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A guide aiming to alleviate the anxiety that many women feel when they obsess over prenatal influences explores how fetuses are shaped in utero, separating the evidence from the hype, and examines the cultural mania that surrounds pregnancy today.

Cardiovascular disease complicates 1–4% of pregnancies — with a higher prevalence when including hypertensive disorders — and is the leading cause of maternal death. In women with known cardiovascular pathology, such as congenital heart disease, timely counselling is possible and the outcome is fairly good. By contrast, maternal mortality is high in women with acquired heart disease that presents during pregnancy (such as acute coronary syndrome or aortic dissection). Worryingly, the prevalence of acquired cardiovascular disease during pregnancy is rising as older maternal age, obesity, diabetes mellitus and hypertension become more common in the pregnant population. Management of cardiovascular disease in pregnancy is challenging owing to the unique maternal physiology, characterized by profound changes to multiple organ systems. The presence of the fetus compounds the situation because both the cardiometabolic disease and its management might adversely affect the fetus. Equally, avoiding essential treatment because of potential fetal harm risks a poor outcome for both mother and child. In this Review, we examine how the physiological adaptations during pregnancy can provoke cardiometabolic complications or exacerbate existing cardiometabolic disease and, conversely, how cardiometabolic disease can compromise the adaptations to pregnancy and their intended purpose: the development and growth of the fetus.In this Review, Roos-Hesselink and colleagues describe how the physiological adaptations during pregnancy can induce cardiometabolic complications or an exacerbation of existing cardiometabolic disease, and discuss the epidemiology, pathophysiology, diagnosis and management of cardiometabolic diseases acquired or presenting during pregnancy, including hypertensive disorders, gestational diabetes mellitus, thromboembolic disorders and peripartum cardiomyopathy.

Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women.

Background Reproductive efficiency is paramount in the dairy industry, where early pregnancy detection of dairy cows will allow to detect the non-pregnant animals early, thus enabling to re-synchronize them and getting them pregnant leading to decrease in calving interval, which, in turn, is critical for maximizing productivity and economic gain. The objective of this study was to evaluate the colour Doppler ultrasonography (CDUS) and peripheral blood leukocytes (PBLs)-based pregnancy-associated biomarker mRNAs expression for the earliest detection of pregnancy status in the dairy cows at post insemination. Intensively managed animals were ovulation synchronized and subjected to timed artificial insemination (TAI). On day 20, corpus luteum blood flow (CLBF) was evaluated using CDUS in 30 cows. The percentage of the incoming blood flow (as an area) of the corpus luteum (CL) was determined using an image analysis software. On day 35, the same operator performed a final pregnancy diagnosis using transrectal ultrasonography to confirm the pregnancy. Blood samples were collected on day 20 and 28 after TAI for biomarkers analysis. The mRNA expression levels of ISG15 , MX1 , MX2 , and PAG9 genes in PBLs were determined by quantitative polymerase chain reaction (qPCR). Results The identified CLBF cutoff point resulted 100% sensitivity and negative predictive value (NPV) in determining non-pregnant status on day 20 in the cows. Overall, MX2 and ISG15 mRNAs showed the most significant ( P  < 0.05) expression levels in pregnant animals on day 20 and 28 compared to non-pregnant animals. Among them, MX2 showed the highest expression levels on both days, ascertaining it as the better candidate biomarker for the earliest identification of pregnancy. Conclusions The CDUS-based CLBF analysis on day 20 after TAI can be potentially used for the early identification of non-pregnancy status in dairy cows and MX2 could be a potential mRNA candidate for the identification of pregnancy in cows. Further studies should be conducted in large scale to validate these findings due to the small sample number used in the current study.

