37th Week Of Gestation Research Articles

Fetal Echocardiography Audit in a Tertiary Hospital in Ibadan, Nigeria

Background: Delayed detection of congenital heart diseases in low- and middle-income countries (LMICs) contributes to the poor outcome of infants with cardiac anomalies. Fetal echocardiography (FE) can detect heart defects in-utero as early as the 18th gestational week (GA), giving parents and medical professionals time to prepare for the baby's delivery and appropriate treatment. University College Hospital, Nigeria, is one of the few centres in Nigeria where FE is performed. Objectives: To examine the indications for referral for FE and the diagnoses made in our first four years of performing FE. Methods: FE was performed in the antenatal clinic of the University College Hospital, Ibadan, Nigeria, using the GE Voluson P6 machine with a 2-6-RS probe. Demographic information was obtained from the antenatal clinic records of the women who had FE using a semi-structured questionnaire. FE diagnoses were retrieved from the FE register. Results: A total of 129 women whose records were available were recruited for this study. The mean age of the women was 31.7±5.5 years. Forty-two women (32.6%) were referred because of echogenic foci, making this the most common indication for FE. Twenty-nine (22.5%) fetuses had structural heart defects, the most common being Ventricular Septal Defect. Conclusion: There is a need for Obstetricians and Paediatricians to be aware of the indications for fetal echocardiography and refer women appropriately.

Adequacy of prenatal care and associated factors in the State of Rio Grande do Sul, Brazil.

This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15-49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women's prenatal cards, hospital records, and medical reports. The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.

Maternal inflammatory, lipid and metabolic markers and associations with birth and breastfeeding outcomes.

Conditions in utero influence intrauterine and postnatal infant growth and a few studies indicate that maternal inflammation and insulin resistance might affect birth and breastfeeding outcomes. Furthermore, hormones in human milk (HM) may influence infant appetite-regulation and thereby milk intake, but the associations are less understood. (1) To investigate associations between maternal inflammatory, lipid and metabolic markers and birth and breastfeeding outcomes, and (2) to assess predictors of maternal inflammatory, lipid and metabolic markers in pregnancy. Seventy-one mother-infant dyads participating in the Mothers, Infants and Lactation Quality (MILQ) study were included in the present study. Fasting blood samples were collected around 28th gestational week, and HM samples at three time points from 1.0 to 8.5 months, where milk intake was assessed using 24-h test weighing. Maternal plasma inflammatory, lipid and metabolic markers included high-sensitive C-reactive protein (hs-CRP), tumor-necrosis factor-α (TNFα), interferon-γ (IFNγ), Interleukin (IL)-6, IL-8, high-, low-, and very-low-density lipoprotein (HDL, LDL, VLDL), total-cholesterol, triglycerides, leptin, adiponectin, insulin, C-peptide, the homeostasis model assessment of insulin resistance (HOMA-IR) and glucose concentration at t = 120 min following an oral glucose tolerance test. Of these, TNFα, IFNγ, IL-6, IL-8, leptin, adiponectin and insulin were also measured in HM samples. HDL in pregnancy was inversely associated with gestational age (GA) at birth and GA-adjusted birthweight z-score, whereas triglycerides and glucose (t = 120) were positively associated with GA-adjusted birthweight z-score. Higher hs-CRP, VLDL and triglycerides were associated with a higher placental weight. Furthermore, higher HDL, insulin, leptin and HOMA-IR were associated with longer duration of exclusive breastfeeding (EBF). Higher pre-pregnancy BMI was the main predictor of higher levels of hs-CRP, log-TNFα, leptin, insulin, C-peptide, and HOMA-IR. Maternal lipid and metabolic markers influenced birthweight z-score and placental weight as well as duration of EBF. Furthermore, pre-pregnancy BMI and maternal age predicted levels of several inflammatory and metabolic markers during pregnancy. Our findings indicate that maternal lipid and metabolic profiles in pregnancy may influence fetal growth and breastfeeding, possibly explained by overweight and/or higher placental weight. https://clinicaltrials.gov/, identifier NCT03254329.

