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Management of Pregnancy Complications

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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: closed (20 August 2024) | Viewed by 15676

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Special Issue Editor

Prof. Dr. Ariel Many

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Guest Editor

1. Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
2. Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
Interests: high-risk pregnancy; preterm labor; fetal growth restriction

Special Issue Information

Dear Colleagues,

We are seeking papers on the topic of high-risk pregnancies, complications, and innovative treatments. High-risk pregnancies are those in which the mother, fetus, or both are at increased risk of complications or adverse outcomes. These can include preterm labor, preeclampsia, diabetes, fetal growth restriction, and many other medical and environmental conditions.

We welcome original research articles, reviews, case reports, and perspectives on any aspect of high-risk pregnancies, including (but not limited to):

Identification and management of high-risk pregnancies.
Predictive factors for adverse outcomes in high-risk pregnancies.
Novel diagnostic tools and interventions for high-risk pregnancies.
Innovative genetic and other fetal diagnostic tools.
Long-term outcomes for mothers and babies after high-risk pregnancies.
High risk deliveries, complications, and treatments.
Ethical considerations in managing high-risk pregnancies.

We welcome submissions from obstetricians, gynecologists, maternal–fetal medicine specialists, neonatologists, geneticists, endocrinologists, epidemiologists, and other researchers interested in high-risk pregnancies.

All submitted papers will undergo rigorous peer-review by our expert panel of reviewers. Accepted papers will be published in a Special Issue dedicated to high-risk pregnancies. We look forward to receiving your contributions.

Prof. Dr. Ariel Many
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

high-risk pregnancy
preterm labor
fetal growth restriction
gestational diabetes
twins
hypertensive disorders during pregnancy
preeclampsia
IUGR
prenatal genetics
congenital anomalies detection
cesarean section
complications of labor and delivery

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Published Papers (10 papers)

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Research

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11 pages, 3309 KiB

Open AccessArticle

Risk Factors for Failure of Second-Trimester Termination with Misoprostol as a Single Agent

by Veera Wisanumahimachai, Saipin Pongsatha, Latchee Chatchawarat and Theera Tongsong

J. Clin. Med. 2024, 13(17), 5332; https://doi.org/10.3390/jcm13175332 - 9 Sep 2024

Viewed by 1137

Abstract

Background: Understanding the potential risk factors for failure of pregnancy termination is crucial for informed clinical decision making. Such insights can assist clinicians in adjusting the dosage or route of various regimens, as well as in counseling patients and predicting the likelihood of successful outcomes. However, research on these risk factors has been limited, and existing studies have yielded inconsistent results. To address this gap, we conducted a study with a large sample size, focusing on identifying the potential risk factors for failure of second-trimester termination using misoprostol as a single agent, specifically between 14 and 28 weeks of gestation. Methods: A secondary analysis based on a database of second-trimester terminations was conducted. The inclusion criteria were a singleton pregnancy, gestational age between 14 and 28 weeks, an unfavorable cervix, no spontaneous labor pain, intact membranes, and termination with misoprostol alone. Potential risk factors for failure of termination, defined as no abortion within 48 h, were analyzed using univariate and multivariate analyses. Results: A total of 1094 cases were included in the analysis, consisting of 991 successful cases and 103 (9.4%) cases of failure. The significant risk factors for failure of termination included early gestational age, live fetuses, sublingual regimen of 400 mcg every 6 h, and high maternal pre-pregnancy BMI. Previous cesarean sections and lower Bishop scores tended to increase the risk but did not reach a significant level. Conclusions: Second-trimester termination with misoprostol as a single agent was highly effective, with a failure rate of 9.4%. The risk factors for failure included gestational age, fetal viability, misoprostol regimen, and maternal pre-pregnancy BMI, suggesting that these factors should be taken into consideration for second-trimester terminations with misoprostol. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

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9 pages, 411 KiB

Open AccessArticle

Time of Birth and the Risk of Adverse Maternal and Neonatal Outcomes—A Retrospective Cohort Study

by Anat Schwartz, Shiri Shinar, Amit Iton-Schwartz, Ronella Marom, Dror Mandel, Ayelet Dangot and Ariel Many

