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Objective: To evaluate the relative cost-effectiveness of starting antenatal fetal surveillance at 32 vs. 36 weeks, in medication-treated gestational diabetes. Methods: We performed a 2017–2022 retrospective cohort study of patients with medication-treated GDM who underwent BPPs. Patients diagnosed before 24 weeks, those delivered before 32 weeks, and those without BPPs or delivery data were excluded. Demographic and outcome data were abstracted by chart review. We performed a cost-effectiveness analysis regarding two outcomes: stillbirth, and decision to alter delivery timing following abnormal BPPs. Results: A total of 652 pregnancies were included. Patients were 49% privately insured, 25% publicly insured, and 26% uninsured. We assumed that each BPP cost $145. In total, 1,284 BPPs occurred after 36 weeks, costing $186,180, and 2,041 BPPs occurred between 32 and 36 weeks, costing an additional $295,945. Twelve deliveries resulted from abnormal BPPs, all after 36 weeks. No stillbirths occurred. The cost to attempt to avoid one stillbirth was $40,177 across all patients. In our sample, starting surveillance at 36 weeks would have theoretically avoided all stillbirths, with cost savings per avoided stillbirth of $51,572 for privately insured patients, $14,123 for publicly insured patients, and $17,799 for patients without insurance. Conclusion: Based on this population with no stillbirths and no BPPs dictating delivery before 36 weeks, surveillance after 36 weeks may be safe and cost-effective. Our findings reflect opportunities for shared decision making and potential practice change, with greatest impact for low socioeconomic status patients and those without insurance. [ABSTRACT FROM AUTHOR]

Objective Our objective was to describe infant mortality within 1 year of life according to gestational age and birth weight percentile in infants delivered between 22 and 28 weeks of gestation. Study Design This study was a retrospective cohort study based on publicly available U.S. birth certificate data linked to infant death data between 2014 and 2020. Maternal–neonate pairs of singleton live births between 22 0/7 and 28 6/7 weeks' gestation (vaginal or cesarean) were evaluated. We excluded infants with major fetal anomalies, chromosomal disorders, and birth weight outliers. Our primary outcome was infant mortality within 1 year of life. Individuals were categorized into eight sex-specific birth weight percentiles categories: less than the 3rd, 3rd-less than the 10th, 10th-less than the 25th, 25th-to less than the 50th, 50th-less than the 75th, 75th-to less than the 90th, 90th-less than the 97th, and 97th or higher. Results Of 27,014,444 individuals with live births from January 2014 to December 2020, 151,677 individuals who gave birth at 22 to 28 weeks of gestation were included in the study population. The mortality rate ranged from 4.2% for the 50th-less than the 75th percentiles at 28 weeks to 80.3% for the 3rd-less than the 10th percentile at 22 weeks. Using the 50th-less than the 75th birth weight percentile at each gestational age as a reference group, birth weight less than the 50th percentile was associated with increased mortality at all gestational ages in a dose-dependent manner. From 22 to 25 weeks of gestation, higher birth weight percentiles were associated with lower mortality, while the 97th or higher birth weight percentile was associated with increased mortality compared with the 50th-less than the 75th birth weight percentile at 26 to 28 weeks of gestation. Conclusion The lower birth weight percentiles were associated with higher mortality across all gestational ages, but the association between higher birth weight percentiles and infant mortality exhibited an opposite pattern at 22 to 25 weeks as compared to later gestational age. Key Points Birth weight ≥97th percentile was associated with increased infant mortality at 26 to 28 weeks. Higher birth weight percentiles were associated with a lower risk of mortality at 22 to 25 weeks. Lower birth weight percentiles were associated with a higher risk of mortality at 22 to 28 weeks. [ABSTRACT FROM AUTHOR]

Background: Obesity is an increasing problem, even in young women of reproductive age. Obesity has a negative impact on conception, the course of pregnancy, and neonatal outcomes. Caring for obese pregnant women has becoming an important aspect of standard prenatal care. The Guideline "Obesity and Pregnancy" of the German Society of Gynecology and Obstetrics aims to create evidence-based recommendations which can be used to improve the care of obese pregnant women. As obesity is a worldwide problem, many societies for obstetrics and gynecology have created national guidelines. Methods: We reviewed the following guidelines for obesity and pregnancy: American College of Obstetricians and Gynecologists (ACOG) 2021, Royal College of Obstetrics and Gynecology (RCOG) 2018; AND Society of Obstetricians and Gynecologists of Canada (SOGC) 2019. These guidelines were compared to the German guideline. Results: There are some variations between the guidelines, though no major contradictions exist. Disparities were found regarding the recommendations for substitution of high folic acid and Vitamin D. Furthermore, the recommended time for screening for gestational diabetes and the methods to control fetal growth differ between the guidelines. Regarding place of birth, RCOG allows delivery in midwifery-led units in the absence of other high-risk circumstances, while others request facility of care by neonatologists and medical staff trained in care of obese women. Induction of labor at term due to increased risk of intrauterine demise is mostly limited to women with a body mass index of 40 kg/m2. Only one guideline considers induction of all obese women. For intrapartum management, the majority allows tolerating of longer labor times to delivery if fetal monitoring is sufficient and fetal stress is excluded. Special encouragement of breastfeeding and healthy lifestyle is commonly recommended; only in the Canadian guideline, postpartum depression evaluation is requested due to the overall high prevalence of depression and anxiety in obese women. Conclusion: All guidelines consider pregnancies in obese women as high-risk pregnancies and emphasize the need for preconception counseling. There are special needs in pregnancy care and in the intrapartum and postpartum management to be observed. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study was conducted to evaluate the impact of listening to fetal heartbeats (FHBs) on the feelings of normal and high-risk pregnancies (HRPs), and to learn the colors and geometrical figures representing their feelings. STUDY DESIGN: This retrospective cohort study consisted of 291 pregnant women who applied for a non-stress test (NST). Participants were divided into two groups; 1: Normal pregnancies (Group1) and 2: HRPs (Group2). Demographic variables, feelings in response to listening to FHBs (negative, neutral, positive), grade mark (0-10) of feelings, color (warm, neutral, cold), and figure (simple, complex) preferences were retrospectively evaluated. RESULTS: Of the 291 women, 172 (59.1%) Group 1 participants were compared to 119 (40.9%) Group 2 participants. Group 1 and Group 2 had similar feelings (p>0.05), however, the rate of negative feelings was higher in Group 2 (11.6% vs. 20.2%). Higher marks were observed in Group 2 with happiness and peace/relaxation after listening to FHBs. Fear was the lowest mark in women with positive/neutral feelings in both groups. Women in Group 1 preferred warm colors regardless of their feelings. Women in Group 2 who have positive feelings chose warm colors, whereas women who felt neutral or negative more commonly chose cold (55.5%) and neutral (41.7%) colors (p=0.017). Independent of feelings, simple figures were predominately preferred (p=0.04). CONCLUSION: NST is more than a perinatal surveillance method and listening to FHBs has a positive impact on the feelings of pregnancies. Warm colors were commonly related to positive feelings. Simple figures were preferred regardless of feelings. [ABSTRACT FROM AUTHOR]

