Intrauterine Growth Restriction Fetuses Research Articles

Effect of L-Arginine Supplementation in treatment of Intrauterine Fetal Growth Restriction

Effect of L-Arginine Supplementation in treatment of Intrauterine Fetal Growth Restriction

Comparative study of pluripotency-related gene expression in Umbilical Cord Mesenchymal Stem Cells (UC-MSC) from IUGR, SGA and normally grown fetuses

Background and Objectives: Intrauterine growth restriction (IUGR) is worldwide a public health problem. IUGR-born individuals acquire epigenetic “thrifty-phenotype” gene adaptations, according to the “Barker hypothesis” and are more susceptible to develop metabolic related diseases. Small for Gestational Age (SGA) fetuses consist of a transitional group between IUGR and normally grown fetuses (Appropriate for Gestational Age, AGA). Currently, there is limited information in the literature whether IUGR or SGA status affects the pluripotency of the Umbilical Cord Mesenchymal Stem Cell (UC-MSC) with respect to gene expression at various stages of cell culture. Materials and Methods: In this study, we investigated stemness marker expression in UC-MSCs derived from twenty-one AGA, IUGR, and SGA fetuses. The relative expression of key genes involved in stemness, pluripotency, and cell proliferation, namely IGF2BP1, CMYC, GLI1, P21, NANOG, OCT4, and SOX2, was assessed in UC-MSCs at passages P0 and P1 using flow cytometry and quantitative PCR. Results: We found lower median expression levels of IGF2BP1 in IUGR group (P=0.044) and P21 in SGA group (P=0.024) at P0 compared to control group. GLI1 and OCT4 exhibited reduced expression at P1 in the IUGR group (P=0.0434 and P=0.0343 respectively) compared to AGA. NANOG median expression differed statistically between CONTROL and IUGR group in P0 (P=0.034) and P1 (P=0.0205). No significant changes were noted for SOX2 and CMYC median expression among the various groups in P0 and P1. Conclusion: The comparative analysis of stemness marker expression among UC-MSCs from these three different sources is a novel descriptive aspect of our study, adding a new perspective to the existing literature.

Heat Stress-Induced Fetal Intrauterine Growth Restriction Is Associated with Elevated LPS Levels Along the Maternal Intestine-Placenta-Fetus Axis in Pregnant Mice.

The exacerbation of the greenhouse effect has made heat stress (HS) an important risk factor for the occurrence of intrauterine growth restriction (IUGR). The experiment aims to uncover the effects of maternal HS on IUGR and its mechanisms. The results showed that HS leads to decreased maternal and fetal birth weights, accompanied by increased serum oxidative stress and cortisol levels. Moreover, HS inflicted significant damage to both the intestinal and placental barriers, altering maternal gut microbiota and increasing intestinal LPS levels. As a result, LPS levels increased in maternal serum, placenta, and fetus. Furthermore, HS damaged the intestinal structure, intensifying inflammation and disrupting the redox balance. The placenta exposed to HS exhibited changes in the placental structure along with disrupted angiogenesis and decreased levels of nutritional transporters. Additionally, the leakage of LPS triggered placental JNK and ERK phosphorylation, ultimately inducing severe placental inflammation and oxidative stress. This study suggests that LPS translocation from the maternal intestine to the fetus, due to a disrupted gut microbiota balance and compromised intestinal and placental barrier integrity, may be the primary cause of HS-induced IUGR. Furthermore, increased LPS leakage leads to placental inflammation, redox imbalance, and impaired nutrient transport, further restricting fetal growth.

Association between intrauterine fetal growth restriction and ABO blood groups at King Abdulaziz University Hospital, Saudi Arabia: Retrospective study.

To investigate the potential association between ABO blood groups and intrauterine fetal growth restriction (IUGR) among pregnant women who delivered at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. This is a retrospective cohort study analyzed the medical records of pregnant women who delivered at KAUH and had postnatal follow-up visits. Missing data were completed by conducting phone interviews with patients. A total of 436 patients with a mean age of 31.2±5.5 years were included in the study. 50.7% of the women had blood type O, 28.4% had blood type A, 16.5% had blood type B, and 4.4% had blood type AB. The majority (94.7%) tested positive for the Rhesus antigen. Although statistically significant, women with blood groups AB and B exhibited higher rates of IUGR (31.6%, and 27.8%, respectively) compared to those with blood groups A and O, who had lower rates of IUGR (26.6%, and 24%, respectively). Our study results showed that women with blood groups AB and B had slightly higher rates of IUGR than those with A and O, who had lower rates of IUGR. A larger study comparing blood group O to other groups may provide more insight into the relationship between ABO blood groups and IUGR.

