Fetal Mortality Research Articles

Prophylactic red cell transfusions for sickle cell disease pregnancy: increased use of therapy could transform outcomes.

Pregnancy for people with sickle cell disease (SCD) is high risk with persistently high rates of severe maternal and fetal mortality and morbidity. Transfusion therapy is the best-studied treatment for SCD in pregnancy; hydroxyurea is not usually used because of teratogenicity concerns. In high-resource settings, red cell transfusions are likely underutilized, while in low-resource settings, they may be altogether unavailable. A randomized controlled trial and meta-analysis, two of the strongest forms of clinical research, show transfusion significantly reduces maternal and fetal death, painful crisis, thrombosis, and acute respiratory failure. Downstream benefits of treatment are less well measured and may include improving maternal anemia, reducing opioid exposure, and avoiding hospitalization, which presents risk for additional complications. Alloimmunization is a particular transfusion risk in SCD. However, many strategies can mitigate this risk. Accordingly, the American Society of Hematology classifies chronic transfusion in pregnancy as low risk. Given the low risk classification, lack of alternative therapies, dismal, stagnant pregnancy outcomes and the potential for profound treatment benefit, wider use of chronic transfusion therapy for SCD pregnancy is likely indicated. This review discusses the benefits and potential risks of prophylactic transfusions for SCD pregnancy. Use of chronic transfusions during pregnancy is indicated to help urgently transform outcomes.

Clinical characteristic and zero-fluoroscopy ablation outcomes of tachyarrhythmias in pregnant: a single center study

Abstract Background Although recommended avoid any intervention during gestation in cases of drug refractory of arrhythmias catheter ablation may be necessary in pregnant women. Purpose To present clinical characteristics and outcomes of zero-fluoroscopy catheter ablation during gestation. Methods This prospective, single center study included 84 cases of tachyarrhythmias during gestation. In 44 cases of drug refractory was performed catheter ablation without fluoroscopy (main group). We evaluated the further course of gestation and obstetric outcomes after ablation in comparison with pregnant with antiarrhythmic therapy of tachyarrhythmias (n=40, control group). Results Both groups were comparable by mean age of pregnant (28.2±4.2 vs. 27.3±3.9 years, p=0.093) and mean duration of gestation (24 ±3.4 vs. 23.8 ±3.2 weeks, p=0.123). New onset arrhythmia prevailed in both groups (64% vs. 55%, p=0,280). Supraventricular tachycardia was the most common arrhythmia during gestation (81,8% vs. 52,5%, p=0,005), which was followed by premature contraction (13,6% vs. 40%, p=0,007). Cases of ventricular tachycardia were rare (4,6% vs. 7,5%, p=0,665). Ablation was performed under the guidance of CARTO (45%) and Ensite Precision systems (55%) without using fluoroscopy in all cases. Acute procedural success of zero-fluoroscopy ablation was in 100% with mean procedural time 71±17 minutes without any complication. Outcomes: further course of gestation characterized by increased incidence of uterine contractile activity and placental abruption only in main group (4,54%, p=0.464 and 2.3%, p=642 respectively). There were no differences in the rate of other complication: uterine blood flow violation (15.9% vs 12.9%, p=0.234) and preeclampsia (4.55% vs 5%, p=0.237). Vaginal type of delivery was in the majority of cases in both groups (82% vs 83%, p=0.242). Neonatal outcomes characterized with normal range of fetal birth weight (median 3207,39±485,61 vs. 3312,3±234,1 grams, p=0.709) and 5 minute Apgar score (median 8,4±1,6 vs. 8,7±1,2, p=0.921). There was no incidence of maternal and fetal mortality. In 12 month, follow-up all there was no arrhythmia recurrence. Conclusions Zero-fluoroscopy ablation of tachyarrhythmias in pregnant is feasible and can be safety performed during gestation in cases of drug refractory with benign outcomes.

