Management Of Pregnancy Research Articles

The Feasibility and Potential Benefits of a Two-Dimensional Amniotic Fluid Index (Afi2) In the Clinical Management of Pregnancy

The Feasibility and Potential Benefits of a Two-Dimensional Amniotic Fluid Index (Afi2) In the Clinical Management of Pregnancy

Promoting African Indigenous Knowledge in the Management of Pregnancy Related Complications: Perceptions and Treatment Regimens: Case of Eclampsia in Yaounde II, Center Region, Cameroon

Promoting African indigenous knowledge which is being neglected to some extent is pivotal in the management and treatment routines of pregnancy related complications especially the case of eclampsia. Indigenous perceptions, treatment routines of eclampsia are complex and diverse reflective of different religious and cultural beliefs. Most often, pregnant women go for conventional options in handling the disease while neglecting the natural and cultural ways. This study argues that promoting indigenous knowledge especially in the management of eclampsia is substantial rather than over dependence on conventional supremacies. Data for this study was gotten through secondary and primary sources. Secondary data were gleaned from soft and hard copies of published and unpublished documents relevant to the study. Primary data were qualitative sourced from a sample of 341 respondents having different religious and cultural backgrounds using interviews, FGDs and observations. Data was processed using the Straus coding method and analysed using content analysis. Results revealed that while others sees eclampsia as; common complications of pregnancy, others perceive it to spirituality and hereditary. Prevention strategies involved; sufficient rest and good feeding habits while others believe in performing traditional rites and tying charms around their waist against all forms of witchcraft. As concerns treatment regimens, herbs were proven to be very effective, as some women prefer such during their pregnancy periods. Nature and culture were more effective in the management process as ascertained by our respondents. A stand-in cultural and natural ways of management to decolonise conventional myths and supremacy regimen of eclampsia are recommended.

Analysis of the diagnosis and management of cervical ectopic pregnancies in Ecuador, through the study of cases described in the bibliography

Ectopic pregnancy is a condition in which the fertilized egg implants and begins to grow outside the uterus, usually in one of the fallopian tubes. Currently, with the advancement of science, the diagnosis can be made within the first weeks of evolution, after fertilization, identifying the gestational sac in the cervix using ultrasound techniques that seek to implement a measured treatment that does not affect the fertility of the the patient. The objective of the research consists of analysis of the diagnosis and management of cervical ectopic pregnancies in Ecuador, through the study of cases described in the bibliography. The type of research is of a descriptive bibliographic nature, because it seeks to identify the diagnostic tools and clinical criteria described, as well as risk factors described in the bibliography. There are clinical criteria that help detect a cervical ectopic pregnancy such as intense abdominal and pelvic pain, abundant vaginal bleeding, hemorrhages and sensitivity in the area near the cervix. Among the treatment options that exist are medications such as methotrexate or some others that inhibit embryonic growth. In Ecuador this problem is growing and is due to the absence of knowledge about the malformation and the lack of a protocol for its management and resolution, given that there is no established order in how to treat patients with this pathology, causing medical care slows down and generates greater complications

Prenatal diagnosis of chorioangioma – series of cases and management options

IntroductionLarge chorioangioma is one of the causes of fetal anemia and heart failure as well as preterm deliveries.AimThe aim of the study was to assess the clinical implications of prenatal diagnosis of chorioangioma and present new treatment options: laser coagulation and embolisation of feeding vessles.Material and methodsChorioangioma was diagnosed in 5 patients (4 singleton pregnancies and 1 dichorionic twin pregnancy). Ultrasound examinations and routine follow-up were performed in these women to detect possible fetal and maternal complications caused by the placental tumor. Pregnancy management, including invasive procedures and outcome, was analyzed.Results and discussionA high proportion of the patients in the study group (80%) required prenatal intervention due to the fetal heart failure or polyhydramnios. Three patients underwent laser coagulation of superficial supplying vessels; embolization of the deep vessel in the tumor was performed in 1 woman with dichorionic twin gestation. One woman opted for termination of pregnancy following an ineffective laser procedure. One pregnancy (20%) was uncomplicated and managed conservatively. In the group of 4 patients after prenatal treatment, all women gave birth to viable neonates; however, in the case of twin gestation, the affected fetus expired.ConclusionsPrenatal diagnosis of chorioangioma should entail a detailed follow-up of the patient to detect pregnancy complications early enough to introduce intrauterine treatment, preventing intrauterine fetal demise.

