37th Week Of Gestation Research Articles

Effect of Bacterial Vaginozis and cervikal length on preterm delivery in second trimester

Objective: Preterm birth is one of the major cause of perinatal morbidity and mortality. Clinical studies have pointed out the association between preterm birth and bacterial vaginosis (BV) infection. Our aim is to discover the incidence of BV and search for the mean cervical length and parameters for the prediction of preterm delivery.
 Materials and Methods: 130 pregnant woman between the 16th and 24th gestational week were included in our study. A detailed medical history was obtained from all of the women, and patients with a history of preterm delivery and the Vaginal Ph values and cervical length measurement were evaluated. Vaginal samples were analyzed, gram staining was performed, and a bacterial vaginosis diagnosis was made with Nugent’s criteria.
 Results: Of 130 woman that we included in our study, only 19 had bacterial vaginosis (14.6 %), and the mean cervical length was measured as 41.79 mm. Preterm birth occurred in nine of the pregnant women (6.9%), and no statistically significant difference was found between BV and shortened cervical length or preterm labor. When we excluded the known preterm birth risk factors from our study, we could not find a significant difference between preterm labor and BV.
 Conclusion: We concluded that BV by itself is not a preterm risk factor. The frequency of BV in the pregnant women in our study group according to the preterm delivery rate and the mean cervical length were similar to those in international studies in which the relationship between cervical length and preterm delivery has been established. We did not come to a significant conclusion in our research; nevertheless, we can relate this result to the preterm delivery rate that is found to be lower than expected.

A case report and mechanism analysis of a normal phenotype mosaic 47, XXY complicated by paternal iUPD (9) who had a normal PGD result

BackgroundUniparental disomy (UPD) refers to the situation in which two copies of homologous chromosomes or part of a chromosome originate from the one parent and no copy is supplied by the other parent.Case presentationHere, we reported a woman whose karyotype was 46, XX, t (1;17)(q42;q21), has obtained 5 embryos by intracytoplasmic sperm injection (ICSI) after one cycle of in vitro fertility (IVF). After microarray-based comparative genomic hybridization (array-CGH) for preimplantation genetic testing for chromosomal structural rearrangements (PGT-SR), two embryos were balanced, one balanced embryo was implanted and the patient successfully achieved pregnancy. Amniocentesis was performed at the 19th week of gestation for karyotype analysis and single nucleotide polymorphism (SNP)-array test. The result of karyotype analysis was: mos 47, XXY [19]/46, XY [81]; SNP-array results revealed 46, XY, iUPD (9) pat. After full genetic counseling for mosaic Klinefelter’s syndrome and paternal iUPD (9), the couple decided to continue pregnancy, and the patient gave birth to a healthy boy. The newborn is now 3.5 years old, and developed normally. This case will provide counseling evidences of paternal iUPD (9) for doctors.ConclusionsThis is the first case report of paternal iUPD9 with mosaic Klinefelter’s syndrome, and no abnormality has been observed during the 3.5-year follow-up. Further observation is required to determine whether the imprinted genes on the chromosomes are pathogenic and whether recessive pathogenetic genes are activated.

Influence of a Concurrent Exercise Training Intervention during Pregnancy on Maternal and Arterial and Venous Cord Serum Cytokines: The GESTAFIT Project.

