Multiple Gestation Pregnancies Research Articles

Maternal Urinary Fluoride and Child Neurobehavior at Age 36 Months

Recent studies in Canadian and Mexican populations suggest an association of higher prenatal fluoride exposure with poorer neurobehavioral development, but whether this association holds for US-based populations is unknown. To examine associations of third trimester maternal urinary fluoride (MUF) with child neurobehavior at age 3 years in the US. This prospective cohort study utilized urine samples archived from 2017 to 2020 and neurobehavioral data assessed from 2020 to 2023 from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort, which consisted of predominately Hispanic women residing in Los Angeles, California. Cohort eligibility criteria at recruitment included being 18 years of age or older, less than 30 weeks' gestation, and a fluent English or Spanish speaker. Exclusion criteria included having a disability preventing participation or provision of informed consent, being HIV positive or incarcerated, and having a multiple gestation pregnancy. There were 263 mother-child pairs who completed the 3-year study visit. In this analysis, women who reported prenatal smoking were excluded. Data analysis was conducted from October 2022 to March 2024. Specific gravity-adjusted MUF (MUFSG), a biomarker of prenatal fluoride exposure. Neurobehavior was quantified using the Preschool Child Behavior Checklist (CBCL), which included composite scores for Total Problems, Internalizing Problems, and Externalizing Problems. CBCL composite T scores range from 28 to 100. T scores from 60 to 63 are in the borderline clinical range, whereas scores above 63 are in the clinical range. Linear and logistic regression models adjusted for covariates were conducted. A total of 229 mother-child pairs (mean [SD] maternal age, 29.45 [5.67] years; 116 female children [50.7%] and 113 male children [49.3%]) who had MUFSG measured were included in the study. Median (IQR) MUFSG was 0.76 (0.51-1.19) mg/L, and 32 participants (14.0%) had a Total Problems T score in the borderline clinical or clinical range. A 1-IQR (0.68 mg/L) increase in MUFSG was associated with nearly double the odds of the Total Problems T score being in the borderline clinical or clinical range (odds ratio, 1.83; 95% CI, 1.17-2.86; P = .008), as well as with a 2.29-point increase in T score for the Internalizing Problems composite (B = 2.29; 95% CI, 0.47-4.11; P = .01) and a 2.14-point increase in T score for the Total Problems composite (B = 2.14; 95% CI, 0.29-3.98; P = .02). In this prospective cohort study of mother-child pairs in Los Angeles, California, prenatal fluoride exposure was associated with increased neurobehavioral problems. These findings suggest that there may be a need to establish recommendations for limiting fluoride exposure during the prenatal period.

Association between hypertensive disorders and Bell's palsy in pregnancy: protocol for a systematic review and meta-analysis.

Bell's palsy is an idiopathic peripheral nerve palsy involving the facial nerve. Pregnancy, diabetes mellitus and hypertension are the risk factors for Bell's palsy. However, the association between hypertensive disorders and Bell's palsy during pregnancy or the puerperium remains unclear. This systematic review will comprehensively summarise the literature and evaluate the association between Bell's palsy and hypertensive disorders during pregnancy or the puerperium. Systematic searches of PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials will be undertaken using prespecified search strategies. Observational studies (cross-sectional studies, cohort studies, case reports and series case reports) written in English that investigate the association between hypertensive disorders of late pregnancy and Bell's palsy during pregnancy or the puerperium will be included. Different authors will independently conduct the eligible study selection, perform data extraction and appraise the quality of included studies. Subgroup analysis will be carried out based on the age of pregnant women (≤35 years old, >35 years old), parity (primipara, multipara) and fetus number (singleton or multiple-gestation pregnancy). This review will be based on published literature, and thus there is no requirement for ethics approval. The results of this study will aid in the knowledge of the relationship between Bell's palsy during pregnancy or the puerperium and hypertensive disorders of late pregnancy. The results of this systematic review will be shared through publication in a peer-reviewed journal with good visibility for the field of obstetrics and presentations at academic conferences. CRD42023422902.

Association of cesarean section delivery with childhood behavior: a systematic review protocol.

