Biophysical Profile Score Research Articles

Fetal Outcome Evaluation in High-risk Term Pregnancy Using Biophysical Profile at a Tertiary Hospital in Anambra State, Nigeria

Introduction: A high-risk pregnancy is defined as a pregnancy in which there is a significant probability of an adverse maternal or fetal outcome that is more than the incidence of that outcome in the general population. Aim: To determine the usefulness of biophysical profile evaluation in women with high-risk term pregnancies. Methods: Biophysical profile (BPP) parameters were used to evaluate 160 high-risk women with term pregnancies. Results: All the participants had normal amniotic fluid index values [AFI] of 8.1-24.0cm. Most of the participants 115 (71.9%) showed good BPP scores. Outcome at delivery was as follows; fetal distress [presence 8.9%, absence 91.1%], stillbirth = none, admission into the intensive care unit (ICU) [Yes 2.0%, No 88%], meconium staining [Yes 8.2%, Clear 91.8%], birth weight [< 2.5kg = 5.7%, > 2.5kg = 94.3%]. APGAR score at 1 minute [<7 = 5.1%, >7 = 94.9%] while at 5 minutes [<7 = 3.2%, > 7= 96.8%]. The commonest mode of delivery was vaginal 84 (52.8%). The association between gross body movement, fetal breathing movement, and fetal outcome was not statistically significant p > 0.05. Conclusion: BPP parameters were found to be associated with fetal outcomes.

Fetomaternal Outcomes of Low-Risk Females Presenting with Perceived Reduced Fetal Movements at Moi Teaching and Referral Hospital, Eldoret, Kenya

Objective: To determine the fetomaternal outcomes of low-risk females presenting with perceived reduced fetal movements at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methods: This was a cross-sectional study among 133 females of gestation between 34–41 weeks presenting with a perception of reduced fetal movement, who were consecutively recruited. Pearson χ2 and Fischer’s exact tests of association were used to test the association between the non-stress test (NST) findings, biophysical profile (BPP) scores, and fetomaternal outcomes, where p≤0.05 was considered statistically significant. Results: A reactive NST finding was seen in 88 (66.2%) participants with 104 (78.2%) of all participants enrolled having a normal BPP score. Active management of the current pregnancy was offered to 89 (66.9%) of the participants, and 81 (60.9%) of the females had a vaginal delivery. Three quarters (76.7%) of the newborns had a 5-minute appearance, pulse, grimace, activity, and respiration (APGAR) score ≥7, 18 (13.5%) were resuscitated, 13 (9.8%) were admitted to the newborn unit, and four (3%) fresh stillbirths were noted. Both NST (p<0.001) and BPP (p<0.001) were good predictors of a 5-minute APGAR score ≥7, but poorly (p=0.086) predicted resuscitation. There was a statistically significant association between the NST findings and admission to newborn unit (p=0.034). Conclusion: A reactive NST is a good predictor of a 5-minute APGAR score greater than 7, and is associated with a reduced likelihood of both admission to the newborn unit and newborn resuscitation. Both reactive NST and normal BPP are good predictors of vaginal delivery as opposed to Caesarean delivery.

BIOPHYSIT: A Novel Biophysical Profile Database for Fetal Stress Measurement in High-Risk Pregnancies

Pregnancy is a time of change. Stress during pregnancy can increase the chances of having a premature baby or a low birth weight baby. Any unusual changes in the heart rate of the baby in the uterus can be examined using Electronic fetal monitoring (EFM). Over the past decades, enormous devices and methods have been developed for EFM. Few devices are invasive and few are non-invasive in nature, larger in size, and high in cost. The main parameter needed to be analyzed during pregnancy is the stress in the fetus as well as the mother. For fetal stress monitoring, two main tests have been used such as CTG (Cardiotocography) and BPP (Biophysical Profile). The BPP test is very important in determining whether the fetus is in a suspicious or normal condition based on a specific BPP score. However, BPP is still used as a visualization method to assess the condition of the fetus. As a result, a quantitative analysis of the BPP parameters is required. But still, now there is no specific BPP database for evaluating the condition of the fetus. So, a novel database for Biophysical profile is proposed named “BIOPHYSIT”, which is used to analyze the health condition of the fetus using various BPP parameters.

