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Medicina
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High-Risk Pregnancy - Series II
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High-Risk Pregnancy - Series II

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

Deadline for manuscript submissions: closed (16 April 2024) | Viewed by 20444

Special Issue Editors

Dr. Anca Maria Panaitescu

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 010164 Bucharest, Romania
Interests: fetal cardiac disease; coronavirus; cytomegalovirus; coxsackievirus; Toxoplasma gondii; flu viruses; HIV; rubella virus; Streptococcus; parvovirus B19; herpes virus
Special Issues, Collections and Topics in MDPI journals
Dr. Nicolae Gica

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
Interests: gynecology; gynecologic oncology; laparoscopy; endometriosis and fertility preservation in women with cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The fields of pregnancy care and obstetrics have evolved rapidly in the last few decades consequent to quality research being undertaken. Pregnancy, childbirth and postpartum are now safer than ever, with high-risk conditions being early anticipated and managed.

The aim of this Special Issue of Medicina is to explore the current advances in the field of obstetrics, including maternal morbidity and mortality, short and long-term outcomes after complicated pregnancy, maternal disease, fetal abnormalities, intrapartum complications, management of pregnancies following assisted reproductive techniques and twin pregnancies. Submission of unpublished original studies is welcome, including fundamental and clinical research studies, observational and interventional studies, randomized controlled trials and reviews, with an emphasis on relevant clinical questions and quantitative syntheses (meta-analyses) of pooled data. Authors are invited to contact the Editorial Team in advance if they require assistance for the preparation of their manuscript.    

Dr. Anca Maria Panaitescu
Dr. Nicolae Gica
Guest Editors

Manuscript Submission Information

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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 2200 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

  • maternal disease
  • fetal abnormalities
  • twin pregnancy
  • outcomes of complicated pregnancy
  • clinical implementation
  • assisted reproductive techniques
  • high-risk pregnancy
  • postpartum hemorrhage
  • emergency peripartum hysterectomy
  • abnormal placentation
  • operative vaginal delivery

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Published Papers (6 papers)

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Research

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11 pages, 572 KiB  
Article
Perinatal Outcomes and Neurodevelopment 1 Year after Birth in Discordant Twins According to Chorionicity
by Mi Ju Kim, Hyun Mi Kim, Hyun-Hwa Cha, Haemin Kim, Hyo-Shin Kim, Bong Seon Lim and Won Joon Seong
Medicina 2023, 59(3), 493; https://doi.org/10.3390/medicina59030493 - 2 Mar 2023
Cited by 3 | Viewed by 2541
Abstract
Background and Objectives: This study aimed to compare maternal complications, perinatal outcomes, and neurodevelopment 1 year after the birth between concordant and discordant twins in monochorionic and dichorionic twins. Materials and Methods: This retrospective study included twin pregnancies delivered between 24 [...] Read more.
Background and Objectives: This study aimed to compare maternal complications, perinatal outcomes, and neurodevelopment 1 year after the birth between concordant and discordant twins in monochorionic and dichorionic twins. Materials and Methods: This retrospective study included twin pregnancies delivered between 24 + 1 and 38 + 2 weeks of gestation between January 2011 and September 2019. Chorionicity was confirmed by ultrasonography and was categorized into monochorionic and dichorionic. Each was then divided into two groups (concordant and discordant) according to birth weight discordancy. Maternal complications and neonatal outcomes, including neurodevelopmental delays, were compared between the two groups. Results: A total of 298 pairs of twin pregnancies were enrolled, of which 58 (19.26%) women were pregnant with monochorionic diamniotic twins and 240 (80.54%) with dichorionic diamniotic twins. In both monochorionic and dichorionic twins, the discordant twins had a greater incidence of emergency deliveries because of iatrogenic causes than the concordant twins. Among dichorionic twins, discordant twins had lower birth weight rates and higher hospitalization rates and morbidities than concordant twins. Among monochorionic twins, discordant twins had a lower birth weight and higher neonatal mortality than concordant twins. The neonatal size was not a predictor of neurodevelopment in this group. Based on the logistic regression analysis, male sex, respiratory distress syndrome, and bronchopulmonary dysplasia were risk factors for the neurodevelopmental delay; birth weight discordancy was significant only in dichorionic twins. Conclusions: Perinatal outcomes in discordant twins may be poor, and neurodevelopment 1 year after birth was worse in discordant twins than in concordant twins. Discordancy in twins can be a risk factor for neurodevelopmental delay. Full article
(This article belongs to the Special Issue High-Risk Pregnancy - Series II)
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Review

