Nuchal Cord Research Articles

Is There an Added Neonatal Risk in Vacuum-Assisted Deliveries with Nuchal Cord?

This retrospective cohort study assessed the association between nuchal cord and adverse outcomes during vacuum-assisted delivery (VAD). Women with singleton pregnancies, 34−41-weeks gestation, who underwent VAD, from 2014 to 2020 were included. The primary outcome was umbilical cord pH ≤ 7.1. Secondary outcomes were neonatal intensive care unit admission, Apgar scores, pH < 7.15, subgaleal hematoma, shoulder dystocia and third/fourth-degree perineal tear. Outcomes were compared between neonates with (1059/3754, 28.2%) or without (71.8%) nuchal cord after VAD. No difference in cord pH ≤ 7.1 was found between groups. The nuchal cord group had a lower rate of nulliparity (729 (68.8%) vs. 2004 (74.4%), p = 0.001) and higher maternal BMI (23.6 ± 4.3 vs. 23.1 ± 5, p = 0.017). Nuchal cord was associated with higher rates of induction (207 (19.5%) vs. 431 (16%), p = 0.009) and lower birthweights (3185 ± 413 vs. 3223 ± 436 g, p = 0.013). The main indication for VAD in 830 (80.7%) of the nuchal cord group was non-reassuring fetal heart rate (NRFHR) vs. 1989 (75.6%) controls (p = 0.004). The second stage was shorter in the nuchal cord group (128 ± 81 vs. 141 ± 80 min, p < 0.001). Multivariate regression found nulliparity, induction and birthweight as independent risk factors for nuchal cord VAD. Although induction and NRFHR rates were higher in VAD with nuchal cord, the rate of umbilical cord acidemia was not.

Monochorionic monoamniotic twin pregnancies.

Monochorionic monoamniotic (MCMA) twin pregnancy is rare and associated with increased complication rates when compared with singletons, dichorionic and monochorionic diamniotic pregnancy in general. Monoamnionicity presents an enormous challenge following its accurate diagnosis, where the absence of an inter-twin membrane subsequently results in cord entanglement and consistently fluctuating foetal position. Furthermore, the detection of twin-twin transfusion syndrome (TTTS) in MCMA pregnancy can be challenging in the absence of amniotic fluid volume discordance without the presence of the inter-twin dividing membrane. Early surveillance of foetal anatomy permits early recognition of foetal structural anomalies, the twin reversed arterial perfusion (TRAP) sequence and conjoined twins. However, the evidence on how best to monitor MCMA pregnancies remains inadequate, though observational studies have demonstrated that once surveillance is initiated, the potential risk of foetal death decreases significantly. In-utero foetal demise can be acute and unpredictable in MCMA pregnancies, despite close surveillance. Elective preterm delivery is usually advocated when the risk of foetal loss upon continuing the pregnancy outweighs the risk of prematurity - around 33 weeks' gestation by caesarean section. Nevertheless, the optimal prenatal surveillance regimen and prompts for delivery have yet to be defined.

Role of Volume Replacement during Neonatal Resuscitation in the Delivery Room.

Volume expanders are indicated in the delivery room when an asphyxiated neonate is not responding to the steps of neonatal resuscitation and has signs of shock or a history of acute blood loss. Fetal blood loss (e.g., feto-maternal hemorrhage) may contribute to perinatal asphyxia. Cord compression or a tight nuchal cord can selectively occlude a thin-walled umbilical vein, resulting in feto-placental transfusion and neonatal hypovolemia. For severe bradycardia or cardiac arrest secondary to fetal blood loss, Neonatal Resuscitation Program (NRP) recommends intravenous volume expanders (crystalloids such as normal saline or packed red blood cells) infused over 5 to 10 min. Failure to recognize hypovolemia and subsequent delay in volume replacement may result in unsuccessful resuscitation due to lack of adequate cardiac preload. However, excess volume load in the presence of myocardial dysfunction from hypoxic–ischemic injury may precipitate pulmonary edema and intraventricular hemorrhage (especially in preterm infants). Emergent circumstances and ethical concerns preclude the performance of prospective clinical studies evaluating volume replacement during neonatal resuscitation. Translational studies, observational data from registries and clinical trials are needed to investigate and understand the role of volume replacement in the delivery room in term and preterm neonates. This article is a narrative review of the causes and consequences of acute fetal blood loss and available evidence on volume replacement during neonatal resuscitation of asphyxiated neonates.

