Fetal Congenital Anomalies Research Articles

Risk of Congenital Anomalies in Pregnant Women with Type 2 Diabetes

Aim: To assess the risk of congenital anomalies in pregnant women with type II diabetes. Study design: Prospective study Place and duration of study: Department of Diabetes & Endocrinology, Chandka Medical College Hospital, Larkana from 1st October 2021 to 31st March 2022. Methodology: Two hundred pregnant women ≥20 weeks of gestation already suffering from type 2 diabetes were enrolled. Information in relation to their anomaly scan was gained through ultrasonography at the 20th to 21st week. The anomalies were identified as inconsequential (minor) and chief and correlated with the HbA1c percentage category. Results: There were 98 (49%) women who were nulliparous. The poor control as well as worst control HbA1C groups had highest value of body mass index. Within the congenital anomalies observed the overall rate of any anomaly was seen in patients with worst control while least number was observed in good control. Cardiovascular events followed by Genitourinary or renal issues were highest reported as congenital anomalies in fetus. Conclusion: There is a high risk of congenital anomalies in pregnant women with type 2 diabetes with cardiovascular anomalies to be the highest in category. HbA1C ≥11.5% and above is at highest risk of congenital anomalies. Keywords: Risk, Congenital anomalies, Pregnant woman, Type 2 diabetes

Patient perspective regarding late termination of pregnancy at a tertiary care Hospital

To arrive at an understanding about the view and attitudes of pregnant women regarding late termination of pregnancy after prenatal diagnosis of a severe fetal anomaly. A semi-structured questionnaire based prospective descriptive study was conducted from January 2022 to September 2022 in Obstetrics and Gynecology department of Saveetha Medical College and Hospital, Thandalam. 16 pregnant women with severe fetal anomalies detected after 23 weeks were included. All the women were counselled about the type and lethality of the anomaly including management option. Informed consent was obtained from all the patients and ethical approval was obtained. A total of 16 women with congenital anomalies in fetus detected after 23 weeks of gestation over 8 months of the study period were included in the study. All the participants were properly counselled and given adequate time to make the decision. Among which 11 decided to terminate the pregnancy and 5 continued. All 11 who opted for termination of pregnancy was joint decision by the family. 5 women continued their pregnancy. Reasons to continue the pregnancy were praying that baby will born normal (n=1), hoping that surgery can correct the abnormality (n=3) and wanting to see the baby (n=1). This study shows that women who are pregnant with serious fetal anomalies have a range of opinions and attitudes regarding termination. To compare with initial decision making larger follow-up studies will be necessary to see whether patient’s perspective changes over time.

Rates and subsequent clinical course of fetal congenital anomalies detected by prenatal targeted ultrasonography of 137 cases over 5 years in a single institute: a retrospective observational study.

With the establishment of international guidelines and changes in insurance policies in Korea, the role of targeted ultrasonography has increased. This study aimed to identify the rates and clinical course of anomalies detected using prenatal targeted ultrasonography. This study was a retrospective analysis of all pregnancies with targeted ultrasonography performed in a single secondary medical center over 5 years. Fetal anomalies were detected by targeted ultrasonography in 137 of the 8,147 cases (1.7%). The rates of anomalies were significantly higher in female fetuses (2.0% vs. 1.3%). In cases of female fetuses, the rate of anomalies was significantly higher in the advanced maternal age group (2.4% vs. 1.2%). In cases of male fetuses, the rate of anomalies was significantly higher in nulliparous (2.4% vs. 1.5%) and twin (5.7% vs. 1.9%) pregnancies. Pulmonary anomalies were significantly more common in the multiparity group (17.6% vs. 5.8%). Among the 137 cases, 17.5% terminated the pregnancy, 16.8% were diagnosed as normal after birth, and 42.3% were diagnosed with anomalies after birth or required follow-up. Through the first study on the rates and clinical course of anomalies detected by targeted ultrasonography at a single secondary center in Korea, we found that artificial abortions were performed at a high rate, even for relatively mild anomalies or anomalies with good prognosis. We suggest the necessity of a nationwide study to establish clinical guidelines based on actual incidences or prognoses.

