Obstetric Monitoring Research Articles

Electronic medical record in neonatology. Development and implementation experience

Electronic medical record (EMR) improves the quality of medical services and the speed of transfer of medical information between organizations and the patient. Purpose. To share the experience of developing a neonatal module and its implementation in a medical organization, and also, to show the advantages and disadvantages of EMR, the problems faced by the authors of the article during the development and implementation of EMR and their solutions. Methods. The experience of developing and implementing the neonatal module of the automated information system Regional Obstetric Monitoring (AIST ROM) on the basis of the Yekaterinburg Clinical Perinatal Center is presented. Results. After studying the regulatory framework, an EMR of the patient was developed and implemented. The neonatal module of AIST ROM includes all the necessary documents. The problems we have encountered in the development and implementation process are common. After studying the literature and taking into account the peculiarities of our medical organization, certain ways of solving them are proposed. Conclusion. EMR in neonatology will improve the quality of care, reduce the number of errors, ensure the availability of information, and reduce the burden on medical personnel.

Effectiveness of Telehealth in Obstetric and Gynecologic Care: A Systematic Review of Health Outcomes.

Telehealth applications are growing in the fields of obstetrics andgynecology. Strong scientific analysis and clinical recommendations are necessary for these innovative advancements. The purpose of this study was to conduct a thorough evaluation of how telehealth interventions can enhance obstetric and gynecologic health outcomes. Using pre-established inclusion and exclusion criteria, we searched the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 968 pertinent research articles were found in these databases, and Endnote software checked them for duplication. Only fifty-two of these articles were deemed relevant after a thorough text examination. Every study that was included had its risk of bias evaluated using the Newcastle-Ottawa Scale (NOS). Overall, telehealth interventions enhanced breastfeeding and smoking cessation obstetric outcomes. While preserving mother and fetal outcomes, telehealth interventions reduced the requirement for high-risk obstetric monitoring office visits. According to one study, women with gestational hypertension had lower rates of preeclampsia diagnoses. For continued use of injectable and oral contraceptives, telehealth treatments proved successful; one text-based study discovered higher rates of oral contraception after six months. When medication abortion services were provided via telehealth, access to early abortion was enhanced, and clinical outcomes were comparable to those of in-person care. Few studies have indicated the value of telehealth in improving the notification of test results for sexually transmitted infections and in improving the symptoms of urine incontinence with app-based interventions. Early availability of medical abortion services, breastfeeding, perinatal smoking cessation, telehealth therapies, and high-risk obstetrics schedule optimization were all linked to better obstetric outcomes. More carefully planned research is required to look at these and other interventions in order to produce data that can guide choices regarding the integration of more recent telehealth technology into obstetrics and gynecology practices.

Placental lesions in patients with antiphospholipid antibody syndrome: experience of a single tertiary-care Italian reference center

IntroductionAbnormal placentation contributes to obstetric morbidity in antiphospholipid antibodies syndrome (APS). The placenta is the main target of antiphospholipid antibodies (aPL) in obstetric APS and is the site of dysfunctional inflammatory responses and thrombosis. Standard treatment for APS during pregnancy includes low-dose aspirin (LDA) plus low molecular weight heparin (LMWH) and, in refractory cases, hydroxychloroquine (HCQ). Recently, a systematic review of the literature identified five main pathological placental lesions in APS patients: placental infarction, decidual vasculopathy, decidual inflammation, increase of syncytial knots due to syncytiotrophoblast death, and decrease in vasculosyncytial membranes. The aims of this study were to investigate whether placental lesions associate with obstetrical outcomes in a cohort of APS patients.Methods130 pregnant APS patients evaluated between 2009 and 2023 at the High-Risk Obstetrics Outpatient Clinic of San Raffaele Hospital, Milan, were enrolled. Placental samples from 25 spontaneously conceived pregnancies in APS patients were collected from January 2017 to May 2023 and analyzed.ResultsAll (n = 130) patients were on LDA and 110/130 (85%) on both LDA and LMWH. Twenty-six patients (20%) also received HCQ. In these patients, signs of placental inflammation (preterm birth and preterm premature rupture of membranes) were less frequently observed. Of the 25 placental samples analyzed, 19 (76%) patients had primary APS, while 6 patients had APS secondary to SLE. All patients were treated with LDA and LMWH. In patients with concomitant systemic lupus erythematosus (SLE) or in refractory APS, HCQ was added. Histological analysis of placental tissue revealed increased syncytial knots in 17/25 (68%) placentas, decreased vasculosyncytial membranes in 11/25 (44%), infarction in 8/25 (32%), presence of macrophages and decidual inflammation in 2/25 (8%), and atherosis or reduction of spiral artery remodeling in 3/25 (12%). We also observed at least two coexisting placental lesions in 12/25 (48%) placentas. In the placenta of patients treated with HCQ we did not observe any decidual inflammation at histology.ConclusionPlacental anomalies have occurred in patients with APS despite close and optimal obstetric monitoring. It is thus tempting to speculate that HCQ may have beneficial effects on pregnancy by decreasing the risk of deciduitis in patients with APS.

