Fetal Impairment Research Articles

A retrospective cross-sectional study on the prevalence of adverse perinatal outcomes and its associated factors in fetuses with late-onset fetal growth restriction

Late-onset fetal growth restriction (FGR) has a possibility of urgent fetal deterioration before labor, which contributes to late-pregnancy mortality, intrapartum fetal distress, and neonatal acidosis. This study was conducted to evaluate the prevalence of adverse perinatal outcomes (APO) and identify factors associated with APO in fetuses with late-onset FGR. This was a retrospective cross-sectional study of singleton pregnancies diagnosed with late-onset FGR, enrolled in Tu Du Hospital from 4/2022 to 12/2022. Late-onset FGR was defined according to the Delphi consensus. Databases of Doppler parameters and APO were recorded. Of 101 pregnancies in the study, APO occurred in 21 cases (20.8%). The need for admission to the neonatal intensive care unit, the mean overall length of hospital stay, neonatal resuscitation requiring mechanical ventilation, neonatal jaundice requiring phototherapy, and neonatal hypoglycemia were recorded, respectively, in 21 (20.8%), 6.67 days, 11 (10.9%), and 2 (2%) cases, while no case of perinatal death and 5-min Apgar score<7 was reported in the study. In the prediction of APO, there was a significant contribution from cerebroplacental ratio (CPR)<5 percentile (adjusted OR (aOR)=4.76, 95% confidence interval [CI] 1.07–21.11, p=0.04), EFW<3 percentile (aOR=3.22, 95% CI 1.01–10.27, p=0.049) and gestational age at delivery (aOR=0.35, 95% CI 0.18–0.65, p=0.001). In our research, the prevalence of APO is 20.8%. CPR<5 percentile, severe late-onset FGR, and gestational age at delivery are independently statistically associated with APO in pregnancies with late-onset FGR.

Magnesium sulfate for fetal neuroprotection in preterm labor: an updated systematic review and meta-analysis of randomized controlled trials.

Antenatal magnesium sulfate has been reported to reduce the risk of neurological impairment in fetuses born to women at risk of preterm labor. However, the evidence to support its use is conflicting. We conducted this meta-analysis to assess the efficacy and safety of magnesium sulfate in women at risk of preterm labor as new research is available from RCTs giving insights into MgSO4 treatment among differing gestational age groups. We searched various electronic databases, including MEDLINE (via PubMed), Embase, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization InternationalClinical TrialsRegistry Platform portal from 1990 till 31st March 2024 to retrieve all randomized controlled trials (RCTs)that investigated the use of magnesium sulfate in women at risk of preterm labor with or without intent of fetal neuroprotection We used the revised Cochrane Risk of Bias tool (RoB 2.0) to assess the quality of the included randomized controlled trials. RevMan 5.4 was used to conduct all statistical analyses using a random-effects model. Our Meta-analysis was registered with the PROSPERO International Register of Systematic Reviews (CRD42024532421). Our meta-analysis including eight RCTs showed that magnesium sulfate reduced the risk of cerebral palsy without a significant change in pediatric mortality. The change was evident in moderate to severe cerebral palsy. Magnesium sulfate showed no beneficial effect in most of the secondary outcomes. This meta-analysis found antenatal magnesium sulfate reduces the risk of cerebral palsy with no difference in pediatric mortality between the magnesium or no magnesium treatment groups, which is a positive finding. However, there is still substantial heterogeneity between the studies, so there is a need for further exploration and discussion. The implications of this review include a concern for developing nations where resources and availability of magnesium sulfate are limited. Hence, further studies are needed to determine the exact dosage, timing, and whether maintenance dosage of magnesium sulfate is required or not and for how long.

Echocardiographic Assessment of Biventricular Mechanics of Fetuses and Infants of Gestational Diabetic Mothers: A Systematic Review and Meta-Analysis.