This review will evaluate the association between cesarean section delivery and child behavior problems. Cesarean section (C-section) deliveries account for over 30% of deliveries in Canada and 21% of all births globally. Mode of delivery via C-section has been associated with altered maternal mental health in the postpartum period, and postpartum depression is linked to an increased risk of internalizing and externalizing behaviors in children. Given the high rates of C-section deliveries worldwide, it is important to determine how mode of delivery impacts child behavior. The review will examine child behavior outcomes among preschool and school-aged children as determined by medical diagnosis or a standardized assessment tool. Multiple gestation pregnancies and pre-term delivery will be excluded. A search will be conducted using APA PsycINFO (Ovid), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), and Scopus. This review will evaluate peer-reviewed primary observational research studies specifically looking at examining C-section delivery. Two reviewers will independently screen titles, abstracts, and full-text studies to determine alignment with the inclusion and exclusion criteria. Data will be recorded using the standardized JBI data extraction tool and be presented using figures, tables, and a summary. Where feasible, we will conduct a meta-analysis and subgroup analysis of suitable populations. Critical appraisal of studies will be performed for included studies. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. PROSPERO CRD42022371294.

U.S. Gestational Carrier Embryo Transfer Trends, 2014–2020 [ID 2683526

INTRODUCTION: Multiple embryo transfers (METs) are common among gestational carriers (GCs) despite increased obstetric risks of multiple gestations and strong recommendations from American Society for Reproductive Medicine (ASRM) for single-embryo transfers. This study assessed GC embryo transfer trends from 2014–2020 to evaluate compliance with national guidelines. METHODS: This retrospective, population-based cohort study used data from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. All cycles from 2014 to 2020 involving an embryo transfer to a GC were analyzed. The number of GC embryo transfers, use of preimplantation genetic testing (PGT), and outcome (singleton versus multiple gestation) were assessed. Poisson and linear regression models evaluated trends in number and proportion of cycles over time. Institutional review board approval was obtained. RESULTS: Of the 40,177 GC transfer cycles from 2014 to 2020, 11,081 (27.6%) involved transfer of two or more embryos. Both the number (n=2,001 in 2014; n=814 in 2020) and proportion of METs (56.6% of all transfers in 2014; 11.8% in 2020) (P<.05 for both) decreased. The use of PGT among MET GC cycles increased from 23.9% in 2014 to 61.4% in 2020. Among live births, there was a 71.0% reduction in the proportion of multiple gestations from 2014 (25.5%) to 2020 (7.4%) (P<.05). Among double-embryo transfers, the majority were performed at the blastocyst stage with an increase from 2014 (76.7%) to 2020 (88.1%) (P<.05). CONCLUSION: With increased use of PGT and extended blastocyst culture, MET and subsequent multiple gestation pregnancies have decreased amongst U.S. GCs. These trends suggest increased compliance with ASRM national guidelines.

Abstract 3441: Application of a maternal comorbidity index to predict childhood cancer risk: A population-based case-control study in Denmark

Abstract Background: Maternal health has been found to be an indicator of children’s health and has also been found to affect the risk of childhood diseases. Children are especially susceptible to in-utero exposures. A mother’s health conditions before and during pregnancy could have important consequences for her child's health, including cancer development, as was observed in some prior studies. Objectives: This study aimed to identify the impact of varying maternal comorbidities on the development of childhood cancers. This study applied an Obstetric Comorbidity Index (Bateman et al, 2013) to examine maternal comorbid conditions in childhood cancer risk. Methods: Using maternal and birth records, and cancer records from the Danish Cancer Registry, we conducted a population-based case-control study with two population groups- the first population included cases (n=2578) and controls (n=64450) with ICD-10 diagnoses from 1994-2013, and the second population included cases (n=8339) and controls (n=208475) with ICD-8 and 10 diagnoses from 1977-2013. Maternal comorbidities were ascertained from the National Patient Register using the Obstetric Comorbidity Index. We estimated the risk of childhood cancer using conditional logistic regression. Results: Multiple gestation pregnancy (OR=1.17, 95% CI 1.05, 1.30), maternal pre-existing diabetes (OR=1.68, 95% CI 1.14, 2.48), congenital heart disease (OR=2.62, 95% CI 1.13, 6.09) and previous cesarean delivery (OR=1.35, 95% CI 1.03, 1.75) showed an increased risk of childhood cancers (all types combined). Children born to mothers between the ages of 35 and 39 also had a higher risk of cancer as compared to those born before. In the 1977-2013 population, there was an increased risk of acute lymphocytic leukemia (ALL; OR=1.08, 95% CI 1.04, 1.13) and rhabdomyosarcoma (OR=1.13, 95% CI 1.01, 1.27) for each unit of increase on the Obstetric Comorbidity Index. There was also an increased risk of retinoblastoma (OR=1.16, 95% CI 1.01, 1.32) for each unit of increase on the maternal comorbidities index in the 1994-2013 population. Examining mothers that had a score of one or more in the Obstetric Comorbidity Index, there was a higher risk of ALL (OR=1.43, 95% CI 1.26, 1.62), non-Hodgkin lymphoma (OR=1.50, 95% CI 1.17, 1.91), Burkitt lymphoma (OR=1.71, 95% CI 1.12, 2.61), and rhabdomyosarcoma (OR=1.58, 95% CI 1.10, 2.26) for children whose mothers with at least one maternal comorbidity. A similar trend was observed in the 1994-2013 population for ALL, non-Hodgkin lymphoma, and Burkitt lymphoma. Conclusion: The results of the study show varying effects of exposure to one or more maternal comorbidities on individual pediatric cancer types, and an overall increased risk of most cancers development in children with exposure of mothers to 1 or more maternal comorbidities. Citation Format: Tobiloba Adanma Adenekan, Julia E. Heck, Cheng Yin, Johnni Hansen. Application of a maternal comorbidity index to predict childhood cancer risk: A population-based case-control study in Denmark [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3441.

