Maternal Conditions Research Articles

Pregnancy Complications and Feto-Maternal Monitoring in Rabbits.

Rabbit production holds significant relevance in modern agriculture due to its potential as a sustainable source of high-quality protein and efficient feed conversion, contributing to food security and economic diversification. Nevertheless, studies incorporating feto-maternal monitoring in this species are uncommon. This review gathers research on the monitoring and evaluation of factors affecting rabbit gestation, providing a better understanding of the causes of prenatal development abnormalities. These include studies regarding how chronic maternal hypertension, gestational diabetes, maternal stress, ectopic gestation, maternal uterine ischemia and fetal hypoxia, intrauterine growth restriction, superfetation, maternal age, maternal nutritional status, maternal physical condition, maternal and embryonic genotype, and the intrauterine location of rabbit fetuses can potentially impact rabbits' reproduction and maternal and fetal health. Among other monitoring techniques, ultrasonography, considered one of the best tools for diagnosing pregnancy and conducting follow-up, is also reviewed. Details on measurable fetal-development parameters in rabbits and precautions to be considered before and during the examination are also provided. Additional studies are required to understand why some events occur and their consequences throughout gestation, allowing the determination of new biomarkers or cut-offs that can be helpful for early diagnosis and improve reproductive efficiency.

Adapting the preterm birth phenotyping framework to a low-resource, rural setting and applying it to births from Migori County in western Kenya

BackgroundPreterm birth is the leading cause of neonatal and under-five mortality worldwide. It is a complex syndrome characterized by numerous etiologic pathways shaped by both maternal and fetal factors. To better understand preterm birth trends, the Global Alliance to Prevent Prematurity and Stillbirth published the preterm birth phenotyping framework in 2012 followed by an application of the model to a global dataset in 2015 by Barros, et al. Our objective was to adapt the preterm birth phenotyping framework to retrospective data from a low-resource, rural setting and then apply the adapted framework to a cohort of women from Migori, Kenya.MethodsThis was a single centre, observational, retrospective chart review of eligible births from November 2015 – March 2017 at Migori County Referral Hospital. Adaptations were made to accommodate limited diagnostic capabilities and data accuracy concerns. Prevalence of the phenotyping conditions were calculated as well as odds of adverse outcomes.ResultsThree hundred eighty-seven eligible births were included in our study. The largest phenotype group was none (no phenotype could be identified; 41.1%), followed by extrauterine infection (25.1%), and antepartum stillbirth (16.7%). Extrauterine infections included HIV (75.3%), urinary tract infections (24.7%), malaria (4.1%), syphilis (3.1%), and general infection (3.1%). Severe maternal condition was ranked fourth (15.6%) and included anaemia (69.5%), chronic respiratory distress (22.0%), chronic hypertension prior to pregnancy (5.1%), diabetes (3.4%), epilepsy (3.4%), and sickle cell disease (1.7%). Fetal anaemia cases were the most likely to transfer to the newborn unit (OR 5.1, 95% CI 0.8, 30.9) and fetal anomaly cases were the most likely to result in a pre-discharge mortality (OR 3.9, 95% CI 0.8, 19.2).ConclusionsUsing routine data sources allowed for a retrospective analysis of an existing dataset, requiring less time and fewer resources than a prospective study and demonstrating a feasible approach to preterm phenotyping for use in low-resource settings to inform local prevention strategies.

Inflammatory Conditions During Pregnancy and Risk of Autism and Other Neurodevelopmental Disorders

