Fetal Pregnancy Outcomes Research Articles

SWATH proteomics analysis of placental tissue with intrahepatic cholestasis of pregnancy

IntroductionIntrahepatic cholestasis of pregnancy (ICP) usually occurs in the second and third trimesters. The disease's etiology and diagnostic criteria are currently unknown. Based on a sequence window to obtain all theoretical fragment ions (SWATH) proteomic approach, this study sought to identify potential proteins in placental tissue that may be involved in the pathogenesis of ICP and adverse fetal pregnancy outcomes. MethodsThe postpartum placental tissue of pregnant women with ICP were chosen as the case group (ICP group) (subdivided into mild ICP group (MICP group) and severe ICP group (SICP group)), and healthy pregnant women were chosen as the control group (CTR). The hematoxylin-eosin (HE) staining was used to observe the histologic changes of placenta. The SWATH analysis combined with liquid chromatography-tandem mass spectrometry (LC-MS) was used to screen the differentially expressed proteins (DEPs) in ICP and CTR groups, and bioinformatics analysis was used to find out the biological process of these differential proteins. ResultsProteomic studies showed there were 126 DEPs from pregnant women with ICP and healthy pregnant women. Most of the identified proteins were functionally related to humoral immune response, cell response to lipopolysaccharide, antioxidant activity and heme metabolism. A subsequent examination of placentas from patients with mild and severe ICP revealed 48 proteins that were differentially expressed. Through death domain receptors and fibrinogen complexes, these DEPs primarily regulate extrinsic apoptotic signaling pathways, blood coagulation, and fibrin clot formation. The differential expressions of HBD, HPX, PDE3A, and PRG4 were down-regulated by Western blot analysis, which was consistent with proteomics. DiscussionThis preliminary study helps us to understand the changes in the placental proteome of ICP patients, and provides new insights into the pathophysiology of ICP.

The association between increased subjective sensation of fetal movements and pregnancy outcome–a prospective cohort and a retrospective comparative analysis

Objective To determine pregnancy outcomes in women with subjective sensation of increased fetal movements (IFM). Methods A prospective cohort study of women after 20 weeks of gestation who were referred with subjective sensation of IFM (April 2018–April 2019) for assessment. Pregnancy outcome was compared to pregnancies with a normal sensation of fetal movements all through pregnancy who underwent obstetrical assessment at term (37–41 weeks of gestation) matched by maternal age and pre-pregnancy BMI in a 1:2 ratio. Results Overall, out of 28,028 women referred to the maternity ward during the study period, 153 (0.54%) presented due to subjective sensation of IFM. The latter mainly occurred during the 3rd trimester (89.5%). Primiparity was significantly more prevalent in the study group (75.5% vs. 51.5%, p = .002). The study group had increased rates of operative vaginal deliveries and cesarean section (CS) due to non-reassuring fetal heart rate (15.1% vs. 8.7%, p = .048). Multivariate regression analysis showed that IFM was not associated with NRFHR affecting the mode of delivery (OR 1.1, CI 0.55 − 2.19), opposed to other variables such as primiparity (OR 11.08, CI 3.21–38.28) and induction of labor (OR 2.46, CI 1.18–5.15). There were no differences in the rates of meconium-stained amniotic fluid, 5 min Apgar score, birth weight, or rates of large/small for gestational-age newborns. Conclusion Subjective sensation of IFM is not associated with adverse pregnancy outcomes.

Pregnancy outcomes in patients with Budd-Chiari syndrome: A tertiary care experience.

