High-risk Pregnancies Research Articles

Counseling in fetal medicine: update on mild and moderate fetal ventriculomegaly.

Ultrasound in Obstetrics & GynecologyAccepted Articles Opinion Counseling in fetal medicine: update on mild and moderate fetal ventriculomegaly D. Di Mascio, D. Di Mascio orcid.org/0000-0002-6560-3393 Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorF. D'Antonio, Corresponding Author F. D'Antonio [email protected] orcid.org/0000-0002-7546-8025 Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, ItalyCorrespondence to: Prof. F. D'Antonio, Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy, E-mail: [email protected]Search for more papers by this authorG. Rizzo, G. Rizzo orcid.org/0000-0002-5525-4353 Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, ItalySearch for more papers by this authorG. Pilu, G. Pilu Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalySearch for more papers by this authorA. Khalil, A. Khalil orcid.org/0000-0003-2802-7670 Fetal Medicine Unit, St George's Hospital, London, UK Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UKSearch for more papers by this authorA. Papageorghiou, A. Papageorghiou Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UKSearch for more papers by this author D. Di Mascio, D. Di Mascio orcid.org/0000-0002-6560-3393 Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorF. D'Antonio, Corresponding Author F. D'Antonio [email protected] orcid.org/0000-0002-7546-8025 Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, ItalyCorrespondence to: Prof. F. D'Antonio, Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy, E-mail: [email protected]Search for more papers by this authorG. Rizzo, G. Rizzo orcid.org/0000-0002-5525-4353 Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, ItalySearch for more papers by this authorG. Pilu, G. Pilu Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalySearch for more papers by this authorA. Khalil, A. Khalil orcid.org/0000-0003-2802-7670 Fetal Medicine Unit, St George's Hospital, London, UK Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UKSearch for more papers by this authorA. Papageorghiou, A. Papageorghiou Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UKSearch for more papers by this author First published: 19 May 2023 https://doi.org/10.1002/uog.26251 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.26251. 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

Home ctg remote care in high-risk pregnancy

Home ctg remote care in high-risk pregnancy

The mode of delivery in high-risk pregnancies without iugr with normal and abnormal tibial artery parameters. A longitudinal study

The mode of delivery in high-risk pregnancies without iugr with normal and abnormal tibial artery parameters. A longitudinal study

High-risk pregnancy after liver transplantation - a case report

High-risk pregnancy after liver transplantation - a case report

Enoxaparin-induced cutaneous panniculitis in a pregnant female

Low-molecular-weight heparins (LMWHs) are currently used as an antithrombotic prophylactic therapy during pregnancy and in post-surgery patients. The safety of various drugs in pregnancy has always been a matter of concern. Enoxaparin, being associated with low fetal and neonatal complications, is used extensively to improve the outcomes in high-risk pregnancies. The duration of treatment with LMWH in pregnancy is generally long; hence, strict monitoring of side effects should be done. We report a case of a 25-year-old pregnant female who experienced painful, erythematous skin necrosis and panniculitis after prophylactic administration of enoxaparin at multiple sites subcutaneously.

Antenatal corticosteroids - The art of high-risk pregnancies selection

Antenatal corticosteroids - The art of high-risk pregnancies selection

The effects of synbiotic supplementation on blood pressure and other maternal outcomes in pregnant mothers with mild preeclampsia: a triple-blinded randomized controlled trial

IntroductionPreeclampsia affects a significant percentage of pregnancies which is a leading cause of premature birth. Probiotics have the potential to affect inflammatory factors, and oxidative stress, which are linked to the development of preeclampsia. The study aimed to compare the effect of synbiotic and placebo on blood pressure and pregnancy duration as primary outcomes, and other pregnancy outcomes.MethodsThis study comprised 128 pregnant women with mild preeclampsia and gestational ages exceeding 24 weeks who were referred to the high-risk pregnancy clinic. It was a randomized, controlled, phase III, triple-blinded clinical experiment. The intervention and control groups were distributed to the participants at random. Intervention group received one oral synbiotic capsule, and control group received placebo daily until delivery. Based on gestational age at the time of diagnosis, preeclampsia was stratificated as early (< 34 weeks) or late (≥ 34 weeks). Data obtained from questionnaires, and biochemical serum factors were analyzed using SPSS software version 23 software.ResultsWith the exception of the history of taking vitamin D3, there were no statistically significant variations in socio-demographic variables between the research groups. After the intervention, the means of systolic blood pressure (adjusted mean difference: -13.54, 95% CI: -5.01 to -22.07), and diastolic blood pressure (adjusted mean difference: -10.30, 95% CI: -4.70 to -15.90) were significantly lower in the synbiotic-supplemented group than in the placebo group. Compared to the placebo group, the incidence of severe PE (p < 0.001), proteinuria (p = 0.044), and mean serum creatinine level (p = 0.005) significantly declined in the synbiotic-supplemented group after the intervention. However, our analysis found no significant association for other outcomes.ConclusionBased on our results, synbiotic had beneficial effects on some pregnancy outcomes. Further studies with larger samples are needed to verify the advantages of synbiotic supplementation for high-risk pregnancies, particularly with regards to higher doses, and longer intervention periods.Trial registrationIRCT20110606006709N20.

