Non-pregnant Patients Research Articles

COVID-19 vaccine safety during pregnancy and breastfeeding in women with autoimmune diseases: results from the COVAD study.

We investigated coronavirus disease 2019 (COVID-19) vaccine safety in pregnant and breastfeeding women with autoimmune diseases (AID) in the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. Delayed-onset (>7 days) vaccine-related adverse events (AE), disease flares and AID-related treatment modifications were analysed upon diagnosis of AID vs healthy controls (HC) and the pregnancy/breastfeeding status at the time of at least one dose of vaccine. Among the 9201 participants to the self-administered online survey, 6787 (73.8%) were women. Forty pregnant and 52 breastfeeding patients with AID were identified, of whom the majority had received at least one dose of COVID-19 vaccine (100% and 96.2%, respectively). AE were reported significantly more frequently in pregnant than in non-pregnant patients (overall AE 45% vs 26%, P = 0.01; minor AE 40% vs 25.9%, P = 0.03; major AE 17.5% vs 4.6%, P < 0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC with respect to AE. Post-vaccination disease flares were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18.3% of age- and disease-matched non-pregnant and non-breastfeeding patients (n = 262). All pregnant/breastfeeding patients who experienced a disease flare were managed with glucocorticoids; 28.6% and 20% of them required initiation or change in immunosuppressants, respectively. This study provides reassuring insights into the safety of COVID-19 vaccines administered to women with AID during the gestational and post-partum periods, helping overcome hesitant attitudes, as the benefits for the mother and for the fetus by passive immunization appear to outweigh potential risks.

Challenges and opportunities for proton therapy during pregnancy.

During pregnancy, the use of radiation therapy for cancer treatment is often considered impossible due to the assumed associated fetal risks. However, suboptimal treatment of pregnant cancer patients and unjustifiable delay in radiation therapy until after delivery can be harmful for both patient and child. In non-pregnant patients, proton-radiation therapy is increasingly administered because of its favorable dosimetric properties compared with photon-radiation therapy. Although data on the use of pencil beam scanning proton-radiation therapy during pregnancy are scarce, different case reports and dosimetric studies have indicated a more than 10-fold reduction in fetal radiation exposure compared with photon-radiation therapy. Nonetheless, the implementation of proton-radiation therapy during pregnancy requires complex fetal dosimetry for the neutron-dominated out-of-field radiation dose and faces a lack of clinical guidelines. Further exploration and standardization of proton-radiation therapy during pregnancy will be necessary to improve radiotherapeutic management of pregnant women with cancer and further reduce risks for their offspring.

Oral versus intravenous acetaminophen for perioperative pain management in adult patients undergoing non-cardiac surgery: A quantile segmented regression analysis

Study objectiveDetermine whether preferential use of perioperative enteral acetaminophen is associated with changes in perioperative pain, narcotic administration, or time to meeting criteria for post anesthesia care unit (PACU) discharge, compared to preferential parenteral administration. DesignRetrospective Cohort with quantile segmented regression analysis. Groups determined by date of surgery, one year pre-initiative and one year post-initiative. SettingOperating room and PACU of a tertiary academic medical center. PatientsAdult (age > 18 years), ASA status 1–5, non-pregnant patients undergoing non-cardiac surgery of less than six hours duration admitted to the PACU postoperatively. InterventionsA multidisciplinary initiative to preferentially utilize enteral over parenteral acetaminophen. MeasurementsThe primary outcome was narcotic consumption in the PACU. Secondary outcomes were intraoperative narcotic administration, pain score on PACU admission and discharge, and time to meeting criteria for PACU discharge. Results24,701 patients were included in the analysis; 12,379 had surgery prior to the initiative and 12,322 after. Enteral acetaminophen administration increased preoperatively from 13.49% to 26.84%, and postoperatively from 43.16% to 51.45%, while intraoperative parenteral APAP use dropped from 43.23% to 6.81%. Quantile Segmented regression analysis after adjusting for period (pre versus postintervention), day, age, gender, inpatient status, and ASA class demonstrated a decrease in adjusted median perioperative acetaminophen dose (−175 mg P < 0.001), with no significant difference in level change of intraoperative or PACU narcotic administration. There was no significant difference in median time to meet criteria for PACU discharge, though there was a significant change in the slope, (−0.36, p = 0.007.)Median pain scores measured on a standard 0–10 numeric rating scale at PACU admission did not change, while median pain scores at PACU discharge decreased slightly (−0.24 p < 0.001). There was no change in the probability of PONV. Conclusion: In adult patients undergoing non-cardiac surgery of <6 h duration, preferential use of enteral rather than parenteral acetaminophen is associated with non-inferior outcomes in narcotic requirements, pain scores, time to PACU discharge, and probability of PONV when compared with routine parenteral administration. Further studies are needed to validate these findings.