The Umbilical Cord and Complications of Twin Gestations

Abstract The rate of twin pregnancies has increased over the last decades, largely because of the ongoing development of assisted reproductive technology and increased maternal age at childbearing. Twins have a higher risk of adverse outcomes during pregnancy and the perinatal period. The prevalence of umbilical cord abnormalities is higher for twin pregnancies compared with singleton pregnancies. Some of these abnormalities are nonspecific to twinning and can also be found in singleton gestations (such as velamentous cord insertion, vasa previa, and single umbilical artery). Other abnormalities are associated with monochorionic twins, such as umbilical cord entanglement, and umbilical proximate cord insertion. Most of these abnormalities can be detected by ultrasound evaluation. The early and accurate ultrasound diagnosis of chorionicity, amnionicity, and placental and umbilical cord characteristics is crucial if we are to predict the risk of complications and to determine the best management for twin pregnancies. Histopathological examination of the placenta and umbilical cord after delivery can help to confirm prenatal diagnosis and to provide a better understanding of the physiopathology of their abnormalities. The aim of this review was to emphasize the role that the umbilical cord plays in twin complications and to describe the management of these high-risk pregnancies.

Pregnancy and fetal outcomes of chronic hepatitis C mothers with viremia in China.

BACKGROUNDData that assess maternal and infant outcomes in hepatitis C virus (HCV)-infected mothers are limited.AIMTo investigate the frequency of complications and the associated risk factors.METHODSWe performed a cohort study to compare pregnancy and fetal outcomes of HCV-viremic mothers with those of healthy mothers. Risk factors were analyzed with logistic regression.RESULTSAmong 112 consecutive HCV antibody-positive mothers screened, we enrolled 79 viremic mothers. We randomly selected 115 healthy mothers from the birth registry as the control. Compared to healthy mothers, HCV mothers had a significantly higher frequency of anemia [2.6% (3/115) vs 19.0% (15/79), P < 0.001] during pregnancy, medical conditions that required caesarian section [27.8% (32/115) vs 48.1% (38/79), P = 0.004], and nuchal cords [9.6% (11/115) vs 34.2% (27/79), P < 0.001]. In addition, the mean neonatal weight in the HCV group was significantly lower (3278.3 ± 462.0 vs 3105.1 ± 459.4 gms; P = 0.006), and the mean head circumference was smaller (33.3 ± 0.6 vs 33.1 ± 0.7 cm; P = 0.03). In a multivariate model, HCV-infected mothers were more likely to suffer anemia [adjusted odds ratio (OR): 18.1, 95% confidence interval (CI): 4.3-76.6], require caesarian sections (adjusted OR: 2.6, 95%CI: 1.4-4.9), and have nuchal cords (adjusted OR: 5.6, 95%CI: 2.4-13.0). Their neonates were also more likely to have smaller head circumferences (adjusted OR: 2.1, 95%CI: 1.1-4.3) and lower birth weights than the average (≤ 3250 gms) with an adjusted OR of 2.2 (95%CI: 1.2-4.0). The vertical transmission rate was 1% in HCV-infected mothers.CONCLUSIONMaternal HCV infections may associate with pregnancy and obstetric complications. We demonstrated a previously unreported association between maternal HCV viremia and a smaller neonatal head circumference, suggesting fetal growth restriction.

Highlights from the International Twins Congress 2021

Highlights from the International Twins Congress 2021

Fetal-maternal incompatibility in the Rh system. Rh isoimmunization associated with hereditary spherocytosis: case presentation and review of the literature.

