Late Second Trimester Of Pregnancy Research Articles

Early prediction of gestational diabetes mellitus using first trimester maternal serum pregnancy-associated plasma protein-a: A cross-sectional study.

The oral glucose tolerance test with 75 g glucose is commonly regarded as the gold standard (GS) for the detection of gestational diabetes mellitus (GDM). However, one limitation of this test is its administration in the late second trimester of pregnancy in some countries (e.g., Iran). This study aimed to evaluate the accuracy of pregnancy-associated plasma protein-A (PAPP-A) for predicting GDM in the early first trimester of pregnancy using a novel statistical modeling technique. The study population consisted of 344 pregnant women who participated in the first trimester screening program for GDM. Maternal serum PAPP-A levels were measured between 11 and 13 gestational weeks for all participants. A Bayesian latent profile model (LPM) under the skew-t (ST) distribution was employed to estimate the diagnostic accuracy measures of PAPP-A in the absence of GS test outcomes. The mean (standard deviation) age of the participants was 28.87 ± 5.20 years. The median (interquartile range (IQR)) PAPP-A MoM was 0.91 (0.69-1.34). Utilizing the LPM under the ST distribution while adjusting for covariates, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of PAPP-A were 92% (95% credible interval [CrI]: 0.89, 0.98), 81% (95% CrI: 0.76, 0.91), and 0.91 (95% CrI: 0.83, 0.97), respectively. Notably, the pregnant women with GDM had significantly lower PAPP-A values ( -0.52, 95% CrI [-0.61, -0.46]). Generally, our findings confirmed that PAPP-A could serve as a potential screening tool for the identification of GDM in the early stages of pregnancy.

First-Trimester Plasmatic microRNAs Are Associated with Fasting Glucose Levels in Late Second Trimester of Pregnancy

Maternal blood glucose regulation adaptation to pregnancy aims to support fetal growth but may also lead to the development of gestational diabetes mellitus, the most common pregnancy complication. MiRNAs are small RNA molecules secreted and stable in the blood, where they could have paracrine hormone-like functions (ribo-hormone) and regulate metabolic processes including fetal growth and glucose metabolism. The objective of this study was to identify plasmatic microRNA (miRNAs) measured during the first trimester of pregnancy that were associated with glucose levels during a 75 g oral glucose tolerance test (OGTT) at ~26 weeks of pregnancy. miRNAs were quantified using next-generation sequencing in 444 pregnant women and replicated in an independent cohort of 106 pregnant women. MiRNAs associated with glucose levels were identified with the DESeq2 package. We identified 24 miRNAs associated with fasting glycemia, of which 18 were common to both cohorts (q-value < 0.1). However, no association was found between miRNAs and 1 h or 2 h post OGTT glycemia. To conclude, we identified 18 miRNAs early in pregnancy that were associated with fasting blood glucose measured 3 months later. Our findings offer new insights into the mechanisms involved in fasting glucose homeostasis regulation in pregnancy, which is critical to understanding how gestational diabetes develops.

Composition of the maternal gastrointestinal microbiome as a predictor of neonatal birth weight.

The biological mechanism by which the maternal gastrointestinal microbiota contributes to fetal growth and neonatal birth weight is currently unknown. The purpose of this study was to explore how the composition of the maternal microbiome in varying pre-gravid body mass index (BMI) groups are associated with neonatal birth weight adjusted for gestational age. Retrospective, cross-sectional metagenomic analysis of bio-banked fecal swab biospecimens (n = 102) self-collected by participants in the late second trimester of pregnancy. Through high-dimensional regression analysis using principal components (PC) of the microbiome, we found that the best performing multivariate model explained 22.9% of the variation in neonatal weight adjusted for gestational age. Pre-gravid BMI (p = 0.05), PC3 (p = 0.03), and the interaction of the maternal microbiome with maternal blood glucose on the glucose challenge test (p = 0.01) were significant predictors of neonatal birth weight after adjusting for potential confounders including maternal antibiotic use during gestation and total gestational weight gain. Our results indicate a significant association between the maternal gastrointestinal microbiome in the late second trimester and neonatal birth weight adjusted for gestational age. Moderated by blood glucose at the time of the universal glucose screening, the gastrointestinal microbiome may have a role in the regulation of fetal growth. Maternal blood glucose in the late second trimester significantly moderates the relationship between the maternal gastrointestinal microbiome and neonatal size adjusted for gestational age. Our findings provide preliminary evidence for fetal programming of neonatal birth weight through the maternal gastrointestinal microbiome during pregnancy.

