Incidence Of Malformations Research Articles

Effect of Anthropogenic Atmospheric Pollutants on the Prevalence of Congenital Malformations in Newborns

Rationale.The congenital malformations are the important indicator of the environmental condition, and the anthropogenic pollution of the atmosphere effects strongly the incidence of malformations in the newborns.Purpose of the Study.It is the study of the cause-and-effect relationship between the incidence of malformations in newborns and anthropogenic atmospheric pollutants using the correlation and variance methods, and the development of the mathematical models to predict the formation of the congenital malformations depending on the specific pollutants.Material and methods.The correlation and variance methods were used to study the relationships of the main anthropogenic atmospheric pollutants with the incidence of the congenital malformations in all newborns in Belgorod city in 2000–2015. The predictive models were developed based on the regression method.Results.The most effect of the excess of the maximum allowable average daily concentrations of ammonia and carbon monoxide in the atmosphere on the prevalence of the congenital malformations of various systems and organs was determined with 11 reliable correlations with the congenital malformations studied and those in general. According to the results of the analysis of variance, the maximum level of the combined effect of the anthropogenic air pollutants was revealed for the congenital malformations of the musculoskeletal system (95.69%), face and neck (94.66%), central nervous system (92.31%), digestive system (93.76%).Conclusion.The regression models created at the level required assure the prediction of the various forms of the congenital malformations depending on the anthropogenic pollutants.

Analysis of Infant Congenital Malformation Data using the Bayesian Count Regression

Background: Congenital malformations are one of the most important and common types of anomalies in infants, which are one of the main causes of disability and mortality in children. Objectives: This study aimed to investigate the risk factors affecting the incidence of congenital malformations, as well as the number of different infant anomalies recorded in neonatal health data in Khoy, Iran, during 2017. Methods: In this study, all neonates born in the maternity wards of hospitals in Khoy, Iran, during 2017 were evaluated in terms of gender, weight, and parental consanguinity. Hurdle and Zero-inflation approaches were utilized for the double Poisson model. Moreover, the data were collected using some checklists, and the analyses were performed in R-3-6-1 software. Result: According to the results of the present study, the Hurdle approach was better than Zero-inflation. The birth weight and parental consanguinity affected the incidence of congenital malformations in infants. Conclusion: Given that a significant proportion of infants are born without any congenital malformations, it is important to use count regression models based on excess zero approaches to assess congenital malformations. It is also necessary to take steps to reduce consanguineous marriages and the number of infants with low-birth-weight to prevent congenital malformations.

Эпидемиология омфалоцеле: анализ данных региональных регистров врожденных пороков развития в РФ

Omphalocele is a congenital malformation belonging to the group of abdominal wall defects. Objective. To determine the incidence of omphalocele and analyze its dynamics for the period 2011–2018 in the regions of the Russian Federation according to monitoring data of congenital anomalies. Materials and methods. Statistical analysis of omphalocele cases among newborns and fetuses with malformations for the period 2011–2018 in 22 regions of the Russian Federation was carried out. The incidence of malformations was calculated per 10,000 births. Results. A total of 1,073 cases of omphalocele were reported from 2011 to 2018, of which 69.34% were in fetuses eliminated due to the prenatal detection of malformation, 27.03% – in liveborn fetuses, and 3.63% – in stillborn fetuses. The male to female ratio was 1.56:1. The overall incidence of omphalocele was 2.95 (95% CI 2.77– 3.13) and the incidence among newborns excluding fetuses was 0.9 per 10,000 (95% CI 0.81– 1.01). There was a statistically significant positive time trend in the dynamics of the overall incidence of omphalocele between 2011 and 2018. Conclusion. The evaluation of the incidence of severe malformation – omphalocele – was obtained in different regions of the Russian Federation for the first time. The incidence of this malformation tended to increase over the study period. Male gender and maternal age over 35 years can be considered as risk factors. These results can be used in planning preventive measures. Key words: congenital malformation, monitoring, newborns, omphalocele, fetuses, incidence, epidemiology

Studies on phenological behaviour and malformation incidence in different cultivars of mango (Mangifera indica L.)

