Diagnostics

Research

14 pages, 3101 KiB

Open AccessArticle

Prenatal Diagnosis of Reno-Urinary Malformations in a Tertiary Center of Republic of Moldavia

by Victor Roller, Angela Ciuntu, Elena Țarcă, Nicolae Sebastian Ionescu, Teodora-Simina Drăgoiu, Jana Bernic, Eva Gudumac, Emil Ceban, Ana Mișina, Tatiana Băluțel, Adriana Ignat, Liliana Fuior-Bulhac and Dana Elena Mîndru

Diagnostics 2024, 14(19), 2243; https://doi.org/10.3390/diagnostics14192243 - 8 Oct 2024

Viewed by 486

Abstract

Malformative uropathy in children is one of the most common pathological conditions, with an incidence of 5–14% in newborns. Recent research shows that even in the current conditions, they are often diagnosed only in the advanced stages, when Chronic Kidney Disease is already [...] Read more.

Malformative uropathy in children is one of the most common pathological conditions, with an incidence of 5–14% in newborns. Recent research shows that even in the current conditions, they are often diagnosed only in the advanced stages, when Chronic Kidney Disease is already affirming. This study’s objective is to identify urinary tract anomalies, including malformative uropathies in the prenatal stage, using imaging techniques, namely ultrasound of the pregnant uterus. Using prenatal ultrasonography of the pregnant uterus and postnatal clinical and paraclinical examination, we prospectively evaluated a cohort of fifty children with pyelectasia. We describe the demographic and pathological characteristics of patients diagnosed with renal–urinary abnormalities, as well as their postnatal management. A prenatal diagnosis made during the first 15 to 22 weeks of pregnancy enables the evaluation of early malformative uropathies and the determination of the best time to operate in order to minimize complications. When prenatal ultrasonography, fetal karyotype, tissue sample, and embryonic appendages work together, problems may be partially or entirely revealed by these methods due to mistakes made in imaging examinations. In the case of a pregnancy with an antenatal malformation detected, it is necessary for the delivery to take place in a clinic that can provide favorable services for the survival and investigation of the child born with malformative abnormalities. Full article

(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)

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14 pages, 2622 KiB

Open AccessArticle

Risks and Probabilities of Adverse Pregnancy Outcomes in Patients Undergoing Trial of Labor after Cesarean—A Retrospective Study

by Alexandru Carauleanu, Iustina Solomon-Condriuc, Petronela Vicoveanu, Demetra Socolov, Ioana-Sadiye Scripcariu, Ingrid-Andrada Vasilache, Iulian-Valentin Munteanu, Luiza-Maria Baean, Ana-Maria Adam, Raluca Mogos and Liliana Gheorghe

Diagnostics 2024, 14(16), 1715; https://doi.org/10.3390/diagnostics14161715 - 7 Aug 2024

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Abstract

(1) Background: Trial of labor after cesarean (TOLAC) can be associated with significant maternal and neonatal complications, and the aim of this retrospective study was to calculate the risks and probabilities of these complications in two tertiary maternity centers in Romania. (2) Methods: [...] Read more.

(1) Background: Trial of labor after cesarean (TOLAC) can be associated with significant maternal and neonatal complications, and the aim of this retrospective study was to calculate the risks and probabilities of these complications in two tertiary maternity centers in Romania. (2) Methods: A total of 216 patients who attempted TOLAC were included in the study and were segregated into two groups, depending on TOLAC success. Medical records were assessed, and clinical data were used to determine the maternal and neonatal risks and complications, using multinomial logistic regression and postestimation predictions. (3) Results: Our data indicated that patients who had a failed TOLAC had significantly higher risks and probabilities of uterine rupture, either complete or incomplete; intensive care unit (ICU) admission; and emergency hysterectomy. The newborns of these mothers had significantly higher risks and probabilities of low Apgar score at birth, neonatal intensive care unit (NICU) admission, and invasive ventilation. (4) Conclusions: Failed TOLAC could lead to significant maternal and neonatal complications, and women who attempt this procedure should be monitored in a tertiary center where a multidisciplinary team and an emergency operating room are available. Full article

(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)