First trimester plasma microRNAs levels predict Matsuda Index-estimated insulin sensitivity between 24th and 29th week of pregnancy.

IntroductionGestational diabetes mellitus (GDM) is a consequence of an imbalance between insulin sensitivity (IS) and secretion during pregnancy. MicroRNAs (miRNAs) are small and secreted RNA molecules stable in blood and known to regulate physiological processes including glucose homeostasis. The aim of this study was to identify plasmatic miRNAs detectable in early pregnancy predicting IS at 24th-29th week of pregnancy.Research design and methodsWe quantified circulating miRNAs in 421 women in plasma collected at 9.6±2.2 weeks of pregnancy using next-generation sequencing.Resultswe detected 2170 miRNAs: 39 (35 positively and 4 negatively) were associated with IS as estimated by the Matsuda Index at 26.4±1.0 weeks of pregnancy. Lasso regression identified 18 miRNAs independently predicting Matsuda Index-estimated IS. Together with gestational age, maternal age and body mass index at first trimester, they explain 36% of IS variance in late second trimester of pregnancy. These miRNAs regulate fatty acid biosynthesis and metabolism among other pathways.ConclusionsIn summary, we have identified first trimester plasmatic miRNAs predictive of Matsuda Index-estimated IS in late second trimester of pregnancy. These miRNAs could also contribute to initiate and support IS adaptation to pregnancy potentially through lipid metabolism regulation.

A prospective study of maternal 25-hydroxyvitamin D (25OHD) in the first trimester of pregnancy and second trimester heavy metal levels

BackgroundVitamin D facilitates the absorption of calcium but may also increase absorption of other metals; the literature is conflicting. ObjectiveTo examine whether 25OHD in the first trimester of pregnancy was associated with subsequent metals levels in the late second trimester of pregnancy. MethodsWe used data from a sample of women in the LIFECODES pregnancy cohort (N = 381). 25-hydroxyvitamin D (25OHD) was measured with a chemiluminescence immunoassay in plasma samples drawn at 10 weeks of gestation. A panel of 17 metals and elements was measured in urine collected at 26 weeks of gestation. We used linear or logistic regression to estimate associations between 25OHD (dichotomous, linear, and in tertiles) and either urinary metal concentrations or the proportion of samples below the limit of detection, respectively. Multivariable models included urinary specific gravity, age, race/ethnicity, education, body mass index, insurance type, gestational age, and season. ResultsAfter multivariable adjustment, low 25OHD was associated with a 47% increase in lead level, a 60% increase in tin level, and 1.58 times the odds of detectable tungsten. A 10 ng/ml increase in 25OHD was associated with a 12% decrease in tin and an 8% increase in molybdenum. While we had a small sample size, we found some evidence of effect modification by race. Women who reported their race as Black or were classified in the other race category, who also had low 25OHD, had 40% higher thallium than women with higher 25OHD and were more likely to have detectable beryllium and tungsten. These metals were not associated with low 25OHD in women who reported their race as White. Tin and lead were higher in women with low 25OHD in all race groups. DiscussionIn total, further research is warranted to determine if vitamin D levels alter metal levels, and to elucidate the shape of the association for each metal across a range of corresponding 25OHD levels, and longitudinally, across pregnancy. This is especially true for pregnant people as exposure to metals during pregnancy has health consequences for the fetus.

Ultrasound-guided induced fetal death, an alternative method for induction of abortion in the bitch.

This study was performed to achieve abortion in a short time and with minimum side effects in a bitch, as an alternative method for termination of unwanted pregnancy. The experimentation was performed on 10 privately owned crossbred pregnant bitches, in their late second trimester of pregnancy, having a variable number of fetuses (3 to 9). Fetal death was induced by transabdominal intracardiac injection of potassium chloride (KCl) into the fetal heart under ultrasonographic guidance. Pregnancy was terminated within 36 to 72 hr (51.60 ± 16.04 hr) and none of the patients experienced any side effects or clinical complications. Data presented in this report provided evidence for the possible use of this technique to selectively reduce the number of canine fetuses without terminating the whole pregnancy. Ultrasound-guided induced fetal death is a safe procedure and a viable method for the induction of abortion in a short time and with no apparent side effects.

