20th Week Research Articles

High prevalence of cardiovascular risk factors in pregnant women in Benin.

Modifiable cardiovascular risk factors (CVRF) are highly prevalent in SubSaharan African communities. In these countries the burden of CVRF during early pregnancy has been poorly documented. The objective of this study was to describe the frequency of CVRF in pregnant women before the 20th week of gestation in Benin. Consecutive pregnant women with a gestational age < 20th week were included in 30 maternity clinics in Benin. Univariate and multivariate analyses were used to determine characteristics associated with CVRF. 1244 pregnant women were included (680 (54.7%) in urban areas and 584 (45.3%) in rural areas). The median age was 26 years. The frequencies of high blood pressure (HBP), obesity and diabetes were 18.9%, 15.0% and 3.1% respectively. Very few women (25.3%) were aware of the HBP disorder. HBP was associated with an age ≥ 35 years (OR = 1.7, 95%CI:1.1-2.7), a rural setting (OR = 2.6; 95%CI:1.9-3.5), an insufficient consumption of fruits and vegetables (OR = 3.2; 95%CI:2.0-5.3) and a history of at least 2 fetal losses (OR = 1.9; 95% CI [1.4-2.7]). The risk of being overweight was associated with an age >24 years old (OR = 1.6; 95%CI:1.1-2.2) conversely a rural setting was protective (OR = 0.7; 95%CI:0.5-0.9). Obesity was associated with an age > 35 years old (OR = 4.1; 95%CI:2.5-6.8) and a rural setting (OR = 0.3; 95%CI: 0.2-0.5). The frequency of CVRF in women before 20th week of gestation was high. Most of the women were unaware of the disorder. Thus the screening of CVRF among women of reproductive age might be relevant.

Nutraceuticals as Modulators of Molecular Placental Pathways: Their Potential to Prevent and Support the Treatment of Preeclampsia

Preeclampsia (PE) is a serious condition characterized by new-onset hypertension and proteinuria or organ dysfunction after the 20th week of gestation, making it a leading cause of maternal and fetal mortality worldwide. Despite extensive research, significant gaps remain in understanding the mechanisms underlying PE, contributing to the ineffectiveness of current prevention and treatment strategies. Consequently, premature cesarean sections often become the primary intervention to safeguard maternal and fetal health. Emerging evidence indicates that placental insufficiency, driven by molecular disturbances, plays a central role in the development of PE. Additionally, the maternal microbiome may be implicated in the pathomechanism of preeclampsia by secreting metabolites that influence maternal inflammation and oxidative stress, thereby affecting placental health. Given the limitations of pharmaceuticals during pregnancy due to potential risks to fetal development and concerns about teratogenic effects, nutraceuticals may provide safer alternatives. Nutraceuticals are food products or dietary supplements that offer health benefits beyond basic nutrition, including plant extracts or probiotics. Their historical use in traditional medicine has provided valuable insights into their safety and efficacy, including for pregnant women. This review will examine how the adoption of nutraceuticals can enhance dysregulated placental pathways, potentially offering benefits in the prevention and treatment of preeclampsia.

Identifying critical periods of susceptibility for maternal exposure to biothermal stress and the risks of stillbirth and spontaneous preterm birth in Western Australia.

A few studies investigated critical periods of temperature and the risks of stillbirth and preterm birth. This study aimed to identify critical periods of composite biothermal stress (Universal Thermal Climate Index, UTCI) for stillbirth and spontaneous preterm birth (sPTB). From the Midwives Notification System, 415,271 singleton births between 1st January 2000 and 31st December 2015 were linked to spatiotemporal UTCI in Western Australia. Covariate-adjusted weekly and monthly distributed lag non-linear Cox regression from twelve weeks before conception to birth were performed. Relative to median exposure (14.2 °C), extreme UTCI levels (1st-10th and 90th-99th centiles) were associated with higher hazards of stillbirth and sPTB, especially stronger at lower than higher exposures. Critical susceptible periods at 1st centile (10.2°C) exposure were found during gestational weeks 21-42 with the strongest hazard of 1.14 (95% CI 1.03, 1.27) in the 42nd week for stillbirth and during gestational weeks 26-36 with the strongest hazard of 1.09 (95% CI 1.06, 1.12) in the 36th week for sPTB. Monthly exposure showed a similar pattern but with greater magnitude. Mid to late gestation showed critical susceptible periods of biothermal stress on the birth outcomes, suggesting further studies and timely climate-related healthcare interventions.

