Do Maternal Heart Diseases Affect Fetal Cardiac Functions?

OBJECTIVES

To investigate whether fetal cardiac function is affected by underlying heart disease in pregnant women.

METHODS

A total of 100 pregnant women who were ≥34 gestational weeks were included in the study, 40 in the maternal heart disease (MHD) group diagnosed with heart disease and 60 in the control group. All cardiac diseases in pregnant women were diagnosed preconceptionally and categorized according to the New York Heart Association (NYHA) classification system. Fetal cardiac functions of study groups were evaluated by M-mode, color tissue Doppler imaging (c-TDI), and pulsed wave Doppler.

RESULTS

Tricuspid annular plane systolic excursion and myocardial performance index (MPI) values were significantly higher and isovolumetric relaxation time was prolonged in the MHD group. The MPI value was found higher in MHD group with NYHA Class II compared to those with NYHA Class I. No significant change in any of the fetal tricuspid annular peak velocity values measured by c-TDI in the MHD group. There were no differences in fetal cardiac functions and perinatal outcomes between pregnant women with acquired and congenital heart diseases. Patients in NYHA Class II had lower birth weight, 1st and 5th minute APGAR scores, and higher neonatal intensive care unit admission rates.

CONCLUSIONS

Underlying heart diseases in pregnant women can cause alterations in the systolic and diastolic function of the fetal heart. High fetal MPI values detected in cardiac patients may indicate that cardiac pathologies during pregnancy affect fetal cardiac globular myocardial function. Cardiac pathologies that progress with restricted physical activity may cause changes in fetal cardiac function and may be associated with adverse perinatal outcomes.

Fetal cardiac functional changes in pregnancies with Behcet's disease: A case-control study

BACKGROUND

Behcet's disease usually progresses with remission during pregnancy, but early subtle changes might be detected in the heart of these fetuses due to inflammation.

AIMS

We aimed to evaluate the cardiac functions in fetuses of pregnant women with Behcet's disease (BD).

STUDY DESIGN

Prospective case-control study.

SUBJECTS

This prospective study enrolled pregnant women diagnosed with Behcet's disease before pregnancy. Twenty-four pregnancies with Behcet's disease and 48 healthy pregnancies were included at 32-34 gestational weeks.

OUTCOME MEASURES

Pulsed-wave Doppler and tissue Doppler imaging (TDI) were used to assess cardiac functions.

RESULTS

Right ventricle (RV) E (early) wave and left ventricle (LV) E were significantly increased in pregnancies with BD (p = .008, p = .041, respectively). Decreased right ventricle E' (peak systolic velocity) was detected with TDI in the case group (6.2 ± 0.5, p < .001). E/E' ratios for RV and LV were significantly increased in the case group (p < .001, p = .001, respectively). The correlation between the duration of the disease and fetal cardiac functions was also evaluated. For RV, E (r = 0.735, p < .001), E' (r = -0.735, p < .001), E/E' (r = 0.894, p < .001), were strongly correlated with the disease duration. The study also showed the correlation between disease duration and LV E' (r = -0.735, p = .005), LV E (r = 0.750, p < .001), and LV E/E' (r = 0.820, p < .001).

CONCLUSION

This is the first study to evaluate the fetal cardiac functions in fetuses of pregnancies with BD. Although BD usually progresses with remission during pregnancy, early subclinical diastolic changes might occur in the heart of these fetuses due to inflammation.

Evaluation of fetal thymus size in maternal autoimmune diseases: systemic lupus erythematosus, Sjögren's syndrome and antiphospholipid antibody syndrome

PURPOSE

To investigate the effect of inflammation on the fetal thymus-thoracic ratio (TTR) in pregnant women with systemic lupus erythematosus (SLE), Sjögren's syndrome (SS) and antiphospholipid antibody syndrome (APS).

METHOD

This prospective case-control study included 45 pregnant women with SLE, SS, and APS and 90 gestational age-matched healthy pregnant women between 24 and 37 gestational weeks. The ratio of the anteroposterior fetal thymus length to the transverse mediastinal length was calculated as the TTR in the study groups.

RESULTS

Fetal TTR was significantly lower in the case group (p < 0.001). Fetal TTR in the APS group was significantly lower than SS group (p = 006). The patients using hydroxychloroquine (HCQ) had significantly higher fetal TTR compared to patients not using HCQ (p = 0.004). A moderate negative correlation was found between the disease duration and fetal TTR (r =  - 0.552, p < 0.001). In predicting admission to the neonatal intensive unit care (NICU), a value of 0.31 was found for the fetal TTR with a sensitivity of 83.3% and a specificity of 69% CONCLUSION: Maternal inflammation in pregnancies with autoimmune diseases may affect the intrauterine milieu of the fetus and cause a lower fetal TTR. Additionally, the lower level of fetal TTR may be more effective and beneficial for the clinician if combined with other risk factors in predicting NICU admission.

The evaluation of fetal interventricular septum with M-mode and spectral tissue Doppler imaging in gestational diabetes mellitus: a case-control study

OBJECTIVES

To demonstrate possible functional changes in the frequently affected fetal interventricular septum (IVS) with spectral tissue Doppler imaging (TDI) and M-mode imaging to compare gestational diabetes mellitus (GDM) and control groups.

METHODS

A total of 63 pregnant women with GDM, 30 on diet (A1 GDM) and 33 on treated with insulin (A2 GDM), and 63 healthy pregnant women randomly selected and matched to the case group in the control group were included.

RESULTS

The GDM fetuses had significantly thickened IVS, increased early diastole (E'), atrial contraction (A'), systole (S'), higher myocardial performance index (MPI'), prolonged isovolumetric relaxation time (IVRT'), shortened ejection time (ET'), and decreased septal annular plane systolic excursion (SAPSE) than the controls. The A2 GDM group fetuses had significantly thickened IVS, increased S' and shortened ET' than the A1 GDM group. In the GDM group, we found a significantly positive low correlation between glycated hemoglobin levels and maternal serum fasting glucose and one-hour postprandial glucose with fetal IVS thickness. We demonstrated a significantly negative low correlation between maternal serum one-hour postprandial glucose, glycated hemoglobin levels, and gestational weight gain with fetal IVS ET'.

CONCLUSIONS

Fetal IVS diastolic and systolic functions were altered in the GDM group compared to controls, and systolic functions were altered in A2 GDM compared to A1 GDM. This may alert clinicians to possible cardiovascular diseases in the postnatal life, and early preventive strategies and long-term lifestyle changes may provide protection in fetuses with GDM.

The Importance of Tissue Doppler Imaging and M-Mode Ultrasonography in Fetuses With Preterm Premature Rupture of Membranes: A Case-Control Study

OBJECTIVE

To compare the cardiac functions of fetuses with preterm premature rupture of membranes (PPROM) between their control groups and investigate its relationship with perinatal outcomes.

