Fetal Factors Research Articles

Associations between preterm birth and low birth weight in parents and autism spectrum disorder (ASD) risk in their offspring: A population-based multigenerational cohort study in Denmark

Background: Fetal exposure risk factors are associated with increased ASD risk. New hypotheses regarding transgenerational risk for ASD have been proposed, but epidemiological evidence is still lacking. We evaluated whether parental preterm birth or low birth weight was associated with ASD risk in offspring.Methods: We conducted a nationwide register-based cohort study that included 230,174 mother-child and 157,926 father-child pairs in Denmark. Logistic regression models were used to estimate Odds Ratios (OR) and 95% confidence intervals (CI) for offspring ASD according to the parental preterm (<37 weeks) and low birth weight (<2500 grams) status, with or without adjustment for grandmaternal sociodemographic factors. Mediation analyses were performed for selected parental and offspring health-related factors.Results: Offspring of mothers or fathers with adverse birth outcomes had about 31-43% higher risk for ASD (maternal preterm birth, OR=1.31, 95% CI= 1.12,1.55; maternal low birth weight, OR=1.35, 95% CI: 1.17,1.57; paternal preterm birth, OR=1.43, 95% CI=1.18, 1.73; paternal low birth weight, OR=1.38, 95% CI= 1.13, 1.70). Parents born very preterm (<32 weeks) marked a nearly 2-fold increase in ASD risk in their children. These associations were slightly attenuated upon adjustment for grandmaternal sociodemographic factors. Mediation analyses suggested a small magnitude of indirect effect of parental social-mental and offspring perinatal risk factors on the child, especially for maternal birth outcome associations.Conclusions: Offspring of parents born with adverse outcomes had an elevated risk for ASD. Transgenerational risk for ASD through maternal and paternal factors should be considered in future research on ASD etiology.

RELAXIN AND IMMUNE FACTORS AS PREDICTORS OF BIOLOGICAL PREPARATION FOR LABOUR

Introduction. Biological preparedness for childbirth plays an important role in ensuring the normal course of spontaneous labour, as well as determining the criteria for preinduction and induction of labour with obstetrics pathologies. Recent studies have shown that labour involves a complex interaction between maternal and fetal factors that contribute to cervical maturation and myometrial contraction. In its turn it prompts the search for predictors that allow early identification of pathologies and improve the prognosis. The Relaxin hormone may function as one of the aforementioned predictors due to the emerging evidence for its involvement in the pathogenesis of abortion. Studies show that Relaxin plays a key role in the adaptation of a female 51 body by targeting the cervix among other organs. Relaxin acts on the cervix by degrading extracellular matrix components through activation of proteolytic enzymes, known as matrix metalloproteinases (MMPs). Remodeling of the cervix is a combination of endocrine and immune interactions. One of the hallmarks of cervix remodeling is infiltration of leukocytes prior to labour. These tissue granulocytes become the source of proinflammatory cytokines that upregulate MMPs. Relaxin controls the local inflammatory response by modulating matrix metalloproteinases. Thus, understanding the regulatory role of Relaxin in systemic production of cytokines and its effect on neutrophils at different stages of cervical maturation is of great interest. Aim: characterise the interplay between Relaxin, cytokines and their joint role in regulation of proteolytic enzymes to establish new criteria for prognosis of cervical maturation. Materials and methods. 69 pregnant women of gestational age 38-40 weeks were examined. The examined women were divided into 3 clinical groups, depending on the degree of cervix maturity at the time of hospitalisation. The degree of cervix maturity was assessed by the EH Bishop scale. Group I consisted of 23 patients with a mature cervix (9-13 points), group II included 21 pregnant women with an immature cervix (6-8 points), group III contained 25 pregnant women with a completely immature cervix (0-5 points). The control group consisted of 15 women of gestational age 35-36 weeks, who were pregnant for the first time. Women of the control group were examined prior to the start of physiological processes of remodeling of cervical tissues before labour and displayed no signs of premature labour. Control group was compared to women from the I, II and III groups by disease history and somatic data. All pregnant women underwent standardized clinical examination and immunological testing. Serum concentration of cytokines IL-6 and TNF-α, MMP-1 and MMP-9, and Relaxin levels were determined by enzyme-linked immunosorbent assay using commercial kits. Statistical analysis of the results was performed using the program "STATISTICA-6". Statistical significance was calculated by Student's t-test. Spearman's rank correlation coefficient was determined between the obtained parameters. The differences were considered accurate with a significance level of p<0.05. Results. The average age of the examined pregnant women was 25 years 7 months (18-33). All patients of the examined groups could be compared to each other by their age, genital features and menstrual function (p ≤ 0.05). The study has shown that the lowest serum concentration of Relaxin was found in women with immature or completely immature cervix, which accounted to 189.7±34.6 pg / ml and 208, 9±27.6 pg / ml, respectively. This suggests that serum concentration of Relaxin could serve as a possible predictor of biological readiness of the body for labour. Furthermore, serum Relaxin concentration can serve as a prognostic marker of the effectiveness of induction and preinduction of labour. The data presented shows that women with mature cervix display maximum levels of matrix metalloproteinases MMP9 and MMP-1. Specifically, the concentration was 1.8 times higher than in the group of women with immature cervix. Thus, maturation of the cervix uterus involves a significant increase in the concentration of matrix metalloproteinases by peripheral neutrophils with a gradual increase in their proteolytic activity. Our study showed that high serum concentrations of the proinflammatory cytokines in pregnant women with a mature cervix before labour were higher compared to women with an immature or completely immature cervix. The interplay between proinflammatory cytokines and other modulators presented here during the preparation of the body for labour was evident from the observed correlation. We observed a strong correlation between the level of Relaxin and matrix metalloproteinases (r = 0, 78), as well as positive correlation between their content and the cytokines of interest. Conclusion. The study allowed to identify the most prognostically significant molecular predictors that characterize the body's preparation for labour, which include the "birth hormone" Relaxin. Furthermore, our analysis implicates immune mechanisms in regulating cervical maturation before labour.

