Fetal Lung Maturity Research Articles

Evaluation of Fetal Lung Maturity Correlated by Various Ultrasound Parameters as Noninvasive Method

Evaluation of Fetal Lung Maturity Correlated by Various Ultrasound Parameters as Noninvasive Method

921-P: Improved Glycemic Control in Pregnancy Using Continuous Subcutaneous Infusion of Concentrated Insulin

Maternal and fetal complications are high in preexisting uncontrolled type 2 diabetes mellitus (T2DM). There is limited data on the use of concentrated insulin in continuous subcutaneous insulin infusion (CSII) during pregnancy. We report a case of 22-year-old woman G4P0030 with T2DM since 10 years of age who was admitted for preterm premature rupture of membrane at 26 weeks gestation. Preconception HbA1c was 12.1% on metformin, and basal bolus insulin. Severe hyperglycemia following betamethasone administration for fetal lung maturity required insulin drip initially which was transitioned to basal bolus insulin. Despite total daily insulin dose >480 units, glucose control was suboptimal. Decision was made to initiate CSII with basal U-500 concentrated regular insulin and U-100 prandial insulin injections. She was started on Dexcom for CGM and Omnipod Dash with basal rate 1.3 units/hour (6.5 units/hour U-500), insulin sensitivity factor 27 mg/dl (5.4 mg/dl with U-500), carb ratio 1 unit lispro to 2 g. Glycemic control improved as noted in CGM even after adjusting the pregnancy target (70-140mg/dl). Patient delivered a male infant (2090 grams) by emergency C-section at 30 weeks gestation due to preterm labor with fetal malpresentation. She was discharged home with U-100 basal bolus insulin regimen on day 3 postpartum. Concentrated insulin in CSII is effective for uncontrolled T2DM in pregnancy. Disclosure N.Mon: None. S.Krishnasamy: None.

Prenatal dexamethasone exposure impaired vascular reactivity in adult male offspring cerebral arteries

BackgroundCerebrovascular disease is one of the leading causes of death worldwide. Middle cerebral artery (MCA) is the largest and most complex of cerebral arteries. The prenatal period is a critical time for development, which largely determines lifelong health. Clinically, glucocorticoids (GCs) administration to accelerate preterm fetal lung maturation has become standard practice. Prenatal GCs administration increases cardiovascular risks in offspring, but little is known regarding the side effects on offspring MCA function. ObjectiveWe investigated the alterations of MCA reactivity following prenatal GCs administration in postnatal offspring. Method and resultsPregnant Sprague-Dawley rats received synthetic GCs (dexamethasone, DEX) during the last week of pregnancy, and we examined vascular reactivity, cellular electrophysiology, and gene promoter epigenetic modifications in the male offspring MCA. Our results showed that prenatal DEX exposure increased the sensitivity of offspring MCA to Angiotensin II, which was resulted from the increased Cav1.2 (L-type Ca2+ channels subunit alpha1 C). Mechanistically, prenatal DEX exposure resulted in a transcriptionally active chromatin structure at the Cav1.2 gene promoter by altering histone modifications. This activation led to increased expression of vascular Cav1.2 gene, ultimately resulting in increased MCA contractility in offspring. ConclusionThe present study is the first to demonstrate that the adverse effects of prenatal GCs administration on cerebrovascular tone persist into adulthood, providing new insights into developmental origins of cerebrovascular disease.

Modified Foam Stability Test (Fs-50) as Predictor of Fetal Lung Maturity in Preterm Premature Rupture of Membrane Patients Given Dexamethasone Therapy

