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

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

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

Fetal sex influences placental function as well as maternal and fetal health, being an important factor to consider in pregnancy studies. However, fetal sex determination in the first trimester of pregnancy still faces some technical limitations. Here we describe an RT-qPCR technique to determine fetal sex based on X-inactive specific transcript (XIST) and DEAD-Box helicase 3 Y-linked (DDX3Y) gene expression. This method is straightforward, reliable, fast and applicable on both, placental tissue and primary cells.

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

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

In the last decade, an abundance of new research from Canada and internationally has provided substantial evidence for the efficacy of exercise in preventing pregnancy complications and improving long-term maternal and fetal outcomes. Indeed, guidelines for exercise during pregnancy are available from several countries. This includes the expert consensus-based 2003 Joint SOGC and Canadian Society for Exercise Physiology Clinical Practice Guidelines: Exercise in Pregnancy and the Postpartum Period. With the plethora of new scientific evidence, it was vital to re-examine the literature by using the rigorous process followed by previous Canadian health behaviour guidelines.The purpose of this document is to outline the process and outcomes for the re-development of the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy, herein referred to as the Guidelines. The target users for these Guidelines are obstetric care providers, policymakers, and exercise professionals who provide guidance for pregnant women regarding prenatal physical activity.

Background and objective Cardiotocography (CTG), consisting in the simultaneous recording of fetal heart rate (FHR) and maternal uterine contractions (UC), is a popular clinical test to assess fetal health status. Typically, CTG machines provide paper reports that are visually interpreted by clinicians. Consequently, visual CTG interpretation depends on clinician's experience and has a poor reproducibility. The lack of databases containing digital CTG signals has limited number and importance of retrospective studies finalized to set up procedures for automatic CTG analysis that could contrast visual CTG interpretation subjectivity. In order to help overcoming this problem, this study proposes an electronic procedure, termed eCTG, to extract digital CTG signals from digital CTG images, possibly obtainable by scanning paper CTG reports. Methods eCTG was specifically designed to extract digital CTG signals from digital CTG images. It includes four main steps: pre-processing, Otsu's global thresholding, signal extraction and signal calibration. Its validation was performed by means of the “CTU-UHB Intrapartum Cardiotocography Database” by Physionet, that contains digital signals of 552 CTG recordings. Using MATLAB, each signal was plotted and saved as a digital image that was then submitted to eCTG. Digital CTG signals extracted by eCTG were eventually compared to corresponding signals directly available in the database. Comparison occurred in terms of signal similarity (evaluated by the correlation coefficient ρ, and the mean signal error MSE) and clinical features (including FHR baseline and variability; number, amplitude and duration of tachycardia, bradycardia, acceleration and deceleration episodes; number of early, variable, late and prolonged decelerations; and UC number, amplitude, duration and period). Results The value of ρ between eCTG and reference signals was 0.85 (P Conclusions eCTG procedure is a promising useful tool to accurately extract digital FHR and UC signals from digital CTG images.

Monitoring fetal health early in pregnancy helps to avert possible fetal damage and even fetal death. Among various fetal monitoring techniques the invasive fetal scalp electrode method is the most accurate method at labor. However this method may cause risk to the baby if used for antepartum monitoring. The Non-invasive fetal ECG (NIFECG) is a simple and the next best method to extract fetal heart rate (FHR) before full term. NIFECG can extract the fetal morphology from the FECG signal which can aid in diagnosing fetal health ahead of delivery. This paper aims to locate the most optimum points to place the ECG electrodes on the maternal abdomen so as to get the best FECG signals. After reviewing few previous techniques, we proposed three schemes using a standard 12 lead ECG recorder. It was observed that the scheme 2 successfully displayed the average FHR as compared to the ultrasound report of a single subject. A further researching and experimental procedures are required in this abdominal ECG (aECG) placement electrode positioning schemes before a standardized electrode configuration which can be introduced in clinical practice.

While it is well known that maternal temperature affects fetal heart rate, the exact relationship is not well described. The circumstances accompanying most cases of maternal hypothermia and rewarming (e.g. a drowning event) have precluded a precise quantitative description of this relationship. We describe hypothermia and controlled rewarming during resection of a maternal brain stem tumor in the early third trimester. Continuous electronic fetal heart rate and core temperature monitoring demonstrated a near linear relationship during the development of hypothermia and rewarming. Recognition of the close relationship between maternal temperature and fetal heart rate can help safeguard maternal and fetal health, and prevent unnecessary delivery during non-obstetric surgery in pregnancy.

