37th Week Of Gestation Research Articles

Application of cook balloon during aorta replacement in a pregnant Marfan-syndrome patient: a case report

BackgroundAortic dissection is a rare and emergent condition. Aortic dissection during pregnancy is not much known but it is quite lethal to both mother and infant. Earlier reports published show that clinicians conducted hysterectomies during cesarean section to avoid anticoagulant-induced uterine bleeding during the following aortic surgery.Case presentationA woman (38, gravida 1, para 0) in the 37th gestational week suffered an acute, severe, sharp pain in the chest and back. She was diagnosed with Standford type A aortic dissection and suspected with Marfan syndrome. An emergency cesarean section was performed immediately to deliver the baby. Since the patient was on anticoagulants during aortic replacement, so Cook balloon was inserted into the uterus to prevent postpartum hemorrhage. This helped to maintain the uterus intact. Family genetic testing showed that the patient was a carrier of FBN1 mutation which was inherited from the patient’s mother, and the newborn also carried the mutation. Hence the patient was concluded to be positive for Marfan syndrome.ConclusionIt is important that clinicians should pay attention to the possibility of aortic dissection in a pregnant woman with chest, abdominal or back pain. In this case study, we employed Cook balloon during cesarean section to avoid anticoagulant-induced uterine bleeding during the following aortic surgery.

Maternal Drinking and Child Emotional and Behavior Problems.

Maternal drinking is associated with child emotional and behavior problems. There is, however, a lack of studies that properly account for confounding. Our objective was to estimate the association between at-risk drinking in mothers of young children and child emotional and behavior problems, taking into account the passive transmission of familial risk. This population-based sample consists of 34 039 children nested within 21 911 nuclear families and 18 158 extended families from the Norwegian Mother, Father, and Child Cohort Study. Participants were recruited between 1999 and 2009 during routine ultrasound examinations. Data were collected during the 17th and 30th gestational week and when the children were 1.5, 3, and 5 years old. We applied a multilevel structural equation model that accounted for unobserved familial risks. Children of mothers with at-risk drinking had a higher likelihood of behavior problems (β = 3.53; 95% confidence interval [CI] 3.01 to 4.05) than children of mothers with low alcohol consumption. This association was reduced after adjusting for factors in the extended family (β = 1.93; 95% CI 1.16 to 2.71) and the nuclear family (β = 1.20; 95% CI 0.39 to 2.01). Maternal at-risk drinking had a smaller association with child emotional problems (β = 1.80; 95% CI 1.26 to 2.34). This association was reduced after adjusting for factors in the extended family (β = 0.67; 95% CI -0.12 to 1.46) and the nuclear family (β = 0.58; 95% CI -0.31 to 1.48). The results suggest an association between maternal at-risk drinking and child behavior problems. A reduction in maternal drinking may improve outcomes for children with such symptoms.

Newborn mid-upper arm circumference as valid proxy measure of gestational age

Background: Prematurity is a significant contributor to neonatal mortality in India. Conventionally, gestational age (GA) of newborn is estimated using Naegele’s formula and New Ballard scoring (NBS), a physical and neurological maturity scoring method of newborn. Objective: The current study was aimed to find out an estimation of GA using neonatal mid-upper arm circumference (MUAC). Materials and Methods: This hospital-based prospective observational study was conducted in the sick newborn care unit and postnatal ward of a tertiary hospital of Central India. A total of 1303 newborns were included in the study. The MUAC was taken and the GA assessed by NBS and Naegele’s formula was filled in a pro forma. Results: A total of 1303 neonates were evaluated. The mean MUAC varied from 6.20±0.5 cm among the preterm newborns to 10.27±0.5 cm among newborns born after the 40th week of gestation. The mean MUAC was 8.04±0.6 cm irrespective of GA. MUAC was found to be significantly correlated with GA (r=0.903, p<0.01). Conclusion: MUAC in newborns can be used as surrogate of GA and can be used for its estimation.

Association of objectively measured physical fitness during pregnancy with maternal and neonatal outcomes. The GESTAFIT Project.

