Risk Of Fetal Death Research Articles

Population-Level Study on Fetal Deaths and Preterm Births during SARS-CoV-2 Pandemic in the State of Michigan.

The aim of the study is to explore the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on preterm birth at different gestational ages and fetal death in the state of Michigan. Data on live births and fetal deaths in the state of Michigan from March to November in the years 2017 through 2020 were obtained from Michigan Department of Health and Human Services (MDHHS). Preterm birth rate, fetal death rate (per 1,000 live births) overall and stratified by race and maternal comorbidities during the period of pandemic (March-November 2020) were compared with the same period (March-November) in the prepandemic years (2017-2019). Of 328,879 live births and 1,470 fetal deaths during the study period, 77,983 live births and 242 fetal deaths were reported in 2020. Compared with prepandemic years, fetal death rate per 1,000 live births was significantly lower in 2020 (3.1 vs. 4.7 [2017], 5.2 [2018], 4.4 [2019], p-value <0.001). The adjusted risk for fetal death in 2020 was decreased (odds ratio [OR] = 0.64 [95% confidence interval (CI): 0.56-0.74], p <0.0001), compared with prepandemic years. Fetal death was significantly associated with African-American race, pregnancy hypertension and prepregnancy diabetes. No significant difference in the proportion of preterm births (<37 weeks' gestation) was noted between pandemic and prepandemic years (9.9 vs. 10.0%, p = 0.50). There was no significant difference in the risk of preterm birth across gestational age strata (<28, 28-316/7, 32-366/7, 37-416/7, and >42 weeks) between pandemic and prepandemic years on multinomial analysis. Significant associations with preterm birth across all years included African American race, lower level of maternal education, pregnancy-induced hypertension, chronic hypertension, prepregnancy diabetes, congenital anomalies, previous preterm birth, and prolonged rupture of membranes >12 hours. Fetal death rate was significantly lower whereas preterm births remained unchanged during pandemic in comparison with prepandemic years in the state of Michigan. · A decrease in fetal death rate was noted during SARS CoV-2 pandemic in the State of Michigan.. · Overall state-wide rates of preterm birth did not change in 2020, compared to previous years.. · Significant risk factors associated with preterm birth and fetal deaths did not differ between prepandemic and pandemic years..

Fetal and infant death associated with short-term ozone exposure

Background: Air pollution is linked to adverse pregnancy outcomes such as preterm births, but few studies evaluated its acute impact on fetal and infant mortality. We evaluated short-term impacts of warm-season ozone and cold-season fine particulate matter &amp;#x3c;2.5 microns (PM2.5) exposures on the risk of fetal death (&amp;#x3e;20 weeks) and infant mortality (live birth to one year). Methods: This time-stratified case-crossover analysis includes 1,880 singleton fetal deaths (2007-2011) and 3,229 singleton infant deaths (2007-2015) from the San Joaquin Valley (SJV), California. Daily ozone and PM2.5 were estimated by the SJV Air Pollution Control District and geospatially linked to maternal zip code at birth. Critical exposure windows of interest included the day of death (lag 0) up to 14 days before (lag 14). Conditional logistic regression models estimated the odds ratio (OR) and 95% confidence intervals (CI) for each 5 units increase in pollutant. Results: In warm season (May-October), a 5-ppb increase in ozone was associated with a 7% (95% CI: 2%-13%) increased risk of fetal death and 6% (95% CI: 2%-10%) increased risk of infant death within two weeks. The estimates were generally consistent from lag 0 to lag 14 for both mortality outcomes, with evidence of slightly stronger estimates for fetal death compared to infant death during certain lags. During lag 7, a 5-ppb increase in ozone was associated with a 9% increased risk in fetal death (95% CI: 5%-14%) and a 4% (95% CI: 1%-7%) increased risk in infant death. No associations were observed for cold-season PM2.5. Conclusions: Ozone exposure is positively associated with short-term risk of fetal and infant mortality in the warm season. Given the ubiquitous nature of air pollution, these associations merit further investigation. Meanwhile, efforts to minimize exposures among pregnant women may be warranted. Keywords: pollution, infant mortality, fetal death, stillbirth, pregnancy, mortality, ozone