The aim of the present study was to analyze the influence of a supervised concurrent exercise-training program, from the 17th gestational week until delivery, on cytokines in maternal (at 17th and 35th gestational week, and at delivery) and arterial and venous cord serum. Fifty-eight Caucasian pregnant women (age: 33.5 ± 4.7 years old, body mass index: 23.6 ± 4.1kg/m2) from the GESTAFIT Project (exercise (n = 37) and control (n = 21) groups) participated in this quasi-experimental study (per-protocol basis). The exercise group followed a 60-min 3 days/week concurrent (aerobic-resistance) exercise-training from the 17th gestational week to delivery. Maternal and arterial and venous cord serum cytokines (fractalkine, interleukin (IL)–1β, IL-6, IL-8, IL-10, interferon (IFN)–γ, and tumor necrosis factor (TNF)–α) were assessed using Luminex xMAP technology. In maternal serum (after adjusting for the baseline values of cytokines), the exercise group decreased TNF-α (from baseline to 35th week, p = 0.02), and increased less IL-1β (from baseline to delivery, p = 0.03) concentrations than controls. When adjusting for other potential confounders, these differences became non-significant. In cord blood, the exercise group showed reduced arterial IL-6 and venous TNF-α (p = 0.03 and p = 0.001, respectively) and higher concentrations of arterial IL-1β (p = 0.03) compared to controls. The application of concurrent exercise-training programs could be a strategy to modulate immune responses in pregnant women and their fetuses. However, future research is needed to better understand the origin and clearance of these cytokines, their role in the maternal-placental-fetus crosstalk, and the influence of exercise interventions on them.

A study of bacteriological profile and outcome of babies born to mother with Premature rupture of membrane and its correlation with blood and gastric culture

Background: PROM, a condition that occurs when fetal membranes are ruptured at least one hour before onset of labor. While PROM is observed in 10% of all pregnancies, 60-80% of PROM is observed in term and 20-40% in pregnancies less than 37th gestational week. PROM is the most significant reason for preterm labor. The three causes of neonatal death associated with PROM are prematurity, sepsis and pulmonary hypoplasia. Infants born with sepsis have a mortality rate four times higher than those without sepsis. Objective of the study was correlation of blood and gastric culture positive sepsis in PROM newborns. It helps to find out the incidence of PROM in our locality.Methods: This retrospective study enrolled 90 neonates born to healthy mothers with history of PROM more than 18 hours duration, admitted in SNCU/ward at a tertiary care hospital for six months duration from 1st January 2017 to 30 June 2017. Clinical profile of these Newborn with history of PROM was noted such as birth weight, gender, gestation, duration of membrane rupture, history of maternal fever. For all newborns with PROM, sepsis screen had been sent. The neonatal outcome was also recorded, and the data was collected and analyzed by using frequency and percentages.Results: Gram negative bacilli were the commonest cause of neonatal sepsis and male neonates were more prone to infection. PROM and low birth weight especially, ELBW and VLBW are the common high-risk factors for early onset sepsis. Most common organisms isolated in blood and gastric culture were Klebsiella and Staphylococcus aureus respectively.Conclusions: PROM is a high-risk obstetric condition. Active management is needed to enable delivery within 24 hours of PROM as it offers better neonatal outcome. Morbidity and mortality increase as the duration of PROM increases. This can be reduced by early diagnosis, specific treatment and strict infection control practices in neonatal units.

Exposure to Glucocorticoids in the First Part of Fetal Life is Associated with Insulin Secretory Defect in Adult Humans.

High glucocorticoid levels in rodents inhibit development of beta cells during fetal life and lead to insulin deficiency in adulthood. To test whether similar phenomena occur in humans, we compared beta-cell function in adults who were exposed to glucocorticoids during the first part of fetal life with that of nonexposed subjects. The study was conducted in 16 adult participants exposed to glucocorticoids during the first part of fetal life and in 16 nonexposed healthy participants with normal glucose tolerance who were matched for age, sex, and body mass index (BMI). Exposed participants had been born to mothers who were treated with dexamethasone 1 to 1.5 mg/day from the sixth gestational week (GW) to prevent genital virilization in children at risk of 21-hydroxylase deficiency. We selected offspring of mothers who stopped dexamethasone before the 18th GW following negative genotyping of the fetus. Insulin and glucagon secretion were measured during an oral glucose tolerance test (OGTT) and graded intravenous (IV) glucose and arginine tests. Insulin sensitivity was measured by hyperinsulinemic-euglycemic-clamp. Age, BMI, and anthropometric characteristics were similar in the 2 groups. Insulinogenic index during OGTT and insulin sensitivity during the clamp were similar in the 2 groups. In exposed subjects, insulin secretion during graded IV glucose infusion and after arginine administration decreased by 17% (P = 0.02) and 22% (P = 0.002), respectively, while glucagon secretion after arginine increased. Overexposure to glucocorticoids during the first part of fetal life is associated with lower insulin secretion at adult age, which may lead to abnormal glucose tolerance later in life.