Impact of Biophysical Profile (BPP) Score on Method of Delivery

Introduction: This study aims to investigate the impact of Biophysical Profile (BPP) scores on the method of delivery and perinatal outcomes in a Bangladeshi context. Considering the significant role of maternal age, socio-economic status, and occupational factors in perinatal health, this research provides insights into how these variables interact with BPP scores to influence delivery methods and perinatal outcomes. Methods: This cross-sectional observational study was conducted with 150 pregnant women at or above 36 weeks of gestation. Participants were selected through purposive convenient sampling from outpatient and admission departments. The study assessed demographic details, BPP scores, mode of delivery, and perinatal outcomes. Statistical analysis was performed using SPSS, with a focus on the association between BPP scores and delivery methods, as well as perinatal outcomes. Result: The study population predominantly consisted of younger women, with 62.00% aged between 18-25 years and 22.67% between 26-30 years. Regarding BPP scores, 75.33% had a score of 10, 14.67% had a score of 8, and 10.00% had a score of 6. No significant correlation was found between BPP scores and the method of delivery (p-value = 0.393). However, a significant association was observed between lower BPP scores and adverse perinatal outcomes: 53.33% of participants with a BPP score of 6 experienced birth asphyxia, and 20.00% faced neonatal death. In contrast, 97.35% of participants with a BPP score of 10 had healthy babies. Conclusion: The study highlights the complex interplay of BPP scores, socio-economic and demographic factors in determining perinatal outcomes and delivery methods. It underscores the need for a holistic approach in obstetric care, integrating BPP scores with a comprehensive understanding of each patient's socio-economic and cultural context. This approach is crucial for optimizing delivery methods and improving perinatal outcomes in similar settings.

The Impact of Lower Apgar Scores on Perinatal Outcomes: A Study of Neonatal Health in Bangladesh

Introduction: The relationship between Apgar scores and perinatal outcomes is a critical area of study in neonatal health, particularly in developing countries like Bangladesh. This study aims to explore the impact of lower Apgar scores on perinatal outcomes, providing valuable insights into neonatal health and the effectiveness of prenatal assessments. Methods: This cross-sectional study involved 150 pregnant women from a medical facility in Dhaka, Bangladesh. Participants were assessed using the Biophysical Profile (BPP) score and Apgar scores at 1 and 5 minutes post-delivery. The study focused on the association between these scores and perinatal outcomes, including birth asphyxia, neonatal death, and INCU admissions. Statistical analysis was conducted to determine the significance of these associations. Result: The majority of the study population were young, with 62% aged between 18-25 years. A significant correlation was found between lower Apgar scores at 1 minute and adverse perinatal outcomes. Specifically, 100% of neonates with a BPP score of 6 had an Apgar score of less than 7 at 1 minute, compared to only 2.65% in the BPP score 10 group. Additionally, 52% of neonates with an Apgar score of less than 7 at 1 minute experienced birth asphyxia, and 48% required INCU admission. Conclusion: The study highlights the critical role of Apgar and BPP scores in predicting adverse perinatal outcomes. Lower Apgar scores at 1 minute post-delivery are significantly associated with negative neonatal health outcomes, emphasizing the need for vigilant prenatal monitoring and preparedness for immediate neonatal care, particularly in resource-limited settings like Bangladesh. This research contributes to the understanding of neonatal health in such contexts and underscores the importance of predictive assessments in improving perinatal health outcomes.

Foetal Assessment Based on Biophysical Profile Scoring

Foetal Assessment Based on Biophysical Profile Scoring

Effect of Steroids on the Biophysical Profile and Doppler Indices of Umbilical and Middle Cerebral Arteries in Preterm Fetuses.

Introduction Preterm birth is a major cause of perinatal death and disability and emerges as an important global public health problem. The antenatal administration of corticosteroids for preventing neonatal death due to respiratory distress syndrome and the serious morbidities associated with preterm birth has become an accepted standard in worldwide obstetric practice since 1994.After administering corticosteroids, the biophysical score deteriorates transiently, leading to a high cesarean section rate. Thus, Doppler indices of the umbilical and middle cerebral arteries are taken into account before the termination of pregnancy in preterm labor. Materials and methods This is an interventional study conducted over a period of one year and six months among 59 eligible singleton pregnancies at risk for preterm delivery, i.e., at risk of preterm birth <34 weeks of gestation, having no contraindication to antenatal steroids, who were admitted to the labor room of the Srirama Chandra Bhanja (SCB) Medical College, Cuttack, India, from January 2014 to August 2015. The participants were prospectively recruited, after giving informed consent to participate in the study. The main indication for hospital admission and steroid use was preterm lower abdominal pain. Results Out of 59 eligible cases, 27 (45.8%) were <25 years of age, 26 (44.1%) were between 25 and 30 years of age, and six (10.2%) were >30 years of age. The range is 14 years (between 19 and 33 years). The mean age is 25.31 years, with a standard deviation of 3.74. The mean of the biophysical profile (BPP) score before steroid administration decreased from 9.19 ± 1.23 to 5.56 ± 1.05 after 48 hours of first dose of steroid. The p-value of this is <0.001, which is statistically significant. The results show that the administration of betamethasone decreased fetal movements by 78.6% and breathing by 71.8%. As a result, the BPP scores decreased significantly. However, the Doppler indices did not change significantly even after administering corticosteroids. Conclusion Doppler indices play an important role in differentiating between steroid-induced compromise in the fetus and real fetal distress. Thus, umbilical and middle cerebral artery (MCA) Doppler should always be done before the termination of pregnancy on the ground of fetal compromise after administering corticosteroids.

