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Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 15 May 2024 | Viewed by 7003

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Special Issue Editors

Prof. Dr. Apostolos Mamopoulos

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Guest Editor

Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: obstetrics; maternal medicine

Dr. Ioannis Tsakiridis

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Guest Editor

Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: high–risk pregnancy; maternal–fetal medicine
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Dear Colleagues,

Pregnancy and childbirth are both situations that can bring about many changes. Pregnancy complications, including hypertensive disorders, gestational diabetes, fetal growth restriction (FGR), stillbirth and preterm delivery, are relatively common and may affect up to 25% of all pregnancies. These complications are in turn associated with both short- and long-term maternal and neonatal morbidity, including increased risk for neurodevelopmental and cardiovascular disease in the future. The goal of maternal–fetal medicine specialists is to improve perinatal outcomes of high-risk pregnancies while also prolonging the gestational age at delivery and eliminating the risk of complications, although the implementation of new techniques or medications is often an obstacle to current research because of ethical issues. The goal of this Special Issue is to encourage the submission of papers on current advances in prenatal diagnosis, the screening, management, prediction and prevention of pregnancy complications and associated clinical risks, and perinatal outcomes in modern obstetrics.

Prof. Dr. Apostolos Mamopoulos
Dr. Ioannis Tsakiridis
Guest Editors

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Keywords

pregnancy complications
perinatal outcomes
childbirth
hypertension
diabetes
fetal growth restriction
stillbirth
preterm delivery

Published Papers (9 papers)

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9 pages, 805 KiB

Open AccessArticle

Comparison of Fetal Crown-Rump Length Measurements between Thawed and Fresh Embryo Transfer

by Kyriaki Mitta, Ioannis Tsakiridis, Evaggelia Giougi, Apostolos Mamopoulos, Ioannis Kalogiannidis, Themistoklis Dagklis and Apostolos Athanasiadis

J. Clin. Med. 2024, 13(9), 2575; https://doi.org/10.3390/jcm13092575 - 27 Apr 2024

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Abstract

Background and Objectives: Neonates born from thawed embryo transfers tend to have a significantly higher birthweight compared to those from fresh embryo transfers. The aim of this study was to compare the crown-rump length (CRL) between thawed and fresh embryos to investigate the potential causes of different growth patterns between them. Materials and Methods: This was a retrospective study (July 2010–December 2023) conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece. In total, 3082 assisted reproductive technology (ART) pregnancies (4044 embryos) underwent a routine scan at 11⁺⁰–13⁺⁶ gestational weeks and were included in the study. Maternal age, the type of embryo transfer (thawed vs. fresh, donor vs. their own oocytes), CRL, twin and singleton gestations were analyzed. Results: The mean maternal age in thawed was significantly higher than in fresh embryos (39.8 vs. 35.8 years, p-value < 0.001). The mean CRL z-score was significantly higher in thawed compared to fresh embryo transfers (0.309 vs. 0.199, p-value < 0.001). A subgroup analysis on singleton gestations showed that the mean CRL z-score was higher in thawed blastocysts compared to fresh (0.327 vs. 0.215, p-value < 0.001). Accordingly, an analysis on twins revealed that the mean CRL z-score was higher in thawed blastocysts (0.285 vs. 0.184, p-value: 0.015) and in oocytes’ recipients compared to own oocytes’ cases (0.431 vs. 0.191, p-value: 0.002). Conclusions: The difference in CRL measurements between thawed and fresh embryos may be a first indication of the subsequent difference in sonographically estimated fetal weight and birthweight. This finding highlights the need for additional research into the underlying causes, including maternal factors and the culture media used. Full article

(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth)

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11 pages, 1438 KiB

Open AccessArticle

Ultrasonographic Evaluation of the Second Stage of Labor according to the Mode of Delivery: A Prospective Study in Greece

by Kyriaki Mitta, Ioannis Tsakiridis, Themistoklis Dagklis, Ioannis Kalogiannidis, Apostolos Mamopoulos, Georgios Michos, Andriana Virgiliou and Apostolos Athanasiadis

