Lung ultrasound versus chest computed tomography for pregnant inpatients with COVID-19.

PURPOSE: To compare lung ultrasound (US) and computed tomography (CT) in the assessment of pregnant women with COVID-19. METHODS: Prospective study comprising 39 pregnant inpatients with COVID-19 who underwent pulmonary assessment with CT and US with a maximum span of 48 h between the exams. The thorax was divided into 12 regions and assessed in terms of the following: the presence of B-lines (>2), coalescent B-lines, consolidation on US; presence of interlobular thickening, ground glass, consolidation on CT. The two methods were scored by adding up the scores from each thoracic region. RESULTS: A significant correlation was found between the scores obtained by the two methods (rICC = 0.946; p < 0.001). They were moderately in agreement concerning the frequency of altered pulmonary regions (weighted kappa = 0.551). In US, a score over 15, coalescent B-lines, and consolidation were predictors of the need for oxygen, whereas the predictors in CT were a lung score over 16 and consolidation. The two methods, US (p < 0.001; AUC = 0.915) and CT (p < 0.001; AUC = 0.938), were fairly accurate in predicting the need for oxygen. CONCLUSION: In pregnant women, lung US and chest CT are of similar accuracy in assessing lungs affected by COVID-19 and can predict the need for oxygen.

The complex search for the cause of gastroschisis.

BACKGROUND: To reveal the complex etiology of gastroschisis through two independent cases. CASES: Case 1 involves gastroschisis recurrence in a consanguineous marriage, and Case 2 concerns a fetus with gastroschisis whose mother had undergone gastroplasty. Methylation array was carried out in both cases (two fetuses with gastroschisis, their two mothers, one father from the consanguineous marriage), and in 16 controls (fetuses and their respective mothers). CONCLUSION: The two cases presented different noninherited methylation profiles.

COVID-19 outcomes in hospitalized puerperal, pregnant, and neither pregnant nor puerperal women.

OBJECTIVE: To compare hospitalized reproductive age women with COVID-19 who were pregnant, puerperal, or neither one nor the other in terms of demographic and clinical characteristics and disease progression using Brazilian epidemiological data. METHODS: A retrospective analysis of the records of the Information System of the Epidemiological Surveillance of Influenza of the Health Ministry of Brazil was performed. It included the data of female patients aged 10 to 49 years hospitalized because of severe COVID-19 disease (RT-PCR+ for SARS-CoV-2), from February 17, 2020 to January 02, 2021. They were separated into 3 groups: pregnant, puerperal, and neither pregnant nor puerperal. General comparisons and then adjustments for confounding variables (propensity score matching [PSM]) were made, using demographic and clinical characteristics, disease progression (admission to the intensive care unit [ICU] and invasive or noninvasive ventilatory support), and outcome (cure or death). Deaths were analyzed in each group according to comorbidities, invasive or noninvasive ventilatory support, and admission to the ICU. RESULTS: As many as 40,640 reproductive age women hospitalized for COVID-19 were identified: 3,372 were pregnant, 794 were puerperal, and 36,474 were neither pregnant nor puerperal. Groups were significantly different in terms of demographic data and comorbidities (p<0.0001). Pregnant and puerperal women were less likely to be symptomatic than the women who were neither one nor the other (72.1%, 69.7% and 88.8%, respectively). Pregnant women, however, had a higher frequency of anosmia, and ageusia than the others. After PSM, puerperal women had a worse prognosis than pregnant women with respect to admission to the ICU, invasive ventilatory support, and death, with OR (95% CI) 1.97 (1.55 - 2.50), 2.71 (1.78 - 4.13), and 2.51 (1.79 - 3.52), respectively. CONCLUSION: Puerperal women were at a higher risk for serious outcomes (need for the ICU, need for invasive and noninvasive ventilatory support, and death) than pregnant women.

Breastfeeding Twins: Factors Related to Weaning.

BACKGROUND: Many factors may influence a woman's decision to start and maintain breastfeeding. Research aim: This study aimed to investigate the factors associated with breastfeeding cessation in twin infants during the first 6 months after birth and to describe the main reasons for weaning cited by mothers of twins. METHODS: This is a secondary data analysis of a prospective randomized trial conducted in Brazil. Data were obtained through longitudinal quantitative and qualitative self-reported interviews. One hundred twenty-eight women pregnant with twins and their 256 infants were followed for up to approximately 6 months, during which time breastfeeding data were obtained through face-to-face interviews at three different points after birth: 30 to 40 days (Time 1), 90 days (Time 2), and 180 days (Time 3). The association between weaning and the investigated factors was examined using survival analysis methodologies. RESULTS: Nonexclusive breastfeeding ( p = .004, Cox proportional hazards regression model), a lack of support during the lactation period ( p = .001), difficulty breastfeeding ( p = .003), a breastfeeding duration shorter than 12 months in a previous pregnancy ( p = .001), and infants' birth weight less than 2,300 g ( p < .001) were the factors associated with breastfeeding cessation. The main reasons for weaning cited by mothers of twins were insufficient human milk supply, infants' behavior, and returning to work. CONCLUSION: We have identified the factors associated with weaning in twin infants during the first 180 days of life. This knowledge can help improve strategies to increase breastfeeding rates in twins.