The Fate of Cervical Dysplastic Lesions during Pregnancy and the Impact of the Delivery Mode: A Review.

Cervical dysplasia, also referred to as cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL), is the precursor lesion of cervical carcinoma. Therefore, its diagnosis is vital for early detection and inhibiting the development of cervical carcinogenesis. Human papillomavirus (HPV) is the most common aetiology of cervical cancer and this infection mainly affects young women of childbearing age, thus affecting pregnant women as well. It is essential to know how CIN progresses in pregnant patients because the management of pregnant and non-pregnant patients is different (considering the safety of both mother and child in pregnancy). This review intends to highlight the studies which have assessed the rates of progression of CIN diagnosed in pregnancy throughout the antenatal period and the impact of the mode of delivery on CIN outcomes. We searched PubMed/MEDLINE and Google Scholar databases for relevant articles. Many studies indicate that the rate of progression of these lesions is very slow during the tenure of pregnancy; many also report postpartum regression of these lesions. Thus, in most of these patients, management can be safely implemented in the postpartum period while just keeping them under observation in the antenatal period. However, patients with high-grade CIN have a higher chance of developing invasive cancer and, therefore, require careful monitoring. There is a dispute regarding the role of the mode of delivery in determining the fate of cervical dysplasia. While some studies supported vaginal births over caesarean sections, others did not find any difference between the two in defining the outcome of the dysplastic lesions.

Plasminogen activator inhibitor-2 and impaired fibrinolysis in pregnancy and sickle cell anemia

PurposeThis is the first study that aimed to determine antigen levels in plasma and genotypes of PAI-2 in pregnant and non-pregnant homozygous sickle cell anemia (SCA) patients.MethodsThe study subjects were all Bahraini females in the reproductive age group. The study population included 31 pregnant homozygous SS (SCA) patients. Three control groups were also studied to evaluate the effect of pregnancy and SCA on PAI-2 levels and fibrinolysis: (1) 31 healthy non-pregnant volunteers; (2) 31 cases of normal pregnancy; and (3) 20 non-pregnant SCA patients. Pregnancies were screened in the second (TM2) and third (TM3) trimesters. Global coagulation, fibrinolysis rate (euglobulin clot lysis time, ECLT), PAI-2 antigen (ELISA), and PAI-2 Ser(413)/Cys polymorphism (restriction fragment length polymorphism analysis) were determined.ResultsFeto-maternal complications were documented in both pregnancy groups. PAI-2 antigen levels were undetectable in the non-pregnant groups, but was quantifiable in both pregnant groups. Impaired fibrinolysis rate and rising PAI-2 levels with progression of pregnancy were observed in both healthy and SCA subjects. These changes were more prominent in SCA, although the rise in ECLT was less steep and PAI-2 antigen levels were not significantly different compared to normal pregnancy in the third trimester. No correlation was observed between PAI-2 genotypes and plasma antigen levels. Also, no significant difference in feto-maternal complications was found in normal (n = 25) versus SCA pregnant patients (n = 30).ConclusionsThese observations suggest that with progression of pregnancy, increasing PAI-2 levels contribute to the hypercoagulable state, particularly in SCA patients.