Fetal electrocardiogram (FECG) morphology plays an essential role in the early diagnosis of fetal health conditions. However, it is intractable to extract the clean morphology of FECG signals, which are usually contaminated by maternal ECG (MECG) and various noises. To extract the clean morphology of FECG signals from non-invasive abdominal ECG records, a high-performance and high-efficient two-stage slow-fast long short-term memory (SFLSTM) based architecture is proposed. The MECG elimination and the FECG enhancement are realized by the elaborately designed slow LSTM and fast LSTM to filter out the MECG and the residual noise components. Qualitative and quantitative experiments are conducted on the records from two public datasets. The experimental results reveal that our designed scheme achieves the best performance in k SQI , signal-to-noise ratio (SNR), and root mean square error (RMSE). The MECG elimination and the FECG enhancement improve SNR by 3.09 and 1.81 dB, respectively. The proposed fast LSTM reduces computation cost by approximately 50%, without any degradation in performance. Our method may leverage non-invasive FECG monitoring for the early detection of fetal heart diseases.

The placenta is critical to fetal health during pregnancy as it supplies oxygen and nutrients to maintain life. It has a complex structure, and alterations to this structure across spatial scales are associated with several pregnancy complications, including intrauterine growth restriction (IUGR). The relationship between placental structure and its efficiency as an oxygen exchanger is not well understood in normal or pathological pregnancies. Here we present a computational framework that predicts oxygen transport in the placenta which accounts for blood and oxygen transport in the space around a placental functional unit (the villous tree). The model includes the well-defined branching structure of the largest villous tree branches, as well as a smoothed representation of the small terminal villi that comprise the placenta's gas exchange interfaces. The model demonstrates that oxygen exchange is sensitive to villous tree geometry, including the villous branch length and volume, which are seen to change in IUGR. This is because, to be an efficient exchanger, the architecture of the villous tree must provide a balance between maximising the surface area available for exchange, and the opposing condition of allowing sufficient maternal blood flow to penetrate into the space surrounding the tree. The model also predicts an optimum oxygen exchange when the branch angle is 24 °, as villous branches and TBs are spread out sufficiently to channel maternal blood flow deep into the placental tissue for oxygen exchange without being shunted directly into the DVs. Without concurrent change in the branch length and angles, the model predicts that the number of branching generations has a small influence on oxygen exchange. The modelling framework is presented in 2D for simplicity but is extendible to 3D or to incorporate the high-resolution imaging data that is currently evolving to better quantify placental structure.

Estimates of the effect of fetal health shocks may suffer from survivorship bias. The fetal origins literature seemingly agrees that survivorship bias is innocuous in the sense that it induces a bias toward zero. Arguably, however, selective mortality can imply a bias away from zero. In the case of the 1918 flu pandemic, a suppressed immune system may have been protective against the most severe consequences of infection. We use historical birth records from the maternity hospital of Bern, Switzerland, to evaluate this possibility. Our results suggest that a careful consideration of survivorship bias is imperative for the evaluation of the 1918 flu pandemic and other fetal health shocks.

Objective: To analyze and compare dental knowledge between two generations of pregnant women attending the same antenatal clinic in Al-Jubail, Saudi Arabia. Methods: A cross sectional self administered questionnaire was conducted among 252 pregnant women in three different antenatal clinics. Data were analyzed using SPSS (v. 21), p value

Utilizing information on exact home addresses on birth records, we exploit arguably exogenous variation in noise exposure triggered by a new Federal Aviation Administration policy called NextGen, which unintentionally increased noise levels in communities experiencing concentrated flight patterns. We examine the fetal health impact of exposure to noise levels in excess of the EPA and the WHO recommended threshold of 55 dB. We find that the likelihood of having low birth weight (LBW) babies increases by 1.6 percentage points among mothers who live close to the airport, in the direction of the runway, exposed to noise levels over the 55 dB threshold, and during the period when NextGen was more actively implemented at the airport. Our finding has important policy implications for the trade-off between flight pattern optimization and human health in light of the long-term impact of LBW on later life outcomes.

