Crown Rump Research Articles

The effects of progesterone treatment on nuchal translucency in women with threatened miscarriage

This study aims to investigate the effects of progesterone on the possible changes in nuchal translucency (NT) levels for patients diagnosed with threatened miscarriage. The study group was composed of 125 patients diagnosed with threatened miscarriage and taking 400 mg/day micronized orally progesterone at least for two weeks, the control group was composed of 160 healthy pregnant women not taking any progesterone. Crown rump length (CRL) NT thickness, Pregnancy-associated plasma protein-A (PAPP-A), free beta human chorionic gonadotropin (Beta-HCG) levels of patients were measured for assessment of aneuploidy risk. Both of the groups were divided into four subgroups to determine the relationship between thickness of NT and progesterone use for specific CRL measurements. CRL in the first, second, third and fourth group was 45–55 mm, 55–65 mm, 65–75 mm, 75–84 mm, respectively. The two groups were age and BMI matched. In all groups of CRL there were no significant difference in Mom levels of NT thickness, PAPP-A and free Beta-HCG between the study and control groups. There havent been any relation between NT thickness and progesterone use. IMPACT STATEMENT What is already known about this subject? Recently some studies have claimed that progesterone use might have caused atypical blood flow pattern on foetal circulation, which could possibly increase NT. If the NT thickness is affected by the use of progesterone, then the false positive rate of detecting Down Syndrome screening tests would increase. What the results of this study add? In this study we did not found any relation between NT thickness and progesterone use. What the implications are of these findings for clinical practice and/or further research? Using orally progesterone due to threatened miscarriage do not change NT thickness levels. Further studies have to be done with a large number of participants.

Clinical and Ultrasonic Study for Detection of Pregnancy in Iraqi Buffaloes

The present study was conducted on 10 Iraqi pregnant buffaloes aged between 3-6 years at Al-Qasim district- Babylon province, Iraq from December 2018 to December 2019. Those animals diagnosed by rectal palpation and ultrasonography technique to estimate the reproduction status. The results of this study reported wandering of ovum in 10% of animals (1/10). While ultrasonography characterized by increasing placentomes measurement gradually with development of gestation, and the placentomes recorded 8.32±2.46 mm, 13.27±3.25 mm, 18.37±5.34 mm, 23.25±8.63 mm and 28.2±6.87 mm in the 2nd , 3rd, 4th, 5th and 6th month, respectively. Also the total size was recorded by the crown rump length (CRL), which was 0.77±0.05 cm, 5.81±2.54 cm and 14.09±0.73 cm in the 1st, 2nd, and 3rd month, respectively. The heart beat and embryonic vesicle during the 1st and 2nd month were detectable by ultrasonography. In conclusions in the present study, rectal palpation and ultrasonography technique represented one of the most important methods to estimate the gestation period in different stages.

In vivo: maternal betaine supplementation normalized fetal growth in diabetic pregnancy.

Diabetes alters maternal metabolism and can lead to aberrant fetal growth. In addition to insulin treatment, nutritional diet interventions are recommended for promoting fetal health against diabetes-induced adverse effects. Therefore, we conducted an in vivo study to investigate betaine efficacy on fetal development against maternal diabetes. Thirty-two dams were divided into four equal groups: control (C), betaine supplementation (BS), diabetic pregnancy (DP) and diabetic pregnancy plus betaine supplementation (DP + BS). Fasting blood sugar (FBS) and body weight (BW) were monitored during pregnancy. After physiological delivery, dams glycated hemoglobin (HbA1c) concentrations were measured, followed by fetal development indices including litter size (LS), neonatal weight (NW) and crown-rump (CR). Also, maternal oxidative status was assessed by evaluating glutathione (GSH) content, glutathione peroxidase (GSH-Px) and catalase (CAT) activities, and malondialdehyde (MDA) concentration in the erythrocytes. Betaine supplementation significantly alleviated FBS and tended to recover BW loss. It also significantly decreased HbA1c values in dams of DP + BS compared to DP group. Normalized fetal indices such as LS, NW and CR under betaine supplementation were associated with a significant increase in GSH content and GSH-Px activity, as well as decreased MDA concentrations in erythrocytes of dams in the DP + BS versus the DP group, indicating improved redox balance in the dams. We indicated for the first time that betaine supplementation improved the maternal glucose metabolism and redox balance associated with normalized fetal growth. Nevertheless, further studies are required to investigate the mechanisms through which betaine protects fetal growth in diabetic pregnancy.