A Successful Pregnancy Despite the Presence of an Intrauterine Fetal Bone Fragment

Objective Intrauterine retention of fetal bones following a termination of a pregnancy is a rare complication. Among the few reported cases in literature, there has been no report describing the birth of a live fetus, despite the presence of an embryonic ossicle within the endometrial cavity. Case Report A 28-year-old woman, with an obstetrical history of a miscarriage at the 19th week of gestation, underwent a diagnostic hysteroscopy for evaluation of pelvic pain and infertility, which revealed an intrauterine embryonic ossicle. The patient did not comply with our recommendations to undergo a surgical hysteroscopy. The patient's next visit was during her 9th week of gestation. She was followed up regularly at our Obstetrics Department. Her gestation was uneventful, while an elective caesarean section at the 39th week of gestation was performed. Conclusion The present clinical case has demonstrated that achieving childbearing is possible, despite the requirement of removing such bone fragments.

Effects of prenatal exposure to air particulate matter on the risk of preterm birth and roles of maternal and cord blood LINE-1 methylation: A birth cohort study in Guangzhou, China

BackgroundEpidemiological studies have found that increased risk of preterm birth (PTB) is associated with higher prenatal exposure to PM10 and PM2.5, but few studies have been conducted to assess the impacts of extremely fine particulate matter (PM1) which may have more toxic effects than other types of ambient particulate air pollution (PM). Several studies have separately investigated the associations between DNA methylation and PTB risk and PM. Maternal LINE-1 methylation level negatively correlated with prenatal exposure to PM and risk of PTB. A comprehensive picture is lacking regarding the associations between prenatal exposure to PM, LINE-1 methylation, and risk of PTB. ObjectivesThis study aimed to estimate the effects of exposure to ambient PM (PM10, PM2.5, and PM1) of different sizes during pregnancy on risk of PTB, identify susceptible exposure windows, and illustrate the roles of LINE-1 methylation in the associations between PM and PTB risk. MethodsThe Birth Cohort Study on Prenatal Environments and Offspring Health (PEOH) has been ongoing since 2016 in Guangzhou, China. A total of 4928 pregnant women were recruited during early pregnancy, and 4278 (86.8%) were successfully followed-up. Each individual weekly exposure to PM10 and PM2.5 from 3 months before pregnancy to childbirth was assessed using a spatiotemporal land use regression model, and the weekly PM1 exposure was estimated by employing a generalized additive model. Maternal and cord blood LINE-1 methylation levels (%5mC) were tested using bisulfite-PCR pyrosequencing. A distributed lag nonlinear model incorporated with a Cox proportional hazard model was applied to assess the effect of weekly-specific maternal PM exposure on PTB risk, and a multiple-linear regression model was employed to investigate the associations between PM exposure and LINE-1 methylation levels of maternal and cord bloods. We also assessed the associations between LINE-1 methylation levels and PTB risk by using a logistic regression model. ResultsThe risk of PTB was positively associated with PM2.5 and PM1 concentrations during the 12th to 20th gestational weeks, and the strongest association was in the fourth quartile (Q4) versus the first quartile (Q1) and observed during the 16th gestational week (PM2.5: harzard ratio [HR] = 1.18, 95%CI: 1.04–1.35, IQR = 11.94 μg/m3. PM1: HR = 1.20, 95%CI: 1.03–1.39, IQR = 11.36 μg/m3). We observed significantly negative associations of PM10(β = −0.51%5mC per 10 μg/m3, P = 0.014), PM2.5 (β = −0.66%5mC per 10 μg/m3, P = 0.032) and PM1 (β = −0.67%5mC per 10 μg/m3, P = 0.032) concentrations with cord blood LINE-1 methylation levels, and a negative association between PM1 concentration and maternal LINE-1 methylation level (β = −0.86%5mC per 10 μg/m3, P = 0.034). ConclusionHigher prenatal exposure to PM1 and PM2.5 during the 12th to 20th gestational weeks was associated with increased risk of PTB. Maternal and fetal LINE-1 methylation alternation might be an underlying mechanism of PM that increasing the risk of PTB.

