Gravid Women Research Articles

Imaging during pregnancy: What the radiologist needs to know

During the last decades, there has been a growing demand for medical imaging in gravid women. Imaging of the pregnant woman is challenging as it involves both the mother and the fetus and, consequently, several medical, ethical, or legal considerations are likely to be raised. Theoretically, all currently available imaging modalities may be used for the evaluation of the pregnant woman; however, in practice, confusion regarding the safety of the fetus often results in unnecessary avoidance of useful diagnostic tests, especially those involving ionizing radiation. This review article is focused on the current safety guidelines and considerations regarding the use of different imaging modalities in the pregnant population; also presented is an imaging work-up for the most common medical conditions of pregnant women, with emphasis on fetal and maternal safety.

Serum Calcium Level in Patients with Pre Eclampsia : A Case Control Study

Background: To compare serum calcium level in pre-eclamptic women and normal pregnant women.
 Materials and methods: It was a case-control study carried out in patient Department of Fetomaternal Medicine unit in the Department of Obstetrics & Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. From September 2010 to February 2011. Total 60 cases, among them 30 comprising control group and 30 were cases. This was a non interventional case control study that was carried out on total 60 women with age range 18 to 38 years of them 30 healthy gravid women as control group and 30 pregnancy with pre eclampsia as case. Serum calcium level of the groups were measured, and compare between this two group. Data were analyzed by computer with the help of SPSS (Statistical Package for Social Sciences) win 13 software package.
 Results: Serum calcium in pre-eclamptic women was significantly low [7.88±0.75mg/dl vs 9.9267±0.58 mg/dl] than in normal pregnant women.
 Conclusion: Serum calcium may be used for earlier detection of preeclampsia. Further studies are required to investigate whether calcium supplementation can be used as a preventable measure for the development of preeclampsia.
 Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 33-36

Three-year follow-up of the compression use in lower limb edema during pregnancy: A case report

Lower limb edema with its accompanying subjective ailments has been increasingly frequent in gravid women and in the postpartum period. The management is essentially non-interventional based on compression therapy (CT) with physical exercise adapted to the severity of venous disease and edema. A case of lower limb edema in a woman in the thirty third week of pregnancy was described. CT including compressive bandaging (CB) by short-stretch bandage and compression garments (CG) with physical activity was applied. Edema volume reduction, changes in consistency from hard to mild in palpation and reduction of accompanying ailments by use of CB after two weeks were observed. Further improvement by use of CG before and after delivery, and 3 years later was confirmed. Compression and physical exercise have a positive impact on edema reduction and leg symptoms intensity during pregnancy and should be recommended.

Comparative Study Between Oxytocin Versus Tranexamic Acid And Ethamsylate To Reduce Blood Loss Intra-operative And Postoperative During Elective Cesarean Section

Background: To compare losing of blood through Elective Cesarean Delivery, Intra and post-operative to conceived women, injected by Oxytocin versus Tranexamic acid with Ethamsylate. Methods: Blinded designated randomized controlled trial, whereas the net number of whom participated are 200 of Gravid women and equally subdivided to double collections, each collection includes100 of gravid women and Each of them is injected with Syntocinon 5 IU infusion on 500 cc saline 0.9%, at the rate of 100cm/hour Or Tranexamic acid with Ethamsylate, 5 to 10 min IV slowly before the abdominal delivery, with the evaluation of the bleeding amount. Results: Amount of bleeding, participants requiring for blood transfer, and participants requiring more intervention, were minimal in the tranexamic acid and ethamsylate collection than in the oxytocin collection. Moreover, the results of hemoglobin and hematocrit postoperatively were elevated in the participants whom were injected by both tranexamic acid and ethamsylate comparing with the participants whom were injected by the Syntocinon. Conclusions: The Evaluated variables with the positive and negative results of the research medications, demonstrated the following: Both Tranexamic acid and Ethamsylate could be effective than Oxytocin in minimizing the demand for blood transfer, with the stability of both hematologic profile and the hemodynamics. SO Tranexamic acid and Ethamsylate both appear to be a safe and efficient option in the management of birth bleeding during and after abdominal delivery.

