Maternal-fetal Medicine Specialists Research Articles

Early detection and management of congenital pulmonary airway malformation in a newborn with stable clinical course

Introduction: Congenital pulmonary airway malformation (CPAM) is a rare developmental lung anomaly characterized by cystic lung lesions, constituting about 25% of congenital pulmonary anomalies. It typically occurs sporadically and is not significantly associated with race, age, or other maternal factors. The prenatal course of CPAM can vary based on factors such as lesion size, mediastinal shift, and associated anomalies. While the overall prognosis is generally favorable in the absence of severe complications like hydrops fetalis, which can adversely affect outcomes, management strategies include corticosteroids, thoracoamniotic shunt (TAS), and, in severe cases, open fetal surgery or the EXIT procedure. Postnatal surgical excision usually offers a curative outcome with an excellent prognosis. Without surgical intervention, there are risks of recurrent infections and, rarely, malignant transformation. Effective prenatal detection significantly impacts clinical decision-making and neonatal outcomes, and the necessity and timing of surgery for asymptomatic infants remain subjects of ongoing debate, underscoring the need for personalized, multidisciplinary care. Case Report: A female infant, delivered at 38 weeks via Cesarean section, was diagnosed with CPAM following routine prenatal ultrasound. Presence of extensive cystic regions in the right lung confirmed the diagnosis and a CPAM volume ratio (CVR) of 0.37 indicated a low risk of severe complications. The pregnancy was largely uneventful, with maternal chronic hypertension managed by Nifedipine and mild intermittent asthma. Postnatal chest radiography corroborated the CPAM diagnosis, while an abdominal ultrasound investigated intrahepatic calcifications. Maternal screening for cytomegalovirus and toxoplasmosis yielded negative results, and postnatally, the infant also tested negative for both infections. The neonate, though asymptomatic and stable, required close monitoring in the neonatal intensive care unit to prevent potential respiratory compromise. Conclusion: Advances in prenatal imaging have greatly improved the early detection and management of CPAM, allowing for targeted neonatal care and strategic planning. This case highlights the importance of a multidisciplinary approach involving obstetricians, maternal-fetal medicine specialists, neonatologists, and pediatric thoracic surgeons in the effective management of CPAM. Early identification and diligent postnatal monitoring are essential for ensuring optimal outcomes and minimizing the risk of complications. The coordinated care and strategic decision-making exemplified in this case underscore the potential for enhanced neonatal health and long-term well-being through comprehensive management of congenital anomalies.

The Role of Collaboration in Prenatal Congenital Heart Disease Diagnosis: A Comparison of Maternal-Fetal Medicine Specialist and Pediatric Cardiologist Performance.

This study compared the accuracy of prenatal congenital heart disease (CHD) diagnosed by maternal-fetal medicine specialists (MFMs) and pediatric cardiologists (PCs), using postnatal cardiac findings as the reference standard. This retrospective analysis at Siriraj Hospital, Bangkok, Thailand, involved 125 pregnancies with fetal CHD diagnosed by MFMs and evaluated by PCs later. Prenatal CHD diagnoses by either MFM or PC were compared with postnatal diagnoses obtained through echocardiography, cardiac surgery/catheterization, or autopsy. Diagnostic accuracy was classified as (A) correct diagnosis, (B) minor differences not impacting clinical management or outcomes, or (C) major differences affecting prognosis or treatment. Cardiac sonography by MFM achieved diagnostic accuracies of 73.6% (A), 16% (B), and 10.4% (C), while fetal echocardiography by PC resulted in accuracies of 72% (A), 20% (B), and 8% (C). No statistically significant differences were found between MFM and PC in each category (P = .375-.832). The MFMs' accuracy was highest for tetralogy of Fallot (94.4%; 95% CI, 72.7-99.9%) and lowest for right atrial isomerism (71.4%; 95% CI, 29-96.3%) and pulmonary atresia with ventricular septal defect (57.1%; 95% CI, 18.4-90.1%). MFMs and PCs demonstrated high and comparable accuracy in prenatal CHD diagnosis. Although PCs tended to outperform MFMs in cases where misdiagnosis could significantly impact neonatal care and outcomes, MFMs can effectively perform primary screening for fetal CHD in all pregnancies. Collaboration with PCs remains essential when fetal CHD is suspected, particularly in complex cases.

