%). First trimester miscarriages (n = 5/42,12%) and stillbirths (n = 3/42,7%) mostly occurred in women with significant risk factors.ConclusionIntravitreal anti-VEGF injections may not necessarily compromise obstetric outcomes, although clear associations cannot be drawn due to small numbers and confounders from high rates of first trimester miscarriages in general and inherently high-risk pregnancies. It may be worth considering routinely investigating pregnancy and breastfeeding status in women of childbearing age prior to each injection, as part of anti-VEGF treatment protocols.

Antenatal ultrasound needs-analysis survey of Australian rural/remote healthcare clinicians: recommendations for improved service quality and access

BackgroundUltrasound is the primary diagnostic tool in pregnancy, capable of identifying high-risk pregnancies and life-threatening conditions, allowing for appropriate management to prevent maternal and fetal morbidity and mortality. Women and babies from rural and remote Australia and low-resource areas worldwide experience poorer health outcomes and barriers to accessing antenatal care and imaging services. Healthcare clinicians working in these regions face significant challenges practising with limited resources and accessing training opportunities.ObjectiveTo perform an exploratory needs-analysis survey investigating the availability, accessibility and use of antenatal ultrasound in rural Australia, exploring rural clinicians’ interest in and access to ultrasound training opportunities.MethodsThe survey tool for this cross-sectional study was designed and distributed as an anonymous online questionnaire targeting healthcare clinicians (doctors, nurses, midwives, clinic managers, Aboriginal healthcare workers) providing antenatal care in rural regions. Descriptive analysis was applied to quantitative data and thematic analysis was used to explore qualitative components.ResultsA total of 114 valid survey responses were analysed. Overall, 39% (43/111) reported ultrasound was not used when providing antenatal care to patients at their clinic, stating ‘Lack of ultrasound equipment (73%,29/40) and inaccessibility of training opportunities (47%,19/40) as the main reasons. For those with ultrasound (61%,68/111), estimating due date (89%,57/64) was the main use, and limited training/skills to operate the equipment (59%,38/64) and inaccessibility/distance of training opportunities (45%,29/64) were the most commonly reported barriers. Clinicians described a lack of childcare options (73%,74/102), long distances to reach ultrasound services (64%,65/102), appointment (59%,60/102) and transport availability/times (46%,47/102) as the main obstacles to patient access. Increased attendance, compliance with care directives, parental bonding and improved lifestyle choices were described by respondents as positive outcomes of antenatal ultrasound use.ConclusionsFuture efforts to combat inequitable service access must adopt a coordinated approach to meet the needs of pregnant women in low-resource settings. Providing portable ultrasound equipment, training in antenatal Point-of-Care ultrasound (PoCUS) with ongoing support/mentoring and accreditation of health professionals could strengthen rural workforce capacity. This, along with addressing the complex economic, environmental and socio-cultural barriers faced by patients, could improve service access and pregnancy outcomes in rural and remote communities.

Perinatal Outcome in High-Risk &amp; Severe-Risk Pregnancy- A Study in a Tertiary Care Hospital

