Serum Uric Acid Levels as a Risk Stratification Tool in Hypertensive Disorders of Pregnancy: A Retrospective Study.

BACKGROUND: Worldwide, hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal and fetal morbidity and mortality. Serum uric acid is a test that can evaluate the severity of HDP and the associated maternal and fetal morbidity and mortality. AIM: To examine the relationship between maternal serum uric acid levels and the severity of HDP and overall pregnancy outcomes. MATERIAL AND METHODS: A retrospective study was conducted on women with a gestational age > 20 weeks and BP >140/90 mmHg over three years. A total of 134 patients were included in the study. Patients with chronic hypertension, hyperuricemia without hypertension, and other major illnesses were excluded. Data were collected from medical records, including age, gravida, parity, weight, height, gestational age, blood pressure at admission, urine albumin, and serum uric acid levels. RESULTS: Of the 134 enrolled women with HDP, 76 had gestational hypertension, 41 had preeclampsia, and 17 had eclampsia. Mean uric acid levels in mg/dL were 6.06±1.651, 6.20±0.824, and 7.38±1.26 in gestational hypertension, preeclampsia, and eclampsia, respectively, which was a significant association (p=0.002). Mean uric acid in mg/dL was 5.86±1.27 in intensive care unit (ICU) patients compared to 6.45±1.39 in ward patients (p=0.015). There was a significantly increased risk of ICU admission and preterm delivery (r=-0.401, p<0.001) in patients with elevated uric acid levels. There was a significantly increased risk of low-birth-weight babies with elevated uric acid levels (r=-0.278, p=0.001). However, there was no statistically significant increased risk of newborn intensive care unit admissions (p=0.264) with elevated uric acid levels. CONCLUSION: Serum uric acid levels vary significantly in HDP and were found to be elevated in severe preeclampsia and eclampsia. It can be considered for risk stratification in HDP based on disease severity; however, its role in determining outcomes is debatable. Using serum uric acid levels in predictive models along with known biomarkers may determine its possible additional value in disease prediction and severity.

Maternal Complications during Pregnancy and Risk Factors for Stunting.

Background: Stunting can be prevented by early detection when the mother is pregnant. Early detection can be carried out by looking for risk factors of stunting during pregnancy so that interventions can be early detected. This study aims to assess complications during pregnancy (disease and infection) and risk factors associated with stunting. Materials and Methods: The type of research was observational analytic with a case-control design on 450 mothers who were selected with simple random sampling (150 mothers who have stunting babies aged 0-2 months and 300 mothers who have not stunting babies aged 0-2 months in Malang Regency, Indonesia. This study used secondary data by looking at medical records, namely, laboratory examinations in the mother's book and cohort records at the public health center. This study was conducted from December 2021 to August 2022. Bivariate analysis with Chi-square and multivariate logistic regression was carried out to determine the variables that most influenced the incidence of stunting. Results: The results of multivariate analysis with logistic regression of maternal complications during pregnancy, which are a risk as a factor causing stunting, are Sexually Transmitted Infections (STIs) (Odds Ratio [OR]: 6.36; 95% Confidence Interval [CI]: 2.97-13.62), coronavirus disease 2019 (COVID-19) accompanied by pneumonia (OR: 5.12; 95% CI: 1.87-14.052), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (OR: 4.63; 95% CI: 1.10-19.59), hepatitis B (OR: 3.97; 95% CI: 1.253-12.565), pre-eclampsia (OR: 3.88; 95% CI: 1.81-8.30), and heart disease (OR: 3.373; 95% CI: 0.99-11.40). Conclusions: After recognizing the maternal factors that cause stunting, intervention should immediately be carried out on pregnant women with diseases (pre-eclampsia and heart disease) and infections (STI, COVID-19 + pneumonia, HIV/AIDS, and hepatitis B) to prevent stunting early.

Pregnancy-Induced Hypertension Pathophysiology and Contemporary Management Strategies: A Narrative Review.

