Term Fetuses Research Articles

Intrauterine deaths - an unsolved problem in Polish perinatology.

The Polish criteria for "intrauterine death" include fetal demise after 22 weeks of gestation, weighing > 500 g and body length at least 25 cm, when the gestational age is unknown. The rate of fetal death in Poland in 2015 is 3:10,000. In 2020, 1,231 stillbirths were registered. An analysis using 142,662 births in the period between 2015-2020 in 11 living in Poland. The first subgroup was admitted as patients > 22 to the beginning of the 30th week of pregnancy (n = 229), and the second from the 30th week of pregnancy inclusively (n = 179). In the case of women from both subgroups, there was a risk of preterm delivery close to hospitalization. It was found that stillbirth in 41% of women in the first pregnancy. For the patient, stillbirth was also the first in his life. The average stillbirth weight was 1487 g, the average body length was 40 cm. Among fetuses up to 30 weeks, male fetuses are born more often, in subgroup II, the sex of the child was usually female. Most fetal deaths occur in mothers < 15 and > 45 years of age. According to the Polish results of the origin of full-term fetuses > 30 weeks of gestation for death in the concomitant antenatal, such as placental-umbilical and fetal hypoxia, acute intrapartum effects rarely, and moreover < 30 Hbd fetal growth restriction (FGR), occurring placental-umbilical, acute intrapartum often.

Cardiovascular Adaptation in Fetal Growth Restriction: A Longitudinal Study From Fetuses at Term to the First Year of Life.

To investigate longitudinal trends in fetal and offspring cardiovascular adaptation in fetal growth restriction (FGR). Prospective longitudinal study. Fetal Medicine Unit. Thirty-five FGR pregnancies and 37 healthy controls assessed as term fetuses (mean age 37 ± 1 weeks) and again in infancy (mean age 8 ± 2 months). Conventional echocardiographic techniques, tissue Doppler imaging and speckle tracking echocardiography. Left ventricular (LV) and right ventricular (RV) geometry and function. Echocardiographic parameters were normalised by ventricular size adjusting for differences in body weight between groups. Compared to healthy controls, late FGR fetuses showed significant alterations in cardiac geometry with more globular LV chamber (LV sphericity index, 0.56 vs. 0.52), increase in biventricular global longitudinal systolic contractility (MAPSE, 0.29 vs. 0.25 mm; TAPSE, 0.42 vs. 0.37 mm) and elevated cardiac output (combined CO: 592 vs. 497 mL/min/kg, p < 0.01 for all). Indices of LV diastolic function in FGR fetuses were significantly impaired with myocardial diastolic velocities (LV A', 0.30 vs. 0.26 cm/s; IVS E', 0.19 vs. 0.16 cm/s) and LV torsion (1.2 vs. 3.5 deg./cm, p < 0.01 for all). At postnatal assessment, FGR offspring revealed persistently increased SAPSE (0.27 vs. 0.24 mm), LV longitudinal strain (-19.0 vs. -16.0%), reduced LV torsion (1.6 vs. 2.1 deg./cm) and elevated CO (791 vs. 574 mL/min/kg, p < 0.01 for all). Perinatal cardiac remodelling and myocardial dysfunction in late FGR fetuses is most likely due to chronic placental hypoxaemia. Persistent changes in cardiac geometry and function in FGR offspring may reflect fetal cardiovascular maladaptation that could predispose to long-term cardiovascular complications in later life.