Endocrine disrupting chemicals mixture and pregnancy glucose levels among women from a fertility clinic

TPS 743: Health effects in pregnancy, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background/Aim: Endocrine disrupting chemicals (EDCs) have been linked to pregnancy complications such as gestational diabetes (GDM). As individuals are exposed to multiple chemicals simultaneously, investigating EDCs as a mixture is required to provide a more realistic assessment. We evaluated the association between pregnancy exposure to EDC mixture and glucose levels in the late second trimester of pregnancy, an established risk factor of GDM. Methods: We used data from 295 women in the Environment and Reproductive Health (EARTH) Study who had data available on 1st and/or 2nd trimester urinary concentrations of 19 EDCs, as well as late 2nd trimester glucose levels. Several methods were used to evaluate chemical mixtures including: weighted quantile sum (WQS) regression, for estimating exposures’ weights in contributing to the mixture-outcome association; shrinkage procedures (LASSO/elastic net) and Bayesian Kernel Machine Regression (BKMR), for variable selection. The 19 chemicals (3 parabens, triclosan, 11 phthalate metabolites, bisphenol A, benzophenone-3, 2,4-dichlorophenol, 2,5-dichlorophenol) concentrations were adjusted for specific gravity and log transformed. All analyses were adjusted for race, education, BMI, age, physical activity, smoking, and infertility diagnosis. A final linear regression model mutually including the selected exposures was further estimated. Results: Focusing on early 2nd trimester exposures, the following chemicals were identified as potential predictors of higher glucose by at least 2 statistical approaches: bisphenol-A, 2,4-dichlorophenol (2,4D), monoethyl phthalate (MEP), and the molar sum of four di(2-ethylhexyl) phthalate metabolites (∑DEHP). When fitting a final model that included these chemicals, suggestive positive associations were observed (e.g., β=2.2 mg/dL for (a unit increase in) log(2,4D), β =5.4 mg/dL for log(MEP), β =3.5 mg/dL for log(∑DEHP)). Analyses on 1st trimester exposures showed similar results. Conclusion: By evaluating EDCs as an environmental mixture, we identified relevant potential risk factors providing important insights in understanding the relationship between this class of chemicals and pregnancy glucose levels.

Plasma Heme Scavengers Alpha-1-Microglobulin and Hemopexin as Biomarkers in High-Risk Pregnancies.

Women with established preeclampsia (PE) have increased plasma concentration of free fetal hemoglobin. We measured two hemoglobin scavenger system proteins, hemopexin (Hpx) and alpha-1-microglobulin (A1M) in maternal plasma using enzyme-linked immunosorbent assay during the late second trimester of pregnancy in women with high and low risk of developing PE. In total 142 women were included in nested case-control study: 42 women diagnosed with PE and 100 controls (49 randomly selected high-risk and 51 low-risk controls). The concentration of plasma A1M in high-risk controls was higher compared to low-risk controls. Women with severe PE had higher plasma A1M levels compared to women with non-severe PE. In conclusion, the concentration of plasma A1M is increased in the late second trimester in high-risk controls, suggesting activation of endogenous protective system against oxidative stress.

Low-dose vaginal misoprostol with or without Foley catheter for late second-trimester pregnancy termination in women with previous multiple cesarean sections

Purpose: To compare between low dose vaginal misoprostol with and without Foley catheter for late second trimester pregnancy termination in women with previous multiple cesarean sections.Materials and methods: A prospective randomized controlled clinical trial, patients were randomly allocated to either low dose vaginal misoprostol group (n = 40) or combined low dose vaginal misoprostol plus Foley catheter group (n = 38). The primary outcome was complete abortion. Secondary outcomes were induction-to-abortion interval, the number of misoprostol doses and occurrence of complications.Results: Incomplete abortion rate was significantly lower in combined group than misoprostol only group (2.6%versus 15% respectively, p = .03). Induction-to-expulsion interval with the combined vaginal misoprostol plus Foley catheter was significantly shorter (p = .01) and the number of misoprostol doses in the combined group was significantly lower (p = .04). No statistically significant difference in the frequency of complications between both groups.Conclusions: The combination of low dose vaginal misoprostol and Foley catheter is an effective and safe method for termination of second trimester pregnancy in women with previous multiple cesarean sections.

