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Objective: Pre‐eclampsia (PE) is a serious complication of pregnancy associated with maternal and fetal morbidity and mortality. As current prediction models have limitations and may not be applicable in resource‐limited settings, we aimed to develop a machine‐learning (ML) algorithm that offers a potential solution for developing accurate and efficient first‐trimester prediction of PE. Methods: We conducted a prospective cohort study in Mexico City, Mexico to develop a first‐trimester prediction model for preterm PE (pPE) using ML. Maternal characteristics and locally derived multiples of the median (MoM) values for mean arterial pressure, uterine artery pulsatility index and serum placental growth factor were used for variable selection. The dataset was split into training, validation and test sets. An elastic‐net method was employed for predictor selection, and model performance was evaluated using area under the receiver‐operating‐characteristics curve (AUC) and detection rates (DR) at 10% false‐positive rates (FPR). Results: The final analysis included 3050 pregnant women, of whom 124 (4.07%) developed PE. The ML model showed good performance, with AUCs of 0.897, 0.963 and 0.778 for pPE, early‐onset PE (ePE) and any type of PE (all‐PE), respectively. The DRs at 10% FPR were 76.5%, 88.2% and 50.1% for pPE, ePE and all‐PE, respectively. Conclusions: Our ML model demonstrated high accuracy in predicting pPE and ePE using first‐trimester maternal characteristics and locally derived MoM. The model may provide an efficient and accessible tool for early prediction of PE, facilitating timely intervention and improved maternal and fetal outcome. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article, titled "OP13.04: Predictive performance of combined screening plus PlGF for fetal growth restriction," evaluates the predictive performance of combined screening for fetal growth restriction compared to combined screening plus PIGF. The study was conducted from 2016 to 2022 and included single pregnancies with combined screening for aneuploidies and determination of PIGF. The results showed that both tests had a positive predictive value and low discriminatory capacity, but identified cut-off points with higher performance that could improve the prediction of fetal growth restriction. The article was authored by S. Acevedo-Gallegos, A. Pérez García, J. Gallardo Gaona, B. Velazquez Torres, M.J. Rodriguez-Sibaja, J. Ramirez-Calvo, Y. Copado Mendoza, M.I. Lumbreras-Marquez, and D.M. Camarena Cabrera. [Extracted from the article]

This article, published in the journal Ultrasound in Obstetrics & Gynecology, discusses the fetal diagnosis of agenesis of the ductus venosus (ADV) and its corresponding perinatal outcomes. The study included 17 patients diagnosed with ADV out of 2,775 patients evaluated at a fetal cardiology unit. The most common type of ADV was the intrahepatic variety, and only two patients had chromosomal abnormalities. The article highlights the high prevalence of pulmonary hypertension in patients with extrahepatic ADV and the higher mortality rates associated with this condition. The authors emphasize the importance of early diagnosis and the need for further research on ADV. [Extracted from the article]

This article discusses a study conducted to assess the knowledge of medical staff regarding perinatal palliative care (PPC). The study involved a survey that was distributed to medical personnel specializing in Obstetrics and Maternal Fetal Medicine. The results showed that there was a lack of access to PPC courses, as only a small percentage of participants had received training in this area. The authors suggest that it is important to include PPC knowledge in the courses of Gynecology and Obstetrics, and Materno‐Fetal Medicine. [Extracted from the article]

This article discusses the approach to perinatal palliative care for cases of life-limiting fetal pathology at the National Institute of Perinatology. The study included 187 patients who received palliative care, with 35 experiencing stillbirth and receiving psychoemotional support for grief, while the remaining 152 patients were formally admitted to the palliative care clinic. The most common diagnosis was fetal heart disease, and the average age of resolution was 35.6 weeks. The majority of patients underwent vaginal resolution, and no stillbirths occurred. Most patients were discharged due to death, while the rest were discharged home. The study highlights the challenges of adapting palliative care to the prenatal stage and emphasizes the importance of providing support and information to parents. [Extracted from the article]

This article, titled "Prenatal and postnatal diagnosis of fetuses with severe ventriculomegaly: 20 years of experience in a tertiary center," provides a retrospective study on the diagnosis of fetuses with severe ventriculomegaly. The study collected data from January 2001 to April 2022 and included patients with single pregnancies and a fetus diagnosed with severe ventriculomegaly. The article presents the different categories of ventriculomegaly and their causes, as well as the correlation between prenatal and postnatal diagnoses. The study concludes that severe ventriculomegaly requires interdisciplinary evaluation and close monitoring due to its uncertain prognosis. [Extracted from the article]

