Maternal and Foetal Outcome among Pregnant Women Infected with COVID-19 in Three Referral Hospitals in Cameroon

Introduction: Pregnancy is generally known to be an immune compromised state, thus placing pregnant women at risk of SARS-COV-2 infection. We therefore carried out this study to assess the maternal and foetal outcomes among pregnant women infected with COVID-19 in three referral hospitals in Cameroon. Methodology: This was a hospital-based retrospective case control study covering a two-year period. Data collection was done over a duration of four months at the Yaoundé Central Hospital, Douala Gynaeco-Obstetric and Paediatric Hospital and the Bamenda Regional Hospital. Cases were pregnant women who gave birth after a confirmed COVID-19 infection, matched 1:2 by age (±1 year) and parity (±1) to pregnant women not infected by COVID-19, who gave birth at the three hospitals within the same period. Results: The rate of caesarean section delivery among our cases was 52.4% as compared to 44.3% among controls (OR, 1.38, 95% CI, 0.74 - 2.60, P = 0.296). Maternal mortality rate in our cases was at 8.2% as compared to 6.6% in controls (OR, 1.60, 95% CI, 0.50 - 5.12, P = 0.422). The rate of preterm delivery in our cases was 24.6% as compared to 11.5% in the control group (OR, 2.39, 95% CI, 1.05 - 5.42, P = 0.025). Perinatal death rate in our study was recorded at 8.2% as compared to 3.4% in the controls (OR, 2.63, 95% CI, 0.68 - 10.18, PS = 0.162) Conclusion: Pregnant women infected with COVID-19 were found to have higher risks of preterm delivery and acute foetal distress as compared to pregnant women who were not infected. Caesarean section deliveries, maternal and foetal mortality were higher in COVID-19 infected pregnant women as compared to those not though these findings were not statistically significant.

Eclampsia: Epidemiological Aspects and Maternal and Foetal Prognosis at the University Teaching Hospital Centre (Uth) of Bouake

Objective: To determine the epidemiology and maternal-fetal prognosis of eclampsia at Bouaké University Teaching Hospital. Material and Methods: This was a prospective study with descriptive and analytical aims over a period from 01 January 2019 to 31 December 2021. It took place in the obstetrics and gynaecology department of the Bouaké University Teaching Hospital. The inclusion criterion was any seizure in the gravid-puerperal period in the context of preeclampsia. Data were entered and analysed using EPI INFO software version 7.2.2.6. Results: We performed 20,958 deliveries and recorded 241 cases of eclampsia, representing a prevalence of 1.14%. The ages of the participants ranged from 13 to 47 years with a mean age ± SD of 22 ± 7 years. The age group ≤ 19 years represented 45.64% of participants. Housewives accounted for 46.47%, and single women accounted for 54.77% of participants. The average parity ± SD was 1 ± 1.6 with range of 0 to 10, and nulliparous women accounted for 49.8% of participants. Patients who were evacuated accounted for 74.27% of our study population. The majority of eclampsia attacks occurred in the antepartum period (56.84%). The mean gestational age ± SD was 36 ± 3.6 weeks with a range of 24 to 42 weeks. The mode of delivery was caesarean section in 64.7% of cases. Maternal lethality was 7.88%. The factors associated with maternal mortality due to eclampsia were evacuation and parity of less than 3. Maternal morbidity was 16.6%. Neonatal lethality was 18.95%. The factor associated with neonatal death in eclampsia was prematurity. Conclusion: We need to detect and manage preeclampsia early and effectively to reduce the frequency of eclampsia and improve its maternal-foetal prognosis in our context.

Labour analgesia effects on foetal heart rate. A mini-review

Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be associated with foetal distress. Decelerations and foetal bradycardia have been described after any type of effective labour analgesia. This review addresses the questions if certain analgesic techniques and/or analgesics lead to clinically relevant FHR changes, what is their aetiology, and how we should manage these FHR changes.

