Non-pregnant Control Group Research Articles

Does Pelvic Floor Muscle Exercise Change the Hemodynamic Responses of the Inferior Vena Cava in Pregnant Women? A Prospective-Controlled Study.

This study was aimed at exploring the immediate impacts of pelvic floor muscle exercises (PFMEs) on various maternal physiological parameters in pregnant women. The study included a total of 52 women, 26 pregnant (Pregnant group: 28.04±6.01 years; 26.83±3.81 kg/m2) and 26 nonpregnant (Control group: 29.42±5.73 years; 25.41±3.03 kg/m2) individuals. All women received PFME as follows: PFME was performed for 5 min (6-s holding contraction, 10 s of relaxation, 3 rapid PFM contractions). Evaluations were conducted before, immediately after, and 5 min post-exercise, with measurements including inferior vena cava (IVC) diameters and pulsatility index, blood pressure, oxygen saturation, and heart rates. Two-way analysis of variance was performed for group and time comparisons in repeated measurements. In both groups, the IVC collapsibility index values were lower 5 min after exercise, although this decrease, although clinically significant, did not reach statistical significance (p= 0.057). Post-exercise systolic blood pressure significantly decreased in both groups, whereas diastolic blood pressure decreased significantly in the pregnant group (p= 0.001, p= 0.023). The study found no statistically significant changes in the collapsibility index of the IVC after PFME but observed a clinically suggestive decrease. The clinical decrease in the collapsibility index can be interpreted as PFME in the supine position increasing venous return. Additionally, PFME was found not to alter maternal and fetal heart rates but contributed to the decrease in maternal systolic and diastolic blood pressure. Our study supports the view that the acute effects of PFME neither induce fetal stress nor pose maternal risks.

Defining Trimester-Specific Reference Intervals for Thyroid Hormones: Insights from a Bulgarian Monocenter Study.

Background and Objectives: Pregnancy introduces various interfering factors that, alongside individual variations, impact the assessment of thyroid function tests. This underscores the necessity of defining trimester-specific reference intervals for thyroid-stimulating hormone (TSH) levels. Differences in population characteristics, including ethnicity, socio-economic factors, iodine prophylaxis, and obesity, emphasize the need to establish trimester-specific TSH ranges for women of reproductive age in the respective region or center. The aim of the present study was to establish first- and second-trimester-specific reference intervals for TSH and free thyroxine (FT4) in a relevant pregnant population. Materials and Methods: A retrospective monocenter analysis utilized the electronic database of Ob/Gyn Hospital "Dr. Shterev", Sofia, Bulgaria. The analysis involved data from 497 pregnant and 250 non-pregnant women, all without evidence of thyroid dysfunction or a family history thereof, no indication of taking medication interfering with thyroid function, no evidence of levothyroxine treatment, and no history of sterility treatment. To establish the limits of the TSH reference range, the percentile method was applied using a bootstrapping procedure following the recommendations of the International Federation of Clinical Chemistry (IFCC). Results: Trimester-specific reference intervals for TSH and FT4 in our center were established as follows: first trimester-0.38-2.91 mU/L, FT4-12.18-19.48 pmol/L; second trimester-0.72-4.22 mIU/L and 9.64-17.39 pmol/L, respectively. We also established the normal reference range for the non-pregnant control group, which is similar to that applicable in our laboratory. Conclusions: Our results differ from the fixed limits recommended by the American Thyroid Association, European Thyroid Association, and Endocrine Society Guidelines. Following the relevant established intervals would significantly impact timely diagnosis and therapy requirements for a substantial proportion of pregnant women.

Abstract WP121: Cerebral Hemodynamics in the First Week Postpartum in Healthy Women and Women With Preeclampsia

Objective: Standard adult normative data for transcranial Doppler (TCD)-based cerebral hemodynamic measures, such as mean and peak cerebral blood flow velocity (mCBFV, pCBFV), are used to identify pathological conditions such as postpartum angiopathy. However, little is known about cerebral hemodynamics during the early postpartum period, particularly in patients with preeclampsia (PEC). We characterized cerebral hemodynamics using TCD in the first week postpartum in patients with and without PEC. Methods: We prospectively recruited women with PEC and normotensive pregnant women delivering at an urban academic medical center. We measured CBFV in the bilateral middle cerebral arteries with TCD and calculated systolic mCBFV and pCBFV as well as pulsatility index (PI) and PI-derived noninvasive intracranial pressure (nICP). We compared systolic mCBFV and pCBFV between postpartum women with and without PEC, and historical data from non-pregnant young adult female controls. Results: Subjects were 51 women with PEC, 19 normotensive postpartum women, and 28 non-pregnant historical controls. In the PEC group, median mCBFV was 75.0 cm/s (IQR 65.2-99.1) and median pCBFV was 106.9 cm/s (IQR 92.7-130.8). In the normotensive postpartum group, median mCBFV was 77.1 cm/s (IQR 66.0-92.3) and median pCBFV was 107.9 cm/s (IQR 96.6-127.4). In the non-pregnant female control group, median mCBFV was 62.0 cm/s (IQR 48.5-67.9) and median pCBFV was 83.6 cm/s (IQR 69.3-95.2) (p<0.0001 for mean and peak 3-way comparisons; see Figure). PI and nICP were within normal range in both postpartum groups and did not differ significantly between groups. Conclusion: Postpartum women with and without PEC had mCBFV and pCBFV significantly higher than non-pregnant controls, and many fell outside the standard normal range for healthy adults, but PI and nICP were within normal range. Standard ranges of CBFV for healthy adults may not apply in the postpartum period.

