Explore the vast range of titles available.

Background Early Neonatal mortality (ENM) (< 7 days) remains a significant problem in low resource settings. Birth asphyxia (BA), prematurity and presumed infection contribute significantly to ENM. The study objectives were to determine: first, the overall ENM rate as well as yearly ENM rate (ENMR) from 2015 to 2019; second, the influence of decreasing GA (< 37 weeks) and BW (< 2500 g) on ENM; third, the contribution of intrapartum and delivery room factors and in particular fetal heart rate abnormalities (FHRT) to ENM; and fourth, the Fresh Still Birth Rates (FSB) rates over the same time period. Methods Retrospective cohort study undertaken in a zonal referral teaching hospital located in Northern Tanzania. Labor and delivery room data were obtained from 2015 to 2019 and included BW, GA, fetal heart rate (FHRT) abnormalities, bag mask ventilation (BMV) during resuscitation, initial temperature, and antenatal steroids use. Abnormal outcome was ENM < 7 days. Analysis included t tests, odds ratios (OR), and multivariate regression analysis. Results The overall early neonatal mortality rate (ENMR) was 18/1000 livebirths over the 5 years and did not change significantly comparing 2015 to 2019. Comparing year 2018 to 2019, the overall ENMR decreased significantly (OR 0.62; 95% confidence interval (CI) 0.45–0.85) as well as infants ≥37 weeks (OR 0.45) (CI 0.23–0.87) and infants < 37 weeks (OR 0.57) (CI 0.39–0.84). ENMR was significantly higher for newborns < 37 versus ≥37 weeks, OR 10.5 ( p  < 0.0001) and BW < 2500 versus ≥2500 g OR 9.9. For infants < 1000 g / < 28 weeks, the ENMR was ~ 588/1000 livebirths. Variables associated with ENM included BW - odds of death decreased by 0.55 for every 500 g increase in weight, by 0.89 for every week increase in GA, ENMR increased 6.8-fold with BMV, 2.6-fold with abnormal FHRT, 2.2-fold with no antenatal steroids (ANS), 2.6-fold with moderate hypothermia (all < 0.0001). The overall FSB rate was 14.7/1000 births and decreased significantly in 2019 when compared to 2015 i.e., 11.3 versus 17.3/1000 live births respectively ( p  = 0.02). Conclusion ENM rates were predominantly modulated by decreasing BW and GA, with smaller/ less mature newborns 10-fold more likely to die. ENM in term newborns was strongly associated with FHRT abnormalities and when coupled with respiratory depression and BMV suggests BA. In smaller newborns, lack of ACS exposure and moderate hypothermia were additional associated factors. A composite perinatal approach is essential to achieve a sustained reduction in ENMR.

The PROPESS, a controlled-release dinoprostone vaginal delivery system, is a pharmacological cervical ripening intervention and promotes cervical change causing uterine contraction. During insertion of the PROPESS, uterine hyperstimulation could occur and result in fetal heart rate (FHR) abnormality. We report a case of uterine hyperstimulation accompanied with FHR abnormality caused by the PROPESS in a pregnant woman. Postural change, oxygenation, fluid infusion, and the immediate PROPESS removal were ineffective to address the adverse event, so we administered nitroglycerin for acute uterine relaxation. The nitroglycerin resulted in uterine relaxation, and the FHR abnormality was resolved immediately, thereby preventing an emergency cesarean section. Therefore, nitroglycerin could be considered an effective option for uterine hyperstimulation accompanied with FHR abnormality caused by the PROPESS.

Induction of labor is the artificial stimulation of uterine contractions for the purpose of vaginal birth. It is one of the most commonly practiced procedures in obstetrics, occurring in over 22% of pregnancies. Risks associated with labor induction include prolonged labors, uterine contractile abnormalities, fetal heart rate abnormalities, and an increased propensity for cesarean birth. Prostaglandins cause dissolution of collagen bundles and an increase in the submucosal water content of the cervix and attempt to mimic the changes of spontaneous labor. Amniotomy can safely and effectively induce or augment labor, particularly in women with favorable Bishop scores. Despite therapeutic advances and continued research into the initiation of human parturition, the clinical features which are most critical for determining induction management and predicting success are the cervical condition at the start of the induction, and gestational age, among other maternal demographic characteristics such as multiparity and normal weight.