Congenital Central Hypoventilation Syndrome (Ondine’s Curse): Clinical Case

Background. Congenital central hypoventilation syndrome (CCHS), or Ondine’s Curse, is rare, incurable and life-threatening disease characterized by autonomic nervous system disorders, it manifests with disability to maintain ventilation function during sleep. Sensitivity to hypoxia and hypercapnia is reduced in case of CCHS, thus, it leads to recurrent episodes of deep apnea. The world literature describes just over 1000 cases of this disease. Clinical case description. An infant born at 37th week of gestation, weight of 3330 g, had episodes of apnea and hypercapnia from the first day of life. CCHS was suspected by the 28th day of life after excluding other causes of respiratory disorders, and it was genetically confirmed by the 43rd day of life — pathogenic variant of PHOX2B gene was revealed. Mechanical ventilation has been initiated by the age of 1 month after disease worsening. Analysis of CCHS cases published in Russian-language medical literature was performed. Typical symptoms and timing of their manifestation, as well as the time before correct diagnosis were mentioned. Conclusion. Symptoms that can be suggestive of CCHS presence early after birth and can urge to perform all the necessary genetic testing that are crucial for timely treatment onset and for minimizing the negative effect of hypoxemia and hypercapnia on the child are described.

Liver Transplantation for Acute Liver Failure During Pregnancy: Case Report and Literature Review

Liver failure during pregnancy is a rare and highly fatal condition frequently resulting from the patient's pre-existing chronic liver disease. There is no established protocol for managing this condition, and physicians tend to adopt a conservative approach due to concerns about the impact of liver transplantation on fetal development. However, conservative treatment may exacerbate the condition, increasing the risk of fetal and miscarriage deaths. In this study, we present a case of acute-on-chronic liver failure resulting from chronic hepatitis during the 19th week of gestation. Despite undergoing conservative treatment, the fetus tragically died, but the patient achieved an excellent clinical outcome after emergency liver transplantation. We also conducted a systematic review of the literature on liver transplantation during pregnancy from the last decade, examining the causes of liver failure and transplantation during pregnancy. Our research complied with the principles outlined in the Declaration of Helsinki and the Istanbul Declaration.

Qatar population-specific centile charts of placental weight in 80 722 newborns: relation to maternal age, gestational age, newborn birth weight, and gender, between the 37 th and 42 nd weeks of gestation.

Data about placental weight (PW) in relation to birth weight (BW) and gestational age (GA) are lacking in Arabic countries. (a) to find out the national PW standards for babies born between 37th and 42nd weeks of gestation in male and female babies born in Qatar; (b) to study the relation, if any, between PW and maternal age, gestational age (GA), birth weight (BW), and gender of the newborn. A National population-based retrospective chart review study was conducted between 1-2016 to 12-2019 (n = 80 722). Data of gestational age (GA) at delivery (in weeks), newborn birth weight (BW), PW, and gender at birth, were collected from singleton babies born between 37 th and 42nd weeks of gestation. The PW ranged from 440 to 860 grams (g) with a mean of 682 ± 96 g. at term for boys and 673 ± 94 g. for girls. The mean BW was 3 036 ± 448 g and BW/PW ratio was 0.203 ± 0.026. The PW continued to increase through 41 weeks' gestation, in boys and girls with a significant decrease at the 42nd week of gestation. PW was significantly correlated with BW (r = 0.596, P: < 0.001) and GA (r = 0.15, P: <0.001) and accounted for 43.4% of the explained variability in birth weight. PW was a significant predictor of BW with a consistent increase in PW until the 41st week of gestation in boys and girls and a positive correlation with BW and GA.