METHODS

This prospective study was conducted with 102 pregnant women. Pregnant women with PPROM were divided into two subgroups Group A, between 26 and 30 weeks, and Group B, between 30 and 34 weeks. A control group was formed by randomly including one healthy pregnant woman for each study patient. Sociodemographic, obstetric data, tissue Doppler imaging, and M-mode imaging results were compared. The relationship between echocardiographic parameters and perinatal outcomes was also investigated.

RESULTS

Tricuspid annular plane systolic excursion (TAPSE), S', and ET' of systolic cardiac parameters were shortened in both groups compared with their controls. Diastolic function indicator E'/A', and global function indicator myocardial performance index' increased in both groups. Isovolumetric contraction time' did not change between groups. A correlation was found between myocardial performance index', and the length of neonatal intensive care unit stay in Group A and TAPSE and duration of respiratory support and length of neonatal intensive care unit stay in Group B.

CONCLUSIONS

The fetal cardiac function seems to be affected by PPROM, and these changes are associated with neonatal outcomes. Therefore, administering fetal cardiac function evaluation in pregnancies complicated by PPROM may help physicians establish more appropriate clinical management protocols in this special population.

The influence of maternal inflammatory bowel diseases on fetal cardiac functions: A case-control study

BACKGROUND

The altered maternal inflammatory milieu and changes in maternal vascular structure (arterial stiffness) and function may affect the fetal heart in pregnant women diagnosed with inflammatory bowel disease (IBD).

AIMS

To investigate fetal cardiac functions in IBD pregnancies and to reveal the relationship between IBD duration and fetal cardiac functions.

STUDY DESIGN

Prospective case-control study.

SUBJECTS

The case group included 19 pregnant women with ulcerative colitis and seven with Crohn's disease who were in remission at the time of the study. The control group consisted of 52 healthy pregnant women matched for gestational age in the third trimester of pregnancy (at 32 to 33 weeks).

OUTCOME MEASURES

Fetal cardiac functions. The assessment was blinded as to whether the patients were cases or controls.

RESULTS

The right ventricular E', E'/A', S', and tricuspid annular plane systolic excursion (TAPSE) were significantly lower, and E/E', myocardial performance index (MPI'), and isovolumetric relaxation time (IVRT') were significantly higher in fetuses of IBD pregnancies. Diastolic functions (E/E', E', E'/A', and IVRT'), systolic functions (S' and TAPSE), and global function (MPI') were changed in the case group. A significantly strong correlation was between maternal disease duration and fetal right ventricle diastolic function parameters (E/E', E, E', E'/A') in the case group (r2 = 0.780; p ≤0.001, r2 = 0.570; p ≤0.001, r2 = 0.604; p ≤0.001, r2 = 0.638; p ≤0.001, respectively).

CONCLUSION

Diastolic and systolic fetal cardiac functions changed in IBD pregnancies. As the disease duration increases, especially fetal cardiac diastolic functions may be affected.

Factors Related to Low COVID-19 Vaccination Rate in Pregnant and Postpartum Women with and without COVID-19

OBJECTIVE

 This study focused on pregnant and postpartum women during the COVID-19 pandemic, aiming to determine the attitudes and behaviors of vaccinated and unvaccinated groups, and the vaccination behaviors in the groups with and without the disease. The reasons for refusing the vaccine were also questioned.

METHODS

 This cross-sectional study was performed from September 2021 to October 2021. The study data were collected using a face-to-face questionnaire. The participants were pregnant women who applied to the hospital for routine antenatal care and were hospitalized, and women in the postpartum period. Additionally, pregnant and postpartum patients who were diagnosed with COVID-19 at the time of admission and were hospitalized and admitted to the intensive care unit due to this disease were also included in the study.

RESULTS

 A total of 1,146 pregnant and postpartum women who completed the questionnaire were included in our study. Only 43 (3.8%) of the participants were vaccinated; 154 (13.4%) of the participants had comorbidities. The number of COVID-19-positive patients was 153. The lack of sufficient information about the safety of the COVID-19 vaccine is the most common reason for the refusal.

CONCLUSION

 Vaccine refusal can significantly delay or hinder herd immunity, resulting in higher morbidity and mortality. Considering the adverse effects of COVID-19 on pregnancy, it is essential to understand pregnant and postpartum women's perceptions toward vaccination to end the pandemic.

Small fetal thymus and adverse perinatal outcome in maternal vasculitis: A prospective case-control study

BACKGROUND

Ultrasonographic evaluation of fetal thymus size may be used to predict the adverse perinatal outcome in pregnant women with vasculitis.

AIM

To compare fetal thymus size in pregnant women with vasculitis and healthy pregnant women and to evaluate whether fetal thymus size predicts the adverse perinatal outcome.

METHODS

Twenty-two pregnant women with previously diagnosed vasculitis, 18 of them with Behçet's disease, three with Takayasu arteritis, and one with Wegener's granulomatosis, were included in the case group. The control group comprised 66 healthy pregnant women whose gestational ages matched the case group. Thymic thoracic ratio (TTR) was measured to assess fetal thymus size in the view of three vessels and trachea.

RESULTS

In the case group, fetal TTR was significantly lower (0.32 ± 0.03 vs. 0.36 ± 0.02, p = < 0.001). Fetal TTR was significantly lower in those using prednisone than those not (p = .001) in the case group. There was no significant difference in fetal TTR between colchicine used and not used (p = .078) in the case group. Also, for the TTR, a sensitivity of 100% and a specificity of 92% were achieved with a cut-off value of 0.33 for predicting adverse perinatal outcomes.

CONCLUSION

The fetuses of pregnant women with maternal vasculitis had a smaller TTR. The small fetal thymus may alert clinicians to possible adverse perinatal outcomes and, with other supporting risk factors, may help predict adverse perinatal outcomes in pregnant women with vasculitis.

The assessment of fetal cardiac functions in pregnancies with autoimmune diseases: a prospective case-control study

OBJECTIVES

This study aimed to assess the effect of the inflammatory process on fetal cardiac functions in pregnant women with autoimmune diseases (AID).

METHODS

This prospective study included 36 pregnant women with diagnosed AID. Nineteen systemic lupus erythematosus, 12 antiphospholipid syndrome, 5 Sjögren's syndrome, and 72 healthy pregnancies were included. Fetal cardiac functions were evaluated with pulsed-wave, tissue Doppler, and M-mode echocardiography.

