Fetal Birth Research Articles

Associations Between Maternal Thyroid Function in Pregnancy and Obstetric and Perinatal Outcomes

Context The effects of maternal subclinical hypothyroidism on pregnancy outcomes are not clear. Objective We aimed to assess potential associations between maternal thyrotropin (thyroid-stimulating hormone [TSH]) levels in pregnancy and obstetric and perinatal outcomes. Design Retrospective cohort study. Setting Tertiary academic medical center. Patients Women aged ≥18 years with a singleton gestation and no known thyroid disease seen for prenatal care at Boston Medical Center from January 1, 2003 through May 22, 2014, and their fetuses and infants were included. Main outcome measures Risk ratios of adverse obstetric and perinatal outcomes. Results A total of 8,413 pregnant women (mean age 29.1 years, 15% white, 60% black, 13% Hispanic) and their fetuses and infants (mean gestational age at birth 38.5 weeks, 52% male, mean birth weight 3.2 kg) were included in the analyses. The median (interquartile range) TSH level was 1.06(0.62-1.60) mIU/L, and 130 women (1.6%) had TSH > 4 mIU/L. Maternal TSH levels > 4 mIU/L were associated with increased risks of prematurity (risk ratio [RR] 2.17 [95% confidence interval 1.15-4.07] P = .016) and neonatal respiratory distress syndrome (RDS) (RR 2.83 [95% confidence interval 1.02-7.86] P = .046) compared to TSH levels ≤ 4 mIU/L. Although not statistically significant, TSH levels > 4 mIU/L were also associated with increased RRs for fetal loss, preeclampsia/eclampsia, and low birth weight. TSH levels > 4 mIU/L were not associated with preterm labor, placental abruption, cesarean section, gestational hypertension or diabetes, or neonatal intensive care unit admission. Conclusion Maternal serum TSH concentration > 4 mIU/L in pregnancy was associated with approximately 2-fold increased risks of prematurity and RDS in offspring. Elevated TSH was also associated with statistically non-significant increases in the risk of fetal loss, preeclampsia/eclampsia, and low birth weight.

A Macerated Advanced Abdominal Pregnancy Co-existing With a Normal Intra -Uterine Pregnancy: A Case Study

An abdominal pregnancy is not a common occurrence reported sparsely in the literature. But what is even more uncommon is the finding of a dead and retained, supra hepatic, abdominal pregnancy co-existing with a live intra uterine pregnancy at different stages of development. This is an extremely rare case of a 22-year old multigravida, who presented with 6 months amenorrhoea, abdominal distension and difficulty in breathing. She had a previous history of a preexisting advanced abdominal pregnancy diagnosed a year earlier which had not been delivered. Evaluations revealed a viable intra-uterine gestation at 24 weeks, co-existing with a non-viable, sub-diaphragmatic/supra-hepatic abdominal pregnancy at term. She had the macerated abdominal pregnancy delivered at laparotomy and the intra-uterine pregnancy was left to continue. She developed Preeclampsia and eventually had pre-term premature rupture of membranes PPROM at 28 weeks of gestation with a live birth of a female fetus that weighed 800 grammes. There have been very few reports on advanced abdominal pregnancy and even more rarely, human superfetation in multiple pregnancy, but not a report on an intrauterine conception with a pre-existing advanced, abdominal ectopic pregnancy until now. This report is thus the first of its kind. We report an extremely rare case of a woman conceiving an intrauterine pregnancy, carrying it to the age of viability in the presence of a previously conceived, undelivered, dead, advanced abdominal pregnancy

Prevalence, Risk Factors and Outcomes of Pregnancies with Small for Gestational Age Fetus at BPKIHS

