Pregnant Woman Research Articles

A Case Report on Intrauterine Growth Retardation (IUGR) With Single Umbilical Artery (SUA)

Intrauterine growth restriction (IUGR) is fetal growth below the expected potential for a given gestational age. Single umbilical artery (SUA) fetuses are more likely to experience a number of concerns, including prematurity, IUGR, and intrauterine fetal demise. Although SUA is a relatively uncommon anomaly, it is clinically significant and frequently associated with various pregnancy complications. This case report presents a 24-year-old pregnant woman who underwent a targeted anatomical ultrasound (TIFF scan) at 21 weeks and six days of gestation. The ultrasound identified a single umbilical artery and two echogenic foci in the left ventricular cavity of the fetal heart, with no other abnormalities observed.

Enhanced clindamycin delivery using chitosan-coated niosomes to prevent Toxoplasma gondii strain VEG in pregnant mice: an experimental study

BackgroundCongenital toxoplasmosis occurs when a pregnant woman becomes infected with Toxoplasma gondii (T. gondii) for the first time. Treatment typically involves antimicrobial medications, with spiramycin commonly used to prevent transmission. However, spiramycin's effectiveness is limited due to poor placental penetration. Clindamycin, another antibiotic, can cross the placenta but reaches the fetus at only half the maternal concentration. Encapsulating the drug in chitosan-coated niosomes (Cs-Nio) could enhance its effectiveness by targeting specific organs and ensuring sustained release. To address the challenges of using clindamycin, a niosome-coated chitosan system was investigated for treating congenital toxoplasmosis caused by the VEG strain of T. gondii in an animal model.MethodsPregnant mice were infected with VEG strain of T. gondii on the 12th day of pregnancy, followed by treatment with various drugs across six groups. The treatments included chitosan-coated niosomes loaded clindamycin (Cs-Nio-Cli) and other controls. Parasitological evaluations (microscopic examination and real-time PCR), along with histopathological and immunological assessments were conducted to assess treatment efficacy. Finally, statistical analysis was conducted using GraphPad Prism 8.0 and SPSS 26, comparing test and control groups with T test and Mann–Whitney test. A p ≤ 0.05 was considered statistically significant.ResultsThe study found that treatment with Cs-Nio-Cli significantly reduced the number of T. gondii cysts in the brain and eyes (97.59% and 92.68%, respectively) compared to the negative control group. It also mitigated inflammatory changes, prevented cell death, and reduced vascular cuffs in the brain. In addition, Cs-Nio-Cli treatment decreased bleeding, placental thrombosis, and inflammatory cell infiltration in the placenta while improving eye tissue health by reducing retinal folds and bleeds. Immunologically, nanoclindamycin treatment resulted in lower TNF-α cytokine levels and higher IL-10 levels, indicating an enhanced anti-inflammatory response.ConclusionsAlthough Cs-Nio-Cli demonstrates promise in reducing the transmission of congenital toxoplasmosis and mitigating the effects of congenital toxoplasmosis, additional research is necessary to determine the optimal treatment regimens for the complete eradication of the parasite in the fetus.

Study protocol for Early Tracking of Childhood Health determinants (ETCHED): A longitudinal observational life course study