Placental weight and birth weight to placental weight ratio in monochorionic and dichorionic growth-restricted and non-growth-restricted twins.

OBJECTIVE:: The aim of the present study was to compare the placental weight and birth weight/placental weight ratio for intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. METHODS:: This was a retrospective analysis of placentas from twin pregnancies. Placental weight and the birth weight/placental weight ratio were compared in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. The association between cord insertion type and placental lesions in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins was also investigated. RESULTS:: A total of 105 monochorionic (intrauterine growth restriction=40; non-intrauterine growth restriction=65) and 219 dichorionic (intrauterine growth restriction=57; non-intrauterine growth restriction=162) placentas were analyzed. A significantly lower placental weight was observed in intrauterine growth-restricted monochorionic (p=0.022) and dichorionic (p<0.001) twins compared to non-intrauterine growth-restricted twins. There was no difference in the birth weight/placental weight ratio between the intrauterine growth restriction and non-intrauterine growth restriction groups for either monochorionic (p=0.36) or dichorionic (p=0.68) twins. Placental weight and the birth weight/placental weight ratio were not associated with cord insertion type or with placental lesions. CONCLUSION:: Low placental weight, and consequently reduced functional mass, appears to be involved in fetal growth restriction in monochorionic and dichorionic twins. The mechanism by which low placental weight influences the birth weight/placental weight ratio in intrauterine growth-restricted monochorionic and dichorionic twins needs to be determined in larger prospective studies.

Placental weight and birth weight to placental weight ratio in monochorionic and dichorionic growth-restricted and non-growth-restricted twins

OBJECTIVE: The aim of the present study was to compare the placental weight and birth weight/placental weight ratio for intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. METHODS: This was a retrospective analysis of placentas from twin pregnancies. Placental weight and the birth weight/placental weight ratio were compared in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. The association between cord insertion type and placental lesions in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins was also investigated. RESULTS: A total of 105 monochorionic (intrauterine growth restriction=40; non-intrauterine growth restriction=65) and 219 dichorionic (intrauterine growth restriction=57; non-intrauterine growth restriction=162) placentas were analyzed. A significantly lower placental weight was observed in intrauterine growth-restricted monochorionic (p=0.022) and dichorionic (p<0.001) twins compared to non-intrauterine growth-restricted twins. There was no difference in the birth weight/placental weight ratio between the intrauterine growth restriction and non-intrauterine growth restriction groups for either monochorionic (p=0.36) or dichorionic (p=0.68) twins. Placental weight and the birth weight/placental weight ratio were not associated with cord insertion type or with placental lesions. CONCLUSION: Low placental weight, and consequently reduced functional mass, appears to be involved in fetal growth restriction in monochorionic and dichorionic twins. The mechanism by which low placental weight influences the birth weight/placental weight ratio in intrauterine growth-restricted monochorionic and dichorionic twins needs to be determined in larger prospective studies.

Effect of Prenatal Counseling on Breastfeeding Rates in Mothers of Twins.

OBJECTIVE: To investigate the effect of antenatal breastfeeding counseling on the breastfeeding rates for women who give birth to twins. DESIGN: Prospective randomized trial. SETTING: Multiple Pregnancy Unit, Obstetrics Department, University of São Paulo, Brazil. PARTICIPANTS: A total of 171 mothers of twins and their 342 infants. METHODS: The participants were randomized into the prenatal counseling group (PCG) or control group (CG). Breastfeeding data were collected through personal interviews at three times after birth: 30 to 40 days (Time 1), 90 days (Time 2), and 180 days (Time 3). The primary endpoint was a comparison of the mothers' breastfeeding rates between PCG and CG in each analyzed period. The secondary endpoint was the comparison of the overall rates of twin infant breastfeeding between PCG and CG until 180 days after birth. RESULTS: The final analysis included 68 women pregnant with twins in the PCG and 60 in the CG. There was no significant difference in the breastfeeding rates between PCG and CG in the analyzed periods: Time 1 (odds ratio [OR] = 1.87, 95% confidence interval [CI] [0.71, 4.95]), Time 2 (OR = 1.50, 95% CI [0.72, 3.10]), and Time 3 (OR = 1.06, 95% CI [0.51, 2.19]). Also, no difference existed in the overall rates of breastfeeding between PCG and CG at 180 days. CONCLUSION: In women pregnant with twins, antenatal breastfeeding counseling did not significantly affect the breastfeeding rates. Further research about the best moment to counsel mothers of twins is needed to improve breastfeeding rates.

