20th Week Of Gestation Research Articles

Risk factors for cerebral palsy

Background/Aim. Cerebral palsy (CP) etiology is multi-factorial and heterogeneous, manifesting as damage to the developing brain. The associated risk factors can arise in the prenatal, perinatal, or postnatal period. The aim of this study was to determine the risk factors for CP and examine the associations between CP type, gestational age, and perinatal risk factors. Methods. The study sample comprised 206 children with CP. Pertinent data were collected from medical records and included participants? gestational age at birth, medical history, and CP clinical characteristics. Risk factors were divided according to the timing of brain injury into prenatal, perinatal, and neonatal. Results. Hormonally maintained pregnancy (55.3%), twin pregnancy (28.9%), vaginal bleeding after the 20th week of gestation (21.1%), threatened abortion in the first half of pregnancy (13.2%), and maternal infection (10.5%) were identified as the main prenatal risk factors for CP. Prematurity (54.5%) was the leading perinatal risk factor, followed by low birthweight (50.8%), Apgar score < 7 (41.7%), assisted delivery (41.4%), and breech presentation (13.5%). Respiratory distress syndrome (16%), need for treatment in the Neonatal Intensive Care Unit (22.3%), assisted ventilation (18.4%), hypoxic-ischemic encephalopathy (11.2%), and neonatal convulsions (5.8%) were identified as the leading neonatal risk factors for CP. A statistically significant difference was found in the total number of perinatal risk factors in relation to gestational age (p < 0.001) and CP type (p = 0.006). Perinatal risk factors were most prevalent in preterm infants and children affected by the CP of spastic bilateral type. A statistically significant difference was noted in the distribution of CP types de-pending on the gestational age (p < 0.001). In particular, spastic bilateral CP type was most prevalent in the group of preterm-born children. Conclusion. CP is characterized by heterogeneous risk factors and is a result of interaction among multiple risk factors.

Impact of Interleukin-10 Promoter Region Polymorphisms on Recurrent Miscarriage: A Case-Control Approach.

Recurrent miscarriage (RM), defined as two or more consecutive miscarriages prior to the 20th week of gestation is characterised by multifactorial aetiology. The prevalence of RM varies from 0.8% to 13.5% amongst women of reproductive age. The aetiological basis of RM has been traced to chromosomal, anatomic, hormonal and immunologic factors while half of the cases remain idiopathic. This study aimed to investigate the association of interleukin-10 (IL-10) polymorphisms with RM amongst the Indian population. The present study included a total of 414 individuals including RM women (n = 199) with two or more pregnancy losses and healthy women (n = 215) without any previous history of pregnancy loss were taken as the control group. Demographic features and reproductive history of women with RM and healthy women were taken. Genotype analysis of IL-10 polymorphisms rs1800872 and rs1800896 was performed using the polymerase chain reaction (PCR) restriction fragment length polymorphism and amplification mutation refractory system PCR, respectively. Student's t-test was used to compare the demographic features and reproductive history amongst both groups. Pearson's Chi-square was used to calculate the Hardy-Weinberg equilibrium, allelic and genotypic frequencies. All the statistical analyses were performed using the SPSS (version 21, IBM SPSS, NY, USA). Our results suggested that the genotypic and allelic frequency of rs1800872 polymorphism did not differ significantly between RM cases and control women (P = 0.07 and P = 0.23, respectively). The GG genotype (P = 0.007) and G allele (P = 0.003) of rs1800896 were significantly associated with an increased risk of RM. A statistically significant difference was also found for the distribution of genetic models (dominant and co-dominant model) between both groups for rs1800896. However, haplotype analysis revealed that none of the haplotypes provides a risk for the progression of RM. The study is the first of its kind from our region and provides baseline data on the genetics of RM.

Molecular investigation of mechanisms considered to cause preterm premature membrane rupture

Purpose: The aim of this study was to investigate the mRNA expression level of p16, CDK4, CDK6, Cyclin D, RB1, and E2F genes in preterm premature rupture of membrane (PPROM) cases and their roles in etiopathogenesis of PPROM. 
 Materials and Methods: Twenty-one pregnancies with PPROM before 34th gestational weeks (study group) were compared with twenty pregnancies with no complication, who gave birth after 37th gestational-week (control group). Both groups chorioamniotic membranes were compared for mRNA expression of p16, cyclin D, CDK4, CDK6, RB1 and E2F genes.
 Results: The mRNA expression levels of p16, cyclin D, CDK4, CDK6, RB1and E2F genes decreased in the PPROM group compared to control group at a statistically significant level.
 Conclusion: Our findings have shown that oxidative stress may not act on the p16 pathway in these cases. In order to understand the molecular mechanism of PPROM, biomarkers of oxidative stress and aging should be evaluated together with other pathways related to aging and oxidative stress in future studies.