8673 Exploring A Case Study On Navigating Complexities In Endocrine Health And Reproductive Challenges

Abstract Disclosure: S.Y. Rizvi: None. E. Villanueva: None. Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting many reproductive-age women, characterized by irregular menstrual cycles, hirsutism, and challenges with fertility. In this case study, we delve into the medical history of a 24-year-old female presenting with PCOS-related symptoms, hirsutism, and infertility, unraveling the multifaceted aspects of her healthcare journey. Case Description: This patient's diagnostic path began when she received an initial diagnosis of PCOS in her home country due to irregular menstrual periods and clinical signs of hirsutism. Her treatment included metformin, but it was interrupted when she relocated to the United States. Upon her arrival in the U.S., her medical course took an unexpected turn as further evaluations revealed elevated salivary cortisol (++), and a 24-hour urine free cortisol recorded 94.2 mcg (normal 4-50 mcg), indicating hypercortisolism. DHEAS: 730 mcg/dl (normal 18-390 mcg/dl), 17-hydroxyprogesterone: 508 (pre-midluteal: 431), free testosterone: 13 pg/ml (normal 0.1-6.4 pg/ml), with normal CBC, TSH, prolactin, and TPO. CT scan showed large 4.8 cm left adrenal mass. These findings indicated adrenal Cushing's syndrome, leading to referral to a tertiary care hospital's endocrine surgeon. Two months post-adrenalectomy, successful removal of the adrenal mass left the patient with relative adrenal insufficiency. Hydrocortisone replacement therapy was initiated, addressing Cushing's syndrome and revealing a potential factor contributing to infertility. Postoperatively, the patient entered the first trimester unexpectedly, complicating her case. Ensuring proper hydrocortisone levels became crucial for her well-being and the fetus, prompting a collaborative approach with obstetricians and maternal-fetal medicine specialists for optimal pregnancy care. Despite ongoing PCOS effects, including hirsutism, treatment options were limited by pregnancy constraints, deferring Aldactone due to its contraindication during pregnancy. Continuous monitoring included hormonal assessments, metabolic panels, and thyroid tests, aiming to balance adrenal insufficiency, PCOS symptoms, and a healthy pregnancy. Conclusion: This case emphasizes challenges in differentiating PCOS from adrenal Cushing's due to overlapping symptoms. Despite classic symptoms, the initial PCOS misdiagnosis highlights the need for vigilance and comprehensive diagnostics. Complex cases underscore the importance of individualized management and interdisciplinary collaboration. Positive outcomes in complex endocrine disorders and pregnancy are attainable through accurate diagnoses and tailored treatments. The case underscores the critical importance of meticulous evaluation for successful outcomes in challenging medical scenarios. Presentation: 6/3/2024

Partnering with the woman who declines recommended maternity care: Development of a statewide guideline in Queensland, Australia.

Choice, a fundamental pillar of woman-centred maternity care, depends in part on the right to decline recommended care. While professional guidance for midwives and obstetricians emphasises informed consent and respect for women's autonomy, there is little guidance available to clinicians or women about how to navigate maternity care in the context of refusal. To describe the process and outcomes of co-designing resources to support partnership between the woman who declines recommended maternity care and the clinicians and health services who provide her care. Following a participatory co-design process involving consumer representatives, obstetricians, midwives, maternal fetal medicine specialists, neonatologists, health service executives, and legal and ethics experts, implementation of the resources was trialled in seven Queensland Health services using Improvement Science's Plan-Do-Study-Act cycles. Resources for Partnering with the woman who declines recommended maternity care have now been implemented statewide, in Queensland, including a guideline, two consumer information brochures (available in 11 languages), clinical form, flowcharts, consumer video, clinician education, and culturally capable First Nations resources. Central to these resources is an innovative shared clinical form, that is accessible online, may be initiated and carried by the woman, and where she can document her perspective as part of the clinical notes. Queensland is the first Australian jurisdiction, and perhaps internationally, to formally establish this kind of guidance in clinical practice. Such guidance is identified as an enabler of choice in the national Australian strategy Woman-centred care: Strategic directions for Australian maternity services.

