Diagnosis, Evaluation, and Management of Diseases during Pregnancy

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

Deadline for manuscript submissions: closed (20 March 2023) | Viewed by 84767

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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
Special Issues, Collections and Topics in MDPI journals

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,

How an individual’s associated comorbidity can affect their pregnancy has always been an essential concern of medical specialists. The presence of these health conditions, no matter how minor, requires additional evaluation and appropriate treatment to avoid complications. They can worsen throughout the gestation period, influencing maternal health status, the evolution of pregnancy, and the outcome of birth. The perinatologist will evaluate the pathology in collaboration with the specialist to reach the most favorable outcome for the patient and the fetus. The purpose of this Special Issue is to share current management strategies regarding maternal-associated pathology from personal acquired experience and guidelines worldwide. This Issue allows specialists worldwide to make public results of state-of-the-art research in prenatal care in cases with comorbidities. Despite success in understanding pathophysiology and treatment development of multiple pathological conditions over the last few decades, many questions remain unsolved.

This Special Issue collects papers reflecting further progress in this field, in the form of original research manuscripts, short communications of preliminary but significant results, reviews, and case reports.

This Special Issue has been closed, and we have opened part II as the continuation. Please access on Special Issue "Diagnosis, Evaluation, and Management of Diseases during Pregnancy: Part II".

Prof. Dr. Marius L. Craina
Dr. Elena Bernad
Guest Editors

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Keywords

  • pregnancy
  • fetus prenatal care
  • high-risk
  • pathology
  • genetics
  • endocrine system diseases
  • nutrition disorders
  • cardiovascular diseases
  • female urogenital diseases
  • immune system diseases
  • infections
  • neoplasms

Published Papers (31 papers)