Characteristics and clinical outcomes of critically ill pregnant patients with COVID-19 disease

Aim To investigate the characteristics and clinical outcomes among critically-ill pregnant patients with COVID-19 and compare them to non-pregnant critically-ill COVID-19 patients. Settings and design This retrospective cohort study was carried out at the ICUs of both Ain Shams University Quarantine Hospital and the Obour Specialized Hospital between April 2020 and September 2021. Methods and material The study included critically-ill, COVID-19 patients above 18 years old. The enrolled participants were divided into two groups, pregnant patients, and a control group of non-pregnant patients. Patient data were retrieved from the medical records. Outcomes included general outcomes (length of ICU stay, need for mechanical ventilation, thromboembolic events, and mortality), obstetric outcomes (pre-eclampsia and mode of delivery), and neonatal outcomes (preterm delivery, neonatal intensive care unit [NICU] admission, intrauterine fetal death, and total perinatal mortality). Results The levels of ferritin and D-dimer, length of ICU stay, need for mechanical ventilation, incidence of thromboembolic events, and mortality showed significant differences between pregnant and non-pregnant women. Women who were critically ill in the second and third trimesters had significantly higher D-dimer and ferritin levels compared to the first trimester critically ill patients. They also had significantly longer ICU stay, higher rate of cesarean delivery, and more incidence of neonatal admission to NICU. Conclusions Pregnant, critically ill women are more prone to adverse pregnancy and neonatal outcomes compared to non-pregnant women. Critical illness in the second and third trimesters poses a higher risk in terms of length of ICU stay and NICU admission.

Benefits and limitations of clinical assessment of abnormal vaginal discharge etiology

Abnormal vaginal discharge (AVD) is a common syndrome. Its management is addressed in many evidence-based guidelines: International Union of Sexually Transmitted Infections (IUSTI) and WHO Guidelines for management of vaginal discharge (2018); American College of Obstetrics and Gynecology (ACOG) Practice Bulletin No. 215 «Vaginitis in non-pregnant patients» (2020); U.S. Centers for Disease Control and Prevention (CDC) Guidelines for the treatment of sexually transmitted diseases (2021) etc. In December 2022, the Ministry of Health of Ukraine approved an adapted Clinical Guidelines and Standards of Medical Care “Abnormal vaginal discharge”.A special aspect of AVD management is frequent recurrence. Among the many hypotheses of the etiology of the recurrent course of vaginal infections the clinical aspect of difficulties of identifying all pathogens in case of mixed forms deserves special attention. Thus, there is need to presume the possibility of a mixed etiology of AVD or an atypical course of mono-infection at the stage of clinical examination.This review focuses on the role of vaginal discharge pH measuring both in the clinical stage of diagnosing the causes of AVD and in the interpreting laboratory results. Vaginal pH testing is an important component of the clinical stage in diagnostics of the AVD causes. This feasible and quick study allows objectifying the vaginal dysbiosis with a decrease in lactoflora and lactic acid value, which requires further laboratory diagnostics during the examination. Also it is an integral part of the Amsel criteria in the diagnostics of bacterial vaginosis, and vaginal health index to assess the degree of vaginal atrophy in menopause. Vaginal pH testing improves the diagnosis of difficult-to-detect infections and rare causes of AVD. Also, this method is useful for telemedicineto prevent unnecessary medical examinations, laboratory tests and self-treatment, or vice versa, to confirm the need for a specialist consultation.

Delivery and short-term maternal and fetal safety of vaginally administered PEG-PLGA nanoparticles.

At the onset of pregnancy, people with preexisting conditions face additional challenges in carrying their pregnancy to term, as the safety of the developing fetus and pregnant person is a significant factor of concern. Nanoparticle (NP)-based therapies have displayed success against various conditions and diseases in non-pregnant patients, but the use of NPs in maternal-fetal health applications needs to be better established. Local vaginal delivery of NPs is a promising administration route with the potential to yield high cargo retention in the vagina and improved therapeutic efficacy compared to systemic administration that results in rapid NP clearance by the hepatic first-pass effect. In this study, we investigated the biodistribution and short-term toxicity of poly(ethylene glycol)-poly(lactic-co-glycolic acid) (PEG-PLGA) NPs in pregnant mice following vaginal delivery. The NPs were either loaded with DiD fluorophores for tracking cargo distribution (termed DiD-PEG-PLGA NPs) or included Cy5-tagged PLGA in the formulation for tracking polymer distribution (termed Cy5-PEG-PLGA NPs). DiD-PEG-PLGA NPs were administered at gestational day (E)14.5 or 17.5, and cargo biodistribution was analyzed 24h later by fluorescence imaging of whole excised tissues and histological sections. No gestational differences in DiD distribution were observed, so Cy5-PEG-PLGA NPs were administered at only E17.5 to evaluate polymer distribution in the reproductive organs of pregnant mice. Cy5-PEG-PLGA NPs distributed to the vagina, placentas, and embryos, whereas DiD cargo was only observed in the vagina. NPs did not impact maternal, fetal, or placental weight, suggesting they display no short-term effects on maternal or fetal growth. The results from this study encourage future investigation into the use of vaginally delivered NP therapies for conditions affecting the vagina during pregnancy.

