Department Of Perinatology Research Articles

Implementation Early of Initiation Breastfeeding (EIB) by Health Workers in the Maternity Room of 'Aisyiyah Ponorogo General Hospital During Covid-19 Pandemic

Background: Early of initiation breastfeeding (EIB) can reduce the Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR). The COVID-19 pandemic reduced early initiation of breastfeeding activities. As a result of the COVID-19 pandemic, access to essential services such as breastfeeding counseling in hospitals has been disrupted. Purpose: The purpose of this study is that researchers want to examine the implementation of the EIB by health workers in the maternity room of "Aisyiyah Ponorogo" General Hospital during the COVID-19 pandemic. Methods: The research used was qualitative with a case study design. The social situation in this study was delivery support health workers in the Maternity Room and Perinatology Room with informants consisting of five implementing midwives and six implementing nurses. The data collection process was carried out until the data collected experienced data saturation. Data validity was tested using source triangulation, namely patients who gave birth at "Aisyiyah Ponorogo" General Hospital. Results: EIB at 'Aisyiyah Ponorogo General Hospital has always been applied to newborns since 2010 and underwent adjustments during COVID-19 pandemic. The EIB was not implemented due to several conditions which made it impossible. Supporting factors for the implementation of early initiation of breastfeeding are the number and ability of health workers and the facilities available from both the hospital and the patient's family. The obstacle in this study is the perinatology room which is located far away so that the nurses in the perinatology department have difficulty carrying out several tasks at once which will cause a discrepancy in the duration of EIB implementation. Conclusion: Collaboration between the hospital, health workers, and the community is needed in an effort to increase the implementation of EIB. Starting from the existence of policies from the Hospital, the ability of health workers and the willingness of the community to improve the implementation of EIB.

"The Killer Placenta" - a threat to the lives of young women giving birth by cesarean section.

It is necessary to create a universal algorithm for the management of placenta accreta spectrum in order to minimize morbidity and mortality in young patients giving birth by caesarean section. This was a retrospective study of seven women before the age of 30 selected out of larger group of 40 pregnant patients. The patients were hospitalized in the Clinical Department of Perinatology, Gynecology and Obstetrics in Ruda Śląska, which is a 3rd level reference department. The inclusion criterion was the suspicion of placent accreta spectrum, based on clinical condition, ultrasound examination and magnetic resonance imaging. A patient with a diagnosed placenta accreta spectrum should be provided with a highly specialized 3rd level referential center by an experienced multidisciplinary team of specialists. There should be free access to the blood bank, adult intensive care unit and neonatal intensive care unit. According to the results of this study, the recommended time of cesarean section is 34 + 0 - 36 + 6 weeks of pregnancy. Hysterectomy after the cesarean section is a method of choice for a placenta increta or percreta. It is the most difficult surgery in obstetrics, with a high risk of intraoperative complications. Damage to the urinary system is the most common complication of perinatal hysterectomy. Preoperative placement of ureteral catheters reduces the risk of intraoperative damage. It is necessary to plan individual procedure for women who has low-lying or previa placenta, and who has history of prior cesarean section - in this group the risk of placenta accreta spectrum is higher.

The relevance of Short-Term Variation (STV) value measured within 1 hour before delivery in predicting adverse neonatal outcome.

Computer CTG analysis (cCTG) included short-term variation (STV) is one of the methods of monitoring fetal condition during delivery. The aim of our study was to define appropriability of STV measured within 1 hour before delivery in prediction of neonatal outcomes. The retrospective study included 1014 pregnant women, who gave birth in the Department of Obstetrics and Perinatology. Participants were divided into two groups: group 1 - term pregnancies (37-41 weeks) and group 2 - preterm pregnancies (lower than 37 weeks). In each of them, two subgroups have been separated: control (STV ≥ 3 ms) and study group (STV < 3 ms). In both groups 1 and 2, there were no statistically significant differences related to Apgar scores in 1st, 3rd and 5th minute between group with STV < 3 ms and group with STV > 3 ms Moreover, for 37-41 weeks the sensitivity, specificity, positive predictive value and negative predictive value were: 22.7%, 83.9%, 3.3% and 97.8% and for lower than 37: 45.7%, 65.4%, 47.1%, 64.2% in 1st minute after delivery. In group 1 the area under curve (AUC) measurements were 0.45 (95% CI: 0.32-0.58) for 1st minute and 0.55 (95% CI: 0.35-0.74) for 5th minute and in group 2: 0.58 (95% CI: 0.45-0.71) for 1st minute and 0.57 (95% CI: 0.42-0.72) for 5th minute. High specificity and negative predictive value of STV indicates a good Apgar score of newborns in term pregnancies. Analysis of STV in preterm pregnancy is not clear. Fetal well-being in preterm pregnancy should include STV and other non-invasive and invasive tools.