RESULTS

Sociodemographic data were similar in both groups. Significant increases were found in tricuspid E (43.5 ± 0.9, p<0.001) and A (59.2 ± 2.2, p<0.001) and E/A (0.74 ± 0.03, p<0.001), E'/A' (0.64 ± 0.15, p<0.001), E/E' (6.5 ± 0.6, p<0.001), and left ventricular myocardial performance index (0.54 ± 0.03, p=0.005). We demonstrated a significant decrease in tricuspid E' (6.7 ± 0.6, p<0.001) and S' (6.9 ± 1, p<0.001) and in TAPSE (7.7 ± 0.5, p=0.002). We also found a significantly prolonged PR interval (130 ± 8, p<0.001). There was a significant increase in E' (6.8, p=0.033) and a significant decrease in E/E' ratio (6.4, p=0.027) in the group using hydroxychloroquine (HCQ) compared to non-users.

CONCLUSIONS

We found that pregnancy with autoimmune diseases affects fetal heart functions. Additionally, hydroxychloroquine may positively affect the heart of AID fetuses. This information might be useful to clinicians in the follow-up of cardiovascular diseases.

Assessment of fetal thymus size in pregnant women with rheumatic diseases: A case-control study

PURPOSE

To investigate the fetal thymic-thoracic ratio (TT-ratio) in pregnancies diagnosed with rheumatoid arthritis (RA) and ankylosing spondylitis (AS).

METHODS

Thirty-two pregnant women with rheumatic disease and 96 low-risk pregnant women between 20 and 37 weeks were included in the study. Three control patients were randomly selected for each study patient. TT-ratio was calculated by measuring the anterior-posterior diameter of the thymus and the intrathoracic mediastinal diameter. Data were compared between the study group, including RA and AS, and the control group.

RESULTS

Thirty-two pregnant women with arthritis, 19 diagnosed with RA and 13 with AS, were evaluated. The mean value of the study group TT-ratio was 0.33; control group, 0.36; a statistically significant difference was found (p < 0.001). Perinatal outcomes were not different when compared with control patients. There was a negative correlation between disease duration, maternal C-reactive protein, erythrocyte sedimentation rate, and TT-ratio.

CONCLUSION

This is the first study to prospectively evaluate the fetal TT-ratio in patients with RA and AS. Systemic inflammation appears to affect fetal thymus size. Appropriate management of maternal rheumatic diseases is essential for developing the thymus, a vital immune system component.

Cervical sliding sign at second trimester in the prediction of early preterm birth in twin pregnancy

OBJECTIVE

To examine the cervical sliding sign (CSS) alongside cervical length (CL) in twin pregnancies to predict preterm birth (PB).

METHODS

Twin pregnancies (n = 37) with no known risk factor for PB were included in this prospective study. CSS was defined as the ultrasonographic finding in which the anterior lip of the cervix slides over the posterior lip with gentle and continuous pressure application. The CSS and CL measurements were held in the second trimester. Early PB was defined as the birth of the fetus before 32 weeks of gestation. The patients were divided into two groups as CSS-positive and CSS-negative.

RESULTS

Whereas 11 (29.7%) of the twin pregnancies were CSS-positive, 26 (70.3%) were CSS-negative. CSS positivity had a sensitivity of 75.0%, a specificity of 82.2%, a positive predictive value of 54.5%, and a negative predictive value of 92.3% to predict early PB. Multivariate logistic regression analysis revealed that CSS positivity was the only significant independent factor related to early PB.

CONCLUSION

CSS was shown to be superior to CL in providing a better insight to predict early PB. CSS evaluation should be performed in twin pregnancies.

Evaluation of Fetal Cardiac Functions in Preeclampsia: Does the Severity or Proteinuria Affect Fetal Cardiac Functions?

OBJECTIVE

To compare the fetal cardiac functions in preeclampsia and control group, and determine whether the severity or amount of proteinuria affects fetal cardiac functions.

METHODS

This prospective case-control study involves 48 pregnant women with preeclampsia and 48 healthy women. Pulsed wave Doppler, M-mode, and tissue Doppler imaging were used to measure the cardiac function between the 32 and 34 gestational weeks in each group. All Doppler indices and cardiac function parameters were also compared in subgroups with mild and severe preeclampsia and between subgroups with proteinuria >3 g/24 hours and <3 g/24 hours.

RESULTS

Decreased diastolic function (decreased E, A, E', and A' values in mitral/tricuspid valves and increased isovolumetric relaxation time) and decreased systolic functions (decreased mitral and tricuspid annular plane systolic excursion and S' value in mitral/tricuspid valves) were detected in the preeclampsia group. Decreased tricuspid E value in severe preeclampsia compared with mild preeclampsia was shown in the present study.

CONCLUSION

Preeclampsia may cause changes in systolic and diastolic functions in the fetal heart. Subclinical functional changes of these fetuses can be detected earlier and more sensitively with the help of tissue Doppler imaging. Biventricular diastolic functional changes are more prominent in preeclamptic cases with proteinuria >3 g/24 hours.

Evaluation of fetal adrenal artery Doppler velocimetry and fetal adrenal gland size in pregnancies after recovery from COVID-19

AIM

Assessment of the fetal adrenal gland (FAG) size and middle adrenal artery (MAA) Doppler parameters in pregnancy recovered from Coronavirus Disease (COVID-19) and comparison of the values with the healthy control group.

METHODS

Thirty-eight pregnant women who had recovered from COVID-19 infection and 76 healthy control group between 33 and 35 weeks of gestation were involved in this case-control study. Fetuses were examined for fetal biometry, fetal well-being, adrenal gland dimensions, and Doppler parameters 4-6 weeks after the diagnosis of COVID 19 infection. FAG dimensions were measured in two planes and MAA blood flow velocity was evaluated with pulsed Doppler. Pregnant women with COVID-19 infection were grouped according to the National Institutes of Health for the severity of the disease, and those with mild and moderate infections were examined in the study.

RESULTS

The total adrenal gland (TAG) height, fetal zone (FZ) length and width, and MAA-Peak Systolic Velocity (MAA-PSV) were significantly higher, and the MAA-Pulsatility Index (MAA-PI) was significantly lower in the COVID-19 group (p < 0.05). The lower in MAA-PI and the higher in MAA-PSV, the width of the FZ, and width of the TAG were found to be significant in the moderate group compared to the mild groups (p < 0.05).

CONCLUSION

COVID-19 pregnancies might cause early maturation of the FAG and its vasculature depends on the intrauterine stress due to the hyper-inflammation, so fetuses exposed to maternal COVID-19 suggested to have an increase in blood flow to the adrenal gland and fetal adrenal size.

Effect of glycemic control on fetal hearts of pregestational diabetic women by tissue doppler and M-mode imaging

OBJECTIVE

To determine whether changes in fetal heart function according to glycemic control in pregnant women with Type 1 and Type 2 diabetes using spectral tissue Doppler imaging (TDI) and M-mode imaging.