Determining Tuffier’s Line by Ultrasound in Pregnant and Non-pregnant Female Patients: a prospective cohort study

Objectives: The correct determination of the vertebral level is important in anesthesia management and the prevention of possible risks. It has been shown that estimation of L4/5 intervertebral lumbar level based on Tuffier’s line determined by palpation (palpated L4/5) is often inaccurate. In this study, it was aimed to investigate how Tuffier’s line changes in the lateral decubitus position due to pregnancy. Material and Methods: The patients were divided into two groups in this prospective cohort study. The pregnant patients were assigned to Group P (n = 75) while the non-pregnant patients were assigned to Group NP (n = 60). Lumbar ultrasound was conducted in both groups in the left lateral decubitus position to verify the vertebral level determined by Tuffier’s line that was detected by palpation. Demographic data, determination time of Tuffier’s line, ultrasound, and the detected vertebral levels were recorded in both groups. Results and Discussion: Vertebral levels detected by both techniques were compatible with 35 (46.6%) patients in Group P and 36 (60%) patients in Group NP (p = 0.165). The vertebral levels in Group P detected via ultrasound were determined at L2 in three (4%) patients, at L2/3 in three (4%) patients, at L3 intervals in three (4%) patients, and at the L3/4 interval in 31 (41.3%) patients. The vertebral levels of the patients in Group NP detected via ultrasound was at L2/3 in 2 (3.3%) patients, and at the L3/4 interval in 22 (36.7%) patients. For the risk of insertion from a risky injection site, the OR = 3.96–95 and GA = 0.82–19.05 in Group P were higher compared to Group NP (approximately 4 times higher). While Group P was significantly limited in the risk analysis, according to L3 (p = 0.087), the risk under this level was similar (p = 0.124). In this study, the verification of Tuffier’s line determined through palpation did not show the correct vertebral level in almost half of the patients in the lateral decubitus position, regardless of pregnancy and demographic data. Conclusion: We believe a possible spinal cord injury can be prevented by determining the needle insertion site via lumbar ultrasound in the pregnant patients. Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 529-535

#5383 THE PREDICTIVE VALUE OF URINARY CONGOPHILIA AS A BIOMARKER IN PREGNANT AND NON-PREGNANT WOMEN WITH LUPUS NEPHRITIS

Abstract Background and Aims Endoplasmic reticulum (ER) stress with protein misfolding has been introduced as a key pathogenetic mechanism in patients with lupus nephritis (LN). Pregnancy is thought to exaggerate ER stress in conjunction with autophagy inhibition. This probably explains disease flares during pregnancy; however, this is not fully addressed. The detection of the abnormally misfolded proteins is made using the Congo red stain, which is referred to as congophilia. This study aimed to assess the predictive value of urinary congophilia as a marker of protein misfolding in pregnant and non-pregnant women with lupus nephritis. Method Urine samples from non-pregnant lupus nephritis patients (n = 45) and pregnant women with lupus nephritis (n = 12), as well as pregnant healthy controls (n = 38) were collected. Urinary congophilia was assessed by Congo Red Dot Blot assay. The disease activity was defined according to SLE Disease Activity Index (SLEDAI) criteria. Renal biopsy was done for 26 adults of non-pregnant lupus nephritis patients at time of urine sampling as it was clinically indicated and modified NIH activity index was assessed. Results The median and range values for SLEDAI score were 14(4-34) for non-pregnant LN patients, and 4(0-6) for pregnant women with LN (Table 1). Congo red retention (CRR) was significantly higher for non-pregnant LN patients (24.18%(0.75-126.29%)), in comparison with pregnant LN patients (0.67%(0.31-27.69%), P = 0.001), and healthy controls (0.33%(0.18-2.7%), P≤0.001). There was a significant positive correlation between CRR on one hand, and anti-ds-DNA (r = 0.791, P≤0.001), as well as SLEDAI score (r = 0.623, P≤0.001) on the other hand. However, no significant correlation has been found between CRR with renal histopathological activity index (r = 0.2, P = 0.425). CRR at a cut point ≥ 21.85% had 83% sensitivity, and 58% specificity to capture high LN activity status (NIH-AI &amp;gt;10) versus lower LN activity status (Fig. 1). Conclusion Urinary congophilia may add a diagnostic value in patients with lupus nephritis and can be a reliable marker of disease activity. CRR is related to disease activity rather than pregnancy.