Comparison of best landmarks for calculating fetal jaw measurements by ultrasound and MRI in micrognathia.

Micrognathia can be diagnosed in utero with ultrasound by measuring the jaw index and/or inferior facial angle, though it can be challenging due to fetal positioning. The jaw index can be measured with magnetic resonance imaging (MRI) using the masseter muscle, but indistinct margins can lead to inaccuracy; the easily visualized posterior teeth buds may be a better landmark. We aimed to evaluate inter-reader variability, agreement with ultrasound, and association with postnatal outcomes using MRI to measure the inferior facial angle, jaw index by masseter muscle, and jaw index by posterior teeth buds. A single-institution retrospective review was performed of singleton pregnancies with prenatally diagnosed micrognathia by ultrasound or MRI from September 2013-June 2022. Ultrasound measurements were obtained by a maternal-fetal medicine specialist and MRI measurements by two radiologists to evaluate inter-reader variability. Intraclass correlation coefficients (ICC) and Bland-Altman analysis were used to assess agreement between imaging methods and logistic regressions and ROC curves to assess associations with postnatal outcomes. Forty-three fetuses (median gestational age 26weeks (IQR 22-31); 47% male (20/43)) were included. Ultrasound measurements could not be obtained for jaw index in 15/43 (35%) fetuses and inferior facial angle in 11/43 (26%); MRI measurements were obtained by at least one reader in all cases. Jaw index by teeth buds demonstrated lowest inter-reader variability (ICC = 0.82, P < 0.001) and highest agreement with ultrasound (bias -0.23, 95% CI -2.8-2.2). All MRI measurements, but not ultrasound, predicted need for mandibular distraction (inferior facial angle P = 0.02, jaw index by masseter muscle P = 0.04, jaw index by teeth buds P = 0.01). Fetal MRI measurements, particularly jaw index measured by posterior teeth buds, demonstrate low inter-reader variability and high agreement with ultrasound, and may predict need for mandibular distraction postnatally.

Management of Red Cell Alloimmunization in Pregnancy.

Rhesus immune globulin has resulted in a marked decrease in the prevalence of RhD alloimmunization in pregnancy; however, antibody formation to other red cell antigens continues to occur. Evaluation for the presence of anti-red cell antibodies should be routinely undertaken at the first prenatal visit. If anti-red cell antibodies are detected, consideration of a consultation or referral to a maternal-fetal medicine specialist with experience in the monitoring and treatment of these patients is warranted. Cell-free DNA can be used to determine fetal red cell antigen status to determine whether the pregnancy is at risk of complications from the red cell antibodies. First-time sensitized pregnancies are followed up with serial maternal titers, and, when indicated, serial Doppler assessment of the peak systolic velocity in the middle cerebral artery should be initiated by 16 weeks of gestation. When there is a history of an affected fetus or neonate, maternal titers are less predictive of fetal risk; if the fetus is antigen positive, serial peak systolic velocity in the middle cerebral artery measurements should be initiated by 15 weeks of gestation because intraperitoneal intrauterine blood transfusions can be used at this gestation if needed. The mainstay of fetal therapy involves intrauterine transfusion through ultrasound-directed puncture of the umbilical cord with the direct intravascular injection of red cells. A perinatal survival rate exceeding 95% can be expected at experienced centers. Neonatal phototherapy and "top-up" transfusions attributable to suppressed reticulocytosis often are still required for therapy after delivery.

Pregnancy in times of war: What are the fallouts ? A review.

The beginning of the conflict in Ukraine has reminded Europeans the many and diverse consequences of armed conflicts. Indeed, the ever more sophisticated conflicts have led to the diffusion of numerous chemicals whose consequences spread even after the end of the war. We present through this paper a review of the consequences on pregnancies of the major conflicts that took place since the end of World War II. MEDLINE, Web of science, and Embase were screened for articles linking perinatal death or birth defects to wartime. A total of 50 papers treating of 8 countries and 4 major and medically documented conflicts were included in the final analysis. An increase in birth defects and perinatal death during and after the end of the conflicts was reported through all the conflicts analyzed. While more data are needed to conclude, maternal fetal medicine specialists ought to be wary when dealing with exposed populations.