A field experiment was conducted to study the phenological behaviour and the incidence of malformation in different mango cultivars under western vidarbha region of Maharashtra during the mango season 2017-18 and 2018-19 at the experimental farm of Department of Fruit Science, Faculty of Horticulture, Dr. Panjabrao Deshmukh Krishi Vidyapeeth, Akola (MS). The results indicated that, the variations were observed in cultivars for the number and time of vegetative flushes, bud bursting and panicle emergence. The maximum number of vegetative flushes (4 flushes) was reported for mango cvs. Pairi and Neelum however the minimum number of flushes (3 flushes) was noted in cvs. Kesar, Amrapali, Mallika, Dashehari and Vanraj. The earliest bud bursting and panicle emergence was recorded in cv. Vanraj followed by cv. Pairi and cv. Amrapali. The least malformation incidence was recorded in cv. Dashehari which was at par with cvs. Mallika, Neelum and Amrapali while it was highest in cv. Pairi.

Impact of Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) on Birth Defects: A Systematic Review and Meta-Analysis.

Objective:It is generally accepted that the incidence of birth defects in spontaneously conceived children ranges between 2.0-4.0%. However, several studies have shown that babies born after assisted reproductive technology (ART) procedures tend to present more congenital malformations than naturally conceived children, with 6.5% of the children born after intracytoplasmic sperm injection (ICSI) presenting birth defects. The use of high magnification sperm selection before ICSI was introduced in the early 2000s to allow the identification of spermatozoa with low risk of sperm DNA damage. Intracytoplasmic morphologically selected sperm injection (IMSI) is expected to change the incidence of congenital malformations, although data on the incidence of birth defects in children conceived after IMSI are still scarce.Methods:A systematic review based on searches performed in electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials) including articles published by February 2021 was conducted to identify trials comparing the neonatal outcomes of ICSI and IMSI. The outcome measured was the rate of birth defects in children born after ICSI or IMSI. Three trials were included as targets for data extraction and meta-analysis.Results:Our meta-analysis included 3907 children conceived after IMSI (1280) or ICSI (2627). The incidence of birth defects was statistically different, with 2.5% (32/1280) in IMSI and 4.5% (119/2627) in ICSI (RR=0.59; 95% CI=0.40-0.87; p=0.007). The results demonstrated that IMSI decreased the incidence of structural defects compared to ICSI - 2.2% (18/830) vs. 3.8% (78/2049) - in a statistically significant manner (RR=0.58; 95%CI=0.35-0.96; p=0.04). No significant difference was observed in chromosomal abnormalities (Trisomy 13; 18; 21 and Triple X) between children conceived after IMSI (8/830) or ICSI (19/2049) (RR=1.07; 95%CI=0.47-2.43; p=0.87).Conclusions:IMSI seems to be an effective tool at reducing the incidence of structural defects compared to ICSI. However, IMSI does not change the incidence of chromosomal abnormalities.

A novel glucokinase activator TMG-123 causes long-lasting hypoglycemia and impairs spermatogenesis irreversibly in rats.

The importance of glucose is well known as an energy source in testes. In order to evaluate the effects of long-lasting hypoglycemia on testes, a novel glucokinase activator, TMG-123, was dosed to rats at 5, 20 and 100 mg/kg for 13 weeks. As a result, plasma glucose levels decreased for several hours with increasing doses over the dose range of 5 to 100 mg/kg. No toxicological findings attributable to the test article were observed in clinical observation, measurements of body weight and food consumption, necropsy, and organ weight measurement. Histopathology showed scattered degeneration of seminiferous tubules in testes, and exfoliation of germ cells related to the degeneration of seminiferous tubules was observed in the lumen of both epididymides in the same animals at the end of the dosing period. Similar histopathological findings were noted at the end of the recovery period. In addition, a fertility study was conducted at the same doses for 13 weeks for males and 5 weeks for females. Sperm analysis showed decreases in the sperm concentration and the motility index and an increase in the incidences of sperm malformations. However, there were no abnormalities in the copulation or fertility rate. These results suggest that long-lasting hypoglycemia in rats is harmful to spermatogenesis and the testicular damage does not recover.

