Fetal Factors Research Articles

Growth factors in the fetus and pre-adolescent offspring of hyperglycemic rats.

Background:Maternal hyperglycemia influences childhood metabolic syndrome, including obesity and hyperglycemia. We tested the hypothesis that the maternal hyperglycemia influences growth factors in the fetal and pre-adolescent offspring.Methods:Hyperglycemia was induced in pregnant rats on embryonic day (E)16 using streptozocin followed by implantation with insulin or placebo pellets at embryonic day 18 (E18). Fetuses at E20 and pre-adolescent pups at postnatal day 14 (P14) were studied: (1) normal untreated controls (CTL) at E20; (2) hyperglycemic placebo-treated (HPT) at E20; (3) hyperglycemic insulin-treated (HIT) at E20; (4) CTL at P14; and (5) HIT at P14. Fetal and pre-adolescent growth factors were determined.Results:Biomarkers of hypoxia were elevated in the HPT group at E20. This group did not survive to term. Maternal insulin improved fetal survival despite lower fetal body weight at E20, however, at normal birth (postnatal day 0 (P0)) and at P14, body weights and blood glucose were higher than CTL. These high levels correlated with aberrant growth factors. Maternal hyperglycemia influenced glucose-6-phosphate dehydrogenase, glucagon, insulin, interleukin-10, and leptin genes.Conclusions:The impact of maternal hyperglycemia on pre-adolescent glucose and body weight was not a consequence of maternal overnutrition. This suggests an independent link which may affect offspring metabolic health in later life.

Risk and Prognostic Factors in Perinatal Hemorrhagic Stroke.

Background:Perinatal stroke encompasses a heterogeneous group of focal neurological injuries early in brain development. In this study, we aimed to compare risk and prognostic factors in preterm and term infants with perinatal hemorrhagic stroke (PHS).Patients and Methods:The study includes 66 infants with PHS. The infants were evaluated for demographic characteristics, fetal and maternal risk factors, perinatal events, clinical and neuroimaging findings, complications, and sequales.Results:Of 66 infants with PHS, 44 (66.70%) were preterm and 22 (33.30%) were term infants. Primiparity, mucosal bleeding, and multiple lobes involvement were more common in term infants than preterm infants (P < 0.05); however, respiratory insufficiency, neonatal sepsis, perinatal asphyxia, respiratory distress syndrome, use of invasive mechanical ventilation, use of noninvasive mechanical ventilation, and prolonged hospitalization were more common in preterm infants than term infants (P < 0.05). Eight (12.12%) infants died during infancy period. Small for gestational age and mucosal bleeding were more common in infants who are dead than those alive (P < 0.05). Forty-two (63.63%) infants were followed. Cerebral palsy and/or epilepsy and/or hydrocephalus were diagnosed in 36 (85.72%) infants during follow-up.Conclusion:Our findings showed that PHS was much more common in preterm infants. Mucosal bleeding and multiple lobes involvement were more common in term infants. PHS has high morbidity and mortality rates. Small for gestational age and mucosal bleeding were more common in infants who are dead.

Dare's Formula Specifications in Assessing Fetal Weight

One of the causes of complicating labor is the fetal factor, namely the fetus's size. If it is not treated immediately, it will increase maternal and neonatal mortality rates. Accurate estimation of fetal birth weight in pregnancy and delivery is an important indicator in determining fetal well-being. Birth weight is important to measure before labor starts, which helps anticipate possible complications in pregnancy, childbirth, and the puerperium. The accuracy of estimation of fetal body weight either by measuring the fundal height or other means will affect labor management. One way to predict the estimated fetal weight, including the Dare's Formula method, is to measure the circumference of the mother's abdomen (abdominal girth) in centimeters, the measurement results times the Fundus Uterine Height (TFU) in centimeters, and the modified Niswander formula (1.12 TFU). - 7,7) 100 (gr). The design used in this study is a Quasi Experiment. Assessment The estimated fetal weight obtained from the measurement is then compared with the newborn's body weight (actual body weight). The population in this study were all pregnant women, both primiparous and multiparous. While the sample to be taken must meet the inclusion criteria that have been set. The results of the study were based on statistical tests using independent t-test, it was found that the p value (0.000) &lt;α (0.05) means that there is a significant difference between the difference in body weight of babies born with Dare's formula and the difference in body weight of babies born with Niswander's modification, the estimated fetal weight is more. Effective using Dare's formula rather than Niswander modification.