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12 pages, 1604 KiB  
Article
Unraveling the Efficacy of Therapeutic Interventions for Short Cervix: Insights from a Retrospective Study for Improved Clinical Management
by Alina-Madalina Luca, Elena Bernad, Dragos Nemescu, Cristian Vaduva, Anamaria Harabor, Ana-Maria Adam, Valeriu Harabor, Aurel Nechita, Cristina Strobescu, Raluca Mogos, Alexandru Carauleanu, Ingrid-Andrada Vasilache and Demetra Socolov
Medicina 2023, 59(6), 1018; https://doi.org/10.3390/medicina59061018 - 24 May 2023
Viewed by 1185
Abstract
Background and Objectives: Preterm birth (PTB) is associated with important neonatal mortality and morbidity. The aim of this study was to retrospectively evaluate the average treatment effects on the treated and the efficacity of various therapeutic interventions for PTB in a cohort [...] Read more.
Background and Objectives: Preterm birth (PTB) is associated with important neonatal mortality and morbidity. The aim of this study was to retrospectively evaluate the average treatment effects on the treated and the efficacity of various therapeutic interventions for PTB in a cohort of patients with singleton pregnancies and short cervical lengths. Materials and Methods: This observational retrospective study included 1146 singleton pregnancies at risk of PTB that were segregated into the following groups: intravaginal progesterone (group 1), Arabin pessary (group 2), McDonald cerclage (group 3), intravaginal progesterone and Arabin pessary (group 4), and intravaginal progesterone and cerclage (group 5). Their treatment effects were evaluated and compared. Results: All evaluated therapeutic interventions significantly reduced the occurrence of late and early preterm births. The risk of late and early PTB was lowered for those pregnant patients who received progesterone and pessaries or progesterone and cerclage in comparison with those who received only progesterone. The extremely PTB risk of occurrence was significantly lowered only by the administration of progesterone in association with cervical cerclage in comparison with progesterone monotherapy. Conclusions: The combined therapeutic interventions had the highest efficacy in preventing preterm birth. An individualized evaluation is needed to establish the best therapeutic approach in particular cases. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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14 pages, 4308 KiB  
Article
Assessment of the Particularities of Thrombophilia in the Management of Pregnant Women in the Western Part of Romania
by Miruna Samfireag, Cristina Potre, Ovidiu Potre, Lavinia-Cristina Moleriu, Izabella Petre, Ema Borsi, Teodora Hoinoiu, Marius Preda, Tudor-Alexandru Popoiu and Andrei Anghel
Medicina 2023, 59(5), 851; https://doi.org/10.3390/medicina59050851 - 28 Apr 2023
Cited by 1 | Viewed by 1404
Abstract
Background and objectives: Thrombophilia in pregnant women is a condition whose incidence is constantly increasing worldwide, and, under these conditions, the development of preventive procedures is becoming essential. In this study, we aimed to evaluate thrombophilia in pregnant women in the western [...] Read more.
Background and objectives: Thrombophilia in pregnant women is a condition whose incidence is constantly increasing worldwide, and, under these conditions, the development of preventive procedures is becoming essential. In this study, we aimed to evaluate thrombophilia in pregnant women in the western part of Romania and to establish anthropometric characteristics, socioeconomic features, and genetic and risk factors. Material and Methods: 178 pregnant women were divided into three study groups, according to the type of thrombophilia, aiming to carry out the genetic profile and the acquired one. Anthropometric measures and biological tests were performed. Results: The mixed type of thrombophilia predominates. The particularities of pregnant women diagnosed with thrombophilia are higher age, living in an urban environment, with normal BMI, approximately 36 weeks of gestational period, and having at least one miscarriage. Regarding the most frequent thrombophilic genetic markers, we obtained the MTFHR gene mutation C677T and A1298C, followed by the PAI-1 4G/5G gene mutation. Smoking represents an aggravating factor in the evolution of this pathology, manifested through the increase of D-dimers and the decrease in antithrombin values, simultaneously with the increase in therapeutic need. Conclusions: The predominance of MTHFR and PAI-1 4G/5G gene polymorphism is a particularity of pregnant women with thrombophilia from the western part of Romania. Smoking is confirmed as an important risk factor in spontaneous abortion. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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9 pages, 795 KiB  
Article
Managing Fetal Ovarian Cysts: Clinical Experience with a Rare Disorder
by Alina-Sinziana Melinte-Popescu, Radu-Florin Popa, Valeriu Harabor, Aurel Nechita, AnaMaria Harabor, Ana-Maria Adam, Ingrid-Andrada Vasilache, Marian Melinte-Popescu, Cristian Vaduva and Demetra Socolov
Medicina 2023, 59(4), 715; https://doi.org/10.3390/medicina59040715 - 06 Apr 2023
Cited by 3 | Viewed by 1782
Abstract
Background and Objectives: Fetal ovarian cysts (FOCs) are a very rare pathology that can be associated with maternal–fetal and neonatal complications. The aim of this study was to assess the influence of ultrasound characteristics on FOC evolution and therapeutic management. Materials and [...] Read more.
Background and Objectives: Fetal ovarian cysts (FOCs) are a very rare pathology that can be associated with maternal–fetal and neonatal complications. The aim of this study was to assess the influence of ultrasound characteristics on FOC evolution and therapeutic management. Materials and Methods: We included cases admitted to our perinatal tertiary center between August 2016 and December 2022 with a prenatal or postnatal ultrasound evaluation indicative of FOC. We retrospectively analyzed the pre- and postnatal medical records, sonographic findings, operation protocols, and pathology reports. Results: This study investigated 20 cases of FOCs, of which 17 (85%) were diagnosed prenatally and 3 (15%) postnatally. The mean size of prenatally diagnosed ovarian cysts was 34.64 ± 12.53 mm for simple ovarian cysts and 55.16 ± 21.01 mm for complex ovarian cysts (p = 0.01). The simple FOCs ≤ 4 cm underwent resorption (n = 7, 70%) or size reduction (n = 3, 30%) without complications. Only 1 simple FOC greater than 4 cm reduced its size during follow-up, while 2 cases (66.6%) were complicated with ovarian torsion. Complex ovarian cysts diagnosed prenatally underwent resorption in only 1 case (25%), reduced in size in 1 case (25%), and were complicated with ovarian torsion in 2 cases (50%). Moreover, 2 simple (66.6%) and 1 complex (33.3%) fetal ovarian cysts were postnatally diagnosed. All of these simple ovarian cysts had a maximum diameter of ≤4 cm, and all of them underwent size reduction. The complex ovarian cyst of 4 cm underwent resorption during follow-up. Conclusions: Symptomatic neonatal ovarian cysts, as well as those that grow in size during sonographic follow-up, are in danger of ovarian torsion and should be operated on. Complex cysts and large cysts (with >4 cm diameter) could be followed up unless they become symptomatic or increase in dimensions during serial ultrasounds. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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7 pages, 1211 KiB  
Article
Maternal Periodontal Status as a Factor Influencing Obstetrical Outcomes
by Petra Völgyesi, Márta Radnai, Gábor Németh, Krisztina Boda, Elena Bernad and Tibor Novák
Medicina 2023, 59(3), 621; https://doi.org/10.3390/medicina59030621 - 20 Mar 2023
Cited by 1 | Viewed by 1551
Abstract
Background and Objectives: Preterm birth as a complex phenomenon is influenced by numerous endogenic and exogenic factors, although its exact cause often remains obscure. According to epidemiological studies, maternal periodontal diseases, in addition to affecting general health, can also cause adverse pregnancy outcomes. [...] Read more.
