Intrauterine Fetal Death Research Articles

Pregnancy Outcome in First Trimester Bleed

Background: There is disagreement on the outcome of vaginal bleeding during the first trimester. The purpose of this study was to ascertain the perinatal and maternal outcome for patients who presenting with vaginal bleeding during the first trimester. Methods: Over the course of a year, 1007 women with vaginal bleeding in the first trimester were included in this prospective observational study at a tertiary care hospital in Peshawar. The diagnosis was confirmed by a USG and a thorough history. All of these patients had their outcomes assessed, including spontaneous, threatened abortions, incomplete, and complete abortions, subchorionic hematoma, intrauterine foetal death, missed abortions, bleeding in the second and third trimesters, pre-mature rupture of membranes, intra-uterine growth restriction, and preterm births. Results: 1007 individuals with 11835 confinements had vaginal bleeding in first trimester. The age range of 21 to 30 years saw the highest occurrence (52.3%). First trimester haemorrhage was detected in 63.9 percent of primigravidas compared to 36.1 percent of multigravidas. It was shown that only 7% of patients who attended after 10 weeks had an abortion, compared to 76.9% of patients who presented before 6 weeks. In the 163 patients who continued to be pregnant after experiencing vaginal bleeding in first trimester, 1.8 percent had an abortion in the 2nd trimester, and 15.3% experienced premature labour. 6.75 percent of pregnancies end prematurely, and 1.8% experience antepartum haemorrhage. Conclusions: First trimester vaginal bleeding foretells ancillary maternal and foetal difficulties, according to the findings of the current study. Additionally, as clinical intervention plays a crucial part in preserving pregnancy and lowering foetal problems, careful supervision and planning by the doctor are crucial. Keywords: First trimester bleeding, Abortions, Threatened abortion, Preterm Labor,

Triple trouble: uncovering the risks and benefits of early fetal reduction in trichorionic triplets in a large national Danish cohort study

Triplet pregnancies are high risk for both the mother and the infants. The risks for infants include premature birth, low birthweight, and neonatal complications. Therefore, the management of triplet pregnancies involves close monitoring and may include interventions, such as fetal reduction, to prolong the pregnancy and improve outcomes. However, the evidence of benefits and risks associated with fetal reduction is inconsistent. This study aimed to compare the outcomes of trichorionic triplet pregnancies with and without fetal reduction and with nonreduced dichorionic twin pregnancies and primary singleton pregnancies. All trichorionic triplet pregnancies in Denmark, including those with fetal reduction, were identified between 2008 and 2018. In Denmark, all couples expecting triplets are informed about and offered fetal reduction. Pregnancies with viable fetuses at the first-trimester ultrasound scan and pregnancies not terminated were included. Adverse pregnancy outcome was defined as a composite of miscarriage before 24 weeks of gestation, stillbirth at 24 weeks of gestation, or intrauterine fetal death of 1 or 2 fetuses. The study cohort was composed of 317 trichorionic triplet pregnancies, of which 70.0% of pregnancies underwent fetal reduction to a twin pregnancy, 2.2% of pregnancies were reduced to singleton pregnancies, and 27.8% of pregnancies were not reduced. Nonreduced triplet pregnancies had high risks of adverse pregnancy outcomes (28.4%), which was significantly lower in triplets reduced to twins (9.0%; difference, 19.4%, 95% confidence interval, 8.5%-30.3%). Severe preterm deliveries were significantly higher in nonreduced triplet pregnancies (27.9%) than triplet pregnancies reduced to twin pregnancies (13.1%; difference, 14.9%, 95% confidence interval, 7.9%-21.9%). However, triplet pregnancies reduced to twin pregnancies had an insignificantly higher risk of miscarriage (6.8%) than nonreduced twin pregnancies (1.1%; difference, 5.6%; 95% confidence interval, 0.9%-10.4%). Triplet pregnancies reduced to twin pregnancies had significantly lower risks of adverse pregnancy outcomes, severe preterm deliveries, and low birthweight than nonreduced triplet pregnancies. However, triplet pregnancies reduced to twin pregnancies were potentially associated with a 5.6% increased risk of miscarriage.

