Congenital heart disease (CHD) is the most common fetal anomaly worldwide. The definite etiology of most CHD is not recognized. A direct genetic etiology is considered for a minority of patients. Most etiologies are attributed to epigenetic and environmental factors. Placental malformation is an overlooked cause of CHD that has recently received attention. This narrative review presents a hypothesis based on clinical reports and animal studies. The placenta and fetal heart have concomitant developmental regulatory pathways, and their diseases have a two-way communication. Placental insufficiency may result in cardiac remodeling. Conversely, placental diseases are more frequent in association with fetal CHD. Fetal vascular malperfusion and genetic defects may play a role in placental and fetal heart disorders. Disturbed embryonic blood flow, such as syncytialization deformities and umbilical cord disorders, may lead to cardiac underdevelopment. Genetic, epigenetic, hormonal, and regulatory factors, including the NOTCH signaling pathway, SUMO-modulated stress responses, and autophagy-related genes, can affect both placental and fetal heart development. This novel information about the interplay between the placenta and fetal heart provides a new perspective on the etiologic factors of CHD and placental insufficiency. The current study aims to clarify the common causes of placental and fetal heart disorders.

The aim of this study is to explore the conditions of pregnancy and gynaecological care for women in prison in Spain. An exploratory qualitative research study was carried out, involving 125 semi-structured interviews with 79 prison professionals and 46 women prisoners in 16 prisons in Spain. The participants were selected through theoretical sampling. The study was based on a thematic analytical procedure inspired by grounded theory, which produced certain unexpected results that are the focus of this study. The results of the interviews reveal that obstetric violence (OV) can take place through actors other than healthcare professionals, such as the police force when they guard and transfer pregnant inmates to obstetrics appointments or other inmates who require gynaecological services. During gynaecological examinations and tests, female inmates are kept in handcuffs or restraints and with police officers present in the room, violating their privacy and rights. The responses of gynaecologists to this situation are diverse. Gynaecologists should be the ones with authority in the medical consultations of female prisoners, and they should not allow the humiliation and violation of the rights of these women, as stated in the United Nations Bangkok Rules. Most female inmates are not dangerous, with non-aggressive and non-violent offences, so they would not put the lives of healthcare personnel at risk, and the continuation of this practice is more a question of compliance with protocols than of real risk.

Background: Amniocentesis (AC) remains the most commonly performed prenatal invasive diagnostic test. The data available till now have been collected before the era of high-end ultrasound machines, NIPS, and chromosomal microarrays. In selected cases, whole-exome sequencing is also offered prenatally. The evolution of ultrasound, NIPS, and genetic testing has made us revisit this topic.Objective: We aimed to research and revisit AC data regarding the indications, procedures, genetic testing methods, and outcomes. We reinforce the knowledge of AC, offer tips to minimize complications, and help communicate and counsel patients based on the AC data.Methods: It was a retrospective study from October 2019 to March 2023 in a tertiary care fetal medicine center in a university hospital. A total of 321 patients who underwent AC were analyzed. We observed the demographic details, indications, procedure details, and maternal–fetal and neonatal outcomes.Results: During the study period, 321 patients underwent AC. Abnormal ultrasound findings (71%) were the most common indication for AC. Then, 9% (30/321) had abnormal genetic results. Down syndrome was the most common abnormality (14), followed by Edwards syndrome. Then, 47.96% of cases were in age > 35 years. We had three cases of bloody tap, one leak per vagina, and two missed abortions following AC. Then, 58% had live births.Conclusion: AC is a relatively safe procedure, and even with the advent of NIPS, it remains the gold standard prenatal diagnostic genetic testing method. Major structural anomalies and parental chromosomal anomalies are irreplaceable indications of AC. The technique and expertise of health professionals dictate the complication rate of that center. Chromosomal microarray, DNA storage, and whole-exome sequencing have added an extended armamentarium to our discovery of genetic diseases. Maternal and neonatal outcomes after AC are favorable, so do not hesitate to carry out this invasive test when indicated.