Changes in the characteristics and outcomes of high-risk pregnant women who delivered prior to and after China’s universal two-child policy: a real-world retrospective study, 2010–2021

BackgroundIn 2016, the “universal two-child” policy, allowing each couple to have two children, was introduced in China. The characteristic change of the long-term period after the implementation of the universal two-child policy was unclear. We studied trends in the obstetric characteristics and their potential impact on the rates of cesarean section and preterm birth in the era of China’s universal two-child policy.MethodsA tertiary center-based study (2010–2021) retrospectively focused single high-risk pregnancies who delivered from the one-child policy period (OCP, 2010–2015) to the universal two-child policy period (TCP, 2016–2021). A total of 39, 016 pregnancies were enrolled. Maternal demographics, complications, delivery mode and obstetric outcomes were analyzed. Furthermore, logistic regression analysis was used to explore the association between the cesarean section rate, preterm birth and implementation of the universal two-child policy, adjusting maternal age, parity, and fetal distress.ResultsUltimately a total of 39,016 pregnant women met the criteria and were included in this analysis. The proportion of women with advanced maternal age (AMA) increased from 14.6% in the OCP to 31.6% in the TCP. The number of multiparous women increased 2-fold in the TCP. In addition, the overall rate of cesarean section significantly decreased over the policy change, regardless of maternal age, whereas the risk of preterm birth significantly increased in the TCP. Adjusting for maternal age, parity and fetal distress, the universal two-child policy showed a significantly favorable impact on the cesarean section rate (RR 0.745, 95%CI (0.714–0.777), P < 0.001). Compared to the OCP group, a higher increase in fetal distress and premature rupture of membranes (PROM) were observed in the TCP group. In pregnancies with AMA, there was no increase in the risk of postpartum hemorrhage, whereas more women who younger than 35 years old suffered from postpartum hemorrhage in TCP. The logistic regression model showed that the universal two-child policy was positively associated with the risk of postpartum hemorrhage (RR: 1.135, 95%CI: 1.025–1.257, P = 0.015).ConclusionsAfter the implementation of the universal two-child policy in China, the rate of the cesarean section significantly decreased, especially for women under 35 years old. However, the overall risk of postpartum hemorrhage increased in women under 35 years old, while there was no change in women with AMA. Under the new population policy, the prevention of postpartum hemorrhage in the young women should not be neglected.

Safety of methotrexate administration in women with pregnancy of unknown location deemed to have high risk of ectopic pregnancy.

This study evaluates the safety of current guidelines on methotrexate (MTX) administration in women with pregnancy of unknown location (PUL) who are considered to have high risk of underlying ectopic pregnancy (EP) and to investigate whether this would result in inadvertent exposure of MTX to viable intra-uterine pregnancy (IUP). A retrospective observational study was conducted on clinically stable women who were classified PUL at Early Pregnancy Unit, Nepean Hospital, between 2007 and 2021. PUL is defined as when a woman presents with a positive pregnancy test but has no signs of IUP or EP on the transvaginal ultrasound (TVS). If patients with a PUL behave biochemically like an EP but the location is not confirmed on ultrasound, these women are eligible for MTX to minimize the risk of subsequent tubal rupture.Criteria discussed in the guidelines of American College of Obstetricians and Gynaecologists (ACOG),American Society for Reproductive Medicine (ASRM),Royal College of Obstetricians & Gynaecologists(RCOG)and National Institute for Health Care Excellence (NICE)were applied to the collected PUL database. The number of patients eligible to receive MTX and the number of women with underlying viable IUP who would be inadvertently given MTX were calculated. A total of 816 consecutive women with PUL were reviewed, and 724 had complete data and were included in the final analysis. 6 patients were persistent PULs,and 718 fell among outcomes of 4 subgroups: viable IUP, non-viable IUP, EP, failed PUL. According to the ACOG, ASRM, RCOG and NICE, the rate of possible MTX administration among patients with a PUL is 2.76%, 4.56%, 0.41% and 35.36%, respectively. However, no single persistent-PUL would have received MTX according to the above protocols, and majority of the MTX treatment were unnecessary because those patients were classified as NVIUP or FPUL later. More importantly, ACOG and ASRM could theoretically result in inadvertent MTX administration to women with an underlying IVUP at rates of 4.1/1000 (3/724). Current guidelines used to predict high risk of EP among PUL population are not safe enough to avoid inadvertent MTX administration to women with an underlying viable IUP.These guidelines need to be wisely used to ensure that no wanted pregnancy is exposed to MTX. Women with PULs should be carefully monitored and MTX should be used with judicious care when the location of pregnancy is yet to be confirmed. This article is protected by copyright. All rights reserved.