Identification of a unique intervillous cellular signature in chronic histiocytic intervillositis

IntroductionChronic histiocytic intervillositis (CHI) is a rare histopathological lesion in the placenta characterized by an infiltrate of CD68+ cells in the intervillous space. CHI is associated with adverse pregnancy outcomes such as miscarriage, fetal growth restriction, and (late) intrauterine fetal death. The adverse pregnancy outcomes and a variable recurrence rate of 25–100% underline its clinical relevance. The pathophysiologic mechanism of CHI is unclear, but it appears to be immunologically driven. The aim of this study was to obtain a better understanding of the phenotype of the cellular infiltrate in CHI. MethodWe used imaging mass cytometry to achieve in-depth visualization of the intervillous maternal immune cells and investigated their spatial orientation in situ in relation to the fetal syncytiotrophoblast. ResultsWe found three phenotypically distinct CD68+HLA-DR+CD38+ cell clusters that were unique for CHI. Additionally, syncytiotrophoblast cells in the vicinity of these CD68+HLA-DR+CD38+ cells showed decreased expression of the immunosuppressive enzyme CD39. DiscussionThe current results provide novel insight into the phenotype of CD68+ cells in CHI. The identification of unique CD68+ cell clusters will allow more detailed analysis of their function and could result in novel therapeutic targets for CHI.

Intrauterine fetal death and associated maternal conditions

Background: Intrauterine fetal death (IUFD) is a cataclysmic event for the parents. It is an important indicator of maternal and perinatal health of a given population. This study was undertaken to study the maternal and fetal factors associated with IUFD. Methods: This was a retrospective study carried out in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, from November 2019 to October 2020 . The details of history, examination findings, investigation reports , mode of delivery and fetal outcome were obtained from records. Results: A total number of 57 intrauterine fetal death were reported amongst 1534 deliveries conducted during the study period. The occurrence of intrauterine fetal death was 37.1/1,000 live births ; Among all these intrauterine fetal death cases, 87.7% deliveries were preterm and 89.4% deliveries were singleton delivery. The other associated maternal conditions were uncontrolled blood glucose in 64.9% cases, hypertensive disorders in 36.8% cases, other medical causes in 10.5% cases. Associated fetal conditions included intrauterine growth retardation of fetus in 28.0% cases, oligohydramnios in 21.0% cases, congenital malformation in 14.0 % cases. Placental condition included antepartum hemorrhage in 3.5% cases. Conclusions: In this study, the occurrence of intrauterine fetal death was associated with high incidence of uncontrolled blood glucose, oligohydramnios and congenital malformations . This emphases the importance of proper antenatal care and identification of risk factors and its proper treatment. BIRDEM Med J 2023; 13(2): 88-91

Imported severe Plasmodium falciparum infection in the first trimester of pregnancy complicated by post-artemisinin delayed hemolysis and intrauterine fetal death, a case report

BackgroundPost-artemisinin delayed hemolysis (PADH) is a serious complication in patients who recover from severe malaria after receiving artemisinin-based combined therapy (ACT), including artemether-lumefantrine. In Japan, among the antimalarial drugs recommended by the World Health Organization (WHO) guideline for severe malaria, intravenous quinine gluconate is available only in 29 designated hospitals, and intravenous artesunate is unavailable. Therefore, oral artemether-lumefantrine is occasionally administered as an alternative, even though it may be a suboptimal treatment. In non-endemic settings like Japan, a lack of knowledge of malaria and the side effects, such as post-artemisinin delayed hemolysis caused by the ACT, can have critical consequences. Like our patient, being a primigravida in the early stages of pregnancy is a serious risk factor for severe malaria and must be carefully monitored.Case presentationThis report describes a severe case of imported Plasmodium falciparum malaria complicated by fetal loss and prolonged anemia, requiring frequent blood transfusions. The patient was a previously healthy pregnant Japanese female in her 30 s. She developed a high fever 2 days after returning from Nigeria. The patient fulfilled the severe malaria criteria by WHO. On arrival, an abdominal ultrasound incidentally revealed a fetus of 5 week gestational age with a heartbeat in the uterus. Given her pregnancy and the severity of the disease, she was administered intravenous quinine 16 mg/kg as a loading dose. However, the second dose of quinine was not administered due to frequent vomiting and QTc prolongation. We initiated treatment with oral artemether-lumefantrine, and clearance of parasitemia was confirmed by microscopic observation on day 4. Miscarriage was noted on day 6 after admission. Moreover, the patient became feverish again up to 39 °C, and from days 14 to 22, the patient required multiple blood transfusions due to PADH. On day 40, follow-up was discontinued as the hemoglobin level exceeded 10 g/dL.ConclusionsIn patients who recover from severe malaria after ACT treatment, monitoring the hemoglobin level for at least a month is strongly recommended for prompt identification of PADH. Travelers to malaria-endemic countries, especially primigravida women, should be provided with adequate information on the risk and prevention of infection.

Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest study

BackgroundWomen with hereditary fibrinogen disorders (HFDs) seem to be at an increased risk of adverse obstetrical outcomes, but epidemiologic data are limited. ObjectivesWe aimed to determine the prevalence of pregnancy complications; the modalities and management of delivery; and the postpartum events in women with hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia. MethodsWe conducted a retrospective and prospective multicentric international study. ResultsA total of 425 pregnancies were investigated from 159 women (49, 95, and 15 cases of hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia, respectively). Overall, only 55 (12.9%) pregnancies resulted in an early miscarriage, 3 (0.7%) resulted in a late miscarriage, and 4 (0.9%) resulted in an intrauterine fetal death. The prevalence of live birth was similar among the types of HFDs (P = .31). Obstetrical complications were observed in 54 (17.3%) live birth pregnancies, including vaginal bleeding (14, 4.4%), retroplacental hematoma (13, 4.1%), and thrombosis (4, 1.3%). Most deliveries were spontaneous (218, 74.1%) with a vaginal noninstrumental delivery (195, 63.3%). A neuraxial anesthesia was performed in 116 (40.4%) pregnancies, whereas general or no anesthesia was performed in 71 (16.6%) and 129 (44.9%) pregnancies, respectively. A fibrinogen infusion was administered in 28 (8.9%) deliveries. Postpartum hemorrhages were observed in 62 (19.9%) pregnancies. Postpartum venous thrombotic events occurred in 5 (1.6%) pregnancies. Women with hypofibrinogenemia were at an increased risk of bleeding during the pregnancy (P = .04). ConclusionCompared with European epidemiologic data, we did not observe a greater frequency of miscarriage, while retroplacental hematoma, postpartum hemorrhage, and thrombosis were more frequent. Delivery was often performed without locoregional anesthesia. Our findings highlight the urgent need for guidance on the management of pregnancy in HFDs.

Preeclampsia: Prevalence, Risk Factors, and Impact on Mother and Fetus

Objectives: Preeclampsia is one of the most common hypertensive disorders in pregnancy accounting for >50,000 maternal deaths, and over 500,000 fetal deaths worldwide. The incidence of preeclampsia is estimated to be 7 times higher in developing countries like India. Women with preeclampsia are several folds more likely to contract cardiovascular diseases such as ischemic heart disease, stroke, and thromboembolism later in life. This study aims to record the prevalence of preeclampsia, examine the incidence of various associated risk factors and document, and analyze the effects preeclampsia has on the mother and fetus. Materials and Methods: A cross-sectional study was conducted. Five hundred pregnant women were randomly selected based on availability of medical records. Prevalence of preeclampsia was identified in them and the preeclamptic population was further studied for various risk factors and epidemiological factors. The impact on mother and fetus was also studied. The data obtained from the medical records were entered into MS excel and variables were expressed as frequency and proportions. Analysis was done on SPSS 26.0 and major data were subjected to Chi-square test for determining significance. Results: Out of a total of 500 pregnant women, 31 developed preeclampsia; hence, the prevalence of preeclampsia was found to be 6.2%. Of the 31 preeclamptic women, majority belonged to the 20–29 age group (51.6%), 19 (61.2%) had a pre-pregnancy body mass index >23, thus being classified as overweight or obese. Thirteen of these 19 (41.9%) were obese class 1, while 5 (16.1%) were obese class 2. Only two patients were multiparous, while nulliparous and primiparous women accounted for 48.38 and 45.16% of preeclamptic women. Twenty of the 31 women had preeclampsia with severe features and this was found to be significantly associated with delivering a baby having lower birth weight (P < 0.05). A significant 45.1% (14 of the 31 women) had to undergo preterm delivery and 48.38% of the preeclamptic women terminated pregnancy by a lower segment cesarean section. Two of the women were also diagnosed with elevated liver enzymes and low platelets syndrome. With respect to the fetal outcomes, 48.4% of infants had low birth weight. Intrauterine fetal death, fetal growth restriction, and cleft lip and palate were also documented in few neonates. Conclusion: Preeclampsia has a high morbidity and mortality rate as well as an increased risk for future cardiovascular diseases. Hence, risk factors which are in an individual’s self-control such as weight must be modified to prevent unfavorable complications. Pregnant women at risk of preeclampsia should be identified and high-quality antenatal care should be given to minimize the complications of preeclampsia both for the mother and the fetus. More research avenues must be explored on this subject so that enhanced treatment and management options can emerge.