The predictive value of weight gain and waist circumference for gestational diabetes mellitus.

Objective:The first objective of this study was to investigate the relationship between gestational diabetes mellitus (GDM) and gestational weight gain (WG), waist circumference (WC), prepregnancy, and gestational body mass index (BMI). The second aim of our study was to assess the ability of WG, WC, prepregnancy, and gestational BMI with special reference to their cut-off points on predicting the risk of GDM in pregnant women in Turkey.Materials and Methods:A total of 261 women who underwent screening for GDM with the 75-g glucose tolerance test (GTT) between 24th and 28th gestational weeks were included. According to the 75-g oral GTT results, women were classified into two groups: the GDM group and non-GDM group. The data collected included age, parity, plasma glucose level for fasting, 1- and 2-h tests, WC, prepregnancy and gestational BMI, prepregnancy weight, WG during pregnancy, gestational age at birth, and birth weight.Results:WC at 20-24 weeks of gestation, prepregnancy BMI, and gestational BMI had a predictive capacity for GDM. According to our results, optimal cut-off points for the best predictive value of GDM were WC of 100 cm with a sensitivity of 84% and specificity of 70%, prepregnancy BMI of 25 kg/m2 with a sensitivity of 81.8% and specificity of 76%, and gestational BMI of 28.3 kg/m2 with a sensitivity of 75% and specificity of 77.4%.Conclusion:The measurement of prepregnancy BMI, gestational BMI, and WC may be useful in predicting the risk of GDM. Pregnant women with increased prepregnancy BMI, gestational BMI, and WC measurements may be susceptible to the development of GDM.

Inguinal hernia repair in preterm neonates: is there evidence that spinal or general anaesthesia is the better option regarding intraoperative and postoperative complications? A systematic review and meta-analysis

ObjectivesWhether spinal anaesthesia (SA) reduces intraoperative and postoperative complications compared with general anaesthesia (GA) was investigated.DesignThe meta-analysis was structured based on the PRISMA (Preferred Reporting Items for Systematic Reviews and...

Accessory Spleen in Human Fetuses: A Cadaveric Study

Abstract Background The aim of the study was to assess the morphological and histological features of accessory spleen in formalin-preserved human fetuses. Methods The study was conducted on spleen of 40 human fetuses of varied gestational ages without any congenital anomalies with due clearance from the ethical committee. The existence of accessory spleen was investigated during dissection. These were then dissected, weighed, and stained by hematoxylin and eosin as well as Masson’s trichrome method and observed under compound light microscope. Results In 5 (12.5%) cases, the accessory spleen was revealed in fetuses aged between 29th and 40th gestational weeks. These were located near the splenic hilum. On histological examination, the tissue of accessory spleen revealed a well-defined capsule. White pulp was less differentiated as compared with red pulp area. Conclusion The accessory spleen is often misdiagnosed by the clinicians for neoplastic growth or lymph node enlargement; therefore, its awareness is important.

Uropathogens and Gestational Outcomes of Urinary Tract Infections in Pregnancies that Necessitate Hospitalization