Maternal and Neonatal Outcomes of Gestational Thrombocytopenia in Pregnant Women from Kirkuk City, Iraq: A Case-Control Study

Background: Thrombocytopenia is the most common hematological disorder in pregnant women, second only to anemia. A platelet count of less than 150x109/L is regarded as low. It is the most common cause of thrombocytopenia during pregnancy when the platelet count does not fall below 70x109\L. Methods: A case-control study was carried out in the department of obstetrics and gynecology at Azadi Teaching Hospital, Kirkuk, Iraq. Two hundred pregnant women were enrolled in the study; they were divided into 100 cases and 100 controls. All participants were in labor at the time of admission. The cases were pregnant women with gestational thrombocytopenia, while the controls were pregnant women with a normal platelet count. A platelet count was performed for all participants using the Swelab Alfa Plus system. Results: mean gestational age and platelet count were significantly lower in patients than controls, while there was no statistically significant difference in age or parity between the study groups. Preterm labor, postpartum hemorrhage (PPH), intrauterine fetal growth restriction (IUGR), and intrapartum fetal distress were significantly higher in the patients than in the controls, and the mean APGAR score at 5 minutes was significantly lower in the patients compared to the controls. Conclusions: Pregnant women with gestational thrombocytopenia may be at higher risk of preterm labor, postpartum hemorrhage, IUGR, intrapartum fetal distress and a low neonatal APGAR score.

239 Impaired Myoblast Function and Poor Muscle Growth in Intrauterine Growth-Restricted Fetal Sheep Is Improved By the Anti-Inflammatory Nutraceutical, Eicosapentaenoic Acid

Abstract Chronic heat stress during pregnancy causes low birthweight due to intrauterine growth restriction (IUGR) of the fetus. Recent findings indicate that IUGR fetal programming includes enhanced inflammatory sensitivity that disproportionally affects skeletal muscle. Thus, our objective was to determine if 5-d intravenous fetal infusion of the anti-inflammatory ω-3 polyunsaturated fatty acid, eicosapentaenoic acid (EPA) improved growth metrics and ex vivo myoblast (i.e., muscle stem cell) function in heat stress-induced IUGR fetal sheep. Maternal heat stress (40°C, 35% humidity, THI = 85) from d 40 to 95 of gestation was used to produce IUGR fetuses. Saline or EPA (25 mg/d) was infused via fetal femoral catheter from d 118 to 122 of gestation. At 122 d gestation, IUGR fetuses (n = 10; 2.31 ± 0.16 kg) were 26% lighter (P < 0.05) than control fetuses (n = 10; 3.10 ± 0.15 kg). Body mass of EPA-infused IUGR fetuses (n = 9; 2.70 ± 0.16 kg) were intermediate between controls and IUGR fetuses. Likewise, IUGR fetuses had lighter (P < 0.05) hindlimbs (28%), semitendinosus (30%), longissimus muscle (28%), flexor digitorum superficialis (30%), and soleus (31%) than controls. EPA infusion partially recovered (P < 0.05) hindlimb and longissimus muscle mass and fully recovered (P < 0.05) flexor digitorum superficialis and soleus mass but did not improve semitendinosus mass. Primary myoblasts were isolated at necropsy and incubated in proliferation media (DMEM + 20% fetal bovine serum) for 2 h or differentiation media (DMEM + 2% fetal bovine serum) for 96 h. Proliferation rates (determined by EdU incorporation over 2 h) were less (P < 0.05) for myoblasts from IUGR fetuses (38 ± 2% EdU+) and EPA-infused IUGR fetuses (39 ± 2% EdU+) than controls (44 ± 1% EdU+). Differentiation rates (determined by myogenin expression after 96 h) were less (P < 0.05) for myoblasts from IUGR fetuses (9 ± 1% myogenin+) but not EPA-infused IUGR fetuses (13±1% myogenin+) compared with controls (12 ± 1% myogenin+). IUGR fetuses had lighter (P < 0.05) heart (19%) and brain (11%) mass than controls, but heart/fetal mass and brain/fetal mass were greater (P < 0.05) than controls, which indicates tissue sparing for these organs. EPA infusion did not affect heart or brain mass but reduced (P < 0.05) heart/fetal mass and brain/fetal mass. Together, these findings demonstrate that skeletal muscle growth is disproportionately restricted compared with whole-body, brain, heart, or liver growth, and that this is facilitated by intrinsic impairment of myoblast function. Moreover, prolonged fetal infusion of the anti-inflammatory nutraceutical, EPA, partially recovered myoblast function and muscle growth in IUGR fetal sheep.

