Half Of Normal Pregnancy Research Articles

Low Fetal Resistance to Hypoxia as a Cause of Stillbirth and Neonatal Encephalopathy

Objective: Low fetal resistance to hypoxia is a factor in stillbirth and neonatal encephalopathy. This review examines fetal movement patterns in response to hypoxia as a predictor of the likelihood of stillbirth. Monitoring the dynamics of fetal movements during maternal apnea could allow the assessment of fetal resistance to hypoxia. The goal of this study is to describe the practical application of this method by doctors and pregnant women. Mechanism: We searched relevant keywords in the international scientific literature databases Scopus and Web of Science, as well as databases for patents granted in China, India, USA, Japan, Germany, Russia and other countries. Devices, drugs and medical technologies that provide diagnosis, modeling, prevention and treatment of intrauterine fetal hypoxia, stillbirth and neonatal encephalopathy were considered. Findings in Brief: During apnea by a pregnant woman in the second half of normal pregnancy, if the maximum duration of fetal immobility exceeds 30 seconds from the onset of breath-holding, then the fetus is considered to show good resistance to hypoxia, thus preserving its health and life during vaginal delivery. On the other hand, excessive fetal movements <10 seconds after the onset of apnea in a pregnant woman indicates low fetal resistance to hypoxia. When fetal resistance to hypoxia is low, there is no alternative to immediate cesarean section for the preservation of fetal life and health. Conclusions: The monitoring of fetal movements during apnea in pregnant women allows real-time assessment of fetal resistance to intrauterine hypoxia. Obtaining timely information on fetal resistance to hypoxia is critical for determining the optimal timing and type of delivery in order to prevent encephalopathy and stillbirth.

Placental capillary pericytes release excess extracellular vesicles under hypoxic conditions inducing a pro-angiogenic profile in term pregnancy

Pericytes are multifunctional cells wrapped around capillary endothelia, essential for vascular health, development, and blood flow regulation, although their role in human placental chorionic villi has not been fully explored. The second half of normal pregnancy is characterized by a progressive decline in placental and fetal oxygen levels which, by term, comprises a substantial degree of hypoxia. We hypothesized this hypoxia would stimulate pericyte regulation of chorionic villous capillary function. This study's objective was to investigate the role of hypoxia on normal term placental pericytes (PLVP) and their signaling to endothelial cells. First, we confirmed fetoplacental hypoxia at term by a new analysis of umbilical arterial blood oxygen tension of 3,010 healthy singleton neonates sampled at caesarean section and before labor. We then measured the release of cytokines, chemokines, and small extracellular vesicles (PLVPsv), from PLVP cultured at 20%, 8% and 1% O2. As O2 levels decreased, secreted cytokines and chemokines [interleukin-6 (IL-6), interleukin-1α (IL-1α) and vascular endothelial growth factor (VEGF)], and small extracellular vesicle markers, (Alix, Syntenin and CD9) increased significantly in the culture supernatants. When primary human umbilical vein endothelial cells (HUVEC) were cultured with PLVPsv, polygon formation, number, and tube formation length was significantly increased compared to cells not treated with PLVPsv, indicating PLVPsv stimulated angiogenesis. We conclude that adding PLVPsv stimulates angiogenesis and vessel stabilization on neighboring endothelial cells in response to hypoxia in term pregnancy compared to no addition of PLVPsv. Our finding that PLVP can release angiogenic molecules via extracellular vesicles in response to hypoxia may apply to other organ systems.

