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There is little written in the orthopaedic literature regarding common musculoskeletal problems that women encounter in relation to pregnancy and their clinical and surgical management. Exercise and other physical activity are generally recommended for most women before, during, and after pregnancy. Unfortunately, a variety of musculoskeletal issues may keep women from starting, continuing, or resuming a healthy exercise regimen throughout a notable portion of their reproductive years. Untreated and undertreated orthopaedic conditions in female athletes may therefore have further unintended negative effects on maternal and fetal health. This article reviews the existing literature on musculoskeletal health considerations before, during, and after pregnancy to provide practical information to orthopaedic surgeons who treat women of all ages and athletic abilities.

Cardiotocography is used to record the information of fetal health through fetal heart rate and uterine contractions during pregnancy. Cardiotocography is widely used technique by doctors to evaluate the health of newborn and maternal health, particularly in an emergency condition. Mostly, maternity period complications restrict fetus from proper growth and can cause impairment or death. Safe maternity period, by predicting risk levels before the occasion of complications, encourage proper fetal growth. Prediction of fetal health state from a set of pre-classified patterns knowledge is important in developing a predictive classifier model using data processing algorithms. The main goal of this research is to build a classification model using machine learning algorithms with feature selection techniques that predict whether the fetal is healthy or unhealthy.

Estimates of the effect of foetal health shocks may suffer from survivorship bias. The foetal origins literature seemingly agrees that survivorship bias is innocuous in the sense that it induces a bias towards 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 foetal health shocks., Applied Economics Letters, 29 (21), ISSN:1350-4851, ISSN:1466-4291, ISSN:1350-5851

During pregnancy, complex anatomical, immunological, and microbial changes take place to ensure successful conception, growth, and birth of a full-term, healthy child. However, perhaps due to its complexity, human pregnancy is an inefficient process, with up to 60%–70% of fertilizations ending prematurely. Pregnancy complications are common and may pose a severe threat to both maternal and fetal health. Increasing evidence suggests that microbial factors that are modulated during healthy pregnancies may also contribute to complications thereof. This chapter discusses maternal pregnancy complications including gestational diabetes mellitus, hypertensive disorders, infections, and anemia, as well as fetal/placental complications such as premature rupture of membranes, preterm, and stillbirth. The role of foodborne pathogens, vaginal microbial composition, as well as the gastrointestinal microbiome in these pregnancy complications will be explored.

Health promotion and disease prevention are essential components of prenatal care. Maternal nutrient insufficiencies could negatively impact the morbidity and mortality of the mother-fetus pair as well as the health of the next generations. Although a healthy diet is usually sufficient to meet the increased nutrient needs, supplementation is part of routine care to ensure a healthy pregnancy and optimal fetal development. Currently, iron and folic acid supplementation is the only globally accepted recommendation for all pregnant women. However, there are vulnerable groups of women who could benefit from complementary individualized supplementation schemes. Recently, relevant information has been published related to the supplementation of single and multiple micronutrients with significant effects on maternal and fetal health, which could have implications in the clinical practice of health professionals. This review presents scientific evidence and the recommendations of different entities on the supplementation of iron, folic acid, calcium, vitamin D and multiple micronutrient supplementation during pregnancy.La promoción de la salud y la prevención de enfermedades son componentes esenciales de la atención prenatal. Las insuficiencias de nutrimentos afectan negativamente la morbimortalidad del binomio madre-hijo, así como a la salud de las siguientes generaciones. Aunque una alimentación saludable generalmente es suficiente para cubrir las necesidades aumentadas de micronutrimentos, la suplementación es parte del cuidado habitual para garantizar un embarazo saludable y el desarrollo óptimo del producto. Actualmente la suplementación de hierro y ácido fólico es la única recomendación mundialmente aceptada para todas las mujeres embarazadas. Por otro lado, existen grupos de mujeres vulnerables que podrían beneficiarse de esquemas de suplementación individualizados complementarios. Recientemente se ha publicado información relevante relacionada con la suplementación de distintos micronutrimentos de forma individual y múltiple con efectos importantes en la salud materno-fetal, lo cual podría tener implicaciones en la práctica clínica de los profesionales de la salud. Esta revisión presenta la evidencia científica y las recomendaciones de distintos organismos sobre la suplementación de hierro, ácido fólico, calcio, vitamina D y suplementación múltiple de vitaminas y minerales durante el embarazo.

