38^th Congress of the Fetus as a Patient Society Ljubljana, Slovenia, 14^th-16^th May 2025

ASSOCIATION BETWEEN PREMATURITY AND NEONATAL MORTALITY IN OUR MATERIAL

Prof. Gabriela Bushinoska Ivanova ¹ , Dr Jasna Bushinoska², Dr Jordancho Ivanov²

¹Gynecology and Obstetrics Clinic Skopje,

²Acibadem Sistina Hospital- Skopje

Abstract:

Introduction: Neonatal mortality is the mortality among newborns in the first 28 days after birth. It consists of the early NNM in the first 7 days after delivery and the late NNM from 8-28 days after delivery. Prematurity and low birth weight are the leading causes of increased NNM. A premature newborn is born < 37 g.w. and as is lower the gestational week of delivery, is greater the risk of increased mortality and morbidity.

Low birth weight is the weight of the newborn <2500 g. As is lower the birth weight, is greater the risk of NNM, especially in fetuses under 1000 g. Low birth weight and low gestational age at delivery are the two most important predictors of NNM.

Aim of study: The purpose of the paper is to show on our material, the impact of prematurity and low birth weight on NNM, as well as the impact of their complications on NNM.

Material and methods: Data from the OINT of Gynecology and Obstetrics Clinic in Skopje were used, on the contribution of prematurity and low birth weight in NNM in a period of 7 years from 2011-2017. Also will be shown that complications from prematurity like LBW, RDS, asphyxia, infections, compromised immunity, all have an association with increased NNM in newborns hospitalized at OINT on GOC in Skopje.

Results: The results of the analysis show that the leading causes of NNM at GOC Skopje are prematurity and low birth weight, as well as factors arising from them: asphyxia, RDS, low birth weight, birth trauma, etc. reasons. Cesarean delivery, prenatal administration of corticosteroids, higher APGAR score in the 1st and 5th minutes, have a significant impact on the survival of newborns and reduction of mortality and morbidity in newborns.

Conclusion: Prevention of prematurity, better health and prenatal protection of mothers, education and better health service are the basis for reducing prematurity and NNM. They are preventable and need programs for health care, education, healthy environment, better public health service, lifestyle.

Key words: neonatal mortality - NNM, prematurity, low birth weight, early NNM, late NNM, prematurity complications

None declared

Table 1. Total births, NNM at NICU and prematurity deaths at NICU, GOC- Skopje

Table 2. Neonatal deaths by gestational week of pregnancy in seven years period, GOC- Skopje

Deficiency Vitamin D during Pregnancy not Risk Fetal Growth, Offspring Abnormalities of Bone and Neurocognitive

Dr. Julian Dewantiningrum ¹

¹Medical Faculty Diponegoro University,

²Kariadi Hospital

Objectives

Incidence stunting has decreased, but did not meet WHO standards (<20%). One of the important micronutrient in fetal programming is vitamin D. This study aim to verify the effect of vitamin D deficiency during pregnancy on bone growth and neurocognitive’s offspring aged 2 years through fetal growth.

Methods

The study design was a retrospective cohort. A total of 120 singleton and live pregnancy at 24-28 weeks of gestation measured 25(OH)D levels and fetal growth by ultrasound. Subjects were divided into 2 groups, deficient and normal. Exclusion criterias were systemic disease, chronic and congenital anomaly. Fetal growth was plotted to WHO chart. Offspring serum levels of bALP and osteocalcin for bone growth, BDNF for neurocognitive biomarker examined in offspring aged 2 years. Maternal and neonatal food intake were also examined. Other variables as confounding factors were considered. Data analysed to know RR (95% CI) after controlled confounding variables.

Results

The difference in vitamin D levels in the two groups wre 22,69 ng/ml compared to 16,07 ng/ml. RR (95% CI) the effect of vitamin D deficiency on fetal growth, bone and neurocognitive biomaker in offspring aged 2 years were 0,74(0,24-2,34), 0,99(0,38-2,58) and 1,45(0,63-3,4) respectively after controlled for confounding variables. RR (95% CI) for the effect of fetal growth on bone and neurocognitive biomarker were 2,35 (0,58-9,5) and 1,06 (0,35-3,1) respectively. Confounding variables of mother were controlled such as age, parity, BMI, anemia (hemoglobin and ferrtitin), food intake, sosioeconomic, prematur, height, level of zinc, IGF-1, CRP and PTH. Confounding variables of offspring were controlled for food intake, level of IGF-1, calcium, zinc, ferritin and vitamin D. Vitamin D deficiency in pregnancy has not been proven to have a deficiency effect on bone growth and neurocognition in offspring aged 2 years through fetal growth. The hypothesis of this possibility caused by subjects of this study without risk factors and it was possible that vitamin D levels in the third trimester might be related with fetal growth, bone and neurocognitive’s neonatal. Many research showed inconsistent because there are also differences in measurement methods, cut off levels of vitamin D, gestational age at the time of examination and confounding factors controlled in the research. Many factors interact each other and can influence fetal growth, bones and neurocognition, such as hormones, calcium, nutrition and socio-economic status. The results of this study support the hypothesis that calcium transfer from mother to fetus is not affected by vitamin D per se. Bone formation in the fetus is largely due to the influence of PTH. This research showed that the PTH between the two groups is not different, so that calcium transport to the fetus is not disturbed even though vitamin D deficiency occurs. Other hormones that influence calcium transport from the placenta to the fetus are prolactin, estrogen and human placental lactogen.

Conclusions

Vitamin D deficiency during pregnancy do not give effect to disorder of bone and neurocognitive biomarker in offspring either directly or through fetal growth.

none declared

Table 1. Multivariate analysis of the effect vitamin D deficiency during pregnancy to fetal growth.

^aRR adjusted for maternal: age, MUAC, intake fat, vitamin A, C, B6, E, folic acid and zinc.

^bRR adjusted for maternal: age, MUAC and vitamin C.

^cRR adjusted for maternal: intake lipid, vitamin A, C, B6, E, folic acid and zinc.

^dRR unadjusted

Table 2. Multivariate analysis for the effect vitamin D deficiency during pregnancy to offspring bone growth.

T2* mapping of fetal brain: preliminary study

Dr. Alexandra Korostyshevskaya ¹, Ms Kseniia Paraskun², Mr Andrey Savelov¹

¹ITC SB RAS,

²NSU

Objectives:

There is a critical need for quantitative methods to assess fetal tissue hypoxia accurately, as current limitations may lead to mismanagement in clinical decision-making. T2* relaxation time decreases due to the paramagnetic properties of deoxyhemoglobin, which accumulates in hypoxic tissues, offering a potential diagnostic marker for hypoxia in fetal MRI. This study aims to develop a standardized approach for T2* mapping and assess its application in fetal brain imaging.

Methods:

Fetal MRI was performed on 1.5T and 3T Philips Ingenia scanners using dStream Aterior coil. A multi-echo T2*-EPI pulse sequence was used with echo times (TE) ranging from 25 to 225 ms. Identical regions of interest (ROIs) were selected in the fetal brain’s white matter across source images, and T2* relaxation times were calculated via monoexponential signal intensity fitting at five TE values (Fig. 1). Data from 40 fetuses (mean gestational age: 25.5±4.7 weeks) meeting inclusion criteria were analyzed. Statistical analysis employed Spearman’s correlation to examine the relationship between T2* values and gestational age.

Results:

The optimized 2D single-shot multi-echo GRE EPI sequence achieved robust results, with an average scanning time of 10 seconds. Average T2* values on 1.5T and 3T scanners were 223 ms (±33) and 157 ms (±40), respectively, reflecting gestational age differences. A strong negative correlation between T2* values and gestational age was observed in the overall sample (r = -0.621) and the third-trimester group (r = -0.721), demonstrated on Fig. 2.

Conclusions:

This study developed and validated a standardized T2* mapping protocol for fetal brain imaging. Strong correlations between T2* values and gestational age underscore its potential as a biomarker for intrauterine brain maturation. Future studies will explore its sensitivity for detecting hypoxic lesions based on deviations from gestational norms.

Acknowledgments:

The study was carried out with the support of a grant from the Russian Science Foundation № 25-25-00023, https://rscf.ru/project/25-25-00023/

None declared

OPTIMOM QUALITY IMPROVEMENT INITIATIVE: ENHANCING EARLY NEONATAL `

Mrs. Josephine powell ¹ , MRS AGNES DESPI¹, MRS DAMILOLA OLAGUNI¹, MRS ARMIDA DELA CRUZ¹

¹Sidra

Objectives:

The OPTIMOM quality improvement initiative aims to increase the number of neonates receiving exclusive mothers’ own milk at hospital discharge by implementing early, evidence-based interventions. In alignment with the Baby-Friendly Hospital Initiative (BFHI) standards and the Qatar National Health Strategy, the project focuses on optimizing early skin-to-skin contact, prompt colostrum expression, and improved parental involvement.

Methods:

A multidisciplinary team implemented a series of interventions in both the delivery room and NICU settings. Key actions included:

– Initiating immediate skin-to-skin contact in the delivery room to enhance neonatal stability and stimulate breastfeeding cues.

– Encouraging midwives to facilitate colostrum expression within 2 hours post-birth, with colostrum packs provided at delivery.

– Involving parents early to promote bonding and support, thereby reducing mother-infant separation.

– Ensuring that all neonates receive their first feed (preferably the mother’s own milk) within 6 hours of birth.

– Implementing a robust documentation system: colostrum pack distribution is recorded in the OPTIMOM book at the 3C ward clerk desk; the charge nurse documents the time of colostrum receipt in the NICU and details of the first feed (type and administrator); and the primary care provider ensures continuous availability of colostrum packs.

Staff education sessions, including the use of talk cards and buccal guides, were also conducted to standardize practices and support parents throughout the process.

Results:

Preliminary audit data indicate that the implementation of these interventions has led to earlier initiation of skin-to-skin contact and colostrum expression. A significant increase was observed in the proportion of neonates receiving their first colostrum feed within 6 hours of birth. Enhanced parental involvement and systematic documentation have improved exclusive breastfeeding rates at discharge.

Conclusions:

The OPTIMOM initiative demonstrates that small, coordinated interventions—such as early skin-to-skin contact, prompt colostrum expression, and meticulous documentation—can substantially impact neonatal feeding outcomes. These results support the continued adoption and expansion of BFHI-aligned practices in the NICU to ensure that more babies benefit from the lifelong advantages of exclusive mother’s milk.

Word count: Approximately 340 words

Keywords: neonatal breastfeeding; quality improvement; colostrum expression; bfhi

NO

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Acrania– Exencephaly–Anencephaly spectrum: insights regarding a case

Dr. Bogdan Ioan Stefanescu ^1,2 , Dr. Andreea Lăcătuş², Dr. Cristina Săraru², Dr. Nadejda Stroe², Dr. Andrei A. Ionescu^1,2, Dr. Ahmad Almubideen², Dr. Tiberiu I. Mihalache^1,2

¹University Dunarea de Jos Galati, Faculty of Medicine and Pharmacy,

²Department of Obstetrics and Gynecology, “Sf. Apostol Andrei” County Emergency Clinical Hospital

Objectives: Acrania is a fetal anomaly defined by the total or partial absence of the calvaria above the orbits and supraciliary ridge. No specific mechanism has been identified for this abnormality; nevertheless, disruptions in mesenchymal migration during the fourth week of development are the most well-documented. The principal sonographic characteristics of acrania include the absence of the calvaria and a dorsally protruding brain, like a Mickey Mouse head.

Case presentation: We present a rare case of fetal acrania identified during the second trimester of gestation, highlighting the significant diagnostic hurdles and the necessity for meticulous morphological screening in the first trimester for all expectant mothers. To attain an early and precise diagnosis, it is recommended to examine not only the standard midsagittal plane utilized for the assessment of nasal bone and nuchal translucency at 11 to 13 weeks of gestation, but also to incorporate the axial and coronal planes for enhanced identification of frontal bone ossification. Drawing from our extensive experience, we advocate for the initiation of screening for fetal anomalies during the first trimester of pregnancy, starting at 12 weeks of gestation. Upon establishing the diagnosis, the preferred course of action, following thorough counseling of the parents, is the termination of pregnancy.

Conclusions: Recognizing the initial indicators of acrania may facilitate prompt diagnosis. Nonetheless, verifying the disease by a follow-up scan is crucial for delivering suitable counseling and facilitating parental decision-making, especially in instances of early diagnosis.

Keywords: acrania; fetal sonography; Mickey Mouse head; prenatal diagnosis.

None declared

First trimester screening for prediction of IUGR

Dr. elko gliozheni ¹

¹University Of Medicine Of Tirana

Abstract

First-trimester screening plays a crucial role in the early prediction of intrauterine growth restriction (IUGR), a condition associated with significant perinatal morbidity and mortality. IUGR is characterized by impaired fetal growth due to placental insufficiency, genetic factors, or maternal conditions such as hypertension and preeclampsia. Identifying pregnancies at risk early in gestation allows for timely interventions and improved perinatal outcomes.

This presentation explores the effectiveness of first-trimester screening methods for predicting IUGR, focusing on biochemical, ultrasound, and maternal risk factor assessments. Biochemical markers, including pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF), have been associated with abnormal placental function, which can contribute to fetal growth restriction. Low levels of these markers in the first trimester are linked to an increased risk of IUGR.

Ultrasound-based measurements, particularly uterine artery Doppler velocimetry, provide valuable insights into placental perfusion. Increased resistance in the uterine arteries during the first trimester correlates with inadequate placental development and a higher likelihood of IUGR later in pregnancy. Additionally, crown-rump length (CRL) discrepancies and early fetal growth assessments may serve as potential predictors of adverse fetal outcomes.

Maternal risk factors, including chronic hypertension, pregestational diabetes, and a history of IUGR in previous pregnancies, also contribute to early risk stratification. Combining these factors with biochemical and ultrasound markers enhances the predictive accuracy of screening models. The integration of machine learning and artificial intelligence into predictive algorithms is an emerging approach that may further improve risk assessment.

Despite advancements in early screening techniques, challenges remain in establishing standardized protocols for IUGR prediction. While first-trimester markers provide valuable information, their sensitivity and specificity vary, necessitating further research to refine predictive models. Future studies should focus on large-scale validation of screening algorithms and explore novel biomarkers to enhance early detection.

In conclusion, first-trimester screening presents a promising approach for the early prediction of IUGR, allowing for closer monitoring and timely interventions to optimize fetal outcomes. A multimodal screening strategy combining biochemical, ultrasound, and maternal risk factors holds the potential to improve risk stratification and management in high-risk pregnancies.

none

Effect of corticosteroid treatment on fetal heart rate short-term variability in growth restricted fetuses

Mrs. Tjaša Šikonja ¹, Mrs. Zala Sršen¹

¹Faculty Of Medicine, University Of Ljubljana

Objective: The decision regarding the necessity of delivery due to suspected fetal hypoxia is also made based on fetal assessment using computer-assisted cardiotocography (cCTG), which provides data on the short-term variability of the fetal heart rate (STV). Glucocorticoids (GCS) administered before 34 weeks of gestation can affect STV, which may lead to misinterpretation of STV, particularly in fetuses with growth restriction (FGR). The study aims to evaluate the effect of antenatal GCS on STV in FGR fetuses in comparison to aproppriate for gestational age (AGA) fetuses.

Methods: A prospective observational cohort study included 41 fetuses with a gestational age (GA) < 34 weeks who required betamethasone therapy (two doses of 14 mg administered intramuscularly 24 hours apart). Among them, 20 were AGA, and 21 had growth restriction following ISUOG Practice Guidelines (2020). cCTG recordings, providing the STV readings (the dependent variable), were taken before the first dose of betamethasone, the independent variable, and after each dose. Logistic regression assessed the relationship between STV, fetal growth, gestational age (GA), and other confounding variables. The correlation between STV and GA was analyzed using Spearman’s Rho. A two-sided p-value < 0.05 was considered significant. The study was approved by National Medical Ethics Committee of RS (No. 0120-516/2022/14).

Results: The baseline characteristics of mothers and maternal physiologic parameters during cCTG recordings in both groups did not differ significantly. FGR fetuses had, on average, a 4.3 ms lower STV than fetuses with normal growth at any GA. STV increased by 0.12 ms per day of GA in all fetuses. The increase in STV 6−12 hours after the first dose of betamethasone was significant in both groups (p < 0.001), while the increase one day after the first dose was significant only in the FGR (p = 0.018). There was no significant difference in STV between before the application and after the second dose in either group (Figure 1). The proportional relationship between STV and GA in the FGR fetuses was disrupted only by the first dose of betamethasone. In contrast, both doses dissrupted the correlation in AGA fetuses (Table 1).

Conclusions: Fetuses with FGR have lower baseline STV values, while the increase in STV with GA is the same for both groups. The initial significant increase in STV after the first dose of betamethasone lasts longer in FGR compared to AGA fetuses. The subsequent decrease in STV does not differ significantly from baseline values in both groups. However, the disrupted proportional correlation between STV and GA present in FGR fetuses only after the first dose of betamethasone raises doubt about the effectiveness of the second dose, highlighting the need for further research in this area. A better understanding of the impact of GCS on STV could improve clinical assessment of fetal status, thereby helping to avoid incorrect decisions regarding planned preterm delivery.

Figure 1: Short-term variability (STV) of a fetal heartbeat before and after two doses of Betamethasone 24 hours apart in growth restricted (FGR) (blue line) and appropriate-for-gestational age (AGA) fetuses (red line) adjusted for gestational age. S TV showed a significant increase in both groups 6-12 hours after the first application, which remained increased in FGR fetuses after 24 hours. After 24 and until 72 hours, STV decreased to levels not significantly different from before application. Throughout the study, STV was significantly lower in FGR fetuses (between-subject effect test; p=0,031).

Physical activity during pregnancy and fetal outcomes

Prof. isabella neri ¹ , Dr Camilla Spano¹, Dr Ramona Infante¹, Dr. Sofia Ceffa¹

¹Mother-infant Dept University Of Modena

Objective: pregnant women are encouraged to adopt a healthy lifestyle which includes regular physical activity (PA) as well as a proper diet in order to reduce fetal and neonatal complications . In particular a growing evidences supported that PA plays a role to limit gestational weight gain and prevents the onset of pregnancy disorders, such as gestational diabetes, gestational hypertension and preeclampsia. On the other hand, few studies take into account the correlation between PA and perinatal outcomes. The objective of this observational study is to investigate the correlations between the amount of PA and labour and delivery variables in a population of low-risk pregnancies.

Materials and Methods: the study was performed from February and September 2024 at the Mother-Infant Department of the University Hospital of Modena and Reggio Emilia and included singleton, uneventful pregnancies at term (>37 weeks + 0 days). The women presenting any maternal and/or fetal disorder or unable to understand italian language were excluded from the study. (Local Ethical Committee approval 0021995/23). The amount of PA was quantified by the administration of the Pregnancy Physical Activity Questionnaire (PPAQ), which is a semi-quantitative validated questionnaire wich allows to investigate PA behavior (sedentary or mild, moderate, vigorous intensity activity, domestic, work, sports activity). Each answer corresponds to a score and the time spent on each activity is then multiplied by its intensity, thus obtaining a measure of average weekly energy expenditure (MET -h · week - 1) for each activity. During post-partum hospitalization,after obtaining written consent to participate in the study, women reaching the inclusion criteria were invited to fill the questionnaire.

Finally, rate of fetal malposition, duration of the first and second stage of labour, mode of delivery, rate of perineal tears and postpartum hemorrhage were collected from electronic clinical charts. Neonatal outcomes as birthweight, 5th minute Apgar score <7 and neonatal intensive care unit (NICU)admission were also considered.

Results: 190 women were enrolled, among them 179 were included for the final analysis because of 11 cases dropped out for incomplete questionnaire compilation. Women experiencing during pregnancy just domestic work without scheduled physical activity showed a higher frequency of fetal malposition and longer labor length (p<0.03). Moreover, women experiencing a mild physical activity showed higher rate of large for gestational age neonates (LGA)(p<0.01), post-partum hemorrhage (500-1000ml) (p<0.05)and episiotomy (p<0.01). No significant differences were found as far as need of labour induction, operative deliveries, caesarean section and birtweight, Apgar score at 5th minute<7, NICU admission.

Conclusions: The present study demonstrated that women experiencing during pregnancy a mild physical activity, in particular domestic and moderate activity, are more likely to present fetal malposition, longer labour lenght, post-partum hemorrhage, episiotomy and LGA neonates. In such view we confirm previous reports about the effect of PA to improve the labor and delivery outcomes. Further studies are needed to define the time and mode of phisical activity which could be adviced during pregnancy also considering the ante-partum women attitude and experiences in order to optimize the positive impact on birth.

no conflict

EFFECTS OF MATERNAL-SUNG LULLABY ON NEONATAL PAIN

An Early Gut-Brain Axis: First Meconium Microbiota and Brain MRI Volumetrics in Newborn

Dr. Enitan Ogundipe ¹

¹CWH / Imperial College London

Background:

The relationship between gut microbiota and brain health is rapidly translating from bench and animal evidence to human clinical practice. The role of gut microbiota on brain health is emerging as a significant link with an urgent call for confirmatory human studies.

Objective:

To determine relationship of infants’ first meconium microbiota to neonatal brain volumetrics measured using Brain MRI scan.

Material and Methods:

Infants of mothers enrolled in a double blinded randomised study of “fish oil” supplementation in pregnancy with first meconium samples were included. Study was approved by the East London Research Ethics Committee; (07/H0704/99) and indemnified by R&D, Chelsea & Westminster NHS Healthcare Foundation Trust. Trial Registration: ISRCTN 24068733.

First newborn meconium was analysed for microbial diversity using microbiological culture and semiquantitative genus-specific real time polymerase chain reaction. Various brain regions including total, white and grey matter and hippocampus volumetrics were quantified by Neonatal Brain MRI scan and the measurements correlated to the newborn first stool microbiota findings.

Results:

Newborn infants’ first stool microbiota was statistically significantly related to their brain volumes measured on MRI scan. Bacteroidetes species positively correlated with brain volumes (p = 0.018). By contrast, some bacteria such as Staphylococcus epidermidis correlated negatively (p = 0.017) with newborn brain MRI sub-region volumetrics.

Conclusions:

This is the first known study to show evidence of a link between human newborn babies’ total and sub-regional brain volumes measured using Brain MRI scan and their first meconium microbiota.

Key words: Meconium, stool microbiota, brain MRI volumes, coagulase staphylococcus epidermidis, gut-brain axis, Omega-3/6 fish oil

None declared

INFANTS BORN AT THE BORDER OF VIABILITY: SINGLE CENTER OUTCOMES FOR 2013–2022

Ms. Tamara Čopi², Ms. Polona Rajar ¹, Ms. Mateja Sladič¹, Mrs. Marijana Vidmar Šimič¹, Mrs. Lilijana Kornhauser Cerar¹

¹UKC Ljubljana, Ginekološka klinika, KO za perinatologijo, ²Ginekološko-porodniški oddelek, Splošna Bolnišnica Murska Sobota

Introduction

The border of viability in extremely premature infants can be clinicaly defined as the point at which the fetus has a 50% survival rate with available clinical support. In Slovenia, this is at gestational age (GA) 24 weeks. Centers using an active approach to treating infants born at the border of viability have reported comparable mortality and morbidity outcomes even for infants born between 22 and 24 weeks GA. Our aim was to review our own data for infants born between 22 and 24 weeks GA over a ten-year period at Ljubljana Maternity hospital, University Medical Centre Ljubljana, Slovenia.

Materials and Methods

We collected clinical data regarding pregnancy, birth, mortality, and morbidity for all live born infants, born at gestational age from 22 weeks 0 days to 24 weeks 6 days, for the period 2013–2022. Data were collected from the National Perinatal Information System of Slovenia and the Vermont Oxford Network (VON) database.

Results

During the period 2013–2022, 185 live-born infants were born between GA 22 0/7 and 24 6/7 weeks. At least two doses of prenatal corticosteroids were given to 44% of women who delivered after 23 weeks GA, and 0% of women who delivered earlier. A high proportion of the smallest infants were not actively treated (91% infants born at 22 weeks of GA died in delivery room). Survival rates according to GA were 4% (22 weeks), 41% (23 weeks), and 65% (24 weeks). Of the infants admitted to the neonatal intensive care unit, 25% had severe intraventricular hemorrhage (grade III or IV) or periventricular leukomalacia, 13% underwent abdominal surgery (necrotizing enterocolitis), and 18% required laser treatment for retinopathy of prematurity. Home oxygen therapy was needed by 46% of the infants who survived until discharge.

Conclusion

At our centre, we achived comparable survival and morbidity outcomes for infants born after 24 weeks GA compared to those reported in the literature. In the future, we will focus on implementing active interventions for pregnant women and infants born after 22 weeks and monitoring the long-term outcomes of all infants born at the border of viability.

None declared

Markers of oxidative stress in Hypertensive disorders of pregnancy

Prof. Mirjana Bogavac ¹ , Doc Dragan Stajić¹, Prof Đorđe Ilić¹

¹1. University of Novi Sad, Medical Faculty, Univeristy Clinical Centre of Vojvodina, Department of Obstetrics and Gyneco

Introduction: Hypertensive disorders in pregnancy are a major cause of maternal and fetal morbidity and mortality. The etiology of hypertensive disorders in pregnancy remains unknown, oxidative stress is speculated to be one of the leading pathophysiological processes of this condition.

Objective: The aim of this study is to determine the degree of oxidative stress, and to determine whether there are differences in the values of markers of oxidative stress in the first trimester of pregnancy in women with hypertensive syndrome as compared to healthy women.

Methodology: The study included a total of 80 pregnant women who were divided into a study and a control group. The study group (n = 40) comprised women with pregnancy-induced hypertension (n = 20), preeclampsia (n = 20)… The control (n = 40) consisted of healthy pregnant women. To all pregnant women in the period between.-14. weeks of gestation specific markers of oxidative stress in serum (glutathione peroxidase-GSH-Px, SOD, super oxide dismutase --1 and total phytic acid exhibited antioxidant of status TAS) were determined by enzymatic colorimetric methods.

Results: The values of SOD-1 (study group 82.46 ± 34.26, 32.28 ± control group 14:53, p = 0.001) and GSH-Px (study group 634.32 ± 124 003, the control group 522.18 ± 147.33; p = 0.0043) were significantly higher in the group with hypertensive syndrome than in the control group, while TAS values were equal in both groups (study group 1:43 ± 1:12, 1:49 control group ± 1.15, p = 0.134).

Conclusion: In conclusion, our research shows that pregnant women with hypertensive disorders of pregnancy have high levels of oxidative stress .

Higher values of antioxidant enzymes in the serum of patients with hypertensive disorders may indicate that a disturbance of oxidative balance appears in early pregnancy, before the clinical manifestation of pathological processes.

An oxidative stress marker may be used in clinical practice in the assessment of the severity of complications and as an indicator for timely delivery in women with hypertensive disorders of pregnancy.

None declared

Innovative balloon for FETO (first Russian experience)

Dr. Yury Naberezhnev ¹ , Dr. Maxim Beluga², Prof Nana Tetruashvili¹, Dr. Artem Burov¹, Dr. Natalia Mashinets¹, Dr. Egor Syrkashev¹, Prof. Kirill Kostyukov¹, Dr. Julia Podurovskaya¹, Dr. Michael Schneiderman¹

¹FSBI «National Medical Research Center For Obstetrics, Gynecology And Perinatology named After Academician V.I.Kulakov»,

²REPUBLICAN SCIENTIFIC AND PRACTICAL CENTER MOTHER AND CHILD

Congenital diaphragmatic hernia (CDH) is a severe developmental defect. The incidence rate is 1:2000-1:5000 in live births. The perinatal mortality rate reaches 75-90%.

The only effective method for treating severe pulmonary hypoplasia in CDH is FETO. Traditionally FETO involves inserting a goldballon2 (Balt) into the trachea at 28-29 weeks and removing it at 34 weeks of gestation. The main complications of this procedure are premature birth and premature rupture of membranes after repeated fetoscopic surgeries.

We developed new Fetoballoon which can be used without removal at 34 weeks. The balloon consists of two innovative components: the programmable valve and the divisible balloon catheter (short and long parts). The valve allows the balloon to be reduced in size after 4-5 weeks from installation and the fetal trachea to be restored. After the balloon is installed into the trachea, the catheter is divided into two parts. The long part is removed from the uterine cavity. The balloon remains in the trachea. The short part of the catheter protrudes freely from the fetal oral cavity (pic. 1). By pulling on the short part, the neonatologist easily removes the balloon from the trachea during the EXIT procedure.

The technical equipment for fetoscopy, fetal and maternal anesthesia, postoperative antibiotic prophylaxis, tocolysis and ultrasound navigation fully corresponds to classical FETO.

Our first experience of using Fetoballoon.

Patient D., 30 years old, without extragenital diseases, history of one spontaneous birth without complications. Congenital diaphragmatic hernia was detected at 20 weeks of pregnancy. Chromosomal microarray analysis of amniotic fluid was performed at 22 weeks - a normal male karyotype of the fetus without pathogenic microdeletions and microduplications. No abnormalities in cardiac development were detected. The degree of pulmonary hypoplasia was determined using ultrasound and MRI. Initial indicators showed a severe degree of pulmonary hypoplasia (according to ultrasound (o/e LHR-25.8%), according to MRI (o/e TFLV=32.7%), according to both examination methods, intestinal loops, stomach, spleen, and left lobe of the liver penetrated the chest.

The Fetoballoon was installed at 29 weeks without complications. The duration of the operation was 45 minutes. Monitoring of pulmonary hypoplasia after 2 and 3 weeks showed that the level of pulmonary hypoplasia corresponded to the mild level (after 2 weeks o/e LHR–76.1%; 3 weeks–o/e LHR–45.9%, o/e TFLV=55.0%). A decrease in o/e LHR after 3 weeks relative to the same indicator after 2 weeks indicated a gradual decrease in the volume of the fetal balloon and restoration of fetal tracheal patency.

At 32.5 weeks of pregnancy the detachment of the normally located placenta occurred. An emergency cesarean section was performed. The diaphragm was restored on the 5th day. Satisfactory ventilation was observed according to X-ray data in both lungs of the newborn (pic. 2). The child was discharged home on the 90th day of life.

Thus the use of the innovative Fetoballoon is a promising option for FETO for the treatment of severe forms of congenital diaphragmatic hernias without PPROM and PTB. The study of the possibilities of using Fetoballoon will be continued.

The authors have not any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within that could inappropriately influence (bias) their work.

Anterior uveitis as a cause of absent red reflex in neonates: a case report

Ms. Tajda Doupona ¹ , Asist. dr. Tina Perme¹

¹Neonatal Intensive Care Unit, Department of Perinatology, Division of Gynaecology, University Medical Centre Ljubljana

Objectives: The absence of a red reflex in a neonate is a significant finding that warrants immediate attention, as it can indicate a serious underlying condition. The red reflex is produced by the reflection of light off the retina, and its integrity relies on an unobstructed pathway through the visual axis. However, opacities or abnormalities in any of the ocular structures that lie along this path, such as the cornea, anterior chamber, lens, vitreous, or retina, can disrupt the normal reflection of light and result in an absent or abnormal red reflex. A range of conditions can cause an absent red reflex in a neonate, including anterior segment dysgenesis, congenital cataract, anterior uveitis, and retinoblastoma.

Case presentation: we present a case of a newborn girl, born at 38 weeks of gestation, via spontaneous vaginal delivery. There were no significant antenatal or perinatal risk factors, apart from gestational diabetes, which was managed with dietary modifications. The labour was uneventful and the baby was delivered with a birth weight of 2910 g. On first paediatric examination, we observed an absent red reflex from the right fundus. The newborn was later examined by a paediatric ophthalmologist, who confirmed the absent red reflex and found a pale right pupil, with inflammatory deposits of granulomatous nature present in the anterior chamber, some on the endothelium and some floating in the chamber. Fibrinous strands were attached to the anterior lens capsule, the lens itself was transparent, but the ocular fundus could not be visualised. An ultrasound of the right eye was performed, which showed a clear vitreous with a normally positioned retina, choroid, and the optic nerve head. No ultrasonically visible membranes were seen extending from the optic nerve head towards the lens. Serology for congenital infections (TORCH) was negative, making congenital infection unlikely. Based on the findings, the diagnosis of anterior uveitis was made, and treatment with neomycin/polymyxin/dexamethasone and homatropine eye drops was initiated. After three days of treatment, a mild improvement was observed on examination. However, later surgical intervention with lens removal was necessary despite ongoing treatment. At three months of age, the infant has had a contact lens installed and is developing normally. Further follow up with paediatric ophthalmologists is scheduled.

Conclusions: over the past decade, our unit has encountered 36 cases of absent red reflex in neonates mostly due to congenital cataracts, with only two newborns having been diagnosed with anterior uveitis. Prompt evaluation is crucial to determine the underlying cause of absent red reflex. Timely diagnosis and treatment of these conditions are critical for preventing long-term visual impairment.

None declared.

The Role of Repeat Fetal MRI in Prenatal Diagnostics

Dr. Alexandra Korostyshevskaya ¹ , Dr. Grigoriy Strizhakov², Dr. Aziz Khalikov³

¹ITC SB RAS, ²“Clinic Expert”, ³Clinic “Scandinavia”

The Role of Repeat Fetal MRI in Prenatal Diagnostics

Korostyshevskaya A¹, Strizhakov G², Khalikov A³

¹ITC SB RAS, Novosibirsk, Russian Federation

²“Clinic Expert,” Voronezh, Russian Federation

³Clinic “Scandinavia,” Saint Petersburg, Russian Federation

Objectives:

To evaluate the timing, nosological structure, and role of repeat MRI in diagnosing a wide range of intrauterine pathologies.

Methods:

We retrospectively analyzed data from 43 repeat fetal and placental MRI scans, selected from a total of 993 prenatal MRI studies conducted at ITC SB RAS (Novosibirsk) and Clinic “Scandinavia” (Saint Petersburg), Russia. MRI findings were compared with primary MRI results and previous ultrasound examinations performed based on clinical indications. The study assessed the frequency, timing, and nosological structure of repeat fetal MRI, the interval between examinations, and the additional contribution of repeat MRI to final prenatal diagnoses.

Results:

Repeat prenatal MRI was performed in only 1.3% of cases. The most common and effective interval between fetal MRI examinations was 5–8 weeks of gestation (WG), with an average interval of 5.25 weeks. The mean gestational age for repeat MRI was approximately 30 weeks (range: 23–38 weeks), as shown in Figure 1.

The most frequent and significant reasons for repeat MRI included additional formations in the brain and abdominal cavity, chest pathologies, and anomalies in cortical development and the cerebellum. Repeat fetal MRI significantly altered the prenatal diagnosis in 6 out of 43 cases. Additionally, it identified concomitant pathologies in 20 cases (46%) and provided insight into the progression of previously detected abnormalities in 19 cases (44%), influencing postnatal management in 46% of cases. Examples of prenatal MRI findings are presented in Figure 2.

Conclusions:

Repeat fetal MRI plays a crucial role in prenatal diagnostics, particularly in cases requiring ongoing observation and clarification of previously detected abnormalities. It enhances diagnostic accuracy in the third trimester, contributing to improved prenatal and postnatal management.

None declared

Severe constipation unmasks acute liver failure in a 37-weeks pregnant patient

Ms. Neža Pezdirc* ^1,2 , Ms. Katja Ražem³, Mr. Nadan Gregorič^2,4, Ms. Andreja Trojner Bregar^2,3

¹General Hospital Slovenj Gradec,

²Faculty of Medicine, University of Ljubljana,

³Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana,

⁴Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana

Acute liver failure (ALF) in pregnancy is an obstetric emergency characterized by severe liver injury, coagulopathy, hypoglycemia, and encephalopathy, leading to severe maternal and fetal morbidity and mortality. Gestational liver diseases include preeclampsia-associated liver impairment, HELLP syndrome and acute fatty liver of pregnancy (AFLP), which can lead to ALF.

AFLP usually manifests with non-specific symptoms (nausea, vomiting, abdominal pain, malaise). Rapid development of ALF can lead to multiple-organ failure (MOF).

We report the case of a patient who presented with severe constipation and was incidentally diagnosed with ALF, that rapidly developed into MOF. Fetal monitoring showed signs of non-reassuring fetal status, prompting a timely delivery of the newborn, preceding further deterioration of the mother’s condition.

A 30-year-old 37-weeks pregnant patient presented in her second pregnancy with a one-week history of constipation and abdominal pain. The patient had no relevant medical history, was a non-smoker and denied alcohol or drug use. First trimester tests for hepatitis B and HIV were negative. She regularly attended prenatal examinations and reported normal fetal movements. At 33 weeks’ gestation, she was hospitalized for a suspected respiratory infection and treated with antibiotics.

On admission, the patient appeared pale, was normotensive and afebrile. Vaginal examination revealed an immature cervix, and a palpable rectal ampulla filled with solid stool. Fetal biophysical profile was normal.

Laboratory findings showed marked leukocytosis with elevated serum procalcitonin, pathologic liver-function-tests and coagulopathy suggestive of severe hepatopathy (Graph 1). Preeclampsia and HELLP syndrome were excluded. Abdominal ultrasonography revealed a normal liver and hepato-biliary system and ruled out generalized ileus. The patient passed stool after an enema.

Three hours after admission, the patient became somnolent and required intensive monitoring. Continuous cardiotocography showed regular uterine activity and fetal tachycardia followed by variable decelerations, likely indicating uteroplacental insufficiency and fetal distress (Figure 1). An urgent caesarean section was performed, a healthy boy (3300 g) was delivered with an APGAR score of 6/8 and an umbilical artery pH 7.20.