Clinical evidence of pacemaker implantation during gestation: a case series

Abstract Background Although recommended avoid any intervention during gestation in cases of poor tolerance to high degree atrioventricular block, pacemaker implantation may be necessary in pregnant women. Purpose To present outcomes of pacemaker implantation during gestation. Methods This prospective, single center study included 10 cases of pacemaker implantation during gestation (median age of patient - 26 years old at 18 weeks of gestation). We evaluated the further course of gestation and obstetric outcomes after implantation in comparison with pregnant with tachyarrythmias (n=111). Results Among 121 pregnant women with varying arrhythmias high degree atrioventricular block was detected in 10 cases (8,3%). In 6 cases this bradyarrhythmia diagnosed for the first time in gestation (60%). All pregnant with high degree atrioventricular block had clinical signs: dizziness and weakness (100%), syncope (70%), episodes of low blood pressure (100%). Pacemaker implantation performed due to hemodynamic instability and poor tolerance of bradyarrhythmia in all cases. Using electroanatomical mapping (Ensite Precision system)and echocardiographic guidance helped to reduce fluoroscopy time. For one pregnant implanted leadless pacemaker (Micra) with achieved more than 80% atrio-ventricular synchronization. Outcomes: further course of gestation characterized by increased incidence of uterine contractile activity (30%) in cases of high degree atrioventricular block, that was significantly higher than in pregnant with tachyarrhythmias (2%) (p=0.007). There were no differences in the rate of other complication: uterine blood flow violation (20% vs 12%, p=0.520), placental abraption (10% vs 5%, p=0.237) and preeclampsia (10% vs 5%, p=0.237). Vaginal type of delivery was in the majority of cases in both groups (70% vs 86%, p=0.553). Neonatal outcomes characterized with normal range of fetal birth weight (median 3163 vs 3212 grams, p=0.981) and 5 minute Apgar score (median 8.6 vs 8.7, p=0.564). There was no incidence of maternal and fetal mortality. In 12 month follow-up all patient have optimal electrical parameters of devise and remained stable over time. Conclusions High degree atrioventricular block in pregnant characterized by increased rate of uterine contractile activity. Pacemaker implantation during gestation can be effectively performed and associated with benign outcomes.

A Case for a Maternal Culturally Tailored Smoking Cessation Research Agenda

Background/Objectives: Despite national efforts, smoking rates during pregnancy remain high among certain demographics, particularly American Indian/Alaska Native and younger women. This study examines the causal link between maternal smoking, maternal and fetal mortality, and social determinants of health, highlighting disparities faced by Black, Indigenous, and People of Color (BIPOC) and American Indian/Alaskan Native (AIAN) pregnant persons. Methods: Data from various sources, including national reports and committee findings, were analyzed to assess trends in maternal smoking, mortality rates, and associated factors. While smoking rates among all groups have declined, disparities persist. Young women, BIPOC, and American Indian/Alaska Native women, and those with lower educational attainment, have higher smoking rates. Black women exhibit significantly higher maternal mortality rates, often linked to cardiac/coronary conditions. Stress, exacerbated by social determinants of health like poverty and housing insecurity, emerges as a key factor driving smoking behavior, particularly among African Americans. The leading causes of pregnancy-related deaths vary by race and ethnicity, with preventability noted in 80% of cases. Perinatal exposure to cigarette smoking is also identified as a leading cause of poor infant health outcomes, emphasizing the importance of addressing smoking behavior during and after pregnancy. Results: This report advocates for a comprehensive approach to reducing maternal and fetal mortality rates, with a focus on adapting existing smoking cessation programs to adopt culturally tailored agendas in order to address social and political determinants of health as well as behavioral drivers of tobacco use among pregnant persons.

Paragangliome et grossesse : une histoire mictionnelle palpitante

Objectives: Carrying out a pregnancy to term in a patient with a paraganglioma or pheochromocytoma (PPGL) results from a multidisciplinary challenge. The objective was to compare our therapeutic attitude with the existing literature and to identify optimal treatment.Methods: Description of a case of paraganglioma treated during pregnancy at the University Hospital Center of Caen (France) in 2024 and comparison with the literature.Results: We describe a patient with a family history of paraganglioma, in whom paravesical PPGL was discovered at 18 weeks of gestation. The symptoms were marked by episodes of palpitations and headaches during urination. The diagnosis was confirmed by a measurement of urinary metanephrines associated with magnetic resonance imaging. After initiation of alpha-blocker treatment, delivery was performed by cesarean section at 36 weeks of gestation. An excision was carried out by laparoscopy 2 months postpartum without intra- and post-operative complications.Conclusions: The absence of antenatal diagnosis of PPGL is the main risk factor increasing maternal and fetal mortality. Certain criteria such as a family history, the appearance of early or malignant arterial hypertension should suggest the diagnosis of PPGL. The initiation of alpha-blocker treatment upon diagnosis is essential. The curative therapy remains surgical excision. Its timing depends on its size, location, term of pregnancy and route of delivery. It is preferable to postpone it until postpartum in order to reduce the risk of complications.

