Gestational Week Of Delivery Research Articles

Hypoxia-inducible factor-1α, hepcidin and interleukin-6 levels in pregnancies with preterm labour

The aim of the study was to investigate whether serum hypoxia-inducible factor-1alpha (HIF-1α), hepcidin and interleukin-6 (IL-6) concentrations differed between threatened preterm labour (TPL) and uncomplicated pregnancies. This study was conducted on 54 women with TDL pregnancies and 26 healthy pregnant women. The TPL group was further divided into two subgroups according to the gestational age at delivery. Patients who gave birth within 48–72 h after the hospitalisation were referred to as preterm delivery (PD) and who gave birth at ≥37 weeks were referred to as term delivery (TD). Maternal levels of serum HIF-1α, hepcidin and IL-6 were measured with the use of enzyme-linked immunosorbent assay kits. The mean maternal serum HIF-1α, hepcidin and IL-6 levels of PD were significantly higher than TD (p < .001*) and control group (p < .001*). The mean maternal serum HIF-1α and hepcidin levels of TD were no significantly higher than the control group (p=.058, p = .064). The mean maternal serum IL-6 level of TD was significantly higher than the control group (p < .001*). A negative correlation was found between serum concentration of HIF1α, hepcidin, IL-6 with the gestational week of delivery (r = –0.421, p < .01* for HIF-1α; r = –0.578, p < .01* for hepcidin and r = –0.435, p < .01* for IL-6). High levels of HIF-1α, hepcidin and IL-6 may have potential to be used as biomarkers for the differentiation of PD and TD.Impact statementWhat is already known on this subject? It is known that hypoxia-inducible factor-1alpha (HIF-1α) is a hypoxia marker and hepcidin and interleukin-6 (IL-6) increase in inflammation. Our study is the comparison of maternal serum HIF-1α, hepcidin and IL-6 levels between the TPL group (TD and PD) and healthy control group.What the results of this study add? The present study demonstrates that serum HIF-1α, hepcidin and IL-6 levels were significantly higher in TPD group than uncomplicated group. The mean maternal serum HIF-1α and hepcidin levels of TD were no significantly higher than the control group.What the implications are of these findings for clinical practice and/or further research? High levels of HIF-1α, hepcidin and IL-6 may be biomarkers in the determination of true preterm labour within the TPL group.

Expression of Dual-Specificity Phosphatase 9 in Placenta and Its Relationship with Gestational Diabetes Mellitus.

Introduction The aim of the present study was to examine placental levels of DUSP9 mRNA and protein and to investigate the potential role of DUSP9 in the development of gestational diabetes mellitus (GDM). Methods Placental tissues from pregnant women with GDM (n = 17) and normal healthy pregnant women (n = 16) were collected at delivery. The expression of DUSP9 mRNA in placental tissue was analyzed by real-time PCR, while the expression of DUPS9 protein was evaluated by immunohistochemistry and western blot. Differences in the expression levels of DUSP9 mRNA and protein between the two groups were assessed, as well as potential correlations between DUSP9 mRNA expression levels and relevant clinical indicators. Results Blood glucose levels were significantly higher in the GDM group than in the control group, based on an oral glucose tolerance test. DUSP9 protein was expressed in the placental cytotrophoblasts in both groups, and placental levels of DUSP9 protein and mRNA were significantly higher in women with GDM. Placental DUSP9 mRNA levels in all 33 women correlated moderately with delivery gestational week (R = 0.465, P = 0.006), fasting plasma glucose (R = 0.350, P = 0.046), 1-hour postload plasma glucose (R = 0.363, P = 0.038), and 2-hour postload plasma glucose (R = 0.366, P = 0.036), but not with maternal age, preconception body mass index, prenatal body mass index, or neonatal birth weight. Multiple linear regression analysis indicated that delivery gestational week was an influence factor of DUSP9 mRNA levels (β1 = 0.026, P < 0.05). Conclusions DUSP9 upregulation in the placenta of GDM pregnant women may promote insulin resistance, which may correlate with the occurrence of GDM. But there is still possibility that DUSP9 upregulation was the results of insulin resistance and/or hyperglycemia. Further research is needed to explore the role of DUSP9 in GDM.

