Maternity Center Research Articles

Amniotic fluid sludge is associated with earlier preterm delivery and raised cervicovaginal interleukin 8 concentrations

Preterm birth is the leading cause of global neonatal mortality. Amniotic fluid sludge, thought to indicate intra-amniotic infection, may have potential as a clinical biomarker of preterm birth risk. This study aimed to analyse whether the presence of amniotic fluid sludge in pregnant participants with a known short cervical length, can help improve understanding of aetiology and guide management choice. A retrospective cohort study analysing the effects of amniotic fluid sludge presence on risk of preterm birth in high-risk asymptomatic pregnant participants with a short cervical length (<25 mm) at a large tertiary referral maternity centre in London. Amniotic fluid sludge was detected on routine transvaginal ultrasound scan. 147 pregnant participants with short cervical length were identified, 54 of whom had amniotic fluid sludge. Pregnant participants with amniotic fluid sludge were more likely to have a short cervical length (14 vs 19 mm, p <0.0001), and increased cervicovaginal fetal fibronectin concentrations at diagnosis, compared to pregnant participants without AFS (125 vs 45 ng/mL, p=0.0006). Pregnant participants with amniotic fluid sludge were at increased risk of mid trimester loss and delivery before 24 gestational weeks (RR 3.4 [1.2-10.3]). Furthermore, we showed that pregnant participants with amniotic fluid sludge have increased cervicovaginal interleukin 8 concentrations supporting the concept of amniotic fluid sludge as an indicator of an inflammatory response to microbial invasion (p=0.03). Neonatal outcomes were similar between the two groups. In our cohort of high-risk asymptomatic pregnant participants with a short cervical length, the presence of amniotic fluid sludge is associated with increased risk of delivery before 24 weeks gestation. Pregnant participants with amniotic fluid sludge were also more likely to have raised fetal fibronectin levels and inflammatory cytokines, particularly interleukin 8, in the cervicovaginal fluid supporting the concept that AFS is associated with an infective or inflammatory process. Future research should aim to further establish the clinical significance of amniotic fluid sludge presence and guide subsequent management.

Association between socioeconomic status with pregnancy and neonatal outcomes: An international multicenter cohort.

Previous evidence examining the association between socioeconomic status and pregnancy complications are conflicted and often limited to using area-based measures of socioeconomic status. In this study, we aimed to examine the association between individual-level socioeconomic factors and a wide range of adverse pregnancy and neonatal outcomes using data from the IMPROvED birth cohort conducted in Sweden, the Netherlands and Republic of Ireland. The study cohort consisted of women who participated in the IMPROvED birth cohort between 2013 and 2017. Data on socioeconomic factors were self-reported and obtained at 15 weeks' gestation, and included level of education, employment status, relationship status, and income. Data on pregnancy and neonatal outcomes included gestational hypertension, pre-eclampsia, gestational diabetes mellitus, emergency cesarean section, preterm birth, post term delivery, small for gestational age and Apgar score at 1 min. These data were obtained within 72 h following delivery and confirmed using medical records. Multivariable logistic regression examined the association between each socioeconomic variable and each outcome separately adjusting for maternal age, maternal body mass index, maternal smoking, maternal alcohol consumption and cohort center. We also examined the effect of exposure to any ≥2 risk factors compared to none. A total of 2879 participants were included. Adjusted results suggested that those with less than third level of education had an increased odds of gestational hypertension (OR: 1.74, 95% CI: 1.23-2.46), while those on a middle level of income had a reduced odds of emergency cesarean section (OR: 0.59, 95% CI: 0.42-0.84). No significant associations were observed between socioeconomic variables and neonatal outcomes. Exposure to any ≥2 socioeconomic risk factors was associated with an increased risk of preterm birth (OR: 1.75, 95% CI: 1.06-2.89). We did not find strong evidence of associations between individual-level socioeconomic factors and pregnancy and neonatal outcomes in high-income settings overall, with only few significant associations observed among pregnancy outcomes.

