Maternal Prognosis Research Articles

High Risk Factors for Placenta Accreta Other than Pregnancy and Their Impact on Patient Prognosis

Abstract Objective This study aimed to determine the most pertinent factors responsible for placenta accreta spectrum disorders in patients without any history of pregnancy and evaluate their prognostic implications. Methods This retrospective cohort study included 1009 patients diagnosed with placenta accreta spectrum disorders based on standardized diagnostic criteria across 10 tertiary hospitals in China between January 1, 2018, and December 31, 2018; 45 patients without a history of pregnancy were selected. The collected data mainly included demographic characteristics (including age, operative history, and ultrasound findings) and maternal-fetal outcomes (including any history of intraoperative bleeding, blood transfusion details, maternal-fetal complications, and fetal Apgar scores). SPSS 24.0 was used for statistical analyses. The Mann-Whitney U test and logistic regression were performed; a two-tailed P < 0.050 was considered statistically significant. Results Ultrasound-based detection of placenta previa (χ 2 = 9.911, P = 0.003) showed a strong association with placenta accreta spectrum types. The severity of placenta accreta spectrum was directly proportional to the likelihood of having coexistent complete placenta previa (χ 2 = 11.626, P = 0.009) and being diagnosed by ultrasound (χ 2 = 5.449, P = 0.047). Blood transfusion also impacted placenta accreta spectrum types in relation to maternal prognosis (χ 2 = 8.785, P = 0.004). On univariate analysis, older age led to more complications (U = 82.000, P = 0.011), and in vitro fertilization-embryo transfer caused more intraoperative bleeding (U = 91.500, P = 0.007). Although the 1- and 5-minute Apgar scores were statistically significant, the rates of neonatal asphyxia did not differ (P > 0.050). Endometrial damage led to lower Apgar scores on both univariate (1 minute: U = 29.500, P = 0.027; and 5 minutes: U = 33.500, P = 0.031) and multivariate (1 minute: β = −1.510, 95% confidence interval, −2.639 to 0.381, P = 0.010; and 5 minutes: β = −0.968, 95% confidence interval, −1.779 to 0.157, P = 0.021) analyses. Conclusion In patients who had no history of pregnancy, placenta previa was a strong risk factor for severe placenta accreta spectrum disorders. Endometrial damage led to lower Apgar scores; this warrants greater consideration in the clinic.

EVALUATING THE MATERNAL OUTCOME IN OBSTETRIC ICU A STUDY FROM A TERITIARY CARE HOSPITAL IN SOUTH INDIA

Background : Critically ill obstetric patients pose challenges to the intensive care unit team due to their altered physiology as well as due the presence of the foetus and safety of both the mother and the foetus is of most important. A better knowledge of the spectrum, characteristics and outcomes of the diseases involving this group of patients is the first step towards achieving prevention and the current study is done to supplement the present knowledge on obstetric emergencies requiring ICU care. Aims and Objectives :The objective is to study the profile of cases admitted to obstetric ICU and to evaluate maternal outcome and prognosis. Materials and Methods :This is observational study was conducted at Andhra Medical College ,visakhapatnam a teritiary care hospital from January 2022 to June 2022 . 1. All antenatal women irrespective of the period of gestation and postnatal women within 42 days of delivery requiring ICU admission for obstetric, non-obstetric reasons,irrespective of age, parity, mode of delivery, and co-morbid conditions were included . 2. Results were subjected to statistical analysis and conclusions drawn. Results : During the study period of 6 months, a total number of 82 obstetric patients were admitted to ICU. Specific interventions that had been undertaken at the ICU (such as the use of intubation, mechanical ventilation, and intensive monitoring )were recorded. The complications that were encountered at the ICU, such as disseminated intravascular coagulation (DIC) and multiorgan failure, were recorded. Majority were of obstetric reasons (n=58, 70.7%).Non-obstetric reasons (n=24, 29.3%) 28 maternal deaths occurred during the study period.Most common cause of death in our study was MODS followed by complications of hypertensive disorders of pregnancy. Discussion : Present centre being a tertiary care hospital majority of the women had severe complications and many were referred after a significant amount of delay .This stresses the idea that, in cases involving obstetric patients, there could not be much time for transfer to an intensive care unit and that things could swiftly deteriorate. Lack of antenatal care, poor socio economic background, delay in referral from the peripheral health centres predicted poor outcomes. Conclusion : The findings of the present study reinforce the statement by WHO that There is a story behind every maternal death or life-threatening complication. Understanding the lessons to be learned can help to avoid such outcomes. A multidisciplinary team approach is required in ICU. All residents of obstetrics and gynaecology should have short mandatory training phase in critical care.

