Navigating Uncertain Waters: First-Trimester Screening's Role in Identifying Neonatal Complications

Background: Contemporary diagnostic methods aimed at assessing neonatal outcomes predominantly rely on the medical history of pregnant women. Ideally, universal biomarkers indicating an increased risk of delivering infants in poor clinical condition, with a heightened likelihood of requiring hospitalization in a Neonatal Intensive Care Unit (NICU), would be beneficial for appropriately stratifying pregnant women into a high-risk category. Our study evaluated whether biochemical and ultrasonographical markers universally used in first-trimester screenings for non-heritable chromosomal aberrations could serve this purpose. Methods: This study encompassed 1164 patients who underwent first-trimester screening, including patient history, ultrasound examinations, and biochemical tests for pregnancy-associated plasma protein-A (PAPP-A) and the free beta-HCG subunit (fbHCG), from January 2019 to December 2021. The research concentrated on the correlation between these prenatal test results and neonatal outcomes, particularly Apgar scores, umbilical blood pH levels, and the necessity for NICU admission. Results: In our cohort, neonates scoring lower than 8 on the Apgar scale at birth exhibited lower concentrations of PAPP-A in the first trimester, both in raw and normalized values (PAPP-A MoM 0.93 vs. 1.027, p = 0.032). We also observed a higher pulsatility index in the venous duct in the first trimester in full-term neonates born with <8 points on the Apgar scale. Additionally, newborns born with an umbilical blood pH < 7.2 had lower normalized first-trimester PAPP-A concentrations (0.69 vs. 1.01 MoM, p = 0.04). We also noted that neonates requiring NICU hospitalization post-delivery had lower first-trimester bHCG concentrations (0.93 MoM vs. 1.11 MoM, p = 0.03). However, none of the correlations in our study translated into a robust prognostic ability for predicting dichotomous outcomes. All areas under the curve achieved a value < 0.7. Conclusions: Low concentrations of PAPP-A and free bHCG subunit in the first trimester may be associated with poorer clinical and biochemical conditions in neonates post-delivery. However, the relationship is weak and has limited predictive capability. Further research evaluating these relationships is necessary for the appropriate stratification of pregnant women into high-risk categories for neonatological complications.

Basic hope, level of stress and strategies used to cope with stress after miscarriage during hospitalization and 3 months after its completion

OBJECTIVES

Basic hope is important for successfully coping with, and adapting to, difficult situations. The aim of the study was to determine the level of stress and basic hope and identify the associated coping processes in women after miscarriage during hospitalization and threemonths after discharge.

MATERIAL AND METHODS

Atotal of 161women hospitalized due to miscarriage were included. To evaluate the level of stress, basic hope and coping strategies, the following standardized questionnaires were used: the Perceived Stress Scale (PSS-10), the Inventory to Measure Coping Strategies with Stress (Mini-COPE) and the Basic Hope Inventory (BHI-12).

RESULTS

110 patients declared high levels of stress during hospitalization and 80 claimed the same three months after discharge. The level of stress decreased after three months (p < 0.001). Adaptive stress-coping strategies were employed more frequently than maladaptive stress-coping strategies. During hospitalization, the most frequently used strategies were acceptance and seeking emotional support; with planning, acceptance, seeking emotional and instrumental support being used three months after discharge. The sense of basic hope increased after three months (p < 0.001). The level of the sense of basic hope correlates significantly (p < 0.001) and negatively (r ˂ 0) with the severity of stress symptoms during and after the hospital stay.

CONCLUSIONS

The sense of basic hope increased significantly after three months in relation to the level experienced during the hospitalization period, and the intensity of stress decreased. Preventive women-oriented interventions are needed to minimize the risk of post-traumatic stress disorder.

Repeatability and Reproducibility of Potential Ultrasonographic Bishop Score Parameters

Determination of the Bishop score (BS) is a traditional method of assessing the cervix in obstetrics and gynecology. This examination is characterized by subjectivity of assessment and low repeatability. In scientific studies intended to evaluate the results of the procedure based on the initial assessment, it is necessary to find an objective scale based on ultrasonography. We selected five ultrasound parameters, measured with a transvaginal transducer, that are equivalent to the individual BS axes (dilatation assessed in three-dimensional ultrasound (DL), angle of progression (AoP), vagino-cervical angle (VCA), strain elastography using the E-Cervix module, and cervical length (CL)). All selected parameters were characterized by good to excellent repeatability (intraclass correlation coefficient (ICC) = 0.878-0.994) and reproducibility (ICC = 0.826-0.996). Each of the selected parameters significantly correlated with its corresponding BS axis. The highest value of the correlation coefficient was achieved with CL (-0.75) and DL (0.71). Other parameters were characterized by an average to high correlation (AoP and station = 0.69, hardness ratio and consistency = -0.33, position and VCA = -0.38). The best correlation with the sum of the BS points was exhibited by AoP (0.52) and CL (-0.61). The selected ultrasound parameters analogous to the BS axes were characterized by high repeatability and significant correlation with the axes of the original clinical BS. Further research into the predictive properties of a multivariate model based on these parameters is needed.

