Search

Iron deficiency anemia is an important problem among pregnant women, and intravenous (IV) iron infusions have been increasingly used. Whether fetal monitoring is required during infusion has been debated, with a recent guideline by Hematologists recommending against such. We report two cases of fetal bradycardia after iron isomaltoside (IIM), in women with otherwise good maternal and fetal health. Both developed dyspnea with desaturation minutes from infusion, followed by persistent fetal bradycardia. Both underwent category 1 CS, with cord arterial pH of 7.08 and 6.94 respectively. Upon literature review, only three case reports on fetal bradycardia in IV iron were identified. For older IV iron formulations, a case was reported after IV dextran test dose, while two cases after ferric gluconate were reported. For the new formulation IIM, only one case was reported so far, but in a woman with Crohn's disease and intrauterine growth restriction. IV iron in pregnancy carries risk of anaphylactic or hypersensitivity reactions, even with the newest formulations and in women with good maternal and fetal health. While rarely reported so far, fetal bradycardia is a possible consequence, commonly preceded by respiratory symptoms. Fetal monitoring should therefore be considered during infusion. Synopsis: Fetal bradycardia/hypoxia can occur with IV iron, even the newest formulations. This is commonly preceded by respiratory symptoms, and fetal monitoring should be considered. [ABSTRACT FROM AUTHOR]

Fetal growth restriction (FGR) is associated with cardiovascular and respiratory complications after birth and beyond. Despite research showing a range of neurological changes following FGR, little is known about how FGR affects the brainstem cardiorespiratory control centres. The primary neurons that release serotonin reside in the brainstem cardiorespiratory control centres and may be affected by FGR. At two time points in the last trimester of sheep brain development, 110 and 127 days of gestation (0.74 and 0.86 of gestation), we assessed histopathological alterations in the brainstem cardiorespiratory control centres of the pons and medulla in early‐onset FGR versus control fetal sheep. The FGR cohort were hypoxaemic and asymmetrically growth restricted. Compared to the controls, the brainstem of FGR fetuses exhibited signs of neuropathology, including elevated cell death and reduced cell proliferation, grey and white matter deficits, and evidence of oxidative stress and neuroinflammation. FGR brainstem pathology was predominantly observed in the medullary raphé nuclei, hypoglossal nucleus, nucleus ambiguous, solitary tract and nucleus of the solitary tract. The FGR groups showed imbalanced brainstem serotonin and serotonin 1A receptor abundance in the medullary raphé nuclei, despite evidence of increased serotonin staining within vascular regions of placentomes collected from FGR fetuses. Our findings demonstrate both early and adaptive brainstem neuropathology in response to placental insufficiency. Key points: Early‐onset fetal growth restriction (FGR) was induced in fetal sheep, resulting in chronic fetal hypoxaemia.Growth‐restricted fetuses exhibit persistent neuropathology in brainstem nuclei, characterised by disrupted cell proliferation and reduced neuronal cell number within critical centres responsible for the regulation of cardiovascular and respiratory functions. Elevated brainstem inflammation and oxidative stress suggest potential mechanisms contributing to the observed neuropathological changes.Both placental and brainstem levels of 5‐HT were found to be impaired following FGR. [ABSTRACT FROM AUTHOR]

Relative uteroplacental insufficiency of labor (RUPI‐L) is a clinical condition that refers to alterations in the fetal oxygen "demand–supply" equation caused by the onset of regular uterine activity. The term RUPI‐L indicates a condition of "relative" uteroplacental insufficiency which is relative to a specific stressful circumstance, such as the onset of regular uterine activity. RUPI‐L may be more prevalent in fetuses in which the ratio between the fetal oxygen supply and demand is already slightly reduced, such as in cases of subclinical placental insufficiency, post‐term pregnancies, gestational diabetes, and other similar conditions. Prior to the onset of regular uterine activity, fetuses with a RUPI‐L may present with normal features on the cardiotocography. However, with the onset of uterine contractions, these fetuses start to manifest abnormal fetal heart rate patterns which reflect the attempt to maintain adequate perfusion to essential central organs during episodes of transient reduction in oxygenation. If labor is allowed to continue without an appropriate intervention, progressively more frequent, and stronger uterine contractions may result in a rapid deterioration of the fetal oxygenation leading to hypoxia and acidosis. In this Commentary, we introduce the term relative uteroplacental insufficiency of labor and highlight the pathophysiology, as well as the common features observed in the fetal heart rate tracing and clinical implications. [ABSTRACT FROM AUTHOR]

Placental insufficiency and gestational diabetes, which are both serious pregnancy complications, are linked to altered fetal growth, whether restricted or excessive, and result in metabolic dysfunction, hypoxic/oxidative injury, and adverse perinatal outcomes. Although much research has been carried out in this field, the underlying pathogenetic mechanisms have not as yet been fully elucidated. Particularly because of the role it plays in cardiovascular performance, glucose metabolism, inflammation, and oxidative stress, the adipokine apelin was recently shown to be a potential regulator of fetal growth and metabolic programming. This review investigated the numerous biological actions of apelin in utero and aimed to shed more light on its role in fetal growth and metabolic programming. The expression of the apelinergic system in a number of tissues indicates its involvement in many physiological mechanisms, including angiogenesis, cell proliferation, energy metabolism, inflammation, and oxidative stress. Moreover, it appears that apelin has a major function in disorders such as diabetes mellitus, fetal growth abnormalities, fetal hypoxia, and preeclampsia. We herein describe in detail the regulatory effects exerted by the adipokine apelin on fetal growth and metabolic programming while stressing the necessity for additional research into the therapeutic potential of apelin and its mechanisms of action in pregnancy-related disorders. [ABSTRACT FROM AUTHOR]