Gestational diabetes mellitus (GDM) is the most common complication in pregnancy, representing a serious risk for the mother and fetus. Identifying new biomarkers to ameliorate the screening and improving GDM diagnosis and treatment is crucial. During the last decade, a few studies have used speckle tracking echocardiography (STE) for assessing the myocardial deformation properties of fetuses (FGDM) and infants (IGDM) of GDM women, providing not univocal results. Accordingly, we performed a meta-analysis to examine the overall influence of GDM on left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) in both FGDM and IGDM. All echocardiographic studies assessing conventional echoDoppler parameters and biventricular strain indices in FGDM and IGDM vs. infants born to healthy pregnant women, selected from PubMed and EMBASE databases, were included. The studies performed on FGDM and IGDM were separately analyzed. The subtotal and overall standardized mean differences (SMDs) in LV-GLS and RV-GLS in FGDM and IGDM studies were calculated using the random-effect model. The full texts of 18 studies with 1046 babies (72.5% fetuses) born to GDM women and 1573 babies of women with uncomplicated pregnancy (84.5% fetuses) were analyzed. Compared to controls, FGDM/IGDM were found with a significant reduction in both LV-GLS [average value -18.8% (range -11.6, -24.2%) vs. -21.5% (range -11.8, -28%), p < 0.05)] and RV-GLS [average value -19.7% (range -13.7, -26.6%) vs. -22.4% (range -15.5, -32.6%), p <0.05)]. Large SMDs were obtained for both LV-GLS and RV-GLS studies, with an overall SMD of -0.91 (95%CI -1.23, -0.60, p < 0.001) and -0.82 (95%CI -1.13, -0.51, p < 0.001), respectively. Substantial heterogeneity was detected for both LV-GLS and RV-GLS studies, with an overall I2 statistic value of 92.0% and 89.3%, respectively (both p < 0.001). Egger's test gave a p-value of 0.10 for LV-GLS studies and 0.78 for RV-GLS studies, indicating no publication bias. In the meta-regression analysis, none of the moderators (gestational age, maternal age, maternal body mass index, maternal glycosylated hemoglobin, white ethnicity, GDM criteria, ultrasound system, frame rate, FGDM/IGDM heart rate, and anti-diabetic treatment) were significantly associated with effect modification in both groups of studies (all p > 0.05). The sensitivity analysis supported the robustness of the results. GDM is independently associated with biventricular strain impairment in fetuses and infants of gestational diabetic mothers. STE analysis may allow for the early detection of subclinical myocardial dysfunction in FGDM/IGDM.

Effects of Cumulative Duration of Repeated Anesthesia Exposure on Fetal Brain Development in the Ovine Model

(J Clin Anesth. 2023;85:111050. https://doi.org/10.1016/j.jclinane.2022.111050) During nonobstetric surgeries, general anesthesia is necessary in ∼1% of pregnant women. In a recent population cohort, 91% of these women underwent a single anesthesia exposure, averaging 89 minutes. However, 9% experienced multiple exposures. The duration of anesthesia varied: 29% had less than an hour, 49% had 1 to 2 hours, 12% had 2 to 3 hours, 6% had 3 to 5 hours, and 2% had 7 to 13 hours. The FDA issued a warning about potential fetal brain development impairment from repeated or prolonged anesthesia exposure (&gt;3 h). A meta-analysis confirmed that in laboratory animals, repeated or prolonged exposure to general anesthesia results in neuronal injury and neurobehavioral impairments in fetuses. Short exposures (≤3 h) to ≤1 MAC of volatile anesthetics did not show significant neurodevelopmental impairments. Most studies were conducted in mice and rats, whose short gestation periods limit direct human comparisons. The 3-hour exposure in rodents equates to 40 to 47 hours in humans. A recent clinical study found no general population evidence linking prenatal anesthesia exposure to impaired neurodevelopment, though small sample sizes limited findings on prolonged exposure effects.