Effects of maternal mental health on fetal visual preference for face-like compared to non-face like light stimulation

The question of whether humans react differentially to face-like versus non face-like light stimulation in the prenatal period has been much discussed, but to date has remained unresolved. In this feasibility study we have come closer to understanding fetal vision. In contrast to other studies examining fetal reactions to prenatal light stimulation, we controlled maternal factors known to affect fetal neurodevelopment; including maternal mental health and attachment. We found that, for fetuses at 33 weeks gestation, maternal mental health (anxiety and depression), and fetal growth factors (femur length) all had a significant effect on fetal reactivity to face-like compared to a non-face-like control light stimulus. This calls into question some previously published results. We discuss implications of these findings in terms of the development of fetal visual perception.

Fetuin-A in Infants Born Small- or Large-for-Gestational-Age.

Fetuin-A is a multifunctional glycoprotein that has been implicated in insulin resistance and bone metabolism. We assessed whether fetuin-A is associated with poor or excessive fetal growth. In the Shanghai Birth Cohort, we conducted a nested case-control study of 60 trios of small-for-gestational-age (SGA, birth weight <10th percentile), optimal-for-gestational-age (OGA, 25–75th, the reference) and large-for-gestational-age (LGA, >90th percentile) infants matched by sex and gestational age. Cord plasma concentrations of fetuin-A and fetal growth factors [insulin, proinsulin, insulin-like growth factor (IGF)-I and IGF-II] were measured. Cord plasma fetuin-A concentrations were higher in SGA (809.4 ± 306.9 μg/ml, P = 0.026) and LGA (924.2 ± 375.9 μg/ml, P < 0.001) relative to OGA (680.7 ± 262.1 μg/ml) newborns, and were not correlated to insulin, proinsulin, IGF-I and IGF-II (all P > 0.2). Higher fetuin-A concentrations were associated with increased risks of SGA [OR = 1.67 (1.08–2.58) per SD increment, P = 0.024] and LGA [OR = 2.36 (1.53–3.66), P < 0.001]. Adjusting for maternal and neonatal characteristics and fetal growth factors, the elevated risk changed little for LGA [adjusted OR = 2.28 (1.29–4.01), P = 0.005], but became non-significant for SGA (P = 0.202). Our study is the first to demonstrate that fetuin-A may be involved in excessive fetal growth. This association is independent of fetal growth factors.