Introduction: High-risk &amp; severe-risk pregnancies are characterized by increased risks of complications for both the mother and the fetus, which can result from several factors such as maternal age, medical situations, lifestyle habits, and previous pregnancies. These complications are a major concern, mostly in developing countries like Bangladesh, where maternal and infant mortality rates remain high. Maternal complications associated with high-risk and severe-risk pregnancies may include maternal death, severe bleeding, sepsis, and hypertensive disorders, while fetal complications may include preterm delivery, fetal growth restriction, and stillbirth. The objective of this study was to investigate the perinatal outcomes of high-risk and severe-risk pregnancies. Methods: This prospective purposive study was carried out on the admitted patients in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2007 to December 2007. Total hundreds of risk groups pregnant women (N=100) were enrolled in the study among them eighty-five (n=85) scoring 3-6 included as high risk pregnancy and fifteen (n=15) scoring 7 or more included as severe-risk pregnancy. All relevant data were recorded for each individual study subject on predesigned data collection sheet. All collected data were compiled and analyzed by computer-based statistical software (Instat). Chi-square tests were performed to compare the prevalence of study variables where, p &lt; 0.05 considered the level of significance with 95%CI. Ethical clearance of this study was obtained from the Institutional Review Board (IRB) of BSMMU, Dhaka, Bangladesh. Results: In the high-risk group (n=85), around one-fourth of the patients (22,25.9%) and in a severe- risk group (n=15), one patient (1,6.7%) underwent vaginal delivery, Caesarean section was done in sixty-three patients (63,74.1%) in high-risk pregnant women and fourteen patients (14,93.3%) in severe-risk pregnant women respectively. The distribution of risk group and mode of delivery is statistically highly significant (P &lt;0.001). Out of sixty-three patients (n1=63), nineteen (19, 30.2%) were required to be delivered by caesarean section for fetal distress and fifteen (15, 30.16%) were malpresentation. Out of forty-one patients (n2=14), the most common indications were a history of previous caesarean section with multiple risk factors in eight patients (8, 57.1%). Birth asphyxia was present in nine neonates (9, 13.6%) in a high-risk group (n = 65) and a severe- risk group (n2=14), and birth asphyxia was present in five neonates (5, 35.7%). Based on the outcome, in high-risk pregnancy (n=85), four neonates (4, 4.5%) died and in severe-risk pregnancy (n=15), one (1, 6.3%) died. Conclusion: The study found various obstetric complications and outcomes associated with high-risk and severe-risk pregnancies. The results indicated a significantly higher proportion of caesarean sections performed in severe-risk pregnancies compared to high-risk pregnancies. Moreover, the overall outcome was favorable, with only five neonatal deaths reported among the one hundred maternal risk groups.

Psychological distress in pregnancy and postpartum: a cross-sectional study of Babol pregnancy mental health registry

BackgroundPsychological distress (PD) is a significant issue during pregnancy and postpartum, adversely affecting both children and mothers. This study aims to determine PD's prevalence and risk factors in a large Iranian population sample during pregnancy and postpartum.MethodsA cross-sectional study was conducted using data from the Babol Pregnancy Mental Health Registry (located in the north of Iran) between June 2020 and March 2021. A total of 2305 women were included, with 1639 during pregnancy and 666 during postpartum. Psychological distress was assessed using the Brief Symptoms Inventory (BSI-18), and data were analyzed using independent t-tests and multiple logistic regressions.ResultsThe prevalence of psychological distress, defined by a cut-off score of BSI ≥ 13, was 19% during pregnancy and 15% during postpartum. Multivariate logistic analysis revealed that high-risk pregnancy was the leading risk factor for psychological distress during the antenatal period (β = 1.776, P < 0.001), as well as its three subscales: somatization (β = 1.355, P = 0.019), anxiety symptoms (β = 2.249, P < 0.001), and depressive symptoms (β = 1.381, P = 0.028). Additionally, women with a gestational age < 20 weeks had a higher risk of psychological distress (β = 1.344, P = 0.038) and the somatization subscale (β = 1.641, P < 0.001). During the postpartum period, women residing in urban areas were at higher risk of psychological distress (β = 1.949, P = 0.012), as well as two subscales: anxiety symptoms (β = 1.998, P = 0.012) and depressive symptoms (β = 1.949, P = 0.020).ConclusionThe high prevalence of psychological distress emphasizes detecting and treating PD during pregnancy and postpartum, particularly in women with high-risk pregnancies. This study suggests that obstetricians and midwives should implement programs to identify women experiencing psychological distress during early pregnancy through postpartum visits.

