Term Fetuses Research Articles

Association of term isolated microcephaly with mode of delivery and perinatal outcome - a retrospective case-control analysis

BackgroundWe aimed to evaluate the association of isolated fetal microcephaly measured by ultrasound prior to delivery at term with mode of delivery and perinatal outcome.MethodsA single-center retrospective study was conducted in 2012–2016. Fetal microcephaly was defined as head circumference > 2 standard deviations of the mean for gestational age and sex. We compared the obstetric, delivery, and outcome parameters of women in whom ultrasound performed up to 10 days prior to term delivery showed isolated fetal microcephaly (study group) or normal head circumference (reference group). Exclusion criteria were intrauterine fetal death, birthweight below the 10th percentile, and antepartum cesarean delivery for any indication.ResultsOf 3677 women included in the study, 26 (0.7%) had a late ultrasound finding of isolated fetal microcephaly. Baseline characteristics were similar in the two groups except for estimated fetal weight based on abdominal circumference and biparietal diameter, which was lower in the microcephaly group (3209.8 ± 557.6 vs. 2685.8 ± 420.8 g, p < .001). There was no significant between-group difference in rate of vaginal operative deliveries (11.7% vs 14.8%, respectively, p = 0.372). The study group had no intrapartum cesarean deliveries compared to 6.3% of the reference group (NS). Compared to controls, neonates in the study group were smaller (3323.2 ± 432.2 vs. 2957.0 ± 330.4 g, p < .001), with lower birthweight percentile (60.5 ± 26.5 vs. 33.6 ± 21.5%, p < .001) and were more often males (48.2 vs. 90.0%, p < .001). No significant differences were noted in perinatal outcomes between the groups, including admission to neonatal intensive care unit, intraventricular hemorrhage, 5-min Apgar score < 7, asphyxia, seizures, and sepsis.ConclusionsIsolated microcephaly in term fetuses is not advantageous for a vaginal delivery, nor does it does not pose a greater than normal risk of adverse perinatal outcome.

Toxicity of Methanolic Extracts of Seeds of Moringa stenopetala, Moringaceae in Rat Embryos and Fetuses

Moringa stenopetala is a medicinal plant that has been used in Ethiopian traditional medicine as a remedy for the treatment of hypertension, diabetes, and stomach pain. The study is aimed at assessing the toxicity of the methanol extracts of the seeds of Moringa stenopetala on the developing embryo and fetuses of rats. The seeds of Moringa were extracted by maceration using 80% methanol. The extract (250–1000 mg/kg) was orally administered to pregnant Swiss albino rats from days 6 to12 of gestation. Embryos and fetuses were recovered by laparotomy on gestational day 12 and day 20, respectively, and were assessed for developmental anomalies. On day 20, significant prenatal growth retardation such as reduced litter weight and crown-rump length were observed in near term fetuses of 1000 mg/kg treated rats. Litter weight in 1000 mg/kg and pair-fed control groups was 2.41 g ± 0.108 and 3.08 g ± 0.093, respectively. Delay in the development of an otic, optic, and olfactory system, as well as a reduction in a number of branchial bars, occurred on day 12 embryos of 1000 mg/kg treated rats. The rate of fetal resorption in 1000 mg/kg and pair-fed control groups was 1.6 ± 0.55 and 0.42 ± 0.52, respectively. There was also a high incidence of fetal death in the 1000 mg/kg treated group but it was not statistically significant. The offspring's of Moringa-treated rats did not show gross external malformations at all doses. These findings suggest that the methanol seed extract of Moringa stenopetala is not safe to rat embryos and fetuses. Its toxic effects were evidenced by a significant delay in embryonic and fetal development and an increase in fetal resorptions and fetal death.

Rothia dentocariosa bacteremia in the newborn: causative pathogen or contaminant?

