Includes bibliographical references. / ith the advances made in the management of cardiac conditions, much importance has been placed on the maternal outcome in pregnancies complicated by heart disease. However, to enable attending clinicians to provide suitable counseling and manage the pregnancy appropriately, the potential complications arising in the fetus and neonate also require attention. Adverse neonatal and perinatal outcome is more common in pregnant women with cardiac disease. Analysis of the available data pertaining to the South African population is important, as this population’s profile, like that of Africa, differs from that of industrialized countries. The relevance of maternal heart disease is highlighted by the National Committee for the Confidential Enquiries into Maternal Deaths (NCCEMD) in South Africa ( http://www.doh.gov.za/docs/reports/2012/Report_on_Confidential_Enquiries_into_ Maternal_Deaths_in_South_Africa ). Objectives To describe the perinatal outcome in women with heart disease and to determine whether there is an associated adverse outcome related to babies born to mothers with heart disease. Methods 82 patients were collected serially over 18 months. Neonatal outcome was recorded. Adverse neonatal outcome was defined as perinatal mortality, admission to NICU and the need for delivery room resuscitation. Results Perinatal mortality rate in this cohort was good, and better than the rate in the general population from whence this cohort came, but was linked to a high rate of obstetric intervention. The rate of adverse neonatal outcome is better than the rate in industrialized countries. Conclusion Perinatal outcome is good when mothers with heart disease are managed in a multidisciplinary clinic.

Includes abstract. / Includes bibliographical references. / Postpartum haemorrhage (PPH) accounts for more than 75% of maternal deaths from obstetric haemorrhage. In South Africa, maternal mortality resulting from postpartum haemorrhage has persistently been shown to be higher in HIV positive compared to HIV negative women. It is unknown whether the incidence of PPH is higher in HIV positive women; and/or whether HIV positive women have more severe bleeding and suffer greater morbidity as a result of PPH. The aim of the study was to investigate the effect of HIV infection on the incidence and severity of PPH. All women delivering at Mowbray Maternity and Groote Schuur Hospital in 2009 who had PPH were identified through a manual search of labour ward and operating theatre records. The women were categorized according to their HIV status as HIV positive, negative and untested. Data was also obtained on HIV status of the whole delivery population at these two hospitals. For women with PPH, data regarding background characteristics:- blood loss; cause of PPH and management provided; severity of and morbidity from PPH was analysed by comparing the HIV positive with the HIV negative group. Severity was assessed in terms of blood loss alone. Morbidity on the other hand was a composite assessment of blood loss, need for blood products, interventions required and complications of the PPH. Data was also collected on CD4 counts and treatment provided although the study was not powered to investigate these factors as associations.

Aim To assess current methods of prediction of adverse pregnancy outcomes, develop a prediction model and assess diet and life style in preventing preeclampsia. Methods Meta-analyses performed to assess the role of abnormal 1st trimester biomarker levels in predicting PE and the predictive accuracy of 2nd trimester UAD indices for stillbirth. A prospective observational study was performed to assess the efficacy of maternal characteristics, biomarkers, arteriography and UADs for predicting adverse pregnancy outcomes. Previously published 1st trimester PE prediction models were validated using data collected from the observational study. A systematic review on the effect of diet and life style based metabolic risk modifying interventions on PE was performed. Results The review of biomarkers found that abnormal levels were particularIy associated with early onset PE. The stillbirth review demonstrated a three-four fold increased risk of still birth with abnormal UAD. 1045 women were included for analysis in the prospective observational study. Our models' detection rate (false positive rate of 15%) was 72% for PE; 48% PIH; 30 % SGA < 10th centile; 57% SGA < 5th centile and 67% stillbirth. In the validation study the observed discrimination ability in the derivation studies ranged from 0.70 to 0.954. When validated against the study cohort, the AUC varied importantly, ranging from 0.504 to 0.833. Dietary interventions were shown to reduce the risk of PE by 33%, with no reduction in risk with mixed interventions or fatty acid supplementation. Conclusion The high heterogeneity of studies in the systematic reviews makes it difficult to draw firm conclusions regarding the use of biomarkers or UADs in screening for pregnancy complications. Our prospective study showed a role for haemodynamics as part of routine 1st trimester screening for assessing the risk of hypertensive disease in pregnancy.