Elevated nuchal translucency, is it time to discuss the cut off?

We aimed to evaluate pregnancy and postnatal outcomes of fetuses with NT between 95th and 99th percentile at first trimester and whether they could benefit from further investigations rather that routine scans. Multicenter retrospective observational study which involved all cases with NT between 95th and 99th percentile from January 2015 to December 2020. Unfavorable outcome was considered as: miscarriage or intrauterine fetal death (IUFD), chromosomal abnormality/genetic syndrome, major malformation or neurodevelopmental delay. Study population outcomes were compared with general population. The rate of unfavorable outcome was 25.44% (167 out of 667). We reported: 6 (0.90%) second trimester miscarriage or IUFD, 90 (13.49%) chromosomal abnormalities/genetic syndromes, 57 (8.55%) major malformations, 13 (1.95%) cases of neurodevelopmental delay. The incidence of chromosomal abnormalities/genetic syndromes and major malformations were significantly higher (OR 6.99 (IC 95% 4.33-11.28), P < 0.001 and OR 17.77 (IC 95%7.22-43.75), P < 0.001 respectively) compared to the general population. The incidence of neurodevelopmental delay was not increased (OR of 0.64 CI 95% 0.33-1.24 P = 0.185). Fetuses with NT between 95th and 99th percentile have an increased risk of pregnancy and postnatal adverse outcomes. According to our data it is reasonable to consider a lower cut of NT (NT > 95th percentile) for offering further investigations such as detailed ultrasound scan, fetal echocardiography and counseling where the option of performing fetal karyotype and CGH array should be discussed.

İkiz Gebeliklerde Tek İntrauterine Fetal Ölümün Perinatal Sonuçları: Üçüncül Merkez Deneyimi

ABSTRACT Aim: Twin pregnancies are associated with increased perinatal mortality and morbidity compared with singleton pregnancies. Single intrauterine fetal death (sIUFD) is difficult to treat. This is because the twin who survives after sIUFD is at high risk for mortality, neurological damage, and other complications of preterm birth. Therefore, in this study, we aimed to determine the perinatal consequences for the surviving fetus. We also investigated the association between chorionicity, maternal characteristics, and fetal and maternal concomitant complications in these cases. Methods: We conducted a retrospective case-control observational study that included twin births complicated by sIUFD followed up in the Department of Perinatology. Data, including demographic characteristics and prenatal invasive procedures, weeks of sIUFD, delivery time, fetal sex, interval between delivery and fetal loss, fetal distress, mode of delivery, birth weight, presence of placental pathology or umbilical cord abnormalities, neonatal Apgar scores in the first and fifth minutes, and need for neonatal intensive care unit (NICU), were obtained from obstetric records and hospital database. Results: Fifty-three twin pregnancies with a single fetal death were included in the study. The mean age of the pregnants participating in the study was 30 (± 6) years. The mean body mass index (BMI) of the mother was 28.8 (22-43). Twenty-four (45.3%) cases were dichorionic (DC) diamniotic, 20 (37.7%) were monochorionic (MC) diamniotic, and 9 (17%) were monochorionic monoamniotic. The time between IUFD and birth of the live twin was 75 days in MCs and 105 days in DCs (p=0.150). The mean gestational age at birth of the surviving twin was 30 weeks’ gestation in MCs and 34 weeks’ gestation in DCs (p=0.030). In 23 (79.3%) MC pregnancies and 15 (62.5%) DC pregnancies, delivery occurred before 37 weeks (p=0.176). In addition, deliveries before 34 weeks occurred more frequently in 19 (65.5%) of MC pregnancies than in 8 (33.3%) of DC pregnancies (p=0.020). Conclusion: We have shown that the birth of the live fetus in the MC group occurred at a significantly earlier time, and mortality and morbidity were observed more frequently in this fetus. However, this research explaining the etiology of sIUFD is insufficient.

