Fetal Mortality Research Articles

Fetal autopsy: Clinicopathologic correlation in consecutive cases

Background: Fetal and neonatal mortality serves as the most sensitive index of maternal and neonatal care. Congenital malformations remain a common cause of perinatal deaths and account for 10–15% in developing countries. Antenatal anomaly scan has become a standard element of obstetric care and their time for a fetal malformation is about 18 weeks. Fetal autopsy serves as a methodology to confirm the sonogram findings with regard to fetal anomalies. Aims and Objectives: The aim of our present study is to review and evaluate fetal autopsy of stillbirth/fetal losses and to confirm the malformations that were diagnosed by ultrasound. Materials and Methods: A cross-sectional study of a total of 10 cases received during the period of September 2023–October 2023 at the Institute of Obstetrics and Gynaecology. All the cases were spontaneous fetal losses. A standard protocol of autopsy procedure was followed which included external, internal, and histopathological examination. In fetuses with prenatally diagnosed malformations, ultrasound findings were compared with autopsy findings. Results: We analyzed a total of 10 fetuses, which included one chromosomal abnormality, four cardiac anomalies, one multiple anomaly, three central nervous system (CNS) anomalies, and one lethal skeletal dysplasia. The fetal autopsy confirmed the prenatal ultrasound findings in eight cases. Fetuses with CNS abnormality were not appreciated grossly due to early autolysis of the brain in the post-mortem. Conclusion: Prenatal imaging and screening are considered milestone development which detects fetal anomalies. However, the time-tested clinical autopsy which used to be conducted for all hospital deaths to find the cause of death was the norm of yesteryears which threw light on many unidentified causes and many syndromic associations not detected antemortem. Likewise, this case highlights the importance of autopsy correlation with prenatal imaging to highlight the same findings and to detect findings not picked up during imaging.

Uterine isthmic tourniquet left insitu as a new approach for placenta previa-accreta surgery: a comparative study.

Placenta previa-accreta spectrum disorders are a cause of obstetric hemorrhage that can lead to maternal fetal mortality and morbidity. We aimed to describe the use of a uterine isthmic tourniquet left in situ as a new uterus-preserving approach for patients with placenta previa-accreta. In this retrospective comparative study, the patients who underwent surgery for placenta previa between 2017 and 2024 at our tertiary hospital were reviewed. Primary outcome of the study is to evaluate feasibility of uterine isthmic tourniquet left in situ for uterine preserving by preventing postpartum hemorrhage for patients with placenta previa-accreta. As a secondary outcome, group 1 (n=28) patients who were managed with uterine isthmic tourniquet left in place were compared with patients in group 2 (n=32) who were managed with only bilateral uterine artery ligation. This new approach uterine isthmic tourniquet technique prevented postpartum hemorrhage with a rate of 100 percent in group 1 patients, while uterine artery ligation prevented postpartum hemorrhage with a rate of 75 % in group 2. Postoperative additional interventions (relaparotomy hysterectomy, balloon tamponade application, uterine or vaginal packing) were performed for eight patients in group 2 (25 %) but not in group 1 (0 %) (p=0.015). The haemoglobin levels before caesarean section were similar in both groups (p=0.235), while the postoperative haemoglobin levels were lower in group 2 (9.69±1.37 vs. 8.15±1.32) (p=0.004). Erythrocyte suspension was given to two patients in group 1 and 12 patients in group 2 (2/28 7 % vs. 12/32 37 %, p=0.018). The uterine isthmic tourniquet left in situ technique is a safe, simple and effective for preventing postpartum hemorrhage and preserving uterus during placenta previa accreta surgery as superior to uterine artery ligation alone.