Introduction: Small-for-gestational-age (SGA) is defined by a birth weight below the 10th percentile for mean weight corrected for gestational age. It is associated with adverse health events throughout life, including substantial perinatal morbidity and mortality rates.
 Objectives: The aims of the study was to estimate the prevalence of the SGA newborns, attributable factors for SGA and perinatal outcomes of SGA.
 Methodology: A hospital based prospective cohort study was conducted among pregnant women after 28 weeks' gestational age in the Department of Obstetrics and Gynaecology, BPKIHS, Dharan from October, 2016 to June, 2017.A total of 150 study population was sampled using purposive sampling technique whose symphysio-fundal height lags the gestational age by four cms. The association for risk factors between the various socio-demographic parameters and SGA was analysed using chi-square test for categorical data and t-Test for continuous data with p value<0.05 considered as significant. The mothers and babies were followed up till discharge from the hospital for outcomes.
 Result: There was a total of 140 SGA with 10 appropriate for gestational age (AGA) fetuses among 6,500 hospital deliveries above 28 weeks' gestation, hence the prevalence was 2.15%. The risk factors for very small for gestational age were history of birth of SGA fetus (OR, 1.25; 95% CI, 1.15-1.35); history of recurrent pregnancy loss (OR, 1.25; 95% CI, 1.15-1.35); personal history of substances abuse in the index pregnancy (OR, 1.68; 95% CI, 1.47-1.92); adverse obstetrics or medical events in the index pregnancy (OR, 2.21; 95% CI, 1.10-4.45); high blood pressure at admission (OR, 1.58; 95% CI, 1.96- 2.59) and significant urinary proteinuria (OR, 2.26; 95% CI, 1.00-5.09).SGA newborns correlated with increased risk of operative delivery and adverse perinatal outcomes, including oligohydramnios, low Apgar scores, resuscitation at birth, admission to the neonatal intensive care unit or nursery, metabolic complications and fetal death.
 Conclusions: SGA have distinct modifiable risk factors and mortality patterns suggesting potential implications for public health and urgent need to intervene with effective interventions.

P1040PREGNANCY IN WOMEN WITH DIABETIC NEPHROPATHY: COMPLICATIONS AND OUTCOMES

Abstract Background and Aims Pregnancy in patients with diabetic nephropathy (DN) is characterized by an increased incidence of complications and adverse outcomes. The aim of the study was to determine the nature and incidence of pregnancy complications and maternal and fetal outcomes in women with DN. Method 61 pregnant women with diabetes mellitus (DM) type 1 and CKD 1-4 stages: 1 st. –29 patients, 2 st. - 19, 3-4 st. – 13 (age 29.7±4.9 years, DM duration 18.6 ± 5,3 years) and 72 pregnant patients with pre-existing (type 1) DM without CKD (age 28.2±4.8 years, DM duration 11.4 ±3.7 years) observed in 2010-2017 were included. The incidence of chronic arterial hypertension (AH), preeclampsia (PE), fetal macrosomia, fetal growth restriction, preterm delivery, cesarean section, stillbirth and the effect of pregnancy on kidney function were evaluated. Results Chronic AH was detected in 19.4% of women w/o CKD, in 10.3% – CKD 1 st, 17.6% – CKD2, 61.3% – CKD 3-4 (p &lt 0.05 CKD3-4 vs CKD1). The incidence of PE in patients w/o CKD was 12.5% (2-3% for general population), with CKD 1 – 24.1%, CKD 2 – 41.2%, CKD 3-4 – 38.5% (p &lt 0.001 when comparing all groups). Macrosomia was common in pregnant diabetic women w/o CKD (30.6%), patients with CKD 1 (41.4%) and CKD 2 (52.9%), but was not observed in CKD 3-4 (0%). In contrast, the incidence of fetal growth restriction was highest with CKD 3-4 (61.5%) compared women w/o CKD (5.6%) and with CKD1(13.8%) and CKD2 (11.8%), p &lt 0.05.Preterm delivery was more common in women with CKD, and its frequency increased with increasing severity of CKD: w/o CKD – 18.1%, CKD 1 – 48.3%, CKD2 – 61.3%, CKD 3-4 –84.6% (p &lt 0.05). Incidence of cesarean section was high and did not differ significantly between groups: w/o CKD – 62.5.1%, CKD 1 – 55.2%, CKD2 – 82.4%, CKD 3-4 –92.3% (p &gt 0.05). Stillbirth was observed only with CKD stage 3-4 in 15.4% of cases.Four out of 13 (30.8%) patients with pre-existing CKD 3-4 and none of the patients with CKD1-2 reached stage 5 CKD and started regular hemodialysis with a median follow-up period of 43.3 months (min 29.7 - max. 81.5). Conclusion DN has a negative effect on pregnancy outcomes, increasing the frequency of preeclampsia, fetal growth restriction, preterm birth and stillbirth, however, fetal macrosomia practically does not occur with CKD 3-4. The rapid achievement of CKD 5D after delivery is typical for diabetic women with advanced stages of CKD.