#4274 CLINICAL FEATURES AND OUTCOMES OF COVID-19-ASSOCIATED ACUTE KIDNEY INJURY REQUIRING DIALYSIS: EXPERIENCE FROM THE FIRST COVID-19 HOSPITAL IN SERBIA

Abstract Background and Aims The new coronavirus disease (COVID-19) pandemic faced the healthcare sector worldwide with an unprecedented challenge. Although respiratory failure is the main feature of the disease, renal involvement is also common, particularly in critically ill patients, and often requires urgent dialysis treatment. This study aimed to analyse clinical features and risk factors for poor outcomes in patients with COVID-19-associated acute kidney injury (AKI) requiring dialysis. Method All 98 patients included in this retrospective observational study were treated in the first hospital in Serbia transformed to exclusively admit COVID-19 patients at the onset of the epidemic. Data were collected from clinical charts and patient histories for the period between March 19, 2020, and March 19, 2022, and analysed with SPSS software, version 22 (IBM Corporation, New York, USA). Results Out of 6,540 non-pregnant adult patients hospitalized for COVID-19 (1,955 in the intensive care unit) in the observed period, 98 (85.7% male, age range 25-89 years) developed dialysis-requiring AKI. A total of 312 hemodialyses (HD) treatments were performed (3.18±2.39, range 1-12, per patient), mostly intermittent HD (85.7% of patients) pertaining to technical resources. The majority of patients (90.8%) had at least one comorbidity – hypertension (38.8%), diabetes (28.6%), cardiovascular disease (11.2%), cerebrovascular disease (3.1%), chronic respiratory disease (7.1%), malignancy (6.1%), or autoimmune disease (1.0%). Most patients (90.8%) required mechanical ventilation. Only 8 (8.2%) were vaccinated. Nearly half (49.0%) of the patients had bilateral pneumonia and 2.0% had ARDS at presentation, with an average CT severity score of 14.05±6.72 (range 1-25) at presentation. Time to AKI presentation was 8.96±5.14 days (range 2-25). The overall mortality rate was 91.8%. Surviving patients had significantly more HD procedures performed (5.00±2.39 vs 3.02±2.34; P = .024) and significantly lower procalcitonin level (1.89±0.16 ng/mL vs 6.14±9.57 ng/mL; P = .015) at presentation. Fatal outcome was significantly more common in individuals requiring mechanical ventilation (p&amp;lt;0.001). Other demographic (age, sex, smoking habit), clinical (comorbidities, vaccination status, radiographic finding, CT severity score, time to AKI onset, type of dialysis) and laboratory parameters (WBC, neutrophil/lymphocyte ratio, CK, LDH, urea, creatinine, CRP, IL-6, D-dimer, ferritin) were not significantly associated with adverse outcome. Multiple logistic regression showed that fewer HD procedures were significantly associated with a higher mortality rate (OR 0.77, 95% CI 0.60-0.99, P = .039). Conclusion Patients who develop dialysis-requiring AKI in the setting of COVID-19 have an extremely high mortality rate. Higher procalcitonin, the need for mechanical ventilation and a lower number of HD procedures are significantly associated with fatal outcomes in this population.