Analysis of preventability of malignancy-related maternal death from the nationwide registration system of maternal deaths in Japan

Objective: We reviewed malignancy related maternal deaths in Japan to ascertain if there were avoidable factors.Methods: Malignancy-related maternal death in Japan reported to the Maternal Death Exploratory Committee, from 2010 to 2016 inclusive.Results: There were 12 cases of maternal death caused by malignancy. There were four gastric cancers (two poorly differentiated adenocarcinoma, one signet ring cell carcinoma with adenocarcinoma, one histology not available), 3 leukemia (two acute myeloid leukemia, one aggressive NK cell leukemia), two ureteral cancers (histology not available), one malignant lymphoma (diffuse large B-cell lymphoma with translocation), one brain tumor (gliomatosis cerebri), and one cervical cancer (glassy cell carcinoma). Two gastric cancer patients had chronic gastric pain before conception. In two cases the physicians commented that they had avoided computed tomography and the brain biopsy needed for diagnosis because the patient was pregnant. At diagnosis, the clinical stages were II–IV in 9, and the performance status was 3–5 in 8. Indication for delivery was exacerbated maternal condition in 5, for treatment in 3, spontaneous labor in 3, and one patient declined elective delivery. Median [interquartile rage] (range) gestational weeks of delivery was 29 [24–30] (19–40). One cervical cancer patient had a radical hysterectomy and chemotherapy for 10 months. However, three leukemia and one gastric cancer patients had chemotherapy within 10 d because they deteriorated rapidly. Another seven cases did not have any treatment because of poor general condition or because they remained undiagnosed. In all cases, the Committee considered that there was no evidence of substandard care.Conclusion: In these cases, both the clinical stages and biological degree of malignancy were high. In two-thirds of cases, early termination of the pregnancy was indicated because of deteriorating maternal condition. Chemotherapy was not effective because of short available time for therapy and the advanced stage of the cancers when diagnosed. Encouraging women to have a thorough medical assessment before conception, and early diagnosis and treatment before pregnancy, appears to be the only practical way to reduce deaths from malignancy while a woman is pregnant.

Analysis of the reproductive outcomes and the size of the unicornuate uterus measured by magnetic resonance imaging and their relationship.

To evaluate the relationship between the uterine size measured by pelvic magnetic resonance and reproductive outcome in women with a unicornuate uterus. This was a retrospective study including 140 patients affiliated with unicornuate uterus diagnosed by the pelvic MR prior to their first pregnancy in the Obstetrics and Gynecology Hospital of Fudan University from April 2010 to December 2017. All the length of the unicornuate uterus were re-measured and recorded by skilled radiologists during the study period. We divided all the 140 participants with complete pelvic MR imaging into four groups by the best reproductive outcomes, which refers to Group 1 (primary infertility, n = 21), Group 2 ( < 24weeks' gestation, n = 34), Group 3 (preterm delivery, 24-35weeks' gestation, n = 13), Group 4 ( ≥ 35weeks' gestation, n = 72), followed them up and then analyzed the data. Measurements of 140 patients with hemi-uteri were retrieved for analysis. The mean length of the uterine was 4.90 ±0.56cm. There were no significant differences in the uterine cavity length, cervical length, endometrial thickness and uterine wall thickness between the four groups while the uterine length (P=0.001) was statistically significant. Women with uterine lengths ≥ 4.5cm were more likely to experience full-term delivery compared with the other group (P=0.001). Ordinal multiple logistic regression analysis showed that the uterine length [OR=9.03 (95% CI: 2.90-28.13)] and uterine cavity length [OR=0.32 (95% CI: 0.06-2.04)] were independent protective factors for better obstetric outcomes CONCLUSION: The uterine length is a reliable prognostic factor for the gestational week of delivery and an appropriate antenatal surveillance factor of women with unicornuate uterus.

544: Neonatal morbidity in preterm infants stratified by gestational week of delivery