93-OR: Low Maternal Insulin Sensitivity Associates with DNA-Related Functions in Human First-Trimester Trophoblast

In first trimester (FT) of pregnancy the human placenta is rapidly growing making it sensitive to environmental influence. We hypothesized that the altered intrauterine milieu associated with maternal obesity modifies placental proteome and function. We used maternal BMI and leptin as measures of obesity and adiposity, characterized the glucose-insulin axis (glucose, C-peptide, insulin sensitivity (ISHOMA)) and quantified fatty acids (GC) in maternal fasted serum (n=123-323). Among those, only higher C-peptide levels and lower ISHOMA were associated with obesity. Subsequent untargeted proteomics (LC-MS/MS, qTOF Bruker maXis ETD II) in FT placentas (weeks 5-6 p.m.) from lean (n=11) and obese (n=11) women and Principal Component Analysis clustered the samples in two groups. Only ISHOMA differed between both clusters (ISHOMA cluster 1: median 0.95, IQR 0.69-1.17; ISHOMA cluster 2: median 0.57, IQR 0.20 - 1.00, P<0.05). Comparing proteomic profiles between ISHOMA groups (separated by median ISHOMA 0.61) identified 86 proteins enriched in the low ISHOMA cluster (P<0.05, FDR 0.05). Biological processes (KEGG pathway analysis) enriched in this group were related to DNA replication and cell cycle (FDR<0.001). Members of the MCM family, involved in DNA damage response and cell cycle arrest, associated with low ISHOMA. This suggested trophoblast growth related processes depend on ISHOMA. Semi-quantitative in-situ analysis found decreased trophoblast proliferation (Ki67, n=22, Δ -33.4%, p<0.05) and increased apoptosis (TUNEL assay, n=22, 5.6 fold, p<0.05) in the low ISHOMA group. These differences were related to an increased DNA damage (𝛄;;H2AX, n=12, 6.9 fold, p<0.001). We conclude that low ISHOMA associated with maternal obesity in FT of pregnancy induces placental proteome changes related to DNA metabolism. This might alter trophoblast, i.e., placental, growth early in pregnancy, which is known to associate with fetal growth and birth weight. Disclosure J. Bandres-Meriz: None. D. Hoch: None. S. Honeder: None. A. Majali-Martinez: None. E. Herrera: None. M. Schittmayer: None. R. Birner-Gruenberger: None. G. Desoye: None.

A comparison of pregnancy outcomes after second-trimester amniocentesis between cases with penetration of the placenta and nonpenetration