BackgroundThe prevalence of childhood obesity and diabetes continues to rise in the United States (US), especially among minority populations. The objective of the Early Tracking of Childhood Health Determinants (ETCHED) study is to investigate the role of adverse fetal and early-life risk exposures that contribute to the development of childhood obesity and metabolic risk.MethodsETCHED is a longitudinal observational study of American Indian/Alaska Native (AI/AN) and Hispanic pregnant woman and their offspring. Pregnant mothers ≥ 18 years old are enrolled at a large public hospital system in the southwestern US. Enrolled mothers are followed through pregnancy, delivery, and the maternal/offspring dyad will be followed until the child’s 18th birthday. At each maternal visit, questionnaires assessing medical history, diet, physical activity, sleep, perceived stress, and socioeconomic and sociocultural information are obtained. Standard laboratory tests during maternal visits include glycemic measures, lipids, and renal function. Additional bio samples obtained include venous blood samples and cord blood for obesity/metabolic biomarkers and genetic/epigenetic testing, urinalysis, placental tissue for examining functional pathways, breast milk for metabolomics, and stool for metabolites and microbiome analysis. The offspring will have 6 infant/toddler visits at 6–12 weeks, 4 months, 6 months, 18 months, 2 and 3 years respectively. Thereafter, they will undergo comprehensive research visits (major visits) at 4–5 years, 6–9 years, 10–13 years, and 14–17 years. The major visits in children include detailed medical history, anthropometry, developmental assessment, socioeconomic and environmental assessments (food insecurity, family structure, and childcare), feeding and activity, biochemical tests, genetics/epigenetic testing, and ultrasound elastography. Electronic health records will be reviewed for additional clinical information. The primary analysis will constitute estimation of correlation coefficients between continuous variables. The planned study duration in this ongoing study is 23-years.DiscussionThis is a life course study that that will examine biological and environmental risk factors for obesity and cardiometabolic risk from the intrauterine period to early childhood and adolescence in a population with high-risk of obesity and type 2 diabetes in the United States. The ETCHED study would also provide a unique opportunity to combine multi-omics and clinical data to create novel integrative models to predict the cardiometabolic risk associated with childhood obesity and possibly identify etiopathogenetic mechanisms and future targets of intervention.Trial registration numberClinicalTrials.gov identifier: NCT03481829. Updated July 19, 2024, https://clinicaltrials.gov/study/NCT03481829?cond=ETCHED&rank=1.

Clinical and epidemiological investigation of human infection with zoonotic parasite Trypanosoma dionisii in China

BackgroundTrypanosomiasis continue to pose a global threat to human health, with human infection mainly caused by Trypanosoma brucei and Trypanosoma cruzi. MethodsWe present a 30-year-old pregnant woman with persistent high fever from Shandong Province, China. High-throughput sequencing revealed the presence of Trypanosoma dionisii in blood. We conducted an analysis of the patient’s clinical, epidemiological, and virological data. ResultsThe patients exhibited fever, shortness of breath, chest tightness, accompanied by change in liver function and inflammatory response. She made a full recovery without any long-term effects. T. dionisii was detected in blood collected 23 days after onset of illness. The 18S rRNA gene sequence showed close similarity to T. dionisii found in bats from Japan, while the gGAPDH gene was closely related to T. dionisii from bats in Mengyin County, Shandong Province. Phylogenetic analysis demonstrated the current T. dionisii belongs to clade B within its species group. Positive anti-Trypanosoma IgG antibody was detected from the patient on Day 23, 66 and 122 after disease onset, as well as the cord blood and serum from the newborn. Retrospective screening of wild small mammals captured from Shandong Province revealed a prevalence rate of 0.54% (7/1304) for T. dionisii; specifically among 0.81% (5/620) of Apodemus agrarius, and 0.46% (2/438) of Mus musculus. ConclusionsThe confirmation of human infection with T. dionisii underscores its potential as a zoonotic pathogen, while the widespread presence of this parasite in rodent and bat species emphasizes the emerging threat it poses to human health.

Comparative characteristics of the dimensions of the pons with the dimensions of the head in human fetes of different gestational age

Annotation. Malformations of human fetuses brains occur in 2-3 cases per 1000 pregnancies and are one of the most common reasons for termination of pregnancy, therefore prenatal diagnosis is extremely important and is aimed at further genetic testing of the fetus and detailed counseling of parents regarding the risk of recurrence. Anthropometric parameters of human fetuses heads allow monitoring the growth of the fetus, estimating the term of pregnancy and determining the method of birth of a pregnant woman. Therefore, the parameters of the head of human fetuses are one of the most important biological characteristics during prenatal research. The purpose of our scientific work is to determine the dimensions of the pons in human fetuses of different gestational ages and compare them with the dimensions of the head. Anatomical research was conducted on 146 human fetuses from 9-10 to 39-40 weeks of gestation. The material for the study was obtained from the maternity hospitals of the city of Vinnytsia and from the communal non-profit enterprise “Vinnytsia Regional Pathological Bureau of the Vinnytsia Regional Council”, and the study was conducted on stillborns who died from various causes not related to brain diseases in relatively healthy mothers. Head circumference, head height, longitudinal and transverse dimensions of the head, pons height, pons width, pons thickness were measured using a ShTs-125 caliper. Statistical processing of digital values was performed using the standard Statsoft software package “Statistica 6.0” on a personal computer using Microsoft Excel 2016, Kolmagorov-Smirnov and Shapiro-Wilk test indicators were determined and histograms were built based on them for visual assessment of the distribution of features. The head circumference of human fetuses of 39-40 weeks compared to fetuses of 9-10 weeks became 5.2 times larger, the longitudinal size of the head – 5 times, the transverse size of the head – 4.9 times, the height of the head – 3.6 times (p<0.01). The height of the pons in human fetuses of 39-40 weeks compared to fetuses of 9-10 weeks became 3.8 times greater, thickness – 3.6 times, width – 3.1 times (p<0.01).

