Neonatal Outcomes Research Articles

Neonatal septicemia: Diagnostic challenges and the role of CRP and blood culture

Neonatal septicemia, a serious blood infection occurring within the first four weeks of life, is a significant cause of neonatal deaths. Its diagnosis is challenging due to the non-specific nature of its signs and symptoms. C-reactive protein (CRP) serves as a valuable biomarker for early detection, facilitating timely treatment and improving survival rates as a rapid adjunct to the standard blood culture process. This study explores the relationship between CRP levels and blood culture findings in diagnosing Neonatal septicemia. The objectives were to determine common organisms causing neonatal septicemia, to evaluate CRP as a diagnostic tool for Neonatal septicemia compared to blood culture results. The study examined the correlation between CRP levels and blood culture outcomes in neonates suspected of having sepsis. Blood samples were aseptically collected and inoculated in 1 set of BD BACTECTM Peds Plus/F blood culture bottles, incubated for five days using a BD BACTEC automated machine. The bacteria isolated from positive blood culture were processed using Vitek-2. CRP levels were determined using the latex agglutination card test, with positive samples further analyzed via quantitative nephelometry. Of the 321 samples, 28.97% (93) tested positive for bacterial sepsis via blood culture. Among these, 33.3% (31 cases) were , 18.3% (17 cases) were , and 11.8% (11 cases) were , with coagulase-negative staphylococci (CONS) being the most common group overall. Among the Gram-negative organisms, (8.6%) and (6.5%) were significant contributors to neonatal septicemia. CRP was positive in 82 cases with blood culture-positive samples and in 105 cases with blood culture-negative samples, underscoring its potential as a diagnostic marker for Neonatal septicemia. While CRP is a valuable biomarker for detection of Neonatal septicemia, it should not be used as a sole diagnostic tool due to its lack of specificity. CRP testing provides a presumptive diagnosis that can guide early antibiotic therapy, emphasizing its significance in neonatal care.

Enhancing neonatal sepsis detection: A comparative analysis of interleukin-6 and the BacT/ALERT blood culture system

One of the main causes of newborn mortality is neonatal sepsis, which has to be diagnosed quickly and precisely. Although the Bact/ALERT method for blood culture is commonly used, it is often slow, for early identification of sepsis, interleukin-6 (IL-6) provides a quicker substitute. : This study evaluates how well the BacT/ALERT system and IL-6 diagnose newborn sepsis, aiming to determine the most reliable and timely method for improving neonatal outcomes. A clinician at the National Institute of Medical Sciences & Research who admitted neonates to the neonatal intensive care unit (NICU) suspected 120 newborns of having sepsis. The inclusion criteria were satisfied by newborns between the ages of 0 and 28 days who showed clinical signs of sepsis. Exclusion criteria included infants with congenital anomalies or those who had received antibiotics before sampling. In this study of 120 neonates, IL-6 levels were elevated in 45% of the cases, with a sensitivity of 100%, specificity 86.84%, PPV 81.48% and NPV 100% for. 36.67% of samples had bacterial growth identified by the BacT/ALERT system. In just three hours, IL-6 produced results, which was far quicker than the BacT/ALERT method. IL-6 is a rapid, sensitive marker for neonatal sepsis, offering faster diagnosis than BacT/ALERT. Combining both methods may improve early detection and treatment outcomes. IL-6 offers rapid, high-sensitivity sepsis detection compared to BacT/ALERT, which, despite being slower, is crucial for pathogen identification. Combining both methods could enhance early diagnosis and treatment.

Automated Neuroprognostication Via Machine Learning in Neonates with Hypoxic-Ischemic Encephalopathy.