Patient with Herlyn–Werner–Wunderlich syndrome and endometriosis achieves successful full-term pregnancy (40 weeks and 6 days): a case report

IntroductionHerlyn–Werner–Wunderlich syndrome , a rare Müllerian ducts congenital disease, is characterized by a diphtheritic uterus, blind hemivagina, and ipsilateral renal agenesis. Diagnosis is at young age by ultrasound and magnetic resonance imaging, and the prognosis is good. Usually, complications evolve endometriosis and secondary pelvic inflammation.Case reportA 40-year-old female patient, Brazilian, white, primigravida, diagnosed at 30 years with a didelphic uterus on ultrasound, and 4 years later, with a left ovarian endometrioma, multiple ovarian cysts, and left renal agenesis on magnetic resonance imaging. Subsequently, due to dyspareunia and a feeling of swelling, the patient underwent transvaginal ultrasound with bowel preparation, and a hematocolpos was found and Herlyn–Werner–Wunderlich syndrome was suspected; 10 years after the diagnosis she had a planned pregnancy. She presented frequent contractions following the 15th week of pregnancy and fortunately there were no complications or premature labor. Labor was inducted at 40 weeks and 6 days without progress and a cesarean section was indicated and performed without complications. Herlyn–Werner–Wunderlich syndrome often goes unnoticed, leading to inadequate treatment. Individuals with Herlyn–Werner–Wunderlich syndrome commonly face fertility issues, such as high miscarriage rate (21–33%), and obstetric complications, such as spontaneous abortions (40% risk), intrauterine growth restriction, postpartum hemorrhage, increased fetal mortality, preterm delivery (21–29%), and elevated rates of cesarean sections. In addition, there is higher susceptibility of developing endometriosis, especially with hemivaginal obstruction, and pelvic adhesions.ConclusionEarly diagnosis enables timely treatment and, consequently, fewer complications. Still, when these factors are absent, vaginal birth may still be possible. The true prevalence and incidence of complications related to Herlyn–Werner–Wunderlich syndrome are still unknown.

In utero nicotine exposure affects murine palate development.

Despite data linking smoking to increased risk of fetal morbidity and mortality, 11% of pregnant women continue to smoke or use alternative nicotine products. Studies confirm that nicotine exposure during pregnancy increases the incidence of birth defects; however, little research has focused on specific anatomic areas based on timing of exposure. We aim to determine critical in utero and postnatal periods of nicotine exposure that affect craniofacial development, specifically palate growth. Malformation of the palatal structures can result in numerous complications including facial growth disturbance, or impeding airway function. We hypothesized that both in utero and postnatal nicotine exposure will alter palate development. We administered pregnant C57BL6 mice water supplemented with 100 μg/mL nicotine during early pregnancy, throughout pregnancy, during pregnancy and lactation, or lactation only. Postnatal day 15 pups underwent micro-computed tomography (μCT) analyses specific to the palate. Resultant pups revealed significant differences in body weight from lactation-only nicotine exposure, and μCT investigation revealed several dimensions affected by lactation-only nicotine exposure, including palate width, palate and cranial base lengths, and mid-palatal suture width. These results demonstrate the direct effects of nicotine on the developing palate beyond simple tobacco use. Nicotine exposure through tobacco alternatives, cessation methods, and electronic nicotine delivery systems (ENDS) may disrupt normal growth and development of the palate during development and the postnatal periods of breastfeeding. Due to the recent dramatic increase in the use of ENDS, future research will focus specifically on this nicotine delivery method.

Is Cardiac Surgery Safe During Pregnancy? A 40-Year Single-Institution Experience

BackgroundLimited data exist to characterize maternal and fetal outcomes during pregnancy undergoing cardiac operations using cardiopulmonary bypass. MethodsA retrospective review was performed of all pregnant individuals who underwent cardiac surgery using cardiopulmonary bypass at a single center from 1978 to 2023. Descriptive statistical analysis was performed, with a median reported for continuous variables and incidence for dichotomous variables. ResultsTwenty-nine pregnant patients with a median age of 28 years (interquartile range [IQR], 25-32 years) years underwent cardiac surgery using cardiopulmonary bypass at a median gestation of 25 weeks (IQR, 16-29 weeks). Surgery was performed in the first trimester for 3 patients (10%), second trimester for 16 (55%), and third trimester for 10 (35%). Procedures were emergent in 15 (52%) and urgent in 14 (48%). There was 1 (3%) maternal death 2 days after mechanical aortic valve thrombectomy and 5 (17%) fetal losses. Fourteen patients who underwent cardiac surgery using cardiopulmonary bypass with continuing pregnancy experienced a 29% fetal mortality rate, and 7 patients underwent delivery before surgery and experienced 14% fetal mortality. Among cases of fetal loss, surgery was performed at a median of 25 weeks (IQR, 21-26 weeks) compared with a median of 23 weeks (IQR, 20-29 weeks) in cases without fetal loss (P = .55). ConclusionsCardiac surgery during pregnancy was associated with low maternal mortality but significant fetal mortality. This single-institution series supports consideration of cesarean delivery before cardiopulmonary bypass procedures if the fetus is of a viable gestational age to minimize mortality.

