Fetal Death In Utero Research Articles

Fetal Death in Utero at the Maternity Hospital of Koutiala in Mali

The aim was to assess the frequency of fetal death in utero; to describe the sociodemographic and clinical characteristics of patients; to identify risk factors for IUD; to describe its management and to determine the maternal prognosis. Material and Method: This was a descriptive, cross-sectional, analytical study of the prospective case/control cohort type from June 2021 to May 2022, i.e. a period of 12 months in the maternity ward of the Koutiala reference health center. Results: Fetal death in utero concerned 85 deliveries out of a total of 3024 deliveries, i.e. a frequency of 28.11 ‰. The epidemiological profile is that of a poor person (37.6%) between 25 and 29 years of age (31.8%), with a pregnancy of 28 to 37 weeks of amenorrhea; they came on their own in (64.7%) of cases. If, in 5.9% of cases, the cause of fetal death was not known in the study; arterial hypertension was the most common etiology with 37.6% of cases. Patients gave birth vaginally in 89.4% and presented complications of infections (endometritis) in 10.6% of cases.

Diet-induced hyperhomocysteinemia causes sex-dependent deficiencies in offspring musculature and brain function.

Hyperhomocysteinemia (HHcy), characterized by elevated homocysteine (Hcy) levels, is a known risk factor for cardiovascular, renal, and neurological diseases, as well as pregnancy complications. Our study aimed to investigate whether HHcy induced by a high-methionine (high-Met) diet exacerbates cognitive and behavioral deficits in offspring and leads to other breeding problems. Dietary HHcy was induced four weeks before mating and continued throughout gestation and post-delivery. A battery of behavioral tests was conducted on offspring between postnatal days (PNDs) 5 and 30 to assess motor function/activity and cognition. The results were correlated with brain morphometric measurements and quantitative analysis of mammalian target of rapamycin (mTOR)/autophagy markers. The high-Met diet significantly increased parental and offspring urinary tHcy levels and influenced offspring behavior in a sex-dependent manner. Female offspring exhibited impaired cognition, potentially related to morphometric changes observed exclusively in HHcy females. Male HHcy pups demonstrated muscle weakness, evidenced by slower surface righting, reduced hind limb suspension (HLS) hanging time, weaker grip strength, and decreased activity in the beaker test. Western blot analyses indicated the downregulation of autophagy and the upregulation of mTOR activity in HHcy cortexes. HHcy also led to breeding impairments, including reduced breeding rate, in-utero fetal death, lower pups' body weight, and increased mortality, likely attributed to placental dysfunction associated with HHcy. In conclusion, a high-Met diet impairs memory and cognition in female juveniles and weakens muscle strength in male pups. These effects may stem from abnormal placental function affecting early neurogenesis, the dysregulation of autophagy-related pathways in the cortex, or epigenetic mechanisms of gene regulation triggered by HHcy during embryonic development.

Critical congenital heart disease: contemporary prenatal screening performance and outcomes in a multi-centre perinatology service