Contemporary issues that affect vaginal birth after cesarean (VBAC) rates include the right for women to have a cesarean with no medical indication, the possibility of future pelvic support disorders after vaginal delivery, and substantial medical legal risks should uterine rupture occur during a trial of labor (TOL) to achieve VBAC. This chapter outlines a careful and safe approach to VBAC. The decision for a TOL after a previous cesarean (TOLAC) involves balancing risks versus benefits. Rupture of the uterine scar is the most serious complication of VBAC, and it can be life‐threatening for both mother and baby. Uterine rupture is sometimes difficult to diagnose, and close surveillance is necessary. Signs and symptoms may progress gradually or rapidly. The most common presenting signs are fetal heart rate (FHR) abnormalities. The condition of the infant is dependent on the severity of the rupture and relationship to the placenta and umbilical cord.

The timely onset of labor and delivery is an important determinant of perinatal outcome. Both preterm births (defined as delivery prior to 37 weeks' gestation) and postterm births (defined as delivery after 42 weeks' gestation) are associated with increased neonatal morbidity and mortality. Much attention has been paid to the problem of preterm birth despite the observation that antepartum stillbirths account for more perinatal deaths than either complications of prematurity or sudden infant death syndrome, and the fact that the risks of postterm pregnancy can be easily avoided by earlier induction of labor. This chapter reviews in detail the risks of continuing pregnancy beyond the due date, the option of induction of labor, and the management of low‐risk postterm pregnancies.

Background This study aimed to estimate population-based frequencies of various fetal heart rate (FHR) evolution patterns in cases with umbilical cord abnormalities and to identify particular FHR evolution patterns associated with different types of umbilical cord abnormalities. Methods We conducted a retrospective cohort study. FHR evolution patterns, evaluating the trend of all FHR tracings from admission to delivery, were retrospectively analyzed and classified into five categories: persistent non-reassuring (p-NR), persistent bradycardia, Hon’s pattern, reactive-prolonged deceleration (PD), and persistent reassuring. The study included pregnant women who delivered after 37 weeks of gestation. Frequencies of the five FHR evolution pattern categories were stratified by the type of umbilical cord abnormalities. Results Among 1,195 participants, 1,074 had no cord abnormalities, and 122 had abnormalities. Overall, the prevalence of FHR patterns in cases with the cord abnormality was: 2% p-NR, 3% Hon’s pattern, 21% reactive-PD, and 74% persistent reassuring. The frequencies of various FHR evolution patterns did not differ significantly between cases with and without umbilical cord abnormalities. However, when analyzing specific cord abnormalities, velamentous cord insertion showed a higher prevalence of p-NR (7% vs. 1%, p  = 0.14) and reactive-PD (40% vs. 17%, p  < 0.05) compared with cases without cord abnormality, along with a lower prevalence of persistence reassuring patterns (53% vs. 79%, p  < 0.05). Conclusion Analysis of FHR evolution patterns in a population-based sample demonstrated a higher occurrence of reactive-PD patterns in cases with umbilical cord abnormalities, which result in sudden deterioration of fetal condition during delivery, compared with cases without umbilical cord abnormalities.

Vital signs monitoring is a fundamental component of ensuring the health and safety of women and newborns during pregnancy, labor, and childbirth. This monitoring is often the first step in early detection of pregnancy abnormalities, providing an opportunity for prompt, effective intervention to prevent maternal and neonatal morbidity and mortality. Contemporary pregnancy monitoring systems require numerous devices wired to large base units; at least five separate devices with distinct user interfaces are commonly used to detect uterine contractility, maternal blood oxygenation, temperature, heart rate, blood pressure, and fetal heart rate. Current monitoring technologies are expensive and complex with implementation challenges in low-resource settings where maternal morbidity and mortality is the greatest. We present an integrated monitoring platform leveraging advanced flexible electronics, wireless connectivity, and compatibility with a wide range of low-cost mobile devices. Three flexible, soft, and low-profile sensors offer comprehensive vital signs monitoring for both women and fetuses with time-synchronized operation, including advanced parameters such as continuous cuffless blood pressure, electrohysterography-derived uterine monitoring, and automated body position classification. Successful field trials of pregnant women between 25 and 41 wk of gestation in both high-resource settings (n = 91) and low-resource settings (n = 485) demonstrate the system’s performance, usability, and safety.

