20th Week Of Gestation Research Articles

Histological Studies on Foetal Thyroid Gland of Developing Human Foetuses

Introduction: Thyroid gland is the first endocrine gland to develop. It is one of the organs of interest for researchers since a long time. Though, detailed study about adult thyroid is there in the literature but histological study of thyroid gland at different stages in the foetal period is far and few. The present study aims to assess the histogenesis of thyroid gland and also to correlate the functional activity with structural changes in thyroid gland.
 Methods: The study was carried out on 30 foetal thyroid gland of known gestational age ranging from 10 to 38 weeks foetuses. The midline dissection of neck was done to expose the thyroid gland. After tissue processing, paraffin blocks were prepared. All sections were stained with Haematoxylin-Eosin stain.
 Results: In the foetuses, below 12th gestational week no colloid was detected in thyroid gland. First appearance of colloid was observed at 14th gestational week. Parafollicular cells were found after 17th gestational week. Capsule thickness and gland vascularity increased with advancement of gestational age. The size of the peripheral follicles is larger than the central follicles.
 Conclusions: The study concluded the developmental stage of foetal thyroid as Precolloidal stage, Colloid formation stage, Follicular stage and Maturation stage in different gestational weeks. The knowledge on the growth and differentiation of foetal thyroid will be helpful to the clinicians to judge the thyroid structure in preterm babies.

Association of chemerin gene promoter methylation in maternal blood and breast milk during gestational diabetes.

The intrauterine environment and early-life nutrition are regulated by maternal biomarkers in the blood and breast milk. We aimed to explore epigenetic modifications that may contribute to differential chemerin expression in maternal plasma, colostrum, and breast milk and find its association with fetal cord blood and infant weight at 6 weeks postpartum. Thirty-three gestational diabetes mellitus (GDM) mothers and 33 normoglycemic mothers (NGT) were recruited. Two maternal blood samples (28th week of gestation and 6 weeks postpartum), cord blood, colostrum, and mature milk were collected. Methylation-specific polymerase chain reaction and enzyme-linked immunosorbent assay were conducted. The weight of the babies was measured at birth and 6 weeks postpartum. Serum chemerin levels at the 28th gestational week and 6 weeks postpartum were significantly lower for the NGT group as compared to the GDM group; (P < 0.05). Higher colostrum chemerin concentrations were observed in the GDM group and remained elevated in mature milk as compared to NGT (P < 0.05). Colostrum and breast milk chemerin levels showed an independent association with infant weight at 6 weeks postpartum (r = 0.270; P = 0.034) (r = 0.464; P < 0.001). Forty percent GDM mothers expressed unmethylated chemerin reflecting increased chemerin concentration in the maternal blood. This pattern was also observed in newborn cord blood where 52% of samples showed unmethylated chemerin in contrast to none in babies born to normoglycemic mothers. The results of this study highlight the critical importance of altered chemerin regulation in gestational diabetic mothers and its effect during early life period and suggest a possible role in contributing to childhood obesity.

Long-term impact of ambient air pollution on preterm birth in Xuzhou, China: a time series study.

Accumulating evidence witnesses the negative influence of air pollution on human health, but the relationship between air pollution and premature babies has been inconsistent. In this study, the association between weekly average concentration of air pollutants and preterm birth (PTB) was conducted in Xuzhou, a heavy industry city, in China. We constructed a distributed lag non-linear model (DLNM), an ecological study, to access the associations between ambient air pollutants and PTB in this study. Totally, 5408 premature babies were included, and the weekly average levels of PM2.5, PM10, SO2, NO2, O3, and CO were 61.24, 110.21, 22.55, 40.55, 104.45, and 1.04 mg/m3, respectively. We found that PM2.5, PM10, SO2, and NO2 significantly increased the risk of PTB, and the susceptibility windows of these contaminants were the second trimester and third trimester (from 12 to 29 weeks). Every 10 μg/m3 increase of PM2.5, PM10, SO2, and NO2, the greatest relative risk (RR) values and 95% confidence interval (CI) on PTB were 1.0075 [95% CI, 1.0019-1.0131], 1.0053 [95% CI, 1.0014-1.0092], 1.0203 [95% CI, 1.0030-1.0379], and 1.0170 [95% CI, 1.0052-1.0289] in lag 16th, 18th, 19th, and 20th gestational weeks, respectively. No significant influence of O3 and CO were found on preterm birth. Subgroup analysis showed that the risk of premature delivery was higher for younger pregnant women and in warm season. This finding shows that prenatal exposure to ambient air pollutants is associated with preterm birth, and there existed an exposure window period.