Senescent Syncytiotrophoblast Secretion During Early Onset Preeclampsia.

Preeclampsia is a severe hypertensive disorder in pregnancy that causes preterm delivery, maternal and fetal morbidity, mortality, and life-long sequelae. Understanding the pathogenesis of preeclampsia is a critical first step toward protecting mother and child from this syndrome and increased risk of cardiovascular disease later in life. However, effective early predictive tests and therapies for preeclampsia are scarce. To identify novel markers and signaling pathways for early onset preeclampsia, we profiled human maternal-fetal interface units (fetal villi and maternal decidua) from early onset preeclampsia and healthy controls using single-nucleus RNA sequencing combined with spatial transcriptomics. The placental syncytiotrophoblast is in direct contact with maternal blood and forms the barrier between fetal and maternal circulation. We identified different transcriptomic states of the endocrine syncytiotrophoblast nuclei with patterns of dysregulation associated with a senescence-associated secretory phenotype and a spatial dysregulation of senescence in the placental trophoblast layer. Elevated senescence markers were validated in placental tissues of clinical multicenter cohorts. Importantly, several secreted senescence-associated secretory phenotype factors were elevated in maternal blood already in the first trimester. We verified the secreted senescence markers, PAI-1 (plasminogen activator inhibitor 1) and activin A, as identified in our single-nucleus RNA sequencing model as predictive markers before clinical preeclampsia diagnosis. This indicates that increased syncytiotrophoblast senescence appears weeks before clinical manifestation of early onset preeclampsia, suggesting that the dysregulated preeclamptic placenta starts with higher cell maturation resulting in premature and increased senescence-associated secretory phenotype release. These senescence-associated secretory phenotype markers may serve as an additional early diagnostic tool for this syndrome.

SFlt-1/PLGF ratio: A promising marker for early detection of preeclampsia in the second and third trimester

: Preeclampsia (PE), characterized by endothelial dysfunction, remains a significant concern in obstetrics due to its association with maternal and fetal morbidity and mortality. One significant contributor to the clinical manifestations of PE is the imbalance in the placental release of various angiogenesis regulatory factors into the maternal circulation. Low levels of the pro-angiogenic biomarker Placental Growth Factor (PLGF) and high levels of antiangiogenic biomarker sFlt-1 (soluble Fms like tyrosine kinase -1) levels are detectable several weeks before the clinical presentation of PE, making them a promising marker for early diagnosis.: This study investigates the utility of the sFlt-1/PLGF ratio in predicting and diagnosing preeclampsia during the second and third trimesters of pregnancy.: A prospective cohort study was conducted with 150 study participants comprising normotensive controls and preeclamptic cases, diagnosed based on blood pressure and proteinuria criteria. Serum samples collected in the second trimester (24-28 weeks) and third trimester (>28 weeks) were analyzed for PLGF and sFlt-1 levels using ELISA kit method. The sFlt-1/PLGF ratio was calculated and evaluated for its diagnostic accuracy through ROC curve analysis.: Significantly lower PLGF levels and higher sFlt-1 levels in preeclamptic pregnancies compared to normotensive pregnancies were seen in both trimesters (p < 0.001). The sFlt-1/PLGF ratio was markedly elevated in preeclampsia, showing strong predictive characteristics with an AUC of 0.929 (sensitivity 90%, specificity 90%) in the second trimester and an AUC of 0.986 (sensitivity 90%, specificity 96.7%) in the third trimester. These findings highlight the potential of the sFlt-1/PLGF ratio as a biomarker for early detection and risk stratification in pregnancies complicated by preeclampsia.

