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Obesity and gestational diabetes mellitus (GDM) have an independent negative impact in pregnancy outcomes. Excessive gestational weight gain (GWG) represents an additional high-risk condition for adverse outcomes. The aims of this study were to evaluate the potential effect of metformin in GWG in overweight or obese women with GDM, to report our experience and to assess metformin’s safety in this population. Retrospective observational cohort study involving pregnant women with GDM and pregestational overweight or obesity. Demographic, anthropometric, glycemic control data, obstetric, fetal and neonatal outcomes were evaluated. The sample was divided into two groups according to metformin treatment. A propensity score-matched analysis was performed using age, initial body mass index (BMI), trimester at GDM diagnosis and previous history of GDM or macrosomia as covariates. Of the 457 enrolled in the study, 177 (38.7%) were treated with metformin. Two groups of 130 well matched patients were balanced regarding baseline characteristics. Women in metformin group had significantly less excessive GWG (29.23% vs. 42.31%, OR 0.56, 95% CI 0.34–0.94, p = 0.028) and more adequate GWG (36.92% vs. 23.08%, OR 1.95, 95% CI 1.14–3.35, p = 0.015). No significant differences were found between both groups regarding glycemic control, rate of insulinization, and obstetric, fetal, and neonatal outcomes. This study highlights metformin as an important and safe tool to prevent excessive GWG and promote adequate GWG in overweight or obese women with GDM, regardless of age, BMI, timing of GDM diagnosis, previous history of GDM or macrosomia.

Este artigo apresenta e avalia a implementação de CityMetrics: um sistema computacional que articula métricas de avaliação de desempenho a recursos e funcionalidades algorítmico‑paramétricas, de maneira a permitir analisar e otimizar diferentes aspectos relativos ao grau de eficiência e as possibilidades de operação de configurações geométricas e algébricas de uma área urbana. Assim, este artigo aborda o uso de recursos computacionais e ferramentas algorítmicas elaboradas para mensurar a performance de áreas urbanas, sob a perspectiva de princípios objetivamente mensuráveis do Desenvolvimento Orientado pelo Transporte Sustentável, um modelo de desenvolvimento urbano que visa a cidades mais autônomas e mais sustentáveis. A presente pesquisa visa a verificar como atributos mensuráveis, geométricos e algébricos (e, portanto, programáveis) podem ser utilizados em um modelo computacional que utiliza métodos de otimização para dar suporte a tomada de decisão no processo de projetos urbanos.

Objective: To compare peripartum outcomes of uterus preserving procedures to caesarean hysterectomy in women with placenta accreta spectrum (PAS), and to identify risk factors associated with adverse maternal outcomes. Design: Retrospective study (ClinicalTrials.gov identifier: NCT04384510) Setting:11 tertiary centres from 9 countries Population or Sample: women with of PAS who were managed in participating centres between January 1st, 2010 and December 31st, 2019. Women who had confirmed diagnosis with PAS with adequate documentation and follow-up, were considered eligible. Main Outcome Measures: Primary outcome was massive PAS-associated perioperative blood loss (intraoperative blood loss ≥ 2500 ml, bleeding associated massive transfusion protocol, or complicated by disseminated intravascular coagulopathy). Results: Out of 797 women, 727 were eligible for the study. Five hundred ninety-two (81.43%) women were managed by uterus preserving procedures versus 135 (18.56%) who underwent caesarean hysterectomy. After adjustment for significant or close-to-significance variables, type of management was not associated with higher risk of massive blood loss (aOR 1.71, 95% CI 0.78 - 3.81). Other factors that were significantly associated with higher risk of massive PAS-associated blood loss included body mass index, preoperative haemoglobin, centrally located placenta, diffuse placental invasion, parametrial invasion, and intrauterine foetal death. Conclusions: In the presence of sufficient experience, uterus preserving procedures may not be associated with higher risk of massive blood loss compared to caesarean hysterectomy. Funding: none