The fetal heart rate and the fetal heart position are two important indicators of the fetus’ health condition. However, most of the fetal heart monitors lack the ability to detect fetal heart position. Moreover, the active fetal heart monitors based on the ultrasound and radio frequency signals could cause concerns about their influence on the fetus thus are not suitable for continuous fetal heart monitoring. To address these issues, we propose Paris, a passive and continuous fetal heart monitoring system that i) passively senses the audible fetal heart sound to eliminate the radiation; ii) extracts the fetal heart rate and the fetal heart position from the audible fetal heart sound to support a complete fetal health assessment; iii) performs continuous fetal heart monitoring with a portable device. We evaluated Paris on 16 pregnant volunteers in a time span of 6 months. The result shows that Paris can measure the fetal heartbeat with an average error of 4.3 beats per minute, and localize the fetal heart with an accuracy as high as 100 % in a range of 33 m m .

Fetal health is an important consideration in policy formation. Unfortunately, a complete census of fetal deaths, an important measure of overall fetal health, is infeasible, and available data are selectively observed. We consider this issue in the context of the Clean Air Act Amendments of 1970 (CAAA), one of the largest and most influential environmental regulations in the history of the United States. We discuss a model of potential bias in measuring observed fetal deaths, and present the sex ratio of live births as an alternative fetal health endpoint, taking advantage of the finding that males are more vulnerable to side effects of maternal stress in utero. We find the CAAA caused substantial improvements in fetal health, in addition to previously identified reductions in post-natal mortality.

Background Cardiovascular emergencies in pregnant patients are often considered a rare event; however, heart disease as a cause of maternal mortality is steadily increasing. Discussion In this article, we review 3 common cardiovascular emergencies and the important subtle differences in their treatment in the pregnant patient: peripartum/postpartum cardiomyopathy, acute myocardial infarction, and cardiac resuscitation. Conclusion Managing these conditions in the emergency department setting requires a high index of suspicion, knowledge of anatomical and physiologic changes associated with pregnancy, and updated management strategies related to optimizing maternal and fetal health.

Delivery of a healthy full term baby following an uneventful antenatal period occurs in the majority of pregnancies. These are classified as a low-risk pregnancy group. There are, however, some pregnancies that are complicated due to maternal or fetal disease that can increase the risk of perinatal morbidity and mortality. This is classified as a high-risk group. The aim of fetal surveillance is to identify these threatened fetuses with the prospect of altering the timing of delivery to prevent the worst outcome, stillbirth. This article looks at the tools available to assess antenatal fetal health in all pregnancies and their ability to identify the at-risk pregnancies that require extra surveillance to improve outcomes. This article does not address fetal surveillance during labour.

The assessment of fetal wellbeing depends heavily on variations in fetal heart rate (FHR) patterns. The variations in FHR patterns are very complex in nature thus its reliable interpretation is very difficult and often leads to erroneous diagnosis. We propose a new method for evaluation of fetal health status based on interval type-2 fuzzy logic through fetal phonocardiography (fPCG). Type-2 fuzzy logic is a powerful tool in handling uncertainties due to extraneous variations in FHR patterns through its increased fuzziness of relations. Four FHR parameters are extracted from each fPCG signal for diagnostic decision making. The membership functions of these four inputs and one output are chosen as a range of values so as to represent the level of uncertainty. The fuzzy rules are constructed based on standard clinical guidelines on FHR parameters. Experimental clinical tests have shown very good performance of the developed system in comparison with the FHR trace simultaneously recorded through standard fetal monitor. Statistical evaluation of the developed system shows 92% accuracy. With the proposed method we hope that, long-term and continuous antenatal care will become easy, cost effective, reliable and efficient.