Lymphoproliferative diseases occurring during pregnancy present unique diagnostic and therapeutic challenges aiming to achieve maternal cure without impairing fetal health, growth, and survival. These goals are further complicated by the fast-paced emergence of novel therapies and their introduction as standard of care, even in newly diagnosed patients. Due to the rarity of hematological malignancies in pregnancy and the exclusion of pregnancy in almost all clinical trials, available data on the fetal effects of novel drugs are limited to animal models and case reports. The current review addresses the entire multidisciplinary team involved in treating pregnant patients with lymphoproliferative diseases. We describe novel agents according to their mechanism of action, and summarize our knowledge of their effects during the gestational period, particularly those associated with fetotoxicity. Therapeutic dilemmas associated with the employment of these new agents are also discussed.

Background Healthcare work environments are fraught with occupational hazards that can impact nurse health as well as patient care. However, little is known about how these hazards impact nurse health during pregnancy, and the experiences of nurses in the work environment during pregnancy and upon their return postpartum. Objective To describe registered nurses’ (RNs’) experiences of working while pregnant and returning to work postpartum. Specifically, their experiences related to the work environment and work-related hazards. Design A qualitative descriptive design was utilized to describe nurse experiences at work, occupational hazards during pregnancy, and experiences of returning to work after pregnancy. Participants and Setting A convenience sample of twenty nurses working in direct patient care roles across the United States were recruited for virtual semi-structured interviews. Method Participants were interviewed using a semi-structured question guide to explore nurse experiences, specifically occupational hazards at work during pregnancy and upon returning to work. Interview transcripts were analyzed using deductive and inductive content analysis. Results Deductive findings for occupational hazards and risks during pregnancy and postpartum included exposure to infectious diseases, imaging, physical tasks (e.g., lifting and performing CPR), cleaning products, patient violence, and medication administration. Inductive thematic findings included: support needed avoid occupational hazards and make necessary modifications; desire to be ‘supernurses’ and put the patient first even when it meant taking risks for our health and that of their child; and fear of the consequences of occupational hazards and exposures. Conclusions Occupational hazards experienced by nurses during pregnancy that may impact their health and that of their baby were broader than previously studied. Pregnant nurses should receive education from their healthcare providers early in their pregnancies about the occupational hazards themselves and the potential modifications they should seek. Managers, occupational health and other health system leaders, and policymakers should be aware of occupational hazards for nurses, including pregnant nurses, and support workplace modifications. Future research should focus on assessing the prevalence of these hazards, the longitudinal impact of exposures that can lead to negative consequences for nurse and fetal health, and reducing the risk of exposure to these hazards for pregnant nurses. Tweetable abstract RNs described a variety of occupational hazards of working while pregnant and postpartum. Inconsistent ability to modify work to protect self and baby leads to completing work demands known to be hazardous.

Monitoring fetal movement patterns is a very common method of assessing fetal health. Currently, there is a lack of a proper device to identify and monitor fetal movement patterns. Therefore in this research, a wearable device with an INS sensor was designed and fabricated to monitor fetal movement. The time-domain data acquired from the device was fed into three analysis methods to separate the fetal movements from the data. Initially, a direct deep learning algorithm was applied. Then a hybrid method where a standard signal processing algorithm combined with CNN was applied. The direct deep learning algorithm identified fetal movements with an average accuracy of 73%. The hybrid method where STFT was combined with CNN identified fetal movement with an average accuracy of 88%.

Coordinated preconception through postpartum cardio-obstetrics care is necessary to optimize both maternal and fetal health. Maternal mortality in the United States is increasing, largely driven by increasing cardiovascular (CV) disease burden during pregnancy and needs to be addressed emergently. Both for women with congenital and acquired heart disease, CV complications during pregnancy are associated with increased future risk of CV disease. Comprehensive cardio-obstetrics care is a powerful way of ensuring that women's CV risks before and during pregnancy are appropriately identified and treated and that they remain engaged in CV care long term to prevent future CV complications.