O PROTAGONISMO DA ENFERMAGEM NA ASSISTÊNCIA AO PARTO HUMANIZADO: UMA REVISÃO INTEGRATIVA DA LITERATURA

The puerperal pregnancy process requires dignified and qualified care, not limited to the expulsion or extraction of the fetus. The implementation of good practices in labor and birth care is essential to guarantee the rights of the parturient. It is up to the care team to provide security in the partutive process, through evidence-based methods. The present research aims to understand the actions of the nursing team involved in the humanization of childbirth, highlighting the main determining factors for maternal satisfaction and dissatisfaction in the experience of labor. This is a systematic bibliographic survey, with a qualitative approach, of the integrative literature review type. The search for research material was carried out through electronic access to the digital databases Virtual Health Library, Latin American and Caribbean Literature in Health Sciences and Scientific Electronic Library. The inclusion criteria adopted were: national articles, available free of charge, with full texts, published between 2014 and 2024. The selection process allowed eight scientific studies to be obtained. Regarding the humanization of the parturition process associated with the direct action of nursing, it can be seen that the adoption of non-invasive practices results in maternal satisfaction and reduction of fetal impairment. It was noted that the incorporation of obstetric nurses in childbirth sectors contributed to the reduction of proscribed or invasive practices. It was concluded that humanized childbirth is closely associated with the use of good practices by professionals, which will directly impact the care for the mother-child binomial. Therefore, labor and birth care policies should be constantly reinforced, providing greater dissemination of knowledge.

The Significance of the Myocardial Performance Index and Fetal Doppler Abnormalities in Growth-Restricted Fetuses: A Systematic Review of the Literature.

Introduction: This review aims to investigate the clinical implications of using the myocardial performance index (MPI), obtained through tissue Doppler imaging (TDI) and spectral Doppler, in assessing fetal cardiac function in growth-restricted fetuses. It explores the MPI's potential in predicting adverse perinatal outcomes and its utility when combined with conventional pulsed-wave Doppler assessments for enhanced fetal well-being evaluations. Material and Methods: A systematic search of PubMed and Google Scholar databases spanning from 2004 to 2023 was conducted to identify pertinent articles on the MPI's clinical application in managing growth-restricted fetuses. Inclusion criteria followed the Fetal Medicine Barcelona definition of fetal growth restriction (FGR) to mitigate study group heterogeneity. The research sources were PubMed and Google Scholar databases, and the review was conducted without any specific clinical or laboratory setting. Only articles meeting the inclusion criteria for FGR, as per the Fetal Medicine Barcelona definition, were considered. Six studies meeting these criteria were included in the review. The review analyzed the correlation between MPI values and conventional Doppler parameters, investigating the progression of myocardial function impairment and its association with the risk of fetal demise. The primary outcome measures included the relationship between MPI values, fetal well-being, and the potential for prenatal cardiac dysfunction in growth-restricted fetuses. Results: The findings indicate that as conventional Doppler parameters deteriorate, MPI values increase, suggesting progressive myocardial dysfunction. The MPI may cross the 95th percentile before abnormal flow in the ductus venosus and aortic isthmus, highlighting the potential for diastolic dysfunction preceding hypoxia in growth-restricted fetuses. Elevated MPI levels were observed in both growth-restricted and small-for-gestational-age (SGA) fetuses, indicating prenatal cardiac impairment. The strong association between an abnormal MPI and perinatal mortality has been shown for early FGR. Conclusions: MPI alterations appear to precede abnormal Doppler parameters in early- and late- onset FGR, potentially indicating diastolic dysfunction preceding hypoxia. Additionally, the MPI correlates with the risk of fetal demise. However, larger studies are needed to establish its sensitivity and specificity. Furthermore, the significance of prenatal cardiac impairment in some SGA fetuses raises questions about its potential impact on perinatal outcomes and cardiovascular programming.

Frontal Lobe Growth Impairment in Fetuses with Congenital Heart Disease Using Ultrasound Parameters; A Comparative Cross-Sectional Study