Evaluation of dry eye and meibomian gland function in pregnancy.

To evaluate the signs and symptoms of dry eye in healthy pregnant women and investigate the effect of pregnancy on meibomian gland loss using non-contact meibography. Healthy pregnant women and age-matched healthy non-pregnant women were included in the study. Subjective symptoms were assessed using the Ocular Surface Disease Index (OSDI). The first and average non-invasive break-up times (first-NIBUT and avg-NIBUT, respectively) were determined, and the Schirmer test was applied. Non-contact meibography was performed. The study included a total of 62 women, 30 pregnant (study group) and 32 non-pregnant (control group). There was no significant difference between the groups in terms of OSDI score and the Schirmer test (p > 0.05). The mean first-NIBUT and avg-NIBUT values of the study group (13.1 ± 5.3 and 13.7 ± 4.5s) were significantly lower than the control group (16.0 ± 2.4 and 16.4 ± 1.5s) (p: 0.015 and p: 0.040, respectively). The mean meibomian gland losses in the upper and lower eyelids were significantly higher in the study group (16.9 ± 8.2% and 11.6 ± 10.2%) compared to the control group (9.7 ± 6.2% and 5.6 ± 4.7%) (p < 0.001 and p: 0.011, respectively). It is considered that loss of the meibomian glands may occur during pregnancy, and this may predispose pregnant women to evaporative dry eye. Although dry eye does not cause significant ocular surface symptoms in pregnancy, NIBUT and non-contact meibography can be considered as effective diagnostic methods for the detection of dry eye in pregnant women.

Folate Catabolism Is Increased during Pregnancy in Rats

The hypothesis examined in the present study is that pregnancy results in a greater rate of folate catabolism. Mammalian folate catabolism proceeds by cleavage of the vitamin at the C9-N10 position to yield p-aminobenzoylglutamate, which is quantitatively excreted in the urine after its acetylation. A recently developed HPLC method for the determination of endogenous levels of this catabolite, acetamidobenzoylglutamate, in rat urine was used to investigate folate catabolism in three groups of female rats (n = 6/group), one nonpregnant and two pregnant groups. One of the pregnant groups was allowed to feed freely whereas the other was pair-fed to the nonpregnant control group. The daily excretion of acetamidobenzoylglutamate was stable in the nonpregnant group over the experimental period but increased significantly with progression of gestation in both pregnant groups, in which values peaked at d 18 to concentrations of up to three times those of the nonpregnant animals. In both pregnant groups the values fell significantly before parturition, demonstrating that increased catabolism of folate is a feature of pregnancy per se and not simply due to increased weight. These results suggest that increased catabolism may make an important contribution to the folate deficiency associated with pregnancy.

Appendectomy during pregnancy: rates, safety, and outcomes over a five-year period. A hospital-based follow-up study

Introduction Appendicitis is the most common acute abdominal complication during pregnancy. If appendix perforation occurs there is an increasing risk of preterm delivery and other pregnancy complications. Objective To assess the outcome of pregnancy after appendectomy, the mode of surgery used, appendectomy rates, and complications. Methods A prospective cohort study of pregnant women with, or without, appendectomy at South Stockholm General Hospital, December 2015 to February 2021 in a setting where pregnant women are prioritized for surgery and laparoscopic surgery was standard of care in first half of pregnancy. Data on preoperative imaging, surgical method, intraoperative findings, microscopic findings, hospital stay, pregnancy, and 30-day complications were prospectively recorded in a local appendectomy register. A non-pregnant control group was gathered comprising women of fertile age in the same study interval. Results During the study period 50 pregnant women, of whom 44 gave birth, underwent appendectomy of 38 199 women giving birth. There were no differences between women with or without appendectomy in proportion of preterm delivery (4.5% vs. 5.6%), small-for-gestational age (2.3% vs. 6.2%), or Cesarean delivery (18.2% vs. 20.4%). The rate of appendix perforation was 19% in non-pregnant control group compared to 12% among pregnancy. There was no case of perforated appendix in the second half of pregnancy. However, women with gestational age > 20 weeks more frequently had an unaffected appendix compared to those operated ≤ 20 gestational weeks (4/11 vs. 2/39, p = .005). Laparoscopic surgery was used in 97% of non-pregnant control group, 92% of appendectomies ≤ 20 weeks gestation, and in 27% >20 weeks. As compared to first half, the appendectomy rate was three times lower during the second half of pregnancy. Pregnant women had priority for surgery < 6 h compared to < 24 h among non-pregnant women, this resulted in a shorter time-to-surgery among pregnant women (p < .001) Conclusion Routine laparoscopic surgery and time priority for pregnant surgery is associated with a low risk of perforation, preterm birth and other complications. However, a low threshold for surgery may increase the risk of a negative exploration.

