Fetal Mortality in the United States: Trends From 2014 Through 2019 and Changes Between 2018–2019 and 2019–2020

This report describes 2014–2019 trends and changes from 2019 to 2020 for total, early, and late fetal mortality, and compares changes by maternal race and Hispanic origin and by state between 2018–2019 and 2019–2020.

Multiple Trauma in Pregnant Women: Injury Assessment, Fetal Radiation Exposure and Mortality. A Multicentre Observational Study.

Purpose: Fetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed.Methods: It is a multicentre observational study. The cohort study included all pregnant women suspected of severe traumatic injury in the participating centres of a national trauma research network. The primary outcome was the cumulative radiation dose (mGy) received by the fetus with respect to the type of injury assessment initiated by the physician in charge of the pregnant patient. Secondary outcomes were maternal and fetal morbi-mortality, the incidence of haemorrhagic shock and the physicians’ imaging assessment with consideration of their medical specialty.Results: Fifty-four pregnant women were admitted for potential major trauma between September 2011 and December 2019 in the 21 participating centres. The median gestational age was 22 weeks [12-30]. Seventy-eight percent of women (n=42) underwent WBCT. The remaining patients underwent radiographs, ultrasound or selective CT scans based on clinical examination. The median fetal radiation doses were 38 mGy [23-63] and 0 mGy [0-1]. Maternal mortality (5.6%) was lower than fetal mortality (16.7%). Two women (out of 3 maternal deaths) and 7 fetuses (out of 9 fetal deaths) died within the first 24 hours following trauma.Conclusion: Immediate WBCT for initial injury assessment in pregnant women with trauma was associated with a fetal radiation dose below the 100 mGy threshold. Among the selected population with either a stable status with a moderate and nonthreatening injury pattern or isolated penetrating trauma, a selective strategy seemed safe.

High Dilution of Dexamethasone in gestation and fetal development of mice

Background: Recently, the use of homeopathy in veterinary medicine has grown significantly, mainly for farm animal practice, because of its usefulness in organic production and low cost. There is a  wide range of veterinary products available in the  marketoften used in females. However, the effect of these products in the litter and derived products for human consummation is completely unknown. Aims: this  study sought to  develop an experimental model to study the putative effects of high diluted substances in newborns after chronic exposure of females. Methods: based on previous studies, the chosen test substance was dexamethasone 15cH; adult female Balb/c mice were divided into 4 groups: a) treated with PBS (control); b) treated with dexamethasone 15 cH; c) treated with dexamethasone 15cH + dexamethasone 4 mg/kg and d) treated with dexamethasone 4 mg/kg. All medicines were administered subcutaneously, 3 times a week, in females from the first day of pregnancy up to the 20th day after parturition (end of lactation period). TDevelopment of the offspring was evaluated daily  for 15 days after birth. Parameters evaluated were: female and offspring viability, number of newborns, time for eye opening, pinna opening, fur growth and postural reflex. Results: the group treated with dexamethasone 15cH  showed 39% increase in mortality rate 39 days after the beginning of treatment and 35% increase in fetal mortality at the end of gestation (p=0.0049). Females treated with dexamethasone 4mg/kg + dexamethasone 15cH showed 100% of fetal mortality. After parturition newborn survival in animals exposed to dexamethasone 4 mg/kg was higher than the control (p=0.0002). All other parameters of neonatal development were unchanged among groups. Conclusions: these data point to adverse effect when using high diluted dexamethasone during gestation detectable by this experimental model in Balb/c mice.