BackgroundPrenatal detection of critical congenital heart disease (CCHD) optimises perinatal decision-making and neonatal outcomes. The objective of this study was to determine the prenatal screening performance, care pathways and perinatal outcomes for prenatally and postnatally diagnosed cases of CCHD over a four-year period.Study designThis retrospective cohort study in a tertiary centre and its two affiliated secondary sites examined all cases of CCHD, including cases of pregnancy termination and in-utero fetal death, neonatal death and liveborn babies that underwent cardiac catheterization or surgery in the first six weeks of life. Prenatal and postnatal data were ascertained from the first trimester assessment for all patients diagnosed prenatally. Cases requiring intervention that were first identified in the postnatal period were included to determine prenatal detection rates. Follow-up for all cases of CCHD continued to one year of age.ResultsIn a consecutive cohort of 49,950 pregnancies in a 4-year period 01/2019 to 12/2022, a prenatal diagnosis of CCHD was made in 96 cases, yielding a prevalence of 1.9 per 1000 births. The prenatal detection for right duct-dependant heart pathology and congenital heart block was 100%, 85% for left duct-dependant pathology and 93% for transposition of the great arteries (TGA). In the prenatally diagnosed group, 37% of cases were complicated by extracardiac structural abnormalities, a genetic diagnosis or both. All cases of prenatal detection were identified in the context of routine anatomy screening rather than specialist Fetal Cardiac screening services. Almost half of all pregnancies complicated by CCHD did not undergo neonatal cardiac intervention, by virtue of parental choice determined either prenatally or after birth. An additional eight babies were diagnosed with CCHD in the neonatal period, such that the prenatal detection rate for CCHD was 92% (96/104, 95% CI = 84%-96%). Survival at 1-year for infants deemed suitable for CCHD surgery was 85%.ConclusionIn a large unselected population, optimal rates of prenatal detection of critical congenital heart disease can be achieved by a protocolised approach to mid-trimester fetal anatomy ultrasound, underpinned by a programme of sonographer education and training. The cardiac abnormalities most likely to evade prenatal detection are left-sided obstructive lesions.

Fetal Death in Utero Associated with a Double Circular Umbilical Cord Tight on Full-Term Pregnancy about a Case at the Lac Tele De Bamako Clinic

Introduction: The circular umbilical cord corresponds to a winding of it in one or more turns of the whorl around the fetal neck. Case observation: She is a 25-year-old primigeste, married, a nurse by profession with no known medical-surgical history, who consulted for painful uterine contractions on pregnancy of 38 weeks of amenorrhea (AS). This is a pregnancy well followed by a gynecological-obstetrician with 06 quality antenatal consultations. The clinical and biological monitoring parameters were well documented in the antenatal diary and show no abnormalities. Conclusion: Fetal death in utero is a common pathology but association with umbilical cord circulars is rare. When the umbilical cord circular is double and tightened around the neck like a knot of the cord. It could be the cause of unexplained fetal death. It is always a tragedy for the parents and a failure for the obstetrician. It is necessary to reassure the woman and her family about the prognosis of subsequent pregnancies.

Abdominal Trauma during Pregnancy with Splenic Rupture and Fetal Death in Utero at Bogodogo University Hospital: A Case Report

Abdominal Trauma during Pregnancy with Splenic Rupture and Fetal Death in Utero at Bogodogo University Hospital: A Case Report

Insights into the Genital Microbiota of Women Who Experienced Fetal Death in Utero.

The aim of this work was to achieve a better understanding of the bacterial pathogens associated with stillbirths that would serve to inform clinical interventions directed at reducing this adverse pregnancy outcome. A prospective observational study was conducted with the participation of 22 women from northern Peru, of whom 11 experienced fetal death in utero and 11 delivered preterm births. Swabs were taken from the vagina, placenta, amniotic fluid and axilla of the infant at birth by Caesarean section. The bacterial populations in the vagina and the amniotic space of each participant were determined by employing the amplicon sequencing of the V4 region of the 16S rRNA genes. The sequence data were analysed using bioinformatics tools. The work showed differences in the composition of the genital microbiomes of women who experienced preterm birth or fetal death in utero. There were no differences in the alpha diversity between the genital microbiotas of both groups of women, but there were more different taxa in the vagina and amniotic space of the preterm participants. Lactobacillus spp. was less abundant in the stillbirth cases. E. coli/Shigella, Staphylococcus, Gardnerella, Listeria and Bacteroides taxa were associated with the stillbirths. In each woman, there was a minimal concordance between the bacterial populations in the vagina and amniotic space.