How COVID-19 pandemic is changing the practice of prenatal screening and diagnosis?

To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.

The influence of smoking on the frequency and characteristics of complications following large loop excision of the transformation zone (LLETZ)

Purpose: Large loop excision of the transformation zone (LLETZ) is the procedure of choice for treating patients with suspected or confirmed cervical intraepithelial lesions. Since it has been established that smoking impairs wound healing, we wanted to determine if smoking increases the incidence of themost common complications that follow the LLETZ procedure and how it affects their intensity and duration.&#x0D; Methods: We included 434 patients that underwent the LLETZ procedure between 1993 and 2015 in the Department of Gynecology and Perinatology, University Medical Centre Maribor. Patients were asked to assess the intensity and duration of abdominal pain, vaginal bleeding and vaginal discharge after the procedure, and to complete a questionnaire on a daily basis. Data obtained from the questionnaires were then analysed.&#x0D; Results: The study group consisted of 237 (54.6%) smokers and 197 (45.4%) non-smokers. After the LLETZ procedure, 237 (54.6%) patients noted the occurrence of vaginal discharge, 193 (44.5%) lower abdominal pain, and 181 (41.7%) vaginal bleeding. No significant difference was observed in terms of the incidence of the observed events when comparing smokers and non-smokers. The duration and intensity of vaginal discharge and pain were not significantly different between the two groups. Non-smokers experienced bleeding that was more severe than smokers.&#x0D; Conclusions: According to the results of our study, smoking did not increase the incidence of vaginal bleeding, vaginal discharge, and lower abdominal pain following the LLETZ procedure, nor did it crucially influence their duration and intensity.

Neonatal mortality in the Maribor region (1997–2008)

Purpose: To provide a summary of neonatal mortality data for a group of 24,044 live births in the Maribor Department of Perinatology between 1997 and 2008.&#x0D; Methods: The National Perinatal Informational System (NPIS) cohort files for 1997–2008 were used for this study. Data are presented using cohorts based on dates of birth and death. The University Clinical Center serves the population of northeastern Slovenia, with 24,044 live births in this 12-year period. Yearly cohorts of neonatal deaths were analyzed by gestational age (GA) distribution, birth weight (BW) distribution, age at death, and cause of death.&#x0D; Results: The average neonatal mortality rate in the 12-year investigated group was 2.2 per 1000 live births with a GA of 28-42 weeks and 4.7 per 1000 live births with a GA of 22-42 weeks. The smallest group, with an extremely low birth weight (ELBW; &lt;1000 g), accounted for approximately 50% of all neonatal deaths, newborns weighing 1000-1500 g accounted for approximately 20% of all neonatal deaths, the group with a BW of 1500-2500 g accounted for 10% of neonatal deaths, and newborns weighing &gt;2500 g accounted for approximately 20% of all neonatal deaths. The largest percentage of neonatal deaths was deaths due to immaturity, and represented 54% of all reported deaths during the investigated period.&#x0D; Conclusion: Oscillations in neonatal mortality rates during the 12 years first occurred in 1997-2005 in direct connection with the number of extremely premature newborns. In the last 4 years of the 12 years we observed a new and better quality indicator, i.e., a lower neonatal mortality rate in spite of the increased preterm delivery rate. Analysis of quality indicators in perinatology should be part of routine clinical care.

