Diagnosis Of Pregnancy Research Articles

Short Synch - A Reproductive Management Tool to Increase the Reproductive Performance in Dairy Cows

Abstract Poor estrus detection is the greatest limiting factor for reproductive performance in dairy cows. The study aimed to compare the reproductive performance by assessing the fertility rate (FR) between cows inseminated after detected estrus and those inseminated after synchronized ovulation with the Short Synch protocol. A total of 138 primi- and multi-parous dairy cows from 5 dairy farms in North Macedonia were included in the study. At day 65±3 postpartum, an ovarian ultrasound examination was performed for presence of corpus luteum (CL), and body condition scoring (BCS) was made (scale from 1-emaciated to 5-obese). Cows with a CL (n=92) were submitted to two synchronization protocols and grouped accordingly: SPG (n=46) synchronized with a single PGF2α injection, and SSG (n=46) synchronized with a Short Sync protocol (PGF2α–24h–PGF2α–32h–GnRH–16h–TAI). Cows were followed up to the second insemination. Pregnancy diagnosis was done at d30 and d60 after each insemination. Eleven cows (n=11) from the SPG didn’t show estrus signs and were excluded from further analysis. Overall, a higher FR (p=0.0008) was observed in the SSG (71.74%, 33/46) compared to the SPG (34.29%, 12/35). Cows in the SSG with BCS>2.75 (76.19%, 16/21) had a higher FR (p=0.0016) than cows in the SPG with BCS>2.75. No differences were observed (p=0.1242) between both groups that had BCS≤2.75 (68.00%, 17/25; 43.75%, 7/16, respectively). Multiparous cows in the SSG had a higher FR (p=0.0021, 71.43%, 25/35) than their counterparts from the SPG (30.43%, 7/23). No significant differences were observed among the primiparous cows. The results indicate that Short Synch protocol might increase the fertility rate in dairy farms.

Monochorionic Diamniotic Twins with Sex Discordance: Case Series

Background and Clinical Significance: Ultrasonographic diagnosis of twin pregnancies has become routine, with chorionicity playing a crucial role in assessing associated risks. Traditionally, monochorionic (MC) twins were believed to derive from a single zygote, ensuring sex concordance. However, recent cases of dizygotic monochorionic (MCDZ) twins challenge this paradigm. In this paper, four cases of MCDZ twins with sex discordance are described. Case presentation: Case 1 and case 2 describe two spontaneous MC/diamniotic twin pregnancies in which sex discordance between twins was attributed to blood chimerism. Case 3 is about a MC/diamniotic twin pregnancy derived from a single blastocyst transfer after in vitro fertilization (IVF), and that was complicated by twin-to-twin transfusion syndrome, with zygosity testing confirming the dizygosity. Case 4 is a twin anemia polycythemia sequence diagnosed after birth in twins considered dichorionic during pregnancy (due to sex difference) and defined as monochorionic after placental examination. Conclusions: The prevalence of monochorionic dizygotic (MCDZ) twins remains uncertain, and many cases likely go unnoticed, particularly when twins are of the same sex. In twin pregnancies, determining chorionicity during the first-trimester ultrasound (US) is critical. Accurate identification of monochorionicity is essential for managing potential complications. Careful verification of sex concordance between twins is necessary. In cases of sex discordance, amniocentesis is required for karyotype evaluation and zygosity testing.

Case report: Successful laparoscopic management of early abdominal pregnancy

BackgroundAbdominal pregnancy is characterized by the implantation of the gestational sac within the peritoneal cavity, specifically outside the fallopian tubes, ovaries, and cervix. This exceedingly rare form of ectopic pregnancy accounts for about 1% of all ectopic pregnancies. When rupture occurs, it can result in a life-threatening situation for the patient, necessitating immediate medical intervention.Case informationIn this study, we report a 33-year-old female patient who presented with abdominal pain and was subsequently diagnosed with an early abdominal pregnancy. Laparoscopic intervention revealed gestational tissue and a rupture site located in the pouch of Douglas. The gestational tissue was successfully excised via laparoscopy, and the rupture site was sutured to achieve hemostasis. Postoperative histopathological analysis confirmed the presence of chorionic villi and trophoblast cells.ConclusionThis case highlights the critical importance of precise diagnosis and laparoscopic intervention in the management of abdominal pregnancy. It is imperative for clinicians to exercise a prudent approach in the diagnosis and treatment of abdominal pregnancy, utilizing a comprehensive assessment that integrates medical history, clinical manifestations, and auxiliary diagnostic tests to enhance the detection and comprehension of this condition.

