First Trimester Of Pregnancy Research Articles

Adverse foetal outcomes in patients with increased risk of preterm preeclampsia in the first trimester of pregnancy: a prospective study

Adverse foetal outcomes in patients with increased risk of preterm preeclampsia in the first trimester of pregnancy: a prospective study

Births in the United States, 2023.

This report presents 2023 data on U.S. births compared with 2022 and 2021 for several key demographic and maternal and infant characteristics. Descriptive tabulations of data reported on the birth certificates of the 3.60 million births that occurred in 2023 are presented. Data are presented for the number of births, the general fertility rate, teenage birth rates, the distribution of births by trimester prenatal care began and the distribution of births by selected gestational age categories. Data for 2023 are compared with data for 2022 and 2021. A total of 3,596,017 births were registered in the United States in 2023, down 2% from 2022. The general fertility rate declined 3% in 2023 to 54.5 births per 1,000 females ages 15-44. Birth rates declined for females ages 15-19 (4%), 15-17 (2%), and 18-19 (5%), from 2022 to 2023. The percentage of mothers receiving prenatal care in the first trimester of pregnancy declined 1% to 76.1% in 2023 while the percentage of mothers with no prenatal care increased 5%. The preterm birth rate was essentially unchanged at 10.41% in 2023 but the rate of early term births rose 2%.

Diagnostic Accuracy of an Integrated AI Tool to Estimate Gestational Age From Blind Ultrasound Sweeps

Accurate assessment of gestational age (GA) is essential to good pregnancy care but often requires ultrasonography, which may not be available in low-resource settings. This study developed a deep learning artificial intelligence (AI) model to estimate GA from blind ultrasonography sweeps and incorporated it into the software of a low-cost, battery-powered device. To evaluate GA estimation accuracy of an AI-enabled ultrasonography tool when used by novice users with no prior training in sonography. This prospective diagnostic accuracy study enrolled 400 individuals with viable, single, nonanomalous, first-trimester pregnancies in Lusaka, Zambia, and Chapel Hill, North Carolina. Credentialed sonographers established the "ground truth" GA via transvaginal crown-rump length measurement. At random follow-up visits throughout gestation, including a primary evaluation window from 14 0/7 weeks' to 27 6/7 weeks' gestation, novice users obtained blind sweeps of the maternal abdomen using the AI-enabled device (index test) and credentialed sonographers performed fetal biometry with a high-specification machine (study standard). The primary outcome was the mean absolute error (MAE) of the index test and study standard, which was calculated by comparing each method's estimate to the previously established GA and considered equivalent if the difference fell within a prespecified margin of ±2 days. In the primary evaluation window, the AI-enabled device met criteria for equivalence to the study standard, with an MAE (SE) of 3.2 (0.1) days vs 3.0 (0.1) days (difference, 0.2 days [95% CI, -0.1 to 0.5]). Additionally, the percentage of assessments within 7 days of the ground truth GA was comparable (90.7% for the index test vs 92.5% for the study standard). Performance was consistent in prespecified subgroups, including the Zambia and North Carolina cohorts and those with high body mass index. Between 14 and 27 weeks' gestation, novice users with no prior training in ultrasonography estimated GA as accurately with the low-cost, point-of-care AI tool as credentialed sonographers performing standard biometry on high-specification machines. These findings have immediate implications for obstetrical care in low-resource settings, advancing the World Health Organization goal of ultrasonography estimation of GA for all pregnant people. ClinicalTrials.gov Identifier: NCT05433519.

Development and validation of a stability-indicating method, structural elucidation of new degradation products from misoprostol by LC-MS time-of-flight, and an ex vivo study of vaginal permeation.

Misoprostol (MSP) is commonly prescribed in obstetrics and gynecology clinical practice for labor induction, cervical ripening, first-trimester pregnancy termination, and the treatment of postpartum hemorrhage. Furthermore, there is a lack of comprehensive discussion evaluating how different commercially available formulations influence the overall efficacy of MSP, even though reports indicate issues with the quality of these formulations, particularly regarding stability and vaginal absorption processes. This study investigates the stability of MSP under acidic conditions and its in vitro permeation using swine vaginal mucosa. A forced degradation study was conducted using 0.2 M HCl, and a high-efficiency LC method was developed. Three degradation products were identified and characterized using electrospray ionization-high-resolution quadrupole-time-of-flight-MS, with respective m/z values of 391.2508, 405.2705, and 387.2259, respectively. These results suggest that the degradation mechanism involves dehydration of the β-hydroxy ketone moiety, followed by isomerization to its most resonance-stable form and de-esterification. Finally, the in vitro permeation study revealed that the esterified form of MSP was unable to permeate the mucosa and required prior degradation for any component to be detected in the receptor fluid.