Stagnation of maternal mortality decline in Bangladesh between 2010 and 2016 in spite of an increase in health services utilisation: Examining data from three large cross-sectional surveys.

After a 40% reduction in maternal mortality ratio (MMR) during 2001-2010 in Bangladesh, the MMR level stagnated between 2010 and 2016 despite a steady increase in maternal health services use and improvements in overall socioeconomic status. We revisited the factors that contributed to MMR decline during 2001-2010 and examined the changes in these factors between 2010 and 2016 to explain the MMR stagnation in Bangladesh. We used data from the 2001, 2010, and 2016 Bangladesh Maternal Mortality Surveys, which sampled 566 115 households in total, to estimate the changes in the risk of dying of maternal causes associated with a pregnancy or birth between 2001-2010 and 2010-2016. We carried out Poisson regression analyses with random effects at the sub-district level to explore the relationship between the change in risk of maternal death from 2001 to 2016 and a range of demographic, socioeconomic, and health care factors. Between 2001 and 2016, the proportion of high-risk pregnancies decreased, except for teenage pregnancies. Meanwhile, there were notable improvements in socioeconomic status, access to health services, and the utilisation of maternal health services. A comparison of factors affecting the risk of maternal death between 2001-2010 and 2010-2016 indicated that first pregnancies continued to offer significant protection against maternal deaths. However, subsequent pregnancies among girls under 20 years became a significant risk factor during 2010-2016, increasing the risk of maternal deaths by nearly 3-fold. Among the key maternal health services, only skilled birth attendants (SBA) were identified as a key contributor to MMR reduction during 2001-2010. However, SBA is no longer significantly associated with reducing mortality risk during 2010-2016. Despite continued improvements in the overall socioeconomic status and access to maternal health services in Bangladesh, the stagnation of MMR decline between 2010 and 2016 is associated with multiple teenage pregnancies and the lack of capacity in health facilities to provide quality delivery services, as SBA has been primarily driven by facility delivery. The findings provide a strong rationale for targeting at-risk mothers and strengthening reproductive health services, including family planning, to further reduce maternal mortality in Bangladesh.

Family-Based Pregnancy Risk Detection With Family-Centered Maternity Care

The ability of pregnant women to detect early high-risk pregnancies is still below average which is one of the causes of complications that can endanger the well-being of the mother and fetus. Family involvement and other social sources of support in the perinatal period are associated with the detection and reduction of pregnancy risk factors. Approach to families in early dedetermination of pregnancy risk can be done with Family Center Maternity Care (FCMC). FCMC is care designed to meet the informational, social, emotional, comfort, and support needs of normal pregnant women during pregnancy and childbirth. The purpose of this study was to determine the determinants of early detection factors for pregnant women with family-based risk with FCMC. This type of research is quantitative and non-experimental with an analytical observational design through a cross-sectional approach.  The population in this study was all pregnant women who experienced risk factors in the Kedungwuni I, Kedungwuni II, Bojong Health Center Area as many as 103 pregnant women. The sampling technique used is the Total Population. The results of this study show that there is a positive and statistically significant relationship of knowledge with the implementation of early detection. Pregnant women who have good knowledge have a likelihood of carrying out early detection of pregnancy risk well by 3,193 times higher than respondents with less knowledge (OR=3,193; CI 95%=1.123-9.078; p=0.029). It is hoped that health workers, especially midwives, can involve their families, especially for early detection of the risk of pregnant women so that pregnant women get optimal health services.

