37th Week Of Gestation Research Articles

Proposing a machine-learning based method to predict stillbirth before and during delivery and ranking the features: nationwide retrospective cross-sectional study

BackgroundStillbirth is defined as fetal loss in pregnancy beyond 28 weeks by WHO. In this study, a machine-learning based method is proposed to predict stillbirth from livebirth and discriminate stillbirth before and during delivery and rank the features.MethodA two-step stack ensemble classifier is proposed for classifying the instances into stillbirth and livebirth at the first step and then, classifying stillbirth before delivery from stillbirth during the labor at the second step. The proposed SE has two consecutive layers including the same classifiers. The base classifiers in each layer are decision tree, Gradient boosting classifier, logistics regression, random forest and support vector machines which are trained independently and aggregated based on Vote boosting method. Moreover, a new feature ranking method is proposed in this study based on mean decrease accuracy, Gini Index and model coefficients to find high-ranked features.ResultsIMAN registry dataset is used in this study considering all births at or beyond 28th gestational week from 2016/04/01 to 2017/01/01 including 1,415,623 live birth and 5502 stillbirth cases. A combination of maternal demographic features, clinical history, fetal properties, delivery descriptors, environmental features, healthcare service provider descriptors and socio-demographic features are considered. The experimental results show that our proposed SE outperforms the compared classifiers with the average accuracy of 90%, sensitivity of 91%, specificity of 88%. The discrimination of the proposed SE is assessed and the average AUC of ±95%, CI of 90.51% ±1.08 and 90% ±1.12 is obtained on training dataset for model development and test dataset for external validation, respectively. The proposed SE is calibrated using isotopic nonparametric calibration method with the score of 0.07. The process is repeated 10,000 times and AUC of SE classifiers using random different training datasets as null distribution. The obtained p-value to assess the specificity of the proposed SE is 0.0126 which shows the significance of the proposed SE.ConclusionsGestational age and fetal height are two most important features for discriminating livebirth from stillbirth. Moreover, hospital, province, delivery main cause, perinatal abnormality, miscarriage number and maternal age are the most important features for classifying stillbirth before and during delivery.

MiR-16-5p, miR-103-3p, and miR-27b-3p as Early Peripheral Biomarkers of Fetal Growth Restriction.

Current tests available to diagnose fetal hypoxia in-utero lack sensitivity thus failing to identify many fetuses at risk. Emerging evidence suggests that microRNAs derived from the placenta circulate in the maternal blood during pregnancy and may be used as non-invasive biomarkers for pregnancy complications. With the intent to identify putative markers of fetal growth restriction (FGR) and new therapeutic druggable targets, we examined, in maternal blood samples, the expression of a group of microRNAs, known to be regulated by hypoxia. The expression of microRNAs was evaluated in maternal plasma samples collected from (1) women carrying a preterm FGR fetus (FGR group) or (2) women with an appropriately grown fetus matched at the same gestational age (Control group). To discriminate between early- and late-onset FGR, the study population was divided into two subgroups according to the gestational age at delivery. Four microRNAs were identified as possible candidates for the diagnosis of FGR: miR-16-5p, miR-103-3p, miR-107-3p, and miR-27b-3p. All four selected miRNAs, measured by RT-PCR, resulted upregulated in FGR blood samples before the 32nd week of gestation. By contrast, miRNA103-3p and miRNA107-3p, analyzed between the 32nd and 37th week of gestation, showed lower expression in the FGR group compared to aged matched controls. Our results showed that measurement of miRNAs in maternal blood may form the basis for a future diagnostic test to determine the degree of fetal hypoxia in FGR, thus allowing the start of appropriate therapeutic interventions to alleviate the burden of this disease.

