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Advancements in Maternal–Fetal Medicine
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Advancements in Maternal–Fetal Medicine

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 March 2025) | Viewed by 28228

Special Issue Editor

Dr. Elena Bernad

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Victor Babes”, 300001 Timisoara, Romania
Interests: gynecology; obstetrics; gynecological oncology; endocrinology and reproductive medicine; ethics; medical education; research design; epidemiology and statistics; computer applications
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Managing health issues of the mother and fetus before, during and soon after pregnancy is the main emphasis of maternal–fetal medicine, sometimes referred to as perinatology or high-risk obstetrics. Pregnant women with chronic conditions (e.g., nervous system, endocrine, genetic, infectious, immune, kidney, liver disease, hypertension, diabetes, mental and blood disorders), pregnancies at risk for pregnancy-related complications (e.g., preeclampsia, obesity, gestational diabetes, preterm labor, placenta previa and multiple pregnancies) and pregnancies with the fetus at risk (e.g., maternal diseases, genetic and chromosomal conditions, and growth restriction) are all encompassed by maternal–fetal medicine.The Special Issue aims to publish high-quality scientific articles in the perinatal health field to reduce maternal and infant mortality rates from pregnancy-related complications. These articles will focus on improving the diagnosis and management of obstetric, medical, surgical and fetal pregnancy complications. We invite original research articles, case studies, case reports and reviews on various maternal–fetal and obstetrical difficulties, from early pregnancy and placentation to prenatal diagnostics, fetal therapy, and maternal–fetal and obstetrical complications

Dr. Elena Bernad
Guest Editor

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Keywords

  • pregnancy
  • fetus
  • ultrasound
  • maternal–fetal medicine
  • perinatal care
  • high risk
  • obstetrics
  • complication
  • pathology
  • screening
  • diagnostics
  • fetal distress
  • psychology
  • medical ethics

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Published Papers (18 papers)

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11 pages, 625 KiB  
Article
Association of the Triglyceride–Glucose Index During the First Trimester of Pregnancy with Adverse Perinatal Outcomes
by Guillermo Gurza, Nayeli Martínez-Cruz, Ileana Lizano-Jubert, Lidia Arce-Sánchez, Blanca Vianey Suárez-Rico, Guadalupe Estrada-Gutierrez, Araceli Montoya-Estrada, José Romo-Yañez, Juan Mario Solis-Paredes, Johnatan Torres-Torres, Isabel González-Ludlow, Ameyalli Mariana Rodríguez-Cano, Maricruz Tolentino-Dolores, Otilia Perichart-Perera and Enrique Reyes-Muñoz
Diagnostics 2025, 15(9), 1129; https://doi.org/10.3390/diagnostics15091129 - 29 Apr 2025
Viewed by 2179
Abstract
Background/Objectives: Insulin resistance during pregnancy is a key factor underlying gestational diabetes mellitus (GDM) and other adverse perinatal outcomes (APOs). While traditional markers, such as HOMA-IR, are used to evaluate insulin resistance, they may be inaccessible in resource-limited settings. The triglyceride–glucose (TyG) [...] Read more.
Background/Objectives: Insulin resistance during pregnancy is a key factor underlying gestational diabetes mellitus (GDM) and other adverse perinatal outcomes (APOs). While traditional markers, such as HOMA-IR, are used to evaluate insulin resistance, they may be inaccessible in resource-limited settings. The triglyceride–glucose (TyG) index has emerged as a practical alternative. This study aimed to assess whether or not a TyG index > 8.6 during the first trimester of pregnancy is associated with an increased risk of APOs, including GDM, preeclampsia, and other maternal and neonatal complications. Methods: A prospective cohort study was conducted involving 333 pregnant women in Mexico City, divided into two groups: Group 1 (TyG index > 8.6, n = 153) and Group 2 (TyG index ≤ 8.6, n = 180). Primary outcomes included gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy, preeclampsia, preterm birth, cesarean section, and large-for-gestational-age (LGA) and small-for-gestational-age (SGA) neonates. Logistic regression models were used to calculate the adjusted relative risk (aRR) and 95% confidence intervals (CIs), adjusting for maternal age, pregestational weight, and body mass index (BMI). Results: Women with a TyG index > 8.6 had a significantly higher pregestational weight and BMI than those with a TyG index ≤ 8.6. Group 1 demonstrated a higher risk of GDM (RR 2.05; 95% CI: 1.23–3.41) and preeclampsia (RR 2.15; 95% CI: 1.10–4.21). After adjusting for maternal age, pregestational weight, and BMI, these associations remained significant: GDM (aRR 1.87; 95% CI: 1.0–2.5) and preeclampsia (aRR 2.18; 95% CI: 1.1–5.0). No significant associations were found between an elevated TyG index and other APOs, including LGA, SGA, preterm birth, or cesarean delivery. Conclusions: A first-trimester TyG index > 8.6 is significantly associated with an increased risk of GDM and preeclampsia, highlighting its potential as a predictive marker for adverse perinatal outcomes. These findings underscore the utility of the TyG index as a practical, cost-effective tool for early risk stratification, particularly in resource-limited settings. Further multi-center research is needed to validate these results and refine population-specific thresholds. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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10 pages, 1196 KiB  
Article
Comprehensive Analysis of the Aberrant Right Subclavian Artery: A Perspective from a Single Institute
by Rou Jiun Lin, Kim-Seng Law and Pei-Jhen Wu
Diagnostics 2025, 15(6), 772; https://doi.org/10.3390/diagnostics15060772 - 19 Mar 2025
Viewed by 459
Abstract
Background/Objectives: This study aimed to provide a descriptive review of fetal aberrant right subclavian artery (ARSA), with a discussion of the genomic and structural anatomy and perinatal prognosis in our hospital’s obstetric department. Methods: In total, 3266 fetal level II sonographies [...] Read more.