To explore the effect of gestational age at delivery on the risk for neonatal morbidity following preterm birth (PTB) <37 weeks. A retrospective cohort study of all live singleton preterm neonates born <37 weeks’ gestation (2010-2016). Deliveries <24 weeks’ gestation or stillbirths were excluded. Short-term morbidity included respiratory (RDS, TTN, Bronchopulmonary dysplasia, meconium aspiration syndrome) or CNS (Encephalopathy, IVH, seizures, PVL) adverse outcome. Total morbidity included all previously mentioned complications. 1. Of 69,625 neonates who were delivered during the study period, 3,468 (4.9%) were preterm and met inclusion criteria. The mean(SD) and median (IQR) GA and birthweight were 34.4±2.3 and 35 (34-36) weeks, and 2,430.0±581.7 and 2,430 (2,050-2,740) grams, respectively. The rate of cesarean delivery was 42.3% in our cohort. 2. The overall rate of neonatal morbidity in our cohort was 17.9% for respiratory morbidity, 2.9% of CNS morbidity (IVH rate of 2.7%), 2.7% of NEC and 20.8% of total neonatal morbidity. The rate of neonatal morbidity was inversely related to GA at delivery (Figure). 3. In multivariable logistic regression analysis controlling for maternal hypertensive disorders, diabetes, labor induction, mode of delivery, meconium, birthweight (BW) centile, small for gestational age, neonate gender and gestational age at delivery, the risk for respiratory and CNS morbidity decreased in 21.9-39.8% for every 1 week of pregnancy prolongation (Table). 4. Factors which were significantly associated with adverse neonatal morbidity were maternal hypertensive disorders OR(95%CI) 1.34 (1.02-1.77), male gender 1.45(1.20-177), induction of labor 1.58 (1.18-2.10) and gestational week 0.62 (0.59-0.65). Interestingly, mode of delivery was not associated with adverse outcome. Additionally, as compared to appropriate for gestational age neonates (BW between 10th and 90th centiles), SGA (<10th centile) was significantly associated with decreased risk for total adverse outcome 0.69 (0.49-0.98) whereas LGA (>90th centile) was associated with increased respiratory morbidity 2.0 (1.17-3.43). In preterm neonates, the risk for respiratory and CNS morbidity was inversely related to GA at delivery with SGA being associated with lower risk for complications. The results can be used for risk assessment and consultations in PTBs.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The effect of cervical canal length on maternal and neonatal outcomes in placenta previa and the predictive value of transvaginal ultrasound measurement of cervical canal length for emergency early cesarean section

Objective To analyze the effect of cervical canal length on maternal and neonatal outcomes in placenta previa and the predictive value of transvaginal ultrasound measurement of cervical canal length for emergency early cesarean section. Methods From January 2014 to December 2017, 63 pregnant women with placenta previa in the General Hospital of Changzhi Lu'an Group were selected in this study.The length of the cervical tube was measured by vaginal ultrasound in the late pregnancy.According to the length of cervical canal during delivery, 63 cases were divided into control group (cervical canal length >25cm, 39 cases) and study group(cervical canal length ≤ 25cm, 24 cases). The maternal and infant outcomes of the two groups were compared, and the diagnostic efficacy of the cervical canal length to the early cesarean section of the placenta preg before 36 weeks of pregnancy was assessed by drawing the receiver operating characteristic curve to evaluate the area and the best diagnostic threshold under the curve, and calculated the sensitivity and specificity. Results The gestational weeks of delivery in the study group was significantly shorter than that in the control group(t=5.95, P 0.05). The birth weight and the 5 min Apgar score in the study group were significantly lower than those in the control group(t=5.48, 4.65, all P<0.05). The incidence rate of neonatal asphyxia in the study group was significantly higher than that in the control group(χ2=5.19, P<0.05). The area of the cervical canal length was 0.87, with the sensitivity of 84.62%, the specificity was 78.38%, and the best diagnostic threshold was 26.5 mm for the pregnant women who was predicted the placenta previa before 36 weeks of pregnancy. Conclusion The incidence rates of adverse outcomes, such as premature birth, prenatal bleeding and neonatal asphyxia, are higher in pregnant women with shorter cervical tube length.The measurement of cervical canal length by vaginal ultrasound for pregnant women with placenta previa can be used as an important evaluation method to predict the early cesarean section of pregnant women, and help to strengthen the clinical intervention, take management to prevent serious perinatal complications. Key words: Cervical length measurement; Placenta previa; Ultrasonography; Vagina; Cesarean section; Pregnant women; Infant, newborn; Pregnancy outcome

How safe is pregnancy after liver transplantation? A large case series study at tertiary referral center in Turkey