Background and Objectives: Preterm birth as a complex phenomenon is influenced by numerous endogenic and exogenic factors, although its exact cause often remains obscure. According to epidemiological studies, maternal periodontal diseases, in addition to affecting general health, can also cause adverse pregnancy outcomes. Nonetheless, the existing results in the literature regarding this topic remain controversial. Consequently, our study aimed to determine the connection between poor maternal periodontal status and neonatal birth weight. Materials and Methods: A total of 111 primigravida–primiparous pregnant, healthy women underwent a periodontal examination in the second trimester of their pregnancies. Probing depth (PD) and bleeding on probing (BOP) were determined, and based on these diagnostic measurements, the patients were divided into three subgroups according to their dental status: healthy (H, n = 17), gingivitis (G, n = 67), and periodontitis (P, n = 27). Results: Considering that poor maternal oral status is an influencing factor for obstetrical outcomes, the presence of PD and BOP (characterized by the sulcus bleeding index, SBI) was evaluated. In the case of P, defined as PD ≥ 4 mm in at least one site and BOP ≥ 50% of the teeth, a significant correlation between BOP and a low neonatal birth weight at delivery (p = 0.001) was found. An analysis of the relationship between SBI and gestational age (GA) at the time of the periodontal examination in the different dental status groups showed a significant correlation between these parameters in the G group (p = 0.04). Conclusions: Our results suggest that a worse periodontal status during pregnancy may negatively affect obstetrical outcomes, especially the prematurity rate and newborn weight. Therefore, the importance of periodontal screening to prevent these complications is undeniable. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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14 pages, 1329 KiB  
Article
Early Onset Intrauterine Growth Restriction—Data from a Tertiary Care Center in a Middle-Income Country
by Marina Dinu, Anne Marie Badiu, Andreea Denisa Hodorog, Andreea Florentina Stancioi-Cismaru, Mihaela Gheonea, Razvan Grigoras Capitanescu, Ovidiu Costinel Sirbu, Florentina Tanase, Elena Bernad and Stefania Tudorache
Medicina 2023, 59(1), 17; https://doi.org/10.3390/medicina59010017 - 21 Dec 2022
Cited by 2 | Viewed by 2188
Abstract
Background and Objectives: In this study, we aimed to describe the clinical and ultrasound (US) features and the outcome in a group of patients suspected of or diagnosed with early onset intrauterine growth restriction (IUGR) requiring iatrogenic delivery before 32 weeks, having no structural [...] Read more.
Background and Objectives: In this study, we aimed to describe the clinical and ultrasound (US) features and the outcome in a group of patients suspected of or diagnosed with early onset intrauterine growth restriction (IUGR) requiring iatrogenic delivery before 32 weeks, having no structural or genetic fetal anomalies, managed in our unit. A secondary aim was to report the incidence of the condition in the population cared for in our hospital, data on immediate postnatal follow-up in these cases and to highlight the differences required in prenatal and postnatal care. Materials and Methods: We used as single criteria for defining the suspicion of early IUGR the sonographic estimation of fetal weight < p10 using the Hadlock 4 technique at any scan performed before 32 weeks’ gestation (WG). We used a cohort of patients having a normal evolution in pregnancy and uneventful vaginal births as controls. Data on pregnancy ultrasound, characteristics and neonatal outcomes were collected and analyzed. We hypothesized that the gestational age (GA) at delivery is related to the severity of the condition. Therefore, we performed a subanalysis in two subgroups, which were divided based on the GA at iatrogenic delivery (between 27+0 WG and 29+6 WG and 30+0–32+0 WG, respectively). Results: The prospective cohort study included 36 pregnancies. We had three cases of intrauterine fetal death (8.3%). The incidence was 1.98% in our population. We confirmed that severe cases (very early diagnosed and delivered) were associated with a higher number of prenatal visits and higher uterine arteries (UtA) pulsatility index (PI) centile in the third trimester—TT (compared with the early diagnosed and delivered). In the very early suspected IUGR subgroup, the newborns required significantly more NICU days and total hospitalization days. Conclusions: Patients with isolated very early and early IUGR—defined as ultrasound (US) estimation of fetal weight < p10 using the Hadlock 4 technique requiring iatrogenic delivery before 32 weeks’ gestation—require closer care prenatally and postnatally. These patients represent an economical burden for the health system, needing significantly longer hospitalization intervals, GA at birth and UtA PI centiles being related to it. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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10 pages, 476 KiB  
Article
Effect of Lipid-Based Multiple Micronutrients Supplementation in Underweight Primigravida Pre-Eclamptic Women on Maternal and Pregnancy Outcomes: Randomized Clinical Trial
by Nabila Sher, Murad A. Mubaraki, Hafsa Zafar, Rubina Nazli, Mashal Zafar, Sadia Fatima and Fozia Fozia
Medicina 2022, 58(12), 1772; https://doi.org/10.3390/medicina58121772 - 30 Nov 2022
Cited by 1 | Viewed by 1495
Abstract
Background and Objectives: In pre-eclampsia, restricted blood supply due to the lack of trophoblastic cell invasion and spiral artery remodeling is responsible for adverse pregnancies and maternal outcomes, which is added to by maternal undernutrition. This study was designed to observe the effect [...] Read more.
Background and Objectives: In pre-eclampsia, restricted blood supply due to the lack of trophoblastic cell invasion and spiral artery remodeling is responsible for adverse pregnancies and maternal outcomes, which is added to by maternal undernutrition. This study was designed to observe the effect of multiple nutritional micronutrient supplements on the pregnancy outcomes of underweight pre-eclamptic women. To investigate the effects of lipid-based multiple micr supplementations (LNS-PLW) on pregnancy and maternal outcomes in underweight primigravida pre-eclamptic women. Materials and Methods: A total of 60 pre-eclamptic, underweight primigravida women from the antenatal units of tertiary care hospitals in the Khyber Pakhtunkhwa Province, Pakistan, were randomly divided into two groups (Group 1 and Group 2). The participants of both groups were receiving routine treatment for pre-eclampsia: iron (60 mgs) and folic acid (400 ug) IFA daily. Group 2 was given an additional sachet of 75 gm LNS-PLW daily till delivery. The pregnancy outcomes of both groups were recorded. The clinical parameters, hemoglobin, platelet count, and proteinuria were measured at recruitment. Results: The percentage of live births in Group 2 was 93% compared to 92% in Group 1. There were more normal vaginal deliveries (NVDs) in Group 2 compared to Group 1 (Group 2, 78% NVD; group 1, 69% NVD). In Group 1, 4% of the participants developed eclampsia. The frequency of cesarean sections was 8/26 (31%) in Group 1 and 6/28 (22%) in Group 2. The number of intrauterine deaths (IUDs) was only 1/28 (4%) in Group 2, while it was 2/26 (8%) in Group 1. The gestational age at delivery significantly improved with LNS-PLW supplementation (Group 2, 38.64 ± 0.78 weeks; Group 1, 36.88 ± 1.55 weeks, p-value 0.006). The Apgar score (Group 2, 9.3; Group 1, 8.4) and the birth weight of the babies improved with maternal supplementation with LNS-PLW (Group 2, 38.64 ± 0.78 weeks: Group 1, 36.88 ± 1.55; p-value 0.003). There was no significant difference in systolic blood pressure, while diastolic blood pressure (Group 2, 89.57 ± 2.08 mmHg; Group 1, 92.17 ± 5.18 mmHg, p-value 0.025) showed significant improvement with LNS-PLW supplementation. The hemoglobin concentration increased with the LNS-PLW supplement consumed in Group 2 (Group 2, 12.15 ± 0.78 g/dL; Group 1, 11.39 ± 0.48 g/dL, p-value < 0.001). However, no significant difference among the platelet counts of the two groups was observed. Conclusions: The pregnancy and maternal outcomes of underweight pre-eclamptic women can be improved by the prenatal daily supplementation of LNS-PLW during pregnancy, along with IFA and regular antenatal care and follow-up. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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8 pages, 676 KiB  
Article
Perineal Massage during Pregnancy for the Prevention of Postpartum Urinary Incontinence: Controlled Clinical Trial
by María Álvarez-González, Raquel Leirós-Rodríguez, Lorena Álvarez-Barrio and Ana F. López-Rodríguez
Medicina 2022, 58(10), 1485; https://doi.org/10.3390/medicina58101485 - 19 Oct 2022
Cited by 2 | Viewed by 2624
Abstract
Background and objectives: Urinary incontinence is any involuntary loss of urine. It may result in anxiety, depression, low self-esteem and social isolation. Perineal massage has spread as a prophylactic technique for treating complications during labor. Acknowledged effects of perineal massage are reduction [...] Read more.