Background and Objectives: Our aim is to identify uropathogens that cause urinary tract infections (UTIs) that necessitate hospitalization, and analyze outcomes of gestational UTIs. Methods: This study consisted of 30 pregnant women who necessitate hospitalization because of UTI (7.8% of gestational UTIs during the same period of time). UTI that necessitates hospitalization is defined as clinical complaints, urination problems, urine analysis and culture positivity, fever and uterine discomfort. Patients with at least two positive cultures (≥ 100,000 cfu/ml) were included to this study. Antimicrobial susceptibility tests were obtained in all cases in order to determine antimicrobial resistance and to choose the ideal antibiotics for treatment. Results: In our study, we have found that Escherichia coli is the most common microorganism (56.7%). Enterococcus faecalis (13.3%) and Klebsiella pneumonia (10%) were other frequently observed microorganisms. In this series, mean gestational week at birth was 35 weeks 5 days (range 23-40 weeks). Mean birthweight was 2,656 g (range 500-3,700 g). Twenty-three cases (76.7%) were hospitalized before 37th gestational week and preterm delivery rate was 56.3%. Maternal risk factors and coexisting diseases were detected in 11 (36.7%) patients as follows: diabetes mellitus in 4, thrombophilia in 3, thyroid disorders in 3 and hydroureteronephrosis in 1 case. Cesarean section rate was 65.2%. Conclusions: Knowing uropathogens of patient population is beneficial in the management of patients and better planning of future medical treatments. Preterm labor seems to be an important complication in pregnancies with UTIs going together with fever and urination problems.

Fetal adrenal gland size in gestational diabetes mellitus.

Background The aim of this study was to compare the adrenal gland size of fetuses of women with gestational diabetes mellitus (GDM) with that of healthy control fetuses. Methods This prospective cross-sectional study included measurements of the adrenal gland size of 62 GDM fetuses (GDM group) and 370 normal controls (control group) between the 19th and 41st week of gestation. A standardized transversal plane was used to measure the total width and the medulla width. The cortex width and an adrenal gland ratio (total width/medulla width) were calculated from these data. Adrenal gland size measurements were adjusted to the week of gestation and compared between the two groups in a multivariable linear regression analysis. A variance decomposition metric was used to compare the relative importance of predictors of the different adrenal gland size measurements. Results For all the investigated parameters of the adrenal gland size, increased values were found in the case of GDM (P < 0.05), while adjusting for the week of gestation. GDM seems to have a greater impact on the size of the cortex than on the size of the medulla. Conclusion The fetal adrenal gland is enlarged in pregnancy complicated by GDM. The width of the cortex seems to be particularly affected.

Ambient air pollution exposure and gestational diabetes mellitus in Guangzhou, China: A prospective cohort study

BackgroundEvidence concerning the effect of ambient air pollution exposure on gestational diabetes mellitus (GDM) is limited. No published studies have examined maternal weekly air pollution exposure and GDM, and the possible effect modification by folic acid supplementation has not been assessed. ObjectivesTo evaluate the association between air pollution exposure and GDM at trimester and weekly levels, and to explore the potential effect modification by folic acid supplementation. MethodsA total of 5421 pregnant women were recruited during 2011–2014 in Guangzhou, China. Daily PM2.5, PM10, SO2 and NO2 levels were collected from 10 monitoring stations. Individual's exposure during pregnancy was estimated using inverse-distance weighting approach. Binary logistic regression was used to examine the trimester-specific association between air pollution exposure and GDM. Distributed lag models (DLMs) were applied to estimate maternal weekly air pollution exposure and GDM. Stratified analyses by folic acid supplementation and interaction test were performed. ResultsThe GDM incidence was 11.69%. An interquartile range (IQR) increase in first trimester SO2 was associated with increased GDM risk in the single pollutant model, the adjusted odds ratio (aOR) and 95% confidence interval (CI) was 1.22 (1.02–1.47). In DLMs, an IQR increase in SO2 during 4th to 10th gestational weeks was associated with increased GDM risk, with the strongest effect in the 7th gestational week. When stratified by maternal folic acid supplementation, first trimester exposure to SO2 was associated with increased GDM risk among women taking folic acid supplements (aOR = 1.25, 95% CI: 1.03–1.53) and P value for interaction was 0.13. No significant effects were observed for PM2.5, PM10 and NO2. ConclusionFirst trimester exposure to SO2 was associated with increased GDM risk, especially during the 4th to 10th gestational weeks. The effect might be stronger among women taking folic acid supplements.

