Background: Contemporary diagnostic methods aimed at assessing neonatal outcomes predominantly rely on the medical history of pregnant women. Ideally, universal biomarkers indicating an increased risk of delivering infants in poor clinical condition, with a heightened likelihood of requiring hospitalization in a Neonatal Intensive Care Unit (NICU), would be beneficial for appropriately stratifying pregnant women into a high-risk category. Our study evaluated whether biochemical and ultrasonographical markers universally used in first-trimester screenings for non-heritable chromosomal aberrations could serve this purpose. Methods: This study encompassed 1164 patients who underwent first-trimester screening, including patient history, ultrasound examinations, and biochemical tests for pregnancy-associated plasma protein-A (PAPP-A) and the free beta-HCG subunit (fbHCG), from January 2019 to December 2021. The research concentrated on the correlation between these prenatal test results and neonatal outcomes, particularly Apgar scores, umbilical blood pH levels, and the necessity for NICU admission. Results: In our cohort, neonates scoring lower than 8 on the Apgar scale at birth exhibited lower concentrations of PAPP-A in the first trimester, both in raw and normalized values (PAPP-A MoM 0.93 vs. 1.027, p = 0.032). We also observed a higher pulsatility index in the venous duct in the first trimester in full-term neonates born with <8 points on the Apgar scale. Additionally, newborns born with an umbilical blood pH < 7.2 had lower normalized first-trimester PAPP-A concentrations (0.69 vs. 1.01 MoM, p = 0.04). We also noted that neonates requiring NICU hospitalization post-delivery had lower first-trimester bHCG concentrations (0.93 MoM vs. 1.11 MoM, p = 0.03). However, none of the correlations in our study translated into a robust prognostic ability for predicting dichotomous outcomes. All areas under the curve achieved a value < 0.7. Conclusions: Low concentrations of PAPP-A and free bHCG subunit in the first trimester may be associated with poorer clinical and biochemical conditions in neonates post-delivery. However, the relationship is weak and has limited predictive capability. Further research evaluating these relationships is necessary for the appropriate stratification of pregnant women into high-risk categories for neonatological complications.

Objective: The twisting of the umbilical cord around the fetal neck is a common phenomenon in the delivery room, and despite the lack of univocal evidence of its negative impact on perinatal events, it causes anxiety and stress in patients. The aim of the study was to assess the prevalence of nuchal cord and its impact on adverse obstetric and neonatal outcomes. Methods: We conducted a retrospective cohort study. All patients who gave birth in the clinic within one year (n = 1467) were included in the study group. We compared the prevalence of nuchal cord in distinct subgroups of patients. In the next stage, we estimated the chance of specific perinatal outcomes and compared the neonatal outcomes between groups with and without nuchal cord. Results: Nuchal cord was present in 24% of labors. It was twice as common among patients giving birth vaginally (32.14%) than among patients giving birth by a caesarean section (16.78%, p < 0.001). Nuchal cord was also more frequent in births with meconium-stained amniotic fluid (33.88% vs. 23.34%, p = 0.009). In the group of patients with nuchal cord, we observed a slight increase in the risk of a non-reassuring fetal heart rate trace (OR = 1.55, CI 95% 1.02–2.36) as an indication of the completion of labor by caesarean delivery. We did not note an increase in the risk of completing natural childbirth by vacuum extraction. In the group of nuchal cord patients, there was a higher chance of a serious or moderate neonatal condition in the first minute of life (Apgar 0–7 points) (OR = 2.00, 95% CI = 1.14–3.49). Conclusions: Nuchal cord increases the risk of a caesarean delivery due to a non-reassuring fetal heart rate trace. Nuchal cord increases the chance of a reduced Apgar score (0–7 points) in the first minute of life. The observed relationships do not translate to neonatal arterial blood gas testing.

Background/Objectives: Functional assessment of the fetal heart remains a significant challenge in contemporary perinatology due to the absence of a universally accepted gold standard for such evaluations. The aim of this study was to evaluate the reproducibility of parameters derived from two-dimensional speckle-tracking echocardiography (2D STE) using the FetalHQ software. Methods: We enrolled 87 pregnant women between 19 and 23 weeks of gestation who were undergoing mid-trimester screening at the Provincial Hospital Complex in Kielce. Two independent operators acquired 5 s cine-loops of four-chamber views (4CVs) according to a standardized protocol. Reproducibility was assessed by examining intra- and interobserver variability using the intraclass correlation coefficient (ICC) for several cardiac parameters, including the global sphericity index (GSI), global longitudinal strain (GLS), stroke volume (SV), and fractional area change (FAC). Results: Reproducibility varied substantially across the assessed parameters. The highest intraobserver reproducibility was observed for the 4CV GSI (ICC > 0.9). Moderate intraobserver reproducibility (ICCs ranging from 0.5 to 0.75) was noted for left ventricular (LV) parameters, such as end-diastolic area, end-systolic area, end-diastolic volume, and end-systolic volume. Interobserver variability demonstrated higher ICC values, with excellent reproducibility (ICC > 0.9) for the 4CV GSI and LV volume measurements. Good reproducibility (ICCs between 0.75 and 0.9) was observed for specific left ventricular segmental strain indices, whereas other parameters showed moderate to poor reproducibility (ICC < 0.5). Conclusions: Two-dimensional speckle-tracking echocardiography (2D STE) using FetalHQ exhibits variable reproducibility, which is influenced by the choice of parameters, operator experience, and technical factors. This method holds potential for fetal cardiac assessment; however, additional research is required to improve its predictive accuracy and streamline the evaluation process for routine clinical application.