Effect of low dose aspirin application during pregnancy on fetal congenital anomalies

BackgroundWith the extensive use of aspirin in obstetrics and reproductive medicine, concerns of potentially related congenital anomalies have been raised in previous studies. However, there is a lack of evidence concerning the safety of application of aspirin during pregnancy in Chinese population, especially during the first trimester.Patients and methodsWe retrospectively included a total of 2,763 patients with 2,856 fetuses (2670 singleton births and 93 pairs of twins), among whom 1,684 took low dose aspirin (LDA) during pregnancy (the LDA group) and the other 1,079 were not exposed to LDA (the control group). The primary outcome was the rate of fetal congenital anomalies, and was compared between the LDA group and the control group. We also conducted logistic regression to examine the potential risk factors of congenital abnormalities.ResultsThe average daily dose of LDA taken was 67.6 mg. The rate of congenital anomalies was comparable between the two groups, suggesting low teratogenicity of LDA application during pregnancy (3.3% vs. 2.8%; P = 0.421). The duration of LDA exposure and the time of LDA exposure showed no association with congenital anomalies. A previous history of fetal congenital anomalies was associated with an increased risk of the recurrence of congenital anomalies in the siblings (adjusted OR = 3.00, 95% CI: 1.00–8.60; P = 0.041).ConclusionExposure to LDA during pregnancy did not increase the risk of congenital anomalies in the fetus, suggesting that it was safe to apply LDA during pregnancy. A history of previous fetal abnormalities was found to be an independent risk factor of congenital anomalies. Our study suggests that LDA can be safely applied during pregnancy without increasing risks of congenital anomalies.

Folic acid and its implications in genetic pathology

Vitamins are essential for the proper functioning of the body, and Folic Acid, also known as Vitamin B9, has many benefits for the body. Folic Acid contributes to the normal development of the fetus, preventing the risk of fetal birth defects, mainly represented by neural tube defects and orofacial clefts. At the same time, Folic Acid deficiency can cause serious health problems. That is why it is necessary to know the roles of Folic Acid in the body, the symptoms of Folic Acid deficiency, but also what foods are rich in Folic Acid and how to supplement the body's need for Folic Acid.

SIRENOMELIA: A RARE CASE REPORT FROM RURAL HOSPITAL OF NEPAL

Sirenomelia (mermaid syndrome) is a rare congenital fetal anomaly with characteristic feature of complete or partial fusion of lower limbs. Additional malformations are genitourinary abnormalities, gastrointestinal abnormalities, anomalies of the lumbosacral spine and pelvis and absence or poor development (agenesis) of one or both kidneys. It has incidence of 0.98 to 4.2 per 100,000 live births. Since antenatal diagnosis of this universally lethal condition is possible, pregnancy can be terminated at the earliest.We report a case of sirenomelia baby born to a twenty one years old female at 41 weeks of gestation at Karnali Academy of Health Sciences, Jumla Nepal.

Abnormal transcriptome-wide DNA demethylation induced by folate deficiency causes neural tube defects.

Neural tube defect (NTDs) is one of the most common and serious fetal and neonatal birth defects. Neural tube closure (NTC) is an exquisitely coordinated process and this procedure is influenced by both genetic and environmental factor. Folic acid (FA) supplementation is an effective for prevention of a proportion of NTDs, however, the mechanism remains unclear. In this study, our data demonstrated genome-wide enrichment of 5-hydroxymethylcytosine (5hmC) modification on active transcriptional start sites (TSS) and decreased 5-methylcytosine (5mC) binding to TSS under folate deficiency in mESCs (mouse embryonic stem cells). Furthermore, folate deficiency promoted 5hmC enrichment enhancer histone 3 lysine 27 acetylation (H3K27ac) binding to Shh pathway genes in mESCs. Upregulation of Shh target genes was observed in mouse brain tissue under low levels of maternal serum folate, along with increased expression of 5-methylcytosine dioxygenase Tet1 levels. Taken together, we found that folate deficiency promoted DNA demethylation and enriched 5hmC through recruitment of H3K27ac to activate the Shh signaling pathway. These results suggest that the 5hmC modification increases concomitantly with a positive correlation to Shh gene expression in folate deficiency-induced mouse NTDs.