Objective: To compare the duration of the biophysical profile assessment (BPP) between pregnant women listening to music and those who did not. Materials and Methods: The present study recruited a cohort of 50 pregnant women with low-risk pregnancies and gestational ages over 32 weeks. The participants were selected from the Department of Obstetrics and Gynecology at Queen Savang Vadhana Memorial Hospital between February and December 2022. Participants were divided equally into two distinct groups, the experimental group and the control group, with 25 participants each. The experimental group was equipped with headphones playing music, while the control group wore headphones without music. The assessment was conducted until both groups fulfilled the BPP criteria. Unpaired t-test and chi-square test were employed to compare continuous and categorical variables between the two groups. A p-value of less than 0.05 was considered statistically significant. Results: The present study found that using music during BPP led to a reduction in the overall evaluation time or the time required for each component. The experimental group during the assessment exhibited a significantly shorter testing time at 4.88±2.42 minutes compared to the control group at 7.04±4.22 minutes (p=0.013). Conclusion: The present study demonstrated that inclusion of music in the assessment process leads to a significant reduction in total BPP assessment time while simultaneously enhancing maternal satisfaction. Nevertheless, further research is required to elucidate the underlying mechanisms of this phenomenon and investigate strategies for integrating music into the assessment process. [ABSTRACT FROM AUTHOR]

Background: Following the development of the Royal Australian College of Obstetricians and Gynaecologists Intrapartum Fetal Surveillance Guideline in 2003, an education program was developed to support guideline implementation and clinical practice. It was intended that improved clinician knowledge, particularly of cardiotocography, would reduce rates of intrapartum fetal morbidity and mortality. The program contains a multiple-choice assessment, designed to assess fetal surveillance knowledge and the application of that knowledge. We used the results of this assessment over time to evaluate the impact of the education program on clinicians’ fetal surveillance knowledge and interpretive skills, in the immediate and longer-term. Methods: We undertook a retrospective analysis of the assessment results for all participants in the Fetal Surveillance Education Program, between 2004 and 2018. Classical Test Theory and Rasch Item Response Theory analysis were used to evaluate the statistical reliability and quality of the assessment, and the measurement invariance or stability of the assessments over time. Clinicians’ assessment scores were then reviewed by craft group and previous exposure to the program. Results: The results from 64,430, broadly similar assessments, showed that participation in the education program was associated with an immediate improvement in clinician performance in the assessment. Performance improvement was sustained for up to 18 months following participation in the program and recurrent participation was associated with progressive improvements. These trends were observed for all craft groups (consultant obstetricians, doctors in training, general practitioners, midwives, student midwives). Conclusions: These findings suggest that the Fetal Surveillance Education Program has improved clinician knowledge and the associated cognitive skills over time. The stable difficulty of the assessment tool means any improvement in clinician’s results, with ongoing exposure to the program, can be reliably assessed and demonstrated. Importantly this holds true for all craft groups involved in intrapartum care and the interpretation of cardiotocography.

Purpose: The aim of the study was to estimate by a survival analysis model the hazard function (HF) for neonatal metabolic acidemia (MA) throughout the 2nd stage of labor (2STG) at the time of occurrence of a terminal bradycardia ≥ 10 min requiring expedited delivery, and the cumulative incidence function (CIF) for MA according with the duration of bradycardia stratified in 10–12 min and > 12 min. Methods: Singleton pregnancies experiencing terminal fetal bradycardia requiring expedited delivery in the 2STG at 38 + 0–41 + 3 weeks and delivering in the year 2019, were identified. The presence of MA (pH < 7 and/or BE ≤ − 12 mmol/L) was determined based on the acid–base status in the umbilical artery cord blood. Survival analysis was used to assess the hazard function (HF) and the cumulative incidence function (CIF) for MA occurring after terminal fetal bradycardia, at the 2STG. Results: Out of a non-consecutive population of 12,331 pregnancies, there were 52 cases that fit the inclusion criteria. Twenty-four (46.2%) of those develop MA. Abnormal quantitative pH values and the HF for MA correlated with the duration of 2STG at the time of bradycardia onset, but not with bradycardia duration. After 60 min of duration of 2STG, the HF (or instantaneous rate of failure) increased dramatically (from 1.2 to 20 about at 120 min). At paired duration of 2STG, a higher CIF was observed for the terminal bradycardia > 12 min. Conclusion: Forty-six percent of term fetuses with terminal bradycardia had MA at birth. Despite the low sensitivity and a non-significant association with quantitative pH values, the duration of terminal bradycardia in the 2STG is associated with a higher CIF for MA. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to determine the cause-specific hazard (CSH) and the cumulative incidence function (CIF) for umbilical cord metabolic acidemia at birth (MA; pH < 7.0 and/or BE ≤ − 12 mmol/L) at delivery in patients experiencing the 2nd stage of labor (2STG), stratified for both FIGO-2015 pathologic intrapartum cardiotocography requiring expedited delivery (CTG_RED) and duration of 2nd stage of labor. Methods: 3459 pregnancies experiencing the 2nd stage of labor and delivering at the Division of Obstetrics and Prenatal Medicine, IRCCS Sant'Orsola-Malpighi Hospital, Bologna (Italy), were identified between 2018 and 2019. Survival analysis was used to assess CSH and CIF for MA, stratified for FIGO-2015 pathologic CTG and relevant covariates. Results: FIGO-2015 pathological CTG with expedited operative delivery or urgent cesarean section within 10 or 20 min from diagnosis, respectively occurred in 282/3459 (8.20%). The rate of MA at delivery was 3.32% (115/3459). The spline of CSH for MA showed a direct correlation with the duration of 2STG always presenting higher values and greater slope in the presence of pathologic CTG, with plateau between 60 and 120 min and rapid increase after 120 min. The CIF at 180 min in the 2STG was 2.67% for nonpathological and 10.63% for pathological CTG_RED. Nulliparity, pathological CTG, and meconium-stained amniotic fluid resulted significant predictors of MA in our multivariable model. Conclusion: The risk for MA increases moderately across the 2STG with nonpathological CTG and quadruples with pathological CTG_RED. Adjustment for other predictors of MA including meconium-stained amniotic fluid and nulliparity reveals a significant hazard increase for MA associated with pathologic CTG_RED. [ABSTRACT FROM AUTHOR]