The role of milk and dairy products in supplying iodine to pregnant women is unknown in Portugal. The aim of this study was to evaluate the association between milk and dairy product consumption and the iodine status of pregnant women in the IoMum cohort of the Oporto region. Pregnant women were recruited between 10 and 13 weeks of gestation, when they provided a spot urine sample and information on lifestyle and intake of iodine-rich foods. Urinary iodine concentration (UIC) was determined by inductively coupled plasma MS. A total of 468 pregnant women (269 iodine supplement users and 199 non-supplement users) were considered eligible for analysis. Milk (but not yogurt or cheese) intake was positively associated with UIC, in the whole population (P = 0·02) and in the non-supplement users (P = 0·002), but not in the supplement users (P = 0·29). In non-supplement users, adjusted multinomial logistic regression analysis showed that milk consumption

Objective: To compare maternal and neonatal outcomes of immediate versus delayed cord clamping in women with placenta accreta spectrum (PAS). Study Design: PAS-ID is an international retrospective multicenter database originating from 11 centers (9 countries), which included women with confirmed PAS between January 1st, 2010 and December 31st, 2019. Women were considered eligible to this study if diagnosis of PAS was confirmed, women were adequately followed ante- and postpartum. Women with intrauterine fetal death were excluded. Primary outcome was massive PAS-associated perioperative blood loss (intraoperative blood loss ≥ 2500 ml, bleeding associated massive transfusion protocol, or complicated by disseminated intravascular coagulopathy). Secondary outcomes include 1-minute, 5-minute APGAR scores, and admission to neonatal intensive care unit (NICU). Multivariable logistic regression was used for analysis and results were presented as adjusted odds ratios (aOR) and 95% confidence interval (CI). Results: Out of 797 women, 716 met our inclusion criteria. Of these women, 120 underwent delayed cord clamping (16.76%). After adjustment for potential confounders, delayed cord clamping was associated with lower risk of massive blood loss (aOR 0.26, 95% CI 0.11 – 0.63) and admission to NICU (aOR 0.45, 95% CI 0.29 - 0.87). It was not associated with lower risk of 1 minute APGAR < 7 (aOR 1.88, 95% CI 0.92 - 3.85) or 5-minute APGAR < 7 (aOR 0.67, 95% CI 0.21 - 2.10). Conclusion: Delayed cord clamping does not seem to increase risk of PAS-associated massive blood loss. However, maternal, and neonatal stability should be considered before a decision can be made. Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Interests: The authors have no conflicts of interest. Ethics Approval Statement: Ethical approval was obtained in each contributing center from their receptive institutional review board before the study was conducted. This includes Aswan University, Egypt (Ethics Committee on Feb 11th, 2020, reference N; Aswu/439/2/20), Inonu University (reference number: 2020/476, dated 3/3/2020), Yuzuncu yil University (reference number: 55163642-100-E.36909, dated 09/06/2020), and Ege University (reference number: 20-4.1 T/3, dated 14/4/2020) in Turkey, Fatima memorial hospital/College of Medicine, and Dentistry, Pakistan (reference number: FMH-03-2020-IRB747-M, dated 5/12/2020), Kazan State University, Russia (reference number: 1765, dated 30/6/2020), Centro Hospitalar Sao Joao, Portugal (reference number: 76/2020, dated 21/5/2020), National Taiwan University College of Medicine, Taiwan (reference number: 202003007RINC, dated 30/3/2020), Faculty of Medicine of University of Yaounde I, Cameroon (reference numbers: 1019/CIERSH/DM/2020, dated 25/2/2020). Both Peking University Shenzhen Hospital and Universitas Padjadjaran Bandung were waived for the minimal risk per their local hospital policies. All data were anonymized and authorized for use before submission for analysis.

