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Medicina
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Management of High-Risk Pregnancies: Current Trends and Future Perspectives
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Management of High-Risk Pregnancies: Current Trends and Future Perspectives

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: closed (31 May 2024) | Viewed by 8575

Special Issue Editors

Dr. Ioannis Tsakiridis

E-Mail Website
Guest Editor
Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: high-risk pregnancy; maternal–fetal medicine
Special Issues, Collections and Topics in MDPI journals
Dr. Themistoklis Dagklis

E-Mail Website
Guest Editor
Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: fetal medicine; obstetric medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

I am pleased to invite you to contribute to the Special Issue "Management of High-Risk Pregnancies: Current Trends and Future Perspectives".

High-risk pregnancies affect a relatively high proportion of women and are mainly attributed to advancing maternal age, high BMI and the use of assisted reproductive technology. They are associated with a high economic burden, but they also have a significant impact on the psychological status of those affected. Congenital anomalies, recurrent miscarriages, hypertensive disorders in pregnancy, fetal growth restriction, preterm birth, gestational diabetes, stillbirth and postpartum hemorrhage represent the most common complications of pregnancy. Aging and associated maternal morbidity may also affect the pregnancy outcomes.

The aim of this Special Issue is to present recent research findings on the diagnosis and management of high-risk pregnancies, to evaluate the aspects in need of further consideration.

Studies reporting high-risk pregnancies, including maternal and fetal morbidity and pregnancy complications, are of particular interest.

All types of articles are welcome. Articles on less common conditions are particularly encouraged.

Dr. Ioannis Tsakiridis
Dr. Themistoklis Dagklis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • high-risk pregnancy
  • obstetric medicine
  • pregnancy complications
  • perinatal comorbidities

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Published Papers (5 papers)