Background and objectives: Urinary incontinence is any involuntary loss of urine. It may result in anxiety, depression, low self-esteem and social isolation. Perineal massage has spread as a prophylactic technique for treating complications during labor. Acknowledged effects of perineal massage are reduction of incidence and severity of perineal tear and use of equipment directly related to the intrapartum perineal trauma. The aim of this study was to determine the effectiveness of massage in urinary incontinence prevention and identification of possible differences in its form of application (self-massage or by a physiotherapist), with the previous assumption that it is effective and that there are differences between the different forms of application. Materials and Methods: A controlled clinical trial with a sample of 81 pregnant women was conducted. The participants were divided into three groups: a group that received the massage applied by a specialized physiotherapist, another group that applied the massage to themselves, and a control group that only received ordinary obstetric care. Results: No differences were identified in the incidence or severity of urinary incontinence among the three groups. The severity of the incontinence was only affected by the body mass index and the weight of the baby at the time of delivery. Conclusions: A relationship between perineal massage interventions and development of urinary incontinence has not been observed. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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9 pages, 333 KiB  
Article
A Cross-Sectional Study Examining the Association between Physical Activity and Perinatal Depression
by Irene Soto-Fernández, Sagrario Gómez-Cantarino, Benito Yáñez-Araque, Jorge Sánchez-Infante, Alejandra Zapata-Ossa and Mercedes Dios-Aguado
Medicina 2022, 58(9), 1174; https://doi.org/10.3390/medicina58091174 - 29 Aug 2022
Cited by 2 | Viewed by 1869
Abstract
Background and Objectives: International organisations recommend that women without illness should have regular moderate-intensity physical exercise throughout their pregnancy and postpartum period as a measure to prevent possible pathologies in both the mother and the newborn. Physical activity during pregnancy reduces the likelihood [...] Read more.
Background and Objectives: International organisations recommend that women without illness should have regular moderate-intensity physical exercise throughout their pregnancy and postpartum period as a measure to prevent possible pathologies in both the mother and the newborn. Physical activity during pregnancy reduces the likelihood of depression during pregnancy and after childbirth, benefiting both the pregnant woman and the foetus. However, most pregnant women are known to be inactive. The Pregnancy Physical Activity Questionnaire (PPAQ) analyses the level of physical activity of pregnant women. These data are correlated with the variable depression, for which the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy was used. Materials and Methods: The research employed a cross sectional study design on ninety-nine pregnant women. Results: The data on physical activity in relation to depression in those pregnant women who had not previously suffered from depression were 719.29 METS min/wk compared with 624.62 METS min/wk in those who had. And for pregnant women who suffered from depression at the time of the study, their physical activity was 698.25 METS min/wk, while those who did not suffer from depression reached 826.57 METS. Conclusions: Pregnant women without depression are much more active. A favourable employment situation or a high level of education is directly related to higher physical activity. Physical activity and higher energy expenditure occur at home, as opposed to activity carried out as transport, exercise or at work. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
10 pages, 552 KiB  
Article
Umbilical Cord Biometry and Fetal Abdominal Skinfold Assessment as Potential Biomarkers for Fetal Macrosomia in a Gestational Diabetes Romanian Cohort
by Andreea Roxana Florian, Gheorghe Cruciat, Georgiana Nemeti, Adelina Staicu, Cristina Suciu, Mariam Chaikh Sulaiman, Iulian Goidescu, Daniel Muresan and Florin Stamatian
Medicina 2022, 58(9), 1162; https://doi.org/10.3390/medicina58091162 - 26 Aug 2022
Viewed by 1949
Abstract
Backgroundand Objectives: Gestational diabetes mellitus (GDM) is a pregnancy-associated pathology commonly resulting in macrosomic fetuses, a known culprit of obstetric complications. We aimed to evaluate the potential of umbilical cord biometry and fetal abdominal skinfold assessment as screening tools for fetal macrosomia [...] Read more.
Backgroundand Objectives: Gestational diabetes mellitus (GDM) is a pregnancy-associated pathology commonly resulting in macrosomic fetuses, a known culprit of obstetric complications. We aimed to evaluate the potential of umbilical cord biometry and fetal abdominal skinfold assessment as screening tools for fetal macrosomia in gestational diabetes mellitus pregnant women. Materials and methods: This was a prospective case–control study conducted on pregnant patients presenting at 24–28 weeks of gestation in a tertiary-level maternity hospital in Northern Romania. Fetal biometry, fetal weight estimation, umbilical cord area and circumference, areas of the umbilical vein and arteries, Wharton jelly (WJ) area and abdominal fold thickness measurements were performed. Results: A total of 51 patients were enrolled in the study, 26 patients in the GDM group and 25 patients in the non-GDM group. There was no evidence in favor of umbilical cord area and WJ amount assessments as predictors of fetal macrosomia (p > 0.05). However, there was a statistically significant difference in the abdominal skinfold measurement during the second trimester between macrosomic and normal-weight newborns in the GDM patient group (p = 0.016). The second-trimester abdominal circumference was statistically significantly correlated with fetal macrosomia at term in the GDM patient group with a p value of 0.003, as well as when considering the global prevalence of macrosomia in the studied populations, 0.001, when considering both populations. Conclusions: The measurements of cord and WJ could not be established as predictors of fetal macrosomia in our study populations, nor differentiate between pregnancies with and without GDM. Abdominal skinfold measurement and abdominal circumference measured during the second trimester may be important markers of fetal metabolic status in pregnancies complicated by GDM. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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8 pages, 307 KiB  
Article
The Impact of Ethnicity on Fetal and Maternal Outcomes of Gestational Diabetes
by Tiziana Filardi, Maria Cristina Gentile, Vittorio Venditti, Antonella Valente, Enrico Bleve, Carmela Santangelo and Susanna Morano
Medicina 2022, 58(9), 1161; https://doi.org/10.3390/medicina58091161 - 25 Aug 2022
Viewed by 1580
Abstract
Background and Objectives: The prevalence of gestational diabetes mellitus (GDM) significantly varies across different ethnic groups. In particular, Africans, Latinos, Asians and Pacific Islanders are the ethnic groups with the highest risk of GDM. The aim of this study was to evaluate [...] Read more.
Background and Objectives: The prevalence of gestational diabetes mellitus (GDM) significantly varies across different ethnic groups. In particular, Africans, Latinos, Asians and Pacific Islanders are the ethnic groups with the highest risk of GDM. The aim of this study was to evaluate the impact of ethnicity on pregnancy outcomes in GDM. Patients and Methods: n = 399 patients with GDM were enrolled, n = 76 patients of high-risk ethnicity (HR-GDM), and n = 323 of low-risk ethnicity (LR-GDM). Clinical and biochemical parameters were collected during pregnancy until delivery. Fetal and maternal short-term outcomes were evaluated. Results: HR-GDM had significantly higher values of glycosylated hemoglobin checked at 26–29 weeks of gestation (p < 0.001). Gestational age at delivery was significantly lower in HR-GDM (p = 0.03). The prevalence of impaired fetal growth was significantly higher in HR-GDM than LR-GDM (p = 0.009). In logistic regression analysis, the likelihood of impaired fetal growth was seven times higher in HR-GDM than in LR-GDM, after adjustment for pre-pregnancy BMI and gestational weight gain (OR = 7.1 [2.0–25.7] 95% CI, p = 0.003). Conclusions: HR-GDM had worse pregnancy outcomes compared with LR-GDM. An ethnicity-tailored clinical approach might be effective in reducing adverse outcomes in GDM. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
8 pages, 492 KiB  
Article
The Hematopoietic Effect of Ninjinyoeito (TJ-108), a Traditional Japanese Herbal Medicine, in Pregnant Women Preparing for Autologous Blood Storage
by Eriko Fukuda, Takuya Misugi, Kohei Kitada, Megumi Fudaba, Yasushi Kurihara, Mie Tahara, Akihiro Hamuro, Akemi Nakano, Masayasu Koyama and Daisuke Tachibana
Medicina 2022, 58(8), 1083; https://doi.org/10.3390/medicina58081083 - 11 Aug 2022
Viewed by 1526
Abstract
Background and Objectives: There are no reports showing the hematopoietic effect of TJ-108 on pregnant women. The aim of this study was to investigate the effect of TJ-108 on the hemoglobin and hematocrit levels, and white blood cell and platelet counts of pregnant [...] Read more.