Objective To compare the fetal loss rate associated with second-trimester amniocentesis between the procedures with penetration and nonpenetration of the placenta, as a primary outcome and to compare the rates of adverse pregnancy outcomes including preterm birth, fetal growth restriction and low birth weight, as secondary outcomes. Method A retrospective cohort study was conducted on women undergoing second-trimester amniocentesis. Our prospective database of amniocentesis, from January 1989 to December 2018, was accessed to retrieve the records meeting the inclusion criteria consisting of singleton pregnancies, gestational age of 16–22 weeks, and known obstetric outcomes. The patients were categorized into two groups: placental penetration and nonpenetration. The rates of fetal loss, including abortion (<24 weeks of gestation) and fetal death in utero (>24 weeks of gestation), and other adverse pregnancy outcomes were compared between the two groups. Results A total of 21,566 procedures were performed during the study period. Of them, 8601 were excluded due to chromosomal/structural abnormalities, various underlying medical diseases and incomplete data or unavailability of final outcomes. Finally, 12,965 cases were available for analysis including 4692 (36.2%) in the group of placental penetration and 8273 (63.8%) in the group of nonpenetration. The abortion rate after amniocentesis trended to be increased in the placental penetration group (0.6 versus 0.4%, p = .064; RR: 1.60, 95%CI 0.97-2.64). Likewise, the fetal loss rate trended to be increased in the placental penetration group (1.0 versus 0.7%, p = .121; RR: 1.35 95%CI 0.92–1.98). Interestingly, preterm birth rate was significantly increased in the placental penetration group (13.8 versus 12.6%, p = .043; RR: 1.10 95%CI 1.00–1.20). Conclusion Fetal loss rate was slightly increased, but not statistically significant, among the procedures with placental penetration. However, penetration of the placenta was slightly but significantly associated with an increase in rates of preterm birth.

The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network\u2019s first protocol: deep phenotyping in three sub-Saharan African countries

BackgroundThe PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network is a new and broadly-based group of research scientists and health advocates based in the UK, Africa and North America.MethodsThis paper describes the protocol that underpins the clinical research activity of the Network, so that the investigators, and broader global health community, can have access to ‘deep phenotyping’ (social determinants of health, demographic and clinical parameters, placental biology and agnostic discovery biology) of women as they advance through pregnancy to the end of the puerperium, whether those pregnancies have normal outcomes or are complicated by one/more of the placental disorders of pregnancy (pregnancy hypertension, fetal growth restriction and stillbirth). Our clinical sites are in The Gambia (Farafenni), Kenya (Kilifi County), and Mozambique (Maputo Province). In each country, 50 non-pregnant women of reproductive age will be recruited each month for 1 year, to provide a final national sample size of 600; these women will provide culturally-, ethnically-, seasonally- and spatially-relevant control data with which to compare women with normal and complicated pregnancies. Between the three countries we will recruit ≈10,000 unselected pregnant women over 2 years. An estimated 1500 women will experience one/more placental complications over the same epoch. Importantly, as we will have accurate gestational age dating using the TraCer device, we will be able to discriminate between fetal growth restriction and preterm birth. Recruitment and follow-up will be primarily facility-based and will include women booking for antenatal care, subsequent visits in the third trimester, at time-of-disease, when relevant, during/immediately after birth and 6 weeks after birth.ConclusionsTo accelerate progress towards the women’s and children’s health-relevant Sustainable Development Goals, we need to understand how a variety of social, chronic disease, biomarker and pregnancy-specific determinants health interact to result in either a resilient or a compromised pregnancy for either mother or fetus/newborn, or both. This protocol has been designed to create such a depth of understanding. We are seeking funding to maintain the cohort to better understand the implications of pregnancy complications for both maternal and child health.

ФАКТОРИ РИЗИКУ ГІПОКСИЧНО-ІШЕМІЧНОЇ ЕНЦЕФАЛОПАТІЇ НЕДОНОШЕНИХ НОВОНАРОДЖЕНИХ

&#x0D; &#x0D; &#x0D; &#x0D; The article presents the results of an assessment of risk factors for the development of hypoxic-ischemic encephalopathy in premature newborns. Perinatal risk factors for hypoxic-ischemic encephalopathy in premature newborns were the factories that lead to the development of placental dysfunction, fetal growth retardation, antenatal fetal distress and premature birth. The most important factor in the development of GIE is gestation (up to 32 weeks gestation), placenta previa with bleeding and premature placental abruption in the given time.&#x0D; &#x0D; &#x0D; &#x0D;

Corrigendum: The cyl Genes Reveal the Biosynthetic and Evolutionary Origins of the Group B Streptococcus Hemolytic Lipid, Granadaene

[This corrects the article DOI: 10.3389/fmicb.2019.03123.].