A Case Report of Dicephalus Parapagus Conjoint Twins: Declined Caesarean Section for Obstructed Labour; Fetal Death in Utero and Successful Vaginal Delivery

A Case Report of Dicephalus Parapagus Conjoint Twins: Declined Caesarean Section for Obstructed Labour; Fetal Death in Utero and Successful Vaginal Delivery

Influence of in utero fetal death on perineal tears in vaginal deliveries

The aim of this work was to evaluate and compare the incidence of perineal tears and Obstetrical anal sphincter injuries (OASIS) after vaginal delivery following a in utero fetal death (IUFD) compared with those with a live-birth. We conducted a single-center, retrospective cohort study using a database of all women who underwent a spontaneous vaginal delivery in the level III maternity ward. Exclusion criteria were breech presentation, cesarean section birth, instrumental delivery, multiple pregnancy, delivery before 24 + 6 weeks of gestation (WG) and termination of pregnancy for medical reasons. Women from the database were divided into two groups: an "in utero fetal death" (IUFD) group and a control group. Women were included in the IUFD group if they had a spontaneous vaginal delivery following a fetal demise after 24 + 6 WG in cephalic presentation between January 2006 and June 2020. Women in the "control" group were selected from the same database and were included if they underwent a spontaneous vaginal delivery of a live fetus in cephalic presentation, after 24 + 6 WG, during the same period. Each woman in the "IUFD" group was matched to two women (ratio 1:2) in the control group for parity, maternal age, body mass index, gestation and birth weight. The primary outcome was the presence of a sutured or unsutured perineal tear. During the study period, 31,208 patients delivered at a level III maternity hospital. Among them, 215 and 430 women were included in the IUFD group and the control group respectively. The two groups were comparable for all demographic and clinical characteristics except for an epidural analgesia (92% versus 70% in the control group, p < 0.01) and labor induction (86% versus 17% in the control group, p < 0.01). The incidence of any perineal tears was 13% (28/15) in the IUFD group versus 16% (70/430) in the control group. Relative risk of any perineal tears was non significative (RR = 0.8 IC95% [0.5–1.2]). The incidence of first-degree perineal tears was 10% in the IUFD group and 11% in the control group. The incidence of second-degree perineal tears was 18% in the IUFD group and 28% in the control group. Relative risk of first-degree perineal tears (RR = 0.88 95% CI [0.5–1.4]) and second-degree tears (RR = 0.51 95% CI [0.2–1.4]) were non significative. No obstetrical anal sphincter injury was found in either group. Vaginal delivery following a fetal demise did not appear to be either a risk factor or a protective factor for perineal tears. But there as a trend toward a lower incidence of second degree perineal tears in this context.

Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications?

Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications.Patients and methods: A monocentric, French study “exposed-unexposed” was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25–35 years old.Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis.Conclusion: A pregnancy after 40 years old is worth considering today as far as the risk factors are controlled and understand by the patient and the obstetrician. However, they have a significantly higher risks of cesarean, preterm delivery, pre-eclampsia, gestational diabetes, and fetal death in utero (FDIU). It is therefore the responsibility of the obstetrician to inform correctly these women in a detailed way, to reassure them and to adapt the monitoring of their pregnancy accordingly.

Seroprevalence of rubella in pregnant women in Southern Morocco.

Rubella is a generally benign but dangerous viral infection in early pregnancy, due to the teratogenic potential of the virus. Indeed, it causes spontaneous abortions, in-utero fetal death, premature labor and congenital malformations known as congenital rubella syndrome. The purpose of this study is to determine the immune status of rubella in pregnant women in southern Morocco. A prospective, multicentre study was conducted in 2017 for the detection of rubella IgG and IgM antibodies in 380 pregnant women aged 17 to 46 years, using the Architect i1000 chemiluminescent microparticle immunoassay. Eigthy for percent (84.7%) of women were seropositive. Ten percent of multiparous women remained seronegative despite recommendations for vaccination after delivery. Preventive measures against congenital rubella need to be strengthened, and vaccination is needed in non-immunized women. Vaccination awareness campaigns, especially among non-immunized multiparous women, remain essential.