Background and Objectives: There are no reports showing the hematopoietic effect of TJ-108 on pregnant women. The aim of this study was to investigate the effect of TJ-108 on the hemoglobin and hematocrit levels, and white blood cell and platelet counts of pregnant women complicated with placenta previa who were managed with autologous blood storage for cesarean section. Materials and Methods: We studied two groups of patients who were complicated with placenta previa and who underwent cesarean delivery. Group A consisted of women who were treated with oral iron medication (100 mg/day), and Group B consisted of women who were treated with TJ-108 at a dose of 9.0 g per day, in addition to oral iron medication, from the first day of blood storage until the day before cesarean delivery. To evaluate the effect of TJ-108, the patients’ red blood cell (RBC); Hb; hematocrit (Ht); white blood cell (WBC); and platelet count (PLT) levels were measured 7 days after storage and at postoperative days (POD) 1 and 5. Results: The study included 65 individuals, 38 in group A and 27 in group B. At the initial storage, a 0.2 g/dL reduction in Hb levels was observed, as compared to the initial Hb levels, in the TJ-108 treated patients, whereas a 0.6 g/dL reduction in Hb levels was observed in the non-TJ-108 treated group. On the other hand, regarding the second and subsequent storages, no significant difference was found in the decrease in the Hb levels of both groups. Conclusions: This study is the first report showing the effect of TJ-108 on improving anemia in pregnant women, presumably by its boosting effect on myelohematopoiesis. Therefore, the combined administration of both iron and TJ-108 is effective as a strategy for pregnant women at a high risk of PPH due to complications such as placenta previa. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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13 pages, 322 KiB  
Article
The Risk of Obstetrical Hemorrhage in Placenta Praevia Associated with Coronavirus Infection Antepartum or Intrapartum
by Irina Pacu, Nikolaos Zygouropoulos, Alina Elena Cristea, Cristina Zaharia, George-Alexandru Rosu, Alexandra Matei, Liana-Tina Bodei, Adrian Neacsu and Cringu Antoniu Ionescu
Medicina 2022, 58(8), 1004; https://doi.org/10.3390/medicina58081004 - 27 Jul 2022
Viewed by 1634
Abstract
Background and Objectives: The aim was to evaluate the severity of obstetrical bleeding in the third trimester associated with COVID infection in placenta previa and accreta. Materials and Methods: A retrospective study was conducted to compare the risk of obstetrical bleeding [...] Read more.
Background and Objectives: The aim was to evaluate the severity of obstetrical bleeding in the third trimester associated with COVID infection in placenta previa and accreta. Materials and Methods: A retrospective study was conducted to compare the risk of obstetrical bleeding in the case of placenta previa with or without associated SARS-CoV-2 infection. Patients presenting with placenta previa before labor were classified into three groups: group A (control) as no infection throughout their pregnancy, group B as confirmed infection during the 1st trimester, and group C as confirmed infection at the time of delivery. Infected patients were stratified according to the severity of signs and symptoms. The severity of obstetrical hemorrhage at birth was assessed quantitatively and qualitatively. All placentas were analyzed histologically to identify similarities. Results: Prematurity and pregnancy-induced hypertension appear significantly related to SARS-CoV-2 infection during the 3rd trimester. Placenta accreta risk increases significantly with infection during the 1st trimester. No statistically significant differences in the severity of hemorrhage associated with childbirth in cases with placenta previa between groups A and C but increased obstetrical bleeding mainly due to emergency hemostatic hysterectomy in group B driven by placenta accrete were detected. Obstetrical hemorrhage at birth in the case of coexistence of the infection was found not to correlate with the severity of the viral disease. Meanwhile, the number of days of hospitalization after birth is related to the specific treatment of COVID infection and not related to complications related to birth. Conclusions: The study finds an increased incidence of placenta accreta associated with placenta previa in cases where the viral infection occurred in the first trimester of pregnancy, associated with an increased incidence of hemostasis hysterectomies in these patients. Placental histological changes related to viral infection are multiple and more important in patients who had COVID infection in the first trimester. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
11 pages, 6581 KiB  
Article
In Vitro Toxicological Profile of Labetalol-Folic Acid/Folate Co-Administration in H9c2(2-1) and HepaRG Cells
by Robert Rednic, Iasmina Marcovici, Razvan Dragoi, Iulia Pinzaru, Cristina Adriana Dehelean, Mirela Tomescu, Diana Aurora Arnautu, Marius Craina, Adrian Gluhovschi, Mihaela Valcovici and Aniko Manea
Medicina 2022, 58(6), 784; https://doi.org/10.3390/medicina58060784 - 10 Jun 2022
Cited by 1 | Viewed by 1703
Abstract
Background and Objectives: The consumption of dietary supplements has increased over the last decades among pregnant women, becoming an efficient resource of micronutrients able to satisfy their nutritional needs during pregnancy. Furthermore, gestational drug administration might be necessary to treat several pregnancy complications [...] Read more.
Background and Objectives: The consumption of dietary supplements has increased over the last decades among pregnant women, becoming an efficient resource of micronutrients able to satisfy their nutritional needs during pregnancy. Furthermore, gestational drug administration might be necessary to treat several pregnancy complications such as hypertension. Folic acid (FA) and folate (FT) supplementation is highly recommended by clinicians during pregnancy, especially for preventing neural tube birth defects, while labetalol (LB) is a β-blocker commonly administered as a safe option for the treatment of pregnancy-related hypertension. Currently, the possible toxicity resulting from the co-administration of FA/FT and LB has not been fully evaluated. In light of these considerations, the current study was aimed at investigating the possible in vitro cardio- and hepato-toxicity of LB-FA and LB-FT associations. Materials and Methods: Five different concentrations of LB, FA, FT, and their combination were used in myoblasts and hepatocytes in order to assess cell viability, cell morphology, and wound regeneration. Results: The results indicate no significant alterations in terms of cell viability and morphology in myoblasts (H9c2(2-1)) and hepatocytes (HepaRG) following a 72-h treatment, apart from a decrease in the percentage of viable H9c2(2-1) cells (~67%) treated with LB 150 nM–FT 50 nM. Additionally, LB (50 and 150 nM)–FA (0.2 nM) exerted an efficient wound regenerating potential in H9c2(2-1) myoblasts (wound healing rates were >80%, compared to the control at 66%), while LB-FT (at all tested concentrations) induced no significant impairment to their migration. Conclusions: Overall, our findings indicate that LB-FA and LB-FT combinations lack cytotoxicity in vitro. Moreover, beneficial effects were noticed on H9c2(2-1) cell viability and migration from LB-FA/FT administration, which should be further explored. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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11 pages, 2016 KiB  
Article
The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study
by Stelian-Gabriel Ilyes, Veronica Daniela Chiriac, Adrian Gluhovschi, Valcovici Mihaela, George Dahma, Adelina Geanina Mocanu, Radu Neamtu, Carmen Silaghi, Daniela Radu, Elena Bernad and Marius Craina
Medicina 2022, 58(6), 709; https://doi.org/10.3390/medicina58060709 - 26 May 2022
Cited by 2 | Viewed by 2314
Abstract
Background and Objectives: Neonatal mortality is a global public health issue, disproportionately affecting low- and middle-income nations. Although Romania is a high-income nation, according to the European Union’s most recent demographic data, it had the second-highest infant death rate in 2019. Although [...] Read more.
