Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester

<b><i>Introduction:</i></b> The aim of this study is to evaluate the outcome of pregnancies complicated by monochorionic monoamniotic twin reversed arterial perfusion sequence (MOMA TRAP) diagnosed in the first trimester. <b><i>Methods:</i></b> All patients diagnosed with MOMA TRAP sequence &#x3c;14.0 weeks of gestation in a 10-year study period were retrospectively analyzed for intrauterine course and outcome. All patients were offered either expectant management or intrauterine intervention. Adverse outcome was defined as either intrauterine death (IUD), neonatal death or preterm birth &#x3c;34.0 weeks of gestation. <b><i>Results:</i></b> In the study period, 17 cases with MOMA TRAP sequence were diagnosed. Of these, 2 couples opted for termination of pregnancy. The remaining 15 were divided into 2 groups depending on the management: group A (<i>n</i> = 8) with expectant management and group B (<i>n</i> = 7) with intrauterine intervention. All fetuses in group A died before 20 weeks. Survival in group B was significantly better with 4/7 (57.1%) life births at a median of 39.6 weeks of gestation (<i>p</i> = 0.0256). The reasons for IUD in the 3 cases in group B were hemodynamic, strangulation, and bleeding complications during intervention. <b><i>Conclusions:</i></b> Intrauterine intervention in MOMA TRAP pregnancies significantly improves neonatal survival, although it is still associated with a substantial risk for IUD by hemodynamic complications or entanglement.

Risk Factors for Fetal Death and Maternal AP Severity in Acute Pancreatitis in Pregnancy

Background: Acute pancreatitis in pregnancy is a rare but highly life-threatening gestational and perinatal disease.Objective: This study aimed to identify the risk factors for fetal death and acute pancreatitis severity.Methods: This retrospective cohort study enrolled patients with acute pancreatitis in pregnancy in our center from January 1, 2012, to August 1, 2020, and classified them according to two clinical endpoints, fetal outcome and disease severity. The groups were examined and compared according to gestational week, etiology, gravidity and parity, complications in pre- and post-delivery, and medical history. Logistic regression analysis was performed to identify the independent risk factors for fetal death and acute pancreatitis severity.Results: Of the 90 enrolled patients, 28 (31.1%) had fetal death and 43 (47.8%) had severe acute pancreatitis. Logistic regression analysis showed that pre-delivery acute respiratory distress syndrome (OR, 5.8; 95% CI, 1.5–22.4; p = 0.010) and gestational week (OR, 0.9; 95% CI, 0.8–1.0; p = 0.011) were risk factors for fetal death. Gestation week (OR, 1.2; 95% CI, 1.1–1.3; p = 0.003) and fetal intrauterine death (OR, 5.9; 95% CI, 1.8–19.4; p = 0.003) were risk factors for severe acute pancreatitis.Conclusions: Pre-delivery acute respiratory distress syndrome and gestational week were independent risk factors for fetal death. Fetal intrauterine death and gestational week were independent risk factors for severe acute pancreatitis.

Maternal and Neonatal Outcomes in Pregnant Women with Dengue

Background: Dengue infection has been observed to cause critical outcomes in mother as well as child from an infected pregnancy. Objective: To assess the maternal and neonatal outcomes of dengue infected pregnancy. Study Design: Prospective study. Place and Duration of Study: Department of Obstetrics & Gynaecology, Sandeman Provincial Hospital, Quetta 1st August 2018 to 28th February 2021. Methodology: Fifty pregnant females were enrolled after their dengue confirmation either by NS1, IgM or IgG test. Clinical and demographic information was recorded. Pregnancy and neonatal outcomes were noticed by following the patients until delivery and postpartum period and the new born if infected then up to post 6 months of delivery. Results: The mean age of patients was 25.5±3.5 years. Out of the total pregnant dengue infected females 60% had multigravida. Fifty percent of females came for clinical assistance in their third trimester. Post-partum hemorrhages were common in 6% patients. Vertical transmission was seen in three cases where two did not survive and had intra uterine death. Maternal mortality was seen in 14% of total cases. Conclusion: Morbidity, preterm labor, vertical transmission, intrauterine death are some of the maternal and neonatal outcomes of dengue infected pregnancy. Keywords: Dengue, Pregnancy, Neonatal outcomes, Maternal outcomes

