Risk Of Fetal Death Research Articles

Effects of pregabalin exposure on risk of fetal death and congenital abnormalities

Effects of pregabalin exposure on risk of fetal death and congenital abnormalities

Fetal death as an outcome of acute respiratory distress in pregnancy, during the COVID-19 pandemic: a population-based cohort study in Bahia, Brazil

BackgroundFetal loss is one of the most serious adverse outcomes of pregnancy. Since the onset of the COVID-19 pandemic, Brazil has recorded an unprecedented number of hospitalizations of pregnant women due to acute respiratory distress (ARD), thereby, we aimed to assess the risk of fetal deaths associated to ARD during pregnancy in Bahia state, Brazil, in the context of the COVID-19 pandemic.MethodsThis is an observational population-based retrospective cohort study, developed with women at or after 20 weeks of pregnancy, residents in Bahia, Brazil. Women who had acute respiratory distress (ARD) in pregnancy during the COVID-19 pandemic (Jan 2020 to Jun 2021) were considered 'exposed'. Women who did not have ARD in pregnancy, and whose pregnancy occurred before the onset of the COVID-19 pandemic (Jan 2019 to Dec 2019) were considered 'non-exposed'. The main outcome was fetal death. We linked administrative data (under mandatory registration) on live births, fetal deaths, and acute respiratory syndrome, using a probabilistic linkage method, and analyzed them with multivariable logistic regression models.Results200,979 pregnant women participated in this study, 765 exposed and 200,214 unexposed. We found four times higher chance of fetal death in women with ARD during pregnancy, of all etiologies (adjusted odds ratio [aOR] 4.06 confidence interval [CI] 95% 2.66; 6.21), and due to SARS-CoV-2 (aOR 4.45 CI 95% 2.41; 8.20). The risk of fetal death increased more when ARD in pregnancy was accompanied by vaginal delivery (aOR 7.06 CI 95% 4.21; 11.83), or admission to Intensive Care Unit (aOR 8.79 CI 95% 4.96; 15.58), or use of invasive mechanical ventilation (aOR 21.22 CI 95% 9.93; 45.36).ConclusionOur findings can contribute to expanding the understanding of health professionals and managers about the harmful effects of SARS-CoV-2 on maternal–fetal health and alerts the need to prioritize pregnant women in preventive actions against SARS-CoV-2 and other respiratory viruses. It also suggests that pregnant women, infected with SARS-CoV-2, need to be monitored to prevent complications of ARD, including a careful assessment of the risks and benefits of early delivery to prevent fetal death.

Morphometric Analysis of Placental Terminal Villi, Capillaries, and Intervillous Space in Normal and Pre-Eclamptic Pregnancies

Background: The placenta reflects the prenatal problems that are linked to high perinatal morbidity and mortality both macroscopically and microscopically. A pregnancy syndrome called pre-eclampsia has terrible consequences for both the mother and the unborn child. It may result in more frequent inductions of labor, fetal growth limitation, respiratory issues in newborns, increased admission rates to neonatal critical care units, and an elevated risk of perinatal or fetal death. To understand the relation of preeclampsia and fetal growth identification of its effects on various components of the placenta is mandatory hence the current study was designed to evaluate the Placental Terminal Villi, Capillaries, and Intervillous Space in Normal and Pre-eclamptic Pregnancies. Methodology: It was a cross sectional study, carried out on 50 samples of placentas, out of which 25 were preeclamptic and 25 were normal. The placentas were recruited after cesarean session, processed as per guidelines and were analyzed for histopathological examination. The set inclusion criteria were Registered cases of Pre-eclampsia, Blood Pressure ≥ 140/90 mmHg, Parity 0 – 4, Age of mother (25 – 35) Years., Gestational Age (36 – 42) Weeks, Mode of delivery Cesarean Sections. The set exclusion criteria were known hypertensive patients, and patient diagnosed with other chronic illnesses. Results: Number of terminal villi, Transverse diameter of terminal villi (μm), Intervillous space (μm), and Transverse diameter of terminal villous capillaries decreased significantly (p=0.001) in preeclamptic group however, Number of terminal villous Capillaries were found to be increased in preeclamptic group (p=0.001). Conclusion: Preeclampsia leads to more significant alterations in placental structure compared to normal pregnancies, emphasizing the importance of early detection and management of this condition to improve maternal and fetal outcomes. Keywords: Pregnancy, preeclampsia, terminal villi, Intervillous space, terminal villous Capillaries