The drug-dependent pregnant woman: therapeutic and ethical reflections

In our approach the drug addict is considered essentially a sick person, with his own clinical specificity, both somatic and, above all, psychic. In dealing with the drug problem we believe that the ‘independent variable’ is not the drug, but the person who uses it; and that this must be leveraged to solve the problem.

Gestantes vivendo com HIV e crianças expostas ao HIV em Santa Catarina, dados epidemiológicos de 2015 a 2021

Vertical transmission is the transmission of an infection or disease from the mother to her fetus in the womb or newborn during childbirth. The main routes of contagion are pregnancy, childbirth and breastfeeding. To prevent transmission, all pregnant women should be investigated and monitored during the gestational period, at the time of delivery and in the puerperium. The follow-up of pregnant women in prenatal care includes the performance of several laboratory tests to identify the presence of infectious agents of vertical transmission, such as the Human Immunodeficiency Virus (HIV), guiding the treatment of the pregnant woman and avoiding infection of the fetus, also providing guidance on the possibilities of prevention. Considering the high number of HIV cases in the state of Santa Catarina, especially in the Alto Vale Itajaí region, the present study aims to present the epidemiological profile of HIV/AIDS indicators of the population of the state of Santa Catarina, specifically pregnant women and children exposed to HIV, in the period from 2015 to 2021. It is an epidemiological, retrospective, descriptive and analytical study of a historical series, also presenting information on the factors involved in vertical transmission of HIV and prevention strategies. The parameters evaluated in this study, collected from the Epidemiological Indicators Panel of the Department of Chronic Conditions Diseases and Sexually Transmitted Infections, were: number of children exposed to HIV, age of children exposed to HIV, number of HIV-infected pregnant women (GVHIV) and monitoring of these in relation to HIV viral load (CV) and CD4+ T lymphocyte count (CD4+) at the beginning of antiretroviral therapy. Although the systematization of the number of pregnant women with HIV and children exposed to the virus in the state of Santa Catarina shows annual differences in the period evaluated, the trend line referring to the number of GVHIV shows a small increase over the years, while the trend line for the number of children exposed to the virus reveals a slight decrease, which can be elucidated by the expansion of the health team and the improvement in surveillance in the prevention of vertical transmission of HIV that has occurred over the years. The percentage of pregnant women with HIV VC lower than 50 copies/mL showed a gradual increase in the years evaluated, while the percentage with VC greater than 50 copies/mL showed a decrease. During the period evaluated in this study, less than 50% of the GVHIV had a CD4+ count and, among these, approximately 20% had CD4+ less than 350 cells/mm³ at the beginning of antiretroviral therapy. Failure to perform CD4+ counts may be related to an increase in the number of pregnant women with a VC of less than 50 copies/mL. Thus, CD4+ counts would be performed primarily in pregnant women with VC greater than 50 copies/mL and part of them with greater depletion of this cell type. In summary, this study shows the evolution of the treatment and follow-up offered to GVHIV and, consequently, to their children. It also reinforces the importance of prevention, diagnosis, treatment and prenatal follow-up strategies.