In the case of PIH, the history is the story of gradually developing awareness and the gradual formation of requisite knowledge. The development of the sphygmomanometer, or blood pressure cuff, in the late 1700s, provided the basis for modern systematic blood pressure reporting for Gravid patients. In the following years and over a few decades, the relationship between high blood pressure and these complications, such as preeclampsia and eclampsia, became clearer. The hypertensive disease was categorized by the American Committee on Maternal Welfare in 1952, which included PIH, chronic hypertension, and preeclampsia. Today, attention is being paid to the identification of such factors, the search for ways to enhance the treatment of diseases, methods for their diagnosis, and the enhancement of pregnancy outcomes. Pregnancy can cause high blood pressure in two of the following ways: preeclampsia and gestational hypertension. These conditions are both part of something called pregnancy-induced hypertension (PIH). In the world, most problems for moms and babies during pregnancy come from PIH. To help both mom and baby, we need to know a lot about what causes it, how to manage it, and how to watch the baby carefully. Aspects like immune responses, the environment, and genes all mix to cause PIH. They make the placenta not work right. When the cells that help the placenta grow don't do their job well, when blood vessels are stiff, when there's too much stress on the body, or when there's not a good balance of chemicals that help build blood vessels, things can get bad. Blood vessels all over the body squeeze tight, blood flow goes down, and blood pressure goes up. That can make a lot of organs stop working right and stop the baby from healthy growth. Various studies concluded that PIH severely limits the blood flow to the placenta and thus contributes to reduced fetal growth. It showed that compared to other hospitals, women who experience PIH are more likely to give birth early before the baby is ready, that is, before 37 weeks, and may cause further health complications to the baby. This normally makes the offspring have low birth weight and exposes them to many complications in infancy and the future in case they are born to mothers with PIH. In severe cases, PIH may lead to the death of the infant either by stillbirth or immediately after birth. The researchers have noted several predisposing factors to PIH, which include histories of elevated blood pressure, diabetes, being overweight or obese, and having a family history of PIH. Educating women about the presence of PIH and its causes can help them consult health facilities early, thus helping leaders in achieving better pregnancy results.

Impending Eclampsia With Protein C Deficiency in Pregnancy: A Case Report From Recovery to Mortality.

This case report details a 30-year-old pregnant woman with inherited protein C deficiency who developed severe preeclampsia (PE), intrauterine growth restriction, and pancytopenia. Despite treatment, including anticoagulants, her condition worsened, resulting in postpartum mortality. Protein C deficiency, integral to the coagulation cascade, can exacerbate pregnancy's hypercoagulable state, contributing to adverse outcomes like PE. Mutations in the protein C gene can cause type I or type II deficiency, affecting protein C antigen and activity levels. The patient's history of recurrent pregnancy losses and conception via in vitro fertilization despite advisories highlights the complexities of managing pregnancy complications with protein C deficiency. Although some studies do not establish a direct link between protein C levels and PE, further research should explore thrombophilia's role in PE development and recurrence. Prospective studies investigating antithrombotic strategies in thrombophilic pregnancies could offer insights into reducing PE recurrence risks. This case underscores the need for multidisciplinary management and ongoing research to enhance clinical strategies and outcomes in high-risk pregnancies involving protein C deficiency.

Determinants of preeclampsia among women who gave birth at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia: a case-control study.

Pre-eclampsia and eclampsia are the second leading causes of maternal mortality and morbidity. It also results in high perinatal mortality and morbidity. Since eclampsia is preceded by preeclampsia and shows the progression of the disease, they share the same pathogenesis and determining factors. The purpose of this study was to determine determinants of preeclampsia, since it is essential for its prevention and/or its associated consequences. An unmatched case-control study was conducted from September 1-30, 2023 among women who gave birth from June 1, 2020, to August 31, 2023, at Hiwot Fana Comprehensive Specialized University Hospital. Women who had preeclampsia were considered cases, while those without were controls. The sample size was calculated using EPI Info version 7 for a case-control study using the following assumptions: 95% confidence interval, power of 80%, case-to-control ratio of 1:2, and 5% non-response rate were 305. Data was collected using Google Form, and analyzed using SPSS version 26. Variables that had a p-value of < 0.05 on multivariable logistic regression were considered statistically significant, and their association was explained using an odds ratio at a 95% confidence interval. A total of 300 women (100 cases and 200 controls) with a mean age of 24.4 years were included in the study. Rural residence (AOR 2.04, 95% CI 1.10-3.76), age less than 20 years (AOR 3.04, 95% CI 1.58-5.85), history of hypertensive disorders of pregnancy (AOR 5.52, 95% CI 1.76-17.33), and no antenatal care (AOR 2.38, 95% CI 1.19-4.75) were found to be the determinants of preeclampsia. We found that living in a rural areas, previous history of preeclampsia, no antenatal care, and < 20 years of age were significantly associated with preeclampsia. In addition to previous preeclampsia, younger and rural resident pregnant women should be given attention in preeclampsia screening and prevention.

