Abnormal Early Pregnancy Research Articles

A Study on the Construction of a Core Midwife-Led Total Maternal Care Program for High-Risk Pregnancies

Objective: To analyze the care needs of high-risk pregnant women during pregnancy, delivery, and postpartum hospitalization. Additionally, to gather obstetrics staff’s suggestions for improving a total care program with core midwives leading. Methods: The study conducted semi-structured interviews with 20 high-risk pregnant women and 10 obstetricians at a tertiary hospital from August 2021 to October 2022. A descriptive qualitative study assessed their care needs and current care models. An evidence-based approach was used to evaluate guidelines and develop a draft care plan. Finally, the Delphi method refined the core midwife-led total care program. Results: The study formulated a draft for a core midwife-led care program, integrating literature and expert feedback. This program defined midwife roles with 7 service standards and 6 qualification standards. The care practice included 3 level 1, 19 level 2, and 58 level 3 entries. Management of common risk factors had detailed entries for conditions like gestational diabetes, advanced maternal age, abnormal early pregnancy weight, hypertensive disorders, and scarred uterus. Conclusion: The study offers a qualitative exploration of high-risk pregnant women’s care needs and suggests improvements based on healthcare professionals’ experiences. It provides a foundation for a midwife-led care program and proposes new research directions. The methodology combines the Ottawa research application model, evidence-based approaches, and theoretical analysis to support this program’s development.

Multiplexed serum biomarkers to discriminate nonviable and ectopic pregnancy

ObjectiveThe use of multiplexed biomarkers may improve the diagnosis of normal and abnormal early pregnancies. In this study we assessed 24 markers with multiple machine learning-based methodologies to evaluate combinations of top candidates to develop a multiplexed prediction model for identification of 1) viability and 2) location of an early pregnancy. DesignA nested case-control design evaluating the predictive ability and discrimination of biomarkers in patients at risk of early pregnancy failure in the first trimester to classify viability and location Subjects218 individuals with a symptomatic (pain and/or bleeding) early pregnancy: 75 with an ongoing intrauterine gestation, 68 ectopic pregnancies, and 75 miscarriages. InterventionsSerum values of 24 biomarkers were assessed in the same patients. Multiple machine learning-based methodologies to evaluate combinations of these top candidates to develop a multiplexed prediction model for identification of 1) a nonviable pregnancy (ongoing intrauterine pregnancy vs miscarriage or ectopic pregnancy) and 2) an ectopic pregnancy (ectopic pregnancy vs ongoing intrauterine pregnancy or miscarriage). Main Outcome MeasuresThe predicted classification by each model was compared to actual diagnosis and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), conclusive classification, and accuracy were calculated. ResultsModels using classification regression tree analysis using three markers (PSG3, CG-Alpha and PAPPA) were able to predict a maximum sensitivity 93.3%, a maximum specificity 98.6%. The model with the highest accuracy was 97.4% (with 70.2% receiving classification). Models using an overlapping group of three markers (sFLT, PSG3 and TFP12) achieved a maximum sensitivity of 98.5%. and a maximum specificity of 95.3%. The model with the highest accuracy was 94.4% (with 65.6% receiving classification). When the models were used simultaneously the conclusive classification increased to 72.7% with an accuracy 95.9%. The predictive ability of the biomarkers random forest produced similar test characteristics when using 11 predictive markers. ConclusionWe have demonstrated a pool of biomarkers from divergent biological pathways that can be used to classify individuals with potential early pregnancy loss. The biomarkers CG-Alpha, PAPPA and PSG3 can be used to predict viability and sFLT, TPFI2 and PSG3 can be used to predict pregnancy location.