A Case of Trisomy 9 Mosaicism Confirmed by Microarray Test

Trisomy 9 mosaicism syndrome is a rare chromosomal abnormality with a high incidence of natural abortion and perinatal death. This syndrome is characterized by intrauterine growth retardation, mental retardation, craniofacial dysmorphism including a prominent nasal bridge with a short root and a fish-shaped mouth with thin lips, skeletal abnormalities, congenital heart defects, and genital abnormalities. The incidence and severity of malformations depend on the percentage of trisomic cells in the different tissues. We report a neonate who had the characteristic features of trisomy 9 syndrome with dysmorphic features including micrognathia, microcephaly, a low-set and malformed ear, a prominent lip, and cardiac defect. No chromosomal abnormalities were detected on a routine peripheral blood chromosomal analysis; however, a chromosomal abnormality with trisomy 9 mosaicism (low-level mosaic type) was detected on genetic tests. This is thought to be due to the low proportion of trisomic cells, and for this reason, the patient in this case shows a better prognosis than four patients previously reported in Korea, they were all diagnosed by peripheral blood chromosome testing.

Cardiovascular risks in infants born with reproductive technologies

Russia is on the second place among European countries in the number of completed cycles of assisted reproductive technologies (ART). The proportion of children conceived using ART becomes annually higher. The present review summarises data on the impact of new reproductive technologies on the risk of developing cardiovascular diseases are presented. Potential health risks in the introduction of ART in babies born are discussed in numerous studies, the impact on all stages of embryo- and organogenesis is noted. The greatest problem is a possible increase in the incidence of congenital malformations (CM) in children after ART compared to the latter in the natural population. The frequency of CM is due not only to the use of APT, but also to factors such as genetic characteristics, age and state of health of the mother, aggravated obstetric-gynecological history, multiplicity, low birth weight of the fetus. In children conceived with ART, often appear early symptoms of systemic endothelial dysfunction, metabolic disorders (lipid metabolism, glucose level), congenital heart defects (interventricular septum defect, small cardiac development abnormality (false chord), open arterial duct, open oval window). There is a need to improve prenatal diagnostics of CM in early pregnancy and regular medical examinations of children conceived with ART.

Pattern of malformations in central nervous system and its association with other congenital anomalies in perinates

Introduction: The congenital malformations of the central nervous system is one of the leading causes of perinatal mortality in this region of the country. It may present as an isolated defect or may be associated with other organ system malformations. Aims and Objectives: Aim of the present study was to find out the pattern of congenital malformations in the central nervous system both in live and still born perinates. Our main objective was to ascertain its association with other organ systems most commonly involved. Materials and Methods: The prospective study was carried out on 76 perinates having congenital anomalies out of 15,970 births (15,614 live born and 356 stillborn) ranging from 28th weeks of gestation to 7 days after birth. Twenty, out of 76 were born with central nervous system malformations. Results and Observations: The congenital malformations of central nervous system were found to be 26.31%. Anencephaly was the most common malformation (50%) observed amongst the central nervous system in the study with a female preponderance 1.5:1, followed by spina bifida with meningomyelocele (35%), hydrocephalus (10%) and holoprosencephaly (5%). Anencephaly was associated with occipital meningoencephalocele in 10% cases. Conclusion: Anencephaly is the most common malformations in the study, followed by spina bifida and meningomyelocele. The other malformations found in the central nervous system are hydrocephalus, meningoencephalocele and holoprosencephaly. The incidence of congenital malformations in present study is comparatively lower than in other parts of India and abroad. Keywords: Congenital malformation, Perinates, Anencephaly, Spina bifida, Meningomyelocele.