Maternal and Neonatal Prognosis of Childbirth Among 14 to 19 Years Teenage Girls at the Ordre De Malte Hospital of Djougou, Benin

<i>Introduction</i>: Despite advances in clinical care, teenage childbirth is still feared both medically and socially. Because of their immature bodies, teenage girls are more prone to complications during pregnancy and delivery. Objective: This study aimed to investigate maternal and neonatal prognosis of childbirth among 14 to 19 years teenage girls at the Ordre de Malte hospital of Djougou (HZ-OMD) in 2021.<i> Method</i>: For descriptive and analytical purposes, we conducted a prospective study in the gynecology and obstetrics section of the Ordre de Malte hospital of Djougou (HZ-OMD), from January 1 to May 31, 2021 (5 months). The study population consisted of all parturients admitted into the gynecology and obstetrics section of the HZ-OMD throughout the study period. Data were collected through a face-to-face interview using a pre-designed and tested questionnaire, as well as through physical checkup. Pearson's chi-square and Fisher's exact tests have been used as appropriate to determine correlation between variables. <i>Result</i>: A total of 240 participants were included in this study. The teenage girls childbirths rate in the HZ-OMD was 18.3%. Deliveries were vaginal (63.7%) and vaginal (36.3%). The dystocia noted during vaginal delivery were mechanical (15.2%) and dynamic (11%). High blood pressure was found in 28.6% and was complicated by eclampsia in 16.4% of cases. No maternal deaths were recorded. Preterm births and low birthweight represented 21% and 33.33% of these births respectively. Acute fetal distress was noted in 13.75%. The neonatal mortality rate was 106 per 1000 live births. Irregular fetal heart rate and a generally narrowed pelvis were associated 5.14 and 5.86 times respectively with the risk of delivering through cesarean section (p=0.001; p=0.033). Fifth minute Apgar <7, a criteria of fetal morbidity, was significantly associated with low birthweight (p=0.01), preterm delivery (p=0.021), and acute fetal distress (p 0.001). Newborns were 5 times more likely to die when they are of low birthweight (p=0.001). <i>Conclusion</i>: Teenage girls’ childbirth presents huge risks due to the immaturity of their bodies and the poor follow-up of their pregnancies in our settings.

Cardiovascular diseases worsen the maternal prognosis of COVID-19.

Cardiovascular diseases (CVD) are a risk factor for severe cases of COVID-19. There are no studies evaluating whether the presence of CVD in pregnant and postpartum women with COVID-19 is associated with a worse prognosis. In an anonymized open database of the Ministry of Health, we selected cases of pregnant and postpartum women who were hospitalized due to COVID-19 infection and with data regarding their CVD status. In the SIVEP GRIPE data dictionary, CVD is defined as "presence of cardiovascular disease", excluding those of neurological and nephrological causes that are pointed out in another field. The patients were divided into two groups according to the presence or absence of CVD (CVD and non-CVD groups). Among the 1,876,953 reported cases, 3,562 confirmed cases of pregnant and postpartum women were included, of which 602 had CVD. Patients with CVD had an older age (p<0,001), a higher incidence of diabetes (p<0,001) and obesity (p<0,001), a higher frequency of systemic (p<0,001) and respiratory symptoms (p<0,001). CVD was a risk factor for ICU admission (p<0,001), ventilatory support (p = 0.004) and orotracheal intubation in the third trimester (OR 1.30 CI95%1.04-1.62). The group CVD had a higher mortality (18.9% vs. 13.5%, p<0,001), with a 32% higher risk of death (OR 1.32 CI95%1.16-1.50). Moreover, the risk was increased in the second (OR 1.94 CI95%1.43-2.63) and third (OR 1.29 CI95%1.04-1.60) trimesters, as well as puerperium (OR 1.27 CI95%1.03-1.56). Hospitalized obstetric patients with CVD and COVID-19 are more symptomatic. Their management demand more ICU admission and ventilatory support and the mortality is higher.