Placental dysfunction affects approximately 1 in 10 pregnant women in both the developed and developing worlds. Most commonly, it is manifested as preeclampsia or fetal growth restriction. Over the past two decades, an increasing body of research into the developmental biology of the placenta has been amassed, which points to defects in the differentiation of the trophoblast cell lineage as a key player in the pathophysiology of placental dysfunction. A number of clinical parameters are known to be associated with an elevated risk of placental dysfunction. These include maternal risk factors (such as chronic hypertension, renal disease, and lupus), history of placental dysfunction in a prior pregnancy, abnormalities in the levels of certain proteins in the maternal blood that are commonly used to estimate the risk of fetal genetic defects, and abnormalities in uterine artery Doppler waveforms. These current methods have significant drawbacks, including low specificity and sensitivity, high cost, lack of widespread availability, and lack of validity early in pregnancy. In order to provide a more cost-effective and reliable method to detect an elevated risk for placental dysfunction early in pregnancy, we explored the potential for extracellular RNAs (exRNA) in the maternal serum to be used as biomarkers. In our study, we used next generation sequencing technologies to compare extracellular microRNA (miRNA) levels in serum samples of pregnant women of different gestational ages, nonpregnant women, and placental tissue samples. We discovered that the large majority of microRNAs that were present at higher levels in pregnant serum samples than nonpregnant serum samples and were likely of placental origin. We also found that these pregnancy-specific miRNAs were enriched for miRNAs encoded on chromosomes (Chr) 14 and 19, with changes in the relative expression of these two groups of miRNAs throughout pregnancy. Moreover, the miRNA signatures of late gestational pregnant samples correlated more closely with placental tissue samples than those of early pregnant samples, which could be related to the increasing impact of a larger placenta on the maternal serum exRNA profile. Our results demonstrate the potential utility of next generation sequencing technologies in regards to differentiating between different conditions using clinical samples.

<strong>Background and objectives:</strong> The incidence of preterm birth (PTB), and the extent to which it results in perinatal mortality in sub-Saharan Africa (sSA) is unclear, partly because reliable estimates of gestational age (GA) at birth are lacking. This research: 1) Describes how clinical and ultrasound (US) estimates of gestational age (GA) influence PTB rates and perinatal mortality amongst a population in Kilifi, Kenya; 2) Implements a novel PTB classification system as proof of concept that such systems are feasible in low-income settings, and 3) Presents two novel approaches for estimating GA for women presenting >24 weeks’ gestation. <strong>Methods:</strong> Objectives 1) and 2) used a perinatal surveillance platform developed at the KEMRI/Wellcome Trust Research Programme in Kilifi, Kenya. Ultrasound (US) was offered for GA estimation in women ≤24 weeks’ gestation clinically. To achieve objective 3), two candidate US dating equations were derived by combining a machine learning algorithm with polynomial regression analyses. Lastly, an entirely automated model with the capacity to estimate GA using computational image analysis of the fetal cerebral cortex was developed and tested. <strong>Results:</strong> 1) Between November 2011 and July 2013, 3630 women presented for antenatal care, 1107 women had US and data were available for 950 (86%) of these. The PTB rate by US (US-GA) was 10.0% compared to 17.1% by a best clinical estimate of GA (C-GA), although the number of perinatal deaths that were preterm by US and C-GA were similar; 2) Implementation of a novel PTB classification system is feasible, and 3) New dating equations and an automated model provide estimates in the 3rd trimester with a prediction error at 34 weeks of 12.4 and 14.2 days, respectively. <strong>Conclusion:</strong> Clinical estimates of GA significantly overestimate the rate of PTBs. Despite this, the proportion of perinatal deaths in those identified as preterm by clinical and US methods was similar, suggesting that US may be a better predictor of PTB and its associated mortality. Novel dating methods can estimate GA at 34 weeks’ gestation with an error equivalent to that provided by routine clinical methods at 22 weeks’. This has important implications and may extend capacity to provide GA estimates amongst a large group of women whose birth phenotypes remain poorly described.