Budd-Chiari syndrome (BCS) is associated with infertility and adverse pregnancy outcomes in affected females. Scant literature is available on the effect of an endovascular intervention on fertility and the outcome of future pregnancies in these patients. To assess the infertility rates, maternal and fetal outcomes of pregnancy and effect of endovascular intervention in women with BCS. In this retrospective analysis, 121 female patients with BCS attending our liver clinic from 2017 to 2020 were included. Demographic details, intervention details, pregnancies -pre- and post-intervention -and fetal outcomes were noted. BCS was diagnosed pre-conception in 58 women (group 1; median age: 22years), during/after pregnancy, but before completion of family in 39 (group 2; median age: 27years), and after completion of family in 24 (group 3; median age: 34years). Median Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores were 7 and 12, respectively. The primary infertility rate was 19.8% (24/121). In group 1, 15 women with primary infertility underwent endovascular intervention with 5/15 (33%) women conceiving subsequently, resulting in four live births and seven abortions. In group 2, five women developed BCS during pregnancy and 11 postpartum; 11/39 had a history of one or more abortions. Overall, 8/34 (23.5%) who underwent endovascular intervention had 4/8 (50%) successful pregnancies. In group 3, no patient had any major complications during past pregnancies. The mode of delivery was vaginal in 88% of cases. No congenital anomaly/major bleeding episodes/decompensation/maternal mortality occurred. Infertility is common in patients with BCS. Pregnancy is well-tolerated in those with compensated liver disease.

Cannabis Use in Pregnancy and Neonatal Outcomes: A Systematic Review and Meta-Analysis.

Objective: To determine whether prenatal cannabis use alone increases the likelihood of fetal and neonatal morbidity and mortality. Study Design: We searched bibliographic databases, such as PubMed, Embase, Scopus, Cochrane reviews, PsycInfo, MEDLINE, Clinicaltrials.gov, and Google Scholar from inception through February 14, 2022. Cohort or case-control studies with prespecified fetal or neonatal outcomes in pregnancies with prenatal cannabis use. Primary outcomes were preterm birth (PTB; <37 weeks of gestation), small-for-gestational-age (SGA), birthweight (grams), and perinatal mortality. Two independent reviewers screened studies. Studies were extracted by one reviewer and confirmed by a second using a predefined template. Risk of bias assessment of studies, using the Newcastle-Ottawa Quality Assessment Scale, and Grading of Recommendations Assessment, Development, and Evaluation for evaluating the certainty of evidence for select outcomes were performed by two independent reviewers with disagreements resolved by a third. Random effects meta-analyses were conducted, using adjusted and unadjusted effect estimates, to compare groups according to prenatal exposure to cannabis use status. Results: Fifty-three studies were included. Except for birthweight, unadjusted and adjusted meta-analyses had similar results. We found very-low- to low-certainty evidence that cannabis use during pregnancy was significantly associated with greater odds of PTB (adjusted odds ratio [aOR], 1.42; 95% confidence interval [CI], 1.19 to 1.69; I2, 93%; p=0.0001), SGA (aOR, 1.76; 95% CI, 1.52 to 2.05; I2, 86%; p<0.0001), and perinatal mortality (aOR, 1.5; 95% CI, 1.39 to 1.62; I2, 0%; p<0.0001), but not significantly different for birthweight (mean difference, -40.69 g; 95% CI, -124.22 to 42.83; I2, 85%; p=0.29). Because of substantial heterogeneity, we also conducted a narrative synthesis and found comparable results to meta-analyses. Conclusion: Prenatal cannabis use was associated with greater odds of PTB, SGA, and perinatal mortality even after accounting for prenatal tobacco use. However, our confidence in these findings is limited. Limitations of most existing studies was the failure to not include timing or quantity of cannabis use. This review can help guide health care providers with counseling, management, and addressing the limited existing safety data. Protocol Registration: PROSPERO CRD42020172343.