Lack of knowledge about iodine has been suggested as a risk factor for iodine deficiency in pregnant women, but no studies have addressed this issue in Portugal. So, the aim of this study was to investigate iodine knowledge among Portuguese pregnant women and its association with iodine status. IoMum, a prospective observational study, included 485 pregnant women recruited at Centro Hospitalar e Universitário de S. João, Porto, between the 10th and 13th gestational weeks. Partial scores for knowledge on iodine importance, on iodine food sources or on iodised salt were obtained through the application of a structured questionnaire. Then, a total iodine knowledge score was calculated and grouped into low, medium and high knowledge categories. Urinary iodine concentration (UIC) was measured in spot urine samples by inductively coupled plasma MS. Of the pregnant women, 54 % correctly recognised iodine as important to neurocognitive development, 32 % were unable to identify any iodine-rich food and 71 % presented lack of knowledge regarding iodised salt. Of the women, 61 % had a medium total score of iodine knowledge. Knowledge on iodine importance during pregnancy was positively associated with iodine supplementation and also with UIC. Nevertheless, median UIC in women who correctly recognised the importance of iodine was below the cut-off for adequacy in pregnancy (150 µg/l). In conclusion, knowledge on iodine importance is positively associated with iodine status. Despite this, recognising iodine importance during pregnancy may not be sufficient to ensure iodine adequacy. Literacy-promoting actions are urgently needed to improve iodine status in pregnancy. This work was supported by National Funds through FCT – Fundação para a Ciência e a Tecnologia/MCTES within CINTESIS, R&D Unit (reference UID/IC/4255/2019) and REQUIMTE (reference UIDB/info:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UIDB/50006/2020/PT) and through FCT postdoctoral fellowship (V. C. F., grant number SFRH/BPD/109153/2015).

© 2020 Elsevier B.V. All rights reserved., Objective: To evaluate the success rate of external cephalic version, predictive factors for success of this maneuver and to examine how it affects mode of delivery, pregnancy and neonatal outcome rates. Study design: Retrospective cross-sectional study performed in a tertiary care university hospital between January 2002 and June 2018. A total of 324 ECVs were performed in 321 pregnancies. Maternal and ultrasound data, procedure-related factors, birth characteristics and neonatal data were collected. Absolute and relative frequencies were used for descriptive analysis and the chi-square test for comparative analysis. Odds ratios with 95 % confidence intervals were calculated. Results: The overall success rate of the procedure was 33,3%. Multiparity, transverse lie, unengaged breech presentation, low body mass index, soft uterus and palpable fetal head were independent risk factors for success. No statistically significant association was found with other variables. Routine use of ECV allowed a reduction in cesarean delivery rates for breech presentation, with no increase in maternal or neonatal morbidity. Operative delivery rates after successful ECV were similar to those of the general population. Discussion and conclusion: Despite a relatively low overall success rate, routine use of ECV can result in reduced cesarean delivery rates with similar perinatal outcomes. Conveyed information on the success rate of ECV can be adapted to individual patient characteristics.

Introduction Placenta accreta spectrum is a major obstetric disorder that is associated with significant morbidity and mortality. The objective of this study is to establish a prediction model of clinical outcomes in these women Materials and methods PAS-ID is an international multicenter study that comprises 11 centers from 9 countries. Women who were diagnosed with PAS and were managed in the recruiting centers between 1 January 2010 and 31 December 2019 were included. Data were reanalyzed using machine learning (ML) models, and 2 models were created to predict outcomes using antepartum and perioperative features. ML model was conducted using python(R) programing language. The primary outcome was massive PAS-associated perioperative blood loss (intraoperative blood loss >= 2500 ml, triggering massive transfusion protocol, or complicated by disseminated intravascular coagulopathy). Other outcomes include prolonged hospitalization >7 days and admission to the intensive care unit (ICU). Results 727 women with PAS were included. The area under curve (AUC) for ML antepartum prediction model was 0.84, 0.81, and 0.82 for massive blood loss, prolonged hospitalization, and admission to ICU, respectively. Significant contributors to this model were parity, placental site, method of diagnosis, and antepartum hemoglobin. Combining baseline and perioperative variables, the ML model performed at 0.86, 0.90, and 0.86 for study outcomes, respectively. Ethnicity, pelvic invasion, and uterine incision were the most predictive factors in this model. Discussion ML models can be used to calculate the individualized risk of morbidity in women with PAS. Model-based risk assessment facilitates a priori delineation of management.