Assessing the Impact of Hematological Changes in Pregnancy on Maternal and Fetal Death: A Narrative Review.

Hematological changes during pregnancy encompass a wide range of alterations in blood composition and function, including variations in hemoglobin levels, red blood cell count, and coagulation factors. These changes can be physiological or pathological and may significantly impact maternal and fetal health outcomes. This narrative review examines the relationship between various hematological changes and disorders during pregnancy and their effects on maternal and fetal mortality and morbidity. We explore conditions such as anemia, sickle cell disease, thrombophilia, and blood-borne infections like malaria, as well as the impact of multiple pregnancies on hematological parameters. The review also discusses the effects of COVID-19 on maternal hematology. Key findings include the high prevalence of adverse perinatal outcomes associated with these conditions, including early miscarriages, preterm birth, low birth weight, intrauterine growth restriction, and increased risk of maternal complications. The importance of early screening, diagnosis, and appropriate management of hematological disorders during pregnancy is emphasized. This review highlights the need for a multidisciplinary approach to managing pregnant women with hematological changes to optimize maternal and fetal outcomes.

A Study of Association of Insulin Resistance with Pregnancy-induced Hypertension.

Preeclampsia is one of the important causes of maternal and fetal mortality and morbidity. One of the important risk factors for the development of diabetes is insulin resistance (IR). To evaluate the association of IR with pregnancy-induced hypertension (PIH) and its severity. Data from 70 pregnant females who had completed 20 weeks of gestation and developed PIH were analyzed and compared with 30 appropriate controls. All females underwent measurement of fasting glucose level, fasting insulin level, and blood pressure. The mean age of the women in the control group was 26.17 years, and in the study group, it was 27.09 years. All females had completed 20 weeks of gestation. Around 86.6% of women in the control group, 54.1% with a variable degree of preeclampsia, and 48.6% of women with eclampsia were at 33-38 weeks of gestation. At the time of sampling, 13.3% of women in the control group, 45.81% of women with preeclampsia, and 51.3% of women with eclampsia were at 26-32 weeks of gestation. The mean IR among the control group was 1.37, in preeclampsia, it was 2.11, and in eclampsia, it was 3.58 with a p-value of 0.000, which is very highly significant. In this study, the severity of the disease was found to be directly proportional to IR. Pregnancy complicated with preeclampsia and eclampsia showed more IR in comparison to pregnant women with normal blood pressure, and this relationship is independent of the age of pregnant women.

Alpinumisoflavone ameliorates H2O2-induced intracellular damages through SIRT1 activation in pre-eclampsia cell models

Pre-eclampsia (PE) is classified as pregnancy-specific hypertensive disease and responsible for severe fetal and maternal morbidity and mortality, which influenced an approximate 3 ∼ 8 % of all pregnancies in both developed and developing countries. However, the exact pathological mechanism underlying PE has not been elucidated and it is urgent to find innovate pharmacotherapeutic agents for PE. Recent studies have reported that a crucial part of the etiology of PE is played by placental oxidative stress. Therefore, to treat PE, a possible treatment approach is to mitigate the placental oxidative stress. Alpinumisoflavone (AIF) is a prenylated isoflavonoid originated in mandarin melon berry called Cudrania tricuspidate, and is well known for its versatile pharmacotherapeutic properties, including anti-fibrotic, anti-inflammatory, anti-tumor, and antioxidant activity. However, protective property of AIF on extravillous trophoblast (EVT) under placental oxidative stress has not been elucidated yet. Therefore, we assessed stimulatory effects of AIF on the viability, invasion, migration, mitochondria function in the representative EVT cell line, HTR-8/SVneo cell. Moreover, protective activities of AIF from H2O2 were confirmed, in terms of reduction in apoptosis, ROS production, and depolarization of mitochondrial membrane. Furthermore, we confirmed the direct interaction of AIF with sirtuin1 (SIRT1) using molecular docking analysis and SIRT1-mediated signaling pathways associated with the protective effects of AIF on HTR-8/SVneo cells under oxidative stress. Finally, beneficial efficacy of AIF against oxidative stress was further confirmed using BeWo cells, syncytiotrophoblast cell lines. These results suggest that AIF may ameliorate H2O2-induced intracellular damages through SIRT1 activation in human trophoblast cells.