Neonatal hypoxic-ischemic encephalopathy is a serious neurologic condition associated with death or neurodevelopmental impairments. Magnetic resonance imaging (MRI) is routinely used for neuroprognostication, but there is substantial subjectivity and uncertainty about neurodevelopmental outcome prediction. We sought to develop an objective and automated approach for the analysis of newborn brain MRI to improve the accuracy of prognostication. We created an anatomic MRI template from a sample of 286 infants treated with therapeutic hypothermia, and labeled the deep gray-matter structures. We extracted quantitative information, including shape-related information, and information represented by complex patterns (radiomic measures), from each of these structures in all infants. We then trained an elastic net model to use either only these measures, only the infants' demographic and laboratory data, or both, to predict neurodevelopmental outcomes, as measured by the Bayley Scales of Infant and Toddler Development at 18 months of age. Among those infants for whom Bayley scores were available for cognitive, language, and motor outcomes, we found sets of MRI-based measures that could predict their Bayley scores with correlations that were greater than the correlations based on only the demographic and laboratory data, explained more of the variance in the observed scores, and generated a smaller error; predictions based on the combination of the demographic-laboratory and MRI-based measures were similar or marginally better. Our findings show that machine learning models using MRI-based measures can predict neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy across all neurodevelopmental domains and across the full spectrum of outcomes. ANN NEUROL 2024.

Incentives for pregnant mothers during antenatal care for better maternal and neonatal health outcomes in low and middle income countries: A Systematic Review and Meta-Analysis

Background Universal access to maternal, newborn, and child healthcare is essential for achieving Sustainable Development Goal 3, but the effectiveness of various incentive-based programs for pregnant mothers in low- and middle-income countries (LMICs) remains uncertain. Objective of this systematic review was to determine if incentive-based interventions influenced maternal and neonatal health outcomes. Methods We conducted a search in various databases from inception. All incentive-based interventional studies conducted on pregnant women in LMICs were included. Evidence from the included trials was synthesized using risk ratios (RRs) to compare the outcomes between groups receiving incentives and not receiving incentives. The meta-analysis was conducted using random-effects model. We assessed the quality of the included studies using the Cochrane Risk of Bias 2.0 tool and reviewed the collected data to determine its suitability for meta-analysis. This study is registered in PROSPERO (CRD42021247681). Results Of the 3,897 records that were identified, 11 met eligibility criteria, all of which exhibited varying degrees of risk of bias, ranging from high to some concerns. Analysis of maternal outcomes across studies revealed no significant differences in the likelihood of delivering at a healthcare facility (RR 1.13, 95% CI: 0.86 to 1.47) and in frequency of prenatal care (RR 0.99, 95% CI: 0.88 to 1.12) between intervention and control groups. However, high levels of statistical heterogeneity were observed for both outcomes indicating variability among study results. Similarly, analysis of tetanus vaccine coverage showed no significant difference between groups (RR 1.00, 95% CI: 0.92 to 1.08), with moderate statistical heterogeneity observed. Conclusion The maternal and neonatal outcomes examined in this review did not have any significant differences in intervention group when compared to the control group. The interventions to address maternal health concerns need to follow a multifactorial approach. There is a need for extensive primary research studies in the future.

Knowledge, Practices, and Adherence to Infection Prevention and Control among Health Care Providers in the Labour Ward at Busia County Referral Hospital

Provider's Infection prevention and control (IPC) skills are essential for healthcare (HCPs), particularly in labour wards, where they significantly affect maternal and neonatal outcomes. Hospital-acquired infections (HAIs) are major contributors to maternal and neonatal sepsis, resulting in high morbidity and mortality rates, especially in low- and middle-income countries. This study aimed to assess knowledge, practices, and adherence to IPC among HCPs in the labour ward at Busia County Referral Hospital, focusing on hand hygiene, use of personal protective equipment (PPE), and maintaining a clean environment. A cross-sectional study design was used to collect quantitative data from HCPs directly involved in patient care. The sample size consisted of 11 HCPs, with 10 participants, including 30% nurses, 30% clinical officers, and 40% nursing students. Most participants (40%) were aged 20-25 years, and 60% were male. Data were gathered through self-administered questionnaires and an observational checklist. Analysis was performed using Microsoft Excel, with results presented in tables, graphs, and pie charts. The findings revealed that 90% of HCPs had received formal IPC training. While 60% demonstrated good IPC knowledge, the mean score was 78% for knowledge, 69% for practices, and 50% for adherence. Although HCPs exhibited strong knowledge and practices, their adherence to IPC protocols was only borderline satisfactory. The study suggests that regular IPC training is needed to improve adherence, along with hospital management providing sufficient resources, conducting supervision, and implementing feedback mechanisms for HCPs

Describing Biological Vulnerability in Small, Vulnerable Newborns in Urban Burkina Faso (DenBalo): Gut Microbiota, Immune System, and Breastmilk Assembly