The Danish newborn standard and the International Fetal and Newborn Growth Consortium for the 21st Century newborn standard: a nationwide register-based cohort study

It is a matter of debate whether 1 universal standard, such as the International Fetal and Newborn Growth Consortium for the 21st Century standard, can be applied to all populations. The primary objective was to establish a Danish newborn standard based on the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century standard to compare the percentiles of these 2 standards. A secondary objective was to compare the prevalence and risk of fetal and neonatal deaths related to small for gestational age defined by the 2 standards when used in the Danish reference population. This was a register-based nationwide cohort study. The Danish reference population included 375,318 singletons born at 33 to 42 weeks of gestation in Denmark between January 1, 2008, and December 31, 2015. The Danish standard cohort included 37,811 newborns who fulfilled the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century standard. Birthweight percentiles were estimated using smoothed quantiles for each gestational week. The outcomes included birthweight percentiles, small for gestational age (defined as a birthweight of 3rd percentile), and adverse outcomes (defined as either fetal or neonatal death). At all gestational ages, the Danish standard median birthweights at term were higher than the International Fetal and Newborn Growth Consortium for the 21st Century standard median birthweights: 295g for females and 320 g for males. Therefore, the estimates of the prevalence rate of small for gestational age within the entire population were different: 3.9% (n=14,698) using the Danish standard vs 0.7% (n=2640) using the International Fetal and Newborn Growth Consortium for the 21st Century standard. Accordingly, the relative risk of fetal and neonatal deaths among small-for-gestational-age fetuses differed by SGA status defined by the different standards (4.4 [Danish standard] vs 9.6 [International Fetal and Newborn Growth Consortium for the 21st Century standard]). Our finding did not support the hypothesis that 1 universal standard birthweight curve can be applied to all populations.

OUTCOME OF MONKEYPOX INFECTION IN GRAVIDA: A LITERATURE REVIEW

Monkeypox is a smallpox-like disease which is an important globally emerging infectious disease caused by the monkeypox virus. WHO declared monkeypox a public health emergency on 23 July 2022. Most research on monkeypox infection in humans has not included pregnant people. However, previous studies in pregnancy on the outcome of infection with smallpox viruses belonging to the Poxviridae family have reported high mortality rates. This literature review aims to determine the effects of monkey pox on pregnancy. Methods: Writing literature reviews is done by searching the Pubmed, Sciencedirect, Web of Science, and Scopus databases. A literature search was carried out using the keywords "outcome", "monkeypox", and "pregnancy". Searches using these keywords are limited to 2014 – 2023 (the last 10 years) and then screening according to inclusion and exclusion criteria. Results: A total of three included literature were reviewed using a qualitative descriptive method. The three literatures reinforce each other
 by finding signs and symptoms of monkeypox in neonates, besides that there are also pregnant women who experience miscarriages. However, there is one literature which states that there is no monkeypox transmission from pregnant women with monkeypox to neonates. Conclusion: The findings from this literature review indicate that the impact of monkeypox on pregnancy is closely associated with a high risk of miscarriage, intrauterine fetal death, vertical transmission, and complaints in pregnant women due to monkeypox infection. Health workers are advised to be more alert to monkeypox cases in pregnancy due to the relatively high risk of fetal death in pregnant women in endemic areas and during monkeypox epidemics.

Insufficient antenatal identification of fetal growth restriction leading to intrauterine fetal death: a regional population-based study in Japan

Objective Fetal growth restriction (FGR) is associated with perinatal adverse outcomes including intrauterine fetal death. Antenatally unidentified FGR has a higher risk of intrauterine fetal death than that identified antenatally. We, therefore, investigated the antenatal identification of FGR among intrauterine fetal deaths, and assessed the perinatal factors associated with the identification of FGR. Methods This retrospective and population-based study reviewed all stillbirths in Shiga Prefecture, Japan, from 2007 to 2016 with exclusion criteria of multiple births, births at unidentified gestational weeks or < 22 gestational weeks, and lethal disorders. We analyzed cases of FGR, using the Japanese clinical definition: Z-score of estimated fetal weight for gestational age <−1.5 standard deviations (SD). Results We identified 94 stillbirths with FGR among 429 stillbirths. Thirty-seven cases were antenatally identified during pregnancy management (39%). Dividing cases by a Z-score of −2.5 SD, 51 cases were classified as ≤−2.5 SD. Twenty-eight of the 51 cases (55%) with a Z-score <−2.5 SD were antenatally identified as having FGR, whereas 9 of the 43 cases (21%) with a Z-score ≥−2.5 SD were antenatally identified as having FGR (p = .002). Among cases with a Z-Score <−2.5 SD, 16 of 21 (76%) beyond 28 weeks’ gestation and 12 of 30 (40%) before 28weeks’ gestation were antenatally identified as having FGR (p = .023). Conclusion Fetal growth restriction leading to intrauterine fetal death in Japan was antenatally identified in less than half of cases. Antenatal identification of FGR was associated with the severity of growth restriction.