AimTo analyse i) the association of physical fitness during early second trimester and late pregnancy with maternal and neonatal outcomes; and ii) to investigate whether physical fitness is associated with the type of birth (vaginal or caesarean section).MethodsPregnant women from the GESTAFIT Project (n = 159) participated in this longitudinal study. Maternal physical fitness including upper- and lower-body strength, cardiorespiratory fitness (CRF) and flexibility were measured through objective physical fitness tests at the 16th and 34th gestational weeks. Maternal and neonatal outcomes were collected from obstetric medical records. Umbilical arterial and venous blood gas pH and partial pressure of carbon dioxide (PCO2) and oxygen (PO2), were assessed.ResultsAt the 16th week, greater upper-body muscle strength was associated with greater neonatal birth weight (r = 0.191, p<0.05). Maternal flexibility was associated with a more alkaline arterial pH (r = 0.220, p<0.05), higher arterial PO2 (r = 0.237, p<0.05) and lower arterial PCO2 (r = -0.331, p<0.01) in umbilical cord blood. Maternal CRF at the 16th gestational week was related to higher arterial umbilical cord PO2 (r = 0.267, p<0.05). The women who had caesarean sections had lower CRF (p<0.001) at the 16th gestational week and worse clustered overall physical fitness, both at the 16th (-0.227, p = 0.003, confidence interval (CI): -0.376, -0.078) and 34th gestational week (-0.223; p = 0.018; CI: -0.432, -0.015) compared with the women who had vaginal births.ConclusionIncreasing physical fitness during pregnancy may promote better neonatal outcomes and is associated with a decrease in the risk of caesarean section.This trial was registered at ClinicalTrials.gov (NCT02582567) on October 20, 2015.

Socioeconomic inequalities in reproductive outcomes in the Italian NINFEA birth cohort and the Piedmont Birth Registry.

socioeconomic inequalities in reproductive outcomes have been consistently reported in several countries. In a European collaborative study conducted in 2012 whose aim was to investigate the association between socioeconomic position (SEP), measured through maternal education, and preterm delivery inconsistent results were found for the NINFEA birth cohort. However, NINFEA contributed to that study with the first 2,500 pregnancies only, and estimates were not adjusted for any potential confounders assuming that SEP is a distal exposure, that could not be affected by other preterm risk factors. to investigate the relationship between SEP and the reproductive outcomes using the entire NINFEA cohort and compare the results with the population-based Piedmont Birth Registry (PBR), accounting for potential baseline collider bias both in the cohort and in the registry. observational study. 5,323 NINFEA singletons, whose mothers registered into the study before the 36th week of gestation, were analysed. Analyses on maternal education were replicated in the 2011 PBR of 35,318 singletons live births. Factors affecting the likelihood of being a member of the NINFEA study or becoming pregnant in the general population were treated as potential confounders to adjust for baseline collider bias. the association of maternal education and a recently developed household income indicator with both preterm delivery (<37th weeks of gestation) and low birth weight (<2,500 gr) were analysed. in the NINFEA cohort, low SEP was positively associated with both preterm delivery and low birth weight, with slightly stronger associations for household income, especially on low birth weight. Results were consistent with those obtained in the PBR data, where an inverse relationship between maternal education and the two reproductive outcomes was found. In both populations, there was confounding due to maternal age and parity, showing that independently of the nature of the source population, baseline factors that affect the probability of being a member of such source population have to be accounted for to allow causal inference. low SEP is associated with adverse reproductive outcomes in a contemporary Italian population.

