Mid-trimester Pregnancy Research Articles

Correlation between markers of DNA and lipid oxidative damage in maternal and fetoplacental compartment in the mid-trimester of pregnancy.

To determine the levels of 8-isoprostane (8-IP) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in urine and in amniotic fluid (AF) of pregnant women and to assess the correlation between oxidative status in the maternal and fetal compartment in the second trimester of pregnancy. One hundred and forty-six women with singleton pregnancies, undergoing amniocentesis at the Department of Obstetrics and Gynaecology at the University Medical Centre Ljubljana, were prospectively enrolled. AF and maternal urine were collected in the second trimester of pregnancy. Paired urinary and AF 8-IP and 8-OHdG were measured and evaluated cross-sectionally. 8-IP and 8-OHdG concentrations were higher in maternal urine compared to AF and the ratios were 47:1 and 50:1, respectively. AF 8-OHdG was very low and in 74% was below the limit of detection (LOD). We found a positive correlation between 8-IP in maternal and fetal compartment (ρ=0.217, P=0.008), which stayed unchanged also after adjustment for possible confounding factors. Oxidative damage to lipids and DNA is also a part of physiologic processes during healthy pregnancy. 8-IP and 8-OHdG are constantly present in urine and AF. A weak positive correlation between maternal and fetal unit suggests a weak reflection of fetal oxidative status in maternal urine in the mid-trimester.

The impact of obesity on cervical cerclage efficacy: A systematic review of the literature.

Cervical cerclage is a commonly applied procedure which is used as a preventive measure against preterm births among women with a short cervix (<25mm) or with previous painless mid-trimester pregnancy losses. The purpose of the present study is to evaluate whether the presence of maternal obesity reduces the efficacy of cervical cerclage. We searched Medline (1966-2015), Scopus (2004-2015), Popline (1974-2015) and ClinicalTrials.gov (2008-2015) along with reference lists of electronically retrieved studies. Three studies were included in our review which involved 606 women. Among them 210 were obese (BMI>30 kg/m2) and 47 morbidly obese (BMI >40 kg/m2). The presence of obesity among women who had a cervical cerclage due to ultrasound or history indications did not seem to affect the gestational age at delivery or the neonatal birthweight. Furthermore, according to the findings of a single study it did not seem to reduce the gestational latency period in days (normal weight group 24.3±3.2, overweight group 21.1±5.1, obese group 21.4±4.9 p = 0.171). According to the findings of our systematic review obesity does not influence the efficacy of cervical cerclage. However, firm results are precluded due to the small number and the methodological heterogeneity of existing studies. Further, studies are needed to corroborate our findings.

Study on the relationship between serum ferritin level at different trimester of pregnancy and gestational diabetes mellitus

Objective To investigate the association between serum ferritin(SF) level at early and mid trimester of pregnancy and gestational diabetes mellitus (GDM) and insulin resistance (IR). Methods A total of 192 cases of women who were accepted antenatal examination from the first trimester of pregnancy at Yueqing People Hospital from July, 2012 to October, 2013 was prospectively analyzed and followed up. All cases were divided into two groups: 96 cases of GDM pregnant women who were diagnosed as GDM at mid trimester of pregnancy as GDM group, and 96 cases of pregnant women with normal glucose tolerance at the same time as the control, normal glucose tolerance (NGT group). The differences in clinical data were compared between two groups. The relationship between SF level and fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model assessment insulin resistance (HOMA-IR), and C-peptide was investigated with Spearman rank correlation analysis. The predictive values of SF and relative variables to GDM were calculated by receiver operating characteristic curve (ROC) or Logistic regression analysis. Results ⑴ There was statistically significant difference in body weight and body mass index (BMI) at prepregnancy and mid trimester of pregnancy, Hb, FPG, FINS, SF, and C-peptide at the first trimester of pregnancy, SF level and FPG and HOMA-IR and C-peptide at mid trimester of pregnancy between two groups (P 0.05). ⑶ The area under the ROC curve of SF at mid trimester of pregnancy for GDM was 0.653. The sensitivity and specificity were 68.8% and 59.4% in predicting GDM at the cut-off value of 16.61 ng/ml. As showed by Logistic regression analysis, high level of SF at mid trimester of pregnancy was a independent risk factor for GDM. Odds ratio (OR) was 1.032 (95% CI: 1.008~1.058, P<0.01). Conclusions The relationship between SF at different trimester of pregnancy and GDM is variant. There is relationship between high level SF of mid trimester of pregnancy in GDM pregnant women and IR. The level of SF might predict the occurrence of GDM. Key words: Ferritins/ME; Diabetes, gestational/ME; pregnancy