Enfermedad microvascular coronaria en gestante con antecedente de síndrome antifosfolípidos

Objective: to report the case of a pregnant woman with antiphospholipid syndrome history, in whom coronary microvascular disease was documented. Antenatal medical treatment improved prognosis and maternal and perinatal outcomes. Case: multigravida woman, 29.6 weeks pregnant, diagnosed with acute coronary syndrome, referred from a first level hospital. Diagnostic workup revealed microvascular disease. After receiving adequate management, she was discharged from hospital and included in the high-risk pregnancy program. Results: the diagnosis was made based on echocardiography, electrocardiography, troponin levels and cardiac catheterization. Anti-ischemic therapy was indicated considering the risk-benefit trade-off; management with aspirin was continued and the baby was born healthy. Conclusions: coronary microvascular disease should be considered, as a differential diagnosis in a pregnant woman with chest pain and history of antiphospholipid syndrome. Patients benefit from receiving antiplatelet and anticoagulant therapy soon after the diagnosis is made. Studies are required to evaluate the safest and most effective management of this condition.

3D printing of realistic body phantoms: Comparison of measured and simulated organ doses on the example of a CT scan on a pregnant woman

AbstractBackgroundMedical examinations or treatment of pregnant women using ionizing radiation are sometimes unavoidable. In such cases, the risk of harm to the embryo and fetus after exposure to ionizing radiation must be carefully estimated. However, no commercially available anthropomorphic body phantoms of pregnant women are available for dose measurements. A promising possibility for the production of body phantoms for patient groups that are not adequately represented by the phantoms of reference persons is 3D printing. However, this approach is still in the evaluation phase.PurposeTo print the abdomen of a woman in the late stage of pregnancy and compare the dose distribution measured using thermoluminescence dosimeters (TLDs) in the printed phantom for two different computed tomography (CT) protocols with the corresponding results of Monte Carlo simulations on voxel models of the pregnant woman.Materials and methodsThe physical phantom was produced through multi‐material extrusion printing using different print materials identified in previous studies to simulate homogeneous soft tissues and the mean compositions of maternal and fetal bones. The 3D printed abdomen was combined with a conventionally produced anthropomorphic female phantom to obtain a whole‐body phantom of a pregnant woman. Dose values resulting from two different CT scans acquired at tube voltages of 80 and 120 kV were measured using TLDs positioned in the physical phantom and cross‐validated with the results of Monte Carlo simulations performed for two different voxel models. The first was a voxelized model of the produced phantom itself and the second a realistic digital model of a pregnant woman. Representative CT values of the materials used in the printed phantom were determined from the acquired CT images.ResultsThe CT values of maternal and fetal tissue structures in the phantom are comparable to CT values of real human tissues. The difference between most organ doses measured in the 3D printed phantom and simulated in the voxel models was below 20% and equivalent within the measurement uncertainties. Only the dose to the fetal head was up to 50% higher and not equivalent for the realistic model and the 80 kV‐protocol. As expected, the agreement was better for the voxelized than for the realistic model. For both models a slight energy dependence was observed, with larger deviations for the 80‐kV protocol especially for organs located in the pelvic region.ConclusionIndividualized physical body phantoms, such as that of a pregnant woman, can be produced using 3D printing. The good agreement between measured and simulated doses to the fetus cross‐validates both dosimetric methods. Therefore, this study demonstrates the suitability of 3D printing phantoms for patients not adequately represented by commercially available body phantoms of reference persons.

Efficacy and safety of 2-drug regime dolutegravir/lamivudine in pregnancy and breastfeeding- clinical implications and perspectives.

