Earlier Gestational Age Research Articles

7488 Robotic-Assisted Resection of a Cornual Ectopic Pregnancy: A Focus on Technique and a Discussion on Pathology

<h3>Study Objective</h3> To demonstrate the robotic-assisted laparoscopic surgical technique in the resection of an advanced cornual ectopic pregnancy in a morbidly obese patient. <h3>Design</h3> Video recording of the cornual ectopic resection edited to highlight the principal steps. <h3>Setting</h3> Operating room at an academic medical center. <h3>Patients or Participants</h3> An asymptomatic morbidly obese (BMI 45) 37-year-old G6P1041 at 9 weeks and 5 days gestation by her LMP who was sent to the emergency room for further management after a transvaginal ultrasound confirmed her gestational age and detected a 4.8cm x 4.9cm x 4.8cm right-sided interstitial ectopic pregnancy with cardiac activity. She was hemodynamically stable with a beta-hCG of 47,458. She was considered a poor candidate for medical management and was taken to the operating room. <h3>Interventions</h3> Robotic-assisted laparoscopic resection of a cornual ectopic pregnancy using vasopressin, the purse-string circumferential suture, and resection of the ipsilateral fallopian tube with securement of collateral blood vessels as hemostatic techniques. <h3>Measurements and Main Results</h3> The robotic resection took approximately 98 minutes to complete with no complications and minimal blood loss. The patient met all postoperative milestones and was discharged from the hospital on postoperative day 1 in stable condition. Her follow up beta-hCG on postoperative day 3 was 3,034. Interestingly, the final pathology resulted in myometrium with a placenta increta with negative margins. <h3>Conclusion</h3> Minimally invasive techniques for the management of cornual ectopic pregnancies have continued to advance as more institutions are adopting these methods. Our case demonstrates that robotic-assisted resections of a cornual pregnancy can achieve minimal blood loss, adequate multi-layer myometrial closure, reduced postoperative complications, and overall safety. Our case highlights the necessity for a complete and careful resection of the myometrium given the very small, but possible association of a placenta accreta spectrum disorder even at this early gestational age.

Impact of SARS-CoV-2 Infection during Pregnancy and Perinatal Outcome: Findings from Private Hospitals at Dhaka, Bangladesh

Introduction: The pandemic novel corona virus (SARS-CoV- 2) infects pregnant women and affects pregnancy outcome. The perinatal outcome of COVID positive pregnancies attended at private hospitals during the last epidemic peak at Dhaka is unknown. The purpose of the study was to evaluate perinatal outcome among COVID positive and COVID negative pregnant women who delivered in the 2 study hospitals at Dhaka during the last epidemic wave. Methods: This retrospective study was conducted in 2 eminent private medical college&amp; hospitals in Dhaka,namely Popular medical college &amp;hospital (PMCH) and Greenlife medical college hospital (GLMC) over a period of 3 months from July 2021 to September 2021. COVID positive and COVID negative pregnant women who delivered in the study hospitals during the study period were included in this study. Outcome variables were COVID related maternal morbidity mortality, rate of caesarean delivery, stillbirth, preterm birth, low birth weight, neonatal COVID-19 positivity, neonatal death. Results: This study included 60 COVID positive and 60 COVID negative pregnant cases. COVID positive pregnant women delivered at earlier gestational age (weeks) than COVID negative cases(34.46±3.58 vs 36.50±3.20; p=0.001) Among COVID infected pregnancies,severe disease was observed in 15%; O2 support was needed in 68.3% and ICU admission required in 16.7% cases.The caesarean delivery rate ((93.3% vs 80%; p-.032) and preterm delivery rate (63.3% vs 35%; p-.002) were significantly higher among COVID positive cases. About 8.3% COVID affected pregnancies ended up with stillbirth.Maternal death rate due to COVID related complications was 5%.Proportion of low birth weight (LBW) was significantly more in infected pregnancies (65% vs 35%; p 0.001).No newborn from COVID positive mother was tested positive by RT-PCR at 24 hours of age. Conclusion: SARS-CoV-2 infection during pregnancy cancause moderate to severe disease requiring ICU admission and maternal death in 5% among COVID positive cases .It gives rise to more still birth, preterm birth, increasing number of LUCSand LBW. However maternal to neonatal transmission is not evident at 24-hour RT-PCR testing. J Bangladesh Coll Phys Surg 2022; 40: 270-278

