-
La Tunisie Medicale Nov 2023Decreased fetal movement is a common reason for consultation. It can reveal an intrauterine death or fetal distress.
INTRODUCTION
Decreased fetal movement is a common reason for consultation. It can reveal an intrauterine death or fetal distress.
AIM
To evaluate the epidemiological profile of decreased fetal movement and to identify the predictive factors of poor pregnancy outcome.
METHODS
We performed a retrospective and descriptive study in the department of Maternity between January 2015 and December 2019 including patients hospitalized for decreased fetal movements.
RESULTS
The study included 150 patients with a mean age of 30.7±5.8 years. The patients were primiparous in 45.3% of cases. The mean term of pregnancy was 37.17±2.97 weeks. Cardiotocography was pathological in 22.7% of patients. The delivery rate during the hospitalization was 87.3% with a mean term of 37.9±2.5 SA. Poor pregnancy outcome was noted in 22.1% of cases. The identified predictive factors of poor pregnancy outcome were: gestational term less than 37 weeks (ORa=9.42), insufficient prenatal care (ORa=2.85), delayed maternal reporting of decreased fetal movement (ORa=1.29), complications during pregnancy (ORa=3.01), small symphysiofundal height for gestational age (ORa=6.17), pathological cardiotocography (ORa=1.66), fetal growth restriction (ORa=6.17), abnormal Umbilical Artery Doppler (ORa=6.51).
CONCLUSION
Decreased fetal movement can be a false alarm but it is important to identify predictive factors of poor pregnancy outcome to recognize patients at increased risk and optimize their management.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Pregnancy Outcome; Fetal Movement; Retrospective Studies; Fetal Growth Retardation; Cardiotocography; Gestational Age; Ultrasonography, Prenatal
PubMed: 38468581
DOI: No ID Found -
Seminars in Perinatology Feb 2024Stillbirth, defined as fetal death at 20 weeks gestation or later, is a devastating pregnancy outcome affecting 1 in 175 pregnancies in the United States. Although...
Stillbirth, defined as fetal death at 20 weeks gestation or later, is a devastating pregnancy outcome affecting 1 in 175 pregnancies in the United States. Although efforts to understand the etiology of stillbirth have expanded, 25 % of cases remain unexplained and some cases previously thought to be explained may have additional unknown causative factors. Determining an etiology for stillbirth is important for clinical management and for grieving families to obtain closure, to find meaning, and to understand recurrence risks. However, the evaluation of stillbirth is not completed uniformly despite American College of Obstetrics and Gynecology (ACOG) guidelines and stillbirth data is frequently incomplete due to lack of genomic analysis, fetal autopsy, and placental pathology. Karyotype and chromosomal microarray have been the gold standard in genetic analysis in perinatal medicine for many years, but next generation sequencing holds promise towards improving diagnostic yields and providing clarity for both clinicians and patients.
Topics: Pregnancy; Humans; Female; Stillbirth; Placenta; Fetal Death; Pregnancy Outcome; Genomics
PubMed: 38238216
DOI: 10.1016/j.semperi.2023.151866 -
Ecotoxicology and Environmental Safety Jul 2023Per- and polyfluoroalkyl substances (PFAS) are a large group of persistent industrial chemicals that can harm reproductive health. PFAS levels were analysed to determine...