Preconception care: What women know, think and do

Preconception care are interventions that help in identifying maternal and fetal risk factors that could be prevented and managed in order to reduce materno-fetal morbidities and mortality. The study determined the predictors of knowledge, attitude, and practice of preconception care among women at the University College Hospital, Ibadan, Nigeria. A cross-sectional study conducted among 414 antenatal attendees using a structured self-administered questionnaire. Data was analyzed using SPSS 20.0 with level of significant set at p<0.05. Above half of the respondents (59.9%) have a good knowledge and positive attitude 223(53.9%) towards preconception care while only 78(18.8%) practiced it. Predictors of good knowledge of preconception care were educational status (OR= 2.350, 95% CI= 1.18-4.70), occupation (OR=5.31, 95% CI=0.42-19.91) and (OR=2.63, 95% CI=0.36-5.10), age at first pregnancy (OR=0.15, 95% CI= 0.04-0.55) and history of contraception use (OR=2.15, 95% CI= 1.32-3.51). Marital status (OR=2.93, 95% CI= 1.04-8.29), occupation (OR=4.01, 95% CI= 1.09-14.79) and history of contraception use (OR=3.00, 95% CI= 1.90-4.72) determined their positive attitude. Factors predicting practice of preconception care were age (OR=0.52, 95% CI= 0.29-0.92), occupation (OR=6.22, 95% CI= 1.70-22.73) and age at first delivery (OR=0.12, 95% CI= 0.02-0.60). Occupation, level of education, age at first delivery, and history of contraception use predicted knowledge, attitude and practice of preconception care. Counseling and educating women on the importance of practicing preconception care will increase their uptake of the service and subsequently lead to reduction in the high maternal and infant morbidity and mortality in our environment. Key words: Preconception care, knowledge, attitude, uptake.

Childhood trauma and insulin-like growth factors in amniotic fluid: An exploratory analysis of 79 women

BackgroundPerinatal stress has adverse effects on fetal outcome, yet the effect of early maternal trauma on fetal outcome has scarcely been studied. We investigated effects of maternal childhood trauma and current environment on important regulators of prenatal growth, fetal insulin-like growth factor (IGF)-1 and IGF-2 in amniotic fluid and assessed the impact of IGFs on newborn anthropometrics. Methods79 pregnant women in their second trimester who underwent amniocentesis (15.9 ± 0.9 weeks of gestational age) and their newborns at birth were analyzed. Maternal childhood trauma was assessed using the childhood trauma questionnaire (CTQ) and current environment was operationalized by assessing maternal psychosocial, physical health and endocrine measurements in amniotic fluid. ResultsIn this exploratory analysis of 79 pregnant women, maternal childhood trauma, defined as reporting at least low scores on any of the CTQ subscales, negatively correlated with fetal IGF-1 (Mln = 3.48 vs. 2.98; p = 0.012) and IGF-2 (Mdnln = 4.99 vs. 4.70; p = 0.002). Trauma severity, defined as the overall trauma score, negatively correlated with fetal IGF-2 (r = −0.24; p = 0.037). From trauma subscales, maternal sexual abuse correlated with fetal IGF-1 (r = −0.32; p = 0.006) and IGF-2 (r = −0.39; p = 0.001). Maternal BMI negatively correlated with fetal IGF-1 (r = −0.26; p = 0.023) and IGF-2 (r = −0.29; p = 0.011). Newborn anthropometrics were operationalized by length, weight, sex, gestational age, length/gestational age and weight/gestational age at birth. Fetal weight at birth associated with a trend with fetal IGF-1 when controlling for BMI. Maternal hypothalamus-pituitary-adrenal axis activity and maternal exercise did not contribute significantly to predicting fetal IGFs. Maternal childhood trauma (β = −0.27; p = 0.011) and BMI (β = −0.24; p = 0.026) remained significantly associated with fetal IGF-1. Maternal childhood trauma (β = −0.32; p = 0.003), maternal BMI (β = −0.30; p = 0.005) and maternal sexual abuse (β = −0.22; p = 0.049) remained significantly associated with fetal IGF-2 and with a trend with fetal IGF-1 (β = −0.21; p = 0.076) when excluding women with gestational diabetes. ConclusionMaternal childhood trauma and BMI associate negatively with fetal IGF-1 and IGF-2 in amniotic fluid. Controlling for maternal BMI, fetal weight at birth remains associated with a trend with fetal IGF-1. The presented data suggests that childhood trauma can affect endocrine measurements of the developing next generation, providing a mechanism by which adverse maternal life events are transmitted to the next generation.

3137 fetuses in 33 years: What we have learned from the Wisconsin stillbirth service program.