Clinical analysis of women with ovarian pregnancy: a retrospective case–control study

BackgroundTo address the clinical features and potential risk factors of ovarian pregnancy (OP).MethodsIn this retrospective case–control study performed in West China Second University Hospital from March 17, 2005 to December 8, 2018, 146 OP patients were selected as a case group, 292 patients with tubal pregnancy (TP) and 292 women with intrauterine pregnancy (IUP) were matched as controls at a ratio of 1:2:2.ResultsWhen compared with TP patients, OP patients tend to have worse clinical complications (hemorrhagic shock (7.41% vs 2.89%), rupture of pregnancy sac (54.07% vs 37.78%), hemoperitoneum (363.1 ± 35.46 ml vs 239.3 ± 27.61 ml) and increased need for emergency laparotomy (9.60% vs 3.97%) at an early gestational age. Assisted reproductive technology (ART) (adjusted OR1 2.08, 95%CI 1.04 to 4.18; adjusted OR2 2.59, 95%CI 1.25 to 5.37) and intrauterine contraceptive device (IUD) use (adjusted OR1 2.19, 95%CI 1.10 to 4.36; adjusted OR2 2.77, 95%CI 1.74 to 5.71) may be risk factors for ovarian ectopic pregnancy as compared to the control groups of TP and IUP patients.ConclusionsOP patients tend to have more severe clinical complications and this study has identified ART and IUD use as potential risk factors for OP. Results of this study may contribute to improve the understanding of OP and promote early surgical intervention.

Characterization of placental and decidual cell development in early pregnancy loss by single-cell RNA sequencing

BackgroundEarly pregnancy loss (EPL) presents as sporadic or recurrent miscarriage during the first trimester. In addition to chromosomal defects, EPL may result from impairment of the placental-decidual interface at early gestational age due to gene-environmental interactions.MethodsTo better understand the pathogenesis associated with this impairment, cell development in chorionic villi and decidua of different forms of EPL (sporadic or recurrent) was investigated with single-cell RNA sequencing and compared to that of normal first-trimester tissue.ResultsUnique gene expression signatures were obtained for the different forms of EPL and for normal tissue and the composition of placental and decidual cell clusters in each form was established. In particular, the involvement of macrophages in the EPL phenotypes was identified revealing an immunoactive state.ConclusionDifferential gene expression and unique marker genes among cell clusters from chorionic villi and decidua of miscarried and normal pregnancies, may lead to identification of biomarker for EPL.

Estimated daily intake of phthalates, parabens, and bisphenol A in hospitalised very low birth weight infants

Very low birth weight infants (VLBW, birth weight (BW) < 1500 g) are exposed to phthalates, parabens and bisphenol A (BPA) early in life. We estimated daily intake (EDI) of these excipients in 40 VLBW infants the first and fifth week of life while hospitalised. Based on urinary samples collected in 2010, EDI was calculated and compared to the tolerable daily intake (TDI) with hazard quotients (HQs) evaluated. A HQ > 1 indicates that EDI exceeded TDI with increased risk of adverse health effects. EDI was higher in VLBW infants compared to term-born infants and older children. VLBW infants born at earlier gestational age (GA), or with lower BW, had higher EDI than infants born at later GA or with higher BW. First week median EDI for BPA was higher than TDI in 100% of infants, in 75% for di(2-ethylhexyl) phthalate (DEHP), 90% for the sum of butyl benzyl phthalate (BBzP), di-n-butyl phthalate (DnBP), DEHP and di-iso-nonyl phthalate (DiNP) = ∑BBzP+DnBP+DEHP+DiNP, and in 50% of infants for propylparaben (PrPa), indicating increased risk of adverse effects. Fifth week EDI remained higher than TDI in all infants for BPA, in 75% for DEHP and ∑BBzP+DnBP+DEHP+DiNP, and 25% of infants for PrPa, indicating prolonged risk. Maximum EDI for di-iso-butyl phthalate was higher than TDI suggesting risk of adverse effects at maximum exposure. VLBW infants born earlier than 28 weeks GA had higher EDI, above TDI, for PrPa compared to infants born later than 28 weeks GA. Infants with late-onset septicaemia (LOS) had higher EDI for DEHP, ∑BBzP+DnBP+DEHP+DiNP and BPA, above TDI, compared to infants without LOS. More 75% of the infants' EDI for DEHP and ∑BBzP+DnBP+DEHP+DiNP, 25% for PrPa, and 100% of infants' EDI for BPA, were above TDI resulting in HQs > 1, indicating increased risk of adverse health effects.

