joanna sichitiu

BackgroundCytomegalovirus is responsible for the most common congenital infection, affecting 0.5% to 1.0% of live births in Europe. Congenital cytomegalovirus infection can be diagnosed during pregnancy by viral DNA amplification in the amniotic fluid, but the prognosis of fetuses without severe brain abnormalities remains difficult to establish on the basis of prenatal imaging alone.ObjectiveTo identify predictors of moderate to severe symptomatic cytomegalovirus infection among fetal blood parameters and to propose an algorithm on the basis of these parameters and on prenatal imaging that would provide the best positive and negative predictive values.Study DesignFetal blood sampling at 21–28 weeks gestation was performed in fetuses with congenital cytomegalovirus infection confirmed by amniocentesis after maternal infection in the first-trimester or periconceptional period. We compared the levels of …

Optimizing blood conservation in caesarean sections: Intravaginal tamponade technique for abnormal placentae insertion - PMC Back to Top Skip to main content NIH NLM Logo Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation Search PMC Full-Text Archive Search in PMC Advanced Search User Guide Journal List Eur J Obstet Gynecol Reprod Biol X v.21; 2024 Mar PMC10830511 Other Formats PDF (282K) Actions Cite Collections Share Permalink Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Journal List Eur J Obstet Gynecol Reprod Biol X v.21; 2024 Mar PMC10830511 As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Logo of eurox Eur J …

Journal Pre-proof Fetal Blood Sampling in Cytomegalovirus Infection: Balancing the Risks and Benefits. Lé o POMAR, PhD, Joanna SICHITIU, MD, David BAUD, MD-PhD PII: S0002-9378 (24) 00567-2 DOI: https://doi. org/10.1016/j. ajog. 2024.04. 041 Reference: YMOB 15617 To appear in: American Journal of Obstetrics and Gynecology Received Date: 16 April 2024 Accepted Date: 26 April 2024 Please cite this article as: POMAR L, SICHITIU J, BAUD D, Fetal Blood Sampling in Cytomegalovirus Infection: Balancing the Risks and Benefits., American Journal of Obstetrics and Gynecology (2024), doi: https://doi. org/10.1016/j. ajog. 2024.04. 041. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting …

Aim The objective of this study was to describe the use of COVID‐19‐related medicines during pregnancy and their evolution between the early/late periods of the pandemic. Methods Pregnant women who tested positive for SARS‐CoV‐2 from March 2020 to July 2021 were included using the COVI‐PREG registry. Exposure to the following COVID‐19‐related medicines was recorded: antibiotics, antivirals, hydroxychloroquine, corticosteroids, anti‐interleukin‐6 and immunoglobulins. We described the prevalence of medicines used, by trimester of pregnancy, maternal COVID‐19 severity level and early/late period of the pandemic (before and after 1 July 2020). Findings We included 1964 pregnant patients who tested positive for SARS‐CoV‐2. Overall, 10.4% (205/1964) received at least one COVID‐19‐related medicine including antibiotics (8.6%; 169/1694), corticosteroids (3.2%; 62/1964), antivirals (2.0%; 39 …

ObjectiveTo investigate the association between an abnormal width of the cavum septi pellucidi (CSP) and early developmental delay.Study DesignWe conducted a cross-sectional study on all fetuses of low risk pregnancies, evaluated in our neurosonography clinic between 18+ 0 and 36+ 6 weeks of gestation from January 2020 to January 2021. Fetuses with a central nervous system (CNS) or extra-CNS anomaly were excluded. The corpus callosum was assessed in all fetuses and was normal for gestation. The width of the CSP was measured by two experienced neurosonographers by placing the calipers on the inner portion of its lateral borders (in-to-in). This measurement was correlated to the biparietal diameter (BPD) by linear regression analysis. Reference ranges were constructed depicting the mean and 2 standard deviations (SD) above and below this value for each BPD. A wide CSP or narrow CSP …

Objectives To determine simple prenatal imaging parameters that can easily be acquired to predict the need for postnatal CSF diversion (PCD) surgery in fetuses undergoing open fetal surgery for open spina bifida (OSB). Methods All fetuses with OSB that underwent open fetal surgery between June 2017 and June 2021 with available follow‐up outcomes were included. Imaging parameters including clivus‐supraocciput angle (CSA) on magnetic resonance imaging, transcerebellar diameter (TCD) and lateral ventricle size (Vp) on ultrasound (US), were collected pre‐ and postoperatively. The requirement for PCD surgery was determined at 1 year of age. The predictive strength of each parameter was determined by Receiver Operating Characteristic curve analysis. Results Among 36 babies eligible for the analyses, 41.7% required PCD by one year of age. Pre‐operative Vp (AUC 0.71; 95% confidence interval …

Pregnancy care has gradually evolved over the last two decades, with a trend towards earlier detection and diagnosis of both maternal and fetal pathologies. At the core of this process, antenatal ultrasound allows to identify a large number of congenital malformations as early as the end of the first trimester. It has also become an increasingly specialized procedure, requiring considerable material and human resources. In this article, we review the basic principles of first-trimester ultrasound, focusing on most recent screening recommendations.