Per- and polyfluoroalkyl substances (PFAS) are a large group of persistent industrial chemicals that can harm reproductive health. PFAS levels were analysed to determine the current sources of exposure and possible associations between prenatal PFAS exposure and adverse pregnancy outcome. Samples from 136 mother-newborn pairs recruited between 2017 and 2019 were analysed for the presence of 31 target PFAS in maternal serum, umbilical cord serum, and placental tissue by high-performance liquid chromatography coupled to a tandem mass spectrometer. Questionnaires and medical records were used to survey sources of exposure and pregnancy outcome, including small for gestational age (SGA), fetal growth restriction (FGR), preeclampsia (PE), preterm birth, large for gestational age (LGA) and gestational diabetes mellitus (GDM). Data were analysed for individual PFAS and sum4PFAS (sum of perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorohexane sulfonate (PFHxS), and perfluorooctane sulfonate (PFOS) serum levels) in logistic regression analyses and categorical regression analyses. Compared to data from a previous Viennese study in 2010-12, sum4PFAS levels were generally lower. Sum4PFAS serum levels of three women (2.2%) exceeded 6.9 µg/L, a level that corresponds to the recently established tolerable weekly intake (TWI) of EFSA for nursing mothers aged 35 years; in the 2010/2012 study it was 13.6%. The large contribution of unidentified extractable organofluorine (EOF) fractions to total PFAS exposure is a concern. Study site, mean maternal corpuscular hemoglobin (MCH), use of facial lotion, and owning upholstered furniture were significantly influencing maternal exposure. While no effect of sum4PFAS on pregnancy outcome could be detected, we found highest placental PFDA levels in SGA births. PFHxS levels in umbilical cord and placenta were highest in preterm births. Further studies are needed to elucidate the relationship of prenatal PFAS exposure and pregnancy outcome, in particular to confirm whether and how placental PFDA levels may contribute to an increased risk for SGA.
Topics: Pregnancy; Humans; Female; Infant, Newborn; Pregnancy Outcome; Prenatal Exposure Delayed Effects; Placenta; Environmental Pollutants; Austria; Premature Birth; Fluorocarbons; Alkanesulfonic Acids; Alkanesulfonates
PubMed: 37182303
DOI: 10.1016/j.ecoenv.2023.115006 -
Scientific Reports Sep 2023The purpose of this study was to implore the association among clinical features, long-term fertility outcomes and the anatomical location of adenomyosis identified by...
The purpose of this study was to implore the association among clinical features, long-term fertility outcomes and the anatomical location of adenomyosis identified by ultrasound. We collected data of non-pregnant patients between 20 and 40 years old who had undergone surgical exploration for benign gynecological conditions at our institution between January 2010 and December 2017. A total of 158 women met the inclusion criteria and were allocated into three groups according to the ultrasound-determined adenomyosis anatomical location: anterior (Group A), posterior (Group B), both posterior and anterior (Group C). 44.3% (70/158) adenomyosis was located at the posterior side. History of miscarriage and parity were significantly higher in Group C (p = 0.036 and 0.001 respectively). Group C also had a higher concurrence rate of ovarian endometrioma (OEM) (80.4%, p = 0.002), pelvic adhesion (80.4%, P = 0.003) and the revised American Fertility Society (rAFS) Score (median64, range2-100, P < 0.001), while a significantly lower rate of concurrent peritoneal endometriosis (P = 0.01). Group B showed a relative higher rate of coexistent heavy menstrual bleeding (28.6%, p = 0.04) and oviduct obstruction (24.3%, P = 0.038). Group A had a higher proportion of coexistent leiomyoma (53.1%, P = 0.002). There were no significant differences between group A, B, and C in terms of pain symptoms, endometrial polyps, operation time, and endometriosis fertility index score and other basic characters (p > 0.05). During the follow-up, 59.2% (61/103) patients had clinical pregnancies, and 26.2% (16/61) of them experienced pregnancy loss. Total in vitro fertilization and embryo transfer pregnancy rate was 64.6% (42/65) and spontaneous pregnancy rate was 50.0% (19/38). The Kaplan-Meier curves demonstrated significant lower cumulative pregnancy rate in Group C than Group A and Group B (p = 0.01). Severe obstetric complications such as placenta previa, placenta accreta, preeclampsia, and preterm birth were only found in women with adenomyosis located in the posterior side. In conclusion, types of adenomyosis based on sonographic location had different clinical features and pregnancy outcome. Patients with adenomyosis lesion in both anterior and posterior sides had higher combination of OEM, pelvic adhesion and rAFS score.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Young Adult; Adult; Pregnancy Outcome; Endometriosis; Adenomyosis; Premature Birth; Abortion, Spontaneous
PubMed: 37679426
DOI: 10.1038/s41598-023-40816-z -
The Journal of Maternal-fetal &... Dec 2023The relationship between prenatal physical activity (PA) and adverse birth outcomes is still inconclusive. We aimed to investigate the association between PA during...