Abstract Objectives To describe an infrequent case of bacteremia by Rothia dentocariosa in a newborn and to discuss its potential pathogenicity. Case presentation R. dentocariosa is an aerobic or facultative anaerobic gram-positive bacillus, common in the human oral cavity that has been isolated in cases of endocarditis, pneumonia, endophthalmitis and peritonitis in adults. Infections in the fetus and newborn have been scarcely reported. We present a full-term newborn with prolonged rupture of membranes, acute elevation of C-reactive protein, and isolation of R. dentocariosa in the blood culture. Endocarditis was ruled out and the patient did well with five days of intravenous broad spectrum antibiotics. To date, only a previous case of sepsis by R. dentocariosa in a neonate with meconium aspiration syndrome and an antenatal death of a full-term fetus with hemorrhagic brain lesions probably related to R. dentocariosa have been reported. Conclusions Until more information about the pathogenicity of this germ in the newborn is available, an individualized approach and a close clinical control of the patient with infectious risk factors and bacteremia by R. dentocariosa seem to be prudent.

Correlation of Fractional Limb Volume Measurements with Neonatal Morphometric Indices

Objectives: Fractional thigh volume (TVol) and fractional arm volume (AVol) measurements by three-dimensional (3D) ultrasound can reveal valuable information on fetal soft tissue development. However, it is not clear whether TVol or AVol provides better estimates of fetal body proportion and adiposity, independent of routine two-dimensional (2D) ultrasound biometry. The primary objective of the current study was to determine the correlations between fractional limb volumes (FLVs) and neonatal anthropometric parameters. Design: In this cross-sectional study, fetal FLVs were obtained within 24 h before term delivery from 40 medically and obstetrically uncomplicated pregnancies scheduled for elective cesarean section. TVol and AVol were determined using offline software. Postnatal morphometric data including birth weight; crown-heel, arm, and leg lengths; head, abdominal, mid-thigh, and mid-arm circumferences; and anterior thigh, biceps, and subscapular skinfold thicknesses were obtained. Pearson and partial correlation analyses were used to determine the relationships across antenatal volume calculations and neonatal indices. Correlation coefficients (r) were calculated. Results: Mean maternal age, BMI, and parity were 29.1 ± 5.4 years, 29.7 ± 3.5 kg/m², and 1.0 ± 1.3, respectively. AVol showed moderate correlations with most of the neonatal parameters, including mid-thigh circumference (r = 0.683), mid-arm circumference (r = 0.627), birth weight (r = 0.583), head circumference (HC, r = 0.560), and abdominal circumference (r = 0.542). However, TVol was weakly related to only some of the indices. After controlling for gestational age, maternal age, BMI, parity, and 2D ultrasound biometry, TVol was no longer associated with any of the parameters, while AVol was independently correlated with mid-thigh (r = 0.724) and mid-arm circumference (r = 0.560), birth weight (r = 0.502), ponderal index (r = 0.402), HC (r = 0.382), biceps (r = 0.384), and subscapular skinfold thickness (r = 0.350). Limitations: The current design includes limited number of pregnancies with only scheduled cesarean deliveries. Neonatal percent body fat was not calculated, and air-displacement plethysmography was not used to assess neonatal body composition. The study population was Caucasian with a relatively high maternal BMI, which may limit extrapolation of the results to other settings. Conclusions: AVoL measurements by 3D ultrasound before delivery are significantly correlated with most of the neonatal morphometric indices, independent of maternal characteristics and 2D biometric parameters. AVol may have advantages over TVol for assessing limb soft tissue development in term fetuses. Future research can focus on feasibility and predictive ability of AVol measurements in prospective studies that include serial biometry over time.

Pathological changes, distribution and detection of Brucella melitensis in foetuses of experimentally-infected does

Background Brucellosis of goats is caused by Brucella melitensis. It is a re-emerging zoonotic disease in many countries due to transmission from domestic animals and wildlife such as ibex, deer and wild buffaloes. Objective To describe the pathological changes, identification and distribution of B. melitensis in foetuses of experimentally infected does. Methods Twelve female goats of approximately 90 days pregnant were divided into 4 groups. Group 1 was exposed intra-conjunctival to 100 µL of sterile PBS while goats of Groups 2, 3 and 4 were similarly exposed to 100 µL of an inoculum containing 109 CFU/mL of live B. melitensis. Goats of these groups were killed at 15, 30 and 60 days post-inoculation, respectively. Foetal fluid and tissues were collected for bacterial identification (using direct bacterial culture, PCR and immuno-peroxidase staining) and histopathological examination. Results Bilateral intra-conjunctival exposure of pregnant does resulted in in-utero infection of the foetuses. All full-term foetuses of group 4 were either aborted or stillborn, showing petechiations of the skin or absence of hair coat with subcutaneous oedema. The internal organs showed most severe lesions. Immune-peroxidase staining revealed antigen distribution in all organs that became most extensive in group 4. Brucella melitensis was successfully isolated from the stomach content, foetal fluid and various other organs. Conclusion Vertical transmission of caprine brucellosis was evident causing mild to moderate lesions in different organs. The samples of choice for isolation and identification of B. melitensis are stomach content as well as liver and spleen tissue.