Highlights from the International Twins Congress 2021

Highlights from the International Twins Congress 2021

Evaluation of anti-epileptic Lacosamide treatment on neural tube development: Chick embryo experimental model

Objective: Even if epileptic women can give birth to healthy babies, the rates of premature birth, low birth weight, fetal and neonatal death risk, congenital malformations and growth retardation in pregnant women who use the antiepileptic drugs (AEDs) are high compared to the population. The present study aimed to examine the effects of AED Lacosamide (LCM) during pregnancy on the fetus in terms of neuronal and embryonic development in 48-hour chick embryo model. Material and Methods: 40SPF fertilized eggs divided into 4 equal numbers. At the 28th hour, LCM was applied in the sub-blastoderm, and the experiment was terminated at the 48th hour. Embryos were evaluated morphologically by neural tube position, somite number, and cranio-caudal length. Histopathologically, hematoxylin-eosin, Caspase-3 immunohistochemistry, and TUNEL staining were performed and and assessed for cell death. Results: LCM adversely affected neural tube position in groups 3 and 4 compared to control. In addition, it regressed embryonic development by decreasing somite number and craniocaudal length in groups 3 and 4. When evaluated in terms of apoptotic cell death, LCM increased caspase-3 immunoreactivity and the number of TUNEL-positive cells in groups 3 and 4, respectively (p=0.002), (p≤0.001). Conclusion: LCM was caused to regression of embryonic development and impaired neural tube position in early chick embryo model, dose-dependent manner. It increased cell death and showed teratogenic effects in the early embryo model. The usage of LCM for pregnant women should be considered carefully. It is obvious that more preclinic studies are needed to demonstrate LCM effects comprehensively.

First- or second-trimester SARS-CoV-2 infection and subsequent pregnancy outcomes

BackgroundSARS-CoV-2 infection during pregnancy is associated with adverse pregnancy outcomes, including fetal death and preterm birth. It is not known whether that risk occurs only during the time of acute infection or whether the risk persists later in pregnancy.ObjectiveThis study aimed to evaluate whether the risk of SARS-CoV-2 infection during pregnancy persists after an acute maternal illness.Study DesignA retrospective cohort study of pregnant patients with and without SARS-CoV-2 infection delivering at 17 hospitals in the United States between March 2020 and December 2020. Patients experiencing a SARS-CoV-2–positive test at or before 28 weeks of gestation with a subsequent delivery hospitalization were compared with those without a positive SAR-CoV-2 test at the same hospitals with randomly selected delivery days during the same period. Deliveries occurring at <20 weeks of gestation in both groups were excluded. The study outcomes included fetal or neonatal death, preterm birth at <37 weeks of gestation and <34 weeks of gestation, hypertensive disorders of pregnancy (HDP), any major congenital malformation, and size for gestational age of <5th or <10th percentiles at birth based on published standards. HDP that were collected included HDP and preeclampsia with severe features, both overall and with delivery at <37 weeks of gestation.ResultsOf 2326 patients who tested positive for SARS-CoV-2 during pregnancy and were at least 20 weeks of gestation at delivery from March 2020 to December 2020, 402 patients (delivering 414 fetuses or neonates) were SARS-CoV-2 positive before 28 weeks of gestation and before their admission for delivery; they were compared with 11,705 patients without a positive SARS-CoV-2 test. In adjusted analyses, those with SARS-CoV-2 before 28 weeks of gestation had a subsequent increased risk of fetal or neonatal death (2.9% vs 1.5%; adjusted relative risk, 1.97; 95% confidence interval, 1.01–3.85), preterm birth at <37 weeks of gestation (19.6% vs 13.8%; adjusted relative risk, 1.29; 95% confidence interval, 1.02–1.63), and HDP with delivery at <37 weeks of gestation (7.2% vs 4.1%; adjusted relative risk, 1.74; 95% confidence interval, 1.19–2.55). There was no difference in the rates of preterm birth at <34 weeks of gestation, any major congenital malformation, and size for gestational age of <5th or <10th percentiles. In addition, there was no significant difference in the rate of gestational hypertension overall or preeclampsia with severe features.ConclusionThere was a modest increase in the risk of adverse pregnancy outcomes after SARS-CoV-2 infection.