This article is a secondary analysis of the ASPIRIN trial, which aimed to determine if there is a difference in the incidence of fetal and neonatal adverse events based on the gestational age of low-dose aspirin (LDA) initiation. The study involved nulliparous women who were randomized to either LDA or a placebo between 6+0/7 and 13+6/7 weeks of gestation. The results showed no significant heterogeneity in the incidence of adverse fetal and neonatal events between patients who started LDA consumption before or after 11.0 weeks of gestation. [Extracted from the article]

Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vertical transmission has been investigated extensively. Recently, the World Health Organization (WHO) published strict criteria to classify the timing of mother-to-child transmission of SARS-CoV-2 into different categories. The aim of this study was to investigate the possibility of vertical transmission in asymptomatic SARS-CoV-2-positive women.Methods: Pregnant women attending for delivery at a perinatology center in Mexico City, Mexico, who had a SARS-CoV-2-positive nasopharyngeal swab 24-48 h before delivery, were asymptomatic at the time of the test and had an obstetric indication for Cesarean section were eligible for inclusion in this study. Amniotic fluid was collected during Cesarean delivery, and neonatal oral and rectal swabs were collected at birth and at 24 h after birth. SARS-CoV-2 detection was carried out using real-time reverse-transcription polymerase chain reaction in all samples. Relevant medical information was retrieved from clinical records. The WHO criteria for classifying the timing of mother-to-child transmission of SARS-CoV-2 were applied to the study population.Results: Forty-two SARS-CoV-2-positive asymptomatic pregnant women fulfilled the inclusion criteria. Twenty-five (59%) women developed mild disease after discharge. Neonatal death occurred in three (7%) cases, of which one had a positive SARS-CoV-2 test at birth and none had coronavirus disease 2019-related symptoms. There were five (12%) cases with strong evidence of intrauterine transmission of SARS-CoV-2, according to the WHO criteria, as amniotic fluid samples and neonatal samples at birth and at 24 h after birth were positive for SARS-CoV-2. Our results also showed that 40-60% of infected neonates would have been undetected if only one swab (oral or rectal) was tested.Conclusion: This study contributes evidence to reinforce the potential for vertical transmission of SARS-CoV-2 even in asymptomatic women and highlights the importance of testing more than one neonatal sample in order to increase the detection rate of SARS-CoV-2 in affected cases. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

To assess the predictive value of abdominal circumference growth velocity (ACGV) between the second and third trimesters for the prediction of adverse perinatal outcomes (APO) in small-for-gestational-age (SGA) fetuses. Crude and adjusted odds ratios (OR) and corresponding confidence intervals (CI) were calculated via logistic regression models to assess the presence and magnitude of a potential association between abnormal ACGV (ACGV < 10 SP th sp centile) and APO defined as a composite outcome (i.e. umbilical artery pH < 7.1, 5-minute Apgar score < 7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). Although we found an association between abnormal ACGV and the primary outcome, the 95% CI for both crude (OR 1.58, 95% CI 0.64, 3.86) and adjusted (aOR 1.92, 95% CI 0.67, 5.53) effects included the null. [Extracted from the article]

To describe accuracy of ultrasound in antenatal diagnosis of abnormally invasive placenta (AIP) prior introducing standardised ultrasound descriptors. Comparison is needed with the performance using standardised ultrasound descriptors. [Extracted from the article]

To assess risk for severe coronavirus disease 2019 (COVID-19) among pregnant individuals by timeframe relative to Delta and Omicron variant predominance. Conclusions Compared to pre-Delta and Delta periods, the risk of mortality, ICU admission, and invasive ventilation was lower among pregnant individuals during Omicron variant predominance. OC05.07: Comparative analysis of maternal morbidity and mortality associated with COVID-19 pre-Delta, Delta and Omicron variants. [Extracted from the article]