Causes and investigation of stillbirths in Brazil: A multicentre cross-sectional study in 10 referral maternity hospitals.

Understanding the local characteristics and statistics related to stillbirths may be the first step in a series of strategies associated with a reduction in stillbirth ratio. The aim of this study was to estimate the fetal mortality ratio and evaluate the investigation processes related to the causes of death, comparing the investigation according to the specific cause of death. A cross-sectional study was retrospectively conducted in 10 tertiary obstetric care centers. Medical records of women with stillbirth managed between January 1, 2009 and December 31, 2018 were analyzed and classified, according to sociodemographic characteristics, and gestational and childbirth data, culminating in stillbirth. The stillbirth ratio and its causes were presented in proportions for the study period and individually for each health facility. Cases of 3390 stillbirths were analyzed. The stillbirth ratio varied from 10.74/1000 live births (LBs) in 2009 to 9.31/1000 in 2018. "Intrauterine hypoxia and asphyxia" (ICD-10 P20) and "unspecific causes of death" (ICD-10 P95) represented 40.8% of the causes of death. Investigation for TORCHS and diabetes occurred in 90.8% and 61.4% of deaths, respectively. Placental and necroscopic tests were performed in 36.6% of the cases. The adoption of a rational and standardized investigation of stillbirth remains an unmet need; the use of additional tests and examinations are lacking, especially when unspecific causes are attributed.

Fetal, neonatal, and infant death among offspring of pregnant women with HIV in Tanzania.

Assess the risk of death for offspring of pregnant women with HIV (PWHIV) and the association with sociodemographic, pregnancy, HIV-related, and birth factors. We conducted a prospective cohort study of PWHIV on antiretroviral therapy (ART) and their offspring in urban Tanzania who were enrolled in a vitamin D trial conducted from June 2015 to October 2019. We described rates of fetal, neonatal, and infant death and assessed risk factors for these outcomes with generalized estimating equations. We also estimated population-attributable risk percentages for the contribution of prematurity and small-for-gestational age (SGA) to neonatal and infant mortality. Among 2299 PWHIV, there were a total of 136 fetal deaths (5.6%) and the stillbirth rate was 42.0 per 1000 total births. Among 2167 livebirths, there were 57 neonatal deaths (26.3 per 1000 livebirths) and 114 infant deaths (52.6 per 1000 livebirths). Twin birth was associated with neonatal death, while maternal CD4 + T-cell count <350 cells/μl in pregnancy was associated with infant death ( P -values < 0.05). As compared to term-appropriate-for-gestational age (AGA) births, the relative risks for neonatal mortality for term-SGA, preterm-AGA, and preterm-SGA infants were 2.07 [95% confidence interval (CI): 1.00-4.28], 2.87 (95% CI 1.54-5.35), and 7.15 (95% CI: 2.11-24.30), respectively. We estimated that 42.7% of neonatal and 29.4% of infant deaths were attributable to prematurity and SGA in the cohort. The risk of death is high for offspring of PWHIV in Tanzania and the combination of prematurity and fetal growth restriction may account for nearly half of neonatal deaths.

