Weeks Of Pregnancy Research Articles

Primary and secondary cerclage in high-risk pregnant women: Influence on prolongation of pregnancy and preterm birth

The aim of the study was to evaluate the effectiveness of cerclage in women with previous late miscarriages or premature births. The primary aim was to prolong pregnancy and achieve a term delivery. Secondarily, it was investigated whether an intervention after an early pathological 75-g-oGTT result influences these endpoints. A total of 133 cases were analyzed retrospectively. 80 women underwent primary cerclage between the 14th and 16th week of pregnancy; 53 women underwent secondary cerclage after cervical shortening of less than 25 mm. This group was further subdivided into therapeutic and emergency cerclage groups. Women with early pathologic 75-g-oGTT were treated diabetologically. Primary cerclage prolonged pregnancy by 20.6 weeks and led to a term delivery in 51 women (63.8%). In the group with secondary cerclage, 25 women (47.2%) had a term delivery with a prolongation of 20.1 weeks. For amniotic sac prolapse, the prolongation was 7.9 weeks. Pathological 75-g-oGTT results were found in 63 women. Early intervention had no significant effect on prolongation and term delivery. Primary cerclage was more effective in achieving term delivery. Women with therapeutic cerclage without amniotic sac prolapse also benefited. With cervical shortening without prolapse, the prolongation was the same in both groups. The worst outcome was observed in emergency cerclage with amniotic sac prolapse. An early 75-g-oGTT is important in order to recognize and treat gestational diabetes in time.

First-Trimester PLGF and PAPP-A and the Risk of Placenta-Mediated Complications: PREDICTION Prospective Study

ObjectivesTo estimate the association between low first-trimester maternal serum placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) and the risk of placenta-mediated complications. MethodsWe performed a secondary analysis of PREDICTION study including nulliparous participants recruited at 11–14 weeks of pregnancy. First-trimester PlGF and PAPP-A were reported in multiples of the median (MoM) adjusted for maternal characteristics and gestational age. Participants were stratified into four groups based on absence/presence of low (<0.4 MoM) PlGF and PAPP-A values. A composite of adverse pregnancy outcomes (including preeclampsia, fetal growth restriction, fetal death, and placental abruption) with delivery before 34, before 37 weeks, and at or after 37 weeks was calculated. ResultsOut of 7262 participants, 86 (1.2%) developed the composite outcome before 37 weeks, including 35 (0.4%) before 34 weeks. The combination of low PAPP-A and low PlGF was associated with the greatest risk of adverse outcomes before 37 weeks (21%) and before 34 weeks (12%) compared to low PlGF alone (7% and 3%), low PAPP-A alone (2% and 1%), or neither marker (1% and 0.4%, respectively, P < 0.001). Looking specifically at pre-term preeclampsia, the combination of low PAPP-A and low PlGF was also associated with a greater risk (12%) compared to low PlGF alone (6%), low PAPP-A alone (0.5%), or neither marker (0.7%, P < 0.001). ConclusionThe combination of low PAPP-A and low PlGF is associated with a very high risk for adverse outcomes before 34 and 37 weeks. An isolated low PAPP-A should not be considered a risk factor for adverse pregnancy outcomes.

Pathways to depressive symptoms in Chinese pregnant women and their influence on delivery approach: a qualitative comparative analysis.

The aim of this study was to apply complexity theory to explain and understand how risk factors combined in complex ways, eventually leading to a high prevalence of depressive symptoms among pregnant women. We also aimed to evaluate whether depressive symptoms affected delivery approach. The study had a longitudinal design and was conducted between May and September 2017. A total of 481 pregnant women were recruited to participate and completed closed-end surveys at two distinct times: during prenatal care at the hospital after 26 weeks of pregnancy and 1 to 4 weeks after delivery. This study identified eleven different pathways that led to an increase in depressive symptoms. Each pathway differentiated the effects of different influencing factors. Among the 481 pregnant women, 128 (26.6%) had cesarean deliveries without medical indications. Although depressive symptoms could affect delivery approach, it was not the most important factor. Surprisingly, the first production emerged as the key factor determining delivery mode. This study was innovative in that it examined which factors and which combinations of factors were necessary for the development of depressive symptoms. Additionally, this study provided a better understanding of the mechanisms underlying the choice of cesarean section without medical indications.

