Search Results (85)

Background: Uterine rupture is a rare but severe obstetric complication with significant maternal and neonatal consequences. While partial uterine ruptures (PURs) are generally associated with less severe outcomes, complete uterine ruptures (CURs) carry a higher risk of serious impact on both mother and child. The present study aimed to evaluate outcomes and identify risk factors for each type of rupture, and also to define high- and low-risk uterine ruptures based on clinical outcomes. Methods: A retrospective analysis of 112 uterine rupture cases, including 29 CURs and 83 PURs, was conducted at the Women’s Hospital of the University of Cologne from October 2010 to January 2021. Results: Maternal outcomes revealed that CUR was associated with higher risks of prolonged hospitalization (p = 0.003), postpartum hemorrhage (p < 0.001), maternal transfusion (p = 0.003), and ICU transfer (p = 0.004) compared to PUR. Neonatal outcomes showed a significantly higher risk of severe acidosis (p < 0.001), low APGAR scores (p < 0.001), NICU transfers (p = 0.004), and resuscitation needs (p = 0.016) in CUR cases. Factors increasing the risk of CUR included pathological CTG (OR = 1.9, 95% CI: 0.99–7.14, p = 0.05), abdominal pain (OR = 2.63, 95% CI: 1.10–6.25, p = 0.03), previous vaginal birth (OR = 7.14, 95% CI: 0.025–20, p < 0.001), and no uterine contractions (OR = 7, 95% CI: 1.21–40.56, p = 0.03). A previous cesarean section significantly increased the risk of CUR (OR = 4.94, 95% CI: 1.38–17.67, p = 0.014), whereas more than two cesarean sections reduced the risk (OR = 0.66, 95% CI: 0.13–3.22, p = 0.61). A comparison of CUR with maternal and neonatal high-risk rupture groups revealed that low gestational age and a history of previous cesarean sections were significant risk factors for neonatal high-risk rupture. Conclusion: Vaginal birth and abdominal pain were identified as key risk factors for CUR, which lead to severe maternal and neonatal outcomes. Recognizing these risk factors can help clinicians optimize risk stratification and decision-making, and enhance monitoring strategies to prevent adverse outcomes. Full article

This study was performed to assess the effects of grape pomace feeding on the immunoglobulin concentration in mammary gland secretions and the biochemical parameters of sows’ blood. This study presents unique results of sow blood parameters obtained during the first day postpartum. Sixteen gestating sows were included in the experiment. The experimental group (DGP) received a supplement of dried grape pomace in the amount of 1% of the basal diet from the 7th day antepartum until the end of lactation. Blood, colostrum, and milk were taken from the sows. On the 1st day postpartum, in the sows’ blood, higher values of total proteins and globulins, as well as lower values of aspartate aminotransferase, creatinine, and the albumin/globulin ratio, were recorded in DGP. There were no significant differences in the concentration of immunoglobulins in the blood of sows between the groups. Also, differences in the concentrations of immunoglobulins in the colostrum and milk of sows throughout lactation were not statistically significant. It can be stated that the feeding of dried grape pomace did not have a negative effect on the biochemical parameters of the sows’ blood, colostrum, and milk. In addition, there is a potential suggestion that the addition of dried grape pomace could have a positive effect on the antioxidant status of sows. Full article

Hypertensive disorders of pregnancy are associated with a higher risk of later cardiovascular disease, but the mechanistic links are unknown. We recruited two groups of women, one during pregnancy and another at least two years after delivery, including both cases (with a hypertensive disorder of pregnancy) and controls (with a normotensive pregnancy). We measured metabolites using liquid chromatography–mass spectroscopy and applied machine learning to identify metabolomic signatures at three time points: antepartum, postpartum, and mid-life. The mean ages of the pregnancy cohort (58 cases, 46 controls) and the mid-life group (71 cases, 74 controls) were 33.8 and 40.8 years, respectively. The levels of 157 metabolites differed significantly between the cases and the controls antepartum, including 19 acylcarnitines, 12 gonadal steroids, 11 glycerophospholipids, nine fatty acids, six vitamin D metabolites, and four corticosteroids. The machine learning model developed using all antepartum metabolite levels discriminated well between the cases and the controls antepartum (c-index = 0.96), postpartum (c-index = 0.63), and in mid-life (c-index = 0.60). Levels of 10,20-dihydroxyeicosanoic acid best distinguished the cases from the controls both antepartum and postpartum. These data suggest that the pattern of differences in metabolites found antepartum continues to distinguish women who had a hypertensive disorder of pregnancy from women with a normotensive pregnancy for years after delivery. Full article