Dystocia due to Dicephalic Parapagus Tetrabrachius Tetrapus Twin Monster in a Cow: A case Report

Monsters are developmental abnormalities that distort organs and body systems. Developmental abnormalities of the ovum, embryo or fetus occur in all species of domestic animals. Monstrosity is a disturbance of the development that involves various organs and systems which can cause great distortion of the individual (Vegad, 2007). The monstrosities are associated with either infectious diseases or congenital disabilities (Arthur et al., 2001), which may or may not interfere with birth. Abnormal duplication and/or disruption of the inner cell mass in an embryo give rise to congenital fetal abnormalities with partial duplication of body structures. Duplication of cranial portion of the fetus is more common than caudal portion (Roberts, 2004). It is important to know various types of monsters in animals that usually cause dystocia, which cannot be easily delivered and require a Caesarean section or a fetotomy mostly (Patil et al., 2004; Sharma, 2006). The incidence of fetal monsters, though rare, have been reported in cows (Khasatiya et al., 2009; Jerome et al., 2010; Ravikumar et al., 2012), in buffaloes (Dhami et al., 2000; Prasad et al., 2006; Sharma et al., 2010) and in goats (Pandit et al., 1994). This communication reports a rare case of conjoined twin monster (Dicephalus Paracopagus Tetrabrachius Tetrapus Dicaudatus) in a pluriparous crossbred cow.

Frequency Of Fetal Congenital Abdominal Anomalies Diagnosed On Ultrasound In Gujrat Pakistan: A Cross-sectional Study

Introduction: A congenital abnormality is referred to as a congenital illness or deformity. In the first four weeks of life, 276,000 newborns die from congenital impairments, giving birth to a total of around 3 million fetuses and babies; these fetuses and infants are affected by abdominal fetal deformities. Each demographic has a different prevalence of birth defects.
 Using standard ultrasonography, we set out to find out how often it is to see congenital fetal abdominal abnormalities in Gujrat District of Pakistan.
 Methods: From January 2022 to June 2022, researchers will conduct cross-sectional study at the Azeem Diagnostic Center Gujrat. 397 This research included pregnant women in the first, second, and third trimesters. Statistical analysis of prenatal ultrasound findings was carried out via the use of a structured questionnaire. A p-value of less than 0.05 was considered significant when using the Chi-square test to look for a relationship. Odds Ratio was used to calculate illness risk. 
 Results: Twenty separate pregnant women who had ultrasounds had fetal congenital impairments discovered. Patients with Atresia or Renal Agenesis are nine times more likely to have an Omphalocele than those without (odds ratio = 0.994, 95 percent confidence range = 0.986-1.002).
 Conclusion: It is a noninvasive imaging technique that is incredibly sensitive and accurate while also being quite affordable in the hands of a skilled professional. At least during the second trimester, obstetricians should encourage their patients to get regular ultrasounds.