Impact of nuchal cord on antenatal and intrapartum foetal heart rate surveillance and perinatal outcome

Analysing antepartum and intrapartum computerised cardiotocographic (cCTG) parameters in physiological term pregnancies with nuchal (NC) or body cord (BC), in order to correlate them with labour events and neonatal outcome. We enrolled 808 pregnant women, composed of 264 with ‘one NC’, 121 with ‘multiple NCs’, 39 with BC and 384 with ‘no NC’, were monitored from the 37th week of gestation before labour, while 49 pregnant women with ‘one or more NCs’ and 47 with ‘no NCs’ were analysed during labour. No differences in maternal characteristics, foetal pH at birth and 5-min Apgar score were observed. The birth weight was significantly lower in the ‘multiple NCs’ group, while 1-minute Apgar score was lower in the BC group than the other groups, respectively. No relevant differences in cCTG parameters were observed, except for LTI, Delta and number of variable decelerations in antepartum period and only variable deceleration in intrapartum period.Impact statementWhat is already known on this subject? Ultrasound cannot predict which foetuses with NCs are likely to have problem during labour. The question arose if single or multiple NC could affects FHR monitoring prior and during labour.What do the results of this study add? Computerised cardiotocography (cCTG) is a standardised method developed to reduce inter- and intra-observer variability and the poor reproducibility of visual analysis. Few studies have investigated the influence of NCs on FHR variability and, to our knowledge, no one has evaluated its linear and nonlinear characteristics in antepartum and intrapartum period using a computerised analysis system. No differences in maternal characteristics, foetal pH at birth and 5-min Apgar score were observed. Birth weight was significantly lower in the ‘multiple NCs’ group, while 1-min Apgar score was lower in the BC group than the other groups, respectively. Foetuses with ‘one or more NCs’ evidenced a larger number of prolonged second stage and meconium-stained liquor cases, while the operative vaginal delivery and emergency caesarean section rates were unchanged. No relevant differences in cCTG parameters were observed, except for LTI, Delta and number of variable decelerations in antepartum period and only variable deceleration in intrapartum period.What are the implications of these findings for clinical practice and/or further research? cCTG monitoring results confirmed their usefulness for assessing the state of good oxygenation for all foetuses investigated.

Insights and expectations for Tdap vaccination of pregnant women in Italy

Background Pertussis is a widespread vaccine-preventable disease, associated with an increasing trend to hospitalization among newborns. Pertussis in newborns can be fatal, and the most effective way to prevent it is maternal immunization (MI) with a reduced antigen content tetanus, diphtheria, and acellular pertussis vaccine (Tdap). In Italy, the National Immunization Plan (NIP) 2017–2019 introduced de novo Tdap vaccination during each pregnancy at no cost for the recipient. Despite this, vaccination coverage is suboptimal. This survey of pregnant women across Italy was conducted to investigate their knowledge and expectations of Tdap. Methods A cross-sectional survey was conducted. Pregnant women up to 28th gestational weeks were interviewed by Telephone using a questionnaire with 16 questions. Statistics were descriptive. Results The final sample recruited 600 respondents evenly distributed across Italy. The average duration of pregnancy at the time of the interview was 20.8 weeks (standard deviation [SD] 6.0). Most women (60.7%) were between 30 and 40 years of age. About half were aware of the risks of pertussis for newborns (54.5%) and the increased risk of hospitalization (59.8%); 47.2% were aware that Tdap MI was offered free of charge under the NIP. Safety information regarding the mother and newborn was considered the most important information in deciding whether to be vaccinated (47.4%), followed by safety information related only to the newborn (29.5%). About half (52.2%) stated that they would “certainly” accept MI, and 25.3% would like to receive more information. Gynecologists were the preferred healthcare providers (HCPs) for the provision of MI information (34.3%), followed by pediatricians (25.5%). Two-thirds of the respondents would prefer to be informed about MI before getting pregnant (66.0%). Vaccines investigated specifically for use in pregnancy were preferred by respondents. Overall, no relevant differences were observed between women pregnant for the first time and those with more than one pregnancy, nor between geographical regions. Conclusions The results show room for improving the awareness and understanding of the risks of pertussis for infants and the protective role of MI. The pregnant women preferred to receive advice on MI from an HCP, primarily their gynecologist. They were most interested in information on the safety profile of Tdap during pregnancy, on the mother, fetus, and newborn. The potential impact of this study to support clinical practice of Healthcare Providers is highlighted in the Focus on the Patient section.