Background: Small vulnerable newborns (SVNs), including those born preterm, small for gestational age, or with low birth weight, are at higher risk of neonatal mortality and long-term health complications. Early exposure to maternal vaginal microbiota and breastfeeding plays a critical role in the development of the neonatal microbiota and immune system, especially in low-resource settings like Burkina Faso, where neonatal mortality rates remain high. Objectives: The DenBalo study aims to investigate the role of maternal and neonatal factors, such as vaginal and gut microbiota, immune development, and early nutrition, in shaping health outcomes in SVNs and healthy infants. Methods: This prospective cohort observational study will recruit 141 mother-infant pairs (70 SVNs and 71 healthy controls) from four health centers in Bobo-Dioulasso, Burkina Faso. The mother-infant pairs will be followed for six months with anthropometric measurements and biospecimen collections, including blood, breast milk, saliva, stool, vaginal swabs, and placental biopsies. Multi-omics approaches, encompassing metagenomics, metabolomics, proteomics, and immune profiling, will be used to assess vaginal and gut microbiota composition and functionality, immune cell maturation, and cytokine levels at critical developmental stages. Conclusions: This study will generate comprehensive data on how microbiota, metabolomic, and proteomic profiles, along with immune system development, differ between SVNs and healthy infants. These findings will guide targeted interventions to improve neonatal health outcomes and reduce mortality, particularly in vulnerable populations.

Stringent Regulations of Oocyte Donation Among Jewish Women in Israel: Characteristics and Outcomes of the National Oocyte Donation Program in One Central IVF Unit.

On September 5, 2010, the Israeli Parliament passed a law that allows Israeli female residents to donate their oocytes to infertile Israeli female residents. This law includes unique restrictions that do not exist in other countries. Our aim was to characterize Israeli oocyte donors and recipients and the outcomes of the oocyte donation program as regulated by national law. This retrospective study included 26 financially compensated volunteer donors (mean age 29 ± 3.52 years) and 69 recipients (mean age 44.6 ± 3.53 years) who underwent 30 intracytoplasmic sperm injection cycles and 166 embryo transfers (ETs) in our unit between March 2016 and November 2020. Stringent legal caveats unique to Israel (e.g., Jewish/Moslem donor only to Jewish/Moslem recipient, only unmarried donor, eggs in one cycle restricted to ≤ 3 recipients, donated sperm only from non-Jewish donors, and more) were meticulously applied. Sociodemographic characterizations of donors and recipients were reviewed, and pregnancy and obstetric outcomes were determined. Variables that were significant in achieving live births among the recipients were examined. Twenty-five donors and all 69 recipients were Jewish, and most were unmarried and childless. The main indication for seeking egg donation was age ≥ 40 years/perimenopause (80%). One-half of the recipients used donor sperm and one-half used partner sperm. The pregnancy, clinical pregnancy, live birth, and miscarriage rates were 28.6%, 19.2%, 18.2%, and 2.8%. The live birth rate was negatively associated with multiple ETs. Maternal complications included hypertensive disorders of pregnancy (18.2%), gestational diabetes mellitus (32.3%), and caesarean sections(78.8%). There were no adverse neonatal outcomes. In conclusion, few young women are interested in donating oocytes in Israel. Pregnancy and live birth rates are lower than published values in other egg donation programs.

The Development of a Forceps-Adaptable Pressure Device for Instrumental Delivery: A Proof-of-Concept Study for Clinical and Educational Applications

Objective: To develop and validate a device that measures the pressure exerted by forceps on the fetal head for clinical use. Background: The lack of clinical tools to quantify forceps pressure on the fetal head may impact maternal and neonatal outcomes. Existing studies have not measured the direct contact pressure between forceps blades and the fetal head, highlighting the need for innovation. Methods: We integrated fluid pressure transducers into obstetric forceps using fluid-filled tubing encased in flexible silicone socks attached to the blades. Tubing materials—polyvinyl chloride (PVC) and polyurethane (PU)—and fluids (air and water) were tested with both biocompatible and non-biocompatible silicone socks. An onboard electronic board collected pressure data and transmitted them via Bluetooth for real-time analysis. The system was evaluated on a custom-built bench simulating forceps application. Results: Air-filled tubing exhibited significant drift and low accuracy due to air compressibility. Water-filled PU tubing reduced drift but was still suboptimal. Water-filled PVC tubing with both types of silicone socks provided the best results, showing minimal drift and a strong correlation between measured pressures and applied forces. Conclusions: The developed device represents a significant advancement, as no existing system measures the pressure exerted by forceps blades on the fetal head. By effectively measuring pressure across the entire contact surface in real time, it offers applications in both training and clinical practice. The device allows for objective feedback, potentially improving the safety and efficacy of forceps deliveries. Future work includes comprehensive mannequin tests and eventual in vivo studies to validate its effectiveness in realistic settings, aiming to enhance obstetric training and reduce maternal and neonatal complications.