Timing of Antiretroviral Therapy: Initiation and Birth Outcomes Among Pregnant Women With Human Immunodeficiency Virus in Tanzania

Combination antiretroviral therapy (cART) initiation during pregnancy reduces the risk of perinatal human immunodeficiency virus (HIV) transmission; however, studies have suggested that there may be unintended adverse consequences on birth outcomes for selected cART regimens. We analyzed adverse birth outcomes among a prospective cohort of 1307 pregnant women with HIV in Dar es Salaam who initiated cART during the first or second trimester of a singleton pregnancy. Our primary analysis compared birth outcomes by gestational age at cART initiation among these women initiating cART in pregnancy. Among women who initiated cART in pregnancy, there was no relationship of gestational age at cART initiation with the risk of fetal death or stillbirth. However, women who initiated cART before 20 weeks of gestation compared with after 20 weeks had increased risk of preterm birth (risk ratio [RR], 1.30; 95% confidence interval [CI], 1.03-1.67) but decreased risk of small-for-gestational age birth (RR, 0.71; 95% CI, .55-.93). With increasing use of cART preconception and early in pregnancy, clinicians should be aware of the benefits and potential risks of cART regimens to optimize birth outcomes.

Maternal and Perinatal Outcomes Associated With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection During Pregnancy, Florida, 2020-2021: A Retrospective Cohort Study.

BackgroundThe objective was to estimate risk of SARS-CoV-2 infection in pregnancy and assess adverse maternal and perinatal outcomes.MethodsWe used a population-based, retrospective cohort of all pregnancies with a live birth or fetal death in Florida from March 1, 2020 to April 30, 2021. COVID-19 case reports were matched to vital registries. Outcomes assessed were risk of infection in pregnancy, preterm birth, maternal or neonatal admission to an intensive care unit (ICU), perinatal or fetal death, and maternal death. Modified Poisson and multinomial logistic regression models were used to derive relative risk estimates.ResultsOf 234,492 women with a live birth or fetal death during the study period, 12,976 (5.5%) were identified with COVID-19 during pregnancy. Risk factors for COVID-19 in pregnancy included Hispanic ethnicity (relative risk [RR] = 1.89), Black race (RR = 1.34), being unmarried (RR = 1.04), and being overweight or obese pre-pregnancy (RR = 1.08-1.32). COVID-19 during pregnancy was associated with preterm birth (RR = 1.31), Cesarean delivery (RR = 1.04), and neonatal (RR = 1.17) and maternal (RR = 3.10) ICU admission; no association was found with increased risk of perinatal (RR = 0.72) or fetal death (RR = 0.86). Women infected during any trimester showed increased risk of preterm birth. Fourteen maternal deaths were identified among COVID-19 cases; of those who died 12 were obese. The death rate per 10,000 was 22.09 among obese and 1.22 among non-obese gravida with COVID-19 during pregnancy (RR = 18.99, P = 0.001).ConclusionsObesity is a risk factor for SARS-CoV-2 infection in pregnancy and for more severe COVID-19 illness among pregnant women. SARS-CoV-2 infection is associated with preterm birth.

Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction.