Maternal morbidity and mortality in Brazil and the urgency of a national surveillance system for maternal near miss

The World Health Organization (WHO) recommends the analysis of severe maternal morbidity/maternal near miss cases as complementary to the analysis of maternal deaths since the incidence is higher and the predictive factors of the two outcomes are similar. Considering that the reasons for maternal mortality in Brazil have remained constant despite the commitment made during the General Assembly of the United Nations in 2015, this article aims to propose a nationwide maternal near miss surveillance system. We propose the inclusion of maternal near miss events in the National List of Compulsory Notification of Diseases, Injuries, and Public Health Events, via the compatibility of the diagnostic criteria of maternal near miss, informed by the WHO, with the codes of the International Classification of Diseases for the identification of cases. Considering that health surveillance is based on several sources of information, notification could be made by health service professionals as soon as a confirmed or suspected case is identified. With the study of the factors associated with the outcomes, we expect a qualified evaluation of the services focused on obstetric care and consequent implementation of more efficient policies to prevent not only maternal death but also events that can both cause irreversible sequelae to women's health and increase the risk of fetal and neonatal death.

Immune Checkpoint Inhibitors and Pregnancy: Analysis of the VigiBase® Spontaneous Reporting System.

In pregnancy, immune checkpoint pathways are involved in the maintenance of fetomaternal immune tolerance. Preclinical studies have shown that immune checkpoint inhibitors (ICIs) increase the risk of fetal death. Despite the fact that using ICIs in pregnant women and women of childbearing potential is not recommended, some case reports of ICI exposure in pregnancy have been published showing favorable fetal outcomes. This study aimed to gain further insight into ICI safety in pregnancy by querying VigiBase®, the World Health Organization's spontaneous reporting system. We performed raw and subgroup disproportionality analyses using the reporting odds ratio and comparing ICIs with the entire database, other antineoplastic agents, and other antineoplastic agents gathered in VigiBase® since 2011. Across 103 safety reports referring to ICI exposure during the peri-pregnancy period, 56 reported pregnancy-related outcomes, of which 46 were without concomitant drugs as potential confounding factors. No signals of disproportionate reporting were found for spontaneous abortion, fetal growth restriction, and prematurity. In light of the expanding indications of ICIs, continuous surveillance by clinicians and pharmacovigilance experts is warranted, along with pharmacoepidemiological studies on other sources of real-world evidence, such as birth records, to precisely assess ICI exposure during the peri-pregnancy period and further characterize relevant outcomes.

The impact of COVID-19 vaccinations on stillbirth rates among pregnant women in the Metro-Detroit area

Infection by COVID-19 increases maternal morbidity and mortality prompting both the American College of Obstetrics and Gynecology and the Society of Maternal Fetal Medicine to strongly recommend vaccination during pregnancy. Limited data exist assessing the risk of intrauterine fetal death (IUFD) associated with COVID vaccination during pregnancy.This was a retrospective chart review at a large multisite hospital system in Metro Detroit which reviewed data from 13,368 pregnancies. We compared IUFD rates between vaccinated and unvaccinated patients. The rate of stillbirths among unvaccinated women (0.75%) was not statistically different from those who were vaccinated (0.60%). Individuals with government insurance were less likely to be vaccinated and more likely to have IUFD in comparison to patients with private insurance. The rate of stillbirths among Black women was significantly higher than among White women at a rate of 1.1% compared to 0.53% (p=0.008) with no difference in stillbirth rates among vaccinated vs unvaccinated racial distribution. Lastly, it is worth noting that the overall vaccination rate at our healthcare system in pregnancy was very poor (0.26%).In conclusion, this is a large population of highly diverse patients which indicates that COVID-19 vaccination does not lead to IUFD. We plan to use this data to help drive an educational vaccination campaign to try to increase our COVID-19 vaccination rate in our pregnant patients. Systemic racism and social determinants of health have played a large factor in COVID-19 outcomes, and our data highlights that this is the case for IUFD in Black women. Improvements must be made to identify barriers for these women to allow for better pregnancy outcomes. We acknowledge that individuals with government insurance may also have other barriers to healthcare or face healthcare inequity which leaves room for improvement on getting these individuals vaccinated and getting the resources they need to have better pregnancy outcomes.