Maternal Night-Fasting Interval during Pregnancy Is Directly Associated with Neonatal Head Circumference and Adiposity in Girls but Not Boys

Background: Synchrony between daily feeding-fasting signals and circadian rhythms has been shown to improve metabolic health in animals and adult humans, but the potential programming effect on fetal growth is unknown.Objective: We examined the associations of the maternal night-fasting interval during pregnancy with offspring birth size and adiposity.Methods: This was a cross-sectional study of mother-offspring dyads within the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. For 384 mothers aged 30.8 ± 4.8 y (mean ± SD), the night-fasting interval at 26-28 wk of gestation was determined from a 3-d food diary based on the average of the fasting duration at night (1900-0659). Offspring birth weight, length, and head circumference were measured and converted to weight-for-gestational age (GA), length-for-GA, and head circumference-for-GA z scores, respectively, by using local customized percentile charts. The percentage of neonatal total body fat (TBF) was derived by using a validated prediction equation. Multivariable general linear models, stratified by child sex, were performed.Results: The mean ± SD maternal night-fasting interval was 9.9 ± 1.3 h. In infant girls, each 1-h increase in the maternal night-fasting interval was associated with a 0.22-SD (95% CI: 0.05-, 0.40-SD; P = 0.013) increase in birth head circumference-for-GA and a 0.84% (95% CI: 0.19%, 1.49%; P = 0.012) increase in TBF at birth, after adjustment for confounders. In infant boys, no associations were observed between the maternal night-fasting interval and birth size or TBF.Conclusions: An increased maternal night-fasting interval in the late second trimester of pregnancy is associated with increased birth head circumference and TBF in girls but not boys. Our findings are in accordance with previous observations that suggest that there are sex-specific responses in fetal brain growth and adiposity, and raise the possibility of the maternal night-fasting interval as an underlying influence. This trial was registered at clinicaltrials.gov as NCT01174875.

Plasma ω-3 fatty acids in pregnancy are inversely associated with postpartum weight retention in a multiethnic Asian cohort ,

Background: Studies have demonstrated associations between polyunsaturated fatty acids (PUFAs) and adiposity. It is unclear whether PUFAs in pregnancy have an effect on maternal weight retention after childbirth, which can contribute to long-term obesity.Objective: We examined the association of maternal plasma PUFAs in pregnancy with 18-mo postpartum weight retention (PPWR) in a multiethnic Asian cohort.Design: We studied pregnant women (n = 653) recruited between June 2009 and September 2010 from a prospective cohort. At 26–28 wk of gestation, plasma phosphatidylcholine PUFA concentrations were measured and determined as percentages of total fatty acids (FAs). PPWR was calculated based on the difference between measured weight at the first antenatal clinic visit and at 18 mo postpartum.Results: The median retained weight of women was 0.90 kg (IQR: −1.40, 3.25) at 18 mo postpartum. Of 653 women, 544 women (83.3%) had PPWR of <5 kg and 109 (16.7%) had PPWR of ≥5 kg. In adjusted linear regression models, higher plasma eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and total ω-3 (n–3) PUFA concentrations were associated with lower PPWR [EPA: β = −0.62 kg/1% increase of total FAs (95% CI: −1.18, −0.05); DHA: β = −0.24 kg/1% increase (95% CI: −0.45, −0.02); total ω-3 PUFAs: β = −0.20 kg/1% increase (95% CI: −0.36, −0.03)], whereas a higher ratio of plasma ω-6-to-ω-3 PUFAs was associated with a higher PPWR [β = 0.21 kg/unit increase (95% CI: 0.05, 0.36)].Conclusions: Higher plasma percentages of ω-3 PUFAs and a lower ratio of ω-6-to-ω-3 PUFAs in the late-second trimester of pregnancy are associated with less weight retention at 18 mo postpartum. This may offer an alternative strategy to assist postpartum weight reduction by increasing EPA and DHA status together with a decreased ratio of ω-6-to-ω-3 PUFA through diet or fish-oil supplementation during pregnancy. This study was registered at clinicaltrials.gov as NCT01174875.