Next-generation monitoring in obstetrics: Assessing the accuracy of non-piezo portable ultrasound technology.

The emergence of handheld ultrasound devices capable of connecting to cell phones or tablets heralds a significant advancement in medical technology, particularly within the field of obstetrics. These devices offer the promise of immediate bedside ultrasound examinations, potentially revolutionizing patient care by enabling fetal assessments in diverse settings. This prospective study aimed to validate the reliability of non-piezo, chip-based handheld ultrasound devices in clinical obstetric practice. Conducted in a university hospital obstetric ward, the study included 100 pregnant women between 17 and 41 weeks of gestation. Participants underwent ultrasound examinations using both conventional and portable point-of-care ultrasound (POCUS) devices to compare the accuracy in estimating fetal weight and other parameters, such as cardiac activity, fetal presentation, placental location, and amniotic fluid volume. The reliability and agreement between the devices were assessed using intraclass correlation coefficients, Bland-Altman plots, and Pearson correlation coefficients. The results show a near-perfect agreement (0.98) and correlation (r = 0.98, p < 0.001) for estimated fetal weight and most biometry measurements between the two types of ultrasound devices, with slight deviations in head circumference and amniotic fluid index measurements. Subgroup analysis revealed variations in agreement and correlation rates with higher BMI and advanced gestational age, indicating areas for further refinement. These findings affirm the high reliability of handheld ultrasound devices for basic obstetric ultrasound evaluations, supporting their integration into daily clinical practice. This technology improves the flexibility and immediacy of prenatal care, although further research is needed to optimize its application across patient populations and treatment settings.

Positive Outcome in a Pregnancy with Anti-kell Alloimmunization Treated with Intravenous Immunglobulin and Therapeutic Plasma Exchange Despite Persistence of High Titre Antibody: A Case Report

Background: Few reports have been published about the current clinical management of anti-Kell alloimmunization in pregnancy; its low frequency of occurrence means that the few long series published have covered an extensive time period in which different treatment approaches have overlapped. The objective of the present paper is to present our experience in the clinical management of a pregnant woman who was positive for the anti-Kell antibody. Materials and Methods: The laboratory follow-up included the weekly measurement of the antibody titre, and identification of the paternal and fetal genotype. The clinical management included TPE and IVIG administration. Obstetric monitoring included ultrasonographic monitoring of the fetus. Case Description: We report a case of anti-Kell alloimmunization with high antibody titre at first observation. Testing for fetal DNA circulating in maternal blood confirmed positivity for KEL1 gene. The patient underwent fifteen sessions of TPE after 18 weeks of gestational age, followed by weekly IVIG infusion, which continued until 27 weeks of pregnancy. Anti-Kell titres were measured before and after each TPE session. The patient had no need for IUBT and delivered by cesarean section at 34 weeks of gestational age. Pregnancy resulted in a live birth with mild HDFN. Discussion: HDFN is a potentially lethal complication of alloimmunization, and IUBT is the standard treatment for severe fetal anemia. TPE and IVIG are two alternative treatment modalities described in the literature to avoid or postpone the need for IUBT transfusion. In the case reported, despite any substantial change in antibody titre, pregnancy resulted in a live birth. This result suggests that the use of TPE and IVIG in alloimmunization during pregnancy could be an effective treatment strategy.