Изменения в системе гемостаза у беременных с задержкой роста плода

Введение: Задержка роста плода (ЗРП) занимает второе место в структуре причин перинатальной смертности, а ее наличие имеет длительное неблагоприятное влияние на здоровье ребенка. Оценка степени активации системы гемостаза при ЗРП в сопоставлении с клиническими исходами имеет важное значение в понимании патогенеза, улучшении прогнозирования и профилактики этого патологического состояния. Цель исследования: оценить состояние гемостаза у беременных с ЗРП в сравнении с женщинами с физиологическим течением беременности. Материалы и методы: Тип исследования: поперечный срез на базе когортного. В исследование включено 52 беременных. Основная группа — 32 пациентки с ЗРП, выявленной при ультразвуковой фетометрии; контрольная группа — 20 практически здоровых женщин без отягощенного акушерско-гинекологического анамнеза, с физиологически протекавшей беременностью, завершившейся неосложненными родами. Оценку состояния системы гемостаза проводили на сроке 24-32 нед гестации. Результаты: Среди факторов тромботического риска у беременных с ЗРП чаще выявлялось табакокурение во время беременности. Наличие ЗРП было значимо связано с маловодием, генитальной и внутриматочной инфекцией, преэклампсией, нарушениями маточно-плацентарно-плодового кровотока. У женщин с ЗРП обнаружен более высокий уровень фибриногена, а также повышение скорости роста сгустка, больший размер сгустка, более частое формирование спонтанных сгустков в сравнении с контрольной группой. Заключение: У беременных с ЗРП имеется протромботическая готовность плазмы, что может служить основанием для дальнейшей разработки антитромботической коррекции с целью улучшения перинатальных исходов. Background: Fetal growth retardation (FGR) is the second leading cause of perinatal mortality, has a long-term adverse effect on child health. Assessment of hemostasis activation in FGR in comparison with clinical outcomes is important for understanding pathogenesis, improving the prognosis and prevention of this pathological state. Objectives: to assess hemostasis state in pregnant women with FGR compared to women with physiological pregnancy. Patients/Methods: Type of study: crosssectional based on cohort. The study included 52 pregnant women. The main group consisted of 32 patients with FGR diagnosed by ultrasound fetometry; the control group consisted of 20 practically healthy women without burdened obstetric-gynecological history, with physiological pregnancy that ended in uncomplicated childbirth. Hemostasis assessment was carried out at 24-32 weeks of gestation. Results: Smoking during pregnancy as a factor of thrombotic risk was more common in pregnant women with FGR. FGR was significantly associated with oligohydramnios, genital and intrauterine infection, preeclampsia, and placental insufficiency. Women with FGR showed a higher level of fibrinogen, as well as an increased rate of clot growth, clot larger size, and more frequent formation of spontaneous clots in comparison with the control group. Conclusions: Pregnant women with FGR are characterized by prothrombotic state that may be the basis for further development of antithrombotic correction for improving perinatal outcomes.

Evaluation of risk factors for perinatal asphyxia in a tertiary care hospital in Bangalore: an observational prospective study

Background: Perinatal asphyxia is an insult to fetus or newborn due to lack of oxygen (hypoxia) or lack of perfusion (ischemia) to various organs of sufficient magnitude and duration. Prenatal asphyxia is one of the major causes of early neonatal mortality in India. Our goal was to evaluate risk factors of perinatal asphyxia.Methods: Observational prospective study on 100 babies delivered in our hospital consecutively and requiring resuscitation were included.Results: The mean age of mothers was 23.5 years. 54% neonates were born to primiparous mothers. Anaemia was widely prevalent in the mothers of neonates requiring resuscitation. The major maternal risk factors for newborns requiring resuscitation were pregnancy-induced hypertension (PIH) (46%), oligohydramnios (41%), polyhydramnios (30%) and meconium stained liquor (28%). The fetal factors associated with resuscitation of newborns were intrauterine growth restriction (IUGR) (30%), prematurity (25%), meconium aspiration syndrome (MAS) (20%), and neonatal seizures (36%). Mortality was highest in hypoxic ischemic encephalopathy (HIE) stage 3 with 11%.Conclusions: The most common maternal risk factors for newborns requiring resuscitation was PIH followed by oligohydramnios, polyhydramnios and meconium stained liquor. IUGR was the most common fetal risk factor followed by, prematurity, MAS and neonatal seizures.