Evaluation of foetal tricuspid annular plane systolic excursion with conventional m-mode ultrasound in normal pregnancy

Background: Foetal tricuspid annular plane systolic excursion (fTAPSE) in-utero helps in the evaluation of the right foetal cardiac function, which is key in the early diagnosis of congenital heart defects and abnormalities. Objectives of the study was to assess foetal TAPSE in the second half of normal pregnancy, establish reference ranges for this measurement in our environment, and to determine the relationship of foetal TAPSE with gestational age and estimated foetal weight.Methods: This descriptive cross-sectional study was conducted between March 2022 and August 2022 at the Obstetric Units and Radiology Departments of the two tertiary facilities, one secondary facility and one radiodiagnostic facility in Bayelsa State, Nigeria. Consenting pregnant women presenting to the antenatal clinic during the second half of pregnancy were consecutively included. An obstetric ultrasound scan was performed transabdominally. Data were analysed using SPSS version 25.Results: There was a very strong, positive and significant relationship between fTAPSE and gestational age (ɼ=0.81; p=0.001); and between fTAPSE and estimated foetal weight (ɼ=0.79; p=0.001). The mean fTAPSE and standard deviation from the 20th to the 23rd week of gestation were 2.10±1.11 mm, 2.43±0.95, 2.74±0.84 mm and 2.94±0.70 mm, showing a gradual increase in mean fTAPSE as gestational age increases.Conclusions: Our study revealed that there was a significant relationship between fTAPSE and gestational age; and between fTAPSE and estimated foetal weight, which correlates with published data around the globe.

Evaluation of foetal mitral annular plane systolic excursion with conventional m-mode ultrasound in normal pregnancy

Background: Foetal mitral annular plane systolic excursion (fMAPSE) helps in the evaluation of the left foetal cardiac function, which is key in the early diagnosis of congenital heart defects and abnormalities.Objectives: To assess foetal MAPSE in the second half of normal pregnancy, to establish reference ranges for this measurement in our environment, and to determine the relationship between foetal MAPSE and gestational age and estimated foetal weight.Materials and Methods: This descriptive cross-sectional study was conducted between March 2022 and August 2022 at the Obstetric Units and Radiology Departments of the two tertiary facilities, one secondary facility and one radiodiagnostic facility in Bayelsa State, Nigeria. Consenting pregnant women presenting to the antenatal clinics of the study centres during the second half of pregnancy were consecutively included. Obstetric ultrasound scans were was transabdominally. Data were analysed using SPSS version 25.Results: The correlation coefficient (ɼ) between fMAPSE and gestational age was 0.21 with a p-value of 0.001, reflecting a significant but weak relationship between fMAPSE and gestational age. There was a positively weak but significant relationship (ɼ = 0.29; p – 0.001) between fMAPSE and estimated foetal weight.Conclusion: Our study revealed that there was a significant relationship between fMAPSE and gestational age, and between fMAPSE and estimated foetal weight, which correlates with published data around the globe.

Blood flow in the umbilical vein of the fetus in first half of pregnancy

The present investigation aims at studying the blood flow in the umbilical vein in the first half of normal pregnancy. It was shown that the establishing of hemocirculation passes through 4 periods: 8- 10th, 11-12th, 13-16th and after the 16th week of pregnancy. Besides that, statistically verified changes in maximum blood flow speed and index of pulsation in this vessel were revealed. Constant bloodstream spectrum reflects stability of oxygenic bloodsupply of the fetus.

Maternal plasma pro-atrial and C-type natriuretic peptide levels and their associations with cardiovascular and renal function in the second half of normal pregnancy: a longitudinal study