Pregnancy outcomes of women with hypoglycemia in the oral glucose tolerance test

ObjectiveThe aim of this study was to investigate the effects of hypoglycemia measured using 2-h 75-g oral glucose tolerance test (OGTT) on neonatal biometrics (birth weight, head circumference and body length of newborns) and perinatal outcomes. Materials and MethodsAccording to the definition of hypoglycemia by the American Diabetes Association, women with blood glucose levels of ≤70 mg/dL after fasting or at 1 or 2 h after eating measured using on 2-h 75-g OGTT were grouped into a hypoglycemia group. In accordance with the criteria of World Health Organization and the International Association of Diabetes and Pregnancy Study Groups, as per the 2-h 75-g OGTT performed in the second trimester, women with gestational diabetes and were excluded from the study. Also, women meeting the following criteria were excluded from the study: missing records, aged <19 or ≥35 years, multiple pregnancies, delivery before the 24th gestational week, and ≤500-g newborn. Other exclusion criteria included pregnant women with known type 1 and type 2 diabetes mellitus, gestational or essential hypertension, cigarette and/or alcohol abuse, thyroid disease, BMI of <19 and >30, placental abnormalities with variation and/or dysfunction, intrauterine growth restriction, and abnormalities of the umbilical cord. ResultsA total of 625 pregnant women who met the inclusion criteria were included in the study. Hypoglycemia was found in 71 pregnant women according to 2-h 75-g OGTT. The remaining 554 women were grouped into the normoglycemia group. The birth weight, head circumference, and body length of newborns were significantly lower in the hypoglycemia group (p < 0.001, p = 0.004, and p = 0.006, respectively). There was no significant difference between both groups in terms of body mass index, parity, fetal sex, delivery type, and Apgar scores. ConclusionsGlycemia with blood glucose levels of ≤70 mg/dL measured using 75-g OGTT during pregnancy is associated with lower birth weight, small head circumference, and short body length in newborns compared to the normoglycemic group. Hence, pregnant women who are diagnosed with blood glucose levels of ≤70 mg/dL using 2-h 75-g OGTT should be carefully managed.

Probabilistic Learning Coherent Point Drift for 3D Ultrasound Fetal Head Registration

Quantification of brain growth is crucial for the assessment of fetal well being, for which ultrasound (US) images are the chosen clinical modality. However, they present artefacts, such as acoustic occlusion, especially after the 18th gestational week, when cranial calcification appears. Fetal US volume registration is useful in one or all of the following cases: to monitor the evolution of fetometry indicators, to segment different structures using a fetal brain atlas, and to align and combine multiple fetal brain acquisitions. This paper presents a new approach for automatic registration of real 3D US fetal brain volumes, volumes that contain a considerable degree of occlusion artefacts, noise, and missing data. To achieve this, a novel variant of the coherent point drift method is proposed. This work employs supervised learning to segment and conform a point cloud automatically and to estimate their subsequent weight factors. These factors are obtained by a random forest-based classification and are used to appropriately assign nonuniform membership probability values of a Gaussian mixture model. These characteristics allow for the automatic registration of 3D US fetal brain volumes with occlusions and multiplicative noise, without needing an initial point cloud. Compared to other intensity and geometry-based algorithms, the proposed method achieves an error reduction of 7.4% to 60.7%, with a target registration error of only 6.38 ± 3.24 mm. This makes the herein proposed approach highly suitable for 3D automatic registration of fetal head US volumes, an approach which can be useful to monitor fetal growth, segment several brain structures, or even compound multiple acquisitions taken from different projections.

Screening of gestational diabetes mellitus using fasting plasma glucose before the 24th gestational week in women with different pre-pregnancy body mass index