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11 pages, 326 KiB  
Review
Beyond Weight Loss: A Comprehensive Review of Pregnancy Management following Bariatric Procedures
by Iulia Huluță, Livia-Mihaela Apostol, Radu Botezatu, Anca Maria Panaitescu, Corina Gică, Romina-Marina Sima, Nicolae Gică and Florina Mihaela Nedelea
Medicina 2024, 60(4), 635; https://doi.org/10.3390/medicina60040635 - 15 Apr 2024
Cited by 3 | Viewed by 2554
Abstract
The increasing prevalence of bariatric surgery among women of childbearing age raises critical questions about the correct management of pregnancy following these procedures. This literature review delves into the multifaceted considerations surrounding pregnancy after bariatric surgery, with a particular focus on the importance [...] Read more.
The increasing prevalence of bariatric surgery among women of childbearing age raises critical questions about the correct management of pregnancy following these procedures. This literature review delves into the multifaceted considerations surrounding pregnancy after bariatric surgery, with a particular focus on the importance of preconception counselling, appropriate nutrition assessment, and the necessity of correct folic acid supplementation. Key areas of investigation include nutrient absorption challenges, weight gain during pregnancy, and potential micronutrient deficiencies. Examining the relationship between bariatric surgery and birth defects, particularly heart and musculoskeletal issues, uncovers a twofold increase in risk for women who underwent surgery before pregnancy, with the risk emphasized before folic acid fortification. In contrast, a nationwide study suggests that infants born to mothers with bariatric surgery exhibit a reduced risk of major birth defects, potentially associated with improved glucose metabolism. In addition, this review outlines strategies for managing gestational diabetes and other pregnancy-related complications in individuals with a history of bariatric surgery. By synthesizing existing literature, this paper aims to provide healthcare providers with a comprehensive framework for the correct management of pregnancy in this unique patient population, promoting the health and well-being of both mother and child. Full article
(This article belongs to the Special Issue High-Risk Pregnancy - Series II)
13 pages, 617 KiB  
Review
Preconceptional Counseling in Women with Hyperthyroidism
by Luminita Nicoleta Cima, Mihaela Tarna, Carmen Sorina Martin, Anca Elena Sirbu, Iulia Soare, Anca Maria Panaitescu, Nicolae Gica, Carmen Gabriela Barbu and Simona Fica
Medicina 2024, 60(2), 234; https://doi.org/10.3390/medicina60020234 - 29 Jan 2024
Cited by 1 | Viewed by 3134
Abstract
Preconception evaluation of couples wishing to conceive is an important step toward a healthy pregnancy and it is especially important in people with a chronic condition or at genetic risk. The most common endocrine disorders in women at reproductive age are those involving [...] Read more.
Preconception evaluation of couples wishing to conceive is an important step toward a healthy pregnancy and it is especially important in people with a chronic condition or at genetic risk. The most common endocrine disorders in women at reproductive age are those involving the thyroid gland and it is well recognized that hyperthyroidism (HT), over-function of the thyroid gland, is associated with risks of maternal, fetal, and neonatal complications. The aim of this paper is to review the latest evidence regarding the components of preconception counseling in women with HT that contemplate a pregnancy. We also want to raise awareness among healthcare professionals about the importance of periconceptional counseling in improving pregnancy outcomes and avoid maternal and fetal complications related to thyroid dysfunction. In women with Graves’ disease seeking pregnancy, it is essential to discuss all the treatment options along with the associated risks and benefits. Extensive prospective studies are still needed to understand the implications of current recommended strategies for the management of HT in preconception and during pregnancy. Full article
(This article belongs to the Special Issue High-Risk Pregnancy - Series II)
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17 pages, 1584 KiB  
Review
Preparing for Pregnancy in Women with Systemic Lupus Erythematosus—A Multidisciplinary Approach
by Ioana Cristina Saulescu, Daniela Opris-Belinski, Andra Rodica Balanescu, Bogdan Pavel, Nicolae Gica and Anca Maria Panaitescu
Medicina 2022, 58(10), 1371; https://doi.org/10.3390/medicina58101371 - 29 Sep 2022
Cited by 2 | Viewed by 6250
Abstract
Pregnancy is one of the most challenging processes the human body is exposed to: the healthy mother can carry to term a genetically different new-born, while her immune system adapts to tolerate this new status and avoids rejection. In autoimmune disorders, motherhood is [...] Read more.
Pregnancy is one of the most challenging processes the human body is exposed to: the healthy mother can carry to term a genetically different new-born, while her immune system adapts to tolerate this new status and avoids rejection. In autoimmune disorders, motherhood is even more challenging, with additional medical counselling, mother care, and foetus development checks being necessary. While the aspects of supplementary mother care and pregnancy progress tracking are associated with well-established medical procedures and protocols, counselling, be it pre- or post-conception, is still underestimated and scarcely applied. Indeed, over the past decades, medical counselling for this particular population has changed significantly, but from a healthcare’s provider point of view, more is required to ensure a smooth, controllable pregnancy evolution. One of the most frequent autoimmune diseases affecting young females during their fertile years is Systemic Lupus Erythematosus (SLE). Like other heterogenous diseases, it exposes the mother to severe, organ-threatening complications and unpredictable evolution. Both the disease and its treatment can significantly affect the mother’s willingness to engage in a potentially risky pregnancy, as well as the likeliness to carry it to term without any impairments. A good collaboration between the patient’s rheumatologist and obstetrician is therefore mandatory in order to: (a) allow the mother to make an informed decision on pursuing with the pregnancy; (b) ensure a perfect synchronization between pregnancy terms and treatment; and (c) avoid or minimize potential complications. The best approach to achieve these outcomes is pregnancy planning. Moreover, knowing one desired prerequisite for a successful pregnancy evolution in SLE mothers is a stable, inactive, quiescent disease for at least six months prior to conception, planning becomes more than a recommended procedure. One particular aspect that requires attention before conception is the treatment scheme applied before delivery as autoantibodies can influence significantly the course of pregnancy. In this view, future SLE mothers should ideally benefit from preconception counselling within their agreed care pathway. A multidisciplinary team including at least the rheumatologist and obstetrician should be employed throughout the pregnancy, to decide on the appropriate timing of conception and compatible medication with respect to disease activity, as well as to monitor organ involvement and foetus development progress. Full article
(This article belongs to the Special Issue High-Risk Pregnancy - Series II)
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Other