To quantify the knowledge about pre-eclampsia and its short and long-term repercussions in postpartum patients with a diagnosis of pre-eclampsia. EP02.17: Knowledge about pre-eclampsia and its repercussions in the short and long term in postpartum patients diagnosed with pre-eclampsia Only 28.9 % of patients knew about risk of hypertensive disease in the future after presenting pre-eclampsia, and 20.1% about renal disease.75.5% of patients were unaware that pre-eclampsia can be prevented. [Extracted from the article]

All analysed variables showed a significant association with the composite outcome: pBMI > 30 (OR 4.8, 95% CI 1.1-20.6), fetal AC > 75th centile at the third trimester scan (OR 5.39, 95% CI 3.06-9.50), and polyhydramnios (OR 3.57, 95% CI 1.42-8.9). To assess the value of auxiliary maternal and fetal variables for the prediction of adverse perinatal outcomes (APO) in women with gestational diabetes with optimal glucose levels. The mean gestational age at the third trimester scan was 32.5 weeks, and the mean gestational age and weight at delivery were 37.8 weeks and 3,107 g, respectively. [Extracted from the article]

Conclusions The results suggest that the placental histopathological profile of T21 GR fetuses is different from euploid GR fetuses. Furthermore, this difference remained significant in GR fetuses (P < 0.001) and among those GR fetuses with abnormal Doppler (P = 0.019); of note, umbilical artery Doppler abnormalities were the most prevalent finding in the latter group. To assess placental histopathological differences between Trisomy 21 (T21) and euploid growth-restricted (GR) fetuses. [Extracted from the article]

Results 72 (33.8%) patients had an elective Caesarean delivery (CD), 73 (34.3%) women had spontaneous labour, and 68 (31.9%) had a labour induction (LI). EP37.05: Intended delivery mode and neonatal outcomes in growth-restricted fetuses To compare neonatal outcomes in pregnancies diagnosed with fetal growth restriction (FGR) by intended delivery mode. [Extracted from the article]

Results A total of 26 patients with diagnosis of Ebstein's anomaly or Tricuspid valve dysplasia were included in our study. Ebstein's anomaly and tricuspid valve dysplasia are rare cardiac malformations associated with high mortality. [Extracted from the article]

EP01.40: External validation of two competing risks model for the prediction of pre-eclampsia The performance of previously created models from Hospital Clinic of Barcelona and the FMF was assessed at 10 and 15% false-positive rates (FPR) and compared using the area under the curve (AUC) by DeLong method. To validate and compare the performance Hospital Clinic of Barcelona's competing risk model for the prediction of preterm pre-eclampsia (pPE) to that of the Fetal Medicine Foundation-2012 (FMF), in Mexican population. [Extracted from the article]

The second model was created by nested logistic regression adding anthropometric variables, serum, and ultrasound biomarkers to a previous model of maternal history using a stepwise method for variable selection. We performed an elastic net model that uses ridge and lasso regressions that automatically selects the best predictive variables for pPE, penalises non-statistically significant variables, and selects the best model using 10-fold cross-validation. To assess the performance of a machine learning algorithm compared to a logistic model for the prediction of preterm pre-eclampsia (< 37 weeks [pPE]) in Mexican population. [Extracted from the article]

Background: Congenital uterine anomalies include a wide diversity of uterine malformations that can compromise reproductive potential. Uterus transplantation (UTx) proposes an innovative treatment for absolute uterine factor infertility; however, there is a lack of standardized protocols to guide clinical management among this population., Objectives: To describe recipient and donor characteristics and obstetric outcomes in patients undergoing UTx., Search Strategy: We performed a literature search using the PubMed database to retrieve available scientific articles. We analyzed the references of included articles to assess additional articles that could be eligible to be included in the review. Likewise, we identified further studies using other methods, including Google Scholar., Selection Criteria: Titles and abstracts were screened in duplicate to select original reports with information available for the outcomes of interest., Data Collection and Analysis: This review assessed the advantages and disadvantages of the techniques used, patient characteristics, obstetric and non-obstetric complications, functional duration of the organ, and neonatal outcomes., Main Results: Among the 36 reports included in this review we found 55 pregnancies and 38 live births following UTx and a higher success rate for in vivo uterine donations. The most common obstetric complications reported included miscarriage, pre-eclampsia, and gestational hypertension. The most common non-obstetric complications reported include episodes of rejection, acute kidney injury, anemia, and cholestasis. Living donors required a comprehensive preoperative workup, decreasing organ rejection, infection, and vascular complications., Conclusions: More studies are needed to standardize the UTx procedure and improve obstetric, fetal, and neonatal outcomes. Further understanding of which recipient and donor characteristics minimize complications will significantly decrease the risk of adverse outcomes., (© 2024 International Federation of Gynecology and Obstetrics.)

