Normal Pregnancy Research Articles

ПОРТРЕТ ПОТРЕБИТЕЛЯ УСЛУГ НЕГОСУДАРСТВЕННЫХ КОММЕРЧЕСКИХ МЕДИЦИНСКИХ ОРГАНИЗАЦИЙ, ОКАЗЫВАЮЩИХ ПЕДИАТРИЧЕСКУЮ АМБУЛАТОРНО-ПОЛИКЛИНИЧЕСКУЮ ПОМОЩЬ

One of the important tasks in organizing the activities of a non-state commercial medical institution is to create such conditions that the consumer of services has a firm confidence that diagnostics, treatment and rehabilitation correspond to the expected level (quality). Therefore, in order to improve its activities, a non-governmental commercial medical organization constantly monitors what level of service the consumer considers acceptable and how much the structure of patients who applied for paid medical care has changed. The purpose of this study was: to study the social portrait of a services consumer of a non-governmental commercial medical organization providing pediatric medical care. For the study, a sociological survey was used - a survey of parents of underage patients, conducted in a non-governmental commercial medical organization in Kazan. The results obtained showed that in the structure of consumers of medical services in the field of commercial pediatric medical care, women predominate - persons aged 32-37 years; married, with two children; with higher education, mostly employees, with more than 10 years work experience; assessing the financial family situation as “average”, while noting that the child (children) observation by commercial medical organization specialists does not affect the family budget; who have chosen a non-governmental commercial medical organization to monitor the child after the existing unsuccessful experience of visiting the state clinic, having listened to the recommendations of friends, relatives, acquaintances; justify their choice: high professionalism of doctors and nurses; polite, helpful staff and no queues. The main reasons that influenced the choice in favor of a commercial medical institution is the desire to receive better medical care in comfortable conditions. Thus, the study allows us to state that the social portrait of the consumer of paid medical services in the studied commercial pediatric medical organization has not changed over the past 10 years. The medical and social characteristics of the children observed in the studied commercial pediatric medical organization are also given: they are full-term, from 1 or 2 normal pregnancies, born naturally, on the Apgar scale of at least 8/9 points, do not belong to frequently ill children.

The Awareness and Knowledge of Normal and Abnormal Signs and Symptoms of Pregnancy Among Women of Childbearing Age in Saudi Arabia.

Pregnancy is a natural physiological process that leads to the outstanding outcome of giving birth. It involves normal and abnormal signs and symptoms that women need to be aware of during this period. This study aims to assess the awareness and knowledge about normal and abnormal signs and symptoms of pregnancy among women of childbearing age in Saudi Arabia. This is an online questionnaire-based cross-sectional study done in 2023 among women in Saudi Arabia, aged 18 to 45. The estimated sample size was 385 after applying inclusion and exclusion criteria. However, 981 responses were collected and included. A total of 981 participants were included in our study. The study findings noted that the majority of women demonstrated a good level of knowledge about the normal signs and symptoms of pregnancy. About 82% of the women reported that they knew mood swings were normal symptoms during pregnancy, 80.1% were aware of nausea, 75.9% knew about fatigue, and 68.9% knew about fainting or dizziness. The findings noted that less than half of the participants were fully aware of the abnormal obstetric signs. For the abnormal signs and symptoms during the first trimester, only 45.2% were fully aware of the symptoms. In the second trimester, 39.0% were fully aware of the symptoms. Only 30.5% of the participants were fully aware of the abnormal signs and symptoms in the third trimester. The study established a statistically significant relationship between age and knowledge of abnormal symptoms during the first, second, and third trimesters (P=0.027, 0.041, and 0.006) (r=0.139, 0.105, and 0.146). Furthermore, a statistically significant relationship was found between the level of education of the participants and the level of awareness of abnormal symptoms during the first trimester (P=0.043). However, there was no significant relationship between education level and the level of knowledge regarding abnormal symptoms during the second and third trimesters (r=0.22, 0.061, P=0.578, 0.603). The study found that the majority of women had a good level of awareness and knowledge about normal signs and symptoms of pregnancy, while less than half of the women were fully aware of the abnormal signs and symptoms at different stages of pregnancy. The older respondents and people with higher levels of education demonstrated more knowledge. The two variables, age and education level, had a statistically significant relationship with knowledge of abnormal signs and symptoms of pregnancy with education level being only significant during the first trimester period. Our study concluded that women had different symptoms during pregnancy, both normal and abnormal. Their knowledge about these signs and symptoms was considerably moderate, but further awareness about the normality of these signs is needed. The study recommends more research to measure women's awareness about normal and abnormal symptoms of pregnancy, and more awareness programs should be carried out in the region as a way of enhancing a better understanding of normal and abnormal pregnancy symptoms. This will go a long way in helping women through their pregnancy and make them more comfortable.