P087Medical management of early pregnancy in emergency departments compared to outpatient: Evaluating a covid-19 institutional policy change to increase healthcare access

<h3>Objectives</h3> To assess the safety and efficacy of prescribing mifepristone and misoprostol for medical management of abnormal early pregnancy in emergency departments (EDs) compared to outpatient management at a complex family planning office, and to compare post-treatment follow-up. <h3>Methods</h3> We conducted a retrospective cohort study after implementing mifepristone and misoprostol prescription in three Bronx, NY EDs during the COVID-19 pandemic's first wave. All patients receiving medical management between April 1, 2020 and March 31, 2021 were reviewed. Outcomes were compared by treatment setting. Induced abortion only occurred in the outpatient setting. Treatment success was defined as pregnancy resolution after one dose of mifepristone and misoprostol. Safety outcomes included emergent interventions and blood transfusion. We assessed rates of post-treatment follow-up. <h3>Results</h3> Some 167 patients received medical management: 33 (19.8%) in the ED and 134 (80.2%) outpatient. ED patients were older (aged 30.9±6.9 vs. 28.1±5.9, p=0.02) and more likely to have Medicaid insurance (81.8% vs. 51.5%, p=0.003). Treatment success occurred for 23 (69.7%) ED and 119 (88.8%) office patients. A multivariate logistic regression adjusting for age, insurance status, and pregnancy diagnosis showed lower odds of treatment success in the ED vs. outpatient setting, but was not statistically significant (adjusted OR (aOR), 0.60; 95% CI, 0.17–2.09; p=0.42). ED safety outcomes included two emergent uterine aspirations, one uterine artery embolization, and two blood transfusions. Outpatient safety outcomes included one admission for intravenous antibiotics. Follow-up was similar: 28 (84%) ED vs 121 (90.3%) outpatients (p=0.36). <h3>Conclusions</h3> Medical management of abnormal early pregnancy with mifepristone and misoprostol in the ED is effective. Larger studies are needed to better quantify ED safety outcomes.

Associations of early pregnancy BMI with adverse pregnancy outcomes and infant neurocognitive development

The prevalence of overweight and obesity amongst reproductive women has been increasing worldwide. Our aim was to compare pregnancy outcomes and infant neurocognitive development by different BMI classifications and investigate whether early pregnancy BMI was associated with risks of adverse outcomes in a Southwest Chinese population. We analysed data from 1273 women enrolled in the Complex Lipids in Mothers and Babies (CLIMB) randomized controlled trial in Chongqing, China. Maternal BMI was classified as underweight, normal weight and overweight/obese according to the Chinese, WHO Asian, and WHO European standards. For the adverse pregnancy outcomes, after adjustment for potential confounders, an underweight BMI was associated with increased risk of small for gestational age (SGA) babies, and an overweight/obese BMI was associated with increased risk of maternal gestational diabetes mellitus (GDM), caesarean section (C-section), macrosomia and large for gestational age (LGA) babies. For infant neurocognitive development, 1017 mothers and their children participated; no significant differences were seen in the Mental Development Index (MDI) or the Psychomotor Development Index (PDI) between the three BMI groups. Our findings demonstrate that abnormal early pregnancy BMI were associated with increased risks of adverse pregnancy outcomes in Chinese women, while early pregnancy BMI had no significant influence on the infant neurocognitive development at 12 months of age.

Preconception folate status and reproductive outcomes among a prospective cohort of folate-replete women

Most studies of folate metabolism and reproduction have been conducted after pregnancy and in folate-deficient populations. However, measurement of maternal folate status preconceptionally may be most relevant to certain folate-linked early processes preceding a successful pregnancy, and there has been a major increase in folate concentrations in women of childbearing age in high resource settings. To examine associations between preconceptional biomarkers of maternal folate status (folate and homocysteine) and reproductive outcomes in folate-replete women. Cohort nested within the Effects of Aspirin in Gestation and Reproduction trial, a block-randomized, double-blind, placebo-controlled trial whereby women were randomized to daily low-dose aspirin (81 mg/day) or placebo and all women received folic acid (400 μg/day). In total, 1228 women with 1-2 previous pregnancy losses and no documented infertility were recruited from 4 clinical sites in the United States (2006-2012) and were attempting pregnancy for up to 6 menstrual cycles. Log-binomial regression models were used to estimate relative risks and 95% confidence intervals between preconception serum folate and plasma homocysteine for anovulation, pregnancy, and pregnancy loss. Greater plasma homocysteine was nonlinearly associated with greater risks of pregnancy loss only among women with 2 previous losses: a relative risk of 1.43 (95% confidence interval, 1.08-1.89) was found for plasma homocysteine concentrations at the study median of 8.0 μmol/L compared with a US population median of 6.0 μmol/L. No meaningful relationships were found between serum folate and any reproductive outcome or between plasma homocysteine and anovulation or becoming pregnant. These data justify further study of the role of folate and homocysteine metabolism in normal and abnormal early pregnancy.