The Frequency of Intraventricular Hemorrhage and its Risk Factors.

Intraventricular hemorrhage) IVH(is the most prevalent type of cerebrovascular accident in premature infants, which can result in lasting neurological complications. The aim of this study was to ascertain the frequency of IVH and its associated risk factors within our particular context. This cross-sectional study was carried out in a tertiary neonatal intensive care unit of a maternal and neonatal hospital from September 2018 to August 2019. Premature infants under 34 weeks of age and with birth weight < 1500 grams who did not have significant congenital anomalies participated in the study. A brain ultrasound was performed by a sonologist during the first week. The infants were subsequently categorized into two groups: those with and without IVH. A comparative analysis was conducted using the chi-square test and logistic regression. A significance level of p<0.05 was considered statistically significant. Of the 205 premature infants who completed the study, IVH was reported in 107 cases (52.1%), of which 97.3% of bleeding cases were grade I and II and 2.7% accounted for severe bleeding (grade III and IV). Gestational age less than 28 weeks, weight less than 1000 g, vaginal delivery, asphyxia and resuscitation, history of intubation and mechanical ventilation, cord blood acidity, dopamine infusion, and history of fever and chorioamnionitis in the mother have been found to be significantly associated with increased risk of IVH (p<0.001). Antenatal corticosteroids decreased the risk (OR=10.63). In this study, IVH has been found to be common in infants under 1500 g of weight, but the severe form was low in frequency and was observed significantly in high-risk pregnancies.

Detection and Control of Pregnancy Hypertension Using Self-Monitoring of Blood Pressure With Automated Telemonitoring: Cost Analyses of the BUMP Randomized Trials.

Pregnancy hypertension continues to cause maternal and perinatal morbidity. Two linked UK randomized trials showed adding self-monitoring of blood pressure (SMBP) with automated telemonitoring to usual antenatal care did not result in earlier detection or better control of pregnancy hypertension. This article reports the trials' integrated cost analyses. Two cost analyses. SMBP with usual care was compared with usual care alone in pregnant individuals at risk of hypertension (BUMP 1 trial [Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension], n=2441) and with hypertension (BUMP 2 trial, n=850). Clinical notes review identified participant-level antenatal, intrapartum, and postnatal care and these were costed. Comparisons between trial arms used means and 95% CIs. Within BUMP 2, chronic and gestational hypertension cohorts were analyzed separately. Telemonitoring system costs were reported separately. In BUMP 1, mean (SE) total costs with SMBP and with usual care were £7200 (£323) and £7063 (£245), respectively, mean difference (95% CI), £151 (-£633 to £936). For the BUMP 2 chronic hypertension cohort, corresponding figures were £13 384 (£1230), £12 614 (£1081), mean difference £323 (-£2904 to £3549) and for the gestational hypertension cohort were £11 456 (£901), £11 145 (£959), mean difference £41 (-£2486 to £2567). The per-person cost of telemonitoring was £6 in BUMP 1 and £29 in BUMP 2. SMBP was not associated with changes in the cost of health care contacts for individuals at risk of, or with, pregnancy hypertension. This is reassuring as SMBP in pregnancy is widely prevalent, particularly because of the COVID-19 pandemic. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03334149.

‘You have a lot of mirrors’: structural and socioecological factors impacting adolescent pregnancy and reproductive health in the Amazon basin, Peru, a qualitative study

Loreto, in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country. However, underlying causes of adolescent pregnancy are not fully understood as data are limited in Indigenous and remote Amazonian communities. This study investigated adolescent reproductive health within Loreto using an ecological systems framework. Forty-one semi-structured interviews were conducted in June 2022: community leaders (n = 12) and adolescent participants between 15 and 17 years of age (pregnant girls, n = 11; never pregnant girls, n = 9; and boys, n = 9). We also conducted focus group discussions with community health workers and educators in October 2022 (three focus groups, n = 15). Adolescent reproductive health is complex with multi-layered factors that put girls at higher risk of pregnancy. We found a paradoxical relationship between expected social and gender norms and individual desires. This research provides a contextual understanding of the lived experience of adolescents and young people in the Amazon region of Peru. Our findings suggest the need for greater exploration of the contradictory ideas surrounding adolescent pregnancy and female sexuality.