240 Prolonged Maternofetal Inflammation in the Pregnant Ewe at Mid-Gestation Increases Subsequent Fetal Inflammatory Tone and Disrupts Skeletal Muscle Growth and Glucose Metabolism Near Term

Abstract Chronic maternofetal inflammation in late gestation (i.e., peak fetal growth) causes fetal intrauterine growth restriction (IUGR) in sheep, which was associated with deficits in growth, body composition, and metabolic function before and after birth. However, the impact of sustained maternofetal inflammation during mid-gestation (i.e., peak placental growth and development) has not been explored. Therefore, our objective was to determine the effects of sustained maternofetal inflammation during this critical window on subsequent fetal inflammatory tone, metabolism, and myoblast (i.e., muscle stem cell) function. Pregnant ewes were injected every 3rd day from the 50th to 65th d of gestational age (dGA; term = 150 dGA) with saline (control; n = 12) or bacterial lipopolysaccharide endotoxin to induce maternofetal inflammation and IUGR (MI-IUGR; n = 12). Fetuses were surgically catheterized on dGA 118 to collect blood samples, and a hyperinsulinemic-euglycemic clamp (HEC) was performed on dGA 123. Fetuses were necropsied on dGA 125 to collect semitendinosus muscle samples. Fetal plasma TNFα concentrations tended to be greater (P = 0.07) for MI-IUGR fetuses (440 ± 45 pg/m l) than for controls (348 ± 24 pg/mL). Fetal blood O2 partial pressures were 12% less (P < 0.05) and maternofetal O2 gradients tended to be 11% greater (P = 0.08) for MI-IUGR fetuses than for controls. Hindlimb-specific glucose uptake rates did not differ between fetal groups, but hindlimb-specific glucose oxidation rates were reduced (P < 0.05) by 15% under basal conditions and by 27% under hyperinsulinemic conditions for MI-IUGR fetuses compared with controls. Semitendinosus glycogen content and β2 adrenoceptor content did not differ between fetal groups, but semitendinosus content of the TNFα receptor, TNFR1, was 41% greater (P < 0.05) for MI-IUGR fetuses than for controls. Immunohistochemistry revealed 18% fewer (P < 0.05) proliferating myoblasts (pax7+/Ki67+) and 38% fewer (P < 0.05) differentiated myoblasts (myogenin+) in semitendinosus from MI-IUGR fetuses compared with controls, which coincided with 13% smaller (P < 0.05) muscle fibers. From these findings, we conclude that sustained maternofetal inflammation during peak placental development at mid-gestation resulted in enhanced fetal inflammatory tone near term, which in turn impaired myoblast function, muscle fiber hypertrophy, and muscle glucose metabolism.

241 Increased Inflammatory Tone and Impaired Skeletal Muscle Growth in Intrauterine Growth-Restricted Neonatal Lambs Is Improved By Daily Supplementation of ω-3 Polyunsaturated Fatty Acid Ca2+ Salts

