Fetal heart rate changes on the cardiotocograph trace secondary to maternal COVID-19 infection

Elsevier grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains activeTo determine the cardiotocograph (CTG) changes in women with symptomatic COVID-19 infection. Study design: 12 anonymised CTG traces from 2 hospitals in Spain were retrospectively analysed by 2 independent assessors. CTG parameters were studied based on fetal pathophysiological responses to inflammation and hypoxia that would be expected based on the pathogenesis of COVID-19 patients. Correlation was made with perinatal outcomes (Apgar score at 5 min and umbilical cord pH). Results: All fetuses showed an increased baseline FHR > 10 percent compared to the initial recording, in addition to absence of accelerations. 10 out of 12 CTG traces (83.3 percent) demonstrated late or prolonged decelerations and 7 out of 12 fetuses (58.3 percent) showed absence of cycling. Not a single case of sinusoidal pattern was observed. ZigZag pattern was found in 4 CTG traces (33 percent). Excessive uterine activity was observed in all CTG traces where uterine activity was monitored (10 out of 12). Apgar scores at 5 min were normal (>7) and absence of metabolic acidosis was found in the umbilical cord arterial pH (pH > 7.0) in the cases that were available (11 and 9, respectively). Conclusion: Fetuses of COVID-19 patients showed a raised baseline FHR (>10 percent), loss of accelerations, late decelerations, ZigZag pattern and absence of cycling probably due to the effects of maternal pyrexia, maternal inflammatory response and the “cytokine storm”. However, the perinatal outcomes appear to be favourable. Therefore, healthcare providers should optimise the maternal environment first to rectify the reactive CTG changes instead of performing an urgent operative interventio

First-Trimester Sequential Screening for Preeclampsia Using Angiogenic Factors: Study Protocol for a Prospective, Multicenter, Real Clinical Setting Study

IntroductionThe incidence of preeclampsia (PE) is about 2–8%, making it one of the leading causes of perinatal morbidity and maternal mortality in the world. Early prophylactic low dose administration (150 mg) of acetylsalicylic acid is associated with a significant reduction in the incidence of early-onset PE, intrauterine growth restriction (IUGR), and neonatal mean stay in the intensive care unit (ICU). Universal implementation of a first-trimester screening system including angiogenic and antiangiogenic markers [the Placental Growth Factor (PlGF) and/or soluble fms-like Tyrosine Kinase-1 (sFlt-1)] has shown a prediction rate of 90% for early-onset PE but entails a high financial cost. The aim of this study is to determine the predictive and preventive capacity of a universal PE first-trimester two-step sequential screening model, determining the PlGF only in patients previously classified as intermediate risk by means of a multivariate model based on resources already used in the standard pregnancy control, in a real clinical setting. We hypothesize that this screening model will achieve similar diagnostic performance as the universal determination of PlGF but at a lower economic cost.Methods and AnalysisThis is a prospective, multicentric, cohort study in a real-world clinical setting. Every singleton pregnancy will be recruited at the routine first pregnancy visit. In a first step, the first-trimester risk of PE will be calculated using a multivariate Gaussian distribution model, based on medical history, mean blood pressure, Pregnancy-Associated Plasma Protein A (PAPP-A), and Uterine Artery Doppler Pulsatility Index (UTPI). Patients will be classified into three risk groups for PE: (1) risk ≥ 1/50, high-risk with no further testing (blinded PlGF); (2) risk between 1/51 and 1/500, medium-risk requiring further testing; and (3) risk ≤ 1/501, low-risk with no further testing. In a second step, the PlGF will only be determined in those patients classified as intermediate risk after this first step, and then reclassified into high- or low-risk groups. Prophylactic administration of aspirin (150 mg/day) will be prescribed only in high risk patients. As a secondary objective, sFlt-1 values will be blindly determined in patients with high and intermediate risk to assess its potential performance in the screening for PE.Ethics and DisseminationThe study will be conducted in accordance with the principles of Good Clinical Practice. This study is approved by the Aragon Research Ethics Committee (CEICA) on 3 July 2020 (15/2020).Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT04767438