A multimodal dual-branch fusion network for fetal hypoxia detection

Labor is the most severe test of a fetus’s ability to survive hypoxia. Even low-risk full-term fetuses may endure variable degrees of hypoxia as a result of intrapartum uterine contractions. It is imperative for clinicians to expeditiously identify fetal hypoxia and implement timely interventions. However, due to the intricacy and intra-class variability of fetal heart rate (FHR) data, distinguishing normal babies from acidotic fetuses is extremely challenging. This research proposes a novel multimodal dual-branch fusion network to improve the accuracy of fetal hypoxia identification. The dual-branch network is constructed through the signal slicing method. Additionally, we present a novel attention guidance module that leverages spatial attention to capture hypoxia-related information from two branches of signal. Ultimately, the network integrates maternal electronic medical records, FHR features, and FHR signals to achieve multimodal fusion of the input features. Furthermore, label smoothing can yield better calibrated networks, thus improving classification performance even further. On the public dataset, this method obtained a sensitivity of 72.58 %, a specificity of 71.08 %, a quality index of 71.59 %, and an area under the curve of 74.70 %. This method combines maternal-fetal medicine and artificial intelligence, represents a new strategy to recognize fetal acidosis.

Perinatal Cardiac Functional Adaptation in Hypoplastic Left Heart Syndrome: A Longitudinal Analysis

The perinatal transition is characterized by acute changes in cardiac loading. Compared with normal newborn combined cardiac output (CCO), single right ventricular (RV) output of neonates with hypoplastic left heart syndrome (HLHS) is markedly greater. The aim of this study was to examine the mechanisms of cardiac adaptation that facilitate this perinatal transition from late fetal to early neonatal life in HLHS. Prospectively recruited pregnancies complicated by fetal HLHS (n=35) and healthy control subjects (Ctrl; n=17) underwent serial echocardiography in late gestation (38±1weeks) and 6, 24, and 48hours after birth. Cardiac function was assessed using conventional, Doppler tissue, and speckle-tracking echocardiography. Term fetuses with HLHS had RV output comparable with Ctrl CCO via higher stroke volume. Compared with both left ventricular and RV indices of Ctrl, they exhibited globular and dilated right ventricles with reduced relative wall thickness (0.40±0.08 vs 0.49±0.10, P<.01), increased Tei index' (HLHS vs Ctrl left ventricle/Ctrl right ventricle: sphericity index, 0.9±0.25 vs 0.5±0.10/0.6±0.11; RV area index, 28±6 vs 15±3/17±5cm2/m2; Tei index', 0.65±0.11 vs 0.43±0.07/0.45±0.09; P<.0001 for all). Neonates with HLHS generated elevated RV cardiac output compared with Ctrl CCO via higher heart rate and stroke volume, with further RV dilatation, increased longitudinal systolic strain at 48hours (-17±4% vs -14±3%/14±5%) with reduced circumferential and rotational myocardial deformation and altered diastolic function. Neonates with HLHS also demonstrated right atrial enlargement with increased longitudinal strain: 6hours (33±12% vs 26±6%), 24hours (37±15% vs 26± 13%), and 48hours (38±11% vs 24±13%) (P<.0001). Term fetuses with HLHS exhibit altered RV geometry and RV systolic and diastolic functional parameters. After birth, further alterations in these cardiac parameters likely reflect adaptation to acutely altered RV loading from increasing cardiac output and pulmonary artery flow demands.

Morphological Variations of Umbilical Cord of Full-Term Foetuses - Correlation with Maternal and Newborn Parameters

Morphological Variations of Umbilical Cord of Full-Term Foetuses - Correlation with Maternal and Newborn Parameters

Uterine contractile activity and neonatal outcome - A blind analysis of a randomized controlled trial cohort.