Objective: To compare the ductus venosus (DV) pulsatility index for veins (PIV) obtained in a mid-sagittal plane with that obtained in an oblique transverse plane of the fetal abdomen. Methods: Prospective observational study in singleton uncomplicated pregnancies undergoing an ultrasound examination between 24 and 34 weeks of gestation. Pregnancies complicated by fetal anomalies, fetal growth restriction, or oligohydramnios were excluded. Two consecutive recordings of DV Doppler waveform were obtained in each woman: one in a mid-sagittal plane, and the other in an oblique transverse plane of the fetal abdomen. The peak velocity during ventricular systole (S-wave) and diastole (D-wave), the velocity during atrial contraction (a-wave), and the time-averaged maximum velocity (TAmax) were measured, and the PIV was calculated. The paired t-test was used to compare results obtained with the two approaches. A change of the DV-PIV of 0.10 or more was considered clinically relevant. Results: The DV waveform was successfully obtained in 53 women (mean gestational age 28.5 weeks). The mean DV-PIV was 0.57 (±0.16 SD) in the sagittal plane and 0.54 (±0.16 SD) in the transverse plane. The mean difference (0.03) was statistically significant (p =.04), but not clinically relevant. The sagittal S-, D-, and a-wave velocities and TAmax were significantly higher in the sagittal plane compared to the transverse plane, with an increase of 12, 8, 8, and 10%, respectively (p <.05). Conclusions: The difference in the DV-PIV obtained in a mid-sagittal plane compared to a transverse plane of the fetal abdomen is small and not clinically significant. The higher DV flow velocities observed in the sagittal plane are likely the result of a better alignment with the vessel obtained using this plane. These findings have implications for clinical practice and for research. [ABSTRACT FROM AUTHOR]

Objective: Portosystemic shunts in growth-restricted fetuses are more common than previously thought. We aimed to describe fetuses with growth restriction and transient oligohydramnios in which a congenital intrahepatic portosystemic shunt (CIPSS) was noted during follow-up., Methods: This was a retrospective study of all fetuses diagnosed with growth restriction and transient oligohydramnios during a 5-year period in a large tertiary referral center. Our routine evaluation of growth-restricted fetuses includes monitoring of estimated fetal weight, assessment of biophysical profile, Doppler imaging, thorough examination of the umbilical-portal system and evaluation of cardiac function using fetal tricuspid annular plane systolic excursion (f-TAPSE). We compared these parameters before and after the resolution of the oligohydramnios using descriptive statistics and the Wilcoxon signed-rank test for paired non-parametric variables. During the surveillance of fetuses with transient oligohydramnios, we noted the appearance of a CIPSS and followed up such cases after birth., Results: A total of 2144 women with a singleton pregnancy with suspected fetal growth restriction were referred to our center between January 2018 and December 2022. In 12 fetuses, oligohydramnios was evident upon initial assessment, and a CIPSS was diagnosed with normalization of amniotic fluid level. The median gestational age at diagnosis of growth restriction and oligohydramnios was 25 (range, 21-30) weeks. The estimated fetal weight was at the 1 st percentile in 10/12 fetuses. The median amniotic fluid index was 5 (range, 2-5) cm at the initial appointment and improved significantly to 13 (range, 11-20) cm following the shunt diagnosis (P = 0.002). Among fetuses with f-TAPSE data available, the f-TAPSE increased significantly from 4.0 (range, 3.0-5.0) mm before the diagnosis of CIPSS to 8.0 (range, 5.0-9.4) mm following the diagnosis (P = 0.043). The median gestational age at delivery was 36.3 (range, 30.8-38.4) weeks. In nine (75%) fetuses, the diagnosed shunt was left portal to left hepatic vein. Neonatal follow-up revealed spontaneous shunt resolution within 30 months in all newborns. One newborn required embolization owing to suspected shunt, however, no shunt was detected during the procedure., Conclusions: The development of CIPSS in growth-restricted fetuses with oligohydramnios appears to improve hemodynamic status as evidenced by normalization of amniotic fluid index and increase in f-TAPSE. Evaluation of the liver portal system in fetuses with growth restriction offers an understanding of the shunt salvage phenomenon. © 2025 International Society of Ultrasound in Obstetrics and Gynecology., (© 2025 International Society of Ultrasound in Obstetrics and Gynecology.)

Objective: The aim of this study was to assess the added value of the soluble fms‐like tyrosine kinase‐1 (sFlt‐1) and placental growth factor (PlGF) ratio for adjusting the periodicity of ultrasound examinations in early‐onset fetal growth restriction (FGR) and small for gestational age (SGA). Design: A prospective, observational study. Setting: Tertiary referral hospital. Population: One hundred and thirty‐four single pregnancies with ultrasonographic estimated fetal weight (EFW) below the 10th centile between 20+0 and 31+6 weeks of gestation with antegrade umbilical artery flow. Methods: The time from Doppler and sFlt‐1/PlGF assessment to delivery was recorded and classified into four ranges: <1, <2, <3 and <4 weeks. Main outcome measures: Sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of sFlt‐1/PlGF values to predict the time to delivery. Results: In the SGA cohort, the NPV calculated for an sFlt‐1/PlGF cut‐off value of 38 was 100% for delivery before 3 weeks, and 98% for delivery before 4 weeks after diagnosis (95% CI 0.89–1.00). In the FGR cohort, the NPV calculated for an sFlt‐1/PlGF cut‐off value of 38 was 100% for delivery before 2 weeks after diagnosis (95% CI 0.92–1.00). By contrast, more than 50% of cases with an sFlt‐1/PlGF value of >85 required an elective delivery before 1 week. Conclusions: sFlt‐1/PlGF values in early‐onset SGA and FGR are predictive of the time to delivery and could be used for planning fetal surveillance, by reducing the frequency of ultrasound in cases with sFlt‐1/PlGF < 38 and by providing closer follow‐up in cases with sFlt‐1/PlGF >85. sFlt‐1/PlGF values in early‐onset SGA/FGR could be used in addition to Doppler for planning fetal surveillance. sFlt‐1/PlGF values in early‐onset SGA/FGR could be used in addition to Doppler for planning fetal surveillance. Linked article: This article is commented on by Cecilia Villalaín, pp. 1878 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471‐0528.17172 [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a chronic disease that needs medical support and continuing patient education to avoid acute complications and decrease the long-term complications. The prevalence of diabetes is high in many areas, especially Asian. There are many risk factors for developing gestational diabetes, such as advanced gestational age, obesity, family history of DM, and previous delivery of large weight baby. There is higher perinatal morbidity and mortality in untreated cases, but this can be reduced with proper antepartum surveillance and adequate insulin treatment. This article consisted of an acceptable definition, pathogenesis, screening, risk factors, management of diabetes during pregnancy, maternal and fetal complication, and prevention.