This study aims to determine the ability of the Modified Foam Stability (FS-50) test to predict fetal lung maturity in preterm premature rupture of membranes treated with Dexamethasone. The study sample included pregnant women with PROM at a gestational age of 24 to less than 34 weeks in the ER and Obstetrics Ward of Sanglah Central General Hospital, Denpasar. The patient underwent a vaginal speculum examination to collect fluid pooled in the vagina or from the outer cervical opening. Fluids are checked with the Modified Foam Stability (FS-50) test and graded from 0 to +4 to estimate fetal lung maturity. The first test was performed before Dexamethasone, followed by serial examinations at 12-hour intervals for 48 hours. Before dexamethasone injection, all patients got 0 scores as a baseline. There were statistically significant differences in FS-50 values before and after injection of the first, second, third, and fourth doses of Dexamethasone in PPROM patients. Fetal lung maturity was reached after the third dose of dexamethasone injection (36 hours after the first injection), characterized by an FS-50 value of > +3 and no asphyxia in the newborn. Spearman's rank analysis showed a significant correlation (p=0.005) between infants' maximum FS-50 value and asphyxia status. The FS-50 value > +3 is associated with the absence of asphyxia in infants born to PPROM patients who were given Dexamethasone for lung maturation. FS-50 can predict fetal lung maturity in preterm premature rupture of membranes given dexamethasone therapy.

Molecular mechanisms underlying adverse effects of dexamethasone and betamethasone in the developing cardiovascular system.

Antenatal glucocorticoids accelerate fetal lung maturation and reduce mortality in preterm babies but can trigger adverse effects on the cardiovascular system. The mechanisms underlying off-target effects of the synthetic glucocorticoids mostly used, Dexamethasone (Dex) and Betamethasone (Beta), are unknown. We investigated effects of Dex and Beta on cardiovascular structure and function, and underlying molecular mechanism using the chicken embryo, an established model system to isolate effects of therapy on the developing heart and vasculature, independent of effects on the mother or placenta. Fertilized eggs were treated with Dex (0.1 mg kg-1 ), Beta (0.1 mg kg-1 ), or water vehicle (Control) on embryonic day 14 (E14, term = 21 days). At E19, biometry, cardiovascular function, stereological, and molecular analyses were determined. Both glucocorticoids promoted growth restriction, with Beta being more severe. Beta compared with Dex induced greater cardiac diastolic dysfunction and also impaired systolic function. While Dex triggered cardiomyocyte hypertrophy, Beta promoted a decrease in cardiomyocyte number. Molecular changes of Dex on the developing heart included oxidative stress, activation of p38, and cleaved caspase 3. In contrast, impaired GR downregulation, activation of p53, p16, and MKK3 coupled with CDK2 transcriptional repression linked the effects of Beta on cardiomyocyte senescence. Beta but not Dex impaired NO-dependent relaxation of peripheral resistance arteries. Beta diminished contractile responses to potassium and phenylephrine, but Dex enhanced peripheral constrictor reactivity to endothelin-1. We conclude that Dex and Beta have direct differential detrimental effects on the developing cardiovascular system.

Evaluation of thalamus echogenicity via ultrasonography as a marker of fetal lung maturity

Background: Fetal lung immaturity is a major problem in the management of elective birth with respect to predicting the development of infant respiratory distress syndrome (IRDS) in the neonate after birth.Aim and Objectives: The aim of this study was to evaluate the validity of measuring fetal thalamic echogenicity by ultrasound as a marker of fetal lung maturity.Subjects and Methods: This was a prospective observational study that was being carried out on 80 pregnant patients. They were recruited from Obstetrics and Gynaecology clinics at Tanta University Hospitals during the period of research from March 2021 till the end of the study.Results: There was statistically significant difference between RDS group and those without RDS regarding thalamic echogenicity, 1 and 5- min APGAR score, NICU admission and neonatal mortality.Conclusion: Evaluation of echogenic thalamus by ultrasound at the level of the BPD is of value, and can be considered as a new marker of fetal lung maturity; however, further studies are required to strengthen such idea.