Healthy pregnancies and essential fats: focus group discussions with Zambian women on dietary need and acceptability of a novel RUSF containing fish oil DHA

BackgroundNut butter-based Ready to Use Supplemental Foods (RUSF) are an effective way to add nutrients and calories to diets of malnourished and food insecure populations. The RUSF formulations have been further modified to add micronutrients including iron and folic acid needed during pregnancy and lactation. Because docosahexaenoic acid (DHA, C22:6 n-3) enhances fetal development and birth outcomes, it has been suggested that perhaps RUSF formulations for pregnancy should also include this Omega 3 fatty acid. The goal of the present study was to gain an understanding of Zambian women’s knowledge of nutritional needs in pregnancy through structured focus group discussions, and to formulate and determine the acceptability of a RUSF with DHA.MethodsStructured focus group sessions were conducted among women attending an antenatal clinic at the University Teaching Hospitals in Lusaka, Zambia. Dietary and nutrition knowledge was surveyed through structured dialogue that was recorded by audio and transcribed verbatim. An RUSF containing 400 mg DHA from fish oil in 50 g RUSF was designed and assessed for fatty acid content and product stability. Participants then sampled the RUSF-DHA, provided feedback on taste, and were surveyed about willingness to consume the novel formula using a standardized hedonic instrument.ResultsThe participants’ knowledge of foods recommended for use in pregnancy included fruits, vegetables, meat, and fish. Most women reported eating fish at least once per week, although the specific type of fish varied. Most did not have prior knowledge of the importance of consuming fish during pregnancy or that some fish types were more nutritional than others as they included omega 3 fatty acids. The participants were uniformly accepting of the RUSF-DHA for the purpose of enhancing birth and developmental outcomes, but were critical of the aroma in hedonic testing.ConclusionsWomen were committed to consuming a healthy diet that would impact the outcome of pregnancy, and were receptive to advice on the importance of consuming foods such as fish as a source of DHA. The RUSF-DHA formulation was acceptable due to the potential benefits for the developing infant, however, the fishy odor may be limiting for long-term daily use.

DNMT3B rs1569686 and rs2424913 gene polymorphisms are associated with positive family history of preterm birth and smoking status

AimTo evaluate the association between spontaneous preterm birth (SPTB) and DNA methyltransferase (DNMT)1, 3A, 3B, and 3L gene polymorphisms, and their contribution to the clinical characteristics of women with SPTB and their newborns.MethodsThis case-control study, conducted in 2018, enrolled 162 women with SPTB and 162 women with term delivery. DNMT1 rs2228611, DNMT3A rs1550117, DNMT3B rs1569686, DNMT3B rs2424913, and DNMT3L rs2070565 single nucleotide polymorphisms were genotyped using polymerase chain reaction and restriction fragment length polymorphism methods. The clinical characteristics included in the analysis were family history of preterm birth, maternal smoking, maternal age, gestational week at delivery, and fetal birth weight.ResultsDNMT gene polymorphisms were not significantly associated with SPTB. DNMT3B rs1569686 and rs2424913 minor alleles (T) were significantly more frequent in women with familial PTB than in women with non-familial PTB, increasing the odds for familial PTB 3.30 and 3.54 times under dominant genetic models. They were also significantly more frequent in women with SPTB who smoked before pregnancy, reaching the most significant association under additive genetic models (odds ratio 6.86, 95% confidence interval 2.25-20.86, P < 0.001; odds ratio 3.77, 95% confidence interval 1.36-10.52, P = 0.011, respectively).ConclusionsDNMT3B rs1569686 and rs2424913 gene polymorphisms might be associated with positive family history of PTB and smoking status.