Comparing population-based fetal growth standards in a US cohort

BackgroundNo fetal growth standard is currently endorsed for universal use in the US. Newer standards improve upon the methodologic limitations of older studies but before adopting into practice, it is important to know how recent standards perform at identifying fetal under- or over- growth and predicting subsequent neonatal morbidity or mortality in US populations. ObjectiveTo compare classification of estimated fetal weight (EFW) that is <5th or 10th percentile or >90th percentile by six population-based fetal growth standards and the ability of these standards to predict a composite of neonatal morbidity and mortality. Study DesignWe used data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to be (nuMoM2b) cohort, which recruited nulliparous women in the first trimester at eight U.S. clinical centers (2010-2014). EFW was obtained from ultrasounds at 16-21 and 22-29 weeks (n=9530 women). We calculated rates of fetal growth restriction (EFW <5th and 10th percentiles; FGR<5 and FGR<10) and EFW >90th percentile (EFW>90) from three large prospective fetal growth cohorts with similar rigorous methodologies: INTERGROWTH-21, World Health Organization (WHO) sex-specific and combined, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) race/ethnic-specific and unified, and the historical Hadlock (1991) reference. To determine whether differential classification of FGR or EFW>90 among standards was clinically meaningful, we then compared area under the curve (AUC) and sensitivity of each standard to predict SGA or LGA at birth, composite perinatal morbidity and mortality alone, and SGA or LGA with composite perinatal morbidity and mortality. ResultsThe standards classified different proportions of FGR and EFW>90 for ultrasounds at 16-21 (visit 2) and 22-29 (visit 3) weeks. At visit 2, the NICHD race/ethnic-specific, WHO sex-specific and WHO-combined identified similar rates of FGR<10 (8.4-8.5%) with the other two having lower rates, while NICHD race/ethnic-specific identified the highest rate of FGR<5 (5.0%) compared to the other references. At visit 3, WHO-sex-specific classified 9.2% of fetuses as FGR<10, while the other five classified a lower proportion: WHO-Combined 8.4%, NICHD-race/ethnic-specific 7.7%, INTERGROWTH 6.2%, Hadlock 6.1%, and NICHD unified 5.1%. INTERGROWTH classified the highest (21.3%) as EFW>90 while Hadlock classified the lowest (8.3%). When predicting composite perinatal morbidity and mortality in the setting of early-onset FGR, WHO had the highest AUC of 0.53 (0.51, 0.53) for FGR<10 at 22-29 weeks, but the AUCs were similar among standards (0.52). Sensitivity was generally low across standards (22.7-29.1%). When predicting SGA-BW with composite neonatal morbidity or mortality, for FGR<10 at 22-29 weeks, WHO-sex-specific had the highest AUC (0.64; 95% CI 0.60, 0.67) and INTERGROWTH had the lowest (AUC=0.58; 95% CI 0.55, 0.62), though all standards had low sensitivity (7.0-9.6%). ConclusionsDespite classifying different proportions of fetuses as FGR or EFW>90, all standards performed similarly in predicting perinatal morbidity and mortality. Classification of different percentages of fetuses as FGR or EFW>90 among references may have clinical implications in the management of pregnancies, such as increased antenatal monitoring for FGR or cesarean for suspected LGA. Our findings highlight the importance of knowing how standards perform in local populations, but more research is needed to determine if any standard performs better at identifying risk of morbidity or mortality.