Next to A and B antigens, agglutinogen D exhibits the highest immunogenicity. Following the transfusion of D-positive red blood cells (RBCs), almost 80% of D-negative recipients develop anti-D antibodies (Abs). Subsequently, anti-D immunization further promotes the synthesis of Abs towards other blood group antigens in or outside the Rh system. The D antigen is also involved in 95% of cases of hemolytic disease of the newborn. Transfusions, hemotherapy, grafts, and obstetric history (abortions, ectopic pregnancy, births) are all risk factors for Rh isoimmunization. In the case of ABO compatibility between mother and fetus, Rh-positive fetal RBCs that have reached the maternal bloodstream are not destroyed by group agglutinins, and Rh antigenic sites are not hidden by the maternal immune system. But a Rh-negative mother with a homozygous Rh-positive husband will certainly have a Rh-positive fetus. As it has an irreversible evolution, the Rh isoimmunization once installed cannot be influenced in the sense of decreasing the Ab titer, therefore, injectable globulin has no effect. A particular case was that of a newborn with Rh system incompatibility associated with hereditary spherocytosis The clinical balance at birth reflects the severe jaundice of the female newborn of 3140 g, gestational age 38∕39 weeks, extracted by lower-segment transverse Caesarean section, with a double loop nuchal cord, Apgar score 8. Because the jaundice was severe and atypical (face and upper chest), we considered the possibility of coexistence of hemolytic disease of the newborn by Rh blood group incompatibility associated with hereditary spherocytosis, as it turned out to be true and mentioned. Changes in genes encoding proteins in the structure of the RBC membrane have amplified hemolysis induced by maternal-fetal isoimmunization in the Rh system. Massive hemolysis accentuated by congenital spherocytosis, confirmed later, imposed blood transfusion and dynamic monitoring.

Study some characteristics of electronic fetal monitoring to diagnose fetal compromise

ABSTRACT Background: Assessing fetal health during pregnancy and labor is important in reducing neonatal morbidity and mortality. In which electronic fetal monitoring is the most commonly used obstetric procedure. The false-positive rate of electronic fetal monitoring to predict adverse outcomes is high. Therefore, the study of fetal heart rate charts to confirm the diagnosis of fetal compromise is very necessary to limit cases of unreasonable cesarean section. Therefore, we conduct this study to: (1) Survey the characteristics of electronic fetal monitoring (EFM) to diagnose fetal compromise. (2) Find out the association between EFM and obstetrical outcomes Methods: Observative cross-sectional study recruited 336 term singleton pregnant women with occipital presentation, presenting with labour symptoms at Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, between June 2019 to June 2021. All participants accepted to participate in the research and fetal being was assessed by EFM using FIGO 2015 classification. Exclusion criteria were multiple gestation, congenital malformation, placenta previa, placenta abruptio, maternal disease affecting the fetus and using medication which can affect the fetus. Results: Among 336 pregnant women, 31 cases (11%) were diagnosed with fetal compromise. Deceleration had the highest sensitivity while baseline heart rate had the lowest to diagnose fetal compromise. Base line heart rate had the highest specificity while acceleration had the lowest to diagnose fetal compromise. There was an association between EFM and Neonatal Intensive Unit Care admission (p&lt;0.001). There was no association between EFM and gestational age, birth weight, nuchal cord, amniotic fluid’s color and first-minute APGAR score. Conclusions: EFM should be indicated for labour women to screen the fetal compromise. However, abnormal EFM was associated with increased c-section rate, operative delivery and Neonatal Intensive Unit Care admission. Therefore, close monitoring should be combined with clinical and subclinical results to prevent unnecessary intervention