Association between Antenatal Vulvovaginitis and Birth-Related Perineal Trauma

Statement of the Problem Birth-related perineal trauma commonly affects women who give birth vaginally and adversely affects postpartum recovery. In general, women who had diagnostic of antenatal vulvovaginitis are more likely to have these injuries; however there is no robust evidence that support such association. Objective: To identify whether antenatal vulvovaginitis is associated with perineal trauma in normal birth. Method: A cross-sectional study with 100 primiparous women, at least 18 years of age, who gave birth to a single, live, full-term fetus in vertex presentation at a midwife-led birth center. Data were collected from the antenatal and birth record and by structured interview of the participants. Results: mean of participants’ age 23.1 years (SD: 4.8), 16% of labor induced with misoprostol, 54% of synthetic oxytocin infusion in labor, 83% of lithotomy birth position, 98% of “hands on” maneuver, 75% of perineal trauma (70.7% first degree and 29.3% second degree laceration), 54% of antenatal vulvovaginitis (42% treated in the antenatal period), mean of newborn birth weight, head and thoracic circumference: 3.102g (SD: 385), 33.3 cm (SD: 1.2) and 32.2 cm (SD: 1.7), respectively. Only the variables antenatal vulvovaginites and newborn birth weight and head circumference were associated with perineal trauma. Women who had antenatal vulvovaginitis were 4.7 more likely to have perineal trauma compared to those without vulvovaginitis, regardless of the newborn birth weight and head circumference. Each increase of 100g in the newborn’s birth weight and 1cm in the head circumference increased by 21% and 51% the chance of maternal perineal trauma in childbirth, respectively. There was no association between treating antenatal vulvovaginitis and perineal trauma or antenatal vulvovaginitis and perineal trauma severity. Conclusion: It is necessary to prevent antenatal vulvovaginites, as well as to offer special perineal care to women who had antenatal vulvovaginitis and to those who have had or is pregnant with a large baby.

Decellularization Methods of Vagina and Cervix in Tissue Engineering.

The vagina is a fibromuscular elastic tubular tract that connects the cervix with the outer genitals and has an important function discharging uterine secretions, sexual intercourse and acts as the passage for the full-term fetus. Currently, a new field of investigation which aims to design tissues and organs similar to their native origin has been developed recently and was named regenerative medicine (tissue engineering and bioengineering). Malformations in cervix tissue represent a hard challenge for medicine. Experts in bioengineering have tried to reconstruct vaginas or cervix with the aim to achieve cervicovaginal disorders, most of them with congenital cause. However, only few research groups have launched themselves upon the decellularization. The aim of this chapter is investigating the decellularization methods for cervix and vaginal tissues.

Genetic Resiliency Associated With Dominant Lethal &lt;i&gt;TPM1&lt;/i&gt; Mutation Causing Atrial Septal Defect With High Heritability

Analysis of large scale human genomic data has yielded unexplained mutations known to cause severe disease in healthy individuals. Here we report the unexpected recovery of a rare dominant lethal mutation in TPM1, a sarcomeric actin-binding protein, in 8 individuals with large atrial septal defect (ASD) in a 5-generation pedigree. Mice with TPM1 mutation exhibited early embryonic lethality with disrupted myofibril assembly and no heartbeat. However, patient induced pluripotent stem cell derived cardiomyocytes showed normal beating with mild myofilament defect, indicating disease suppression. A variant in TLN2, another myofilament actin-binding protein, was identified as a candidate suppressor. Mouse CRISRP knockin of both the TLN2/TPM1 variants rescued heart beating, with near term fetuses exhibiting large ASD. Thus, the role of TPM1 in ASD pathogenesis unfolded with the suppression of its embryonic lethality by a TLN2 protective variant. These findings provide evidence that genetic resiliency can arise with genetic suppression of a deleterious mutation.