ANTENATAL BETAMETHASONE COMPARED WITH DEXAMETHASONE IN TERMS OF FETAL HEART RATE VARIABILITY AND FETAL BODY MOVEMENTS

Introduction: Preterm labor occurs between 20th and 37th gestational week which is regardless of the birth weight. The incidence of preterm birth is increasing and continues to be the leading cause of neonatal mortality and morbidity. Antenatal corticosteroids are used for pregnant women at risk of preterm labor to reduce fetal mortality and morbidity by increasing fetal lung maturation and preventing the fetus from respiratory distress syndrome. In this study, we aimed to evaluate the effects of antenatal dexamethasone and betamethasone on fetal heart rate variability and fetal body movements. Material and method: The pregnant women applied to clinic due to the risk of preterm labor between November 2003 and May 2004 hospitalised due to the risk of preterm labor and tocolytic treatment. The glucocorticoids to be initiated and to provide lung maturation were included in the study. Included in the study pregnant women were randomly divided into two groups. 24 hours for 20 pregnant women in the first group, 12 mg betamethasone was administered intramuscularly. 20 in the second group 6 mg dexamethasone was administered intramuscularly every 12 hours. NSTs for later evaluation of fetal well-being and baby movements were compared. Results: Pregnant women in betamethasone and dexamethasone groups compared in terms of age, gravida, parity and gestational week, there was no significant difference between the two groups (p&gt; 0.05). At the time of first glucocorticoid application (onset) and 24 hours after the last dose of betamethasone/dexamethasone therapy, fetal heart rate, acceleration, deceleration and fetal movement counts were calculated for 3 days in the morning and evening. A significant increase was observed at heart rate in the betamethasone group after treatment, but there was no change in basal heart rate in the dexamethasone group. In the number of acceleration; significant increase was observed in betamethasone group while there was no statistically significant change was observed in the dexamethasone group. Fetal body movements were changed significantly in both groups compared with the basal movements. Conclusion: Antenatal glucocorticoid application (especially betamethasone) caused a temporary suppression in the NST and fetal movements that were used to determine fetal well-being. It should be kept in mind that these temporary changes may be misdiagnosed as fetal distress. Both dexamethasone and betamethasone can be applied in preterm delivery as a safe manner.

Association of Self-Reported Physical Fitness with Pregnancy Related Symptoms the GESTAFIT Project.

We explored the association of physical fitness (PF) with pregnancy-related symptoms, at the 16th and 34th gestational weeks (g.w.). The International Fitness Scale and the Pregnancy Symptoms Inventory were employed to assess self-reported PF and pregnancy-related symptoms, respectively. At the 16th g.w. greater self-reported overall PF was associated with lower incidence of urinary frequency (p = 0.020); greater overall PF, cardiorespiratory fitness (CRF), muscular strength and speed-agility were associated with lower incidence of tiredness-fatigue (all, p < 0.05); greater overall PF and speed-agility were associated with lower incidence of poor sleep (both, p < 0.05); greater CRF and flexibility were associated with lower limitations by tiredness-fatigue (both, p < 0.05); and greater flexibility was associated with lower limitations by poor sleep (p = 0.021). At the 34th g.w. greater self-reported overall PF, CRF and muscular strength were associated with lower incidence of tiredness-fatigue (all, p < 0.05); greater CRF was associated with lower incidence of poor sleep (p = 0.019); and, greater flexibility was associated with lower incidence of increased vaginal discharge (p = 0.023). Adequate levels of PF, especially CRF, may help women to cope with the most endorsed pregnancy-related symptoms and its limitations, especially tiredness-fatigue and poor sleep.