Objective: To determine the individual learning curves for cordocentesis in a low-cost simulator for maternal-fetal medicine (MFM) fellows., Methods: This observational, descriptive, educational, and prospective study was performed from July through November 2022. After an introductory course based on a standardized technique for cordocentesis, each second-year MFM fellow who accepted to participate in the study performed this procedure using a low-cost simulation model, and experienced operators supervised the cordocenteses. Learning curves were then created using cumulative sum analysis (CUSUM)., Results: Seven second-year MFM fellows with no previous experience in cordocentesis accepted to participate in the study. A total of 2676 procedures were assessed. On average, residents performed 382 ± 70 procedures. The mean number of procedures to achieve proficiency was 369 ± 70, the overall success rate was 84.16%, and the corresponding failure rate was 15.84%. At the end of the study, all fellows were considered competent in cordocentesis. One fellow required 466 attempts to achieve competency, performing a total of 478 procedures, but the resident with the fewest attempts to reach competency required 219 procedures, completing 232 procedures. Some of the most frequent reasons for failed attempts included not reaching the indicated point for vascular access (20.99%) and being unable to retrieve the sample (69.10%)., Conclusion: CUSUM analysis to assess learning curves, in addition to using low-cost simulation models, helped to appraise individualized learning, allowing an objective demonstration of competency for cordocentesis among MFM fellows., (© 2024 International Federation of Gynecology and Obstetrics.)

Background: Research on the definition of fetal growth restriction (FGR) has focused on predicting adverse perinatal outcomes. A significant limitation of this approach is that the individual outcomes of interest could be related to the condition and the treatment. Evaluation of outcomes that reflect the pathophysiology of FGR may overcome this limitation., Objective: To compare the diagnostic performance of the FGR definitions established by the International Society for Ultrasound in Obstetrics and Gynecology (ISUOG) and the Society for Maternal-Fetal Medicine (SMFM) to predict placental histopathological findings associated with placental insufficiency and a composite adverse neonatal outcome (ANeO)., Study Design: In this retrospective cohort study of singleton pregnancies, the ISUOG and the SMFM guidelines were used to identify pregnancies with FGR and a corresponding control group. The primary outcome was the prediction of placental histopathological findings associated with placental insufficiency, defined as lesions associated with maternal vascular malperfusion (MVM). A composite ANeO (ie, umbilical artery pH≤7.1, Apgar score at 5 minutes ≤4, neonatal intensive care unit admission, hypoglycemia, respiratory distress syndrome requiring mechanical ventilation, intrapartum fetal distress requiring expedited delivery, and perinatal death) was investigated as a secondary outcome. Sensitivity, specificity, positive and negative predictive values, and the areas under the receiver-operating-characteristics curves were determined for each FGR definition. Logistic regression models were used to assess the association between each definition and the studied outcomes. A subgroup analysis of the diagnostic performance of both definitions stratifying the population in early and late FGR was also performed., Results: Both societies' definitions showed a similar diagnostic performance as well as a significant association with the primary (ISUOG adjusted odds ratio 3.01 [95% confidence interval 2.42, 3.75]; SMFM adjusted odds ratio 2.85 [95% confidence interval 2.31, 3.51]) and secondary outcomes (ISUOG adjusted odds ratio 1.95 [95% confidence interval 1.56, 2.43]; SMFM adjusted odds ratio 2.12 [95% confidence interval 1.70, 2.65]). Furthermore, both FGR definitions had a limited discriminatory capacity for placental histopathological findings of MVM and the composite ANeO (area under the receiver-operating-characteristics curve ISUOG 0.63 [95% confidence interval 0.61, 0.65], 0.59 [95% confidence interval 0.56, 0.61]; area under the receiver-operating-characteristics SMFM 0.63 [95% confidence interval 0.61, 0.66], 0.60 [95% confidence interval 0.57, 0.62])., Conclusion: The ISUOG and the SMFM FGR definitions have limited discriminatory capacity for placental histopathological findings associated with placental insufficiency and a composite ANeO. El resumen está disponible en Español al final del artículo., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Preeclampsia (PE) is a multifactorial pregnancy disorder characterized by hypertension and proteinuria, posing significant risks to both maternal and fetal health. Despite extensive research, its complex pathophysiology remains incompletely understood. This narrative review aims to elucidate the intricate mechanisms contributing to PE, focusing on abnormal placentation, maternal systemic response, oxidative stress, inflammation, and genetic and epigenetic factors. This review synthesizes findings from recent studies, clinical trials, and meta-analyses, highlighting key molecular and cellular pathways involved in PE. The review integrates data on oxidative stress biomarkers, angiogenic factors, immune interactions, and mitochondrial dysfunction. PE is initiated by poor placentation due to inadequate trophoblast invasion and improper spiral artery remodeling, leading to placental hypoxia. This triggers the release of anti-angiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), causing widespread endothelial dysfunction and systemic inflammation. Oxidative stress, mitochondrial abnormalities, and immune dysregulation further exacerbate the condition. Genetic and epigenetic modifications, including polymorphisms in the Fms-like tyrosine kinase 1 (FLT1) gene and altered microRNA (miRNA) expression, play critical roles. Emerging therapeutic strategies targeting oxidative stress, inflammation, angiogenesis, and specific molecular pathways like the heme oxygenase-1/carbon monoxide (HO-1/CO) and cystathionine gamma-lyase/hydrogen sulfide (CSE/H2S) pathways show promise in mitigating preeclampsia's effects. PE is a complex disorder with multifactorial origins involving abnormal placentation, endothelial dysfunction, systemic inflammation, and oxidative stress. Despite advances in understanding its pathophysiology, effective prevention and treatment strategies remain limited. Continued research is essential to develop targeted therapies that can improve outcomes for both mothers and their babies.