BackgroundPhysiological adaptation in pregnancy is characterized by remodeling of endocrine, cardiovascular and renal functions leading to fluid retention, volume expansion, altered cardiac loading conditions and hyperdynamic circulation. Natriuretic peptides have been used as biomarkers of cardiovascular function, but their associations with gestational age-related changes in maternal cardiac, endothelial and renal function have not been elucidated. The aim of this study was to establish longitudinal reference values for maternal plasma atrial natriuretic peptide (proANP) and C-type natriuretic peptide (CNP) and investigate their temporal association with cardiovascular and renal function in the second half of pregnancy.MethodsThis study was a prospective longitudinal study of 53 low-risk pregnancies. Women were examined every 3–5 weeks during 22–40 weeks of gestation (252 observations). Fasting maternal blood samples were obtained to measure proANP, CNP, creatinine, cystatin C, uric acid, and fibrinogen levels. Cardiac function and systemic hemodynamics were assessed noninvasively by impedance cardiography (ICG) and vascular endothelial function by flow-mediated vasodilation of brachial artery (FMD).ResultsThe plasma proANP (R2adj = 0.79; P = 0.007), CNP (R2adj = 0.54; P = 0.005) decreased between 22 and 40 weeks. The creatinine (R2adj = 0.90; P < 0.001), cystatin C (R2adj = 0.93; P = < 0.001) and uric acid (R2adj = 0.83; P < 0.001) increased significantly, whereas the estimated glomerular filtration rate (R2adj = 0.93; P < 0.001) decreased with gestational age. The FMD did not change significantly but fibrinogen (R2adj = 0.79; P < 0.001) increased with advancing gestation. The maternal systemic vascular resistance index (R2adj = 0.50; P < 0.001) increased, stroke index (R2adj = 0.62; P < 0.001) decreased, whereas the cardiac index (R2adj = 0.62; P = 0.438) and thoracic fluid content (R2adj = 0.72; P = 0.132) did not change significantly with gestation. The proANP was associated with thoracic fluid content (R2adj = 0.74; P < 0.001) and fibrinogen (R2adj = 0.78; P = 0.034) but not with other variables of systemic hemodynamics, endothelial function, or renal function. The CNP was not associated significantly with parameters of cardiovascular or renal function.ConclusionLongitudinal reference values for maternal plasma proANP and CNP were established. These natriuretic peptides decreased slightly with advancing gestation, but they did not reflect the temporal physiological changes in maternal systemic hemodynamics, vascular endothelial function and renal function during the second half of pregnancy. The proANP correlated with the thoracic fluid content reflecting volume load in pregnancy.

Serum cytokine patterns in first half of pregnancy

IntroductionHuman pregnancy is a state of elevated maternal systemic inflammation, and pregnancy complications are often associated with a dysfunctional immune response. The network of cytokines reflects this complex immune activity, and broad serum cytokine profiling provides a new tool to understand the changes in immune status during pregnancy. ObjectiveThis study aimed to determine how maternal serum cytokine patterns change during the first half of pregnancy. MethodsMaternal peripheral serum samples collected at a mean gestation of 10, 13, 18 and 24 weeks were included from a prospective clinical study of healthy women (n = 110) in first half of normal pregnancy. The serum samples were analysed for 27 different cytokines using multiplex magnetic bead-based immunoassays, and high sensitivity C-reactive protein (CRP) was analysed by ELISA. Serum cytokine and CRP patterns were explored with linear mixed effects models (LMM) and multilevel partial least squares discriminant analysis (PLS-DA). ResultsSerum cytokine profiling provided partial overview of the maternal immune status and corresponding reference values for serum cytokine levels during the first half of pregnancy. Several cytokines decreased in concentration from first to second trimester. Cytokine pattern analysis revealed that chemokines provided the most sensitive measurement of variation with gestational age in normal pregnancies. The nine inflammatory cytokines showed the highest intra-group correlation during pregnancy, while CRP levels did not correlate with changes in the inflammatory cytokines. ConclusionChemokines showed the greatest gestational variation and inflammatory cytokines showed a strong intra-group correlation during the first half of pregnancy.

Automated analysis of fetal cardiac function using color tissue Doppler imaging in second half of normal pregnancy.