Secondhand smoke exposure is associated with the risk of hypertensive disorders of pregnancy: the Japan Environment and Children’s Study

Hypertensive disorders of pregnancy (HDP) are associated with poor maternal and neonatal prognoses. Although several studies have indicated an effect of secondhand smoke (SHS) exposure on HDP, such evidence is lacking in Japan. Therefore, we analyzed data from the Japan Environment and Children’s Study, a large-scale epidemiological investigation, to elucidate a possible link between SHS exposure and HDP risk. Data were obtained from the all-birth fixed datasets and included information on 104,062 fetuses and their parents. SHS exposure was assessed in terms of the frequency (rarely, 1–3, or 4–7 days/week) and the daily duration of exposure (<1, 1–2, or ≥2 h(s)/day). Modified Poisson regression model analyses were performed with adjustment for known risk factors for HDP. Additionally, the population attributable fractions (PAFs) of SHS exposure and maternal smoking to HDP prevalence were estimated. The relative risks of developing HDP among individuals with SHS exposures of 4–7 days/week and ≥2 h/day were 1.18 and 1.27 (95% confidence interval: 1.02–1.36 and 0.96–1.67), respectively, compared to the reference groups (rare exposure and <1 h/day). The PAFs for the risk of HDP due to SHS exposure and perinatal smoking were 3.8% and 1.8%, respectively. Japanese women with greater exposure to SHS have a higher risk of HDP after adjustment for possible confounding factors; thus, relevant measures are required to reduce SHS exposure to alleviate HDP risk.The association between second-hand smoking exposure and hypertensive disorders of pregnancy risk was analyzed using the JECS data. The relative risks in 4–7 days/week and ≥2 h/day of SHS exposures were 1.18 and 1.27, respectively. The PAFs due to SHS exposure and maternal smoking were 3.80% and 1.81%, respectively.

Evaluation of The Relationship between Cell-Free DNA Fetal Fraction of The Circulatory System and Fetal and Maternal Pregnancy Prognosis: A Prospective Study.

Non-invasive prenatal testing (NIPT), sometimes called noninvasive prenatal screening (NIPS), is a non-invasive prenatal genetic test using cell-free DNA in maternal blood. This method is used to diagnose fetal aneuploidy disorders such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18) and Patau syndrome (trisomy 13), which causes disability disorders or significant postpartum defects. The aim of this study was to investigate the relationship between high and low fetal fraction (FF) and prognosis of maternal pregnancy. In this prospective study, after obtaining informed consent, 10 ml of blood was collected from 450 mothers with singleton pregnancies with gestational age above 11 weeks (11-16) at the request of NIPT for cell-free DNA BCT test. After obtaining the test results, maternal and embryonic results were evaluated based on the amount of non-cellular DNA FF. Data analysis was performed by using SPSS software version 21 and independent t test, chi-square statistical tests. Based on test results, 20.5% of women were nulli par. The mean FF index in the studied women was 8.3% with a standard deviation of 4.6. The minimum and maximum values were 0 and 27, respectively. The frequency of normal, low and high FFs was 73.2, 17.3 and 9.5%, respectively. High FF has fewer risks to the mother and fetus than low FF. The use of FF level (high or low) can help us determining the prognosis of pregnancy and using it to better manage the pregnancy.

Insulin requiring Gestational Diabetes: Risk factors and correlation with postpartum diabetes and prediabetes.

A2 gestational diabetes mellitus (A2GDM) is a more severe form of GDM that requires additional medical intervention, such as insulin or oral antidiabetic drug (OAD). The present study explored the determinants of A2GDM and analyzed the associated risk of post-partum diabetes or prediabetes. This retrospective study included 247 pregnant women, diagnosed with GDM and followed up until delivery at the Obstetric Medicine Clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2014 and January 2018. Women with personal history of diabetes or prediabetes were excluded. Collected data included patient's age, body mass index, personal history of thyroid dysfunction and GDM, HbA1c level at diagnosis, management of GDM (diet only, insulin, or OAD), and postpartum metabolic assessment. The prevalence of A2GDM was 29.6%, of which 21.5% were insulin-requiring and 8.1% were OAD-requiring cases. The risk of A2GDM was independently associated with a positive history of GDM (OR=3.19, 95% CI = 1.41-7.20) and HbA1c >7% (OR=8.66, 95%CI = 2.15- 34.94); the model explained 20% of the variance of A2GDM. The postpartum assessment showed that 10.1% have developed prediabetes, while no one developed overt diabetes. Postpartum prediabetes was independently predicted by age category ≥45 years (OR=39.94, 95%CI = 4.62-345.06), history of GDM (OR=0.18, 95%CI = 0.03 - 0.97), and A2GDM (OR=6.96, 95%CI = 1.91-25.42). Approximately one-third of GDM patients in our institution require insulin or OAD for glycemic control and are at high risk of developing prediabetes postpartum. Adherence to and effectiveness of medical nutrition therapy should be further explored among GDM patients to improve their glycemic control and both maternal and fetal prognosis.