Latent representation learning for classification of the Doppler ultrasound images.

The classification of Doppler ultrasound images plays an important role in the diagnosis of pregnancy. However, it is a challenging problem that suffers from a variable length of these images with a dimension gap between them. In this study, we propose a latent representation weights learning method (LRWL) for pregnancy prediction using Doppler ultrasound images. Unlike most existing methods, LRWL can handle a variable length of multiple images, especially with an irregular multi-image issue. Furthermore, a spatial interaction measurement (SIM) method is proposed to verify the hypothesis that LRWL can more accurately capture relationships among the images. The images, along with diagnostic indices and weights, are integrated as inputs to a deep learning (DL) model for pregnancy prediction. The study conducts comprehensive experiments involving classification tasks on real irregular reproduction datasets and two synthetic regular datasets. Results demonstrate that LRWL surpasses existing methods and is well-suited for irregular multi-image datasets. The proposed method can be effectively implemented using the limited-memory Broyden-Fletcher-Goldfarb-Shanno bound constraint (L-BFGS-B) and the alternating direction minimization (ADM) framework, exhibiting strong performance in terms of accuracy and convergence.

Prenatal diagnosis of vasa praevia in routine clinical practice: Prevention of stillbirths and impact on perinatal outcomes.

Vasa praevia (VP) is defined as the presence of unsupported fetal blood vessels in close proximity of the internal os of the cervix. There is robust evidence from observational cohort studies and meta-analysis that prenatal diagnosis of VP is associated with excellent perinatal outcomes. We have previously proposed a two-stage strategy for prenatal diagnosis that can be implemented in routine clinical practice leading to effective prenatal diagnosis and prevention of fetal and neonatal mortality and morbidity. To demonstrate the feasibility and effectiveness of a two-stage screening strategy for prenatal diagnosis of VP in routine clinical practice and to estimate the potential impact on prevention of stillbirths and perinatal deaths. This was an observational retrospective cohort study carried out at the Medway Fetal and Maternal Medicine Centre between January 2010 and June 2022. We examined the feasibility and effectiveness of this policy in terms of identification of a high-risk cohort and prenatal diagnosis of VP through routine 11-13 and 20-22weeks' ultrasound assessments based on the two-stage protocol. We also examined the impact on maternal, neonatal and perinatal outcomes in pregnancies with a confirmed diagnosis of VP. Absolute risks (95%) were calculated based on rates of events in the two groups. Logistic regression analysis was used to estimate independent contribution from maternal and pregnancy characteristics in prediction of VP. The study population of 53,648 singleton pregnancies included 45 pregnancies with VP (0.83 per 1,000 pregnancies or an incidence of 1 in 1,192 pregnancies). VP was suspected in 56 cases and were resolved in 11 cases (19.6%), thus leaving 45 pregnancies with a confirmed diagnosis of VP. The main findings that predicted VP included a low-lying placenta at 20-22weeks', placenta praevia, bilobed placenta and a velamentous cord insertion. In our study population, pregnancies with a prenatal diagnosis of VP had a livebirth rate of 100% and an intact perinatal survival rate of 97.8%. Our study demonstrates that effective prenatal diagnosis of pregnancies with VP can be achieved in routine clinical practice with good perinatal outcomes.

Development of an innovative intravaginal model of probiotic inoculation in dairy ovine flocks: positive effects on the vaginal microbiota, vaginitis and fertility.

In vitro studies have reported the antimicrobial effect of an inoculum (L2) made from commercial probiotic strains of Lactobacillus spp. (Lactobacillus (L.) crispatus, L. brevis and L. gasseri) against some ruminants' pathogens. However, their possible beneficial effects on controlling the vaginosis caused by the use of intravaginal sponges for oestrus synchronisation have not been evaluated in in vivo models. Therefore, the purpose of this study was to perform an intravaginal double inoculation of this same non-lyophilised (non-freeze-dried) L2 inoculum, in 120 ewes from four dairy commercial ovine flocks using straws similar to those used in artificial insemination. Globally, in the entire study population, the fertility percentage (65%) of the inoculated groups increased by 10% compared to the control groups (55%). Specifically, increases in the percentages of pregnant sheep in flocks 1 and 4 (10.7 and 5.7% respectively; P>0.05) and flock 3 (27.3%; P<0.05) were observed in inoculated ewes. Overall, the administration of L2 on the day of intravaginal sponge insertion decreased the number of ewes with vaginitis by 11.13% at the time of sponge removal (T1). In the first flock, the administration of the probiotic positively modulated the microbiota with an increased richness and presence of Lactobacillales accompanied by a reduction in Mycoplasma spp. Genera such as Fusobacterium, Streptobacillus, Campylobacter or Trueperella were linked to the presence of vaginitis at T1. Genera belonging to Lactobacillales, including some genera previously reported to be beneficial for pregnancy, significantly increased at the time of pregnancy diagnosis but significantly decreased at T1. The results of this study suggest that the use of probiotics via intravaginal inoculation as a strategy to positively modulate the microbiota and vaginal inflammation, derived from the use of intravaginal sponges, is also associated with improved fertility. This novel approach could improve animal welfare in oestrus-synchronisation protocols and represents an alternative to the prophylactic use of antibiotics.