Relationship between Twin-to-Twin Selective Intrauterine Growth Restriction with sFas/sFasL Level of Umbilical Cord Blood Using Doppler Ultrasound Fetal Heart Rhythm Detection Algorithm

The study focused on the application value of ultrasound Doppler fetal heart rate detection algorithm based on short-time Fourier transform (STFT) in the diagnosis of twin-to-twin selective intrauterine growth restriction (sIUGR) and the correlation between twin-to-twin sIUGR and sFas/sFasL levels of umbilical cord blood. The normalized method was introduced into the STFT algorithm to optimize it to detect the fetal instantaneous heart rate. 82 pregnant women with twin pregnancies were selected as the research subjects and they were divided into the restricted group (41 cases) and the control group (41 cases) according to whether the fetus had selective growth restriction. The two groups were compared for the differences in the fetal mortality, complication rate, and sFas/sFasL expression levels. The results showed that the STFT-based ultrasonic Doppler fetal heart rate detection algorithm could ensure the quality of the fetal heart rate signal and had high resolution at the 200–400 Hz characteristic frequency band and that the accuracy in distinguishing S1 and S2 was 5.8% higher than that of the traditional autocorrelation algorithm. The proportion of abnormal fetal heart rate in the restricted group was significantly higher than that in the control group ( P < 0.05 ), birth weight was significantly lower than that in the control group ( P < 0.05 ), and fetal mortality was significantly higher than that in the control group ( P < 0.05 ). There was no statistical difference in the incidence of complications between the two groups ( P > 0.05 ). In restricted group, the content of sFas in cord blood was (3326.54 ± 317.42) pg/mL and that in the control group was (2003.29 ± 196.45) pg/mL. The content of sFas in cord blood of the restricted group was significantly higher than that of the control group ( P < 0.01 ). In the restricted group, the content of sFasL in cord blood was (382.52 ± 36.17) pg/mL, and that in the control group was (180.84 ± 16.20) pg/mL. The content of sFasL in cord blood of the restricted group was significantly higher than that of the control group ( P < 0.001 ). It was concluded that the STFT-based ultrasound Doppler fetal heart rate monitoring is beneficial to early diagnosis and timely intervention of twin-to-twin sIUGR.

Acute pulmonary edema as a complication of urinary infection in pregnant women: a case report

Introduction: Urinary infection (UI) is the third most common pathology during pregnancy, affecting 10-12% of pregnant women in the first trimester. Thus, the prenatal care is important to reduce indicators of maternal-fetal mortality, promoting quality of life during pregnancy and postpartum. Objective: The aim of this study is to report the case of a pregnant woman with pyelonephritis, who evolved with acute pulmonary edema. Case report: The present study was elaborated according to the rules of CARE case report. This study was analyzed and approved by the Research Ethics Committee (CEP) according to a substantiated opinion number 4,375,418 and obtaining the patient's consent. The present study therefore highlights pyelonephritis as the most severe form of UI in pregnant women, associated with septic shock, with evolution to respiratory failure, resulting from acute pulmonary edema, and may be related to worse maternal-fetal prognoses. This clinical study contributes to the literature, emphasizing that, currently, all forms of UI during pregnancy should be considered as great potential for complications, and should be treated even in its asymptomatic form. Conclusion: It is evident the need for early intervention to minimize maternal-fetal losses, unnecessary interventions and to reduce costs in relation to additional treatments. The importance of rapid diagnosis and early treatment is emphasized in order to minimize or extinguish the damage. As well as promoting actions to encourage pregnant women to perform prenatal care.

Spatial dynamics of fetal mortality and the relationship with social vulnerability

Objectives To analyze the spatial-temporal patterns of fetal mortality according to its relationship with social vulnerability, identifying priority areas for intervention. Methods Ecological study conducted in the state of Pernambuco, Northeast region of Brazil, from 2011 to 2018. The mean fetal mortality rate per city was calculated for the studied period. A cluster analysis was performed to select cities with homogeneous characteristics regarding fetal mortality and social vulnerability, then the Attribute Weighting Algorithm and Pearson correlation techniques were employed. In the spatial analysis it was used the local empirical Bayesian modeling and global and local Moran statistics. Results Twelve thousand nine hundred and twelve thousand fetal deaths were registered. The fetal mortality rate for the period was 11.44 fetal deaths per 1,000 births. The number of groups formed was 7, in which correlation was identified between fetal mortality and dimensions, highlighting the correlations between fetal mortality rate and the Index of Social Vulnerability urban infrastructure for the municipalities in group 1 and 5, the values of the correlations found were 0.478 and 0.674 respectively. The spatial analysis identified areas of higher risk for fetal mortality distributed in regions of medium, high and very high social vulnerability. Conclusions The study allowed observing the existing correlations between fetal mortality and social vulnerability and identifying priority areas for intervention, with a view to reducing fetal mortality in the state.