BackgroundPregnancy complications are known to be risk factors for the onset of depression and anxiety symptoms. This study assessed associations between pregnancy complications, including concurrent complications, and symptoms of anxiety and depression among pregnant women living in France.MethodsA cross-sectional study was carried out among 492 pregnant women. Sociodemographic and obstetric characteristics were collected using an online questionnaire. Depression and anxiety symptoms were evaluated using the Edinburgh Postnatal Depression Scale and the Spielberger State–Trait Anxiety Inventory, respectively. Multivariate logistic regressions were employed to identify associations between mental health outcomes and pregnancy complications.ResultsWhile 37% of women declared no pregnancy complications, 9.76% declared two or more complications, and 63% of participants had at least one complication. Among these latter, 68.9% had a high risk of depression, 83.9% elevated state anxiety, and 77.4% elevated trait anxiety. State anxiety scores were significantly higher in women who felt they did not receive adequate social support from their partner, family, and friends and who reported dissatisfaction with medical care. Adjusting for confounders, we identified that women with complications had higher odds of experiencing higher state anxiety scores (adjusted OR: 2.94; 95% CI: 1.40–6.10). Positive associations were also observed between gestational diabetes mellitus and increased likelihood of reporting depressive symptoms (adjusted OR: 1.99; CI:1. 20–3.29) and high state anxiety scores (OR: 3.31; CI: 1.22–9.01).ConclusionWe found a high prevalence of depression and anxiety among pregnant women with complications. Gestational diabetes mellitus was positively associated with antenatal depression and high state anxiety levels. These findings suggest that women with complications have a higher risk of developing depressive and anxious symptoms. Screening for and treating physical and mental health problems in women experiencing pregnancy complications and poor mental health symptoms are crucial to safeguard the well-being of the mother and the fetus.

BackgroundAfrican refugee communities in Uganda encounter significant barriers to maternal health services, particularly regarding men's involvement in maternal health. This study explored the perspectives of African refugees and stakeholders on men's engagement in couple's maternal health decisions, utilizing an interdependence-based theoretical model as a framework.MethodsThis qualitative study, conducted in Uganda's Nakivale refugee settlement, included 14 in-depth interviews with healthcare providers, community leaders, and religious leaders, along with eight focus group discussions (n = 78) with refugee men and women. Participants were purposefully recruited to represent diverse experiences. Data were analyzed through deductive analysis to identify factors influencing men's engagement and couple's behaviors in maternal health, emphasizing predisposing factors that affect motivation and communal coping.ResultsKey individual-level factors influencing engagement included men's financial status, mental health, and peer/community influence. At the couple level, closeness, trust, commitment, communication, and joint household decision-making were crucial for fostering male participation. Couples with a high transformation of motivation viewed maternal health as a shared concern rather than an individual one. Those practicing effective communal coping, discussing and jointly deciding to address maternal health issues, also expressed higher engagement in health-promoting behaviors, such as saving for birth, attending antenatal visits together, utilizing family planning, and sharing household chores.ConclusionsMaternal health should be reframed as a shared responsibility between partners, not solely women's issue. To effectively engage African refugee couples and improve outcomes, interventions must prioritize men's involvement alongside women-focused efforts, eventually addressing couples together. These initiatives should enhance men's financial literacy, mental health, knowledge, and relationship quality to foster equitable discussions, decisions, and behaviors between refugee couples.

Background: There is insufficient evidence to assess the risk of the production of clinically important alloimmune irregular red blood cell (RBC) antibodies in first-time pregnant women. Methods: Using the microcolumn gel antiglobulin method, 18,010 Chinese women with a history of pregnancy and pregnant women were screened for irregular RBC antibodies, and for those with positive test results, antibody specificity was determined. The detection rate and specificity of irregular RBC antibodies in women with a history of multiple pregnancies (two or more) and first-time pregnant women were determined. Results: In addition to 25 patients who passively acquired anti-D antibodies via an intravenous anti-D immunoglobulin injection, irregular RBC antibodies were detected in 121 (0.67%) of the 18,010 women. Irregular RBC antibodies were detected in 93 (0.71%) of the 13,027 women with a history of multiple pregnancies, and antibody specificity was distributed mainly in the Rh, MNSs, Lewis, and Kidd blood group systems; irregular RBC antibodies were detected in 28 (0.56%) of the 4983 first-time pregnant women, and the antibody specificity was distributed mainly in the MNSs, Rh, and Lewis blood group systems. The difference in the percentage of patients with irregular RBC antibodies between the two groups was insignificant (χ 2 = 1.248, P > 0.05). Of the 121 women with irregular RBC antibodies, nine had anti-Mur antibodies, and one had anti-Dia antibodies; these antibodies are clinically important but easily missed because the antigenic profile of the reagent RBCs that are commonly used in antibody screens does not include the antigens that are recognized by these antibodies. Conclusion: Irregular RBC antibody detection is clinically important for both pregnant women with a history of multiple pregnancies and first-time pregnant women. Mur and Dia should be included in the antigenic profile of reagent RBCs that are used for performing antibody screens in the Chinese population.