LAPAROSCHISIS: ABOUT A CASE REPORT AND LITERATURE REVIEW

Laparoschisis is a congenital anomaly characterized by the protrusion of abdominal organs, predominantly the intestines, through a defect in the abdominal wall, typically observed on the right side. It is categorized into simple and complex types based on the extent of the defect and involvement of other organs. The estimated prevalence of laparoschisis is approximately 1 in 10,000 births, with variations noted in different regions. Interestingly, certain areas, like New York and Georgia exhibit an increasing trend, particularly among younger mothers. In Morocco, a study carried out at the Les Orangers hospital in Rabat in 2020 showing that the laparoschisis represent 5.1% of musculoskeletal malformations in newborns (equivalent to 1.7per 10,000 total births). Prenatal ultrasound is the primary diagnostic tool, enabling early detection of the abdominal wall defect and protruding organs. Magnetic resonance imaging (MRI) can provide additional information for diagnosis. Treatment options for laparoschisis include primary repair, performed shortly after birth, and delayed closure, which is postponed for a certain period after birth, depending on case-specific factors such as defect size, condition of protruding organs, and the presence of complications such as stenosis and atresia. Prognosis is influenced by the gravity of the malformation and associated conditions, necessitating close obstetrical and neonatal monitoring with tailored interventions for optimal outcomes. To illustrate the practical aspects of laparoschisis management, we present a case study involving a live-born infant diagnosed with laparoschisis at 34 weeks gestation using prenatal ultrasound. A comprehensive one-stage surgical repair was performed on the newborn. This case highlights the importance of early antenatal diagnosis through ultrasound, potential complications, and immediate and secondary management strategies for optimal outcomes in affected infants.

Acute pancreatitis and pregnancy: Clinical profile, management and maternal-fetal outcomes

Acute pancreatitis during pregnancy, a rare occurrence primarily noted in the third trimester, has been predominantly linked to gallstone lithiasis. This study delves into the multifaceted landscape of this unique clinical entity, aiming to elucidate its manifestation, clinical presentation, therapeutic strategies, and impact on maternal and fetal well-being. A retrospective investigation encompassing cases from January 2009 to October 2021 scrutinized the clinical trajectories of 31 pregnant or postpartum patients with acute pancreatitis. A comprehensive assessment of their profiles, encompassing demographic data, temporal occurrence, symptomatic manifestations, biochemical markers, and imaging findings, formed the basis of this inquiry. The study revealed a mean patient age of 29 years, with 62% being multiparous. The temporal distribution showcased pancreatitis events occurring in various trimesters, with vomiting and epigastralgia as the predominant symptoms. Serum lipase levels, indicative of pancreatic enzyme perturbation, were notably elevated. A concomitant rise in C-reactive protein levels was observed in a significant proportion of cases. Hepatic cytolysis and renal insufficiency were concomitant factors. Diagnosis was facilitated by a combination of clinical symptoms and imaging findings, thus underlining the importance of clinical vigilance. Gallstone etiology emerged as the foremost causative factor, reinforcing the relevance of gallstone lithiasis in this context. Therapeutic measures centered on symptomatic relief, encompassing fluid resuscitation, pain management, and obstetric monitoring. Maternal and fetal outcomes were characterized by an overall positive trajectory, with a maternal mortality rate of 5.8%. Vaginal deliveries constituted the predominant mode of childbirth, with cesarean sections employed in a minority of cases. This study illuminates the complex interplay between acute pancreatitis and pregnancy, shedding light on diagnostic challenges, therapeutic considerations, and the dynamic maternal-fetal interface. The findings underscore the significance of timely diagnosis and management in optimizing outcomes for both maternal and fetal entities. The pursuit of comprehensive insights into this niche domain remains integral to enhancing our understanding and refining clinical practices for this distinctive clinical scenario.