Background: Gestational Diabetes Mellitus (GDM) is usually diagnosed between 24th and 28th gestational week using the 75-g Oral Glucose Tolerance Test (OGTT). It is controversial that if FPG ≥92 mg/dL before 24th gestational week should be intervened or not. The aim of this study was to evaluate the value of FPG to screen GDM before 24th gestational week in women with different pre-pregnancy Body Mass Index (BMI).Methods: This was a hospital based retrospective cohort study done at CHC Balipatna, Khurdha, Odisha. Women who had a singleton live birth between June 20, 2016 and June 30, 2019, resided in Balipatna block area and received prenatal care in the Community Health Centre, were included in this study. Pre-pregnancy BMI, FPG before the 24th gestational week, and one-step GDM screening with 75 g-OGTT at the 24th to 28th gestational weeks were extracted from medical records and analyzed. The pregnant women were classified into four groups based on pre-pregnancy BMI: Group A (underweight), Group B (normal), Group C (overweight) and Group D (obesity). Statistical analysis using independent sample t-test, Analysis of Variance (ANOVA) and Pearson Chi-square test was done.Results: The prevalence of GDM was 20.0% (68/341) in the study population. FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week. The incidence of GDM in women with FPG ≥92 mg/dL in the 19th to 24th gestational weeks and pre-pregnancy overweight or obesity was significantly higher than that in women with FPG ≥92 mg/dL and pre-pregnancy BMI &lt;24.0 kg/m2.Conclusions: FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week. Pre-pregnancy overweight or obesity was associated with an increased FPG value before the 24th gestational week. FPG ≥92 mg/dL between 19 and 24 gestational weeks should be treated as GDM in women with pre-pregnancy overweight and obesity.

The Effects of Massage Therapy with or without Physical Exercises on the Weight of Premature Infants Admitted to the Neonatal Intensive Care Unit: A Randomized Clinical Trial

Background: The infants born before the 37th week of gestation are considered as preterm. Premature birth may have several consequences including low birth weight (LBW). Infants born with the weight below 2500 g are known as LBW. Birth weight can be a proper characteristic of healthy neonate. Integrated interventions, including massage, simulate uterus environment for direct growth of an infant through the target route; hence, such interventions can be beneficial to the premature infant. Objectives: Therefore, the current study aimed at comparing the effects of massage therapy with or without physical exercises on the weight of premature infants admitted to the neonatal intensive care unit (NICU). Methods: The current randomized, clinical trial was conducted on 45 neonates born at 30th to 36th weeks of gestation with the weight below 2500 g admitted to the NICU of Shohada Hospital in Bandar Lengeh, Iran in 2017. Infants were classified into three groups of 15 as massage, massage with physical exercise, and control. Infants in the massage group were massaged with olive oil in the morning and noon after feeding. The massage took 15 minutes and was repeated for five consecutive days. The massage with exercise group received extension and flexion for five minutes after the massage. The control group received no treatment intervention. All the infants weighed the day before as well as the 5th day of the intervention using a fixed scale. The weights were recorded and analyzed using SPSS version 22. Paired and independent samples t-tests and analysis of variance were used for data analysis. The P value less than 0.05 was considered statistically significant. The study protocol was registered in the Iranian Registry of Randomized Clinical Trials (ID: IRCT20170520034039N3). Results: The three groups were homogenous in terms of birth weight, gestational age, and newborn age. After the 5th day of the intervention, the results of the two groups of massage and exercise-massage were compared with that of the control. It was observed that those two groups gained more weight in comparison with the control group. More weight gain was also observed in the exercise-massage group compared with the massage group, but the differences were not statistically significant (P = 0.65). Conclusions: The results of the current study showed that massage with or without exercises may lead to gaining weight in LBW infants. Massage may lead to weight gain; therefore, knowledge about this issue might be useful in the weight gain of the neonates.

A population-based study on the prevalence of gestational diabetes mellitus in association with temperature in Taiwan

BackgroundPrevious studies showing seasonal clustering of gestational diabetes mellitus (GDM) were conducted in the temperate or frigid zones and mostly included pregnant Caucasian women. This study aims to investigate the association of ambient temperature with prevalence of GDM in Taiwan, a sub-tropic country. MethodsThis population-based cohort study comprised women (n = 371,131) who gave births between 2013 and 2014; of which, 43,538 (11.7%) were diagnosed with GDM. The mean daily temperature and difference in temperature within a day was calculated over a 35-day period prior to GDM diagnosis or the first day of the 27th gestational week (for non-GDM subjects). Multiple logistic regression models with generalized estimation equation were performed to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of GDM in association with temperature. ResultsAfter controlling for potential confounders, summer and fall were associated with higher risk of GDM diagnosis, with aOR [95% CI] of 1.05 [1.04–1.07] and 1.04 [1.02–1.06] in reference to winter. Additionally, an increase of 1 °C from 14 °C to 27 °C was associated with an aOR of 1.03 [1.02–1.03]. The aOR greatly increased to 1.54 [1.48–1.60] after 28 °C. An increase of 1 °C difference within a day was associated with a reduced aOR at 0.90 [0.87–0.92]. ConclusionA higher prevalence of GDM was associated with a higher daily temperature, but with a smaller difference in temperature within a day.