Comparison of Ultrasonographic and Doppler Mapping of the Intervillous Circulation in Normal and Abnormal Early Pregnancies

Comparison of Ultrasonographic and Doppler Mapping of the Intervillous Circulation in Normal and Abnormal Early Pregnancies

Corpus Luteum Blood Flow in Abnormal Early Pregnancy

Corpus Luteum Blood Flow in Abnormal Early Pregnancy

Selected non-somatic risk factors for pregnancy loss in patients with abnormal early pregnancy.

Spontaneous abortion constitutes one of the most frequent complication of human pregnancy. Despite intensive research efforts undertaken to date, the etiopathogenesis of early pregnancy loss has not been fully elucidated. The objective of this study was to analyze the role of selected non-somatic risk factors for early pregnancy loss in patients with various clinical manifestations of spontaneous abortion. The study included 242 women hospitalized between 2001 and 2004 in the 3rd Chair and Department of Gynecology, Medical University of Lublin, Poland (Teaching Hospital No.4) with various clinical categories of spontaneous abortion. Each patient completed a questionnaire assessing her exposure to the examined factors. In patients with threatened abortion dismissed from the hospital with viable gestation, the course of pregnancy was followed-up using questionnaire data and medical records. In the studied population of women with abnormal early pregnancy course, a significant impact on the risk of miscarriage was observed in case of such factors as: exposure to stress at home and limited number of hours of nightly sleep. Factors such as occupational hazards, diet, stress, heavy housework and use of cigarettes or alcohol did not exert a significant effect on the risk of miscarriage in the studied population. The results of this study confirm the complexity of the early pregnancy loss etiopatogenesis. Further research need to be conducted in order to identify the non-somatic causative agents of various clinical forms of miscarriage. It may help do select women in reproductive age at high risk of early pregnancy loss and show the ways in which effective preventive measures can be introduced in such population.

Autophagy in Normal and Abnormal Early Human Pregnancies.

Autophagy is an inducible catabolic process by which cells degrade and recycle materials to survive stress, starvation, and hypoxia. The aim of this study was to evaluate autophagy at the fetal-maternal interface, to assess autophagy involvement during the early phase of human gestation, and to explore autophagic modification in case of early abnormal pregnancy outcome. Specimens were collected from first-trimester normal gestations undergoing legal termination of pregnancy and first-trimester sporadic spontaneous miscarriages. Autophagy was studied in villous and decidual samples by transmission electron microscopy, immunohistochemistry, immunofluorescence, and Western blotting. Autophagy markers were found in cytotrophoblast, syncytiotrophoblast, extravillous trophoblast, and decidual stromal cells. Autophagy is physiologically involved in early normal gestation. Compared with normal pregnancy, spontaneous miscarriage presents an increase in autophagy expression in villous specimens due to an increment in concentration of autophagic vacuole in syncytiotrophoblast, suggesting a cytoprotective mechanism of the cells to respond to microenvironmental challenge.