Maternal and Perinatal Outcome After Induction of Labor Versus Expectant Management in Low-risk Pregnancies Beyond Term.

Due to still controversial discussion regarding appropriate termination of low-risk singleton pregnancies beyond term, this retrospective study aimed to evaluate maternal and perinatal outcomes depending on gestational age and obstetric management. This is a retrospective cohort analysis including 3.242 low-risk singleton deliveries at the Department of Obstetrics of the University Hospital of Cologne between 2017 and 2022. According to current national guidelines, the cohort was subdivided into three gestational groups, group 1: 40+0-40+6 weeks, group 2: 40+7-40+10 weeks and group 3>40+10 weeks. In our cohort, advanced gestational age was associated with higher rates of secondary caesarean sections, lower rates of spontaneous vaginal deliveries, higher rates of meconium-stained amniotic fluid and depressed neonates with APGAR < 7 after 5 min. Analyzing obstetric management, induction of labor significantly increased the rate of secondary sections and reduced the rate of spontaneous deliveries, while the percentage of assistant vaginal deliveries was independent from obstetric management and gestational age. Induction of labor also significantly enhanced the need for tocolytic subpartu and epidural anesthesia and caused higher rates of abnormalities in cardiotocography (CTG), which also resulted in more frequent fetal scalp blood testing; however, the rate of fetal acidosis was independent of both obstetric management and gestational age. Our study supports expectant management of low-risk pregnancies beyond term, as induction of labor increased the rate of secondary sections and did not improve perinatal outcome.

Pregnancy management in a patient with a neuroendocrine tumor of the pancreas. The clinical case

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Pregnancy-Associated Cancer: A Case Report of a Gastric Cancer Diagnosis in the III Trimester of Pregnancy and Subsequent Management

The co-occurrence of gastric carcinoma and pregnancy is very rare event. Diagnosis is often delayed, frequently at an advanced stage due to the nonspecific symptomatology, which can be confused with the normal physiological symptoms of pregnancy. Therefore, a multidisciplinary approach is essential to initiate the treatment of maternal pathology as early as possible, with the goal of delivering at a moderately preterm gestation age to ensure favorable neonatal outcome. We present a case of gastric carcinoma diagnosed during the third trimester, where the earliest presentation included liver metastases, and the primary tumor’s location was unknown. Throughout our observation period, we conduced clinical-laboratory monitoring, a preliminary radiological staging of the illness (considering the limitations imposed by pregnancy), and a histological diagnosis with biopsy sampling. An elective cesarean section was performed in the moderately preterm period, following the completion of Respiratory Distress Syndrome (RDS) prophylaxis.

Navigating the Complexity: A Comprehensive Review of Managing Pregnancy in Complete Heart Block Cases.

This review explores the comprehensive management of pregnancy in cases of complete heart block, a cardiac condition characterized by the dissociation between atrial and ventricular conduction. The review begins with a thorough examination of preconception counseling, emphasizing the assessment of maternal health, the evaluation of cardiac function, and the identification of potential risks. Subsequently, the medical management section delves into using beta-blockers, pacemakers, and antiarrhythmic drugs to monitor cardiac function during pregnancy and adjust medication regimens. Obstetric considerations highlight the importance of antenatal care, fetal monitoring, and thoughtful delivery planning, including the choice between vaginal delivery and cesarean section. The section on complications underscores the risks of arrhythmias, heart failure, premature birth, and neonatal cardiac issues. Looking ahead, the future directions and research section explores ongoing studies in genetics, pharmacology, and technological innovations, envisioning potential advancements in pacing technology and personalized medicine approaches. The conclusion synthesizes key findings, offering recommendations for clinical practice and reflecting on the challenges and opportunities inherent in managing pregnancy in complete heart block cases. The multidisciplinary approach emerges as paramount, with collaborative efforts paving the way for improved patient outcomes and advancements in the field.