First trimester SHARP1 and second-trimester uterine artery Doppler to predict preeclampsia

Objectives The objective of this study was to identify the predictive value of the first-trimester serum SHARP1 level and the second-trimester uterine artery Doppler in singleton pregnancy for the prediction of preeclampsia. Methods A prospective study including singleton pregnancy presenting at an antenatal clinic, King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University from 2019–March 2020 was conducted. Serum SHARP1 was collected at the gestational age (GA) of 11–13+6 weeks, and transabdominal uterine artery Doppler ultrasound was performed at GA of 18–24 weeks. Serum SHARP1 level and uterine artery pulsatility index (PI) were combined to calculate the predictive value for preeclampsia detection. Results 288 pregnant women were enrolled in the first trimester, but only 249 participants completed the study. Thirteen patients had preeclampsia (5.2%), which three cases (1.2%) had early-onset preeclampsia. The median serum SHARP1 level in the first trimester of pregnant women with preeclampsia was lower than the normal pregnancy group (1392 pg/ml vs. 1941 pg/ml, p = 0.046). The second-trimester uterine artery PI and prevalence of early diastolic notching were higher in the preeclampsia group than in the normal pregnancy group (p = 0.029 and p = 0.001, respectively). When the first-trimester serum SHARP1 level is combined with the second-trimester uterine artery PI, the sensitivity, specificity, PPV, and NPV for preeclampsia prediction were 84.6%, 47.5%, 8.2%, and 98.3%, respectively. Conclusions This study demonstrated that serum SHARP1 level in the first trimester combined with the uterine artery PI in the second trimester had good sensitivity to predict preeclampsia.

Proteomic profiling analysis of human endometrium in women with unexplained recurrent spontaneous abortion

Unexplained recurrent spontaneous abortion (URSA) seriously affects female reproductive health, causing a great burden to patients both physically and mentally. Endometrial decidualization plays an important role in pregnancy, and impaired decidualization is an essential cause of URSA, but the cause of the damage is still poorly understood. This study aimed to reveal the pathogenesis of URSA by analyzing the differential protein expression profiles in the decidual tissue of patients with recurrent abortion compared to those with normal pregnancy. Morphological analysis revealed abnormal decidualization of endometrial tissue in patients with URSA. Quantitative proteomics analysis showed that a total of 146 differentially expressed proteins were identified between the two groups, among which 95 proteins were downregulated and 51 proteins were upregulated. Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways revealed that the protein expression profile and signaling pathways of endometrium in patients with URSA changed significantly, and cytoskeleton remodeling and morphological transformation disorders were associated with abortion induced by incomplete decidualization. Meanwhile, transcription factors analysis showed that the 3 most affected families were zf-C2H2, MYB and HMG. Therefore, our study may provide a basis for searching for potential markers of decidualization injury. SignificanceAt present, there are still about 50% of RSA patients with unknown causes, which brings great difficulties and blindness to clinical diagnosis and treatment.The limited proteomic studies on URSA further contribute to the lack of understanding in this field. However, in this study, the focus was on proteomic profiling analysis of the human endometrium in URSA patients compared to normal women. The findings revealed that cytoskeletal remodeling disorder is a significant contributor to the failure of decidualization in URSA patients. This insight highlights the potential role of cytoskeleton-related proteins in the pathogenesis of URSA, providing valuable information for further research and potential therapeutic interventions.