Time trends in cerebral palsy incidence in correlation with development of perinatal and neonatal care in Maribor (1988–2003)

Purpose: To investigate time trends in cerebral palsy (CP) incidence in correlation with development of perinatal and neonatal intensive care in Maribor, Slovenia.&#x0D; Methods: A population–based study covering the 52.450 live births (1988– 2003) at the Department of Perinatology, University Clinical Center, Maribor and residents in one of the five communities of the Maribor region on January 1, 2006. Multiple sources were used. Neuropediatrician and other professional medical records were evaluated for all children at the rehabilitation units. The prevalence of CP was analyzed in yearly cohorts according to birth weight, gestational age, type of CP, and degree of disability.&#x0D; Results: Calculated crude mean prevalence of CP for this population group was 3.7/1000 infant survivors, 2.7/1000 for preterm CP, and 1/1000 for term CP, and 44% were Gross Motor Function Classification System levels I and II. Spastic diplegia was the most prevalent subtype of CP. The increase in CP rates in 1999, 2000 and 2001 could be explained by improved survival of preterm infants at 28–32 weeks gestation. The neonatal mortality rate has declined in Maribor significantly from 6.6/1000 live births in 1997 to 3.1/1000 in 2001 and 1.8/1000 in 2009.&#x0D; Conclusion: Progressive changes in perinatal and neonatal intensive care in Maribor since 1994 have led to a fall in the early neonatal mortality rate, and this increase in survival of preterm infants has increased CP morbidity rate.

Development of Communication Skills Among Residents of the Department of Obstetrics, Gynecology and Perinatology

The aim of the study is to assess the effectiveness of the development of communicative competence among residents of the Department of Obstetrics, Gynecology and Perinatology using a series of psychological trainings. According to the results of post-tests, there was an increase in reflexivity in 50% of respondents, as well as a change in the level of empathy. There was a transition from the subject-object relationship with the patient to the subject-subject relationship, which made it possible to hold patients more accountable for their own health and the health of their future children. The developed training will be used in the work with young specialists.

Comparison of Pregnancy Outcomes of Women with and Without Hypertension at the Latent Phase of Labor Who Were Under Medical Care for Preeclampsia

OBJECTIVE: We explored the association between hypertension (&gt;140/90) at the latent phase of labor (resistant hypertension) and the subsequent development of major maternal complications or adverse infant outcomes in women with preeclampsia under medical care. STUDY DESIGN: We drew data from 824 women who were under follow-up at the Department of Perinatology of Health Sciences University Zeynep Kamil Women and Children’s Health Training and Research Hospital with a diagnosis of preeclampsia. Women with and without resistant hypertension were compared in terms of major maternal complications and adverse infant outcomes. RESULTS: Mean age and body mass index were similar between the two groups (p&gt;0.05). The rate of preeclamptic complaints was significantly higher in groups with resistant hypertension (90.1% vs. 67.2%, p&lt;0.05). Proteinuria was more frequent in the resistant hypertension group (78.7% vs. 66.8%, p&lt;0.001). The newborn intensive care unit admission rate was significantly higher in the group with resistant hypertension (65.6% vs. 45.9%, p&lt;0.001). Gestational age at delivery was significantly lower in the group with resistant hypertension compared to the normotensive group (34.6 vs. 32.9 weeks, p&lt;0.001). There was a significant difference between the two groups in terms of the rate of preterm delivery (78.5% vs. 66.7%, p=0.04). CONCLUSION: Resistant hypertension is associated with a higher rate of preeclamptic symptoms during labor and newborn intensive care unit admission.

Maternal serum calprotectin level in intrahepatic cholestasis of pregnancy.