Endometrial preparation and maternal and obstetrical outcomes after frozen blastocyst transfer

Two types of endometrial preparation protocols are used for frozen embryo transfers in current practice: hormone replacement and the natural cycle. Endometrial preparation in the natural cycle reportedly increases the chances of live birth and decreases early pregnancy loss compared with that in the hormone replacement cycle. However, the influence of endometrial preparation on maternal and neonatal health remains unclear. This study aimed to investigate whether the differences between hormone replacement cycle and natural cycle influence perinatal outcomes and risk of congenital anomalies in frozen-thawed blastocyst transfer fetuses or births. Perinatal outcomes and congenital abnormalities were compared between the natural and hormone replacement cycles. According to the timing of ovulation, frozen-thawed blastocyst transfers in the natural cycle were classified into 2 patterns: on day 4.5 (ovulation 4.5) or day 5 (ovulation 5.0) after ovulation. When the serum luteinizing hormone level was not increased on the day of the trigger, a single vitrified-warmed blastocyst transfer was performed on day 7 after the trigger (ovulation 5.0). When the luteinizing hormone level was slightly increased on the day of trigger, single vitrified-warmed blastocyst transfer was performed on day 6 after the trigger (ovulation 5.0). In total, 67,018 cycles (ovulation 4.5, 29,705 cycles; ovulation 5.0, 31,995 cycles; hormone replacement, 5318 cycles) of frozen-thawed blastocyst transfer between January 2008 and December 2017 at Kato Ladies Clinic were retrospectively analyzed. During the study period, embryo cryopreservation was performed using a vitrification method in all cycles. Hormone replacement cycles were associated with a higher occurrence of hypertensive disorders of pregnancy (adjusted odds ratio, 2.16; 95% confidence interval, 1.66-2.81) and placenta accreta (adjusted odds ratio, 4.14; 95% confidence interval, 1.64-10.44) compared with the natural cycle. The risks of cesarean delivery (adjusted odds ratio, 1.93; 95% confidence interval, 1.78-2.18), preterm birth (adjusted odds ratio, 1.55; 95% confidence interval, 1.25-1.93), and low birthweight (adjusted odds ratio, 1.42; 95% confidence interval, 1.18-1.73) were also higher for hormone replacement cycles. No significant difference in the risk of congenital anomalies was observed between the 2 cycles. The risk of hypertensive disorders of pregnancy, placenta accreta, cesarean delivery, preterm delivery, and low birthweight was higher in hormone replacement cycles than in natural cycles, whereas the risk of congenital anomalies was similar between both cycles. Further follow-up is needed to investigate these risks and to explore alternative endometrial preparation methods.

Holding a baby after stillbirth: the impact of fetal congenital and structural abnormalities.

ObjectiveStillbirth can result in numerous adverse psychosocial sequelae. Recommendations vary with regard to holding the baby after a stillbirth. Few studies have addressed the impact of fetal abnormalities on these outcomes.Study designAnalyses of singleton stillbirths within the Stillbirth Collaborative Research Network were conducted. Patient and stillbirth characteristics were compared between those who did and did not hold their baby. Results from psychometric surveys were compared between cases with and without visible fetal anomalies.ResultThere were no significant differences between those who held and those who did not hold in any patient or stillborn characteristics. Visible fetal abnormalities were not associated with adverse psychological outcomes.ConclusionFetal abnormalities, including congenital and post-demise changes, do not differ between those who held and did not hold their baby after stillbirth. This suggests that patients should not be discouraged from holding their stillborn infant in the presence of visible abnormalities.

Comparison of the Screening Tests for Gestational D.M One Step and Two Step Methods among the Pregnant Women

Gestational Diabetes Mellitus (GDM) has defined by the World Health Organization (WHO) in 1999 as any degree of carbohydrate intolerance resulting in hyperglycemia of variable severity, with onset or first recognition during pregnancy, excluding overt diabetes in early pregnancy [1]. Its prevalence varies worldwide and also with the testing method and diagnostic criteria used [2]. Extensive research has demonstrated that GDM is associated with short- and longterm complications concerning both mother and child. Screening and treating GDM are an effective means to prevent short term complications and a significant opportunity for intervention in order to avoid long term ones [3]. Short term complications of GDM such as macrosomia, shoulder dystocia, birth trauma, increased rate of cesarean section, in uterine fetal death, neonatal hypoglycemia, congenital anomalies, and respiratory distress syndrome, and to the occurrence of maternal hypertensive disorders [4]. Long term complications include maternal increased risk of developing Type 2 Diabetes (T2DM) later in life and major potential metabolic pattern disorders in the offspring, which would lead to increased risks of abnormal glucose tolerance, obesity and metabolic syndrome [5].