Intrauterine Fetal Death in the Third Trimester of Pregnancy in Kamina, DR Congo: Identification of High-Risk Mothers and Impact of the Periodicity of Antenatal Care

Purpose: Intrauterine fetal death (IUFD) is a problem frequently encountered in obstetrical practice in developing countries. The objectives of this study were to identify maternal risk factors for IUFD in the third trimester of pregnancy and to establish its relationship with the norms of periodicity of antenatal care in Kamina. Materiel and methods: This is a case-control study conducted in 6 health facilities in Kamina from January 2021 to May 2022. The effects of the socio-demographic characteristics and obstetrical history of mothers, number of prenatal attendances, age of pregnancy at the first prenatal attendance and number of consultations in third trimester of pregnancy on the occurrence of IUFD were studied. A total of 78 cases of IUFD were linked to 234 controls. Results: The adjustment allowed us to retain 5 parameters significantly associated with IUFD: residence in a rural environment (aOR=2.25; CI= [1.23-4.48]), absence of a history of abortion (aOR=2.97; CI=[1.21-7.26]), history of stillbirth (aOR=2.97; CI =[1.21-7.26]), non-follow up of prenatal care (aOR=3.69; CI=[1.78-7.68]) and insufficient number of prenatal attendances in the third trimester of pregnancy (aOR= 2.22; CI=[1.04 -4.73]). The values of the area under the ROC curve (AUC) found indicate a good capacity of the model (80.3%). Conclusion: The modifiable maternal determinants and those related to identified ANC should serve providers to reduce the occurrence of IUFD in Kamina and its surroundings.

Maternal Hyperhomocysteinemia as a Predictor of Placenta-Mediated Pregnancy Complications: A Two-Year Novel Study.

Background Placenta-mediated pregnancy complications (PMPCs) are a significant contributor to adverse maternal and fetal outcomes. Though the exact cause of the array of pregnancy-related vascular disorders is still unknown, increased maternal serum homocysteine (Hct) levels have been linked to the pathophysiology. Hyperhomocysteinemia (HHct) has been strongly linked with the risk of developing PMPCs such as preeclampsia (PE), fetal growth restriction (FGR), intrauterine fetal death (IUFD), preterm births and placental abruption. Methodology The present observational study was carried out on 810 low-risk antenatal women in their early second trimester (13-20 weeks gestation age) in the department of obstetrics and gynecology of a tertiary care rural hospital to identify the significance of abnormally raised maternal serum Hct level in developing PMPCs. Results Of the 810 participants studied, 224 (27.65%) had raised Hct levelswhereas the rest of the 586 (72.35%) participants had normal Hct levels. The mean Hct level of raised homocysteine group (18.59 ± 2.46 micromol/L) was substantially raised than the normal Hct group (8.64 ± 3.1 micromol/L). It was observedthat women with elevated serum Hct levels developed PMPCs significantly morethan women with normal serum Hct levels (p-value <0.05).Among HHct subjects, 65.18% developed PE, 34.38% had FGR, 28.13% had a preterm delivery, 4.02% had abruptio placentae and 3.57%had IUFD. Conclusions The focus of the current study is on an easy and quick intervention suchas assessing the often-ignored levels of Hct duringpregnancythat can help predict and prevent PMPCs. It also highlights the necessity for well-thought-out large-scale studies and trials to further examine the phenomena, as pregnancy may be the only time whenrural women willhave the opportunityto receive advice and tobe tested for HHct.

Impact of misoprostol in inducing labor in patients having intrauterine foetal death

Background: The most detrimental outcome of pregnancy, intrauterine foetal death (IUFD), causes psychological suffering to the expectant mother and the entire family. Objective: The purpose of this study was to evaluate the effectiveness as well as safety of misoprostol for labour induction in IUFD. Methods: The Department of Obstetrics and Gynecology at the MTI-HMC, Peshawar, conducted this clinical research on 120 women who had IUFD from 09 September 2020 to 09 March 2021. With the patient's informed agreement, labour was induced with vaginal misoprostol pills at a dose of 50 mcg four times per day. Results: In research including 120 women, the majority of the women (n=55; 45.83%) were between the ages of 21 and 30, with a median gestational age of 37.61 ± 4.17 weeks. The majority of patients (n=83; 69.17%) did not have appointments, were from rural areas (n=79; 65.83%), and had no formal education (n=91; 75.83%). In our study, 49 women (40.83%) were primigravidas, whereas 71 women (59.17%) were multigravidas. Following misoprostol introduction, the average Bishop's score increased to 6.89 ± 2.3 from 2.32 ± 1.28 at baseline, a difference of 4.57 on average.