Isolated and multiple causes of equine dystocia

BackgroundDystocia is rare in horses, but is life-threatening for mares and foals. Therefore, veterinary research depends on up-to-date data to optimise equine dystocia management. In addition, knowledge of the prognosis of equine dystocia is necessary to advise animal owners. This retrospective study of equine dystocia aimed to enrich existing datasets with up-to-date information. For the first time, the focus was on the causes of dystocia that occurred alone or in combination. Over a period of 10 years, 72 cases of dystocia were analysed using a standardised, predetermined diagnosis code.ResultsOf the 72 cases of dystocia, an isolated cause of dystocia was identified in 37 cases (51.4%) and 35 mares showed a combination of two or more causes (48.6%). Foetal causes were significantly more frequent origin of dystocia (66/69) than maternal causes (3/66) (P < 0.0001). Incorrect posture of the foetal forelimbs and head was the most common combination at 25.7%. The most common isolated cause of dystocia was incorrect posture of the foetal forelimbs (18.9%). A foetotomy was performed in 68% of cases. A caesarean section or an extraction was performed in 13.9% of the cases. Three mares died before any obstetric care was provided. Nine mares (12.5%) were not discharged alive. 73 foals were delivered of which 55 were already dead before veterinary treatment began. In relation to the total number of births in which the foetus was alive at the start of obstetric care, the foetal mortality rate was 61.1% and 88.9% by the time the mare was discharged.ConclusionsIt has been demonstrated for the first time that multiple causes of dystocia in horses are almost as common as isolated causes of dystocia. Neonatal mortality remains high, indicating that the timely detection and treatment of dystocia has the highest priority.

Increased Stillbirth Rates and Exposure to Environmental Risk Factors for Stillbirth in Counties with Higher Social Vulnerability: United States, 2015-2018.

Exposure to unfavorable environmental conditions during pregnancy, such as extreme heat and air pollution, has been linked to increased risk of stillbirth, defined as fetal mortality at or after 20 weeks' gestation, however no studies have examined its association with social vulnerability. We examined associations between county-level stillbirth rates, environmental risk factors for stillbirth, and social vulnerability in the United States. This ecologic study linked county-level data from three nationwide datasets on stillbirths (National Vital Statistics System), environmental conditions (North American Land Data Assimilation System and Environmental Protection Agency), and social vulnerability (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index). Poisson and negative binomial models were fit to the variables and produced rate ratios to estimate associations among stillbirth rates, environmental risk factors, and social vulnerability. Social vulnerability was positively associated withn stillbirth rates, annual average number of extreme heat days, and ambient concentration of particulate matter ≤ 2.5μm in diameter (PM2.5). The average number of days that ozone and PM2.5 each exceeded regulatory standards were not associated with stillbirth rates or social vulnerability. A positive association between average annual PM2.5 concentration and stillbirth rates was detected; no other significant associations between environmental risk factors and stillbirth rates were observed. We found evidence of associations between social vulnerability and stillbirth rates, and between social vulnerability and environmental risk factors for stillbirth at the county level. Further research could inform understanding of how social vulnerability impacts the relationship between environmental exposures and stillbirth risk.

Understanding preeclampsia from cutting edge knowledge-protecting maternal and fetal health.

Preeclampsia (PE) is conventionally been defined clinically by new-onset or aggravating hypertension during pregnancy >20 weeks associated with proteinuria or other organ damages. PE is a major cause of maternal and fetal morbidity and mortality globally and expected to increase even more. Nevertheless, there are still much to be established regarding pathophysiology, prediction, prevention, and management of PE and thus, research concerning PE is being actively conducted. This mini-review discusses on latest knowledge on PE.

ANÁLISE DAS REPERCUSSÕES FETAIS, NEONATAIS E OBSTÉTRICAS RELACIONADAS A IDADE MATERNA AVANÇADA E PRECOCE

In Brazil, pregnancy at extreme ages, whether in adolescence or advanced age, poses significant challenges to maternal and neonatal health. In a country where one in every seven babies is born to adolescent mothers, and there has been a 70% increase in pregnancies among women aged 35 to 38 over the last two decades, it becomes essential to understand the obstetric and neonatal repercussions of these pregnancies. This study aimed to analyze the fetal, neonatal, and obstetric complications associated with early and advanced maternal age. It is an epidemiological study with data collected from TabNet of DataSUS, covering the period from 1996 to 2020. The variations found included maternal and fetal deaths, as well as sociodemographic characteristics of the mothers. The results show that adolescent mothers have a higher risk of newborns with low birth weight and fetal mortality, especially in the Northeast region. On the other hand, older mothers show lower fetal mortality but a higher prevalence of obstetric complications, particularly in the Southeast region. The research highlights the need for public policies focused on reducing risks in pregnancies with greater vulnerability and on training health professionals for better monitoring.