Calcium plus vitamin D supplementation during pregnancy has no impact on postpartum transient longitudinal changes in hip geometry in adolescent mothers: a secondary analysis of a randomised controlled trial.

We have previously demonstrated that calcium plus vitamin D supplementation during adolescent pregnancy reduces the magnitude of transient postpartum bone mass loss. In the present post hoc analysis, we further investigated the effect of calcium plus vitamin D supplementation during pregnancy in hip geometry throughout one year postpartum in Brazilian adolescents with low daily calcium intake (∼600 mg/d). Pregnant adolescents (14-19 years) were randomly assigned to receive calcium (600 mg/d) plus vitamin D3 (200 μg/d) or a placebo from 26 weeks of gestation until parturition. Dual-energy X-ray absorptiometry images were obtained at 5 (n 30 and 26 for calcium plus vitamin D and placebo, respectively), 20 (n 26 and 21) and 56 (n 18 and 12) weeks postpartum, and hip geometry parameters were analysed by Advanced Hip Assessment software. The effects of the intervention, time point and their interaction were assessed using repeated-measures mixed-effects models. No significant intervention effects or intervention × time interactions were observed on hip geometry parameters (P > 0·05). Time effects were observed in cross-sectional area, cross-sectional moment of inertia and section modulus parameters with decreases from the 5th to the 20th week postpartum followed by recovery from the 20th to the 56th week (P < 0·05). Our findings indicate that the postpartum period is associated with transient changes in the hip geometry of lactating adolescent mothers, regardless of the low calcium intake and the supplementation offered during pregnancy, suggesting that a physiological adaptation of these adolescents to low calcium intake is at play.

Cardiopulmonary bypass of acute type A aortic dissection during pregnancy at the 20th gestational week with maternal and foetal survival: A case report.

Type A acute aortic dissection, an aggressive and highly fatal disease, is particularly common among pregnant women and foetuses. This disease often occurs during the third trimester of pregnancy and the postpartum period. This case involves a female who was 20 weeks pregnant with type A acute aortic dissection. While maintaining pregnancy, the patient underwent Bentall surgery and Sun's procedure. The duration of circulatory arrest was a brief 4 min. The patient fully recovered 40 days after surgery and remained pregnant post-discharge. At the 38th gestational week, she delivered a healthy male infant via caesarean section. Gestational morbidity can have a serious impact on the safety of mothers and children. Currently, the shortest time reported for hypothermic circulatory arrest is 5 min. In this case, the lower body circulatory arrest was controlled to approximately 4 min during cardiopulmonary bypass while simultaneously safeguarding both individuals. Ideal strategies for cardiopulmonary bypass to reduce foetal risk include shorter cardiopulmonary bypass times, higher flow rates, and higher perfusion pressures. A reduction in the duration of hypothermic circulatory arrest further increases foetal survival rates. The development of a rational cardiopulmonary bypass plan should be tailored to the physiological characteristics of the pregnant woman to ensure the safety of both the pregnant woman and the foetus, reduce complications, and improve the success rate of the operation.