Genetic characteristics and prognostic analysis of 162 fetal cardiac abnormalities

Objective: To analyze the type and characteristics of fetal cardiac abnormalities and their relationships with genetic abnormalities and clinical prognosis. Methods: The clinical data of 162 pregnant women with fetal cardiac abnormalities who came to the prenatal diagnosis center of Peking University First Hospital and performed genetic tests from February 2013 to February 2021 were reviewed. Genetic testing methods included chromosome karyotype analysis, array-based comparative genomic hybridization (aCGH) and pathogenic gene detection. Fetuses with isolated cardiac abnormalities and no fatal genetic abnormalities were assessed using the fetal cardiac birth defects clinical outcome score and followed up. Results: (1) Ultrasonography results: among the 162 fetuses, 86 cases (53.1%, 86/162) had isolated cardiac abnormalities, and 76 cases (46.9%, 76/162) had extra-cardiac abnormalities; single cardiac abnormalities were in 84 (51.9%,84/162) cases, and multiple cardiac abnormalities occurred in 78 cases (48.1%,78/162). (2) Genetic examination results: there were 39 cases (24.1%, 39/162) of pathogenic genetic abnormalities, including 35 cases (21.6%, 35/162) of pathogenic chromosome karyotype abnormality, 3 cases (1.9%, 3/162) of pathogenic copy number variant (CNV), and 1 case (0.6%, 1/162) of pathogenic gene variation. The detection rates of pathogenic genetic abnormalities were 16.3% (14/86) in fetuses with isolated cardiac abnormalities and 32.9% (25/76) in fetuses with cardiac abnormalities and extra-cardiac abnormalities, and the difference was statistically significant (χ2=6.094, P=0.014). The detection rate of genetic abnormalities was 28.6% (24/84) in the single cardiac abnormalities, among which ventricular septal defect was 36.7% (11/30), atrioventricular septal defect was 8/13, tetralogy of Fallot was 3/17, persistent trancus arteriosus was 1/1, cardiac tumor was 1/1; no genetic abnormality was detected in the other single cardiac abnormality types (22 cases in total). The main types of pathogenic genetic abnormalities were trisomy 21 (41.7%, 10/24) and trisomy 18 (41.7%, 10/24). (3) Pregnancy outcome and fetal prognosis: among 72 fetuses with isolated heart abnormalities without pathogenic genetic abnormalities, there were 4 cases of grade Ⅰ, all of which continued pregnancy; 39 cases of grade Ⅱ, with 21 cases induced labor, 18 cases continued pregnancy; 26 cases of grade Ⅲ, with 23 cases induced labor, 3 cases continued pregnancy; 3 cases of grade Ⅳ, all of which induced labor. Totally, there were 47 cases induced labor and 25 cases continued pregnancy, 24 cases (96.0%, 24/25) of which were alive. Conclusions: When fetal cardiac abnormalities are detected by prenatal ultrasound, comprehensive cardiac and extra-cardiac ultrasound assessment and further genetic testing are recommended. Fetuses excluded pathogenic genetic abnormalities and extra-cardiac abnormalities should perform clinical prognostic score evaluation through multidisciplinary collaboration, to improve maternal and fetal outcomes.