Postnatally, the patient`s condition deteriorated rapidly: she became febrile, tachycardic, and hypoxemic, requiring oxygen supplementation. Empiric antibiotics were initiated. Due to MOF, she was transferred to a tertiary center where she received intensive medical care (oxygen supplementation, replacement of fibrinogen, albumin and blood products, correction of electrolytes and hypoglycemia).

A negative hemoculture, tests for acute viral hepatitis and autoimmune liver disorders ruled out possible differential diagnoses. Tests for metabolic disorders were inconclusive due to preceding dextrose treatment. An abdominal CT showed increased fatty infiltration in the liver, suggesting AFLP as the definitive diagnosis.

In the first days after delivery, the patient was stabilized with supportive treatment and laboratory values gradually improved (Graph 1). The patient was discharged 11 days postpartum in good psychophysical condition. Liver-function-tests normalized two weeks after discharge. The patient was referred to an endocrinologist for further metabolic diagnostic workup, which was not yet performed, as she did not attend the appointment.

Early recognition of ALF, timely delivery, and referral of the mother to a tertiary center were crucial in improving the prognosis for mother and fetus.

None declared.

Metabolites changes in obese women receiving Lifestyle intervention. Predicting Large for Gestational Age babies.

Professor Fabio Facchinetti ³ , Dr. Cristina Piras², Dr. Serena Lecis¹, Dr. Martina Spada², Dr. Luigi Atzori², Dr. Daniela Menichini³, Prof. Vassilios Fanos², Prof. Isabella Neri¹

¹Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Italy,

²Department of Surgical Science,

³University of Modena and Reggio Emilia

Objective: Lifestyle intervention (LI) is a clue to avoid adverse perinatal outcomes in obese women, namely abnormal fetal growth. Changes in diet are part of the mechanistic effect. However, LI efficacy is closely related to adherence. We thus evaluate maternal metabolic changes at third trimester in obese women receiving LI intervention.

Materials and Methods: A cohort of singleton, nulliparous, obese women was submitted to LI (hypocaloric, low-glycemic index diet plus 3 times/week, 30 minutes moderate physical activity) starting <12th week, in face-to-face sessions with a dietitian, and including 3 follow-up. Gestational Weight Gain (GWG), gestational Diabetes Mellitus (GDM) and neonatal size were primarily monitored.

At 36th week, 24-h urines were collected for metabolome evaluation. Analysis of the metabolomic profile was performed by using NMR and GC-MS. The discriminating metabolites were subjected to non-parametric univariate analysis (p-value<0.01 was only considered).

Eleven women with Large for Gestational Age babies (-LGA- failure group) were compared with 11 controls giving birth to normal weight babies (AGA), after matching for pre-pregnancy BMI (±1), age (±2 yrs) and ethnicity. Perinatal outcomes were prospectively collected and analyzed blindly to the laboratory data.

Results: Median pre-pregnancy BMI was similar (failure 36.6 ± 6.9 kg/m2; controls 37.1 ± 6.4 kg/m2, p=0.86) while in failure group both GWG (7.48 ± 2.6 kg) and birthweight (4120 ± 450 g) were higher than in controls (3.48 ± 3.01 Kg and 3020 ± 365 g, for GWG and birthweight, respectively, p<0.05). More GDM (8/11) and C-Section (6/11) were reported in failure than in successful (GDM 1/11 and CS 3/11) group. The OPLS-DA model validated through a permutation test (500 iterations, Q2=-0.0347) showed a distinct profile of 15 metabolites over-excreted in the failure group (Fig.1). Enrichment and Network analyses indicated the pathway impact and centrality of the involved metabolites (Oxidative stress, energy production and glucose metabolism) in women with LI failure and LGA babies.

Conclusions: A set of maternal metabolites mainly linked to Oxidative stress and Krebs’ cycle predict the birth of a LGA baby in obese women failing LI implementation. Besides possible diagnostic use as predictors, this information shed light to fetal overgrowth mechanisms and help to guide targeted dietary interventions to prevent LGA babies and their associated perinatal adverse outcomes.

none declared

Conversion of TTTS to sIUGR Type III after Fetoscopic Laser Coagulation in MCDA Twins

Prof. Anton Mikhailov** ^1,2 , Dr. Artem Romanovsky^1,3, Dr. Alexandr Kuznetsov^1,2, Dr. Anna Savel”eva¹, Dr. Alexey Kyanksep¹, Dr. Aitemir Nurlan¹, Dr. Yana Pilugina^1,3

¹Maternity Hospital 17,

²First Pavlov State Medical University of St.-Petersburg,

³St.-Petersburg State University

Objectives. Fetoscopic laser coagulation of placental anastomoses (FLC) is the method of choice for correcting twin-to-twin transfusion syndrome (TTTS). However, this intervention in the angioarchitecture of the placenta can lead to the development of other specific complications in monochorionic multiple pregnancies.

Case presentation. A 36-year-old primipara underwent FLC at 18 5/7 weeks of gestation due to the presence of stage II TTTS complicated by selective intrauterine growth restriction (sIUGR) in the second twin of type I. During FLC, coagulation of 13 vascular arteriovenous anastomoses crossing the amniotic membrane was performed, followed by amnioreduction of 800 ml. Upon revision of the vascular equator of the placenta, no superficial arterioarterial or venovenous anastomoses were visualized. At the time of FLC, the discordance between the twins was 26%. Within 5 days post-operation, normalization of amniotic fluid volume and normal hemodynamics of both fetuses were observed, with restoration of visualization of the donor twin’s bladder. During dynamic monitoring over 5 weeks after FLC, the development of selective growth restriction syndrome in the second twin of type III was noted, with episodes of intermittent blood flow in the identified superficial arterioarterial anastomosis of the placenta, which was accompanied by a gradual progression of weight discordance from 26% to 33%. At 32 1/7 weeks of gestation, the patient underwent elective cesarean section. The weight of the first twin was 1720 g, the weight of the second twin was 1230 g, with a discordance of 29.5%, and Apgar scores of 7/8 for both newborns. The first newborn exhibited progressive polycythemia within the first 24 hours, while the second’s hematological parameters were within normal limits. Given the polycythemia, hemodilution was performed on the first twin. Upon examination of the placenta, marginal attachment of the second twin’s umbilical cord was confirmed. Separate color dye injection of the placental vessels revealed a small-diameter arterioarterial anastomosis (less than 2 mm) between the hemodynamic systems of both twins, which apparently determined the development of sIUGR type III in the second twin with a characteristic Doppler pattern, expressed in periodic episodes of absent and reverse end diastolic blood flow and intermittent blood flow in this anastomosis.

Conclusions. This clinical case demonstrates the potential change in the role of residual superficial arteriovenous anastomoses, which can play both a protective role against the development of TTTS and become a cause of manifestations of type III selective growth restriction syndrome after coagulation of arteriovenous anastomoses. Thus, even after successful FLC and resolution of TTTS, patients remain at high risk for the development of other specific complications of monochorionic multiple pregnancies and require careful dynamic monitoring.

None declared

Assessing Influences on Elective and Non-Elective Cesarean Sections: Utilizing Multinomial Regression and Robson’s Classification in a Southeastern European Context

Dr. Arjan Shtylla ¹ , Assoc. Professor Daniela Teferici¹, Dr. Redi Hoxhallari¹

¹Faculty Of Medicine Tirana

Abstract

Background: This study conducted in Albania, a middle-income, Southeastern European country experiencing an increase in cesarean section rates, aims to thoroughly examine cesarean practices through the Robson classification, identifying patterns and providing vital insights into elective and non-elective cesarean trends.

Methods: This retrospective cohort study was conducted at the University Hospital of Obstetrics and Gynecology “Koco Gliozheni” in Albania, a leading tertiary hospital, from January to May 2023, involving 5315 consecutive women who delivered during this period, including both live births and stillbirths, with a gestational age minimum of 28 weeks to align with standards of viability. We defined a function to systematically evaluate each case based on multiple criteria: parity, fetal presentation, onset of labor, previous deliveries, number of fetuses, and gestational age according to Robson Classification. Multinomial multiple regression was used to estimate the relationship between each above-mentioned variables and the likelihood of each type of cesarean delivery compared to normal births.

Results: The participants’ mean age was 28.2 years (59.6% < 30 years vs. 40.4% ≥ 30 years), while gestational age varied (12.1% before 37 weeks, the majority (72.3%) between 37 and 40 weeks, and 15.6% > 40 weeks). In elective cesarean sections, maternal age (OR = 1.06) and gestational age (OR = 1.13) are associated with increased odds, with previous cesarean delivery women showing significantly higher odds (OR = 20.6), breech position (OR=15.7), and multiple pregnancies elevating odds (OR = 7.3), whereas in non-elective cesarean sections, similar associations are observed with slightly different odds ratios: maternal age (OR = 1.07), gestational age (OR = 1.16), previous cesarean delivery (OR = 6.3), breech position (OR=8.5) and multiple pregnancies (OR = 5.1). Significant disparities in cesarean section rates are observed across various groups, with rates ranging from as low as 0.74% in Group 1 to as high as 89.24% in Group 5, and notable contributions from Group 2 with a rate of 69.95% and Group 6 with a rate of 81.29%.

Conclusion: In conclusion, this study emphasizes the significance of factors such as maternal age, gestational age, previous cesarean deliveries, fetal presentation, number of fetuses and multiple pregnancies in impacting the rates of elective, non-elective, and overall cesarean sections in Albania, highlighting the need for targeted strategies to improve maternal and fetal health outcomes.

None declared

Reducing endocrine-disrupting chemical exposure in pregnant and lactating women: The HYPIEND perinatal randomized controlled trial

Mr. cedric moulin ¹ , Ms. L. M.¹, Dr. A B.¹, Dr. C. F.², Dr. I. V.³, Dr. M. O.³, Dr. A. B.⁴, Dr. M. C.⁴, Dr. R. D.¹

¹KU Leuven,

²University of Granada (UGR),

³Germans Trias i Pujol Research Institute (IGTP),

⁴Centre for Postgraduate Medical Education (CMKP)

Increasing evidence suggests that exposure to mixtures of endocrine-disrupting chemicals (EDCs) during the perinatal period may adversely affect maternal and infant health. Found in nutrition, cosmetics, and the environment, EDCs can disrupt the endocrine system governed by the hypothalamus-pituitary (HP) axis. This is especially concerning during critical developmental stages like the perinatal period, as data suggest high EDC exposure can harm infant growth and neurodevelopment, and may contribute to the rise of obesity and diabetes. To date, few intervention studies have assessed whether reducing perinatal EDC exposure can mitigate these harmful effects, and they have entailed considerable limitations. The HYPIEND trial aims to assess whether a multicomponent lifestyle-based intervention can effectively reduce perinatal EDC exposure and mitigate adverse endocrine-related outcomes. In addition, the study seeks to identify links between EDC exposure, HP-axis regulation, and epigenetic modifications.

The study will evaluate a perinatal intervention in a tri-centric, two-arm Randomized Controlled Trial. The experimental group will receive a multicomponent intervention during pregnancy and up to 18 months postpartum, including a digital tool promoting lifestyle habits to reduce EDC exposure, telephone monitoring, and environmental health education workshops. The control group will receive a digital booklet on EDC reduction and a single online module featuring questionnaires, without professional feedback.

We will perform a multicomponent perinatal intervention based on the Health Action Process Approach (HAPA) for behavioural change to evaluate its effectiveness in reducing EDC exposure and mitigating adverse HP-related effects. Biological samples will be analysed at multiple time points to assess correlations between EDC concentrations, HP-related hormones, cytokines, DNA methylation, and gene expression in blood and gut microbiota, providing insights into the mechanisms by which EDCs impact health.

This study has the potential to reveal how EDC co-exposure impacts HP axis function and epigenetic programming, and to develop strategies minimizing exposure and neuroendocrine consequences during perinatal stages.

None declared

Management of unexplained fetal supraventricular tachyarrhythmia with fetal hydrops: a case report

Dr. Sandra Benzon^1,2, Dr. Jasminka Rešić ^1,2, Dr. Marko Mimica^1,2, Dr. Zoran Meštrović¹, Dr. Zdeslav Benzon¹

¹Department of Obstetric and Gynecology, University Hospital Split and University of Split, School of Medicine,

²University department of health studies, University of Split

Objectives

This case report presents multidisciplinary management of fetal tachyarrhythmia with fetal ascites, prenatal evaluation and intervention with maternal transplacental treatment at University Hospital in Coastal region of Croatia with positive outcomes of the mother and the infant.

Case presentation

The patient was previously healthy pregnant 29-year-old woman (gravida 1, para 1) admitted at our hospital at 32nd week of gestation with fetal arrhythmia and hydrops manifested as abdominal ascites and pleural effusion detected during an outpatient visit. The patient had no signs of early pregnancy complications. No significant abnormalities, no complaints of dizzines or palpitation were observed during pregnancy. The obstetric ultrasound Doppler M mode imaging confirmed supraventricular tachyarrhythmia with hydrops. Fetal echocardiogram revealed no obvious abnormalities of the fetal heart. Maternal routine blood and urine analyses were normal just as serum electrolyte levels. We immediately started transplacental administration of antiarrhhytmic drugs digoxin and flecainid. We prescribed oral metildigoxin loading dose for rapid loading of 1 to 2 mg, which had been given in three doses: 0,5 mg; 0,3 mg; 0,2 mg over 24 hours. Our target level was 1 to 2 ng/ml, closer to 2. Flecainid was prescribed 3x100 mg during 24 hours. We monitored daily maternal electrocardiographic changes and other potential symptoms looking for low grade toxicity. Two days after administration of antiarrhythic agens fetal heart rate slowly started to falling down and hydrops was started to withdrow. Maternal echocardiography and electrolyte serum level were normal. After five days there was no sign of fetal hydrops and fetal heart rate was around 190/min. After seven days the fetal heart rate and movements were normal. We then lowered the dose of digoxin to 0,2 mg; 0,2 mg; 0,1 mg and we reduced flecainid to 2x100mg. The fetal heart rate remained normal. After one week patient continued to take digoxin at dosage of 0,2mg; 0,2 mg; 0,1 mg with correction of the dose depending on the concentration in the blood. Flecainide was discontinued. We then controled levels of metildigoxin once a week together with maternal echocardiography and electrolyte serum level. Fetal ultrasound was performed weekly and showed normal heart rate and rhythm. Eutrophic female baby was delivered at 39+4 weeks of gestation spontaneusly, 3220 g , 51 cm. Apgar score 10. Transthoracic echocardiogram was performed and showed normal cardiac function and absence of structural heart defects. Electrocardiogram showed no signs of arrhythmya during next seven days, so the baby had been discharged with mandatory cardiological control after one month.

Conclusion

In conclusion, fetal arrhythmias have to be diagnosed in time and treated using right antiarrhythmic drugs. It is necessary to perform randomized controlled trials to establish the safest and most effective treatment for fetal tachyarrhythmia. Delayed treatment in such cases might result in permanent damage or fetal demise. If there is no significant improvement in the fetal heart rate after conservative treatment, preparation for pregnancy termination should be done. Awarenes and knowledge of proper managment of fetal tacchyarrhythmias should be kept in mind so prematurity could be avoided.

None declared

Impact of HbA1c status and BMI on prevalence of urinary infections in gestational diabetes mellitus

Dr. Andrea Dagelić ¹, Dr. Stipe Dumančić¹, Dr. Bianka Mimica¹, Dr. Andrija Stanišić¹, Assistant Professor Jasminka Rešić Karara¹

¹University Hospital Centre Split

Objectives: to determine whether HbA1c (hemoglobin A1c) status and BMI (body mass index) of pregnant women with gestational diabetes mellitus (GDM) affect the higher incidence of urinary infections.

Methods: Data were collected from medical history of pregnant women who were hospitalized due to the diagnosis of GDM and gave birth in The University Hospital Centre Split in the time period from January 1st of 2022. till December 31st of 2024. Recorded data were type of diabetes, age, height, weight before pregnancy and weight at birth, weight gain during pregnancy, BMI and BMI status, HbA1c (%) status, microbiological findings of urine culture of pregnant women, weeks of gestation at birth, method of termination of pregnancy and therapy. Depending on the data distribution in this cohort study following statistics test were used: chi-squared test or Fisher’s exact test, Kolmogorov-Smirnov test and Mann-Whitney U test. For logistic regression receiver operating characteristic (ROC) curve was used.

Results: This research examined 541 pregnant women diagnosed with GDM, categorizing them into two groups: those with a negative urine culture (NUC, n=358) and those with a positive urine culture (PUC, n=183). The analysis focused on differences in anthropometric data, metabolic indicators, and pregnancy outcomes. Glycemic control varied slightly between the groups, with the PUC group having a marginally higher average HbA1c level (5.35% vs. 5.27%) that reached statistical significance (p = 0.017). The use of antidiabetic medications, including metformin and insulin, did not significantly differ between the groups. Pre-pregnancy weight and BMI were notably higher in the PUC group (p = 0.014 and p = 0.031, respectively). The incidence of overweight and obesity was greater among those with positive urine cultures. Women in PUC group were slightly older, with an average age of 33.3 years compared to 32.3 years of women in the NUC group (p = 0.024). The first positive urine culture was typically detected around gestational week 30. No significant variations were observed in preterm birth (PTB) rates (6.6% in PUC vs. 6.4% in NUC), or the average gestational weeks of PTB nor term births. A receiver operating characteristic (ROC) curve was generated to evaluate the ability of HbA1c levels to predict the occurrence of positive urine cultures (PUC) in pregnant women with GDM. The area under the curve (AUC) was 0.562 and a 95% confidence interval (CI) ranging from 0.511 to 0.614. The AUC value, while statistically significant (p = 0.0178), suggests a modest discriminatory ability of HbA1c levels in distinguishing between those with and without PUC.

Conclusions: The findings suggest that higher pre-pregnancy weight, BMI, and elevated HbA1c levels may be linked to an increased likelihood of positive urine cultures in pregnant women with GDM. Despite these metabolic disparities, pregnancy outcomes and delivery modes remained comparable between the two groups in regard to the onset of urine tract infections (UTI). The modest AUC value suggests that HbA1c alone may not be a highly reliable predictor of PUC but could still contribute to risk assessment when combined with other clinical factors.

Forties are the new thirties

Dr. Ivana Paljk Likar ^1,2 , Dr Andreja Trojner Bregar^1,2

¹Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center,

²Division for gynecology and obstetrics, Faculty of Medicine, University of Ljubljana

Objectives: Advanced maternal age, which traditionally refers to pregnant women who are 35 years or older at the time of delivery, is associated with an increased risk of maternal and perinatal complications. This is a growing trend in high-income countries. Older mothers have a higher risk of perinatal complications, such as placental abruption, placenta previa, fetal malpresentation, low birth weight, preterm or post-term delivery, and postpartum hemorrhage. These risks differ from those associated with multiple gestations. Conditions such as higher body weight, obesity, hypertension, and diabetes occur more frequently with increasing age and increase the likelihood of pre-eclampsia and gestational diabetes. In addition, older mothers independently have a higher risk of prenatal and intrapartum stillbirths. We aimed to determine, whether there is a significant difference in adverse perinatal outcomes among pregnant women of advanced maternal age over the past decade.

Methods: We analyzed singleton births in women over 30 years of age from 2013 to 2022 using the Slovenian National Perinatal Information System (NPIS) a population-based dataset to compare perinatal outcomes in three maternal age groups: 30–34.9, 35–39.9, and women over 40 years of age. Perinatal outcomes were compared with a reference group of women aged 30-34 years. Maternal characteristics, such as pregravid body mass index (BMI), parity, mode of conception, gestational diabetes mellitus, and hypertensive disorders (chronic hypertension, gestational hypertension, and preeclampsia), were evaluated. In addition, birth characteristics such as the cesarean section rate, the rate of operative vaginal deliveries, and preterm births were analyzed. We also compared neonatal outcomes. Cases with chromosomal abnormalities, severe congenital anomalies, and abortions due to fetal anomalies were excluded from the analysis. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS software) to calculate the odds ratio (OR) and 95% confidence interval (CI) between frequencies.

Results: During the ten-year study period from 2013 to 2022, there were 106,309 singleton births among women aged 30 years. This included 31,785 births (29.9%) in the age group 35 to 39.9 years, 6,438 births (6.1%) in the age group over 40 years, and 68,086 births (64%) in our reference group (30 to 34.9 years). We found that BMI increases with age, with older women more likely to be obese and less likely to be underweight than younger women (Table 1). Older mothers were also more likely to have cesarean births, and early and late preterm births, compared to the reference group. Perinatal mortality also increased with maternal age (Table 2).

Conclusions: The older the mother, the higher was the likelihood that the pregnancy was complicated by GDM, hypertensive disorders, cesarean section, preterm delivery and asmission to the NICU. In our population, perinatal mortality was higher and tended to worsen with age. Compared with our previous study on the same age groups and the results from 2003 to 2012 the number of pregnancies at advanced maternal age increased significantly. All women should be encouraged to consider motherhood at a younger age.

None declared

Gestational diabetes and fetal macrosomia: A dissenting opinion

Dr. Renata Košir Pogačnik ^1,2, Maja Krajec³, Marija Batkoska¹, Dr. Andreja Trojner Bregar^1,2

¹UMC Ljubljana,

²Faculty of Medicine, University of Ljubljana,

³Institute of Oncology

Abstract

Objective.

To examine the effect of interaction between parity, overweight/obesity, gestational weight gain, and gestational diabetes mellitus (GDM) on the incidence of fetal macrosomia.

Methods.

We used a population-based dataset to establish the incidence of macrosomia (birth weight >4000 g) in singleton births at ≥38 weeks’ gestation. The cohort included women who were overweight/obese or had normal body mass index (BMI) before pregnancy, nulliparous or multiparous, with appropriate or excessive weight gain, and without GDM, with GDM controlled by non-pharmacological treatment (GDM0), or with GDM requiring insulin treatment (GDM1).

Results.

We examined 129 686 births at ≥38 weeks. The mean gestational age at birth for all subgroup was similar. When compared with a reference incidence for nulliparas with a normal pregravid BMI, appropriate weight gain, and without GDM, all variables, except GDM, independently and significantly increase the incidence of neonates weighing >4000 g. The logistic regression analysis found that excessive weight gain, pregravid BMI >25, and parity were the only independent factors associate with birth weight >4000 g.

Conclusions.

Well-managed GDM is not significantly associated with macrosomia, whereas pre-pregnancy obesity, excessive gestational weight gain, and parity appear to be significant risk factors. These results emphasize the need for effective weight management before and during pregnancy to reduce the risk of fetal overgrowth.

None declared

Table 1. Incidence of neonates > 4000 g by parity, weight gain, pregravid BMI, and GDM status in Slovenia (2016 – 2023).

Data are shown as N (%); statistics are shown as OR (95% CI) as compared to the reference incidence.

Figure 4: Adjusted impact of pre-pregnancy BMI on macrosomia in multiparous women, controlling for age

Withdrawal syndrome in newborn: When the intrauterine exposure is hidden

Dr. Manel Charfi ¹ , Dr. Chiraz Regaiëg¹, Dr. Nadia Kolsi¹, Dr. Amina Abdennadher¹, Dr. Dhouha Kammoun¹, Dr. Nihed Bouzidi¹, Dr. Ridha Regaïeg¹, Dr Amel Ben Hamad¹, Dr. Afef Ben Thabet¹, Dr. Amira Bouraoui¹, Dr. Nedia Hamida¹

¹Department of neonatology, Hedi Chaker University Hospital

Keywords:

withdrawal syndrome, newborn, irritability, seizures, selective serotonin reuptake inhibitors (SSRI)

Objectives:

To insist on the importance of searching intrauterine exposure to toxics or drugs in front of neurological signs in newborn, even if the exposure is initially not mentioned or denied.

Case presentation :

We report the case of a female newborn admitted in our neonatal intensive care unit for management of prematurity and respiratory distress. The mother was a 32-year-old primipara with a history of type 1 diabetes that require insulin therapy. The pregnancy was well monitored. An emergency c-section was performed at 33 weeks of gestation as the mother showed signs of severe preeclampsia. At birth, the newborn had good neonatal adaptation and mild respiratory distress that required oxygen therapy during 36 hours. By H40 of life, the newborn showed neurological signs including irritability, flexion spasms and facial clonic jerks. Metabolic disorders as well as central nervous system infection were rapidly excluded by laboratory investigations. Cranial ultrasound was normal. Electroencephalogram (EEG) showed a periodic and paroxysmal EEG patterns. Given the nonresponse to phenobarbital administration, the clinical features and the EEG patterns, pyridoxine dependent epilepsy was suspected. However, the seizures did not stop after pyridoxine administration. A withdrawal syndrome was then strongly suspected. After asking the mother several times about eventual intrauterine exposure to toxics or drugs, she finally confessed that she was taking fluoxetine during all pregnancy. Spontaneous resolution of the symptoms was obtained by day 5 of life. The girl is currently 5 years old and her physical exam is normal

Conclusion:

Intrauterine exposure to selective serotonin reuptake inhibitor, especially in third trimester may lead to withdrawal syndrome in newborn. The most common reported signs were irritability, tremors and constant crying. Seizures has been rarely reported. Most often, the resolution of symptoms is spontaneous in few days like in our case. Withdrawal syndrome should be always kept on mind in front of every neurological signs in newborn. The intake of neurotropic treatment is often hidden in our society. That is why physician should not hesitate to ask several times about intrauterine exposure to toxics or drugs especially when symptoms remains unexplained.

No conflict of interest to declare

Fetal arrhythmia: a challenging case

Dr. Manel Charfi ¹ , Dr. Amira Bouraoui¹, Dr. Chiraz Regaïeg¹, Dr. Dhouha Kammoun¹, Dr. Amina Abdennadher¹, Dr. Nihed Bouzidi¹, Dr. Ridha Regaïeg¹, Dr. Amel Ben Hamad¹, Dr. Afef Ben Thabet¹, Dr. Nadia Kolsi¹, Dr. Nedia Hamida¹

¹Hedi Chaker University Hospital

Keywords:

fetal, atrial flutter, management, prognosis

Objective:

To illustrate the difficulties of management of fetal atrial flutter when it is complicated with hydrops fetalis.

Case presentation:

We report the case of a male newborn admitted in our neonatal intensive care unit for hydrops that complicated a fetal atrial flutter. His mother was a 24 years old primipara. Pregnancy was well monitored and complicated with gestational diabetes that required insulin therapy. Fetal ultrsound performed at 29 weeks of gestation reveled signs of hydrops fetalis associated to fetal tachycardia with a heart rate of 200 beats per minute. Fetal echocardiography concluded to fetal atrial flutter that leaded to heart failure and hydrops. An intrauterine treatment using digoxin was then started but it was ineffective. Regarding signs of fetal distress, a c-section was performed at 31 weeks of gestation. At birth, the newborn had poor neonatal adaptation, severe skin edema with a birth weight of 2700 gram, a heart rate of 210 beats per minute and severe respiratory distress. Mechanical ventilation was then immediately started in association to intravenous administration of furosemide. Postnatal electrocardiogram confirmed the diagnosis of atrial flutter. Echocardiography showed severe biventricular dysfunction and significant persistant pulmonary hypertension. Conversion to sinus rhythm was obtained by H6 of life after amiodarone administration and external electric conversion. Despite of optimal mechanical ventilation, inhaled nitric oxide and vasoactive drugs administration and iterative ascites puncture the newborn died at day four of life.

Conclusion:

Fetal atrial flutter is a rare condition. Most often, it is benign. It may be reduced by intrauterine treatment. The occurrence of hydrops is a poor prognosis factor as it reflects heart failure and makes the intra-uterine treatment less effective. Furthermore, it often leads to preterm delivery, which will further increase morbidity and mortality. In our case, the heart failure was severe and refractory despite the conversion to sinus rhythm leading then to death.

No conflit of interest to declare

Management and outcome of fetal pleural effusion

Dr. Manel Charfi ¹ , Dr. Amira Bouraoui¹, Dr. Chiraz Regaïeg¹, Dr. Amina Abdennadher¹, Dr. Dhouha Kammoun¹, Dr. Nihed Bouzidi¹, Dr. Ridha Regaïeg¹, Dr. Amel Ben Hamad¹, Dr. Afef Ben Thabet¹, Dr. Nadia Kolsi¹, Dr. Nedia Hentati¹

¹Hedi Chaker University Hospital

Key words:

fetal, pleural effusion, congenital chylothorax, mangement

Objective:

To remind how to manage fetal pleural effusion and to illustrate the difficulties of postnatal management when it is associated to pulmonary hypoplasia.

Case report:

We report the case of a female newborn admitted in our neonatal intensive care unit for management of fetal pleural effusion. The mother was 34 years old. Her blood group was O positive. The pregnancy was well monitored. Fetal ultrasound performed at 25 weeks of gestation, showed a moderate right fetal pleural effusion. Ultrasound monitoring revealed a progressive increase of the pleural effusion, becoming severe and compressive. Thoraco-amniotic shunts was proposed, but the parents refused. Fetal MRI performed at 32 weeks of gestation, showed a severe right pleural effusion associated to pulmonary hypoplasia. Fetal echocardiography was normal as well as fetal karyotype. Screening for congenital infections was negative. The girl was born by vaginal delivery at 40 weeks of gestation. At birth, she had immediate and severe respiratory distress that required immediate mechanical ventilation. Chest X-ray and lung ultrasound showed severe and compressive pleural effusion. A pleural drainage was then performed bringing initially 165ml of lemon yellow fluid. The fluid analysis concluded to congenital chylothorax. Mechanical ventilation was necessary till day 11 of life. It was associated to Inhaled nitric oxide and Sildenafil administration as the echocardiography showed severe persistent pulmonary hypertension. Medium chain triglyceride formula feed was started by day 9 of life. The lung ultrasound performed at day 11 of life concluded to a full resolution of the pleural effusion. The chest tube was then removed. Oxygen weaning was achieved by day 17 of life. Chest CT scan angiography performed by day 20 of life was normal. The newborn was discharged by the age of one month. She is now 3 months old. She is breastfed. She had a normal physical exam and her chest x ray is normal.

Conclusion:

Fetal pleural effusion is a rare condition that can be life threatening with serious perinatal morbidity and mortality. Once diagnosed, detailed ultrasound evaluation and further investigations should be started to establish etiology and guide fetal therapy including: thoracocentesis, pleuroamniotic shunting and pleurodesis. Delivery should occur in a tertiary care center as neonatal intensive cares are needed. After discharge, a long-term follow up is necessary for respiratory and neurodevelopmental outcomes.

no conflit of interst to declare

Difficulties of management of fetal nephromegaly

Dr. Manel Charfi ¹ , Dr. Nadia Kolsi¹, Dr. Amira Bouraoui¹, Dr. Nihed Bouzidi¹, Dr. Amina Abdennadher¹, Dr. Dhouha Kammoun¹, Dr. Ridha Regaïeg¹, Dr. Amel Ben Hamad¹, Dr. Afef Ben Thabet¹, Dr. Chiraz Regaïeg¹, Dr. Nedia Hamida¹

¹Hedi Chaker University Hospital of Sfax

Keywords:

fetal, nephromegly, management, prognosis

Objective:

To illustrate the difficulties of management of fetal nephromegaly

Case presentation:

We report the case of a female newborn admitted in our neonatal intensive care unit for management of fetal nephromegly and severe respiratory distress. Her mother was 28 years old primipara. The pregnancy was well monitored. The fetal ultrasound performed at 32 weeks of gestation revealed a severe oligohydramnios and bilateral nephromegaly with massive enlargement of the kidneys, diffuse hyperechogenicity of both cortex and medulla, and loss of corticomedullary differentiation. Delivery was programmed at 36 week of gestation by elective c-section. At birth, the newborn had immediate and severe respiratory distress requiring immediate mechanical ventilation. Chest X-ray showed hypoplasic lungs. Postnatal ultrasound exam showed a massive enlargement of the kidneys that contain numerous small cysts. Autosomal recessive polycystic kidney disease was then suspected. Despite optimal mechanical ventilation the newborn died of sever hypoxemia by H28 of life. Histological exam of kidney confirmed the diagnosis of autosomal recessive polycystic kidney disease. Sample for genetic analysis was performed before death. Result is in progress. Genetic counseling is proposed to parents.

Conclusion:

Fetal nephromegaly is a rare condition. It is usually due to polycystic kidney disease especially autosomal recessive ones. Prenatal confirmation diagnosis is difficult unless using molecular genetic diagnostic tests. Prognosis is rather poor with high neonatal mortality rate especially when associated to severe oligohydramnios. Death is then rather due to respiratory failure than to renal dysfunction like in our case. Molecular genetic diagnostic tests should be discussed with parent in future planned pregnancy as there is a risk of recurrence. Ending pregnancy is considered if there are poor prognosis factors.

No conflict of interst to declare

Takotsubo syndrome after caesarean section: a case report and literature review

Dr. Kenana Ljuca ¹ , Prof Miha Lučovnik^1,3, Dr Marta Cvijić^2,3, Dr Jana Ambrožič²

¹Department of Gynaecology and Obstetrics, University Medical Centre Ljubljana,

²Department of Cardiology, University Medical Centre Ljubljana,

³Faculty of Medicine, University of Ljubljana

Takotsubo syndrome after caesarean section: a case report and literature review

Kenana Ljuca1*, Miha Lučovnik1,3, Marta Cvijić2,3, Jana Ambrožič2

Affiliations

1 Department of Gynaecology and Obstetrics, University Medical Centre, Ljubljana, Slovenia

2 Department of Cardiology, University Medical Centre Ljubljana, Slovenia

3 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.

Corresponding author:

Kenana Ljuca

keanana.ljuca.medf@gmail.com

Department of Gynaecology and Obstetrics, University Medical Centre Ljubljana

Šlajmerjeva ulica 3, 1000 Ljubljana, Slovenia

Objectives

Takotsubo syndrome (TTS) is considered to be rare in premenopausal women and presents as a transient non-ischemic acute heart failure with relatively fast spontaneous recovery of myocardial function. It is characterized by apical ballooning or dysfunction of the midventricular segments of the left ventricle, commonly triggered by acute emotional stress and therefore also known as “broken-heart syndrome” and stress induced cardiomyopathy”.

Case presentation

In this article, we present a case of 26-year-old female patient pregnant with dichorionic - diamniotic twins, who developed TTS peripartum following emergency caesarean section due to premature membrane rupture at 33 gestational weeks. On the first postoperative day she suddenly developed dyspnea with desaturation to 80 % oxygen on pulse oximetry. She became hypotensive and tachycardic. An electrocardiogram revealed inversion of T-wave in aVL and ST-segment changes in V4-V6 leads. An assay of cardiac enzymes and laboratory tests revealed elevated. In order to exclude acute myocardial infarction and pulmonary thromboembolism, CT angiography of the lungs and coronary arteries were performed. Transthoracic echocardiography revealed akinesia of the mid-segments of the left ventricle and moderately reduced ejection fraction. After the introduction of cardioprotective therapy with bisoprolol 1.25 mg ECG normalized. She was normotensive, normocardic and oxygen saturation on pulse oximetry was within the normal range.

The echocardiogram on the eleventh postpartum/postoperative day revealed Post-Stress Cardiomyopathy Status, partial spontaneous regression of segmental contraction disorders and improvement of left ventricular ejection fraction. On the day of discharge, the patient was eupnoic with normal oxygen saturation without supplemental oxygen. She was normotensive and normocardic. The uterus was appropriately contracted, lochia normal, and the wound was healing normally. She was breastfeeding. She was prescribed bisoprolol 1.25 mg once daily until follow-up heart ultrasound 6 months after the discharge.

Conclusions

In a state that suggests cardiac emergency, TTS should be considered among other differential diagnosis, such as: myocardial infarction, acute myocarditis, pulmonary embolism and peripartal cardiomyopathy. It is very important to differentiate TTS from peripartal cardiomyopathy, because of the differences in management and prognosis. The clinical awareness and holistic approach to differential diagnosis are crucial for management of acute heart failure after caesarean section.

Keywords: Takotsubo syndrome; stress-induced cardiomyopathy; caesarean section; preterm delivery;

None declared

Outcomes of singleton pregnancies among obese women: two-year retrospective cohort study in Croatian tertiary center

Dr. Matea Jukic ¹ , Dr. Baumgartner Tihana¹, Dr. Stipe Dumancic¹, Prof. Jasminka Resic Karara^1,2

¹Department of obstetrics and gynecology, University Hospital Center Split,

²University Department of Health Studies, University of Split

Objectives: The prevalence of obesity varies globally and is projected to increase continually [1]. Maternal obesity is linked to adverse perinatal and obstetrical outcomes, including hypertensive and metabolic disorders, macrosomia or prematurity, and Cesarean section (CS) delivery [2,3]. This study aimed to evaluate differences in outcomes among singleton pregnancies based on maternal pre-pregnancy obesity classification.

Methods: The University Hospital Center (UHC) Split (Croatia) carried out a two-year retrospective study from January 2023 to the end of 2024, tracking a cohort of all obese pregnant women, classified into three groups based on pre-pregnancy body mass index (BMI): Obesity Class 1 (30-34.99 kg/m2), Obesity Class 2 (35-39.99 kg/m2), and Obesity Class 3 (>40 kg/m2). Clinical and obstetric characteristics, including maternal age, parity, height, pre-pregnancy weight and BMI, gestational diabetes mellitus (GDM), hypertensive disorders (arterial hypertension – HA/preeclampsia – PE), prior CS delivery, gestational age at labor, preterm birth (PTB) rate, mode of delivery, neonatal birth weight classification (hypotrophic, eutrophic, hypertrophic), and puerperal complications, were analyzed while being obtained from patients’ electronic health records. Continuous variables were presented as median (interquartile range, 25th–75th percentile), and categorical variables as frequency and percentage. Statistical analyses were performed using Kruskal-Wallis ANOVA and the chi-square (χ²) test, with a significance threshold of p<0.05, using GraphPad Prism Software version 10.4.1 (Boston, MA, USA). The study was approved by the Ethics Committee of UHC Split (protocol class no. 520-03/25-01/32, Feb 12th 2025).