Nonimmune fetal ascites: identification of ultrasound findings predictive of perinatal death.

AIM: To determine the ultrasonographic findings that predict death in fetal ascites. METHODS: This was a retrospective cohort study involving pregnancies with ultrasonographic findings related to fetal ascites. The inclusion criteria were as follows: single pregnancy with a live fetus; ultrasound findings of ascites; ascites unrelated to maternal fetal alloimmunization; and pregnancy follow-up at our institution. The χ2-test was used to evaluate the association of ultrasound findings and death. Multiple logistic regression analysis was performed to determine the ultrasound findings that are predictive of death prior to hospital discharge. RESULTS: A total of 154 pregnancies were included in the study. In 8 (5.19%) cases, ascites was an isolated finding, and in 146 cases, other alterations were observed during the ultrasound evaluation. Death before hospital discharge occurred in 117 cases (76.00%). The following ultrasonographic findings were significantly associated with death: gestational age at diagnosis <24 weeks (P<0.0001); stable/progressive ascites evolution (P=0.004); the presence of hydrops (P<0.0001); and the presence of cystic hygroma (P<0.0001). The presence of hydrops, the presence of respiratory tract malformations, and stable/progressive ascites evolution were significantly associated with the prediction of death. CONCLUSIONS: Based on ultrasound examination, the presence of hydrops, malformation of the respiratory tract, and stable/progressive evolution of ascites increase the chances of death in cases of fetal ascites.

Myocardial performance index in fetal anemia.

OBJECTIVE: The objective of the study was to examine the correlation between fetal myocardial performance index (MPI) and hemoglobin (Hb) levels. METHODS: It is a prospective study involving singleton pregnancies at risk of fetal anemia as a result of maternal anti-D alloimmune disease. Right and left ventricle (LV) MPIs were evaluated by ultrasound up to 72 h before cordocentesis. Zeta-score values for fetal MPI and Hb levels were calculated, and correlation was examined with linear regression analysis. Significance level was set as 0.05. RESULTS: Fourteen singleton pregnancies underwent 31 cordocentesis procedures at a mean gestation of 28.2 ± 4.1 weeks. Zeta-score values for LV MPI, isovolumetric relaxation time (IRT), and ejection time (ET) correlated significantly with fetal Hb zeta-score (LV MPI zeta = 3.816 + 0.336 × Hb zeta, r = 0.59, p < 0.001; LV IRT zeta = 2.643 + 0.218 × Hb zeta, r = 0.45, p = 0.01; LV ET zeta = -2.474 - 0.271 × Hb zeta, r = -0.42, p = 0.02). LV isovolumetric contraction time (ICT) zeta-score and right ventricle (RV) MPI did not show significant correlation (LV ICT zeta, r = 0.35, p = 0.054; RV MPI, r = 0.12, p = 0.53). CONCLUSION: LV myocardial performance not only remains preserved but also is actually enhanced in cases of moderate/severe fetal anemia.

Maternal postpartum complications according to delivery mode in twin pregnancies

OBJECTIVE: We aimed to examine maternal postpartum complications of twin deliveries according to mode of delivery and investigate the associated risk factors. METHODS: This was a retrospective cohort review of twin pregnancies with delivery after 26 weeks at a tertiary teaching hospital (1993-2008). The rates of maternal postpartum complications were compared among vaginal, elective cesarean and emergency cesarean deliveries. Significant predictors of complications were investigated with stepwise regression analysis and relative risks were calculated. RESULTS: A total of 90 complications were observed in 56/817 (6.9%) deliveries: 7/131 (5.3%) vaginal, 10/251 (4.0%) elective cesarean and 39/435 (9.0%) emergency cesarean deliveries. Significant predictors included high-risk pregnancy, gestational age at birth and delivery mode. The occurrence of complications was significantly increased in emergency compared to elective cesarean deliveries (RR = 2.34). CONCLUSIONS: Maternal postpartum complications in twin pregnancies are higher in emergency compared to elective cesarean deliveries and are also related to preexisting complications and earlier gestational age at delivery. .