A successfully treated case of an acute presentation of congenital thrombotic thrombocytopenic purpura (Upshaw–Schulman syndrome) with decreased ADAMTS13 during late stage of pregnancy

We herein report the case of a 28-year-old pregnant woman with an acute presentation of remarkable petechiae on her lower extremities and severe thrombocytopenia (16 000/mm3 ) at the 35th week of gestation. Although idiopathic thrombocytopenic purpura was initially suspected, subsequent examinations revealed that her ADAMTS13 (a Disintegrin And Metalloprotease, with ThromboSpondin type 1 repeats, member 13) titer was extremely decreased, while she was negative for antibodies against ADAMTS13. Infusion of fresh frozen plasma was immediately performed, and the platelet count was observed to increase. However, severe pregnancy-induced hypertension and proteinuria emerged at 36 weeks and 2 days of gestation, and a male infant was delivered by emergency cesarean section on the 37th week of gestation. The postnatal development was uncomplicated. After delivery, although the mother's platelet count and ADAMTS13 activity decreased temporarily, both values increased following fresh frozen plasma transfusion. This case showed interesting aspects of congenital thrombocytopenic purpura (Upshaw-Schulman syndrome) in pregnancy. Moreover, the rapid measurement of the patient's ADAMTS13 activity and the subsequent accurate diagnosis of congenital thrombocytopenic purpura made it possible to treat the patient with fresh frozen plasma infusion and avoid contraindicated platelet infusion. Close cooperation between obstetricians, hematologists and pediatricians is necessary to achieve successful outcomes in cases of thrombocytopenic purpura during pregnancy.

Prevention of preterm delivery by cervical cerclage; a comparison of prophylactic and emergency procedures

Objective:Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes.Material and Methods:Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center.Results:Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6±4.5 and 33.6±5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery ≥34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery.Conclusion:Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures.

Pregnancy Risk Factors as Predictors of Offspring Cerebrovascular Disease: The Northern Finland Birth Cohort Study 1966.

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Complete blood count parameters to predict retinopathy of prematurity: when to evaluate and what do they tell us?

To evaluate the relationship of novel inflammatory markers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with retinopathy of prematurity (ROP) development and requirement for laser photocoagulation (LP) treatment. The charts of infants screened for ROP were reviewed retrospectively, and 120 newborns who had complete blood count (CBC) data in the first 24hours after delivery (early period) and between 35 and 37th gestational weeks (late period) were included. Study population consisted of 34 infants who required LP for ROP treatment, 52 newborns with ROP that regressed without treatment, and 34 controls who did not developed any ROP stages. Demographics, etiological factors and CBC data including NLR and PLR values were noted. Risk factors forROP development and treatment requirement were investigated using logistic regression analyses. Significantly lower NLR was found in ROP cases compared to non-ROP group during late period (p = 0.003), while there was no difference in NLR during early period (p = 0.298). No significant difference was observed in PLR during both early and late periods (p = 0.230 and p = 0.349, respectively). Multivariate analysis revealed daily weight gain as major risk factor for ROP development (p = 0.001; OR: 0.870, 95% CI: 0.799-0.947), and hyperbilirubinemia as an independent risk factor for LP requirement (p = 0.045; OR: 0.204, 95% CI: 0.043-0.966). NLR or PLR does not appear to be predictive risk factors for treatment requirement in cases with ROP. CBC values during first 24h of life may be misleading; therefore, a late period CBC is recommended to evaluate prognostic factors for ROP development.

A CASE STUDY ON 3 WEEKS PREMATURE RUPTURE OF MEMBRANES CAUSED BY OROPHARYNGEAL MICROBIOTA

Premature rupture of membrane (PROM) is produced when amniotic membranes tear before labor onset and is recorded in around 8 % of full-term gestations. Preterm PROMs (PPROMs) take place before the 37th week of gestation, with an incidence of 2–4 % of pregnancies, and it is associated with higher maternal and perinatal morbidity and mortality, mainly related to infectious processes and prematurity. Among maternal complications, which include postpartum infection, premature placental detachment, and maternal sepsis, we highlight clinical chorioamnionitis for its incidence and severity. Of decreasing frequency, perinatal complications include respiratory distress, neonatal sepsis, intraventricular hemorrhage, necrotizing enterocolitis, and neurological lesions. Full-term PROM frequently has a physiological cause and is a consequence of uterine contractions; however, PPROM usually has a multifactorial etiology that is often unknown, although the most frequently reported cause is an infection, observed in up to 60 % of cases. Therefore, the etiology of PPROM, although probably infectious, remains unknown in most cases. The obstetric approach varies as a function of gestational age, actively inducing the pregnancy in full-term PROM but performing an overall evaluation of maternal-fetal status in PPROM. In the latter situation, an assessment is made of the relative risks and benefits of a wait-and-see attitude versus pregnancy induction, considering signs of infection and/or prematurity, and ordering antibiotic treatment when PPROM is diagnosed . Multiple combinations of antimicrobial drugs have been proposed and better perinatal and maternal outcomes have been reported for the prophylactic administration of some new combinations. This study describes a case of PPROM caused by urinary tract infection.