Le Registre de malformations congénitales d’Alsace constitue l’un des cinq registres de malformations congénitales de France métropolitaine. Membre du réseau européen EUROCAT, il génère un enregistrement continu et exhaustif des malformations congénitales parmi les 23 000 naissances annuelles recensées dans les deux départements d’Alsace (ce qui correspond à approximativement 3% de l’ensemble des naissances en France). Ses objectifs s’inscrivent dans une triple démarche clinique, épidémiologique et de santé publique.Notre étude s’est intéressée à période 1995-2009, marquée par un développement majeur de la médecine foetale et du diagnostic prénatal. La prévalence totale des malformations congénitales est de 3,6% des naissances. Les 6 845 cas enregistrés se répartissent en 80,3% d’enfants nés vivants, 18,7% d’interruptions médicales de grossesse (IMG) et 1% de morts foetales in utero. Les quinze années de l’étude sont marquées par une augmentation progressive du taux global de diagnostic prénatal, de 26,1% en 1995 à 46,5% en 2009. L’étude concernant les fentes oro-faciales le démontre avec un taux passant de 43% en 1995-1999, à 53% en 2000-2004 et 66% en 2005-2009. Cette période voit également évoluer les pratiques médicales avec la création des centres pluridisciplinaires de diagnostic prénatal dont la multidisciplinarité favorise la diffusion du savoir parmi les professionnels pour une meilleure prise en charge des grossesses. / The Registry of congenital malformations of Alsace is one of the five registries of congenital malformations of metropolitan France. As a member of EUROCAT network, it provides a continuous registration for congenital malformations and chromosome abnormatities among the 23,000 annual births recorded in the two departments of Alsace (corresponding to approximately 3% of all births in France).This system is a crucial tool for clinical, epidemiological and public health studies.Our study concerns the 15-year period 1995-2009 period, marked by a major development of fetal medicine and prenatal diagnosis. The total prevalence of congenital malformations is 3.6%. The 6,845 registered cases are divided into 80.3% of livebirths, 18.7% terminations of pregnancy and 1% of stillbirths. The study emphasizes an increasing rate of prenatal diagnosis from 26.1% in 1995 to 46.5% in 2009. The study about orofacial clefts demonstrates these advances in prenatal diagnosis with increasing detection rates from 43% (1995-1999) to 53% (2000-2004) and 66% (2005-2009).This period is also marked by an important evolution in the field of medical practices, including the setting-up of multidisciplinar centres of prenatal diagnosis which contribute to an easier diffusion of knowledge between professionals.

No description available.

Yes / perinatal palliative care services are increasingly available globally, offering a range of clinical and psychological support services to families during pregnancy, in the neonatal period and following the death of a baby with a life-limiting or life-threatening condition. Little is understood about the role of children’s hospice care and how it contributes to effective perinatal palliative care. Design: The study aims to answer the question ‘what is the role of children’s hospices in the provision of perinatal palliative care and advance care planning in the United Kingdom?’ Methods: An electronic survey was sent to all 54 children’s hospices in the United Kingdom between May and June 2022. Results: 30 hospices responded, representing 54% of the sector. All regions of all four counties are represented. Numbers of referrals to hospices for perinatal palliative care have increased significantly over the last five years. Hospices provide a range of services for families and babies, usually from the point of diagnosis or recognition of a life-limiting or life-threatening condition, underpinned with counselling and emotional support. Hospices worked with a range of professionals and services, most commonly fetal medicine and neonatal services. Advance care plans were an important element of effective perinatal palliative care, strengthening parent-professional and interprofessional relationships. Conclusion: Children’s hospice services play an important and growing role in the perinatal care of babies and families following the diagnosis or recognition of a life limiting or life-threatening condition. The family centred approach to care, from a broad, biopsychosocial perspective means that hospices make a unique and meaningful contribution to both the clinical and psychological needs of families. / University of Bradford. Grant Number: DA5151. SURE Research Project