Clinical outcomes of fresh versus frozen embryo transfers and its influence on mid-trimester miscarriage and fetal birth weight: A retrospective study

Aim: The aim of the study was to compare the clinical outcomes of fresh and frozen embryo transfer (FET) in women undergoing assisted reproductive technology and its influence on mid-trimester miscarriage and fetal birth weight.Materials and Methods: The study was conducted between June 2016 and June 2019. The study group comprised 778 cycles, of women, who were undertaken in this retrospective analysis of in vitro fertilization cycles who underwent fresh and FET. These women were randomly divided into two groups, fresh embryo transfers (n = 410) and FETs (n = 368). Both groups were compared with their respective outcome measures such as the clinical pregnancy rates (CPRs), miscarriage rates, multiple pregnancy rates as well as live births and birth weights.Results: The mean age of the participants in fresh and FET groups was 31.13 ± 4.39 and 31.45 ± 4.25, respectively. There were statistically significant differences with respect to clinical pregnancy (P = 0.002) between the groups. Fetal miscarriage rates (30.14% vs. 23.53%) as well as birth weights were not statistically significant (P = 0.164) between fresh versus FET. The results clinically signified that the FET gives a lower miscarriage rate and higher CPRs while not affecting the average fetal birth weight.Conclusion: Adjusting the baseline characteristics and exclusion criteria of participants, women undergoing FET were associated with better clinical outcomes than women undergoing fresh ET cycles Contrary to existing literature, our incidence of neonatal morbidities, or large birth weights were not increased and fetal macrosomia did not occur. Gaining debates on the advantage of frozen over fresh transfers and its effects on obstetric and neonatal outcomes may require a large multicenter pooling of data and analyses.

Эндотоксикоз и плацентарная дисфункция при остром пиелонефрите у беременных

Objective. To assess the impact of endotoxicosis in pregnant women with acute pyelonephritis (AP) on the function of the utero-placental-fetal complex and gestational outcomes. Patients and methods. This study included 37 pregnant women with AP (Group 1) and 35 women with uncomplicated pregnancy (Group 2). Patients have undergone Doppler ultrasonography. In addition to that, we measured leukocyte intoxication index, total endotoxin, pregnancy-specific beta-1-glycoprotein (PSBG-1), and placental alpha microglobulin-1 (PAMG-1) in serum using enzyme-linked immunosorbent assay (ELISA). Results. AP during pregnancy led to placental dysfunction with desynchronization of pregnancy protein synthesis, endotoxicosis, and changes in hemodynamics in the uterine arteries, which, in case of standard treatment, increased the frequency of placental premature aging (43.2%), amniotic fluid disorders (32.4%), fetal growth retardation (27.8%), gestational hypertension (40.5%), preeclampsia (37.8%), preterm birth (27.8%), and caesarean section (32.4%). We found a correlation between the uterine artery resistance index and the level of endotoxicosis markers, as well as PSBG-1 and PAMG-1 levels. Conclusion. Our findings suggest the need for further studies in this area in order to develop a complex of therapeutic measures to increase the number of successful pregnancy outcomes after AP. Key words: pregnancy, acute pyelonephritis, placental dysfunction, endotoxicosis

Pregnancy outcomes associated with an abnormal 50-g glucose screen during pregnancy: a systematic review and Meta-analysis

Objective To assess the association between an abnormal 1-h 50-g glucose challenge test (GCT) followed by a normal 3-h 100-g glucose tolerance test (GTT) on fetal macrosomia and other adverse outcomes. Data sources MEDLINE, Cochrane, clinicaltrials.gov, and Google Scholar were searched from inception to March 2019. Methods of study selection Any studies reporting adverse perinatal and/or maternal outcomes in women with an abnormal 50-g 1-h glucose challenge test (GCT) followed by a normal 3-h, 100-g glucose tolerance test (GTT) were included. Studies were critically appraised by three independent reviewers. Outcomes included fetal macrosomia, cesarean delivery, preeclampsia, birth weight, neonatal hypoglycemia, shoulder dystocia, NICU admission, respiratory morbidity, and low Apgar score. A random-effects model was employed to calculate pooled odds ratios (OR) for each outcome with their 95% confidence intervals (CI) and 95% predictive intervals (PI). Tabulation, integration, and results We identified 30 studies comprising 18,067 patients with a normal 3-h GTT after an abnormal 1-h GCT (study group) and 117,091 patients with a normal 1-h, 50-g GCT (comparison group). Patients in the study group had an increased risk of macrosomia (OR 1.68, 95% CI 1.48–1.91, 27 studies, 132,027 patients), cesarean delivery (OR 1.39, 95% CI 1.30–1.48, 24 studies, 128,495 women), preeclampsia (OR 1.48, 95% CI 1.15–1.91, 17 studies, 110,930 patients), hypoglycemia (OR 1.43, CI 1.07–1.91) and shoulder dystocia (OR 1.52, 95% CI 1.09–2.12, 9 studies, 41,229 patients). Neonatal birth weight was significantly higher in the study group. The incidence of NICU admission, low Apgar score, and respiratory morbidity was similar in the two groups. Controlling for body mass index and 1-h glucose screen cut off did not alter these results. Conclusion Even in the absence of gestational diabetes, patients who fail the GCT test are at mildly increased risk of maternal and neonatal morbidity including macrosomia, cesarean delivery, preeclampsia, and shoulder dystocia.