Stair-Related Injuries Among Pregnant Women Treated in United States Emergency Departments.

Falls are one of the leading causes of trauma during pregnancy, and most falls occur on stairs. The purpose of this study was to describe stair-related falls among pregnant women who were treated in United States emergency departments during a 10-year period. This study utilized a cross-sectional analysis of National Electronic Injury Surveillance System (NEISS) data, 2008-2017. Emergency department visits by pregnant women aged 12years and older were identified using case narratives. From 2008 to 2017, 1466 cases of pregnant women who had sustained stair-related falls were reported to NEISS, equating to a national estimate of 57,512 over the 10-year study period. Variables examined included age, body part injured, location of injury, discharge disposition, gestation, mechanism of injury, and other fall-associated hazards and symptoms. Most injuries involved contusions or abrasions, other injuries commonly reported were sprains/strains and contusions/abrasions. Wet/icy conditions represented hazards associated with 4.1% of all injuries. Severe obstetric symptoms, such as decreased fetal movement and vaginal bleeding, were describedin study narratives. Falls are a leading cause of injury among women of childbearing age and stair-related falls comprise a large proportion of maternal falls. Physiological changes associated with pregnancy can put gravid women at greater risk for falls. Healthcare providers can provide women anticipatory guidance that may reduce their risk for falls as they progress in pregnancy.

PCOCheck AMH ELISA: A Clinical Case Report to Resolve Miss-Matched Antral Follicle Counts (AFC) to Serum AMH

Introduction: At times clinicians wonder why a subject’s Anti-Mullerian Hormone (AMH) does not correlate to the antral follicle count (AFC). AMH is secreted as a full-length protein and undergoes proteolytic cleavage at amino acid 451 to become biologically active. Additional proteolytic processing takes place at aa229. This processing, which may differ between individuals with different clinical conditions, exposes new antigenic sites which affect AMH measurements. Moreover, AMH epitopes might be masked by protein interaction in the circulation. Clinical Case: A 24-year-old woman gravida 0 presented with metrorrhagia for several months. The bleeding pattern was unresponsive to a trial of oral contraceptive pills, and they were discontinued. The patient’s history is remarkable for a microprolactinoma, managed with dopamine agonist. She has facial acne, but no hirsutism. Her BMI is 24 kg/m2. Laboratory studies revealed normal testosterone (27 ng/mL) and DHEAS (64 mcg/dL). Her prolactin was 1.1 ng/mL Thyroid function tests were in the normal range. hCG was negative. A random progesterone was 12 ng/mL, consistent with an ovulatory cycle. Her ovarian assessment showed FSH of 6.6 IU/L, LH of 6.7 IU/L, estradiol of 51 pg/mL, Inhibin B of 139 pg/mL, all in the normal range. Transvaginal pelvic ultrasound determined the ovarian volumes to be 8 and 6 mL, respectively, with a basal antral follicle count of 15 per side. This would have predicted a normal AMH level in this patient. However, AMH levels were repeatedly found to be low (0.05 to 0.1 ng/mL) using the pro-Mature AMH assay. As this patient was interested in future fertility, additional studies to further investigate her AMH production were carried out. AMH Measurement: Novel AMH ELISAs with antibody epitopes specific to Pro-Mature, Mature-Mature and Pro-Pro were used to analyze the sample. The observed AMH concentration by Pro-AMH ELISA, Mature-Mature ELISA and PCOCheck ELISAs were 0.1 ng/mL, 0.14 ng/mL, and 4.99 ng/mL, respectively. AMH Pro-Pro assay (PCOCheck) uses a linear epitope two-sided antibody that is not impacted by post-translational modifications, known AMH mutations or conformational changes due to thermal instability. Conclusions: The AMH measurements indicate that the patient’s serum may not contain pro-mature associated form of AMH or the C-fragmented AMH in circulation. This may be due to mutated AMH in the C-terminus and can result in C-truncation. This subject’s AMH is mostly fragmented and contains enriched pro-region AMH, which was measured by PCOCheck ELISA. The Teaching: Tests such as PCOCheck ELISA, targeted to specific regions of AMH will provide clinicians better tools for patient management. Such tests will also help resolve the observed AMH discrepancies with AFC using legacy AMH tests. PCOCheck ELISA can be a valuable tool for assessment of ovarian reserve or polycystic ovary syndrome (PCOS).