Monochorionic diamniotic twin pregnancies complicated by Type-III selective fetal growth restriction (sFGR) are at high risk of fetal death. The aim of this study was to identify predictors of fetal death in these pregnancies. This was an international multicenter retrospective cohort study. Type-III sFGR was defined as fetal estimated fetal weight (EFW) of one twin below the 10th percentile and intertwin EFW discordance of ≥ 25% in combination with intermittent absent or reversed end-diastolic flow in the umbilical artery of the smaller fetus. Predictors of fetal death were recorded longitudinally throughout gestation and assessed in univariable and multivariable logistic regression models. The classification and regression trees (CART) method was used to construct a prediction model of fetal death using significant predictors derived from the univariable analysis. A total of 308 twin pregnancies (616 fetuses) were included in the analysis. In 273 (88.6%) pregnancies, both twins were liveborn, whereas 35 pregnancies had single (n = 19 (6.2%)) or double (n = 16 (5.2%)) fetal death. On univariable analysis, earlier gestational age at diagnosis of Type-III sFGR, oligohydramnios in the smaller twin and deterioration in umbilical artery Doppler flow were associated with an increased risk of fetal death, as was larger fetal EFW discordance, particularly between 24 and 32 weeks' gestation. None of the parameters identified on univariable analysis maintained statistical significance on multivariable analysis. The CART model allowed us to identify three risk groups: a low-risk group (6.8% risk of fetal death), in which umbilical artery Doppler did not deteriorate; an intermediate-risk group (16.3% risk of fetal death), in which umbilical artery Doppler deteriorated but the diagnosis of sFGR was made at or after 16 + 5 weeks' gestation; and a high-risk group (58.3% risk of fetal death), in which umbilical artery Doppler deteriorated and gestational age at diagnosis was < 16 + 5 weeks' gestation. Type-III sFGR is associated with a high risk of fetal death. A prediction algorithm can help to identify the highest-risk group, which is characterized by Doppler deterioration and early referral. Further studies should investigate the potential benefit of fetal surveillance and intervention in this cohort. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Antenatal Detection of True Knot in the Umbilical Cord - How Accurate Can We Be?

Umbilical cord knot (UCK) is associated with increased risk of fetal death, but is usually diagnosed only after delivery. Our objective was to examine the accuracy of prenatal ultrasound in the diagnosis of UCK and the outcomes of these pregnancies. A prospective study was performed on 56 patients in which UCK was suspected during a routine level-II anatomical scan (study group). Data included demographics, pregnancy outcome, and short-term neonatal follow-up. The control group included pregnant women with normal pregnancy without UCK in a 4:1 ratio matched for gestational age at delivery. True knot was observed postnatally in 54 out of 56fetuses (detection rate of 96.4 %). Gestational age at diagnosis of UCK was 22.1 ± 3.1 weeks. The female to male ratio was 1:1 in both groups. Maternal age and parity were significantly higher in pregnancies with UCK compared to controls. The mean gestational age at delivery was 37.1 weeks of gestation in the UCK group. There was no difference in the birthweight percentile. 47 patients (87 %) underwent induction of labor. There were no differences in the rate of cesarean section or Apgar scores. No neonate with UCK needed ventilation. None suffered from seizures and none needed brain imaging. There were no cases of fetal or neonatal death in the pregnancies with UCK. There is a high detection rate of UCK during targeted scan of the umbilical cord performed during the level-II anatomical scan. Careful pregnancy follow-up and early term delivery may result in excellent obstetrical outcomes.

Prenatal Diagnosis and Management of Thrombocytopenia-Absent Radius Syndrome.

Prenatal Diagnosis and Management of Thrombocytopenia-Absent Radius Syndrome.

Assessment of the fetoplacental complex and hemostasis system status in perinatal care of pregnant women with fetal congenital malformations