Hypertensive Disorders in Pregnancy at the John F. Kennedy Maternity Center (JFKMC), Liberia: Burden, Sub-Types, and Maternofetal Outcome.

Hypertensive disorders in pregnancy (HDP) are a leading cause of maternal and fetal death, especially in a resource-constrained setting. There is no study from Liberia on the disorder. This pilot study aimed to determine the burden, sub-types, and maternal-fetal outcomes of hypertensive disorders in pregnancy at the John F. Kennedy Maternity Center (JFKMC), Liberia. From January 1 to December 31, 2020, the medical records of 130 pregnant and post-partum patients admitted with Hypertensive disorders in pregnancy (HDP) in a census method of sampling were retrieved, while 83.1% (108) were suitable for analysis in an institutional cross-sectional retrospective study in the department of obstetrics and gynecology at the John F. Kennedy Maternity Center, Liberia. The extracted information was analyzed using SPSS version 26. Results were presented in frequencies and percentages. The statistical association between categorical variables was subjected to the Chi-square test. The level of significance was set at a P-value of < 0.05. There was an institutional prevalence of 3.0% of HDP. The maternal fatality rate was 12.3%, while the perinatal fatality rate was 14.3%. There was a significant association between HELLP syndrome and Severe pre-eclampsia with maternal death, P< 0.001. Prematurity, first minutes Apgar score <5, NICU admission, and low birth weight were associated with perinatal deaths (P <0.001). HDP was an important contributor to maternal and perinatal deaths at the JFKMC, Liberia. Continuous support by the government and development partners for the provision of critical life-saving medical equipment at the JFKMC is recommended.

Calcium and vitamin D supplementation to pregnant women in urban maternity centre

Prevalence of vitamin D deficiency in pregnant women in India is high. There have been case reports from India of neonatal tetany and vitamin D deficiency in breast-fed infants. India initiated the calcium and vitamin D supplementation programmes for pregnant women a decade ago. There is a need to assess compliance with calcium and vitamin D supplementation and impact of supplements on vitamin D levels in pregnant women.Women attending antenatal clinic in an urban maternity centre who fulfilled the eligibility criteria and were willing to participate in the study were enrolled. They were given one month’s supply of supplements, and form for recording compliance and side effects and were followed up every month. Blood samples were drawn at enrolment and after three months of supplementation and plasma vitamin D levels were estimated.Two third of the women had vitamin D level below 20 ng/ml at enrolment There was excellent compliance with supplementation; women who were followed up consumed 94% of the tablets provided. None of the women had clinical signs suggestive of vitamin D deficiency or any major obstetric problems; their offsprings were healthy. A third of the pregnant women continued to have low vitamin D levels after three months supplementation.The current dose of supplements appears to be inadequate to correct the vitamin D levels in deficient individuals. There is a need to undertake studies to find out the optimal dose of vitamin D supplementation which corrects vitamin D deficiency as assessed by maternal vitamin D levels.

Management of anaemia in pregnancy using ‘test and treat’ strategy: hospital based open randomized study