[pt] Esta pesquisa interdisciplinar aborda os avanços tecnológicos obtidos no desenvolvimento da técnica de conversão de exames de imagens médicas em modelos virtuais e físicos, na área de medicina fetal. A técnica tem por objetivo melhorar a visualização e contribuir com as tomadas de decisão clínica através do desenvolvimento de modelos tridimensionais que simulam com acurácia as formas anatômicas do paciente. Ao longo de dez anos, diversos avanços foram criados e incorporados, ampliando significativamente as formas de visualização e interatividade. A relação interdisciplinar entre o design e a medicina, possibilitou a constante atualização da técnica, atestado pela vasta produção cientifica nacional e internacional produzida. Um procedimento complexo na área de neurologia foi escolhido como estudo de caso de forma a exemplificar a gama de modelos e simulações que permitiram observar como o design contribui em todo o processo. / [en] This interdisciplinary research approaches the technological advances obtained in the development of the technique of converting medical image images into virtual and physical models, in the area of fetal medicine. The technique aims to improve visuality and contribute to clinical decision making through the development of threedimensional models that accurately simulate the patient s anatomical shapes. Over ten years, several advances were created and incorporated, significantly expanding the ways of visualization and interactivity. The interdisciplinary relationship between design and medicine enabled the constant updating of the technique, attested by the vast national and international scientific production. A complex procedure in the field of neurology was chosen as a case study in order to exemplify the range of models and simulations that allowed us to observe how design contributes to the entire process.