Association of TP53 rs1042522 G > C, MDM2 rs2279744 T > G, and miR-34b/c rs4938723 T > C polymorphisms with aneuploidy pregnancy susceptibility

BackgroundAneuploidy pregnancy is a severe major birth defect and causes about 50% spontaneous miscarriages with unknown etiology. To date, only a few epidemiological studies with small sample sizes have investigated the risk factors for aneuploidy pregnancy. TP53, MDM2, and miR-34b/c genes are implicated in tumorigenesis with aneuploidy, yet the function of their polymorphisms in aneuploidy pregnancy susceptibility needs to be clarified.ObjectiveTo elucidate the association of TP53 rs1042522 G > C, MDM2 rs2279744 309 T > G, and miR-34b/c rs4938723 T > C specific polymorphisms with aneuploidy pregnancy.MethodsIn the retrospective case-control study, 330 aneuploidies pregnancy women and 813 normal pregnancy controls were recruited between January 2018 and April 2022 at the First People’s Hospital of Yunnan Province, Kunming, China. Three functional polymorphisms, the TP53 rs1042522 G > C (Arg72Pro), MDM2 rs2279744 309 T > G, and miR-34b/c rs4938723 T > C, were genotyped using the snapshot method.ResultsThe frequency distribution of three genotypic variants was not different between case and control pregnant women and was similar to with Hardy-Weinberg Equilibrium (HWE). However, in the younger subgroup (less than 35 years old), a significant difference was detected in allele and recessive model (p = 0.01). In the advanced age subgroup (more than or equal to 35 years old), G of MDM2 rs2279744 T > G revealed a significantly higher frequency in cases than controls (p = 0.045), and miR-34b/c rs4938723 T > C revealed a significant difference under the dominant model (p = 0.03), but no significant differences were observed in other models and in both younger and older subgroup (p > 0.05, respectively). These results suggest that individual polymorphisms were not associated with aneuploidy pregnancy, combined with age, they may serve as a risk factor for aneuploidy pregnancy.ConclusionCombination of TP53 rs1042522 G > C, MDM2 rs2279744 T > G, and miR-34b/c rs4938723 T > C polymorphisms with maternal age may be related to aneuploidy pregnancy susceptibility. These findings might elaborate on the genetic etiology of aneuploidy pregnancy.

The Effect of Preeclampsia on the Quality of Life of Children

Children who born to pregnant women with preeclampsia are at risk of having low physical and cognitive functions due to the influence of placental blood flow ischemia which affects children's neurodevelopment. The object of this research was to determine the effect of preeclampsia during pregnancy on the quality of life of children 2-4 years. The study used a retrospective cohort. The sample was 104 (consisted of 52 pregnant women with preeclampsia and 52 normal pregnant women), not suffering from chronic disease, taken randomly. Preeclampsia was assessed based on the diagnosis from medical records, while children’s quality of life was assessed using PedsQL. Data were analyzed by using logistic regression. The results showed preeclampsia has an effect on physical quality of children (p-value 0.03 <0.05), but did not affect the child's social and emotional function. Children born to mothers with preeclampsia are at 5.9 times the risk of having low physical quality compared to children born to normal maternal pregnancies. Early efforts are needed to stimulate children born to mothers who suffer from Preeclampsia in order to obtain optimal quality of life and physical function.

Prediction of postnatal abnormal umbilical cord coiling by antenatal evaluation in pregnant women: Diagnostic accuracy study; a systematic review.

Umbilical cord abnormalities increase neonatal morbidity and mortality. Considering uncertainties about the best time of an antenatal ultrasonography scan to evaluate the umbilical coiling index (UCI), this systematic review was designed to assess the diagnostic accuracy value of antenatal ultrasound assessments to predict abnormal postpartum UCI. All observational, cross-sectional, case-control, cohort, and diagnostic accuracy studies up to March 26, 2022, were searched and assessed according to PRISMA guidelines in Ovid, Cochrane, Scopus, PubMed, Web of Science, Embase, Proquest, Science Direct, and Clinical Key databases, and Google Scholar search engine. The total number of 63 190 documents were retrieved from databases. The duplicates (19 272) were removed, 43 918 articles were screened for relevance, and 56 papers were selected for full-text evaluation, resulting in 14 qualified pieces subjected to the quality CASP tools for each type of study. Finally, six articles were evaluated, extracted, and confirmed. Overall, we had 16 evaluations (11 normal pregnancies, 4 gestational diabetes mellitus, and 1 group at risk for small gestational age), from which 9 and 7 were respectively performed in the second and third trimesters. Most of the evaluations considered both hypocoiling and hypercoiling. The sensitivity, specificity, and area under curves (AUCs) change range between the evaluations were 0.09-0.97, 0.59-0.96, and 0.262-0.84, respectively. Observing any coiling abnormalities in every trimester, both the second and third, is highly sensitive to predicting abnormal postnatal UCI (pUCI). Conclusively, any detected antenatal abnormality is worth attention. Both trimesters' evaluations are essential, and no superiority is seen for any of them. The systematic review revealed statistical and clinical heterogeneity; a meta-analysis was impossible.