Implementation of an interprofessional model for the management of postpartum hypertension.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Postpartum hypertension (PPHTN) poses increased risks, including of stroke. Timely assessment and management by clinicians is imperative but challenging. Team-based care involving pharmacists has shown promise in improving blood pressure control, yet its application in PPHTN management remains unexplored. The objective of this study was to determine the impact and feasibility of an interprofessional model for PPHTN management. This initiative implemented a novel interprofessional model at a safety-net hospital to address previous workflow limitations. Ambulatory care pharmacists collaborated with an obstetric nurse (OBRN) and a maternal fetal medicine specialist to manage high-risk patients with PPHTN utilizing electronic consults (e-consults). Data collection and symptom assessment were completed by an OBRN via telemedicine appointments. Pharmacists employed a collaborative practice agreement based on a preestablished algorithm to initiate medications. Data on patient demographics, consult volume, prescriptions, and pharmacist comfort were collected during the first quarter of full integration. Pharmacists completed 55 e-consults and generated 54 prescriptions. The average time spent per chart review was 12.5 minutes, and the average time to completion of e-consults was 54 minutes. Forty-five unique patients received care, who were primarily non-English-speaking and non-Hispanic Black patients. Pharmacists reported moderate to high comfort levels in managing PPHTN based on the algorithm and provided feedback leading to workflow adjustments. Integration of pharmacists into PPHTN care enables prompt medication initiation and titration. This innovative model, involving remote blood pressure monitoring, telemedicine visits with an OBRN, and e-consults completed by pharmacists, ensures delivery of timely and equitable care and improved access across a diverse population.

Obstetric anesthesia considerations in pregnancy-associated myocardial infarction: a focused review

Pregnancy-associated myocardial infarction (PAMI) is a rare but serious complication that can occur either during pregnancy or postpartum. The etiologies of PAMI are atherosclerosis, spontaneous coronary artery dissection, coronary thrombosis, coronary embolism, and coronary vasospasm. Therapy of acute PAMI depends largely on the ECG presentation, hemodynamic stability, and suspected etiology of myocardial infarction. Anesthetic management during delivery in patients with PAMI should consist of early and carefully titrated neuraxial analgesia and anesthesia, maintenance of normal sinus rhythm, preservation of afterload, and monitoring for and avoiding myocardial ischemia. To improve the care of women with PAMI, a multidisciplinary team of cardiologists, maternal fetal medicine specialists, obstetric providers, neonatologists, and anesthesiologists must work collectively to manage these complex patients.