Evaluation of thalamus echogenicity via ultrasonography as a marker of fetal lung maturity

Background: Fetal lung immaturity is a major problem in the management of elective birth with respect to predicting the development of infant respiratory distress syndrome (IRDS) in the neonate after birth.Aim and Objectives: The aim of this study was to evaluate the validity of measuring fetal thalamic echogenicity by ultrasound as a marker of fetal lung maturity.Subjects and Methods: This was a prospective observational study that was being carried out on 80 pregnant patients. They were recruited from Obstetrics and Gynaecology clinics at Tanta University Hospitals during the period of research from March 2021 till the end of the study.Results: There was statistically significant difference between RDS group and those without RDS regarding thalamic echogenicity, 1 and 5- min APGAR score, NICU admission and neonatal mortality.Conclusion: Evaluation of echogenic thalamus by ultrasound at the level of the BPD is of value, and can be considered as a new marker of fetal lung maturity; however, further studies are required to strengthen such idea.

Ultrasonic evaluation of fetal lung development using deep learning with graph

BackgroundThe neonatal respiratory morbidity that was primarily caused by the immaturity of the fetal lung is an important clinical issue in close relation to the morbidity and mortality of the fetus. In clinics, the amniocentesis has been used to evaluate the fetal lung maturity, which is time-consuming, costly and invasive. As a non-invasive means, ultrasonography has been explored to quantitatively examine the fetal lung in the past decades. However, existing studies required the contour of the fetal lung which was delineated manually. This may lead to significant inter- and intra-observer variations. MethodsWe proposed a deep learning model for automated fetal lung segmentation and measurement, which was constructed combined U-Net with Graph model and pre-trained Vgg-16 network. The graph connection would extract stable feature for final segmentation and pre-trained method could speed up convergence.The model was trained with 3500 datasets augmented from 250 ultrasound images with both the fetal lung and heart delineated manually, and tested on 50 ultrasound images. In addition, the correlation between the size of fetal lung/heart as delineated by the model with gestational age was analyzed. ResultsThe fetal lung and cardiac area were segmented automatically with the accuracy, average Intersection over Union(IoU), sensitivity and precision being 0.991, 0.818, 0.909 and 0.888, respectively. In addition, the size of fetal lung/heart was well correlated with the gestational age, demonstrating good potentials for assessing the fetal development. ConclusionsThis study proposed a new robust method for automatic fetal lung segmentation in ultrasound images using Vgg16-GCN-UNet. Our proposed method could be utilized potentially not only to improve existing research in quantitative analyzing the fetal lung using ultrasound imaging technology, but also to alleviate the labor of the clinicians in routine measurement of the fetal lung/cardiac.

Management of preterm birth using protocols in a low resource setting.

Preterm birth is the leading cause of neonatal deaths and the second leading cause of death in children under five after pneumonia. The study aimed at improving the management of preterm birth through the development of protocols for standardization of care. The study was conducted in Mulago National Referral Labor ward in two phases. A total of 360 case files were reviewed and mothers whose files had missing data interviewed for clarity for both the baseline audit and the re-audit. Chi squares were used to compare results for the baseline and the re-audit. There was significant improvement in four parameters out of the six that were used to assess quality of care and these were 32% increase in administration of Dexamethasone for fetal lung maturity, 27% increase in administration of Magnesium Sulphate for fetal neuroprotection and 23% increase in anti-biotic administration. A 14% reduction noted in patients who received no intervention. However, there was no change in the administration of Tocolytic. The results of this study have shown that protocols standardize care and improve the quality of care in preterm delivery to optimize outcomes.

Sonographic prediction of fetal main pulmonary artery (MPA) Doppler indices of lung maturity and neonatal respiratory distress syndrome (RDS) development

PurposeThe aim of this study is to highlight the predictive role of perinatal fetal main pulmonary artery (MPA) Doppler measurements in neonatal respiratory distress syndrome development. Respiratory distress syndrome (RDS) is one of the lead causes of neonatal respiratory distress as well as neonatal death. Thus, it seems logic to evaluate fetal lung maturity before labour.MethodsThe study is a prospective cohort study performed in tertiary hospital over a period of one-year duration. 70 pregnant ladies between 34 and 38 weeks of gestation were referred for fetal echo, when pregnancy was considered a high risk. A trained radiologist using dedicated ultrasound machine with updated obstetric and fetal echo software performed the fetal echo. Doppler mode and curvilinear probe of 5.7 MHz transducer. Pediatric neonatologist observed the neonatal outcome post-natally.ResultsA total of 70 pregnant patients with risk factors underwent fetal echo, 26/70 (37.1%) were diagnosed with RDS conforming to the neonatal criteria. The mean acceleration time/ejection time ratio (At/Et ratio) of the fetal pulmonary artery was significantly reduced in fetuses that subsequently developed RDS than those without RDS. Contrarily, the mean pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) of the fetal pulmonary artery were significantly high in fetuses who later developed RDS than in those who did not.ConclusionFetal MPA Doppler measurements have a major role in anticipating the development of neonatal RDS in preterm and early term neonates.

