scholarly journals Experience with different techniques of laser coagulation of placental anastomoses to relieve feto-fetal transfusion syndrome in monochorionic diamniotic twins

2021 ◽  
Vol 20 (3) ◽  
pp. 4-13
Author(s):  
M. V. Pavlichenko ◽  
N. V. Kosovtcova ◽  
T. V. Markova ◽  
J. Y. Pospelova
Keyword(s):  
Pregnant Women ◽  
Survival Rates ◽  
Perinatal Outcomes ◽  
Perinatal Period ◽  
Surgical Correction ◽  
Laser Coagulation ◽  
Steady Increase ◽  
Fetal Survival ◽  
Group 2 ◽  
Method Group

Introduction. In recent years, the problem of multiple fetuses has become particularly important, which is associated with a steady increase in the frequency of multiple pregnancies worldwide. The feto-fetal transfusion syndrome (FFTS) is a classic example of unbalanced functioning of placental anastomoses, which leads to transfusion between fetuses. The incidence of this syndrome in a group of monochorionic diamniotic twins ranges from 8% to 15% and, in the absence of timely diagnosis and intrauterine correction, leads to death of one or both fetuses in 70-100% of cases. The effect of different methods of intrauterine surgical correction of FFTS in monochorionic diamniotic multiple fetuses on perinatal outcomes is of scientific interest. Purpose of the study — to investigate the effect of different types of laser coagulation of placental anastomosis (LCPA) on perinatal outcomes in intrauterine surgical correction of FFTS. Materials and methods. Depending on the surgical technique used, women were divided into three groups: the total placental anastomosis coagulation method, Group 1 (58 pregnant women); the selective placental anastomosis coagulation method, Group 2 (67 pregnant women); the sequential selective laser coagulation of placental anastomoses, Group 3 (62 pregnant women). Results. We analyzed the results of intrauterine surgical correction of FFTS by different methods of laser coagulation of placental anastomoses in 187 women with monochorionic diamniotic type of placentation of II-IV degrees according to Quintero. We obtained statistically significant differences in many perinatal period indices depending on the LCPA method used. Discussion. Sequential selective LCPA has proven to be the most effective, safe, and promising technique for correction of FFTS. The data obtained indicate possible ways to improve pregnancy prolongation and fetal survival rates after the use of intrauterine surgical correction of placental vascular anastomoses. Conclusion. Sequential selective LCPA has proven to be the best technique to correct FFTS with the least perinatal losses and postoperative complications, as well as the highest efficacy.

scholarly journals Nutritional Support and Prophylaxis of Azithromycin for Pregnant Women to Improve Birth Outcomes in Peri-Urban Slums of Karachi, Pakistan – A Protocol of Multi-arm Assessor Blinded Randomized Controlled Trial (Mumta PW Trial)

2021 ◽  
Author(s):  
Ameer Muhammad ◽  
Zoha Zahid Fazal ◽  
Benazir Baloch ◽  
Imran Nisar ◽  
Fyezah Jehan ◽  
...  
Keyword(s):  
Informed Consent ◽  
Pregnant Women ◽  
Low Income ◽  
Controlled Trial ◽  
Perinatal Outcomes ◽  
Urban Slum ◽  
Control Group ◽  
Maternal Undernutrition ◽  
Randomized Controlled ◽  
Group 2