Limited additional value of karyotyping cultured amniotic fluid cell colonies in addition to microarray on uncultured cells for confirmation of abnormal non-invasive prenatal testing results.

Non-invasive prenatal testing (NIPT) allows the detection of placental chromosome aberrations. To verify whether the fetus also has the chromosome aberration, diagnostic follow-up testing is required. The aim of this retrospective study was to assess the added value of analyzing amniotic fluid (AF) cell cultures in addition to uncultured AF cells for the detection of fetal mosaicism. NIPT was performed as part of the Dutch TRIDENT study. Cytogenetic studies in uncultured AF were performed using single nucleotide polymorphism (SNP)-array. Cultured AF cell colonies (in situ method) were investigated with fluorescent in situ hybridization and/or karyotyping. Clinical outcome data were collected in cases with discordant results. Between April 2014 and December 2021, 368 amniocenteses were performed after a chromosomal aberration was detected with NIPT. Excluding 134 cases of common aneuploidies (confirmed by quantitative fluorescence polymerase chain reaction), 29 cases with investigation of uncultured cells only and 1 case without informed consent, 204 cases were eligible for this study. In 196 (96%) cases, the results in uncultured and cultured cells were concordant normal, abnormal or mosaic. Five cases (2%) showed mosaicism in cultured AF cells, whereas uncultured AF cells were normal. Two (1%) of these, one mosaic trisomy 13 and one mosaic trisomy 16, were considered true fetal mosaics. The added value of investigating AF cell cultures in addition to uncultured cells is limited to two of 204 (1%) cases in which true fetal mosaicsm would otherwise be missed. The clinical relevance of one (trisomy 13) remained unknown and the other case also showed ultrasound anomalies, which determined pregnancy management. This seems to justify limiting prenatal cytogenetic confirmatory testing to SNP arrays on uncultured AF cells, considerably shortening the reporting time.

Management of Pregnancy in a Case of Endolymphatic Sac Tumour as a Part of Von Hippel–Lindau Syndrome Complex: A Case Report and Review of Literature

Management of Pregnancy in a Case of Endolymphatic Sac Tumour as a Part of Von Hippel–Lindau Syndrome Complex: A Case Report and Review of Literature

The effectiveness of cervical cerclage in twin pregnancies with a mid-trimester short cervix: A retrospective cohort study

ObjectiveTo analyze the effectiveness of cerclage in twin pregnancies with a short cervix. Study designRetrospective cohort study performed in two University Institutions in Valencia (Spain) with two different protocols for the management of asymptomatic dichorionic diamniotic twin pregnancies with mid-trimester cervical length ≤ 25 mm: treatment with indomethacin, antibiotics and cerclage (cerclage group) (N = 43) versus expectant management (control group) (N = 37). ResultsThe initial cervical length was similar in both groups but detection of a short cervix was performed earlier in the cerclage group (21.6 vs 24.1 weeks, p < 0.001). Women with cerclage had a greater pregnancy latency (12.5 vs. 7.7 weeks, p < 0.001); higher gestational age at delivery (34.1 vs. 31.8 weeks, p < 0.04); less spontaneous preterm birth (SPB) < 28 weeks (11.6 % vs 37.8 %, p < 0.009); higher birthweight (2145 vs 1733 g, p < 0.001); lower birthweight < 1500 g (12.5 % vs 40.0 %, p < 0.001); less admissions to the neonatal intensive care unit (NICU) (24.1 % vs 43.3 %, p < 0.03); shorter stay at NICU (25.6 vs 49.4 days, p < 0.02); lower respiratory distress requiring mechanical ventilation (14.9 % vs 36.5 %, p < 0.02); fewer patent ductus arteriosus (8.9 % vs 26.9 %, p < 0.008); and lower composite adverse neonatal outcome (26.6 % vs. 44.8 %, p < 0.03). Cerclage and gestational age at diagnosis were the only independent predictors of SPB < 32 and < 28 weeks by multivariate analysis. The cumulative data in the literature show promising beneficial effects of cerclage. ConclusionOur data suggest that cerclage in asymptomatic twin pregnancies with a short cervix may reduce the earliest SPB and may improve neonatal outcome.