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15 pages, 923 KiB

Open AccessArticle

Characteristics of the Basel Postpartum Hypertension Cohort (Basel-PPHT Cohort): An Interim Analysis

by Thenral Socrates, Céline Wenker, Annina Vischer, Christina Schumacher, Fiona Pugin, Andreas Schötzau, Michael Mayr, Irene Hösli, Beatrice Mosimann, Olav Lapaire and Thilo Burkard

Diagnostics 2024, 14(13), 1347; https://doi.org/10.3390/diagnostics14131347 - 25 Jun 2024

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Abstract

Postpartum hypertension (PPHT) is hypertension that persists or develops after delivery and is a frequent cause of readmission, affecting 10% of pregnancies. This interim analysis aims to describe the cohort and to determine the feasibility and acceptance of a home-based telemonitoring management strategy [...] Read more.

Postpartum hypertension (PPHT) is hypertension that persists or develops after delivery and is a frequent cause of readmission, affecting 10% of pregnancies. This interim analysis aims to describe the cohort and to determine the feasibility and acceptance of a home-based telemonitoring management strategy (HBTMS) in PPHT patients. Enrollment at the University Hospital Basel began during the 2020 SARS-CoV-2 pandemic. Maternity-ward patients were screened for preexisting hypertension, hypertensive disorders of pregnancy, and de novo PPHT. In this pragmatic non-randomized prospective trial, the participants chose the HBTMS or standard of care (SOC), which consisted of outpatient hypertension clinic appointments. The HBTMS was a smartphone application or a programmed spreadsheet to report blood pressure (BP), followed by telephone consultations. Three months postpartum, the participants underwent a 24 h BP measurement and a blood, biomarker, and urine analysis. A total of 311 participants were enrolled between 06/20 and 08/23. The mean age was 34 (±5.3) years. The current pregnancy history demonstrated the following (≥1 diagnosis possible): 10% had preexisting hypertension, 27.3% gestational hypertension, 53% preeclampsia (PE), 0.3% eclampsia, 6% HELLP (hemolysis, elevated liver enzymes, and low platelets), and 18.3% de novo PPHT. A family history of cardiovascular disease and PE was reported in 49.5% and 7.5%, respectively. In total, 23.3% were high-risk for PE. A total of 68.5% delivered via c-section, the mean hospitalization was 6.3 days (±3.9), and newborn intrauterine growth restriction occurred in 21%. A total of 99% of the participants chose the HBTMS. This analysis demonstrated that the HBTMS was accepted. This is vital in the immediate postpartum period and pertinent when the exposure of hospital visits should be avoided. Full article

(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)

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11 pages, 238 KiB

Open AccessArticle

The Association between Low Fetal Fraction of Non-Invasive Prenatal Testing and Adverse Pregnancy Outcomes for Placental Compromise

by Soo-Hyun Kim, You-Mi Hong, Ji-Eun Park, Sung-Shin Shim, Hee-Jin Park, Yeon-Kyung Cho, June-Seek Choi, Joong-Sik Shin, Hyun-Mee Ryu, Moon-Young Kim, Dong-Hyun Cha and You-Jung Han

Diagnostics 2024, 14(10), 1020; https://doi.org/10.3390/diagnostics14101020 - 15 May 2024

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Abstract

(1) Background: Non-invasive prenatal testing (NIPT) is a screening test for fetal aneuploidy using cell-free fetal DNA. The fetal fragments (FF) of cell-free DNA (cfDNA) are derived from apoptotic trophoblast of the placenta. The level of fetal cfDNA is known to be influenced [...] Read more.

