Fetal Outcomes Research Articles

Pregnancy-associated melanoma (PAM): A single institution retrospective review between 2005 and 2023.

30 Background: Melanoma is the most prevalent cancer during pregnancy, representing 31% of all gestational cancers, with its incidence rates rising globally. Pregnancy-associated melanoma (PAM) presents unique challenges in diagnosis and management due to maternal physiological and hormonal changes, as well as consideration of fetal impact. This study aims to understand the impact of pregnancy on melanoma outcomes to optimize patient care. Methods: We conducted a retrospective study of patients diagnosed with PAM at The University of Texas MD Anderson Cancer Center between 2005 and 2023. Eligible patients were diagnosed either during pregnancy or within one year of delivery. Frequencies and percentages were used to describe the study population. Our primary outcome was to describe melanoma characteristics and prognosis, and our secondary outcome was to investigate melanoma’s impact on obstetrical outcomes. Results: The study included 76 patients with a mean age of 31.3 ± 4.4 years, 93.4% of whom were of white or Caucasian origin. The median follow-up was 39.8 months. Diagnoses included Stage 0 (7.9%), Stage I (36.8%), Stage II (3.9%), Stage III (22.4%), and Stage IV (25%) melanoma. The mean Breslow Thickness was 2.1± 4.7 mm. Primary diagnoses occurred in 76.6% of patients, while 21.9% experienced recurrent episodes during pregnancy. At the time of their PAM event, 47.4% had localized disease, and 48.7% had metastatic disease. The average mean time from diagnosis to first surgery was 2.1 months in patients diagnosed during pregnancy (group 1) and 0.9 months in patients diagnosed after pregnancy (group 2). The average time from diagnosis to systemic therapy was 3.3 ± 2.8 months in group 1 and 1 ± 0.7 months in group 2. Patients diagnosed during pregnancy had an average gestational age of 17.8 weeks: 30.65% were diagnosed in the first trimester, 54.84% in the second, and 14.52% in the third trimester. Thirty-three (43.4%) patients had term deliveries, while fifteen (19.7%) patients gave birth prematurely. There were 75.0% live births, 5.3% spontaneous abortions and 3.9% elective terminations. Conclusions: Our findings contribute to the limited literature on PAM outcomes, emphasizing the importance of a collaborative approach in managing these patients. Close surveillance of pregnant patients with melanoma is essential to prevent treatment delays and ensure optimal maternal and fetal outcomes.

Cancer diagnosis during pregnancy is associated with severe maternal and neonatal morbidity

BackgroundData on maternal and fetal outcomes in patients diagnosed with cancer during pregnancy are limited. Given expected increase in patients diagnosed with cancer during pregnancy, there is a growing need to evaluate clinical outcomes. ObjectiveTo evaluate obstetric outcomes among women with early-stage gynecologic or breast cancer who were diagnosed during pregnancy compared to women without cancer in a population-based cohort. MethodsWe performed a population-based study of women aged 18-45 years with stage I gynecologic or stage I-III breast cancer reported to the California Cancer Registry for the years 2000-2012. Data were linked to the 2000-2012 California birth data to produce a database with cancer characteristics and obstetric outcomes. We included patients who had a delivery within the 10 months following cancer diagnosis. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included pre-term birth (PTB) and neonatal morbidity. Propensity scores were used to match similar controls to cases in a 2:1 ratio based on demographic attributes and medical comorbidities included in the Obstetric Comorbidity Index (OB-CMI). Logistic regressions were used to evaluate outcomes. ResultsThe cohort consisted of 503 women with cancer in pregnancy (319 breast, 125 ovarian, 59 cervical), and 1,006 matched controls. Cancer during pregnancy was associated with higher odds of SMM (6.8% vs <1.1%; odds ratio [OR] 8.03, 95% CI 3.82-16.88), PTB between 32-36 weeks (32.6% vs 8.3%, OR 5.38, 95% CI 4.02-7.20), and neonatal morbidity (12.5% vs 6.1%; OR 2.22, 95% CI 1.53-3.21) compared to matched controls. In sub-analysis of SMM indicators, hysterectomy and sepsis were significantly associated with cancer during pregnancy (4.8% vs <1.1%, P<.001; <2.2% vs 0.0%, P=.037, respectively). ConclusionCancer during pregnancy is associated with increased risk of maternal and neonatal morbidity. These findings highlight the need for careful management and consideration of obstetric outcomes in these patients.