Objective: To investigate pregnancy outcomes and to define preventative measures against to risk factors and complications in pregnancy after liver transplantation. Secondary aim is to report postpartum allograft functions in these patients.Method: This is a case series study. All pregnant women with liver transplantations performed in our hospital were enrolled. Patients’ hospital medical records, electronic records Neonatal Intensive Care Unit (NICU) records were used to collect data. Obstetric characteristics and antenatal complications, risk factors, pregnancy and neonatal outcomes, all aspects of liver transplant variables and allograft functions after pregnancy were studied.Results: A total of 11 patients were included in the study. All of them were singleton. Mean maternal age was 29.3 ± 3.9 years. And mean gestational week of delivery was 37.2 ± 2.2. 78% of the women were delivered at term (>37 weeks) only two babies were preterm and discharged from NICU without any complications. Birth weight (gr median ± SD) was 2575 ± 345. Five (45%) patients were nulliparous, majority of the cases (8/11, 72%) were conceived of pregnant with natural way. Live birth rate was 81% (9/11). Only one patient for each has suffered from fetal growth restriction, maternal anemia, maternal hyperthyroidism, and ulcerative colitis. Vaginal bleeding was seen in five women during the pregnancy. There was no maternal death, stillbirth or neonatal death. The mode of delivery for all live birth pregnancies was C-section. And none of them was emergency C-section. No complication of allograft function was seen after pregnancy.Conclusion: Pregnancy in women with liver transplantation is not associated with poor pregnancy outcomes and complications for both the mother and the neonates when these patients followed up at tertiary referral center with multidisciplinary approaches.

PREECLAMPTIC WOMEN WITH FEATURES OF SUBCLINICAL SECONDARY HYPERPARATHYROIDISM HAVE ELEVATED BLOOD PRESSURE LEVELS AFTER DELIVERY

Objective: Calcium supplementation has shown beneficial effects on blood pressure and its metabolism is altered in pregnancy hypertensive-related disorders. In this study, we hypothesized that calcium metabolism can be associated with blood pressure levels in preeclampsia complicated pregnancy. Design and method: A group of 63 multiethnic preeclamptic women (age 35 ± 6 y., 83% European, 14% African, and 3% Hispanic) was consecutively recruited at our Hypertension Unit at 1 month after delivery. We collected clinical and anthropometric variables, blood and urinary samples and performed 24-hours ambulatory blood pressure monitoring (ABPM). We measured plasma and 24-hours urinary calcium, plasma 25-hydroxycholecalciferol, parathyroid hormone (PTH), and creatinine levels, and 24-hours protein excretion. Renal function was estimated by the Modification of Diet in Renal Disease (MDRD) study equation. No women knew to be hypertensive before the current pregnancy or took calcium or vitamin D supplements. Results: At recruitment, 60% of women were taking antihypertensive agents, all of which alpha-methyldopa. For statistical purposes, we divided the group in tertiles according to PTH levels. Women in the third tertile showed biochemical characteristics of secondary hyperparathyroidism with elevated PTH and reduced vitamin D plasma levels (PTH 93 ± 15 pg/ml; 25-hydroxycholecalciferol 20 ± 8 ng/ml). In-office and ABPM blood pressure levels were higher in the third tertile then those in the first. At univariate analysis, PTH was directly associated with in-office systolic (Pearson's correlation coefficient r = 0.417; P < 0.001) and diastolic (r = 0.372; P = 0.003), 24-hours systolic (r = 0.449; P < 0.001) and diastolic (r = 0.401; P = 0.001), daytime systolic (r = 0.421; P < 0.003) and diastolic (r = 0.378; P = 0.002), and nighttime systolic (r = 0.379; P = 0.002) and diastolic (r = 0.442; P < 0.001) blood pressure. Multivariate analysis showed that PTH was associated with systolic and diastolic in-office and 24-hours blood pressure levels independently of age, body mass index, gestational week of delivery, plasma and urinary calcium, vitamin D, renal function, and urinary protein excretion. Conclusions: Plasma PTH is independently associated with blood pressure levels in the post-partum and higher blood pressure was observed in preeclamptic women with subclinical secondary hyperparathyroidism. Further evaluations on the effects of calcium and vitamin D supplementation on blood pressure control of women with a preeclamptic complication should be performed.

Labor Onset, Oxytocin Use, and Epidural Anesthesia for Vaginal Birth after Cesarean Section and Associated Effects on Maternal and Neonatal Outcomes in a Tertiary Hospital in China: A Retrospective Study.