Association between epidural-related maternal fever and short-and long-term prognosis of parturients: A prospective observational study.

We aimed to explore the association between epidural-related maternal fever (ERMF) and prognosis of parturients. 159 parturients who underwent vaginal delivery under labor epidural analgesia (LEA) received noninvasive continuous core body temperature monitoring. 122 of them completed the 42-day postpartum follow-up. Parturients with body temperature ≥38°C during labor were categorized as the Fever group, while the others were categorized as the No-Fever group. Compared to No-Fever group, Fever group had a greater proportion of primiparas, greater gestational age of parturients, and longer third stage of labor. The cesarean section and forceps delivery rates, and the amount of intrapartum hemorrhage in Fever group were significantly higher. There were no significant between-group differences with respect to puerperal infection, and amniotic fluid turbidity degree, neither significant between-group difference at 42-days postpartum. We found that ERMF was associated with some short-term outcomes. However, it showed no relation with long-term prognosis of the parturients at 42-days postpartum.

Placenta Percreta with Bladder Invasion: Case Report

Background: Placenta previa with bladder invasion is an uncommon and serious pathology, involving the maternal prognosis. However, as the rate of cesareans has increased, the disease has become more common. Case presentation: We present the case of placenta previa percreta in 34 weeks of amenorrhea, gravida 2 para 1, with a history of a single caesarean section 5 years prior. Initially admitted for threat of premature delivery, we found a totally covering placenta previa with accretization sign and suspicion of bladder invasion. Abdomino pelvic MRI confirmed the diagnosis of placenta previa percreta. During monitoring, the patient presented an acute fetal distress requiring an emergency fetal extraction. She underwent a caesarean section for fetal rescue followed by a total hysterectomy requiring the removing of the anterior part of the bladder. Conclusion: With a rising rate of cesarean sections, the risk of placenta accreta spectrum is increasing as well. Obstetricians and clinicians should be vigilant in prenatal diagnosis, especially if the risk factors are present. Multidisciplinary approach for preoperative, intraoperative and postoperative management can significantly improve maternal and fetal prognosis.

Emergency C-Section on Multi-Scar Uterus: Maternal and Fetal Prognosis at the Nianankoro Fomba Hospital in Segou, Mali

Background: Multi-scar uterus is a uterus with two or more scars due to surgery or trauma. Objective: The aim was to compare the maternal and fetal prognosis of emergency C-sections of bi-scar uteruses to those of uteruses with at least 3 scars at the Nianankoro Fomba Hospital in Segou. Materials and Methods: It was a descriptive and analytical cross-sectional study with prospective data collection over a 24-month period from March 20, 2018, to March 20, 2020. Results: In 2 years, we collected 103 emergency C-sections for multi-scar uterus out of 1198 C-sections with a frequency of 8.6%. The age group of 20 to 35 years was the most represented with 86.4%. The bi-scar uteruses were the most frequent with 77.7%. In 71.8% of cases, the C-section was performed during the latent phase of labor. The C-section was performed under loco-regional anesthesia in 89.3% of cases. Difficulties in hemostasis and bladder injury were the most frequent intraoperative accidents. Surgical site infection was the main postoperative complication. No maternal deaths were recorded. The perinatal prognosis was marked by 4.3% fresh stillbirths in bi-scar uterus against 3.7% in three or more scar uteruses and including 2 fresh stillbirths and 1 macerated. We did not record any early neonatal deaths after C-section. Conclusion: The frequency of emergency C-sections in patients with a multi-scar uterus remains very high in our hospital. A better awareness of the patients, their spouses and all the actors involved in the management of pregnancies and childbirth, can contribute to curb this trend.

