Major Anomalies Research Articles

Paracetamol preceding very preterm birth: Is it safe?

The use of paracetamol for pain relief in pregnancy is common. However, the influence of paracetamol on the perinatal adaptation of high-risk infants has not been studied. These data are important for safety, since another inhibitor of prostaglandin synthesis is harmful to infants born very preterm and increases serious morbidity. We studied whether the use of paracetamol had an adverse influence on neonatal adaptation and the outcomes of infants during the first hospitalization. We studied the patient records of high-risk mothers and their infants born before 32 weeks of gestation for multiple variables over a period of 84 months in Oulu University Hospital, a regional tertiary care hospital caring for high-risk deliveries and providing neonatal intensive care. In a matched cohort setting, the exposition was defined as paracetamol use <24 h before childbirth. The controls had consumed no paracetamol up to 1 week before delivery. Infants with major anomalies were excluded. The primary outcome was defined as the need for early interventional treatments for the preterm infants. Outcomes during the first hospitalization were also studied. Altogether, 170 fetuses from 149 mothers were exposed to paracetamol during the study period. The control population, delivering during the same period, consisted of 118 non-exposed fetuses from 104 mothers. Among them, the mothers were pairwise matched according to their medications, amniotic fluid leakage time, clinical infections, and delivery mode. After matching, 72 mothers/group remained, resulting in 88 paracetamol-exposed infants and 85 controls. No perinatal adverse reactions were detected. There were no differences in either circulatory support during the first postnatal day or in the risk for major diseases during the first hospitalization. Paracetamol-exposed infants needed fewer acute delivery room therapies (51.1% vs 65.9%, mean difference -14.89; 95% confidence interval -0.29 to -0.003). Maternal total paracetamol dose in the 1 week before delivery correlated positively with Apgar scores. Antenatal paracetamol given within 24 h before birth had no adverse effects on extremely or very preterm infants. The long-term safety of paracetamol and the potential acute benefits for preterm infants during perinatal transition remain to be proven in larger, prospective settings.

Minigene Splicing Assays Identify 20 Spliceogenic Variants of the Breast/Ovarian Cancer Susceptibility Gene RAD51C.

Simple SummaryLoss-of-function variants of the RAD51C gene are known to confer a risk of breast and ovarian cancers. In this study, we analyzed the impact of RAD51C variants on splicing, a highly regulated gene expression step by which introns are removed and exons are sequentially joined. Exon recognition is guided by specific sequences, the 3′ and 5′ splice sites, which define the exon boundaries. Variants of these sequences of susceptibility genes may lead to aberrant splicing and abnormal transcripts that may trigger a disease. Splicing can be tested using a biotechnological tool called minigenes, which mimic the human gene of interest. Thus, we checked 20 RAD51C splice-site variants using the minigene mgR51C_ex2-8. We found that they all disrupted the splicing mechanism, and 16 variants could be classified as likely pathogenic. Our findings are clinically actionable, and variant carriers may benefit from tailored prevention protocols and therapies.RAD51C loss-of-function variants are associated with an increased risk of breast and ovarian cancers. Likewise, splicing disruptions are a frequent mechanism of gene inactivation. Taking advantage of a previous splicing-reporter minigene with exons 2-8 (mgR51C_ex2-8), we proceeded to check its impact on the splicing of candidate ClinVar variants. A total of 141 RAD51C variants at the intron/exon boundaries were analyzed with MaxEntScan. Twenty variants were selected and genetically engineered into the wild-type minigene. All the variants disrupted splicing, and 18 induced major splicing anomalies without any trace or minimal amounts (<2.4%) of the minigene full-length (FL) transcript. Twenty-seven transcripts (including the wild-type and r.904A FL transcripts) were identified by fluorescent fragment electrophoresis; of these, 14 were predicted to truncate the RAD51C protein, 3 kept the reading frame, and 8 minor isoforms (1.1–4.7% of the overall expression) could not be characterized. Finally, we performed a tentative interpretation of the variants according to an ACMG/AMP (American College of Medical Genetics and Genomics/Association for Molecular Pathology)-based classification scheme, classifying 16 variants as likely pathogenic. Minigene assays have been proven as valuable tools for the initial characterization of potential spliceogenic variants. Hence, minigene mgR51C_ex2-8 provided useful splicing data for 40 RAD51C variants.