J. Clin. Med. 2024, 13(10), 2952; https://doi.org/10.3390/jcm13102952 - 17 May 2024

Viewed by 1101

Abstract

Objectives: To determine whether in a labor floor housed continuously by senior physicians the risk of adverse maternal and neonatal outcome is affected by time of delivery. Methods: This retrospective cohort study, conducted at a tertiary medical center, assessed singleton term deliveries from 1 January 2011 to 30 January 2020. Participants were categorized based on delivery timing, correlating with nursing shifts, to evaluate perinatal outcomes. The primary endpoint included adverse maternal outcomes such as emergency Cesarean section, anal sphincter injuries, blood product transfusions, and postpartum surgeries (laparotomy/laparoscopy). Secondary outcomes focused on neonatal health indicators, including low Apgar scores, ICU admissions, respiratory issues, extended hospital stays, and neurological complications. Results: 87,863 deliveries were available for analysis with equal distribution during the day. The risk of adverse composite maternal outcome was highest during the evening (aOR 1.25, 95% CI 1.18–1.32) and lowest during the night (aOR 0.94, 95% CI 0.88–0.99) compared to daytime deliveries. This difference was primarily driven by the highest rate of emergency CD in the evening. Neonatal outcomes were comparable, except for length of stay > 5 days, which was more frequent among newborns delivered during the evening and night shifts compared to the morning shift (aOR 1.19, 95% CI 1.07–1.33 and aOR 1.17, 95% CI 1.05–1.31, respectively). Conclusions: In term pregnancies, the evening shift is associated with the highest risk of adverse maternal and neonatal outcomes despite physician seniority. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

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12 pages, 1802 KiB

Open AccessArticle

The sFlt-1/PlGF Ratio at 12, 24, and 32 Weeks Gestation in Twin Pregnancies as a Predictor of Late Preterm Birth and Perinatal Event Secondary to Prematurity

by Elena Satorres-Pérez, Alicia Martínez-Varea, Blanca Novillo-Del Álamo, José Morales-Roselló and Vicente Diago-Almela

J. Clin. Med. 2024, 13(9), 2699; https://doi.org/10.3390/jcm13092699 - 4 May 2024

Cited by 1 | Viewed by 1378

Abstract

Background: Preterm birth impacts 60% of twin pregnancies, with the subsequent risk of complications in both newborns secondary to the immaturity of organs. This study aims to assess the utility of the sFlt-1/PlGF ratio throughout pregnancy in predicting late preterm birth and adverse perinatal outcomes related to prematurity in twin pregnancies. Methods: This is a prospective cohort study developed at a tertiary hospital. All pregnant women with a twin pregnancy who signed the informed consent were included. The sFlt-1/PlGF ratio was measured at 12, 24, and 32 weeks’ gestation. Results: Seventy patients were included, from which 54.3% suffered late preterm birth. Results revealed a significant difference in sFlt-1/PlGF ratio at week 32 between term and preterm groups, with a one-unit increase associated with a 1.11-fold increase in the probability of preterm birth. The sFlt-1/PlGF ratio at week 32 alone presented considerable predictive capacities (sensitivity of 71%, specificity of 72%, a PPV of 75%, and an NPV of 68%. Similarly, at week 24, a one-unit increase in sFlt-1/PlGF ratio was associated with a 1.24-fold increase in the probability of adverse perinatal events due to prematurity. Combining parity, maternal age, conception method, BMI, and chorionicity, the model yielded better predictive capacities (sensitivity of 82%, specificity of 80%, PPV of 58%, NPV of 93%). Conclusions: The potential of the sFlt-1/PlGF ratio as a predictive tool for preterm birth and adverse perinatal outcomes secondary to prematurity in twin pregnancies is underscored. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

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18 pages, 3243 KiB

Open AccessArticle

Changes in Maternal Heart Rate Variability and Photoplethysmography Morphology after Corticosteroid Administration: A Prospective, Observational Study

by Maretha Bester, Thomas J. Nichting, Rohan Joshi, Lamyae Aissati, Guid S. Oei, Massimo Mischi, Judith O. E. H. van Laar and Rik Vullings