Fetal magnetic resonance imaging, ultrasound, and echocardiography findings in twin reversed arterial perfusion sequence.

Twin reversed arterial perfusion (TRAP) sequence is a rare complication of monochorionic multiple gestation pregnancies, in which the pump twin provides hemodynamic support to a nonviable co-twin (acardius). Fetal magnetic resonance imaging (MRI) is used to detect pump twin abnormalities, particularly brain ischemia, prior to fetal intervention to interrupt umbilical blood flow to the acardius. To summarize the imaging findings of TRAP sequence pregnancies in a large series. A single-center retrospective review was performed of all TRAP sequence pregnancies referred for fetal MRI (2004-2021). Fetal MRI, ultrasound, and echocardiography data were collected. Eighty-eight TRAP sequence pregnancies with MRI were included (mean gestational age, 19.8±2.8 weeks). Demise of the pump twin was noted in two pregnancies at the time of MRI. By MRI, 12% (10/86) of live pump twins had abnormalities, including 3% (3/86) with brain abnormalities and 9% (8/86) with extra-cranial abnormalities. By echocardiography, 7% (6/86) of pump twins had structural cardiac abnormalities. Three acardius morphological subtypes were identified by MRI: acephalus (55%, 48/88), anceps (39%, 34/88), and amorphous (7%, 6/88). The mean ultrasound acardiustopump twin ratioA/Pratio, calculated for each twin pair as the ratio of the acardius trunk (and head, if present) plus limb volume to the pump twin estimated fetal weight) differed among the three acardius subtypes (P=.03). The mean A/P ratio moderately correlated with pump twin cardiothoracic ratio and combined cardiac output (Pearson's r=0.45 and 0.48, respectively, both P<.001). Fetal MRI of TRAP sequence pregnancies found anomalies in a substantial number of pump twins. The three acardius subtypes differed in A/P ratio, which moderately correlated with the pump twin cardiothoracic ratio and combined cardiac output.

Fetal sex and the development of gestational diabetes mellitus in gravidae with multiple gestation pregnancies.