Maternal Risk Factors Associated with Antepartum Stillbirth

Background: Stillbirth is a worldwide devastating adverse pregnancy outcome and specific maternal conditions have been associated with an increased risk of fetal death. However, despite the worldwide increased efforts in prevention of stillbirth, little improvements have been achieved in recent years. Our aim was to explore the role of maternal conditions that can be ascertained at the beginning of pregnancy (i.e., demographic and medical conditions/diseases) and estimate their contribution to antepartum stillbirth. An early identification of risk factors could offer to high-risk pregnancies a tailored antenatal surveillance by trained staff leading to a potential reduction of stillbirth rates. Methods: Retrospective case-control study in singleton pregnancies. The difference between fetal survival rates in women with or without risk factors was evaluated. Results: Antepartum stillbirth occurs more frequently in infertile, older women, with systemic diseases. Maternal conditions may affect fetal outcome in a time-dependent manner. Subdividing cases in early stillbirths (before 28 weeks of gestation) and late stillbirth (≥28 weeks of gestation) we observed that early stillbirths are associated with assisted reproductive technologies (Odds Ratio (OR) 3.10; 95% Confidence Interval (CI) 1.43–6.71), maternal age above 35 years (OR 1.59; 95% CI 1.17–2.17) and pre-gestational hypertension (OR 3.68; 95% CI 1.28–10.56). Autoimmune disease (OR 6.55; 95% CI 2.90–14.80), inherited thrombophilia (OR 2.94; 95% CI 1.40–6.18) and pre-gestational diabetes (OR 7.57; 95% CI 2.17–26.35) are independent risk factors for late stillbirths. Further, the risk of stillbirth rises with the increasing of the number of pathological maternal clinical conditions, reaching an OR of 5.27 (95% CI 2.32–11.98) in cases of mother with three or more conditions/diseases. Conclusions: Early awareness of the maternal conditions/diseases addressable at the beginning of pregnancy is crucial to offer a personalized plan for high quality care during gestation; for the prevention of stillbirth, a cared clinical management should acknowledge that pregnancies can be affected more severely and earlier as the number of abnormal maternal conditions increases.

Pregnancy outcomes after snakebite envenomations: A retrospective cohort in the Brazilian Amazonia.

Snakebite envenomations (SBEs) in pregnant women can result in adverse maternal or neonatal effects, such as abortion, placental abruption, preterm labor, fetal malformations, and maternal, fetal or neonatal deaths. Despite the high incidence of SBEs in the Brazilian Amazon, there is no literature on the impact of SBEs on pregnancy outcomes. The objective of this study was to describe clinical epidemiology and outcomes associated with SBEs in women of childbearing age and pregnant women in the state of Amazonas, Western Brazilian Amazon, from 2007 to 2021. Information on the population was obtained from the Reporting Information System (SINAN), Mortality Information System (SIM) and Live Birth Information System (SINASC) for the period from 2007 to 2021. A total of 36,786 SBEs were reported, of which 3,297 (9%) involved women of childbearing age, and 274 (8.3%) involved pregnant women. Severity (7.9% in pregnant versus 8.7% in non-pregnant women) (P = 0.87) and case-fatality (0.4% in pregnant versus 0.3% in non-pregnant women) rates were similar between groups (P = 0.76). Pregnant women who suffered snakebites were at higher risk for fetal death (OR: 2.17, 95%CI: 1.74-2.67) and neonatal death (OR = 2.79, 95%CI: 2.26-3.40). This study had major limitations related to the completeness of the information on the pregnancy outcomes. Although SBE incidence in pregnant women is low in the Brazilian Amazon, SBEs increased the risk of fetal and neonatal deaths.