LPCAT1 levels in the placenta, the maternal plasma and the fetal plasma do not predict fetal lung responses to glucocorticoids in a sheep model of pregnancy

IntroductionLysophosphatidylcholine acyltransferase 1 (LPCAT1) is important for saturated phosphatidylcholine (Sat-PC) production in the lung. Sat-PC is a critical component of pulmonary surfactant, which maintains low alveolar surface tension, facilitating respiration. Previous studies have reported an association between maternal and fetal LPCAT1 levels and neonatal lung function. Using a sheep model of pregnancy, we investigated a potential correlation between glucocorticoid-induced lung maturation and LPCAT1 mRNA and/or protein levels in the fetal lung, the placenta, the fetal plasma, and the maternal plasma. MethodsEighty seven single pregnant ewes received maternal intramuscular injections of betamethasone. A sub-group of five animals had both maternal and fetal catheters installed to allow for sequential sampling from both plasma compartments. Lambs were surgically delivered under terminal anaesthesia between 2 and 8 days after initial ANS treatment, at a gestational age of 121–123 days. Lambs were ventilated for 30 min to determine functional lung maturation before being euthanized for necropsy and sample collection. Fetal lung, placenta, and fetal and maternal plasma samples were used to analyse LPCAT1 gene expression and protein levels. ResultsThe expression of LPCAT1 mRNA in the fetal lung was significantly corelated to Sat-PC levels at 8 days (R2 = 0.23, p < 0.001) and lung maturation status overall (gas exchange efficiency as determined by measurements of lamb PaCO2 during ventilation, R2 = 0.20, p < 0.001). Similarly, fetal lung LPCAT1 mRNA was also significantly correlated with the individual durability of ANS effects on fetal lung maturation (R2 = 0.20, p < 0.001). Although ANS therapy altered LPCAT1 mRNA expression in the placenta, observed changes were independent of fetal lung maturation outcomes. Neither maternal nor fetal plasma LPCAT1 levels were changed by ANS therapy over the period, including in analysis of serial maternal and fetal samples from chronically catheterised animals. DiscussionLPCAT1 expression in the fetal lung was associated with the durability of glucocorticoid effects on fetal lung maturation. However, LPCAT1 expression in the placenta, the fetal plasma, and the maternal plasma was neither associated with, nor predictive of fetal lung maturation after glucocorticoid treatment in a sheep model of pregnancy.

Spontaneous uterine venous plexus complicated with ovarian rupture in the third trimester of pregnancy: a case report

BackgroundSpontaneous uterine venous rupture combined with ovarian rupture in late pregnancy is extremely rare. It often has an insidious onset and atypical symptoms, develops rapidly, and is easily misdiagnosed. Wewould like to discuss and share this case of spontaneous uterine venous plexus combined with ovarian rupture in the third trimester of pregnancy with colleagues.Case presentationA pregnant woman, G1P0 at 33+4 weeks of gestation,was admitted to the hospital due to threatened preterm labour on March 3, 2022. After admission, she was treated with tocolytic inhibitors and foetal lung maturation agents. The patient's symptoms did not improve during the treatment. After many examinations, tests, discussions, a diagnosis, and a caesarean section, the patient was finally diagnosed with atypical pregnancy complicated by spontaneous uterine venous plexus and ovarian rupture.ConclusionsSpontaneous rupture of the uterine venous plexus combined with ovarian rupture in late pregnancy is an occult and easily misdiagnosed condition, and the consequences are serious. Clinical attention should be given to the disease and prevention attempted to avoid adverse pregnancy outcomes.