Effect of high-risk versus low-risk pregnancy at the first antenatal care visit on the occurrence of complication during pregnancy and labour or delivery in Kenya: a double-robust estimation

ObjectivesWe evaluated the causal effects of high-risk versus low-risk pregnancy at the first antenatal care (ANC) visit on the occurrence of complications during pregnancy and labour or delivery among women...

Breast Cancer and Pregnancy about a Case and Review of the Literature, Experience of the Obstetric Gynecology Department of the Military Training Hospital Mohamed V of Rabat

The management of pregnancy-associated breast cancer is a challenge for physicians, often stemming from the mother's desire to carry the pregnancy to term despite the need for chemotherapy. 26-year-old patient, multiparous, with no particular history, followed from 20 weeks of amenorrhea (SA) for triple-negative infiltrating mammary carcinoma who underwent two courses of neo-adjuvant chemotherapy combining 5-Fluorouracil, Epirubicin and Cyclophosphamide after discussion in multidisciplinary consultation meeting (RCP) and the consent of the couple, who presented a threat of premature delivery at 34 WA, the day after their 2nd course of chemotherapy. The evolution of the pregnancy was favorable; the delivery was vaginally at 37 SA of a newborn with good neonatal adaptation. Several parameters must be considered when administering antineoplastics, hence the importance of close fetal and obstetric monitoring. A multidisciplinary approach is recommended for the therapeutic decision and follow-up.

Management of Annulo-Ectasitic Disease during Pregnancy

Annulo-ectasitic disease is a group of disorders with similar phenotypic features, combining aneurysm of the aortic duct and dilatation of the aortic annulus. Its incidence is estimated at 4.5 cases per 100,000. It is the 13th leading cause of death in Western countries. Aneurysms of the ascending aorta are divided into two distinct entities according to etiology and surgical management. Pregnancy and peri-partum are two situations where the risk of aortic dissection is higher, with a more rapid progression of aortic diameters. This risk is directly related to the diameter of the aorta at the beginning of pregnancy, compliance with beta-blocker treatment, and the need for concerted cardiological and obstetric monitoring as soon as the desire for pregnancy is expressed and up to the 2nd month of the peripartum period. The aim of this review is to illustrate, through 02 clinical situations, the difficulties in managing parturient patients suffering from the different types of annuloectasitic disease of the aorta.

TRIAL OF LABOR AT THE MATERNITY DEPARTMENT OF THE SOUROSANOU UNIVERSITY HOSPITAL (CHUSS): CLINICAL ASPECTS, THE MATERNAL AND PERINATAL PROGNOSTICS

Aims : We aimed at studying the clinical aspects and the maternal and perinatal prognostics during trial of labor at the Gynecology and Obstetrics Unit. Patients and Methods : This is a transversal and Descriptive study over a period of 06 months from 1 st May to 30 th October 2016 in the Gynecology and Obstetrics Unit of the SourôSanou University Hospital (CHUSS). The data were collected and analyzed by the software Epi info version 3.4.5. Results : During the period of study, 109 cases of trial of labor for a total of 2124 births were registered, with an overall frequency of 5.13%. The average age of the patients was 26.6 years. In 42.2% of cases, the patients were primiparious . Admission was direct in 85.5% of cases. The coverage rate for prenatal consultation was 100%. There was vaginal delivery for 108 patients, ie a success rate of 99.08% for trial of labor. An episiotomy was performed in 18.34% of those who delivered vaginally with a labor time less than 3 hours in 65.13% of cases. The indication of the cesarean section during the failure of the trial of labor was dominated by acute fetal distress in 0.91% of cases. Among the 14 patients who had complications during the postpartum period, 06 cases of postpartum hemorrhage of 22.85%, were noted, but did not occasion any maternal death. We registered 109 newborns including 106 alive (97.2%), 10 fresh stillborn, 02 perinatal deaths and 01 macerated stillborn. Among the 13 cases of perinatal morbidity, infections, neonatal suffering and hypotrophy were largely dominant with 5.5%, 38, and 5.34% of the cases. Conclusion : The results of our study (99.08% of success) argue in favor of vaginal delivery after uterine scar, with little risk related to this scar when the pregnancies are followed closely. Indeed, with a normal and careful obstetric monitoring, a scarred uterus after one segmental cesarean section must be considered as a normal uterus that can allow the woman to deliver simply without her being exposed to any particular risk of uterine rupture.