Adverse obstetric outcomes in cases of meconium-stained amniotic fluid complicated with intrapartum fever.

Meconium-stained amniotic fluid (MSAF) often signifies colonization of the amniotic sac by microorganisms. This study investigated additional adverse obstetric outcomes associated with MSAF in deliveries complicated by maternal intrapartum fever (IF). This retrospective study included all singleton pregnancies from 2014 to 2020, with intrapartum maternal fever ≥ 38°C during a trial of labor. In accordance with departmental protocol, all patients received intravenous antibiotic therapy consisting of ampicillin and gentamicin in the absence of allergies to these medications. Subsequent antibiotic therapy was adjusted based on the culture results. Antibiotic treatment was discontinued postpartum after 48h without fever. Swab cultures were obtained immediately postpartum from both the maternal and fetal sides of the placenta. Maternal and fetal outcomes, along with positive placental cultures, were compared between participants with MSAF&IF and those with clear amniotic fluid &IF (control group). In comparison to the control group (n = 1089), the MSAF&IF group (n = 264) exhibited significantly higher rates of cesarean delivery (CD) (p = 0.001), CD due to non-reassuring fetal heart rate (p = 0.001), and cord pH ≤ 7.1 (p = 0.004). Positive swab cultures from the placental maternal and fetal sides were more prevalent among the MSAF&IF group (23.1% vs. 17.6%, p = 0.041 and 29.2% vs. 22.9%, p = 0.032, respectively). Placental cultures yielding gastrointestinal pathogens and extended spectrum beta-lactamase were notably more common in the MSAF&IF group compared to controls (p = 0.023). However, there was no significant difference between groups regarding the rate of group B streptococcus positive placental cultures. Women experiencing IF and MSAF during labor face an elevated risk of CD compared to those with IF alone. The presence of MSAF heightens the risk of positive placental cultures, particularly with gastrointestinal and extended spectrum beta-lactamase pathogens.

Analysis of Fetal Growth and Pregnancy Outcome in Pregnant Women Infected with Novel Coronavirus in Mid-Pregnancy.

To investigate whether fetal prenatal ultrasound, fetal growth rate, and pregnancy outcome statistically differ between women infected with novel coronavirus (COVID-19) in mid-pregnancy and an uninfected control group. A retrospective analysis of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and z-scores for each among 46 pregnant women diagnosed with COVID-19 in mid-pregnancy between December 01, 2022 and June 31, 2023 was conducted. A control group included 92 pregnant women negative for COVID-19 during the same period and was also analyzed. To examine fetal growth, rate of increase in BPD, HC, AC, FL, and estimated fetal weight (EFW) between second and third trimester scans were analyzed. In addition, pregnancy outcome, maternal comorbidities, and neonatal prognosis were assessed. The occurrence of gestational diabetes differed significantly between groups, but the fetal growth rate and EFW did not. Similarly, pregnancy outcomes and neonatal prognoses did not differ significantly between groups. Gestational diabetes was a complication that differed between patients with and without COVID-19 in this study. COVID-19 in pregnant women did not affect fetal development. Therefore, these preliminary data suggest that increased fetal monitoring is not necessary for women infected with COVID-19 during the second trimester, and these women should be reassured of the low risk of adverse fetal outcomes.

Real-World Assessment of Psychotropic and Antiepileptic Drug Use During Pregnancy in Belgium: Trends, Predictors, and Comparative Risk of Congenital Anomalies (2010-2016).