Umbilical Cord Maternal Microchimerism in Normal and Preeclampsia Pregnancies.

Bidirectional exchange of cells between mother and fetus establishes microchimerism (Mc). Mc can persist for decades and is associated with later-life health and disease. Greater fetal Mc is detected in the maternal compartment in preeclampsia (PE), but whether maternal Mc (MMC) in umbilical cord blood (CB) is altered in PE is unknown. We evaluated MMc in CB from normal and PE pregnancies. DNA from CB mononuclear cells following placental delivery (n = 36 PE, n = 37 controls) and maternal blood was extracted and genotyped. MMc, quantified by qPCR assays targeting maternal-specific nonshared polymorphisms in CB, was compared using logistic and negative binomial regression models. Clinically and statistically relevant confounders were included, and included the total number of cell equivalents tested, gravidity, mode of delivery, birthweight, and fetal sex. PE participants delivered at earlier gestational ages, with higher Cesarean rates, and lower infant birthweights. CB MMc detection was similar between PE and controls (52.8% vs. 51.3%, respectively, p = 0.90) and unchanged after adjustment for confounders. MMc concentration was not different between groups (mean 73.7 gEq/105gEq in PE vs. mean 22.8 gEq/105 in controls, p = 0.56), including after controlling for confounders (p = 0.64). There was no difference in CB MMc detection or concentration between PE and normal pregnancies, despite previously noted greater fetal Mc in the maternal compartment. This suggests possible differential transfer of cells at the maternal fetal interface in PE. Phenotypic evaluation of Mc cells may uncover underlying mechanisms for differential cellular exchange between mother and fetus in PE.

Relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass index.

There is growing evidence that induction of labor at 41 completed weeks improves neonatal outcome, at least among primiparous women. This study was performed to investigate whether maternal body mass index (BMI) should be considered when deciding on timing of intervention in term pregnancies. The study design was a historical cohort study using data from the Swedish Medical Birth Register, singletons in cephalic presentation with births 39+0 to 41+6 weeks, with available information on maternal BMI 2005-2017 (n= 352 567). Modified Poisson regression analyses were used to investigate the association between gestational duration and stillbirth or death before 45 postmenstrual weeks (primary outcome) and Apgar score <7 at 5 minutes (secondary outcome) by BMI, respectively. Adjustments were made for maternal age, smoking, country of birth and educational level. The adjusted relative risk (ARR) of stillbirth or death before 45 weeks among infants born at 41+0 to 41+6 vs 40+0 to 40+6 weeks, was 1.26 with a 95% confidence interval (CI) of 1.07-1.48. Among women with BMI≥30, the offspring mortality risk in pregnancies lasting 39+0 to 39+2 weeks was significantly above the corresponding risk among women of normal BMI who delivered at 41+0 to 41+2 weeks (ARR=1.95; 95% CI 1.07-3.56) but no statistically significant heterogeneity was found regarding the magnitude of the association between gestational duration and offspring mortality. The ARR, for Apgar <7 at 5minutes (41+0 to 41+6 vs 40+0 to 40+6 weeks, regardless of BMI), was 1.36 (95% CI 1.27-1.45). The risk for low Apgar score at 41+0 weeks was 1.5% among all children regardless of maternal BMI. Among children to women with BMI≥30, this magnitude of risk was found already at 39+3 weeks. In primiparous women with obesity the risk of stillbirth or death before 45 postmenstrual weeks were increased throughout all full-term gestational age categories, compared with women with overweight or normal BMI. Children to obese women had the same risk for Apgar scores <7 at 5minutes compared with women overall at earlier gestational age. The results suggest that maternal BMI needs to be considered when discussing timing of elective induction in term healthy pregnancies of primiparous women.

Birth Outcomes Related to Distance in Rural and Frontier Kansas.