Background Screening for changes in pregnancy-related anxiety and depressive symptoms during pregnancy may further our understanding of the relationship between these two variables and preterm birth. Objectives To determine whether changes in pregnancy-related anxiety and depressive symptoms during pregnancy influence the risk of preterm birth among Pakistani women; explore whether perceived stress moderates or mediates this relationship, and examine the relationship between the various components of pregnancy-related anxiety and preterm birth. Methods A prospective cohort study design was used to recruit a diverse sample of 300 low-risk pregnant women from four centers of Aga Khan Hospital for Women and Children in Karachi, Pakistan. Changes in pregnancy-related anxiety and depressive symptoms during pregnancy were tested. Multiple logistic regression analysis was used to determine a predictive model for preterm birth. We then determined if the influence of perceived stress could moderate or mediate the effect of depressive symptoms on preterm birth. Results Changes in pregnancy-related anxiety (OR = 1.1, CI 0.97–1.17, p = 0.167) and depressive symptoms (OR = 0.9, CI 0.85–1.03, p = 0.179) were insignificant as predictors of preterm birth after adjusting for the effects of maternal education and family type. When perceived stress was added into the model, we found that changes in depressive symptoms became marginally significant after adjusting for covariates (OR = 0.9, CI 0.82–1.01, p = 0.082). After adjusting for the mediation effect of change in perceived stress, the effect of change in depressive symptoms on preterm birth were marginally significant after adjusting for covariates. Among six different dimensions of pregnancy-related anxiety, mother’s concerns about fetal health showed a trend towards being predictive of preterm birth (OR = 1.3, CI 0.97–1.72, p = 0.078). Conclusions There may be a relationship between perceived stress and antenatal depressive symptoms and preterm birth. This is the first study of its kind to be conducted in Pakistan. Further research is required to validate these results.

We investigated the effects of the timing of early prenatal care on infant health by exploiting a reform that required expectant mothers to initiate prenatal care during the first ten weeks of gestation to obtain a one-time monetary transfer paid after childbirth. Applying a difference-in-differences design to individual-level data on the population of births and fetal deaths, we identified small but statistically significant positive effects of the policy on neonatal health. We further provide suggestive evidence that improved maternal health-related knowledge and behaviors during pregnancy are plausible channels through which the reform might have affected fetal health.

Recruitment planning is needed to establish a foundation for obesity prevention research with high risk, disadvantaged perinatal adolescent populations. In the context of developing clinical trial protocols, investigators partnered with Mississippi's Nutrition Program for Women, Infants and Children (WIC) and adopted the Clinical Trials Transformative Initiative (CTTI) framework for recruitment planning to identify and mitigate challenges to recruitment early in the clinical trial development process. The recruitment protocol consisted of 20 passive strategies grounded in principles of partner and community engagement and was flexible, accommodating, altruistic, community-focused, and minimally burdensome to partners and participants. The recruitment goal included 150 adolescent-coparticipant dyads and 145 dyads (96.7%) were successfully recruited. Investigators demonstrated the feasibility of recruiting a disadvantaged and vulnerable perinatal adolescent population that is underrepresented in health research, in one of the most persistently impoverished and poor health regions in the U.S. Four important aspects of recruitment planning using the CTTI framework are discussed including: (1) establishing partnerships with trusted community resources is a paramount investment; (2) dedicating time and resources to know and go to your community is invaluable; (3) fostering trust by offering convenient, continuous and clear communication; and (4) encouraging collaboration and participation through limiting partner and participant burden. Establishing organizational and community partnership requires a substantial amount of invaluable time and fosters recruitment success. Following the CTTI recommendations for recruitment planning led to a robust recruitment protocol that will be used in future intervention trials with an understudied perinatal adolescent population with high risk for poor maternal and fetal health outcomes.

Fetal movements (FM) are an important factor in the assessment of fetal health. However, there is currently no reliable way to monitor FM outside clinical environs. While extensive research has been carried out using accelerometer-based systems to monitor FM, the desired accuracy of detection is yet to be achieved. A major challenge has been the difficulty of testing and calibrating sensors at the pre-clinical stage. Little is known about fetal movement features, and clinical trials involving pregnant women can be expensive and ethically stringent. To address these issues, we introduce a novel FM simulator, which can be used to test responses of sensor arrays in a laboratory environment. The design uses a silicon-based membrane with material properties similar to that of a gravid abdomen to mimic the vibrations due to fetal kicks. The simulator incorporates mechanisms to pre-stretch the membrane and to produce kicks similar to that of a fetus. As a case study, we present results from a comparative study of an acoustic sensor, an accelerometer, and a piezoelectric diaphragm as candidate vibration sensors for a wearable FM monitor. We find that the acoustic sensor and the piezoelectric diaphragm are better equipped than the accelerometer to determine durations, intensities, and locations of kicks, as they have a significantly greater response to changes in these conditions than the accelerometer. Additionally, we demonstrate that the acoustic sensor and the piezoelectric diaphragm can detect weaker fetal movements (threshold wall displacements are less than 0.5 mm) compared to the accelerometer (threshold wall displacement is 1.5 mm) with a trade-off of higher power signal artefacts. Finally, we find that the piezoelectric diaphragm produces better signal-to-noise ratios compared to the other two sensors in most of the cases, making it a promising new candidate sensor for wearable FM monitors. We believe that the FM simulator represents a key development towards enabling the eventual translation of wearable FM monitoring garments.