Circulating hyaluronidase in early pregnancy and increased risk of gestational diabetes in Chinese pregnant women: A nested case control study

Background and aimsTo explore association of serum hyaluronidase 1 (HYAL1) level in early pregnancy with gestational diabetes mellitus (GDM), and to examine interactive effects of HYAL1 with ceramides species on GDM risk. Materials and methodsWe conducted a 1:1 matched case-control study (n = 414) of pregnant women from 2010 to 2012 in Tianjin, China. Blood samples were collected at the first antenatal care visit (at a median of 10th gestational weeks). Binary conditional logistic regression and restricted cubic spline (RCS) analysis were used to examine full-range risk association between HYAL1 and GDM. Additive interactions and multiplicative interactions were employed to test interactive effects of HYAL1 with ceramides species on GDM risk. ResultsLn HYAL1 was linearly associated with GDM risk and the adjusted OR of HYAL1 ≥ vs. < its median for GDM was significant (1.65, 95%CI: 1.08–2.52). High HYAL1 markedly enhanced the ORs of high ceramide 18:0 for GDM from 2.31 (1.06–5.01) to 6.74 (2.85–16.0), and low ceramide 24:0 from 3.08 (1.33–7.11) to 8.15 (3.03–21.9), with significant additive interactions. ConclusionsHigh HYAL1 in early pregnancy may increase the risk of GDM in Chinese women, possibly via enhancing the effects of high ceramide 18:0 and low ceramide 24:0 on GDM risk.

Influence of a Concurrent Exercise Training Program on Health-Related Quality of Life During Advanced Pregnancy: The GESTAFIT Project.

Health-related quality of life (HRQoL) may be altered during pregnancy due to pregnancy-related changes in all domains of women's health. A supervised concurrent exercise-training program from the 17th gestational week until birth positively influences HRQoL. Randomized controlled trial. Level 1. Eighty-six pregnant women (age, 33.1 ± 4.6 years; prepregnancy body mass index, 23.5 kg/m2), divided into exercise (n = 41) and control (n = 45) groups, participated in this study (per-protocol basis). The exercise group followed a 60-min, 3 days/week, concurrent (aerobic + resistance) exercise training program. HRQoL was assessed with the 36-Item Short Form Health Survey (SF-36), where higher scores (0-100) indicate better HRQoL. After adjusting for potential confounders, the exercise group decreased 16.1 points less than the control group in the SF-36 physical functioning domain [between-group differences (B): 95% confidence interval (CI), 9.02 to 23.22; P < 0.01], and 4.5 points less in the SF-36 physical component summary than the control group (between-group differences (B): 95% CI, 0.65 to 8.28; P = 0.02). Intention-to-treat basis analyses depicted similar results, where the exercise group decreased 10.03 points less than the control group the in the SF-36 social functioning domain (between-group differences (B): 95% CI, 0.39 to 19.68; P = 0.04). A supervised concurrent exercise training program ameliorates HRQoL decreases along gestation. Although HRQoL decreased throughout pregnancy in both groups, this impact was less in the exercise group, especially in the SF-36 physical functioning, the SF-36 social functioning, and the SF-36 physical component summary. Healthcare providers may encourage pregnant women to exercise in this physiological stage for a better HRQoL throughout pregnancy. NCT02582567; Date of registration: 20/10/2015.

Correlation between Neonatal Outcomes and Maternal Anemia among Attending Pregnant Women in Al-Elwiya Maternity Teaching Hospital.