Color tissue Doppler imaging (cTDI) is a promising tool for the assessment of fetal cardiac function. However, the analysis of myocardial velocity traces is cumbersome and time-consuming, limiting its application in clinical practice. The aim of this study was to evaluate fetal cardiac function during the second half of pregnancy and to develop reference ranges using an automated method to analyze cTDI recordings from a cardiac four-chamber view. This was a cross-sectional study including 201 normal singleton pregnancies between 18 and 42 weeks of gestation. During fetal echocardiography, a four-chamber view of the heart was visualized and cTDI was performed. Regions of interest were positioned at the level of the atrioventricular plane in the left ventricular (LV), right ventricular (RV) and septal walls of the fetal heart, to obtain myocardial velocity traces that were analyzed offline using the automated algorithm. Peak myocardial velocities during atrial contraction (Am), ventricular ejection (Sm) and rapid ventricular filling, i.e. early diastole (Em), as well as the Em/Am ratio, mechanical cardiac time intervals and myocardial performance index (cMPI) were evaluated, and gestational age-specific reference ranges were constructed. At 18 weeks of gestation, the peak myocardial velocities, presented as fitted mean with 95% CI, were: LV Am, 3.39 (3.09-3.70) cm/s; LV Sm, 1.62 (1.46-1.79) cm/s; LV Em, 1.95 (1.75-2.15) cm/s; septal Am, 3.07 (2.80-3.36) cm/s; septal Sm, 1.93 (1.81-2.06) cm/s; septal Em, 2.57 (2.32-2.84) cm/s; RV Am, 4.89 (4.59-5.20) cm/s; RV Sm, 2.31 (2.16-2.46) cm/s; and RV Em, 2.94 (2.69-3.21) cm/s. At 42 weeks of gestation, the peak myocardial velocities had increased to: LV Am, 4.25 (3.87-4.65) cm/s; LV Sm, 3.53 (3.19-3.89) cm/s; LV Em, 4.55 (4.18-4.94) cm/s; septal Am, 4.49 (4.17-4.82) cm/s; septal Sm, 3.36 (3.17-3.55) cm/s; septal Em, 3.76 (3.51-4.03) cm/s; RV Am, 6.52 (6.09-6.96) cm/s; RV Sm, 4.95 (4.59-5.32) cm/s; and RV Em, 5.42 (4.99-5.88) cm/s. The mechanical cardiac time intervals generally remained more stable throughout the second half of pregnancy, although, with increased gestational age, there was an increase in duration of septal and RV atrial contraction, LV pre-ejection and septal and RV ventricular ejection, while there was a decrease in duration of septal postejection. Regression equations used for the construction of gestational age-specific reference ranges for peak myocardial velocities, Em/Am ratios, mechanical cardiac time intervals and cMPI are presented. Peak myocardial velocities increase with gestational age, while the mechanical time intervals remain more stable throughout the second half of pregnancy. Using an automated method to analyze cTDI-derived myocardial velocity traces, it was possible to construct reference ranges, which could be used in distinguishing between normal and abnormal fetal cardiac function. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Reference range of gestational uterine artery resistance index in small canine breeds

The objectives of this study were to evaluate the uterine artery blood flow during the second half of normal pregnancy in small breed dogs and to determine the RI reference values of this artery in these bitches. Fifty-two, 1.5–6.5 kg, purebred healthy pregnant bitches were included in this study. Doppler ultrasonographic examinations of the uterus were performed every 10 days from Day 30 of the estrous cycle to parturition. Peak systolic velocity (PSV) and end diastolic velocity (EDV) of the uterine artery were measured while RI [(PSV−EDV)/PSV] was automatically calculated. Values of PSV, EDV and RI were analyzed by repeated measures ANOVA followed by Tukey test using age, body weight, litter size and parity as covariates. Resistance index reference ranges were constructed by regressing this index on gestational age. Equation of the polynomial regression curves was used to calculate the mean, 95th and 5th centiles for each gestational age (GA). A gradual increase of PSV (P < 0.01) and EDV (P < 0.01) and a decrease in RI (P < 0.01) were found throughout the study period. PSV and EDV were influenced by litter size (P < 0.05), while RI was not. None of the Doppler parameters were influenced by age, body weight or parity. A second-degree polynomial described the relationship between RI of uterine artery and GA in the different time points: [RI = 0.993 + 8.4x10-5 x GA2- 0.0117 x GA]. It is concluded that uterine artery blood flow progressively increased throughout normal pregnancy in small breed bitches. In addition, reference ranges of uterine artery RI were 0.64–0.79, 0.57 to 0.75, 0.53 to 0.71 and 0.52 to 0.66 on Days 30, 40, 50 and 60 of gestation, respectively.

Sexual Dimorphism in Umbilical Vein Blood Flow During the Second Half of Pregnancy: A Longitudinal Study.