Effects of COVID-19 Infection on Fetal Growth in Pregnancy

Background: Infections are known to affect fetal development and growth. Studies have shown that there is a higher frequency of maternal vascular malperfusion in the placental bed in pregnant women infected with COVID-19. It is further suggested that the abovementioned changes seen in the placentas of women infected with COVID-19 is associated with significant clinical sequelae, such as, preterm birth, fetal growth restriction (FGR), and fetal demise. Although there are growing studies that have evaluated the impact of COVID-19 infection on fetal growth, data remains limited. As a result, there is little consensus on perinatal recommendations and counseling that should be given to women infected patients COVID-19 during pregnancy. During the COVID-19 pandemic, our Maternal Fetal Medicine Clinics opted to perform serial growth ultrasounds and additional antenatal testing in the third trimester in women infected with the disease. Whether performance of these ultrasounds identified cases of fetal growth restriction and impacted fetal outcomes remains unknown. The purpose of this study is to perform a retrospective review of all ultrasounds performed in women identified to have COVID-19 during June 2020-December 2022, and to evaluate the impact on fetal growth. We hypothesize that COVID-19 will increase the risk of fetal growth restriction compared to pregnant women without COVID-19. Study Design: This is a retrospective cohort study within the Obstetrix Maternal-Fetal Medicine Specialist of Houston Clinics. The study included all patients aged 16-55 years old with a singleton pregnancy who received an ultrasound at Obstetrix Maternal-Fetal Medicine Specialist of Houston between June 2020-December 2022. COVID-19 infection during pregnancy was defined as a self-reported positive SARS-Co-2 RT-PCR or Rapid Test. FGR was defined as estimated fetal weight less than the 10% or abdominal circumference less than the 10% for gestational age. Maternal and fetal characteristics, including FGR, were collected and compared between the two groups. Results: Among the 21,917 women with a singleton pregnancy who received an ultrasound at Obstetrix Maternal-Fetal Medicine Specialist of Houston between June 2020-December 2022, 484 (2%) had COVID-19 infection during pregnancy and 21,433 (98%) did not. Of those who had COVID-19 infection during pregnancy there were 45 (9%) cases of FGR, and when compared to pregnant individuals reporting negative for COVID-19 there were 2,928 (14%) cases of FGR, p=005. When the 484 women who had COVID-19 were stratified by the timing of their COVID-19 infection by first, second and third trimester, there was no significant difference in the proportion who had an offspring with FGR (p=0.33 Cochran-Armitage test for trend). Conclusion: COVID-19 infection in pregnancy, when compared to those who do not have COVID-19 infection in pregnancy does not appear to be more associated with FGR. The performance of routine serial fetal growth ultrasounds may not be indicated in pregnant women solely for the purpose of having a history of a COVID-19 infection during pregnancy.

Postural orthostatic tachycardia syndrome during pregnancy, labor, and post-delivery: A case series

Postural orthostatic tachycardia syndrome (POTS) is an autonomic condition characterized by the presence of a &gt;30 bpm increase in heart rate, accompanied by orthostatic symptoms, including heart palpitations, light-headedness, weakness, blurred vision, nausea, and headache. Females are commonly affected by POTS at childbearing age. This case series aims to compare the clinical presentations, autonomic dysfunction management, and pregnancy outcomes of four women with POTS. In our autonomic neurology clinic, the goal for our patients is consistent blood pressure during pregnancy. The patients were all interviewed retrospectively to determine pregnancy outcomes. Our study indicates the need for neurologists to collaborate with a team of maternal-fetal medicine specialists with advanced training in high-risk pregnancies to optimize autonomic function throughout the course of pregnancy. In addition, our results suggest that reducing medications to minimize harm can be achieved through regular monitoring at 1 &amp;ndash; 3 month intervals during pregnancy, with a 6-week postpartum evaluation.

Pregnancy Loss: A Comparative Analysis of Information Delivery Between ACOG FAQs and ChatGPT [ID 2683594

INTRODUCTION: Pregnancy loss is a sensitive topic, and clear, reliable information is crucial. This study compares the readability and accuracy of ChatGPT's responses to ACOG's frequently asked questions (FAQ) sheets on the subject. METHODS: Within the five FAQ sheets under “Pregnancy Loss,” 66 questions were assessed using ChatGPT-3.5. Readability scores, ie, Flesch–Kincaid Reading Ease, Flesch–Kincaid Grade Level, Gunning Fog Score, Smog Index, Coleman Liau Index, and Automated Readability Index were computed for each response. The quality of responses were also graded by two maternal–fetal medicine specialists using a 1–4 scale, where 1 represents a comprehensive response and 4 indicates an incorrect response. Statistical analysis utilized a two-tailed t-test. A weighted Cohen’s kappa coefficient evaluated interrater reliability. RESULTS: ACOG attained better readability scores over ChatGPT across all six metrics with statistical significance (P&lt;.001). Among grading, ACOG also outperformed ChatGPT in quality of information with a summative mean of 1.53 (SD 0.60) versus 1.85 (SD 0.90) with statistical significance (P&lt;.001). Grading for ACOG possessed a Cohen's kappa coefficient of 0.493, implying moderate agreement between graders. Grading for ChatGPT possessed a Cohen's kappa coefficient of 0.744, implying substantial agreement between graders. CONCLUSION: The responses by ACOG to frequently asked questions on pregnancy loss were both clearer and more comprehensive than those of ChatGPT with consistent agreement between graders. Although ChatGPT can be a convenient source of medical queries, further improvements ought to be made to these large-language models to provide clear and accurate information regarding pregnancy loss to patients.