In India, prevalence of nutritional anaemia due to iron, folic acid and vitamin B12 deficiency is high. National anaemia control programme envisaged detection and treatment of anaemic pregnant women. Prevalence of anaemia continues to be high because this strategy was not operationalised and coverage and compliance with iron folic acid supplementation remains low. : The present study aimed at: 1. Operationalizing Hb estimation in urban maternity center, 2. assessing prevalence of iron, folic acid and vitamin B12 deficiency, 3. undertaking an open randomized study in women with Hb between 8.0 and 10.9 g/dL to assess impact of supplementation with iron and folic acid (Group 1) or iron, folic acid and vitamin B 12 (Group 2). The ‘Test and treat’ strategy was operationalized in urban maternity center. At enrolment 100% of women were anaemic, 60% had ferritin &amp;#60;12ng/ml, 5% had folic acid &amp;#60;3ng/ml and 1/3 had vitamin B12 &amp;#60;200pg/ml. After eight weeks of supplementation, there was an increase in mean Hb (&amp;#62;1.0 g/dL), mean ferritin and folic acid in both Gr 1 and 2. There was a fall in mean vitamin B12 at 8 weeks in Gr 1 women who received 5 mg folic acid. Addition of vitamin B12 to IFA does not improve mean Hb or vitamin B12.With assured regular supply and supportive supervision, iron folic acid supplementation for 8 weeks reduces prevalence of anaemia in pregnancy by 50%; with continued supplementation till 38 weeks of pregnancy, there was 70% reduction in prevalence of anaemia.

Obstetric Complications and Adverse Birth Outcomes among Adolescent and Adult Pregnant Women in Dhaka, Bangladesh

Background and Objective: The current study aimed to determine the association of maternal age and obstetric complications and adverse birth outcomes among the adolescent and adult pregnant women.&#x0D; Methods: A cross-sectional study was conducted involving about 150 pregnant women (75 adolescent and 75 adult) who were purposively selected from three maternity centers of Dhaka city. All of them were primigravida experiencing their third trimester of pregnancy. They were interviewed twice (first visit during third trimester and second visit after delivery) with a semi-structured questionnaire. Statistical analysis was done by IBM SPSS Statistics version 20.0. Adjusted odds ratios were achieved by conducting binomial logistic regression analysis.&#x0D; Results: The mean age of the adolescent pregnant girls and adult pregnant women were 16.54±2.38 and 25.23±5.67 years of age, respectively. It was explored that adolescent pregnant girls had higher risks for anemia, preeclampsia, eclampsia, severe fever, jaundice, abnormal position of the baby and urinary problems during gestation. On the contrary, they were observed with lower risks for gestational diabetes, excessive bleeding and leakage of amniotic fluid during pregnancy. During delivery, adolescent group had higher risks for excessive bleeding and placental abruption. Findings of the study also showed that pregnant adolescents had higher risks of various adverse birth outcomes like preterm delivery, still birth, small for gestational age (SGA), very low birth weight (LBW), and low birth weight (LBW).&#x0D; Conclusion: Adolescent pregnancy in Dhaka city had augmented the risk of obstetric complications during pregnancy, during delivery as well as adverse birth outcomes.

To screen or not to screen for asymptomatic bacteriuria in pregnancy: A comparative three-year retrospective review between two maternity centres

BackgroundCurrent national guidance in Ireland states that asymptomatic bacteriuria (AB) should be screened for at 12–16 weeks’ gestation and treated with a seven-day course of antimicrobials, due to the potential risk of preterm birth and low birth weight infants (LBWI), however, this is based on low quality evidence. MethodsOver a three-year period (2018–2020), a retrospective review was undertaken in two neighbouring maternity hospitals; one of which screens for AB (Rotunda hospital (RH)) and one which does not (National Maternity Hospital (NMH)). Patients were included on the basis of fulfilling the IDSA definition for pyelonephritis and requiring admission for intravenous antibiotics. Rates of antenatal pyelonephritis were compared between hospitals, and between screened and unscreened populations. Secondary outcomes including rates of preterm births and LBWI were compared across sites. ResultsA total of 47,676 deliveries between the two centres (24,768 RH; 22,908 NMH) were assessed, of which 158 patients met inclusion criteria for antenatal pyelonephritis (n = 88 RH, n = 70 NMH). There was no statistically significant difference in the rate of antenatal pyelonephritis (p = 0.34) or preterm births (p = 0.21) across sites. RH had a significantly higher rate of LBWI at 6.45% versus 5.68% of all births in NMH (p=<0.004). Given the screening rate in RH was below 100%, this cohort was further subdivided into ‘RH screened’ and ‘RH unscreened’. There was no statistically significant difference in the rate of antenatal pyelonephritis both between the ‘NMH unscreened’ group (n = 70) versus the ‘RH screened’ group (n = 62) (p = 0.53), or in the ‘RH screened’ group (n = 62) versus the ‘RH unscreened’ group (n = 26) (p = 0.53). ConclusionOmission of a screening programme for AB in NMH did not result in higher rates of antenatal pyelonephritis, preterm birth or LBWI. Our findings may inform decision-making on screening protocols and whether selective screening (i.e. screening in high-risk patients only) could be more cost-effective without compromising best quality of care.