Seroprevalence of Chlamydia trachomatis, cytomegalovirus, herpes simplex virus 1 and 2 in Saudi women with normal and abnormal early pregnancy: A case control study

This work measured the seroprevalence of Chlamydia trachomatis, cytomegalovirus, herpes simplex virus-1 and 2 in Saudi women with normal and abnormal early pregnancy. This is a case-control study; serum samples were collected from 250 women as follows: 100 normal pregnancies, 70 ectopic pregnancies and 80 spontaneous abortions. IgG and IgM antibodies against candidate organisms were measured using enzyme linked immunosorbant assay (ELISA). The prevalence of C. trachomatis IgG, but not IgM, was significantly higher in ectopic pregnancy (18.5%) and abortion (10%) as compared to normal pregnancy (5%) (P < 0.05). The frequency of HSV-1 IgG, but not HSV-2, was also higher in ectopic pregnancy (94.3%) and abortion (87.5%) than in normal pregnancy (64%). However, the rate of detecting both IgM and IgG antibodies together either against HSV-1 or HSV-2 was higher in the ectopic (41.1 and 30%, respectively) and abortion groups (28.7 and 36.2%, respectively) as compared to the control (9 and 16%, respectively). Correspondingly, the frequency of cytomegalovirus (CMV) IgG was significantly higher in ectopic pregnancy (91.4%) and abortion (75%) as compared to normal pregnancy (58%). Similar results were also observed for CMV IgM antibodies either alone or with IgG antibodies in the ectopic and abortion groups as compared to control (P < 0.05). Candidate organisms were common by serology in Saudi females with abnormal early pregnancy. Additionally, the high frequency rate in normal pregnancy alarms the potential high risk of congenital infection. Further studies are needed to measure the true prevalence of these sexually transmitted infections (STIs) and their associated pregnancy complications in Saudi Arabia. Key words: Chlamydia trachomatis, cytomegalovirus, herpes simplex virus, ectopic pregnancy, abortion, Saudi Arabia.

Placental growth factor (PLGF) in first trimester aneuploid pregnancies

Objective To evaluate placental growth factor (P1GF) in abnormal early pregnancies. Methods Placental growth factor (P1GF) was retrospectively quantified (DELFIA DXpress; Perkin Elmer) in women with known pregnancy outcomes. Study group consisted of: (i) normal (n = 300); (ii) abnormal: trisomy 21 (n = 56), trisomy 18 (n = 23), trisomy 13 (n = 6), triploid (n = 15), monosomy X (n = 7). P1GF MoM values were calculated by LifeCycle v4 (Perkin Elmer), using lot specific derived polynomial regression curve. Results Median P1GF MoM values were depressed in pregnancies carrying a fetus affected with: trisomy 21 = 0.81 (95%CI 0.72-0.90), trisomy 13=0.87 (95%CI 0.79-0.95), trisomy 18 = 0.89 (95%CI 0.78-1.00) and triploidy = 0.68 (95%CI 0.59-0.77). However, in viable sex chromosome aneuploidy, such as monosomy X, P1GF proved less discriminatory with median MoM = 0.91 (95%CI 0.76-1.06). Conclusions The above findings support the inclusion of P1GF in the marker panel for first trimester screening for fetal aneuploidy. In addition to improving detection of fetal aneuploidy, P1GF has a role in first trimester detection of early onset pre-ecalmpsia1. To evaluate placental growth factor (P1GF) in abnormal early pregnancies. Placental growth factor (P1GF) was retrospectively quantified (DELFIA DXpress; Perkin Elmer) in women with known pregnancy outcomes. Study group consisted of: (i) normal (n = 300); (ii) abnormal: trisomy 21 (n = 56), trisomy 18 (n = 23), trisomy 13 (n = 6), triploid (n = 15), monosomy X (n = 7). P1GF MoM values were calculated by LifeCycle v4 (Perkin Elmer), using lot specific derived polynomial regression curve. Median P1GF MoM values were depressed in pregnancies carrying a fetus affected with: trisomy 21 = 0.81 (95%CI 0.72-0.90), trisomy 13=0.87 (95%CI 0.79-0.95), trisomy 18 = 0.89 (95%CI 0.78-1.00) and triploidy = 0.68 (95%CI 0.59-0.77). However, in viable sex chromosome aneuploidy, such as monosomy X, P1GF proved less discriminatory with median MoM = 0.91 (95%CI 0.76-1.06). The above findings support the inclusion of P1GF in the marker panel for first trimester screening for fetal aneuploidy. In addition to improving detection of fetal aneuploidy, P1GF has a role in first trimester detection of early onset pre-ecalmpsia1.