Pre-eclampsia and future cardiovascular disease risk: Assessing British clinicians' knowledge and practice.

OBJECTIVE: To explore UK-based clinicians' knowledge of long-term cardiovascular disease (CVD) risks after pre-eclampsia and capture current risk management practice. STUDY DESIGN: A voluntary online survey was designed to explore clinicians' perception and management of CVD risks after pre-eclampsia. Distribution occurred May-July 2022 via social media and email. The survey assessed awareness of pre-eclampsia's association with future CVD, knowledge of published guidelines on CVD risk management after pre-eclampsia, and current practice of risk-reduction counselling. Results were analysed descriptively. MAIN OUTCOME MEASURE: Clinician knowledge of postpartum cardiovascular risk and management following pre-eclampsia. RESULTS: Of 240 respondents, 72 were midwives, 46 obstetricians, 8 cardiologists, and 114 general practitioners (GPs). Most clinicians knew that pre-eclampsia increases the risk of chronic hypertension (89 %) and stroke (75 %). Awareness was worse for heart failure (47 %) and peripheral vascular disease (55 %). Obstetricians provide CVD risk-reduction counselling to women with pre-eclampsia most frequently: 43 % always counsel and 27 % often counsel. Most other clinicians never counsel patients (midwives: 76 %, cardiologists: 75 %, GPs: 62 %). Most clinicians (84 %) were not aware of CVD risk management guidance after pre-eclampsia and 75 % of cardiologists and GPs never consider pre-eclampsia when assessing cardiovascular risk. Almost all clinicians (91 %) wished for greater education on the topic. CONCLUSIONS: This study presents the first assessment of cardiovascular risk awareness after pre-eclampsia amongst UK-based clinicians. Although most knew pre-eclampsia increases CVD risk, patient counselling was limited. Targeted educational initiatives are needed to improve the knowledge-to-practice gap and reduce CVD prevalence after pre-eclampsia.

Analysis of ventricular-vascular properties during preeclampsia: an echocardiography study.

The aim of the study is to analyze ventricular-vascular properties with different ventricular-arterial coupling (VAC) ratio in the preeclamptic women. Seventy-seven pregnant women with preeclampsia and eighty-nine with normal pregnancy were performed echocardiography. VAC was defined as the ratio between aortic elastance (Ea) and left ventricular (LV) end-systolic elastance (Ees). Using the VAC value of 0.8 as the cut-off near uncoupling, the preeclampsia cases were divided into two subgroups: VAC ratio ≥ 0.8 and <0.8. Cardiac structure and function, VAC properties, as well as four components of the LV pressure-strain loop, including global myocardial work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE) were determined. The preeclampsia with VAC ≥ 0.8 had an enlarger indexed ventricular volume and a thicker relative ventricular wall than the VAC < 0.8. The Ees significantly increased in the subgroup with VAC < 0.8 and decreased in the VAC ≥ 0.8, while the Ea increased in both of them. The preeclampsia with VAC ≥ 0.8 showed an obvious augmentation in GWI, GCW and GWE, along with a similar GWW compared to those with VAC < 0.8. There were variable relationships between the LV pressure-strain components and VAC properties. Thus, the preeclampsia with VAC ≥ 0.8 undergoes a more adverse remodeling and a greater impact on cardiac contractility. The increased stiffness of the heart and arterial system, and increased resistance of peripheral vessels net lead to the deteriorative ventricular efficiency with elevated myocardial oxygen consumption during a preeclampsia pregnancy.