Could pelvic floor sonography be a standalone method for excluding genuine stress urinary incontinence in women?

OBJECTIVES

Determine whether introital pelvic floor sonography with transvaginal probe (PFS-TV) can be an independent method in the diagnosis of genuine stress urinary incontinence (SUI) and to create a ultrasonographic diagnostic model to objectify diagnostic process.

MATERIAL AND METHODS

The study involved 315 patients with a history of urinary incontinence problems. Based on the clinical examination and urodynamic examination, the final diagnosis was made. Patients were divided into two groups. Group I included women with SUI and Group II included patients without SUI (OAB and no-UI). Each patient underwent PFS-TV at rest and during straining. The groups were compared in terms of ultrasound parameters.

RESULTS

Patients from both groups differed statistically in a significant way (p < 0.05) in terms of mean distance between the lower edge of the pubic symphysis at rest 19 mm vs 22 mm (Group I vs Group II) and during straining (D1 and D2) 22 mm vs 26 mm, the average value of the γ angle (at rest (γ1) 37.5° vs 40° and during straining (γ2) and 66° vs 58.5°, average difference value of angle γ during straining and at rest (γ2-γ1) 29° vs 14°, and frequency of urethral funneling 89% vs 17%. Two parameters studied during PFS-TV were included in the logistic regression model used to exclude the stress component of urinary incontinence. Diagnostic test parameters of model were sensitivity 86.6%, specificity 90.4%, accuracy 93.1%.

CONCLUSIONS

PFS-TV makes it possible to exclude the stress component of urinary incontinence. The developed logistic regression model allows for the objectification of the results of ultrasound examination in patients with urinary incontinence.

Implementation of the Publicly Funded Prenatal Screening Programme in Poland during the COVID-19 Pandemic: A Cross-Sectional Study

The COVID-19 pandemic in 2020 affected the entire healthcare system in Poland, causing medical personnel to be relocated to other duties and limiting patients’ contacts with healthcare professionals. A large part of the planned diagnostics and treatment was delayed due to lack of equipment and personnel. Against this background, we analysed the implementation of the publicly funded prenatal screening programme (PSP) in Poland compared to the previous year. This is a cross-sectional study. We used nationwide datasets on the implementation of the prenatal testing programme over the period 2019−2020, datasets from the Statistics Poland on birth and the data on the development of the COVID-19 epidemic in Poland. In the year 2020, we observed a 12.41% decrease in woman enrolled to the programme compared to 2019. However, the decrease concerned only women under 35 years of age. With respect to the number of deliveries in the calendar year, the number of patients enrolled in the programme decreased by 3% (31% vs. 34%, p < 0.001). We also observed an increase in estriol measurements per the number of patients included in the programme, and a reduction in the number of PAPP-A tests in the first trimester, which proves an increased share of the triple test in the prenatal diagnosis of chromosomal aberrations. With respect to the number of deliveries, the number of amniocentesis procedures performed under PSP decreased by 0.19% (1.8% vs. 1.99%, p < 0.0001). In 2020, compared to the previous year, the number of patients included in the prenatal testing programme in Poland decreased. In terms of the number of births in Poland, the number of integrated screening tests also decreased, at the expense of increasing the percentage of triple tests. There were also significant reductions in the number of invasive diagnostic tests.

Birth weight prediction by Lee formula based on fractional thigh volume in term pregnancies - is it helpful?

INTRODUCTION

Ultrasonographic estimation of fetal weight (EFW) is a standard obstetrical procedure in daily clinical practice. Formulas for calculating EFW most commonly are a combination of two-dimensional measurements. A relatively new approach is the use of three-dimensional measurements such as fractional thigh volume (TVol) incorporated into specific regression equations. The objective of this study was to compare the Lee formula based on three-dimensional ultrasonographic TVol in the estimation of fetal weight before delivery in term pregnancies to the Hadlock I formula.

MATERIAL AND METHODS

2D/3D abdominal ultrasonography was performed in 104 women, 37-41 gestational weeks, and measurements of biparietal diameter, head circumference, abdomen circumference, and femur length, TVol were taken. Using these measurements, we compared the Lee to the Hadlock formulas in EFW. The timing of procedures was measured in 20 randomly chosen patients by an independent observer.