BackgroundMaternal inflammation can result from immune dysregulation and metabolic perturbations during pregnancy. Whether conditions associated with inflammation during pregnancy increase the likelihood of autism spectrum disorder (ASD) or other neurodevelopmental disorders (DDs) is not well understood. MethodsWe conducted a case-control study among children born in California from 2011 to 2016 to investigate maternal immune-mediated and cardiometabolic conditions during pregnancy and risk of ASD (n = 311) and DDs (n = 1291) compared with children from the general population (n = 967). Data on maternal conditions and covariates were retrieved from electronic health records. Maternal genetic data were used to assess a causal relationship. ResultsUsing multivariable logistic regression, we found that mothers with asthma were more likely to deliver infants later diagnosed with ASD (odds ratio [OR] = 1.62, 95% CI: 1.15–2.29) or DDs (OR = 1.30, 95% CI: 1.02–1.64). Maternal obesity was also associated with child ASD (OR = 1.51, 95% CI: 1.07–2.13). Mothers with both asthma and extreme obesity had the greatest odds of delivering an infant later diagnosed with ASD (OR = 16.9, 95% CI: 5.13–55.71). These increased ASD odds were observed among female children only. Polygenic risk scores for obesity, asthma, and their combination showed no association with ASD risk. Mendelian randomization did not support a causal relationship between maternal conditions and ASD. ConclusionsInflammatory conditions during pregnancy are associated with risk for neurodevelopmental disorders in children. These risks do not seem to be due to shared genetic risk; rather, inflammatory conditions may share nongenetic risk factors with neurodevelopmental disorders. Children whose mothers have both asthma and obesity during pregnancy may benefit from earlier screening and intervention.

Mapping high-risk clusters and identifying place-based risk factors of mental health burden in pregnancy

PurposeDespite affecting up to 20% of women and being the leading cause of preventable deaths during the perinatal and postpartum period, maternal mental health conditions are chronically understudied. This study is the first to identify spatial patterns in perinatal mental health conditions, and relate these patterns to place-based social and environmental factors that drive cluster development. MethodsWe performed spatial clustering analysis of emergency department (ED) visits for perinatal mood and anxiety disorders (PMAD), severe mental illness (SMI), and maternal mental disorders of pregnancy (MDP) using the Poisson model in SatScan from 2016 to 2019 in North Carolina. Logistic regression was used to examine the association between patient and community-level factors and high-risk clusters. ResultsThe most significant spatial clustering for all three outcomes was concentrated in smaller urban areas in the western, central piedmont, and coastal plains regions of the state, with odds ratios greater than 3 for some cluster locations. Individual factors (e.g., age, race, ethnicity) and contextual factors (e.g., racial and socioeconomic segregation, urbanity) were associated with high risk clusters. ConclusionsResults provide important contextual and spatial information concerning at-risk populations with a high burden of maternal mental health disorders and can better inform targeted locations for the expansion of maternal mental health services.

Risks of motor vehicle crash before and during pregnancy: A population-based controlled study in Taiwan

BackgroundChanges in risk of motor vehicle crashes (MVCs) during pregnancy are less known, and very few studies have assessed this issue by using unselected population-based datasets and adopting a before-and-during design. The study aimed to address the risk of MVC events in association with pregnancy using a national pregnant women cohort in Taiwan. MethodsWe conducted a self-matched design in which each woman served as a driver before and during pregnancy. A total of 1,372,664 pregnant women with live birth(s) at 18–50 years of age between 2008 and 2017 were identified from the Birth Notification dataset. MVC events as a driver were ascertained from the Police-reported Traffic Accident Registry dataset. We calculated the rate ratio (RR) with a 95 % confidence interval (CI) using the conditional Poisson regression model to compare the MVC event rates between pre-pregnancy and pregnancy periods. ResultsThe overall rate of MVC events was significantly reduced during pregnancy (RR = 0.69, 95 % confidence interval (CI) = 0.68–0.71). Mothers with alcoholism during pregnancy were associated with an increased RR at 2.00 but with a very wide CI. Reduction in RR was primarily attributed to the reduced MVC event rate involving scooter crashes (0.60, 95 % CI = 0.58–0.62). ConclusionAlthough MVC event rates decreased during women became pregnant, many women drivers were still involved in MVCs during pregnancy. Their potential maternal and perinatal conditions along with their offspring's health outcomes need further investigations.

