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ABSTRACT The first 1000 days of life lay the foundations for subsequent growth. This ambidirectional study, including prenatal, perinatal and postnatal factors, aimed to identify exposure variables affecting body size and composition and corresponding Z‐score outcomes at age 18 months in infants born to women at low risk of adverse pregnancy outcomes in a peri‐urban area of South Africa. Prenatal factors (maternal age, HIV status, anthropometry, parity, food insecurity and umbilical artery resistance index Z‐score (UmA‐RIAZ) as a measure of placental function, with higher UmA‐RIAZ indicating poorer placental function); perinatal factors (infant sex, gestational age and birth anthropometry) and postnatal factors (infant feeding) were included as exposure variables, with infant anthropometry and body composition at 18 months as outcomes. Simple linear regression analysis was used to investigate associations between exposure variables and infant outcomes, and variables with p < 0.10 were included in the subsequent multiple regression analyses. Multiple regression analysis showed that higher UmA‐RIAZ predicted lower birthweight [−0.11 kg (95% CI: −0.17, −0.04 kg)], birthweight‐for‐age Z‐score [−0.24 (95% CI: −0.39, −0.09)] and 18‐month infant length [−0.9 cm (95% CI: −1.4, −0.4 cm)] and length‐for‐age Z‐score [−0.28 (95% CI: −0.45, −0.11)]. Maternal HIV infection predicted reduced 18‐month infant length‐for‐age Z‐score [−0.46 (95% CI: −0.83, −0.09)]. Household food insecurity predicted reduced fat‐free mass‐for‐age Z‐score at 18 months [−0.27 (95% CI: −0.51, −0.03)]. Infant anthropometry and body composition outcomes, therefore, are greatly affected by pre‐ and postnatal nutrition‐related factors, such as placental insufficiency in utero and household food insecurity, with long‐term consequences including stunting, which impact the individual, future generations and society. [ABSTRACT FROM AUTHOR]

ABSTRACT Fetal asphyxia, a condition resulting from the combined effects of hypoxia and hypercapnia, leads to approximately 900,000 annual deaths worldwide. One cause is umbilical cord compression during labor‐induced uterine contractions, disrupting the transport of metabolites to and from the placenta, and resulting in asphyxia. Current fetal well‐being assessment relies on monitoring fetal heart rate and uterine contractions as indicators of oxygen delivery to the brain. To enhance our understanding of this complex relationship, this study aims to develop a modular mathematical model including fetal blood gas dynamics, the autonomic nervous system, and cerebral blood flow regulation. The novelty of this study lies in the capability of the model to simulate fetal growth. These submodels are part of a larger multiscale mathematical model describing fetal circulation in the second half of pregnancy. The blood gas model realistically replicates partial oxygen and carbon dioxide pressures in umbilical arteries and veins during healthy fetal development reported in the literature. An in silico experiment is conducted to simulate umbilical cord occlusion and is compared with lamb experiments to verify the realism of the regulation models during fetal growth. Our findings suggest that premature infants are more susceptible to umbilical cord occlusion, exhibiting elevated cerebral perfusion pressure and flow. This modular mathematical model may serve as a valuable tool for testing hypotheses related to the fetal regulatory system. [ABSTRACT FROM AUTHOR]

Our practice utilizes Doppler ultrasound as one of the most objective and effective methods to assess at-risk pregnancies. This review will discuss the application of arterial and venous Doppler techniques in assessing and managing various diseases and conditions for high-risk fetuses. [ABSTRACT FROM AUTHOR]

• Norepinephrine reduces maternal bradycardia versus phenylephrine. • Both vasopressors equally maintain blood pressure and neonatal outcomes. • No significant difference in umbilical blood gas between both vasopressors. • Larger trials are needed to confirm and guide clinical practice. We conducted a systematic review and meta -analysis to evaluate the fetomaternal outcomes after the administration of norepinephrine or phenylephrine for the treatment of post spinal hypotension in preeclamptic women undergoing a cesarean section. We searched on PubMed, Embase, Scopus, Cochrane CENTRAL, and clinicaltrials.gov from inception till June 2024. Randomized controlled trials of preeclamptic women receiving norepinephrine or phenylephrine for post spinal hypotension were included. Two reviewers extracted data onto an Excel spreadsheet. R version 4.4 was used for statistical analysis. Risk ratios (RR) and their 95% confidence intervals (CIs) were calculated and pooled using the random effects model. Cochrane's risk of bias (RoB 2) tool was used for quality assessment. This review has been registered with PROSPERO (CRD42024532740). A total of 4 trials, comprising 413 participants, were included in this review. 206 patients received norepinephrine, while 207 received phenylephrine. The incidence of maternal bradycardia was significantly lower in the norepinephrine group compared with the phenylephrine group (RR = 0.25, 95 % CI = 0.16 to 0.39, p < 0.01). There were no statistical differences in other maternal outcomes or in the umbilical artery and umbilical vein blood gas analysis values. We also analyzed adverse events such as nausea (RR = 1.00, 95 % CI: 0.62 to 1.60, p = 1.00) and vomiting (RR = 0.99, 95 % CI: 0.89 to 1.11, p = 0.61), but they did not show a significant association with any group. All the trials had a moderate or low risk of bias. Bolus doses of NE and PE for the treatment of post-spinal hypotension in preeclamptic women undergoing cesarean sections were found to exhibit comparable neonatal outcomes. However, NE provided superior maternal safety due to a lower incidence of bradycardia compared to PE. [ABSTRACT FROM AUTHOR]

Objective: Fetal head malposition can result in neonatal and maternal complications. Fetal head malposition occurs frequently in labor. Appropriate and timely managements are required. Maternal posture and cognitive-behavioral interventions could improve labor outcomes in primigravidas with fetal head malposition. Methods: A randomized controlled clinical trial was performed between January and December 2022 (Chinese Clinical Trial Registry, ChiCTR2100049359). Eligible primigravidas were randomly assigned into four groups. Group A received traditional perinatal care. Group B, C, and D received posture management, posture management with music therapy, and posture management with video education, respectively, in addition to traditional perinatal care. The maternal postures referred to place pregnant women in certain positions (lateral, lateral-prone, hands and knees, open knee-chest) to change the anatomical structure of pelvis, thus, to facilitate the fetal downward movement and birth. Maternal and neonatal outcomes were recorded and compared. Results: A total of 136 primigravidas were included, with 34, 35, 34, and 33 women in group A, B, C, and D, respectively. The incidences of cesarean section were lower in groups B, C, and D than that in group A (5.7%, 2.9%, and 3.0% versus 20.6%, p < 0.05). The fetal position correction rates at the time of full dilation of cervix were higher in groups B, C, and D than that in group A (66.7%, 63.6%, 68.8% versus 27.6%, p < 0.05). Primigravidas in groups B, C, and D had better experiences and a lower anxiety level than those in group A (p < 0.001). The four groups had no statistically significant differences in the total labor duration, operative vaginal delivery, umbilical artery blood pH, and neonatal Apgar scores. Conclusion: Fetal head malposition could happen in primigravidas. Maternal posture management and cognitive-behavioral interventions during labor could improve labor outcomes in primigravidas with fetal head malposition. [ABSTRACT FROM AUTHOR]

Background: This study investigates the effects of administering intravenous esketamine at a dose of 0.25 mg/kg to pregnant patients receiving epidural anesthesia for emergency cesarean section on both maternal and neonatal outcomes. Methods: Medical records of pregnant patients transitioning from labor analgesia to epidural anesthesia for emergency cesarean sections between January 2020 and December 2022 were analyzed. The patients were categorized based on whether they received esketamine infusions during the incision-to-delivery interval. The variables compared between the groups included hemodynamic parameters, perioperative and postoperative adverse reactions, and neonatal outcomes (gender, weight, Apgar scores at 1 and 5 min, need for neonatal intensive care, and umbilical artery/vein blood gas analysis). Results: For maternal outcomes, the systolic blood pressure (SBP) in the esketamine group showed a significant increase at 5 and 10 min' post-administration, and the diastolic blood pressure (DBP) significantly increased at 5 min, compared to the control group (p < 0.01). No significant differences were observed in heart rate (HR) and oxygen saturation (SpO2) at any time point (p > 0.05). The esketamine group experienced a significant rise in the incidence of arrhythmias, dizziness, and nystagmus during the perioperative period, a notable decrease in hypotension incidence, and an increase in postoperative nausea and dizziness. Regarding neonatal outcomes, there were no significant differences in gender, weight, Apgar scores ≤7 at 1 and 5 min, and the need for neonatal intensive care. However, the pH level in the umbilical artery blood of the esketamine group was significantly higher. The levels of PCO2 and PO2 in umbilical artery and venous blood did not show significant differences between the groups. Conclusions: In pregnant women undergoing emergency cesarean section, intravenous administration of 0.25 mg/kg esketamine is correlated with favorable maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Preeclampsia (PE) is a common complication of pregnancy that carries significant risks for both the mother and the fetus, and is frequently accompanied by hyperuricemia, yet the exact source of elevated uric acid (UA) levels remains partially elucidated. Several potential origins for increased UA levels include abnormal renal function, increased tissue breakdown, and increased activity of the enzyme Xanthine Oxidase (XO). The aim of the study was to determine serum levels of UA and XO not only in maternal serum, but also in umbilical vein (UV) and umbilical artery (UA) and explore their possible role in PE development. Methods: A prospective case-control pilot study was conducted in women who were found positive for PE with severe features, and had elevated UA levels above 6 mg/dL, with normotensive pregnant women serving as controls. Renal function, UA and XO levels were measured in maternal, UV and UA serums immediately after delivery. They were then compared between PE (n = 21) and control (n = 18) groups, as well as across all mediums (maternal, UV and UA) among the total study sample (N = 39). Diastolic blood pressure (DBP) was also measured immediately following delivery. Results: The mean serum maternal creatinine levels did not differ significantly between groups (0.65 ± 0.03 vs 0.6 ± 0.07, p = 0.13). Both mean maternal serum UA and XO concentrations were higher in PE group than in control (7.3 ± 1.2 vs 4.2 ± 0.9, p < 0.01 and 3.6 ± 3.5 Vs 1.7 ± 0.8, p < 0.01, respectively). The mean UV and UA serum XO concentrations were significantly higher in PE group compared to control (4.2 ± 3.6 vs 2.2 ± 1.4, p < 0.01 and 4.2 ± 3.6 vs 2.1 ± 1.5, p < 0.01, respectively). Polynomial fit correlation test demonstrated a significant association between maternal DBP and UV XO concentration for all the total study participants (p = 0.03). Conclusion: Despite preserved renal functions, UA and XO levels were elevated in women with PE. Importantly, this pattern was found to be applied to the feto-placental unit as well, which may indicate an active involvement of the fetus in the hypoxic process. Further study is needed to clarify the possible role of the feto-placental unit in pregnancies complicated by PE. [ABSTRACT FROM AUTHOR]