Growth-restricted fetuses are at risk of hypoxemia, acidemia, and stillbirth because of progressive placental dysfunction. Current fetal well-being, neonatal risks following delivery, and the anticipated rate of fetal deterioration are the major management considerations in fetal growth restriction. Surveillance has to quantify the fetal risks accurately to determine the delivery threshold and identify the testing frequency most likely to capture future deterioration and prevent stillbirth. From the second trimester onward, the biophysical profile score correlates over 90% with the current fetal pH, and a normal score predicts a pH >7.25 with a 100% positive predictive value; an abnormal score on the other hand predicts current fetal acidemia with similar certainty. Between 30% and 70% of growth-restricted fetuses with a nonreactive heart rate require biophysical profile scoring to verify fetal well-being, and an abnormal score in 8% to 27% identifies the need for delivery, which is not suspected by Doppler findings. Future fetal well-being is not predicted by the biophysical profile score, which emphasizes the importance of umbilical artery Doppler and amniotic fluid volume to determine surveillance frequency. Studies with integrated surveillance strategies that combine frequent heart rate monitoring with biophysical profile scoring and Doppler report better outcomes and stillbirth rates of between 0% and 4%, compared with those between 8% and 11% with empirically determined surveillance frequency. The variations in clinical behavior and management challenges across gestational age are better addressed when biophysical profile scoring is integrated into the surveillance of fetal growth restriction. This review aims to provide guidance on biophysical profile scoring in the in- and outpatient management of fetal growth restriction. [ABSTRACT FROM AUTHOR]

Pregnancy-associated breast cancer is one of the leading pregnancy-related types of cancer with an increasing incidence. It represents a special situation which requires careful attention for the medical team in fulfilling the goals of the treatment: the cure of the disease and the well-being of the pregnancy. The decisions regarding the most appropriate therapeutic methods should be made by a multidisciplinary team after offering counseling to the patient. The diagnosis of breast cancer during pregnancy or breastfeeding is a challenging situation considering the physiological changes. The first line of treatment is considered to be surgery indicated in any trimester of pregnancy, with mastectomy being often used. Chemotherapy can be offered, except for the first trimester, taking into account the risk of malformations. Radiotherapy, hormonal and biological treatment are contraindicated during pregnancy. The fetus must be evaluated regularly during treatment and the decision of delivery should be made on obstetrical and oncological indications.

Introduction: A revised intrapartum cardiotocography (CTG) classification was introduced in Sweden in 2017. The aims of the revision were to adapt to the international guideline published in 2015 and to adjust the classification of CTG patterns to current evidence regarding intrapartum fetal physiology. This study aimed to investigate adverse neonatal outcomes before and after implementation of the revised CTG classification. Material and Methods: A before‐and‐after design was used. Cohort I (n = 160 210) included births from June 1, 2014 through May 31, 2016 using the former CTG classification, and cohort II (n = 166 558) included births from June 1, 2018 through May 31, 2020 with the revised classification. Data were collected from the Swedish Pregnancy and Neonatal Registers. The primary outcome was moderate to severe neonatal hypoxic ischemic encephalopathy (HIE 2–3). Secondary outcomes were birth acidemia (umbilical artery pH <7.05 and base excess < −12 mmol/L or pH <7.00), A‐criteria for neonatal hypothermia treatment, 5‐min Apgar scores <4 and <7, neonatal seizures, meconium aspiration, neonatal mortality and delivery mode. Logistic regression was used (period II vs period I), and results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs). Results: There were no statistically significant differences in HIE 2–3 (aOR 1.27; 95% CI 0.97–1.66), proportion of neonates meeting A‐criteria for hypothermia treatment (aOR 0.96; 95% CI 0.89–1.04) or neonatal mortality (aOR 0.68; 95% CI 0.39–1.18) between the cohorts. Birth acidemia (aOR 1.36; 95% CI 1.25–1.48), 5‐min Apgar scores <7 (aOR 1.27; 95% CI 1.18–1.36) and <4 (aOR 1.40; 95% CI 1.17–1.66) occurred more often in cohort II. The absolute risk difference for HIE 2–3 was 0.02% (95% CI 0.00–0.04). Operative delivery (vacuum or cesarean) rates were lower in cohort II (aOR 0.82; 95% CI 0.80–0.85 and aOR 0.94; 95% CI 0.91–0.97, respectively). Conclusions: Although not statistically significant, a small increase in the incidence of HIE 2–3 after implementation of the revised CTG classification cannot be excluded. Operative deliveries were fewer but incidences of acidemia and low Apgar scores were higher in the latter cohort. This warrants further in‐depth analyses before a full re‐evaluation of the revised classification can be made. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a chronic disease that needs medical support and continuing patient education to avoid acute complications and decrease the long-term complications. The prevalence of diabetes is high in many areas, especially Asian. There are many risk factors for developing gestational diabetes, such as advanced gestational age, obesity, family history of DM, and previous delivery of large weight baby. There is higher perinatal morbidity and mortality in untreated cases, but this can be reduced with proper antepartum surveillance and adequate insulin treatment. This article consisted of an acceptable definition, pathogenesis, screening, risk factors, management of diabetes during pregnancy, maternal and fetal complication, and prevention. [ABSTRACT FROM AUTHOR]