Ectopia Cordis Thoraco-Abdominal Diagnosed with Antenatal Ultrasound

In this article we report a case of ectopia cordis, which is a rare congenital malformation characterized by an extra-thoracic position of the heart. This is the thoracic-abdominal form, of antenatal discovery on a pregnancy of 35 weeks and 03 days, during an obstetric ultrasound monitoring pregnancy during the third trimester of pregnancy, made at the University Hospital Professor Zafisaona Gabriel, Mahajanga Madagascar. The objective of this work is to report the antenatal ultrasound diagnostic elements of this rare malformation. Ultrasound plays an important role in antenatal diagnosis and the search for other related malformations, especially in low-income countries.

The Value of Non-invasive Electrocardiography in Assessing Fetal Status at Term Delivery.

The electrocardiograph (ECG) is efficient method for the accurate assessment of fetal heart rate. The barriers for accurate assessment are maternal heart rate, uterine contractions and abdominal muscles. Although previous monitoring methods have struggled to overcome these barriers, recent advances have led to a greater degree of success for listening and recording pulse-by-pulse fetal heart rate. A prospective cohort study evaluating the use, reliability and safety of non-invasive electrocardiography, in conjunction with Fetal Heart Rate parameters such as, Short Term Variability (STV) together with umbilical cord PH and Apgar score, during the active phase of childbirth. A total of 41 women with single, normal, full-term pregnancies had systematic obstetric monitoring with Monica AN24. 20 had only monitoring and 21 also had and arterial blood flow measurements. pH was measured and correlated with neonatal Apgar score at 1 and 5 min. The study also included a questionnaire about the safety and usability of obstetric monitoring. Statistical analysis was done using IBM SPSS v. 26.0. Mean age was 28.8 years, (SD ± 6.153). Electrocardiogram recordings (ECG) were classified as normal (71%) and suspicious (29%). Baseline between ECGs was different (p = 0.025) similarly for Short term variability (STV) (p <0.0001). BMI did not differentiate SVT rates. Only high acceleration (p <0.029) and small slowdowns had a statistically significant difference between normal and suspected cardiographs (p <0.029). APGAR score did not differ, whereas the umbilical cord pH was different in normal ECGs compared to the suspect (p = 0.012) and STV was also differentiated. A usability and safety survey was conducted after recording with MONIKA AN24, and the response to whether they would accept recording with the device again, was positive for 96% of the 30 responders. The present study shows that the use of electrocardiography in obstetrics allows to draw conclusions about the fetal hematopoiesis and oxygenation status. This method could be clinically applied and be an important tool for further screening in embryos that may be hypoxic and to decide whether to continue with a vaginal or cesarean delivery, thereby achieving the goal of reducing perinatal morbidity and mortality.

DIAGNOSIS AND MANAGEMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS IN PREGNANCY: A CASE REPORT

Systemic lupus erythematosus (SLE) is a heterogenous autoimmune disorder with a complex pathogenesis that results in interactions between susceptibility genes and environmental factors. Almost 90 percent of SLE cases are in women; especially in child bearing age. It is a chronic inammatory disease with multisystemic involvement in which immune complex deposition causes damage to the tissues involved. Maternal and fetal mortality and morbidity are still signicantly high despite improvements in outcomes. Maternal morbidity includes higher risk of disease ares, preeclampsia and other pregnancy-related complications. Fetal issues include higher rates of preterm birth, fetal growth restriction, and neonatal lupus syndromes. Management option is limited to few safer drugs. A multidisciplinary approach, with close medical, obstetric and neonatal monitoring, is essential for optimal outcomes. This case report describes a 27 years old primigravida diagnosed with SLE for the rst time in pregnancy, evaluated and managed with a good fetomaternal outcome.