Comparison of Urine Specimen with Recto-Vaginal Swab to establish carriage of Group B Streptococcus Colonization in Pregnant Females

Objective: To determine maternal vaginal colonization with Group B Streptococcus using both recto-vaginal swab and mid-stream urine in order to determine which specimen type can give better results. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi Pakistan, Department of Gynecology and Obstetrics, Combined Military Hospital and Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2022. Methodology: Recto-vaginal swabs and mid-stream urine were taken from 194 pregnant women between 36th and 37th weeks of pregnancy. Swabs were inoculated on blood and MacConkey agar while urine specimen was inoculated on blood and CLED agar. All plates were incubated at 37°C in either ambient air or CO₂ incubator. Identification of Group B Streptococcus was made on the basis of colony morphology (β-haemolytic colonies on blood agar), Gram stain, catalase test and confirmation were done by means of latex agglutination tests. Results: In comparison to urine, a Group B Streptococcus carriage rate of 8.2% was detected in recto-vaginal swab. Urine specimen of only 3 patients yielded growth of Group B Streptococcus giving a urine carriage rate of 1.5%. Conclusion: Recto-vaginal swab gives a better insight to the presence of Group B Streptococcus as compared to mid-stream urine.

The WE-RISE™ multi-domain intervention: a feasibility study for the potential reversal of cognitive frailty in Malaysian older persons of lower socioeconomic status

BackgroundCognitive frailty (CF) is an emerging concern among older persons, particularly within lower socioeconomic statuses (SES) populations. Currently, there is limited evidence on the potential reversibility of CF through multi-domain interventions within this demographic. This study aimed to investigate the effectiveness of the WE-RISE™ multi-domain intervention in addressing the potential reversibility of CF among community-dwelling older persons of lower SES, the intervention effects on multiple health dimensions, and to determine if WE-RISE™ is of low cost.MethodsThis 24-week randomised controlled trial included 55 community-dwelling older persons of lower SES with CF, who were randomised into either the WE-RISE™ intervention group (n = 27), or the control group receiving usual care (n = 28). The WE-RISE™ intervention comprised of 12 weeks of instructor led, community-based intervention, followed by 12 weeks of WE-RISE™@Home. CF status, cognitive and physical function, nutrition, disability, health-related quality of life, exercise self-efficacy and depression were assessed at baseline, 12th and 24th weeks. Changes in CF status was analysed descriptively, while intervention effects were analyzed with split plot ANOVA. The cost of the WE-RISE™ intervention was calculated using activity-based costing.ResultsAt baseline, all participants in both the intervention and control groups (100%) were classified as CF. Following 12 weeks of the WE-RISE™ intervention, 74.1% of participants in the experimental group no longer met the criteria for cognitive frailty, with 63% maintaining this improvement at 24 weeks. In contrast, the CF status of participants in the control group remained largely unchanged, with only 10.7% showing improvement at 12 weeks and falling to 3.6% at 24 weeks. Significant intervention effects were observed for cognition, physical function, body composition, disability, health-related quality of life and self-perceived exercise self-efficacy (p < 0.05) following participation in WE-RISE™. The cost per intervention session was RM4.06 (≈ RM3.88), and the cost per subject for 48 sessions was RM194.74 (≈ RM187.01).ConclusionThe WE-RISE™ multi-domain intervention has demonstrated potential in reversing CF among older persons of lower SES, leading to significant improvements across multiple health dimensions at a low cost. WE-RISE™ shows promise to enrich the well-being of ageing societies, contribute to societal health, and ensure equitable access to healthcare, supporting broader implementation by enhancing equitable access to health programs and addressing the needs of older persons, WE-RISE™.Trial registrationThis trial was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12619001055190) on the 29th of July 2019 – retrospectively registered.

Prevalence and risk factors for gestational diabetes in Jambi, Indonesia

The most common time for gestational diabetes mellitus (GDM), which affects anywhere from 1% to 40% of pregnant women, is between the 24th and 28th week of pregnancy. One of the provinces in Indonesia, Jambi, was the focus of this study, which aimed to characterize the incidence and risk factors of GDM. One hundred twenty-two women without GDM and twelve women with GDM participated in this case control research. Oral glucose tolerance tests were used to diagnose gestational diabetes mellitus (GDM) in women who were assessed between 24 and 28 weeks of gestation. Data Collection in this research used questionnaire about woman’s social demographics, history GDM, parity, family support, and social support. Multivariate analysis is used to measure the relationship between variables. The results of the study showed a huigh prevalence of GDM of 37,6%. The identified risk factors were hypertension (OR=2,121;CI95%=1,405-3,203), family history of DM (OR=1,610;CI95%=1,333-1,946),BMI&gt;30 kg/m2(OR=1,465;CI95%=1,243-1,727) and history of GDM previous pregnancy (OR=2,857;CI95%=0,839-9,727). We conclude that a GDM risk factor score is required so that health services can utilize these indicators as gold standards for screening GDM, due to the large heterogeneity in GDM risk factors.