The relationship between prenatal physical activity (PA) and adverse birth outcomes is still inconclusive. We aimed to investigate the association between PA during pregnancy and adverse birth outcomes by using data from the Guangxi Zhuang birth cohort (GZBC) in China. A total of 11,292 mother-infant pairs were included from GZBC in China. The information on PA status, intensity, adequacy, and volume and birth outcomes were collected. Multivariable linear and logistic regression models were applied to analyze the effects of PA during pregnancy on birth weight z-scores (BW z-scores) and gestational age and risk of small-for-gestational age (SGA) and preterm birth (PTB), respectively. Cubic spline analysis was conducted to detect a nonlinear dose-response of total weekly activity metabolic equivalents (MET) and birth outcomes. Compared to no regular PA during pregnancy, moderate and high-intensity PA (MVPA) was associated with increase BW z-scores ( = 0.08, 95%CI: 0.002, 0.15, = .044) and associated with a marginal significant decrease in risk of PTB (OR = 0.73, 95%CI: 0.51, 1.05, = .093). However, PA had no relationship with gestational age and risk of SGA, and Nonlinear relationships were not observed between total weekly activity MET and risk of SGA and PTB. These finding shows that PA during pregnancy may increase the BW z-score and reduce risk of PTB, supporting the guidelines that pregnant women should be encouraged to engage in appropriate physical activity during pregnancy in China.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Premature Birth; Prospective Studies; China; Infant, Small for Gestational Age; Birth Weight; Parturition; Fetal Growth Retardation; Exercise; Pregnancy Outcome
PubMed: 36597826
DOI: 10.1080/14767058.2022.2162819 -
Lancet (London, England) Feb 2024The cerebroplacental ratio is associated with perinatal mortality and morbidity, but it is unknown whether routine measurement improves pregnancy outcomes. We aimed to... (Randomized Controlled Trial)
Randomized Controlled Trial
Term planned delivery based on fetal growth assessment with or without the cerebroplacental ratio in low-risk pregnancies (RATIO37): an international, multicentre, open-label, randomised controlled trial.
BACKGROUND
The cerebroplacental ratio is associated with perinatal mortality and morbidity, but it is unknown whether routine measurement improves pregnancy outcomes. We aimed to evaluate whether the addition of cerebroplacental ratio measurement to the standard ultrasound growth assessment near term reduces perinatal mortality and severe neonatal morbidity, compared with growth assessment alone.
METHODS
RATIO37 was a randomised, open-label, multicentre, pragmatic trial, conducted in low-risk pregnant women, recruited from nine hospitals over six countries. The eligibility criteria were designed to be broad; participants were required to be 18 years or older, with an ultrasound-dated confirmed singleton pregnancy in the first trimester, an alive fetus with no congenital malformations at the routine second-trimester ultrasound, an absence of adverse medical or obstetric history, and the capacity to give informed consent. Women were randomly assigned in a 1:1 ratio (block size 100) using a web-based system to either the concealed group or revealed group. In the revealed group, the cerebroplacental ratio value was known by clinicians, and if below the fifth centile, a planned delivery after 37 weeks was recommended. In the concealed group, women and clinicians were blinded to the cerebroplacental ratio value. All participants underwent ultrasound at 36 + 0 to 37 + 6 weeks of gestation with growth assessment and Doppler evaluation. In both groups, planned delivery was recommended when the estimated fetal weight was below the tenth centile. The primary outcome was perinatal mortality from 24 weeks' gestation to infant discharge. The study is registered at ClinicalTrials.gov (NCT02907242) and is now closed.