TRUE KNOT OF UMBILICAL CORD- A HIDDEN HAZARD

The umbilical cord is the lifeline of the baby. It helps in performing various functions in utero. Abnormalities of the umbilical cord can compromise the fetus and pose a threat in utero. A true knot of the umbilical cord is one such entity, which is rare and challenging to diagnose in the antenatal period. It can be an incidental nding but sometimes a tight true knot is reported to be associated with a fourfold increased risk of fetal death. Prenatal fetal ultrasound and doppler studies may be helpful in the identication of the true knot.

Fetal death after the introduction of COVID-19 mitigation measures in Sweden, Denmark and Norway: a registry-based study

It remains unclear whether the rate of fetal death has changed during the COVID-19 pandemic. We assessed the impact of COVID-19 mitigation measures on fetal death in Sweden (449,347 births), Denmark (290,857 pregnancies) and Norway (261,057 pregnancies) using robust population-based registry data. We used Cox regression to assess the impact of the implementation of pandemic mitigation measures on March 12th, 2020, on miscarriage (fetal loss before gestational week 22) and stillbirth (fetal loss after gestational week 22). A total of 11% of 551,914 pregnancies in Denmark and Norway ended in miscarriage, while the proportion of stillbirths among 937,174 births across the three countries was 0.3%. There was no difference in the risk of fetal death during the year following pandemic mitigation measures. For miscarriage, the combined hazard ratio (HR) for Norway and Denmark was 1.01 (95% CI 0.98, 1.03), and for stillbirth, the combined HR for all three countries was 0.99 (95% CI 0.89, 1.09). We observed a slightly decreased risk of miscarriage during the first 4 months, with an HR of 0.94 (95% CI 0.90, 0.99) after lockdown. In conclusion, the risk of fetal death did not change after the implementation of COVID-19 pandemic mitigation measures in the three Scandinavian countries.

Monochorionic monoamniotic twin pregnancies.

Monochorionic monoamniotic (MCMA) twin pregnancy is rare and associated with increased complication rates when compared with singletons, dichorionic and monochorionic diamniotic pregnancy in general. Monoamnionicity presents an enormous challenge following its accurate diagnosis, where the absence of an inter-twin membrane subsequently results in cord entanglement and consistently fluctuating foetal position. Furthermore, the detection of twin-twin transfusion syndrome (TTTS) in MCMA pregnancy can be challenging in the absence of amniotic fluid volume discordance without the presence of the inter-twin dividing membrane. Early surveillance of foetal anatomy permits early recognition of foetal structural anomalies, the twin reversed arterial perfusion (TRAP) sequence and conjoined twins. However, the evidence on how best to monitor MCMA pregnancies remains inadequate, though observational studies have demonstrated that once surveillance is initiated, the potential risk of foetal death decreases significantly. In-utero foetal demise can be acute and unpredictable in MCMA pregnancies, despite close surveillance. Elective preterm delivery is usually advocated when the risk of foetal loss upon continuing the pregnancy outweighs the risk of prematurity - around 33 weeks' gestation by caesarean section. Nevertheless, the optimal prenatal surveillance regimen and prompts for delivery have yet to be defined.

Multi-decade national cohort identifies adverse pregnancy and birth outcomes associated with acute respiratory illness hospitalisations during the influenza season.

Despite the World Health Organization (WHO) recommendation that pregnant women be prioritised for seasonal influenza vaccination, coverage in the Western Pacific Region remains low. Our goal was to provide additional data for the Western Pacific Region about the value of maternal influenza vaccination to pregnant women and their families. We conducted a 16-year retrospective cohort to evaluate risks associated with influenza-associated maternal acute respiratory infection (ARI) in New Zealand. ARI hospitalisations during the May to September influenza season were identified using select ICD-10-AM primary and secondary discharge codes from chapter J00-J99 (diseases of the respiratory system). Cox proportional hazards models were used to calculate crude and adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). We identified 822,391 pregnancies among New Zealand residents between 2003 and 2018; 5095 (0.6%) had ≥1 associated ARI hospitalisation during the influenza season; these pregnancies were at greater risk of preterm birth (aHR 1.50, 95% CI 1.39-1.61) and low birthweight (aHR 1.64, 95% CI 1.51-1.79) than pregnancies without such hospitalisations. We did not find an association between maternal ARI hospitalisation and fetal death (aHR 0.96, 95% CI 0.69-1.34) during the influenza season. Maternal influenza vaccination was associated with reduced risk of preterm birth (aHR 0.79, 95% CI 0.77-0.82), low birthweight (aHR 0.87, 95% CI 0.83-0.90) and fetal death (aHR 0.50%, 95% CI 0.44-0.57). In this population-based cohort, being hospitalised for an ARI during the influenza season while pregnant was a risk factor for delivering a preterm or a low birthweight infant and vaccination reduced this risk.