IntroductionWomen from rural communities must travel greater distances to secure obstetrical care. This study sought the extent to which distance traveled by mothers for obstetrical services affects birth outcomes in rural and frontier counties of Kansas.MethodsMedical students invited women over the age of 18 to participate in a recall survey regarding their children under three years old. Participants were a sample of convenience, and the length of data collection was a month. A bivariate analysis was performed on the responses gathered regarding obstetrical measures as a function of self-reported distance traveled to the hospital of delivery.ResultsEighty-five women completed the survey, but only 76 satisfied all eligibility requirements. No statistical difference in birth outcomes were found between women who travel more than or less than 20 miles. However, when correlating data to that of the Kansas Hospital Association and the Kansas Department of Health and Environment, counties without birth facilities had a higher percentage of very low birth weights (< 1,500 grams) and more babies born at full-term when compared to counties that offer birth facilities. Babies born to mothers who reside in counties with obstetrical services were born at an earlier gestational age than those without birth facilities. Lastly, babies born into a family with income less than $50,000 weighed less and had a shorter gestational age than those from a more affluent household.ConclusionsThe results revealed counterintuitive findings that deserve to be explored further by a study with greater statistical power.

Different expressions of cardiac biomarkers between different types of acquired right ventricular outflow tract abnormality in monochorionic twins.

To investigate the differences in amniotic fluid cardiac biomarkers and clinical features among types of right ventricular outflow tract (RVOT) abnormality in monochorionic (MC) twins. This prospective study included MC twins that underwent laser surgery. Recipient or larger twins (group A) and donor or smaller twins (group B) were assessed and divided into those with a normal right ventricular outflow tract (normal RVOT), functional pulmonary atresia (fPA), or pulmonary stenosis (PS). Amniotic fluid levels of NT-proBNP (afNT-proBNP) and cardiac troponin T (afTnT) were examined during surgery. Of 190 fetuses in group A, there were 14 RVOT abnormality cases (including 7 fPA and 7 PS). No group B fetuses showed RVOT abnormality findings. In group A, later and earlier gestational age at surgery were observed in fPA (25.1±2.8weeks) and PS groups (17.8±0.9weeks). All survived PS cases demonstrated progressive pulmonary valve obstruction, not observed in fPA groups. AfNT-proBNP were significantly higher in fPA and PS than in the normal RVOT group (p<0.05). AfTnT was significantly higher in group A with PS than fPA and normal RVOT groups (p<0.05). Among RVOT abnormality types in group A, amniotic fluid cardiac biomarkers were differently expressed, and clinical features were also differentiated. These findings provide insight into the pathophysiological influence on RVOT in MC twins. This study was registered with the Japanese Clinical Trial Registry "UMIN-CTR" (http://www.umin.ac.jp/ctr/index-j.htm; trial ID numbers UMIN000024486 and 000037702).

The Prevalence and Clinical Significance of Congenital Anomalies of the Kidney and Urinary Tract in Preterm Infants

The prevalence and importance of congenital anomalies of the kidney and urinary tract (CAKUT) in preterm infants is unknown. To determine the prevalence of CAKUT in preterm infants and association with in-hospital morbidity and mortality. This cohort study included infants cared for in neonatal intensive care units managed by a large US network of hospitals and doctors. Eligible participants were infants born at 23 to 33 weeks' gestation between 2000 and 2020. Infants transferred from or to other health care facilities prior to discharge or death were excluded in analysis of outcomes. Data were analyzed from December 2021 until May 2022. The presence of anomalies of the kidneys, ureters, bladder, or urethra was assessed. Covariates were discharge year, exposure to antenatal steroids, sex, maternal race, gestational age, birthweight, mechanical ventilation in first 72 hours of life, genetic disorders, and extrarenal anomalies. Death or in-hospital severe illness (acute kidney injury, kidney failure, intracranial hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, bacterial sepsis, or administration of inotrope or vasopressor). In this cohort of 409 704 infants, 191 105 (46.6%) were girls, mean (SD) gestational age was 30.1 (2.84) weeks, and mean (SD) birth weight was 1.49 (0.53) kg. A total of 8093 infants (2.0%) had CAKUT, with urinary tract dilation comprising the majority of cases (5669 [70.0%]). The presence of CAKUT correlated with earlier gestational age and was associated with genetic disorders and extrarenal anomalies. Analysis of 323 957 infants after exclusions demonstrated an adjusted odds ratio of 3.96 (95% CI, 3.70-4.24) of death or severe illness. This risk was found across all forms of CAKUT including isolated urinary tract dilation. The findings of this cohort study suggest that clinicians caring for preterm infants should have higher suspicion for CAKUT and consider screening, particularly those with extrarenal anomalies or genetic disorders, as preterm infants with CAKUT appear to be at significantly higher risk of death or severe illness. Detection of CAKUT can inform risk stratification and clinical decision making, and should also prompt clinicians to consider a genetic evaluation.