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

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

EP12.05: Prenatal risk factors for urgent atrial septostomy at birth in fetuses with complete transposition of the great arteries: a systematic review and meta‐analysis

EP12.05: Prenatal risk factors for urgent atrial septostomy at birth in fetuses with complete transposition of the great arteries: a systematic review and meta‐analysis

LABOR COURSE AND CONDITION OF NEWBORNS IN WOMEN WITH PLACENTAL DYSFUNCTION DUE TO GESTATIONAL ENDOTHELIOPATHY

&#x0D; &#x0D; &#x0D; The purpose of the study is to evaluate the effect of placental dysfunction caused by gestational endotheliopathy on the course of labor and the condition of the newborn. The first group consisted of 70 patients with placental dysfunction with gestational endotheliopathy confirmed by laboratory-instrumental findings in the first trimester of pregnancy. The control group included 30 pregnant women with physiological gestational course. PD secondary to GE leads to preterm birth, fetal distress, increases the percentage of caesarean section, contributes to the delay of fetal growth and birth weight, poor infant status and perinatal complications.&#x0D; &#x0D; &#x0D;

High DNA stainability in the SCSA® is associated with poor embryo development and lower implantation rate

Objective To determine if the high DNA stainability index (HDS), as measured by the sperm chromatin structure assay (SCSA®), is associated with in vitro embryo development and concurrent assisted reproductive technology (ART) outcomes. Design A retrospective IRB approved, chart review of patients who completed at least one ART cycle (in vitro fertilization or intracytoplasmic sperm injection) and had a male partner in a DNA fragmentation index (DFI) of 25%. Materials and Methods Semen samples for ART patients were analyzed at SCSA® Diagnostics Inc. A list of male partners with a DFI less than 25% and an HDS greater than 25% was compared to those who completed ART cycle(s) with their female partner. We collected data on the number of patients, the number of cycles, quality of Day 3 and Days5/6 embryos, positive serum human chorionic gonadotropin (hCG) results, fetal cardiac activity (FCA) and live births (LB). We stratified the data into four groups by mean HDS. Results 75 IVF cycles had confirmed DFI levels below 25% and HDS levels above 25%. The number of top quality Day 3 and Day 5 embryos decreased when the HDS was above 31% (25%-30%, n=344; 31-35%, n=132; 36-40%, n=79%; 41+%, n=65), however the total percentage of cycles with successful blastocyst formation was similar (25-30% = 33%, 31-35% = 25%; 36-40% = 39%; 41+% = 42%). The total number as well as percentage of positive hCG results after fresh embryo transfer diminished as HDS climbed (25-30%, n = 18 (42%); 31-35% n = 6 (46%); 36-40% n = 4 (44%); 41+% n = 1 (10%). The same trend occurred with FCA (25-30%, n = 18 (42%); 31-35% n = 6 (46%); 36-40% n = 2 (22%); 41+% n = 0 (0%), and LB outcomes (25-30%, n = 14 (33%); 31-35% n = 3 (23%); 36-40% n = 2 (22%); 41+% n = 0 (0%). The implantation rate declined when the HDS was above 36% (25-30% = 30%, 31-35% = 30%; 36-40% = 16%; 41+% = 15%). Conclusions These data suggest that while a sperm with an HDS above 25% can fertilize oocytes, as HDS rises, it may be associated with delayed and/or impaired embryo development in vitro as well as poor live birth outcomes. Disclosures Co-author D. Evenson is the owner and CEO of SCSA® Diagnostics Inc. Funding None

