Affect Pregnancy Outcome Research Articles

Epidural anesthesia as a sole anesthetic for a parturient with cardiac disease and low ejection fraction – a case report in resource limited setup

Introduction and importance: The effective care of pregnant women with cardiac conditions relies on collaboration among the obstetrician, cardiologist, and anesthesiologist throughout the peripartum period. Limited research exists regarding the safety of specific anesthetic approaches for patients with congestive heart failure (CHF), particularly in the context of pregnancy. Case presentation: This was a 28-year-old woman who was pregnant with her third child (gravida III, para II) and has not had a menstrual period for the past 8 months. She had been receiving antenatal care at a local health center. Currently, she was experiencing symptoms including coughing, difficulty breathing, epigastric pain, and chest pain, which had been present for 1 week. Upon examination, she was diagnosed with New York Heart Association class IV CHF with pulmonary edema, and preeclampsia with severe features, and she was in the third trimester of pregnancy. Clinical discussion: Pre-existing medical conditions can adversely affect pregnancy outcomes for women and their offspring, especially in resource-poor settings in Africa. The goals of anesthetic management are avoidance of myocardial depression, maintaining normovolemia, avoiding an overdose of drugs during induction as the circulation time is slow, and avoiding sudden hypotension when regional anesthesia is the choice. Conclusion: We believe that successful management of anesthesia for this critical case depends on a thorough understanding of the pathophysiology of the disease condition, the selection of anesthetic techniques, and the decision-making of our team. We showed epidural anesthesia could be safely used to manage high-risk cardiac patients, however, further interventional study is needed to prove safety.

The mechanism of paclitaxel induced damage on placental trophoblast cells

ObjectiveChemotherapy during pregnancy has a certain risk of causing a series of complications, such as miscarriage, premature birth, or fetal growth restriction, although the relationship between these complications and chemotherapy is currently unclear. This experiment focuses on the possible damage mechanism of the chemotherapeutic drug paclitaxel on placental trophoblast cells, and explores whether chemotherapy can affect pregnancy outcomes by directly damaging placental tissue.MethodsThis study explored the mechanism of paclitaxel induced damage on placental trophoblast cell lines JEG-3 and BEWO through immunofluorescence staining, Western blot experiments, cell flow cytometry, Seahorese cell metabolism experiments, and mouse modeling verification.ResultsThe experiment found that paclitaxel could induce JEG-3 and BEWO cells to produce reactive oxygen species (ROS), and elevate the ratio of Bax/Bcl-2 expression. Besides, paclitaxel mediated the reduction of mitochondrial membrane potential in JEG-3 and BEWO cells, causing damage and leading to mitochondrial autophagy and the occurrence of unfolded protein response. Paclitaxel inhibited the glycolysis rate of JEG-3 and BEWO cells, and leaded to impaired mitochondrial function, including decreased basal respiratory values, decreased respiratory reserve capacity, and proton leakage. In pregnant mice with tumor modeling, paclitaxel could cause DNA damage in placental tissue cells, and might lead to apoptosis of chemotherapy mice placental tissue cells and impairment of normal physiological functions.ConclusionPaclitaxel may directly or indirectly affect the normal physiological functions of placental trophoblast cells, including energy metabolism and protein synthesis dysfunction, which may be related to the adverse pregnancy outcomes caused by paclitaxel chemotherapy.

Inflammatory and cardiovascular markers in placenta following SARS-CoV-2 infection during pregnancy: A Swedish prospective cohort study