Factors influencing parental decisions to terminate pregnancies following prenatal diagnoses of major fetal anomalies at Ramathibodi Hospital, Bangkok, Thailand

BackgroundThe rate of termination of pregnancy (TOP) for fetal anomalies and the factors affecting TOP vary among different populations. Optimisation of prenatal care and counselling requires understanding the factors influencing parental decisions in the relevant population. This study aimed to evaluate the rate of TOP after diagnoses of major fetal anomalies and assess factors associated with TOP-related decisions at a university hospital in Thailand.MethodsA retrospective chart review was conducted at the Fetal Anomaly Clinic of Ramathibodi Hospital, Bangkok, Thailand. Medical records of all women with singleton pregnancies prenatally diagnosed with major fetal anomalies before 24 gestational weeks between 2010 and 2020 were reviewed.ResultsDuring the study period, 461 cases of major fetal anomalies were diagnosed, and 264 (57.3%) of these pregnancies were terminated. Three factors influencing parental TOP decisions were lethal anomalies (odds ratio [OR], 197.39; 95% confidence interval [CI], 49.95–779.95; p < 0.001), presence of genetic abnormalities (OR, 10.19; 95% CI, 4.17–24.87; p < 0.001) and gestational age at diagnosis (OR, 0.74; 95% CI, 0.65–0.84; p < 0.001).ConclusionsOver half of the pregnant women whose records were reviewed and who were prenatally diagnosed with major fetal anomalies terminated their pregnancies. Fetal factors, particularly lethality, genetic abnormalities and early gestational age at diagnosis, showed the most powerful associations with parental TOP decisions. Other maternal background factors were not key considerations.

Role of CT in the Pre- and Postoperative Assessment of Conotruncal Anomalies.

Conotruncal anomalies, also referred to as outflow tract anomalies, are congenital heart defects that result from abnormal septation of the great vessels' outflow tracts. The major conotruncal anomalies include tetralogy of Fallot, double-outlet right ventricle, transposition of the great arteries, truncus arteriosus, and interrupted aortic arch. Other defects, which are often components of the major anomalies, include pulmonary atresia with ventricular septal defect, pulmonary valve agenesis, aortopulmonary window, and double-outlet left ventricle. CT has emerged as a robust diagnostic tool in preoperative and postoperative assessment of various congenital heart diseases, including conotruncal anomalies. The data provided with multidetector CT imaging are useful for treatment planning and follow-up monitoring after surgery or intervention. Unlike echocardiography and MRI, CT is not limited by a small acoustic window, metallic devices, and need for sedation or anesthesia. Major advances in CT equipment, including dual-source scanners, wide-detector scanners, high-efficiency detectors, higher x-ray tube power, automatic tube current modulation, and advanced three-dimensional postprocessing, provide a low-risk, high-quality alternative to diagnostic cardiac catheterization and MRI. This review explores the various conotruncal anomalies and elucidates the role of CT imaging in their pre- and postoperative assessment. Keywords: CT, CT Angiography, Stents, Pediatrics © RSNA, 2022.

Diagnostic yield of exome sequencing in fetuses with multisystem malformations: systematic review and meta-analysis.