Sufficient contractions are necessary for a successful delivery but each contraction temporarily constricts the oxygenated blood flow to the fetus. Individual fetal or placental characteristics determine how the fetus can withstand this temporary low oxygen saturation. However, only a few studies have examined the impact of uterine activity on neonatal outcome and even less attention has been paid to parturients' individual characteristics. Our objective was therefore to find out whether fetuses compromised by maternal or intrapartum risk factors are more vulnerable to excessive uterine activity. Uterine contractile activity was assessed by intrauterine pressure catheters. Women (n = 625) with term singleton pregnancies and fetus in cephalic presentation were included in this secondary, blind analysis of a randomized controlled trial cohort. Intrauterine pressure as Montevideo units (MVU), contraction frequency/10 min and uterine baseline tone were calculated for 4 h prior to birth or the decision to perform cesarean section. Uterine activity in relation to umbilical artery pH linearly or ≤7.10 was used as the primary outcome. Need for operative delivery (either cesarean section or vacuum-assisted delivery) due to fetal distress was analyzed as a secondary outcome. In addition, belonging to vulnerable subgroups with, for example, chorioamnionitis, hypertensive or diabetic disorders, maternal smoking or neonatal birthweight <10th percentile were investigated as additional risk factors. A linear decline in umbilical artery pH was seen with increasing intrauterine pressure in all deliveries (p < 0.001). Among parturients with suspected chorioamnionitis, every increasing 10 MVUs increased the likelihood of umbilical artery pH ≤7.10 (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02-1.34, p = 0.023). The need for operative delivery due to fetal distress was increased among all laboring women by every increasing 10 MVUs (OR 1.05, 95% CI 1.01-1.09, p = 0.015). This association with operative deliveries was further increased among parturients with hypertensive disorders (OR 1.23, 95% CI 1.05-1.43, p = 0.009) and among those with diabetic disorders (OR 1.13, 95% CI 1.04-1.28, p = 0.003). Increasing intrauterine pressure impairs umbilical artery pH especially among parturients with suspected chorioamnionitis. Fetuses in pregnancies affected by chorioamnionitis, hypertensive or diabetic disorders are more vulnerable to high intrauterine pressure.

Morphological Variations of the Umbilical Cord of Full-term Fetuses – Correlation with Maternal and Newborn Parameters

Introduction: Abnormalities in the development and site of insertion of the umbilical cord (UC) can cause problems which have the potential to affect maternal and fetal health. The aim of the present study was to evaluate the gross features of UC of singleton pregnancies and correlate it to the newborn parameters and maternal parameters at term. Materials and Methods: An observational, descriptive pilot study was carried out with 100 placentas. All ethical principles for human research were followed and ethical approval was obtained from the institutional ethics committee of the medical college from where data were collected. The inclusion criteria were the adequately preserved placenta with no gross abnormalities. Placenta belonging to hypertensive mothers and mothers with gestational diabetes were excluded. Results and Conclusion: The UC morphology was recorded and analyzed. Newborn parameters and maternal parameters were correlated to UC parameters. The present study statistics showed 53% placentas with central insertion, 36% eccentric insertion, 3% furcated and marginal insertions each, and 5% specimens with velamentous insertion. A correlation between the UC insertion site and birth weight was observed. Low birth weight was observed when the cord was inserted eccentrically. Further investigations are required among velamentous insertion to reach a conclusion for maternal blood group correlations.

The use of intrapartum ultrasound in operative vaginal birth: a retrospective cohort study

BackgroundPoor outcomes from operative vaginal birth (OVB) have been associated with failure to recognize malposition, breakdown in interdisciplinary communication and deviation from accepted guidelines. We recently implemented a safety bundle, including routine intrapartum ultrasound (IPUS), a structured time-out and procedural checklist, aiming to reduce maternal and perinatal morbidity from OVB. ObjectivesTo compare births where IPUS was and was not used during the safety bundle implementation period at Monash Health. Study DesignWe performed a retrospective cohort study at Monash Health during the transitional phase of implementing an OVB safety bundle. We studied all women with OVB and fully-dilated cesarean (FDCS) births with a singleton cephalic term fetus. We compared births when IPUS was and was not used. The primary outcome was neonates delivered in an unexpected position. Neonatal and maternal morbidity were also assessed, including a neonatal composite of Apgar score <7 at 5 minutes, cord lactate >8mmol/L, need for resuscitation, significant birth trauma or neonatal intensive care unit admission. To control confounding by indication, we estimated propensity scores (PS) for the probability of using IPUS for each case based on maternal and labor characteristics, and adjusted the effect estimates for the PS using multivariable logistic regression models. ResultsFrom August 2022 to July 2023 there were 1205 OVB or FDCS at Monash Health, including 743 (61.7%) forceps, 346 (28.7%) vacuum, and 116 (9.6%) FDCS births. Over this time, we observed increased uptake of IPUS from 26% in August 2022 to 60% (p < 0.001) in July 2023, of the time-out from 21% to 58% (p <0.001) and the checklist from 33% to 80% (p <0.001). of operative second stage births. Of births where IPUS was used (n = 509) compared to not used (n = 696), there were significantly more forceps births (67% vs. 58%, adjusted OR [aOR] 1.35, 95% CI 1.05 to 1.74, p = 0.021) and a reduction in vacuum births (24% vs. 32%, aOR 0.77, 95% CI 0.58 to 1.01, p = 0.059).There were no significant differences in FDCS or maternal morbidity. IPUS use was associated with significantly fewer infants being delivered in an unexpected position (0.2% vs. 2.2%, aOR 0.08, 95% CI 0.00 to 0.44, p = 0.019) and a significant reduction in composite neonatal morbidity (22% vs. 25%, aOR 0.73, 95% CI 0.54 to 0.97, p = 0.031). ConclusionsDuring the implementation of a safety bundle, the use of ultrasound prior to OVB was associated with fewer infants delivered in an unexpected position and reduced neonatal morbidity.