The Wisconsin Stillbirth Service Program (WiSSP) provided expert review by a dysmorphologist for community-acquired data on 3137 fetal deaths between 1983 and 2017. Intrinsic fetal causes were consistently identified in about 25% while placental and maternal causes were recognized with increasing frequency as attention was shifted from a primarily fetal to a multifocal approach. Identification of causes increased from 40% to 78% and in about half of cases results of the review altered recurrence risk and/or future pregnancy management. Banked data from WiSSP formed the basis of 24 publications, more than half of which have a genetic counselor and/or summer premedical student intern as an author. The earlier publications emphasized validation of the concept of community-based evaluation with central review, the utility of various parts of the WiSSP protocol, the similarity of second-trimester miscarriages <20 weeks to later stillbirths with respect to causes identified and recurrence risks, and the potential for results of etiologic evaluation to influence future prenatal care. The most important recurrent theme, however, was the interaction of intrinsic fetal, placental, and maternal factors in contributing to fetal demise. This implies that, at least in developed nations with available obstetric care, reduction in stillbirth will require careful attention to the myriad of factors contributing to fetal, placental, and maternal well-being.

Gestational age-specific normative values and determinants of serum progesterone through the first trimester of pregnancy

Progesterone is a steroid hormone that is critical for implantation and maintenance of pregnancy, and low levels are associated with higher miscarriage risk. However, little is known about its trajectory during early pregnancy. We sought to determine the gestational age-specific normative values of serum progesterone on a week-by-week basis, and its associated maternal and fetal factors, during the first trimester of a viable low-risk pregnancy. A cross-sectional study was conducted at KK Women’s and Children’s Hospital from 2013 to 2018. 590 women with a single viable intrauterine low-risk pregnancy, between gestational weeks 5 and 12, were recruited. Serum progesterone showed an increasing trend during the first trimester, with a transient decline between gestational weeks 6–8, corresponding to the luteal–placental shift. Lowest levels were seen at week 7. Maternal age, BMI, parity, gestational age and outcome of pregnancy at 16 weeks’ gestation were found to be associated with progesterone levels. Normative values of serum progesterone for low-risk pregnancies would form the basis for future work on pathological levels of serum progesterone that may increase risk of miscarriage. Larger studies are required to validate these normative values, and personalize them to account for maternal age, BMI, parity and gestational age.

Antenatal predictors of stem cell content for successful umbilical cord blood donation

PurposeThe most important HLA-independent factor for the selection of cord blood units (CBU) for hematopoietic stem cell transplantation is the total nucleated cell (TNC) count over 150 × 107 as a surrogate marker for stem cell content. The purpose of this prospective study was to define prenatal clinical predictors for TNC count that would help to identify successful CBU donors before the onset of active labor.MethodsThis was a prospective analysis of 594 CBUs, collected from all eligible term singleton pregnancies at Basel University Hospital between 4/2015 and 9/2016 analyzing several maternal and fetal factors. The impact of these factors on TNC count (< 150 × 107 cells vs. ≥ 150 × 107 cells) of the CBUs was modeled in a multivariate analysis.ResultsA total of 114 (19.2%) CBUs had a TNC count of ≥ 150 × 107. In a ROC analysis there was no significant difference between the AUC of all prenatal factors (AUC 0.62) and estimated fetal birth weight by ultrasound alone (AUC 0.62). For women planning a trial of labor a recruitment cut-off at an estimated birth weight of 3300 g would allow 72.6% of all donors with sufficient TNC count to be recruited and 22.8% of all collected CBUs would have a sufficient TNC count for banking. For women planning for elective CS a cut-off of 3400 g would allow 71.4% of all donors with sufficient TNC count to be recruited and 22.7% of all collected CBUs would have sufficient TNC count for banking.ConclusionThe estimated fetal birth weight within 2 weeks of delivery by ultrasound as single parameter can be considered at the time of recruitment to estimate the chances of a successful CBU donation.

Abstract PS1-18: Pregnancy-associated breast cancer: Does timing of presentation affect outcome?