Influence of temperature on the risk of gestational diabetes mellitus and hypertension in different pregnancy trimesters

Previous studies have proved that exposure to extreme temperature in specific windows of pregnancy could cause some complications, such as pregnancy induced hypertension (PIH) and gestational diabetes mellitus (GDM), but differences in the effect of extreme temperature on the 2 complications are rarely studied. We carried a retrospective study on the impact of temperature on GDM/PIH in different trimesters based on data from a maternal and child health center in Beijing, China. Ambient temperatures (°C) were obtained from the China Meteorological Administration from January 1st, 2013 to May 15th, 2018. We use distributed lag non-linear models (DLNMs) combined with logistic regression to calculate the lag exposure-response relationships between the temperature and GDM/PIH from 1st to 24th/20th weeks of pregnancy. In both first and second trimesters, the risk of GDM was increased in summer with high temperatures; in second trimester, the risk of GDM increased in winter with low temperatures. In first half of pregnancy, risk of PIH was decreased in winter with low temperatures. These findings can provide the guideline for preventing the GDM and PIH induced by extreme temperature during pregnancy.

Immune-checkpoint proteins, cytokines, and microbiome impact on patients with cervical insufficiency and preterm birth.

Microenvironmental factors, including microbe-induced inflammation and immune-checkpoint proteins that modulate immune cells have been associated with both cervical insufficiency and preterm delivery. These factors are incompletely understood. This study aimed to explore and compare interactions among microbiome and inflammatory factors, such as cytokines and immune-checkpoint proteins, in patients with cervical insufficiency and preterm birth. In particular, factors related to predicting preterm birth were identified and the performance of the combination of these factors was evaluated. A total of 220 swab samples from 110 pregnant women, prospectively recruited at the High-Risk Maternal Neonatal Intensive Care Center, were collected between February 2020 and March 2021. This study included 63 patients with cervical insufficiency receiving cerclage and 47 control participants. Endo- and exocervical swabs and fluids were collected simultaneously. Shotgun metagenomic sequencing for the microbiome and the measurement of 34 immune-checkpoint proteins and inflammatory cytokines were performed. First, we demonstrated that immune-checkpoint proteins, the key immune-regulatory molecules, could be measured in endocervical and exocervical samples. Secondly, we identified significantly different microenvironments in cervical insufficiency and preterm birth, with precise cervical locations, to provide information about practically useful cervical locations in clinical settings. Finally, the presence of Moraxella osloensis (odds ratio = 14.785; P = 0.037) and chemokine CC motif ligand 2 levels higher than 73 pg/mL (odds ratio = 40.049; P = 0.005) in endocervical samples were associated with preterm birth. Combining M. osloensis and chemokine CC motif ligand 2 yielded excellent performance for predicting preterm birth (area under the receiver operating characteristic curve = 0.846, 95% confidence interval = 0.733-0.925). Multiple relationships between microbiomes, immune-checkpoint proteins, and inflammatory cytokines in the cervical microenvironment were identified. We focus on these factors to aid in the comprehensive understanding and therapeutic modulation of local microbial and immunologic compositions for the management of cervical insufficiency and preterm birth.