To determine morphology after administration of tetracycline and zinc chloride in adult albino rats and prenatal conceptus.

Introduction: Administration of tetracycline therapy is controversial during growing age as stated by earlier workers. However the effect of simultaneous administration of tetracycline & Zncl2 on pre-natal concepts has remained undocumented.Objective: To compare the effect on conceptus after maternal ingestion of tetracy-cline and Zncl2 by prospective experimental animal study model using adult albino rats.Methodology: Tetracycline & ZnCl2 was administrated to pregnant female albino rats two times therapeutic dose for 10 days. (from day 8 to day 18 of pregnancy.) Each animal was weighted on day 1, day 8 & day 18 of pregnancy. Abortion resulted on day 18th of pregnancy. Each group of pregnant animal were scarified on day 18 of gestation by overdose of either anesthesia, abdomen opened, uterus & both cornu containing conceptus identified, removed, there weight recorded, crown rump length was measured & was compared with similar value of control animals. The results were statistically analyzed to find out the significance.Result: Maternal administration of tetracycline decreased maternal bodyweight to 38.4 ±0.9gm. However simultaneous administration of ZnCl2 maintained body-weights to 41.4 ±0.7gm. The body weight and crown rump length (CR Length) in conceptus decreased by 4.52 ±0.10gm and 3.06 ±0.09 cm respectively. That tetracy-cline & ZnCl2 administration maintained the body weight & CR length by 5.46 ±0.09 gm and 3.79 ±0.13gm respectively.Conclusion: Pre-natal administration of Tetracycline alone cause reduction in ma-ternal body weight as well as reduction in body weight & CR length of rat conceptus. However simultaneous Zncl2 maintain body weight & CR length leading to growth of the rat conceptus.Keywords: Tetracycline, ZnCl2, Rat Conceptus. Crown Rump Length (CR Length).

Early Abdominal Ectopic Pregnancy Masquerading as a Missed Miscarriage

A 43-year-old lady, gravida 2 para 0, presented to our emergency department with complaints of vaginal bleeding and lower abdominal pain. Her urine pregnancy test was positive. She was unable to recall her last menstrual period. A trans-vaginal ultrasound revealed a pregnancy with a crown rump length of 47 mm corresponding to 11.4 weeks with no fetal heartbeat detected. She was diagnosed with a missed miscarriage and was sent for a second confirmatory scan. The repeat scan was concordant with the initial scan and she was counseled for an evacuation of uterus. Her serum beta human chorionic gonadotropin level was 45,195 IU/L and her hemoglobin level was 6.5 g/dL. She underwent an evacuation of uterus as planned, but the Hegar dilator was only able to be advanced to a cavity length of 6 cm with minimal products of conception obtained. A bedside ultrasound was performed and it showed that the Hegar dilator was in the uterine cavity but not in continuity with the gestational sac and fetus. The diagnosis of an ectopic pregnancy was made and the surgery was converted to a diagnostic laparoscopy. On entry into the abdominal cavity, there was frank hemoperitoneum with adhesions limiting access to the pelvis, therefore decision was made to convert to laparotomy. The findings at laparotomy revealed a large inflamed left tubo-ovarian complex with tubal rupture and expulsion of the entire fetus and placenta into the Pouch of Douglas (POD). The diagnosis of a secondary implantation of the ectopic pregnancy in the POD after tubal rupture was confirmed and we performed adhesiolysis and left salpingectomy. The patient recovered uneventfully and the final histology showed products of conception within the lumen of the left fallopian tube in keeping with ruptured tubal ectopic pregnancy. J Med Cases. 2020;11(6):169-173 doi: https://doi.org/10.14740/jmc3484

Sonographic detection of fetal abnormalities before 11 weeks of gestation.

Sonographic detection of fetal abnormalities before 11 weeks of gestation.