IntroductionMaternal SARS-CoV-2 infection can affect pregnancy outcome, but the placental response to and the effect of timing of infection is not well studied. The aim of this study was to investigate the placental levels of inflammatory and cardiovascular markers in pregnancies complicated by SARS-CoV-2 infection compared to non-infected pregnancies, and to investigate whether there was an association between time point of infection during pregnancy and placental inflammatory and cardiovascular protein levels. MethodsPlacental samples from a prospectively recruited pregnancy cohort of SARS-CoV-2-infected (n = 53) and non-infected (n = 50) women were analysed for 177 inflammatory and cardiovascular proteins, using an antibody-based proximity extension assay. In the SARS-CoV-2-infected group, half of the women were infected before 20 weeks of gestation, and five women were hospitalised for severe SARS-CoV-2 infection. Single-protein analyses were performed with linear mixed effects models, followed by Benjamini-Hochberg correction for multiple testing. Multi-protein analyses were performed using principal component analysis and machine learning algorithms. ResultsThe perinatal outcomes and the placental levels of inflammatory or cardiovascular proteins in women with SARS-CoV-2 infection were similar to those in non-infected women. There were no differences in inflammatory or cardiovascular protein levels between early and late pregnancy SARS-CoV-2 infection, nor any linear correlations between protein levels and gestational age at time of infection. DiscussionWomen with SARS-CoV-2 infection during pregnancy without clinical signs of placental insufficiency have no changes in inflammatory or cardiovascular protein patterns in placenta at time of birth regardless of the timing of the infection.

Application of machine learning algorithm incorporating dietary intake in prediction of gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) significantly affects pregnancy outcomes. Therefore, it is crucial to develop prediction models since they can guide timely interventions to reduce the incidence of GDM and its associated adverse effects. A total of 554 pregnant women were selected and their sociodemographic characteristics, clinical data and dietary data were collected. Dietary data was investigated by a validated semi-quantitative food frequency questionnaire (FFQ). We applied random forest mean decrease impurity for feature selection and the models are built using Logistic Regression, XGBoost, and LightGBM algorithms. The prediction performance of different models was compared by Accuracy, Sensitivity, Specificity, Area Under Curve (AUC) and Hosmer-Lemeshow test. Blood glucose, age, pre-pregnancy body mass index (BMI), triglycerides and high-density lipoprotein cholesterol (HDL) were the top five features according to the feature selection. Among the three algorithms, XGBoost performed best with an AUC of 0.788, LightGBM came second (AUC = 0.749), and Logistic Regression performed the worst (AUC = 0.712). In addition, XGBoost and LightGBM both achieved a fairly good performance when dietary information was included, surpassing their performance on the non-dietary dataset (0.788 vs. 0.718 in XGBoost; 0.749 vs. 0.726 in LightGBM). XGBoost and LightGBM algorithms outperform Logistic Regression in predicting GDM among the Chinese pregnant women. In addition, dietary data may have a positive effect on improving model performance, which deserves more in-depth investigation with larger sample size.

Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018

Historically redlined neighborhoods may experience disinvestment, influencing their likelihood of gentrification, a process of neighborhood (re-)development that unequally distributes harms and benefits by race and class. Understanding the combined outcomes of redlining and gentrification informs how the mutually constitutive systems of structural racism and racial capitalism affect pregnancy outcomes. To examine if historical redlining and contemporary gentrification is associated with increased severe maternal morbidity (SMM) odds. This cross-sectional study used data from a statewide population-based sample of all live hospital births at 20 weeks' gestation or more between 2005 and 2018 in California. Analysis was conducted from March 2023 to January 2024. Redlining (as characterized by the federal Home Owners' Loan Corporation mortgage security maps) and displacement (using present-day sociodemographic and housing market information). Mixed-effects logistic regression models were used to assess the association of census tract-level exposure to historical redlining and contemporary gentrification with increased SMM odds, adjusting for sociodemographic and pregnancy related factors. Outcome classification was based on the Centers for Disease Control and Prevention SMM index, which defines SMM as having any of the 21 procedures and diagnoses based on the International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. The study sample included 1 554 837 births (median [SD] maternal age, 29.0 [6.4] years; 3464 American Indian or Alaskan Native [0.2%], 224 774 Asian [14.5%], 132 240 Black [8.5%], 880 104 Hispanic [56.6%], 312 490 White [20.1%]), with 22 993 cases of SMM (1.4%). Residents in historically redlined neighborhoods that were undergoing gentrification or displacement were more likely to be Black, Hispanic, and American Indian or Alaskan Native. Independent of individual-level characteristics, SMM odds were greater for individuals living in redlined neighborhoods that experienced displacement (OR, 1.21; 95% CI, 1.14-1.28) and in redlined neighborhoods undergoing gentrification (OR, 1.21; 95% CI, 1.13-1.29) compared with those in continuously advantaged neighborhoods. Findings from this cross-sectional study demonstrate that the legacies of redlining, intertwined with current dynamics of displacement and gentrification, affect SMM. Place-based sociopolitical mechanisms that inequitably distribute resources may be important intervention points to address structural drivers of adverse pregnancy outcomes and their racial inequities.