Scourge of intra-partum foetal death in Sub-Saharan Africa

Intra-partum foetal death has been variously defined.However, a definition adopted at a technical consultation in 2006 is employed in this review. The quality of intrapartum care is a crucial factor for pregnancy outcome for both mothers and new-borns. Intra-partum stillbirth is defined as late foetal death during labour, which clinically presents as fresh stillbirth. The largest proportion of the world's stillbirths occurs in the late preterm, term and intra-partum periods. The Western Pacific region has the greatest reduction in stillbirth with a 3.8% annual decline between 1995 and 2009; however, the annual decline in the African region is less than 1%. Caesarean delivery is still uncommon, especially in rural areas: 1% of births in rural Sub-Saharan Africa and 5% in rural South Asia are by caesarean delivery; 62% of stillbirths occurred during the intra-partum period; 61.4% of stillbirths are attributable to obstetrical complications. Preventive measures aimed at reducing the incidence of intra-partum foetal death entail all measures aimed at improving quality antenatal care and preventing intrapartum asphyxia. This review discusses intra-partum foetal deaths from a Sub-Saharan African perspective. It explores the contribution of research within the region to identifying its impact on new-born health and potential cost-effective policy interventions.

Non-invasive foetal heartbeat rate extraction from an underdetermined single signal

Extraction of foetal heartbeat rate from a single passive sound sensor on the mother’s abdomen is demonstrated. The extraction is based on the assumption that a disjoint band of frequencies exist and foetal signal is concentrated in this band, and further that it can be represented conveniently as a set of wavelet coefficients. The algorithm has been applied to each stream of data obtained from six different channels and the detection performance is elaborated. The algorithm has also been tested on signals from non-pregnant abdomens to show successful rejection of adult heartbeat. The extraction of the desired signal is done in two stages so as to eliminate components from the maternal heart-beat.

Maternal and foetal risk factors of cerebral palsy among Iraqi children. A case control study

Background: The importance of studying cerebral palsy comes from the fact that, this disorder imposes huge burden families psychologically, emotionally, financially and socially. Moreover, it imposes a major burden on the National Health System because it is simply a chronic disorder, which needs a continuous care and multiple financial resources. At the same time, it needs collaborative efforts and team work between many parties and organizations for a good management and rehabilitation. In Iraq, risk factors of cerebral palsy have not been explored before. Our study objective was to measure the association between, maternal factors, foetal and early neonatal factors, and occurrence of cerebral palsy among Iraqi children. Postnatal risk factors of cerebral palsy were excluded in our study. Methods: We did a retrospective case-control study in Baghdad-Iraq. The place of study was The Central hospital of Children of Baghdad. Cases and controls were fully investtigated (retrospectively) for the risk factors of cerebral palsy using a self-administered questionnaire. The sample size was 300. Number of cases in our study was 100 while the number of controls in our study was 200. Results and conclusion: 84% of the mothers of Cerebral Palsy children were employed compared to 49% of the mothers of normal children who were employed (P value 0.00). After using a multiple logistic regression model, the final adjusted odd ratios included 6 variables which were, employment of mother (OR 8.05, 95% CI 0.98 - 6.62), Primigravida(OR 0.24, 95% CI 0.10 - 0.60), gender of the child(OR 0.15, 95% CI 0.04 - 0.51 ), asphyxia (OR 10.58, 95% CI 3.59 - 31.21), hypoglycemia (OR 40.99, 95% CI 6.93 - 242.27) and hypocalcaemia (OR 27.91, 95% CI 2.04 - 380.96). Our study came to a conclusion that neonatal asphyxia, hypoglycemia and hypocalcaemia were still the major risk factors for cerebral palsy In Iraq.