Effects of maternal folic acid supplementation during the second and third trimesters of pregnancy on neurocognitive development in the child: an 11-year follow-up from a randomised controlled trial

BackgroundMaternal folic acid (FA) supplementation before and in early pregnancy prevents neural tube defects (NTD), but it is uncertain whether continuing FA after the first trimester has benefits on offspring health. We aimed to evaluate the effect of FA supplementation throughout pregnancy on cognitive performance and brain function in the child.MethodsFollow-up investigation of 11-year-old children, residing in Northern Ireland, whose mothers had participated in a randomised trial of Folic Acid Supplementation in the Second and Third Trimesters (FASSTT) in pregnancy and received 400 μg/day FA or placebo from the 14th gestational week. Cognitive performance (Full Scale Intelligence Quotient, Verbal Comprehension, Working Memory, Perceptual Reasoning, and Processing Speed) was assessed using the Wechsler Intelligence Scale for Children. Neuronal function was assessed using magnetoencephalographic (MEG) brain imaging.ResultsOf 119 mother-child pairs in the FASSTT trial, 68 children were assessed for neurocognitive performance at 11-year follow-up (Dec 2017 to Nov 2018). Children of mothers randomised to FA compared with placebo scored significantly higher in two Processing Speed tests, i.e. symbol search (mean difference 2.9 points, 95% CI 0.3 to 5.5, p = 0.03) and cancellation (11.3 points, 2.5 to 20.1, p = 0.04), whereas the positive effect on Verbal Comprehension was significant in girls only (6.5 points, 1.2 to 11.8, p = 0.03). MEG assessment of neuronal responses to a language task showed increased power at the Beta (13–30 Hz, p = 0.01) and High Gamma (49–70 Hz, p = 0.04) bands in children from FA-supplemented mothers, suggesting more efficient semantic processing of language.ConclusionsContinued FA supplementation in pregnancy beyond the early period currently recommended to prevent NTD can benefit neurocognitive development of the child. MEG provides a non-invasive tool in paediatric research to objectively assess functional brain activity in response to nutrition and other interventions.Trial registrationISRCTN ISRCTN19917787. Registered on 15 May 2013.

Management of acute and recurrent pericarditis in pregnancy.

This review summarizes the currently available evidence on the management of acute and recurrent pericarditis during pregnancy, focusing on the safety of diagnostic procedures and treatment options for the mother and fetus. Family planning should be addressed in women with recurrent pericarditis of reproductive age and adjustment of therapy should be considered before a planned pregnancy. The treatment of pericarditis in pregnancy is similar to that for non-pregnant women but considers current knowledge on drug safety during pregnancy and lactation. The largest case series on this topic described 21 pregnancies with idiopathic recurrent pericarditis. Pregnancy should be planned in a phase of disease quiescence. Non-steroidal anti-inflammatory drugs can be used at high dosages until the 20th week of gestation (except low-dose aspirin 100 mg/die). Colchicine is allowed until gravindex positivity; after this period, administration of this drug during pregnancy and lactation should be discussed with the mother if its use is important to control recurrent pericarditis. Prednisone is safe if used at low-medium doses (2.5-10 mg/die). General outcomes of pregnancy in patients with pericarditis are good when the mothers are followed by a multidisciplinary team with experience in the field.