Circulating vascular endothelial growth factor receptor-3, a pro-lymphangiogenic and pro-angiogenic mediator, is decreased in pre-eclampsia.

OBJECTIVE: To compare circulating levels of vascular endothelial growth factor receptor 3 (VEGFR-3) in women with pregnancy-induced hypertension (PIH) and in non-pregnant (NP) and healthy pregnant (HP) women. METHODS: We conducted a case-control study including PIH (n = 135), HP (n = 68), and NP (n = 49) women from southeastern Brazil. PIH were diagnosed according to international guidelines, and defined as gestational hypertension (GH, n = 61) or pre-eclampsia (n = 74). VEGFR-3 was measured in plasma using ELISA. RESULTS: Plasma VEGFR-3 was increased in HP (1207 pg/mL) compared with NP (133 pg/mL) women; however, PIH (729 pg/mL) patients exhibited lower levels than HP women (both p < 0.05). In addition, plasma VEGFR-3 was decreased in pre-eclampsia compared with GH (537 versus 980 pg/mL; p < 0.05). When pre-eclampsia was classified according to different clinical presentations, plasma VEGFR-3 was further decreased in the cases identified as pre-eclampsia with severe features, preterm pre-eclampsia, and pre-eclampsia accompanied by small for gestational age (all p < 0.05). CONCLUSION: Our data indicate reduced circulating VEGFR-3 levels in patients with PIH, specifically in those diagnosed with pre-eclampsia. Moreover, decreased VEGFR-3 was associated with adverse clinical outcomes in pre-eclampsia. These findings expand previous evidence of reduced VEGFR-3 expression in pre-eclampsia. Future studies should investigate whether it can be used as a predictive biomarker and/or therapeutic target for pre-eclampsia.

Time in therapeutic range and risk of preeclampsia in chronic hypertensive pregnant women.

Pregnancy Hypertensive Disorders (PHD), particularly Preeclampsia (PE), are significant contributors to maternal-fetal morbidity and mortality, with chronic arterial hypertension (CH) being a major risk factor. The prevalence of CH has risen alongside obesity and advanced maternal age. While antihypertensive treatment mitigates adverse pregnancy outcomes, the duration of effective blood pressure (BP) control, termed Time in Therapeutic Range (TTR), has not been extensively studied in pregnant women. TTR, reflecting the proportion of time BP remains within target ranges, predicts long-term cardiovascular and renal events in the general population but remains unexplored in pregnancy. This study investigates the association between TTR, assessed through office BP (OBP) and ambulatory BP monitoring (ABPM), and PE development in pregnant women with CH. In a retrospective longitudinal study, data from 166 pregnant women with HA referred to our hospital analyzed. BP was measured using OBP and ABPM from 10 weeks of gestation, with TTR calculated as the percentage of visits where BP remained within target ranges. The study defined four TTR control groups: 0%, 33%, 50-66%, and 100%. Results showed that 28% of the participants developed PE, with a higher incidence correlating with lower TTR in ABPM. TTR in ABPM was a significant predictor of PE risk, with the best-controlled group (100% TTR) demonstrating a 92% reduced risk compared to those with 0% TTR. The agreement between OBP and ABPM TTR was low, emphasizing the importance of ABPM for accurate BP monitoring in pregnancy. This study indicates that integrating ABPM for TTR assessment in high-risk pregnancies has the potential to reduce maternal and fetal complications.

A prediction model for hemolysis, elevated liver enzymes and low platelets syndrome in pre-eclampsia with severe features.