Asymptomatic Bacteriuria among Pregnant Women Attending Antenatal Care

The complication associated with bacteriuria during pregnancy not only result increase morbidity of the mother but also have detrimental effects on the fetus which may result in preterm labor, fetal growth retardation, hypertension and anemia. Studies have shown that the fetal mortality rate was 2.4 times higher than in pregnancy associated with urinary tract infection.This study conducted to determine the prevalence of asymptomatic bacteriuria in pregnant women. A cross-sectional study carried out during the year 2017 at a tertiary care hospital Alkhadra in Tripoli/Libya. 200 pregnant women aged between 19-43 years attending the obstetrics and gynecology clinics were included in this study. From these patient’s mid- stream clean catch urine samples were collected and processed. The following information were obtained from the patients; demographic data, parity, abortion history, history of UTI, history of DM, Urine culture result, type of organism. The minimum age was 19 years and the oldest was 43 years old. The mean maternal age of the cases was 29.2 ± 3.1 years. The multiparous cases were 61% and 48% of women had positive history to UTI before the study, also only 4% of cases were diabetic, regarding the time of diagnosis 18% were diagnosed at first trimester and 46% at the 2nd trimester while 36% diagnosed at the 3rd trimester. Regarding the urine culture results only 23% of cases had significant bateriuria and 8% had insignificant bateriuria, 14% the result was contaminated and 55% of cases their results were sterile, E. coli was the most predominant organism in the current study. The prevalence of asymptomatic bacteriuria in pregnant women (23%) was comparable with similar studies in other countries. The most common uropathogens isolated in this study were E.coli followed by K. pnuemoniae.

Influence of Seasonality on the Frequency and Prognosis of Retroplacentary Hematoma at the Gabriel Touré University Hospital in Bamako (Mali)

This was a cross-sectional, retrospective study on the influence of seasonality on the frequency and prognosis of HRP at the Gabriel Touré University Hospital from January 1, 2020 to December 31, 2022, i.e. a duration of 3 years. This study allowed us to identify over a period of 3 years, 595 cases of HRP out of a total of 9447 deliveries, i.e. a frequency of 6.2%, with an increase in cases of HRP during the rainy season to 43.02%. The main reason for admission was metrorrhagia/pregnancy 83.03%. We found at the end of our study that the rainy season is a risk factor for the occurrence of HRP with a frequency of 43.02% during the rainy season, followed by the hot season at 30.25% and the cold season at 26.72%. Sher's HRP grade IIIA was the most diagnosed type at 76.63% and especially during the rainy season, with more complications of anemia and hemorrhagic shock at 73.61% and 14.96%. Caesarean section was performed in 80.2% of cases. We recorded 42 HRP-related maternal deaths or 7.05%, with a higher number during the rainy season at 59.52%. The fetal prognosis was poor with 89.06% fetal mortality. Retroplacental hematoma is a relatively common obstetric pathology. The rainy season would have an impact on its occurrence, but also on the maternal and fetal prognosis in our context.

Adnexal torsion: A comprehensive review of types, pathophysiology, diagnosis, and management strategies during pregnancy

Adnexal torsion is a gynecological surgical emergency which during pregnancy can be associated with high patient morbidity and fetal mortality if not managed promptly. Fertility preservation is an essential concern. The underlying pathophysiology involves ovarian tissue torsion on its pedicle, leading to decreased venous return, stromal edema, internal hemorrhage, and infarction. It can affect females of all age groups, and they present mainly with an acute onset of pelvic pain, followed by nausea and vomiting. Multiple risks can lead to adnexal torsion, including ovulation induction, use of in vitro fertilization, and the presence of an ovarian mass. Early diagnosis is challenging and mainly depends on clinical suspicion, ultrasound, or MRI findings; however, it is necessary to preserve the function of the ovaries and fallopian tubes and prevent the occurrence of infertility. Once adnexal torsion is suspected, surgery or detorsion is the main line of treatment. This review will summarize the most relevant studies on risk factors, radiological findings, and managing maternal adnexal torsion in pregnancy.

Acute febrile illness in pregnancy: Spectrum of disease and impact on maternal and foetal outcome.

Acute febrile illness (AFI) in pregnancy is a neglected cause of maternal and foetal mortality and morbidity in low-and middle-income countries. This prospective cohort studied antenatal and postpartum women admitted with acute fever to a tertiary care university teaching hospital from July 2014 to March 2015 for aetiology, maternal and foetal complications, and the impact on maternal mortality ratio (MMR) and perinatal mortality rate. Among the 180 women admitted with AFI, urinary tract infection 54(30%) was the commonest cause, followed by airborne infections (67; 37.2%), peripartum or wound infections (25; 13.8%) and vector-borne diseases (21; 11.6%). Maternal deaths were 4 (2%) and foetal deaths 9 (5%). Post-operative gram-negative sepsis was the most common cause of maternal mortality. The MMR was ten times higher with AFI 2778 against 197 (p < 0.0001) among the other hospital deliveries during the same period. Screening for asymptomatic bacteriuria , maintaining aseptic precautions, and vaccination may impact maternal and foetal morbidity significantly.