804: eFGR prevalence, prognosis and outcomes in a UK population dataset

Extremely early onset fetal growth restriction (eFGR; FGR < 3rd centile diagnosed prior to 28 weeks’ gestation, delivered prior to 33 weeks’ gestation) is a rare, but devastating pregnancy complication. Relatively little is known about its prevalence and prognosis, complicating counselling and management. In this study we have examined eFGR using a large national dataset combined with detailed fetal medicine measurements. Scottish national health service data (333,213 births from 2012-2017) was used to retrospectively determine prevalence and survival in eFGR. Prognostic information was derived from a single fetal medicine database of eFGR cases (n=183). Potential prognostic indicators of fetal death in-utero (FDIU) including presenting characteristics and longitudinal growth velocity were examined using logistic and mixed level regression. eFGR prevalence is 3 per 1000 pregnancies. Survival was >75% for those born after 29 weeks, and at a birthweight above 800g. Using the detailed eFGR database, sonographic factors predictive of FDIU at diagnosis (adjusted for gestation) included estimated fetal weight (EFW) (25g increment: aOR 0.71 (95% confidence interval 0.62-0.81)), umbilical artery end-diastolic flow (present compared to absent/reversed: 13.4 (3.70-48.6)) and mean uterine artery resistance index (0.1 increment: 2.05 (1.23-3.43)). A multivariate prognostic model using these factors correctly identified 43/45 cases of FDIU, with a positive likelihood ratio (LR) of 4.4 but a negative LR of 0.09. Growth velocity in pregnancies ending in FDIU was significantly slower (Figure 1), with a 50g/week increase in EFW between 24-26 weeks’ gestation associated with a 53% reduction in FDIU. This is the largest single study to date of eFGR prognosis prediction, and the first to determine eFGR prevalence in a population dataset. We have identified factors predictive of FDIU and proposed a potential model to use in clinical care which, due to its strong negative LR, would allow clinicians to reassure those with a normal result that pregnancy is likely to result in a live birth.

Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial

SummaryBackgroundIntrahepatic cholestasis of pregnancy, characterised by maternal pruritus and increased serum bile acid concentrations, is associated with increased rates of stillbirth, preterm birth, and neonatal unit admission. Ursodeoxycholic acid is widely used as a treatment without an adequate evidence base. We aimed to evaluate whether ursodeoxycholic acid reduces adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy.MethodsWe did a double-blind, multicentre, randomised placebo-controlled trial at 33 hospital maternity units in England and Wales. We recruited women with intrahepatic cholestasis of pregnancy, who were aged 18 years or older and with a gestational age between 20 weeks and 40 weeks and 6 days, with a singleton or twin pregnancy and no known lethal fetal anomaly. Participants were randomly assigned 1:1 to ursodeoxycholic acid or placebo, given as two oral tablets a day at an equivalent dose of 500 mg twice a day. The dose could be increased or decreased at the clinician's discretion, to a maximum of four tablets and a minimum of one tablet a day. We recommended that treatment should be continued from enrolment until the infant's birth. The primary outcome was a composite of perinatal death (in-utero fetal death after randomisation or known neonatal death up to 7 days after birth), preterm delivery (<37 weeks' gestation), or neonatal unit admission for at least 4 h (from birth until hospital discharge). Each infant was counted once within this composite. All analyses were done according to the intention-to-treat principle. The trial was prospectively registered with the ISRCTN registry, number 91918806.FindingsBetween Dec 23, 2015, and Aug 7, 2018, 605 women were enrolled and randomly allocated to receive ursodeoxycholic acid (n=305) or placebo (n=300). The primary outcome analysis included 304 women and 322 infants in the ursodeoxycholic acid group, and 300 women and 318 infants in the placebo group (consent to use data was withdrawn for 1 woman and 2 infants). The primary composite outcome occurred in 74 (23%) of 322 infants in the ursodeoxycholic acid group and 85 (27%) of 318 infants in the placebo group (adjusted risk ratio 0·85 [95% CI 0·62–1·15]). Two serious adverse events were reported in the ursodeoxycholic acid group and six serious adverse events were reported in the placebo group; no serious adverse events were regarded as being related to treatment.InterpretationTreatment with ursodeoxycholic acid does not reduce adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy. Therefore, its routine use for this condition should be reconsidered.FundingNational Institute for Health Research Efficacy and Mechanism Evaluation Programme.