This study aimed to investigate maternal serum levels of calprotectin in patients with intrahepatic cholestasis of pregnancy (ICP) and to compare these with serum calprotectin levels in healthy pregnant women. Ninety pregnant women (ICP group, n=45; healthy control group, n=45) were included in the study. The gestational age and body mass index of the participants in the two groups were similar. This prospective cross-sectional study was conducted between November 2019 and May 2020 in the perinatology department of University of Health Sciences Doctor Zekai Tahir Burak Women's Education Hospital, Ankara, Turkey. Patients were recruited from those attending the perinatology outpatient and inpatient clinics. Biochemical (alanine aminotransferase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), total bilirubin), fasting bile acid, hemogram, and calprotectin parameters of maternal blood were evaluated. The mean fasting bile acid value in the ICP group was 30.3 ± 27.3μmol, with severe ICP present in 11 (24.4%) patients. ALT, AST, LDH, total bilirubin, and mean platelet volume (MPV) values in the ICP group were higher and the red cell distribution width (RDW) value was lower than those in the control group (p < 0.001). The mean serum calprotectin levels in the control group and ICP group were 48.0 ± 10.4 and 765.4 ± 126.8μg, respectively (p < 0.001). There was no significant correlation between serum fasting bile acid levels and serum calprotectin levels in the ICP group (p > 0.005). Serum levels of calprotectin in patients with ICP were higher than those in healthy pregnant women. The serum calprotectin level may be an important diagnostic marker of ICP.

Comparison of one hour versus 90 minute postprandial glucose measurement in women with gestational diabetes; which one is more effective?

In the present study, we aimed to compare postprandial 90 minute measurements and postprandial 1 hour (PP1-HR) measurements for prediction of foetal growth disturbances and pregnancy complications. This was a prospective study conducted in Acıbadem Mehmet Ali Aydınlar University Altunizade Hospital in Department of Perinatology. The study group consisted of patients diagnosed with gestational diabetes. In each antepartum visit, the patients fasting plasma glucose as well as PP1-HR and 90 minute measurements were made. Perinatal and neonatal data were obtained from each patient. The rate of large for gestational age infants was increased in patients when either PP1-HR measurement above 140 mg/dl or postprandial 90 minute measurement above 165 mg/dl compared to patients with normal PP1-HR or postprandial 90 minute measurement. Preterm delivery rate was increased in patients with postprandial 90 minute measurement above 165 mg/dl but not in patients with PP1-HR measurement above 140 mg/dl. The optimal cut-off for postprandial 90 minute measurement was 165 mg/dl based on receiver operating characteristics curve. Our preliminary data show that postprandial 90 minute measurements are superior to PP1-HR measurements in predicting large for gestational age infants. Impact Statement What is already known on this subject? Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset or first recognition in pregnancy. Maternal hyperglycaemia has been linked to metabolic alterations in the foetus and thus brings about foetal macrosomia as well as other pregnancy complications such as preterm delivery and preeclampsia. What the results of this study add? The findings of the present study suggest that postprandial 90 minute predicted more cases of LGA infants than postprandial 1-hour (PP1-HR) measurements. In addition, the rate of preterm deliveries was found to be increased in patients with mean postprandial 90 minute measurements above 165 mg/dl compared to patients with postprandial 90 minute measurements below 165 mg/dl. However, the rate of preterm deliveries was similar in patients with elevated PP1-HR measurements and patients with normal PP1-HR measurements. What the implications are of these findings for clinical practice and/or further research? Our study is the first to investigate the usefulness of postprandial 90 minute in a prospective design. Our preliminary data show that postprandial 90 minute measurements are superior to PP 1 measurements in predicting LGA babies. It also correlates better with preterm deliveries.

Evaluation of the diagnostic possibility of hemorrhagic risk in pregnant women with severe preeclampsia by rotational thromboelastography

AIM: The aim of this study was to determine the risk of hemorrhagic complications in pregnant women with severe preeclampsia using rotational thromboelastometry (ROTEM) in two screening tests EXTEM and INTEM.&#x0D; MATERIALS AND METHODS: We examined 30 pregnant women with severe preeclampsia, who were observed in the intensive care unit, the Department of Obstetrics and Perinatology, the Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott, Saint Petersburg. The control group consisted of 10 patients with normal pregnancy, delivered by caesarean section for reasons not related to obstetric complications.&#x0D; RESULTS: When interpreting the ROTEM results, the reference intervals for pregnant women in the third trimester were used, as determined in the study by J. Lee et al. (2019). According to the analysis of thromboelastograms of pregnant women with severe preeclampsia, 9 (30%) of them had a tendency towards hypocoagulation. Of these, 3 thromboelastograms had deviations via the intrinsic coagulation pathway (in the INTEM tests), 3 thromboelastograms via the extrinsic coagulation pathway (in the EXTEM tests), and the rest combined both options. Two patients with severe preeclampsia developed a complication in the form of HELLP syndrome, and the phenomena of hypocoagulation, according to the results of ROTEM performed before delivery, were observed in only one patient. A comparative analysis of ROTEM parameters among pregnant women with severe preeclampsia and normal pregnancy did not reveal statistically significant differences.&#x0D; CONCLUSIONS: The use of the ROTEM method with the main screening tests (EXTEM and INTEM) did not show diagnostic value in assessing the risk of hemorrhagic complications of severe preeclampsia.