Role of Ultrasonography and Color Doppler in the Assessment of High-Risk Pregnancies and Their Accuracy in Predicting Fetal Outcome.

Introduction Various methods are employed to evaluate the well-being of the fetus in high-risk pregnancies which consists of a biophysical profile (BPP), a non-stress test (NST), and daily fetal movements. Detection of aberrant blood flow in fetoplacental beds has been revolutionized by recent developments in ultrasound technology, such as color Doppler flow velocimetry. The cornerstone of maternal and fetal care is lowering maternal and perinatal mortality and morbidity is antepartum fetal surveillance. Doppler ultrasound is a non-invasive way of obtaining a qualitative and quantitative evaluation of maternal and fetal circulation and is utilized to investigate complications like fetal growth restriction (FGR) and fetal distress.Thus, it is useful in making distinctions between fetuses that are truly growth restricted and small for gestational age and healthy fetuses. The aim of the current study was to determine the role of Doppler indices in high-risk pregnancies and their accuracy in predicting fetal outcomes. Material and methods This prospective cohort studyincluded 90 high-risk pregnancies in the III trimester (after 28 weeks of gestation) on whom ultrasonography and Doppler were performed.Ultrasonography was performed using PHILIPS EPIQ 5, a curvilinear probe of frequency 2-5MHz. Gestational age was determined with a biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femoral length (FL). Placental grading and position werenoted. Estimated fetal weight and the amniotic fluid index were calculated. BPP scoring was done. Doppler study was conducted and the findings of Doppler indices that is pulsatility index (PI) and resistive index (RI) of the middle cerebral artery (MCA), umbilical artery (UA), and uterine artery (UTA), and cerebroplacental (CP) ratio in these high-risk pregnancies were documented and compared with standard. The flow patterns in MCA, UA, and UTA were also assessed. These findings were correlated with fetal outcomes. Results Among 90 cases, the common high-risk factor in pregnancy was preeclampsia without severe features (30%). Growth lag was present in 43 (47.8%) participants. Among the study population, HC/AC ratio was increased in 19 (21.1%) participants which indicatesasymmetrical intrauterine growth restriction. Adverse fetal outcomes were seen in 59 (65.6%) of the subjects. CP ratioand UA PIhad better sensitivity (83.05% and 79.66%, respectively) and positive predictive value (PPV) (87.50% and 90.38%, respectively) in identifying the adverse fetal outcomes. Diagnostic accuracy of CP ratio and UA PI (Accuracy=81.11%) was highest in predicting adverse outcomes than all the other parameters. Conclusion CP ratio and UA PI had better sensitivity, PPV, and diagnostic accuracy in identifying adverse fetal outcomes than other parameters. The study's findings support that the use of color Doppler imaging in high-risk pregnancies will help in the early identification of adverse fetal outcomes and aid in early intervention. This study is non-invasive, simple, safe, and reproducible. This study can also be performed bedside in high risk and unstable patients.This study is required to accurately assess fetal well-being in all high-risk pregnancies in order to improve fetal outcomes and to incorporate this procedure as a part of the protocol for the assessment of fetal well-being in these patients.

Ramadan fasting and pregnancy: an evidence-based guide for the obstetrician

Pregnant Muslim women may be religiously exempt from fasting during the Islamic month of Ramadan, especially if there is concern for undue hardship or harm to maternal or fetal health. However, several studies demonstrate that most women still choose to fast during pregnancy and avoid discussing fasting with their providers. A targeted literature review of published studies on fasting during Ramadan and pregnancy or maternal and fetal outcomes was performed. We generally found little to no clinically significant effect of fasting on neonatal birthweight or preterm delivery. Conflicting data exist on fasting and mode of delivery. Fasting during Ramadan has been mainly associated with signs and symptoms of maternal fatigue and dehydration, with a minimal decrease in weight gain. There is conflicting data regarding the association with gestational diabetes mellitus and insufficient data on maternal hypertension. Fasting may affect some antenatal fetal testing indices, including nonstress tests, lower amniotic fluid levels, and lower biophysical profile scores. Current literature on the long-term effects of fasting on offspring suggests possible adverse effects, but more data are required. The quality of evidence was negatively impacted by the variation in defining "fasting during Ramadan" in pregnancy, study size and design, and potential confounders. Therefore, in counseling patients, obstetricians should be prepared to discuss the nuances in the existing data while demonstrating cultural and religious awareness and sensitivity to foster a trusting relationship between patient and provider. We provide a framework for obstetricians and other prenatal care providers to aid in that effort and supplemental materials to encourage patients to seek clinical advice on fasting. Providers should engage patients in a shared decision-making process and offer them a nuanced review of the evidence (including limitations) and individualized recommendations based on clinical experience and patient history. Finally, should certain patients choose to fast while pregnant, providers should offer medical recommendations, closer observation, and support to reduce harm and hardship while fasting.