Is it time to end the use of base deficit for fetal well-being assessment?

Authors have expressed reservations regarding the use of base deficit measured in umbilical artery blood samples to assess fetal well-being during the course of labor and to predict neonatal neurologic morbidity. Despite its integration into clinical practice for more than 50 years, obstetricians and maternal-fetal medicine specialists may not realize that this marker has significant limitations in accurately identifying neonatal metabolic acidosis as a proxy for fetal well-being. In brief, there are 2 large families of base deficit, namely whole blood and extracellular fluid. Both rely on equations that use normal adult acid-base characteristics (pH 7.40 and partial CO2 pressure of 40 mm Hg) that overlook the specificity of the normal in utero acid-base status of pH 7.27 and partial CO2 pressure of 54 mm Hg. In addition, it ignores the unique characteristic of the in utero fetal response to acute hypoxia. The dependence on placental circulation for CO2 elimination may lead to extremely high values (up to 130 to 150 mm Hg) during hypoxic events, a phenomenon that is absent in adults with acute metabolic acidosis who can hyperventilate. The dispute over if to include a correction for high partial CO2 pressure in the bicarbonate estimation, as presented in the Great Trans-Atlantic Debates, remains unresolved. The key constants computed for adult acid-base physiology in the current base deficit algorithms, without accounting for the impact of high partial CO2 pressure or other fetal characteristics of buffering capacity (eg, differences in body water content composition, plasma protein, and hemoglobin attributes), may lead to an overestimation of metabolic acidosis, especially in newborns who are experiencing hypercarbia during the early stages of the hypoxic response. These unrecognized limitations impact the base deficit results and may mislead clinicians on fetal well-being assessments when discussing the management of fetal heart rate monitoring and neonatal outcomes. Based on our arguments, we believe that it is prudent to consider an alternative to base deficit for drawing conclusions regarding fetal well-being during the course of birth management. We propose a marker specifically related to the newborn acid-base physiology--the neonatal eucapnic pH correction. This marker can be added to arterial cord blood gas analysis, and we have described how to interpret it as a marker of neonatal metabolic acidosis.

Cell-Free DNA Screening for Single-Gene Disorders.

In pregnancy, cell-free DNA (cfDNA) represents short fragments of placental DNA released into the maternal blood stream through natural cell death. Noninvasive prenatal screening with cfDNA is commonly used in pregnancy to screen for common aneuploidies. This technology continues to evolve, and laboratories now offer cfDNA screening for single-gene disorders. This article aims to review cfDNA screening for single-gene disorders including the technology, current syndromes for which screening may be offered, limitations, and current recommendations. Original research articles, review articles, laboratory white papers, and society guidelines were reviewed. Cell-free DNA screening for single-gene disorders is not currently recommended by medical societies. There may be a role in specific circumstances and only after comprehensive pretest counseling. It can be considered in the setting of some fetal ultrasound anomalies, and usually only after diagnostic testing is offered and declined. Given the limitations of using cfDNA screening for single-gene disorders, caution is recommended when considering these tests. It should only be offered with involvement of a reproductive genetic counselor, medical geneticist, or maternal fetal medicine specialist to ensure comprehensive counseling and appropriate utilization.

Prevention of Preeclampsia in Saudi Arabia: Knowledge about Risk Factors and Aspirin Use among Obstetrical Care Physicians - A National Survey