Successful use of single-port laparoscopic surgery for ovarian cyst removal during pregnancy: a case series of three cases

Abstract Pregnant patients have an increased risk of torsion compared to that seen in nonpregnant patients, and those with larger cysts undergo torsion more frequently, which can cause obstructions during labor. The risks associated with emergent surgery are higher than those with elective surgery. Laparoscopic surgery can be safely performed during pregnancy. Single-port laparoscopic surgery is reported to be a minimally invasive laparoscopic technique. We report three cases of ovarian dermoid cysts, which were successfully removed during pregnancy through elective single-port laparoscopic surgery. In all cases, imaging showed a dermoid cyst and the cyst size was greater than 6 cm. All patients requested the surgery. The ovarian cysts were successfully removed by single-port laparoscopy without additional ports and without intra- or postoperative complications. All pregnancies progressed well and delivered vaginally at full term. The single-port laparoscopic approach is useful for removing ovarian cysts during pregnancy.

Venous Thromboembolism Management in Pregnant Patients

Pulmonary embolism (PE) in pregnancy accounts for 10% of maternal deaths in the United States. As maternal morbidity and mortality continue to increase, it is imperative for all specialties interfacing with pregnant patients to understand the current research and guidelines surrounding risk stratification, diagnosis, and treatments of PE in pregnancy. Given the complexity of high-risk pregnancy-associated PE (PA-PE), that is, which is associated with hemodynamic instability or collapse, and the rising popularity of new technologies to treat high-risk PA-PE in the nonpregnant population, this review aims to emphasize the differences in diagnosis, risk stratification, and management of the pregnant and nonpregnant PE patients. Furthermore, this review will cover treatment paradigms that include anticoagulation versus advanced therapies such as systemic thrombolysis, surgical embolectomy, extracorporeal membrane oxygenation, and inferior vena cava disruption as well as the more novel therapies which fall under the umbrella term of catheter-based treatments. Finally, this review will include a case-based review of 2 patients with PA-PE requiring catheter-based therapies and their ultimate clinical outcomes.

Evaluation of left ventricular function of pregnant women with autoimmune diseases using speckle tracking echocardiography.

Pregnancy can cause fluctuations in autoimmune diseases (AD) women, which may aggravate the cardiac damage. Maternal heart function is very important for maternal and fetal health. Therefore, early and accurate evaluation of the heart function of AD pregnant women is necessary. This study was aimed to evaluate the left ventricular (LV) function of AD pregnant women using two-dimensional speckle tracking echocardiography (2DSTE). A total of 96 subjects, including 26 non-pregnant AD patients (AD group), 33 AD pregnant women (AD-P group), and 37 healthy pregnant women (H-P group) were conducted. Baseline clinical and conventional echocardiography characteristics of all the subjects were collected. The 2DSTE was performed to acquire layer-specific strain parameters of LV. Compared with H-P group, AD-P group showed no significant differences in GLSmid and GLSepi. However, the GLSendo (24.10 [22.30 to 25.40] vs. 21.70 [19.05 to 25.15], P = 0.023) and ΔGLS (5.50 [4.80 to 6.00] vs. 4.90 [4.20 to 5.80], P = 0.017) were decreased, while the PSD (27 [23 to 32] vs. 32 [24 to 44], P = 0.014) was increased. At the segmental level, there was no significant difference in apex LSmid and LSepi between the two groups, while the AD-P group showed transmural dysfunction in basal and middle segments, and the LSendo in apex segments (32.84 [28.34 to 34.25] vs. 27.97 [21.87 to 33.61], P = 0.021) were significantly decreased. Compared with AD group, AD-P group showed no significant difference in ΔGLS, PSD, and GLS parameters of three layers. For the segmental level, there were no significant differences in the LSepi of the apex segment and the LS in three layers of the basal and middle segments between the two groups, while LSendo (32.69 [29.13 to 35.53] vs. 27.97 [21.87 to 33.60], P = 0.017) and LSmid (24.70 [22.24 to 27.78] vs. 21.32 [16.91 to 26.11], P = 0.023) in apex segments were significantly lower in AD-P group. The anti-SSA/Ro antibody were positive independently correlated with PSD. In conclusion, layer-specific strain parameters and PSD by 2DSTE provide an accurate and reproducible measurement of myocardial function. There are subclinical LV myocardial dysfunction in AD pregnant women. Besides, the positive of anti-SSA/Ro antibody maybe associated with LV myocardial dysfunction.