This review clearly demonstrates the dramatic impact of a C-section on the morbidity for both mother (pyhsical and emotional) and child (especially related to adverse microbiom development in the growing infant). In addition millions of women who suffer symptoms both locally around the surgical site and more importantly distant effects related to sympathetic up-regulation, mainly through fascial/ fibrotic nerve stimulation. Our experience of the application of Micro Point Stimulation Scar Release therapy to C- section scars resulted in markedly improved pain in these patients who had long-standing symptoms The preliminary but impressive ultrasound findings showing the dramatic reduction in the fibrous/fascial mass after just one session of Micro Point Stimulation Scar therapy of 35 secs adds credence to the efficacy of this procedure in relieving pain symptoms from a simple inexpensive method of treatment. Micro Point Stimulation scar release therapy impacts on distant locations of pain; this challenges the traditionally held concepts of diseases and its pathophysiology. Abdominal and C-section scars may now be viewed as significant systemic contributors to pain and dysfunction throughout the entire body. The overuse of C-sections cannot be justified and it is imperative that the entire practice be reviewed to stem the rising use of this procedure. Where ever possible a delivery should happen in home friendly environment, which is conducive to good health for mother and child.

OBJECTIVE To inform clinical practice by describing a model of perinatal palliative care delivery within a fully staffed fetal health center (FHC) inside a freestanding children's hospital. STUDY DESIGN The team conducted a retrospective chart review of the palliative care team (PaCT) database from FHC's inception in 2010 to 31 December, 2018, and surveyed the FHC neonatologists. RESULTS PaCT consults in the FHC increased from 1 in 2010 to 102 in 2018. PaCT met 430 mothers for prenatal consultation. Of the 390 live-born infants, 172 died; 48 received comfort care only from birth; and 19 survived to discharge home with hospice. At the time of review, PaCT still follows 109 children met prenatally. PaCT discharged 96 patients that no longer required PaCT services. CONCLUSIONS PaCT provides an integral service within the FHC as evidenced by the increasing volume of consultations, variety of care provided and perceived value by FHC neonatologists.

Background The study was performed to evaluate the association between socio-demographic factors on the one hand, and quality of life and illness acceptance on the other, in pregnant women with hyperglycemia. Methods The study was performed in the years 2016–2017 in south-eastern Poland. The study included 676 women: 339 pregnant women with hyperglycemia in the case group, and 337 healthy pregnant women in the control group. The research instruments applied included the WHOQOL-BREF quality of life questionnaire, the Acceptance of Illness Scale (AIS), and a general questionnaire. Results Factors associated with quality of life in women with hyperglycemia include: relationship status, residence, professional activity, living conditions, number of pregnancies, self-reported knowledge of diabetes treatment and lifestyle and also of the potential pregnancy complications and fetal health impact associated with the disease, as well as the type of diabetes treatment (p p Conclusion Better overall quality of life, general perceived health, and quality of life in all specific domains was found among healthy pregnant women compared to those with hyperglycemia. A higher level of illness acceptance has a positive effect on overall quality of life, general perceived health, and quality of life in all specific domains. General Quality of Life is positively correlated with reported living conditions and self-reported knowledge on glucose tolerance disorder treatment and lifestyle recommendations. AIS is positively correlated with living conditions, self-reported knowledge on glucose tolerance disorder treatment and lifestyle recommendations, and self-reported knowledge on possible pregnancy complications and infant health impact associated with glucose tolerance disorders.

The Cardiotocography is the most broadly utilized technique in obstetrics practice to monitor fetal health condition. The foremost motive of monitoring is to detect the fetal hypoxia at early stage. This modality is also widely used to record fetal heart rate and uterine activity. The exact analysis of cardiotocograms is critical for further treatment. In this manner, fetal state evaluation utilizing machine learning technique using cardiotocogram data has achieved significant attention. In this paper, we implement a model based CTG data classification system utilizing a supervised Random Forest (RF) which can classify the CTG data based on its training data. As per the showed up results, the overall performance of the supervised machine learning based classification approach provided significant performance. In this study, Precision, Recall and F-Score has been employed as the metric to evaluate the performance. It was found that, the RF based classifier could identify normal, suspicious and pathologic condition, from the nature of CTG data with 94.8% accuracy. We also highlight the major features based on Mean Decrease Accuracy and Mean Decrease Gini.