Analysis of the guidance and predictive value of uterine artery flow parameters in patients with recurrent spontaneous abortion.

To analyze the uterine artery blood flow parameters of patients with recurrent spontaneous abortion (RSA) at different gestational ages and to investigate the effects of aspirin and low molecular weight heparin (LMWH) on uterine artery blood flow parameters and pregnancy outcomes. This was a retrospective cohort study involving analysis of clinical data for 140 patients: 47 in an aspirin group, 49 in a combination group, and 44 in a control group. The uterine artery blood flow parameters of the three groups in the middle luteal period and 10th, 12th, 16th, and 20th gestational weeks were compared. Trends in uterine artery flow parameters were predicted by function fitting, and the uterine artery flow parameters and pregnancy outcomes between different drug administration regimens were compared. With increasing gestational age, the uterine artery blood flow parameters of the three groups gradually decreased. In the middle luteal phase, the uterine artery blood flow parameters (mRI, mPI, mS/D) of the recurrent spontaneous abortion group, that is, the aspirin and combination groups, were significantly higher than those of the control group. Uterine artery blood flow parameters from 10 to 20 weeks of gestation were as follows: combined group < aspirin group < normal pregnancy group. The mean resistance index (mRI) in the combination group decreased most rapidly compared with the aspirin group between 10 and 20 weeks of gestation. The live birth rate was higher in the combination group than in the aspirin group. Both aspirin and aspirin combined with LMWH can reduce uterine artery blood flow parameters, and combination therapy is superior to aspirin alone. In the RSA group, the rate of mRI decline may predict pregnancy outcome to some extent. Combination therapy can improve the live birth rate and reduce the miscarriage rate.

Screening of New-Borns for Thyroid Status Admitted in Neonatal Ward of a Tertiary Care Hospital

Background: Neonatal screening program is very fruitful in saving our newborns from preventable neonatal diseases, thereby healthy grooming of future generations. Though newborn screening for a thyroid disorder is one of the greatest successes in preventive pediatrics but still has not practically worked out for all neonates in Bangladesh at the national level.The majority of newborns with a thyroid disorder have a normal appearance without detectable physical signs and are almost always missed. Screening at the proper time (Approximately 2-7 days after birth), rechecking of suspicious cases within a week, and initiation of treatment (Within 2 weeks of age) of thyroid disorders particularly Congenital Hypothyroidism (CH), can prevent the irreversible mental and physical impairments. Transient neonatal hyperthyroidism is the common form of neonatal hyperthyroidism. The purpose of the study was, Neonatal Screening (NS) to evaluate the rate of thyroid disorders among Preterm (Early preterm born before 34th week of gestation, late preterm born between 34th week and before 37th week of gestation), Term (Born within 37th to 42nd week of gestation) and Post-term (Born after 42nd week of gestation) newborns. Birth weight was alsomeasured to categorize the newborns according to their weight.&#x0D; Materials and methods: It was a cross-sectional, observational type of study. The place was the Neonatal Department of Chattogram Maa-O-Shishu Hospital Medical College, Chattogram. Blood samples were collected from eighty neonates aging 2 to 7 days and sent to the laboratory for estimation of TSH and FT4.&#x0D; Results: Total number of samples was 80. Out of them, preterm new-born were 19 and term new-born were 61, no post-term case was found. Both groups wereagain divided into normal birth weight (³2.5 kg) and low birth weight (&lt; 2.5 kg). Hyperthyroidism (High or normal FT4 but low TSH) was observed in 23 term newborns (37.7%) and hypothyroidism (Low or normal FT4 but high TSH) in 11 term newborns (18.03%) and the rest were Euthyroid (TSH normal, FT4 normal/increased/decreased). In the case of preterm, there were more hypothyroid 03 (15.78%) than hyperthyroid 02(10.52%).&#x0D; Conclusion: Our study observed that, among the newborns, who were admitted to the hospital,around half of them (39 out of 80) had abnormal thyroid function. The newborns with abnormal thyroid status were informed to their parents for further evaluation by the Department of Endocrinology. It would be helpful to reach the final diagnosis and treat it accordingly.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 44-47