Anemia in pregnancy can considerably elevate the maternal mortality risk and can negatively distress the development of fetus. To assess the association between neonatal outcomes and maternal anemia (MA) among pregnant women (PW). The present work is a clinical prospective one performed at Al-Elwiya Maternity Teaching Hospital in Baghdad from January 1, 2022 to June 30, 2022. Current study selected 120 term PW with anemia admitted to hospital for caesarian section. Data were collected as a questionnaire. The data were directly taken from PW. The acquired data from anemic PW were distributed as followings: Age of anemic PW, which was classified into two groups; 25-29 years and 30-35 years. The gestational age of anemic PW, which was categorized into three groups; 37th week, 38th week, and 39th week of gestation. Anemia characteristics were studied, which included hemoglobin level (Hb) and packed cell volume test (PCV), which were done by taking 5 ml blood from each PW for s. ferritin, s.iron, Hb level, and blood film in laboratory of Al-Elwiya Maternity Teaching Hospital. The Hb helped in detecting anemic PW joined this study, as Hb was <10.5 g/dl at third trimester. Mean gestational age (GA) of anemic PW was 37.5 ± 0.5 weeks; 58.3% of them were at 37th week, 39.2% of them were at 38th week, and 2.5% of them were at 39th week GA. So, the mean Hb of anemic PW was 8.6 ± 1.3 mg/dl, and the mean PCV was 28.6 ± 3.6%. Anemia was classified into mild (20%) and moderate (72.5%); also, mean ultrasound fetal head circumference (HC) among PW with mild anemia was 32.3 cm and for PW with moderate anemia was 32.1 cm, and mean ultrasound fetal abdominal circumference (AC) for PW with mild anemia was 31.3 cm and with moderate anemia was 31 cm, and validity results of MCA/UA-PI ratio regarding severe anemia of anemic were as follows: sensitivity (81.8%), specificity (79.8%), +ve predictive value (29%), -ve predictive value (97.8%), and accuracy (80%). The gestational mean age (GA) of anaemic PW was 37.50.5 weeks; 58.3% of them were in the 37th week and 39.2% were in the 38th week. Thus, the mean ultrasound foetal head circumference (HC) was 32.3 cm for PW with mild anemia and 32.1 cm for those with moderate anaemia. The mean ultrasound foetal abdominal circumference (AC) was 31.3 cm for those with mild anaemia and 31 cm for those with moderate anaemia, but 30 cm for those with severe anaemia, with no discernible difference. The following were the MCA/UA-PI ratio's validity findings for severe anaemia of anaemic: sensitivity (81.8%) and specificity (79.8%).

Herniated amniotic sac through uterine dehiscence at the 30th gestational week after prior laparoscopic salpingectomy

Uterine rupture is a rare complication during pregnancy which may even lead to the death of the mother and the fetus. In this report, the management of a herniated amniotic sac associated with uterine dehiscence is presented. A 25-year-old primigravida at 30 weeks with a history of a previous unilateral salpingectomy was transferred to our hospital with the potential diagnosis of a herniated amniotic sac, which was discovered during a routine ultrasound scan. The patient had no prior complaints or any other signs that would have indicated a serious condition during her pregnancy. She underwent an emergency cesarean section and a two-layer closure of the lesion. An adequate suture during laparoscopic salpingectomy provides prevention of uterine rupture during subsequent pregnancies. A medical history with a previous laparoscopic dehiscence should necessitate a more frequent sonographic observation during pregnancy. Orv Hetil. 2023; 164(25): 988-992.

#6931 TWO CASES OF PREGNANCY IN PATIENTS WITH TUBEROUS SCLEROSIS COMPLEX

Abstract Background and Aims Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder that is characterized by formation of benign tumors of the brain, kidney, eyes, heart, lung, liver and skin. The disease is frequently associated with adverse pregnancy outcomes. Our aim is to present two cases of Tuberous sclerosis complex in pregnancy which might be illustrative in the management of these patients. Method The first patient was a 32-year-old woman with a history of renal angiomyolipoma (AML) and pulmonic lymphangiomyomathosis (LAM) due to Tuberous sclerosis complex diagnosed at a young age. In the 35th gestational week she had an emergency Cesarean section due to acute retroperitoneal bleeding from angiomyolipoma of the right kidney and gave birth to a preterm male infant (birth mass 2077 g, Apgar 4/6). The patient did not take any medications during the course of pregnancy. Since 2015 she is being treated with everolimus (5 mg/day) due to complications for pulmonic lymphangiomyomathosis, subependymomas and epilepsy and AMLs. After eight years of treatment renal AMLs and LAM and subependymomas show no dynamic in size or number. The second patient was a 29-year-old nulliparous woman who has presented with seizures at the age of 2 and was diagnosed with TSC. At 37th gestational week of a twin pregnancy she gave birth to one male neonate (birth mass 2660 g, Apgar 8/9), while the other fetus died in utero. During the course of the pregnancy she was treated with phenobarbital, folic acid and iron supplementation. Her epilepsy is well-controlled and AMLs show no dynamic in size or number. Results: Conclusion We have showed two cases with relatively good outcomes which have long-term stable disease. Female patients with TSC have increased risk of hemorrhagic complications of AMLs during pregnancy and it can be complicated by intrauterine growth restriction. A multidisciplinary approach is needed in the planning and monitoring pregnancies in these patients to achieve optimal outcomes.