Objective To create a model for prediction of success of uterine preserving procedures in women with placenta accreta spectrum (PAS) METHODS: PAS-ID is a multicenter study that included 11 centers from 9 countries. Women with PAS, who were managed between January 1st, 2010 and December 31st, 2019, were retrospectively included. Data were split into model development and validation cohorts, and a prediction model was created using logistic regression. Main outcome was success of uterine preservation. Results Out of 797 women with PAS, 587 were eligible. Uterus preserving procedures were successful in 469 patients (79.9%). Number of previous cesarean sections (CS) was inversely associated with management success (adjusted odds ratio "aOR" 0.02; 95% confidence interval "CI", 0.001-3.63 with 5 previous CSs). Other variables were complete placental invasion (aOR 0.14; 95%CI, 0.05-0.43), type of CS incision (aOR 0.04; 95%CI, 0.01-0.25 for classical incision), compression sutures (aOR 2.48; 95%CI, 1.00-6.16), accreta type (aOR 3.76; 95%CI, 1.13-12.53), incising away from placenta (aOR 5.09; 95%CI, 1.52-16.97), and uterine resection (aOR 102.57, 95%CI, 3.97-2652.74). Conclusion This current study provides a prediction model for success of uterine preservation, which may assist preoperative and intraoperative decisions, and promote incorporation of uterine preservation procedures in comprehensive PAS protocols.

Objective: The aim of this study was to describe the effect of obesity on the duration of labor, specifically latent and active phases of labor, and on mode of delivery, among nulliparous women wit...

Background The ductus venosus agenesis (DVA) is a rare condition with a variable prognosis that relies partly on the presence of associated conditions. The purpose of our study was to analyze the literature regarding the post-natal outcome of fetuses with DVA associated with fetal malformations, in order to discuss the best management options for couples. Methods We performed a systematic review of the literature of MEDLINE and SCOPUS electronic databases in a 25-year period from 1992 to September 2017. Methods We found 340 cases of DVA associated with fetal abnormalities. The most common chromosomal abnormalities were: monosomy X (12/48, 25%), trisomy 21 (11/48, 22.9%) and trisomy 18 (6/48, 12.5%). From the 340 cases with DVA, in 31 cases the umbilical venous shunt type was not reported. Of the fetuses, 60.8% (188/309) had an extrahepatic umbilical venous drainage while 39.2% (121/309) presented an intrahepatic connection. The DVA was associated in 71 cases (23.0%) with cardiac abnormalities, in 82 cases (26.5%) with extracardiac abnormalities and in 85 cases (27.5%) with both cardiac and extracardiac abnormalities. Conclusion DVA associated with both cardiac and extracardiac malformations may confer a poorer fetal outcome, a clinically relevant fact that should clarify what can be expected from this entity and help prenatal counseling.

Background: Engaging in physical activity (PA) and reducing sedentary behaviour (SB) are important for health during pregnancy, yet relatively few studies have examined these variables using objective measures and across trimesters during pregnancy. Objective: To determine the amount of objectively assessed PA and SB engaged in whether there was any weekday to weekend day variation in PA and SB during the first and second trimester of pregnancy. Method: PA and SB were determined using accelerometry worn over 7 consecutive days during each trimester in 137 Portuguese females (mean age ± SD = 29.6 ± 5.7). Results: In regard to the proportion of participants meeting the ACSM guidelines for PA, 37.5% of the participants in the first trimester and 29.6% of participants in the second trimester met the cut off of 30min or more of any type of moderate intensity activity on most (5) days of the week. Moderate intensity PA was significantly lower in trimester 2 compared to trimester 1 (P = 0.003). Moderate intensity PA was also significantly lower during weekends compared to weekdays irrespective of trimester (P = 0.003). SB, light and vigorous intensity PA were relatively stable from trimester 1 to trimester 2 and between weekdays and weekends (P < 0.05). Conclusion: The present study suggests that the majority of women do not meet PA guidelines for health during pregnancy and that moderate intensity PA declines form trimester 1 to 2 and is lower at weekends.