Growth of muscles and nerves in the upper eyelid: a morphometrical and immunohistochemical study using term human fetuses.

There is no information about muscle growth in eyelids with infrequent blinking in fetuses. To examine the muscle and nerve morphology, we morphometrically and immunohistochemically examined sagittal sections of unilateral upper eyelids obtained from 21 term fetuses (approximately 30-42weeks of gestation) and, for the comparison, those from 10 midterm fetuses (12-15weeks). The approximation margin of the upper eyelid always corresponded to the entire free margin in midterm fetuses, whereas it was often (18/21) restricted in the posterior part in term fetuses. Thus, in the latter, the thickness at the approximation site to the lower lid often ranged from 0.8 to 1.6mm and corresponded to 18-56% of the nearly maximum thickness of the lid. In the lower part of the upper eyelid, a layer of the orbicularis oculi muscles often (14/21) provided posterior flexion at 90-120° to extend posteriorly. Nerve fibers running along the mediolateral axis were rich along the approximation surface at term, but they might not be reported in the upper eyelid of adults. Being different from adult morphologies, the term eyelid was much thicker than the approximation surface and it carried a flexed muscle layer and transversely-running nerve. The infrequent blinking in fetuses seemed to provide a specific condition for the muscle-nerve growth. Plastic and pediatric surgeons should pay attention to a fact that infants' upper eyelid was unlikely to be a mini-version of the adult morphology.

Sirenomelia: An anatomical assessment and genetic sex determination of two cases.

The etiology of sirenomelia is currently unknown. Data are limited in comparing external and internal abnormalities using modern imaging technologies and molecular genetic analysis. The purpose of the current study was designed to compare external and internal anatomical defects in two cases of sirenomelia and Potter's sequence. Considered rare, Potter's sequence is a fetal disorder with characteristic features of bilateral renal agenesis, obstructive uropathy, atypical facial appearance, and limb malformations. The internal and external malformations of two term fetuses with sirenomelia and Potter's sequence were compared using assessment of external features, radiography and MRI on internal structures, and molecular genetic studies on sex determination. Data reveal that both fetuses were male and manifested with an overlapping but distinct spectrum of abnormalities. Principal differences were noted in the development of the ears, brain, urogenital system, lower limbs, pelvis, and vertebral column. Defects of the axial mesoderm are likely to underlie the abnormalities seen in both fetuses. The first one, which had only caudal defects, was found to have a spectrum of abnormalities most similar to those associated with more severe forms of the small pelvic outlet syndrome, although the structure and orientation of the sacrum and iliae were different from previously reported cases. The other had both caudal and cranial defects, and was most similar to those described in the axial mesodermal dysplasia syndrome. Defects associated with sirenomelia can be evaluated with standard gross anatomy examination, radiology, MRI, and modified PCR techniques to determine anatomical abnormalities and the sex of preserved specimens, respectively. Evidence indicated that sirenomelia could be developed via various etiologies.

