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Background Indomethacin is one of the most effective and widely used tocolytic agents for treating threatened preterm labor and prolonging pregnancy. Nonetheless, data on its fetal effects, particularly regarding cardiac functions, remain limited. The primary aim of this study was to evaluate the effects of indomethacin treatment on fetal cardiac structures, the modified myocardial performance index (Mod-MPI), and hemodynamic parameters to establish evidence-based monitoring recommendations in cases of threatened preterm labor. Methods In this prospective study of 114 pregnant women, 57 cases diagnosed with threatened preterm birth received indomethacin tocolytic therapy, while 57 controls had uneventful pregnancies. Demographic characteristics, perinatal outcomes, Doppler measurements, cardiac structural measurements, Mod-MPI, and tricuspid regurgitation were compared between groups. Results Doppler analysis revealed no significant differences except for umbilical artery pulsatility index, which was elevated in the indomethacin group (0.941 ± 0.160 vs. 0.869 ± 0.171, p  = 0.023) due to vasoconstrictive effects from prostaglandin synthesis inhibition. Isovolumetric contraction and relaxation times were lower in the indomethacin group (42.3 ± 0.5 vs. 47.2 ± 2.7, p  = 0.020; 49.3 ± 1.9 vs. 48.2 ± 1.8, p  = 0.030). However, Mod-MPI did not differ significantly between the groups (0.464 ± 0.11 vs. 0.44 ± 0.09, p  = 0.349). Although tricuspid regurgitation was observed in 14 of 57 fetuses (24.6%) exposed to indomethacin, perinatal outcomes were not significantly different. Conclusions Indomethacin treatment does not negatively affect fetal cardiac function or Mod-MPI. When tricuspid regurgitation occurs, increased monitoring is recommended rather than treatment cessation if other parameters remain stable.

Background and Objectives: Predictive performance of the modified myocardial performance index (Mod-MPI) for emergency cesarean delivery secondary to intrapartum fetal compromise (IFC) was examined in late-onset fetal growth restriction (FGR) or small-for-gestational-age (SGA) pregnancies. Materials and Methods: This prospective observational cohort comprised 120 singleton term pregnancies affected by late-onset FGR or SGA, classified in line with the Delphi consensus criteria, for whom a trial of vaginal delivery was planned. The primary endpoint was emergency cesarean delivery indicated by IFC, while the secondary endpoint was the development of composite adverse perinatal outcomes (CAPO). Measurements of Mod-MPI, the umbilical artery, the middle cerebral artery, and the cerebroplacental ratio (CPR) were performed within the final 72 h before delivery and were blinded to the clinicians managing the intrapartum period. Results: IFC constituted 28.3% (n = 34) of the study cohort. The IFC group exhibited significantly higher Mod-MPI values and lower CPR values (p < 0.001). In multivariable analysis, elevated Mod-MPI (≥0.61) and reduced CPR (<5th percentile) were identified as independent predictors of IFC. On receiver operating characteristic analysis, Mod-MPI demonstrated superior discriminative performance compared with CPR for predicting IFC (area under the curve [AUC]: 0.835 vs. 0.759). In contrast, CPR showed the highest diagnostic performance for predicting CAPO (AUC: 0.779). Conclusions: Mod-MPI reflects subclinical cardiac dysfunction in fetuses with late-onset FGR and SGA and represents a valuable parameter for predicting tolerance to acute intrapartum stress. Rather than routine implementation, it appears most appropriate as a complementary tool contributing to intrapartum risk assessment in selected high-risk cases.