Smokeless tobacco ‘sadagura’ and areca nut extract exposure induces extensive embryotoxicity in chick embryo, Gallus gallus domesticus

Areca nut (AN) and sadagura (SG, homemade smokeless tobacco) are often consumed alone or in combination irrespective of gender including pregnant women in the southern region of Assam, India. However, very few studies have been carried out so far to evaluate its ill effect during embryogenesis. The present study aims to determine the effects of AN, SG, and combination of both (AN + SG) in developing chick embryos as it serves as an excellent model for teratogenic and developmental toxicity study owing to its similarity with the human embryo. Fertile White Leghorn chicken eggs (Gallus gallus domestucus) were exposed to different concentrations of 0.125, 0.25, 0.5, and 1 mg/egg of AN, SG, and AN + SG extract, respectively. The eggs were divided into four groups: control, AN extract-, SG extract-, and AN + SG-treated group. Three different parameters, viz. mortality rate, morphometric measurements, and qualitative anomalies, were studied to observe teratogenic effects. Results indicated a dose-dependent increase in mortality rate in all the treatment groups. Also, quantitative measures suggested significant decrease (p < 0.001) in wet body weight, crown–rump length, anterior–posterior head length, and eyeball diameter in all the concentration of AN, SG and AN + SG of treatment groups when compared to control group. Compared to control, anomalies like microcephaly, microphthalmia, deformed beak, hemorrhage, omphalocele, flexed limbs, and ectopia cordis were prominent in treated groups. Our findings depict organ-specific as well as systemic defects in the developing embryos. Our results suggest that exposure to AN, SG, and AN + SG causes adverse developmental abnormalities and embryo mortality in the chick embryo.

International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project

BackgroundReference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges.ObjectivesTo produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.Study DesignIn Phase II of the INTERGROWTH-21st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original populations in Pelotas (Brazil), Nairobi (Kenya), and Oxford (United Kingdom) that had participated in the Fetal Growth Longitudinal Study. Women with a singleton pregnancy were recruited at <14 weeks’ gestation, confirmed by ultrasound measurement of crown–rump length, and then underwent standardized ultrasound every 5±1 weeks until delivery. From 22 weeks of gestation umbilical artery indices (pulsatility index, resistance index, and systolic/diastolic ratio) were measured in a blinded fashion, using identical equipment and a rigorously standardized protocol. Newborn size at birth was assessed using the international INTERGROWTH-21st Standards, and infants had detailed assessment of growth, nutrition, morbidity, and motor development at 1 and 2 years of age. The appropriateness of pooling data from the 3 study sites was assessed using variance component analysis and standardized site differences. Umbilical artery indices were modeled as functions of the gestational age using an exponential, normal distribution with second-degree fractional polynomial smoothing; goodness of fit for the overall models was assessed.ResultsOf the women enrolled at the 3 sites, 1629 were eligible for this study; 431 (27%) met the entry criteria for the construction of normative centiles, similar to the proportion seen in the original fetal growth longitudinal study. They contributed a total of 1243 Doppler measures to the analysis; 74% had 3 measures or more. The healthy low-risk status of the population was confirmed by the low rates of preterm birth (4.9%) and preeclampsia (0.7%). There were no neonatal deaths and satisfactory growth, health, and motor development of the infants at 1 and 2 years of age were documented. Only a very small proportion (2.8%–6.5%) of the variance of Doppler indices was due to between-site differences; in addition, standardized site difference estimates were marginally outside this threshold in only 1 of 27 comparisons, and this supported the decision to pool data from the 3 study sites. All 3 Doppler indices decreased with advancing gestational age. The 3rd, 5th 10th, 50th, 90th, 95th, and 97th centiles according to gestational age for each of the 3 indices are provided, as well as equations to allow calculation of any value as a centile and z scores. The mean pulsatility index according to gestational age = 1.02944 + 77.7456*(gestational age)–2 – 0.000004455*gestational age3.ConclusionWe present here international gestational age-specific normative centiles for umbilical artery Doppler indices produced by studying healthy, low-risk pregnant women living in environments with minimal constraints on fetal growth. The centiles complement the existing INTERGROWTH-21st Standards for assessment of fetal well-being.