Background:In the mainland of China, the trial of labor after cesarean section is still a relatively new technique. In this study, we aimed to investigate the effects of labor onset, oxytocin use, and epidural anesthesia on maternal and neonatal outcomes for vaginal birth after cesarean section (VBAC) in a tertiary hospital in China.Methods:This was a retrospective study carried out on 212 VBAC cases between January 2015 and June 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Relevant data were acquired on a form, including maternal age, gravidity and parity, body mass index before pregnancy, weight gain during pregnancy, type of labor onset, gestational age, the use of oxytocin and epidural anesthesia, birth mode, the duration of labor, and neonatal weight. The factors affecting maternal and neonatal outcomes for cases involving VBAC, especially with regards to postpartum hemorrhage (PPH) and fetal distress, were evaluated by univariate analysis and multivariable logistic regression.Results:Data showed that 36 women (17.0%) had postpartum hemorrhage (PPH) and 51 cases (24.1%) featured fetal distress. Normal delivery took place for 163 infants (76.9%) while 49 infants (23.1%) underwent operative vaginal deliveries with forceps. There were 178 cases (84.0%) of spontaneous labor and 34 cases (16.0%) required induction. Oxytocin was used in 54 cases (25.5%) to strengthen uterine contraction, and 65 cases (30.7%) received epidural anesthesia. The rate of normal delivery in cases involving PPH was significantly lower than those without PPH (61.1% vs. 80.1%; χ2 = 6.07, P = 0.01). Multivariate logistic analysis showed that the intrapartum administration of oxytocin (odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.07–5.74; P = 0.04) and birth mode (OR = 0.40; 95% CI = 0.18–0.87; P = 0.02) was significantly associated with PPH in VBAC cases. Operative vaginal delivery occurred more frequently in the group with fetal distress than the group without (49.0% vs. 14.9%, χ2 = 25.36, P = 0.00). Multivariate logistic analysis also revealed that the duration of total labor (OR = 1.01; 95% CI = 1.00–1.03; P = 0.04) and the gestational week of delivery (OR = 1.08; 95% CI = 1.05–1.11; P = 0.00) were significantly associated with fetal distress in VBAC.Conclusions:The administration of oxytocin during labor and birth was identified as a protective factor for PPH in VBAC while birth mode was identified as a risk factor. Finally, the duration of total labor and the gestational week of delivery were identified as risk factors for fetal distress in cases of VBAC. This information might help obstetricians provide appropriate interventions during labor and birth for VBAC.

THE ROLE OF BIOCHEMICAL MARKERS OF FIRST TRIMESTER TRISOMY SCREENING TEST IN THE PREDICTION OF GESTATIONAL DIABETES MELLITUS

Objective: To investigate the potential advantage of routinely examined biochemical markers; PAPP-A (pregnancy related plasma protein A) and ßHCG values, in the first trimester screening test for the screening and early diagnosis of gestational diabetes mellitus (GDM) disease that occured in the following weeks of pregnancy without bringing any additional cost.Material and Method: This study was designed as a retrospective cohort study. In this study singleton pregnancies were included whose first trimester trisomy screening tests were examined in our hospital and also deliviries of them took place in our hospital with the routine pregnancy follow up between January 2014 – December 2016. The pregnancies were divided into two groups as GDM and control group. The functional role of biochemical markers ( PAPP-A (MoM), ßhcg (MoM)) in the first trimester screening test were investigated for early diagnosis of GDM which appeared in the later gestational weeks of pregnancy. Results: In the GDM group; maternal age, the number of pregnancies, parity, abort and living children were found significantly high, according to the control group (p&amp;lt;0.05). Statistically significant difference was not observed between PAPP-A (MoM), ßhcg (MoM), NT (mm) ve NT (MoM), gestational week of delivery, birth infant weight, APGAR 1.minute and APGAR 5.minute in the GDM group.Conclusion: No statistically significant relationship was established between biochemical markers of first trimester screening test and GDM in this study. However, more patients and carefully planned prospective studies are needed in this subject.

Does Prior LEEP and Genital Mycoplasma Co-Infection Increase Preterm Birth Risk? [12C

INTRODUCTION: Excisional cervical procedures and genital infections are independent risks for preterm birth (PTB). We evaluated if LEEP history and cervical Mycoplasma/Ureaplasma (Myco/Urea) co-infection increases risk of PTB. METHODS: Retrospective cohort study (1/2005 to 6/2016) of patients delivered under 37 weeks. Patients were selected by Myco/Urea admission cervical culture results. Medical record abstractions: demographics, cervical procedures history, pregnancy outcome. Exclusions: cerclage, knife cone, cryotherapy, multifetal gestations. CASES: LEEP history and positive Myco/Urea result, CONTROL GROUP A: LEEP history and negative Myco/Urea result, CONTROL GROUP B: without LEEP history and positive Myco/Urea result. Primary outcome: delivery gestational weeks (GW). Data analyzed by Fisher's exact, chi-square and Wilcoxon rank-sum tests. A linear regression model for comparison of CASES vs CONTROLS was adjusted for potential confounders. A p-value less than 0.05 (two-tailed) was significant. RESULTS: We identified 1755 patients with Myco/Urea results: 37 CASES, 17 GROUP A , 47 GROUP B. Delivery GW: Cases 32±3.8, Control A 30.6 ±4.4, Control B 31.6±3.3 (p more than 0.05 Cases vs Controls). No significant difference in percentage of PPROM, smoking, antibiotic use between Cases vs Controls (p more than 0.05). A history of PTB was greater in Cases (32%) vs Control A (18%, p=0.34) or Control B (13%, p= 0.04). However, cases delivered earlier than controls. Antibiotic use was not different in CASES (51%) vs CONTROL B (48%); p=0.95. CONCLUSION: LEEP history and co-infection with genital Myco/Urea is not associated with increased risk for PTB compared to patients with LEEP history alone or Myco/Urea infection alone.