Anesthesia Management in Caesarean Section with Preeclampsia and Partial HELLP Syndrome

Introduction. Pre-eclampsia is a significant cause of maternal and fetal mortality and morbidity. Pre-eclampsia is characterized by hypertension (blood pressure ≥ 140/90 mmHg), oedema and amount of protein in urine 300 mg in the 24-hour, which appears after 20 weeks of gestation. Pre-eclampsia can cause complications, one of which is HELLP syndrome. This case report discusses the use of anaesthesia in a patient who underwent a cesarean section with indications for pre-eclampsia and partial HELLP syndrome. Case Presentation. A woman, 41 years old, G4P3A0 34 weeks pregnant with pre-eclampsia + syndrome HELLP will undergo emergency cesarean section with ASA IIE physical statusLabouror pain management was carried out using regional spinal anaesthesia technique, using bupivacaine 0.5% hyperbaric agent 12.5 mg. The operation lasted for 1 hour 30 minutes, with 300 ml bleeding, hemodynamically stable. Conclusion. Difficult intubation in emergency cases can be avoided by choosing of neuraxial anaesthesia technique is recommended. It will lead to better uteroplacental perfusion, good analgesia/anaesthesia quality, reducing surgical stress, reducing drugs that enter the uteroplacental circulation, and maternal psychological to be able to see the baby at birth.

Intra-urban differentials of fetal mortality in clusters of social vulnerability in São Paulo Municipality, Brazil

This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007–2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.

Complications Associated With a Monocorial Twin Pregnancy Monoamniotic.

A case report of a monoamniotic monochorionic twin pregnancy is presented and a literature review of its associated complications is carried out. A literature search was carried out in databases such as Medline / Pubmed, selecting articles published in Spanish and English during the period from January 1990 to May 2013. The terms “twins”, “monozygotic twins”, “ multiple pregnancy”, “twin pregnancy”. Review articles and cross-sectional studies were included. Monoamniotic monochorial twin gestation is a rare event. This condition is associated with multiple obstetric complications including fetal death related to umbilical cord accidents (crossovers). The objective of prenatal care is the prevention of fetal mortality, so continuous testing of fetal well-being is suggested. Termination of pregnancy in the 34th week of gestation by caesarean section, after administration of steroids, has been proposed.

A Fatal Case of Streptococcal Toxic Shock Syndrome Caused By Genotype Emm1 In The Third Trimester of Pregnancy, China

Background: Group A streptococcal (GAS) toxic shock syndrome (TSS) is a rare invasive disease, causing a high risk of maternal and fetal mortality during pregnancy. We report a fatal case of a female caused by GAS-TSS in the third trimester of pregnancy in Guangzhou, China. Case presentation: The patient is a 33-year-old female who presented at 37 weeks’ gestation with a history of three hours fever. The patient underwent an early onset and rapid progression with dramatic clinical picture and laboratory characters within 24 hours. The neonate survived after an aggressive anti-infection treatment.The GAS strains were isolated from two bottles of blood cultures and airway secretion culture, which confirmed as Streptococcus pyogenes associated with genotype emm1 by molecular analysis.Conclusion: Dramatic clinical picture and laboratory characters of the pregnant woman presented here might help improve clinicians' awareness and recognition of Streptococcus pyogenes, which could be of great importance for the early diagnosis of GAS- TSS in pregnancy.