Influence between Body Mass Index and Blood Pressure With Results of Urine Protein Examination in Pregnant Women at Bangkalan Health Center

Background: Preeclampsia is an increase in blood pressure that occurs after the 20th week of gestation. Until now, the exact cause of preeclampsia is not known. During the second trimester of pregnancy the pressure in the renal veins (renal venous pressure) changes and increases. Increased renal venous pressure causes proteinuria, especially in the orthostatic position, which causes a slightly greater change in kidney size. Purpose: The aim of this study was The Relationship Between Body Mass Index And Blood Pressure With Results Of Urine Protein Examination In Pregnant Women At Bangkalan Health Center. Methods: Analytical Research Design with a cross sectional approach. Independent variable Body Mass Index and Blood Pressure, dependent variable results of urine protein examination. The sample of this study were 210 pregnant women who carried out Integrated ANC at the Bangkalan Health Center, the sampling technique used Simple random sampling. Secondary data collection by looking at medical record data, statistical tests using Rank Spearman. Results: Based on statistical tests using Rank-Spearman, the results showed ρ value (0.024) &lt;α (0.05) indicating that there is a relationship between Body Mass Index and urine protein examination results. The results of the study ρ value (0.020) &lt;α (0.05) there is a relationship between blood pressure and the results of urine protein examination. Conclusion: Detection of proteinuria is very important in the diagnosis and treatment of hypertension in pregnancy. Proteinuria is the last symptom to appear in patients with preeclampsia.

Adipose Tissue Macrophages of the Human Fetus.

Prenatal adipose tissue development affects body composition and growth trajectory in early infancy, therefore it is a key determinant of adiposity in childhood. Childhood overweight and obesity increase the probability of being obese as an adult. After birth and in adulthood, adipose tissue macrophages (ATMs) are relevant constituents of the fat depots, and they are necessary for physiological adipose tissue development and fat metabolism. In obesity, however, ATMs may induce chronic inflammation leading to insulin resistance, pancreatic beta cell damage and self-immunity. Despite being relevant regulators of adipose tissue development and functioning, it is unknown whether ATMs are present in the fetal adipose tissue, therefore it is elusive whether they may affect the prenatal establishment of fat depots. Here we studied the distribution of ATMs in the human fetus between gestational weeks 17 and 38 and labeled ATMs in the early postnatal life. We found that CD45+/CD14+/CD68+ ATMs infiltrated the fetal adipose tissue from the 17th week of gestation and remained persistent throughout the second and third trimesters. ATMs were phagocytic in the neonate and expressed interleukin-6, along with other pro-inflammatory gene products. These findings show that ATMs colonize the adipose tissue early in gestation, raising the possibility that intrauterine ATM-adipocyte communication may exist, eventually allowing ATMs to affect prenatal adipose tissue development.

Gestational diabetes and pregnancy outcome in Kurdish, Somali and general population in Finland