FTY720, a sphingosine analog, altered placentome histoarchitecture in ewes

BackgroundThe lysosphingolipid, sphingosine-1-phosphate, is a well-described and potent pro-angiogenic factor. Receptors, as well as the sphingosine phosphorylating enzyme sphingosine kinase 1, are expressed in the placentomes of sheep and the decidua of rodents; however, a function for this signaling pathway during pregnancy has not been established. The objective of this study was to investigate whether sphingosine-1-phosphate promoted angiogenesis within the placentomes of pregnant ewes. Ewes were given daily jugular injections of FTY720 (2-amino-2[2-(− 4-octylphenyl)ethyl]propate-1,3-diol hydrochloride), an S1P analog.ResultsFTY720 infusion from days 30 to 60 of pregnancy did not alter maternal organ weights nor total number or mass of placentomes, but did alter placentome histoarchitecture. Interdigitation of caruncular crypts and cotyledonary villi was decreased, as was the relative area of cotyledonary tissue within placentomes. Also, the percentage of area occupied by cotyledonary villi per unit of placentome was increased, while the thickness of the caruncular capsule was decreased in ewes treated with FTY720. Further, FTY720 infusion decreased the number and density of blood vessels within caruncular tissue near the placentome capsule where the crypts emerge from the capsule. Finally, FTY720 infusion decreased asparagine and glutamine in amniotic fluid and methionine in allantoic fluid, and decreased the crown rump length of day 60 fetuses.ConclusionsWhile members of the sphingosine-1-phosphate signaling pathway have been characterized within the uteri and placentae of sheep and mice, the present study uses FTY720 to address the influence of S1P signaling on placental development. We present evidence that modulation of the S1P signaling pathway results in the alteration of caruncular vasculature, placentome architecture, abundance of amino acids in allantoic and amniotic fluids, and fetal growth during pregnancy in sheep. The marked morphological changes in placentome histoarchitecture, including alteration in the vasculature, may be relevant to fetal growth and survival. It is somewhat surprising that fetal length was reduced as early as day 60, because fetal growth in sheep is greatest after day 60. The subtle changes observed in the fetuses of ewes exposed to FTY720 may indicate an adaptive response of the fetuses to cope with altered placental morphology.

Teratogenic effects (resorptions and reduction in weight and crown rump length) of valproate on fetal mice

Background and Aims: Teratology is the study of abnormal development in fetus. Teratology first came into existence in 1930 when a number of experiments were conducted. There are various causes of congenital anomalies such as genetic factors, environmental factors such as radiation, changes in temperature, hypoxia, chemical substances, drugs, and maternal infections. At present, valproic acid is the most widely used antiepileptic drug. Valproic acid is salt of dipropyl acetic acid. Most of the studies on the valproate were done at higher doses starting from 400 mg/kg. Hence, the present study was done to assess teratogenic effects at lower dose of valproate i.e., 200 mg/kg. Only few studies are conducted on fetal mice at Valproate dose of 200 mg/kg. The aim of the present study is to report the teratogenic effects of valproate at dose of 200 mg/kg on single gestational day (8th) and multiple gestational days (7th, 8th, and 9th) in fetal mice. Materials and Methods: Forty pregnant mice were taken in the present study, and these are distributed in three groups. Group A which was control group received normal saline. In Group B, Valproate was administered on single gestational day (8th). In Group C, Valproate was administered on multiple gestational days (7th, 8th, and 9th). Dose of valproate given in each group was 200 mg/kg intraperitoneally. On the 18th gestational day, fetuses were collected after uterotomy. The fetuses of all three groups were weighed by digital laboratory weighing scale. Crown rump length (CRL) of fetuses of all groups was documented by means of graph paper. Mean, standard deviation, and P value were calculated. Statistical analysis was done by the ANOVA one-way test. Results: Valproate administered groups showed resorptions. CRL and fetal weight reduction were found in treated groups. These findings were more found in Group C in comparison to Group B. Conclusion: Valproate is teratogenic drug at 200 mg/kg dose, so valproate should be prescribed at lowest efficacious dosage to minimize the teratogenic risk.

Abortifacient efficacy of aqueous-acetone extracts of Adenopus breviflorus Benth seed in female albino rats