The association between imbalances in vaginal microflora and duration of pregnancy as well as selected maternal and neonatal parameters.

Abnormal vaginal flora (AVF) is a result of excessive growth of some aerobic bacteria and fungi in relation to the scarce presence of Lactobacillus spp. It has been suggested that AVF is responsible for preterm birth and such neonatal conditions as infections or sepsis. The aim of the study was to assess the influence of excessive vaginal colonization with aerobic bacteria and fungi on the selected postnatal parameters of newborns, duration of pregnancy and length of hospitalisation of neonates. Retrospective data of all 1057 patients who delivered between 01.2019 and 06.2019 in the Department of Perinatology of Medical University of Lodz was analyzed. Eight hundred nine patients were included in this retrospective study. The study group consisted of 396 patients with abundant growth of aerobic bacteria and fungi obtained between 26 and 42 weeks of gestation, while 413 patients with physiologic vaginal biocenosis constituted the control group. Two hundred forty-eight patients (23.46%) were excluded from the study due to incomplete data. Patients with abnormal vaginal flora (AVF) gave birth prematurely (9.09%) more often than patients with balanced microflora (5.31%), p = 0.038. Newborns of mothers with AVF obtained an Apgar score under four more frequently (1.21% vs 0%; p = 0.024). Eutrophic neonates were born less frequently in the study group (82.08% vs 88.65%; p = 0.025). Hospitalisation period was longer for children of mothers with AVF (mean of 6.30 ± 9.87 days) than those of mothers from the control group (mean of 5.06 ± 5.30), p = 0.025. Newborns of mothers with AVF developed perinatal infections more often (23.97% vs 15.94%; p = 0.004). Four infants died in the study group whereas no deaths were recorded in the control group (p = 0.045). The most prevalent pathogens were: Streptococcus agalactiae (GBS) 57.32%, Candida spp. 39.64%, Klebsiella spp. 9.85%, Staphylococcus aureus 7.32%. Signs of infection were more frequently recorded in newborns of mothers infected with Klebsiella spp. (35.90% vs 19.16%; p = 0.011). Premature birth was more prevalent in GBS carriers (11.81% vs 6.28%; p = 0.022). Abundant growth of aerobic bacteria in the 3rd trimester of gestation contributes to preterm birth, causes the development of infection signs in newborns, increases their mortality rate and prolongs hospitalisation period.

Preterm delivery risk in infertile women who conceived after reproductive surgery: natural conception versus IVF/ICSI.