A CASE STUDY ON 3 WEEKS PREMATURE RUPTURE OF MEMBRANES CAUSED BY OROPHARYNGEAL MICROBIOTA

Premature rupture of membrane (PROM) is produced when amniotic membranes tear before labor onset and is recorded in around 8 % of full-term gestations. Preterm PROMs (PPROMs) take place before the 37th week of gestation, with an incidence of 2–4 % of pregnancies, and it is associated with higher maternal and perinatal morbidity and mortality, mainly related to infectious processes and prematurity. Among maternal complications, which include postpartum infection, premature placental detachment, and maternal sepsis, we highlight clinical chorioamnionitis for its incidence and severity. Of decreasing frequency, perinatal complications include respiratory distress, neonatal sepsis, intraventricular hemorrhage, necrotizing enterocolitis, and neurological lesions. Full-term PROM frequently has a physiological cause and is a consequence of uterine contractions; however, PPROM usually has a multifactorial etiology that is often unknown, although the most frequently reported cause is an infection, observed in up to 60 % of cases. Therefore, the etiology of PPROM, although probably infectious, remains unknown in most cases. The obstetric approach varies as a function of gestational age, actively inducing the pregnancy in full-term PROM but performing an overall evaluation of maternal-fetal status in PPROM. In the latter situation, an assessment is made of the relative risks and benefits of a wait-and-see attitude versus pregnancy induction, considering signs of infection and/or prematurity, and ordering antibiotic treatment when PPROM is diagnosed . Multiple combinations of antimicrobial drugs have been proposed and better perinatal and maternal outcomes have been reported for the prophylactic administration of some new combinations. This study describes a case of PPROM caused by urinary tract infection.

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.

Pessary use in patients diagnosed with short cervix and cervical insufficiency

Objective The aim was to evaluate the effectiveness of Arabin pessary use in patients with cervical insufficiency or short cervix before the 24th week of gestation and the impact of cervical examination findings prior to pessary application on the outcome in terms of the gestational week. Materials and methods In our study, among the pregnancies between the 12th and 24th gestational weeks, 60 pregnant women with a preterm delivery history and/or cervical length less than 25 mm were included. Among these 60 patients, 43 of them had a short cervix, 17 of them had cervical insufficiency. Routine medical and obstetric history was obtained. In the vaginal examination, the cervix was evaluated in terms of patency, dilatation, and position. Cervical length, presence of debris, and funneling were evaluated by transvaginal ultrasound. After receiving patients’ approval a cervical pessary was applied to patients. Pessaries of pregnant women with 37 weeks of gestation were removed. Before reaching the 37th gestation week, pessaries were withdrawn in patients who had ongoing vaginal bleeding, premature rupture of membranes, and preterm contractions unresponsive to tocolytic treatment. Results Thirty-one pregnant women (51.7%) out of 60 pregnant women who underwent pessary, delivered at 37 weeks and below. Delivery rates in the short cervical measurement group and cervical insufficiency group at ≤28 weeks, ≤34 weeks and ≤37 weeks were respectively (n = 21) 34.8% vs 36.3% (p = 0.976), (n = 29) 41.8% vs 64.7% (p = 0.111), (n = 31) 44.2% vs 70.6% (p = 0.888). The presence of cervical funneling before pessary application shows a statistically significant difference in terms of patient’s giving birth before or after 28 weeks (p = 0.033). In patients with cervical funneling, there was a significant increase in a birth before 28 weeks. Depending on whether or not patients applying with pain need for tocolysis, it shows the statistically meaningful difference in terms of the patients giving birth before or after 34 weeks (p = 0.001) (OR 7, 61, 95% GA 2.4–24.6). In the group without the need for tocolysis, there is a meaningful increase in birth after 34 weeks. Conclusions Our findings showed that, alongside the defined cervical risk factors, cervical funneling and the need for tocolysis are remarkable prognostic variables in pessary application.

Iodine knowledge is associated with iodine status in Portuguese pregnant women: results from the IoMum cohort study.

