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Special Issue "Maternal and Perinatal Outcomes in High and Low Risk Pregnancies"

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: 25 June 2023 | Viewed by 2915

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Special Issue Editors

Dr. Ioannis Tsakiridis

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Guest Editor

3rd Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: maternal-fetal medicine; obstetrics; high risk pregnancy; epidemiology
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Themistoklis Dagklis

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Guest Editor

Third Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: obstetrics; fetal medicine; fetal monitoring; Doppler ultrasound; ultrasound; amniocentesis; chorionic villi sampling
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Prenatal care constitutes a major public health issue, both in high and medium/low income countries. Preterm birth, congenital anomalies, hypertensive disorders in pregnancy, fetal growth restriction and postpartum hemorrhage are the most severe complications in pregnancy. As science advances and experience is accumulating, new therapies are emerging and new algorithms are proposed to clasify pregnancies based of the risk of developing complications. At the same time, populations in high-income countries include more and more women that are older, with higher BMI and pre-existing morbidities.

The aim of this special issue was to present recent evidence on the perinatal outcomes in populations considered low risk or high risk. This includes populations with preexisting morbidities, i.e. obesity, diabetes mellitus, metabolic syndrome, congenital heart disease, autoimmune disease, but also advanced maternal age, history of preterm birth or stilbirth.

Studies reporting perinatal outcomes of interest, preterm birth, macrosomia, small for gestational age neonates are of particular interest.

Furthermore, reviews or meta-analyses of studies addressing less common conditions or outcomes help developing new strategies for the antenatal surveillance of these cases.

Dr. Ioannis Tsakiridis
Prof. Dr. Themistoklis Dagklis
Guest Editors

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. Medicina is an international peer-reviewed open access monthly 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 1800 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
obstetric medicine
pregnancy complications
perinatal commorbidities

Published Papers (3 papers)

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Research

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Open AccessArticle

Management of Pregnancy with Cervical Shortening: Real-Life Clinical Challenges

and

Medicina 2023, 59(4), 653; https://doi.org/10.3390/medicina59040653 - 26 Mar 2023

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Abstract

Background and Objectives: Preterm birth is the leading cause of neonatal mortality worldwide and may be responsible for lifelong morbidities in the survivors. Cervical shortening is one of the common pathways to preterm birth associated with its own diagnostic and management challenges. The preventive modalities that have been tested include progesterone supplementation and cervical cerclage and pessaries. The study aimed to assess the management strategies and outcomes in a group of patients with a short cervix during pregnancy or cervical insufficiency. Materials and Methods: Seventy patients from the Riga Maternity Hospital in Riga, Latvia, were included in the prospective longitudinal cohort study between 2017 and 2021. Patients were treated with progesterone, cerclage, and/or pessaries. The signs of intra-amniotic infection/inflammation were assessed, and antibacterial therapy was given when the signs were positive. Results: The rates of PTB were 43.6% (n = 17), 45.5% (n = 5), 61.1% (n = 11), and 50.0% (n = 1) in progesterone only, cerclage, pessary, and cerclage plus pesssary groups, respectively. The progesterone therapy was associated with a reduced preterm birth risk (x2(1) = 6.937, p = 0.008)), whereas positive signs of intra-amniotic infection/inflammation significantly predicted the risk of preterm birth (p = 0.005, OR = 3.82, 95% [CI 1.31–11.11]). Conclusions: A short cervix and bulging membranes, both indicators of intra-amniotic infection/inflammation, are the key risk factors in preterm birth risk predictions. Progesterone supplementation should remain at the forefront of preterm birth prevention. Among patients with a short cervix and especially complex anamnesis, the preterm rates remain high. The successful management of patients with cervical shortening lies between the consensus-based approach for screening, follow-up, and treatment on the one side and personalising medical therapy on the other. Full article

(This article belongs to the Special Issue Maternal and Perinatal Outcomes in High and Low Risk Pregnancies)

Open AccessArticle

Investigation of The Effects of Oxytocin Administration Timing on Postpartum Hemorrhage during Cesarean Section