Foetal heart rate variability frequency characteristics with respect to uterine contractions

Monitoring foetal health is important to appropriately plan pregnancy management and delivery. Cardiotocography (CTG) is one of the most employed diagnostic techniques. Because CTG interpretation still lacks of complete reliability, new methods of interpretation and parameters are necessary to further support physicians’ decisions. To this aim, indexes related to variability of foetal heart rate (FHRV) are particularly studied. Frequency components of FHRV and their modifications can be analysed by applying a time-frequency approach, which allows for a distinct understanding of the spectral components related to foetal reactions to internal and external stimuli and their change over time. Being uterine contractions (UC) strong stimuli for the foetus and his autonomic nervous system (ANS), it is worth exploring the FHRV response to UC. This study analysed modifications of FHRV frequency characteristics with respect to 108 UC (relative to 35 healthy foetuses). Results showed a statistically significant (t-test, p < 0.01) power increase of the FHRV in both LF and HF bands in correspondence of the contractions. Moreover, we observed a shift to higher values of the maximum frequency contained in the signal corresponding to the power increase. Such modifications of the FHRV power spectrum can be a sign of ANS reaction and therefore represent additional, objective information about foetal reactivity and health during labour.

Maternal PAPP-A Levels at 11 - 13 Weeks of Gestation Predict Foetal and Neonatal Growth

Recent reports suggest that maternal serum levels of pregnancy-associated plasma protein A (PAPP-A) may predict perinatal outcome. PAPP-A is a syncytiotrophoblast derived protease for insulin-like growth factor binding protein (IGFBP4);its protease activity cleaves complexed growth factor binding protein increasing insulin-like growth factor I (IGF-I) bioavailability. The aim of our study was to evaluate the correlation between maternal PAPP-A serum levels and neonatal growth. We analysed 100 full term and preterm (30 - 36 weeks) small for gestational age (SGA) and adequate for gestational age (AGA) babies whose mothers had been tested for serum PAPP-A at 11 - 13 weeks of gestation. We found a significant positive correlation between maternal PAPP-A and neonatal weight, length, and head circumference at birth in both term and preterm infants. Low maternal PAPP-A serum levels (maternal PAPP-A < 0.5) were associated with small for gestational age neonates. A significant positive correlation was also evident between maternal PAPP-A and babies’ growth parameters at 6 months of age. Our results suggest that maternal levels of PAPP-A in early pregnancy affect growth during both foetal and early postnatal life.

Foetal Position: Can It Be Used to Predict the Sex of Unborn Baby?

Sex is used to define the biological categorization of a human being as either a male or female. Globally, most of the pregnant women have expressed desire to know the sex of their babies prenatally. To determine sex of the baby before birth, both traditional and modern sex prediction methods have been used. The study aimed at answering the question;can foetal position and sex be related? If so, can it be used to predict the sex of the baby? Analytical perspective utilizing quantitative approach was conducted in a Referral County Hospital to collect data from a sample size of 340 women who were admitted in labour. Selection was done through convenience sampling method. Data were cross tabulated to determine variable frequencies and establish the association, while chi-square was used to test the study hypothesis. Overall results revealed statistically significant relationship between foetal position and sex of the baby (P = 0.001). Majority of female neonates (74.4%) had adopted right occipital anterior, while most of male neonates (57.4%) had adopted left occipital anterior. It follows then, that sex of the baby may be related to the foetal position. This knowledge may be used by the midwives to predict the foetal sex for the women who may not afford ultrasound scan. Further research may be necessary in a different setting.