Background/Objectives: This study aimed to provide a descriptive review of fetal aberrant right subclavian artery (ARSA), with a discussion of the genomic and structural anatomy and perinatal prognosis in our hospital’s obstetric department. Methods: In total, 3266 fetal level II sonographies were performed between January 2020 and June 2023. The 21 cases diagnosed with ARSA were included in this study. Obstetric ultrasound screening, noninvasive prenatal screening, and fetal karyotyping were performed. Fetal echocardiograms, postnatal information, and follow-up data were recorded. Results: In our dataset of 3266 cases, the overall incidence rate of ARSA was 0.6%. Of the 21 fetuses with ARSA, no abnormalities were detected in either prenatal or genetic tests, and no chromosomal anomalies were identified. Conclusions: Our study provides informative insights into ARSA, emphasizing the need for a comprehensive evaluation of its structural and genetic aspects. The findings of this study prompt further exploration, especially regarding the increasing incidence of ARSA and the potential role of advanced genetic analyses in enhancing diagnostic precision and fetal prognostic evaluation. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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10 pages, 439 KiB  
Article
Relationship Between Thyroid Function Tests and Birth Parameters at 41-Week-And-Above Pregnancies: A Prospective Cohort Study
by Mustafa Can Sivas, Karolin Ohanoglu Cetinel and Ipek Emine Geyikoglu
Diagnostics 2025, 15(5), 641; https://doi.org/10.3390/diagnostics15050641 - 6 Mar 2025
Viewed by 504
Abstract
Background: In the literature, there is no study investigating the relationship between thyroid hormones in pregnancies at 41 weeks and above and the birth timing, labor duration, frequency of fetal distress, premature rupture of membranes (PROM), and maternal hemogram values. Methods: A total [...] Read more.
Background: In the literature, there is no study investigating the relationship between thyroid hormones in pregnancies at 41 weeks and above and the birth timing, labor duration, frequency of fetal distress, premature rupture of membranes (PROM), and maternal hemogram values. Methods: A total of 68 nulliparous pregnant women who were admitted to Basaksehir Cam and Sakura City Hospital with indications of delivery between August 2023 and January 2024, between the ages of 20 and 38 and with no comorbidities, were included in the study. Pregnant women with ≥41 weeks of gestation were classified as the late-term pregnancy group (n = 37), and those between 37 and 38 weeks were classified as the control group (n = 31). The thyrotropin (TSH), free thyroxine (FT4), and hemoglobin levels and relevant parameters were evaluated. Results: The FT4 values of pregnant women diagnosed with fetal distress in the entire population were observed to be statistically significantly lower (p < 0.05). A statistically significant negative linear relationship was detected between the FT4 values of the entire population and the weights of newborns (p < 0.05). It was determined that, as the FT4 values decreased, the newborn weights increased. There was no statistically significant difference between the two groups in terms of the TSH/FT4 values, birth types, labor duration, or postpartum Hb/Htc decrease (p > 0.05). No statistically significant relationship was found between the TSH/FT4 values of the entire population and the diagnosis of PROM, labor duration, or Hb/Htc decrease amount (p > 0.05). Conclusions: TSH/FT4 levels may be important in the mature and late–mature periods of pregnancy. There may be an association between the FT4 levels and the fetal distress risk, type of birth, and newborn weight. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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11 pages, 204 KiB  
Article
Impact of Extended Membrane Rupture on Neonatal Inflammatory Responses and Composite Neonatal Outcomes in Early-Preterm Neonates—A Prospective Study
by Maura-Adelina Hincu, Liliana Gheorghe, Luminita Paduraru, Daniela-Cristina Dimitriu, Anamaria Harabor, Ingrid-Andrada Vasilache, Iustina Solomon-Condriuc, Alexandru Carauleanu, Ioana Sadiye Scripcariu and Dragos Nemescu
Diagnostics 2025, 15(2), 213; https://doi.org/10.3390/diagnostics15020213 - 18 Jan 2025
Viewed by 748
Abstract
Background/Objectives: Prolonged prelabour rupture of membranes (PROMs), and the resulting inflammatory response, can contribute to the occurrence of adverse neonatal outcomes, especially for early-preterm neonates. This prospective study aimed to measure neonates’ inflammatory markers in the first 72 h of life based [...] Read more.