Objectives: To assess the level of awareness among obstetrical care providers about preeclampsia prevention including risk factors, good practice in aspirin prophylaxis, and to analyze the associated factors. Methods: A cross-sectional study conducted among gynecologists and obstetricians, maternal and fetal medicine specialists, and internal or family medicine physicians working in public or private care centers whom involved in obstetric care in Saudi Arabia. An online-administered questionnaire was designed to assess familiarity of aspirin role in prevention of preeclampsia and fetal growth restriction including proper dose, timing of intake, gestational age to start and discontinuation of treatment as well as the risk factors of PE among set of 13 conditions. An awareness score was calculated and divided into two levels: adequate and inadequate familiarity and knowledge. Practice in PE prevention and attitude towards aspirin use, in addition to participants’ demographic and professional factors, were investigated and analyzed as profound factors. Results: Hundred sixty physicians were participated, 85% were obstetrician/gynecologists and 13.1 were maternal fetal medicine Specialists. Less than half of participants have adequate knowledge and awareness in aspirin role and a minority provided correct answers regarding the recommended aspiring dose, timing of intake, gestational age to start and discontinuation of treatment. However, knowledge about preeclampsia risk factors was relatively acceptable. Maternal fetal medicine specialist and physicians working in teaching hospitals were remarkably with better knowledge compared to their respective counterparts in primary and secondary centers. The existence of institutional guidelines about ASA use in pregnancy did not improve the knowledge level. Conclusion: The overall familiarity and knowledge in that regard was relatively poor, associating misconceptions about the risk factors and substantial gaps regarding the optimal timing and prescribing practice. Formal and continuous medical education curricula should be reviewed to promote good clinical practice in preeclampsia prevention as an essential dimension of maternal and fetal care.

The impact of specialty training and physician attitudes on fetal cardiac counseling

Objective Fetal cardiac anomalies are the most commonly diagnosed structural anomalies. In these cases, Maternal-Fetal Medicine (MFM) specialists are tasked with counseling patients on a spectrum of diagnoses as well as their prognostic implications. A recent study of pediatric cardiologists demonstrated that personal beliefs regarding termination impact the counseling provided to patients. Our objective was to study whether the personal beliefs of MFMs impact counseling of patients with severe fetal cardiac anomalies and to compare these providers to their cardiology counterparts. Methods We conducted an anonymous cross-sectional survey of MFMs in New England that assessed personal beliefs and counseling practices when diagnosing hypoplastic left heart syndrome (HLHS). We subsequently compared these providers to the previously surveyed cardiologists. Results A total of 34 respondents representing a broad spectrum of age and experience across several states in New England were analyzed. When presented with the statement “some life is always better than no life at all,” 79% (n = 27) of respondents disagreed and all respondents (n = 34) offered termination, palliative care, and treatment options when counseling patients with HLHS. Additionally, while 74% (n = 25) of providers would personally support a decision to terminate a pregnancy with HLHS, 94% (n = 32) would professionally support the decision to pursue termination. MFMs and cardiologists differed in their responses to “some life is better than no life” and the belief that termination should be offered, though differences did not reach statistical significance. However, with respect to the providers’ personal and professional support of the decision to terminate the pregnancy, the groups of respondents varied significantly in their level of support, both professionally and personally with fewer cardiologists supporting this decision. Conclusion When diagnosing a severe and potentially fatal congenital cardiac anomaly, counseling by MFMs was largely unaffected by personal beliefs regarding termination of pregnancy. While this is consistent with previously published data on counseling practices among pediatric cardiology specialists, some important differences between the specialties were seen.

Review of nutrition and hydration in relation to physical exercise during pregnancy

Studies on nutritional recommendations for pregnant women who exercise are scarce. The objective of this article is not to focus on the diet of pregnant women as a whole, but to review those aspects of it that may be related to physical exercise. To this end, the nutritional and hydration recommendations contained in the main clinical practice guides on physical exercise during pregnancy are collected, including the first Spanish guides. Likewise, the energy requirements required by pregnant women who perform physical exercise during pregnancy for adequate gestational weight gain are addressed, aspects related to macronutrients in the aforementioned population group, and two specific topics, such as nutritional needs in the adolescent who practices physical exercise during pregnancy and eating disorders in pregnant athletes It is concluded by stating that pregnant women who exercise regularly should eat a varied and balanced diet, such as the Mediterranean diet, avoid long periods of fasting to avoid the appearance of hypoglycemia and maintain adequate fluid intake before, during and after physical exercise. Pregnant adolescents who engage in physical exercise require nutritional supervision to achieve adequate gestational weight gain. The pregnant athlete with an eating disorder has a higher risk of complications during pregnancy and childbirth, gynecological, fetal and neonatal, and, therefore, requires close monitoring by specialists in maternal-fetal medicine.

