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Management of Complications during Pregnancy

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (31 July 2021) | Viewed by 10199

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Special Issue Editor

Dr. Ramesha Papanna

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Guest Editor

Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UT Health School of Medicine, Houston, TX, USA
Interests: fetal surgery; twin twin transfusion syndrome; spina bifida repair; preterm birth; preterm premature rupture of membranes; prenatal diagnosis; placenta disorders; monochorionic twin pregnancies

Special Issue Information

Dear Colleagues,

Complications during pregnancy are common and can occur due to medical, surgical, fetal or obstetrical causes. Management strategy of such complications including diagnosis and treatment is ever changing. This Special Issue invites submission of manuscripts that are hypothesis generating or testing studies that shed light on the pressing questions in management. All conditions or disorders are included, as long as a component of management is explored. Diagnosis modalities could include, but not limited to, laboratory and imaging modalities such as ultrasound, MRI and computerized tomography scan. Clinical surveillance for complications exploring the cost-effectiveness of different strategies is also considered. Randomized controlled trials exploring the efficacy of treatment methods is highly desired.

Dr. Ramesha Papanna
Guest Editor

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Keywords

high-risk pregnancy
preterm birth
preeclampsia
placenta accreta disorders
medical complications of pregnancy
multifetal pregnancy
postpartum depression
prenatal diagnosis
ultrasound
labor abnormalities
congenital anomalies
in-utero fetal surgery

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Published Papers (4 papers)

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Research

17 pages, 4799 KiB

Open AccessArticle

Allografts for Skin Closure during In Utero Spina Bifida Repair in a Sheep Model

by Lovepreet K. Mann, Jong Hak Won, Rajan Patel, Eric P. Bergh, Jeannine Garnett, Meenakshi B. Bhattacharjee, Ponnada A. Narayana, Ranu Jain, Stephen A. Fletcher, Dejian Lai and Ramesha Papanna

J. Clin. Med. 2021, 10(21), 4928; https://doi.org/10.3390/jcm10214928 - 25 Oct 2021

Cited by 4 | Viewed by 2873

Abstract

Objectives: Use of off-label tissue graft materials, such as acellular dermal matrix (ADM), for in utero repair of severe spina bifida (SB), where primary skin layer closure is not possible, is associated with poor neurological outcomes. The cryopreserved human umbilical cord (HUC) patch has regenerative, anti-inflammatory, and anti-scarring properties, and provides watertight SB repair. We tested the hypothesis that the HUC is a superior skin patch to ADM for reducing inflammation at the repair site and preserving spinal cord function. Methods: In timed-pregnant ewes with twins, on gestational day (GD) 75, spina bifida was created without a myelotomy (functional model). On GD 95, repair was performed using HUC vs. ADM patches (randomly assigned) by suturing them to the skin edges. Additionally, full thickness skin closure as a primary skin closure (PSC) served as a positive control. Delivery was performed on GD 140, followed by blinded to treatment neurological assessments of the lambs using the Texas Spinal Cord Injury Scale (TSCIS) for gait, proprioception, and nociception. Lambs without spina bifida were used as controls (CTL). Ex vivo magnetic resonance imaging of spines at the repair site were performed, followed by quantitative pathological assessments. Histological assessments (blinded) included Masson’s trichrome, and immunofluorescence for myeloperoxidase (MPO; neutrophils) and for reactive astrocytes (inflammation) by co-staining vimentin and GFAP. Results: The combined hind limbs’ TSCIS was significantly higher in the HUC group than in ADM and PSC groups, p = 0.007. Both ADM and PSC groups exhibited loss of proprioception and mild to moderate ataxia compared to controls. MRI showed increased pathological findings in the PSC group when compared to the HUC group, p = 0.045. Histologically, the meningeal layer was thickened (inflammation) by 2–3 fold in ADM and PSC groups when compared to HUC and CTL groups, p = 0.01. There was lower MPO positive cells in the HUC group than in the ADM group, p = 0.018. Posterior column astrocyte activation was increased in ADM and PSC lambs compared to HUC lambs, p = 0.03. Conclusion: The HUC as a skin patch for in utero spina bifida repair preserves spinal cord function by reducing underlying inflammation when compared to ADM. Full article

(This article belongs to the Special Issue Management of Complications during Pregnancy)

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8 pages, 213 KiB

Open AccessArticle

Pregnancy Outcomes among Women with Graves’ Hyperthyroidism: A Retrospective Cohort Study