Background/Objectives: Prolonged prelabour rupture of membranes (PROMs), and the resulting inflammatory response, can contribute to the occurrence of adverse neonatal outcomes, especially for early-preterm neonates. This prospective study aimed to measure neonates’ inflammatory markers in the first 72 h of life based on ROM duration. The second aim was to examine the relationship between PROMs, serum inflammatory markers, and composite adverse neonatal outcomes after controlling for gestational age (GA). Methods: Data from 1026 patients were analyzed considering the following groups: group 1 (ROM < 18 h, n = 447 patients) and group 2 (ROM > 18 h, n = 579 patients). These groups were further segregated depending on the GA at the moment of membranes’ rupture into subgroup 1 (<33 weeks of gestation and 6 days, n = 168 patients) and subgroup 2 (at least 34 completed weeks of gestation, n = 858 patients). Multiple logistic regressions and interaction analyses adjusted for GA considering five composite adverse neonatal outcomes and predictors were employed. Results: PROMs and high c-reactive protein (CRP) values significantly increased the risk of composite outcome 1 occurrence by 14% (95%CI: 1.03–1.57, p < 0.001). PROMs and high CRP values increased the risk of composite outcome 5 by 14% (95%CI: 1.07–1.78, p < 0.001), PROM and leukocytosis by 11% (95%CI: 1.02–1.59, p = 0.001), and PROMs and high PCT values by 21% (95%CI: 1.04–2.10, p < 0.001). Conclusions: The combination of PROMs and high CRP values significantly increased the risk of all evaluated adverse composite outcomes in early-preterm neonates and should point to careful monitoring of these patients. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
12 pages, 1051 KiB  
Article
Predicting Adverse Neurodevelopmental Outcomes in Premature Neonates with Intrauterine Growth Restriction Using a Three-Layered Neural Network
by Anca Bivoleanu, Liliana Gheorghe, Bogdan Doroftei, Ioana-Sadiye Scripcariu, Ingrid-Andrada Vasilache, Valeriu Harabor, Ana-Maria Adam, Gigi Adam, Iulian Valentin Munteanu, Carolina Susanu, Iustina Solomon-Condriuc and Anamaria Harabor
Diagnostics 2025, 15(1), 111; https://doi.org/10.3390/diagnostics15010111 - 5 Jan 2025
Viewed by 1055
Abstract
Background/Objectives: There is a constant need to improve the prediction of adverse neurodevelopmental outcomes in growth-restricted neonates who were born prematurely. The aim of this retrospective study was to evaluate the predictive performance of a three-layered neural network for the prediction of [...] Read more.
Background/Objectives: There is a constant need to improve the prediction of adverse neurodevelopmental outcomes in growth-restricted neonates who were born prematurely. The aim of this retrospective study was to evaluate the predictive performance of a three-layered neural network for the prediction of adverse neurodevelopmental outcomes determined at two years of age by the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) scale in prematurely born infants by affected by intrauterine growth restriction (IUGR). Methods: This observational retrospective study included premature newborns with or without IUGR admitted to a tertiary neonatal intensive care unit from Romania, between January 2018 and December 2022. The patients underwent assessment with the Amiel-Tison scale at discharge, and with the Bailey-3 scale at 3, 6, 12, 18, and 24 months of corrected age. Clinical and paraclinical data were used to construct a three-layered artificial neural network, and its predictive performance was assessed. Results: Our results indicated that this type of neural network exhibited moderate predictive performance in predicting mild forms of cognitive, motor, and language delays. However, the accuracy of predicting moderate and severe neurodevelopmental outcomes varied between moderate and low. Conclusions: Artificial neural networks can be useful tools for the prediction of several neurodevelopmental outcomes, and their predictive performance can be improved by including a large number of clinical and paraclinical parameters. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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10 pages, 520 KiB  
Article
Prenatal Predictors and Early Postnatal Outcomes in Fetuses Diagnosed with Tricuspid Atresia
by Ozge Kahramanoglu, Omer Gokhan Eyisoy and Oya Demirci
Diagnostics 2024, 14(24), 2855; https://doi.org/10.3390/diagnostics14242855 - 19 Dec 2024
Viewed by 956
Abstract
Objective: To assess the prenatal course and early postnatal outcomes of fetuses diagnosed with tricuspid atresia and to identify predictors of survival. Methods: This was a retrospective study of 25 fetuses diagnosed with tricuspid atresia in a single tertiary referral center, evaluating prenatal [...] Read more.