Background/Objectives: Severe thrombocytopenia (platelet count ≤ 50,000/µL) is a diagnostically heterogeneous condition during pregnancy, encompassing obstetric and non-obstetric etiologies that require distinct management approaches. The aims of this study were to determine the etiological distribution of severe thrombocytopenia during pregnancy and to evaluate its management strategies and perinatal outcomes in a tertiary perinatology center. Methods: This retrospective cohort study included 203 pregnant women with severe thrombocytopenia (platelet count ≤ 50,000/µL) stratified into three groups: Group A (30,000 < platelet count ≤ 50,000/μL, n = 123), Group B (10,000 < platelet count ≤ 30,000/μL, n = 54), and Group C (<10,000/µL, n = 26). Demographic characteristics, etiological diagnoses, treatment modalities, and perinatal outcomes were evaluated. Results: The etiological distribution varied significantly across severity groups (p = 0.001). HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome was the most common cause overall (36.5%) and predominated in milder thrombocytopenia (Group A: 40.7%; Group B: 42.6%), whereas non-obstetric etiologies, such as immune thrombocytopenia (ITP), were significantly more frequent in Group C (57.7%). Treatment intensity increased with severity, with 79.7% of Group A requiring no intervention compared to only 26.9% of Group C (p = 0.001). Gestational age at delivery (median 37 weeks, p = 0.587) and birth weight (mean 2547 ± 968 g, p = 0.191) were comparable across severity groups. Minimum platelet count showed no significant correlation with delivery timing, birth weight, or hemoglobin decline. Conclusions: Severe thrombocytopenia in pregnancy exhibits distinct etiological patterns that vary according to platelet count severity. Favorable perinatal outcomes are achievable with appropriate diagnosis and management in specialized centers, underscoring the importance of comprehensive diagnostic evaluation rather than relying solely on platelet count thresholds for clinical decision-making.

Objective: To investigate the impact of proteinuria severity on obstetric and neonatal outcomes and to assess the predictive value of 24 h urinary protein excretion, both alone and within a multivariable model, for adverse pregnancy outcomes. Methods: This retrospective cohort study included 203 pregnant women with proteinuria who were classified into mild (≥0.3 g/day and <3.0 g/day, n = 50), severe (≥3.0 g/day and <5.0 g/day, n = 67), and massive (≥5.0 g/day; n = 86) groups based on 24 h urine protein levels. Maternal and neonatal outcomes were compared between these groups. Correlation analysis, receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression were used to evaluate the predictive value of proteinuria for obstetric complications and identification of increased risk of early delivery. The AUC values of the proteinuria-only model and the multivariable model were compared using the DeLong test, as both models were derived from the same dataset and therefore represented correlated ROC curves. Results: The incidence of obstetric complications was significantly higher in the severe (68.7%) and massive (81.4%) proteinuria groups compared with the mild group (32.0%; p < 0.001). Increasing proteinuria severity was associated with earlier gestational age at delivery, lower birth weight, and higher rates of fetal growth restriction (all p < 0.001). The 24 h proteinuria level demonstrated moderate predictive ability for obstetric complications (AUC 0.73; 95% CI 0.66–0.80). A multivariable model including nephrotic-range proteinuria (≥3 g/day) and gestational age at diagnosis showed improved discriminatory performance compared with proteinuria alone (AUC 0.81; 95% CI 0.75–0.88). The model based on continuous 24 h proteinuria yielded an AUC of 0.73 (95% CI, 0.66–0.80) for identifying pregnancies at increased risk of obstetric complications. The multivariable model showed a numerically higher AUC of 0.81 (95% CI, 0.73–0.86); however, the difference between the two AUCs was not statistically significant according to the DeLong test (z = 0.82, p = 0.41). Conclusions: The severity of maternal proteinuria is associated with a higher likelihood of adverse maternal and neonatal outcomes, and higher proteinuria levels appear to show a graded association with increasing risk. A multivariable model integrating proteinuria with key clinical parameters demonstrated moderate discriminatory ability for obstetric complications, may support a more holistic approach to risk stratification in clinical practice.