The Prevalence and Antibiotic Resistance Pattern of Gram-Negative Pathogens Isolated from Inanimate Hospital Sources in A Maternity Centre in Lagos State, Nigeria

The Prevalence and Antibiotic Resistance Pattern of Gram-Negative Pathogens Isolated from Inanimate Hospital Sources in A Maternity Centre in Lagos State, Nigeria

Early diagnosis of sickle cell disease at birth hospitals and vaccination centers in Angola using point-of-care tests

AbstractSickle cell disease (SCD) is a life-threatening blood disorder affecting >500 000 infants annually, mostly in sub-Saharan Africa. Most infants do not have access to an early diagnosis and die early from treatable complications of SCD. Universal newborn screening (NBS) is not yet available in any African country for a variety of reasons, including lack of laboratory capacity, difficulty in tracking affected infants, and the relatively short stay of mothers and newborns at maternity hospitals. Several point-of-care (POC) tests for SCD have been recently developed and validated, but the 2 most well-established tests (Sickle SCAN and HemoTypeSC) have not been rigorously compared with one another. In this study, we aimed to evaluate and compare these 2 POC tests to screen infants aged ≤6 months in Luanda, Angola. Challenging the traditional NBS paradigm, we performed testing not only at maternity centers, but also at vaccination centers across Luanda. We enrolled 2000 babies and performed 1000 tests with each POC test. Both tests demonstrated diagnostic accuracy, with 98.3% of Sickle SCAN results and 95.3% of HemoTypeSC results aligning with the gold standard isoelectric focusing hemoglobin pattern. When the result was provided at the POC, 92% of infants were linked to SCD care compared with 56% in the pilot Angolan NBS program, which used centralized laboratory testing. This study demonstrates the real-world feasibility and accuracy of POC tests to screen infants for SCD in Angola. This study also suggests that including vaccination centers may improve the capture rate for early infant SCD screening programs.

Effect of the COVID-19 pandemic on racial disparities in postpartum visits at a Texas level IV maternal center

Background The primary aim of our study was to determine the attendance of postpartum visits stratified by race and if the COVID-19 pandemic affected racial disparities in postpartum visit attendance. Methods We searched our labor and delivery records from July 1, 2019 to December 31, 2019 and from July 1, 2020 to December 31, 2020 and included patients who delivered liveborn infants. The final analysis was restricted to patients who identified as White or Caucasian only, Black or African American only, or Hispanic. We then performed joint tests on the logistic regression with an interaction term of race and year of delivery to determine the final model. Results The odds ratio of Black or African American and Hispanic patients attending a postpartum visit was 0.589 (95% CI 0.456, 0.760; P < .001) and 0.836 (95% CI 0.676, 1.034; P = 0.099), respectively, compared to White or Caucasian patients. The interaction term of race and year of delivery was not statistically significant. Conclusion Black or African American patients at our hospital had a clinically and statistically significant lower utilization of postpartum visits compared to White or Caucasian patients and this disparity was not exacerbated by the COVID-19 pandemic.

DeepCTG® 1.0: an interpretable model to detect fetal hypoxia from cardiotocography data during labor and delivery.