FINDINGS
Between July 29, 2016, and Aug 3, 2021, we enrolled 11 214 women, of whom 9492 (84·6%) completed the trial and were eligible for analysis (4774 in the concealed group and 4718 in the revealed group). Perinatal mortality occurred in 13 (0·3%) of 4774 pregnancies in the concealed group and 13 (0·3%) of 4718 in the revealed group (OR 1·45 [95% CI 0·76-2·76]; p=0·262). Overall, severe neonatal morbidity occurred in 35 (0·73%) newborns in the concealed group and 18 (0·38%) in the revealed group (OR 0·58 [95% CI 0·40-0·83]; p=0·003). Severe neurological morbidity occurred in 13 (0·27%) newborns in the concealed group and nine (0·19%) in the revealed group (OR 0·56 [95% CI 0·25-1·24]; p=0·153). Severe non-neurological morbidity occurred in 23 (0·48%) newborns in the concealed group and nine (0·19%) in the revealed group (0·58 [95% CI 0·39-0·87]; p=0·009). Maternal adverse events were not collected.
INTERPRETATION
Planned delivery at term based on ultrasound fetal growth assessment and cerebroplacental ratio at term was not followed by a reduction of perinatal mortality although significantly reduced severe neonatal morbidity compared with fetal growth assessment alone.
FUNDING
La Caixa foundation, Cerebra Foundation for the Brain Injured Child, Agència per la Gestió d'Ajuts Universitaris i de Recerca, and Instituto de Salud Carlos III.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Fetal Development; Fetus; Perinatal Death; Pregnancy Outcome; Prenatal Care; Ultrasonography, Prenatal
PubMed: 38219773
DOI: 10.1016/S0140-6736(23)02228-6 -
Annual Review of Nutrition Aug 2023Pregnancy entails a large negative balance of iron, an essential micronutrient. During pregnancy, iron requirements increase substantially to support both maternal red... (Review)
Review
Pregnancy entails a large negative balance of iron, an essential micronutrient. During pregnancy, iron requirements increase substantially to support both maternal red blood cell expansion and the development of the placenta and fetus. As insufficient iron has long been linked to adverse pregnancy outcomes, universal iron supplementation is common practice before and during pregnancy. However, in high-resource countries with iron fortification of staple foods and increased red meat consumption, the effects of too much iron supplementation during pregnancy have become a concern because iron excess has also been linked to adverse pregnancy outcomes. In this review, we address physiologic iron homeostasis of the mother, placenta, and fetus and discuss perturbations in iron homeostasis that result in pathological pregnancy. As many mechanistic regulatory systems have been deduced from animal models, we also discuss the principles learned from these models and how these may apply to human pregnancy.
Topics: Animals; Pregnancy; Female; Humans; Placenta; Pregnancy Outcome; Fetus; Iron; Homeostasis
PubMed: 37253681
DOI: 10.1146/annurev-nutr-061021-030404 -
JBRA Assisted Reproduction Jun 2024To evaluate the impact of possible maternal and paternal prognostic factors and ovarian stimulation protocols on clinical pregnancy and live birth rates in intrauterine... (Observational Study)
Observational Study
OBJECTIVE
To evaluate the impact of possible maternal and paternal prognostic factors and ovarian stimulation protocols on clinical pregnancy and live birth rates in intrauterine insemination (IUI) cycles.
METHODS
Retrospective observational study of 341 IUI cycles performed from January 2016 to November 2020 at the Assisted Reproduction Service of the Clinics Hospital of the Ribeirão Preto Medical School, University of São Paulo. Clinical pregnancy and live birth rates and their potential prognostic factors were evaluated. Wilcoxon's non-parametric test was used to compare quantitative variables, and the chi-square test to compare qualitative variables, adopting a significance level of p<0.05. A logistic regression model was performed to verify which exploratory variables are predictive factors for pregnancy outcome.
RESULTS
The ovulation induction protocol using gonadotropins plus letrozole (p=0.0097; OR 4.3286, CI 1.3040 - 14.3684) and post-capacitation progressive sperm ≥ 5million/mL (p=0.0253) showed a statistically significant correlation with the live birth rate. Female and male age, etiology of infertility, obesity, multifollicular growth, endometrial thickness ≥ 7 mm, and time between human chorionic gonadotropin administration and IUI performance were not associated with the primary outcomes. In the group of patients with ideal characteristics (women aged< 40 years, BMI < 30 kg/m2, antral follicle count ≥ 5, partner aged< 45 years, and post-capacitation semen with progressive spermatozoa ≥ 5 million/mL), the rate of clinical pregnancy was 14.8%, while that of live birth, 9.9%.