Treatable traits in asthma during pregnancy: a call for a shift towards a precision-based management approach.

Asthma is the most common chronic medical condition in pregnancy. Asthma exacerbations in pregnancy are unpredictable, and are associated with adverse maternal and fetal perinatal outcomes such as preterm birth and low birthweight. Goals of asthma management in pregnancy are to establish effective asthma control and prevent exacerbations. Optimising the management of asthma in pregnancy is an important goal of practice and future research.Treatable traits is a precision medicine paradigm proposed for the management of airways diseases, which holistically addresses the complexity and heterogeneity of airways disease. It is an individualised treatment approach that aims to improve outcomes. This makes treatable traits well suited for pregnant women with asthma, who have a high prevalence of obesity, mental health conditions, poor symptom perception and suboptimal asthma management skills including low treatment adherence. These traits are measurable and treatable. In this review, we explore current knowledge on the burden of asthma, maternal and perinatal consequences of asthma during pregnancy, the treatable traits paradigm, the prevalence of treatable traits in pregnant women with asthma, and consider how the treatable traits paradigm can be integrated into the management of asthma in pregnancy.

Congenital Tumors-Magnetic Resonance Imaging Findings with Focus on Rare Tumors.

Congenital tumors are rare and, owing to this rarity, there is limited information on many of them. A total of 839 fetal and postnatal MRI studies performed in the first 3 months of life were retrospectively reviewed. They were performed with the use of 1.5 T scanners. Seventy-six tumors were diagnosed based on fetal MRI between 20 and 37 gestational weeks, and 27 were found after birth, from 1 day of age to 3 months of life. Teratomas were the most common tumors in our dataset, mainly in the sacrococcygeal region (SCT), followed by cardiac rhabdomyomas and subependymal giant cell astrocytomas (SEGA) associated with TSC, and neuroblastomas. The group of less common tumors consisted of infantile fibrosarcomas, malignant rhabdoid tumors, mesoblastic nephromas and Wilms tumor, craniopharyngiomas, brain stem gliomas, desmoplastic infantile astrocytoma, choroid plexus carcinoma, glioblastoma, hemangiopericytoma, rhabdomyosarcoma, melanoma, mesenchymal hamartomas of the chest wall and the liver, and juvenile xanthogranuloma, with special consideration of blue rubber bleb nevus syndrome. MRI plays a significant role in further and better characterization of congenital tumors, leading to a correct diagnosis in many cases, which is crucial for pregnancy and neonatal management and psychological preparation of the parents. No diagnosis is impossible and can be absolutely excluded.

Modern management of pregnancy and childbirth with placental attachment disorder

One of the main causes of maternal mortality in the 21st century is postpartum uterine hemorrhage. The period of euphoria in the obstetric community associated with successes in the treatment of hypotonic and coagulopathic hemorrhages ended with the emergence of a new problem - placental invasion into the uterus in the postoperative scar. Placenta increta is the result of abnormal implantation into the decidua or myometrium. This condition is rarely diagnosed in obstetric practice, but it is associated with about 7% of maternal mortality. With the increase in the number of cesarean section surgeries, the incidence of placenta increta is increasing. Diagnosis and treatment are important clinical issues. Since there is no standard clinical treatment protocol, the choice of tactics should be carefully and individually considered.

Umbilical Artery Doppler Indices in Hypertensive Disorders of Pregnancy: Impact on Fetal Outcomes.