Gestational diabetes mellitus: The optimal time of delivery.

Gestational diabetes mellitus (GDM) is a common pregnancy complication strongly associated with poor maternal-fetal outcomes. Its incidence and prevalence have been increasing in recent years. Women with GDM typically give birth through either vaginal delivery or cesarean section, and the maternal-fetal outcomes are related to several factors such as cervical level, fetal lung maturity, the level of glycemic control still present, and the mode of treatment for the condition. We categorized women with GDM based on the latter two factors. GDM that is managed without medication when it is responsive to nutrition- and exercise-based therapy is considered diet- and exercise-controlled GDM, or class A1 GDM, and GDM managed with medication to achieve adequate glycemic control is considered class A2 GDM. The remaining cases in which neither medical nor nutritional treatment can control glucose levels or patients who do not control their blood sugar are categorized as class A3 GDM. We investigated the optimal time of delivery for women with GDM according to the classification of the condition. This review aimed to address the benefits and harms of giving birth at different weeks of gestation for women with different classes of GDM and attempted to provide an analytical framework and clearer advice on the optimal time for labor.

Correlation between lung maturity and backscatter coefficient calculations in fetal lung. Simulations

Fetal lung maturity is a public health problem, and developing quantitative ultrasonic (QUS) techniques has become a possible way of assessing lung development. To estimate the feasibility of using quantitative medical ultrasound, we performed numerical simulations of radio frequency signals scattered from lung tissue. Given the distribution of sizes of alveoli, and wall lining thicknesses corresponding to different stages of lung maturity, we calculate the effective speed of sound using an effective medium approximation. The attenuation and backscattering coefficient is calculated from many-body scattering techniques. Also, for the attenuation and the backscattering coefficient, different statistical configurations are considered to determine the correlation between size of alveoli and acoustic properties. The results using QUS are compared to light scattering techniques (1). Our simulations are compared with ultrasonic measurements made with sponges with different pore sizes following the work of . Once the measurements are analyzed, the sponges are cut and analyzed under a dark-filed microscope to obtain the average size of pores. As a proof of concept, we show that quantitative medical ultrasound can provide information on fetal lung maturity accurately. (1) M. S. Durkee, G. K. Fletcher, C. Carlson, K. Matheson, S. K. Swift, et al. Opt. Lett. Vol. 43, No. 20, 5001 (2018).

Evaluation of fetal lung maturity by ultrasound

Background: Monitoring lung development is important for both birth preparation and counselling parents. Clinical procedures such as menstrual history, LMP, pelvic abdomen inspection, and date of quickening can be used to estimate when a foetus' lungs are fully developed. Extra diagnostic procedures include amniocentesis, x-rays, and ultrasounds.Objective: to assess the non-invasive parameters to determine the fetal lung maturity by ultrasound.Patients and Methods: it was is a cross-sectional study was conducted on Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta University Hospitals on 75 pregnant cases. Study duration was from August 2020 till 30th May 2022.Results: Correlation foetal biometry and Shake scores significantly differed among groups. Test, Relation between Placental grading and postnatal lung maturity, Relation between Shake test and postnatal lung maturity and the Diagnostic profile. Conclusion: Based on the previous findings, ultrasound might be a useful method of evaluation of fetal lung maturity. Either of placental grading, free floating particles and shake test are good predictive tools for detecting lung maturity, with the superior hand for the floating particles.