Study of clinical profile and associated risk factors for congenital malformations in neonates: a hospital based prospective study

Background: Congenital malformations are major cause of neonatal morbidity and mortality and account for 8-10% of all peri-natal deaths especially in developing countries. Incidence of congenital malformation is increasing owing to reduction in other causes of neonatal deaths due to improvement in perinatal care worldwide. This study was aimed to evaluate the incidence, perinatal variables and contributing risk factors associated with birth defects that will help to plan future strategies for prevention, early diagnosis and timely management. Methods: This is a hospital-based prospective observational study conducted in department of pediatrics of a tertiary care centre of western India over period of two year. All new-borns with anatomical congenital malformations detected antenatal or postnatal (prior to discharge) period were included in this study. Detailed and careful clinical examination was carried out for all new-born.Results: The incidence of congenital malformation in the present study is 1.27%. Prematurity (76.1%), low birth weight (68%) and male neonates (67%) were associated with increased risk of congenital malformation. Most common system involved in this study was cranio-spinal system (47.3%). Overall, most common congenital anomaly was Hydrocephalus with meningomyelocele (8%). Among maternal variables, malnutrition (90%), consanguinity (40%) and abortions (40%) are strongly associated with malformations. Conclusions: Congenital malformations are important cause of neonatal death. Strategies to diagnose, prevent, treat and rehabilitate the neonate are utmost necessary. Early screening to identify high risk pregnancies and timely management is strongly recommended.

Accuracy Of Transperineal Sonography And Distal Loopogram In Determining Distal Rectal Pouch-Perineal Distance And Fistula On Anorectal Malformation Post Colostomy Patients At Dr. Mohammad Hoesin Palembang

Abstract
 Background : Imperforated anus is a congenital abnormality which is better known as anorectal malformation. The incidence of anorectal malformations is 1 in 4000 to 5000 live births. The incidence of anorectal malformations in Europe varies from 1.14 to 5.96 per 10,000 people and can change each year.1-3 The surgical approach in the management of anorectal malformations depends on the classification of anorectal malformations based on low, intermediate and high location. The distal loopogram or distal colostrography / colostrogram examination is an examination that is very important to determine the location of the distal rectum before definitive repair, but this examination has the disadvantage of using contrast and x-ray radiation. One alternative radiological examination that can be used for faster initial management is sonographic.7
 Method : This study was a diagnostic test study to assess the diagnostic accuracy of the distal loopogram / colostrography examination and sonographic examination with the transperineal approachon post-colostomy Anorectal Malformations patients at Mohammad Hoesin Hospital, Palembang in August 2019-October 20120 or until the number of research samples is met.
 Result : There were 21 samples in this study, 11 (52.4%) samples were dominated by clinical appearance without fistula. On the results of ultrasound examination, the majority of samples of rectouretral fistulas were 7 (33.3%). Loopogram examination found the majority of samples without fistulas as many as 10 (47.6%) samples. On intraoperative examination, 7 (33.3%) samples were obtained for rectouretral fistulas. The result of pouch-perineum measurement on ultrasound examination was 1.15 ± 0.6 cm, loopogram was 0.7 ± 1.5 cm, intra-operasionem was 1.8 ± 1.6 cm. In this study, USG has a very high accuracy value with a sensitivity of 100% and a specificity of 93.8% while the Loopogram has a sensitivity of 100% and a specificity of 68.8%.
 Conclusion : Transperineal ultrasound has a very high accuracy value with a sensitivity of 100% and a specificity of 93.8% while the Loopogram has a sensitivity of 100% and a specificity of 68.8%. Although there is a significant difference between the distal rectum -perineal distance calculation with a difference of -0.38 ± 0.70 cm, these two methods are equally accurate in assessing the distal rectal pouch -perineal distance and the location of the fistula.