Treatment with chemotherapy plus brentuximab vedotin in anaplastic large cell lymphoma and pregnancy: A case report

Introduction: Brentuximab vedotin (BV) is a CD-30 directed antibody and microtubule inhibitor conjugate indicated for the treatment of multiple types of lymphoma, including anaplastic large cell lymphoma (ALCL). Consensus-based guidelines recommend BV with cyclophosphamide, doxorubicin, and prednisone (CHP) as first-line treatment in a patient with ALCL. Alternative treatment options for ALCL can be limited due to patient-specific factors. Lymphomas account for approximately 11% of cancers in pregnancy. Brentuximab vedotin has not been studied in pregnancy; therefore, making the use of an antibody drug conjugate in this patient the first documented use in pregnancy. Case Report: A 26-year-old female was diagnosed with anaplastic large cell lymphoma at 14 weeks gestation. The patient has a past medical history of ALCL in 2004 at eight years old and a prior miscarriage. Consensus-based guidelines recommend BV with cyclophosphamide, doxorubicin, and prednisone (CHP) as first-line treatment in a patient with ALCL. Treatment with BV plus CHP was initiated at 15 weeks gestation for a total of 6 cycles during the antepartum period. At 33 weeks gestation, the patient delivered a 4-pound infant male without complications, birth defects, or health disparities. Two additional cycles of BV and CHP were administered during the postpartum period. Complete remission has been achieved in this patient. Conclusion: The outcomes in this case indicate the potential safety of BV in patients after the first trimester of pregnancy.

First-trimester ultrasound of the cerebral lateral ventricles in fetuses with open spina bifida: a retrospective cohort study

Beyond 18 weeks of gestation, an increased size of the fetal lateral ventricles is reported in most fetuses with open spina bifida. In the first trimester of pregnancy, the definition of ventriculomegaly is based on the ratio of the size of the choroid plexus to the size of the ventricular space or the entire fetal head. However, contrary to what is observed from the midtrimester of pregnancy, in most fetuses with open spina bifida at 11 to 13 weeks of gestation, the amount of fluid in the ventricular system seems to be reduced rather than increased. This study aimed to compare the biometry of the lateral ventricles at 11 0/7 to 13 6/7 weeks of gestation between normal fetuses and those with confirmed open spina bifida. This was a retrospective cohort study that included all cases of isolated open spina bifida detected at 11 0/7 to 13 6/7 weeks of gestation over a period of 5 years and a group of structurally normal fetuses attending at our center over a period of 1 year for the aneuploidy screening as controls. Transventricular axial views of the fetal brain obtained from cases and controls were extracted from the archive for post hoc measurement of cerebral ventricles. The choroid plexus-to-lateral ventricle length ratio, sum of the choroid plexus-to-lateral ventricle area ratio, choroid plexus area-to-fetal head area ratio, and mean choroid plexus length-to-occipitofrontal diameter ratio were calculated for both groups. The measurements obtained from the 2 groups were compared, and the association between each parameter and open spina bifida was investigated. A total of 10 fetuses with open spina bifida were compared with 358 controls. Compared with controls, fetuses with open spina bifida showed a significantly smaller size of the cerebral ventricle measurements, as expressed by larger values of choroid plexus-to-lateral ventricle area ratio (0.49 vs 0.72, respectively; P<.001), choroid plexus-to-lateral ventricle length ratio (0.70 vs 0.79, respectively; P<.001), choroid plexus area-to-fetal head area ratio (0.28 vs 0.33, respectively; P=.006), and choroid plexus length-to-occipitofrontal diameter ratio (0.52 vs 0.60, respectively; P<.001). The choroid plexus-to-lateral ventricle area ratio was found to be the most accurate predictor of open spina bifida, with an area under the curve of 0.88, a sensitivity of 90%, and a specificity of 82%. At 11 0/7 to 13 6/7 weeks of gestation, open spina bifida is consistently associated with a reduced amount of fluid in the lateral cerebral ventricles of the fetus, as expressed by a significantly increased choroid plexus-to-lateral ventricle length ratio, choroid plexus-to-lateral ventricle area ratio, choroid plexus area-to-fetal head area ratio, and choroid plexus length-to-occipitofrontal diameter ratio.