(1) Background: Non-invasive prenatal testing (NIPT) is a screening test for fetal aneuploidy using cell-free fetal DNA. The fetal fragments (FF) of cell-free DNA (cfDNA) are derived from apoptotic trophoblast of the placenta. The level of fetal cfDNA is known to be influenced by gestational age, multiple pregnancies, maternal weight, and height. (2) Methods: This study is a single-center retrospective observational study which examines the relationship between the fetal fraction (FF) of cell-free DNA in non-invasive prenatal testing (NIPT) and adverse pregnancy outcomes in singleton pregnancies. A total of 1393 samples were collected between 10 weeks and 6 days, and 25 weeks and 3 days of gestation. (3) Results: Hypertensive disease of pregnancy (HDP) occurred more frequently in the low FF group than the normal FF group (5.17% vs. 1.91%, p = 0.001). Although the rates of small for gestational age (SGA) and placental abruption did not significantly differ between groups, the composite outcome was significantly higher in the low FF group (7.76% vs. 3.64%, p = 0.002). Furthermore, women who later experienced complications such as HDP or gestational diabetes mellitus (GDM) had significantly lower plasma FF levels compared to those without complications (p < 0.001). After adjustments, the low FF group exhibited a significantly higher likelihood of placental compromise (adjusted odds ratio: 1.946). (4) Conclusions: Low FF in NIPT during the first and early second trimesters is associated with adverse pregnancy outcomes, particularly HDP, suggesting its potential as a predictive marker for such outcomes. Full article

(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)

13 pages, 1068 KiB

Open AccessArticle

Immune Responses of Healthy Pregnant Women following an Elective Cesarean Section: Effects of Anesthetic Procedures

by Marius Bogdan Novac, Lidia Boldeanu, Anda Lorena Dijmărescu, Mihail Virgil Boldeanu, Simona Daniela Neamțu, Lucreţiu Radu, Maria Magdalena Manolea, Mircea-Sebastian Șerbănescu, Maria Stoica, Luciana Teodora Rotaru and Constantin-Cristian Văduva

Diagnostics 2024, 14(9), 880; https://doi.org/10.3390/diagnostics14090880 - 24 Apr 2024

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Abstract

A weakened immune system and more inflammatory cytokines being released are possible effects of the surgical stress that a cesarean section induces. This kind of reaction, in addition to the altered reaction to catecholamines, has the potential to significantly affect the immune system [...] Read more.

A weakened immune system and more inflammatory cytokines being released are possible effects of the surgical stress that a cesarean section induces. This kind of reaction, in addition to the altered reaction to catecholamines, has the potential to significantly affect the immune system of the mother and the patients’ general postoperative course. This prospective study compared the plasma levels of catecholamines and cytokines in healthy pregnant patients having cesarean sections under spinal anesthesia versus general anesthesia. A total of 30 pregnant women undergoing elective cesarean sections were divided into two groups: 15 who received general anesthesia (GA) and 15 who received spinal anesthesia (SA). Blood samples were collected from all subjects before anesthesia induction (pre-OP), 6 h postoperatively (6 h post-OP), and 12 h (12 h post-OP), to measure levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-8, IL-4, IL-10, norepinephrine (NE), and epinephrine (EPI). When we compared the two groups, we discovered that only IL-6 and IL-4 had significantly higher levels pre-OP, whereas all studied cytokines exhibited an increase in the GA versus SA group at 6 and 12 h post-OP. In the case of catecholamines, we discovered that serum levels are positively related with pro-inflammatory or anti-inflammatory cytokines, depending on the time of day and type of anesthetic drugs. Compared to SA, GA has a more consistent effect on the inflammatory response and catecholamine levels. The findings of this study confirm that the type of anesthesia can alter postoperative immunomodulation to various degrees via changes in cytokine and catecholamine production. SA could be a preferable choice for cesarean section because it is an anesthetic method that reduces perioperative stress and allows for less opioid administration, impacting cytokine production with proper immunomodulation. Full article

(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)

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Review

Jump to: Research, Other

14 pages, 6081 KiB

Open AccessReview

Struma Ovarii during Pregnancy

by Gabriela Dumachița-Șargu, Răzvan Socolov, Teodora Ana Balan, Dumitru Gafițanu, Mona Akad and Raluca Anca Balan

Diagnostics 2024, 14(11), 1172; https://doi.org/10.3390/diagnostics14111172 - 1 Jun 2024

Viewed by 806

Abstract

Struma ovarii is a rare type of ovarian teratoma primarily composed of over 50% thyroid tissue. Its occurrence is reported in 2–5% of all ovarian teratomas, with approximately 0.5% to 10% showing malignant transformation. Managing it during pregnancy poses significant challenges as pregnancy [...] Read more.