Iron-Dependent Apoptosis Causes Embryotoxicity in Inflamed and Obese Pregnancy

Since iron is essential for pregnancy, iron supplements are routinely prescribed to pregnant women without screening for iron deficiency. Most women in developed countries have sufficient iron stores, prompting concerns of the potential risks of iron supplementation in iron-replete women. A signal of potential harm of this practice is the association of maternal iron marker ferritin and pregnancy complications. Since ferritin is also induced by inflammation, it is unclear whether iron excess, inflammation, or their interaction cause fetal injury. We used mouse models to address this question. Two mouse models of maternal iron excess were used and compared to mice with normal iron status. To model dietary iron supplementation, C57BL/6 females were fed high-iron diet (2500-5000ppm iron) for 1 week prior to and during pregnancy. To model genetic iron loading, hepcidin knockout females were used and fed standard chow (185ppm iron). Two models of maternal inflammation were used. Acute systemic maternal inflammation was induced by a single subcutaneous injection of LPS on E8.5 or 15.5. Obesity was used as a model of mild chronic systemic maternal inflammation and was induced by feeding female mice Western diet. We evaluated the maternal, placental, and embryo response to iron excess in LPS- and obesity-induced inflammation at various time points. In the model of acute inflammation, we observed an adverse synergistic effect on embryo development when dams were both iron-loaded and LPS-injected, but not with either condition alone. On E8.5, LPS injection in iron-loaded dams caused embryo loss and encephalic malformations (Fig 1a) and on E15.5, LPS injection in iron-loaded dams caused embryo demise and resorption (Fig 1b). Western blotting and immunostaining showed increased apoptotic marker cleaved caspase-3 protein localized to endothelia in placentas and embryos, only when the dam was both iron-loaded and LPS-injected. Cytokine screen in vitro identified TNFα as the signal that synergized with iron to potentiate apoptosis of endothelial cells. Treatment of iron-loaded dams with TNFα-neutralizing antibody protected embryos from LPS-induced death, demonstrating the embryotoxic role of maternal TNFα in iron-loaded dams. Furthermore, RNA-Seq analysis of placental endothelial cells showed enrichment in oxidative stress pathways with maternal iron loading. Treatment of iron-loaded dams with antioxidant α-tocopherol protected against LPS-induced embryo death, attenuated placental inflammation and cleaved caspase-3 expression, and prevented endothelial apoptosis in the placenta and embryo. These data show that iron loading causes endothelial oxidative stress, which sensitizes endothelial cells to inflammation-induced apoptosis. In the obesity model, iron loading worsened embryotoxicity, causing subcutaneous hemorrhaging and eye malformations (Fig 1c), and potentiated placental cleaved caspase-3 expression. Iron loading increased TNFα levels in maternal serum. Importantly, treatment of obese iron-loaded dams with neutralizing TNFα antibody throughout pregnancy reduced the incidence of embryo eye malformations, confirming the role of TNFα in causing embryo injury in iron-loaded obese pregnancy. In summary, maternal iron excess worsened inflammation-induced embryo injury. Iron-dependent embryotoxicity was mediated by TNFα causing lethal apoptotic damage to embryo and placental endothelium which was prevented by antioxidant therapy. Our models raise the possibility that women exposed to both excessive iron and inflammation could be at risk for preventable pregnancy complications. Figure 1. Embryo outcomes in mouse pregnancies with maternal iron loading and inflammation. Figure 1 Disclosures Ganz: Akebia: Consultancy; Vifor: Consultancy; Ionis Pharmaceuticals: Consultancy; Silarus Therapeutics: Current equity holder in private company; Intrinsic LifeSciences: Current equity holder in private company; Global Blood Therapeutics: Consultancy; Ambys: Consultancy; Gossamer Bio: Consultancy; Astellas: Consultancy; Rockwell: Consultancy; Sierra Oncology: Consultancy; Disc Medicine: Consultancy; American Regent: Consultancy. Nemeth:Intrinsic LifeSciences: Current equity holder in private company; Vifor: Consultancy; Protagonist: Consultancy; Silarus Therapeutics: Current equity holder in private company; Ionis Pharmaceuticals: Consultancy.

Diagnosis of Fetal Esophageal Atresia by Prenatal MRI and Analysis of Prognostic Factors