The prevalence of optrA-carrying Enterococci in the vaginal micro-ecology of pregnant women in late pregnancy.

The colonization of Enterococcus in the female vagina leads to neonatal and pediatric enterococcal septicemia. Linezolid (LZD) is a kind of mainstream drug for treating multidrug-resistant Gram-positive infections. OptrA is the main LZD-resistance gene at Enterococci in human isolates. It is essential to explore the prevalence of optrA-carrying Enterococcus in vaginal secretions of late pregnant women and the drug resistance of optrA. From May to June 2023, this study recruited 340 volunteers in late pregnancy (35-40 weeks of pregnancy) to provide non-repetitive vaginal discharge samples. Luria-Bertani broth and florfenicol (10 µg/mL) were used to enrich bacteria. Enterococci was identified through time-of-flight mass spectrometry. Additionally, antimicrobial susceptibility, polymerase chain reaction, and next-generation sequencing assays were applied to this study. Fifty-four optrA-carrying Enterococcus strains were obtained, the proportion of the whole vagina of late pregnant women was 15.88% (54 out of 340), and Enterococcus faecalis account the highest proportion. All optrA-carrying Enterococcus were resistant to at least three drugs. Tetracycline, chloramphenicol, erythromycin, and LZD have higher bacterial resistance rates. Genetic environment analysis revealed that IS1216E, fexA, and erm(A) may synergistically exert multidrug resistance with optrA. It is necessary to strengthen the surveillance of optrA-carrying Enterococcus in pregnant women. This study provides scientific support for controlling hospital infections and managing antibiotic-resistant bacteria, and provides a scientific basis for rational clinical medication.IMPORTANCEThe disruption of cervicovaginal microbiota homeostasis is considered a key factor in causing imbalance in the microenvironment, leading to inflammation, transmission of infections, and illness. Enterococcus is considered a major cause of healthcare-related infections globally. It has resistance to multiple antimicrobial drugs, which pose significant challenges for clinical treatment. Therefore, it is crucial to assess the prevalence of optrA-carrying Enterococcus in vaginal secretions of late pregnant women and the drug resistance of optrA. This study detected 15.88% of optrA-carried Enterococci in 340 pregnant women. Furthermore, we found that optrA-carrying Enterococcus strains are highly resistant to tetracycline, chloramphenicol, erythromycin, and Linezolid. Additionally, genetic environment analysis revealed that IS1216E, fexA, and erm(A) may synergistically exert multidrug resistance with optrA. This study provides scientific support for controlling hospital infections and managing antibiotic-resistant bacteria and provides a scientific basis for rational clinical medication.

New insights into gestational diabetes: genetic and epigenetic factors

ABSTRACT Gestational diabetes is generally diagnosed between the 24th and 28th weeks of pregnancy because of hormonal changes leading to insulin resistance. Key risk factors include obesity, a family history of diabetes and ethnicity, as well as genetic and epigenetic influences. Epigenetic modifications, such as DNA methylation and histone acetylation, alongside environmental factors like diet and exposure to endocrine disruptors, contribute to the risk. Effective management of gestational diabetes is crucial to prevent complications such as macrosomia, birth trauma, and an increased risk of caesarean delivery. This management requires dietary changes, regular blood glucose monitoring, and sometimes insulin therapy. Current research focuses on understanding genetic and epigenetic influences to improve prediction and develop targeted therapies, highlighting the necessity for personalised approaches to managing and preventing gestational diabetes. Advances in this area could lead to more effective and individualised treatment strategies, benefiting both mothers and their babies.