The present study evaluated the abortifacient potential of aqueous-acetone extract of Adenopus breviflorus Benth Seed on the reproductive health of matured female albino rats by monitoring the indices of dysfunctions in reproductive system. Prior to the conduction of the fertility studies, the oral acute toxicity of the seed extract was evaluated for autonomic, behavioral and neurological changes, within 24 h to determine the LD50.The influence of aqueous-acetone extract of Adenopus breviflorus Benth Seed was evaluated for antioxidant, reproductive hormones and histology of uteri tissues primarily to monitor effects in female fertility. Female rats exhibiting thick clump of spermatozoa in their vaginal smear were randomly selected and used for the study to determine the abortifacient activity of the seed extract. Parameters such as number of live and dead fetuses, anogenital distance (AGD) and crown rump length (CRL), and the variation in birth weight of liters and gestation period between control and experimental animals were determined. The phytochemical composition of the seed extract was characterized by Gas Chromatography and Mass Spectrophotometry for the identification of phytochemical of toxic or therapeutic effects. Symptoms similar to clinical toxicity such as salivation, respiratory distress, weight loss and change in appearance of hair were noticed at concentrations above 1600 mg/kg BWT, there was no maternal mortality at any period of the experiment. There were changes in the behavioural, neurological and autonomic profile in groups with doses greater than 1600 mg/kg BWT. The LD50 evaluation showed that the aqueous-acetone extract of the seed was safe at dose of 5000 mg/kg BWT. The GC–MS characterization of the aqueous-acetone seed revealed isomeric derivatives of benzene-mesitylene and pseudocumene 4.28 g/100 g of sample) and 5.85 g/100 g of sample respectively as most predominant phytochemicals in the seed extract which demonstrated maternal toxicity. The effects on the female reproductive hormones of the treated animals revealed that FSH, LH and prolactin were significantly reduced (p < 0.05) in all the treated groups by the extract. Progesterone (PH) and estrogen (EH) were also reduced significantly. The study revealed scientific evidence in support of the abortifacient activity of seed extract that was significantly corresponding to the discovered phytochemical compounds.

Risk factors associated with stillbirth of piglets born from oxytocin-assisted parturitions.

Aim:The present study aimed to investigate the effects of different risk factors on stillbirth of piglets born from oxytocin-assisted parturitions.Materials and Methods:Data were collected from a total of 1121 piglets born from 74 Landrace x Yorkshire crossbred sows from a herd. Logistic regression models were used to determine the associations between stillbirth and different risk factors including parity (1, 2, 3-5, and 6-10), gestation length (GL) (112-113, 114-116, and 117-119 days), litter size, birth order (BO), sex, birth interval (BI), cumulative farrowing duration, birth weight (BW), crown rump length, BW deviation, body mass index, ponderal index (PI), and the use of oxytocin during expulsive stage of farrowing.Results:The incidence of stillbirth at litter level and stillbirth rate was 59.5% (44/74) and 8.1% (89/1094), respectively. The final multivariate logistic regression selected BO, BI, PI, GL, and parity as the five most significant risk factors for stillbirth. Increased BO and BI, GL <114 and >116 days, parity 6-10, and low PI increased the stillbirth rate in piglets.Conclusion:Several factors previously determined as risks for stillbirth in exogenous oxytocin-free parturitions also existed in exogenous oxytocin-assisted parturitions. One dose of oxytocin at fairly high BO did not increase stillbirth, whereas two doses of oxytocin were potentially associated with increased values.

Antioxidants increase blastocyst cryosurvival and viability post-vitrification.

What is the effect of antioxidants acetyl-L-carnitine, N-acetyl-L-cysteine and α-lipoic acid (A3) in vitrification and warming solutions on mouse blastocyst development and viability? The combination of three antioxidants in vitrification solutions resulted in mouse blastocysts with higher developmental potential in vitro and increased viability as assessed by both an outgrowth model in vitro and fetal development following uterine transfer. The antioxidant combination of acetyl-L-carnitine, N-acetyl-L-cysteine and α-lipoic acid present in IVF handling and embryo culture media has significant beneficial effects on mouse embryo and fetal development, especially under oxidative stress. The study was a laboratory-based analysis of an animal model. Rapid cooling through vitrification was conducted on F1 mouse blastocysts, with antioxidants (A3) supplemented in vitrification and/or warming solutions, followed by culture and embryo transfer. Pronucleate oocytes were collected and cultured in groups to Day 4 blastocysts. Expanded blastocysts were vitrified and warmed in solutions with and without the A3 antioxidants and cultured for a further 24h. Blastocyst cell number and allocation, apoptosis and histone acetylation levels were all quantified, and viability through outgrowths and transfers assessed. Mouse blastocysts vitrified with no antioxidants had significantly lower cell numbers (P < 0.001) and higher apoptotic cells (P < 0.05) compared to non-vitrified embryos. Addition of combined A3 antioxidants to the vitrification and warming solutions resulted in a significant increase in inner cell mass cell (ICM) number (P < 0.001) and total cell number (P < 0.01), and an increase in outgrowth area (P < 0.05), which correlated with the increased fetal weight (P < 0.05), crown rump length (P < 0.05) and limb development (P < 0.05) determined following transfer compared to embryos with no antioxidants. Furthermore, while blastocyst vitrification significantly reduced acetylation levels (P < 0.05) compared to non-vitrified embryos, the inclusion of A3 antioxidants helped to ameliorate this. Embryo development was only examined in the mouse. Results in this study demonstrate that vitrification and warming of blastocysts have significant detrimental effects on embryo histone acetylation and subsequent viability. The presence of antioxidants in the vitrification solutions helps to alleviate the negative effects of cryopreservation. Our data indicate that antioxidants need to be present in the medium at the time of exposure to increased oxidative stress associated with vitrification and that prior exposure (i.e. during culture or IVF alone) is insufficient to protect cells against cryo-induced injury. Hence, A3 antioxidants may assist in maintaining the viability of vitrified human embryos in ART through the reduction of oxidative stress. This work was funded by a research grant from Vitrolife AB (Sweden). The authors have no conflict of interest to declare.