Effects of Iron and Amloki (Emblica Officinalis) on Serum Zinc Level in Anaemia with Pregnancy

Introduction: Pregnancy is associated with several trace elements deficiency in developing countries. Supplementation of iron in iron deficiency anaemia (IDA) has several side effects including alterations of serum zinc level. Traditionally, amloki is used as a well known supplement in pregnancy, which is rich in trace elements. Aims were to determine the effects of iron and amloki on serum zinc level in IDA with pregnancy.&#x0D; Materials and Methods: This Prospective, longitudinal and interventional study was done by non blinded, non randomized sampling followed by inclusion and exclusion criteria. This study was performed in the Department of Physiology, Dhaka Medical College, Dhaka on 43 pregnant women between 13th to 20th weeks of gestation with IDA from July 2016 to June 2017. They were recruited from Outpatient Department of Obstetrics and Gynaecology of Dhaka Medical College Hospital. Anaemic pregnant women supplemented with oral iron and amloki were considered as study group (A) and control group (B) were with only iron supplementation for 45 days. Serum zinc level was estimated in the laboratory of the Department of Soil, Water and Environment, University of Dhaka, Dhaka. For statistical analysis, Paired Student’s ‘t’ test and Unpaired Student’s ‘t’ test were considered using SPSS 22.0 version.&#x0D; Results: Significant decrease (p&lt;0.001) of serum zinc level was observed after intervention of iron in both groups. In this study, there was no significant difference in serum zinc level in between study and control group.&#x0D; Conclusion: It can be concluded that oral iron supplementation causes decrease in serum zinc level in IDA with pregnancy. Amloki shows no significant role in preventing decrease of serum zinc level in this study.&#x0D; Medicine Today 2021 Vol.33(1): 61-64

Gestational systolic blood pressure trajectories and risk of adverse maternal and perinatal outcomes in Chinese women

BackgroundAssociations between trajectories of systolic blood pressure (SBP) during pregnancy and pregnant outcomes remain unclear and disparate.MethodsData of 20,353 mothers without chronic hypertension and who delivered live singletons between January, 2014 and November, 2019, was extracted from Taicang register-based cohort. Based on SBP measured during 10 to 40 weeks of gestation, SBP trajectories were explored using latent class growth mixture model, and their associations with maternal and neonatal outcomes were assessed by logistic regression analyses.ResultsSix heterogeneous SBP trajectories were identified: low delayed-increasing (7.47%), low reverse-increasing (21.88%), low-stable (19.13%), medium-stable (21.64%), medium reverse-increasing (16.47%), and high stable (13.41%) trajectories. The high-stable trajectory had SBP around 125 mmHg in the 10th gestational week, and increased slightly onwards. When compared with the low-stable trajectory, the high-stable trajectory had maximally adjusted odds ratio (95% confidence interval) of 5.28 (2.76–10.10), 1.30 (1.13–1.50), 1.53 (1.12–2.08), 1.32 (1.06–1.65) and 1.64 (1.08–2.48) for gestational hypertension (GH), early-term delivery (ETD), preterm delivery (PTD), small for gestational age and low birth weight (LBW), respectively. Besides, the medium reverse-increasing trajectory showed significantly increased risk of GH and ETD, while the medium-stable trajectory had significantly elevated risk of ETD and PTD. Notably, SBP trajectories slightly but significantly improved risk discrimination of GH, ETD and LBW, over traditional risk factors.ConclusionWomen with different SBP trajectories were at varied risk of adverse maternal and fetal outcomes. Meanwhile, our study suggested that BP monitoring during pregnancy is necessary, especially for women with high SBP in early pregnancy or upward trajectory.

Corticosteroids for management of Rh-isoimmunization, extended study in a tertiary referral centre.