High Serum Adrenomedullin and Mid-Regional Pro-Atrial Natriuretic Peptide Concentrations in Early Pregnancy Predict the Development of Gestational Hypertension

Objectives: Adrenomedullin (AM) and natriuretic peptide levels are elevated in pre-eclampsia. The aim of the present study was to determine AM and natriuretic peptide concentrations before 20 weeks of pregnancy in women who later developed gestational hypertension and in normal pregnancies. Methods: 95 pregnant Caucasian women were included in the study. Gestational hypertension (GH) was diagnosed in 18 patients. The control group consisted of 41 patients with normal pregnancies (non-GH). Blood samples were taken during the first trimester of pregnancy. Results: Analysis of NT-proBNP showed no significant differences between the group of patients who later developed GH and those with normal pregnancies. Patients who developed GH later in pregnancy had higher levels of both MR-proANP (p &lt; 0.001) and adrenomedullin (p &lt; 0.001). Higher levels of MR-proANP were found in the GH with pre-eclampsia group compared with the GH without pre-eclampsia group. Higher levels of AM (p &lt; 0.05) and MR-proANP (p &lt; 0.005) correlated with the risk of preterm birth. Conclusions: (1) Plasma adrenomedullin and MR-proANP concentrations were higher before the 20th week of pregnancy in women who later developed GH; (2) NT-proBNP concentrations did not differ between women with pregnancy-induced hypertension and normal pregnancies; (3) MR-proANP concentrations were highest in patients who developed pre-eclampsia in advanced pregnancy; and (4) there was a correlation between higher plasma adrenomedullin, MR-proANP concentrations before the 20th week of pregnancy, and the risk of preterm birth.

Study on Adolescents Reproductive Health &amp; Problems in a Tertiary Care Hospital, Chattogram

Background: Adolescence is a stage where the physical and psychological development of a child takes place. Inother words, teenagers passing the years between the puberty and adulthood, from ages 10-19 years. Adolescents are likely to face a range of health and social challenges, for instance initiation of sexual activity while there is still lack of adequate knowledge and skill. High prevalence of early marriage and child bearing are associated with higher rate of morbidity and mortality. They are also in higher risk of unwanted pregnancy, unsafe abortion and sexually transmitted infections. The main objective of this study is to suggest the strategies for improvement of adolescents reproductive health status in Bangladesh. Materials and methods: This retrospective observational study was conducted in the Obs and Gynae Department of Chattagram Maa-O-Shushu Hospital Medical College (CMOSHMC) from July to December 2022. Total 436 adolescents were included in this study who were admitted in Obs and Gynae Department instudy period. All cases reviewed retrospectively from in patients records. An inclusion criterion of age in this study is 10-19 years. Results: A Total 436 patients were enrolled in this study with age limit between 10- 19 years. Total Obstetric patients were 360 (82.57 %). Among them antenatal patients were 348 (97 %), postnatal patients were 12 (3%). Among antenatal patients primipara 344 (99 %), multi para (2nd pregnancy) 4 (1%). Total delivery occurred in 302 patients. Vaginal delivery occurred in 147 patients (49 %), cesarean section were needed in 140 patients (46%). Repair of perineal tear done in 2 post natal patients. Secondary wound closure was done in 1 patient. Conservative management was given to 70 patients. Sexual abuse in 3 patients, came with 14, 16 and 25 weeks of pregnancy and medical termination were done in all cases. Maternal death was 1 (4.2%) due to primary PPH following LSCS due to central placenta Previa with postoperative cardiac arrest. Total baby delivered 302, alive 287(95%), intrauterine death 15 (5%). LBW (Low Birth Weight) 49 (17 % of alive baby ), IUGR (Intrauterine Growth Restriction) 6 (2%), NND (Neonatal Death) 5 (1.7%). Total Gynae patients admitted were 76 (17.43%), abortion related complications were 52 (68%), menstrual abnormality were 7(9.2%), ruptured ectopic pregnancy following sexual abuse was 1 (0.92% of total patients ) . Conclusion: There is growing attention being paid to improving access to quality maternal care for pregnant and parenting adolescents preventing pregnancy among adolescents are fundamental to achieving positive health outcomes across the life course and imperative for achieving the SDGS (Sustainable Developmental Goals) related to maternal and newborn health. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 60-63

Efficacy of amniotic fluid, blood and urine samples for the diagnosis of toxoplasmosis in pregnant women candidates for amniocentesis using serological and molecular techniques