Fetal hypoxia is a condition characterized by a lack of oxygen supply in a developing fetus in the womb. It can cause potential risks, leading to abnormalities, birth defects, and even mortality. Cardiotocograph (CTG) monitoring is among the techniques that can detect any signs of fetal distress, including hypoxia. Due to the critical importance of interpreting the results of this test, it is essential to accompany these tests with the evolving available technology to classify cases of hypoxia into three cases: normal, suspicious, or pathological. Furthermore, Machine Learning (ML) is a blossoming technique constantly developing and aiding in medical studies, particularly fetal health prediction. Notwithstanding the past endeavors of health providers to detect hypoxia in fetuses, implementing ML and Deep Learning (DL) techniques ensures more timely and precise detection of fetal hypoxia by efficiently and accurately processing complex patterns in large datasets. Correspondingly, this review paper aims to explore the application of artificial intelligence models using cardiotocographic test data. The anticipated outcome of this review is to introduce guidance for future studies to enhance accuracy in detecting cases categorized within the suspicious class, an aspect that has encountered challenges in previous studies that holds significant implications for obstetricians in effectively monitoring fetal health and making informed decisions. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship of umbilical vein flow (UVF) measured close to term with abnormal fetal growth and adverse perinatal outcome in a cohort of pregnancies at low risk of placental insufficiency. Methods: This was a prospective multicenter observational study conducted across two tertiary maternity units. Patients with a singleton appropriate‐for‐gestational‐age fetus between 35 and 38 weeks' gestation were included. Pregnancies at higher risk of placental insufficiency or with fetal anomalies were excluded. At ultrasound examination, the abdominal circumference (AC), umbilical vein diameter and peak velocity of the umbilical vein were measured, and, using these variables, a new variable, UVF/AC, was calculated. The primary outcome was the occurrence of severely stunted fetal growth, defined as a greater than 40‐percentile drop between estimated fetal weight at the third‐trimester ultrasound and birth weight. The occurrence of adverse perinatal outcome (defined as one of the following: neonatal acidosis (umbilical artery pH < 7.15 and/or base excess > 12 mmol/L) at birth, 5‐min Apgar score < 7, neonatal resuscitation or neonatal intensive care unit admission) was analyzed as a secondary outcome. Results: Between April 2021 and March 2023, 365 women were included in the study. The mean UVF/AC at enrolment was 6.4 ± 2.6 mL/min/cm, and 35 (9.6%) cases were affected by severely stunted fetal growth. Severely stunted fetal growth was associated with a lower mean UVF/AC (5.4 ± 2.6 vs 6.5 ± 2.6 mL/min/cm; P = 0.02) and a higher frequency of UVF/AC < 10th percentile (8/35 (22.9%) vs 28/330 (8.5%); P = 0.01). Moreover, UVF/AC showed an area under the receiver‐operating‐characteristics curve (AUC) of 0.65 (95% CI, 0.55–0.75; P = 0.004) in predicting the occurrence of severely stunted fetal growth, and the optimal cut‐off value of UVF/AC for discriminating between normal and severely stunted fetal growth was 7.2 mL/min/cm. This value was associated with a sensitivity and specificity of 0.77 (95% CI, 0.60–0.90) and 0.33 (95% CI, 0.28–0.39), and positive and negative predictive values of 0.11 (95% CI, 0.07–0.15) and 0.93 (95% CI, 0.87–0.97), respectively. Regarding the occurrence of adverse perinatal outcome, this was associated independently with maternal age (adjusted odds ratio (aOR), 0.93 (95% CI, 0.87–0.99); P = 0.04), UVF/AC Z‐score (aOR, 0.53 (95% CI, 0.30–0.87); P = 0.01) and augmentation of labor (aOR, 2.69 (95% CI, 1.28–5.69); P = 0.009). UVF/AC showed an AUC of 0.65 (95% CI, 0.56–0.73; P = 0.005) in predicting the occurrence of adverse perinatal outcome, and the optimal cut‐off value of UVF/AC for discriminating between normal and adverse perinatal outcome was 6.7 mL/min/cm. This value was associated with a sensitivity and specificity of 0.70 (95% CI, 0.54–0.83) and 0.40 (95% CI, 0.34–0.45), and positive and negative predictive values of 0.14 (95% CI, 0.09–0.19) and 0.91 (95% CI, 0.85–0.95), respectively. Conclusions: Our data demonstrate an association between reduced UVF close to term, severely stunted fetal growth and adverse perinatal outcome in a cohort of low‐risk pregnant women, with a moderate ability to rule out and a poor ability to rule in either outcome. Further studies are needed to establish whether the assessment of UVF can improve the identification of fetuses at risk of subclinical placental insufficiency and adverse perinatal 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]

