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Background/Objectives: ACR/EULAR has recently developed new classification criteria for antiphospholipid syndrome (APS). The present study aims to analyze the impact of these new 2023 ACR/EULAR classification criteria in a cohort of pregnant women with primary APS. Methods: Retrospective cohort study of 93 consecutive pregnant women attending the Autoimmune Diseases Pregnancy Clinic, a multidisciplinary unit of a tertiary care teaching hospital, between 2005 and 2023. All of them fulfilled the Sydney classification criteria for APS. Women diagnosed with rheumatic autoimmune diseases other than APS were excluded. Results: Twenty-four out of ninety-three patients (25.8%) met the 2023 ACR/EULAR criteria for APS. Patients who met the new classification criteria were very similar to those who did not, except for being younger (p < 0.001), and had a lower number of clinical pregnancies (p = 0.004). The obstetric domain was clearly underrepresented in women who fulfilled the 2023 ACR/EULAR criteria (p < 0.001). Patients meeting the new classification criteria were primarily characterized by preterm births before 34 weeks due to severe placentation disorders (p = 0.004). Women with early and late fetal loss were significantly underrepresented (p < 0.0001 and 0.03, respectively). Nearly half of these patients had thrombocytopenia (p < 0.001). Serologically, these patients showed a higher frequency of persistent lupus anticoagulant (p = 0.02) and a lower frequency of IgM isotype antiphospholipid antibodies (p = 0.05). Conclusions: Almost three-quarters of the patients included in the study did not meet the 2023 ACR/EULAR criteria. Most patients who could not be classified according to these new classification criteria were those with early and/or late fetal deaths, as well as patients carrying only IgM aCL/AB2GPI antibodies. The high specificity of the 2023 ACR/EULAR criteria, restricted to severe placentation disorders, may leave the majority of patients with obstetric APS out of the new classification criteria. [ABSTRACT FROM AUTHOR]

We described the pathological findings of an abortion associated with Yersinia enterocolitica infection in an ewe. A late-gestation aborted ovine fetus and placenta were submitted for necropsy. Pathologic changes were restricted to the chorioallantois. Grossly, cotyledons and intercodilenary regions had areas of mild red discoloration, and cotyledons were covered with a small amount of fibrin. Histological lesions consisted of multifocal, severe necrotizing and fibrinosuppurative placentitis with fibrinoid vasculitis and mineralization. Bacterial culture of lung, abomasum, and placenta samples yielded pure growth of Y. enterocolitica. This report described the first case of infection by Yersinia enterocolitica causing ovine abortion in Brazil. [ABSTRACT FROM AUTHOR]

Abstract Background This dynamic nomogram model was developed to predict the probability of fetal loss in pregnant patients with systemic lupus erythematosus (SLE) with mild disease severity before conception. Methods An analysis was conducted on 314 pregnancy records of patients with SLE who were hospitalized between January 2015 and January 2022 at Shenzhen People's Hospital, and the Longhua Branch of Shenzhen People's Hospital. Data from the Longhua Branch of the Shenzhen People's Hospital were utilized as an independent external validation cohort. The nomogram, a widely used statistical visualization tool to predict disease onset, progression, prognosis, and survival, was created after feature selection using multivariate logistic regression analysis. To evaluate the model prediction performance, we employed the receiver operating characteristic curve, calibration curve, and decision curve analysis. Results Lupus nephritis, complement 3, immunoglobulin G, serum albumin, C-reactive protein, and hydroxychloroquine were all included in the nomogram model. The model demonstrated good calibration and discriminatory power, with an area under the curve of 0.867 (95% confidence interval: 0.787–0.947). According to decision curve analysis, the nomogram model exhibited clinical importance when the probability of fetal loss in patients with SLE ranged between 10 and 70%. The predictive ability of the model was demonstrated through external validation. Conclusion The predictive nomogram approach may facilitate precise management of pregnant patients with SLE with mild disease severity before conception.

The clustered homeobox gene family known as the Hox family plays a fundamental role in the morphogenesis of the vertebrate's embryo. A long noncoding RNA (lncRNA), known as HOTTIP (HOXA transcript at the distal tip), has been functionally characterized and contributed to the pathogenesis of various conditions. The current case–control study was undertaken to examine the gene frequencies and shared alleles of the HOTTIP gene in Iranian participants with or without idiopathic recurrent spontaneous abortion (RSA). Both ARMS-PCR reaction and RFLP-PCR techniques were employed to detect three HOTTIP polymorphisms (rs2023843C/T, rs78248039A/T, and rs1859168C/A) in a DNA sample of 161 women with RSA and 177 healthy women. We found that the TT genotype of the HOTTIP rs2023843 C/T polymorphism was associated with a lower risk for idiopathic RSA. In contrast, the TT genotype of the HOTTIP rs78248039 A/T polymorphism was correlated with an enhanced risk of RSA. The presence of the A-allele for HOTTIP rs1859168 C/A polymorphism was associated with an increased risk for idiopathic RSA. Haplotype analysis showed that the T/T/A, C/T/A, T/T/C, and T/A/A haplotypes of rs2023843/rs78248039/rs1859168 enhanced RSA susceptibility. Computational analysis predicted that this lncRNA might act as a potential sponge for some microRNAs; therefore, affecting the expression of genes being targeted by them. In addition, both rs2023843 and rs1859168 variants could alter the local secondary structure of HOTTIP. Our results showed that HOTTIP rs2023843C/T, rs78248039A/T, and rs1859168C/A polymorphisms may confer genetic susceptibility to idiopathic RSA in an Iranian population. [ABSTRACT FROM AUTHOR]

Background: This dynamic nomogram model was developed to predict the probability of fetal loss in pregnant patients with systemic lupus erythematosus (SLE) with mild disease severity before conception. Methods: An analysis was conducted on 314 pregnancy records of patients with SLE who were hospitalized between January 2015 and January 2022 at Shenzhen People's Hospital, and the Longhua Branch of Shenzhen People's Hospital. Data from the Longhua Branch of the Shenzhen People's Hospital were utilized as an independent external validation cohort. The nomogram, a widely used statistical visualization tool to predict disease onset, progression, prognosis, and survival, was created after feature selection using multivariate logistic regression analysis. To evaluate the model prediction performance, we employed the receiver operating characteristic curve, calibration curve, and decision curve analysis. Results: Lupus nephritis, complement 3, immunoglobulin G, serum albumin, C-reactive protein, and hydroxychloroquine were all included in the nomogram model. The model demonstrated good calibration and discriminatory power, with an area under the curve of 0.867 (95% confidence interval: 0.787–0.947). According to decision curve analysis, the nomogram model exhibited clinical importance when the probability of fetal loss in patients with SLE ranged between 10 and 70%. The predictive ability of the model was demonstrated through external validation. Conclusion: The predictive nomogram approach may facilitate precise management of pregnant patients with SLE with mild disease severity before conception. [ABSTRACT FROM AUTHOR]

ABSTRACT: We described the pathological findings of an abortion associated with Yersinia enterocolitica infection in an ewe. A late-gestation aborted ovine fetus and placenta were submitted for necropsy. Pathologic changes were restricted to the chorioallantois. Grossly, cotyledons and intercodilenary regions had areas of mild red discoloration, and cotyledons were covered with a small amount of fibrin. Histological lesions consisted of multifocal, severe necrotizing and fibrinosuppurative placentitis with fibrinoid vasculitis and mineralization. Bacterial culture of lung, abomasum, and placenta samples yielded pure growth of Y. enterocolitica. This report described the first case of infection by Yersinia enterocolitica causing ovine abortion in Brazil.