Interval laparoscopic abdominal cerclage for recurrent pregnancy loss

Abdominal cerclages are necessary when the standard trans-vaginal cerclages fail or anatomical abnormalities preclude the vaginal placement. In 1965, Benson and Durfee described an abdominal approach to cerclage, a procedure that was applied to congenitally short or surgically amputated cervices. Thirty-eight women with history of either recurrent mid-trimester pregnancy losses, short cervix or failed vaginal cerclage had trans-abdominal cerclage, of which 30 were done laparoscopically. A 5-mm non-absorbable needled polyester fibre tape (Mersilene) suture was placed laparoscopically at the level of the internal os as an interval procedure. All the procedures were successful. All women were discharged on post-operative day 2 and none of them required blood transfusions. There were no intraoperative or post-operative complications. Subsequently, 15 patients conceived and the foetal survival rate recorded was as high as 85.71%. Some patients manifest severe cervical injures, and others have apparent congenital absence of the cervix, rendering Shirodkar or McDonald cerclage technically difficult or impossible. The main interest of this technique is to avoid a laparotomy; thus, reducing the morbidities of a laparotomy and also the recovery time post-surgery.

Preconception Laparoscopic Cervical Cerclage: The Preferred Technique for Cervical Incompetence?

Objective: To explore the ease and effectiveness of placing a cervical suture preconception using a laparoscopic technique. Design: A case study with systematic literature review. Setting: PIVET Medical Centre, a private facility providing comprehensive services over 35 years in gynaecology, andrology and reproductive endocrinology for infertility and recurrent pregnancy loss. Patients: Case report of a 35 year old woman with recurrent mid-trimester pregnancy losses and well-define cervical incompetence. Intervention: Preconception placement of cervical suture by laparoscopic trans-abdominal cerclage (LTAC) as a day case. Main outcome measure: Details of ensuing pregnancy. Results: Conception without delay and normal pregnancy with delivery by elective caesarean section near term of healthy 2645 g female infant. Conclusion: We are impressed with the ease of the LTAC technique which appears likely to have fewer complications than traditional vaginal techniques, as well as speedier recovery compared to a laparotomy approach.

Controversial ultrasound findings in mid trimester pregnancy. Evidence based approach.

Mid trimester fetal anatomy scan is a fundamental part of routine antenatal care. Some U/S soft markers or controversial U/S signs are seen during the scan and create some confusion regarding their relation to fetal chromosomal abnormalities. Example of these signs: echogenic focus in the heart, echogenic bowel, renal pyelectasis, ventriculomegaly, polydactely, club foot, choroid plexus cyst, single umbilical artery. We are presenting an evidence based approach from the literature for management of these controversial U/S signs.

Cervical Cerclage Often Is Performed for Non-Evidence-Based Indications

Recent evidence has suggested that the benefit of cervical cerclage to prevent midtrimester pregnancy loss or preterm birth applies only to women with

Presenting Twins Are Exposed to Higher Levels of Inflammatory Mediators than Nonpresenting Twins as Early as the Midtrimester of Pregnancy.

ObjectivePresenting twins are less likely to develop respiratory complications than non-presenting twins. The precise reason for this difference is not well understood, although it is known that the presence of inflammation reduces the risk of respiratory morbidity at birth. To further investigate this association, we compared the concentrations of inflammatory biomarkers in mid-trimester amniotic fluid (AF) of asymptomatic twin pairs.Study DesignThe study population consisted of women with twin pregnancies who underwent mid-trimester amniocentesis (15–20 weeks) for routine clinical indications and delivered at term. AF was analyzed for pro-inflammatory cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IL-15, IFN-γ, TNF-α), matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, MMP-12), and chemokines (Complement Factor D/Adipsin, Serpin E1/PAI-1, Adiponectin/Acrp30, CRP, CCL2/MCP-1, Leptin, Resistin) using Luminex Performance Assay multiplex kits. Data were analyzed using Wilcoxon signed rank test.ResultsA total of 82 twin pairs were enrolled. Mid-trimester AF concentrations of IL-8, MMP-8, CRP, MCP-1, leptin, and resistin were significantly higher in the presenting twin compared with the non-presenting twin (p<0.05 for each). Differences in AF concentrations of IL-8, MMP-8, and CRP persisted after adjustment for the fetal growth restriction at the time of birth and chorionicity.ConclusionThese data suggest that, as early as the mid-trimester, the presenting fetus in an otherwise uncomplicated twin pregnancy is exposed to higher levels of pro-inflammatory mediators (especially IL-8, MMP-8, and CRP) than its non-presenting co-twin. Whether this pro-inflammatory milieu reduces the risk of neonatal respiratory morbidity at birth or has other functional implications needs to be further evaluated.