Fetal hypoxia is a condition characterized by a lack of oxygen supply in a developing fetus in the womb. It can cause potential risks, leading to abnormalities, birth defects, and even mortality. Cardiotocograph (CTG) monitoring is among the techniques that can detect any signs of fetal distress, including hypoxia. Due to the critical importance of interpreting the results of this test, it is essential to accompany these tests with the evolving available technology to classify cases of hypoxia into three cases: normal, suspicious, or pathological. Furthermore, Machine Learning (ML) is a blossoming technique constantly developing and aiding in medical studies, particularly fetal health prediction. Notwithstanding the past endeavors of health providers to detect hypoxia in fetuses, implementing ML and Deep Learning (DL) techniques ensures more timely and precise detection of fetal hypoxia by efficiently and accurately processing complex patterns in large datasets. Correspondingly, this review paper aims to explore the application of artificial intelligence models using cardiotocographic test data. The anticipated outcome of this review is to introduce guidance for future studies to enhance accuracy in detecting cases categorized within the suspicious class, an aspect that has encountered challenges in previous studies that holds significant implications for obstetricians in effectively monitoring fetal health and making informed decisions.

Abstract Background While the effectiveness of cardiotocography in reducing neonatal morbidity is still debated, it remains the primary method for assessing fetal well-being during labor. Evaluating how accurately professionals interpret cardiotocography signals is essential for its effective use. The objective was to evaluate the accuracy of fetal hypoxia prediction by practitioners through the interpretation of cardiotocography signals and clinical variables during labor. Material and methods We conducted a cross-sectional online survey, involving 120 obstetric healthcare providers from several countries. One hundred cases, including fifty cases of fetal hypoxia, were randomly assigned to participants who were invited to predict the fetal outcome (binary criterion of pH with a threshold of 7.15) based on the cardiotocography signals and clinical variables. After describing the participants, we calculated (with a 95% confidence interval) the success rate, sensitivity and specificity to predict the fetal outcome for the whole population and according to pH ranges, professional groups and number of years of experience. Interobserver agreement and reliability were evaluated using the proportion of agreement and Cohen’s kappa respectively. Results The overall ability to predict a pH level below 7.15 yielded a success rate of 0.58 (95% CI 0.56-0.60), a sensitivity of 0.58 (95% CI 0.56-0.60) and a specificity of 0.63 (95% CI 0.61-0.65). No significant difference in the success rates was observed with respect to profession and number of years of experience. The success rate was higher for the cases with a pH level below 7.05 (0.69) and above 7.20 (0.66) compared to those falling between 7.05 and 7.20 (0.48). The proportion of agreement between participants was good (0.82), with an overall kappa coefficient indicating substantial reliability (0.63). Conclusions The use of an online tool enabled us to collect a large amount of data to analyze how practitioners interpret cardiotocography data during labor. Despite a good level of agreement and reliability among practitioners, the overall accuracy is poor, particularly for cases with a neonatal pH between 7.05 and 7.20. Factors such as profession and experience level do not present notable impact on the accuracy of the annotations. The implementation and use of a computerized cardiotocography analysis software has the potential to enhance the accuracy to detect fetal hypoxia, especially for ambiguous cardiotocography tracings.

Objective: The main purpose of the study was to evaluate the clinical outcomes of fetuses who had intrapartum non-reassuring fetal heart rate tracings. Material and Methods: Patients who underwent cesarean section as an emergency operation due to non-reassuring fetal heart rate patterns were included in the study. All FHR paper traces were reevaluated by an expert obstetrician, blinded to the neonatal outcomes, based on the guidelines of the NICHD workshop. Patients were placed into five groups considering the variability and accompanying deceleration type. Clinical outcomes, Apgar scores, and umbilical artery blood parameters were evaluated. Results: The study consisted of 84 patients; Group 1, normal variability with late decelerations (n=32); Group 2, normal variability with variable decelerations (n=16); Group 3, decreased variability (n=10); Group 4, decreased variability with late decelerations (n=14); Group 5, decreased variability with variable decelerations (n=12). Groups with decreased variability and decelerations (groups 4 and 5) had higher rates of NICU admission than the groups with normal variability with decelerations (groups 1 and 2) (p<0.05). In the decreased variability with late decelerations group (Group 4), umbilical artery blood pH and ABE were significantly lower while lactate levels were higher than in groups 1, 2, and 3 (p<0.001). Among all patients, inverse correlations were shown between umbilical artery blood lactate and pH (r=-0.734, p<0.001), and also between lactate and ABE (r=-0.581, p<0.001). For the prediction of umbilical artery blood pH<7.1 and/or ABE<-12, the optimal umbilical artery blood lactate cut-off level is 7 mmol/L with a sensitivity of 88.9% and specificity of 89.3%. Conclusion: Decreased variability in non-reassuring intrapartum fetal heart rate patterns should be considered as important as decelerations. In the evaluation of intrapartum fetal asphyxia, lactate appears to be as good a marker as pH and ABE. [ABSTRACT FROM AUTHOR]