BackgroundsToxoplasmosis, a prevalent parasitic infection, is primarily caused by Toxoplasma gondii (T. gondii). This infection poses a significant threat to neonates during pregnancy and individuals with compromised immune systems. Consequently, it is imperative to develop a novel diagnostic approach that combines high sensitivity with low-risk sampling to effectively manage patients. The aim of this study is to utilize serological and molecular techniques for the diagnosis of T. gondii infection in 100 pregnant women who were under the care of a gynecologist and were candidates for amniocentesis.MethodsDuring the 15-19th weeks of pregnancy, a total of 100 samples each of amniotic fluid, buffy coat, plasma, and urine simultaneously were collected from pregnant women candidates for amniocentesis in Mazandaran province, northern Iran. This study involved various assessments: (1) detecting anti-T. gondii IgM and IgG in plasma through chemiluminescence assay (2) determining IgG avidity in plasma using the Enzyme-linked immunosorbent assay technique (3) identifying of T. gondii DNA in amniotic fluid, buffy coat and urine by nested PCR (nPCR) and quantitative real-time PCR (qPCR) methods targeting the REP-529 gene, as well as genotyping using GRA6 target genes, and (4) assessing the sensitivity and specificity of the nPCR and qPCR tests.ResultsOut of 100 pregnant women screened, 70 were between the ages of 31 to 40 years old. Among them, 23 and 44 had one and two previous pregnancies. Additionally, 13 and 8 women had one and two history of abortions, respectively. Following serologic testing, 52% of the individuals were positive for T. gondii antibodies. Of these, 52 samples were positive for IgG antibodies, and one sample was positive for both IgG and IgM antibodies. Notably, all 52 cases with IgG positivity exhibited a high level of IgG avidity. Regarding the molecular testing of amniotic fluid samples, two pregnant women tested positive in the nPCR assay, while three tested positive in the qPCR assay. Furthermore, genotyping revealed that all positive samples belonged to type I of the T. gondii genotype. Moreover, none of the 100 buffy coat and urine samples tested positive for T. gondii using the nPCR and qPCR techniques.ConclusionThe findings of the current study suggest that serological methods alone may not be reliable in diagnosing congenital toxoplasmosis and cannot rule out the diagnosis of toxoplasmosis and must be approved by molecular tests.

Evaluation of the clinical course of hypertensive disorders against the background of subclinical hypothyroidism in pregnant women

Background. Hypertensive disorders during pregnancy, such as gestational hypertension and preeclampsia, pose significant health risks. They require a personalized treatment approach due to their multifactorial nature. The presence of subclinical hypothyroidism may exacerbate these risks, making thyroid function monitoring before and during pregnancy particularly important.The aim. To investigate the clinical features and severity of hypertension in newly diagnosed subclinical hypothyroidism among women in Andijan.Methods. A case-control study conducted from November 2022 to April 2023 included 272 pregnant women aged 18 to 40 years without chronic diseases. The main group comprised 88 women diagnosed with hypertension after the 20th week of pregnancy. The control group consisted of 184 women without hypertension. The study excluded HIV-positive women, as well as those with congenital anomalies or who had undergone surgical interventions on the genitourinary and cardiovascular systems. Socio-demographic and lifestyle characteristics of the participants were studied. The analysis revealed significant differences in age, activity level, place of residence, employment, and education, as well as a correlation between body mass index, health status, and hypertension severity.Results. The findings underscored the importance of thyroid function monitoring during pregnancy, linking hypertension to age, activity level, and obesity. This confirms the necessity for a comprehensive approach to pregnancy management, including thyroid function and lifestyle modifications.

Gong’s acupuncture treatment for mid pregnancy insomnia and anxiety: A case report

Rationale: Gong’s brain acupuncture (GBA) is a acupuncture technique that restores the balance of the central nervous system by stimulating specific acupoints on the skull to transmit stimulation to the nerves. Insomnia during pregnancy is an increasingly concerning issue, and GBA provides new solutions. Patient’s concerns: The patient, a 26-year old woman at 26 + 1 weeks of pregnancy, presented with unexplained insomnia for 3 weeks. Her symptoms included difficulty initiating sleep, light sleep, and intermittent wakefulness throughout the night. Diagnoses: The patient was diagnosed with primary insomnia, scoring 16 on the Pittsburgh sleep quality index, which indicates poor sleep quality. Her self-rating anxiety scale (SAS) score was 49 points, suggesting that she had not yet reached a state of mild anxiety. Interventions: The patient received 15 sessions of GBA treatment. Outcomes: One month after treatment completion, the patient’s Pittsburgh sleep quality index score improved to 3 points, indicating good sleep quality. Her self-rating anxiety scale score decreased to 39 points. Lessons: This case report demonstrated the successful treatment of mid pregnancy insomnia with GBA, providing preliminary evidence for further research on the therapeutic potential of GBA. However, further research is still needed to enhance persuasiveness.