Impacts of Cold-Stress Stimulation On Mice Pregnancy.

Animals exposed to cold stress develop hypertension; however, the effects of cold-induced hypertension on pregnancy remain unclear. We therefore, aimed to investigate the impacts of cold-stress stimulation on mice pregnancy. Four groups of mice were used in the study: non-pregnant control group (NN), non-pregnant cold-stress group (NC), pregnant control group (PN) and pregnant cold-stress group (PC). control groups were kept at 25℃, and the cold-stress groups were kept in a room for cold-stress stimulation (4 ± 2℃) for 4 hours (then back to 25℃) every day from the 1st to the 18th day. The blood pressure of the PC was the highest among the four groups, and the hypertensive percentage of the PC was significantly increased. However, plasma angiotensinⅡ levels of the PC were the lowest. The weights of the foetus and placenta in the PC were significantly decreased compared to the PN. More apparent changes in kidneys and placenta were observed in the PC compared to the PN. The blood pressure of pregnant mice showed no difference between the PN and PC groups 50 days after delivery. Intermittent cold-stress stimulation had significantly adverse effects on the pregnant mice, leading to maternal hypertension, renal and placental lesions, body weight and placenta reduction in offspring. The study results may offer a non-invasive method to establish an animal model of hypertensive disorders in pregnancy. Cold-stress stimulation may be one of the inducible factors of pregnancy-induced hypertension.Cold-stress stimulation may be one of the inducible factors of pregnancy-induced hypertension.

Evaluation of changes of apelin and apelin receptor (APJ) expression in cervix-uterus and placental axis in an LPS-induced preterm labor model.

Although preterm birth is among the preventable causes of maternal and infant death, its mechanism has not yet been clarified. When evaluated in terms of the results, the psycho-social burden of mother-infant losses and the costs of rehabilitation, care, and treatment for postpartum sequelae are high. When evaluated in terms of its causes, infection/inflammation has an important place. Therefore, it is essential to understand the role of pro- and anti-inflammatory proteins in the process. In our study, apelin and apelin receptor (APJ) expression in the cervix-uterus and placental axis were evaluated at tissue and protein levels in pregnant and non-pregnant control, sham, PBS, and LPS groups in the infection model in which LPS induction was performed by midline laparotomy, in CD-1 mice. The evaluation of this axis regarding apelin and apelin receptor in the preterm birth model is new in the literature. Apelin is expressed more intensely in uterine epithelial cells than in the cervix. In the placenta, expression is more intense in the junctional zone compared to other zones. Apelin protein levels decrease significantly in the cervix and placenta whereas it increases in the uterus. While no change was observed in the expression of the apelin receptor at the tissue and protein level in the cervix and uterus, it increased in both aspects in the placenta in the invasive procedure groups. We propose that the decrease in apelin protein due to LPS in the preterm delivery model may be related to the effort to compensate for the balance deteriorated in the pro-inflammatory direction with post-transitional modification at the tissue level. The tendency of apelin to increase with pregnancy has led to the conclusion that it is necessary for a healthy pregnancy. Although the apelin receptor does not change with inflammation, it is necessary to investigate the mechanisms associated with its stress and trauma-induced increase, since it increases in the invasive procedure group.

Evaluation of platelet count and platelet distribution width during Normal pregnancy course