Objective To investigate the value of prenatal ultrasound and MRI in the diagnosis of types I and III fetal esophageal atresia (EA), in addition to analyzing the factors related to prognosis. Methods The clinical data regarding six cases of type I and 39 cases of type III EA, with the diagnosis confirmed by postnatal autopsy, MRI, CT, or surgical operation from November 2012 to January 2018, were retrospectively analyzed. Moreover, the prenatal ultrasound and MRI features were summarized. According to the prognosis, 45 fetuses with EA were divided into study (poor prognosis) and control (better prognosis) groups. Logistic regression was used to analyze the prognostic factors. Results The imaging features of 45 EA cases were as follows: Ultrasound features of fetal EA: polyhydramnios (AFI ≥ 25), continuously absent stomach bubble (rechecked 48 hours later), and reduced or no fetal swallowing over 30 minutes; the measured values for fetal head circumference (HC), abdominal circumference (AC), and estimated fetal weight (EFW) were lower than expected according to the clinical gestational age. MRI features: appearance of line-like long T1 and long T2 signals from the fetal neck to the esophagus at the upper mediastinal spinal anterior area; esophageal disconnection, sagging, or the appearance of a visible blind-ended pouch, and disappearance of the stomach bubble. Three cases (6.67%, 3/45) were diagnosed accurately by prenatal ultrasound, while 45 cases (100%, 45/45) were diagnosed accurately by MRI after prenatal ultrasound suggested EA. The incidences of complex cardiovascular malformation, low birth weight ( < 1200 g), EA type (type I), hypoproteinemia, and an esophageal deletion length > 5 cm were significantly higher in the poor prognosis group than those in the better prognosis group ( P < 0 05). Conclusions Due to interference factors such as fetal movement, excessive skin thickness, skeleton, and surrounding tissues and organs, only 6.67% of types I and III EA were directly diagnosed by prenatal ultrasound in the present study. The risk factors for poor prognosis of EA were complex cardiovascular malformation, low birth weight, EA type, hypoproteinemia, and esophageal deletion length > 5 cm; when these ultrasound features were found, performing MRI to diagnose EA and predict prognosis was valuable.

Diagnosis of Fetal Esophageal Atresia by Prenatal MRI and Analysis of Prognostic Factors

Objective To investigate the value of prenatal ultrasound and MRI in the diagnosis of types I and III fetal esophageal atresia (EA), in addition to analyzing the factors related to prognosis. Methods The clinical data regarding six cases of type I and 39 cases of type III EA, with the diagnosis confirmed by postnatal autopsy, MRI, CT, or surgical operation from November 2012 to January 2018, were retrospectively analyzed. Moreover, the prenatal ultrasound and MRI features were summarized. According to the prognosis, 45 fetuses with EA were divided into study (poor prognosis) and control (better prognosis) groups. Logistic regression was used to analyze the prognostic factors. Results The imaging features of 45 EA cases were as follows: Ultrasound features of fetal EA: polyhydramnios (AFI ≥ 25), continuously absent stomach bubble (rechecked 48 hours later), and reduced or no fetal swallowing over 30 minutes; the measured values for fetal head circumference (HC), abdominal circumference (AC), and estimated fetal weight (EFW) were lower than expected according to the clinical gestational age. MRI features: appearance of line-like long T1 and long T2 signals from the fetal neck to the esophagus at the upper mediastinal spinal anterior area; esophageal disconnection, sagging, or the appearance of a visible blind-ended pouch, and disappearance of the stomach bubble. Three cases (6.67%, 3/45) were diagnosed accurately by prenatal ultrasound, while 45 cases (100%, 45/45) were diagnosed accurately by MRI after prenatal ultrasound suggested EA. The incidences of complex cardiovascular malformation, low birth weight ( < 1200 g), EA type (type I), hypoproteinemia, and an esophageal deletion length > 5 cm were significantly higher in the poor prognosis group than those in the better prognosis group ( P < 0 05). Conclusions Due to interference factors such as fetal movement, excessive skin thickness, skeleton, and surrounding tissues and organs, only 6.67% of types I and III EA were directly diagnosed by prenatal ultrasound in the present study. The risk factors for poor prognosis of EA were complex cardiovascular malformation, low birth weight, EA type, hypoproteinemia, and esophageal deletion length > 5 cm; when these ultrasound features were found, performing MRI to diagnose EA and predict prognosis was valuable.