Abstract Background There is evidence; in neonates with critical congenital heart disease CHD, that the abnormal hemodynamics do not affect all brain regions similarly, with the frontal lobe growth being more severely impaired, especially in cases with univentricular heart anatomy. Aim and Objectives To assess whether fetuses with congenital heart disease (CHD) have smaller frontal brain areas compared with normal controls. Subjects and Methods This Cross-sectional study was conducted at Ain Shams University Maternity Hospital (Fetal Medicine unit). The study group included 280 women, 140 women whose fetuses are normal and the other 140 women whose fetuses suffered congenital heart disease using ultrasonography. Measuring the distance from the internal edge of the frontal bone to the posterior edge of the CSP (measured in-to-in), i.e the frontal lobe anteroposterior diameter (FAPD), which was assumed to be representative of the area of the frontal lobes; measuring of the occipitofrontal diameter (OFD), (also measured in-to-in), from the internal edge of the frontal bone to the internal edge of the occipital bone. The ratio of these two measurements, calculated as FAPD/OFD×100 and referred to as ‘FAPD/OFD ratio’, represents the reference index that was used in this investigation to assess the growth of the frontal component of the fetal brain in relation to the growth of the whole brain. Fetal echocardiography was done for both groups to assess the cardiac anomalies. Result There was a statistically significant difference between the studied groups regarding History of CHD. the FAPD/OFD ratio was significantly smaller in both the group of left-heart lesion or univentricular heart and the group of all other CHDs, compared with normal fetuses (P &amp;lt; 0.0001), with no statistically significant difference between the two CHD groups. There was no statistically significant difference between the studied groups regarding comparison between surgical history, co-morbidities and Correlation of frontal anteroposterior diameter (FAPD), occiptofrontal diamter (OFD) and FAPD/OFD ratio with the other studied parameters in all cases except in gestational age and CNS anomalies. Conclusion Fetuses with CHD have a shorter FAPD and a smaller FAPD/OFD ratio compared to normal fetuses. This impaired growth of the frontal area of the brain seems to occur in all types of CHD, regardless of their impact on the hemodynamics.

Pregnancy and Long-Term Postnatal Outcomes of Congenital Sacrococcygeal Teratoma: A Single Institution's 18-Year Experience.

The objective of this study is to evaluate outcomes of fetal sacrococcygeal teratoma (SCT) from an academic tertiary center. This is a retrospective study evaluating pregnancy and postnatal outcomes of fetal SCT management at a single institution between 2006 and 2023. Results are reported as median (range). Fourteen patients with fetal SCT were studied. Hydrops fetalis occurred in 2 (14.3%) cases. Pregnancy course included expectant management in 12 (85.7%) and palliative preterm induction in 1 patient (7.1%). Indications for delivering timing included fetal deterioration in 7 patients (50%), preeclampsia in 3 (21.4%), elective induction of delivery in 3 (21.4%), and preterm labor in 1 (7.1%). Delivery GA was 36.4 weeks (26.4-40.1 weeks), with 11 (78.5%) cesareans and 3 (21.4%) vaginal deliveries. There were 13 (92.9%) live births and 11 (78.6%) long-term survivors. Postnatal resection pathology demonstrated 7 (53.8%) mature, 3 (23.1%) immature, and 3 (23.1%) malignant SCTs. Of the 11 long-term survivors, 3 (27.3%) had teratoma recurrences, including 2 (18.2%) with metastatic disease requiring chemotherapy. Notable long-term complications involved gastrointestinal (n = 7, 63.6%), genitourinary (n = 4, 36.4%), and musculoskeletal (n = 2, 18.2%) systems. SCT confers significant morbidity to both the pregnant patient and neonate. Multidisciplinary prenatal and postnatal care is needed to comprehensively manage this complex condition.

Magnesium sulfate for fetal neuroprotection in preterm pregnancy: a meta-analysis of randomized controlled trials

BackgroundIntravenous administration of magnesium sulfate (MgSO4) to expectant individuals before childbirth, has been evaluated to reduce the likelihood of mortality and occurrence cerebral palsy in their offspring. Therefore, this systematic review and meta-analysis conducted to determine if were the prophylactic use of magnesium sulfate in women at risk for preterm delivery leads to decrease in the incidence of death or cerebral palsy.MethodsA comprehensive search of electronic databases was done to identify relevant studies. Selection of eligible studies was based on predetermined inclusion criteria. Data extraction was performed, and the methodological quality of the selected studies was assessed using appropriate evaluative tools. A meta-analysis was carried out to estimate the overall effect of intravenous administration of magnesium sulfate on the incidence of death or cerebral palsy.ResultsA total of 7 studies met the inclusion criteria and were included in the final analysis. No significant publication bias was observed. The risk of fetal neurological impairment was significantly lower in the MgSO4 group compared to the control group relative risk (RR = 0.70, 95% CI: 0.56 to 0.87; I20%). However, neonatal mortality was not significantly associated with MgSO4 injection. (RR = 1.03, 95% CI: 0.88 to 1.21; I2 = 42%). Subgroup analysis was done based on the bolus dosage of MgSO4 and the duration of the trial follow-up. revealing a non-significant differences between-group.ConclusionThis study demonstrated that MgSO4 administration can improve fetal neurological impairment and cerebral palsy but is not linked to reducing mortality. Further studies are necessary to strengthen the evidence and clarify the underlying mechanisms.