Abstract BackgroundMaternal undernutrition is critical in the etiology of poor perinatal outcomes and accounts for 20% of small-for-gestational-age (SGA) births. High levels of food insecurity, antenatal undernourishment and childhood undernutrition necessitate the supplementation of fortified balanced energy-protein (BEP) during pregnancy in low-income settings especially with scarce literature available in this subject. Hence, this paper extensively covers the protocol of such a trial conducted in an urban slum of Karachi, Pakistan. Methods The trial is community-based, open-labelled, four-arm, and randomized controlled that will include parallel group assignments with a 1:1:1:1 allocation ratio in low-income squatter settlements in urban Karachi, Pakistan. All pregnant women (PW), if identified between > 8 and <19 weeks of gestation based on ultrasound, will be offered routine antenatal care (ANC) counseling and voluntary participation in the trial after written informed consent. A total number of 1836 PW will be enrolled with informed consent and randomly allocated to one of the four arms receiving: (1) ANC counseling only (control group), (2) ANC counseling plus BEP supplement (intervention arm 1), (3) ANC counseling plus BEP supplement plus 2 doses Azithromycin (intervention arm 2), or (4) ANC counseling plus BEP supplement plus daily single dose of Nicotinamide and Choline (intervention arm 3). Trial Registration ClinicalTrials.gov NCT04012177. Registered on July 9, 2019. (https://clinicaltrials.gov/ct2/show/NCT04012177)

Systemic erythematosus lupus and pregnancy outcomes in a Colombian cohort

Lupus ◽  
2021 ◽  
pp. 096120332110614
Author(s):  
Valeria Erazo-Martínez ◽  
Ivana Nieto-Aristizábal ◽  
Isabella Ojeda ◽  
Michelle González ◽  
Cristian C Aragon ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Pregnant Women ◽  
Lupus Erythematosus ◽  
Preterm Labor ◽  
Activity Index ◽  
Perinatal Outcomes ◽  
Disease Activity Index ◽  
Obstetric Outcomes ◽  
Maternal Complications ◽  
Fetal Survival

Objective Pregnant women with SLE have higher probabilities of maternal complications. SLE during pregnancy has alternating patterns of remission and flare-ups; however, most pregnant SLE patients tend to worsen with associated poor obstetric and perinatal outcomes. This study aimed to describe obstetric outcomes in pregnant women with SLE. Methods This retrospective study was performed between 2011 and 2020 at a highly complex referral health center in Cali, Colombia. Pregnant women with a diagnosis of SLE were included. Demographic, clinical, and laboratory features and obstetric and fetal outcomes, including intensive care unit (ICU) characteristics, were evaluated. Results Forty-eight pregnant women with SLE were included. The median age was 29 (25–33.7) years. The SLE diagnosis was made before pregnancy in 38 (79.1%) patients, with a median disease duration of 46 (12–84) months. Thirteen (27.1%) patients had lupus nephritis. Preterm labor (34, 70.8%), preeclampsia (25, 52%), and preterm rupture of membranes (10, 20.8%) were the most common obstetric complications. A relationship between a greater systemic lupus erythematosus pregnancy disease activity index (SLEPDAI) and the development of hypertensive disorders during pregnancy was established (preeclampsia = p < 0.0366; eclampsia = p < 0.0153). A relationship was identified between lupus nephritis (LN) and eclampsia ( p < 0.01), preterm labor ( p < 0.045), and placental abruption ( p < 0.01). Seventeen (35.4%) patients required ICU admission; 52.9% of them were due to AID activity, 17.6% for cardiovascular damage, 11.7% for septic shock, and 5.8% for acute kidney failure. Fetal survival was 89.5% ( N = 43/48). Among the live births, two (4.2%) newborns were diagnosed with neonatal lupus, and two (4.2%) were diagnosed with congenital heart block. One maternal death was registered due to preeclampsia and intraventricular hemorrhage. Conclusions This study is the first to describe SLE during pregnancy in Colombia. SLE was the most prevalent AID in this cohort, and complications included preterm labor, preeclampsia, and postpartum hemorrhage. A higher SLEPDAI and lupus nephritis predicted adverse maternal outcomes.

scholarly journals High prevalence of vitamin D deficiency in pregnant women and its relationship with adverse pregnancy outcomes in Guizhou, China

2018 ◽  
Vol 46 (11) ◽  
pp. 4500-4505 ◽  
Author(s):  
Song Hong-Bi ◽  
Xu Yin ◽  
Yang Xiaowu ◽  
Wang Ying ◽  
Xu Yang ◽  
...  
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Perinatal Outcomes ◽  
Perinatal Period ◽  
Maternal Outcomes ◽  
Serum Vitamin D ◽  
Adverse Perinatal Outcomes ◽  
Adverse Pregnancy