Investigation of Blood Pressure during the First Trimester of Pregnancy in relation to the MTHFR C677T Polymorphism

AbstractThe common C677T polymorphism in the MTHFR gene encoding the folate-metabolising enzyme methylenetetrahydrofolate reductase is implicated in hypertension and hypertension in pregnancy. Hypertension affects up to 15% of all pregnancies and has been identified as a leading cause of maternal and neonatal morbidity and mortality worldwide. We previously reported higher systolic and diastolic blood pressure (BP) in non-pregnant women with the variant MTHFR 677TT genotype compared to CT/CC genotypes. In addition, randomised controlled trials (RCTs) in non-pregnant hypertensive adults from our Centre demonstrated that supplemental riboflavin (co-factor for MTHFR) lowers BP specifically in those with the TT genotype. However, the role of this common folate polymorphism and its interaction with riboflavin during pregnancy remains unclear. The aim of this study was to investigate the impact of MTHFR genotype and riboflavin status on BP in pregnancy. Data were generated from the ongoing Optimal Nutrition for the Prevention of Hypertension (OptiPREG) project. Pregnant women were recruited at the end of the first trimester from antenatal clinics in Northern Ireland and in the Republic of Ireland. Participants were screened for MTHFR genotype and BP was measured according to current clinical guidelines. Biomarker status of riboflavin was determined using the erythrocyte glutathione reductase activation coefficient (EGRac), a functional assay with higher EGRac values representing a lower status. Overall, 117 (11.6%) participants were identified with the variant MTHFR 677TT genotype. Both systolic and diastolic BP decreased from 8th to 16th gestational week (GW), however, this typical BP pattern was not observed in the TT genotype group. After adjusting for maternal age, GW and body mass index, women with the TT genotype at 12th GW had higher mean systolic (P 0.035) and diastolic (P 0.034) BP. When the results at the 12th GW were stratified by riboflavin status, the BP phenotype owing to this polymorphism was evident only among women with lower status (i.e. EGRac &gt; 1.30), with mean (SEM) systolic BP of 120.4 (3.1) mmHg compared to 112.6 (2.5) mmHg in those with higher status (EGRac ≤ 1.30) within the TT genotype group; in contrast, low versus high riboflavin status had no impact on BP in CT/CC genotype groups. These results suggest that MTHFR genotype influences BP during pregnancy and that riboflavin can exert an important modulating effect on BP in women with TT genotype. An RCT is required to fully investigate the role of MTHFR genotype and its interactive effect with riboflavin in BP during pregnancy.

Salivary and plasma inflammatory mediators and secretory status in preterm delivery women with periodontitis - a cross sectional study

Bacground/Aim. Preterm birth is defined as a delivery prior to the completed 37th week of gestation. Literature data suggested that periodontal processes may influence to the feto-placental unit and induce preterm delivery. The degree of the periodontal disease is influenced by secretor status. Pro-inflammatory cytokines are involved in periodontitis as well as in delivery. The combined influence of these factors on the risk of preterm birth has not been explored. The aim of our study was to investigate the associations between periodontal diseases, secretor status, and interleukin- 1-? (IL1-?) and prostaglandine E2 (PGE2) levels in women delivered preterm. Methods. The study included 56 preterm delivery women and 56 women delivered at term as a control group, aged between 17 and 41 years. Periodontal examination, blood and saliva sampling were performed within 48 hours following delivery. Secretor phenotype was determined by hemagglutination inhibition method. The concentrations of IL1-? and PGE2 were measured by high sensitivity Enzyme-linked Immunosorbent Assay (ELISA). Results. In the pre-term birth group there were 66.1% of women with periodontitis, while in the control one there were 12.5% (p &lt; 0.01). Concentrations of IL1-? and PGE2 in plasma were significantly higher in the non-secretor group of women who gave birth pre-term and had periodontitis comparing to other groups. There was a significant correlation between salivary and plasma levels of PGE2 and IL1-? in the preterm birth group (R = 0.416, p = 0.017 and R = -0.592, p &lt; 0.001, respectively). There were no such correlations in women who delivered at term. Conclusion. Our results support the hypothesis that non-secretor phenotype and periodontitis are at least in part responsible for pathogenesis of preterm birth. This probability of negative impact of non-secretor status cannot be ignored. These findings support the need for additional research into the biology of human parturition.