Background and Objectives: Neonatal mortality is a global public health issue, disproportionately affecting low- and middle-income nations. Although Romania is a high-income nation, according to the European Union’s most recent demographic data, it had the second-highest infant death rate in 2019. Although significant progress has been made in the last three decades in lowering newborn mortality, more initiatives to accelerate progress are required to meet the 2030 Sustainable Development Goals (SDG) objective. Therefore, we aimed to develop an observational study to determine the influence of maternal factors on in-hospital neonatal intensive care unit admission and mortality in premature infants born in western Romania. While newborn mortality has decreased globally, the pace of decline is far less than what is desired. Materials and Methods: A retrospective study comprising 328 premature patients and 422 full-term newborns, was developed at a tertiary obstetrics and gynecology clinic in western Romania, comprising the period of the last 24 months before the COVID-19 pandemic and the first 24 months of the pandemic. Results: The following variables were identified as statistically significant risk factors for neonatal intensive care unit admission: age > 35 years, OR = 1.59; twin births, OR = 1.14; low gestational age, OR = 1.66; preeclampsia, OR = 2.33; and peripartum infection, OR = 2.25. The same risk factors, with the exception of twin births, were significantly associated with in-hospital neonatal mortality. Except for a longer duration of maternal hospitalization and neonatal therapy with surfactant, steroids, and antibiotics, the COVID-19 pandemic did not cause significant differences in the evolution and outcomes of preterm newborns. Conclusions: The major maternal risk factors for NICU admission were advanced age, twin pregnancy, low gestational age, preeclampsia, and peripartum infection. Additionally, these characteristics contributed to a high likelihood of death, despite adequate access to medical care and advanced life support for the neonates. Understanding the causes of morbidity and death in neonates admitted to the neonatal intensive care unit enables better prioritization and planning of health services, resource reallocation, and care quality improvement. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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10 pages, 322 KiB  
Article
Pregnancy Outcomes in a Cohort of Patients Who Underwent Double-J Ureteric Stenting—A Single Center Experience
by Viorel Dragos Radu, Ingrid-Andrada Vasilache, Radu-Cristian Costache, Ioana-Sadiye Scripcariu, Dragos Nemescu, Alexandru Carauleanu, Valentin Nechifor, Veaceslav Groza, Pavel Onofrei, Lucian Boiculese and Demetra Socolov
Medicina 2022, 58(5), 619; https://doi.org/10.3390/medicina58050619 - 29 Apr 2022
Cited by 4 | Viewed by 4130
Abstract
Background and Objectives: Minimally invasive procedures, such as double-J ureteric stenting, could be a promising therapeutic alternative to conservative management of obstructive urinary tract pathology. We aimed to evaluate the safety and effectiveness of double-J ureteric stenting in pregnant women with ureterohydronephrosis [...] Read more.
Background and Objectives: Minimally invasive procedures, such as double-J ureteric stenting, could be a promising therapeutic alternative to conservative management of obstructive urinary tract pathology. We aimed to evaluate the safety and effectiveness of double-J ureteric stenting in pregnant women with ureterohydronephrosis or urolithiasis, along with their infectious complications, and to assess the pregnancy outcomes of this cohort of patients in comparison with a control group. Materials and Methods: This observational retrospective study included 52 pregnant patients who underwent double-J ureteric stenting for urologic disorders in the Urology Department of ‘C.I. Parhon’ University Hospital, and who were followed up at a tertiary maternity hospital- ‘Cuza-Voda’, Iasi, Romania. The control group (63 patients) was randomly selected from the patient’s cohort who gave birth in the same time frame at the maternity hospital, without urinary pathology. Clinical, sonographic, and laboratory variables were examined. Descriptive statistics, non-parametric tests, and a one-to-one propensity score-matched analysis were used to analyze our data. Results: The univariate analysis indicated a significant statistical difference between the control group and the interventional group regarding maternal age (p = 0.018), previous maternal history of renal colic (p = 0.005) or nephrolithiasis (p = 0.002). After applying the propensity score-matched analysis, cesarean delivery rates (p < 0.001), preterm labour (p = 0.039), premature rupture of membranes (p = 0.026), preterm birth rates (p = 0.002), and post-partum UTI rates (p = 0.012) were significantly different between the control group and the matched treatment group. Ureterohydronephrosis, whether simple (n = 37; 71.2%) or infected (n = 13; 25%), was the main indication for double-J ureteric stenting. Complications such as pain (n = 21; 40.3%), stent migration (n = 3; 5.76%) or encrustation (n = 2; 3.84%), as well as reflux pyelonephritis (n = 2; 3.84%) and gross hematuria (n = 1; 1.92%) were recorded during follow-up. Conclusions: Our results show that double-J stenting is a safe and effective treatment option for pregnant patients with obstructive urological disorders. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
8 pages, 311 KiB  
Article
The Impact of SARS-CoV-2 Infection on Premature Birth—Our Experience as COVID Center
by Tina-Ioana Bobei, Bashar Haj Hamoud, Romina-Marina Sima, Gabriel-Petre Gorecki, Mircea-Octavian Poenaru, Octavian-Gabriel Olaru and Liana Ples
Medicina 2022, 58(5), 587; https://doi.org/10.3390/medicina58050587 - 25 Apr 2022
Cited by 6 | Viewed by 1999
Abstract
Information about the impact of SARS-CoV-2 infection on pregnant women is still limited and raises challenges, even as publications are increasing rapidly. The aim of the present study was to determine the impact of SARS-CoV-2 infection on preterm birth pregnancies. We performed a [...] Read more.
Information about the impact of SARS-CoV-2 infection on pregnant women is still limited and raises challenges, even as publications are increasing rapidly. The aim of the present study was to determine the impact of SARS-CoV-2 infection on preterm birth pregnancies. We performed a prospective, observational study in a COVID-only hospital, which included 34 pregnant women with SARS-CoV-2 infection and preterm birth compared with a control group of 48 healthy women with preterm birth. The rate of cesarean delivery was 82% in the study group versus 6% for the control group. We observed a strong correlation between premature birth and the presence of COVID-19 symptoms (cough p = 0.029, fever p = 0.001, and chills p = 0.001). The risk for premature birth is correlated to a lower value of oxygen saturation (p = 0.001) and extensive radiologic pulmonary lesions (p = 0.025). The COVID-19 pregnant women with preterm delivery were older, and experienced an exacerbation of severe respiratory symptoms, decreased saturation of oxygen, increased inflammatory markers, severe pulmonary lesions and decreased lymphocytes. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
10 pages, 926 KiB  
Article
Brain-Derived Neurotrophic Factor Levels in Cord Blood from Growth Restricted Fetuses with Doppler Alteration Compared to Adequate for Gestational Age Fetuses
by Jara Pascual-Mancho, Pilar Pintado-Recarte, Jorge C. Morales-Camino, Carlos Romero-Román, Concepción Hernández-Martin, Coral Bravo, Julia Bujan, Melchor Alvarez-Mon, Miguel A. Ortega and Juan De León-Luis
Medicina 2022, 58(2), 178; https://doi.org/10.3390/medicina58020178 - 25 Jan 2022
Cited by 2 | Viewed by 2328
Abstract
Background and Objectives: Fetal growth restriction (FGR) is a severe obstetric disease characterized by a low fetal size entailing a set of undesired consequences. For instance, previous studies have noticed a worrisome association between FGR with an abnormal neurodevelopment. However, the precise [...] Read more.
Background and Objectives: Fetal growth restriction (FGR) is a severe obstetric disease characterized by a low fetal size entailing a set of undesired consequences. For instance, previous studies have noticed a worrisome association between FGR with an abnormal neurodevelopment. However, the precise link between FGR and neurodevelopmental alterations are not yet fully understood yet. Brain-derived neurotrophic factor (BDNF) is a critical neurotrophin strongly implicated in neurodevelopmental and other neurological processes. In addition, serum levels of BDNF appears to be an interesting indicator of pathological pregnancies, being correlated with the neonatal brain levels. Therefore, the aim of this study is to analyze the blood levels of BDNF in the cord blood from fetuses with FGR in comparison to those with weight appropriate for gestational age (AGA). Materials and Methods: In this study, 130 subjects were recruited: 91 in group A (AGA fetuses); 39 in group B (16 FGR fetuses with exclusively middle cerebral artery (MCA) pulsatility index (PI) < 5th percentile and 23 with umbilical artery (UA) PI > 95th percentile). Serum levels of BDNF were determined through ELISA reactions in these groups. Results: Our results show a significant decrease in cord blood levels of BDNF in FGR and more prominently in those with UA PI >95th percentile in comparison to AGA. FGR fetuses with exclusively decreased MCA PI below the 5th percentile also show reduced levels of BDNF than AGA, although this difference was not statistically significant. Conclusions: Overall, our study reports a potential pathophysiological link between reduced levels of BDNF and neurodevelopmental alterations in fetuses with FGR. However, further studies should be conducted in those FGR subjects with MCA PI < 5th percentile in order to understand the possible implications of BDNF in this group. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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Review