Introduction: Intrapartum cardiotocography (CTG) was used for several decades to detect a stressed fetus so that delivery can be expedited to prevent birth asphyxia. The main aim of the study was to calculate the risk of neonatal acidemia (pH ≤ 7.10) according to duration of the 2nd stage of labor and occurrence of the International Federation of Gynecology and Obstetrics (FIGO) 2015 CTG classification parameters.Materials and Methods: This was a retrospective case-control study on 552 pregnancies receiving continuous CTG monitoring in labor and immediate hemogasanalysis at birth. Cases with umbilical artery (UA) pH ≤ 7.10 and controls with UA pH ≥ 7.10 were matched for parity and gestational age at delivery, with ratio 1:5. Logistic regression analysis, adjusted for the expected risk in the general population, was used to calculate the baseline risk of UA pH ≤ 7.10 in the absence of any CTG pathological feature and those associated with pathological CTG patterns occurring in the 2nd stage according to FIGO 2015.Results: Seventy-three cases and 387 controls reached 2nd stage and were included in the analysis. For those reaching 2nd stage, the mean adjusted risk of acidemia associated with nonpathological CTG was 1.6%. Stratification of risk according to duration of the 2nd stage yielded risks of neonatal acidemia of 1.23, 2.08, 5.81, and 15.22% at 30, 60, 120, and 180 min, respectively. Bradycardia >10 min was associated with risk of neonatal acidemia of 9.9 and 15.8% for 2nd-stage durations of 30 and 60 min, respectively. Risks associated with 1 prolonged deceleration >5 min were 6.80, 11.08, 27.0, and 51.0% at 30, 60, 120, and 180 min, respectively. Repetitive late or prolonged decelerations >30 min were associated with risk of neonatal acidemia of 2.43, 4.14, 11.17, and 26.45% at 30, 60, 120, and 180 min, respectively.Conclusion: The risk of neonatal acidemia is directly proportional to duration of the 2nd stage, irrespective of the presence of CTG abnormalities, increasing 12-fold (1.2-15.3%) from 30 to 180 min. Occurrence of FIGO 2015 pathological CTG patterns showed a decreasing impact from bradycardia >10 min to decelerations >5 min, recurrent later or prolonged decelerations >30 min, and nonpathological CTG. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the utility of ultrasound markers in the management of pregnancies complicated by preterm prelabor rupture of membranes (PPROM) between 23 + 0 and 33 + 6 weeks' gestation, and to assess the ability of ultrasound markers to predict adverse neonatal outcomes.Methods: This was a retrospective cohort study of all patients with PPROM between 23 + 0 and 33 + 6 weeks' gestation and latency period (PPROM to delivery) > 48 h, who delivered before 34 weeks' gestation at a tertiary referral center between 2005 and 2017. All patients underwent a non-stress test daily and an ultrasound scan twice a week for assessment of amniotic fluid volume, biophysical profile (BPP) and umbilical artery (UA) pulsatility index (PI). In patients with suspected fetal growth restriction, fetal middle cerebral artery (MCA)-PI was also assessed and the cerebroplacental ratio (CPR) calculated. The last ultrasound examination performed prior to delivery was analyzed. We compared the characteristics and outcomes between women who were delivered owing to clinical suspicion of chorioamnionitis and those who were not delivered for this indication. The primary objective was to evaluate the utility of ultrasound in the management of patients with PPROM. The secondary objective was to assess the diagnostic performance of ultrasound markers (BPP score < 6, oligohydramnios, UA-PI > 95th percentile, MCA-PI < 5th percentile, CPR < 5th percentile) for the prediction of composite adverse neonatal outcome, which was defined as the presence of one or more of: perinatal death, respiratory distress syndrome, periventricular leukomalacia, intraventricular hemorrhage Grade 3 or 4, necrotizing enterocolitis, hypoxic ischemic encephalopathy, neonatal sepsis or neonatal seizures.Results: A total of 504 women were included in the study, comprising 120 with suspected chorioamnionitis and 384 without. Women with suspected chorioamnionitis, compared with those without, were less likely to be nulliparous (34.2% vs 45.3%; P = 0.03) and more likely to have fever (50.8% vs 2.6%; P < 0.001) and be delivered by Cesarean section (69.2% vs 42.4%; P < 0.001), mainly owing to a history of previous Cesarean section (18.3% vs 9.1%; P = 0.005) and to having non-reassuring fetal heart rate tracings (32.5% vs 14.6%; P < 0.001). No significant differences were found between the two groups with regard to the median amniotic fluid volume, overall BPP score, BPP score < 6, MCA-PI or CPR. Median UA-PI was slightly higher in the suspected-chorioamnionitis group, yet the incidence of UA-PI > 95th percentile was similar between the two groups. There was a higher incidence of composite adverse neonatal outcome in the group with suspected chorioamnionitis than in the group without (78.3% vs 64.3%, respectively; P = 0.004). However, on logistic regression analysis, none of the ultrasound markers evaluated was found to be associated with chorioamnionitis or composite adverse neonatal outcome, and they all had a poor diagnostic performance for the prediction of chorioamnionitis and composite adverse neonatal outcome.Conclusions: Commonly used ultrasound markers in pregnancies complicated by PPROM were similar between women delivered for suspected chorioamnionitis and those delivered for other indications, and performed poorly in predicting composite adverse neonatal outcome. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Abstract Background Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. Methods Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA. Results We interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses’ behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social influences; Behavioural regulation). Conclusion We identified potential influences on birthing unit nurses’ use of IA as their primary method of fetal surveillance. These beliefs suggest potential targets for behaviour change interventions to promote IA use.

Measurement of lactate in fetal blood is used to assess the degree of anaerobic metabolism. The technical difficulties in obtaining enough scalp blood for analysis by a bloodgas-analyzer advocates for the use of a point-of-care device. StatStrip®Xpress™ (SSX) has shown promising properties but needs further evaluation before implementation into fetal surveillance. Arterial/venous umbilical cord blood from 112 newborns were analyzed simultaneously with SSX and the reference method ABL800™. From 321 fetuses with abnormal heart rate scalp blood was sampled and analyzed repeatedly with SSX. ABL800™ -lactate ranged from 1.9–13.3 mmol/L in arterial to 1.5–10.2 mmol/L in venous cord blood with excellent correlation to SSX (R2 = 0.95). SSX-values were lower compared to the reference method ranging from −0.79 mmol/L for low values to −1.68 mmol/L for high values. The mean CV for SSX-values in cord respectively scalp blood was: lactate ≤3 mmol/L 7.1% respectively 8.4%; lactate >3 mmol/L 3.8% respectively 6.8%. Repeated measurements of the same sample with SSX where without significant difference in cord/scalp blood (p = 0.11). SSX-lactate values were constantly lower but correlated excellent to the reference method. The reproducibility was good for cord and scalp blood. We suggest SSX as an attractive device for measurement of fetal lactate. • Fetal scalp blood lactate is easily measured by StatStrip®Xpress™ (SSX). • The correlation between SSX and the reference method is excellent, but with lower values for SSX. • The CV is acceptable with lactate values >3 mmol/L in fetal blood. • Repeated analysis of scalp blood is recommended due to the risk of contamination of amnion fluid and fetal tissue. [ABSTRACT FROM AUTHOR]