Normal and Abnormal Early Pregnancy

ABSTRACT The first trimester, mostly defined as the first 100 days of pregnancy, is characterized by many important landmarks heralding the ultimate outcome of pregnancy. Woman becomes aware of her pregnancy after missing her period, being already two weeks postconception at that time. A positive pregnancy test opens Pandora's Box, raising more questions than giving answers. Although a positive pregnancy test most likely suggests an intrauterine pregnancy, production of human chorionic gonadotropin (hCG) occurs as well in tumors (dysgerminoma, choriocarcinoma) or maldeveloped pregnancies, such as ectopic pregnancy, blighted ovum or mola hydatidosa. Other early pregnancy complications and failures, like subchorionic hematoma, missed abortion, incomplete miscarriage, retained products of conception, are likely to be accompanied by clinical symptoms such as lower abdominal pain and/or vaginal bleeding, and suboptimal beta hCG serum levels. Transvaginal ultrasound probes with frequencies of up to 14 MHz have lowered the threshold for US-detection of intrauterine pregnancy to 1200 mIu/ml beta hCG/serum (discriminatory zone), and enable identification of all above-mentioned 1st trimester pregnancy disorders earlier than ever before. Furthermore, the additional interrogation of the region of interest (ROI) with color Doppler (CD) and pulsed-wave Doppler (PW) supplies important information about characteristics of vascularization and flow indices, which assists in further differentiation and prognosis of abnormal early pregnancy findings. With the introduction of transvaginal three-dimensional (3D) sonography, and real-time 3D ultrasound (4D), in vivo studies of the early fetal life became possible. The developmental progress of the embryo and early fetus, its anatomy, and first movement patterns, have been explored by means of ultrasonic 3- and 4D imaging, which can be considered as nonteratogenic as long as investigators adhere to certain safety rules. The new field of sonoembryology has emerged, and researchers are penetrating the mists hiding the beginning of human life. Another area of remarkable expansion has been the 1st trimester scan between 11 and 13/6 weeks of gestation. It includes not only the early diagnose of fetal structural anomalies, like acranius-anencephalus sequence, and the screening for fetal aneuploidies such as trisomia 21,18 and 13, but also offers likelihood ratios for hypertensive pregnancy disorders (pre-eclampsia) and intrauterine growth restriction (IUGR).

Presumptive treatment of abnormal early pregnancy of unknown Location

Early pregnancies with inappropriately increasing serum hCG may be intrauterine or ectopic. When ultrasound is unable to localize the gestation, suction curettage can exclude an intrauterine gestation before methotrexate administration. Whether suction curettage is necessary in this setting is unclear. We performed a decision analysis to evaluate whether abnormal pregnancy of unknown location may be treated primarily with intramuscular methotrexate regardless of location, thus avoiding curettage.

Ultrasound Evaluation of Abnormal Early Pregnancy

Abstract Ultrasound examination has become the “golden standard” in follow-up of the development and complications in early pregnancy. With introduction of transvaginal sonography a possibility for early morphological and biometrical ultrasound examinations has been significantly improved. The essential aim of an early pregnancy ultrasound is not only to diagnose a pregnancy, but also to differentiate between normal and abnormal pregnancy. Application of color Doppler ultrasound has enabled functional hemodynamic presentation and evaluation soon after implantation.

Ultrasonography in the Diagnosis and Management of Abnormal Early Pregnancy

Ultrasonography in the Diagnosis and Management of Abnormal Early Pregnancy

Biochemistry in the Diagnosis and Management of Abnormal Early Pregnancy

To examine the current state of knowledge regarding the biochemical parameters of early pregnancy failure. Earlier studies have concentrated on the role of human chorionic gonadotropin and progesterone in early pregnancy failure and recent studies have also explored newer markers such as the inhibins and insulin growth factor binding proteins. Multiparameter models have now been created for the prediction of successful expectant management of early pregnancy failure. Examining the role of newer biochemical markers in the early pregnancy failure has led to an improved understanding of the underlying mechanisms and has clinical benefit in the selection of appropriate management for patients.