Background Quitting smoking is often associated with weight gain and prenatal cessation may lead to increased gestational weight gain (GWG). Although previous reports have suggested a link between prenatal smoking cessation and GWG, no studies have examined the relationship between cessation and guideline-recommended GWG, and there is little information about the relationship between the timing of prenatal cessation and GWG. Thus, we examine GWG among women in a community prenatal smoking cessation program and assess the relationship between the timing of prenatal cessation GWG. Methods Pregnant women from care clinics serving economically disadvantaged women who participated in a smoking cessation intervention offered free of charge, self-reported weight, and provided biochemical verification of smoking. Relationships between duration of cessation and GWG were evaluated in t-tests and regression models. GWG was calculated from self-reported weight before pregnancy and self-reported weight at the last visit before delivery. Findings Women who quit earlier during pregnancy had greater GWG (16.9 ± 7.5 kg) than did those who never quit (13.6 ± 8.9). After adjusting for timing of weight assessment and prepregnancy body mass index, however, GWG was not different between women who did and did not quit. Conclusion Quitting earlier in pregnancy is associated with greater GWG, but women who do and do not quit do not differ on total GWG. Despite increased GWG with early cessation, the maternal and fetal health benefits of prenatal smoking cessation outweigh risks of potential risks of excessive GWG.

Empirically based lifting criteria established by the National Institute for Occupational Safety and Health (NIOSH) to reduce the risk of overexertion injuries in the general US working population were evaluated for application to pregnant workers. This report proposes criteria to guide decisions by medical providers about permissible weights for lifting tasks performed at work over the course of an uncomplicated pregnancy. Our evaluation included an extensive review of the literature linking occupational lifting to maternal and fetal health. Although it has been 29 years since the American Medical Association’s Council on Scientific Affairs published its report on the Effects of Pregnancy on Work Performance, these guidelines continue to influence clinical decisions and workplace policies. Provisional clinical guidelines derived from the NIOSH lifting criteria that account for recent evidence for maternal and fetal health are presented and aim to improve the standard of care for pregnant workers.

Adequate folate and iron intake during pregnancy is critical for maternal and fetal health. No previous studies to our knowledge have reported dietary supplement use and folate status among pregnant women sampled in NHANES, a nationally representative, cross-sectional survey. We analyzed data on 1296 pregnant women who participated in NHANES from 1999 to 2006 to characterize overall supplement use, iron and folic acid use, and RBC folate status. The majority of pregnant women (77%) reported use of a supplement in the previous 30 d, most frequently a multivitamin/-mineral containing folic acid (mean 817 μg/d) and iron (48 mg/d). Approximately 55–60% of women in their first trimester reported taking a folic acid- or iron-containing supplement compared with 76–78% in their second trimester and 89% in their third trimester. RBC folate was lowest in the first trimester and differed by supplement use across all trimesters. Median RBC folate was 1628 nmol/L among users and 1041 nmol/L among nonusers. Among all pregnant women, median RBC folate increased with trimester (1256 nmol/L in the first, 1527 nmol/L in the second, and 1773 nmol/L in the third). Given the role of folic acid in the prevention of neural tube defects, it is notable that supplement use and median RBC folate was lowest in the first trimester of pregnancy, with 55% of women taking a supplement containing folic acid. Future research is needed to determine the reasons for low compliance with supplement recommendations, particularly folic acid, in early pregnancy.

Acute renal failure (ARF) is a dreaded complication of pregnancy-associated with significant mortality and morbidity. It is important to know the pregnancy specific causes of ARF. The aim is to write a review on the etiology, differential diagnosis, and management of ARF in women during pregnancy and puerperal period. The principles of management must take into consideration the fetal health. The treating physician must have a good knowledge of physiologic changes that occur in pregnancy. With timely diagnosis and multidisciplinary approach both maternal and fetal outcome improves.

In this paper we estimate long-run effects of fetal exposure to the 1918/19 influenza pandemic for a European country. Using data from the 1970 Swiss census, we find that the male 1919 cohort that had a strongly increased likelihood of fetal exposure to the pandemic performs significantly worse in terms of educational attainment and has a lower chance of marriage than the surrounding cohorts. Further, we find similar results when we in addition use regional differences in influenza severity to test for the impact of influenza on later-life outcomes. A set of robustness tests confirm our findings.

Most pregnancies lead to the delivery of a healthy baby, irrespective of risk factors. Some pregnancies, however, are complicated by differing pathologies that can lead to increased risk of perinatal morbidity and mortality. Fetal surveillance should be instituted, attempting to identify at-risk fetuses and reduce their chances of complications. Traditionally obstetricians have classified pregnancies into ‘low-risk’ or ‘high-risk’ and applied surveillance tools to the latter group. However, the majority of stillbirths occur in low-risk women. In this article we will evaluate the evidence behind the current tools used to assess antepartum fetal health in both high- and low-risk groups, and their ability to detect an at-risk fetus or improve outcome. This article does not address fetal surveillance during labour.