There is an increasing incidence of pregnancies with twin gestations. One outcome more likely to occur with multiple gestations is gestational diabetes mellitus. Studies have suggested that in singleton pregnancies, fetal sex may affect insulin resistance. However, the effects of fetal sex in twins and the development of gestational diabetes mellitus are unknown. We hypothesized that rates of gestational diabetes mellitus and degree of insulin resistance might vary in twin gestations based on the fetal sex pairing: male-male, male-female or female-female. We aimed to employ a large population-based database to ascertain any correlations between fetal sex and gestational diabetes mellitus in multifetal gestations. A two-hospital, single academic institution database comprised of over 39 000 participants with pregnancy data from August 2011 to January 2022 was employed. All twin deliveries of live-born neonates >24 weeks' gestational age from gravidae without preexisting diabetes or twin-twin transfusion syndrome were included. Entries were then grouped based on the fetal sex of the pairing. The presence or absence of gestational diabetes and type of gestational diabetes - diet-controlled (gestational diabetes mellitus classification A1) vs medication-controlled (gestational diabetes mellitus classification A2) - were identified. Statistical analysis was performed using a generalized linear mixed method, and a P-value ≤0.05 was considered statistically significant. We identified 1924 twin deliveries that met the inclusion criteria in our database (male-male =652; male-female = 638; female-female = 634). We found no association between fetal sex pairing and the development of gestational diabetes mellitus. There was a significant association between the fetal sex pairing and the type of gestational diabetes mellitus developed, with 32.0% of male-male twins, 33.3% of male-female twins and 58.3% of the female-female twin deliveries associated with medication-controlled gestational diabetes classification A2: male-female vs female-female (P = 0.05) and male-male vs female-female (P = 0.046). While gestational diabetes mellitus is of multifactorial origin, we found a significant association between the fetal sex pairing and the treatment needed for gravidae with twins who develop gestational diabetes mellitus. A higher proportion of female-female twins was associated with gestational diabetes classification A2 compared with male-female or male-male deliveries. Further research on the physiology driving this association is warranted.

Contribution of Preterm Birth to Mortality Among Neonates With Birth Defects

ABSTRACT Birth defects are an important cause of death among infants who die within their first year. Among other complications associated with birth defects, mothers are at higher risk for preterm delivery, which is also associated with infant mortality. Some previous research has shown that in a population of infants with birth defects, those born at term are 3 to 4 times more likely to survive as their preterm peers. This study aimed to clarify the relationship between birth defects, infant mortality, and preterm birth using the population attributable fraction (PAF), examining the mortality risk attributable to preterm birth in infants with birth defects. Data for this study came from the Texas Birth Defects Registry, which includes live births, still births, and pregnancy terminations with a structural birth defect or chromosomal abnormality. The sample included live-born infants with 1 or more major birth defects between January 1, 1999 and December 31, 2014. Exclusion criteria were infants with a chromosomal abnormality or diagnosed syndrome, infants missing data on gestational age or with a gestational age less than 24 weeks, and anencephaly. The final sample included 169,148 infants; of these, 40,872 were preterm (&lt;37 weeks), 128,276 were term, and 2715 died as neonates. Distributions of maternal and infant characteristics were significantly different between the 2 groups (P &lt; 0.01), with more mothers of preterm infants experiencing diabetes, hypertension, multiple gestation pregnancies, or cesarean delivery. In addition, more preterm infants had multiple birth defects or congenital heart defects than their term peers. Analysis of the data included estimates of PAF for infant mortality risk attributed to 31 different birth defects, with results ranging from 12.5% to 71.9%. Highest PAF estimates were observed for anotia or microtia (71.9%; CI, 41.1–86.6), hypospadias (69.4%; CI, 53.9–79.7), talipes equinovarus (69.4%; CI, 60.0–76.6), and stenosis or atresia of the large intestine, rectum, or anal canal (69.1%; CI, 56.3–78.1). On the other hand, lowest PAF estimates included hypoplastic left heart syndrome (12.5%; CI, 8.7–16.1), coarctation of the aorta (19.7%; CI, 9.8–28.4), diaphragmatic hernia (23.8%; CI, 19.2–28.2), and holoprosencephaly (26.0%; CI, 14.5–35.9). For each defect associated with a higher PAF, a large percentage of infant deaths were those born preterm. Infants with defects that had a high PAF estimate were 11.4–17.8 times more likely to die if born preterm than term, and those with a low PAF estimate were only 1.9–2.3 times more likely to die if born preterm as opposed to full term. Overall, analysis showed that 51.7% of neonatal mortality in infants with birth defects is attributable to preterm birth. Stratified analyses performed to reduce confounders showed similar results. The relationship between birth defects and other factors contributing to preterm delivery and infant mortality is complex, and thus this study is unable to fully characterize these relationships. The associations revealed in this analysis indicate that preterm birth is a significant contributor to infant mortality in infants with birth defects, and further research can more fully characterize this association by attempting interventions both to mitigate preterm birth and to reduce infant mortality after preterm birth. Further research might also focus on particular types of birth defects and how rates of preterm birth might be reduced in specific cases of either infant or maternal risks.

Childhood mortality and associated factors in Migori County, Kenya: evidence from a cross-sectional survey

ObjectivesThe under-five mortality (U5M) rate in Kenya (41 per 1000 live births) remains significantly above international goals (25 per 1000 live births). This is further exacerbated by regional inequalities in...

