This study was aimed to assess the utility of diagnostic tests of maternal and fetal infection in the evaluation of stillbirth.A single-center retrospective study from January 2011 to December 2016 of all women presenting to the hospital with intrauterine fetal death at or after 20 weeks of gestation. Standard evaluation included review of medical records, clinical and laboratory inflammatory workup, maternal serologies, fetal autopsy, placental pathology, and fetal and placental cultures. A suspected infectious etiology was defined as meeting at least two diagnostic criteria, and only after exclusion of any other identifiable stillbirth cause.During the 7-year study period, 228 cases of stillbirth were diagnosed at our center. An infectious etiology was the suspected cause of stillbirth in 35 cases (15.3%). The mean gestational age of infection-related stillbirth was 28 1/7 (range: 22-37) weeks, while for a noninfectious etiology, it was 34 0/7 (range: 25-38) weeks (p = 0.005). Placental histological findings diagnostic of overt chorioamnionitis and funisitis were observed in 31 (88.5%) cases. In 16 (45.7%) cases the placental and fetal cultures were positive for the same pathogen. Serology of acute infection was positive in three (8.5%) of the cases.Maternal and fetal infectious workup is valuable in the investigation of stillbirth, particularly before 30 weeks of gestation and should be considered a part of standard evaluation.
Abstract Study question Does inheritance of FMR1 pre mutant allele affect embryos morphokinetic development? Summary answer Embryos that inherit the FMR1 pre-mutant allele are of a lower morphokinetic quality at the blastocyte stage compared to those with the normal allele. What is known already Previous studies suggest lower oocyte yield and blastulation rate in FMR1 premutation carriers undergoing preimplantation genetic testing for monogenic diseases (PGT-M). Yet, data is lacking concerning embryo morphokinetic development in this group. Study design, size, duration Retrospective analysis, on 529 embryos from 126 in vitro fertilization (IVF)- PGT-M cycles of 39 FMR-1 premutation women carriers. Participants/materials, setting, methods Morphological and morphokinetic parameters acquired by the time-lapse monitoring system were compared between embryos carrying the FMR-1 permutated allele (FMR1 group n = 271) to those who inherited the normal allele (Normal group n = 258). Outcomes measures were embryos morphokinetic parameters up to day 3, the start of blasulation time (tSB) for day 5 embryos, and the rate of top-quality embryos at days 3 and 5. Main results and the role of chance No differences were found between the groups in all morphokinetic parameters from the time of ICSI until biopsy on day 3. Blastulation rate was comparable between the groups. However, FMR1 embryos exhibited delayed start of blastulation compared to the genetically normal embryos (median tSB 104.2 hrs (99.3-110.3) vs 101.6 hrs (94.5-106.7), P = 0.01) and had lower top quality embryo rate (25.6% vs 38.8%, P = 0.04). Limitations, reasons for caution This study is limited by its retrospective design and inability to assess CGG expansion in the embryo. Wider implications of the findings This study offers new insight into the impact of permutated FMR1 gene in the early stages of embryo development. Further studies are needed in order to apply these results in clinical decision-making. Trial registration number not applicable
Physical activity of resident physicians (RPs) during on-call shifts is difficult to objectively evaluate. The integration of smartphones in our daily routines may allow quantitative assessment, employing pedometric assessment.To evaluate the number of steps that RPs walk during on-call shifts as a marker of physical activity by using smartphone-based pedometers.Step counts were collected from 100 RPs' smartphones who volunteered to participate in the study between January 2018 and May 2019. The conversion rate was 1400 steps = 1 km (application's default). A shift was defined as regular morning work followed by an in-house on-call stay, totalling 26 hours. Statistical analyses included univariate and multivariate linear mixed models, and Fisher exact test. A P-value < 0.05 was considered statistically significant.The average walking distance was 12 118 steps (8.6 km/RP/shift). Paediatric intensive care unit and neurosurgery residents recorded the longest walking distances 16 347 and 15 630 steps (11.67 and 11.16 km/shift), respectively. Radiology residents walked the shortest distances 4718 steps (3.37 km/shift). Physically active RPs walked significantly longer distances during their shifts than non-physically active RPs: 12 527 steps versus 11 384 steps (8.95 versus 8.13 km/shift, P < 0.05), respectively. Distances covered during weekday shifts were longer than weekend shifts: 12 092 steps versus 11 570 steps (8.63 versus 8.26 km/shift, P < 0.05), respectively.Smartphone-based pedometers can aid in analysing physical activity and workload during on-call shifts; such information can be valuable for human resource department, occupational health authorities and medical students with impaired physical mobility when choosing a speciality.