Effects on reduction of morbidity and mortality in ACHD population of childbearing age as a result of ESC Guidelines

Abstract Introduction Cardiovascular disease remains the leading cause of maternal death during pregnancy and peripartum period. ACHD is a rising cause for maternal cardiovascular complications. Several studies demonstrated the beneficial role of systematic maternal cardiovascular risk assessment culminating in the European Society of Cardiology guidelines in 2018 endorsing the use of the modified World Health Organization (mWHO) classification to stratify maternal risk and further guide surveillance and management of women with underlying cardiac conditions. Purpose In this study we aim to reduce maternal cardiovascular morbidity risks by actively implementing recommendations from the 2018 ESC guidelines for the management of cardiovascular diseases in women with ACHD in childbearing age in Grampian region, Scotland. Methods We identified women of childbearing age (n = 204) in the ACHD population of NHS Grampian (n = 594). We initially calculated baseline percentage of ACHD women who had pre-pregnancy counselling, documented mWHO risk assessment and, if applicable, contraception advice and pregnancy rate. This population has been prospectively followed up during the period from 2020 to 2022 and ESC guidelines were implemented. By the end of the follow up period we assessed the changes in the pregnancy rate in ACHD women. Results Overall, the population of ACHD women of childbearing age in Grampian region has significantly grown (expanded) during the study period (from n = 204 to n = 230) and the vast majority (90.5%) of these patients are diagnosed with mWHO class I (38.3%, ESC mild ACHD) or mWHO class II / class II-III (52.2%, ESC moderate ACHD). There has been an increase in the percentage of women reviewed in Transition Clinic compared to baseline (44.7% versus 27.8%, respectively), a clearer documentation of mWHO pregnancy risk (31.6% versus 7.3%) and an increase in contraceptives use, especially in moderate and severe ACHD patients compared to baseline (65.2% versus 57.1%, respectively). This resulted in an overall reduction of the numbers of pregnancy in ACHD women compared to baseline (7.9% versus 40.1%, respectively), especially in women with ESC moderate and severe ACHD (Table 1) with consequent reduction in hospital admissions and morbidity. Conclusions Implementing risk stratification tools (mWHO pregnancy risk stratification) and systematic pre-pregnancy counselling with contraceptive advice (all key recommendations from the ESC guidelines) reduce the rate of high-risk pregnancy in ACHD women. This translates to an improvement in survival rates and lower morbidity in ACHD women. Further follow up is required to ensure the consistency of this finding.

Relationship between emotional intelligence and prenatal attachment levels of women with healthy and high-risk pregnancies

Objectives: Emotional intelligence enables pregnant women to effectively cope with environmental effects and stressors in a dynamic and changing process. This research was planned for evaluating the relationship between emotional intelligence and prenatal attachment levels of women with healthy and high-risk pregnancies. Methods: Based on the descriptive research design and regression analysis, the research was performed with the participation of 281 pregnant women. Research data were collected through Information Form, Emotional Intelligence Self-Evaluation Scale (EISES) and Prenatal Attachment Inventory (PAI). Results: As per means of scores obtained from the EISES and PAI by women with healthy (133.34 ± 32.30) and high-risk (126.81 ± 35.80) pregnancies, it was found that pregnant women had high levels of emotional intelligence and medium levels of prenatal attachment. Based on research variables, there were no statistically significant differences in means of scores obtained from the Scale and the Inventory by women with healthy and high-risk pregnancies (p &amp;gt; 0.05). It was found that women who voluntarily got pregnant had higher prenatal attachment levels and this difference was statistically significant (x2= 102.81, p &amp;lt; 0.001). It was identified that there was no statistically significant difference in means of scores obtained by pregnant women from the EISES ans PAI (r= -0.060, p = 0.318). Conclusions: It was found that there was no statistically significant difference in prenatal attachment levels of women with healthy and high-risk pregnancies and their prenatal attachment levels had no statistically significant association with their emotional intelligence levels.

