Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study.

OBJECTIVE: To assess risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic using Mind-COVID, a prospective cross-sectional study that compares outcomes in middle-income economies and high-income economies. METHODS: A total of 7102 pregnant women from 12 high-income economies and nine middle-income economies were included. The web-based survey used two standardized instruments, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). RESULT: Pregnant women in high-income economies reported higher PHQ-9 (0.18 standard deviation [SD], P < 0.001) and GAD-7 (0.08 SD, P = 0.005) scores than those living in middle-income economies. Multivariate regression analysis showed that increasing PHQ-9 and GAD-7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ-9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD-7 scores were associated with a pregnancy-related complication, fear of adverse outcomes in children related to COVID-19, and feeling of burden related to finances. CONCLUSIONS: According to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.

Birth Weight < 3rd Percentile Prediction Using Additional Biochemical Markers-The Uric Acid Level and Angiogenesis Markers (sFlt-1, PlGF)-An Exploratory Study.

(1) Aim: Ultrasound is the gold standard for assessing fetal growth disorders. The relationship between high sFlt-1/PlGF scores and LBW (low birth weight) was described. In this study, we attempted to assess whether uric acid could be used as a secondary marker in estimating the pregnancy risk associated with LBW. (2) Material and methods: 665 pregnant women with a suspected or confirmed form of placental insufficiency were enrolled. In each of the patients, sFlt-1 and PlGF and uric acid levels were determined. Patients were divided into two groups according to birth weight below and above the third percentile for the given gestational age with the criteria of the neonatal definition of FGR (fetal growth restriction). (3) Results: A significant negative correlation between neonatal birth weight and the uric acid level across the entire study group was observed. We found a significant negative correlation between neonatal birth weight and the uric acid level with birth weights < 3rd percentile. (4) Conclusions: There is a significant link between the uric acid concentration and LBW in the group with placental insufficiency. Uric acid can improve the prediction of LBW. An algorithm for LBW prognosis that makes use of biophysical (ultrasound) and biochemical (uric acid level, angiogenesis markers) parameters yields better results than using these parameters separately from each other.

Amniocentesis in Twin Pregnancies: Risk Factors of Fetal Loss.

This study aims to determine if second trimester amniocentesis in twin pregnancies provides a significant independent contribution in the prediction of miscarriage or fetal loss at any stage of pregnancy. This was a retrospective cohort study of women with twin gestations booked for routine prenatal care in four fetal medicine units in Poland in the years 2010-2020. The study population included: (1) twin pregnancies that underwent amniocentesis at 16-20 weeks' gestation; (2) twin pregnancies that did not require any further testing and were followed-up routinely. Univariable and multivariable regression analysis was used to define which maternal and pregnancy characteristics provided a significant independent contribution in the prediction of miscarriage and fetal loss at any stage of pregnancy. In the study period, 2645 twin pregnancies were eligible for analysis. There were 144 cases of miscarriage defined as fetal loss of one or both twins before 24 weeks and 40 cases of intrauterine death of one or both twins after 24 weeks. A total number of 162 twin pregnancies underwent amniocentesis at 16-20 weeks' gestation. The rate of miscarriage before 24 weeks and the rate of fetal loss at any stage of pregnancy in the group that underwent amniocentesis was 10.49% and 13.58%, respectively, compared to 5.11% and 6.52% that did not undergo amniocentesis. Multivariable regression analysis showed that factors providing a significant independent contribution in the prediction of miscarriage and fetal loss at any stage of pregnancy were monochorionicity (MC), large intertwin discordance in crown-rump length (CRL), low Pregnancy Related Plasma Protein (PAPP-A) MoM and nuchal translucency (NT) above 95th centile. Amniocentesis in twin pregnancies does not provide a significant contribution in the prediction of miscarriage or fetal loss at any stage of pregnancy.

Effectiveness of Different Algorithms and Cut-off Value in Preeclampsia First Trimester Screening.

Results: For the cut-off point >1 : 150, 86 women at an increased risk of eo-PE using algorithm 1 were identified. Of these 86 patients, 83 (96%) were identified using algorithm 2, 62 (72%) using algorithm 3, and 60 (69%) using algorithm 4. In addition, it was demonstrated that between 21% and 29% of women at a low risk of eo-PE could be given acetylsalicylic acid if a screening test was used that did not account for PlGF. Conclusions: In order to provide the highest level of health care to pregnant women, it is extremely important that full screening for eo-PE should be ensured. The cheapest algorithm based only on MAP and UtPI resulted in our patients being unnecessarily exposed to complications.

First-Trimester Fetal Hepatic Artery Examination for Adverse Outcome Prediction.