Neonatal outcomes following preterm birth classified according to placental features

Preterm birth has staggering health implications, and yet the causes of most cases are still unknown. Placental features have been understudied as an etiology for preterm birth, and the association between placental pathologic lesions and neonatal outcomes are incompletely understood. We sought to characterize births according to placental pathology and relate these to adverse neonatal outcomes. We studied 20,091 births (15,710 term and 4381 preterm) with placental evaluations. Births were classified according to the presence or absence of placental lesions consistent with malperfusion (vasculopathy, infarct, advanced villous maturation, perivillous fibrin, fibrin deposition) and intrauterine inflammation/infection (chorioamnionitis, funisitis, vasculitis). Outcomes were gestational week of delivery, birthweight z-score, neonatal respiratory distress syndrome, and intraventricular hemorrhage. Among all preterm births, evidence of placental malperfusion was identified more often than inflammation/infection (50.6% vs 27.3%, P< .0001). Placental malperfusion was associated with reduced fetal growth (adjusted birthweight z-score, -0.83, P < .0001) and lesions of inflammation/infection were associated with earlier delivery (adjusted difference -2.08 weeks, P < .0001) than those with no lesions. When both placental lesions were present, earlier delivery (adjusted difference -2.28 weeks, P < .0001) and reduced fetal growth (adjusted birthweight z-score difference, -0.24, P= .001) were observed more often than when neither lesion was present. Findings were similar when restricted to cases of spontaneous preterm birth. Intraventricular hemorrhage was higher in preterm births with malperfusion lesions than cases with no lesions (7.6% vs 3.4%; odds ratio, 1.98; confidence interval, 1.18-3.32), accounting for gestational age and other covariates. Placental pathology provides important insight into subtypes of preterm birth with adverse neonatal outcomes. Co-occurrence of malperfusion and inflammation/infection, especially among spontaneous preterm births, may be a novel pattern of placental injury linked to severe adverse outcomes.

First trimester ultrasonographic parameters in prediction of the course and outcome of monochorionic twin pregnancies.

The aim of the study was to evaluate the association and the potential predictive value of first trimester ultrasonographic parameters on the course and outcome of monochorionic diamniotic twin pregnancies. A prospective cohort study was undertaken of 39 healthy women with consecutive monochorionic diamniotic twin pregnancies. During first-trimester screening, crown-rump length (CRL) and nuchal translucency (NT) were measured. The intertwin discordance in CRL and NT was determined. As pregnancy outcomes we assessed twins' live-born rates, Apgar scores, birth weight, pregnancy complications, and gestational week of delivery. None of the assessed pregnancy outcomes significantly correlated with standard CRL discordance ≥10%. The newly established cut-off was 3.75 mm for CRL and 1.3 mm for NT. Monochorionic diamniotic twins were delivered in a later gestational week and had better chance of survival if CRL intertwin difference was <3.75 mm. Apgar scores significantly negatively correlated only with NT of corresponding twins. When intertwin NT difference was ≥1.3 mm, twins had lower birth weight and pregnancy complications were more frequent. Regression models show that intertwin CRL difference <3.75 mm is a significant predictor of live-born monochorionic diamniotic twins. CRL and NT in monochorionic diamniotic twin pregnancies could indicate pregnancy complications and outcomes.