Comparison of two misoprostol regimens for mid-trimester pregnancy terminations after FIGO’s misoprostol dosage recommendation in 2012

Objective: To compare the safety and efficacy of two misoprostol regimens for mid-trimester pregnancy terminations.Methods: Retrospective analysis of 263 cases of pregnancy terminations with misoprostol between 12 and 24 weeks was performed. Group 1 (total 129 patients) consisted of patients who were given 200 mcg vaginal misoprostol every 4 h until the abortion, whereas Group 2 patients (total 134 patients) were given misoprostol as in International Federation of Gynecology and Obstetrics’s (FIGO) 2012 recommendation. In case of a previous cesarean section doses were halved in both groups. Primary outcomes of the study were the time to abortion and the total drug dose used. Secondary outcome was the rate of complications.Results: Total dose and time to abortion did not differ between the groups. As for complications, one patient (%0.8) in group 1 developed HELLP syndrome and had hysterotomy. One patient (%0.8) in group 2 had uterine rupture and had total hysterectomy. Two patients in both groups considered failure of induction and terminated with surgery (hysterotomy). Groups did not show difference in induction failure rates.Conclusions: We respect the presence of dose recommendation stated by the FIGO and found similar results with our recent protocol. Other misoprostol regimens used worldwide should also be compared with this guideline in order to improve its efficacy.

Clinical analyses of 66 cases of mid-trimester pregnancy termination in women with prior cesarean.

Background:The rate of cesarean delivery has significantly increased in China in the last decade. Women with prior cesarean history tend to have a higher risk of uterine rupture during termination of the pregnancy in mid-trimester than those without such a history. The aim of our study was to evaluate the influences of the potential risk factors on uterine rupture in women with prior cesarean.Methods:We conducted this retrospective study of women with prior cesarean section, who underwent mid-trimester pregnancy termination between January 2006 and December 2013 in Peking Union Medical College Hospital. The protocol was oral administration of mifepristone and misoprostol for the patients with the gestational ages below 16 weeks or intra-amniotic injection of ethacridine lactate (EL) for those with at least 16 weeks of gestational ages. The thickness of the lower uterine segment (LUS) was measured before the termination of pregnancy. Logistic regression was used to study the risk factors of uterine rupture.Results:The total rate of successful abortion was 93.9% (62/66). Four patients failed in induction, and one of them received curettage, whereas the other three experienced uterine rupture (4.5%). The successful rates of abortion were 85.7% (30/35) for women treated with mifepristone-misoprostol and 86.1% (31/36) for those treated with EL. There was a significant difference in the mean LUS thickness between the uterine rupture group (3.0 ± 2.0 mm) and the nonrupture group (7.0 ± 3.0 mm) (P < 0.05). The LUS thickness of <3 mm was associated with uterine rupture during mid-trimester pregnancy termination in women with prior cesarean (odds ratio, 94.0; 95% confidence interval 4.2–2106.1) after adjusted maternal age, gestational age, interdelivery interval and prior cesarean section. Severe bleeding that required transfusion occurred in one case (1.5%).Conclusions:Both the mifepristone-misoprostol and the EL regimens were effective and safe for the termination of mid-trimester pregnancy in women with prior cesarean. A thinner LUS is associated with a relatively high risk of uterine rupture.

Antenatal Maternal Antidepressants Drugs Affect S100B Concentrations in Fetal-Maternal Biological Fluids.

Antidepressant treatment during pregnancy is speedily increasing in developed countries and this phenomenon has occurred without firm evidence on safety and/or efficacy. The present study investigated from mid-trimester of pregnancy up to 24 hours after birth the pattern of a brain damage marker, namely S100B, in maternal fetal and neonatal biological fluids of pregnant women and their newborns antenatally treated by antidepressant drugs such as selective serotonin re-uptake inhibitors (SSRI). we conducted an observational study on 75 pregnant women treated in the mid -third trimester by antidepressant drugs and 231 healthy pregnancies. S100B concentrations were measured at 7 predetermined monitoring time-points before, during and after treatment in maternal, fetal and neonatal biological fluids and correlated with neurological follow-up at 7 days from birth. In SSRI group S100B concentrations were significantly higher in SSRI than controls (P<0.001, for all) in maternal blood, in amniotic fluid, in arterial and venous cord blood and at 24-h from birth. Highest (P<0.05) S100B levels were found in SSRI infants showing major neurological symptoms at 7-d follow-up. The present data on increased S100B levels in maternal, fetal and neonatal biological fluids suggest that SSRI administration although beneficial to the mother, presents some risks for the infant.