Late Intrauterine Foetal Death in a Tertiary Centre of Bangladesh

Background: Late intrauterine foetal death (IUFD > 28 weeks) is a tragedy to mothers and family members. The first step to reduce IUFD is to obtain an accurate and detailed data for IUFD. The present study was done to identify the probable causes of foetal death and determine the risk of recurrence, prevention or corrective action. Methods: This prospective observational study was conducted in a tertiary hospital during a period of one year in Chattogram Maa-O-Shishu Hospital Medical college, from January to December 2018, on all admitted pregnant women with intrauterine foetal death (>28 weeks). Detailed history, clinical examination, associated conditions, mode of delivery, foetal conditions, placenta, condition of cord and investigation reports were analyzed. Results: A total of 188 IUFD were reported amongst 8013 deliveries with its incidence 23.46/1000 live birth and recurrence rate 8.5%. Maximum (89.89%) occurred in antepartum period. Mean maternal age 26.03 years. 59% unbooked cases, 48.93% belonging to lower class family and maximum (59%) from slum and rural area. Most of the cases were Multigravidas (59.6%) and preterm (52.7%) gestation. Regarding causes of IUFD hypertensive disorders in pregnancy (45.2%) were commonest, followed by unexplained 24.5%, diabetes Mellitus and gestational diabetes mellitus (23.9%), anaemia 20.7%, hypothyroidism 11.2%, oligohydramnios 11.2%, maternal infection 9.6%, antepartum haemorrhage 8.5%, malpresentation 7.44%, intrauterine growth retardation 4.8%, fetal congenital anomalies 4.8% & cord accident 4.3%. Maternal complications occurred 14.9% cases. Those were postpartum haemorrhage 11.2%, sepsis 2.6%, acute renal failure 0.53% and disseminated intravascular coagulation (DIC) 0.53%. Most of the patients (86.2%) delivered vaginally. Maximum number of IUFD was seen in birth weight between 1 - 1.5 kg (31.4%), followed by 2 - 2.5 kg (21.8%). Conclusions: HDP, GDM and anaemia were major causes of IUFD. Most of the causes of IUFD may have been preventable by pre-conceptional councelling, regular antenatal checkup, proper screening, early diagnosis and treatment. Large number IUFD remained unexplained. So, to unravel the complex pathophysiology of IUFD further study is needed.

D-二聚体、Fib及孕酮在预测孕早期先兆流产保胎结局的价值

目的探讨D-二聚体(D-dimer,D-D)、纤维蛋白原(Fibrinogen,Fib)及孕酮(Progesterone,P)在预测孕早期先兆流产保胎结局的价值。方法选取2022年1月至2023年9月医院收治的200例先兆流产孕妇,均接受保胎治疗,且在保胎治疗前接受实验室指标检查,随访孕妇的保胎结局,根据结果分为失败组与成功组,比较失败组与成功组患者的基线资料与实验室指标,重点分析D-D、Fib、P预测孕早期先兆流产保胎结局的价值。结果200例先兆流产孕妇中有62例保胎失败,占比31.00%(62/200);失败组D-D、Fib水平比成功组高,P水平比成功组低,有统计学差异(P<0.05),组间其他资料比较,无同统计学差异(P>0.05);经回归分析发现,D-D、Fib过表达均是孕早期先兆流产保胎结局的风险因子(OR>1,P<0.05),P水平过表达为孕早期先兆流产保胎结局的保护因子(OR<1,P<0.05);绘制受试者工作曲线(Receiver Operating Curve,ROC),结果显示,D-D、Fib、P预测孕早期先兆流产保胎失败的AUC均>0.70,预测价值理想。结论D-D、Fib、P在预测孕早期先兆流产保胎失败价值理想,随着D-D、Fib水平升高,P水平降低,孕早期先兆流产孕妇保胎失败风险升高。

ADAMTS3 and FLT4 gene mutations result in congenital lymphangiectasia in newborns:A case report