J. Clin. Med. 2024, 13(4), 1068; https://doi.org/10.3390/jcm13041068 - 13 Feb 2024

Viewed by 618

Abstract

Background and Objectives: Accurate diagnosis of labor progress is crucial for making well-informed decisions regarding timely and appropriate interventions to optimize outcomes for both the mother and the fetus. The aim of this study was to assess the progress of the second stage of labor using intrapartum ultrasound. Material and methods: This was a prospective study (December 2022–December 2023) conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece. Maternal–fetal and labor characteristics were recorded, and two ultrasound parameters were measured: the angle of progression (AoP) and the head–perineum distance (HPD). The correlation between the two ultrasonographic values and the maternal–fetal characteristics was investigated. Multinomial regression analysis was also conducted to investigate any potential predictors of the mode of delivery. Results: A total of 82 women at the second stage of labor were clinically and sonographically assessed. The mean duration of the second stage of labor differed between vaginal and cesarean deliveries (65.3 vs. 160 min; p-value < 0.001) and between cesarean and operative vaginal deliveries (160 vs. 88.6 min; p-value = 0.015). The occiput anterior position was associated with an increased likelihood of vaginal delivery (OR: 24.167; 95% CI: 3.8–152.5; p-value < 0.001). No significant differences were identified in the AoP among the three different modes of delivery (vaginal: 145.7° vs. operative vaginal: 139.9° vs. cesarean: 132.1°; p-value = 0.289). The mean HPD differed significantly between vaginal and cesarean deliveries (28.6 vs. 41.4 mm; p-value < 0.001) and between cesarean and operative vaginal deliveries (41.4 vs. 26.9 mm; p-value = 0.002); it was correlated significantly with maternal BMI (r = 0.268; p-value = 0.024) and the duration of the second stage of labor (r = 0.256; p-value = 0.031). Low parity (OR: 12.024; 95% CI: 6.320–22.876; p-value < 0.001) and high HPD (OR: 1.23; 95% CI: 1.05–1.43; p-value = 0.007) were found to be significant predictors of cesarean delivery. Conclusions: The use of intrapartum ultrasound as an adjunctive technique to the standard clinical evaluation may enhance the diagnostic approach to an abnormal labor progress and predict the need for operative vaginal or cesarean delivery. Full article

(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth)

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11 pages, 1309 KiB

Open AccessArticle

Gastrointestinal Disorders and Atopic Dermatitis in Infants in the First Year of Life According to ROME IV Criteria—A Possible Association with the Mode of Delivery and Early Life Nutrition

by Maciej Ziętek, Małgorzata Szczuko and Tomasz Machałowski

J. Clin. Med. 2024, 13(4), 927; https://doi.org/10.3390/jcm13040927 - 06 Feb 2024

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Abstract

Background: Functional gastrointestinal disorders are very common condition. The aim of this study is to evaluate the implications of the mode of pregnancy termination and early infant feeding on the incidence of gastrointestinal disorders and atopic dermatitis at birth and 3, 6, and 12 months of age. Methods: This study included 82 pregnant women and their newborns born at term. All newborns were examined at birth and 3, 6, and 12 months of age according to the ROME IV criteria. Results: In children born after cesarean section, the incidence of regurgitation was significantly higher. In children fed mostly or exclusively with formula, dry skin with allergic features was observed more often compared to breastfed children, but this relation was statistically significant only at the age of 12 months. The use of antibiotic therapy increased the risk of allergic skin lesions by almost seven times at 3 months of life. Gastrointestinal disorders in the form of regurgitation, colic, and constipation occur within the period of up to 12 months of the child’s life and may be related to the mode of the termination of pregnancy via cesarean section and the use of artificial feeding or antibiotic therapy. The occurrence of atopic dermatitis in infants at 12 months of life is correlated with the mode of the termination of pregnancy after cesarean section. Conclusions: One of the risk factors for the occurrence of atopic dermatitis and gastrointestinal disorders in the period up to 12 months of the child’s life may be a cesarean section and the use of formula feeding or antibiotic therapy. Full article

(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth)