Aorta Tetrafurcation

A 35-year-old woman (gravida 0) presented to the gynecology clinic with a 1-year history of heavy menstrual bleeding and pelvic pain. Ultrasonography revealed an enlarged uterus with 1 intramural leiomyomatous node measuring 10 cm × 10 cm × 10 cm, and laparoscopic myomectomy was scheduled. Given the leiomyoma size, temporary uterine ischemia by clipping its arteries was planned to reduce blood loss. Intraoperatively, the isolation of the uterine arteries was hindered by an enlarged uterus; therefore, the internal iliac arteries were chosen for clipping.

Multilocular Peritoneal Inclusion Cysts Throughout the Pelvis

A 33-year-old woman (gravida 3 para 3) complained of new onset pelvic pain that was constant and sharp during her annual examination. Surgical history included a laparoscopic bilateral salpingectomy 3 years before, with no abnormal findings. Transvaginal ultrasound showed the rectovaginal pouch filled with a poorly circumscribed multicystic mass measuring approximately 9.6 × 5.2 × 8.6 cm with multiple grape-like cysts and no vascular flow (Fig. 1A). MRI was obtained before her referral to assist with characterizing the cysts.

Prevalence of Malaria with Anaemia and HIV Status in Women of Reproductive Age in Onitsha, Nigeria

The major health problems affecting pregnant women in sub-Saharan African are anaemia, malaria and HIV. A case-control study aimed at determining the prevalence of malaria, anaemia and HIV status among women of reproductive age between 20-49 years attending General Hospital, Onitsha was conducted. Blood samples of three hundred and sixty-two apparently healthy gravid women attending antenatal and 181 non-gravid apparently healthy women in Onitsha were recruited using random sampling method. A structured questionnaire was used for data collection. Haemoglobin was estimated using automated method, Malaria, diagnosed microscopically using gold standard staining method and HIV screened using qualitative immunochromatographic method, confirmed molecularly. Statistical analysis was done using SPSS version 21. Results revealed that out of the 362 pregnant test groups,125 (34.5%) had malaria parasite (mp) in their blood and were anaemic 53(37.6%) though fewer in control groups ;23,14 (12.7%; 16.1%) (p = 0.195; p =0.055). Out of 347 HIV sero-negative pregnant women, 110 (31.7%) tested HIV positive when confirmed by PCR molecular method while only 1(0.6%) sero-negative controls were confirmed positive with molecular method with statistical significance observed in the test and control groups (p = 0.000; p = 0.000). However, as pregnancy affects HIV serology testing, it is necessary to use molecular method to increase its sensitivity and more enlightment programmes on the importance of balanced diet, compliance to Malaria control and routine gynecological drugs intake in pregnant women.

788 Can urinary metabolite markers at 12-20 weeks’ gestation be used to predict birthweight?

To examine if urinary metabolites are predictive of birthweight. Urine samples were collected at 12-20 weeks’ from 126 women participating in the Mothers, Omega 3 & Mental Health Study, a double blind, placebo-controlled randomized controlled trial of omega-3 fatty acid supplementation for pregnant women identified at high risk for depression. Delivery birthweights were available for 112 of the participants and classified as small for gestational age (SGA, n=9), appropriate for gestational age (AGA, n=84) and large for gestational age (LGA, n=19). Urine samples underwent ion pairing reverse phase LC-MS analysis for 49 metabolites. Principle component analysis (PCA) was used to determine if there was a relationship between individual metabolites and weight classification. Means of each metabolite were calculated for each birthweight group and were statistically compared using T tests. In the SGA group, we found increased mean concentrations of urinary gluconate (P=0.046), inosine (P=0.020), and a-hydroxyisobutyrate (P=0.043) as well as decreased concentration of hypoxanthine (P=0.021) when compared with the mean urinary concentrations of these metabolites among mothers who gave birth to AGA infants. There were no significant differences between mean metabolite concentrations in the LGA and AGA groups. Our exploratory study found four early pregnancy urinary metabolites (gluconate, inosine, a-hydroxyisobutyrate, hypoxanthine) to be correlated with later SGA birthweight. Further research is warranted to evaluate whether these markers may identify women at risk of delivering SGA neonates. Earlier detection may impact pregnancy care and antenatal fetal surveillance. This may be particularly important for gravid woman at risk for developing depressive symptoms.

