Analysis of the course and outcomes of pregnancy in patients with advanced stages chronic kidney disease

Background. Pregnancy in patients with advanced chronic kidney disease (CKD) is associated with a high risk of adverse outcomes for the mother and the fetus, but data on the characteristics of the course of pregnancy in these women is limited. Aim. To analyse of the course and outcomes of pregnancy in patients with CKD stages 3a4. Materials and methods. Thirty five pregnant women with CKD stages 34 were included: 3a 12 (34.3%) patients, stage 3b 10 (28.6%), stage 4 13 (37.1%). Results. Proteinuria, serum creatinine, blood pressure in dynamics, the presence of a physiological response were investigated. Pregnancy management included blood pressure correction, antianemic, antiplatelet, anticoagulant therapy, prevention and treatment of urinary infection, correction of metabolic disorders. All pregnant women had proteinuria of varying severity, which increased towards the end of pregnancy. Seventeen (51.5%) patients had hypertension, successfully corrected with antihypertensive drugs. The average delivery term was 34.6 weeks. Preeclampsia developed in 14 (42.4%) cases, an inverse relationship was found between the presence of a physiological response and preeclampsia (p=0.009; rs=-0.463). All children were born alive and viable. After delivery in patients with CKD 3a creatinine values returned to the pre-gestational level, in patients with grade 3b and 4 progression of CKD was noted. Conclusion. A favorable pregnancy outcome in women with late stages of CKD is possible with constant monitoring by a multidisciplinary team of doctors with mandatory monitoring of renal function, proteinuria, blood pressure, coagulation, markers of preeclampsia and indicators of fetal health. It was proposed to consider the physiological response of the kidneys to pregnancy as a predictor of a favorable outcome.

2021 Update on obstetrics

Essential updated guidance on FGR workup and timing of delivery; term and preterm PROM management strategies based on gestational age; and approaches to VTE prophylaxis, including for patients with COVID-19 infection

A role of comprehensive cervix assessment in the first trimester of pregnancy for predicting preterm delivery

Aim: to improve efficacy of predicting preterm labor in the first trimester of pregnancy by combining diverse parameters of cervical ultrasound examination.Materials and methods. A prospective cohort study of 1517 women with uncomplicated pregnancy was performed. Inclusion criteria were: females underwent cervicometry at 11–14 weeks of gestation, singleton pregnancy, revealing no complaints at the onset of examination. All women were subdivided into four groups: Group 1 – 27 pregnant women with shortened cervix (less than 30 mm); Group 2 – 24 pregnant women without cervical gland area (СGA); Group 3 – 30 pregnant women with two risk factors (shortened cervix less than 30 mm and lacked СGA); Group 4 (control) consisted of 1436 pregnant women with cervix length exceeding 30 mm and presence of СGA.Results. Average delivery term in Group 1 was 35.7 weeks (95 % CI = 34.7–36.8), in Group 2 – 34.7 weeks (95 % CI = 33.59–35.0), in Group 3 – 33.23 weeks (95 % CI = 31.6–34.8), in Group 4 (control) – 38.11 weeks (95 % CI = 38.06–38.17). A significant moderate correlation (Rxy = 0.534) between shortened cervix, absence of СGA and delivery term was found (p < 0.001). A regression model consisting of cervical length and presence of СGA was simulated based upon 50.8 % factors underlying probability of preterm birth, revealing 42.6 % sensitivity, 99.1 % specificity, and 96.6 % overall diagnostic value. The area under the ROC curve was 0.902 ± 0.022 (95 % CI = 0.860–0.945). The data obtained reflect diverse biochemical changes such as collagen decomposition, altered glucosamine level and fluid amount within cervical tissues. Such processes result in shortened, softened and expanded (matured) cervix. Uncovering markers for preterm cervical maturation underlies a logical strategy to predict miscarriage.Conclusion. Untrasound cervical measurement in the first trimester of pregnancy allows for revealing valuable miscarriage predictors (shortened cervix and absence of GI). Risk assessment by combining diverse ultrasound cervix parameters would allow to improve overall predictive efficacy.