An Analysis of Outcomes After Trauma in Obstetric Patients.

Traumatic injury in obstetric patients has been shown to correlate with adverse fetal outcomes; however, data predates modern resuscitation and imaging techniques. A single center retrospective review was performed analyzing risk factors for obstetric outcomes for pregnant patients seen at a Level 1 Trauma Center from 2010 to 2020. 571 pregnant patients were compared to nonpregnant child-bearing age women. Injury Severity Scores (ISS) were higher in nonpregnant patients (5 vs 0, P < .001), with similar mortality (P = .07). 558 (98%) injured pregnant patients had an ISS < 9. 122 (21%) pregnant patients suffered obstetric or fetal complications, had higher ISS (P < .001), higher abbreviated injury scales (AIS) for thorax, abdomen, spine, lower extremities (P < .05), and lower gestational age (P = .005). Age, Glasgow Coma Score (GCS), AIS Abdomen and Lower Extremity, and preterm pregnancy were predictive of adverse outcomes. Non-caucasian race, higher gestational age, and term pregnancy were predictive of labor during admission.

Sugammadex Use for Reversal in Nonobstetric Surgery During Pregnancy: A Reexamination of the Evidence.

Sugammadex Use for Reversal in Nonobstetric Surgery During Pregnancy: A Reexamination of the Evidence.

Differential expression of serum mir-363-3p in patients with polycystic ovary syndrome and its predictive value for their pregnancy

BackgroundThis study aimed to investigate the expression of serum miR-363-3p in patients with polycystic ovary syndrome (PCOS) and its predictive value for pregnancy after ovulation induction therapy.MethodsThe expression of serum miR-363-3p was detected by Reverse transcription quantitative polymerase chain reaction (RT-qPCR). PCOS patients were treated with ovulation induction therapy, and after the successful pregnancy was confirmed, they were followed up for 1 year in outpatient department to record the pregnancy outcomes of the patients. The Pearson correlation coefficient was used to evaluate the correlation between the expression level of miR-363-3p and biochemical indicators of PCOS patients. Logistic regression analysis was used to analyze the risk factors of pregnancy failure after ovulation induction therapy.ResultsThe serum level of miR-363-3p in PCOS group was significantly lower than that in control group. Compared with the control group, both pregnant and non-pregnant groups had lower miR-363-3p levels, while the non-pregnant group had a greater reduction in miR-363-3p levels than the pregnant group. Low levels of miR-363-3p showed high accuracy in distinguishing pregnant and non-pregnant patients. Logistic regression analysis showed that high levels of luteinizing hormone, testosterone (T), prolactin (PRL) and low level of miR-363-3p were independent risk factors for pregnancy failure after ovulation induction in PCOS patients. Additionally, compared with pregnancy outcomes of healthy women, the incidence of premature delivery, macrosomia, and gestational diabetes in PCOS patients increased.ConclusionsThe expression of miR-363-3p in PCOS patients was reduced and correlated with abnormal hormone levels, suggesting that miR-363-3p may be involved in the occurrence and development of PCOS.

An Assessment of Association of Gravidity of Pregnant and Non-Pregnant Females with Periodontal Health and Periodontal Treatment Needs

Objective: To assess the association of gravidity of pregnant and non-pregnant females with their periodontal health and treatment needs. Methodology: A cross sectional study was conducted from March 2019 to August 2019 among 44 pregnant and 52 non-pregnant women visiting the gynecology department of Sharif Medical and Dental College and Raiwind Polyclinic, Lahore (community out¬reach program of the institute) using non-probability convenient sampling technique. Data was collected using the Community Periodontal Index of Treatment Needs (CPITN). Results: A non-significant association was seen between the periodontal health and gravidity of pregnant females (p=0.454) and non-pregnant females (p=0.863). Most of the primigravida had periodontal treatment needs (TN1). TN 2 was required by both groups equally Conclusion: Primigravida pregnant females had a higher percentage of healthy periodontium while the multigravida pregnant females had more calculus deposition and a higher percentage of pocket depth 4-5mm. The multigravida non-pregnant patients had calculus deposition as their major periodontal problem followed by bleeding gums. Most of the primigravida pregnant females required oral hygiene instructions and had periodontal treatment needs (TN1). Those requiring (TN 2) were approximately equal in both groups while none of the females from both the groups required complex treatment (TN3). Keywords: Primigravida, Multigravida, periodontal health, pregnant females, periodontal treatment needs.