Objectives Recently, it was noted that fetuses with open spina bifida (OSB) may have a midline cystic structure evident on ultrasound. Our aims were to determine the prevalence of this cystic structure, shed light on its pathophysiology and investigate the association between its presence and other characteristic brain findings in fetuses with OSB. Methods This was a single‐center retrospective study of all fetuses with OSB and available cineloop images in the axial plane referred to the Ontario Fetal Centre, Toronto, Canada, between June 2017 and May 2022. Ultrasound and magnetic resonance imaging (MRI) data obtained between 18 + 0 and 25 + 6 weeks were reviewed in search of a midline cystic structure. Pregnancy and lesion characteristics were collected. Transcerebellar diameter (TCD), clivus–supraocciput angle (CSA) and additional brain abnormalities (abnormal cavum septi pellucidi (CSP …

BACKGROUNDWith the rise in the number of women giving birth at an advanced age, the association between advanced maternal age and adverse obstetrical outcomes is a growing concern in developed countries. Despite the well-established link between advanced maternal age and pregnancy-related complications, there has been limited research examining the specific risks related to unscheduled cesarean delivery in nulliparas at term.OBJECTIVEThis study aimed to evaluate the risks associated with unscheduled cesarean delivery in nulliparas at ≥37 weeks of gestation, comparing the outcomes of younger patients with those aged ≥40 years.STUDY DESIGNThis retrospective cohort study was conducted in a tertiary maternity hospital in Switzerland (high-income country). The study included nulliparas who delivered a live-born infant at ≥37 weeks between January 2015 and December 2019. We …

At the beginning of the COVID-19 pandemic, the extent of the risks of a COVID infection during pregnancy were unknown. During the start of the pandemic, there were only a few studies published comparing outcomes between pregnant women with and without COVID-19 infections. The INTERGROWTH-21st Consortium conducted a prospective, longitudinal, observational study (INTERCOVID), which assessed the association between COVID-19 and maternal/neonatal outcomes in pregnant women with a COVID-19 diagnosis compared with enrolled pregnant women without a COVID-19 diagnosis.

ObjectiveTo compare maternal outcomes using Carbetocin versus Oxytocin for the active management of the third stage of labor, given a temporary national shortage of Oxytocin.MethodsWe conducted a retrospective observational study on a cohort of 866 women with vaginal deliveries at our center, >36 weeks of gestation, between November 2018 and March 2019. During the shortage period, each woman received a single slow intravenous injection of Carbetocin 100 µg at delivery of the anterior shoulder, rather than Oxytocin 5 UI, as postpartum hemorrhage prophylaxis. 146 (16.9%) patients received Carbetocin versus 720 (83.1%) receiving Oxytocin. The outcomes were rates of postpartum hemorrhage, severe postpartum hemorrhage, and placental retention.ResultsIncidence rates of placental retention and postpartum hemorrhage were 4.9% and 9.4% respectively. Placenta retention was significantly more …

SARS-CoV-2-related placentitis shows distinctive histologic characteristics, and its impact on perinatal outcomes is increasingly under scrutiny. We present two such cases in the third trimester displaying mild maternal clinical symptoms and associated with maternal coagulopathy, reduced fetal movements, and nonreassuring fetal heart rate tracing. Both cases resulted in emergency cesarean deliveries. Our cases and a review of the literature highlight that SARS-CoV-2 undermines placental function and thus greatly impacts late-term pregnancies, even in the absence of severe systemic disease.

BackgroundAmong nonpregnant individuals, diabetes mellitus and high body mass index increase the risk of COVID-19 and its severity.ObjectiveThis study aimed to determine whether diabetes mellitus and high body mass index are risk factors for COVID-19 in pregnancy and whether gestational diabetes mellitus is associated with COVID-19 diagnosis.Study DesignINTERCOVID was a multinational study conducted between March 2020 and February 2021 in 43 institutions from 18 countries, enrolling 2184 pregnant women aged ≥18 years; a total of 2071 women were included in the analyses. For each woman diagnosed with COVID-19, 2 nondiagnosed women delivering or initiating antenatal care at the same institution were also enrolled. The main exposures were preexisting diabetes mellitus, high body mass index (overweight or obesity was defined as a body mass index ≥25 kg/m2), and gestational …