Objective: To assess the prenatal course and early postnatal outcomes of fetuses diagnosed with tricuspid atresia and to identify predictors of survival. Methods: This was a retrospective study of 25 fetuses diagnosed with tricuspid atresia in a single tertiary referral center, evaluating prenatal echocardiographic features and postnatal outcomes. Results: A total of 4 of 29 initially diagnosed fetuses were excluded due to changes in diagnosis or loss to follow-up, leaving 25 fetuses for analysis. Of these, 16 (64%) had concordant VA alignment, 8 (32%) had discordant VA connections, and 1 had a double-outlet left ventricle (DOLV). Pulmonary stenosis was observed in 13 fetuses, and 10 (40%) had extracardiac anomalies. Genetic testing, performed in 5 cases, identified a chromosomal anomaly in one case (trisomy 18). Overall, three pregnancies were terminated due to severe associated anomalies. Among the 22 liveborn infants, survival at 12 months was 72%. Restrictive ventricular septal defect (VSD) and the high ductus venosus pulsatility index were significantly associated with lower survival (p = 0.021 and p = 0.034, respectively). Conclusions: Tricuspid atresia can be accurately diagnosed in utero with a thorough echocardiographic evaluation. Restrictive VSD and outflow tract obstructions are critical determinants of early survival, while abnormal DV Doppler patterns may serve as additional markers for adverse outcomes. More extensive studies are needed to validate these findings and improve prognostic counseling. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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11 pages, 690 KiB  
Article
Comparison of Modified Labor Induction Strategies for Pregnant Women at a Single Tertiary Center Before and During the COVID-19 Pandemic
by Yi-Sin Tan, Ching-Chang Tsai, Hsin-Hsin Cheng, Yun-Ju Lai, Pei-Fang Lee, Te-Yao Hsu and Kun-Long Huang
Diagnostics 2024, 14(23), 2739; https://doi.org/10.3390/diagnostics14232739 - 5 Dec 2024
Viewed by 965
Abstract
Background: The COVID-19 pandemic has substantially impacted healthcare systems and obstetric practices worldwide. Labor induction is a common procedure for preventing obstetric complications in high-risk populations. This study evaluated perinatal outcomes of labor induction using a modified management protocol in a tertiary care [...] Read more.
Background: The COVID-19 pandemic has substantially impacted healthcare systems and obstetric practices worldwide. Labor induction is a common procedure for preventing obstetric complications in high-risk populations. This study evaluated perinatal outcomes of labor induction using a modified management protocol in a tertiary care center during the COVID-19 pandemic. Methods: We conducted a retrospective study by reviewing electronic structured delivery records of women who underwent elective labor induction between June 2020 and October 2022. We analyzed maternal characteristics, maternal outcomes, and neonatal outcomes during the pre-pandemic (June 2020 to May 2021) and pandemic periods (May 2021 to October 2022). Results: The study included 976 cases: 325 pregnancies in the pre-pandemic group and 651 in the pandemic group. The pandemic group showed earlier gestational age at delivery (39 vs. 40 weeks, p < 0.01) and lower body mass index (27.1 vs. 27.5 kg/m2, p = 0.03). During the pandemic period, we observed a significant increase in labor induction cases and a decrease in cesarean sections. Neonatal outcomes, including Apgar scores and intensive care admissions, showed no significant differences between groups. Subgroup analysis identified advanced maternal age (OR = 1.08; 95% CI = 1.03–1.14; p < 0.01) and primiparity (OR = 5.24; 95% CI = 2.75–9.99; p < 0.01) as independent risk factors for cesarean delivery. Conclusions: Even under modified protocols for labor induction during the COVID-19 pandemic, more pregnancies underwent labor induction while achieving a significant reduction in cesarean sections. Advanced maternal age and primiparity were identified as independent risk factors associated with cesarean delivery. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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13 pages, 246 KiB  
Article
A Prospective Evaluation of Health Literacy Levels of Pregnant Women in Antenatal Classes: Impact on Delivery Outcomes in Nulliparous and Multiparous Women
by Sakine Rahimli Ocakoglu, Zeliha Atak, Ozlem Ozgun Uyaniklar and Gokhan Ocakoglu
Diagnostics 2024, 14(22), 2580; https://doi.org/10.3390/diagnostics14222580 - 17 Nov 2024
Viewed by 1098
Abstract
Backgrounds/Objectives: Modern technology and educational activities, such as antenatal classes (ACs), increase patient informedness in medicine and improve collaboration between physicians and patients. The present study aimed to evaluate and compare the impact of maternal health literacy (HL) on delivery outcomes between [...] Read more.
Backgrounds/Objectives: Modern technology and educational activities, such as antenatal classes (ACs), increase patient informedness in medicine and improve collaboration between physicians and patients. The present study aimed to evaluate and compare the impact of maternal health literacy (HL) on delivery outcomes between nulliparous and multiparous women who attended antenatal classes. Methods: This prospective study recruited 281 pregnant women who regularly attended ACs, but only 188 who gave birth at our academic tertiary hospital were included in the final analysis. Socio-demographic characteristics, peripartum data (cervical dilatation at the time of admission to the hospital, duration of labor, and mode of delivery), and obstetric interventions (cesarean section (C/S) rate and rate of instrumental vaginal birth and episiotomy) were recorded, and the level of HL was assessed using the European Health Literacy Survey Questionnaire (HLS-EU-Q16). HL levels did not significantly affect peripartum and postpartum outcomes. Results: The study results showed that HL levels did not impact labor duration and newborn Apgar scores (p > 0.05). Patient education levels and employment status affected the peripartum duration of labor (p = 0.048 and p = 0.001, respectively). There were no differences in the HL total score and subscale scores (p > 0.05) between nulliparous and multiparous patients, and the rate of primary C/S was similar in both groups. Conclusions: HL levels did not impact delivery (peripartum) outcomes in pregnant women who attended antenatal classes. However, the primary C/S rate was similar between the nulliparous and multiparous groups, which may indicate that antenatal education services can correct the negative impact of low HL levels on the primary C/S rate. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
14 pages, 3101 KiB  
Article
Prenatal Diagnosis of Reno-Urinary Malformations in a Tertiary Center of Republic of Moldavia
by Victor Roller, Angela Ciuntu, Elena Țarcă, Nicolae Sebastian Ionescu, Teodora-Simina Drăgoiu, Jana Bernic, Eva Gudumac, Emil Ceban, Ana Mișina, Tatiana Băluțel, Adriana Ignat, Liliana Fuior-Bulhac and Dana Elena Mîndru
Diagnostics 2024, 14(19), 2243; https://doi.org/10.3390/diagnostics14192243 - 8 Oct 2024
Viewed by 1151
Abstract
Malformative uropathy in children is one of the most common pathological conditions, with an incidence of 5–14% in newborns. Recent research shows that even in the current conditions, they are often diagnosed only in the advanced stages, when Chronic Kidney Disease is already [...] Read more.