Is preterm delivery an infertility treatment-related adverse outcome in infertile women who conceived after reproductive surgery? Compared with matched fertile women, preterm delivery appears to be a modest infertility treatment-related adverse outcome in infertile women who have reproductive surgery then conceived naturally or after IVF/ICSI. Most observational studies have shown that women who receive any infertility treatment are more likely to deliver preterm than do fertile women. However, studies on the outcome of pregnancies in infertile women who conceive naturally after reproductive surgery are scarce. This was a single-centre historical two-part study: cohort and matched cohort study. Anonymized data of 761 infertile women who conceived after reproductive surgery and 758 fertile women were obtained by linking three computerized databases from 1 July 2012 to 31 December 2015. In the cohort study, we evaluated the association between the mode of conception and preterm delivery <37 and <32 gestational weeks in 703 infertile women, with a singleton pregnancy who conceived after reproductive surgery, using logistic regression adjusted for relevant co-variates to calculate the adjusted odds ratio with a 95% CI. In the matched cohort study, we evaluated preterm delivery as infertility treatment-related adverse outcome using the propensity score (PS) method. The matched cohort comprised 758 infertile women and 758 fertile women with a twin or singleton pregnancy. Infertile women conceived after reproductive surgery either naturally or through IVF/ICSI. Infertile and fertile women were matched using PS matching. Infertile and fertile women were matched for pre-defined risk factors for preterm delivery. Three infertile women out of an original 761 were not included in the analysis because they lacked all required matching variables. We performed a 1:1 matching with an optimal matching algorithm with a caliper width of the linear predictor of 0.1 standard deviations. The effect of reproductive surgery on preterm delivery was evaluated in the PS-matched sample using Pearson's χ2 test and presented as the odds ratio (OR) with 95% CI. All women delivered at the Department of Perinatology, University Medical Centre Ljubljana, Slovenia. Among 761 infertile women who conceived after reproductive surgery, 428 (56.2%) women conceived naturally and 333 (43.8%) conceived after IVF/ICSI. The incidence of twin pregnancies was significantly lower after natural conception (2.6% vs 14.1%). Among the 703 infertile women with a singleton pregnancy, 417 (59.3%) conceived naturally and 286 (40.7%) conceived after IVF/ICSI. Adjusted for maternal age and parity in infertile women with singleton pregnancies, IVF/ICSI showed a moderate association with preterm delivery <32 weeks. Compared with natural conception after reproductive surgery, the odds for preterm delivery after IVF/ICSI was 1.07 (95% CI 0.63-1.81) <37 weeks and 2.25 (95% CI 0.80-6.34) <32 weeks. Preterm delivery appears to be a modest infertility treatment-related adverse outcome. Compared with fertile women in the PS-matched sample, infertile women who conceived after reproductive surgery either naturally or after IVF/ICSI the odds of preterm delivery <37 weeks were 1.31 (95% CI 0.97-1.78) and odds of preterm delivery <32 weeks were 1.57 (95% CI 0.78-3.18). However, none of the estimations were statistically significant. The main limitations of the study were the retrospective design, the heterogeneity of the types of reproductive surgery performed and underlying reproductive pathologies. The low number of preterm deliveries in the present study might influence the precision of estimations. The present study aims to alter the prevailing opinion that reproductive surgery should only be considered preceding IVF to increase implantation and pregnancy rates after IVF. It implies that in selected infertile women who have had reproductive surgery, a high rate of natural conception, a low rate of multiple pregnancies, and a modest infertility treatment-related effect on preterm delivery should be the reasons to encourage natural conception after reproductive surgery. Furthermore, by allowing for natural conception, we can avoid a high-cost invasive medical procedure. The study received no funding. We have no competing interest to declare. N/A.

Evaluation of Actual Maternal Serum Alpha-Fetoprotein (MSAFP) Levels in Placental Abruption and Associations with Adverse Outcomes

To evaluate the relationship between the actual maternal serum alpha-fetoprotein (MSAFP) levels and maternal, fetal, and neonatal outcomes in patients diagnosed with placental abruption. This prospective case-control study included 40 patients who presented at the Perinatology Department between December 15, 2018, and September 01, 2019, were diagnosed with placental abruption and underwent cesarean section delivery at ≥ 34 weeks, and 41 healthy individuals without any additional systemic pathologies, who had a cesarean section under elective conditions. The patient demographic data, MSAFP levels, and maternal, fetal, and neonatal results were compared. Correlation analyses were applied between the MSAFP levels and demographic characteristics, birthweight, Apgar scores, and transfusion requirement in the group with placental abruption. MSAFP levels (ng/ml) were significantly higher in the group with placental abruption than in the healthy control group (299.1 ± 214 and 156.2 ± 52.3, p = 0.012). In the neonatal results, birthweight and 1st and 5th minutes Apgar scores were lower in the group with placental abruption than in the control group (p = 0.025 and p < 0.001). The neonatal intensive care unit admission rate was higher in the group with placental abruption than in the healthy control group (p = 0.017 and p = 0.002). A statistically significant, negative correlation was found between MSAFP and 1st and 5th minutes Apgar scores (r = − 0.526, r = − 0.522 and p < 0.001, p = 0.001, respectively). The data obtained in this study suggest that MSAFP, which is a simple test, can be used in the clinical management of suspicious placental abruption or antepartum hemorrhage of unknown origin and the prediction of neonatal prognosis.