J. Clin. Med. 2024, 13(8), 2442; https://doi.org/10.3390/jcm13082442 - 22 Apr 2024

Viewed by 1037

Abstract

Background: Owing to the association between dysfunctional maternal autonomic regulation and pregnancy complications, assessing non-invasive features reflecting autonomic activity—e.g., heart rate variability (HRV) and the morphology of the photoplethysmography (PPG) pulse wave—may aid in tracking maternal health. However, women with early pregnancy complications typically receive medication, such as corticosteroids, and the effect of corticosteroids on maternal HRV and PPG pulse wave morphology is not well-researched. Methods: We performed a prospective, observational study assessing the effect of betamethasone (a commonly used corticosteroid) on non-invasively assessed features of autonomic regulation. Sixty-one women with an indication for betamethasone were enrolled and wore a wrist-worn PPG device for at least four days, from which five-minute measurements were selected for analysis. A baseline measurement was selected either before betamethasone administration or sufficiently thereafter (i.e., three days after the last injection). Furthermore, measurements were selected 24, 48, and 72 h after betamethasone administration. HRV features in the time domain and frequency domain and describing heart rate (HR) complexity were calculated, along with PPG morphology features. These features were compared between the different days. Results: Maternal HR was significantly higher and HRV features linked to parasympathetic activity were significantly lower 24 h after betamethasone administration. Features linked to sympathetic activity remained stable. Furthermore, based on the PPG morphology features, betamethasone appears to have a vasoconstrictive effect. Conclusions: Our results suggest that administering betamethasone affects maternal autonomic regulation and cardiovasculature. Researchers assessing maternal HRV in complicated pregnancies should schedule measurements before or sufficiently after corticosteroid administration. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

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18 pages, 2507 KiB

Open AccessArticle

The sFlt-1/PlGF Ratio at 12, 24, and 32 Weeks Gestation in Twin Pregnancies as a Predictor of Placental Dysfunction

by Elena Satorres-Pérez, Alicia Martínez-Varea, Blanca Novillo-Del Álamo, José Morales-Roselló and Vicente Diago-Almela

J. Clin. Med. 2024, 13(6), 1784; https://doi.org/10.3390/jcm13061784 - 20 Mar 2024

Cited by 2 | Viewed by 1475

Abstract

Background: This study aims to assess the utility of the sFlt-1/PlGF ratio throughout pregnancy in predicting placental dysfunction and neonatal outcomes in twin pregnancies. Methods: Prospective study at a tertiary hospital. All pregnant women with a twin pregnancy who signed the informed consent were included. The sFlt-1/PlGF ratio was measured at 12, 24, and 32 weeks’ gestation. Results: Seventy patients were included, and 30% developed placental dysfunction. Differences were found in the mean sFlt-1/PlGF ratios at week 32 (13.6 vs. 31.8, p = 0.007). Optimal cutoffs at 12, 24, and 32 weeks to identify patients who develop placental dysfunction were 32.5, 8.5, and 30.5, respectively, with ORs of 4.25 (1.13–20.69 95% IC; p = 0.044), 13.5 (3.07–67.90 95% IC; p = 0.001), 14.29 (3.59–66.84 95% IC; p < 0.001). The sFlt-1/PlGF ratio at 32 weeks was associated with gestational age at birth. The sFlt-1/PlGF ratio in weeks 24 and 32 had a statistically significant negative correlation with the birth weight percentile in both twins. Conclusions: The potential of the sFlt-1/PlGF ratio as a predictive tool for placental dysfunction in twin pregnancies is underscored. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

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12 pages, 552 KiB

Open AccessArticle

The 300 versus 300 Study—Low Volume versus High Volume Single Balloon Catheter for Induction of Labor: A Retrospective Case-Control Study

by Maciej W. Socha, Wojciech Flis, Miłosz Pietrus, Mateusz Wartęga and Monika Szambelan