Purpose: To compare the effect of antenatal corticosteroids (ACS) on neonatal outcomes among singleton and twin pregnancies and the impact of completeness and timing of ministration. Materials and methods: Retrospective cohort study involving 951 preterm deliveries (25+0–34+6 weeks), between 2006 and 2015. Neonatal outcomes were evaluated according to completeness of ACS (“Complete” n = 441; “Rescue” n = 38; “Incomplete” n = 175; “No ACS” n = 98) and timing of therapy related to delivery (“Before 7 days” n = 260; “After 7 days” n = 181). Results: On respiratory distress syndrome (RDS), odds ratio (OR) for twins was 0.172, 95% confidence interval (CI) was 0.047; 0.591 and for singletons 0.390 (95%CI 0.214; 0.703) for complete or rescue courses, and 0.280 (95%CI 0.069; 1.066) for twins and 0.906 (95%CI 0.482; 1.698) for singletons for incomplete courses. About the need for mechanical ventilation (MV), twins had an OR of 0.189 (95%CI 0.052; 0.642) and singletons of 0.404 (95%CI 0.222; 0.727) for complete or rescue courses and twins had OR = 0.225 (95%CI 0.053; 0.874) and singletons of 0.404 (95%CI 0.222; 0.727) for incomplete courses. About timing, group “After 7 days” had OR = 2.00 for RDS (95%CI 1.21; 3.30) and 2.32 (95%CI 1.42; 3.78) for MV. Conclusions: ACS improves neonatal outcomes both in singleton and twins. Delivering 7 days after a complete course decreased neonatal morbidity.

Post-partum hemorrhage is one of the leading causes of maternal mortality and it's etiology needs to be identified in order for adequate treatment to be provided. We report a case of a post-partum hemorrhage in a multiparous woman treated with selective coil packing embolization after identification of laceration of the right uterine artery's ascending branch. The patient was admitted to an intensive care unit in hemorrhagic hypovolemic shock and disseminated intravascular coagulation and underwent total hysterectomy due to infectious complications.A hemorragia pós-parto é uma das principais causas de mortalidade materna e a sua etiologia deve ser identificada para um tratamento adequado. Descrevemos um caso de hemorragia pós parto numa multípara tratada com embolização selectiva após identificação de uma laceração total do ramo ascendente da artéria uterina direita. A puérpera foi admitida na unidade de cuidados intensivos em choque hipovolémico hemorrágico e coagulação intravascular disseminada que culminou numa histerectomia abdominal por complicações infeciosas.

The different aspects and specific technicalities of screening and diagnosis of aneuplodies in monozygotic twins are discussed in this chapter, from maternal age to non invasive prenatal test (cfDNA). Counseling couples may be more complex than in singletons, and it is generally based on chorionicity more feasible than zygosity.

The present study aims to understand to what extent obesity is related to adverse maternal, obstetrical, and neonatal outcomes in a Portuguese obstetrical population. A retrospective case-control study was conducted at the Department of Obstetrics of a differentiated perinatal care facility. The study compared 1,183 obese pregnant women with 5,399 normal or underweight pregnant women for the occurrence of gestational diabetes, hypertensive pregnancy disorders, and preterm birth. Mode of delivery, birthweight, and neonatal intensive care unit (ICU) admissions were also evaluated. Mean blood glucose values were evaluated and compared between groups, in the first and second trimesters of pregnancy. Only singleton pregnancies were considered. The prevalence of obesity was 13.6%. Obese pregnant women were significantly more likely to have cesarean sections (adjusted odds ratio [aOR] 2.0, Obesity is associated with increased risks of adverse pregnancy and neonatal outcomes. These risks seem to increase progressively with increasing body mass index (BMI) class. Female obesity should be considered a major public health issue and has consequences on maternal-fetal health. O presente estudo pretende avaliar em que medida a obesidade influencia os desfechos maternos, obstétricos e neonatais em uma população obstétrica portuguesa. MéTODOS: Um estudo caso-controle retrospectivo foi realizado no departamento de obstetrícia de um centro perinatal diferenciado. O estudo comparou 1.183 grávidas obesas com 5.399 grávidas normoponderais ou com baixo peso para a ocorrência de diabetes gestacional, doenças hipertensivas da gravidez e parto pré-termo. Via de parto, peso ao nascimento e admissão na unidade de cuidados neonatais também foram avaliados. Os valores glicêmicos médios foram avaliados e comparados entre os dois grupos, no primeiro e segundo trimestres de gravidez. Apenas as gravidezes unifetais foram avaliadas. A prevalência da obesidade foi de 13.6%. As grávidas obesas tiveram risco significativamente superior a ter uma cesariana (odds ratio ajustado [Ora] 2.0