The Role of Hyperemesis Gravidarum in the First-Trimester as a Predictor of Intrahepatic Cholestasis of Pregnancy

Background: Intrahepatic cholestasis of pregnancy (ICP) and hyperemesis gravidarum (HEG) are pregnancy-specific liver diseases associated with significant fetal and maternal complications. Typically, HEG is diagnosed in the first trimester of pregnancy, and ICP in the third trimester of pregnancy. The aim of this study is to investigate whether primigravid women diagnosed with ICP between the 26th and 37th weeks of pregnancy were also diagnosed with HEG during the first trimester, and to evaluate whether the diagnosis of ICP can be predicted in pregnant women with a prior diagnosis of HEG. Methods: Our study is a retrospective analysis. A total of 4000 pregnant women, aged 18 to 45 years and between 26th and 37th weeks of gestation, who presented to the Gynecology and Obstetrics Clinic of the Health Sciences University, Istanbul Training and Research Hospital with complaints of pruritus between 01/07/2018 and 01/07/2023, were screened. 227 patients were diagnosed with ICP. Complete medical records and blood test results were available for 141 patients. 39 patients with a history of previous pregnancies and/or comorbidities, as well as 30 patients without available serum total bile acids (TBA) results, were excluded from the study. Of these, 72 pregnant women who met the inclusion criteria were enrolled in the study and grouped into primigravid women with and without a history of HEG in the first-trimester. Demographic characteristics, gestational age, detailed medical history, ultrasound findings, and biochemical parameters—including alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, bilirubin, and fasting bile acid (FBA) levels were statistically compared. Results: In our study, comparisons revealed no significant differences in AST, ALT, alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and direct bilirubin levels (p &gt; 0.05) between the groups with and without a history of HEG diagnosed with cholestasis. In pregnant women diagnosed with cholestasis, the total bilirubin and indirect bilirubin levels were significantly lower (p &lt; 0.05) in the group with a history of HEG compared to the group without a history of HEG. In contrast, TBA levels were significantly higher (p &lt; 0.05) in the group with a history of HEG compared to the group without a history of HEG. Conclusions: This study found that primigravid women with ICP and a history of HEG had elevated TBA levels, while total and indirect bilirubin levels were reduced. This suggests that patients with a history of HEG should be closely monitored in later stages of pregnancy for the development of ICP and potential liver damage. However, larger and more comprehensive studies are needed to confirm these findings.

Maternal Plasma Lipid Concentration in Early Pregnancy and Risk of Preeclampsia

Objective: To determine the relationship between maternal plasma lipid concentration in early pregnancy and risk of preeclampsia. Study Design: Cross-sectional study. Place and Duration of Study: Gynecology and Obstetrics Department Pak Emirates Military Hospital, Rawalpindi Pakistan, Jan 2019 to Jan 2020. Methodology: A total of 500 pregnant women who came for routine antenatal checkup and underwent serum lipid profile testing at 13th week of pregnancy were included in our study. They were followed up till the end of pregnancy for any signs and symptoms of pre-eclampsia. Age and lipid profile parameters were correlated with the presence of preeclampsia in the study participants. Results: Out of 500 pregnant women studied, 443(88.6%) had no preeclampsia during the course of pregnancy while 53(11.4%) had preeclampsia. Mean age of participants was 33.72±6.731 years. With binary logistic regression analysis, it was found that raised levels of total cholesterol, triglycerides and low density lipoprotein cholesterol at 13 weeks of pregnancy had statistically significant relationship with presence of preeclampsia later among the target population. Conclusion: Deranged lipid profile emerged as strong predictor of preeclampsia in our target population. Raised total cholesterol level, triglyceride levels and low density lipoprotein levels were significantly more in patients who developed preeclampsia as compared to those who did not develop this condition.