Objective: To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode. Methods: This is a retrospective cohort study of singleton pregnancies with FGR that were delivered ≥34.0 weeks gestation. Neonatal outcomes were compared according to the intended delivery mode, which the attending obstetrician determined. Of note, none of the subjects had a contraindication to labor. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between intended delivery mode and neonatal morbidity defined as a composite outcome (i.e. umbilical artery pH ≤7.1, 5-min Apgar score ≤7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). A sensitivity analysis excluded intrapartum fetal distress requiring emergency cesarean delivery from the composite outcome since only patients with spontaneous labor or labor induction could meet this criterion. Potential confounders in the adjusted effects models included maternal age, body mass index, hypertensive disorders, diabetes, FGR type (i.e. early or late), and oligohydramnios. Results: Seventy-two (34%) patients had an elective cesarean delivery, 73 (34%) had spontaneous labor and were expected to deliver vaginally, and 67 (32%) underwent labor induction. The composite outcome was observed in 65.3%, 89%, and 88.1% of the groups mentioned above, respectively ( p  < 0.001). Among patients with spontaneous labor and those scheduled for labor induction, 63% and 47.8% required an emergency cesarean delivery for intrapartum fetal distress. Compared to elective cesarean delivery, spontaneous labor (OR 4.32 [95% CI 1.79, 10.42], p  = 0.001; aOR 4.85 [95% CI 1.85, 12.66], p  = 0.001), and labor induction (OR 3.92 [95% CI 1.62, 9.49] p  = 0.002; aOR 5.29 [95% CI 2.01, 13.87], p  = 0.001) had higher odds of adverse neonatal outcomes. Conclusion: In this cohort of FGR, delivering at ≥34 weeks of gestation, pregnancies with spontaneous labor, and those that underwent labor induction had higher odds of neonatal morbidity than elective cesarean delivery.