To determine the diagnostic yield of exome sequencing (ES) above that of chromosomal microarray analysis (CMA) or karyotyping in fetuses with multisystem structural anomalies (at least two major anomalies in different anatomical systems). This was a systematic review conducted in accordance with PRISMA guidelines. Searching PubMed, Web of Knowledge and Cochrane database, we identified studies describing ES, whole-genome and/or next-generation sequencing in fetuses with multisystem malformations. Included were observational studies involving five or more eligible fetuses. A fetus was eligible for inclusion if it had at least two major anomalies of different anatomical systems and a negative CMA or karyotyping result. Only positive variants classified as likely pathogenic or pathogenic determined to be causative of the fetal phenotype were considered. A negative CMA or karyotype result was treated as the reference standard. The diagnostic yield of the primary outcome was calculated by single-proportion analysis using random-effects modeling. A subgroup analysis was performed to compare the diagnostic yield of the solo approach (fetus alone sequenced) with that of the trio approach (fetus and both parents sequenced). Seventeen articles with data on ES diagnostic yield, including 694 individuals with multisystem malformations, were identified. Overall, a pathogenic or likely pathogenic variant potentially causative of the fetal phenotype was found in 213 fetuses, giving a 33% (95% CI, 27-40%) incremental yield of ES. A stratified analysis showed similar diagnostic yields of ES using the solo approach (30%; 95% CI, 11-52%) and the trio approach (35%; 95% CI, 26-44%). ES applied in fetuses with multisystem structural anomalies was able to identify a potentially causative gene when CMA or karyotyping had failed to do so in an additional one-third of cases. No differences were observed between the solo and trio approaches for ES. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

LE SYNDROME DE LIMB BODY WALL COMPLEX A PROPOS DUN CAS ET REVUE DE LA LITTERATURE

Limb body wallcomplex (LBWC) is a rare poly malformative syndrome of unknownorigin, comprising major anomalies of the ventral body wall (thoracoabdominal) associatedwithother anomalies, includingthose of the limbsthatmay range frompositionaldeformity to agenesis, unusualcraniofacial malformations, and a variety of visceral anomalies thatinclude the heart, lungs, and genitourinary system. Twophenotypes are describeddepending on the feto-placentalattachment. We report a case of LBWC diagnosed post partum in a stillbornwith the following malformations: a large anterioromphalocele, spina bifida withmeningocele, and severescoliosis. The lowerlimbsappearedasymmetricalwithbilateral club feetassociatedwithpolydactyly. The stillbirthadheres to the placenta by a very short cord of 3 cm comprising 2 arteries and a vein.

Umbilical Artery Cord Gas Abnormalities in the Presence of a Nuchal Cord in Term Singleton Pregnancies: A Cohort Study.

The clinical significance of nuchal cord (NC) at the time of delivery is unclear. Studies have found that NC is associated with lower umbilical artery (UA) pH. Since fetal hypercarbia precedes respiratory acidosis, we hypothesize UA pCO2 is elevated in neonates with NC at the time of delivery. This is a secondary analysis of a prospective cohort study of women with full-term singleton pregnancies admitted in labor or for induction of labor at an institution with a universal umbilical cord gas policy. We compared patients with NC at the time of delivery to those without NC. Women were excluded if they did not have validated UA gases, had a major fetal anomaly, or had an intrauterine fetal demise. The primary outcome of the study was UA pCO2. Secondary outcomes were other components of UA gas and neonatal morbidity composite. Baseline characteristics were compared utilizing chi-square or Fisher's exact test or the Student's t-test. UA gas parameters were compared using the Kruskal-Wallis test. Multivariable logistic regression was utilized to adjust for confounders. Of the 8,580 study participants, 7,608 had validated umbilical cord gases. The incidence of NC in the population was 24.15% (n = 1,837). UA pCO2 was higher in those with NC than without (58 mm Hg [53-64] vs. 55 mm Hg [50-60], p < 0.01). There was a greater odds of hypercarbia in the NC group (pCO2 > 65 mmHg; adjusted odds ratio [aOR]: 1.97, 95% confidence interval [CI]: 1.72-2.25, p < 0.01). Additionally, the NC group was more likely to be mildly acidemic (pH < 7.2, aOR: 1.74, 95% CI: 1.51-2.01, p < 0.01). There was no difference in composite neonatal morbidity between the groups. NC is associated with an increased risk of hypercarbia and acidemia. However, this is not associated with increased risk of neonatal morbidity. · Nuchal cord is associated with an increased risk of hypercarbia and mild acidemia.. · Nuchal cord is not likely associated with neonatal morbidity.. · Neonatal management should not be altered due to the presence of a nuchal cord at delivery..