Hyperglycemia alters retinoic acid catabolism in embryos exposed to a maternal diabetic milieu.

Pregestational diabetes is highly associated with increased risk of birth defects. We previously reported that the expression of Cyp26a1, the major catabolizing enzyme for controlling retinoic acid (RA) homeostasis, is significantly down-regulated in embryos of diabetic mice, thereby increasing the embryo's susceptibility to malformations caused by RA dysregulation. However, the underlying mechanism for the down-regulation of Cyp26a1 remains unclear. This study aimed to investigate whether elevated maternal blood glucose in the diabetic milieu is a critical factor for the altered Cyp26a1 expression. Streptozotozin-induced diabetic pregnant mice were treated with phlorizin (PHZ) to reduce blood glucose concentrations via induction of renal glucosuria. Embryonic Cyp26a1 expression level, RA catabolic activity and susceptibility to various RA-induced abnormalities were examined. To test the dose-dependent effect of glucose on Cyp26a1 level, early head-fold stage rat embryos of normal pregnancy were cultured in vitro with varying concentrations of D-glucose, followed by quantification of Cyp26a1 transcripts. We found that Cyp26a1 expression, which was down-regulated in diabetic pregnancy, could be normalized under reduced maternal blood glucose level, concomitant with an increase in RA catabolic activity in embryonic tissues. Such normalization could successfully reduce the susceptibility to different RA-induced malformations including caudal regression, cleft palate and renal malformations. The expression level of Cyp26a1 in the embryo was inversely correlated with D-glucose concentrations. Diabetic patients suffer from retinopathy, dermopathy, male infertility and increased cancer risk. Coincidentally, RA dysregulation is also associated with these health problems. Our results provided evidence that elevated glucose can down-regulate Cyp26a1 expression level and disturb RA homeostasis, shedding light on the possibility of affecting the health of diabetic patients via a similar mechanism.

Prevalence of Vitamin D Deficiency in Recurrent Early Pregnancy Loss

Background Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the etiology is often unknown and there are few evidence-based diagnostic and treatment strategies. Studies on the etiology, evaluation, and management of RPL are often flawed. Aim of the Work The aim of the current study was to assess the association between vitamin D status and recurrent pregnancy loss. Patients and Methods The current study was conducted at Ain shams University Maternity Hospital during the period between October 2020 and April 2021. This research recruited 60 pregnant women categorized in to two research groups: Group A - study group: 30 pregnant women with early pregnancy loss and history of repeated pregnancy loss, Group B - control group: 30 pregnant women complete the first trimester with no early pregnancy loss. The 25(OH)D concentration measured in this case control study with predominantly first-trimester blood sampling. Results Choosing matched controls was to decrease confounders so according demographic variables; there was a statistically insignificant difference between group A (RPL) and group B (Normal pregnancy) as regards the demographic research data of study subjects recruited, the mean age was 24.5±2.6 years, the mean BMI was 25.8±2.1 Kg/m2. There was a statistically significant difference between Group A (RPL) and group B (Normal pregnancy) as regard 25(OH)D level (p < 0.001), mean was 11.9±3.2 ng/ml and 16.9±6.5 ng/ml respectively. Vitamin D was significantly associated with recurrent pregnancy loss. Conclusion The current study showed a significant association between vitamin D deficiency in pregnancy and occurrence of Recurrent pregnancy loss. A lot of researches needed to increase the quality of evidence about the association between low levels of vitamin D and recurrent pregnancy loss.