Facilitators and Strategies for Breaking the News of an Intrauterine Death—A Mixed Methods Study among Obstetricians

(1) Background: The death of a baby in utero is a very sad event for both the affected parents and the caring doctors. By this study, we aimed to assess the tools, which may help obstetricians to overcome this challenge in their profession. (2) Methods: We conducted a cross-sectional online survey in 1526 obstetricians registered with the Austrian Society of Obstetrics and Gynecology between September and October 2020. (3) Results: With a response rate of 24.2% (n = 439), our study shows that diagnosing fetal death was associated with a moderate to high degree of stress, regardless of position (p = 0.949), age (p = 0.110), gender (p = 0.155), and experience (p = 0.150) of physicians. Coping strategies for delivering the news of intrauterine death to affected parents were relying on clinical knowledge and high levels of self-confidence (55.0%; 203/369), support from colleagues (53.9%; 199/369), and debriefing (52.8%; 195/369). In general, facilitators for breaking bad news were more commonly cultivated by female obstetricians [OR 1.267 (95% CI 1.149–1.396); p < 0.001], residents [χ2(3;369) = 9.937; p = 0.019], and obstetricians of younger age [41 (34–50) years vs. 45 (36–55) years; p = 0.018]. External facilitators were most frequently mentioned, including professional support, training, professional guidance, time, parents’ leaflets, follow-up consultations, a supporting consultation atmosphere, and preparation before delivering the bad news. Internal facilitators included knowledge, empathy, seeking silence, reflection, privacy, and relief of guilt. (4) Conclusions: Communicating the diagnosis of fetal death evokes moderate to high levels of stress among obstetricians. Resources from both the professional and private environment are required to deal with this professional challenge on a personal level.

Effect of the Obesity on Maternal and Fetal Outcome in Pregnant Women Presenting to Tertiary Care Hospital

Background: Obesity is well considered a well known risk factor for obstetric complications like pre eclampsia, gestational diabetes mellitus, intrauterine death, dysfunctional labour, meconium stained amniotic fluid, cesarean section, high birth weight and shoulder dystocia. The objective of this study was to determine the frequency of maternal and fetal outcome in obese pregnant women. Material and Methods: This descriptive case series study was conducted in department of obstetrics and gynaecology, FGPC, Islamabad from Aug 1, 2017 to Feb 1, 2018. A total of 250 consecutive antenatal women with BMI > 30 Kg/m2 were included in the study. BMI was calculated according to weight and height of the patient using the formula Kg/m2. RESULTS: Out of 250 primigravidas , 84.4% had BMI of 30-35 Kg/m2 and 15 % BMI of 36-40 Kg/m2 . Gestational diabetes was diagnosed in 51 (20.4%) cases. Preeclampsia was observed in 12 (4.8%) patients. Seventy pts (28%) patients ended on cesarean section, 21 (8.4%) cases had induction of labour and 9 (3.6%) had pre term birth. Apgar score (>7) was seen in 61 (24.4%) cases. Macrosomia was observed in 55 (22%) cases. 20 (8%) patients had stillbirth. Conclusions: Maternal obesity in pregnancy is associated with high maternal and fetal complications. Keywords: complications. fetal, maternal; morbidity ,Obesity, overweight-; risk factors

A case of thoraco-omphalopagus conjoined twins with intrauterine death

Conjoined twins or Siamese twins are identical twins that are joined in utero. The original Siamese twins were born in Siam (now Thailand) in 1811. They were males and lived for about 62 years. Incidence being 1 in 49,000 births to 1 in 1,89,000 births, this phenomenon is very rare. Approximate half are stillborn and one- third die within 24 hours of birth. Five types of conjoint twins are classically described, thoracopagus, omphalopagus, pygopagus, ischiopagus and craniopagus. With a reported incidence of 74-75% of all conjoint twins, Thoracopagus is the most common type. Omphalopagus with an incidence of 0.5% is the least common. Here we are reporting a case of thoraco-omphalopagus twin pregnancy with intra uterine death delivered by hysterotomy.