Assesment of pregnancy outcomes among twin pregnancies with single fetal demise regarding chorionicity and fetal death time

Objective:The objective of this study was to assess maternal and perinatal outcomes of twin pregnancies with single fetal demise in terms of chorionicity and fetal death time.Material and Methods:All deliveries between January 2008 and July 2015 were reviewed retrospectively and 85 twin pregnancies with single fetal demise were included. These cases were grouped according to chorionicity and fetal death time.Results:The incidence of single fetal demise was 4.7%. The mean delivery week was later in the dichorionic group (34.16±4.65) than in the monochorionic group (31.1±3.83). The ratios of deliveries before the 34th gestational week were 71.4% in monochorionics and 35% in dichorionics. Monochorionics had a 13 times greater risk for having delivery before the 37th gestational week and a 4 times greater risk for having delivery before the 34th gestational week compared with dichorionics. Furthermore, monochorionics had a 7 times greater risk for having abruptio placenta compared with dichorionics. The newborn intensive care unit admission ratios were 61.3% in dichorionics and 85.7% in monochorionics. Also, monochorionics had a 3.7 times greater risk for admission to newborn intensive care unit compared with dichorionics.Conclusion:We recommend follow-up of twin pregnancies with single fetal demise in terms of premature birth, regardless of chorionicity. Also, close monitoring is recommended for monochorionic twin pregnancies with single fetal demise in terms of premature birth before 34 weeks of gestation, abruptio placenta, the need for neonatal intensive care, and respiratory distress syndrome.

Morphological and morphometrical studies of the human foetal lung

Background: Foetal lung is one of the organs of interest for researchers since a long time. Though, detailed study about adult lung is there in the literature but lungs at different stages in foetal period is less available.&#x0D; Aims and Objective: To find out the morphological and morphometrical features of the foetal lung in different gestational weeks.&#x0D; Materials and Methods: After ethical approval the study was carried out on 66 human foetal lungs aged between 16th to 40th gestational weeks in the Department of Anatomy, Manipal College of Medical Sciences. After the dissection of foetuses, the lungs were removed out and the presence of fissures and lobes for both lungs were noted. Weights of both lungs were calibrated by digital weighing machine. Dimensions of foetal lungs were recorded by vernier calliper. All the data were represented as mean then analyzed with MS excel 2007 software and represented graphically.&#x0D; Results: In the normally developing foetuses the dimensions of both lung increases with increase in gestational age with more or less difference between the dimension of right and left lung. There was number of variations seen in the fissures and lobes of the lungs.&#x0D; Conclusion: The fissures and lobes are needed for locating broncho-pulmonary segments hence, knowledge of their position is necessary both anatomically as well as clinically for planning lobectomies and surgical resections.

Nomograms of the fetal thymus for clinical practice.

IntroductionThe fetal thymus may be visualized using ultrasonography (USG) and is typically located in the mediastinum. In the past years, the size of the fetal thymus has served not only as a marker of genetic or heart defects but also as a predictive factor for intrauterine growth restriction, premature birth, preeclampsia, chorioamnionitis or even neonatal sepsis.Material and methodsA total of 410 fetuses were qualified for the study. Fetuses with heart defects were excluded from the study. The fetal thymus was evaluated with ultrasonography between the 14th and 40th week of gestation. After obtaining a standard transverse view encompassing the three great vessels, thymus measurements were attempted, i.e. maximal transverse diameter, circumference and surface area. Linear regression was used for statistical analysis, yielding 3 models, each with a different dependent variable. The confidence interval for each model was set at 80% to aid the comparison with centile grid growth charts for neonates and children. The test was regarded as statistically significant when p < 0.05.ResultsFrom a total of 410 fetuses the thymus transverse diameter, circumference and area were successfully measured in 410, 320 and 330 cases, respectively. The probabilities are lower than 0.0005 for each model, which means that each model is quite statistically significant.ConclusionsThe coverage of healthy thymus nomograms in the fetal population may be the basis for the identification of fetuses at risk of hypoplasia or thymic hyperplasia, which seems particularly important from the point of view of the detection of potential inborn immunological disorders