Background: Pregnancy in women with systemic lupus erythematosus (SLE) has remained a great challenge for clinicians in terms of maternal and fetal outcomes. The outcomes in women with pre-existing lupus nephritis (LN) are variable. The impact of different classes of LN on maternal and fetal outcomes during pregnancy is not well defined, as data is very scarce, especially from the developing countries. Methods: A retrospective analysis was conducted on 52 women with 89 pregnancies. All had biopsy-proven LN. Those women who conceived at least 6 months after the diagnosis were included. The analysis was conducted between July 1998 and June 2018 at Sindh Institute of Urology and Transplantation (SIUT), evaluating the outcomes for both the mother and the fetus with a minimum follow-up of 12 months after child birth. Results: The mean maternal age at SLE diagnosis was 21.45 ± 6 years and at first pregnancy was 26.49 ± 5.63 years. The mean disease duration was 14.02 ± 19.8 months. At conception, 47 (52.8%) women were hypertensive, 9 (10%) had active disease while 38 (42.7%) and 42 (47.2%) were in complete and partial remission, respectively. A total of 17 (19.1%) were on mycophenolate mofetil (MMF), which was switched to azathioprine (AZA). Out of 89 pregnancies, 56 (62.9%) were successful, while 33 (37.07%) had fetal complications like spontaneous abortion, stillbirth, perinatal death, and intrauterine growth retardation (IUGR). There were more vaginal deliveries (33 [58.92%]) than caesarean sections (23 [41.07%]). Renal flare was observed in 33 (37.1%) women while 15 (16.9%) developed pre-eclampsia. Proliferative LN was found in 56 (62.9%) cases, but no significant differences were found in maternal and fetal outcomes in relation to LN classes (p =.58). However, disease outcomes at 12 months were significantly poor in those with active disease at the time of conception (p <.05). There was only one maternal death. A total of 10 (11.2%) women showed deterioration in renal function and 5 (5.6%) were dialysis-dependent at 12 months. Conclusion: The maternal and fetal outcomes in pre-existing LN depend on the disease activity at the time of conception. No correlation was found between International Society of Nephrology/Renal Pathology Society (ISN/RPS) classes of LN and adverse disease and pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Inherited thrombophilia (IT) has been implicated as a potential causal factor of adverse pregnancy outcomes (APOs), including recurrent miscarriage with and without the presence of antiphospholipid syndrome (APS). The aim of this study was to assess the prevalence and impact of IT on fetal–maternal outcomes and thrombotic risk in women within the spectrum of obstetric APS. Three hundred and twenty-eight women with APS-related obstetric morbidity ever pregnant were included. Of these, 74 met the APS classification criteria, 169 were non-criteria (NC)-APS, and 85 were seronegative (SN)-APS. Patients with other autoimmune diseases were excluded. APOs included early pregnancy loss, fetal death, preeclampsia, abruptio placentae, and preterm birth. Successful pregnancy was defined as the achievement of a live newborn. A literature search was also performed. The mean age of the overall group was 33.9 ± 5.3 years, and the patients were followed up for 35 (11–79) months. During the study period, there were 1332 pregnancies. Nearly 14% of the patients had an associated IT. IT patients more frequently received the standard-of-care (SoC) therapy. The presence of IT was not associated with worse maternal–fetal outcomes in patients treated with SoC treatment. Overall, IT patients had a lower frequency of newborns without treatment, especially those without definite APS. In addition, IT did not increase the risk of thrombosis during pregnancy or the postpartum period. A detailed analysis of the literature review identified only four publications related to our study and did not show conclusive evidence of the impact of IT on patients with obstetric APS. The group of women with APS-related obstetric morbidity and IT who did not receive treatment, especially those without definite APS, had a worse prognosis in terms of a live birth. However, with SoC therapy, the prognosis is similar in those patients without IT. The association of IT with APS does not seem to predispose to the development of thrombosis during pregnancy and/or the postpartum period. [ABSTRACT FROM AUTHOR]

Fetal loss (FL) from the 45th day of gestation until calving can impose a significant economic burden on dairy farmers, resulting in lost profits and increased production costs. Pregnancy-associated glycoprotein (PAG) is commonly used for detecting pregnancy in cows. PAG is secreted by binucleated trophoblast cells of the placenta and regulated by more than 24 genes. The purpose of this study was to determine the PAG threshold for FL and a probability of pregnancy maintenance until calving based on milk PAG levels. Our results reveal that primiparous and multiparous cows that maintained pregnancy until the 40th week exhibited higher PAG sample-negative (SN) values in their milk in the 6th week of gestation than did those that experienced FL later in gestation. Pregnant cows with higher PAG SN values in the 6th week of gestation were more likely to maintain their pregnancies. The area under the receiver operating characteristic curve for predicting the probability of pregnancy maintenance was 0.722 for our prediction model. On the other hand, a milk PAG SN value of <0.192 indicated 95 % confidence that FL would occur between the 7th and 40th weeks of gestation. Milk PAG testing is a noninvasive sampling technique that does not induce additional stress in lactating cows. The study reveals that PAG SN values increase significantly in Holstein cows during the 6th week of gestation. The predictive model developed was effective in forecasting pregnancy outcomes up to the 40th week of gestation or calving. The model's performance is moderately good for field application and could be a useful tool for dairy producers. • PAG levels in milk predict fetus gestational health in cows. • Effective prediction model of pregnancy maintenance to 40 weeks. • Model with 72.2 % accuracy aids in cow pregnancy management. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Human brucellosis, otherwise known as undulant fever, is one of the most widespread zoonotic diseases in the world. Even though 9%–15% of stillbirths are known to be caused by infectious diseases, the study of the link between human Brucella melitensis and the termination of births in humans is a topic that has received little attention. This study examines if there was an association between infection of undulant fever, an endemic zoonotic disease in the Maltese Islands from 1919 until 1954, and reproductive loss through stillbirths. Methods A univariate descriptive analysis was used to show the temporal trend of undulant fever time, as well as the age and sex distribution. Time series analysis was used to assess the relationship between time (months) and undulant fever cases with stillbirth proportions. Results On the island of Gozo, the majority of undulant fever cases for both males and females occurred in their reproductive period between 15 and 45 years of age. Based on regression analysis, undulant fever had a statistically significant effect on the stillbirth rate for males (t = 2.8986, p = 0.0039). The effect of undulant fever on stillbirths was not significant for females (p = 0.9103). Conclusion This paper highlights the importance of undulant fever as having implications for the health burden in pregnant women and potential fetal loss through stillbirths in the contemporary context.

Background/Objectives: ACR/EULAR has recently developed new classification criteria for antiphospholipid syndrome (APS). The present study aims to analyze the impact of these new 2023 ACR/EULAR classification criteria in a cohort of pregnant women with primary APS. Methods: Retrospective cohort study of 93 consecutive pregnant women attending the Autoimmune Diseases Pregnancy Clinic, a multidisciplinary unit of a tertiary care teaching hospital, between 2005 and 2023. All of them fulfilled the Sydney classification criteria for APS. Women diagnosed with rheumatic autoimmune diseases other than APS were excluded. Results: Twenty-four out of ninety-three patients (25.8%) met the 2023 ACR/EULAR criteria for APS. Patients who met the new classification criteria were very similar to those who did not, except for being younger (p < 0.001), and had a lower number of clinical pregnancies (p = 0.004). The obstetric domain was clearly underrepresented in women who fulfilled the 2023 ACR/EULAR criteria (p < 0.001). Patients meeting the new classification criteria were primarily characterized by preterm births before 34 weeks due to severe placentation disorders (p = 0.004). Women with early and late fetal loss were significantly underrepresented (p < 0.0001 and 0.03, respectively). Nearly half of these patients had thrombocytopenia (p < 0.001). Serologically, these patients showed a higher frequency of persistent lupus anticoagulant (p = 0.02) and a lower frequency of IgM isotype antiphospholipid antibodies (p = 0.05). Conclusions: Almost three-quarters of the patients included in the study did not meet the 2023 ACR/EULAR criteria. Most patients who could not be classified according to these new classification criteria were those with early and/or late fetal deaths, as well as patients carrying only IgM aCL/AB2GPI antibodies. The high specificity of the 2023 ACR/EULAR criteria, restricted to severe placentation disorders, may leave the majority of patients with obstetric APS out of the new classification criteria.