METHODS

This study included 68 pregestational diabetic women (DM) at 30-32 gestational weeks. All participants were divided into two groups: type 1(n = 17) and type 2(n = 51), and then these groups were divided into the subgroups as well-controlled and poorly controlled, according to fasting glucose (FG) and 1-h postprandial glucose (PPG) values. Cardiac parameters were compared for well- and poorly-controlled groups with TDI and M-mode imaging. The correlation of cardiac parameters with FG, PPG, and HbA1c values was evaluated. Their roles in predicting neonatal outcomes were also assessed.

RESULTS

Thickness measurements, early diastolic annular peak velocity (E'), late diastolic annular peak velocity (A'), tissue isovolumetric relaxation time (IRT'), and tissue myocardial performance index (MPI') were increased in both poorly controlled groups. Tissue ejection time (ET') was significantly reduced in the poorly controlled groups, while tissue isovolumetric contraction time (ICT') was not significantly changed in any group. Tricuspid, mitral, and septal annular plane excursions (TAPSE, MAPSE, and SAPSE, respectively) were significantly decreased in all poorly controlled subgroups. E', E'/A', MPI', IRT', ET', and M-mode imaging parameters significantly correlated with FG notably.

CONCLUSION

Maternal hyperglycemia leads to subtle changes in systolic and diastolic functions both in the interventricular septum and ventricles, so it is essential to ensure glycemic control in both Type 1 and Type 2 DM.

Assessment of fetal cardiac functions in pregnant women with asthma

AIM

This study aims to investigate the effects of maternal asthma on fetal cardiac functions.

METHODS

The study was planned with 30 pregnant women who presented to a tertiary health center and were diagnosed with asthma and 60 healthy controls with similar gestational ages. The fetal echocardiographic assessment was assessed between 33 and 35 weeks of gestation with pulsed-wave Doppler (PW), M-mode, and tissue Doppler imaging (TDI). Fetal cardiac functions were compared between maternal asthma and the control group. Cardiac functions were assessed according to the duration of maternal asthma diagnosis, as well.

RESULTS

Early diastolic function parameters, tricuspid E wave (p = .001), and tricuspid E/A ratio (p = .005) were significantly lower in the group with maternal asthma. Tricuspid annular plane systolic excursion (TAPSE) and measurements of mitral annular plane systolic excursion (MAPSE) values were statistically lower in the study group than in the control group; p = .010 and p = .012, respectively. Parameters assessed with TDI (E', A', S', E/E', and MPI' of tricuspid valves) and global cardiac function parameters assessed with PW like myocardial performance index (MPI) and left cardiac output (LCO) were similar between groups (p > .05). Although, MPI did not change between groups, and the isovolumetric relaxation time (IVRT) value was prolonged in maternal asthma cases (p = .025).

CONCLUSION

We found that maternal asthma disease causes alteration in fetal diastolic and early systolic cardiac functions, but the global fetal cardiac function does not change. Diastolic heart function values also varied with the duration of maternal asthma. Prospective studies are needed to compare fetal cardiac functions with additional patient groups according to disease severity and type of medical treatment.

Assessment of fetal pulmonary artery Doppler indices in pregnant women with rheumatoid arthritis and ankylosing spondylitis

PURPOSE

To investigate fetal pulmonary artery Doppler parameters in pregnant women with rheumatoid arthritis (RA) and ankylosing spondylitis (AS).

METHODS

This case-control study included 24 pregnant women diagnosed with 13 AS and 11 RA and 48 healthy pregnant women at 29-30 weeks of gestation. The demographic and clinical features were recorded, including disease type and duration, attacks during pregnancy, and medications. Pulmonary artery acceleration time (AT), ejection time (ET), and pulmonary artery acceleration time to ejection time (PATET) ratio were measured by manual trace with spectral Doppler ultrasound.

RESULTS

A shorter pulmonary AT and lower PATET ratio were found in the case group (34.8 ± 2.3, p < 0.001, 0.18 ± 0.02, p < 0.001, respectively). When comparing the groups that had an attack during pregnancy and had not, there were no significant differences in the pulmonary artery indices. We also demonstrated a moderate correlation between maternal disease years and the PATET ratio (r = -0.562, p = 0.004).

CONCLUSION

This is the first study to evaluate the effect of RA and AS on fetal pulmonary indices. Maternal inflammation might affect pulmonary development and circulation. Fetal pulmonary Doppler indices can be used to obtain further information about neonatal respiratory morbidities in rheumatological disorders.

Assessment of fetal cardiac morphology and functional changes in early-onset and late-onset fetal growth restriction

OBJECTIVE

To compare the fetal cardiac morphology and functions of early-onset fetal growth restriction (EO-FGR) and late-onset fetal growth restriction (LO-FGR) groups with gestational weeks-matched controls.

METHODS

A total of 164 pregnant women were included, 28 of whom were in the EO-FGR group, 54 in the LO-FGR group, and 82 in the control group. Fetal echocardiographic evaluation was performed with two-dimensional, M-mode, tissue Doppler imaging (TDI), and pulsed wave Doppler.

RESULTS

Fetal cardiac morphologic measurements and diastolic and systolic functions changed in EO-FGR and LO-FGR fetuses compared with controls. The EO- and LO-FGR fetuses had reduced right and left cardiac output, increased myocardial performance index, and significantly higher mitral and tricuspid E/E' ratios compared with controls. The EO-FGR fetuses had lower mitral and tricuspid E and E' values. In LO-FGR fetuses, mitral and tricuspid E' values were lower than in their controls (P = 0.001 and P < 0.001). On the other hand, the mitral and tricuspid E values were not significantly changed (P = 0.107 and P = 0.196).

CONCLUSION

We hypothesized that EO-FGR and LO-FGR fetuses had insufficient myocardial maturation. Especially in the LO-FGR fetuses, TDI is the earliest and most sensitive technique to show subtle changes in fetal cardiac functions.

Maternal serum midkine level in fetal growth restriction: a case-control study

OBJECTIVES

To compare maternal serum midkine (MK) level in pregnant women with idiopathic fetal growth restriction (FGR) and healthy. In addition, we assessed the value of maternal serum MK level in predicting neonatal intensive care unit (NICU) admission.

METHODS

A total of 144 pregnant women were included, 72 with idiopathic FGR and 72 healthy in this study. The control group was matched for the mother's age, parity, gestational age, and pre-pregnancy body mass index (BMI) with the idiopathic FGR group at the time of recruitment into the study and sample collection.

RESULTS

Serum MK level is higher in the idiopathic FGR than the control group (0.24 ng/mL (0.19-0.32) vs. 0.18 ng/mL (0.14-0.23), p<0.001). In addition, we compared the maternal serum MK level of those with and without NICU admission in the FGR group (0.25 ng/mL (0.19-0.37) vs. 0.21 ng/mL (0.18-0.28), p=0.014). We performed ROC curve analysis to serum MK level predicting NICU admission in the FGR group (AUC: 0.668, %95 CI [0.550, 0.785], p=0.014). A sensitivity of 63% and a specificity of 62% for the serum MK level were achieved with a cut-off value of 0.22 for NICU admission.