Transient connection or origin of the inferior pharyngeal constrictor during fetal development: A study using human fetal sagittal sections

The inferior pharyngeal constrictor (IPC) originates from the thyroid and cricoid cartilages and inserts to the pharyngeal raphe. In serial sagittal sections of 37 embryos and fetuses at 6–15 weeks (crown rump length 15–115mm), we found (1) the IPC connecting to the sternothyroideus and thyrohyoideus muscles (16 fetuses at 6–11 weeks) or (2) the cricothyroideus muscle (6 fetuses at 12–15 weeks) in addition to the usual cricoid origin. These aberrant connections were most likely to be transient origins of the IPC not from a hard tissue but nearby striated muscles. In four of the latter six specimens, a tendinous band from the IPC inferior end connected to the cricothyroideus muscle to provide a digastric muscle-like appearance. These aberrant connections with nearby muscles seemed to become separated by a growing protrusion of the thyroid cartilage. Therefore, these aberrant origins were, even if developed, most likely to be “corrected” to the adult morphology during midterm or late prenatal period. The aberrant or transient origin of the IPC seemed to result from a discrepancy in growth of the cartilage and muscles. Such a discrepancy in growth seems to resemble the IPC wrapping around the superior cornu of thyroid cartilage. In addition, a final or adult-like morphology was found in two of the present 37 fetal specimens. It seemed to suggest a significant redundancy in growth rate of the laryngeal structures.

Effect of intrauterine marijuana exposure on fetal growth patterns and placental vascular resistance

Objective The recent legalization of marijuana has increased overall use, including in pregnancy. Studies have previously associated marijuana use with adverse fetal neurodevelopmental outcomes. We sought to compare fetal sonographic growth parameters and placental perfusion, as measured by umbilical artery Dopplers, in women using daily marijuana versus nonusers. Methods A retrospective cohort study capturing self – identified pregnant daily marijuana users with gestational aged matched controls was performed. We compared maternal demographics, fetal biometry, nuchal translucency, and umbilical artery Dopplers in marijuana users versus controls. Intrauterine growth restriction was defined as an estimated fetal weight <10th %. Results In 55 first trimester ultrasounds, there were no differences in crown rump lengths or nuchal translucencies between the groups. Likewise, in 195-second trimester ultrasounds, no differences were noted in biometry. Second trimester umbilical artery systolic to diastolic ratios were higher in marijuana users compared to nonusers (4.02 versus 3.92, p = .024). In the third trimester, 26 of 192 marijuana exposed fetuses were growth restricted compared to 6 of 192 controls (p = .002), and umbilical artery systolic to diastolic ratios were higher (3.52 versus 3.12, p = .0001). Four cases of absent and reversed end diastolic flow were observed in marijuana users, while no cases were observed in controls. Conclusions Our data shows that daily marijuana use is associated with impaired fetal growth and increased placental vascular resistance. Marijuana consumption in pregnancy should be avoided until further studies delineate its exact potential for fetotoxicity.

The Impact of Neighbourhood Deprivation on Embryonic Growth Trajectories: Rotterdam Periconception Cohort.