Fetal Outcome in Pregnancy with Oligohydramnios

Objective: The purpose of this study was to calculate the frequency of adverse fetal outcomes in oligohydramnios pregnancies. Study Design: Descriptive study Place and Duration: Department of Obstretics and Gynaecology,PUMHS Nawabshah Hospital. August 2018-February 2019 Methods: A total of 164 pregnant women with oligohydromnios were included in this study. Diagnosis was established after detailed history and abdominal examination. An extensive obstetric ultrasound was performed to verify the presence of alcohol, the baby's viability, the presence of two congenital defects, and the presence of the fetal heartbeat using Doppler ultrasonography. Information will then be filled in the performa. SPSS 22.0 was used to analyze all data. Results: The average age of the women was 25.76±4.18 years. Out of 164 cases, fetal growth retardation was observed in 39.02%, low birth weight 34.15%, NICU admission 30.5%, birth axpysia 27.44%, respiratory distress syndrome 12.8%, Apgar scores &lt;7 at1 minutes 43.35% and at 5 minutes 23.2%, meconium aspiration syndrome 4.27% and perinatal mortality was observed in 4% . Conclusion: Assessment of AFI in the first part of the third trimester helps to identify women who need greater antepartum surveillance, and hence, correct care, to enhance perinatal outcome. Keywords: Oligohydramnios, Birth axpysia, Low birth weight

Fetal outcome of adolescent pregnancy in a tertiary care center in western Nepal: A case control study

Background: The incidence of adolescent pregnancy is decreasing in developed countries, whereas developing countries like Nepal still report a high incidence. Aims: To compare the fetal outcomes of adolescent pregnancies with those of the optimal reproductive age group in a country that accounts for 95% of teenage pregnancies, in contrast to 11% worldwide. Method: A hospital-based case-control study was conducted with 150 pregnant women with singleton gestation admitted to Kathmandu University Hospital. An adolescent pregnancy (&lt;19 yrs.) was considered a case, and pregnant women of the optimal age group (20-35 yrs.) were considered the control. The data were collected from Jan 5, 2018, to Jan 5, 2019. The control group was selected by matching the parity of the cases in the study groups during the same study period. Respondents were interviewed and examined with a pre-structured tool. Odds Ratio (OR) and 95% Confidence Interval (CI) were calculated using conditional logistic regression (P&lt;0.05 considered significant). Results: The mean age of adolescent mothers was 17 years, the majority being primigravida. This study identified that fetal complications were higher in adolescent pregnancies (61% vs. 40%). The fetal complications like low birth weight (OR 2.42, 95%CI :1.044-5.43, P=0.03), NICU admission (OR 3.27, 95%CI:1.48-7.25, P=0.003), low APGAR score (OR 2.32, 95%CI:1.05-5.11, P=0.034) and Neonatal Death (OR 3.72, 95%CI:1.15-12.01, P=0.04) were associated with the adolescent pregnancies respectively. Conclusion: Adolescent pregnancies are at increased risk of fetal complications compared to pregnancies in the optimal reproductive group. Adolescent pregnancies were at increased risk of low birth weight, neonatal death, low APGAR score, and higher admission in NICU. Therefore, an adequate antenatal visiting program for early detection and timely management likely will reduce the fetal complications during adolescent pregnancy.

Cyanotic Congenital Heart Disease in Pregnancy: A Review of Pathophysiology and Management.

The advancement of medical treatment and surgical technique, along with the invention of cardiopulmonary bypass, has allowed for long-term survival of patients with cyanotic congenital heart disease (CHD)-with many women with CHD now reaching child-bearing age and wishing to become pregnant. Pregnancy in these women is a major concern as the physiologic adaptations of pregnancy, including an increased circulating volume, increased cardiac output, reduced systemic vascular resistance, and decreased blood pressure, place a substantial load on the cardiovascular system. These changes are essential to meet the increased maternal and fetal metabolic demands and allow for sufficient placental circulation during gestation. However, in women with underlying structural heart conditions, they place an additional hemodynamic burden on the maternal body. Overall, with appropriate risk stratification, pre-conception counseling, and management by specialized cardiologists and high-risk obstetricians, most women with surgically corrected CHDs are expected to carry healthy pregnancies to term with optimization of both maternal and fetal risks. In this article, we describe the current understanding of 5 cyanotic CHDs-Tetralogy of Fallot, Transposition of the Great Arteries, Truncus Arteriosus, Ebstein's Anomaly, and Eisenmenger Syndrome-and explore the specific hemodynamic consequences, maternal and fetal risks, current guidelines, and outcomes of pregnancy in women with these conditions.

Correlations between Maternal and Fetal Outcomes in Pregnant Women with Kidney Failure.