Diagnostic Tests in the Prediction of Neonatal Outcome in Early Placental Fetal Growth Restriction

Background and Objectives: Monitoring pregnancies with fetal growth restriction (FGR) presents a challenge, especially concerning the time of delivery in cases of early preterm pregnancies below 32 weeks. The aim of our study was to compare different diagnostic parameters in growth-restricted preterm neonates with and without morbidity/mortality and to determine sensitivity and specificity of diagnostic parameters for monitoring preterm pregnancies with early preterm fetal growth restriction below 32 weeks. Materials and Methods: Our clinical study evaluated 120 cases of early preterm deliveries, with gestational age ≤ 32 + 0 weeks, with prenatally diagnosed placental FGR. All the patients were divided into three groups of 40 cases each based on neonatal condition,: I-Neonates with morbidity/mortality (NMM); II-Neonates without morbidity with acidosis/asphyxia (NAA); III-Neonates without neonatal morbidity/acidosis/asphyxia (NWMAA). Results: Amniotic fluid index (AFI) was lower in NMM, while NWMAA had higher biophysical profile scores (BPS). UA PI was lower in NWMAA. NWMAA had higher MCA PI and CPR and fewer cases with CPR <5th percentile. NMM had higher DV PI, and more often had ductus venosus (DV) PI > 95th‱ or absent/reversed A wave, and pulsatile blood flow in umbilical vein (UV). The incidence of pathological fetal heart rate monitoring (FHRM) was higher in NMM and NAA, although the difference was not statistically significant. ROC calculated by defining a bad outcome as NMM and a good outcome as NAA and NWMAA showed the best sensitivity in DV PIi. ROC calculated by defined bad outcome in NMM and NAA and good outcome in NWMAA showed the best sensitivity in MCA PI. Conclusions: In early fetal growth restriction normal cerebral blood flow strongly predicts good outcomes, while pathological venous blood flow is associated with bad outcomes. In fetal growth restriction before 32 weeks, individualized expectant management remains the best option for the optimal timing of delivery.

Biochemical and ultrasonographic markers in fetal surveillance

Introduction/Objective. Fetal growth restriction (FGR) is associated with increased fetal and neonatal mortality and morbidity. The study objective was to investigate the correlation of maternal blood biochemical markers routinely determined in the first and second trimester screening and ultrasound fetal surveillance parameters in the prediction of fetal growth and condition in singleton pregnancies. Methods. In the first trimester we measured serum levels of beta subunit of human chorionic gonadotropin (?HCG) and pregnancy-associated plasma protein A (PAPP-A). In the second trimester we measured values of chorionic gonadotropin (HCG), alpha fetoprotein (AFP), unconjugated estriol (E3) and inhibin A, also examined ultrasonographic biometric fetal parameters, amniotic fluid index (AFI) and Doppler resistance indexes. FGR was defined as ultrasonographically determined fetal weight and growth parameters below the 10th percentile for the gestational age. Obtained biochemical and ultrasonographic parameters were correlated. Results. Study included 104 singleton pregnancies. ?HCG in the first trimester correlated negatively with fetal growth in the second and third trimester, and the second trimester AFI. Increased PAPP-A correlated positively with elevated resistance index in medial cerebral artery, lower biophysical profile scores, and intermediate type of non-stress test. Lower values of E3 were associated with FGR. Elevated serum AFP levels were linked to oligoamnion in the third trimester. There was no correlation of inhibin A levels with fetal condition. Conclusion. First and second trimester biochemical markers of pregnancy (?HCG, PAPP-A, HCG, AFP and E3) in combination with ultrasonographic biophysical parameters of fetus have predictive value for fetal growth and development.

Efficacy, safety and tolerability of dimethylfumarate during pregnancy and breastfeeding