Lack of knowledge about iodine has been suggested as a risk factor for iodine deficiency in pregnant women, but no studies have addressed this issue in Portugal. So, the aim of this study was to investigate iodine knowledge among Portuguese pregnant women and its association with iodine status. IoMum, a prospective observational study, included 485 pregnant women recruited at Centro Hospitalar e Universitário de S. João, Porto, between the 10th and 13th gestational weeks. Partial scores for knowledge on iodine importance, on iodine food sources or on iodised salt were obtained through the application of a structured questionnaire. Then, a total iodine knowledge score was calculated and grouped into low, medium and high knowledge categories. Urinary iodine concentration (UIC) was measured in spot urine samples by inductively coupled plasma MS. Of the pregnant women, 54 % correctly recognised iodine as important to neurocognitive development, 32 % were unable to identify any iodine-rich food and 71 % presented lack of knowledge regarding iodised salt. Of the women, 61 % had a medium total score of iodine knowledge. Knowledge on iodine importance during pregnancy was positively associated with iodine supplementation and also with UIC. Nevertheless, median UIC in women who correctly recognised the importance of iodine was below the cut-off for adequacy in pregnancy (150 µg/l). In conclusion, knowledge on iodine importance is positively associated with iodine status. Despite this, recognising iodine importance during pregnancy may not be sufficient to ensure iodine adequacy. Literacy-promoting actions are urgently needed to improve iodine status in pregnancy.

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 >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.

A time series analysis of ambient air pollution and low birth weight in Xuzhou, China

ABSTRACT The objective of this study was to examine the relationship between weekly specific maternal air pollution exposures and low birth weight. We fitted a distributed lag nonlinear model (DLNM) to analyze the nonlinear exposure-response association and delayed effects of air pollutants on the risk for low birth weight. The model assumed that all live births have 40 gestational weeks.The 1st week lag was the 40th gestational week, and 40th lag week was the 1st gestational week.The study included 71,809 live births (from July 1, 2016, to June 30, 2019), of which 2,391 (3.33%) exhibited low birth weight. The results demonstrated that exposure of pregnant women to PM10 at lag 22-30 weeks was significantly associated with low birth weight risk, with the greatest impact at the lag 30 week. Exposure to SO2 at lag 29-37 weeks was significantly associated with low birth weight risk. The sensitive exposure window for NO2 began at lag 25-37 weeks of pregnancy. The lag 6-10 weeks constituted the susceptible exposure window for O3. Therefore we concluded that maternal exposures to PM10, SO2, NO2, and O3 were associated with increased risk for low birth weight.

Antenatal care in Mozambique: Number of visits and gestational age at the beginning of antenatal care.

Objective:1)to assess the gestational age at the beginning of antenatal care and its covariates; 2)to assess the number of antenatal visits and its covariates; and 3)to identify the reasons for the late initiation of antenatal care and for attending less than four visits among postpartum women living in Nampula, Mozambique.Method:cross-sectional study conducted with 393 mothers who answered a structured instrument in face-to-face interviews. Logistic regression was used to analyze the covariates of having initiated antenatal care up to the 16thgestational week, having attended four or more antenatal visits, and reporting both situations simultaneously.Results:all postpartum women underwent antenatal care, but only 39.9% started it until the 16thgestational week, 49.1% attended four or more visits, and 34.1% reported both events. Having concluded high school (ORadj=1.99; 95%CI=1.19-3.31) or college (ORadj=3.87; 95%CI=1.47-10.18) were aspects associated with reporting both situations. The reasons for the late initiation of antenatal care and attending less than four visits were as follows: not finding it important to attend several visits, not having easy access to the health facility, not being aware about pregnancy, and not having a companion for the visits.Conclusion:the gestational age at the beginning of antenatal care and the number of antenatal visits are lower than the current recommendations in the country.