Obesity Prevalence and Its Impact on Maternal and Neonatal Outcomes in Pregnant Women: A Systematic Review

Obesity Prevalence and Its Impact on Maternal and Neonatal Outcomes in Pregnant Women: A Systematic Review

Evaluation of Neonatal and Maternal Outcomes in Pregnant Women with COVID-19 in Southern Iran: A Case-Control Study

Background: Pregnant women and their fetuses are considered high-risk populations during pandemics, including coronavirus disease 2019 (COVID-19). Objectives: This study aims to evaluate maternal and neonatal outcomes among pregnant women infected with COVID-19. Methods: This descriptive, analytical, retrospective case-control study included COVID-19-infected pregnant women referred to hospitals affiliated with Shiraz University of Medical Sciences in southern Iran from March 2021 to March 2022. Data were collected using a pre-designed checklist covering demographic information and maternal and neonatal outcomes. Analyses were performed using SPSS version 25, with the significance level set at P < 0.05. Results: Significant differences were observed in maternal and neonatal outcomes for variables such as vaginal bleeding, fetal distress, premature birth, intrauterine death, ICU admission, low birth weight, and NICU admission (P < 0.05). Although neonatal transient tachypnea and pneumonia were more than twice as common in infants of COVID-19-infected mothers compared to controls, these findings were not statistically significant (P > 0.05). Similarly, abnormal lung X-rays, thrombocytopenia, and positive CRP were slightly more frequent in infants born to COVID-19-infected mothers, but these differences did not reach statistical significance (P > 0.05). Conclusions: The study highlights the increased risks of adverse short-term and long-term maternal and neonatal outcomes associated with COVID-19 during pregnancy. Prioritizing pregnancy-specific interventions is crucial in pandemic management to mitigate these risks and improve outcomes for both mothers and their infants.

External cephalic version in nonvertex second twin-Success rate, mode of delivery, and safety: A systematic review.

One of the key challenges regarding the management of twins involves choosing the optimal mode of delivery, which is strongly influenced by the final presentation of both fetuses. In cases of vertex-nonvertex pregnancies attempting the trial of vaginal delivery, external cephalic version (ECV) is one of possible management options. The main objective of this review was to collect and summarize available data in terms of the application of ECV in the population of nonvertex second twins. Using the PRISMA guidelines, we searched for original, English-language studies investigating ECV in nonvertex second twins. The PubMed/MEDLINE, SCOPUS, and COCHRANE databases were searched until May 2024. Reviews, case reports, editorials, and conference papers were excluded from further analysis. Out of 260 papers retrieved, 10 were subjected to the final analysis in terms of success rates, modes of delivery, and adverse outcomes. The total number of ECVs was 289, with an overall success rate of 64.4%. In the group of successful versions, vertex vaginal delivery was achieved in 171 cases (91.9%). The incidence of adverse maternal and neonatal outcomes was low. The purpose of this review was to consolidate and update the current knowledge regarding ECV in nonvertex second twins. Based on the results of this series of studies, ECV appears to be a reasonable management option. However, it is important to highlight several significant limitations. The primary concern is the lack of recent research in this field over the past three decades, with the most recent study in our review being published in 1998. Furthermore, the actual number of studies addressing this topic is relatively low, characterized by a retrospective nature and questionable methodologies. These limitations make it challenging to draw definitive conclusions for clinical practice. This is an important message for our community, emphasizing the need for further studies in this area, particularly randomized controlled trials, to evaluate the safety and success rate of vaginal twin delivery after ECV when the second twin presents in a nonvertex position.