Progesterone and nifedipine for maintenance tocolysis after arrested preterm labor: A systematic review and meta-analysis of randomized controlled trial

ObjectiveNo treatment is recommended for routine maintenance tocolysis after an arrested preterm birth. Our present study aimed to evaluate the effect of progesterone and nifedipine as maintenance tocolysis therapy after an arrested preterm birth. Materials and MethodsFor relevant studies, we systematically searched the literature in databases of PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library. Only randomized controlled trials were included. ResultsNine trials were included in our review. Nifedipine and progesterone were used for maintenance tocolysis. Compared to placebo treatment or no treatment, maintenance tocolysis with progesterone could significantly prolong the delivery gestational weeks [standard mean difference (SMD) 1.64; 95% confidence interval (CI), 1.21, 2.07; p < 0.00001], reduce the proportion of patients with delivery before 37 weeks (risk ratio 0.63; 95% CI, 0.47, 0.83; p = 0.001), and increase the birth weight (SMD 317.71; 95% CI, 174.89, 460.53; p < 0.0001). However, no such benefits were observed after maintenance tocolysis with nifedipine. Both nifedipine and progesterone had no significant influences on the following outcomes: neonatal intensive care unit stay, proportion of neonatal intensive care unit admission, neonatal mortality, and incidence of respiratory distress syndrome. ConclusionOur results with maintenance tocolysis with progesterone may be useful for patients who had an episode of threatened preterm labor successfully treated with acute tocolytic therapy.

The Correlation Between Breastfeeding Success in the Early Postpartum Period and the Perception of Self-Efficacy in Breastfeeding and Breast Problems in the Late Postpartum.

The research was conducted to determine the correlation between breastfeeding success in the early postpartum period and the perception of self-efficacy in breastfeeding and breast problems in late postpartum. This analytic and cross-sectional research was carried out at Aydın Obstetrics and Gynecology and Children's Diseases Hospital. Three hundred twenty-seven primipara mothers who had delivered a single baby of healthy term at 37 or more gestational weeks with no previous experience with breastfeeding and who agreed to cooperate participated in the research. The mothers' mean gestational week of delivery was 39.25 ± 1.10 weeks, and it was found that 56.0% had delivered by cesarean section and 57.0% had started to breastfeed immediately after the birth. The mothers' LATCH mean score was 6.55 ± 0.86; their postnatal breastfeeding self-efficacy mean score was found to be 59.10 ± 7.21. Mothers who had high success in breastfeeding at early postpartum were found to experience fewer problems with their breasts (Z = -2.65, p < 0.05), gave birth by vaginal delivery (Z = -2.88, p < 0.05), and had not received anesthesia during the delivery (Z = -2.52, p < 0.05). In the correlation analysis, it was seen that mothers with high success in breastfeeding also had high self-efficacy scores (r = 0.210, p = 0.003). The results of the research indicated that breastfeeding success in the early postpartum period reduced breast problems and increased the perception of breastfeeding self-efficacy in the late postpartum period.

Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus.

Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients' ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hour OGTT plasma glucose levels). Fasting and 1-hour plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies.

Expression of interleukin-37 in placenta and its relationship with the pathogenesis of severe preeclampsia

To investigate the expression of interleukin-37 (IL-37) in placenta tissue and its relationship with the pathogenesis of severe preeclampsia. All the patients were recruited in Qilu Hospital of Shangdong University from November 2012 to November 2013. Among them, thirty patients with severe preeclampsia were assigned to the preeclampsia group, and thirty-one healthy pregnant women were assigned to the control group. Immunohistochemistry of SP was used to detect the IL-37 protein expression in placenta tissue of the two groups. The expression level of IL-37 in placenta tissue of the two groups was detected by western blot. Besides, reverse transcription (RT)-PCR was used to detect the expression of IL-37 mRNA. The correlation between the expression of IL-37 mRNA and the delivery gestational age, body mass index (BMI) was analyzed. (1) IL-37 were detected in the placenta of both the preeclampsia group and the control group, and the expression site mainly located in the syncytiotrophoblast, with a small amount in cytotrophoblast. (2) The expression levels of IL-37 protein in the preeclampsia group and the control group were 0.59 ± 0.39 and 0.88 ± 0.22, respectively. The IL-37 mRNA levels in the preeclampsia group and the control group were 0.55 ± 0.17 and 1.11 ± 0.21, respectively. Both decreased significantly when compared to the control group (P < 0.05). (3) Significant correlation between the expression of IL-37 mRNA and the delivery gestational weeks (r = 0.209, P > 0.05) was seen neither in the preeclampsia group nor in the control group (r = -0.053, P > 0.05). In the severe preeclampsia group, the pregnant women's BMI had no significant correlation with IL-37 mRNA expression of placenta tissue (r = 0.102, P > 0.05), neither did the control group(r = -0.115, P > 0.05). IL-37 expression is significantly lower in severe preeclampsia placenta tissue than that in the normal pregnant women, which may play a protective role in the course of severe preeclampsia.