Systematic Approach of Basic Fetal Echocardiography in Normal and High Risk Pregnancy

Background Fetal echocardiography was initially used to identify congenital heart defects (CHD) and arrhythmias. Since then, technical advances have enabled a notable improvement in the assessment of cardiac structure and function. Objective to highlight the importance of a systematic approach of basic fetal echocardiography in normal and high risk pregnancy. Patients and Methods Normal and high risk pregnant females will be studied in this research using colour doppler ultrasound. Two-dimensional imaging is still the gold standard and commonly used in fetal echocardiography. Therefore, we present standard views of the normal fetal heart obtained during the second trimester by two-dimensional ultrasound, and color and pulsed wave Doppler. Study place: Ain Shams university hospitals. Sample size: 30 normal and 30 high risk pregnant female patients. Results we have provided reference values for cardiac morphometric parameters across second trimester of pregnancy in a low-risk and high risk population including the Right and left atria longitudinal diameters, right and left ventricular longitudinal diameters, cardiothoracic ratio and heart rate and correlate low to high risk values. All dimensions showed a progressive increase with gestational age, some of the parameters show significant difference between low risk and high risk including the LV diameter with p value of 0.023, cardiothoracic ratio with p value of 0.001 and heart rate with p value of 0.001 Conclusion Fetal Echocardiography at the second trimester of pregnancy is crucial for detection of any abnormality at the high risk group and their follow up along the whole pregnancy for a better outcome.

Hypoxia-inducible factor 1 signaling drives placental aging and can provoke preterm labor.

Most cases of preterm labor have unknown cause, and the burden of preterm birth is immense. Placental aging has been proposed to promote labor onset, but specific mechanisms remain elusive. We report findings stemming from unbiased transcriptomic analysis of mouse placenta, which revealed that hypoxia-inducible factor 1 (HIF-1) stabilization is a hallmark of advanced gestational timepoints, accompanied by mitochondrial dysregulation and cellular senescence; we detected similar effects in aging human placenta. In parallel in primary mouse trophoblasts and human choriocarcinoma cells, we modeled HIF-1 induction and demonstrated resultant mitochondrial dysfunction and cellular senescence. Transcriptomic analysis revealed that HIF-1 stabilization recapitulated gene signatures observed in aged placenta. Further, conditioned media from trophoblasts following HIF-1 induction promoted contractility in immortalized uterine myocytes, suggesting a mechanism by which the aging placenta may drive the transition from uterine quiescence to contractility at the onset of labor. Finally, pharmacological induction of HIF-1 via intraperitoneal administration of dimethyloxalyl glycine (DMOG) to pregnant mice caused preterm labor. These results provide clear evidence for placental aging in normal pregnancy, and demonstrate how HIF-1 signaling in late gestation may be a causal determinant of the mitochondrial dysfunction and senescence observed within the trophoblast as well as a trigger for uterine contraction.

Hypoxia-inducible factor 1 signaling drives placental aging and can provoke preterm labor

Most cases of preterm labor have unknown cause, and the burden of preterm birth is immense. Placental aging has been proposed to promote labor onset, but specific mechanisms remain elusive. We report findings stemming from unbiased transcriptomic analysis of mouse placenta, which revealed that hypoxia-inducible factor 1 (HIF-1) stabilization is a hallmark of advanced gestational timepoints, accompanied by mitochondrial dysregulation and cellular senescence; we detected similar effects in aging human placenta. In parallel in primary mouse trophoblasts and human choriocarcinoma cells, we modeled HIF-1 induction and demonstrated resultant mitochondrial dysfunction and cellular senescence. Transcriptomic analysis revealed that HIF-1 stabilization recapitulated gene signatures observed in aged placenta. Further, conditioned media from trophoblasts following HIF-1 induction promoted contractility in immortalized uterine myocytes, suggesting a mechanism by which the aging placenta may drive the transition from uterine quiescence to contractility at the onset of labor. Finally, pharmacological induction of HIF-1 via intraperitoneal administration of dimethyloxalyl glycine (DMOG) to pregnant mice caused preterm labor. These results provide clear evidence for placental aging in normal pregnancy, and demonstrate how HIF-1 signaling in late gestation may be a causal determinant of the mitochondrial dysfunction and senescence observed within the trophoblast as well as a trigger for uterine contraction.

Decidualized human decidual stromal cells inhibit chemotaxis of activated T cells: a potential mechanism of maternal-fetal immune tolerance.