BACKGROUND: Platelet (PLT) counts (PCs) underwent various changes during pregnancy that occur due to hormonal profiles. A reduction in PC is the major event that occurs in PLT disorder during pregnancy. The common laboratory and clinical findings of these disorders make the diagnosis challenging.OBJECTIVES: The study aimed to evaluate the effect of pregnancy on PLT indices among healthy pregnant ladies.METHODS: A case–control hospital-based study was carried out from February 2020 to February 2021 on 150 participants, 100 of them were healthy pregnant Sudanese ladies at different trimesters (36 pregnant in 1st trimester, 33 pregnant in 2nd trimester, and 31 pregnant in 3rd trimester). The control group included 50 healthy nonpregnant Sudanese ladies matched according to age and body mass index. A structured questionnaire was used covering data about demographic history, trimetric period, number of pregnancies, and parity. Five milliliters of blood samples was obtained for the measurement of PLT indices using Sysmex KX-21 automated hematology analyzer. Data were analyzed using the SPSS computer programs version 2S. Independent sample t-test was used to compare the PLT indices between the healthy pregnant and nonpregnant (control). P ≤ 0.05 is considered statistically significant.RESULTS: The mean of participant's age was found to be 25 years (range of 18–45 years) and all of the participants were within the reproductive age. In all pregnant groups, the mean of PCs, mean PLT volume (MPV), and PLT distribution width (PDW) were found to be 284.3 ± 71.7 × 103/μL, 8.8 ± 1.0 fL, and 13.7 ± 2.5, respectively. While in control groups, the mean of PCs, PMV, and PDW was found to be 218 ± 14.4 × 103/μL, 10.3 ± 3.2 fL, and 11.5 ± 2.5, respectively. The MPV was not significantly changed during pregnancy (P = 0.774). However, the changes in the PC and PDW between the pregnant and nonpregnant (control) group were significant with a P = 0.020 and 0.007, respectively. In the course of pregnancy, the PC in the first, second, and third trimesters was found to be 312 ± 78.3 × 103/μL, 268 ± 62.5 × 103/μL, and 273 ± 65.8 × 103/μL with only statistically significant change between the 1st and 2nd trimesters of pregnancy (P = 0.027). The MPV in the first, second, and third trimesters was found to be 8.7 ± 0.92 fL, 8.9 ± 1.1 fL, and 8.8 ± 1.0 fL, with no statistically significant change during the course of pregnancy. The PDW in the first, second, and third trimesters was found to be 12.8 ± 2.6, 13.7 ± 2.5, and 15 ± 1.8 with only statistically significant change between the 1st and 3rd trimesters of pregnancy (P = 0.001).CONCLUSION: The PC and PDW increase significantly during pregnancy in comparison to the control group. PC has the highest reading in the first trimester, and the PDW has the highest reading in the third trimester in comparison to the other trimesters. On the other hand, the MPV is nonsignificantly decreased throughout the three trimesters of pregnancy in comparison to the general population. These new values, which are most likely due to the hormonal profile of pregnancy, should be taken into consideration.

Traumatic Injury in Pregnancy: A Propensity Score-Matched Analysis

IntroductionTrauma represents the leading cause of nonobstetrical maternal death. How in-hospital outcomes of acutely injured pregnant patients (PP) compares to that of similarly aged nonpregnant control groups (CGs) has not been described. We hypothesized that PPs suffering acute traumatic injuries would have worse outcomes compared to a matched CG. Materials and methodsThe American College of Surgeons Trauma Quality Improvement Program (TQIP) was used to identify traumatically injured females between 2017 and 2019. Propensity score matching on age, race, injury severity score , and type of trauma (blunt, penetrating, or other) was used to compare PPs and the CG. Primary outcomes were mortality, disposition, length of stay (LOS), and complications. ResultsA total of 1078 traumatically injured pregnant females were identified. Propensity score matching resulted in 990 patients in the PP and CG cohorts. After matching, PPs were more likely to be assault victims (11% versus 6%, P < 0.001), had longer length of stay (LOS) (5 versus 3 d, P < 0.001), and were more likely to require mechanical ventilation (26% versus 16%, P < 0.001) or intensive care unit (ICU) admission (44% versus 32%, P < 0.001). PPs were more likely to proceed directly to the operating room (OR)(34% versus 15%, P < 0.001) and less likely to be discharged home from the emergency department (ED) (1% versus 12%, P < 0.001). Complications and mortality rates were similar among PPs. ConclusionsAfter acute trauma, PPs did not have increased mortality or complications when compared to matched controls, although they were more likely to be victims of assault, directly proceed to the OR, require mechanical ventilation or ICU admission, and have longer LOSs.

Judgment Bias During Gestation in Domestic Pigs.

In humans and rats, changes in affect are known to occur during pregnancy, however it is unknown how gestation may influence mood in other non-human mammals. This study assessed changes in pigs' judgment bias as a measure of affective state throughout gestation. Pigs were trained to complete a spatial judgment bias task with reference to positive and negative locations. We tested gilts before mating, and during early and late gestation, by assessing their responses to ambiguous probe locations. Pigs responded increasingly negatively to ambiguous probes as gestation progressed and there were consistent inter-individual differences in baseline optimism. This suggests that the pigs' affective state may be altered during gestation, although as a non-pregnant control group was not tested, an effect of learning cannot be ruled out. These results suggest that judgment bias is altered during gestation in domestic pigs, consequently raising novel welfare considerations for captive multiparous species.

Pregnancy and Labor Epidural Effects on Gastric Emptying: A Prospective Comparative Study.