Background: RhD isoimmunization is a life threatening condition for affected fetuses. It is currently treated only by intrauterine transfusion of packed red blood cells. This procedure required special skill and has potential complications.Aim : The aim of the present study was to evaluate the role of corticosteroids in prevention of fetal anemia due to RhD isoimmunization.Material and Methods: The study was conducted on 15 pregnant patients with RH isoimmunization in Shatby Maternity University Hospital, Alexandria, Egypt, during the period from July 30th 2016 to July 30th 2019. Recruited women received 40 mg oral prednisolone starting from 10th week of gestation. Follow up of Anti-Rh antibodies titer and-from 18 weeks gestation- middle cerebral artery peak systolic velocity (MSA-PSV) was done every 2 weeks. Patients were delivered at 34 weeks gestation by elective caesarean section after receiving 4 doses of dexamethasone to enhance fetal lung maturity.Results: 12 patients continued the trial. Significant reduction was achieved in anti-Rh antibodies titer. Reduction in MSA-PSV was achieved and maintained below 1.5 MOM. Gestational age at delivery ranged from30.3-34 weeks (33.18±1.2 weeks). Fetal eight at delivery ranged from 1550-2270 grams (1978.5±232.5 gm). 9 newborns required NICU admission, only 2 newborns underwent exchange transfusion therapy.Conclusion: In Rh iso-immunization, oral prednisolone proved to have a good rule in preventing fetal anemia and introducing its use should be considered. More studies with bigger sample size are needed to confirm its efficacy

Machine learning improves early prediction of small-for-gestational-age births and reveals nuchal fold thickness as unexpected predictor.

To investigate the performance of the machine learning (ML) model in predicting small-for-gestational-age (SGA) at birth, using second-trimester data. Retrospective data of 347 patients, consisting of maternal demographics and ultrasound parameters collected between the 20th and 25th gestational weeks, were studied. ML models were applied to different combinations of the parameters to predict SGA and severe SGA at birth (defined as 10th and third centile birth weight). Using second-trimester measurements, ML models achieved an accuracy of 70% and 73% in predicting SGA and severe SGA whereas clinical guidelines had accuracies of 64% and 48%. Uterine PI (Ut PI) was found to be an important predictor, corroborating with existing literature, but surprisingly, so was nuchal fold thickness (NF). Logistic regression showed that Ut PI and NF were significant predictors and statistical comparisons showed that these parameters were significantly different in disease. Further, including NF was found to improve ML model performance, and vice versa. ML could potentially improve the prediction of SGA at birth from second-trimester measurements, and demonstrated reduced NF to be an important predictor. Early prediction of SGA allows closer clinical monitoring, which provides an opportunity to discover any underlying diseases associated with SGA.

355 Risk factors for moderate-to-severe polyhydramnios among patients with diabetes

Nearly 20% of polyhydramnios is attributed to poorly controlled or undiagnosed diabetes, yet we do not have guidance for who to watch closely for polyhydramnios. We aimed to identify risk factors for moderate to severe polyhydramnios in pregnancies complicated by diabetes. This is a nested case-control study of patients with pre/gestational diabetes with singleton pregnancies complicated by polyhydramnios from 2014-2018. Patients with multiple gestations, fetal anomalies, and chromosomal abnormalities were excluded. Polyhydramnios was defined by a deepest vertical pocket (DVP) > 8 cm or amniotic fluid index (AFI) > 24 cm after the 20th week of gestation. Cases were moderate or severe polyhydramnios (defined as AFI >30 or DVP >12 cm), while controls were mild polyhydramnios (defined as AFI 24.0-29.9 or DVP 8-11 cm). Diabetes-related exposures were compared between groups. Unadjusted and adjusted odds ratios were calculated using multivariable logistic regression. Of 90 patients with pre/gestational diabetes, 12 (13.3%) had moderate/severe polyhydramnios. Tobacco use (45.5% vs 17.1%, aOR [95% CI] 5.60 [1.34, 23.3] was the only risk factor associated with moderate/severe polyhydramnios. Fewer women in the moderate/severe polyhydramnios group took antihypertensive medication (0% mod/severe vs. 29.5% mild, p=0.03). Diabetes-specific exposures, such as hemoglobin A1c and glucose screening results, were similar between groups. Tobacco use is a modifiable risk factor associated with moderate/severe polyhydramnios in patients with diabetes. Provided established maternal and fetal risks associated with moderate/severe polyhydramnios, there may be utility in optimizing this risk factor.