Objective: To construct fetal limb bone nomograms in the Chinese ethnic population. Methods: This was a prospective cross-sectional study on singleton pregnancies between 12 and 37 weeks of gestation. Femur, tibia, fibula, humerus, ulna, radius, and foot length were measured in a standardized manner by one of the three sonographers. Each fetus's measurements were only included once and those who developed maternal or fetal complications were excluded. Fractional polynomial regression model was used to obtain the 3rd, 10th, 50th, 90th, and 97th centiles for each of the limb measurement. Z-score for the 50th centile of each fetal limb measurement was then compared with published nomograms derived from other populations. Results: Of the 843 scans performed, 775 were included in analysis after excluding conditions such as pre-eclampsia, chromosomal abnormalities, single umbilical artery and skeletal dysplasia. Comparison with other populations showed that Chinese had shorter fetal limb bone lengths than the Caucasian and Afro-Caribbean populations. Conclusion: This study established nomograms for all the fetal limb bones in the Chinese ethnic population, which showed lengths comparatively shorter than Caucasian and Afro-Caribbean nomograms. This would reduce the false alarm of short fetal limb bone lengths and its consequent anxiety and intervention. [ABSTRACT FROM AUTHOR]

Objective: To determine cardiotocographic patterns in newborns with metabolic acidosis, based on clinical signs of neurological alteration (NA) and the need for hypothermic treatment. Methods: All term newborns with metabolic acidosis in a single center from 2016 to 2020 were included in the study. Three segments of intrapartum CTG (cardiotocography) were considered (first 30 min of active labor, 90 to 30 min before birth, and last 30 min before delivery) and a longitudinal analysis of CTG pattern was performed according to the 2015 FIGO classification. Results: Three hundred and twenty-four neonates with metabolic acidosis diagnosed at birth were divided into three groups: the first group included all neonates with any clinical sign of neurological alteration, requiring hypothermia according to the recommendation of the Italian Society of Neonatology (group TNA—Treated neurological Alteration, n = 17), the second encompassed neonates with any clinical sign of neurological alteration not requiring hypothermia (group NTNA—Not Treated neurological Alteration, n = 83), and the third enclosed all neonates without any sign of clinical neurological involvement (group NoNA—No neurological Alteration, n = 224). The most frequent alterations of CTG in TNA group were late decelerations, reduced variability, bradycardia, and tachysystole. Unexpectedly, from the longitudinal analysis of the CTG, 49% of all cases with metabolic acidosis never showed a pathological CTG with normal trace at the beginning of labor followed by normal or suspicious trace in the final part of labor, the same as in TNA and NTNA groups (10 and 39%, respectively). Conclusions: CTG has limited specificity in identifying cases of acidosis at birth, even in babies who will develop NA. [ABSTRACT FROM AUTHOR]

Objectives: To assess the predictive accuracy of three-dimensional (3D) power Doppler combined with two-dimensional (2D) Doppler ultrasonography in detecting fetal growth restriction (FGR). Methods: The study was conducted on singleton pregnancies presenting for growth ultrasound examinations between 20 and 40 weeks of gestation. 63 patients with FGR were enrolled and matched 1:1.8 for gestational age with normal fetuses. Both groups were further divided into subgroups, with 32 weeks as the threshold—early-onset and late-onset FGR groups, and corresponding control groups. Conventional 2D Doppler parameters and standardized 3D power Doppler measurements of the placenta, including vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were obtained for each patient. Results: (1) The average gestational weeks of delivery and birth weight of newborns in early-onset and late-onset FGR case groups were lower than those in control groups, while the incidence of placenta previa and adverse pregnancy outcomes were higher than those in control groups. (2) The biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight, middle cerebral artery systolic/diastolic velocity ratio (S/D), pulsatility index (PI), resistance index (RI), and placental blood perfusion indices of vascular index (VI), flow index (FI), vascular flow index (VFI), and cerebro-placental ratio (CPR) of the early-onset and late-onset FGR case groups were all lower than those of the control group. Moreover, the S/D, PI, and RI of the umbilical and uterine arteries were higher than those of the corresponding control group. (3) For early-onset FGR, the area under the curve (AUC) of the umbilical artery PI was the largest (0.861), exhibiting the highest predictive value. When combined with the placental blood perfusion index, the AUC was 0.789. For late-onset FGR, the AUC of the CPR was 0.861. After integrating the placental blood perfusion index, the AUC increased to 0.877. The positive likelihood ratio (PLR) of combined 2D Doppler indexes (21.938) and negative likelihood ratio (NLR) of VFI (0.565) were the highest in the early-onset FGR group. The PLR of combined 3D Doppler indexes (8.536) and NLR of VFI (0.557) were the highest in the late-onset FGR group. Conclusions: The combination of 3D Doppler indices with 2D Doppler ultrasonography demonstrated superior predictive value in diagnosing late-onset FGR compared to other conventional indicators. The 3D Dower index, VFI, has a good true-negative predictive value for both early- and late-onset FGR. [ABSTRACT FROM AUTHOR]

Introduction: It is still no consensus on the use of ropivacaine or bupivacaine in epidural anesthesia for cesarean section (CS), because their anesthetic potency and relative complications remains controversial. This system review and meta-analysis aimed to compare the efficacy of epidural ropivacaine and bupivacaine for elective CSs and investigate relative complications for parturients and neonates. Methods: We searched PubMed, MEDLINE, Embase, Cochrane Library, Science-Direct, and Google Scholar to June 30, 2023 for randomized controlled trials (RCTs), which compared epidural ropivacaine with bupivacaine for elective CSs. The success rate of epidural anesthesia (EA) was primary outcome. The secondary outcomes included onset times of sensory block, maternal side effects, neonatal Apgar scores and umbilical artery pH. Results: We analyzed 8 RCTs with 532 parturients. 0.75% ropivacaine is associated with a shorter onset time of sensory block than 0.5% bupivacaine (SMD = −0.43, 95% CI: −0.70 to −0.17; p =.001). 0.5% ropivacaine resulted in a reduced nausea than 0.5% bupivacaine (RR = 0.49, 95% CI: 0.28 to 0.83; p =.008). In addition, there were no significant difference between ropivacaine and bupivacaine groups in terms of success rate of epidural anesthesia, maternal side effects (hypotension, bradycardia, shivering), and neonatal Apgar scores and umbilical artery pH. Conclusions: The findings suggest that there were no significant difference between epidural ropivacaine and bupivacaine for elective CSs in terms of the success rate (85.9% vs. 83.5), maternal side effects (hypotension, bradycardia, shivering), and neonatal Apgar scores and umbilical artery pH. But compared with 0.5% bupivacaine, epidural 0.75% ropivacaine was mildly effective for reducing onset time of sensory block and 0.5% ropivacaine reduced the incidence of maternal nausea. [ABSTRACT FROM AUTHOR]

Previous studies showed that hyperhomocysteinemia (HHcy) induced endothelial dysfunction by endoplasmic reticulum (ER) stress induction and autophagy stimulation. This study aimed to determine the effect of hydrogen sulfide (H 2 S) in homocysteine (Hcy)-induced endothelial dysfunction and observe the possible mechanism involved. Male Wistar rats (160–180g) were used and randomly divided into four groups: Control group, HHcy group, HHcy+Sodium hydrosulfide (NaHS) group and NaHS group. Rats were fed with 2% high methionine diet for 8 weeks to set up HHcy model. Plasma concentration of Hcy was measured by ELISA. Endothelium-dependent and non-endothelium-dependent vasodilation of rat renal arteries were determined by myograph. The protein expression of cystathionine-γ-lyase (CSE), ER stress- and autophagy-related proteins in renal arteries or human umbilical vein endothelial cells (HUVECs) were analyzed by western blotting. The endothelial function was impaired in HHcy rats and HUVECs. NaHS supplementation could improve the ACh-induced vasodilation, however it was eliminated by ER stress inducer Tunicamycin (TM) or autophagy inducer Rapamycin. Western blotting in renal arteries showed that Glucose-regulated protein 78 (GRP78) and three branches of ER stress (p-IRE1α, p-PERK, ATF6) , p-JNK1+p-JNK2 were downregulated, simultaneously the autophagy marker Beclin1, LC3BII/LC3BI ratio were decreased and p62 was increased with NaHS treatment in HHcy rats. In HUVECs, IRE1α-JNK induced autophagy was involved in HHcy-induced endothelial dysfunction, while NaHS stimulation reversed the protein expression in IRE1α/JNK-autophagy pathway with Hcy incubation. This study might suggest that endothelial dysfunction induced by HHcy might be correlated with IRE1α-JNK-autophagy axis pathway, which was suppressed by exogenous supplementation of H 2 S donor, NaHS. [Display omitted] • High-methionine diet leads to hyperhomocysteinemia (HHcy) with impaired endothelium-dependent relaxation. • IRE1α/JNK-mediated autophagy pathway is involved in endothelial dysfunction induced by HHcy. • Exogenous administration of H 2 S improves HHcy-induced endothelial dysfunction by suppressing IRE1α/JNK-mediated autophagy pathway. • These findings provide experimental basis for exploring new mechanisms and therapeutic targets of endothelial dysfunction. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the physiological variation in common pulsed-wave Doppler (PWD) indices of impedance to determine the number of waveforms to be averaged to minimise variability to 5%. A single-centre, prospective, cross-sectional cohort study of uncomplicated singleton pregnancies at 20–37 week's gestation. From each patient 100 PWD waveforms were acquired including the umbilical artery (UA), middle cerebral artery (MCA) and uterine arteries (UtAs), with 30 waveforms acquired from the ductus venosus. Each waveform was individually measured using the machine's in-built software in automated mode. The variability was assessed using coefficient of variation. The number of waveforms to be averaged was calculated using the moving average and standard error of mean. From a cohort of 200 pregnancies, a total of 189 were analysed. The pulsatility index (PI) demonstrated greater variability compared with the resistance index (RI) in all vessels studied. A minimum of 14 UA and MCA, and 13 UtA PWD waveforms were required to reduce PI variability to 5%, while only 2 RI waveforms were required for UA, 1 for MCA and 8 for UtAs. The variability shown across all PWD indices and between vessels means that PWD indices results should be interpreted cautiously and averaged over multiple waveforms. Consideration should be given to adoption of RI, as it showed greater stability than PI for maternal-fetal Doppler. [ABSTRACT FROM AUTHOR]