Abortion beyond a medical issue; women's perception on the current Ethiopian abortion law among reproductive-aged women by 2023, a community-based cross-sectional study.

A nationwide study on the contribution of abortion to maternal mortality in Ethiopia was 6%-9%. To bring Ethiopia's legal system into compliance with the country's new constitution, a new criminal code was created in 2005. In the new penal code, after 2005, abortion was permitted under broad circumstances; in the case of rape, incest, or fetal impairment; if pregnancy continuation or birth would endanger the health or life of the woman or fetus; if the woman has physical or mental disabilities; and if the woman is a minor who is physically or mentally unprepared for childbirth. To determine the status of women's perception toward the current Ethiopian abortion law among reproductive-aged women. A community-based study was conducted from June 10 to October 30, 2023. Chi-square test and multivariable logistic regression methods were employed using SPSS 23. The strength of associations and the significance level was examined using p-value and odds ratio at 95% CI, respectively. The prevalence of women's positive perception toward Ethiopian abortion law among reproductive-aged women is 21.18%. The age group of between 18 and 24, educational status of being unable to read and write, living solely, history of unplanned pregnancy, and age of marriage under 18 were associated with women's perception to the current abortion law of Ethiopia. The finding of this study is unexpectedly low, which needs exhaustive intervention.

Cord Blood pH and Lactate- A Step Ahead in Diagnosis of Fetal Acidaemia in Patients with Abnormal Cardiotocography

OBJECTIVES: Electronic fetal monitoring (EFM) is used to identify early signs of fetal deterioration. However, caution is advised when interpreting cardiotocographic parameters. A promising alternative is umbilical cord blood sampling. The analysis of blood gases and lactate levels in the cord within the ini-tial minutes of life is a recommended approach. STUDY DESIGN: This prospective cohort study, conducted over eighteen months from June 2021 to December 2022, enrolled 70 patients with non-reactive and 70 with reactive cardiotocograph (CTG) pat-terns. APGAR scores were recorded at 1 and 5-minute intervals. 1 ml of umbilical artery blood was as-sessed in an arterial blood gas machine and fetal acidosis was defined as pH &lt;7.0 and a lactate con-centration exceeding 4 mmol/L. RESULTS: In the non-reactive CTG group, 35.7% had early decelerations, 37.1% had variable decel-erations, and 17.1% had late decelerations (p&lt;0.001). The mean cord blood lactate was 5.220±1.970 mmol/L in the non-reactive CTG group and 3.400±0.228 mmol/L in the reactive CTG group. Similarly, the mean cord blood pH was 7.030±0.007 in the non-reactive CTG group and 7.170±0.076 in the reac-tive CTG group (p&lt;0.001). 14.3% of cases in the non-reactive CTG group had a 5-minute APGAR &lt;7, with a higher APGAR score in the reactive group. CONCLUSION: The study suggests that abnormal or indeterminate CTG readings are linked to a higher risk of intrapartum fetal acidosis. Non-reactive CTG results were associated with higher mean cord blood lactate and pH levels and more number of Neonatal Intensive Care Unit (NICU) admissions. There is a definite correlation between abnormal CTG patterns and poorer neonatal outcomes.

Endocrine disruption and male reproductive disorders: unanswered questions.