The lack of reliable data on gastric emptying of solid food during labor has led to some discrepancies between current guidelines regarding fasting for solid food in the parturient. This prospective comparative study aimed to test the hypothesis that the gastric emptying fraction of a light meal would be reduced in parturients receiving epidural analgesia and with no labor analgesia compared with nonpregnant and pregnant women. Ten subjects were enrolled and tested in each group: nonpregnant women, term pregnant women, parturients with no labor analgesia, and parturients with epidural labor analgesia. After a first ultrasound examination was performed to ensure an empty stomach, each subject ingested a light meal (125 g yogurt; 120 kcal) within 5 min. Then ultrasound measurements of the antral area were performed at 15, 60, 90, and 120 min. The fraction of gastric emptying at 90 min was calculated as [(antral area90 min / antral area15 min) - 1] × 100, and half-time to gastric emptying was also determined. For the Parturient-Epidural group, the test meal was ingested within the first hour after the induction of epidural analgesia. The median (interquartile range) fraction of gastric emptying at 90 min was 52% (46 to 61), 45% (31 to 56), 7% (5 to 10), and 31% (17 to 39) for nonpregnant women, pregnant women, parturients without labor analgesia, and parturients with labor epidural analgesia, respectively (P < 0.0001). The fraction of gastric emptying at 90 min was statistically significant and lower in the Parturient-Epidural group than in the Nonpregnant and Pregnant Control groups. In addition, the fraction of gastric emptying at 90 min was statistically significant and lower in the Parturient-No-Epidural group than in the Parturient-Epidural group. Gastric emptying in parturients after a light meal was delayed, and labor epidural analgesia seems not to worsen but facilitates gastric emptying. This should be taken into consideration when allowing women in labor to consume a light meal.

Graft function and pregnancy outcomes after kidney transplantation

BackgroundAfter kidney transplantation, pregnancy and graft function may have a reciprocal interaction. We evaluated the influence of graft function on the course of pregnancy and vice versa.MethodsWe performed a retrospective observational study of 92 pregnancies beyond the first trimester in 67 women after renal transplantation from 1972 to 2019. Pre-pregnancy eGFR was correlated with outcome parameters; graft function was evaluated by Kaplan Meier analysis. The course of graft function in 28 women who became pregnant after kidney transplantation with an eGFR of < 50 mL/min/1.73m2 was compared to a control group of 79 non-pregnant women after kidney transplantation during a comparable time period and with a matched basal graft function.ResultsLive births were 90.5% (fetal death n = 9). Maternal complications of pregnancy were preeclampsia 24% (graft loss 1, fetal death 3), graft rejection 5.4% (graft loss 1), hemolytic uremic syndrome 2% (graft loss 1, fetal death 1), maternal hemorrhage 2% (fetal death 1), urinary obstruction 10%, and cesarian section. (76%). Fetal complications were low gestational age (34.44 ± 5.02 weeks) and low birth weight (2322.26 ± 781.98 g). Mean pre-pregnancy eGFR was 59.39 ± 17.62 mL/min/1.73m2 (15% of cases < 40 mL/min/1.73m2). Pre-pregnancy eGFR correlated with gestation week at delivery (R = 0.393, p = 0.01) and with percent eGFR decline during pregnancy (R = 0.243, p = 0.04). Pregnancy-related eGFR decline was inversely correlated with the time from end of pregnancy to chronic graft failure or maternal death (R = -0.47, p = 0.001). Kaplan Meier curves comparing women with pre-pregnancy eGFR of ≥ 50 to < 50 mL/min showed a significantly longer post-pregnancy graft survival in the higher eGFR group (p = 0.04). Women after kidney transplantation who became pregnant with a low eGFR of > 25 to < 50 mL/min/1.73m2 had a marked decline of renal function compared to a matched non-pregnant control group (eGFR decline in percent of basal eGFR 19.34 ± 22.10%, n = 28, versus 2.61 ± 10.95%, n = 79, p < 0.0001).ConclusionsAfter renal transplantation, pre-pregnancy graft function has a key role for pregnancy outcomes and graft function. In women with a low pre-pregnancy eGFR, pregnancy per se has a deleterious influence on graft function.Trial registrationSince this was a retrospective observational case series and written consent of the patients was obtained for publication, according to our ethics’ board the analysis was exempt from IRB approval. Clinical Trial Registration was not done. The study protocol was approved by the Ethics Committee of Hannover Medical School, Chairman Prof. Dr. H. D. Troeger, Hannover, December 12, 2015 (IRB No. 2995–2015).

Acute Appendicitis During Pregnancy: A Case Series of 42 Pregnant Women.