Accuracy of Estimated Fetal Weight by Ultrasound Versus Leopold Maneuver.

Estimated fetal weight (EFW) is frequently used for clinical decision-making in obstetrics. The goals of this study were to determine the accuracy of EFW assessments by Leopold and ultrasound and to investigate any associations with maternal characteristics. Postgraduate years 1 and 2 obstetrics and gynecology resident physicians from Harbor-UCLA Medical Center from 2014 to 2020 performed EFW assessments on 10 preterm (<37 weeks' gestational age) fetuses by ultrasound biometry and 10 full-term (≥37 weeks' gestational age) fetuses by ultrasound biometry and Leopold maneuver. Assessments were included if the patients delivered within 2 weeks of the assessments. One thousand six hundred ninety-seven EFW assessments on 1183 patients performed by 33 residents were analyzed; 72.6% of sonographic full-term EFWs, 69% of Leopold full-term EFWs, and 61.5% of sonographic preterm EFWs were within 10% of the neonatal birth weight (BW). The lowest estimation error in our study occurred when actual BW was 3600 to 3700 g. After adjusting for BW, residents were found to have lower accuracy when the mother had a higher body mass index (BMI) for full-term estimation methods (Leopold and ultrasound, β = 0.13 and 0.12, P = 0.001 and 0.002, respectively). Maternal BMI was not related to estimation error for preterm fetuses ( β = 0.01, P = 0.75). Clinical and sonographic EFW assessments performed by obstetrics and gynecology junior residents are within 10% of neonatal BW much of the time. In our cohort, they tended to overestimate EFWs of lower-BW infants and underestimate EFWs of higher-BW infants. Accuracy of full-term EFW assessments seems to decrease with increasing maternal BMI.

Impacts of maternal microbiota and microbial metabolites on fetal intestine, brain, and placenta

BackgroundThe maternal microbiota modulates fetal development, but the mechanisms of these earliest host-microbe interactions are unclear. To investigate the developmental impacts of maternal microbial metabolites, we compared full-term fetuses from germ-free and specific pathogen-free mouse dams by gene expression profiling and non-targeted metabolomics.ResultsIn the fetal intestine, critical genes mediating host-microbe interactions, innate immunity, and epithelial barrier were differentially expressed. Interferon and inflammatory signaling genes were downregulated in the intestines and brains of the fetuses from germ-free dams. The expression of genes related to neural system development and function, translation and RNA metabolism, and regulation of energy metabolism were significantly affected. The gene coding for the insulin-degrading enzyme (Ide) was most significantly downregulated in all tissues. In the placenta, genes coding for prolactin and other essential regulators of pregnancy were downregulated in germ-free dams. These impacts on gene expression were strongly associated with microbially modulated metabolite concentrations in the fetal tissues. Aryl sulfates and other aryl hydrocarbon receptor ligands, the trimethylated compounds TMAO and 5-AVAB, Glu-Trp and other dipeptides, fatty acid derivatives, and the tRNA nucleobase queuine were among the compounds strongly associated with gene expression differences. A sex difference was observed in the fetal responses to maternal microbial status: more genes were differentially regulated in male fetuses than in females.ConclusionsThe maternal microbiota has a major impact on the developing fetus, with male fetuses potentially more susceptible to microbial modulation. The expression of genes important for the immune system, neurophysiology, translation, and energy metabolism are strongly affected by the maternal microbial status already before birth. These impacts are associated with microbially modulated metabolites. We identified several microbial metabolites which have not been previously observed in this context. Many of the potentially important metabolites remain to be identified.

EP22.04: Ultrasonographic measurement of alpha and beta angles of hip joints in term fetus: a pilot study for predicting developmental dysplasia of the hip

EP22.04: Ultrasonographic measurement of alpha and beta angles of hip joints in term fetus: a pilot study for predicting developmental dysplasia of the hip

Association of Cerebroplacental Ratio by Colour Doppler with Perinatal Outcome in Near Term and Term Foetuses.