Kidney function impairment in pregnancy is challenging, with incidence and prognosis only partially known. Studies concerning maternal and fetal outcomes in pregnancies occurring in patients with renal injury and the therapeutic strategies for improving the prognosis of these patients are scarce due to the limited number of cases reported. We aimed to establish correlations between the main maternal and fetal outcomes in patients with severe CKD or AKI in pregnancy to improve the prognosis, referring to a control group of patients with mild kidney impairment. For this purpose, we conducted a retrospective study, at University Emergency Hospital in Bucharest, Romania, from January 2019 until December 2021, selecting 38 patients with AKI and 12 patients diagnosed with advanced CKD, compared to 42 patients displaying borderline values of serum creatinine (0.8-1 mg/dL), reflecting the presence of milder kidney impairment. The probability of having a child that is premature and small for gestational age, with a lower Apgar score and more frequent neonatal intensive care unit admissions, delivered by cesarean section, is higher in patients with highly reduced kidney function. Severe kidney function impairment is associated with a grim fetal prognosis and obstetrical complications.

Maternal and Fetal Outcomes in Pregnancies Affected by Osteosarcoma of the Jaw: A Case Report

Maternal and Fetal Outcomes in Pregnancies Affected by Osteosarcoma of the Jaw: A Case Report

Placenta Previa: Maternal and Fetal Outcome a Two Year Study

Introduction: Placenta previa is one of the major causes of antepartum hemorrhage and a life-threatening conditionfor both the mother and the fetus. The incidence of placenta previa is 0.3 to 1% in 300 to 400 deliveries.[1] Thepresent study was done retrospectively to observe the maternal and fetal outcome in pregnancies with placentaprevia.Method: The retrospective study was done from June 2019 to June 2021 to study the maternal and neonataloutcome in pregnancies with placenta previa who got admitted in Obstetrics and Gynecology department ofRajindra Hospital, Government Medical College Patiala. Detailed history, clinical examination and investigationswere evaluated and analysis was done at the end of the study.Result: Total number of deliveries during this period were 8193 out of which placenta previa was present in 210with an incidence of 2.5%.The major risk factor for placenta previa in the present study was previous LSCS in34.3% followed by previous dilatation and curettage (D&amp;C) in 16.6%. The majority of the women 57.2% had majordegree placenta previa, out of which placenta accreta was present in 5.8%. The majority of the women 94.7% weredelivered by LSCS and 4.2% had obstetric hysterectomy, 16% had PPH intraoperatively and 1.4% needed ICU care.60% of the babies were born prematurely and 25.7% required NICU care.Conclusion: Placenta previa is a major contributor in increasing maternal and fetal morbidity and mortality. Thepresent study showed that increasing maternal age, multiparity, previous cesarean section, previous dilatationand curettage are the risk factors for placenta previa. Placenta previa is associated with increased intraoperativeinterventions, surgical complications and maternal morbidit

Evaluation of Maternal and Fetal Outcomes in Pregnant Women with COVID-19 based on Different Trimesters.

COVID-19 is the leading cause of the recent pandemic in the globe. This disease might have different effects on the maternal and fetal outcomes in pregnancy. The aim of this study was to assess these outcomes in pregnant women with COVID-19 infections in different trimesters. This is a prospective cohort study that was performed in February 2020 to August 2021 in Isfahan on 430 pregnant women with definite diagnosis of COVID-19 infection admitted to our medical centers. The included cases were followed based on the gestational age in which they were diagnosed with COVID-19 infection. Patients were divided into three groups (first, second, and third trimesters) based on COVID-19 infection. The frequency of requiring mechanical ventilation was higher in mothers with COVID-19 in the second trimester (P = 0.049) and the frequency of PIH was significantly higher in mothers with COVID-19 in the third trimester compared to other women (P = 0.009). Fetal growth restriction (FGR) was also observed in 22 patients (5.3%) that was mostly observed with COVID-19 in the third trimester (P = 0.012). Oligohydramnios and fetal distress leading to C/S were observed in 19 patients (4.6%) and 12 patients (2.9%), respectively. The majority of maternal mortality was among cases with COVID-19 infection in the third trimester (44.4%). We observed higher maternal and fetal complications in women especially those in the third trimester. Our results were in line with the findings of previous studies. Women with COVID-19 infection in the third trimester had highest frequencies of preterm labor and FGR.