Barbed suture in laparoscopic myomectomy.

Uterine myomas are the most common benign gynecological tumors among women of reproductive age. The laparoscopic approach, when feasible, is considered the most suitable and safe technique for intervention. Typically, uterine muscular wall defects are sutured with absorbable filaments. However, performing intra-corporeal knots during laparoscopic procedures demands significant surgical abilities and experience. While laparoscopic myomectomies are often recommended, they pose a high risk of hemorrhage. Barbed sutures may address the challenges of laparoscopic knotting due to their inherent barbs, leading to filament cohesion with tissues. This characteristic could potentially reduce the total operative time and blood loss during surgery. In consideration of the latest literature meta-analysis on the topic, published in 2018 and cited in the present work, six papers were included in this review, excluding case reports, reviews and articles without a control group. The objective of this narrative review is to explore the literature and establish the safety profile of barbed suture compared to conventional laparoscopic sutures. Additionally, given the potential for postoperative adhesion formation with the use of barbed sutures, the review also emphasizes reproductive outcomes. Consistent with previous literature, patients undergoing barbed suture laparoscopic myomectomy experienced significantly lower suturing time and blood loss. Regarding obstetric outcomes, all studies analyzing this aspect concluded that barbed sutures in myomectomy are as safe as, and represent an easier alternative to, conventional sutures. Importantly, these findings did not adversely affect pregnancy outcomes.

An Insight into Red Cell Distribution Width Fluctuations and Pregnancy Outcomes in HIV-Affected Women

Red Cell Distribution Width (RDW), a measure of the variability in red blood cell size, has gained attention as a potential biomarker for assessing pregnancy outcomes, particularly in women living with HIV. This review explores the relationship between RDW fluctuations and maternal and fetal health during pregnancy in HIV-affected women. Elevated RDW levels have been associated with various adverse outcomes, including preeclampsia, preterm birth, and low birth weight, which are of significant concern in this population. HIV infection introduces additional complexity to pregnancy, increasing the risk of complications for both mother and infant. The interaction between HIV, antiretroviral therapy, and RDW levels can influence maternal hematological health, potentially affecting pregnancy outcomes. This review examines current literature to understand how RDW variations correlate with these complications and the implications for maternal and fetal well-being.

An interplay between orthopaedic trauma and pregnancy—A case series of 42 patients

BackgroundPregnancy and trauma are complex situations with significant implications for maternal and fetal health. Physical and psychological trauma during pregnancy can lead to pre-term labor, abruptio-placenta, and fetal injury or death. Management of trauma is challenging due to physiological and anatomical changes, which can affect fracture management and the risk of radiation exposure. A multidisciplinary approach is beneficial for patient care. This study aimed to determine the impact of orthopaedic trauma on pregnancy and its outcome, and influence of pregnancy on fracture management. Methods and materialA retrospective-study was conducted at a Level-1 trauma-care-center, focusing on 54 pregnant women who sustained trauma between January 2015 and December 2022. The study included patients with closed or open fractures, but excluded those without fractures. Forty-two patients were available with minimum 1 year follow-up. Data was collected from hospital records and PACS, including demographic details, emergency care, and laboratory parameters. Changes made in protocol in fracture management due to pregnancy (primary definitive fixation vs staged management), and impact of trauma on pregnancy outcome; mode-of-delivery, maternal and fetal loss were evaluated. ResultsThe mean age was 30-years (range: 21–43years). Road-traffic-collision was most-common mode-of-injury (66.7 %). 38.1 % were in the first-trimester, 35.7 % in second, and 26.2 % in third-trimester. Eight patients had polytrauma, seven had multiple-injuries, and 27 had isolated-injuries. The maternal-mortality-rate was 0.45 %. Three polytraumatized patients ended up with intrauterine death, two polytrauma patients underwent elective abortion, one patient presented with spontaneous-abortion, and fetal loss was 14.3 % (6-of-42). Out of 42 patients, 10 had open-injuries and 32 had closed-injuries. Nine patients underwent LSCS(lower-segment-caesarean-section), six of them were planned for elective-LSCS due to injury and associated fractures (two patients with pelvic injuries, two neck femur fracture patients, one open distal femur fracture, and one ankle fracture dislocation). ConclusionOrthopaedic trauma during pregnancy can significantly affect pregnancy outcomes and is associated with a notably higher risk of fetal loss. An elective-caesarean-section is recommended for patients with polytrauma, pelvic-injuries, and those who are immobilized for longer-duration. During the third-trimester and in polytraumatized patients, external-fixator-application for lower-limb-injuries is a safe strategy, and definitive fixation could be performed post-delivery.