Research objective: to assess the morpho-functional status of the fetoplacental complex and hemostasis system in pregnant women with congenital malformations in the fetus to prevent antenatal fetal death and determine further tactics of management and delivery.Materials and methods. The state of fetoplacental circulation was studied in 120 pregnant women with fetal congenital malformations in the third trimester by Doppler assessment of blood flow in the umbilical artery (UA) and middle cerebral artery (MCA) in the fetus, with resistance index, pulse index and maximum systolic and terminal diastolic velocities ratio. The functional activity of the hemostasis system was assessed by low-frequency piezoelectric thromboelastography. Morphological examination of the placenta was performed. The control group included 25 pregnant women without fetal congenital malformations.Results. In case of Doppler flow disturbances in UA and combination of these disturbances with hypercoagulability, the probability of antenatal fetal death if there were congenital malformations ranged from 2–3 to 7–14 days (r = 0.51 and r = 0.55, respectively). A high risk of antenatal fetal death occurred with blood flow disorders in the UA and MCA (r = 0.70), as well as with blood flow disorders in the UA in combination with hypercoagulation and inhibition of fibrinolysis (r = 0.78). The highest risk of antenatal death occurred in case of impaired blood flow in the MCA with hypercoagulation and inhibition of fibrinolysis (r = +0.99).An urgent delivery within a day is indicated when there are blood flow disorders in the UA or MCA, combined with hypercoagulation and inhibition of fibrinolysis. The respiratory distress syndrome is treated by administering a surfactant at gestational ages up to 34 weeks. Delivery within 2–3 days is indicated in case of impaired blood flow in the UA and hypercoagulation, this allows preventing of respiratory distress syndrome with corticosteroids if the gestational age is less than 34 weeks. Conclusions. In pregnant women with fetal congenital malformations, significant disturbances in blood flow in the UA (increased resistance index and maximum systolic and final diastolic velocities ratio) and decreased pulse index in the MCA were revealed, which indicates intrauterine hypoxia and centralization of blood flow. The functional activity of the hemostasis system was characterized by an increase in the blood coagulation potential in the vascular-platelet, a coagulation unit, which was accompanied by morphological and functional changes in the placenta in response to hypoxia.Implementation of the proposed algorithm for perinatal support of pregnant women with fetal congenital malformations and placental dysfunction helps to optimize pregnancy management and delivery, reduce perinatal morbidity and mortality.

Prospective risk of stillbirth according to fetal size at term.

Fetal growth and size are associated with stillbirth risk. We wanted to investigate the week by week predictive value of fetal size at term on the prospective risk of stillbirth. Anonymised database from the UK GAP program, with 2,094,702 term (≥37weeks) deliveries including 4,670 stillbirths. Prospective stillbirth risk was defined as fetal death in the current week divided by total undelivered pregnancies. The data were analysed in five centile bands for stillbirth risk and risk ratios (RR) for 38, 39, 40 and 41+weeks, using appropriate for gestational age (AGA) at 37weeks as reference. Baseline stillbirth risk at 37weeks was 0.29 per 1,000 and rose to 1.39 at 41+weeks, with RR increasing to 4.8. In the 3<10 centile band risk rose from 0.72 to 2.43 over the same period, with RR increasing from 2.5 to 8.4. In the <3 centile group, the stillbirth risk rose from 1.62 to 6.16 (RR (5.6 to 21.2). In the 97>90 centile band, risk increased from 0.40 to 1.50 (RR 1.4 to 5.2) and for >97 centiles, it rose from 0.80 to 2.13 (RR 2.8-7.3). Prospective risk of fetal death at term is related to fetal size. The information provided, together with other considerations and results of investigations where available, will help clinicians to determine the advice to give to mothers about the best timing for delivery, balancing the baby's risk of compromise with iatrogenic sequelae of early delivery.

Time-varying association between fetal death and gestational exposure to ambient fine particles: a nationwide epidemiological study of 49 million fetuses in the contiguous US from 1989 to 2004.