Abstract Low birthweight due to fetal intrauterine growth restriction (IUGR) often results from maternofetal heat stress. IUGR fetuses exhibit enhanced inflammatory tone, which persists after birth and impacts body composition, skeletal muscle growth, and metabolic function. Therefore, our objective was to determine whether daily oral supplementation of Ca2+ salts of ω-3 polyunsaturated fatty acids (ω-3 PUFA) to IUGR-born neonatal lambs improved inflammatory tone, body composition, and growth metrics. Pregnant ewes were exposed to heat stress (40°C, 35% humidity, THI = 85) from d 40 to 95 of gestation to induce IUGR. Lambs were weaned at birth and hand-reared on milk replacer. Daily oral boluses of 0.5 mL molasses containing 0 or 0.42 g/kg bodyweight of ω-3 PUFA (Virtus Nutrition) were administered. Femoral catheters were placed at d 24 and lambs were necropsied at d 30. At birth, IUGR lambs (n = 8; 3.12 ± 0.34 kg) and IUGR+ω-3 lambs (n = 7; 3.67 ± 0.32 kg) were lighter (P < 0.05) than controls (n = 12; 4.28 ± 0.15 kg). Plasma TNFα concentrations were greater (P < 0.05) at birth for IUGR (557 ± 121 pg/mL) and IUGR+ω-3 lambs (437 ± 82 pg/mL) than for controls (213 ± 78 pg/mL). Plasma TNFα concentrations remained increased (P < 0.05) for IUGR lambs but not for IUGR+ω-3 compared with controls at 2, 3, and 4 wk of age. Adjusted 30-d bodyweights were lighter (P < 0.05) for IUGR lambs (9.83 ± 0.6 kg) but not for IUGR+ω-3 lambs (11.59 ± 0.4 kg) than for controls (12.35 ± 0.2 kg). Heart and brain weights were 17% and 6% lighter (P < 0.05), respectively, for IUGR lambs than for controls. Brain weight deficits were resolved in IUGR+ω3 lambs, but heart weights did not differ between IUGR and IUGR+ω-3 IUGR lambs. Crown circumference/ bodyweight, abdominal circumference/ bodyweight, and cannon bone length/ bodyweight (indicators of asymmetric body composition) were 11% to 15% greater (P < 0.05) for IUGR lambs than for IUGR+ω-3 lambs or controls. At necropsy, IUGR lambs had lighter (P < 0.05) whole hindlimbs (29%) and flexor digitorum superficialis (24%), soleus (36%), biceps femoris (25%), semitendinosus (24%), gastrocnemius (29%), and longissimus dorsi (26%) muscles compared with controls. Weight deficits were partially or fully resolved in IUGR+ω-3 lambs for whole hindlimbs and for all muscles but the soleus, which did not differ from IUGR lambs. These findings demonstrate that daily oral supplementation of Ca2+ salts of ω-3 PUFA reduced the enhanced inflammatory tone observed in IUGR-born offspring, which coincided with improved skeletal muscle growth and indicators of symmetrical body composition.

PSVIII-30 Impaired Glucose-Stimulated Insulin Secretion in Intrauterine Growth-Restricted Neonatal Lambs Is Improved By Daily Supplementation of ω-3 Polyunsaturated Fatty Acid Ca2+ Salts