Background & Objective: Despite the high efficacy of the Apgar score in finding respiratory distress, a low Apgar score doesn't necessarily indicate fetal hypoxiaasphyxia. Umbilical Artery pH (UApH) is one of the best indicators of fetal hypoxia. Therefore, it's so beneficial to consider these criteria and their relationship with the Apgar score for accurate diagnosis of prenatal respiratory distress retrospectively which reduces the unnecessary cesarean section (CS) rate. Materials & Methods: 162 full-term (=259 days) neonates delivered by CS with the diagnosis of decreased fetal heart rate (FHR) were evaluated. 1-min and 5-min Apgar scores and UApH were measured. The correlation between Apgar scores with UApH and the association between UapH and Apgar with the NICU admission were evaluated. The effect of other variables including mother's age, gravidity, gestational age, birth weight, newborn sex, and causes of decreased FHR on Apgar scores and UApH were studied as well. Results: The most common cause of decreased FHR was fetal distress, boys had higher weight (P=0.033) and lower UApH (P=0.049) than girls. Other parameters were not different significantly between both sexes. There was a positive correlation between UApH and 1-min and 5-min Apgar scores (r=0.464 and r=0.370 respectively) when controlled for birth weight (P<0.0001). The RR for NICU admission in male acidemic neonates with abnormal 1-min Apgar was 14.05 (CI95%: 5.7-34.6) in comparison to females (RR=1.06, CI95%: 1-1.26). Conclusion: Mild acidemia (UApH<7.2) at least in a male fetus would be a good predictor for postnatal complications and need for NICU admission. Future studies with more samples are suggested. [ABSTRACT FROM AUTHOR]

Meconium-stained amniotic fluid (MSAF) affects 15-20% of term pregnancies. Recent studies have shown that MSAF has adverse effects on neonatal outcomes. There is no scientific consensus on the incidence of fetal distress in MSAF neonates, and most cesarean sections due to MSAF are unnecessary. The present study was conducted to assess umbilical artery blood pH in neonates with MSAF and to examine whether there is a relationship between MSAF and fetal distress. A clinical survey case-control was conducted on the neonates of 200 pregnant women admitted to a delivery unit of the obstetrics and Gynecology center in Amir al-Momenin Hospital, Zabol in 2014. Neonates born with MSAF made up the case group, and the control group consisted of neonates born with clear amniotic fluid. Umbilical cord arterial pH, gestational age, gender, mode of delivery, and one and five-minute Apgar scores were considered in both groups. The mean pH of the umbilical cord artery blood in the infants of the case group was 7.25, and the mean pH of the umbilical cord artery in the infants of the control group was 7.29 (P = 0.93). The mean gestational age in the case and control groups was 40.08 weeks and 38.32 weeks, respectively (P= 0.03). In this study, a cesarean delivery (P=0.001) and female gender (P= 0.016) were higher in the case group than in the control group. MSAF does not necessarily imply fetal distress, so urgent cesarean sections are unnecessary. This study showed that based on the acidity variables of the umbilical cord artery, there is no statistically significant correlation between the Apgar score at the 1st and 5th minute. While a significant difference has been observed between the type of delivery, gestational age and baby's gender.

Amniotic banding is a rare condition that can lead to structural limb anomalies, fetal distress and adverse obstetric outcomes. The main hypothesis for its etiology is a rupture of the amniotic membrane in early pregnancy, with the formation of tightly entangling strands around the fetus. These strands can constrict, incise, and subsequently amputate limb parts, the neck or head. More rarely, the amniotic banding can affect the umbilical cord, leading to fetal distress or potential intra-uterine fetal demise. We present a unique case of a 26-week pregnant woman who attended a polyclinical consultation due to reduced fetal movements with concerning cardiotocography (CTG) findings. A review of the literature about amniotic banding of the umbilical cord was conducted as well, identifying diagnostic and interventional options for the obstetrician's practice. This is a case report, alongside a review of the literature. The CTG indicated fetal distress, prompting an emergency caesarean section (C-section). Upon delivery, the neonate exhibited signs of amniotic band sequence, with distal phalangeal defects on the right hand and severe constriction of the umbilical cord caused by amniotic strands, the latter precipitating fetal hypoxia. Direct ultrasound diagnosis remains a challenge in the absence of limb amputation, yet indirect signs such as distal limb or umbilical doppler flow abnormalities and distal limb edema may be suggestive of amniotic banding. MRI is proposed as an adjuvant diagnostic tool yet does not present a higher detection rate compared to ultrasound. Fetoscopic surgery to perform lysis of the amniotic strands with favorable outcome has been described in literature. This case presents the first reported survival of an extremely preterm fetus in hypoxic distress as a cause of amniotic banding of the umbilical cord, with a rare degree of incidental timing. Ultrasound diagnosis remains the gold standard. Obstetrical vigilance is warranted, with fetal rescue proven to be feasible. [ABSTRACT FROM AUTHOR]

Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases (CHD), which presents with classical tetrad ventricular septal defect (VSD) with overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. Women with uncorrected TOF have maternal hypoxemia with miscarriage, poor fetal growth, preterm delivery, or even fetal death with chances of maternal heart failure as its consequence event. We are reporting three cases of pregnancy in women having uncorrected TOF who were managed successfully at our institute. Pregnant women with class III-IV NYHA are counseled for MTP, as done in the third case here. However, if the patient refuses, we can proceed with the pregnancy with total bed rest and supportive care, as done in the first two cases. Intense monitoring is required throughout pregnancy as hypoxia and polycythemia both are related to poor maternal and fetal outcomes. Our findings in all three cases were comparable to published cases and studies like done by Veldtman et al., Balci et al., and Drenthen et al. So, patients with TOF during pregnancy need multidisciplinary team care consisting of obstetricians, cardiologists, anesthesiologists, and neonatologists among others. At the initial booking itself, these high-risk patients should be admitted for evaluation of the severity of TOF and its effect on pregnancy. [ABSTRACT FROM AUTHOR]

Aim:There is conflicting data regarding the utility of Doppler indices in patients with diabetes. Our objective was to investigate the value of fetal Doppler parameters on umbilical blood gas abnormalities and Apgar scores in term diabetic pregnancies treated with insulin.Methods:A total of 120 pregnant women with pregestational or gestational diabetes underwent Doppler screening between 37 and 38 weeks of gestation. The main outcome was to compare the diagnostic performance of the umbilical artery-pulsatility index (UA-PI), middle cerebral artery-PI (MCA-PI), cerebroplacental ratio (CPR), and umbilicocerebral ratio (UCR) in detecting the presence of intrauterine hypoxemia.Results:From the sample, 18 (15%) had type 1 diabetes mellitus (DM), 40 (33.3%) had type 2 DM, and 62 (51.7%) had GDM A2. The median gestational age at the time of Doppler screening was 37 weeks and 3 days (range 37 weeks to 38 weeks 2 days) and the mean ± standard deviation gestational age at delivery was 38 weeks 4 days ± 3 days. No significant correlations were observed for MCA-PI, UA-PI, CPR, or UCR with any of the measured outcomes. Analysis of Doppler parameters of normal neonates and those with abnormal composite tests showed that Doppler parameters were non-significant in predicting abnormal composite outcomes.Conclusion:The data obtained from this study show that the low predictive ability of Doppler velocimetry in abnormal neonatal tests results in pregnancies complicated by diabetes.

In high-resource countries, adverse perinatal outcomes are currently rare in term, non-malformed fetuses, undergoing labor, but they remain a leading cause of medico-legal dispute. Precise terminology is important to describe situations related to inadequate fetal oxygenation in labor, to ensure appropriate communication between healthcare professionals and adequate transmission of information to parents. This position statement provides consensus definitions from European perinatologists and midwives regarding the most appropriate terminology to describe situations related to inadequate fetal oxygenation in labor: suspected fetal hypoxia, severe newborn acidemia, newborn metabolic acidosis, and hypoxic-ischemic encephalopathy. It also identifies terms that are imprecise or nonspecific to this situation, and should therefore be avoided by healthcare professionals: fetal well-being, fetal stress, fetal distress, non-reassuring fetal state, and birth asphyxia. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between undetected small‐for‐gestational age (SGA) fetuses and abnormal admission cardiotocography (admCTG) in a low‐risk population. Design: An observational study. Setting: Four hospitals in Stockholm‐Gotland, Sweden. Sample: A cohort of 127 461 deliveries between 1 February 2012 and 15 June 2020. Methods: This cohort was linked to the Swedish Neonatal Quality Register. Pregnancies were designated as high or low risk at the time of admission to the labour ward according to pre‐defined risk measures. SGA was defined as a birthweight at or below the tenth centile and at or below the third centile for gestational age. Main outcome measures: The main outcome was the proportion of undetected SGA by admCTG (normal or abnormal). The secondary outcome was a composite severe adverse neonatal outcome for fetuses born less than 6 hours after admission (Apgar score <4 at 5 minutes, hypoxic–ischaemic encephalopathy grade of 2–3, neonatal seizures and neonatal death). Results: The rate of abnormal admCTG was 4.9%. The proportion of SGA at or below the tenth centile was higher in the abnormal admCTG group than in the normal admCTG group, 18.6% versus 9.7% (odds ratio 2.1, 95% CI 1.9–2.3). Abnormal admCTG and SGA (≤10th) was associated with a more than 20‐fold increased risk of an adverse outcome compared with normal admCTG and non‐SGA (adjusted odds ratio 23.7, 95% CI 9.8–57.3). The latter had a risk of 1/2000 of an adverse outcome. Conclusions: In this low‐risk population, undetected SGA fetuses were more prone to having abnormal admCTG and had a substantially higher risk of severe adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