Background: Research on fetal loss related to germline mutations in single genes remains limited. Disruption of CEP55 has recently been established in association with perinatal deaths characterized by hydranencephaly, renal dysplasia, oligohydramnios, and characteristic dysmorphisms. We herein present a Chinese family with recurrent fetal losses due to compound heterozygous nonsense CEP55 variants. Case presentations: The Chinese couple had a history of five pregnancies, with four of them proceeding abnormally. Two stillbirths (II:3 and II:4) sequentially occurred in the third and fourth pregnancy. Prenatal ultrasound scans revealed phenotypic similarities between fetuses II:3 and II:4, including oligohydramnios, bilateral renal dysplasia and hydrocephalus/hydranencephaly. Clubfoot and syndactyly were also present in both stillborn babies. Fetus II:3 presented with endocardial cushion defects while fetus II:4 did not. With the product of conception in the fourth pregnancy, whole exome sequencing (WES) on fetus II:4 identified compound heterozygous nonsense CEP55 variants comprised of c.190C>T(p.Arg64*) and c.208A>T(p.Lys70*). Both variants were expected to result in lack of the TSG101 and ALIX binding domain. Sanger sequencing confirmed the presence and cosegregation of both variants. Conclusion: This is the fifth reported family wherein biallelic CEP55 variants lead to multiple perinatal deaths. Our findings, taken together with previously described phenotypically similar cases and even those with a milder and viable phenotype, broaden the genotypic and phenotypic spectrum of CEP55-associated lethal fetal syndrome, highlighting the vital biomolecular function of CEP55. [ABSTRACT FROM AUTHOR]

Background: Cordocentesis is used in clinical situations in which lower-risk diagnostic procedures do not deliver the desired results. The aim of this study was to evaluate the risk for procedure-related complications and fetal loss in correlation to maternal risk factors. Methods: This is a multicenter retrospective study investigating the complications, risk factors and perinatal outcome of diagnostic cordocentesis between 1998 and 2019 in three different centers. Results: A total of 1806 cordocenteses were performed and procedure-related complications (IUFD within 48 h, contractions, bradycardia, unsuccessful puncture, chorioamniotic separation) were noted in 1.6% of cases. Fetuses with chromosomal aberrations, intrauterine growth restriction and hydropic fetuses had a significantly higher rate of fetal loss compared to other indications. Fetal blood sampling (FBS) performed before 17+0 weeks of gestation was associated with a higher risk of procedure-related complications. Maternal BMI ≥ 40 increased the risk for fetal loss, whereas maternal age, number of previous miscarriages, number of previous abortions, history of vaginal bleeding or nicotine abuse did not affect the risk for complications or overall fetal loss rate. Conclusions: In the hands of experienced operators, FBS is a safe way to further fetal diagnostics, and the risk of complications is low. [ABSTRACT FROM AUTHOR]

Bacillus cereus is a Gram-positive bacterium commonly reported in soils and plants that occupy various ecological habitats, and the main source of contamination for cattle is silage. This report described a case of fetal loss associated with B. cereus infection in a cow. An 8-month-old, Nelore female bovine fetus from a beef farm was submitted for necropsy. A gross examination revealed fibrinous pleuropneumonia and fibrin exudation on the liver surface. The morphological diagnosis was restricted to the lungs and liver. In the lungs there was fibrinosuppurative pleuropneumonia associated with numerous aggregates of rod-shaped bacteria. In the liver there was moderate focally extensive fibrinous peri hepatitis.The lungs, liver, thoracic, and abomasal fluid cultures yielded pure cultures of B. cereus, indicating that these bacteria should be recognized as a cause of bovine abortion in fetuses that macroscopically present fibrin in the abdominal and thoracic cavity. [ABSTRACT FROM AUTHOR]

Restricting to live births can induce bias in studies of pregnancy and developmental outcomes, but whether this live-birth bias results in underestimating disparities is unknown. Bias may arise from collider stratification due to an unmeasured common cause of fetal loss and the outcome of interest, or depletion of susceptibles, where exposure differentially causes fetal loss among those with underlying susceptibility.MethodsWe conducted a simulation study to examine the magnitude of live-birth bias in a population parameterized to resemble one year of conceptions in California (N = 625,000). We simulated exposure to a non-time-varying environmental hazard, risk of spontaneous abortion, and time to live birth using 1000 Monte Carlo simulations. Our outcome of interest was preterm birth. We included a social vulnerability factor to represent social disadvantage, and estimated overall risk differences for exposure and preterm birth using linear probability models and stratified by the social vulnerability factor. We calculated how often confidence intervals included the true point estimate (CI coverage probabilities) to illustrate whether effect estimates differed qualitatively from the truth.ResultsDepletion of susceptibles resulted in a larger magnitude of bias compared with collider stratification, with larger bias among the socially vulnerable group. Coverage probabilities were not adversely affected by bias due to collider stratification. Depletion of susceptibles reduced coverage, especially among the socially vulnerable (coverage among socially vulnerable = 46%, coverage among nonsocially vulnerable = 91% in the most extreme scenario).ConclusionsIn simulations, hazardous environmental exposures induced live-birth bias and the bias was larger for socially vulnerable women.

Inherited thrombophilia (IT) has been implicated as a potential causal factor of adverse pregnancy outcomes (APOs), including recurrent miscarriage with and without the presence of antiphospholipid syndrome (APS). The aim of this study was to assess the prevalence and impact of IT on fetal–maternal outcomes and thrombotic risk in women within the spectrum of obstetric APS. Three hundred and twenty-eight women with APS-related obstetric morbidity ever pregnant were included. Of these, 74 met the APS classification criteria, 169 were non-criteria (NC)-APS, and 85 were seronegative (SN)-APS. Patients with other autoimmune diseases were excluded. APOs included early pregnancy loss, fetal death, preeclampsia, abruptio placentae, and preterm birth. Successful pregnancy was defined as the achievement of a live newborn. A literature search was also performed. The mean age of the overall group was 33.9 ± 5.3 years, and the patients were followed up for 35 (11–79) months. During the study period, there were 1332 pregnancies. Nearly 14% of the patients had an associated IT. IT patients more frequently received the standard-of-care (SoC) therapy. The presence of IT was not associated with worse maternal–fetal outcomes in patients treated with SoC treatment. Overall, IT patients had a lower frequency of newborns without treatment, especially those without definite APS. In addition, IT did not increase the risk of thrombosis during pregnancy or the postpartum period. A detailed analysis of the literature review identified only four publications related to our study and did not show conclusive evidence of the impact of IT on patients with obstetric APS. The group of women with APS-related obstetric morbidity and IT who did not receive treatment, especially those without definite APS, had a worse prognosis in terms of a live birth. However, with SoC therapy, the prognosis is similar in those patients without IT. The association of IT with APS does not seem to predispose to the development of thrombosis during pregnancy and/or the postpartum period.

Passive transfer of antithyroid antibodies in mice leads to reproductive disorders. The purpose was to assess the placental tissue of experimental animals under the influence of the circulating thyroperoxidase antibodies. We performed an immunohistochemical examination of murine placentae after a passive transfer of thyroperoxidase antibodies. Placentae of mice that passively transferred IgG from healthy donors were used as control samples. For histological examination, 30 placental samples were selected from mice from the anti-TPO group and 40 placental samples were taken from mice from the IgG group. Immunostaining for VEGFR1, THBS 1, Laminin, CD31, CD34, FGF-β, CD56, CD14, TNF-α, kisspeptin, MCL 1, and Annexin V was performed. There is a significant decrease in the relative area of the expression of VEGFR1 (23.42 ± 0.85 vs. 33.44 ± 0.35, P < 0.01), thrombospondin 1 (31.29 ± 0.83 vs. 34.51 ± 0.75, P < 0.01), CD14 (25.80 ± 0.57 vs. 32.07 ± 0.36, P <.01), CD56 (30.08 ± 0.90 vs. 34.92 ± 0.15, P < 0.01), kisspeptin (25.94 ± 0.47 vs. 31.27 ± 0.57, P < 0.01), MCL 1 (29.24 ± 1.06 vs. 38.57 ± 0.79, P < 0.01) in the labyrinth zone of the placentae of mice from the anti-TPO group compared with control group. A significant increase in the relative expression of laminin and FGF-β was noted in the group of mice to which antibodies to thyroperoxidase were transferred, compared with the control group (36.73 ± 1.38 vs. 29.83 ± 0.94, P < 0.01 and 23.26 ± 0.61 vs. 16.38 ± 1.01, P < 0.01respectively). Our study exposed an imbalance of pro- and anti-angiogenic factors, decreased representation of placental macrophages and NK cells, abnormal trophoblast invasion processes, and insufficient expression of antiapoptotic factors in the placentae of mice in which anti-TPO antibodies were passively transferred. We performed an immunohistochemical examination of murine placentae after a passive transfer of thyroperoxidase antibodies. Our study exposed an imbalance of pro- and anti-angiogenic factors, decreased representation of placental macrophages and NK cells, abnormal trophoblast invasion processes, and insufficient expression of antiapoptotic factors in the placentae of mice in which anti-TPO antibodies were passively transferred. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendectomy (LA) is the standard treatment for acute appendicitis (AA) in general population. However, the safety of LA during pregnancy has remained a matter of debate. The purpose of this study was to compare surgical and obstetrical outcomes in pregnant women who underwent LA vs. open appendectomy (OA) for AA. We hypothesized that LA results in improved surgical and obstetric outcomes during pregnancy. Methods: Using a nationwide claim-based database in Estonia, a retrospective review of all cases of pregnant women undergoing OA or LA for AA from 2010 to 2020 was performed. Patient characteristics, surgical and obstetrical outcomes were analyzed. Primary outcomes were preterm delivery, fetal loss and perinatal mortality. Secondary outcomes included operative time, hospital length of stay (HLOS) and 30-day postoperative complications. Results: Overall, 102 patients were included of whom 68 (67%) underwent OA and 34 patients (33%) LA, respectively. Patients in LA cohort had a significantly shorter length of pregnancy in terms of gestational weeks when compared to OA cohort (12 weeks versus 17 weeks, p = 0.002). Most of the patients in their 3rd trimester pregnancy were subjected to OA. Operative time in LA cohort was shorter than in OA cohort (34 min. versus 44 min., p = 0.038). HLOS in LA cohort was shorter than in OA cohort (2.1 days versus 2.9 days, p = 0.016). There were no differences between OA and LA cohorts in terms of surgical complications or obstetrical outcomes. Conclusions: Laparoscopic appendectomy for acute appendicitis was associated with a significantly shorter operative time and a shorter hospital length of stay while open and laparoscopic appendectomy cohorts experienced comparable obstetrical outcomes. Our findings support the laparoscopic approach for acute appendicitis in pregnancy. [ABSTRACT FROM AUTHOR]