Pregnancy Loss After Amniocentesis and Chorionic Villus Sampling: Cohort Study.

IntroductionIntroduction: To estimate the procedure-related risks of pregnancy loss following chorionic villus sampling (CVS) and amniocentesis (AC) compared to pregnancies without procedure.MethodsThis cohort study enrolled all women who underwent CVS or AC at the Department of Perinatology, University Medical Centre, Ljubljana, Slovenia (from January 2013 to June 2015). For each group we obtained a maternal age and gestational age (11–14 weeks for CVS and >15 weeks for AC) for a matched control group without invasive procedures from the national database. The data was obtained from hospital records and telephone surveys concerning pregnancy outcomes. Pregnancy loss rates in intervention vs. control groups were compared by generating relative risk (RR) with a 95% confidence interval.ResultsDuring the study period, 828 women underwent CVS and 2,164 women underwent AC. Complete outcome data was available in 2,798 cases (93.5%, 770 CVS, 2,028 AC). Pregnancy loss occurred in 8/770 (1.04%, 95% CI 0.4–2.0%) after CVS vs. 15/1130 (1.33%, 95% CI 0.8–2.2%) in matched control (RR 0.8, 95% CI 0.33–1.8, p=0.6). It occurred in 16/2028 (0.79%, 95% CI 0.5–1.3%) after AC vs. 14/395 (3.29%, 95% CI 2.1–5.8%) in matched control (RR 0.2, 95% CI 0.11–0.45, p<0.0001).ConclusionThe pregnancy loss rates after CVS and AC were comparable to losses in pregnancies without these procedures. With the increasing use of non-invasive prenatal testing, information that the invasive procedures are safe when indicated is essential.

Magnetic resonance imaging of the fetal central nervous system: Timing and consistency between pre- and postnatal diagnoses.

It has been shown that a proper comparison of prenatal ultrasound and magnetic resonance imaging (MRI) is possible only in the case of a short interval between tests. However, it is worth noting that the reference test is a postnatal examination. The aim of our study was to evaluate the effect of time between prenatal MRI (pMRI) and postnatal examinations on the consistency of diagnoses. The prospective observational study was carried out between 2014 and 2017 at the Department of Obstetrics and Perinatology of Krakow University Hospital. In total, 60 patients with fetuses suspected of central nervous system (CNS) defects were included in the study group. PMRI examinations were conducted in the third trimester of pregnancy. The median gestational age of pMRI was 35 weeks and median of the time interval between carrying out pre- and postnatal test was 34.5 days. In the group of nonconcordant diagnoses, the interval was longer. The analysis did not show a statistically significant relationship between consistency of diagnoses and timing of pMRI. The median time of pregnancy at which pMRI was performed was similar in both groups. A prolongation of the interval between examinations reduced the probability of consistency of diagnoses. The number of inaccurate results increased with the prolongation of the interval between pre- and postnatal tests. Prolongation of the interval between pre- and postnatal increases number of inaccurate results.

The Role of Measuring Placental Volume for the Prediction of Preeclampsia and Intrauterine Growth Restriction (IUGR)*