Vitamin A as a Transcriptional Regulator of Cardiovascular Disease

Vitamin A is a micronutrient and signaling molecule that regulates transcription, cellular differentiation, and organ homeostasis. Additionally, metabolites of Vitamin A are utilized as differentiation agents in the treatment of hematological cancers and skin disorders, necessitating further study into the effects of both nutrient deficiency and the exogenous delivery of Vitamin A and its metabolites on cardiovascular phenotypes. Though vitamin A/retinoids are well-known regulators of cardiac formation, recent evidence has emerged that supports their role as regulators of cardiac regeneration, postnatal cardiac function, and cardiovascular disease progression. We here review findings from genetic and pharmacological studies describing the regulation of both myocyte- and vascular-driven cardiac phenotypes by vitamin A signaling. We identify the relationship between retinoids and maladaptive processes during the pathological hypertrophy of the heart, with a focus on the activation of neurohormonal signaling and fetal transcription factors (Gata4, Tbx5). Finally, we assess how this information might be leveraged to develop novel therapeutic avenues.

Is the older perineum a safer perineum? Risk factors for obstetric anal sphincter injury.

Obstetric anal sphincter injury (OASI) is the most common cause of anal incontinence. Identifying risk factors may facilitate change in labour and delivery practice, potentially reducing the risk. The objective of this study is to identify maternal, foetal and intrapartum risk factors for OASI in a regional hospital. We conducted a retrospective analysis of vaginal deliveries over a 10-year period (2008-2017). Anal sphincter injury was diagnosed by an experienced clinician and classified according to RCOG recommendations. A multiple logistic regression model was created using the presence of OASI as the dependent variable. Coefficients were adjusted for relevant maternal, foetal and intrapartum risk factors. During the study period, there were 23,887 vaginal deliveries. Of these births, 18,550 were spontaneous (77.66%), 3746 vacuum-assisted (15.68%), 1196 forceps (5.01%) and 395 sequential instrumental deliveries (1.65%). The overall rate of OASI was 1.76%, with an upward trend seen in nulliparous mothers. Significant factors that increased the risk of OASI were nulliparity, Asian ethnicity, delivery by forceps or sequential instruments, and shoulder dystocia. Vacuum delivery did not significantly increase risk. Maternal age ≥ 35years confers a protective effect after adjusting for parity, birth weight and mode of delivery. Given the context of an ageing reproductive population, additional research is required to investigate the impact of maternal age on anal sphincter injury.

Update on Transplacental Transfer of IgG Subclasses: Impact of Maternal and Fetal Factors.

Transplacental antibody transfer from mother to fetus provides protection from infection in the first weeks of life, and the four different subclasses of IgG (IgG1, IgG2, IgG3, and IgG4) have diverse roles in protection against infection. In this study, we evaluated concentrations and transplacental transfer ratios of the IgG subclasses in a healthy UK-based cohort of mother-cord pairs, and investigated associations with maternal, obstetric, and fetal factors. In agreement with previous studies, we found a strong association between maternal and cord IgG for all subclasses. We report a transfer efficiency hierarchy of IgG1>IgG3>IgG4=IgG2 in our study population, and our review of the literature demonstrates that there is no consensus in the hierarchy of subclass transfer, despite the commonly made statement that the order is IgG1>IgG4>IgG3>IgG2. We report additional data regarding negative associations between elevated maternal IgG concentrations and maternal/cord transfer ratios, finding an effect on IgG1, IgG2, and IgG3 subclasses. Levels of IgG subclasses were the same between venous and arterial blood samples from the umbilical cord, but there was a significantly higher level of total IgG in arterial blood. We found no correlation between placental FcRn protein levels and IgG transfer in our cohort, suggesting that IgG is the main determinant of observed differences in transplacental transfer ratios at term. Neonatal IgG1 and IgG4 levels were increased with later gestation at delivery, independent of any increase in transplacental transfer, indicating that the benefit of later gestation is through accumulation of these subclasses in the fetus. Neonatal IgG2 levels and transfer ratios were reduced in rhesus-negative pregnancies, suggesting that administered anti-D antibodies may compete for transplacental transfer of this subclass. Maternal influenza vaccination resulted in elevated maternal and neonatal levels of IgG4, whereas maternal Tdap vaccination had no impact on neonatal levels of the subclasses, nor transfer. However, within Tdap vaccinated pregnancies, later gestation at Tdap vaccination was associated with higher transplacental transfer. Our study provides information regarding levels and transfer of IgG subclasses in healthy term pregnancies and demonstrates the importance of recording detailed clinical information in studies of antibody transfer, including parity, ethnicity, and timing of maternal vaccine delivery.