BACKGROUND Congenital lymphangiectasia is a rare disease characterized by dilated interstitial lymphatic vessels and cystic expansion of the lymphatic vessels.Congenital lymphangiectasia can affect various organ systems;however,it frequently occurs in the lungs accompanied with unexplained pleural effusion.Further,it might not be diagnosed during prenatal examination owing to the absence of pronounced abnormalities.However,after birth the newborn rapidly develops respiratory distress that quickly deteriorates.Genetic variations in proteins controlling the development of lymphatic vessels contribute to the pathophysiology of this disease.We report a rare case of heterozygous mutation of ADAMTS3 and FLT4 genes,which have not been reported previously.CASE SUMMARY We analysed the case of a neonate who had presented with only pleural effusion at a late gestational age and eventually died due to its inability to establish spontaneous breathing after birth.An autopsy revealed lymphangiectasia of the organ systems.Further,whole exome sequencing revealed heterozygous mutations of the lymphangiogenesis-controlling genes,ADAMTS3 and FLT4,and Sanger verification revealed similar lesions in the mother with no symptoms.CONCLUSION Considering the presented case,obstetricians should observe unexplained foetal pleural effusion,and perform pathology analysis and whole exome sequencing for a conclusive diagnosis and prompt treatment.

先天性心脏病产前产后诊断研究进展

先天性心脏病(congenital heart disease, CHD)是影响生育健康的难题之一,是我国新生儿出生缺陷的重要原因,也是5岁以内儿童致死的重要因素之一。CHD发病率高、危害大,但治愈率高。产前超声检查具有安全、无创、操作简便、敏感性较高的特点。本研究旨在阐述胎儿时期诊断和筛查CHD的相关指标以及对于产后的指导价值。

体外诱导骨髓基质干细胞向神经元分化的机制研究

目的:探讨神经细胞形成的体外微环境,诱导骨髓基质干细胞(bonemarrowstromalcell,BMSC)向神经元分化的机制。方法:从SD大鼠骨髓中提取BMSC进行体外培养、扩增,并用免疫组化染色进行鉴定。以绿色荧光染料PKH67标记BMSC后,将BMSC与神经细胞共培养以及用双层培养皿联合培养8d后,用免疫荧光检测BMSC是否分化为神经元。结果:将BMSC与神经细胞共培养后,BMSC出现神经元的形态特点,且有(32.72±2.56)%的神经元表达特异性烯醇化酶(neuron specificenolase,NSE),与BMSC自然分化组(对照组)相比较差异非常显著(P<0.05);但用双层培养皿联合培养时,只有(4.87±0.79)%的BMSC表达NSE,与对照组相比较差异不显著(P>0.05),但与BMSC和神经细胞共培养组相比较差异显著(P<0.05)。结论:体外培养时,神经细胞形成的局部微环境可促进BMSC向神经元方向分化,并且细胞间的紧密接触是诱导BMSC向神经元分化的重要条件。

中国人精母细胞和卵母细胞联会复合体的电镜观察

以微铺展技术结合硝酸银染色,对中国人精母细胞和流产胎儿卵巢联会复合体的形态和行为作了电镜观察。列出中国人的SC核型和模式图。根据减数分裂前期XY的复杂形态变化,XY的配对可分为5种类型。对XY短臂之间形成的SC和XY长臂顶端的次级联合以及XY配对的性质和机理作了描述和讨论。本文还报道了一个罕见的三倍体精母细胞,对三倍体精母细胞中SC的配对行为以及和人类染色体疾病病因的可能关系作了分析和讨论。

L-赖氨酸锌的大鼠生殖毒性实验研究

用L -赖氨酸锌对大鼠进行了生殖毒性实验 ,并与对照组进行了比较 .表明L -赖氨酸锌对孕鼠具有明显的增重作用 ,对孕鼠生殖各项指标及胎鼠的内脏、骨骼、生长发育等无明显影响 .结果表明 ,实验组与阳性对照组比较 ,除低剂量组 (Ⅱ组 )差异显著外 (P <0 .0 5) ,余者均差异非常显著 (P <0 .0 1 ) ,而各剂量组之间精子畸变率无明显的剂量 -反应关系 .