OBJECTIVE: The aim of the present study was to determine the risk factors for patients with pre-eclampsia (PE) with severe features to develop hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and to design a prediction score model that incorporates these risk factors. METHODS: A retrospective cohort study was conducted at a tertiary university-affiliated medical center between 2011 and 2019. The study population comprised patients diagnosed with PE with severe features, divided into two groups: those with HELLP syndrome (study group) and those without (control group). A logistic regression was employed to identify independent predictors of HELLP syndrome. A predictive model for the occurrence of HELLP syndrome in the context of PE with severe features was developed using a receiver operating characteristic curve analysis. RESULTS: Overall, 445 patients were included, of whom 69 patients were in the study group and 376 in the control group. A multivariate logistic analysis regression showed that maternal age <40 (OR = 2.28, 95% CI: 1.13-5.33, P = 0.045), nulliparity (OR = 2.22, 95% CI: 1.14-4.88, P = 0.042), mild hypertension (OR = 2.31, 95% CI: 1.54-4.82, P = 0.019), epigastric pain (OR = 3.41, 95% CI: 1.92-7.23, P < 0.001) and placental abruption (OR = 6.38, 95% CI: 1.29-35.61, P < 0.001) were independent risk factors for HELLP syndrome. A prediction score model reached a predictive performance with an area under the curve of 0.765 (95% CI: 0.709-0.821). CONCLUSION: This study identified several key risk factors for developing HELLP syndrome among patients with PE with severe features and determined that a prediction score model has the potential to aid clinicians in identifying high risk patients.

Eclampsia or epilepsy? The intriguing experiences of pregnant women diagnosed with preeclampsia and eclampsia: A descriptive exploratory study.

Aim: The purpose of this study was to explore the experiences of pregnant women who suffer the stressful effects of preeclampsia and eclampsia through pregnancy, delivery, and postpartum. Methods: A descriptive exploratory approach was adopted to gather in-depth data from women diagnosed with preeclampsia and eclampsia during pregnancy from February to March 2022. Purposive sampling was used to enlist 12 participants from a Municipal Hospital in the Ahafo region of Ghana. Data were analyzed thematically following Braun and Clark approach. Results: The study found that women had strong negative emotional reactions after being diagnosed with preeclampsia or eclampsia. They frequently felt guilty, angry, scared, in denial, or disbelief about their condition. Many women held mistaken beliefs about the diseases (they misconstrued eclampsia to be epilepsy) and isolated themselves, mainly because of false perceptions and stigma around their illness in the community. Participants expressed unfulfilled needs for informational and emotional support. The information they received about their condition was insufficient, contradictory, and confusing. Some women also felt pressured into having cesarean deliveries without enough discussion or say in the decision-making process. Conclusion: These findings reveal important psychosocial impacts of preeclampsia/eclampsia and gaps in condition-specific education and empathetic, patient-centered communication. Improving provider knowledge and counseling skills along with community awareness may help address these unmet needs among Ghanaian women facing this threat to maternal health.

Association of serum homocysteine with vitamin B12 and folate levels in women with pre-eclampsia in a tertiary health care center in Nepal.

BACKGROUND: Pre-eclampsia is a syndrome that chiefly includes the development of new-onset hypertension and proteinuria after 20 weeks of pregnancy. Pre-eclampsia is one of the major causes of mortality and morbidity in Nepal. Hyperhomocysteinemia may be a cause of the endothelial dysfunction provoked by oxidative stress in pre-eclampsia. This study was designed to evaluate the association of homocysteine with Vitamin B12 and folate in patients with pre-eclampsia. METHOD: An observational cross sectional study was performed in the Gynecology and Obstetrics Department of TUTH involving seventy two subjects with pre-eclampsia. Blood pressure, urinary protein levels, serum homocysteine, Vitamin B12 and folate levels were compared in both mild and severe forms of pre-eclampsia. Concentration of Vitamin B12 and folate were measured using Vitros ECI and homocysteine was measured using CLIA. SPSS 23.0 was used to analyze the data. Tests were performed with Mann Whitney Test and Spearman's rank correlation test. A p-value < 0.05 was considered statistically significant. RESULTS: This study showed no significant difference in age and weeks of gestation in both mild and severe forms of pre-eclampsia. Mean concentration of homocysteine was higher (13.1 ± 6.4 micromol/L) in severe Pre-eclampsia as compared to mild cases (7.6 ± 2.8 micromol/L). Mean concentration of folate was lower in severe cases (35.4 ± 24.1 micromol/L) when compared with mild cases of pre-eclampsia (57 ± 23.4 micromol/L). CONCLUSION: Homocysteine levels were increased in severe Pre-eclampsia when compared with mild pre-eclampsia and this finding can be used to predict and prevent complications in patients with pre-eclampsia.