Anatomical Diseases Caused by Congenital Duodenal Abnormalities

Disorders of duodenal anatomy are rare and originate during the early embryological development of the foregut. These disorders are associated with significant morbidity in children; however, they may remain undetected during childhood and present during adolescence or adulthood. Duodenal atresia or web, annular pancreas, Ladd’s bands associated with midgut volvulus, and preduodenal portal vein represent duodenal anomalies that may cause partial or complete duodenal obstruction. Duodenal atresia and web occur secondary to incomplete recanalization of the duodenal lumen during the 8th to 10th week of gestation. These anomalies usually require surgical correction; however, the role of endoscopic interventions using innovative equipment is being investigated. Duodenal duplication cysts are an extremely rare congenital anomaly. Most abut the second or third portion of the duodenum and histologically show the normal duodenal wall layers. These lesions clinically present with abdominal pain, weight loss, vomiting, pancreatitis, or features of biliary tract obstruction. Imaging studies including transabdominal ultrasonography, computed tomography, MRI, and endoscopic ultrasonography are useful for detection of the cystic structure. Surgery is the conventional therapeutic modality used for management of duodenal duplication cysts; however, marsupialization (endoscopic intervention to establish communication between the cyst cavity and the duodenal lumen to facilitate duodenal drainage of cystic contents) is increasingly being performed in clinical practice. Duodenum inversum and duodenal diverticula are congenital duodenal disorders that require endoscopic or surgical management in symptomatic patients.

Predictive and diagnostic value of serum sVEGFR-1 level in women with preeclampsia: A prospective controlled study.

Pre-eclampsia (PE), a pregnancy-specific syndrome consisting of hypertension and proteinuria occurring de novo after the 20th week of gestation, remains the leading cause of maternal and fetal morbidity and mortality worldwide. Endothelial dysfunction is proposed to be a central feature of the pathophysiology of preeclampsia. However, the mechanism by which this endothelial dysfunction occurs remains uncertain. We investigated the predictive and diagnostic value of serum soluble vascular endothelial growth factor receptor-1 (VEGFR-1) with by comparison of its prepartum and postpartum serum levels in the management of women with PE. This prospective case-controlled study was composed of pre-eclamptic (n=44) and normal, healthy pregnant (n=44) women. Blood samples were collected before any intervention at the first antenatal examination of the women in the control group and at the admission of the women to the hospital in the PE group, additionally, from all women in the study groups within six hours of the postpartum period, and used for the serum VEGFR-1 analyses. Within both groups, prepartum serum levels of sVEGFR-1 were higher than postpartum levels (p<0.05). In PE, pre-partum and postpartum serum levels of sVEGFR-1 were higher than levels in the control group (p<0.05). Serum sVEGFR-1 levels of preeclamptic women were positively correlated with the degree of proteinuria (p<0.05, r=0.25), systolic (p<0.05, r=0.25), and diastolic blood pressure (p<0.05, r=0.31). These findings seem to point to an involvement of sVEGFR-1 in the pathophysiology of PE. Serum sVEGFR-1 has the potential to be used as a valuable biomarker in the prediction, diagnosis, and risk management of women with subtypes of PE including mild and severe PE, HELLP syndrome, and eclampsia. There is a need to study serum sVEGFR-1 as a biomarker in pregnant women with different subtypes of PE.

Association of Serum Leptin with Gestational Diabetes Mellitus

Background: It has been stated that leptin has a role in glucose regulation as it decreases the insulin resistance and regulates the insulin mediated glucose metabolism. As the body need more glucose, more secretion of insulin which stimulates adipose tissues to secrete more leptin which causes the release of cytokines which decreases insulin sensitivity and develop insulin resistance. The aim of the current study was to find out the association of serum leptin with gestational diabetes mellitus in current setting. Methods: A case control study was conducted at the Gynecology department of Abbasi Shaheed Hospital Karachi during April to September 2022. A self-designed proforma was used, consisting of 4 parts consisting of demographic variables, general physical examination and laboratory findings. Blood sample was collected during 24th to 28th week of gestation for testing fasting blood sugar, OGTT and then ELISA was done. Statistical Package for Social Science (SPSS) version-20 was used to analyze the data. p-value ≤0.05 was considered as significant. Results: The mean age of the study participants was 27.42 ± 0.39 and 24.96 ± 0.51 in cases and controls respectively. The basal metabolic index (BMI) was higher among the cases of gestational diabetes as compared to normal controls. Likewise, oral glucose tolerance test results showed higher levels of blood glucose than the normal controls during all steps of the test. The comparison of serum insulin and serum leptin during pregnancy and after delivery in cases of gestational diabetes showed a decrease in both serum insulin and serum leptin levels with significant p-value (p-value ≤0.05). Conclusion: Leptin is the contributory factor of insulin resistance and leads to gestational diabetes mellitus. Both serum insulin and serum leptin levels were having strong significant association with gestational diabetes mellitus. Keywords: Gestational diabetes mellitus, Serum Leptin, Hyperinsulinemia