Preeclampsia is among the most common medical complications of pregnancy. The clinical utility of invasive hemodynamic monitoring in preeclampsia (e.g., Swan-Ganz catheter) is controversial. Thoracic impedance cardiography (TIC) and Doppler echocardiography are noninvasive techniques but they both have important limitations. NICaS™ (NI Medical, PetachTikva, Israel) is a noninvasive cardiac system for determining cardiac output (CO) that utilizes regional impedance cardiography (RIC) by noninvasively measuring the impedance signal in the periphery. It outperformed any other impedance cardiographic technology and was twice as accurate as TIC. We used the NICaS™ system to compare the hemodynamic parameters of women with severe preeclampsia (PET group, n = 17) to a cohort of healthy normotensive pregnant women with a singleton pregnancy at term (control group, n = 62) (1/2015–6/2015). Heart rate (HR), stroke volume (SV), CO, total peripheral resistance (TPR) and mean arterial pressure (MAP) were measured 15–30 min before CS initiation, immediately after administering spinal anesthesia, immediately after delivery of the fetus and placenta, at the abdominal fascia closure and within 24–36 and 48–72 h postpartum. The COs before and during the CS were significantly higher in the control group compared to the PET group (P < .05), but reached equivalent values within 24–36 h postpartum. CO peaked at delivery of the newborn and the placenta and started to decline afterwards in both groups. The MAP and TPR values were significantly higher in the PET group at all points of assessment except at 48–72 h postpartum when it was still significantly higher for MAP while the TPR only exhibited a higher trend but not statistically significant. The NICaS™ device noninvasively demonstrated low CO and high TPR profiles in the PET group compared to controls. The immediate postpartum period is accompanied by the most dramatic hemodynamic changes and fluid shifts, during which the parturient should be closely monitored. The NICaS™ device may help the clinician to customize the most optimal management for individual parturients. Our findings require validation by further studies on larger samples.
Objectives: The objective of this study is to assess the reliability of the cardiac index (CI) in healthy pregnant women at term by investigating the correlation between the cardiac output (CO) and the body surface area (BSA) using a novel non-invasive cardiography technique (NICaS™).Methods: Sixty-one healthy, normotensive women with a singleton pregnancy at term (≥37 gestational weeks) participated in this prospective observational study between 1/2015 and 6/2015 L. Each woman was assessed for CO by the NICaS™, an impedance device that non-invasively measures the CO and its derivatives. The NICaS™ demonstrated a very good correlation with the gold standard Swan–Ganz catheter. BSA was determined by the Dubois nomogram.Results: The mean ± standard deviation maternal age was 34.2 ± 5.3 years, mean height 166 ± 6 cm, and mean body mass index 23.9 ± 4.9 kg/m2. The mean gestational age was 38.8 ± 0.7 weeks. The correlation between the CO and the BSA was poor (Pearson r = 0.254, p < .005).Conclusions: The current study demonstrated poor correlation between the CO and the BSA in pregnant women, therefore, making the CI a non-reliable variable for assessing CO in pregnant women. We, therefore, suggest that the CO rather than the CI is the preferred parameter for hemodynamic measurements in this population.