Chronic intrauterine hypoxia is a significant pregnancy complication impacting fetal heart growth, metabolism, and mitochondrial function, contributing to cardiovascular programming of the offspring. PGC1α (peroxisome proliferator-activated receptor γ co-activator 1α) is the master regulator of mitochondrial biogenesis. We investigated the effects of hypoxia on PGC1α expression following exposure at different gestational ages. Time-mated pregnant guinea pigs were exposed to normoxia (NMX, 21% O2) or hypoxia (HPX, 10.5% O2) at either 25-day (early-onset) or 50-day (late-onset) gestation, and all fetuses were extracted at term (term = ~65-day gestation). Expression of nuclear PGC1α, sirtuin 1 (SIRT1), AMP-activated protein kinase (AMPK), and mitochondrial sirtuin 3 (SIRT3) was measured, along with SIRT3 activity and mitochondrial acetylation of heart ventricles of male and female fetuses. Early-onset hypoxia increased (P<0.05) fetal cardiac nuclear PGC1α and had no effect on mitochondrial acetylation of either growth-restricted males or females. Late-onset hypoxia had either no effect or decreased (P<0.05) PCC1α expression in males and females, respectively, but increased (P<0.05) mitochondrial acetylation in both sexes. Hypoxia had variable effects on expression of SIRT1, AMPK, SIRT3, and SIRT3 activity depending on the sex. The capacity of the fetal heart to respond to hypoxia differs depending on the gestational age of exposure and sex of the fetus. Further, the effects of late-onset hypoxia on fetal heart function impose a greater risk to male than female fetuses, which has implications toward cardiovascular programming effects of the offspring. [ABSTRACT FROM AUTHOR]

Copyright of Revista Habanera de Ciencias Médicas is the property of Universidad de Ciencias Medicas de La Habana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The embryo and fetus grow in a hypoxic environment. Intrauterine oxygen levels fluctuate throughout the pregnancy, allowing the oxygen to modulate apparently contradictory functions, such as the expansion of stemness but also differentiation. We have recently demonstrated that in the last weeks of pregnancy, oxygenation progressively increases, but the trend of oxygen levels during the previous weeks remains to be clarified. In the present retrospective study, umbilical venous and arterial oxygen levels, fetal oxygen extraction, oxygen content, CO2, and lactate were evaluated in a cohort of healthy newborns with gestational age < 37 weeks. A progressive decrease in pO2 levels associated with a concomitant increase in pCO2 and reduction in pH has been observed starting from the 23rd week until approximately the 33–34th week of gestation. Over this period, despite the increased hypoxemia, oxygen content remains stable thanks to increasing hemoglobin concentration, which allows the fetus to become more hypoxemic but not more hypoxic. Starting from the 33–34th week, fetal oxygenation increases and ideally continues following the trend recently described in term fetuses. The present study confirms that oxygenation during intrauterine life continues to vary even after placenta development, showing a clear biphasic trend. Fetuses, in fact, from mid-gestation to near-term, become progressively more hypoxemic. However, starting from the 33–34th week, oxygenation progressively increases until birth. In this regard, our data suggest that the placenta is the hub that ensures this variable oxygen availability to the fetus, and we speculate that this biphasic trend is functional for the promotion, in specific tissues and at specific times, of stemness and intrauterine differentiation. [ABSTRACT FROM AUTHOR]

Abstract Background Fetal hypoxia causes vital, systemic, developmental malformations in the fetus, particularly in the brain, and increases the risk of diseases in later life. We previously demonstrated that fetal hypoxia exposure increases the susceptibility of the neonatal brain to hypoxic-ischemic insult. Herein, we investigate the effect of fetal hypoxia on programming of cell-specific transcriptomes in the brain of neonatal rats. Results We obtained RNA sequencing (RNA-seq) data from neurons, microglia, oligodendrocytes, A2B5+ oligodendrocyte precursor cells, and astrocytes from male and female neonatal rats subjected either to fetal hypoxia or control conditions. Substantial transcriptomic responses to fetal hypoxia occurred in neurons, microglia, oligodendrocytes, and A2B5+ cells. Not only were the transcriptomic responses unique to each cell type, but they also occurred with a great deal of sexual dimorphism. We validated differential expression of several genes related to inflammation and cell death by Real-time Quantitative Polymerase Chain Reaction (qRT-PCR). Pathway and transcription factor motif analyses suggested that the NF-kappa B (NFκB) signaling pathway was enriched in the neonatal male brain due to fetal hypoxia, and we verified this result by transcription factor assay of NFκB-p65 in whole brain. Conclusions Our study reveals a significant impact of fetal hypoxia on the transcriptomes of neonatal brains in a cell-specific and sex-dependent manner, and provides mechanistic insights that may help explain the development of hypoxic-ischemic sensitive phenotypes in the neonatal brain.

Among the total number of newborns, about 11% face hypoxia problems. It is hypoxia that becomes the main cause of premature birth, fetal and newborn mortality, as well as various pathologies. Fetal respiration passes through the placenta with the participation of the erythrocytes. Thus, fetal respiration is affected by the rate of passage of erythrocytes through small blood capillaries. Ultimately, the elasticity, area, and permeability of the erythrocyte membrane have a direct impact on the quality of fetal intrauterine respiration. This article discusses the main methods of studying the dynamic characteristics of erythrocytes and also analyzes the number of anion exchangers on the erythrocyte membrane. The experiment involved 4 pregnant women, two of whom have a risk of premature birth. These patients undergo tocolytic therapy, the purpose of which is to reduce the risk of premature birth. As a result of the study, the dynamics of changes in the ratio of dynamic strength to the elasticity of the erythrocyte membrane, the amount of band 3 protein, as well as the dynamics of the CO2-O2 exchange rate during tocolytic therapy of pregnant patients are determined. [ABSTRACT FROM AUTHOR]