Cardiotocography, which consists in monitoring the fetal heart rate as well as uterine activity, is widely used in clinical practice to assess fetal wellbeing during labor and delivery in order to detect fetal hypoxia and intervene before permanent damage to the fetus. We present DeepCTG® 1.0, a model able to predict fetal acidosis from the cardiotocography signals. DeepCTG® 1.0 is based on a logistic regression model fed with four features extracted from the last available 30 min segment of cardiotocography signals: the minimum and maximum values of the fetal heart rate baseline, and the area covered by accelerations and decelerations. Those four features have been selected among a larger set of 25 features. The model has been trained and evaluated on three datasets: the open CTU-UHB dataset, the SPaM dataset and a dataset built in hospital Beaujon (Clichy, France). Its performance has been compared with other published models and with nine obstetricians who have annotated the CTU-UHB cases. We have also evaluated the impact of two key factors on the performance of the model: the inclusion of cesareans in the datasets and the length of the cardiotocography segment used to compute the features fed to the model. The AUC of the model is 0.74 on the CTU-UHB and Beaujon datasets, and between 0.77 and 0.87 on the SPaM dataset. It achieves a much lower false positive rate (12% vs. 25%) than the most frequent annotation among the nine obstetricians for the same sensitivity (45%). The performance of the model is slightly lower on the cesarean cases only (AUC = 0.74 vs. 0.76) and feeding the model with shorter CTG segments leads to a significant decrease in its performance (AUC = 0.68 with 10 min segments). Although being relatively simple, DeepCTG® 1.0 reaches a good performance: it compares very favorably to clinical practice and performs slightly better than other published models based on similar approaches. It has the important characteristic of being interpretable, as the four features it is based on are known and understood by practitioners. The model could be improved further by integrating maternofetal clinical factors, using more advanced machine learning or deep learning approaches and having a more robust evaluation of the model based on a larger dataset with more pathological cases and covering more maternity centers.

Association of C-Reactive Protein with Parameters of Early Onset Sepsis and Blood Culture

Background: Blood culture is a gold standard technique to diagnose neonatal sepsis but the C-reactive protein (CRP) is also an important biomarker of acute phase reaction. CRP has a role in humoral immunity against infection, leading to inflammation. Very few of the data is available to conclude the diagnostic accuracy of CRP in association with parameters of early stage neonatal sepsis in pre-term or low birth weight babies. So the aim of current study was to find out the association of C-reactive protein with parameters of early onset sepsis and blood culture in pre-term and low birth weight babies. Methods: A cross-sectional study was conducted at the Pediatric Medicine department of Maternal and Child Health Center (MCH), Shaheed Benazirabad during August 2022 to January 2023. Early onset sepsis was diagnosed on the basis of maternal factors, prenatal history and clinical examination. Blood sample was collected and sent to the pathology laboratory of Peoples University of Medical and Health Sciences for Nawabshah for measurement of C-reactive protein, white blood cell count and culture and sensitivity testing. Data was analyzed by using the Statistical Package for Social Science (SPSS) version-20. p-value less than 0.05 was considered as significant. Results: A total of 120 patients of neonatal sepsis were enrolled in the study out of them 52 were positive for C-reactive protein. The mean age of the study participants was 1.6 ±0.69 days. Male participants were predominant (63.5%) over their female counterpart. Majority cases of septicemia (57.7%) were having birth weight less than 2.5kg. Odd ratio of C-reactive protein was estimated at 95% confidence interval and the results found that age had significant association with positive C-reactive protein. Birth weight less than 2.5kg also showed significant negative association with C-reactive protein but the term of birth found no any significant association. Patients having positive blood culture and those who had WBC count more than 25000/mm3 reported strongly significant association with C-reactive protein. Conclusion: It can be concluded that the C-reactive protein is significantly associated with parameters like age, WBC count more than 25000/mm3 and blood culture but no association has been found with maturity of neonate i.e. term or pre-term babies. The birth weight less than 2.5kg is negatively associated with the C-reactive protein. Keywords: Neonatal sepsis, C-reactive protein, Pre-term

Prevalence of microbiologically confirmed neonatal sepsis at a maternity center in the City of Buenos Aires.