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12 pages, 4275 KiB

Open AccessArticle

Accuracy and Reliability of Pelvimetry Measures Obtained by Manual or Automatic Labeling of Three-Dimensional Pelvic Models

by Johann Hêches, Sandra Marcadent, Anna Fernandez, Stephen Adjahou, Jean-Yves Meuwly, Jean-Philippe Thiran, David Desseauve and Julien Favre

J. Clin. Med. 2024, 13(3), 689; https://doi.org/10.3390/jcm13030689 - 25 Jan 2024

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Abstract

(1) Background: The morphology of the pelvic cavity is important for decision-making in obstetrics. This study aimed to estimate the accuracy and reliability of pelvimetry measures obtained when radiologists manually label anatomical landmarks on three-dimensional (3D) pelvic models. A second objective was to design an automatic labeling method. (2) Methods: Three operators segmented 10 computed tomography scans each. Three radiologists then labeled 12 anatomical landmarks on the pelvic models, which allowed for the calculation of 15 pelvimetry measures. Additionally, an automatic labeling method was developed based on a reference pelvic model, including reference anatomical landmarks, matching the individual pelvic models. (3) Results: Heterogeneity among landmarks in radiologists’ labeling accuracy was observed, with some landmarks being rarely mislabeled by more than 4 mm and others being frequently mislabeled by 10 mm or more. The propagation to the pelvimetry measures was limited; only one out of the 15 measures reported a median error above 5 mm or 5°, and all measures showed moderate to excellent inter-radiologist reliability. The automatic method outperformed manual labeling. (4) Conclusions: This study confirmed the suitability of pelvimetry measures based on manual labeling of 3D pelvic models. Automatic labeling offers promising perspectives to decrease the demand on radiologists, standardize the labeling, and describe the pelvic cavity in more detail. Full article

(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth)

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16 pages, 673 KiB

Open AccessFeature PaperArticle

Maternal Stress, Anxiety, Well-Being, and Sleep Quality in Pregnant Women throughout Gestation

by Rosalia Pascal, Irene Casas, Mariona Genero, Ayako Nakaki, Lina Youssef, Marta Larroya, Leticia Benitez, Yvan Gomez, Anabel Martinez-Aran, Ivette Morilla, Teresa M. Oller-Guzmán, Andrés Martín-Asuero, Eduard Vieta, Fàtima Crispi, Eduard Gratacos, María Dolores Gomez-Roig and Francesca Crovetto

J. Clin. Med. 2023, 12(23), 7333; https://doi.org/10.3390/jcm12237333 - 26 Nov 2023

Cited by 1 | Viewed by 1281

Abstract

Background: Maternal stress, anxiety, well-being, and sleep quality during pregnancy have been described as influencing factors during pregnancy. Aim: We aimed to describe maternal stress, anxiety, well-being, and sleep quality in pregnant women throughout gestation and their related factors. Methods: A prospective study including pregnant women attending BCNatal, in Barcelona, Spain (n = 630). Maternal stress and anxiety were assessed by the Perceived Stress Scale (PSS) and State-Trait Anxiety Inventory (STAI)-validated questionnaires. Maternal well-being was assessed using the World Health Organization Well-Being Index Questionnaire (WHO-5), and sleep quality was assessed using the Pittsburgh Sleep Quality Index Questionnaire (PSQI). All questionnaires were obtained twice during the second and third trimester of pregnancy. A multivariate analysis was conducted to assess factors related to higher maternal stress and anxiety and worse well-being and sleep quality. Results: High levels of maternal stress were reported in 23.1% of participants at the end of pregnancy, with maternal age <40 years (OR 2.02; 95% CI 1.08–3.81, p = 0.03), non-white ethnicity (OR 2.09; 95% CI 1.19–4.02, p = 0.01), and non-university studies (OR 1.86; 95% CI 1.08–3.19, p = 0.02) being the parameters mostly associated with it. A total of 20.7% of women had high levels of anxiety in the third trimester and the presence of psychiatric disorders (OR 3.62; 95% CI 1.34–9.78, p = 0.01) and non-university studies (OR 1.70; 95% CI 1.11–2.59, p = 0.01) provided a significant contribution to high anxiety at multivariate analysis. Poor maternal well-being was observed in 26.5% of women and a significant contribution was provided by the presence of psychiatric disorders (OR 2.96; 95% CI 1.07–8.25, p = 0.04) and non-university studies (OR 1.74; 95% CI 1.10–2.74, p = 0.02). Finally, less sleep quality was observed at the end of pregnancy (p < 0.001), with 81.1% of women reporting poor sleep quality. Conclusion: Maternal stress and anxiety, compromised maternal well-being, and sleep quality disturbances are prevalent throughout pregnancy. Anxiety and compromised sleep quality may increase over gestation. The screening of these conditions at different stages of pregnancy and awareness of the associated risk factors can help to identify women at potential risk. Full article

