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Aim: Fontan surgery is a palliative procedure commonly performed for functional single‐ventricle heart diseases. Fontan circulation is characterized by elevated central venous pressure and low cardiac output. It causes placental hypoxia, which could lead to poor obstetric outcomes. During post‐Fontan pregnancies, ultrasonography may detect abnormal appearance of the placenta. We have focused on higher incidences of unexpected onset of labor when this ultrasonographic finding is present. In this study, we aimed to investigate whether this finding could be an indicator of premature delivery before pre‐scheduled dates in post‐Fontan pregnancies. Methods: During post‐Fontan pregnancies, the placenta exhibits a mosaic pattern with areas of low and high echogenicity and unusually thick on ultrasonography. We refer to these changes as "ultrasonographic placental edematous changes." We retrospectively analyzed clinical charts and ultrasonograms for post‐Fontan pregnancies between 2015 and 2022. Results: Fifteen patients were included in this study. Ultrasonographic placental edematous changes in the placenta during pregnancy were detected in eight cases (53%). Six (75%) of these patients experienced unexpected premature labor. Two patients underwent vaginal delivery because of sudden onset of labor. Four patients underwent emergency cesarean sections. Two patients underwent planned preterm cesarean sections. In the seven pregnancies without placental edematous changes, all deliveries occurred on the pre‐scheduled dates determined based on the maternal heart condition. Conclusions: Pregnancies with ultrasonographic placental edematous changes have a higher risk of unexpected preterm delivery than those without these changes. Ultrasonographic placental edematous changes may serve as predictive markers for unplanned preterm births in post‐Fontan pregnancies. [ABSTRACT FROM AUTHOR]

Introduction: There is a paucity of objectively verified data on substance use among Danish pregnant women. We estimated the prevalence of substance use including alcohol and nicotine among the general population of Danish pregnant women. Material and Methods: In this anonymous, national, cross‐sectional, descriptive study, pregnant women were invited when attending an ultrasound scan between November 2019 and December 2020 at nine Danish hospitals. Women submitted a urine sample and filled out a questionnaire. Urine samples were screened on‐site with a qualitative urine dipstick for 15 substances including alcohol, nicotine, opioids, amphetamines, cannabis, and benzodiazepines. All screen‐positive urine samples underwent secondary quantitative analyses with gold standard, liquid chromatography‐tandem mass spectrometry (LC–MS/MS) analysis. Results were compared to questionnaire information to analyze the validity of self‐reporting and to examine possible cross‐reactions. Results: A total of 1903 of 2154 invited pregnant women participated (88.3%). The prevalence of dipstick‐positive urine samples was 25.0%. 44.0% of these were confirmed positive, resulting in a total confirmed prevalence of 10.8%. The prevalence of nicotine use was 10.1%—and for all other substances, <0.5%. Nicotine use was more prevalent among younger pregnant women, while other substance use appeared evenly distributed over age groups. Self‐reporting of use of nicotine products was high (71.1%), but low for cannabis and alcohol intake (0% and 33.3%, respectively). Prescription medication explained almost all cases of oxycodone, methylphenidate, and benzodiazepine use. Conclusions: Substance use among pregnant women consisted mainly of nicotine. Dipstick screening involved risks of false negatives and false positives. Except for alcohol intake and cannabis use, dipstick analyses did not seem to provide further information than self‐reporting. LC–MS/MS analyses remain gold standard, and future role of dipstick screenings should be discussed. [ABSTRACT FROM AUTHOR]

Introduction: In early‐onset fetal growth restriction the fetus fails to thrive in utero due to unmet fetal metabolic demands. This condition is linked to perinatal mortality and severe neonatal morbidity. Maternal administration of corticosteroids in high‐risk pregnancies for preterm birth at a gestational age between 24 and 34 weeks has been shown to reduce perinatal mortality and morbidity. Practice variation exists in the timing of the administration of corticosteroids based on umbilical artery monitoring findings in early‐onset fetal growth restriction. The aim of this study was to examine differences in neonatal outcomes when comparing different corticosteroid timing strategies. Material and methods: This was a post‐hoc analysis of the Dutch STRIDER trial. We examined neonatal outcomes when comparing institutional strategies of early (umbilical artery pulsatility index >95th centile) and late (umbilical artery shows absent or reversed end‐diastolic flow) administration of corticosteroids. The primary outcomes were neonatal mortality and a composite of neonatal mortality and neonatal morbidity, defined as bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis or retinopathy of prematurity. We also analyzed predictors for adverse neonatal outcomes, including gestational age at delivery, birthweight, maternal hypertensive disorders, and time interval between corticosteroids and birth. Results: A total of 120 patients matched our inclusion criteria. In 69 (57.5%) the early strategy was applied and in 51 (42.5%) patients the late strategy. Median gestational age at delivery was 28 4/7 (± 3, 3/7) weeks. Median birthweight was 708 (± 304) g. Composite primary outcome was found in 57 (47.5%) neonates. No significant differences were observed in the primary outcome between the two strategies (neonatal mortality adjusted odds ratio [OR] 1.22, 95% CI 0.44–3.38; composite primary outcome adjusted OR 1.05, 95% CI 0.42–2.64). Only gestational age at delivery was a significant predictor for improved neonatal outcome (adjusted OR 0.91, 95% CI 0.86–0.96). Conclusions: No significant differences in neonatal outcomes were observed when comparing early and late strategy of antenatal corticosteroid administration on neonatal outcomes in pregnancies complicated by early‐onset fetal growth restriction. We found no apparent risk contribution of interval between corticosteroid administration and delivery in multivariate analysis. Gestational age at delivery was found to be an important predictor of neonatal outcome. [ABSTRACT FROM AUTHOR]

