Maternity After Orthotopic Liver Transplantation: Can the Use of Biological Fertility Indicators Help? Our Own Experience and Literature-based Recommendations

Over the last 5 decades, the fulfillment of maternity wishes in solid organ transplanted women has become a reality. Despite pregnancy contraindication in transplanted women during the early post-transplant period, such a condition can be overcome after 12 months if patients show a good clinical evolution and do not present other general pre-conceptional findings. This article presents the case report of a young female liver transplanted patient that used symptothermal method as a reliable family planning method. After her gestational contraindication was lifted, observation of biological fertility indicators and fertility-guided sexual intercourse helped her fulfill her maternity wish and conceive and carry out a healthy offspring. Based on this case and on the available bibliographic evidence, this paper reviews the potential implications of the use of this kind of approach as a safe and effective alternative to assisted reproduction technology in the management of potential infertility problems in the young female transplanted population, a population which according to literature has higher rates of unsuccessful parenthood and might also be more vulnerable to iatrogenicity of ovarian hyperstimulation process and to multiple pregnancy.

The Maternal Risk Factors for Preterm Birth in Universitas Airlangga Hospital Surabaya in 2017-2018

Introduction: Preterm birth becomes a global problem due to its high rate of morbidity and mortality. In 2010, it is estimated approximately 15 premature birth cases per 100 lives birth in Indonesia. This study aimed to analyze the maternal risk factors towards preterm birth at Universitas Airlangga Hospital Surabaya in 2017-2018.Methods: This was observational analytic study using case-control approach to observe 178 medical records at Universitas Airlangga Hospital Surabaya. The population of this study was women who had preterm and aterm birth. The sample consisted of case group and control group which were convenient to exclusion and inclusion criteria. Univariate analysis was used to observe the relationship between dependent and independent variable. The significance value was p ≤ 0.05. The data were analysed using SPSS.Results: The research samples consisted of 89 case groups and 89 control groups. The case sample characteristic showed that 36% patients had overweight BMI; 62.9% patients had normal/hypotension; 69.7% patients gave birth to male baby; and 82% patients had no history of disease.There was no patient who used drugs and substance abuse (0%). Mothers aged 20 years old and older than 35 years old had OR = 2.13 (95% CI : 1.106-4.11) to become preterm birth. The primiparous women had risk for preterm birth 2.978 folds (95%, CI : 576-5.625) higher.Conclusion: There was a relationship between maternal age and parity to preterm birth. There was no relationship between maternal education, maternal occupation, hemoglobin levels, history of obstetric complications, and multiple pregnancy to preterm birth.

Outcome of Preterm Admissions at the Neonatal Unit of a Tertiary Care Military Hospital of Bangladesh

Introduction: Preterm deliveries contribute to major morbidity and mortality in developing countries. They are a leading cause of admission in neonatal care units. It is a major hindrance to the attainment of the Sustainable Development Goal (SDG)-3 targets given its high contribution to neonatal mortality. Early detection of its risk factors and advances in the management have ensured better survival of preterm births. This study was conducted to determine the prevalence, underlying causes, morbidity patterns and outcome of preterm admissions to a neonatal intensive care unit (NICU) of a tertiary care center in Combined Military Hospital (CMH) Sylhet. Material and Methods: A descriptive study was conducted in CMH Sylhet from July 2018 to June 2020. All live preterm babies delivered at CMH Sylhet during the study period were included. Information obtained included gestational age at birth, gender, cause for preterm birth, problems during admission and outcome. Results: During this period, a total of 662 neonates were admitted out of which 107 (16.2%) were preterm with gestational ages ranging from 27 completed weeks to less than 37 completed weeks with a mean gestational age 33.2 weeks (± 2.7 weeks) and birth weights from 800 - 2600 gm with a mean of 2100 gm (± 700 gm). There were 52 males and 55 females (M: F 0.95). One hundred and thirty three (20.1%) were delivered by normal vaginal delivery while 529 (79.9%) were delivered by Caesarean section. The duration of hospital stay ranged from 1 - 45 days, with a mean duration of 15 days (± 9.2 days). The commonest reason for prematurity was premature rupture of membrane (PROM) (39.3%) followed by gestational diabetes mellitus (GDM) (35.5%), hypertensive disorders in pregnancy (30.8%), multiple pregnancy (29.9%) and inadequate ante natal care (ANC) (20.6%). The commonest morbidity in the patients in the present study was neonatal jaundice (90.7%) followed by respiratory problems (78.5%), sepsis (17.8%) and congenital heart disease (CHD) (15.9%). Case fatality rate for patients with respiratory distress syndrome (7.7%) and sepsis (5.3%) were common. Overall survival rate was 91.6% and was significantly (p <0.001) higher in the moderate to late preterm category compared to the very preterm and extremely preterm births. Conclusion: PROM, GDM, hypertensive disorders in pregnancy, multiple pregnancy and inadequate ante natal care were significantly associated with preterm birth. Neonatal jaundice, respiratory problems, sepsis and CHD were common morbidities observed. Case fatality rate was significant in neonates with respiratory distress syndrome and sepsis and overall survival rate was 91.6%. So, at-risk mothers should receive intensified antenatal care to mitigate preterm birth. J Bangladesh Coll Phys Surg 2022; 40: 39-44

Fetal growth retardation in multiple pregnancy: anthropometrical and haemodynamic criteria of early antenatal diagnosis

Ultrasound investigation o f feta l biometry and haemodynamic indices in fetoplacental system during pregnancy since 14 weeks was carried out in 53 women havingtwins as a result o f spontaneous pregnancy or using o f assisted reproductive technology methods. The frequency and possible reasons oflU G R development in multiple pregnancy were analyzed. To predict the possibility o f IUG R in II and III trimester o f multiple pregnancy the mathematic model was worked out based on the standard fetometric indices measuring at 14-16 weeks o f pregnancy.