Background Hypertensive disorders of pregnancy (HDP) are associated with increased maternal and fetal risks. Doppler ultrasound indices of the umbilical artery have shown promise in predicting adverse fetal outcomes in HDP patients. This observational study investigated the correlation between abnormal umbilical artery Doppler indices and adverse fetal outcomes in HDP patients. Methodology Over a two-year period from2020 to 2022, in Acharya Vinoba Bhave Rural Hospital, central India, we enrolled 138 pregnant women with HDP beyond 28 weeks of gestation and singleton pregnancies. Comprehensive clinical assessments, laboratory investigations, and Doppler studies of the umbilical artery were performed. Doppler indices assessed included the systolic/diastolic (S/D) ratio, resistance index (RI), and pulsatility index (PI). Adverse fetal outcomes were defined based on birth weight and neonatal intensive care unit admissions. Chi-square or Fisher's exact test was used for analyzing the relationship between qualitative data, while an independent-sample t-test was employed for quantitative data. Results Abnormal umbilical artery Doppler indices, including an elevated S/D ratio, RI, and PI, demonstrated a positive correlation with adverse fetal outcomes in HDP patients. These findings highlight the significance of umbilical artery Doppler indices as reliable indicators for anticipating adverse fetal outcomes in HDP patients. Conclusions Abnormal Doppler indices in the umbilical artery, including an elevated S/D ratio, RI, and PI, appear to be valuable predictors for adverse fetal outcomes in patients with HDP. Monitoring these indices can aid in risk stratification and improve the management of pregnancies complicated by HDP.

Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series.

A standardized consensus for the management of cesarean scar pregnancy (CSP) is lacking. The study objective is to evaluate the efficacy, safety and outcomes of the laparoscopic management of CSP as a single therapeutic surgical approach without being preceded by vascular pretreatment or vasoconstrictors injection. This is a retrospective bi-centric study, a case series. Eight patients with a future desire to conceive underwent the laparoscopic treatment of unruptured CSPs. Surgery consisted of "en bloc" excision of the deficient uterine scar with the adherent tissue of conception, followed by immediate uterine repair. The data collected for each patient was age, gestity, parity, number of previous c-sections, pre-pregnancy isthmocele-related symptoms, gestational age, fetal cardiac activity, initial β-human chorionic gonadotropin levels, intra-operative blood loss, blood transfusion, operative time and the postoperative complications, evaluated according to Clavien-Dindo classification. The CSP was successfully removed in all patients by laparoscopy. The surgical outcomes were favorable. All patients with histories of isthmocele-related symptoms reported postoperative resolution of symptoms. The median residual myometrium thickness increased significantly from 1.2 mm pre-operatively to 8 mm 3 to 6 months after surgery. The laparoscopic management seems to be an appropriate treatment of CSP when performed by skilled laparoscopic surgeons. It can be safely proposed as a single surgical therapeutic approach. Larger series and further prospective studies are needed to confirm this observation and to affirm the long-term gynecological and obstetrical outcomes of this management.

Fetal fraction of cell-free DNA in noninvasive prenatal testing and adverse pregnancy outcomes: a nationwide retrospective cohort study of 56,110 pregnant women

