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Current Trends in Prenatal Medicine: Research and Care

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

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 37430

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Dr. Dan-Bogdan Navolan

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Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy of Timisoara, Timisoara, Romania
Interests: obstetrics; gynaecology; pregnancy immunology; maternal–fetal medicine; pregnancy-related complications; preterm birth; risk evaluation; ultrasound in prenatal medicine
Special Issues, Collections and Topics in MDPI journals

Dr. Eliza Claudia Filimon

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Guest Editor

English Department of FLIT, West University of Timisoara, Timisoara, Romania
Interests: medical language development

Special Issue Information

Dear Colleagues,

The technological leap in recent decades has enabled more intense research in the field of prenatal medicine, and has facilitated the collection of evidence that has contributed to the implementation of the goal of the World Health Organization, “Making pregnancy safer”. A number of high-tech investigations have become widely available for research and medical practice. This progress has made it possible to capitalize on the creativity of human resources in more and more regions of the world. The development of databases at national and international levels, digitization, and the increase of the remote communication capacity through faster transfer of large volumes of information have facilitated the collaboration and the performance of multicenter studies. All this ultimately translates into a better understanding of the pathophysiological mechanisms and the development of new screening and treatment protocols. Technological progress has also amplified the interdisciplinary nature of research and care in the field of antenatal medicine. The improved quality of life of many population segments has changed habits, and has led to changes in the structure and manifestation of pathology. Despite all the progress made, a large part of the world’s population and the doctors who care for pregnant women carry out their lives and work in precarious conditions.

The purpose of this Special Issue is to provide authors around the world with the opportunity to publicize cutting-edge research results as well as aspects of epidemiology and particularities of antenatal care in the field of antenatal medicine, specific to various regions of the world.

Dr. Dan-Bogdan Navolan
Dr. Eliza Claudia Filimon
Guest Editors

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Keywords

Trends in prenatal medicine
Technological development
Pregnancy physiology and physiopathology
Pregnancy immunology
Epidemiology
Pregnancy-related disease
Ultrasound in prenatal medicine
Worldwide diversity in prenatal care
Risk factors
Pregnancy outcome

Related Special Issue

Current Trends in Prenatal Medicine: Research and Care - Part II in Medicina

Published Papers (11 papers)

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Research

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11 pages, 468 KiB

Open AccessArticle

Clinical and Biological Risk Factors Associated with Increased Mother-to-Child Transmission of HIV in Two South-East HIV-AIDS Regional Centers in Romania

by Simona Claudia Cambrea, Eugenia Andreea Marcu, Elena Cucli, Diana Badiu, Roxana Penciu, Cristian Lucian Petcu, Elena Dumea, Stela Halichidis, Loredana Pazara, Cristina Maria Mihai and Florentina Dumitrescu

Medicina 2022, 58(2), 275; https://doi.org/10.3390/medicina58020275 - 11 Feb 2022

Cited by 6 | Viewed by 2024

Abstract

Background and Objectives: The occurrence of human immunodeficiency virus (HIV) infection in children in Romania has been reported since 1989. This retrospective study was aimed at assessing clinical and biological risk factors for mother-to-child transmission (MTCT) of HIV in two HIV-acquired immune deficiency syndrome (AIDS) Regional Centers (RCs), Constanta and Craiova in Romania. Materials and Methods: During the study period (2008–2019), 408 HIV-positive pregnant women, 244 from Constanta RC and 164 from Craiova RC who attended antenatal visits, were included. All HIV-positive pregnant women were under combined antiretroviral therapy (cART) during pregnancy and childbirth, being followedup with their infants up to 18 months after delivery. We investigated the clinical as well as biological risk factorsassociated with increased MTCT of HIV. Results: Comparing different variables of HIV-positive pregnant women from the two HIV-AIDS CRs, we find that there are significant differences between the mean value of hemoglobin, CD4 level, environmental area, marital and amniotic membranes status, and HIV patient stage in the last trimester of pregnancy (p < 0.05), but without any differences in mother’s mean age, education level, type of delivery, breastfeeding, the duration of cART administration, HIV viral load, and survival rate. Conclusions: In 408 HIV-positive pregnant women followed up at two HIV-AIDS RCs in Romania, the most important clinical and biological risk factors associated with increased MTCT of HIV are represented by anemia, CD4 level, and HIV patient stage. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

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16 pages, 4781 KiB

Open AccessArticle

The Additional Role of the 3-Vessels and Trachea View in Screening for Congenital Heart Disease

by Roxana Gireadă, Demetra Socolov, Elena Mihălceanu, Roxana Matasariu, Alexandra Ursache, Mona Akad, Iuliana Bujor, Ioana Scripcariu, Radu Florin Popa and Răzvan Socolov