Risk estimation for subclinical heart failure using the PREVENT calculator in patients with autoimmune rheumatic diseases

Abstract Background Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and psoriatic arthritis (PsA) are heterogeneous autoimmune diseases with established cardiovascular involvement associated with a higher risk of developing heart failure (HF). Studies have shown a greater risk for HF in rheumatologic patients compared to the general population, however, the calculated risk varies among studies. PREVENTTM is the first cardiovascular risk calculator to predict the risk of HF. Purpose To evaluate the performance of the novel PREVENTTM cardiovascular risk calculator to detect subclinical HF in patients with inflammatory autoimmune diseases. Methods Cross-sectional, descriptive study involving RA, SLE, and PsA patients of a single cardiology-rheumatology preventive clinic in a tertiary-care hospital. This cohort includes patients aged 30-79 who met the ACR/EULAR/CASPAR classification criteria for diagnosing RA, SLE, and PsA, respectively. Exclusion criteria included a previous diagnosis of atherosclerotic cardiovascular disease, overlap syndromes, or pregnancy. The risk of heart failure was assessed using the new 10-year PREVENTTM calculator and patients were categorized as high risk if they had ≥20%. The result was multiplied by 1.5 according to EULAR 2015/2016 recommendations in the patients with RA. A transthoracic echocardiogram was performed on all participants by a board-certified cardiologist. Distribution was assessed by the Kolmogorov-Smirnov test. Results are shown as frequencies (%) for qualitative variables and mean ± SD or median (p25-p75) according to the distribution of quantitative variables. Cohen's Kappa coefficient was used to evaluate the agreement between the transthoracic echocardiogram and the PREVENTTM algorithm to detect subclinical HF. Results A total of 238 patients with rheumatic diseases were included, mostly women (n = 204, 85.7%) with a mean age of 52.8 ± 10.1 years. Demographic and clinical characteristics are shown in Table 1. The PREVENTTM calculator classified 4 (1.6%) patients of the 3 rheumatologic diseases as a high-risk category. Employing echocardiography, 144 (60.5%) patients with subclinical HF were identified. By Kappa analysis, a slight concordance was found in patients with RA (k = 0.033) and poor concordance in patients with SLE (k = -0.049) between the PREVENTTM algorithm and the echocardiogram for the classification of high-risk subclinical HF patients. No concordance was found in patients with PsA. Conclusion Our study demonstrates that the PREVENTTM risk algorithm failed to detect a high proportion of patients with subclinical HF and that there is no concordance between the two methods. Echocardiography as part of cardiovascular evaluation may help detect those patients with rheumatologic diseases and subclinical HF.

Living in a Constant State of Fear: Phenomenological Study on Experiences of Women with High-Risk Pregnancy Waiting for Childbirth in Mpumalanga Province, South Africa

Research and obstetric medicine often ignore the emotional aspect of high-risk pregnant women in clinical management and care. Even more so, research does not adequately address psychosocial well-being in high-risk pregnancies, particularly in low and middle-income countries, including South Africa. Thus, this study aimed to explore and describe the experiences and psychosocial support needs of women waiting for childbirth in high-risk pregnancies. We conducted a descriptive phenomenological inquiry in special clinics in two hospitals in the Nkangala District Municipality of Mpumalanga Province, South Africa. A purposive sampling strategy was used to select 15 women aged 22 to 43 years, and in-depth interviews were conducted. An inductive thematic analysis approach was used. The women experience high levels of negative emotions such as shock and disbelief, fear, pain and sorrow, lack of control and hopelessness, and anxiety following a diagnosis of high-risk pregnancy. Fear was the most expressed feeling by the women; their thoughts were dominated by fear, and they lived in constant fear throughout the pregnancy journey due to the unpredictable pregnancy outcomes and the potential risks in high-risk pregnancies. Overall, the negative emotions are interlinked and bonded in the experiences of women with high-risk pregnancies, are experienced throughout the journey of waiting for childbirth, and contribute to high levels of stress and anxiety. Further exploration is needed to identify effective ways to support these women.

Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta-analysis.

Intrauterine devices (IUDs) are highly effective contraceptives. Despite their effectiveness, pregnancies can occur during IUD use, and the management of such cases, particularly when the pregnancy is desired, remains controversial. We conducted a systematic review and meta-analysis to evaluate outcomes in women who unintentionally conceived while using IUDs and chose to continue their pregnancies. We searched PubMed, Embase, and Cochrane databases to identify studies comparing women who removed their IUD after pregnancy discovery to those who retained it. The primary outcomes assessed were miscarriage, bleeding during pregnancy, and preterm delivery. Secondary outcomes included cesarean delivery, chorioamnionitis, congenital malformations, intrauterine growth restriction, preterm premature rupture of membranes, and stillbirth. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the binary outcomes using random-effects models to account for variability across studies. The certainty of evidence was measured using the Grading of Recommendations Assessment, Development, and Evaluation approach. From 3719 records, 4 cohorts were included. Among the 693 pregnant women analyzed, 402 had their IUD removed, while 291 retained the device. The analysis focused on copper IUDs, with most studies reporting removal during the first trimester and after ultrasound evaluation, although gaps in standardized reporting practices and removal methods were noted. Significant benefits were observed for the IUD-removed group, including reduced incidences of bleeding during gestation (OR 0.42; 95% CI 0.24 to 0.73; p < 0.01. Moderate certainty of evidence), and miscarriage (OR 0.29; 95% CI 0.17 to 0.48; p < 0.01. Moderate certainty of evidence). There was no significant difference in preterm delivery rates (OR 0.78; 95% CI 0.34 to 1.76; p = 0.55). This meta-analysis, based on data from cohort studies with moderate certainty of evidence, indicates that removing an IUD after pregnancy diagnosis may reduce the odds of miscarriage and bleeding during gestation. However, further high-quality research is needed to evaluate outcomes in pregnancies associated with hormonal IUDs, as well as critical factors such as gestational age at diagnosis, timing of IUD removal, and the position of the gestational sac relative to the device.

Early Diagnosis of Cesarean Site Ectopic Pregnancy: The Critical Role of Ultrasound in Preventing Complication

Cesarean scar ectopic pregnancy (CSP) is a rare type of ectopic pregnancy where the embryo implants on the cesarean scar from a prior surgery. We present a case of a 34-year-old woman, gravida 6, para 5, with history of five previous cesarean sections and uncontrolled type 2 diabetes. She presented with 8 weeks and 3 days of amenorrhea. Transabdominal and transvaginal ultrasound confirmed a viable gestation implanted in the anterior part of the lower uterine segment, within the cesarean scar region. Subsequently, laparotomy for excision of ectopic pregnancy was done. Gestational sac adherent to previous uterine scar was removed with all its membranes. Histopathology report confirmed the product of conception. Early diagnosis of cesarean scar ectopic pregnancy (CSP) via ultrasound is vital. Recognizing a gestational sac in the lower uterine segment helps guide timely treatment and prevent serious complications. Key Words: Cesarean scar ectopic pregnancy (CSP), ultrasound diagnosis, laparotomy.

P0984 Treatment with allopurinol and low-dose azathioprine during pregnancy in patients with Inflammatory Bowel Disease. A Danish single center experience