EFFECT OF NICKEL AND ITS INSOLUBLE INORGANIC COMPOUNDS ON REPRODUCTIVE FUNCTION OF WHITE RATS

Introduction. The problem of women's health protection in enterprises producing and using nickel and its compounds is particularly relevant, since women make up a significant contingent of workers at some stages of production. Nickel and its compounds are used in the production of high-alloy steels, alloys with copper, chromium, aluminum, as a catalyst in the processes of hydrogenation of fats, in the production of batteries, nickel-plating of metal products. In case of violations of the technological process, labor protection conditions, workers may be exposed to nickel aerosol and its oxides. Purpose. To study the effect of nickel and its insoluble compounds on the reproductive function of white rats. Method of research. The studies were carried out on sexually mature female white rats weighing 180-200 g with a stable estrous cycle lasting 4-6 days. Experimental studies were conducted in accordance with national and international regulatory requirements ensuring humane treatment of animals used in experiments: Directive 2010/63/EU of the European Parliament and of the Council of the European Union of September 22, 2010 on the protection of animals used in scientific purposes, Order of the Ministry of Health of the Russian Federation of 01.04.2016 No. 199n «On approval of the Rules of good laboratory Practice». The industrial conditions for the action of aerosol of insoluble nickel compounds were simulated in a special chamber with an individual intake of aerosol into the breathing zone at a concentration of 0.2 mg / m3 daily for 4 hours during the entire gestation period. The animals were assessed for the dynamics of body weight on the 1st, 8th, 14th and 20th days of pregnancy. On the 20th day of pregnancy, the number of yellow bodies of pregnancy, placentas and fetuses was determined, pre-, post-implantation and total intrauterine death, average length and weight of fetuses, and average placenta weight were calculated. The total number of pregnant females and fetuses was recorded with the subsequent calculation of the number of fetuses per female. Results. The action of an aerosol of insoluble nickel compounds at a concentration of 0.2 mg / m3 in this mode did not lead to a violation of the reproductive function of white rats in all the studied parameters. Conclusion. The experimental data obtained indicate that insoluble nickel compounds at the level of the maximum permissible concentrations for the air of the working area will not pose a risk of developing reproductive health pathology in working women.

Features of Laboratory Diagnostics CMVI by IFA Method (IgM, IgG) for the Period 2014-2020 in Kyrgyzstan

This article discusses the problem of informing students of medical universities in Kyrgyzstan about CMVI, as well as an analysis of the population survey by ELISA for the detection of specific immunoglobulins of class M and G for 7 years (2014–2020). The article provides an analysis of the surveyed by sex of all ages, which allows us to conclude that the bulk of the surveyed are women of childbearing age. Thus, cytomegalovirus infection poses a particular danger to the fetus, up to its intrauterine death. The work is interdisciplinary in nature, written at the intersection of medical microbiology, epidemiology and public health and health care. Considerable attention in the work is paid to the fact that those examined by the ELISA method for specific IgM are ten times less than for the detection of specific IgG. Although it is the detection of specific IgM that poses a particular danger to the fetus — it can lead to its especially life-threatening complications such as: heart disease, retinopathy, which can lead to blindness, deafness and even mental retardation, intrauterine hypotrophy, immaturity, prematurity, chronic intrauterine fetal hypoxia. The idea is substantiated how important it is for future and practicing doctors to inform the population about this infection, which will help in the future to timely detect IgM and possibly save the fetus from intrauterine death. Using the results of an ELISA test for the detection of specific IgM and IgG, which today is one of the most reliable and affordable ways to detect a disease, the author proves in his studies the huge problem of informing and examining the population. The topic under consideration will be of particular interest to specialists in the field of public health and health care, since this is a truly national problem. The presented work indicates that CMVI is currently a serious medical and social problem. This problem is extremely poorly understood and requires further study.