Different DNA Sequencing Using DNA Graphs: A Study

Natural genetic material may shed light on gene expression mechanisms and aid in the detection of genetic disorders. Single Nucleotide Polymorphism (SNP), small insertions and deletions (indels), and major chromosomal anomalies are all chromosomal abnormality-related disorders. As a result, several methods have been applied to analyze DNA sequences, which constitutes one of the most critical aspects of biological research. Thus, numerous mathematical and algorithmic contributions have been made to DNA analysis and computing. Cost minimization, deployment, and sensitivity analysis to many factors are all components of sequencing platforms built on a quantitative framework and their operating mechanisms. This study aims to investigate the role of DNA sequencing and its representation in the form of graphs in the analysis of different diseases by means of DNA sequencing.

The countercyclical long-term operating accrual-based trading strategy in the Stoxx Europe 600 index: The importance of asset and liability components.

This work uses long-term operating accruals, rather than current, as an accounting measure to identify major anomalies. Past and abundant accounting and financial literature associates anomalies with problems of reliability and assigns lower reliability to long-term operating accruals than to current accruals. We investigate the relation between scaled operating accruals and size-adjusted abnormal returns for nonfinancial firms listed in the Stoxx Europe 600 index for the period 2000–2021. We find consistent evidence of (1) a higher long-term operating accrual anomaly than working capital accrual, especially, when asset and liability components are separated (2) long-short trading strategies aimed at taking advantage of the anomaly that achieves significant annual returns between 2% and 6% and (3) this trading strategy strongly reduces the risk of stock portfolios during an economic crisis due to its countercyclical nature. These findings have important implications not only for academics, but also for asset managers who want to protect the return of their stock portfolios from high market volatility.

Association of neutrophil to lymphocyte ratio with preterm necrotizing enterocolitis: a retrospective case-control study

BackgroundThere have been few studies on the relationship between the neutrophil to lymphocyte ratio (NLR) and necrotizing enterocolitis (NEC). We conducted a retrospective case-control study to investigate this relationship in preterm neonates.MethodsA total of 199 preterm neonates diagnosed with NEC between January 2018 and January 2020 were included in this study. For each preterm infant with NEC that was admitted to the neonatal intensive care unit (NICU), controls were preterm neonates (matched for gestation and year of birth) who were not diagnosed with NEC. Exclusion criteria were post-maturity, small or large for gestational age (week of pregnancy), congenital major anomalies, and cyanotic congenital heart disease. Univariate and multivariate logistic regression analyses were used to identify the association between NLR and preterm NEC.ResultsThis study included 93 preterm neonates with NEC and 106 matched controls. There were no significant differences in gestational age (GA), birth weight (BW), age, sex, vaginal delivery (VD), chorioamnionitis (CA), and gestational diabetes mellitus (GDM) between the groups. Compared with the control group, the lower and higher NLR levels in the NEC group were statistically different. Following univariate analysis, NLR was a risk factor for NEC (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.00–1.90; P = 0.042), and according to multivariate analysis, risk factors for NEC were NLR ≥ 3.20 and NLR < 1.60, within 1 week before NEC diagnosis. Thus, NLR values of ≥ 1.60 and < 3.20 were determined as the predictive cut-off values for protecting preterm infants from NEC (Model I: OR, 0.20; 95% CI, 0.10–0.40; P < 0.001) and (Model II: OR, 0.10; 95% CI, 0.00–0.40; P < 0.001].ConclusionsNLR ≥ 1.60 and NLR < 3.20 were associated with a decreased risk of NEC in preterm infants.