Reference intervals for 23 common biochemical parameters during pregnancy and the first six postpartum months

The concentration of many biochemical parameters changes significantly during pregnancy and the postpartum period, causing a need for specific reference values for biochemical parameters in these life periods. We have collected blood samples in pregnancy week 18, 28 and 36 and six weeks, four months and six months postpartum from 139 healthy women. Blood samples from 59 healthy never-pregnant women were included as controls. Serum samples were analyzed for 23 common biochemical parameters and reference intervals for pregnancy and postpartum periods were computed with the non-parametric method in accordance with recommendations from IFCC and CLSI. The dynamics of different biochemical parameters during and after pregnancy vary considerably between parameters. Some analytes like serum amylase and HDL cholesterol do not differ from never-pregnant values. Of the 23 parameters, serum alkaline phosphatase, chloride, gamma-glutamyl transferase and sodium and urea which were still significantly changed at six months postpartum compared to never-pregnant women. The physiological changes related to pregnancy and lactation have profound effects on biochemical parameters, denoting the use of specific reference intervals for both pregnancy and the postpartum period.

The Nuchal Cord Conundrum: Understanding and Addressing Umbilical Entanglement in the Third Trimester of Pregnancy.

Background/Objectives: Better understanding of and addressing umbilical entanglement in the third trimester of pregnancy is necessary to estimate its impact on fetal circulation. An analysis of single physiological pregnancies wrapped with one or two coils of the umbilical cord around the neck makes it possible to understand the severity of the problem and distinguish it from perinatal umbilical strangulation. Methods: In an echocardiographic study performed at 32.1 weeks of pregnancy in fetuses with one and two coils of the umbilical cord around the neck, the pulsatility index (PI) and the Tei index for the left (Tei LV) and right ventricle (Tei RV) of the heart were measured to evaluate cardiac function. Results: The study showed significantly higher Tei RV and Tei LV for fetuses with one (93 cases) and two coils of the umbilical cord around the fetal neck (26 cases) with respect to the control group of fetuses (680 cases) with no umbilical cord around the fetal neck, whereas PI UMBA did not differ significantly. Conclusions: Wrapping of the umbilical cord around the fetal neck may affect the study of the fetal heart without any mechanically induced compression of the umbilical vessels in normal pregnancy.

Abstract 4135893: The Importance of Genetic Testing in Diagnosis and Management of Peripartum Cardiomyopathy: A Case Study

Introduction: At least 15% of women diagnosed with peripartum cardiomyopathy (PPCM) are found to have a pathogenic genetic variant associated with dilated cardiomyopathy. We present a patient with PPCM who required orthotopic heart transplantation (OHT) for cardiogenic shock. Her explant pathology and genetic testing played a critical role in identifying the etiology of her cardiomyopathy. Case Description: A 22-year-old primigravid woman with a history of asthma presented in labor and underwent a Cesarean delivery for non-reassuring fetal heart tones. She had noted exertional dyspnea, a dry cough, and orthopnea in her final weeks of pregnancy but had an otherwise uncomplicated pregnancy. Immediately following delivery, she suffered a cardiac arrest with pulseless electrical activity and developed cardiogenic shock. She was found to have severe biventricular systolic dysfunction with a left ventricular (LV) ejection fraction of 10%. She was cannulated on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and transferred to our center. She was transitioned from VA-ECMO to an axillary Impella 5.5 device but continued to require inotropic support without evidence of LV recovery. Therefore, she was listed for and successfully underwent OHT. Explant pathology (Figure 1) revealed arrhythmogenic cardiomyopathy (ACM). Her family history was significant for a maternal grandfather who died of an unspecified arrhythmia at age 57. Genetic testing via a commercial arrhythmia and cardiomyopathy panel revealed a pathogenic desmoplakin ( DSP) truncating variant ( DSP tv) p.Ser1894Leufs*34 in the N-terminal constitutive NMD-competent region, confirming the diagnosis of ACM. The patient had minor cutaneous findings, including curly hair, consistent with the clinical presentation of DSP -mediated ACM. Discussion: This case highlights the importance of genetic testing in all patients with PPCM, as well as attention to the explant pathology in those who undergo OHT. These practices can elucidate the mechanism of cardiomyopathy, inform the risks of disease progression and of relapse with subsequent pregnancy, and allow for cascade testing of family members.