Influence of a concurrent exercise training program during pregnancy on the placenta mitochondrial DNA integrity and content of minerals with enzymatic relevance. The GESTAFIT project

IntroductionWe aimed i) to investigate the effects of a concurrent (aerobic plus strength) exercise intervention during pregnancy on placental mtDNA copy number, proportion of deleted mtDNA, and on the content of some trace and ultra-trace minerals with coenzymatic relevance; ii) to explore the association of such mitochondrial markers with the concentration of these minerals. MethodsFor the present study specific aims, 47 placentas were randomly selected from women that participated in the GESTAFIT project into exercise (n = 24) or control (n = 23) groups. The exercise group followed a concurrent aerobic and strength training program, three 60-min sessions/week, from the 17th gestational week until birth. Placenta tissue was collected and processed for minerals determination by the inductively coupled plasma mass spectrometry technique. RT-PCR was used to determine placentas mtDNA copy number and ND1/ND4 deletion. ResultsAfter adjusting for potential confounders, the mothers who participated in the exercise program had placentas with greater mtDNA copy number (p = 0.04) and lower mtDNA deletion (p = 0.003). Placentas from mothers in the exercise group presented higher manganese content than those from the controls (0.26 ± 0.03 mg/dL vs. 0.13 ± 0.03 mg/dL, p = 0.003). Placenta manganese content was significantly associated with lower mtDNA deletions (r = −0.382) and greater mtDNA copy number (r = 0.513). Iron content was associated with higher mtDNA copy number (r = 0.393). Selenium content was associated with lower mtDNA deletion (r = −0.377) and greater mtDNA copy number (r = 0.442). Finally, zinc and magnesium content were associated with higher mtDNA copy number (r = 0.447 and r = 0.453, respectively). DiscussionThis concurrent exercise training program induced a better placental status, which might be mediated through an improvement of mitochondrial bioenergetics and antioxidative capacity.

Investigation of Serum Phoenixin-14 Concentration in Pregnant Women Diagnosed with Hyperemesis Gravidarum.

We aimed to investigate the relationship between the hyperemesis gravidarum (HG) and maternal serum phoenixin-14 (PNX-14) concentrations. This cross-sectional study was conducted with 88 pregnant women who applied to the Umraniye Training and Research Hospital Gynecology and Obstetrics Clinic between February 2022 and October 2022. The HG group consisted of 44 pregnant women diagnosed with HG between the 7th and 14th gestational weeks, and the control group consisted of 44 healthy pregnant women matched with the HG group in terms of age, BMI, and gestational week. Demographic characteristics, ultrasound findings, and laboratory outcomes were noted. The two groups were compared in terms of maternal serum PNX-14 concentrations. Gestational age at blood sampling for PNX-14 was similar in both groups (p=1.000). While maternal serum PNX-14 concentration was 85.5 pg/ml in the HG group, it was 71.3 pg/ml in the control group (p=0.012). ROC analysis was performed to determine the value of maternal serum PNX-14 concentration in terms of predicting HG. AUC analysis of maternal serum PNX-14 for HG estimation was 0.656 (p=0.012, 95% CI=0.54-0.77). The optimal cutoff value for maternal serum PNX-14 concentration was determined as 79.81 pg/ml with 59% sensitivity and 59% specificity. In this study, maternal serum PNX-14 concentration was found to be higher in pregnant women with HG, which indicates that high serum PNX-14 concentrations may have an anorexigenic effect on food intake in pregnancy. Concentrations of other PNX isoforms in HG and changes in PNX concentrations in pregnant women with HG who regained weight after treatment remain to be investigated.