Bariatric Surgery Impacts Levels of Serum Lipids during Pregnancy

Introduction: Bariatric surgery confers a high risk for nutritional deficiencies that could affect physiologic adaptation of lipids during pregnancy. We aimed to evaluate differences in serum lipids in pregnant women after bariatric surgery compared to obese and lean mothers. Methods: 25 women with a history of Roux-en-Y gastric bypass (RYGB), 19 obese and 19 normal-weight controls were included at the 24th–28th gestational week for determination of fasting lipids with follow-up in a subgroup after delivery. Data on neonatal biometry were additionally assessed. Results: Women after RYGB showed lower total-cholesterol (TC), low-density lipoprotein C (LDL-C), non-high-density lipoprotein C (non-HDL-C) and triglycerides (TG) compared to obese mothers. Despite their higher BMI, women after RYGB showed lower TC, LDL-C and non-HDL-C than normal-weight mothers. Ultrasensitive C-reactive protein was lower in RYGB mothers than in obese ones, reaching values of lean controls. Differences remained unchanged in BMI-matched comparison. Birth weight percentiles of RYGB offspring were associated with maternal TC (r = 0.59, p = 0.021), LDL-C (r = 0.71, p = 0.003), non-HDL (r = 0.59, p = 0.021) but not HDL-C or TG. After delivery, lipids decreased in all women; however, TC and LDL-C showed more attenuated decline in mothers after RYGB than control women. Conclusion: Pregnancies after RYGB show alterations of physiologic patterns in lipid profile. Further studies are required to evaluate whether imbalances in maternal lipids constitute a risk for abnormal fetal growth in this special cohort.

PERINATAL OUTCOMES OF PREGNANT WOMEN WITH TYPE 1 DIABETES MELLITUS: COMPARISON OF MULTIDOSE INJECTION AND CONTINUOUS SUBCUTANEOUS INSULIN INFUSION.

To evaluate obstetric and neonatal outcomes of patients with type 1 diabetes mellitus (T1DM) and compare multidose injection (MDI) and continuous subcutaneous insulin infusion (CSII). Retrospective study of 53 pregnant patients with T1DM reaching at least 24th gestational week. Fourteen patients (26.4%) hospitalized for insulin dose regulation. Ten patients had hypertensive diseases. Perinatal mortality occurred in 2 neonates owing to cardiac malformations. Neonatal hypoglycemia, small for gestational age, large for gestational age, and neonatal jaundice were demonstrated in 8, 4, 12 and 19 newborns, respectively. Sixteen newborns were admitted to the NICU for various reasons. Congenital malformations were detected in 7 newborns (6 cardiovascular and 1 central nervous system anomaly). Despite lack of statistical significance, total daily insulin doses were higher in the MDI group than in the CSII group with doses of 62 IU (18-166) and 51 IU (20-114), respectively (p=0.119). Gestational and perinatal outcomes also showed no statistical significance. However, all congenital abnormalities and perinatal deaths occurred in the MDI group. T1DM in pregnancy is a challenging problem in terms of having better obstetric and perinatal results. CSII may be used safely instead of MDI in appropriate patients.