Heteropagus twins: six cases with systematic review and embryological insights.

Heteropagus twinning (HT) is a rare anomaly. Six new cases along with a systematic review are described. Six cases of HT managed at two tertiary care teaching hospitals over the last 26years are described. A PubMed search with words: Heteropagus AND/ OR parasitic twins from 2001 to 2021 hit 183 articles. 36 were added from non-PubMed sources. Finally, 120 cases including 114 from 69 articles and 6 new cases were analysed. Of the new cases, 2/6 had an antenatal diagnosis. Five were males. 4 autosites had omphaloceles. Split notochord and 2 parasites attached to a single autosite were encountered. 5/6 autosites survived. On systematic review, the most frequent variant seen was rachipagus (n = 50) followed by omphalopagus (n = 46). Limbs were reported in 75 cases. Congenital heart disease was seen in 17/120(14.2%) autosites. Omphalocele and meningomyelocele were the most common extracardiac anomalies in autosites. Weight along with the anatomy and position of heteropagus twins was a better determinant of the mode of delivery than weight alone. Mortality was reported in 12 cases. Autosites in HT generally carry a good prognosis, however, final outcome depends mainly on associated major cardiac anomalies. Meticulous antenatal assessment and preoperative planning are of paramount importance. IV.

Evaluation of the mechanical contribution of wood degraded by insects in old timber beams through analytical calculations and experimental tests

Existing timber structures are often affected by peripheral degradation due to insect attack. The contribution of the degraded areas of the beam cross-section to the load bearing capacity is usually neglected, leading to an over-conservative approach to the structural verification of historic wooden constructions. This work analyses timber elements dismantled from a nineteenth century building by means of a comprehensive geometrical survey, the evaluation of the degraded portion of the cross-section and by destructive bending tests. An iterative procedure based on the linear elastic theory of composite beams was set up to define a reduction coefficient of the mechanical properties of degraded wood, in order to include the contribution of the degraded parts during the structural calculation. The analytical procedure proved to be effective only for timber elements without localised major defects or anomalies, such as woodworking or internal decay, which may alter the linear elastic flexural behaviour of the beam. The values obtained of the reduction coefficient ranged from 1.7 to 5.0 and were successfully verified by numerical models.

Differences in Congenital Anomalies in In-Vitro Fertilization (IVF) Versus Non-IVF Dichorionic-Diamniotic Twin Pregnancies [A333

INTRODUCTION: The aim of this study was to evaluate the incidence of congenital anomalies in dichorionic-diamniotic twins conceived with in-vitro fertilization (IVF) versus non-IVF in a large geographically diverse population. METHODS: This is a secondary analysis of data from a retrospective cohort study of twin pregnancies seen at 17 centers between 12/2011-2/2020. Institutional review board approval was obtained. Monochorionic, vanishing twins, triplets, and cases with chromosomal abnormalities or incomplete follow-up were excluded. Neonates with an abnormal newborn exam were evaluated for having a major or minor congenital anomaly, and anomalies were further classified by organ system (cardiac, renal/genitourinary, gastrointestinal, and musculoskeletal). Chi-squared, Fisher’s exact tests, and multivariate logistic regression were used. RESULTS: Of the 1,112 dichorionic-diamniotic twin pregnancies included, 523 (47.0%) were conceived with IVF and 589 (53.0%) were conceived spontaneously or with other assisted reproductive technology (ART). Congenital anomalies were found in 91 pregnancies (8.18%). Of those, 42 were found in IVF pregnancies (8.03%) versus 49 non-IVF pregnancies (8.32%; P=.86). There were no significant differences between IVF and non-IVF for major anomalies (P=.57) or minor anomalies (P=.62). There was no significant difference between IVF and non-IVF pregnancies when classifying anomalies by system, and this held true when adjusting for maternal age, race, BMI, and parity. CONCLUSION: In this large cohort of twin pregnancies, there is no significant difference in the incidence of anomalies for pregnancies conceived by IVF versus non-IVF. Given that previous data has shown increased incidence of congenital heart defects in IVF pregnancies, this should be further evaluated specifically in dichorionic-diamniotic twin pregnancies.