Results: This study included 448 pregnant women, classified into Obesity Class 1 (n=327), Obesity Class 2 (n=91), and Obesity Class 3 (n=30) (Table 1). Despite non-significant differences in maternal age and parity, primigravidas were more common in Obesity Class 1 and Class 2 than Class 3 (p=0.040). Pre-pregnancy weight and BMI were significantly higher with obesity severity (p<0.001). Obesity Class 3 had the highest prevalence of prior CS, though this difference did not reach statistical significance. Hypertensive disorders were significantly more prevalent in Class 2 and Class 3 compared to Class 1 (p=0.001). The GDM rate was highest in Obesity Class 2 without statistical significance. The mean gestational age at labor was significantly lower in Obesity Class 3 (p=0.047), with PTB being frequent in Class 3 without statistical significance. Mode of delivery was similar across groups. Vaginal delivery rates ranged from 50–52.7% (p=0.938), while CS rates were between 47.3–50% (p=0.962). Vacuum-assisted delivery was observed only in Obesity Class 1 (1.8%). Neonatal birth weight showed no significant differences across groups, while most neonates were eutrophic (71.4–80.4%) and more hypertrophic in Class 2. Puerperal complications were most common in Class 3 without statistical significance.

Conclusions: Severe obesity was associated with a higher prevalence of hypertensive disorders, and a non-significant trend toward frequent preterm birth and puerperal complications, underscoring the enhanced monitoring in this population. Despite variations of maternal risk factors, delivery modes were comparable among obesity groups. This study highlights the importance of individualized pregnancy management to mitigate complications related to maternal obesity, emphasizing the role of interventions in preconception counseling.

None declared.

Table 1 Perinatal and obstetrics outcomes in obese women classified into Obesity classes.

Neonatal pancytopenia: do not forget the intrauterine drug exposure

Dr. Manel Charfi ¹ , Dr. Chiraz Regaiëg¹, Dr. Nadia Kolsi¹, Dr. Dhouha Kammoun¹, Dr. Amina Abdennadher¹, Dr. Nihed Bouzidi¹, Dr. Ridha Regaïeg¹, Dr. Amel Ben Hamad¹, Dr. Afef Ben Thabet¹, Dr. Amira Bouraoui¹, Dr. Nedia Hamida¹

¹Hedi Chaker University Hospital of Sfax

Keywords:

neonatal pancytopenia, management, intrauterine drug exposure

Objectives:

To remind the management of neonatal pancytopenia which is a rare condition and to remind physician to always verify the intrauterine exposure to drugs or toxics even when it is initially not mentioned or hidden.

Case presentation:

We report the case of a full-term and eutrophic male newborn who was admitted in our neonatal intensive care unit for petechiae. The mother was a 39 years old primipara with a medical history of breast cancer treated with chemotherapy and hormone therapy one year before pregnancy. The pregnancy was well monitored. Delivery was by elective c-section at 39 weeks of gestation with good neonatal adaptation. At birth, the newborn presented with petechiae on the face and trunk without any other clinical signs. Complete Blood Count (CBC) showed pancytopenia with white blood cells count of 4100 cells/ml, platelets count of 12000 cells/ml and a hemoglobin level at 9.5 gr/dl. The newborn received in emergency a transfusion of platelet and a course of antibiotics that was stopped after 3 days as infectious investigation was negative. The mother’s CBC was normal. The cranial ultrasound was normal as well as abdominal ultrasound. The direct coombs test, the platelet coombs test and the screening for congenital infections (Parvovirus B19, CMV, EBV and rubella) were negative. The bone marrow puncture performed on day 9 of life showed a rich bone marrow but with many lysed cells. Spontaneous normalization of the CBC was observed by day 14 of life. When asking mother about intrauterine exposure to toxics or drugs she declared that she took levocetirizine during pregnancy for pruritus. This drug intake was not mentioned in her medical file. The infant is now 4 years old. His physical exam is normal as well as his CBC.

Conclusion:

Neonatal pancytopenia is a rare condition. Once diagnosed immediate symptomatic treatment should be started. It aims to prevent severe complication especially the risk of hemorrhage and neonatal infection. Well- guided investigations should also be started to determine the underlying cause for specific treatment. In our case, the pancytopenia was transient due to an intrauterine exposure to levocetirizine.

No conflict of interest to declare

CONTEMPORARY METHOD FOR MANAGING OF POSTPARTUM HEMORRHAGE

Prof Anton Mikhailov ^1,2,3 , Dr. Alexandr Kuznetsov^1,2, Anna Loseva⁴

¹Meternity Clinic 17,

²Pavlov University,

³The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott,

⁴North-Western State Medical University named after I.I. Mechnikov

Objectives

Postpartum hemorrhage (PPH) remains one of the leading causes of maternal mortality worldwide, contributing to 34% of estimated global maternal deaths annually. FIGO has identified the reduction of PPH as a principal goal, using all available and cost-effective approaches. Uterotonic and hemostatic drugs is the first line therapy could be helpful, but limited in severe cases of PPH. Second-line treatment options are effective but highly more invasive or irreversible methods, such as blood transfusion, intrauterine balloon tamponade, compression sutures, arterial ligation, and hysterectomy. Lately, chitosan z-tape (CZT) has been introduced in obstetrics as a successful treatment for PPH.

Material and methods

The mechanism of action for CZT is a multi-step process critical to its hemostatic effectiveness. Chitosan was derived from the shells of ocean crustaceans or mushrooms and affects the body through a physiological process related to electrical charges on red blood cells, which is independent of the coagulation system. Originally developed for military trauma applications. We included 63 women who delivered in Maternal Clinic 17 and experienced PPH. Blood loss was measured using gravimetric and volumetric methods. Women who experienced PPH despite receiving standard uterotonic medications were considered candidates for off-label CZT use.

Results

Chitosan nanofiber-coated z-tape (GEMOFLEX) was used in 63 patients. There were 32 women delivered vaginal – group I and 31 by cesarean section – group II. In all cases, CZT was the only and final method of persistent hemostasis. The average blood loss before CZT application was 659 ml in group I and 487 ml in group II. CZT was removed within 6 to 24 hours after installation. The total blood loss was 1124 ml and 1232 ml respectively. The initial average hemoglobin level in group I was 118 and 124 g/l in group II. The medium hemoglobin drop over 3 days was 20 and 10,4 g/l correspondingly.

Conclusion

CHT is promising strong and efficient first and second-line approach for achieving complete hemostasis in cases of PPH. There were no cases that required surgical hemostasis methods. There were no major adverse events or specific treatment morbidity were associated with CZT. Moreover, the relatively lower price compose it an attractive option not alone for lower-income countries.

None declared

Treatment of damaged and painful nipples with PolyMem breast pads in comparison with dexpanthenol during breastfeeding

Ms. Andreja Cerkvenik Škafar ¹

¹Hospital For Gynaecology And Obstetrics, Kranj, Slovenia

Breastfeeding has benefits both for the baby and the mother, as well as for society and the environment. Damaged and painful nipples are among the most common reasons for cessation of breastfeeding. However, the treatment of nipple trauma is not uniform.

It is crucial to create the optimal environment for rapid healing and to provide a more effective and safe approach to treating this common and pressing problem of breastfeeding mothers all around the world.

The aim of this study was to compare two treatment methods: PolyMem breast pads and dexpanthenol and find optimal treatment. After obtaining approval from the national Medical Ethics Committee, the following research outline was prepared. This trial included postpartum mothers with signs and symptoms of damaged nipples at the Hospital for Gynaecology and Obstetrics Kranj and was conducted with the highest ethical standards.

The research protocol included monitoring pain and local status (nipple trauma) after the application of the PolyMem breast pads. This was then followed by monitoring after 6, 12, 24 and 48 hours and involved a follow-up as needed. The control group of postpartum mothers were informed that they would be treated with dexpanthenol, as was the practice prior to the study. The monitoring of pain and local status were set at the same time intervals as the sample group.

In the conducted clinical trial, we were the first to find that PolyMem breast pads were statistically more effective at healing damaged nipples (cracks, redness) and relieving pain during breastfeeding compared to dexpanthenol in the first 24 hours after application. By commencing the use of PolyMem breast pads in the first few days after birth 76% of infants (before 56%) born in our maternity hospital were breastfed exclusively at three months of age.

We concluded that PolyMem breast pads, based on polymem dressing technology – a combination of cleansing, moisturising and super absorption – are a new effective therapy due to their composition. The breast pads’ rapid pain relief and effectiveness at treating damaged nipples allowed mothers to continue breastfeeding their infants.

None declared

Table 1

A comparison of effectiveness in nipple pain relief of polymem and dexpanthenol

AoP AND ΔAoP VALUE IN PROLONGED SECOND STAGE OF LABOR

professor Anton Mikhailov, mister Andrei Chernov, missis Vera Shman, mister Aleksei Maksimenko, missis Assel Yeskarayeva

¹Maternity Clinic 17, ²D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology, Saint Petersburg, Russia, ³Khoja Akhmet Yassawi International Kazakh-Turkish University

Introduction: Accurate diagnosis of labor progress is crucial for making well-informed decisions regarding timely and appropriate interventions to improve outcomes for both the mother and the fetus. Over the past few years, performing an intrapartum ultrasound (IPU) before OVD (operative vaginal delivery) has been proposed. However, there is no clear ultrasound parameters of normal and protracted second stage of labor have been summarized yet.

Purpose: The aim of this study was to identify ultrasound parameters of protracted descent fetal head in second stage of labor.

Materials and methods: The study prospectively included 248 patients in the second stage of labor. Of these, 68 patients (27%), the labor failed to progress in the second stage, leading to the use of oxytocin augmentation. In this group, 9 patients (13%) experienced ineffective augmentation of labor and were delivered by cesarean section (CS). 59 patients (78%) had a VD, and in 15 of them (22%), the second stage was assisted by vacuum extraction. The comparison group include of 180 (73%) patients with an uncomplicated second stage dilatation. The IPU was performed on all patients every subsequent hour after the complete cervical dilatation. The AoP and ΔAoP were also determined.

Results: With a AoP value of ≤110° in the second period, all births were complicated by the development of protracted descent fetal head and the need for prolonged of oxytocin augmentation. In case of protracted second stage the average hourly increase in the AoP value was 5.6⁰ (0-10⁰), if its values did not increase against the background of oxytocin augmentation, all births ended with either abdominal or OVD. The average ΔAoP value at the time of diagnosis of slow of labor was 7⁰ (0-10) ⁰. The values obtained during the diagnosis of slow of labor significantly differed from those in uncomplicated births (p <0.01). The study showed that in the second stage of labor, the limits of ultrasound criteria for arrest of labor are: AoP values ≤ 110°, AoP increase ≤ 10°/hour, ∆AoP ≤ 10°. The diagnosis of slow labor or lack of progress can be established when two or more criteria are identified based on the results of their hourly determination. When the UP and ∆ AoP values are in the intermediate zone, namely, when their values are greater than those established for arrest of labor, but smaller than their values in an uncomplicated second stage of labor, the dynamics of the indicators were assessed after 2 hours, in cases of persistence of abnormal parameters oxytocin augmentation was started.

Conclusions: Dynamic ultrasound examination made it possible to obtain objective criteria for slow labor or lack of progress in the second stage of labor, which may eliminate unnecessary interventions - oxytocin augmentation and operative delivery, minimize the number of vaginal examinations during labor and reduce the risk of septic complications in the mother and fetus, improve perinatal outcomes and patient satisfaction during labor.

None declared

AoP and ΔAoP value for assessment of fetal head descent in second stage of labor

Diabetes Mellitus as a Possible Risk Factor for Intrauterine Fetal Death

Špela Kozinc** ¹ , MD, PhD Maja Dolanc Merc¹, Assist. Professor, MD, PhD Renata Košir Pogačnik*¹

¹University Medical Centre Ljubljana, Division of Gyneacology and Obstetrics, Clinical Department of Perinatology

Keywords: Intrauterine Fetal Death; Gestational Diabetes Mellitus; Pregestational Diabetes Mellitus

Objectives:

To analyse and characterise fetal intrauterine death (MFIU) cases of unknown cause, that could be associated with pregestational or gestational diabetes mellitus (GDM) in Clinical Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana.

Methods:

A retrospective analisys of fetal intrauterine death cases between january 2016 and december 2023 at University Clinical Centre Ljubljana, Clinical Department of Perinatology was performed. We reviewed 87 cases of intrauterine fetal deaths of unknown cause. We included cases with full medical documentation, where gestational diabetes mellitus or diabetes mellitus (DM) type I was diagnosed. Because of relativelly small number of cases a very detailed statistical analysis was not possible, but a thorough review of every case was performed. We analysed patients BMI, age at MFIU, weeks of gestation at MFIU, parity, HbA1c value and fetal weight.

Results:

After the review of medical documentation we included 79 cases with unknown cause of MFIU. 18 patients had diabetes in pregnancy, 14 of them had GDM and 4 had diabetes mellitus type I. There were none with type II diabetes mellitus. The mean age of patients without diabetes at MFIU was 30,5 years. Patients with GDM were younger (29 years) while ones with pregestational diabetes mellitus type I were older (32,8 years). MFIU occured at earliest weeks of gestation in women without diabetes (27 weeks) in comparison to those with GDM (31 weeks) and pregestational diabetes (32 weeks). Consequently fetal weight was the lowest amongst women without diabetes (1490g). The highest rate of primiparous women at MFIU was in the GDM group (64%). The GDM group also had the highest BMI (27,9 kg/m²). Glycated haemoglobin (HbA1c) was highest in the pregestational diabetes (type I) group (7,6%).

Conclusion:

In our centre the incidence of MFIU in patients with diabetes mellitus is lower comparing to data avalibale in literature because of good prenatal management of gestational and pregestational diabetes mellitus. Coexisting risk factors for MFIU in women with GDM are higher BMI and primiparity. In avalibale data from all Slovenian perinatology departments collected from PERIS (Perinatal Informational System of Slovenia) between years 2016 and 2022 the incidence of MFIU in women with pregestational diabetes mellitus type I was significantly higher 13/1000 in comparison to women without DM (3/1000). The incidence of MFIU in women with GDM was lower (2/1000). We can explain this with the fact, that prenatal management of GDM in Slovenia is performed thoroughly. In avaliable literature DM is considered a possible risk factor for MFIU, we did not show that in Clinical Department of Perinatology UMC Ljubljana. We still have to take into consideration possible unknown underlying causes and coexisting risk factors, such as unknown genetic conditions. This is why we can not confirm that DM is the cause of MFIU, but is considered a risk factor.

Ethycal approval:

The study was approved by the National Medical Ethics Committee of the Republic of Slovenia (consent number 0120-637/2016/9).

None declared.

Prevention of postpartum depression new algorithm in limited resources during full-scale invasion in Ukraine

Prof. Volodymyr Artyomenko* ^1,2 , Dr Daria Lahoda¹, Dr Mykola Shapoval¹, RN Ganna Velichko³

¹Odessa National Medical University, ²Odesa City Maternity Hospital № 5, ³ODESSA REGIONAL MEDICAL CENTER FOR MENTAL HEALTH, ODESA REGIONAL COUNCIL

Postpartum depression (PPD) is a most common psychological disorder that can occur a few days after childbirth, usually lasting from 2-3 days/weeks and even up to 1-2 years affecting 6,5% to 60% of postpartum women globally. It is well known that war and all changes in life related to hostilities are a significant factor that affects the mental state of a person. Women throughout the evolution have become pregnant and gave birth to children not depending on the presence or absence of hostilities. . In order to identify possible anxiety-depression disorders, post-traumatic stress disorder (PTSD) and PPD further prevention, we have developed and introduced our own management algorithm consisting of screening online survey and subsequent personalized interventions.

Ethics Commission in Conducting Experimental and Clinical Research Communal Non-profit Enterprise “Maternity Hospital № 5” Odesa City Council approved the study. All methods were performed according to the Declaration of Helsinki. All study participants signed a general consent form for using their clinical data for scientific purposes. 1120 pregnant women from the Odesa City Maternity hospital № 5 during 2023-2024 performed that screening tool answering questions, including age, body weight, skin color, eye color, quality and duration of sleep, living conditions, nutrition, social and economic components and other synthesis of standardized questionnaires for mental health condition.

After the online survey, women were offered on request a course of psychological interventions by personalized approach:

1. Psychoeducation (training and information)

2. Psycho -emotional support (Individual consultations with a psychologist to identify risk groups; relaxation techniques: breathing, meditation, art therapy).

3. Social support (partners’ program, husband or relatives).

4. Physical recovery (Light gymnastics, Nutrition recommendations).

Women were divided into a main group that conducted our interventions and control group that receive standart support.

It was found that 415 women during pregnancy had signs of anxiety-depressive disorders (37.05 %), post-traumatic stress disorder had 121 patients (10.80 %).

681 pregnant women were included in the intervention group, while 56 women decided not to participate. There were 321 pregnant women in the control group, and 56 refused to participate. Eleven participants from the intervention group and 8 from the control group were unable to join through a busy work schedule. In addition, 13 pregnant women from the intervention group and 17 from the control group were abandoned due to pregnancy discomfort.

We found that the intervention group had a lower level of postpartum depression, 13% versus 21% in the control group (P<0.05). It is important to note that the maternity hospital staff informed us about the fact that the algorithm of PPD screening and subsequent management was easily introduced into the maternity hospital routine work, even in limited resources such as war and full-scale invasion.

1120 pregnant women screening showed that 37.05% had signs of anxiety-depressive disorders, and 10.80%-PTSD.

In the intervention group, the level of postpartum depression was 13% versus 21% in the control group (p≤0.05).

The screening and support algorithm was effective and easily implemented even in war conditions.

postpartum depression; hostilities; pregnancy personalized care; prevention

None declared

Maternal and perinatal outcomes in confirmed HIV positive pregnant women

Asoc Prof Enkeleda Prifti ^1,2 , Dr. Lorela Hysi¹, Dr. Enxhi Vrapi²

¹University Hospital Of Obstetrics And Gynecology “Koço Gliozheni”,

²University of Medicine

Objective: The aim of this study was to investigate the impact of HIV on maternal and fetal wellbeing.

Methods: This is a retrospective cohort of 14 HIV positive women in Albania, diagnosed from 2008 till 2020. Women were enrolled in a specialized HIV care center, while receiving individualized prenatal care. Data such as age, parity, HIV diagnose in regard to pregnancy, gestational age at delivery, mode of delivery and birth weight were investigated. Statistical analyses were done by means of chi-square test, to test possible associations between variables.

Results: Among the 14 HIV positive women, 6 (42.8%) were diagnosed during antenatal testing. Half of the women (3 patients) were diagnosed during the first trimester. 2 women (33.3%) acknowledged their HIV status during the second trimester and 1 patient (16.7%) was diagnosed only before delivery. Delivery was mainly done by means of an elective cesarean section, as indicated by our national guideline, in 10 cases (71.4%) Signs of fetal compromise guided the performance of an emergency section in 2 patients (14.3%). Vaginal delivery, among 2 women (14.3%), was only done in the failure to perform a cesarean section in the face of advanced labor. Only 2 patients (14.3%) in our cohort delivered prematurely. All women were receiving adequate therapy by the moment of delivery. Nor prematurity or the fetal compromise were linked to longer exposure to anti-retroviral (p=0.2). No neonatal HIV infections were registered.

Conclusions: Adverse obstetric outcomes were found to be more prevalent among HIV positive women. Receiving HIV therapy did increase neither the risk of premature births nor the other neonatal related complications

no

Identifing the risk factors and the outcomes of Placenta Accreta Spectrum (PAS): data from a University Hospital setting in Tirana, Albania

Asoc Prof Enkeleda Prifti ^1,2 , Dr. Lorela Hysi¹, Dr. Enxhi Vrapi²

¹University Hospital Of Obstetrics And Gynecology “Koço Gliozheni”,

²University of Medicine

Objective: This study aims to investigate the independent risk factors and outcomes of Placenta Accreta Spectrum.

Methods: This is a retrospective cohort of all cases admitted with the diagnosis of PAS during a five year period (2019 - 2024) in a tertiary referral center. Only cases that subsequently delivered at our institution were included. To produce results, the cases were compared to a control group, comprised of women who delivered during the study period, and for whom the diagnoses of abnormal placentation was excluded. The control group was selected by randomly picking 1 in 3 patients. Univariate analysis were performed to predict possible risk factors and a multivariate logistic regression model was designed to predict the relation between Placenta Previa, prior Cesarean Sections and In-vitro Fertilization as independent risk factors for PAS.

Results: A total of 7330 deliveries were included in this analysis, of which 147 presented with a history of abnormal placentation. 1209 (16.5%) patients presented with a history of prior cesarean section and 126 (1.7%) women had in vitro fertilization pregnancies. Placenta Previa (p<0.0001), prior c-sections (p=0.009) and IVF (p=0.007) were found to serve as independent risk factors for developing placenta accreta spectrum.

Conclusion: There was a statistically significant association between a history of cesarean sections and occurrence of abnormal placentation. This relationship was dependent on the number of prior CS. In vitro fertilization was identified as an independent risk factor.

No

Maternal and perinatal outcomes of pregnat patients with Coronavirus Disease-19: data from a University Hospital setting in Tirana, Albania

Asoc Prof Enkeleda Prifti ^1,2 , Dr. Lorela Hysi¹, Dr. Enxhi Vrapi²

¹University Hospital Of Obstetrics And Gynecology “Koço Gliozheni”,

²University of Medicine

Objective: The aim of this study is to determine the maternal and perinatal outcome in pregnant women with confirmed Covid-19, based on clinical presentation of the disease, in our triage-setting.

Methods: We conducted a prospective observational cohort study of 177 pregnant and puerperal women confirmed as having COVID-19. Women were categorized as either having mild/moderate and severe COVID-19 and the two groups were further compared to determine predisposing factors for adverse maternal and neonatal outcomes. Significance is set as p < 0.05.

Results: 46 women (26%) presented with severe disease and 131 (74%) women had mild disease. Overall, 14 (7.9%) patients were admitted to an intensive care unit, of which, 6 (3.4%) required mechanical ventilation. The need for ICU was statistically correlated (OR 11.31, CI 1.2 - 104, p=0.03) to women who manifested severe COVID-19 at presentation, with 13 (92.9%) patients belonging to this group. Five (2.8%) maternal deaths were recorded, all among women infected during the third trimester (mean 34.8 gestational weeks). Severe disease at presentation increased the odds of maternal death 12 fold (OR 12, CI 1.3 - 110.3, p=0.02). Infection above 24 weeks gestation (OR 1.87, CI 0.7 - 4.6, p=0.17) or 32 weeks gestation (OR 1.16, CI 0.57 - 2.3, p=0.66) were not statistically linked to severe disease, or adverse maternal outcomes, such as need of intensive care (OR 4.17, CI 0.5 - 33.03, p=0.17). No significant changes were observed among the severe and mild disease groups regarding maternal BMI >30kg/m2 (p=0.49), age (p=0.57) or presence of comorbidity (p=0.13). Delivery by means of emergency cesarean section was significantly higher for the women with severe disease (OR 8.0, CI 3.42 - 18.67, p<0.001) Iatrogenic prematurity was also increased in women with severe disease (32 weeks +/- 4.5 vs 36 weeks +/- 6.8, p<0.001). This translated with a significant change in the weight of babies delivered (mean 2792 +/- 780 gr vs 3169 +/- 653 gr, p=0.003) and increased need for neonatal intensive care (p=0.048). Perinatal mortality was calculated to be 2.06 % (3/144 live births), linked in all three cases to prematurity. Only 2 (1.38%) babies delivered to COVID-19 positive mothers had a positive swab for coronavirus disease.

Conclusion: In pregnant women with confirmed COVID-19, severe presentation of disease resulted in adverse maternal and perinatal outcome, while mild cases had a favorable course during pregnancy.

None declared

Vaccination During Pregnancy: Protection for Mother and Child

Dr. Fatilba Skoku ¹ , Ass.Prof Enkeleda Prifti, Dr Enida Avdolli, EM.Prof Emilio Piccione

¹Nostra Signora Del Buon Consiglio

Vaccination During Pregnancy: “Protection for Mother and Child”.

Dr.Fatilba Skoku

Dr.Enida Avdolli

Ass. Prof. Enkeleda Prifti

EM.Prof. Emilio Piccione

Gynecological Obstetric University Hospital Koco Gliozheni

Our Lady of Good Counsel University

Presents: Fatilba SKOKU

ABSTRACT

Introduction

Vaccination during pregnancy is essential to protect both the mother and the fetus, ensuring indirect protection through the passage of antibodies from the mother to the child, particularly in the first months of life, when the newborn’s immune system is still developing. In response to the growing debate and the globally recognized importance of vaccinations during pregnancy, we conducted a study on the current situation of vaccinations during pregnancy in Albania.

Objective

The objective of the study was to investigate: the factors that led to a lack of vaccination of pregnant women; information on vaccinations during pregnancy; the role of health professionals.

Methods

The study was conducted in Tirana, at the “Mother Theresa” University Hospital Center, the “Queen Geraldine” Maternity Hospital and the “Our Lady of Good Counsel “ University Tirana , between July 2018 and September 2019, on a sample of 560 individuals. The data were collected through three anonymous and voluntary questionnaires: one for 400 women of childbearing or gestational age, one for 80 Gynecologists-Obstetricians and one for 80 Pediatricians. The results were processed in a modular format and presented in a pie chart.

Discussion/Results

Vaccination during pregnancy raises concerns among women of childbearing age. 51.3% say that the doctor does not discuss the topic, and 53.8% are undecided, mainly due to fear of complications (36.2%). Many rely on doctors, midwives and nurses (76.4%), but 79.1% do not get vaccinated, fearing a link with autism. Gynecologists-Obstetricians (88.6%) and Pediatricians (97%) recommend the flu vaccine, but prefer natural immunity (47.2% of Gynecologists, 54.8% of Pediatricians). Both believe it is essential to provide scientific data to encourage vaccinations.

Conclusion:

50% of Albanian women are uninformed about vaccinations during pregnancy. Most rely on the opinions of doctors, but do not get vaccinated. In Albania, many medical specialists prefer natural immunity to vaccinations during pregnancy. It is necessary to develop an information campaign that clarifies the safety and effectiveness of vaccinations. The role of Gynecologists-Obstetricians and other health professionals is essential in this process.

Abstract Title:

“Vaccination During Pregnancy: Protection for Mother and Child – A Study in Albania”

Abstract: This study examines the awareness and attitudes toward vaccination during pregnancy in Albania. Conducted between 2018 and 2019 with 560 participants, including 400 women, 80 Gynecologists-Obstetricians, and 80 Pediatricians, the research reveals that 50% of women are uninformed about pregnancy-related vaccines. While most women rely on healthcare providers for guidance, many are hesitant to vaccinate due to safety concerns and misinformation, particularly fears about autism. The study highlights the need for an information campaign to educate the public and the critical role of healthcare professionals in promoting safe vaccination practices for both mother and child.

None declared

Perinatal outcomes of maternal physical activity.

Dr. Lorela Hysi ¹ , Asoc Prof Enkeleda Prifti^1,2, Dr. Enxhi Vrapi², Dr. Redi Hoxhallari^1,2

¹University Hospital Of Obstetrics And Gynecology “Koço Gliozheni”,

²University of Medicine

Objective:This study aims to identify the association between maternal physical activity before or during early pregnancy and the risk for adverse pregnancy outcomes. This research seeks to provide evidence on how pre-pregnancy and early pregnancy exercise may influence the likelihood of conditions such as gestational diabetes mellitus (GDM) and preterm delivery (PTD).

Methods:This study was designed as a prospective cohort study conducted at the University Hospital of Obstetrics and Gynecology “Koço Gliozheni.” Pregnant patients who consented to participate completed self-administered questionnaires regarding their physical activity levels before and during early pregnancy. The study aimed to differentiate between those who engaged in any form of physical activity and those who did not. Perinatal outcomes were then compared between these two groups to determine if there was a statistically significant association between physical activity and adverse pregnancy outcomes. A multivariable logistic regression model was used to analyze the association between engaging in physical activity and pregnancy outcomes, while adjusting for potential confounding factors. These included body mass index (BMI), maternal age, and socioeconomic status. The inclusion of these variables ensured a more accurate assessment of the relationship between maternal physical activity and pregnancy complications.

Results:A total of 188 pregnant women met the eligibility criteria for this study. Of these, 67.7% (n=127) reported being physically active either before or during early pregnancy. The findings revealed a significant association between physical activity and a lower risk of developing gestational diabetes mellitus (GDM) and preterm delivery (PTD). Specifically, the incidence of GDM was notably lower among women who engaged in physical activity compared to those who did not (15.4% vs. 2.0%, p=0.022). Similarly, the likelihood of experiencing PTD was reduced in the physically active group (10.2% vs. 4.4%, p=0.038).

Further statistical analysis using adjusted odds ratios (OR) confirmed these findings. Engaging in physical activity during early pregnancy was significantly associated with a decreased risk of developing GDM (adjusted OR = 0.098, 95% CI: 0.017 – 0.56). However, the same association was not observed for PTD, as the adjusted OR for PTD was 0.872 (95% CI: 0.36 – 2.11), suggesting that additional factors may influence the risk of preterm birth beyond physical activity alone.

Conclusions:This study provides compelling evidence that engaging in physical activity before and during the first trimester of pregnancy is associated with a decreased risk of developing adverse pregnancy outcomes, particularly GDM. While the findings on preterm delivery were inconclusive, the overall benefits of maternal physical activity suggest that it should be encouraged as a preventive measure. Promoting safe and appropriate physical activity guidelines for pregnant women could contribute to improved maternal and fetal health outcomes.

None declared

Association of birthweight discordance in dichorionic twins with preeclampsia

Ms. Sara Čebron¹, Ms. Anja Rupar ¹

¹Faculty Of Medicine, University Of Ljubljana

Objectives

Preeclampsia is one of the leading causes of maternal and perinatal mortality, complicating 2–8% of pregnancies. It accounts for up to 26% of maternal deaths in developing countries, whereas in developed countries, the proportion is up to 16%. The risk is known to be higher in multiple pregnancies, especially in dichorionic twins. A characteristic feature of twins is that they do not always grow the same way, reflected in a twin’s birthweight discordance. Insufficient placental function in the smaller twin could be a cause of weight discordance, as well as a factor contributing to the development of preeclampsia in the mother. However, the extent of discordance that significantly increases the risk of pregnancy complications has not been uniformly defined in research, with current thresholds primarily established through the Delphi consensus method. Our study aimed to determine whether birthweight discordance in dichorionic twins is associated with the development of preeclampsia, irrespective of other risk factors, and to identify the discordance threshold that best predicts the onset of preeclampsia. This knowledge could improve prenatal care of pregnant women with ultrasound-detected differences in fetal size.

Methods

We conducted a retrospective population-based cohort study of 2,546 women with dichorionic twins who gave birth in Slovenia from 2013 to 2022. Aggregated data were obtained from the National Perinatal Information System. The association between twin birthweight discordance, the main independent variable, and preeclampsia, the main outcome variable, was determined using multivariate logistic regression adjusted for a variety of covariates that reached p-value <0,1 in univariate logistic regression. We calculated the crude odds ratio (OR) and adjusted OR (aOR) with a 95% confidence interval. ROC analysis was used to calculate the area under the curve (AUC) and the sensitivity and false positive predictive value for predicting preeclampsia with birthweight discordance. Two-sided p-values < 0.05 were considered statistically significant.

Results

We analyzed data from 2,546 women with dichorionic twins. The incidence of preeclampsia was 5.38%. Compared with a birthweight discordance of <10%, a discordance >25% was identified as a statistically significant independent risk factor for the development of preeclampsia (aOR = 1.66; 1.10–2.52; p = 0.016) (table 1). Birthweight discordance between 10% and 25% was not significantly associated with preeclampsia. The AUC for predicting preeclampsia with birthweight discordance was significant at 55.2% (51.6–58.8%). However, used as a single risk factor, at a birthweight discordance threshold of >25%, only 10.2% of pregnant women with preeclampsia could be identified with 5.8% false-positive results (figure 1).

Conclusions

Our study revealed that a birthweight discordance between dichorionic twins >25% significantly adds to an increased risk of preeclampsia. Therefore, understanding the risk of developing preeclampsia in discordant dichorionic twin pregnancy can help in prenatal monitoring, diagnostics and intervention. Combined with other risk factors, this can significantly impact the incidence of preeclampsia-related complications and lead to a better perinatal outcome.

Figure 1: ROC curve of birthweight discordance for prediction of preeclampsia in dichorionic twin pregnancy. The area under the curve is 55,2 % (51,6 %–58,8 %) (p = 0,004). At the threshold of 24,5 % discordance, sensitivity is 12,4 % at a 6,8 % false positive rate. At the threshold of 25,5 % discordance, sensitivity is 10,2 % at a 5,8 % false positive rate.

Management and outcome of prenatally diagnosed cervical meningocele

Dr. Manel Charfi ¹ , Dr. Nadia Kolsi¹, Dr. Amira Bouraoui¹, Dr. Nihed Bouzidi¹, Dr. Amina Abdennadher¹, Dr. Dhouha Kammoun¹, Dr. Ridha Regaïeg¹, Dr. Amel Ben Hamad¹, Dr. Afef Ben Thabet¹, Dr. Chiraz Regaïeg¹, Dr. Nedia Hamida¹

¹Hedi Chaker University Hospital of Sfax

Keywords:

cervical meningocele, prenatal diagnosis, management, outcome

Objective:

To remind management and outcome of cervical meningocele which is a rare condition and to insist on the importance of prophylaxis of neural tube defects by periconceptional folic acid supplementation.

Case presentation:

We report the case of a male newborn from consanguineous parents. His mother was 29 years old and obese. This was her third pregnancy. Her second pregnancy was medically terminated due to the diagnosis of spina bifida in the fetus. The mother did not take preconceptional folic acid supplementation in current pregnancy. The pregnancy was well monitored and complicated by gestational diabetes. Fetal ultrasound at 15 weeks of gestation revealed a 14 mm cystic mass located posteriorly at the occipitocervical junction. Fetal MRI concluded to posterior cervical myelomeningocele measuring 18 mm in long axis associated with complete agenesis of the corpus callosum and ventriculomegaly. The mother decided to continue the pregnancy. Ultrasound monitoring has been ensured every month. Delivery was by elective C-section at 37 weeks of gestation with good neonatal adaptation. Physical exam showed posterior cervical swelling measuring 5*4 cm covered by thin skin without fistulization. Cerebrospinal MRI performed on day 15 of life showed cervical myelomeningocele associated to a type III Chiari malformation, partial agenesis of the corpus callosum and triventricular hydrocephalus. He had two surgical stages. At 2 months, he had a ventriculoperitoneal shunt due to a rapid increase of head circumference. At 2 years, he had a surgical repair of his myelomeningocele with simple postoperative course. He had a long term follow up and cares. Physiotherapy and occupational therapy were started since the age of 5 months as he showed a delay in motor acquisitions. He is now 7 years old. He walk almost normally despite deformation of the lower limbs in genu-valgum external rotation with flat valgus feet. He has a mild partial deficit of the left upper limb. His intellect is normal compared to his age. He attend school normally with good results.

Conclusion:

Cervical myelomeningocele is a very rare condition. It differs from other distal dysgraphia by its pathogenesis and its better neurological prognosis. Therapeutic progress, in particular prenatal repair under fetoscopy, has further improved the prognosis. However, the best treatment remains preventive, especially since it is based on simple hygiene and dietary measures. We therefore insist on the importance of supplementing women with folic acid during periconception, especially if there are risk factors or a history of an affected child as in our case.

No conlict of interest to declare

Hypertrophic Cardiomyopathy in Neonates of Diabetic Mothers: From Prenatal Diagnosis to Clinical Outcomes

Dr. Nadia Kolsi¹, Dr. chiraz Regaieg¹, Dr. Manel Charfi ¹, Dr. Amina Abdennadher¹, Dr. Amel Ben Hamad¹, Dr. Dhouha Kammoun¹, Dr. Afef Ben Thabet¹, Dr. Amira Bouraoui¹, Pr. nedia hentati¹

¹Departement of neonatology Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia

Objectives : Hypertrophic cardiomyopathy (HCM) is a well-documented complication in neonates of diabetic mothers. Early prenatal detection during routine fetal echocardiographic follow-up for maternal diabetes can optimize perinatal management. This study aims to analyze cases of prenatally diagnosed HCM confirmed postnatally and to determine prognostic factors.

Methods : We conducted a retrospective descriptive study including all neonates diagnosed with HCM during fetal echocardiographic screening for maternal diabetes and confirmed postnatally. We analyzed maternal diabetes type, fetal and neonatal echocardiographic findings, clinical outcomes, and the need for treatment.

Results : Among 50 cases of neonatal HCM, 38 cases (76%) were diagnosed prenatally during routine fetal echocardiography for maternal diabetes follow-up. Postnatal echocardiography confirmed the diagnosis in all cases, revealing asymmetric septal hypertrophy in 78%, global hypertrophy in 22%, and obstructive forms in 34%. Maternal diabetes type distribution was as follows: 18% with type 1 diabetes, 22% with type 2 diabetes (associated with the most severe forms), and 60% with gestational diabetes. Prenatal and neonatal complications included hydramnios (41%), macrosomia (86%), and respiratory distress (88%). Tachycardia was observed in 23% of neonates. Cardiac auscultation revealed a systolic murmur in 54% and a gallop rhythm in 9%. Half of the neonates (50%) required propranolol treatment, with a mean duration of 5.7 months. Follow-up echocardiograms (performed in 15 cases after 5.4 months) showed complete regression of hypertrophy. The overall prognosis was favorable, except for one neonatal death due to severe obstructive HCM. Disease severity was correlated with type 2 diabetes and poor glycemic control.