Human milk mycobiota composition: relationship with gestational age, delivery mode, and birth weight

Intestinal and human milk microbiota studies during infancy have shown variations according to geographical location, delivery mode, gestational age, and mother-related factors during pregnancy. In this study, we performed metagenomic mycobiota analyses of 44 transient and mature human milk among five different groups: mothers of normal spontaneous delivery-term (NS-T), caesarean delivery-term (CS-T), premature (PT), small for gestational age (SGA), and large for gestational age (LGA) infants. Fungi were detected in 80 out of the 88 samples. Regarding the number of observed fungal species, the NS-T group was more homogeneous (less variable) comparing the other groups (P<0.05). In the transient human milk samples, the most abundant species were Saccharomyces cerevisiae (33.3%) and Aspergillus glaucus (27.4%). While A. glaucus (33.7%) was second most abundant species in mature milk, S. cerevisiae disappeared (P<0.01) and Penicillium rubens became the most abundant species (35.5%) (P<0.05). Among the NS-T group, the most abundant species was Malassezia globosa in both transient and mature milk. In contrast, S. cerevisiae was the most abundant species in transient human milk (45.0%) in the CS-T group, but it disappeared in mature milk (P<0.01). In transient milk, M. globosa was only represented 6.0-9.0% of taxa in the PT, SGA, and LGA groups (P<0.05). In transient and mature milk in the PT, SGA and LGA groups, the most abundant species were A. glaucus and P. rubens. In mature milk samples, P. rubens is more abundant in CS-T group, PT group and LGA group, than the NS-T groups (P<0.05 for all). Although fungi constitute only a very small part of the human milk microbiome, we observed some changes that the human milk mycobiota composition varies in caesarean delivery, premature, SGA and LGA groups, comparing the normal spontaneous delivery, as well as differences between transient and mature human milk.

LARGE SCALE QUALITY ENGINEERING IN DISTANCE LEARNING PROGRAMS

Embry-Riddle Aeronautical University serves more than 36,000 online students across the globe, many of whom are military and other non-traditional students, offering 34 undergraduate, graduate, and professional education/workforce certificate programs, presented both online (Blackboard) and via blended delivery modes. Our highly-centralized model of online course production and management produces and maintains more than 200 turnkey-style courses, including several award winners, which all meet the highest quality standards. Courses are designed by faculty members in partnership with an instructional design production team, working together to ensure course goals and learning objectives are achieved. Then, more than 800+ geographically- dispersed instructors are prepared to facilitate the courses and are monitored and coached throughout each course delivery term. With a student satisfaction rate above 85%, how do we ensure that quality is pervasive at every stage in the distance learning process? In addition, how do we innovate and continue to ensure the quality of design and instruction remains our top priority? The article addresses components of our distance learning model at ERAU-Worldwide, including administration, course design, instructor professional development, and course delivery, all with a focus on how we assure instructional quality at every stage. The people and processes used and how we harness Web 2.0, mobile, and cloud technologies to facilitate distance learning administration, teaching, and learning are detailed.

Preterm delivery in a patient with frontal lobe brain tumor

Introduction/Aim. Brain tumors are very rare in pregnancy. Diagnosis could be very simple if one consider brain tumor alongside blurred symptoms of headache, repetitive vomiting and/or epileptic attacks during pregnancy. The aim of this paper was to emphasize the importance of such pregnancy expert control and completion. Case report. We presented a 45-year-old pregnant woman at 30 weeks of gestation, and with brain tumor recidive in frontal lobe, hystologicaly confirmed as astrocytoma. The patient was newly diagnosed with tumor in 1995, and monitored until 2003, when she was operated. Due to malignant profile and a partial removal of tumor masses, postoperative gamma-ray therapy was recommended. Because of the continuous need for that kind of therapy, termination of pregnancy was also recommended. It was carried out by the application of PGE2 vaginal tablets. Delivery lasted for 8 hours and 50 minutes, and with auxilium manuale sec. Bracht, due to the breech presentation, newborn was delivered 1 550 grams in weight and 39 cm length. Apgar score was 6/7. Conclusion. Pregnancy in patient with brain tumors can be intensively monitored by neurosurgeons and obstetricians, and with the use of the symptomatical therapy almost up to the delivery term. Surgical intervention is recommended to be performed during the second and/or third trimester if the condition requires. The way of delivery in these patients should be individually determined in the most appropriate way both for the mother and the newborn, under given circumstances.