Medicina 2022, 58(2), 262; https://doi.org/10.3390/medicina58020262 - 10 Feb 2022

Cited by 7 | Viewed by 3723

Abstract

Background and Objectives: Although frequent and associated with high mortality and morbidity rate, congenital heart disease (CHD) has a suboptimal prenatal detection rate, with significant variation according to the scanning protocol. The aim of this study was to evaluate the role of the 3-vessels and trachea view (3VT) in detecting CHD, with or without the use of Color Doppler, with an emphasis on major CHD. Materials and Methods: We performed a retrospective study on 1596 unselected pregnant patients presenting at 11–37 weeks of gestation for a routine anomaly scan. We selected all CHD cases, and we analyzed the performance of the 4-chamber (4C) and 3VT view in detecting CHD. Results: A total of 46 fetuses with CHD were identified, yielding a 2.86% overall incidence, and 0.87% for major CHD. Grayscale 4C detected 47.8% of all CHD, going up to 71.7% by adding grayscale 3VT, with no major CHD remaining undetected by combining grayscale 4C and 3VT. Conclusions: Grayscale 4C and 3VT views are effective in detecting major CHD, thus proving their utility even in a low resource setting. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

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19 pages, 1670 KiB

Open AccessArticle

Genetic Counseling and Management: The First Study to Report NIPT Findings in a Romanian Population

by Cristina Gug, Ioana Mozos, Adrian Ratiu, Anca Tudor, Eusebiu Vlad Gorduza, Lavinia Caba, Miruna Gug, Catalina Cojocariu, Cristian Furau, Gheorghe Furau, Monica Adriana Vaida and Dorina Stoicanescu

Medicina 2022, 58(1), 79; https://doi.org/10.3390/medicina58010079 - 05 Jan 2022

Cited by 10 | Viewed by 2860

Abstract

Background and Objectives: Non-invasive prenatal testing (NIPT) has been confirmed as the most accurate screening test for trisomies 21, 18, 13, sex chromosomes aneuploidies and several microdeletions. This study aimed to assess the accuracy of cell free DNA testing based on low-level whole-genome sequencing to screen for these chromosomal abnormalities and to evaluate the clinical performance of NIPT. Materials and Methods: 380 consecutive cases from a single genetic center, from Western Romania were included in this retrospective study. Cell-free nucleic acid extraction from maternal blood, DNA sequencing and analysis of sequenced regions were performed by BGI Hong Kong and Invitae USA to determine the risk of specific fetal chromosomal abnormalities. In high-risk cases the results were checked by direct analysis of fetal cells obtained by invasive methods: 6 chorionic villus sampling and 10 amniocenteses followed by combinations of QF-PCR, karyotyping and aCGH. Results: NIPT results indicated low risk in 95.76% of cases and high risk in 4.23%. Seven aneuploidies and one microdeletion were confirmed, the other results were found to be a false-positive. A gestational age of up to 22 weeks had no influence on fetal fraction. There were no significant differences in fetal fraction across the high and low risk groups. Conclusions: This is the first study in Romania to report the NIPT results. The confirmation rate was higher for autosomal aneuploidies compared to sex chromosome aneuploidies and microdeletions. All cases at risk for trisomy 21 were confirmed. Only one large fetal microdeletion detected by NIPT has been confirmed. False positive NIPT results, not confirmed by invasive methods, led to the decision to continue the pregnancy. The main limitation of the study is the small number of patients included. NIPT can be used as a screening method for all pregnancies, but in high-risk cases, an invasive confirmation test was performed. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

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10 pages, 296 KiB

Open AccessArticle

Simultaneous Seroprevalence to Toxoplasma gondii, Cytomegalovirus and Rubella Virus in Childbearing Women from Western Romania

by Adelina Geanina Mocanu, Florin Gorun, Ioana Ciohat, Dan Navolan, Daniel Malita, Tatjana Vilibic-Cavlek, George Dahma, Radu Neamtu, Daniela Popescu, Andreea Cioca and Marius Craina

Medicina 2021, 57(9), 927; https://doi.org/10.3390/medicina57090927 - 02 Sep 2021