Meckel-Gruber Syndrome: A Case Report at RHUH

A rare lethal autosomal recessive condition called Meckel-Gruber Syndrome (MGS) has a clinical and genetical heterogenicity. A 15-year-old primigravid presented at the 16th gestational week of her pregnancy at the Rafic Hariri University Hospital (RHUH) for antenatal ultrasonography. She had a third degree consanguineous marriage with no previous uterine scars, no previous invasive testing, no previous fetal anomaly, no comorbidities and no family history of congenital anomalies. On the other hand, her current pregnancy was not the result of an Artificial Reproductive technique (ART) and her medication at home was only based on vitamins and calcium. The antenatal ultrasonography showed the following features: (1) occipital encephalocele (2) diffuse subcutaneous edema (3) bilateral dysplastic kidneys and the bladder was not visualized. These features were suggestive of Meckel Gruber Syndrome (MGS). We concluded that ultrasound in the context of genetic diseases, especially our MGS case, is considered as a secondary prevention tool.

Twin pregnancies concieved by assisted reproduction - early prediction of preterm birth

Background/Aim. Twins conceived by assisted reproduction techniques (ART) are the most susceptible for perinatal complications. The aim of this study was to examine the role of prenatal noninvasive fetal screening of the first and second trimester in prediction of delivery time of ART conceived twins. Methods. Prospective cohort study of all ART conceived twin pregnancies was conducted at the Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, during the period from January 1, 2016 to December 31, 2017. In the 12th gestational week (GW) twins crown-rump lenght (CRL) and thickness nuchal translucency (NT) were measured ultrasonographically. Moreover, serum levels of beta subunit of human chorionic gonadotropin (? hCG) and pregnancy-associated plasma protein A (PAPPA) were assessed. In the 17th GW twins biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) were determined ultrasonografically. Additionally, ? hCG, alphafetoprotein (AFP), estriol (E3) and inhibin (INH) were measured in mothers serum. The GW of delivery was noted for each pregnancy. Results. Study included 100 pregnant women with mean age 35.44 ? 5.82. In the examined sample of ART conceived twins significantly more (51%) were delivered in term (? 35 GW) (p = 0.001). Delivery time correlated negatively with NT and first trimester ? hCG serum levels, while it correlated positively with FL of the smaller twin, second trimester ? hCG, AFP and E3 concentrations. According to obtained model for prediction of delivery time in ART conceived twin pregnancies based on first trimester diagnostic tests the significant predictors were PAPPA and ? hCG in the 12th GW as well as NT of the first larger twin. Nevertheless, reliability (sensitivity 50%?75%, specificity 30%?40%) of these diagnostic tests was moderate. Conclusion. Prenatal noninvasive fetal screening of the first and second trimester (ultrasonography and laboratory testing) can be used for prediction of delivery time of ART conceived twins.

The Unusual Presentation of HELLP Syndrome

HELLP syndrome is a serious pregnancy-related syndrome characterised by hemolysis, elevated liver enzymes and low platelet count occurring in 0.5-0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. Typical presenting symptoms are right upper quadrant or epigastric pain, nausea and vomiting. Seventy percent of the cases develop antepartum, majority between the 27th and 37th gestational weeks. Thirty percent of the cases are diagnosed postpartum, often within 48 h post-delivery. The occurrence of preeclampsia post-delivery is well established. However, in most reported cases, HELLP syndrome persisted since late pregnancy. We report a case of HELLP syndrome in combination with preeclampsia that developed 2 days post-delivery in an uncomplicated pregnancy. J Clin Gynecol Obstet. 2019;8(4):118-120 doi: https://doi.org/10.14740/jcgo605