Estrogen in Luteal Phase Support: Effects on IVF-ICSI Antagonist Protocol Pregnancy Results

Aim: This study aimed to investigate the effect of luteal phase support (LPS) with estradiol in addition to progesterone on pregnancy outcomes in patients who underwent ovulation induction with GnRH antagonist protocol in in vitro fertilization- intracytoplasmic sperm injection (IVF-ICSI).&#x0D; Materials and Methods: This retrospective study was carried out at reproductive medicine center of Necmettin Erbakan University Meram Medical Faculty. The study enrolled 128 patients undergoing ICSI on an antagonist protocol for controlled ovarian hyperstimulation. Study group administered 7.8 mg transdermal estradiol (E2) daily in addition to progesterone for LPS (n=64). Control group administered only progesterone for LPS (n=64). All women received 200 mg progesterone 3x1 intravaginal daily and 50 mg progesterone intramuscular injection per two days for LPS. Blood samples were drawn 12 days after embryo transfer for β-hCG. If the result is negative, treatment was discontinued, if positive, estradiol was discontinued and progesterone support was continued until the 10th week of gestation. Pregnancy outcomes were the main endpoint.&#x0D; Results: There was no difference between groups in terms of biochemical pregnancy, clinical pregnancy, abortus and ongoing pregnancy rates.&#x0D; Conclusion: In our study, the use of estrogen for luteal phase support in GnRH antagonist protocol did not show any difference on pregnancy outcomes.

Combining curcumin and aspirin ameliorates preeclampsia-like symptoms by inhibiting the placental TLR4/NF-κB signaling pathway in rats.

Preeclampsia (PE) is a common medical complication of pregnancy characterized by high blood pressure and proteinuria after the 20th gestational week. This study aimed to investigate the potency of the combination of curcumin and aspirin in the treatment of PE and explore the underlying mechanisms. The PE model was constructed in female rats by administering 0.5mg/mL N-nitro-L-arginine methyl ester from gestational days (GDs) 6 to 16. The pregnant female rats were divided into five groups according to the drug treatment. The curcumin or aspirin was given to the rats by tail vein injection (0.36 mg/kg) or gavage treatment (1.5mg/kg BW/day) from GD4 to GD18. Treatment with curcumin and aspirin combination significantly reduced the systolic blood pressure and proteinuria in the PE rats. Meanwhile, in comparison to the PE rats treated with single-dose curcumin or aspirin, the rats treated with combined curcumin and aspirin showed significantly decreased sFlt-1, increased placental growth factor, and alleviated oxidative stress in both blood and placental tissues, which are abnormal in no-treated PE rats. Furthermore, dramatically decreased inflammatory cytokines secretion and TLR4 and NF-κB p65 expression in placental tissues were also observed in the PE rats with combined treatment compared to those of no-treated, signal-dose curcumin or aspirin-treated PE rats. Our results suggested that the combined treatment of curcumin and aspirin significantly ameliorates the symptoms of PE in rats, which is most likely due to the inhibition of the placental TLR4/NF-κB p65 signaling pathway.

Histomorphometry of the cortical layers and the dentate nucleus of the human fetal cerebellum