Background: Neighbourhood deprivation is a risk factor for impaired health and adverse pregnancy outcomes. We investigated whether living in a deprived neighbourhood is associated with embryonic growth. Methods: From the Predict cohort, we studied 566 women who underwent repeated first trimester ultrasound examinations. Crown rump length (CRL; n = 1707) and embryonic volume (EV; n = 1462) were measured using three-dimensional techniques. Neighbourhood deprivation was assessed using the neighbourhood status scores (NSS) of the Dutch Social Cultural Planning office. A high NSS represents a non-deprived neighbourhood. Associations between the NSS and embryonic growth were investigated using linear mixed models. Adjustment was performed for individual-level factors: maternal age, geographic origin, educational level, BMI, folic acid supplement use, fruit and vegetable intake, alcohol use and smoking habits. Results: The NSS was negatively associated with embryonic growth: a higher score (a less deprived neighbourhood) was associated with a smaller CRL and EV; adjusted β: −0.025 (95% CI −0.046, −0.003) and adjusted β: −0.015 (95% CI −0.026, −0.003). At 11 weeks of pregnancy, we observed a 0.55 cm3 smaller EV (7.65 cm3 vs. 7.10 cm3) and 1.08 mm smaller CRL (43.14 mm vs. 42.06 mm) in the highest compared to the lowest category. Conclusion: In deprived neighbourhoods, embryos are larger than in non-deprived neighbourhoods.

Teratological Effect of Indoxacarb on Chick Embryos (Gallus gallus domesticus)

The present study was designed to assess the teratological effects of Indoxacarb on chick embryos (Gallus gallus domesticus) by administering different doses of commercial Indoxacarb (0.5, 1.0 and 1.5ml/1000ml/egg, in three experimental groups B, C and D) injected into the yolk sac of eggs before incubation. Embryos were recovered at day 12 of incubation. The mortality rate gradually increased from lower to higher doses. A total of twelve morphometric parameters viz., wet body weight, crown rump length, anterior posterior head diameter, eye diameter, beak length, neck length, humerus length, radius and ulna length, metacarpus length, femur length, fibula length and metatarsus length were recorded and compared with control group. These quantitative parameters indicated significant plessthan0.05) decrease in all treated groups compared to control group. While the qualitative anomalies such as microcephaly, hydrocephaly, edematous swelling, hematoma formation, abnormal body coloration, anophthalmia, microphthalmia, deformed beak, agnathia, wry neck, micromelia, amelia, omphalocele and ectopia cardis were also recorded in treated groups as compared to untreated groups. Therefore, it is concluded that Indoxacarb has potentially harmful effects on the development of avian embryos even at very low dose concentration. Hence, due to toxicity of this pesticide it must be used with utmost caution.

Vermiform Appendix During the Repackaging Process from Umbilical Herniation to Fixation onto the Right Posterior Abdomen: A Study of Human Fetal Horizontal Sections.

The anatomical position of the vermiform appendix varies among adults, and these variations are responsible for differences in the symptoms of appendicitis. However, to date no study has examined how and when these variations occur during fetal development. The present study examined horizontal sections of 27 midterm fetuses (crown rump length [CRL] 38-97 mm, gestational age approximately 8-15 weeks). There were 10 fetuses (CRL 56 mm or more) in which the cecum and appendix were in a posterosuperior site near the right kidney (postmigration phase), and 12 fetuses (CRL 39-72 mm) in which the ileocecal junction and appendix remained on the visceral surface of the liver in the anterior or anterolateral abdominal cavity (migration phase, after physiological umbilical herniation). Analysis of the 12 fetuses in the migration phase indicated that the appendix extended inferiorly in eight fetuses and superiorly in four fetuses. Likewise, a "preileal" appendix (a morphology in which the distal part of the appendix was in front of the terminal ileum) was present in eight of these fetuses. Extension of the appendix superiorly or inferiorly during the migration phase seems unrelated to the topographical relationship of the appendix with the terminal ileum at the postmigration phase in fetuses and in adults. Conversely, it seems likely that a retroileal appendix leads to a coiled appendix behind the ileocecal junction. "Guidance" by the liver surface seemed to be important for posterior migration, which ended with the ascent of the liver. Clin. Anat., 33:667-677, 2020. © 2019 Wiley Periodicals, Inc.