Multiple acyl-CoA dehydrogenase deficiency (MADD), also known as glutaric acidemia/glutaric aciduria type II (GA II), is an inborn error of fatty acid, amino acid, and choline metabolism. The chronic management of MADD involves both dietary fat and protein restriction to reduce the substrates of the dehydrogenases affected, the avoidance of prolonged fasting as in any fat metabolism disorder, and monitoring for potential complications. Due to its rarity, there is little published experience on the management of MADD in pregnancy. Herein, we report the successful management of a pregnancy in a patient with late-onset or type III MADD, with considerations for preconception, antepartum, intrapartum, and postpartum care. Full article

The Oropouche virus (OROV) is an arbovirus (Peribunyaviridae: Orthobunyavirus) that traditionally causes febrile outbreaks in Latin America’s Amazon region. Previously, OROV was not associated with severe pregnancy outcomes. During the 2022–2024 outbreak in Brazil, OROV expanded geographically, revealing links to adverse pregnancy outcomes. This study describes six cases with varied fetal outcomes, including miscarriage, antepartum, intrauterine fetal demise (IFD), and normal development, correlating with maternal symptoms but not symptom severity. Vertical transmission was confirmed by detecting OROV through RT-qPCR, ELISA, and immunohistochemistry in fetal tissues. Genome sequencing from an IFD case identified a novel reassortment pattern reported in the 2022–2024 outbreak. Severe encephalomalacia, meningoencephalitis, vascular compromise, and multi-organ damage were evident, underscoring the significant risk OROV poses to fetal development and emphasizing the need for further investigation. Full article

Antepartum Cardiotocography (CTG) is a biomedical sensing technology widely used for fetal health monitoring. While the visual interpretation of CTG traces is highly subjective, with the inter-observer agreement as low as 29% and a false positive rate of approximately 60%, the Dawes–Redman system provides an automated approach to fetal well-being assessments. However, it is primarily designed to rule out adverse outcomes rather than detect them, resulting in a high specificity (90.7%) but low sensitivity (18.2%) in identifying fetal distress. This paper introduces PatchCTG, an AI-enabled biomedical time series transformer for CTG analysis. It employs patch-based tokenisation, instance normalisation, and channel-independent processing to capture essential local and global temporal dependencies within CTG signals. PatchCTG was evaluated on the Oxford Maternity (OXMAT) dataset, which comprises over 20,000 high-quality CTG traces from diverse clinical outcomes, after applying the inclusion and exclusion criteria. With extensive hyperparameter optimisation, PatchCTG achieved an AUC of 0.77, with a specificity of 88% and sensitivity of 57% at Youden’s index threshold, demonstrating its adaptability to various clinical needs. Its robust performance across varying temporal thresholds highlights its potential for both real-time and retrospective analysis in sensor-driven fetal monitoring. Testing across varying temporal thresholds showcased it robust predictive performance, particularly with finetuning on data closer to delivery, achieving a sensitivity of 52% and specificity of 88% for near-delivery cases. These findings suggest the potential of PatchCTG to enhance clinical decision-making in antepartum care by providing a sensor-based, AI-driven, objective tool for reliable fetal health assessment. Full article

Background/Objective: Preterm births disproportionately affect low- and middle-income countries (LMICs), where evidence-based interventions to improve birth outcomes are lacking. The objective of this study was to systematically review, collate, and synthesize data on low-dose aspirin’s (LDA) effect on the incidence of preterm births in women from LMICs. Materials and Methods: This review included nine randomized controlled trials (RCTs) spanning thirteen LMICs, with 22,545 participants. The intervention group comprised 11,275 participants and the control group comprised 11,270 participants. The relative risk ratios and pooled intervention effects were calculated using Review Manager software, RevMan v5.4.1, with a random effects model. Low-dose aspirin’s effects on five outcomes were analyzed: preterm birth, perinatal mortality, low birth weight, antepartum hemorrhage, and post-partum hemorrhage. The quality of the studies was assessed by the Cochrane risk-of-bias tool and overall quality of evidence, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Two independent authors participated in screening, data extraction, and quality assessment of the included studies. Results: Low-dose aspirin therapy significantly lowered the risks of preterm births (RR 0.91, 95% CI 0.84–0.98, p = 0.02) and perinatal mortality (RR 0.83, 95% CI 0.73–0.94, p < 0.01) in at-risk pregnant women from LMICs. Its effects on low birthweight and ante- and post-partum hemorrhages were less conclusive. Conclusions: Targeted LDA therapy should be considered to reduce preterm births in at-risk pregnant women from LMICs. Full article