Abstract Maternofetal heat stress during placental development induces fetal intrauterine growth restriction (IUGR), which in turn reduces birthweight. IUGR-born livestock exhibit deficits in insulin stimulus-secretion coupling and glucose metabolism that contribute to poor growth efficiency. Thus, our objective was to determine whether daily oral supplementation of Ca2+ salts of ω-3 polyunsaturated fatty acids (ω-3 PUFA) to IUGR-born neonatal lambs improves glucose-stimulated insulin secretion and other indicators of metabolic efficiency. Maternal heat stress (40°C, 35% humidity, THI = 85) from d 40 to 95 of gestation was used to induce IUGR. Lambs were weaned at birth and hand-reared on milk replacer. Beginning at birth, lambs received daily oral boluses of 0.5 mL molasses containing 0 or 0.42 g/kg bodyweight of ω-3 PUFA (Virtus Nutrition). All lambs were fitted with femoral catheters at d 24 and a square-wave hyperglycemic clamp study was performed on d 28 to assess basal (i.e., resting) and glucose-stimulated insulin secretion (GSIS). Blood glucose concentrations did not differ among IUGR lambs (n = 8), IUGR+ω-3 lambs (n = 7), and controls (n = 12), but by study design were increased (P < 0.05) 205% from basal during hyperglycemic periods. Basal plasma insulin concentrations did not differ among groups, but basal glucose-to-insulin ratios were greater (P < 0.05) for IUGR+ω-3 lambs than for controls or IUGR lambs. During hyperglycemia, plasma insulin concentrations were 53% less (P < 0.05) for IUGR lambs but only 30% less (P < 0.05) for IUGR+ω-3 lambs compared with controls. Hyperglycemic glucose-to-insulin ratios were greater (P < 0.05) for IUGR lambs (3.24 ± 0.59) compared with controls (1.10 ± 0.29) and were intermediate for IUGR+ω-3 lambs (2.08 ± 0.86). Blood lactate concentrations did not differ among groups or between periods, but blood pH was was greater (P < 0.05) for IUGR (7.448 ± 0.006) and IUGR+ω-3 lambs (7.439 ± 0.003) compared with controls (7.422 ± 0.004). Blood partial pressure of CO2 was less (P < 0.05) for IUGR lambs (43.0 ± 0.3 mmHg) than for controls (46.7 ± 0.9 mmHg) and was intermediate for IUGR+ω-3 lambs (44.0 ± 0.4 mmHg). Blood HCO3 concentrations and O2-bound hemoglobin were greater (P < 0.05) for IUGR and IUGR+ω-3 lambs than for controls. Blood Na+ tended to be less (P = 0.07) and blood K+ was less (P < 0.05) for IUGR and IUGR+ω-3 lambs than for controls. Blood Ca2+ was less (P < 0.05) for IUGR lambs but not for IUGR+ω-3 lambs than for controls. These findings demonstrate that daily oral supplementation of Ca2+ salts of ω-3 PUFA improved deficits in insulin stimulus-secretion coupling and several other metabolic indicators observed in IUGR-born offspring. However, it did not improve all electrolyte concentrations or acid-base balance of the blood.

286 Evaluation of Serotonin as a Vasorelaxant in Ovine Saphenous Artery and Vein

Abstract Herbivores that consume ergot alkaloids frequently suffer from vasoconstriction that can result in a myriad of symptoms that can range from necrosis of peripheral tissues to fetal intra-uterine growth restriction. As part of a larger study screening compounds that may mitigate the vasoconstrictive effects of ergot alkaloids, the objective of this experiment was to evaluate serotonin (5-HT) as vasorelaxant in the ovine saphenous artery and vein. Blood vessels were collected from a total mixed breed market rams (n = 16; approximate BW = 58 kg) at slaughter, cleaned of surrounding adipose and connective tissue, sliced into 2-mm cross-sections, and mounted in a multimyograph. Artery and vein cross-sections were equilibrated to 1 g tension in continuously gassed (95% O2/5% CO2) Krebs-Henseleit buffer (pH 7.4; 37.5 °C) for 90 min, precontracted with 0.0001 M phenylephrine for 15 min, exposed to concentrations of 5-HT that ranged from 1 x 10-9 to 1 x 10-4 M for a 5-min interval. Response data were normalized to the 0.0001 M phenylephrine response and were analyzed as a completely randomized design in SAS. The lateral saphenous vein (n = 5 lambs) relaxed to increasing concentrations of 5-HT (P < 0.05) with 65 to 75 % relaxation occurring at 1 x 10-7 M through 1 x 10-4 5-HT. Conversely, the lateral saphenous artery (n = 6 lambs) contracted in response to increasing concentrations of 5-HT (P < 0.05) resulting in a 255% increase from the phenylephrine response by the 1 x 10-4 M addition. In a subsequent experiment, saphenous veins from the remaining lambs (n = 5) were treated the same, but in place of increasing concentrations of 5-HT, saphenous veins were exposed to increasing concentrations of selective 5-HT receptor agonists to determine the receptor subtypes involved in the previously observed vasorelaxation. Agonists for receptors 5-HT2B (BW 723C86; α-methyl-5-(2-thienylmethoxy)-1H-indole-3-ethanamine hydrochloride), 5-HT4 (BIMU-8; 2,3-Dihydro-N-[(3-endo)-8-methyl-8-azabicyclo[3.2.1]oct-3-yl]-3-(1-methylethyl)-2-oxo-1H-benzimidazole-1-carboxamide hydrochloride), and 5-HT7 (LP44; 4-[2-(methylthio)phenyl]-N-(1,2,3,4-tetrahydro-1-naphthalenyl)-1-piperazinehexanamide, monohydrochloride) were used. These 5-HT receptor subtypes were selected based on their association with vascular smooth muscle relaxation. While all three 5-HT receptor subtypes resulted in vasorelaxation (P < 0.05), the 5-HT2B agonist only stimulated a maximal relaxation of 32% compared with the agonists for 5-HT4 and 5-HT7 that resulted in maximal relaxation of 68% and 50%, respectively. The agonist for 5-HT4 produced the greatest relaxation in the ovine lateral saphenous vein and should be targeted in subsequent research. It is likely that the combined effect of binding multiple receptor subtypes contributes to the overall effect of 5-HT. The focus on development of ergot alkaloid mitigation strategies should consider the divergent responses of arteries and veins to serotonin in peripheral tissues.