Malformative uropathy in children is one of the most common pathological conditions, with an incidence of 5–14% in newborns. Recent research shows that even in the current conditions, they are often diagnosed only in the advanced stages, when Chronic Kidney Disease is already affirming. This study’s objective is to identify urinary tract anomalies, including malformative uropathies in the prenatal stage, using imaging techniques, namely ultrasound of the pregnant uterus. Using prenatal ultrasonography of the pregnant uterus and postnatal clinical and paraclinical examination, we prospectively evaluated a cohort of fifty children with pyelectasia. We describe the demographic and pathological characteristics of patients diagnosed with renal–urinary abnormalities, as well as their postnatal management. A prenatal diagnosis made during the first 15 to 22 weeks of pregnancy enables the evaluation of early malformative uropathies and the determination of the best time to operate in order to minimize complications. When prenatal ultrasonography, fetal karyotype, tissue sample, and embryonic appendages work together, problems may be partially or entirely revealed by these methods due to mistakes made in imaging examinations. In the case of a pregnancy with an antenatal malformation detected, it is necessary for the delivery to take place in a clinic that can provide favorable services for the survival and investigation of the child born with malformative abnormalities. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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14 pages, 2622 KiB  
Article
Risks and Probabilities of Adverse Pregnancy Outcomes in Patients Undergoing Trial of Labor after Cesarean—A Retrospective Study
by Alexandru Carauleanu, Iustina Solomon-Condriuc, Petronela Vicoveanu, Demetra Socolov, Ioana-Sadiye Scripcariu, Ingrid-Andrada Vasilache, Iulian-Valentin Munteanu, Luiza-Maria Baean, Ana-Maria Adam, Raluca Mogos and Liliana Gheorghe
Diagnostics 2024, 14(16), 1715; https://doi.org/10.3390/diagnostics14161715 - 7 Aug 2024
Viewed by 1183
Abstract
(1) Background: Trial of labor after cesarean (TOLAC) can be associated with significant maternal and neonatal complications, and the aim of this retrospective study was to calculate the risks and probabilities of these complications in two tertiary maternity centers in Romania. (2) Methods: [...] Read more.
(1) Background: Trial of labor after cesarean (TOLAC) can be associated with significant maternal and neonatal complications, and the aim of this retrospective study was to calculate the risks and probabilities of these complications in two tertiary maternity centers in Romania. (2) Methods: A total of 216 patients who attempted TOLAC were included in the study and were segregated into two groups, depending on TOLAC success. Medical records were assessed, and clinical data were used to determine the maternal and neonatal risks and complications, using multinomial logistic regression and postestimation predictions. (3) Results: Our data indicated that patients who had a failed TOLAC had significantly higher risks and probabilities of uterine rupture, either complete or incomplete; intensive care unit (ICU) admission; and emergency hysterectomy. The newborns of these mothers had significantly higher risks and probabilities of low Apgar score at birth, neonatal intensive care unit (NICU) admission, and invasive ventilation. (4) Conclusions: Failed TOLAC could lead to significant maternal and neonatal complications, and women who attempt this procedure should be monitored in a tertiary center where a multidisciplinary team and an emergency operating room are available. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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15 pages, 923 KiB  
Article
Characteristics of the Basel Postpartum Hypertension Cohort (Basel-PPHT Cohort): An Interim Analysis
by Thenral Socrates, Céline Wenker, Annina Vischer, Christina Schumacher, Fiona Pugin, Andreas Schötzau, Michael Mayr, Irene Hösli, Beatrice Mosimann, Olav Lapaire and Thilo Burkard
Diagnostics 2024, 14(13), 1347; https://doi.org/10.3390/diagnostics14131347 - 25 Jun 2024
Cited by 1 | Viewed by 1969
Abstract
Postpartum hypertension (PPHT) is hypertension that persists or develops after delivery and is a frequent cause of readmission, affecting 10% of pregnancies. This interim analysis aims to describe the cohort and to determine the feasibility and acceptance of a home-based telemonitoring management strategy [...] Read more.