Background: Neonatal sepsis is a major cause of infant mortality, and it accounts for a significant consumption of antimicrobials in paediatrics. This is the first comprehensive study on neonatal sepsis in Hong Kong. Methods: From 2014 to 2023, all neonates admitted to a single institution with culture-proven infections from the blood and/or cerebrospinal fluid were selected and reviewed retrospectively. The infecting organisms, their antibiotic nonsusceptibility pattern, and the concordance of empirical antimicrobial therapy with the microbiological profiles were described and were further compared between infants of normal/low birth weight (≥1.5 kg) and very low/extremely low birth weight (<1.5 kg), early-onset sepsis (<72 h), and late-onset sepsis (4–28 days), the first and the second 5-year periods (2014–2018 vs. 2019–2023). Results: After contaminants were excluded, there were 118 affected neonates with 125 organisms identified. Fifty-nine were male. Thirty-four were very low/extremely low birth weight infants, and twenty-eight infants had early-onset sepsis. Patient demographics and the microbiology findings did not differ between the first 5 years and the latter 5 years. However, the incidence of neonatal sepsis was significantly lower in the latter 5 years (3.23 vs. 1.61 per 1000 live births, p < 0.001), the period that coincided with the COVID-19 pandemic. Escherichia coli was the most common Gram-negative pathogen. Streptococcus agalactiae and Streptococcus bovis group infections were more common in early-onset sepsis, while coagulase-negative Staphylococcus and non-E. coli Gram-negative pathogens were more likely to occur in late-onset sepsis. In very low/extremely low birth weight infants, the rate of cefotaxime or ceftriaxone nonsusceptibility among Gram-negative isolates was higher (p = 0.01), and concordance of empirical antimicrobial therapy was lower (p = 0.006). Conclusions: Management of neonatal sepsis remains challenging, and there is a need for optimising antimicrobial therapy, especially in preterm patients. Antepartum screening with intrapartum antibiotic prophylaxis is effective in reducing the risk of early-onset sepsis associated with S. agalactiae, while stringent infection control measures are important for the prevention of late-onset sepsis. Full article

The global rise in obesity presents serious concerns, particularly due to its association with pregnancy complications such as gestational diabetes, preeclampsia, cesarean delivery, and fetal macrosomia. Maternal obesity also contributes to intergenerational health risks, increasing the likelihood of long-term issues in offspring. Preconception counseling is an essential preventive measure to reduce complications; however, many women miss this opportunity due to unplanned pregnancies. This study explores the impact of pregestational body mass index (BMI) and gestational weight gain (GWG) on pregnancy outcomes, underscoring the importance of routine monitoring of these parameters. Existing studies identify both BMI and GWG as independent risk factors for adverse maternal and neonatal outcomes, with elevated BMI combined with excessive GWG posing an even greater risk. Specifically, a BMI > 30 kg/m² doubles the risk of complications such as gestational diabetes, hypertension, and cesarean delivery. Additionally, a review of national and international guidelines highlights a lack of consensus on managing gestational weight gain in women with obesity, particularly regarding antepartum surveillance and timing of delivery. Similarly, no specific guidelines have been established for underweight pregnant women. Additionally, few studies have thoroughly assessed the maternal and fetal risks associated with underweight during pregnancy. Despite this, numerous studies have highlighted an increased risk of preterm birth (PTB) and small-for-gestational-age (SGA) infants. This narrative review emphasizes the need for further research to develop tailored guidelines for managing pregnant women based on pregestational BMI, ultimately improving maternal and neonatal health outcomes. Full article