News from the European Journal of Therapeutics: A new issue and a new editorial board

News from the European Journal of Therapeutics: A new issue and a new editorial board

Cervical Length Surveillance in Patients With a History of Early Versus Late Preterm Birth [ID: 1378074

INTRODUCTION: The American College of Obstetricians and Gynecologists recommends patients with a history of a preterm birth (PTB) be monitored with serial cervical length (CL) measurements for short cervix. We sought to evaluate the utility of serial CL surveillance in patients based on gestational age at the time of their prior PTB. METHODS: This was a multi-institutional retrospective study of pregnant patients with a history of spontaneous PTB between 23 weeks 0 days and 36 weeks 6 days that underwent a transvaginal CL between January 2017 and December 2021. Multiple gestation pregnancies were excluded. Data were compared between patients with a history of late PTB (&gt;34 weeks) and patients with a history of early PTB (&lt;34 weeks) using χ2 tests, t tests, and ANOVA analyses, as appropriate (α=0.05). Institutional review board approval was obtained for the study. RESULTS: Of 321 patients with a history of spontaneous PTB, 106 (33%) had a late PTB and 215 (67%) had an early PTB. Patients with a prior late PTB were less likely to be on 17-OHP (42.5% versus 54.5%, P=.04) and have a cerclage placed (4% versus 19.5%, P=.0002) compared to patients with an early PTB. Patients with a prior late PTB had their first CL performed at later gestations (18 weeks 0 days versus 17 weeks 2 days, P=.016) and fewer CL measurements (3.2 versus 3.5, P=.034). There was no difference in the gestational age that the shortest CL was detected (21 weeks 0 days versus 21 weeks 0 days, P=.98). CONCLUSION: In patients with either a history of early or late spontaneous PTB, universal CL surveillance at the time of the anatomy (18–20 weeks) may be sufficient to identify patients for intervention.

Factors Associated With Pregnancy Duration up to 32 Weeks in Patients With Twin Gestations Who Underwent Cerclage Placement [ID: 1378167

INTRODUCTION: Historically, cerclages were not recommended in multiple-gestation pregnancies because of uncertain efficacy and concern for harm. However, a meta-analysis of twin pregnancies found cerclage was associated with reduction in preterm birth (PTB) less than 32 weeks with cervical length (CL) of 15 mm or lower. METHODS: We conducted a retrospective analysis of women who underwent cervical cerclage placement at a single tertiary academic center from 2008 to 2020. Data pertaining to maternal demographics, obstetric course, sonographic CL, and cerclage operative technique were abstracted for women with twin gestations. Factors with P value of .2 or lower on univariate analysis of spontaneous PTB (sPTB) less than 32 weeks were considered for incorporation along with history of sPTB into a Cox proportional-hazards model to assess factors associated with pregnancy duration up to 32 weeks. RESULTS: Seventy-five twin gestations were analyzed. On univariate analysis, neuraxial anesthesia during cerclage placement, preoperative cervical dilation, use of Foley catheter for membrane elevation, shorter postoperative CL, and twin B male sex were found to be significantly associated with sPTB less than 32 weeks. Cox proportional-hazards analysis demonstrated that use of Foley catheter for membrane elevation, neuraxial anesthesia, postoperative CL less than 25 mm recorded 24 weeks or earlier, and history of sPTB greater than 16 weeks had significantly higher adjusted hazard ratios. The bias-corrected bootstrapped (1,000 repetitions) AUROC for a logistic regression model with these four covariates predictive of sPTB less than 32 weeks was 0.83 (95% CI 0.69–0.89). CONCLUSION: A survival analysis approach offers valuable clinical insight into predictors of shorter pregnancy duration up to 32 weeks in twin gestations undergoing cervical cerclage placement.