Objective: Measurement of fetal scalp blood lactate is a supplementary tool to cardiotocography in the case of a non-reassuring tracing. Several hand-held lactate meters have been launched, all with differentials in absolute values. Therefore, the reference intervals must be calculated for each device. The internationally accepted reference interval is based on measurement with Lactate ProTM with recently got out of production. The aim of this study was to propose cutoffs for normality, preacidemia, and acidemia in fetal scalp blood for Lactate ProTM2 based on the comparison of lactate values measured with Lactate ProTM and Lactate ProTM2.Design: Seven hundred one fetal scalp blood samples were analyzed simultaneously. The conversion equations were retrieved from the linear regression model. On the basis of the cutoffs for Lactate ProTM cutoffs for Lactate ProTM2 were calculated.Results: The conversion equations obtained were Lactate ProTM = -0.02 + 0.68 × Lactate ProTM2 (SD: -0.09-0.07 × Lactate ProTM2) and Lactate proTM2 (LP2) = 0.03 + 1.48 × Lactate ProTM (SD: 0.16 + 0.17 × Lactate ProTM). The correlation to umbilical arterial pH was identical for the two devices (r = -0.18), whereas the correlation to umbilical arterial lactate was better for Lactate ProTM than for Lactate ProTM2 (r = 0.38, respectively, r = 0.33). The correlation to umbilical arterial lactate was dependent on time from sampling to delivery.Conclusion: Proposed reference values for Lactate ProTM2: scalp lactate <6.3 mmol/L = normal, no indication for intervention; 6.3-7.1 mmol/L = preacidemia, repeated testing has to be considered; > 7.1 mmol/L = acidemia, expedite delivery. [ABSTRACT FROM AUTHOR]

Fifteen years ago a survey of Victorian public maternity services showed that the majority of services provided no fetal surveillance education to their staff and that only one in ten undertook any sort of assessment of staff knowledge. Today, all hospitals, public and private, provide training and all public hospitals require their midwifery and medical staff to undertake regular assessment of knowledge. The requirements of specialist obstetricians in private practice remain variable. [ABSTRACT FROM AUTHOR]

Aim of the work: The aim of this work is to determine the role of venous Doppler Ultrasonography for the prediction of adverse perinatal outcome in “intrauterine growth restricted fetus”, providing the obstetrician with additional information about the time frame and significance of the IUGR to help determine the optimal time of delivery. Patients and methods: Sixty pregnant females with their age ranging between 28 and 35 years, gestational age between 27 and 37 weeks of gestation were enrolled in the study. All patients in the study were subjected to Doppler examination of the umbilical vein (UV), Ductus venosus (DV), right hepatic vein (HV) and umbilical artery (UA). Results: Abnormal UA Doppler was found in 40 patients. Abnormal DV Doppler was found in 40 patients. Abnormal UV Doppler was found in 10 patients. Abnormal Rt. HV Doppler was found in 20 patients. All parameters studied were strongly related to perinatal mortality, however, none had 100% sensitivity, the pulsatility index in the Rt. HV and DV were the best single indices to use in the prediction of perinatal mortality. Conclusion: We observed that venous Doppler is superior to arterial Doppler in predicting poor perinatal outcome and that the abnormal equivocal BPP scoring significantly correlated with adverse outcome. We also, concluded that multi-vessel Doppler Ultrasonography and BPP can effectively stratify IUGR fetuses with placental vascular insufficiency into risk categories. Fetal deterioration appears to be independently reflected in these two testing modalities; their combined use is likely to be complementary.

Background: Lactic acid dehydrogenase (LDH) is a valuable marker for some of the most important diseases in newborns and the plasma LDH activity in newborns correlates well with conditions such as asphyxia. If LDH should be considered as a useful tool also in obstetric care, key factors associated with maternal health before and during pregnancy which could affect umbilical cord LDH activity need to be known. The aims of this study were to explore relationships between selected maternal conditions and arterial lactic acid dehydrogenase activity (aLDH) in umbilical cord blood at delivery. Methods: A prospective observational study was conducted at Sodersjukhuset, Stockholm, Sweden. Included in the study were 1247 deliveries, and cord blood samples from each were analyzed for aLDH. Background, delivery and neonatal data were collected from the medical records. Results: Higher median values of aLDH were found (P=0.001) among women with chronic disorders not related to pregnancy but there was no increased frequency of high aLDH levels (>612 μ/L, P=0.30). No difference in aLDH was identified between infants born to women with pregnancy-related disorders compared with healthy women, neither in median values, nor in high values (>612 μ/L, P=0.95). Conclusion: Newborn infants born to women with non-pregnancy-related chronic disorders had a somewhat higher median value of aLDH in cord blood at delivery. The influence of common maternal conditions and diseases on umbilical cord arterial LDH levels is small compared to the increase reported in fetal distress and several other critical conditions in the newborn. [ABSTRACT FROM AUTHOR]

Introduction: The updated intrapartum cardiotocography (CTG) classification system by FIGO in 2015 (FIGO2015) and the FIGO2015-approached classification by the Swedish Society of Obstetricians and Gynecologist in 2017 (SSOG2017) are not harmonized with the fetal ECG ST analysis (STAN) algorithm from 2007 (STAN2007). The study aimed to reveal homogeneity and agreement between the systems in classifying CTG and ST events, and relate them to maternal and perinatal outcomes.Material and Methods: Among CTG traces with ST events, 100 traces originally classified as normal, 100 as suspicious and 100 as pathological were randomly selected from a STAN database and classified by two experts in consensus. Homogeneity and agreement statistics between the CTG classifications were performed. Maternal and perinatal outcomes were evaluated in cases with clinically hidden ST data (n = 151). A two-tailed p < 0.05 was regarded as significant.Results: For CTG classes, the heterogeneity was significant between the old and new systems, and agreements were moderate to strong (proportion of agreement, kappa index 0.70-0.86). Between the new classifications, heterogeneity was significant and agreements strong (0.90, 0.92). For significant ST events, heterogeneities were significant and agreements moderate to almost perfect (STAN2007 vs. FIGO2015 0.86, 0.72; STAN2007 vs. SSOG2017 0.92, 0.84; FIGO2015 vs. SSOG2017 0.94, 0.87). Significant ST events occurred more often combined with STAN2007 than with FIGO2015 classification, but not with SSOG2017; correct identification of adverse outcomes was not significantly different between the systems.Conclusion: There are discrepancies in the classification of CTG patterns and significant ST events between the old and new systems. The clinical relevance of the findings remains to be shown. [ABSTRACT FROM AUTHOR]