Introduction. Neonatal sepsis is often suspected in hospitalized newborn infants, but only in 25-30% of cases it is confirmed via a positive culture. Selecting the antibiotics based on local epidemiology favors their rational use and minimizes their side effects. Primary objective. To describe the prevalence of early- and late-onset sepsis with microorganism isolation and their clinical characteristics. Population and method. Retrospective, cross-sectional study conducted between 01-01-2013 and 12-31-2017 in a public maternity center of Argentina in all hospitalized newborn infants with a diagnosis of early- and late-onset sepsis with microorganism isolation, and those re-admitted in their first month of life. Results. A total of 3322 newborn infants were admitted; 1296 were assessed for suspected early- onset sepsis; 25 had a positive culture (1.9%; rate: 0.86‰). Of these, 52% were born before 33 weeks of gestation. Microorganisms: Escherichia coli 5, Listeria monocytogenes 4, Streptococcus agalactiae (SGB) 3, Streptococcus pneumoniae 3. Also, 68% of late-onset sepsis cases (rate: 8.73‰) occurred in infants born before 33 weeks of gestation. Hospital-acquired microorganisms: coagulase-negative Staphylococcus 115, Staphylococcus aureus 47, Escherichia coli 30, Candida spp. 16, Enterococcus faecalis 13, Klebsiella pneumoniae 11, and Streptococcus agalactiae 10. In re-admissions: E. coli 11, S. aureus 12, SGB 3, and Haemophilus influenzae 3. Conclusions. During the study period, the frequency of early-onset sepsis was similar to international reports, with a predominance of E. coli and L. monocytogenes. The rate of late-onset sepsis showed a downward trend in the analyzed years, with a predominance of Gram-positive cocci.

Effect of nurse-led intervention on knowledge and preventive behavior of diabetic pregnant women regarding COVID-19 associated mucromycosis infection in mid-delta region of Egypt

BackgroundBlack fungus (mycoses) is an opportunistic invasive infection that predominantly occurred among immunosuppressed persons. It has been recently detected in COVID-19 patients. The pregnant diabetic woman is susceptible to such infections and needs recognition for protection. This study aimed to evaluate the effect of the nurse-led intervention on the knowledge and preventive practice of diabetic pregnant women regarding fungal mycosis during the COVID-19 pandemic.MethodThis quasi-experimental study was conducted at maternal health care centers in Shebin El-Kom, Menoufia Governorate, Egypt. The study recruited 73 diabetic pregnant women through a systematic random sampling of pregnant women attending the maternity clinic during the period of the study. A structured interview questionnaire was used to measure their knowledge regarding Mucormycosis and COVID-19 manifestations. The preventive practices were assessed through an observational checklist of hygienic practice, insulin administration, and blood glucose monitoring for the prevention of Mucormycosis infection.ResultsThe study revealed a statistically significant increment in the participants’ knowledge, preventive practice, personal hygiene, and diabetes self-care scores (9.56 ± 1.75 ,3.6 ± 1.18, 3.18 ± 1.29 post-intervention) comparable to (6.19 ± 1.66, 1.97 ± 1.35, 0.89 ± 1.38 pre-intervention) respectively. There was a significant improvement in the overall COVID-19 protective score against Mucormycosis (from 2.66 ± 1.74 to 4.53 ± 1.43).ConclusionNursing educational sessions had a positive effect on pregnant women’s awareness and preventive behavior. Hence, it is recommended to integrate nurse-led intervention targeting the preventive practice against COVID-19-associated Mucormycosis infection (CAM) as routine services for diabetic pregnant women during antenatal care.

Analysis of MYRF gene variant in a fetus with Cardiac-urogenital syndrome

To explore the genetic basis for a fetus with Cardiac-urogenital syndrome (CUGS). A fetus with congenital heart disease identified at the Maternal Fetal Medical Center for Fetal Heart Disease, Beijing Anzhen Hospital Affiliated to Capital Medical University in January 2019 was selected as the study subject. Clinical data of the fetus was collected. Copy number variation sequencing (CNV-seq) and trio-whole exome sequencing (trio-WES) were carried out for the fetus and its parents. Candidate variants were verified by Sanger sequencing. Detailed fetal echocardiographic examination had revealed hypoplastic aortic arch. The results of trio-WES revealed that the fetus has harbored a de novo splice variant of the MYRF gene (c.1792-2A>C), for which both parents were of the wild-type. Sanger sequencing confirmed the variant to be de novo. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was rated as likely pathogenic. CNV-seq has identified no chromosomal anomalies. And the fetus was diagnosed with Cardiac-urogenital syndrome. The de novo splice variant of the MYRF gene probably underlay the abnormal phenotype in the fetus. Above finding has enriched the spectrum of MYRF gene variants.