IntroductionIt is difficult to diagnose the symptoms of acute appendicitis in pregnant women due to its similarities with pregnancy physiology. In this study, we examined the diagnostic value of laboratory parameters in the diagnosis of acute appendicitis in pregnant women.Material and methodsForty-two patients who underwent appendectomy during pregnancy were evaluated. The demographic characteristics, laboratory parameters and imaging methods of the patients were examined. According to the pathology results, the patients were evaluated in two groups as normal appendix and acute appendicitis. In addition, a non-pregnant control group was formed to compare the results between the pregnant and control groups.ResultsThe mean age of the 42 patients was 30±6 years, and the pathology results were evaluated as normal in 16 (38.1%) of the patients. As imaging methods, ultrasonography was undertaken in all patients, with MRI being additionally performed in two patients. When the normal appendix and acute appendicitis groups were compared, no significant difference was observed in terms of laboratory parameters (neutrophil, lymphocyte, white blood cell and platelet counts, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, mean thrombocyte volume, red cell distribution width, and pregnancy trimesters (P>0.05). The group that had undergone appendectomy had a significantly higher rate of negative appendectomy compared to the control group (P=0.001).ConclusionLaboratory parameters alone cannot be sufficient for the diagnosis of acute appendicitis in pregnant patients. If clinical examination, laboratory parameters and USG are not sufficient for diagnosis, MRI is the imaging method that should be considered to reduce negative appendectomy rate.

Utility of viscoelastography with TEG 6s to direct management of haemostasis during obstetric haemorrhage: a prospective observational study

BackgroundThe TEG 6s is an automated cartridge-based device with limited description of use in obstetric haemorrhage. The aim of this analysis was to describe the utility of TEG 6s in identifying abnormal laboratory results of coagulation and platelet count, and inform an interventional treatment algorithm for postpartum haemorrhage. MethodsA prospective observational cohort study of 521 women with moderate to severe obstetric haemorrhage (>1000 mL blood loss), including 372 women with at least one TEG 6s test. A non-pregnant control group was used for reference. TEG 6s test parameters Citrated Functional Fibrinogen (CFF), Citrated Kaolin TEG (CK) and Citrated Rapid TEG (CRT) were compared with paired laboratory tests of fibrinogen, PT/aPTT and platelet count, obtained during haemorrhage. ResultsAmong 456 TEG 6s tests, 389 were matched with laboratory coagulation results. The receiver operator characteristic area-under-the-curve (95% CI) for CFF amplitude by 10 min to detect Clauss fibrinogen ≤2 g/L was 0.95 (0.91 to 0.99) (P<0.0001, sensitivity 0.74 and specificity 0.97 at ≤17 mm). False positives had median (IQR) Clauss fibrinogen of 2.4 (2.3–2.7) g/L. The CK-R time had some utility for detecting prolonged PT/aPTT, however a threshold for fresh frozen plasma transfusion was not established. A CRT maximum amplitude <57 mm, when CFF was ≥15 mm, identified four of eight samples with platelet count <75 × 109/L. ConclusionThe TEG 6s CFF can be used to identify low fibrinogen during obstetric haemorrhage. A value to identify transfusion thresholds for PT/aPTT and platelets was not established, and laboratory results should continue to be used.

Transcriptional Levels of Autophagy and UPR Markers in the Brain and Liver of Pregnant Rats

Background: Pregnancy is associated with oxidative stress that results in endoplasmic reticulum (ER) stress and unfolded protein response (UPR). Prolonged-unalleviated ER stress causes the activation of the autophagy pathway via UPR. Expression of genes encoding glucose-regulated protein 78 (GRP78) and BECLIN1 are induced in UPR and autophagy. Objectives: We studied the mRNA expression of the aforementioned genes in the liver and brain of Nulligravida versus saline and ethanol-treated pregnant rats. Methods: Control pregnant rats were orally treated with normal saline, and test animals received ethanol 250 mg/kg or resveratrol 120 mg/kg from day 1 to day 21 of gestation. Nulligravida rats treated by saline comprised the non-pregnant control group. On day 21, mRNAs encoding GRP78 and BECLIN1 were extracted from the liver and brain tissues and assessed using real-time PCR. Results: Our results showed that the level of transcripts encoding GRP78 and BECLIN1 was higher in the liver of pregnant rats compared to Nulligravida ones. Further, ethanol decreased the mRNA levels of GRP78 and BECLIN1 in the liver of pregnant rats, an effect that was reversed by resveratrol. Levels of GRP78 transcripts were decreased, and those of BECLIN1 remained unchanged in the brain of ethanol exposed pregnant rats. Conclusions: Levels of mRNAs for GRP78 and BECLIN1 are up-regulated during pregnancy. These levels are reduced in the liver of ethanol-treated rats, and resveratrol compensates these effects.