(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth)

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10 pages, 412 KiB

Open AccessArticle

Multifactorial Colonization of the Pregnant Woman’s Reproductive Tract: Implications for Early Postnatal Adaptation in Full-Term Newborns

by Piotr Gibała, Anna Jarosz-Lesz, Zuzanna Sołtysiak-Gibała, Jakub Staniczek and Rafał Stojko

J. Clin. Med. 2023, 12(21), 6852; https://doi.org/10.3390/jcm12216852 - 30 Oct 2023

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Abstract

This retrospective study aimed to investigate the impact of microorganisms identified in the reproductive tract on disorders during the early adaptation period in newborns. A cohort of 823 patients and cervical canal cultures were analyzed to identify the presence of microorganisms. Newborns included in the study were divided into two groups due to the number of pathogens identified in the swab from the cervical canal of the mother. The first group consisted of newborns whose mothers had one pathogen identified (N = 637), while the second group consisted of newborns whose mothers had two or more pathogens identified (N = 186). The analysis of disorders of the early adaptation period included the incidence of respiratory distress syndrome, the number of procedures performed with the use of CPAP, oxygen therapy, antibiotic therapy and parenteral nutrition. Respiratory distress syndrome was more common in group II than in group I (85 vs. 31, p = 0.001). In group II, CPAP (63 vs. 21, p = 0.001), oxygen therapy (15 vs. 8, p = 0.02) and antibiotics were used more frequently (13 vs. 8, p = 0.01). The findings of this study revealed that the number of pathogens colonizing the reproductive tract had a significant influence on the early adaptation period in newborns. Multifactorial colonization of the reproductive tract was associated with an increased incidence of infections in newborns and a higher prevalence of acid–base balance disorders. This study highlights the importance of monitoring and addressing the microbial composition of the reproductive tract during pregnancy. Full article

(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth)

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Other

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16 pages, 792 KiB

Open AccessPerspective

Incidence and Risk Factors of Perianal Pathology during Pregnancy and Postpartum Period: A Prospective Cohort Study

by Zivile Sabonyte-Balsaitiene, Tomas Poskus, Eugenijus Jasiunas, Diana Ramasauskaite and Grazina Drasutiene

J. Clin. Med. 2024, 13(8), 2371; https://doi.org/10.3390/jcm13082371 - 18 Apr 2024

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Abstract

Objective: We aimed to identify the incidence and risk factors of perianal pathology during pregnancy and the postpartum period. Methods: A prospective cohort study was conducted in three institutions in Lithuania. A total of 190 patients were examined and interviewed three times (<12, 18–20 weeks of gestation, and during the first 2 months after delivery). They completed a questionnaire including demographic, obstetric, coloproctological, and birth data. Results: A total of 73 (34.59%) women developed hemorrhoidal disease after delivery, and 120 (56.87%) developed perianal pathology. Multivariate analysis identified a neonatal birth weight ≥3380 g (OR 4.22; 95% CI 1.83–9.71, p < 0.001) and consumption of eggs (OR 3.10; 95% CI 1.13–8.53, p = 0.028) or cereals (OR 2.87; 95% CI 1.32–6.25, p = 0.008) several times per week as significant risk factors for hemorrhoidal disease. Neonatal birth weight ≥3380 g (OR 3.95; 95% CI 1.47–10.59, p = 0.006), maternal BMI ≥ 21.48 (OR 3.58; 95% CI 1.51–8.47, p = 0.004), the duration of the second labor period ≥38 min (OR 2.81; 95% CI 1.09–7.23, p = 0.032), and consumption of flour products several times per week (OR 2.77; 95% CI 1.10–6.98, p = 0.030) were associated with a higher risk of perianal pathology. Daily consumption of fruits and vegetables (OR 0.35; 95% CI 0.15–0.81, p = 0.014) and less frequent consumption of eggs were protective factors (OR 0.18; 95% CI 0.06–0.56, p = 0.003). Conclusions: Perianal diseases, especially hemorrhoidal disease, are common during pregnancy and the postpartum period. A neonatal birth weight ≥ 3380 g, a maternal BMI of ≥21.48, duration of the second labor period of ≥38 min, and consumption of flour products and cereals several times a week are risk factors for developing these diseases. Full article