Obesity and Pregnancy.

The worldwide rates of obesity have increased significantly in recent decades. In the United States, more than 50% of pregnant women are overweight or obese. Obese gravid women are more prone to adverse pregnancy outcomes, including gestational diabetes, hypertensive disorders, and cardiovascular diseases. The adverse outcomes extend beyond the pregnant obese woman; offspring of obese women are themselves at increased risk of prematurity, fetal death, injury during birth, and transient respiratory problems and metabolic effects (ie, neonatal hypoglycemia). Furthermore, maternal obesity can predispose their offspring to long-term health problems, potentially generating an intergenerational cycle of obesity and insulin resistance.

240 Does the timing of gestational diabetes screening affect provider management of GDM?

A recent multicenter, randomized clinical trial (RCT) demonstrated that obese women screened early for gestational diabetes (GDM) did not have improved perinatal outcomes and required more insulin compared to women screened at the routine time. We assessed patterned blood glucose logs and medication use in early versus routine screening as a mediator of this conclusion. Secondary analysis of a multicenter RCT comparing early (14-20 weeks) to routine (24-28 weeks) GDM screening in obese gravid women with singleton, non-anomalous gestations. In this analysis, we included women diagnosed with GDM who had home blood glucose monitoring documented. Average fasting and post-prandial blood glucose levels were compared between randomization groups: weeks 1, 3, 5, and 7 after GDM diagnosis were assessed since visits are typically every two weeks. Secondly, we compared the average fasting and postprandial blood glucose levels for those visits at time of hypoglycemic agent initiation and by type of medication chosen. Groups were compared using chi-square, student’s t-test, or Wilcoxon rank sum test as appropriate. Of 114 women with GDM, 65 (57%) were screened early. Women in the early group were more likely to be White and have hypertension. At each visit (by week after diagnosis), the early screened group did not have higher fasting or postprandial blood glucose than the routine screen (Table 1). The early screening group was not initiated on a hypoglycemic agent (oral or insulin) at lower blood glucose levels than the routine screening group; in addition, the average dose of glyburide at initiation was the same for both groups (Table 2). Women in general did not receive a trial of an oral agent prior to insulin initiation (11.1% vs 50.0%, p = 0.35). The management of GDM did not vary by the timing of screening (early versus late) and differences in hypoglycemic agent use may be more related to length of time monitored rather than severity of disease.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Circumferential shoulder laceration after posterior axilla sling traction: a case report of severe shoulder dystocia

BackgroundShoulder dystocia is an unpredictable and potentially catastrophic complication of vertex vaginal delivery. Posterior axilla sling traction (PAST) has recently been proposed as a method to resolve severe shoulder dystocia when commonly used techniques have failed.Case presentationA 33-year-old woman (gravida 5, para 0) at 35 weeks, 1 day gestation underwent induction of labor for poorly controlled type 2 diabetes mellitus. Delivery of the large-for-gestational-age infant (4,060 g) was complicated by intractable shoulder dystocia, relieved at 3 minutes with PAST, resulting in a deep, circumferential laceration of the fetal posterior shoulder and contralateral phrenic nerve palsy.ConclusionsPAST provides a potentially lifesaving option during intractable shoulder dystocia. Simulation or education about the technique facilitates its use when standard maneuvers fail. It is important to disseminate information about potential complications associated with these novel maneuvers.