CONCLUSIONS

To the best of our knowledge, this study is the first to compare maternal serum MK level in pregnant women with idiopathic FGR and healthy. We showed that maternal serum MK level was significantly elevated in pregnant women with FGR than healthy.

The utility of systemic immune-inflammation index and systemic immune-response index in the prediction of adverse outcomes in pregnant women with coronavirus disease 2019: Analysis of 2649 cases

AIM

To investigate the association of systemic immune-inflammation index (SII) and systemic immune-response index (SIRI) with adverse perinatal outcomes in pregnant women with coronavirus disease 2019 (COVID-19).

METHODS

The cases were divided into (1) the Mild-moderate COVID-19 group (n = 2437) and (2) the Severe-critical COVID-19 group (n = 212). Clinical characteristics, perinatal outcomes, SII (neutrophilXplatelet/lymphocyte), and SIRI (neutrophilXmonocyte/lymphocyte) were compared between the groups. Afterward, SII and SIRI values were compared between subgroups based on pregnancy complications, neonatal intensive care unit (NICU) admission, and maternal mortality. A receiver operator characteristic analysis was performed for the determination of optimal cutoff values for SII and SIRI in the prediction of COVID-19 severity, pregnancy complications, NICU admission, and maternal mortality.

RESULTS

Both SII and SIRI were significantly higher in complicated cases (p < 0.05). Cutoff values in the prediction of severe-critical COVID-19 were 1309.8 for SII, and 2.3 for SIRI. For pregnancy complications, optimal cutoff values were 973.2 and 1.6. Cutoff values of 1045.4 and 1.8 were calculated for the prediction of NICU admission. Finally, cut-off values of 1224.2 and 2.4 were found in the prediction of maternal mortality.

CONCLUSION

SII and SIRI might be used in combination with other clinical findings in the prediction of poor perinatal outcomes.

Role of cervical sliding sign in predicting preterm delivery in pregnancies complicated with preterm premature rupture of membranes

OBJECTIVE

To investigate the effect of cervical sliding sign (CSS) to predict preterm delivery in patients with premature rupture of membranes.

METHODS

This prospective cohort study included 88 pregnant women between 24^0/7 and 36^6/7  weeks of gestation who were complicated with preterm premature rupture of membranes (PPROM) between June 2020 and January 2022. We measured the cervical length (CL) and applied pressure to the anterior fornix of the cervix with the transvaginal probe to investigate the CSS, which is defined as the sliding of the anterior lip of the cervix on the posterior lip.

RESULTS

The time between PPROM and delivery was significantly shorter in the CSS+ group (P < 0.001). Receiver operating characteristic curve analysis was performed for CSS with regard to predicting delivery within 7 days following PPROM (area under the curve, 0.749 [95% confidence interval, 0.642-0.857], P < 0.001). On logistic regression analysis, CL <25 mm increased the predictive accuracy of delivery within 7 days following PPROM 1.91-fold, and CSS increased the predictive accuracy of delivery within 7 days following PPROM 10.71-fold.

CONCLUSION

CSS is an effective sonographic marker in predicting preterm delivery and provides better information of oncoming preterm delivery in patients with PPROM than CL measurement.

Effect of maternal autoimmune diseases on fetal pulmonary artery Doppler indices: A case-control study

OBJECTIVE

To compare the fetal pulmonary artery Doppler indices of pregnant women with autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and antiphospholipid syndrome (APS) with healthy pregnant women.

METHODS

Thirty-nine pregnancies were included in the case group, 19 of them SLE, 12 with SS, and eight with APS. The gestational age-matched 54 healthy pregnant women were included in the control group. Peak systolic velocity, time-averaged velocity, systolic/diastolic ratio, pulsatility index, resistance index, acceleration time (AT), ejection time (ET), and AT/ET ratio were obtained from pulmonary artery waveform by using spectral Doppler ultrasound.

RESULTS

Significantly shorter AT and lower AT/ET ratio were detected in the case group (p = < .001, p = < .001, respectively). The shortening of AT and decreasing of the AT/ET ratio were more predominant in the APS group. However, there was no significant difference between the SLE, SS, and APS groups in fetal pulmonary artery Doppler indices. Also, a moderate correlation was found between maternal disease duration (years) and fetal pulmonary artery AT (r = -.516, p = .001) and AT/ET ratio (r = -.558, p = < .001).

CONCLUSION

Fetal pulmonary artery Doppler indices may be affected in maternal autoimmune diseases. Further studies are needed to evaluate fetal pulmonary Doppler indices such as AT and AT/ET ratio to predict neonatal respiratory morbidity and lung maturation in pregnant women with SLE, SS, and APS.

The influence of COVID-19 pandemic on intrauterine fetal demise and possible vertical transmission of SARS-CoV-2

OBJECTIVE

The impact of COVID-19 on intrauterine fetal demise (IUFD) and vertical transmission of the SARS-CoV-2 from the mother to the fetus are crucial issues of the COVID-19 pandemic. In the current study, we aimed to detect the pandemic's influence on the IUFD and evaluate the vertical transmission of the SARS-CoV-2 through analysis of placental tissues collected from PCR positive women with IUFD above 20 weeks of gestation.

MATERIALS AND METHODS

The pregnant women above 20 weeks of gestation and had a fetus intrauterine demised during pandemic were included in the study. The pregnant women screened for COVID-19. Vertical transmission searched from placental tissues of COVID-19 positive women by RT-PCR tests for the presence of SARS-CoV-2 RNA. The number of IUFD before the pandemic and during the pandemic compared to assess the influence of the COVID-19 pandemic on the IUFD ratio.

RESULTS

Among 138 pregnant women with IUFD, 100 of them could screen for COVID-19 status. RT-PCR test results of 6 of the screened pregnant women were positive for SARS-CoV-2. Placental tissues of these six women were analyzed, and one test result was positive for SARS-CoV-2 RNA. The IUFD ratio was significantly increased during the pandemic.

CONCLUSION

It is clear that COVID-19 increases the IUFD ratio. Previous data for vertical transmission of SARS-CoV-2 during the second trimester is limited. We present the third case of literature that has positive placental results for SARS-CoV-2 RNA in the second trimester of pregnancy.

The assessment of fetal cardiac output in maternal hypothyroidism under levothyroxine treatment

OBJECTIVE

In this study, we investigated whether maternal hypothyroidism has a role in the cardiac output (CO) of the fetus or not.