The association between maternal pre-pregnancy body mass index and pregnancy outcomes of preeclampsia

ObjectiveTo evaluate the effects of pre-pregnancy maternal body mass index (BMI) to pregnancy outcomes in patients diagnosed as preeclampsia. Materials and methodsThis was a retrospectively study on women who had been diagnosed as preeclampsia and delivered at Seoul National University Bundang Hospital between June 2017 and March 2020. Multifetal gestation, major fetal anomaly, and fetal death in utero were excluded. A total of 150 singleton pregnancies were included and divided into four groups according to the pre-pregnancy BMI classification: underweight (<18.5 kg/m2, n = 6), normal (18.5–22.9 kg/m2, n = 66), overweight (23.0–24.9 kg/m2, n = 26), and obese (≥25.0 kg/m2, n = 52). Pregnancy outcomes including gestational age at delivery, birthweight, and delivery modes were reviewed. ResultsThe rates of preterm birth before 34 weeks of gestation were 67%, 49%, 35%, and 27% for underweight group, normal BMI group, overweight group, and obese group, respectively (p-trend = 0.006). The birthweight of newborn increased significantly as pre-pregnancy BMI increased (p-trend<0.001). The proportions of small for gestational age (SGA) were highest in underweight group and decreased as pre-pregnancy BMI increased (67%, 41%, 42%, and 10% for each group, respectively, p-trend<0.001). ConclusionThe rates of preterm birth before 34 weeks and SGA increased as pre-pregnancy BMI decreased in patients with preeclampsia. Implications for practiceWomen with underweight before pregnancy are at the highest risk for preterm birth and SGA, therefore they need to be monitored more intensively when diagnosed as preeclampsia.

Association between respiratory distress syndrome of newborns and fetal growth restriction evaluated using a dichorionic twin pregnancy model

AimsTo evaluate the association between respiratory distress syndrome (RDS) and intrauterine fetal growth restriction (IUGR) by using a dichorionic twin model. MethodsWe retrospectively analyzed twins delivered between September 2012 and December 2018. A dichorionic (DC) twin pregnancy with selective IUGR (sIUGR) was defined as the presence of (i) a birthweight discordance of ≥25% and (ii) a smaller twin with birth weight below the 10th percentile. Pregnancies with major fetal anomalies, delivery at gestational age below 23 weeks, and intrauterine fetal demise were excluded. ResultsWe included 53 DC twins with sIUGR. The sIUGR twin had a higher risk of RDS than did his appropriate for gestational age (AGA) cotwin (32.1% vs. 11.3%, p = 0.001); however, the risk of severe RDS did not significantly differ between the twins (17.0% vs 9.4%, p = 0.125). The findings of logistic regression analysis indicated that younger gestational age (weeks) at delivery (odds ratio = 0.48, p < 0.001) and IUGR (odds ratio = 13.87, p = 0.009) were significant risk factors for RDS in newborns in DC twin pregnancies with selective sIUGR. ConclusionsIUGR was identified as a risk factor for newborn RDS. However, the association between IUGR and severe newborn RDS was not significant possibly due to the small sample size of this study.