Jump to: Research, Other

18 pages, 1435 KiB  
Review
Infective Endocarditis during Pregnancy—Keep It Safe and Simple!
by Viviana Aursulesei Onofrei, Cristina Andreea Adam, Dragos Traian Marius Marcu, Radu Crisan Dabija, Alexandr Ceasovschih, Mihai Constantin, Elena-Daniela Grigorescu, Antoneta Dacia Petroaie and Florin Mitu
Medicina 2023, 59(5), 939; https://doi.org/10.3390/medicina59050939 - 12 May 2023
Cited by 1 | Viewed by 3206
Abstract
The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the [...] Read more.
The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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15 pages, 735 KiB  
Review
Considering the Effects and Maternofoetal Implications of Vascular Disorders and the Umbilical Cord
by Lara Sánchez-Trujillo, Cielo García-Montero, Oscar Fraile-Martinez, Luis G. Guijarro, Coral Bravo, Juan A. De Leon-Luis, Jose V. Saez, Julia Bujan, Melchor Alvarez-Mon, Natalio García-Honduvilla, Miguel A. Saez and Miguel A. Ortega
Medicina 2022, 58(12), 1754; https://doi.org/10.3390/medicina58121754 - 29 Nov 2022
Cited by 2 | Viewed by 3132
Abstract
The umbilical cord is a critical anatomical structure connecting the placenta with the foetus, fulfilling multiple functions during pregnancy and hence influencing foetal development, programming and survival. Histologically, the umbilical cord is composed of three blood vessels: two arteries and one vein, integrated [...] Read more.
The umbilical cord is a critical anatomical structure connecting the placenta with the foetus, fulfilling multiple functions during pregnancy and hence influencing foetal development, programming and survival. Histologically, the umbilical cord is composed of three blood vessels: two arteries and one vein, integrated in a mucous connective tissue (Wharton’s jelly) upholstered by a layer of amniotic coating. Vascular alterations in the umbilical cord or damage in this tissue because of other vascular disorders during pregnancy are worryingly related with detrimental maternofoetal consequences. In the present work, we will describe the main vascular alterations presented in the umbilical cord, both in the arteries (Single umbilical artery, hypoplastic umbilical artery or aneurysms in umbilical arteries) and the vein (Vascular thrombosis, aneurysms or varicose veins in the umbilical vein), together with other possible complications (Velamentous insertion, vasa praevia, hypercoiled or hypocoiled cord, angiomyxoma and haematomas). Likewise, the effect of the main obstetric vascular disorders like hypertensive disorders of pregnancy (specially pre-eclampsia) and chronic venous disease on the umbilical cord will also be summarized herein. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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7 pages, 289 KiB  
Review
Long QT Syndrome Management during and after Pregnancy
by Agne Marcinkeviciene, Diana Rinkuniene and Aras Puodziukynas
Medicina 2022, 58(11), 1694; https://doi.org/10.3390/medicina58111694 - 21 Nov 2022
Cited by 1 | Viewed by 1819
Abstract
Long QT syndrome (LQTS) is majorly an autosomal dominantly inherited electrical dysfunction, but there are exceptions (Jervell and Lange-Nielsen syndrome is inherited in an autosomal recessive pattern). This disorder prolongs ventricular repolarization and increases the risk of ventricular arrhythmias, syncope, and even sudden [...] Read more.
Long QT syndrome (LQTS) is majorly an autosomal dominantly inherited electrical dysfunction, but there are exceptions (Jervell and Lange-Nielsen syndrome is inherited in an autosomal recessive pattern). This disorder prolongs ventricular repolarization and increases the risk of ventricular arrhythmias, syncope, and even sudden cardiac death. The risk of fatal events is reduced during pregnancy, but dramatically increases during the 9 months after delivery, especially in patients with LQT2. In women with LQTS, treatment with β-blockers at appropriate doses is recommended throughout pregnancy and the high-risk postnatal period. In this review, we summarize the management of LQTS during pregnancy and beyond. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
17 pages, 372 KiB  
Review
Invasive Prenatal Diagnostic Testing for Aneuploidies in Singleton Pregnancies: A Comparative Review of Major Guidelines
by Eirini Giovannopoulou, Ioannis Tsakiridis, Apostolos Mamopoulos, Ioannis Kalogiannidis, Ioannis Papoulidis, Apostolos Athanasiadis and Themistoklis Dagklis
Medicina 2022, 58(10), 1472; https://doi.org/10.3390/medicina58101472 - 17 Oct 2022
Cited by 8 | Viewed by 2011
Abstract
Sophisticated screening protocols for genetic abnormalities constitute an important component of current prenatal care, aiming to identify high-risk pregnancies and offer appropriate counseling to parents regarding their options. Definite prenatal diagnosis is only possible by invasive prenatal diagnostic testing (IPDT), mainly including amniocentesis [...] Read more.
Sophisticated screening protocols for genetic abnormalities constitute an important component of current prenatal care, aiming to identify high-risk pregnancies and offer appropriate counseling to parents regarding their options. Definite prenatal diagnosis is only possible by invasive prenatal diagnostic testing (IPDT), mainly including amniocentesis and chorionic villous sampling (CVS). The aim of this comparative review was to summarize and compare the existing recommendations on IPDT from the most influential guidelines. All the reviewed guidelines highlight that IPDT is indicated based on a positive screening test rather than maternal age alone. Other indications arise from medical history and sonography, with significant variations identified between the guidelines. The earlier time for amniocentesis is unequivocally set at ≥15 gestational weeks, whereas for CVS, the earlier limit varies from ≥10 to ≥11 weeks. Certain technical aspects and the overall approach demonstrate significant differences. Periprocedural management regarding Rhesus alloimmunization, virologic status and use of anesthesia or antibiotics are either inconsistent or insufficiently addressed. The synthesis of an evidence-based algorithm for IPDT is of crucial importance to healthcare professionals implicated in prenatal care to avoid unnecessary interventions without compromising optimal prenatal care. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
21 pages, 1771 KiB  
Review
The Main Changes in Pregnancy—Therapeutic Approach to Musculoskeletal Pain
by Felicia Fiat, Petru Eugen Merghes, Alexandra Denisa Scurtu, Bogdan Almajan Guta, Cristina Adriana Dehelean, Narcis Varan and Elena Bernad
Medicina 2022, 58(8), 1115; https://doi.org/10.3390/medicina58081115 - 17 Aug 2022
Cited by 11 | Viewed by 10828
Abstract
Background and Objectives: During pregnancy, women undergo various physiological and anatomical changes that are accentuated as the pregnancy progresses, but return to their previous state a few weeks/months after the pregnancy. However, a targeted therapeutic approach is needed. Most of the time, [...] Read more.
Background and Objectives: During pregnancy, women undergo various physiological and anatomical changes that are accentuated as the pregnancy progresses, but return to their previous state a few weeks/months after the pregnancy. However, a targeted therapeutic approach is needed. Most of the time, during this period, these changes precipitate the appearance of pain, musculoskeletal pain being the most common. Pregnant women should avoid treating musculoskeletal pain with medication and should choose alternative and complementary methods. Exercise along with rest is the basis for treating chronic musculoskeletal pain. Side effects of physical therapy are rare and, in addition, it is not contraindicated in pregnant women. The benefits of this type of treatment in combating pain far outweigh the risks, being an easy way to improve quality of life. The objective of this article is to discuss the management of musculoskeletal pain during pregnancy, to identify the main musculoskeletal pain encountered in pregnant women along with drug treatment, and to expose the beneficial effects of alternative and complementary methods in combating pain. Materials and Methods: A literature search was conducted using medical databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords “changes of pregnancy”, “musculoskeletal pain”, “pregnancy pain”, “pain management”, “pharmacological approach”, “alternative and complementary treatment” and specific sites. Information was collected from studies whose target population included pregnant women who complained of musculoskeletal pain during the 9 months of pregnancy; pregnant women with other pathologies that could increase their pain were not included in this review. Results: The articles related to the most common non-obstetric musculoskeletal pain in pregnancy along with pharmacological treatment options and alternative and complementary methods for musculoskeletal pain management during pregnancy were selected. Conclusions: The results were used to guide information towards the safest methods of therapy but also to raise awareness of the treatment criteria in order to compare the effectiveness of existing methods. Treatment must consider the implications for the mother and fetus, optimizing non-pharmacological therapeutic options. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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14 pages, 646 KiB  
Review
Approach to Thrombophilia in Pregnancy—A Narrative Review
by Miruna Samfireag, Cristina Potre, Ovidiu Potre, Raluca Tudor, Teodora Hoinoiu and Andrei Anghel
Medicina 2022, 58(5), 692; https://doi.org/10.3390/medicina58050692 - 23 May 2022
Cited by 9 | Viewed by 4211
Abstract
Thrombophilia is a genetic predisposition to hypercoagulable states caused by acquired haemostasis conditions; pregnancy causes the haemostatic system to become hypercoagulable, which grows throughout the pregnancy and peaks around delivery. Genetic testing for thrombophilic gene mutations is evaluated using different methodologies of real-time [...] Read more.
Thrombophilia is a genetic predisposition to hypercoagulable states caused by acquired haemostasis conditions; pregnancy causes the haemostatic system to become hypercoagulable, which grows throughout the pregnancy and peaks around delivery. Genetic testing for thrombophilic gene mutations is evaluated using different methodologies of real-time polymerase chain reaction and DNA microarrays of specific genes. Adapting the general care of the pregnant woman to the particularities caused by thrombophilia is an important component, so screening is preferred to assess the degree of genetic damage that manifests itself as a risk of thrombosis. The major goal of this narrative review was to quantitatively evaluate the literature data on the specific care of pregnant women with thrombophilia that are at risk of developing unplanned miscarriages. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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Other