SONOGRAPHIC IDENTIFICATION AND MEASUREMENT OF THE EPIPHYSEAL OSSIFICATION CENTERS IN THE PREDICTION OF FETAL LUNG MATURITY IN EGYPTIAN WOMEN

Background: The most common cause of mortality and neonatal morbidity in preterm and early term fetuses is lung immaturity. Respiratory distress syndrome (RDS) is a major cause of neonatal mortality and morbidity where the lung cannot provide sufficient oxygen. Objective: Evaluating the distal femoral, proximal tibial and proximal humeral ossification centres as predictive tools of fetal lung maturity. Patients and methods: This study was conducted at Obstetrics and Gynecology Department, Damanhur Teaching Hospital, from May 2019 to January 2020 and included a sample of 100 pregnant women. The mean age of mother in our study was 25.35±3.75 years, the mean BMI was 32.85±4.33. The mean gestational age by U/S was 38.01±1.65 weeks, the mean epiphyseal ossification centers was ranged from 2.4-6.8 with a mean of 4.53±1.22, and the epiphyseal ossification centres were parallel to gestational age. Results: The results of this study showed that the relation between Mean Epiphyseal Ossification Centers and neonatal Respiratory distress syndrome. The mean Epiphyseal Ossification Centers were significantly low in neonatal with respiratory distress syndrome (p <0.05). It was found that there was a positive significant correlation between mean epiphyseal ossification centers and APGAR score at 5 min. It was found that the Mean Epiphyseal Ossification Centers were significantly increased with increasing gestational age. Conclusion: The distal femoral, proximal tibial and proximal humeral ossification centers have good predictive values of fetal lung maturity.

SONOGRAPHIC IDENTIFICATION AND MEASUREMENT OF THE EPIPHYSEAL OSSIFICATION CENTERS IN THE PREDICTION OF FETAL LUNG MATURITY IN EGYPTIAN WOMEN

Background: The most common cause of mortality and neonatal morbidity in preterm and early term fetuses is lung immaturity. Respiratory distress syndrome (RDS) is a major cause of neonatal mortality and morbidity where the lung cannot provide sufficient oxygen. Objective: Evaluating the distal femoral, proximal tibial and proximal humeral ossification centres as predictive tools of fetal lung maturity. Patients and methods: This study was conducted at Obstetrics and Gynecology Department, Damanhur Teaching Hospital, from May 2019 to January 2020 and included a sample of 100 pregnant women. The mean age of mother in our study was 25.35±3.75 years, the mean BMI was 32.85±4.33. The mean gestational age by U/S was 38.01±1.65 weeks, the mean epiphyseal ossification centers was ranged from 2.4-6.8 with a mean of 4.53±1.22, and the epiphyseal ossification centres were parallel to gestational age. Results: The results of this study showed that the relation between Mean Epiphyseal Ossification Centers and neonatal Respiratory distress syndrome. The mean Epiphyseal Ossification Centers were significantly low in neonatal with respiratory distress syndrome (p <0.05). It was found that there was a positive significant correlation between mean epiphyseal ossification centers and APGAR score at 5 min. It was found that the Mean Epiphyseal Ossification Centers were significantly increased with increasing gestational age. Conclusion: The distal femoral, proximal tibial and proximal humeral ossification centers have good predictive values of fetal lung maturity.

Longitudinal adrenal gland measurements and growth trajectories as risk markers for late preterm delivery

BackgroundThe fetal adrenal gland receives rising awareness as a predictor of spontaneous preterm birth. We hereby provide longitudinal growth assessments of the fetal adrenal gland in a low risk population with an additional focus on trajectories in fetuses born preterm.MethodsFetal adrenal gland was assessed via transabdominal ultrasound at gestational weeks (gw) 24–26, 28–30, and 34–36 in a low-risk pregnancy cohort. Longitudinal trajectories of the total gland and the mark (so called fetal zone) as well as ratio of fetal zone width/ total widths (w/W) were analyzed using repeated ANOVA analyses. To compare trajectories of the ratio w/W for preterm and term fetuses respectively, as well as women with and without clinical signs of preterm labor, the propensity score method was applied.ResultsFetal zone width increased over the course of pregnancy (p < 0.0001), while the ratio w/W decreased (p < 0.0001) (n = 327). Comparing the trajectories of the ratio w/W in fetuses born preterm (n = 11) with propensity-score matched term born fetuses (n = 22), a decrease between gw 24–26 and 28–30 was observed in both groups, which continued to decrease for the term born fetuses. However, in preterm born fetuses, the ratio increased above the term born values at gw 34–36.ConclusionOur study provides for the first time longitudinal growth data on the fetal adrenal gland and supports the hypothesis that fetal zone enlargement is associated with preterm birth which could play an important role in risk-prediction.