Utilization of Phyo Referral Score in assessing maternal referral quality in emergency cesarean section of maternal COVID-19 cases in Pekanbaru, Indonesia

Link of Video Abstract: https://youtu.be/H8GILKBIJwo Introduction: During the Coronavirus disease 2019 (COVID-19) pandemic, basic and emergency obstetric healthcare was hampered due to health service protocol changes. The reduced coverage of antenatal service during the COVID-19 pandemic increased the number of undetected high-risk pregnancies and the likelihood of obstetric emergency cases. This study assessed maternal referral quality using the Phyo Referral Score (PRS) on emergency cesarean section (ECS) patients infected by SARS-CoV-2. Methods: This retrospective cohort study used secondary data originating from patient medical records who went through ECS from 1 January 2021 to 31 December 2021. The subject was chosen purposively by the inclusion criteria. A Total of 609 mothers went through Cesarean Section in 2021, there were 52 mothers who met the criteria. The data were described by frequencies, percentages, and mean ± standard deviation. The data was analyzed by Levene’s test and Chi-square test using IBM SPSS version 26.0. Results: During the retrospective year, a total of 609 mothers went through Cesarean Section in 2021, there were 52 mothers who met the criteria. The most common indications of ECS were persistent fetal hypoxia (50.0%), placenta previa (13.5%), and maternal respiratory failure (13.5%). Most of the patients had good referral quality. From the parameters of PRS, patients are more likely to have good referral quality if accompanied by medical staff, receiving stabilization procedures, and communicating with the hospital by phone before being referred, and transported by ambulance within the same cities. Conclusion: Accessibility is a critical component of obstetric emergency cases. Even during the COVID-19 pandemic, ensuring that mothers have a good referral quality to access advanced obstetrical care can help the survival of both mothers and fetuses.

The needs of multiple birth families during the first 1001 critical days: A rapid review with a systematic literature search and narrative synthesis.

Supporting families during the first 1001 days from conception to the age of two is vital for setting the emotional, cognitive, and physical building blocks for children's futures. Families with twins, triplets, or higher order multiples (multiple birth families) have unique challenges due to caring for more than one baby at the same time. Therefore, identifying the needs of multiple birth families is necessary to provide optimum support during the first 1001 critical days. A rapid review was undertaken to synthesize knowledge of the needs of multiple birth families in the United Kingdom (UK) during the first 1001 critical days. Findings from five databases (MEDLINE, APA PsycArticles, APA PsycInfo, CINAHL, and Web of Science) for peer-reviewed studies and grey literature published between 2012 and 2022 were synthesized. Fifteen studies were reviewed using narrative synthesis. Multiple birth families have unique and complex emotional and practical needs across the first 1001 critical days, and in particular, the first-year post birth, impacted further by complicated pregnancies and prematurity. Needs were identified within the four key themes: high risk pregnancy and birth; transformed reality of raising multiples; inadequate support; and positively affecting experiences. Health professional support was inconsistent and particularly lacking in intrapartum, postnatal, and community care including transition. Multiple birth families' needs should be considered in the design and delivery of care within the first 1001 critical days, especially within the first year after birth. Multiples specific advice across the first 1001 critical days is needed and training for health professionals to adapt universal advice for this population is one way to achieve this. Further research is needed to ensure this advice is evidence based and effective.

Hidden in plain sight: role of residual myometrial thickness to predict outcome of Cesarean scar pregnancy.