Placental Chorioangiomas: A Single Tertiary Center Experience

Abstract Background Chorioangiomas are benign vascular placental tumors. Although most of them remain small and are asymptomatic, large tumors (>4 cm) may cause maternal or fetal complications. Methods We report seven cases of chorioangioma over a span of 8 years in a single tertiary center managed either conservatively or with necessary intervention. All cases were followed up and postnatal outcomes were recorded. Results Six cases were diagnosed in the second trimester and one in the third trimester by ultrasound. Four were managed conservatively, while three of them required prenatal therapy: one interstitial laser and the other two an intrauterine arterial embolization of the feeder vessel. One underwent a rescue intrauterine fetal transfusion before definitive embolization. Conservatively managed patients developed gestational hypertension and growth restriction. They had low birth weight and needed neonatal intensive care. There was one intrauterine demise (IUD) and two healthy neonates in the cases that needed a fetal intervention. Conclusion The management of chorioangioma is dynamic and challenging, ranging from conservative to prenatal intervention. Treatment failure can result in serious complications adversely affecting pregnancy outcomes. However, regular monitoring by ultrasound and Doppler surveillance with timely interventions can lead to good neonatal and maternal outcomes.

Effect and Predictive Value of Blood HbA1c, FBG, 2hPBG, and FINS on the Pregnancy Outcome in Patients with Gestational Diabetes Mellitus.

This study aimed to investigate the effects of hemoglobin A1c (HbA1c), fasting blood glucose (FBG), 2-hours postprandial blood glucose (2hPBG), and fasting insulin (FINS) levels on pregnancy outcomes and their predictive value in patients with gestational diabetes mellitus (GDM). A total of 109 pregnant women with GDM (GDM group) were included and assayed for serum FBG, 2hPBG, HbA1c, and FINS levels. The incidence of adverse pregnancy outcomes was recorded. GDM patients were divided into the poor pregnancy outcome group and the favorable pregnancy outcome group and analyzed for HbA1c, FBG, 2hPBG, and FINS. The predictive value of serum index combined detection on GDM pregnancy outcome was assessed, and the effect of serum indices on pregnancy outcome was evaluated in GDM patients with logistic regression. In the GDM group, there were 8 cases of premature membranes breaking (7.34%), 6 cases of premature delivery (5.50%), 3 cases of hyperamniotic fluid (2.75%), 2 cases of neonatal asphyxia (1.83%), 5 cases of fetal growth restriction (4.59%), and 3 cases of low-birth-weight infants (2.75%). The total incidence of adverse preg-nancy outcomes was 24.77% (27/109). HbA1c, FBG, 2hPBG, and FINS in the poor pregnancy outcome group were higher than those in the favorable pregnancy outcome group. The AUC value of blood biochemical indicators combined detection in predicting pregnancy outcome in GDM patients was higher than of HbA1c, FBG, 2hPBG, and FINS alone detection. HbA1c ≥ 6.94%, FBG ≥ 7.18 mmol/L, 2hPBG ≥ 9.36 mmol/L, and FINS ≥ 13.07 U/L were the risk factors affecting pregnancy outcomes in GDM patients. The changes of HbA1c, FBG, 2hPBG, and FINS levels in GDM patients are associated with adverse pregnancy outcomes, and the combined detection of serum indicators has predictive value for pregnancy outcomes in GDM patients.