Cited by 8 | Viewed by 2028

Abstract

Background and Objectives: Toxoplasma gondii, cytomegalovirus (CMV) and rubella virus, besides other agents, belong to a group named the TORCH complex. Research on the epidemiology of these agents in women is of particular interest, as primary infection during pregnancy could cause severe damage to the fetus. Women who had contracted infection before pregnancy develop IgG antibodies, so the fetus is protected in case of contact with the same agent. Our scope was to identify the childbearing women simultaneously protected or susceptible to a primary infection to two or three agents mentioned above. Materials and Methods: A cross-sectional study was performed on 6961 fertile Caucasian women from Western Romania, to analyze the simultaneous seroprevalence to two or three of the pathogens from the TORCH complex: Toxoplasma gondii, CMV, and rubella virus. Sampling was conducted at two time points: 2008–2010 (group 1; 1461 participants) and 2015–2018 (group 2; 5500 participants). Results: The percentage of women simultaneously seropositive to IgG-anti-Toxoplasma gondii/IgG-anti-CMV, IgG-anti-Toxoplasma gondii/IgG-anti-rubella, IgG-anti-CMV/IgG-anti-rubella or IgG-anti-Toxoplasma gondii and IgG-anti-CMV/IgG-anti-rubella antibodies decreased between the two groups (2008–2010 vs. 2015–2018): 41.4% vs. 36.1%, OR = 0.79, p = 0.0002; 41.8% vs. 35.7%, OR = 0.77, p < 0.0001; 88.9% vs. 83.6%, OR = 0.63, p < 0.0001; 39.6% vs. 33.2%, OR = 0.75, p < 0.0001. When comparing women from urban and rural areas, the simultaneous seroprevalence was higher in rural areas. In women tested 2008–2010 (group 1) the simultaneous seroprevalence (urban vs. rural) was: 38.4% vs. 49.1%, OR = 1.54, p = 0.0002; 38.4% vs. 50.6%, OR = 1.64, p < 0.0001; 88.8% vs. 89.2%, OR = 1.04, NS; 36.4% vs. 47.7%, OR = 1.58, p = 0.0001. A similar trend was found in women tested in group 2. Conclusions: The rate of simultaneous seropositivity to Toxoplasma gondii, CMV and rubella virus among Romanian women of reproductive age decreased significantly between 2008–2010 and 2015–2018 and the susceptibility to infections increased. It is necessary to apply increased prevention measures among susceptible pregnant women. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

8 pages, 2020 KiB

Open AccessArticle

Ethnicity-Specific Normative Models of Quadruple Test as a Screening Test for Down Syndrome

by Praetip Praikaew, Kuntharee Traisrisilp, Chanane Wanapirak, Ratanaporn Sekararithi and Theera Tongsong

Medicina 2021, 57(7), 651; https://doi.org/10.3390/medicina57070651 - 24 Jun 2021

Cited by 1 | Viewed by 1965

Abstract

Background and Objectives: To establish normative models for median levels of serum biomarkers of the second trimester quad test (alpha-fetoprotein: AFP; free beta-human gonadotropins: hCG; inhibin-A; and unconjugated estriol: uE3) specific to Thai women and to compare multiples of the median (MoMs) derived from ethnicity-specific models and those derived from Caucasian models with ethnic correction. Materials and Methods: A cross-sectional study was undertaken in a tertiary, medical teaching center among low-risk pregnant Thai women between 14 and 21 weeks of gestation to measure the levels of the four serum biomarkers. The measured values of each biomarker were analyzed using the multivariable factorial polynomial technique for quantile regression as a function of gestational age and maternal weight. Results: The Thai-specific normative models for the four biomarkers were generated and available for use. The MoMs of all individuals generated from our models were significantly different from conventional (Caucasian) models with ethnic correction (Wilcoxon signed-rank test; p < 0.0001 for all biomarkers). The MoMs of AFP and hCG from both methods were in agreement, but those from Thai-specific models were significantly higher. However, those of inhibin-A and uE3 were markedly different and ethnic correction was unlikely to be useful. Conclusions: The Thai-specific normative models of the quad test as a function of gestational age and maternal weight were constructed using multivariable factorial polynomial models, better than simple quantile regression or log-linear regression used in earlier decades. The analysis of MoMs supports the use of ethnicity-specific models instead of Caucasian models with ethnic correction. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

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8 pages, 626 KiB

Open AccessArticle

How Did Prenatal Education Impact Women’s Perception of Pregnancy and Postnatal Life in a Romanian Population

by Anca Maria Balasoiu, Octavian Gabriel Olaru, Romina Marina Sima and Liana Ples

Medicina 2021, 57(6), 581; https://doi.org/10.3390/medicina57060581 - 07 Jun 2021