Risk factors for Microtia and preventive approaches

Microtia is a congenital anomaly that directly affects the external ear. Although the etiology of this pathology is not fully elucidated, there are several factors that are associated with its occurrence, such as genetics, perinatal and maternal conditions. During organogenesis of the outer ear it is important to mention that as anomalies occur before the sixth week of pregnancy, the chances of severe defects or total absence of the outer ear increase. At the genetic level, the etiology of microtia has been related to multiple causes, as well as the identification of genes involved in allelic expression pathways and transcription factors. Furthermore, this anomaly does not always occur alone, but associated with other pathologies such as cleft palate (12.8%), cleft lip and palate (11.5%), anophthalmia/microphthalmia (11.5%), facial asymmetry (10.6%), as well as oculoauriculovertebral spectrum syndromes, Goldenhar syndrome, craniofacial microsomia, Treacher Collins syndrome, Nager, DiGeorge or 22q deletion, Townes-Brock syndrome and branchi oto-renal syndrome. Treatments are based on the aesthetic management of the patient, but also related to the improvement of the patient's hearing ability. Epidemiologically, the prevalence ranges from 0.8 to 17.5 per 10,000 live births. One of the main risk factors for variation in case identification is altitude, genetics and maternal-perinatal factors. This literature review provides a thorough analysis of information for the better understanding, analysis and clinical management of this congenital anomaly.

Teenage pregnancy and Violence: A current public health problem.

Every year, an estimated 21 million teenage girls aged 15–19 years become pregnant, and at least 777,000 births occur to adolescent girls younger than 15 years in developing countries. 1 Latin America has the world's second highest teenage pregnancy rate, with about 18 % of births to mothers under 20. Each year, one and a half million adolescent women aged 15 and 19 have babies in the region.2 Injuries, Violence, self-harm, and maternal conditions are the leading causes of death among adolescents and young adults. Pregnant teenagers are prime targets of different types of Violence. Violence and adolescent pregnancy are public health problems and risk factors for maternal and fetal morbidity and mortality. The United Nations Sustainable Development Cooperation Framework (UNSDCF) prioritizes ending Violence against girls and child marriage.3,4

Becoming aWARE: The Development of a Web-Based Tool for Autism Research and the Environment.

A sharp rise in autism spectrum disorder (ASD) prevalence estimates, beginning in the 1990s, suggested factors additional to genetics were at play. This stimulated increased research investment in nongenetic factors, including the study of environmental chemical exposures, diet, nutrition, lifestyle, social factors, and maternal medical conditions. Consequently, both peer- and non-peer-reviewed bodies of evidence investigating environmental contributors to ASD etiology have grown significantly. The heterogeneity in the design and conduct of this research results in an inconclusive and unwieldy 'virtual stack' of publications. We propose to develop a Web-based tool for Autism Research and the Environment (aWARE) to comprehensively aggregate and assess these highly variable and often conflicting data. The interactive aWARE tool will use an approach for the development of systematic evidence maps (SEMs) to identify and display all available relevant published evidence, enabling users to explore multiple research questions within the scope of the SEM. Throughout tool development, listening sessions and workshops will be used to seek perspectives from the broader autism community. New evidence will be indexed in the tool annually, which will serve as a living resource to investigate the association between environmental factors and ASD.

Causes and consequences of child growth faltering in low-resource settings

Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.

The Association between Grand Multiparity and Adverse Neonatal Outcomes: A Retrospective Cohort Study from Ha'il, Saudi Arabia.

Inconsistent evidence exists regarding the association of grand multiparity with adverse neonatal outcomes. This study aims to compare specific adverse outcomes in grand multiparas (those with five or more births at twenty or more weeks of gestation, regardless of fetal outcome) compared to those with lower parity (those with less than five births at twenty or more weeks of gestation, regardless of fetal outcome). A retrospective cohort study was undertaken at the Maternity and Children Hospital in Ha'il region, Saudi Arabia. After calculating the required sample size, data were collected from consenting participants with a viable singleton delivery. Socio-demographic variables, select maternal characteristics, and adverse neonatal outcomes (admission to the neonatal intensive care unit, low birth weight, prematurity, and APGAR score less than 7 in the first 5 min) were compared between grand multiparas and women with lower parity. Two hundred ninety-four participants were recruited (ninety-eight grand multiparas and one hundred ninety-six of lower parity). There was a statistically significant difference between the two groups in relation to age, level of education, body mass index, and the occurrence of gestational diabetes. Out of the studied adverse neonatal outcomes after the adjustment for maternal age between the two groups, no statistically significant difference in the adverse neonatal outcomes was found between the two groups. Grand multiparity does not incur an additional risk of adverse neonatal outcomes compared to women of lower parity. Furthermore, increasing maternal age and comorbid conditions might have a more detrimental effect on neonatal outcomes than grand multiparity per se.