水疗联合抚触对新生儿的生长发育、黄疸及睡眠的影响

目的探讨新生儿游泳联合抚触对新生儿的生长发育、黄疸及睡眠的影响。方法将经阴道顺产分娩的正常新生儿100例随机分为两组,观察组(水疗联合抚触组)50例,对照组(单纯沫浴组)50例。①测定两组10日、28日的体重、身长、上臂围;②观察记录胎便转黄时间,测定血清胆红素;③记录24h睡眠时间。结果两组新生儿10日、28日体重、身长、上臂围增长有显著差异(P<0.05),两组新生儿5日时,胎便转黄时间及黄疸指数比较均有显著性差异(P<0.01),两组睡眠时间比较有统计学意义(P<0.05),两组并发症比较无统计学意义(P>0.05)。结论新生儿水疗联合抚触可促进新生儿的生长发育,能加速胎粪的早排出,减轻生理性黄疸程度,有效地降低新生儿高胆红素血症的发病率,提高睡眠质量。

胎衣不下奶牛母体胎盘α-烯醇化酶异常表达分析及验证

试验通过对胎衣不下奶牛母体胎盘组织中差异α-烯醇化酶(enolase,ENO1)的分析验证,探讨ENO1在胎衣不下中的作用。本研究选取了年龄、胎次、体重和泌乳量均相近的产后胎衣不下和产后胎衣正常排出奶牛各3头,分为两组,提取了胎衣不下组与胎衣正常排出组母体胎盘组织中的总蛋白,采用双向凝胶电泳的方法筛选出差异蛋白,并利用Western blotting及实时荧光定量PCR的方法对其中差异表达量大的ENO1进行验证。结果发现,胎衣不下组和胎衣正常组母体胎盘组织中ENO1差异表达量大且倍数较大,Western blotting及实时荧光定量PCR验证发现ENO1在胎衣不下奶牛母体胎盘中的表达量升高,t检验结果分别为P=0.015<0.05,差异显著;P=0.001<0.01,差异极显著。该基因参与机体的能量调节、免疫和纤溶等过程,而这些过程与奶牛胎衣不下密切相关,提示ENO1可能参与该病的发生发展。

胎脑提取液对衰老小鼠海马神经元酶活性影响的实验研究

目的 观察胎脑提取液对衰老小鼠海马神经元酸性磷酸酶 (ACP)和琥珀酸脱氢酶 (SDH)活性的影响 ,探讨胎脑提取液的抗衰老作用。方法 选用健康昆明种小白鼠 30只 ,随机分为 3组 ;采用D -半乳糖制备亚急性衰老模型 ;酶组织化学方法结合显微图像分析 ,观察各组小鼠海马神经元ACP和SDH的活性。结果 衰老模型组与正常对照组相比 ,小鼠海马神经元ACP活性明显升高 ,SDH活性明显降低 ;给药组与衰老模型组相比 ,小鼠海马神经元ACP活性明显降低 ,SDH活性明显升高。结论 胎脑提取液可以延缓海马神经元的衰老进程 ,具有一定的抗衰老作用。

用差异显示法从人胎脑基因文库分离一个编码序列

人１８周、２２周胎儿脑、肝肾组织总ｍ ＲＮＡ 用ＤＤＲＴ－ＰＣＲ显示出差异的条带，回收胎脑和肝肾特异性表达的４８７条电泳条带．其中某些条带用３种组织的ｃＤＮＡ 探针作点杂交，筛选只对胎儿脑总呈阳性的ＤＮＡ 片段．以其中某一条带ＤＮＡ 为探针，从胎儿脑ｃＤＮＡ 文库筛选阳性克隆，得到ＧＣ５８．经Ｎｏｒｔｈｅｒｎ 杂交和ＤＮＡ 测序，表明它是人脑表达的序列，与数据库中ＫＩＡＡ０５１５有同源性，并编码一个有２７４个氨基酸的蛋白质，该蛋白质序列尚未见报道．探讨了ＤＤＲＴ－ＰＣＲ的条件和假阳性问题．