Objective: We aim to quantify the risk of maternal and fetal complications in patients with SLE in order to identify the impact of SLE on pregnancy and of pregnancy on SLE. Methods: This retrospective record review study was conducted in Aga khan university hospital, Karachi, from Jan 1998 to Dec 2019. All pregnant patients with SLE diagnosed and delivered during this time were included in the study. Categorical variables were analyzed by using chi-square test and fisher exact test. Whereas quantitative point estimate was estimated as mean and SD. We matched the data and computed crude odds ratio of pre-eclamptic patients with respect to age of conception, gravida, and body mass index in both case and control group. Results: The SLE disease activity was monitored during pregnancy under SLEDAI-2K Scoring system. The patients with mild (25.6%) and moderate (25.6%) disease activity were prevalent and most antenatal patients (51.7%) had flare up in third trimester. Adverse maternal outcomes include pre-eclampsia (28.8%), eclampsia (3.2%), cesarean section (57.6%), and thrombocytopenia (9.6%), whereas perinatal outcomes includes intrauterine growth retardation (24%), preterm birth <34 weeks (19.2%) and <37 weeks (63.2%), APGAR Score < 7 at 1 min (5.6%), and neonatal death (5.6%) found to be statistically significant in between two groups There were more high-risk patients (42) with positive IgG (88%), IgM (83.3%), and lupus anticoagulant (33.3%) as compared to low-risk APS group. Conclusion: Planned pregnancy and less severe disease flares during pregnancy is associated with more favorable feto-maternal outcomes. [ABSTRACT FROM AUTHOR]

Background: Pregnancy is often anticipated as a positive experience for women with the expectation of having a healthy infant in the end. However, some pregnancies end in fetal loss, which can have profound effects on parents and families and is characterized by shock, anger, emptiness, helplessness, and loneliness. Aims: The study aimed to describe the lived experiences of nurses and midwives regarding care provided for mothers and families during the fetal loss at King Abdul-Aziz Medical City, Western region. Setting and Design: The study setting was the labor and delivery units at King Abdul-Aziz Medical City, Western region, Saudi Arabia. Husserl's phenomenological approach was used. Materials and Methods: Purposive sampling included 11 nurses and midwives were included. Data were collected through in-depth interviews that were audio reordered and then transcribed verbatim. Statistical Analysis: Thematic analysis using Giorgi's data analysis steps was used. Results: Two themes emerged regarding the experiences of nurses in caring for mothers and families who experience fetal loss, namely emotional turmoil with subthemes, heavy heart, feeling helpless, lack of self-control, feeling guilty, feeling extreme sadness, feeling isolation; and barriers with subthemes culture, lack of nursing care, and limited skill. Conclusion: Two major themes emerged from the study that highlighted that nurses found caring for patients and families after a fetal loss a challenging experience and, at times, were unable to manage their own emotions.

Objectives: Pregnancy failure represents a major fitness cost for any mammal, particularly those with slow life histories such as primates. Here, we quantified the risk of fetal loss in wild hybrid baboons, including genetic, ecological, and demographic sources of variance. We were particularly interested in testing the hypothesis that hybridization increases fetal loss rates. Such an effect would help explain how baboons may maintain genetic and phenotypic integrity despite interspecific gene flow. Materials and Methods: We analyzed outcomes for 1020 pregnancies observed over 46 years in a natural yellow baboon‐anubis baboon hybrid zone. Fetal losses and live births were scored based on records of female reproductive state and the appearance of live neonates. We modeled the probability of fetal loss as a function of a female's genetic ancestry (the proportion of her genome estimated to be descended from anubis [vs. yellow] ancestors), age, number of previous fetal losses, dominance rank, group size, climate, and habitat quality using binomial mixed effects models. Results: Female genetic ancestry did not predict fetal loss. Instead, the risk of fetal loss is elevated for very young and very old females. Fetal loss is most robustly predicted by ecological factors, including poor habitat quality prior to a home range shift and extreme heat during pregnancy. Discussion: Our results suggest that gene flow between yellow and anubis baboons is not impeded by an increased risk of fetal loss for hybrid females. Instead, ecological conditions and female age are key determinants of this component of female reproductive success. [ABSTRACT FROM AUTHOR]

High blood urea nitrogen (BUN) decreases fertility of several mammals; however, the mechanisms have not been investigated in mares. We developed an experimental model to elevate BUN, with urea and control treatments (7 mares/treatment), in a crossover design. Urea-treatment consisted of a loading dose of urea (0.03 g/kg of body weight (BW)) and urea injections over 6 hours (0.03 g/kg of BW/h). Control mares received the same volume of saline solution. Blood samples were collected to measure BUN. Uterine and vaginal pH were evaluated after the last intravenous infusion, then endometrial biopsies were collected for RNA-sequencing with a HiSeq 4000. Cuffdiff (2.2.1) was used to identify the differentially expressed genes (DEG) between urea and control groups (false discovery rate-adjusted p-value < 0.1). There was a significant increase in BUN and a decrease of uterine pH in the urea group compared to the control group. A total of 193 genes were DEG between the urea and control groups, with five genes identified as upstream regulators (ETV4, EGF, EHF, IRS2, and SGK1). The DEG were predicted to be related to cell pH, ion homeostasis, changes in epithelial tissue, and solute carriers. Changes in gene expression reveal alterations in endometrial function that could be associated with adverse effects on fertility of mares.

Invasive Haemophilus influenzae infection during pregnancy can cause preterm birth and fetal loss, but the mechanism is unclear. We investigated 54 cases of pregnancy-associated invasive H. influenzae disease in 52 unique pregnancies in the Auckland region of New Zealand during October 1, 2008‒September 30, 2018. Intraamniotic infection was identified in 36 (66.7%) of 54 cases. Outcome data were available for 48 pregnancies. Adverse pregnancy outcomes, defined as fetal loss, preterm birth, or the birth of an infant requiring intensive/special care unit admission, occurred in 45 (93.8%) of 48 (pregnancies. Fetal loss occurred in 17 (35.4%) of 48 pregnancies, before 24 weeks’ gestation in 13 cases, and at >24 weeks’ gestation in 4 cases. The overall incidence of pregnancy-associated invasive H. influenzae disease was 19.9 cases/100,000 births, which exceeded the reported incidence of pregnancy-associated listeriosis in New Zealand. We also observed higher rates in younger women and women of Māori ethnicity.

Objective: The aim of this study was to analyze the indications of second-the trimester amniocentesis in a tertiary center and evaluate the difference between aseptic techniques before amniocentesis. Material and Methods: The study sample was drawn from the patients who had amniocentesis between 16th and 22th weeks of pregnancy at Trakya University high-risk pregnancy unit between 2015 and 2018. The patients were divided into two groups according to the antiseptic solutions, which used before the operation. Group I comprised of patients in whom 10% povidine- iodine solution was used for aseptic skin preparation. Group II consisted of patients in whom 10% povidine- iodine solution with 70% isopropyl alcohol solution was used. Results: One hundred fifty eight patients were in group I and took 10% povidine- iodine solution was used for aseptic skin preparation before the procedure and 119 (42.9%) patients were in group II and 10% povidine-iodine +2% chlorhexidine gluconate were used for skin preparation. There were no fetal loss in either group. Two patients (0.7%) in group II was admitted to the hospital in the first week after amniocentesis with increased vaginal discharge and slight abdominal pain. Conclusion: Although the lack of evidence for the superiority of any asepsis technique, a combination of aseptic solutions may be an option for the patients with a high risk of fetal loss.