Maternal Circadian Eating Time and Frequency Are Associated with Blood Glucose Concentrations during Pregnancy

Synchronizing eating schedules to daily circadian rhythms may improve metabolic health, but its association with gestational glycemia is unknown. This study examined the association of maternal night-fasting intervals and eating episodes with blood glucose concentrations during pregnancy. This was a cross-sectional study within a prospective cohort in Singapore. Maternal 24-h dietary recalls, fasting glucose, and 2-h glucose concentrations were ascertained at 26-28 wk gestation for 1061 women (aged 30.7 ± 5.1 y). Night-fasting intervals were based on the longest fasting duration during the night (1900-0659). Eating episodes were defined as events that provided >50 kcal, with a time interval between eating episodes of ≥15 min. Multiple linear regressions with adjustment for confounders were conducted. Mean ± SD night-fasting intervals and eating episodes per day were 9.9 ± 1.6 h and 4.2 ± 1.3 times/d, respectively; fasting and 2-h glucose concentrations were 4.4 ± 0.5 and 6.6 ± 1.5 mmol/L, respectively. In adjusted models, each hourly increase in night-fasting intervals was associated with a 0.03 mmol/L decrease in fasting glucose (95% CI: -0.06, -0.01 mmol/L), whereas each additional daily eating episode was associated with a 0.15 mmol/L increase in 2-h glucose (95% CI: 0.03, 0.28 mmol/L). Conversely, night-fasting intervals and daily eating episodes were not associated with 2-h and fasting glucose, respectively. Increased maternal night-fasting intervals and reduced eating episodes per day were associated with decreased fasting glucose and 2-h glucose, respectively, in the late-second trimester of pregnancy. This points to potential alternative strategies to improve glycemic control in pregnant women. This study was registered at www.clinicaltrials.gov as NCT01174875.

Serum Follistatin-like-3 was elevated in second trimester of pregnant women who subsequently developed preeclampsia

Objective: To determine whether serum Follistatin-like-3 was enhanced in second trimester of pregnant women who subsequently developed preeclampsia. Methods: Thirty-nine pregnant women subsequently developed preeclampsia and 73 normal pregnancy women were included. Serum samples taken in 24–28 weeks gestation were used for assay of Follistatin-like-3. Results: Follistatin-like-3 was significantly elevated in preeclampsia group compared with control. However, there was no significant difference of Follistatin-like-3 in women with mild or severe preeclampsia. Conclusion: The elevation of Follistatin-like-3 was demonstrated in late second trimester of pregnancy destined to developing preeclampsia, suggesting its causal role in the pathogenesis and prediction of preeclampsia.

Comparison of spread of subarachnoid sensory block and incidence of hypotension in early and late second trimester of pregnancy

BackgroundObstetric or non-obstetric surgery can be performed in pregnant women during the second trimester. We evaluated maximal sensory block level (MSBL), and other sensory block characteristics after spinal anesthesia in early and late second trimester pregnant women.MethodsForty-four pregnant women scheduled for cervical cerclage under spinal anesthesia in the early second trimester (Group E) or in the late second trimester (Group L) were enrolled in this study. Spinal anesthesia was performed at the L3/4 and 7 mg of 0.5% hyperbaric bupivacaine was injected into the subarachnoid space. Hemodynamic variables, incidence of nausea/vomiting, ephedrine dose, and sensory block were recorded every 2.5 min during the first 15 min and 20 min after the injection. The MSBL, the time at which MSBL was achieved, and the time to the two-segment regression of the sensory level were also recorded.ResultsThe maximum number of segments blocked was significantly greater in the Group L than in the Group E. The incidence of nausea/vomiting and hypotension, and dose of administrated ephedrine were significantly higher in the Group L than in the Group E. The mean arterial pressure during the 15 min after subarachnoid injection was significantly lower compared to the baseline value in the Group L.ConclusionsThe MSBL of spinal anesthesia with hyperbaric bupivacaine 7 mg were T9 in the early and T5 in the late second trimester groups. Pregnant women in the late second trimester exhibited increased incidence of hypotension and need for ephedrine than women in the early second trimester.

