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Deep Learning Classification is often used to analyze biomedical data. One of them is to analyze the Fetal Heart Rate (FHR) signal data used to check and monitor maternal and fetal health and prevent mobility and mortality in fetuses at risk of developing hypoxia. The problem that often occurs in the data is data unbalance. Time Series Generative Adversarial Networks (TSGAN) solves data imbalance in the FHR signal and generate more data and better classification performance. Augmentation using the GAN model in this study obtained an increase in the Quality Index of 3%–44% from other models.

Fetal Heart Rate(FHR), an important recording in Cardiotocography(CTG)-based fetal health status monitoring, is the only information that clinical obstetricians can directly obtain and use. A challenge, however, is that missing samples are very common in FHR due to various causes such as fetal movements and sensor malfunctions. The aim is the development of an inpainting tool which is suitable for different missing lengths q and various total missing percentages Q, as well as for use in online mode. This study focused on two major impediments to existing inpainting methods: the longer the missing length, the more difficult it is to recover with mathematical methods; the reliance on tens of thousands of training samples, and the computational burden caused by full batch-based dictionary learning algorithms. We present a regularized minimization approach to signal recovery, which combines a L0.6-norm minimized sparse dictionary learning algorithm (MSDL) and a model optimization strategy for using a mini-batch version for signal recovery. Using 100 FHR recordings with 2 protocols designed to simulate missing clinical data scenarios, the combined method performed favorably in terms of 5 data analysis metrics and 3 clinical indicators. Comparing 4 inpainting methods, we were able to prove the superiority of the proposed algorithm for both large q and large Q. The experimental results showed the lowest values (2.64 (MAE), 4.68 (RMSE)) when Q=5% with short interval lengths. The developed architecture provides a reference value for the practical application of recovering missing samples online.

Exposure to benzene, toluene, ethylbenzene, and xylenes (BTEX) may have different adverse effects on the health of pregnant women and fetal health, as pregnant women and fetuses are particularly vulnerable to exposure to contaminants.This cross-sectional study was conducted to investigate the exposure of pregnant women living in the vicinity of the Ilam petrochemical complex to BTEX and associations with serum pro-inflammatory cytokines IL-6 and TNF-α. Based on the distance from the petrochemical complex, 110 pregnant women were enrolled in two groups of exposed (n = 60) and control (n = 50). Urinary BTEX was measured by a headspace gas chromatography-mass spectrometry (GC/MS). The serum cytokines were measured using enzyme-linked immunosorbent assay (ELISA) diagnostic method. Results showed that the urinary concentrations of benzene, toluene, ethylbenzene, m-p-xylene, and o-xylene levels in the exposed group were 572, 829, 403, 567, and 416 ng/L, respectively, that were higher than the corresponding values in the control group. The mean serum concentrations of IL-6 and TNF-α in the exposed group were 5.26 and 6.0 pg/ml. Based on Spearman’s correlation coefficient analysis, in the exposed group, only benzene had the most positive and significant correlation with serum levels of IL-6 (r = 0.515, p

A sizeable number of women face difficulties during pregnancy, which eventually can lead the fetus towards serious health problems. However, early detection of these risks can save both the invaluable life of infants and mothers. Cardiotocography (CTG) data provides sophisticated information by monitoring the heart rate signal of the fetus, is used to predict the potential risks of fetal wellbeing and for making clinical conclusions. This paper proposed to analyze the antepartum CTG data (available on UCI Machine Learning Repository) and develop an efficient tree-based ensemble learning (EL) classifier model to predict fetal health status. In this study, EL considers the Stacking approach, and a concise overview of this approach is discussed and developed accordingly. The study also endeavors to apply distinct machine learning algorithmic techniques on the CTG dataset and determine their performances. The Stacking EL technique, in this paper, involves four tree-based machine learning algorithms, namely, Random Forest classifier, Decision Tree classifier, Extra Trees classifier, and Deep Forest classifier as base learners. The CTG dataset contains 21 features, but only 10 most important features are selected from the dataset with the Chi-square method for this experiment, and then the features are normalized with Min-Max scaling. Following that, Grid Search is applied for tuning the hyperparameters of the base algorithms. Subsequently, 10-folds cross validation is performed to select the meta learner of the EL classifier model. However, a comparative model assessment is made between the individual base learning algorithms and the EL classifier model; and the finding depicts EL classifiers’ superiority in fetal health risks prediction with securing the accuracy of about 96.05%. Eventually, this study concludes that the Stacking EL approach can be a substantial paradigm in machine learning studies to improve models’ accuracy and reduce the error rate.

Topicality. Currently, intrapartum fetal health care is aimed at an adequate choice of anesthetic aid used during delivery to minimize the negative impact. Despite the wide range of currently existing anesthetics, the choice of anesthetic drug is limited by its negative effect not only on the fetus, but also on the contractile activity of the uterus, which significantly reduces the number of anesthetics used in obstetric practice.The purpose of this study is to analyze domestic and foreign literature in order to study the effect of anesthesia on the condition of the fetus. Material and methods. In the course of this study, an analysis of modern Russian and foreign literary sources, as well as the latest scientific works in the field of methods of general and regional anesthesia in the field of obstetrics and gynecology, was carried out.Results. Almost all drugs used for general anesthesia in obstetric practice can have a negative effect on the fetus. Neuroaxial pain relief methods are leading in obstetric practice, but their use is associated with complications that can lead to an adverse outcome not only from the mother, but also from the fetus. One such complication is the risk of arterial hypotension. It is interesting that comparative studies of general and regional anesthesia methods during operative delivery differ in the results obtained. Regarding the issue of anesthesia of natural births, the information of the Congress of the American Society of Anesthesiologists (lecture C.A. Wong (Chicago) “Neuroaxial Labor Analgesia and Prognancy Outcome: Factand Fiction”) remains relevant, according to which neuroaxial anesthesia methods do not affect the condition of the fetus, provided that the mother has stable hemodynamics.Conclusion. Due to the appearance and release of neuroaxial pain relief methods, completely unreasonably little attention is paid to the issues of general anesthesia of pregnant women, while according to the results of a study of scientific literary sources, it was revealed that this method of pain relief in obstetric practice is accompanied by the most direct and mediated effects on the fetus. Neuroaxial pain relief methods have practically no effect on the condition of the fetus, provided that the mother has stable hemodynamics.