ABSTRACT Hepatitis E virus (HEV) causes adverse clinical outcomes in pregnant women, but the underlying mechanisms remain poorly understood. To delineate the mechanisms of pregnancy-associated adverse effects during HEV infection, we utilized a genotype 3 HEV from rabbit (HEV-3ra) and its cognate host (rabbits) to systematically investigate the clinical consequences, viral replication dynamics, and host immune and hormonal responses of HEV infection during pregnancy. We found a significant fetal loss of 23% in HEV-infected pregnant rabbits, indicating an early-stage miscarriage. HEV infection in pregnant rabbits was characterized by higher viral loads in feces, intestinal contents, liver, and spleen tissues, as well as a longer and earlier onset of viremia than in infected nonpregnant rabbits. HEV infection altered the pattern of cytokine gene expressions in the liver of pregnant rabbits and caused a transient increase of serum interferon gamma (IFN-γ) shortly after a notable increase in viral replication, which may contribute to early fetal loss. Histological lesions in the spleen were more pronounced in infected pregnant rabbits, although moderate liver lesions were seen in both infected pregnant and nonpregnant rabbits. Total bilirubin was elevated in infected pregnant rabbits. The serum levels of estradiol (E2) in HEV-infected pregnant rabbits were significantly higher than those in mock-infected pregnant rabbits at 14 days postinoculation (dpi) and correlated positively with higher viral loads in feces, liver, and spleen tissues at 28 dpi, suggesting that it may play a role in extrahepatic virus dissemination. The results have important implications for understanding the severe diseases associated with HEV infection during pregnancy. IMPORTANCE HEV causes adverse pregnancy outcomes, with a mortality rate of >30% in pregnant women, but the underlying mechanisms are poorly understood. In this study, we utilized HEV-3ra and its cognate host (pregnant rabbit) to delineate the potential underlying mechanisms of pregnancy-associated adverse outcomes during HEV infection. We found that infected pregnant rabbits had a fetal loss of 23%, which coincided with enhanced viral replication and an elevated systemic IFN-γ response, followed by longer viremia duration and extrahepatic viral dissemination. Estradiol levels were increased in infected pregnant rabbits and correlated positively with higher fecal viral shedding and higher viral loads in liver and spleen tissues. Infected pregnant rabbits had more pronounced splenic lesions, higher serum total bilirubin, and an altered cytokine gene expression profile in the liver. The results will contribute to our understanding of the mechanisms of HEV-associated adverse pregnancy outcomes.

ABSTRACT: Bacillus cereus is a Gram-positive bacterium commonly reported in soils and plants that occupy various ecological habitats, and the main source of contamination for cattle is silage. This report described a case of fetal loss associated with B. cereus infection in a cow. An 8-month-old, Nelore female bovine fetus from a beef farm was submitted for necropsy. A gross examination revealed fibrinous pleuropneumonia and fibrin exudation on the liver surface. The morphological diagnosis was restricted to the lungs and liver. In the lungs there was fibrinosuppurative pleuropneumonia associated with numerous aggregates of rod-shaped bacteria. In the liver there was moderate focally extensive fibrinous peri hepatitis.The lungs, liver, thoracic, and abomasal fluid cultures yielded pure cultures of B. cereus, indicating that these bacteria should be recognized as a cause of bovine abortion in fetuses that macroscopically present fibrin in the abdominal and thoracic cavity.

Background: Currently, no guidelines specifically recommend scoring systems and biomarkers for early evaluation of the severity and prognosis of acute pancreatitis in pregnancy (APIP). Objectives: This study aimed to explore the early predictive value of scoring systems and routine laboratory tests on APIP severity and maternofetal prognosis. Design: This study retrospectively analyzed 62 APIP cases in a 6-year period. Methods: The predictive value of scoring systems and routine laboratory tests that were collected 24h and 48h after admission, for APIP severity and fetal loss, were analyzed. Results: To detect severe acute pancreatitis (SAP), a 24-h Bedside Index for severity in acute pancreatitis (BISAP) achieved a higher area under the curve (AUC) value of 0.910 than the Acute Physiology and Chronic Health Evaluation II (AUC=0.898) and Ranson score (AUC=0.880). The combination of BISAP, glucose, neutrophil-to-lymphocyte ratio (NLR), hematocrit (Hct), and serum creatinine (Scr) provided an AUC value of 0.984, which had greater predictive power than BISAP (푝=0.015). 24-h BISAP and Hct were independent risk factors for predicting SAP of APIP. The cutoff values of Hct and blood urea nitrogen (BUN) to predict SAP were 35.60% and 3.75mmol/l in the APIP. Furthermore, 24-h BISAP had the highest predictive power (AUC=0.958) for fetal loss. Conclusion: BISAP is a convenient and reliable indicator for the early prediction of SAP and fetal loss in APIP. The combination of BISAP, glucose, NLR, Hct and Scr proved to be the optimal early markers for the prediction of SAP in APIP within 24h after admission. In addition, Hct>35.60% and BUN>3.75mmol/l may be suitable thresholds for predicting SAP in APIP. [ABSTRACT FROM AUTHOR]

Background: Pregnancy is often anticipated as a positive experience for women with the expectation of having a healthy infant in the end. However, some pregnancies end in fetal loss, which can have profound effects on parents and families and is characterized by shock, anger, emptiness, helplessness, and loneliness. Aims: The study aimed to describe the lived experiences of nurses and midwives regarding care provided for mothers and families during the fetal loss at King Abdul-Aziz Medical City, Western region. Setting and Design: The study setting was the labor and delivery units at King Abdul-Aziz Medical City, Western region, Saudi Arabia. Husserl's phenomenological approach was used. Materials and Methods: Purposive sampling included 11 nurses and midwives were included. Data were collected through in-depth interviews that were audio reordered and then transcribed verbatim. Statistical Analysis: Thematic analysis using Giorgi's data analysis steps was used. Results: Two themes emerged regarding the experiences of nurses in caring for mothers and families who experience fetal loss, namely emotional turmoil with subthemes, heavy heart, feeling helpless, lack of self-control, feeling guilty, feeling extreme sadness, feeling isolation; and barriers with subthemes culture, lack of nursing care, and limited skill. Conclusion: Two major themes emerged from the study that highlighted that nurses found caring for patients and families after a fetal loss a challenging experience and, at times, were unable to manage their own emotions. [ABSTRACT FROM AUTHOR]

Background: To assess the variations in protein C (PC) activity throughout pregnancy and investigate potential correlations between plasma PC activities and adverse pregnancy outcomes. Methods: A retrospective cohort study was conducted among 1511 women who underwent PC activity testing at a hospital in China from June 2011 to August 2021. t-test, Kruskal Wallis, Fisher’s exact test, logistic regression and receiver operator characteristic (ROC) analysis were used for analysis of data. Results: The PC activity demonstrated a significant increase during the second trimester of pregnancy. The PC activity was found to be lower in pregnant women with a history of thrombosis (median, 95.70% [interquartile range (IQR), 85.50–114.60%]) as compared to those without (median, 109.00% [IQR, 95.00–124.60%], p = 0.008) or with current thrombosis (median, 101.10% [IQR, 85.30–117.00%]) compared to those without such events (median, 109.00% [IQR, 95.00–124.78%], p = 0.013). History of thrombosis was the independent risk factor of current thrombosis during pregnancy (odd ratio (OR) 260.57; 95% confidence interval (95% CI), 76.751–884.689; p < 0.001). The PC activity of 125 cases of threatened abortion was significantly lower than that of asymptomatic women (median, 100.80% [IQR, 91.30–113.15%] vs median, 110.00% [IQR, 95.65–125.00%], p < 0.001). Multivariate analysis showed that the low PC activity (OR 0.985; 95% CI, 0.976–0.994, p = 0.001), gestational age (OR 0.960; 95% CI, 0.946–0.975; p < 0.001) and hypothyroidism (OR 1.888; 95% CI, 1.054–3.381; p < 0.05) were risk factors for threatened abortion. There was no difference in PC activity between fetal loss, hypertensive disorder complicating pregnancy (HDCP), fetal growth restriction (FGR), oligohydramnios, placental abruption and those without. Conclusions: Women with a history of thrombosis and decreased PC activity are risk factors for thrombosis and threatened abortion during pregnancy, respectively. However, no significant correlation was observed between PC activity and fetal loss, HDCP, FGR, oligohydramnios or placental abruption.