Role of Matrix Metalloproteinase–9 in the Pathogenesis of Preeclampsia

Objectives: The goal of this research was to investigate whether metalloproteinases could be used as predictors of preeclampsia (PE) during pregnancy. Materials and Methods: This case-control study included 100 pregnant women which they further grouped into PE and control group (each composed of 50 women). Both groups were further subdivided according to their gestational age (GA), using the 37th week of gestation as a divider, as preterm and term infants. Results: In both preterm (P=0.001) and term infants (P=0.001), mean metalloproteinase-9 (MMP-9) was considerably lower in PE mothers compared to controls, with the difference being greater in preterm infants. In ROC analysis, MMP-9 showed excellent ability to predict PE in preterm infants (AUC = 0.980, cut-off ≤26.2) and good ability to predict PE in term infants (AUC 0.770, cut-off ≤ 34.4). Conclusions: The matrix MMP-9 is a non-specific predictor of PE for term and preterm pregnant women, with higher accuracy for preterm pregnant women.

Wernicke encephalopathy revealed by areflexic flaccid tetraparesis associated with gravidarum hyperemesis.

The authors present the case of a 25-year-old female patient at the 19th week of gestation (Gravid 1 para 0) with an unremarkable medical history who was admitted to the hospital for an areflexic flaccid tetraparesis with ataxia after persistent vomiting. The brain and spinal MRIs did not reveal any abnormalities, and the evolution was marked by an important improvement after supplementation with thiamine. Gayet Wernicke encephalopathy is a medical emergency. Clinical symptoms are inconstant and varied. MRI is the reference examination to confirm the diagnosis, but in 40% of cases it is strictly normal. Early thiamine administration can prevent morbidity and mortality in pregnant women.

Cold knife conization for cervical cancer in the second trimester of pregnancy: a case report

Cervical cancer is one of the most common oncologic diseases, diagnosed during pregnancy and its management significantly varies depending on the stage of the cancer, the age of the pregnancy, and the patient’s wishes. We present a case of a 31-year-old multiparous woman, diagnosed with cervical cancer during routine pregnancy monitoring at 12 weeks of gestation. Due to desire to keep the pregnancy, the cervical cancer was treated during the 14th gestational weeks of the pregnancy and a cold knife conization was done. The pregnancy was successful with a normal delivery in 39th gestational week. The presented case is an example for the role and importance of colposcopy in the diagnostic management of abnormal cytology, diagnosed during pregnancy.

EFFECT OF SUBCLINICAL HYPOTHYROIDISM ON MATERNAL AND PERINATAL OUTCOME

Background:Adverse maternal outcomes and perinatal complications are closely associated with overt maternal hypothyroidism, but whether these complications occur in women with subclinical hypothyroidism (SCH) during pregnancy remains controversial.The aim of this study was to evaluate the effects of SCH on maternal and perinatal outcomes during pregnancy. Methods:This retrospective cohort study was conducted by examining the pregnant women who applied to the Gynaecology Department of Hind Institute of Medical Sciences and Hospital at their 6th to 14th gestational weeks and had antenatal follow-ups between February 1, 2021 and December 31, 2022. Results: The TSH concentration was significantly lower in the first trimester than in the third trimester (P,0.001). The fT4 concentration was higher in the first trimester than in the second and third trimesters (P,0.001). The incidences of GH and PROM were significantly higher in women with SCH than in euthyroid women (5% vs. 1.57%, P= 0.020 10% vs. 5%, P= 0.002).IUGR was more frequent in women with SCH than in euthyroid women (7.5% vs. 1.3%, P,0.001). More LBW infants were delivered in the SCH group than in the euthyroid group (12.5% vs. 5%, P,0.001). Conclusion:The results of this study indicate that pregnant women with SCH had increased risks of GH and PROM, and their foetuses and infants had increased risks of IUGR and LBW. Thus, routine maternal thyroid function testing is necessary to improve maternal and perinatal outcomes.

The impact of cerclage placement on gestational length in women with premature cervical shortening.