Vorteile der KI-gestützten geburtshilflichen Überwachung

BackgroundArtificial intelligence (AI) mimics the way the human brain processes information. Machine learning (ML) is a subarea of AI that can be used to extract knowledge from large amounts of data, whereby different ML methods can be differentiated. The use of AI can help obstetricians to make informed decisions, reduce the number of medical errors and improve the accuracy in interpreting various diagnoses.ObjectiveIn the field of obstetrics, studies that describe the successful use of ML in screening for risks in pregnancy and the prediction of an adverse perinatal outcome (APO) are increasing. The following overview examines the potential of AI-supported obstetric monitoring with a focus on the most common problem areas in perinatal medicine. With their help, under certain circumstances an objective analysis of real data with the aim of identifying the most important risk factors and ultimately reducing the rate of APO can be made possible.

Design and Implementation of Obstetric Central Monitoring System Based on Medical Image Segmentation Algorithm.

At present, the incidence of emergencies in obstetric care environment is gradually increasing, and different obstetric wards often have a variety of situations. Therefore, it can provide great help in clinical medicine to give early warning and plan coping plans according to different situations. This paper studied an obstetrics central surveillance system based on a medical image segmentation algorithm. Images obtained by central obstetrics monitoring are segmented, magnified in detail, and image features are extracted, collated, and trained. The normal distribution rule is used to classify the features, which are included in the feature library of the obstetric central monitoring system. In the gray space of the medical image, the statistical distribution of gray features of the medical image is described by the mixture model of Rayleigh distribution and Gaussian distribution. In the gray space of the medical image, Taylor series expansion is used to describe the linear geometric structure of medicine. The eigenvalues of Hessian matrix are introduced to obtain high-order multiscale features of medicine. The multiscale feature energy function is introduced into Markov random energy objective function to realize medical image segmentation. Compared with other segmentation algorithms, the accuracy and sensitivity of the proposed algorithm are 87.98% and 86.58%, respectively, which can clearly segment small medical features.

Burn and Pregnancy

Burns in pregnant women, although rare, can be serious, and therefore can be life-threatening for the mother and fetus. Morbidity and mortality are influenced by factors related to the burn, such as the depth and the TBSA burned, and patient-related factors, such as age, pre-existing medical conditions, associated injuries, and the term of the pregnancy. The fetal prognosis is generally good when the mother does not develop severe complications such as sepsis, hypotension, or hypoxia. The management’s goal is maternal and fetal rescue. The treatment protocol must be well codified, requiring the establishment of a multidisciplinary team involving plastic surgeons, reanimators, and obstetricians. Treatment including aggressive hydro-electrolyte resuscitation, oxygen therapy, thromboprophylaxis, and early and effective antibiotic prophylaxis, are effective measures for both maternal and fetal management. Early excision of deep lesions and skin grafts is the cornerstone of the management of burnt pregnant women, in order to reduce the amount of prostaglandin and cytokines released into the circulation. As part of the fetal rescue, labor induction is imperative if pregnancy is in the third trimester for extraction from the toxic environment, otherwise, tocolysis and obstetrical monitoring to reach the third trimester. We present a case series of burns occurring in pregnant women treated at the National Center for Burns and Plastic and Restorative Surgery.

Are wheezing, asthma and eczema in children associated with mother\u2019s health during pregnancy? Evidence from an Australian birth cohort

