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BACKGROUND: Following the latest trends in the development of artificial intelligence (AI), the possibility of processing an immense amount of data has created a breakthrough in the medical field. Practitioners can now utilize AI tools to advance diagnostic protocols and improve patient care. OBJECTIVE: The aim of this article is to present the importance and modalities of AI in maternal-fetal medicine and obstetrics and its usefulness in daily clinical work and decision-making process. METHODS: A comprehensive literature review was performed by searching PubMed for articles published from inception up until August 2023, including the search terms "artificial intelligence in obstetrics", "maternal-fetal medicine", and "machine learning" combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion. RESULTS: According to recent research, AI has demonstrated remarkable potential in improving the accuracy and timeliness of diagnoses in maternal-fetal medicine and obstetrics, e.g., advancing perinatal ultrasound technique, monitoring fetal heart rate during labor, or predicting mode of delivery. The combination of AI and obstetric ultrasound can help optimize fetal ultrasound assessment by reducing examination time and improving diagnostic accuracy while reducing physician workload. CONCLUSION: The integration of AI in maternal-fetal medicine and obstetrics has the potential to significantly improve patient outcomes, enhance healthcare efficiency, and individualized care plans. As technology evolves, AI algorithms are likely to become even more sophisticated. However, the successful implementation of AI in maternal-fetal medicine and obstetrics needs to address challenges related to interpretability and reliability. [ABSTRACT FROM AUTHOR]

Hydrops fetalis is defined as the accumulation of fluid with or without edema involving at least two fetal components. About 10% of cases are due to maternal hemolytic antibodies, that is, immune hydrops, while 90% of cases are nonimmune. Nonimmune hydrops fetalis (NIHF) is a heterogeneous condition that may be secondary to over 100 conditions, the cardiovascular causes are the most common. A significant percentage of cases will still not have an identifiable cause even after postnatal evaluation. Sonographic features include increased amniotic fluid volume, increased nuchal translucency, placentomegaly, fetal pleural or pericardial effusion, generalized fetal body swelling, and umbilical venous dilatation. Once the diagnosis of NIHF has been established, scans should be performed every 2-3 weeks to monitor the evolution of hydrops, and every effort should be made to identify the underlying cause. The treatment of nonimmune hydrops is determined by the gestational age (GA) at which the diagnosis is made, as well as the ability to identify the cause of the NIHF. Delivery should be done at a tertiary care hospital for appropriate neonatal interventions. Timing and method of delivery depend on the cause of hydrops. Preterm delivery is recommended only for obstetric indications including the development of "mirror syndrome." The prognosis is dependent on the underlying cause and onset of NIHF. Progressive unexplained hydrops is often lethal before or soon after birth with an overall mortality of 50-90%. NIHF secondary to treatable causes such as fetal arrhythmia, chylothorax, or infection with parvovirus B19 has a better survival rate. [ABSTRACT FROM AUTHOR]

Rhabdomyoma is the most common fetal cardiac tumor accounting for 60-65% of all fetal tumors and up to 90% of cardiac tumors in pediatric population. Rhabdomyomas are benign lesions and the symptoms depend on the size and location of the rhabdomyomas. A single or multiple lesions are usually located within the left ventricle and projecting into the ventricular cavity or moving freely as a pedunculated mass. Intracavitary growth may cause ventricular outflow tract obstruction, valvular compromise, and disruption of intracardiac blood flows, leading to congestive heart failure. Rhabdomyomas >30 mm in diameter, regardless of number and location, are associated with postnatal arrhythmia. Cardiac rhabdomyoma is associated with tuberous sclerosis in about 50-90% of cases. Rhabdomyomas can be detected as early as the second trimester by echocardiography which is the primary diagnostic tool for the evaluation of cardiac tumors. They usually grow until 32 weeks gestation due to the transmission of maternal estrogens to the fetus, and then gradually regress. When cardiac rhabdomyoma is suspected on fetal echocardiography, it is important to check the kidneys and brain for tuberous sclerosis complex (TSC)-specific lesions. The prognosis depends on the number, size, and location of the tumors, as well as the presence or absence of associated anomalies. Rhabdomyomas, single or multiple, in the majority of cases, are not hemodynamically relevant and regress in infancy. Expectant management is the recommended approach, and neonatal management is always preferred when lung maturity is assured. Prenatal therapy is recommended only in case of severe fetal hemodynamic deterioration, hydrops, or uncontrollable arrhythmias. [ABSTRACT FROM AUTHOR]