ObjectivesThis study was aimed at determining the histomorphometry of the cerebellar cortical laminae and the dentate nucleus of the human fetal cerebellum; the number and shape of the neurons; and the gestational age of appearance of the cerebellar folia, white matter and arbor vitae cerebelli. MethodsMicroscopic sections of the human fetal cerebellum stained with hematoxylin and eosin and Bielschowsky silver stain were studied. ResultsThe thickness of the cortical laminae of the human fetal cerebellum varied among gestational weeks as follows: external granular layer: 36.06 ± 9.36–50.05 ± 34.06 μm, molecular layer: 32.76 ± 17.16–52 ± 28.6 μm, Purkinje cell layer: 9.36 ± 6.8–15.6 ± 4.68 μm and internal granular layer: 66.65 ± 24.42–146.63 ± 47.79 μm. Similarly, the number of neurons per field of view at 1000X under a compound microscope varied among gestational weeks as follows: external granular layer: 89.92 ± 42–142.84 ± 50, molecular layer: 15 ± 12.5–25 ± 8.25, Purkinje cell layer: 3.5 ± 1–5 ± 2.5 and internal granular layer: 98.5 ± 69.75–224 ± 47.White matter in the fetal cerebellum was already present at the age of 12th gestational week, whereas cerebellar folia appeared at 16–20 gestational weeks. Arbor vitae cerebelli and the dentate nucleus became conspicuous after the 20th gestational week. Fetal neurons were round except for Purkinje cells. ConclusionsThe thickness and neuronal counts of the human fetal cerebellar cortical layers and the measurements of the dentate nucleus along with other histomorphological features varied with gestational age from the 12th week of gestation until birth.

Salivary progesterone as a biomarker for predicting preterm birth: A systematic review and meta-analysis.

Several biomarkers have been studied to predict spontaneous preterm birth, including salivary progesterone. However, due to limited studies, the utility of this biomarker remains controversial. This study synthesized the available literature and determined the role of salivary progesterone as a potential biomarker for preterm birth. All studies reporting the levels of salivary progesterone among pregnant women with reported birth outcomes were obtained from Ovid Medline, Scopus, CINAHL, and Cochrane Central Register of Controlled Trials from inception to January 10, 2022. A review of titles and abstracts was done independently by three reviewers. The quality of the studies was assessed using the Newcastle-Ottawa scale. Meta-analysis was performed in R v.4.1.3 using the "meta" package. Five studies involving 861 pregnant patients from Egypt, India, Iraq, and the US were included in this meta-analysis. The random-effects model showed that salivary progesterone level after the 28th week of gestation was significantly different between patients with term and preterm birth (standardized mean difference [SMD]: 1.99; 95% confidence interval [CI]: .44-3.54) with a high degree of heterogeneity (I2 =96%, P<.001). Based on the results of this meta-analysis, women with term birth had higher level of salivary progesterone after the 28th week of gestation than those with preterm birth. In conclusion, the study results suggest that low salivary progesterone level after the 28th week of gestation is significantly associated with preterm birth. This study also highlights the use of saliva samples for monitoring sex steroid hormones throughout pregnancy.

Cell-free fetal DNA testing performance and fetal fraction estimation are not affected in ART-conceived pregnancies.

Does ART-based conception influence fetal fraction (FF) estimation and cell-free fetal DNA (cffDNA) testing performance? Mode of conception (ART versus natural) does not impact FF estimation or cffDNA test informativity rates. Pregnancies achieved via ART are increasing, and cffDNA testing is displacing traditional prenatal screening methods due to its high sensitivity and specificity and noninvasive nature. However, conflicting data exist on cffDNA testing performance and FF in ART pregnancies compared with natural pregnancies. We performed a case-control study that included 21 558 consecutive pregnancies (spontaneous, n = 15 707; ART, n = 5851). ART-conceived pregnancies were stratified into two groups according to oocyte origin. Samples were collected from April 2015 to September 2019. The study included women from different centers worldwide. Blood samples were drawn from the 10th week of gestation onward. Massive parallel whole-genome sequencing was used to analyze cffDNA content in blood plasma. Two different types of technologies (single-end and paired-end) were applied because of analysis technology changes made by the sequencing provider over time. FF was determined using different methods depending on the type of technology used. Cases with an FF <2% or with failure in any quality control metrics were classified as noninformative. An analysis of covariance model was selected to identify which qualitative (sequencing methodology, mode of conception, type (i.e. multiplicity) of gestation and age (women >35 or <35 years old)) and quantitative (gestational age, BMI) variables were predictors of FF value. Multinomial logistic regression was used to evaluate whether the mode of conception impacted cffDNA testing performance. A univariate t-test demonstrated no significant differences in FF values between ART (median FF = 9.2%) and spontaneous pregnancies (median FF = 9.2%). Also, a multivariate analysis showed that the mode of conception, did not strongly impact the percentage of FF. ART-treated women showed a lower incidence of high-risk cffDNA results compared to women who conceived naturally, specifically for trisomy (T)21 (0.7% versus 1.3%, P = 0.001) and T18 (0.1% versus 0.3%, P = 0.001). A multivariate model stratified by type of aneuploidy suggested that these differences were conditioned by oocyte origin, especially for the T21 risk classification (P < 0.0001). False-positive rates (FPRs) were significantly higher in the ART population, mainly for T13 (P = 0.001) and sexual chromosome aneuploidies (SCAs; P < 0.001). A multivariate model suggested that the differences observed in SCAs were caused by sequencing modality rather than by mode of conception. Likewise, ART-treated women who used their own oocytes had a higher probability of a false positive for T13 (P = 0.004). Our study lacks follow-up data for low- and high-risk cases of both ART-conceived and naturally conceived pregnancies. Therefore, the results comparing FPR in both populations should be interpreted carefully. Also, collecting information about different ART modalities and regarding preimplantation genetic testing for aneuploidy treatments would help draw definite explanations for the trends observed in this study. This is the first study that demonstrates, with a large sample size, that FF is not influenced by mode of conception, demystifying the notion that patients undergoing ART have a higher probability of noninformative cffDNA testing results. Multivariate models stratified by oocyte origin and type of aneuploidy demonstrated that ART-conceived pregnancies do not have a higher probability of classification as a high-risk pregnancy in prenatal testing. This information is especially valuable to clinicians and genetic counselors when informing patients about the risks and limitations of cffDNA testing in ART pregnancies. This study was financially supported by Igenomix Lab S.L.U. All authors declare no conflict of interest. N/A.