Background/Objectives: Preeclampsia can be divided into two groups (with and without severe features) based symptom severity. We aimed to distinguish these two entities with the aid of fibrinogen to albumin ratio (FAR), uric to acid albumin ratio (UAR) and LDH to albumin ratio (LAR). Methods: This retrospective study was conducted in Istanbul Basaksehir Cam and Sakura City Hospital between 2020 and 2023. Seventy-three patients with preeclampsia were included in this study which were categorized into two groups according to disease severity: 40 patients with preeclampsia without severe features and 33 patients with severe features. Additionally, 30 healthy pregnant women were included as a control group. Neutrophil–lymphocyte ratio (NLR), monocyte–lymphocyte ratio (MLR), platelet–lymphocyte ratio (PLR), mean platelet volume (MPV), red cell distribution width (RDW), mean platelet volume (MPV), Uric acid, LDH, AST, ALT, fibrinogen, albumin, FAR, UAR and LAR were compared among the groups. Results: FAR was significantly higher in preeclampsia patients with and without severe features compared to control group (Odds ratio 8.32 for ≥0.139 vs. <0.139, p < 0.001). There was no significant difference in FAR levels between preeclampsia patients according to disease severity. UAR and LAR were significantly different between preeclampsia patients with and without severe features and the control group (p < 0.001). Receiver operating characteristics (ROC) curves for UAR showed that a cut-off value of 1.727 had a sensitivity of 73% and a specificity of 68% in discriminating between preeclampsia with and without severe features (Odds ratio 5.53 for ≥1.727 vs. <1.727). ROC curves for LAR showed that a cut-off value of 79.09 had a sensitivity of 85% and a specificity of 73% in discriminating between preeclampsia with and without severe features (Odds ratio 14.76 for ≥79.09 vs. <79.09). Conclusions: UAR and LAR appear to be better markers than FAR for identifying preeclamptic patients who require delivery due to severe features. They are easily accessible and promising biomarkers, and to our knowledge, this is the first study to evaluate LAR in this context. Further studies are needed to validate their diagnostic accuracy and compare their performance with established biomarkers.

Objective: Abnormal localization of the placenta with complete or partial closure of the cervix is called placenta previa. Placenta previa occurs in approximately 0.3-0.5% of pregnancies. In this study, we aimed to determine the risk factors and adverse fetal outcomes by comparing the neonatal outcomes of patients who underwent cesarean section for placenta previa with those of patients who underwent cesarean section for other indications. Method: Patients with singleton pregnancies diagnosed with placenta previa were retrospectively analyzed. Placenta previa, risk factors, and adverse neonatal outcomes were estimated using multivariate logistic regression models. Results: A total of 61,110 deliveries were analyzed, and 632 deliveries (288 patients, 344 controls) were included in the study. The prevalence of placenta previa was 0.47%. Advanced maternal age [odds ratio (OR)=3.03], multigravida (≥5) (OR=2.31), previous abortion (OR=1.58) and curettage (OR=2.32) were significant risk factors for placenta previa. However, these patients had an increased risk of 1st minute Apgar score <7 (OR=1.59) and neonatal intensive care unit (NICU) admission (OR=2.15). At the same time, the risk of Apgar score <7 at 1 min (OR=5.59) and 5 min (OR=3.94) and NICU admission (OR=28.47) increased in infants of patients with placenta previa <34 weeks. Newborns in the >37 weeks gestational age group with placenta previa were more likely to have a lower birth weight (OR=4.21) and an Apgar score <7 at 5 min (OR=1.89). Conclusion: Pregnancies with a diagnosis of placenta previa were associated with an increased risk of serious fetal outcomes compared with cesarean deliveries for all other indications, regardless of delivery timing.

Hypertensive disorders of pregnancy are significant contributors to maternal and perinatal morbidity and mortality. The definition, classification, and management of these disorders have evolved over time. Notably, the disease classification enables caretakers to manage the disease as well as safeguard maternal and fetal health. The approach and management for pregnancies with gestational and chronic hypertension or pre-eclampsia with or without severe features should be adequately elucidated to mitigate adverse perinatal outcomes. This review aimed to present the most recent definition and classification of hypertensive disorders of pregnancy to address their management, determine the optimal timing of birth, and establish short- and long-term follow-up protocols following parturition.

The aim of this study was to evaluate maternal serological status and fetal sonographic findings of Cytomegalovirus (CMV) infection. This is a retrospective study performed at Perinatology Department of Istanbul Başakşehir Çam and Sakura City Hospital. A computerized search was conducted to identify cases who underwent prenatal diagnosis of fetal CMV infection between September 2020 and December 2023. We identified nine cases with fetal CMV infection. The clinical data of the patients, gestational age at the time of diagnosis, serological, sonographic findings, and pregnancy outcomes were analyzed. A computer search of the database was made for the seroprevalance of CMV-IgM and CMV-IgG in our population. The CMV-IgM and IgG results of the 1235 patients who underwent CMV screening in the first trimester between September 2020 and December 2023 were evaluated. Fetal CMV infection was identified in nine patients. None of the 9 cases showed maternal CMV-IgM positivity. Seven of the 9 patients showed high IgG avidity index. Pregnant population had 98 % positivity for CMV-IgG. The evaluation of serologic tests for CMV is not straightforward in the second and third trimester. IgM and IgG avidity should be interpreted with caution in the second and third trimester. In the presence of ultrasound findings suggesting fetal CMV infection and CMV-IgG positivity, invasive diagnostic tests rather than serological test should be discussed with the patient, and non-primary infections should always be considered to minimize overlooked fetal cytomegalovirus infections and missed antiviral treatment opportunity.