Cited by 6 | Viewed by 3364

Abstract

Background and Objectives: Prenatal education represents an important part of maternal prenatal care in Western countries. In Romania, prenatal education is of recent interest but there is no official information about prenatal courses and their impact on prenatal care and patients in Romania. Material and methods: A prospective study based on the STROBE statement was designed in order to assess the prenatal education delivered in our unit. The study group included women who gave birth at Bucur Maternity, “Saint. John” Hospital, Bucharest, Romania and attended the prenatal courses, compared with a control group (women who gave birth in our unit but did not attend the prenatal lecture). Patients’ perception about the impact of prenatal education was collected by applying a questionnaire. Results: The analysis included 89 women who fulfilled the questionnaire online. In our study, 62 women (69.7%) attended the prenatal education classes and represented the study group while 27 women (30.3%) constituted the control group. Women who attended the prenatal lecture recognized the utility of the topic regarding newborn care (90.3%), while women from the control group did not consider it useful (n = 55.6%), χ2 = 18.412, p < 0.001. Patients from the study group admitted the importance of the topics (93.5%) from the lectures about breast feeding, while the percentage of these women from the control group is significantly lower (55.6%) χ2 = 27.867, p < 0.001. Conclusions: The benefits of prenatal education were recognized by women who attended the prenatal lecture, while women who did not participate underestimated the utility of the topics. Further actions are required to inform mothers about the necessity of antenatal education. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

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Review

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14 pages, 847 KiB

Open AccessReview

HELLP Syndrome—Holistic Insight into Pathophysiology

by Aida Petca, Bianca Corina Miron, Irina Pacu, Mihai Cristian Dumitrașcu, Claudia Mehedințu, Florica Șandru, Răzvan-Cosmin Petca and Ioana Cristina Rotar

Medicina 2022, 58(2), 326; https://doi.org/10.3390/medicina58020326 - 21 Feb 2022

Cited by 24 | Viewed by 8924

Abstract

HELLP syndrome, also known as the syndrome of hemolysis, elevated liver enzymes, and low platelets, represents a severe pregnancy complication typically associated with hypertension. It is associated with increased risks of adverse complications for both mother and fetus. HELLP occurs in 0.2–0.8% of pregnancies, and, in 70–80% of cases, it coexists with preeclampsia (PE). Both of these conditions show a familial tendency. A woman with a history of HELLP pregnancy is at high risk for developing this entity in subsequent pregnancies. We cannot nominate a single worldwide genetic cause for the increased risk of HELLP. Combinations of multiple gene variants, each with a moderate risk, with concurrent maternal and environmental factors are thought to be the etiological mechanisms. This review highlights the significant role of understanding the underlying pathophysiological mechanism of HELLP syndrome. A better knowledge of the disease’s course supports early detection, an accurate diagnosis, and proper management of this life-threatening condition. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

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6 pages, 1216 KiB

Open AccessReview

Heterotopic Quadruplet Pregnancy. Literature Review and Case Report

by Brîndușa Cimpoca, Amira Moldoveanu, Nicolae Gică, Corina Gică, Anca Marina Ciobanu, Anca Maria Panaitescu and Dana Oprescu

Medicina 2021, 57(5), 483; https://doi.org/10.3390/medicina57050483 - 12 May 2021

Cited by 4 | Viewed by 2517

Abstract

Heterotopic pregnancy is the condition where both intrauterine and ectopic pregnancy are present. It rarely occurs after natural conception, but is more common with assisted reproductive techniques, when more than one embryo is transferred. Quadruplet heterotopic pregnancy is exceedingly rare. Methods: A literature review was conducted aiming to highlight the diagnosis difficulties and the management options in heterotopic quadruplet pregnancies. Results: Nine relevant studies were identified by researching PubMed up to 2021 for “heterotopic quadruplet pregnancy”, “quadruplet intrauterine and ectopic pregnancy”, “synchronous intrauterine and ectopic pregnancy”. Conclusions: In this paper, we present a case of heterotopic quadruplet pregnancy and address the difficulty in diagnosing this condition and make formal recommendations. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

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9 pages, 2482 KiB

Open AccessReview

Fetal Growth Acceleration—Current Approach to the Big Baby Issue

by Jan Modzelewski, Anna Kajdy, Katarzyna Muzyka-Placzyńska, Dorota Sys and Michał Rabijewski

Medicina 2021, 57(3), 228; https://doi.org/10.3390/medicina57030228 - 02 Mar 2021