Robotic Resection of a Non-Communicating Right Uterine Horn

Study Objective We present an uncomplicated robotic resection of a uterine horn in a teenage patient to highlight a minimally invasive approach, emphasize the importance of preoperative imaging, discuss potential areas for intraoperative complications, and address the possibility of trial of labor. Design N/A Setting Academic Medical Center - The patient was a 14-year-old nulligravida who presented to the Emergency Room for cyclic, right sided abdominal four months after menarche. The patient was found to have a unicornuate uterus with a functional, non-communicating rudimentary right uterine horn as demonstrated by an MRI obtained with and without contrast. The MRI included examination of the renal system, which was normal in this patient. Patients or Participants N/A Interventions Robotic resection of a non-communicating uterine horn with right salpingectomy. Measurements and Main Results N/A Conclusion Uterine malformations do not always occur in isolation. Given the high incidence of renal tract malformations associated with Mullerian duct anomalies, specifically unicornuate uterus, it is imperative that you obtain preoperative imaging to confirm a normal or abnormal renal system. As far as we are aware, there is not a standardized approach to removal of uterine horns. A minimally invasive approach, whether laparoscopic or robotic, should be the standard of care. Although this case was without complications, due to the unpredictability of these anomalies, a skilled surgeon should be involved with the case, especially one who is prepared to deal with a variety of complications. Additionally, we propose that patients with a history of a non-communicating uterine horn resection without entry in the uterine cavity be given the option for a trial of labor, with caution, similar to myomectomies.

Effects of Asherman Syndrome on Maternal and Neonatal Morbidity with Evaluation by Conception Method

Create a comprehensive summary of maternal and neonatal morbidities from patients previously treated for Asherman syndrome and evaluate for differences in perinatal outcomes based on conception method. Retrospective cohort. Community teaching hospital affiliated with a large academic medical center. Total of 43 singleton births identified from 40 patients previously treated at our institution for Asherman syndrome. Review of fertility and obstetric data to summarize the maternal and neonatal outcomes in singleton births from patients with Asherman syndrome who had been treated with hysteroscopic adhesiolysis. Primary outcomes of maternal morbidity (i.e., hypertensive disease, gestational diabetes, ruptured membranes, postpartum hemorrhage, morbidly adherent placenta [MAP]) and secondary outcomes of neonatal morbidity (i.e., gestational age at birth, method of delivery, weight, length, 1- and 5-minute Apgar score oxygen requirement, anatomic malformations, length of neonatal admission) were evaluated. We identified 40 patients who completed successful treatment of Asherman syndrome and went on to carry a singleton gestation within our institution: 20 (50%) with mild disease, 18 (45%) with moderate disease, and 2 (5%) with severe disease under the March classification system. In total, 43 singleton births were examined, with 27 of 43 (62.8%) conceived without in vitro fertilization (IVF) (group A: non-IVF conception) and 16 of 43 (37.2%) conceived through IVF (group B: IVF conception). The overall rate of preterm birth in Asherman pregnancies was 11.6%, with no difference between the 2 conception groups. We documented 9.3% cases with intrauterine growth restriction, with no difference based on conception groups. The rate of MAP in patients with Asherman syndrome was 14.0%, and the rate of postpartum hemorrhage was 32.6%, with no differences between the conception groups. Newborn anatomic malformations of any cause were documented in 18.6% of all singleton births, with no difference between the conception groups. Our series indicates a higher incidence of intrauterine growth restriction, MAP, postpartum hemorrhage, and newborn anatomic malformations in Asherman syndrome pregnancies than that reported in pregnancies within the general population. However, we found no significant differences in the maternal and neonatal outcomes of patients with Asherman syndrome who conceived with or without IVF after being treated with hysteroscopic adhesiolysis.

Folic acid rescues all-trans retinoic acid-induced anorectal malformations in rats.

To investigate whether folic acid (FA) can rescue anorectal malformations (ARMs) induced by all-trans retinoic acid (ATRA) in rats. Pregnant Sprague-Dawley rats were randomly divided into three groups. In the model group, rats were administered ATRA (110 mg/kg) by gavage on the 10th day of gestation (E10.5). Rats in the rescue group were administered FA (40 mg/kg) by gavage 0.5 and 12 hr after treatment with ATRA. All fetuses were harvested on E20.5 using cesarean section and examined for ARMs. We recorded the weight, body length, tail length, and associated malformations of all the embryos. Hematoxylin and eosin staining was used to analyze the histopathology of the fetuses. Control rats did not show any abnormalities. ARMs, tail deformities (less than half of normal length), and neural tube defects were found in 97.98% (97/99), 92.93% (92/99), and 32.32% (32/99) of the rats in the model group, respectively. The incidence of ARMs and tail deformities were 48.57% (51/105) and 35.24% (37/105), respectively, in the rescue rats; no neural tube defects were observed in these rats. The weight, body length, and tail length of the fetal rats in the rescue group were more than those in the model group, but less than those in the control group. Taken together, FA rescued ARMs induced by ATRA in rats. Thus, FA may reduce the incidence of associated malformations and improve the growth and development of fetal rats.