BackgroundThis study investigated the prevalence of wheezing, asthma, and eczema among Australian children using longitudinal data from birth to 15 years of age. This study also examined the association between maternal health status during pregnancy and their offspring’s respiratory and allergic morbidities using sex-segregated data.MethodsThis study used data from the Longitudinal Study of Australian Children (LSAC) where approximately 5000 children of a birth cohort across Australia were surveyed in 2004. These children were followed biennially in eight waves up to their age of 15 years until 2018. The status of the children’s wheezing, asthma, and eczema were reported by the mothers upon doctors’ diagnosis (for asthma) or self-assessment (for wheezing or eczema). Binomial logistic regression models were used to analyse associations between maternal health during pregnancy and their children’s health outcomes.ResultsAsthma prevalence among 0–1-year aged children was 11.7%, increased to 15.4% when the children were 10–11 years old, and then decreased to 13.6% when they were 14–15 years old. Wheezing and eczema were most prevalent when the children were 2–3 years old (26.0 and 17.8% respectively) and were least prevalent when the children were 14–15 years old (7.3 and 9.5% respectively). Maternal asthma, smoking during pregnancy, and pre-pregnancy obesity were significantly associated with an increased risk of wheezing and asthma in Australian children. Childhood eczema was associated only with maternal asthma. These associations were stronger among male children up to age 10–11 and during adolescence (12–15 years of age), female children were more prone to wheezing, asthma, and eczema.ConclusionThis is a comprehensive longitudinal study of Australian children (0–15 years of age) to assess the prevalence (with sex-specific differences) of wheezing, asthma and eczema as well as the association between these respiratory and allergic morbidities and maternal health during pregnancy. The study findings suggest that careful medical and obstetric monitoring, improved specific age-sex wise risk factor prevention for children and health promotion for pregnant women would help protect child health.

Remission or low disease activity at pregnancy onset are linked to improved foetal outcomes in women with systemic lupus erythematosus: results from a prospective observational study.

Systemic lupus erythematosus (SLE) patients show variably increased risk for pregnancy complications. We analysed pregnancy outcomes (foetal and maternal), patterns of disease activity and use of medications in a contemporary Caucasian SLE population. Prospective observational study, involving hospital units and private rheumatologists in Greece, of incident pregnancies (period 2015-2018) in women with SLE. Clinical and obstetrical monitoring was performed at regular intervals up to 9 months post-partum. Regression and mixed model analyses were used to determine predictors for adverse foetal outcomes and flares. We monitored 82 pregnancies in 64 SLE patients. Foetal loss, prematurity and small for gestational age neonate occurred at 15.8%, 34.1% and 8.5%, respectively; 53.7% of pregnancies were complicated with at least one adverse outcome. Patients with antiphospholipid antibodies (aPL) had increased risk (odds ratio [OR] 5.67, p=0.015), whereas those at low disease activity at pregnancy onset were protected (OR 0.20, p=0.024) against foetal complications. Persistent activity and glucocorticoid intake during pregnancy also predicted poor foetal outcomes. SLE patients experienced an average 1.08 mild/moderate and 0.27 severe flares. The latter occurred more frequently post-partum, in patients with alopecia (OR 8.92, p=0.003), hypocomplementaemia (OR 10.34, p=0.038) and nephritis (OR 7.32, p=0.052). Lupusactivity post-labour was paralleled by decreased use of hydroxychloroquine, glucocorticoids and azathioprine. In SLE women, foetal complications are common especially in the presence of aPL and increased activity, which corroborates the importance of pregnancy planning and tight disease control at pregnancy onset. Flares, mostly mild or moderate, can occur both during and after pregnancy.

What if Depressed and Pregnant?

Depression is the most prevalent mood disorder among pregnant women. Only 50% of women seek intervention during gestation. Untreated during pregnancy, depression can induce obstetric and neonatal complications, most commonly, anhedonia, suboptimal weight gain, suicidal behavior, pre-term birth, and/or spontaneous miscarriage. The babies more often suffer cognitive deficits, low birth weight, and growth delay. The mothers subsequently also experience an increased risk for significant degrees of postpartum depression. Those with relatively milder cases of depression should initially receive psychotherapy. Otherwise, there are many antidepressant medications available for the pharmacotherapy of depression. However, treating pregnant females with depression is a challenge because of potential teratogenic effects caused by many pharmaceuticals. Physicians should know the recommended guidelines for treating depressed women during a time of gestation. It is crucial to identify women suffering from depression during pregnancy, and electing those that warrant pharmacotherapy while picking the best and safest medication is a complex process with paramount significance. Before prescribing an antidepressant drug, explain the advantages and disadvantages of the interventions. Whenever prescribing during these circumstances, more than conventionally close obstetric, emotional, and medication monitoring is to be provided. This would also include an emphasis on diet, exercise, psychotherapy, and avoidance of any non-critical medicinal or other substance exposures.