Bovine lactoferrin in preterm labor with sterile inflammation

Background Preterm delivery (PTD) that occurs before the 37th week of gestation complicates 10% of all pregnancies. Iron deficiency, iron-deficiency anemia, and inflammatory processes either related to infection or sterile inflammatory response represent risk factors for PTD (Genc and Ford, 2010). Bovine lactoferrin (BLF), an emerging important regulator of iron and inflammatory homeostasis, can represent a new therapeutic approach for PTD, with significant improvement of maternal serum interleukin 6 (IL-6) after oral administration. Aim The goal of the study was to evaluate the role of BLF in preventing PTD associated with sterile inflammation between the gestational age of 28 and 34 weeks. Patients and methods The study was carried out at Al Zahra University Hospital at the Department of Obstetrics and Gynecology, including 50 patients, with single pregnancy, no previous preterm birth, gestational age between 28 and 34 weeks, rhythmic uterine contraction (three to five contraction in 10 min; every one last from 40 to 60 s), cervical dilation of 2–4 cm and cervical effacement of ∼50–80% by local pelvic examination, and cervical length 2–3 cm and/or funneling by ultrasound. On admission, all patients were given 100 mg BLF and subjected to withdrawal of 5-ml blood, and samples were sent to Clinical Pathology Department to detect IL-6 before and after BLF intake. Results Oral BLF administration blocked further shortening of cervical length and prolonged pregnancy. This prospective study provides strong evidence for a role of BLF in PTD treatment, thus extending the therapeutic potential of this multifunctional protein. Conclusion Determination of maternal serum IL-6 may be useful for management of patients with preterm labor, and BLF can represent a new therapeutic approach of PTD.

Congenital uterine anomalies and perinatal outcomes: a retrospective single-center cohort study

Congenital uterine anomalies result from the abnormal differentiation, migration, fusion and canalization of Mullerian ducts with a prevalence of 1-10% for unselected population, 2-8% for infertile women and 5-30% for women with a history of miscarriage. Uterine anomalies are implicated as cause of reduced fertility as well as early pregnancy loss. Moreover, their presence is related to an increased risk of preterm birth, abnormal fetal presentation, cesarean delivery, placental abruption and small-for-gestational age infants. The presented study aims to evaluate the correlation between congenital uterine anomalies and poor perinatal outcomes. This was a retrospective, single-center cohort study including 29 women with congenital uterine anomalies. The control group included 100 women hospitalized for delivery with normal uterine morphology. Primary perinatal outcome was preterm birth (delivery before the 37th week of gestation); secondary endpoints were fetus small for gestational age (SGA) (< 10th percentile weight) and fetal abnormal presentation (non-cephalic presentation at the end of pregnancy). Data are presented as median or frequency. Correlations were compared using Mann-Whitney or Pearson’s chi square test. Statistical tests were considered significant if P < 0.05. Preterm birth, fetal abnormal presentation, small for gestational age fetuses were significantly higher (P < 0.001) in the congenital uterine malformations group. Congenital uterine anomalies are associated with poor perinatal outcomes; moreover, our study shows that type of malformations mostly associated with worse reproductive outcomes are the septate uterus and sub-septate uterus.

Antenatal Tanılı Fetal Over Kistlerinin Tedavisi: Olgu Sunumu

Fetal ovarian cysts (FOC) are the most common intra-abdominal masses during fetal ultrasonography performed on the fetus. With conservative follow-up after detection, it is usually seen that it shrinks and disappears within a few months after birth without any procedure. Although the earliest period in which FOC can be detected is reported as the 19th gestational week, most FOCs are diagnosed at 28th gestational week. FOCs that do not shrink during follow-up and have a cyst appearance complicated by imaging tests may cause ovarian torsion, ovarian loss and infertility. In this study, it is aimed to discuss FOC diagnosis and treatment methods according to the current literature in the light of case reports.

Fetal Macrosomia: Ultrasonographic Parameters and Associated Risk Factors in Pregnancies with and without Gestational Diabetes Mellitus

Introduction: Fetal macrosomia is a clinical condition that significantly affects maternal and fetal health. The objective of this study is to determine the frequency and the associated risk factors of fetal macrosomia in pregnant women with and without gestational diabetes mellitus (GDM). Materials and Methods: Our study was carried out by retrospectively examining the records of pregnant women who delivered babies with birth weights of ≥4000 g, after the 37th gestational week in the Gynecology Department of Okmeydani Training and Research Hospital between January 1, 2014, and December 31, 2020. Pregnant women were divided into 2 groups as those did not receive (Group 1, n:311) and did (Group 2, n:98) the diagnosis of GDM during their pregnancy. Results: Frequencies of preeclampsia, polyhydramnios, and shoulder dystocia were statistically significantly higher in the GDM(+) group relative to the GDM(-) group (p=0.007, p=0.006, and p=0.004, respectively). Receiver operator characteristic (ROC) curves were formed to determine cut-off values for age, parity, BPD, FL, and AC. Age (>35 years), FL (≤77 mm), AC (>356 mm), polyhydramnios, and shoulder dystocia were determined as effective factors on fetal macrosomia (p=0.0001, p=0.025, p=0.023, p=0.045, and p=0.009, respectively). Conclusion: Polyhydramnios, shoulder dystocia, preeclampsia, and an increase in AC but a decrease in BPD and FL values are more common in macrosomia associated with GDM compared to the non-GDM patient group.