Gestational exposure to fine particulate matter (PM2.5) has been reported to be associated with an increased risk of fetal death in recent studies, but earlier studies in the past century have usually reported a non-significant association. As such, it remains unknown whether this adverse effect of PM2.5 exposure varies with time. Nearly 49.2 million eligible birth and fetal death records from 1989 to 2004 were selected from the United States (US) birth and fetal death certificate datasets. For each record, the level of prenatal exposure to PM2.5 was taken as the average concentration in the mother's residential county during the entire gestational period, according to well-established estimates of monthly levels across the contiguous US. We first stratified the dataset by the month of the last menstrual period (LMP) and then independently evaluated the nationwide association between PM2.5 exposure and fetal death within each stratum using five typical logit models: unadjusted, covariate-adjusted, propensity-score, double robust, and diagnostic-score models. Finally, we conducted a meta-analysis to pool estimated LMP-specific associations and explored how the overall association varied by LMP month. Different models showed temporal heterogeneity in the estimated association between PM2.5 exposure and fetal death. According to the meta-analysis, double robust model estimates were more homogeneous than the rest, and thus the model outcome was recognized as the main result. For each 1-µg/m3 increase in prenatal exposure to PM2.5, the pooled odds ratio (OR) of fetal death was estimated to be 1.08 [95% confidence interval (CI): 1.05, 1.10]. The LMP-specific ORs exhibited a slightly increasing trend and a significant seasonal pattern. Compared with the pooled OR among samples with the LMP in spring, the estimates for summer, fall and winter were higher by 11.1% (95% CI: 6.2%, 16.3%), 27.8% (95% CI: 22.1%, 33.8%) and 28.8% (95% CI: 23.7%, 34.1%), respectively. We also found that temporal patterns in the association between PM2.5 exposure and fetal death could be explained by several population-level indicators or modifiers (i.e. ethnicity, maternal age, gestational weight gain, previous pregnancy of abnormal termination and diabetes). Prenatal exposure to PM2.5 can increase the risk of fetal death. The effects of PM2.5 exposure may be modified by complex factors, which leads to a time-varying association.

COVID-19 vaccines in pregnancy.

COVID-19 caused by SARS-CoV-2 coronavirus has been associated with severe illness in pregnant women. Furthermore, COVID-19 during pregnancy is associated with adverse fetal outcomes including preterm labor. Pregnant women were largely excluded from initial clinical trials investigating the safety and efficacy of COVID-19 vaccines; however, they have since been included as part of the routine roll-out of these vaccines. This narrative review synthesizes the evidence on the safety, immunogenicity, and effectiveness predominantly of the mRNA COVID-19 vaccines which have been most widely used in pregnant women.

Analysis of awareness and acceptance of SARS-CoV-2 vaccination among pregnant women.

Vaccination is a widely discussed topic during pregnancy and breastfeeding. Due to newly emerging covid-19 variants, vaccination has become more and more important. These new variants pose a risk for the development of maternal and neonatal complications. The aim of this study was to conduct a survey among pregnant women to assess the awareness of covid-19 and vaccination. Among the respondents, 58% were vaccinated with at least one dose and 51% were fully vaccinated. Also, 77% percent of responders thought that there was an increased risk of severe covid-19 infection among pregnant women versus non-pregnant women, while 71% were aware of the risk of fetal death associated with covid-19 infection. Although the rate of awareness among pregnant women is quite high (up to 87%), it is crucial to present the advantages of vaccination among gynecologists and doctors of other specialties as they are able to motivate women to be vaccinated.

Effect of Vitamin D Supplementation on the Fetal Growth Rate in Pregnancy Complicated by Fetal Growth Restriction.

Background: Fetal growth restriction (FGR) increases the risk of intrauterine fetal death, infant death and complications in childhood, and diseases that appear in adulthood. Vitamin D may affect fetal vascular flow. The aim of the study was to check if the rate of fetal growth in pregnant women with FGR differs depending on whether the patient was supplemented with vitamin D in the recommended dose of 2000 IU, not supplemented at all, or supplemented with vitamin D in low doses. Methods: Patients were divided into two groups: suboptimal vitamin D dosage and an accurate dosage of 2000 IU. Fetal growth progress was observed for 14 days. Results: Fetal weight was higher at the beginning, after 1 and 2 weeks of observation in the optimal vit. D group compared with the suboptimal group. The analysis was adjusted to the mother’s age, gestational week, and the number of pregnancies. Conclusions: Greater fetal weight gain can be observed in women with FGR (fetal growth restriction) who intake vitamin D at the recommended dose of 2000 IU compared with women with FGR and with a vitamin D intake dosage lower than 500 IU.