Imbalanced Angiogenesis in Pregnancies Complicated by SARS-CoV-2 Infection.

COVID-19 and preeclampsia (preE) share the ANG-II mediated endothelial dysfunction, resulting from a significant dysregulation of RAS and an imbalanced proportion of anti-angiogenic and pro-angiogenic soluble plasmatic factors. Of note, an increased incidence of preE has been reported among COVID-19-infected mothers compared to the general pregnant population. The two most promising angiogenic markers are the soluble fms-like tyrosine kinase receptor-1 (sFlt-1), the major antiangiogenic factor, and the placental growth factor (PlGF), a powerful angiogenic factor. Since these markers have proven useful in the prediction, diagnosis, and severity of preE, this study aimed to evaluate their maternal serum levels in pregnancies complicated by SARS-CoV-2 infection and to assess their potential use to guide the management of these women. A retrospective analysis of SARS-CoV-2-positive pregnant women was performed. The serum levels of sFlt-1 and PlGF were collected at the diagnosis of SARS-CoV-2 infection at the hospital, before the beginning of steroid/hydroxychloroquine and/or antithrombotic therapy. The sFlt-1/PlGF ratio was stratified using cut-off values clinically utilized in the diagnosis and prediction of preE (low < 38, intermediate 38–85/110* and high >85/110*, * if before or after the 34th week of gestation). A total of 57 women were included, of whom 20 (35%) had signs and symptoms of COVID-19 at hospital presentation and 37 (65%) were asymptomatic. None were vaccinated. The mean gestational age at diagnosis of SARS-CoV-2 infection was 32 weeks in symptomatic patients and 37 weeks and 5 days in asymptomatic ones (p = 0.089). sFlt-1 serum levels were higher in SARS-CoV-2 positive asymptomatic patients compared to women with COVID-19 related symptoms (4899 ± 4357 pg/mL vs. 3187 ± 2426 pg/mL, p = 0.005). sFlt-1/PlGF at admission was <38 in 18 of the 20 symptomatic women (90%) compared to 22 (59%) of the asymptomatic patients (p = 0.018). Of note, two of the three women admitted to the intensive care unit had a very low ratio (<2). In turn, rates of patients with sFlt-1/PlGF at admission > 85/110 were not significantly different between the two groups: 11% in asymptomatic patients (4/37) vs. none of the symptomatic patients (p = 0.286), and all of them presented a placental dysfunction, like preE (n = 1) and FGR (n = 3). Of note, there were no stillbirths or maternal or neonatal deaths among symptomatic patients; also, no cases of preE, FGR, or small for gestational age neonates were diagnosed. In conclusion, our data suggest that SARS-CoV-2 infection during pregnancy could influence the angiogenic balance. A significant pathological alteration of the sFlt-1/PlGF ratio cannot be identified during the symptomatic phase; however, if left untreated, SARS-CoV-2 infection could potentially trigger placental dysfunction.