Comparison of Prenatal and Postmortem Diagnoses from 251 Fetal Autopsies: High Rate of Placenta Pathologies, Low Rate of Discrepancies

Background: In cases of intrauterine fetal death (IUFD), autopsy and placenta pathology can provide additional information to sonographic findings. We assessed the frequency of prenatally missed relevant diagnoses. Materials and methods: A retrospective evaluation of fetal autopsies from 2006 to 2021 was performed and were classified as: i) agreement, ii) cases where autopsy revealed additional findings, or iii) postmortem findings which changed the diagnosis. Results: A total of 199/251 spontaneous IUFD and 52/251 induced abortions were included. In spontaneous IUFD, placenta pathologies were the leading cause of death (89%). Full agreement was found in most cases (91% and 87% in spontaneous IUFD and induced abortion, respectively), while additional findings (7% and 12%) and major discrepancies (each 2%) were detected less frequently. Conclusion: In some cases where major findings were missed, autopsy could establish a diagnosis.

Serum LDH Levels in Normotensive and Preeclamptic-Eclamptic Pregnant Women and Its Correlation With Fetomaternal Outcome.

Background One of the most prevalent medical issues observed during pregnancy is hypertension. Hypertensive disorders of pregnancy (HDP) and their consequences affect around 5-10% of all pregnancies globally. Preeclampsia is caused by endothelial dysfunction, which causes widespread endothelial leakage and contributes to potentially fatal consequences, such as eclampsia, placental abruption, disseminated intravascular coagulation (DIC), severe renal failure, pulmonary edema, and hepatocellular necrosis. As a result, looking for predictive markers for at-risk pregnancies that can suggest poor maternal or fetal outcomes is critical. Elevated levels of lactate dehydrogenase (LDH), as a sign of cellular damage and dysfunction, can be utilized as a biochemical marker in pregnancy-induced hypertension (PIH) as it represents the severity of the disease, and the occurrence of problems, and has also been demonstrated to co-relate with fetomaternal outcomes. Methodology A total of 230 singleton pregnant women of 28-40 weeks of gestational age were enrolled in this study. All women were divided into two groups - normotensive and preeclamptic-eclamptic groups; the second group was further divided intomild preeclampsia, severe preeclampsia, and eclampsia, based on blood pressure and the presence of proteinuria. Serum lactate dehydrogenase levels were measured in both groups and correlated with their fetomaternal outcome. Results Mean serum lactate dehydrogenase (LDH) levelin eclamptic women was 1515.86 ± 754, in severely preeclamptic women was 932.2 ± 448, mild preeclamptic women were 580.5±213, while in normotensive women mean LDH level was 378.6 ± 124. The difference between normotensive and preeclamptic-eclamptic women was statistically significant (p < 0.001). The complications in the preeclamptic-eclamptic group were increased significantly in women with LDH > 800 IU/L, 600-800 IU/L compared to those who had < 600 IU/L LDH levels. Conclusions Serum LDH levels were significantly higher in women of preeclamptic-eclamptic group compared to the normotensive pregnant women. Higher LDH levels were positively correlated with disease severity and maternal complications like placental abruption, hemolysis elevated liver enzymes low platelet count (HELLP), disseminated intravascular coagulation (DIC), acute renal failure, intracranial hemorrhage, pulmonary edema, and maternal death and for fetal complications like preterm, intrauterine growth restriction (IUGR), APGAR at 1 minute < 7, APGAR at 5 minutes < 7, low birth weight (LBW), neonatal intensive care unit (NICU) admission and intrauterine fetal death (IUFD).

EVALUATION OF THE EFFECTIVENESS OF ORAL AND VAGINAL MISOPROSTOL FOR INTRAUTERINE FETAL DEATH AND FETAL ANOMALY IN SECOND TRIMESTER PREGNANCY TERMINATION: A RANDOMIZED CLINICAL TRIAL