Postpartum hypertension (PPHT) is hypertension that persists or develops after delivery and is a frequent cause of readmission, affecting 10% of pregnancies. This interim analysis aims to describe the cohort and to determine the feasibility and acceptance of a home-based telemonitoring management strategy (HBTMS) in PPHT patients. Enrollment at the University Hospital Basel began during the 2020 SARS-CoV-2 pandemic. Maternity-ward patients were screened for preexisting hypertension, hypertensive disorders of pregnancy, and de novo PPHT. In this pragmatic non-randomized prospective trial, the participants chose the HBTMS or standard of care (SOC), which consisted of outpatient hypertension clinic appointments. The HBTMS was a smartphone application or a programmed spreadsheet to report blood pressure (BP), followed by telephone consultations. Three months postpartum, the participants underwent a 24 h BP measurement and a blood, biomarker, and urine analysis. A total of 311 participants were enrolled between 06/20 and 08/23. The mean age was 34 (±5.3) years. The current pregnancy history demonstrated the following (≥1 diagnosis possible): 10% had preexisting hypertension, 27.3% gestational hypertension, 53% preeclampsia (PE), 0.3% eclampsia, 6% HELLP (hemolysis, elevated liver enzymes, and low platelets), and 18.3% de novo PPHT. A family history of cardiovascular disease and PE was reported in 49.5% and 7.5%, respectively. In total, 23.3% were high-risk for PE. A total of 68.5% delivered via c-section, the mean hospitalization was 6.3 days (±3.9), and newborn intrauterine growth restriction occurred in 21%. A total of 99% of the participants chose the HBTMS. This analysis demonstrated that the HBTMS was accepted. This is vital in the immediate postpartum period and pertinent when the exposure of hospital visits should be avoided. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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11 pages, 238 KiB  
Article
The Association between Low Fetal Fraction of Non-Invasive Prenatal Testing and Adverse Pregnancy Outcomes for Placental Compromise
by Soo-Hyun Kim, You-Mi Hong, Ji-Eun Park, Sung-Shin Shim, Hee-Jin Park, Yeon-Kyung Cho, June-Seek Choi, Joong-Sik Shin, Hyun-Mee Ryu, Moon-Young Kim, Dong-Hyun Cha and You-Jung Han
Diagnostics 2024, 14(10), 1020; https://doi.org/10.3390/diagnostics14101020 - 15 May 2024
Viewed by 2542
Abstract
(1) Background: Non-invasive prenatal testing (NIPT) is a screening test for fetal aneuploidy using cell-free fetal DNA. The fetal fragments (FF) of cell-free DNA (cfDNA) are derived from apoptotic trophoblast of the placenta. The level of fetal cfDNA is known to be influenced [...] Read more.
(1) Background: Non-invasive prenatal testing (NIPT) is a screening test for fetal aneuploidy using cell-free fetal DNA. The fetal fragments (FF) of cell-free DNA (cfDNA) are derived from apoptotic trophoblast of the placenta. The level of fetal cfDNA is known to be influenced by gestational age, multiple pregnancies, maternal weight, and height. (2) Methods: This study is a single-center retrospective observational study which examines the relationship between the fetal fraction (FF) of cell-free DNA in non-invasive prenatal testing (NIPT) and adverse pregnancy outcomes in singleton pregnancies. A total of 1393 samples were collected between 10 weeks and 6 days, and 25 weeks and 3 days of gestation. (3) Results: Hypertensive disease of pregnancy (HDP) occurred more frequently in the low FF group than the normal FF group (5.17% vs. 1.91%, p = 0.001). Although the rates of small for gestational age (SGA) and placental abruption did not significantly differ between groups, the composite outcome was significantly higher in the low FF group (7.76% vs. 3.64%, p = 0.002). Furthermore, women who later experienced complications such as HDP or gestational diabetes mellitus (GDM) had significantly lower plasma FF levels compared to those without complications (p < 0.001). After adjustments, the low FF group exhibited a significantly higher likelihood of placental compromise (adjusted odds ratio: 1.946). (4) Conclusions: Low FF in NIPT during the first and early second trimesters is associated with adverse pregnancy outcomes, particularly HDP, suggesting its potential as a predictive marker for such outcomes. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
13 pages, 1068 KiB  
Article
Immune Responses of Healthy Pregnant Women following an Elective Cesarean Section: Effects of Anesthetic Procedures
by Marius Bogdan Novac, Lidia Boldeanu, Anda Lorena Dijmărescu, Mihail Virgil Boldeanu, Simona Daniela Neamțu, Lucreţiu Radu, Maria Magdalena Manolea, Mircea-Sebastian Șerbănescu, Maria Stoica, Luciana Teodora Rotaru and Constantin-Cristian Văduva
Diagnostics 2024, 14(9), 880; https://doi.org/10.3390/diagnostics14090880 - 24 Apr 2024
Viewed by 1400
Abstract
A weakened immune system and more inflammatory cytokines being released are possible effects of the surgical stress that a cesarean section induces. This kind of reaction, in addition to the altered reaction to catecholamines, has the potential to significantly affect the immune system [...] Read more.