Effect of Placental Histological Chorioamnionitis and Prenatal Steroids on the Nervous System of Preterm Infants

Background: The placenta, as a link between mother and fetus, is closely related to the development of the fetal nervous system. Histological chorioamnionitis (HCA) is common placental inflammation and an important factor in triggering premature delivery. Anabolic steroid (AS) is an important medication to promote fetal lung maturity. Therefore, this study investigated the relationship between HCA, AS, and brain injury in premature infants. Objectives: This research aimed to explore the correlation of pathological changes in the placental HCA and the prenatal use of AS with brain injury in preterm infants. Methods: In total, 339 premature infants with a gestational age of under 34 weeks were taken as research subjects, and the placenta was examined by pathology after delivery. The samples were divided into HCA+ AS+, HCA+ AS-, HCA- AS+, and HCA- AS- groups based on the pathological results of the placenta and the prenatal use of steroid hormones. The occurrence of brain injury in preterm infants and the level of inflammatory indicators 2 h after birth were compared between the groups. Results: The incidence of brain injury in preterm infants in the HCA+ group was higher than in the HCA- group (χ2 = 5.713, P &lt; 0.05), and the AS- group than in the AS+ group (χ2 = 4.368, P &lt; 0.05); The incidence of brain injury in the HCA+ AS+, HCA+ AS- and HCA- AS-groups was significantly higher than in the HCA- AS+ group (χ2 = 6.105, P = 0.013; χ2 = 9.086, P = 0.003; χ2 = 4.848, P = 0.047, respectively). The incidence of brain injury in preterm infants was the highest in the group (30%). When the procalcitonin level 2 h after birth was 0.213 ng/mL, sensitivity to predict the occurrence of brain injury in preterm infants was 70.7%, and specificity was 80.2%. Conclusions: Brain damage in premature infants is related to HCA in the mother and insufficient AS treatment before delivery. Brain damage is more likely to occur when both factors exist.

Effect of Placental Histological Chorioamnionitis and Prenatal Steroids on the Nervous System of Preterm Infants

Background: The placenta, as a link between mother and fetus, is closely related to the development of the fetal nervous system. Histological chorioamnionitis (HCA) is common placental inflammation and an important factor in triggering premature delivery. Anabolic steroid (AS) is an important medication to promote fetal lung maturity. Therefore, this study investigated the relationship between HCA, AS, and brain injury in premature infants. Objectives: This research aimed to explore the correlation of pathological changes in the placental HCA and the prenatal use of AS with brain injury in preterm infants. Methods: In total, 339 premature infants with a gestational age of under 34 weeks were taken as research subjects, and the placenta was examined by pathology after delivery. The samples were divided into HCA+ AS+, HCA+ AS-, HCA- AS+, and HCA- AS- groups based on the pathological results of the placenta and the prenatal use of steroid hormones. The occurrence of brain injury in preterm infants and the level of inflammatory indicators 2 h after birth were compared between the groups. Results: The incidence of brain injury in preterm infants in the HCA+ group was higher than in the HCA- group (χ2 = 5.713, P &lt; 0.05), and the AS- group than in the AS+ group (χ2 = 4.368, P &lt; 0.05); The incidence of brain injury in the HCA+ AS+, HCA+ AS- and HCA- AS-groups was significantly higher than in the HCA- AS+ group (χ2 = 6.105, P = 0.013; χ2 = 9.086, P = 0.003; χ2 = 4.848, P = 0.047, respectively). The incidence of brain injury in preterm infants was the highest in the group (30%). When the procalcitonin level 2 h after birth was 0.213 ng/mL, sensitivity to predict the occurrence of brain injury in preterm infants was 70.7%, and specificity was 80.2%. Conclusions: Brain damage in premature infants is related to HCA in the mother and insufficient AS treatment before delivery. Brain damage is more likely to occur when both factors exist.

On optimal timing of antenatal corticosteroids: time to reformulate the question.