EPA and DHA are essential for maternal and fetal health, but epidemiological data are sparse in China. We examined the trends of EPA alone and a combination of EPA plus DHA in pregnant and lactating women in three distinct geographic regions in China and explored their potential influencing factors. A total of 1015 healthy women during mid-pregnancy, late pregnancy or lactation were recruited from Weihai (coastland), Yueyang (lakeland) and Baotou (inland) cities of China between May and July of 2014. Maternal EPA and DHA concentrations (percentage of total fatty acids) in plasma and erythrocytes were measured by capillary GC. Adjusted EPA plus DHA concentrations in both plasma and erythrocytes significantly declined from mid-pregnancy (2·92 %, 6·95 %) to late pregnancy (2·20 %, 6·42 %) and lactation (2·40 %, 6·29 %) (Ptrend < 0·001); and both concentrations were highest in coastland, followed by lakeland, and lowest in inland (P < 0·001). Regarding EPA alone, the concentrations were higher in women during lactation or late pregnancy and in women in coastland and inland areas. Moreover, concentrations of EPA or EPA plus DHA were higher in women with older age, higher education, higher annual family income per capita and higher dietary intake of marine aquatic product and mutton. In lactating women, erythrocyte EPA concentration was higher in those having breast-feeding partially v. exclusively. In conclusion, maternal plasma and erythrocyte concentrations of EPA plus DHA or EPA alone differed with geographic regions, physiological periods and maternal characteristics, indicating a need of population-specific health strategies to improve fatty acids status in pregnant and lactating women.

Background: The increasing prevalence of obesity worldwide has prompted the World Health Organization (WHO) to designate obesity as one of the most important global health threats. The epidemic is especially pronounced in women of reproductive age. Prepregnancy obesity is an independent risk factor for maternal and neonatal morbidity and mortality. The origin of this epidemic is unhealthy lifestyle – high energy and high-fat diet and physical inactivity. During periconceptual period and pregnancy, the composition of a woman’s diet is of particular importance, as it may influence the pregnancy, the delivery and the health of the mother and the infant later on, so an excessive gestational weight gain (GWG) is not recommended. The aim of our study is to clarify the complications related to excess prepregnancy body weight on maternal and fetal health. Methods: Hundred obese pregnant women with BMI (30-40 Kg/m2) measured at first trimester were prospectively enrolled into this study. Routine blood pressures, random blood sugar measuring and ultrasonographic follow up are required during pregnancy for early detection of any complications related to maternal obesity and excessive gestational weight gain (GWG). Results: cases statistically evaluated in these study were 100 pregnant females with mean age 27.34 years + 5 years SD and mean BMI 32.97 Kg/m2 + 2.92 Kg/m2 SD. Denoting in our study, the effect of maternal obesity om maternal and fetal health. Conclusion: A causal relationship between the prepregnancy BMI and obstetric complications is proven. Weight management is important for every women of reproductive age. Thus, medical Practice must consider these complications by providing early detection and management to improve both maternal and neonatal outcome.

Supplemental Digital Content is available in the text., The extent to which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at different points in the pregnancy timeline may affect maternal and fetal outcomes remains unknown. We sought to characterize the impact of SARS-CoV-2 infection proximate and remote from delivery on placental pathology. We performed a secondary analysis of placental pathology from a prospective cohort of universally tested SARS-CoV-2 positive women >20 weeks gestation at 1 institution. Subjects were categorized as having acute or nonacute SARS-CoV-2 based on infection 0.99). When including 188 SARS-CoV-2 negative placentas, significant differences in frequency of fetal vascular malperfusion lesions remained between acute, nonacute and control cases (53.8% vs. 18.8% vs. 13.2%, respectively; P

Intimate partner violence (IPV) during pregnancy has become a focus of attention in recent years, owing to its relatively high prevalence, its impact on maternal and fetal health, and its cumulative effects over time. This study aims to determine the magnitude and characteristics of IPV among pregnant Saudi Arabian women, to identify the factors that increase the risk, and to assess the willingness of abused women to report IPV. This is a cross-sectional, community-based survey of pregnant women in the Eastern Province of Saudi Arabia. A modified Abuse Assessment Score (AAS) questionnaire was used. Sociodemographic data were collected. Data related to willingness to report IPV, including reasons for declining to report IPV, were also collected. A total of 1,330 women completed the three parts of the survey. In total, 345 (25.9%) women reported emotional abuse during pregnancy, whereas 72 (5.4%)reported physical abuse and 180 (13.5%) reported sexual abuse. In emotional abuse, a significant association was found between having more children (p = .001), having a lower education (p = .05), having a lower income (p = .04), and being abused. In physical abuse during pregnancy, no significant associations were found between all variables and being abused. However, in reporting sexual abuse among women during pregnancy, a significant increase in the risk was found in those with four or more children (p = .01) and those who are employed (p = .01). More than two-thirds (71.2%) of abused pregnant women were unwilling to report the abusive acts to a medical authority. IPV is common among pregnant Saudi women. Emotional abuse is the commonest form of IPV, affecting one in four women. More than two-thirds of abused women were unwilling to report their partner’s abusive acts. Screening for IPV may encourage women to seek help and improve both maternal and fetal health.

The worldwide infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacts human health and life on multiple levels. People infected with SARS-CoV-2 suffer from physical disorders and psychological distress. At present, no direct evidence indicates that SARS-CoV-2 negatively influences human reproduction, and the possibility that gametes and embryos are affected requires further investigation. To evaluate the potential effects of SARS-CoV-2 infection on human reproduction and fetal health, this review summarizes the basic and clinical research of SARS-CoV-2 on reproduction up to date, hoping to offer guidance and advice to people at reproductive age and provide clues for the prevention and treatment of associated diseases.

Cardiotocography is a series of inspections to determine the health of the fetus in pregnancy. The inspection process is carried out by recording the baby's heart rate information whether in a healthy condition or contrarily. In addition, uterine contractions are also used to determine the health condition of the fetus. Fetal health is classified into 3 conditions namely normal, suspect, and pathological. This paper was performed to compare a classification algorithm for diagnosing the result of the cardiotocographic inspection. An experimental scheme is performed using feature selection and not using it. CFS Subset Evaluation, Info Gain, and Chi-Square are used to select the best feature which correlated to each other. The data set was obtained from the UCI Machine Learning repository available freely. To find out the performance of the classification algorithm, this study uses an evaluation matrix of precision, Recall, F-Measure, MCC, ROC, PRC, and Accuracy. The results showed that all algorithms can provide fairly good classification. However, the combination of the Random Forest algorithm and the Info Gain Feature Selection gives the best results with an accuracy of 93.74%.