METHODS

Pregnant women between 33 and 37 gestational weeks known to have hypothyroidism and using levothyroxine were accepted as the case group. Gestational age-matched healthy euthyroid pregnant women constituted the control group. Fetal echocardiography was performed. Diameters and the velocity waveform of the pulmonary artery (PA) and aortic valves were measured. Velocity time integral (VTI) was also measured from the ventricular outflow tract. CO was calculated using VTI × π (Aortic Valve or Pulmonary Valve diameter/2) 2 × heart rate formula.

RESULTS

The aortic and PA annulus were measured larger in the control group. (p = .003, p = .005, respectively). Furthermore, the right and left CO of the case group were lower than the control group. Whereas the mean combined CO (ml/min) of the case group was 674.8 ± 146.2, it was 827.8 ± 167.9 in the control group (p < .001). Additionally, a negative correlation was observed between thyroid-stimulating hormone and aortic VTI (r:-.480; p:.006).

CONCLUSION

The findings of our study suggest that the CO of the fetus may be affected by maternal hypothyroidism.

Evaluation of fetal middle adrenal artery Doppler and fetal adrenal gland size in pregnancies with fetal growth restriction: a case-control study

OBJECTIVES

This study aims to evaluate sonographic measurements of fetal adrenal gland size and middle adrenal artery Doppler in pregnancies with fetal growth restriction (FGR) and in a healthy control group.

METHODS

This prospective study included 107 singleton pregnancies with FGR between 24 and 42 weeks of gestation and 107 pregnancies with fetuses whose growth was appropriate for gestational age (AGA). Adrenal gland size and Doppler parameters of the adrenal artery were measured and the values and obstetric outcomes were compared between the study and control groups.

RESULTS

In the study group, the Z-scores of total adrenal width-length and height, fetal zone width-length and middle adrenal artery-peak systolic velocity (MAA-PSV) were significantly higher than those in the control group (p<0.05). The Z-scores of middle adrenal artery-pulsatility index (MAA-PI) were significantly lower in the study group than in the control group (p<0.05). The rate of neonatal intensive care unit admission in fetuses with high adrenal artery PI scores was higher in the FGR group (p<0.05).

CONCLUSIONS

In the present study, we observed decreased adrenal artery PI, increased adrenal blood flow, and increased fetal adrenal volume in fetuses diagnosed with fetal growth restriction, most likely in response to placental insufficiency and chronic hypoxia.

Fetal echocardiographic evaluation before and after nifedipine treatment in preterm labor

OBJECTIVE

To assess the effect of nifedipine used for tocolysis on cardiac morphology and functions.

METHODS

The study included 47 pregnant women diagnosed with preterm labor at 32-33 weeks. Fetal echocardiographic evaluation was performed with two-dimensional (2D) imaging, M-mode, pulsed wave (PW) Doppler, and tissue Doppler imaging (TDI) before and after the 48^th hour of nifedipine treatment.

RESULTS

No significant change was observed in Doppler parameters (pulsatility indices of the umbilical artery, middle cerebral artery, ductus venosus) and cardiac morphology (cardiothoracic ratio, end-diastolic longitudinal diameters, sphericity indices, wall thickness) after nifedipine treatment. The parameters obtained with TDI (e', a', s', e'/a', E/e' of mitral and tricuspid valves), M- mode (TAPSE, MAPSE), pulsed Doppler (myocardial performance index, left cardiac output, right cardiac output, tricuspid E, A waves, tricuspid E/A ratio, mitral E, A waves, mitral E/A ratio) did not change after nifedipine treatment.

CONCLUSION

To date, this is the first study to examine the effects of nifedipine on the fetal heart using the TDI. Since nifedipine is a drug that is frequently used and well-tolerated in the prevention of preterm labor, it is crucial that it does not cause changes in fetal cardiac parameters during tocolysis. Therefore, we used TDI in addition to conventional methods to evaluate the effect of nifedipine, which is frequently used in obstetrics, on cardiac functions in the early period. Nifedipine treatment seems not to affect systolic or diastolic functions. This indicates that nifedipine is reliable on cardiac functions and morphology in pregnancies treated for preterm labor.

Has the COVID-19 delayed the diagnosis of fetal anomalies and reduced in the follow-up of high-risk pregnancies?

Objective: COVID-19 has deeply affected our lives in terms of social, economic, education and health issues. Pregnant women have had concerns about routine antenatal care visits and decreased follow-up numbers due to concern of COVID-19 transmission. We aimed to evaluate whether there is a delay in the diagnosis of fetal anomaly during the COVID-19 pandemic period and whether patients diagnosed with fetal anomaly attend antenatal care regularly or not, and to investigate the factors that prevent them from regular follow-up. Methods: Pregnant women diagnosed with fetal anomaly during pandemic period (March 1, 2020 to September 1, 2020) and diagnosed with fetal anomaly before pandemic period (September 1, 2019 to February 28, 2020) were compared with a questionnaire in terms of antenatal follow-up frequency and gestational age of fetal anomaly diagnosis. Results: In the during pandemic period group, regular pregnancy follow-up was decreased from 87% to 51% because of maternal anxiety, fear of virus transmission in hospital and the anxiety of passing it on to baby. Attending a detailed ultrasound scan for detecting fetal anomaly at 18–22 weeks was significantly lower in the during pandemic group. In the pandemic period, the most commonly diagnosed fetal anomalies were central and peripheral nervous system, and cardiovascular and gastrointestinal system anomalies similar to the before pandemic period group. The mean frequency of follow-ups in the third trimester in the before pandemic period group and during pandemic period group was 6.02 (±2.36) times and 4.02 (±1.97) times, respectively, and it was a considerable and statistically significant decrease. In addition, the mean week of fetal anomaly diagnosis was 23±6 weeks in during pandemic group, while it was 22±5 weeks in before pandemic group, and there was no statistically significant difference. Conclusion: Antenatal follow-up of the patients has been decreased significantly during the pandemic period, although it does not seem to cause delay in the diagnosis of fetal anomaly. In experienced perinatal centers, if the concerns of patients are relieved and they are examined under suitable conditions for the pandemic, there will be no delay in diagnosis of fetal anomalies.

Post-COVID-19 fetal cardiac evaluation in moderate infection group of pregnant women

PURPOSE

To determine the long-term fetal cardiac effects of the SARS-CoV-2 infection in pregnant women recovered from moderate COVID-19 with fetal echocardiography (ECHO).

METHODS

Forty-five pregnant women that recovered from moderate COVID-19 (CRG) 4 weeks after the infection confirmation, were compared with 45 gestational and maternal age-matched control groups (CG) in terms of demographic features fetal cardiac morphological (sphericity index, cardiothoracic ratio), and functional (myocardial performance index, mitral E/A, tricuspid E/A, mitral and tricuspid annular plane systolic excursion) parameters.