Raised uterine artery impedance is associated with increased maternal arterial stiffness in the late second trimester

ObjectiveTo assess the relationship between uterine artery Doppler pulsatility index (PI) and maternal global arterial stiffness and aortic stiffness in women at high a priori risk of preeclampsia in the late second trimester of pregnancy. MethodsA prospective cohort study was performed. 99 women were recruited from the high-risk obstetric ultrasound clinic in the second trimester; median (±IQR) age and gestation were 33 (29–37) years and 23+6 (23+3–24+4) weeks respectively. Transabdominal uterine artery Doppler was performed and mean values recorded. Women returned at a later date, median gestation (±IQR) 26+5 (25+6–28+0) weeks, for measurement of blood pressure, augmentation index (AIx) and aortic pulse wave velocity (aPWV). ResultsUterine artery PI is positively associated with both AIx (r = 0.4, P <0.0001, 95% CI: 0.22–0.55) and aPWV (r = 0.22, P = 0.03, 95% CI: 0.02–0.40). No relationship was found between uterine artery PI and mean arterial pressure or pulse pressure. AIx was significantly higher in women with uterine artery PI > 1.45 (P = 0.003, 95% CI: 3.1–14.9) but not aPWV (P = 0.45). AIx, but not aPWV, was significantly higher in women who developed preeclampsia (14% vs 9%, 95% CI: 2.0–8.6, P = 0.0018) or IUGR (11% vs 9%, 95% CI: 0.3–4.2, P = 0.027). AIx showed a negative correlation with birth weight z-score (r = −0.25, 95% CI: −0.43 to −0.06, P = 0.013). ConclusionIncreasing uterine artery Doppler PI reflects impaired placentation and increasing risk of preeclampsia. We show a positive association between uterine artery Doppler PI and both global arterial and aortic stiffness. We also show that increased maternal arterial stiffness is associated with a lower birth weight. These findings may represent evidence of an early effect of impaired placentation on the maternal vasculature. Alternatively, given the association between preeclampsia and later cardiovascular disease, ineffective placentation may result from impaired arterial function.

Pre-pregnancy cardiovascular risk in women with previous preeclampsia (PET)/intrauterine growth restriction (IUGR)

wave form using a SphygmoCor device. Three consistent readings were performed and a mean value calculated. AIx was adjusted for heart rate and height using univariate analysis (SPSS v18.0). Results: There was a significant positive association between uterine artery Doppler pulsatility index and increasing maternal AIx (r = 0.36, P = 0.0005) Conclusions: In the late second trimester of pregnancy, increasing UAD PI reflects impaired placentation and increasing risk of preeclampsia. We show that women at increasing risk of preeclampsia have higher arterial stiffness, even in the absence of preeclampsia. Further studies are required to determine whether this is a reflection of abnormal placentation on arterial stiffness, or whether the increased arterial stiffness precedes pregnancy.

Assessment of Fetal Brain Uptake of Paraquat In Utero Using In Vivo PET/CT Imaging

Prenatal in utero conditions are thought to play a role in the development of adult diseases including Parkinson's disease (PD). Paraquat is a common herbicide with chemical structure similar to 1-methyl-4-phenyl 1,2,3,6-tetrahydropyridine, a neurotoxin known to induce parkinsonism. In order to assess the role of in utero paraquat exposure in PD, uptake in maternal and fetal brains were measured using positron emission tomography (PET)/computed tomography (CT) imaging. Two anesthetized pregnant rhesus macaques in the late second trimester of pregnancy were given bolus iv injections of ¹¹C-paraquat, and whole-body PET/CT imaging was performed. Using maternal ventricular blood pool as the input function, the unidirectional influx rate constants (K(i)s), a measure of the irreversible transport of paraquat from plasma to brain, were calculated for the maternal and fetal brains using Patlak graphical analysis. Results indicate minimal uptake of paraquat by both maternal and fetal brains with average K(i)s of 0.0009 and 0.0016 per minute, respectively. The highest regional cerebral uptake in the maternal brain (0.0009% injected dose) was seen in the pineal gland, a structure known to lack a blood brain barrier. The finding of minimal paraquat uptake in maternal and fetal brains is similar to previous findings in adult male macaques and extends the contention that a single acute paraquat exposure, prenatally or postnatally, is unlikely to play a role in PD.

