Transcutaneous Discrimination of Fetal Heart Rate from Maternal Heart Rate: A Fetal Oximetry Proof-of-Concept.

Intrapartum care uses electronic fetal heart rate monitoring (EFHRM) for over 50 years to indirectly assess fetal oxygenation. However, this approach has been associated with an increase in cesarean delivery rates and limited improvements in neonatal hypoxic outcome. To address these shortcomings, a novel transabdominal fetal pulse oximeter (TFO) is being developed to provide an objective measurement of fetal oxygenation. Previous studies have evaluated the performance of TFO on pregnant ewe. Building on the animal model, this study aims to determine whether TFO can successfully capture human fetal heart rate (FHR) signals during non-stress testing (NST) as a proof-of-concept. Eight ongoing pregnancies meeting specific inclusion criteria (18-40 years old, singleton, and at least 36 weeks' gestation) were enrolled with consent. Each study session was 15 to 20 min long. Reference maternal heart rate (MHR) and FHR were obtained using finger pulse oximetry and cardiotocography for subsequent comparison. The overall root-mean-square error was 9.7BPM for FHR and 4.4 for MHR, while the overall mean-absolute error was 7.6BPM for FHR and 1.8 for MHR. Bland-Altman analysis displayed a mean bias ± standard deviation between TFO and reference of -3.9 ± 8.9BPM, with limits of agreement ranging from -21.4 to 13.6 BPM. Both maternal and fetal heart rate measurements obtained from TFO exhibited a p-value < 0.001, showing significant correlation with the reference. This proof-of-concept study successfully demonstrates that TFO can accurately differentiate maternal and fetal heart signals in human subjects. This achievement marks the initial step towards enabling fetal oxygen saturation measurement in humans using TFO.

Cardiac and Pregnancy Outcomes of Pregnant Patients With Congenital Heart Disease According to Risk Classification System.

Pregnancy risk assessment for patients with adult congenital heart disease (ACHD) must include physiologic and anatomic impacts. We aimed to determine whether maternal cardiac and pregnancy outcomes vary by disease severity defined according to the following 3 different classifications: ACHD anatomic severity, ACHD physiologic class, and modified World Health Organization (mWHO) class. Cardiac outcomes included a composite of arrhythmia, heart failure, stroke, and thromboembolism. Pregnancy outcomes included a composite of intrauterine growth restriction, preterm birth, preeclampsia, or postpartum hemorrhage. We employed generalized estimating equations to account for multiple pregnancies. Of the 245 pregnancies, 17.1% were preterm and 45.7% were cesarean deliveries. Cardiac hospitalizations occurred in 22.0% and arrhythmias in 12.7%. Cardiac outcomes tended to be more prevalent in people with more severe heart disease. Pregnancy outcomes were U-shaped or less prevalent in people with more severe disease. There was a 2.9-fold increased risk for the composite cardiac outcome for complex anatomy (adjusted incidence rate ratio 2.90, 95% confidence interval 1.08 to 7.81, p = 0.04), a 9.4-fold increased risk for physiologic class C or D (9.37, 1.28 to 68.79, p = 0.03), and a fourfold increased risk for mWHO class III or IV (3.99, 1.53 to 10.40, p = 0.005). There was a lower risk for the composite pregnancy outcome for mWHO class II or II to III (0.54, 0.36 to 0.79, p = 0.002) but no association with anatomy or physiology. In conclusion, physiologic class may be most accurately associated with adverse outcomes and therefore efforts to optimize hemodynamics before pregnancy may help to mitigate the risk.

Landscape of Preterm Birth Therapeutics and a Path Forward.

Preterm birth (PTB) remains the leading cause of infant morbidity and mortality. Despite 50 years of research, therapeutic options are limited and many lack clear efficacy. Tocolytic agents are drugs that briefly delay PTB, typically to allow antenatal corticosteroid administration for accelerating fetal lung maturity or to transfer patients to high-level care facilities. Globally, there is an unmet need for better tocolytic agents, particularly in low- and middle-income countries. Although most tocolytics, such as betamimetics and indomethacin, suppress downstream mediators of the parturition pathway, newer therapeutics are being designed to selectively target inflammatory checkpoints with the goal of providing broader and more effective tocolysis. However, the relatively small market for new PTB therapeutics and formidable regulatory hurdles have led to minimal pharmaceutical interest and a stagnant drug pipeline. In this review, we present the current landscape of PTB therapeutics, assessing the history of drug development, mechanisms of action, adverse effects, and the updated literature on drug efficacy. We also review the regulatory hurdles and other obstacles impairing novel tocolytic development. Ultimately, we present possible steps to expedite drug development and meet the growing need for effective preterm birth therapeutics.

Biofouling detection methods that are widely applicable and useful across disciplines: a mini-review.

Biofouling, or the build-up of microorganisms in a biofilm at the solid-water or water-air interface, is an interdisciplinary problem. Biofouling causes various issues including clogging systems, contaminating devices, and creating infections that are extremely difficult to treat, to name but a few. Therefore, engineers, pharmacologists, microbiologists, wastewater treatment operators, chemists, food preservative formulators, home and personal care product formulators, and toxicologists all play a role in studying and have an interest in solving biofouling. High-throughput studies on biofilm prevention and removal can take the form of biofilm antimicrobial microdilution susceptibility (BAMS) tests. Due to vested interests of many disciplines, the results from these tests should be applicable and useful to each discipline. This critical review analyses the focuses, biological implications, and metrics required by each discipline. The possible detection methods that could satisfy each desired metric are then summarized. The detection methods were analysed in order to recommend two methods of biofilm detection, Crystal Violet stain and the LIVE/DEAD BacLight stain, which correspond with three metrics including total biomass, log reduction, and the MIC, BPC, MBIC, MBC, BBC, and/or MBEC values. Determining these three metrics for each BAMS test will allow this type of research to be widely applicable and useful across many disciplines.

Low Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2 Among Pregnant and Postpartum Patients With Universal Screening in Seattle, Washington.

We found low prevalence of SARS-CoV-2 (2.7% [5/188]) among pregnant and postpartum patients with universal testing. Prevalence among symptomatic patients was similar under initial targeted screening (22.2% [4/18]) and universal approaches (19.1% [8/42]). Among 170 asymptomatic patients, 2 were positive or inconclusive, respectively; repeat testing at 24 hours was negative.

The Best-Practice Organism for Single-Species Studies of Antimicrobial Efficacy against Biofilms Is Pseudomonas aeruginosa.

As potable water scarcity increases across the globe; it is imperative to identify energy and cost-effective processes for producing drinking-water from non-traditional sources. One established method is desalination of brackish and seawater via reverse osmosis (RO). However, the buildup of microorganisms at the water-membrane interface, known as biofouling, clogs RO membranes over time, increasing energy requirements and cost. To investigate biofouling mitigation methods, studies tend to focus on single-species biofilms; choice of organism is crucial to producing useful results. To determine a best-practice organism for studying antimicrobial treatment of biofilms, with specific interest in biofouling of RO membranes, we answered the following two questions, each via its own semi-systematic review: 1. Which organisms are commonly used to test antimicrobial efficacy against biofilms on RO membranes? 2. Which organisms are commonly identified via genetic analysis in biofilms on RO membranes? We then critically review the results of two semi-systematic reviews to identify pioneer organisms from the listed species. We focus on pioneer organisms because they initiate biofilm formation, therefore, inhibiting these organisms specifically may limit biofilm formation in the first place. Based on the analysis of the results, we recommend utilizing Pseudomonas aeruginosa for future single-species studies focused on biofilm treatment including, but not limited to, biofouling of RO membranes.