Maternal exposure to endocrine-disrupting chemicals (EDCs) in human pregnancy is widely considered as an important cause of adverse changes in male reproductive health due to impaired foetal androgen production/action. However, the epidemiological evidence supporting this view is equivocal, except for certain phthalates, notably diethyl hexyl phthalate (DEHP). Maternal phthalate exposure levels associated with adverse reproductive changes in epidemiological studies are several thousand-fold lower than those needed to suppress foetal androgen production in rats, and direct studies using human foetal testis tissue show no effect of high phthalate exposure on androgen production. This conundrum is unexplained and raises fundamental questions. Human DEHP exposure is predominantly via food with highest exposure associated with consumption of a Western style (unhealthy) diet. This diet is also associated with increased exposure to the most common EDCs, whether persistent (chlorinated or fluorinated chemicals) or non-persistent (phthalates, bisphenols) compounds, which are found at highest levels in fatty and processed foods. Consequently, epidemiological studies associating EDC exposure and male reproductive health disorders are confounded by potential dietary effects, and vice versa. A Western diet/lifestyle in young adulthood is also associated with low sperm counts. Disentangling EDC and dietary effects in epidemiological studies is challenging. In pregnancy, a Western diet, EDC exposure, and maternal living in proximity to industrial sites are all associated with impaired foetal growth/development due to placental dysfunction, which predisposes to congenital male reproductive disorders (cryptorchidism, hypospadias). While the latter are considered to reflect impaired foetal androgen production, effects resulting from foetal growth impairment (FGI) are likely indirect. As FGI has numerous life-long health consequences, and is affected by maternal lifestyle, research into the origins of male reproductive disorders should take more account of this. Additionally, potential effects on foetal growth/foetal testis from the increasing use of medications in pregnancy deserves more research attention.

Association of Low Levels of Placental Growth Factor With Abnormal Fetal Doppler Assessment [ID 2683423

INTRODUCTION: Placental growth factor (PlGF) is involved in placental angiogenesis and maturation. Low maternal serum PlGF levels predict placental dysfunction and associated conditions, such as preeclampsia, and fetal growth restriction. These pregnancy complications can lead to abnormal fetal Doppler assessment, indicating progressive fetal deterioration prompting preterm delivery. METHODS: We collected retrospective data from laboratory results of PlGF levels and fetal Dopplers (umbilical artery [UA], middle cerebral artery [MCA], and ductus venosus [DV]) from patients who had clinical indication for PlGF testing. Over 100 patients were identified to have results of all assessments between 2021 and 2023. Levels of PlGF were stratified in five categories according to gestational age and compared with normal and abnormal doppler results. For comparisons, the values were aggregated in normal and low PlGF. RESULTS: There were statistically significant associations between PlGF levels and Dopplers. Patients with low PlGF (less than 5th percentile for gestational age) were more likely to have abnormal dopplers than patients with normal PlGF (UA, P&lt;.001; MCA, P&lt;.001; DV, P&lt;.001). A normal PlGF had a high negative predictive value (NPV) for normal dopplers (UA, 88%; MCA, 94.3%; DV, 98.6%). CONCLUSION: The results show that normal PlGF is highly associated with normal Dopplers. Additional data will be required to account for confounding factors; however, our preliminary data suggest that PlGF could be a useful tool for patients in rural and remote locations, as normal PlGF has a statistically and clinically significant negative predictive value for normal Doppler assessment.

Clomiphene Citrate Administered in Periconception Phase Causes Fetal Loss and Developmental Impairment in Mice.

Clomiphene citrate is a common treatment for ovulation induction in subfertile women, but its use is associated with elevated risk of adverse perinatal outcomes and birth defects. To investigate the biological plausibility of a causal relationship, this study investigated the consequences in mice for fetal development and pregnancy outcome of periconception clomiphene citrate administration at doses approximating human exposures. A dose-dependent adverse effect of clomiphene citrate given twice in the 36 hours after mating was seen, with a moderate dose of 0.75 mg/kg sufficient to cause altered reproductive outcomes in 3 independent cohorts. Viable pregnancy was reduced by 30%, late gestation fetal weight was reduced by 16%, and ∼30% of fetuses exhibited delayed development and/or congenital abnormalities not seen in control dams, including defects of the lung, kidney, liver, eye, skin, limbs, and umbilicus. Clomiphene citrate also caused a 30-hour average delay in time of birth, and elevated rate of pup death in the early postnatal phase. In surviving offspring, growth trajectory tracking and body morphometry analysis at 20 weeks of age showed postweaning growth and development similar to controls. A dysregulated inflammatory response in the endometrium was observed and may contribute to the underlying pathophysiological mechanism. These results demonstrate that in utero exposure to clomiphene citrate during early pregnancy can compromise implantation and impact fetal growth and development, causing adverse perinatal outcomes. The findings raise the prospect of similar iatrogenic effects in women where clomiphene citrate may be present in the periconception phase unless its use is well-supervised.