The purpose of this study was to investigate pregnant women’s consumption and perception of functional foods in Korea. A survey was conducted among 112 pregnant women in Chungcheongnam-do Province and 110 responses were included for final analyses. Results revealed that vitamin D, folic acid, and iron were the most frequently consumed functional foods. Of these respondents, 73.6% had experience in counseling with experts including doctors, pharmacists, and dietitians about functional food intakes. With such counseling experience, pregnant women were more likely to purchase functional foods at hospitals, to take two different kinds of them at the same time, and to spend about 50,000 to 100,000 won each month to purchase them. Those with counseling experience were also more likely to perceive effects of functional foods on diseases, but less likely to worry about their side effects. They tended to take functional foods for fetal health, although they have concerns about the quality and the high price of functional foods. These results could be used for future studies and policy development to promote and support healthy consumption of functional foods among pregnant women.

GPER1 in utero to the rescue! Several common pathogens, including influenza A virus (IAV), can activate systemic type I interferon (IFN) signaling during pregnancy. Such infections would be expected to cause birth defects and fetal mortality, but maternal IAV infections rarely produce such effects, suggesting the presence of a protective mechanism in fetal tissues. Harding et al. used a CRISPR screen to uncover IFN regulators that can mediate differential IFN control across tissues in human cell lines. They found that G protein–coupled estrogen receptor 1 (GPER1), which is expressed in fetal tissues, acts as a protective suppressor of IFN responses in the placenta during maternal infection. In a mouse model, pharmacological activation of GPER1 shielded fetuses from maternal inflammation. Activation of GPER1 might be promising therapeutically to protect the fetus from both maternal and fetal infections. Science , this issue p. 271

Aneurysmal subarachnoid hemorrhage (aSAH) is an emergent condition requiring rapid intervention and prolonged monitoring. There are few recommendations regarding the management of aSAH in pregnancy. We identified all available literature and compiled management decisions as well as reported outcomes through a systematic literature review without meta-analysis to provide recommendations for management of aSAH during pregnancy. We included a total of 23 articles containing 54 cases of pregnancy-related aSAH in our review. From these reports and other literature, we evaluated information on aSAH pathophysiology, diagnosis, and management with respect to pregnancy. Early transfer to an appropriate facility with neurocritical care, a high-risk obstetric service, and a neurosurgery team available is crucial for the management of aSAH in pregnancy. Intensive monitoring and a multidisciplinary approach remain fundamental to ensure maternal and fetal health.

Permanent maxillary and mandibular first molars are the first permanent teeth to erupt into the oral cavity along with the mandibular incisors. It serves as an excellent record of maternal and fetal health, reflecting the prenatal, perinatal, and postnatal health and diseases. This review focuses on the molar morphogenesis, molar malformations, their etiopathogenesis, and pathologies causing specific pattern of molar malformations.

Previous epidemiological studies have shown that prenatal exposure to organochlorine pesticides (OCPs) entails a variety of adverse impacts on fetal health, but it is not yet known whether it is associated with risk for orofacial clefts (OFCs). This study of 103 fetuses or newborns with a diagnosis of OFCs (cases) and 103 healthy newborns without malformations (controls) examined whether prenatal exposure to OCPs, as indicated by their concentrations in placental tissue, is a risk factor for OFCs. No differences were found in the median concentrations of OCPs between cases and controls, with exception of o,p'-dichlorodiphenyldichloroethylene, o,p'-dichlorodiphenyldichloroethane, and total o,p'-dichlorodiphenyltrichloroethane (DDTs), whose concentrations were higher in controls than in cases (Ps 0.05). Although higher concentrations of placental δhexachlorocyclohexane and isodrin were found to be associated with decreased risk for OFCs in logistic regression, no association was observed in the Bayesian kernel machine regression, a novel statistical model in analyzing exposure mixtures. Women who reported periconceptional folic acid supplementation had lower placental concentrations of DDTs than women who did not. In conclusion, no association between levels of OCPs in placental tissue and risk for OFCs was observed in this population. Supplementation with folic acid may help decrease the levels of DDTs in placental tissue, but further studies are needed to confirm this unexpected finding.

The current health program in Indonesia is focused on improving the health status of vulnerable groups, one of which is pregnant women. This is indicated by the high rate of maternal and infant mortality. One of the government's efforts to overcome this problem is the concept of safe motherhood and antenatal care. During the Covid-19 pandemic, most pregnant women did not get medical check-up because they were worried about the corona virus. Therefore, online classes for pregnant women were conducted. This community service method is in the form of interactive education based on information technology online and offline. The targets are all pregnant women who carry out examinations at the Midwife Independent Practice of Yanyan Mulyani, while the targets for pregnancy exercise and prenatal yoga are 35 pregnant women with a gestational age of 28-39 weeks. The implementation technique is divided into three stages, namely the first stage is to assess the level of understanding of the respondent with a pre test, the second stage, namely the implementation of classes for pregnant women by providing online material and the implementation of offline pregnancy and prenatal yoga exercises, and the third stage, namely evaluating the material with post tests . The results of the activity showed an increase in knowledge to be good by 68.6%. Providing information to the class of pregnant women by the facilitator on a regular basis and carried out every week with different materials makes pregnant women make pregnancy visits and regularly attend classes for pregnant women to stay healthy.

Objectives Active and passive exposure to tobacco cigarettes during pregnancy is associated with multiple negative health outcomes for the fetus. In addition, exposure to e-cigarettes has been progressively discussed as a new threat to fetal health. Until now, there has been a lack of studies examining active and passive exposure to tobacco and e-cigarettes among pregnant women. The objective of our current STudy on E-cigarettes and Pregnancy (STEP) was to advance and complement the current knowledge regarding active and passive exposure to tobacco and e-cigarettes before pregnancy and during early and late pregnancy. Methods One element of the STEP study was a quantitative cross-sectional design: A sample of 540 pregnant women recruited at an obstetrician clinic in Hamburg from April 2018 to January 2019 were surveyed once via a standardized questionnaire and provided complete information regarding their consumption of tobacco and e-cigarettes. We performed a descriptive analysis of tobacco and e-cigarette use before pregnancy and during early and late pregnancy, as well as bivariate analysis of these variables with sociodemographic determinants. Passive exposure was assessed by asking the participating pregnant women about the consumption of tobacco and e-cigarettes by their partners, in general, and in their homes. Results Before pregnancy, 20.0% of the participants used tobacco cigarettes exclusively, 1.3% used e-cigarettes exclusively, and 6.5% were dual users. Educational level was significantly associated with tobacco cigarette use (p Conclusions for Practice Among pregnant women, the use of tobacco cigarettes remains prominent before and during pregnancy, while e-cigarette use predominately occurs before pregnancy. Our study shows that pregnant women are frequently exposed to their partners’ tobacco and e-cigarette use within their homes. Strategies to reduce such exposure should be further intensified.