Fetoplacental vascular effects of maternal adrenergic antihypertensive and cardioprotective medications in pregnancy.

Maternal cardiovascular diseases, including hypertension and cardiac conditions, are associated with poor fetal outcomes. A range of adrenergic antihypertensive and cardioprotective medications are often prescribed to pregnant women to reduce major maternal complications during pregnancy. Although these treatments are not considered teratogenic, they may have detrimental effects on fetal growth and development, as they cross the fetoplacental barrier, and may contribute to placental vascular dysregulation. Medication risk assessment sheets do not include specific advice to clinicians and women regarding the safety of these therapies for use in pregnancy and the potential off-target effects of adrenergic medications on fetal growth have not been rigorously conducted. Little is known of their effects on the fetoplacental vasculature. There is also a dearth of knowledge on adrenergic receptor activation and signalling within the endothelium and vascular smooth muscle cells of the human placenta, a vital organ in the maintenance of adequate blood flow to satisfy fetal growth and development. The fetoplacental circulation, absent of sympathetic innervation, and unique in its reliance on endocrine, paracrine and autocrine influence in the regulation of vascular tone, appears vulnerable to dysregulation by adrenergic antihypertensive and cardioprotective medications compared with the adult peripheral circulation. This semi-systematic review focuses on fetoplacental vascular expression of adrenergic receptors, associated cell signalling mechanisms and predictive consequences of receptor activation/deactivation by antihypertensive and cardioprotective medications.

Maternal atopic conditions and autism spectrum disorder: a systematic review.

Autism spectrum disorder (ASD) is a disabling neurodevelopmental condition with complex etiology. Emerging evidence has pointed to maternal atopy as a possible risk factor. It is hypothesized that maternal atopic disease during pregnancy can lead to increased levels of inflammatory cytokines in fetal circulation via placental transfer or increased production. These cytokines can then pass through the immature blood-brain barrier, causing aberrant neurodevelopment via mechanisms including premature microglial activation. The objective of this study is to systematically review observational studies that investigate whether a maternal history of atopic disease (asthma, allergy, or eczema/atopic dermatitis) is associated with a diagnosis of ASD in offspring. A search was conducted in Ovid MEDLINE, PsycINFO, and Embase databases for relevant articles up to November 2021; this was later updated in January 2022. Observational studies published in peer-reviewed journals were included. Data were synthesized and qualitatively analyzed according to the specific atopic condition. Quality assessment was done using the Newcastle-Ottawa Scale. Nine articles were identified, with all including asthma as an exposure, alongside four each for allergy and eczema. Findings were inconsistent regarding the association between a maternal diagnosis of either asthma, allergy, or eczema, and ASD in offspring, with variations in methodology contributing to the inconclusiveness. More consistent associations were demonstrated regarding maternal asthma that was treated or diagnosed during pregnancy. Evidence suggests that symptomatic maternal asthma during pregnancy could be associated with ASD in offspring, underscoring the importance of effective management of atopic conditions during pregnancy. Further research is needed, particularly longitudinal studies that use gold-standard assessment tools and correlate clinical outcomes with laboratory and treatment data.PROSPERO Registration Number and Date: CRD42018116656, 26.11.2018.

Characteristics of pregnancy complicated with type 1 and type 2 diabetes.