<h3>Background</h3> The disease course in relapsing-remitting multiple sclerosis (RRMS) is notably affected by pregnancy. Disease-modifying therapies are usually contraindicated during pregnancy and breastfeeding for safety reasons. We assessed safety and tolerability of dimethylfumarate (DMF) in women with RRMS and their infants. <h3>Methods</h3> We observed 29 pregnancies of 26 women, followed from 2015 to 2020. DMF was administered through week 24 of pregnancy and resumed one month after delivery. We followed mothers with clinical follow-up, MRI and regular ultrasounds to establish the safety and efficacy of DMF during pregnancy and lactation. Infants were monitored up to the third year for infections and developmental disorders. <h3>Results</h3> No voluntary terminations, ectopic pregnancies, miscarriages or congenital abnormalities were detected. 3 infants (10%) were born preterm. 26 and 3 newborns had an 8/8 and a 7/8 biophysical profile (BPP) score, respectively. During growth, all children resulted between the 70^th and 95^th percentile for height and weight. Only 1 serious infection was detected in a child. 22/26 mothers decided to breastfeed (interval: 4–7 months). No relapses were observed during pregnancy and during the first 6 months post-delivery. 2 relapses were observed in the 6–12-month interval. New T2 lesions were detected in 3/26 scans at 3 months, 2/26 scans at 12 months, 3/24 scans at 24 months. <h3>Conclusion</h3> All outcomes related to infant birth and development were comparable to the general population, despite DMF intake during pregnancy. DMF effectively prevented increased disease activity during puerperium. According to our data, continuing therapy while breastfeeding is also safe. <h3>Keywords</h3> Pregnancy, Breastfeeding, Case series, Dimethylfumarate, Safety, Magnetic resonance imaging <h3>Disclosures</h3> AI has received consulting fees from Janssen. GB has no conflict of interest or other disclosures to report.

Diagnostic accuracy of middle cerebral artery Doppler findings in intrauterine growth restriction taking biophysical profile as gold standard.

Objective: To find the diagnostic accuracy of middle cerebral Artery Doppler findings in Intrauterine Growth Restriction taking Biophysical Profile as Gold Standard. Study Design: Cross Sectional study. Setting: Department of Radiology, Allied Hospital Faisalabad. Period: 11 February 2021 to 30 April 2022. Material &amp; Methods: A cross-sectional study of 161 pregnant women was conducted at the radiology department of allied hospital Faisalabad. The Inclusion Criteria were 114 pregnant women with abnormal biophysical profile and with a history of previous IUGR fetus pregnancy. All women's ultrasounds were performed on color Doppler. Data was analyzed by using IBM-SPSS version 25. Results: In our study age ranged from 18-42 years with mean age of 27.2547 ± 6.46363 years. The RI of MCA ranged from 0.30-0.90 % in the IUGR patients with the mean value 0.5330 ± 0.16134, and the RI of MCA ranged from 0.60-0.70 % in the normal was 0.6632 ± 0.4828. Similarly the PI of MCA ranged from 1.00-2.00 % in the IUGR patients with the mean value 1.9825 ± 0.13187, and the PI of MCA ranged from 2.00-2.00 % in the normal was 2.0000 ± 0.00000. The biophysical profile scoring of MCA_PI with range from 0.5-0.6 was 8 in two patients while with range from 0.6-7.98 was 6 in 32 patients, and was 8 in 127 patients. Conclusion: In conclusion, the diagnostic accuracy of Color Doppler of umbilical and cerebral pulsatility is very excessive in diagnosing IUGR.

Assessment of High-Risk Pregnancies using Biophysical Profile

The purpose of the current study was to know the importance of using BPP for primary fetal surveillance in predicting fetal outcome. Methods: A total of 70 individuals with high risk pregnancies were included from 16-45 years examined through ultrasound and Doppler (Toshiba Xario 100 colour Doppler (C5-2 convex probe) having a real-time frequency range of 3.0 to 5.0 MHZ) at a private hospital in Gujranwala from October 2021 to March 2022. A Convenient sampling approach was used to collect data through informed consent forms. Data was collected using SPSS 21. Results: The current study included 70 patients who were examined using Doppler for fetal well-being. Study concluded to have correlation between age groups and development of fetal anomalies of age group 16-25years 44(62.9%), 26-35 years 21(30.0%), 36-45 years (7.1%). Most of the females in gestational weeks 34-37 weeks. Frequency of high-risk pregnancy most common is hypertension 25(35.7%) followed by other such as low fetal movement 10(14.3%), oligohydramnios 8(11.4%) and the least common is diabetes mellitus. Reactive 50(71.4%), and non-reactive 20(28.6%). Result shows the frequency of biophysical profile score in total number of patients included. Biophysical profile score 0-2 in 16(22.9%), 4-6 BPP score in 42(66%) and 8-10 BPP in 12(17.1%) patients. The frequency of IUGR in relation to biophysical profile score showing 18(72.0%), in 0-2 BPP score and 7(28%) in 4-6 BPP score. Conclusions: Normal BPP assures good fetal status and perinatal outcome. Abnormal BPP indicates that the fetus may be compromised. The study concluded that BPP has significant role in predicting fetal outcome.

