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Extremely Preterm Delivery: Prediction and Prevention


Background: The development of neonatology has led to survival of extremely preterm neonates. Sequels for the neonate might be serious, and for that reason very preterm delivery has been recognised as one of the main problems of public health. But, too many lay persons and even professionals are not aware of the fact that there are, before pregnancy as well as in pregnancy, possibilities of prevention of extremely preterm delivery. There are many causes for preterm delivery and not all are known. It is not probable that one method or one drug would effectively stop preterm labor or prevent delivery. Most of preterm deliveries occur in the group of pregnant women without risk factors.
Methods: Prediction model for preterm delivery risk estimation is used in Slovenia with suggestion that additional tests are performed. Screening tests should be used for all pregnant women. These tests would improve the prediction in the group of pregnant population with no risk factors in their medical history. Besides, such risk factors could be found that could be influenced. Some risk factors can not be changed [...]

Surgical Termination of Pregnancy for Maternal Cardiac Disease: A Safer Option?

Introduction: Cardiac disease is one of the leading indirect causes of maternal mortality and morbidity in the UK. Pregnancy is generally not recommended where the patient reaches functional class 3 or 4 on the New York Heart Association (NYHA) whatever the underlying condition. However if it occurs termination may be advised as the maternal mortality and morbidity is high. Even termination of pregnancy carries significant risk of further compromise to the maternal cardiac status. Whether a surgical approach is safer than the medical one it is not clear as the evidence is scarce. Material and methods: We present two cases of first trimester surgical termination of pregnancy for two patients suffering with severe aortic stenosis and idiopathic dilative cardiomyopathy, respectively. A literature review was performed in an attempt to ascertain whether a surgical approach would be safer in women with severe pre-existing cardiac conditions. Conclusion: Surgical abortion in women with pre-existing cardiac conditions seems to be safer as it can be performed in a planned manner making better use of resources. [...]

First Trimester Fetal Echocardiography. State of the Problem

Cardiac anomalies are the most frequent congenital malformations and it has been shown that prenatal diagnosis has a major impact on the prenatal and postnatal management of affected pregnancies. Technical improvements and highly skilled operators, have demonstrated that early echocardiography, at 11-14 weeks scan, is feasible and a significant proportion of cardiac lesions present with abnormal ultrasound findings at this stage. Early evaluation is at this moment best reserved for cases at greater risk of cardiac defects (increased nuchal translucency and presence of extra cardiac lesions) but we proposed that it forms part of the early morphologic evaluation in low risk population where 80% of the cardiac anomalies happen. Second trimester fetal echocardiogram continuly to be the gold standard and has to be performed for the ongoing pregnancies. [...]