The effect of coronavirus disease 2019 vaccination on pregnant women: A scoping review

Background: Globally, reports have shown that pregnant women refuse to receive the coronavirus disease 2019 (COVID-19) vaccine. This has posed a significant concern given the global impact of the COVID-19 pandemic.Aim: This study aims to explore the current evidence on the effect of COVID-19 vaccination on pregnant women.Method: A scoping review was conducted using Levac et al.’s five-stage framework. Relevant articles were searched in the Web of Science, PubMed, Scopus and EBSCOhost (CINAHL) databases. The identified articles were screened based on predetermined inclusion and exclusion criteria. Data from the selected articles were charted and summarised into meaningful units.Results: Twelve articles from developed countries were included in the review. Studies have reported that COVID-19 vaccination during pregnancy is generally safe and does not increase the risk of pregnancy complications. There was no significant difference in delivery outcomes between vaccinated and unvaccinated women. Neonatal outcomes were not affected by the vaccination. However, one study identified a potential risk of spontaneous abortion between 6 and 9 weeks of gestation among vaccinated women.Conclusion: Coronavirus disease 2019 vaccination is considered safe during pregnancy. While some studies have identified potential associations with certain conditions, the overall benefits of vaccination outweigh the risks. Continued monitoring of the safety and effectiveness of COVID-19 vaccines during pregnancy is recommended. Pregnant women should consult healthcare providers to make informed decisions regarding vaccination.Contribution: The findings of this review may assist in alleviating anxiety and reducing vaccine hesitancy among pregnant women.

Pregnancy and neonatal outcomes in Eastern Democratic Republic of the Congo: a systematic review

Pregnancy and neonatal outcomes in Eastern Democratic Republic of the Congo: a systematic review

Maternal oxygenation and fetal-neonatal mortality among patients with COVID-19 requiring advanced respiratory support in ICU: A multicenter prospective cohort study.

To explore the association of maternal characteristics, oxygenation, and mechanical ventilatory parameters with fetal and neonatal outcomes. The present study was a multicenter, binational (Argentina/Colombia), prospective, cohort study, conducted in 21 intensive care units (ICUs) and including pregnant or postpartum patients with COVID-19 pneumonia requiring advanced respiratory support and their fetuses/neonates. Advanced respiratory support was defined as high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV). A total of 91 patients were admitted to 21 ICUs: 63 (69%) antepartum and 28 (31%) postpartum. Among those admitted antepartum (63), delivery was induced in 43 (68.3%), being the reasons mostly maternal (28/43; 65.1%). Of 71 births, 64 (90%) were preterm. A total of 14 fetal/neonatal losses (14/91;15.4%) occurred. The main differences between patients whose fetuses/neonates survived versus those who did not survive were in APACHE II (12 [7-15] vs. 16.5 [14-20]; P = 0.003), SOFA24 (4 [3-5] vs. 6.5 [5-8]; P = 0.001), gestational age at delivery (32.9 ± 3 vs. 27.6 ± 6.2; P = 0.014), acute respiratory distress syndrome (54 [70.1%] vs. 14 [100%]; P = 0.011), septic shock (26 [33.8%] vs. 9 [64.3%]; P = 0.031), IMV (55 [71.4%] vs. 14 [100%]; P = 0.019) and plateau pressure before delivery (23 [21-26] vs. 28 [27-30]; P = 0.019). The incidence of fetal/neonatal mortality among 47 pregnant patients requiring IMV with SpO2 < 95% versus SpO2 >95% before intubation was 12/35 (34.28%) versus 1/12 (8.33%), respectively; P = 0.163. The incidence of fetal/neonatal mortality among those with SpO2 <95% versus SpO2 >95% before delivery was 5/18 (27.77%) versus 8/29 (25.58%), respectively; P = 0.999. The vast majority of births were preterm. Among patients admitted antepartum, most deliveries were induced for maternal reasons. Fetal/neonatal losses were associated with gestational age at delivery, maternal severity of illness on admission and certain ventilatory parameters but not with maternal oxygenation, as is commonly the focus in these patients.