Assessment of maternal and fetal outcomes according to induction methods following negative oxytocin challenge test

Background/Aim: There is insufficient information about how long fetal well-being will last after a negative oxytocin challenge test (OCT) and the factors affecting this process. We aim to evaluate maternal and perinatal outcomes in high-risk patients who had negative OCTs and to investigate the effects of methods of induction on the development of fetal distress. Methods: The study was designed as a retrospective cohort study. Data of patients who were hospitalized in the perinatal intensive care unit due to high-risk pregnancies between January 2016 and December 2016 were reviewed retrospectively. The patient’s gestational age, gravidity, parity, and body mass index (BMI), risk factors leading to the OCT, labor induction methods used following a negative OCT, time from negative OCT to delivery, mode of delivery, and indications for cesarean section were recorded. In addition, data regarding fetal sex, birth weight, birth height, labor complications, Apgar scores at minutes 1 and 5, admission to the neonatal intensive care unit (NICU), indications for NICU admission, length of NICU stay, and stillbirth were also recorded. Results: OCT was performed on 551 patients and was negative in 447 patients. Among patients with a negative OCT, labor induction was preferred in 427 (95.5%) patients. When fetal distress development was assessed according to the induction method used following a negative OCT, fetal distress developed in 9.1% of 427 patients who underwent labor induction. Conclusion: When outcomes were considered in pregnant women with a negative OCT, it was observed that there were no fetal deaths and a limited number of newborns with low Apgar scores. Further randomized studies are needed to draw definitive conclusions.

Therapeutic hypothermia for neonatal encephalopathy in developing countries: Current evidence

Problem consideredBirth asphyxia and resultant brain injury are an important cause of neonatal mortality and morbidity in resource-limited countries. Prevention of birth asphyxia needs effective coverage of evidence-based interventions during antenatal care, childbirth, and high-risk pregnancies, close intrapartum monitoring, access to emergency obstetric care, and neonatal resuscitation. Therapeutic hypothermia is the only specific therapy proven to reduce the incidence of death and disability in neonates with hypoxic-ischemic encephalopathy (HIE). While therapeutic hypothermia is the standard of care in high-income contours, its benefit in low- and middle-income countries remains unproven. MethodsThis article analyzes the evidence from randomized controlled trials conducted in different settings. As systematic reviews of these trials have shown significant statistical heterogeneity in the efficacy of therapeutic hypothermia, this article examines the reasons behind heterogeneity in the outcome of death before discharge from the hospital. ResultsThe following factors were found to be associated with the loss of efficacy of therapeutic hypothermia – the absence of objective evidence of acute birth asphyxia, suboptimal care during transport of extramural neonates, uncontrolled hypothermia before admission to a neonatal unit, and the severity of HIE. ConclusionA sufficiently powered randomized controlled trial that takes into account these effect modifiers needs to be conducted in rescue-limited settings.

Evaluation of a short in-person and online antenatal educational intervention for high-risk pregnant women linked to antenatal consultation.

The aim of this study was to evaluate a short educational intervention that focused on labor pain (through visual analogue scale, VAS), postpartum anxiety, and birthing experience before and during the SARS-CoV-2 (COVID-19) pandemic. This was a quasi-experimental study conducted between November 2019 and May 2021 in Brazil in 100 women with a high-risk pregnancy in the third trimester of pregnancy with an intervention group with in-person or virtual sessions (during the COVID-19 pandemic) and a non-intervention group. The antenatal intervention included breathing and relaxation techniques, upright positions, and information about labor. For evaluation, an antenatal questionnaire, State-Trait Anxiety Inventory (STAI) and a postpartum questionnaire were used. For data analysis, Student's t-test, chi-squared and Fisher's exact tests, ANOVA, bivariate, and multivariate regression analysis, were used. When comparing the women in the intervention group to the non-intervention group, it was observed that the latter group reported higher fear of pain at labor during antenatal consultations (p<0.013); more women needed analgesia at 0-4 cm dilation (17/40) (p<0.018); the duration of labor was ≥12 hours (37/50) (p<0.037); while the intervention reported having a regular, good or excellent labor period (36/50) (p=0.014). The multiple regression analysis for labor pain showed a significant relationship between mode of delivery (cesarean delivery: RR; SE -21.43; 5.32, p<0.001) and labor pain, and good satisfaction with labor (RR; SE -13.86; 6.40, p=0.033). Women from the intervention group had more satisfaction and less pain during labor than women from the non-intervention group.