Features of functional maturation of the central nervous system in fetuses with multiple pregnancies

The study was undertaken to detect some peculiarities of fetal rest activity cycle formation in multiple pregnancy. 86 fetuses (43 twins) were observed with the following assessment of the newbornsneurological status. The rest activity cycle parameters and haemodynamic indices of fetoplacental system were examined. Also there was considered the influence of IUGR and twins birth weight discordance on CNSfunctionalformation. The results showed that twins comparing with single pregnancies are characterized by the retardation of rest activity cycle formation that is manifested in shortening оf the quite and prolongation оf the intermediate states, lowering of cardiac rhythm variability and motorcardial reflex. These findings substantiate the necessity of including twins into high-risk group concerning neurological disorders in the newborns. The IUGR appears an additional factor increasing this risk.

Intra-Hepatic Cholestasis of Pregnancy and Its Consequences: A Review

Background: The most common cause of liver illness in pregnancy is intrahepatic cholestasis (IHCP). It has a varying incidence due to geographic variance; factors such as advanced age, multiple pregnancy, family history, and previous pregnancy cholestasis have demonstrated a higher prevalence in these patients. Cholestasis in pregnancy has an aetiology that is currently unknown. It usually occurs after ovarian hyperstimulation syndrome in early pregnancy and coincides with growing oestrogen levels in the second half of pregnancy [1]. The ABCB4 gene mutation is largely associated in a subtype of progressive familial intrahepatic cholestasis, where disease clustering in first-degree relatives increases hereditary predisposition. Itchy palms and soles with elevated liver enzymes and bile acids are the most common symptoms. Some of the reported maternal problems in these patients include preterm labour, HELLP syndrome, acute fatty liver of pregnancy, and postpartum haemorrhage [2]. There are no precise antenatal foetal monitoring tests that can predict foetal fatalities in the womb. To reduce perinatal death with expectant treatment beyond this gestation, it is recommended that a pregnancy be terminated near 36–37 weeks of pregnancy.

Trends of Selective Fetal Reduction and Selective Termination in Multiple Pregnancy, in England and Wales: a Cross-Sectional Study

Selective abortion was shown to be increasingly common in England and Wales over a 9-year period, occurring most frequently as twin to singleton reductions in the 1st trimester. We analysed the trends in selective abortion (SA) in multiple pregnancies in England and Wales between 2009 and 2018. This is a cross-sectional study looking at 1143 women with multiple pregnancies in England and Wales undergoing SA. There were a total of 1143 cases of SA between 2009 and 2018 in England and Wales, representing 0.07% of total abortions. There has been a steady increase in cases, from 90 in 2009 to 131 in 2018, with 82.3% justified under ground E of The Abortion Act 1967. The majority of SAs were carried out at 13–19 weeks gestation, and intracardiac injection of potassium chloride was the most prevalent method (75%). Twin to singleton reductions accounted for 59%, the most common form of SAs. Over half of all cases (59%) were performed in women aged 30–39 years, and 84% of all women were of White ethnicity. SA has been an option available for couples diagnosed with multiple pregnancy, especially when there are discordant anomalies. Although SA may decrease multiple pregnancy-related complications, preventative methods must be championed.

Reproductive and Economic Evaluation of Sexual Stimulation in Anestrus Period at a Farm Experiencing Neonatal Lamb Losses

Lamb deaths occurring in the neonatal phase, which covers the first four weeks after birth, cause serious economic losses for farms. This study was carried out on 140 Akkaraman-Kangal sheep that lost their lambs due to pneumonia and enteritis in the neonatal phase during the anestrus period. In the study, an intravaginal sponge containing progesterone was applied to the animals in Group 1 (n:70) on day 0, and 7 days after the application, the vaginal sponges were removed, and 263 µg PGF2α and 500 IU eCG (PMSG) hormone were applied. After removing the intravaginal sponge, rams were introduced for 7 days (between the days 8th and 14th ). Without any manipulations to the animals in Group 2, the ram effect was utilized by performing simultaneous ram introduction with Group 1. To determine the reproductive response, the economic implications between the groups were compared by considering the reproductive parameters such as oestrous rate, pregnancy rate, multiple pregnancy rate, embryonic death rate, number of births, number of offspring, and fertility. The study group created a positive economic difference compared to the control group while analyzing the statistical differences in terms of each reproductive parameter between the study and control groups. When lamb losses are experienced in farms that build their profitability on lamb production, it was concluded that pregnancy should be achieved by sexual stimulation without waiting for the breeding season.