Diabetes in pregnancy is a major risk factor for adverse perinatal outcomes such as congenital anomalies, hypertensive disorders of pregnancy (HDP), and macrosomia. For the mechanism of onset of type 1 and type 2 diabetes are different, we focused on the difference in perinatal outcomes between the type 1 and type 2 diabetes groups. We retrospectively reviewed 22 pregnancies with type 1 diabetes and 15 pregnancies with type 2 diabetes, who were managed in our single center, with regard to maternal diabetes conditions during pregnancy and neonatal birthweight and blood glucose level. Furthermore, we checked the effect of continuous glucose monitoring and continuous subcutaneous insulin injection in pregnancies with type 1 diabetes. Type 1 diabetes in pregnancy was less controllable and increased neonatal birth weight and neonatal hypoglycemia within 2h after birth after neonatal care unit admission. Continuous glucose monitoring and continuous subcutaneous insulin injection that are convenient to use, had a similar effect in the management of type 1 diabetes during pregnancy, compared with conventional diabetes treatment. In contrast, maternal BMI and HDP were increased in women with type 2 diabetes. In the management of pregnancy with diabetes, we should pay attention to the difference in pregnancy prognosis between type 1 and type 2 diabetes.

Maternal obesity and diabetes during pregnancy and early autism screening score at well-child visits in standard clinical practice.

Early intervention and treatment can help reduce disability in children diagnosed with autism spectrum disorder. Screening for autism spectrum disorder in young children identifies those at increased likelihood of diagnosis who may need further support. Previous research has reported that exposure to maternal obesity and diabetes during pregnancy is associated with higher likelihood of autism spectrum disorder diagnosis in children. However, little is known about whether these maternal conditions are associated with how very young children score on autism spectrum disorder screening tools. This study examined associations between exposure to maternal obesity and diabetes during pregnancy and offspring scores on the Quantitative Checklist for Autism in Toddlers, an autism spectrum disorder screening questionnaire administered between 18-24 months at well-child visits. A higher score on the Quantitative Checklist for Autism in Toddlers suggests a higher likelihood of autism spectrum disorder; children with scores 3 or greater are referred to developmental pediatricians for evaluation. Our study found that children of mothers with obesity or diabetes during pregnancy had higher scores than children whose mothers did not have these conditions. Associations with maternal obesity and gestational diabetes diagnosed at or before 26 weeks of pregnancy were also present in children who did not have later autism spectrum disorder diagnoses, suggesting that exposure to these conditions during early pregnancy may be associated with a broad range of social and behavioral abilities. Identifying associations between maternal health conditions and early Quantitative Checklist for Autism in Toddlers screening scores could influence future screening and provision of support for children of mothers with these conditions.

Utilization of Partograph for Labor Management Among Healthcare Providers in Healthcare Facilities in India: A Systematic Review.

The partograph is a cost-effective tool used to monitor maternal and fetal conditions during labor. It plays a crucial role in facilitating prompt and appropriate intervention in the event of abnormal labor. Effective and timely detection of abnormal labor progression and proactive measures to prevent prolonged labor is crucial in mitigating the potential risks associated with postnatal hemorrhage, sepsis, obstructed labor, uterine rupture, and its subsequent complications. This study aims to conduct a comprehensive review to assess the level of knowledge, practice, and attitude related to the utilization of partographs among healthcare providers in the labor room of healthcare facilities. Systematic reviews of articles were collected from online databases to analyze the utilization of a partograph for labor management among healthcare providers in healthcare facilities in India. A total of 21 articles were selected to examine the outcomes of partograph utilization. The articles included healthcare facilities in 15 Indian states. The majority of the study participants were nurses and midwives. Most of the healthcare providers showed average or inadequate knowledge, while some demonstrated good knowledge about the partograph. Most articles concluded that there was inadequate practice and accuracy in completing the partograph. This inadequacy is observed across various designations of healthcare providers. This review found that the major challenges for healthcare providers include the unavailability of partographs, a shortage of healthcare providers, insufficient knowledge and competence, and limited training opportunities. Partograph training led to improvements in knowledge, tool utilization, and attitudes, as shown by significant differences in post-assessment outcomes. Improvement of healthcare in India necessitates strengthening partograph provision, ensuring adequate human resources, and providing regular training to healthcare providers. These interventions will serve to bridge the current gaps in partograph utilization in the country.