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9–9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0–7.0] and diabetes [aOR2.2, 95% CI 1.1–4.5]. Pregnant women with severe maternal outcomes …

This study aims to evaluate the feasibility and clinical interest of shear wave elastography, by quantitatively estimating the baseline stiffness of the myometrium before and after placental expulsion. We conducted a prospective cohort study of women at term, without known risk factors for postpartum hemorrhage, who gave birth via spontaneous labor in our tertiary center. Myometrium tonicity was evaluated based on measurements of shear wave speed (SWS) in the anterior uterine corpus. All data points were collected by a single operator. Measurements were carried out at three different time points: after fetal delivery (T1), after placental delivery (T2) and 30 min after placental delivery (T3). Our primary objective was to assess the feasibility of this new imaging technique. Ten valid SWS measurements obtained at each of the three different time points were considered as a positive primary outcome. Our secondary …

Methods We included all postmortem examinations with at least one congenital abnormality and with a certain diagnosis, either by molecular confirmation or by clinical postmortem examination. To assess the performance of ultrasound phenotype for the identification of a rare disorder based on a cohort of postmortem examinations following termination of pregnancy. Conclusions Following the diagnosis of a malformation, the prenatal ultrasonographic phenotype can lead to the diagnosis of a rare disorder in 80% of cases, at best.[Extracted from the article]Copyright of Ultrasound in Obstetrics & Gynecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the …

The increased rate of cesarean section in developed countries is a worrying public health issue, due to the increased risk of feto-maternal morbidity and significant health costs accrued. In an attempt to control this inflation, recommendations have been issued by the leading obstetrical organizations worldwide which have resulted in a stabilization rather than a significant reversal of this trend. In our tertiary center, we took up this challenge, resulting in a reduction of one third in the global cesarean section rate from 2015 to 2017 (from 33.2 to 24%, with 3200 births per annum). Our interventions to achieve these results can be summarized in Ten Commandments:

Abstract OC08. 09: Functional magnetic resonance imaging of the placenta in monochorionic twin pregnancies complicated by Twin-twin transfusion syndrome Conclusions In this pilot study, we have illustrated that placental perfusion discrepancy can be demonstrated by means of functional MRI, identifying a decrease in T2* in the donor placental area. To evaluate placental functional imaging markers in monochorionic twin pregnancies with or without Twin-twin transfusion syndrome (TTTS), using diffusion-weighted magnetic resonance imaging (MRI) and relaxometry.[Extracted from the article]Copyright of Ultrasound in Obstetrics & Gynecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be …

In the last 30 years, with increasing cesarean section rates, the incidence of the placenta accreta spectrum has also increased. It is estimated that by the year 2020 there will be nearly 9000 cases annually in the United States. Currently, no consensus exists regarding optimal management. Conventional treatment by cesarean–hysterectomy is challenging, with a high maternal morbidity due to massive hemorrhage, and surgical complications such as urinary tract, bowel and pelvic nerve injury, in addition to loss of fertility and its accompanying psychological trauma. Innovative approaches seek to preserve the uterus with the adherent placenta in situ, thus maintaining fertility and potentially reducing hemorrhage and adjacent organ injury. This review reports strategies for conservative treatment of such conditions, based on the current literature.

Background In order to manage a protracted second stage of labor, “eminence-based” birth positions have been suggested by some healthcare professionals. Recent biomechanical studies have promoted the use of an optimized supine birthing position in this setting. However, uncertainty exists regarding the feasibility of this posture, and its acceptability by women. This pilot study primarily aimed to assess these characteristics. Objective and methods In this monocentric prospective study, 20 women with a protracted second stage of labor were asked to maintain a biomechanically-optimized position for at least 20 minutes at full dilatation. This posture is similar to the McRoberts’ maneuver. Maintaining the position for 20 minutes or more was considered clinically relevant and indicative of feasibility and acceptability. Satisfaction with the position was assessed using a Visual Analogue Scale (VAS). A sub-group analysis was performed to assess eventual differences between more and less satisfied patients, according to the median of patients’ satisfaction scores. Results Seventeen patients (85%) maintained the optimized position for at least 20 minutes. The median satisfaction score of these participants was 8 (interquartile range: 1) out of 10. No significant differences were found between the two sub-groups (satisfaction score <8 vs satisfaction score ≥8) regarding general and obstetric characteristics, as well as obstetrical and fetal outcomes. Conclusion The optimized position is acceptable and feasible for women experiencing a protracted second stage of labor. Further clinical studies are needed to assess the efficiency of such positions …