Background Maternal health during pregnancy is a key input in fetal health and child development. This study aims to systematically describe the health behaviors of pregnant women in rural China and identify which subgroups of women are more likely to engage in unhealthy behaviors during pregnancy. Methods We surveyed 1088 pregnant women in rural northwestern China on exposure to unhealthy substances, nutritional behaviors, the timing and frequency of antenatal care, and demographic characteristics. Results Pregnant women were active in seeking antenatal care and had low rates of alcohol consumption (5.1%), exposure to toxins (4.8%), and exposure to radiation (2.9%). However, tobacco exposure was widespread (40.3%), as was low dietary diversity (61.8%), unhealthy weight gain (59.7%), unhealthy pre-pregnancy BMI (29.7%), and no folic acid intake (17.1%). Maternal education is closely linked to better health behaviors, whereas experience with a previous pregnancy is not. Conclusions Tobacco exposure and unhealthy nutritional behaviors are common among pregnant women in rural northwestern China. The findings indicate that in the absence of professional health information, relying on experience of previous pregnancies alone may not help rural women avoid unhealthy maternal behaviors. Maternal health education campaigns targeting nutrition and tobacco exposure during pregnancy may improve maternal, fetal, and child health in rural China.

AIM Characteristics of variability of concentrations total protein and its electrophoretic fractions in serum of healthy pregnant women between successive trimesters and post-partum for initial classification of proteins involved in specific metabolic processes associated with pregnancy. METHODS Total serum protein concentrations were measured by biuret method and serum protein fractions were electrophoretically separated in 166 serum samples collected from healthy pregnant women in three trimesters of pregnancy (1st, n = 55; 2nd, n = 42; 3rd, n = 39) and in post-partum (n = 30), and in 20 samples from nonpregnant controls. RESULTS Across pregnancy, there were gradual, but occurring at different rates, decreases over time in serum total protein, albumin and gamma globulins compared to controls (P

Smoking during pregnancy has negative effects on both maternal and fetal health. One of these negative maternal effects is the potential for depression. A high rate of cigarette smoking in pregnancy is an important public health issue since it affects not only the pregnant woman but also the newborn and its healthy development. The aim of this study is to investigate the relationship between smoking, influencing factors, and depression prevalence in pregnant Syrian refugees and pregnant citizens of the Republic of Turkey (TR). Pregnant citizens in the TR and pregnant Syrian refugees who were registered at health centers between 15.04.2017 and 15.10.2017 in the border city of Ceylanpınar in the Province of Şanlıurfa in Syria were visited in their living areas in the district center and at a tent village, respectively. A total of 414 pregnant women agreed to participate in the study and were included in the survey. To collect data for the cross-sectional study, a sociodemographic and pregnancy characteristics questionnaire was used, in addition to the Fageström Test for Nicotine Dependence (FTND) and the Beck Depression Inventory (BDI). The rate of smoking in all pregnant women was determined to be 49.3% (n = 204) before pregnancy and 37.9% (n = 157) during pregnancy. A statistically significant difference was found between age groups and educational status in relation to smoking status (p = 0.005, p = 0.001). There was also a statistically significant difference between the smoking status of pregnant women and that of their partners and family members (p = 0.001, p = 0.002). The percentage of pregnant women who were passive smokers was 80.2% (n = 332), and a statistically significant difference was found between passive smoking and smoking status (Fisher; 0.000). The presence of risk for depression was detected in 49.8% (n = 206) of all pregnant women surveyed; the rate of depression risk was 50.5% (n = 104) in pregnant TR citizens and 49.5% (n = 102) in pregnant refugees, with no significant difference between the two groups. There was a statistically significant difference between smoking status in pregnancy and the presence of depression risk (p = 0.001). 32.5% of pregnant women were highly nicotine dependent. A moderate positive correlation was determined between the FTND and BDI scores of pregnant women (r = 0.346; p = 0.001). It was found that one-third of all pregnant women smoked and that one of every two showed a risk for depression. A statistically significant correlation was found between smoking status and risk for depression. No statistically significant difference was determined between the two groups, despite high levels of smoking, nicotine dependence, and depression in both. These data suggest the need to develop new preventive strategies in regard to smoking among pregnant women.

Objective The risk factors, clinical trends, and maternal and fetal health of early- and late-onset preeclampsia have not been adequately studied. We examined the effects of early- and late-onset preeclampsia on maternal and perinatal outcomes as well as the known risk factors of preeclampsia. Methods One hundred and fifty women with preeclampsia were consecutively enrolled in each group. Those who developed preeclampsia before 34 weeks of gestation were identified as having early-onset preeclampsia, while those who developed at 34 weeks or later were identified as having late-onset preeclampsia. Maternal and perinatal outcomes were compared between groups. Results Compared with the late-onset group, the early-onset group had higher rates of abruptio placentae (16% vs. 7.3%; P=0.019), but there was no intergroup difference in the composite maternal outcomes. A significantly higher number of women with early-onset preeclampsia developed severe features during the disease course, and most required treatment with antihypertensive drugs. Late-onset preeclampsia was more prevalent among primigravid mothers. Babies born to mothers with early-onset preeclampsia had a significantly higher rate of adverse outcomes. Conclusion These study findings indicate that women with early-onset preeclampsia had more adverse outcome than those with late-onset preeclampsia, but the difference was not statistically significant. There were more babies with adverse perinatal outcomes in the early-than late-onset group.