Association of Cerebroplacental Ratio by Colour Doppler with Perinatal Outcome in Near Term and Term Foetuses.

Treatment, not delivery, of the late preterm and term fetus with supraventricular arrhythmia.

While in-utero treatment of sustained fetal supraventricular arrhythmia (SVA) is standard practice in the previable and preterm fetus, data are limited on best practice for late preterm (34 + 0 to 36 + 6 weeks), early term (37 + 0 to 38 + 6 weeks) and term (> 39 weeks) fetuses with SVA. We reviewed the delivery and postnatal outcomes of fetuses at ≥ 35 weeks of gestation undergoing treatment rather than immediate delivery. This was a retrospective case series of fetuses presenting at ≥ 35 weeks of gestation with sustained SVA and treated transplacentally at six institutions between 2012 and 2022. Data were collected on gestational age at presentation and delivery, SVA diagnosis (short ventriculoatrial (VA) tachycardia, long VA tachycardia or atrial flutter), type of antiarrhythmic medication used, interval between treatment and conversion to sinus rhythm and postnatal SVA recurrence. Overall, 37 fetuses presented at a median gestational age of 35.7 (range, 35.0-39.7)weeks with short VA tachycardia (n = 20), long VA tachycardia (n = 7) or atrial flutter (n = 10). Four (11%) fetuses were hydropic. In-utero treatment led to restoration of sinus rhythm in 35 (95%) fetuses at a median of 2 (range, 1-17)days; this included three of the four fetuses with hydrops. Antiarrhythmic medications included flecainide (n = 11), digoxin (n = 7), sotalol (n = 11) and dual therapy (n = 8). Neonates were liveborn at 36-41 weeks via spontaneous vaginal delivery (23/37 (62%)) or Cesarean delivery (14/37 (38%)). Cesarean delivery was indicated for fetal SVA in two fetuses, atrial ectopy or sinus bradycardia in three fetuses and obstetric reasons in nine fetuses that were in sinus rhythm at the time of delivery. Twenty-one (57%) cases were treated for recurrent SVA after birth. In-utero treatment of the near term and term (≥ 35-week) SVA fetus is highly successful even in the presence of hydrops, with the majority of cases delivered vaginally closer to term, thereby avoiding unnecessary Cesarean section. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Endometrium procurement and transplantation restores fertility in rats

Research questionCan rat endometrium be successfully procured and transplanted, and can a similar method be used to procure human endometrium? DesignRat endometrium was procured using an endometrium stripping method and transplanted into female Sprague–Dawley rats. Macroscopic and histological changes, endometrial receptivity-related protein concentrations and fertility were assessed. Additionally, a preliminary experiment was conducted to procure human endometrium using a similar method. ResultsEndometrium was successfully procured from both rats and humans, which contained intact endometrium and parts of the adjacent inner annulus myometrium. Endometrium auto-transplantation was conducted in rats and the procedure lasted a total of 41.3 ± 5.7 min with a mean blood loss of 0.09 ± 0.04 g. The transplanted endometrium survived well, but a fibrotic zone formed between the transplant and recipient tissue. Compared with sham rats, those with endometrium transplantation had similar endometrial thickness and endometrial gland numbers but reduced vascular density at 8 weeks after surgery. Endometrium transplantation also retained expression of the endometrial receptivity-related proteins leukaemia inhibitory factor and vascular endothelial growth factor. In contrast to non-pregnancy in the stripped horn, a mean of 5.0 ± 2.7 fetuses developed in the transplanted horn, and full-term live fetuses were conceived in the horns with transplanted endometrium. ConclusionsEndometrium procurement by stripping method can obtain an intact and functional endometrium, and endometrium transplantation can reconstruct the uterine cavity and restore fertility in rats.

Fetal Oxygenation from the 23rd to the 36th Week of Gestation Evaluated through the Umbilical Cord Blood Gas Analysis.