Abstract Gestational diabetes (GDM) increases the risk of type II diabetes and cardiovascular morbidity later in life but GDM incidence in women from different cultural backgrounds varies. This study aims to examine treatment of GDM and pregnancy outcomes in Somali, Kurdish and general population women. Patient data of 312 Kurdish, 254 Somali and 508 general population women was collected from Turku University Hospital records from 2008 to 2019. The general population was selected by randomization with matching year, BMI, age, and parity. Singleton deliveries after 34th gestational week with no prior diabetes mellitus were included. Descriptive and comparison analyses (SPSS, version 29.0) were used to identify associations between ethnic background and pregnancy outcomes in women with GDM. The incidence of GDM was 22 % (CI 95 % 17-27) in Somali, 36 % (CI 95 % 31-42) in Kurdish, and 16 % (CI 95 % 13-19) in the general population women. Kurdish women had medication for GDM more often (43 % CI 95 % 34-53) than the Somali (22 % CI 95 % 11-33) and general population women (18 % CI 95 % 9-26). Metformin was more commonly used among Kurdish (30 % CI 95 % 22-39) compared to the general population (12 % CI 95 % 4-18) and Somali women (13 % CI 95 % 4-22). There was no difference in insulin or combined metformin and insulin treatment between the groups. In GDM group, vaginal deliveries were more common in general population (89 % CI % 81-95) than in Somali women (67 % CI % 64-81). Induction of labour (indication GDM or other) and instrumental vaginal delivery rates were similar between the groups. Newborns of all Somali women had a lower weight (SD -0.3 CI 95 % -0.7 - -0.2) compared to the general population (SD 0 CI 95 % -0.1 - 0.3). The prevalence of GDM was increased and dietary treatment decreased in Kurdish women compared to the general population in Finland. In the future, the treatment of GDM should be adjusted to better optimize the care for different cultural background women. Key messages • Kurdish women have increased incidence of GDM and less dietary treatment compared to the general population with similar risk factors. The pregnancy outcomes remain good in all groups. • With Somali women, the birth weight of the child is lower despite GDM status. This might direct clinicians to underestimate the effect of GDM when considering individual treatment.

Accurate prenatal diagnosis of facioscapulohumeral muscular dystrophy 1 using nanopore sequencing

BackgroundFacioscapulohumeral muscular dystrophy 1 (FSHD1) is an autosomal dominant muscular disorder mainly caused by the contraction and hypomethylation of the D4Z4 repeat array in chromosome 4q35. Prenatal diagnosis of FSHD1...

A new spectrum of neonatal urethral pathologies in the era of early vesicoamniotic shunting?

Intrauterine vesicoamniotic shunting (VAS) was shown to affect survival of male fetuses with megacystis in suspected lower urinary tract obstruction (LUTO). Data on postnatal management are largely lacking. We aim to describe the pathologies diagnosed in children born after vesicoamniotic shunt placement in early pregnancy for megacystis. All newborns with previous intrauterine VAS treated in our institution were analyzed retrospectively. We evaluated the clinical spectrum of urethral pathologies. We also compared patients who received a shunt before the 17th gestational week with those who received it later. Between 2014 and 2023, 26 patients (all male) with a history of VAS for suspected LUTO were treated in our institution postnatally. Five fetuses with dislocated shunts underwent re-implantation in utero. Overall, premature birth before the 38th week of gestation was observed in 14 patients. Seven patients received a Harrison® shunt whereas 19 received a Somatex® shunt. Twelve patients required surgical shunt removal under general anesthesia due to shunt migration/embedding. Posterior urethral valves were found in 10/26 patients, 10/26 patients showed a urethral hypoplasia [Fig.1] and two patients had urethral duplications. In two patients, we identified a prune belly syndrome. One patient had posterior and anterior urethral valves. One patient had a high grade bilateral vesicoureteral reflux without LUTO. The 11 patients shunted early (before 17GW) showed a trend towards a higher proportion of urethral hypoplasia in the early shunt group (54% vs. 26%) without statistical significance. In our observation, patients treated with VAS had a noticeable high proportion of complex urethral pathologies such as urethral hypoplasia. These data should be taken into consideration for prenatal counselling of parents and planning of postnatal management.

Perinatal outcomes of selective termination in dichorionic twin pregnancies: a retrospective study from a single center.