Intrauterine fetal hypoxia is one of the leading cause of perinatal mortality and morbidity. This can eventually lead to severe neurological damage like cerebral palsy and in extreme cases to fetal demise. It is thus necessary to monitor the fetus during intrapartum and antepartum period. Cardiotocograph (CTG) as a method of assessing the status of the fetus had been in use for last six decades. Nowadays it is the most widely used non-invasive technique for the continuous monitoring of the fetal heart rate (FHR) and the uterine contraction pressure (UCP). Though its introduction limited the birth related problems, the accuracy of interpretation was hindered by quite a few factors. Different guidelines that are provided for the interpretation are based on crisp logic which fails to capture the inherent uncertainty present in the medical diagnosis. Misinterpretations had led to inaccurate diagnosis which resulted in many medico-legal litigations. The vagueness present in the physician’s evaluation is best modeled using soft-computing based techniques. In this paper authors used the CTG dataset from UCI Irvine Machine Learning Data Repository which contains 2126 data and each data-point is represented by 37 features. Dimensionality of the feature set was reduced using different automated methods as well as manually by the physicians. The resulting data sets were classified using various machine learning algorithms. Aim of this study is to establish which set of features is best suited to give good insight into the status of the fetus and also determine the most effective machine learning technique for this purpose. The accuracy of the outcomes were measured using statistical methods such as sensitivity, specificity, precision, F-Measure, confusion matrix and kappa value. We obtained an accuracy of 99.91% and kappa measure of 0.997 when the feature set was reduced using MRMR.

The lifestyle of pregnant women has a close relationship with maternal and fetal health. In pregnant women, health-promoting behaviors lead to the promotion of quality of life and improvement of pregnancy outcomes. Therefore, the present study aimed to determine the effect of cognitive-behavioral counseling on pregnant women’s lifestyle. This randomized controlled clinical trial study was performed in the health centers of Sanandaj, Iran. Seventy pregnant women were randomly assigned to intervention (n = 35) and control (n = 35) groups. The study was completed with 33 pregnant women in each group. In addition to routine pregnancy care, the control group received, the intervention group received 8 consecutive 60-90-minute counseling sessions with a cognitive-behavioral approach weekly. The Walker Health Promotion Lifestyle Questionnaire was completed before, immediately, and one month after the intervention by the participants of control and intervention groups. Data were collected from February until June 2017. Data were analyzed using SPSS version 16. The mean score of lifestyle in the intervention and control group was 139.78 ± 21.71 and 142.63 ± 19.12 before the intervention, which reached 151 ± 17.72 and 159.14 ± 14.77, respectively, after the intervention. The difference was significant in the intervention group (P = 0.001) but not in the control group (P = 0.619). Also, the mean scores of the two groups were not significantly different before intervention (P = 0.574), but this difference was statistically significant after the intervention (P = 0.029) and one month after the intervention (P = 0.001). Based on the results of this study, cognitive-behavioral counseling improves the lifestyle of pregnant women. Therefore, it is suggested that this type of counseling be used along with other services to improve the lifestyle of pregnant women in health care centers.

Ultrasound growth measurements are monitored to evaluate if a fetus is growing normally compared with a defined standard chart at a specified gestational age. Using data from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st project, we have modelled the longitudinal dependence of fetal head circumference, biparietal diameter, occipito-frontal diameter, abdominal circumference, and femur length using a two-stage approach. The first stage involved finding a suitable transformation of the raw fetal measurements (as the marginal distributions of ultrasound measurements were non-normal) to standardized deviations (Z-scores). In the second stage, a correlation model for a Gaussian process is fitted, yielding a correlation for any pair of observations made between 14 and 40 weeks. The correlation structure of the fetal Z-score can be used to assess whether the growth, for example, between successive measurements is satisfactory. The paper is accompanied by a Shiny application, see https://lxiao5.shinyapps.io/shinycalculator/ .

Problem Too much or too little gestational weight gain (GWG) can negatively impact maternal and fetal health, according to Institute of Medicine Guidelines. Background Health care providers are key players in providing reliable evidence-informed prenatal advice related to appropriate GWG. However, there appears to be inconsistent GWG communication among healthcare providers during prenatal care. Aim To determine pregnant women and new mothers’ perceptions of healthcare provider GWG and dietary counselling during the pregnancy period. Methods A reliable and validated cross-sectional electronic survey was administered to currently pregnant women and women who had recently given birth. The web-based questionnaire was self-administered and took 10–25 min. Findings A total of 1507 eligible women participated in the survey. More than half (57%) reported that their healthcare provider talked to them about personal weight gain limits. Of these participants, about a third (34%) of participants were counselled regularly at each or most visits. Among the women that were not counselled on personal GWG limits, over half (56%) reported that healthcare provider guidance would have been helpful to achieve their target weight. Less than half (45%) of participants reported that their healthcare providers discussed dietary requirements or changes in pregnancy. Discussion These findings highlight areas for improvement in prenatal dialogue, which can support better outcomes for both mother and baby. Conclusion A better understanding of pregnant and mothers’ perceptions about weight and diet counselling is needed to understand what may need greater attention and clarification and to improve such dialogue.

The review discusses the impact of nutrients on women’s health before and during pregnancy and on the health of their babies. Considerable attention is paid to the short-term and long-term effects of malnutrition or overeating of pregnant women. The article also discusses the need for the use of vitamin-mineral complexes during pregnancy to replenish nutrient stores. The issue of the relationships between the diet and early pregnancy outcomes is considered. Based on the conducted thorough analysis, it is concluded that doctors should inform future mothers about the importance of a balanced diet and additional intake of microelements and vitamins. Although this topic has been extensively studied, it requires further research for working out optimal clinical recommendations regarding the nutritional behavior of pregnant women.

Pregnancy complications are commonplace and the challenges of treatment during pregnancy with few options available pose a risk to the health of both the mother and baby. Patients suffering from conditions such as preeclampsia, placenta accreta, and intrauterine growth restriction have few treatment options apart from emergency caesarean section. Fortunately, researchers are beginning to develop nanomedicine-based therapies that could be utilized to treat conditions affecting the mother, placenta, or fetus to improve the prognosis for mothers and their unborn children. This review summarizes the field’s current understanding of nanoparticle biodistribution and therapeutic effect following systemic or vaginal administration and overviews the design parameters researchers should consider when developing nanomedicines for maternal/fetal health. It also describes safety considerations for nanomedicines to limit undesirable maternal or fetal side effects and discusses future work that should be performed to advance nanomedicine for maternal/fetal health. With additional development and implementation, the application of nanomedicine to treat pregnancy complications may mitigate the need for emergency caesarean sections and allow pregnancies to extend to term.