Fetal Autopsy-Categories and Causes of Death at a Tertiary Care Center.

A fetus is defined from 8 weeks after conception until term while in the uterus. Fetal death is defined as death of the fetus before the complete expulsion or extraction from the mother, irrespective of the duration of pregnancy that is not an induced termination of pregnancy. The causes of fetal death determined after fetal autopsy can be categorized according to the classification proposed by Cunningham and Hollier as fetal, placental, and maternal. All fetuses dying in utero, that is, prior to birth, regardless of the gestational age, to the mothers admitted in the Department of Obstetrics and Gynecology along with the respective placentas were received in the Department of Pathology, MGM Medical College, Aurangabad, after an informed and written consent from October 26, 2017, to October 30, 2019, and were included in this study. Clinical details along with obstetric history and antenatal ultrasonographic findings were also recorded. Anthropometric examination of the fetus was performed and evisceration was then done using the Rokitansky technique. Representative sections from each of the organs were taken and kept in tissue cassettes and processed for routine hematoxylin and eosin staining. This study was done on 33 cases of fetal death. Most fetal deaths occurred in the gestational age between 15 and 19 weeks (14 cases [42.42%]) and the least amount during 35 to 39 weeks (2 cases [6.06%]). The cause of death could not be ascertained in 6 cases (18.18%), whereas the maximum cases had fetal factor as the cause of death (15 cases [45.45%]). Maternal causes were seen in only 4 cases (12.12%). Gestational hypertension was seen to be the most common maternal factor associated with fetal death, which comprised 24.24% of cases (8 of 33). Thirteen of the total 33 cases did not have any associated obstetric complication. Of the total 33 fetal deaths, only 7 had associated placental defects on gross examination. Twenty-six placentas did not show any gross abnormality. Of these 7 cases, 5 were seen to have placental infarction. Fetal autopsy is a valuable and cost-effective modality for the confirmation of cause of fetal death. Fetal autopsy can also prove beneficial to the parents in planning for future pregnancies. Fetal autopsy can serve as the ultimate tool in diagnosing cause of fetal death in cases where no other diagnostic clue is available. Therefore, it should be encouraged and couples to be counseled regarding its importance and clinical utility.

Lumbar Neuraxial Procedures in Thrombocytopenic Patients Across Populations: A Systematic Review and Meta-analysis

(J Clin Anesth. 2020;61:109666) Presently, there is no agreement among experts in regards to the safe minimum threshold platelet count for lumbar neuraxial anesthetic procedures, as there are limited data available on neuraxial anesthetic procedures performed on thrombocytopenic patients. During cesarean deliveries, there are important maternal and fetal factors and side effects to consider when choosing to administer general anesthesia rather than neuraxial anesthesia. Because more data on spinal epidural hematoma are needed, Bauer and colleagues conducted this systematic review to assemble reported lumbar neuraxial procedures (lumbar puncture; spinal, epidural, or combined spinal-epidural analgesia/anesthesia; epidural catheter removal) from various thrombocytopenic populations to bring some clarity to the risk of spinal epidural hematoma.

Role of routine fetal echocardiography in an unselected group of pregnant women for prenatal detection of cardiac malformations