Effect of LH level on HCG trigger day on clinical outcomes in patients with diminished ovarian reserve undergoing GnRH-antagonist protocol

Research questionDoes luteinizing hormone (LH) levels on human chorionic gonadotropin (HCG) trigger day (LHHCG) affect the clinical outcomes of patients with diminished ovarian reserve (DOR) undergoing gonadotropin-releasing hormone antagonist (GnRH-ant) protocol?MethodsRetrospective analysis fresh embryo transfer cycles of DOR patients who underwent GnRH-ant protocol from August 2019 to June 2023. The participants were divided into different groups according to LHHCG level and age. The clinical data and outcomes were compared between groups.ResultsIn patients with DOR, the HCG positive rate (59.3% versus 39.8%, P = 0.005), embryo implantation rate (34.5% versus 19.7%, P = 0.002), clinical pregnancy rate (49.2% versus 28.4%, P = 0.003), live birth rate (41.5% versus 22.7%, P = 0.005) in LHHCG < 2.58 IU/L group were significantly higher than LHHCG ≥ 2.58 IU/L group. There was no significant correlation between LHHCG level and clinical pregnancy in POSEIDON group 3. In POSEIDON group 4, the HCG positive rate (52.8% versus 27.0%, P = 0.015), embryo implantation rate (29.2% versus 13.3%, P = 0.023), clinical pregnancy rate (45.3% versus 18.9%, P = 0.010) in LHHCG < 3.14 IU/L group were significantly higher than LHHCG ≥ 3.14 IU/L group. Logistic regression analysis indicated that LHHCG level was an independent influencing factor for clinical pregnancy in POSEIDON group 4 patients (OR = 3.831, 95% CI: 1.379–10.643, P < 0.05).ConclusionsLHHCG level is an independent factor affecting pregnancy outcome of fresh embryo transfer in DOR patients undergoing GnRH-ant protocol, especially for advanced-aged women. LHHCG had a high predictive value for POSEIDON group 4 patients, and LHHCG ≥ 3.14 IU/L predicts poor pregnancy outcomes.

Precision Interventions Targeting the Maternal Metabolic Milieu for Healthy Pregnancies in Obesity.

Entering pregnancy with obesity increases the risk of adverse health outcomes for parent and child. As such, research interventions are largely focused on limiting excess gestational weight gain during pregnancy, especially in those with obesity. Yet, while many lifestyle interventions are successful in reducing GWG, few affect pregnancy outcomes. Here we review work targeting the metabolic milieu instead of focusing solely on weight. Work done in non-pregnant populations suggests that specifically targeting glucose, triglyceride, and leptin levels or inflammatory makers improves the metabolic milieu and overall health. We posit that precision interventions that include strategies such as time restricted eating, following the 24h movement guidelines, or reducing sedentary behavior during pregnancy can be successful approaches benefiting the maternal metabolic milieu and minimize the risk of adverse pregnancy outcomes. Personalized tools such as continuous glucose monitors or community-based approaches play an important role in pre-conception health and should be extrapolated to pregnancy interventions to directly benefit the metabolic milieu optimizing health outcomes for both parent and child.