To analyze the prescription patterns and sociodemographic factors associated with the use of antipsychotic, antidepressant, and antiepileptic drugs during pregnancy in Belgium, and to investigate their potential association with congenital anomalies. Using a nationwide linked database, we identified antidepressants, antipsychotics, and antiepileptics via the Anatomical Therapeutic and Chemical Classification (ATC) codes. For each medication group, we calculated the overall prevalence and prevalence for the three most used medications at the fifth ATC level. Sociodemographic factors influencing medication use during pregnancy were analyzed, and potential associations with congenital anomalies were investigated through logistic regression models based on generalized estimating equations. Overall, 828 016 live births pregnancies associated with 611 094 mothers were identified. We found that the use of antidepressants, antipsychotics, and antiepileptics was decreasing with the arrival of pregnancy. Mothers with a less favorable sociodemographic status were more likely to be exposed to these medications. Antiepileptics used in the first trimester were associated with an increased risk of congenital anomalies (aOR = 1.65, 95% CI 1.11-2.45) compared with unexposed women. The three most used antiepileptics were lamotrigine, valproate, and levetiracetam, among them, we found an association with congenital anomalies only for valproate (aOR = 3.92, 95% CI 2.30-6.67). Psychotropic and antiepileptic drug use decreased during pregnancy. Pregnant women with a less favorable sociodemographic status were more likely to be exposed to psychotropics and antiepileptics during pregnancy. The elevated risk of congenital anomalies associated with antiepileptics use, particularly valproate, underscores the need for targeted interventions and increased awareness to improve maternal and fetal health outcomes.

Testing an artificial intelligence algorithm to predict fetal heartbeat of vitrified-warmed blastocysts from a single image: predictive ability in different settings.

Could an artificial intelligence (AI) algorithm predict fetal heartbeat from images of vitrified-warmed embryos? Applying AI to vitrified-warmed blastocysts may help predict which ones will result in implantation failure early enough to thaw another. The application of AI in the field of embryology has already proven effective in assessing the quality of fresh embryos. Therefore, it could also be useful to predict the outcome of frozen embryo transfers, some of which do not recover their pre-vitrification volume, collapse, or degenerate after warming without prior evidence. This retrospective cohort study included 1109 embryos from 792 patients. Of these, 568 were vitrified blastocysts cultured in time-lapse systems in the period between warming and transfer, from February 2022 to July 2023. The other 541 were fresh-transferred blastocysts serving as controls. Four types of time-lapse images were collected: last frame of development of 541 fresh-transferred blastocysts (FTi), last frame of 467 blastocysts to be vitrified (PVi), first frame post-warming of 568 vitrified embryos (PW1i), and last frame post-warming of 568 vitrified embryos (PW2i). After providing the images to the AI algorithm, the returned scores were compared with the conventional morphology and fetal heartbeat outcomes of the transferred embryos (n = 1098). The contribution of the AI score to fetal heartbeat was analyzed by multivariate logistic regression in different patient populations, and the predictive ability of the models was measured by calculating the area under the receiver-operating characteristic curve (ROC-AUC). Fetal heartbeat rate was related to AI score from FTi (P < 0.001), PW1i (P < 0.05), and PW2i (P < 0.001) images. The contribution of AI score to fetal heartbeat was significant in the oocyte donation program for PW2i (odds ratio (OR)=1.13; 95% CI [1.04-1.23]; P < 0.01), and in cycles with autologous oocytes for PW1i (OR = 1.18; 95% CI [1.01-1.38]; P < 0.05) and PW2i (OR = 1.15; 95% CI [1.02-1.30]; P < 0.05), but was not significantly associated with fetal heartbeat in genetically analyzed embryos. AI scores from the four groups of images varied according to morphological category (P < 0.001). The PW2i score differed in collapsed, non-re-expanded, or non-viable embryos compared to normal/viable embryos (P < 0.001). The predictability of the AI score was optimal at a post-warming incubation time of 3.3-4 h (AUC = 0.673). The algorithm was designed to assess fresh embryos prior to vitrification, but not thawed ones, so this study should be considered an external trial. The application of predictive software in the management of frozen embryo transfers may be a useful tool for embryologists, reducing the cancellation rates of cycles in which the blastocyst does not recover from vitrification. Specifically, the algorithm tested in this research could be used to evaluate thawed embryos both in clinics with time-lapse systems and in those with conventional incubators only, as just a single photo is required. This study was supported by the Regional Ministry of Innovation, Universities, Science and Digital Society of the Valencian Community (CIACIF/2021/019) and by Instituto de Salud Carlos III (PI21/00283), and co-funded by European Union (ERDF, 'A way to make Europe'). M.M. received personal fees in the last 5 years as honoraria for lectures from Merck, Vitrolife, MSD, Ferring, AIVF, Theramex, Gedeon Richter, Genea Biomedx, and Life Whisperer. There are no other competing interests. N/A.