Doppler ultrasound findings in symptomatic pregnant women diagnosed with COVID-19

The primary aim of this study was to investigate the potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on maternal and foetal Doppler findings. Doppler ultrasound findings were compared in 40 pregnant women diagnosed with COVID-19 disease who required hospitalisation (group 1) and 30 healthy pregnant women (group 2). Maternal characteristics and birth histories were recorded. Body mass index, gestational week at birth, type of delivery, oligihydroamnios, pre-term birth (<37 weeks), low birth weight (<10 percentile), perinatal death and f1st and 5th minute Apgar scores were recorded. Birth weights and foetal biophysical profile (BPP) scores in group 1 were significantly lower than those in group 2. There was a statistically significant between-group difference in the umbilical artery pulsatility index (PI), umbilical artery resistive index (RI), middle cerebral artery (MCA) PI, MCA RI, mean uterine artery (UtA) PI, mean UtA RI and cerebroplacental ratio (CPR), the parameters used to evaluate foetal-maternal blood flow. In the pregnant group diagnosed with COVID-19 and hospitalised, all foetal-maternal Doppler indicators of foetal-maternal blood flow were impaired, and birth weights and BPP scores in these patients were statistically significantly lower than those in the healthy controls. Impact statement What is already known on this subject? Foetal and maternal vascular malperfusion characterised by decidual arteriopathy have been reported in pathologies of placentas from pregnant women with SARS-CoV-2 infection. What the results of this study add? It was determined that COVID-19 disrupted foetal and maternal blood flow. What the implications are of these findings for clinical practice and/or further research? Foetal biometric measurements and foetal Doppler may be useful in the follow-up of perinatal outcomes in pregnant women with COVID-19

Diagnostic accuracy of sonographic transvaginal ovarian biophysical profile as a predictor of infertility taking transvaginal ultrasound as a gold standard

Ovarian biophysical profile refers to assessment of ovaries to produce a successful conception and implantation environment. The ovarian scoring system for reproduction comprises the following parameters, taken in mid-cycle: ovarian volume, follicular size, and ovarian artery Doppler flow Resistive index and pulsatility index. Objective: To determine the diagnostic accuracy of sonographic transvaginal ovarian biophysical profile as a predictor of infertility taking transvaginal ultrasound as gold standard. Material and methods: The study comprised women visiting the department with diagnosed infertility for treatment during the period of two years. A total of 550 cycles were inducted primarily referred for ovarian assessment by ultrasound with patent tubes and normal utero-ovarian morphology. All those women having no conception with normal semen analysis of their husbands. Male factor infertility was also excluded. Baseline transvaginal sonography (TVS) was performed at proliferative phase, of the cycle. Mature follicles were studied by TVS. On an individual basis, the following parameters, that is, follicle size, ovarian volume and ovarian artery Doppler Pulsatility index, Resistive index were studied. Follicle size and ovarian artery Doppler flow were highly significant for a pregnancy. Results: The Ovarian biophysical profile was determined by applying the ovarian scoring system for reproduction (OSSR). In this research we compare infertile females with fertile. Out of 550 patients 243 (44.18%) patients were infertile and 307 (55.82%) were normal were discussed, as for as the primary infertile females were 99 (18.00%) and secondary infertile females were 144 (26.18%) and normal were 307 (55.82%). Out of five hundred and fifty cycles 331 woman had a perfect ovarian biophysical profile score of 10. The mean score of fertile was 9.39 ±1.56 and in infertile female was 7.05±2.55. The p- values &lt;0.001. The sensitivity and specificity of ovarian biophysical profile at cut off value 1is 100% and 0.04%. The sensitivity and specificity of ovarian biophysical profile at cut off value 8 it can be consider to rule out in future with 85.3% and 63.8% respectively. Conclusions: Ovarian scoring system for reproduction (OSSR) can prove to be a simple, diagnostic and authentic score to predict the ovarian environment and thereby helping in the prediction of the outcome in infertility. Six out of the nine parameters were found to be high score to predict a pregnancy all by themselves, but these parameters needed expertise and better instrumentation for evaluation. Of the remaining three parameters, two was same or equal on an individual basis and one was found to be not significant.

Cerebroplacental ratio and neonatal outcome in low-risk pregnancies with reduced fetal movement: A prospective study.

ObjectiveTo evaluate the effectiveness of the cerebroplacental ratio (CPR) in predicting poor outcomes in low-risk pregnancies with reduced fetal movements (RFMs).Study DesignThis prospective study included singleton pregnancies at 28–40 weeks, presenting with RFM but no additional risk factors. Sub analysis was performed for pregnancies between 36 and 40 weeks. Umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PIs) were measured, and the MCA-PI to UA-PI ratio (CPR) was calculated. Mode of delivery, gestational age, fetal monitoring category, Apgar score at 1 and 5 min, birth weight, presence of meconium, umbilical artery pH, and neonatal intensive care unit (NICU) admission were recorded. Women with good and poor outcomes were compared with doppler indices and pregnancy characteristics.ResultsOf 96 women, 86 had good outcomes. There was no significant difference in UA-PI (0.871 ± 0.171 vs. 0.815 ± 0.179, P = 0.446), MCA-PI (1.778 ± 0.343 vs. 1.685 ± 0.373, P = 0.309), or CPR (2.107 ± 0.635 vs. 2.09 ± 0.597, P = 0.993) between the poor and good outcome groups. No difference was found in the location of the placenta, biophysical profile (BPP) score, fetal sex, or amniotic fluid index (AFI) at the time of presentation. The proportion of nulliparous patients in the poor outcome group was higher than that of multiparous patients. Sub analysis for 36–40 weeks revealed the same results; no significant difference in UA-PI (0.840 ± 0.184 Vs 0.815 ± 0.195, P = 0.599), MCA-PI (1.724 ± 0.403 vs. 1.626 ± 0.382, P = 0.523), or CPR (2.14 ± 0.762 vs. 2.08 ± 0.655, P = 0.931) between poor and good outcome groups.ConclusionsCPR is not predictive of neonatal outcome in low-risk pregnancies with RFM. However, a higher proportion of poor outcomes in nulliparous women warrants further investigation.