Objective This study was performed to investigate the prevalence of vitamin D deficiency in pregnant women in Guizhou, China and its correlation with adverse infant and maternal outcomes during the perinatal period. Methods In total, 220 pregnant women who received perinatal care and delivered in the Affiliated Hospital of Guizhou Medical University from November 2014 to April 2015 were enrolled. Each woman’s serum vitamin D concentration was tested during early pregnancy, and its correlation with adverse infant and maternal outcomes in the perinatal period was analyzed. Results The mean serum vitamin D concentration was 29.5 ± 5.8 nmol/L. More than 90% of pregnant women had vitamin D insufficiency. Additionally, 38.4% of women with vitamin D deficiency and 22.2% with vitamin D inadequacy developed adverse perinatal outcomes. The vitamin D level was negatively correlated with adverse pregnancy outcomes. Conclusion Vitamin D deficiency is highly prevalent among pregnant women in Guizhou, China. The incidence of adverse perinatal outcomes was far higher in association with vitamin D deficiency than sufficiency. A negative correlation was found between the vitamin D level and the incidence of adverse perinatal outcomes in pregnant women. Therefore, targeted screening and proper supplementation are needed during early pregnancy.

scholarly journals Markers of the pathological course of perinatal period in children with echogenic intracardiac focus

2020 ◽  
Vol 3 (2) ◽  
pp. 132-135
Author(s):  
E.I. Malinina ◽  
◽  
O.A. Rychkova ◽  
T.V Chernysheva ◽  
◽  
...  
Keyword(s):  
Pregnant Women ◽  
Clinical Signs ◽  
Perinatal Period ◽  
Somatic Status ◽  
Perinatal Center ◽  
Umbilical Artery Doppler ◽  
Group 2 ◽  
Central Nervous System Defects ◽  
First Time

Aim: to describe the course of perinatal period in children with echogenic intracardiac focus (EIF) diagnosed in the antenatal period.Patients and Methods: in this case-control study, the groups were similar in age, obstetric history, and somatic status of mothers. Group 1 included 214 pregnant women whose fetus (newborn later) was diagnosed with EIF. Inclusion criteria were an echoic focus within the fetal heart (by prenatal ultrasound) as well as pregnancy follow-up and childbirth in the Perinatal Center of Tyumen city. Group 2 included 107 pregnant women whose fetus (newborn later) had no this sonographic sign. Retrospective analysis of the course of antenatal and intranatal periods of newborns with EIF was performed. The course of early neonatal period was described. Placental histology (n = 69) and autopsies of perinatal losses (n=12) were discussed.Results: it was demonstrated that EIFs identified for the first time after 20 weeks of gestation persist after delivery much more common (p<0.01) when associated with impaired fetoplacental circulation. More than 50% of mothers (p>0.01) whose fetuses were diagnosed with EIF had patho-logical pregnancy. During the delivery, clinical signs of chronic hypoxia in newborns with EIF were identified twice as common as in newborns without EIF (p=0.029). Moreover, none of the children had typical signs of Down syndrome while the number of preterm newborns was simi-lar (p>0.05). Only newborns with EIF were diagnosed with different types of birth defects (7.94%) and generalized cytomegalovirus infection (1.46%). Hypoxic cardiopathy (that illustrates cardiovascular deadaptation) was 3.2 times more common in newborns with EIF (p=0.005) Conclusion: combination of EIF (2.67±0.9 mm) localized in the left or right ventricle and other sonographic signs, central nervous system defects and/or cardiovascular abnormalities require screening for perinatal infections as well as uterine and umbilical artery Doppler to minimize the risk of perinatal events.Keywords: perinatal period, echogenic intracardiac focus, newborns, perinatal losses, congenital anomaly, hypoxic cardiopathy, sonographic sign.For citation: Malinina E.I., Rychkova O.A., Chernysheva T.V. Markers of the pathological course of perinatal period in children with echogenic intracardiac focus. Russian Journal of Woman and Child Health. 2020;3(2):132–135. DOI: 10.32364/2618-8430-2020-3-2-132-135.