S-10-2: OPTIMAL BLOOD PRESSURE TARGET TO PREVENT SEVERE HYPERTENSION IN PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Severe hypertension in pregnancy is a hypertensive crisis that requires urgent and intensive care due to its high maternal and fetal mortality. However, there still remain some discrepancies between guidelines in a target blood pressure to prevent severe hypertension in pregnancy. This study aimed to find the optimal blood pressure (BP) levels to prevent severe hypertension in pregnant women with nonsevere hypertension. Design and method: We searched Ovid MEDLINE and the Cochrane Library to identify all randomized controlled trials, which compared effects of antihypertensive drugs and placebo/no treatment or more intensive and less intensive BP-lowering treatments on adverse maternal and fetal pregnancy outcomes among pregnant women with nonsevere hypertension. A random effects model meta-analysis was performed to estimate the pooled risk ratio (RR) and 95% confidence interval (CI) for the outcomes. Results: Forty RCTs with 6355 patients were included in this study. BP lowering treatment significantly prevented severe hypertension (RR, 0.46; 95% CI, 0.37 to 0.56), preeclampsia (RR, 0.82; 95% CI, 0.69 to 0.98), severe preeclampsia (RR, 0.38; 95% CI, 0.17 to 0.84), placental abruption (RR, 0.52; 95% CI, 0.32 to 0.86), and preterm birth (before 37 weeks; RR, 0.81; 95% CI, 0.71 to 0.93), while the risk of small for gestational age infants was increased (RR, 1.25; 95% CI, 1.02 to 1.54). An achieved systolic blood pressure (SBP) of lower than 130 mmHg reduced the risk of severe hypertension to nearly one-third compared with an achieved SBP of 140 mmHg or higher, with a significant interaction of the BP levels achieved with BP lowering therapy. There was no significant interaction between BP lowering treatment and the subtypes of hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and chronic hypertension. Conclusions: BP lowering treatment aimed at a SBP of lower than 130 mmHg and accompanied by careful monitoring of fetal growth might be recommended to prevent severe hypertension among pregnant women with nonsevere hypertension.

Maternal and Fetal Outcomes in Adolescent Pregnancies

Maternal and Fetal Outcomes in Adolescent Pregnancies

Pregnancy outcomes of normal karyotype fetuses with increased nuchal translucency.

Although the association between first-trimester increased nuchal translucency (NT) and chromosomal defects is well-defined, there is little knowledge about the importance of increased NT in fetuses with normal karyotypes. Hence, this study was designed to evaluate outcomes of normal karyotype fetuses with increased NT. This observational retrospective study was conducted on 720 pregnancies with increased NT (>3mm) at 11 to 13 weeks of gestational age in Yas Hospital, Tehran, Iran, from 2016 to 2020. Study outcomes were incidence of preeclampsia, intrauterine growth restriction) IUGR (, preterm labor, fetal anomaly, cardiac malformations, hydrops fetalis, abortion, and intrauterine fetal death (IUFD) in pregnancies without evident chromosomal karyotype abnormalities. Out of 720 participants who underwent karyotyping in the study center, 523 fetuses had normal karyotype results. In the pregnancies assessed for outcome, 357 (68.3%) reached live birth, 104 (19.9%) aborted, and 62 (11.9%) resulted in IUFD. Study outcomes including preeclampsia (<0.001), IUGR (<0.001), preterm labor (<0.001), fetal anomaly (<0.001), cardiac malformations (<0.001), hydrops fetalis (0.017), abortion (<0.001), and IUFD (<0.001) resulted in a statistically significant difference in the distribution of cases across NT intervals. This study demonstrated adverse pregnancy outcomes increased with increasing NT despite normal karyotyping. Hence, tight observation of mothers and fetuses should be done in normal karyotype fetuses with increased NT.