Unplanned Pregnancy in Women with Lupus Nephritis Is Common and Is Associated with Poor Fetal Outcomes

Unplanned Pregnancy in Women with Lupus Nephritis Is Common and Is Associated with Poor Fetal Outcomes

The Pharmacotherapy Practices and Clinical Outcomes of Pre-eclampsia/Eclampsia: An Observational Study

Background: This study observes fetal, pregnancy, and maternal outcomes with different regimens of Magnesium sulphate (MgSO4), used for prophylaxis and treatment of convulsions in eclampsia. Methods: In this observational study, the current prescribing practice and management outcomes of pre-eclampsia/eclampsia were observed in three tertiary care hospitals in Lahore, Pakistan. Data were collected by using data collection form, containing information related to patient demographics, history, laboratory findings, drug administration record, and therapeutic outcomes for pregnancy, fetus, and mother. Results: Of the 50 patients studied, most (74%) were of eclampsia. The mean age of the patients was 25.7 (+5.05) years with the majority (36%) in the age range 21–25 years. Forty-one patients received MgSO4, of which most received the Pritchard regimen (n = 35), whereas only 5 patients were managed with Zuspan regimen. Liner logistic analysis revealed better fetal outcomes (OR 0.217, CI –0.283 – 1.543) and pregnancy outcomes (OR 0.186, CI –0.164 – 0.635) with Zuspan regimen as compared to Pritchard. Whereas, both regimens showed no difference in maternal outcomes (OR 0.044, CI –0.129 – 0.170). Conclusion: Zuspan regimen proved to be better in morbidity and mortality associated with eclampsia. Additionally, national as well as institutional guidelines should be developed, implemented, properly monitored, and evaluated for management of preeclampsia/ eclampsia. Mandatory in-service training and expertise should be provided for health professionals at all levels of the healthcare system, especially those working in gynecological setup.

The Association of a Vegan Diet during Pregnancy with Maternal and Child Outcomes: A Systematic Review

Background: With the increasing prevalence of pregnant women adhering to a vegan diet, gaining insight into their nutritional intake and its association with maternal and fetal outcomes is essential to providing recommendations and developing guidelines for general practice. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the available scientific literature in Medline, Embase, and Cochrane was conducted in January 2024. Results: The titles and abstracts of 2211 unique articles were screened. Only six studies were eligible for inclusion and assessed for methodological quality using the (National Institutes of Health Study Quality (NIHSQ) Assessment Tool. The intake of protein and various micronutrients was significantly lower among vegan pregnant women compared to omnivorous women. Vitamin B12 supplements seemed sufficient in optimizing maternal and umbilical cord vitamin B12 levels amongst vegan mothers. Further, women on a vegan diet less often showed excessive pregnancy weight gain. However, children from women on a vegan diet had a significantly lower birth weight than those from women on an omnivorous diet. Conclusion: So far, only a few studies, with a large diversity of (assessment of) outcomes and insufficient power, have been published on this topic, limiting our ability to make firm conclusions about the effects of a vegan diet during pregnancy on maternal and fetal outcomes.

Preliminary Investigation of Potential Early Biomarkers for Gestational Diabetes Mellitus: Insights from PTRPG and IGKV2D-28 Expression Analysis

Gestational diabetes mellitus (GDM) poses significant health risks to both mothers and infants, emphasizing the need for early detection strategies to mitigate its impact. However, the existing diagnostic methods, particularly the oral glucose tolerance test (OGTT) administered in the second or third trimester, show limitations in the detection of GDM during its early stages. This study aimed to explore the potential of the genes Protein Tyrosine Phosphatase Receptor-type Gamma (PTPRG) and Immunoglobulin Kappa Variable 2D-28 (IGKV2D-28) as early indicators for GDM among Filipino pregnant women. Utilizing reverse transcription–quantitative polymerase chain reaction (RT-qPCR), the gene expressions were analyzed in first-trimester blood samples obtained from 24 GDM and 36 non-GDM patients. The diagnostic performance of PTPRG and IGKV2D-28 was analyzed and evaluated using receiver operating characteristic (ROC) curves. The findings revealed elevated expression levels of PTPRG and IGKV2D-28 within the GDM cohort. Remarkably, PTPRG exhibited a sensitivity of 83%, while IGKV2D-28 demonstrated a specificity of 94% at determined cut-off values. Combining both genes yielded an improved but limited diagnostic accuracy with an area under the curve (AUC) of 0.63. This preliminary investigation of PTPRG and IGKV2D-28 sheds light on novel avenues for early GDM detection. While these findings are promising, further validation studies in larger cohorts are necessary to confirm these results and explore additional biomarkers to enhance diagnostic precision in GDM pregnancies and, ultimately, to improve maternal and fetal outcomes.

