Condensation: An evidence-based guideline from the International Society for abnormally invasive placenta (AIP) for the antenatal and intra-partum management of AIP.

AGA pregnancies may present with fetal cerebral and placental blood flow redistribution indicative of fetal hypoxemia. Fetal Doppler assessment may be of value in detecting AGA pregnancies that are subject to placental insufficiency, fetal hypoxemia and FRGP. Future studies are needed to evaluate the appropriate threshold for the diagnosis of FRGP and the diagnostic performance of this new approach for the management of growth disorders.

Topics: Neonatal Morbidity and Mortality, Systems-based Practice I dentifying whether a fetus is at risk for intrapartum hypoxia and other adverse conditions is challenging. Although smaller fetal size is more strongly associated with nonreassuring fetal status, many appropriate weight babies are also at risk for conditions such as cerebral palsy. A recent study suggested that fetal cerebroplacental ratio (CPR) measured within 72 hours of delivery, can successfully identify patients that will require obstetric intervention for intrapartum fetal compromise. The purpose of this study was to determine whether or not the CPR can in fact serve as a reliable indicator of both intrapartum fetal compromise and admission to a neonatal unit.The study was conducted from 2000 to 2013 in a single tertiary referral center and involved a retrospective analysis of prospectively collected data. Within 2 weeks of delivery, information on umbilical artery pulsatility index, middle cerebral artery pulsatility index, and CPR was collected for each case. Birth weights were converted into centiles and Doppler parameters were converted into multiples of the median, with reference ranges used to adjust for gestational age. Possible confounding variables were addressed through the use of logistic regression analysis.A total of 9772 singleton pregnancies were included in the study. Operative delivery in response to presumed fetal compromise occurred in 17.2% of cases, while admission to a neonatal unit occurred in 3.9% of cases. CPRs were lower in cases that required either operative delivery or admission to a neonatal unit (P < 0.01). Logistic regression showed that both CPR and birth weight were independently associated with an increased risk of operative delivery for presumed fetal compromise [adjusted odds ratio (OR), 0.67; 95% confidence interval (CI), 0.52-0.87; P = 0.003 and adjusted OR, 0.994; 95% CI, 0.992-0.997; P < 0.001, respectively). The association with birth weight persisted even when small-for-gestational-age cases were excluded. CPR was shown to be an independent indicator for admission to a neonatal unit at term (adjusted OR, 0.55; 95% CI, 0.33-0.92; P = 0.021), while birth weight was not (adjusted OR, 1.00; 95% CI, 0.99-1.00; P = 0.794).The findings of this study show that there is an association between low fetal CPR measured at term and the need for emergency operative delivery and admission to a neonatal unit. Even after the results were adjusted for potential confounders, this association remained significant. These results emphasize that Doppler assessment is a better indicator of fetal compromise than size alone. The authors recommend that future studies focus on how fetal hemodynamic status could be useful in predicting perinatal morbidity and guiding the best choice of delivery method.

Objective To determine whether small-and appropriatefor-gestational-age (SGA and AGA)

The detection rate of CoA may improve when a multiple-criteria prediction model is adopted. Further large multicenter studies sharing the same imaging protocols are needed to develop objective models for risk assessment in these fetuses.

Objective Placental insufficiency contributes to the risk of stillbirth. Cerebroplacental ratio (CPR) is an emerging marker of placental insufficiency. The aim of this

Condensation: An evidence-based guideline from the International Society for abnormally invasive placenta (AIP) for the antenatal and intra-partum management of AIP.

ObjectivesTo evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19.MethodsSecondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI).ResultsMean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8–0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09–1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3–7.9; p=0.001) were independently associated with composite adverse fetal outcome.ConclusionsEarly gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.