Effect of fetal sex on maternal total testosterone level

ObjectiveTo study the effect of fetal sex on maternal serum total testosterone level and its application for fetal sex determination.BackgroundOur study has been made to find a prenatal sex determination test that is rapid, accurate, and can be performed in early pregnancy.Patients and methodsThis study was done on 66 pregnant healthy women (aged 18–35 years) in their second trimester of pregnancy (13–26 gestational weeks) as a case group and another 20 healthy nonpregnant women, age-matched as a control group. Those cases with a history of drug intake, chronic diseases, and history of previous operations were excluded. Both groups were subjected to measurement of total testosterone levels. The pregnant women were rechecked after delivery to know the delivered baby's sex. After excluding five cases from the pregnant group, including three cases (abortion) and two cases (still birth) the final number of the case group was 61; after that the pregnant group was classified into two subgroups: pregnant with male (30) and pregnant with female (31).ResultsThe maternal serum total testosterone level is significantly higher in the pregnant group compared with the nonpregnant control group. Regarding maternal testosterone in women carrying female fetus and others carrying male fetus, there was no statistically significant difference regarding the maternal total testosterone level between those who are pregnant in women compared with those who are carrying male fetus.ConclusionMaternal serum total testosterone level is not a good predictor of fetal sex.

Infection for the Hepatitis E virus in pregnant women of Córdoba, Argentina

Background: The hepatitis E virus (HEV) is an important and poorly studied pathogen of worldwide distribution that causes enteric hepatitis. The HEV infection in humans is usually self-limited. However, cases of severe fulminant hepatitis have been reported in pregnant women and immunosuppressed patients. In Argentina, serological evidence of human HEV infection has been described in different geographical regions. In Córdoba, HEV prevalence of 4.4% in general population, 7.3% in HIV + individuals, 5.8% in solid organ transplant patients and 10.2% in hemodialysis patients have been documented. Besides, RNA-HEV detections have been performed and genotype 3 was detected. The aim of this research was to describe the circulation of HEV in pregnant women from Córdoba, know if there were symptomatic cases, analyse risk factors related to the infection, and compare the findings with the non-pregnant control group Methods and materials: A total of 202 serum samples from pregnant women (52 prospective and 150 retrospective samples), and 155 samples from non-pregnant women with the same ages (control group) from Córdoba were analysed for IgG anti-HEV detection. Positive samples were tested for IgM anti-HEV and RNA-HEV. Two samples from pregnant women with acute hepatitis were also analysed for HEV detection. Results: The seropositivity of IgG anti-HEV obtained for pregnant women was 8.4%, higher than the 2.6% obtained in the control group, and association between pregnancy and HEV infection was found (p = 0.023). There were no differences between seropositivity rates according to the trimester of pregnancy, although differences were found among age groups, with the higher prevalence in pregnant women younger than 25 years (16.7%, p = 0.032). From the IgG anti-HEV + patients, 2 presented IgM anti-HEV, although both were asymptomatic. None of these samples were positive for RNA-HEV detection. Conclusion: The present study shows, for the first time, the circulation of HEV in pregnant women from Córdoba, generating data that contributes to improve the surveillance and diagnosis of a virus little known in our environment, and under-diagnosed. These association between pregnancy and HEV infection should alert the local health team to consider this microorganism as an agent of liver disease in pregnant women.

Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls

BackgroundIn March 2020, as community spread of severe acute respiratory syndrome coronavirus 2 became increasingly prevalent, pregnant women seemed to be equally susceptible to developing coronavirus disease 2019. Although the disease course usually appears mild, severe and critical cases of coronavirus disease 2019 seem to lead to substantial morbidity, including intensive care unit admission with prolonged hospital stay, intubation, mechanical ventilation, and even death. Although there are recent reports regarding the impact of coronavirus disease 2019 on pregnancy, there is a lack of information regarding the severity of coronavirus disease 2019 in pregnant vs nonpregnant women.ObjectiveWe aimed to describe the outcomes of severe and critical cases of coronavirus disease 2019 in pregnant vs nonpregnant, reproductive-aged women.Study DesignThis is a multicenter, retrospective, case-control study of women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection hospitalized with severe or critical coronavirus disease 2019 in 4 academic medical centers in New York City and 1 in Philadelphia between March 12, 2020, and May 5, 2020. The cases consisted of pregnant women admitted specifically for severe or critical coronavirus disease 2019 and not for obstetrical indications. The controls consisted of reproductive-aged, nonpregnant women admitted for severe or critical coronavirus disease 2019. The primary outcome was a composite morbidity that includes the following: death, a need for intubation, extracorporeal membrane oxygenation, noninvasive positive pressure ventilation, or a need for high-flow nasal cannula O2 supplementation. The secondary outcomes included intensive care unit admission, length of stay, a need for discharge to long-term acute care facilities, and discharge with a home O2 requirement.ResultsA total of 38 pregnant women with severe acute respiratory syndrome coronavirus 2 polymerase chain reaction-confirmed infections were admitted to 5 institutions specifically for coronavirus disease 2019, 29 (76.3%) meeting the criteria for severe disease status and 9 (23.7%) meeting the criteria for critical disease status. The mean age and body mass index were markedly higher in the nonpregnant control group. The nonpregnant cohort also had an increased frequency of preexisting medical comorbidities, including diabetes, hypertension, and coronary artery disease. The pregnant women were more likely to experience the primary outcome when compared with the nonpregnant control group (34.2% vs 14.9%; P=.03; adjusted odds ratio, 4.6; 95% confidence interval, 1.2–18.2). The pregnant patients experienced higher rates of intensive care unit admission (39.5% vs 17.0%; P<.01; adjusted odds ratio, 5.2; 95% confidence interval, 1.5–17.5). Among the pregnant women who underwent delivery, 72.7% occurred through cesarean delivery and the mean gestational age at delivery was 33.8±5.5 weeks in patients with severe disease status and 35±3.5 weeks in patients with critical coronavirus disease 2019 status.ConclusionPregnant women with severe and critical coronavirus disease 2019 are at an increased risk for certain morbidities when compared with nonpregnant controls. Despite the higher comorbidities of diabetes and hypertension in the nonpregnant controls, the pregnant cases were at an increased risk for composite morbidity, intubation, mechanical ventilation, and intensive care unit admission. These findings suggest that pregnancy may be associated with a worse outcome in women with severe and critical cases of coronavirus disease 2019. Our study suggests that similar to other viral infections such as severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, pregnant women may be at risk for greater morbidity and disease severity.