Conclusion : HCM can be diagnosed prenatally during routine screening for maternal diabetes and confirmed postnatally. Early fetal detection allows optimized perinatal care and monitoring. The severity of neonatal HCM correlates with maternal diabetes type and glycemic control, emphasizing the need for strict metabolic control and systematic prenatal echocardiographic assessment in diabetic pregnancies.

none declared

The Challenge of Diagnosing and Managing Immune Congenital Heart Block in Newborns

Dr. Chiraz REGAIEG¹, Dr Nadia KOLSI¹, Dr Yosra ACHICH¹, Dr Amira BOURAOUI¹, Pr Afef BEN THABET¹, Dr Rania GARGOURI², Dr Manel CHARFI ¹, Pr Nedia HAMIDA¹

¹Departement of neonatology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia, ²Department of Cardiology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia

Objectives: This study aims to evaluate the clinical presentation, therapeutic approaches, and outcomes of immune congenital heart block (CHB) in newborns and to establish a practical approach for managing pregnancies in women with autoimmune diseases.

Patients and methods: We conducted a retrospective study of newborns diagnosed with immune CHB over 18 years (2005–2022) in the Neonatology Department of Sfax. The diagnosis of immune CHB was confirmed based on the presence of CHB in association with maternal and/or neonatal SSA and/or SSB autoantibodies.

Results: A total of 13 cases of immune CHB were identified, with a slight male predominance. Five newborns were premature. Maternal autoimmune disease was known in only one case. Antenatal diagnosis was made in three cases at 27, 29, and 31 weeks of gestation, respectively. Two mothers received antenatal glucocorticoid therapy, but it was ineffective. Postnatally, severe bradycardia was observed in 10 newborns, with heart failure occurring in two cases. Electrocardiography confirmed CHB in all cases: 10 had third-degree (complete) CHB, and two had second-degree CHB. Echocardiography revealed reduced left ventricular ejection fraction in two newborns. Immunological testing was performed in 10 mother-newborn pairs to confirm the autoimmune origin. Pacemaker implantation was required in 7 out of 12 newborns, including four within the first nine days of life. Three infants died postoperatively. The remaining newborns showed favorable outcomes.

Conclusions: Close monitoring of high-risk pregnancies is essential for the early detection of immune CHB. Early antenatal diagnosis allows for timely intervention, which may help mitigate disease progression and improve neonatal outcomes.

none declared

Prenatal Diagnosis is Associated with Higher Neonatal Mortality in Newborns with Coarctation of the Aorta: A Retrospective Cohort Study

Dr. Chiraz REGAIEG¹, Dr Nadia KOLSI¹, Dr Manel CHARFI ¹, Dr Rania GARGOURI², Pr Amel BEN HAMED¹, Pr Afef BEN THABET¹, Dr Amira BOURAOUI¹, Pr Nedia HAMIDA¹

¹1) Department of Neonatology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia,

²Department of Cardiology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia

Objectives: Prenatal diagnosis of congenital heart disease (CHD) is generally associated with improved outcomes and reduced mortality. However, this may not hold for coarctation of the aorta (CoA). This study aims to assess the impact of prenatal diagnosis on neonatal mortality by comparing outcomes in newborns diagnosed with CoA before and after birth.

Materials and Methods: We conducted a retrospective cohort study including all patients diagnosed with isthmic CoA either prenatally or postnatally at the Neonatology Department of Hedi Chaker Hospital in Sfax between 2012 and 2023. Newborns diagnosed more than 28 days after birth were excluded. Severe CoA was defined as the presence of symptoms within the first 7 days of life.

Results: This study included 53 newborns with CoA: Prenatal diagnosis group (10 newborns) and postnatal diagnosis group (43 newborns). In the postnatal period, heart failure was observed in 38.5% of cases. Femoral pulse abolition was noted in 74% of cases. Asymmetric blood pressure was found in all patients. Prostaglandin therapy was required in 89.3% of cases diagnosed antenatally. The overall mortality rate was 46.3%, with a postoperative mortality rate of 5.5%. Mortality risk was significantly higher in newborns with a prenatal diagnosis (p=0.01) and those diagnosed at an earlier age (p=0.01). Although hypotrophy (63.7% vs. 42%) and the presence of additional malformations (43.5% vs. 25%) were associated with higher mortality, these differences were not statistically significant.

Conclusions: While prenatal identification of CoA is expected to improve neonatal outcomes, our findings suggest that, in our setting, prenatal diagnosis is associated with a higher risk of mortality. This highlights the need for further investigation into factors influencing outcomes and the optimization of perinatal management strategies for neonates diagnosed with CoA.

None declared

Psychological Impact of NICU Hospitalization: Identifying Post-Traumatic Stress Disorder and Risk Factors in Parents

Dr. Chiraz REGAIEG¹, Dr Chiraz REGAIEG¹, Dr Lobna ARIBI², Dr Mariam ABDELKEFI², Dr Manel CHARFI ¹, Dr Afef BEN THABET¹, Pr Jihen ALOULOU², Dr Amira BOURAOUI¹, Pr Nedia HAMIDA¹

¹Departement of neonatology-hedi chaker university hospital,

²‘B’ psychiatry department - Hedi Chaker University Hospital of Sfax, Tunisia,l, University of Sfax, Sfax, Tunisia

Objectives: The hospitalization of a newborn in a neonatal intensive care unit (NICU) is a highly stressful experience for parents, potentially leading to PTSD. This study aims to assess the prevalence of post-traumatic stress disorder (PTSD) among parents and identify associated risk factors.

Patients and Methods

This was a prospective, descriptive, and analytical study conducted over three months (January–March 2024). Parents of newborns hospitalized in the NICU at CHU Hédi Chaker between November 2023 and March 2024 were included. Newborns hospitalized for more than 28 days were excluded. Data were collected through telephone interviews conducted at least one month after the newborn’s admission to the NICU. The PCL-5 questionnaire, which aligns with DSM-5 diagnostic criteria for PTSD, was used to assess symptoms.

Results

A total of 100 parents were included in the study (65 mothers and 35 fathers), with a mean age of 34.26 years (range: 23–50 years).

– Partner Support: 97% of participants reported receiving emotional support from their partner when facing challenges related to their newborn’s hospitalization.

– First Contact with the Newborn: 38% of parents saw their newborn for the first time immediately after birth.

– PTSD Prevalence: 31% of parents exhibited symptoms of PTSD.

Analysis of risk factors revealed:

– Gender Differences: Women had significantly higher PTSD scores than men (27.21% versus 16%; p = 0.000).

– Age Factor: Parents under 30 years old had higher PTSD scores compared to older parents (28.77% versus 20%; p = 0.017).

– Gynecological History: A significant association was found between PTSD and women’s gynecological history (p = 0.018).

Conclusions

This study highlights the importance of preventing PTSD through effective communication with parents during their newborn’s hospitalization. Implementing a structured PTSD screening protocol could help identify at-risk parents and provide them with necessary psychological support. Early referral to mental health professionals is crucial to helping parents cope with this difficult experience and promoting their psychological well-being.

none declared

antenatal detection and postnatal management of cystic adenomatoid pulmonary malformations in neonates

Dr. Nadia Kolsi¹, Dr. Manel Charfi ¹, Dr Yosra Achich¹, Dr. Chiraz Regaieg¹, Dr. Dhouha Kammoun¹, Dr. Nihed Bouzidi¹, Dr. Amel Ben Hamad¹, Dr Afef Ben Thabet¹, Dr. Amira Bouraoui¹, Pr nédia Hentati¹

¹department of neonatology, Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia

Objectives

This study aims to explore the antenatal detection, clinical presentation, therapeutic approach, and prognosis of cystic adenomatoid pulmonary malformations (CAPM) in neonates.

Materials and Methods

A retrospective descriptive study covering 16 years, including all neonates diagnosed with CAPM, with a focus on antenatal diagnosis through screening and its implications for postnatal management.

Results

Nine neonates with CAPM were identified, with antenatal diagnosis made at a mean gestational age of 25 weeks using morphological ultrasound. In 8 cases, cystic lesions were visible on ultrasound, while one diagnosis was made postnatally based on radiological findings. Five neonates presented with immediate respiratory distress at birth. Chest radiography revealed parenchymal opacity in all cases, while thoracic angioscanner confirmed CAPM in all 9 infants. Due to the severity of the clinical presentation, two neonates underwent surgery: lobectomy in 2 cases and thoracoscopy in 1 case, all showing good recovery. Following an average follow-up of 3 years, all infants were asymptomatic, with a favorable outcome.

Conclusion

Antenatal detection through ultrasound is crucial in identifying the majority of CAPM cases. Early identification allows for better postnatal management and monitoring. Given the potential for spontaneous regression, most cases require only expectant management, with surgical intervention only in severe instances. Antenatal screening remains the cornerstone for improving neonatal outcomes in CAPM cases.

none declared

Umbilical cord arterial blood gas in newborns with gastroschisis and its correlation with APGAR scores: a case-control study

Prof. Samirah Mohamed ^1,3,4 , PhD Luiz Santos², Professor Hazem Ashmawi³

¹University Hospital of University of São Paulo (HU-USP),

²Instituto de Psicologia IP-USP,

³Clinical Hospital of the University of São Paulo Medical School (HCFMUSP),

⁴FAM - CENTRO UNIVERSITÁRIO DAS AMÉRICAS

OBJECTIVES: The main objective is to assess whether there is a difference between umbilical cord arterial blood gas (UCABG) parameters in newborns (NBs) with and without gastroschisis, born by cesarean section, without having gone into labor and in single pregnancies. The secondary objectives are to correlate UCABG values with APGAR values in the first and fifth minute and to present the frequency of gasometric severity criteria in the groups.

METHODS: This is a case-control study in which the UCABG of NBs with and without gastroschisis was analyzed between October 2019 and September 2023, at the Hospitals of the Faculty of Medicine of the University of São Paulo and Vitória, Brazil. The cases were divided into GROUP A (preterm and term NBs) and GROUP B (term NBs). The controls were divided into GROUP C (preterm and term NBs) and GROUP D (term NBs). The UCABG measured pH, pO₂, PaCO₂, ctCO₂, HCO₃, BE, SO₂, glucose, Na+, K+, lactate and Ca²+. The pH, base deficit and lactate values were used for the severity criteria.

RESULTS: The variables that differed between groups A and C (p< 0.05) were: pH, pO₂, PaCO₂, ctCO₂, HCO₃, SO₂, glucose and Ca²+. Between groups B and D, there was no difference in the pH variable compared to groups A and C. The highest Ca²+ and glucose values were obtained in the case groups. Regarding the correlation with APGAR values in the first minute, in GROUP A there was a correlation for HCO₃, BE and Ca²+, in GROUP B for pH, PaCO₂ and lactate, in GROUP C for pH, PaCO₂ and Ca²+ and in GROUP D for pH, PaCO₂ and SO₂. In the fifth minute of APGAR, there were no correlations in the case groups. In the control groups, both had correlations for pH, PaCO₂. In GROUP C, for HCO₃, BE, K+ and Ca²+ and in GROUP D for SO₂ and lactate. With regard to acidemia < 7.2, there were 7.1%, 23.8%, 7.1% and 25% for groups A, C, B and D, respectively. There was no severe or moderate acidemia in the case groups, only 2.4% and 2.5% in groups C and D, and moderate acidemia of 7.1% and 7.5% in groups C and D, respectively. Mild acidemia was 3.6%, 14.3%, 7.1% and 15% in groups A, C, B and D, respectively. There was no base deficit ≥ 12 mmol/L in the groups. Hyperlactinemia was 7.1%, 14.3%, 14.3% and 15% in groups A, C, B and D, respectively.

CONCLUSIONS: The variables that differed between groups A and C were: pH, pO₂, PaCO₂, ctCO₂, HCO₃, SO₂, glucose and Ca²+ When comparing groups B and D, there was no difference in the pH variable. Although Ca²+ levels were lower in the premature newborns, it and glucose showed higher values in the case groups. In the case groups, there were moderate correlations between HCO₃, BE, Ca²+, pH, PaCO₂ and lactate levels and first minute APGAR values. The gasometric severity criteria were not prominent in any group.

Keywords: gastroschisis; severe acidemia; umbilical arterial gasometry

None declared

Table 1. Comparisons of umbilical arterial blood gasometry between groups

Table 2. Correlation of the blood gas analysis findings with the one-minute and five-minute APGAR scores.

A rare cause of neonatal heart failure

Dr. Nadia Kolsi¹, Dr Amira Bouraoui¹, Dr. chiraz Regaieg¹, Dr Dhouha Kammoun¹, Dr. Amel Ben Hamad¹, Dr Amina Abdennadher¹, Dr. Manel Charfi ¹, Dr. Nedia Hentati¹

¹department of neonatology ,Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia

Objectives:

We report the case of a newborn with heart failure secondary to a Vein of Galen aneurismal malformation (VGAM) which is a rare congenital vascular malformation representing <1% of all arteriovenous malformations which can cause severe morbidity and mortality in neonates including heart failure.

Case presentation:

A male neonate was born at 41 weeks’ amenorrhoea by emergency caesarean section due to foetal distress. He was eutrophic. Hospitalized at birth with transient respiratory distress requiring oxygen therapy for 8 hours. At the age of 2 days, he presented with severe heart failure and dyspnoea , tachycardia with a murmur on cardiac auscultation and a gallop sound, hepatomegaly and oedema of the lower limbs. The chest X-ray showed cardiomegaly with a cardiothoracic index of 0.61 and healthy lung parenchyma. Cardiac ultrasound showed high-flow heart failure with normal cardiac architecture. transfontanellar ultrasound showed a 3 cm cerebral vascular aneurysm connected to several arterial and venous structures. Cerebral magnetic resonance imaging (MRI) showed a circulating aneurysm of the ampulla of Galen with dual arterial afference and venous drainage into the right sinus, which was dilated, with no detectable parenchymal repercussions. The child was put on oxygen therapy, with diuretic and digitalis treatment. The outcome was unfavourable, death occured at 16 days due to untractable cardiac failure.

Conclusion:

VGAM is a rare cause of neonatal heart failure with high morbidity, antenatal diagnosis is possible and endovascular therapy is the first-line treatment.

None declared

A neonatal atrial flutter treated by synchronized cardioversion

Dr. Nadia Kolsi¹, Dr. Chiraz Regaieg¹, Dr Manel Charfi ¹, Dr. Amina Abdennadher¹, Dr Nihed Bouzidi¹, Dr Amel Ben Hamad¹, Dr. Afef Ben Thabet¹, Dr Amira Bouraoui¹, Dr Nedia hentati¹

¹department of neonatology, Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia

Objectives : Atrial flutter (AFL) is a relatively common but potentially severe arrhythmia in neonates. Prompt recognition and management are crucial, as pharmacological treatment alone may be ineffective. This report highlights a case of neonatal AFL successfully treated with synchronized electrical cardioversion (ECV).

Case Presentation : A 3,500 g female infant was delivered at 39 weeks of gestation via cesarean section due to fetal tachycardia. At birth, Apgar scores were 9 and 10 at 1 and 5 minutes, respectively. Two hours postpartum, the infant exhibited persistent tachycardia (240 bpm) and respiratory distress (tachypnea, respiratory rate: 70/min) but showed no signs of cardiovascular collapse. She was admitted to the neonatal intensive care unit (NICU). Initial electrocardiography (ECG) revealed supraventricular tachycardia (SVT) with a narrow QRS complex (240 bpm), leading to the initiation of intravenous amiodarone (5 mg/kg). However, the treatment was unsuccessful, and the patient experienced recurrent AFL episodes associated with respiratory distress and hypoxemia (SpO₂ = 88%). Synchronized cardioversion was performed at 1 J/kg, successfully restoring sinus rhythm. A second cardioversion at 3 J was required due to AFL recurrence, again achieving rhythm normalization. To prevent further arrhythmic episodes, amiodarone was continued at 15 mg/kg/day. After 24 hours without recurrence, intravenous therapy was transitioned to oral administration. Laboratory tests were unremarkable, and echocardiography confirmed normal cardiac function. The infant remained arrhythmia-free and was discharged on the 15th day of life in stable condition with ongoing oral amiodarone therapy. During a one-year follow-up, no further AFL episodes were recorded. Serial Holter ECG and echocardiography findings were normal, leading to the discontinuation of amiodarone therapy.

Conclusion : Neonatal atrial flutter may be refractory to conventional antiarrhythmic therapy, emphasizing the importance of early recognition and intervention. Synchronized electrical cardioversion remains a safe and effective treatment option. Additionally, brain ultrasound should be considered in the early months of life to screen for potential hypoxic lesions.

None declared

esophageal atresia: predictive factors of morbidity and mortality

Dr. Nadia Kolsi¹, Dr Saloua Ammar², Dr Taycir Chikrouhou², Dr. Manel Charfi ¹, Dr. Afef Ben Thabet¹, Dr Riadh Mhiri², Dr Amira Bouraoui¹, Dr Nédia Hentati¹

¹Department of neonatology, Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia,

²department of Pediatric surgery, hedi chaker Hospital,Faculty of medicine of sfax, University of Sfax, TunisiaHospital

Objectives: To identify predictive factors (PFs) of morbidity and mortality in esophageal atresia (EA) in the short and medium term.

Methods: A retrospective, descriptive, and analytical study conducted over 8 years, including all cases of EA.

Results: A total of 55 cases were analyzed. Early mortality was reported in 12 cases, with an average age of 8.5 days at the time of death. The PFs for early mortality included prematurity (p=0.001), birth weight <2 kg (p=0.015), congenital heart disease (p=0.004), diagnostic delay ≥24 hours (p=0.003), intubation duration ≥4 days (p=0.011), and high-tension anastomosis (p=0.017). Postoperative complications occurred in 32 cases. Short-term complications were observed in 23 patients, mainly recurrent pneumonia (15 cases). The PF for complicated short-term outcomes was prolonged postoperative intubation (p=0.005). Medium-term complications were noted in 21 patients, with gastroesophageal reflux (9 cases) being the most common. The PFs for complicated medium-term outcomes included perioperative morbidity (p=0.05) and complicated short-term evolution (p=0.002).

Conclusions: Despite advances in pediatric anesthesia and neonatal care, the morbidity and mortality rates of esophageal atresia remain high.

None declared

epidemiological, clinical, therapeutic, and prognostic profile of esophageal atresia: a study of 55 cases

Dr. Nadia Kolsi¹, Dr. Saloua Ammar², Dr Taycir Chikrouhou², Dr Chiraz Regaieg¹, Dr. Amel Ben Hmad¹, Dr Amira Bouraoui¹, Dr. Riadh Mhiri², Dr Manel Charfi ¹, Dr. Nédia hentati¹

¹Department of neonatology, Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia,

²department of Pediatric surgery, hedi chaker Hospital,Faculty of medicine of sfax, University of Sfax, TunisiaHospital

Objectives: To describe the epidemiological, clinical, therapeutic, and prognostic characteristics of esophageal atresia (EA).

Methods: A retrospective descriptive study conducted over 8 years, including all cases of EA.

Results: A total of 55 cases were analyzed. A clear male predominance was observed, with a sex ratio of 2. Prenatal diagnosis was suspected in 36.36% of cases. A diagnostic delay (≥24 hours) was noted in 29.09% of cases. Neonatal respiratory distress was the most common clinical sign (63.3%). The most frequent type of EA was Type III, found in 72.7% of cases. The average time to surgery was 1.8 days, and the mean postoperative hospital stay was 18 days. Postoperative complications occurred in 58.2% of cases. Early mortality was reported in 12 cases, with an average age of 8.5 days at the time of death. Short-term complications were observed in 23 patients, mainly recurrent pneumonia (15 cases). Medium-term complications were noted in 21 patients, with gastroesophageal reflux (9 cases) being the most common.

Conclusions: Esophageal atresia is a congenital malformation associated with significant morbidity and mortality, despite advancements in prenatal imaging, which increasingly allow for early in utero diagnosis and improved prognosis.

None declared

Rare complications of central catheter in neonates

Dr. Nadia Kolsi¹, Dr Amira Bouraoui¹, Dr Manel Charfi ¹, Dr Dhouha Kammoun¹, Dr Amina Abdennadher¹, Dr Nihed Bouzidi¹, Dr Amel Ben Hamad¹, DR Afef Ben Thabet¹, DR Chiraz Regaieg¹, Dr Nedia Hentati¹

¹Department of neonatology ,Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia

Objectives :

The aim of this study was to investigate non-infectious complications of central lines and to identify risk factors for the development of these complications.

Methods :

A retrospective study was carried out by Neonatal intensive care units of Sfax from january 2014 to March 2024. A total of 16 case records of central catheters mechanical complications were collected.

Results :

Major mechanical complications occurred in 16 central lines with, 14 pericardial effusions, one pleural effusion and one case of pneumopericardium. All newborns were premature (27 to 33 weeks of amenorrhea).14 patients had epicutaneo-cave catheters, one patient had umbilical venous catheters and one had broviac catheter. Catheters were inserted at a median age of 13 (1 to 26) days. Parenteral nutrition was the commonest indication.The catheter position was intracardiac in all cases. The incident occurred in an average of 5.9 days after the catheter insertion (1to 26 days). Clinical manifestations were not specific miming sepsis in almost all cases. Hemodynamic disorders with tachycardia, tachypnea and mottled skin were noticed in 5 cases of pericardial effusion. Six preterm newborns with tamponade presented moreover severe apnea. Ultrasound scan confirmed the diagnosis in all cases related to leakage of parenteral nutrition. For the case of pneumopericardium diagnosis was made on chest radiography. Management consisted of the removal of the catheter in 12 cases and reposition in three cases. An ultrasound-guide pericardium puncture was performed in 10 cases of pericardial effusion. Death occurred in 4 patients, outcome was favorable four the others.

Conclusion :

Clinician should be aware of the risk of leakage of parenteral nutrition. Thus every neonate with central catheter must be monitored and the extracardiac position of the catheter must be systematically verified.

None declared

Premature Rupture of Membranes Before 28 Weeks of Gestation: Predictive Factors for Neonatal Mortality

Dr. Chiraz REGAIEG¹, Dr Manel CHARFI ¹, Dr Fatma KHANFIR², Dr Nadia KOLSI¹, Pr Kais CHAABEN², Pr Afef BEN THABET¹, Dr Amira BOURAOUI¹, Pr Nedia HAMIDA¹

¹Departement of neonatology-hedi chaker university hospital,

²Department of Obstetrics and gynaecology , Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia

Objectives: To identify the antenatal and perinatal risk factors associated with neonatal mortality in infants born from pregnancies complicated by premature rupture of membranes (PROM) before 28 weeks of gestation.

Materials and Methods: This retrospective, analytical study reviewed all singleton pregnancies with PROM before 28 weeks of gestation, conducted from 2016 to 2020. We included only babies who were hospitalized in the department of neonatology.

Results: A total of 200 pregnancies were complicated by PROM before 28 weeks. The average gestational age at PROM was 23 weeks. Of the 93 patients managed expectantly, 16 experienced intrauterine fetal death (IUFD). The average gestational age at delivery was 28 weeks and 5 days, with an average birth weight of 1,248 grams. Seventy-seven newborns were included in the analysis, with 93.5% presenting symptoms at birth. The neonatal mortality rate was 47%. Significant antepartum factors associated with mortality included gestational age at PROM (p<0.001), estimated fetal weight (p<0.001), duration of tocolysis (p<0.001), number of antenatal corticosteroid courses (p=0.003), and mode of delivery (p=0.016). Neonatal mortality was inversely related to birth weight (p<0.001) and higher in cases with low Apgar scores (p<0.001) and the need for intensive resuscitation (p=0.003). Morbidities significantly associated with neonatal mortality included hyaline membrane disease (p<0.001), pulmonary hypoplasia (p<0.001), and maternal-fetal infection (p<0.001).

Conclusion: Patients should be counseled on the poor prognosis associated with PROM before 28 weeks of gestation and be informed of the key predictive factors for neonatal morbidity and mortality.

None declared

Parents’ perception of the quality of life of former very preterm children at school age.

Dr. Nadia Kolsi¹, Dr. Chiraz Regaieg¹, DR. Amina Abdennadher¹, Dr Charfi Manel ¹, Dr. Amel Ben Hamad¹, Dr Afef Ben Thabet¹, Dr Amira Bouraoui¹, Dr Nedia Hentati¹

¹Department of neonatology,Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia

Objectives: To explore the various dimensions of quality of life in former very preterm children at school age.

Materials and Methods: A descriptive analytical study assessing parents’ perceptions of the quality of life of their formerly very preterm children at school age.

Results: A total of 60 mothers completed the questionnaire. The average maternal age was 28.9 years; 36.7% were from rural areas, 56.7% had a primary education level, and 58.3% had a middle socio-economic status. Regarding their children’s quality of life, 81.7% had average physical abilities, 51.7% had an average level of socialization, and 55% experienced moderate academic difficulties. Overall, 85% of parents rated their child’s quality of life as good. A significant correlation was found between geographic origin, education level, and socio-economic status.

Conclusion: Former very preterm children are at risk of neurodevelopmental disorders, learning difficulties, and parental stress. Providing adequate parental support is essential to improving the quality of life of this vulnerable population.

None declared

early-onset neonatal sepsis in new borns: a study of 100 cases

Dr. Nadia Kolsi¹, Dr Chiraz Regaieg¹, Dr Dhouha Kammoun¹, Dr Manel Charfi ¹, Dr Nihed Bouzidi¹, Dr Amel Ben Hamad¹, DR Afef Ben Thabet¹, DR Amira Bouraoui¹, DR Nedia Hentati¹

¹Department of neonatology, Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia

Objectives: To determine the prevalence of confirmed early-onset neonatal sepsis (EONS) in newborns, identify the main risk factors, and highlight the most frequently involved pathogens.

Materials and Methods: A retrospective study conducted over one year (2021) including newborns suspected of EONI aged ≤3 days.

Results: A total of 100 cases were analyzed. EONS was classified as probable in 37 cases and confirmed in 13 cases. Among newborns with confirmed EONS, 46.6% were preterm, and 38.5% had intrauterine growth restriction. The main risk factors included premature rupture of membranes for ≥12 hours, unexplained prematurity (30.8%), and maternal fever. Clinical symptoms were present in 76.9% of infected newborns, appearing within the first hour of life in 53.9% of cases. Respiratory distress was the most common clinical sign (58.3%). Hemogram abnormalities were detected in 19.2% of cases, and C-reactive protein (CRP) levels were elevated in 41.6% of cases. The most frequently isolated pathogens were Escherichia coli (30.8%) and Group B Streptococcus (23.1%). First-line antibiotic therapy consisted of Cefotaxime-Gentamicin in 76.9% of cases, with treatment modification required in 46.2% of cases. The outcome was favorable in 76.9% of cases, while the mortality rate was 23.1%.

Conclusion: Early-onset neonatal sepsis is a common and serious condition in neonatology, requiring close collaboration between obstetricians, neonatologists, and microbiologists for timely diagnosis and management.

None declared

An Unusual Case of Poland Syndrome with Bilateral

High Burden of Multi-drug Resistant Organisms in Level III Neonatal Intensive care Unit from a Developing Country

Prof. ASHOK KUMAR ¹

¹Professor, ²Postgraduate student

Objectives: To describe the antimicrobial resistance pattern of organisms in a Level III NICU.

Methods: Records were analyzed for various organisms grown in blood cultures and their sensitivity patterns.

Results: A total of 853 culture samples were sent, out of which positive cultures were 333 with culture positivity rate of 39%. Among positive culture samples 36.9% (n=123) were positive for gram positive bacteria, 17.7% (n=59) were positive for fungal growth and 45.3% (n=151) were positive for gram negative bacteria. Total 9 culture samples were contaminated (1%). Overall most common organisms were MRSA (Methicillin resistant Staphylococcus aureus), Candida sp and Klebsiella pneumonia followed by CONS (Coagulase negative Staphylococcus aureus) and Acinetobacter baumannii (each of 17.7% of total positive cultures). MRSA were 100% sensitive for Vancomycin and Linezolid. Acinetobacter were 100% sensitive to Polymyxin B, 22% to Levofloxacin and 14% to Meropenam. Candida sp. were 100% sensitive to Amphotericin B and 93% to Fluconazole.

Conclusions: There is a high burden of multi-drug resistant pathogens which makes management of sepsis a challenging experience.

None declared

Extreme β-hCG elevation with normal fetal karyotype mimicking gestational trophoblastic disease: a case report

Dr. Mirjam Druškovič ¹ , Dr. Gorazd Kavšek¹

¹UMC Ljubljana

To present a rare case of extreme β-hCG elevation and spontaneous ovarian hyperstimulation (SOH) in a singleton pregnancy with normal fetal karyotype, mimicking gestational trophoblastic disease (GTD), but ultimately demonstrating a distinct atypical clinical course and resolution. We highlight diagnostic and management challenges.

A 24-year-old G2P1, with spontaneously achieved pregnancy, presented at 17 2/7 weeks with lower abdominal pain and severe early-pregnancy nausea. Family history included a grandfather’s pituitary tumor, and a sister with Hashimoto’s thyroiditis. She has no remarkable personal medical history, and her first pregnancy was uncomplicated, with spontaneous vaginal delivery of a haelthy girl at 39 5/7 weeks. First-trimester nuchal translucency screening was at low risk for congenital conditions. Ultrasound at presentation revealed a morfologicaly normal fetus and a thickened, unhomogeneous placenta without classic molar features, and large, bilateral multi-cystic ovaries consistent with SOH. Initial β-hCG was markedly elevated (∼590.000 U/L), raising strong suspicion for GTD, specifically partial hydatidiform mole. However, amniocentesis at 18 4/7 weeks revealed a normal 46, XX fetal karyotype. In this pregnancy, she experienced transient dizziness, lightheadedness, memory impairment, and motor deficits; however, brain MRI and thyroid tests were normal. Subsequent weekly monitoring at our perinatal center included serial β-hCG measurements, screening for preeclampsia/preterm birth, and serial fetal ultrasounds. β-hCG showed a decline, but remaining significantly elevated during pregnancy. The prenatal ultrasounds demonstrated appropriate growth and development of the fetus. At 32 weeks, maternal deterioration occurred, characterized by elevated liver enzymes, impaired renal function, and severe pruritus. Suspected preeclampsia was not supported by typical hypertension, and the clinical picture was further complicated by emerging signs suggestive of gestational diabetes insipidus (polydipsia, polyuria). Antenatal corticosteroids were administered for fetal lung maturity. At 34 4/7 weeks, worsening symptoms and evidence of progressive liver/renal dysfunction prompted labor induction, with spontaneous vaginal delivery of a live-born female (2150g, Apgar 9/9). The placenta was delivered spontaneously and sent for histopathology. Postpartum ultrasound showed a well-contracted uterus; blood loss was normal. Notably, low postpartum sodium and cortisol prompted hydrocortisone administration for presumed adrenal insufficiency secondary to possible hypophysitis. Subsequent pituitary MRI showed evidence of transient hyperplasia or inflammation without hemorrhage. Placental histopathology showed no evidence of hydatidiform mole or choriocarcinoma. Postpartum, the mother’s β-hCG levels declined exponentially, becoming negative at five weeks. Concurrently, her hepatic and renal profiles normalized. At eight months postpartum, both maternal and neonatal assessments remained normal.

This case illustrates a rare presentation of extreme β-hCG and SOH in a singleton pregnancy with normal karyotype, posing a diagnostic challenge. While mimicking GTD, the normal karyotype, absence of classic molar features, and eventual β-hCG resolution suggest a distinct, possibly paraneoplastic, etiology. The rapid β-hCG decline and organ function normalization support a pregnancy-related, rather than neoplastic, origin. This underscores the importance of comprehensive evaluation in cases of markedly elevated β-hCG and ovarian hyperstimulation, highlighting the potential for non-molar etiologies to mimic GTD. Further research is needed to elucidate the precise mechanisms.

None declared

Ultrasound as the main method in decision-making in selective reduction and MFPR

Dr. Anna Saveleva ¹ , Dr. Tatiana Kashtanova, Prof. Anton Mikhailov

¹Maternity Clinic #17, Saint-Petersburg, Russia

Objectives

Selective fetal reduction with discordance in chromosomal or structural abnormalities is a possible option in heterochorionic multiple pregnancies. The frequency of multiple pregnancies with three or more fetuses in the natural population is relatively stable and low. Single embryo transfer significantly reduced the frequency of multiple and super-multiple pregnancies in ART programs, but eliminate their occurrence completely is not possible.

Methods

As a reference center for multiple pregnancy patients, our clinic is responsible for first trimester ultrasound and biochemical screening and perinatal counselling in this population. In cases of ultrasound markers of chromosomal or structural abnormalities in one of the fetuses in dichoriоnic multiple pregnancy perinatal counseling, karyotyping of the fetuses are proposed, followed by a discussion of selective reduction of the affected extra wishing fetus. Detection of developmental anomaly in one of the fetuses in monochorionic multiple pregnancy is indication for discussion as an option of pregnancy prolongation and feticide of compromised fetus during childbirth.

Results

From 2015 to 2025, selective or multifetal pregnancy reduction was performed in 116 patients with a gestational age from 11 to 21 w, the majority of procedures – 89 before 14 w, 28 before 18 w and only 5 before 22 w. 62 fetal reductions under ultrasound guidance were performed in DCDA, 24 – in TCTA, 18 - in DCTA and 18 in pregnancies with 4 and more fetuses with different types of placentation. In 110 patients, reductions were performed in one session, in 6 - in two sessions. Ultrasound played a major role in determining the reduced fetus/fetuses based on the significance of indication such as the presence of markers of chromosomal or structural abnormalities, monochorionicity, the CRL value, and the convenience of puncture access. No pregnancy loss was registered within 4 weeks after the procedure, 6 patients had amniotic fluid leakage from the amniotic cavity of the reduced fetus, 3 had moderate bleeding stopped by conservative methods.

Conclusions

Ultrasound plays a key role in management of multiple pregnancies. Selective and MFPR is relatively save procedures to reduce perinatal mortality and morbidity in complicated multiple pregnancy.

None declared

Gut microbiome and obesity: preconception and pregnancy preparation specialties and peculiarities

Prof. Volodymyr Artyomenko* ^1,2 , Dr Sergiy Derishov², Dr Nataliia Domakova^1,3

¹Odessa National Medical University, ²Odesa City Maternity Hospital № 5, ³CNE «Bilyaiv Multidisciplinary Hospital» of the Bilyaiv City Council

Modern recommendations for weight gain during pregnancy are between 5 and 18 kg, depending on the woman’s pre-pregnancy body mass index (BMI). After each subsequent pregnancy many women gain 2-5 kg. Pregravid preparation, pregnancy and the postpartum period can be important times to prevent or treat overweight or obesity systematically. varying in intensity and methodology, including diet and/or exercise in different formats: online, offline or via mobile apps.

It should be noted that the higher the pre-pregnancy BMI, the higher the risks during pregnancy.

We conducted a gut microbiome investigation in 21 obese (BMI 31,8 to 37,2 ) and normal BMI (19,2 to 23,7) women during pre-conception preparation, performing the digitized microscopy of native material, the in-depth study of intestinal microbiota state with identification of commensal and opportunistic microorganisms to the species (MIKRO-LA-TEST by PLIVA- LACHEMA (Brno, Czech Republic)), as well as 2 different genetic analysis: PCR by Femoflor-16 and Next Generation Sequencing (NGS).

For gut microbiota correction by personalized selection of author’s 6 strains: Lactobacillus Bulgaricus S6, L. Bulgaricus S19, L. Rhamnosus S25, L. Plantarum A, L. Bulgaricus A6 and L. bulgaricus A22 by BioMECombi (Technical Specification TU U 10.8-41253026-001:2021 Dietary Supplements «BiоMe COMBI 10+1» TM «EDIENS») were used. Pharmabiotics were considered effective if they showed antagonistic activity towards etiologically significant conditionally pathogenic microorganisms whose concentrations were beyond the norm, without affecting the growth of the commensal microbiota representatives.

Ethics Commission in Conducting Experimental and Clinical Research Communal Non-profit Enterprise “Maternity Hospital № 5” Odesa City Council approved the study - protocol №7 from December 7th, 2023.

We found that individuals with obesity have a higher prevalence of Firmicutes (Fusobacteria, Proteobacteria and Lactobacillus reuteri) and a lower prevalence of Bacteroidetes (Akkermansia muciniphila, Faecalibacterium prausnitzii, Lactobacillus plantarum and Lactobacillus paracasei) compared with normal-weight individuals. Furthermore, they have a higher ratio of Firmicutes/Bacteroidetes, which resides in specific changes of bacterial metabolic activities found by NGS.

These changes have a negative impact on pregnancy and have both immediate and long-term consequences for both mother and child, including epigenetic issues.

Definitely, we can’t compare due to the small number of patients the pregnancy and labor complications in our groups but the absolute numbers seemed to be lower in our obese women in comparison with the literature data.

We consider that women who are overweight or obese before pregnancy need mandatory preconception counseling with a personalized lifestyle modification strategy that will be implemented in the woman’s daily life in the long term with mandatory personalized pre-conception preparation with the inclusion of a gut microbiome study in the diagnostic plan. In addition, a woman who is overweight or obese during pregnancy needs more detailed follow-up to prevent and treat possible complications for both mother and child.

Our approach is focusing on the mother’s and child’s health before conception to have a positive impact on pregnancy, labor and decrease maternal and neonatal mortality and morbidity.

obesity; gut microbiome; pregravid preparation; pregnancy complications

None declared

Parvovirus B19 epidemic in 2023 – consequences for pregnant women and the fetuses

Ms. Eva Kukec ¹ , Ms. Tina Uršič², Mr. Miroslav Perovec², Ms. Sergeja Gregorčič³, Ms. Tanja Premru-Sršen¹

¹Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Šlajmerjeva 4, ² Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, ³Division of infectious diseases, University Medical Centre Ljubljana, Japljeva 2

Keywords: fetal anemia; non-immune fetal hydrops; fetal death; intrauterine transfusion

Objectives

The aim of this study was to determine the timing, symptoms and source of infection with Parvovirus B19 (B19V) in pregnant women. Consequent pregnancy complications (fetal anemia, non-immune fetal hydrops and fetal death) and neonatal complications (fetal anemia and thrombocytopenia) were examined.