The embryo and fetus grow in a hypoxic environment. Intrauterine oxygen levels fluctuate throughout the pregnancy, allowing the oxygen to modulate apparently contradictory functions, such as the expansion of stemness but also differentiation. We have recently demonstrated that in the last weeks of pregnancy, oxygenation progressively increases, but the trend of oxygen levels during the previous weeks remains to be clarified. In the present retrospective study, umbilical venous and arterial oxygen levels, fetal oxygen extraction, oxygen content, CO2, and lactate were evaluated in a cohort of healthy newborns with gestational age < 37 weeks. A progressive decrease in pO2 levels associated with a concomitant increase in pCO2 and reduction in pH has been observed starting from the 23rd week until approximately the 33-34th week of gestation. Over this period, despite the increased hypoxemia, oxygen content remains stable thanks to increasing hemoglobin concentration, which allows the fetus to become more hypoxemic but not more hypoxic. Starting from the 33-34th week, fetal oxygenation increases and ideally continues following the trend recently described in term fetuses. The present study confirms that oxygenation during intrauterine life continues to vary even after placenta development, showing a clear biphasic trend. Fetuses, in fact, from mid-gestation to near-term, become progressively more hypoxemic. However, starting from the 33-34th week, oxygenation progressively increases until birth. In this regard, our data suggest that the placenta is the hub that ensures this variable oxygen availability to the fetus, and we speculate that this biphasic trend is functional for the promotion, in specific tissues and at specific times, of stemness and intrauterine differentiation.

Does a three-hour delayed pushing benefit the mode of delivery?

The objective of this study was to compare two strategies for passive second stage management: three-hour vs two-hour delayed pushing after the diagnosis of full cervical dilation on mode of delivery and perinatal outcomes. This retrospective observational study included low-risk nulliparous women who reatched full cervical dilation under epidural analgesia with a single term fetus in cephalic presentation and normal fetal heart rate, between September and December 2016. Mode of delivery (spontaneous vaginal delivery versus operative delivery including cesarean section and instrumental vaginal delivery) and perinatal outcomes (post-partum hemorrhage, perineal lacerations, 5-min Apgar score, umbilical cord pH and transfer to neonatal intensive care unit) were compared between two maternity units: maternity unit A, where women could have up to a three-hour delayed pushing period after full cervical dilation diagnosis, and maternity unit B, where the delayed pushing period was a maximum of 2h. Outcomes were compared using univariate and multivariable analyses. Adjusted odds ratios (aOR) were estimated using a logistic regression multivariable model that included potential cofounders. During the study period, 614 women were included, 305 in maternity unit A and 309 in maternity unit B. Women's pre-existing characteristics were comparable between the two maternity units. Women delivering in the maternity unit A had significantly lower risks of having an operative delivery compared to women delivering in the maternity unit B (respectively 18.4vs 26.9%; aOR=0.64; 95%CI [0.43 - 0.96]). Perinatal outcomes were comparable in the two maternity units, particularly in terms of post-partum hemorrhage rates (7.4vs 7.8%; aOR=1,19 [0.65 - 2.19]). Increasing the possible length of the delayed pushing period from 2 to 3h after the diagnosis of full cervical dilation in low-risk nulliparous women appears to reduce operative deliveries without adverse effects on maternal or neonatal morbidity.

COMPARATIVE CHARACTERISTICS OF TONSILLAR LYMPHOID COMPONENT IN FETUSES WITH INTRAUTERINE GROWTH RETARDATION AND NORMAL BODY WEIGHT IN LATE PRENATAL PERIOD

