How COVID-19 pandemic is changing the practice of prenatal screening and diagnosis?

Objectives To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. Methods We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. Results A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. Conclusions The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.

The incidence and distribution of anomalies found in the pregnant women applied to Kayseri City Hospital for obstetric ultrasound in 2019: a retrospective analysis

Objective Our aim is to determine the incidence and distribution of anomalies found in the pregnant women referred to the first obstetric radiology outpatient clinic of our hospital for ultrasound (US) examination in 2019. Methods A total of 5661 obstetric US examinations were performed in 4018 pregnant women, 588 of whom were foreigners, for routine control, follow-up and screening purposes between January 1 and December 31, 2019, and their results were analyzed retrospectively after obtaining the approval of ethics committee. All US examinations were conducted by a single radiologist (ŞT) with Canon Aplio 500 ultrasound device (Canon Medical Systems Corporation, Tokyo, Japan) using 3.5 Mhz convex probe. The results of the cases with anomalies were accessed and grouped systematically, and their incidence and distribution were reviewed by comparing with the literature. Results As a result of the reviewed obstetric US examinations, a total of 62 fetuses with anomalies, 17 of whom were from the foreign pregnant women, were found to have anomalies. Of these anomalies, 29 were craniospinal, 10 were genitourinary, 6 were cardiac, 6 were skeletal, 3 were gastrointestinal, 2 were thoracic and 6 were unclassified. The pregnant women were between 17 and 43 (27.5±7.21) years old and their weeks of gestation were varying between 11 and 39 (22.3±8.63) weeks. There were 8 (13%) pregnant women younger than 20 years old, 43 (69%) pregnant women between 20 and 35 years old, and 11 (18%) pregnant women older than 35 years old. Anomaly diagnosis was established during first trimester in 14 (22.5%) fetuses, 26 (42%) fetuses during second trimester, and 22 (35.5%) fetuses during third trimester. Conclusion We found in our study that the incidence of fetuses with congenital anomaly was 1.54% in total, 2.89% in foreigners and 1.31% in Turkish citizens. The most common anomaly is acrania with 7 (0.15%) cases, and the diagnosis was established during first trimester in six of them. Detailed fetal screening during first trimester is very important for the detection of non-chromosomal anomalies. However, second- and third-trimester examinations are also important for the accurate diagnosis in pregnancies without follow-up.

EFEKTIFITAS TERAPI MOXA DAN HYPNOBIRTHING UNTUK PERBAIKAN LETAK SUNGSANG PADA IBU HAMIL TRIMESTER III

Breech pregnancy is a pregnancy with fetal abnormalities where this condition puts the mother and fetus at high risk of morbidity and mortality. The risk of breech delivery makes caesarean sections the safest way to help with childbirth. Based on Riskesdas data (2010), WHO sets the indicator of caesarean delivery 5–15% for each country, where in Indonesia 10% of Caesarean sections are performed on pregnant women with breech location. Normal labor is the desire of every pregnant woman, therefore some kind of maneuver is promoted in changing the breech position into the location of the head. Moxa therapy is a therapy done by burning mugwort potions that are compacted and rolled cylindrical and placed near the bladder acupuncture point (BL) 67 located on the outside of the little finger of the foot until it produces hyperemi from local vasodilatation, the goal of which is to help the fetal playback version. Hypnobirthing can suggest and reprogram the subconscious mind that can be directed to make changes in the mother's body. The release of fear in hypnobirthing helps the mother relax and allow her baby to spin. The purpose of this study is to find out the effectiveness of moxa and hypnobirthing therapy and the most effective methods for improving breech location in Trimester III pregnant women. The research method used is pure experimentation with post test control group design. Samples in this study as many as 33 pregnant women with gestational age of 32-37 weeks. The data analysis used is kruskall-wallis test. The results of the study found that moxa therapy and hypnobirthing are effective in improving breech location with a value of p 0.001 (p<0.05). Moxa therapy is the most effective method with a mean value (25.50). Moxa therapy recommendations are effective and safe to help the fetal screening version with breech location.

Fetal medicine and surgery

This chapter begins by discussing fetal screening (screening for and diagnosis of chromosomal defects) and the use of magnetic resonance imaging in detecting problems such as brain abnormalities or congenital diaphragmatic hernia. Fetal diagnosis of cardiac anomalies, lung anomalies, congenital diaphragmatic hernia, abdominal wall defects, gastrointestinal anomalies, abdominal masses, obstructive uropathy, hydrocephalus, and spina bifida are discussed. There are probably two relevant surgical conditions where actual fetal intervention has a potential role. These are FETO fetoscopic endoluminal tracheal occlusion (FETO) for severe diaphragmatic hernia and in utero closure of spina bifida.

Twin pregnancies concieved by assisted reproduction - early prediction of preterm birth

Background/Aim. Twins conceived by assisted reproduction techniques (ART) are the most susceptible for perinatal complications. The aim of this study was to examine the role of prenatal noninvasive fetal screening of the first and second trimester in prediction of delivery time of ART conceived twins. Methods. Prospective cohort study of all ART conceived twin pregnancies was conducted at the Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, during the period from January 1, 2016 to December 31, 2017. In the 12th gestational week (GW) twins crown-rump lenght (CRL) and thickness nuchal translucency (NT) were measured ultrasonographically. Moreover, serum levels of beta subunit of human chorionic gonadotropin (? hCG) and pregnancy-associated plasma protein A (PAPPA) were assessed. In the 17th GW twins biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) were determined ultrasonografically. Additionally, ? hCG, alphafetoprotein (AFP), estriol (E3) and inhibin (INH) were measured in mothers serum. The GW of delivery was noted for each pregnancy. Results. Study included 100 pregnant women with mean age 35.44 ? 5.82. In the examined sample of ART conceived twins significantly more (51%) were delivered in term (? 35 GW) (p = 0.001). Delivery time correlated negatively with NT and first trimester ? hCG serum levels, while it correlated positively with FL of the smaller twin, second trimester ? hCG, AFP and E3 concentrations. According to obtained model for prediction of delivery time in ART conceived twin pregnancies based on first trimester diagnostic tests the significant predictors were PAPPA and ? hCG in the 12th GW as well as NT of the first larger twin. Nevertheless, reliability (sensitivity 50%?75%, specificity 30%?40%) of these diagnostic tests was moderate. Conclusion. Prenatal noninvasive fetal screening of the first and second trimester (ultrasonography and laboratory testing) can be used for prediction of delivery time of ART conceived twins.