Selective termination (ST) is an appropriate procedure for managing discordant fetal anomalies in dichorionic diamniotic (DCDA) twin pregnancies. The aim of this study was to investigate the perinatal outcomes of ST at different gestational ages in DCDA twin pregnancies. This retrospective study was conducted on DCDA twin pregnancies with STs at West China Second University Hospital between January 2012 and December 2022. According to the gestational age at which ST was performed, the patients were assigned to four groups: Group 1 (13 to 17 + 6weeks), Group 2 (18 to 23 + 6weeks), Group 3 (24 to 27 + 6weeks), and Group 4 (≥ 28weeks). We identified 230 patients for this study. The overall rates of miscarriage, preterm delivery at < 32weeks, and term delivery were 1.3%, 10.5%, and 50%, respectively, while the rates of live birth and neonatal survival were 98.7% and 98.2%, respectively. The rate of term birth was highest (70.6%) and the birth weight was heaviest (2931 ± 535g) in Group 1 (p = 0.000). In the presence of a fetus subjected to feticide, the mean delivery age was earlier than that in the non-presenting group (p = 0.017); accordingly, the mean birth weight in the feticide group was lower (2366 ± 628g) than that in the non-presenting group (2590 ± 634g) (p = 0.011). When we examined the relative relationship between reduction weeks and delivery weeks of twins by correlation analysis, we observed that with regard to maternal prognosis, two pregnancies involved preterm premature rupture of membranes (PPROM) at 7days and 3days after the procedure. Intrauterine infection occurred in two patients in Group 4, but there were no maternal deaths or maternal coagulatory abnormalities. Optimal perinatal outcomes were obtained by ST of DCDA pregnancies before 18weeks, regardless of whether or not the reduced fetus was the presenting twin. However, if legally possible, late (i.e., after 28weeks) procedures can be a safe alternative for patients diagnosed after the 18th week of gestation. Overall, we herein noted a negative correlation between the procedure week and the delivery week in this study. Moreover, ST of the non-presenting twin was associated with a heavier birth weight and later gestational age at delivery.

Vitamin D Supply of Twins during Fetal Life, Its Relation to Anthropometric Parameters of Newborns and the Analysis of Other Factors Related to Birth Size

Background/Objectives: Vitamin D deficiencies are very common in pregnant women, raising concerns about adverse health outcomes in children. This issue has hardly been studied in multiple pregnancies, the prevalence of which has been steadily increasing. Therefore, our study investigated the relationship between newborns’ anthropometric parameters and the concentration of 25(OH)D in maternal blood of women with twin pregnancies and umbilical cord blood. Methods: The study included 50 women who gave birth after the 36th week of twin gestation. The concentration of 25(OH)D was determined in maternal blood collected during the antenatal period and in the umbilical cord blood of 100 newborns. Anthropometric parameters of the newborns (birth weight, length and head and chest circumference) were obtained from hospital records. Data on nutrition and lifestyle during pregnancy were collected from the patients during an interview conducted by a dietitian. Results: No relationship between maternal and neonatal cord blood vitamin D concentrations and any of the anthropometric parameters of the newborns was found. However, only 6% of the mothers and 13% of the newborns had vitamin D deficiency (≤20 ng/mL). The type of pregnancy and maternal height were the main factors associated with neonatal size. Newborns from dichorionic pregnancies were on average 202 g heavier (p &lt; 0.001) and 1 cm longer (p = 0.006) than newborns from monochorionic pregnancies. Newborns of mothers ≤160 cm in height had on average 206 g lower birth weight (p = 0.006) and were 3.5 cm shorter (p = 0.003) compared to newborns of taller mothers. Conclusions: Therefore, in our study, the neonatal size of twins was not related to the vitamin D status but to other factors such as the type of pregnancy and maternal height.