The data about pregnancy while having a low ejection fraction are scarce, since pregnancy is not recommended for women with an ejection fraction of less than 30%. There is an increased risk of obstetrical complications and adverse maternal-fetal outcomes. Pregnancy is a rough journey for this group of patients. However, a successful pregnancy can be achieved when cardiac complications are managed during pregnancy. The early recognition of women at risk of cardiovascular events and early referral can optimize the maternal and neonatal outcomes with close collaboration between the maternal-fetal medicine specialist and the cardiologist. The study’s aim was to assess the experience of our tertiary center with regard to the adverse maternal outcome for women with an ejection fraction ≤ 30% compared to those with an EF > 30% in our tertiary center. The fetal and obstetric outcome for pregnancies with an EF ≤ 30% was compared to that for pregnancies with an EF > 30%. Methodology: After receiving the approval of the local Ethical Board Review, a retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSHRC) in the city of Riyadh, Kingdom of Saudi Arabia. Our study population included women with cardiomyopathy (acquired or congenital) who were followed up or delivered in KFSHRC from the period of January 2004 till March 2020. Cases were identified by reviewing the database from the Cardiac Center Echocardiograph and maternal fetal medicine unit. The data on the maternal and fetal outcome were gathered from the hospital medical records. An adverse maternal outcome included: death, hospitalization due to decompensated heart failure, and worsening cardiovascular status during pregnancy. Adverse fetal outcomes included: miscarriages, termination of pregnancy, FGR, and placental insufficiency. Obstetrics complications included: complications related to the mode of delivery, antepartum hemorrhage, postpartum hemorrhage, or preeclampsia. Results: Our study included 44 subjects, examining the differences between those with an ejection fraction greater than 30 (n = 21 subjects) and those with an ejection fraction less than or equal to 30 (n = 23) with respect to demographics, co-morbidities, and outcomes (maternal, pregnancy, fetal, ultrasound, and baby). There was no evidence of any differences in the demographics. From among the co-morbidities, there was a statistically higher rate of dilated cardiomyopathy and lower rate of rheumatic heart disease in those with a lower ejection fraction. Also, women with a lower ejection fraction tended to deliver through a means other than simple vaginal delivery. There was a significant association (p = 0.0296) indicating that individuals with a lower ejection fraction tended to have a lower gestational age at delivery. The information on whether the pregnancy resulted in a live birth was available for all but one of the mothers. Across all the mothers, 32 (74%) resulted in a live birth and 11 did not. The percentage of pregnancies resulting in a live birth in the group for which the ejection fraction was greater than 30 was 90% and that in the group for which the ejection fraction was less than or equal to 30 was 59% (p = 0.0339). From among the ultrasound and baby outcomes, only the rate of the babies being discharged alive differed statistically between the two ejection fraction groups, with those mothers having a lower ejection fraction experiencing fewer babies being discharged alive (p = 0.0310). Conclusions: In conclusion, women with a low ejection fraction are at an increased risk of maternal-fetal complications. In our study, the lower the EF (≤30) the worse were the fetal and neonatal outcomes; however, in terms of the maternal outcomes, it was the same whether the EF was low or ultra-low. Yet, these groups of patients need to be counseled about the facts of poor obstetrical outcomes with an emphasis on preconceptual counseling. Full article

During pregnancy, reproductive hormonal changes could affect the mental health of women, such as depression and anxiety. Previous studies have shown that exposure to endocrine disrupting chemicals (EDCs) is significantly associated with mental health symptoms; however, the results were inconsistent. We aimed to examine the association between 24 endocrine-disrupting chemicals (EDCs) in maternal urine and perinatal depression and their association with dietary and lifestyle factors. Participants were recruited from the “No Environmental Hazards for Mother–Child” cohort in Korea. Structured questionnaires asking dietary and lifestyle factors and evaluation of depressive symptoms were administered during antepartum (14 weeks of gestation) and postpartum (within four weeks after birth) periods. Urine samples were collected from 242 and 119 women during antepartum and postpartum periods, respectively. To assess perinatal depression, we used the Center for Epidemiological Studies-Depression Scale and the Edinburgh Postnatal Depression Scale. Antepartum depression and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP) (1.50, 1.01–2.23) and 1-hydroxypyrene (1-OHP) (0.05, 0–0.89) showed significant positive association. Additionally, postpartum depression showed significant associations with mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) (2.78, 1.00–7.70), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) (2.79, 1.04–7.46), 2-hydroxynaphthalene (2-NAP) (7.22, 1.43–36.59), and 2-hydroxyfluorene (2-FLU) (<0.01, 0–0.004). Some dietary factors (consumption of fish, fermented foods, cup noodles, and popcorn) and consumer product factors (use of skin care, makeup, perfume, antibiotics, sunscreen, nail polish, new furniture, plastic tableware, detergent, polish, paint, and pesticide) were associated with the concentration level of chemicals. We found that exposure to several EDCs during pregnancy and the postpartum period was associated with perinatal depression and dietary–lifestyle factors. Women in childbirth need to actively seek out information about exposure to EDCs and make efforts to avoid them for their own and fetal health. Full article