Seasonal patterns of birth outcomes, such as low birth weight, preterm birth and stillbirth, have been found around the world. As a result, there has been an increasing interest in evaluating short-term exposure to ambient temperature as a determinant of adverse birth outcomes. This paper reviews the epidemiological evidence on seasonality of birth outcomes and the impact of prenatal exposure to ambient temperature on birth outcomes. We identified 20 studies that investigated seasonality of birth outcomes, and reported statistically significant seasonal patterns. Most of the studies found peaks of preterm birth, stillbirth and low birth weight in winter, summer or both, which indicates the extremes of temperature may be an important determinant of poor birth outcomes. We identified 13 studies that investigated the influence of exposure to ambient temperature on birth weight and preterm birth (none examined stillbirth). The evidence for an adverse effect of high temperatures was stronger for birth weight than for preterm birth. More research is needed to clarify whether high temperatures have a causal effect on fetal health.

Introduction Early-onset of preeclampsia/eclampsia (EO-PE/E) before 34 weeks of gestation and late-onset of preeclampsia/eclampsia (LO-PE/E) after 34 weeks are associated with negative maternal and fetal health outcomes. Objective We examined birth outcomes of women admitted to the maternity unit before and after 34 weeks. Methods A total of 146 PE/E women were admitted to a tertiary hospital in Bangladesh between November 2017– March 2018; 40 women admitted before 34 weeks and 106 women after 34 weeks gestation. Descriptive statistics and logistic regression were used to examine birth outcomes of women admitted. Results Significantly more women admitted before 34 weeks were older (>=35 year) than those admitted after 34 weeks (15.0% vs. 7.0%, p MgSO 4 ) loading dose before and after 34 weeks from outside hospital (p Discussion Women admitted in the hospital with EO-PE/E had significantly worse birth outcomes compared to women who had admitted with LO-PE/E. Further follow-up of these women will help us to understand more details of postpartum health complications of mothers and babies.

Infections in pregnancy and in the postpartum period represent an important knowledge base that emergency physicians should have. Being able to understand the risk that pregnancy-related infections have on maternal and fetal health in addition to the initiation of appropriate treatment for these infections is crucial. In the postpartum period, most infections (94%) are likely to manifest after hospital discharge; therefore, patients frequently present to the emergency department.

During pregnancy several physical and hormonal alterations may affect normal sleep and the respiratory system and predispose pregnant women to the development of sleep-disordered breathing (SDB) or worsen pre-existing obstructive sleep apnea syndrome (OSAS). SDB has been associated with several complications of pregnancy affecting maternal and fetal health. Clinicians should evaluate more closely obese pregnant women and those who develop hypertension. Early recognition and treatment of SDB may improve the outcome of pregnancy but the indications for treatment of OSAS need to be investigated. The diagnosis of OSAS in pregnancy requires a high index of suspicion and prevention of suspected SDB should be incorporated in the management of pregnancy.

The published evidence is summarized with respect to the best methods of performing fetal assessment in pregnancy. The fetal surveillance programme depends on the level of perceived fetal risk. Currently, assessment of the health of a fetus presumed to be at low-risk comprises: enquiry about fetal movements; recording fundal height growth; auscultation of the fetal heart. Reduced fetal activity is the only assessment shown to identify fetuses at risk of intrauterine death. In such cases, fetal health should be assessed in the same way as in any other high-risk pregnancies (see below). There is a need to develop better methods of identifying fetuses at risk in apparently low-risk pregnancies. For most high-risk pregnancies a comprehensive assessment of fetal health should be undertaken using: • ‘chronic measures’ (umbilical artery Doppler recordings, fetal growth measurements and amniotic fluid volume) should be recorded routinely • ‘acute measures’ (cardiotocography, CTG or biophysical profile score, BPS) should be used selectively but always if there is evidence of chronic compromise.