To assess the efficacy and safety of a two-drug regimen (2DR) with dolutegravir (DTG) and lamivudine (3TC) in maintaining viral suppression during pregnancy and breastfeeding, and to evaluate its potential as an alternative to the recommended three-drug regimen (3DR) in preventing mother-to-child transmission (MTCT) of HIV. We present a case of a 34-year-old pregnant woman who, after discontinuing 3DR due to side effects and poor adherence, was switched to DTG/3TC at gestational week 23. Maternal viral load (VL) and infant HIV status were monitored throughout pregnancy and a ten-month breastfeeding period. Data on pharmacokinetic changes in pregnancy and the risks associated with 2DR were reviewed. The patient's VL remained suppressed (<20 copies/mL) from gestational week 23 until the end of the breastfeeding period. A healthy HIV-negative baby was born at 39 weeks, and the child remained HIV-negative after ten months of breastfeeding. The 2DR was well-tolerated, improved adherence, and reduced fetal drug exposure. Despite limited experience with 2DR in pregnancy, no viral rebound occurred, and no adverse effects were observed. Although 3DR remains the preferred therapy during pregnancy and breastfeeding, this case indicates that DTG/3TC may be an effective alternative for patients experiencing intolerance or poor adherence to 3DR. Further studies are needed to explore the impact of pharmacokinetic changes in pregnancy on 2DR efficacy and to confirm its safety and role in preventing MTCT.

Assessment of the Knowledge, Attitude and Practice (KAP) of PMTCT among Healthcare Providers at the University of Ghana Legon

One of the leading causes of morbidity and mortality among communicable diseases is acquired immunodeficiency syndrome (AIDS). A vulnerable group in this setting is HIV exposed infants, (born to women living with HIV). The magnitude of the pandemic of HIV infection in developing countries is such that multiple approaches are required to show its spread and alleviate the burden on the health sector and society in general. Every woman of childbearing age needs to be aware of HIV infection, the risks of Mother-to-Child Transmission and the services available to reduce such risks. Considering these, this study assessed the knowledge, attitude and practice of Prevention of mother-to-child transmission (PMTCT) among healthcare providers at the University of Ghana Legon. A descriptive cross-sectional design was used in this study. The minimum sample size for this study was calculated using the single proportion population formula by Fisher (1978): The study area was the University of Ghana Hospital Legon. The collected data was exported into STATA version 16.0 for cleaning and analysis. Descriptive analysis, such as simple frequencies, percentages, means, and standard deviations, were used to summarize the data. Findings were presented in tables and graphs. Generally, the data accumulated from the research on the knowledge, attitude and practice of PMTCT among healthcare workers indicate that there is unsatisfactory knowledge and practice. In this study, no participants had a total good score above 85%. The relationship between gender, ward and knowledge was investigated using a chi-square. The p-value was higher than the alpha-value, indicating acceptance of the null hypothesis (p-value = 0.79 and 0.053, alpha value = 0.05). Sixteen (16) of the respondents, representing 17.6%, said HIV positive pregnant women should be managed like any other pregnant woman in Labour. The majority of the respondents (56) said at the first week of pregnancy, while only (2) said at week 28. However, their attitude was satisfactory. It must be noted that without further training and an increase in staffing levels, the quality and accessibility of PMTCT will be severely affected. It is therefore recommended that there should be continuous and pre-service training on PMTCT. All new medical officers, midwives and nurses should undergo PMTCT training, and those who are already in service should take refresher courses on new and updated guidelines.

Pathomorphological Changes of the Placenta in Antenatal Asphyxia of the Fetus Associated with the Coronavirus Disease (COVID-19) in Pregnant Women