ANTENATAL SURVEILLANCE IN HIGH-RISK FETAL CARDIAC DISEASE: FREQUENCY, RESULTS AND RELATIONSHIP WITH SURVIVAL

BACKGROUND Certain congenital heart diseases (CHDs) are associated with a high risk of intrauterine fetal demise (IUFD) and post-natal death, including Ebstein's anomaly, tetralogy of Fallot with absent pulmonary valve and cardiomyopathy. Established obstetric guidelines that recommend frequent antenatal surveillance (AS) of fetal wellbeing in the case of specific maternal and fetal risk factors do not currently include fetuses with high-risk CHD. We sought to establish whether frequent antenatal surveillance could improve fetal outcomes in high-risk fetal CHD and if surveillance results are predictive of outcomes in this setting. We hypothesized that fetuses with high-risk cardiac lesions would benefit from frequent AS and that outcomes would be poorer where surveillance results were abnormal. METHODS AND RESULTS We undertook a single center, retrospective review of 61 pregnancies with high-risk fetal CHD diagnosed from 2006-2020. Data pertaining to frequency and results of AS were collected. AS was conducted using the biophysical profile score, non-stress testing and/or fetal echocardiogram. Where possible, the cardiovascular profile score (CVPS) was calculated retrospectively. Frequent surveillance was defined as at least weekly fetal wellbeing testing commencing by 28-32 weeks gestation, or from later diagnosis, until delivery. Outcome measures included survival and mode of delivery. Chi-square testing, or Fisher's exact where numbers were small, were used to determine statistical significance. Antenatal surveillance results were abnormal in 18% (10/56) of pregnancies carrying a fetus with high-risk CHD. There was a trend toward survival at last follow up when AS results were normal (72%, 33/46) compared to those in which surveillance results were abnormal (40%, 4/10), p 0.07. Where AS results were abnormal, significantly more had emergency caesarean sections for fetal indications (7/10 (70%), vs. 2/46 (4%), p < 0.001). IUFD occurred in 20% (2/10) of cases where AS results were abnormal, compared to 7% (3/46) of cases where surveillance results were normal, p 0.21. Where AS was infrequent, IUFD occurred in 13% (4/30), compared to 3% (1/31) where surveillance was frequent, p=0.20. A final CVPS of ≤7 carried a significantly higher mortality rate (11/21, 52%) than a score of ≥8 (6/31, 19%), p 0.01. CONCLUSION Abnormal AS results and/or a CVPS of ≤7 may identify compromised fetuses with high-risk cardiac lesions who could benefit from altered management or expedited delivery. Given the high rates of abnormal surveillance results in this population, frequent surveillance should be considered. A larger trial is warranted to establish whether this leads to a reduction in fetal demise. Certain congenital heart diseases (CHDs) are associated with a high risk of intrauterine fetal demise (IUFD) and post-natal death, including Ebstein's anomaly, tetralogy of Fallot with absent pulmonary valve and cardiomyopathy. Established obstetric guidelines that recommend frequent antenatal surveillance (AS) of fetal wellbeing in the case of specific maternal and fetal risk factors do not currently include fetuses with high-risk CHD. We sought to establish whether frequent antenatal surveillance could improve fetal outcomes in high-risk fetal CHD and if surveillance results are predictive of outcomes in this setting. We hypothesized that fetuses with high-risk cardiac lesions would benefit from frequent AS and that outcomes would be poorer where surveillance results were abnormal. We undertook a single center, retrospective review of 61 pregnancies with high-risk fetal CHD diagnosed from 2006-2020. Data pertaining to frequency and results of AS were collected. AS was conducted using the biophysical profile score, non-stress testing and/or fetal echocardiogram. Where possible, the cardiovascular profile score (CVPS) was calculated retrospectively. Frequent surveillance was defined as at least weekly fetal wellbeing testing commencing by 28-32 weeks gestation, or from later diagnosis, until delivery. Outcome measures included survival and mode of delivery. Chi-square testing, or Fisher's exact where numbers were small, were used to determine statistical significance. Antenatal surveillance results were abnormal in 18% (10/56) of pregnancies carrying a fetus with high-risk CHD. There was a trend toward survival at last follow up when AS results were normal (72%, 33/46) compared to those in which surveillance results were abnormal (40%, 4/10), p 0.07. Where AS results were abnormal, significantly more had emergency caesarean sections for fetal indications (7/10 (70%), vs. 2/46 (4%), p < 0.001). IUFD occurred in 20% (2/10) of cases where AS results were abnormal, compared to 7% (3/46) of cases where surveillance results were normal, p 0.21. Where AS was infrequent, IUFD occurred in 13% (4/30), compared to 3% (1/31) where surveillance was frequent, p=0.20. A final CVPS of ≤7 carried a significantly higher mortality rate (11/21, 52%) than a score of ≥8 (6/31, 19%), p 0.01. Abnormal AS results and/or a CVPS of ≤7 may identify compromised fetuses with high-risk cardiac lesions who could benefit from altered management or expedited delivery. Given the high rates of abnormal surveillance results in this population, frequent surveillance should be considered. A larger trial is warranted to establish whether this leads to a reduction in fetal demise.