Determination of pregnant women’s exposure to thirdhand smoke, beliefs and affecting factors: a cross-sectional study from Turkey

ABSTRACT This study was conducted to determine pregnant women’s exposure to third-hand smoke, beliefs and influencing factors. The study included 400 pregnant women in a tertiary care obstetrics and gynecology hospital in Turkey. Data were collected using personal information form, Beliefs About Third-Hand Smoke Scale (BATHS-T) and Fagerström Test for Nicotine Dependence. 13.5% of the pregnant women smoked during pregnancy. However, 78.8% of the pregnant women were exposed to cigarette smoke at home. The mean score of BATHS-T scale and sub-scales increased in those whose spouses had university education or higher, and in pregnant women and their spouses who were public employees. The mean scores of BATHS-T scale and sub-scales were higher in pregnant women in the first trimester of pregnancy and in pregnant women with higher income levels. Community-based awareness of the effects of first, second and third-hand exposure to cigarette smoke on maternal and fetal health should be increased.

Effectiveness of "SAFAL MATRUTV GATS" (Stunting alleviation by facilitation of antenatal-postnatal-interventions for low birth weight reduction) - A peer-led self-empowerment group at rural villages in Eastern Maharashtra: Protocol for a pragmatic cluster randomized controlled trial.

Stunting or chronic malnutrition has been one of the major challenges to mankind for ages. The trends from the National Family Health surveys are more or less stagnant with a huge failure of the public health systems to tackle the problem of malnutrition. Innovative approaches are needed to tackle malnutrition. This pragmatic cluster randomized controlled trial (CTRI registration no. Trial REF/2023/08/071521) is planned to assess the effectiveness of a multifaceted antenatal and postnatal health educational intervention package implemented from the first trimester of pregnancy up to one year of infant age in reducing the rates of Low Birth Weight and improving the maternal-infant growth and developmental indicators in a cohort of rural pregnant women as compared to existing standards of care. Implication - The study emphasizes the importance of an ongoing continuum of care during the first 1000 days for effective birth weight, preventing malnutrition, and fostering infant growth and development as its programmatic pathway to impact. We anticipate that the intervention will complement the existing health programs and will be implemented through the grassroot-level workers along with a community peer named "Safalta Tai" enabling community ownership of the intervention. It also has a robust inbuilt monitoring and evaluation system through participatory action research for making it scalable and sustainable beyond the implementation period. The program leverages on the existing goverment programs like the poshan abhiyaan and the digital health mission. It has the potential to be incorporated in the exsiting health infrastructure without any additional resources and scaled up if found effective in reduction of low birth weight which is an important determinant of stunting in under five children.

Determination of the effective dose of remimazolam combined with sufentanil for inhibiting body movement during surgical abortion: An up-and-down sequential allocation trial.

Remimazolam, a recently developed anesthetic characterized by its rapid and ultra-short-acting properties, exhibits pharmacological attributes that make it potentially suitable for painless surgical abortion procedures. The objective of this study was to determine the effective dose of remimazolam when administered in combination with sufentanil, with the intention of inhibiting body movement during surgical abortion. Additionally, a secondary objective was to assess the recovery profile from general anesthesia. The study enrolled a total of 25 healthy women aged 20 to 40, with a body mass index between 18 and 28 kg/m2, in their first trimester of pregnancy (up to 12 weeks), and American Society of Anesthesiologists status I and II. Anesthesia induction was initiated by administering sufentanil at a dose of 0.1 μg/kg. The modified Dixon up-and-down method was employed to determine the induction dose of remimazolam for each patient. The 50% and 95% effective dose of remimazolam for inhibitory effects of body movement was estimated using centered isotonic regression to be 0.145 mg/kg (95% CI: 0.115, 0.207), and 0.242 mg/kg (95% CI: 0.232, 0.620), respectively. Five out of 25 (20%) experienced hiccups, with 1 patient having persistent hiccups until the end of the surgery. The mean time to first eye-opening was 51.4 ± 20.5 seconds, and the time to obey verbal command was 54.5 ± 20.6 seconds. Upon arrival at the postanesthesia care unit, 95.7% of the patients achieved a Modified Aldrete score ≥ 9. The 50% and 95% effective dose of remimazolam for inhibiting body movement during surgical abortion when used in combination with 0.1 μg/kg of sufentanil were 0.145 mg/kg and 0.242 mg/kg, respectively.

Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study

ObjectiveTo assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems.DesignA prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks’ gestation and followed at three different time points: at 12–14 weeks of pregnancy, at 29–30 weeks of pregnancy, and 4–6 weeks postpartum. All women completed a mental screening at week 12–14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS).SettingSeven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain.ParticipantsPregnant women (N = 335, age 18–45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020.FindingsThe most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12–14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner’s income. In weeks 29–30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4–6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems.ConclusionsEarly screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.

Association between Prenatal Control and the Incidence of Preeclampsia in Ecuadorian Pregnant Women: A Cross-Sectional Study

Hypertensive disorders are one of the main complications that affect pregnancy, which makes them one of the most important causes of high maternal and fetal morbimortality. Approximately 80% of cases occur at term gestational age, while the remaining percentage begin at earlier gestational ages. Most cases of preeclampsia occur in healthy pregnant women. Therefore, it is important to establish the risk factors in prenatal control visits. Prenatal control is fundamental in which comprehensive surveillance of the pregnant woman is performed. It is known that hypertension in pregnancy is a frequent and potentially dangerous complication for the mother, fetus and newborn. For this reason, one of the objectives of prenatal care is to detect pre-pregnancy hypertension and pregnancy-induced hypertension syndrome (preeclampsia). A nationally representative sample of 20648 mothers from the National Health and Nutrition Survey 2018 (ENSANUT) was used. We used multicollinearity tests to rule out possible statistical modeling problems and a binary logistic linear regression model where Odds Ratio (OR) with their 95% confidence intervals (95% CI) were estimated for each of the independent variables. In addition, we used specificity tests to test the fit between our dependent and independent variables. Our results reveal that prenatal control reduced 2 times (OR= -2.0005; CI=-1.981;-2.055) the probability of suffering complications during pregnancy such as preeclampsia. This result is statistically significant (p&lt;0.05). It was also demonstrated that women from rural areas, with lower income and low schooling are more susceptible to suffer complications during pregnancy compared to the rest of the population. Preeclampsia-eclampsia continues to be one of the pathologies that has the greatest impact on maternal and perinatal morbidity and mortality, so work should continue to find ways to prevent its onset or modify its evolution, avoiding eclampsia or other severe forms of the disease. The results found in this study showed that adequate prenatal care (more than five visits starting in the first trimester of pregnancy) has an impact on the prevention of pregnancy complications such as preeclampsia, since identifying and avoiding it is one of the main purposes of prenatal care.

Pregnancy outcomes and risk factors analysis in patients with systemic lupus erythematous

BackgroundThe management of systemic lupus erythematosus (SLE) during pregnancy remains a challenge currently. Identifying early predictors of adverse pregnancy outcomes in SLE patients can help to develop treatment plan and improve prognosis. The aim of this study is to explore the clinical and laboratory variables in the early pregnancy that can predict adverse neonatal and maternal outcomes, thereby facilitating the grading management of SLE.MethodsA retrospective analysis was conducted on 126 pregnant women with SLE who were admitted to Zhongnan Hospital of Wuhan University between January 2017 and December 2022. All enrolled patients were diagnosed (including newly diagnosed and previously diagnosed) during first trimester of pregnancy and their clinical records, laboratory results and pregnancy outcomes were reviewed. The association between the clinical and laboratory characteristics of patients at 12 gestational age and the adverse neonatal (ANOs) as well as maternal outcomes (AMOs) were analyzed.ResultsA total of 117 live births (92.8%) were recorded in the study. ANOs occurred in 59 (46.8%) cases, including fetal loss in 9 cases (7.1%), preterm birth in 40 cases (31.7%), small for gestational (SGA) in 15 cases (11.9%), and complete heart block in 2 cases (1.5%). Univariate analysis showed that disease activity index (P < 0.0001), lupus nephritis (P = 0.0195), anti-SSB positivity (P = 0.0074) and hypocomplementemia (P = 0.0466) were related to ANOs. However, multivariate analysis showed that only disease activity during early pregnancy was an independent predictor for ANOs (OR = 7.053, 95% CI: 1.882 to 26.291, P = 0.004). In addition, 48 patients experienced AMOs during subsequent trimester, including 24 (19.0%) patients with disease flare and 23 (18.3%) patients with pre-eclampsia. Unplanned pregnancy (P = 0.010), active disease (P = 0.0004), new onset SLE (P = 0.0044) and lupus nephritis (P = 0.0009) were associated with AMOs in univariate analysis, while disease activity was identified as an independent risk factor for AMOs (OR = 2.553, 95% CI: 1.012–6.440, P = 0.047).ConclusionActive disease in early pregnancy is associated with adverse pregnancy outcomes. For patients with high risk factor for ANOs and AMOs, more intensive treatment and follow-up should be a wise measure. Especially for those who suffer from active disease, they should be fully informed and given the option to terminate or continue their pregnancy.