Aim: There is conflicting data regarding the utility of Doppler indices in patients with diabetes. Our objective was to investigate the value of fetal Doppler parameters on umbilical blood gas abnormalities and Apgar scores in term diabetic pregnancies treated with insulin. Methods: A total of 120 pregnant women with pregestational or gestational diabetes underwent Doppler screening between 37 and 38 weeks of gestation. The main outcome was to compare the diagnostic performance of the umbilical artery-pulsatility index (UA-PI), middle cerebral artery-PI (MCA-PI), cerebroplacental ratio (CPR), and umbilicocerebral ratio (UCR) in detecting the presence of intrauterine hypoxemia. Results: From the sample, 18 (15%) had type 1 diabetes mellitus (DM), 40 (33.3%) had type 2 DM, and 62 (51.7%) had GDM A2. The median gestational age at the time of Doppler screening was 37 weeks and 3 days (range 37 weeks to 38 weeks 2 days) and the mean ± standard deviation gestational age at delivery was 38 weeks 4 days ± 3 days. No significant correlations were observed for MCA-PI, UA-PI, CPR, or UCR with any of the measured outcomes. Analysis of Doppler parameters of normal neonates and those with abnormal composite tests showed that Doppler parameters were non-significant in predicting abnormal composite outcomes. Conclusion: The data obtained from this study show that the low predictive ability of Doppler velocimetry in abnormal neonatal tests results in pregnancies complicated by diabetes. [ABSTRACT FROM AUTHOR]

Initially developed from hospital feasibility data from the 1980s, the "30-minute rule" has perpetuated the belief that the decision-to-incision time in an emergency cesarean delivery should be <30 minutes to preserve favorable neonatal outcomes. Through a review of the history, available data on delivery timing and associated outcomes, and consideration of feasibility across several hospital systems, the use and applicability of this "rule" are explored, and its reconsideration is called for. Moreover, we have advocated for balanced consideration of maternal safety with rapidity of delivery, encouraged process-based approaches, and proposed standardization of terminology regarding delivery urgency. Furthermore, a standardized 4-tier classification system for delivery urgency, from class I, for a perceived threat to maternal or fetal life, to class IV, a scheduled delivery, and a call for further research with a standardized structure to facilitate comparison have been proposed. [ABSTRACT FROM AUTHOR]

IntroductionCardiotocography, which consists in monitoring the fetal heart rate as well as uterine activity, is widely used in clinical practice to assess fetal wellbeing during labor and delivery in order to detect fetal hypoxia and intervene before permanent damage to the fetus. We present DeepCTG® 1.0, a model able to predict fetal acidosis from the cardiotocography signals.Materials and methodsDeepCTG® 1.0 is based on a logistic regression model fed with four features extracted from the last available 30 min segment of cardiotocography signals: the minimum and maximum values of the fetal heart rate baseline, and the area covered by accelerations and decelerations. Those four features have been selected among a larger set of 25 features. The model has been trained and evaluated on three datasets: the open CTU-UHB dataset, the SPaM dataset and a dataset built in hospital Beaujon (Clichy, France). Its performance has been compared with other published models and with nine obstetricians who have annotated the CTU-UHB cases. We have also evaluated the impact of two key factors on the performance of the model: the inclusion of cesareans in the datasets and the length of the cardiotocography segment used to compute the features fed to the model.ResultsThe AUC of the model is 0.74 on the CTU-UHB and Beaujon datasets, and between 0.77 and 0.87 on the SPaM dataset. It achieves a much lower false positive rate (12% vs. 25%) than the most frequent annotation among the nine obstetricians for the same sensitivity (45%). The performance of the model is slightly lower on the cesarean cases only (AUC = 0.74 vs. 0.76) and feeding the model with shorter CTG segments leads to a significant decrease in its performance (AUC = 0.68 with 10 min segments).DiscussionAlthough being relatively simple, DeepCTG® 1.0 reaches a good performance: it compares very favorably to clinical practice and performs slightly better than other published models based on similar approaches. It has the important characteristic of being interpretable, as the four features it is based on are known and understood by practitioners. The model could be improved further by integrating maternofetal clinical factors, using more advanced machine learning or deep learning approaches and having a more robust evaluation of the model based on a larger dataset with more pathological cases and covering more maternity centers.