Since 1960s, Cardiotocography (CTG) has been considered the primary tool for monitoring fetal health during antepartum and intra-partum periods. It records both Fetal Heart Rate (FHR) and mother's Uterine Contraction Pressure (UCP) simultaneously. However, due to inter and intra-observer variations, the introduction of CTG in fetal care did little to reduce the fetal mortality and morbidity. To ensure that the signs of hypoxia are recognized at the onset it is needed to have a robust and automated clinical decision support system since the visual analysis (clinicians) can be error-prone. In this work, we proposed methods to identify the periodic changes i.e. acceleration and deceleration. Our method detected 987 accelerations and 1755 decelerations from the 556 CTG data. There were 96.6% and 97.3% agreements with the three clinicians estimate for acceleration and deceleration, respectively. Besides, we also proposed a novel method to detect Sinusoidal Heart Rate (SHR) pattern. With Random Forest classifier, the SHR classification accuracy was 93%. The sensitivity and specificity were 93% and 86%, respectively, while both Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were found to be 100%. We conclude that the proposed method can be used as a "gold standard" for SHR identification.

Pregnancy is a cycle that invites us to give up on the hidden power behind all life. A stable pregnancy is a good thing. The likelihood of safe pregnancy is increased by timely and daily fetal treatment. Fetal welfare is a program that controls a pregnant woman during her pregnancy. Every pregnant woman should know what the result of pregnancy is about. Every day about 800 women die from pregnancy and birth complications. Maternal and fetal health have a close relation, as nearly three million newborns die every year. Therefore, adequate treatment is important, including risk evaluations for the health of both mother and child prior, after and during delivery. CTG (Cardiotocography) is a way to monitor and predict fetal well-being in females with a complex issue. Through supplying data on infant heart rate from the abdomen of the mother, CTG avoids premature birth. In this research, we focused on an evolutionary multi-objective genetic algorithm (MOGA) for extracting important factors causing fetal death by cardiotocographic analysis of fetal evaluation. In particular, the feature importance value is taken into consideration when there is a tie among the set of non dominated solutions. Seven existing classification models (LR, SVM, RF, DT, KNN, GNB, XGBoost) are used to test its efficiency concerning fetal health classification in the dataset of most relevant features.

Maternal mortality rates in the United States have steadily increased since 1987 to the current rate of over 16 deaths per 100,000 live births. Whereas most of these deaths are related to an underlying condition, such as cardiovascular disease, many pregnant women die from diseases that emerge as a consequence of pregnancy. Both pre-existing and emergent diseases and conditions are difficult to treat in pregnant women because of the potential harmful effects of the treatment on the developing fetus. Often the health of the woman and the health of the baby are at odds and must be weighed against each other when medical treatment is needed, frequently leading to iatrogenic preterm birth. However, the use of engineered nanomedicines has the potential to fill the treatment gap for pregnant women. This review describes several conditions that may afflict pregnant women and fetuses and introduces how engineered nanomedicines may be used to treat these illnesses. Although the field of maternal-fetal nanomedicine is in its infancy, with additional research and development, engineered nanotherapeutics may greatly improve outcomes for pregnant women and their offspring in the future.

The characterization of the fetal cardiac cycle is an important determination of fetal health and stress. The anomalous appearance of different anatomical structures during different phases of the heart cycle is a key indicator of fetal congenital hearth disease. However, locating the fetal heart using ultrasound is challenging, as the heart is small and indistinct. In this paper, we present a viewpoint agnostic solution that automatically characterizes the cardiac cycle in clinical ultrasound scans of the fetal heart. When estimating the state of the cardiac cycle, our model achieves a mean-squared error of 0.177 between the ground truth cardiac cycle and our prediction. We also show that our network is able to localize the heart, despite the lack of labels indicating the location of the heart in the training process.

Recommendations for screening for hepatitis B immunity in pregnancy and vaccinating susceptible women vary among professional societies. The American College of Obstetricians and Gynecologists recommends vaccinating high-risk women for hepatitis B. However, only one fourth of U.S. adults have received a complete hepatitis B vaccination series. Because two thirds of individuals with chronic hepatitis B are unaware of their diagnosis, risk-based screening for immunity followed by vaccination of susceptible women may not identify and protect all women at risk. Acquisition of hepatitis B poses short-term and long-term risks to maternal and fetal health, an outcome that can be prevented by vaccination. Hepatitis B vaccination in pregnancy is safe and efficacious and can be completed during the course of prenatal care. Universal screening for hepatitis B immunity and vaccination of susceptible women in pregnancy should be a priority during prenatal care. Cost-effectiveness studies are needed to validate this approach.