Abstract 4137145: Aortic Stenosis in Pregnancy: A Multidisciplinary Team Approach

Introduction: The hemodynamic adaptations that occur during pregnancy can have significant effects on patients with aortic stenosis (AS). These changes can lead to structural changes identified on echocardiogram even during uncomplicated pregnancies. While some cases can be managed with medical therapy and activity modification, others may require valve intervention in the gestational period. Case: A 29-year-old female with history of congenital bicuspid aortic valve, G1P0 presented at 42+2 weeks of pregnancy and was admitted to cardiac intensive care unit for continuous hemodynamic monitoring via use of arterial line. Her prior aortic valve disease was treated by valve repair with valvotomy, removal of tissue from pseudo raphe, removal of calcified scar tissue from both commissures, and a mitral valve repair for closure of an iatrogenic tear in her anterior leaflet. She followed closely with maternal fetal medicine and cardiology but became symptomatic at week 28 with lightheadedness, shortness of breath and decreased exercise tolerance (NYHA Class II). By week 33 she noticed lower extremity edema. Despite recommendations for planned delivery, she opted to wait until full term for delivery. Surveillance echoes revealed rising velocities yet stable valve area by planimetry. She ultimately underwent an uncomplicated Cesarean delivery of baby boy in week 42. At 6 months post partum she had successful transcatheter aortic valve replacement. Discussion: As the severity of valvular disease worsens there is a higher risk of complications during pregnancy. In our case, aortic valve velocities were elevated due to the expected hemodynamic changes of pregnancy. Thus, echocardiography monitoring should be used to assess the left ventricle’s ability to tolerate and compensate for these changes, while intervening based on symptoms and NYHA classification. We highlight the importance of multidisciplinary collaboration for safe and successful delivery in patients with AS.

Inequalities and Differences in Health Status of Pre- and Perinatal Periods in Hungarian Long-Term Series Analysis (1997-2019).

The main goal of this study is to publish findings on the lifestyle factors of pregnant women in Hungary and their impact on early childhood health status by examining changes over time and regional/geographical disparities. The source of the data is the raw indicators reported by health visitors as per mandatory annual report data for the period of 1997-2019. To examine the association, we used indicators of pregnant women's states as explanatory variables (for example, pregnant women in very late care, prenatal smoking habits, and pregnant women without care), and the outcome indicators were prematurity, intrauterine malnutrition, and newborn babies with developmental disorders. A univariate Poisson regression was used to examine the correlations. Our results show a decreasing trend in the proportion of pregnant women who smoke and of pregnant women who apply late for care (after 28 weeks of pregnancy), with an increasing indicator of regional differences. The research results of the prenatal and perinatal indicators show that the counties Borsod-Abaúj-Zemplén and Szabolcs-Szatmár-Bereg are the most critical areas in terms of health status in Hungary. The number of pregnancies attended very late (after 28 weeks) and the number of women who gave birth without health visitor care are associated with the number of preterm births (R2 = 0.7313; p < 0.001; R2 = 0.5519; p < 0.001) and intrauterine growth restrictions (R2 = 0.3306; p < 0.001; R2 = 0.2632; p < 0.001). Interventions to improve early childhood health in some counties of Hungary are urgently needed to reduce regional disparities. Such counties include Borsod-Abaúj-Zemplén, Szabolcs-Szatmár-Bereg, Heves, Somogy, Bács-Kiskun, and Nógrád. Health education for pregnant women and activities to strengthen the compliance of pregnant women are key to improving early childhood health outcomes.

The Single Ventricle of the Heart in Combination with Transposition of the Main Vessels in the Practice of a Doctor: A Clinical Case

The most vulnerable period in terms of the formation of congenital malformations of organs is 3-4 weeks of pregnancy. It is during this period that the formation of the interventricular septum occurs. Exposure to teratogenic factors on the fetus or genetic mutations at the initial stages of embryogenesis can lead to the development of a single ventricle of the heart, which is considered a severe congenital malformation. The article describes a clinical case of a single heart ventricle in a 19-year-old patient complicated by cardiorenal syndrome.