OBJECTIVE: To assess whether there are differences in first-trimester fetal hepatic artery flows depending on pregnancy outcomes. METHODS: The prospective study conducted in 2012-2020 included 1841 fetuses from singleton pregnancies assessed during the routine first-trimester ultrasound examination (between 11- and 14-weeks' gestation). Also, each fetus was examined to determine their hepatic artery flows by measuring the artery's pulsatility index (HA-PI) and peak systolic velocity (HA-PSV). RESULTS: The fetuses that were classified as belonging to the adverse pregnancy outcome group (those with karyotype abnormalities and congenital heart defects) were characterized by a significantly lower HA-PI and higher HA-PSV compared to normal outcome fetuses. CONCLUSION: Hepatic artery flow assessment proved to be a very useful tool in predicting adverse pregnancy outcomes, in particular karyotype abnormalities and congenital heart defects.

Evaluation of the Risk of Birth Defects Related to the Use of Assisted Reproductive Technology: An Updated Systematic Review.

Fertility problems constitute a serious medical, social, and demographic problem. With this review, we aim to critically appraise and evaluate the existing literature surrounding the risk of birth defects in offspring conceived using techniques based on assisted reproductive technology (ART). Based on searches of the literature in PubMed and ScienceDirect, we obtained a total of 2,003,275 works related to the topic. Ultimately, 11 original papers published in the last 10 years qualified for inclusion in the study. Based on five studies included in this analysis, it was shown that ART significantly increases the risk of congenital malformations in associated newborns. Due to the specifics of given studies, as well as potential confounding risk factors, this influence cannot be ignored. Therefore, considering the information contained in the articles included in this systematic review, it was determined that the risk of birth defects is not directly related to the use of ART itself but also depends on the age of partners, causes of infertility, comorbidities, and the number of fetuses during a pregnancy, as well as many other factors not covered in the literature. It is thus necessary to impress upon infertile couples who wish to have offspring that the use of ART is not risk-free but that the benefits outweigh the risks. Further education in this field, as well as social understanding, is also required.

The role of individual blood flow parameters through ductus venosus in the first and second trimesters of pregnancy in predicting the condition of the fetus and newborn.

OBJECTIVES: To predict fetal and neonatal outcome during pregnancy based on detailed analysis of ductus venosus blood flow velocities in first and second-trimester fetuses. MATERIAL AND METHODS: A retrospective analysis was made in 680 patients with single pregnancies in years 2015 and 2016. The following ductus venosus blood flow velocities in first and second-trimester were analyzed: S-wave velocity, D-wave velocity, a-wave velocity, Tmax velocity, PIV. Results were divided into sub-groups with reduced value, normal value and increased value and compared with fetal and neonatal condition. RESULTS: The relationship between the increased PIV value in the first trimester of pregnancy and an increased risk of chromosomal aberrations was observed, whereas the increased DV PI value in the second trimester of pregnancy with reduced A -wave were associated with a higher incidence of FGR. No correlation between the remaining DV blood flow velocities in the first and second trimester of pregnancy and the more frequent occurrence of fetal and neonatal complications has been confirmed. CONCLUSIONS: The increased DV PIV is a good prognostic tool for the detection of chromosomal aberrations in first trimester of pregnancy. In the second trimester, the increased DV PIV and the reduced A- wave velocity correlate with the fetal growth restriction. Ductus venosus seems to be an indirect indicator of intrauterine hypoxia with moderate prognostic value for adverse obstetric outcomes.

The Polish Society of Gynecologists and Obstetricians Guideline for the diagnostic assessment and management of multiple-gestation pregnancy complicated by fetal growth restriction.

The aim of the Guideline is to unify the diagnostic-therapeutic management of multiple-gestation pregnancies complicated by fetal growth restriction in at least one fetus.

Implementation of the Publicly Funded Prenatal Screening Programme in Poland during the COVID-19 Pandemic: A Cross-Sectional Study.