ObjectivesWe investigated the potential for improvement in prenatal detection of congenital heart disease (CHD) by routinely performing detailed fetal echocardiography (FE) in all pregnant women. MethodsFollowing routine obstetric sonography, 1445 unselected pregnant women were prospectively subjected to FE at gestational ages between 16 and 24 weeks, or at first visit, if they presented later. Maternal or fetal factors, conventionally known to be associated with risk of CHD, were noted.The prevalence and detection rates of cardiac abnormalities were determined, and confirmation of findings by postnatal follow-up was done to ensure accuracy of FE. Prevalence of CHD was compared in pregnancies with or without conventional risk factors. ResultsThe overall prevalence of CHD was 8.3 per 1000; only 2 CHD cases belonged to the high maternal risk group, while 10 cases were observed without maternal risk factors. Cardiac malformations were suspected in 14 fetuses during obstetric scan; but, only 5 of them had CHD, remaining 9 had structurally normal hearts. 50% of CHD cases occurred in pregnancies not associate with any (fetal or maternal) risk factor. The sensitivity, and specificity for prenatal CHD detection were 91.7% and 100% respectively. ConclusionsOur study indicates that a substantial proportion of CHD cases occur in women not having high risk of giving birth to children with CHD. FE is a highly sensitive and specific test with strong predictive values. We recommend that FE should be done in every pregnancy.

Interaction of chorioamnionitis at term with maternal, fetal and obstetrical factors as predictors of neonatal mortality: a population-based cohort study

BackgroundChorioamnionitis is a frequent complication of pregnancy and is known to be associated with serious adverse post-natal outcomes including death. However, the assessment of fetal well-being in labor in the context of chorioamnionitis is often challenging because of fetal tachycardia. Identifying specific risk factors for adverse neonatal outcomes in the context of chorioamnionitis could therefore be of paramount importance. This study aimed to determine if maternal and fetal risk factors for increased neonatal mortality and early neonatal mortality are modified in the context of chorioamnionitis in term pregnancies.MethodsA retrospective population-based cohort study using the United States birth/infant death public file from 2011 to 2013 was performed, including all live births at 37 weeks gestation and beyond. Interaction between chorioamnionitis and maternal demographic variables as well as labor and delivery potential risk factors were analyzed for association with neonatal death (< 28 days) and early neonatal death (< 7 days) using multivariate logistic regressions.ResultsAmong 9,034,428 live births, the prevalence of chorioamionitis was 1.29% (95% CI 1.28–1.30%). The incidence of neonatal death and early neonatal death were 0.09 and 0.06% in the chorioamnionitis group versus 0.06 and 0.04% in the no chorioamnionitis group (p = 0.0003 and < 0.0001), respectively. Smoking was significantly associated with neonatal death and early neonatal death in the context of chorioamnionitis (OR 2.44, CI:1.34–4.43/ 2.36 CI:1.11–5.01) but was either less strongly or not associated in the absence of chorioamnionitis (OR 1.24, CI:1.14–1.35/0.93, CI:0.82–1.05). The association between gestational age (37 weeks compared to 39 weeks) and neonatal death was more important in the context of chorioamnionitis (OR = 3.19, CI: 1.75–5.82 versus 1.63, CI: 1.49–1.79). Multivariate analysis identified the following risk factors for neonatal death and/or early neonatal death: low maternal education, extreme maternal age, obesity (BMI > 35 kg/m2), late or no prenatal care, diabetes, meconium-stained amniotic fluid, gestational ages other than 39 weeks, neonatal weight < 2500 g and delivery by vacuum or caesarian.ConclusionsSmoking as well as early term have a positive interaction with chorioamnionitis for the risk of neonatal mortality. This should be taken into account when counseling pregnant women and managing laboring pregnant women with suspected chorioamnionitis.

Evaluation of changes in anesthetic methods for cesarean delivery: an analysis for 5 years using the big data of the Korean Health Insurance Review and Assessment Service

BackgroundAs an anesthesia induced during cesarean section, spinal anesthesia is preferred over general and epidural anesthesia. This study aimed to review the trend of anesthetic methods for cesarean section based on data obtained from the Korean Health Insurance Review and Assessment Service from 2013 to 2018.MethodsThe anesthetic methods were analyzed in 753,285 parturients who underwent a cesarean section in Korea from 2013 to 2018. We determined the association between each anesthetic method and hospital type and maternal and fetal factors. We also evaluated whether the anesthetic method was associated with the parturients’ length of hospital stay.ResultsGeneral anesthesia, spinal anesthesia, and epidural anesthesia were induced in 28.8%, 47.7%, and 23.6% of parturients from 2013 to 2018, respectively. Trend analyses showed that spinal anesthesia increased from 40.0% in 2013 to 53.7% in 2018. The opposite trend applied to general anesthesia, decreasing from 37.1% in 2013 to 22.2% in 2018. The factors that were significantly associated with the anesthetic method were parturient’s parity, emergency condition, gestational age, and fetal weight. The type of hospital, parturient’s age, and multiple birth were also associated with the anesthetic methods. There was a strong association between general anesthesia and hospital stay longer than 7 days.ConclusionsSpinal anesthesia is currently the main anesthetic method used for cesarean delivery, and the rate of spinal anesthesia is gradually increasing in Korea.