Methods

The study included pregnant women who tested positive for B19V infection during B19V epidemic from january to august of 2023. Data concerning source and course of infection, pregnancy and neonatal complications was collected retrospectively from patient records and through telephone enquiry.

Results

Of 53 included pregnant women, B19V infection was confirmed by IgM antibodies and PCR in 51 (96 %) and only by IgM antibodies in 2 (4 %) patients. The gestational age at the time of test ranged from 8-35 weeks, while almost half (49 %) were tested in second trimester. 19 (36 %) women were asymptomatic, 17 (32 %) had cold like simptoms, 16 (30 %) skin rash and 9 (17 %) painful joints. Majority of women (66 %) got infected from their own child, while 23 % were exposed during work in primary school, kindergarden, healthcare or library. Very rarely the source of infection was contact with other children. Of 53 women, 50 (94 %) had serial ultrasounds performed to find signs of fetal infection and 2 (4 %) due to other reasons. Peak systolic velocity in medial cerebral artery was measured in 48 (90 %) and was >1,5 MoM in 5 (9 %) women, indicating fetal anemia. 2 of those had fetal hydrops and 3 had no other signs of infection of fetus. In total there were 4 (8 %) cases of fetal hydrops and consequent fetal death in 12th, 20th, 21st and 25th week of gestation. The latest mentioned hydropic fetus recieved three intrauterine transfusions of erythrocytes between 23rd and 24th week of gestation and unfortunately died in 25th week of gestation. There were two cases of skin edema that resolved spontaneously during pregnancy. One of those had very high nuchal translucecny in first trimester in an otherwise healthy fetus. After birth, there was one case of neontatal anemia and two cases of neonatal thrombocytopenia.

Conclusions

The majority of B19V infections occur in the second trimester of pregnancy. While the infection can present with symptoms of cold, skin rash and painful joints, one third of infected women remain asymptomatic. In two thirds of pregnant women the source of infection is their own child, one quarter get infected in the workplace. The percentage of fetal hydrops and fetal death in study population was 8 %, similar as described in literature. Fetal hydrops and fetal death were most common in second trimester. Neonatal consequences such as anemia and thrombocytopenia were rare and temporary.

None declared.

Respectful maternity care in Odesa, Ukraine during a time of war

Prof. Volodymyr Artyomenko* ^1,2 , Dr Dmytro Zhelezov², Dr Zinaida Velieva², Dr Annekathryn Goodman^3,4, Ms Mary Greenwald³, Dr Marcella Cardoso³, Ms Katherine Fachon³, Dr Christina Duzyj^3,4

¹Odessa National Medical University,

²Odesa City Maternity Hospital № 5,

³Massachusetts General Hospital,

⁴Harvard Medical School

Maternity care given by clinicians during labor and delivery is influenced by physical and medical resources, the training of the medical providers, and implicit societal attitudes towards pregnant people. An increasing body of evidence has revealed disrespectful and abusive care in facility-based childbirth as a barrier to maternal and child health. Providers have noted poor work environments, lack of staffing, and attitudes toward marginalized groups as barriers to respectful maternity care. What has not been studied is the impact of disaster and violence on the delivery of respectful maternity care. The purpose of this study was to evaluate the state of obstetrical care in a maternity hospital in Odesa, Ukraine during a time of full sale invasion.

Ethics Commission in Conducting Experimental and Clinical Research Communal Non-profit Enterprise “Maternity Hospital № 5” Odesa City Council approved the study : protocol № 1 from June 6th, 2024. We surveyed 202 maternity care providers currently working and have worked at Odessa City Maternity Hospital № 5 for at least one year (physicians, senior and junior nurses, midwives, orderlies, and other personnel) during June and July 2024. A cross-sectional study that consists of around 15-25-minute online survey. Measurements and topics covered in the questionnaires include respectful care practices performed; types of disrespectful behaviors witnessed; the impact of war on the provision of respectful maternity care; perceived stress and post-traumatic stress; factors related to stress and support; attitudes about consent in obstetric care This data collection approach aims to gain insights into the challenges and perceptions surrounding respectful maternity care in the context of ongoing military conflict.

As a planned analysis of obstetrical care in Odesa, Ukraine in 2024 during the third year of a full-scale Russian invasion since February 24, 2022 and by delving into the experiences of healthcare providers working under duress and stress, the study tried to uncover the challenges faced and identify areas for intervention. 50% of respondents believed disrespect was an issue in the field of obstetrics. A slight majority (55.0%) reported that the frequency of disrespect and abuse remained the same before and after the invasion, while 32.2% reported a lower frequency and 9.4% reported a higher frequency of disrespect. For all types of disrespect, the proportion of respondents reporting less frequency of disrespectful incidents after invasion was greater than the proportion of those reporting more frequency. There was very little change in reported performance of respectful maternity care before and after the full-scale invasion.

Reported effects of the invasion on respectfulness of care were minimal. However, the relatively low knowledge of disrespect, along with the large spread of frequency of reported respectful behavior, indicates room for improvement. We hope to use this information to help develop support systems, and training and education to enhance support of respectful care despite challenges of resources, lack of safety, and emotional stress. Through these efforts, the study aims to contribute to the enhancement of maternal healthcare delivery in conflict-affected regions.

respectful maternity care; hostilities impact; maternity care providers; education and training

None declared

Should we conduct a trial of labor in women with a macrossomic fetus? A cohort study

Dr. Luis Carlos Machado Junior ¹ , Dr. Emy Kikugawa¹, Dr. Patrícia de Carvalho Jacobsen¹, Dr. Paula Affonso Ferreira Trotta¹, Dr. Josikwylkson Costa Brito¹, Dr. João Mateus Junior¹, Dr. Heráclito Barbosa de Carvalho¹

¹Women’s Hospital Of São Bernardo Do Campo

OBJECTIVE

There is much debate about the best mode of delivery for the macrossomic fetus. Many studies report the outcomes of macrossomic in general, but few ones report outcomes related to mode of delivery. The objective of this study is to compare maternal and neonatal outcomes of macrossomic fetuses in prelabor cesareans (PLC) versus in trials of labor (TOL).

METHODS

We conducted a retrospective cohort study including neonates with birthweight of 4,000g or more delivered in a public teaching hospital between October 2019 and December 2024. Exclusions: preterm, non cephalic, fetal death and malformed. Data collected from medical records. We created three composite outcomes: “any adverse neonatal outcome”, including: brachial plexus injury, meconium aspiration syndrome, fifth minute Apgar less than seven, and death; “any adverse maternal outcome”, including death, hysterectomy, puerperal infection, blood transfusion, and third or fourth degree perineal tears, and “neonatal respiratory morbidity”: mechanical ventilation and/or need of oxygen. It was considered significant a value of p < 0.05. Approved by the Ethics Committe of Faculty of Medicine of ABC, number 5.944.335, date March 15th, 2023.

RESULTS

In the period of the study, we had 612 births included. There was no maternal death, no maternal near miss and, in the group of TOL, one neonatal death. Only 19.3% of the women had a diagnosis of diabetes, and 39 (6.4%) of the neonates weighed 4,500g or more. There were 231 vaginal births (37.7%), and 381 cesareans (62.3%). Were performed 269 (44%) prelabor cesareans, from which 51.7% were for suspected macrossomia (all by ultrasound weigh estimation). Were conducted 341 (56%) TOL’s; from these, 112 (32.8%) finished in cesarean sections. In only six women with suspected macrossomia (ultrasound), TOL was conducted, and four achieved vaginal birth. Among 231 vaginal births, we had 61 (26.4%) cases of shoulder dystocia, among which 9 neonates were discharged with brachial plexus injury (3.9% of vaginal births; one out of 25; 14.8% of all shoulder dystocia). We found a greater frequency of “any neonatal adverse outcome” in the group of TOL, although in the limits of significancy, 4.4% vs. 1.8%, Odss Ratio (OR) 2.57, p= 0.053. There was a lower frequency of “respiratory morbidity” in TOL, OR 0.77, p= 0.032. A surprising finding was that in the group of TOL, the frequency of “any maternal adverse outcome” (mostly blood tranfusion for post partum hemorrhage) was significantly higher than in the group of PLC: 28 (8.2%) vs. 7 (2.6%), (OR) 3.72; p= 0.012.

CONCLUSION:

We had a high frequency of shoulder dystocia and of infants discharged with brachial plexus injury. Unfortunately, we were not able to follow up these infants to access their long term outcome. The higher maternal morbidity in the TOL group could be because of the high rate of failed TOL. Not accessed in this work, there is still some difficulty in correctly identifiying the macrossomic fetus before birth.

None declared

Atypical presentation of gastric duplication cyst diagnosed prenatally : a case report

Dr. Chiraz REGAIEG¹, Dr Amira BOURAOUI¹, Dr Manel CHARFI ¹, Dr Saloua AMMAR², Pr Afef BEN THABET, Pr Amel BEN HAMED¹, Pr Nedia HAMIDA¹

¹Departement of neonatology-hedi chaker university hospital,

²Department of Pediatric Surgery, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia

Objective: Gastric duplications are rare congenital anomalies of the alimentary tract, with limited reports in newborns. We highlight the diagnostic challenges of imaging in a prenatally diagnosed case of gastric duplication.

Case Presentation: A male infant was born at 39 weeks of gestation via spontaneous vaginal delivery. Prenatal ultrasound revealed a round anechoic lesion adjacent to the gastric fundus, with a cystic mass displaying two distinct layers: a hyperechoic inner layer and a hypoechoic outer layer. Postnatal examination detected a palpable abdominal mass. Abdominal ultrasonography (US) identified a cystic structure between the spleen, the greater curvature of the stomach, and the duodenum, raising suspicion of a small communication with the gastric lumen. Abdominal computed tomography (CT) showed a non-opacified mass with fluid density compressing the posterior aspect of the stomach, suggesting a non-communicating gastric duplication. The infant remained asymptomatic and was discharged at 15 days of life. At three months, laparoscopic exploration confirmed a cystic gastric duplication located between the stomach’s greater curvature and the spleen, with no communication to the gastric lumen. The postoperative course was uneventful.

Conclusion: Prenatal diagnosis aids in the early planning and management of gastric duplication. However, due to the variability of imaging findings, the diagnosis remains challenging and often inconclusive, making histopathological examination the gold standard for confirmation.

none declared

Enhancing emergency response in obstetrics and gynecology through simulation-based training

Dr. Barbara Bonča ¹ , Dr. Emil Havránek², Dr. Matej Anton², Dr. Bernhard Roessler³, Dr. Caroline Holaubek³, Dr. Veronica Falcone³, Dr. Katarina Langton⁴, Dr. Monika Sobočan¹

¹Univerzitetni klinični center Maribor,

²Masaryk University,

³Medical University of Vienna,

⁴Technische Universität Dresden

Keywords: simulation training; obstetrics; gynecology; multidisciplinary team

Background: Obstetric and gynecological emergencies require swift and coordinated responses to ensure maternal and neonatal safety. Despite the recognized importance of simulation-based training, a standardized, internationally applicable course does not yet exist. The ROUTINE project aims to develop and evaluate a structured simulation course to enhance multidisciplinary team training in managing obstetric and gynecological emergencies.

Methods: This Erasmus+ funded initiative brings together four European institutions specializing in obstetrics, gynecology, and medical education. This project runs from November 2024 to October 2026 (24 months). Through a project group consensus on course topics, development of learning units and refinement of such a two-day training program will incorporate high-fidelity simulations, structured debriefings, and e-learning modules. The effectiveness of the course will be assessed through pre- and post-training evaluations measuring knowledge acquisition, technical skills, and non-technical competencies such as teamwork and decision-making. The course materials, including scenarios and e-learning content, will be made freely accessible online.

Results: The project aims to produce a fully standardized simulation course covering seven high-priority obstetric and gynecological emergencies. The project team agreed in the initial development phase to the following topics: eclampsia, shoulder dystocia, anaphylaxis, postoperative dyspnoea and pulmonary embolism, postpartum haemorrhage, maternal collapse, resuscitation, perimortem caesarean section and acute fetal hypoxia. Pilot implementations will train 72 healthcare professionals from Czech Republic, Germany, Austria and Slovenia, with impact assessments demonstrating improvements in technical and non-technical competencies. The validation process will compare simulation-trained participants with a control group receiving only theoretical instruction.

Conclusion: ROUTINE seeks to establish a benchmark for simulation-based training in obstetric and gynecological emergencies across Europe. By fostering interdisciplinary cooperation and standardizing training methodologies, the project aims to enhance patient safety, improve emergency response skills, and contribute to the broader adoption of simulation-based education in medical curricula.

None declared.

A Fetal Abdominal Cyst Mass Leading to the Diagnosis of Total Neonatal Jejunoileal Atresia

Dr. Chiraz REGAIEG¹, Dr Manel CHARFI ¹, Dr Amira BOURAOUI¹, Dr Nadia KOLSI¹, Pr Amel BEN HAMED¹, Pr Afef BEN THABET¹, Pr Nedia HAMIDA¹

¹Departement of neonatology-hedi chaker university hospital

Objective: We report an unusual case in which prenatal magnetic resonance imaging (MRI) of a fetal abdominal cystic mass was related to a total neonatal jejunoileal atresia

Case Presentation: We report a rare case in which prenatal magnetic resonance imaging (MRI) identified a fetal abdominal cystic mass, later confirmed as total jejunoileal atresia with a normal appendix and colon. At birth, the neonate exhibited significant abdominal distension, reduced bowel sounds, and no palpable mass. By the sixth hour of life, the infant developed bilious vomiting, severe abdominal distension, and signs of peritoneal irritation. Given the diagnostic complexity, emergent laparotomy was performed, revealing total jejunoileal atresia. A duodenocolic anastomosis was successfully performed, and the patient received postoperative parenteral nutrition with a favorable outcome.

Conclusion: Total congenital absence of the jejunum and ileum without associated gastrointestinal anomalies is a severe and life-threatening condition with a poor prognosis. Prenatal MRI plays a crucial role in assessing intestinal obstruction and facilitating perinatal management. Further large-scale studies are essential to establish comprehensive prenatal diagnostic criteria for these rare anomalies.

none declared

Prenatal Diagnosis of Osteogenesis Imperfecta: A Case Report

Dr. dhouha kamoun¹, dr amina abdenadher, dr nadia kolsi, dr manel charfi, dr amira bouraoui, dr nadia hmida

¹CHU hedi chaker , sfax , tunisia

Introduction: Osteogenesis imperfecta (OI), also known as “Lobstein disease” or “glass bone disease,” is a group of genetic disorders characterized by extreme bone fragility, abnormally low bone mass, and a tendency to fracture with varying severity.

Observation:

We report the case of a male newborn, born to a 34-year-old mother, G4P4 she had one healthy living child and two early miscarriage). The pregnancy was well-monitored. The prenatal ultrasound revealed severe and harmonious intrauterine growth restriction, and short femurs with images of multiple fractures.

The baby was delivered by emergency cesarean section at 32 weeks and 3 days of gestation.

At birth, the newborn weighed 1350g (<3rd percentile), had a head circumference of 29.5 cm.

He presented respiratory distress requiring intubation.

At the examination, facial dysmorphism was noted including triangular face , low-set ears, a saddle nose, blue sclerae,wide sutures, and short and deformed long bones. Also he had a skin that bruises easily .X-ray imaging revealed short long bones with multiple fractures and osteopenia

osteogenesis imperfecta was suspected and confirmed by genetic testing, which identifies mutations in the COL1A1

At day 6 of life, the neonate passed away due to severe and refractory hypoxia.

Conclusion:

The therapeutic management of osteogenesis imperfecta is multidisciplinary and complex, requiring ongoing care throughout the patient’s life. Significant hopes are currently placed on the development of future gene therapy.

none declared

Congenital Mediastinal Mass Diagnosed Antenatally: What Do You Think?

Dr. Chiraz REGAIEG¹, Dr Amira BOURAOUI¹, Dr Amina ABDENNADER¹, Dr Douha KAMOUN¹, Pr Afef BEN THABET, Pr Nedia HAMIDA¹

¹Departement of neonatology-hedi chaker university hospital

Objective: This report presents a case of congenital pericardial teratoma diagnosed prenatally via ultrasonography.

Case presentation: A male newborn was delivered vaginally following prenatal detection of a mediastinal mass, accompanied by significant pericardial and pleural effusion, cardiac displacement, and hydramnios. At birth, the neonate exhibited severe respiratory distress, necessitating mechanical ventilation. A chest X-ray revealed a widened mediastinum with cardiomegaly, while echocardiography identified a large pericardial effusion associated with an intrapericardial tumor. Chest tomography confirmed the presence of an intrapericardial mass along with substantial pericardial and pleural effusion. The infant rapidly developed complications, including ascites, severe hemodynamic instability, and cardiac tamponade, leading to heart failure. Despite intensive resuscitation efforts, the newborn did not survive. Histopathological analysis confirmed an immature teratoma.

Conclusion: Early prenatal diagnosis is crucial, as it may allow for antenatal interventions, such as in-utero drainage, which can facilitate postnatal management and potentially improve neonatal outcomes.

none declared

Postnatal hospitalization and relational withdrawal in babies

Dr Khadija CHIHA², Dr Chiraz REGAIEG¹, Dr Khaoula KHAMEKHEM², Dr Donia BEN TOUHEMI², Dr Manel CHARFI ¹, Pr Nedia HAMIDA¹, Pr Yousr MOALLA²

¹Departement of neonatology-hedi chaker university hospital,

²Child Psychiatry Department, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia

Objectives: we proceeded to study the prevalence of relational withdrawal among babies hospitalized in neonatology and the factors associated with it.

Methods :This was a prospective, descriptive, and analytical study spanning 18 months from April 2021 to September 2022, carried out on a sample of mother-baby dyads for whom the babies were hospitalized in neonatology for a period of between 5 and 15 days. Relational withdrawal was assessed by the Baby Distress Alarm (ADBB) scale. The examination took place in the child psychiatry department of Sfax-Tunisia at 3 months and then at 4 months after leaving the neonatology department.

Results :In the first phase, 64 dyads participated in our study compared to 62 dyads in the second phase.

Relational withdrawal of babies was found in 21.9% and 24.2% of cases at three and four months respectively.

The absence of partner support during pregnancy, the female sex of the baby, and the absence of cooing were the main factors associated with relational withdrawal.

Conclusion : It appears from the present study that postnatal hospitalization seems to affect the quality of the mother-baby relationship.

none declared

Obstetric anal sphincter injuries in Slovenia: maternal, neonatal and socio-demographic factors between 2013 and 2022

Dr. Renata Košir-Pogačnik ^1,2 , Dr. Maruša Herzog¹, Dr. Gorazd Kavšek¹, Dr. Mirjam Druškovič¹

¹UMC Ljubljana,

²Faculty of Medicine, University of Ljubljana

Objectives: The aim of the review of data from the National Perinatal Information System (NPIS) was to assess the risk to the mother and fetus and to find possible protective factors for Obstetric anal sphincter injuries (OASIS) in the Slovenian population.

Methods: The research group included 144561 women with a singleton pregnancy who were 37+0 weeks or more pregnant and delivered vaginally in Slovenia between 2013 and 2022. Using a population-based dataset, risk ratios and adjusted risk ratios for anal sphincter rupture were determined using regression analysis (SPSS; IBM). Adjustments were made for year of delivery and maternal age, parity, BMI classes, smoking, maternal height classes and maternal education level. In the second calculation model, adjustments for the type of delivery were added to the variables already mentioned. In the third and final calculation model, the infant’s birth weight was also added to the adjustments. Results with p-values ​​below 0.05 are considered statistically significant.

Results: The OASIS rate for all years in the analyzed period was 0.8%. First-time mothers were about three times more likely to have OASIS than women who had multiple deliveries. The strongest risk factor for OASIS was instrumental vacuum delivery. The birth weight of the newborn was also associated with an increased risk of OASIS, with the risk increasing sharply as the birth weight of the newborn increased. The BMI of the Slovenian pregnant women had no influence on the risk of OASIS. Low maternal height showed a positive association with the risk of OASIS, for maternal height <164 cm. We found a significantly increased risk of OASIS in vaginal delivery after previous caesarean section (VBAC).

Conclusion: We investigated some maternal and fetal risk factors for OASIS. In particular, we aim to investigate what may influence the increased proportion of OASIS in VBAC. In Slovenia, pregnant women are encouraged to attempt vaginal delivery after a previous caesarean section. We want to know if there are factors that we can influence to reduce the proportion of OASIS in VBAC.

None declared.

A case of a retroperitoneal tumor in pregnancy

Mrs. Valentina Trpkovska ¹ , Mrs Barbara Bonča¹, Dr. Maja Pakiž¹, Miss Pija Čater¹

¹University Medical Centre Maribor

Objectives: retroperitoneal tumors are a rare and diverse group of neoplasms arising in the retroperitoneal space, comprising less than 1% of all diagnosed neoplasms. When occurring during pregnancy, they present unique diagnostic and management challenges due to their deep-seated nature, potential malignancy, and the physiological changes of pregnancy. This case report details the presentation, diagnostic workup, management, and outcome of a patient with a retroperitoneal tumor during pregnancy.

Case presentation: a 25-year-old patient was presented to our Department of Gynaecological Oncology at 32 6/7 gestation with pain in the left lumbar region and a cystic formation presumably arising from the left ovary, seen on ultrasound by her gynecologist. With transabdominal ultrasound, we found a solid cystic formation by the left side of the uterus measuring 14 x 12 cm, containing a solid proliferation measuring 61x41 mm, with poor blood flow. We admitted her to our Department of Perinatology. Ultrasound of the fetus showed biometry, amniotic fluid, umbilical artery doppler were normal and CTG was reassuring. The laboratory tests showed highly elevated CA 19-9 (> 12000 kU/L), elevated CA - 125 (47.7 kU/L), and mildly elevated CRP (28 mg/L). MRI of the thorax and abdomen confirmed a retroperitoneal tumor measuring 125 x 140 x 135 mm, not congested to the left ovary. There were no signs of metastatic disease. Otherwise, core biopsy is safe in pregnancy, but in this case, we didn’t perform it because of the cystic nature of the tumor, to prevent possible dissemination. There was a multidisciplinary tumor board meeting, including the sarcoma team, perinatologists, and neonatologists. They decided on an operative therapy. After the course of corticosteroids for fetal lung maturation, at 34 3/7 gestation, we performed a cesarean section by median laparotomy and in the same act removed the retroperitoneal tumor as a whole. We delivered a baby girl with a birth weight of 2130g and an APGAR score 8/9. The pathohistological report showed a primary retroperitoneal mucinous cystadenocarcinoma, completely removed with clear margins. Nearby tissue had elements of cystadenoma and mucinous borderline tumor. There were areas of necrosis but without lymphovascular invasion. Estrogen and progesterone receptors were negative. Afterwards, the gastroscopy and colonoscopy showed no signs of malignant disease. One month after the surgery CA 19-9 dropped to 5646 kU/L and CA -125 elevated to 103 kU/L. After the final histopathological and molecular genetic analysis a consultation with experts from abroad was done. We opted for a follow-up every 3 months, imaging with an MRI of the pelvis, MRI of the upper abdomen, or CT of the thorax and abdomen, alternately. The patient also received psychological support in our department. Four months after the surgery the Ca 19-9 returned to normal values.

Conclusions: This case highlights the complexity of diagnosing and managing retroperitoneal tumors during pregnancy. Early recognition through imaging, accurate histopathological classification, and appropriately timed surgical intervention are crucial in improving maternal and fetal outcomes. It also emphasizes the importance of an individualized approach to treatment planning and a multidisciplinary approach to clinical decision-making.

None declared

From Normal Foetal Scan to Severe Brain Changes: The Unforeseen Neurodevelopmental Effects of Untreated Toxoplasmosis.

Mrs. Keerthika Thangathurai ¹ , Dr Oghenetega Edokpolor¹, Dr Helen Gbinigie¹

¹Medway Maritime Hospital

Introduction:

Toxoplasma gondii is an intracellular protozoan parasite that can be transmitted to the foetus through the placenta. Transmission occurs via raw/undercooked meat containing tissue cysts, food or water contaminated with oocysts from cat faeces, unwashed vegetables, gardening or vertical transmission.

Antenatal treatment reduces transmission risk, which increases from 10–15% in the first trimester to 70–80% in the third, with more severe outcomes if transmission occurs during the first trimester.

Majority of congenitally infected newborns may have no findings on routine examination. Investigations such as CSF analysis, neuroimaging, and ophthalmological evaluation are necessary to identify subclinical end-organ abnormalities.

Long-term complications may include learning difficulties, seizures, hydrocephalus, motor and hearing impairments, chorioretinitis, retinal scarring and impaired vision.

Case description:

Female infant, born at 35+6 weeks, birth weight on the 9th centile and HC on the 75th. Vasa praevia was identified on anomaly scan, prompting regular scans. At 32+1, foetus was small for gestational age. The mother tested IgG and IgM positive for toxoplasmosis with high Toxoplasma Dye Test with low avidity.

Cranial USS showed multiple cystic lesions, hydrocephalus, multiple septations in right ventricle. MRI confirmed obstructive ventricular dilation complicating congenital toxoplasmosis.

Bloods showed Toxoplasma IgG positive, IgM negative, with positive serum and CSF PCR, and high CSF protein.

Treatment was commenced with pyremithamine, sulfadiazine, folinic acid and steroids.

The patient is doing well, monitored for medication toxicity and followed by specialist teams.

Discussion:

Significant brain changes were observed postnatally, despite normal foetal scans three weeks earlier. This underscores the variable course of infection, challenges the notion that severity is inversely proportional to the gestational age at onset, and highlights the importance of thorough postnatal assessments and investigations. Normal antenatal scans and exams do not rule out congenital toxoplasmosis, making early diagnosis and treatment crucial for improving outcomes and preventing severe consequences.

None declared

Monochoriotic monoamniotic twins placenta with true umbilical cord knot

Dr. Andreja Trojner Bregar^1,2, Dr. Ivana Paljk Likar ^1,2, Prof Erika Cvetko^2,4, Prof Nataša Tul Mandić^2,3

¹Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center,

²Division for gynecology and obstetrics, Faculty of Medicine, University of Ljubljana,

³Hospital for Women Diseases and Obstetrics Postojna,

⁴Institute of Anatomy, Faculty of Medicine, University of Ljubljana

Objectives Twin pregnancies are high risk pregnancies. The most important determinant of the perinatal outcome pregnancies are chorionicity and amnionicity. Monoamniotic twins carry an increased risk of adverse pregnancy outcomes compared to monochorionic diamniotic twins. Monochorionic pregnancies are rare and have a high risk of miscarriage, fetal death, preterm delivery, low birth weight, congenital anomalies and complications due to placental vascular anastomoses. A specific complication of monoamniotic pregnancies is umbilical cord entanglement - with a prevalence of almost 100% in monochorionic monoamniotic twin pregnancies. We present a case of true knot and severe umbilical cord entanglement with favorable perinatal outcome.

Case presentation

A 33-year-old healthy primigravida, with a normal body mass index (21 kg/m2) and unexplained infertility, conceived after IVF with single embryo transfer. She was referred to our department at 12 weeks. We diagnosed a monochorionic – monoamniotic twin pregnancy with normal growth, anatomy and dopplers in both fetuses, an anterior placenta with eccentric insertion of both umbilical cords and a cervical length of 40 mm. After extensive counseling about the risks and complications of monochorionic – monoamniotic twins, the parents decided to continue the pregnancy. The course of the pregnancy was uneventful for the mother and the fetuses with all biweekly ultrasound examinations showing normal results. At 30 weeks she was given corticosteroids for fetal lung maturation. A planned cesarean section was performed at 32 weeks +1 day. Two healthy female newborns were delivered, with birth weight 1770 g and 1510g respectively. They were subsequently discharged from NICU after 16 days of uneventful course without any medical intervention.

Postpartum examination of the placenta revealed a monochorionic placenta with massive intertwining of the umbilical cords with a true knot in each cord. Additionally, an unusual, partially velamentous course of both the two umbilical cords and their vessels was observed. The placenta was then prepared for preservation. All arteries and veins of the umbilical cords were injected with acrylate monomers (PoliRepair S, PoliDent, Volčja Draga, Slovenia) mixed with different dyes to identify the fetal connections .

Conclusions Umbilical cord entanglements and knots are associated with frequent adverse perinatal outcomes in monochorionic monoamniotic twins. Our case of monochorionic monoamniotic pregnancy after single embrio IVF transfer had a favoruble outcome. We made detailed postpartum placental vessels analysis with dye preparation.

None declared

Antimicrobial prophylaxis administration in relation to umbilical cord clamping and the risk of Surgical Site Infection: cohort data at University Hospital of Obstetrics and Gynecology, Tirana, Albania

Asoc Prof Enkeleda Prifti ^1,2 , Dr. Lorela Hysi¹, Dr. Enxhi Vrapi²

¹University Hospital Of Obstetrics And Gynecology “Koço Gliozheni”, ²University of Medicine

Objectives: This study aims to estimate the additional risk of Surgical Site Infections, if antimicrobial prophylaxis is given before incision, during cesarean delivery.

Methods: This is an ongoing one center, randomized controlled study at UHOG “ Koco Gliozheni “, with about 6000 delivery for year, with a cesarean section rate of 33% . We prospectively collected data from patients who delivered by cesarean section from March 2023 until February 2024. Patients were all given Surgical Antimicrobial Prophylaxis, and they were randomized in two groups : SAP before incision versus SAP after cord clamping. They all received the same prophylactic antibiotic, cephazoline or metronidazole, according to ACOG guideline. Patients were evaluated on site, before discharge, 10 days after the delivery and were assessed by phone interview one month after the procedure. Women who failed to answer or present for follow-up evaluation were excluded from the study. Co- variables taken into consideration, as possible risk factors for SSI, were age, BMI, ASA score of comorbidity, emergency or elective c-section and duration of surgery. Surgical site infection, classified according to the CDC criteria as either superficial, deep incisional or organ tissue space, served as the primary outcome studied.

Statistical analyzes was performed by means of adjusted odd ratios, chi-square test and logistic regression. Significance level was set at < 0.05.

Results: Out of the 329 patients who underwent a cesarean section during the study period, 224 patients met the inclusion criteria. SAP was administered before incision in 107 (47.8%) patients and after clamping in 117 (52,2 %) patients. Overall 30 (13.4%) SSIs were documented , of which 16 (53.3%) occurred before incision and 14 (46.7%) after clamping. The adjusted odd ratio for SAP administration after clamping was not significantly associated with an increased SSI rate compared to before incision (OR 0.69, CI 0.18 - 2.6, p=0. 59). Age (OR 1.58, p = 0.5) and BMI (OR 1.31, p = 0.69) were not found to statistically increase infection rates. Emergency cesarean section and ASA score of 1 or higher increased risk of infection 5 fold and 4.5 fold respectively. Despite the high Odd Ratio of SSI, both were not statistically significant (p=0.08 and p=0.2). The logistic regression analyzes also showed no increased risk of surgical site infection following administration of SAP after cord clamping.

Conclusions: There is no increased risk of Surgical Site Infections, if Surgical Antibiotic Prophylaxis is given after umbilical cord clamping. The growing concern about long-term consequences of early life exposure to antibiotics, requires implementing new strategies regarding the use of them during delivery.

Aim: This study aims to estimate the additional risk of Surgical Site Infections, if antimicrobial prophylaxis is given before incision, during cesarean delivery.

Materials and methods: This is an ongoing one center, randomized controlled study at UHOG “ Koco Gliozheni “, with about 6000 delivery for year, with a cesarean section rate of 33% . We prospectively collected data from patients who delivered by cesarean section from March 2021 until February 2022. Patients were all given Surgical Antimicrobial Prophylaxis, and they were randomized in two groups : SAP before incision versus SAP after cord clamping. They all received the same prophylactic antibiotic, cephazoline or metronidazole, according to ACOG guideline. Patients were evaluated on site, before discharge, 10 days after the delivery and were assessed by phone interview one month after the procedure. Women who failed to answer or present for follow-up evaluation were excluded from the study. Co- variables taken into consideration, as possible risk factors for SSI, were age, BMI, ASA score of comorbidity, emergency or elective c-section and duration of surgery. Surgical site infection, classified according to the CDC criteria as either superficial, deep incisional or organ tissue space, served as the primary outcome studied.

Statistical analyzes was performed by means of adjusted odd ratios, chi-square test and logistic regression. Significance level was set at < 0.05.

Results: Out of the 329 patients who underwent a cesarean section during the study period, 224 patients met the inclusion criteria. SAP was administered before incision in 107 (47.8%) patients and after clamping in 117 (52,2 %) patients. Overall 30 (13.4%) SSIs were documented , of which 16 (53.3%) occurred before incision and 14 (46.7%) after clamping. The adjusted odd ratio for SAP administration after clamping was not significantly associated with an increased SSI rate compared to before incision (OR 0.69, CI 0.18 - 2.6, p=0. 59). Age (OR 1.58, p = 0.5) and BMI (OR 1.31, p = 0.69) were not found to statistically increase infection rates. Emergency cesarean section and ASA score of 1 or higher increased risk of infection 5 fold and 4.5 fold respectively. Despite the high Odd Ratio of SSI, both were not statistically significant (p=0.08 and p=0.2). The logistic regression analyzes also showed no increased risk of surgical site infection following administration of SAP after cord clamping.

Conclusion: There is no increased risk of Surgical Site Infections, if Surgical Antibiotic Prophylaxis is given after umbilical cord clamping. The growing concern about long-term consequences of early life exposure to antibiotics, requires implementing new strategies regarding the use of them during delivery.

Prognosis of fetal pleural effusion in the absence of prenatal intervention

Dr. Amira Bouraoui¹, Dr Chiraz Regaieg¹, Dr Manel Charfi ¹, Dr Amina Abdennadher¹, Dr Afef Ben Thabet¹, Dr Nadia Kolsi¹, Dr Nedia Hamida¹

¹Department of Neonatology, university of Sfax

Fetal pleural effusions are associated with perinatal morbidity and mortality which may improve with fetal intervention.

Background: We aimed to present the outcomes of fetal pleural effusions in a country who there’s no possibility of fetal intervention.

Methods: Fetuses with prenatal diagnosis of fetal pleural effusion delivered between January 2015 and December 2024 were included. Fetal pleural effusion was diagnosed, using fetal echocardiography. Hydrops fetalis was excluded.

Results:

Among 8 fetuses with antenatal diagnosis of pleural effusion, the was only one death. In 3 cases, there were bilateral pleural effusions. Fetal MRI was performed in half of cases and diagnosis bronchopulmonary dysplasia in three cases. Delivery was occurred in a tertiary care center without fetal intervention. Cesarian section was performed in all cases. Six newborns are full term, two are preterm and all infants have severe respiratory distress with necessity of mechanical ventilation and urgently inserted chest tube. The diagnosis after birth was pulmonary sequestration in one newborn and chylothorax in 6 cases. One patient had down syndrome. No other malformation was diagnosed. After neonatal care, pulmonary sequestration spontaneously regressed at the age of 18 months. Chylothorax required treatment with somatostatin in 2 cases and regressed after the average age of 1 month in the other cases.

Conclusion: In most cases of fetuses with prenatal pleural effusion, the perinatal outcomes were generally favorable. This information will be useful in optimizing the counseling and care of these patients.

no

Risk factor of neonatal mortality in a north African country

Dr. Amira Bouraoui¹, Dr. Manel Charfi ¹, Dr. Dhouha Kammoun¹, Dr Nadia Kolsi¹, Dr Afef Ben Thabet¹, Dr Chiraz Regaieg¹, Dr Nedia Hamida¹

¹Département of neonatology, university of Sfax

In this tertiary neonatal unit, mortality decreased from 46.6% in 1972 to 11.5% in 2012. However, it is still considerably high.

Purpose: Identify the risk factors of mortality in a southern country of Tunisia.

Methods: we conduct a retrospective and comparative case-control study over a period of 2 years from January 2020 to December 2022. We included newborns with gestational age greater than 26 weeks’ gestation and birth weight greater than 800g.

Results: Over this period, 3309 newborns were hospitalized. We included 512 newborns divided into 254 cases of death and 258 controls. Mother age was in 30.6% between 30 and 35 years, consanguinity was noted in 26.8%. Cesarean section was performed in 66.9%. Mortality rate was 8 %. In the dead group, 55.1 % was male, 52.4 % have a low birth weight, and 48.8 % was very preterm baby, 51.6 % dead after a first week of life.

The main risk factors of mortality in the first week of life was chromosomal abnormalities, the lack of antenatal corticosteroid therapy which is related to lack of pregnancy survey, and hypoxic encephalopathy. During hospitalization, healthcare-related infections were a significant factor in mortality as well as respiratory complications, particularly in premature babies.

Conclusion:

A lack of pregnancy monitoring resulting to lack of resources and perinatal networks in our country is an avoidable risk factor of neonatal mortality. Healthcare related infections continues despite prevention, to be a risk factor for excess hospital mortality.

No

Antenatal diagnosis of the posterior urethral valves in a developing country: cases series

DR Saloua Ammar², Dr Sahla Sellami², Dr Chiraz Regaieg¹, Dr. Nadia Kolsi¹, Dr Manel Charfi ¹, DR Manar Hbaieb², DR Hayet Zitouni², DR Amira Bouraoui¹, DR Nédia Hentati¹, Dr Riadh Mhiri²

¹Departement of neonatology, Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia,

²department of Pediatric surgery, hedi chaker Hospital,Faculty of medicine of sfax, University of Sfax, TunisiaHospital

Objectives :

Valves of the posterior urethra (VUP) are the most frequent low obstructive malformative uropathy of the newborn male, whose prognosis can be unfavorable due to its impact on the upper urinary tract and bladder function. The aim of this work is to evaluate the contribution of antenatal ultrasound in the antenatal diagnosis of VUP in the region of the south our country, as well as its evolutionary aspects.