The risk of developing new-onset arrhythmia or exacerbation of a pre-existing arrhythmia is increased during pregnancy because of profound physiological and hormonal changes. The incidence of arrhythmias in pregnancy is not well-reported and especially data on ventricular arrhythmia are scarce. Arrhythmia during pregnancy is associated with adverse maternal and fetal outcomes and the optimization of clinical management is hindered by a paucity of evidence, as guidelines are either based on studies in the general population or on case series in pregnancy. In any case, optimal care for these patients includes a multidisciplinary approach, integrating the different considerations in maternal cardiac, obstetric and fetal health. In this manuscript we present three cases of ventricular arrhythmia during pregnancy and describe our considerations in clinical decision-making with regard to diagnostic challenges and treatment choices.

Fetal echocardiography (FECG) analysis was rarely used earlier in clinical practice using ECG surface electrodes. With recent research studies have been extensively monitoring the wellbeing of the fetus using non-invasive FECG (NIFECG). The reliable assessment of changes in fetus condition is of high importance today. Monitoring changes in the fetal heart rate (FHR) can be used as an excellent diagnostic aid to access fetal health status. NIFECG can be extracted by intelligent detection techniques. In this article, three known FECG extraction algorithms namely, Independent Component Analysis (ICA), Adaptive neuro-fuzzy inference system (ANFIS) and hybrid model of ICA-ANFIS have been evaluated. The results are compared with the direct scalp ECG of the Physionet FECG database. ICA technique with 2 iteration stages matched the scalp FECG FHR. However using ANFIS, the FHR matched almost 100% with the invasive fetal ECG. It shows that the hybrid ICA-ANFIS is a promising non-invasive solution for producing FECG, which is close to invasive scalp FECG peaks.

Fetal distress is the main cause of frequent adverse events such as asphyxia and disability. It is particularly important to monitor the fetal intrauterine state in late pregnancy so as to detect fetal abnormalities in time. Cardiotocography (CTG) is an important tool for fetal health assessment in clinical practice. But the accuracy and consistency of CTG are generally not ideal as the correct interpretation is affected by the doctor's clinical experience and ability. Therefore, this paper proposed an intelligent assistant diagnosis algorithm based on fetal heart rate (FHR) signals, which integrated by the input layer construction based on MelFrequency Cepstral Coefficients (MFCCs) and the deep neural network model based on bidirectional long short-term memory (BLSTM). Through 200 sets of intrapartum data from a public database, the results show that the proposed algorithm achieves a high accuracy of 96.25%, which can achieve a pretty well assessment of the fetal state and assist clinicians to make an auxiliary diagnosis of the fetal health.

Introduction A clinician’s willingness to provide abortion care is complex. Anesthesia providers’ experiences in providing anesthesia for abortion are not well studied. We aimed to explore anesthesia providers’ perspectives on abortion provision. Methods We conducted semi-structured, qualitative interviews with currently practising anesthesia providers in the southeastern United States. Participants were recruited from scientific meetings of two regional anesthesiology organizations and via snowball sampling. A semi-structured interview guide included domains of standardized second trimester abortion cases and personal abortion attitudes. Data were coded and analyzed iteratively using both inductive and deductive approaches with MAXQDA software. Deductive results are presented. Results Fifteen participants completed interviews from February 2018 to February 2019, at which point thematic saturation occurred. Participants represented a range of provider type, years of experience, workplace setting, and prior abortion experience. Participants demonstrated varied personal abortion attitudes, with greater acceptability of maternal or fetal health indications than social or financial indications for abortion. Most participants were willing to provide anesthesia for abortion in specific clinical scenarios. Conclusions Southeastern U.S. anesthesia providers hold a spectrum of personal views on abortion and are willing to provide anesthesia for second trimester abortion in specific clinical scenarios. Findings may inform future research or professional development activities, which are important efforts toward improving multidisciplinary abortion care.

The universal criticality of mother’s and child’s health can scarcely be overstated. Deterioration in an expectant mother’s health may lead to several complications in the antepartum and intrapartum period that which may be fatal. Hence, simultaneous tracking of prenatal parameters such as uterine contraction and Fetal Heart Rate (FHR) through Cardiotocography (CTG) is of critical importance. This preponderantly remains a manual procedure in developing nations as the inclusion of machine learning (ML) technology is still not widespread. Numerous studies have pointed to the fact that electronic monitoring of FHR has not had any noteworthy benefit in lowering the incidence of perinatal mortality and morbidity. Further, FHR monitoring is beset with other problems such as high disparities in intra-and inter-observations and enhanced rate of caesarean vis-a-vis normal delivery. These drawbacks of FHR notwithstanding, the fact remains that FHR is regarded as a vital obstetric procedure and CTG as equipment is deployed the most in perinatal diagnostics. With advancements in medical technology, techniques viz. computerized analysis of FHR and ECG are now being utilized as an accompaniment to CTG. These sophisticated computerized methods enable an analysis of variations in heart rate and assessing the patterns of short term heart rate. Further studies about multiple parameters causing FHR variability is needed to better our understanding of the primacy and salience of various parameters of raw fetal heartbeat data. Our experimental results using AutoML approach gave an accuracy rate of 0.9561, Recall 0.9056, Kappa 0.8792, Precision 0.9552, AUC 0.9864, F1 0.9550, MCC 0.8805 with model handling time of 2 minutes.

Background The effects of COVID-19 lockdown measures on maternal and fetal health remain unclear. We examined the associations of COVID-19 lockdown with gestational length and preterm birth (PTB) in a Chinese population. Methods We obtained medical records of 595,396 singleton live infants born between 2015 and 2020 in 5 cities in Guangdong Province, South China. The exposed group (N = 101,900) included women who experienced the COVID-19 Level I lockdown (1/23–2/24/2020) during pregnancy, while the unexposed group (N = 493,496) included women who were pregnant during the same calendar months in 2015–2019. Cumulative exposure was calculated based on days exposed to different levels of emergency responses with different weighting. Generalized linear regression models were applied to estimate the associations of lockdown exposure with gestational length and risk of PTB ( Results The exposed group had a shorter mean gestational length than the unexposed group (38.66 vs 38.74 weeks: adjusted β = − 0.06 week [95%CI, − 0.07, − 0.05 week]). The exposed group also had a higher risk of PTB (5.7% vs 5.3%; adjusted OR = 1.08 [95%CI, 1.05, 1.11]). These associations seemed to be stronger when exposure occurred before or during the 23rd gestational week (GW) than during or after the 24th GW. Similarly, higher cumulative lockdown exposure was associated with a shorter gestational length and a higher risk of PTB. Conclusions The COVID-19 lockdown measures were associated with a slightly shorter gestational length and a moderately higher risk of PTB. Early and middle pregnancy periods may be a more susceptible exposure window.