Fibrinogen-Like Protein 2-Associated Transcriptional and Histopathological Features of Immunological Preeclampsia.

Preeclampsia is a multifactorial hypertensive disorder of pregnancy, with variable presentation in both maternal and fetal factors, such that no treatment or marker is currently universal to all cases. Here, we demonstrate that the prothrombinase and immunomodulatory secreted factor FGL-2 (fibrinogen-like protein 2) is differentially expressed across previously characterized gene expression clusters containing clinically relevant disease subtypes. FGL2 is low in a cluster consistent with the traditional paradigm of the pathology of preeclampsia (canonical preeclampsia) and high in a cluster exhibiting evidence of immune activation (immunological preeclampsia). We show that it is part of an immunoregulatory gene module integral to the transcriptional profile and placental pathology specific to immunological preeclampsia. We determine that FGL2 associates positively with chronic inflammation lesions of the placenta while associating negatively with maternal vascular malperfusion lesions. The transcriptional profiles of maternal vascular malperfusion lesions show downregulation of FGL2 and upregulation of previously investigated preeclampsia biomarkers, such as FLT1 (Fms Related Receptor Tyrosine Kinase 1) and ENG (endoglin). Conversely, the profiles of chronic inflammation lesions show an interesting downregulation of these genes, but an upregulation of FGL2 and of FGL2-correlated immunoregulatory genes, suggesting it is upregulated downstream of major inflammatory mediators such as TNF (tumor necrosis factor)-α and IFN (interferon)-γ, hallmarks of the immunological preeclampsia subtype. This work, overall, demonstrates that FGL-2 expression levels in the term placenta reflect the unique pathophysiology that leads to immunological preeclampsia, leading to its potential as a subtype-specific biomarker.

Mother, Fetal and Disease History Factors as a Preeklampsia Risk in Asia and Africa: A Meta-Analysis

Background: Preeclampsia accounts for nearly 10 percent of maternal deaths in Asia and Africa. Therefore, it is important to detect signs and symptoms early on by knowing the factors that are at risk for a mother experiencing preeclampsia. Objective: To determine the risk factors for preeclampsia in Asia and Africa through the application of meta-analysis. Method: A systematic review was carried out on 26 case-control and cohort studies related to risk factors for preeclampsia from four databases (PubMed, BioMed Central, ProQuest, and Google Scholar). The pooled odds ratio was calculated with the fixed-effect and random-effect model using Review Manager 5.3. Result: A total of 20 studies consisting of 2,954,769 women were included in the meta-analysis. Risk factors for preeclampsia based on maternal factors were chronic hypertension=9.74(95% CI 1.69-56.04), gestational diabetes=9.28(95% CI 4, 49-19.19), pre-pregnancy body mass index=2.70(95% CI 2.08-3.50), maternal age during pregnancy=2.37(95% CI 2.29-2.46) and nulliparity=2.08(95% CI 1.44-3.01). The fetal factor was multiple pregnancy=4.24(95% CI 3.14-5.73). Four disease history factors were family history of preeclampsia=13.99(95% CI 6.91-28.33), history of chronic hypertension=8.28(95% CI 5.92- 11.59), history of preeclampsia=OR 6.90(95% CI 3.58-13.31) and family history of hypertension=2.81(95% CI 1.75-4.50). Conclusion: The results of a meta-analysis of 10 risk factors for preeclampsia could be used as a screening tool to determine the magnitude of risk and early diagnosis of preeclampsia that allows timely intervention.