The Sonographic Umbilical Cord Coiling in Late Second Trimester of Gestation and Perinatal Outcomes

This study was conducted to determine whether or not the umbilical cord coiling index (UCI) during the late second trimester of gestation is associated with perinatal outcomes. This was a retrospective study of 251 pregnancies in which a fetal anatomic survey with a recorded UCI was performed at 22-28 weeks gestation. The subjects were divided into normocoiled, hypocoiled, and hypercoiled groups and compared perinatal outcomes. Two hundred twenty-six patients were included. The incidence of preterm deliveries in hypocoiled group was 35%, which was significantly greater than the normocoiled groups (p=0.041). The incidence of neonates with low birth weights in the hypocoiled group was 36.4%, which was significantly greater than the normocoiled groups (p=0.044). In the hypocoiled group, 27.3% of newborns were admitted to the NICU which was significantly greater than the normocoiled and hypercoiled groups (p=0.041). After the adjustment by logistic regression analysis, only preterm delivery were significantly increased in hypocoiled group (OR=9.6, 95% CI=2.09-44.07). The hyporcoiling of the umbilical cord during the late second trimester of pregnancy suggest that the risk for preterm delivery is high, consequently the delivery of low birthweight neonates is high, and the admission to the neonatal intensive care unit is increased.

Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections

To assess whether there is an increased perioperative risk in termination of late second-trimester pregnancy after multiple cesarean sections by laminaria dilatation and evacuation. During the period between January 2002 and June 2008, 636 consecutive patients underwent late second-trimester (17-24 weeks) pregnancy terminations by dilatation and evacuation. Patients were divided into 3 subgroups: those with no previous cesarean section (n = 545), those with 1 previous cesarean section (n = 59), and those with several previous cesarean sections (n = 32). There were no significant differences in major perioperative complications, such as anesthetic complications, need for blood transfusion, and cervical lacerations comparing the 3 subgroups. Importantly, there were neither cases of uterine perforation nor retained products of conception in the 3 subgroups. Late second-trimester pregnancy termination after multiple cesarean sections by laminaria dilatation and evacuation is probably not associated with an increased perioperative risk. Larger studies are needed to empower this study.

Detorsion and conservative therapy for twisted adnexa: Our experience

Objective:1) To determine if detorsion of the twisted adnexa is better than traditional adnexectomy to conserve the adnexa and preserve its function. 2) To determine the feasibility of detorsion in conservation of adnexa.Design:Prospective Study from September 2004 to September 2008.Setting:Private IVF and Endoscopy Centre.Patients:22 patients with twisted adnexa (15 non-pregnant and 7 pregnant).Intervention:Surgical intervention and either detorsion of adnexa or adnexectomy.Main Outcome Measures:Ovarian preservation and conservation of ovarian function in 77.2% cases determined by: a) Follicular development on sonography (performed for one year after adnexectomy). b) Subsequent surgery for unrelated cause showing healthy ovaries. c) controlled ovarian hyperstimulation and successful oocyte retrieval subsequently.Results:We could conserve the adenexa in 77.2% cases. Laparoscopic detorsion was performed in 11/15(73.33 %) of non-pregnant women and adnexectomy done in four women 26.66%. Among the seven pregnant women, adnexa could be preserved in 6/7(85.7%) and only one woman required adnexectomy. Laparotomy was required in 2/22(9%) women both of which were in late second trimester of pregnancy. In one case (4.54%) we had recurrence of torsion. 88.23% of the women with conserved adnexa showed preservation of ovarian function.Conclusion:Our study showed that timely diagnosis and intervention could make the difference between ovarian loss and salvage- an outcome of great importance in population of reproductive age females. Laparoscopy with its many benefits proves to be superior to laparotomy.