The incidence of malformations of the small intestine in regions with varying degrees of use of chemical protective agents and their surgical treatment

The incidence of malformations of the small intestine in regions with varying degrees of use of chemical protective agents and their surgical treatment

Which is better for mothers and babies: fresh or frozen-thawed blastocyst transfer?

BackgroundIn recent years, there have been many reports on the pregnancy outcomes of fresh blastocyst transfer (BT) and frozen-thawed BT, but the conclusions are controversial and incomplete. To compare the pregnancy outcomes, maternal complications and neonatal outcomes of fresh and frozen-thawed BT in the context of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles, we conducted a meta-analysis.MethodsA meta-analysis was conducted by searching the PubMed, Embase, and Cochrane Library databases through May 2020. Data were extracted independently by two authors.ResultsFifty-four studies, including 12 randomized controlled trials (RCTs), met the inclusion criteria. Fresh BT was associated with a lower implantation rate, pregnancy rate, ongoing pregnancy rate, and clinical pregnancy rate and higher ectopic pregnancy rate than frozen-thawed BT according to the results of the RCTs. The risks of moderate or severe ovarian hyperstimulation syndrome, placental abruption, placenta previa and preterm delivery were higher for fresh BT than for frozen-thawed BT. The risk of pregnancy-induced hypertension and pre-eclampsia was lower for fresh BT; however, no significant differences in risks for gestational diabetes mellitus and preterm rupture of membrane were found between the two groups. Compared with frozen-thawed BT, fresh BT appears to be associated with small for gestational age and low birth weight. No differences in the incidences of neonatal mortality or neonatal malformation were observed between fresh and frozen-thawed BT.ConclusionsAt present there is an overall slight preponderance of risks in fresh cycles against frozen, however individualization is required and current knowledge does not permit to address a defintive response.

Risk factors for anorectal and associated malformations in German children: A 10-year analysis

Incidences of anorectal malformations (ARM) occur in 1 of 2000-5000 live births and up to 64% have associated malformations (ARMa). The aim of the study was to evaluate possible prenatal risk factors for ARM in a tertiary hospital. A case-control design was used to compare risk factors in ARM (n=44) to a control group (CG; n=26). We used modified prenatal questionnaires, analyzed mothers' prenatal records and participants completed a structured interview. Endpoints were medical history, drug consumption, occupational risk factors, and time point of diagnosis, associated malformations and sensitivity of radiological imaging. Our results showed that ARM couples had a significantly higher age difference (p=0.028) compared to CG. ARM mothers had more abnormalities during pregnancy (p=0.002), more positive vaginal smears of group B streptococci (p=0.024), urogenital infections (p=0.005), gestosis (p=0.03), emesis (p=0.025) and higher numbers of chronic diseases (p=0.018). ARM mothers took less medication during pregnancy (p=0.013) than CG mothers including folic acid (p=0.041); their intake of iodine tablets was significantly higher (p=0.035) and they continued smoking for longer (p=0.036) than CG mothers, and they had more stillbirths (p=0.035). In using illegal drug and alcohol use, the groups did not show significant differences. ARMa was present in 68.1% (n=30), of which 45.5% were of urogenital origin (n=20). ARM diagnosis was made on the first day of life in 72.7% (n=32), while diagnosis was delayed in 12 patients (27.3%). A combination of different risk factors seem to be associated with the development of ARM, which takes place at an early stage (<7th week) of pregnancy. Therefore, risk factors influencing fetal development must be critically considered. We advocate an interdisciplinary assessment in unclear clinical findings on first day of life to optimize the therapy and positively influence the outcome.