Prolonged pregnancy is defined by duration greater than 294 days from the last menstrual period, or equivalent gestational age calculated by ultrasonic fetal biometry. The latter is a more accurate method for establishing the diagnosis. The specific causes of prolonged pregnancy are unknown, but identified risk factors are nulliparity, increased maternal weight, and previous history of prolonged pregnancy. Prolonged pregnancy is associated with obstetrical and neonatal adverse outcomes, and the risks appear to increase along a spectrum with the degree of prolongation. Prolonged pregnancy may be avoided by interventions to cause delivery prior to 294 days gestation, including complementary therapies, labour induction, or caesarean section. The risks of these interventions must be considered in the context of the low absolute risks of prolonged pregnancy. There remains no clear evidence of benefit in these strategies from well-designed prospective studies. However, retrospective studies have shown reduced perinatal problems when methods to avoid prolonged pregnancy have been utilized. In addition to consideration of risks, decision-making in cases of prolonged pregnancy must also take into account healthcare resources and maternal wishes. [ABSTRACT FROM AUTHOR]

Background: Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour.Methods: Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA.Results: We interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses' behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social influences; Behavioural regulation).Conclusion: We identified potential influences on birthing unit nurses' use of IA as their primary method of fetal surveillance. These beliefs suggest potential targets for behaviour change interventions to promote IA use. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to test the predictive value of antenatal umbilical coiling index (aUCI) among a prospectively recruited cohort of antenatal women. Methods: Women with singleton pregnancies were recruited at their second-trimester scan. Images of the umbilical cord were used to calculate the aUCI. Pregnancy and birth outcomes were recorded and statistical associations between aUCI and small for gestational age (SGA) using international standard birth weight centiles and preterm birth were investigated (n = 430). Results: aUCI results were consistent with the literature and showed good reproducibility between observers. Abnormal aUCI was not associated with SGA, but there was a statistical association with preterm birth (odds ratio 3.3 (95% confidence interval 1.4-7.7, P = 0.003). The sensitivity, specificity, and positive and negative predictive values for preterm birth were 47.6%, 76.9%, 9.6%, and 96.6%, respectively. Conclusions: The coiling index is unlikely to be useful in clinical practice as a screening tool for preterm birth owing to limited predictive value. We exclude a statistically or clinically significant association between abnormal coiling and SGA. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal blood velocity in the ductus venosus is more frequently detected than pulsations in the umbilical vein, but both are considered to be indicators of fetal compromise. The aim of this study was to investigate blood flow patterns in the ductus venosus and the association between individual blood velocity ratios and pulsations in the umbilical vein and perinatal outcome.Material and Methods: Retrospective cohort study on Doppler ultrasound examination of ductus venosus and umbilical venous blood velocity in 358 high-risk pregnancies. Ductus venosus blood velocity pattern was analyzed for pulsatility index and the following velocity ratios: S/ES, S/a and ES/a (where S is systole, ES is end-systole, and a is atrial contraction). Ductus venosus ratio z-scores were calculated and related to pulsations in the umbilical vein and adverse perinatal outcome.Results: Systolic ratios in the ductus venosus were less frequently abnormal than ratios taking into account diastolic velocities, particularly at full-term. High S/ES, ES/a ratios and pulsatility index (z-score >2), were all related to presence of pulsations in the umbilical vein. Umbilical venous pulsations were the best indicator of adverse perinatal outcome.Conclusions: Changes in ductus venosus blood flow during systole occur more rarely than diastolic changes, and alterations in end-diastolic blood velocity in the ductus venosus might give false-positive indications of worsening fetal condition. Umbilical venous pulsations seem to better predict adverse outcome of pregnancy than do indices in the ductus venosus. [ABSTRACT FROM AUTHOR]

Objective: To report the outcomes of 38 monoamniotic twin pregnancies managed homogeneously to assess whether continuing the pregnancy past 32 weeks of gestation and vaginal delivery are reasonable options.Study Design: Single-centre retrospective study including all monoamniotic pregnancies managed over a 20-year period at Port-Royal Obstetrics Department, Paris, France.Methods: In the study department, both continuation of the pregnancy up to 36 weeks of gestation and vaginal delivery are allowed for monoamniotic pregnancies in some conditions. Perinatal outcomes are described and then compared according to mode of delivery for patients who gave birth at or after 32 weeks of gestation.Results: Three of the 38 pregnancies included fetal malformations; in two of these cases, both fetuses died in utero at 26 weeks of gestation. In cases without malformations, one twin died in utero in two women at 28.0 and 29.2 weeks of gestation, and both fetuses died in two other women at 24.0 and 24.5 weeks of gestation. Mean gestational age at delivery was 32.9 weeks (range 24.0-36.3). Five women gave birth between 22 and 26 weeks of gestation, six women gave birth between 27 and 31 weeks of gestation, and 27 women gave birth at or after 32 weeks of gestation (26 after excluding those with fetal malformations). No intrauterine or neonatal deaths were observed at or after 32 weeks of gestation. The 28 infants delivered vaginally did not differ significantly from the 22 infants born by caesarean section in terms of umbilical artery pH or 5-min Apgar scores.Conclusion: Continuation of monoamniotic pregnancies beyond 32 weeks of gestation and trial of vaginal delivery are both reasonable options if the parents agree, and optimal surveillance is provided. [ABSTRACT FROM AUTHOR]

This chapter describes the current evidence and recommendations for surveillance and delivery timing for multifetal gestations. Ultrasound surveillance should include early determination of chorionicity, anatomic survey for all twins with fetal echocardiography for monochorionic twins, and growth assessment every 4 weeks. Monochorionic twins should also undergo ultrasound surveillance for twin- twin transfusion syndrome every 2 weeks starting at 16 weeks. Weekly testing with nonstress tests or biophysical profiles is recommended at 32 weeks formonochorionic, diamniotic twins, and 34 weeks for dichorionic twins. If this surveillance is reassuring, optimal delivery timing is 36 weeks 0 days to 37 weeks 0 days for monochorionic, diamniotic twins, and 37 week 0 days to 38 weeks 0 days for dichorionic twins. Key words: multiple gestation, twins, delivery timing, fetal surveillance, fetal growth [ABSTRACT FROM AUTHOR]