Clinical Characteristics of Acute Appendicitis in Pregnancy: 10-Year Experience at a Single Institution in South Korea.

Acute appendicitis is the most common cause of non-obstetric surgical disease in pregnant women. The diagnosis and treatment of appendicitis during pregnancy are very important because it can cause life-threatening morbidity to the fetus and mother. We evaluated the clinical characteristics of acute appendicitis in pregnant women. We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis at our hospital from January 2013 through December 2022. We compared non-pregnant women of reproductive age with pregnant women. We classified the pregnant women according to gestational age. A total of 828 patients were reproductive-aged women between 15 and 44 years old. There were 759 non-pregnant patients and 69 pregnant patients. ASA (American Society of Anesthesiologists) physical status classes were significantly higher and hospital stays were significantly longer in the pregnant group. There was no significant intergroup difference in terms of the proportions of complicated appendicitis, extended surgery, or complications. When the enrolled pregnant women were divided into three subgroups according to gestational age, the mean operation time was longest in the third-trimester subgroup. There were no differences among the subgroups in terms of the proportions of complicated appendicitis, extended surgery, or complications, nor were there differences among the subgroups in terms of laboratory findings. Preterm labor and stillbirth occurred in two pregnant women with complicated appendicitis in the second trimester. Immediate surgical treatment should be strongly considered in pregnant women with appendicitis. Efforts for more accurate diagnosis are needed for pregnant women with appendicitis.

An integrative analysis of endometrial steroid metabolism and transcriptome in relation to endometrial receptivity in in vitro fertilization patients

To study the relation between the steroid concentration in endometrium, in serum and the gene expression level of steroid metabolizing enzymes in the context of endometrial receptivity in IVF patients. Case-control study of 40 IVF patients recruited in the SCRaTCH study (NTR5342), a randomized controlled trial investigating pregnancy outcome after 'endometrial scratching'. Endometrial biopsies and serum were obtained from patients with a first failed IVF cycle randomized to the endometrial scratch in the mid-luteal phase of the natural cycle prior to the next fresh embryo transfer during the second IVF cycle. Twenty women with clinical pregnancy were compared with 20 women that did not conceive after fresh embryo transfer. Cases and controls were matched for primary versus secondary infertility, embryo quality and age. Steroid concentrations in endometrial tissue homogenates and serum were measured with liquid chromatography-mass spectrometry. The endometrial transcriptome was profiled by RNA-sequencing followed by principal component analysis and differential expression analysis. False Discovery Rate-adjusted p<0.05 and log Fold Change >|0.5| were selected as threshold for differentially expressed genes. Estrogen levels were comparable in both serum (n=16) and endometrium (n=40). Androgens and 17-hydroxyprogesterone were higher in serum as compared to endometrium. Although steroid levels did not vary between pregnant and non-pregnant groups, subgroup analysis of primary infertile women showed a significantly lower estrone concentration and estrone:androstenedione ratio in serum of the pregnant group (n=5) compared to the non-pregnant group (n=2). Expression of 34 out of 46 genes encoding the enzymes controlling the local steroid metabolism was detected and estrogen receptor β gene was differentially expressed between pregnant and non-pregnant women. When only the primary infertile group was considered, 28 genes were differentially expressed between pregnant and non-pregnant women, including HSD11B2, that catalyses the conversion of cortisol into cortisone. Steroidomic and transcriptomic analyses show that steroid concentrations are regulated by the local metabolism in the endometrium. Although no differences were found in endometrial steroid concentration in the pregnant and non-pregnant IVF patients, primary infertile women showed deviations in steroid levels and gene expression, indicating that a more homogeneous patient group is required to uncover the exact role of steroid metabolism in endometrial receptivity.