Neonatal Outcome and Mode of Delivery with Nuchal Cord - A Cross Sectional Study

Aim: To determine the incidence of umbilical cord around the fetal neck and its effects on fetal outcome. Study Design: It is single center cross sectional study. Duration: The duration of study is two year from January 2020 to January 2021. Settings: This study was carried out in Independent University Hospital Faisalabad. Methodology: All patients presents after 28 weeks upto 41 weeks of gestation either delivered by caesarean section or delivered vaginal birth with baby having one, two or three loops of cord around the neck were selected. Fetal outcome was observed, maternal age, Parity, Gestational age, Mode of delivery, APGAR score and admission to NICU were noted. Results: A total of 102 patients (27.4%) were delivered having nuchal cord 65 patients (63.7%) were in age group (26-30y) and 60 patients (58%) were multipara delivered with cord around the neck of fetus. In present study cesarean section rate was 70.5%. In 25 patients (24.5%) nuchal cord was diagnosed before delivery and in 77 patients (75.4%) nuchal cord was incidental findings during labour. Regarding fetal outcome; In 47 babies (46%) delivered with nuchal cord were having APGAR score less than 5 but in 55 babies (53.9%) having good APGAR score. Conclusion: Nuchal cord is common incidental finding during labour and fetal outcome regarding APGAR score &amp; NICU admission was better in patients delivered with nuchal cord. But the cesarean section rate was higher. Keywords: Nuchal cord, Frequency, Fetal outcome

Perinatal maternal characteristics predict a high risk of neonatal asphyxia: A multi-center retrospective cohort study in China.

ObjectiveThis study aimed to identify various perinatal maternal characteristics that contributed to neonatal asphyxia (NA) in term and late-preterm newborns based on the data obtained from a Chinese birth registry cohort and to establish an effective model for predicting a high risk of asphyxia.MethodWe retrospectively reviewed and analyzed the birth database from July 1, 2016, to June 30, 2017, in the main economically developed regions of China. Asphyxia was defined as an Apgar score <7 at 5 min post-delivery with umbilical cord arterial blood pH < 7.2 in the infant born after 34weeks. We compared the perinatal maternal characteristics of the newborns who developed asphyxia (NA group, n = 1,152) and those who did not (no NA group, n = 86,393). Candidate predictors of NA were analyzed using multivariable logistic regression. Subsequently, a prediction model was developed and validated by an independent test group.ResultOf the maternal characteristics, duration of PROM ≥ 48 h, a gestational week at birth <37, prolonged duration of labor, hypertensive disorder, nuchal cord, and birth weight <2,500 or ≥4,000 g, abnormal fetal heart rate, meconium-stained amniotic fluid, and placenta previa were included in the predicting model, which presented a good performance in external validation (c-statistic of 0.731).ConclusionOur model relied heavily on clinical predictors that may be determined before or during birth, and pregnant women at high risk of NA might be recognized earlier in pregnancy and childbirth using this methodology, allowing them to avoid being neglected and delayed. Future studies should be conducted to assess its usefulness.

Relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes: A retrospective study in China

BackgroundNeonatal birth weight and length are important indicators of neonatal survival and morbidity during later life and are influenced by maternal factors and obstetrical complications. Therefore, we aimed to determine the relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes in Wuhan University Renmin Hospital, Hubei, China. MethodsA total of 10517 neonatal births were recorded in a tertiary-hospital-based retrospective study and term singleton (n=7787) and termtwins (n=169) were included for data analysis. Birth weight and birth length were measured immediately after birth. Correlation, independent student t-test, and backward multiple linear regression were used for statistical analysis. ResultsWomen with singleton gestation have an increased rate of obstetric complications compared to women with twin gestation. However, a higher frequency of cesarean section and breech were found in twin gestation compared to singleton gestation. Weight before pregnancy, gestational weight gain, and gestational diabetes mellitus were significantly positive (p&lt;0.05) associated with singleton neonatal birth length and weight. In contrast, preeclampsia, placenta previa, oligohydramnios, premature rupture of membrane, breech, and multiparity had a significantly negative (p&lt;0.05) association with singleton neonatal birth length and weight. Maternal age was significantly positive (p&lt;0.05) associated with only singleton neonatal birth weight. Moreover, the nuchal cord was significantly positive (p&lt;0.05) associated with singleton neonatal birth length. On the other hand, maternal age and multiparity were significantly positive (p&lt;0.05) associated with twins’ neonatal birth length and weight. Furthermore, gestational weight gain was significantly positive (p&lt;0.05) associated with only twins’ neonatal birth weight. ConclusionIn term gestation, obstetric complications were significantly associated with singleton birth size rather than twin birth size.