Background: which method of the expulsion of intrauterine fetal death and fetal anomaly in second trimester is effective, safe, and suitable for pregnant women. Objectives: to evaluate the effectiveness of oral misoprostol and vaginal misoprostol for intrauterine fetal death and fetal anomaly in second trimester pregnancy termination. Materials and Methods: a clinical trial in 108 women experiencing intrauterine fetal death and fetal anomaly during the second trimester in the obstetric department, Can Tho central general hospital in 2014. Excluded criteria: multiple pregnancies, uterus cesarean section scar, and misoprostol contraindication. Intervention: randomized division into two groups: group 1: misoprostol oral, group 2: vaginal misoprostol; dosage as recommended by FIGO. Success was defined as a complete and natural fetal and placenta expulsion without dilation and curettage or other treatment; and healthy hospital discharge. Results: the success rate of group 1 was 75.9%; group 2 was 83.3%. The success rates for fetal conditions of intrauterine fetal death were 74.6%, and the fetal anomaly was 86.7%. In group 1, the success rate in intrauterine fetal death was 63%, fetal anomaly was 88.9%. In group 2, the success rate in intrauterine fetal death was 81.3% and fetal anomaly was 86.4%. The rate of expulsion in the first 24 hours was 78.1% in group 1; 88.9% in group 2, which was not different statistically. Some side effects encountered in the study such as headache, nausea, diarrhea, fever/chills, rash were mainly seen in the oral misoprostol group; all side effects and complications were mild and transient. Related factors to complete expulsion in both groups were gestational age, parity, and fetal conditions. Conclusion: vaginal misoprostol has the same effectiveness and fewer complications than oral misoprostol.

Maternal, Fetal, and Neonatal Outcomes of Gestation in Women with and Without Brucella Infection.

Maternal, fetal, and neonatal complications of brucellosis in pregnant women are probably higher than those in the general population. This comparative study aimed to survey the mentioned complications in pregnant women with positive and negative Brucella serologic tests. This is a prospective cohort study. In this study, 2160 pregnant women residing in the rural area of Hamadan province were screened for Brucella infection by agglutination test. Then, 106 (4.90%) pregnant women with a positive test (exposed group) were compared with 210 subjects (non-exposed group) who were randomly selected from more than 2000 pregnant women with a negative serological test in terms of maternal, fetal, and neonatal outcomes from October 2018 to March 2020. Data were analyzed by SPSS 20 software at a 95% confidence level. The mean age of mothers in both exposed and unexposed groups was 27.84±6.13 and 38.71±6.85 years, respectively. Past medical history of brucellosis, animal contact, and the consumption of unpasteurized dairy products were reported to be 14 (13.2%), 63 (59.4%), and 82 (77.4%), respectively, in the exposed group. The mentioned measures were 3 (1.5%), 109 (51.9%), and 54 (26.9%) in the unexposed group, respectively. Among exposed and unexposed groups, the incidence of abortion was 9 (8.6%) and 5 (2.4%) with P=0.005, intrauterine fetal death was 2 (1.9%) and zero with P=0.211, low birth weight was 10 (10.6%) and 7 (3.4%) with P=0.012, and premature birth was 15 (15.2%) and 18 (8.8%) with P=0.066, respectively. Brucella infection in pregnant women appears to be associated with the risk of miscarriage, low birth weight, and premature birth.

The Cardiovascular Profile Score in Patients with Non-immune Hydrops Fetalis and Cardiac Anomalies — a Pilot Study

The purpose of this paper is to explore whether the cardiovascular profile score (CVPS) correlates with fetal outcome in patients with non-immune hydrops fetalis (NIHF) and cardiac anomalies. In this retrospective study, we included fetuses with NIHF and the suspicion of a cardiac anomaly in prenatal ultrasound. The CVPS was calculated using information obtained by fetal echocardiographic examination. Feto-neonatal mortality (FNM) was defined as intrauterine fetal demise or death in the first 6 months of life. We reviewed 98 patients, who were referred to the Department of Obstetrics and Gynecology of the Johannes Gutenberg University in Mainz with the diagnosis of NIHF between January 2007 and March 2021. By eighteen of them, the suspicion of a cardiac anomaly was raised. After exclusion of six pregnancies (one termination of pregnancy and five because of incomplete data), 12 cases were left for analysis. Mean gestational age at which the CVPS was calculated was 29 + 2 weeks. Two fetuses died in utero. Of the remaining ten hydropic fetuses, three newborns died in the neonatal period, and seven survived after a 6-month surveillance period. Median CVPS of all fetuses was 6 points. Surviving fetuses showed statistically significantly higher CVPS values (median 8 points) than fetuses with FNM (median 5 points, p value = 0.009). Our results point towards a positive association between CVPS and fetal outcome in fetuses with NIHF and cardiac anomalies. The CVPS appears to be a useful marker in the assessment of heart failure in utero.Graphical

Research on the Demographic Variables associated with Diabetes and Fetal Death in the United States

Infant mortality has declined significantly worldwide from the last century to the present. Over the past few decades, however, the decline in neonatal mortality has far outpaced that of fetal mortality. Fetal death accounts for almost 50% of all perinatal deaths, and with intrauterine fetal death ranking in the top five causes worldwide, fetal death remains an important and understudied problem. Diabetes is one of the main reasons and increases fetal mortality risk fivefold. In the United States, from 2014 to 2016, this study compares the disparities in fetal fatalities among women of all races who had gestational diabetes or did not. With a total of 1300 patients reporting a diagnosis of gestational diabetes, statistical significance was shown for the variables of mother education of high school or equivalent, pre-pregnancy body mass index of overweight, and area of fetal birth of the South. The rate of fetal mortality was 16% higher in patients with gestational diabetes than in non-patients without gestational diabetes, according to a negative binomial regression model.