Background: Symptoms of anxiety are common among pregnant and postpartum women, and 15%‐20% of pregnancies are affected by medical complications. Despite this, little is known about the relationship of medical complications in pregnancy and women's experience of anxiety. The purpose of this research was to conduct a systematic review and meta‐analysis of differences in anxiety symptom severity among women experiencing a medically complicated versus a medically uncomplicated pregnancy. Methods: This work was guided by the PRISMA reporting process. Electronic databases MEDLINE and PsycINFO were searched to identify studies that met the inclusion criteria. An adaptation of the Newcastle‐Ottawa Quality Assessment Scale for case‐control studies was used to perform a quality assessment review. A random‐effects meta‐analysis was used to calculate the estimated average standardized mean differences. Results: Based on the five studies which met our inclusion criteria, findings provide evidence of higher levels of anxiety symptoms among pregnant women experiencing a medically complicated versus a medically uncomplicated pregnancy. Despite considerable heterogeneity, all mean difference estimates are in the direction of greater anxiety in the high‐risk groups. Conclusions: Women experiencing a medically complex pregnancy report higher levels of anxiety symptoms compared to women experiencing a medically uncomplicated pregnancy. [ABSTRACT FROM AUTHOR]

Background: To evaluate obstetrical and perinatal outcomes of pregnancies with ankylosing spondylitis (AS). Methods: This was a retrospective study evaluating obstetric outcomes of 52 patients with AS who were followed up at our institution between 2006 and 2019. Patients were classified as having disease greater than or less than 5 years, and according to disease‐related medical treatment during pregnancy, as drug free, single medication or multiple medication. Results: Overall rates of preterm delivery, intrauterine growth retardation and preeclampsia were 17.3%, 13.4% and 7.7%, respectively. Thirty‐three of the patients were followed up without any medication, while 19 patients used drugs during pregnancy. Seven patients used a single drug and 12 patients had multiple drugs. There was no significant difference in terms of obstetrical and neonatal outcomes. However, a higher rate of neonatal intensive care unit (NICU) admission was observed in the group using medication for AS, despite a lack of statistical significance (31.5% vs 15%, P =.162). On the other hand, patients having disease more than 5 years had higher rates of Apgar scores less than <7 and admission to the NICU despite a lack of statistical significance (4% vs 7.4% and 16% vs 26%; P =.267 and P =.297, respectively). Conclusion: In conclusion, pregnancies of patients with AS must be considered as high risk due to increased rates of adverse outcomes such as preterm delivery, intrauterine growth retardation or preeclampsia. [ABSTRACT FROM AUTHOR]

Introduction: Hypertensive disorders of pregnancy have been the most frequent cause of maternal death in Norway since 1996 and are strongly associated with substandard care. In the UK, the number of maternal deaths due to hypertensive disorders has decreased drastically due to the implementation of updated guidelines, indicating a potential for reducing the number of deaths in other countries as well. Through audits of maternal deaths, we aim to prevent future deaths from hypertensive disorders in pregnancy by identifying suboptimal factors in treatment.Material and Methods: Maternal deaths in Norway from 1996 to 2014 were identified through linked registries. The Norwegian Maternal Mortality Audit Group performed all case assessments included in this study, classified the cause of death, evaluated the treatment, and identified suboptimal factors to care in each case. Emphasis was placed on antihypertensive treatment, timing of delivery, stabilization before delivery, and quality of care. Learning points were prepared to improve the treatment of hypertensive disorders of pregnancy.Results: We identified 74 maternal deaths. The maternal mortality rate was 6.5 deaths per 100 000 live births. The most common cause of death was hypertensive disorders (n = 16 deaths). In 14 of these deaths (87%), the audit group concluded that improvements to care could have made a difference to the outcome.Conclusions: In 1996-2014, hypertensive disorders were the most common cause of maternal death in Norway. Our study indicates that such deaths can be prevented by improvements in antihypertensive treatment and the timing of delivery. [ABSTRACT FROM AUTHOR]