225 Idiopathic polyhydramnios and neonatal morbidity at term: respiratory support at delivery?

Idiopathic polyhydramnios (IP) is the most common etiology of polyhydramnios. Yet, conflicting evidence exists regarding the relationship between IP and neonatal morbidity. We investigated the association between IP and neonatal morbidity at term. This is a retrospective cohort of singleton, term pregnancies from 2014-2018. Pregnancies complicated by IP were defined by a deepest vertical pocket (DVP) > 8 cm or amniotic fluid index (AFI) > 24 cm after the 20th week of gestation and were compared to women without polyhydramnios at time of delivery. These groups were matched 1:2 by gestational age within seven days at delivery and maternal race. The primary outcome was a composite neonatal morbidity (neonatal death, respiratory morbidity, hypoxic-ischemic encephalopathy, therapeutic hypothermia, seizures, and umbilical artery pH < 7.10). Outcomes were compared between pregnancies with and without IP. The trend with neonatal morbidity by polyhydramnios severity category (mild, moderate, and severe) was assessed using the Cochrane-Armitage test. Unadjusted and adjusted relative risk were estimated using multivariable logistic regression using the Zhang method. IP was diagnosed in 192 pregnancies that were matched to 384 pregnancies without polyhydramnios. After adjustment for obesity, women with pregnancies complicated by IP had an increased risk of composite neonatal morbidity 21.4% vs 5.5% adjusted risk ratio aRR [95%CI] 4.0 [2.3-6.7], driven primarily by respiratory morbidity 20.3% vs 4.2%, aRR [95% CI] 4.8 [2.7-8.7]. Increasing polyhydramnios severity category was associated with a trend towards increased neonatal morbidity (mild 31/166 (18.7%), moderate 8/20 (40%), and severe polyhydramnios 2/2 (100%), p-value <0.01). IP is associated with increased risk of neonatal morbidity at term, driven primarily by respiratory morbidity. Pregnancies complicated by polyhydramnios should have neonatal respiratory support at the time of delivery.

Management of a patient in the state of total occlusion of aorta due to Takayasu arteritis in preconceptional and pregnancy period

Abstract Objectives Total aortic occlusion is a severe complication of Takayasu arteritis (TAK). Pregnancy follow-up in the state of total aortic occlusion due to TAK has not been reported before. Case presentation A 35 year-old nulliparous woman with total aortic occlusion in the distal aorta due to TAK, admitted with pregnancy desire. She had developed a collateral vessel system which has maintained the lower body circulation. She was informed about the potential risks after an evaluation and she admitted to our clinic at the seventh week of pregnancy, and acetylsalicylic acid was prescribed. At 20th gestational week anomaly screening was in normal limits although the uterine artery Doppler had lower S/D, PI and RI values. She was followed-up regularly in every two weeks. Vascular examination was performed by using an ankle brachial index (ABI) by duplex ultrasound. At 20th gestational week ankle brachial index score was 0.8–0.9 which indicates mild disease. Around 28th gestational week her claudication got worse again and ABI was in moderate level (0.5–0.8) and low molecular weight heparin was started. Until 37th gestational week her disease was stable, ABI was above 0.5, her blood pressure was in normal limits, no vascular complication occurred and the baby’s growth percentile was at 25th centile. At 37th gestational week a 2,640 g baby was delivered. Patient was discharged without any complications at third post-operative day. Conclusions Complicated TAK patients may have good obstetric outcomes with a multidisciplinary approach in experienced tertiary centers.