Background: Umbilical line migration not only increases the risks of complications but also results in malposition and, ultimately, loss of the umbilical line. Purpose: To evaluate the use of an umbilical line securement bundle to reduce unintended line discontinuation after line adjustment in the neonate at a single 40-bed Level IV neonatal intensive care unit. Methods: A pre-post design of 75 neonates, preimplementation (n = 50) and postimplementation (n = 25), was analyzed using data collection from the electronic health record. Results: There was a 37.5% absolute reduction in removal of the umbilical line due to malposition after line adjustment utilizing the umbilical line bundle, standardizing the adjustment order, nursing process, and follow-up x-ray evaluation. This absolute reduction has clinical significance although not statistically significant. Provider compliance rates with line adjustment order bundle were 75%, decreasing with additional adjustments (50%). Nursing staff reported comfort with umbilical line management, ranging from 63% to 87% on different tasks. Implications for Practice: The use of umbilical line bundles reduces rates of line discontinuation due to malposition. The adoption of umbilical line bundles in neonatal intensive care unit practice may help to prevent unintended line discontinuation. Implications for Research: There is a need for continued research regarding the use of secondary securement devices for decreased rate of malposition and the timing and methods for surveillance of umbilical line position. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The study's aim was to perform serial placental biometry and Doppler assessments in antenatal women and compare the characteristics of preeclampsia (PE) and normal outcome.This prospective cohort study was carried out after ethical clearance. Placental length (PL), thickness, and plavental volume (PV), along with the uterine artery (Ut), middle cerebral artery (MCA), and umbilical artery (UA) blood flow were evaluated serially at 11–14, 20–24, and 28–32 weeks of gestation. The women were followed until delivery, those with PE were considered cases, and those with no other adverse outcome were controls. The placental attributes between cases and controls were compared.A total of 135/1008 (13.4%) had hypertensive disorders of pregnancy (HDP) and 44/1008 (4.4%) had PE, and no maternal or fetal adverse outcomes were seen in 600 (59.5%) women. The PL and PV were significantly less in those with PE (P = 0.005) than in controls. The ratios of PL/Ut A PI and PV/Ut A PI were significantly lower in cases than in controls in all trimesters (P <0.001). In the first trimester, the area under the curve (AUC), sensitivity, and specificity of PV/Ut A PI for PE prediction were 0.801, 81.8%, and 70.5%, respectively. The sensitivity and specificity of the PL/Ut PI ratio was 81.8% and 70.5%, whereas that at 28–32 weeks was 73.3% & 70.7%.Placental parameters were significantly lower in PE than in normal outcome, and the ratios of PL/Ut A PI and PV/Ut A PI proved to be promising markers. [ABSTRACT FROM AUTHOR]

To evaluate the diagnostic value of ultrasound spectra of the middle cerebral artery (MCA) and umbilical artery (UA) blood flow in predicting adverse pregnancy outcomes.Data from 202 late singleton pregnancies (32–34 weeks gestation) were analyzed. Group A included 155 normal pregnancies, while Group B comprised 47 high-risk pregnancies. Color Doppler ultrasonography was used to measure and compare pulsatility index (PI), resistance index (RI), and end-systolic peak/end-diastolic peak (S/D) ratios of fetal MCA and UA between the groups.UA-related parameters (PI, RI, and S/D) were significantly higher in Group B compared to Group A, whereas MCA-related parameters (PI, RI, and S/D) were significantly lower in Group B than in Group A. In pregnancies with adverse outcomes, fetal UtA and UA-related parameters were elevated, while MCA parameters were decreased compared to those with favorable outcomes.Ultrasound spectra of MCA and UA blood flow provide valuable clinical information for assessing fetal intrauterine growth and predicting adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: Fetal growth restriction (FGR) is associated with various perinatal complications. Limited research has focused on the fetal heart in the context of FGR. This study aimed to investigate the application value of fetal heart quantification (HQ) technology in evaluating the size, morphology, and function of the heart in FGR. Methods: A total of 31 fetuses diagnosed with FGR in our hospital from April 2022 to May 2024 were included, alongside another 31 normal fetuses matched for gestational age as the control group. Ultrasound Doppler parameters of the middle cerebral artery (MCA), umbilical artery (UA), venous catheter, and fetal HQ parameters were collected for comparative analysis, and perinatal data were followed up. Results: Fetuses with FGR exhibited significant differences in various parameters of the MCA and UA compared to the control group (P < 0.05). The four-chamber view end-diastolic transverse width, end-diastolic area, left ventricular (LV) end-diastolic area, end-systolic area, end-systolic length, end-diastolic volume, end-systolic volume, and right ventricular (RV) end-systolic area in the FGR group were significantly lower than those in the control group (P < 0.05). In the 24-segment analysis, the LV fractional shortening in the FGR group was greater than in the control group at segments 12 to 14, while the end-diastolic diameter (ED) at segments 5 to 13 of the LV and segments 1 to 14 of the RV were smaller than those in the control group, with statistical significance (P < 0.05). Analysis of each subgroup indicated that fractional shortening (FS) in the early-onset group was significantly greater than in the late-onset group at RV segments 2 to 8. LV-ED at segments 1 to 15 and RV-ED at segments 1 to 16 were significantly smaller in the early-onset group than in the control group, and LV ED segments 20 to 21 were significantly smaller in the early-onset group compared to the late-onset group (P < 0.05). FS in the mild group was significantly larger than in the normal group at LV segments 10 to 16. The severe group exhibited significantly smaller LV segment 2 to 11 ED and the mild group showed smaller RV segments 1 to 13 compared to the control group (P < 0.05). Conclusions: Fetal HQ is a promising technique for evaluating the cardiac function, size, and morphology in cases of FGR. [ABSTRACT FROM AUTHOR]

Background: SCUBE-1 (Signal peptide-CUB (complement C1r/C1s, Uegf, and Bmp1)-EGF (epidermal growth factor)-domain-containing protein 1) is a novel marker of ischemia, which is a cell surface-secreted protein in the platelets and endothelial cells. The aim of the study is to measure serum SCUBE-1 levels and investigate their association with uteroplacental blood flow in patients with preeclampsia. Methods: The study was conducted on patients with preeclampsia. Maternal serum SCUBE1 and IMA levels were the main outcomes. The control group consisted of gestational-age-matched pregnant women. Fetal umbilical artery (UA) pulsatility index (PI), middle cerebral artery PI, cerebroplacental ratio (CPR), and maternal uterine artery (UtA)-PI were also examined, and correlation analysis was performed to reveal the association between maternal serum SCUBE1 levels and Doppler findings. Results: The study group consisted of thirty-two preeclamptic patients, and the control group consisted of thirty-two uncomplicated singleton pregnancies. Maternal serum SCUBE1 and IMA levels were significantly higher in preeclamptic women compared to the control group (p < 0.000, p < 0.004, respectively). Mean UtA-PI values and fetal UA-PI values were significantly higher in preeclamptic pregnant women compared to the control group (p < 0.05, p < 0.05, respectively). However, the average CPR was significantly lower in pregnant women with preeclampsia (p < 0.05). While no significant correlation was found between maternal serum SCUBE1 levels and UA-PI and CPR (p > 0.05, p > 0.05, respectively), a significant correlation was found between right and left UtA-PI (p < 0.004, p < 0.006, respectively). Conclusions: The maternal serum SCUBE1 level is increased in patients with preeclampsia, and this increase is significantly correlated with the maternal uterine artery pulsatility index. [ABSTRACT FROM AUTHOR]