The predictive value of ultrasound markers for pregnancy outcomes in recurrent pregnancy loss: a retrospective study

Establishing prediction models of pregnancy outcomes for recurrent pregnancy loss women at specific gestational weeks will provide patients and physicians with more precise information, ultimately leading to time and cost savings associated with unnecessary revisits. Therefore, our aim was to develop a prediction model for first trimester pregnancy loss in RPL patients. We used ultrasound indices during the first trimester of pregnancy in combination with demographic characteristics and commonly used serum markers. The independent risk factors for each week were as follows: age and P in the fifth week; age, mGSD and CRL in the sixth week; age, hCG and CRL in the seventh week; CRL in the eighth week; mGSD and CRL in ninth week. The corresponding AUC was 0.671, 0.796, 0.872, 0.871, 0.813, respectively. There is a linear relationship between age and first trimester pregnancy loss. hCG < 69,636.6 mIU/ml was associated with a higher risk of pregnancy loss in the seventh gestation week. An mGSD < 18.3 mm, adjusted for age, BMI, and previous pregnancy loss in the sixth week, was linked to an increased risk of first trimester pregnancy loss. A small CRL measurement (less than 2.4 mm, 9.9 mm, 16.9 mm, and 18.6 mm) in the sixth, seventh, eighth and ninth week was closely correlated with higher risk of first trimester pregnancy loss. Furthermore, an mGSD < 33.3 mm and > 48.3 mm in ninth gestational week was associated with a higher risk of pregnancy loss. These models and thresholds may help physicians and patients make more informed decisions together. Further studies are needed to confirm the results.

Reference Ranges of 2-Dimensional Placental Biometry and 3-Dimensional Placental Volume between 11 and 14 Weeks of Gestation.

The purpose of this study was to provide gestational age (GA) specific reference ranges for 2-dimensional (2D) placental biometry and 3-dimensional (3D) placental volume between 11 and 14 weeks of gestation. Placental biometry including 2D and 3D variables was calculated in 1142 first-trimester singleton pregnancies with non-complicated outcome between September 2016 and February 2020. Ultrasound datasets were obtained at the time of the first-trimester ultrasound, and 2D basal plate (BP), chorionic plate (CP), placental thickness (PT), and 3D placental volume (PV) were measured following a standardized methodology. Reference ranges for each variable were calculated according to GA and crown-rump-length (CRL). A total of 1142 uncomplicated pregnancies were considered for analysis. All placental measurements increased significantly between 11 and 14 weeks, especially for PT (39.64%) and PV (64.4%). Reference ranges were constructed for each 2D and 3D first-trimester placental variable using the best-fit regression model for the predicted mean and SD as a function of GA and CRL. Reference ranges of 2D placental biometry and 3D placental volume between 11 and 14 weeks of gestation were constructed, generating reference values. Placental biometry showed a progressive increase during the first trimester. This highlights the importance of using reference range charts according to GA.

Covid-19 infection and vaccination during first trimester and risk of congenital anomalies: Nordic registry based study

ObjectivesTo evaluate the risk of major congenital anomalies according to infection with or vaccination against covid-19 during the first trimester of pregnancy.DesignProspective Nordic registry based study.SettingSweden, Denmark, and Norway.Participants343 066...