Diagnostic and Prognostic Epidemic Aspect of Eclampsia at the Kolda Regional Hospital Center (Senegal)

Objectives: To evaluate the epidemiology of eclampsia, to assess maternal and perinatal prognosis and management. Material and method: This was a retrospective, descriptive study from January 1, 2015 to December 31, 2018. Included were all women received in the emergency department of our health facility for generalized seizures and/or disturbances of consciousness, occurring between the 20th Week of Amenorrhea (WA) and the 6th week of postpartum on a field of hypertension. The sources of the data consisted of antenatal consultation cards, delivery records, hospital records, operating theater and resuscitation records. The variables studied were sociodemographic characteristics, the course of pregnancy, childbirth and neonatal parameters. Data were captured and analyzed using SPSS 11.0 software. Results: The study focused on 190 cases with a prevalence of 3.5%. The average age of the patients was 20 years with extremes of 14 and 40 years. The average parity was 4.1 deliveries with extremes of 1 and 7. Nearly three-quarters of the patients (74.7%) of the patients were primiparous. Almost all the patients were evacuated. More than half of the seizures (53.1%) were recorded before work and more than one out of two patients had two seizures. Caesarean section was the mode of delivery in more than one out of two patients (56.8%). Maternal complications were marked by renal failure (23 cases), the HELLP syndrome (72 cases), and the retro placental hematoma (83 cases). The fetal impact was marked by prematurity in 90% of cases and 17 cases of fetal death in-utero. Nineteen maternal deaths were recorded while early neonatal mortality was 437 per 1000 live births. The average hospital stay of the survivors was 6.2 days. Conclusion: Eclampsia is still common in our regions. It occurs preferentially in young primiparas with hypertension and/or proteinuria on a poorly followed pregnancy. Magnesium sulphate and cesarean section can improve the maternal and fetal prognosis. Prevention necessarily means quality prenatal care.

A Local Experience of Pregnancy Outcomes in Sickle Cell Disease and Red Cell Exchange