(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth)

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13 pages, 643 KiB

Open AccessSystematic Review

Genetic and Epigenetic Factors Associated with Postpartum Psychosis: A 5-Year Systematic Review

by Sophia Tsokkou, Dimitrios Kavvadas, Maria-Nefeli Georgaki, Kyriaki Papadopoulou, Theodora Papamitsou and Sofia Karachrysafi

J. Clin. Med. 2024, 13(4), 964; https://doi.org/10.3390/jcm13040964 - 08 Feb 2024

Viewed by 911

Abstract

Purpose: Postpartum psychosis (PPP) is a serious mental health illness affecting women post-parturition. Around 1 in 1000 women are affected by postpartum psychosis, and the symptoms usually appear within 2 weeks after birth. Postpartum mental disorders are classified into 3 main categories starting from the least to most severe types, including baby blues, postpartum depression, and postpartum psychosis. Materials and Methods: In this systematic review, genetic and epigenetic factors associated with postpartum psychosis are discussed. A PRISMA flow diagram was followed, and the following databases were used as main sources: PubMed, ScienceDirect, and Scopus. Additional information was retrieved from external sources and organizations. The time period for the articles extracted was 5 years. Results: Initially, a total of 2379 articled were found. After the stated criteria were applied, 58 articles were identified along with 20 articles from additional sources, which were then narrowed down to a final total of 29 articles. Conclusions: It can be concluded that there is an association between PPP and genetic and epigenetic risk factors. However, based on the data retrieved and examined, the association was found to be greater for genetic factors. Additionally, the presence of bipolar disorder and disruption of the circadian cycle played a crucial role in the development of PPP. Full article

(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth)

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9 pages, 740 KiB

Open AccessBrief Report

Gestational Weight Gain Is Associated with the Expression of Genes Involved in Inflammation in Maternal Visceral Adipose Tissue and Offspring Anthropometric Measures

by Renata Saucedo, María Isabel Peña-Cano, Mary Flor Díaz-Velázquez, Aldo Ferreira-Hermosillo, Juan Mario Solis-Paredes, Ignacio Camacho-Arroyo and Jorge Valencia-Ortega

J. Clin. Med. 2023, 12(21), 6766; https://doi.org/10.3390/jcm12216766 - 26 Oct 2023

Viewed by 1020

Abstract

Background: Adequate gestational weight gain (GWG) is essential for maternal and fetal health. GWG may be a sign of higher visceral adipose tissue (VAT) accretion. A higher proportion of VAT is associated with an inflammatory process that may play a role in the fetal programming of obesity. This study aimed to (1) compare the expression of genes involved in inflammatory responses (TLR2, TLR4, NFκB, IKKβ, IL-1RA, IL-1β, IL-6, IL-10, TNF-α) in the VAT of pregnant women according to GWG and (2) explore whether VAT inflammation and GWG are related to offspring anthropometric measures. Material and methods: 50 women scheduled for cesarean section who delivered term infants were included in the study. We collected maternal omental VAT, and the expression of genes was examined with RT-qPCR. Results: Women with excessive and with adequate GWG had significantly higher expressions of most inflammatory genes than women with insufficient GWG. Neonates from mothers with excessive GWG had greater birth weight and chest circumference than those from mothers with insufficient GWG. GWG was positively correlated with fetal birth weight. Conclusions: The VAT expression of most genes associated with inflammatory pathways was higher in excessive and adequate GWG than in pregnant women with insufficient GWG. Moreover, GWG was found to be positively associated with newborn weight. Full article

(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth)

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