Cómo afecta el diagnóstico prenatal de una cardiopatía congénita en las relaciones conyugales de los padres

En el presente artículo se estudia el impacto que produce en los padres el diagnóstico de una cardiopatía congénita en uno de los hijos durante el embrazo. Estas familias se encuentran en una nueva etapa del ciclo de la vida que implica distintos cambios, cuando los padres reciben el diagnóstico aparecen distintas reacciones que se han de saber gestionar para poder tener una buena evolución y aceptar la situación y las posibles consecuencias posteriores. En el estudio han participado 20 madres con fetos diagnosticados de una cardiopatía congénita y sus parejas. Los instrumentos utilizados han sido el FACES-III, el DAS, el BSI-18 y una entrevista semiestructurada durante la 20-40 semana de gestación. Los resultados muestran que las parejas tienden a tener puntuaciones altas en malestar psicológico y un ajuste diádico idealizado, aunque muestren unas dinámicas familiares moderadas mayoritariamente (45% en los padres y 40% en las madres).In this article, we studied the impact relationships in parents who have received a prenatal diagnosis of congenital heart disease. These families are in a new stage in the life cycle that involves several changes, when parents receive the diagnosis arise many reactions that they have to manage to have a good evolution and accept the situation and the consequences that can be appear. In the investigation, 20 couples participate with their fetuses are diagnosed with a congenital heart disease. The instruments used were the FACES-III, the DAS, the BSI-18 and a semi-structured interview, which were administered between 20th-40th weeks of gestation. Results shows that couples tend to have high scores on psychological distress and idealized dyadic adjustment, but family dynamics have mostly moderate (45% of parents and 40% of mothers)

Cord blood cardiovascular biomarkers in left-sided congenital heart disease.

Fetal echocardiography has limited prognostic ability in the evaluation of left-sided congenital heart defects (left heart defects). Cord blood cardiovascular biomarkers could improve the prognostic evaluation of left heart defects. A multicenter prospective cohort (2013-2019) including fetuses with left heart defects (aortic coarctation, aortic stenosis, hypoplastic left heart, and multilevel obstruction (complex left heart defects) subdivided according to their outcome (favorable vs. poor), and control fetuses were evaluated in the third trimester of pregnancy at three referral centers in Spain. Poor outcome was defined as univentricular palliation, heart transplant, or death. Cord blood concentrations of N-terminal precursor of B-type natriuretic peptide, Troponin I, transforming growth factor β, placental growth factor, and soluble fms-like tyrosine kinase-1 were determined. A total of 45 fetuses with left heart defects (29 favorable and 16 poor outcomes) and 35 normal fetuses were included, with a median follow-up of 3.1 years (interquartile range 1.4-3.9). Left heart defects with favorable outcome showed markedly increased cord blood transforming growth factor β (normal heart median 15.5 ng/mL (6.8-21.4) vs. favorable outcome 51.7 ng/mL (13.8-73.9) vs. poor outcome 25.1 ng/mL (6.9-39.0), p = 0.001) and decreased placental growth factor concentrations (normal heart 17.9 pg/mL (13.8-23.9) vs. favorable outcome 12.8 pg/mL (11.7-13.6) vs. poor outcome 11.0 pg/mL (8.8-15.4), p < 0.001). Poor outcome left heart defects had higher N-terminal precursor of B-type natriuretic peptide (normal heart 508.0 pg/mL (287.5-776.3) vs. favorable outcome 617.0 pg/mL (389.8-1087.8) vs. poor outcome 1450.0 pg/mL (919.0-1645.0), p = 0.001) and drastically reduced soluble fms-like tyrosine kinase-1 concentrations (normal heart 1929.7 pg/mL (1364.3-2715.8) vs. favorable outcome (1848.3 pg/mL (646.9-2313.6) vs. poor outcome 259.0 pg/mL (182.0-606.0), p < 0.001). Results showed that fetuses with left heart defects present a distinct cord blood biomarker profile according to their outcome