Objective: Understanding the effects of benzodiazepines (BZDs) on maternal/fetal health remains incomplete despite their frequent use. This article quantifies the effects of antenatal BZD exposure on delivery outcomes. Methods Data Sources: Medline, PsycINFO, CINAHL, Embase, and the Cochrane Library were searched till June 30, 2018. Study Selection: English-language cohort studies comparing antenatal BZD exposure to an unexposed group on any delivery outcome were eligible. In all, 23,909 records were screened, 56 studies were assessed, and 14 studies were included. Data Extraction: Two reviewers independently assessed quality and extracted data. Estimates were pooled using random effects meta-analysis. Sub-analyses examined several potential moderators including timing of exposure. Results: There were 9 outcomes with sufficient data for meta-analysis. Antenatal BZD exposure was significantly associated with increased risk of 6 outcomes initially: spontaneous abortion (pooled odds ratio = 1.86; 95% confidence interval [CI], 1.43 to 2.42), preterm birth (1.96; 95% CI, 1.25 to 3.08), low birth weight (2.24; 95% CI, 1.41 to 3.88), low Apgar score (2.19; 95% CI, 1.94 to 2.47), Neonatal Intensive Care Unit (NICU) admission (2.61; 95% CI, 1.64 to 4.14), and induced abortion (2.04; 95% CI, 1.23 to 3.40). There was significant heterogeneity between studies for most outcomes without consistent moderators. Birth weight (mean difference [MD]: −151.35 g; 95% CI, −329.73 to 27.03), gestational age (−0.49 weeks; 95% CI, −1.18 to 0.19), and small for gestational age (SGA; 1.42; 95% CI, 1.00 to 2.01) did not show significant associations although after adjusting for publication bias, gestational age, and SGA became significant, totaling 8 significant outcomes. Conclusions: Antenatal BZD exposure appears to be statistically associated with increased risk of several adverse perinatal outcomes. Although confounds cannot be ruled out, NICU admission does appear clinically relevant and consistent with the antidepressant literature.

Fetal ECG monitoring has become important as it helps to detect the abnormalities in child during pregnancy. The prior knowledge about the fetal health could help in reducing complications and maintaining good and healthy pregnancy. FECG is contaminated by many external factors so its extraction becomes little complicated. FECG is used to examine the structure and functioning of baby’s heart. It helps us to identify and diagnose congenital heart defects before birth. The total nine months of pregnancy is divided into three trimesters. During each trimester, the fetus grows and develops to the next stage. A test will be done on each trimester to detect birth defects, identify correct some kinds of fetal problems that may affect child birth. This paper performs some research explorations on various techniques and algorithms used for the extraction of Fetal ECG from Maternal ECG.

Electrocardiogram (ECG) is a cardiac test that records the timing and strength of electrical signals primarily responsible for heartbeats. An ECG data is used to gain an insight into irregularities in the heart rhythms. A Fetal Electrocardiogram (fECG) is extracted from the abdominal electrocardiogram signal of pregnant women. This is a non-invasive method for recording fECG during the early weeks of pregnancy and is an effective diagnostic tool used by clinicians to regularly evaluate the foetus health status. The aim of this paper is to put forward architecture for continuous monitoring of fetal electrocardiogram from maternal ECG to avoid any kind of acute condition caused to the newborn child at the time of birth. The continuous acquisition of fECG will lead to a very large amount of data to send over the cloud for further examination by the doctor, this data has to be pre-processed before moving it to the cloud for a much faster and efficient evaluation. The proposed architecture along with the Healthcare 4.0 environment and mobile fog computing; will have a potential to extend, virtualize new and efficient healthcare processes for fetal health monitoring.