Objectives: This study therefore aims to determine the perinatal prognosis and delineate the key risk factors associated with outcomes in fetuses with a prenatal diagnosis of absence of pulmonary valve syndrome (APVS), with particular emphasis on Doppler ultrasound parameters, the presence of extracardiac anomalies, and comprehensive genetic findings - including rare monogenic mutations - as significant contributors to the observed perinatal course. Methods: This retrospective study included eight fetuses diagnosed with absent pulmonary valve syndrome (APVS) between 2020 and 2024 at a tertiary perinatology referral center. One patient with major extracardiac anomalies was electively terminated and excluded from the outcome analysis. For the remaining seven fetuses, detailed fetal echocardiographic assessments—including cardiac anatomy and Doppler hemodynamic parameters - were evaluated alongside genetic testing results (prenatal and/or postnatal), associated extracardiac anomalies, and postnatal clinical and surgical outcomes. Results: Among eight fetuses prenatally diagnosed with APVS, one case was electively terminated due to major extracardiac anomalies and excluded from further analysis. All of the remaining seven cases resulted in live births. Four neonates underwent surgical intervention, three of whom survived postoperatively, yielding a surgical survival rate of 75%. Two fetuses that developed hydrops fetalis died in the early postnatal period before surgery could be performed. The overall perinatal mortality rate was 57.1%. Clinically significant genetic anomalies, including trisomy 21, 22q11.2 deletion, and a novel ABAT gene mutation detected via prenatal whole-exome sequencing, were identified in three patients (42.9%). Nonsurvivors were more likely to present with an absent ductus arteriosus and severely dilated pulmonary arteries. Conclusions: Our study highlights that prognosis is more strongly influenced by prenatal hemodynamic markers - such as pulmonary artery velocities, ductus arteriosus status, and hydrops - than by anatomic subtype. The identification of both common chromosomal anomalies and novel ABAT gene mutations underscores the value of comprehensive genetic evaluation.

Fetal arrhythmias occur in 1-2% of all pregnancies and can be categorized into three types: rhythm irregularities. tachyarrhythmias and bradyarthythmias. The rate, duration and severity of the arrhythmia typically determine its hemodynamic consequences. The aim of this study was to evaluate prenatal management strategies and clinical outcomes of fetal arrhythmias in a tertiary perinatal center over a 4 year period. We retrospectively reviewed 46 fetuses diagnosed with arrhythmia between October 2020 and December 2024. Maternal characteristics, type and of arrhythmia, prenatal treatment, birth parameters and neonatal outcomes were collected. Forty-six cases of fetal arrhythmia were included in the study. The participants were divided into three groups based on arrhythmia type: rhythm irregularities (n=21, 46%), bradyarrhythmias (n=14, 30%), and tachyarrhythmias (n=11, 24%). Most patients in the bradyarrhythmia group (n=7, %50) were diagnosed with complete atrioventricular block (CAVB), all of whom tested positive for maternal autoantibodies. Supraventricular tachycardia was the most common type of tachyarrhythmia observed, followed by 2:1 atrial flutter. Fetuses with rhythm irregularities generally have favorable outcomes. The course of fetal CAVB associated with congenital heart defects, particularly left atrial isomerism, appear to be worse than that of immune-mediated CAVB. Persistent tachyarrhythmias should be treated in utero due to the risk of rapid progression to cardiac failure. Once fetal arrhythmias are diagnosed, close follow-up and parental counseling is recommended, using a multidisciplinary team approach involving pediatric cardiology and maternal-fetal medicine specialists.