Perioperative Maternal-Fetal Outcomes in the Setting of Minimally Invasive Fetal Therapy for Complex Monochorionic Pregnancies with Monitored Anesthesia Care

Introduction: Fetoscopic selective laser photocoagulation (FSLPC) and selective cord occlusion with radiofrequency ablation (RFA) can improve fetal outcomes when vascular anastomoses between fetuses cause twin-to-twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR) in multiple gestation pregnancies with monochorionic placentation. This study analyzed perioperative maternal-fetal complications and anesthetic management in a high-volume fetal therapy center over a 4-year period. Methods: Included patients received MAC for minimally invasive fetal procedures for complex multiple gestation pregnancies between January 1, 2015, and September 20, 2019. Maternal and fetal complications, intraoperative maternal hemodynamics, medication usage, and reasons for conversion to general anesthesia, if applicable, were analyzed. Results: A total of 203 (59%) patients underwent FSLPC and 141 (41%) had RFA. Four patients (2%; rate 95% CI: 0.00039, 0.03901) undergoing FSLPC had conversion to general anesthesia. No conversions to general anesthesia occurred in the RFA group. The incidence of maternal complications was higher in those who underwent FSLPC. No aspiration or postoperative pneumonia events were observed. Medication usage was similar in FSLPC and RFA groups. Conclusion: A low rate of conversion to general anesthesia and no serious adverse maternal events were observed in patients receiving MAC.

Correlation of IVF outcomes and number of oocytes retrieved: a UK retrospective longitudinal observational study of 172 341 non-donor cycles

ObjectiveHow do numbers of oocytes retrieved per In vitro fertilisation (IVF) cycle impact on the live birth rate (LBR) and multiple gestation pregnancy (MGP) rates?DesignRetrospective observational longitudinal study.SettingUK IVF clinics.PopulationNon-donor...

OBSERVATIONAL STUDY ON PLACENTA ACCRETA SPECTRUM DISORDERS IN A TERTIARY CENTRE FOR TWO YEARS

Introduction: Incidence of placenta previa is 3-5per 1000 pregnancies. Placenta previa includes: i) Low lying placenta: when the lower edge of placenta is within 2cms distance from internal os. (ii) Placenta previa : when placenta lies directly over the internal os. The rising incidence of cesarean section combined with increasing maternal age, the number of cases of placenta previa and its complications, including placenta accreta spectrum (PAS), will continue to increase. Aims And Objectives:To analyse : Incidence Evaluate risk factors Maternal and Neonatal outcome Methodology: A retrospective study was conducted over a period of 2 years (august 2020 - august 2022) in the Department of Obstetrics and Gynaecology, King George Hospital, Visakhapatnam. A total of 144 pregnant women with placenta previa were enrolled in this study according to the inclusion and exclusion criteria. Systematic analysis was done with respect to their age, parity, gestational age, past obstetric history, period of gestation at delivery, mode of delivery, birthweight Criteria Inclusion: Singleton pregnant women with placenta previa confirmed by ultrasonography gestational age beyond 28 weeks were selected irrespective of their parity alive or dead fetus. Exclusion: Women with multiple gestation pregnancies are excluded to avoid overrepresentation of studying high risk women. Discussion: Incidence of Placenta previa in King George Hospital, Visakhapatnam, Andhra Pradesh over a period of 2 years is 1.0% as total no. of deliveries in that year was 13552 of which placenta previa were 144. Incidence was found to be maximum i.e.,37.5% among age of 20-24 age group, 11.1% in the age group of &gt;30 years. Placenta previa incidence was highest among multigravida accounting for 76.3% of which 43.6% were previous c-sections and 33.3% were previous abortions Conclusion: Community level education regarding Safe Abortion Practices and Anemia correction should be done. Complete management and mock drills for PostPartum Hemmarhage management in cases of Placenta previa is important inorder to reduce the maternal and fetal complications Safe abortion procedures and also C section Audit should be done.

Pregnancy outcomes after first-trimester treatment with artemisinin derivatives versus non-artemisinin antimalarials: a systematic review and individual patient data meta-analysis