Practice of Obstetrical Hysterectomy at the Sylvanus Olympio University Hospital Center: Indications and Maternal Prognosis

Practice of Obstetrical Hysterectomy at the Sylvanus Olympio University Hospital Center: Indications and Maternal Prognosis

The Relationship between Uterine Torsion Pathology and Maternal Prognosis in Dairy Cattle

The Relationship between Uterine Torsion Pathology and Maternal Prognosis in Dairy Cattle

Retracted: Risk Factors for Recurrence of Gestational Diabetes Mellitus and Its Correlation with Maternal and Infant Prognosis.

[This retracts the article DOI: 10.1155/2022/7237777.].

Management of Deliveries at the University Gynecology-Obstetrics Department of the institute of social hygiene hospital of Dakar

Objectives: Describe the epidemiological profile of patients, specify the characteristics of the delivery and evaluate the maternal and perinatal prognosis at the Maternity Hospital Institute of Social Hygiene in Dakar. Materials and Methods: This was a retrospective and descriptive study conducted over a period of six months from January 1 to June 30, 2019, involving all women who gave birth in the Gynecology-Obstetrics Department of the Institut d&#39;Hygiène Sociale Hospital in Dakar. Results: During the study period, we collected 689 delivery records, i.e., 8.2% of the department&#39;s overall activities and 69% of emergency activities. The epidemiological profile of the patients was that of a woman with an average age of 27 years, married (96%), with an average parity of 2, and residing outside the Southern Health District of Dakar (58%). More than half of the patients (58.1%) had received at least 4 prenatal consultations. The majority of parturients had a single pregnancy (97%) at term (72%). Uterine height measurement and fetal heart rate assessment were normal in 59% and 95.5% of the sample respectively. The vaginal touch revealed ruptured membranes in 34.5% of the patients with amniotic fluid that was mostly clear (68.1%) and a vertex presentation (96%). Clinical pelvimetry allowed the diagnosis of 19% of moderately narrowed pelvises and 2% of surgical pelvises. Slightly more than half of the parturients (56.6%) were in the latent phase of labor. We recorded 130 labor events (18.9%), 67 uterine events (9.7%), 76 directions of labor (11%), and 45 labor inductions (6.5%). In our series, 55.4% of the patients had benefited from labor monitoring by cardiotocograph and complications were found in 25.5% of the patients. These were mainly cases of non-reassuring fetal status (71.8%). More than half of the parturients (55.3%) had given birth by vaginal delivery. Caesarean sections and instrumental extractions represented 44.6% and 0.1% of deliveries respectively. Complications recorded (6.8%) were dominated by retroplacental hematoma (4%) and eclampsia (1.1%). We recorded 98% live births. Most newborns (87.4%) had an Apgar score of 7 or more at the first minute. We recorded 82% eutrophic, 13.3% hypotrophic, and 4.7% macrosomic newborns. Among the newborns transferred to neonatology (9.8%), 17.4% died during hospitalization. Stillbirth was estimated at 20‰ live births. Conclusion: Childbirth constitutes the main emergency activity at the Maternity Hospital of the Institute of Social Hygiene of Dakar with low maternal and perinatal morbidity and mortality.

Vaginal Birth after a Cesarean Section at Good Shepherd Mission Hospital at Tshikaji in Democratic Republic of the Congo (DRC)

Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1st to December 31st, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.

PS-BPR03-10: A CASE OF A WOMAN WITH IGA NEPHROPATHY PRESENTING DURING PREGNANCY

Background: Pregnancy has an influence on autoimmune diseases course and many autoimmune diseases go into remission during pregnancy. The details of the autoimmune mechanism of IgA nephropathy have not been elucidated. The disease activity of IgA nephropathy commonly is stable during pregnancy, however, IgA nephropathy is at high risk of pregnancy complications even if renal function is preserved, and prevention of pregnancy complications are important in pregnant woman with IgA nephropathy. Case: A 29 year-old woman, gravida 2, para 0, no history of abnormal urine analysis before pregnancy, presented preeclampsia at 32 weeks pregnancy, and an emergency cesarean section was performed at 32 weeks and 5 days pregnancy. After delivery, microscopic hematuria persisted. Renal biopsy was performed 1 year and 9 months after delivery, and IgA nephropathy was diagnosed. Tonsillectomy was performed for IgA nephropathy, and the patient's renal function did not deteriorate during the follow-up period. In the second pregnancy, low-dose-aspirin was administered from the first trimester, and full term infants delivered without any pregnancy complications. Conclusion: IgA nephropathy can become apparent in pregnancy. Postpartum evaluation of urinalysis is important for the early detection of the primary renal disease. In pregnant woman with IgA nephropathy, stabilization of the disease state and administration of low-dose aspirin are very important for outcome of pregnancy and maternal renal prognosis.