CERVICOVAGINAL FLUID CYTOKINES' LEVELS IN PRETERM BIRTH HIGH-RISK WOMEN COULD BE USED AS EARLY PREDICTORS FOR RECURRENT PRETERM BIRTH

Background: Differences in cytokine distribution across different biological fluids; maternal plasma, cervicovaginal fluid (CVF), and amniotic fluid are evident throughout normal pregnancy, but profiles of numerous cytokines varied across trimesters in women delivering term versus preterm in both CVF and serum. Objective: To evaluate cytokine profile in cervicovaginal fluid (CVF) of women had previous preterm birth (PTB) and the effect imposed by cerclage on these levels. Patients and Methods: Seventy study women with previous PTB and currently had cercical length (CL) of 25 mm were studied. At the 24th gestational week (GW; T1), all women had CL estimation and CVF sampling. At time of labor or removal of the suture (T2), study women had CL re-estimation and CVF re-sampling. CVF levels of monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-6 were ELISA estimated. Shirodkar cervical cerclage (CC) was performed within 4 days after T1 sampling. Outcomes included difference in T1-CVF cytokines' levels between study and control women, effect of cerclage on CL and CVF cytokines' levels and the value of T1-CVF cytokines' levels as predictors of pregnancy duration. Results: T1-CVF levels were significantly higher in study than control women and to their T2- levels. T1- and T2-CL in study women was significantly shorter than T1-CL in controls with significant difference between T1- and T2-CL. Percentage of T2-CL decrease was negatively correlated with the percentage of decrease of T2-CVF levels. Duration of pregnancy of study women was negatively correlated with percentage of CL shortening, while was positively correlated with percentage of decrease of T2-CVF levels of MCP-1 and TNF-α. Statistical analyses defined high T1-CVF levels of MCP-1, IL-β and TNF-α as significant early predictor for PTB. Conclusion: High CVF cytokines' levels were associated with increased risk of PTB. Cerclage worked beyond its mechanical action through reduction of CVF cytokines' levels. High CVF cytokines' levels at 24th GW, especially high levels of MCP-1 and TNF-α, may help to predict PTB.

Gangliosidome of human anencephaly: A high resolution multistage mass spectrometry study

Widely dispersed throughout the entire body tissues, gangliosides (GGs) are essential components of neuronal cell membranes, where exhibit a vital role in neuronal function and brain development, directly influencing the neural tube formation, neurogenesis, neurotransmission, etc. Due to several factors, partial or complete closing faults of the fetal neural tube may occur in the first trimester of pregnancy, generating a series of neural tube defects (NTD), among which anencephaly. The absence in anencephaly of the forebrain and skull bones determines the exposure to the amniotic fluid of the remaining brain tissue and the spinal cord, causing the degeneration of the nervous system tissue. Based on the previously achieved information related to the direct alteration of neural development with deficient concentration of several GGs, a systematic and comparative mass spectrometry (MS) mapping assay on GGs originating from fetuses in different intrauterine developmental stages, i.e. the 29th (denoted An29), 35th (An35) and the 37th (An37) gestational weeks was here conducted. Our approach, based on Orbitrap MS under high sensitivity, resolution and mass accuracy conditions, enabled for the first time the nanoelectrospray ionization, detection and identification of over 150 glycoforms, mainly novel, polysialylated species. Such a pattern, specific for incipient developmental stages reliably documents the brain development stagnation, characteristic for anencephaly. Further, the fragmentation MS2-MS3 experiments by collision induced dissociation (CID) confirmed the incidence in all three samples of GT2(d18:1/16:2) as a potential biomarker. Therefore, this fingerprinting of the anencephalic gangliosidome may serve in development of approaches for routine screening and early diagnosis.