Abstract Background Low-dose azathioprine in combination with allopurinol (LD-AZA/ALLO) is a widely used treatment option in inflammatory bowel disease (IBD). Data on pregnancy and birth outcomes from exposure to combination therapy are sparse. The aim of this study was to provide data on safety and risk for adverse pregnancy and birth outcomes in women with IBD treated with LD-AZA/ALLO at the Gastrounit, Hvidovre Hospital, Copenhagen. Methods The study was a retrospective single center study. Inclusion criteria were established IBD diagnosis and treatment with LD-AZA/ALLO (AZA 50-75 mg/ ALLO 100 mg) during conception and pregnancy between 2013-2023. Data was collected from electronic medical charts and by questionnaire to all included women. Data registered was; demographics, diagnosis, disease characteristics, disease activity, IBD medications and number of pregnancies. Pregnancy outcomes were neonatal characteristics, obstetric complications, lactation and congenital malformations, disease, infections and admission to the hospital during the first year of life. Results In all, 44 women with 62 pregnancies (one twin pregnancy) and 59 live births were included. There were 1 spontaneous and 3 provoked abortions due to genetic disorders (1 trisomy 21 and 2 spinocerebellar ataxia). Obstetric complications were present in 8 (13%) pregnancies, (1 pre-eclampsia, 1 HELLP syndrome, 6 hypertension and/or gestational diabetes mellitus). 7 (11%) women had an IBD flare during pregnancy, none resulting in obstetrical complications. 5 (9 %) children were born prematurely, 4 (7 %) had low birth weight. No congenital malformations were reported. One child was born with facial nerve paralysis and later diagnosed with hyper-IgD syndrome. 8 (14 %) were admitted to neonatal ward (hours to days), mainly due to immature lungs. During the first year of life, one child was admitted to the hospital due to COVID. One child was suspected to have an immune defect, but all symptoms and biochemical abnormalities resolved and interpreted as side effect to LD-AZA/ALLO. 5 children (9%) were treated with antibiotics due to minor infections. In total 84 % of the children were breastfed during LD-AZA/ALLO treatment. Conclusion In this large single center experience with 62 pregnancies in women treated with LD- AZA/ALLO, no malformations or indications of increased risk of complications of pregnancy and birth were observed. The majority of children were breastfed and no serious signals or complications were reported first year of life. Treatment with LD-AZA/ALLO during pregnancy and breastfeeding seems safe.

Comparative performance of microscopy, rapid diagnostic tests, and multiplex real-time PCR for detection of malaria parasites among pregnant women in northwest Ethiopia

BackgroundLow malaria parasitaemia is a diagnostic challenge in pregnancy, leading to false negative microscopy and rapid diagnostic test (RDT) results. However, these submicroscopic or subpatent infections could cause adverse pregnancy outcomes. Thus, evaluating the diagnostic performance of microscopy, RDT, and multiplex qPCR in pregnancy is vital for informed decisions.MethodsA total of 835 peripheral blood and 372 placental blood samples were collected from 835 pregnant women attending first antenatal care or admitted for delivery at selected health facilities in northwest Ethiopia between November 2021 and July 2022. In multiplex qPCR, all microscopy and/or RDT positive samples were extracted and amplified individually, whereas all samples negative by both RDT and microscopy were extracted after pooling ten samples together and tested for Plasmodium genus. The diagnostic performance of microscopy, RDT, and multiplex qPCR in pregnancy was compared and evaluated against each other.ResultsUsing multiplex qPCR as a reference test, microscopy had a sensitivity of 73.8% (95% confidence interval (CI): 65.9–80.7) and 62.2% (95% CI: 46.5–76.2) to detect Plasmodium parasites in peripheral and placental blood samples, respectively, with a 100% (95% CI: 98.9–100) specificity in both samples. Similarly, the RDT had a sensitivity of 67.6% (95% CI: 59.3–75.1) and a specificity of 96.5% (95% CI: 94.9–97.8) for Plasmodium infection diagnosis in peripheral blood and a sensitivity of 62.2% (95% CI: 46.5–76.2) and a specificity of 98.8% (95% CI: 96.9–99.7) in placental blood samples. Considering microscopy as a reference test, multiplex qPCR showed a sensitivity of 100% (95% CI: 96.6–100) and a specificity of 94.8% (95% CI: 93.0–96.3) to diagnose Plasmodium infections in both peripheral and placental blood samples. Pooled multiplex qPCR detected 34 peripheral and 12 placental blood Plasmodium infections from microscopy and RDT negative samples. The pooled assay obviated about half of the reactions and its testing costs. Microscopy showed almost perfect agreement (κ = 0.823) with multiplex qPCR for detecting malaria parasites in pregnancy, whereas the RDT showed a substantial agreement (κ = 0.684).ConclusionMultiplex qPCR had a better performance for Plasmodium infection diagnosis in pregnancy compared to microscopy and RDT. Pooled multiplex qPCR could be a sensitive and resource-efficient strategy for epidemiological surveillance of Plasmodium infections in pregnancy.

Symptom appraisal and help-seeking before a cancer diagnosis during pregnancy: a qualitative study.