Introduction: There has been an increase in rate of caesarean section over past five decades. This is matter of public health concern as it increases the caesarean section related maternal morbidity and mortality. Asadvised by WHO guidelines and US health initiative C-section rate should not beyond 15%. According to NHFS-4 C-section rate in India 17.2%. The aim of present study aimed to assess the rate of CS and perform and analysis based on Robson classification system. Methods: In present study all the cases delivered by caesarean section during period of six months were recorded. Data were collected from medical records of women who delivered from October to march 2021.They were classified according to Robsons’10 group classification system. This was an attempt to see which relevant group contributed most to the c- section rates. Results: There was a trend of increased percentage of caesarean section in group5 patients in present study. Poor tolerance to pain and increased rate of previous c section contributes to this. Conclusion: We should make use of vaginal delivery after caesarean section but not at the cost of maternal and fetal health. These target groups require more in depth analysis to identify modifiable risk factors and apply specific intervention to reduce cs rates. Keywords: Indications, Caesarean, Robsons criteria.

BACKGROUND Reference intervals of clinical laboratory indexes are the basis of interpretation of test results. While intrahepatic cholestasis of pregnancy (ICP) could severely threaten maternal and fetal health, reference intervals of the biomarkers serum total bile acids (TBA) and glycocholic acid (GCA) are unsatisfactory. The purpose of this study was to derive gestational age-specific reference intervals for serum TBA and GCA in a Chinese population to promote early diagnosis of ICP. METHODS A total of 416 healthy pregnant Chinese were recruited and divided into three groups by gestational age: 140 in the first trimester (1 - 13 weeks) group, 136 in the second trimester (14 - 27 weeks) group, and 140 in the third trimester (≥ 28 weeks) group. Serum TBA and GCA levels were measured respectively by cyclic enzymatic method and latex enhanced immune turbidimetry. Reference intervals were calculated with non-parametric method. RESULTS The reference intervals of serum TBA are 0.90 - 6.60 μmol/L, 1.20 - 9.10 μmol/L, and 1.50 - 8.90 μmol/L respectively in the first, second, and third trimester. The reference intervals of serum GCA are 0.24 - 1.14 μg/mL in the first and second trimesters (combined) and 0.00 - 2.04 μg/mL in the third trimester. CONCLUSIONS Gestational age-specific reference intervals of serum TBA and GCA for pregnant Chinese were derived in strict accordance with CLSI C28-A3 guidelines, which will be valuable for early diagnosis of ICP.

Objectives With a growing interest in the mother–infant dyad and the Developmental Origins of Health and Disease hypothesis among biological and medical anthropologists, this study set out to provide all the information required to evaluate if mineralization defects in dentine might be caused by vitamin D deficiency in the critical first 1000 days of life. Materials and Methods Information was compiled on dentine formation in utero to approximately 18 years, and a method for determining the location of the neonatal line in dentine was devised, allowing the assessment of the prenatal and early life period. Re‐evaluation of previously analyzed teeth (n = 61) was undertaken with detailed examination of n = 5/22 first permanent molars forming in the prenatal and critical early life periods. Results First permanent molars and all deciduous teeth give information on intrauterine development and on the first 1000 days postnatally providing a direct window on maternal and fetal health. Three archaeological individuals had interglobular dentine that formed prenatally suggesting that their mothers experienced vitamin D deficiency at the time dentine was forming and all other individuals had a deficiency during the first 1000 days of life. Conditions that could cause systemic mineralization defects were determined, and in each, case they were found to be consistent with vitamin D deficiency. Discussion The neonatal line serves as a clear baseline for determining prenatal and postnatal events, particularly those related to vitamin D, calcium, and phosphate metabolism, and can be used to investigate the maternal–infant dyad for both past and present communities.

Cardiotocography (CTG) is the most popular prenatal diagnostic test for establishing fetal health and consists in simultaneous recording of fetal heart rate (FHR, bpm) and maternal uterine contraction (UC, mmHg) traces. Typically, FHR and UC traces are visually analyzed and interpreted by clinicians. Recently, software applications like CTG Analyzer have been developed to support visual CTG interpretation by making it more objective and independent from clinician’s experience. Automatic CTG analysis requires CTG-traces digitalization and thus assessment of a correct sampling frequency (SF). Thus, this paper aims to investigate dependency of automatic CTG analysis on SF in order to identify optimal SF (OSF) for FHR and UC traces that minimizes computational efforts without jeopardizing CTG interpretation. To this aim, the “CTU-CHB intra-partum CTG database” was considered and visually annotated by an expert gynecologist. FHR and UC traces, originally sampled at 4 Hz, were down sampled at 2 Hz, 1 Hz, 0.4 Hz and 0.2 Hz, and automatically analyzed using CTG Analyzer. Eventually, results obtained through automatic analysis were compared to visual annotations, which were taken as reference. A cumulative statistical index (CSI), ranging from 0.00% to 100.00%, was defined as a linear combination of positive-predictive value, sensitivity, false-positive rate and false-negative rate. OSF was defined as the one that maximizes CSI. If CSI was showing the same value for more than one SF, the lowest SF was selected as the optimal since minimizing computational efforts. Results indicate that OSF for FHR is 2 Hz (CSI ≥ 85.41%), whereas OSF for UC is 0.2 Hz (CSI = 75.21%).