9396 Deciphering The Enigma: A Case Report On New-onset Graves Disease Presenting As Thyroid Storm In The First Trimester Of Pregnancy, Managed In The Intensive Care Setting

Abstract Disclosure: M. Zeb: None. S.W. Salari: None. A. Tiwari: None. A. Vadher: None. A. Dabaja: None. S. Kambhatla: None. Graves' disease, an autoimmune disorder characterized by hyperthyroidism, presents unique challenges when manifesting as thyroid storm during pregnancy. We report a case of a 27-year-old African American woman at 9 weeks gestation who presented with palpitations, agitation, and fever. On examination, she exhibited fever, tachycardia, tremors in hands, and mild bilateral exophthalmos. Thyroid function tests revealed markedly elevated free thyroxine and suppressed thyroid-stimulating hormone levels. Thyroid ultrasound confirmed diffuse thyroid enlargement with increased vascularity, consistent with Graves' disease. Pelvic ultrasound estimated the gestational age at 9 weeks and 2 days, with a serum β-hCG level of 135,037 mIU/mL. An electrocardiogram revealed sinus tachycardia, and a complete metabolic panel indicated mild hypokalemia. The Thyroid Stimulation Immunoglobulin (TSI) and Thyrotropin receptor antibodies were tested positive. The Burch-Warsofsky point score of 45, supported the diagnosis of thyroid storm. The patient received intensive care treatment including intravenous fluids, hydrocortisone, beta-blockers, Lugol’s iodine, propylthiouracil, and potassium replacement. Following treatment, thyroid function stabilized within 48 hours, and her hyperthyroid symptoms resolved. The patient was discharged on oral labetalol and propylthiouracil. Thyroid storm, characterized by severe manifestations of hyperthyroidism, is a rare but potentially life-threatening condition, especially during pregnancy. Prompt recognition and intervention are crucial due to associated maternal and fetal morbidity and mortality. A multidisciplinary approach, involving endocrinology, obstetrics, and critical care, is essential to optimize outcomes. The unique physiologic changes of pregnancy, such as increased thyroid hormone production and altered thyroid hormone-binding globulin levels, can complicate the diagnosis and management of hyperthyroidism. Our case underscores the importance of vigilance for thyroid dysfunction in pregnant women, even in the absence of prior thyroid disease. Additionally, the potential impact of hyperthyroidism and thyroid storm on pregnancy outcomes highlights the need for early recognition and intervention. Long-term management of Graves' disease during pregnancy may also require adjustment of antithyroid medication dosage and monitoring of thyroid function to maintain euthyroidism while minimizing fetal exposure to medication. Further research is warranted to refine diagnostic criteria, treatment protocols, and long-term management strategies for thyroid storm in pregnancy. Increased awareness among healthcare providers about the risks and management strategies for this rare but serious complication is also necessary. Presentation: 6/3/2024

12209 Validation Of A Novel Placenta Explant Protocol For Studying Circadian Rhythms In The Mouse Placenta In Early, Mid And Late Pregnancy