A weakened immune system and more inflammatory cytokines being released are possible effects of the surgical stress that a cesarean section induces. This kind of reaction, in addition to the altered reaction to catecholamines, has the potential to significantly affect the immune system of the mother and the patients’ general postoperative course. This prospective study compared the plasma levels of catecholamines and cytokines in healthy pregnant patients having cesarean sections under spinal anesthesia versus general anesthesia. A total of 30 pregnant women undergoing elective cesarean sections were divided into two groups: 15 who received general anesthesia (GA) and 15 who received spinal anesthesia (SA). Blood samples were collected from all subjects before anesthesia induction (pre-OP), 6 h postoperatively (6 h post-OP), and 12 h (12 h post-OP), to measure levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-8, IL-4, IL-10, norepinephrine (NE), and epinephrine (EPI). When we compared the two groups, we discovered that only IL-6 and IL-4 had significantly higher levels pre-OP, whereas all studied cytokines exhibited an increase in the GA versus SA group at 6 and 12 h post-OP. In the case of catecholamines, we discovered that serum levels are positively related with pro-inflammatory or anti-inflammatory cytokines, depending on the time of day and type of anesthetic drugs. Compared to SA, GA has a more consistent effect on the inflammatory response and catecholamine levels. The findings of this study confirm that the type of anesthesia can alter postoperative immunomodulation to various degrees via changes in cytokine and catecholamine production. SA could be a preferable choice for cesarean section because it is an anesthetic method that reduces perioperative stress and allows for less opioid administration, impacting cytokine production with proper immunomodulation. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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Review

Jump to: Research, Other

11 pages, 486 KiB  
Review
A State-of-the-Art Review of Ophthalmological Indications for a Cesarean Section: Is There a Patient for Whom a Cesarean Section Is Really Indicated?
by Paola Quaresima, Giuseppe Covello, Giovanna Bitonti, Costantino Di Carlo, Michele Morelli and Maurizio Guido
Diagnostics 2025, 15(4), 418; https://doi.org/10.3390/diagnostics15040418 - 9 Feb 2025
Viewed by 1047
Abstract
Purpose: Our purpose was to review the current literature regarding ophthalmologic indications for cesarean section (CS). Methods: A literature search was conducted using MEDLINE, Embase, and the Cochrane Library from inception through October 2024. The databases were searched using the following keywords: “Caesarean [...] Read more.
Purpose: Our purpose was to review the current literature regarding ophthalmologic indications for cesarean section (CS). Methods: A literature search was conducted using MEDLINE, Embase, and the Cochrane Library from inception through October 2024. The databases were searched using the following keywords: “Caesarean section” OR “Caesarean section” OR “delivery” OR “pregnancy” AND “eyes” OR “eye disorders” OR “ocular disease” OR “diabetic retinopathy” OR “myopia” OR “retinal detachment” OR “glaucoma” OR “keratoconus”. Studies were considered eligible if they described pregnancy management in women affected by an eye disorder, with insight into the mode of delivery. Results: A total of 8383 results were identified, including only 1 specific guideline and no randomized controlled trials. After a manual review, 38 manuscripts were selected for inclusion. Based on the available evidence, an elective CS may be considered on a case-by-case basis in the presence of specific ophthalmic conditions, such as high-grade myopia with subretinal neovascularization, proliferative diabetic retinopathy, advanced glaucoma, or advanced keratoconus. These conditions are rare among women of childbearing age. Conclusions: Currently, only a limited number of highly specific ophthalmic conditions may benefit from an elective CS. Considering the potential short- and long-term implications of a CS, and in line with the current World Health Organization recommendations, this surgical procedure should be reserved for cases with a clear indication. Given the paucity of data in the available literature, further prospective randomized controlled trials are necessary to enhance the quality of evidence. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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14 pages, 6081 KiB  
Review
Struma Ovarii during Pregnancy
by Gabriela Dumachița-Șargu, Răzvan Socolov, Teodora Ana Balan, Dumitru Gafițanu, Mona Akad and Raluca Anca Balan
Diagnostics 2024, 14(11), 1172; https://doi.org/10.3390/diagnostics14111172 - 1 Jun 2024
Viewed by 1511
Abstract
Struma ovarii is a rare type of ovarian teratoma primarily composed of over 50% thyroid tissue. Its occurrence is reported in 2–5% of all ovarian teratomas, with approximately 0.5% to 10% showing malignant transformation. Managing it during pregnancy poses significant challenges as pregnancy [...] Read more.