The purpose of this study is to identify the effect of religious beliefs on the attitudes of pregnant women toward the health of the fetus. Pregnancy, one of the important periods of life, is a special period in terms of affecting both the mother’s and the baby’s health. Health beliefs and attitudes are the factors that have effects on mother–baby death rates (mortality)—which is one of the most important criteria showing health level of societies. However, the literature has limited number of studies on this issue. Volunteer participants who applied to the Gynecology and Obstetrics Polyclinic were administered a questionnaire in order to identify the frequency of performing worship practices. Women’s beliefs about their roles in determining their fetus’s health were measured using Fetal Health Locus of Control (FHLC) scale. FHCL scale is composed of 3 sub-scales which include Internality Locus of Control (FHLC-I), Chance Locus of Control (FHLC-C), and Powerful Others Locus of Control (FHLC-P). Non-normally distributed scale scores were analyzed with Mann–Whitney U test for two independent groups and Kruskal–Wallis test for three independent groups. The scores obtained from all the sub-scales of the FHLC scale according to the praying groups were statistically significant (p = 0.008, p < 0.001, p < 0.001, respectively). The sub-scale scores were not statistically significant according to the tendency of giving alms (p = 0.269, p = 0.695, p = 0.079, respectively). The FHLC-I and FHLC-P scores did not indicate differences according to the tendency of going to pilgrimage (p = 0.914, p = 0.578), but FHLC-C scores were significantly higher in those who tended to go to pilgrimage (p = 0.004). There was a significant relationship between the tendency of performing prayer and going to pilgrimage and attitudes toward performing double–triple tests and oral glucose tolerance test (p = 0.002, p = 0.035, respectively). Religious beliefs were influential on the attitudes of pregnant women toward the health of the fetal. Gynecologists should consider patients’ religious belief sensitivity while recommending them screening tests or planning their medication. © 2019, Springer Science+Business Media, LLC, part of Springer Nature. 2-s2.0-85064282093 PubMed: 30972610

The umbilical cord (UC) is a platform for fetal nourishment and growth. The fetus, mother and placenta with UC form a triad, which contributes to pregnancy outcome. When pregnancy is complicated by a medical condition like hypertension, affects both maternal and fetal health. Being a fetal structure it can be used as a window to know the maternal dysfunctions and their impacts on fetal wellbeing. The present study is to explore the histomorphometric changes of the UC and its vessels involved in the development of hypertension during pregnancy. Sixty UCs were used and the following parameters, total UC area; total vessel area; jelly area; wall area, luminal area and wall thickness of umbilical arteries 1 and 2 and vein were studied using ImageJ software. From the results, the mean differences of above parameters of hypertensive UCs were found to be lesser than control and it was significantly higher in cases of severe preeclampsia (P≤0.05). From the present study, we conclude hypertensive cords and its vessels are associated with significant structural changes. Since it is a global health issue it is important to know the factors contributing it to diagnose and prevent.

Introduction: Knowledge of obstetric danger signs among pregnant women is of paramount importance in improving maternal, and fetal health outcomes. This study aims to determine the knowledge of danger signs among pregnant women seeking antenatal care in a teaching hospital. Materials and Methods: A cross-sectional study was carried out for two months among pregnant women who visited the antenatal clinic of a teaching hospital. A pre-tested and pre-designed proforma was used. Mean knowledge scores were computed and knowledge was classified into adequate and inadequate. Results: A total of 170 pregnant women fulfilling the inclusion criteria were included. Mean age of the study participants was found to be 26.40 ± 4.14 years. Nearly 67.10% were aware of bleeding per vagina being a danger sign, 50.0% stated excessive vomiting as a danger sign, 23.50% knew that blurring of vision was a danger, while a mere 20.0% reported that convulsions were a danger sign. Overall, adequate knowledge (total knowledge score of 5 and above) was observed in 54.70% of the participants. Conclusion: Majority of the study participants had adequate knowledge of danger signs in pregnancy. However, when knowledge about specific individual danger signs were further assessed, a high proportion had very poor knowledge. The mean knowledge scores were found to be low.

Regular radiofrequency (RF) catheter ablation is not encouraged during pregnancy, owing to radiation exposure and the uncertainties about the maternal and fetal health, being postponed to the postpartum period. However, the intervention may be indispensable in pregnant women with severe drug-resistant tachyarrhythmia. In such cases, catheter ablation without fluoroscopy is recommended. The aim of this case report is to describe a successful atrial tachycardia catheter ablation on the non-coronary cusp, during pregnancy, and without fluoroscopy.

Maintaining maternal and fetal health is an important challenge in modern healthcare worldwide. Longterm passive monitoring will allow monitoring the condition of the mother and fetus for a long time, which will increase the effectiveness of medical support for a pregnant woman. The motor activity of the fetus is an important marker of its condition and the level of its nervous development. Also, the signal of fetal motor activity can be effectively recorded by passive recorders, which is critically important when organizing a passive monitoring system. The aim of this work is to analyze the applicability of passive recorders (accelerometers and gyroscopes) for recording a signal of fetal motor activity. To improve the accuracy of the analysis of fetal activity, the paper proposes an algorithm for automatic detection of episodes of fetal activity.

The coronavirus 19 (COVID-19) pandemic and the measures implemented for its control meant the interruption of prenatal care, with potential risk to maternal and fetal health. However, conventional in-person prenatal would imply exposure and risk of infection in patients and health care providers. The Instituto Nacional Materno Perinatal (INMP) has incorporated teleconsultation as part of a new model of mixed prenatal care, which aims to reduce in-person appointments and, therefore, the contact and risk of viral transmission. The prenatal care package performs essential activities to care for pregnant women of specific gestational ages with a greater impact on perinatal and maternal outcomes. This new model could be generalized nationally and be part of the solution to the disparities of healthcare in Peru, through policies for the use of telemedicine in prenatal care that facilitate its implementation, as well as its sustainability after the COVID-19 pandemic. La pandemia del coronavirus 19 (COVID-19) y las medidas instauradas para su control significaron la interrupción de la atención prenatal, con potencial riesgo en la salud materna y fetal. Por otro lado, la atención prenatal convencional presencial implicaría exposición y riesgo de infección en pacientes y proveedores de salud. El Instituto Nacional Materno Perinatal (INMP) ha incorporado la teleconsulta como parte de un nuevo modelo de atención prenatal mixto, cuyo objetivo es disminuir las citas presenciales y, por tanto, el contacto y riesgo de transmisión viral. El paquete de atención prenatal incluye actividades esenciales para atender gestantes en edades gestacionales específicas con mayor impacto en los desenlaces perinatales y maternos. Este nuevo modelo podría generalizarse a nivel nacional y ser parte de la solución a las disparidades de atención en el Perú, mediante políticas del uso de la telemedicina en la atención prenatal que faciliten su implementación, así como su sostenibilidad después de la pandemia de COVID-19.