THE EFFECT OF RAMADAN FASTING ON PREGNANCY OUTCOMES DURING THE SECOND AND THIRD TRIMESTER

Background &#x0D; Fasting during pregnancy has always been considered a debatable condition. Some Muslim women do not fast during pregnancy for their children’s health; however, they feel uncomfortable because of their religious beliefs. On the other hand, some pregnant mothers prefer to fast despite their anxiety about their children’s health, and they fast during pregnancy.&#x0D; Objectives &#x0D; To evaluate Ramadan fasting effects in the second and third trimesters of pregnancy on maternal health, fetal growth and early neonatal outcome.&#x0D; Patients and Methods&#x0D; An observational case-control study carried out in Sulaymaniyah City/Kurdistan region/Iraq within a period between April to October 2021, involving 220 healthy pregnant women presented one week before and within the first week of Ramadan in their second or third trimester of pregnancy, they are grouped into two groups (fasting and non-fasting) according to their choice. Both groups followed 4-8 weeks after the first visit and at the delivery time.&#x0D; The parameters observed in the first and second visits were maternal age, weight, residency, maternal job, maternal blood pressure, haemoglobin (Hb), random blood glucose (RBS), gestational age measured by ultrasound, amniotic fluid index (AFI), fetal growth measured by ultrasound.&#x0D; The mode of delivery with an indication of cesarean section(C/S) was recorded in addition to the above parameters at the time of delivery. In addition, birth weight and 5 minutes APGAR score were also recorded.&#x0D; Results&#x0D; Of 220 women, 77 were not fasting, and 143 were fasting. About 87 women presented in the second trimester (57 cases were fasting), while 133 women presented in the third trimester (86 cases were fasting), and no significant changes in the evaluated parameters were observed. There was no significant difference between the fasting and non-fasting groups. Three babies from the fasting group were delivered during the preterm period, while two were delivered preterm in the non-fasting group. This study recorded neither intrauterine fetal death (IUFD) nor stillbirth. No significant difference in APGAR scores at 5 minutes and birth weight was observed between the two groups. &#x0D; Conclusion&#x0D; Ramadan fasting does not increase the risk of maternal, fetal and early neonatal complications. Most Muslim pregnant women do not recognize their right to be excused from fasting Ramadan by the Islamic religion, and they have a high rate of fasting with very strong desire and happiness.

Predictive factors for severe placental damage in pregnant women with SARS-CoV-2 infection

IntroductionSARS-Cov-2 infection during pregnancy can lead to severe placental lesions characterized by massive perivillous fibrin deposition, histiocytic intervillositis and trophoblast necrosis. Diffuse placental damage of this kind is rare, but can sometimes lead to obstetric complications, such as intrauterine fetal death (IUFD). The objectives of this study were to identify possible predictors of severe placental lesions. MethodsWe retrospectively studied 96 placentas from SARS-Cov-2 positive pregnant women who gave birth between March 2020 and March 2022. Cases with and without severe placental lesions were compared in terms of clinical and laboratory findings. ResultsTwelve of the 96 patients had severe placental lesions. There was no significant association with diabetes, obesity or severe clinical maternal disease. In contrast, presence of severe placental lesions was significantly associated with neonatal intensive care, cesarean section, prematurity, IUFD, intrauterine growth restriction (IUGR), gestational age, maternal hypofibrinogenemia and thrombocytopenia. No cases of severe placental lesions were observed in vaccinated patients or in those with the Omicron variant. DiscussionIn these patients, severe placental lesions due to SARS-Cov-2 were significantly associated with the presence of coagulation abnormalities (hypofibrinogenemia and thrombocytopenia), IUGR and gestational age. These results support laboratory and ultrasound monitoring of these parameters in pregnant women with SARS-Cov-2 infection, especially during the second trimester, to predict potential negative fetal outcomes.