by Panwad Harn-a-morn, Prapai Dejkhamron, Theera Tongsong and Suchaya Luewan

J. Clin. Med. 2021, 10(19), 4495; https://doi.org/10.3390/jcm10194495 - 29 Sep 2021

Cited by 7 | Viewed by 1880

Abstract

Objective: The primary objectives of this study are to compare the rates of preterm birth; fetal growth restriction and low birth weight between the following groups: (1) pregnant women treated for thyrotoxicosis and low-risk pregnancies; (2) between pregnant women with thyrotoxicosis with no need of medication and low-risk pregnancies; and (3) between those treated with MMI and PTU. Methods: The medical records of singleton pregnancies with thyrotoxicosis were comprehensively reviewed. Low-risk pregnancies matched for age and parity were randomly recruited as controls. The obstetric outcomes were compared between both groups; the outcomes of various subgroups of the thyrotoxicosis group were also compared. Results: A total of 408 pregnant women with thyrotoxicosis were recruited. Compared with the controls; the women of the thyrotoxicosis group had significantly higher rates of low birth weight (LBW) (23.7% vs. 17.7%; p: 0.036), preterm birth (19.3% vs. 12.3%; p: 0.007), preeclampsia (8.5% vs. 4.4%; p: 0.019) and cesarean section (21.5% vs. 16.0%; p: 0.046). In the thyrotoxicosis group; 67; 127; and 158 patients were treated with MMI; PTU and no anti-thyroid drug (ATD), respectively. All obstetric outcomes were comparable between the women treated with PTU and those with MMI; and between the controlled and uncontrolled groups. However, women who needed ATD had significantly higher rates of LBW and preterm birth than those without medications. Conclusions: Thyrotoxicosis, whether treated or not needing ATDs, was significantly associated with an increased risk of adverse pregnancy outcomes. Also, active disease, indicated by the need for ATD significantly increased the risk of such adverse outcomes; whereas the patients treated with MMI or PTU had comparable adverse outcomes. Full article

(This article belongs to the Special Issue Management of Complications during Pregnancy)

11 pages, 2698 KiB

Open AccessArticle

Risk Factors and Outcomes Following Septostomy during Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome

by Clifton O. Brock, Eric P. Bergh, Edgar A. Hernandez-Andrade, Rodrigo Ruano, Anthony Johnson and Ramesha Papanna

J. Clin. Med. 2021, 10(16), 3693; https://doi.org/10.3390/jcm10163693 - 20 Aug 2021

Cited by 4 | Viewed by 2448

Abstract

Fetoscopic laser photocoagulation (FLP) of placental anastomoses is the preferred treatment for twin-to-twin transfusion syndrome (TTTS). Iatrogenic septostomy (IOS) during FLP is associated with increased risk of neonatal morbidity and mortality. We sought to identify risk factors for IOS and quantify the resultant outcomes. This is a secondary analysis of prospectively collected cases of TTTS in monochorionic diamniotic twins following FLP at a single center. Pre-operative ultrasound characteristics and operative technique (i.e., cannula size, total energy used) were compared between cases with vs. without IOS. Pregnancy and neonatal outcomes were also compared. Of 475 patients that had FLP, 33 (7%) were complicated by IOS. There was no association between operative technique and IOS. IOS was more common with later diagnosis, but less likely when selective fetal growth restriction (sFGR) was present. Survival was similar between groups (76% vs. 76% dual survivors, p = 0.95); however, IOS was associated with earlier delivery (29.7 vs. 32.0 wks, p < 0.01) and greater composite neonatal morbidity (25% vs. 8% in both twins, p = 0.02). Risks of IOS at greater gestational ages without sFGR may be related to a larger collapsed intervening membrane area and the resulting increased risk of puncture on entry. Full article

(This article belongs to the Special Issue Management of Complications during Pregnancy)

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7 pages, 494 KiB

Open AccessArticle

The Antenatal and Postnatal Consequences of Antenatal Exposure to Prolonged Low Dose Indomethacin

by Vera Donadono, Nicky Manning and Lawrence Impey

J. Clin. Med. 2021, 10(9), 1851; https://doi.org/10.3390/jcm10091851 - 24 Apr 2021

Cited by 1 | Viewed by 2253

Abstract

Despite its many clinical applications, indomethacin is seldom used in pregnancy, principally because of concerns regarding the potential for constriction of the arterial duct. The aim of this study was to document adverse antenatal effects and postnatal outcomes after in utero exposure to low-dose indomethacin. We studied a retrospective cohort of pregnancies between 2005 and 2016 at the John Radcliffe Hospital, Oxford, UK, in which mothers at extremely high risk of preterm birth were treated as prophylaxis with indomethacin 25 mg, 12 hourly, before 29 weeks. Antenatal effects on the arterial duct and postnatal outcomes were analysed. Overall, 198 fetuses had in utero follow-up, and 13 (6.6%) had ductal constriction, all within 9 days of starting treatment. No ductal constriction was seen in pregnancies when therapy was started before 20 weeks, and all effects were reversed after cessation of therapy. An analysis of postnatal complications was possible in 181 neonates. There were eight (4.4%) neonatal deaths, all but one associated with extreme preterm birth. Seven (5%) patent ductus arteriosus cases occurred in the 140 neonates delivered after 28 weeks who were alive at discharge. Postnatal complications were not more common in neonates in whom antenatal ductal constriction had been demonstrated. In conclusion, fetuses exposed to prolonged low dose indomethacin have a low incidence of in utero complications; these complications can be diagnosed with ultrasound and are reversible. Adverse postnatal events are related to gestation at birth and do not appear more common. Full article

(This article belongs to the Special Issue Management of Complications during Pregnancy)

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