Numerous lines of evidence confirm that decidual stromal cells (DSCs) play a key role in maternal-fetal immune tolerance. Under the influence of progesterone and other hormones, the DSCs go through a process of differentiation (decidualization) during normal pregnancy. In mice, DSCs inhibit the expression of chemokines that attract abortigenic Th1 and Tc cells to the decidua. We have studied this phenomenon in humans. We established human DSC lines and decidualized these cells in vitro with progesterone and cAMP. We determined the expression of the chemokines CXCL9, CXCL10 and CXCL11, whose receptor CXCR3 is expressed by Th1 and Tc cells, in undifferentiated DSCs and decidualized DSCs by qRT-PCR. Activated CD3+CXCR3+ cells, including CD4+ Th1 cells and CD8+ Tc cells, were induced in vitro. The migration capacity of these activated lymphocytes was investigated in Transwell chambers with conditioned media from undifferentiated and decidualized DSCs. We demonstrated that CXCL9 was not expressed by DSCs, whereas the expression of CXCL10 and CXCL11 was inhibited in decidualized cells. Conditioned media from decidualized cells significantly inhibited the migration of Th1 and Tc cells. We found that decidualized cells secrete factors of MW less than 6000-8000 Da, which actively inhibit the chemotaxis of these lymphocytes. These results confirm in humans that decidualization of DSCs inhibits the expression by these cells of chemokines that attract Th1 and Tc cells and induces the secretion by DSCs of factors that inhibit the chemotaxis of these lymphocytes, thus preventing the arrival of abortigenic T cells in the decidua.

Regulatory mechanisms underlying endoplasmic reticulum stress involvement in the development of gestational diabetes mellitus entail the CHOP-PPARα–NF–κB pathway

ObjectiveWe investigated the proinflammatory functions of endoplasmic reticulum stress and peroxisome proliferator-activated receptor α (PPARα) in the development of gestational diabetes mellitus (GDM) and their relationship in regulating inflammation in GDM. MethodsThis study was performed on placentas of normal pregnant women, women with GDM, and HTR8 cells. Transmission electron microscopy, immunohistochemistry, Western blot analysis, and RT-PCR were performed to analyze ERS and PPARα expression on both normal and GDM pregnancy placentas. ELISA was performed to analyze inflammatory biomarkers. To generate models of the GDM-like state, placentas of normal pregnancy were treated with LPS and polyinosinic-polycytidylic acid (poly [I:C]). TG, CHOP plasmid, and CHOP siRNA were assessed as to their regulation of HTR8 cells to discern the relationship between ERS and PPARα in regulating the inflammation associated with GDM. ResultsERS was elevated in GDM placentas, induced the secretion of IL-6 and TNF-α, and attenuated the expression of GLUT-4. PPARα was diminished in GDM placentas and inhibited the inflammatory responses via the NF-κB nuclear-transport process. 4-PBA reduced CHOP and augmented PPARα, and it decreased IL-6 and TNF-α in our GDM-like explant. However, with both 4-PBA and MK886 treatment, we noted no significant difference in CHOP expression. The level of PPARα was reduced, and that of NF-κB p65 in the nucleus was elevated with TG treatment in the HTR8/Svneo. Knockdown of CHOP increased PPARα and reduced NF-κB p65, while expression of PPARα declined, and that of NF-κB p65 rose with the application of CHOP when HTR8 cells were treated with TG. ConclusionsERS contributes to the pathophysiology of GDM in pregnancy via the CHOP-PPARα–NF–κB-signalling pathway by inducing aberrant activation of inflammation and insulin resistance.

Middle Cerebral Artery Blood Flow Velocity During Normal Pregnancy.

The present study aimed to evaluate resting middle cerebral artery (MCA) blood flow velocities using transcranial Doppler ultrasound (TCD) in healthy women at different stages of pregnancy, and to compare these velocities with those of normal controls. A total of 105 healthy normotensive pregnant women and 25 non-pregnant healthy controls were included in the study. We formed 3 groups according to gestational age: first trimester (7 to 13wk pregnant), second trimester (14 to 28wk pregnant), and third trimester (29 to 42wk pregnant). Age, body mass index, heart rate, arterial blood pressure, and hematological data were recorded and TCD was performed on the subjects. Regarding TCD, we evaluated the mean cerebral blood flow velocity, the peak systolic velocity, the end-diastolic flow velocity, S/D ratio, the pulsatility Index (PI) and the resistance Index (RI). The MCA mean blood flow velocities differed significantly among the groups (P<0.001) and were higher in the controls than those of the first trimester, second trimester, and third trimester groups (P<0.01, P<0.001, P<0.001 respectively). The MCA mean and peak blood flow velocities, and the PI and RI decreased significantly with advancing gestation. TCD is a noninvasive and non-toxic method of monitoring the adaptation of the maternal cerebral blood flow in pregnancy. The progressive decreases in the MCA mean and peak blood flow velocities, PI, and RI during gestation may be the result of chemical and neuronal factors. This study supports the need for additional studies using TCD to establish normative cerebral blood flow volumes throughout pregnancy.