(1) Background: Crossed fused renal ectopia is a rare migration and fusion renal anomaly, more frequently affecting males, with an incidence of between 1:2000 and 1:7500 observed at autopsy. (2) Case presentation: This paper presents the case of a 34-year-old woman, IIIG IIIP, who presented to our clinic for a first-trimester screening evaluation. The risk calculation was performed using the Fetal Medicine Foundation’s first-trimester screening software, version 2.8.1. The screening indicated a low risk for aneuploidies, but the ultrasound scan revealed an empty right renal fossa in the standard coronal section. A more detailed axial examination raised the suspicion of crossed fused renal ectopia. No other anomalies were detected. The morphological scans conducted in the second and third trimesters confirmed and upheld the diagnosis initially established in the first trimester. The fetus did not develop any potential antepartum complications. The patient gave birth via caesarean section at 36 weeks to a live female infant, weighing 3000 g, with an APGAR score of 9 at 1 min. Postnatally, the first trimester diagnosis of the renal malformation was confirmed. (3) Conclusions: Crossed fused renal ectopia, probably the rarest renal migration anomaly, can be diagnosed as early as the first trimester of pregnancy. Full article

Background: Deranged antepartum laboratory parameters may be risk factors for postpartum hemorrhage (PPH). However, whether this is also valid in women who give birth prematurely is currently unknown. Methods: We performed a retrospective single-center study to assess the role of antepartum hemoglobin, platelet count, fibrinogen, activated partial thromboplastin time, and prothrombin time as risk factors for PPH following caesarean section. We defined PPH as documented blood loss of at least 1 L and/or transfusion of red blood cell concentrates. We stratified the included patients according to gestational age: extremely preterm (gestational age < 28 weeks), very preterm (gestational age between 28 and 32 weeks), late and moderate preterm (gestational age between 32 and 37 weeks), and term (gestational age ≥ 37 weeks). Results: We included 1734 patients, 112 (6%) of whom had PPH. In total, 19 patients (10%) were in the extremely preterm group, 13 patients (10%) were in the very preterm group, 44 patients (9%) were in the late and moderate preterm group, and 36 patients (4%) were in the term group. Hemoglobin predicted PPH in all gestational age groups. Platelet count was associated with PPH in term, but not in preterm patients. Fibrinogen was associated with PPH in late prematurity but not in term patients and not in patients with early or extreme prematurity. Conclusions: Antepartum hemoglobin was the only factor predicting PPH in preterm and term caesarean sections. Platelet count and fibrinogen concentration were associated with PPH in term and late prematurity, respectively, but not in earlier stages of prematurity. Full article

High-yielding dairy cows need diets that meet their energy demand and contain sufficient essential nutrients such as n-3 fatty acids (FAs). Conjugated linoleic acid (CLA) is able to relieve the energy metabolism, but common corn silage and concentrate-based diets contain insufficient amounts of essential fatty acids (EFA). Abomasal infusion was used in the current study to supplement cows from 9 weeks antepartum to 9 weeks postpartum with either coconut oil (CTRL, n = 8), EFA (n = 9), or conjugated linoleic acid (CLA, n = 9), or a combination of both (EFA + CLA, n = 10). The study focused on the effects of FAs on peripheral tissues, such as longissimus muscle (MLD) and adipose tissues, which were harvested after slaughter. Fatty acid composition, muscle fiber and fat cell morphology, muscle fiber type transition, and gene expression were analyzed. Supplemented FAs and their metabolites were increased (p < 0.05) in MLD and intermuscular fat (INTF) but not in subcutaneous fat (SCF). The intramuscular fat content and gene expression of ACACA and FASN were increased in CLA-supplemented cows (p < 0.05). Supplementation did not affect the muscle fiber size and fiber type composition. Supplemented CLA had more effects than EFA, improving the energy balance of cows accompanied with increased triglyceride formation and storage. Full article

Background: Obstetric Anal Sphincter Injuries (OASI) are associated with significant morbidity. Data regarding induction of labor (IOL) and risk of OASI is conflicting. The objective of this study is to evaluate if IOL increases the odds of OASI when compared to spontaneous labor. Methods: This is a retrospective case–control study in women with term, singleton pregnancies, who had a vaginal delivery at a single, academic center in an urban setting from October 2015 to December 2021. Individuals with the primary outcome, OASI, were identified and matched with controls (no OASI) by delivery date. Results: 303 OASI individuals were identified and matched with 1106 controls. Women with OASI were more likely to be White or Asian, have commercial insurance, and have a previous cesarean delivery (CD). IOL increased the likelihood of OASI by 49% compared to spontaneous labor (OR 1.49, 95% CI [1.138, 1.949]). IOL was no longer significant when adjusting for confounding variables and known risk factors. Conclusion: IOL was not associated with OASI when accounting for known antepartum and intrapartum risk factors. Further investigation of modifiable and non-modifiable risks during labor is imperative to decrease the risk of OASI and associated pelvic floor disorders. Full article