Ultrasonography in the Diagnosis and Management of Abnormal Early Pregnancy

The demand for ultrasound in early pregnancy has been increasing steadily, and is now a routine investigation for most women within the first trimester of their pregnancy. It is a safe investigation which provides reassurance, charts normal development, and identifies women with abnormal or high risk pregnancies. Transvaginal ultrasound has revolutionized the diagnosis of early pregnancy as it can detect a pregnancy at an earlier stage, whether it is normal and therefore reassuring, or abnormal and require intervention. Ultrasound is also a useful tool to aid decisions regarding management of abnormal pregnancy, such as ectopic pregnancy or miscarriage. This chapter looks at the important role ultrasound plays in the diagnosis and management of abnormal pregnancy.

Normal and Abnormal Early Pregnancy Assessed by 3D Sonography

SUMMARY Ultrasound instruments are now able to provide a good view of the uterus-endometrium and ovaries and normal anatomy can be confirmed with a single scan before conception. Ultrasonographic confirmation of conception is usually only performed after medically assisted reproductive procedures but embryo and fetal development can be followed weekly, from weeks 4, to obtain important physiological information, to check anatomy and to find aneuploidy markers. Three and four dimensional (3 or 4D) scans provide better images than 2D for definition and vision, and facilitate diagnosis of pathology. MATERIALS AND INSTRUMENT

382 ULTRASONOGRAPHIC EVALUATION OF AMNIOTIC SAC SIZE DURING EARLY PREGNANCY IN COWS

In ruminants, the embryonic vesicle is composed of the yolk and the allantoic and amniotic sacs. In cattle, the allantoic sac represents the largest fluid accumulation in the uterus from early pregnancy onward, but is irregular in shape as it conforms to the uterine horns. It is, therefore, difficult to ultrasonographically measure the allantoic compartment. Conversely, the amniotic sac remains ellipsoidal in shape and can be evaluated more easily. The aim of this study was to characterize the development of the amniotic sac in relation to embryo development. Thirteen multiparous, nonlactating Aberdeen Angus cows were examined weekly from 30 days to 72 days of gestation. Epidural anesthesia was induced (6 mL of 2% lidocaine) to obtain light relaxation of the rectum and prevent straining. Measurements were taken by ultrasonography (Toshiba Nemio 20, Tokyo, Japan) using a 5–10 MHz intraoperative finger probe from 30 days to 58 days of pregnancy, and a 3–6 MHz linear-array probe thereafter. Length (D1) was registered in a longitudinal section of the amniotic sac, whereas width (D2) and height (D3) were measured in a cross section. Volume (cm3) was calculated with the formula 4 ÷ 3 × Pi × (D1 ÷ 2) × (D2 ÷ 2) × (D3 ÷ 2) ÷ 1000 and mean amniotic diameter (MAD) was calculated as the average of the three measurements (Hellman et al. 1969 Obstet. Gynecol. 103, 789). Crown rump length (CRL) was measured in a longitudinal section of the embryo when it was in a neutral position. Results show that volume, MAD, and the CRL increase progressively during the first trimester (Table 1). In the first 50 days of gestation, the difference (MAD-CRL) changed from a negative to a positive value, probably as a reflection of increasing embryonic production of amniotic fluid (Wallenburg et al. 1988 Med. 5, 191). From 58 days of gestation onward, the difference became progressively more negative due to a faster relative growth rate of the embryo than of the amniotic sac. To conclude, the present table may be useful in distinguishing between normal and abnormal early pregnancy, including embryonic growth retardation and hydrops amnios (Wintour 1986 et al. Aust. Vet. J. 216, 221). Table 1. Mean amniotic diameter (MAD), crown rump length (CRL), and the difference (MAD-CRL) during pregnancy in cattle (mean ± SD; n = 13)

Laparoscopic arterial ligation can prevent or limit massive intractable uterine bleeding in abnormal early pregnancy: A report of two cases

Laparoscopic arterial ligation can prevent or limit massive intractable uterine bleeding in abnormal early pregnancy: A report of two cases