A single umbilical artery (SUA), resulting in a two-vessel cord instead of a three-vessel cord, is the most common umbilical cord abnormality in humans with a prevalence of 1 in 100-200 pregnancies. In approximately 65% of cases, SUA is an isolated finding. Of those cases with SUA, the left umbilical artery is absent in approximately 70%. The incidence of SUA in twins is higher than in singletons, with no relation to chorionicity. Approximately 33% of fetuses with SUA have additional structural anomalies, and 10% are affected by aneuploidy. The most common chromosomal abnormalities are trisomy 18, trisomy 13, and triploidy, which together account for 82.9% of cases. An SUA is associated with over twofold increased risk of intrauterine growth restriction (IUGR), threefold increased risk of renal anomalies, and >20-fold increased risk of cardiac anomalies. Abnormalities affecting cardiovascular, skeletal, gastrointestinal, genitourinary, and central nervous systems are found in 20% of cases. It is usually identified sonographically when an artery is visible coursing adjacent to the fetal bladder along only one side. Although SUA may be visible in the first trimester, it is usually identified during the routine second-trimester fetal anatomic survey. The prognosis of the fetus with an SUA is determined by the presence of other malformations; in isolated cases, the prognosis is normal. [ABSTRACT FROM AUTHOR]

Prenatal cardiology is a part of preventive cardiology based on fetal echocardiography and fetal interventional cardiology, which facilitates treatment of congenital heart defects (CHD) in pediatric patients and consequently in adults. Timely prenatal detection of CHD plays a pivotal role in facilitating the appropriate referral of pregnant women to facilities equipped to provide thorough perinatal care within the framework of a well-structured healthcare system. The aim of this paper is to highlight the role of left atrial strain (LAS) in prenatal evaluation of fetal heart and prediction of structural and functional disorders. We conducted a comprehensive literature review searching PubMed for articles published from inception up until August 2023, including the search terms "left atrial strain", "fetal echocardiography", and "prenatal cardiology" combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion. Our review underscores the significance of LAS parameters in fetal echocardiography as a screening tool during specific gestational windows (starting from 11 to 14 weeks of gestation, followed by better visualization between 18 and 22 weeks of gestation). The left atrial strain technique and its parameters serve as valuable indicators, not only for identifying cardiac complications but also for predicting and guiding therapeutic interventions in cases of both cardiac and noncardiac pregnancy complications in fetuses. Evidence suggests establishment of second-trimester reference strain and strain rate values by speckle-tracking echocardiography in the healthy fetal cohort is essential for the evaluation of myocardial pathologies during pregnancy. Finding of LAS of fetal heart is feasible and probably can have potential for clinical and prognostic implications. [ABSTRACT FROM AUTHOR]

Performance measurement in the health sector is essential. Research results so far show that studies have mainly focused on the Balanced Scorecard (BSC) design process rather than the implementation of the BSC. There is no agreement on the perspectives that should be adopted in healthcare. Regarding the implementation of the BSC, leadership, culture and communication are especially important. Subject of research. A systematic review of research on the application of the BSC model in healthcare. Aim. Understanding the evolution of the BSC model in healthcare. The aim is to define a model for measuring the achievement of development goals through perspectives. Method. Inductive method as a systematic method by which the analysis of individual facts leads to general conclusions. The deductive and comparative method is a systematic application of the deductive way of reasoning in which individual conclusions were reached from general judgments. Using the case study method, the results of this research were defined, that is, the key business indicators, grouped into 4 perspectives, which enable the operationalization of the strategic goals of the development of the healthcare organization. Results. The possibility is demonstrated. The paper provides further research opportunities regarding the stages suitable for the implementation of BSC in healthcare. [ABSTRACT FROM AUTHOR]

Congenital pulmonary airway malformation (CPAM) is a hamartoma-like lesion characterized by a polycystic mass of lung tissue with abnormal bronchial proliferation. It is the most frequent congenital thoracic malformation, accounting for 30-47% of fetal thoracic lung lesions. The exact pathogenesis is still unknown. Comorbidities associated with CPAM include pulmonary sequestration, lung malignancy, polyhydramnios, fetal hydrops, agenesis of the corpus callosum, congenital nephrotic syndrome, cleft lip and cleft palate, renal agenesis, esophageal atresia, diaphragmatic hernia, cardiovascular, and skeletal defects. Histopathological classification consists of five types of lesions; however, the most common clinical practice is to describe the CPAM lesion as microcystic (<5 mm) or macrocystic (>5 mm) and state its size. Microcystic lesions are associated with fetal hydrops and have a poor prognosis, whereas macrocystic lesions are usually not associated with hydrops and have a favorable prognosis. Ultrasound (US) scans every 2 weeks are recommended to monitor growth, lung lesions, and amniotic fluid volume for possible complications. Around 40% of CPAMs increase with the gestational age and stabilize around 26 weeks of gestation; however, in some cases, these lesions may continue to grow late into the third trimester. Fetal hydrops occur in about 5% and are associated with a close to 100% mortality rate. In cases of fetal hydrops, prenatal interventions may allow survival to birth. In the absence of contraindications, term delivery is recommended at a tertiary care center. In cases of poor growth, fetal hypoxia, or hydrops, earlier delivery is recommended for immediate postpartum treatment. About 70% of the children are asymptomatic at birth. For symptomatic infants, surgical resection is the management of choice. [ABSTRACT FROM AUTHOR]