Although the link between the fetal environment and later life health and achievement is well-established, few studies have evaluated the extent to which public policies aimed at improving fetal health can generate benefits that persist into adulthood. In this study, we evaluate how a rapid expansion of prenatal and child health insurance through the Medicaid program affected adult outcomes of individuals born between 1979 and 1993 who gained access to coverage in utero and as children. We conduct this analysis by exploiting state- and cohort-level variation in the timing and generosity of Medicaid expansions using a simulated eligibility instrumental variables model. We find that cohorts whose mothers gained eligibility for prenatal coverage under Medicaid have lower rates of obesity as adults and fewer hospitalizations related to endocrine, nutritional and metabolic diseases, and immunity disorders as adults. We also find that the prenatal expansions increased high school graduation rates among affected cohorts. We find effects of public eligibility in other periods of childhood on self-reported health and hospitalizations later in life, but these effects are smaller in magnitude. Our results indicate that expanding Medicaid prenatal coverage had sizeable long-term benefits for the next generation.

• Interpretation of the fetal heart rate is part of the essential information required by the paediatrician when called to the delivery room • Accelerations and normal baseline variability are indicative of fetal health • Hypoxia and acidosis may develop quickly in the presence of an abnormal trace with scanty thick meconium, intrauterine growth restriction, intrauterine infection, prematurity and post-term gestation • Consideration of the overall clinical picture and the cardiotocograph provides necessary information to ensure optimal management of the labour.

Pruritus, or itching, is a most uncomfortable affiction and will likely result in a physician visit if it does not resolve quickly. Timely relief is of utmost importance to the patient. The clinician is faced with a diagnostic challenge that begins with determining whether the complaint is localized or more generally distributed. In the pregnant patient, there are potential diagnoses that should be considered early in the course of evaluation as they may affect maternal and fetal health. This approach to the pregnant patient includes a review of the pregnancy-specific and nonpregnancy-related etiologies of pruritus. Emphasis is placed on whether a rash or lesion is present at the onset of itching. Diagnoses are then separated into those specific to and those not specific to pregnancy. A decision tree is provided to facilitate diagnosis, and finally, treatment recommendations and referral suggestions are included.

Profound physiologic and anatomic changes of the urinary tract during pregnancy contribute to the increased risk for symptomatic urinary tract infection in women with bacteriuria. Asymptomatic bacteriuria is the major risk factor for developing symptomatic UTIs during pregnancy and may be associated with adverse effects on maternal and fetal health. Because most symptomatic UTIs develop in women with bacteriuria earlier in pregnancy, treatment of bacteriuria is undertaken to prevent symptomatic infections. All pregnant women should be screened at the first antenatal visit, which is reliably and inexpensively done with a dipstick culture. Short-course therapy should be given to women with bacteriuria and clearance of bacteriuria should be documented after therapy is complete. Failure to eliminate bacteriuria with repeated therapy or recurrence with the same organism is indicative of renal parenchymal infection or a structural abnormality. All women with persistent bacteriuria or recurrent infection should have follow-up cultures and a urologic evaluation after delivery.

Knowledge of gastrointestinal ontogeny provides a rational basis for the use of enteral nutrition in the preterm infant. In all but the least mature infants, digestive and absorptive capacity is good. Immature motility commonly results in gastrointestinal problems, which include poor toleration of milk feeds, gastro-oesophageal reflux, and inadequate gastric emptying. Problems are exacerbated by poor fetal health and intra-uterine growth retardation. These considerations are important in the choice of method of nutrition. When parental nutrition is used, minimal enteral feeding has beneficial effects upon maturation of gut motility.

Despite widespread use of fetal assessment techniques, it is not always possible to detect fetal compromise at an early stage before permanent damage has occurred or to intervene effectively to prevent or ameliorate fetal damage. The only intervention that can ‘rescue' the fetus from an adverse intrauterine environment is delivery, which may result in death or disability from prematurity. Delivery should be undertaken just before fetal compromise becomes permanent damage, but current assessment techniques do not predict this point accurately. Thus, some fetuses are delivered more prematurely than necessary and others delivered after they are irreversibly damaged. In the antepartum period various measurements are used to provide an overall impression of fetal health. The simplest is asking the mother whether the baby is moving well. Ultrasound scanning is commonly used. Electronic fetal heart rate (FHR) monitoring to produce a cardiotocograph (CTG) is widely available, though research does not support its use in the antepartum period. Whatever the method used, effective assessment depends on the background risk in the pregnancy. The aim of intrapartum FHR monitoring is to identify fetuses that become hypoxic and acidotic during labour so that delivery can be expedited. Interpretation of the CTG is explained. A suspicious CTG requires further investigation or delivery. Once the cervix has dilated beyond 3 cm a sample of fetal scalp blood can be analysed for pH and base deficit. After birth, if the neonate shows signs of compromise, blood from the umbilical cord can be analysed for pH, base deficit and partial pressure of carbon dioxide.