Administration of antenatal corticosteroids (ACS) for accelerating foetal lung maturation in threatened preterm birth is one of the cornerstones of prevention of neonatal mortality and morbidity. To identify the optimal timing of ACS administration, most studies have compared subgroups based on treatment-to-delivery intervals. Such subgroup analysis of the first placebo-controlled randomised controlled trial indicated that a one to seven day interval between ACS administration and birth resulted in the lowest rates of neonatal respiratory distress syndrome. This efficacy window was largely confirmed by a series of subgroup analyses of subsequent trials and observational studies and strongly influenced obstetric management. However, these subgroup analyses suffer from a methodological flaw that often seems to be overlooked and potentially has important consequences for drawing valid conclusions. In this commentary, we point out that studies comparing treatment outcomes between subgroups that are retrospectively identified at birth (i.e. after randomisation) may not only be plagued by post-randomisation confounding bias but, more importantly, may not adequately inform decision making before birth, when the projected duration of the interval is still unknown. We suggest two more formal interpretations of these subgroup analyses, using a counterfactual framework for causal inference, and demonstrate that each of these interpretations can be linked to a different hypothetical trial. However, given the infeasibility of these trials, we argue that none of these rescue interpretations are helpful for clinical decision making. As a result, guidelines based on these subgroup analyses may have led to suboptimal clinical practice. As an alternative to these flawed subgroup analyses, we suggest a more principled approach that clearly formulates the question about optimal timing of ACS treatment in terms of the protocol of a future randomised study. Even if this 'target trial' would never be conducted, its protocol may still provide important guidance to avoid repeating common design flaws when conducting observational 'real world' studies using statistical methods for causal inference.

Fetal lung maturity assessment with lamellar body count in women with obesity and excessive gestational weight gain

The aim of this study was to evaluate fetal lung maturation in term pregnant women with obesity and excessive gestational weight gain using the lamellar body count (LBC) test in amniotic fluid samples obtained during cesarean section. This retrospective study included women experiencing term pregnancies and undergoing cesarean delivery, categorized as normal weight (n=37), overweight (n=59), or obese (n=48) due to body mass index values of 18.5 to 24.9; 25 to 29.9; and ≥30, respectively, as well as presence of excessive weight gain during pregnancy. During cesarean delivery, amniotic fluid samples were obtained without contamination of blood or meconium. Lamellar bodies in these samples were quantified using a standard hematologic counter. No significant difference was found among the LBC of the normal weight, overweight, and obese groups [42 (32-60), 40 (26-63), and 43 (24-52) x103/µL; p=0.307], although there was a subtle decrease in the LBC of the obese group with excessive weight gain. Although it is noteworthy that the LBC in the amniotic fluid of mothers with obesity and excessive weight gain during pregnancy showed a partial decrease, this decrease did not reach statistical significance, likely due to the relatively low number of cases in the study groups. Additional research is warranted to elucidate the relationship between LBC alterations and the severity of obesity and weight gain during pregnancy.

Combined Fetal Pulmonary Artery Doppler and Proximal Humeral Ossification center for prediction of Neonatal Respiratory Distress Syndrome at term: a Cohort Prospective Study

Background: Fetal lung maturity is one of the huge dilemmas since a long time ago. Timing of the delivery is crucial for safe fetal delivery since verification of pulmonary maturity diminishes the respiratory morbidity possibility. Recently Pulmonary artery indices have been used to predict the possibility of RDS especially in early term. Together with humeral ossification center which has a remarkable value in estimation of term gestation, both of them can help prediction of fetal lung maturity. Aim of the Work: utilizing PHE with pulmonary artery Doppler indices for accurate prediction of fetal respiratory distress syndrome. The use of PHE in prediction of term gestation. Patients and Methods: Our study included 115 uncomplicated singleton pregnant women with gestational age between 37 to 40 weeks patients from Al-Azhar University Ob/Gyn hospitals during the period from November 2019 to October 2020. The ultrasound scans were done inside a 24 hours interval before delivery with Cesarean section. After delivery, the neonatal APGAR score at 1, 5 minutes, fetal diagnosis with RDS, any NICU admission were recorded respectively. Results: Pulmonary artery RI and PHE had statistically significant diagnostic performance in predicting fetal distress. PHE of ≤1.95 had highest diagnostic characteristics in predicting fetal distress. Among Pulmonary Artery Doppler, RI of ≥0.79 had highest diagnostic characteristics. Conclusion: PHE and Pulmonary artery R.I could predict fetal distress. Pulmonary artery indices and PHE combination (sum) predicted fetal distress better than using pulmonary indices alone. Presence of PHE confirms term gestation.