Abstract Disclosure: J.S. Lee: None. A.M. Yaw: None. H.M. Hoffmann: None. Introduction: The placenta serves as an interface facilitating the exchange of essential nutrients and oxygen between the mother and fetus. Preeclampsia, a complication of pregnancy driven by placental dysfunction, is one of the leading causes of maternal, fetal, and neonatal morbidity and mortality. While deregulation of the genes driving circadian rhythm has been associated with preeclampsia, the role of circadian rhythms in the placenta largely remains unknown. To address this gap of knowledge, our goal was to establish and validate an organotypic ex vivo preparation to study placenta circadian rhythms at gestation day (GD) 10, GD14, and GD18 in the mouse. Methods: To establish an organotypic placenta culture GD10, GD14, and GD18 placental explants, we sectioned the placenta into 350μm sections using a vibratome. The explants were prepared from the validated circadian Per2::Luciferase reporter mouse, allowing automated circadian rhythms recording of the explants in a LumiCycle. We compared explant success rate and rhythm quality in 2x2mm section vs whole slice explants at GD14. Using hematoxylin and eosin (H&amp;E) staining we validated the explants to be decidua which is strictly of maternal origin, labyrinth which is strictly of fetal origin, and the junctional zone which consists of binucleated cells fused of maternal and fetal cells. Results: Through H&amp;E staining, we confirmed the decidua is enriched with neutrophils, the junctional zone contains spongiotrophoblasts and glycogen trophoblasts, and the labyrinth has red blood cells. Both explant types were enriched with &amp;gt;80% of cells from the targeted region. We next established a protocol to record Per2::Luciferase rhythms for &amp;lt;6 days. The fragility of the GD10 placentas required the whole explant protocol, whereas the GD18 2x2mm sectioned explants produced strong rhythms with a high success rate. At GD14, the whole explants resulted in stronger rhythms with higher amplitude and higher goodness of fit compared to the 2x2mm explants. Conclusion: We found that depending on GD recording success differs. Specifically, the whole placental explant provides a more robust and reliable model for studying circadian rhythms in GD10 and GD14, whereas 2x2mm explants are successful at GD18. This novel placental preparation protocol will be valuable in studying disease- and drug-induced changes to circadian rhythms in a placenta layer-specific manner in the mouse. Presentation: 6/1/2024

A-313 Use of the Preeclampsia Ratio in the Prognosis of Preterm Delivery and Adverse Outcomes

Abstract Background Preeclampsia (PE) is a hypertensive disorder of pregnancy that is characterized by high blood pressure and end-organ dysfunction with or without proteinuria after 20 weeks gestation. PE occurs in 6-8% of pregnancies and contributes to significant fetal, neonatal, and maternal morbidity and mortality. The ratio of two angiogenic placental proteins, soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF), are used in the management of PE. The purpose of this study was to evaluate use of the sFlt-1/PlGF ratio (PE ratio) generated using the ADVIA Centaur® and Atellica® IM sFlt-1 assay and the ADVIA Centaur and Atellica IM PlGF assays in the prognosis of preterm delivery and adverse outcomes in women presenting with signs and symptoms of PE. Methods A total of 654 females with singleton pregnancies between gestational weeks 20+0 days and 35+6 days and who had signs and symptoms of PE, but without severe features of PE were enrolled at 24 collection sites and followed prospectively for two weeks. Serum samples were collected at enrollment and adverse outcomes that included preterm delivery were prospectively collected within the two weeks after enrollment. Serum samples from approximately half of the population (n=316) were tested in singlicate using the sFlt-1 and PlGF assays on the ADVIA Centaur system in a derivation study that determined the optimal cutoff of the PE ratio in relation to adverse outcome. The remaining serum samples (n=338) were subsequently tested on the ADVIA Centaur system in a cut-off validation study that evaluated the clinical performance (sensitivity [SE], specificity [SP], positive predictive value [PPV], negative predictive value [NPV]) of the PE ratio at the derived cutoff in relation to adverse outcome. Method comparison studies were performed between the ADVIA Centaur versus the Roche Elecsys sFlt-1 and PlGF assays (n=255) and the ADVIA Centaur versus the Atellica IM sFlt-1 and PlGF assays (n=316). Results The rate of maternal adverse outcomes within two weeks was similar in the derivation study (32.3%) and validation study (28.1%). Using a receiver operating characteristic (ROC) curve analysis with the derivation cohort, a derived cutoff of 38 showed optimal clinical performance of the PE ratio in relation to adverse outcome (SE=72.5%, SP=94.7%, PPV=84.6%, NPV=89.5%). Similar clinical performance results of the PE ratio at the cutoff of 38 in relation to adverse outcome were found with the verification cohort (SE=88.42%, SP=87.65%, PPV=73.68%, NPV=95.09%). Weighted Deming regression analysis demonstrated equivalency between the Centaur, Roche, and Atellica PE ratios with correlation coefficients (r) of 0.9242 (Centaur vs Roche) and 0.995 (Centaur vs Atellica). Conclusions Measurement of sFlt-1 and PlGF to determine PE ratio can be performed on either the ADVIA Centaur or Atellica Analyzer and can be used to identify women presenting with PE or signs and symptoms of PE who are at high risk of experiencing an adverse event in the subsequent two weeks. Not available for sale in the U.S.A. The products/features mentioned herein are not commercially available in all countries. Their future availability cannot be guaranteed.