FETO-MATERNAL OUTCOME OF ANTE-NATAL CARE PATIENTS WITH CORD AROUND THE NECK FINDING IN TERM PREGNANCY

Umbilical cord may sometimes surround the fetal neck, often detected during routine ultrasonography or delivery. The cord around neckmay untwines spontaneously, however, the continued presence of cord loops around neck affects the fetal outcome. Objectives: To study the incidence of cord around the neck finding (nuchal cord)and feto-maternal outcome. Methodology: The retrospective study was conducted at a tertiary care hospital of Central India. During the study period of 18 months, out of 1672deliveries, 470 deliveries had nuchal cord. The relevant data was extracted from the hospital records. Results: At the time of delivery, nuchal cord incidence was 28.1%. Out of 470 deliveries, 273 underwent LSCS with fetal distress possibly due to oligohydramnios as their prime indication. Low birth weight was seen among 26.8% newborns. 8.7 % newborns were admitted in NICU. However, no perinatal mortality was reported. Conclusion: Presence of nuchal cord at the time of delivery is quite common. One must rely on clinical skills for pre-delivery diagnosis of nuchal cord, especially in rural and peri-urban areas,where last-trimester USG reports are not available. The nuchal cord when accompanied by oligohydramniosdoes interfereduringlabour, and the outcome of delivery with respect to fetal distress.

Monochorionic-Diamniotic Twin Pregnancy Complicated by Spontaneous Septostomy and Cord Entanglement: A Systematic Review, Evaluation of Complication Rates and Presentation of an Additional Case

Background: Our purpose is to describe the ultrasound findings, both with bi-dimensional and three-dimensional imaging, suggestive of spontaneous septostomy in monochorionic-diamniotic twin pregnancies. Methods: PubMed, Medline and reference lists were searched using “Spontaneous septostomy and twin pregnancy” as keywords. Seventeen articles reporting a total of 25 cases, adding our own, were included in the systematic review. Only English full text articles, the main purpose of which was to describe spontaneous septostomy in twin pregnancies, were included. Results: In our sample the major ultrasound sign arousing suspicion of spontaneous septostomy was found to be an absent or disrupted inter-twin membrane (79% of cases). Twins close to each-other were described in 33% of cases, while cord entanglement was suspected only in 27% of cases. We reported a lower antenatal detection of entanglement when compared with intrapartum evaluation (27% vs 59%). Adverse fetal outcomes occurred in 12% of cases, while 88% of cases were born alive. Conclusions: Spontaneous septostomy represents a diagnostic and clinical challenge for obstetrics providers. Clinicians must focus on ultrasound findings to close surveil fetal wellness and reduce both fetal and neonatal impairment.

Umbilical Artery Cord Gas Abnormalities in the Presence of a Nuchal Cord in Term Singleton Pregnancies: A Cohort Study.