Given that the stillbirth rate in the UK has seen only a small reduction in the last 20 years and that fetal demise is most often preceded by periods of reduced or an absence of fetal movements, it is important to ask 'how is the assessment of in-utero activity undertaken?' The evidence suggests that antenatally, women should be regularly asked about their fetal movements and informed on methods of self-assessment. However, there appears to be wide variation in policy and practice, which may be as a result of the lack of consensus as to the definition of reduced fetal movements. As midwives, we offer the majority of care and assessment antenatally and as such have a responsibility for ensuring that women are aware of both the importance of self-assessment of fetal movements and the techniques. [ABSTRACT FROM AUTHOR]

Prolonged pregnancy is defined by duration greater than 294 days from the last menstrual period, or equivalent gestational age calculated by ultrasonic fetal biometry. The latter is a more accurate method for establishing the diagnosis. The specific causes of prolonged pregnancy are unknown, but identified risk factors are nulliparity, increased maternal weight, and previous history of prolonged pregnancy. Prolonged pregnancy is associated with obstetrical and neonatal adverse outcomes, and the risks appear to increase along a spectrum with the degree of prolongation. Prolonged pregnancy may be avoided by interventions to cause delivery prior to 294 days gestation, including complementary therapies, labour induction, or caesarean section. The risks of these interventions must be considered in the context of the low absolute risks of prolonged pregnancy. There remains no clear evidence of benefit in these strategies from well-designed prospective studies. However, retrospective studies have shown reduced perinatal problems when methods to avoid prolonged pregnancy have been utilized. In addition to consideration of risks, decision-making in cases of prolonged pregnancy must also take into account healthcare resources and maternal wishes. [ABSTRACT FROM AUTHOR]

Aim of the work The aim of this work is to determine the role of venous Doppler Ultrasonography for the prediction of adverse perinatal outcome in “intrauterine growth restricted fetus”, providing the obstetrician with additional information about the time frame and significance of the IUGR to help determine the optimal time of delivery. Patients and methods Sixty pregnant females with their age ranging between 28 and 35 years, gestational age between 27 and 37 weeks of gestation were enrolled in the study. All patients in the study were subjected to Doppler examination of the umbilical vein (UV), Ductus venosus (DV), right hepatic vein (HV) and umbilical artery (UA). Results Abnormal UA Doppler was found in 40 patients. Abnormal DV Doppler was found in 40 patients. Abnormal UV Doppler was found in 10 patients. Abnormal Rt. HV Doppler was found in 20 patients. All parameters studied were strongly related to perinatal mortality, however, none had 100% sensitivity, the pulsatility index in the Rt. HV and DV were the best single indices to use in the prediction of perinatal mortality. Conclusion We observed that venous Doppler is superior to arterial Doppler in predicting poor perinatal outcome and that the abnormal equivocal BPP scoring significantly correlated with adverse outcome. We also, concluded that multi-vessel Doppler Ultrasonography and BPP can effectively stratify IUGR fetuses with placental vascular insufficiency into risk categories. Fetal deterioration appears to be independently reflected in these two testing modalities; their combined use is likely to be complementary. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between an umbilical artery notch and fetal deterioration in monochorionic/monoamniotic (MC/MA) twins. Methods: Six MC/MA twin pregnancies were admitted at 24-28 weeks of gestation for close fetal surveillance until elective delivery at 32 weeks or earlier in the presence of signs of fetal deterioration. Ultrasound (US) examinations were performed twice weekly. The presence of cord entanglement, umbilical artery notch, abnormal Doppler parameters, a non-reassuring fetal heart rate pattern, or an abnormal fetal biophysical profile were evaluated. Results: Umbilical cord entanglement was observed on US in all pregnancies. The presence of an umbilical artery notch was noted in four out of six pregnancies and in two of them an umbilical artery notch was seen in both twins. The umbilical artery pulsatility index was normal in all fetuses. Doppler parameters of the middle cerebral artery and ductus venosus, fetal biophysical profile and fetal heart rate monitoring remained normal until delivery in all pregnancies. All neonates experienced morbidity related to prematurity; however, all were discharged home in good condition. Conclusion: The presence of an umbilical artery notch and cord entanglement, without other signs of fetal deterioration, are not indicative of an adverse perinatal outcome. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate whether interpreting CTG pairwise brings about a higher level of correctly classified CTG recordings in a non-selected population of midwives and physicians. Study design: A comparative study. Setting: Five delivery units in Stockholm and one delivery unit in Uppsala, with 1589, 3740, 3908, 4539, 6438, and 7331 deliveries in 2011, respectively. Subjects: 536 midwives and physicians classified one randomly selected CTG recording individually followed by a pairwise classification. The pairs consisted of two midwives (119 pairs) or one midwife and one physician (149 pairs), a total of 268 pairs. Main outcome measure: The proportion of individually correctly classified CTG recordings versus the proportion of pairwise correctly classified CTG recordings. Results: The proportion of individually correctly classified CTG's was 75% and the proportion of pairwise correctly classified CTG's was 80% (difference 5%, p = 0.12). Conclusions: There was no statistically significant difference when CTG's were classified pairwise compared to individual classifications. The proportion of individually correctly classified CTG's was high (75%). There were differences in the proportion of correctly classified CTG recordings between the delivery units, indicating potential areas of improvement. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the association of a small third-trimester abdominal circumference (AC < 10th percentile) in the setting of a normal estimated fetal weight (EFW ⩾ 10th percentile) with gestational age at delivery, indication for delivery and neonatal outcomes. Methods: Retrospective cohort study at an academic hospital of women with singleton pregnancy seen for ultrasound from 28+0-33+6 weeks of gestation during 2009-2011. Outcomes were compared between two groups: normal AC (AC and EFW ⩾ 10th percentile) and small AC (AC < 10th percentile and EFW ⩾ 10th percentile). Results: Among 592 pregnancies, fetuses in the small AC group (n = 55) experienced a higher incidence of overall preterm delivery (RR: 2.2, 95% Cl: 1.3-3.7) and provider-initiated preterm delivery (RR: 3.7, Cl: 1.8-7.5) compared to those in the normal AC group (n = 537). Neonates in the small AC group had a lower median birth weight whether delivered at term (p<0.001) or preterm (p = 0.04), but were not more likely to experience intensive care unit admission or respiratory distress syndrome (all p > 0.35). Conclusions: Small AC, even in the setting of an EFW ⩾ 10th percentile, was associated with a higher incidence of overall and provider-initiated preterm delivery despite similar neonatal outcomes. Further investigation is warranted to determine whether these preterm deliveries could be prevented. [ABSTRACT FROM AUTHOR]