Prevalence and Antibiotic Resistance Patterns of Neonatal Bloodstream Pathogens in Tertiary Care Hospitals: A Retrospective Analysis

Background: Neonatal bloodstream infections (BSIs) are a leading cause of mortality in developing countries, necessitating effective treatment strategies. Objective: This retrospective study investigated the prevalence and antibiotic susceptibility patterns of bacterial pathogens causing neonatal BSIs in two tertiary hospitals in Dhaka, Bangladesh. Methodology: This is a retrospective study took place in Ad-din Women’s Medical College &amp; Hospital, Dhaka &amp; Rushmono specialized Hospital, Dhaka, Bangladesh in between the time period of July 2019 to December 2020. A total of 1825 blood samples were obtained from patients who were admitted at the Neonatal Intensive care unit of Ad-din Women’s Medical College &amp; Hospital, Dhaka &amp; Rushmono specialized Hospital, Dhaka, Bangladesh from July 2019 to December 2020. All the blood samples were processed for culture using a BACT/Alert blood culture machine. Further identification &amp; antimicrobial susceptibility tests were performed using standard microbiological procedure. Results: The analysis of 1825 blood samples obtained from neonatal intensive care facilities unveiled a bloodstream infection (BSI) rate of 17.2%. The predominant isolates identified were coagulase-negative Staphylococci (CONS) (10%) and Acinetobacter spp. (60%); these organisms are classified as Gram-positive and negative bacteria, respectively. The preponderance of infections was caused by Gram-positive organisms, specifically CONS, which evolved highly sensitive to imepenem, vancomycin, and linezolid but resistance to ampicillin, cephradine and erythromycin. Methicillin resistance is present in 31.5% of Staphylococcus aureus and nearly half (47%) of the CONS. Vancomycin resistance is present in one-tenth of the isolated Staphylococcus species. Acinetobacter spp. exhibited greater susceptibility to colistin (100%), meropenem (90.67%), piperacillin-tazobactum (92%), and amikacin (82.67%), but resistance to ampicillin (90%), cephradin (80%), cefuroxime (90%), and cefixime (61%). Proteus, Enterobacterieceae, including E. coli, Klebsiella, and Enterobacter, exhibited greater resistance to ampicillin, cephradin, and chloramphenicol while demonstrating greater sensitivity to meropenem (100%), piperacillin-tazobactum (95-98%), amikacin (80-82%), and gentamycin (76%-80%). Conclusion: Major causative agents of neonatal blood stream infection were coagulase-negative Staphylococci (CONS) and Acinetobacter spp. Multidrug resistance among these bacteria was observed in the study ; which necessitate the implementation of antibiotic stewardship program to improve neonatal outcome. Bangladesh Journal of Medical Microbiology, January 2024;18(1):22-29

Placental nanoparticle-mediated IGF1 gene therapy corrects fetal growth restriction in a guinea pig model.

Fetal growth restriction (FGR) caused by placental insufficiency is a major contributor to neonatal morbidity and mortality. There is currently no in utero treatment for placental insufficiency or FGR. The placenta serves as the vital communication, supply, exchange, and defense organ for the developing fetus and offers an excellent opportunity for therapeutic interventions. Here we show efficacy of repeated treatments of trophoblast-specific human insulin-like 1 growth factor (IGF1) gene therapy delivered in a non-viral, polymer nanoparticle to the placenta for the treatment of FGR. Using a guinea pig maternal nutrient restriction model (70% food intake) of FGR, nanoparticle-mediated IGF1 treatment was delivered to the placenta via ultrasound guidance across the second half of pregnancy, after establishment of FGR. This treatment resulted in correction of fetal weight in MNR + IGF1 animals compared to sham treated controls on an ad libitum diet, increased fetal blood glucose and decreased fetal blood cortisol levels compared to sham treated MNR, and showed no negative maternal side-effects. Overall, we show a therapy capable of positively impacting the entire pregnancy environment: maternal, placental, and fetal. This combined with our previous studies using this therapy at mid pregnancy in the guinea pig and in two different mouse model and three different human in vitro/ex vivo models, demonstrate the plausibility of this therapy for future human translation. Our overall goal is to improve health outcomes of neonates and decrease numerous morbidities associated with the developmental origins of disease.