ANXIETY SYNDROME IN PREGNANT WOMEN WITH OBESITY AND GESTATIONAL DIABETES MELLITUS

Introduction. Over the past three years, the population of Ukraine has faced chronic stress due to ongoing military actions within its borders. In current conditions, psychoemotional disorders in patients with somatic pathology are often underestimated, with physiological states being confused with pathological anxiety. This oversight can lead to ineffective treatment, worsening patient conditions, and negative prognoses. As a result, the diagnosis and treatment of anxiety syndrome, particularly in pregnant women with both obstetric and extragenital pathology under chronic stress, is a pressing issue in modern obstetrics. The purpose of this study was to assess the presence of anxiety syndrome in pregnant women of the Kharkiv region with obesity and gestational diabetes mellitus during martial law. Materials and methods. To achieve the objective of this study, 85 women aged 24 to 39 years were examined at 30–42 weeks of pregnancy. The main group consisted of 63 pregnant women with obesity and gestational diabetes mellitus, further divided into three clinical subgroups: the first group included 24 women with gestational diabetes mellitus, the second group comprised 16 women with pre-pregnancy obesity, and the third group consisted of 23 women with both gestational diabetes mellitus and obesity. The control group included 22 women without somatic or obstetric pathology. The GAD-7 questionnaire was used to assess the overall level of anxiety. Results and discussion. All participants answered the questionnaire with scores of 2–3 points, indicating significant anxiety levels, as total scores reached 14 points or higher. Notably, the average anxiety scores in the groups with gestational diabetes mellitus, obesity, and gestational diabetes mellitus with obesity were similar—16.5±2.3, 17.9±1.8, and 17.6±2.5, respectively— and were significantly higher than those of the control group, which averaged 4.4±2.6 (p &lt; 0.05). Thus, all women in the main group (63 pregnant women) exhibited clear signs of anxiety, including irritability (95.2%), restlessness (79.4%), inability to relax (74.6%), and anticipation of dreadful events (66.0%). These symptoms were more pronounced in women with obesity compared to those with gestational diabetes mellitus without obesity. Conclusion. Under martial law conditions, pregnant women with comorbidity of gestational diabetes mellitus and obesity exhibit a significantly higher level of anxiety compared to women with a physiological pregnancy, although the latter also experience anxiety disorders, but to a lesser degree. Assessing anxiety disorders in pregnant women with gestational diabetes mellitus and obesity using the GAD-7 scale enables timely detection of these issues, even remotely. This facilitates appropriate referrals to specialists such as psychologists, psychotherapists, or psychiatrists, and allows for the early initiation of necessary therapy.

Predicting cervical insufficiency in twin pregnancies using ultrasound cervical measurements and elastography.

Background: To evaluate the predictive effect of transvaginal ultrasound measurement of cervical length and cervical elasticity examination on cervical insufficiency in twin pregnancies. Methods: Data from twin pregnant women in our hospital were collected retrospectively, including relevant vaginal ultrasound parameters (e.g., cervical length, cervical elasticity score, and the strain value of each part of the cervix). We assessed the risk factors using receiver operating characteristic curve analysis to evaluate the predictive effect of each factor on the occurrence of cervical insufficiency. Results: A total of 284 pregnant women with twin pregnancies, including 142 with cervical insufficiency and 142 without cervical insufficiency, were included. Significant differences between the two groups were observed in the use of assisted reproductive technology, age, history of second-trimester miscarriage, etc. The cervical length of pregnant women with cervical insufficiency was significantly shorter at 22-24 weeks of gestation. Cervical length had the largest area under the receiver operating characteristic curve for predicting cervical insufficiency at that time. The area under the curve of cervical insufficiency predicted by the cervical elasticity score at 12-14 weeks of pregnancy was greater than that predicted by the cervical length at the same time, and the area under the curve of cervical insufficiency predicted by the elasticity score and pre-pregnancy body mass index during the same period was the largest. Conclusions: The cervical elasticity score at 12-14 weeks of gestation effectively predicted the occurrence of cervical insufficiency. The combination of the cervical elasticity score and pre-pregnancy body mass index predicted cervical insufficiency in women with twin pregnancies.