Soner Gök

and

Mehmet Babür Kaleli

Medicina 2023, 59(2), 222; https://doi.org/10.3390/medicina59020222 - 24 Jan 2023

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Abstract

Background and Objectives: To determine and compare the effects of the timing of oxytocin administration (routinely used for intraoperative uterotonic purposes in cesarean section (CS) deliveries in our clinic) on the severity of postpartum hemorrhage following CS. Materials and Methods: All study participants (n = 216) had previous cesarean deliveries, were 38–40 weeks pregnant, and had CS planned under elective conditions. The cases were randomly divided into two groups: one group (n = 108) receiving oxytocin administration before the removal of the placenta (AOBRP) and another group (n = 108) receiving oxytocin administration after the removal of the placenta (AOARP). In all cases, the placenta was removed using the manual traction method. The standard dose of oxytocin is administered as an intravenous (IV) push of 3 international units (IU); simultaneously, 10 IU of oxytocin is added to 1000 cc isotonic fluid and given as an IV infusion at a rate of 250 cc/h. All methods and procedures applied to both groups were identical, except for the timing of administration of the standard oxytocin dose. Age, body mass index (BMI), parity, gestational week, preoperative hemoglobin (HB) and hematocrit (HTC), postoperative 6th and 24th hour HB-HTC, intraoperative hemorrhage, additional uterotonic need during cesarean section, postoperative hemorrhage (number of pads), need for blood transfusion during or after cesarean section, cesarean section time, and postpartum newborn baby weight were evaluated. Results: Age (year), BMI (kg/m²), parity, gestational week, surgical time, and newborn weight (g) did not differ between the groups (p > 0.05). The AOBRP group had significantly higher postoperative 6th hour HB and HTC and postoperative 24th hour HB and HTC values (p < 0.05). The intraoperative hemorrhage level was higher in the AOARP group (p = 0.000). Conclusions: The administration of oxytocin before placenta removal did not change the volume of bleeding in the postoperative period but significantly reduced the volume of bleeding in the intraoperative period. Therefore, in the postoperative period, the HB and HTC values of the AOBRP group were higher than those of the AOARP group. Full article

(This article belongs to the Special Issue Maternal and Perinatal Outcomes in High and Low Risk Pregnancies)

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Open AccessCase Report

Foetal Intrapartum Compromise at Term: Could COVID-19 Infection Be Involved? A Case Report

Adrian-Ioan Toma

Bashar Haj Hamoud

Caliopia Gavril-Parfene

Mihaela Farcaş

Romina-Marina Sima

and

Liana Ples

Medicina 2023, 59(3), 552; https://doi.org/10.3390/medicina59030552 - 11 Mar 2023

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Abstract

The impact of the SARS-CoV-2 infection on pregnancy has been studied and many reports have been published, mainly focussing on complications and in utero transmission with neonatal consequences. Although the effects of other viruses on foetuses are well known, the impact of maternal COVID-19 during pregnancy is not completely understood. We report a case of acute foetal intrapartum hypoxia without other risk factors than maternal COVID-19 disease 2 weeks previous to birth at term. Placental histological changes suggested that the viral infection could have been the culprit for the unfavourable outcome during labour. The neonate was promptly delivered by Caesarean section. Neonatal intensive care was started, including therapeutic hypothermia. The procedure was successful, the evolution of the neonate was favourable, and she was discharged after 10 days. Follow-up at 2 months of life indicated a normal neurological development but a drop in head growth. The case raises the idea that pregnancies with even mild COVID-19 symptoms may represent the cause of neonate compromise in a low-risk pregnancy. An important follow-up in the neonatal period and infancy is required to identify and treat any subsequent conditions. Further long-term studies are necessary to identify a cause–effect relationship between COVID-19 pregnancies and the whole spectrum of neonatal and infant consequences. Full article

(This article belongs to the Special Issue Maternal and Perinatal Outcomes in High and Low Risk Pregnancies)

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