Detection of fetal conduction system abnormalities relies upon magnetocardiographic or electrocardiographic recording techniques. Appropriate fetal treatment requires awareness of arrhythmia characteristics, mechanisms, and their potential associations. This Review discusses current and future diagnostic techniques and pharmacologic treatments for fetal arrhythmia. The human fetal heart develops arrhythmias and conduction disturbances in response to ischemia, inflammation, electrolyte disturbances, altered load states, structural defects, inherited genetic conditions, and many other causes. Yet sinus rhythm is present without altered rate or rhythm in some of the most serious electrophysiological diseases, which makes detection of diseases of the fetal conduction system challenging in the absence of magnetocardiographic or electrocardiographic recording techniques. Life-threatening changes in QRS or QT intervals can be completely unrecognized if heart rate is the only feature to be altered. For many fetal arrhythmias, echocardiography alone can assess important clinical parameters for diagnosis. Appropriate treatment of the fetus requires awareness of arrhythmia characteristics, mechanisms, and potential associations. Criteria to define fetal bradycardia specific to gestational age are now available and may allow detection of ion channelopathies, which are associated with fetal and neonatal bradycardia. Ectopic beats, once thought to be entirely benign, are now recognized to have important pathologic associations. Fetal tachyarrhythmias can now be defined precisely for mechanism-specific therapy and for subsequent monitoring of response. This article reviews the current and future diagnostic techniques and pharmacologic treatments for fetal arrhythmia. Key Points Fetal demise related to cardiac depolarization or repolarization abnormalities may be preventable Genetic ion channel diseases often present with fetal bradycardia The prognosis of patients with complete atrioventricular block depends on the etiology of this condition Fetal magnetocardiography enhances diagnosis and treatment

Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging has enabled the accurate assessment of myocardial infarction (MI). However, LGE CMR has not been performed successfully in the fetus, where it could be useful for animal studies of interventions to promote cardiac regeneration. We believe that LGE imaging could allow us to document the presence, extent and effect of MI in utero and would thereby expand our capacity for conducting fetal sheep MI research. We therefore aimed to investigate the feasibility of using LGE to detect MI in sheep fetuses. Six sheep fetuses underwent a thoracotomy and ligation of a left anterior descending (LAD) coronary artery branch; while two fetuses underwent a sham surgery. LGE CMR was performed in a subset of fetuses immediately after the surgery and three days later. Early gadolinium enhancement (EGE) CMR was also performed in a subset of fetuses on both days. Cine imaging of the heart was performed to measure ventricular function. The imaging performed immediately after LAD ligation revealed no evidence of infarct on LGE (n=3). Two of four infarcted fetuses (50%) showed hypoenhancement at the infarct site on the EGE images. Three days after the ligation, LGE images revealed a clear, hyper-enhanced infarct zone in four of the five infarcted fetuses (80%). No hyper-enhanced infarct zone was seen on the one sham fetus that underwent LGE CMR. No hypoenhancement could be seen in the EGE images in either the sham (n=1) or the infarcted fetus (n=1). No regional wall motion abnormalities were apparent in two of the five infarcted fetuses. LGE CMR detected the MI three days after LAD ligation, but not immediately after. Using available methods, EGE imaging was less useful for detecting deficits in perfusion. Our study provides evidence for the ability of a non-invasive tool to monitor the progression of cardiac repair and damage in fetuses with MI. However, further investigation into the optimal timing of LGE and EGE scans and improvement of the sequences should be pursued with the aim of expanding our capacity to monitor cardiac regeneration after MI in fetal sheep.