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12 pages, 7912 KiB  
Systematic Review
Maternal Serum Amyloid A as a Marker of Preterm Birth/PROM: A Systematic Review and Meta-Analysis
by Ioana-Evelina Chiriac, Narcis Vilceanu, Adrian Maghiar, Csep Andrei, Bianca Hanganu, Lucia Georgeta Daina, Simona Dunarintu and Liana-Camelia Buhas
Medicina 2023, 59(6), 1025; https://doi.org/10.3390/medicina59061025 - 25 May 2023
Cited by 2 | Viewed by 2103
Abstract
Background and Objectives: Preterm birth, one of the leading causes of neonatal mortality, occurs in between 5 and 18% of births. Premature birth can be induced by a variety of triggers, including infection or inflammation. Serum amyloid A, a family of apolipoproteins, increases [...] Read more.
Background and Objectives: Preterm birth, one of the leading causes of neonatal mortality, occurs in between 5 and 18% of births. Premature birth can be induced by a variety of triggers, including infection or inflammation. Serum amyloid A, a family of apolipoproteins, increases significantly and rapidly at the onset of inflammation. This study aims to systematically review the results of studies in the literature that have examined the correlation between SAA and PTB/PROM. Materials and Methods: To examine the correlation between serum amyloid A levels in women who gave birth prematurely, a systematic analysis was performed according to PRISMA guidelines. Studies were retrieved by searching the electronic databases PubMed and Google Scholar. The primary outcome measure was the standardized mean difference in serum amyloid A level comparing the preterm birth or premature rupture of membranes groups and the term birth group. Results: Based on the inclusion criteria, a total of 5 manuscripts adequately addressed the desired outcome and were thus included in the analysis. All included studies showed a statistically significant difference in serum SAA levels between the preterm birth or preterm rupture of membranes groups and the term birth group. The pooled effect, according to the random effects model, is SMD = 2.70. However, the effect is not significant (p = 0.097). In addition, the analysis reveals an increased heterogeneity with an I2 = 96%. Further, the analysis of the influence on heterogeneity found a study that has a significant influence on heterogeneity. However, even after outline exclusion, heterogeneity remained high I2 = 90.7%. Conclusions: There is an association between increased levels of SAA and preterm birth/PROM, but studies have shown great heterogeneity. Full article
(This article belongs to the Special Issue High-Risk Pregnancy - Series II)
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9 pages, 4829 KiB  
Case Report
Foley Catheter as a Tourniquet for Peripartum Hemorrhage Prevention in Patients with Placenta Accreta Spectrum—A Two Case Report and a Review of the Literature
by Jakub Staniczek, Maisa Manasar-Dyrbuś, Kaja Skowronek, Ewa Winkowska and Rafał Stojko
Medicina 2023, 59(4), 641; https://doi.org/10.3390/medicina59040641 - 23 Mar 2023
Cited by 3 | Viewed by 2558
Abstract
One of the most perilous complications in obstetrics, often leading to severe bleeding and sometimes a need for urgent hysterectomy, is placenta accreta spectrum, which significantly increases the risk of peri-partum complications, even including the risk of death for the mother and the [...] Read more.
One of the most perilous complications in obstetrics, often leading to severe bleeding and sometimes a need for urgent hysterectomy, is placenta accreta spectrum, which significantly increases the risk of peri-partum complications, even including the risk of death for the mother and the child. Dealing with excessive bleeding in this situation is paramount. We have found a Foley catheter tourniquet to be useful as a temporary tourniquet to control placental and uterine hemorrhage. We have used this method and find it very useful. In this publication, we describe the last two cases of the use of the Foley catheter as a tourniquet for peri-partum hemorrhage prevention, and we will present a review of the literature in this field. Full article
(This article belongs to the Special Issue High-Risk Pregnancy - Series II)
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