Folic acid: The key to a healthy pregnancy - A prospective study on fetomaternal outcome.

The objective of the study is to study the fetomaternal outcome associated with folic acid deficiency in pregnancy. This hospital-based observational study was conducted in the Department of Obstetrics and Gynaecology at Base Hospital, Delhi Cantt, and a total of 351 participants were enrolled who were fulfilling the inclusion criteria. The plasma folic acid level of the selected patients was measured in the booking visit by automated chemiluminescence assay. The cutoff levels of folic acid were taken at 8.6 ng/mL. Based on these values, the study population was divided into two groups, one with folic acid values <8.6 ng/mL and the other with values ≥8.6 ng/mL. Plasma Vitamin B12 levels were measured to check for any concurrent deficiencies. Obstetric outcomes included first- and second-trimester miscarriages, development of anemia, gestational hypertension/preeclampsia, gestational diabetes mellitus, hypothyroidism, placental abruption, and intrauterine fetal growth restriction (FGR). Furthermore, the period of gestation at delivery, fetal weights, APGAR scores at 5 min were documented. The study also considered fetal neural tube defects, intrauterine fetal demise for data collection. Collected data were analyzed statistically to find the association of the above-mentioned outcomes with levels of folic acid. The rate of preterm deliveries was significantly higher in the folic acid group with levels <8.6 ng/mL (16.94%). The incidence of small for gestational age/FGR was higher in the folic acid group with levels <8.6 ng/mL (27.11%) compared to the high folic acid group with levels ≥8.6 ng/mL (13.38%). The differences in the incidence of anemia, gestational hypertension, gestational diabetes, and preeclampsia between the two groups were not statistically significant and no cases of intrauterine fetal demise or placental abruption were observed in either group. Moreover, there was no significant difference in the relative risk of low Apgar scores at 5 min between the two groups. The present study suggests that low folic acid levels during pregnancy are associated with a higher risk of adverse pregnancy outcomes such as anemia, miscarriages, preterm delivery, and FGR. Therefore, adherence to nutritional recommendation of folic acid supplementation during pregnancy is essential to prevent these adverse outcomes.

Maternal Risk Factors and Their Effect on Outcome and Procedure-Related Complications in Cordocentesis: A Multicenter Retrospective Study.

Cordocentesis is used in clinical situations in which lower-risk diagnostic procedures do not deliver the desired results. The aim of this study was to evaluate the risk for procedure-related complications and fetal loss in correlation to maternal risk factors. This is a multicenter retrospective study investigating the complications, risk factors and perinatal outcome of diagnostic cordocentesis between 1998 and 2019 in three different centers. A total of 1806 cordocenteses were performed and procedure-related complications (IUFD within 48 h, contractions, bradycardia, unsuccessful puncture, chorioamniotic separation) were noted in 1.6% of cases. Fetuses with chromosomal aberrations, intrauterine growth restriction and hydropic fetuses had a significantly higher rate of fetal loss compared to other indications. Fetal blood sampling (FBS) performed before 17+0 weeks of gestation was associated with a higher risk of procedure-related complications. Maternal BMI ≥ 40 increased the risk for fetal loss, whereas maternal age, number of previous miscarriages, number of previous abortions, history of vaginal bleeding or nicotine abuse did not affect the risk for complications or overall fetal loss rate. In the hands of experienced operators, FBS is a safe way to further fetal diagnostics, and the risk of complications is low.