Highlights from the International Twins Congress 2021

Highlights from the International Twins Congress 2021

An exploratory analysis of leukocyte telomere length among pregnant and non-pregnant people

BackgroundLeukocyte telomere length (LTL) is a biomarker that is affected by older age, psychosocial stress, and medical comorbidities. Despite the relevance of these factors to obstetric practice, little is known about LTL in pregnancy. Our study explored longitudinal LTL dynamics in pregnant and non-pregnant people. ObjectiveThis pilot study compares changes in LTL between pregnant and non-pregnant people over time, explores potential correlations between LTL and mental health measures, and investigates associations between short first-trimester LTL and adverse pregnancy outcomes. Study designThis was a prospective pilot cohort study of nulliparous pregnant and non-pregnant people between ages 18 and 50 who presented for care at a single institution from January to November 2020. Pregnant people were enrolled between 10 and 14 weeks gestation. Participants had two blood samples drawn for LTL; the first on the day of enrollment and the second on postpartum day 1 (pregnant cohort) or 7 months later (non-pregnant cohort). LTL was measured using quantitative PCR. The primary outcome was the difference between pregnant and non-pregnant people in LTL change between the two timepoints (basepair difference per 30-day period). Secondary outcomes included differences in responses to the Patient Health Questionnaire-9 (PHQ-9) and a survey about stress related to COVID-19. Differences in LTL were tested using t-tests and linear regression models, both crude and adjusted for age. A subgroup analysis was conducted within the pregnant cohort to examine whether shorter first-trimester LTL was associated with adverse pregnancy outcomes. We conducted t-tests to compare LTL between people with and without each categorical outcome and computed Pearson correlation coefficients between LTL and continuous outcomes such as gestational age at delivery. Results46 pregnant and 30 non-pregnant people were enrolled; 44 pregnant and 18 non-pregnant people completed all LTL assessments. There were no between-group differences in LTL change (−4.2 ± 22.2 bp per 30 days pregnant versus −6.4 ± 11.2 bp per 30 days non-pregnant, adjusted beta 2.1, 95% CI -9.0-13.2, p = 0.60). The prevalence of depression and pandemic-related stress were both low overall. The two groups did not differ in PHQ-9 scores, and no correlations were significant between LTL and PHQ-9 scores. Among the 44 pregnant people, shorter first-trimester LTL was significantly correlated with earlier gestational age at delivery (r = 0.35, p = 0.02). ConclusionIn this exploratory pilot cohort of reproductive-aged people with low levels of psychological stress, we described baseline changes in LTL over time in pregnant and non-pregnant participants. We found a correlation between shorter first-trimester LTL and earlier gestational age at delivery, which warrants further investigation in a larger cohort.

Comparison of cesarean section rates between obstetricians preferring labor induction at early versus late gestational age

ObjectiveTo compare the cesarean section (CS) rates of obstetricians with a preference of labor induction at early versus late gestational age. Material and methodsMedical records of women who were low risk, nulliparous, singleton pregnancy, and >37 weeks and delivered their babies, were reviewed. Obstetricians, who preferred labor induction at<41 weeks, were allocated to the early induction group; and the other obstetricians were allocated to the late induction group. ResultsThe late induction group had a higher percentage of labor induction at ≥41 weeks, compared with the early induction group (21% vs. 8%, p = 0.007). The late induction group had a lower CS rate (11.0% vs. 19.1%, p < 0.001). Multivariable Cox proportional hazard model revealed that the early induction group (hazard ratio [HR] = 2.14, p < 0.001), maternal age (HR = 1.04, p = 0.001), premature rupture of membranes (HR = 1.59, p = 0.006), and birth body weight (kg, HR = 2.13, p < 0.001) were independent predictors of CS. In women receiving labor induction (n = 312), birth body weight (kg, HR = 1.72, p = 0.04) was the sole predictor of CS; and there is a trend that the early induction group (HR = 1.54, p = 0.051) has a higher CS rate, compared with the late induction group. However, gestational age at labor induction was not a predictor of CS. ConclusionIn low-risk pregnancies, obstetricians preferring labor induction at early gestational age seem to be associated with a higher CS rate, compared with obstetricians preferring labor induction at late gestational age. Nonetheless, the above finding seems to be associated with physician's factor, instead of gestational age at labor induction.

Postnatal Outcomes in Infants WithaHistory of Fetal SupraventricularTachycardia.