Abstract Background: Pregnancy-associated breast cancer (PABC) comprises breast cancer diagnosed during the gestational period or within the first year post-partum. PABC is associated with worse prognosis, especially for women diagnosed in the postpartum period. Methods: This is an IRB-approved retrospective review of an institutional database of women with stage 0-III PABC diagnosed between 1992 and 2019. Clinicopathologic features, treatments, and clinical outcomes were compared between women who were diagnosed with PABC during pregnancy and those who were diagnosed during lactation (1-12 months after delivery). Comparisons were made using Fisher’s exact tests and chi-square tests of independence. Results: A total of 341 women were identified; 131 (38%) diagnosed during pregnancy (pregnancy associated, PA) and 210 (62%) diagnosed post-partum during lactation (lactation associated, LA). Median age for the cohort was 36 (25-46). Median follow-up was 73 months (range, 11-325). Among women with PA diagnoses, 35% (n = 46) presented with breast masses during first trimester, 32% (n = 42) and 33% (n = 43) presented during second and third trimester, respectively; 28% (n = 36) of pregnancies ended in miscarriage or abortion. Fifty-five percent (n = 116) of LA diagnoses were within 6 months of delivery while 44% (n = 92) were between 6-12 months of delivery. The study population was Caucasian (n = 272, 80%), Black (n=26, 7.6%) and Asian (n = 27, 7.9%). Presenting T-stage, N-stage, and AJCC stage were similar between groups. HR+/HER-2-was the most common subtype in both groups (PA n = 49, 37% vs LA n = 71, 34%, p = 0.6). Distribution of other breast cancer receptor profiles were similar between groups (Table). Chemotherapy was administered to 94% (n = 321) of women; 229, 67% as adjuvant and 92, 27% as neoadjuvant (NAC). 72% of women received ddAC-T. Median time to chemo was 3 weeks (range 1-13) for NAC compared to 4 weeks (range 1-16) for adjuvant. Breast cancer treatment was deferred until after delivery for the PA group in 85 women, 65%. Median time from histologic diagnosis to any treatment was 4 weeks (range, 1-22) for PA group and 4 weeks (range 1-17) for LA group. Radiation therapy was received by most women (n = 194, 57%). Endocrine therapy receipt was also common (n = 168, 93% of women with hormone receptor (HR) positive tumors). Patterns of recurrence were similar between groups with most patients in both groups experiencing no recurrence (PA n = 82, 63% vs LA n = 158, 75%, p = 0.10). Differences were observed in disease status with PA having higher rates of women alive with disease (PA n = 16, 12% vs LA n = 12, 5.7%, p = 0.002) and a lower rate of women with no evidence of disease (PA n = 87, 66% vs LA n = 172, 82%, p = 0.002). Conclusions: Clinicopathologic features were similar between women in both PA and LA groups. Despite these similarities, PA appeared to be associated with higher rates of women alive with disease and lower rates of women with no evidence of disease. Although median time from histologic diagnosis to treatment was similar between PA and LA groups, 65% of women in the PA group had treatment delayed until after delivery, which could potentially impact oncologic outcomes. This highlights the balance between fetal and maternal factors in treatment decisions including possible patient or physician reluctance to treat during pregnancy. Further study is necessary to evaluate this finding. Table 1. Clinicopathologic features and outcomes associated with PABCCharacteristicPregnancy Associated, n=131*Lactation Associated, n=210*p-value**Presenting T02 (1.5%)2 (1.0%)0.3147 (36%)98 (47%)267 (51%)85 (40%)310 (7.6%)19 (9.0%)45 (3.8%)6 (2.9%)Presenting N Stage054 (41%)97 (46%)0.2177 (59%)109 (52%)20 (0%)4 (1.9%)AJCC Stage02 (1.5%)2 (1.0%)0.5126 (20%)54 (26%)261 (47%)99 (47%)342 (32%)55 (26%)SubtypeTN45 (34%)59 (28%)0.3HR+/HER2-49 (37%)71 (34%)0.6HR+/HER2+21 (16%)30 (14%)0.8HR-/HER2+10 (7.6%)31 (15%)0.072RecurrenceContralateral Breast3 (2.3%)5 (2.4%)0.10Distant33 (25%)31 (15%)Ipsilateral LRR9 (6.9%)13 (6.2%) No Recurrence82 (63%)158 (75%)Simultaneous LRR and Distant4 (3.1%)3 (1.4%)Disease StatusAWD16 (12%)12 (5.7%)0.002DOC3 (2.3%)0 (0%)DOD25 (19%)26 (12%) NED87 (66%)172 (82%)*Statistics presented: n (%); **Statistical tests performed: Fisher's exact test; chi-square test of independence Citation Format: Angelena Crown, Damian McCartan, Michael Curry, Maya Feldman, Sujata Patil, Sabrina Kamer, Shari B Goldfarb, Mary Gemignani. Pregnancy-associated breast cancer: Does timing of presentation affect outcome? [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-18.

Factors Related to Late Intrauterine Fetal Death in a Tertiary Referral Center: A Retrospective Study