AimPregnancy outcomes in women with Sickle Cell Disease (SCD) have traditionally been poor with rates of both maternal and fetal complications greater than that seen in non-SCD populations (Oteng-Ntim et al, 2015). This association has been demonstrated across both low- and high-income countries with no significant correlation to discrepancies in health care (Boafor et al, 2015). Complications associated with pregnancy in SCD include preterm delivery, intrauterine growth restriction (IUGR), low birth weight, fetal distress in labour, Cesarean section, eclampsia, sickle cell vaso-occlusive crisis, infection, postpartum hemorrhage, and perinatal and maternal death. The introduction of prophylactic Red Cell Exchange (RCE) for high-risk SCD patients has seen a significant reduction in SCD-associated morbidity and mortality (Josephson et al, 2007). Limited studies have examined whether prophylactic RCE also translates to improved pregnancy outcomes in the SCD population with mixed conclusions (Asma et al, 2015). Whilst the association between SCD and adverse pregnancy outcomes has been well characterised in large multi-centre retrospective studies internationally, local data of pregnancy outcomes in SCD, particularly in patients receiving regular RCE, is lacking.MethodWe conducted a retrospective review of pregnancies within the SCD population managed at the Royal Melbourne Hospital between 2001 (date of commencement of regular RCE program) and 2018 to identify pregnancy complications and outcomes. Medical records across two sites (the Royal Melbourne Hospital and the Royal Women's Hospital) were reviewed to identify patient demographics, RCE received, mode and date of delivery, birth weight, fetal and maternal complications, and outcome of pregnancy.ResultsWe identified 10 pregnancies amongst 5 patients with SCD managed during this time. Three patients had HbSS and two HbSC disease. Mean maternal age at time of pregnancy was 27 years. Two patients were receiving regular RCE prior to pregnancy and continued throughout at 3 to 4 week intervals, with a further patient commenced on RCE at 27/40 as per local hospital practice. Of the 3 women receiving regular RCE during pregnancy, all had live births (n=7); 1 via normal vaginal delivery (NVD) and 6 elective Cesarean-section due to cephalopelvic disproportion. Six of these pregnancies were at term, with one induced at 32/40 due to line sepsis as a complication of RCE. Two pregnancies were also complicated by gestational diabetes.Two patients were not managed with regular RCE. The first declined treatment throughout both pregnancies, with pregnancy 1 complicated by intrauterine growth restriction (IUGR) with delivery via NVD at 37/40, and pregnancy 2 complicated by placental abruption and fetal death in utero (FDIU) at 22/40. Both pregnancies were also complicated by gestational thrombocytopenia. The second patient was on hydroxyurea (HU) at time of conception, initially continued during pregnancy in the setting of normal morphology scans and a rare blood phenotype prohibitive of RCE. HU was subsequently ceased at 27/40 due to the development of IUGR. She was commenced on RCE at 30/40 but suffered placental abruption and FDIU at 34/40. No offspring had a haemoglobinopathy of clinical significance.ConclusionRCE was well-tolerated and associated with good and possibly improved maternal and fetal outcomes in this small cohort of sickle cell patients. Larger studies are required to further characterise the benefit of prophylactic RCE during pregnancy in the SCD population. DisclosuresSzer:Alexion Pharmaceuticals, Inc.: Consultancy, Honoraria, Other: Travel Support , Research Funding.

Adverse effects of maternal enterovirus infection on the pregnancy outcome: a prospective and retrospective pilot study

BackgroundEnteroviruses account for about one billion infections worldwide each year, the majority remain asymptomatic. Data on enterovirus infections during pregnancy appear to be very rare. Several cases have been reported in the literature of fetal and neonatal complications attributed to these viruses, but prospective data on these infections during pregnancy are not available.ObjectiveTo estimate the prevalence of enterovirus infections in febrile syndromes in pregnant women, and in case of in utero fetal death (IUFD).MethodsTtri-centric observational cohort study. We performed prospective inclusion for patients with fever during a four-month period. We also analyzed the amniotic fluid in patients with unexplained IUFD retrospectively during a five-year period. Investigations of enteroviruses are made by RT-PCR from routine biological samples (amniocentesis, RT-PCR in maternal blood or CSF).ResultsProspectively, 33 patients were included during the study period. We have identified 4 cases of confirmed enterovirus infection (12.4%). We have recorded a severe form of perinatal enterovirus infection involving the vital prognosis of the newborn.In the retrospective cohort of 75 IUFD cases, we had only one case of enterovirus-positive RT-PCR in amniotic fluid during 5 years, meaning a frequency of 1.3%. We did not had any positive EV case in case of early miscarriage, but the limited number of inclusions cannot help us to conclude.ConclusionEnteroviruses are probably an underestimated cause of obstetric and neonatal complications. Investigation of enterovirus by PCR should be discussed during pregnancy and peripartum in case of febrile syndrome with no obvious bacterial cause, and unexplained IUFD.

Investigating in utero fetal death: outcome of internal medicine consultation.