Prevention of Pregnancy Complications Using a Multimodal Lifestyle, Screening, and Medical Model.

Prevention of pregnancy complications related to the "great obstetrical syndromes" (preeclampsia, fetal growth restriction, spontaneous preterm labor, and stillbirth) is a global research and clinical management priority. These syndromes share many common pathophysiological mechanisms that may contribute to altered placental development and function. The resulting adverse pregnancy outcomes are associated with increased maternal and perinatal morbidity and mortality and increased post-partum risk of cardiometabolic disease. Maternal nutritional and environmental factors are known to play a significant role in altering bidirectional communication between fetal-derived trophoblast cells and maternal decidual cells and contribute to abnormal placentation. As a result, lifestyle-based interventions have increasingly been recommended before, during, and after pregnancy, in order to reduce maternal and perinatal morbidity and mortality and decrease long-term risk. Antenatal screening strategies have been developed following extensive studies in diverse populations. Multivariate preeclampsia screening using a combination of maternal, biophysical, and serum biochemical markers is recommended at 11-14 weeks' gestation and can be performed at the same time as the first-trimester ultrasound and blood tests. Women identified as high-risk can be offered prophylactic low dose aspirin and monitored with angiogenic factor assessment from 22 weeks' gestation, in combination with clinical assessment, serum biochemistry, and ultrasound. Lifestyle factors can be reassessed during counseling related to antenatal screening interventions. The integration of lifestyle interventions, pregnancy screening, and medical management represents a conceptual advance in pregnancy care that has the potential to significantly reduce pregnancy complications and associated later life cardiometabolic adverse outcomes.

Oxidative stress biomarkers in pregnancy: a systematic review.

BACKGROUND: This systematic review explores the level of oxidative stress (OS) markers during pregnancy and their correlation with complications. Unlike previous studies, it refrains from directly investigating the role of OS but instead synthesises data on the levels of these markers and their implications for various pregnancy-related complications such as preeclampsia, intrauterine growth restrictions, preterm premature rupture of membranes, preterm labour, gestational diabetes mellitus and miscarriages. METHOD: STUDY DESIGN: Utilizing a systematic review approach, we conducted a comprehensive search across databases, including MEDLINE, CINAHL (EBSCOhost), ScienceDirect, Web of Science, and SCOPUS. Our search encompassed all publication years in English. RESULTS: After evaluating 54,173 records, 45 studies with a low risk of bias were selected for inclusion. This systematic review has underscored the importance of these markers in both physiological and pathological pregnancy states such as preeclampsia, intrauterine growth restrictions, preterm premature rupture of membranes, preterm labour, gestational diabetes mellitus and miscarriages. CONCLUSION: This systematic review provides valuable insights into the role of OS in pregnancy and their connection to complications. These selected studies delved deeply into OS markers during pregnancy and their implications for associated complications. The comprehensive findings highlighted the significance of OS markers in both normal and pathological pregnancy conditions, paving the way for further research in this field.

Pheochromocytoma During Pregnancy: A Hidden Cause for Hypertension.

Pheochromocytoma, a rare but potentially serious condition, poses challenges in timely identification, especially during pregnancy due to misconceptions about pregnancy-related hypertension causes. However, paroxysmal symptoms heighten diagnostic suspicion. The diagnosis relies on biochemical confirmation of catecholamine hypersecretion followed by imaging for tumor localization. When diagnosed at or after 24 weeks, alpha-adrenoceptor blockers are recommended during pregnancy to manage catecholamine excess, delaying tumor removal until viability or post-delivery. The rarity of this condition during pregnancy, coupled with diagnostic and management challenges, underscores its importance for obstetric professionals in addressing hypertensive control, delivery timing, and surgical intervention.

A prediction model for stillbirth based on first trimester pre-eclampsia combined screening.