Fetal deaths and maternal injury in motor-vehicle crashes using NASS-CDS and CISS field data

Objective This study determined the risk for fetal death and maternal injury in the same sample of motor-vehicle crashes. The frequency and risk of serious injury (MAIS 3 + F) were also assessed by sex, pregnancy, seating position and crash type. Method The 2008–2015 NASS-CDS and 2017–2020 CISS are representative samples that were analyzed for the risk of fetal death and the risk of maternal injury grouped by MAIS 0–2, MAIS 3 + F and death (F) in 2000+ model year (MY) light vehicles. All electronic cases involving fetal mortality were reviewed for mechanism of injury. Separately, the 2000–2015 NASS-CDS and 2017–2020 CISS data was analyzed for the risk of serious injury for male, female and pregnant female occupants by seating position and crash type in 2000+ MY light vehicles. All calculations are made with weighted data. The significance of differences in risk was determined by the Rao-Scott chi-square test in SAS and z-test for differences in proportions. Results There were 2,467 ± 1,407 fetal deaths in light vehicle crashes from 2008–2015 and 2016–2020 with an annual occurrence of 206/yr. The risk for fetal death was 1.25% ± 0.74% of exposed pregnant females. There were 127 ± 67 deaths of pregnant females, or 11/yr in the same sample. The fatality risk was 0.065% ± 0.035%. The difference in proportions was statistically significant (z = 46.1, p < 0.0001). Fetal deaths occurred 19.4-times more often than deaths of pregnant females. In 82.9% of the crashes with a fetal death, the pregnant female was not seriously injured (MAIS 3 + F). The most common mechanism of fetal death was a minor crash, in 80.1% of the weighted cases based on review of photos of the case vehicle and observing very minor structural damage to the vehicle. The minor crash involved either yaw of the occupant compartment with side loading of the pregnant female or her displacement into the restraint system and side interior in 71.7% of the crashes. A severe crash with intrusion at the seating position of the pregnant female occurred in only 11.5% of cases. It usually caused serious injury to the pregnant female and fetal death. Conclusions Fetal deaths occurred 19.4-times more often than deaths of pregnant females in a 12-year sample of motor-vehicle crashes. The most common mechanism was a minor crash that resulted in a fetal death without serious injury to the pregnant female and involved side or oblique loading of the pregnant female.

ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence.

ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence.

Delivery decision in pregnant women rescued by ECMO for severe ARDS: a retrospective multicenter cohort study

BackgroundAlthough rarely addressed in the literature, a key question in the care of critically pregnant women with severe acute respiratory distress syndrome (ARDS), especially at the time of extracorporeal membrane oxygenation (ECMO) decision, is whether delivery might substantially improve the mother’s and child’s conditions. This multicenter, retrospective cohort aims to report maternal and fetal short- and long-term outcomes of pregnant women with ECMO-rescued severe ARDS according to the timing of the delivery decision taken before or after ECMO cannulation.MethodsWe included critically ill women with ongoing pregnancy or within 15 days after a maternal/child-rescue-aimed delivery supported by ECMO for a severe ARDS between October 2009 and August 2021 in four ECMO centers. Clinical characteristics, critical care management, complications, and hospital discharge status for both mothers and children were collected. Long-term outcomes and premature birth complications were assessed.ResultsAmong 563 women on venovenous ECMO during the study period, 11 were cannulated during an ongoing pregnancy at a median (range) of 25 (21–29) gestational weeks, and 13 after an emergency delivery performed at 32 (17–39) weeks of gestation. Pre-ECMO PaO2/FiO2 ratio was 57 (26–98) and did not differ between the two groups. Patients on ECMO after delivery reported more major bleeding (46 vs. 18%, p = 0.05) than those with ongoing pregnancy. Overall, the maternal hospital survival was 88%, which was not different between the two groups. Four (36%) of pregnant women had a spontaneous expulsion on ECMO, and fetal survival was higher when ECMO was set after delivery (92% vs. 55%, p = 0.03). Among newborns alive, no severe preterm morbidity or long-term sequelae were reported.ConclusionContinuation of the pregnancy on ECMO support carries a significant risk of fetal death while improving prematurity-related morbidity in alive newborns with no difference in maternal outcomes. Decisions regarding timing, place, and mode of delivery should be taken and regularly (re)assess by a multidisciplinary team in experienced ECMO centers.