The objectives were to determine the frequency of in utero fetal death (IUFD) related to placental disorders and to assess the frequency of antiphospholipid antibodies syndrome (APS) among women referred to the internal medicine department. A retrospective clinical study conducted in Rennes University Hospital, France. From January 2007 to December 2014, 53 women who presented an IUFD at 14 weeks or more of gestational age were included. The main cause for each IUFD was determined by expert agreement. Primary outcome was to analyze the final etiologies diagnosed and the prevalence of IUFD related to placental disorders. Secondary outcomes included the frequency of APS among patients with IUFD of placental origin and the pathological and clinical features associated with APS. IUFD resulted from placental disorders in 36/53 (68%) patients, and remained unexplained in 11 cases (20.8%). Among the 36 patients with placental disorders, APS was diagnosed in five (13.9%) cases, and four (11.1%) patients were considered as having 'non-criteria' APS. History of thrombosis (P = 0.001) and placental infarcts (P = 0.047) were significantly associated with APS. Placental disorders were the major cause for IUFD in patients who were referred to internal medicine specialists. Importantly, APS was seldom found in patients with placental disorders. Venous thromboembolism history and placental infarcts were both significantly associated with APS. Further studies are needed in order to deepen our understanding of the physiopathology of placental disorders and its underlying causes among non-APS women, and to determine the best treatment regimen for future pregnancies.

Severe antenatal strangulation and sudden fetal death occurs in term: case report

The authors report a case of a sudden antenatal death, by severe strangulation, unlikely related in a term pregnancy; multiple loops of nuchal umbilical cord (UC) (ten), rarely describe in literature, were observed around the fetal neck. The in utero fetal death (IFD) was suspected by the non-attendance of fetal movements and confirmed by US scan. The tight nuchal cord around the neck (tCAN) diagnostic was made during caesarean delivery, as it was not discovered in pregnancy US scan monitoring nor in the US scan made in emergency. The newborn examination shows severe fetal strangulation by the presence of many spires of a too long UC (1.50 m). Autopsy was not been accepted by the family. Through this reported case the authors wanted to show the difficulties of its diagnosis in less developed Sub-Saharan country were US scan practice is not usual.

A streptococcal lipid toxin induces membrane permeabilization and pyroptosis leading to fetal injury.

Group B streptococci (GBS) are Gram-positive bacteria that cause infections in utero and in newborns. We recently showed that the GBS pigment is hemolytic and increased pigment production promotes bacterial penetration of human placenta. However, mechanisms utilized by the hemolytic pigment to induce host cell lysis and the consequence on fetal injury are not known. Here, we show that the GBS pigment induces membrane permeability in artificial lipid bilayers and host cells. Membrane defects induced by the GBS pigment trigger K+ efflux leading to osmotic lysis of red blood cells or pyroptosis in human macrophages. Macrophages lacking the NLRP3 inflammasome recovered from pigment-induced cell damage. In a murine model of in utero infection, hyperpigmented GBS strains induced fetal injury in both an NLRP3 inflammasome-dependent and NLRP3 inflammasome-independent manner. These results demonstrate that the dual mechanism of action of the bacterial pigment/lipid toxin leading to hemolysis or pyroptosis exacerbates fetal injury and suggest that preventing both activities of the hemolytic lipid is likely critical to reduce GBS fetal injury and preterm birth.

PFM.31 Retrospective review of in-utero fetal death cases in Leicester. Could the use of customised birth centiles and risk stratification improved the detection of in utero growth restriction?

Fetal growth restriction (FGR) affects around 5% of pregnancies. Failing to detect and manage pregnancies with FGR increases the risk of stillbirth. There are two main challenges to detecting these...

Disseminated Intravascular Coagulation leading to Fetal Death in Utero and Uterine Infarction.

This is a unique case report in the medical literature in which DIC is a causative factor for FDIU and subsequent uterine infarction. It is important to recognize early signs of sepsis in pregnant women to minimize this rare but important condition, which may lead to FDIU, PPH, and uterine infarction. Accurate diagnosis based on clinical history, laboratory results, and imaging findings is crucial in the management of this life-threatening disease and the recognition of its associated complications.