Transposition of the great arteries (TGA) is a conotruncal abnormality characterized by discordant ventriculoarterial alignments, with the aorta arising from the right ventricle and the pulmonary artery arising from the left ventricle and resultant parallel circulation of the systemic and pulmonary circuits. TGA can be dextro-TGA or levo-TGA based on the position of the aortic valve, right or left, regarding the pulmonary valve, and simple or complex TGA based on associated cardiac anomalies. With an incidence of 0.2-0.3/1,000 live births, TGA is the secondmost common cyanotic heart disease following the tetralogy of Fallot. Around 98% of TGA cases have a normal four-chamber view (4CV). The International Society of Ultrasound in Obstetrics and Gynecology and the American Institute of Ultrasound in Medicine added evaluation of the outflow tracts, three-vessel view (3VV), and three-vessel trachea view (3VTV) which improved the sensitivity of ultrasound screening for congenital heart disease (CHD). However, the prenatal detection rate of TGA, especially simple TGA, is generally low internationally, ranging from 25 to 50%. Without treatment, 50% of these infants die within the 1st month and 90% within the 1st year of life. The prenatal diagnosis of TGA improves postnatal outcomes through planned delivery at a tertiary care center and timely perinatal management. Immediately after birth, prostaglandin-E1 is given to keep the ductus arteriosus open to allow the mixing of oxygen-rich and oxygen-poor blood. If necessary, an atrial septostomy can be performed for short-term survival. Arterial switch operation (ASO) restores normal pulmonary and systemic circulation, with a 20-year survival rate of 90-97%. [ABSTRACT FROM AUTHOR]

Maternal and neonatal health is one of the main global health challenges. Every day, approximately 800 women and 7,000 newborns die due to complications during pregnancy, delivery, and neonatal period. The leading causes of maternal death in sub-Saharan Africa are obstetric hemorrhage (28.8%), hypertensive disorders in pregnancy (22.1%), non-obstetric complications (18.8%), and pregnancy-related infections (11.5%). Diagnostic ultrasound examinations can be used in a variety of specific circumstances during pregnancy. Because adverse outcomes may also arise in low-risk pregnancies, it is assumed that routine ultrasound in all pregnancies will enable earlier detection and improved management of pregnancy complications. The World Health Organization (WHO) estimated in 1997 that 50% of developing countries had no access to ultrasound imaging, and available equipment was outdated or broken. Unfortunately, besides all the exceptional benefits of ultrasound in obstetrics, its inappropriate use and abuse are reported. Using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication can be considered ethically unjustifiable. Ultrasound assessment when indicated should be every woman's right in the new era. However, it is still only a privilege in some parts of the world. Investment in both equipment and human resources has been clearly shown to be cost-effective and should be an obligatory step in the improvement of health care. Well-developed health systems should guide developing countries, creating principles for the organization of the health system with an accent on the correct, legal, and ethical use of diagnostic ultrasound in pregnancy to avoid its misuse. The aim of the article is to present the importance of correct and appropriate use of ultrasound in obstetrics and gynecology with reference to developing countries. [ABSTRACT FROM AUTHOR]

Hypertensive syndrome in pregnancy complicates up to 15% of pregnancies, and preeclampsia (PE) occurs in about 3–10% of pregnant women. Inadequate prenatal care is associated with higher mortality from PE, possibly due to reduced monitoring, detection, and missed opportunities for early intervention. The imperative of the clinician's work is to monitor the symptoms and clinical signs of PE, and stratification of patients in relation to the risk of PE is essential. PE represents a multisystem inflammatory response, and the consequences can be expected in all organs. The question of the effect of PE on long-term maternal health is raised. The aim of the paper is to present the effect of PE on the patient's health through the prism of low-income countries. [ABSTRACT FROM AUTHOR]