scholarly journals Nutritional support and prophylaxis of azithromycin for pregnant women to improve birth outcomes in peri-urban slums of Karachi, Pakistan—a protocol of multi-arm assessor-blinded randomized controlled trial (Mumta PW trial)

Trials ◽  
2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Ameer Muhammad ◽  
Zoha Zahid Fazal ◽  
Benazir Baloch ◽  
Imran Nisar ◽  
Fyezah Jehan ◽  
...  
Keyword(s):  
Informed Consent ◽  
Pregnant Women ◽  
Low Income ◽  
Controlled Trial ◽  
Perinatal Outcomes ◽  
Urban Slum ◽  
Control Group ◽  
Maternal Undernutrition ◽  
Randomized Controlled ◽  
Group 2

Abstract Background Maternal undernutrition is critical in the etiology of poor perinatal outcomes and accounts for 20% of small-for-gestational-age (SGA) births. High levels of food insecurity, antenatal undernourishment, and childhood undernutrition necessitate the supplementation of fortified balanced energy protein (BEP) during pregnancy in low-income settings especially with scarce literature available in this subject. Hence, this paper extensively covers the protocol of such a trial conducted in an urban slum of Karachi, Pakistan. Methods The trial is community-based, open-labelled, four-arm, and randomized controlled that will include parallel group assignments with a 1:1:1:1 allocation ratio in low-income squatter settlements in urban Karachi, Pakistan. All pregnant women (PW), if identified between > 8 and < 19 weeks of gestation based on ultrasound, will be offered routine antenatal care (ANC) counseling and voluntary participation in the trial after written informed consent. A total number of 1836 PW will be enrolled with informed consent and randomly allocated to one of the four arms receiving: (1) ANC counseling only (control group), (2) ANC counseling plus BEP supplement (intervention arm 1), (3) ANC counseling plus BEP supplement plus 2 doses azithromycin (intervention arm 2), or (4) ANC counseling plus BEP supplement plus daily single dose of nicotinamide and choline (intervention arm 3). Trial registration ClinicalTrials.govNCT04012177. Registered on July 9, 2019.

scholarly journals COMBINED APPROACH TO CLINICAL CLASSIFICATION OF CHRONIC PLACENTAL INSUFFICIENCY IN PERINATAL PERIOD: SETTING STANDARD IN DIAGNOSTIC AND OBSTETRIC MANAGEMENT

2019 ◽  
Vol 4 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Yurii V. Tezikov ◽  
Igor' S. Lipatov ◽  
Lyudmila Yu. Gogel ◽  
Amir R. Azamatov ◽  
Valibek K. Ermetov
Keyword(s):  
Pregnant Women ◽  
Rating Scale ◽  
Cell Transformation ◽  
Perinatal Outcomes ◽  
Perinatal Period ◽  
Placental Insufficiency ◽  
Blood Analysis ◽  
Clinical Classification ◽  
Severity Rating

Objectives - to implement both a new clinical classification of chronic placental insufficiency (CPI) and a new complex rating scale based on calculation of an integral indicator of compensatory-adaptive placental reactions in order to improve perinatal outcomes. Material and methods. We examined 154 pregnant women with high risk of severe placental insufficiency (PI) in whom the markers of apoptosis, endothelial dysfunction, cell transformation and energy exchange were detected in gestation weeks 18-24 and 28-38 via blood analysis. It served the basis for development of the CPI severity rating scale. Diagnostic correlations in 359 pregnant women with various clinical and morphological manifestation of chronic PI allowed us to develop an original method of diagnosing the severity of this complication. Results and Discussion. The sequential changes in placenta in CPI ("placenta dysfunction" ^ "decompensated PI" ^ "progressive decompensated PI" ^ "acute PI") formed the basis of a new CPI clinical classification. The final indicator was calculated according to the complex point scale. The indicator's value from 1 to 3 points corresponds to placental dysfunction; the decompensated PI is diagnosed at 4 to 9 points; at 10 to 13 points - progressive decompensated PI; starting from 14 points - acute PI. The absence of PI is reported if the value of the final indicator scores zero. Conclusion. Setting a standard in the CPI diagnostic makes it 39% more accurate in severe PI, improves the perinatal outcomes by 60%, helps to avoid the disabling conditions in the neonates. High informativity and reliability of the developed PI severity rating diagnostic method was confirmed within the evidence-based medicine approach.