Pregnancy Alters Platelet Counts and Enhances Platelet Reactivity in Mice

Background: Pregnancy is a major risk factor for venous thromboembolism (VTE) and is the leading cause of maternal death during pregnancy and the immediate post-partum period. Although plasma levels of clotting factors and fibrinolysis inhibitors are known to increase during pregnancy peaking during the third trimester as parturition nears, little is known about whether platelets are affected in response to pregnancy. Platelets are derived from megakaryocytes and have a circulating half-life of 5-10 days. They are essential for blood coagulation, delivering procoagulant molecules directly to sites of vascular injury. Platelets contain a spliceosome that processes pre-mRNA, providing them with the necessary machinery to respond to external stimuli. Thus, platelets can be affected by diseases such as cancer, which can alter platelet mRNA profiles and function. The plasticity of platelets in these contexts suggests that they could also change in response to pregnancy as an adaptation to preventing blood loss during parturition. However, little is known about the transcriptional and/or functional changes that could occur in platelets during the course of pregnancy. Aims: We aimed to analyze mouse platelet function at early, middle, late gestation, and postpartum timepoints in order to identify pregnancy related functional changes. Methods: C57BL/6J female mice were mated with C57BL/6J male mice to generate pregnant mice. Pregnancy was confirmed by the presence of a vaginal plug, which was used to estimate embryonic day 0.5. Pregnant mice were randomly assigned to one of four groups based on gestational stages corresponding to human trimesters and postpartum. The stages are early (days 7-9), middle (days 11-14), late (days 16-20), and postpartum (days 22-24). The maximum volume of mouse whole blood was drawn into a 1:9 volume of buffered sodium citrate via cardiac puncture. A 20ul aliquot was used for complete blood counts using the Advia 2120 with settings optimized for C57BL/6 mouse blood. The remaining blood was reserved for platelet aggregation studies using the Roche Multiplate Aggregometer. ADP and type 1 collagen were used as the aggregating agents with the operator blinded to the gestational groups. Studies were initiated at the same time of day in order to control for the circadian rhythm and the gestational age. Results: The maximum blood volume we were able to draw from each mouse was significantly increased for all groups (early, middle and late gestational stages and postpartum) compared to the non-pregnant control group (p ≤ 0.03, n ≥ 9). Platelet counts (per microliter of blood) were statistically unchanged among the control and the three gestational groups. However, postpartum platelet counts were significantly increased relative to all groups (control, early, middle and late gestational stages) (p ≤ 0.02, n ≥ 9). There was a more vigorous platelet aggregation response in the late gestational group compared to the non-pregnant control and early gestational groups (areas under the curve with ADP (p ≤ 0.004, n ≥ 7) and collagen (p ≤ 0.028, n ≥ 7). Conclusions and future directions: Our results demonstrate significant changes in blood volume and a dramatic increase in postpartum platelet counts. Our results are consistent with those observed in pregnant humans, indicating that platelet counts have a similar response to pregnancy in both humans and mice. Our results demonstrating a late gestational increase in platelet reactivity suggest that pregnancy induced platelet alterations could play a role in the increased risk of VTE during pregnancy and the immediate post-partum period. We are currently performing additional analyses including RNA sequencing, to determine the mechanisms responsible for the phenotypic changes that we have observed here. The results of our studies could lead to enhanced treatment strategies for pregnancy associated VTE. Disclosures No relevant conflicts of interest to declare.