Methods:

Records of patients managed for VUP in the department of pediatric surgery were retrospectively reviewed.

Results:

Twenty files were collected. Pregnancy was monitored by obstetric ultrasound in 18 patients. Antenatal diagnosis of malformative uropathy was suspected in 12 patients (at the third-trimester ultrasound for 9 patients, and the morphological ultrasound for three patients). Pelvic dilation in 7 cases, ureteral and pelvic dilatations in 4 cases, renal parenchymal anomaly in 2 cases and megavessia in 4 cases associated with oligohydramnios in 3 cases were found on ultrasound. Keyhole sign” or urethral dilatation was not visualized in any patient. In the 12 patients with antenatal diagnosis, a systematic post-natal ultrasound was performed in 9 patients. Three patients had post-natal ultrasound after the appearance of clinical signs. For the remaining 8 patients, the diagnosis was made postnatally after a urinary tract infection or disfonction. All patients underwent a temporary urinary diversion (bladder catheterization, vesicostomy and ureterostomy) prior to electro-section of the urethral valves. Mean follow-up time was 64 months. The course was marked by recurrent UTIs and mictional disorders in 65% and chronic renal failure in 4 cases and death in the neonatal period in one patient.

Conclusion:

Obstetrical ultrasonography often allows to suspect the malformative uropathy without specifying the diagnosis of VUP. Strongly suggestive ultrasound signs (keyhole sign, megavessia and oligohydramnios) were noted in only 22.5% of our series. The active search for these signs in the presence of antenatal hydronephrosis, and the performance of postnatal ultrasound in these patients during the first hours of life, would enable optimal early management and a better prognosis.

none declared

Risk factors of postoperative mortality in neonatal intestinal obstruction

Dr Saloua Ammar², Dr Emna Krichen², Dr. Nadia Kolsi¹, DR Manel Charfi ¹, Dr Salma Kharrat², DR Chiraz Regaieg¹, DR Hayet Zitouni², DR Amira Bouraoui¹, Dr Nedia Hentati¹, DR Riadh Mhiri²

¹Departement of neonatology,Hedi Chaker Hospital, Faculty Of Medicine Of Sfax, University Of Sfax, Tunisia,

²department of Pediatric surgery, hedi chaker Hospital,Faculty of medicine of sfax, University of Sfax, TunisiaHospital

OBJECTIVES:

Neonatal intestinal obstruction (NIO) is still a life threatening condition. Preventable complicated outcomes and death from NIO need to be identified with insight into how to improve survival. This study aimed to evaluate perioperative variables potentially predictive of morbidity and mortality in newborns with NIO.

METHODS:

We carried out a retrospective, descriptive and analytic study of the records of patients operated on for NIO in the pediatric surgery department in collaboration with the neonatology department of Hedi Chaker Hospitl in Tunisia between January 2010 and December 2022. We performed uni and multivariate analytic study of factors predictive of morbidity and mortality.

RESULTS:

There were 130 cases who required surgical repair. The sex ratio was 1.6. Prematurity was found in 42.3% of cases. Occlusive syndrome associating vomiting, abdominal bloating and meconium emission anomaly was found in 53% of newborns. Associated congenital malformations were observed in 32.3% of patients. The etiologies of NIO were anorectal malformation in 32.3% of cases, duodenal atresia in 29.2% of cases, small bowel atresia in 16.9% of cases, Hirschsprung disaese in 8.5% of cases, enterocolitis in 7.7% of cases, small bowel volvulus in 3.8%, colonic atresia in two cases. Post-operative complications occurred in 36.2% of cases.The most common early postoperative complication in our study was sepsis observed in 10% of cases. Mortality was observed in 23.1% of cases.After the univariate analysis, the predictive factors of mortality were prematurity (p=<10.3), birth weight <2500g (p=<10.3), age at diagnosis>2 days (p=0.04), preoperative intubation for respiratory distress (p=0.006), duration of surgery>120 min (p=0.002) and occurrence of postoperative complications (p=0.03).

On the multivariate analysis, the independent risk factors of postoperative mortality were the duration of surgery>2hours (p=003, OR = 3.072 CI [1.112–8.488]) and the occurance of early postoperative complications (p=0.04, OR=2.992 CI[1.051-8.513]).

CONCLUSION:

Despite advances in pediatric anesthesia and neonatal care, mortality and morbidity rates remain high compared with series in developed countries. These results highlight the critical need sepsis prevention, for the early diagnosis of associted malformations and optimizing the time of the surgical intervention. Further studies on intra-operative surgical and anesthetic parameters for the management of this population may give insights on how to reduce intra-operative risks.

None declared

Prenatal diagnosis of isolated dextrogastria

Dr. Besjona Kodra ¹

¹Uhog “mbreteresha Geraldine”, ²University of Medicine

Objectives

Dextrogastria, the right-sided positioning of the fetal stomach, is a rare prenatal finding often associated with situs anomalies or other congenital abnormalities. However, isolated dextrogastria without additional findings is uncommon, and its clinical significance remains unclear.

Case Presentation

We report the case of a 29-year-old woman, G2P1, whose first pregnancy was uneventful. In her second pregnancy, routine first-trimester ultrasound raised suspicion of dextrogastria, which was confirmed in the second trimester. A detailed anatomical scan, including fetal echocardiography, showed no additional anomalies. Although the double test screening resulted normal (low risk) for chromosomal aneuploidies, invasive genetic testing was offered but was declined by the patient. The pregnancy progressed normally uneventful, and the baby was delivered at term via cesarean section for maternal indications (previous cesarean birth). The newborn weighed 3400 g and was healthy, with postnatal assessment confirming isolated dextrogastria without associated abnormalities. There were no problems with feeding, GI transit and the growth rate for the first 3 months is normal.

Conclusion

Dextrogastria is typically linked to complex syndromes, necessitating a thorough prenatal workup to rule out associated anomalies. Literature review indicates that most cases are part of situs anomalies or heterotaxy syndromes 1; however, isolated cases have been reported with favorable outcomes. It is estimated that this finding is extremely rare (0.00005%) – situs inversus with levocardia.2 Management primarily involves detailed imaging and individualized counseling. In the absence of other findings, prognosis is generally excellent, as demonstrated in this case.

Isolated dextrogastria is a rare but benign prenatal finding. The diagnosis of situs inversus with levocardia is challenging but as our case shows it is possible to diagnose even early during the pregnancy. This case highlights the importance of comprehensive prenatal assessment and counseling while emphasizing that normal outcomes are possible in the absence of additional anomalies.

Keywords: Dextrogastria, fetal ultrasound, situs anomalies, prenatal diagnosis, isolated dextrogastria, case report

References:

1. Antenatally diagnosed right-sided stomach (dextrogastria): A rare rotational anomaly Versteegh, Hendt P. et al. Journal of Pediatric Surgery, Volume 51, Issue 2, 236 - 239

2. Mendonça, C. et al “Abdominal Situs Inversus with the Heart in the Right Place – A Case Report.” The Fetal Medicine Foundation, 2022, https://fetalmedicine.org/abstracts/2022/var/pdf/abstracts/2022/04189.pdf.

None declared

Comparison of Dried Blood Spots and Dried Urine for Congenital Cytomegalovirus Neonatal Screening

Dr. Nika Eržen ¹ , Dr. Jernej Kovač², Dr. Marko Pokorn^3,4, Dr. Darja Paro Panjan^1,4, Dr. Gregor Nosan^1,4

¹Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana,

²Clinical Institute of Special Laboratory Diagnostics, University Medical Centre Ljubljana,

³Department of Infectious Diseases, University Medical Centre Ljubljana,

⁴Department of Paediatrics, Faculty of Medicine, University of Ljubljana

Introduction: Screening newborns for congenital cytomegalovirus (CMV) infection (cCMV) is crucial for early diagnosis and timely antiviral treatment of moderate and severe cases. The standard screening method for CMV detection is polymerase chain reaction (PCR) testing of saliva, which has an approximate sensitivity of 93 % and specificity of 100 % (1). Positive results are typically confirmed through PCR testing of urine. Dried blood spots (DBS) are also used for cCMV screening, offering comparable specificity (100 %) but lower sensitivity (86 %) (1). Given the higher viral load in urine, PCR testing of dried urine samples may serve as a feasible alternative screening method for cCMV (2). This study aimed to assess the feasibility of CMV detection using DBS and dried urine and to evaluate both approaches as potential cCMV screening methods.

Methods: A prospective study was conducted on a representative cohort of newborns delivered in all Slovenian maternity hospitals between May and September 2023. DBS were collected on filter paper within the first days of life and screened for CMV DNA using quantitative PCR (qPCR). In newborns with a positive screening result, urine samples were tested for CMV DNA within the first 21 days of life using PCR to confirm cCMV. With parental consent, dried urine samples collected on filter paper were also tested for CMV DNA using qPCR. The study was approved by the Slovenian National Medical Ethics Committee (reference number 0120-38/2023/4).

Results: During the five-month study period, 5560 newborns were screened, and 11 tested positive for CMV. Confirmatory PCR urine testing was performed in 10 of these cases, all of which were CMV-positive. Additionally, all 10 newborns were also tested positive for CMV in dried urine samples collected on filter paper. When comparing DBS and dried urine samples, the cycle threshold (Ct) values were higher in DBS (Ct 33) than in dried urine (Ct 20), indicating higher viral load in dried urine.

Conclusion: Our findings indicate that qPCR analysis of both DBS and dried urine samples accurately detected cCMV in the 10 confirmed cases, suggesting that both methods could serve as potential screening approaches. The higher viral load in dried urine is likely to enhance the sensitivity of this screening method compared to DBS. However, implementing urine collection and processing on a large scale would require substantial infrastructure adaptations and increased costs (2). Consequently, DBS remains a promising low-cost, high-throughput alternative for cCMV screening.

References

1. Dollard SC, Dreon M, Hernandez-Alvarado N, et al. Sensitivity of Dried Blood Spot Testing for Detection of Congenital Cytomegalovirus Infection. JAMA Pediatr. 2021;175(3):e205441.

2. Amin MM, Wong P, McCann M, et al. Detection of Cytomegalovirus in Urine Dried on Filter Paper. J Pediatric Infect Dis Soc. 2021;10:958-61.

Key words: congenital cytomegalovirus infection; neonatal screening, dried blood spot; dried urine

None declared

Paraurethral cyst in a female newborn: witch therapy to choose

Dr. Amina Abdennadher¹, Dr Dhouha Kammoun¹, Dr Chiraz Regaieg¹, Dr Manel Charfi ¹, Dr Nihed Bouzidi¹, Dr Afef Ben Thabet¹, Dr Amel Ben Hamed¹, Dr Amira Bouraoui¹, Dr Nedia Hamida¹

¹Department of neonatology,Chu Hédi Chaker

Objectives:

In this case, we aimed to present a case of paraurethral cyst in a female infant to provide insight into the typical progression of paraurethral cysts in newborn girls and to educate medical professionals on accurate diagnosis and effective treatment.

Case presentation:

We report the case of a 1-day-old female newborn who was referred to our hospital for an interlabial mass. The patient was born via vaginal delivery without any complications at 40 with a weight of 3.300 grams (50th-75th percentile) at a height of 52 cm (75-90th percentile). On systemic examination, the patient’s general status was good. The neonatal reflexes were active and alive, and her vital signs were normal. On conducting a genital examination, we noticed a mass that measured roughly 3 by 2 centimeters in size. The mass was covered with genital mucosa, had an ovoid shape, felt soft, and was partially reddish with a generally creamy appearance (Figure1). The patient had spontaneous urine output. Urethra was easily catheterized by 6 Fr. Complete blood count (CBC), C-reactive protein, and urine cytobacteriological examination (UCBE) were normal. Ultrasonography revealed a cystic lesion with a smoothly contoured, thick-walled, and hypoechoic center that was adjacent to the urethra. Based on the results of the clinical characteristics and the imaging findings, the diagnosis of Skene’s duct cyst was evoked. After informed consent was obtained from the family, the patient underwent needle puncture under sterile conditions at her bedside without anesthesia. The needle aspiration cleared out a mucoid, slightly hematic, fluid from the mass. The urethra and vagina were normal after the procedure (figure 2). A direct examination of the fluid showed the presence of numerous leukocytes, isolated and in clusters, altered and not with Some red blood cells. A bacteriological examination revealed the presence of Proteus mirabilis. Cefotaxime with gentamicin were given up to 7 days. The cyst did not recur during follow up at the neonatal unit or after the patient’s discharge.

Conclusion:

Despite the potential for diagnosis through physical examination alone, the lack of awareness among physicians about Skene’s duct cyst may lead to in improper management such the unnecessary use of invasive tests or radiographic examinations. Hence, being mindful of the distinctive characteristics of Skene’s duct cyst can prevent such interventions. The treatment of this condition is still a subject of debate, with some advocating for surgical excision and others favoring non-operative treatment.

Key words: Newborn- Paraurethral cysts - Skene’s duct cyst – Therapy

None declared

The effect of intestinal endometriosis on conception, pregnancy and delivery – a retrospective research

Mrs. Tina Sirc ¹ , dr. Vesna Šalamun²

¹Woman’s hospital Kranj, ²Clinical department of reproductive medicine, Gynecology clinic, University clinical center Ljubljana

Objectives: Intestinal endometriosis is a form of deep endometriosis. While the association with chronic pain has been established, the assiciation with infertility is less well defined. The impact of endometriosis on pregnancy and birth outcomes is poorly studied. Placenta previa is one of the most common complications in obstetrics related to endometriosis. The aim of our research was to examine the impact of intestinal endometriosis on conception, pregnancy and delivery outcomes in women with intestinal endometriosis.

Methods: Retrospective research from 2014 to 2021 at the Clinical department of Reproduction, Gynecology Clinic, UKC Ljubljana included 134 women with intestinal endometriosis, of whom 79 became pregnant, and we obtained data for 69 deliveries. The control group is 134 843 women without known bowel endometriosis who gave birth during the same time period.

Results: Women with intestinal endometriosis had a higher incidence of placenta previa, gestational hypertension and premature birth. Bowel endometriosis was an independent risk factor for placenta previa. They had more abnormalities during childbirth, more frequent breech or transverse presentation of the fetus, more postpartum bleeding and more frequent cesarean delivery. Newborns were more often small for gestational age, had a worse Apgar score, were more often treated in the neonatal intensive care unit, there were more stillbirths and higher perinatal mortality. Women with intestinal endometriosis concieved later and frequently needed ART procedures compared to general population.

Conclusion: Women with intestinal endometriosis have more complications during pregnancy and childbirth compared to the control group, therefore we should adjust treatment accordingly.

None declared

Table 1.pdf (could not be inserted)

Management of severe bilateral vesicoureteral reflux in a newborn: A case report

Dr. Amina Abdennadher¹, Dr Dhouha Kammoun, Dr Manel Charfi ¹, Dr Nadia Kolsi¹, Dr Chiraz Regaieg¹, Dr Nihed Bouzidi¹, Dr Afef Ben Thabet¹, Dr Amel Ben Hamed¹, Dr Amira Bouraoui¹, Dr Nedia Hamida¹

¹Departement of neonatology, Chu Hédi Chaker

Objectives: In this study, we aimed to review the prognostic factors that should be evaluated in fetuses with bilateral urinary tract dilation (UTD).Furthermore, we discussed the therapeutic strategies for preserving renal function in neonates with congenital urinary tract anomalies, with the goal of minimizing the risk of long-term renal damage.

We present the case of a male newborn with severe oligohydramnios and bilateral moderate hydronephrosis diagnosed at 35 weeks of gestation (WG). The pregnancy was well-monitored, and the patient was delivered via C-section at 35 WG, with an Apgar score of 9/10 and a birth weight of 2650 g. Upon admission to the neonatal unit, clinical examination was normal, and urine was emitted with a good stream at 4 hours of life.

Initial renal ultrasound (RUS) on Day 1 showed normal-sized kidneys, regular contours, and good cortico-medullary differentiation, while a follow-up ultrasound on Day 3 revealed bilateral ureteropelvic dilation with an APD of 10 mm on the left and 7 mm on the right. Creatinine levels were elevated at 219 µmol/L, with a pH of 7.29. A Voiding Cystourethrogram (VCUG) identified bilateral grade 5 vesicoureteral reflux(Figure 1). Despite 3 days of urinary drainage, creatinine levels remained high at 240 µmol/L.

The patient underwent a bilateral ureterostomy via single-site laparoscopic surgery. Post-surgery, serum creatinine decreased to 155 µmol/L, and he was discharged at 40 days of age with a weight of 2500 g. A DMSA scan at discharge showed right renal function at 12.5% and left renal function at 87.5%, with irregular contours and a lower polar notch on the left kidney.

At 1 year and 4 months, the child had normal growth and development (weight 11 kg, height 80 cm), with no recurrent urinary tract infections. Renal function improved, with a creatinine level of 55 µmol/L and a renal clearance of 53 ml/min/1.73m². A follow-up VCUG showed a rudimentary bladder and a tortuous left ureter, with mild right ureteral dilation(Figure 2).

Conclusion :

This case highlights the importance of early diagnosis and intervention in newborns with severe bilateral vesicoureteral reflux. Timely surgical intervention, such as bilateral ureterostomy, can help manage urinary tract abnormalities and prevent renal. damage. Follow-up evaluations demonstrated significant improvement in renal function and growth, underscoring the potential for positive outcomes with appropriate management.

Keywords: hydronephrosis; vesicoureteral reflux; ureterostomy; Acute kidney failure

None declared

Thirteen Years of Clinical Experience with NIPT Testing

Dr. Ursula Res Muravec ¹ , MAJA MERKUN, MILI LOMSEK, IRENA TONIN, STANKO PUSENJAK, NATASA TUL MANDIC

¹Health Center Dravlje

Objectives:

Non-invasive prenatal testing (NIPT) has transformed prenatal screening a lot by offering a highly sensitive and specific method for detecting fetal aneuploidies from maternal plasma. This study aims to assess the trends in maternal age, other prenatal tests, rate of inconclusive results, high-risk results rate, evaluate test accuracy, problems with sex chromosome abnormalities.

Methods:

We conducted a retrospective analysis of all NIPT tests performed at our institution from 2012 to 2024. Statistical analysis focused on the following:

1. Maternal Age Trends: Yearly average maternal age of patients undergoing NIPT was calculated, and linear graph was generated.

2. Use of other prenatal screening tests - nuchal translucency and double hormonal test - before NIPT test.

3. Test Performance: The proportion of tests resulting in an official report, requiring resampling, or remaining inconclusive was calculated.

4. High-Risk Results: The frequency of high-risk classifications was determined.

5. Positive Predictive Value (PPV): The PPV for trisomy 21 was calculated to assess the reliability of high-risk results.

6. Accuracy in Sex Chromosome Abnormalities: We examined the rate of false-positive results for sex chromosome aneuploidies.

Results:

1. A total of 4454 patients performed NIPT over thirteen years. A linear decrease in average maternal age was observed.

2. Majority of NIPT patients have performed other prenatal tests, 58.78% nuchal translucency, 33.41% nuchal translucency and double hormonal test before NIPT. For 7.81% we don’t have the information, or they performed no test.

3. Regarding test performance, 99.66% of tests resulted in official report, while 0.34% received NoCall report. In 0,96% resample was needed.

4. Among all tested patients, 1.48% received a high-risk result, necessitating further clinical evaluation and diagnostics: 69.70% amniocentesis, 19.70% chorionic villus sampling, 3.03% diagnostics after miscarriage, 4.55% no further diagnostics, 1.52% miscarriage and no diagnostics, 1.52% amniocentesis and chorionic villus sampling. There were 22,72 % false positive results.

5. The PPV for trisomy 21 was 96,97%, confirming the test’s exceptional accuracy for T21.

6. 70% of all false positive results belonged to sex chromosome abnormalities (X0, XYY, XXX).

Conclusions:

Our findings confirm that NIPT is highly reliable screening tool. Over time, we have observed a significant increase in the number of patients performing NIPT, including younger women. This shift reflects growing awareness and trust in NIPT. NIPT is expected to become an even more integral part of routine prenatal care, together with nuchal translucency, double hormonal test and other invasive tests. We have to point out the increased false-positive rate observed for sex chromosome aneuploidies, which is likely due to: placental or maternal mosaicism, maternal sex chromosomal abnormality, X chromosome degradation, vanishing twin syndrome or other. That highlights the need for enhanced interpretation strategies and patient counselling. However, NIPT packages with deeper sequencing and improved bioinformatic algorithm may decrease the false positive rate also among sex chromosome aneuploidies. NIPT offers increasing number of additional chromosomal abnormalities which can be detected, such as deletions, duplications, dominant monogenic conditions. NIPT should be incorporated in insurance covering as part of prenatal testing with more indications.

NO

APGAR SCORE AT THE FIRST AND FIFTH MINUTE AS A PREDICTOR OF SURVIVAL AND INCREASED NEONATAL MORTALITY IN NEWBORNS TREATED IN THE NICU

Prof. Gabriela Bushinoska Ivanova ¹ , Dr Jordancho Ivanov², Dr Jasna Bushinoska²

¹Gynecology and Obstetrics Clinic Skopje, ²Acibadem Sistina Hospital- Skopje

Introduction: The APGAR score at birth in the first and fifth minutes of birth is a significant predictor of survival or increased neonatal mortality rate in the first 28 days after birth. Newborns with higher APGAR scores at 1st and 5th minutes after birth are more vital and more protected from developing complications such as asphyxia, RDS, and severe infections after birth.

Aim of study: The aim of the paper is to show that a higher APGAR score at birth in the newborn, in the first and fifth minutes, or the condition in which the newborn was received at birth, has a significant predictive role in the survival of newborns.

Material and methods: Data from the OINT of the University Clinic of Gynecology and Obstetrics in Skopje were used, among newborns who were cared and treated in the period from 1. 5. 2019 - 31. 1. 2020. During this period, a total of 3453 live births were born at the Clinic, of which 445 newborns were transferred and treated at the NICU. Of these, 368 (82.7%) of the newborns survived, and 77 (17.3%) of the newborns died in the neonatal period of 28 days after birth, as a result of various causes.

Results: Of the total 445 treated neonates, 44(9.90%) neonates had a 1st minute Apgar score < 3, 174(39.10%) neonates had a 1st minute Apgar score of 4 - 6 and 227(51%) neonates had a 1st minute Apgar score of 7 - 10. Of the 44 infants who had an Apgar score at 1 minute < 3, 11 (25%) of the infants survived, while 33 (75%) of the infants died in the neonatal period of 28 days after birth. Of the 174 newborns who had an Apgar score of 4–6 at 1 minute, 140 (80%) of the newborns survived, and 34 (20%) died. Of the 227 newborns who had an Apgar score of 7–10 at 1 minute, 217 (96%) survived, while 10 (4%) died (Figure 1).

Of the total 445 treated neonates, 27 (6.10%) neonates had a 5-minute Apgar score < 3, 98 (22.00%) neonates had a 5-minute Apgar score of 4 - 6, and 320 (71.90%) neonates had a 5-minute Apgar score of 7 - 10. Of the 27 infants with a 5-minute Apgar score < 3, only 3 (11%) survived, while 24 (89%) died. Of the 98 infants with a 5-minute Apgar score of 4–6, 68 (69%) survived, and 30 (31%) died in the neonatal period. Of the 320 infants with a 5-minute Apgar score of 7–10, 297 (93%) survived, and 23 (7%) died (Figure 2).

Conclusion: The APGAR score in the first and fifth minutes of birth, or the condition in which the newborn was received, showed a significant prediction and association with survival and neonatal mortality rate of newborns transferred and treated at NICU.

Key words: APGAR score, neonatal mortality rate- NMR, respiratory distress syndrome - RDS, prematurity, complications of prematurity

None declared

PREMATURE BIRTH AS A RESULT OF CONGENITAL ANOMALY IN A UNICORN UTERUS

Prof. Gabriela Bushinoska Ivanova ¹ , Dr Jordancho Ivanov, Dr Jasna Bushinoska

¹Gynecology and Obstetrics Clinic Skopje, ²Acibadem Sistina Hospital- Skopje

Introduction: Anomalies like unicorn uterus lead to spontaneous abortions, preterm births, fetal malpresentation, PROM, bleeding in pregnancy, increased number of caesarean sections and intrauterine fetal growth retardation. Especially if the condition is complicated and with additional interventions, such as conization of the cervix, but even in such complicated cases, pregnancy is possible despite the small capacity of the uterus and the weakened support from the shortened cervix.

Case report: We report a case of pregnancy in a 39 years patient, with previous conization and with a congenital unicorn uterus with a small capacity, who carried the pregnancy and gave birth prematurely at 32 weeks of pregnancy. Conization was made 18 months before the pregnancy, with histopathological diagnosis of invasive squamous carcinoma of the cervix on the posterior lip, with the greatest depth of invasion up to 1 mm, (PT1A1), and lines of the operative incision endo and exocervical passed through healthy tissue.

The pregnancy was conceived by IVF. The patient became pregnant during the first IVF attempt and the pregnancy began to develop successfully. The length of the cervix was 25 mm. at the start of the pregnancy and the first shortening on the cervix was observed at 21 weeks of pregnancy, when the length became 20 mm. Rest, progestogens and tocolytic therapy were performed, and the first contractions appeared for the first time at 26 weeks of gestation. Corticosteroids were administrated for maturation of the fetal lung at 28 and 31 weeks of pregnancy and the process of delivery began with contractions at 32 weeks of pregnancy, when was decided to end the pregnancy with Caesarean section. A live male fetus weighing 1345 grams and 40 cm. length and with APGAR score 6/7/7, was born at 32,2 gestational weeks. There was no complications from delivery and the patient left the hospital fourth day of operation. The newborn had a proper adaptation after delivery and was placed in the NICU, where it spent 29 days, without major complications, with spontaneous respirations only on the support of diffused oxygen, the first ten days. On the thirtieth day after delivery, the newborn was discharged from the hospital.

Conclusion: Despite the fact that it is difficult to achieve a successful pregnancy in patients with congenital unicorn uterus, and in this case complicated by shortening of the cervix due to conization, however, with good pregnancy management, delivery of a healthy fetus is possible in such cases as well. With timely prescription of corticosteroids and termination of the pregnancy to the maximum gestational week, in this case it was 32 g.w., a healthy and vital fetus can still be obtained, even with a premature birth.

Key words: preterm birth, unicorn uterus, conization, microinvasive carcinoma, caesarean section.

None declared

The role of oxidative stress in placental pathogenesis and adverse neonatal outcome in patients infected with SARS-COV-2 during pregnancy: A prospective clinical study

Dr. Marija Bićanin Ilić ^1,2 , dr Aleksandar Nikolov^1,2, dr Srđan Mujković^1,2

¹Faculty of Medical Sciences, Department of Gynecology and Obstetrics, University of Kragujevac, ²Clinic of Gynecology and Obstetrics, University Clinical Center Kragujevac

Objectives: The impact of the SARS-CoV-2 viral infection during pregnancy on the fetus can be direct—transmitted through the placenta—and indirect—creating unfavorable conditions for the development of the fetus because of inflammation, micro-thrombosis, and hypercoagulation. Our study aimed to determine the types and frequency of pathohistological changes in placental tissue in SARS-CoV-2-positive pregnant women and to examine the possible role of oxidative stress in the prognosis of the delivery and its maternal and fetal complications. Methods: This prospective clinical study included 50 pregnant women divided into two groups, SARS-CoV-2 positive (COVID-19 group) and SARS-CoV-2 negative (control group), from who we collected demographic, clinical, obstetric, biochemical and pathologic data. Data about the newborn characteristics were also collected, which included anamnestic, clinical, and biochemical data. Results: The values of the superoxide anion radical and index of lipid peroxidation were significantly different in mothers concerning the presence of the SARS-CoV-2 infection, while the levels of the nitric oxide, index of lipid peroxidation, reduced glutathione, and superoxide dismutase were significantly different in the newborns depending on the SARS-CoV-2 infection. Newborn characteristics were similar between groups except for concentrations of IgM antibody. The incidence of pathohistological changes of the FVM type in the COVID-19 group of pregnant women was 46%, while in the control group, the incidence was 18%. Conclusions: This study confirmed the significant impact of the SARS-CoV-2 viral infection on maternal and fetal biochemical parameters and oxidative stress-mediated placental dysfunction. Future studies should be performed with more participants and follow-up neonatal development.

None declered

Midtrimester abortion and Emergecy Cerclage

Prof. Rubena Moisiu¹, PHD Rezart Ajazi

¹University Hospital K. Gliozheni, Tirana., Albania

Introduction:

Midtrimester abortion is defined as fetal loss that occurs from the end of the first trimester until the fetus weight is more than 500 grams or gestational age is 20-24 weeks. In many cases the cause of fetal loss in this trimester can be identified.The incidence of spontaneous fetal loss in the second trimester is estimated to be 1%. Main causes of midtrimester spontaneous pregnancy loss are: fetal anomalies, uterine defects, placental causes and maternal disorders.Risk factors for second trimester abortion include race, ethnicity, prior poor obstetrical outcomes, and extremes of maternal age.

In this presentation we will discuss in particular midtrimester abortion as a result of cervical insufficiency, which is an obstetrical entity characterized by painless cervical dilatation in the second trimester. This cervical insufficiency can be followed by prolapse and balloning of membranes into the vagina, and ultimately the expulsion of an immature fetus.If it is not treated effectively, this sequence may repeat in future pregnancies.

Classical cervical insufficiency is treated surgically with cerclage, which reinforces a weak cervix by a purse string suture. Cerclage is contraindicated when there is rupture of membranes, bleeding and contractions because in these cases the likelihood of failure is increased. As a result, prophylactic cerclage before dilatation is preferable. At times, this may not be possible and an emergency cerclage is performed after the cervix is found to be dilated, effaced, or both. Emergency cerclage usually is not performed after 23 weeks gestation.

Cerclage procedures are divided in transabdominal and vaginal. In the vaginal cerclage procedures the main two techniques are McDonald and Shirodkar. When these two procedures are performed prophylactically they have excellent outcomes, whereas emergency cerclage is of course more difficult to perform.

This presentation will give a quick review of some of the cases of the emergency cervical cerclage performed in Obstetrics and Gynecology Hospital Koco Gliozheni, the type of technique used, the fetal and obstetrical outcome and the differences between these techniques.

Methodology:

This is a retrospective study,including 16 pregnant women who underwent emergency cervical cerclage because of cervix dilatation and protruding membranes in mid-trimester at Koco Gliozhen, University Hospital

Results:

At the time of cerclage ,the mean maternal age was 29.9 years, the mean gestational age was 21 weeks and the cervical dilatation was 1-2 cm

The mean interval between cerclage and delivery was 13.5 weeks.Emergency cerclage led to live-births,most of them in term,with a survival rate 87%

Most of the cases gave birth via Sectio Cesare.

Conclusions:

Our study demostrates a favorable prolongation of pregnancy and neonatal outcome in women with cervical dilatation and bulging of fetal membranes who underwent emergency cerclage

None

BELL’S PALSY DURING TWIN GESTATION AND PREECLAMPSIA WITHOUT SEVERE FEATURES

Dr. Angela Jusmine RACINES ¹ , Dr. Ma. Asuncion Fernandez, Fellow POGS, PSREI, PSGE¹

¹St. Luke’s Medical Center- Global City

Various neuromuscular disorders often preexist in women of childbearing age. Accounting for approximately 80% of all nerve palsies is Bell’s palsy otherwise known as Idiopathic Peripheral Facial Palsy. In pregnant patients, the occurrence of such is three times more common compared with non- pregnant individuals. Pregnancy-related Bell’s palsy is often due to alterations in immune tolerance, increased susceptibility to viral infection, and an interplay in hormonal balance. Its coexistence with hypertensive disorders like gestational hypertension, eclampsia, and preeclampsia has remained inconclusive. Some suggest that pregnancy-related Bell’s palsy is a known risk factor for hypertensive disorders, particularly pre-eclampsia. While the association between multifetal pregnancies and preeclampsia has been well-documented, the relationship between multifetal pregnancies, pre-eclampsia, and neurological disorders remains largely unexplored. A possible correlation for these three entities might have to do with increased levels of Soluble fms-like tyrosine kinase 1 (sFlt1), an endogenous inhibitor of vascular endothelial growth factor (VEGF) and placental growth factor (PGF) made within the placenta that specifically relates to the onset and severity of preeclampsia. This is a case of a 33-year- old female G2P1 (1001) pregnancy uterine at 32 4/7 weeks, twin gestation, previous cesarean section I (2019 for failure of descent) with preeclampsia without severe features and Bell’s palsy.

Keywords: Bell’s palsy, Hypertension, Neuromuscular disorder, Pregnancy- Related Bell’s palsy, Preeclampsia, Soluble fms-like tyrosine kinase 1 (sFlt1), placental growth factor (PGF)

none

Spontaneous quadruplet pregnancy with monochorionic tri-amniotic triplets: obstetric challenges, perinatal outcomes, and neonatal management

Mrs Mirjam Druškovič ¹ , Mr Gorazd Kavšek¹, Dr. Tina Perme¹

¹Department of Perinatology, University Medical Centre Ljubljana

Objectives: To describe the obstetric course and management challenges of a rare case of spontaneously conceived quadruplets comprising one singleton and monochorionic tri-amniotic triplets, emphasizing the potential complications and the strategies adopted to optimize maternal–fetal outcomes.

Case Presentation: A 28-year-old G2P1, with an uncomplicated previous pregnancy and spontaneous vaginal delivery at 40 weeks, presented at 13 3/7 weeks gestation with a spontaneously conceived quadruplet pregnancy. Ultrasound confirmed one singleton (foetus A) and monochorionic triamniotic triplets (foetuses B, C, D), with a λ sign between A and B/C/D and a T sign between B, C, and D. Nuchal translucency screening was low-risk for all foetuses. Bi-weekly monitoring was initiated due to the inherent risks of multifetal gestations, particularly the potential for twin-to-twin transfusion syndrome (TTTS), asymmetric placental distribution between foetuses and preterm birth. Preventive hospitalization occurred at 23 weeks. Maternal complications included urinary tract infection (Group B Streptococcus) and anaemia, both managed with therapy, and gestational diabetes with diet. From 26 weeks, selective fetal growth restriction (sFGR) type I was identified in foetus D. At 28 weeks, the patient reported abdominal cramps, prompting maturation therapy with antenatal corticosteroids (betamethasone 14mg IM/24h x 2 doses). At 29 3/7 weeks, estimated foetal weight (EFW) of foetus D was < 2nd percentile with oligohydramnios and normal umbilical artery doppler. EFW discordance of foetus D with foetus B and C was 30 %. At 30 1/7 weeks, an emergency caesarean section was performed due to preterm labor and suspected fetal distress. Neuroprotective MgSO4 was administered preoperatively. Four male neonates were delivered (A: 1280g, B: 1450g, C: 1420g, D: 1030g) and transferred to the neonatal intensive care unit. Placental histopathology confirmed a bichorionic-tetraamniotic (monochorionic tri-amniotic) configuration, with velamentous cord insertion in foetuses A, B, and D.

As expected, all 4 neonates developed various levels of respiratory distress due mainly to their prematurity. In neonates B, C and D, respiratory distress was managed with non-invasive ventilation. Neonate A, however, developed a left-sided pneumothorax. He was intubated, a chest drain was placed and he received replacement surfactant. All neonates with the exception of neonate B also received red blood cell transfusion. Babies B and D required surgical correction of inguinal hernias. The neonates were discharged at around 2 months of postnatal age. Baby D was hospitalised with a viral respiratory infection that required non-invasive mechanical ventilation. Following that episode, their development has been uneventful. They are now at one-year corrected age and are developing appropriately.

Conclusion: Spontaneous quadruplet pregnancies pose significant obstetric and perinatal risks, including preterm birth, fetal growth restriction, and complex placental anatomy. Since there is no universally standardized recommendation for the exact timing of quadruplet delivery, determining the optimal delivery time is challenging, individually oriented. After birth, the outcomes primarily depend on the level of prematurity and potential complications of preterm birth in the neonates. Intensive antenatal surveillance, timely hospitalization, and multidisciplinary management are key to optimizing maternal and neonatal outcomes in these rare high-risk pregnancies.

None declared.

Epidemiological characteristics of healthcare-associated infections and their link to mortality

Dr. Amina Abdennadher¹, Dr Dhouha Kammoun¹, Dr Nihed Bouzidi¹, Dr Manel Charfi ¹, Dr Chiraz Regaieg¹, Dr Nedia Kolsi¹, Dr Afef Ben Thabet¹, Dr Amel Ben Hamed¹, Dr Amira Bouraoui¹, Dr Nedia Hamida¹

¹Departement of Neonatology , CHU Hédi Chaker

Objectives

Specify the epidemiological characteristics of Healthcare-associated infections ( HAIs) in neonates.

Determine the epidemiological characteristics with prognostic significance and a link to mortality In HAIs

Methods

This is a retrospective, analytical descriptive study conducted over a period of 3 years, from November 1, 2020, to November 30, 2023. The study was carried out within the neonatology department of the Hedi Chaker University Hospital in Sfax, under the direction of a hospital-university team specialized in level III care.

We included in our study all neonates with a hospitalization duration of 48 hours or more, with clinical or biological symptoms suggestive of healthcare-associated infections (HAIs), for which we confirmed the diagnosis through a positive blood culture (BC) for nosocomial pathogens.

We excluded all maternal-fetal infections, localized nosocomial infections with a negative blood culture, and all viral or fungal HAIs.

During the study period, we collected 82 cases of HAIs, representing 1.9% of the total number of admitted neonates (N=4382). The cumulative incidence was 2.5% of the total number of neonates hospitalized for more than 48 hours (N=3340).