RESULTS

There was no difference in demographic features between the groups. Fetal cardiac morphologic parameters were found to be similar between the two groups. When the fetal cardiac functional assessment of the two groups was compared, only mitral E/A ratio results were found to be statistically significantly lower in the CRG than in the control group (p = 0.030).

CONCLUSION

The fetal heart does not seem to be negatively affected by COVID-19 after recovery from moderate infection. These results about the fetal effect of SARS-CoV-2 may improve our limited knowledge of the utility of fetal ECHO in pregnant women who recovered from COVID-19.

Decreased fetal cardiac output in pregnant women with severe SARS-Cov-2 infection

AIM

We aimed to examine fetal cardiac output (CO) in patients who recovered from severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection.

MATERIALS

This prospective study included 48 pregnant women recovered from SARS-CoV-2 infection and 50 control cases. SARS-CoV-2 infection was diagnosed by polymerase chain reaction (PCR) test in patients. Fetal echocardiographic evaluations were performed at 24-37 weeks of gestation in pregnant women who recovered from the infection and control group.

RESULTS

The median value of ultrasound evaluation was 34 (2.6) weeks of gestation in the recovery from the SARS-CoV-2 infection (RSI) group, and 32 (7.6) weeks in the control group (p = .565). Left cardiac output (LCO) z score was significantly lower in the RSI group than the control group (p = .041). LCO and combine cardiac output (CCO) z score were significantly lower in the severe disease group than mild, moderate disease groups, and controls (p = .019 and p = .013). CCO (ml/min/kg) was decreased in the severe disease group when compared with control and mild disease groups (p = .044).

CONCLUSION

In the present study, fetal cardiac output in pregnant women who recovered from SARS-CoV-2 infection was found to be significantly reduced in those with severe disease, while there was no significant difference in mild and moderate cases. Placental dysfunction and inflammatory cytokines might cause fetal cardiac changes. Further studies could be clarified on the impact of SARS-CoV-2 infection on fetal cardiac function.

Maternal serum midkine level increases in pregnant women with diabetes mellitus: a case-control study

OBJECTIVE

We aimed to compare maternal serum midkine level in pregnant women with different types of diabetes mellitus (DM) and healthy pregnant women. We also assessed maternal serum midkine level performance to predict adverse neonatal outcomes in the DM group.

METHODS

The study included 57 pregnant women diagnosed with gestational diabetes mellitus (GDM) and 41 pregnant women with preexisting DMThe control group consisted of 98 healthy pregnant women.

RESULTS

Serum midkine level is higher in the DM group than healthy ones (0.93 ± 0.8 vs. 0.23 ± 0.2, p<.001). When the diabetic groups were compared, the highest serum midkine level was found in GDM, followed by Type 1 DM and Type 2 DM (1.33 ± 0.9 ng/ml, 0.58 ± 0.5 ng/ml vs. 0.30 ± 0.2, respectively). Maternal serum midkine level was higher in the DM group with adverse perinatal outcomes than those without adverse outcomes, but there was no statistical difference (0.97 ± 0.91vs. 0.87 ± 0.73, p=.571).

CONCLUSIONS

Serum midkine level was significantly higher in pregnant women with GDM, Type 1, and 2 DM than healthy ones. Serum midkine level did not predict adverse neonatal outcomes in the DM group.

Evaluation of fetal cardiac morphology and functions in pregnant women with familial Mediterranean fever

OBJECTIVE

We aimed to evaluate and compare fetal cardiac morphology and functions of pregnant women with familial Mediterranean fever (FMF) and healthy pregnant women.

METHODS

The study included 34 pregnant women with FMF and 68 healthy pregnant women matched with maternal age, gravidity, parity, gestational age, and pre-pregnancy body mass index (BMI) in 34th-37th gestational weeks. Fetal echocardiographic evaluation was performed with two-dimensional (2D) imaging, M-mode imaging, pulsed wave (PW) Doppler, and tissue Doppler imaging (TDI).

RESULTS

Fetal cardiac morphological measures, including cardiothoracic ratio, cardiac axis angle, right and left ventricular area, sphericity index, and ventricular septal thickness was similar in both groups. Compared with the control group, myocardial performance index (MPI), which indicates global myocardial performance, was significantly higher, and ejection time (ET) was significantly shortened in the FMF group. In addition, which shows the diastolic functional parameters such as, tricuspid E wave, E/A, E/E' ratio, and mitral E wave, E/A, E/E' ratio, were significantly higher; tricuspid A and mitral A waves were significantly lower. We found that mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE) were significantly lower in those with FMF duration over eight years than those with FMF duration less than 8 years.

CONCLUSION

There is no fetal cardiac morphological change in pregnant women with FMF. However, there may be changes in diastolic function. As the maternal FMF duration increases, systolic functions may also change.

Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases

Purpose

To compare the clinical features and perinatal outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the pre-variant and post-variant periods.

Methods

This prospective cohort study includes pregnant women with SARS-CoV-2 who were followed-up at Ankara City Hospital between 11, March 2020 and 15, September 2021. Demographic features, clinical characteristics and pregnancy outcomes were compared between the pre-variant (n = 1416) and post-variant (n = 519) groups.

Results

The rates of severe and critical cases significantly increased in the post-variant group (9.7% vs 2%, p < 0.001). The rates of respiratory support (26.8% vs 7.3%, p < 0.001), ICU admission (12.9% vs 1.8%, p < 0.001) and maternal mortality (2.9% vs 0.4%, p < 0.001) were significantly higher in the post-variant group. A significant increase was observed for pregnancy complications in the post-variant group (45.6% vs 18.8%, p = 0.007). The rates of preterm delivery (26.4% vs 4.4%, p < 0.001) and NICU admission (34% vs 18.8%, p < 0.001) were significantly higher in the post-variant group. Positive, weak, statistically significant correlations were observed between the post-variant period, disease severity and maternal mortality (r = 0.19, r = 0.12 and p < 0.001).

Conclusion

Post-variant COVID-19 period was associated with a severe course of the disease and increased rates of adverse obstetric outcomes in pregnant patients.

Influence of Covid-19 infection on fetal thymus size after recovery

OBJECTIVES

To investigate the long-term effects of the SARS-CoV-2 infection on the fetal immune system by fetal thymus size measurements with ultrasound (USG).

METHODS

This prospective study was conducted in the Turkish Ministry of Health Ankara City Hospital between November 1, 2020 and April 1, 2021, with recovered, pregnant women, four weeks after they had been confirmed for the SARS-CoV-2 infection by real-time polymerase-chain-reaction (RT-PCR). COVID-19 recovered (CR) pregnant women compared with age-matched pregnant controls in terms of demographic features, fetal thymic-thoracic ratio (TTR), and laboratory parameters.