Referenced by Centralbl. f. Gynaek., 1894

Morisam (Naples) gave a talk "On symphysiotomy". Symphysiotomy is undertaken to extract a live, full-term fetus, with narrow pelvis with a true conjugate in 6.7 - 8.8 cm, with the onset of labor in the period of opening the throat.

Meta-Analyses of Fraternal and Sororal Birth Order Effects in Homosexual Pedophiles, Hebephiles, and Teleiophiles.

This study investigated the relations between numbers of older brothers, numbers of older sisters, and the odds of homosexuality in later-born males, including males who are most attracted sexually to prepubescent or early pubescent children (pedohebephiles) and males who are most attracted sexually to adults (teleiophiles). The authors meta-analyzed data from 24 samples of homosexual and heterosexual men, originally reported in 18 studies, and totaling 18,213 subjects. The results confirmed that older brothers increase the odds of same-sex preference in pedohebephiles as they do in teleiophiles. They also replicated the recent finding that older sisters have a similar but weaker statistical association with the odds of homosexuality. These findings have two theoretical implications. First, the findings for older brothers and older sisters indicate some commonality in the factors that influence sexual preference in teleiophiles and those that influence sexual preference in pedohebephiles. Second, the finding for older sisters confirms a prediction stemming from the hypothesis that male fetuses stimulate maternal antibodies that increase the odds of homosexuality in later-born males. Such immunization could result from miscarried as well as full-term fetuses, and number of older sisters should correlate with number of male fetuses miscarried before gestation of the subject.

The ability of various cerebroplacental ratio thresholds to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction.

Our primary aim was to evaluate the ability of various cerebroplacental ratio (CPR) reference values suggested by the Fetal Medicine Foundation to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction (LOFGR). Our secondary aim was to evaluate the effectiveness of other obstetric Doppler parameters used to assess fetal well-being in terms of predicting adverse neonatal outcomes. This was a retrospective cohort study of 317 pregnant women diagnosed with LOFGR at 37-40weeks of gestation between January 1, 2016, and September 1, 2019. Receiver operating characteristic (ROC) curves were drawn to determine the predictive performance of CPR <1, CPR <5th or <10th percentile, and umbilical artery pulsatility (PI) >95th percentile in terms of predicting adverse neonatal outcomes. Pregnant women exhibiting LOFGR who gave birth in our clinic during the study period at a mean of 38 gestational weeks (minimum 37+0; maximum 40+6 weeks); the median CPR was 1.51 [interquartile range (IQR) 1.12-1.95] and median birthweight 2,350g (IQR 2,125-2,575g). The CPR <5th percentile best predicted adverse neonatal outcomes [area under the curve (AUC) 0.762, 95% confidence interval (CI) 0.672-0.853, p<0.0001] and CPR <1 was the worst predictor (AUC 0.630, 95% CI 0.515-0.745, p=0.021). Of other Doppler parameters, neither the umbilical artery systole/diastole ratio nor the mid-cerebral artery to peak systolic velocity ratio (MCA-PSV) predicted adverse neonatal outcomes (AUC 0.598, 95% CI 0.480-0.598, p=0.104; AUC 0.521, 95% CI 0.396-0.521, p=0.744 respectively). The CPR values below the 5th percentile better predicted adverse neonatal outcomes in pregnancies complicated by LOFGR than the UA PI and CPR <1 by using Fetal Medicine Foundation reference ranges.

Use of Cesarean Birth among Robson Groups 2 and 4 at Mizan-Tepi University Hospital, Ethiopia.