348 Training and Competency of Emergency Department Advanced Practice Providers in First Trimester Pregnancy Ultrasound

Assess advanced practice provider (APP) competency in ultrasound (US) for symptomatic first trimester pregnancy after a targeted training protocol. Describe confidence of APPs in US image acquisition and interpretation. As part of a quality assurance (QA) initiative, APPs were trained in point-of-care (POC) first trimester pregnancy transabdominal ultrasound (TAU) via a didactic and supervised examinations. Prior to training, APPs did not utilize POCUS. This is a retrospective chart review of the 6-month period encompassing the training period and subsequent US. All TAU was performed on stable patients in an academic urban tertiary care center emergency department. APPs utilized a brief, systematic acquisition protocol. If there was an intrauterine pregnancy (IUP), large free fluid, or large adnexal mass, a credentialed emergency physician over-read the US for safety. If no IUP was visualized, a radiology ultrasound (RUS) was ordered. A 10-question QA form including interpretations and confidence was completed for all US. Confidence was based on a 5-point Likert scale with the anchors of “not at all confident” (1) to “completely confident” (5). Of the 12 APPs who completed the didactic, 8 (67%) performed TAU. A total of 52 exams were performed identifying 36 (70%) IUPs. Fetal cardiac activity was noted in 94% (34), of which M-mode was obtained in 78% (28) versus visual inspection in 22% (5). Crown rump length (CRL) measurements were obtained in 67% (24) of IUPs. Of those with a calculated CRL, the average gestation was 8 weeks 6 days (SD 15 days). There were no missed ectopic pregnancies. For patients with a TAU confirmed IUP, confidence in identifying IUP, determining CRL, and scanning the adnexa was rated fairly to completely confident (4 or 5) in 86.1%, 79.2%, and 66.7% of exams respectively. There were 4 RUS for patients with an APP-identified IUP. The reasons for RUS were indeterminate if free fluid in the abdomen; no fetal cardiac activity; abnormal appearing cervix; and abnormal tissue in the gestational sac. RUS noted multiple uterine fibroids and small subchorionic hemorrhage; early embryonic demise; Nabothian cysts and cervical calcifications; and choriodecidual hematoma or chorionic bump, respectively. Of the 16 (30%) TAU that did not identify an IUP, 13 of the RUS found an IUP with average gestation of 6 weeks 4 days (SD 15 days). All RUS utilized transvaginal US. In 7 of the 13 RUS confirmed IUP, only a yolk sac and no fetal pole was identified. For TAU with no identified IUP, confidence in scanning the adnexa was 50%. Providing APPs with training and a protocol increased their POCUS utilization. In patients with an IUP, APPs were most confident in the assessment of the location of the pregnancy and least confident in scanning the adnexa. The average gestational age for radiology determined IUP was 2 weeks younger than APP determined IUP. In this small sample, APPs competently identified IUP or appropriately referred to a credentialed emergency physician or RUS. There were no missed ectopic pregnancies. The study of APP-performed first trimester pregnancy US is ongoing.

EP07.20: Early detection and characterisation of CNS anomalies at 11–14 weeks in a mixed population attending a tertiary centre in a metropolitan city in India

To diagnose and characterise fetal CNS anomalies at 11-14 weeks of gestation to facilitate early management decisions. This was a retrospective analysis of 2377 pregnancies from a mixed economic and cultural background who underwent an 11-14 week-scan at a centre that provides primary, secondary and tertiary imaging care in Mumbai (India) between 2017 and 2018. Crown–rump length was 45 to 84 mm. The age range was 18-46 years (median 27 years). All scans followed ISUOG guidelines. The prevalence of CNS anomalies was about 1.09%. Of a total of 26 anomalous fetuses, 12 had an acrania-exencephaly sequence, 6 open spina bifida, 3 encephaloceles, 2 holoprosencephalies, 1 closed NTD and 2 suspected posterior fossa anomalies. 3 patients were lost to follow up. One encephalocele had associated Iniencephaly. Another had a double outlet right ventricle at 16 weeks follow up. Acrania-exencephaly was easily identified because of gross anatomical distortion. All open spina bifidas were suspected by nonvisualisation of the intracranial translucency. Complete or partial non-visualisation of the falx led to the diagnosis of holoprosencephaly. The overall prevalence of NTDs in India is high (0.05-1.1%) compared to other regions of the world, consequent to multiple factors possibly including lack of periconceptional folate supplementation, poor patient compliance, genetic predisposition and suboptimal ultrasound evaluation. These defects frequently give rise to quality of life issues. High end technology and operator skill enable early diagnosis. This potentially facilitates patient counseling and family decision making at a stage in pregnancy when termination, if opted for, is safer and psychologically simpler. EP07.20: Table 1. Various CNS anomalies found in our study Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.