Fetal medicine is a subspecialty of obstetrics investigating the development, growth and disease of the human fetus. The advances in fetal imaging (ultrasonography, MRI) and molecular diagnostic techniques, together with the possibility of intervention in utero, make fetal medicine an important, rapidly developing field within women's healthcare. Therefore, a variety of specialists, such as neonatologists, pediatric cardiologists, medical geneticists, radiologists and pediatric surgeons, are necessary to adjunct in the diagnosis and treatment of the fetus as a patient. In this commentary, we provide a description of some organizational and educational aspects of fetal medicine in the Nordic countries, using examples of the management of specific conditions such as aneuploidy screening, red cell allo-immunization and fetal interventions. Clearly, there are several cultural, legal, organizational and practical differences between the Nordic countries; these are not necessarily negative, given the high standards of care in all Nordic countries. The scope of the newly founded Nordic Network of Fetal Medicine is to enhance cooperation in clinical practice, education and research between the participant countries. Hopefully, this initiative will find the necessary political and economic support from the national authorities and bring a new era in the field of fetal medicine in the Nordic region. [ABSTRACT FROM AUTHOR]

Background Preconception care ( PCC) is a form of primary prevention for promoting health, assessing risk, and intervening to modify risk factors to try to improve maternal and infant outcomes. Clinical provision of preconception care before and after the release of recommendations has not been evaluated. Our objective was to determine trends in self-reported receipt of PCC from 2004 to 2010, and factors associated with self-reported receipt of PCC. Methods Pregnancy Risk Assessment Monitoring System ( PRAMS) data from 12 states were used to determine trends in PCC. Weighted multivariable logistic regression was used to identify factors associated with self-reported receipt of PCC. Results The sample consisted of n = 64,084 women, with 30.8 percent reporting receipt of PCC. PCC increased from 30.3 percent in 2004 to 32.6 percent in 2010 ( p = 0.08 for trend). Women who were younger, with lower household income, or with a preterm birth were less likely to report PCC. Women with lower levels of education, who were non-Hispanic black, intending pregnancy, without previous children, or with prepregnancy government insurance were more likely to report PCC. Conclusions Only one-third of women with a recent live birth report receipt of any PCC. There is a need to increase PCC receipt, especially among populations that demonstrate lower levels. [ABSTRACT FROM AUTHOR]

Premature luteal demise or luteal insufficiency is not well characterised as a cause of pregnancy loss in domestic species, including horses. In this report, a mare inseminated with cooled-transported semen at our facility returned for a routine pregnancy diagnosis at 15 days post ovulation. Ultrasonography per rectum revealed endometrial oedema and the absence of visual indication of a corpus luteum on either ovary. Nonetheless, an embryonic vesicle small for the gestational age was identified. Daily oral altrenogest treatment was implemented immediately. Serum progesterone concentration was 0.67 ng/ml, which is below the threshold considered adequate for pregnancy maintenance in the mare. Examinations were repeated at 17, 25, 30, 39, 49, 72 and 120 days post ovulation. At 25 days post ovulation the embryonic vesicle presented normal development for the gestational age. In addition, sequential blood samples were collected to measure progesterone, equine chorionic gonadotrophin and oestrone sulphate concentrations. Although progesterone concentration did not exceed 2 ng/ml until 72 days post ovulation, all other results were unremarkable and a healthy filly was born uneventfully at 344 days post ovulation. [ABSTRACT FROM AUTHOR]

van Kuijk SMJ, Sep SJS, Nelemans PJ, Smits LJM. How long do preconception risk prediction models hold? Influence of selective fertility on model performance. Paediatric and Perinatal Epidemiology 2010; 24: 602-607. Risk estimates derived from preconception prediction models can be used to counsel women with regard to any future pregnancies. Women with a high predicted risk of an adverse pregnancy outcome may decide more frequently not to try for another pregnancy than women with a low predicted risk. This prediction-guided selective fertility can cause a change in the composition of the pregnant population with respect to those parameters that are included in the prediction model. The question is whether such a change in composition could influence the performance parameters of the prediction model, such as sensitivity, specificity, positive and negative predictive values as well as the discriminative ability, when evaluating risks in the new population and whether it could compromise the longevity of the model. Using a hypothetical example, we show that the original sensitivity and specificity estimates of a preconception prediction model for an adverse pregnancy outcome no longer hold when the model is applied to a population affected by model-based selective fertility: sensitivity decreases, while specificity increases. However, individual patient risk estimates remain unbiased and discriminative ability, expressed as the area under the receiver operating characteristic curve, remains unaffected. [ABSTRACT FROM AUTHOR]

Prematurity is the single greatest cause of morbidity and mortality in obstetrics. Families, health care services, and education systems experience the impact of prematurity for the lifetime of the preterm-born child. Health care providers have tried to lower the preterm birth rate with prevention both before and during pregnancy and intervention for symptomatic women. The inability of the health care system to significantly decrease the incidence of preterm birth continues to be a challenge. To further complicate the situation, new data shows that infants born between 34 and 37 weeks’ gestation who were thought to have minimal long-term effects of preterm birth may be more at risk than previously appreciated. This article reviews evidence-based risk identification, prevention, and management of women experiencing preterm labor and birth. [Copyright &y& Elsevier]