Effects of Iron and Amloki (EmblicaOfficinalis) on Serum Zinc Level in Anaemia with Pregnancy

Pregnancy is associated with several trace elements deficiency in developing countries. Supplementation of iron in iron deficiency anaemia (IDA) has several side effects including alterations of serum zinc level. Traditionally, amloki is used as a well known supplement in pregnancy, which is rich in trace elements.To determine the effects of iron and amloki on serum zinc level in IDA with pregnancy. The study was a non blind, non random sampling interventional type of clinical trial. This study was performed in the Department of Physiology, Dhaka Medical College, Dhaka on 43 pregnant women between 13th to 20th weeks of gestation with IDA from July 2016 to June 2017. They were recruited from Outpatient Department of Obstetrics and Gynaecology of Dhaka Medical College Hospital. Anaemic pregnant women supplemented with oral iron and amloki were considered as study group (A) and control group (B) were with only iron supplementation for 45 days. Serum zinc level was estimated in the laboratory of the Department of Soil, Water and Environment, University of Dhaka, Bangladesh. For statistical analysis, Paired Student’s‘t’ test and Unpaired Student’s‘t’ test were considered using SPSS 22.0 version. Significant decrease (p&lt;0.001) of serum zinc level was observed after intervention of iron in both groups. In this study, there was no significant difference in serum zinc level in between study and control group. It can be concluded that oral iron supplementation causes decrease in serum zinc level in IDA with pregnancy. Amloki shows no significant role in preventing decrease of serum zinc level in this study. Emblicaofficinalis (amloki) is traditionally used to treat iron deficiency anaemia. It can increase haemoglobin concentration and decrease side effects of iron supplementation.&#x0D; Bangladesh Med J. 2020 Jan; 49 (1): 33-37

The utility HBA1c test as a screening biomarker for detecting gestational diabetes mellitus

BackgroundGlycated Hb (HbA1c) has not been used for the diagnosis of gestational diabetes mellitus (GDM). Measurement of HbA1c levels is less complicated and more comfortable than glucose challenge test (GCT) for pregnant women. We studied HbA1c as a biomarker of GDM and as a screening test to avoid the use of GCT. MethodsA prospective case-control study involves 745 pregnant women between 24th and 28th gestation week. HbA1c levels were measured and GDM was diagnosed according to Carpenter–Coustan criteria. Mean and SD were calculated for GCT value, HbA1c, age, and body mass index (BMI). A receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of HbA1c test in diagnosing GDM. Cut-off points were calculated to rule out GDM and sensitivity (Se) and specificity (Sp) were also determined. A study of the implementation of HbA1c cut-offs was performed to avoid the GCT or to perform the confirmatory oral glucose tolerance test (OGTT). ResultsThe area under the curve (AUC) was 0.67 (0.58–0.76). Using 4.6% HbA1c as a cut-off prevented false negatives but only decreased the number of GCTs performed by 7.2%. However, using 4.7% HbA1c resulted in one false negative (reduction of 15.0%). Finally, by selecting 4.8% HbA1c, we found two false negatives, but there were 25.9% who do not require a GCT. ConclusionsAdoption of HbA1c as a screening test for GDM may eliminate the need of GCT. Although the HbA1c test does not have sufficient Se and Sp to be used as the only diagnostic test, the use of a rule-out strategy in combination with the OGTT could be useful.

Identifying the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine curettage

AbstractAimTo evaluate the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine evacuation and curettage.MethodsA total of 2546 patients who had surgical abortion (uterine evacuation and curettage) before the 20th gestational week with indications of missed abortion, anembryonic pregnancy, incomplete abortion, and elective curettage in a tertiary antenatal care center were recruited. The patients were called and surveyed for their symptoms; including infertility, oligo‐amenorrhea and recurrent pregnancy loss, preterm birth and intrauterine growth retardation and abnormal placentation as criteria of Asherman Syndrome. Diagnostic (office) hysteroscopy was performed for 177 who had one of those complaints.ResultsThe incidence of Asherman Syndrome was 1.6% (n = 43/2546). History of ≥3 abortions was the main factor that increased the risk of Asherman Syndrome for by 4.6 times. Use of vacuum aspiration or sharp curettage, premedication for cervical priming, and having a pregnancy &gt;10th gestational weeks were not risk factors for Asherman Syndrome.ConclusionWhen the diagnosis was based on presence of symptoms who underwent uterine instrumentation, the incidence of Asherman Syndrome was found to be 1.6%. Repeated abortions were the main risk factor for Asherman Syndrome and avoiding from repeated uterine instrumentations may have a role in prevention.