The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage

The transcatheter pelvic arterial embolization (TAE) is effective for postpartum hemorrhage (PPH). There has been a little information about the factors for ineffectiveness of TAE. The aim of this study was to determine factors associated with TAE failure for PPH. Fifty-five women who underwent TAE for intractable PPH were included. Clinical factors involving age, history of pregnancy, gestational weeks of delivery, mode of delivery, causes of PPH, complete blood count, blood loss volume, transfusion amount, shock index and disseminated intravascular coagulation (DIC) score were compared between TAE success group (n=48) and TAE failure group (n=7). The uni- and multi-variate analyses revealed that advanced maternal age (OR 1.46, 95% CI 1.12-2.18) and retained placenta as a cause of PPH (15.48, 2.04-198.12) were found to be significant factors for TAE failure. The advanced age and retained placenta were independent factors associated with TAE failure for intractable PPH.

Analysis of clinical features of pregnant women with hypertrophic cardiomyopathy

To discuss the clinical features of pregnant women with hypertrophic cardiomyopathy (HCM). There were 28 patients with HCM who delivered in Renji hospital of Shanghai Jiaotong University from January 2000 to August 2012. Clinical data were analyzed, including diagnosis, cardiac functional grading, gestational weeks of delivery, delivery mode, birth weight, Apgar scores, etc. (1) Of all the 28 patients, 14 (50%) were diagnosed before pregnancy and others (50%) were diagnosed during pregnancy.(2) Four cases were obstructive HCM (14%), 3 with cardiac function grade I and 1 with grade II. Twenty four cases were non-obstructive HCM (86%), 14 with cardiac function grade I, 9 with grade II and 1 with grade IV. (3) Of all the 28 patients, 4 had family history, 18 (64%) had clinical symptoms or signs which occurred in 8-32 gestational weeks. Twenty-three cases had abnormal ECG (82%). Among them 21 had non-obstructive HCM (88%), with average interventricular septal thickness of (22 ± 3) mm. The other 2 patients had obstructive HCM, with average interventricular septal thickness of (23 ± 4) mm.7 patients (7/28, 25%) had mild-to-moderate pulmonary hypertension [6 with non-obstructive HCM (6/24, 25%) ], and 10 patients had abnormal myocardial enzyme spectrum or troponin levels [9 with non-obstructive HCM (9/24, 38%) ].(4) Among all the patients, only one had vaginal delivery and others received cesarean section. Twenty-two patients had term pregnancies and 6 had preterm birth. The average gestational weeks of delivery in non-obstructive HCM and obstructive HCM were (36.5 ± 2.5) and (38.5 ± 0.4) weeks, respectively. The average birth weight of neonates were (2684 ± 563) and (3164 ± 321) g, and Apgar scores were 9.9 and 10 (10 minutes) respectively. Patients transferred to NICU after delivery were 8 and 0. There was 1 maternal death (with non-obstructive HCM whose ejection fraction was only 26%) and no perinatal death. More attention should be paid to the clinical signs and abnormal ECG.HCM could be definitely diagnosed by timely echocardiography. Patients with hypertrophic cardiomyopathy were mainly non-obstructive HCM, with cardiac function grade I and II. Monitoring the change of ejection fraction during pregnancy would help. Perinatal outcomes were fine.

Striae gravidarum as a predictor of spontaneous preterm delivery: A case control study

Background/Aims: The association between striae gravidarum (SG) and preterm delivery may be postulated because of sharing similar poor organization of extracellular matrix in both skin and cervix. Our goal was to compare the frequency of striae gravidarum in women who gave preterm birth and women who gave term birth. Methods: A case-control study was conducted in women who gave preterm birth (n = 66) and age matched women who gave term birth (n = 68). Cases and controls were recruited from puerperal women consequently seen at delivery wards of perinatology unit. All women underwent dermatologic examination in terms of SG blindly to theirs gestational weeks of delivery. The frequency of SG was compared in all groups. Results: The frequency of SG was 63.6% in women with preterm birth and 54.4% in women with term birth (p = 0.278). SG is five times more common in late preterm group than in women with term group, but this difference was not statistically significant [(p = 0.227, OR: 5.02, CI 95% (0.5 - 44.0)]. The rate of preventive cream usage was not statistically different in women with SG and without SG (p = 0.245). Conclusions: It seems that there was no statistically significant association between the risk of preterm labor and the presence of striae gravidarum. Larger prospective observational studies are needed to state expressly the probable clinical association between the presence of SG and preterm delivery.