Gestational diabetes mellitus is a progressive and complex pregnancy complication, which threatens both maternal and fetal health. It is urgent to screen for specific biomarkers for early diagnosis and precise treatment, as well as to identify key moleculars to better understand the pathogenic mechanisms. In the present review, we comprehensively summarized recent studies of gestational diabetes using mass spectrometry-based proteomic technologies. Focused on the entire experimental design and proteomic results, we showed that these studies have covered a broad range of research contents in terms of sampling time, sample types, and outcome associations. Although most of the studies only stayed in the stage of initial discovery, several proteins were further verified to be efficient for disease diagnosis. Functional analysis of all the combined significant proteins also showed that a small number of proteins are known to be involved in the regulation of insulin or indirect signaling pathways. However, many factors such as diagnostic criteria, sample processing, proteomic method, and statistical method can greatly affect the identification of reproducible and reliable protein candidates. Thus, we further provided constructive suggestions and recommendations for carrying out proteomic or follow-up studies of gestational diabetes or other pregnancy complications in the future.

Background and Objective: Biometric measurements of fetal head are important indicators for maternal and fetal health monitoring during pregnancy. 3D ultrasound (US) has unique advantages over 2D scan in covering the whole fetal head and may promote the diagnoses. However, automatically segmenting the whole fetal head in US volumes still pends as an emerging and unsolved problem. The challenges that automated solutions need to tackle include the poor image quality, boundary ambiguity, long-span occlusion, and the appearance variability across different fetal poses and gestational ages. In this paper, we propose the first fully-automated solution to segment the whole fetal head in US volumes. Methods: The segmentation task is firstly formulated as an end-to-end volumetric mapping under an encoder-decoder deep architecture. We then combine the segmentor with a proposed hybrid attention scheme (HAS) to select discriminative features and suppress the non-informative volumetric features in a composite and hierarchical way. With little computation overhead, HAS proves to be effective in addressing boundary ambiguity and deficiency. To enhance the spatial consistency in segmentation, we further organize multiple segmentors in a cascaded fashion to refine the results by revisiting context in the prediction of predecessors. Results: Validated on a large dataset collected from 100 healthy volunteers, our method presents superior segmentation performance (DSC (Dice Similarity Coefficient), 96.05%), remarkable agreements with experts. With another 156 volumes collected from 52 volunteers, we ahieve high reproducibilities (mean standard deviation 11.524 mL) against scan variations. Conclusion: This is the first investigation about whole fetal head segmentation in 3D US. Our method is promising to be a feasible solution in assisting the volumetric US-based prenatal studies., Comment: Accepted by Computer Methods and Programs in Biomedicine

Environmental chemicals comprise a major portion of the human exposome, with some shown to impact the health of susceptible populations, including pregnant women and developing fetuses. The placenta and cord blood serve as important biological windows into the maternal and fetal environments. In this article we review how environmental chemicals (defined here to include man-made chemicals [e.g., flame retardants, pesticides/ herbicides, per- and polyfluoroalkyl substances], toxins, metals, and other xenobiotic compounds) contribute to the prenatal exposome and highlight future directions to advance this research field. Our findings from a survey of recent literature indicate the need to better understand the breadth of environmental chemicals that reach the placenta and cord blood, as well as the linkages between prenatal exposures, mechanisms of toxicity, and subsequent health outcomes. Research efforts tailored towards addressing these needs will provide a more comprehensive understanding of how environmental chemicals impact maternal and fetal health.

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.

Frecuentemente, el ginecólogo obstetra debe enfrentar situaciones complicadas en la práctica de la obstetricia; una de ellas es la rotura de membranas en un embarazo pretérmino. Si bien la conducta médica que debe tomar está encaminada a preservar la salud tanto materna como fetal, muchas veces, la decisión puede afectar la salud fetal en aras de preservar la salud materna. Esto ocurre cuando la presencia de una infección hace imposible mantener el curso normal de la gestación y la edad gestacional no es de término. En muchos casos, las complicaciones que ocasionará la prematuridad del recién nacido pondrán en riesgo su vida y por lo tanto debemos estar preparados para minimizar las consecuencias de nuestra decisión. En el presente artículo revisamos el manejo basado en evidencias, que el ginecólogo obstetra debería considerar cuando ocurre esta situación.

This article aims to provide an initiative for future research to explore the relationships among impulsivity, palatable food intake, and gestational weight gain in pregnancy. Drawing from the extensive evidence linking impulsivity to a tendency towards palatable food intake and subsequent risk for weight gain and obesity in non-pregnant populations, it is argued that impulsivity may serve as an important maternal characteristic that augments risk for excessive gestational weight gain by promoting increased palatable food intake in and difficulty adhering to dietary guidelines for pregnancy. Given the maternal and fetal health risks associated with excessive gestational weight gain, there is a need to better understand whether and how impulsivity, palatable food intake, and gestational weight gain interrelate in pregnancy to determine their potential clinical relevance.