Socio-Demographic Factors, Clinical Characteristics and Maternal Prognosis of Hypertensive Disorders in Pregnancy at Panzi General Referral Hospital

Socio-Demographic Factors, Clinical Characteristics and Maternal Prognosis of Hypertensive Disorders in Pregnancy at Panzi General Referral Hospital

First Trimester Bleeding in Pregnancy within the Gynecology and Obstetrics Department of Sourô Sanou Teaching Hospital in BoboDioulasso: 422 Cases Studied and Literature Review

Objectives: Study the epidemiological, clinical, therapeutic and prognostic aspects of the first trimester bleeding of pregnancy. Methodology: This was a descriptive cross-sectional study conducted within the Gynecology and Obstetrics Department of Sourô Sanou Teaching Hospital from January 1st to December 31st, 2019. The study included any patients admitted and treated for endo uterine bleeding in pregnancy with a term inferior or equal to 15 weeks of amenorrhea. The parameters studied were the following: sociodemographic characteristics (age, parity, level of education, occupation, marital status, origin), clinical and paraclinical aspects, diagnosis retained, treatment, and maternal prognosis. Information was collected from a survey form, from clinical records, operating protocols and anatomopathological reports. Data entry and analysis was made through Word and Epi-info 7.2.3 software. Results: During the period of study, 422 cases of first trimester bleeding were reported, corresponding to a frequency of 10.33%. The average age was 29 ± 6.4 years [15-49 years] and the average parity was 1.95 ± 1.7 [0-11]. Married women accounted for 75% of the population. The average gestational age was 9.14 weeks of amenorrhea [5-14 weeks of amenorrhea]. Clinical signs were dominated by vulvar bleeding in 100% of cases and pelvic pains in 86% of cases. All our patients had gone through pelvic ultrasound. As for the diagnoses retained, these included: a threatened abortion in 11.84% of cases, an incomplete abortion (46.77% of cases), an ectopic pregnancy (EP) (26.8% of cases), a terminated pregnancy (17.9% the cases) and a molar pregnancy (8.3% of cases).Abortions were managed through MVA (68.27%) and medical abortion (4.8%). All the cases of EP were treated surgically and no maternal deaths were recorded in our study. Conclusion: First trimester bleeding in pregnancy is common within the department. The main etiologies are threatened abortion, incomplete abortion, molar pregnancy and ectopic pregnancy.

Fetal Brain Tumors, a Challenge in Prenatal Diagnosis, Counselling, and Therapy

Fetal brain tumors are a rare entity with an overall guarded prognosis. About 10% of congenital brain tumors are diagnosed during fetal life. They differ from the postnatally encountered pediatric brain tumors with respect to location and tumor type. Fetal brain tumors can be benign or malignant and infiltrate or displace adjacent brain structures. Due to their high mitotic rate, they can show rapid growth. Outcome depends on age of diagnosis, size, and histological tumor type. Findings like polyhydramnios and macrocephaly encountered on routine ultrasound are frequently associated. Detailed prenatal anomaly scan and subsequent fetal magnetic resonance imaging (MRI) may identify the brain tumor and its severity. Both maternal and fetal prognosis should be included in prenatal counselling and decision making.

Prognosis, counseling, and indications for termination of pregnancy.

As the coincidence of pregnancy and cancer rise, clinicians must be prepared to counsel their patients on the complex relationship between maternal and fetal health. In most types of cancer, maternal prognosis mirrors that of non-pregnant women. However, challenges associated with the timing of diagnosis and treatment can present additional risks. Consequently, pregnant cancer patients must be counseled early and effectively with regard to how their pregnancy status affects treatment options and the range of expected outcomes for both mother and fetus. Some patients choose to terminate pregnancy after such counseling, though the specific course of action depends on the cancer in question, the stage at diagnosis, and the personal priorities and values of the patient.