Edukasi Anemia melalui Kelas Ibu Hamil Menggunakan Buku Saku Cegah Anemia pada Kehamilan sebagai Upaya Pencegahan Anemia pada Ibu Hamil

Anemia is one of the most frequent complications associated with pregnancy. Normal physiological changes in pregnancy affect hemoglobin (Hb) and there is a relative or absolute decrease in Hb concentration. Anemia adversely affects maternal and fetal well-being and is associated with increased fetal morbidity and mortality. Adverse perinatal outcomes includeintrauterine growth retardation (IUGR), prematurity and low birth weight are significant risks of death, especially in developing countries. This service to society is of a natureeducational persuasive by providing health education in the form of health education about anemia in pregnancy through classes for pregnant women using media in the form of a pocket book to prevent anemia in pregnancy. The characteristics of pregnant women who took part in this community service activity included an average age of 29.13 years, most of them had low and middle education, did not work, were multigravida and most were in the third trimester of pregnancy. The average knowledge score of pregnant women before receiving health education using a pocket book to prevent anemia in pregnancy was 56 and after the education was carried out there was an increase in the knowledge score of 86 so that the pocket book could be an alternative use of health education media to increase the knowledge of pregnant women.

An augmented illness-death model for semi-competing risks with clinically immediate terminal events.

Preeclampsia is a pregnancy-associated condition posing risks of both fetal and maternal mortality and morbidity that can only resolve following delivery and removal of the placenta. Because in its typical form preeclampsia can arise before delivery, but not after, these two events exemplify the time-to-event setting of "semi-competing risks" in which a non-terminal event of interest is subject to the occurrence of a terminal event of interest. The semi-competing risks framework presents a valuable opportunity to simultaneously address two clinically meaningful risk modeling tasks: (i) characterizing risk of developing preeclampsia, and (ii) characterizing time to delivery after onset of preeclampsia. However, some people with preeclampsia deliver immediately upon diagnosis, while others are admitted and monitored for an extended period before giving birth, resulting in two distinct trajectories following the non-terminal event, which we call "clinically immediate" and "non-immediate" terminal events. Though such phenomena arise in many clinical contexts, to-date there have not been methods developed to acknowledge the complex dependencies between such outcomes, nor leverage these phenomena to gain new insight into individualized risk. We address this gap by proposing a novel augmented frailty-based illness-death model with a binary submodel to distinguish risk of immediate terminal event following the non-terminal event. The model admits direct dependence of the terminal event on the non-terminal event through flexible regression specification, as well as indirect dependence via a shared frailty term linking each submodel. We develop an efficient Bayesian sampler for estimation and corresponding model fit metrics, and derive formulae for dynamic risk prediction. In an extended example using pregnancy outcome data from an electronic health record, we demonstrate the proposed model's direct applicability to address a broad range of clinical questions.

Spontaneous rupture of uterine during pregnancy after laparoscopic myomectomy: A case report

The danger of future uterine rupture is a serious concern for women who become pregnant after uterine leiomyomectomy or adenomyomectomy, despite the fact that these procedures are commonly used to alleviate symptoms like dysmenorrhea or hypermenorrhea and improve fertility. Although it happens very infrequently, uterine rupture is the most dreaded pregnancy complication and is linked to a high rate of maternal and fetal morbidity and mortality. Here, we present a case of spontaneous uterine rupture during the third trimester of pregnancy.

“Maternal and Perinatal Outcome in Preterm Placenta Praevia”

Introduction: Placenta previa (PP) is a significant cause of maternal and fetal morbidity and mortality worldwide. However, there is limited data from developing countries on the maternal and fetal outcomes and complications associated with placenta previa. Aim of the study: The aim of this study was to evaluate maternal and perinatal outcome in preterm placenta praevia. Methods: This prospective observational study was conducted in the Department of Gynae and Obstetrics of Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from March 2010 to August 1010. Result: Total 66 patients were diagnosed with placenta previa. We found, the majority (42%) of participants were aged between 26-30 years and with lower socio-economic status significantly associated with higher prevalence due to lack of regular antenatal care. The majority were admitted at 35-37 weeks gestation, with the highest perinatal loss occurring before 30 weeks. Initial bleeding was generally small, and many presented with labor pain and anemia. Ultrasonography diagnosed 55% of cases, with cesarean sections frequently used, leading to better outcomes compared to vaginal deliveries. Severe postpartum complications like hemorrhage and urinary tract infections were common in more severe cases. Conclusion: Placenta previa is a major cause of maternal and perinatal morbidity and mortality. Early registration, regular antenatal care, early detection of high-risk cases, and timely referral to higher centers with good NICU services and blood bank facilities can help prevent these adverse outcomes.