Factors influencing neonatal outcomes in twin pregnancies undergoing cesarean section: a cross-sectional study

This study aimed to evaluate maternal and fetal characteristics and factors affecting fetal outcomes in twin pregnancies delivered by cesarean section. This was a cross-sectional study in a tertiary care referral hospital. The primary outcome was to ascertain the effects of independent factors on the 1st and 5th minute APGAR scores, neonatal intensive care unit admissions, the need for mechanical ventilation, and neonatal mortality. A total of 453 pregnant women and 906 newborns were included in the analysis. The final logistic regression model revealed that early gestational weeks and neonates <3rd weight percentile at the time of delivery were the most significant predictors of all poor outcome parameters in at least one of the twins (p<0.05). General anesthesia for cesarean section was associated with 1st minute APGAR<7 and the need for mechanical ventilation, and emergency surgery was correlated with the need for mechanical ventilation (p<0.05) in at least one of the twins. General anesthesia, emergency surgery, early gestational weeks, and birth weight <3rd weight percentile were strongly associated with poor neonatal outcomes in at least one of the twins delivered by cesarean section.

Maternal and fetal outcomes among pregnant women with cardiac disease attending a tertiary care hospital: A prospective observational study

BACKGROUND: Pregnancy in women with cardiac disease is associated with an increased risk for adverse maternal and neonatal outcomes and the present study evaluated maternal and fetal outcomes of pregnancies complicated by cardiac disease.MATERIALS AND METHODS: An observational prospective study was conducted among 105 pregnant women with cardiac disease attending a tertiary care hospital from February 1, 2017, to January 31, 2018, and followed 30 days postpartum. Data on maternal and gestational age, nature of the underlying cardiac lesion, comorbidities, cardiac intervention, and medication were recorded. Up until 28 weeks, the patients were checked every 2 weeks by an obstetrician and a cardiologist, then weekly until birth. Age groups, cardiac lesion, and maternal and fetal outcomes were presented as frequency, and proportion was analyzed using coGuide software, V.1.0 was used for statistical analysis BDSS, Bangalore, Karnataka, India.RESULTS: Out of 101 subjects, 98 (97.03%) were aged 18–35 years, 75 (74.3%) participants had K/C/O cardiac disease, and in 24 (23.8%) subjects, rheumatic heart disease with isolated mitral stenosis was the predominant cardiac problem. Twenty-two (21%) subjects had undergone surgical correction before to pregnancy, and 6 (8%) patients had cardiac complications, among which 1 (2.9%) had pulmonary edema. Maternal death was noted in 4 patients (3.6%). The incidence of cases with small for gestational age was noted in 36 (35.6%) patients, fresh stillbirth in 1 (2.9%), macerated stillbirth in 1 (2.9%), and neonatal death was noted in 1 (2.9%) patients. Twenty-six (25.7%) participants were diagnosed for the first time with cardiac disease.CONCLUSIONS: Heart disease is linked to an increased risk of severe maternal and perinatal outcomes, such as maternal and fetal death and morbidity, among pregnant women.

The Relationship Between the Full Biophysical Profile and Rapid Biophysical Profile in Antepartum Fetal Surveillance

Background: One of the best tests for the assessment of a fetus is the biophysical profile test which has a significant effect on the fetus’s health and the outcome of pregnancy. The present study was designed to determine the relationship between the full biophysical profile (FBP) and the rapid biophysical profile (RBP) tests in antepartum fetal surveillance. Methods: In this prospective study, Singleton pregnancies (n=209) with more than 34 weeks of gestational age were chosen. Both FBP and RBP tests were performed for all the patients. The main outcome is the Apgar score and neonatal intensive care unit admission analyzed by SPSS software, version 24. The sensitivity, specificity, positive predictive value, and negative predictive value of RBP were calculated. Findings: Out of 209 people who entered the study, 48 women (23.0%) had gestational diabetes, 84 women (40.2%) had hypertension pregnancy (preeclampsia), 45 people (21.5%) had intrauterine growth restriction, and 45 women (21.5%) had post-date pregnancy. For predicting adverse fetal outcomes of pregnancy, the sensitivity, specificity, positive predictive value, and negative predictive value of RBP were 95%, 73%, 52%, and 98%, respectively. Conclusion: According to the statistically significant positive correlation between RBP and FBP and its simple and rapid application, RBP might be an acceptable alternative method for primary antepartum fetal screening tests in overcrowded obstetrics centers.