A Review of Third-Trimester Complications in Pregnancies Complicated by Diabetes Mellitus.

Pregnancies affected by both pregestational and gestational diabetes mellitus carry an increased risk of adverse maternal and neonatal outcomes. While the risks associated with diabetes in pregnancy have been well documented and span across all trimesters, maternal and neonatal morbidity have been associated with select third-trimester complications. Further, modifiable risk factors have been identified that can help improve pregnancy outcomes. This review aims to examine the relationship between select third-trimester complications (large for gestational age, intrauterine fetal demise, hypertensive disorders of pregnancy, preterm birth, perineal lacerations, shoulder dystocia, and cesarean delivery) and the aforementioned modifiable risk factors, specifically glycemic control, blood pressure control, and gestational weight gain. It also highlights how early optimization of these modifiable risk factors can reduce adverse maternal, fetal, and neonatal outcomes. KEY POINTS: · Diabetes mellitus in pregnancy increases the risk of third-trimester complications.. · Modifiable risk factors exist for these complications.. · Optimizing these modifiable risk factors improves maternal and neonatal outcomes..

Maternal and fetal outcome of postdated pregnancy; A cross sectional study

Background: Postdated pregnancy refers to a pregnancy that extends beyond the expected date of delivery, which is 280 days. When a pregnancy surpasses 42 weeks (more than 294 days), it is termed as post-term pregnancy. Postdated pregnancy is one of the most common obstetric problems associated with increased maternal and foetal morbidity, and mortality. Gestational age is among the most important determinants of perinatal outcomes, but studies have focused more on preterm births (&lt;37 completed gestational weeks) and less on the understanding and prevention of post term births. Objectives: To assess the maternal and fetal outcome of postdated pregnancy. Material and Methods: Present observational descriptive cross sectional study was conducted for the period of 1 year from 1st April 2023 to 31st March 2024. Total 150 postdated pregnant women included in present study as per predefined after satisfying the inclusion and exclusion criteria. Results: During study period out of total deliveries 110 were postdated deliveries. Out of them 46.36% and 28.18% were of 21-25 years and 26-30 years of age respectively. The mean age of all participants was 25.51 ± 4.58 years. A statistically significant association was found between the gestational age of postdated women and their mode of delivery. Out of 110 postdated women, 68.18% and 31.81% had vaginal and caesarean deliveries, respectively. Conclusion: Adverse maternal and fetal outcomes of post-dated pregnancy should be anticipated and counseling of women at risk of post-term pregnancy and timely management for its prevention is recommended

MATERNAL AND FETAL OUTCOME OF PREGNANCY IN SLE: A SINGLE CENTER SURVEY FROM PAKISTAN

Systemic Lupus Erythematosus (SLE) is an autoimmune disease with multifactorial origins, affecting multiple organ systems. Pregnancy in women with SLE is associated with a higher risk of complications and adverse outcomes. This study aimed to evaluate maternal and fetal outcomes in pregnant patients with SLE. Objective: To analyse the maternal and fetal pregnancy outcomes in patients with SLE. Methods: This cross-sectional study was conducted over six months, from Jan 2024 to July 2024, after approval from the institutional ethical review board. Sixty-six pregnant women with SLE were enrolled based on specific inclusion and exclusion criteria. Detailed medical histories were collected, and patients were followed throughout pregnancy for maternal and fetal outcomes. Data was analyzed using SPSS version 26.0. Results: The mean age of the participants was 35.11 ± 7.27 years. Maternal complications included SLE flare in 47 (71.2%) patients, onset of disease during pregnancy in 4 (6.1%) patients, and normal pregnancy in only 15 (22.7%) cases. Fetal outcomes revealed intrauterine growth retardation (IUGR) in 12 (18.2%) cases and intrauterine death in 5 (7.6%) cases. Conclusion: Pregnancy in women with SLE is associated with significant maternal and fetal complications. The high prevalence of adverse outcomes underscores the need for careful monitoring and specialised care during pregnancy to improve prognoses.