Ultrasound in Obstetrics & GynecologyAccepted Articles Opinion Hidden in plain sight: role of residual myometrial thickness to predict outcome of Cesarean scar pregnancy I. E. Timor-Tritsch, Corresponding Author I. E. Timor-Tritsch [email protected] orcid.org/0000-0001-9774-3107 Department of Obstetrics and Gynecology, New York University, New York, NY, USACorrespondence to: Prof. I. E. Timor-Tritsch, Department of Obstetrics and Gynecology, New York University, New York, NY, USA, E-mail: [email protected]Search for more papers by this authorA. Monteagudo, A. Monteagudo Icahn School of Medicine, Carnegie Maternal–Fetal Associate's, NY, USASearch for more papers by this authorG. Calỉ, G. Calỉ Department of Obstetrics and Gynecology, Maternal–Fetal Medicine Unit, Azienda Ospedaliera Villa Sofia-Cervello, Palermo, Italy Maternal–Fetal Unit, Candela Clinic, Palermo, ItalySearch for more papers by this authorA. Kaelin Agten, A. Kaelin Agten orcid.org/0000-0002-3344-0315 Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. M. Palacios Jaraquemada, J. M. Palacios Jaraquemada Department of Obstetrics and Gynecology, CEMIC University Hospital, Buenos Aires, ArgentinaSearch for more papers by this authorF. D'Antonio, F. D'Antonio orcid.org/0000-0002-7546-8025 Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, ItalySearch for more papers by this author I. E. Timor-Tritsch, Corresponding Author I. E. Timor-Tritsch [email protected] orcid.org/0000-0001-9774-3107 Department of Obstetrics and Gynecology, New York University, New York, NY, USACorrespondence to: Prof. I. E. Timor-Tritsch, Department of Obstetrics and Gynecology, New York University, New York, NY, USA, E-mail: [email protected]Search for more papers by this authorA. Monteagudo, A. Monteagudo Icahn School of Medicine, Carnegie Maternal–Fetal Associate's, NY, USASearch for more papers by this authorG. Calỉ, G. Calỉ Department of Obstetrics and Gynecology, Maternal–Fetal Medicine Unit, Azienda Ospedaliera Villa Sofia-Cervello, Palermo, Italy Maternal–Fetal Unit, Candela Clinic, Palermo, ItalySearch for more papers by this authorA. Kaelin Agten, A. Kaelin Agten orcid.org/0000-0002-3344-0315 Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. M. Palacios Jaraquemada, J. M. Palacios Jaraquemada Department of Obstetrics and Gynecology, CEMIC University Hospital, Buenos Aires, ArgentinaSearch for more papers by this authorF. D'Antonio, F. D'Antonio orcid.org/0000-0002-7546-8025 Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, ItalySearch for more papers by this author First published: 09 May 2023 https://doi.org/10.1002/uog.26246 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.26246. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Building and Optimizing the Interdisciplinary Heart Team.

A multidisciplinary care team model, or Heart Team approach, has become a central tenet of cardiovascular care. Though initially applied to the management of heart transplantation and subsequently complex coronary artery disease, the Heart Team is now utilized broadly across cardiovascular medicine, including in the treatment of valvular disease, pulmonary embolism, cardiogenic shock, high-risk pregnancies in patients with pre-existing cardiovascular disease, and adult congenital heart disease. The Heart Team model improves interdisciplinary collaboration among specialties, adherence to societal guidelines, and shared decision-making with patients and families. In this review, we highlight the development and rationale supporting the Heart Team model, address the challenges of implementing a multidisciplinary care team, and discuss the optimal methods to continue to build, optimize, and implement this approach.

De novo variants of dominant monogenic disorders in Vietnam detected by a noninvasive prenatal test: a case series.

Background: Noninvasive prenatal tests for monogenic diseases (NIPT-SGG) have recently been reported as helpful in early-stage antenatal screening. Ourstudy describes the clinical and genetic features of cases identified by NIPT-SGG. Materials & methods: In a cohort pregnancy with abnormal sonograms, affected cases were confirmed by invasive diagnostic testsconcurrently, with NIPT-SGG targeting 25 common dominant single-gene diseases. Results: A total of 13single-gene fetuses were confirmed, including Noonan and Costello syndromes, thanatophoric dysplasia, achondroplasia, osteogenesis imperfectaand Apert syndrome. Two novel variants seenwere tuberous sclerosis complex (TSC2 c.4154G>A) and Alagille syndrome (JAG1 c.3452del). Conclusion: NIPT-SGG and standard tests agreeon the results for 13 fetuses with monogenic disorders. This panel method ofscreening can benefit high-risk Vietnamese pregnancies, butfurther research is encouraged to expand on the causative gene panel.