The aim of this work is to identify the morphological and functional features of the lymphoid component of the tonsils in foetuses with intrauterine growth retardation (IUGR) in the late prenatal period. Material and Methods. The autopsy material of the study was tonsils from 10 full-term stillborn foetuses of average body weight (3.0-3.5 kg) (comparison group hereinafter CG) and 11 stillborn foetuses weighing 2.1-2.5 kg (hereinafter IUGR). The morphological material was stained by histological, histochemical methods, followed by morphometry on an Olympus BX-41 microscope with subsequent processing with Olympus DP-soft version 3.1 program. Immunohistochemical study was carried out using the direct Coons technique. The paraffin slices were treated with monoclonal antibodies (mAb) to Thy-1, CD3, CD4, CD5, CD8, CD19, CD22, HLA-Dr. The specimens were studied with the help of Carl Zeiss Axioskop 40 FL luminescent microscope and photographed with a CANON A520 digital camera. The light intensity was analyzed, determining the optical density of immunofluorescence of the immune cells using the original method. Results. Lymphoid follicles average diameter in IUGR group was 35.45±1.507 μm, which is significantly less than the value in CG group – 54.90±1.286 μm, (p ≤0.05). The relative volume of lymphoid tissue in the tonsils of the foetuses with IUGR was also significantly lower, amounting to 63.36±2.110% compared to 72.20±2.898% in CG group (p ≤0.05), the density of cellular elements in ×600 field of vision (IUGR group – 112.63±2.284, CG – 123.40±3.392; p ≤0.05). In IUGR group, the number of CD5 lymphocytes was significantly higher, amounting to 15.63±1.286 c.u. (in CG group, 12.30±1.159 c.u.) (p ≤0.05). The population of mature CD19 lymphocytes was significantly reduced in IUGR group (IUGR – 62.09±2.625 c.u., CG – 77.0±2.660 c.u.; p ≤0.05). The luminescence intensity of the areas, where CD3-mature T-lymphocytes were localized, was significantly reduced in IUGR group in comparison with the indicator of CG group (group CG – 55.70±1.828 c.u., IUGR – 51.72±1.190 c.u.; p ≤0.05). In IUGR group, CD4 population was significantly reduced – 33.72±2.101 c.u., vs. 45.80±1.813 c.u. in CG group (p ≤0.05), while CD8 population was enlarged (41.90±1.578 vs. 33.0±1.632 c.u. in CG group) (p ≤0.05). Conclusion. The results of the quantitative and qualitative assessment of the lymphoid component of the palatine tonsils of foetuses with IUGR revealed signs of hypoplasia and delayed maturation of both Tand B-lymphoid populations against the background of increased suppressor activity. Complete maturation may occur in the early stages of the postnatal development of the child, at the same time, an increase in the population of B-1 lymphocytes, as well as an increase in the suppressor activity of CD8, which has already been formed in utero, can later play the role of an important link in the morphogenesis of immunopathological reactions of various origins.

Is There an Age Limit for a Trial of Vaginal Delivery in Nulliparous Women?

The number of nulliparous women over the age of 35 is consistently increasing, and the optimal delivery strategy is a subject of ongoing discussion. This study compares perinatal outcomes in nulliparous women aged ≥35 years undergoing a trial of labor (TOL) versus a planned cesarean delivery (CD). A retrospective cohort study including all nulliparous women ≥ 35 years who delivered a single term fetus at a single center between 2007-2019. We compared obstetric and perinatal outcomes according to mode of delivery-TOL versus a planned CD, in three different age groups: (1) 35-37 years, (2) 38-40 years, and (3) >40 years. Out of 103,920 deliveries during the study period, 3034 women met the inclusion criteria. Of them, 1626 (53.59%) were 35-37 years old (group 1), 848 (27.95%) were 38-40 (group 2), and 560 (18.46%) were >40 years (group 3). TOL rates decreased as age increased: 87.7% in group 1, 79.3% in group 2, and 50.1% in group 3, p < 0.001. Rates of successful vaginal delivery were 83.4% in group 1, 79.0% in group 2, and 69.4% in group 3, p < 0.001). Neonatal outcomes were comparable between a TOL and a planned CD. Using multivariate logistic regression, maternal age was found to be independently associated with slightly increased odds for a failed TOL (aOR = 1.13, CI 95% 1.067-1.202). A TOL at advanced maternal age appears to be safe, with considerable success rates. As maternal age advances, there is a small additive risk of intrapartum CD.