J. Clin. Med. 2023, 12(14), 4839; https://doi.org/10.3390/jcm12144839 - 22 Jul 2023

Cited by 1 | Viewed by 3606

Abstract

The use of a Foley catheter is one of the oldest known methods of labor induction. Therefore, protocols using different volumes of Foley catheter balloons have been developed and tested to accurately determine their effectiveness. In this study, it was decided to retrospectively evaluate two induction of labor (IOL) protocols. The last 300 eligible patients who met the criteria and underwent the low-volume balloon protocol (40–60 mL) IOL were selected. Then next, 300 patients who met the criteria and underwent high-volume balloon (80–100 mL) IOL were selected. Outcomes included time to delivery and parturition type, oxytocin augmentation, operative deliveries and application of intrapartum anesthesia. Overall, the majority of patients delivered within 24 h. Patients who received a high-volume Foley catheter had statistically significantly more vaginal deliveries. The mean-time to delivery in the high-volume catheter group was statistically significantly shorter than in the low-volume catheter group. Patients who received a high-volume Foley catheter required statistically significantly less oxytocin augmentation during induction of labor compared to patients with a low-volume Foley catheter. Regardless of the balloon volume used, the percentage of operative deliveries remained at a similar, low level (8.36% and 2.14%). Regardless of the catheter volume used, the majority of patients chose epidural over intravenous anesthesia. In conclusion, a high-volume balloon Foley catheter IOL is characterized by an increased percentage of vaginal deliveries, shortened time to delivery regardless of the type of delivery, and lower need for oxytocin augmentation. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

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Review

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12 pages, 1167 KiB

Open AccessReview

Historical Assessment, Practical Management, and Future Recommendations for Abnormal Amniotic Fluid Volumes

by Julie R. Whittington, Suneet P. Chauhan, Michael P. Wendel, Taylor L. Ghahremani, Megan E. Pagan, Meagen M. Carter and Everett F. Magann

J. Clin. Med. 2024, 13(16), 4702; https://doi.org/10.3390/jcm13164702 - 10 Aug 2024

Viewed by 933

Abstract

Objective: The purpose of this review is to examine the evidence that defines normal and abnormal amniotic fluid volumes (AFVs) and current recommendations on the management of abnormalities of AFV. Methods: The studies establishing normal actual AFVs and the ultrasound estimates used to identify normal and abnormal AFVs were evaluated. Recommendations from national and international organizations were reviewed for guidance on the definitions and management of abnormal AFVs. Results: A timeline of the development of the thresholds that define abnormal AFVs was created. Recommendations from 13 national and international guidelines were identified, but the definitions and management recommendations for abnormal AFVs varied considerably between groups. An algorithm for the management of oligohydramnios and polyhydramnios was developed. Knowledge gaps and the structure of future studies were examined. Conclusions: Assessment of AFV is performed multiple times per day in antenatal clinics and hospitals. Current recommendations on defining and managing abnormal AFVs differ between national and international organizations. We have proposed algorithms to assist in the management of abnormal AFVs until further studies can be undertaken. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

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20 pages, 886 KiB

Open AccessReview

Prevention of Pregnancy Complications Using a Multimodal Lifestyle, Screening, and Medical Model

by Jim Parker, Pierre Hofstee and Shaun Brennecke

J. Clin. Med. 2024, 13(15), 4344; https://doi.org/10.3390/jcm13154344 - 25 Jul 2024

Viewed by 1810

Abstract

Prevention of pregnancy complications related to the “great obstetrical syndromes” (preeclampsia, fetal growth restriction, spontaneous preterm labor, and stillbirth) is a global research and clinical management priority. These syndromes share many common pathophysiological mechanisms that may contribute to altered placental development and function. The resulting adverse pregnancy outcomes are associated with increased maternal and perinatal morbidity and mortality and increased post-partum risk of cardiometabolic disease. Maternal nutritional and environmental factors are known to play a significant role in altering bidirectional communication between fetal-derived trophoblast cells and maternal decidual cells and contribute to abnormal placentation. As a result, lifestyle-based interventions have increasingly been recommended before, during, and after pregnancy, in order to reduce maternal and perinatal morbidity and mortality and decrease long-term risk. Antenatal screening strategies have been developed following extensive studies in diverse populations. Multivariate preeclampsia screening using a combination of maternal, biophysical, and serum biochemical markers is recommended at 11–14 weeks’ gestation and can be performed at the same time as the first-trimester ultrasound and blood tests. Women identified as high-risk can be offered prophylactic low dose aspirin and monitored with angiogenic factor assessment from 22 weeks’ gestation, in combination with clinical assessment, serum biochemistry, and ultrasound. Lifestyle factors can be reassessed during counseling related to antenatal screening interventions. The integration of lifestyle interventions, pregnancy screening, and medical management represents a conceptual advance in pregnancy care that has the potential to significantly reduce pregnancy complications and associated later life cardiometabolic adverse outcomes. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