Background Estimated incidence of cancer diagnosis during or shortly after pregnancy is 1 in 1,000 women. Pregnancy can impact symptom appraisal and help-seeking for symptoms subsequently diagnosed as cancer. Little is known about the pathway to cancer diagnosis in pregnancy or delays that women can encounter. Aim To explore symptom appraisal, help-seeking decisions, and experience of receiving a cancer diagnosis during pregnancy. Design and setting Semi-structured interviews with women diagnosed with cancer during or shortly after pregnancy in the previous four years, recruited between January and May 2022 via the charity Mummy's Star. Method Reflexive Thematic Analysis of 20 interviews. Analysis was largely inductive, and the themes generated were mapped onto the intervals of the Model of Pathways to Treatment. Results Symptoms were often interpreted through the lens of pregnancy by both participants and most of the healthcare professionals from whom they sought help. Participants who found breast lumps were likely to suspect cancer and be referred promptly for tests in secondary care. While most participants sought timely help for their symptoms, some subsequently encountered health system delays, partly due to both the vague nature of their symptoms and the COVID-19 pandemic. Conclusion Health services need to better support women presenting with possible cancer symptoms during pregnancy to ensure timely diagnosis. Recommendations include prioritising symptoms over attributing them solely to pregnancy, ensuring timely referrals to rule out serious conditions, and emphasising clear communication alongside robust safety-netting practices. A full assessment is essential before dismissing symptoms as pregnancy related.

Investigation of the relationship between self-perception and alexithymia levels of high-risk pregnant women

Abstract Alexithymia, known as emotional unresponsiveness, can occur at any time in response to extreme stress during upsetting life events. A risky pregnancy is also a challenging process associated with psychological and emotional difficulties, and pregnant women may experience perception problems. Therefore, a risky pregnancy diagnosis may trigger the development of alexithymia. This study aimed to examine the relationship between self-perception and alexithymia levels in women diagnosed with high-risk pregnancies. This cross-sectional study was conducted with 250 high-risk pregnant women admitted to the hospital between June and November 2022. Data were gathered using the “Socio-demographic Information Form”, A Alexithymia Scale” and the “Pregnant Women’s Self-Perception Scale “. The data was analyzed using the Independent T-test, One-Way Analysis of Variance (ANOVA), Pearson Correlation Test, and Simple Linear Regression Analysis. The statistical significance level was accepted as p &lt; 0.05. The mean age of the pregnant women in the study group was 30.25 ± 5.78 years. It was found that there was a significant negative correlation between the total score of the A Alexithymia Scale and the Total Score of the Motherhood Perception of Pregnancy Sub-dimension (r=-.197; p &lt; 0.05) and the Total Score of the Body Perception of Pregnancy Sub-dimension (=-.395; p &lt; 0.05). A one-unit increase in the pregnant women’s score on the Body Perception Sub-dimension causes a decrease of 1.822 points in the A Alexithymia Scale score. The study’s findings indicate that pregnant women with a high motherhood perception but a negative body perception have lower alexithymia levels. Therefore, alexithymia levels decrease in pregnant women who can make sense of and express their negative emotions during risky pregnancies.

The relationship between anxiety, depression, and COVID-19 diagnosis in term pregnancy: a hospital-based Romanian study

Background and aim. There are few published data on the mental health problems of women with pregnancy complicated by SARS-CoV-2 infection. Our study aimed to evaluate anxiety and depression related to a COVID-19 diagnosis in women who gave birth in a Romanian tertiary maternity. Methods. A hospital-based cross-sectional study was conducted between September 2020 and October 2021 on 105 women admitted for term delivery; 51 women were diagnosed with SARS-CoV-2 infection just before delivery, and 54 without infection. Participants were assessed during the first 72 hours postpartum (T1) and the following two weeks postpartum (T2). Hospital Anxiety and Depression Scale (HADS) was used for anxiety and depression assessment at T1. The COVID-19 Pandemic Mental Health Questionnaire (CoPaQ) was applied at T2 only in the COVID-positive cases identified at T1. Results. Postnatal anxiety levels were higher in COVID-positive women compared to COVID-negative women (p = .004), but there were no differences in the postnatal depression level between the groups. Psychological manifestations related to the pandemic, such as contamination anxiety, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) symptoms, were positively related to HADS anxiety scores, while maintaining social relationships were negatively associated with the scale. The COVID-19 diagnosis was found to be a significant predictor for adverse pregnancy outcomes (APOs), with COVID-positive women having a 4.72-fold higher risk of developing them than those who tested COVID-negative (OR=4.72, 95% CI [2.05; 10.86]). The multivariate analysis using anxiety and depression as dependent variables indicated a significant effect for COVID-19 diagnosis, Wilks’ Lambda = 0.940, p = 0.048. Conclusion. Increased levels of anxiety, PTSD, and obsessive-compulsive symptoms were associated with the postpartum period in pregnant women with COVID-19 infection during delivery. Maintaining social interaction proved to be a protective factor against the increased anxiety reported by COVID-19-infected women.