Struma ovarii is a rare type of ovarian teratoma primarily composed of over 50% thyroid tissue. Its occurrence is reported in 2–5% of all ovarian teratomas, with approximately 0.5% to 10% showing malignant transformation. Managing it during pregnancy poses significant challenges as pregnancy can promote the growth of malignant struma ovarii due to elevated levels of ovarian and pregnancy-related hormones, including estrogen, progesterone, and human chorionic gonadotrophin (hCG). Most ovarian tumors, including struma ovarii, are detected during routine ultrasonography in the first and second trimesters, often as acute emergencies. Diagnosis during pregnancy is rare, with some cases incidentally discovered during cesarean section when inspecting the adnexa for ovarian cysts. This review explores the diagnostic, management, and therapeutic approaches to struma ovarii during pregnancy. Full article

(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)

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19 pages, 349 KiB

Open AccessReview

Current Trends in Diagnosis and Treatment Approach of Diabetic Retinopathy during Pregnancy: A Narrative Review

by Luminioara M. Rosu, Cătălin Prodan-Bărbulescu, Anca Laura Maghiari, Elena S. Bernad, Robert L. Bernad, Roxana Iacob, Emil Robert Stoicescu, Florina Borozan and Laura Andreea Ghenciu

Diagnostics 2024, 14(4), 369; https://doi.org/10.3390/diagnostics14040369 - 8 Feb 2024

Cited by 8 | Viewed by 2418

Abstract

Diabetes mellitus during pregnancy and gestational diabetes are major concerns worldwide. These conditions may lead to the development of severe diabetic retinopathy during pregnancy or worsen pre-existing cases. Gestational diabetes also increases the risk of diabetes for both the mother and the fetus [...] Read more.

Diabetes mellitus during pregnancy and gestational diabetes are major concerns worldwide. These conditions may lead to the development of severe diabetic retinopathy during pregnancy or worsen pre-existing cases. Gestational diabetes also increases the risk of diabetes for both the mother and the fetus in the future. Understanding the prevalence, evaluating risk factors contributing to pathogenesis, and identifying treatment challenges related to diabetic retinopathy in expectant mothers are all of utmost importance. Pregnancy-related physiological changes, including those in metabolism, blood flow, immunity, and hormones, can contribute to the development or worsening of diabetic retinopathy. If left untreated, this condition may eventually result in irreversible vision loss. Treatment options such as laser therapy, intravitreal anti-vascular endothelial growth factor drugs, and intravitreal steroids pose challenges in managing these patients without endangering the developing baby and mother. This narrative review describes the management of diabetic retinopathy during pregnancy, highlights its risk factors, pathophysiology, and diagnostic methods, and offers recommendations based on findings from previous literature. Full article

(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)

Other

Jump to: Research, Review

4 pages, 3006 KiB

Open AccessInteresting Images

Body Stalk Anomaly

by Nicolae Gică, Livia Mihaela Apostol, Iulia Huluță, Anca Maria Panaitescu, Ana Maria Vayna, Gheorghe Peltecu and Nicoleta Gana

Diagnostics 2024, 14(5), 518; https://doi.org/10.3390/diagnostics14050518 - 29 Feb 2024

Viewed by 1752

Abstract

Abdominal wall defects encompass three primary classifications: gastroschisis, omphalocele and anomalies resembling body stalk. Potential causative factors include early amnion rupture, amniotic bands, vascular disruptions or abnormal folding of the embryo. The prevalence of these defects stands at 1 in 14,000 live births. [...] Read more.

Abdominal wall defects encompass three primary classifications: gastroschisis, omphalocele and anomalies resembling body stalk. Potential causative factors include early amnion rupture, amniotic bands, vascular disruptions or abnormal folding of the embryo. The prevalence of these defects stands at 1 in 14,000 live births. Body stalk anomaly is characterized by a substantial abdominal defect coupled with spine and limb anomalies, along with a very short or absent umbilical cord. We present a case of a rare abdominal defect known as body stalk anomaly, the most severe form of this spectrum of diseases. The diagnosis of this anomaly was established during the first trimester of pregnancy. Subsequently, the patient opted for pregnancy termination and chose not to undergo genetic testing. The anatomo-pathological results confirmed the findings. Body stalk anomaly is not compatible with life; therefore, early identification and understanding the clinical implications of this rare anomaly for informed decision-making in prenatal care are very important. Full article

(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)

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