scholarly journals Impact of maternal mental health problems on perinatal outcomes for the infant

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L F Christensen ◽  
S Heuckendorff ◽  
K Fonager ◽  
C Overgaard
Keyword(s):  
Mental Health ◽  
Pregnant Women ◽  
Mental Health Problems ◽  
Maternal Mental Health ◽  
Perinatal Outcomes ◽  
Health Problems ◽  
Increased Risk ◽  
Adverse Perinatal Outcomes ◽  
Group 2 ◽  
Group 1

Abstract Background Mounting evidence suggests that mental health problems in pregnant women may negatively affect the intra- and extrauterine health and development of the child. This is especially of concern as the prevalence of mental health problems in pregnant women is high and believed to be increasing. We set out to quantify the effect of maternal mental health status on the risk of adverse perinatal outcomes for the infant. Methods We undertook a nationwide register-based cohort study including children born alive in Denmark between 2000 and 2016. The exposed cohort was children born to mothers with mental health problems in the two years prior to childbirth that had been cared for in primary care settings only (Group 1, minor problems, n = 71 759) or had required psychiatric intervention (Group 2, moderate-severe problems, n = 41 099). All non-exposed children served as comparison group (n = 908 268). We calculated risk ratios (RRs) with 95% confidence intervals (CI) for each perinatal outcome of interest. Results Infants in Group 1 as well as Group 2 were at higher risk of neonatal death than infants born to unaffected mothers, although for Group 2 the trend was non-significant (Group 1: adjusted RR (aRR) 1.34, 95% CI 1.17-1.52; Group 2: aRR 1.11, 95% CI 0.94-1.32). Both exposure groups were furthermore at significantly increased risk of 5-minute Apgar scores &lt;7 (Group 1: aRR 1.27, 95% CI 1.17-1.37; Group 2: aRR 1.52, 95% CI 0.94-1.32) and &lt;4 (Group 1: aRR 1.26, 95% CI 1.10-1.44; Group 2: aRR 1.28, 95% CI 1.08-1.52) and of hospital admission in the neonatal period (Group 1: aRR 1.22, 95% CI 1.19-1.24; Group 2: 1.29, 95% CI 1.26-1.32), paralleled by a significantly higher risk of preterm birth and several neonatal morbidities. Conclusions Infants born to mothers with moderate-severe as well as minor mental health problems were at increased risk of multiple adverse perinatal outcomes, thus calling for effective preventive strategies to improve outcomes in both groups.

scholarly journals Isthmico-cervical insufficiency associated with cervicovaginal infections: features of the course of pregnancy and perinatal outcomes

2021 ◽  
Vol 20 (1) ◽  
pp. 23-29
Author(s):  
V. F. Dolgushina ◽  
E. S. Alikhanova ◽  
I. V. Kurnosenko ◽  
T. V. Nadvikova
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Perinatal Mortality ◽  
Perinatal Outcomes ◽  
Intrauterine Infection ◽  
Cervical Insufficiency ◽  
Cervical Remodeling ◽  
History Of ◽  
Group 2 ◽  
Group 1