Intrapartum fetal health surveillance, in particular electronic fetal heart-rate monitoring (EFM), is a perinatal issue that has sparked much debate both nationally and internationally. Prevention of cerebral palsy is a major objective of all healthcare providers when assessing fetal health in labour. The Fetal Health Surveillance Working Group of the Society of Obstetricians and Gynaecologists of Canada (SOGC) should be commended for its efforts in presenting and discussing the literature and for raising important issues in EFM in the SOGC's Clinical Practice Guideline on Standard Fetal Surveillance in Labour , published in JOGC in March 2002, the first half of the SOGC document Fetal Health Surveillance in Labour . These, as all, SOGC Clinical Practice Guidelines are widely used by hospitals and health-care providers when evaluating practices in their own environments, and we believe, as practitioners of and investigators in fetal health surveillance, that there is not good supporting evidence for recommending continuous intrapartum EFM for pregnancies in which there is an increased risk of perinatal death, cerebral palsy, or neonatal encephalopathy, or when oxytocin is being used for induction of labour, and that if we recommend that the fetal heart be electronically monitored while the nurse is elsewhere, we are on a slippery slope. We encourage reopening discussion regarding these recommendations in the document.

All of the testing methods described above are very good at predicting continued fetal health when test results are reassuring. Each test also suffers from a very poor ability to predict compromise when results are abnormal. Thus, the primary value of antepartum fetal monitoring is in identifying those pregnancies that do not require immediate intervention and may be allowed to continue. Certainly, all pregnant women (regardless of risk status) should monitor fetal movement as part of their fetal surveillance. For patients at risk, a variety of testing schemes are available using combinations of the NST, CST and BPP. There are several reasons for using the NST as the primary testing method for those at risk. Even a small antenatal testing area can accommodate three or four FHR monitors, and a single antenatal testing nurse can perform several NSTs at a time. Because the BPP requires an ultrasound machine and a trained technician to perform, and because only one BPP can be done at a time, many obstetricians who do their own in-office fetal testing are unable to adopt BPP testing as their primary means of surveillance. Additionally, it is more economical to use the NST than the BPP for first-line testing. Assuming charges of $150 and $300 for the NST and BPP, respectively, and assuming that 20% of NSTs are nonreactive and require a BPP for second-line testing, the weekly cost of testing 100 patients is $21,000 for the NST and $37,500 for the BPP. This increase-in-testing cost must be balanced against the small improvement in perinatal mortality rates achieved with the use of the BPP. Because it must be performed in a hospital setting and takes an average of 90 minutes to complete, the CST is more expensive and time-consuming than either the NST or BPP and it is less frequently used as the primary method of fetal testing. In the past the CST was the most commonly used secondary test after a nonreactive NST, but use of the BPP in this situation has now become commonplace. Although the CST still has an important role in fetal testing, the BPP is better suited for use in this setting because of its technical ease and low incidence of abnormal results. Thus, many centers use the NST as the primary mode of testing for the fetus at risk, often with a sonographic assessment of AFV.(ABSTRACT TRUNCATED AT 400 WORDS)

Fifty-six human immunodeficiency virus seropositive-women and 76 human immunodeficiency virus seronegative-women had known CD4 cell values and were followed up throughout pregnancy. The women with seronegative results and the 40 with seropositive results and CD4 (helper cell) counts consistently 3 had no serious infections during pregnancy. Among the 16 with seropositive results and counts that fell below 300 cells/mm 3 , three developed opportunistic infections, one had pneumonia, and one had a post-cesarean-section abscess. Human immunodeficiency virus seropositive-women with low CD4 counts are at markedly increased risk of serious infections during pregnancy. The consequences of this for fetal health, pregnancy management, maternal well-being, and human immunodeficiency virus testing policies are discussed. (AM J OBSTET GVNECOL 1990;162:30-4.)