The Potential of Sewage Sludge to Predict and Evaluate the Human Chemical Exposome

Chemicals are part of our daily lives, and we are exposed to numerous chemicals through multiple pathways. Relevant scientific evidence contributing to the regulation of hazardous chemicals require a holistic approach to assess simultaneous exposure to multiple compounds. Biomonitoring provides an accurate estimation of exposure to chemicals through very complex and costly sampling campaigns. Finding efficient proxies to predict the risk of chemical exposure in humans is an urgent need to cover large areas and populations at a reasonable cost. We conducted an exploratory study to characterize the human chemical exposome in maternal blood and placenta samples of a population-based birth cohort in Barcelona (2018-2021). Ultimate HRMS-based approaches were applied including wide-scope target, suspect, and nontarget screening. Forty-two chemicals were identified including pesticides, personal care products, or industrial compounds, among others, in the range of ng/mL and ng/g. In parallel, sewage sludge from the wastewater treatment plants serving the residence areas of the studied population were also screened, showing correlations with the type and concentrations of chemicals found in humans. Our findings were suggestive for the potential use of sewage sludge as a proxy of the human exposure and its application in early warning systems to prevent bioaccumulation of hazardous chemicals.This work received support from the “La Caixa” Foundation (ID 100010434), fellowship code LCF/BQ/PR20/11770013, and Barcelona Council (Expo-Bar). The BiSC cohort study is funded by the European Research Council (ERC) under Grant Agreement No. 785994 (AIR-NB), and the Health Effects Institute (HEI) with Grant Agreement No. 4959-RFPA15-1/ 18-1 (FRONTIER). IDAEA-CSIC and ISGlobal are Centres of Excellence Severo Ochoa (Spanish Ministry of Science and Innovation).Peer reviewe

Multicenter prospective clinical study to evaluate children short-term neurodevelopmental outcome in congenital heart disease (children NEURO-HEART): study protocol.

BACKGROUND: Congenital heart disease (CHD) is the most prevalent congenital malformation affecting 1 in 100 newborns. While advances in early diagnosis and postnatal management have increased survival in CHD children, worrying long-term outcomes, particularly neurodevelopmental disability, have emerged as a key prognostic factor in the counseling of these pregnancies. METHODS: Eligible participants are women presenting at 20 to < 37 weeks of gestation carrying a fetus with CHD. Maternal/neonatal recordings are performed at regular intervals, from the fetal period to 24 months of age, and include: placental and fetal hemodynamics, fetal brain magnetic resonance imaging (MRI), functional echocardiography, cerebral oxymetry, electroencephalography and serum neurological and cardiac biomarkers. Neurodevelopmental assessment is planned at 12 months of age using the ages and stages questionnaire (ASQ) and at 24 months of age with the Bayley-III test. Target recruitment is at least 150 cases classified in three groups according to three main severe CHD groups: transposition of great arteries (TGA), Tetralogy of Fallot (TOF) and Left Ventricular Outflow Tract Obstruction (LVOTO). DISCUSSION: The results of NEURO-HEART study will provide the most comprehensive knowledge until date of children's neurologic prognosis in CHD and will have the potential for developing future clinical decisive tools and improving preventive strategies in CHD

Cohort Profile: Barcelona Life Study Cohort (BiSC)