The Role of Afamin and Other Trace Elements in the Prediction of GDM: a Tertiary Center Experience.

The objective of this study was to evaluate the utility of first trimester maternal serum afamin levels together with vitamin E and various elements (zinc, copper, selenium, and magnesium) for the prediction of gestational diabetes mellitus (GDM). All pregnant women between 11th and 14th weeks of gestation admitted for combined test were asked to participate in the study. A total of 797 women gave permission to participate in the study between January and September 2019. Serum was obtained by centrifugation and samples were frozen and kept at - 80 °C. For final analysis, forty-three GDM patients and forty-four healthy controls were selected. Levels of afamin, vitamin E, zinc, copper, selenium, and magnesium were compared between groups. The mean levels of afamin were found to be higher in women with GDM without statistical significance (63.69 ± 82.33 vs 44.25 ± 32.25 mg/L, p = 0.149). Vitamin E levels were found to be higher in women with GDM compared to controls without any statistical significance (5.04 ± 5.33 vs 4.47 ± 3.83 μg/mL, p = 0.568). While first trimester copper concentrations were higher among diabetic women (187.26 ± 34.78 vs 175.17 ± 30.40 μg/L, p = 0.088), this was not statistically significant. The other element levels (zinc, selenium, and magnesium) were found to be similar between the two groups (p = 0.624, p = 0.088, p = 0.254, p = 0.872, respectively). The results of our study demonstrated that mean levels of afamin, vitamin E, and copper were higher in women with GDM compared to controls. Additionally, first trimester maternal zinc, selenium, and magnesium levels were similar between diabetic and healthy pregnant women. However, more studies are needed to clarify the relationship between blood trace concentrations and GDM.

Субкапсулярная гематома печени: оперировать или нет?

The pregnancies after the 28th week of gestation have a formidable complication - preeclampsia, which can lead to the development of the HELLP syndrome if not timely diagnosed and treated. That leads to multiple organ failure with decompensation of the basic vital functions. In half of the cases the DIC syndrome and acute renal failure may develop; rather seldom, subcapsular haematoma of the liver develops, while the liver rupture can lead to extremely serious consequences for a pregnant woman or a woman in labor, up to fatal outcome. There is little information about the treatment tactics for that pathology. It is still unclear if the patients with a large subcapsular haematoma of the liver due to HELLP syndrome should be operated. The article presents a clinical case of conservative treatment of a patient with this complication.

Gestational Diabetes Mellitus and Folic Acid Supplementation in Pregnant Women: A Systematic Review

Background: Gestational diabetes mellitus (GDM) is a common pregnancy disorder screened for between the 24th and 28th weeks of gestation using oral glucose tolerance test. GDM has maternal and fetal health implications. Objective: To assess the relation between folic acid supplementation in pregnant women and the risk of developing GDM. Search Strategy: The search employed topic-based strategies designed for each database in June 2020. Databases searched were Pubmed, Cochrane Library, Embase and Lebanese American University online database. Selection Criteria: Studies eligible were those targeting the association of GDM development and folic acid supplementation, including pregnant women who have developed GDM and pregnant women who were on folic acid supplementation and developed GDM. Both interventional and observational studies were included. Data Collection and Analysis: Two reviewers extracted the data independently. A third reviewer checked the data for consistency and clarity. Data extracted included the sample characteristics, sample size and outcomes. Cohen’s κ was used to assess agreement between reviewers. All tools and processes were piloted prior to use. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data was presented in a tabulated form. Main Results: Six studies showed a proportional relation between folic acid intake and GDM, two reported a protective effect, and one cohort found no association. Conclusion: The inconsistent results made the formulation of a definitive conclusion difficult. Hence, larger studies are needed.