Features of the functional state of the fetoplacental complex in pregnant women with a history of sexually transmitted infections

The objective: a study of the features for the formation and functioning of the fetoplacental complex in pregnant women with a history of sexually transmitted infections.Materials and methods. We examined 50 pregnant women with a history of sexually transmitted infections (I group – the main group). The control group consisted of 30 pregnant women without somatic and gynecological pathology, who had vaginal delivery. All pregnant women underwent a comprehensive clinical examination, taking into account complaints, medical history, objective and additional methods of examination. The levels of estriol, cortisol, placental lactogen and progesterone in the blood serum of pregnant women and the state of fetoplacental complex in terms of 18–20th, 28–30th and 38–40th weeks were determined.Results. In the pregnant women in I group, starting from the 18th weeks there was a significant decrease in the secretion of progesterone (160,8±15,9 nmol/L versus 202,4±5,5 nmol/L, respectively; p&lt;0,05), placental lactogen (77,5±13,2 nmol/L versus 91,3±23,8 nmol/L)/ This means that already in these stages of pregnancy there are signs of placental dysfunction in pregnant women with a history of sexually transmitted infections. The changes in the functional state of the fetoplacental complex at the 28–30th weeks are more pronounced, as evidenced by an increase in the frequency of early intrauterine growth restriction (12.0 %), disorders of fetal breathing (11.0 %) and fetal movements (18.0 %) (according to the biophysical profile score assessment); premature of the placenta, increased hormonal insufficiency of the fetoplacental complex and the first signs of hemodynamic disorders (an increased blood flow in the umbilical artery and uterine arteries and a slight decrease in blood circulation in the middle cerebral artery of the fetus). At the final assessment of the condition of the fetoplacental complex at the 38–40th weeks in pregnant women with a history of sexually transmitted infections, a satisfactory condition was observed in 24 % of cases, compensated ultrasound changes occurred in 46.0 % of cases; subcompensated – in 20.0 % and decompensated – in 10.0 % of cases, respectively, which causes a high frequency of obstetric and perinatal complications in this group of pregnant women.Conclusions. The formation and functional state of the fetoplacental complex in pregnant women with a history of sexually transmitted infections, from early pregnancy is characterized by a significant level of functional disorders of the fetus, placenta and the amount of amniotic fluid on the background of pronounced hemodynamic and endocrinological disorders, which requires prevention in the pre-pregnancy period.

COLOR DOPPLER EVALUATION OF CEREBRAL-UMBILICAL PULSATILITY INDICES AND RATIO AND IT'S USEFULLNESS AT HIGH RISK PREGNANCY.

Objective: The correlation between cerebro-umbilical pulsitility indices and high risk pregnancy. Subjects: The study was included 40patients, 20 preeclampsia patients, 20 gestational diabetes patients. Methods: All patients in the study underwent ultrasound assessment that includes fetal biometry, fetal weight, a four component biophysical profile score and Doppler ultrasound studies of umbilical artery (UA) and middle cerebral artery ( MCA). Results: The study was included 40 patients with high risk pregnancy. They were classified into 2 groups according to the risk pre-eclampsia group and diabetic group whether the two groups are equal in number being 20 per each.UA-PI is significant higher in pre-eclampsia group than diabetic group as well as MCA-PI and C/U ratio is significantly lower in pre-eclampsia group than diabetic group . Conclusion: Doppler investigation of the cerebro – umbilical pulsitlity indices and ratio play an important role in monitoring high risk pregnancies complicated by placental vascular insufficiency and fetal growth restriction (FGR). In a relatively well controlled diabetic pregnancies not complicated by preeclampsia or FGR the values of color Doppler indices are similar to normal pregnancy