Hemodynamic changes and perinatal outcome associated with umbilical artery thrombosis: a retrospective study

ObjectivePoor fetal and perinatal outcomes in fetuses associated with umbilical artery thrombosis (UAT), such as severe intrauterine growth restriction (IUGR) and intrauterine asphyxia have been reported by some case series. Its hemodynamic impact remains unclear. The aim of this study was to evaluate the hemodynamic changes and perinatal outcome in UAT fetuses with a relatively large sample.MethodsWe included singleton fetuses diagnosed with UAT and with at least one available Doppler evaluation before the end of pregnancy in our center from 2016 to 2023. Fetuses with structural abnormalities and with no follow-up results were excluded. Doppler waveforms from the Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV) and uterine artery (UtA) were routinely evaluated according to ISUOG Practice Guidelines from diagnosis. The same sample of GA-matched normal fetuses with Doppler measurements during the same period were randomly selected as control group.ResultsEighty-nine singleton fetuses with UAT with at least one Doppler evaluation before the end of pregnancy were identified, 13 fetuses with no follow-up results were excluded. After comprehensive prenatal counseling, 14 cases received urgent cesarean section, the remaining 55 cases received expectant management, the median day between GA at diagnosis and end of pregnancy was 13 (5–53) days (range, 2-159). 7 (7/76, 9.2%) cases occurred stillbirth, and the incidence of IUGR and Neonatal Intensive Care Unit (NICU) admission were 18.4% (14/76) and 13.2% (10/76) respectively. 49 fetuses (49/76, 64.5%) combined with Doppler abnormalities. UA abnormalities (35/76, 46.1%) and MCA abnormalities (34/76, 44.7%) were the most changes at presentation. Compared to control group, UA-EDV was significantly increased in UAT fetuses [21.84 (15.59–26.64) vs. 16.40 (12.43–20.70) cm/s, p < 0.001], UA-PI and UA-RI significantly decreased [0.68 (0.57–0.84) vs. 0.92 (0.79–1.11), p<0.001; 0.51 (0.44–0.59) vs. 0.62 (0.55–0.68), p < 0.001, respectively]. Both the MCA-PSV and MCA-EDV were significantly higher in UAT fetuses [54.60 (48.00-61.34) vs. 44.47 (29.66–57.60) cm/s, p < 0.001; 11.19 (7.84–17.60) vs. 8.22 (5.21-12.00) cm/s, p < 0.001, respectively], this led to a lower MCA-PI and MCA-RI. Meanwhile, DV-PIV was significantly higher in UAT fetuses [0.6 (0.47–0.87) vs. 0.45 (0.37–0.55), p < 0.001], CPR and UtA-PI were no significant difference between these two groups. Multivariate logistic regression analysis showed that DV-PIV was an independent risk factor for adverse pregnancy outcomes (OR 161.922, p<0.001), the area under the ROC curve (AUC) was 0.792 (95% CI 0.668–0.917; p < 0.001).ConclusionOur data showed serious adverse pregnancy consequences are combined with UAT fetuses. Hemodynamic changes in UAT fetuses showed the remaining artery for compensation and brain perfusion derangement. With a comprehensive and standardized Doppler evaluation, progression of fetal deterioration may be detailed presented.

Fetal bladder rupture after high-dose maternal opioid treatment: a case report

Abstract Objectives Fetal bladder rupture is rare and mainly caused by lower urinary tract obstruction (LUTO). Our case report describes a rupture at a gestational age of 31 weeks following high-dose maternal opioid exposure during intensive care treatment. Opioids perturb the interplay of afferent and efferent signals between the bladder, urethra, and the central nervous system (CNS) which is crucial in contributing to urinary retention. They rapidly cross the human placenta, affecting also the fetus. To date, there is no clear proof of the connection between maternal opioid treatment and fetal bladder rupture, but the association seems to strengthen. Case presentation A 18-year old first Gravida at 31 weeks of gestation developed a severe sepsis with progressive hypoxic lung failure and need for intubation. During the ICU-treatment, several opioids were administered for sedation and pain relief. Four days after induction of opioid treatment the ultrasound revealed a decompressed fetal bladder, hematoma and significant ascites. Fetal bladder rupture with urinary ascites was suspected. A caesarean section was performed at 33 weeks of gestation due to massive fetal urinary ascites, fetal deterioration and imminent abdominal compartment syndrome. Adequate ventilation and circulation could only be established after percutaneous drainage of 350 mL of abdominal fluid, that was confirmed to be urine. A defect of the bladder was confirmed by ultrasound. On the fifth day of life, the bladder was closed surgically by pediatric surgery. Conclusions Growing awareness of the possible connection between maternal opioid therapy and fetal bladder rupture is necessary to plan follow-up ultrasound examinations to assess the fetal situation.