Low-molecular-weight heparin for the prevention of preeclampsia in high-risk pregnancies without thrombophilia: a systematic review and meta-analysis

ObjectivesTo systematically evaluate the efficacy of low molecular weight heparin (LMWH) to prevent preeclampsia in high risk pregnant women without thrombophilia.Search strategyPubMed, Embase and the Cochrane library were searched for articles published before 1st August 2022 using the combination keywords “preeclampsia”, “Low Molecular Weight Heparin”, “LMWH”, “Heparin, Low Molecular Weight”, “Dalteparin”, “Nadroparin”, and “Tinzaparin”. Selection criteria: Randomized controlled trials evaluating the use of LMWH in pregnant women at high risk of preeclampsia without thrombophilia.Data collection and analysisTen studies were included in the meta-analysis (1758 patients in total). Outcomes were expressed as relative risk (RR) with 95% confidence intervals (CI).ResultsLMWH reduced the incidence of PE (RR = 0.67; 95% CI = 0.50–0.90; P = 0.009) in high risk pregnant women without thrombophilia. Subgroup analysis found that the prophylactic effect of LMWH was only significant in studies using low-dose aspirin (LDA) as the primary intervention. The combination of LMWH and LDA was also effective for the prevention of preterm birth and fetal growth restriction, but had no effect on the incidence of placenta abruption.ConclusionFor women at high risk of developing preeclampsia without thrombophilia, the combination of LMWH and low-dose aspirin is effective for the prevention of preeclampsia, preterm birth and fetal growth restriction and is superior to LDA alone.

Enhancing Maternal and Neonatal Outcomes in High-Risk Pregnancies: The Efficacy of Staged Nursing and Nutritional Interventions

Considering the escalating prevalence of high-risk pregnancies encountered in clinical settings, the imperative to safeguard the well-being and survival of both high-risk pregnant women and their babies represents a hotspot of clinical research. This study investigated the clinical effects of an innovative care model for high-risk pregnancies, specifically a combination of staged nursing and nutritional interventions, on maternal nutritional status. Initially, 96 pregnant women were assigned randomly into two groups: a control group receiving routine care and a research group benefiting from the combined approach of staged nursing and nutritional interventions. Comparative analysis revealed that the research group experienced a significant reduction in labor duration and a decrease in the incidence of adverse pregnancy outcomes, thereby highlighting the efficacy of this combined approach in enhancing the safety of childbirth for high-risk pregnancies. Additionally, the research group exhibited more significant improvements in nutritional status than the control group, further endorsing the combined approach as a more effective and reliable safeguard for the health of high-risk pregnant women. Therefore, the implementation of staged nursing in conjunction with nutritional interventions is advocated for use during childbirth in high-risk pregnancies.

Correlation between total deceleration area in CTG records and cord blood pH in pregnancies with IUGR.

Fetal cardiotocography is the most common method to assess fetal well-being during labor. Nevertheless, its predictive ability for acidemia is limited, both in low-risk and high-risk pregnancies (Nelson et al. in N Engl J Med 334: 613-9, 1996; Rinciples P et al. in Health and Human Development Workshop Report on Electronic Fetal Monitoring : Update on Definitions. no. 2007, 510-515, 2008), especially in high-risk pregnancies, such as those complicated by growth restriction. In this study we aim examine the association between deceleration and acceleration areas and other measure of fetal heart rate in intrapartum fetal monitoring and neonatal arterial cord blood pH in pregnancies complicated by growth restriction. A retrospective cohort study of 100 deliveries complicated by growth restriction, delivered during 2018, was conducted. Known major fetal anomalies, non-vertex presentation and elective cesarean deliveries were excluded. Total deceleration and acceleration areas were calculated as the sum of the areas within the deceleration and acceleration, respectively. In deliveries complicated by growth restriction, cord blood pH is significantly associated with total deceleration area (p = 0.05) and correlates with cumulative duration of the decelerations (Spearman's rank -0.363, p < 0.05), and total acceleration area (-0.358, p < 0.05). By comparing the cord blood pH in deliveries with a total deceleration area that was above and below the median total deceleration area, we demonstrated a significant difference between the categories. Cord blood pH significantly correlates with total deceleration area and other fetal monitoring characteristics in neonates with growth restriction. Future studies using real-time, machine-learning based techniques of fetal heart rate monitoring, may provide population specific threshold values that will support bedside clinical decision making and perhaps achieve better outcomes.