Reproductive Efficiency of Nelore Cows in Fixed-Time Artificial Insemination Programs with Early Resynchronization.

We aimed to evaluate the reproductive efficiency of Nelore cows in fixed-time artificial insemination (FTAI) programs with early resynchronization. A total of 468 Nelore cows were divided into two experimental groups: R30-conventional resynchronization at 30 days (n = 234); R22-early resynchronization at 22 days (n = 234). Both groups followed a synchronization protocol using intravaginal progesterone devices combined with the administration of steroids and gonadotropins. The R30 protocol involved resynchronization 30 days after FTAI, while the R22 protocol implemented early resynchronization 22 days after FTAI without prior pregnancy diagnosis. In both groups, one FTAI was followed by two resynchronizations. The results showed similar pregnancy rates between the groups, with the pregnancy rate in the 1st FTAI being 50.85% in the R30 group and 48.72% in the R22 group (p = 0.742). During the 1st resynchronization, the rates were 45.22% in the R30 group and 46.67% in the R22 group (p = 0.742). The cumulative pregnancy rate after the 1st FTAI, 1st, and 2nd resynchronizations was 80.77% in the R30 group and 82.91% in the R22 group (p = 0.643), with no significant difference observed. Follicular dynamics were also monitored, with ovulation occurring in 78.95% of cases in the 1st FTAI, 91.67% in the 1st resynchronization, and 88.98% in the 2nd resynchronization. The mean diameter of the ovulatory follicle was 13.64 ± 3.48 mm, and the largest follicle diameter was significantly greater (14.47 ± 2.76 mm) in cows that ovulated compared to those that did not (11.54 ± 4.24 mm) (p < 0.05), reinforcing the association between follicle size and the likelihood of ovulation. These findings indicate that both early and conventional resynchronization protocols perform similarly, with early resynchronization offering advantages in reducing the calving interval. Furthermore, the relationship between follicular diameter and ovulation confirms the importance of follicle size as an indicator of reproductive success.

Oral administration of cyantraniliprole to wistar rats during pregnancy and lactation alters maternal behavior and harms the female reproductive system of pubertal and adult offspring.

Over the past years, global pesticide use has increased by 20%. New insecticidal molecules, like cyantraniliprole, aim to reduce side effects due to the high toxicity of pesticides and their harmful effects on health and the environment. Its mechanism involves binding to ryanodine receptors, causing rapid calcium ion release. As a new molecule, studies on its effects on mammals are scarce. This work evaluates oral cyantraniliprole's impacts during pregnancy and lactation on maternal behavior and the reproductive system of female offspring. Approved by CEUA-UEL (OF. CIRC. CEUA n. 20/2020), Wistar rats were mated, and after pregnancy diagnosis, divided into control groups, C1, C10, and C150, receiving water and cyantraniliprole at 1, 10, and 150mg/kg/day, respectively, by gavage. Maternal behavior, offspring physical development, uterine and ovarian histology, and oxidative stress levels were analyzed. Maternal exposure to 150mg/kg/day was toxic to pregnancy, causing loss of the experimental group. Analysis showed significant changes in maternal behavior in C1 and C10, with increased pup contact, longer breastfeeding, and less cleaning time. No changes in offspring development were observed in C1 and C10. Histology and oxidative stress analysis of the ovaries showed no changes, while uterine analysis indicated thickening and increased oxidative stress.

Accuracy of point-of-care ultrasound in diagnosing retained products of conception.