Transuterine Ultrasound-Guided Fetal Embolization of Vein of Galen Malformation, Eliminating Postnatal Pathophysiology.

Transuterine Ultrasound-Guided Fetal Embolization of Vein of Galen Malformation, Eliminating Postnatal Pathophysiology.

Evaluation of clinicoepidemiological features of pediatric dermatoses in Egyptian children

Background Epidemiological studies determine the burden of skin diseases, especially in children, which is required for proper health-care planning. Objectives To evaluate the clinicoepidemiologic features of skin diseases among Egyptian children. Patients and methods This was a cross-sectional, community-based study that included 2594 children of both sexes with ages that ranged from birth to less than 18 years. This study included government schools, private schools, and maternity and childhood care centers in Sohag Governorate, Upper Egypt. Sociodemographic data, the general examination included body parameters, and dermatological examination of children were documented. Results Skin diseases were detected in 25.1% (651/2594) of the examined children. Allergic skin diseases were the most common detected, one in 32.4% of children followed by sebaceous gland disorders (acne vulgaris) in 30.7% and then infectious skin diseases in 24.85%. Head was affected in the majority of patients (54.8%). The median age of children with skin diseases was 11 (1–18) years. Females constituted 66% of children with skin diseases. Children with skin diseases from rural areas constituted 63.1%. The median age of children with an infectious skin disease was 8 (2–14) years. Female sex, rural residence, and parents of low educational levels were associated with higher percentages of infectious skin diseases in children. Conclusion This study concluded that the most common detected pediatric skin diseases were allergic skin disorders, sebaceous gland disorders, and infectious skin diseases, respectively. Socioeconomic status, environmental factors, and medical resources are the most important factors affecting the prevalence of skin diseases.

Antenatal pyelonephritis: a three-year retrospective cohort study of two Irish maternity centres

Pyelonephritis affects 1–2% of pregnant women, and is associated with significant maternal and fetal morbidity. Antenatal pyelonephritis has been associated with PPROM (preterm premature rupture of membranes), preterm labour, low birth weight (LBW) and prematurity. A three-year retrospective dual-centre cohort study of antenatal pyelonephritis cases was conducted in two neighbouring Irish maternity hospitals – the Rotunda Hospital (RH) and the National Maternity Hospital (NMH). Patient demographics, clinical presentation, investigations, management and maternal/neonatal outcomes were recorded. A total of 47,676 deliveries (24,768 RH; 22,908 NMH) were assessed. 158 cases of antenatal pyelonephritis were identified (n = 88 RH, n = 70 NMH), with an incidence of 0.33%. The median age was 28 years. The median gestation was 27 + 6 weeks, with 51% presenting before 28 weeks’ gestation. Risk factors included; obesity (18.4%), diabetes mellitus (13.3%) and self-reported clinical history of recurrent urinary tract infection (28.5%). Rate of relapse with UTI in the same pregnancy was 8.2%. Renal ultrasound was performed in 30.4%. Predominant uropathogens were Escherichia coli (60%), Klebsiella pneumoniae (11%) and Proteus mirabilis (5%). 7.5% of cases had a concurrent bloodstream infection, 13.3% of cases were complicated by sepsis and 1.9% with septic shock. Complications including PPROM (6.3%), preterm delivery < 37 weeks’ gestation (11%), LBW < 2,500 g (8.2%) were comparable between sites. Delivery within 72 hours of diagnosis was noted in 7% (n = 11) of patients, of which three were preterm and one had LBW. Appropriate and prompt investigation and management of antenatal pyelonephritis is essential given the associated maternal and neonatal morbidity.