O Desenvolvimento Orientado pelo Transporte (DOT) é um modelo de desenvolvimento urbano que preconiza cidades mais sustentáveis. Este artigo tem por objetivo identificar e apresentar métricas para avaliação de desempenho que se relacionam com seus princípios básicos, de natureza objetivamente mensurável. Pretende-se, portanto, contribuir para abordagens de análise e proposição que possam ser suportadas pela implementação instrumental dos princípios e das métricas aqui caracterizadas.

Background The difficulties in the psychological adaptation to the infertility diagnosis and assisted reproductive technology (ART) treatments have shown influence on the sperm quality. The biological and psychological aspects of infertility seem not to be independent. Objective To analyze the impact of depressive symptoms, anxiety, dyadic adjustment and infertility stress on the sperm quality of the men proposed to ART first or repeated experience. Materials and Methods This transversal study was conducted in the Medically Assisted Reproduction Unit of Centro Hospitalar de São João, in Porto, Portugal. 112 men with infertility diagnosis were included to initiate an ART cycle. Participants completed the Inventory State–Trait Anxiety-Form Y (STAI-Y), the Beck Depression Inventory-II (BDI-II), the Dyadic Adjustment Scale (DAS) and the Inventory of Fertility Problems (IFP) before the beginning of the treatment. Results The state-anxiety had a negative linear impact on the slow progressive motility (p < 0.05). However, depressive symptoms assumed a suppressor effect on this variable, enhancing its importance as a predictor. Conclusion Results show that psychopathological symptoms before an ART cycle can influence the sperm motility. However, this association seems to only be present in men undergoing first experience ART treatments. Thus, this research shows the need for mental health professionals to respond to emotional difficulties of the male gender, through the development of psychological interventions adjusted, so as to minimize the impact of exposure to ART treatments. published

To estimate the prevalence of velamentous cord insertion (VCI) in dichorionic (DC) and monochorionic (MC) twins with and without twin-twin transfusion syndrome (TTTS), and to study the associated outcomes.We recorded the type of umbilical cord insertion in all consecutive DC and MC placentas examined in two European tertiary medical centers. The association between VCI and perinatal outcomes was estimated and compared.A total of 1498 twin placentas were included in this study (DC placentas n = 550, MC placentas without TTTS n = 513 and MC placentas with TTTS n = 435). The prevalence of VCI in DC, MC without TTTS and MC with TTTS groups was 7.6%, 34.7% and 36.1%, respectively (P 0.001). In MC twins (non-TTTS and TTTS groups), VCI was associated with severe birth weight discordance (odds ratio [OR] 4.76 95% CI 2.43, 10.47 and OR 4.52 95% CI 1.30, 28.59, respectively). In MC twins without TTTS, VCI was associated with small for gestational age (OR 1.66, 95% CI 1.12, 2.50). VCI was significantly associated with increased risk of intrauterine fetal demise in MC twins, and this effect was greater in the non-TTTS group (OR 2.71 95% CI 1.38, 5.47). These associations did not occur in DC group. Gestational age at birth was lower in the presence of VCI in the DC and MC twins without TTTS.Our findings confirm that the prevalence of VCI is higher in MC twins than in DC twin pregnancies. VCI is an important indicator of adverse perinatal outcome, particularly in MC twins.