Background Pregnancy-associated atypical hemolytic uremic syndrome (aHUS) is a form of thrombotic microangiopathy (TMA) caused by uncontrolled activation of the complement system during pregnancy or the postpartum period. In the intensive care unit, aHUS must be differentiated from sepsis-related multiple organ dysfunction, thrombotic thrombocytopenic purpura (TTP), hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. Early recognition of aHUS is critical for effective treatment and improved prognosis. Although tests such as the ADAMTS13 level, peripheral blood smears, complement testing, and blood cultures are useful for diagnosing aHUS, these tests are time-consuming and may not be widely available. This report describes a case of severe aHUS in a pregnant woman during the coronavirus disease 2019 (COVID-19) pandemic. Case presentation A 26-year-old patient with a history of four pregnancies and one delivery (P4G1) presented at 30 weeks and 2 days of gestation with vaginal fluid leakage and fetal growth restriction detected by ultrasound at a different hospital. During labor induction, the patient developed a high fever and coagulopathy, followed by heart failure, acute kidney injury, anemia, and severe thrombocytopenia. The patient remained alert and coherent, with no evidence of neurological dysfunction. She was transferred to our department and was given invasive respiratory support, blood transfusion, continuous renal replacement therapy, capacity management, and other comprehensive treatments. Due to the ongoing COVID-19 pandemic, ADAMTS13 testing and complement inhibitor therapy were unavailable. A diagnosis of pregnancy-associated aHUS was made based on the patient's history, clinical presentation, and standard laboratory results. The patient was prescribed 13 sessions of hemodialysis. Post-treatment evaluation showed normalized complement C3 and C4 levels, stabilized platelet and hemoglobin levels, and gradual normalization of liver function. Renal function improved gradually, and a bone marrow biopsy revealed no fragmented red blood cells. The patient was transferred to the Department of Nephrology on day 40 and back to the local hospital on day 42. The patient was followed up for 3 years, during which her renal function returned to normal, with no recurrence of thrombocytopenia or microangiopathic hemolytic anemia. Conclusions This case highlights the challenges and importance of diagnosing and managing pregnancy-associated aHUS and multiple organ failure in a low-resource setting.

Bovine pregnancy diagnosis (PD) by transrectal palpation (TRP) is one of the most frequently performed procedures in bovine practice, and an important competency for veterinary graduates. It is currently not known if pre-existing TRP skills on non-pregnant cows can be used to predict students’ future PD accuracy. The study objective was to evaluate if TRP objective structured clinical examination (OSCE) scores can predict students’ future PD accuracy.Fourth year (of a six-year programme) veterinary students (n=128) received TRP and PD training on Breed’n Betsy (BB) simulators and live cows. Students’ TRP skills were assessed using a live cow TRP OSCE after completion of the fourth year training. The same students received additional TRP (BB and live cows) and PD (BB) training sessions in the first semester of their fifth year. PD accuracy was assessed after the additional TRP and PD training, five months after the TRP OSCE assessment and measured as sensitivity and specificity (the ability to correctly identify the presence and absence of pregnancy, respectively). Each student palpated six cows transrectally to diagnose pregnancy status and stage for the PD assessment. The TRP OSCE results were analysed as predictors for students’ PD accuracy.Students with ‘competent palpation skills’ on the TRP OSCE had higher PD specificity. The individual OSCE components that were predictive of higher PD accuracy were students’ ability to estimate ovarian size, identify uterine position and exclude intrauterine fluid. It was concluded that a TRP OSCE has the ability to predict students’ future PD accuracy.

Some have attributed risks of adverse outcomes associated with GDM, such as birth weight that is large for gestational age (LGA), excess fetal adiposity, and higher rate of cesarean section, to confounding characteristics, such as obesity, more advanced maternal age, or other medical complications, rather than glucose intolerance (7-9). [...] it is likely that additional well-designed randomized controlled trials and other clinical studies will be needed to determine 1 cost-effective therapeutic strategies for treatment of GDM diagnosed by the IADPSG Consensus Panel-recommended criteria; 2 optimal glycemic treatment targets; 3 appropriate follow-up of mothers to determine risks for later development of diabetes, other metabolic disorders, or CVD risk factors; and 4 follow-up of children to assess potential associations of maternal glycemia with long-term risks of obesity, altered glucose metabolism, and CVD risk factors.