O transplante intrauterino de células-tronco (TIUCT) é um método de tratamento de doenças genéticas, congênitas, hematológicas e imunológicas em um feto durante a gestação. Em pesquisa básica este modelo permite o estudo da dinâmica de migração, enxertia e estado funcional de diferentes tipos de células-tronco (CT). Estas células podem ser transplantadas em diferentes momentos do período gestacional, que pode ser dividido em três momentos do desenvolvimento fetal, sendo estes, diferentes funcionalmente. A escolha deste momento para o transplante influenciará tanto no comportamento celular quanto no resultado. Para o TIUCT são utilizadas as CT mesenquimais derivadas da medula óssea ou fetais ou hematopoiéticas. Para esta pesquisa utilizamos células-tronco derivadas da polpa dentária imatura humana (CTIPDh) as quais apresentam potencial pluripotente e propriedades imunomodulatórias. Nosso principal objetivo foi avaliar a capacidade migratória, bem como de proliferação e endereçamento (homing) das CTIPDh durante o terceiro período gestacional do desenvolvimento fetal no modelo canino. Todos os procedimentos experimentais foram elaborados sob protocolo anestésico apropriado e aprovados pelo comitê de ética da FMVZ da USP. Foram transplantadas via intraperitoneal (IP) 1x106 CTIPDh GFP+ em cada feto, durante procedimento cirúrgico de laparotomia exploratória com ultrassonografia guiada intraoperatóriamente em quatro fetos com idade gestacional aproximada de 45 dias, e outros dois fetos os quais não receberam o transplante, utilizados como controle. Avaliamos os fetos pré e pós-transplante através do ultrasson. Após sete dias, realizamos a ovário-salpingo-histerectomia (OSH) para a colheita dos fetos. Em seguida coletamos seus órgãos e tecidos os quais foram fixados em paraformoldeído a 4% e criopreservados a temperatura de -80oC. Analisamos a biodistribuição das CTIPDh dentro dos órgãos e tecidos em criocortes de 5&micro;m sob microscopia Confocal. Constatamos o homing das CTIPDh nos órgãos derivados das linhas germinativas endodermais, ectodermais e mesodermais. No estômago e intestinos as CTIPD/GFP+ foram identificadas tanto no espaço intraglandular, como na camada muscular da mucosa; no fígado no parenquima hepático; no coração especialmente no tecido muscular do miocárdio; no cérebro nos vasos da substância branca, e cerebelo entre células de Purkinje. Na placenta estas células foram encontradas especialmente junto aos vasos. Quantificamos as CTIPD GFP+ utilizando a citometria de fluxo. Comparativamente dentre os órgãos analisados, obtivemos resultados expressivos do homing celular no miocárdio (~50%), no baço e fígado. Nossos resultados foram confirmados através das análises de imunohistoquímica e imunofluorescência utilizando os anticorpos Anti-núcleo (HuNu), Anti-CTIPD e Anti-GFP humanos. Concluímos que as CTIPDh apresentam grande potencial migratório e proliferativo após o TIUCT em fetos caninos. Estas células indiferenciadas demonstraram homing, especialmente nos tecidos: hematopoiéticos fetais (placenta, fígado e baço), tecido epitelial e glandular de órgãos, bem como de nichos perivasculares de CT. Estes dados sugerem que as CTIPD através do TIU, é uma alternativa viável, segura e promissora para o tratamento de doenças genéticas, congênitas, hematológicas e imunológicas. / Intra-uterine stem cells transplantation (IUSCT) is a method for the treatment of genetic, congenital, hematological, and immunological diseases. In basic research it provides a model for studying the dynamics of migration, graft and functional status of different types of stem cells. The cells can be transplanted in different moments of gestational period, which can be divided into quarters that are not functionally equivalent. The choice of the cells and quarter where the stem cells will be applied can influence cells behavior and results of transplantation. Fetal and adult hematopoietic or bone marrow derived mesenchymal stem cells (MSCs) were mainly used for IUSCT. We previously obtained human immature dental pulp stem cell (IDPSCs), which showed pluripotent potential and immune-compatible properties. The goal of our study was to evaluate migration capacity, proliferation and homing of IDPSCs after IUSCT during the third fetal period in dogs. All experimental procedures were approved by the Ethical Committee of the School of Veterinary Medicine and Animal Science of São Paulo University and were performed under appropriate anesthesia. 1x106 of undifferentiated GFP-positive human IDPSCs were transplanted following laparotomy and intraperitoneal injection under intra-operative ultrasound control into 5 fetuses at the 45 days of gestation. Five fetuses, which did not receive IDPSCs, were used as a control. Ultrasound analyses were performed daily before collection of the fetuses. After 7 days ovarian hysterectomy was performed, fetuses were collected; organs and tissues were isolated and fixed in 4% paraformaldehyde or cryopreserved. Biodistribution of IDPSCs within the organs and tissues were analyzed on cryosections (5&micro;m) under Confocal Microscopy. Homing of IDPSCs was observed in organs derived from three germ lines, endoderm, ectoderm and mesoderm. In stomach and in intestine GFP IDPSCs were found in intraglandular space as well as in muscularis mucosae. In liver they appeared in hepatic parenchyma; in heart in myocardium and in brain in bold vessels, in cerebellum within Purkinje cells. Using Flow cytometry assay GFP IDPSCs graft was quantified. Among the different organs an expressive homing was observed in myocardium of heart (~50%), in spleen and liver. The IDPSCs were also found in canine placenta, especially in blood vessels. These data were confirmed using anti-human nucleus (HuNu), anti-GFP and anti-IDPSCs anti-bodies. Human IDPSCs showed high migration and proliferation potential after IUSCT in dog fetuses. Undifferentiated IDPSCs demonstrated homing in fetal hematopoietic (placenta), epithelial (gastric glands) and perivascular stem cells niches. Our data suggest that IDPSCs is a new promising source for genetic, congenital, hematological, and immunological treatment for those diseases through IUSCT.