Chlorophyll Derivatives Exert Greater Potency Over Progesterone in the Prevention of Infection-Induced Preterm Birth in Murine Models.

Preterm birth (PTB) is a significant cause of maternal and neonatal morbidity and mortality worldwide. However, the effectiveness of progesterone (P4) which is clinically used for PTB management remains controversial and necessitates research into new therapeutic options METHOD OF STUDY: In the current study, we investigated the effectiveness of two chlorophyll derivatives, pheophorbide a (PBa) and pheophytin a (PTa), in counteracting PTB. Timed-pregnant mice (gestation day 17±0.5) received lipopolysaccharide (LPS) (25µg/mouse) or phosphate-buffered saline (PBS) intraperitoneally, with PBa, PTa, progesterone (P4), and co-administration of P4 and ibuprofen (IBP), administered orally 2h prior. The LPS group experienced PTB and 100% fetal mortality, whereas the PBa and PTa groups showed a delayed onset of LPS-induced PTB, with significantly decreased PTB rate and fetal mortality. In addition, PBa and PTa suppressed LPS-induced pro-inflammatory cytokines and NF-κB transcription factor while increasing anti-inflammatory cytokines in the placenta and uterus. Our findings indicate that the chlorophyll derivatives, PBa and PTa increase fetal survival in infection-induced PTB and demonstrate greater efficacy than P4 in preventing PTB.

Fetal meconium peritonitis after maternal hepatitis B: a case report and review of the literature.

Maternal hepatitis virus has rarely been implicated in fetal meconium peritonitis (FMP), and its underlying mechanism is largely unknown. We describe a case of FMP presumably caused by maternal chronic hepatitis B virus (HBV). A 29-year-old primigravid woman was referred to our hospital at 35 weeks of gestation for the disappearance of fetal movements. The maternal prenatal history included HBV for more than 10 years. Her HBV DNA level was suppressed (<20 IU/mL) and she was taking oral tenofovir disoproxil fumarate (300 mg/day). At 21+5 weeks, fetal ascites, echogenic bowel, and intra-abdominal calcifications were observed by abdominal ultrasound. These findings were confirmed by magnetic resonance imaging and were regarded as diagnostic for FMP. Cord blood and amniotic fluid were positive for hepatitis B e antigen and hepatitis B surface antigen. Ascites of the FMP was completely self-absorbed at 27+3 weeks. At 35 weeks of gestation, fetal movements had vanished and male stillbirth was induced. A histopathological examination of the placenta showed meconium uptake by macrophages in the amniochorionic membranes. Our findings suggest that maternal HBV can cross the placenta and induce FMP. Close surveillance may allow an early diagnosis of FMP and prevent fetal mortality.

Intrauterine deaths - an unsolved problem in Polish perinatology.

The Polish criteria for "intrauterine death" include fetal demise after 22 weeks of gestation, weighing > 500 g and body length at least 25 cm, when the gestational age is unknown. The rate of fetal death in Poland in 2015 is 3:10,000. In 2020, 1,231 stillbirths were registered. An analysis using 142,662 births in the period between 2015-2020 in 11 living in Poland. The first subgroup was admitted as patients > 22 to the beginning of the 30th week of pregnancy (n = 229), and the second from the 30th week of pregnancy inclusively (n = 179). In the case of women from both subgroups, there was a risk of preterm delivery close to hospitalization. It was found that stillbirth in 41% of women in the first pregnancy. For the patient, stillbirth was also the first in his life. The average stillbirth weight was 1487 g, the average body length was 40 cm. Among fetuses up to 30 weeks, male fetuses are born more often, in subgroup II, the sex of the child was usually female. Most fetal deaths occur in mothers < 15 and > 45 years of age. According to the Polish results of the origin of full-term fetuses > 30 weeks of gestation for death in the concomitant antenatal, such as placental-umbilical and fetal hypoxia, acute intrapartum effects rarely, and moreover < 30 Hbd fetal growth restriction (FGR), occurring placental-umbilical, acute intrapartum often.

