Treatment of COVID-19 disease in pregnancy and breastfeeding

The physiological and anatomical clinical characteristics of pregnant women make them susceptible to complications caused by coronavirus disease (COVID-19). Increased coagulation and risk of thromboembolic phenomena are common during pregnancy; they are further enhanced when associated with a thrombogenic pathology such as in COVID-19. The treatment of COVID-19 is controversial and limited, even for non-pregnant patients. During pregnancy, the options are even more restricted due to the teratogenicity of some drugs and anatomical and physiological difficulties, especially in advanced pregnancy in patients with respiratory failure. Therefore, the focus of treatment for pregnant patients should be centered on isolation, monitoring fetal and maternal vital signs, uterine activity, and general maternal-fetal well-being. The prescription of drugs and management orientation should be based on gestational age and maternal clinical conditions. The optimal type of delivery is guided by obstetric indications and COVID-19 disease severity. Breastfeeding should be encouraged with the use of masks and hand hygiene. The treatment of pregnant women with COVID-19 brings important peculiarities that should be considered in order to make better decisions for preserving the health of the mother and fetus.

Non-invasive fetal electrocardiography, electrohysterography and speckle-tracking echocardiography in the second trimester: study protocol of a longitudinal prospective cohort study (BEATS-study)

Background Worldwide, hypertensive disorders of pregnancy (HDP), fetal growth restriction (FGR) and preterm birth remain the leading causes of maternal and fetal pregnancy-related mortality and (long-term) morbidity. Fetal cardiac deformation changes can be the first sign of placental dysfunction, which is associated with HDP, FGR and preterm birth. In addition, preterm birth is likely associated with changes in electrical activity across the uterine muscle. Therefore, fetal cardiac function and uterine activity can be used for the early detection of these complications in pregnancy. Fetal cardiac function and uterine activity can be assessed by two-dimensional speckle-tracking echocardiography (2D-STE), non-invasive fetal electrocardiography (NI-fECG), and electrohysterography (EHG). This study aims to generate reference values for 2D-STE, NI-fECG and EHG parameters during the second trimester of pregnancy and to investigate the diagnostic potential of these parameters in the early detection of HDP, FGR and preterm birth. Methods In this longitudinal prospective cohort study, eligible women will be recruited from a tertiary care hospital and a primary midwifery practice. In total, 594 initially healthy pregnant women with an uncomplicated singleton pregnancy will be included. Recordings of NI-fECG and EHG will be made weekly from 22 until 28 weeks of gestation and 2D-STE measurements will be performed 4-weekly at 16, 20, 24 and 28 weeks gestational age. Retrospectively, pregnancies complicated with pregnancy-related diseases will be excluded from the cohort. Reference values for 2D-STE, NI-fECG and EHG parameters will be assessed in uncomplicated pregnancies. After, 2D-STE, NI-fCG and EHG parameters measured during gestation in complicated pregnancies will be compared with these reference values. Discussion This will be the a large prospective study investigating new technologies that could potentially have a high impact on antepartum fetal monitoring. Trial registration Registered on 26 March 2020 in the Dutch Trial Register (NL8769) via https://www.trialregister.nl/trials and registered on 21 October 2020 to the Central Committee on Research Involving Human Subjects (NL73607.015.20) via https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm.

Technology for predicting abnormal labor

BACKGROUND: Abnormal labor is the most common complication of labor. It occurs in 10-15% cases of labor and is an indication for operative delivery in a third of all cases. Until now, there are no effective ways to predict abnormal labor. Meanwhile, the use of high-tech forecasting methods is not available for a wide range of obstetric institutions in the Russian Federation. AIM: The aim of this study was to create a technology for predicting abnormal labor, based on generally available methods of laboratory and instrumental research. MATERIALS AND METHODS: Based on the data collected in the Regional Clinical Hospital Perinatal Center, Chita, Russia in 2018-2021, the retrospective analysis of 200 cases of labor was carried out. The total sample was divided into four study groups: 100 women with normal labor activity (group 1), 30 women with uterine inertia (group 2), 30 women with incoordinate uterine activity (group 3), and 50 women with excessive uterine activity (group 4). The groups were comparable in terms of age, anthropometric parameters and extragenital pathology. All women on the eve of labor (1-2 days) underwent general clinical and ultrasound examination. Statistical processing of the results was carried out using the IBM SPSS Statistics version 25.0 software. RESULTS: The technology for predicting abnormal labor is implemented based on a multilayer perceptron, with the percentage of incorrect predictions being 21.3%. The structure of the trained neural network included nine input neurons: labor parity, gestational age, leukocyte count, erythrocyte sedimentation rate, total protein concentration, amniotic fluid index, biparietal size, as well as fetal head and abdomen circumference. CONCLUSIONS: An integrated approach based on generally available laboratory and instrumental research methods, such as complete blood count and biochemical blood test, as well as ultrasound examination, on the eve of labor allows for predicting the abnormal labor development with an accuracy of up to 70%. The use of this technology in clinical practice will help, in the future, not only to prevent abnormal labor, but also to reduce the incidence of adverse obstetric and perinatal outcomes.