Features of the course of pregnancy and health of newborns with intrauterine growth restriction

Introduction. The development of intrauterine growth restriction (IUGR) begins with fertilization and trophoblast invasion. IUGR is manifested in a decrease in fetal growth rate. However, data on risk factors for fetal growth retardation, their combination with various chronic diseases in a pregnant woman are contradictory.Objective. To study the features of the course of pregnancy, childbirth, the health status of newborns with IUGR. Materials and methods. The study was a retrospective cohort study. At the first stage, we analyzed 1574 birth histories with a diagnosis of IUGR, placental insufficiency, women with normal pregnancy who gave birth (2016–2021). According to the inclusion and exclusion criteria, 408 women were included in the study. The women were divided into 2 groups. The first group included 202 pregnant women with a diagnosis of IUGR. In the second Group – 206 pregnant women with normal pregnancy, without IUGR, delivered at the time corresponding to the terms in the main group.Results. We have clarified the risk factors and premorbid conditions involved in the development of IUGR (somatic and gynecological morbidity, pregnancy course). Their analysis is necessary to predict IUGR. The analysis of the timing and method of delivery in the studied groups was carried out. A higher incidence of complications in the early neonatal period was revealed when assessing the health status of newborns with IUGR.Conclusion. Thus, the study of the mechanisms of IUGR formation in the future will allow the development of modern pathogenetic approaches to prevention and treatment.

Detection of HPV-16 in Cervical Swab in Woman with Recurrent Pregnancy Loss by Real-Time PCR

Human Papilloma Virus is one of the most common sexually transmitted infections. It causes a series of neoplasms, including cervical, vulvar, vaginal, penile, anal, and head-and-neck cancers. The current study aimed to determine the role of human papillomavirus and its relationship to the incidence of recurrent miscarriages. A cross-sectional hospital-based study was carried out in Kirkuk City on 114 women who had recurrent miscarriages and included 36 women with previous two or more normal pregnancies as controls. Deep vaginal swabs were collected from all women enrolled in the study according to the standard procedure of vaginal swab sampling until PCR extraction and amplification tests were done by realtime PCR for qualitative and quantitative. The study showed that 10.53% (12 of 114) of RPL patients tested positive by PCR, while none of the control patients had PCR +ve results. The mean HPV DNA load detected by RT-PCR from the RPL group (n=12) was 10.95 copies/cell (range 7.665–15.75 copies/cell). Furthermore, it demonstrated that the high mean of HPV DNA load (13.724 copies/cell) was recorded among RPL with a number of abortions (5 and more). It was concluded that human papillomavirus is highly related to recurrent abortion. Keywords: RPL; HPV DNA; E6 protein; RT-PCR

A Study to assess the effectiveness of Structured Teaching Programme on knowledge and practice regarding infection control measures in labour room among fourth year BSc(N) students in selected Nursing Colleges of Tumkur

Background: Pregnancy, delivery is a normal physiological process. Most of the time the women achieve normal pregnancy outcome without any complication. But too many mothers and children in the world are dying and suffering from the effects ill health, poor nutrition and inadequate health care. The Puerperal sepsis is the second leading cause for maternal mortality i.e. 15% of maternal death due to sepsis. Today’s student Nurses are Tomorrow staff nurses. Nurses being the backbone of health care services at all levels play vital role in achieving this goal. Aim and Objectives: To evaluate the effectiveness of structured teaching programme on knowledge and practice regarding infection control measures in labour room among fourth year BSc(N) students. Methodology: A Pre-experimental design was chosen for the study and conducted at selected Nursing colleges. The sample consisted of 60 students. The convenience sampling technique was used to select the samples. The pre test assessment of knowledge and practice were done using a Structured knowledge questionnaire and Observational checklist respectively. The structured teaching programme was administered to fourth year B.Sc Nursing students on Infection control measures in labour and the practice of Infection control measures were demonstrated to them. The Post test was conducted after a week. Result: The comparison of pre test and post test level of knowledge and practice revealed a calculated paired t value of 13.285 and 14.281 respectively which was found to be statistically highly significant at p&lt;0.01. The post test knowledge and practice correlation value was 0.82 the value was more than table value, which shows that there is high correlation between knowledge and practice. It was highly significant at p&lt;0.000 value. A statistically significant level of association was identified between the source of information and knowledge level of fourth year B.Sc Nursing students. Conclusion: The study was concluded that structured teaching programme on infection control measures in labour room was an effective method to improve the knowledge and practice level of student nurses on the significance of decreasing maternal mortality and morbidity.