To investigate gestational age-specific serial changes in umbilical vein (UV) volume blood flow during the second half of normal pregnancy and establish sex-specific reference ranges. This work was a prospective longitudinal study of singleton low-risk pregnancies. The UV diameter and maximum blood flow velocity were serially measured by sonography at the intra-abdominal portion of the UV over 19 to 41 weeks. Umbilical vein volume blood flow was calculated and normalized for estimated fetal weight. One hundred seventy-nine women and their fetuses (87 male and 92 female) were included in the final analysis, and a total of 746 observations were used to construct sex-specific reference intervals. We found no statistically significant sex-specific differences in the UV parameters examined. However, the temporal development patterns of normalized UV volume blood flow appeared to differ between male and female fetuses during the second half of pregnancy, with crossovers at 24 and 32 weeks' gestation. Umbilical vein volume blood flow is similar among male and female fetuses in quantitative terms, but the pattern of gestational age-dependent temporal changes may be different, which may have important physiologic implications with regard to in utero development and maturation of the fetoplacental unit.

Longitudinal reference ranges for maternal plasma laeverin, and its role as a potential biomarker of preeclampsia.

BackgroundLaeverin is a placenta-specific membrane-bound aminopeptidase. In this study we wanted to: 1) serially measure plasma levels of laeverin in healthy women during the second half of pregnancy and postpartum, 2) determine whether laeverin is differently expressed at 22–24 weeks in women who later develop preeclampsia compared to controls, 3) compare laeverin protein expression in placenta and umbilical vein serum in healthy and preeclamptic pregnancies at birth.MethodsPlasma was obtained serially, approximately every 4-weeks, from 53 healthy women with uncomplicated pregnancies during 22+0 to 39+6 weeks of gestation, and at 22–24 weeks from 15 women who later developed preeclampsia. Enzyme-linked immunosorbent assay was used to measure laeverin protein concentration. Serum from healthy non-pregnant premenopausal women (n = 10), menopausal women (n = 10) and men (n = 11) were used as negative controls. Protein extracts from placental tissue were obtained after birth from healthy- (n = 11) and preeclamptic women (n = 13). Paired umbilical artery and vein serum samples from the neonates (n = 10) of healthy mothers were also analyzed. Multilevel modeling was used to determine the reference centiles. Differences between groups were analyzed using Student’s t-test.ResultsHealthy pregnant women at term (37–40 weeks) had significantly higher plasma levels of laeverin (mean 4.95 ± 0.32 ng/mL; p < 0.0001) compared to men (mean 0.18 ± 0.31 ng/mL), non-pregnant premenopausal women (mean 0.77 ± 0.26 ng/mL) and postmenopausal women (mean 0.57 ± 0.40 ng/mL). Maternal plasma laeverin levels decreased with advancing gestation, from 6.96 ± 0.32 ng/mL at 22–24 weeks to 4.95 ± 0.32 ng/mL at term (p < 0.0001) in uncomplicated pregnancies. Half of the women who developed preeclampsia had plasma laeverin levels below the 5th percentile at 22–24 weeks gestation. However, laeverin levels were 1.6 fold higher in preeclamptic compared to healthy placentas (p = 0.0071). Umbilical venous samples of healthy neonates (n = 38) had higher (p = 0.001) mean levels of laeverin (16.63 ± 0.73 ng/mL), compared to neonates of preeclamptic (n = 14) mothers (12.02 ± 1.00 ng/mL). Postpartum plasma levels of laeverin decreased in healthy and preeclamptic women with a half-life of 3 and 5 days, respectively.ConclusionsMaternal plasma levels of laeverin decrease with advancing gestation during the second half of normal pregnancy and lower levels measured at 22–24 weeks might be associated with the development of preeclampsia later in gestation.