To validate a model for predicting magnesium concentration in magnesium sulfate treatment in preeclampsia. Retrospective cohort study. Setting. Three secondary care hospitals, one accepting neonates from gestational week 28 + 0. Population. Women with preeclampsia undergoing magnesium sulfate treatment. Subjects initially received Zuspan treatment (4 g bolus and 1 g/h maintenance dose), commonly increased by individual titration. Main Outcome Measures. Difference in mean between measured and predicted magnesium concentration. Proportion of women reaching target concentration (>2 mM) in 25 h. 56 women were included, with 356 magnesium measurements available. Mean magnesium concentration was 1.82 mM. The prediction model overestimated magnesium concentration by 0.10 mM (CI 0.04-0.16) but exhibited no bias for weight, creatinine, or treatment duration. Weighted mean infusion rate was 1.22 g/h during 30 hours. Overall success rate in reaching target concentration was 54%, decreasing to 40% in women > 95 kg. Overall success rate at 8 hours was 11%. No toxic concentrations were found. Zuspan regimen is very safe, but slow to reach therapeutic concentrations-despite efforts of individual titration. Success rate is lower in heavy women, which is of particular importance considering their predisposition to develop preeclampsia. The validated pharmacokinetic model performs well and may be used to individually tailor treatment from the outset.

Introduction: Herbal medicine is described by the World Health Organization (WHO) as plant-derived compounds, either raw or processed, that are thought to have therapeutic advantages. Herbal medication is becoming more and more popular worldwide, particularly during pregnancy. The WHO estimates that 80% of people utilize herbal remedies. In Ethiopia, grandmothers and grandfathers frequently use herbal medicine at home to treat common health issues. Instead of using medically proven treatments during their pregnancy, the majority of expectant mothers trust herbal remedies.Objective: The aim of this study was to assess the magnitude and associated factors of herbal medicine use during pregnancy among women attending antenatal care in public health institutions of central Tigray, northern Ethiopia.Methods: Facility-based cross-sectional study was conducted from March 01 to May 15, 2020. Data were collected using a structured and pretested questionnaire. Data were entered into Epi-data manager version 7.2.5 and analyzed using SPSS version 23. Both binary and multivariate logistic regression analyses were carried out to assess the associated factors. Variables with p value less the 0.2 in bivariate analysis were transferred to multivariate analysis, and variables with p value ≤ 0.05 were considered as significant.Result: Out of the total 333 respondents, making a response rate of 100%, 176 (52.9%) used herbal medicine during current pregnancy. The most common medicines used during pregnancy were garlic (59.4%) and ginger (51.7%). Occupation that is housewife had educational status (AOR = 11.816, 95% CI 1.848–35.535), illiterate (AOR = 1.886, 95% CI 1.586–2.241), residency/rural (AOR = 2.905, 95% CI 1.173–7.197), and average monthly income less than 500 Ethiopian birrs (AOR = 7.621, 95% CI 2.691–21.585) were factors that are significantly associated with the use of herbal medicine during pregnancy.Conclusion and Recommendation: Based on our results, herbal medicine use during pregnancy is highly practiced in this study, and occupation, residency, educational status, and average monthly income were the significantly associated factors of herbal medicine use during pregnancy. There is a need to educate and counsel pregnant women on the harmful effects of herbal medicine use during pregnancy by the health care personnel and health extension worker.

Background: Preinduction cervical ripening in previous caesarean pregnancy is limited to intracervical Foley catheter. This study is aimed at finding the vaginal birth rates, improvement of Bishop score, and safety of osmotic dilator (Dilapan-S) among women with previous caesarean pregnancy. Methods: We conducted this single-group clinical study after the approval of the institute ethics committee, clinical trial registration, and obtaining informed consent. We recruited women above 18 years with a prior caesarean section at term and a Bishop score of less than 6 by systematic random sampling prospectively. The first or second author inserted two to a maximum of five osmotic dilators (Dilapan-S) in the cervical canal. After 24 h, we removed Dilapan and induced labour with a low-dose oxytocin regimen up to a maximum dose of 24 mIU/min. We assessed the improvement of the Bishop score and vaginal birth rates for efficacy and safety concerns like bleeding, fragmentation, displacement, infections, and scar dehiscence. Results: Eighty-two women completed the study. The Bishop score significantly improved from a mean of 2.6 before to 5.3 after Dilapan. Three opted for a caesarean section after Dilapan removal and refused oxytocin infusion. Seventy-nine women completed the trial of labour. Forty-one (52%) achieved active labour (52%). Twenty-seven delivered vaginally, and 52 required emergency caesarean section (34% vaginal birth rate; 18 spontaneous, nine instrumental, four with forceps, and five with vacuum). None had entrapment, fragmentation, or upward displacement of Dilapan. Two women had scar dehiscence, and one had a traumatic postpartum haemorrhage. There was no maternal or perinatal mortality. Conclusions: We conclude that the hygroscopic dilator Dilapan effectively ripens the cervix before labour induction in women with a previous caesarean scar. They are safe, but more extensive studies are needed to evaluate scar-related complications during labour. Trial Registration: Clinical Trial Registry of India: CTRI/2019/03/017927.