Abstract The fertility of sows mainly depends on the embryo losses during gestation and the survival rate of the post-farrowing piglets. The selection of highly-prolific sows has been mainly focused on the selection of genotypes with high ovulatory quota. However, in the early- and post-implantation stages, the rate of embryo losses was increased with the increase of zygotes. Among the various factors, placental growth and development is the vital determinant for fetal survival, growth, and development. Despite the potential survival of fetuses with deficient placental development, their life-conditions and growth can be damaged by a process termed intrauterine growth retardation (IUGR). The newborn piglets affected by IUGR are prone to increased morbidity and mortality rates; meanwhile, the growth, health and welfare of the surviving piglets will remain hampered by these conditions, with a tendency to exacerbate with age. Functional amino acids such as glycine, proline, and arginine continue to increase with the development of placenta, which are not only essential to placental growth (including vascular growth) and development, but can also be used as substrates for the production of glutathione, polyamines and nitric oxide to benefit placental function in many ways. However, the exact regulation mechanism of these amino acids in placental function has not yet been clarified. In this review, we provide evidence from literature and our own work for the role and mechanism of dietary functional amino acids during pregnancy in regulating the placental functional response to fetal loss and birth weight of piglets. This review will provide novel insights into the response of nutritionally nonessential amino acids (glycine and proline) to placental development as well as feasible strategies to enhance the fertility of sows.

Haemophilus influenzae can cause intra-amniotic infection and early pregnancy loss. The mode of transmission and risk factors for H. influenzae uterine cavity infections are unknown. Here, we present the case of chorioamnionitis caused by ampicillin-resistant H. influenzae in a 32-year-old Japanese woman at 16 weeks of gestation. Despite empirical treatment, including ampicillin, as recommended by the current guidelines, she had fetal loss. The antimicrobial regimen was changed to ceftriaxone, and the treatment was completed without complications. Although the prevalence and risk factors for chorioamnionitis caused by ampicillin-resistant H. influenzae are unknown, clinicians need to recognize H. influenzae as a potentially drug-resistant and lethal bacterium for pregnant women.

Objectives: The objective of this study is to examine the performance of Ductus venosus (DV) Doppler done at the routine first trimester screening (11–13 + 6 weeks) in predicting the adverse fetal outcomes in Indian population. Methods: This observational study was conducted between 2013 and 2019, on 4340 singleton pregnancies. Ductus Doppler were considered abnormal if DV pulsatility index values were >95th centile for that gestation or with a reversed "a" wave. Anatomical survey was done to rule out other abnormalities. Women were followed up till delivery and outcomes were divided into 4 groups: 1) aneuploidies; 2) cardiac defects; 3) non‐cardiac structural abnormalities; and 4) miscarriages before 24 weeks or fetal deaths after 24 weeks. Results: Prevalence of abnormal DV Doppler is 5.12% (205/4004). There were significantly higher number of fetal losses (4.4 versus 0.3%), aneuploidies (10.2 versus 1.7%), fetal cardiac defects (5.9 versus 1.4%), and non‐cardiac structural defects (5.4 versus 1.4%) among the pregnancies with abnormal DV Doppler in comparison to those with normal flow (P <.001). Logistic regression analysis has shown that significant contribution to fetal chromosomal abnormalities and cardiac defects was associated with abnormal DV. Other factors which were found to have a significant association with adverse fetal outcome were increased nuchal translucency and increased body mass index (BMI). Conclusion: DV Doppler in first trimester can be used as a screening tool for cardiac defects and fetal deaths. Women with abnormal DV Dopplers should be offered fetal echocardiography at 18–22 weeks and third trimester growth scans with Dopplers. [ABSTRACT FROM AUTHOR]

(1) Background: Arsenic (As) is a common drinking water contaminant that is regulated as a carcinogen. Yet, As is a systemic toxicant and there is considerable epidemiological data showing As adversely impacts reproductive health. This study used data from a birth cohort in Bangladesh (2008–2011) to examine associations between drinking water As levels and reproductive outcomes. (2) Methods: Pregnant individuals (n = 1597) were enrolled at <16 weeks gestation and drinking water As was measured. Participants with live births (n = 1130) were propensity score matched to participants who experienced miscarriage (n = 132), stillbirth (n = 72), preterm birth (n = 243), and neonatal mortality (n = 20). Logistic regression was used to examine drinking water As recommendations of 50, 10, 5, 2.5, and 1 µg/L on the odds of adverse birth outcomes. (3) Results: The odds of miscarriage were higher for pregnant women exposed to drinking water ≥2.5 versus <2.5 µg As/L [adjusted odds ratio (OR) 1.90, 95% Confidence Interval (CI): 1.07–3.38)]. (4) Conclusions: These preliminary findings suggest a potential threshold where the odds of miscarriage increases when drinking water As is above 2.5 µg/L. This concentration is below the World Health Organizations and Bangladesh's drinking water recommendations and supports the re-evaluation of drinking water regulations. [ABSTRACT FROM AUTHOR]

Antenatal screening for hepatitis B surface antigen seropositivity is widely adopted to identify pregnant women with chronic hepatitis B virus (HBV) infection in order to target their newborn infants for combined passive-active neonatal immunization to prevent the maternal-to-child transmission of HBV. It is less certain whether the presence of chronic HBV infection in these largely asymptomatic women could impact their pregnancy outcome. There is now gathering information in the literature, though sometimes conflicting, on the obstetric implications of chronic HBV infection. The conflicting data is most probably related to confounding factors such as the immunological phase of chronic HBV infection, viral genotype and activity, presence of hepatic inflammation and other co-existing liver disorders such as non-alcoholic fatty liver disease, and coinfection with other virus such as hepatitis C virus and micro-organisms, which are usually not examined, but which could have made significant influence on the occurrence of many of the pregnancy complications and adverse fetal and neonatal outcome. For pregnancy complications, the evidence suggests association with increased gestational diabetes mellitus, preterm birth, intrahepatic cholestasis of pregnancy, caesarean delivery, and postpartum haemorrhage, probably increased placental abruption and prelabour rupture of the membranes, and no effect or a reduction in the hypertensive disorders of pregnancy, especially preeclampsia. For perinatal outcome, there may be increased miscarriage and fetal malformations, and increase in both low birthweight and large-for-gestational age/macrosomic infants, as well as increased intrauterine fetal demise/stillbirth and fetal distress. However, most studies have not elaborated on the mechanisms or explanations of many of the adverse outcomes. Taken together, maternal chronic HBV infection increases the risk of adverse obstetric outcome overall, but further prospective studies are warranted to elucidate the reasons and mechanisms of, and with a view to mitigating, these adverse obstetric outcomes.

Background: This study introduced the Perinatal Grief Intensity Scale (PGIS) and applied it to assess the reliability and validity of perinatal loss in Chinese mothers. Methods: To sinicize PGIS and cultural debugging of the scale, reliability validity was assessed in this prospective cross-sectional study. Results: The Chinese version of the PGIS contained 14 items in three dimensions: reality, confront others, and congruence. The content validity index (CVI) at the total scale level, mean scale level, and item level was 0.92, 0.909, and 0.860–1.000. Exploratory factors were identified as three metric factors with a cumulative variance contribution rate of 66.627%. The Chinese version of the Perinatal Grief Scale (PGS) was used as a calibration standard, and the correlation coefficient was 0.759. The total Cronbach’s alpha coefficient for the Chinese version of the PGIS was 0.768, with a fold-half reliability of 0.749. The scale showed good reliability and validity. Conclusions: The Chinese version of the PGIS was used as a calibration standard by exploratory factor testing, and the correlation coefficient was good, and the scale had good reliability and validity for application in China.