Implementing K-Nearest Neighbors (k-NN) Algorithm and Backward Elimination on Cardiotocography Datasets

Having a healthy baby is a dream for mothers. Unfortunately, high maternal and fetal mortality has become a vital problem that requires early risk detection for pregnant women. A cardiotocograph examination is necessary to maintain maternal and fetal health. One method that can solve this problem is classification. This research analyzes the optimal use of k values and distance measurements in the k-NN method. This research expects to become the primary reference for other studies examining the same dataset or developing k-NN. A selection feature is needed to optimize the classification method, particularly for improving accuracy results. This study used the cardiotocography dataset from cardiotocograph examinations related to fetal conditions. The cardiotocography dataset consisted of 2,126 records with 22 features and variables. It also had three classification classes, normal, suspect, and pathological, from the Universal Child Immunization Machine Learning Repository website. It employed the K-Nearest Neighbor (k-NN) method and the backward elimination feature with ordinary least squares regression. The test in this research applied the scenarios of three distance calculations, i.e., Euclidean distance, Manhattan distance, and Minkowski distance, as well as four variations of k values. Evaluation of each scenario indicated the accuracy of the confusion matrix and execution time. This study compared K-Nearest Neighbor (k-NN) and Backward Elimination methods with K-nearest neighbor (k-NN) without selection features. The best accuracy of the Backward Elimination and K-Nearest Neighbor (K-NN) methods was 91%, as was the K-Nearest Neighbor (k-NN) method without selection features. Both had similar k values (k = 3) and Manhattan distance. The backward elimination method reduced the number of features from 22 to 14. Meanwhile, the execution times of the Backward Elimination and K-Nearest Neighbor (k-NN) methods got better results as each distance averaged 26.54, 19.23, and 68.09 seconds. K-Nearest Neighbor (k-NN) execution times without selection features were 26.83, 19.39, and 68.84, respectively. In conclusion, backward elimination did not increase accuracy because it yielded the same accuracy. However, backward elimination and K-nearest Neighbor (k-NN) produced faster results, with differences of 29%, 16%, and 75%, respectively.

Position statement on the management of pregnancy in sickle cell disease.

Sickle cell disease (SCD) is a hereditary haemoglobinopathy which causes multi-organ dysfunction. Pregnancies in SCD are high risk with significant maternal and fetal morbidity and mortality, including vaso-occlusive crises, thrombosis, anaemia, placental insufficiency, fetal growth restriction, preterm birth and medication effects. High level evidence on this topic is lacking. The Australian Sickle Cell Disease Working Group has reviewed international guidelines on this topic and provide an up-to-date and structured approach to the pre-conception, antenatal, birth and post-partum management of these women. Early and comprehensive multidisciplinary care involving experienced clinicians is recommended.

Nutrigenetic Investigations in Preeclampsia.

Background: Preeclampsia is a leading cause of pregnancy-related maternal and fetal morbidity and mortality. Although its precise cause and prevention remain unclear, risk factors such as overweight and inadequate nutrient intake (e.g., calcium, folic acid, and vitamin D) are known to increase its incidence. Recent research has focused on the genetic predisposition to preeclampsia, identifying polymorphisms that may affect enzyme or receptor function. This study aims to review existing literature examining the relationship between genetic polymorphisms, BMI (body mass index), and nutrient levels in preeclampsia to develop more actionable therapeutic strategies. Methods: A systematic review was conducted to analyze studies on the nutrigenetic relationship between BMI, micronutrients, and preeclampsia. Results: A total of 17 studies investigating 12 genes related to BMI and 10 studies exploring 3 genes in relation to micronutrient levels were included in the analysis. Several polymorphisms associated with preeclampsia were found to be influenced by maternal BMI or serum vitamin levels. The interactions between certain gene variants and these factors suggest that both BMI and micronutrient status may modify the risk of developing preeclampsia in genetically predisposed individuals. Conclusions: Our findings emphasize the potential for reanalyzing existing data by categorizing based on genotype and nutrient levels. This approach could yield more personalized dietary and therapeutic recommendations for managing preeclampsia. In the future, genetic information may support the development of tailored nutritional counseling during pregnancy to mitigate preeclampsia risk.