Background Primary cesarean birth rates were high among women who were either nulliparous (Group 2) or multiparous (Group 4) with a single, cephalic, term fetus who were induced, augmented, or underwent cesarean birth before labor in our study cohort. Objectives The objective of this analysis was to determine what risk factors were associated with cesarean birth among Robson Groups 2 and 4. Methods This study was a prospective hospital-based cross-sectional analysis of a convenience sample of 1,000 women who delivered at Mizan-Tepi University Teaching Hospital in the summer and fall of 2019. Results Women in Robson Groups 2 and 4 comprised 11.4% (n = 113) of the total population (n = 993). The cesarean birth rate in Robson Group 2 (n = 56) was 37.5% and in Robson Group 4 (n = 57) was 24.6%. In Robson Group 2, of all prelabor cesareans (n = 5), one birth was elective cesarean by maternal request; the intrapartum cesarean births (n = 16) mostly had a maternal or fetal indication (93.8%), with one birth (6.2%) indicated by “failed induction or augmentation,” which was a combined indication. In Robson Group 4, all 4 women delivered by prelabor cesarean had a maternal indication (one was missing data), and 3 of the intrapartum cesareans were indicated by “failed induction or augmentation.” In multivariable modeling of Robson Group 2, having a labor duration of “not applicable” increased the risk of cesarean delivery (RR 2.9, CI (1.5, 5.4)). The odds of requiring maternal antibiotics was the only notable outcome with increased risk (RR 11.1, CI (1.9, 64.9)). In multivariable modeling of Robson Group 4, having a labor longer than 24 hours trended towards a significant association with cesarean (RR 3.6, CI (0.9, 14.3)), and women had a more dilated cervix on admission trended toward having a lower odds of cesarean (RR 0.8, CI (0.6, 1.0)). Conclusion Though rates of primary cesarean birth among women who have a term, single, cephalic fetus and are induced, augmented, or undergone prelabor cesarean birth are high, those that occur intrapartum seem to be associated with appropriate risk factors and indications, though we cannot say this definitely as we did not perform an audit. More research is needed on the prelabor subgroup as a separate entity.

Embryological and surgical considerations of absent infra-renal part of inferior venacava and left renal vein

Background: Development of inferior vena cava (IVC) is a complex process that involves the anastomoses between three pairs of embryonic veins. Specific permutations exist in the venous plane of the abdomen and pelvis resulting in variations such as single left IVC, double IVC, and left renal retroaortic vein. Anomalies of the inferior vena cava and renal veins occur infrequently but may contribute to serious morbidity throughout surgical exploration if unidentified. Most anomalies remain asymptomatic until surgical intervention or clinical presentation with thromboembolic complications.&#x0D; Aims and Objective: Our research is aimed to link embryology with developmental disorder and the complications associated with the anomalous vessels in the field of surgery.&#x0D; Materials and Methods: Ten IUD fetuses (ranging from 20 weeks to term fetuses) were collected from the O&amp;G department of the college and injected locally with dilute formalin and placed in containers filled with formalin. Dissection of the fetuses was done to identify congenital anomalies.&#x0D; Results: The external appearance of the 28-week-old fetus showed no gross anomaly. Examination abdominal cavity showed absent infrarenal segment of IVC and left renal vein. The right renal vein was seen running a long course to the left side with tributaries of lumbar veins and was seen continuing as the left femoral vein medial to the femoral artery. Segments of suprarenal and renal IVC were present.&#x0D; Conclusion: Correlating anomalies and variations of IVC and its tributaries to embryology. However, understanding of such anomaly is necessary to avoid significant diagnostic pitfalls and in preoperative surgicaland radiological intervention planning.

Maternal and neonatal outcomes associated with induction of labor after one previous cesarean delivery: A French retrospective study.