A High Sperm DNA Fragmentation Index Negatively Affects Pregnancy Outcomes in ART

A High Sperm DNA Fragmentation Index Negatively Affects Pregnancy Outcomes in ART

Analysis of factors affecting pregnancy outcomes in patients with adenomyosis after high intensity focused ultrasound ablation: a retrospective study

Objectives To investigate all pregnancies and analyze the factors influencing pregnancy outcomes in patients with adenomyosis after high intensity focused ultrasound (HIFU). Materials and methods A total of 231 patients with adenomyosis who completed HIFU and wished to conceive were enrolled. The symptom improvement and information of pregnancy were recorded during the follow-up period. Factors influencing pregnancy outcomes were analyzed using multivariate regression analysis and survival analysis. Results After HIFU, 100 of 231 (43.3%) patients became pregnant within 96 months, including 77 (77/194, 39.7%) in natural and 23 (23/37, 62.2%) in vitro fertilization and embryo transfer (IVF-ET) pregnancies following gonadotropin-releasing hormone agonist (GnRHa). Among the 108 (46.8%, 108/231) infertile patients (defined as the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse, 40 primary infertility and 68 secondary infertility), 31 (28.7%) became pregnant. At the end of the follow-up, 70 successfully delivered 71 healthy babies. No uterine rupture occurred during pregnancy and delivery. Patients with pelvic adhesion and infertility history had a lower pregnancy chance than that of patients without pelvic adhesion and infertility history (OR < 1, p < 0.05). Patients with small adenomyotic lesion volume had a greater pregnancy chance than that of patients with large lesion volume (OR < 1, p < 0.05). IVF-ET following GnRHa had a better pregnancy chance (p < 0.05). Conclusions HIFU seems to have a beneficial effect on fertility of patients with adenomyosis. Pelvic adhesion, infertility history, and large adenomyotic lesion volume have adverse effects on pregnancy, but IVF-ET following GnRHa after HIFU could increase the pregnancy chance.

Effect of combined exposure to phthalates and polycyclic aromatic hydrocarbons during early pregnancy on gestational age and neonatal size: A prospective cohort study

Many studies have indicated that individual exposure to phthalates (PAEs) or polycyclic aromatic hydrocarbons (PAHs) affects pregnancy outcomes. However, combined exposure to PAEs and PAHs presents a more realistic situation, and research on the combined effects of PAEs and PAHs on gestational age and newborn size is still limited. This study aimed to assess the effects of combined exposure to PAEs and PAHs on neonatal gestational age and birth size. Levels of 9 PAE and 10 PAH metabolites were measured from the urine samples of 1030 women during early pregnancy from the Zunyi Birth Cohort in China. Various statistical models, including linear regression, restricted cubic spline, Bayesian kernel machine regression, and quantile g-computation, were used to study the individual effects, dose–response relationships, and combined effects, respectively. The results of this prospective study revealed that each ten-fold increase in the concentration of monoethyl phthalate (MEP), 2-hydroxynaphthalene (2-OHNap), 2-hydroxyphenanthrene (2-OHPhe), and 1-hydroxypyrene (1-OHPyr) decreased gestational age by 1.033 days (95 % CI: −1.748, −0.319), 0.647 days (95 % CI: −1.076, −0.219), 0.845 days (95 % CI: −1.430, −0.260), and 0.888 days (95 % CI: −1.398, −0.378), respectively. Moreover, when the concentrations of MEP, 2-OHNap, 2-OHPhe, and 1-OHPyr exceeded 0.528, 0.039, 0.012, and 0.002 µg/g Cr, respectively, gestational age decreased in a dose–response manner. Upon analyzing the selected PAE and PAH metabolites as a mixture, we found that they were significantly negatively associated with gestational age, birth weight, and the ponderal index, with 1-OHPyr being the most important contributor. These findings highlight the adverse effects of single and combined exposure to PAEs and PAHs on gestational age. Therefore, future longitudinal cohort studies with larger sample sizes should be conducted across different geographic regions and ethnic groups to confirm the impact of combined exposure to PAEs and PAHs on birth outcomes.

Analysis of factors influencing pregnancy and its outcomes in women undergoing in vitro fertilization-embryo transfer/frozen embryo transfer cycles: A retrospective study.