The predictive value of fetal middle cerebral artery/descending aorta ratio doppler parameter in the evaluation of perinatal results of intrauterine growth restriction

Introduction. Although there are various reasons for intrauterine growth restriction (IUGR), the main cause is inadequate utero- placental and feto-placental circulation. Aim. To determine the predictive values of fetal middle cerebral artery/descending aorta (MCA/DA) Doppler parameter in the evaluation of perinatal outcomes in pregnancies with IUGR. Material and methods. 15 with IUGR and 35 normal newborn, who were born at the 34th gestational week or over included into the study. Doppler ultrasonography (US) measurements were performed. The ratio of pulsatility index/resistive index (PI/ RI) from MCA, umbilical artery (Umb), DA was determined. Neonatal characteristics such as Apgar scores, neonatal intensive care unit (NICU) requirement, weight and sex were also recorded. Results. In the IUGR group, mean MCA/DA RI-PI, MCA/UmB RI-PI were 0.88±0.19, 0.86±0.28, 1.22±0.18 and 1.55±0.39, respectively. In the control group, mean MCA/DA RI-PI, MCA/UmB RI-PI were 1.15±0.13, 1.09±0.41, 1.37±0.35 and 1.82±0.44, respectively. There were statistically significant relationship between MCA/DA PI with cord blood pH value and NICU requirement, age with gravida, parity, MCA/UmB RI, MCA/UmB PI; gravida with age and parity; parity with age, gravida, weight, MCA/DA RI, PI ratios. Conclusion. Intrauterine MCA and DA Doppler US parameters of IUGR can be used safely in predicting perinatal outcomes in pregnancies with IUGR over 34 weeks.

Učestalost anomalija skeleta u fetalnim i neonatalnim obdukcijama

Introduction: Skeletal anomalies are a heterogeneous group of disorders including changes in bone shape, size, and density that cause abnormalities of the extremities, trunk, and head. They rank second in Europe in the frequency of all congenital anomalies. The most common skeletal anomalies include head, face and limb anomalies. Aim: The aim of this study was to determine the frequency of skeletal anomalies and their association with anomalies of internal organs, as well as to show the age of the mother and the gestational week of the fetus with established skeletal anomalies. Material and methods: All fetal and neonatal autopsies in the period from January 1, 2018 to December 31, 2020 at the Institute of Pathology "Djordje Joannovic" of the Faculty of Medicine University of Belgrade were analyzed. In the mentioned period, 580 fetal and neonatal autopsies were performed. Clinical data were obtained from the Gynecology and Obstetrics Clinic "Narodni Front" on the basis of completed requests for clinical autopsy. Descriptive statistics methods were used (data are presented as absolute numbers and percentage frequencies). Results: The most common skeletal anomalies are divided into seven groups: spina bifida (20; 33.34%), limb anomalies (16; 26.67%), head and face bone anomalies (15; 25%), joint anomalies (2; 3.33%), achondroplasia (3; 5%), osteogenesis imperfecta (2; 3.33%) and other anomalies (2; 3.33%). The most common associated anomalies were central nervous system (CNS) abnormalities, followed by heart and kidney abnormalities. The youngest mother was 15 years old, and the oldest was 47 years old. The mean age of the mothers was 30 years. Conclusion: In our study, the most common anomaly was spina bifida, while limb anomalies and craniofacial anomalies are next in frequency. Skeletal anomalies were often associated with anomalies of the heart, kidneys, and CNS. They were mostly diagnosed between the 22nd and 27th gestational week. Our results showed that skeletal anomalies are more common in fetuses or neonates of mothers older than 30 years.