Optimization of monitoring of contractile uterus activity and fetus status in women with the threat of preterm birth

Research objective: to study the use of uterine activity and variables of acceleration capacity (AC) and deceleration capacity (DC) in uterine contractile activity and fetal well-being monitoring in women at risk of preterm birth.Materials and methods. 292 pregnant women were included in the prospective study. All involved women underwent ultrasound cervicometry at 16 weeks. 124 pregnant women with a “short cervix” of the III (main) group were observed in the dynamics, as well as uterine activity and fetal AC/DC at 26, 32 and 38 weeks of gestation, and during labor were studied. In 112 women of group II the variables of fetal AC/DC were detected at these terms of pregnancy. They were monitored via conventional cardiotocography during labor. 56 pregnant women in group I with normal cervicometry were monitored.Results. Sensitivity and specificity of the diagnosis of the threatened preterm birth in the main group was 97.30% and 94.74% respectively. Diagnostic accuracy in the case of uterine activity according to fetal non-invasive electrocardiography was 96.18%. Sensitivity and specificity of the diagnosis of the threatened preterm birth in the comparison group were significantly lower: 89.29% and 87.80% respectively. The diagnostic accuracy was 88.41%.Patients in all clinical groups at 26 weeks had low AC/DC values. However, later in women of group I was found highest AC/DC level. AC/DC values in patients with risk of preterm birth were reduced compared with controls (p < 0.05). Sensitivity and specificity of the diagnosis of fetal distress if AC/DC was used were 91.67% and 99.12% respectively. Diagnostic accuracy of the test was 98.41%. In the comparison group the sensitivity was 77.78%, and the specificity was 89.22%. Diagnostic accuracy of intranatal cardiotocography was 86.82%.Conclusions. Uterine activity extracted from the maternal abdominal signal can significantly improve the diagnosis of the threatenedpreterm delivery. Patients at risk of preterm birth have a delayed fetal neurological, which leads to fetal distress. AC/DC variables obtained via fetal non-invasive electrocardiography allow increasing the accuracy of fetal distress diagnosis.

Risk factors of abnormal uterine activity

Aim. To identify risk factors for abnormal uterine activity.Materials and Methods. We recruited 200 pregnant women who delivered in the Maternity Hospital of the Podgorbunskiy Regional Clinical Emergency Hospital from 2018 to 2019, evaluating course of pregnancy and labor activity. Patients were further stratified into those who delivered at term (n = 100) but had abnormal uterine activity and those with urgent delivery (n = 100).Results. The most significant risk factors for abnormal uterine activity were smoking (OR = 26.9, 95% CI = 9.1-79.6), lack of prenatal care visits (OR=16,882, 95% CI = 7.3-39.2), common-law marriage (OR = 5.4, 95% CI = 2.3-12.5), low socioeconomic status (OR = 2.5, 95% CI = 1.3-4.6), higher education (OR = 4.5, 95% CI = 2.5-8.2), and age > 30 years (OR = 3.6, 95% CI = 1.0-13.5). Patients with abnormal uterine activity more frequently suffered from dysmenorrhea, cervical pathology (OR = 1.8, 95% CI = 0.9-3.7), anemia (OR = 1.7, 95% CI = 0.9-3.1), and obesity (OR=2.6, 95% CI = 1.2-5.5). The leading factors associated with abnormal uterine activity are normal birth canal and fetoplacental unit as well as proper cervical ripening.Conclusions. Psychophysiological alterations represent a major risk factor for abnormal uterine activity, contributing to placental insufficiency, fetal growth restriction, and premature rupture of membranes. Procedures aimed at cervical ripening may reduce the incidence of abnormal uterine activity and improve both maternal and newborn outcomes.

Successful Anesthesia Management of Postoperative Maternal Pulmonary Edema and Uterine Hyperactivity following Open Fetal Myelomeningocele Repair

Effective tocolysis is essential after fetal myelomeningocele repair and is associated with the development of pulmonary edema. The increased uterine activity in the immediate postoperative period is commonly treated with magnesium sulfate. However, other tocolytic agents such as nitroglycerine, nifedipine, indomethacin, terbutaline, and atosiban (outside the US) have also been used to combat uterine contractility. The ideal tocolytic regimen which balances the risks and benefits of in-utero surgery has yet to be determined. In this case report, we describe a unique case of fetal myelomeningocele repair complicated by maternal pulmonary edema and increased uterine activity resistant to magnesium sulfate therapy.