The role of pre-pregnancy care for women with pregestational diabetes mellitus for improving maternal and perinatal outcomes

The occurrence of diabetes mellitus in women before pregnancy (pregestational diabetes mellitus can have various adverse consequences for the mother, fetus, child, and pregnancy. Pregnancy planning in women with pregestational diabetes mellitus significantly improves the outcomes of pregnancy and childbirth. The introduction of diabetes self-control skills, the use of human insulin and insulin analogues, the use of constant subcutaneous insulin infusion and family planning allows for optimal glycemic control in early pregnancy and reduces the incidence of fetal congenital anomalies and perinatal mortality. Lifestyle optimization, weight loss, taking adequate doses of folic acid, discontinuation of teratogenic medications, and quitting smoking are essential components of preconception care. Of significant clinical value is the training of women planning pregnancy at the Diabetes school, training in self-control and insulin therapy skills, consultation with an endocrinologist, an obstetrician-gynecologist, an ophthalmologist, a nephrologist, and a nutritionist.
 The aim of this study was to present current data on pre-pregnancy care in patients with pregestational diabetes mellitus and to show its possibilities in reducing the frequency of obstetric and perinatal complications. We analyzed 74 domestic and foreign literature sources using the following databases: PubMed, PubMed Central, Google Scholar, and UpToDate.

Hyperemesis Gravidarum and the Potential for Cancer: A Longitudinal Cohort Study over Three Decades.

Our objective was to assess whether hyperemesis gravidarum is associated with the risk of endodermal, mesodermal, and ectodermal human chorionic gonadotropin (hCG) receptor+ cancer in women. We performed a longitudinal cohort study of 1,343,040 women who were pregnant between 1989 and 2019 in Quebec, Canada. We identified women with and without hyperemesis gravidarum and followed them over time to capture incident cancers, grouped by embryonic germ cell layer of origin and organ hCG receptor positivity. We used time-varying Cox regression to model hazard ratios (HR) and 95% confidence intervals (CI) for the association between hyperemesis gravidarum and cancer onset, adjusted for maternal age, comorbidity, multiple gestation, fetal congenital anomaly, socioeconomic deprivation, and time period. Women with hyperemesis gravidarum had a greater risk of endodermal cancer compared with no hyperemesis gravidarum (5.8 vs. 4.8 per 10,000 person-years; HR, 1.36; 95% CI, 1.17-1.57), but not mesodermal or ectodermal cancer. Severe hyperemesis with metabolic disturbance was more strongly associated with cancer from the endodermal germ layer (HR, 1.97; 95% CI, 1.51-2.58). The association between hyperemesis gravidarum and endodermal cancer was driven by bladder (HR, 2.49; 95% CI, 1.37-4.53), colorectal (HR, 1.41; 95% CI, 1.08-1.84), and thyroid (HR, 1.43; 95% CI, 1.09-1.64) cancer. Women with hyperemesis gravidarum have an increased risk of cancers arising from the endodermal germ cell layer, particularly bladder, colorectal, and thyroid cancers. Future studies identifying the pathways linking hyperemesis gravidarum with endodermal tumors may help improve the detection and management of cancer in women.

Impact of vitamin D on maternal and fetal health: A review.

The role of vitamin D in improving maternal health and reducing the risk of developmental disorders in fetus has been an important domain of research since the past few years. Vitamin D, owing to its immunomodulatory, anti‐inflammatory, developmental roles, and regulating calcium homeostasis, is predicted to have a significant influence on maternal and fetal health status. Several observational studies and clinical trials, determining the impact of vitamin D on gestational diabetes, C‐section, postpartum depression, pre‐eclampsia, miscarriages, and preterm delivery, have been elaborated in this review. In addition, fetal birth defects including neurological development, reduced birth weight, respiratory infections, bone development, and altered anthropometrics have also been summarized with available evidences. Other important mechanisms related to the roles of vitamin D in the body are also explained. Furthermore, recent studies determining the effect of vitamin D at genetic level will also help in understanding and future design of research in the area of maternal and fetal health.