Anti-Diabetic Effects of Allium hookeri Extracts Prepared by Different Methods in Type 2 C57BL/J-db/db Mice

This study was conducted to evaluate whether Allium hookeri can control diabetic symptoms. Aqueous extract (AE1: 100 mg/kg BW, AE2: 200 mg/kg BW) and ethanol extract (EE1: 100 mg/kg BW, EE2: 200 mg/kg BW) of A. hookeri were orally administrated to diabetic mice (C57BL/J-db/db) for 8 weeks. The negative (NC) and the positive (PC) control groups were treated with 0.9% saline and metformin (150 mg/kg BW), respectively. Glucose and lipid profile (triglyceride, total cholesterol (TC), LDL-C, and HDL-C) as biochemical parameters, toxicological factors such as liver/kidney functional parameters (ALT, AST, BUN, and Cr), and NK cell activity in blood were measured. Oral glucose tolerance test (OGTT) and histopathological examination were also conducted. Compared with the NC group, AE and EE decreased blood glucose, HbA1c, area under the curve (AUC) during OGTT, and leptin levels while increasing adiponectin levels. Serum lipid profiles and toxicological factors levels were reduced by the A. hookeri extract. Interestingly, HDL-C, glomerular mesangial expansion score in the kidney, and NK cell activity were effectively controlled in EE groups. Based on the results, EE is considered to be more effective in reducing high blood glucose, lipid profile, and related factor levels than AE, and is comparable to metformin in some biomarkers. It can be presumed that EE can more effectively control the major anomalies in the diabetic model than AE, and it may be used to prevent diabetic symptoms without toxicity in the Type 2 diabetic model.

Trial of labor of vertex-nonvertex twins following a previous cesarean delivery

Maternal and neonatal outcomes of trial of labor after cesarean delivery of twins are similar to those of singleton trials of labor after cesarean delivery. However, previous studies did not stratify outcomes by second-twin presentation on admission to labor. To examine maternal and neonatal outcomes following trial of labor after cesarean delivery in twins with vertex-nonvertex presentation. A retrospective multicenter study was conducted including data on deliveries occurring between the years 2005 and 2020. We included trials of labor after a previous cesarean delivery (at ≥320/7 weeks' gestation) of twin gestations with a vertex-presenting first twin on admission to labor. The exposed group was defined as deliveries with a nonvertex second twin at admission to labor, whereas the comparison group included deliveries with a vertex second twin at admission. Only parturients who attempted vaginal delivery were included. Cases of prelabor fetal death of either twin or major fetal anomalies were excluded. The primary outcome was uterine rupture. A total of 236 twin trials of labor after cesarean delivery were included, of which 128 involved nonvertex second twins and 108 a second vertex twin. Uterine rupture rates were comparable between the groups (1/128 [0.9%] vs 1/108 [0.8%]; P=1.000). Successful trial of labor after cesarean delivery of both twins occurred in 76.6% of the exposed group vs 81.5% of the comparison group, whereas cesarean delivery of both twins was performed in 21.9% of the exposed group vs 17.6% of the comparison group (P=.418; odds ratio, 1.32; confidence interval, 0.7-2.5). Two cases of cesarean delivery of the second twin occurred in the exposed group and 1 in the comparison group (1.6% vs 0.9%, respectively, P=1.000). There was no difference between the groups in maternal outcomes, including rates of postpartum hemorrhage, blood transfusion, placental abruption, thromboembolic events, and maternal fever. Neonatal outcomes were also comparable between the groups, including rates of intensive care admission and low (≤7) 5-minute Apgar scores. Our data show thattrial of labor after cesarean delivery of noncephalic second twins holds favorable maternal and neonatal outcomes, comparable with those of vertex-vertex trials of labor after cesarean delivery.Second-twin noncephalic presentation should not discourage parturients and caregivers from considering trial of labor after cesarean delivery if desired.