An Evaluation of T-Regulatory Cells and Inflammatory Cytokines in Preeclampsia.

Background Preeclampsia (PE) is a prenatal hypertension condition with unknown aetiology which is one of the leading causes of maternal morbidity and mortality, premature delivery, and foetal and neonatal mortality. T-regulatory cells (T-regs) are the specific subsets of T-lymphocytes that play a key role in the mechanisms of maternal-foetal tolerance, contributing to an effective immunological role in protecting the allogenic foetus during pregnancy and preventing pregnancy-related complications. This study evaluated the T-regs in PE and correlated the T-regs with inflammatory markers in the pathophysiology and for early diagnosis of PE. Methods After clearance from Institutional Ethics Committee, the participants were recruited from the Department of Obstetrics and Gynaecology. Three study groups were included a) normal reproductive age group women b) normal pregnant women c) PE pregnant women. 5 ml of venous blood was collected from each participant. Biochemical and haematological parameters estimation was done in Hospital's central laboratory. T-regs (CD4, CD25, FOXP3) were assessed using a flow-cytometer, and inflammatory markers (TGF-β1, IL-6, hsCRP) were assessed by ELISA and Beckman Coulter autoanalyzer in the Department of Biochemistry, AIIMS, Bhubaneswar. Results We found that the levels of CD4+CD25+ T-regs were lower in PE than in normal pregnancy, but this difference was not statistically significant (p = 0.349). The levels of CD4+FOXP3+ T-regs in PE were significantly lower compared to both normal pregnant women (p = 0.001) and normal non-pregnant women (p = 0.001). In comparison to women with PE, the levels of TGF-β1 were significantly higher in normal non-pregnant women (p = 0.020) and were higher, although not significantly so, in normal pregnant women (p = 0.994). The levels of IL-6 in women with PE were significantly higher than in normal pregnant women (p = 0.01) and normal non-pregnant women (p = 0.048). The levels of hsCRP in women with PE were significantly higher than in normal pregnant women (p = 0.045) and were higher, but not statistically significant, compared to normal non-pregnant women (p = 0.094). Conclusion The results of the study, showing a decrease in T-regs and an increase in inflammatory markers like TGF-β1, IL-6, and hsCRP levels in PE, have potential implications for the early diagnosis and management of the condition. Incorporating assessments of CD4+FOXP3+ T-regs and inflammatory markers into screening protocols, along with regular prenatal care and monitoring, can aid in the timely detection and implementation of appropriate management strategies. By intervening early, the risks associated with PE can be reduced, optimizing both maternal and fetal health.

Micro Rna 182-3-P, 519-D-5p, 378-3p As Non-Invasive Predictors Of Preeclampsia.

MicroRNAs (miRNAs) are an emerging field of interest in many diseases. Some of the miRNAs have been reported to be expressed differentially in diseased states of pregnancy. The current study was designed to measure and compare the levels of microRNA 182-3-p, 519-d-5p, and 378-3p and it was hypothesized that the microRNA 182-3-p, 519-d-5p, and 378-3p can be used as a non-invasive predictor of preeclampsia. Expression level of the miRNAs 182-3-p, 519-d-5p, and 378-3p was measured in the serum of preeclamptic and normal pregnancies by real-time PCR. Data was entered and analysed by Statistical Package for the Social Sciences 22 (SPSS). Significantly high expression levels of MiRNA 182-3p, 519-d-5p and low levels of miR-378-3p were associated with preeclampsia (PE). The results revealed that miR-182-3p is a powerful predictor of PE with an Odds Ratio of 5.9 and can be used as a noninvasive, reliable predictor of PE to screen these patients at an early stage. Screening at early gestation with follow-up studies can emphasize the results.