Preeclampsia is today one of the most important causes of perinatal and maternal death around the world. Vascular growth and development during placental process and the implantation are essential for successful pregnancy and outcome. Intrauterine growth restriction (IUGR), affecting 3–7% of all newborns, is the failure of the fetus to reach its growth potential in utero accordance with gestational week. IUGR, which has a negative effect on perinatal mortality and morbidity, is also the weight of the fetus being lower than expected. The most common cause of intrauterine growth restriction (IUGR) in the developed world is placental insufficiency. In this context, the aim of this study is to predict preeclampsia and IUGR in the first trimester with placental volume measurement by using 3D ultrasonography imaging methods in women who were pregnant between 11 and 14 weeks with CRL measurement between 45-84 mm. Quantitative analysis method was used to test the hypothesis of the research and to investigate the relationship between variables. Statistical analysis was done using SPSS 21. 450 pregnant women, who enrolled in the patient information management system, were the sample of our study. These women applied for the first three months screening test in the Perinatology Department of Manisa Celal Bayar University Hafsa Sultan Hospital and the sample was studied with permission from the ethics committee The relation between placental volume and smoking, weight, gravida, maternal age, gestational age, fetal weight, IUGR, and preeclampsia were found insignificant. In addition, the relationship between the weight of the baby, the relationship between maternal weight, age, gravida and the weeks of pregnancy were also found significant. Preeclampsia appeared in 16 out of 448 cases. Of these 16 cases, 11 (78.6%) had a placental volume of 0-32mm3 and the placenta volume of 5 cases (1.2%) was more than 32mm3. Thus, the relation between placental volume and preeclampsia was statistically found significant (p= 0.000). IUGR was also occurred in 16 out of 448 cases. In 14 cases of these, placental volume was between 0-32 mm3 and placenta volume was more than 32 mm3 in 2 cases. The relation between placental volume and IUGR was also statistically found significant (p = 0.000). The relation between placental volume and preeclampsia and IUGR was statistically found significant (p = 0.000).

Management of newborns at increased risk for early-onset sepsis in perinatology department

Introduction Assessing newborn infants at risk for early-onset sepsis (EOS) is a common clinical task conducted by pediatricians. A change in the internal protocol for managing neonates at risk was implemented in 2016. Unlike the previous protocol, which determined laboratory testing in asymptomatic newborns in the presence of one risk factor (RF) for sepsis; the new protocol advocates the screening in the presence of at least two RF. The purpose of this study was to characterize newborns at increased risk for EOS before and after the implementation of a diagnostic/treatment protocol. Methods Retrospective analysis of asymptomatic newborns with RF to EOS who had laboratory testing performed at perinatology department in a central hospital in north of Portugal before and after the protocol was reviewed (2016), in the years 2015 and 2017, respectively. Patients were divided in two groups: preprotocol (2015) and postprotocol (2017), according to the date of admission. Results A total of 361 newborns were enrolled, 296 (82%) pre-protocol and 65 (18%) post-protocol. There was a significant raise in the number of preterm newborns (9.5 versus 30.8%, pre- and post-protocol, respectively; p < .001), with similar other sociodemographic characteristics. There were 36 positive laboratory screenings at 12 h of life and 8.6% were transferred to the neonatology department, without differences between the groups (p = .250 and p = .488). All presented a favorable outcome, without differences in the number of readmissions in the first month of life (p = .204). Discussion The modification of the approach protocol has led to a significant decline in the laboratory testing performed, minimizing newborn pain, unnecessary antibiotic exposure and costs, without increased risk of readmission for sepsis.

The Relationship Between MicroRNAs And Congenital Kidney Anomalies

Objective: The purpose of this study was to identify diagnostic microRNAs (miRNAs) associated with congenital kidney anomalies. Methods: Twenty-five healthy pregnant women who were found to have fetal kidney anomaly in the second trimester of their pregnancy at Department of Perinatology, were included in the study. Serum samples were taken from the pregnant women at the moment of diagnosis in the antenatal 20th gestational week, whereas serum samples were taken from the cord blood of babies during birth. There were 11 multicystic dysplastic kidney patients, 6 autosomal recessive polycystic kidney patients, and 8 unilateral hypoplastic kidney patients. Expression of specific miRNAs was monitored using specific primer assays in Real-Time PCR. The expression of the following miRNAs was quantified: miR-17, miR-192, miR-194, miR-204, miR-215, and miR-216. Results: mir-17 expression was significantly lower in children with congenital kidney anomalies than in the control group. ROC curve analysis showed that the area under the curve was 0.700 for miR-17 in the prediction of congenital kidney anomalies. Conclusions: In children with congenital kidney anomalies, miR-17 expression was significantly different than in the control group. Thus, this miRNA may be used in the antenatal early detection of these congenital kidney anomalies.