Four-dimensional ultrasound in the diagnosis of intrauterine central nervous system anomalies: four dimensional in CNS congenital anomalies

Background Central nervous system (CNS) anomalies are an important factor of neonatal deaths. Three-dimensional (3D)/4D ultrasound (US) has an advantage over the conventional 2D US as it provides additional multiple options like multiplanar view, tomographic view, and surface rendering view leading to accurate diagnosis of fetal congenital anomalies. Aim The aim of this study was to evaluate the role of the 4D US in the diagnosis of in utero congenital CNS anomalies. Patients and methods The current study was conducted on 30 pregnant women with suspected congenital CNS anomalies by 2D US in Tanta University Hospitals. All the patients were subjected to 2D and 4D US examination in cases with suspected anomalies by 2D US. Results Out of 30 anomalies, two (6.5%) anomalies were lobar holoprosencephaly; six (20%) anomalies were anencephaly, three (10%) anomalies were exencephaly, one (3.5%) anomaly was aqueductal stenosis, three (10%) anomalies were chiari malformation with its two types I and II, and three (10%) anomalies were Dandy–Walker. Three anomalies were hydranencephaly (10%), three (10%) meningocele, one (3.5%) spina bifida, and two cases were obstructive hydrocephalus distal to the 4th ventricle (obstruction of foramen of luschka and magendie) (6.5%). As regards brain anomalies, sensitivity of 4D US=96.4%, specificity of 4D US=100%, positive predictive value=100%, negative predictive value=50.0%, and accuracy=96%. So, 4D US is more superior to 2D US in demonstrating anomalies of the CNS (through multiplanar view and tomographic views), which may affect the postnatal outcome. 4D US offers precise demonstration of normal and abnormal fetal structures through its different modes, so it helps in accurate prenatal diagnosis of CNS anomalies. Conclusion 4D US is considered now an important diagnostic tool in fetal medicine as it provides many advanced diagnostic options such as multiplanar view or tomographic imaging, volume calculation, and surface rendering mode, which aided in early diagnosis of fetal anomalies and improved postnatal outcome.

Evaluation of Pregnancies with Pre-existing Hypertension and Diabetes

The complications in pregnancy can happen due to diabetes and hypertension which may affect the mother or the fetus. Objective: To evaluate pregnancy in hypertensive and diabetic pregnant women to detect associated risk factors and complications. Methods:The research was a cross-sectional method of study, conducted over 4 months from December 2021 to March 2022 in a private hospital in Gujranwala, Pakistan. A sample size of 50 was considered as per convenience. The data was analyzed using SPSS V20 software. The age of patients considered was minimum 18 years to maximum 50 years . The scan was done using greyscale type 2D Mindary ultrasound equipment. A written consent form was also taken from patients. Results: The results showed that 15(30%) patients were presented with diabetes mellitus, 32(64%) has hypertension and 3(6%) has both hypertension and diabetes mellitus. The complications included low lying placenta and placental abruption in 1(2%), polyhydramnios in 3(6%) and oligohydramnios in 1(2%). Microcephaly was found in 1(2%) and hydrocephalus was seen in 2(4%). Fetal abortion was found in 7(14%) and only 3(6%) have chance of having a fetus with abnormalities due to hypertension and diabetes whereas most of them have normal birth 43(86%) with no complications. Conclusion: In conclusion, the majority of women with diabetes mellitus and hypertension can have a normal pregnancy and birth, but some may face difficulties such as intrauterine fetal mortality, fetal congenital abnormalities and defects and still birth

O-059 Pregnancy, delivery and neonatal outcomes among women with an arcuate uterus, a large American population based study