Introduction. The formation of isthmic-cervical insufficiency (ICI) in 80% is associated with intraamnial inflammation, this is the subject of discussion of new mechanisms of the pathogenesis of premature cervical remodeling. In this regard, it is of interest to study the relationship of ICS with intrauterine and cervicovaginal infections during pregnancy and their impact on the course and outcomes of pregnancy, which was the purpose of our study.Methods. A prospective cohort study included 100 pregnant women with ICI, taken by a continuous sample. All patients at the time of ICI manifestation underwent a comprehensive clinical and laboratory examination aimed at diagnosing cervicovaginal infections, according to e results of which the pregnant women were divided into 2 groups: the first group consisted of 72 women with ICI and cervicovaginal infections, the second group — 28 women with ICI and normocenosis of the vagina.Results. There were no significant differences between the compared groups in terms of the history of miscarriage, extragenital pathology and the frequency of complications of this pregnancy. Intrauterine infection during pregnancy in patients of group 1 was observed 4 times more often, being 55.6% (40) versus 14.3% (4) in group 2 (RR = 3.9, 95% CI = 1.5-9.9, p <0.001). Preterm birth was significantly more frequent in women of group 1, accounting for 62.5% (45), in group 2 — 28.6% (8). Perinatal mortality cases were observed only in group 1, amounting to 97‰ (7). In children from women in group 1, complications of the early neonatal period were more common, primarily due to prematurity. In addition, IUI in newborns was diagnosed 10 times more often in group 1, reaching 38.8% (26) of cases, compared with group 2 — 3.6% (1) (RR = 10.87, 95% CI = 1.55–76.22, p <0.001).Discussion. Perinatal outcomes in ICI associated with cervicovaginal infections are characterized by the presence of perinatal mortality, a higher incidence of preterm birth and IUI of the newborn than in women with ICI without cervicovaginal infection.

scholarly journals Prediction of perinatal outcomes in pregnant women with fetal growth retardation

2021 ◽  
Vol 20 (4) ◽  
pp. 4-11
Author(s):  
V. F. Dolgushina ◽  
N. K. Vereina ◽  
Ju. V. Fartunina ◽  
T. V. Nadvikova
Keyword(s):  
Pregnant Women ◽  
Fetal Growth ◽  
Growth Retardation ◽  
Perinatal Outcome ◽  
Perinatal Outcomes ◽  
Intrauterine Infection ◽  
First Trimester ◽  
Fetal Growth Retardation ◽  
Adverse Perinatal Outcomes ◽  
Group 2

Introduction. An important problem of modern obstetrics is the development and improvement of methods for predicting fetal growth retardation (FGR) and pregnancy outcomes in this pathology, since there are no proven effective treatments for FGR. Purpose of the study — to develop prediction criteria for newborn hypotrophy and cumulative adverse perinatal outcome in pregnant women with FGR. Objective. To identify key predictive factors for adverse perinatal outcomes in pregnancy complicated by FGR. Material and methods. A case-control, cohort-based study was conducted that included 155 pregnant women with FGR, who were divided into two groups after delivery: Group 1 included 90 patients with neonatal hypotrophy and Group 2 included 65 patients without neonatal hypotrophy. A comprehensive analysis of clinical and anamnestic, laboratory and instrumental data, peculiarities of the course of pregnancy and perinatal outcomes was performed. FGR was determined on the basis of ultrasound fetometry. Results. Factors associated with neonatal hypotrophy and unfavorable perinatal outcome were: impaired blood flow in the uterine arteries and/or umbilical artery, early preeclampsia and scarcity of water. Protective factors were antibacterial therapy for intrauterine infection, administration of low-molecular-weight heparin in the first trimester, and acetylsalicylic acid starting from the 12th to 16th weeks of gestation. Conclusion. The most promising measures in the prevention of FGR and adverse perinatal outcomes in this pathology may be timely prescription of antithrombotic correction and treatment of genital infections.

Comparison of Perinatal Outcomes of Pregnant Women with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Pengming Sun ◽  
Hangjing Gao ◽  
Xiqi Huang ◽  
Huanrui Zheng ◽  
Hongning Cai ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Meta Analysis ◽  
Perinatal Outcomes
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