Backgroun: Intrauterine fetal death (IUFD) is a contributor of perinatal outcome and is an important indicator of the quality of antenatal care. Despite efforts, risk factors cannot be identified in cases of intrauterine fetal deaths. This study aims to identify the maternal, fetal, placental and cord related factors related to it. &#x0D; Methods: It is a retrospective cross-sectional study conducted analyzing patients admitted with IUFDs after 28 weeks of pregnancy at Tribhuwan University Teaching Hospital from April 2019 to March 2020. It was conducted after taking ethical approval from Institutional Review Committee (IRC) of Institute of Medicine. Data were collected from review of charts of individual patients in MS Excel and was analyzed using SPSS.&#x0D; Results: There were 5496 births and 46 intrauterine fetal deaths during the study period giving stillbirth rate of 8 per 1000 births. It was common in the age group of 26-30 years (34.8%), 62.2% were from inside Kathmandu valley,43.5% were just literate, 13% were illiterate, 84.8% were housewives, 56.5% were primigravida and 69.57% of the babies were preterm. Only four percent had previous history of intra uterine fetal deaths. Hypertensive disorders complicating pregnancy were found in 30.5% followed by heart disease in 10.9% of the mothers. There were no known co-morbidities in 26.1% of the patients. Out of total 46 cases, 62% were female. Two had Rh isoimmunization and four had congenital malformations. Placenta previa was seen in four percent and abruptio placenta in two percent. Twin pregnancy with diamniotic dichorionic placenta was present in four percent. Seventeen percent of the babies had cord around the neck and two percent had thrombosis of the umbilical cord. &#x0D; Conclusion: Low level of maternal education and maternal comorbidities like hypertensive disorders complicating pregnancy were found to be most common factors seen in cases of intrauterine fetal deaths.

The Prenatal Diagnosis~ What should we do? What can we do?

Purpose: Prenatal diagnostic accuracy has improved; however, the pediatric surgeon’s role remains unclear. This paper aimed to determine the prenatal diagnoses made and the role of pediatric surgeons. Methods: A 6-year retrospective review of 904 pregnancies managed at our institute was conducted. They were classified as a normal pregnancy (NP, n=194), abnormal pregnancy maternal factor (MF, n=449), or abnormal pregnancy fetal factor (FF, n=261). Results: In the FF group, the identified conditions were twin pregnancies (n=75), intrauterine growth restriction (IUGR) (n=49), breech presentation (n=26), arrested development (n=19), hypoamnion (n=42), fetal distress (n=16), hydramnios (n=10), abnormal heart sounds (n=5), meconium staining (n=5), surface anomaly (n=4), calcification (n=2), fetal hydrops (n=2), fetal death (n=2), bowel dilatation (n=2), abdominal mass (n=1) and diaphragmatic hernia (n=1). Case of twin pregnancies, breech presentation, arrested development, IUGR, hypoamnion, abnormal heart sounds, meconium staining and fetal hydrops did not require surgery. Of the 16 cases of fetal distress, 1 had biliary atresia. Of the 10 cases of hydramnios, 1 had meconium peritonitis. Of the 4 with surface anomalies, 3 had gastroschisis. Of the 2 with calcification, 1 had meconium peritonitis. Of the two fetal deaths, 1 had anal atresia suggesting a chromosomal abnormality. Of the 2 cases of bowel dilatation, 1 had bowel atresia. The abnormal mass was caused by adrenal bleeding. These diagnoses were made at an average of 27.4 gestational weeks; however, 2 cases of gastroschisis, suggesting a body stalk anomaly; diaphragmatic hernia; and brain cysts were diagnosed before 20 weeks and were aborted. After delivery, the mortality rate was 0% in neonates treated by pediatric surgeons and neonatologists. Conclusion: Fetal abnormalities are rare; however, early aggressive management with the cooperation of obstetricians and parents is crucial for pediatric surgeons to minimize the effects of anomalies.

Demographic Predictors of Gestational Age at Delivery among Women of Ijaw Tribe in Bayelsa State, in the Niger Delta Region in Nigeria

Background: Though most pregnant women tend to deliver around their expected date of confinement, quite a significant number deliver preterm and postterm. The variation of delivery timing can result from obstetrics complications, genetic or demographic factors.&#x0D; Objective: The objective of this study is to determine the influence of demographic factors of pregnant Ijaw women on gestational age at delivery, like: maternal age, parity, occupation, educational level, gestational age at booking, maternal height, and body mass index, on gestational age at delivery. It also intends to determine the effects of birth weight and fetal sex.&#x0D; Materials and Methods: It was an observational cross-sectional study of 1484 booked pregnant women of Ijaw ethnic group, who delivered in the labour ward of the Niger Delta University Teaching Hospital. Their case notes were retrieved and relevant information such as maternal age, parity, educational level, and occupation was obtained. Others include maternal height and weight at booking, gestational age at booking, gestational age at delivery and birth weight. Body mass index was calculated from height and weight and categorized. Data was analyzed with Chi square, Pearson’s correlation coefficient, simple linear regression, and multivariate analysis&#x0D; Results: The prevalence of preterm birth (PTB) among Ijaw women was 9.7%, and the prevalence of PTB was significantly associated with underweight, Odd ratio = 7.79[3.12, 19.50], low educational level, Odd ratio =2.27[1.40, 3.68], and late booking for antenatal care P = 0.004. Delivery postterm was significantly associated with class 1 obesity, Odd ratio =16.0[4, 59, 55.8], and delivery of male babies Odds ratio = 6.76[2.41, 18.96].&#x0D; Demographic factors from multivariate analysis could only account for 15.9% of the factors responsible for gestational age at delivery, of which the most important were birth weight, educational level and maternal height at booking.&#x0D; Conclusion: Though maternal and fetal demographic factors significantly affects birth weight, the bulk of the determinants (84.1%) are outside these factors, and it could be from obstetrics, genetic, or other factors.