PS-031 Congenital Heart Disease In The In-vitro Fertilisation Prevalence Distribution

Introduction A higher prevalence of all congenital malformations in children conceived through assisted reproductive technologies (ART) was fairly extensively suggested in literature. However, there are few studies which only address congenital heart disease (CHD) specifically and most have examined data from registers. The aim of this study was determined the prevalence of CHD in fetus and newborn conceived by ART and comparison with newborn in outpatient obstetric clinics. All data was collected in a specialist paediatric service in the Taichung Taiwan. Methods This study was detected fetus and newborns with CHD. All pregnancies treated by ART who received fetal echocardiography between gestational age from 20 to 24 weeks and examine done month after delivery or reported by echocardiographic screening from their birth hospital. The controlled group was normal conceived newborn receiving postnatal echocardiographic screening at age of one week at the same area in Taichung city. Results Among 2,780 fetus in ART, the prevalence of major CHD with immediate life-threatening risk and overall CHD were 503.5/100,000 (n = 14) and 1,223/100,000 (n = 34), respectively. In comparison with control group of 12,022 newborn, the major CHD was 2 times of normal pregnancy but all CHD were only one half of normal pregnancy. In assisted conception were observed increased in a number of individual subgroups rates, the highest among those with pulmonary atresia. Conclusions We found no increased risk of overall CHD but more risky in major CHD in those conceived by ARTs. Further analysis of individual subgroups of CHD and different methods of conception is required. Prenatal echocardiographic screening can play a useful tool for early detection of major CHD in ART to improve the outcome of CHD.

Longitudinal Reference Values for Ductus Venosus Doppler in Low-Risk Pregnancies

The aim of this study was to establish normal ranges of blood flow velocities and indices in the fetal ductus venosus (DV) during the second half of normal pregnancy. A Doppler study of 60 healthy pregnant women without fetal pathologies was performed during the second half of pregnancy. The peak systolic velocity (PSV), peak diastolic velocity (PDV), maximum velocity during atrial contraction (VAC), peak systolic velocity / maximum velocity during atrial contraction (S/A ratio), pulsatility index for the vein (PIV), preload index (PLI) and velocity index for the vein (VIV) were calculated from the DV at 4-week intervals. A significant increase in PSV, PDV and VAC was observed from the 20–23 6/7 to the 28–31 6/7 weeks, with stabilization of values until the end of the pregnancy. On the other hand, the study showed a significant decrease for the S/A ratio, PIV, PLI and VIV from the 20–23 6/7 to the 28–31 6/7 weeks and remaining stable from then until term. (E-mail: dralemar@uol.com.br)

Insulin sensitivity and resistin levels in gestational diabetes mellitus and after parturition

Resistin is expressed and secreted by the placenta during pregnancy. Increased serum resistin levels have been found in the second half of normal pregnancy, but its role in the pathogenesis of the insulin resistance of pregnancy is undetermined. The objective of the study was to assess the relationship between circulating resistin levels and insulin sensitivity in gestational diabetes mellitus (GDM). A case (n=23)-control (n=35) study was performed at the obstetrics and endocrinology clinic of a university hospital. In total, 58 Caucasian women with a singleton pregnancy who had been referred for a 100 g oral glucose tolerance test were enrolled between the weeks 26 and 30, and 22 women with GDM were also evaluated after pregnancy. Serum resistin and insulin sensitivity in GDM during and after pregnancy. The relationship of resistin to metabolic abnormalities was evaluated. Resistin levels were lower in GDM women than in pregnant women with normal glucose tolerance (NGT) (4.32+/-1.56 vs 9.30+/-1.32 ng/ml, P<0.001), and experienced a further decrease after parturition (4.24+/-1.56 vs 3.11+/-1.63 ng/ml, P=0.003). The association between low serum resistin levels and the diagnosis of GDM was independent of the degree of insulin sensitivity. Lower resistin levels were observed in GDM than in NGT women and decreased after parturition, suggesting a role for resistin in the development of this disease. But we have failed to find an independent relationship between resistin levels and insulin sensitivity during pregnancy.