PREVALENCE OF ASYMPTOMATIC BACTERIURIA IN ANTENATAL WOMEN ATTENDING TERTIARY CARE HOSPITAL-A CROSS-SECTIONAL STUDY

Objective: Urinary tract infection (UTI) is one of the most common bacterial infections during pregnancy due to anatomical changes and physiological adaptations during pregnancy. Asymptomatic bacteriuria is the significant presence of bacteria in the urine of an individual without symptoms. Untreated asymptomatic bacteriuria (ASB) in pregnancy predisposes to symptomatic UTI in 25% of infected women. Screening of antenatal women help in early diagnosis and treatment of ASB and thus to prevent maternal and fetal morbidity and mortality. The present study was carried out to determine the prevalence of UTI in pregnant women and to study the bacteriological profile and antimicrobial sensitivity patterns of uropathogens. Methods: A Cross-sectional study was conducted for a period of six months and midstream urine specimens were collected from 480 pregnant females and were processed by standard protocols. All subjects were clinically identified to have no signs and symptoms of UTI. Antibiotic susceptibility testing was done as per CLSI guidelines. Results: Prevalence rate of asymptomatic bacteriuria was seen 10% in pregnant women. Majority of the culture-positive patients belonged to the age group of 26-30 y (31.25%). 70.84% were Gram-negative isolates and 29.16% were Gram-positive organisms. The commonest pathogen isolated was Escherichia coli (33.33%). In the present study, Extended Spectrum Beta-Lactamase (ESBL) production was seen in (20.58%) isolates, and Metallo Beta-Lactamase (MBL) production was seen in (17.64%) isolates. Conclusion: This study reveals the importance of screening of pregnant women for UTI. Emerging multi-drug resistance seen in uropathogens emphasizes the need to rationalize use of antibiotics, which eventually prevent development of resistant strains.

Prevalence of fetal anomalies, stillbirth, neonatal morbidity, or mortality in pregnancies complicated by placenta accreta spectrum disorders.

Placenta accreta spectrum disorders (PAS) lead to major complications in pregnancy. While the maternal morbidity associated with PAS is well known, there is less information regarding neonatal morbidity in this setting. The aim of this study is to describe the neonatal outcomes (fetal malformations, neonatal morbidity, twin births, stillbirth, and neonatal death), using an international multicenter database of PAS cases. This was a prospective, multicenter cohort study based on prospectively collected cases, using the international multicenter database of the International Society for PAS, carried out between January 2020 and June 2022 by 23 centers with experience in PAS care. All PAS cases were included, regardless of whether singleton or multiple pregnancies and were managed in each center according to their own protocols. Data were collected via chart review. Local Ethical Committee approval and Data Use Agreements were obtained according to local policies. There were 315 pregnancies eligible for inclusion, with 12 twin pregnancies, comprising 329 fetuses/newborns; 2 cases were excluded due to inconsistency of data regarding fetal abnormalities. For the calculation of neonatal morbidity and mortality, all elective pregnancy terminations were excluded, hence 311 pregnancies with 323 newborns were analyzed. In our cohort, 3 neonates (0.93%) were stillborn; of the 320 newborns delivered, there were 10 cases (3.13%) of neonatal death. The prevalence of major congenital malformations was 4.64% (15/323 newborns), most commonly, cardiovascular, central nervous system, and gastrointestinal tract malformations. The overall prevalence of major neonatal morbidity in pregnancies complicated by PAS was 47/311 (15.1%). There were no stillbirths, neonatal deaths, or fetal malformations in reported twin gestations. Although some outcomes may be too rare to detect within our cohort and data should be interpreted with caution, our observational data supports reassuring neonatal outcomes for women with PAS.