Fetal Cerebroplacental Artery Ratio versus Uterine Artery Doppler Ultrasonography for Prediction of Late Onset Intrauterine Fetal Growth Restriction among High Risk Pregnant Women

Fetal Cerebroplacental Artery Ratio versus Uterine Artery Doppler Ultrasonography for Prediction of Late Onset Intrauterine Fetal Growth Restriction among High Risk Pregnant Women

Omphalocele, bifid scrotum, hypospadias and micropenis: clinical outcome in cases with normal karyotype

Background. This study aims to describe the omphalocele, hypospadias, bifid scrotum and micropenis association characteristics, along with the care, prenatal diagnosis strategies and postnatal outcomes. We also present a case with this unusual association of malformations in a fetus with a normal male karyotype. Methodology. For this study, we present a case with detailed imaging and follow-up investigations before and after birth. Also, we searched the literature regarding the management of this complex malformation, and we present the review results. Results. According to literature, the following syndromes were linked to the spectrum of omphalocele-hypospadias: trisomy 13, trisomy 18, trisomy 21, 45X, 47XXY and 47XXX, Beckwith-Wiedemann syndrome, and 2q22.1q22.3 deletion. According to our complex investigations, the omphalocele, bifid scrotum, hypospadias and micropenis, in the case of our patient, were isolated, despite literature findings. In the absence of associated major structural or genetic abnormalities, the management was conservative, with a good outcome. Conclusions. Structural anomalies can often appear alone, spontaneously or in association with other structural anomalies as part of syndromes. According to the detailed prenatal and postnatal evaluation, micropenis-hypospadias and omphalocele associations were isolated in our case, despite the literature findings. Fetal growth and well-being should be monitored, as intrauterine fetal growth restriction may occur.

Fetal brain volumes and neurodevelopmental outcome of intrauterine growth restricted fetuses

ObjectiveThis study aims to investigate the correlation of MRI measured fetal brain volumetrics with long-term neurodevelopmental outcome, among intrauterine growth restricted (IUGR) and apparently healthy fetuses. Study designA historical cohort study at a single tertiary referral medical center during 6 years period, of fetuses diagnosed with IUGR due to placental insufficiency, and apparently healthy fetuses, who had fetal brain MRI scan. The volumes of the supratentorial brain region, both hemispheres and the cerebellum were measured by 3D MRI semi-automated volume measurements. The cerebellar to supratentorial ratio (CER/ST) was calculated. Volumes were plotted on normal growth curves. 17 IUGR fetuses, and 53 apparently healthy fetuses adhered to participate in the VABS-II questionnaire, evaluating neurodevelopmental outcome. Results70 patients (mean age at conducting VABS-II questionnaire 4.4 ± 2.1 years, 38 males) were evaluated. Among fetuses born in a gestational age of 36 weeks or later, IUGR fetuses demonstrated a significantly larger number of abnormal results in the VABS-II communication domain (p =.049). No significant differences were found in other domains or in overall neurodevelopmental outcome. The CER/ST ratio correlated with the overall neurodevelopmental outcome of the total study population (r = 0.40, p <.001), and of the IUGR group separately (ρ = 0.58, p =.02). ConclusionCER/ST ratio measured using fetal brain MRI was found to be correlated with long term neurodevelopmental outcome. This result may aid in clinical interpretation of biometric data obtained by fetal brain MRI, linking it with long term neurodevelopmental outcome.

Lipid profile and pregnancy associated pathologies

Throughout pregnancy, maternal lipid metabolism changes substantially, all of which can be seen by analysing the lipid profile. Determination of serum total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels may have a predictive role in the subsequent development of pregnancyspecific pathologies such as preeclampsia, intrahepatic cholestasis of pregnancy and gestational diabetes. Also, disorders present in the lipid profile may influence the weight of the newborn at birth. Early dyslipidaemia during pregnancy, manifested by elevated triglycerides and low-density lipoprotein cholesterol serum levels, has been associated with the development of preeclampsia. In laboratory tests, pregnant women diagnosed with intrahepatic cholestasis have significantly higher plasma triglycerides levels and reduced high-density lipoprotein cholesterol concentrations compared to healthy pregnant women. In case of foetal intrauterine growth restriction in the newborn, literature data report significantly increased triglycerides levels. Women who during pregnancy developed gestational diabetes had higher plasma triglycerides levels and lower high-density lipoprotein cholesterol levels, with no statistically significant difference between serum triglycerides or high-density lipoprotein cholesterol levels.