Anticoagulant therapy in pregnant women with mechanical and bioprosthetic heart valves.

The aim of the present study was to review maternal and fetal outcomes in pregnant women with prosthetic heart valves. A retrospective record review of pregnant women with prosthetic heart valves on anticoagulation was performed at the Specialist Cardiac Antenatal Clinic, Johannesburg South Africa from 2015 to 2023. Fifty pregnancies with mechanical heart valves and three with tissue valves, on anticoagulation for comorbid atrial fibrillation were identified. The majority were of African ethnicity at a mean age of 33 ± 6 years. Anti-Xa adjusted enoxaparin was commenced at 10.5 ± 5.6 weeks' gestation until delivery in 48 (90.6%) pregnancies and warfarin was continued in five (9.4%) pregnancies. The live birth rates on enoxaparin and warfarin were 56.3% (95% confidence interval [CI]: 42.3-69.3) and 20.0% (95% CI: 2.0-64.0), respectively. There were 12 (22.6%) miscarriages at a mean of 11.3 ± 3.7 weeks' gestation, four (7.5%) intrauterine fetal deaths on warfarin and two (3.8%) warfarin embryopathy/fetopathy. The rates of antepartum/secondary postpartum bleeding and primary postpartum bleeding were 29.4% (95% CI: 18.6-43.1) and 5.9% (95% CI: 1.4-16.9), respectively. Maternal complications included anemia (n = 11, 20.8%), arrhythmia (n = 2, 3.8%), heart failure (n = 2, 3.8%) and paravalvular leak (n = 2, 3.8%). There was one (1.9%) mitral valve thrombosis and one (1.9%) stuck valve in pregnancies who defaulted warfarin prior to pregnancy. There were no maternal deaths. Multidisciplinary management of pregnant women with prosthetic heart valves with anti-Xa adjusted low molecular weight heparin throughout pregnancy represents an effective anticoagulation option for low-middle-income countries.

Missed nursing care and associated factors among nurses and midwives in maternity wards of Sidama region public hospitals, Ethiopia

BackgroundMissed nursing care refers to any aspect of care performed by nursing staff that is omitted or significantly delayed. Even though the potential impact of missing nursing care on maternal and fetal outcomes is significant, there is currently limited evidence regarding the extent of this issue specifically within the maternity wards. Therefore, this study aimed to assess missed nursing care and associated factors in the maternity wards of public hospitals in the Sidama region, Ethiopia 2022.MethodsA hospital-based cross-sectional study was conducted among 361 nurses and midwives in maternity wards of Sidama region public hospitals from March 28 to April 26, 2022. Simple random sampling was used to select participants. The data was collected using the MISSCARE survey tool and analyzed with SPSS version 26. Simple linear and multiple linear regression analyses were used to identify the factors associated with missed nursing care.ResultsThe overall mean missed nursing care score was 67 out of 130 (95% CI: 65.92, 68.02) and the average score for each nursing intervention was 2.58 out of 5 (95% CI: 2.54, 2.62). The intention to leave the institution (β = 3.812, 95% CI: 2.285, 5.340) and increasing weekly work hours (β = 0.203, 95% CI: 0.134, 0.272) were factors positively associated with missed nursing care. However, increased work experience (β= -0.963, 95%CI: -1.475, -0.452) and job satisfaction (β= -4.976, 95%CI: -6.431, -3.522) were negatively associated with missed nursing care.ConclusionThis study found that the level of missed nursing care was significant. Factors positively associated with missed nursing care included an intention to leave the institution and an increase in weekly work hours. In contrast, an increase in work experience and higher job satisfaction were negatively associated with missed nursing care.

Postnatal outcome of fetal cortical malformations: systematic review.