Сoronavirus disease (COVID 19) in a pregnant woman remains a risk factor for perinatal losses despite the barrier function of the placenta. This prompted us to do some research. Objective — to determine the pathomorphological changes of the placenta and fetus during antenatal asphyxia in the acute period of COVID-19 in a pregnant woman. Materials and methods. We studied placentas and fetuses in case of antenatal asphyxia (n = 16) in the acute period of the COVID-19 in a pregnant woman, confirmed by a positive PCR test (determination of SARS-CoV-2 RNA). The duration of the post-COVID interval (time from the diagnosis of COVID-19 to delivery) was 1—3 weeks. Results and discussion. Intrauterine death of the fetus occurred at different gestational period: from 26 to 38 weeks (median 33). At the same time, the woman fell ill with COVID-19 between 18 and 35 weeks of gestation (median 31). Hemorrhages in the right atrium and auricle of the heart were observed in fetuses — 93.8 % (95 % CI: 75.4—100); dark blood clots in the chambers of the heart; hemorrhages under the periosteum of the bones of the skull, stasis in the veins of the brain — 81.3 % (95 % CI: 57.1—96.7), hemorrhages in the scrotum, spermatic cord — 6.3 % (95 % CI: 0.0—24.6) and kidney hemorrhages — 62.5 % (95 % CI: 36.2—85.4). When examined macroscopically, the placenta was characterized by a flabby or dense consistency; diffuse hemorrhages or local blood clots in numerous cysts; areas of abruption, thrombosis of umbilical cord vessels. Microscopic examination of the placenta revealed chorioamnionitis — 81.3 % (95 % CI: 57.1—96.7 %), intervillositis — 93.8 % (95 % CI: 75.4—100), acute villitis — 56.3 % (95 % CI: 30.2—80.6). Basal deciduitis was detected in all observations in 100 % (95 % CI: 88.8—100). Disorders of blood circulation were found in the placentas: stasis, thrombosis, hemorrhages; and necrosis of the arteriole endothelium — 100 % (95 % CI: 88.8—100 %). Conclusions. COVID-19 in a pregnant woman from 18 to 35 weeks of gestation (median 31) is a risk factor for perinatal losses. No significant differences were found between the severity of the course of COVID-19 in the mother and the morphological changes of the placenta. Pathognomonic changes in the fetus with COVID-19 in the mother in the acute period: «porphyry lung», hemorrhages in the right atrium, under the periosteum of the bones of the skull, spermatic cord, kidneys, blood clots in the chambers of the heart. The cause of antenatal death of the fetus in the acute period of COVID-19 in a pregnant woman is acute placental insufficiency associated with disorder of placental-fetal blood circulation, due to manifestations of the exudative phase of inflammation: placentitis (focal chorioamnionitis, acute villitis, intervilositis, basal deciduitis) and disorder of blood rheology, which was manifested by thrombosis, hemorrhages in the intervillous space, detachment of the placenta.

Assessment of emotions in pregnancy: introduction of the Pregnancy Anxiety and Stress Rating Scale (PASRS) and its application in the context of hospitalization.

Pregnancy is a special time that brings both joy and challenges. Among these challenges, anxiety and stress are emotions that can affect the mental wellbeing of the pregnant woman as well as the developing baby. In response to these challenges, we present the Pregnancy Anxiety and Stress Rating Scale (PASRS), an innovative tool that aims to identify and assess anxiety and stress levels among pregnant women. The PASRS contains 15 questions that are more comprehensive and cover various aspects of pregnancy, including the health of the baby, the health of the mother, body changes, finances and social support. In an era where mental health is just as important as physical health, SOLiSC is a step forward in recognising and addressing the unique mental challenges that pregnant women may face.

Conservative management of an incarcerated uterus in a pregnant woman

Incarceration of a retroverted uterus is a rare, but harmful obstetric complication increasing foetal mortality and maternal morbidity if untreated. In this case report, a pregnant woman at 16+3 presented with urine retention. Assessment showed an incarcerated uterus due to retroversion. To facilitate mobilisation of the uterus, she performed the yoga position Downward facing dog and had a permanent catheter inserted for 48 hours. The procedure was successful. This case report addresses the diagnosis, management, and risk of an incarcerated retroverted uterus in pregnancy. We aim to raise awareness, facilitate early diagnosis, and promote the conservative treatment.

Hypophisitis in pregnant women with persistent diabetes insipidus in the outcome

Autoimmune/lymphocytic hypophysitis is one of the rare causes of central diabetes insipidus in adults and is most common among women in the second or third trimester of pregnancy. Numerous studies have shown that lymphocytic hypophysitis is characterized by a very variable clinical signs with the development of neurological symptoms, visual disturbances and hypopituitarism with partial or complete loss of pituitary function, as well as a number of features in magnetic resonance imaging (MRI). Isolated lymphocytic indibuloneurohypophysitis occurs in fewer cases and involves the posterior lobe and stalk of the pituitary gland with a clinical presentation of diabetes insipidus. The above clinical case describes the development of hypophysitis in a pregnant woman with a predominant lesion of the posterior pituitary gland and an outcome in diabetes insipidus, which persists 6 years after pregnancy and childbirth. In the article some aspects of the differential diagnosis of diabetes insipidus in pregnant women, as well as instrumental diagnosis and treatment approaches of hypophysitis are discussed.

