Lung fractional moving blood volume in normally grown and growth restricted foetuses.

Objective: To examine foetal lung blood perfusion using power Doppler ultrasound (PDU) and to compare fractional moving blood volume (FMBV) and mean pixel intensity (MPI) estimations in the lungs of normally grown (NG) foetuses and foetuses with intrauterine growth restriction (IUGR) and also to correlate foetal lung FMBV and MPI with respiratory complications after birth. Methods: Lungs of 47 NG and 25 IUGR foetuses after 32 weeks of gestation were examined with PDU. FMBV and MPI were estimated in a defined region in the posterior part of the foetal lung closest to maternal abdominal wall. FMBV and MPI were correlated to foetal weight deviation and gestational age. Perinatal outcome and respiratory complications after birth were recorded in both groups. Results: There were significantly lower FMBV and MPI values in IUGR than in NG foetuses. The overall variation was lower for FMBV than for MPI. There was a slightly higher correlation between FMBV and foetal weight deviation [r = 0·33, 95% confidence intervals (CI) 0·11-0·52] than between MPI and foetal weight deviation (r = 0·26, 95% CI 0·03-0·46). There was no significant correlation between FMBV or MPI and gestational age. No differences between the groups were found in the rate of respiratory complications, and they were not correlated either to the FMBV or MPI. Conclusion: FMBV and MPI, estimated from the PDU signals of foetal lung circulation, showed lower values in third-trimester pregnancies complicated by IUGR. The frequency of neonatal respiratory complications was not increased in cases with low pulmonary FMBV and MPI values

Attitudes of Swedish midwives towards management of extremely preterm labour and birth.

OBJECTIVE: the aim of the study was to ascertain the attitudes of Swedish midwives towards management of very preterm labour and birth and to compare the attitudes of midwives at university hospitals with those at general hospitals. DESIGN: this cross-sectional descriptive and comparative study used an anonymous self-administrated questionnaire for data collection. Descriptive and analytic statistics were carried out for analysis. PARTICIPANTS: the answers from midwives (n=259) were collected in a prospective SWEMID study. SETTING: the midwives had experience of working on delivery wards in maternity units with neonatal intensive care units (NICU) in Sweden. FINDINGS: in the management of very preterm labour and birth, midwives agreed to initiate interventions concerning steroid prophylaxis at 23 gestational weeks (GW), caesarean section for preterm labour only at 25 GW, when to give information to the neonatologist before birth at 23 GW, and when to suggest transfer to NICU at 23 GW. Midwives at university hospitals were prone to start interventions at an earlier gestational age than the midwives at general hospitals. Midwives at university hospitals seemed to be more willing to disclose information to the parents. KEY CONCLUSIONS: midwives with experience of handling very preterm births at 21-28 GW develop a positive attitude to interventions at an earlier gestational age as compared to midwives without such experience. IMPLICATIONS FOR PRACTICE: based on these results we suggest more communication and transfer of information about the advances in perinatal care and exchange of knowledge between the staff at general and university hospitals. Establishment of platforms for inter-professional discussions about ethically difficult situations in perinatal care, might benefit the management of very preterm labour and birth

Apparently isolated ventricular septal defect, prenatal diagnosis, association with chromosomal aberrations, spontaneous closure rate in utero and during the first year of life: a systematic review

Aim: To evaluate the incidence of chromosomal aberrations in apparently isolated ventricular septal defects (VSD), quantify the timing of diagnosis of prenatally diagnosed VSDs, and define the spontaneous closure rate prenatally both in utero and during the first year of life. Materials and methods: Medline, PubMed, and the Cochrane Database Library were searched to identify studies published between January 2013 and January 2023 using keywords and word variant combinations for isolated ventricular septal defect, fetal echocardiography, karyotype, genetics, array CGH, spontaneous closure, and outcome. Inclusion criteria: studies reporting apparently isolated ventricular septal defect. Primary outcomes: to find the incidence of chromosomal aberrations in apparently isolated ventricular septal defects, and quantify the timing of diagnosis. Secondary outcome: to define the spontaneous closure rate in utero and in the first year of life. Statistical analysis was performed using Jamovi Meta-Analysis major package 2.3.21 Solid. To combine data, we used proportions and maximum likelihood ratios. Results: Overall, the maximum likelihood ratio of chromosomal aberrations in antenatally diagnosed apparently isolated VSD was 2.7%. The different types of defects showed substantially different rates of chromosomal aberrations. Muscular VSDs had a chromosomal aberrations rate of 0.4% vs. 4.8% for perimembranous VSDs. Mean gestational age of diagnosis was 25+4 days. Spontaneous closure rate maximum likelihood ratio in utero was 28.6%. Higher closure rate in utero was observed for the perimembranous type while muscular VSDs showed higher closure rates after birth. Closure in utero was observed in 28.9% of the perimembranous VSDs and in 14.5% of the muscular VSDs. Closure after 12 months was found in 22% for the perimembranous defects and in 53.8% for the muscular defects. The presented results could be of use in informed prenatal counseling and of great help in parental decision making. Conclusions: This systematic study included 740 isolated ventricular septal defects, of which 422 were muscular and 165 were perimembranous. Other types were not specified. One hundred fifty-nine perimembranous and 384 muscular VSDs were available for a follow-up after 12 months of life. Chromosomal aberrations were detected in 4.8% of the perimembranous VSDs and in 0.4% of the muscular VSDs

Cesarean delivery on maternal request: Can the ethical problem be solved by the principlist approach?

In this article, we use the principlist approach to identify, analyse and attempt to solve the ethical problem raised by a pregnant woman's request for cesarean delivery in absence of medical indications