The COVID-19 pandemic in 2020 affected the entire healthcare system in Poland, causing medical personnel to be relocated to other duties and limiting patients' contacts with healthcare professionals. A large part of the planned diagnostics and treatment was delayed due to lack of equipment and personnel. Against this background, we analysed the implementation of the publicly funded prenatal screening programme (PSP) in Poland compared to the previous year. This is a cross-sectional study. We used nationwide datasets on the implementation of the prenatal testing programme over the period 2019−2020, datasets from the Statistics Poland on birth and the data on the development of the COVID-19 epidemic in Poland. In the year 2020, we observed a 12.41% decrease in woman enrolled to the programme compared to 2019. However, the decrease concerned only women under 35 years of age. With respect to the number of deliveries in the calendar year, the number of patients enrolled in the programme decreased by 3% (31% vs. 34%, p < 0.001). We also observed an increase in estriol measurements per the number of patients included in the programme, and a reduction in the number of PAPP-A tests in the first trimester, which proves an increased share of the triple test in the prenatal diagnosis of chromosomal aberrations. With respect to the number of deliveries, the number of amniocentesis procedures performed under PSP decreased by 0.19% (1.8% vs. 1.99%, p < 0.0001). In 2020, compared to the previous year, the number of patients included in the prenatal testing programme in Poland decreased. In terms of the number of births in Poland, the number of integrated screening tests also decreased, at the expense of increasing the percentage of triple tests. There were also significant reductions in the number of invasive diagnostic tests.

"The Killer Placenta" - a threat to the lives of young women giving birth by cesarean section.

OBJECTIVES: It is necessary to create a universal algorithm for the management of placenta accreta spectrum in order to minimize morbidity and mortality in young patients giving birth by caesarean section. MATERIAL AND METHODS: This was a retrospective study of seven women before the age of 30 selected out of larger group of 40 pregnant patients. The patients were hospitalized in the Clinical Department of Perinatology, Gynecology and Obstetrics in Ruda Slaska, which is a 3rd level reference department. The inclusion criterion was the suspicion of placent accreta spectrum, based on clinical condition, ultrasound examination and magnetic resonance imaging. RESULTS: A patient with a diagnosed placenta accreta spectrum should be provided with a highly specialized 3rd level referential center by an experienced multidisciplinary team of specialists. There should be free access to the blood bank, adult intensive care unit and neonatal intensive care unit. According to the results of this study, the recommended time of cesarean section is 34 + 0 - 36 + 6 weeks of pregnancy. Hysterectomy after the cesarean section is a method of choice for a placenta increta or percreta. It is the most difficult surgery in obstetrics, with a high risk of intraoperative complications. Damage to the urinary system is the most common complication of perinatal hysterectomy. Preoperative placement of ureteral catheters reduces the risk of intraoperative damage. CONCLUSIONS: It is necessary to plan individual procedure for women who has low-lying or previa placenta, and who has history of prior cesarean section - in this group the risk of placenta accreta spectrum is higher.

Prediction of preterm birth using PAMG-1 test: a single centre experience - preliminary report.

OBJECTIVES: Placental alpha microglobulin-1 (PAMG-1) is a novel biomarker detected in cervicovaginal discharge in patients threatened with preterm birth (PTB). This study aimed to show a single centre experience of assessment of imminent spontaneous PTB risk in patients with symptoms suggesting preterm labour (PTL). MATERIAL AND METHODS: The study group consisted of 46 women with singleton pregnancies between 24 + 0/7 and 33 + 6/7 weeks of gestation who presented with symptoms of threatened PTL, with cervical dilatation of < 3 cm, cervical length (CL) of < 30 mm and clinically intact fetal membranes. CL was measured via transvaginal ultrasound and the PAMG-1 test was performed in all of the objectives. RESULTS: Sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of prediction of PTB within seven days for CL were 100%, 11.11%, 5.88% and 100%, respectively. The PAMG-1 test SN, SP, PPV and NPV of the same endpoint were 50%, 80.56%, 12.5% and 96.67%, respectively. CONCLUSIONS: PAMG-1 is a more accurate predictor of PTB when compared to CL. Routine use of both mentioned tests could allow identification of low-risk patients and reduction of rate of unnecessary hospitalizations and treatments.

Risk Assessment of the Increased Occurrence of Congenital Cardiac and Non-Cardiac Defects in Fetuses with a Normal Karyotype after Assisted Fertilization in Comparison to Natural Fertilization Based on Ultrasound Diagnostics.

The goal of the study was to assess changes in parameters based on ultrasound examinations-these were Crown Rump Length (CRL), Nuchal Translucency (NT), Fetal Heart Rate (FHR), and Pulsatility Index for Ductus Venosus (DV-PI)-in the first trimester of pregnancy in women in which there was a natural initiation of the pregnancy due to spontaneous ovulation, women in which the pregnancy was initiated as a result of stimulated ovulation, as well as in the group in which pregnancy was achieved through the use of In-Vitro Fertilization (IVF)-assisted reproduction. A total of 1581 women became pregnant without the use of assisted reproduction methods. Out of 283 pregnancies, in 178 patients, induced ovulation was utilized. Next, 137 women had sexual intercourse and became pregnant; 41 of them became pregnant through Intrauterine Insemination (IUI) as a result of Artificial Insemination by Husband (AIH), and 13 became pregnant after Artificial Insemination by Donor (AID). The third group consisted of 105 women subjected to Controlled Ovarian Hyperstimulation (COH). In this group of pregnant women, 53 pregnancies were resultant of Intracytoplasmic Sperm Injection (ICSI), and 52 pregnancies were the result of Intracytoplasmic Morphologically selected Sperm Injection (IMSI). The obtained results did not indicate that the chosen method of fertilization or the chosen ovulation method had a statistically significant effect on the development risk of congenital heart or non-heart defects in the fetus.