Objective: To assess the predictive value of abdominal circumference growth velocity (ACGV) between the second and third trimesters to predict adverse perinatal outcomes in a cohort of small-for-gestational-age fetuses without evidence of placental insufficiency (i.e. fetal growth restriction)., Material and Methods: This is a single-center retrospective cohort study of all singleton pregnancies with small-for-gestational-age fetuses diagnosed and delivered at a quaternary institution. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between abnormal ACGV (i.e. ≤10th centile) and adverse perinatal outcomes defined as a composite outcome (i.e. umbilical artery pH <7.1, 5-min Apgar score <7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). Furthermore, the area under the receiver-operating characteristic curve (AUC) of three logistic regression models based on estimated fetal weight and ACGV for predicting the composite outcome is also reported., Results: A total of 154 pregnancies were included for analysis. The median birthweight for the cohort was 2,437 g (interquartile range [IQR] 2280, 2635). Overall, the primary composite outcome was relatively common (29.2%). In addition, there was a significant association between abnormal ACGV and adverse perinatal outcomes (OR 3.37, 95% CI 1.60, 7.13; adjusted OR 4.30, 95% CI 1.77, 10.49). Likewise, the AUC for the ACGV was marginally higher (0.64) than the estimated fetal weight (0.54) and ACGV + estimated fetal weight (0.54). Still, no significant difference was detected between the curves ( p  = 0.297)., Conclusions: Our results suggest that an ACGV below the 10th centile is a risk factor for adverse perinatal outcomes among small-for-gestational-age fetuses.

Objective: To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021., Design: Descriptive multi-country secondary data analysis., Setting: Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021., Population: Liveborn infants., Methods: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study., Results: Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%)., Conclusions: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objective: To identify and quantify the effects of maternal characteristics and medical history on the distribution of Placental Growth Factor (PlGF), mean arterial pressure (MAP), and Uterine Artery Mean Pulsatility Index (UtA-PI); and to standardize the expected values for these biomarkers in the first trimester to create unique multiples of the median (MoMs) for Latin-American population., Methods: This is a prospective cohort built exclusively for research purposes of consecutive pregnant women attending their first-trimester screening ultrasound at a primary care center for the general population in Mexico City between April 2019 and October 2021. We excluded fetuses with chromosomal abnormalities, major fetal malformations, and women delivering in another care center. Linear regression was used on log-transformed biomarkers to assess the influence of maternal characteristics on non-preeclamptic women to create MoM., Results: Of a total of 2,820 pregnant women included in the final analysis, 118 (4.18%) developed PE, of which 22 (0.78%) delivered before 34 weeks of gestation, 74 (2.62%) before 37 weeks, and 44 (1.56%) from 37 weeks gestation. Characteristics that significantly influenced PLGF were fetal crown rump length (CRL), maternal age, nulliparity, body mass index (BMI), chronic hypertension, Lupus, spontaneous pregnancy, polycystic ovary syndrome (PCOS), hypothyroidism, preeclampsia (PE) in a previous pregnancy, and mother with PE. MAP had significant influence from CRL, maternal age, PE in a previous pregnancy, induction of ovulation, a mother with PE, chronic hypertension, BMI, and hypothyroidism. UtA-PI was influenced by CRL, maternal age, a mother with PE, chronic hypertension, and gestational diabetes mellitus (GDM) in a previous pregnancy., Conclusion: Population-specific multiples of the median (MoMs) for PlGF, MAP, and UtA-PI in the first trimester adequately discriminate among women developing preeclampsia later in pregnancy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Torres-Torres, Espino-y-Sosa, Villafan-Bernal, Orozco-Guzman, Solis-Paredes, Estrada-Gutierrez, Martinez-Cisneros, Mateu-Rogell, Acevedo-Gallegos and Martinez-Portilla.)

Background: COVID-19 symptoms vary widely among pregnant women. We aimed to assess the most frequent symptoms amongst pregnant women with SARS-CoV-2 infection in a tertiary hospital in Mexico City., Methods: A cross-sectional study of pregnant women attending the National Institute of Perinatology in Mexico City was performed. All women who attended the hospital, despite their symptoms, were tested for SARS-CoV-2. A multivariate-age-adjusted logistic regression was used to assess the association between the main outcome and each characteristic of the clinical history., Results: A total of 1880 women were included in the data analysis. Among all women, 30.74% ( n  = 578) had a positive PCR for SARS-CoV-2 from which 2.7 ( n  = 50) were symptomatic. Symptoms associated with a positive PCR result were headache ( p =.01), dyspnea ( p =.043), and myalgia ( p =.043)., Conclusions: At universal screening for SARS-CoV-2, one-third of the population had a positive result, while those symptoms associated with a positive PCR were headache, dyspnea, and myalgia.