Invasive Haemophilus influenzae infection during pregnancy can cause preterm birth and fetal loss, but the mechanism is unclear. We investigated 54 cases of pregnancy-associated invasive H. influenzae disease in 52 unique pregnancies in the Auckland region of New Zealand during October 1, 2008‒September 30, 2018. Intraamniotic infection was identified in 36 (66.7%) of 54 cases. Outcome data were available for 48 pregnancies. Adverse pregnancy outcomes, defined as fetal loss, preterm birth, or the birth of an infant requiring intensive/special care unit admission, occurred in 45 (93.8%) of 48 (pregnancies. Fetal loss occurred in 17 (35.4%) of 48 pregnancies, before 24 weeks' gestation in 13 cases, and at >24 weeks' gestation in 4 cases. The overall incidence of pregnancy-associated invasive H. influenzae disease was 19.9 cases/100,000 births, which exceeded the reported incidence of pregnancy-associated listeriosis in New Zealand. We also observed higher rates in younger women and women of Māori ethnicity. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyze the indications of second-the trimester amniocentesis in a tertiary center and evaluate the difference between aseptic techniques before amniocentesis. Material and Methods: The study sample was drawn from the patients who had amniocentesis between 16th and 22th weeks of pregnancy at Trakya University high-risk pregnancy unit between 2015 and 2018. The patients were divided into two groups according to the antiseptic solutions, which used before the operation. Group I comprised of patients in whom 10% povidine-iodine solution was used for aseptic skin preparation. Group II consisted of patients in whom 10% povidine- iodine solution with 70% isopropyl alcohol solution was used. Results: One hundred fifty eight patients were in group I and took 10% povidine- iodine solution was used for aseptic skin preparation before the procedure and 119 (42.9%) patients were in group II and 10% povidine-iodine +2% chlorhexidine gluconate were used for skin preparation. There were no fetal loss in either group. Two patients (0.7%) in group II was admitted to the hospital in the first week after amniocentesis with increased vaginal discharge and slight abdominal pain. Conclusion: Although the lack of evidence for the superiority of any asepsis technique, a combination of aseptic solutions may be an option for the patients with a high risk of fetal loss. [ABSTRACT FROM AUTHOR]

Background Acute appendicitis (AA) is considered the most frequent nonobstetric, nongynecologic surgical disease during pregnancy. Laparoscopic appendectomy (LA) is safe and feasible for complicated appendicitis in adults, whereas the role of laparoscopy in complicated AA during pregnancy is not identified. Aim This study aimed to assess perioperative surgical and obstetrical outcomes of LA in pregnant women with complicated AA. Patients and methods This retrospective cohort study enrolled 19 pregnant women who underwent LA for AA during any trimester of pregnancy and were found to have complicated appendicitis that was defined intraoperatively as perforation of the appendix, gangrene, empyema, phlegmon, or abscess formation. A laparoscopic threeport technique was used. All patients were followed up at the outpatient clinic on postoperative days 7 and 14. Operative and postoperative surgical and obstetric outcomes were recorded. Results The mean age of the studied patients was 35.9±6.6 years, and the mean gestational age was 20.9±5.2 weeks. The mean operative time was 63.6±8.0min, and conversion to open surgery was not needed in any case. Postoperative surgical complications were infected supraumbilical wound and intra-abdominal subhepatic localized abscess formation (5.3% each). Obstetric complications involved abortion in only one (5.3%) patient that occurred 5 days after the operation. The mean length of hospital stay was 2.3±0.9 days. Conclusion LA for complicated appendicitis in pregnant women was safe for the mother and the fetus regardless of the gestational age. The procedure was associated with a low risk of operative and postoperative surgical complications, which were managed conservatively. Further, the incidence of fetal loss was also low. [ABSTRACT FROM AUTHOR]

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by clinical manifestations such as thrombosis and obstetric complications with documented persistence of antiphospholipid antibodies (aPLs). Recent studies have revealed that the cause of aPL-related obstetric complications is dysfunction of placental trophoblasts and inflammation of the maternal–fetal interface induced by aPLs, not thrombosis. Although aPLs are associated with recurrence of serious complications during pregnancy, appropriate combination therapy with heparin and low-dose aspirin can improve the course of 70–80% of subsequent pregnancies. Preconception counseling and patient-tailored treatment are fundamental to improving maternal and fetal outcomes. Non-anticoagulant treatments such as hydroxychloroquine and statins are being developed for cases refractory to conventional treatment. Risk factors for thrombosis after pregnancy complications were identified based on the analysis of large databases of obstetric APS.

The objective of this study was to investigate both antiphospholipid antibodies (aPLs) and non-criteria aPLs (NC-aPLs) in relation with pregnancy outcomes. We retrospectively analyzed 1574 pregnant women with experienced at least one miscarriage who were tested for aPLs and NC-aPLs, and compared their clinical characteristics, immune biomarkers, and pregnancy outcomes. The χ2 test or Fisher's exact test compared pregnancy outcomes among patients negative for all aPLs, positive for NC‑aPLs subtypes, and positive for criteria aPLs subtypes. Multivariate logistic regression analysis indicated that positive aPLs (OR = 2.216, 95 % CI 1.381–3.558), and positive NC-aPLs (OR = 1.619, 95 % CI 1.245–2.106) are linked to adverse outcomes. For fetal loss, positive aPLs (OR = 2.354, 95 % CI 1.448–3.829), NC-aPLs (OR = 1.443, 95 % CI 1.076–1.936) were significant. Premature delivery was associated with positive NC-aPLs (OR = 2.102, 95 % CI 1.452–3.043). In the NC-aPLs positive group, the rate of adverse outcomes was higher in the multiple-positive subgroup (77.8 %) compared to the double-positive (52.3 %) and single-positive (37.0 %) subgroups. The rates of fetal loss and premature delivery were also higher in the multiple-positive NC-aPLs subgroup compared to the single-positive subgroup (48.1 % vs. 22.6 % for fetal loss and 57.1 % vs. 16.5 % for premature delivery). Our findings suggest that both aPLs and NC-aPLs are associated with an increased incidence of adverse pregnancy outcomes, and patients presenting with multiple NC-aPLs positivity were found to have a higher incidence of adverse outcomes compared to their single-positive counterparts. • Both aPLs and NC-aPLs are associated with adverse pregnancy outcomes. • Patients with multiple NC-aPLs positivity have a higher incidence of adverse outcomes. • Different subtypes of NC-aPLs positivity lead to varying pregnancy outcomes. [ABSTRACT FROM AUTHOR]

On November 4, 2008, Barack Obama was elected the first Black President of the United States. His campaign and electoral win served as a symbol of hope for a more just future, fostering an "Obama effect" that appears associated with improved well-being among non-Hispanic (NH) Black communities. Situating the Obama election within the symbolic empowerment framework, we consider the potentially protective role of the Obama election on NH Black fetal death, an important but understudied measure of perinatal health that has stark racial disparities. Using restricted-use natality files from the National Center for Health Statistics, we proxy fetal death using the male twin rate (number of twins per 1000 male live births). Male twins have a relatively high risk of in utero selection that is sensitive to maternal and environmental stressors, making the twin rate an important marker of fetal death. We then estimate interrupted time-series models to assess the relation between the Obama election and male twin rates among NH Black births across monthly conception cohorts (February 2003–October 2008). Greater-than-expected male twin rates signal less susceptibility to fetal loss. Results indicate a 4.5% higher male twin rate among all NH Black cohorts exposed in utero to the Obama election, after accounting for historical and NH white trends (p < 0.005). The greater-than-expected rates concentrated among births conceived in the months preceding Obama's nomination at the Democratic National Convention and Obama's presidential win. These results suggest a salutary perinatal response to election events that likely reduced NH Black fetal loss. They also indicate the possibility that sociopolitical shifts can mitigate persisting NH Black-NH white disparities in perinatal health. • Greater-than-expected male twin rates signal reduced susceptibility to fetal loss. • Black male twin rates increased for cohorts in utero during Obama's 2008 election. • Increases were greatest for births conceived months prior to primary, election wins. • Symbolic sociopolitical shifts may mitigate persisting perinatal health disparities. [ABSTRACT FROM AUTHOR]

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by clinical manifestations such as thrombosis and obstetric complications with documented persistence of antiphospholipid antibodies (aPLs). Recent studies have revealed that the cause of aPL-related obstetric complications is dysfunction of placental trophoblasts and inflammation of the maternal–fetal interface induced by aPLs, not thrombosis. Although aPLs are associated with recurrence of serious complications during pregnancy, appropriate combination therapy with heparin and low-dose aspirin can improve the course of 70–80% of subsequent pregnancies. Preconception counseling and patient-tailored treatment are fundamental to improving maternal and fetal outcomes. Non-anticoagulant treatments such as hydroxychloroquine and statins are being developed for cases refractory to conventional treatment. Risk factors for thrombosis after pregnancy complications were identified based on the analysis of large databases of obstetric APS. [ABSTRACT FROM AUTHOR]