Visualising the cytoskeletal machinery in neuronal growth cones using cryo-electron tomography

ABSTRACTNeurons extend axons to form the complex circuitry of the mature brain. This depends on the coordinated response and continuous remodelling of the microtubule and F-actin networks in the axonal growth cone. Growth cone architecture remains poorly understood at nanoscales. We therefore investigated mouse hippocampal neuron growth cones using cryo-electron tomography to directly visualise their three-dimensional subcellular architecture with molecular detail. Our data showed that the hexagonal arrays of actin bundles that form filopodia penetrate and terminate deep within the growth cone interior. We directly observed the modulation of these and other growth cone actin bundles by alteration of individual F-actin helical structures. Microtubules with blunt, slightly flared or gently curved ends predominated in the growth cone, frequently contained lumenal particles and exhibited lattice defects. Investigation of the effect of absence of doublecortin, a neurodevelopmental cytoskeleton regulator, on growth cone cytoskeleton showed no major anomalies in overall growth cone organisation or in F-actin subpopulations. However, our data suggested that microtubules sustained more structural defects, highlighting the importance of microtubule integrity during growth cone migration.

Prenatal Diagnosis and Outcome of Umbilical-Portal-Systemic Venous Shunts: Experience of a Tertiary Center and Proposal for a New Complex Type.

Aims: To share our experience in the prenatal diagnosis of umbilical–portal–systemic venous shunts (UPSVS) and to study the prognostic factors for proper prenatal and perinatal management. Material and Methods: A five-year prospective study regarding the detection of UPSVS was conducted in two referral centers, Medgin Ginecho Clinic and the Prenatal Diagnostic Unit of the tertiary center, University Emergency County Hospital Craiova, Romania. We included in the analysis a series of agenesis of ductus venosus (ADV) cases previously reported by our center. We analyzed the incidence of the UPSVS types, their associations, and outcome predictors. Results: UPSVS were diagnosed in all 16 cases that were presented to our center at the time of first trimester anomaly scan, except one (94.12%). We diagnosed: 19 type I (61.2%), 4 type II (12.9%) and 5 type IIIa (16.1%) UPSVS. In three cases (9.6%) we noted multiple shunts, which we referred to as type IV (a new UPSVS type). Type IIIa-associated fetal growth restriction (FGR) was found in 60% of cases. Major anomalies worsened the outcome. Of the UPVSS cases, 57.1% were associated with PVS anomalies. Genetic anomalies were present in 40% of the tested cases. Conclusions: The incidence of UPSVS in our study was 0.2%. Early detection is feasible. The postnatal outcome mainly depends on the presence of structural, genetic and PVS anomalies. FGR may be associated. The new category presented a poor outcome secondary to poor hemodynamic and major associated anomalies.

Accuracy of ultrasound in the estimation of customised birth weight in a public hospital service.

Studies have shown that ultrasound estimated foetal weight (EFW) in small for gestational age (SGA) babies tends to be less-accurate when compared to appropriate (AGA) and large (LGA) for gestational age babies. We aimed to analyse the accuracy of ultrasound EFW overall, and by customised birth weight centile category (severe SGA, SGA, AGA, LGA). Also, the accuracy of estimating the centile category using calculated customised EFW centiles. We performed a retrospective study of pregnant women between 20-43 weeks gestation who underwent ultrasound within 7 days of delivery at a large tertiary maternity unit between January 2018 and December 2020. Stillbirths, major foetal anomalies and multiple pregnancies were excluded. The EFW and birth weight were compared, and an accurate estimate defined as ≤15% difference. The customised EFW and birth weight centiles were calculated and used to analyse the accuracy of category prediction. Of 2061 foetuses included, 92% (n = 1902) were born weighing within 15% of their EFW. Accuracy was not affected by maternal BMI, ethnicity, parity or gestation. 87% of SGA babies were within 15% of their EFW. Ultrasound sensitivity for SGA was 51% (95% CI: 46-55%). The specificity and positive predictive values were 97% (95% CI: 96-98%) and 87% (95% CI: 82-90%) respectively. The accuracy of Ultrasound EFW overall is good, however, is reduced in SGA babies whose EFW and birth weight centile categories tended to be overestimated. The high specificity for SGA supports monitoring with a lowered threshold to intervene in pregnancies identified by ultrasound as SGA.