Struma ovarii is a rare type of ovarian teratoma primarily composed of over 50% thyroid tissue. Its occurrence is reported in 2–5% of all ovarian teratomas, with approximately 0.5% to 10% showing malignant transformation. Managing it during pregnancy poses significant challenges as pregnancy can promote the growth of malignant struma ovarii due to elevated levels of ovarian and pregnancy-related hormones, including estrogen, progesterone, and human chorionic gonadotrophin (hCG). Most ovarian tumors, including struma ovarii, are detected during routine ultrasonography in the first and second trimesters, often as acute emergencies. Diagnosis during pregnancy is rare, with some cases incidentally discovered during cesarean section when inspecting the adnexa for ovarian cysts. This review explores the diagnostic, management, and therapeutic approaches to struma ovarii during pregnancy. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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19 pages, 349 KiB  
Review
Current Trends in Diagnosis and Treatment Approach of Diabetic Retinopathy during Pregnancy: A Narrative Review
by Luminioara M. Rosu, Cătălin Prodan-Bărbulescu, Anca Laura Maghiari, Elena S. Bernad, Robert L. Bernad, Roxana Iacob, Emil Robert Stoicescu, Florina Borozan and Laura Andreea Ghenciu
Diagnostics 2024, 14(4), 369; https://doi.org/10.3390/diagnostics14040369 - 8 Feb 2024
Cited by 13 | Viewed by 3593
Abstract
Diabetes mellitus during pregnancy and gestational diabetes are major concerns worldwide. These conditions may lead to the development of severe diabetic retinopathy during pregnancy or worsen pre-existing cases. Gestational diabetes also increases the risk of diabetes for both the mother and the fetus [...] Read more.
Diabetes mellitus during pregnancy and gestational diabetes are major concerns worldwide. These conditions may lead to the development of severe diabetic retinopathy during pregnancy or worsen pre-existing cases. Gestational diabetes also increases the risk of diabetes for both the mother and the fetus in the future. Understanding the prevalence, evaluating risk factors contributing to pathogenesis, and identifying treatment challenges related to diabetic retinopathy in expectant mothers are all of utmost importance. Pregnancy-related physiological changes, including those in metabolism, blood flow, immunity, and hormones, can contribute to the development or worsening of diabetic retinopathy. If left untreated, this condition may eventually result in irreversible vision loss. Treatment options such as laser therapy, intravitreal anti-vascular endothelial growth factor drugs, and intravitreal steroids pose challenges in managing these patients without endangering the developing baby and mother. This narrative review describes the management of diabetic retinopathy during pregnancy, highlights its risk factors, pathophysiology, and diagnostic methods, and offers recommendations based on findings from previous literature. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)

Other

Jump to: Research, Review

9 pages, 5410 KiB  
Case Report
Massive Fetomaternal Hemorrhage Caused by an Intraplacental Choriocarcinoma: Case Report and Review of the Literature
by Felice Sorrentino, Teresa Silvestris, Francesca Greco, Lorenzo Vasciaveo, Guglielmo Stabile, Veronica Falcone, Andrea Etrusco, Antonio D’Amato, Antonio Simone Laganà and Luigi Nappi
Diagnostics 2024, 14(21), 2454; https://doi.org/10.3390/diagnostics14212454 - 1 Nov 2024
Viewed by 1244
Abstract
Intraplacental choriocarcinoma (IC) is a gestational trophoblastic neoplasia located within the placenta. Due to its silent presentation, more than half of the cases are diagnosed incidentally. An association with fetomaternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction has been found. The aim of [...] Read more.
Intraplacental choriocarcinoma (IC) is a gestational trophoblastic neoplasia located within the placenta. Due to its silent presentation, more than half of the cases are diagnosed incidentally. An association with fetomaternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction has been found. The aim of this review is to describe the clinical management of this rare condition stemming from a case report of an incidental diagnosis following an emergency cesarean section, and taking into account the available literature. Emergency interventions and examination of the placenta, even for the smallest IC lesion can ensure timely treatment and improve maternal and fetal outcomes. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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4 pages, 3006 KiB  
Interesting Images
Body Stalk Anomaly
by Nicolae Gică, Livia Mihaela Apostol, Iulia Huluță, Anca Maria Panaitescu, Ana Maria Vayna, Gheorghe Peltecu and Nicoleta Gana
Diagnostics 2024, 14(5), 518; https://doi.org/10.3390/diagnostics14050518 - 29 Feb 2024
Cited by 2 | Viewed by 2737
Abstract
Abdominal wall defects encompass three primary classifications: gastroschisis, omphalocele and anomalies resembling body stalk. Potential causative factors include early amnion rupture, amniotic bands, vascular disruptions or abnormal folding of the embryo. The prevalence of these defects stands at 1 in 14,000 live births. [...] Read more.
Abdominal wall defects encompass three primary classifications: gastroschisis, omphalocele and anomalies resembling body stalk. Potential causative factors include early amnion rupture, amniotic bands, vascular disruptions or abnormal folding of the embryo. The prevalence of these defects stands at 1 in 14,000 live births. Body stalk anomaly is characterized by a substantial abdominal defect coupled with spine and limb anomalies, along with a very short or absent umbilical cord. We present a case of a rare abdominal defect known as body stalk anomaly, the most severe form of this spectrum of diseases. The diagnosis of this anomaly was established during the first trimester of pregnancy. Subsequently, the patient opted for pregnancy termination and chose not to undergo genetic testing. The anatomo-pathological results confirmed the findings. Body stalk anomaly is not compatible with life; therefore, early identification and understanding the clinical implications of this rare anomaly for informed decision-making in prenatal care are very important. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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