Critical analysis of risk factors for intrapartum fetal death.

Intrapartum fetal death is devastating for both parents and medical caregivers. The purpose of this study was to evaluate the risk factors for intrapartum fetal death, which often influence management in subsequent pregnancies. This population-based cohort study included all singleton deliveries between the years 1991-2016 at Soroka University Medical Center. Trends over the years, risk factors for intrapartum fetal death and the effect of day of the week were examined. A generalized estimation equation (GEE) model was used to control for confounders. During the study period 344,536 deliveries were recorded, of which 251 (0.1%) suffered intrapartum fetal death. Rates did not change significantly over the years (p = 0.130, using the chi-square test for trends). Preterm delivery, placental abruption, uterine rupture, shoulder dystocia, congenital malformations, severe preeclampsia and fetal malpresentation were significantly more common in pregnancies complicated by intrapartum death. Using a GEE model; shoulder dystocia (aOR 23.8, 95% CI 9.9-57.3, p < 0.005), uterine rupture (aOR 19.0, 95% CI 7.0-51.4, p < 0.05), preterm delivery (aOR 11.9, 95% CI 8.6-16.5, p < 0.001), placental abruption (aOR 6.2, 95% CI 4.1-9.4, p < 0.001), fetal malpresentation (aOR 3.6, 95% CI 2.6-4.9, p < 0.005) and congenital malformations (aOR 2.6, 95% CI 1.9-3.5, p < 0.05) were all independent risk factors for intrapartum fetal death. Weekend deliveries were not at increased risk of intrapartum fetal death. Several risk factors were identified for intrapartum fetal death, with shoulder dystocia demonstrating the highest risk. Unfortunately most factors are neither preventable nor predictable and interventions to decrease the rate of intrapartum fetal death remain elusive.

Risk of fetal or neonatal death or neonatal intensive care unit admission associated with gadolinium magnetic resonance imaging exposure during pregnancy

Concerns have been raised about prenatal exposure to magnetic resonance imaging with gadolinium-based contrast agents because of nonclinical findings of gadolinium retention in fetal tissue and 1 population-based study reporting an association with adverse pregnancy outcomes. This study aimed to evaluate the association between prenatal magnetic resonance imaging exposure with and without gadolinium-based contrast agents and fetal and neonatal death and neonatal intensive care unit admission. We constructed a retrospective cohort of >11 million Medicaid-covered pregnancies between 1999 and 2014 to evaluate the association between prenatal magnetic resonance imaging exposure with and without gadolinium-based contrast agents and fetal and neonatal death (primary endpoint) and neonatal intensive care unit admissions (secondary endpoint). Medicaid claims data were linked to medical records, Florida birth and fetal death records, and the National Death Index to validate the outcomes and gestational age estimates. Pregnancies with multiples, concurrent cancer, teratogenic drug exposure, magnetic resonance imaging focused on fetal or pelvic evaluation, undetermined gadolinium-based contrast agent use, or those preceded by or contemporaneous with congenital anomaly diagnoses were excluded. We adjusted for potential confounders with standardized mortality ratio weighting using propensity scores. Among 5991 qualifying pregnancies, we found 11 fetal or neonatal deaths in the gadolinium-based contrast agent magnetic resonance imaging group (1.4%) and 73 in the non-gadolinium-based contrast agent magnetic resonance imaging group (1.4%) with an adjusted relative risk of 0.73 (95% confidence interval, 0.34-1.55); the neonatal intensive care unit admission adjusted relative risk was 1.03 (0.76-1.39). Sensitivity analyses investigating the timing of magnetic resonance imaging or repeat magnetic resonance imaging exposure during pregnancy and simulating the impact of exposure misclassification corroborated these results. This study addressed the safety concerns related to prenatal exposure to gadolinium-based contrast agents used in magnetic resonance imaging and the risk thereof on fetal and neonatal death or the need for neonatal intensive care unit admission. Although the results on fatal or severe acute effects are reassuring, the impact on subacute outcomes was not evaluated.