Determination of Fetal Transcerebellar Diameter Nomogram in the Second Trimester

AbstractThe aim of the study was obtain nomogram of fetal transcerebellar diameter at 18–24 weeks of gestation with known prognosis of normal pregnancies. The study included 1236 healthy fetuses in the 18th–24th gestational week of women aged from 18 to 40 years (mean: 28.70 ± 5.26). The transcerebellar diameter, bi-parietal diameter, femur length and abdominal circumference of the fetuses were measured. Additionally, groups were divided according to maternal age and according to body mass index. The transcerebellar diameter of fetuses from 18 to 24 weeks gestation varied from 18.13 ± 2.16 to 26.42 ± 1.91 mm (mean: 22.12 ± 2.57 mm). Additionally, the mean and standard deviation of transcerebellar diameter and fetal parameters were determined according to gestational week, maternal age and maternal body mass index. Later, the correlations between transcerebellar diameter with pregnancy week, maternal age, maternal body mass index and fetal parameters were examined. Transcerebellar diameter was correlated with pregnancy week and fetal parameters (p &lt; 0.01) but was not correlated with maternal age (p &gt; 0.01). Additionally, transcerebellar diameter and fetal parameters were determined to show negative correlation with maternal body mass index (p &lt; 0.01). Comparison of transcerebellar diameter with pregnancy week determined differences between weeks (p &lt; 0.05), but no differences for age groups and body mass index groups (p &gt; 0.05). Maternal age and maternal body mass index are significant factors affecting fetal development. We believe our data related to the transcerebellar diameter obtained at the end of the study will be beneficial for assessment of fetal development and identification of fetal anomalies.

Ultrasound diagnosis of fetal adrenal hemorrhage

The confirmed incidence of new-onset adrenal gland hemorrhage has increased with the development of ultrasound diagnostics in recent years. Intrauterine developed cases are rarely recognized. Differential diagnosis of cystic lesions of the adrenal gland is often only possible after birth. In our case study, we report the ultrasonographic diagnosis and follow-up of a cystic lesion measuring 4 × 3 cm in the left fetal epigastrium in the 33rd gestational week. During pregnancy, multimodal imaging methods (both ultrasound and magnetic resonance) have confirmed the diagnosis of hemorrhage in the left adrenal gland. In the 37th gestational week, the hematoma completely resolved. At term, a 4150 gram neonate was delivered in good condition by an elective cesarean section. Postnatal endocrinological and follow-up ultrasound examinations did not find any disorder. This study is the first published case report in the literature that proves that fetal adrenal hemorrhage can intrauterin spontaneously absorb within a short period of time. Our case draws attention to the fact that adrenal bleeding may occur in the newborn regardless of birth trauma. It can also be assumed that the incidence of adrenal bleeding during pregnancy is higher than that reported in neonatal cases. Orv Hetil. 2019; 160(52): 2073-2078.

Does the measurement of the size of the first trimester subchorionic hematoma by 2D and 3D ultrasonographic techniques have any effect on adverse pregnancy outcomes?

Aim: We aimed to evaluate whether the measurement of subchorionic hematoma (SCH) size with 2D and 3D ultrasonography affects adverse pregnancy outcomes. Methods: One hundred fifty-eight pregnant patients having SCH were enrolled in the study. The diagnosis of SCH was made by 2D and 3D ultra-sonographic methods in the first trimester, between 6th and 14th gestational weeks. Patients having SCH were determined with adverse pregnancy outcomes such as miscarriage, intrauterine fetal death (IUFD), and preterm labor (PL). Logistic regression analyses were applied for the relationship of miscarriage, IUFD, PL, and SCH. Results: There were no statistically significant differences for body mass index, 2-D hematoma sizes, 3-D hematoma sizes, and pregnancy outcomes between the groups. Miscarriage/IUFD rate was 4.6%, PL rate was 6.9%, and the term delivery rate was 88.5% in the primiparas having SCH. Miscarriage/IUFD rate was 7%, PL rate was 3.5%, and the term delivery rate was 89.5% in the multiparas having SCH. No significant association was observed between 2D and 3D hematoma sizes and IUFD and PL. In the logistic regression model, SCH ≥ 500 cm3 was found to be a risk factor associated with PL, not regarding the measurement technique (OR:1.008, 95% CI: 1.002-1.012, p=0.006). Conclusion: We determined that SCH size increases the risk of PL. We observed no effect of diagnosis and follow-up of SCH, by 2D and 3D ultrasonography techniques on adverse pregnancy outcomes such as miscarriage, IUFD, and PL.