Abstract Study question In this study, we evaluated the pregnancy, delivery and neonatal outcomes among women with an arcuate uterus. Summary answer The arcuate uterus is associated with multiple adverse pregnancy outcomes, particularly, increased risk for; cesarean delivery (CS), venous thromboembolism (VTE) and pulmonary embolism (PE). What is known already Congenital uterine anomalies (CUAs) have been associated with poor reproductive outcomes. The arcuate uterus is one of the most common CUAs, however, it is believed to be a variation of normal and should as such have minimal adverse effects on pregnancies. However, the published studies evaluating the effects of arcuate uteri on pregnancy outcomes, involved only small numbers of participants, and were not powered to detect differences, while reporting conflicting results. Study design, size, duration A retrospective population-based study was conducted using data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). Unique in-hospital births occurring between 2010 and 2014 were included. Cases of arcuate uterus were identified using the ICD code 752.36. A total of 3,840,147 control births and 754 in women with an arcuate uterus occurred during the study period. Pregnancies in women with an arcuate uterus were compared to those without CUAs. Participants/materials, setting, methods We assessed hypertensive disorders, gestational diabetes and placenta previa, preterm premature rupture of membranes (PPROM), preterm delivery, placental abruption, chorioamnionitis, delivery mode, bleeding, clotting and wound complications, maternal infections or death. Selected neonatal outcomes included small for gestational age(SGA), intrauterine fetal demise and congenital anomalies. A multivariate logistic regression was used to adjust for confounding effects. IRB approval was not required since the study included only publicly available anonymized data. Main results and the role of chance Women with an arcuate uteri were more likely to be older, Caucasian, with a higher income, and private insurance (P-value < 0.0001 all). They were also more likely to have had a Cesarean in the past, to have pre-gestational diabetes, thyroid disorders, an in-vitro pregnancy and multiple gestations (P-value <0.01 all). Pregnancies associated with the arcuate uterus had higher rates of pregnancy-induced hypertension (PIH) (aOR 1.32, 95% CI 1.03-1.70), preeclampsia (aOR 1.63, 95% CI 1.18-2.24), premature preterm rupture of membranes (PPROM) (aOR 2.86, 95% CI 1.86-4.40), preterm delivery (aOR 1.86, 95% CI 1.45-2.37) and placental abruption (aOR 3.08, 95% CI 1.99-4.77). They also had 10.88 times the odds of delivering via Cesarean (95% CI 8.90-13.30), 4.81 times the odds of suffering from a VTE (95% CI 1.20-19.30) and 15.14 times the odds of having a PE (95% CI 3.76-60.91). Small for gestational age (SGA) neonates were also more common (aOR 2.21, 95% CI 1.58-3.10). Limitations, reasons for caution The database may be affected by recall bias and coding issues. Information on the method of diagnosing arcuate uteri was lacking. However, to our knowledge, this is the largest study looking at the reproductive outcomes with the arcuate uterus. We were powered to adjust results to identified confounding factors. Wider implications of the findings Our study demonstrates that women with an arcuate uterus are at increased risk for certain undesirable pregnancy outcomes. Physicians following these women should be prepared to manage these complications. Since our results differ from those of some smaller cohorts, additional large studies should be undertaken to confirm the results. Trial registration number Not applicable

Understanding the Immune System in Fetal Protection and Maternal Infections during Pregnancy.

The fetal-maternal immune system determines the fate of pregnancy. The trophoblast cells not only give an active response against external stimuli but are also involved in secreting most of the cytokines. These cells have an essential function in fetal acceptance or fetal rejection. Other immune cells also play a pivotal role in carrying out a successful pregnancy. The disruption in this mechanism may lead to harmful effects on pregnancy. The placenta serves as an immune barrier in fetus protection against invading pathogens. Once the infections prevail, they may localize in placental and fetal tissues, and the presence of inflammation due to cytokines may have detrimental effects on pregnancy. Moreover, some pathogens are responsible for congenital fetal anomalies and affect almost all organs of the developing fetus. This review article is designed to address the bacterial and viral infections that threaten pregnancy and their possible outcomes. Moreover, training of the fetal immune system against the exposure of infections and the role of CD49a + NK cells in embryonic development will also be highlighted.