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9 pages, 2848 KiB  
Case Report
Management of Postpartum Extensive Venous Thrombosis after Second Pregnancy
by Andreea Taisia Tiron, Anca Filofteia Briceag, Liviu Moraru, Lavinia Alice Bălăceanu, Ion Dina and Laura Caravia
Medicina 2023, 59(5), 871; https://doi.org/10.3390/medicina59050871 - 30 Apr 2023
Viewed by 1593
Abstract
Background: Pregnancy induces a physiological prothrombotic state. The highest risk period for venous thromboembolism and pulmonary embolism in pregnant women is during the postpartum period. Materials and Methods: We present the case of a young woman who gave birth 2 weeks [...] Read more.
Background: Pregnancy induces a physiological prothrombotic state. The highest risk period for venous thromboembolism and pulmonary embolism in pregnant women is during the postpartum period. Materials and Methods: We present the case of a young woman who gave birth 2 weeks before admission and was transferred to our clinic for edema. She had an increased temperature in her right limb, and a venous Doppler of the limb confirmed thrombosis of the right femoral vein. From the paraclinical examination, we obtained a CBC with leukocytosis, neutrophilia, and thrombocytosis, and a positive D-dimer test. Thrombophilic tests were negative for AT III, lupus anticoagulant negative, and protein S and C, but were positive for heterozygous PAI-1, heterozygous MTHFR A1298C, and EPCR with A1/A2 alleles. After 2 days of UFH with therapeutic APTT, the patient had pain in her left thigh. We performed a venous Doppler, which revealed bilateral femoral and iliac venous thrombosis. During the computed tomography examination, we assessed the venous thrombosis extension on the inferior cava, common iliac, and bilateral common femoral veins. Thrombolysis was initiated with 100 mg of Alteplase given at a rate of 2 mg/h; however, this did not lead to a considerable reduction in the thrombus. Additionally, the treatment with UFH was continued under therapeutic APTT. After 7 days of UFH and triple antibiotic therapy for genital sepsis, the patient had a favorable evolution with remission of venous thrombosis. Results: Alteplase is a thrombolytic agent that is created with recombinant DNA technology, and it was successfully used to treat thrombosis that occurred in the postpartum period. Conclusions: Thrombophilias are associated with a high VTE risk but also with adverse pregnancy outcomes, including recurrent miscarriages and gestational vascular complications. In addition, the postpartum period is associated with a higher VTE risk. A thrombophilic status with heterozygous PAI-1, heterozygous MTHFR A1298C, and EPCR with A1/A2 positive alleles is associated with a high risk of thrombosis and cardiovascular events. Thrombolysis can be successfully used postpartum to treat VTEs. Thrombolysis can be used successfully in VTE developed in the postpartum period. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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8 pages, 2109 KiB  
Case Report
Endocrine Disorders in a Newborn with Heterozygous Galactosemia, Down Syndrome and Complex Cardiac Malformation: Case Report
by Ioana Rosca, Alina Turenschi, Alin Nicolescu, Andreea Teodora Constantin, Adina Maria Canciu, Alice Denisa Dica, Elvira Bratila, Ciprian Andrei Coroleuca and Leonard Nastase
Medicina 2023, 59(5), 856; https://doi.org/10.3390/medicina59050856 - 28 Apr 2023
Cited by 4 | Viewed by 1846
Abstract
Down syndrome is the most common chromosomal abnormality diagnosed in newborn babies. Infants with Down syndrome have characteristic dysmorphic features and can have neuropsychiatric disorders, cardiovascular diseases, gastrointestinal abnormalities, eye problems, hearing loss, endocrine and hematologic disorders, and many other health issues. We [...] Read more.
Down syndrome is the most common chromosomal abnormality diagnosed in newborn babies. Infants with Down syndrome have characteristic dysmorphic features and can have neuropsychiatric disorders, cardiovascular diseases, gastrointestinal abnormalities, eye problems, hearing loss, endocrine and hematologic disorders, and many other health issues. We present the case of a newborn with Down syndrome. The infant was a female, born at term through c-section. She was diagnosed before birth with a complex congenital malformation. In the first few days of life, the newborn was stable. In her 10th day of life, she started to show respiratory distress, persistent respiratory acidosis, and persistent severe hyponatremia, and required intubation and mechanical ventilation. Due to her rapid deterioration our team decided to do a screening for metabolic disorders. The screening was positive for heterozygous Duarte variant galactosemia. Further testing on possible metabolic and endocrinologic issues that can be associated with Down syndrome was performed, leading to hypoaldosteronism and hypothyroidism diagnoses. The case was challenging for our team because the infant also had multiple metabolic and hormonal deficiencies. Newborns with Down syndrome often require a multidisciplinary team, as besides congenital cardiac malformations they can have metabolic and hormonal deficiencies that can negatively impact their short- and long-term prognosis. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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7 pages, 1064 KiB  
Case Report
Prenatal Diagnosis of Fetal Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA) Syndrome
by Soo Jung Kim, So-Yeon Shim, Hyun-Hae Cho, Mi-Hye Park and Kyung A. Lee
Medicina 2023, 59(4), 703; https://doi.org/10.3390/medicina59040703 - 04 Apr 2023
Cited by 3 | Viewed by 2635
Abstract
Background: Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome, also known as Herlyn-Werner-Wunderlich syndrome, is a rare syndrome characterized by the triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Most cases of OHVIRA have been reported in adolescents or adults. [...] Read more.
Background: Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome, also known as Herlyn-Werner-Wunderlich syndrome, is a rare syndrome characterized by the triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Most cases of OHVIRA have been reported in adolescents or adults. Gartner duct cysts, including those manifesting as vaginal wall cysts, are also rare. Fetal OHVIRA syndrome and Gartner duct cysts are difficult to diagnose. Case Presentation: Here, the authors report a case of combined OHVIRA and Gartner duct cyst diagnosed prenatally by ultrasonography, along with a brief review of the relevant published reports. A 30-year-old nulliparous female was referred to our institution at 32 weeks’ gestation for fetal right kidney agenesis. Detailed ultrasonographic examinations using 2D, 3D, and Doppler ultrasounds revealed hydrocolpometra, and uterus didelphys, with a normal anus and right kidney agenesis. Conclusions: When encountering female fetuses with ipsilateral renal agenesis or vaginal cysts, clinicians should be aware of OHVIRA syndrome and Gartner duct cysts and perform systematic ultrasonographic examinations for other genitourinary anomalies. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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5 pages, 979 KiB  
Case Report
Trophoblastic Tissue Reimplantation below the Spleen Following Laparoscopic Bilateral Salpingectomy for Ectopic Tubal Pregnancy: A Case Report
by Dominyka Surgontaitė, Artūras Sukovas, Dalia Regina Railaitė, Tautvydas Jankauskas, Arnoldas Bartusevičius and Eglė Bartusevičienė
Medicina 2023, 59(4), 701; https://doi.org/10.3390/medicina59040701 - 03 Apr 2023
Viewed by 1271
Abstract
Background: Trophoblastic tissue reimplantation after laparoscopic salpingectomy is a very rare complication. These cases may present a diagnostic challenge and the majority of patients need a surgical treatment. Case presentation: A 31-year-old patient came to a tertiary referral center for nausea and pain [...] Read more.
Background: Trophoblastic tissue reimplantation after laparoscopic salpingectomy is a very rare complication. These cases may present a diagnostic challenge and the majority of patients need a surgical treatment. Case presentation: A 31-year-old patient came to a tertiary referral center for nausea and pain in the upper left abdominal quadrant. Ultrasound and abdominal CT scan showed a 68 × 60 × 87 mm size heterogenic mass below the spleen with arterial extravasation from the lower spleen pole. Recent history of surgery for ectopic pregnancy and serum hCG testing allowed to diagnose extratubal secondary trophoblastic tissue reimplantation below the spleen. Embolization of the bleeding vessel and successful treatment with methotrexate was achieved. Conclusions: In cases of a nondisseminated trophoblastic tissue reimplantation, consider embolization and treatment with methotrexate if the patient is hemodynamically stable; thus, secondary surgical treatment is preventable. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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9 pages, 1921 KiB  
Case Report
Interstitial Ectopic Pregnancy—Case Reports and Medical Management
by Małgorzata Kampioni, Karolina Chmaj-Wierzchowska, Katarzyna Wszołek and Maciej Wilczak
Medicina 2023, 59(2), 233; https://doi.org/10.3390/medicina59020233 - 26 Jan 2023
Cited by 2 | Viewed by 2963
Abstract
The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is [...] Read more.
The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is 2–4% of all ectopic pregnancies. Surgery is the primary treatment for interstitial ectopic pregnancy; the pharmacological management of ectopic pregnancy, including IP, in asymptomatic patients includes systemic administration of methotrexate. In this report, we present two cases of this rare pregnancy type, reviewing our management technique and treatment ways presented in the literature. In our patients, the management was initially conservative and included methotrexate, administered as intravenous bolus injection, regular beta-human chorionic gonadotropins (β-HCG) level measurements in peripheral blood, and monitoring of the patient’s general condition. Due to signs of intra-abdominal bleeding in patient A and inadequate β-HCG level reduction in patient B, both patients eventually underwent laparoscopic cornual resection. Pregnancy, implanted into the interstitial part of the Fallopian tube and surrounded by myometrial tissue with myometrial invasion of the trophoblast, poses a serious diagnostic challenge to modern gynecology due to particularly low sensitivity and specificity of symptoms, and may require both pharmacological and surgical treatment. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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9 pages, 9072 KiB  
Case Report
Diagnosis and Management of Fetal and Neonatal Thyrotoxicosis
by Roxana-Elena Bohîlțea, Bianca-Margareta Mihai, Elena Szini, Ileana-Alina Șucaliuc and Corin Badiu
Medicina 2023, 59(1), 36; https://doi.org/10.3390/medicina59010036 - 23 Dec 2022
Cited by 2 | Viewed by 2123
Abstract
Background and Objectives: Clinical fetal thyrotoxicosis is a rare disorder occurring in 1–5% of pregnancies with Graves’ disease. Although transplacental passage of maternal TSH receptor stimulating autoantibodies (TRAb) to the fetus occurs early in gestation, their concentration in the fetus is reduced [...] Read more.
Background and Objectives: Clinical fetal thyrotoxicosis is a rare disorder occurring in 1–5% of pregnancies with Graves’ disease. Although transplacental passage of maternal TSH receptor stimulating autoantibodies (TRAb) to the fetus occurs early in gestation, their concentration in the fetus is reduced until the late second trimester, and reaches maternal levels in the last period of pregnancy. The mortality of fetal thyrotoxicosis is 12–20%, mainly due to heart failure. Case report: We present a case of fetal and neonatal thyrotoxicosis with favorable evolution under proper treatment in a 37-year-old woman. From her surgical history, we noted a thyroidectomy performed 12 years ago for Graves’ disease with orbitopathy and ophthalmopathy; the patient was hormonally balanced under substitution treatment for post-surgical hypothyroidism and hypoparathyroidism. From her obstetrical history, we remarked a untreated pregnancy complicated with fetal anasarca, premature birth, and neonatal death. The current pregnancy began with maternal euthyroid status and persistently increased TRAb, the value of which reached 101 IU/L at 20 weeks gestational age and decreased rapidly within 1 month to 7.5 IU/L, probably due to the placental passage, and occurred simultaneously with the development of fetal tachycardia, without any other fetal thyrotoxicosis signs. In order to treat fetal thyrotoxicosis, the patient was administered methimazole, in addition to her routine substitution of 137.5 ug L-Thyroxine daily, with good control of thyroid function in both mother and fetus. Conclusions: Monitoring for fetal thyrotoxicosis signs and maternal TRAb concentration may successfully guide the course of a pregnancy associated with Graves’ disease. An experienced team should be involved in the management. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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10 pages, 2654 KiB  
Case Report
The Very First Romanian Unruptured 13-Weeks Gestation Tubal Ectopic Pregnancy
by Ciprian Ilea, Ovidiu-Dumitru Ilie, Olivia-Andreea Marcu, Irina Stoian and Bogdan Doroftei
Medicina 2022, 58(9), 1160; https://doi.org/10.3390/medicina58091160 - 25 Aug 2022
Cited by 5 | Viewed by 9290
Abstract
Tubal ectopic pregnancies remain a challenging and life-threatening obstetric condition in the early stages that unavoidably lead to abortion or rupture, further reflected by the associated maternal mortality. Therefore, in the present case report, we report the experience of a 36-year-old woman who [...] Read more.
Tubal ectopic pregnancies remain a challenging and life-threatening obstetric condition in the early stages that unavoidably lead to abortion or rupture, further reflected by the associated maternal mortality. Therefore, in the present case report, we report the experience of a 36-year-old woman who presented to our Emergency Department with a history of moderate hypogastric pain, mild vaginal bleeding, and bilateral mastalgia, symptoms that started 20 days ago after uterine curettage for a declarative eight-week pregnancy. On admission, a physical examination showed regular standard signs. The ultrasound examination revealed in the left abdominal flank a gestational sac with a live fetus corresponding to the gestational age of 13 weeks. Given the position of the gestational sac, we suspected a possible abdominal pregnancy. Independently on her human chorionic gonadotropin (hCG) of 33.980 mIU/mL and hemoglobin (Hb) of 13.4 g/dL, the exact location of the pregnancy following ultrasound was hard to establish. Magnetic resonance imaging (MRI) examination was requested, after which we suspected the diagnosis of ovarian pregnancy. Given the paraclinical and clinical context of the worsening of painful symptoms, we decided to perform an exploratory laparoscopy in the multidisciplinary team (digestive and vascular surgeon) that showed the existence of a tubal pregnancy. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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4 pages, 745 KiB  
Case Report
Extremely Rare Case of Fetal Anemia Due to Mitochondrial Disease Managed with Intrauterine Transfusion
by Jinha Chung, Mi-Young Lee, Jin-Hoon Chung and Hye-Sung Won
Medicina 2022, 58(3), 328; https://doi.org/10.3390/medicina58030328 - 22 Feb 2022
Cited by 1 | Viewed by 1825
Abstract
This report describes a rare case of fetal anemia, confirmed as a mitochondrial disease after birth, treated with intrauterine transfusion (IUT). Although mitochondrial diseases have been described in newborns, research on their prenatal features is lacking. A patient was referred to our institution [...] Read more.
This report describes a rare case of fetal anemia, confirmed as a mitochondrial disease after birth, treated with intrauterine transfusion (IUT). Although mitochondrial diseases have been described in newborns, research on their prenatal features is lacking. A patient was referred to our institution at 32 gestational weeks owing to fetal hydrops. Fetal anemia was confirmed by cordocentesis. After IUT had been performed three times, the anemia and associated fetal hydrops showed improvement. However, after birth, the neonate had recurrent pancytopenia and lactic acidosis. He was eventually diagnosed with Pearson syndrome and died 2 months after birth. This is the first case report of fetal anemia associated with mitochondrial disease managed with IUT. Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)
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