Maternal obesity (MO) is a significant cause of increased cardiometabolic risk in offspring, who present endothelial dysfunction at birth. Alterations in physiologic and cellular redox status are strongly associated with altered gene regulation in arterial endothelium. However, specific mechanisms by which the pro‐oxidant fetal environment in MO could modulate the vascular gene expression and function during the offspring's postnatal life are elusive. We tested if oxidative stress could reprogram the antioxidant‐coding gene's response to a pro‐oxidant challenge through an epigenetic transcriptional memory (ETM) mechanism. A pro‐oxidant double‐hit protocol was applied to human umbilical artery endothelial cells (HUAECs) and EA.hy 926 endothelial cell lines. The ETM acquisition in the HMOX1 gene was analyzed by RT‐qPCR. HMOX1 mRNA decay was evaluated by Actinomycin‐D treatment and RT‐qPCR. To assess the chromatin accessibility and the enrichment of NRF2, RNAP2, and phosphorylation at serin‐5 of RNAP2, at HMOX1 gene regulatory regions, were used DNase HS‐qPCR and ChIP‐qPCR assays, respectively. The CpG methylation pattern at the HMOX1 core promoter was analyzed by DNA bisulfite conversion and Sanger sequencing. Data were analyzed using two‐way ANOVA, and p < 0.05 was statistically significant. Using a pro‐oxidant double‐hit protocol, we found that the Heme Oxygenase gene (HMOX1) presents an ETM response associated with changes in the chromatin structure at the promoter and gene regulatory regions. The ETM response was characterized by a paused‐RNA Polymerase 2 and NRF2 enrichment at the transcription start site and Enhancer 2 of the HMOX1 gene, respectively. Changes in DNA methylation pattern at the HMOX1 promoter were not a hallmark of this oxidative stress‐induced ETM. These data suggest that a pro‐oxidant milieu could trigger an ETM at the vascular level, indicating a potential epigenetic mechanism involved in the increased cardiovascular risk in the offspring of women with obesity. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate the presence of aortic isthmus flow reversal and its associated factors in fetuses with positive and false‐positive coarctation of the aorta (CoA) compared with normal controls. Material and Methods: Pregnant women with fetuses suspected of CoA and normal control were enrolled, and these women experienced prenatal ultrasound scan and followed up for 6 months after birth to confirm the presence of CoA. All the ultrasound parameters were analyzed. Results: A total of 134 pregnant women were enrolled, with 43 CoA‐positive fetuses and 91 CoA false‐positive fetuses, and 334 matched pregnant women were enrolled in the control group. Aortic isthmus flow reversal occurred in 28 (65.1%) fetuses in the CoA‐positive group, significantly (p < 0.05) more than in the false‐positive (37 or 40.7%) or control group (64 or 19.2%). Aortic isthmus flow reversal was mostly in the full systole (n = 17 or 60.7%) or late systole and early‐middle diastole (n = 10 or 35.7%) in the CoA‐positive fetuses (n = 27 or 96.4%), significantly (p < 0.001) different from that in the false‐positive or control group. The aortic isthmus flow reversal peak systolic velocity (PSV), flow volume, and ratio of reversed flow/forward flow were significantly (p < 0.05) increased in the CoA‐positive and false‐positive groups than in the control group. The aortic isthmus flow reversal incidence was significantly (p < 0.05) correlated with the middle cerebral artery (MCA) PSV in the total three groups or in the false‐positive group but was significantly (p < 0001) negatively correlated with the MCA resistance index (RI) in the CoA‐positive group. The incidence of the aortic isthmus flow reversal was significantly (p < 0.05) positively correlated with the umbilical artery (UA) RI in the false‐positive group and with the UA RI in the total three groups. Independently associated factors for aortic isthmus flow reversal were isthmic flow volume/CCO (combined cardiac output) in the CoA‐positive group. Conclusions: Reversal of flow in the aortic isthmus is much more common in true‐positive cases of CoA as compared to controls, and isthmic flow reversal in the full systolic phase only suggests presence of CoA. The aortic isthmic reversed flow volume accounts for over half of the isthmic forward flow volume in the CoA‐positive fetuses than in the normal controls. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to determine the feasibility and interobserver reliability of umbilical cord and placental arteriolar flow assessment in low‐risk pregnancies near term. Methods: This was a prospective pilot study in low‐risk pregnancies at 36 weeks with anterior placentas. We excluded any with an indication for antenatal testing or delivery before 39 weeks. Each participant underwent two ultrasounds by different examiners, which included arterial and venous velocimetry at three cord sites (fetal, free loop, and placental) in addition to maternal and fetal placental arterioles. The interobserver reliability was quantified using the Pearson correlation coefficient with that of standard clinical parameters serving as a benchmark for interpretation. Results: Among 53 participants scanned at 356/7–371/7 weeks, the mean examination duration was 20.5 ± 4.2 minutes. Ascertainment success was high for measures at the free loop, placental cord insertion, and fetal placental arterioles (range 90.6%–99.1%) and was lower at the fetal cord insertion and maternal spiral arterioles (range 47.2%–87.7%). Interobserver reliability estimates for free‐loop systolic/diastolic and pulsatility index ranged from 0.38 to 0.44. Interobserver reliability for experimental parameters varied by measurement site, and all were poor at the fetal insertion and in placental arterioles. Parameters had significant variation across cord sites (range 4.3%–21.7%). Conclusion: In our cohort, flow assessments of the free loop, placental insertion, and placental arterioles are feasible, but interrater reliability varies by measurement type and cord site. Future studies are needed to establish feasibility and reliability in nonanterior placentation and to assess clinical relevance. [ABSTRACT FROM AUTHOR]

Umbilical cord hemangiomas are rare lesions, for which data on pregnancy outcome is lacking. This study combines a multi-institution 4-case series with a systematic literature search (n = 52) to determine possible pathologic lesion parameters which may have an effect on pregnancy outcome. Of all 56 pregnancies, lesion size ranged from 0.2 to 23.0 cm with pregnancy outcomes ranging from healthy liveborns (58.9%), liveborns with severe complications largely due to prematurity and/or fluid overload (12.5%), intrauterine/neonatal demise (25.0%), and pregnancy termination (3.6%). Of the 52 cases included for statistical analysis, there was no significant association between fetal outcome and vascular lesion location (P =.12) or fetal outcome and single umbilical artery involvement versus involvement of other vasculature (P =.29). The mean length of vascular lesions that resulted in healthy liveborns did not significantly differ from those resulting in severe fetal complications and/or demise (P =.72). Cases resulting in severe complications and/or demise were significantly earlier at delivery than those resulting in healthy liveborns (P <.001). Combined findings suggest that functional lesion characteristics, such as the degree of turbulent flow generated, have more significance than size, especially in early gestation losses. Moving forward, standardized reporting of pathologic lesion characteristics is paramount to better predict pregnancy prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Extraction of Doppler-based measurements from feto-placental Doppler images is crucial in identifying vulnerable new-borns prenatally. However, this process is time-consuming, operator dependent, and prone to errors. Methods: To address this, our study introduces an artificial intelligence (AI) enabled workflow for automating feto-placental Doppler measurements from four sites (i.e., Umbilical Artery (UA), Middle Cerebral Artery (MCA), Aortic Isthmus (AoI) and Left Ventricular Inflow and Outflow (LVIO)), involving classification and waveform delineation tasks. Derived from data from a low-and middle-income country, our approach's versatility was tested and validated using a dataset from a high-income country, showcasing its potential for standardized and accurate analysis across varied healthcare settings. Results: The classification of Doppler views was approached through three distinct blocks: (i) a Doppler velocity amplitude-based model with an accuracy of 94%, (ii) two Convolutional Neural Networks (CNN) with accuracies of 89.2% and 67.3%, and (iii) Doppler view- and dataset-dependent confidence models to detect misclassifications with an accuracy higher than 85%. The extraction of Doppler indices utilized Doppler-view dependent CNNs coupled with post-processing techniques. Results yielded a mean absolute percentage error of 6.1 ± 4.9% (n = 682), 1.8 ± 1.5% (n = 1,480), 4.7 ± 4.0% (n = 717), 3.5 ± 3.1% (n = 1,318) for the magnitude location of the systolic peak in LVIO, UA, AoI and MCA views, respectively. Conclusions: The developed models proved to be highly accurate in classifying Doppler views and extracting essential measurements from Doppler images. The integration of this AI-enabled workflow holds significant promise in reducing the manual workload and enhancing the efficiency of feto-placental Doppler image analysis, even for non-trained readers. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders of pregnancy (HDP) are associated with placental insufficiency and adverse perinatal outcomes—over half (58.9%) of women with HDP at Mbarara Regional Referral Hospital (MRRH) have adverse perinatal outcomes. The cerebroplacental ratio (CPR) is an important predictor and prevents approximately 30% of these adverse perinatal outcomes. We determined the prevalence and factors associated with abnormal CPR among women with HDP at MRRH. Methods: We conducted a cross‐sectional study from December 2022 to May 2023 at the high‐risk obstetrics unit of MRRH. We consecutively enrolled all women with hypertensive disorders and gestational ages ≥ 26 weeks and performed obstetric Doppler studies to document the pulsatility index (PI) of the umbilical artery (UA) and middle cerebral artery (MCA) and then calculated the CPR as a ratio of the MCA‐PI and UA‐PI. The prevalence of women with an abnormal CPR ≤ 1.0 was expressed as a percentage. We used robust modified Poisson regression analysis to determine the factors associated with abnormal CPR. Results: We enrolled 128 women with hypertensive disorders in pregnancy, with a mean age of 28.8 ± 6.3 years. Of these, 67 (52.3%) had abnormal CPR. The factors associated with abnormal CPR were severe pre‐eclampsia (adjusted prevalence ratio (aPR): 5.0, 95% CI: 1.28, 29.14) and eclampsia (aPR: 5.27, 95% CI: 1.11, 34.27). Conclusion: On average, half of the women with hypertensive disorders have abnormal CPR. Women with severe pre‐eclampsia or eclampsia are more likely to have abnormal CPR. Obstetric Doppler studies with CPR may be warranted for all pregnant women with severe pre‐eclampsia and eclampsia. We recommend further research to assess perinatal outcomes among those with and without abnormal CPR to profile women with HDP at increased risk of adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: The present study investigated the association between fetal renal artery Doppler flow, hourly urine output, and amniotic fluid volume in fetuses with a gestational age of 30 to 34 weeks in normal pregnancies. Methods: This cross-sectional study was conducted on 95 eligible pregnant women referred for their routine thirdtrimester care from March 2022 to March 2023. Each fetus's amniotic fluid volume, kidney size, and hourly urine output were recorded in resistance (RI) and plausibility (PI) indexes of the umbilical and renal arteries. The hourly urine production was calculated by considering bladder volume differences at a 30-minute duration. Results: With gestational age increasing, amniotic fluid volume (p-value=0.005) and the hourly urine output (pvalue=0.005) increased significantly. RI of umbilical (p-value=0.022), right (p-value<0.001), and left (p-value=0.001) renal arteries and PI of right (p-value=0.042) and left (p-value=0.001) renal arteries decreased significantly through the pregnancy. There was a negative linear association between RI and PI of the renal arteries with hourly urine output. The results showed that the mean of renal artery Doppler indices, including right and left RI (0.87 ± 0.08 vs. 0.88 ± 0.07, p-value=0.274) and right and left PI (2.52 ± 0.59 vs. 2.56 ± 0.64, p-value=0.614) was similar in both sides. In adjusted linear regression analysis, two variables of gestational age and renal artery RI were (p-value<0.001) significantly associated with hourly urine output. Conclusion: The fetus's renal artery Doppler findings and urine outputs seem to represent fetal renal function, warning the physicians about post-natal evaluation after birth. [ABSTRACT FROM AUTHOR]