Mother, Fetal and Disease History Factors as a Preeklampsia Risk in Asia and Africa: A Meta-Analysis

Background: Preeclampsia accounts for nearly 10 percent of maternal deaths in Asia and Africa. Therefore, it is important to detect signs and symptoms early on by knowing the factors that are at risk for a mother experiencing preeclampsia. Objective: To determine the risk factors for preeclampsia in Asia and Africa through the application of meta-analysis. Method: A systematic review was carried out on 26 case-control and cohort studies related to risk factors for preeclampsia from four databases (PubMed, BioMed Central, ProQuest, and Google Scholar). The pooled odds ratio was calculated with the fixed-effect and random-effect model using Review Manager 5.3. Result: A total of 20 studies consisting of 2,954,769 women were included in the meta-analysis. Risk factors for preeclampsia based on maternal factors were chronic hypertension=9.74(95% CI 1.69-56.04), gestational diabetes=9.28(95% CI 4, 49-19.19), pre-pregnancy body mass index=2.70(95% CI 2.08-3.50), maternal age during pregnancy=2.37(95% CI 2.29-2.46) and nulliparity=2.08(95% CI 1.44-3.01). The fetal factor was multiple pregnancy=4.24(95% CI 3.14-5.73). Four disease history factors were family history of preeclampsia=13.99(95% CI 6.91-28.33), history of chronic hypertension=8.28(95% CI 5.92- 11.59), history of preeclampsia=OR 6.90(95% CI 3.58-13.31) and family history of hypertension=2.81(95% CI 1.75-4.50). Conclusion: The results of a meta-analysis of 10 risk factors for preeclampsia could be used as a screening tool to determine the magnitude of risk and early diagnosis of preeclampsia that allows timely intervention.

Perfil sociodemográfico, clínico e obstétrico de puérperas em um alojamento conjunto: um estudo descritivo

Objetivo: descrever o perfil sociodemográfico, clínico e obstétrico de puérperas internadas em um alojamento conjunto. Método: estudo descritivo, transversal sedimentada em pesquisa documental com 227 prontuários. A coleta de dados ocorreu entre maio e outubro de 2016 em uma maternidade escola federal. Foi realizada análise descritiva para variáveis sociodemográficas e clínicas, além de teste Qui-quadrado de Pearson e exato de Fischer. Resultados: constatou-se uma média de 2,1 gestações e 0,3 abortos; 97,4% puérperas realizaram pré-natal, das quais 79,8% compareceram a 6 consultas. Predominou o parto cirúrgico (51,9%), associado a diagnósticos de trabalho de parto e parto, cesárea eletiva, síndromes hipertensivas da gravidez (p&lt;0.001), diabetes mellitus na gravidez (0.040), iteratividade (0.002) e a ruptura prematura de membranas (0.021). Conclusão: a caracterização de puérperas em um alojamento conjunto, pode apontar fatores maternos e fetais a fim de subsidiar a implementação de ações específicas durante o parto ou ainda na gestação a partir da identificação precoce de situações de risco.

Performance of non-invasive prenatal screening for sex chromosome aneuploidies and parental decision-making.

Performance of non-invasive prenatal screening for sex chromosome aneuploidies and parental decision-making.

The Presence of Patent Foramen Ovale in the Superior Type of Sinus Venosus Atrial Septal Defect.

Background: The superior type of sinus venosus atrial septal defect (SVASD) is a rare form of the atrial septal defect (ASD) in which the upper part of the atrial septum does not exist. The presence of other cardiac anomalies such as anomalous pulmonary venous connections has been reported in this type of congenital heart disease. This study aimed to assess the presence of the patent foramen ovale (PFO) in patients with the superior type of SVASD. Methods: This retrospective case-control study on 387 patients, consisting of 187 patients with a definite SVASD and 200 patients with problems other than the ASD, was conducted in Rajaie Cardiovascular Medical and Research Center between February 2005 and July 2014. Seven patients with inadequate data were excluded from the analysis. The presence/absence of the PFO was also evaluated in the case and control groups. Results: The analyses were performed on 182 male and 198 female patients at a mean age of 39.07±14.41 and 51.01±15.80 years in the case and control groups, respectively. The PFO was significantly more frequent in the patients with the superior type of SVASD than in those without the condition (P<0.001). The persistence of the left superior vena cava was seen in 34 out of 180 patients with SVASD and in 1 out of 200 patients without the condition (18.9% vs 0.5%; P<0.001). Conclusion: This study was the first to highlight the coexistence of the PFO and the superior type of SVASD. Physiological, genetic, or fetal factors may play an important role in the association between the PFO and the SVASD.