The role of T helper subsets in the pregnancy outcomes of a pregnant pristane-induced lupus mouse model

This research aimed to identify the role of T helper (Th) subsets in the pregnancy outcomes of a pregnant pristane-induced lupus mouse model. Thirty Balb/c mice were separated into healthy pregnant and lupus pregnant groups. For lupus induction, 0.5 cc of pristane was administered; the mice were mated 12 weeks later, and gestational day 0 (GD0) was determined by the presence of a vaginal plug. Blood pressure and urine albumin were measured at GD17. At GD18, the mice were euthanised, and serum samples, spleens and foetuses were collected. The foetal weights and lengths, number of viable foetuses and resorption were measured. The lupus group had higher systolic (p = 0.017), diastolic (p = 0.011), urine albumin (p = 0.004) and serum anti double stranded DNA levels (p = 0.000) and higher foetal resorption (p = 0.000). In contrast, it had a lower foetal weight (p = 0.004), length (p = 0.046) and number of viable foetuses (p = 0.005). Absolute numbers and percentages of Th1 (p = 0.001), Th2 (p = 0.000) and Th17 cells (p = 0.000) were also significantly higher in the lupus group. The Th1/Th2 (p = 0.012) and Th1/Th17 (p = 0.031) ratios in the lupus group were significantly higher compared with those of the healthy group. Correlation analyses revealed that Th1, Th2 and Th17 had significant correlations with foetal and maternal pregnancy outcomes. Th1/Th2/Th17 cells were elevated in the pregnant pristane-induced lupus mouse model and correlated with poor pregnancy outcomes.

Association between Abortion History and Perinatal and Neonatal Outcomes of Singleton Pregnancies after Assisted Reproductive Technology

At present, few people have studied the associations between abortion history before pregnancy on the outcomes of women and their infants after assisted reproductive technology (ART). To explore the association between the history of abortion and the outcomes of singleton pregnancies after ART. This was a retrospective study in a hospital from 2015 to 2020 in Shanghai, China. Pregnant women with live singleton births through ART were included (n = 3043). Abortion was classified into spontaneous abortion (SAB) and induced abortion. We compared the maternal and fetal outcomes of singleton pregnancies obtained through ART with different abortion histories. Logistic regression analysis was used to evaluate the associations between the history of pre-pregnancy abortion with perinatal complications and neonatal outcomes. We observed that compared with those who had no abortion history and obtained singleton pregnancies through ART, women who had an abortion history before pregnancy (including SAB or induced abortion history) and only SAB history were more likely to have gestational diabetes mellitus (GDM), thyroid-related diseases, and placenta-related diseases. After adjusting the potential confounding factors, these differences still existed. The adjusted odds ratios (ORs) and 95% confidence interval (CI) of GDM, thyroid-related diseases, and placenta-related diseases in women with a history of abortion and only a history of SAB were 1.239 (1.030-1.492) and 1.240 (1.010-1.522), 1.589 (1.261-2.002) and 1.724 (1.344-2.213), 1.465 (1.183-1.815) and 1.433 (1.132-1.814), respectively. However, we did not observe the association between the history of induced abortion and GDM and thyroid-related diseases. Our research showed that pregnant women with singleton pregnancies through ART who had a history of abortion or only a history of SAB were more likely to have GDM, thyroid-related diseases, and placenta-related diseases. Pregnant women who had both SAB and induced abortion before pregnancy had a higher risk of thyroid-related diseases and placenta-related diseases, while women who had only a history of induced abortion had a higher risk of placenta-related diseases. Further research is needed to explore the biological mechanism of different types of abortion related to subsequent pregnancy.