The Role of Prenatal Ultrasound Examination in Predicting the Outcomes of Ovarian Fetal Cysts: A Pictorial Essay

Objectives: The aim of this study was to evaluate prenatal ultrasound features, fetal postnatal outcomes, and the need for postnatal surgery in the suspicion of ovarian torsion. Methods: We included patients with a singleton pregnancy with a suspicion of ovarian fetal cyst referred to our center. Data derived from prenatal ultrasound evaluations, delivery, and postnatal follow-up were then extracted from the hospital registers. Results: The ultrasound features of 32 fetal ovarian cysts and related neonatal outcomes were analyzed. The mean gestational age at diagnosis was 32 weeks (28–36), while the mean diameter of the cyst diagnosis was 34.8 ± 13.2 mm. In 78.1% of cases, the cysts did not change their characteristics during pregnancy, while in 9.4%, they increased their dimensions, and in 12.5%, they reduced their size. In 78.1% of cases, the diagnosis was confirmed postnatally, and in 40% of cases, a spontaneous regression occurred during follow-up. Surgery was performed in 60% of cases, and most of the time (66.7%), an adnexectomy was required. Conclusions: An unfavorable outcome was associated with cystic dimensions and ultrasound feature modifications during pregnancy. However, our study demonstrated that a hemorrhagic content is not always indicative of adnexal torsion, and spontaneous resolution may occur. In addition, only a few of the simple anechoic cysts managed surgically presented with necrosis at histopathological examination; therefore, a conservative approach might be proposed in those cases.

Prenatal Maternal Psychological Stress (PMPS) and Its Effect on the Maternal and Neonatal Outcome: A Retrospective Cohort Study

Background/Objectives: Prenatal psychology studies show that stress, depression, and psychological stress during pregnancy can have a significant impact on maternal and fetal health and are highly prevalent. The aim of the study was to compare maternal and neonatal short-term outcomes in pregnant women* (the asterisk (*) is used at the appropriate places in this text to indicate that all genders are included) with a history of prenatal maternal psychological stress (PMPS) with those of pregnant women* not exposed to PMPS to determine differences and identify risk factors. Methods: Statistical tests for differences and relative risks between the groups were carried out with the perinatal data of University Hospital Tübingen from 2022 using IBM SPSS. Results: The study shows that PMPS has significant negative effects on various parameters, including the rate of premature births, preeclampsia, induction of birth, birth duration, and fetal asphyxia, as well as the birth weight of the children and their Apgar values (an assessment of newborn health scored shortly after birth). In addition, the risk of PMPS increases in women* with stillbirths and two or more previous miscarriages. However, the practical relevance must be critically scrutinized and confirmed by bigger studies. Conclusions: PMPS has a significant impact on the maternal and neonatal birth outcomes and must be identified as a risk factor in pregnancy. There is still a need for further research with larger samples, more balanced groups, and multivariate regression models to generate detailed, more transferable results and a deeper insight into the significant effects of PMPS and the role midwives can play in helping it.

Adding naloxone to buprenorphine during pregnancy was not linked to increased adverse neonatal or maternal outcomes.

Straub L, Bateman BT, Hernández-Díaz S, et al. Comparative safety of in utero exposure to buprenorphine combined with naloxone vs buprenorphine alone. JAMA. 2024;332:805-816. 39133511.

A cross-sectional study of paramedic management of out-of-hospital obstetric emergencies

Background/Aims Most birth-related ambulance calls occur without difficulty, but in some cases, complications can arise. Paramedics’ involvement in birth is infrequent; therefore, the knowledge and skills required to manage complications can atrophy over time, particularly without educational interventions. This may impact outcomes. The study's aims were to measure the knowledge, attitude, and practice of paramedics in managing obstetric cases. Methods This cross-sectional questionnaire-based study was carried out with 264 paramedics. Spearman's measure of correlation was used to observe linear correlations between ranks of the observations. Results The majority of participants were advanced care paramedics (81.1%). Participants reported infrequently attending births in the community, with under half feeling confident in managing these (44%). Antenatal complications and trauma in pregnancy were self-reported areas of weakness; this was consistent with assessed knowledge. Conclusions Paramedics self-reported infrequently responding to obstetric calls and the majority lacked confidence in managing these. Few indicated an excellent level of obstetric knowledge, reporting a desire to receive more education in this area. Implications for practice When paramedics lack confidence in managing obstetric emergencies, it can lead to delayed decision making, inadequate assessment, increased error rates and adverse maternal and neonatal outcomes.