RESULTS

Mean percentage errors of formulas, Lee vs. Hadlock, were 2.13 ±9.31% vs. -2.02 ±8.79%, (p = 0.001). There was no statistically significant difference in median absolute percentage errors between the two formulas (6.09% vs. 6.10%, p = 0.56). The proportion of newborns with estimated birth weights (BW) within ±10% of actual BW was not significantly different between the two formulas (73% vs. 71%, p = 0.11). There was a significant difference in the proportion of the newborns with estimated BW within ±5% (33% vs. 42%, p = 0.000006). Statistical measurements for test performance in detecting fetuses with BW ≥ 4000 g were sensitivity 85% vs. 60%, specificity 88% vs. 96%, and accuracy 88% vs. 89%. There was no significant difference in the time to perform the measurements (69 s for Lee formula vs. 58 s for Hadlock formula, p = 0.16).

CONCLUSIONS

Thigh volume measurement incorporated into the Lee single parameter formula is comparable to the Hadlock I formula in terms of accuracy in predicting fetal weight before delivery. There was no significant difference in the time needed for taking necessary measurements between the two groups.

Misoprostol vaginal insert and Foley catheter in labour induction - single center retrospective observational study of obstetrical outcome

OBJECTIVES

Induction of labour is one of the most common procedures used in obstetrics and its prevalence tends to increase. In patients with an unripe cervix (Bishop score < 7) pre-induction procedures are used before the start of oxytocin induction. Currently there is no consensus among scientific societies on the optimal way of pre-induction. We have conducted a single-centre retrospective observational study comparing obstetric induction results of patients after 37 weeks of gestation who were pre-induced with misoprostol vaginal insert (MVI) with 200 μg of misoprostol (Misodel - Ferring Pharmaceuticals Poland) or Foley catheter (20 F, 60 mL baloon).

MATERIAL AND METHODS

We have reviewed the medical records of 503 patients (group A pre-induced MVI - 135 patients, group B pre-induced Foley catheter - 368 patients) who were in a single, full-term pregnancy, pre-induced due to unripe cervixes (Bishop score < 7) with a Foley catheter or Misodel (MVI 200 μg). We compared obstetric results between groups.

RESULTS

Group A patients had a lower chance of using oxytocin in labour induction/augmentation (OR = 0.21 95% CI = 0.13-0.32), and a greater chance of surgical delivery by caesarean section (OR = 2.14 95% CI = 1.42-3.23) and vacuum extraction (OR = 3.29 95% CI = 1.08-10.00). Group A patients also had a greater chance of abnormal CTG (OR = 2.66 95% CI = 1.5-4.7) compared to group B. The groups did not differ in terms of meconium stained amniotic fluid and postpartum haemorrhage. The percentage of children born with a pH from umbilical cord blood < 7.2 and < 7.1 and newborns of medium general condition (Apgar 4-7) did not differ between the groups.

CONCLUSIONS

Neonatological results of children from Foley catheters and MVI induced delivery do not differ. Patients pre-induced with MVI rarely require labour augmentation with oxytocin. MVI-preinduced patients have a better chance of having a delivery by CS or VE compared to the Foley catheter.

Relationship between Apgar score and umbilical cord blood acid-base balance in full-term and late preterm newborns born in medium and severe conditions

OBJECTIVES

Application of Apgar scores (AS) and umbilical cord blood acid-base analysis is a base for the prediction of future neurological development in children. In clinical practice we often observe huge discrepancy between clinical and biochemical status of newborn. Because many obstetricians consider both assessments as substitute and measure of their proceeding's outcome, we decided to scientifically measure actual correlation between them among newborns born with Apgar less than 8 points.

MATERIAL AND METHODS

This was an observational retrospective study. The study included 141 newborns born in general medium and severe condition (Apgar < 8 points in first minute of life). Acid-base analysis of umbilical cord vein blood immediately after birth was performed. We correlated gasometer parameters with Apgar scores of newborns.

RESULTS

The clinical condition of a newborn at 1, 5, and 10 minutes after birth correlates positively and significantly with pH values (0.25; 0.24; and 0.26; respectively) and bicarbonate levels (0.21; 0.27; 0.28; respectively) in the umbilical cord vein, however correlation was low. Subsequently we qualified newborns to four groups depending on the degree of invasiveness of respiratory support after delivery, and the groups were compared in terms of parameters of acid-based balance. No significant differences were observed between groups in terms of acid-base balance parameters.