The clinical significance of nuchal cord (NC) at the time of delivery is unclear. Studies have found that NC is associated with lower umbilical artery (UA) pH. Since fetal hypercarbia precedes respiratory acidosis, we hypothesize UA pCO2 is elevated in neonates with NC at the time of delivery. This is a secondary analysis of a prospective cohort study of women with full-term singleton pregnancies admitted in labor or for induction of labor at an institution with a universal umbilical cord gas policy. We compared patients with NC at the time of delivery to those without NC. Women were excluded if they did not have validated UA gases, had a major fetal anomaly, or had an intrauterine fetal demise. The primary outcome of the study was UA pCO2. Secondary outcomes were other components of UA gas and neonatal morbidity composite. Baseline characteristics were compared utilizing chi-square or Fisher's exact test or the Student's t-test. UA gas parameters were compared using the Kruskal-Wallis test. Multivariable logistic regression was utilized to adjust for confounders. Of the 8,580 study participants, 7,608 had validated umbilical cord gases. The incidence of NC in the population was 24.15% (n = 1,837). UA pCO2 was higher in those with NC than without (58 mm Hg [53-64] vs. 55 mm Hg [50-60], p < 0.01). There was a greater odds of hypercarbia in the NC group (pCO2 > 65 mmHg; adjusted odds ratio [aOR]: 1.97, 95% confidence interval [CI]: 1.72-2.25, p < 0.01). Additionally, the NC group was more likely to be mildly acidemic (pH < 7.2, aOR: 1.74, 95% CI: 1.51-2.01, p < 0.01). There was no difference in composite neonatal morbidity between the groups. NC is associated with an increased risk of hypercarbia and acidemia. However, this is not associated with increased risk of neonatal morbidity. · Nuchal cord is associated with an increased risk of hypercarbia and mild acidemia.. · Nuchal cord is not likely associated with neonatal morbidity.. · Neonatal management should not be altered due to the presence of a nuchal cord at delivery..

ANALYSIS OF RISK FACTORS AND CLINICAL AND PARACLINICAL MANIFESTATIONS OF GASTROINTESTINAL DYSFUNCTION IN NEWBORNS IN PERINATAL PATHOLOGY

In recent decades, there has been a worldwide trend toward increasing rates of functional and organic pathology of the gastrointestinal (GI) tract in children. Presently, diseases of digestive organs rank second in frequency among pathologies of the pediatric population after acute respiratory diseases. Development of functional disorders of the gastrointestinal tract in children in the first year of life is mainly caused by anatomic and physiological characteristics of the digestive system, as well as high sensitivity and ease of damage of all its parts. Current literature suggests that children born to mothers during difficult pregnancy or childbirth are at increased risk for developing this pathology.Objective of the study: To determine perinatal risk factors and clinical and paraclinical features of gastrointestinal functional disorders in newborns with perinatal pathology.Materials and methods. The study enrolled 82 full-term infants with severe perinatal pathology, with clinical manifestations of gastrointestinal dysfunction (Group I), and 50 healthy infants (Group II) as a comparison group. Exclusion criteria for the study were: congenital malformations, low birth weight, clinical manifestations of infection. To assess metabolic disorders, a comprehensive assessment of the biochemical blood spectrum with the level of total protein and albumin, total bilirubin and its fractions, glucose, urea and uric acid, cholesterol and triglycerides; activity of AlAT, AsAT, LDH, LF, GGTP. Biochemical studies were performed using a Cormay ACCENT biochemical analyzer (Poland, Cormay reagents).Results and discussion. Disorders of postnatal adaptation of newborns are noted in the conditions of mothers’ somatic disadvantages, implementation of unfavorable factors during pregnancy and labor. Analysis of somatic anamnesis, antenatal and intrapartum problems has made it possible to identify the main causes of neonatal adaptation disorders in the early neonatal period. The most important, taking into account maternal anamneses, in the patients of the main group were: cardiovascular system pathology in 30 (36, 59%) cases, urinary system pathology in 22 (26, 83%) cases, endocrine system pathology in 17 (20, 73%) cases, digestive system pathology in 11 (13, 41%) cases, and respiratory system pathology in 8 (9, 76%) cases; gynecological pathology was diagnosed in 16 (19, 51%). The antenatal period was complicated by: placental dysfunction in 10 (12.20%) cases, hydramnios in 8 (9.76%) cases, fetal distress in 10 (12.20%) cases, and cord entanglement around the neck in 5 (6.10%) cases. Overall, there were 14 (17.07%) cases with a poor obstetric history. Caesarean section was performed in 24 (29.27%) cases, vacuum-assisted delivery in 4 (4.88%) cases.The list of diseases responsible for the severity of the newborn's condition was presented according to the main diagnosis: 66 (80.5%) cases had central nervous system involvement in the form of hypoxic-ischemic lesion/neonatal encephalopathy, 27 (32.9%) cases had severe respiratory distress, 13 (15.9%) cases had moderate asphyxia and 11 (13.4%) cases had severe asphyxia, 10 (12.2%) cases had moderate respiratory distress and 2 (2.4%) cases had hemolytic disease in newborn. All patients of the main group also had concomitant diagnoses. The condition of the main group neonates was characterized by more severe somatic and neurological status disorders, formation of MOD syndrome with the development of signs of food intolerance due to complex disorders of the gastrointestinal system. Complex disorders of food tolerance were observed in 71 (86,59%) children, regurgitation/stasis - in 66 (80,49%) neonates, paresis/weak intestinal peristalsis - in 47 (57,32%) patients, flatus - in 3 (3,66%) cases, meconium retention - in 3 (3.66%) cases, isolated absence of sucking reflex/ wobbly sucking was found in 3 (3.66%) cases, enlargement of liver and spleen - in 1 (1.22%) patient. The complex of serum biochemical studies showed significant dysmetabolic changes, which to some extent explain the pathophysiological mechanisms of gastrointestinal dysfunction. In particular, revealed violations of protein-synthetic function of the liver and delays in the production and excretion of bile, enzyme deficiency and cytolytic syndrome.Conclusions. Disorders of the digestive system in newborns is one of the manifestations of general body dysfunction in conditions of hypoxia with the implementation of unfavorable factors of pregnancy and childbirth in the mother.Clinical signs of food intolerance in newborn infants are regurgitation/stasis, paresis/weak intestinal peristalsis, flatus, meconium retention, absence of sucking reflex/wobbly sucking, enlarged liver and spleen.Complex serum biochemical studies in newborns with gastrointestinal disorders showed impaired protein-synthetic liver function, delayed production and excretion of bile, enzymatic insufficiency and cytolytic syndrome.