Abstract 478: Identifying Signaling Pathways Regulated by Trophoblasts in Placental Vascular Development Using 3D Tissue Models

The placenta is an essential yet transient organ that supports healthy pregnancy and normal fetal development. Placental vascular dysfunction is associated with preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelets), fetal growth restriction, hemorrhaging, preterm birth, and loss of life. Placental vascular dysfunction can also negatively impact long-term maternal and offspring health, increasing risk for cardiovascular disease, coronary artery calcification, and stroke later in life. The vasculature of the maternal-fetal interface is uniquely characterized by the presence of trophoblast cells. Multiple trophoblast cell lineages serve essential functions in both the maternal vascular compartment and the feto-placental angioarchitecture. Functional roles for FGF2, VEGF, and angiopoietin signaling pathways in endothelial vasculogenesis and angiogenesis are well supported by a large body of literature, but there is a gap in knowledge of placenta-specific molecular mechanisms that account for the unique interaction of trophoblasts and endothelial cells. I hypothesize that trophoblasts generate angiogenic signals that promote vascular development at the maternal-fetal interface in both an autocrine and paracrine manner. Using 3D assays, I evaluated the role of endovascular cytotrophoblast and syncytiotrophoblast cell lines in establishment of a vascular compartment. Trophoblasts harbor intrinsic angiogenic competency evident by their ability to form angiogenic sprouts and generate 3D vascular networks under defined conditions. My current research implements 3D bioassays, bio-engineered vessels, and chemical inhibition to further investigate paracrine angiogenic signaling between trophoblasts and endothelial cells. Our work is the first to evaluate autocrine and paracrine angiogenic properties of trophoblasts under physiological 3D conditions that mimic development. When coupled with histological evaluation of human placenta, these systems will allow us to better evaluate and understand molecular mechanisms of placental vascular development and vascular dysfunction.

Use of gestational surrogates for women with Eisenmenger syndrome: a cost-effectiveness analysis

Objective: Eisenmenger syndrome (ES) is regarded as a contraindication to pregnancy, with therapeutic abortion recommended in the event of unintended pregnancy. However, women with ES continue to desire and attempt pregnancy despite grave risks to their own health. This study compares the costs and outcomes of pregnancy in women with ES to the use of gestational surrogates in their pregnancies.Study design: A decision-analytic model was built using TreeAge software that compared use of gestational surrogates and pregnancy in women with ES. Maternal death and neonatal outcomes including intrauterine fetal demise, preterm birth, cerebral palsy, and death were assessed. All probabilities and costs were derived from the literature. Utilities were discounted at a rate of 3% across the expected lifespan to generate quality-adjusted life years (QALYs). Univariate and multivariate sensitivity analyses were performed to evaluate the robustness of the model given changes in baseline assumptions.Results: In a theoretical cohort of 1000 women with ES, pregnancy would result in 360 maternal deaths, 100 stillbirths, 477 preterm births, and 157 neonatal deaths . In these highly desired pregnancies, use of gestational surrogates would prevent 99 and 98% of maternal and neonatal death, respectively. Cases and costs of preterm birth and associated cerebral palsy are also significantly reduced. Use of a gestational surrogate would save $518,255 per woman with a gain of 6.77 QALYs, a dominant strategy. The approach is cost-effective up to a cost of surrogacy of $1.2 million and even if the surrogate achieves pregnancy only 30% of the time.Conclusions: The use of surrogate mothers for those with ES is cost-effective and results in significantly improved maternal and neonatal outcomes. These benefits are robust in the face of high surrogacy costs largely due to the marked reduction in maternal mortality and preterm birth. These findings should be used to underscore the importance of broadening health care financing for medically-indicated assisted reproduction.