Local immune state in the women with miscarriage

Functional state of immunity provides maintenance of immunological tolerance for allogeneic fetus, and high level of local protection against antigenic stimulation. Increased functional activity of phagocytic cells at systemic and local levels may cause impairment of complete fetoplacental complex, thus leading to abortion. The purpose of our study was to assess the state of local immunity in women with pregnancy loss.&#x0D; The study involved 174 women in their reproductive age. The first group consisted of 65 patients (37.4%) with a diagnosis of miscarriage, the history of 2 abortions over the period from conception to the 20th week of gestation. The second group included 37 patients (21.2%) with documented recurrent pregnancy loss, with a history of 3 miscarriages. The control group consisted of 72 conditionally healthy women (41.4%) who had 2 or more term pregnancies with the same partner, without a history of obstetric and gynecological complications. Their mean age was 366 years old. Total number and viability of leukocytes, the indices of functional neutrophil activity, their functional reserve and neutrophil stimulation index were determined in cervical mucosal samples over the first phase of the menstrual cycle.&#x0D; In the first phase of menstrual cycle, the women with miscarriage and recurrent pregnancy loss exhibited a statistically significant increase of phagocytosis by the neutrophils from cervical mucus as compared to the group of conditionally healthy women. Intensity of neutrophil phagocytosis in cervical mucus reached higher values in the women with recurrent pregnancy loss more often, compared to the control group. Evaluation of the functional reserve of cervical mucus neutrophils in the subjects with recurrent pregnancy loss and miscarriage showed a trend towards statistically significant differences: this parameter was higher in the patients than in control group. The ability of cervical mucosal neutrophils to produce reactive oxygen species (both spontaneous and induced) did not show statistically significant differences between the patients and controls.&#x0D; Hence, we have observed aberrant functional activity of neutrophilic granulocytes from cervical mucosa in the groups of women with 2 or more abortions, without changing ability of the cells to produce reactive oxygen species. This finding may be explained by prevalence of oxygen-independent mechanisms of intracellular killing, thus suggesting a role of neutrophils for impaired balance of immunological tolerance in pregnant women at the local level.

The Diagnostic Value of Hepatic and Renal Biochemical Tests for the Detection of Preeclampsia Among Pregnant Women Attending the Antenatal Care Clinic at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia.

BackgroundPreeclampsia has a deleterious effect on renal and liver function, which results in alterations of various biochemical tests. Therefore, the main aim of this study was to evaluate the role of some hepatic and renal biochemical tests in the diagnosis of preeclampsia.MethodsA comparative cross-sectional study was carried out on a total of 126 pregnant women after 20th week of gestation who attended at the University of Gondar Comprehensive Specialized Hospital. The participants were divided into two groups as cases and controls. The case group consisted of 63 preeclamptic women, whereas the control group had 63 age and gestational week matched normotensive pregnant women. From each participant, three milliliters of blood was collected, the serum part was separated, and selected biochemical tests were measured using Humastar 800 chemistry analyzer. An independent t-test and receiver operating characteristics were done using SPSS 20 for comparison and diagnostic value determination of different biochemical tests between the study groups.ResultsThe maternal serum aminotransferases, total bilirubin, Creatinine, and Urea levels were all significantly elevated in preeclamptic women compared to normotensive pregnant women. The receiver operating characteristics plots revealed that serum aspartate aminotransferase level had area under the curve of 0.89 (95% CI: 0.84–0.95) and can distinguish preeclampsia patients from normotensive pregnant women at cut-off value of ≥58.5 U/l with 74.6% sensitivity, 87.3% specificity, and 80.9% diagnostic accuracy. Serum Creatinine level had area under the curve of 0.91 (95% CI: 0.86–0.96), which enabled to indicate preeclampsia at a cut-off value ≥0.90 mg/dl with 77.8% sensitivity and 85.7% specificity.ConclusionAn increased serum aminotransferases, total bilirubin, creatinine, and Urea levels in pregnant women could indicate the development of preeclampsia, and needs to be investigated. Among biochemical tests, serum Creatinine level was the best diagnostic marker of preeclampsia, followed by serum aspartate aminotransferase level.

Cohort profile: the Swedish Maternal Microbiome project (SweMaMi) – assessing the dynamic associations between the microbiome and maternal and neonatal adverse events

PurposeThe Swedish Maternal Microbiome (SweMaMi) project was initiated to better understand the dynamics of the microbiome in pregnancy, with longitudinal microbiome sampling, shotgun metagenomics, extensive questionnaires and health registry linkage.ParticipantsPregnant...

Magnetic resonance imaging of the supra-cervical fetal membrane detects an increased risk of prelaborrupture of membranes.