Objective: - To study CP ratio & its correlation with feto -maternal outcome. Methods: - This was a prospective observational study done in Department of Obstetrics and Gynaecology, MGM Medical college, Indore, over a period of one year. Women > 37-week singleton pregnancy with no known risk factor who had Doppler USG done at the time of labor were included. CPR was calculated by dividing the Doppler indices of middle cerebral artery (MCA) by umbilical artery (MCA PI/UA PI). CPR < 1 was taken as abnormal. Results: - Out of 150 low risk term pregnancy who went for USG colour doppler Scan, 14 (9%) patients were having CPR <1 and 136 (90.6%) were having CPR >1. Among 14 patient with CPR <1, 10 (71%) were delivered by caesarean section as compared to only 6 (4.41%) patients with CPR >1. Among 14 patient with CPR <1,13 (92.86%) had adverse outcome as compared to only 11.76% patients with CPR >1. Conclusion: - Our study found CPR measure to be a very promising tool for optimising the identifcation of at-risk foetus in low-risk AGA pregnancies. [ABSTRACT FROM AUTHOR]

Background: Routine Doppler study is a common tool for early diagnosis of Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA) patients. It aimed to determine the role of the Foramen Ovale Pulsatility Index (FOPI) study beside routine Doppler study among patients with FGR and SGA fetuses. Methods: This prospective study was conducted on 35 FGR, 32 SGA, and 33 Appropriate for Gestational Age (AGA) fetuses. Demographic data, amniotic fluid index, neonatal outcome, and Doppler velocimetry, including Umbilical Artery Pulsatility Index (UMAPI), Uterine Artery Pulsatility Index (UTAPI), Middle Cerebral Artery Pulsatility Index (MCAPI), Ductus Venosus Pulsatility Index (DVPI), and FOPI were documented. Kolmogorov-Smirnov normality test, one-way ANOVA, Mann-Whitney U, Kruskal-Wallis, non-parametric pairwise comparisons adjusted for Bonferroni correction, Pearson correlation test, Chi square, Fisher's exact test, and Receiver Operating Characteristic Curve (ROC) analysis with Youden's Index (sensitivity+specificity-1) to estimate cut-off point were used to analyze the data at significance level <0.05 for all tests. Results: FOPI cut-off points were 2.24 (sensitivity=77%, specificity=94%) and 1.15 (sensitivity=90%, specificity=20%) to predict FGR and SGA, respectively. FOPI showed a positive correlation with UMAPI and UTAPI (r=0.52 and r=0.30, P<0.001 and P=0.006, respectively), but not with MCAPI and DVPI (r=0.08 and r=0.12, P=0.50 and P=0.30, respectively). Besides, UMAPI, UTAPI, and FOPI were altered among patients with stages I and II FGR. Umbilical cord potential hydrogen (umbilical cord pH), 1- and 5-min Apgar score significantly increased by Birth weight centile; however, UMAPI, FOPI, and UTAPI significantly decreased. Conclusion: UMAPI is recommended to predict short-term neonatal morbidities and demonstrate the early or late onset FGR. Besides, FOPI is suggested as the first-line Doppler study to detect abnormal growth velocity. More studies are warranted, especially considering long-term neonatal morbidities. [ABSTRACT FROM AUTHOR]

Objective: This study will evaluate whether fetal cerebroplacental ratio (CPR) can predict perinatal adverse outcomes in singleton pregnancies with mild and moderate idiopathic polyhydramnios (IP). Method: This study was designed as a prospective case–control study between January 2023 and November 2023. Pregnant women diagnosed with mild‐to‐moderate IP and low‐risk singleton pregnancies were included in the study. In all cases, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PIs) were measured at 36–40 weeks of gestation, and CPR was calculated. The group with polyhydramnios was divided into two parts according to whether the CPR value was below 1.08 or 1.08 and above. Perinatal outcomes of all groups were compared. Results: A total of 140 patients were included in the study. Seventy of these were IP cases, and 70 were low‐risk pregnant women. UA PI in the IP group was not statistically different from that in the low‐risk group, but MCA PI and CPR were significantly lower in the IP group (P = 0.07, P = 0.001, and P = 0.004, respectively). IP cases were divided into a low group (<1.08, n = 18) and a normal group (≥1.08, n = 52) according to the CPR value. Cesarean section rates due to fetal distress were significantly higher in the low‐CPR group (n = 8 [44.4%] vs 5 [9.6%], P = 0.001). In the low‐CPR group, 5‐min Apgar <7, and neonatal intensive care unit (NICU) admission rates were significantly higher (P = 0.045 and P = 0.001, respectively). Conclusion: It is encouraging that in cases with mild‐to‐moderate IP, low CPR predicts emergency delivery due to fetal distress, a low Apgar score at 5 min, and NICU admission. Synopsis: In pregnant women with IP, low CPR predicts emergency delivery due to fetal distress, low Apgar score at 5 min, and admission to the NICU. [ABSTRACT FROM AUTHOR]

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common morbidities of pregnancy. The impact of increased maternal blood glucose on fetoplacental hemodynamics is not fully elucidated, especially in patients with uncontrolled GDM necessitating insulin therapy. The objective of this study was to assess the impact of insulin therapy on the umbilical artery dopplers in GDM pregnancies adequate for gestational-age fetuses. Methods: Retrospective observational study among 447 GDM pregnant women, divided according to their treatment (nutritional therapy (NT), long acting (LA) insulin, combined insulin) and 100 healthy controls with the same gestational age. The umbilical artery pulsatility index (UA-PI) was recorded at 28, 32 and 36 weeks. Results: UA-PI values declined in both GDM and healthy controls at all three time intervals. The combined insulin group showed reduced UA-PI values in comparison to the LA insulin group, but the difference never reached statistical significance. The combined insulin group exhibited significantly reduced UA-PI values at 32- and 36-weeks' gestation compared to the NT groups. Conclusions: A decreased impedance to blood flow in the umbilical artery of diabetic mothers on insulin therapy was observed. This was more pronounced during the last trimester. The extent to which umbilical artery PI can predict unfavorable outcomes has yet to be determined. Further additional studies are necessary to confirm the precise impact of glucose levels and medical interventions on the circulation of both the fetus and the mother. [ABSTRACT FROM AUTHOR]

Background: Routine Doppler study is a common tool for early diagnosis of Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA) patients. It aimed to determine the role of the Foramen Ovale Pulsatility Index (FOPI) study beside routine Doppler study among patients with FGR and SGA fetuses.Methods: This prospective study was conducted on 35 FGR, 32 SGA, and 33 Appropriate for Gestational Age (AGA) fetuses. Demographic data, amniotic fluid index, neonatal outcome, and Doppler velocimetry, including Umbilical Artery Pulsatility Index (UMAPI), Uterine Artery Pulsatility Index (UTAPI), Middle Cerebral Artery Pulsatility Index (MCAPI), Ductus Venosus Pulsatility Index (DVPI), and FOPI were documented. Kolmogorov-Smirnov normality test, one-way ANOVA, Mann-Whitney U, Kruskal-Wallis, non-parametric pairwise comparisons adjusted for Bonferroni correction, Pearson correlation test, Chi square, Fisher’s exact test, and Receiver Operating Characteristic Curve (ROC) analysis with Youden’s Index (sensitivity+specificity-1) to estimate cut-off point were used to analyze the data at significance level

Objectives: This study aimed to compare plasma concentrations of anesthetic drugs administered during Cesarean section with low Apgar score in neonates deliveried under general anesthesia and analyze associated risk factors. Methods: Data from 76 neonates undergoing Cesarean section under general anesthesia with blood concentrations of anesthetic drugs were analyzed. A low Apgar score was defined as ≤ 7. Perioperative maternal and neonatal data were collected and analyzed. Neonates were divided into a control group (Group CON, n = 65) and a low Apgar score group (Group LAS, n = 11) based on Apgar score. Results: There were no significant differences in the plasma concentrations of anesthetic drugs in maternal artery, umbilical vein or umbilical artery blood between the two groups. Risk factors for neonatal low Apgar scores during Cesarean section under general anesthesia were premature delivery (aOR 10.2, 95% CI = 1.8–56.9) and preoperative fetal distress (aOR 9.6, 95% CI = 1.3–69.0). The prediction model was: probability = 1/(e‑Y), Y= -4.607 + 2.318× (premature delivery) + 2.261× (fetal distress) (yes = 1, no = 0). The Hosmer–Lemeshow test showed χ²= 9.587, P = 0.213, and the area under the curve (AUC) was 0.850 (0.670 ~ 1.000). With a cutoff value of 0.695, sensitivity and specificity were 81.8% and 87.7%, respectively. Conclusions: There was no correlation between blood concentration of general anesthetic drugs and Apgar score or occurrence of neonatal low Apgar scores. Premature delivery and preoperative fetal distress were identified as independent risk factors for neonatal low Apgar scores after Cesarean section under general anesthesia. [ABSTRACT FROM AUTHOR]

A 35‐year‐old woman (gravida 1, para 0) was admitted to our hospital at 28 weeks' gestation with vaginal bleeding from placenta previa. Severe fetal bradycardia was observed during fetal heart rate monitoring. Ultrasonography showed widely dilated veins on the fetal surface of the placenta and an extraordinarily low umbilical artery peak systolic velocity in the Doppler study. Umbilical cord torsion was suspected. On the subsequent day, we performed a cesarean section due to worsening fetal heart rate patterns. Umbilical artery blood gas analysis indicated severe acidemia (pH 7.063), and umbilical cord torsion was confirmed at the placental cord insertion site. Diagnosing UCT prenatally is challenging; however, it can be suspected by scanning for the widely dilated veins on the fetal placental surface, termed as the "Sunset Sign," an abnormally low umbilical artery peak systolic velocity, and other fetal Doppler abnormalities. [ABSTRACT FROM AUTHOR]