Use of holmium laser for umbilical cord transection in a monoamniotic pregnancy threatened by an acardiac co-twin: a case report

BackgroundTwin reversed arterial perfusion sequence is a rare complication of monochorionic multifetal pregnancies. In this syndrome, the acardiac twin has a nonfunctional heart, while the other twin, the pump twin, has normal development. The pump twin perfuses the acardiac twin and is therefore at risk for cardiac decompensation. In monoamniotic cases, the normal co-twin is also at risk of sudden death due to cord entanglement. Treatment consists of coagulation and transection of the acardiac’s umbilical cord. We report the first intrauterine use in pregnancy of a Ho:yttrium aluminum garnet laser to safely and successfully transect the umbilical cord after Nd:yttrium aluminum garnet coagulation.Case presentationA 30-year-old Caucasian woman was referred to our fetal–maternal medicine unit at 9 weeks gestation with a monochorionic–monoamniotic twin pregnancy complicated by an acardiac twin. After counseling, she opted for an elective intervention to minimize the risks to the pump twin. At 16 weeks, fetoscopy was performed using a single 2-mm entry port. Through this port, a 1.0-mm fetoscope and a 0.365-mm laser fiber were introduced. Under fetoscopic sight and ultrasound (Doppler) guidance, the umbilical cord of the acardiac twin was first coagulated by laser energy using a Nd:yttrium aluminum garnet laser and then, using the same fiber, transected using a Ho:yttrium aluminum garnet laser. The patient underwent cesarean section at 38 weeks and delivered a healthy baby.ConclusionsWe present the first report on intrauterine use of an Ho:yttrium aluminum garnet laser in human pregnancy. Ho:yttrium aluminum garnet laser energy can be successfully and safely used for umbilical cord transection and carries fewer risks than other methods of transection.