Introduction. The success of healthcare organizations depends on the quality and speed of providing services to patients. Synonym for the term success of health care organization is the implementation of modern concepts Synonymous with the success of healthcare organizations is the implementation of modern concepts. In this paper, the emphasis is on the lean concept, affects the quality and speed of providing health services. Subject of research. The subject being researched in this paper is a lean concept which essence is determined by the implementation of methods that affect the speed and quality of providing health services. The aim of the work is to point out the actuality of the lean concept and its application at the tertiary level of health care. Examine the opinion of healthcare workers about the effects that would be achieved by applying the new management system (lean concept). Aim of this paper is to indicate the actuality of the lean concept and its application at the tertiary level of health care system. Examine the opinion of healthcare workers about the effects that would be achieved by applying the new management system (lean concept). More precise possibilities of implementing the lean methodology, which can be used to improve clinical processes. Materials and methods. The research was conducted by designing and using research questionnaires. Questionnaire structured by the author for the purposes of research in this paper. The questionnaire was sent to 472 employees’ mail addresses and was filled out by 91 employees. One of the reasons for the lower questionnaire return rate is the lack of familiarity of employees with the lean concept and its effects on the provision of health services. The return rate of referrals indicates the need for prior presentation and familiarization with the concept itself and its impact on business processes. A Likert scale was used to assess the opinions of healthcare services workers about the effects that would be achieved by applying the lean concept at the tertiary level. Medical wastes are shown in the oncology department (case analysis). We statistically processed the data obtained from the questionnaire using the SPSS 20.0 software package. The results are presented tabularly and graphically. The following methods are used in the paper: analysis method, inductive - deductive method, synthesis method, description method and proof method. Results. The results of the research showed that (analysis of health organizations that apply the lean concept) and the opinion of health workers about the possibility of applying the lean concept at the tertiary level of health care has a positive impact on improving the efficiency of the provision of health services. The interpretation of the correlation coefficient from the previous table indicates the existence of a positive relationship between the effectiveness and efficiency of business processes (r=0.846; p<0,05). Based on the literature review and the obtained results, it was determined that there is no formalized concept with instructions on the implementation of clinical process improvement methods. There was a positive impact on improving the efficiency of the provision of health services, through the implementation of modern methods. The review of the literature and the obtained results revealed that there is no formalized concept with instructions on the implementation of clinical process improvement methods. Conclusion The expected positive effects of the implementation of the lean concept at the tertiary level of the health care of are manifested through: faster service delivery to patients, reduction of service waiting time and general improvement of business processes. The implementation of the lean concept would reduce medical waste, which would positively affect the quality of health care services. [ABSTRACT FROM AUTHOR]

The aim of this prospective study was to correlate the Doppler ultrasonography of the uterine arteries with the Kurjak Antenatal Neurodevelopmental Test (KANET), to investigate the effect of uterine artery flow assessed by the Doppler on fetal behavior. A population of 80 pregnant women in the second trimester of pregnancy was included for uterine artery Doppler (UAD) assessment. The investigation group consisted of 40 women with abnormal UAD, while the control group consisted of 40 women with normal UAD. The inclusion criteria for the investigated group were: gestation above 20 weeks, and an abnormal finding of Doppler ultrasonography of the uterine arteries. All patients underwent a KANET test and were followed up to the end of their pregnancy. There was a statistically significant difference in the average score of KANET tests between the two groups (9.20±3.32 vs. 13.55±2.21; p=0.001). In the first group, an abnormal flow on the side of the placenta affected the score of the KANET test (B=11.948; p=0.005), while abnormal flow on the opposite side did not affect the score of the KANET test (p>0.05). Physiological flow had no effect on the KANET test in the control group (p>0.05). Abnormal flow affects the value of the KANET score, and can be used as one of the parameters in evaluation of probable fetal neurodevelopmental disorders. [ABSTRACT FROM AUTHOR]

Objective - The aim of the paper is to present a rare and complex congenital heart defect (CHD), congenitally corrected transposition of the great arteries of the heart (ccTGA) with associated anomalies, including ventricular septal defect (VSD), valvular and subvalvular pulmonary stenosis, dysplasia of the tricuspid valve, and atrial septal defect (ASD) with first-degree atrioventricular block, which was diagnosed, monitored and successfully treated with heart surgery in an infant. Case Report - A female infant was born with 3350 grams in weight, 50 cm in length, oxygen saturation of 98%, and heart rate of 170 beats per minute. The antenatal and perinatal period was normal. CHD was verified by ultrasound at the age of 3 days. Angiotensin-converting-enzyme inhibitors (ACE inhibitors) and diuretics were introduced in therapy after one month. Cardiac surgery (Senning-Rastelli procedure with placement of an 18-mm Contegra conduit) was performed at the age of 9 months. After the operation, the infant was stable on therapy with diuretics, antiaggregants, beta blockers, and antianemic therapy with vitamin D in prophylaxis. Conclusion - ccTGA with associated anomalies is a rare, life-threatening, congenital heart disease. After birth it demands correct diagnosis, adequate follow-up, and cardiac surgery in infancy. [ABSTRACT FROM AUTHOR]