Osteopathic status and quality of life of pregnant women in megacities

Introduction. According to the World Health Organization, the natural and human-transformed natural environment affects the health of urban residents. In modern socio-economic conditions of megapolis there are unfavorable trends of deterioration of health and quality of life indicators of urban population. Pregnancy is a crisis state for both the woman herself and her family as a whole, so it is during this period that a woman needs to ensure a high level of quality of life, which is often not given due attention due to the high rhythm of life in megacities. The course of pregnancy is determined by the development of structural and functional changes in a woman′s body, which in turn affect not only physical well-being, but also mental health, thus changing the level of quality of life of a woman. Along with this physiological changes during pregnancy can serve as a background for the formation of somatic dysfunctions, the clinical manifestations of which are determined by the compensatory capabilities of the body of the pregnant woman. Pregnancy support at the present stage dictates the necessity of timely detection of functional changes and quality of life disorders in order to prevent complications during pregnancy.The aim of the study: to evaluate the osteopathic status and the level of quality of life of pregnant women in megacitiesMaterials and methods. In a cross-sectional cohort study conducted in the period from 03.2018 to 05.2023g on the basis of medical clinics in St. Petersburg (LLC «Institute of Osteopathy Mokhov»), in Moscow (Balashikha Maternity Hospital), in Kazan (City Clinical Hospital № 16) and Medical Clinic «Medexpert» (Kazan) were included 225 somatically healthy pregnant women at different stages of pregnancy, aged 25–45 years. The mean age of the subjects was 34±3,8 years at the time of follow-up. A unified osteopathic examination was performed in all pregnant women with the formation of an osteopathic report and the level of quality of life was assessed according to the criteria of the SF-36 questionnaire.Results. The analysis of the results of the conducted studies demonstrated that as pregnancy progresses, somatic dysfunctions of the pelvic region come to the forefront (p&lt;0,05), and the indicators of the level of both physical and psychological components of the quality of life significantly decrease (p=0,02) with increasing gestational age. At the same time, a significantly lower level of quality of life indicators at baseline and as pregnancy progresses is observed in the residents of Moscow compared to pregnant women living in St. Petersburg and Kazan.Conclusion. Healthy pregnant women are characterized by the presence of somatic dysfunctions of regional and local level, and the frequency of their detection, degree of severity and level of manifestation depends on the term of pregnancy and does not statistically differ in the residents of the cities of St. Petersburg, Moscow and Kazan. As pregnancy progresses, the inhabitants of megacities are characterized by a decrease in both physical and psychological components of quality of life. The fact that we have revealed a statistically significantly lower level of quality of life indicators in women living in Moscow compared to those living in St. Petersburg and Kazan needs further study by specialists.

Porphyria in pregnancy with exacerbation after delivery due to COVID-19

We present a case of acute intermittent porphyria (AIP) diagnosed in a pregnant woman with subsequent exacerbation after delivery due to COVID-19 infection. The patient’s symptoms manifested with acute neurovisceral attacks - abdominal pain followed by flaccid quadriparesis, sensory disturbances, hypertension and disturbance in electrolyte levels. The blood plasma test and a 24-hour urine collection revealed increased levels of urine porphobilinogen, 5-aminolevulinic acid and uroporphyrins, which led to the diagnosis of AIP. The patient received i.v. human hemin with positive outcome. After delivery she was again admitted to the hospital due to abdominal pain and trunk hyperesthesia that occurred after a mild course of COVID-19 infection. The second administration of human hemin led to the improvement of the patient's condition. The aim of this case report is to indicate that even with severe risk factors of AIP such as infection and pregnancy, proper diagnostics can increase the chance of quick recovery.