Umbilical vascular thromboembolism is a rare condition that can lead to serious consequences such as fetal hypoxia, fetal growth restriction, and even stillbirth. However, there is currently a lack of research on the pathology, pathogenesis, clinical management, and prognosis of this condition. Therefore, the purpose of this article is to analyze this condition's high-risk factors, clinical characteristics, pregnancy management, and discuss its corresponding pregnancy outcomes. Databases such as PubMed are searched using the relevant keywords of umbilical vascular thromboembolism in worldwide. And related information is analyzed such as maternal risk factors, fetal risk factors, umbilical cord and placental risk factors, and pregnancy outcomes. The literature search yields 113 articles, 64 of which meet the inclusion criteria for umbilical vascular thromboembolism. There are 4 retrospective cohort studies and 8 case series, the rest are all case reports. A total of 262 cases of umbilical vascular thromboembolism are found. The most common maternal complications and fetal related risk factors are diabetes (25 cases, 9.5%) and stillbirths (106 cases, 40.5%), respectively. Among these 262 cases, 98 (37.4%) cases are found by prenatal ultrasound to have umbilical vascular thromboembolism and the fetus is in a viable state with complete clinical information. In addition, considering the effectiveness and safety of low molecular weight heparin in thromboembolic conditions, twenty-four patients of umbilical artery thromboembolism attempted to use low molecular weight heparin during observation. Maternal diabetes was the highest risk factor for this condition. When umbilical artery thromboembolism occurs, the incidence of stillbirth increases. Premature patients with this condition can continue their pregnancy under close external monitoring. However, due to the small sample size, further research is needed. [ABSTRACT FROM AUTHOR]

Introduction: This study evaluated fetal pancreas size and echogenicity, and splenic artery (SA) waveforms in pregnant women with gestational diabetes mellitus (GDM). Methods: This prospective case-control study was performed from October 2022 to November 2023 and included 124 pregnant women (62 with GDM and 62 controls). Pancreatic circumference, pancreatic echogenicity, umbilical artery Doppler measurements (systolic/diastolic ratio [S/D] and pulsatility index [PI]), SA Doppler measurements (S/D, PI, peak systolic velocity [PSV], time-averaged maximum velocity, and pressure gradient [PG] mean and maximum) values were compared between the GDM and control groups. Results: The mean pancreatic circumference was higher and grade 2/3 echogenicity was more common in the GDM group, while grade 1 echogenicity was more common in the control group (p < 0.001 and p < 0.001, respectively). SA S/D and PI measurements were significantly higher in the GDM group than in the control group (p < 0.001 and p = 0.001, respectively). Moreover, PGmax was significantly higher in the GDM group than in the control group (p = 0.038). Pancreatic circumference was positively correlated with SA PSV (p = 0.004). Additionally, pancreatic circumference was positively correlated with PGmean and PGmax (p = 0.010 and p = 0.016, respectively). The increase in pancreas echogenicity was positively correlated with SA S/D and PI measurements (p = 0.007 and p = 0.002, respectively). PGmax was also positively correlated with increased pancreas echogenicity (p = 0.023). Conclusion: This study showed that fetal pancreas size and echogenicity were significantly higher in pregnant women with GDM than in controls. SA Doppler waveforms were consistent with an increase in vascular resistance associated with elevations of both S/D and PI in the GDM group. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a cohort of fetuses with congenital heart disease (CHD) who underwent serial umbilical artery (UA) Doppler surveillance and assess perinatal outcome according to UA Doppler assessment. Methods: A retrospective cohort study of singleton fetuses with CHD at a single academic center was performed between 2018 and 2020. Fetuses with a chromosomal abnormality or growth restriction were excluded. We compared fetuses with normal versus abnormal UA Doppler assessment at any time in pregnancy. Abnormal UA Doppler assessment was defined as decreased end diastolic flow, determined by an elevated systolic/diastolic ratio >95th percentile for gestational age, or absent/reversed end diastolic flow. Logistic regression assessed the odds of fetuses with CHD and abnormal UA Doppler assessment having a composite adverse perinatal (defined as fetal, neonatal, or infant death), adjusting for relevant covariates. Results: We identified a cohort of 171 fetuses with CHD that met inclusion criteria. Of these, 154 (90%) had normal UA Doppler assessment and 17 (10%) had abnormal UA Doppler assessment throughout pregnancy. Maternal characteristics did not differ between groups except for maternal race and history of preeclampsia. There was no statistically significant difference in primary outcome between groups [14% (21/154) of fetuses with normal UA Doppler assessment had an adverse perinatal outcome compared to 24% (4/17) of those with abnormal UA Doppler assessment, p = 0.28]. Conclusion: UA Doppler assessment is unlikely to predict adverse perinatal outcome in normally grown, euploid singleton fetuses with CHD. [ABSTRACT FROM AUTHOR]

Objective: To evaluate twin survival stratified by Quintero stage in patients with twin‐to‐twin transfusion syndrome (TTTS) after Solomon laser treatment. Methods: This was a single‐center study at Johns Hopkins Center for Fetal Therapy, investigating a cohort of consecutive twin pregnancies treated with the Solomon laser technique for TTTS. Preoperative Quintero stage, perioperative characteristics and obstetric factors were investigated in relation to neonatal survival of the recipient and donor twins at discharge. Determinants of twin survival were evaluated using univariate logistic regression and cumulative survival probability analyses. Results: Of 402 pregnancies with TTTS that underwent Solomon laser treatment, 80 (19.9%) were diagnosed with Quintero Stage‐I TTTS, 126 (31.3%) with Stage II, 169 (42.0%) with Stage III and 27 (6.7%) with Stage IV. Post‐laser twin anemia polycythemia sequence or recurrent TTTS occurred in 19 (4.7%) patients and 11 (2.7%) required repeat laser surgery. Preterm prelabor rupture of membranes occurred in 150 (37.3%) patients and median gestational age at delivery was 32 + 1 weeks. In 303 (75.4%) patients, both twins were alive at discharge; 67/80 (83.8%) were Stage I, 101/126 (80.2%) were Stage II, 113/169 (66.9%) were Stage III and 22/27 (81.5%) were Stage IV (P = 0.062). Donor twin survival was lower than that of recipients in cases with Stage‐III TTTS (118/169 (69.8%) vs 145/169 (85.8%) (χ2 = 26.076, P < 0.0001)). Higher intertwin size discordance and absent or reversed umbilical artery (UA) end‐diastolic velocity (EDV) were associated with donor demise (Nagelkerke R2, 0.38; P < 0.001). Overall, spontaneous post‐laser donor demise occurred in 53 (39.6%) patients, accounting for the majority of all losses. Cumulative donor survival decreased from 92% to 65% when intertwin size discordance was >30% and to 48% when UA‐EDV was absent or reversed (P < 0.001). Conclusions: The Solomon laser technique achieves TTTS resolution and double twin survival in a high proportion of cases. Recipient and donor survival is comparable unless there is significant intertwin size discordance and placental dysfunction. This degree of unequal placental sharing, typically found in Stage‐III TTTS, is the primary factor preventing double survival due to a higher rate of donor demise. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

• MVFI can display the real-time perfusion status of fetal microvessels, including blood flow velocity, volume, and other related parameters. This technology is a non-invasive method that can be used to evaluate the blood flow situation in the fetal cranial region. • Growth restricted fetuses have lower biparietal diameter, head circumference, abdominal circumference, and femur length than normal fetuses, and their microvascular index and peak systolic velocity of internal arteries are also lower than normal fetuses. • The larger the microvascular index and peak systolic velocity of the internal artery, the more severe the fetal growth restriction. The study conducted retrospective analysis design, aiming to explore the use of Microvascular Imaging Technique (MVFI) to assess fetal cerebral microcirculation and analyze the relationship between Microvascular Index (MVI) and fetal growth and development. 100 pregnant women who met the criteria for fetal growth restriction (FGR) provided in the Expert Consensus on Fetal Growth Restriction (2019 Edition) and underwent routine prenatal examinations at the Obstetrics and Gynecology Department of Peking University Third Hospital from January 2021 to June 2023 were selected as the study subjects. A normal fetus with a fetal weight less than 10 % can be classified as FGR, Pregnant women with fetal umbilical artery (UA) systolic and diastolic (S/D) values ≥3 were included in the observation group, while 200 pregnant women with normal fetuses were selected as the control group during the same period. The fetuses' change in both groups were measured using color Doppler ultrasound, including bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). The cerebral microcirculation of the fetuses in both groups was evaluated using MVFI, and the MVI values were compared. The clinical characteristics of FGR fetuses with umbilical artery S/D ratio ≥ 3 were summarized, and the correlation between fetal cerebral microvascular status and fetal growth and development was analyzed using Pearson correlation analysis. The outcomes told that the BPD, HC, AC, and FL values of the fetuses in the control group were lower the other's value (P < 0.05), and the MVI and peak systolic velocity of the middle cerebral artery (MCA-PSV) values were also lower in the control group (P < 0.05). Pearson correlation analysis revealed a positive correlation between fetal growth and development and MVI and MCA-PSV values in FGR fetuses. In conclusion, MVFI can monitor and quantitatively analyze fetal intracranial microcirculation, visualize slow blood flow in microvascular structures, and this study provides preliminary evidence of the close relationship between fetal cerebral microcirculation and intrauterine growth and development. [ABSTRACT FROM AUTHOR]