Meckel's Diverticulitis as a Cause of an Acute Abdomen in the Second Trimester of Pregnancy: Laparoscopic Management.

Introduction. Meckel's diverticulitis is an extremely rare cause of an acute abdomen in pregnancy. Its clinical presentation tends to be rather unusual and therefore commonly delaying diagnosis. The surgical method of exploration can be either by laparoscopy or through an open incision. Case Report. We report a case of a 34-year-old, P1 with previous Caesarean section, who presented at 20 weeks with worsening right-sided abdominal pain, distention, and peritonism. Ultrasound scan showed an area of a possibly thickened loop of bowel inconsistent with an appendicitis. The findings at laparoscopy were purulent fluid in the pelvis, a congested appendix, and inflamed Meckel's diverticulum. An appendectomy and excision of the diverticulum was performed using stapler technique. Discussion. Meckel's diverticulitis in pregnancy can have nonspecific presentation and poses difficulties for preoperative diagnosis. Delay in diagnosis and management poses significant maternal and fetal risks. The use of laparoscopy if the gestational age and uterine size permit its use allows a thorough exploration of the abdominal cavity and management of rarer and unexpected pathology. Laparoscopic management of acute abdomen in the midtrimester of pregnancy has been found to be safe and effective.

Mifepristone followed by Misoprostol for Mid trimester Abortion-A Prospective Study

Background: Over the last decade there is an increase in number of second trimester pregnancy termination due to better prenatal screening. Medical methods, using combination of mifepristone and Misoprostol are increasing being used for mid-trimester pregnancy termination. Objective: Objective of study was to analyse safety and effectiveness of combination of mifepristone and Misoprostol for mid-trimester MTP. Material & Methods: A prospective study of 68 women who underwent Mid-trimester MTP (between 13-20 weeks gestation) at Gian Sagar Medical College & Hospital, Banur, Rajpura (India) during January 2012- June 2015. Results: Data was analysed for 48 cases who fulfilled the inclusion criteria. Complete abortion occurred in 36(75%) of cases, 13(25%) required dilatation & curettage for incomplete abortion including manual removal of placenta in 8 cases. There were seven cases with previous caesarean section all of whom had complete abortion. Conclusion: Combination on Mifepristone & Misoprostol is an effective & safe method for mid-trimester MTP and can be used in cases of previous caesarean section with close supervision. Keywords: Mid-trimester abortion, Mifepristone, Misoprostol, Medical method MTP.

Study on risk factors for bleeding associated with midtrimester pregnancy termination induced by gemeprost

Study on risk factors for bleeding associated with midtrimester pregnancy termination induced by gemeprost

543: Presenting twins are exposed to higher levels of inflammatory mediators than non-presenting twins as early as the mid-trimester of pregnancy

543: Presenting twins are exposed to higher levels of inflammatory mediators than non-presenting twins as early as the mid-trimester of pregnancy

P13.10: Sonographic measurement of the diameter and blood volume of umbilical vessels during mid‐trimester to predict small‐for‐gestational age

The objective of this study was to evaluate the diameter, blood velocity and blood volume of umbilical artery and vein using ultrasonography during mid-trimester of pregnancy to predict small for gestation age (SGA) at delivery. This study was performed in 104 low-risk pregnancies. Diameter, blood velocity and blood volume of umbilical artery and vein were measured between 20 and 25 weeks of gestation using ultrasonography and we checked the fetal birhweight among full term deliveries. We evaluated the reference value of its parameter during mid-trimester and analyzed the useful parameter to predict SGA at delivery. The mean diameter and blood volume of umbilical artery were increased according to gestational age from 20 to 25 weeks (r = 0.5678, p < 0.0001 and r = 0.4920, p < 0.0001, respectively), but the mean blood velocity of umbilical artery was not changed. The mean diameter and blood volume of umbilical vein were also increased according to gestational age (r = 0.7465, p < 0.0001 and r = 0.5837, p < 0.0001, respectively), but the blood velocity of umbilical vein was decreased without significance. SGA at delivery were 10 pregnancies (9.6%). Among its parameter during mid-trimester pregnancies, umbilical vein diameter was most predictable parameter to predict SGA (AUC = 0.769, p < 0.0001), and umbilical artery diameter and blood volume, and umbilical vein blood volume were also predictable for SGA. Diameter and blood volume of umbilical vessels are increased according to gestational age in low-risk pregnancies, but blood velocity of its vessels are not changed. Mid-trimester umbilical vein diameter seems to useful parameter to predict future SGA at delivery, although more additional parameters are related to fetal growth.