Fetal supraventricular tachycardia (SVT) is rare and proposed predictors of postnatal outcomes in fetal SVT have not been validated. Valid predictors can guide postnatal management. The authors correlated fetal characteristics to the incidence of postnatal SVT and compared SVT outcomes in infants with and without a history of fetal SVT. Mother-fetus dyads with fetal SVT and a structurally normal heart were described and compared with a second cohort of infants with a postnatal diagnosis of SVT. SVT was observed in 78 fetuses and 76 survived to delivery. Maternally administered transplacental antiarrhythmics were used in 49 mother-fetus dyads. Rhythm control was achieved in 37 of 49 (76%). Among fetuses with intermittent SVT, there was no ventricular dysfunction or hydrops. Postnatal SVT occurred in one-half of infants (37 of 76), and 94% presented within the first 2days of life. The following fetal characteristics were associated with postnatal SVT on univariable analysis: sustained SVT (87% vs 56%), ventricular dysfunction (41% vs 15%), lack of conversion to sinus rhythm (49% vs 10%), and earlier gestational age at delivery (37.6weeks vs 38.9weeks; P≤ 0.01 for each comparison). Compared with infants with a postnatal diagnosis of SVT, infants with a fetal diagnosis presented earlier (median age 0days vs 17days; P&lt; 0.01) and had a lower incidence ventricular dysfunction at presentation (5% vs 42%; P&lt; 0.01). One-half of infants with fetal SVT had postnatal SVT, nearly all within 2days of life. These data and predictors of postnatal SVT may influence parental counseling and postnatal clinical decision-making.

PREDICTIVE VALUE OF PLATELET INDICES IN DEVELOPMENT OF PREECLAMPSIA

Introduction: Preeclampsia (PE) is a multisystem hypertensive disorder that is a major contributor to maternal, neonatal morbidity and mortality. In modern obstetrics, identicaton of pregnant women with an increased PE risk is an objective of paramount importance. In preeclampsia, increased platelet indices may occur earlier than development of other recognized manifestations like hypertension and proteinuria. On the other hand, lowered platelet count and increased platelet indices in pregnant women during antenatal check may be considered as a risk factor for development of preeclampsia and eclampsia.This group of pregnant women may be considered for special attention to prevent the development of preeclampsia. So, the present study was conducted with an aim to assess the association between changes in platelet indices and development of pre-eclampsia. To estima Objectives: te the prevalence of preeclampsia among pregnant women and assess the changes occurring in platelet indices in pregnant women with duration of gestation. A Prospective Material And Methods: Observational study was carried out over a period of 6 months ie., from March to August 2022 in pregnant women with history of normal blood pressure before 24 weeks of gestational age. Institutional ethical committee clearance was obtained for the study. Data collected was entered into MS-Excel 2013 spreadsheet. The collected data was analysed using IBM statistical package for social sciences. Chi-square test and Unpaired t-test was used to nd the signicant difference between two groups. ROC analysis was done to nd out the cut-off values of platelet indices in diagnosing preeclampsia. The prevalence of preeclampsia in the pre Results: sent study was 6.5%. The mean age of the study population was 23.47 ± 2.68 Years. There was a statistical signicant association between platelet indices and preeclampsia (p&lt;0.05) at various weeks of gestational period with high mean value in the preeclamptic women. At 24 – 28 Weeks of gestational age the cut-off &gt; 9.5fL for MPV the sensitivity of detecting preeclampsia was 92.3% and specicity was 80.7%. At cut-off &gt; 15.5% for PDW the sensitivity of detecting preeclampsia was 84.6% and specicity was 69.5%. At cut-off &lt; 0.22% for PCT the sensitivity of detecting preeclampsia was 53.8% and specicity was 59.4%. Patients with preeclampsia are more likely to ha Conclusion: ve rapid and signicant decrease in platelet count and plateletcrit, increase in PDW and MPV in comparison to the normotensive counterparts. These signicant changes can be observed at an earlier gestational age than signicant rise in BP can be observed and changes are more signicant in patients who are destined to develop progressive preeclampsia. Thus estimation of platelet indices seems to be a reliable, rapid, easy and economical method for early detection of preeclampsia.