580 Maternal factors influence delivery route more than fetal factors in prenatally diagnosed congenital heart disease

For poorly understood reasons, women with prenatally diagnosed congenital heart disease (CHD) have demonstrated increased cesarean delivery (CD) rates, with no discernable improvement in outcomes. We aim to examine indications for delivery, indications for CD and risk factors associated with CD. Retrospective cohort of 322 singleton pregnancies prenatally diagnosed with moderate to severe CHD requiring surgical intervention in first year of life. Patients with Trisomy 13 or 18 were excluded. We compared contributing maternal and fetal factors for correlation with delivery route. Statistical analysis was completed by Chi-square and Fisher exact tests to compare categorical variables and two-tailed unpaired T-test for continuous variables. Logistic regression risk ratios were utilized to estimate effect size. In the cohort, 147 women underwent CD (rate 46%, 95%CI 40, 51%). Of all CD, 31.3% (95%CI 23.8, 38.7) were secondary to urgent fetal indications. Maternal indications accounted for 42.2% of CD (95%CI 34.2, 50.2%). If CD occurred during labor, 66.7% (95%CI 51.3, 82.1) were due to abnormal fetal heart rate tracing. However, 79.7% of inductions resulted in vaginal delivery (VD) (95%CI 72.8, 86.8) and spontaneous labor resulted in VD in 84.7% (95%CI 75.3, 94.2). Factors significantly associated with CD include morbid obesity (RR 3.0, 95%CI 1.5, 6.1), diabetes (RR 3.9, 95%CI 2.0, 7.3) and severe pre-eclampsia (6.0, 95%CI 1.7, 21.4). Late preterm and early term deliveries were associated with a higher CD rate (2.3, 95%CI 1.2, 4.3 and 1.7, 95%CI 1.1, 2.7, respectively). Fetal growth restriction was associated with CD (RR 3.8, 95%CI 1.6, 9.2). Of the 10 most frequent CHD diagnoses encountered, only hypoplastic left heart was associated with CD (OR 1.9, 95%CI 1.02, 3.4). Although the CD rate is higher in women with fetal CHD, most indications for CD are maternal. Induction and spontaneous labor are successful in this patient population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Incidence and maternal-fetal risk factors of stillbirth. A population-based historical cohort and a nested casecontrol study.

For parents, stillbirth is a tragic experience; thus, identifying the associated risk factors can be beneficial in order to prevent this event. This study aimed to investigate the incidence and risk factors associated with stillbirth. In this historical cohort study, a total of 18,129 birth records were investigated. The outcome variable was having or not having stillbirth. For each case of stillbirth, three live birth infants on the same day and same hospital were selected as controls, which were matched for gestational age. The data were collected using a researcher-made checklist. Finally, data were analyzed using STATA, 13.0 with Cox proportional hazards regression model at the significance level of 0.05. The cumulative incidence of stillbirth was 9.48 per 1,000 live births. Based on multivariate Cox regression model, five risk factors for stillbirth were identified, including male gender, fetal diseases, gestational hypertension, gestational diabetes, and maternal hypothyroidism, (all hazard ratios > 1 and p<0.05), and - for the first time in Iran - maternal hypothyroidism, oligohydramnios, and polyhydramnios were shown as risk factors for stillbirth, which were not evaluated in any previous study. The findings of this study suggest that some maternal and fetal risk factors can be recognized as predictors of stillbirth, which might help to detect and prevent high-risk parents at early stages in order to avoid adverse health consequences in the mother and her neonate.

IGF-1 infusion to fetal sheep increases organ growth but not by stimulating nutrient transfer to the fetus.