The role of incretins in gestational diabetes: a case-control study on the impact of obesity

BackgroundThis study aimed to evaluate the role of serum Glucagon-Like Peptide-1 (GLP-1), Glucagon-Like Peptide-2 (GLP-2), and Glucose-Dependent Insulinotropic Polypeptide (GIP) levels in relation to obesity and gestational diabetes mellitus (GDM) in pregnancy.MethodsA case-control study was conducted, including 96 pregnant women with singleton pregnancies who underwent the Oral Glucose Tolerance Test (OGTT) for GDM diagnosis during the 24th–28th weeks of gestation. Blood samples were collected for measuring GLP-1, GLP-2, GIP, and fasting glucose. Statistical analyses included receiver operating characteristic (ROC) curves and correlation analysis.ResultsAmong the 96 women, no significant difference in age was observed between the groups, but Body Mass Index (BMI) was significantly higher in GDM-O (Gestational Diabetes Mellitus-Obese) and non-GDM-O groups (p < 0.001). GLP-1 had an area under the curve (AUC) of 0.666 (95% CI: 0.553–0.778, p = 0.005) for diagnosing GDM. The optimal GLP-1 cutoff was 815.86 ng/mL, with 65% sensitivity and 77% specificity. A significant correlation was found between GLP-2 and GIP (r = 0.289, p = 0.004), but no significant correlations were observed between GLP-1 and other peptides or gestational age (p > 0.05).ConclusionsImpaired secretion of GLP-1, GLP-2, and GIP likely contributes to the pathogenesis of GDM. GLP-1 may serve as a potential biomarker for diagnosing GDM.

Ensemble machine learning models for sperm quality evaluation concerning success rate of clinical pregnancy in assisted reproductive techniques

This study aimed to investigate the influence of various sperm quality characteristics, including morphology, motility, and count, on the success rates of clinical pregnancy achieved through assisted reproductive technologies (ART) such as in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and intrauterine insemination (IUI). The secondary objective was to assess the impact of these sperm parameters on the clinical pregnancy rate that resulted in the detection of a fetal heartbeat during the 11th week of gestation, a crucial milestone in successful ART-derived pregnancies. The researchers employed a retrospective analysis, evaluating data from 734 couples undergoing IVF/ICSI and 1197 couples undergoing IUI across two infertility centers. Exclusion criteria included cases involving donated eggs or sperm, surrogate uteri, and infertile couples with combined male and female factors. Five ensemble machine-learning models were utilized to predict the clinical pregnancy success rates. The Random Forest (RF) model achieved the highest mean accuracy (0.72) and area under the curve (AUC) (0.80), outperforming the other models for both IVF/ICSI and IUI procedures. The Shapley Additive Explanations (SHAP) value analysis revealed that for IUI cycles, all three sperm parameters (morphology, motility, and count) had significant negative impacts on the prediction of clinical pregnancy success. In contrast, for IVF/ICSI cycles, sperm motility had a positive effect, while sperm morphology and count were negative factors. In cycles with 1 to 5 retrieved eggs, sperm motility, and count, they positively affected the clinical pregnancy rate. The study also identified cut-off values for sperm count, with 54 and 35 being the respective thresholds for IVF/ICSI and IUI. Additionally, a significant cut-off point 30 was found for the sperm morphology parameter across all procedures. This study underscores the immense potential of leveraging ensemble machine learning models with traditional sperm quality assessments. This integrated approach can elevate the precision and personalization of clinical decision-making in the field of assisted reproductive technologies, ultimately offering more hope and better outcomes for couples struggling with infertility.

Impact of Conservation Tillage and Nitrogen Management on Soil Temperature and Soil Moisture in Aerobic Rice

