Congenital fetal neck anomaly-diagnostic and therapeutic dilemma in low-resource setting: case report.

Fetal neck masses are uncommon but challenging to manage, particularly in limited-resource settings. We prenatally diagnosed a large fetal neck mass after consultative referral for polyhydramnios at 30 weeks' gestation. The pregnant patient was counseled on the findings, differential diagnoses, and the prenatal and postnatal management options. She delivered at 38 weeks' gestation through emergent cesarean delivery after presenting in labor owing to concern for labor dystocia with the large mass. The diagnosis of lymphangioma was made postnatally through imaging. Good prognosis has been reported in several cases with surgery and/or sclerotherapy, even in low-resource settings. Despite the availability of a pediatric surgeon to perform a resection, the family declined treatment because of a belief that the mass was of supernatural etiology. Patient-centered, multidisciplinary services focusing on maternal and fetal complications should assess and account for cultural beliefs to better understand and counsel families who have a fetus or neonate with a congenital anomaly.

Impact of the Coronavirus Disease (COVID-19) Pandemic on Neonatal Nutrition: Focus on Low- and Middle-Income Countries.

Purpose of Review: This review serves to account for the published literature regarding the changing impact of the COVID-19 pandemic with a focus on neonatal nutrition in low- and middle-income countries. Recent Findings: Initial national and international guidelines regarding breastfeeding were often contradictory. Lack of clear guidelines resulted in separation of mother-neonate dyads and the reliance on non-human sources of milk at institutional levels. Mothers and families were less likely to initiate and/or continue breastfeed during the pandemic due to confusion regarding guidelines, lack of support for lactation, and concern for infection transmission to their neonates. Continued research in neonatal nutrition, however, continues to support the use of breastmilk as the optimal nutritional source for neonates. Summary: Despite concerns for increased risk of COVID-19 transmission with breastfeeding, the use of breastmilk with preserved and combined mother-baby care is associated with improved neonatal nutrition.

Measurement of maternal functioning during pregnancy and postpartum: findings from the cross-sectional WHO pilot study in Jamaica, Kenya, and Malawi.

BACKGROUND: The World Health Organization's definition of maternal morbidity refers to "a negative impact on the woman's wellbeing and/or functioning". Many studies have documented the, mostly negative, effects of maternal ill-health on functioning. Although conceptually important, measurement of functioning remains underdeveloped, and the best way to measure functioning in pregnant and postpartum populations is unknown. METHODS: A cross-sectional study among women presenting for antenatal (N = 750) and postpartum (N = 740) care in Jamaica, Kenya and Malawi took place in 2015-2016. Functioning was measured through the World Health Organization Disability Assessment Schedule (WHODAS-12). Data on health conditions and socio-demographic characteristics were collected through structured interview, medical record review, and clinical examination. This paper presents descriptive data on the distribution of functioning status among pregnant and postpartum women and examines the relationship between functioning and health conditions. RESULTS: Women attending antenatal care had a lower level of functioning than those attending postpartum care. Women with a health condition or associated demographic risk factor were more likely to have a lower level of functioning than those with no health condition. However, the absolute difference in functioning scores typically remained modest. CONCLUSIONS: Functioning is an important concept which integrates a woman-centered approach to examining how a health condition affects her life, and ultimately her return to functioning after delivery. However, the WHODAS-12 may not be the optimal tool for use in this population and additional components to capture pregnancy-specific issues may be needed. Challenges remain in how to integrate functioning outcomes into routine maternal healthcare at-scale and across diverse settings.

Placenta accreta spectrum: accreta, increta, and percreta.

Placenta accreta can lead to hemorrhage, resulting in hysterectomy, blood transfusion, multiple organ failure, and death. Accreta has been increasing steadily in incidence owing to an increase in the cesarean delivery rate. Major risk factors are placenta previa in women with prior cesarean deliveries. Obstetric ultrasonography can be used to diagnose placenta accreta antenatally, which allows for scheduled delivery in a multidisciplinary center of excellence for accreta. Controversies exist regarding optimal management, including optimal timing of delivery, surgical approach, use of adjunctive measures, and conservative (uterine-sparing) therapy. We review the definition, risk factors, diagnosis, management, and controversies regarding placenta accreta.