Predelivery placenta-associated biomarkers and computerized intrapartum fetal heart rate patterns

BackgroundIncreasing syncytiotrophoblast stress in term and postdate placentas is reflected by increasing antiangiogenic dysregulation in the maternal circulation, with low “proangiogenic” placental growth factor concentrations and increased “antiangiogenic” soluble fms-like tyrosine kinase-1 concentrations. Imbalances in these placenta-associated proteins are associated with intrapartum fetal compromise and adverse pregnancy and delivery outcome. Cardiotocography is widely used to assess fetal well-being during labor, but it is insufficient on its own for predicting adverse neonatal outcome. Development of improved surveillance tools to detect intrapartum fetal stress are needed to prevent neonatal adverse outcome. ObjectiveThis study aimed to assess whether predelivery circulating maternal angiogenic protein concentrations are associated with intrapartum computerized fetal heart rate patterns, as calculated by the Oxford System for computerized intrapartum monitoring (OxSys) 1.7 prototype. We hypothesized that in pregnancies with low “proangiogenic” placental growth factor levels, increased “antiangiogenic” soluble fms-like tyrosine kinase-1 levels, and increased soluble fms-like tyrosine kinase-1–placental growth factor ratio, the OxSys 1.7 prototype will generate more automated alerts, indicating fetal compromise. Our secondary objective was to investigate the relationship between maternal circulating placenta-associated biomarkers and rates of automated alerts in pregnancies with and without adverse neonatal outcome. Study DesignThis was an observational prospective cohort study conducted at a single tertiary center from September 2016 to March 2020. Of 1107 singleton pregnancies (gestational week ≥37+0), 956 had available prelabor and predelivery placental growth factor and soluble fms-like tyrosine kinase-1 concentrations and intrapartum cardiotocography recordings. All neonatal and delivery outcomes were externally reviewed and categorized into 2 groups—the “complicated” group (n=32) and the “uncomplicated” group (n=924)—according to predefined adverse neonatal outcome. Eight different cardiotocography features were calculated by OxSys 1.7: baseline at start of cardiotocography, baseline at end of cardiotocography, short-term variation at start, short-term variation at end, nonreactive initial trace, and throughout the entire cardiotocography, maximum decelerative capacity, total number of prolonged decelerations, and OxSys 1.7 alert. OxSys 1.7 triggered an alert if the initial trace was nonreactive or if decelerative capacity and/or the number of prolonged decelerations exceeded a predefined threshold. Included women and attending clinicians were blinded to both biomarker and OxSys 1.7 results. ResultsMean maternal placental growth factor concentration was lower in the group with OxSys 1.7 alert compared with the group without the alert (151 vs 169 pg/mL; P=.04). There was a weak negative correlation between predelivery high soluble fms-like tyrosine kinase-1 and low short-term variation start (rs=−0.068; 95% confidence interval, −0.131 to −0.004; P=.036), predelivery high soluble fms-like tyrosine kinase-1 and low short-term variation end (rs=−0.068; 95% confidence interval, −0.131 to −0.005; P=.036), and high soluble fms-like tyrosine kinase-1–placental growth factor ratio and low short-term variation end (rs=−0.071; 95% confidence interval, −0.134 to −0.008; P=.027). The rate of decelerative capacity alerts increased more rapidly as placental growth factor decreased in the “complicated” compared with the “uncomplicated” group (0% to 17% vs 4% to 8%). ConclusionMore automated alerts indicative of fetal distress were generated by OxSys 1.7 in pregnancies with low maternal predelivery placental growth factor level, in line with likely increasing placental stress toward the end of the pregnancy. An antiangiogenic predelivery profile (lower placental growth factor) increased the rates of alerts more rapidly in pregnancies with adverse neonatal outcome compared with those without. We suggest that future studies developing and testing prediction tools for intrapartum fetal compromise include predelivery maternal placental growth factor measurements.