Evaluation of indications for amniocentesis in cases of normal fetal ultrasound results.

OBJECTIVES: The objective of this study was to analyze indications for amniocentesis in cases of patients with normal fetal ultrasound results between 11+0 and 13+6 weeks of gestation. MATERIAL AND METHODS: The results of first-trimester screening tests performed between 2014 and 2018 on 6,863 patients of the Prenatal Testing Outpatient Clinic at the Clinical Department of Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland, were analyzed. The inclusion criteria were a singleton pregnancy and normal results of fetal ultrasound between 11+0- and 13+6-weeks' gestation. Depending on the calculated risk of fetal trisomy 21, the patients were divided into three groups (group A = RS > 1:300, group B = RS 1:300 - 1:999, group C = RS ≤ 1:1000). Subsequently, values such as PAPP-A and fß-hCG protein levels and maternal age were analyzed for each of the groups. RESULTS: The patients, 6,310 (91.94%) met the inclusion criteria. A high risk of fetal trisomy 21 was identified for 514 women (8.15%). Group B had 733 (11.62%) and group C 5,063 (80.23%) patients. In group A, an fß-hCG level of ≥ 2.000 MoM was shown for 50.97% of the women. A PAPP-A level ranging from 0.001 to 0.499 MoM was observed for 38.72% of group A patients. The mean maternal age in groups A, B and C was 36.45, 36.08 and 31.64 years, respectively. CONCLUSIONS: In the first-trimester, patients with normal ultrasound results obtained during prenatal screening tests, the main cause of an increased risk of trisomy 21 was elevated PAPP-A and fß-hCG concentrations. According to this paper's authors, in these cases extension of diagnosis to include other gestational complications, e.g. preeclampsia, should be considered.

The Impact of COVID-19 on Female Sexual Health.

INTRODUCTION: Coronavirus disease (COVID-19), announced as a pandemic by the World Health Organization, recently has dominated people's lifestyle. The impact of COVID-19 seems to be relevant to the sexual health as well. METHODS: This prospective study was conducted on two occasions involving 764 female patients between March and April 2020-before and during the time of social quarantine. The sexual function was assessed using the Polish version of the Female Sexual Function Index (FSFI). Every patient filled out the survey concerning socio-demographic characteristics as well as the influence of SARS-CoV-2 pandemic on their lives. RESULTS: The overall FSFI score before the pandemic was 30.1 ± 4.4 and changed to 25.8 ± 9.7 during it. Scores of every domain: desire, arousal, lubrication, orgasm, satisfaction and pain decreased as well (p < 0.001). There was statistically significant association between the workplace and the change of FSFI scores before and during COVID-19 pandemic (p < 0.01). We noticed the biggest decrease in FSFI score in the group of women who did not work at all (5.2 ± 9.9). Religion had a statistically important impact on level of anxiety (p < 0.01). CONCLUSION: The main finding of our study was the influence of COVID-19 pandemic on the quality of sexual lifestyle and frequency of intercourse among Polish women.

Nasal bone in screening for Trisomy 18 and 13 at 11-13 + 6 weeks of gestation - own experiences.

OBJECTIVES: The objective of the paper is the suitability assessment of screening for Trisomy 18 and 13 on the basis of NT measurement, FHR, double test and assessment of Nasal Bone. MATERIAL AND METHODS: The study was performed in 6,661 singleton pregnancies. In each fetus NT, FHR, DV-PIV were examined. Double test from maternal blood was examined. These ultrasound and biochemical factors were in combined screening investigated. Additional ultrasound marker - Nasal Bone was and its impact on Trisomies 18 and 13 screening was examined. RESULTS: Two groups of patients were compared - with chromosomal normal and chromosomal abnormalities - Trisomy 18 and 13. Detection Rate of Trisomies 18 and 13 at the risk cutoff 1/300 using combined screening was 84.1% and FPR was 7.1%. Detection Rates of examined chromosomal abnormalities using screening with additional marker - NB was 93.2% and False Positive Rate - 5.6%. CONCLUSIONS: It should be noted that the qualitative analysis of the assessment of NB in the first trimester significantly influences the improvement of screening values focusing on Trisomy 18 and 13 detection. In summary, our research indicates a more effective type of Trisomy 13 and 18 screening using NT, double test, maternal age, CRL and FHR as well as nasal bone presence and absence.