The Effects of General Anesthetics on the Developing Brain of Fetus

The Effects of General Anesthetics on the Developing Brain of Fetus

Frontal Lobe Growth impairment in fetuses with congenital heart disease using Ultrasound parameters; A Comparative Cross-sectional study

Introduction and the Αim: 2D and 3D biometry measures can record the increased development of the fetal brain in the later part of gestation. The objective of this study is to determine whether or not the frontal brain regions of fetuses with congenital heart disease (CHD) are smaller than those of healthy controls. Patients and Μethods: The fetal Medicine unit of the Ain Shams University Maternity Hospital carried out a comparative cross-sectional study, including 140 normal fetuses and 140 fetuses with isolated CHD evaluated between 20 and 39 gestational weeks at our fetal medicine unit in the period November 2021–September 2023 Results: Our results showed the occipito-frontal diameter (OFD) and frontal antero-posterior diameter (FAPD) utilising ultrasonography. FAPD Mean±SD: 26.53 ± 10.44, OFD Mean±SD: 89.14 ± 28.34, and FAPD/OFD Mean±SD: 0.29 ± 0.05. The OFD Mean±SD was found to be 82.18 ± 18.42, the FAPD Mean±SD to be 31.68±6.58, and the FAPD/OFD Mean±SD to be 38.70±2.15. Our results showed that 0.7% of patients exhibited anomalies related to the central nervous system, such as dilated posterior fossa, vermis = 25 mm, and aberrant posterior cranial fossa. The percentage of those with a history of CHD was 3.9%.The history of CHD showed a statistically significant difference between the research groups. When examining comorbidities, surgical history, and the relationship between the other parameters and FAPD, OFD, and FAPD/OFD, there was no statistically significant difference between the groups under investigation, except for CNS abnormalities and gestational age. Conclusion, compared to normal fetuses, fetuses with CHD had shorter FAPDs and a lower FAPD/OFD ratio. Despite the fact that different types of CHD affect hemodynamics differently, there appears to be a common deficiency in the development of the frontal cortex.

How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study

Clinical tools for use in practice—such as medicine reconciliation charts, diagnosis support tools and track-and-trigger charts—are endemic in healthcare, but relatively little attention is given to how to optimise their...

Predictive value of General Movements Assessment for developmental delay at 18 months in children with complex congenital heart disease

BackgroundInfants with complex congenital heart disease are at increased risk of impaired fetal brain growth, brain injury, and developmental impairments. The General Movement Assessment (GMA) is a valid and reliable tool to predict cerebral palsy (CP), especially in preterm infants. Predictive properties of the GMA in infants with complex congenital heart disease (CCHD) are unknown. AimTo evaluate predictive properties of the GMA to predict developmental outcomes, including cerebral palsy (CP), at 18-months corrected age (CA) in children with CCHD undergoing heart surgery in the first month of life. MethodsA prospective cohort of 56 infants with CCHD (35 males, 21 females) was assessed with GMA at writhing age (0–6 weeks CA) and fidgety age (7–17 weeks CA) and the Bayley Scales of Infant Development at 18 months. GMA focused on markedly reduced GM-variation and complexity (definitely abnormal (DA) GM-complexity) and fidgety movements. Predictive values of GMA for specific cognitive, language and motor delay (composite scores <85th percentile) and general developmental delay (delay in all domains) were calculated at 18 months. ResultsAt fidgety age, all infants had fidgety movements and no child was diagnosed with CP. DA GM-complexity at fidgety age predicted general developmental delay at 18 months (71 % sensitivity, 90 % specificity), but predicted specific developmental delay less robustly. DA GM-complexity at writhing age did not predict developmental delay, nor did it improve prediction based on DA GM-complexity at fidgety age. ConclusionsIn infants with CCHD and fidgety movements, DA GM-complexity at fidgety age predicted general developmental delay.