Parental counseling for fetal malformations of cortical development (MCD) is based on data from studies in children and adults undergoing imaging investigation for abnormal neurodevelopment. However, such postnatal findings may not be applicable to prenatally diagnosed cases. The aim of this study was to review the existing data on postnatal neurodevelopmental outcome for fetuses diagnosed with MCD. A literature search was conducted in PubMed, Web of Science and EMBASE for articles published between 2013 and 2023, using standardized keywords to describe fetal cortical malformations. Full-text articles were accessed for the retrieved citations and data on participant characteristics, imaging findings, and pregnancy and neonatal outcomes were extracted. Fetal MCD was defined as either complex or isolated, according to the presence or absence, respectively, of additional brain or extracranial defects. Overall, 30 articles including 371 cases of fetal MCD were reviewed. The cases were classified as complex (n = 324), isolated (n = 21) or unknown (n = 26). There were 144 terminations and four stillbirths, with pregnancy outcome unreported in 149 cases. A total of 108 cases had postnatal magnetic resonance imaging or postmortem examination data available. In nine of these cases, a diagnosis of complex fetal MCD was changed to isolated MCD after birth, and one case was found not to have MCD. There were 74 live births, for which postnatal neurodevelopment data were available in only 30 cases. Normal neurodevelopmental outcome was reported in seven (23.3% (95% CI, 9.9-42.2%)) infants, with the remaining 23 exhibiting various levels of neurodevelopmental delay (three mild, seven moderate and 13 severe) from 6 months to 7 years of age. Most reviewed cases of fetal MCD were complex in nature and underwent termination of pregnancy. There is a paucity of data on postnatal neurological development in fetuses diagnosed with MCD. The available data suggest antenatal overdiagnosis of case severity in about 5% of cases with known outcome, and either normal neurodevelopment or mild neurodevelopmental delay in approximately one-third of liveborn cases with neurological follow-up. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Asthma and pregnancy: Understanding the dynamic relationship - A comprehensive review

The health of pregnant women and their developing fetuses can be greatly impacted by asthma, a prevalent chronic respiratory disease. Pregnancy-related asthma is a serious health risk. A potentially fatal condition that makes many pregnancies more difficult is asthma. The prevalence of asthma has increased within the past few decades. This comprehensive review explored the complex connection between asthma and pregnancy. Analyzing physiological alterations during pregnancy revealed dynamic interactions between immunological responses and respiratory function. These Important discoveries highlight the susceptibility to exacerbations of asthma. This discussion focuses on the links between poorly managed asthma and unfavourable - perinatal outcomes, with particular attention given to maternal and fetal outcomes, tracking and tailored treatment to provide the best possible management of asthma. This review emphasizes how important it is to manage asthma throughout pregnancy because it can have a positive impact on both the mothers and fetuses long-term health. Consequences for clinical practice emphasize the value of preconception care, ongoing surveillance, and joint obstetrician-pulmonologist efforts. This review also sheds light on how common asthma is in expectant mothers, and this field's future directions require further investigation. Low birth weights and small for gestational age are associated with a greater risk, especially in women who have moderate-to-severe asthma and have episodes of the condition during pregnancy. Additionally, there was a slight but statistically significant increase in the chance of congenital deformities. By preventing exacerbations, active management may lessen these risks. Ensuring optimal management of asthma during pregnancy is crucial for the welfare of the expectant mother and the unborn child. While poorly managed and undertreated asthma is linked to a number of dangers for both mothers and fetuses, well-controlled asthma reduces the risk of complications for both mothers and fetuses.

Oligohydramnios at term in the high-risk population- how severe is severe?

The term oligohydramnios is linked to pregnancy complications. We previously presented the outcome of the low-risk population (no pregnancy complications) with term oligohydramnios. This study aims to address the high-risk group (Any maternal complication during pregnancy, such as gestational diabetes, pre-gestational diabetes, chronic hypertension, preeclampsia, anemia, asthma, obesity, and multi parity.). This retrospective cohort study of 1,114 singleton term (≥37), oligohydramnios (AFI <50 mm) pregnancies from Shamir Medical Center between 2017 and 2021. Compering the low-risk to high-risk groups with subdivision by severity of oligohydramnios. A total of 211 subjects (19 %) were high-risk cases and 903 (81 %) low-risk cases. Comparing these two groups, subjects of the high-risk group were older (31.34±5.85 vs. 29.51 vs. 4.96), had earlier gestational age at delivery 39.53±1.18 vs. 40, had higher mean AFI (35±12.7 vs. 33±14.5), were subject to more labor inductions (81 vs. 69.7 %), and CS rate (19.9 vs. 12.4 %). Logistic regression revealed a need for more cesarean sections in the high-risk group. Additionally, more labor inductions and a higher risk of negative fetal outcomes. This study highlights the importance of considering pregnancy risk factors when we are approaching oligohydramnios in high-risk pregnancies.