Cited by 2 | Viewed by 2135

Abstract

Background and Objectives: Fetal overgrowth is related to many perinatal complications, including stillbirth, cesarean section, maternal and neonatal injuries, and shoulder dystocia. It is related to maternal diabetes, obesity, and gestational weight gain but also happens in low-risk pregnancies. There is ongoing discussion regarding definitions, methods of detection, and classification. The method used for detection is crucial as it draws a line between those at risk and low-risk popula-tions. Materials and Methods: For this narrative review, relevant evidence was identified through PubMed search with one of the general terms (macrosomia, large-for-gestational-age) combined with the outcome of interest. Results: This review summarizes evidence on the relation of fetal overgrowth with stillbirth, cesarean sections, shoulder dystocia, anal sphincter injury, and hem-orrhage. Customized growth charts help to detect mothers and fetuses at risk of those complica-tions. Relations between fetal overgrowth and diabetes, maternal weight, and gestational weight gain were investigated. Conclusions: a substantial proportion of complications are an effect of the fetus growing above its potential and should be recognized as a new dangerous condition of Fetal Growth Acceleration. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

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Other

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13 pages, 696 KiB

Open AccessSystematic Review

Myelomeningocele Surgery over the 10 Years Following the MOMS Trial: A Systematic Review of Outcomes in Prenatal versus Postnatal Surgical Repair

by Francesca Gabriela Paslaru, Anca Maria Panaitescu, George Iancu, Alina Veduta, Nicolae Gica, Alexandru Catalin Paslaru, Anamaria Gheorghiu, Gheorghe Peltecu and Radu Mircea Gorgan

Medicina 2021, 57(7), 707; https://doi.org/10.3390/medicina57070707 - 12 Jul 2021

Cited by 10 | Viewed by 3629

Abstract

Background and Objectives: Myelomeningocele is the most severe form of spina bifida, a congenital neural tube defect arising from an incomplete neural tube closure during early development with damage worsening with advancing gestational age. The Management of Myelomeningocele Study (MOMS) Trial proved that surgery performed before 26 weeks of gestation significantly improved the prognosis, significantly changing treatment paradigms. This article aims to provide a review of the changes and updates in spina bifida repair over the 10-year period following the MOMS Trial. Material and methods: We performed a systematic review in the PubMed and Cochrane databases as well as a hand-search of high-impact journals using the reference list of all identified articles, searching for randomized controlled trials and observational studies. Results: We identified 27 articles published between 2011 and 2021 that fulfilled the inclusion criteria and review them in the present study. Conclusions: With growing experience and with the improvement of prenatal open and fetoscopic techniques, the outcome of SB-associated conditions could be improved and the risks to both the mother and the fetus reduced. A continuous follow-up of the treated infants and further randomized trials are essential to study the complications and advantages or disadvantages of any given treatment strategy. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

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8 pages, 3337 KiB

Open AccessCase Report

Can SARS-CoV-2 Induce Uterine Vascular Anomalies and Poor Contractile Response?—A Case Report

by Anca Lesnic, Bashar Haj Hamoud, Mircea-Octavian Poenaru, Valentin-Tiberiu Moldovan, Radu Chicea, Romina-Marina Sima, Mihai Popescu and Liana Ples

Medicina 2021, 57(7), 670; https://doi.org/10.3390/medicina57070670 - 29 Jun 2021

Cited by 3 | Viewed by 2209

Abstract

We are reporting a case of a 36 year-old Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) positive hypertensive primigravida with postpartum uterine atony that required emergency subtotal hysterectomy at Saint John Hospital Bucur Maternity Bucharest. The maternity was designated as the Coronavirus Disease 2019 (COVID-19) Maternity for Bucharest and Ilfov County since March 2020. The patient was mildly symptomatic for SARS-CoV-2, infection confirmed with reverse transcription polymerase chain reaction (RT-PCR). The caesarean section was performed and a live male fetus was born, 2630 g and Apgar Score of 9 (the male fetus was negative for SARS-CoV-2). Postpartum hysterectomy with adnexal preservation was performed because of uterine atony. The postoperative evolution was favorable. The patient was discharged with her baby 10 days after birth. Given the limited resources, the placenta, the umbilical cord and the uterus were not tested for SARS-CoV-2. The pathology exam revealed that on the maternal side there were specific uterine atony lesions as well as endometrial and miometrial ischaemia. The placenta had nonspecific findings: chronic ischemic lesions with small villi, fibrin deposits in the materno-fetal interface. The peculiarity of the case is that we report the morphological findings of the placenta and uterus resulted from intrapartum uterine atonia in a patient with gestational arterial hypertension, premature birth and COVID-19. Further studies are required to characterize the pattern of such intricate conditions. Full article

(This article belongs to the Special Issue Current Trends in Prenatal Medicine: Research and Care)

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