BackgroundNon-invasive prenatal testing by cell-free DNA analysis is offered to pregnant women worldwide to screen for fetal aneuploidies. In non-invasive prenatal testing, the fetal fraction of cell-free DNA in the maternal circulation is measured as a quality control parameter. Since fetal cell-free DNA originates from the placenta, the fetal fraction might also reflect placental health and maternal pregnancy adaptation. ObjectiveTo assess the association between the fetal fraction and adverse pregnancy outcomes. Study DesignWe performed a retrospective cohort study of women with singleton pregnancies opting for non-invasive prenatal testing between June 2018 and June 2019 within the Dutch nationwide implementation study (TRIDENT-2). Multivariable logistic regression analysis was used to assess associations between fetal fraction and adverse pregnancy outcomes. Fetal fraction was assessed as a continuous variable and as <10th percentile, corresponding to a fetal fraction below 2.5%. ResultsThe cohort comprised 56,110 pregnancies. In the analysis of fetal fraction as a continuous variable, a decrease in fetal fraction was associated with an increased risk of hypertensive disorders of pregnancy (adjusted OR [aOR] 2.27 [95% CI 1.89 to 2.78]), small for gestational age neonates <p10 (aOR 1.37 [1.28 to 1.45]) and <p2.3 (aOR 2.63 [1.96 to 3.57]), and spontaneous preterm birth from 24 to 37 weeks of gestation (aOR 1.02 [1.01 to 1.03]). No association was found for fetal congenital anomalies (aOR 1.02 [1.00 to 1.04]), stillbirth (aOR 1.02 [0.96 to 1.08]), or neonatal death (aOR 1.02 [0.96 to 1.08]). Similar associations were found for adverse pregnancy outcomes when fetal fraction was <10th percentile. ConclusionsIn early pregnancy, a low fetal fraction is associated with an increased risk of adverse pregnancy outcomes. These findings can be utilized to expand the potential of non-invasive prenatal testing in the future, enabling the prediction of pregnancy complications and facilitating tailored pregnancy management through intensified monitoring or preventive measures.

The management and clinical outcomes of pregnancies in women with urea cycle disorders: A review of the literature and results of an international survey

AbstractAn increasing number of women with urea cycle disorders (UCDs) are reaching child‐bearing age and becoming pregnant. Improved diagnostics and increased awareness of inherited metabolic diseases has also led to more previously undetected women being diagnosed with a UCD during or shortly after pregnancy. Pregnancy increases the risk of acute metabolic decompensation with hyperammonemia—which can occur in any trimester, and/or the postpartum period, and may lead to encephalopathy, psychosis, coma, and even death, if not diagnosed promptly and treated appropriately. There are also (theoretical) concerns that a maternal UCD, or its treatment, may cause potential risks for the unborn child. Currently evidence on management and outcome of pregnancies in UCDs is limited to case reports and there are no clear guidelines. In order to inform management and investigate outcomes of pregnancies in women with a UCD, we performed a retrospective review of published cases and analyzed data collected from an international online survey. We conclude that, although risk during the intra‐ and postpartum period exists, multidisciplinary management by an experienced team and a prospective plan usually result in successful pregnancy, labor, delivery, and postpartum period. No deaths were reported in mothers managed accordingly. With the exception of male neonates with Ornithine Transcarbamylase deficiency, the clinical outcome of children born to mothers with UCDs appears positive, although follow‐up is limited. The outcome for women presenting with a first acute metabolic decompensation during pregnancy or postpartum is less favorable. Deaths were associated with diagnostic delay/late management of hyperammonemia in previously undiagnosed women.

Managing pregnancy in patients with sickle cell disease from a transfusion perspective.

Advances in the management of sickle cell disease (SCD) have made it possible for most female patients (whether homozygous or compound heterozygous) to reach childbearing age and become pregnant. However, even in the less symptomatic forms of SCD a high risk of complications during pregnancy and the postpartum period can occur for both the mother (1% to 2% mortality) and the fetus. Coordinated care from the obstetrician and the sickle cell disease expert is essential, together with the active participation of the patient. Vaso-occlusive complications, such as vaso-occlusive crisis and acute chest syndrome, often increase in frequency when hydroxyurea treatment is interrupted. Obstetric complications, such as pre-eclampsia, fetal growth restriction, and preterm delivery, are more common in women with SCD. Recent meta-analysis-based studies support prophylactic transfusion. However, there have been no randomized trials assessing the benefits of prophylactic transfusion. Given the known risk of transfusion complications, including delayed hemolytic transfusion reaction and hyperhemolysis, transfusion is not systematically performed in pregnant women with SCD. We describe here a case-by-case approach to the management of pregnancy in women with SCD based on the medical and transfusion history of each patient.