Pre-eclampsia is a pregnancy-specific disorder that can significantly alter maternal physiology and result in a considerable threat to maternal and fetal health. Although many of the mechanisms involved in its pathophysiology have been elucidated, significant knowledge gaps remain. Perhaps as a result, there is no known treatment for the condition, and birth is the only known cure. The optimal timing of birth can present a difficult decision in the face of maternal or fetal demise; therefore maternal and fetal condition must be monitored and stabilised with the aim of prolonging pregnancy until this time is evident, or until birth becomes necessary. Intervention involves screening pregnant women with the aim of initiating aspirin prophylaxis for those deemed to be at increased risk. This article discusses the pathophysiological mechanisms involved in pre-eclampsia, factors that may impact on pathophysiology, controversies around screening, and the mechanism of aspirin prophylaxis.

Magnetic resonance neuroimaging (MRI) studies of healthy pregnant women could identify key mechanisms of spontaneous health behavior changes observed in expectant mothers as novel intervention targets, but are currently unprecedented. As balancing potential benefits of research with unknown risks, including participant perceptions of risk, is foundational to ethical conduct, we surveyed a convenience obstetric sample to understand pregnant women's perspectives on this issue. Respondents were 76 pregnant women (modal age of 30-39 years; 64% multiparous) presenting for obstetric care from April to June 2016 at privately and publicly funded clinics at an urban academic medical center in the Midwestern USA. Following a written description about functional magnetic resonance neuroimaging (fMRI) and its known and unknown risks, women were queried on their willingness to participate in a hypothetical study involving fMRI during pregnancy, and specific concerns about doing so, if hesitant or unwilling. Willingness to participate was "yes" (28.4%, n = 21), "maybe" (28.4%, n = 21), and "no" (43.2%, n = 32). Among those responding "maybe" or "no" (n = 53, 73.6%), 11 women (20.7%) articulated concern about the fetus. Other concerns expressed were time commitment (n = 11, 20.7%) and discomfort being in an MRI machine (n = 4; 7.5%). Pregnant women may be open to participating in research involving MRI provided concerns about fetal health, time, and personal comfort are addressed.

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.

Maternal fatty acids are essential for fetal growth and development. Here, we examine associations between maternal mid-pregnancy plasma n-3 and n-6 polyunsaturated fatty acids (PUFAs) and fetal health determined by fetal growth velocity, birth weight and duration of pregnancy.Participants were 6974 pregnant women and their infants from a population-based birth cohort, the Generation R Study. Maternal plasma n-3:n-6 PUFA ratio and n-3 and n-6 PUFA percentage in glycerophospholipids in mid-pregnancy were related to fetal growth velocity calculated from repeatedly measured weight, length and head circumference, birth weight, and duration of pregnancy.A higher maternal mid-pregnancy n-3:n-6 PUFA ratio was associated with a higher growth velocity of the fetal weight (β = 0.082 SD-score/week, 95% CI 0.055; 0.108, P 0.001), length (β = 0.085 SD-score/week, 95% CI 0.052; 0.119, P 0.001); and head (β = 0.055 SD-score/week, 95% CI 0.019; 0.091, P = 0.003). We also observed positive associations between n-3:n-6 PUFA ratio and birth weight (β = 0.76 SD-score, 95% CI 0.22; 1.29, P = 0.006), and duration of pregnancy (β = 1.32 weeks, 95% CI 0.24; 2.40, P = 0.02).These results are consistent with the hypothesis that a higher n-3:n-6 PUFA ratio is important for fetal health.

Effective fetal monitoring is an important guarantee for fetal health and early treatment. Fetal movement is one of critical indicators of fetal monitoring, which plays an important role in fetal health. Counting the number of fetal movement by pregnant women is a traditional method for long-term monitoring. However, there are many defects in pregnant women’s feeling count, which cannot meet the accurate requirements of modern perinatal medicine. With the rapid development of biological and electronic technology, various sensors are used to probe the fetal dynamic monitoring, but not on fetal movement. This research proposes a monitoring method for fetal movement via three electrodes. Briefly: first, three electrodes are used to extract electrical signals in the abdomen of pregnant women; second, these signals are amplified and filtered; third, A/D converter with microprocessor is used to make analog digital conversion, which can be stored in the SD card under the control of the microprocessor; finally, the SD card data are processed by computer software and the fetal movement information is analyzed.

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.

Modeling the Placenta Placental health is critical to fetal health, but modeling the placenta is difficult. A recent study shows that both human and porcine stem-cell cultures can, in fact, be effi...