Malaria in the first trimester of pregnancy is associated with adverse pregnancy outcomes. Artemisinin-based combination therapies (ACTs) are a highly effective, first-line treatment for uncomplicated Plasmodium falciparum malaria, except in the first trimester of pregnancy, when quinine with clindamycin is recommended due to concerns about the potential embryotoxicity of artemisinins. We compared adverse pregnancy outcomes after artemisinin-based treatment (ABT) versus non-ABTs in the first trimester of pregnancy. For this systematic review and individual patient data (IPD) meta-analysis, we searched MEDLINE, Embase, and the Malaria in Pregnancy Library for prospective cohort studies published between Nov 1, 2015, and Dec 21, 2021, containing data on outcomes of pregnancies exposed to ABT and non-ABT in the first trimester. The results of this search were added to those of a previous systematic review that included publications published up until November, 2015. We included pregnancies enrolled before the pregnancy outcome was known. We excluded pregnancies with missing estimated gestational age or exposure information, multiple gestation pregnancies, and if the fetus was confirmed to be unviable before antimalarial treatment. The primary endpoint was adverse pregnancy outcome, defined as a composite of either miscarriage, stillbirth, or major congenital anomalies. A one-stage IPD meta-analysis was done by use of shared-frailty Cox models. This study is registered with PROSPERO, number CRD42015032371. We identified seven eligible studies that included 12 cohorts. All 12 cohorts contributed IPD, including 34 178 pregnancies, 737 with confirmed first-trimester exposure to ABTs and 1076 with confirmed first-trimester exposure to non-ABTs. Adverse pregnancy outcomes occurred in 42 (5·7%) of 736 ABT-exposed pregnancies compared with 96 (8·9%) of 1074 non-ABT-exposed pregnancies in the first trimester (adjusted hazard ratio [aHR] 0·71, 95% CI 0·49-1·03). Similar results were seen for the individual components of miscarriage (aHR=0·74, 0·47-1·17), stillbirth (aHR=0·71, 0·32-1·57), and major congenital anomalies (aHR=0·60, 0·13-2·87). The risk of adverse pregnancy outcomes was lower with artemether-lumefantrine than with oral quinine in the first trimester of pregnancy (25 [4·8%] of 524 vs 84 [9·2%] of 915; aHR 0·58, 0·36-0·92). We found no evidence of embryotoxicity or teratogenicity based on the risk of miscarriage, stillbirth, or major congenital anomalies associated with ABT during the first trimester of pregnancy. Given that treatment with artemether-lumefantrine was associated with fewer adverse pregnancy outcomes than quinine, and because of the known superior tolerability and antimalarial effectiveness of ACTs, artemether-lumefantrine should be considered the preferred treatment for uncomplicated P falciparum malaria in the first trimester. If artemether-lumefantrine is unavailable, other ACTs (except artesunate-sulfadoxine-pyrimethamine) should be preferred to quinine. Continued active pharmacovigilance is warranted. Medicines for Malaria Venture, WHO, and the Worldwide Antimalarial Resistance Network funded by the Bill & Melinda Gates Foundation.

Noninvasive Prenatal Screening for Trisomy 21 in Patients with a Vanishing Twin.

A vanishing twin (VT) occurs in up to 30% of early diagnosed twin pregnancies and is associated with an increased risk of fetal aneuploidy. Here, we describe our experience in a large VT population of 847 patients that underwent noninvasive prenatal testing (NIPT) for common fetal trisomies over a three-year period. All patients underwent an ultrasound examination prior to NIPT. Two comparison populations were included, namely, the singleton (n = 105,560) and the viable multiple gestation pregnancy samples (n = 9691) collected over the same period. All NIPT samples in the VT population received a result, of which 14 were high-risk for trisomy 21 (1.6%), nine for trisomy 18 (1.1%), and six for trisomy 13 (0.7%). Diagnostic testing confirmed the presence of trisomy 21 in 6/12 samples, giving a positive predictive value of 50%. One trisomy 18 case and no trisomy 13 cases were confirmed. The time between fetal demise and NIPT sampling did not appear to affect the number of true- or false-positive cases. In conclusion, NIPT is an effective screening method for trisomy 21 in the surviving fetus(es) in VT pregnancies. For trisomies 18 and 13, a positive NIPT should be interpreted carefully and ultrasound monitoring is preferrable over invasive diagnostic testing.

Determinants of Preeclampsia Among Pregnant Women in Public Hospitals of Wolaita and Dawuro Zones, Southern Ethiopia: A Case-Control Study.