Insulin-like growth factor-1 (IGF-1) is an important fetal growth factor. However, the role of fetal IGF-1 in increasing placental blood flow, nutrient transfer, and nutrient availability to support fetal growth and protein accretion is not well understood. Catheterized fetuses from late gestation pregnant sheep received an intravenous infusion of LR3 IGF-1 (LR3 IGF-1; n = 8) or saline (SAL; n = 8) for 1 wk. Sheep then underwent a metabolic study to measure uterine and umbilical blood flow, nutrient uptake rates, and fetal protein kinetic rates. By the end of the infusion, fetal weights were not statistically different between groups (SAL: 3.260 ± 0.211 kg, LR3 IGF-1: 3.682 ± 0.183; P = 0.15). Fetal heart, adrenal gland, and spleen weights were higher (P < 0.05), and insulin was lower in LR3 IGF-1 (P < 0.05). Uterine and umbilical blood flow and umbilical uptake rates of glucose, lactate, and oxygen were similar between groups. Umbilical amino acid uptake rates were lower in LR3 IGF-1 (P < 0.05) as were fetal concentrations of multiple amino acids. Fetal protein kinetic rates were similar. LR3 IGF-1 skeletal muscle had higher myoblast proliferation (P < 0.05). In summary, LR3 IGF-1 infusion for 1 wk into late gestation fetal sheep increased the weight of some fetal organs. However, because umbilical amino acid uptake rates and fetal plasma amino acid concentrations were lower in the LR3 IGF-1 group, we speculate that animals treated with LR3 IGF-1 can efficiently utilize available nutrients to support organ-specific growth in the fetus rather than by stimulating placental blood flow or nutrient transfer to the fetus.NEW & NOTEWORTHY After a 1-wk infusion of LR3 IGF-1, late gestation fetal sheep had lower umbilical uptake rates of amino acids, lower fetal arterial amino acid and insulin concentrations, and lower fetal oxygen content; however, LR-3 IGF-1-treated fetuses were still able to effectively utilize the available nutrients and oxygen to support organ growth and myoblast proliferation.

Comparison of estimated and calculated fetal radiation dose for a pregnant woman who underwent computed tomography and conventional X-ray examinations based on a phantom study.

This study aimed to determine the mean fetal doses for patients who underwent computed tomography (CT) and/or conventional X-ray (CXR) examinations. In addition to developing an approach to estimate the fetal dose based on data registered in the picture archive and communication system (PACS), the radiation doses for pregnant women and their fetuses were estimated using the VirtualDoseCT and VirtualDoseIR softwares. To verify the data, the fetal dose was measured using thermoluminescent dosimeters (TLDs) implanted at different uterus sites of an anthropomorphic pregnant phantom. Calculated fetal dose values were estimated in relation to the dose-area product (DAP) and volume CT dose index (CTDIvol). DAP and CTDIvol were obtained from data registered in the PACS. The fetal doses varied between < 0.001 and 3.9mGy and between 0.26 and 16.21mGy for the CXR and CT examinations, respectively. These values were similar to those of previous studies on both imaging modalities. The conversion factors obtained to calculate fetal doses for CXR examinations were between 0.01 and 0.73mGy/Gy cm2, whereas they varied between 0.02 and 0.61mGy/mGy for CT examinations. Overall, the fetal dose conversion factors based on DAP and CTDIvol values can be used for fast fetal dose estimations in common CXR and CT examinations.

Risk Factors for Birth Asphyxia in Togo: A Case-Control Study

Background: Birth Asphyxia (BA) is one of the leading causes of neonatal death in developing countries. In Togo, 30.55% of neonatal deaths were related to BA and caused by several risk factors. The purpose of this piece of work is to analyse the antepartum, intrapartum, and foetal risk factors of BA. Methods: This is a case control study, conducted from 1st December 2019 to 28th February 2020 in obstetrics wards and at neonatal intensive care of paediatric ward at the Sylvanus Olympio university teaching hospital (CHU-SO) in Lomé, Togo. Neonates diagnosed with BA (Apgar score th minute) were considered as “cases” (N = 200) while neonates born either with normal vaginal delivery or by cesarean section having no abnormality were considered as “control” (N = 200). Results: The prevalence rate of BA was 9.13%. Age (p = 0.0391), gravidity (p = 0.0040), type of facility for prenatal follow-up (p 0.0001), use of Long-lasting impregnated mosquito nets (LLIN) (p 0.0001), notion of maternal fever (p 0.0001) and chronic pathology (p 0.0001) were related to occurrence of BA. Significant antepartum risk factors observed were age private one (OR = 1.62; CI95% [1.03 - 12.55], p 0.0001), non-use of LLIN (OR = 2.50; CI 95% [1.61 - 3.88], p 0.0001), maternal fever (OR = 3.73; CI 95% [2.33 - 5.97], p 0.0001). Significant intrapartum risk factors were PRM (OR = 7.89; CI 95% [2.62 - 14.02], p 0.0001), abnormal AF (OR = 5.40; CI 95% [2.57 - 11.38],], p 0.0001), long labour (OR = 2.11; CI 95% [1.34 - 3.34],], p = 0.0004), use of oxytocin (OR = 2.14; CI 95% [1.38 - 3.32], p = 0.0003), and spontaneous vaginal (OR = 1.76; CI 95% [1.14 - 2.72,], p = 0.0008]). Significant Foetal risk factors were male gender (OR = 1.55; CI 95% [1.03 - 2.33], p = 0.0423), preterm babies (OR = 8.83; CI 95% [3.79 - 20.60], p 0.0001) and baby birth weight 0.0001). The Sarnat score had shown anoxo-ischemic encephalopathy stage III (19.00%), corresponding to 87.80% of case fatality rate (p Conclusion: Various risk factors lead to BA in Lomé. Early identification of high-risk cases with improved antenatal and perinatal care can decrease the high mortality of BA in Togo.