OBJECTIVE: To evaluate the accuracy of combined models of maternal biophysical factors, ultrasound, and biochemical markers for predicting stillbirths. METHODS: A retrospective cohort study of pregnant women undergoing first-trimester pre-eclampsia screening at 11-13 gestational weeks was conducted. Maternal characteristics and history, mean arterial pressure (MAP) measurement, uterine artery pulsatility index (UtA-PI) ultrasound, maternal ophthalmic peak ratio Doppler, and placental growth factor (PlGF) serum were collected during the visit. Stillbirth was classified as placental dysfunction-related when it occurred with pre-eclampsia or birth weight <10th percentile. Combined prediction models were developed from significant variables in stillbirths, placental dysfunction-related, and controls. We used the area under the receiver-operating-characteristics curve (AUC), sensitivity, and specificity based on a specific cutoff to evaluate the model's predictive performance by measuring the capacity to distinguish between stillbirths and live births. RESULTS: There were 13 (0.79%) cases of stillbirth in 1643 women included in the analysis. The combination of maternal factors, MAP, UtA-PI, and PlGF, significantly contributed to the prediction of stillbirth. This model was a good predictor for all (including controls) types of stillbirth (AUC 0.879, 95% CI: 0.799-0.959, sensitivity of 99.3%, specificity of 38.5%), and an excellent predictor for placental dysfunction-related stillbirth (AUC 0.984, 95% CI: 0.960-1.000, sensitivity of 98.5, specificity of 85.7). CONCLUSION: Screening at 11-13 weeks' gestation by combining maternal factors, MAP, UtA-PI, and PlGF, can predict a high proportion of stillbirths. Our model has good accuracy for predicting stillbirths, predominantly placental dysfunction-related stillbirths.

Pre-eclampsia challenges and care in low and middle-income countries: Understanding diagnosis, management, and health impacts in remote and developing regions.

As an example of a low- and middle-income country (LMIC), India ranks pre-eclampsia among the top three causes of maternal mortality, following haemorrhage and infections. It is one of the primary concerns for maternal and perinatal health in LMICs. Many LMICs lack clear consensus and guidelines for the prevention, diagnosis, and management of hypertensive disorders in pregnancy, including pre-eclampsia. The International Society for the Study of Hypertension in Pregnancy 2021 guidelines address LMIC applications, offering customisable solutions. Atypical presentations of pre-eclampsia contribute to diagnostic delays, resulting in additional adverse maternal and perinatal outcomes. Implementing management strategies faces challenges in both urban and rural settings. Adapting global research involving local populations is imperative, with the potential for cost-effective adoption of international guidelines. Prevention, early diagnosis, and education dissemination are essential, involving healthcare providers and advocacy initiatives. Encouraging government investment in pre-eclampsia management as a public health initiative is important. This article explores socio-economic, cultural, and legislative factors influencing the management of pre-eclampsia in LMICs, addressing emerging challenges and potential partnerships for healthcare provision.

Antenatal reproductive screening for pregnant people including preconception: Provides the best reproductive opportunity for informed consent, quality, and safety.

INTRODUCTION: This antenatal screening review will include reproductive screening evidence and approaches for pre-conception and post-conception, using first to third trimester screening opportunities. METHODS: Focused antenatal screening peer-reviewed publications were evaluated and summarized. RESULTS: Evidenced-based reproductive antenatal screening elements should be offered and discussed, with the pregnancy planning or pregnant person, during Preconception (genetic carrier screening for reproductive partners, personal and family (including reproductive partner) history review for increased genetic and pregnancy morbidity risks); First Trimester (fetal dating with ultrasound; fetal aneuploidy screening plus consideration for expanded fetal morbidity criteria, if appropriate; pregnant person preeclampsia screening; early fetal anatomy screening; early fetal cardiac screening); Second Trimester for standard fetal anatomy screening (18-22 weeks) including cardiac; pregnant person placental and cord pathology screening; pregnant person preterm birth screening with cervical length measurement); Third Trimester (fetal growth surveillance; continued preterm birth risk surveillance). CONCLUSION: Antenatal reproductive screening has multiple elements, is complex, is time-consuming, and requires the use of pre- and post-testing counselling for most screening elements. The use of preconception and trimesters 'one to three' requires clear patient understanding and buy-in. Informed consent and knowledge transfer is a main goal for antenatal reproductive screening approaches.