sFlt-1/PlGF ratio as a predictive and prognostic marker for preeclampsia.

OBJECTIVE: Preeclampsia is clinically unpredictable and associated with adverse outcomes. Pregnant women with suspected preeclampsia require intensive monitoring or hospitalization for elevated sFlt-1 (soluble fms-like tyrosine kinase-1) to PlGF (placental growth factor) ratios before symptoms arise. We aimed to determine the sFlt-1/PlGF ratio's usefulness in predicting adverse pregnancy outcomes in preeclampsia. METHODS: From January 2017 to February 2019, we measured the sFlt-1/PlGF ratio in 73 singleton pregnant women suspected of preeclampsia and classified them into three groups: low-risk (sFlt-1/PlGF ratio < 38, n = 19), intermediate (38 ≤ ratio < 85, n = 9), and high-risk (ratio ≥ 85, n = 32). RESULTS: Although the low- and high-risk groups both experienced weight gain during pregnancy, their body mass index (BMI) differed after pregnancy (p = 0.004). The number of women who had been taking antihypertensive medications for chronic hypertension since early pregnancy was higher in the low-risk group (31.6% vs. 22.2%, 6.7%). The gestational weeks at birth were lower in the high-risk group compared to that of the low-risk group (32.0 weeks vs. 35.79 weeks, p < 0.001). In the high-risk group, the average neonatal weight was significantly lighter (p = 0.021), and the period of stay in the neonatal intensive care unit was longer than that in the low-risk group (p = 0.003). CONCLUSION: The sFlt-1/PlGF ratio is a useful indicator of preeclampsia severity and can be utilized as a prognostic marker.

Efficacy of intraoperative wireless ultrasonography for uterine incision among patients with adherence findings in placenta previa.

AIM: We evaluated the effectiveness of intraoperative wireless ultrasonography in determining the location of uterine incision during cesarean delivery in patients with placenta previa who have sonographic adherence findings in order to assess intraoperative blood loss and maternal morbidity. METHODS: A prospective study using wireless sonography, including 15 patients with previa, was conducted among women with singleton pregnancies who delivered by cesarean section between August 1, 2017, and August 30, 2019. Retrospective study for the control group included 32 patients with placenta previa who underwent cesarean section between January 1, 2016, and July 31, 2017, without wireless sonography. Patients with previa who had adherence findings in prenatal sonography were included in both groups. Logistic regression was used to identify the association between massive intraoperative bleeding loss and use of wireless ultrasound sonography. RESULTS: Intraoperative blood loss was significantly reduced in the study group compared to that in the control group (P = 0.009). The hospital stay was significantly shorter in the study group compared to the control group (5 days vs 6 days, P < 0.001). The use of intraoperative wireless sonography (P = 0.01) had a significant association with massive intraoperative hemorrhage in multivariable analysis. CONCLUSION: Our study is the first study to apply a wireless ultrasound sonography device in women with placenta previa during cesarean section to examine maternal morbidity. This latest wireless ultrasound sonography device is advantageous for uterine incision guidance in women with placenta previa and improves maternal morbidity by reducing intraoperative hemorrhage.

Effect of smartphone app-based health care intervention for health management of high-risk mothers: a study protocol for a randomized controlled trial.

BACKGROUND: The 4th Industrial Revolution with the advent of the smart era, in which artificial intelligence, such as big data analysis and machine learning, is expected, and the provision of healthcare services using smartphones has become a reality. In particular, high-risk mothers who experience gestational diabetes, gestational hypertension, and prenatal and postpartum depression are highly likely to have adverse effects on the mother and newborn due to the disease. Therefore, continuous observation and intervention in health management are needed to prevent diseases and promote healthy behavior for a healthy life. METHODS: This randomized controlled trial will provide mothers 18 years of age or older with health care information collected based on evidence-based literature data using a smartphone app for 6 weeks. About 500 mothers will be selected in consideration of the dropout rate due to the characteristics of mothers. The study group and control group will be computer-generated in a 1:1 ratio through random assignment. The research group will receive health management items through the app, and health management information suitable for the pregnancy cycle is pushed to an alarm. The control group will receive the health management information of the paper. We also followed the procedure for developing mobile apps using the IDEAS framework. DISCUSSION: These results show the effectiveness of smart medical healthcare services and promote changes in health behaviors throughout pregnancy in high-risk mothers. TRIAL REGISTRATION: Clinical trial registration information for this study has been registered with WHO ICTRP and CRIS (Korea Clinical Research Information Service, CRIS). Clinical trial registration information is as follows: Study of development of integrated smart health management service for the whole life cycle of high-risk mothers and newborns based on community, KCT0007193 . Registered on April 14, 2022, prospectively registered. This protocol version is Version 1.0. April 14, 2022.

Hypertriglyceridemia-induced acute pancreatitis in pregnancy causing maternal death.

Acute pancreatitis in pregnancy is rare and occurs in approximately 3 in 10,000 pregnancies. It rarely complicates pregnancy, and can occur during any trimester, however over half (52%) of cases occur during the third trimester and during the post-partum period. Gallstones are the most common cause of acute pancreatitis. On the other hand, acute pancreatitis caused by hypertriglyceridemia due to increase of estrogen during the gestational period is very unusual, but complication carries a higher risk of morbidity and mortality for both the mother and the fetus. We experienced a case of pregnant woman who died of acute exacerbation of hypertriglyceridemia-induced acute pancreatitis at 23 weeks of gestation. We report on progress and management of this case along with literature reviews.