BackgroundThe safety of methods of labor induction in women with previous cesarean deliveries is still debated. We investigated perinatal outcomes associated with labor induction among women with a trial of labor after one cesarean delivery.MethodsThis retrospective study included 339 women with a trial of labor after one prior cesarean and a singleton term fetus in cephalic presentation in 2013–2016 in a French maternity unit. Labor induction was performed with oxytocin, artificial rupture of membranes and/or prostaglandin E2, according to the Bishop score. The primary outcome was a composite of uterine rupture, low Apgar score, neonatal resuscitation or admission to a neonatal unit. The secondary outcomes included cesarean delivery after onset of labor, postpartum hemorrhage and maternal hospital stay after delivery. We used logistic regression to estimate odds ratios adjusted (aOR) for potential confounders.ResultsIn our sample, 67.3% of women had spontaneous labor and 32.7% were induced. More than half of the women received oxytocin during labor regardless of the mode of labor. The proportions of the composite outcome and of cesarean after onset of labor were higher in the induced group compared to the spontaneous group (26.1% vs 15.8%, p = 0.02 and 45.0% vs 27.6%, p<0.01, respectively). There were 9 uterine ruptures (2.6%) and this proportion was higher in the induced group compared to the spontaneous group, although this difference was not statistically significant (3.6% vs 2.2%, p = 0.48). After adjustment, labor induction was associated with higher risks of the composite outcome (aOR = 2.45, 95% CI: 1.29–4.65), cesarean after onset of labor (aOR = 2.06, 95% CI: 1.15–3.68) and maternal hospital stay after delivery ≥6 days (aOR = 6.20, 95% CI: 3.25–11.81). No association was found with postpartum hemorrhage.ConclusionLabor induction after one prior cesarean was associated with a higher risk of adverse perinatal outcome. Nevertheless, the higher proportion of uterine rupture did not differ significantly from that in the spontaneous labor group.

Relationship between maternal thyroid function disturbance and malpresentation in term fetus

Background: Malpresention is any presentation other than the vertex, breech presentation at term is the most common abnormal fetal presentation and is associated with neonatal and maternal morbidity and mortality. Many etiological factors associated with malpresention including prematurity, intrauterine growth restriction; uterine and pelvic abnormality and endocrine diseases as in hypo – or hyperthyroidism which impair obstetrical outcome. Objectives: To study and evaluate the relationship of disturbed maternal thyroid function during gestation and abnormal fetal presentation at term. Patients and methods: Prospective randomized study of pregnant women Over nine months period from October 2013 to July 2014 A hundred healthy pregnant women who living in Tikrit and Al-Fallujah cities with age ranging from 19 – 45 years old (mean age of 28.5) randomized selected undergone history and clinical examination, obstetrical ultrasonic examination done for them with blood sample taken at term(37 gestational week and more) for thyroid function assessment through free thyroxin T3, bound thyroxin T4, thyroid stimulating hormone TSH. Result: A fifty pregnant women were cephalic presentation (50%), thirty five were breech (35%) and other presentations such as shoulder, face, brow were 10%, 4% and 1% respectively. Normal thyroid function through thyroid parameters was shown in (83%) of the pregnant (class I), (8%) of cases were associated with hyperthyroxinaemia (class II) and (9%) were hypothyroxinaemia (class III); 2 cases of cephalic presentation (2%) of total cases; 6 cases of breech (6%) of total cases and one case of shoulder presentation (1%) of total cases were hypothyroxinaemia, 4 cases of cephalic presentation (4%), 3 cases of breech (3%) and one case (1%) face presentation were (class II) Hyper thyroxinaemia). Conclusion: Pregnant women with abnormal thyroid function during gestation are at risk of fetal malpresentation. Hypothyroxinaemic pregnant showing high incidence of breech presentation with more incidence of caesarean section and more fetal, maternal and obstetrical complications.

Mean Platelet Volume is Affected in Term Fetuses with Intrauterine Growth Restriction

The aim of our study was to analyze the mean platelet volume levels as a potential marker of altered placentation in intrauterine growth restriction (IUGR) cases. A total of 126 term singleton pregnant women with IUGR fetuses and 345 healthy pregnant controls were recruited and compared. The mean platelet volume was significantly higher in the IUGR group (10.8±0.9 fl) than the control group (9.9±1.1 fl) (p=0.03). The mean hemoglobin was lower in IUGR group (11.3 (8.3-14.5) g/dl) than the control group (11.9 (8.2-13.0) g/dl) (p=0.04). The optimal cut-off MPV for prediction of IUGR was ≥10.55 fl, with a sensitivity of 59% and a specificity of 75%. Increased MPV levels in term pregnant women may be particularly helpful for discrimination and prediction of high-risk fetuses when IUGR is suspected.

Observational Descriptive Study of Clinical Outcomes on Extremely Obese Pregnant, Nulliparous Women Carrying a Single Term Fetus in Vertex Presentation (NTSV)

Observational Descriptive Study of Clinical Outcomes on Extremely Obese Pregnant, Nulliparous Women Carrying a Single Term Fetus in Vertex Presentation (NTSV)