Preeclampsia is a leading cause of maternal and fetal morbidity and mortality in Ethiopia. It is defined by the onset of new hypertension (HTN) and proteinuria in the second trimester of pregnancy. There is a research gap in the study area and there is an inconsistency of findings in previous studies. Therefore, this study aimed to determine the factors of preeclampsia among pregnant women in public hospitals. An institution-based unmatched case-control study was conducted in public hospitals in Wolaita and Dawuro Zones from February 1 to June 26, 2021. Women who were diagnosed with preeclampsia were cases, while those who did not have it were controls. They were selected using a consecutive sampling method. Descriptive statistics and logistic regression were done by STATA. A total of 349 cases and 698 controls participated in this study. The average age of the cases and controls was 26.1 ± 4.6 standard deviation (SD) and 24.6 ± 4.8 SD years, respectively. The determinants of preeclampsia in this study were a family history of HTN (adjusted odds ratio [AOR = 11.5; 95% confidence interval, CI: 6.46-20.41], family history of diabetes mellitus [AOR = 2.1; 95% CI: 1.10-3.90], having two or multiple pregnancies [AOR = 6.33; 95% CI: 2.28-17.51], primigravida [AOR = 1.49; 95% CI: 1.01-2.21], and being gravida 5-9 [AOR = 2.47; 95% CI: 1.34-4.58]). In this study, family history of HTN, family history of diabetes mellitus, history of preeclampsia, primigravida, and multiple gestation pregnancies were the determinants of preeclampsia. As a result, health care providers should pay special attention to pregnant women with a family history of HTN, primigravida, and two or multiple gestation pregnancies during antenatal care follow-up.

Determinants of death from malformations of the circulatory system

Abstract Background Congenital malformations (CMs) were the second cause of death in infants under the age of 1 year in North America and Europe in 2017, behind perinatal causes.Of the CMs, those of the circulatory system (MCSs) were the most lethal. Studies in Brazil, North America and England have reported higher mortality from MCS in the presence of prematurity, non-white skin color of the newborn, asphyxia, low birthweigth, advanced maternal age, and low maternal education level. The magnitudes of those associations vary. Those studies have investigated neither the risk of death from MCS, with control of the mediation provoked by those and other variables, nor the construction of a model to explain the relationship between variables and deaths. Objective To assess the associations of maternal geographic and socioeconomic factors, as well as gestational and birth factors, with deaths from MCSs in the first year of life in Brazil from 2006 to 2016, and to build an explanatory model of the relationship between variables and death. Methods Study of the Brazilian databases Information System on Live Births and Mortality Information System, which were linked by deterministic relationship and submitted to the cohort strategy. Crude and controlled relative risks were estimated. Acyclic graphs directed the creation of explanatory models of the relationship between maternal and fetal variables and the risks of death from MCSs and all causes. Results The deterministic linkage of 32,011,727 live birth certificates and 266,215 deaths yielded 248,027 linked pairs. Low birth weight (RR=14.38), asphyxia in the first (RR=5.95) and fifth minute (RR=11.86), maternal age ≥35 years (RR=1.66), male sex (RR=1.13), residing in the West-Central Brazil (RR=1.22) and small number of prenatal visits (RR=2.24) increased the risk of death from MCSs. Prematurity and multiple-gestation pregnancy had effects on death mediated by low birth weight and asphyxia regardless of the cause of death. Maternal education level and skin color did not increase the risk of death from MCS but influenced deaths from other causes. Conclusion The explanatory model of the relation of maternal geographic and socioeconomic, gestational and birth factors with deaths in the first year of life in Brazil from 2006 to 2016 showed that the small number of prenatal visits, male sex, low birthweigth, and presence of asphyxia in the first and fifth minutes are variables with a direct effect on the risk of death regardless of the cause of death. Deaths from MCSs in the West-Central regions and maternal age ≥35 years pose a higher risk of death, but this effect was not evidenced for other causes of death. Better gestational care with an adequate number of prenatal visits would enable the early diagnosis of MCSs with proper life support and treatment. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Federal University of Rio de Janeiro

Delayed-interval delivery in multiple gestation pregnancies: neonatal mortality, morbidity, and development.

Delayed-interval delivery (DID) is the delivery of the first fetus in a multiple gestation pregnancy without prompt delivery of the remaining fetus(es). We aimed to assess infant outcomes of DID. We performed a retrospective cohort study of infants born 22-28 weeks' gestation or weighing 401-1500 g. DID was defined as a passage of >24 h between the birth of firstborn and retained infants. Rates of mortality, morbidity, and developmental outcomes were compared within DID multiples, to other multiples not born by DID, and all infants in the Generic Database and follow-up datasets (excluding DID-born). DID-born multiples were younger and smaller than other multiples. Retained infants had no significantly different rates of mortality and morbidities compared to their firstborn counterparts, apart from less bronchopulmonary dysplasia. DID showed no evidence of harm and a potential benefit of decreased bronchopulmonary dysplasia mediated by increased gestational age and birthweight.