Navigating pregnancy and scholarship: Exploring positionality, reflexivity, and intersectionality in research

The paper highlights the crucial role of positionality and reflexivity in understanding knowledge creation and research processes, drawing on my experience as a pregnant woman conducting semi-structured interviews with policy elites. Previous literature has acknowledged the impact of appearance and gender on the research process. By employing an adapted self-presentation technique during the interviews, observable effects on the research process were noted. This paper shares my observations as a researcher before and after disclosing my pregnancy. Participant reactions revealed clashes in expectations, worldviews, and meanings within the interviews’ initial moments. The positive experience demonstrated that pregnancy facilitated access to policy elites, recruitment of additional interviewees, and initiated meaningful dialogues, shedding light on the role of positionality and reflexivity in fieldwork. My open vulnerability, transparency in disclosing personal information, and accessibility enhanced participant reciprocity and diminished perceived threats, fostering engaging and profound conversations. These findings underscore how the distinctive attributes of the pregnant body—consciousness, vulnerability, power, and fluidity—significantly influence key methodological aspects, shaping the epistemological process of knowledge creation.

Associations between Fetal Symptoms during Pregnancy and Neonatal Clinical Complications with Toxoplasmosis.

Toxoplasmosis is a parasitism transmitted by Toxoplasma gondii, part of the TORCH complex, the most prevalent parasitism worldwide. It is asymptomatic in immunocompetent individuals but causes severe infections and developmental abnormalities in pregnant women, mainly affecting the central nervous system and the gastrointestinal system. In our prospective study, we analyzed cases of recent maternal Toxoplasma infections confirmed by serological testing between 1996 and 2020 at the Department of Obstetrics and Gynecology, Semmelweis University. Amniocentesis, followed by PCR, was performed in cases of recent infection confirmed by serological testing during pregnancy. After birth, a neonatological, microbiological, pediatric neurological and ophthalmological examination and a follow-up was carried out. During the study period, a total of 238 cases of amniotic fluid Toxoplasma PCR testing due to Toxoplasma recent infection were performed. In terms of pregnancies, there were 219 deliveries and seven abortions. Twelve cases had no data available on the outcome of the pregnancy. In total, 133 cases of ultrasound abnormalities were detected during pregnancy, while in 105 cases, no abnormalities were detected on ultrasound examination. During amniocentesis, eight cases of Toxoplasma infection were revealed in amniotic fluid samples by PCR, and in 230 cases, the result was negative. Neonatal follow-up was performed in 139 cases, with no abnormalities during follow-up in 117 cases, and in 22 cases, there was a detectable complication that was likely to be related to Toxoplasma infection. In all 22 cases, amniotic fluid PCR Toxoplasma testing was negative. The most common ultrasound abnormalities involve the nervous system and the gastrointestinal system. In cases of suspicion, it is recommended to perform amniocentesis Toxoplasma PCR testing besides the indirect methods to help the pregnant woman decide whether to carry the pregnancy to term. During follow-up, a multidisciplinary team experienced in pregnancies complicated by toxoplasmosis must carry out the follow-up, care and subsequent development.

Posterior reversible encephalopathy syndrome (PRES) on the second postpartum day: learning experience from a case report and literature review

BackgroundPosterior reversible encephalopathy syndrome (PRES) is an uncommon neurological disorder which is characterised by variable symptoms. The transient clinical condition may be underestimated and misdiagnosed as other conditions, especially, among pregnant women with severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome in the puerperium. We hereby contribute to the literature this rare complication and hightlight the appropriate management of PRES .Presentation caseA pregnant woman (gravida 3, parity 2) had a normal antenatal course. However, she was diagnosed with severe preeclampsia and HELLP syndrome at 29 weeks and 5 days of gestation. Therefore, she was indicated for a medical termination of pregnancy following a patient’s consent at our tertiary referral hospital. Severely, the patient developed rapidly with altered mental health in early puerperium. In result, PRES was diagnosed based on a brain magnetic resonance imaging (MRI) evidence with typical findings. After a strict multidisciplinary management, the clinical condition improved after 5 days of onset and recovered completely after a 4-month follow-up without any sequelae.ConclusionIn summary, despite its rarity, clinicians ought to be knowledgeable and raise an aware of PRES during pregnancy. Importantly, a brain imaging modalities should be taken into account among pregnant women with neurological symptoms subsequent to severe preeclampsia. In addition to early diagnosis, a timely appropriate treatment with multidisciplinary team is strongly indicated. Further studies with a large case series are required for this uncommon entity.