Determinan Kejadian Stunting pada Balita Usia 24-59 Bulan di Wilayah Kerja Puskesmas Pahandut Kota Palangka Raya

Stunting is a condition of growth failure in children (body and brain) due to lack of nutritional intake so that it can cause growth disorders in children who have less height compared to age. Maternal health and nutrition conditions during pregnancy and during pregnancy and after delivery can affect fetal growth and can lead to the risk of stunting. Based on WHO, the Z-score for height for age less than -2 standard deviations (<-2 SD) is categorized as stunting. Stunting is a linear growth disorder that can affect the increased risk of illness, death, delayed motor development disorders, and stunted mental growth. This study aims to determine the factors associated with the incidence of stunting at the Pahandut Public Health Center, Palangka Raya. This study used an observational method with a cross sectional research design. The sample in this study were 96 toddlers who were in the work area of the Pahandut Health Center. Data were analyzed by univariate and bivariate by using chi-square test. The results showed that the factors associated with stunting were a history of exclusive breastfeeding with a p-value of 0.031, a history of infectious diseases with a p-value of 0.041. Based on the results obtained, it can be concluded that the factors that have a significant relationship with the incidence of stunting in the work area of the Pahandut Health Center, Palangka Raya City are the history of exclusive breastfeeding and a history of infectious diseases.

The Influence of Maternal Condition on Fetal Cardiac Function during the Second Trimester.

Maternal health has a direct, profound and lasting effect on the formation and development of the fetal cardiovascular system. The aim of this research was to find whether maternal age, BMI hypertension (GH) or gestational diabetic mellitus (GDM) would affect fetal cardiac function in the second trimester. 329 mothers who had a fetal echocardiogram examination at the International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China, from 1 January 2020 to 30 April 2020 were enrolled at the gestational age of 21 to 26 weeks (mean 22.78 ± 1.13 weeks). Single-factor analysis and multi-factor line regression analysis were used to find the contribution values of each factor to fetal cardiac function. at the second trimester, maternal age had a minor influence on the fetal left ventricle diastolic function. Higher maternal BMI could cause a decrease in the fetal diastolic function of both the left and right ventricle and the systolic function of the left ventricle. Maternal hypertension and gestational diabetic mellitus had a profound influence on both the left and right fetal heart ventricles of both systolic and diastolic function. maternal condition will have a profound influence on fetal cardiac function as early as the second trimester.

Clinical validation of the nursing diagnosis risk for disturbed maternal-fetal dyad in high-risk pregnancy: A case-control study.

To obtain evidence of the clinical validity of the nursing diagnosis (ND) risk for disturbed maternal-fetal dyad in high-risk pregnancy. Causal validation of the ND through a case-control study performed in a university hospital with 155 high-risk pregnant women: 31 cases and 124 controls. A causal association was found between the ND etiological factors and the occurrence of disruption of the symbiotic maternal-fetal dyad; an association was verified when the etiological factor presented a p-value <0.05 and odds ratio >1. The risk factor absent-inadequate prenatal care; populations at risk, such as young-advanced maternal age and economically disadvantaged pregnant women; and association conditions, such as maternal conditions and compromised fetal oxygen transport, increased the outcome likelihood. The associated condition maternal illnesses appeared as a protective factor. Evidence of clinical validity of the ND risk for disturbed maternal-fetal dyad was obtained, and an association between etiological factors and disruption of the symbiotic maternal-fetal dyad was found. The results contribute to advance scientific knowledge in nursing teaching, research, and practice and support the nursing process in high-risk pregnancies.

Role of Fetal Cardiac MRI in Assessment of Congenital Heart Diseases in Comparison to Fetal Echocardiography