Passive transplacental immunity is crucial for neonatal protection from infections. Data on the correlation between neonatal immunity to SARS-CoV-2 and protection from adverse outcomes is scarce. This work aimed to describe neonatal seropositivity in the context of maternal SARS-CoV-2 infection, seropositivity, and neonatal outcomes. This retrospective nested case-control study enrolled high-risk pregnant women with a SARS-CoV-2 RT-PCR positive test who gave birth at the Instituto Nacional de Perinatología in Mexico City and their term neonates. Anti-SARS-CoV-2 IgG antibodies in maternal and cord blood samples were detected using a chemiluminescent assay. In total, 63 mother-neonate dyads (mean gestational age 38.4 weeks) were included. Transplacental transfer of SARS-CoV-2 IgG occurred in 76% of neonates from seropositive mothers. A positive association between maternal IgG levels and Cycle threshold (Ct) values of RT-qPCR test for SARS-CoV-2 with neonatal IgG levels was observed. Regarding neonatal outcomes, most seropositive neonates did not require any mechanical ventilation, and none developed any respiratory morbidity (either in the COVID-19 positive or negative groups) compared to 7 seronegative neonates. Furthermore, the odds of neonatal respiratory morbidity exhibited a tendency to decrease when neonatal IgG levels increase. These results add further evidence suggesting passive IgG transfer importance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Helguera-Repetto, Villegas-Mota, Arredondo-Pulido, Cardona–Pérez, León-Juárez, Rivera-Rueda, Arreola-Ramírez, Mateu-Rogell, Acevedo-Gallegos, López-Navarrete, Valdespino-Vázquez, Martínez-Salazar, Rodríguez-Bosch, Coronado-Zarco, Castillo-Gutiérrez, Cuevas-Jiménez, Moreno-Verduzco, Espino-y-Sosa, Cortés-Bonilla and Irles.)

(1) This study aimed to evaluate characteristics, perinatal outcomes, and placental pathology of pregnant women with or without SARS-CoV-2 infection in the context of maternal PCR cycle threshold (C T ) values. (2) This was a retrospective case-control study in a third-level health center in Mexico City with universal screening by RT-qPCR. The association of COVID-19 manifestations, preeclampsia, and preterm birth with maternal variables and C T values were assessed by logistic regression models and decision trees. (3) Accordingly, 828 and 298 women had a negative and positive test, respectively. Of those positive, only 2.6% of them presented mild to moderate symptoms. Clinical characteristics between both groups of women were similar. No associations between C T values were found for maternal features, such as pre-gestational BMI, age, and symptomatology. A significantly higher percentage of placental fibrinoid was seen with women with low C T s (<25; p < 0.01). Regarding perinatal outcomes, preeclampsia was found to be significantly associated with symptomatology but not with risk factors or C T values ( p < 0.01, aOR = 14.72). Moreover, 88.9% of women diagnosed with COVID-19 at <35 gestational weeks and symptomatic developed preeclampsia. (4) The data support strong guidance for pregnancies with SARS-CoV-2 infection, in particular preeclampsia and placental pathology, which need further investigation.

To date, mother-to-fetus transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19) pandemic, remains controversial. Although placental COVID-19 infection has been documented in some cases during the second- and third-trimesters, no reports are available for the first trimester of pregnancy, and no SARS-CoV-2 protein has been found in fetal tissues. We studied the placenta and fetal organs from an early pregnancy miscarriage in a COVID-19 maternal infection by immunohistochemical, reverse transcription quantitative real-time polymerase chain reaction, immunofluorescence, and electron microscopy methods. SARS-CoV-2 nucleocapsid protein, viral RNA, and particles consistent with coronavirus were found in the placenta and fetal tissues, accompanied by RNA replication revealed by double-stranded RNA (dsRNA) positive immunostain. Prominent damage of the placenta and fetal organs were associated with a hyperinflammatory process identified by histological examination and immunohistochemistry. The findings provided in this study document that congenital SARS-CoV-2 infection is possible during the first trimester of pregnancy and that fetal organs, such as lung and kidney, are targets for coronavirus. The infection and multi-organic fetal inflammation produced by SARS-CoV-2 during early pregnancy should alert clinicians in the assessment and management of pregnant women for possible fetal consequences and adverse perinatal outcomes., (© 2021 Wiley Periodicals LLC.)