RESULTS

There was no difference in demographic features between the two groups. TTR found significantly lower in the CR group than the control group (p=0.001). The fetal TTR showed a significant and moderate correlation with maternal monocyte counts, monocyte to lymphocyte ratio (MLR), and red cell distribution width (RDW); while it did not correlate with lymphocyte counts, c-reactive protein (CRP), and procalcitonin levels.

CONCLUSIONS

The 2019 novel coronavirus disease (COVID-19) reduces fetal thymus size in pregnant women with mild or moderate symptoms after recovery from the infection.

Systemic immune-inflammation index in twin pregnancies compared to singleton pregnancies

Objective To evaluate the systemic immune-inflammation index (SII) in twin pregnancies. Methods The retrospective study included 200 twin (dichorionic/ diamniotic and monochorionic/diamniotic) and 200 singleton pregnancies (control group). All pregnant women were in the first trimester (<14 weeks of gestation). The study and the control groups were compared in terms of demographic characteristics, laboratory test results, and SII values. Results The mean week of gestation was 9.7±2 in dichorionic diamniotic twin pregnancy group, 10.4±2 in monochorionic diamniotic twin pregnancy group and 9.4±2 for the control group (p=0.083). The lymphocyte value was lower in the dichorionic group and monochorionic group than in the control group (p=0.020 and p=0.020, respectively). The platelet-to-lymphocyte ratio (PLR) values were higher in the dichorionic group than in the control group (p=0.002). However, there was no statistical difference between the groups for neutrophil-to-lymphocyte ratio (NLR) and SII values (p>0.05). Conclusion Physiological inflammatory/immune reaction of early pregnancy may affect PLR values in twin pregnancies. We observed that chorionicity is considerable for these inflammatory indices, especially for dichorionic twin pregnancies. However, we could not detect a significant change in SII values in twin pregnancy.

Factors affecting the acceptability of COVID-19 vaccine in the postpartum period

BACKGROUND

Coronavirus disease 2019 (COVID-19) has spread rapidly around the world, causing massive morbidity and mortality. Vaccination during puerperium protects both the mother and the newborn and is important to keep the pandemic under control.

METHODS

Women who gave birth at Ankara City Hospital between February 11, 2021 and March 21, 2021 were included. Data were collected through a face-to-face questionnaire.

RESULTS

We asked 412 postpartum women were surveyed about their acceptance of the COVID-19 vaccine; 137 (33.3%) of them wanted to be vaccinated, while 275 (66.7%) of them did not want to be vaccinated. Reasons for vaccination rejection; 209 (76%) of them stated that there was not enough information about the safety of the vaccine for the postpartum period, and 89 (32.4%) of them thought that the vaccine would not be effective for the disease. Three of the answers in the survey were found significantly different in high-risk pregnancy (HRP) group compared to low-risk pregnancy (LRP) group; 1) Having their babies to be vaccinated, 2) To be vaccinated if it will be recommended to the puerperal women, and 3) Feeling anxious about being infected by SARS-CoV-2 (p < .05).

CONCLUSIONS

Health authorities recommend the COVID-19 vaccine to breastfeeding mothers. However, a relatively low vaccination acceptance rate was observed in the present study. For newly developed vaccines, concern over vaccine safety is the biggest obstacle to vaccine administration. Therefore, the reasons that influence acceptance or refusal of vaccines are important for developing targeted communication strategies and healthcare policies.

Fetal pulmonary artery Doppler evaluation in pregnant women after recovery from COVID-19

Objective

To evaluate fetal lung development using pulmonary artery Doppler in pregnant women who had recovered from COVID‐19.

Methods

The prospective case–control study included 41 pregnant women who had recovered from COVID‐19 and 43 healthy pregnant women (control group). All the women in the study group had been diagnosed with COVID‐19 and had completed a quarantine period.

Results

The demographic data of patients were similar in the groups (P > 0.05). Main pulmonary artery peak systolic velocity was higher and pulsatility indices were lower in pregnant women who recovered from COVID‐19 compared to the controls (P < 0.001, P = 0.001). Acceleration time, ejection time, and acceleration/ejection time ratio (PATET) of the fetal MPA Doppler were significantly decreased in pregnant women who recovered from COVID‐19 (P < 0.001, P = 0.036, and P = 0.002, respectively). The patients who had recovered from COVID‐19 were divided into two groups: those treated with expectant management and those treated in hospital. The pulmonary artery acceleration time and PATET ratio were significantly lower in the group treated in the hospital (P = 0.023 and P = 0.045, respectively).

Conclusion

Detailed Doppler evaluations of the pulmonary artery may help in evaluating the fetal adverse effects of COVID‐19 disease.

Detailed Doppler evaluations of the pulmonary artery may help in evaluating the fetal adverse effects of COVID‐19 disease.

Effects of nifedipine on fetal pulmonary blood flow in preterm labor

Objective To determine the effect of nifedipine on the fetal pulmonary system by acceleration/ejection time ratio of the fetal main pulmonary artery Doppler waveform. Methods This prospective study was conducted in a high-risk pregnancy clinic with pregnant women who required nifedipine treatment to prevent preterm labor between 24 and 34 weeks of gestation. An ultrasound examination that included measurements of the acceleration time (AT), ejection time (ET), and AT/ET ratio (PATET) were performed before and 48 h after the first nifedipine dose. Results Forty-three pregnant women were included in this study. AT and PATET found higher in the after nifedipine group when compared with before nifedipine group. When the ET parameters were compared, no differences were detected between the groups. Conclusion Nifedipine increases fetal pulmonary blood flow which appears to increase AT and PATET on Doppler parameters in pregnant women with preterm labor after 48h treatment.

COVID-19 vaccine acceptance in pregnant women

Objective

To determine vaccine acceptance and hesitancy attitudes toward coronavirus disease 2019 (COVID‐19) vaccines in pregnant women.

Methods

Three hundred pregnant women were surveyed face to face with 40 questions. Sociodemographic characteristics, vaccination history, perception of risk for the COVID‐19 pandemic, the impact of the COVID‐19 pandemic, and acceptance of and attitude toward future COVID‐19 vaccination were prospectively evaluated.

Results

Among all participants, 111 (37%) stated their intent to receive the vaccine if it were recommended for pregnant women. Most common refusal reasons were lack of data about COVID‐19 vaccine safety in pregnant populations and possibility of harm to the fetus. There was a weak positive correlation between COVID‐19 vaccine acceptancy and number of school‐age children. Pregnant women in the first trimester expressed higher acceptance of COVID‐19 vaccination than those in the second and third trimesters.

Conclusion

The present study reported low acceptance of COVID‐19 vaccination in a sample of pregnant women. Concern about vaccine safety was the major reason for hesitancy. Identifying attitudes among priority groups will be useful for creating vaccination strategies that increase uptake during the current pandemic.

Identifying attitudes among priority groups like pregnant women will be useful to create vaccination strategies in the prevention and control of COVID‐19.