Authors have expressed reservations regarding the use of base deficit measured in umbilical artery blood samples to assess fetal well-being during the course of labor and to predict neonatal neurologic morbidity. Despite its integration into clinical practice for more than 50 years, obstetricians and maternal-fetal medicine specialists may not realize that this marker has significant limitations in accurately identifying neonatal metabolic acidosis as a proxy for fetal well-being. In brief, there are 2 large families of base deficit, namely whole blood and extracellular fluid. Both rely on equations that use normal adult acid-base characteristics (pH 7.40 and partial CO 2 pressure of 40 mm Hg) that overlook the specificity of the normal in utero acid-base status of pH 7.27 and partial CO 2 pressure of 54 mm Hg. In addition, it ignores the unique characteristic of the in utero fetal response to acute hypoxia. The dependence on placental circulation for CO 2 elimination may lead to extremely high values (up to 130 to 150 mm Hg) during hypoxic events, a phenomenon that is absent in adults with acute metabolic acidosis who can hyperventilate. The dispute over if to include a correction for high partial CO 2 pressure in the bicarbonate estimation, as presented in the Great Trans-Atlantic Debates, remains unresolved. The key constants computed for adult acid-base physiology in the current base deficit algorithms, without accounting for the impact of high partial CO 2 pressure or other fetal characteristics of buffering capacity (eg, differences in body water content composition, plasma protein, and hemoglobin attributes), may lead to an overestimation of metabolic acidosis, especially in newborns who are experiencing hypercarbia during the early stages of the hypoxic response. These unrecognized limitations impact the base deficit results and may mislead clinicians on fetal well-being assessments when discussing the management of fetal heart rate monitoring and neonatal outcomes. Based on our arguments, we believe that it is prudent to consider an alternative to base deficit for drawing conclusions regarding fetal well-being during the course of birth management. We propose a marker specifically related to the newborn acid-base physiology––the neonatal eucapnic pH correction. This marker can be added to arterial cord blood gas analysis, and we have described how to interpret it as a marker of neonatal metabolic acidosis. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the umbilical cord blood chondroitin sulfate proteoglycan 4 (CSPG4) concentrations in pregnancies complicated with fetal growth restriction (FGR) and aimed to investigate the relationship between the CSPG4 levels in these pregnancies and adverse neonatal outcomes. Methods: This prospective case-control study was conducted between August 2023 and January 2024. The study included 80 singleton pregnancies at 35 to 39 weeks of gestation. Among these, 40 were diagnosed with FGR and 40 served as the control group. After the delivery, samples of the cord blood were collected prior to the placental delivery. Results: The CSPG4 levels were significantly higher in the study group (FGR), 1,153 (1,059 - 1,261) pg/mL, than in the control group, 1,107 (873 - 1,197) pg/mL (p = 0.024). When all patients were evaluated, the CSPG4 levels showed a positive correlation with the systolic/diastolic (S/D) ratio of the umbilical arteries (r = 0.276, p = 0.013). A statistically significant negative correlation was observed between the levels of CSPG4 in the umbilical cord blood and the Apgar scores at the 1st (r = -0.256, p = 0.022) and 5th (r = -0.250, p = 0.026) minutes. The discriminatory power of the umbilical cord CSPG4 level in the determination of composite adverse neonatal outcomes was evaluated by ROC analysis and a cutoff point of > 1,091.25 pg/mL, showing a sensitivity of 93.3%, a specificity of 46.2%, and an AUC of 0.661 (95% CI: 0.547 - 0.763, p = 0.019). Conclusions: Elevated levels of CSPG4 have been observed in the umbilical cord blood in pregnancies complicated by FGR; higher levels are associated with adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

Aim: Is there a change in the circulatory system in fetuses with renal disease in the prenatal period to make hemodynamic assessments. In addition, fetal cardiac functions in the same patients will be studied in detail using fetal echocardiography. Material and Method: Thirty-one fetuses with renal disease were included in the study; 4 with polycystic kidneys, 4 with bilateral hydronephrosis, 12 with unilateral hydronephrosis, and 28 with pelvicalyceal ectasia. In the control group, there were 30 fetuses of the same gestational week without renal disease. The circulatory system and hemodynamic status were examined in detail by fetal echocardiography in both groups. Results: High umbilical artery pulsatility index (PI) values were observed in 2 fetuses with bilateral hydronephrosis and 2 fetuses with unilateral hydronephrosis. The PI values of the middle cerebral artery were high in 2 fetuses with bilateral hydronephrosis and 2 cases with isolated pelvicalyceal ectasia. When the right and left myocardial performance index values of fetuses with renal disease were compared with normal fetuses, no significant results were observed, but the tricuspid valve pulse Doppler was abnormal in fetuses with fetal kidney disease. In addition, the right spherical index was higher in fetuses with renal disease than in the control group. Conclusion: Although there is no functional change, morphologic findings of right ventricular overload can be observed in fetuses with fetal renal disease. [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the association between arterial and venous Doppler ultrasound parameters and the risk of secondary cesarean delivery for intrapartum fetal compromise (IFC) and neonatal acidosis in small-for-gestational-age (SGA) fetuses. Methods: This single-center, prospective, blinded, cohort study included singleton pregnancies with an estimated fetal weight (EFW) < 10th centile above 36 gestational weeks. Upon study inclusion, all women underwent Doppler ultrasound, including umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, fetal aortic isthmus (AoI) PI, umbilical vein blood flow (UVBF), and modified myocardial performance index (mod-MPI). Primary outcome was defined as secondary cesarean section due to IFC. Results: In total, 87 SGA pregnancies were included, 16% of which required a cesarean section for IFC. Those fetuses revealed lower UVBF corrected for abdominal circumference (AC) (5.2 (4.5–6.3) vs 7.2 (5.5–8.3), p = 0.001). There was no difference when comparing AoI PI, UA PI, ACM PI, or mod-MPI. No association was found for neonatal acidosis. After multivariate logistic regression, UVBF/AC remained independently associated with cesarean section due to IFC (aOR 0.61 [0.37; 0.91], p = 0.03) and yielded an area under the curve (AUC) of 0.78 (95% CI, 0.67–0.89). A cut-off value set at the 50th centile of UVBF/AC reached a sensitivity of 86% and specificity of 58% for the occurrence of cesarean section due to IFC (OR 8.1; 95% CI, 1.7–37.8, p = 0.003). Conclusion: Low levels of umbilical vein blood flow (UVBF/AC) were associated with an increased risk among SGA fetuses to be delivered by cesarean section for IFC. [ABSTRACT FROM AUTHOR]

Background: This systematic review and meta-analysis aimed to compare the effects of using phenylephrine or norepinephrine on the pH and base excess (BE) of the umbilical artery and vein in parturients undergoing cesarean section. Methods: The study protocol was registered in INPLASY. Independent researchers searched Ovid-Medline, Ovid-EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases and Google Scholar for relevant randomized controlled trials (RCTs). The primary outcome of this study was the umbilical artery (UA) or umbilical vein (UV) pH as neonatal condition at birth, and the secondary outcome was the UA or UV BE as an additional prognostic value over the measurement of umbilical pH. Results: There was no evidence of a difference between phenylephrine and norepinephrine for overall, UA, and UV pH (mean difference (MD) −0.001, 95% confidence interval (CI) −0.004 to 0.007; MD 0.000, 95%CI −0.004 to 0.004; and MD 0.002, 95%CI −0.013 to 0.017). There was also no evidence of a difference between phenylephrine and norepinephrine for overall, UA, and UV BE (MD 0.096, 95% CI −0.258 to 0.451; MD 0.076, 95%CI −0.141 to 0.294; and MD 0.121, 95%CI; −0.569 to 0.811). A meta-regression showed that factors such as umbilical artery or vein, infusion method, single or twin, and the number of parturients per study had no effect on the UA pH, UV pH, UA BE, or UV BE. No evidence of publication bias was detected. Conclusions: There was no evidence of a difference between phenylephrine and norepinephrine for umbilical pH and BE. A subgroup analysis and meta-regression also did not show evidence of differences. [ABSTRACT FROM AUTHOR]

Catheter-based interventions are relatively rare in the neonate population but serve as an invaluable tool in managing many pathologies. Here we present a case report of a neonate with a vascular hepatic tumor managed by embolization via transumbilical access. In neonates, the small size of the common femoral artery makes cannulation difficult and is thought to increase the risk of catheter-associated thrombosis and ischemia. Often, these patients reside in the neonatal intensive care unit (NICU) and already have an umbilical artery catheter (UAC) in place, which can be used as an effective alternative route of vascular access to carry out life-saving interventions. [ABSTRACT FROM AUTHOR]