During the study period, the incidence density was 44 cases of HAIs per 1,000 days of hospitalization.

The mean maternal age was 30.91±5.39, with extremes ranging from 20 to 42 years.

The median parity was 2 (IQR = [1-3]), with extremes ranging from 1 to 6 pregnancies.

It was a singleton pregnancy in 85.4% of cases (n=70), a twin pregnancy in 12.2% of cases (n=10), and a multiple pregnancy in 2.4% of cases (n=2). Six pregnancies were induced.

One or more conditions during pregnancy were observed in 56 women (68.3%). Preeclampsia was the most common condition (n=25; 30.5%), followed by the threat of preterm labor (n=22; 26.8%) and gestational diabetes (n=16; 19.5%).

No statistically significant relationship was found between maternal characteristics or prenatal care and mortality due to healthcare-associated infections.

The three main reasons for neonatal hospitalization were: neonatal respiratory distress syndrome (NRDS) (n=73; 89%), prematurity (n=70; 85.4%), and neonatal neurological distress (NND) (n=23; 28%).

The median gestational age at delivery was 31.07 weeks of amenorrhea (IQR = [28.75–34.46]), with a range from 25 weeks (+6 days) to 41 weeks (+6 days).

No statistically significant relationship was found between the gestational age and mortality due to healthcare-associated infections.

The median birth weight of our patients was 1,490 grams (IQR = [1,050–2,262]), with extremes ranging from 650 grams to 4,650 grams. Weight had a significant performance in predicting neonatal mortality (AUC=0.654; 95% CI=0.524-0.766) with sensitivity and specificity of 60.4% and 67.6%, respectively, corresponding to a threshold of 1440 g or less.

Conclusion :

HAIs continue to pose a significant risk to patient outcomes, with notable epidemiological characteristics influencing their impact on mortality. Our findings underline the importance of identifying key factors, such as birth weight, in predicting outcomes.

Keywords: Healthcare-associated infections; epidemiological characteristics ;Neonates ; mortality

None declared

Diagnosis of short umbilical cord at 11 weeks of amenorhea : Case Report

Mrs. Elaa Sassi ¹ , Mrs Arina Jbari¹, Mr Houssem Ragmoun¹, Mr Montacer Hafsi¹

¹department of obstetrics and gynecology of Menzel Tmim

Objectives:

The umbilical cord is important in fetal development, facilitating nutrient, oxygen, and waste exchange . Abnormalities in cord length, especially a short umbilical cord (less than 35 cm at term), are linked to negative perinatal outcomes, such as limited fetal movement, intrauterine growth restriction (IUGR), and preterm birth. While these conditions are usually identified later in pregnancy or after birth, improvements in ultrasonographic technology now allow for earlier detection. This case represents a short umbilical cord detected at 11 weeks of gestation during routine prenatal ultrasonography, highlighting the importance of early diagnosis for clinical decision-making and improving maternal-fetal outcomes.

Case Presentation:

A 29-year-old woman, gravida 1, para 0, underwent routine prenatal ultrasonography at 11 weeks of gestation. Transabdominal ultrasound and three-dimensional imaging revealed an umbilical cord measuring 8 cm, notably shorter than expected. Doppler studies demonstrated normal umbilical artery blood flow. Amniotic fluid volume, fetal movements, and structural development were evaluated, with no additional anomalies detected. After multidisciplinary counseling, the pregnancy was ended at 11 weeks. Post-procedure fetopathologic examination confirmed the findings

Fetopathologic examination confirmed the short length of the umbilical cord (8 cm), with normal placental morphology and no fetal structural abnormalities. This early diagnosis facilitated informed counseling and management, prioritizing maternal well-being due to the uncertain fetal prognosis.

Since it is a rare malformation that can have serious implications for both fetal and maternal outcomes. Early detection through advanced ultrasonography, as demonstrated in this case, enables prompt counseling and management. The decision to terminate the pregnancy was made to minimize maternal risks and address the uncertain prognosis.

Conclusion:

This case highlights the value of early detection of rare prenatal anomalies through advanced ultrasonography. Early diagnosis enables timely counseling and management, improving maternal and fetal outcomes. The decision to terminate the pregnancy prioritized maternal well-being due to the uncertain prognosis. Further research is needed to better understand the condition and refine diagnostic and management guidelines.

none declared

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Prenatal Diagnosis of Laparoschisis : Case Report

Mrs. Elaa Sassi ¹ , Mrs Arina Jbari¹, Mr Houssem Ragmoun¹, Mr Montacer Hafsi¹

¹Department of obstetrics and gynecology

Objectives:

Laparoschisis is a rare congenital abdominal wall defect characterized by the protrusion of abdominal organs through a paraumbilical opening. Early prenatal detection is crucial for appropriate counseling, surveillance, and management. This case emphasizes the importance of timely diagnosis and highlights how ultrasonography can aid in identifying such anomalies early in pregnancy.

Case presentation:

A 30-year-old woman, gravida 2, para 1, presented for routine prenatal ultrasonography at 12 weeks of amenorrhea. The patient had an unremarkable obstetric history, and her pregnancy had progressed normally . High-resolution transabdominal ultrasonography was performed, which revealed a paraumbilical abdominal wall defect with bowel loops protruding into the amniotic cavity, consistent with the diagnosis of laparoschisis. Doppler studies showed normal umbilical artery blood flow, and no abnormalities were detected in the fetal heart rate neither.

Amniotic fluid volume was within normal limits, and fetal crown-rump length corresponded with the gestational age. The first trimester screening for chromosomal abnormalities was also negative. Further anatomical ultrasonography confirmed the absence of additional structural abnormalities, suggesting that the laparoschisis was isolated. After thorough counseling by a multidisciplinary team, the patient opted for pregnancy termination at 12 weeks due to the uncertain prognosis and potential for significant neonatal morbidity.

Following the pregnancy termination, a fetopathologic examination was performed. The examination confirmed the ultrasonographic findings, revealing an isolated laparoschisis without any associated structural abnormalities or chromosomal abnormalities. The fetus had no other visible malformations, and the placental morphology was normal.

Conclusion :

Early diagnosis of laparoschisis enables the implementation of personalized management strategies, such as prenatal monitoring and delivery planning. This case underscores the value of ultrasonography in identifying rare anomalies during the first trimester and highlights the critical role of a multidisciplinary approach in clinical decision-making.

None declared

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Arachnoid Cyst detected in Fetal Ultrasound: A Case Report

Mrs. Elaa Sassi ¹ , Mr Houssem Ragmoun¹, Mrs Arina Jbari¹, Mr Montacer Hafsi¹

¹Department of obstetrics and gynecology

Objectives:

Arachnoid cysts, though rare, are fluid-filled lesions located within the arachnoid membrane of the central nervous system. While they often present asymptomatically postnatally, their identification during prenatal screening offers unique diagnostic challenges and may carry prognostic implications. Early detection through advanced imaging is crucial to guide counseling, management strategies, and ensure optimal outcomes for both mother and fetus.

Case Presentation:

We present the case of a 30-year-old gravida 2, para 1 woman who underwent routine second-trimester prenatal ultrasound at 20 weeks of gestation. High-resolution ultrasonography revealed the presence of an arachnoid cyst in the fetal brain. Further evaluation was performed using fetal MRI, which confirmed the cyst’s isolated nature and its non-compressive properties. Genetic testing, alongside serological assessments, was conducted to exclude associated chromosomal abnormalities. The results were consistent with a normal karyotype, and no additional structural anomalies were noted. The pregnancy progressed without further complications, and the fetus continued to show normal growth and development.

Conclusion:

This case underscores the importance of early prenatal detection of arachnoid cysts, allowing for timely counseling and personalized care planning. While isolated arachnoid cysts generally carry a favorable prognosis, they warrant careful monitoring throughout gestation. A multidisciplinary approach involving obstetricians, pediatricians, and genetic counselors is critical to ensuring the best possible outcomes. Further research into the long-term implications of prenatal diagnosis of arachnoid cysts is essential to refine management protocols and improve clinical decision-making.

None declared

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Prompt Diagnosis and Management of Neonatal Duodenal Atresia: A Case Report

Mrs. Elaa Sassi ¹ , Mr Houssem Ragmoun¹, Mrs Arina Jbari¹, Mr Montacer Hafsi¹

¹Department of obstetrics and gynecology

Objectives

This case report aims to present the clinical management and outcomes of a 37-year-old pregnant woman diagnosed with suspected duodenal atresia at 35 weeks and 5 days of gestation. The report highlights the significance of prenatal assessments, the role of a multidisciplinary approach, and the complexities of managing rare congenital anomalies like duodenal atresia in the perinatal period.

Case Presentation

Madame R.A., a 37-year-old woman in her third pregnancy, presented to the hospital with acute pelvic pain at 35 weeks and 5 days of gestation. Prenatal assessments raised suspicion for duodenal atresia, a rare congenital digestive tract anomaly. Her medical history was notable for a uterine scar from previous deliveries, which influenced the clinical management.

An emergency cesarean section was performed due to uterine scarring and the onset of active labor. The neonate, a female, weighed 2600 grams, with Apgar scores of 8/9/10 at one, five, and ten minutes, respectively. The newborn was transferred to the pediatric surgery team for further evaluation of suspected duodenal atresia. Despite timely surgical intervention and intensive neonatal care, the infant developed secondary respiratory distress and passed away on the second day of life. Duodenal atresia was confirmed post-delivery.

Conclusion

This case underscores the challenges in managing rare congenital conditions like duodenal atresia. It emphasizes the need for improved prenatal diagnostic protocols, vigilant perinatal care, and effective multidisciplinary collaboration. While early detection and proactive care are essential, this case also highlights the inherent unpredictability in managing such complex conditions and the importance of continued research and refinement of management strategies to optimize outcomes for both mothers and neonates.

None declared

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Early Detection of Muscular Ventricular Septal Defect: A Case Report

Mrs. Elaa Sassi ¹ , Mr Houssem Ragmoun¹, Mrs Arina Jbari¹, Mr Montacer Hafsi¹

¹Department of obstetrics and gynecology

Objectives

The aim of this case report is to present the diagnosis and management of a rare case of a muscular-type ventricular septal defect (VSD) detected during a morphological ultrasound at 23 weeks of gestation. This report seeks to explore the impact of parental consanguinity on the likelihood of congenital heart defects , the significance of maternal obstetric history in managing pregnancies at risk for congenital anomalies and emphasizes the importance of a multidisciplinary approach in decision-making and management.

Case Presentation

A 26-year-old woman, gravida 2, para 1, with a history of a previous stillbirth likely due to heart malformation, presented for routine prenatal care. She reported consanguinity with her partner, raising concerns about the potential for inherited congenital defects. A morphological ultrasound at 23 weeks of gestation revealed a muscular-type ventricular septal defect (VSD) in the fetus. The defect was characterized by a small, localized opening in the muscular portion of the ventricular septum. There were no other associated anomalies detected. Due to the mother’s previous obstetric history of a stillbirth with suspected heart malformation, a thorough evaluation and monitoring plan were developed. The pregnancy was managed with close follow-up, and multidisciplinary consultations with a pediatric cardiologist were initiated. The pregnancy continued with regular fetal assessments, and the neonate was delivered at term. Postnatal echocardiography confirmed the diagnosis of a muscular VSD, and the baby was closely monitored in the neonatal unit.

Conclusion

This case emphasizes the importance of early detection of congenital heart defects, particularly in pregnancies with a relevant obstetric history and parental consanguinity. The identification of a muscular-type VSD at 23 weeks gestation allowed for appropriate prenatal counseling and the development of a comprehensive care plan. The case highlights the need for careful surveillance and multidisciplinary management in pregnancies at risk for congenital heart defects, aiming to improve neonatal outcomes. This report contributes to the understanding of the relationship between parental consanguinity and the increased risk of congenital anomalies, particularly heart defects like VSD

None declared

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The impact of PGH and IGF1 on the kidney glomeruli of mice born with IUGR

Dr. Nataša Stašuk ¹ , Dr. Dušanka Mitrović¹, Dr. Branka Ivanović¹

¹University Clinical Center Of Vojvodina, Clinic for Gynecology and Obstetrics

Objectives: Neonates that were in utero subject to aberrant fetal, maternal or placental factors that retard normal growth and development of the fetus are a high-risk group of newborns with intrauterine growth restriction (IUGR). Developmental programing of chronic illness leads to long term consequences of IUGR that are present up until adulthood. Lowered nephron number at birth in IUGR offspring causes compensatory hypertrophy of glomeruli and initiates pathological mechanisms that can cause the development of hypertension, glomerulosclerosis and chronic kidney failure.

Using an experimental model of IUGR in mice, the aim of this study is to investigate 1) whether IUGR affects the number of glomeruli, 2) whether placental growth hormone (PGH) and insulin-like growth factor 1 (IGF1) treatment affects the number and size of glomeruli and 3) the effects of PGH and IGF1 treatment on kidney function in adult IUGR mice.

Methods: Experimental IUGR was accomplished by subcutaneous dexamethasone administration (100μg/kg/day) to pregnant mice, from 15th-21st day of gestation. The cubs were randomly divided into one of six groups and left on natural food. They were sacrificed after a month. 0.5 ml of blood was taken from the heart for analysis of cystatin C and creatinine concentration, and then one kidney was removed from each sacrificed individual. Plates were obtained through histological processing. The numerical density and volume of the glomeruli of each group was calculated individually, in all three zones of the kidney cortex.

Results: Mice with experimentally induced IUGR had a lower number of glomeruli compared to the control group (27,700 vs 36,111). In the group of mice that received a higher dose of IGF1 (10μg), the number and volume of glomeruli increased, and the creatinine concentration was the lowest compared to all other groups, with a statistically significant difference (p<0.033) compared to the control group without intervention. Administration of a lower dose of IGF1 (1 μg), as well as administration of a lower (2 μg) and higher (10 μg) dose of PGH did not cause an increase in the number and volume of glomeruli. The administration of 10 μg of PGH led to a decreased number of glomeruli in the superficial and intermediate zone with a statistically significant difference (p<0.05) compared to the group that received 10 μg of IGF1 and the control group without intervention, as well as to a decrease in the volume of glomeruli with a statistically significant difference (p<0.05) compared to the group that received 10 μg of IGF1. Cystatin C analysis didn’t reveal any differences between studied groups.

Conclusion: A higher dose of IGF1 (10 μg) increases the numerical density and volume fraction of glomeruli, but long-term studies in both animal models and human populations are needed to determine whether applying IGF1 after birth to IUGR offspring has a protective effect and can preserve the function of their kidneys longer. No research has been done on the effect of PGH on the glomeruli of IUGR offspring, and further studies are needed to obtain relevant data on the pathophysiological effect of PGH.

None declared.

Cesarean Myomectomy: Challenging the Stigma of Hemorrhagic Risk – A Case Report

Dr. Anika Dokle ¹ , Dr. Aida Hoxha¹, Miss Irini Stavro

¹Gynecological Obstetric University Hospital “koço Gliozheni”

Authors: Anika Dokle, Aida Hoxha, Irini Stavro

Institutional Affiliations: Gynecological Obstetric University Hospital “Koço Gliozheni”

Presenter Full Name: Anika Dokle

Case Report

Objectives:

Cesarean myomectomy has long been avoided due to concerns about excessive bleeding and the potential need for peripartum hysterectomy. However, recent evidence suggests that, when performed with appropriate hemostatic techniques, it can be a safe and effective procedure. This case report aims to challenge the stigma surrounding cesarean myomectomy by demonstrating its feasibility in an emergency setting.

Case Presentation:

We report the case of a 33-year-old Albanian woman who underwent an emergency cesarean section in Tirana due to severe fetal bradycardia. The patient, with a history of in vitro fertilization (IVF) pregnancy, was admitted in active labor at 5 cm cervical dilation. Following a successful delivery, an 8 cm interstitial fundal fibroid was identified, necessitating a myomectomy performed post-cesarean section as part of the surgical management.

Hemostasis was successfully achieved using oxytocin, misoprostol, and tranexamic acid, and a surgical drain was placed as a precaution to monitor postoperative bleeding. The procedure was completed without complications, and the patient experienced an uneventful recovery, demonstrating no excessive postoperative bleeding or adverse outcomes. She was discharged in stable condition.

Conclusions:

This case reinforces the growing body of evidence that cesarean myomectomy should not be universally avoided due to concerns over hemorrhagic risk. With appropriate surgical expertise and hemostatic management, it can be a safe and necessary intervention, particularly in cases where fibroids interfere with uterine integrity or future pregnancies. Further research and standardized guidelines are essential to support its broader acceptance in clinical practice.

none declared

Vaccination Against Influenza, RSV, and Pertussis During Pregnancy – An Overview of National Vaccination Data and a Comparison with the Maribor Region

Ms. Tamara Čopi ¹ , Mrs Martina Juder Kogler², Mr Zoran Simonović², Mrs Lucija Kuder³, Mrs Barbara Bonča³

¹Splošna Bolnišnica Murska Sobota, ²NIJZ OE Maribor, ³Oddelek za perinatologijo, UKC Maribor

Objectives:

Vaccination against influenza, respiratory syncytial virus (RSV), and pertussis during pregnancy is essential to protect the mother and fetus from potentially severe infections. It also provides protection for the newborn in the first months of life and is proven to be safe for both the mother and child.

This study aims to analyze vaccination coverage rates among pregnant women against influenza, RSV, and pertussis in the Maribor region and compare them with national vaccination rates in Slovenia between 2019 and 2024.

In Slovenia, vaccination of pregnant women against all three infectious diseases is financed by mandatory health insurance, is voluntary, and is recommended by public health authorities.

Methods:

Data on the number of vaccinations against influenza, RSV, and pertussis administered to pregnant women were collected from the Electronic Register of Vaccinated Persons and Adverse Events (eRCO) of the National Institute of Public Health (NIJZ).

Based on the number of births per year, we analyzed annual vaccination coverage and trends from 2019 to 2024. During this period, voluntary vaccination of pregnant women against influenza and pertussis was implemented at the national level in Slovenia, while vaccination against RSV was introduced in September 2024.

Results:

The data indicate that vaccination coverage among pregnant women against influenza, pertussis, and RSV in Slovenia is relatively low. The highest influenza vaccination rate at the national level was recorded in 2019 (2.9%). In the Maribor region, the rate of vaccinated pregnant women against influenza was 3.6% in the same year. Between 2020 and 2022, influenza vaccination rates among pregnant women gradually declined, with a slight increase in 2023 – 0.9% nationally and 1.1% in the Maribor region.

The number of pertussis vaccinations at the national level increased between 2019 and 2020, remaining at approximately the same level since 2021 (6.6% in 2023). In the Maribor region, the highest pertussis vaccination rate was observed in 2022 (11.3%).

Vaccination against RSV was only introduced in September 2024, so no prior data on vaccination rates are available. During the period September-December 2024, 5,1% of pregnant women were vaccinated against RSV in Slovenia , while in the Maribor region, the vaccination rate was 6.6% during the same period.

Conclusions:

Vaccination of pregnant women against influenza, pertussis, and RSV is effective and safe, providing significant protection to the mother, fetus, and newborn. Nevertheless, vaccination coverage among pregnant women against influenza, RSV, and pertussis remains low in Slovenia.

Increased awareness and promotion of vaccination by healthcare professionals are necessary. Low vaccination rates highlight the need for better education of pregnant women on the benefits and safety of vaccination and easier access to vaccination services, which could contribute to improved public health outcomes.

None declared

The challenge of managing adrenal insufficiency in pregnancy: five case reports and literature review

Prof. Kawtar Iraqi Houssaini ¹ , Dr M A Guennouni¹, Prof Bouchra Fakhir¹, Prof Karam Harou¹, Prof Ahlam Bassir¹, Prof Lahcen Boukhanni¹, Prof Abderrahim Aboulfalah¹, Prof Hamid Asmouki¹, Prof Abderraouf Soummani¹

¹Gynecology Obstetrics Department, Mohammed The VI University Medical Center, Cadi Ayyad University

Objectives

Adrenal insufficiency (AI) is a rare condition, the diagnosis and management during pregnancy and the postpartum period is a clinical challenge. Undiagnosed or inadequately treated, it can lead to serious maternal and fetal complications such as adrenal crisis, intrauterine growth restriction (IUGR), fetal demise (IUFD) or metabolic abnormalities (hypoglycemia, glycemic excursions). The similarity between the symptoms of AI and those of normal pregnancy (fatigue, nausea, vomiting, myalgia) makes diagnosis difficult. We focus on collaboration between obstetrician and endocrinologist to provide a practical approach to the management of patients with adrenal insufficiency during pregnancy and after delivery.

Patients

The prospective study involved five patients with AI, one of whom had Addison’s disease. Hydrocortisone posology ranging from 10 to 30 mg were administered orally twice daily as part of a standardized protocol treatment. Peripartum management with hydrocortisone hemisuccinate was adopted using 100 mg at labor induction, followed by 50 mg every 6 hours on day 1, every 8 hours on day 2, every 12 hours on day 3, then 50 mg on day 4 before resuming oral treatment. Patient monitoring included clinical symptoms assessment and treatment response evaluation throughout pregnancy and postpartum, as well as the fetal outcome.

Results

The five cases in the study had different results. Two patients gave birth at term without any problems, while two others suffered unfavorable outcomes that led to intrauterine fetal demise. The importance of careful prenatal diabetes follow up in AI patients is highlighted by the onset of diabetic ketoacidosis in one patient. Because cortisol level measurements were less reliable during pregnancy, a strictly clinical diagnosis approach was needed. The multidisciplinary collaboration of the pediatricians, endocrinologists, and obstetricians allowed for efficient treatment adjustments and the prevention of Complications.

Discussion

The hypothalamic-pituitary-adrenal (HPA) axis undergoes major physiological changes during pregnancy, making AI diagnosis and treatment more challenging. Standard diagnostic limits for adrenal hormones could not apply during pregnancy, according to the study. Given the physiological hypercortisolism of pregnancy and the activated renin-angiotensin-aldosterone system, treatment regimens have to be regularly adjusted, especially during the third trimester.

Conclusion

Adrenal insufficiency during pregnancy and in the post-partum period represents a major challenge for maternal and fetal health. Early diagnosis, individualised adaptation of treatment and multidisciplinary coordination are essential to prevent complications and improve prognosis. Further studies are needed to validate diagnostic thresholds specific to pregnancy and optimise management protocols and guidelines.

Keywords: Adrenal insufficiency; pregnancy, hydrocortisone; gestational diabetes

None declared

A Detailed Review of Dandy-Walker Malformation Through Three Case Studies

Mme. Arina Jbari ¹ , Mme. Ela Sassi¹, Mr Houssem Ragmoun¹, Mr Montacer hafsi¹, Mme Eya Kristou¹

¹Department of Obstetrics and Gynecology, Menzel Temime Hospital

Dandy-Walker malformation (DWM) is a congenital brain anomaly that primarily affects the cerebellar vermis and the fourth ventricle. It is characterized by agenesis or hypoplasia of the cerebellar vermis, cystic dilation of the fourth ventricle, and enlargement of the posterior fossa. DWM occurs in about 1 in 30,000 live births and accounts for 4 to 12% of cases of infantile hydrocephalus. The condition is heterogeneous, with varying degrees of severity and associated intracranial and extracranial abnormalities.

This article presents three cases of Dandy-Walker malformation diagnosed during pregnancy through routine prenatal ultrasound, followed by confirmation via postnatal magnetic resonance imaging (MRI). These cases emphasize the diagnostic approach, management, and outcomes for DWM patients.

In the first case, a 29-year-old woman at 18 weeks of gestation had a prenatal ultrasound revealing a cystic malformation of the posterior fossa, agenesis of the cerebellar vermis, significant hydrocephalus, and agenesis of the corpus callosum. Despite these complex findings, the karyotype was normal. After counseling, the patient chose to continue the pregnancy. A cesarean section at 38 weeks resulted in the birth of a healthy male neonate with normal Apgar scores. Postnatal MRI confirmed the DWM diagnosis.

The second case involved a 26-year-old woman whose 28-week ultrasound showed a cystic mass in the posterior fossa, complete agenesis of the cerebellar vermis, and dilation of the fourth ventricle, consistent with DWM. The patient opted to continue the pregnancy, and at 38 weeks, a cesarean section was performed, resulting in the birth of a healthy male neonate with normal Apgar scores. Postnatal MRI confirmed the DWM diagnosis with no additional anomalies.

In the third case, a 28-year-old woman at 24 weeks of gestation was found to have a cystic structure in the posterior fossa, with a dilated fourth ventricle and absence of the cerebellar vermis, suggestive of DWM. The fetal head circumference was slightly increased, indicating hydrocephalus. The patient was monitored closely, and at 37 weeks, an uncomplicated cesarean section was performed, leading to the birth of a healthy male neonate with normal Apgar scores. Postnatal MRI confirmed DWM with moderate hydrocephalus, and the infant required a ventriculoperitoneal shunt to manage the hydrocephalus.

DWM is often associated with other intracranial malformations, such as agenesis of the corpus callosum, as well as extracranial anomalies like cardiac defects and cleft palate. Although genetic factors are generally involved, the exact causes of DWM remain unclear. Prenatal diagnosis is typically made through ultrasound, but MRI can provide confirmation, especially in distinguishing it from other cystic posterior fossa anomalies like mega cisterna magna.

In conclusion, Dandy-Walker malformation is a rare condition with variable clinical presentation and prognosis. Early prenatal diagnosis allows for informed decision-making during pregnancy. A multidisciplinary approach, including genetic counseling and postnatal evaluation, is essential for providing optimal care.

None declared

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A Case Report on Stenosis in the Sylvius Aqueduct and Hydrocephalus

Mme. Arina Jbari ¹ , Mme. Ela Sassi¹, Mr Houssem Ragmoun¹, Mr Montacer hafsi¹, Mme Amina Abaab¹

¹Department of Obstetrics and Gynecology, Menzel Temime Hospital

Introduction: Hydrocephalus is a pathological condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the cerebral ventricles, leading to their expansion and increased intracranial pressure. Among its various etiologies, congenital hydrocephalus due to aqueductal stenosis is a significant cause. Early antenatal diagnosis through ultrasound and MRI plays a crucial role in determining prognosis and management options.

Case Presentation: We report a case of fetal hydrocephalus diagnosed at 21 weeks of gestation in a 30-year-old woman. The anomaly was first detected during a routine second-trimester ultrasound, which revealed tri-ventricular dilatation without other cerebral abnormalities. The first-trimester screening indicated an increased risk of Down syndrome (1/50), but amniocentesis confirmed a normal 46,XX karyotype without chromosomal abnormalities. Maternal serology was negative for infections, and there was no personal or familial history of congenital anomalies.

Further evaluation through ultrasound and fetal MRI at 30 weeks confirmed severe tri-ventricular hydrocephalus caused by aqueductal stenosis, with significant cerebral parenchymal thinning. A multidisciplinary team, including radiologists, neonatologists, neurosurgeons, and obstetricians, opted for a term delivery. At 39 weeks and 5 days, a female neonate was delivered vaginally. The Apgar scores were 4 at one minute, 3 at three minutes, and 3 at ten minutes, with neonatal death occurring at 30 minutes of life. Post-mortem examination confirmed the diagnosis.

Discussion: Congenital hydrocephalus results from impaired CSF dynamics due to secretion, circulation, or resorption anomalies. Aqueductal stenosis, as observed in this case, is a frequent obstructive cause, leading to ventricular dilation. Prenatal imaging, including ultrasound and MRI, is essential for early diagnosis, severity assessment, and decision-making regarding pregnancy continuation or intervention. Prognosis remains poor in severe cases, necessitating individualized multidisciplinary discussions with parents regarding therapeutic options, including in utero interventions, preterm delivery, or postnatal neurosurgical procedures.

Conclusion: This case highlights the importance of precise antenatal imaging for the early identification of congenital hydrocephalus and its underlying etiology. Despite advancements in prenatal screening, many cases of hydrocephalus remain idiopathic. Further research, including genetic investigations, may provide deeper insights into the pathophysiology of fetal hydrocephalus and improve management strategies.

None declared

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Clinical and paraclinical characteristics of healthcare-associated infections in Neonate and their link to mortality

Dr. Amina Abdennadher¹, DR Amira Bouraoui¹, Dr Dhouha Kammoun¹, Dr Manel Charfi ¹, Dr Nadia Kolsi¹, Dr Nihed Bouzidi¹, Dr Afef Ben Thabet¹, Dr Amel Ben Hamed¹, Dr Chiraz Regaieg¹, Dr Nedia Hamida¹

¹Department of neonatology,Chu Hédi Chaker

Objectives

Detail the clinical and paraclinical manifestations of nosocomial infections in neonatology.

Determine the clinical and paraclinical prognostic factors in nosocomial infections in newborns

Methods

This is a retrospective, analytical descriptive study conducted over a period of 3 years, from November 1, 2020, to November 30, 2023. The study was carried out within the neonatology department of the Hedi Chaker University Hospital in Sfax, under the direction of a hospital-university team specialized in level III care.

We included in our study all neonates with a hospitalization duration of 48 hours or more, with clinical or biological symptoms suggestive of healthcare-associated infections (HAIs), for which we confirmed the diagnosis through a positive blood culture (BC) for nosocomial pathogens.

We excluded all maternal-fetal infections, localized nosocomial infections with a negative blood culture, and all viral or fungal HAIs.

Results :

During the study period, we collected 82 cases of HAIs,representing 1.9% of the total number of admitted neonates (N=4382).

The median delay between admission and the infection declaration was 6 days (IQR = [3-13]), with extremes ranging from 2 to 31 days.Signs suggestive of a nosocomial infection were observed in 100% of cases (n=82).Clinical warning signs were observed in 96.3% of cases (n=79). The asymptomatic babies were premature in 2 cases (N=2/3). The mode of detection was either during the post-mortem evaluation (with a positive blood culture) or through biological signs as part of a visceral assessment. Skin color changes were the most common clinical sign suggesting a nosocomial infection (n=56; 68.3%).Hemodynamic disturbances (HD) were the second most frequent mode of revealing the nosocomial infection (n=54; 65.8%). A biological abnormality was found after the declaration of the nosocomial infection in 67 patients (81.7%). Neonatal mortality was significantly associated with hyperglycemia (p=0.009), tachycardia (p=0.007), and major hemodynamic disturbances (p<0.001).Isolated biological abnormalities without clinical expression were found in 3 infected newborns (3.7%). C-reactive protein (CRP) levels were measured in 71 newborns (86.6%), with a median value of 25 mg/l (IQR = [5-70]), ranging from 0 to 229 mg/l. An increase in CRP was the most common paraclinical sign suggesting a nosocomial infection (n=47; 57.3%), followed by thrombocytopenia (n=44; 53.7%), leukopenia (n=28; 34.1%), and leukocytosis (n=8; 9.8%). The procalcitonin test was performed on 3 patients in whom a nosocomial infection was strongly suspected despite a negative CRP. All 3 tests returned positive results (11 ng/ml, 9 ng/ml, and 5 ng/ml).

We did not find a significant correlation between mortality and paraclinical signs.

Conclusion :

Neonatal mortality is significantly associated with certain clinical signs, such as hyperglycemia, tachycardia, and major hemodynamic disturbances. However, despite the identification of these signs, mortality does not seem to be significantly correlated with paraclinical abnormalities alone, highlighting the importance of a comprehensive clinical assessment of the newborn.

Keywords: Healthcare-associated infections; Clinical Manifestations ; mortality; Paraclinical Findings; Neonatology

None declared

Pregnancy and Tako-tsubo Syndrome: An Unexpected Cardiac Emergency Case Study

Mme. Arina Jbari ¹ , Mme. Ela Sassi¹, Mr Houssem Ragmoun¹, Mr Montacer hafsi¹, Mme Hanene Jemli¹

¹Department of Obstetrics and Gynecology, Menzel Temime Hospital

Introduction:

Tako-Tsubo syndrome, also known as stress cardiomyopathy or “broken heart syndrome,” is a transient left ventricular dysfunction occurring after intense physical or emotional stress. First described in 1990 by Sato et al., this syndrome primarily affects postmenopausal women. Here, we report a rare case of Tako-Tsubo syndrome occurring in a pregnant woman in her third trimester.

Case presentation:

A 30-year-old patient, with no prior cardiac history but a history of two depressive episodes, was admitted to the emergency department at 31 weeks of gestation for intense chest pain radiating to the left upper limb, which occurred one hour after receiving news of a close relative’s death. This pain was associated with nausea and a brief loss of consciousness. On examination, the patient was conscious, slightly dyspneic, with a blood pressure of 84/52 mmHg and a heart rate of 91 bpm. Cardiac auscultation was normal, as was the obstetric examination. The ECG showed a minimal ST-segment elevation in the anterior leads, a Q wave, deep negative T waves, and QT segment prolongation. Biological markers revealed a moderate elevation of troponin I (2.8 ng/mL) and creatine kinase MB (8.7 ng/mL).

A transfer to the intensive cardiac care unit was decided after confirming the absence of obstetric abnormalities. A cardiac ultrasound showed apical and mid-ventricular akinesia with basal hyperkinesia, suggestive of Tako-Tsubo syndrome. Urgent coronary angiography confirmed the integrity of the coronary arteries. The patient’s condition improved rapidly, with hemodynamic stabilization, normalization of troponin levels within three days, and a progressive recovery of left ventricular ejection fraction (56% on day 7). She was hospitalized for 22 days under beta-blocker therapy and later gave birth to a healthy baby at 37 weeks of gestation.

discussion:

Tako-Tsubo syndrome is a well-characterized condition with diagnostic criteria defined by the Mayo Clinic: transient left ventricular wall motion abnormalities not following a coronary artery distribution, absence of significant coronary lesions, suggestive electrocardiographic changes, and exclusion of pheochromocytoma or myocarditis. Its incidence is estimated between 0.7% and 2.5% of acute coronary syndromes and predominantly affects postmenopausal women. Its occurrence during pregnancy is exceptional.

The pathophysiology is based on excessive catecholamine discharge leading to myocardial stunning. The clinical presentation mimics acute coronary syndrome, necessitating differential diagnosis with myocardial infarction, peripartum cardiomyopathy, and pulmonary embolism. The prognosis is generally favorable, with complete cardiac function recovery within weeks. However, acute complications such as heart failure, cardiogenic shock, or arrhythmias may occur, requiring close monitoring.

conclusion:

This case highlights the need to consider Tako-Tsubo syndrome in the differential diagnosis of chest pain during pregnancy. Since there is no specific treatment, management remains symptomatic and supportive. Despite a good long-term prognosis, recurrence, although rare, is possible. This case underscores the importance of a multidisciplinary approach involving cardiologists and obstetricians to ensure maternal and fetal safety.

None declared

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Case Report: Life-Threatening Late Postpartum Haemorrhage 32 Days After Caesarean Section

Ms Veronika Vogrin* ¹ , Ms Primož Kastelic², Mr Dragan Graovac², Mrs Marijana Vidmar Šimic¹

¹The Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana,

²Clinical Department of Anaesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana

Objectives

The objectives of this case report are to highlight the potential for life-threatening late postpartum haemorrhage (PPH) and emphasise the critical role of a multidisciplinary approach in ensuring timely diagnosis, resuscitation, and surgical management.

Case presentation

A 39-year-old postpartum woman was admitted to the maternity hospital 32 days after a caesarean section due to heavy vaginal bleeding. Upon admission, she was bradycardic, and her blood pressure was immeasurably low. At the time of admission, she was not actively bleeding, as she was almost completely exsanguinated and in hypovolemic shock. She was immediately transferred to the operating room. Bimanual uterine compression was performed, and the anaesthesiology team initiated stabilisation, including intravenous fluid resuscitation, blood transfusion, and arterial line placement for blood pressure monitoring. Blood samples were taken for testing, including rotational thromboelastometry (ROTEM). With the administration of fluids, vaginal bleeding returned.

In the operating room a suspicion of retained placental tissue in the uterus was raised. Ultrasonography (US) revealed a 4 cm × 3 cm mass in the cervico-isthmic region, with a negative Doppler signal. Curettage under US guidance was performed. Due to the recurrence of massive vaginal bleeding, uterotonics were administered. Despite this, heavy bleeding persisted, necessitating a re-laparotomy. During surgery, dehiscence of the caesarean section scar was observed in the left uterine corner. Due to this finding, a hysterotomy was performed. Additionally, diffuse bleeding from the posterior uterine wall was identified and managed using bipolar coagulation and TachoSil®. After achieving satisfactory haemostasis, the uterus was sutured again. No hysterectomy was performed. The total estimated blood loss was 4000 mL, with 2000 mL lost in the operating room.

The patient received a total of 4500mL of crystalloids, 1000mL of colloids, 3325mL (12 units) of packed red blood cells, 1568mL (6 units) of fresh frozen plasma, 675mL (2 units) of platelets, 10g of fibrinogen, 2000 units of Octaplex, 20mL of 20% human albumin, 2g of tranexamic acid, and 3g of calcium gluconate. The postoperative course was uneventful.

A review of the patient’s medical history revealed that she was a second-time mother with a previous caesarean section. Vaginal birth after caesarean (VBAC) was attempted, but due to foetal distress, an emergency caesarean section (grade 1 urgency) was performed. Intraoperatively, a contained uterine rupture (ruptura tecta) was noted. The myometrium was closed using a continuous suture, with additional haemostatic stitches placed at both uterine corners and two extra sutures in the middle of the incision. Due to uterine atony, additional uterotonics were administered.

Conclusion

Late PPH requires careful evaluation for common causes such as retained tissue, subinvolution, and infection, as well as rarer causes like uterine scar dehiscence and coagulation disorders. In this case, the most likely causes were subinvolution of the placental site and caesarean scar dehiscence. Successful management of the patient was achieved through prompt and appropriate interventions by both the anaesthesiology and obstetric teams, with close collaboration between both specialties.