Fetal urinary tract dilation: What to tell the parents.

Urinary tract dilation (UTD), which refers to the abnormal dilation of the urinary collection system, is the most common finding on prenatal ultrasound and presents with varying severity, presentation, etiology, and prognosis. Prenatal classification and risk stratification aim to prevent postnatal complications, such as urinary tract infections and further kidney dysfunction. Parents expecting a child with UTD should be counseled by a multidisciplinary team consisting of maternal-fetal medicine specialists, and pediatric urology and nephrology providers. This review summarizes the key points in the diagnostic evaluation and management during the prenatal and initial postnatal period, focusing on the information that should be provided to future parents. We address frequently asked parental questions and concerns that our multidisciplinary clinical practice faces.

Absence of Ductus Venosus: A Comparison of 2 Distinctive Fetal Autopsy Cases and Embryologic Perspectives.

In fetal circulation, oxygenated blood from the placenta flows through the umbilical vein into the ductus venosus (DV), then enters the inferior vena cava, and subsequently reaches the right atrium of the heart. The DV serves as a shunt, allowing this oxygen-rich blood to bypass the liver. The absence of the DV (ADV), also known as agenesis of the DV, is a rare congenital anomaly. Without a DV, blood from the umbilical vein must follow alternative routes to the heart. In ADV cases, blood from the umbilical vein must follow 1 of 2 primary drainage patterns: either an extrahepatic shunt or an intrahepatic shunt. This report details the antenatal ultrasound and postmortem findings of 2 fetuses diagnosed with ADV by prenatal imaging studies. The first case involved a fetus with a persistent right umbilical vein connected directly to the suprahepatic IVC, accompanied by early obliteration of the left umbilical vein and true agenesis of the DV. This fetus also had additional congenital anomalies. In contrast, the second case involved a fetus with a normal left umbilical vein that entered the liver. However, despite an ultrasound diagnosis of "absence" of the DV, a DV was present, though markedly hypoplastic and probably minimally functional or non-functional. In this case, blood from the umbilical vein likely followed an alternate intrahepatic route through the portal and hepatic veins, before reaching the heart (intrahepatic shunt). These contrasting cases emphasize the heterogeneity of vascular anomalies and embryologic origins captured by the term "ADV." Additionally, the terminology of "absence" or "agenesis" may be misleading in some purported ADV cases. Specifically, in the second case, the DV was not absent; it was markedly hypoplastic instead. This also appears to be the first reported case of a hypoplastic DV in a fetus. Both cases underscore the importance of effective collaboration and clear communication between maternal-fetal medicine specialists and pathologists.

Utility of Fetal Cardiac Resonance Imaging in Prenatal Clinical Practice: Current State of the Art

The field of prenatal cardiac imaging has revolutionized the way we understand and manage congenital heart diseases (CHD) in the developing fetus. In the prenatal period, cardiac imaging plays a pivotal role in the diagnostic pathway, from screening to classification and follow-up of CHD. The ability to visualize the fetal heart in utero allows healthcare professionals to detect abnormalities early, thus enabling timely interventions and informed decision-making processes for both the mother and the medical team. Early CHD detection improves preparation for delivery, postnatal care, and postnatal outcomes. Advancements in medical technology and imaging techniques have provided clinicians with insights into the fascinating workings of the fetal heart. Several imaging modalities have proven to be helpful in this field, with echocardiography undoubtedly representing the primary modality for evaluating the fetus. By providing detailed anatomical and functional information, fetal cardiac magnetic resonance (CMR) imaging contributes to better prenatal counseling and enhances the coordination of care between obstetricians, maternal–fetal medicine specialists, and pediatric cardiologists. Shortcomings of fetal CMR are due to technical concerns related to the intrauterine position of the fetus and subsequent challenges to following a standard scan protocol. The aim of this paper was to revise the current state-of-the-art in the field of fetal CMR and its clinical applications and to delve into methods, challenges, and future directions of fetal CMR in prenatal imaging.