OP13.12: Fetal behavior assessed during second half of normal pregnancy by four‐dimensional ultrasonography in Korea

OP13.12: Fetal behavior assessed during second half of normal pregnancy by four‐dimensional ultrasonography in Korea

Middle Cerebral Artery Peak Systolic Velocity of Healthy Fetuses in the First Half of Pregnancy

The purpose of this study was to establish normative data of middle cerebral artery (MCA) peak systolic velocity (PSV) in the first half of normal pregnancies (11-22 weeks). A prospective cross-sectional descriptive study was conducted in which low-risk pregnant women whose pregnancies were singleton with accurate gestational age were recruited into the study. All neonates were subsequently proven to be healthy at birth. The sonographic measurements of MCA PSV were performed by the same examiner with a high-resolution machine. The total number of measurements was 410, and the number of measurements for each gestational week ranged from 30 to 40. The best regression model between gestational week and placental thickness was observed to be a linear function, and reference curves were constructed. The results showed a continuous increase in MCA PSV over the period from 11 to 22 weeks. During the period of study, 3 fetuses with hemoglobin Bart disease in the first half of pregnancy were encountered, and all of them had PSV of greater than the 95th percentile as well as 1.5 multiples of the median for each gestational week. A nomogram of MCA PSV for each gestational age from 11 to 22 weeks was constructed. These reference ranges may be useful noninvasive tools in risk assessment for fetal anemia in early pregnancy, especially due to hemoglobin Bart disease.

The Role of Soluble Tumor Necrosis Factor Receptor Types I and II and Tumor Necrosis Factor–α in Malaria during Pregnancy

In a prospective study of rhesus monkeys inoculated with Plasmodium coatneyi or saline on an infection/gestational timeline, we determined the serum levels of tumor necrosis factor-alpha (TNF-alpha), soluble tumor necrosis factor receptor type I (sTNFR-I), and soluble tumor necrosis factor receptor type II (sTNFR-II) in peripheral blood throughout primigravid pregnancy, malaria infection, and a combination of the two. Our goal was to determine the association between levels of TNF-alpha and of its 2 soluble receptors and the course of pregnancy and/or malaria and infant outcome. We found that any detectable level of TNF-alpha was always associated with fetal death and that the sTNFRs may be important for fetal protection, possibly through neutralizing the toxic effects of TNF-alpha. Our findings also showed that increased levels of sTNFR-II were associated specifically with malaria and not with normal pregnancy or even pregnancy with low birth weight due to other causes. In contrast, increases in sTNFR-I levels during the later half of normal pregnancies indicate that sTNFR-I may be important in regulating TNF-alpha levels in preparation for normal labor and delivery.

Comparison of lipid profiles in normal and hypertensive pregnant women

Comparison of lipid profiles in normal and hypertensive pregnant women

Cardiothoracic ratio in the first half of pregnancy.

The present study was conducted to establish the nomogram of fetal cardiothoracic (C/T) ratio in the first half of normal pregnancies (eg, 11-20 weeks of gestation), using conventional sonographic techniques. Two hundred thirty-eight normal pregnant women enrolled in our prenatal care were recruited into this study. All the patients had singleton fetuses whose gestational age could be accurately determined by the patient's last menstrual period and sonographic measurements. All the newborns were proven to be normal at birth. The sonographic measurements used to calculate the C/T ratio were obtained from axial scans at the level of the four-chamber view. All measurements were made by the same examiner using a single high-resolution machine. A total of 238 C/T ratio measurements were made. The mean C/T ratio values increased slightly with gestational age, rising from 0.38 at 11 weeks to 0.45 at 20 weeks. The mean C/T value at each gestational week was never greater than 0.50, and no fetus had a C/T ratio greater than 0.50 at 11-15 weeks of gestation. The means and 5th, 50th, and 95th percentiles of the C/T ratio were calculated for each week of gestation and the nomogram was established. Calculation of the C/T ratio is a simple, reliable, reproducible, and time-efficient means of assessing the size of the fetal heart. By comparing the C/T ratio with the normal values presented here, physicians should be able to more easily identify cases of cardiomegaly early in their patients' pregnancies.

Fetal and maternal plasma leptin levels during the second half of normal pregnancies and those with Down syndrome

Fetal and maternal plasma leptin levels during the second half of normal pregnancies and those with Down syndrome