Noninherited Factors in Fetal Congenital Heart Diseases Based on Bayesian Network: A Large Multicenter Study

Background: Current studies have confirmed that fetal congenital heart diseases (CHDs) are caused by various factors. However, the quantitative risk of CHD is not clear given the combined effects of multiple factors. Objective: This cross-sectional study aimed to detect associated factors of fetal CHD using a Bayesian network in a large sample and quantitatively analyze relative risk ratios (RRs). Methods: Pregnant women who underwent fetal echocardiography (N = 16,086 including 3,312 with CHD fetuses) were analyzed. Twenty-six maternal and fetal factors were obtained. A Bayesian network is constructed based on all variables through structural learning and parameter learning methods to find the environmental factors that directly and indirectly associated with outcome, and the probability of fetal CHD in the two groups is predicted through a junction tree reasoning algorithm, so as to obtain RR for fetal CHD under different exposure factor combinations. Taking into account the effect of gestational week on the accuracy of model prediction, we conducted sensitivity analysis on gestational week groups. Results: The single-factor analysis showed that the RRs for the numbers of births, spontaneous abortions, and parental smoking were 1.50, 1.38, and 1.11 (P < 0.001), respectively. The risk gradually increased with the synergistic effect of ranging from one to more environmental factors above. The risk was higher among subjects with five synergistic factors, including the number of births, upper respiratory tract infection during early pregnancy, anemia, and mental stress as well as a history of spontaneous abortions or parental smoking, than in those with less than 5 factors (RR = 2.62 or 2.28, P < 0.001). This result was consistent across the participants grouped by GWs. Conclusion: We identified six factors that were directly associated with fetal CHD. A higher number of these factors led to a higher risk of CHD. These findings suggest that it is important to strengthen healthcare and prenatal counseling for women with these factors.

Survey of factors influencing women's selection of the delivery method of their second child in Shanxi Province, China.

Objective:To explore the factors influencing women’s selection of the delivery method of their second child.Methods:A questionnaire survey was administered among 431 women in the age range of interest from January 2015 to January 2017, and the survey results were evaluated and analyzed statistically. The experts evaluating the questionnaire are professionals in the Department of Obstetrics and Gynecology, Heji Hospital Affiliated to Changzhi Medical College.Results:A total of 70.99% of subjects were 28-35 years old. Approximately 82.35% wished to undergo vaginal delivery, and the remaining 17.65% expressed to undergo cesarean delivery. The reasons for cesarean delivery included the following: fetal factors: worry about fetal health (33.33%), birth trauma (12.90%), and fetal macrosomia (38.17%); maternal factors: advanced age (36.56%), inability to bear uterine contraction pains (21.51%), worry about uracratia after vaginal delivery (10.75%), worry about perineum laceration (8.60%) and the impacts on sexual gratification after delivery (5.38%); social factors: faster delivery mode (54.84%), selection of birth time (27.96%), and better planning of maternity leave (17.20%).Conclusion:Most women tend to undergo vaginal delivery. However, due to the influence of age, educational level and other factors, an increasing number of women prefer cesarean delivery. Medical institutions have the responsibility for providing overall and fair medical information to women of childbearing age to help them make informed choices regarding mode of delivery.

Is it Possible to Predict Massive Bleeding in Nulliparous Women with Placenta Previa?

We evaluated risk factors to determine if there were specific risk factors that could predict massive bleeding in nulliparous women with placenta previa. The participants were classified into two groups. Women with a calculated blood loss ≥ 1,000 mL were included in the massive bleeding group. Women without any signs or symptoms related with hypovolemia or with a calculated bleeding volume < 1,000 mL were categorized into the non-massive bleeding group. There were 28 patients (40.6%) with massive bleeding and 41 cases (59.4%) with non-massive bleeding. The calculated blood loss and number of cases that required red cell transfusions were statistically different between the groups (< 0.005 and 0.002, respectively). There were no statistically significant differences in terms of maternal or fetal factors, placental location, or delivery characteristics between the two groups. We could not determine the predictive features for massive hemorrhage based on clinical features, delivery features, or placental location.