Objective: Fetoscopic closure of spina bifida using heated and humidified carbon dioxide gas (hhCO2) has been associated with lower maternal morbidity compared with open closure. Fetal cardiovascular changes during these surgical interventions are poorly defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR) < 110 bpm for 10 min) and changes in umbilical artery (UA) Doppler parameters during open vs fetoscopic closure. Methods: This was a prospective cohort study of 22 open and 46 fetoscopic consecutive in‐utero closures conducted between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and UA Doppler velocimetry were obtained systematically during preoperative assessment, every 5 min during the intraoperative period, and during the postoperative assessment. FHR, UA pulsatility index (PI) and UA end‐diastolic flow (EDF) were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocity was measured in the fetoscopic cohort. At each timepoint at which FHR was recorded, maternal heart rate and systolic and diastolic blood pressure were measured. Results: Fetal bradycardia occurred in 4/22 (18.2%) cases of open closure and 21/46 (45.7%) cases of fetoscopic closure (P = 0.03). FHR decreased gradually in both cohorts after administration of general anesthesia and decreased further during surgery. FHR was significantly lower during hour 2 of surgery in the fetoscopic‐repair cohort compared with the open‐repair cohort. The change in FHR from baseline in the final stage of fetal surgery was significantly more pronounced in the fetoscopic‐repair cohort compared with the open‐repair cohort (mean, −32.4 (95% CI, −35.7 to −29.1) bpm vs −23.5 (95% CI, −28.1 to −18.8) bpm; P = 0.002). Abnormal UA‐EDF (defined as absent or reversed EDF) occurred in 3/22 (13.6%) cases in the open‐repair cohort and 23/46 (50.0%) cases in the fetoscopic‐repair cohort (P = 0.004). There were no differences in UA‐EDF or UA‐PI between closure techniques at the individual stages of assessment. Conclusions: We observed a decrease in FHR and abnormalities in UA Doppler parameters during both open and fetoscopic spina bifida closure. Fetal bradycardia was more prominent during fetoscopic closure following hhCO2 insufflation, but FHR recovered after cessation of hhCO2. Changes in FHR and UA Doppler parameters during in‐utero spina bifida closure were transient, no cases required emergency delivery and no fetoscopic closure was converted to open closure. These observations should inform algorithms for the perioperative management of fetal bradycardia associated with in‐utero spina bifida closure. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Rychik. Click here to view the Editorial. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of abnormal cerebroplacental ratio (CPR) and predicting values for adverse perinatal outcomes in uncomplicated full-term pregnancies. Materials and Methods: This prospective cross-sectional study was conducted at Bhumibol Adulyadej Hospital, Royal Thai Air Force, Thailand between July and December 2023. The study population comprised pregnant women between the ages 18 and 45 presenting uncomplicated full-term pregnancies. Transabdominal ultrasonography in Doppler color mode was performed on all participants. Umbilical artery pulsatility index (UAPI) and middle cerebral artery pulsatility index (MCAPI) were both measured. CPR was calculated by MCAPI divided by UAPI. A CPR value was considered low if it was less than 1.03. Obstetric and perinatal outcomes were recorded including route of delivery, gestational age (GA) at delivery, obstetric complications, Apgar score, neonatal birth weight, neonatal intensive care unit (NICU) admission, and fetal non-reassuring tracing (FNR). Results: A total of 250 pregnant women were recruited. The mean maternal age and GA was 27.7 years, 39.6 weeks, respectively. Low CPR prevalence was recorded at 16.4 percent. There were 41 and 209 cases in low (<1.03) and normal (≥1.03) CPR groups, respectively. UAPI and MCAPI of the normal/low CPR group were 0.8/1.3 and 1.1/0.9 with statistical significance. CPR for predicted value of FNR (1.03) gave sensitivity, specificity, PPV, and NPV at 95.5, 91.2, 51.2 and 99.5 percent, respectively. This study presented no adverse perinatal outcomes. Conclusion: Low CPR prevalence was 16.4 percent. Normal CPR values measured within a week before birth was a good indicator of normal perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Currently, no normal ultrasound data of the fetuses during the 20–40 gestation have been obtained for references of fetal growth and development. If such ultrasound data existed for prenatal diagnosis of possible diseases and abnormalities, neonates would be able to get timely treatment immediately after birth. This study was thus performed to obtain ultrasound parameters of normal fetuses during the 20–40 week gestation and the distribution of ultrasound parameters with the gestational age for references of detecting potential fetal diseases and abnormalities. Methods: Normal fetuses without any abnormalities were enrolled, and the ultrasound parameters of the general biology, arteries, and aorta were measured and analyzed. Results: 417 normal fetuses were enrolled. A significant (P < 0.05) negative correlation with the gestational age was detected in the peak systolic velocity/peak diastolic velocity (S/D), pulsatility index (PI) and resistance index (RI) of the umbilical artery (UA). A relatively stable relationship with the gestational age was detected in the fetal weight%, S/D, PI and RI of the middle cerebral artery (MCA), peak systolic velocity (PSV) and velocity time integral (VTI) of the intra-abdominal UA, fetal heart to chest ratio, mitral valve (MV)- and tricuspid valve (TV)-E/A peak flow velocity, aortic isthmic Z-score and displacement, distance between the brachiocephalic artery-left common carotid artery (BA-LCCA) and LCCA-left subclavian artery (LSA), Z-score of aorta, ascending aorta (AAO), pulmonary artery (PA), main pulmonary artery (MPA), and descending aorta (DAO). A significant (P < 0.05) positive correlation with the gestational age was detected in the fetal biological data, MCA PSV and VTI, free-UA PSV and VTI and cardio-thoracic ratio, cardiac parameters, ductus arteriosus (DA) and isthmus diameter, aortic parameters, PA and MPA diameter, MPA PSV and VTI, isthmus flow volume and velocity and PA flow volume, DA and BA parameters, and LCCA and LSA parameters (flow volume, PSV, and VTI). Conclusion: A certain correlation and distribution trend is detected in the ultrasound parameters of normal fetuses, and the ratios among different parameters remain relative stable. These findings can be used for determination of abnormal growth of the fetuses in prenatal ultrasound scan. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The aim of the present study was to compare the fetal umbilical artery blood flow parameters in the third trimester and perinatal outcomes between pregnant women with and without thalassemia minor in South China.This was a retrospective cohort study. Doppler ultrasound was used to detect fetal umbilical artery hemodynamics in pregnant women with or without thalassemia minor during the third trimester. The main parameters assessed were umbilical artery peak systolic flow velocity/end‐diastolic flow velocity (S/D), resistance index (RI), pulsation index (PI), and relevant perinatal outcomes.This study included 540 pregnant women, 180 with thalassemia minor and 360 being healthy controls. In the third trimester, the thalassemia minor group had higher umbilical artery S/D (P = 0.002), RI (P = 0.002), and PI (P = 0.012) than healthy pregnant women, as well as lower levels of hemoglobin (Hb) (P < 0.001) and higher ferritin levels (P < 0.001). Compared to the non‐thalassemia group, neonatal body weight in the thalassemia minor group was significantly lower (P = 0.001). Additionally, the incidence of maternal anemia (odds ratio [OR] 3.92; 95% confidence interval [CI]: 2.57–5.99, P < 0.001), low birth weight (OR 15.35; 95% CI: 1.71–137.93, P = 0.015), fetal distress (OR 2.18; 95% CI: 1.12–4.26, P = 0.023), neonatal asphyxia (OR 12.81; 95% CI: 1.40–117.33, P = 0.024), oligohydramnios (OR 18.25; 95% CI: 2.21–150.36, P = 0.007) and Apgar score <7 at 1 min after birth (OR 7.97; 95% CI: 1.53–41.54, P = 0.014) was significantly higher in the thalassemia minor group.Pregnant women with thalassemia minor have higher umbilical artery S/D, RI and PI during the third trimester and a higher risk of adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to investigate fetal echocardiographic findings in predicting the need for surgical repair in fetuses with coarctation of the aorta (CoA) and to evaluate perinatal outcomes. Study Design In this retrospective study, fetuses diagnosed with CoA in a tertiary center between January 2015 and June 2021 were analyzed. Fetal echocardiographic measurements and quantitative findings, middle cerebral artery (MCA) and umbilical artery (UA) Doppler indices, and perinatal outcomes were recorded. Results A total of 57 fetuses with CoA were included in the study. In total, 51 (89.5%) pregnancies resulted in live births and 32 (62.8%) of the neonates underwent surgical repair. The left ventricle/right ventricle width ratio and aortic isthmus z -score were significantly lower in fetuses who underwent surgical repair (p = 0.004 0.001, respectively). Retrograde flow in the aortic isthmus (odds ratio [OR]:7.43; 95% confidence interval [CI]: 1.98–27.76), left-to-right foramen ovale shunt (OR: 8.50; 95% CI: 1.68–42.98), and ventricular septal defect (OR: 9.63; 95% CI: 1.90–48.74) were associated with the need for surgical repair. A new scoring system integrating these echocardiographic findings had 89% specificity and 54% sensitivity in predicting surgical repair. Fetal growth restriction rates, preterm birth rates, mean MCA pulsatility index (PI), and mean UA PI were similar in fetuses with and without surgical repair. Conclusion A scoring system integrating echocardiographic findings in fetuses with CoA may improve the prediction of surgical repair need. There is no evidence of an increased risk of FGR, preterm birth, and brain sparing effect in fetuses with CoA who require surgical repair. Key Points Coarctation of the aorta is one of the most difficult congenital heart defects to diagnose. A new scoring system may improve the prediction of surgical repair need. There is no increased risk of fetal growth restriction in fetuses requiring early surgical repair. [ABSTRACT FROM AUTHOR]

Background: Placental insufficiency is a significant cause of perinatal morbidity and mortality in high-risk pregnancies. Doppler ultrasound has emerged as a potential tool for early detection and management of this condition. Objective: To evaluate the role of Doppler ultrasound in assessing placental insufficiency and predicting adverse outcomes in high-risk pregnancies. Methods: In this study, we enrolled 100 high-risk pregnant women and performed Doppler ultrasound examinations of the umbilical artery (UA), middle cerebral artery (MCA), and uterine artery (UtA). Pregnancy outcomes and management changes were recorded. Results: Abnormal Doppler findings were observed in 35% of UA, 28% of MCA, and 32% of UtA examinations. UA Doppler showed high diagnostic accuracy for placental insufficiency (sensitivity 82.5%, specificity 96.7%). Abnormal UA Doppler was associated with increased odds of preterm delivery (OR 3.8, 95% CI: 2.1-6.9). Abnormal MCA Doppler correlated with low birth weight (OR 2.9, 95% CI: 1.7-5.2), while abnormal UtA Doppler was associated with pre-eclampsia (OR 4.2, 95% CI: 2.3-7.6). Doppler findings led to management changes in 45% of cases, including increased fetal monitoring (45%), antenatal corticosteroid administration (30%), and early delivery (22%). Conclusion: Doppler ultrasound is an effective tool for assessing placental insufficiency and predicting adverse outcomes in high-risk pregnancies, often guiding management decisions. [ABSTRACT FROM AUTHOR]

Background and Aims: Vasopressor usage can affect the rostral spread of intrathecal drug and, hence, its requirement during cesarean delivery. Although a decreased spread is evidenced with phenylephrine, there is no data for norepinephrine usage. The present study aimed to evaluate the minimum effective dose of intrathecal hyperbaric bupivacaine for cesarean section with and without prophylactic norepinephrine infusion. Material and Methods: Patients scheduled for elective cesarean section under combined spinal–epidural block were randomized to receive intravenous infusion of norepinephrine (0.05 μg/kg/min) or normal saline (placebo), initiated immediately after intrathecal injection. Postspinal hypotension in either group (systolic arterial pressure ≤0.8 baseline) was treated with norepinephrine 4 μg rescue. Dose of intrathecal hyperbaric bupivacaine (0.5%) was decided for individual patients using up-and-down sequential allocation method. Primary outcome measure was the minimum effective dose of intrathecal hyperbaric bupivacaine (0.5%) defined as ED50, while secondary observations included spinal block characteristics and neonatal outcomes. Results: Demographic parameters were statistically similar between both groups (P > 0.05). ED50 of intrathecal hyperbaric bupivacaine was 7.8 mg (95% confidence interval [CI]: 6.7–8.8) and 7.4 mg (95% CI: 6.1–8.7) for normal saline and norepinephrine group respectively (P = 0.810). Block characteristics were similar between both groups as was neonatal APGAR score, but umbilical artery base excess was greater for norepinephrine versus normal saline group (−4.4 ± 3.6 vs. −6.5 ± 2.4, P = 0.038). Conclusion: Use of prophylactic norepinephrine (0.05 μg/kg/min) during cesarean delivery does not require adjustment of intrathecal hyperbaric bupivacaine. [ABSTRACT FROM AUTHOR]