Background: The agenesis of the ductus venosus (DVA) is a rare condition with a variable prognosis that relies partly on the presence of associated conditions. Therefore, the prenatal evaluation should include a careful examination of fetal circulation, particularly the umbilical and portal venous malformations.Methods In this study, we describe four cases of DVA diagnosed at our institution. For each case, we access the patient’s files in order to extract the following information: gestational age, umbilical vein connection, pre-natal imaging findings, gestational age at delivery or at pregnancy termination, fetal outcomes, post-natal imaging findings, post-mortem findings and karyotype.Results From the four cases included, two were diagnosed in the first trimester and the other two cases in the second trimester of gestation. Prenatal ultrasound studies revealed an intrahepatic shunt in one case and an extrahepatic shunt in three cases. In one case, the karyotype was not performed, whereas the other three had a normal karyotype. Cardiac anomalies were found in three of the four fetuses. All but one case presented with extracardiac abnormalities. None of the cases developed hydrops. Two cases are currently alive and well, one termination of pregnancy occurred at 25 weeks of gestation and one case died at 14 days during surgical correction of a complex cardiac malformation.Conclusions Clinicians should be aware of different and important findings during the fetal examination, which can be indicative of a DVA, and, when suspected, serial revaluations should be scheduled in order to identify any malformation.

This study examined the developmental trajectories of general and breathing movements in fetal twins. Fetal movement patterns were assessed from real-time ultrasound recordings performed at 12-15, 20-23, and 28-32 weeks of gestation in 42 twin pairs. Results indicated that both general movements and breathing movements followed a curvilinear, inverted U-shaped curve. Developmental trajectories were unrelated within pairs of twins and were not associated with gestational age at birth and birth weight. However, sex differences were found for general movements with males displaying more time making general movements at 21 weeks and a steeper decline in time spent making general movements during the second half of pregnancy than females. These age-related changes in fetal movements may reflect CNS development. These findings also suggest that twins' behavioral development is largely independent of co-twin development, gestational age at birth, and birth weight, but not of fetal sex.

Purpose: To evaluate neonatal outcomes in preterm infants with less than 34 weeks after spontaneous labor, preterm premature rupture of membranes (PPROM) or iatrogenic delivery and to clari...

Background: Changes in the coagulation system during pregnancy and puerperium produce a physiological hypercoagulable state. These changes are thought to be the cause of the higher rates of deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, and mechanical prosthetic valve thrombosis (PVT) during pregnancy. Thrombolysis can be a treatment option in this case. However, there are no available data from randomized controlled trials in pregnant patients and information about the security of thrombolytics in pregnancy is missing. Objective: The aim of this review is to summarize the available data regarding the use of thrombolytic agents in pregnancy, describing maternal and fetal outcomes. Methods: A systematic review was performed, searching the electronic database MEDLINE for relevant studies published up to April 2017. The search included MeSH terms "thrombolytic therapy" OR "fibrinolysis" OR "streptokinase" OR "tissue plasminogen activator" AND "pregnancy". All publications that reported the use of a thrombolytic agent for DVT, PE, stroke or PVT in pregnancy were included in the review. Data on the type and total dose of the thrombolytic agent, gestational week, outcome of mothers and children, preterm delivery and bleeding complications were described. Results: Sixty-five articles have been published describing outcomes in 141 pregnant women with serious thrombotic events. There have been no randomized trials involving the use of thrombolytics in pregnancy. Only one prospective study was found. Four maternal deaths (2.8%), 12 major bleeding episodes (8.5%), 13 mild/moderate bleeding episodes (9.2%), two fetal death (1.4%), one child death (0.7%), nine miscarriages (6.4%), and 14 preterm delivery (9.9%) were described. Conclusions: The risk of using thrombolytics in pregnancy seems reasonable taking into account the risk of death in a life-threatening event, with the majority of cases presented in this article resulting in encouraging outcomes. The complication rate of thrombolytic treatment does not seem higher in pregnant women than in the nonpregnant. Poor fetal outcome occurred in mothers with poor prognosis. Specific consensus recommendations are needed in the use of thrombolytics in pregnancy.