This work was supported by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (785994—AirNB project) and the Health Effects Institute (HEI), an organization jointly funded by the United States Environmental Protection Agency (EPA) (Assistance Award No. R-82811201) and certain motor vehicle and engine manufacturers. The contents of this article do not necessarily reflect the views of HEI, or its sponsors, nor do they necessarily reflect the views and policies of the EPA or motor vehicle and engine manufacturers. A full list of the funding sources that supported specific parts of the project can be found at https://projectebisc.org/en/funding-sources/. ISGlobal acknowledges support from the grant CEX2018-000806-S funded by MCIN/AEI/10.13039/501100011033 and support from the Generalitat de Catalunya through the CERCA Program. Mireia Gascon holds a Miguel Servet fellowship (Grant CP19/00183) funded by Acción Estratégica de Salud—Instituto de Salud Carlos III, co-funded by European Social Fund ‘Investing in your future’. Ioar Rivas received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie (Grant Agreement No. 886121) and Ramón y Cajal fellowship (RYC2021-032781-I), funded by the MCIN/AEI/10.13039/501100011033 and the European Union «NextGenerationEU»/PRTR. Elisenda Eixarch has received funding from ‘Convocatòria Intensificació Interna per als professionals de l’Hospital Clínic de Barcelona 2023’, granted by Hospital Clínic de Barcelona.Peer reviewe

Protocol d'atenció i acompanyament al naixement a Catalunya

Acompanyament al naixement; Voluntats de la dona; Atenció al nadóBirth support; Women's wills; Newborn careAcompañamiento en el nacimiento; Voluntades de la mujer; Atención al recién nacidoL’Organització Mundial de la Salut, l’any 2018 va proposar una sèrie d’actuacions per a l’atenció al moment del part, que tenen per lema ‘Atenció per a una experiència positiva en el naixement’. En aquest document s’actualitza el ‘Protocol del part, puerperi i atenció al nadó’, document elaborat pel Departament de Salut, publicat l’any 2003 i actualitzat l’any 2019 com a ‘Protocol d’atenció i acompanyament al naixement’, seguint les recomanacions de l’OMS, així com totes aquelles basades en l’evidència científica, amb el màxim respecte a les opinions i voluntats de les dones gestants i amb l’objectiu d’ajudar-les a elles i a les seves famílies a tenir una experiència positiva en el part. Les activitats de promoció de la salut i prevenció de la malaltia són l’eix vertebrador d’aquest protocol i de tots els que es coordinen des del Servei de Salut Maternoinfantil de la Sub-direcció de Promoció de la Salut de l’Agència de Salut Pública de Catalunya del Departament de Salut. En aquest sentit, cal ressaltar la seva relació amb el Protocol del seguiment de l’embaràs a Catalunya (3a. edició) que es va presentar el 2018, amb el qual comparteix principis i enfocament. El protocol s’estructura en tres capítols en relació a les etapes (prepart, part i puerperi), recollint en el tercer, l’atenció la nadó. Cada capítol té diversos apartats en les activitats a realitzar, la informació a donar i el registre, entre d’altres. Es recull, després, la bibliografia i una sèrie de annexos amb eines pràctiques

Fetal Left Ventricle Function Evaluated by Two-Dimensional Speckle-Tracking Echocardiography across Clinical Stages of Severity in Growth-Restricted Fetuses

Fetal growth restriction (FGR) can result in adverse perinatal outcomes due to cardiac dysfunction. This study used 2D speckle-tracking echocardiography to assess left ventricle (LV) longitudinal strain across FGR severity stages. A prospective longitudinal cohort study measured global (GLS) and segmental LV longitudinal strain in FGR fetuses, with evaluations conducted at various time points. FGR was classified into subtypes based on published criteria using fetal weight centile and Doppler parameters. A linear mixed model was employed to analyze repeated measures and compare Z-score measurements between groups throughout gestational age. The study included 40 FGR fetuses and a total of 107 evaluations were performed: 21 from small for gestational age (SGA), 74 from the FGR stage I, and 12 from the FGR stage ≥ II. The results indicate that SGA and stage I FGR fetuses exhibit higher LV GLS than stages ≥ II. Throughout gestation, SGA and FGR stage I fetuses showed similar behavior with consistently better LV GLS values when compared to FGR stages ≥ II. No significant differences were observed in LV GLS strain behavior between SGA and FGR stage I. In conclusion, all FGRs show signs of early cardiac dysfunction, with severe cases demonstrating significantly a lower LV GLS when compared to mild cases, suggesting deterioration of cardiac dysfunction with progression of fetal compromise