Choice of standards for sonographic fetal abdominal circumference percentile

The diagnosis of abnormal fetal abdominal circumference is based on values >90th or <10th percentile. There are dozens of established norms that can be used to determine the percentile of a given abdominal circumference measurement, but there is no established method to determine which norms should be used. This study aimed to evaluate the applicability of 5 established abdominal circumference norms to our measurements and to determine which, if any, should be used for the diagnosis of abnormal fetal abdominal circumference. Data were pooled from 6 maternal-fetal medicine practices to conduct a cross-sectional study. The inclusion criteria were a singleton fetus at 22.0 to 39.9 weeks of gestation with cardiac activity present, complete fetal biometry measured, and examination from 2019 or 2020. For patients with >1 eligible examination during the study period, a single examination was chosen at random for inclusion. Five norms of abdominal circumference were studied: the Hadlock formula, the World Health Organization Fetal Growth Curves, the International Fetal and Newborn Growth Consortium for the 21st-Century Project; and the National Institutes of Child Health and Human Development Fetal Growth Studies (fetuses of White patients and unified standard). Using formulas relating abdominal circumference to gestational age, we calculated the z scores of abdominal circumference (standard deviations from the mean), standard deviation of the z score, Kolmogorov-Smirnov D statistic, and relative mean squared error. The 5 norms were assessed for fit to our data based on 6 criteria: mean z score close to 0, standard deviation of the z score close to 1, low D statistic, low mean squared error, fraction of values >90th percentile close to 10%, and fraction of values <10th percentile close to 10%. The inclusion criteria were met in 40,684 ultrasound examinations in 15,042 patients. Considering the 6 evaluation criteria, observed abdominal circumferences had the best fit to the World Health Organization standard (mean z score of 0.11±1.05, D statistic of 0.041, mean squared error of 0.84±1.46, 13% of examinations >90th percentile, and 7% of examinations <10th percentile). The Hadlock reference had an anomaly in its assumption of a constant standard deviation, resulting in the underdiagnosis of abnormal values at early gestational ages and overdiagnosis at late gestational ages. The International Fetal and Newborn Growth Consortium for the 21st-Century Project standard had a mean circumference smaller than all the other norms, resulting in the underdiagnosis of small circumferences and the overdiagnosis of large circumferences. Similar results were observed when restricting the analyses to a low-risk subgroup of 5487 examinations without identified risk factors for large for gestational age or small for gestational age. The diagnosis of abnormal abdominal circumference depends on the norms used to define abdominal circumference percentiles. The World Health Organization standard had the best fit for our data.

Gestational age at birth and academic attainment in primary and secondary school in England: Evidence from a national cohort study.

Preterm birth (<37 weeks’ gestation) is a risk factor for poor educational outcomes. A dose-response effect of earlier gestational age at birth on poor primary school attainment has been observed, but evidence for secondary school attainment is limited and focused predominantly on the very preterm (<32 weeks) population. We examined the association between gestational age at birth and academic attainment at the end of primary and secondary schooling in England. Data for children born in England from 2000–2001 were drawn from the population-based UK Millennium Cohort Study. Information about the child’s birth, sociodemographic factors and health was collected from parents. Attainment on national tests at the end of primary (age 11) and secondary school (age 16) was derived from linked education records. Data on attainment in primary school was available for 6,950 pupils and that of secondary school was available for 7,131 pupils. Adjusted relative risks (aRRs) for these outcomes were estimated at each stage separately using modified Poisson regression. At the end of primary school, 17.7% of children had not achieved the expected level in both English and Mathematics and this proportion increased with increasing prematurity. Compared to full term (39–41 weeks) children, the strongest associations were among children born moderately (32–33 weeks; aRR = 2.13 (95% CI 1.44–3.13)) and very preterm (aRR = 2.06 (95% CI 1.46–2.92)). Children born late preterm (34–36 weeks) and early term (37–38 weeks) were also at higher risk with aRR = 1.18 (95% CI 0.94–1.49) and aRR = 1.21 (95% CI 1.05–1.38), respectively. At the end of secondary school, 45.2% had not passed at least five General Certificate of Secondary Education examinations including English and Mathematics. Following adjustment, only children born very preterm were at significantly higher risk (aRR = 1.26 (95% CI 1.03–1.54)). All children born before full term are at risk of poorer attainment during primary school compared with term-born children, but only children born very preterm remain at risk at the end of secondary schooling. Children born very preterm may require additional educational support throughout compulsory schooling.