Study of Prevalence of Placenta Previa and Circumstances among Pregnant Women in Fallujah Hospital

Placenta previa refers to placenta which is totally or partly implanted in lower segment of the uterus.Mortality and morbidity of mother increase with placenta previa due to the increase in the incidence ofbleeding during pregnancy. This study aims to define placenta previa prevalence among pregnant womenat AL-Fallujah teaching hospital and to determine the risk factors and their association with placenta previaincidence in al-Fallujah city population.This retrospective cohort study investigated medical registry of 6339 gravid women in al-Fallujah teachingHospital in Iraq. We find 13 cases of placenta previa (0.21%) amongst the 6339 cases registered. The riskfactors that strongly appeared to affect the complication of pregnancy with placenta previa were; advancedmaternal age of ? 35, parity, previous curettage and previous cesarean section (P<0.01).The most important pregnancy outcomes of the placenta previa were lost blood of mother more than fivehundred cubic centimeter (P = 0.000) and Apgar score of the baby at first minute equal or less than 7 (P =0.003), Placenta accretta and cesarean hysterectomy (P< 0.01).These findings are the same as those recorded in other research for Asian, American and European gravidwomen, with some other detected factors.

Management of Uterine Arteriovenous Malformation: Uterine Artery Embolization followed by Gonadotropin-Releasing Hormone Agonist

A 33-year-old woman (gravida 2 para 0) presented with abnormal uterine bleeding for 2 months after dilatation and curettage for a miscarriage at 10 weeks of gestation. She underwent a hysteroscopic examination for a 3-cm intrauterine mass 6 weeks after the dilatation and curettage, which was identified as blood clots intraoperatively. One week after the hysteroscopy, she had sudden heavy vaginal bleeding, and an ultrasound scan (US) showed a 3-cm mass in the fundus of the uterus, which was suspicious for uterine arteriovenous malformation (AVM).

Hypoparathyroidism in pregnancy

Hypoparathyroidism is a disorder rarely observed during pregnancy. It poses a major challenge in managing a patient appropriately to prevent maternal and fetal complications. We report a case of a 21-year-old gravid woman, a diagnosed case of hypoparathyroidism. She was successfully treated with calcium and calcitriol before pregnancy. Dosage was adjusted according to serum calcium values, and she delivered a healthy baby with normal serum calcium level.

Prevalence &amp; Factors Associated With Anxiety Among Pregnant Women Attending Antenatal Clinic of a Hospital

Introduction: Anxiety during pregnancy is an important predictor of postpartum anxiety. Pregnancy is a time of increased vulnerability for the development of anxiety. Maternal anxiety may also have an impact on the developing fetus. The current study aims to estimate the prevalence and associated factors of anxiety during pregnancy.&#x0D; Material and Method: A descriptive cross-sectional study was conducted among 95 pregnant women during the antenatal period. A purposive sampling technique was used and data collection was done from November 15, 2019, to December 14, 2019. Ethical permission was obtained from the concerned authority. All pregnant women were interviewed during their antenatal visit and a semi-structured questionnaire was used to collect the data. Descriptive and inferential statistics were used to analyze and interpretation of the findings.&#x0D; Results: The prevalence of anxiety was 32.6%. Among them, 18.9% had borderline anxiety and 13.7% had abnormal anxiety. More than one-fifth (21.1%) of pregnant women were worried about the sex of the baby. Although, 68.4% of them had occasionally felt tense, and 75.8% had worried thoughts from time to time. Anxiety during pregnancy was significantly associated with gravida, history of abortion, maternal desire regarding the pregnancy and worry about the sex of a fetus (p&lt;0.05).&#x0D; Conclusion: The status of anxiety was quite common during pregnancy and its occurrence is associated with the pregnant woman's gravida, history of abortion, intention of pregnancy and worried about the sex of a fetus. Antenatal screening for anxiety should be carried out early from the antenatal clinics for improving the psychological well-being of women.