None declared.

Ramadan Fasting and Pregnancy in Tunisia: A Prospective Cohort Study

Mme. Arina Jbari ¹ , Mme. Ela Sassi¹, Mr Houssem Ragmoun¹, Mme Mariem Bezzine¹, Mme Ikram Ben Abdallah¹

¹Department of Obstetrics and Gynecology, Menzel Temime Hospital

Introduction :

Fasting during the holy month of Ramadan is one of the five pillars of Islam and holds particular significance for Muslims. Although pregnant women are exempt from this obligation, many still choose to fast. In Tunisia, a predominantly Muslim country, the fasting behaviors of pregnant women and their potential impact on maternal and fetal health remain underexplored. This study aims to assess the prevalence of fasting among pregnant women in Tunisia, the factors influencing their decision, and its effects on pregnancy outcomes.

Methods:

A prospective cohort study was conducted in the obstetrics and gynecology department of a university hospital in Tunisia from April to July 2023, covering the Ramadan period and the immediate postpartum phase. The sample included 300 Muslim pregnant women who gave birth to a single live infant. The primary outcome was the decision to fast or not during Ramadan. Secondary outcomes included preterm birth and average birth weight. Logistic regression models were applied to analyze the factors influencing fasting choices and its impact on perinatal outcomes.

Results:Adjusted analysis showed that the likelihood of fasting was higher among women with an obese BMI at the time of prenatal care registration (OR 2.85; 95% CI 1.32-6.12), multiparous women compared to nulliparous women (OR 3.55; 95% CI 1.45-9.21), and women living in rural areas compared to those in urban areas (OR 3.20; 95% CI 1.10-9.45). Conversely, the likelihood of fasting was lower among women with a higher education level (OR 0.45; 95% CI 0.20-0.98) and those with an increasing maternal age (OR 0.88; 95% CI 0.82-0.95). No significant association was found between fasting and the risk of preterm birth or low birth weight.

Conclusions:

Pregnant women in Tunisia who choose to fast during Ramadan exhibit distinct socio-demographic and behavioral characteristics. This study did not identify adverse effects of fasting on perinatal outcomes, but further research on larger samples is necessary to assess the long-term implications of fasting during pregnancy. These findings could contribute to the development of tailored recommendations for pregnant Muslim women who wish to fast while safeguarding their health and that of their child.

none declared

Case report: Galen Vein Aneurysmal Malformation in Fetus

Ms. Nuša Stopar ¹ , Assist. Vesna Fabjan Vodušek¹

¹Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana

Objectives

Galen vein aneurysmal malformation (GVAM) is a rare congenital arteriovenous malformation of the fetal cerebral vascular system. Normally, during the 11th week of embryonic development, the median prosencephalic vein of Markowski involutes into the vein of Galen, and pericallosal arteries form anastomoses with posterior cerebral arteries. In GVAM, cerebral arteries abnormally shunt into the vein of Markowski, forming an aneurysm. GVAM accounts for approximately 30% of congenital vascular malformations and is typically detected in the third trimester via ultrasound.

Case Presentation

We present a case of a 40-year-old multipara. In the beginning of pregnancy nuchal translucency initially showed a slightly increased risk of chromosomal abnormalities, but non-invasive prenatal testing (NIPT) indicated low risk. A morphology scan at 21 weeks and fetal echocardiography were normal. However, at 27 weeks, an ultrasound revealed enlarged lateral ventricles, prompting referral for further evaluation at the Maternity Hospital Ljubljana.

At 29 weeks, additional expert ultrasound and fetal MRI confirmed a 14 mm Galen vein aneurysm with ventriculomegaly, hydrocephalus, enlarged jugular veins, and an enlarged fetal heart. Amniocentesis ruled out TORCH infections and chromosomal abnormalities. A multidisciplinary team of perinatologists, neonatologists and radiologists, consulted specialists from the University Hospital in Lausanne, that proposed three management options: pregnancy termination, conservative monitoring with palliative care, or intrauterine embolization due to the severity of the aneurysm.

A control fetal MRI at 32 weeks showed aneurysm enlargement to 16.5 mm, worsening hydrocephalus with ventriculomegaly, and the presence of pseudo-feeders of the middle cerebral artery—poor prognostic markers indicating impaired cerebral blood flow. Additionally, an enlarged fetal heart with minor functional impairment was observed. Specialists in Lausanne reviewed the case again. The parents opted for immediate intrauterine embolization at 32+0 weeks, but the procedure failed due to fetal bleeding into the choroid plexuses. Following the procedure, preterm premature rupture of membranes (PPROM) occurred, delaying re-embolization until after birth. The patient returned to Ljubljana for continued care.

At 33 weeks, spontaneous labor started and a male infant was born (2365 g, Apgar 4/4/6). The newborn required immediate respiratory support and intensive care. Despite full neonatal intervention, he developed respiratory failure, anemia, necrotizing enterocolitis, and right-sided heart failure with pulmonary hypertension. A control MRI revealed progressive hydrocephalus, severe ischemic changes, and periventricular leukomalacia. Due to the poor prognosis, the multidisciplinary team and the parents decided to withdraw intensive treatment and life support 10 days after birth.

Conclusions

GVAM presents significant diagnostic and therapeutic challenges, with high morbidity and mortality. Endovascular embolization with closure of arteriovenous fistula is the preferred treatment. Early prenatal detection is crucial for parental counseling and treatment planning. The standard approach involves postnatal treatment, typically performed at six months. In cases with rapid progression, intrauterine treatment may be considered, though this remains experimental and carries a high risk of inducing preterm birth. This situation presents a difficult choice: either awaiting natural delivery, risking a severely affected newborn, or opting for early embolization to preserve fetal brain and heart development while accepting the complications of premature birth.

None declared

Craniorachischisis: A Rare and Lethal Neural Tube Defect – Case Report and Review of Prevention Strategies

Mme. Arina Jbari ¹ , Mme. Ela Sassi¹, Mr Houssem Ragmoun¹, Mr Achref Ouadday¹, Mr Montacer Hafsi¹, Mme Sawssen Fenni¹

¹Department of Obstetrics and Gynecology, Menzel Temime Hospital

Introduction:

Neural tube defects (NTDs) result from a failure of neurulation around the 28th day post-conception, before most women are aware of their pregnancy. The main forms of NTDs include anencephaly, encephalocele, and spina bifida cystica. A rare and particularly severe form is craniorachischisis, which combines anencephaly and spina bifida, leading to a fatal prognosis. Although the prevalence of NTDs has decreased due to folic acid supplementation and prenatal screening, these malformations remain common in developing countries.

Case Presentation:

We report the case of a 28-year-old primigravida with no medical history or known risk factors, who had not taken folic acid supplementation and missed first-trimester screening. Second-trimester screening at 16 weeks revealed an elevated maternal alpha-fetoprotein level, suggesting an NTD. A morphological ultrasound at 19 weeks confirmed the presence of a thoracic-cervical myelomeningocele and anencephaly, establishing the diagnosis of craniorachischisis.

Given the lethal prognosis, and following prenatal counseling, the parents opted for a medical termination of pregnancy. The delivery resulted in the expulsion of a stillborn male fetus with major anomalies, including acrania and spinal retroflexion. The post-procedural course was uneventful, and the patient received lactation suppression. Genetic counseling and folic acid supplementation were recommended for future pregnancies.

Discussion:

NTDs result from multiple factors, including folic acid deficiency, maternal conditions such as diabetes and obesity, and genetic predispositions. Mutations in the CELSR1 and SCRIB genes may be implicated. The prevalence of NTDs varies by geographic region, fetal sex, and socioeconomic status. Early ultrasound examination and maternal alpha-fetoprotein screening are the main diagnostic tools.

Conclusion:

Currently, there is no curative treatment for craniorachischisis, which remains universally fatal. Effective prevention relies on daily intake of 400 µg of folic acid starting in the preconception period and early prenatal follow-up.

none declared

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Cervical cerclage: A 10-year retrospective study on effectiveness in preventing preterm birth

Ms. Nuša Stopar ¹ , Dr. Maruša Herzog¹

¹Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana

Objectives

Cervical cerclage is a surgical procedure that mechanically reinforces the cervix to prevent premature dilation and reduce the risk of preterm birth or late miscarriage in women with cervicoisthmic insufficiency (ICI). According to FIGO guidelines, vaginal cerclage is recommended for women with a history of ≥3 preterm births or late miscarriages due to ICI, ultrasound-indicated cerclage for women with a history of one such event and cervical length <25 mm before 24 weeks, or multiple pregnancies where cervical length is <15 mm. Abdominal cerclage is considered in cases of unsuccessful vaginal cerclage leading to preterm birth before 28 weeks or in women with an extremely short or absent cervix.

Methods

​​This retrospective study analyzes vaginal and abdominal cervical cerclage cases at the University Medical Center Ljubljana between January 1, 2014, and December 31, 2023. Electronic medical records and the Perinatal Information System of Slovenia were assessed for patient history, surgical indications, techniques, and pregnancy outcomes.

Results

A total of 258 cerclage procedures were performed, including 238 vaginal and 20 abdominal cerclages. Of 238 women with vaginal cerclage, 192 delivered at Ljubljana Maternity Hospital, while 46 gave birth elsewhere. The majority (97.9%) were performed preventively, while 4 cases (2.1%) required emergency cerclage. The average gestational age at the time of cerclage was 13.8 weeks (95% CI: 13.55-14.08). Of the 203 children born following vaginal cerclage, 71.7% were delivered after 37+0 weeks. The Shirodkar technique was used in 74.5% of cases, while 25.4% underwent the McDonald technique.

A linear regression analysis identified risk factors for preterm birth before 37 weeks. Timing of cerclage initially appeared significant (p=0.29, 95% CI: 1.021-1.489); however, after excluding urgent cerclage cases, no significant correlation was observed (p=0.507). Compared to other cerclage indications, only prior cervical interventions such as conization or LLETZ were associated with a tenfold increased risk of preterm birth before 37 weeks (p<0.001, 95% CI: 2.637-48.912) and an elevenfold increased risk before 32 weeks (p<0.001, 95% CI: 2.637-48.912), despite the cerclage procedure. Maternal age and BMI were not significant risk factors, additional progesterone therapy didn’t significantly reduce preterm birth risk following vaginal cerclage.

Among 20 abdominal cerclage cases, 9 women conceived and delivered 11 children, including one twin pregnancy and one woman who delivered twice. Nine pregnancies reached full term, while two deliveries occurred after 34+0 weeks.

Conclusions

Cervical cerclage remains a crucial intervention for preventing preterm birth and late miscarriage in women with ICI. McDonald and Shirodkar techniques showed comparable success rates. The majority

of vaginal cerclages performed in our study were history-indicated preventative cerclages. Rather than adhering to FIGO’s recommendation of waiting for multiple preterm births or miscarriages, we opted for cerclage placement following a single adverse pregnancy outcome. Abdominal cerclage remains an important consideration for patients with previous unsuccessful vaginal cerclage, multiple cervical procedures, or trachelectomy for cervical cancer. Further research on effectiveness of complementary treatments such as progesterone therapy and antibiotic prophylaxis in enhancing cerclage success rates is needed.

None declared

Prenatal Diagnosis of Morquio A Disease: A Case Report and Review of the Literature

Mme. Arina Jbari ¹ , Mme. Ela Sassi¹, Mr Houssem Ragmoun¹, Mr Achref Ouadday¹, Mme Mariem Rahmani¹

¹Department of Obstetrics and Gynecology, Menzel Temime Hospital

Introduction:

Mucopolysaccharidosis type IV A (MPS IVA), or Morquio A disease, is a rare autosomal recessive lysosomal storage disorder caused by a deficiency in N-acetylgalactosamine-6-sulfate sulfatase (GALNS). This enzymatic defect leads to the accumulation of keratan sulfate and chondroitin-6-sulfate, primarily affecting bone and cartilage, resulting in severe skeletal dysplasia and growth retardation. The disease has a variable prevalence worldwide and is often associated with consanguinity.

Case Report:

We report the case of a 31-year-old pregnant woman (G2P1) with no significant medical history. Her first child, born in 2017 from a non-consanguineous marriage, was diagnosed with Morquio A disease at the age of two after presenting with severe growth retardation and skeletal abnormalities. Concerned about her current pregnancy, the patient underwent prenatal molecular diagnosis at 17 weeks of gestation via amniocentesis. Genetic analysis confirmed that the fetus carried pathogenic mutations in the GALNS gene, indicating Morquio A disease.

A detailed morphological ultrasound at 21 weeks revealed skull bone overlap at the occipital level, thoracic enlargement, and mild subcutaneous edema, with no other apparent malformations. Given the confirmed diagnosis and poor prognosis, the parents opted for medical termination of pregnancy. The procedure involved cervical ripening with a Foley catheter and misoprostol, leading to the delivery of a female fetus. Due to placental retention, ultrasound-guided aspiration was performed under general anesthesia. The post-intervention period was uneventful, and lactation inhibition was administered.

Discussion:

Morquio A disease exhibits significant clinical heterogeneity, with severity correlating to the age of symptom onset. The most common early manifestations include skeletal abnormalities such as pectus carinatum, genu valgum, and kyphoscoliosis, often accompanied by corneal clouding and respiratory complications. Diagnosis relies on elevated urinary glycosaminoglycans, deficient GALNS enzymatic activity, and genetic testing.

Prenatal diagnosis is essential for at-risk pregnancies, particularly in populations with high consanguinity rates. In Tunisia, studies indicate a relatively high prevalence of MPS IVA, primarily among children from consanguineous unions. However, our case presents a non-consanguineous couple, highlighting the potential for de novo or unrecognized inherited mutations. While enzyme replacement therapy with elosulfase alfa offers symptomatic relief, it remains inaccessible in resource-limited settings, making prenatal diagnosis the only preventive measure.

Conclusion:

Morquio A disease is a severe, progressive disorder with no curative treatment. Genetic testing for GALNS mutations is crucial for accurate diagnosis and prenatal screening in high-risk families. Early molecular diagnosis provides essential reproductive options and facilitates informed decision-making. In Tunisia, where therapeutic options are scarce, prenatal diagnosis remains the most effective strategy for disease prevention.

none declared

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Challenges in Prenatal Diagnosis of Trisomy 21: A Case Involving an Intracardiac Echogenic Focus

Mme. Arina Jbari ¹ , Mme. Ela Sassi¹, Mr Houssem Ragmoun¹, Mr Montacer hafsi¹

¹Department of Obstetrics and Gynecology, Menzel Temime Hospital

Introduction: The intracardiac echogenic focus (IEF) is a hyperechoic nodule resulting from mineralization and calcification of the papillary muscles and chordae tendineae. It is detected via second-trimester morphological ultrasound, commonly in the left ventricle, and is considered a weak marker for trisomy 21. The risk increases when IEFs are multiple, bi-ventricular, or associated with other anomalies.

Case Report: We present the case of a 37-year-old patient (G6P3A3) with a history of myomectomy and complicated pregnancies. Her current pregnancy was managed under Enoxaparin and Kardegic due to previous obstetric complications. At 22 weeks of gestation, an ultrasound revealed an isolated 2mm IEF in the left ventricle with minimal anterior pericardial effusion. First-trimester serum markers indicated a low risk for trisomy 21 (1/1427), but the likelihood ratio increased due to the presence of the IEF. Non-invasive prenatal testing (NIPT) and amniocentesis were declined due to financial constraints. The pregnancy resulted in a cesarean delivery at 38+5 weeks, with postnatal confirmation of trisomy 21 in the newborn.

Discussion: Identifying fetal morphological markers through ultrasound has been crucial in detecting aneuploidies like trisomy 21. While major anomalies such as atrioventricular canal defects are strong indicators, minor markers, including IEFs, contribute to risk stratification. The likelihood ratio for an isolated IEF is 1.1 but rises significantly when combined with other markers. Our case underscores the importance of integrating ultrasound findings with biochemical screening for accurate risk assessment. Despite advancements in prenatal screening, financial and personal considerations often limit access to definitive diagnostic testing.

Conclusion: This case highlights the challenges in prenatal screening for trisomy 21. A multidisciplinary approach incorporating ultrasound, biochemical markers, and individualized patient counseling remains essential for optimizing prenatal diagnosis and informed decision-making.

None declared

Impact of Myelomeningocele Volume on Motor Function Outcomes After Prenatal Surgery: A Retrospective Cohort Study

Mme. Arina Jbari ¹ , Mme. Ela Sassi¹, Mr Houssem Ragmoun¹, Mme Hanene Jemli¹

¹Department of Obstetrics and Gynecology, Menzel Temime Hospital

Objective:

To evaluate the impact of myelomeningocele (MMC) volume, measured by prenatal MRI before in utero surgery, on both prenatal and postnatal motor function (MF).

Methods:

This retrospective cohort study included 71 patients who underwent prenatal MMC repair between 2011 and 2020 (37 fetoscopic / 34 open-hysterotomy approach). The MMC sac volume was measured on preoperative MRI (18–26 weeks of gestation) using the ellipsoid formula (length × width × depth × 0.52). Prenatal MF was assessed by ultrasound following a metameric distribution, while postnatal MF was evaluated through a neurological examination at birth. Intact MF (S1) was defined as visible ankle plantar flexion. A receiver operating characteristic (ROC) analysis determined the optimal cut-off for predicting intact MF at birth, defining a large MMC as >2.7cc. Prenatal and postnatal MF outcomes were compared between large and non-large lesions, adjusting for surgical approach (fetoscopic vs. open-hysterotomy), learning curve, anatomical lesion level, gestational age at birth, and presence of clubfoot when relevant. Results are presented as odds ratios (OR) with 95% confidence intervals (CI) and p-values.

Results:

Among the 71 patients, 29 had a large MMC. At diagnosis, fetuses with large lesions were less likely to exhibit intact MF (OR 0.2 [0.1–0.6], p < 0.01) and had a higher risk of clubfoot (OR 9.5 [2.1–41.8], p < 0.01). At birth, infants with large MMCs remained less likely to have intact MF (OR 0.1 [0.01–0.49], p < 0.01) and had an increased risk of clubfoot (OR 3.7 [0.8–18.3], p = 0.11). In the fetoscopic surgery subgroup, infants with large MMCs were significantly less likely to have intact MF at birth (OR 0.1 [0.01–0.6], p = 0.02).

Conclusion:

Fetuses with large MMCs (>2.7cc in our cohort) had a higher risk of motor function impairment at birth, despite undergoing in utero surgical repair. These findings suggest that excessive placode stretching in large MMCs may lead to early and irreversible neurological damage.

none declared

Predictive Factors of Motor Function in Children with Spina Bifida: Impact of Prenatal and Postnatal Surger

Mme. Arina Jbari ¹ , Mme. Ela Sassi¹, Mr Houssem Ragmoun¹, Mme Eya Kristou¹

¹Department of Obstetrics and Gynecology, Menzel Temime Hospital

Objective:

To identify predictive factors of an intact motor function (MF) at birth and at one year of age in children with spina bifida (SB) who underwent either prenatal or postnatal surgery.

Methods:

This retrospective cohort study included 125 fetuses with SB who underwent prenatal surgery (49fetoscopic / 42 open-hysterotomy) or postnatal surgery (34 cases). MF was assessed via ultrasound using a metameric distribution at SB diagnosis (MF1), six weeks after prenatal surgery—or the equivalent time in postnatal surgery cases (MF2)—and during the last ultrasound before birth (MF3). Postnatal MF was evaluated at birth and at one year of age by a neurosurgeon. An intact MF (S1) was defined as the visualization of plantar ankle flexion. Results are presented as odds ratios [95% confidence interval], p-value.

Results:

In the “prenatal surgery” group, predictive factors for an intact MF at birth and at one year of age were:

Absence of clubfoot (11.3 [3.2-39.1], p<0.01 and 10.8 [2.4-47.6], p<0.01)

Detection of an intact MF at MF1 (19.7 [5-76.9], p<0.01 and 8.7 [2-38.7], p<0.01), MF2 (22 [6.5-74.2], p<0.01 and 13.5 [3-61.4], p<0.01), and MF3 (13.7 [3.4-55.9], p<0.01 and 12.6 [2.5-64.3], p<0.01)

Myeloschisis-type lesion (11.2 [2.4-51.1], p<0.01 and 4.1 [1.1-16.5], p=0.04)

Gestational age at birth was also predictive of an intact MF at birth (1.2 [1.1-1.5], p<0.01).

An intact MF at birth was predictive of an intact MF at one year of age (33.6 [7.1-159.7], p<0.01).

In the “postnatal surgery” group, only the observation of an intact MF at birth predicted an intact MF at one year of age (15.2 [2-113.3], p=0.03).

Conclusion:

The prenatal ultrasound detection of an intact MF is predictive of an intact MF at birth and at one year of age in children who underwent prenatal SB surgery. Thus, in utero MF assessment helps refine parental counseling and patient selection for prenatal surgery.

none declared

Congenital Facial Anomalies: A Rare Presentation of Diamond-Blackfan Anemia Type 15 with Mandibulofacial Dysostosis

Špela Kozinc¹, Ms. Nuša Stopar ¹, Maruša Škrjanec Pušenjak², Assist. Prof. Aneta Soltirovska Šalamon³, Dr. Lilijana Kornhauser Cerar⁴, Assist. Prof. Andreja Trojner Bregar¹

¹Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana,

²Clinical Institute of Genomic Medicine, University Medical Center Ljubljana,

³Department of Neonatology, Division of Pediatrics, University Medical Center Ljubljana,

⁴Neonatal intensive care unit, Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana

Objectives

Congenital facial anomalies in fetuses and newborns present significant challenges in prenatal diagnostics and postnatal care. Craniofacial abnormalities are usually complex and connected with genetic syndromes. Early recognition of these anomalies is essential for appropriate perinatal management and improving patient outcomes.

Case Report

We present a case of 24-year-old primipara with no prior medical history. In the beginning of pregnancy, she underwent routine prenatal screenings. Nuchal translucency scan showed an increased risk of chromosomal abnormalities (NS = 3,2 mm, risk for T 21 was 1:24, T18 was 1:61 and T 13 was 1:130), non-invasive prenatal testing (NIPT) results indicated low risk for aneuploidies of 13, 18, 21 and sex chromosomes. Morphology scan at 21 weeks of gestation was normal, without structural deviations, although estimated fetal weight was on the 1 %. Further fetal growth controls were indicated.

At 35 + 1 week of pregnancy, the patient was admitted to Maternity Hospital due to fetal growth restriction. She complained of skin pruritus and had elevated liver enzymes and the sFlt-1/PLGF ratio was elevated (148,9). During hospitalization growth restriction progressed, fetal wellbeing was monitored with cCTG and ultrasound. At 36 + 2 weeks, the patient underwent a cesarean section due to severe fetal growth restriction and preeclampsia. The newborn, a girl, weighed 2135 grams and measured 43 cm in length, with an APGAR score of 8/8. The baby required no resuscitation but showed signs of poor adaptation, hypotonia, and irregular breathing.

Postnatal examinations revealed symmetrical growth restriction and multiple dysplastic facial features called Pierre-Robin sequence, including microretrognathia, macroglossia, medial palatoschisis, microtia, downward-facing palpebral fissures, spaced-out mammary glands, and a triphalangeal thumb. Further genetic diagnostics, including whole-exome sequencing of newborn and parents (WES-trio), were recommended.

In further days after birth the newborn developed neonatal anemia and neutropenia, which progressed, and required blood transfusion. Cardiac ultrasound detected minor atrial and ventricular septal defects. Neonatologists suspected Diamond-Blackfan anemia, a congenital bone marrow failure that in 50 % of cases includes craniofacial and limb anomalies. Maxillofacial consultant confirmed U-shaped palatoschisis, with deviated mandibula - suggested for surgical correction at 2 years of age. Due to obstruction caused by glossoptosis, she required a nasopharyngeal tube to maintain an open airway. Given the feeding disorders, she was initially fed via an orogastric tube and later via a gastrostomy. Genetic, pulmonological, hematological, and neurological consultations were carried out for further care and de novo mutation of the RPS28 gene - Diamond Blackfan anemia type 15 with mandibulofacial dysostosis was identified.

Conclusions

This case underscores the complexity of diagnosing and managing congenital facial anomalies, particularly those associated with genetic syndromes. Anemia Diamond Blackfan with mandibulofacial dysostosis with gene mutation of RPS28 or TSR2 genes is described in 3 more cases worldwide so far. It is a heterogeneous disease where similar clinical presentation can be caused by variations of different genes and can include other skeletal anomalies (thumbs), diaphragmal hernia, hearing problems, low growth or motor and speech delay.

None declared

Puerperal pelvic thrombophlebitis: a clinical analysis of two cases and literature review

Prof. Kawtar Iraqi Houssaini ¹ , Dr M A Guennouni¹, Prof Bouchra Fakhir¹, Prof Karam Harou¹, Prof Ahlam Bassir¹, Prof Lahcen Boukhanni¹, Prof Abderrahim Aboulfalah¹, Prof Hamid Asmouki¹, Prof Abderraouf Soummani¹

¹Gynecology Obstetrics Department, Mohammed The VI University Medical Center, Cadi Ayyad University

Objectives

Pelvic thrombophlebitis is a rare but potentially severe complication, associated with a high risk of pulmonary embolism and sepsis. Although its prevalence is low (about 1 in 3000 deliveries), It is an important differential diagnosis of postpartum fever and abdominal pain and its diagnosis can be challenging, regarding the lack of consensus on reference imaging to confirm it. The literature highlights the heterogeneity of treatment protocols, both in terms of anticoagulant with antibiotic and the post-treatment follow-up.

Case presentations

The first patient, aged 23 years old, presented at 4 days post partum following vaginal delivery with fever and pelvic pain. The clinical examination showed a febrile patient with fetid lochia and pain on uterine mobilization. Vaginal sampling revealed a multisensitive Escherichia coli infection, and pelvic imaging using abdominopelvic angioscan allowed the diagnosis of deep pelvic thrombophlebitis involving the right ovarian vein extended to the right renal vein.

The second patient, aged 37 years old, was admitted six days after vaginal delivery for right iliac fossa pain in a febrile setting with no evident signs of endometritis associated to a positive infectious assessemnt (elevated white blood cells and CRP). Pelvic imaging was requested for suspected right pyosalpinx or appendicitis, revealing a right ovarian thrombosis.

Both patients made good progress with antibiotic treatment and anticoagulation.

Discussion

The condition follows Virchow’s triad mechanisms and is notably ten times more prevalent in cesarean deliveries compared to vaginal births. Significantly, 67% of cases are associated with postpartum endometritis, with 80% of occurrences localizing to the right ovarian vein. Multiparity appears to be a contributing risk factor in both presented cases. CT imaging emerges as the superior diagnostic tool compared to other imaging modalities. Treatment protocol combines therapeutic anticoagulation with targeted antibiotic therapy based on culture results. While no consensus exists regarding anticoagulation duration, treatment typically continues for 3-6 months. Prevention primarily focuses on avoiding potentially septic or traumatic interventions during delivery and immediate postpartum period. Both cases demonstrated favorable outcomes under appropriate treatment, highlighting the importance of prompt diagnosis and intervention.

Conclusion

These cases underscore the significance of maintaining high clinical suspicion for postpartum pelvic thrombophlebitis, despite its rarity.

The key to this diagnosis is to consider it among the differential diagnoses for postpartum persistent puerperal fever, especially when it is resistant to broad-spectrum antibiotic therapy and resolves after systemic anticoagulation; and also be aware of puerperal pelvic pain contrasting with negative endometritis features. The successful outcomes emphasize the effectiveness of combined anticoagulation and antibiotic therapy when properly implemented, though standardization of treatment protocols remains an ongoing challenge in obstetric care.

Keywords: puerperal; fever; pelvic; thrombophlebitis

None declared

Discrepancy Between NIPT Screening and Ultrasound Morphological Assessment of Fetal Sex: A case report

Ms. Tamara Čopi ^1,2 , Mr Luka Roškar¹, Mrs Simona Čopi^1,2

¹Ginekološko-Porodniški oddelek, Splošna Bolnišnica Murska Sobota, ²Gemini, Simona Čopi ZZD

Objectives:

De la Chapelle syndrome, also known as 46,XX male syndrome, is a rare chromosomal anomaly (1 in 20,000) where individuals have an XX karyotype but develop male genitalia. Diagnosis is typically confirmed in adulthood due to infertility; however, increasing use of non-invasive prenatal testing (NIPT) has led to earlier detection, especially when discrepancies arise between NIPT and ultrasound findings.

Case presentation:

A 36-year-old primigravida underwent first-trimester combined screening (nuchal translucency measurement and a double hormonal test) at 12 5/7 weeks of gestation, which indicated a low risk for aneuploidies 21, 18, and 13. The early first-trimester ultrasound assessment of fetal morphology showed no abnormalities. At 13 2/7 weeks of gestation, the patient underwent NIPT, with a fetal fraction of 14%, which revealed a 46, XX karyotype, suggesting a female fetus.

During the second-trimester ultrasound at 21 5/7 weeks, fetal development appeared normal, but male genitalia were clearly visualized. Due to the discrepancy between the NIPT result and the ultrasound findings, the patient was referred for genetic counseling and amniocentesis.

Amniocentesis was performed, and both karyotyping and fluorescence in situ hybridization (FISH) confirmed the presence of a derivative X chromosome with translocation of the sex determining region SRY gene onto the X chromosome and a deletion of the ARSL gene. These findings were consistent with a diagnosis of 46,XX testicular disorder of sex development with short stature. Chromosomal and FISH analysis of both parents revealed a normal karyotype, confirming that the genetic rearrangement in the fetus occurred de novo.

During genetic counseling, parents were informed of potential outcomes, including normal intelligence, male genitalia, hypergonadotropic hypogonadism, gynecomastia, incomplete sexual development, azoospermia, and below-average adult height. The prognosis was considered favorable based on available literature.

The remainder of the pregnancy was uneventful, with regular ultrasound monitoring of fetal growth and genital development. The patient delivered at term. Postnatally, the newborn was found to have cryptorchidism and hearing unresponsiveness in the right ear.

By one year of age, the child had achieved age-appropriate developmental milestones and hearing impairment was ruled out. Unilateral cryptorchidism persisted and surgical intervention was planned, along with continued monitoring of growth and development.

Conclusions:

The 46, XX male karyotype most commonly results from translocation of the SRY region onto the X chromosome during meiosis. The presence of the SRY gene determines the development of a male phenotype.

Although various prenatal screening tests are available for detecting chromosomal abnormalities, there is no single optimal test for diagnosing this syndrome.

This case highlights the importance of detailed ultrasound evaluation in conjunction with NIPT screening. The discrepancy between ultrasound findings and NIPT results underscores the key role of ultrasound in prenatal diagnostics, despite the growing use of NIPT in prenatal screening. While NIPT provides valuable insights into fetal chromosomal composition, it should not replace ultrasound confirmation of fetal sex.

none declared

Neonatal Morbidity and Mortality in Preterm Breech Fetuses: Impact of Labor Onset Method

Mme. Arina Jbari ¹ , Mme. Ela Sassi¹, Mr Houssem Ragmoun¹, Mr Montacer hafsi¹

¹Department of Obstetrics and Gynecology, Menzel Temime Hospital

Introduction

The objective of this study was to evaluate neonatal morbidity and mortality in preterm breech infants following cervical ripening, compared to spontaneous labor.

Materials and Methods:

This was a retrospective study conducted in a level 3 university maternity unit. Included patients had a singleton pregnancy with a live fetus in breech presentation between 27 and 36+6 weeks of gestation. Exclusion criteria included multiple uterine scars, fetal malformations, and contraindications to vaginal delivery. Two groups were compared: women with spontaneous labor and those who underwent cervical ripening. The primary outcome was a composite measure of neonatal morbidity and mortality, defined by the occurrence of at least one of the following events: death, neonatal trauma, APGAR score <3 at 5 minutes, encephalopathy, seizures, grade 3 or 4 intraventricular hemorrhage, or grade 2 or 3 necrotizing enterocolitis.

Results

A total of 220 patients were included: 68 in the cervical ripening group and 140 in the spontaneous labor group. Cervical ripening was mainly indicated for fetal growth restriction with growth arrest, oligohydramnios, chorioamnionitis, or preeclampsia. Spontaneous labor typically occurred following premature rupture of membranes or failure of tocolysis.

In the cervical ripening group, 46.1% of patients delivered vaginally.

No significant difference was observed in the primary neonatal morbidity and mortality outcome (4.6% in the induced labor group vs. 5.4% in the spontaneous labor group, p=0.889).

Conclusion

Nearly half of the patients who underwent cervical ripening for preterm breech presentation delivered vaginally. The mode of labor initiation does not appear to affect neonatal morbidity and mortality in this population. Cervical ripening can therefore be considered in these cases.

none declared

An incidental finding of low grade appendiceal mucinous neoplasm during C-section: a case report

Prof. Kawtar Iraqi Houssaini ¹ , Prof Bouchra Fakhir¹, Prof Karam Harou¹, Prof Ahlam Bassir¹, Prof Lahcen Boukhanni¹, Prof Abderrahim Aboulfalah¹, Prof Hamid Asmouki¹, Prof Abderraouf Soummani¹

¹Gynecology Obstetrics Department, Mohammed The VI University Medical Center, Cadi Ayyad University

Objectives

Appendiceal mucinous neoplasm (AMN) is an uncommun condition for the obstetricians (less than 0.3%). It’s a group of malignancies with high heterogeneity of histopathologic subtypes and survival outcomes. They range from low-grade neoplasms (LAMN) with favorable prognosis to highgrade tumors with significantly worse outcomes. we reviewed diagnostic pitfalls during pregnancy and the challenging treatment

Case presentation

We report a case of 30-year-old parturient, with history of a pelvic pain , who has undergone an emergency caesarean section. After delivery, the abdominal check-up revealed a swollen appendix without peritoneal spreading. An appendectomy was performed. The pathological findings revealed a LAMN with healthy margins. She was discharged the third postoperative day. A CT Scan at one month showed no metastasis or invasion and the patient remained disease-free for over five years, and her child is healthy.

Discussion

Treating neoplasms diagnosed during pregnancy entails weighing the risks and benefits for both mother and fetus. This requires considering multiple factors, such as tumor biology and prognosis, stage, gestational age at diagnosis, efficacy, toxicity, invasiveness of required treatment, and patient preferences. The literature review highlights the challenges that physicians face in treating pregnant patients with advanced appendiceal tumors. However, their slow progression and favorable prognosis allow deferring definitive treatment until after spontaneous delivery, a reasonable period of breastfeeding, and fertility preservation. Fortunately, the early LAMN screening in this case report improved the prognosis.

Conclusion

Pregnancy management decisions in patients with peritoneal spread from mucinous appendiceal tumor should be based on understanding the tumor biology and prognosis. We must be aware of an occult appendiceal neoplasm and insist on a systematic peritoneal lavage with saline solution and a routine check-ups of the abdomino-pelvic cavity during C-section. Definitive treatment in pregnant patients with favorable tumors, such as LAMN, may be delayed until spontaneous delivery without compromising maternal survival.

Keywords:

incidental LAMN; appendectomy; C-section.

None declared

25 years of reverent care for perinatally deceased children and their parents in Slovenia

Prof. Vislava Globevnik Velikonja ¹

¹University Medical Centre Ljubljana

Objectives

To highlight the development of perinatal bereavement care in Slovenia over the past 25 years, including psychological support, burial options, and the role of healthcare professionals in assisting grieving families.

Presentation of the holistic support for grieving parents in Slovenia

The loss of a desired pregnancy and the perinatal death of a child are among the most difficult experiences for parents, often leading to prolonged grief. In the past, women were not considered capable of mourning unborn children and were frequently denied the opportunity to see their deceased baby or arrange a funeral. Research now confirms that women bond with their fetuses during pregnancy. The intensity of grief depends on the significance of the pregnancy rather than gestational age. Despite distinctions between miscarriage and stillbirth, grieving parents have similar needs that should be respected.

In Slovenia, the first training for healthcare professionals on supporting grieving parents was conducted in 1997. In 2000, the Park of Snowdrops was established at Ljubljana’s Žale Cemetery as a burial site for perinatally deceased children. The Solzice Association was founded in 2002, uniting grieving parents, and the book Empty Cradle, Broken Heart was published. Since then, similar burial sites have been created near most Slovenian maternity hospitals. In 2016, a symposium was held on holistic care for families facing fetal anomalies, pregnancy termination, and the rights of deceased children and grieving parents. That same year, the booklet A Nest Without Birds was published to support parents experiencing perinatal loss.

A multidisciplinary team approach is recommended for perinatal grief management, providing holistic care to families before, during, and after birth. Psychological support is available when parents face decisions about pregnancy termination, perinatal palliative care, or raising a child with severe disabilities. Assistance is provided in preparing for miscarriage or stillbirth and in saying goodbye. Parents are offered condolences, the opportunity to see and hold their baby, create memories, choose burial options, and name their child. Before discharge, they receive information on grieving and available support. Counselling is offered throughout the grieving process—individually, for couples, and families—before a subsequent pregnancy (addressing anxiety, depression, and post-traumatic stress) and during pregnancy (monitoring emotional well-being and preventing postpartum depression).

Compassion and respect are vital in supporting grieving parents. Healthcare professionals must provide clear information, allow parents time for decisions, and honour their choices. Cultural and religious beliefs should be respected, and parents should be offered support, including the presence of a partner in the maternity ward and guidance on communicating loss to siblings.

Conclusions

The grieving process is often hindered by societal silence, as many struggle with how to respond to perinatal loss. Healthcare professionals play a crucial role in recognizing and validating parents’ grief, helping them create memories and preserve their often unacknowledged parental identity.

Working with grieving parents is emotionally demanding. Awareness of personal emotions, sharing experiences, and developing counselling skills are essential. Public education is also necessary to ensure that grieving parents receive the understanding and support they need within their communities.

None declared