Discrepancy Rate and Associated Factors of Gestational Age Determination by Last Menstrual Period Compared with First-Trimester Ultrasound in Certain Menstrual Period Pregnant Women

Objective: To assess discrepancy rate and associated factors of gestational age (GA) determination by last menstrual period (LMP) compared with first-trimester ultrasound in certain menstrual period pregnant women.0 Materials and Methods: The present study was a cross-sectional study that was conducted at Srinagarind Hospital, Khon Kaen University, Thailand between May 2020 and January 2021. Participants were singleton pregnant women who reported certain LMP dates. GA was estimated using Naegele’s rule and crown-rump length (CRL) measurement. Differences of GA more than five days at GA of 8 or fewer⁶/⁷ weeks and more than seven days at GA of nine⁰/⁷ to twelve⁶/⁷ weeks were considered discrepant. Factors associated with discrepancy were determined by calculating an odds ratio (OR) with a 95% confidence interval (CI). Results: Of the 220 participants, 67 had discrepant GA obtained from LMP and CRL measures, accounting for a rate of 30.5% (95% CI 24.4% to 36.9%). Factors associated with increased risk of discrepant GA consisted of low household income (adjusted OR 2.76; 95% CI 1.43 to 5.31) and long intervals of the menstrual cycle (adjusted OR 3.85; 95% CI 1.85 to 8.02). Conclusion: Approximately one-third of participants in the present study had a discrepancy of LMP and early ultrasound-based GA measures. Factors influencing the risk of discrepant GA between these two methods included household income and interval of menstruation. Keywords: Gestational age; Last menstrual period; First-trimester ultrasound; Discrepancy

Prenatal Diagnosis of Structural Anomaly Among Singletons and Twins: Eight-Year Experience in a Chinese Tertiary Center.

This study was designed to reveal structural abnormalities in singleton and twin pregnancies in the Chinese population. This retrospective study spanned 8 years and included 1228 singleton pregnancies (112,919 examinees) and 49 twin pregnancies (1865 examinees) with structural anomalies diagnosed by ultrasound. Detailed descriptions of anomalies, gestational weeks at diagnosis, and maternal age were recorded. The odds ratio was evaluated in twin pregnancies with detectable structural anomalies. The annual average "ultrasound prevalence of fetal anomalies" among singleton and twin pregnancies were 1.09 and 3.06%, respectively. Mothers with twin anomalies were older (P < .001), and twin pregnancies were diagnosed with anomalies in earlier gestational weeks than singleton (P=.011). No differences were found in the types of anomalies between singleton and twin pregnancies. Central nervous system anomaly was the most common type in singleton and twin pregnancies. Twin pregnancies had higher rates of major anomalies than singleton (total OR 2.45), especially cardiovascular, central nervous, and gastrointestinal systems and ear/eye/face/neck disorders. Compared with singleton, twin pregnancies had higher odds of detectable structural anomalies. Twin pregnancies with structural anomalies were diagnosed at earlier gestational age and associated with older maternal age. Central nervous system anomaly was the most common type in singleton and twin pregnancies.

Ultrasound assessment of twin reversed arterial perfusion sequence for the prediction of adverse pregnancy outcomes in the first trimester.

To investigate twin reversed arterial perfusion (TRAP) sequence for the prediction of TRAP-related adverse pregnancy outcomes at the gestational age of 11-14weeks. Pregnant women in the first trimester diagnosed with TRAP were recruited at West China Second University Hospital from January 2015 to June 2018. Systematic screening for the pump twin's crown-rump length (CRL) and acardiac twin's upper pole-rump length (URL) was conducted using ultrasonic detection. The (CRL- URL)/CRL and URL/CRL ratios were used to assess the pregnancy outcomes for the pump twin. Twenty-one pregnant women aged 21-39years with a gestation of 11-14weeks were recruited. TRAP was diagnosed on average(±standard deviation (SD)) at pregnancy week 13.1±0.18. The pump twins' mean(±SD) CRL was 6.65±1.1cm. The incidence of intrauterine death for the pump twins was 19.0% (n=4), the miscarriage rate was 14.3% (n=3), and the live birth rate was 66.7% (n=14). The (CRL- URL)/CRL ratios between the nonsurvival (intrauterine death and miscarriage) and survival groups significantly differed (0.33±0.08vs. 0.58±0.08, p<0.05). Similarly, the URL/CRL ratios between the nonsurvival and survival groups significantly differed (0.67±0.08vs. 0.42±0.08, p<0.05). The (CRL- URL)/CRL and URL/CRL ratios were valuable indicators for determining pregnancy outcomes of pump twins with TRAP at an early gestational age.