Oral Misoprostol Solution In Comparison To Vaginal misoprostol for Induction of Labour in a Randomized controlled trial

Background: With more than 15% of all gravid women requiring prostaglandins in cervical ripening and labour induction. However, evidence is not clear about the preferred route or dose of the drug. So this study was designed with objectives to compare the induction delivery interval and safety of titrated oral misoprostol solution with vaginal misoprostol for labour induction in term primigravida women. Methods: This randomized controlled clinical trial was conducted on a total of 100 patients randomly selected among primigravida at term women undergoing induction of labour for obstetric or medical indication for labour induction in Ain Shams University Maternity Hospital. They were divided into two Groups: Group I: patients undergoing induction of labour using misoprostol oral solution and Group II: patients undergoing induction of labour using vaginal misoprostol. Results: Oral misoprostol solution has less induction delivery duration and less side effects than vaginal misoprostol. The induction-delivery time with the oral route compared to the vaginal one (15.2 vs. 20.3 hours respectively) with significant p-value (

Severe Case of Cutaneous Endometriosis

A 32-year-old woman gravida 3, para 3 with a surgical history of 3 cesarean sections presented with a 3-year history of pain and cyclic bleeding from her Pfannenstiel incision scar. Her abdominal pain was incapacitating, with multiple syncopal episodes. On examination, we noted a large and painful abdominal mass (Fig. 1). A presumed cutaneous endometriotic implant was suspected. Computerized tomography revealed a soft tissue density measuring 13 × 3.4 cm in the lower anterior abdominal wall. The patient underwent an operative excision of presumed cutaneous and subdermal endometriosis (Fig.

Intraplacental Fetal Vessel Diameter May Help Predict for Placental Invasiveness in Pregnant Women at High Risk for Placenta Accreta Spectrum Disorders.

Background Prenatal identification of placenta accreta spectrum (PAS) disorder is essential for treatment planning. More objective means for predicting PAS and clinical outcome may be provided by MRI descriptors. Purpose To investigate the association of intraplacental fetal vessel (IFV) diameter at MRI with PAS and peripartum complications. Materials and Methods Between March 2016 and October 2019, 160 gravid women suspected of having PAS underwent placental MRI as part of a prospective trial. Secondary analysis was performed by two experienced genitourinary radiologists for presence and maximum diameter of IFVs. Relative risk ratios were computed to test the association of IFVs with presence and depth of PAS invasiveness. Receiver operating characteristic analysis was used to evaluate the ability of IFV diameter to help predict PAS, placenta percreta, and peripartum complications and for comparison of the area under the curve (AUC) versus that from other combined MRI predictors of PAS (eg, myometrial thinning, intraplacental T2-hypointense bands, uterine bulge, serosal hypervascularity, and signs of extrauterine placental spread). Intraoperative and histopathologic findings were the reference standard. Results A total of 155 women were evaluated (mean age, 35 years ± 5 [standard deviation]; mean gestational age, 32 weeks ± 3). PAS was diagnosed in 126 of 155 women (81%) (placental percreta in 68 of 126 [54%]). At delivery, 30 of 126 women (24%) experienced massive blood loss (>2000 mL). IFVs were detected at MRI in 109 of 126 women with PAS (86%) and in 67 of 68 women with placental percreta (98%). The relative risk ratio was 2.4 (95% CI: 1.6, 3.4; P < .001) for PAS and 10 (95% CI: 1.5, 70.4; P < .001) for placental percreta when IFVs were visible. IFVs of 2 mm or greater were associated with PAS (AUC, 0.81; 95% CI: 0.67, 0.95; P = .04). IVFs of 3 mm or greater were associated with placenta percreta (AUC, 0.81; 95% CI: 0.73, 0.89; P < .001) and with peripartum complications, including massive bleeding (AUC, 0.80; 95% CI: 0.71, 0.89; P < .001). Combining assessment of IFVs with other MRI descriptors improved the ability of MRI to predict PAS (AUC, 0.94 vs 0.89; P = .009). Conclusion Assessment of intraplacental fetal vessels with other MRI descriptors improved the ability of MRI to help predict PAS. Vessel diameter of 3 mm or greater was predictive of placenta percreta and peripartum complications. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Dighe in this issue.