Background: Fetal hypoxia causes vital, systemic, developmental malformations in the fetus, particularly in the brain, and increases the risk of diseases in later life. We previously demonstrated that fetal hypoxia exposure increases the susceptibility of the neonatal brain to hypoxic-ischemic insult. Herein, we investigate the effect of fetal hypoxia on programming of cell-specific transcriptomes in the brain of neonatal rats. Results: We obtained RNA sequencing (RNA-seq) data from neurons, microglia, oligodendrocytes, A2B5+ oligodendrocyte precursor cells, and astrocytes from male and female neonatal rats subjected either to fetal hypoxia or control conditions. Substantial transcriptomic responses to fetal hypoxia occurred in neurons, microglia, oligodendrocytes, and A2B5+ cells. Not only were the transcriptomic responses unique to each cell type, but they also occurred with a great deal of sexual dimorphism. We validated differential expression of several genes related to inflammation and cell death by Real-time Quantitative Polymerase Chain Reaction (qRT-PCR). Pathway and transcription factor motif analyses suggested that the NF-kappa B (NFκB) signaling pathway was enriched in the neonatal male brain due to fetal hypoxia, and we verified this result by transcription factor assay of NFκB-p65 in whole brain. Conclusions: Our study reveals a significant impact of fetal hypoxia on the transcriptomes of neonatal brains in a cell-specific and sex-dependent manner, and provides mechanistic insights that may help explain the development of hypoxic-ischemic sensitive phenotypes in the neonatal brain. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine whether early-onset and late-onset fetal growth restriction (FGR) differentially affects the blood–brain barrier integrity. Furthermore, the purpose of the study was to investigate the relationship between the blood–brain barrier breakdown and neurological disorders in FGR newborns. To evaluate the serum tight junction (TJ) proteins and the placental TJ proteins expression, an ELISA method was used. A significant difference in serum OCLN concentrations was noticed in pregnancies complicated by the early-onset FGR, in relation to the intraventricular hemorrhage (IVH) occurrence in newborns. No significant differences in concentrations of the NR1 subunit of the N-methyl-d-aspartate receptor (NR1), nucleoside diphosphate kinase A (NME1), S100 calcium-binding protein B (S100B), occludin (OCLN), claudin-5 (CLN5), zonula occludens-1 (zo-1), the CLN5/zo-1 ratio, and the placental expression of OCLN, CLN5, claudin-4 (CLN4), zo-1 were noticed between groups. The early-onset FGR was associated with a higher release of NME1 into the maternal circulation in relation to the brain-sparing effect and premature delivery. Additionally, in late-onset FGR, the higher release of the S100B into the maternal serum in regard to fetal distress was observed. Furthermore, there was a higher release of zo-1 into the maternal circulation in relation to newborns' moderate acidosis in late-onset FGR. Blood–brain barrier disintegration is not dependent on pregnancy advancement at the time of FGR diagnosis. NME1 may serve as a biomarker useful in the prediction of fetal circulatory centralization and extremely low birth weight in pregnancies complicated by the early-onset FGR. Moreover, the serum zo-1 concentration may have prognostic value for moderate neonatal acidosis in late-onset FGR pregnancies. [ABSTRACT FROM AUTHOR]

Cardiotocography is defined as the recording of fetal heart rate and uterine contractions and is widely used during labor as a screening tool to determine fetal wellbeing. The visual interpretation of the cardiotocography signals by the practitioners, following common guidelines, is subject to a high interobserver variability, and the efficiency of cardiotocography monitoring is still debated. Since the 1990s, researchers and practitioners work on designing reliable computer‐aided systems to assist practitioners in cardiotocography interpretation during labor. Several systems are integrated in the monitoring devices, mostly based on the guidelines, but they have not clearly demonstrated yet their usefulness. In the last decade, the availability of large clinical databases as well as the emergence of machine learning and deep learning methods in healthcare has led to a surge of studies applying those methods to cardiotocography signals analysis. The state‐of‐the‐art systems perform well to detect fetal hypoxia when evaluated on retrospective cohorts, but several challenges remain to be tackled before they can be used in clinical practice. First, the development and sharing of large, open and anonymized multicentric databases of perinatal and cardiotocography data during labor is required to build more accurate systems. Also, the systems must produce interpretable indicators along with the prediction of the risk of fetal hypoxia in order to be appropriated and trusted by practitioners. Finally, common standards should be built and agreed on to evaluate and compare those systems on retrospective cohorts and to validate their use in clinical practice. [ABSTRACT FROM AUTHOR]

BackgroundPreterm birth (PTB) is a major cause of infant morbidity and mortality in developing countries. Recent data suggest that in addition to Human Immunodeficiency Virus (HIV) infection, use of antiretroviral therapy (ART) increases the risk of PTB. As the mechanisms remain unexplored, we conducted this study to determine whether HIV and ART were associated with placental changes that could contribute to PTB.SettingWe collected and evaluated placentas from 38 HIV-positive women on ART and 43 HIV-negative women who had preterm deliveries in Nairobi, Kenya.MethodsAnatomical features of the placentas were examined at gross and microscopic levels. Cases were matched for gestational age and compared by the investigators who were blinded to maternal HIV serostatus.ResultsAmong preterm placentas, HIV infection was significantly associated with thrombosis (P = 0.001), infarction (P = 0.032), anomalies in cord insertion (P = 0.02), gross evidence of membrane infection (P = 0.043), and reduced placental thickness (P = 0.010). Overall, preterm placentas in both groups were associated with immature villi, syncytial knotting, villitis, and deciduitis. Features of HIV-positive versus HIV-negative placentas included significant fibrinoid deposition with villus degeneration, syncytiotrophoblast delamination, red blood cell adhesion, hypervascularity, and reduction in both surface area and perimeter of the terminal villi.ConclusionsThese results imply that HIV infection and/or ART are associated with morphological changes in preterm placentas that contribute to delivery before 37 weeks. Hypervascularity suggests that the observed pathologies may be attributable, in part, to hypoxia. Further research to explore potential mechanisms will help elucidate the pathways that are involved perhaps pointing to interventions for decreasing the risk of prematurity among HIV-positive women.