Role of vimentin in the morphogenesis of endometrial decidualization during pregnancy with IVF methods

BACKGROUND: Early reproductive loss is a complex problem, the solution of which requires a systematic approach to the study of the morphogenesis of gravid transformation. Violations of the morphofunctional characteristics of the endometrium are associated with chronic endometritis, which entails implantation pathology and the development of pregnancy, while formulating indications for the use of IVF methods. Chronic endometritis disrupts the differentiation of stromal cells and intermediate filaments with subsequent pathology of decidualization and gravid transformation. AIM: The aim of this study was to evaluate vimentin expression in decidual cells of the gravid endometrium in an undeveloped first-trimester pregnancy after IVF, depending on its transformation in patients with chronic endometritis. MATERIALS AND METHODS: Histological and immunohistochemical studies were performed on 40 samples of abortion material with normal chorionic villi karyotype from a non-developing pregnancy after IVF in patients with chronic endometritis and 15 samples of abortion material from a progressive pregnancy, surgically terminated at the woman’s request at similar terms. Two groups were formed — I group with a full-fledged gravid transformation in a non-developing pregnancy after IVF (n = 20) and II group with an incomplete gravid transformation in a non-developing pregnancy after IVF (n = 20). Histological examination was performed according to the standard procedure. Immunohistochemical study was performed using a one-step protocol with antigen unmasking. Primary monoclonal antibodies to vimentin (Clon V9, Diagnostic BioSystems Inc., Spain) were used at a 1 : 1000 dilution. Vimentin expression was evaluated in the compact layer of the gravid endometrium. RESULTS: A full-fledged gravid transformation of the endometrial stroma in the abortion material in study group I and the control group was represented by mature deciduocytes of the epithelioid type, round or polygonal in shape, with a light vesicular nucleus. With an incomplete gravid transformation, the compact layer of the gravid endometrium was represented by fibroblasts with varying degrees of cytoplasmic development, from mild changes to the formation of pre-decidual and immature decidual cells. A decrease in vimentin expression was verified in the gravid endometrium after IVF compared to the control group. In case of an incomplete gravid transformation, a decrease in vimentin expression was also verified compared to the control group and study group I. CONCLUSIONS: The presence of chronic endometritis in patients with infertility and chronic endometritis not only causes pathology of the original endometrium, but also disrupts decidualization, leading to reproductive loss with normal embryo karyotype.

Dynamics of indicators of the vascular membrane of the ciliary body in predicting the risk of diabetic retinopathy in pregnant women with diabetes mellitus

BACKGROUND: According to statistics, microvascular complications of diabetes mellitus are registered in a third of patients during their lifetime, and diabetic retinopathy is the main cause of irreversible blindness in people of reproductive age. Changes in the vascular membrane of the eye in patients with diabetes mellitus are currently being studied as predictors of the progression of diabetic retinopathy. Further study of changes in the vascular membrane in pregnant women with type 1 and type 2 diabetes may help in identifying criteria for the manifestation and progression of diabetic microangiopathy. AIM: To develop a methodology for predicting the risk of diabetic retinopathy progression by analyzing the dynamics of the state of the vascular membrane of the ciliary body. METHODS: The study was conducted in each trimester of pregnancy. A pregnant patient with confirmed diabetes mellitus 1 or diabetes mellitus 2 underwent a comprehensive ophthalmological examination, including visometry with maximally corrected visual acuity, tonometry, biomicroscopy of the anterior segment of the eye, ophthalmoscopy under conditions of drug-induced mydriasis (phenylephrine) with a high-diopter lens (78–90 D), and optical coherence tomography of the anterior and posterior eye segments. RESULTS: With an increase in the thickness of the vascular layer of the ciliary body by ≥10% at one or more points compared with the study conducted in the first trimester of pregnancy, the patients exhibited diabetic retinopathy progression during subsequent routine examinations. Quantitative analysis of the vascular layer of ciliary body revealed the transition of diabetic retinopathy to its next stage; however, photoregistration of the fundus did not show obvious signs of transformation into another stage of the disease. CONCLUSION: Dynamic examination of the thickness of the vascular layer of the ciliary body during gestation and its increase by 10% from the initial one enables prediction of progression of diabetic retinopathy to the next stage.