Childbearing Poster Presentation Background Cardiac disease occurs in approximately 1% of all pregnancies. Tin Man syndrome, though rare, is a disorder encompassing physical and/or electrophysiological cardiac mutations that may present at any time in life. Historically, women with cardiac anomalies were discouraged from pregnancy. While medical advancements have increased the possibility of pregnancy in this population, they may also be minimizing the perception of risk and severity of complications for the mother and infant. This presentation will cover the challenges of dealing with the multidisciplinary care of a pregnant woman with an implantable cardioverter defibrillator ICD pacemaker and neonate with Tetrology of Fallot.

The continued development and use of engineered nanomaterials (ENM) has given rise to concerns over the potential for human health effects. Although the understanding of cardiovascular ENM toxicity is improving, one of the most complex and acutely demanding "special" circulations is the enhanced maternal system to support fetal development. The Barker hypothesis proposes that fetal development within a hostile gestational environment may predispose/program future sensitivity. Therefore, the objective of this study was 2-fold: (1) to determine whether maternal ENM exposure alters uterine and/or fetal microvascular function and (2) test the Barker hypothesis at the microvascular level.Pregnant (gestation day 10) Sprague-Dawley rats were exposed to nano-titanium dioxide aerosols (11.3 ± 0.039 mg/m(3)/hr, 5 hr/d, 8.2 ± 0.85 days) to evaluate the maternal and fetal microvascular consequences of maternal exposure. Microvascular tissue isolation (gestation day 20) and arteriolar reactivity studies (150 μm passive diameter) of the uterine premyometrial and fetal tail arteries were conducted.ENM exposures led to significant maternal and fetal microvascular dysfunction, which was seen as robustly compromised endothelium-dependent and -independent reactivity to pharmacologic and mechanical stimuli. Isolated maternal uterine arteriolar reactivity was consistent with a metabolically impaired profile and hostile gestational environment that impacted fetal weight. The fetal microvessels that were isolated from exposed dams demonstrated significant impairments to signals of vasodilation specific to mechanistic signaling and shear stress.To our knowledge, this is the first report to provide evidence that maternal ENM inhalation is capable of influencing fetal health and that the Barker hypothesis is applicable at the microvascular level.

FETAL ANOMALIES DETECTED BY STANDARD OBSTETRICAL ULTRASOUND (US) LESLEY BEVAN, FRANCESCA FACCO, SVENA JULIEN, TALBOT CHRISTOPHER, Northwestern University, Obstetrics and Gynecology, Chicago, Illinois, Children’s Memorial Hospital, Institute for Fetal Health, Chicago, Illinois OBJECTIVE: To evaluate the utility of MRI in the diagnosis of US detected fetal anomalies. STUDY DESIGN: Retrospective chart review of patients who underwent fetal US and subsequent MRI at our institution over a 3 year period. Data collected included US diagnosis and gestational age (GA) at US and MRI. MRI findings were reviewed and compared with initial US findings and diagnosis. RESULTS: 70 cases were identified. Forty-seven (67%) MRI=s were performed for central nervous system (CNS) abnormalities, 10 (14%) for cardiovascular/thoracic anomalies, 6 (9%) for genitourinary or gastrointestinal anomalies, and 7 (10%) for other indications. MRI enhanced or altered the diagnosis in 67% of the cases. There was no difference in GA of cases in which MRI enhanced or altered US diagnosis versus cases in which MRI yielded no additional information (25.0 versus 25.3 weeks, P .67). MRI confirmed the original US diagnosis in 87% of cases, provided additional clinically useful information regarding the initial diagnosis in 36% of cases, diagnosed an additional anomaly in 26% of cases, and refuted the original diagnosis in 13% of cases. The percentage of cases altered in some way by MRI, stratified by US findings, is presented in the table below. MRI=s performed for CNS anomalies were more likely to provide an additional diagnosis not originally seen on US than MRI’s performed for any other indication (17/47 (36%) vs. 1/22 (5%), P .004). CONCLUSION: MRI enhances the evaluation of US detected fetal anomalies. It is particularly useful in the evaluation of the fetus with an US detected CNS anomaly.