Maternal and Neonatal Outcomes After Assisted Reproductive Technology: A Retrospective Cohort Study in China.

BackgroundWith the progress of assisted reproductive technology (ART) and the increasing number of ART pregnancy, its safety has become the focus of attention. The present study aimed to explore the associations of ART pregnancy with maternal and neonatal outcomes, as compared with naturally pregnancy.MethodsThis retrospective cohort study included all pregnant women who delivered at Women’s Hospital of Nanjing Medical University in 2011–2020. We compared maternal characteristics and pregnancy outcomes between group of ART pregnancy and group of naturally pregnancy using Logistic regression adjusted for confounders.ResultsA total of 13,604 ART pregnancies and 198,002 naturally pregnancies were included. The proportion of ART pregnancies has increased every year for the past 10 years, peaking in 2020 (9.0%). Multivariable logistic regression analysis showed that the risks of gestational diabetes, preeclampsia, moderate or severe anemia, liver-related diseases, thyroid-related diseases, preterm birth, placenta previa, postpartum hemorrhage, and cesarean section were significantly increased in ART pregnancy. For neonatal outcomes, women conceived by ART were more likely to have twins or multiples, and the risk of stillbirth or abnormal development was also significantly increased. When restriction to singletons, these risks were reduced. And the effects of ART on the risk of premature rupture of membrane, cord entanglement, intrapartum fever, cesarean section, and stillbirth or abnormal development were more pronounced in singletons pregnancies compared with that in pregnancies of twins or multiples.ConclusionWomen conceived by ART were at increased risks of several adverse pregnancy outcomes compared with women conceived naturally. Multiple pregnancies could partly explain this phenomenon. For ART pregnancy, prenatal and intrapartum monitoring should be strengthened, and neonatal outcomes should be closely observed.

Preterm Infant with Respiratory Distress, Hypotonia, and Hypoglycemia.

Preterm Infant with Respiratory Distress, Hypotonia, and Hypoglycemia.

Umbilical Cord Entanglement.

Umbilical Cord Entanglement.

Cord Blood Proteomic Biomarkers for Predicting Adverse Neurodevelopmental Outcomes in Monoamniotic Twins.

Monoamniotic twins have a high risk of mortality and perinatal morbidity due to cord entanglement and vascular anastomosis. Despite efforts to reduce the mortality rate through intensive fetal surveillance and timed delivery, poor long-term neurodevelopmental outcomes remain an unsolved problem. This study aimed to identify novel biomarkers predicting abnormal neurodevelopmental outcomes in monoamniotic twins with cord blood samples taken at the time of delivery. Abnormal neurodevelopmental outcomes were defined as (1) a severe brain lesion on neonatal brain ultrasound, (2) developmental delay, (3) cerebral palsy, and/or (4) blindness or deafness. Cord blood was analyzed with mass spectrometry-based proteomics according to the neurodevelopmental outcomes. Statistical analysis was performed to determine the differentially expressed proteins between neonates with normal and abnormal neurodevelopmental outcomes. Several candidate proteins were further validated with enzyme-linked immunosorbent assays. A total of 20 neonates (10 pairs) of monoamniotic twins were included in the proteomic analysis, of which 25% had abnormal neurodevelopmental outcomes. Eighteen proteins were differentially expressed in neonates with abnormal neurodevelopmental outcomes. The upregulated proteins in the neonates with adverse neurodevelopmental outcome were immunoglobulin (Ig)-gamma-4 chain C region, apolipoprotein E, and alpha-fetoprotein. In contrast, Ig-lambda chain V region 4A, Ig-heavy variable 3, Ig-kappa chain C region, Ig-mu chain C region, C1q, ceruloplasmin, and Ig-lambda chain V-I region were decreased. In the validation experiment, the cord blood concentration of ceruloplasmin was significantly lower in neonates with adverse neurodevelopmental outcomes than in those without. Therefore, ceruloplasmin could be a useful predictive biomarker of adverse neurodevelopmental outcomes in monoamniotic twins.