CONCLUSIONS
In this study, the ovulation induction protocol with gonadotropins plus letrozole and post-capacitation progressive sperm ≥ 5 million/mL were the only variables that significantly correlated with intrauterine insemination success.
Topics: Humans; Female; Pregnancy; Retrospective Studies; Adult; Male; Ovulation Induction; Prognosis; Insemination, Artificial; Pregnancy Rate; Pregnancy Outcome
PubMed: 38546118
DOI: 10.5935/1518-0557.20240017 -
BJOG : An International Journal of... Apr 2024To explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women.
OBJECTIVE
To explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women.
DESIGN
Prospective cohort.
SETTING
Workplaces in Tamil Nadu, India.
SAMPLE
A cohort of 800 pregnant women engaged in moderate to heavy physical work in 2017-2019 and 2021-2022.
METHODS
Participants were recruited at between 8 and 14 weeks of gestation. Occupational heat exposure and heat strain indicators were captured each trimester. 'Heat exposed' was defined as heat stress exceeding the threshold limit value (TLV) for safe manual work (with maximum wet-bulb globe temperatures of 27.5°C for a heavy workload and 28.0°C for a moderate workload). Physiological heat strain indicators (HSIs) such as core body temperature (CBT) and urine specific gravity (USG) were measured before and after each shift. Heat-related health symptoms were captured using the modified HOTHAPS questionnaire.
MAIN OUTCOME MEASURES
The main outcome measures included (1) a composite measure of any adverse pregnancy outcome (APO) during pregnancy (including miscarriage, preterm birth, low birthweight, stillbirth, intrauterine growth restriction and birth defects), (2) a composite measure of adverse outcomes at birth (3) and miscarriage.
RESULTS
Of the 800 participants, 47.3% had high occupational heat exposure. A rise in CBT was recorded in 17.4% of exposed workers, and 29.6% of workers experienced moderate dehydration (USG ≥ 1.020). Heat-exposed women had a doubled risk of miscarriage (adjusted odds ratio, aOR 2.4; 95% confidence interval, 95% CI 1.0-5.7). High occupational heat exposure was associated with an increased risk of any adverse pregnancy and foetal outcome (aOR 2.3; 95% CI 1.4-3.8) and adverse outcome at birth (aOR 2.0; 95% CI 1.2-3.3).
CONCLUSIONS
High occupational heat exposure is associated with HSIs and adverse pregnancy outcomes in India.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Abortion, Spontaneous; Prospective Studies; India; Premature Birth; Pregnancy Outcome; Heat-Shock Response
PubMed: 37814395
DOI: 10.1111/1471-0528.17680 -
Best Practice & Research. Clinical... Dec 2023Cesarean scar pregnancy (CSP) rate is rising worldwide, in parallel with the rising rates of cesarean delivery. Multiple therapeutic strategies and a timely diagnosis... (Review)
Review
Cesarean scar pregnancy (CSP) rate is rising worldwide, in parallel with the rising rates of cesarean delivery. Multiple therapeutic strategies and a timely diagnosis have led to a successful management in most cases, with many women preserving fertility after treatment. Despite this, still little is known regarding pregnancy outcomes after a CSP. The main adverse outcomes reported after CSP are recurrence of CSP, miscarriage, preterm birth, placenta accreta spectrum (PAS) disorders and uterine rupture. In addition, little is known about the influence of the different treatments on subsequent pregnancy outcomes after a CSP. Being aware of the impact of the different management strategies on the fertility outcomes is highly relevant to counsel pregnant women after a CSP. The aim of this manuscript is to provide an up-to-date review of the reproductive outcomes of women with a history of CSP and of the influence of various treatments on subsequent pregnancy outcomes.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Cicatrix; Premature Birth; Pregnancy, Ectopic; Pregnancy Outcome; Abortion, Spontaneous
PubMed: 37355427
DOI: 10.1016/j.bpobgyn.2023.102362