ObjectiveIn 10% of term deliveries and 40% of preterm deliveries, the fetal membrane (FM) ruptures before labor. However, the ability to predict these cases of premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM) is very limited. In this paper, our objective was to determine whether a prediction method based on T2 weighted magnetic resonance imaging (MRI) of the supra-cervical FM could predict PROM and PPROM.MethodsThis prospective cohort study enrolled 77 women between the 28th and 37th weeks of gestation. Two indicators of fetal membrane defects, including prolapsed depth >5 mm and signal abnormalities, are investigated for our prediction. Fisher’s exact test was used to determine whether prolapsed depth >5 mm and/or signal abnormalities were associated with PROM and PPROM. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for prolapsed depth >5 mm, signal abnormalities, and the combination of prolapsed depth >5 mm and signal abnormalities.ResultAmong 12 women with PROM (5 preterm and 7 term, prior to labor onset), 9 had membrane prolapse >5 mm and 5 had FM signal abnormalities. Among 65 women with rupture of membranes at term, 2 had membrane prolapse >5 mm and 1 had signal abnormalities. By Fisher’s exact test both indicators, membrane prolapse >5 mm and signal abnormalities, were associated with PROM (P<0.001, P<0.001) and PPROM (P=0.001, P<0.001). Additionally, membrane prolapse >5 mm, signal abnormalities, and the combination of the two indicators all demonstrated high specificity for predicting PROM (96.9%, 98.5%, and 100%, respectively) and PPROM (90.3%, 97.2%, and 100%, respectively).ConclusionMRI can distinguish the supra-cervical fetal membrane in vivo and may be able to identify women at high risk of PPROM.

Do First-Trimester Subchorionic Hematomas Affect Pregnancy Outcomes?

The aim of this study is to investigate the relationship between first trimester subchorionic hematomas and pregnancy outcomes in women with singleton pregnancies. Between January 2018 and January 2019, patients who had a single pregnancy between the 6th and 14th weeks of their pregnancy and were hospitalized with the diagnosis of abortus imminens in the early pregnancy service were included in the study. According to the ultrasonographic examination, those with subchorionic hematoma and those with no hematoma were compared in terms of demographic data, pregnancy outcomes and pregnancy complications. 400 abortus immines cases with subchorionic hematoma and 400 abortus imminens cases without subchorionic hematoma were compared. Preterm delivery percentages were similar in both groups, however abortus percentage was significantly higher in the hematoma group (34.2 vs. 24.7%; p=0.007). In addition, it was revealed that the presence of subchorionic hematoma before the 20th gestational week increased the risk of miscarriage 1.58 times. However, no data could be found in the study that could correlate the size of the hematoma with pregnancy loss. The presence of subchorionic hematoma increases abortion rates in abortus imminens cases. And the presence of subchorionic hematoma in cases with ongoing pregnancy does not increase the complications of delivery.

Symptomatic preterm infants suffer from lung function deficits, regardless of bronchopulmonary dysplasia.

The long-term respiratory consequences for children with bronchopulmonary dysplasia (BPD) are well known. However, there is little emphasis on monitoring preterm infants without BPD. Few studies have explored the lung function status of infants with the symptoms of chronic lung disease of prematurity (CLD). To evaluate functional lung deficits in preterm infants with CLD, and to assess the perinatal determinants of diminished lung function. In our cross-sectional study, 132 preterm infants with symptomatic CLD underwent infant pulmonary function testing (iPFT) at a median post-term age of 0.9 years. The iPFT included bodypletysmography, compliance measurement, tidal breath analysis, and rapid thoracoabdominal compression. The relationships between the respective z scores of the iPFT parameters and perinatal characteristics, postnatal treatment, and BPD status were investigated. Seventy-threepatients (55.3%) were born before the 28th week of gestation, and 92 (69.7%) met the BPD criteria. Functional deficits were detected in 85.8%. The obstructive ventilatory pattern was more prevalent than restrictive (36.3 vs. 12.4%, p < 0.001). Infants with restriction had lower birth weight (BW) and required a longer duration of oxygenotherapy. In a univariate model, the lung function correlated with the duration of invasive mechanical ventilation, gestational week, and BW. In a general linear model, BPD status was not an additional determinant of the iPFT results. IPFT may reveal significant functional deficits in preterm infants with CLD even without BPD. The current symptoms and perinatal factors may be more important determinants of functional deficits than the BPD status itself.