Cervical insufficiency (CI) is a condition consistent with painless cervical dilatation that can lead to preterm delivery. Cervical cerclage is a procedure in which cervical suture is performed for preventing preterm labor in several indications. Late emergency cerclage is technically more challenging compared to elective cerclage, performed earlier during pregnancy, prior to cervical changes. Pregnancy outcomes with emergency cerclage were found to be improved in previous reports, but there is still inconclusive data. To assess the effectiveness and safety of emergency cerclage vs. conservative management with progesterone and/or bed resting, in preventing preterm birth and improving neonatal outcomes in women with clinically evident cervical insufficiency. This is a retrospective cohort study conducted on all women diagnosed with cervical insufficiency between the 16th and 24th gestational week who met the inclusion criteria, from January 2012 to December 2018. Obstetric and neonatal outcomes: time from diagnosis to delivery, duration of pregnancy, birth weight and Apgar score, were compared between women who underwent cerclage and those who treated conservatively. Twenty eight women underwent emergency cerclage (cerclage group) and 194 managed with a conservative therapy, progesterone and/or bed rest (control group). Time from diagnosis to delivery 13 weeks vs. 8weeks and birth weight 2,418 g vs. 1914 g were significantly higher in the first cohort. Average pregnancy duration was three weeks longer in the cerclage group, but that was not significant. No complications occurred in the cerclage group and no difference in mode of delivery were found. Emergency cerclage is an effective and safe procedure in preventing preterm birth and prolongation of pregnancy, in women with cervical insufficiency in the late second trimester.

Synergic effects of PM1 and thermal inversion on the incidence of small for gestational age infants: a weekly-based assessment.

The synergic effects of thermal inversion (TI) and particulate matter with an aerodynamic diameter ≤1 μm (PM1) exposure and incidence of small for gestational age (SGA) was not clear. We aimed to explore the independent effects of prenatal TI and PM1 exposure on incidence of SGA and their potential interactive effects. A total of 27,990 pregnant women who delivered in Wuhan Children's Hospital from 2017 to 2020 were included. The daily mean concentration of PM1 was obtained from ChinaHighAirPollutants (CHAP) and matched with the residential address of each woman. Data on TI was derived from National Aeronautics and Space Administration (NASA). The independent effects of PM1 and TI exposures on SGA in each gestational week were estimated by the distributed lag model (DLM) nested in Cox regression model, and the potential interactive effects of PM1 and TI on SGA were investigated by adapting the relative excess risk due to interaction (RERI) index. Per 10 μg/m3 increase in PM1 was associated with an increase in the risk of SGA at 1-3 and 17-23 gestational weeks, with the strongest effect at the first gestational week (HR = 1.043, 95%CI: 1.008, 1.078). Significant links between one day increase of TI and SGA were found at the 1-4 and 13-23 gestational weeks and the largest effects were observed at the 17th gestational week (HR = 1.018, 95%CI: 1.009, 1.027). Synergistic effects of PM1 and TI on SGA were detected in the 20th gestational week, with RERI of 0.208 (95%CI: 0.033,0.383). Both prebirth PM1 and TI exposure were significantly associated with SGA. Simultaneous exposure to PM1 and TI might have synergistic effect on SGA. The second trimester seems to be a sensitive window of environmental and air pollution exposure.

Non immune hydrops fetalis due to Parvovirus B19 infection. A case report

Backround: The term “hydrops fetalis” refers to excessive accumulation of pathologic serous fluid within the fetal soft tissues and body cavities. There are two categories, the immune and the nonimmune hydrops (NIHF). Currently 90 percent of cases of hydrops are nonimmune, because of the decrease of incidence of immune with the advent of anti-D immune globulin. Case presentation: We present a case of Parvovirus B19 (PB19) infection that resulted in NIHF. Fetus had severe ascites, mild pericardial effusion and mild myocardial dilation, that appeared during the 30th gestational week. Fetal evaluation with sonography was repeated every week and the fetal growth curves, Dopplers and amniotic fluid index were normal. Each week there was a gradual recession of the effusions until the 36th gestational week, when they eventually resolved without any treatment. After delivery, the neonate was symptom – free. Conclusions: The cause of NIHF is identified in at least 60 percent prenatally and in more than 80 percent postnatally, while only 40 percent of pregnancies with NIHF result in a liveborn neonate. The prognosis is heavily dependent on etiology. Diaplacental transmission of PB19 on second trimester can cause fetal complications like hydrops, premature rapture of membranes, even fetal loss in about 30 percent. These cases should be closely followed in a Fetal Medicine Unit, especially if there is evidence of fetal anemia or hydrops.