Retained products of conception (RPOC) refers to residual intrauterine tissue in female patients after a recent birth, pregnancy termination, or miscarriage. Ultrasound is the primary diagnostic modality for RPOC, but the accuracy of point-of-care ultrasound (POCUS) has not been evaluated for this diagnosis. Our aim was to determine the test characteristics of POCUS in detecting RPOC, and to evaluate the management of RPOC in the Emergency Department. This was a retrospective cohort study of all patients presenting to an Emergency Department with over 110,000 annual visits between January 1, 2017, and December 31, 2023, who had an Emergency Department performed pelvic POCUS. All Emergency Department patients ≥18years old who had a pelvic POCUS performed during the study period and had no identifiable intrauterine pregnancy were included. Patients were excluded if their sex was male, age was greater than 55, if there was inadequate chart data, or if there were inadequate or no POCUS images saved. Chart review was conducted by three nonblinded investigators, and POCUS review was conducted by two ultrasound fellows, blinded to the chart review. RPOC on POCUS was defined as heterogenous or hyperechoic products within the endometrium measuring greater than 10mm. The gold standard for the diagnosis of RPOC on chart review was radiology ultrasound or obstetrics and gynecology (OBGYN) diagnosis for patients who did not receive a radiology ultrasound. There were 703 patients included in the study while 58 met exclusion criteria, leaving 645 patients for review. Radiology ultrasound was performed in 512 patients (79.4%), and identified 42 cases of RPOC. In the 133 patients who did not receive a radiology ultrasound, 20 were confirmed to have RPOC based on OBGYN diagnosis, for a total of 62 patients with RPOC (a 9.6% prevalence). There were 70 total POCUS examinations identified as RPOC, with 17 indeterminant examinations. In the 265 patients with a history concerning for RPOC based on chart review, the sensitivity and specificity for RPOC on POCUS were 79.0% (95% CI; 66.1%-88.6%) and 93.8% (95% CI; 90.0%-96.6%) respectively when compared to the gold standard diagnosis. If all eight indeterminant POCUS examinations from this group were considered positive, the sensitivity and specificity were 80.7% (95% CI; 68.1%-90.0%) and 90.4% (95% CI; 85.5%-94.0%) and 80.7% (95% CI; 68.1%-90.0%). Of the 62 total patients with RPOC based on chart review, 21 (33.9%) were admitted, 26 (41.9%) had a surgical procedure, 26 (41.9%) were managed medically, and 10 (16.1%) were expectantly managed. POCUS demonstrated high specificity and low sensitivity for diagnosing RPOC in patients with a history concerning for RPOC. POCUS can be used to diagnose RPOC, but caution should be exercised when making the diagnosis in early pregnancy given the variable appearance of the endometrium on transabdominal POCUS during that timeframe.

Echo-Biometry Assessment of a Quadruple Pregnancy in a Captive Capybara.

A 5-year-old female capybara, conditioned ex situ before mating, was monitored by ultrasound to establish prenatal growth and assess fetal echo-biometric variables. The records were taken twice weekly until delivery (i.e., 5 months). The measurements included gestational sac width (GSW), gestational sac height (GSH), gestational sac length (GSL), crown-rump length (CRL), trunk diameter (TD), heart major axis (HMA), biparietal diameter (BDP), and femur length (FL). The gestational sacs were detected on the 25th day after mating (DAM), embryos appeared on the 42nd DAM, and the parturition of four healthy offspring occurred three days after reaching averages of 30.74cm (CRL), 8.65cm (TD), 5.37cm (HMA), and 6.08cm (BDP). For initial pregnancy and fetal growth, GSL and BDP seem to be the best measurements. The formulas shown here can be a reference for gestational age estimation. This longitudinal study shows that ultrasonography is helpful for early pregnancy diagnosis and gestational age determination in capybaras.

Optimization of a milk pregnancy-associated glycoproteins ELISA test for pregnancy in Holstein cows using time-dependent cut-points between 23 and 90 days after insemination.

Our hypothesis was that the accuracy of a commercial milk pregnancy-associated glycoproteins (PAG) ELISA test using the same thresholds at all stages of gestation would be improved by adjusting the cut-points according to the number of days since last breeding (DSLB) between 23 and 90 d after insemination in Holstein dairy cows. Our objectives were to develop a DSLB-specific set of thresholds that would provide better test performance under field conditions and provide more information for the inconclusive test results, by dichotomizing these into "probably open" and "probably pregnant" categories. Milk samples (n = 182,738) submitted to the Lactanet (Canadian Dairy Herd Improvement) laboratory from 2013 to 2021 for pregnancy testing using a commercial PAG ELISA test were compared with records on insemination outcomes. The data were separated randomly into a training dataset used to develop the DSLB-specific interpretation grid and a validation dataset to quantify its test characteristics and compare the performance of the DSLB-specific and fixed thresholds. Our aim was to achieve negative predictive value >0.99 at all stages of test use and positive predictive value (PPV) ≥0.95 at ≤59 d and ≥0.99 between 60 and 90 d after insemination. Neither approach met these targets between 23 and 25 DSLB. The DSLB-specific interpretation grid had greater PPV than the fixed threshold between 26 and 49 DSLB and met the targets. Both approaches were very near the targets of performance between 50 and 90 DSLB. The DSLB-specific interpretation grid has a similar prevalence of inconclusive test results compared with the fixed threshold but provided additional information on the likelihood of the cow being pregnant or open. Classification of milk PAG results using DSLB-specific cut-points improved the predictive value of pregnancy diagnosis between 23 and 49 d after insemination.