Gonadotropins combined with and without 100mg Clomiphene Citrate drug on ovulation induction and role of epidural analgesia in pregnancy outcome of infertility women.

Successful ovulation induction can overcome the common condition of infertility associated with ovulatory dysfunction. Monotherapy of clomiphene citrate (CC) or combined with gonadotrophins are the best treatment modalities for ovulation induction with a successful outcome. We concentrated on evaluating the effects of 100 mg Clomiphene Citrate, both with and without gonadotrophins, on ovulation induction and the outcome of labor analgesia in women with infertility. This prospective cohort consists of 136 women with infertility who were medicated with 100 mg of clomiphene citrate alone and 100 mg of clomiphene citrate with gonadotropins. We recorded the endometrial thickness, details of the dominant follicle, and the incidence of a positive pregnancy rate. Women with positive pregnancy were managed with epidural labor with labor analgesia to relieve labor pain and evaluated the foetal outcome. In CC alone, the ovulation rate was 57%, while in CC with gonadotrophins, it was 81%. The mean dominant follicle size and endometrial thickness were high in CC with gonadotrophins (p &lt; 0.05). The overall incidence of positive pregnancies was 28.98%. Levobupivacaine with dexmedetomidine significantly reduced the mean VAS score from baseline, resulting in a higher foetal body weight. Taking 100 mg of Clomiphene citrate with gonadotropins works better than taking Clomiphene citrate by itself at starting ovulation, increasing the size of the dominant follicle, and improving the thickness of the endometrium. With levobupivacaine plus dexmedetomidine, the labor analgesia showed better stability in hemodynamic parameters and effective control on labor pain scores.

Prenatal Surgery for Open Fetal Spina Bifida in Patients with Obesity: A Review of Current Evidence and Future Directions.

Background: Obesity rates have significantly increased globally, affecting up to 40% of women of childbearing age in the United States. While prenatal repair of open fetal spina bifida has shown improved outcomes, most fetal surgery centers exclude patients with a body mass index (BMI) ≥ 35 kg/m2 based on criteria from the Management of Myelomeningocele Study (MOMS) trial. This exclusion raises concerns about healthcare equity and highlights a significant knowledge gap regarding the safety and efficacy of fetal spina bifida repair in patients with obesity. Objective: To review the current state of knowledge regarding open fetal surgery for fetal spina bifida in patients with obesity, focusing on safety, efficacy, and clinical considerations. Methods: A comprehensive literature search was conducted using the PubMed and EMBASE databases, covering articles from the inception of the databases to April 2024. Studies discussing fetal surgery for neural tube defects and documenting BMI measurements and their impact on surgical outcomes, published in peer-reviewed journals, and available in English were included. Quantitative data were extracted into an Excel sheet, and data synthesis was conducted using the R programming language (version 4.3.3). Results: Three retrospective studies examining outcomes of prenatal open spina bifida repair in a total of 43 patients with a BMI ≥ 35 kg/m2 were identified. These studies did not report significant adverse maternal or fetal outcomes compared to patients with lower BMIs. Our pooled analysis revealed a perinatal mortality rate of 6.1% (95% CI: 1.76-18.92%), with 28.0% (95% CI: 14.0-48.2%) experiencing the premature rupture of membranes and 82.0% (95% CI: 29.2-98.0%) delivering preterm (<37 weeks). Membrane separation was reported in 10.3% of cases (95% CI: 3.3-27.7%), the mean gestational age at birth was 34.3 weeks (95% CI: 32.3-36.3), and the average birth weight was 2651.5 g (95% CI: 2473.7-2829.4). Additionally, 40.1% (95% CI: 23.1-60.0%) required a ventriculoperitoneal shunt. Conclusion: While current evidence suggests that fetal spina bifida repair may be feasible in patients with obesity, significant limitations in the existing body of research were identified. These include small sample sizes, retrospective designs, and a lack of long-term follow-up data. There is an urgent need for large-scale, prospective, multicenter studies to definitively establish the safety and efficacy of fetal spina bifida repair in patients with obesity. Such research is crucial for developing evidence-based guidelines, improving clinical outcomes, and addressing healthcare disparities in this growing patient population with obesity.