Midtrimester pregnancy interruption: providers’ perspectives, practice and knowledge

Midtrimester pregnancy interruption: providers’ perspectives, practice and knowledge

Laparoscopic Transabdominal Cerclage: Successful Term Pregnancy Following Radical Trachelectomy

Abstract Background: Radical trachelectomy is an effective fertility-sparing treatment for early stage cervical cancer but is associated with an increased incidence of preterm labor and mid-trimester pregnancy loss. Cervical cerclage is associated with improved pregnancy outcomes in patients who have previously undergone trachelectomy. Some researchers have reported complications associated with cerclage placement at the time of radical trachelectomy. Case: A 36-year-old woman underwent trachelectomy and laparoscopic pelvic lymphadenectomy for a stage 1b cervical adenocarcinoma. Eighteen months later, the patient became pregnant through in-vitro fertilization. After placement of a laparoscopic transabdominal cerclage at 10 weeks and 6 days of gestation, the patient had a sucessful term pregnancy: Results: This patient had an uneventful pregnancy and underwent routine antenatal care plus regular ultrasound testing. Via cesarean section at 38 weeks of gestation, she was delivered of a healthy baby boy weigh...

Ketamine administered to pregnant rats in the second trimester causes long-lasting behavioral disorders in offspring

Commonly used anesthetic agents, e.g. ketamine, may be neurotoxic to the developing brain but there has been little attention to the neurobehavioral consequences for offspring when used for maternal anesthesia. We hypothesize that treatment of pregnant rats with ketamine during the second trimester would affect brain development of the offspring. Pregnant rats on gestational day 14, about equal to midtrimester pregnancy in humans, received a sedative dose of ketamine intravenously for 2h. Brain hippocampal morphology of their pups at postnatal days 0 (P0) and P30 was examined by Nissl-staining and the characteristics of dendrites were determined using the Golgi-Cox staining, while cell proliferation in subventricular zone (SVZ) and dentate gyrus (DG) was labeled with bromodeoxyuridine (BrdU). Their neurobehavioral functions were tested at P25–30 after which the NR1 and NR2 subunits of N-methyl-d-aspartate (NMDA) receptor, brain-derived neurotrophic factor (BDNF) and postsynaptic density protein 95 (PSD-95) in the hippocampus were analyzed by western blot. When pregnant rats were exposed to ketamine, there was neuronal loss, pyramidal neuronal abnormality and reduced cell proliferation in the hippocampus of offspring. These morphological abnormalities were associated with depression- and anxiety-like behaviors, and impaired memory up to young adult age. The treatment further caused NR2A receptor subunit up-regulation and NR2B receptor subunit, BDNF and PSD-95 down-regulation. These data suggest that maternal anesthesia with ketamine during the fetal brain development period can cause fetal brain damage and subsequent neurobehavioral abnormality, which is likely associated with the imbalanced expression of NMDA receptor subunits.

Impact of the nitric oxide-donor pentaerythrityl-tetranitrate on perinatal outcome in risk pregnancies: a prospective, randomized, double-blinded trial

Intrauterine growth restriction (IUGR) and preeclampsia (PE) are associated with impaired placentation. Patients who are at risk of developing both these disorders can be identified by abnormal uterine artery Doppler at mid-trimester pregnancy. Nitric oxide (NO)-donors like pentaerithrityl-tetranitrate (PETN) reduce the impedance in the uteroplacental vessels and possess protecting effects on the endothelium. We tested the effectiveness of the NO-donor PETN for secondary prevention of IUGR, PE, and preterm birth in pregnancies at risk. Some 111 women who presented with abnormal placental perfusion at 19-24 weeks of gestation (w.o.g.) were included into a prospective, randomized, placebo-controlled, double-blinded study. The primary endpoint was IUGR and/or perinatal death. Secondary endpoints were preterm birth, PE, and placental abruption. Pentaerithrityl-tetranitrate significantly decreased the risk for IUGR and/or perinatal death [adjusted odds ratio (OR) 0.410; 95% confidence interval, CI, 0.184-0.914] and for IUGR (adjusted OR 0.436; 95% CI 0.196-0.970). Preterm birth before 32 w.o.g. (adjusted OR 0.204; 95% CI 0.052-0.801) was reduced, but not the risk for PE. No placental abruption occurred in the PETN, but five occurred in the placebo group [corrected]. These results suggest that secondary prophylaxis of adverse pregnancy outcome might be feasible in pregnancies exhibiting abnormal placentation using PETN.