Pregnancy rates of Holstein cows showed a substantial decline in the past years, which caused intensive TAI programs for nonpregnant cows to shorten the period between unsuccessful insemination and the next attempt on the same cow. Although many studies examined the improvement in pregnancy rates following TAI, only a few examined the economic impact of such programs. In this study, we look at the feasibility of reproductive programs that included early pregnancy diagnosis performed by transrectal ultrasonography 25 days after artificial insemination (AI) and TAI of nonpregnant cows. This resulted in the following two TAI programs: a modified OvSynch program with a second PGF2α treatment at 24 h interval (GPPG, n = 100) and a modified OvSynch program with an intravaginal progesterone-release device inserted between days 0–7 (PRID + GPPG, n = 100). Cows included in the TAI programs recorded an improvement in the cumulative pregnancy rate (67% vs. 53%; 69% vs. 53%) compared to those in which this strategy was not applied (p < 0.05). An economic analysis was performed using a decision-support tool to estimate the net present value (NPV; USD/cow/year). The analysis revealed a difference in NPV of 89.6 USD/cow/year between the programs (rebreeding the nonpregnant cows following the TAI program vs. AI at detected estrus). In summary, rebreeding the nonpregnant cows after early negative pregnancy diagnosis (25 days after AI) using this strategy can improve the cumulative pregnancy rate and profitability of dairy farms.

Pregnancy diagnosis during early gestation is important for cattle reproduction. The expression of interferon-stimulated genes (ISGs) in peripheral blood leukocytes (PBLs) was studied in embryo-transferred (ET) Japanese Black cattle. ISGs in PBLs—ISG15, MX1, MX2, and OAS1—were detected in multiple ovulation ET cattle using a real-time quantitative polymerase chain reaction, and receiver operating characteristic (ROC) curve analysis was performed. Gestational status was predicted using the average ISG levels during the normal estrous cycle (AVE) and the Youden index from the ROC curve analysis as cutoff values. The ISG15, MX1, and MX2 levels were significantly higher in pregnant cattle (n = 10) than in non-pregnant cattle (n = 23) on gestation day 21, whereas the levels of all ISGs were similar between non-pregnant and non-pregnant cattle with late embryonic death (n = 7). ISG15, MX1, and MX2 appropriately predicted the gestational status of ET cows. The statistical evaluation of the diagnostic accuracy in ET cows on day 21 of gestation presented higher values of sensitivity, specificity, accuracy, and positive predictive values of ISG15, MX1, and MX2 using the Youden index than using the AVE. Therefore, ISG15, MX1, and MX2 are excellent biomarkers of gestational status during the peri-implantation period in ET cattle.

Background Heterotopic pregnancy (HP), characterized by coexisting intrauterine (IUP) and ectopic pregnancy (EP), poses diagnostic challenges due to overlapping symptoms with conditions like acute appendicitis in pregnancy (AAIP). This case highlights the complexities of managing HP with concurrent AAIP and bilateral tubal pregnancies following ovulation induction. Case presentation A 32-year-old female with a history of clomiphene-induced ovulation presented at 9 weeks’ amenorrhea with vaginal bleeding and right lower abdominal pain. Transvaginal ultrasound revealed an IUP, a left adnexal mass with embryonic cardiac activity, and a right lower abdominal mixed-echoic lesion suggestive of appendicitis. Laparoscopic left salpingectomy and appendectomy were performed in the first operation, and the diagnosis was confirmed by postoperative pathology. Postoperatively, β-hCG remained elevated (161,134 IU/L), and a right adnexal mass enlarged progressively. A second laparoscopic surgery was performed to remove the right fallopian tube and successfully preserve intrauterine pregnancy, and a healthy male baby was delivered by cesarean section at 38 weeks and 5 days of gestation. Conclusion This case underscores the diagnostic complexity of overlapping HP and AA symptoms, emphasizing the role of serial biomarker assessment and early surgical intervention in high-risk populations. Bilateral tubal ectopic pregnancies, though rare, warrant heightened vigilance in assisted reproductive technology (ART) patients. Dynamic imaging and intraoperative exploration are critical to avoid missed diagnoses. Timely laparoscopic surgery, coupled with threatened abortion management, can optimize maternal and neonatal outcomes.