Introduction •Abnormalities of the cardiovascular system are the most common congenital diseases in the fetus and the first cause of infant mortality (Johnson et al. 2014). •Without a doubt, Echocardiography is the method of choice to visualize the fetal cardiac cardiovascular abnormalities. Unlike fetal echocardiography imaging, cardiovascular magnetic resonance (CMR) is relatively unaected by maternal and fetal conditions such as maternal obesity, uterine myoma, twins, oligohydramnios, fetal position and rib calcification, which particularly impair sonographic visualization of the fetal heart (Donofrio et al. 2014; Wielandner et al. 2013). •Fetal cardiac MR imaging is a novel MRI technique which can provide valuable information that could add to the prenatal diagnosis and evaluation of cardiac and most of extra-cardiac anomalies. The evaluation of pre-natal congenital cardiac anomalies is important for postnatal management. Aim of the work To highlight the advantage of MRI over fetal echocardiography in assessment of fetal congenital cardiac anomalies. Methods and material Twenty-six feti with suspected or diagnosed congenital cardiac anomalies. All cases underwent detailed history taking, fetal echocardiography and fetal cardiac MR. Study is approved by the ethics review board of Ain Shams University Hospital. Fetal echocardiography was done according to standard protocol and performed by suitable curvilinear probe. Then MRI of the fetal heart was done with uterine SURVEY_BFFE (balanced fast field echo), Black blood single shot -BH, white blood Cine, sBFFE_RLT DYN 3D(real time 3Ddynamic). Images were acquired in the transverse, four-chamber, shortaxis, coronal and oblique sagittal views. Findings of fetal echocardiography were compared with that of cardiac MRI. Results •Regarding the diagnostic performance of prenatal Echo and fetal cardiac MRI showed significant moderate agreement between the two modalities in the detection of different congenital cardiac anomalies, Kappa test: 0.500; p-value 0.021*. •Qualitative analysis: All cardiac structures were delineable by echocardiography and cardiac MRI. There was full agreement(κ = 1) between fetal echocardiography and cardiac MRI in evaluating the cardiac situs(24normal,1 levocardia, 1 ectopia cordis), aorta (20normal, 3 hypoplastic aorta,1 aortic stenosis,1 rt. Sided aortic arch and 1 small sized aorta), transverse cardiac diameter (22 normal, 4 cardiomegaly), foramen ovale (25 normal, 1 large single atrium), Good agreement was found between echocardiography and cardiac MRI for detection of position of the cardiac apex (23 normal, 2 dextrocardia and 1 mesocardia) •Fetal MRI had a significant role in detection of additional extracardiac anomalies in 13 cases. Conclusion fetal cardiac MR imaging as an adjunct to fetal echocardiography may provide valuable information that could add to the prenatal diagnosis and evaluation of cardiac and most of extra cardiac anomalies.

Doppler Ultrasound for Fetal Assessment in High Risk Pregnancies

Background When it comes to the provision of antenatal care or research, pregnant women tend to be divided into low- and high-risk populations; however, the boundaries between the groups are often blurred. For most researchers, ‘high-risk status’ includes maternal conditions associated with increased perinatal mortality and morbidity such as diabetes, hypertensive disorders (chronic hypertension and pre-eclampsia) and cardiac disorders. The waveform analysis of the feto- maternal circulation by Doppler ultrasound has become a quick and a simple way for the assessment of fetal well-being in high-risk pregnancies. It helps identify fetuses at risk of hypoxia and acidaemia, when the results are applied clinically; they contribute to reduced perinatal mortality rates. Objectives The main objective of this study is to evaluate Doppler flow indices as an index for assessing fetal wellbeing in high-risk pregnancies. Methods A total of 40 pregnant women with singleton pregnancies at a gestational age ≥3234 weeks were included in this study, 30 of them had a high risk factor were selected as 10 preeclampsia patient, 10 gestational diabetes patient, 10 cardiac patient, the remaining 10 women had no obstetric disorder or any risk factor were selected as control. All pregnant women underwent uniform antenatal assessment protocol that includes an Ultrasound examination and Doppler evaluation of fetoplacental circulation: umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) Doppler ultrasound studies. Results Our findings showed no statistically significant difference in the Doppler indices between gestational diabetes group and control group. There was only a considerable change in DV Doppler waveform in this study that is also insignificant. At preeclampsia group, it was found that there was statistically significant difference regarding UA RI, MCA RI, and MCA RI/UA RI ratio compared to control group. In the cardiac group, fetal Doppler indices were comparable to those of the control group. Conclusion The result of the present study suggest that Doppler indices in the third trimester may be useful markers of fetal well-being in high risk pregnancy. Hypertensive disorders with pregnancy can be considered the most important indication for third trimester Doppler examination. Two-vessel examination in these cases seems a good practice.