Outcomes of pregnancy in women with hypertrophic cardiomyopathy: A systematic review

IntroductionHypertrophic cardiomyopathy (HCM) is a genetic disorder that can be complicated by heart failure and sudden cardiac death. Pregnancy causes hemodynamic changes, which may be deleterious in patients with HCM. Existing cohort studies, analyzing maternal and fetal outcomes of pregnant HCM patients, are limited by small sample sizes. We performed a systematic review of maternal and fetal outcomes of pregnancy in patients with HCM. MethodsWe performed a literature search for studies reporting maternal or fetal outcomes in pregnant women with HCM. Primary outcomes included maternal death, stillbirth, and fetal death. Secondary maternal outcomes included both sustained and non-sustained ventricular tachycardia (VT), atrial fibrillation, heart failure (HF), syncope, cesarean delivery, and preeclampsia/eclampsia. The secondary fetal outcome was preterm birth. We used a random-effects model to determine pooled incidences of outcomes. ResultsWe identified a total of 18 studies with 1624 pregnancies. The incidence of maternal death was 0.2%. The rates of sustained VT, any VT (including non-sustained), AF, HF, and syncope were 1% (0–1%), 6% (4–8%), 4% (2–6%), 5% (3–8%), and 9% (3–14%), respectively. Postpartum hemorrhage, preeclampsia/eclampsia, and cesarean section complicated 2% (1–4%), 4% (2–6%), and 43% (32–54%) of pregnancies, respectively. Neonatal death occurred in 0.2% of pregnancies. Stillbirth complicated 1% (95% CI, 0–3%) of pregnancies, whereas the incidence of preterm birth was 22% (95% CI, 18–25%). ConclusionsWomen with HCM considering pregnancy can be reassured that the risk of maternal, fetal, or neonatal death is low. However, they are at risk of several non-fatal cardiac and pregnancy-related complications.

Preterm Infant with Respiratory Distress, Hypotonia, and Hypoglycemia.

Preterm Infant with Respiratory Distress, Hypotonia, and Hypoglycemia.

A Nonimmune Hydrops Case.

A Nonimmune Hydrops Case.

Compare the Histological Features between the Normal and Hypertensive Placenta

Objective: The purpose of the current research was to investigate the morphology and histology of placentas collected from moms who had PIH and to compare those results to placentas taken from women who had normal pregnancies. Study Design: The study was conducted at Anatomy department of Women Medical and Dental College Hospital Abbottabad and Mohi-ud-Din Islamic Medical College, Mirpur, AJK during the period from February 2021 to July 2021. Place and Duration: Observational/comparative study Methods: In this study total 80 pregnancies, 40 normal placenta’s and 40 hypertensive placenta’s were presented. At first, the physical aspects of placentas, also known as their morphological traits, were noted. In order to investigate the histology, pieces of each placenta measuring 5 millimetres in thickness were removed. After this, the tissue underwent further histological processing, after which it was fixed in formal saline at a concentration of 10 percent. It was noted down how much newborns weighed at birth. SPSS 23.0 was used to analyze complete data. Results: Placental weight, size, surface area and number of cotyledons were decreased in hypertensive placentas, whereas regions of infarction, retroplacental clot, and calcification were increased. Hyalinized villi and atherosclerosis have been reported in hypertensive placentas (p0.05). Foetal mortality and morbidity were closely linked to these alterations. We also found that among women with high blood pressure who had the aforementioned histological alterations in their placentas, the risk of foetal death and morbidity was higher. Conclusion: We concluded that, PIH reduces placenta weight and size. Changes in utero-placental blood flow may induce placental insufficiency. It affects newborn birth weight. PIH impacts placenta shape, histology, and foetal development. Keywords: Placenta, Pregnancy-induced hypertension, Histological, Morphological, Mortality, Morbidity