This study investigates the impact of different tillage practices, namely Conventional Tillage (CT) (T1), Minimum Tillage with residue retention (MT) (T2) and Zero Tillage (ZT) (T3) and nitrogen fertilizer schedules 100% RDN (N1) (120 kg ha-1), 100% RDN + foliar spray of nano urea 2.5 ml l-1 at active tillering and panicle initiation stage (N2), 100% RDN + foliar spray of nano DAP 2.5 ml l-1 at active tillering and panicle initiation stage (N3), 75% RDN + Nano urea 2.5 ml l-1 at active tillering and panicle initiation stage (N4), 75 % RDN + Nano DAP 2.5 ml l-1 at active tillering and panicle initiation stage (N5) on soil temperature, moisture and their interaction in aerobic rice cultivation. Soil temperature was measured using digital thermometer and soil moisture was determined by Owen drying method. Results revealed that soil temperature and soil moisture was significantly influenced by tillage practices and Nitrogen fertilizer schedules showed no significant effect on soil temperature and soil moisture. Zero tillage (T3) consistently recording the lowest soil temperatures compared to T1 and T2 in both years. During rabi 2022-2023, T3 recorded 18.23°C in the 1st week, significantly lower than T1 (19.32°C). This trend persisted in the rabi 2023-2024, with T3 recording 27.1°C in the 19th week, significantly lower than T1 (28.61°C). In terms of soil moisture, zero tillage (T3) also consistently resulted in the highest moisture levels. During rabi 2022-2023 season, T3 recorded 18.93% soil moisture in the 1st week, significantly higher than T1 (18.11%). This pattern continued in the rabi 2023-2024, with T3 maintaining significantly higher moisture levels in most weeks. Zero tillage is effective in reducing soil temperature and enhancing soil moisture retention. Minimum tillage with residue retention performing similar to zero tillage.

Analysis of Construction Project Cost and Time Using the Earned Value Method

This study aims to analyze the cost and time performance of the renovation project of Arwana Restaurant The Laguna Resort and Spa Nusa Dua by applying the Earned Value method. The data used in this study include the Cost Budget Plan (RAB), project implementation schedule, weekly project progress reports, and project expenditure reports. The calculation is done by calculating the value of ACWP (Actual Cost of Work Performed), BCWS (Budgeted Cost of Work Schedule), BCWP ( Budgeted Cost of Work Performed ), CV ( Cost Variance ), SV ( Schedule Variance ), CPI (Cost Performance Index), SPI (Schedule Performance Index), ETC (Estimate to Complete), ETS (Estimate Time to Complete), EAC (Estimate at Completion), and EAS (Estimate at Schedule). The results of the analysis show that at the beginning of the project the performance was good, but other things began to decline from the 11th week to the 23rd week. At the end of the project, performance improved again as indicated by a CPI value of 1.07 and an SPI of 1 indicating lower costs and time according to plan. The estimated total final project cost (EAC) of Rp2,947,878,984.57 was lower than the Cost Budget Plan (RAB) of Rp3,143,852,000, resulting in a profit of Rp195,973,015.43. The estimated total final project time (EAS) was in accordance with the planned schedule, which was 27 weeks. In conclusion, overall the project performance was quite good even though it had declined in the middle of the project implementation.

The role of the lower uterine segment thickness in predicting preterm birth in twin pregnancies presenting with threatened preterm labor.

To examine the relationship between the lower uterine segment (LUS) thickness and the onset of labor in dichorionic twin pregnancies experiencing threatened preterm labor. This prospective cohort study included dichorionic twin pregnancies between 24 and 32weeks of gestation, presenting with symptoms of preterm labor. The LUS thickness and mid-anterior wall thickness were measured via transabdominal ultrasonography, cervical length, and posterior cervical lip thickness were measured transvaginally. The presence of the cervical sliding sign and funneling findings were recorded. Among the patients with an onset of labor before the 34th week, the mean LUS thickness was 3.8±0.9 mm, compared to 4.6±1.1 mm in those with an onset of labor at or after 340/7 GW, indicating a statistically significant difference (p=0.012). Similarly, accepting the GW threshold as 350/7 weeks, a statistically significant difference was found in the mean LUS thickness, which was 4.0±1.0 mm in those with an earlier onset of labor and 4.7±1.0 mm in those with a later onset of labor (p=0.022). While univariate analysis indicated that the LUS thickness was a significant predictor (p=0.017 for <34 GW and p=0.028 for <35 GW), multivariate analysis showed a reduced effect (p=0.04 and p=0.06, respectively). LUS was significantly thinner in pregnancies with an onset of labor before the 34th and 35th GW. The measurement of the LUS thickness can be considered an alternative method for predicting spontaneous preterm birth in dichorionic twin pregnancies.