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11 pages, 353 KiB  
Article
Association between Perinatal Outcomes and Maternal Risk Factors: A Cohort Study
by Raquel Martin-Alonso, Paula Prieto, Irene Fernández-Buhigas, Cristina German-Fernandez, Cristina Aramburu, Victor Piqueras, Diana Cuenca-Gomez, Emilia Ferrer, Valeria Rolle, Belén Santacruz and María M. Gil
Medicina 2024, 60(7), 1071; https://doi.org/10.3390/medicina60071071 - 29 Jun 2024
Viewed by 1086
Abstract
Background and Objectives: The aim of this study was to analyze the association between maternal risk factors, such as age, body mass index (BMI), and cigarette smoking, and perinatal outcomes. Materials and Methods: We conducted a retrospective analysis based on prospectively [...] Read more.
Background and Objectives: The aim of this study was to analyze the association between maternal risk factors, such as age, body mass index (BMI), and cigarette smoking, and perinatal outcomes. Materials and Methods: We conducted a retrospective analysis based on prospectively collected data at Hospital Universitario de Torrejón (Madrid, Spain) between September 2017 and December 2019. All pregnant women with singleton pregnancies and non-malformed live fetuses attending their routine ultrasound examination at 11+0 to 13+6 weeks’ gestation were invited to participate. The association between preeclampsia, preterm birth, gestational diabetes mellitus (GDM), small-for-gestational-age (SGA) or fetal-growth-restricted (FGR) neonates, and type of delivery and maternal age, BMI, and cigarette smoking was studied. Logistic mixed models were used to analyze the data. Results: A total of 1921 patients were included in the analysis. Women who were ≥40 years old had a significantly higher risk of having GDM (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.08 to 2.36) and SGA neonates (OR 1.54, 95% CI 1.00 to 2.37). Women with a BMI < 18 had an increased rate of giving birth to SGA and FGR neonates (OR 3.28, 95% CI 1.51 to 7.05, and OR 3.73, 95% CI 1.54 to 8.37, respectively), whereas women with a BMI ≥ 35 had a higher risk of GDM (OR 3.10, 95% CI 1.95 to 4.89). Smoking increased the risk of having SGA and FGR neonates (OR 1.83, 95% CI 1.36 to 2.46, and OR 1.91, 95% CI 1.29 to 2.78). Conclusions: Advanced maternal age, low or high BMI, and smoking status are significant risk factors for pregnancy complications. Both clinicians and society should concentrate their efforts on addressing these factors to enhance reproductive health. Full article
(This article belongs to the Special Issue Management of High-Risk Pregnancies: Current Trends and Future Perspectives)
13 pages, 1173 KiB  
Article
The Impact of Platelet-Rich Plasma Application during Cesarean Section on Wound Healing and Postoperative Pain: A Single-Blind Placebo-Controlled Intervention Study
by Michał Barwijuk, Katarzyna Pankiewicz, Aleksander Gałaś, Filip Nowakowski, Patrycja Gumuła, Artur J. Jakimiuk and Tadeusz Issat
Medicina 2024, 60(4), 628; https://doi.org/10.3390/medicina60040628 - 13 Apr 2024
Cited by 2 | Viewed by 1816
Abstract
Background/Objectives: The aim of this study was to evaluate if platelet-rich plasma (PRP) application into the wound during cesarean delivery improves wound healing and reduces pain in the postoperative period. Materials and Methods: A total of 46 patients undergoing cesarean section [...] Read more.
Background/Objectives: The aim of this study was to evaluate if platelet-rich plasma (PRP) application into the wound during cesarean delivery improves wound healing and reduces pain in the postoperative period. Materials and Methods: A total of 46 patients undergoing cesarean section (CS) were included in this single-blind placebo-controlled intervention study: 23 women in the PRP group and 23 in the placebo group. Every patient was asked to evaluate pain by using the Visual Analogue Scale (VAS) immediately after surgery, as well as 6 and 12 h after the surgery. The use of analgetics was also recorded. The postoperative scar was assessed using the Patient and Observer Scar Assessment Scale (POSAS). Results: There was no case of wound dehiscence in either group. Significant differences between the groups in the scar quality assessment were detected in both patient and doctor POSAS results on days 8, 30 and 90 after surgery in the favor of the PRP group. There was no difference in the pain intensity assessment on the VAS recorded after surgery, but PRP patients required fewer paracetamol doses per day than the control group. Conclusions: PRP application during CS significantly improved wound healing in both short- and long-term assessment. Although it did not influence postoperative pain intensity, it may reduce the use of analgetics after surgery. Full article
(This article belongs to the Special Issue Management of High-Risk Pregnancies: Current Trends and Future Perspectives)
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11 pages, 277 KiB  
Article
Mode of Delivery and Neonatal Outcomes of Preterm Deliveries: A Retrospective Study in Greece
by Kyriaki Mitta, Ioannis Tsakiridis, Georgios Kapetanios, Antigoni Pavlaki, Efthymios Tarnanidis, Themistoklis Dagklis, Apostolos Athanasiadis and Apostolos Mamopoulos
Medicina 2024, 60(1), 10; https://doi.org/10.3390/medicina60010010 - 20 Dec 2023
Cited by 4 | Viewed by 1886
Abstract
Background and Objectives: Preterm birth is a significant concern in obstetrics and neonatology since preterm neonates are at higher risk of various health complications and may require specialized care. The optimal mode of delivery in preterm birth is a matter of debate. [...] Read more.
Background and Objectives: Preterm birth is a significant concern in obstetrics and neonatology since preterm neonates are at higher risk of various health complications and may require specialized care. The optimal mode of delivery in preterm birth is a matter of debate. This study aimed to evaluate the mode of delivery in preterm neonates and the associated neonatal outcomes. Material and Methods: This was a retrospective cohort study including all preterm neonates born between January 2010 and December 2020 at the 3rd Department of Obstetrics & Gynecology of Aristotle University of Thessaloniki, Greece. The mode of delivery in relation to gestational age groups and the cause of preterm birth were analyzed. Neonatal outcomes were also evaluated according to gestational age, indication and mode of delivery. Results: A total of 1167 preterm neonates were included in the study; the majority of them were delivered via cesarean section (76.1%). Most of the preterm neonates (n = 715; 61.3%) were delivered at 