Pregnancy and Unilateral Krukenberg Tumour: Factual or Fictious – A Case Report

Krukenburg tumor, a secondary ovarian neoplasm, arises from various primary sites. It’s occurrence during pregnancy is extremely rare. We are reporting the case of a 24 year old G2P1L1 lady with a unilateral Krukenberg tumor diagnosed in first trimester of pregnancy. The case posed as a diagnostic challenge as the presentation is non-specific and radiological diagnosis is very challenging owing to the similarity of the tumour to ectopic pregnancy on imaging. The sparsity of data and unique presentation of the patient inspired us to write this report. This is a 24 year old lady who presented to the emergency department with the complaints of amenorrhea for 2 months, pain abdomen and bleeding per vaginum for 2 days. Urine Pregnancy Test done at home was positive. She was found to be in shock and was resuscitated. Ultrasonography done showed a possibility of an ectopic pregnancy with rupture or a partial molar pregnancy. She was taken up for emergency laparotomy, a lobulated, irregular right sided ovarian mass suggestive of a right ovarian neoplasm with a normal left ovary and an intrauterine incomplete abortion was found. She underwent right salpingo-oophorectomy along with the ovarian mass; with stepwise exploration of pelvis and abdomen followed by dilatation and curettage for the evacuation of the retained product of conception. Histopathological examination revealed features suggestive of metastatic Signet Ring Cell Carcinoma. Further investigation with CECT chest, abdomen and pelvis and upper GI endoscopy revealed a gastric primary. This case depicts the challenges faced by physicians in correctly diagnosing malignant tumours during pregnancy. By reporting this case, we aim to raise awareness among physicians regarding the need for heightened vigilance and multi-disciplinary approach in order to timely and accurately diagnose such conditions.

3Dimensional sonography for the diagnosis of congenital uterine anomalies in women with eccentric pregnancy implantation: a novel approach.

The eccentric implantation of pregnancies in the upper lateral aspect of the uterine cavity is poorly defined clinically. The aim of the current study was to investigate whether differentiating between uterine anomalies that can lead to cavitary distortion has implications for the management of these pregnancies. Eight cases of first-trimester eccentric pregnancy implantation within the endometrial cavity (study group) were retrospectively identified. For each woman in the study group, 10 women identified as having a first-trimester concentric pregnancy implantation during the first-trimester US examination were retrieved from our database (control group). After delivery or pregnancy demise, the presence of uterine anomalies was assessed by a 3D-US examination in all patients. In the study group patients, an increased incidence of uterine anomalies (50.0% vs. 8.8%, p = 0.007) was found, compared to the controls. In the study group, the eccentric location persisted in half of the pregnancies (n = 4; 50%), whereas the other half migrated to a more centric location within the endometrial cavity (n = 4; 50%). The follow-up examination showed that all the early pregnancy demises occurred in cases where the pregnancy persisted at the eccentric location. Uterine malformations were also detected in all these cases. The data point to a significantly higher incidence of uterine anomalies in patients diagnosed with eccentric pregnancy implantation within the endometrial cavity. These results advocate for the value of differentiating between eccentric pregnancies in non-anomalous versus anomalous uteri.

Interaction of maternal smoking and gestational diabetes mellitus on newborn head circumference and birthweight.

Maternal smoking during pregnancy and gestational diabetes mellitus (GDM) have opposite effects on fetal growth during pregnancy. The aim of the study was to evaluate the interaction of smoking during pregnancy and gestational diabetes mellitus on head circumference and birthweight of newborns. The study included all primiparous women with singleton pregnancies (n = 290 602) without previously diagnosed diabetes or hypertension in Finland between 2006 and 2018. The information on gestational diabetes mellitus, newborn birthweight and head circumference, and maternal smoking and backgrounds was derived from the Finnish Medical Birth Register. Linear regression models were used in the analyses. In total 8.0% of parturients quit smoking during the first trimester and 9.9% continued smoking thereafter. The prevalence of GDM was 8.9% (n = 25 948). Newborns of women who continued smoking had a smaller head circumference (b = -0.24, SE = 0.01, p < 0.0001) and birthweight (b = -0.28, SE = 0.01, p < 0.0001) compared to newborns of women who did not smoke. Head circumference and birthweight were greater in newborns of women with GDM (b = 0.09, SE = 0.01, p < 0.0001 and b = 0.16, SE = 0.01, p < 0.0001, respectively) compared to newborns of women without GDM. In the interaction analyses, head circumference (b = -0.13, SE = 0.01, p < 0.0001) was smaller and birthweight (b = -0.13, SE = 0.02, p < 0.0001) was lower in newborns of women with GDM who continued smoking compared to newborns of women without GDM who did not smoke. Although smoking and GDM have opposite effects on fetal growth, the negative effects of exposure to smoking are also seen in newborns of women with GDM. Compared to smoking after the first trimester of pregnancy, cessation of smoking during the first trimester was associated with greater head circumference and birthweight in newborns.