CONCLUSIONS

There is low, but significant correlation between clinical condition of a newborn after birth with most of acid-base parameters from umbilical vein blood. The assessment of the newborn's condition after birth using the Apgar score, (but not acid-base parameters) determines the degree of invasiveness of respiratory support activities for newborns after birth.

Reliability of The King's Health Questionnaire and the International Consultation on Incontinence Modular Questionnaire (ICIQ-SF) Short Form in assessing urinary incontinence effects in Polish women

OBJECTIVES

The King's Health Questionnaire (KHQ) and the International Consultation on Incontinence Modular Questionnaire (ICIQ-SF) Short Form are widely used in clinical practice. The aim of this study was to assess the reliability of KHQ and ICIQ-SF in Polish women.

MATERIAL AND METHODS

One hundred fifty-five women with urinary incontinence (UI) aged between 19-82 years underwent urodynamic investigation and completed both KHQ and ICIQ-SF. We performed Principal Component Analysis (PCA) using VARIMAX rotation for all questionnaire pieces to estimate the factor structure and construct the validity of the KHQ and ICIQ. PCA results were also confirmed by Spearman's correlations between KHQ and ICIQ items. Moreover, by Cronbach's alpha coefficient (α) we assessed the internal consistency of the KHQ and ICIQ. STATISTICA version 13.1 software (StatSoft, Poland), and open-source Rsoftware (version 3.4.4) were used for statistical analysis.

RESULTS

Of the study group, 77 (49.6 %) patients had stress urinary incontinence (SUI), 9 (5.8%) patients had Urgency, 10 (6.45%) had OAB and 21 (13.5 %) had MUI. The factor analysis of the KHQ questions showed four main components, and ICIQ-SF- two main components. Correlations between KHQ and ICIQ-SF were from weak (0.1-0.3) to high (0.5-0.7). The KHQ's Cronbach's alpha was 0.93 and the ICIQ- 0.7. The results obtained from the questionnaire forms did not differ among study groups.

CONCLUSIONS

The Polish versions of the KHQ and ICIQ-SF questionnaires have good psychometric values and are useful diagnostic tools in the population of urinary incontinent women.

Collection of umbilical cord blood and the risk of complications in postpartum women after natural labour in the context of the possibility of umbilical cord stem cells usage in clinical practice

OBJECTIVES

Comparison of changes in peripheral blood venous morphology and the frequency of select complications in patients who underwent umbilical cord blood collection during the third stage of labour by in the utero method compared to patients who did not undergo this procedure. Presentation of current therapeutic possibilities of cord blood stem cells.

MATERIAL AND METHODS

The study involved 248 patients who had a vaginal delivery and had umbilical cord blood taken by in utero method during the third stage of labour. The control group consisted of the first 400 patients who gave vaginal delivery starting in 2019. Each patient had a venous peripheral blood count taken before delivery and 18 hours after delivery. Changes in the results of laboratory tests and the occurrence of adverse outcomes, such as postpartum curettage, postpartum haemorrhage and manual removal of placenta, in the 3rd and 4th stage delivery periods, were analysed.

RESULTS

In the blood donor group there were significantly lower haemoglobin (11.32 g/L vs 11.61 g/L, p = 0.004) and haematocrit (32.83% vs 33.82% p = 0.001) concentrations after delivery. Umbilical cord donors had a greater difference in haemoglobin (postpartum minus prepartum) (-1.4 g/L vs -0.9 g/L, p = 000), and haematocrit (-4.05% vs -2.5% , p = 0.000). The study group had a higher percentage of patients with postpartum anaemia (haemoglobin concentration < 10 g/L) (15.9% vs 10.64%, p = 0.05), but the result were borderline significant. The groups did not differ in terms of the percentage of postpartum curettage, PPH, manual removal of placenta, percentage of severe anaemia (Hb < 7g/L) or transfusion requirement.

CONCLUSION

Collection of umbilical cord blood during the 3rd stage of labour using the in utero method is associated with a statistically significant increase of blood loss and a higher probability of postpartum anaemia. The observed changes are minor and may have little clinical significance in otherwise healthy patients.

Cerebral palsy and obstetric-neonatological interventions

Cerebral palsy is a disease that puts a great mental burden on caregivers and generates very high social costs. Children with CP require many years of rehabilitation and medical care. The etiology of the disease is undoubtedly multifactorial, and the pathogenesis is associated with focal damage to the central nervous system. One can find descriptions of well-documented interventions in the literature that reduce the risk of CP in certain groups of pregnant and neonatal patients, and interventions that have a potentially protective effect. In this review, we have analyzed the available literature in terms of prenatal and postnatal interventions that may have an impact on reducing the incidence of this condition in children.