The relationship between clinical outcomes and various factors influencing pregnancy was analyzed to provide reference data for patients and clinicians when selecting embryo transfer protocols. This was a retrospective study of 1309 transfer cycles between June 1, 2018, and May 1, 2023, in the Reproductive Medicine Center. Univariate analysis was performed on various factors that may have affected pregnancy outcomes, and further regression analysis was performed on those factors found by univariate analysis to correlate positively with clinical pregnancy outcomes. Finally, the embryo transfer schemes were compared based on the analysis results. The results showed that the stage of embryonic development significantly affected pregnancy outcomes after transplantation (P < .01, 95% confidence interval: 2.554 [1.958-3.332]). There was no significant difference in the pregnancy rate between 1 high-quality blastocyst transfer and 2 cleavage-stage embryos or blastocyst transfer (64.22% vs 70.11%, P = .439); however, the rate of multiple pregnancies after 1 high-quality blastocyst transfer was close to the rate of natural conception. These data show that the transfer of single high-quality blastocysts can significantly reduce the multiple pregnancy rate while ensuring an ideal pregnancy rate, which can be used as a reference for planning the first transplantation in patients with good prognoses.

Determinants of Adverse Pregnancy Outcomes among Women Attending Antenatal Care-Clinic in Public Health Facilities in Nyando Sub-County, Kenya

Adverse pregnancy outcome (APO) refers to gestation results other than vaginal birth, which include premature birth, miscarriage and low birth weight which are main causes of maternal and neonatal illness and death. In Kenya, the maternal mortality ratio stands at 355 deaths per 100,000 live births. In Kisumu County maternal mortality rate stands at 495 per 100,000 live births per year and Nyando Sub-County has the second- worst record of adverse pregnancy outcomes. Therefore, the current the current study assessed the determinants of adverse pregnancy outcomes among women attending 4 selected public health facilities in Nyando Sub-County. In this multicenter hospital-based cross-sectional study, n=301 women who delivered at the 4 randomly selected hospitals Nyando Sub-County hospital and visited the ANC department at least twice were systematically randomly recruited from November 2022 to September 2023. Data was collected using pre-tested and structured questionnaire which consisted of sections of demographic and obstetric characteristics. Presence of at least one maternal complication was used to determine the presence of APO. SPSS version 27 was used for data analysis. Chi-square ( 2) was used to compare proportions based on pregnancy outcomes as normal and adverse. Association between socioeconomic status and APO, obstetric factors and APO as well as ANC visits and APO were determine using Binary logistic regression. Of the 301 participants, 96 (31.9%) had normal pregnancy outcome (NPO) while 205 (68.1%) had APO. Woman’s age, parity, marital status, family income and education were associated with APO p=0.001, p=0.001, p=0.001, p=0.001 and p=0.04 respectively. With regard to obstetric factors, women of between 16-35 years were less likely to develop APO [OR=0.410, 95% CI=0.260-0.670, p=0.001]. In terms of gestation period with 37 weeks as the reference group, women with 28-37 weeks of gestation are less likely to develop APO [OR=0.114, 95% CI=0.132- 0.497, p=0.001]. The study did not find any association with the number of ANC visits [OR=0.39 95% CI=0.36-1.26, p=0.314] however, women visiting ANC in the second trimester less likely to develop APO [OR=0.221, 95% CI=0.142-0.927, p=0.001]. Therefore, both sociodemographic and obstetric factor affect pregnancy outcome and early ANC visit is associated with better or normal pregnancy outcome.

Tailor-made embryo transfer considering embryonic developmental speed to overcome the dilemma of personalized embryo transfer

Research QuestionDoes tailor-made embryo transfer (TmET), timed with respect to embryonic developmental speed, affect pregnancy outcomes in patients with recurrent implantation failure? DesignAmong 741 patients identified as receptive through endometrial receptivity testing, the clinical pregnancy rates and live birth rates were retrospectively compared between those who underwent standard personalized embryo transfer and those who underwent TmET in hormone replacement therapy cycles. Personalized embryo transfer was performed according to endometrial receptivity test results (standard personalized embryo transfer group) or considering embryonic developmental speed (TmET group). For TmET, the expansion grade of warmed blastocysts was estimated based on each patient's previous embryonic developmental pattern. The embryo transfer days were set so that estimated blastocyst grades 3, 4, 5 and 6 were transferred on days P+5, P+5.5, P+6.0 and P+6.5, respectively. ResultsIn a propensity score matching analysis, the clinical pregnancy rate was significantly higher in the TmET group than the standard personalized embryo transfer group (P = 0.014), whereas the live birth rates were similar between the two groups (P = 0.65). In a subgroup analysis with euploid embryo transfers, the clinical pregnancy rate was significantly higher in the TmET group than the standard personalized embryo transfer group, although there was no difference in live birth rate between the two groups (P = 0.045 and P = 0.057, respectively). ConclusionsFor patients experiencing recurrent implantation failure and identified as receptive through endometrial receptivity testing, subsequent TmET strategies may further enhance pregnancy outcomes.