Background and Objectives: Placenta accreta spectrum (PAS) complicating placenta praevia is associated with increased maternal morbidity; however, neonatal respiratory burden may be underappreciated. We compared neonatal outcomes between pregnancies complicated by placenta praevia with and without histopathologically confirmed PAS, with additional adjustment of respiratory outcomes for gestational age at delivery. Materials and Methods: We conducted a retrospective single-centre cohort study (n = 82). Based on placental histopathology, women were classified as PAS (n = 37; accreta/increta/percreta) or non-PAS (n = 45). Respiratory endpoints included respiratory resuscitation at birth, non-invasive respiratory support, and supplemental oxygen requirement with fraction of inspired oxygen (FiO₂) > 0.21 during neonatal intensive care unit (NICU) hospitalization. Logistic regression models adjusted respiratory endpoints for gestational age. Results: Data were available for 80/82 neonates. Compared with non-PAS, PAS cases had higher rates of respiratory resuscitation at birth (26/36 [72.2%] vs. 19/44 [43.2%], p = 0.013), non-invasive respiratory support (31/36 [86.1%] vs. 24/44 [54.5%], p = 0.003), and supplemental oxygen requirement (29/36 [80.6%] vs. 21/44 [47.7%], p = 0.003). After adjustment for gestational age, PAS remained associated with respiratory resuscitation (adjusted odds ratio [aOR] 3.34, 95% confidence interval [CI] 1.21–9.27; p = 0.020) and supplemental oxygen requirement (aOR 4.60, 95% CI 1.35–15.75; p = 0.015). The association with non-invasive respiratory support did not reach statistical significance (aOR 4.46, 95% CI 0.92–21.68; p = 0.064). Conclusions: Histopathologically confirmed PAS was associated with higher neonatal respiratory support requirements after adjustment for gestational age, supporting anticipatory obstetric–neonatal planning when PAS is suspected.

BACKGROUND Tubal heterotopic pregnancy is an extremely rare complication of pregnancy, in which there is a simultaneous presence of a pregnancy in the uterine cavity and in an ectopic location, most commonly in the fallopian tube. The management of such cases is not clearly established. In the case of a desire to maintain an intrauterine pregnancy, the surgical procedure consisting of a salpingectomy or salpingostomy is the most common. Such a procedure is effective, but it involves potential complications typical of surgeries, so, in some cases, it seems reasonable to apply the expectant management. CASE REPORT A 31-year-old woman was admitted to the clinic due to pain in the right lower abdomen. An ultrasound examination revealed a gestational sac in the uterine cavity corresponding to 5 weeks of pregnancy with a yolk sac. A twin sac was found in the right fallopian tube. Due to the patient's mild symptoms, absence of bleeding into the peritoneal cavity, concerns about the safety of the embryo and the pregnant woman in case of surgery, conservative management was decided. On the 20th day, the patient was discharged from the clinic with a viable intrauterine pregnancy and a partially absorbed ectopic pregnancy. CONCLUSIONS In the case of an ectopic tubal pregnancy, if there are no symptoms of bleeding into the peritoneal cavity, it is possible to adopt a safe conservative approach with strict patient observation.

BACKGROUND Disseminated peritoneal leiomyomatosis is a rare complication of laparoscopic procedures involving uterine morcellation. These fibroid-like lesions, which derive their blood supply from non-uterine sources, may develop after myomectomy, supracervical hysterectomy, or total laparoscopic hysterectomy - particularly when mechanical morcellation is used. Although the incidence is low, disseminated leiomyomatosis should be considered in the differential diagnosis of abdominal or pelvic pain in patients with a history of such surgeries. CASE REPORT A 40-year-old woman presented with intermittent lower abdominal pain. She had undergone a laparoscopic supracervical hysterectomy with salpingectomy 5 years earlier due to abnormal uterine bleeding, during which uncontained mechanical morcellation was performed. At present, transvaginal ultrasound revealed a solid mass adjacent to the bladder with features suggestive of a leiomyoma. Magnetic resonance imaging (MRI) showed multiple lesions, including a polycyclic mass located above the bladder and additional foci near the sigmoid colon and the bladder dome. Laparoscopy confirmed the presence of leiomyomas on the anterior abdominal wall, sigmoid colon adventitia, and bladder dome. All lesions were excised using laparoscopic techniques, and the postoperative course was uneventful. Histopathological examination confirmed leiomyomas with positive estrogen and progesterone receptor expression. CONCLUSIONS This case underscores the importance of considering disseminated peritoneal leiomyomatosis in the differential diagnosis of abdominal or pelvic pain in patients with a history of laparoscopic hysterectomy with morcellation. It also emphasizes that this condition can mimic malignancy on imaging studies and highlights the essential role of histopathological examination in diagnosing this benign disease.