Polish Society of Gynecology and Obstetrics statement on safety measures and performance of ultrasound examinations in obstetrics and gynecology during the SARS-CoV-2 pandemic.

We present recommendations on performance and safety measures of ultrasound examinations in obstetrics and gynecology during the SARS COV-2 pandemic. The statement was prepared based on the current knowledge on the coronavirus by the Ultrasound Section of the Polish Society of Obstetrics and Gynecology. It has to be noted that the presented guidance is based on limited evidence and is primarily based on experiences published by authors from areas most affected by the virus thus far, such as China, Singapore, Hong Kong, and Italy. We realize that the pandemic situation is very dynamic. New data is published every day. Despite the imposed limitations related to the necessity of social distancing, it is crucial to remember that providing optimal care in safe conditions should remain the primary goal of healthcare providers. We plan to update the current guidelines as the situation develops.

Quantitative and qualitative Ductus Venosus blood flow evaluation in the screening for Trisomy 18 and 13 - suitability study.

OBJECTIVES: The objective of the paper is the suitability assessment of screening for Trisomy 18 and 13 on the basis of nuchal translucency (NT) measurement, Fetal Heart Rate (FHR), double test, quantitative [Ductus Venosus (DV) Pulsatility Index for Veins (PIV)] and qualitative (the A-wave assessment) blood flow evaluation in the DV. MATERIAL AND METHODS: The study was performed in 7296 singleton pregnancies. In each fetus NT, FHR, DV-PIV were examined. Double test from maternal blood was examined. These ultrasound and biochemical factors were in combined screening investigated. Additional doppler ultrasound markers such as abnormal a-wave in Ductus Venosus and Pusatility Index for Veins of Ductus Venosus were and their impact on Trisomies 18 and 13 screening were examined. RESULTS: Two groups of patients were compared - with chromosomal normal and chromosomal abnormalities - Trisomy 18 and 13. Detection Rate of Trisomies 18 and 13 at the risk cutoff 1/300 using combined screening was 90.2% and FPR was 6%. Detection Rates of examined chromosomal abnormalities using contingent screening were: 92.1% using DV abnormal a-wave and 94.84% using DV-PIV. FPR's for booths parameters 5.8% and 5.4% respectively. CONCLUSIONS: Quantitative analysis of the flow - assessment of DV-PIV in the first trimester significantly influences the improvement of screening values focusing on Trisomy 18 and 13 detection.

A Retrospective Study on the Risk of Respiratory Distress Syndrome in Singleton Pregnancies with Preterm Premature Rupture of Membranes between 24+0 and 36+6 Weeks, Using Regression Analysis for Various Factors.

AIM: This study aimed to investigate the cause of respiratory distress syndrome (RDS) in neonates from singleton pregnancies with preterm premature rupture of membranes (pPROM) between 24+0 and 36+6 weeks by using regression analysis for various factors. METHODS: In 175 singleton pregnancies with pPROM, 95 cases of RDS (54,29%) were diagnosed. In all cases the following information was collected: latency period of PROM, gestational age at birth, Umbilical Artery Pulsatility Index (UA PI), Middle Cerebral Artery Pulsatility Index (MCA PI), fetal distress, antenatal steroids use, delivery type, pregnancy hypertension disease, gestational glucose intolerance or diabetes, neonatal laboratory parameters, gender, weight, Apgar score, and other neonatal complications. Logistic regression analysis was used to investigate the effect of variables on RDS. RESULTS: The results of logistic regression analysis showed that the following variables are closely correlated with RDS: female gender (OR=0.52; 95%CI:0.28-0,97), antenatal steroids use (OR=0,46; 95%CI:0,34-0,64), abnormal UA PI and MCA PI (OR=2.96; 95%CI:1,43-6,12) (OR=2.05; 95%CI:1,07-3,95), fetal distress (OR=2.33; 95%CI:1,16-4,71), maternal HGB (OR=0.69; 95%CI:0,5-0,96), and neonatal RBC, HGB (OR=0.32; 95%CI:0,19-0,55) (OR=0.75; 95%CI:0,65-0,88). CONCLUSIONS: The main RDS risk factors in premature neonates are gender, abnormal fetoplacental circulation, and fetal distress. The laboratory parameters such as lower RBC and HGB count are observed in infants with RDS.