Intersectional Factors Affecting Pregnancy Outcomes of Black Mothers With Type 1 Diabetes

Abstract Date Presented 03/23/24 This poster offers a comprehensive overview of existing literature on pregnancy outcomes in Black mothers with Type 1 diabetes. It highlights gaps in the current literature, signaling areas that require further research and intervention. Primary Author and Speaker: Jordan W. Major Additional Authors and Speakers: Angela M. Miles Contributing Authors: Jane Morgan-Daniel, Stefanie Bodison

Impact of Luteinizing Hormone on IVF/ICSI Assisted Reproduction on the Initiation Day of Gonadotropin-releasing Hormone Antagonist Protocol.

The aim of the study was to explore the optimal timing of gonadotropin initiation and the reasonable interval of luteinizing hormone (LH) levels in the gonadotropin-releasing hormone antagonist (GnRH-A) protocol. A retrospective cohort study was conducted to analyze the data concerning the oocyte retrieval cycles from 1,361 cases with the GnRH-A protocol implemented. The ovarian responses (including AMH, AFC) in these patients were divided into the poor ovarian response group (an antral follicle count [AFC] ≤ 6, n = 394), the normal ovarian response group (an AFC > 6 and < 15, n = 570), and the high ovarian response group (an AFC ≥ 15, n = 397), according to the AFC. The patients were sub-grouped according to LH levels on the protocol initiation day, and the clinical outcomes (including dose of Gn initiation, Gn administration days, GnRH-ant administration days, P levels on the HCG day, E2 levels on the HCG day, LH levels on the HCG day, number of embryos transferred, total fertilization rate, embryo implantation rate(%), proportion of 2PN, proportion of good-quality embryos, endometrial thickness on the hCG injection day(mm), moderate to severe OHSS, AFC on the initiation day, proportion of type A endometrium on the hCG injection day, clinical pregnancy rate, biochemical pregnancy rate, early abortion rate, ectopic pregnancy rate) were compared. On the GnRH-A protocol initiation day, among all patients with different ovarian responses, the body mass index (BMI) in those with an LH ≥ 5 IU/L was lower. The differences in pregnancy outcomes between the LH < 5 IU/L group and the LH ≥ 5 IU/L group were not statistically significant across the different ovarian response groups, but the LH < 5 IU/L group had a higher proportion of good-quality embryos (80.3±24.9 vs. 74.8±26.9, P =0.035) than the LH≥5IU/Lgroup in those with poor ovarian response. The total fertilization rate (82.2±18.1 vs 85.4±15.1, P =0.021) and proportion of two pronuclei (2PN) (69.0±20.9 vs 72.7±19.9, P =0.035) were higher in the LH ≥ 5 IU/L group than the LH<5 IU/L group for those with normal ovarian responses. The embryo implantation rate (41.4±41.3 vs 52.6±43.4, P =0.012) was higher in the LH ≥ 5 IU/L group than in the LH<5 IU/L group in those with high ovarian response. The results of the multivariate logistic analysis showed that the age of the female partner, number of embryos transferred, proportion of good-quality embryos, endometrial thickness on the hCG injection day, and moderate- to-severe ovarian hyperstimulation syndrome (OHSS) were independent factors correlated with the outcome of live births (P < 0.05). The LH levels on the gonadotropins (Gn) initiation day in the GnRH-A protocol will not affect pregnancy outcomes.