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15 pages, 1640 KiB

Open AccessSystematic Review

Is a Higher Amniotic Fluid Viral Load Associated with a Greater Risk of Fetal Injury in Congenital Cytomegalovirus Infection—A Systematic Review and Meta-Analysis

by Noa Gilad, Swati Agrawal, Eleni Philippopoulos, Kellie E. Murphy and Shiri Shinar

J. Clin. Med. 2024, 13(7), 2136; https://doi.org/10.3390/jcm13072136 - 7 Apr 2024

Cited by 1 | Viewed by 1161

Abstract

Background: Numerous studies have aimed to predict prenatal and neonatal outcomes for pregnancies complicated by congenital cytomegalovirus (CMV). Presently, assessing CMV severity prenatally relies largely on fetal imaging. A controversy exists regarding CMV viral load (VL) and its association with fetal and neonatal sequelae. Objective: To perform a systematic review and meta-analysis investigating the association between CMV DNA VL in amniotic fluid and fetal and neonatal outcomes in pregnancies with congenital CMV. Results: All cohort, case-control and observational studies that compared outcomes of fetuses with congenital CMV and provided information on individual patient CMV VL quantified in copies per milliliter (c/mL) from inception to January 2023 were included, with no geographical or language restrictions. A total of 1251 citations were reviewed with eight studies meeting inclusion criteria and included in meta-analysis. Affected pregnancies had a higher VL in the amniotic fluid compared to those unaffected with a mean difference of 2.2e+7 (range 1.5e+7 to 2.8e+7). In subgroup analysis, the VL was significantly higher in the fetuses, with imaging findings related to CMV compared to asymptomatic fetuses with a mean difference of 4.1e+7 (95% CI 2.8e+7–5.4e+7). However, among babies with congenital CMV, the VL was not significantly different between symptomatic and asymptomatic babies. Conclusions: Amniotic fluid CMV VL is associated with fetal sequalae in congenital CMV, with a higher VL conferring a greater risk for prenatal injury. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

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7 pages, 1192 KiB

Open AccessBrief Report

Fetal Renal Duplicated Collecting System at 14–16 Weeks of Gestation

by Nizar Khatib, Moshe Bronshtein, Gal Bachar, Ron Beloosesky, Yuval Ginsberg, Osnat Zmora, Zeev Weiner and Ayala Gover

J. Clin. Med. 2023, 12(22), 7124; https://doi.org/10.3390/jcm12227124 - 16 Nov 2023

Viewed by 1245

Abstract

(1) Background: To examine the incidence of the prenatal diagnosis of the renal double-collecting system (rDCS) and describe its clinical outcome and associated genetic abnormalities. (2) Methods: This retrospective study included women who attended the obstetric clinic for early fetal anatomic sonography with findings of a renal DCS. Diagnosis was conducted by an expert sonographer using defined criteria. (3) Results: In total, 29,268 women underwent early ultrasound anatomical screening at 14–16 weeks, and 383 cases of rDCS were diagnosed (prevalence: 1:76). Associated abnormalities were diagnosed in eleven pregnancies; four had chromosomal aberrations. No chromosomal abnormalities were reported in isolated cases. Ectopic uretrocele and dysplastic kidney were diagnosed in 6 (1.5%) and 5 (1.3%) fetuses, respectively. One girl was diagnosed with vesicoureteral reflux and recurrent UTIs, and two boys were diagnosed with undescended testis. The recurrence rate of rDCS was 8% in subsequent pregnancies. (4) Conclusions: In light of its benign nature, we speculate that isolated rDCS may be considered a benign anatomic variant, but a repeat examination in the third trimester is recommended to assess hydronephrosis. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

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