This study aims to determine if second trimester amniocentesis in twin pregnancies provides a significant independent contribution in the prediction of miscarriage or fetal loss at any stage of pregnancy. This was a retrospective cohort study of women with twin gestations booked for routine prenatal care in four fetal medicine units in Poland in the years 2010–2020. The study population included: (1) twin pregnancies that underwent amniocentesis at 16–20 weeks' gestation; (2) twin pregnancies that did not require any further testing and were followed-up routinely. Univariable and multivariable regression analysis was used to define which maternal and pregnancy characteristics provided a significant independent contribution in the prediction of miscarriage and fetal loss at any stage of pregnancy. In the study period, 2645 twin pregnancies were eligible for analysis. There were 144 cases of miscarriage defined as fetal loss of one or both twins before 24 weeks and 40 cases of intrauterine death of one or both twins after 24 weeks. A total number of 162 twin pregnancies underwent amniocentesis at 16–20 weeks' gestation. The rate of miscarriage before 24 weeks and the rate of fetal loss at any stage of pregnancy in the group that underwent amniocentesis was 10.49% and 13.58%, respectively, compared to 5.11% and 6.52% that did not undergo amniocentesis. Multivariable regression analysis showed that factors providing a significant independent contribution in the prediction of miscarriage and fetal loss at any stage of pregnancy were monochorionicity (MC), large intertwin discordance in crown-rump length (CRL), low Pregnancy Related Plasma Protein (PAPP-A) MoM and nuchal translucency (NT) above 95th centile. Amniocentesis in twin pregnancies does not provide a significant contribution in the prediction of miscarriage or fetal loss at any stage of pregnancy. [ABSTRACT FROM AUTHOR]

The fertility of sows mainly depends on the embryo losses during gestation and the survival rate of the post-farrowing piglets. The selection of highly-prolific sows has been mainly focused on the selection of genotypes with high ovulatory quota. However, in the early- and post-implantation stages, the rate of embryo losses was increased with the increase of zygotes. Among the various factors, placental growth and development is the vital determinant for fetal survival, growth, and development. Despite the potential survival of fetuses with deficient placental development, their life-conditions and growth can be damaged by a process termed intrauterine growth retardation (IUGR). The newborn piglets affected by IUGR are prone to increased morbidity and mortality rates; meanwhile, the growth, health and welfare of the surviving piglets will remain hampered by these conditions, with a tendency to exacerbate with age. Functional amino acids such as glycine, proline, and arginine continue to increase with the development of placenta, which are not only essential to placental growth (including vascular growth) and development, but can also be used as substrates for the production of glutathione, polyamines and nitric oxide to benefit placental function in many ways. However, the exact regulation mechanism of these amino acids in placental function has not yet been clarified. In this review, we provide evidence from literature and our own work for the role and mechanism of dietary functional amino acids during pregnancy in regulating the placental functional response to fetal loss and birth weight of piglets. This review will provide novel insights into the response of nutritionally nonessential amino acids (glycine and proline) to placental development as well as feasible strategies to enhance the fertility of sows. [ABSTRACT FROM AUTHOR]

The aim of this retrospective cohort study was to review rate of miscarriage following antenatal invasive diagnostic procedures from a unit where relatively low annual numbers of procedures are undertaken. Data were analysed for 201 chorionic villous samplings (CVSs) performed between January 2007 and June 2019 and 511 amniocenteses performed between January 2008 and June 2019, in singleton pregnancies. The miscarriage rates after CVS was 0% at 48 hours, 0.6% at 2 weeks and 2.5% up to 24 weeks of gestation. All four miscarriages following CVS had significant inherent high-risk features, therefore, it would be inappropriate to attribute these losses solely to the procedure itself. None of the women who had an amniocentesis had a miscarriage during the study period. We did not find a causal association between number of invasive procedures performed by an operator and miscarriage rate in our setting even with low annual numbers of invasive procedures. What is already known on this subject? Royal College of Obstetricians and Gynaecologists (RCOG) of UK recommends a minimum of at least 30 CVSs or amniocenteses procedures per year for a practitioner in order to maintain skills. A centre performing more fetal invasive procedures has lower miscarriage rates due to more experience of practitioners. What the results of this study add? This study is the first long-term audit data from a smaller fetal medicine unit with relatively low annual case load, suggesting that miscarriage risk may actually be lower than the current understanding. No additional risk of miscarriage or pregnancy loss following fetal invasive procedures even with relatively low annual numbers than that recommended by the RCOG. What the implications are of these findings for clinical practice and/or further research? The findings of this study are important in the era of non-invasive prenatal testing which will see the overall number of fetal invasive procedures decline with time. Competence in safely undertaking antenatal invasive procedure can possibly be maintained with lower annual procedure numbers. Units undertaking low number of antenatal invasive procedure must continuously audit their practice to ensure satisfactory standards and outcomes. More research is needed from smaller units to corroborate or refute the findings of this study. [ABSTRACT FROM AUTHOR]

Introduction: Stillbirth fetal loss (SFL) is a significant cause of infant death in the US, with 23,000 reported in 2017. Negative psychological and emotional repercussions of SFL, for parents and nurses, may be mitigated by nurses' preparedness to provide bereavement support (BS). Several studies exploring BS for miscarriage-related fetal loss were found. However, studies exploring SFL BS and nurses' preparedness for providing SFL BS are sparse. The purpose of this study was to assess nurses' confidence and knowledge for providing BS to families experiencing stillbirth fetal loss. Methods: This was a cross-sectional quantitative descriptive study. Postpartum registered nurses (RN) were recruited via email, staff meetings, posted flyers, and personal invitation. RNs completed the 43-item Perinatal Bereavement Care Confidence Scale (PBCCS) and demographic information. The PBCCS has four subscales: Bereavement Support Knowledge (BSK), Bereavement Support Skills (BSS), Self-Awareness (SA), and Organizational Support (OS). Data were collected from May to July 2021 and analyzed using Pearson's correlation and one-way ANOVA. Results: The sample consisted of 48 RNs. PBCCS subscale averages were BSK = 50.85/75, BSS = 28.72/45, SA = 26.31/55, and OS = 33.79/40. Statistically significant correlations (r = .311-.386) were found between BSK and age groups, BSK and level of experience, and SA and RNs who received prior BS education. Statistically significant one-way ANOVA results showed differences in a) BSK across age groups, b) BSK across experience levels, c) total PBCCS scores and age groups, and d) total PBCCS scores and prior BS education. Discussion: Nurses' confidence in providing BS affects the psychological/emotional well-being of parents and RNs. Results suggest RNs need further BS education with assessment of actual knowledge/skills. [ABSTRACT FROM AUTHOR]

Jørn Olsen,1 Zeyan Liew2 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N 8200, Denmark; 2Department of Environmental Health Sciences, Yale School of Public Health, Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT 06510, USACorrespondence: Zeyan LiewDepartment of Environmental Health Sciences, Yale School of Public Health, Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USATel +1 203-764-9727Email zeyan.liew@yale.eduAbstract: In perinatal epidemiology, fetal deaths occur over the first timeline, from conception to birth or fetal death. Majority of other epidemiological research on human diseases focus on the second timeline, from birth to death. The transition from the first to the second timeline is not a fixed duration of time and it depends on when birth occurs. We discussed the complications when switching from the first to the second timeline in epidemiological studies of early life exposures, pregnancy events, and future health outcomes. Population-based studies often lack accurate data on the date of conception for most pregnancies and the complete count of fetal death, leading to chances for selection and misclassification biases. To address these problems, better research data and methodological advancement in study designs and biases evaluations are needed.Keywords: fetal loss, miscarriage, bias, birth cohort, epidemiology

Fertile chicken eggs were used as an alternative model for large animals to evaluate suspect toxic dietary ingredients for fetal loss disorders associated with mare reproductive loss syndrome (MRLS) and fetal losses in other livestock. Nitrate, ammonia, and sulfate may react with proteinaceous compounds to enable the formation of abiotic pathogenic nanoparticles which were constant findings in pathognomonic placental lesions associated with non-infectious fetal losses of previously unknown etiology in mares, chickens and other livestock. The pathogenic nanoparticles may be produced naturally by toxic elements associated with air pollution that affect pasture forages or crops, unintentionally by reactions of these elements in protein-mineral mixes in dietary rations, or endogenously within tissues of fetuses and adult animals. The nanoparticles may form niduses in small vessels and predispose animals to a host of secondary opportunistic diseases affecting the reproductive, respiratory and gastrointestinal tracts of animals. The newly recognized abiotic pathogenic micro and nanoparticles are associated with MRLS. The discovery of the pathogenic nanoparticles led to the identification of nitrate, ammonium, and sulfur, in the form of sulfate, that seemingly enable the formation of the pathogenic nanoparticles in embryonic and fetal tissues.