Diagnosis and Management of Fetal Growth Restriction

Fetal Growth Restriction (FGR) or Intrauterine Growth Restriction (IUGR) is one of the complications in pregnancy that is quite common, especially in developing countries, which is one of the contributors to neonatal mortality and morbidity rates. This literature review aims to provide related information, so that proper diagnosis and management can be carried out to reduce fetal morbidity and mortality rates. We searched from online databases and used review articles, research, guidelines from professional organizations, such as POGI from Indonesia, ACOG from the USA, and RCOG from the UK. Risk factor assessment and examination of fundal height can be the first steps in diagnosing IUGR. If suspicion is found, ultrasound (USG) and Doppler velocimetry can be performed. IUGR management mostly works in influencing the vasodilation of the placenta as the most common cause of IUGR events. Fetal Growth Restriction can be diagnosed immediately by screening for risk factors in pregnant women.

Maternal serum ferritin level during pregnancy as a predictor of intrauterine fetal growth restriction

Maternal serum ferritin level during pregnancy as a predictor of intrauterine fetal growth restriction

Early changes in S100B maternal blood levels can predict fetal intrauterine growth restriction.

Intrauterine growth restriction (IUGR) represents one of the main causes of perinatal mortality and morbidity. Nowadays, IUGR early diagnosis is mandatory in order to limit the occurrence of multiorgan failure, especially the brain. Therefore, we investigated whether longitudinal S100B assessment in maternal blood could be a trustable predictor of IUGR. We conducted a prospective study in 480 pregnancies (IUGR: n=40; small for gestational age, SGA: n=40; controls: n=400) in whom S100B was measured at three predetermined monitoring time-points (T1: 8-18 GA; T2: 19-23 GA; T3: 24-28 GA). Lower S100B in IUGR fetuses than SGA and controls (p<0.05, for all) at T1-T3. Receiver operating characteristic curve showed that S100B at T1 was the best predictor of IUGR (sensitivity: 100 %; specificity: 81.4 %) than T2, T3. The early lower S100B concentration in pregnant women lately complicated by IUGR support the notion that non-invasive early IUGR diagnosis and monitoring is becoming feasible. Results open the way to further studies aimed at diagnosing and monitoring fetal/maternal diseases at earliest time.

Perinatal morbidity and mortality in neonates of mothers with sickle cell disease at the Teaching Hospital of Borgou /Alibori (Benin)-II

Introduction: Pregnancy in women with sickle cell disease exposes the neonate to an increased risk of perinatal mortality. Objective: To determine perinatal morbidity and mortality in neonates of mothers with sickle cell disease at the teaching hospital of Borgou/Alibori in northen Benin. Patients and methods: This was a descriptive and observational study conducted in maternity and neonatology departments at the teaching hospital of Borgou/Alibori from January 1, 2015 to August 31, 2019. It included neonates of at least 22 weeks or weighing more than 500g, alive or not at birth from mothers with sickle cell disease. The variables studied were sociodemographic, clinical and evolutionary. The protocol was submitted to the ethics committee of the University of Parakou and obtained its approval under the reference 0289/CLERB-UP/P /SP/R/SA. Results: During the period, 130 pregnant women with sickle cell disease were admitted out of a total of 10,087, representing a frequency of 1.3%. The main perinatal morbidities were: acute fetal distress (10,4%), prematurity and intrauterine growth restriction (49.5%), respiratory distress (40%), bacterial infections (30.5%) and perinatal asphyxia (21.1%). Perinatal deaths occurred in 28 neonates and the perinatal mortality rate was 243.5‰. Conclusion: Acute fetal distress and low birth weight are the main perinatal morbidities observed. Perinatal mortality in these neonates is higher than in the general population in our context. Hence the need for early multi-disciplinary care.