32+0–36+6 weeks, while cesarean section was the most common mode of delivery after 28+0 weeks. Furthermore, spontaneous onset of labor (OR: 6.038; 95% CI: 3.163–11.527; p < 0.001), multiple gestation (OR: 1.782; 95% CI: 1.165–2.227; p = 0.008) and fetal distress (OR: 5.326; 95% CI: 2.796–10.144; p < 0.001) were the main causes of preterm delivery at 32+0–36+6 weeks. The overall mortality rate was 8.1% among premature neonates. Regarding morbidity, 919 (78.7%) neonates were diagnosed with respiratory disorders, 129 (11.1%) with intraventricular hemorrhage and 30 (2.6%) with necrotizing enterocolitis. Early gestational age at delivery was the main risk factor of neonatal morbidity and mortality. Notably, the mode of delivery did not have any impact on neonatal survival (OR: 1.317; 95% CI: 0.759–2.284; p = 0.328), but preterm neonates born via cesarean section were at higher risk of respiratory disorders, compared to those born via vaginal delivery (OR: 2.208; 95% CI: 1.574–3.097; p < 0.001). Conclusions: Most preterm deliveries occurred in the moderate-to-late preterm period via cesarean section. Early gestational age at delivery was the main prognostic factor of neonatal morbidity and mortality, while the mode of delivery did not have any impact on neonatal survival. Future research on the mode of delivery of the preterm neonates is warranted to establish definitive answers for each particular gestational age. Full article
(This article belongs to the Special Issue Management of High-Risk Pregnancies: Current Trends and Future Perspectives)
15 pages, 848 KiB  
Article
Gestational Diabetes Mellitus: Association with Maternal and Neonatal Complications
by Rebecca Karkia, Tara Giacchino, Saadia Shah, Andrew Gough, Ghada Ramadan and Ranjit Akolekar
Medicina 2023, 59(12), 2096; https://doi.org/10.3390/medicina59122096 - 29 Nov 2023
Cited by 5 | Viewed by 2341
Abstract
Background and objectives: Gestational diabetes mellitus (GDM) is known to be associated with pregnancy complications but there is limited evidence about the strength of these associations in recent clinical practice, especially after the introduction of strict guidelines for the management of pregnancies [...] Read more.
Background and objectives: Gestational diabetes mellitus (GDM) is known to be associated with pregnancy complications but there is limited evidence about the strength of these associations in recent clinical practice, especially after the introduction of strict guidelines for the management of pregnancies with GDM in a multidisciplinary team setting. The objectives of our study were to first compare the rates of complications in pregnancies with GDM with those that had pre-existing diabetes mellitus and those without diabetes; and second, to derive measures of effect size expressed as odds ratios after adjustment for confounding factors to assess the independent association of GDM in prediction of these pregnancy complications. Materials and Methods: This was a prospective cohort study undertaken at a large maternity unit in the United Kingdom between January 2010 and June 2022. We included singleton pregnancies that were booked at our unit at 11–13 weeks’ gestation. Multivariate regression analysis was carried out to determine the risks of complications in pregnancies with GDM after adjusting for pregnancy characteristics. Risks were expressed as odds ratio (OR) (95% confidence intervals [CI]) and expressed graphically in forest plots. Results: The study population included 53,649 singleton pregnancies including 509 (1%) with pre-existing DM, 2089 (4%) with GDM and 49,122 (95%) pregnancies without diabetes. Multivariate regression analysis demonstrated that there was a significant independent contribution from GDM in the prediction of adverse outcomes, including maternal complications such as preterm delivery, polyhydramnios, preeclampsia and delivery of large for gestational age neonates and elective caesarean section (CS); and neonatal complications including admission to neonatal intensive care unit, hypoglycaemia, jaundice and respiratory distress syndrome. Conclusions: GDM is associated with an increased rate of pregnancy complications compared to those without diabetes, even after adjustment for maternal and pregnancy characteristics. GDM does not increase the risk of stillbirth, hypoxic ischaemic encephalopathy or neonatal death. Full article
(This article belongs to the Special Issue Management of High-Risk Pregnancies: Current Trends and Future Perspectives)
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7 pages, 2044 KiB  
Case Report
Torsion of Tubo-Ovarian Complex during Pregnancy: A Case Report
by Taruna Agrawal, Jhia Jiat Teh, Stergios Bobotis, Elisavet Arsenaki, Selim Maxwell, Konstantinos S. Kechagias, Suparna Sinha and Nosheen Rashid
Medicina 2024, 60(9), 1471; https://doi.org/10.3390/medicina60091471 - 9 Sep 2024
Viewed by 902
Abstract
Introduction: Adnexal torsion is characterised by the rotation of the ovary and, occasionally, the fallopian tube around their supporting ligaments by more than 45 degrees. It predominantly occurs during the first and second trimesters of pregnancy, with an incidence of up to 0.1% [...] Read more.
Introduction: Adnexal torsion is characterised by the rotation of the ovary and, occasionally, the fallopian tube around their supporting ligaments by more than 45 degrees. It predominantly occurs during the first and second trimesters of pregnancy, with an incidence of up to 0.1% in the third trimester. Dermoid and functional ovarian cysts, most commonly associated with benign serous cystadenomas, are frequently identified among the torted adnexal masses. Case Presentation: We report the case of a 32-year-old primigravida with a known ovarian cyst diagnosed in the first trimester, which was managed conservatively throughout the pregnancy. At 36 weeks of gestation, she presented with abdominal pain and was subsequently managed with an emergency caesarean section at 37 weeks due to the development of an acute surgical abdomen. During the procedure, a torted left tubo-ovarian complex was excised, with partial preservation of the healthy-appearing ovarian tissue. Histopathological examination identified the mass as a benign serous cystadenoma. Conclusions: Ovarian torsion during pregnancy poses a significant diagnostic challenge. The decision between conservative management and surgical intervention is primarily guided by a high index of suspicion for torsion. Full article
(This article belongs to the Special Issue Management of High-Risk Pregnancies: Current Trends and Future Perspectives)
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