Perinatal Parameters Research Articles

Parâmetros maternos e perinatais após intervenções não farmacológicas: um ensaio clínico randomizado controlado

Resumo Objetivo Analisar os efeitos do banho quente, de exercicios perineais com bola suica ou de ambos durante o trabalho de parto em parâmetros maternos e perinatais. Metodos Ensaio clinico randomizado controlado incluindo 101 gestantes de baixo risco admitidas em dois centros obstetricos entre junho de 2013 e fevereiro de 2014 com idade minima de 18 anos, gestacao a termo, feto unico em apresentacao cefalica, dilatacao cervical entre 3 e 8 cm, escala de dor ≥5, sem patologias clinicas ou obstetricas ou doenca mental, nao usuarias de drogas psicoativas ou de corticosteroides naturais ou sinteticos, e que nao fizeram uso de produtos de tabaco, cafeina e analgesicos duas, quatro e seis horas antes de serem incluidas no estudo. Os arâmetros maternos e perinatais foram avaliados antes e 30 minutos apos as intervencoes, incluindo: pressao arterial materna, frequencia cardiaca e respiratoria, contratilidade uterina, dilatacao cervical, frequencia cardiaca fetal, linha de base, variabilidade, aceleracoes e desaceleracoes usando cardiotocografia e escala de Apgar (no 1o e 5o minutos apos o nascimento). Os participantes foram alocados aleatoriamente em tres grupos: A) banho quente (33); B) bola suica (35); e C) intervencoes combinadas (33). Resultados Em relacao aos parâmetros maternos, a pressao arterial sistolica foi mantida abaixo de 100 mmHg, com um pequeno aumento no grupo B. A pressao arterial diastolica diminuiu em todos os grupos, mantendo-se, contudo, acima de 70 mmHg. A frequencia cardiaca apresentou diminuicao nos grupos B e C e esteva acima de 80 bpm. A frequencia respiratoria ficou acima de 20 rpm em todos os grupos apos as intervencoes, enquanto a dilatacao cervical foi de 5,0 cm em media antes das intervencoes com aumento de 1,3 cm apos as intervencoes em todos os grupos. Em relacao aos parâmetros fetais, 90% dos fetos em todos os grupos apresentaram frequencia cardiaca normal nos dois periodos avaliados, aceleracoes transitorias estiveram presentes em mais de 80% dos fetos em todos os grupos em ambos os periodos analisados. Nao foi constatada desaceleracao antes da intervencao em aproximadamente 58,4% dos casos. Observou-se desaceleracoes em 52,5% dos casos, principalmente nos grupos A e B. A variabilidade foi normal em mais de 80% dos casos, e um valor <7 na escala de Apgar no primeiro minuto apos o nascimento so foi observado em 14 casos. Nao foram encontradas diferencas significativas na pressao arterial e frequencia cardiaca materna e fetal, incluindo a ocorrencia de aceleracoes transitorias, variabilidade ou desaceleracoes e valores na escala de Apgar tanto na analise inter e intragrupo quanto nos periodos avaliados. Ao comparar os parâmetros maternos antes e 30 minutos apos as intervencoes, observou-se aumento na frequencia respiratoria (p=0,037) e na dilatacao cervical (p<0,001) em todos os grupos de intervencao. Na analise intergrupo, a progressao do trabalho de parto estimulada dos grupos A (p=0,041) e C (p=0,021) em relacao as contracoes uterinas aumentou em comparacao com o grupo B. Conclusao As intervencoes isoladas ou combinadas sao uma forma segura de assistencia ao parto uma vez que elas nao afetam negativamente os parâmetros maternos e perinatais.

Perinatal outcomes of African refugees after their integration into the Israeli health care system

ObjectiveEvaluate whether the incorporation of the refugees into the Israeli medical system resulted in improvements in perinatal outcomes, namely a reduction in the number of preterm deliveries and a decrease in NICU admissions. MethodsRetrospective cohort study. Electronic medical records of all African immigrants who delivered in our tertiary referral center between January 2018 and September 2019 were reviewed. African patients’ demographics, maternal and perinatal outcomes were compared to those of native Israeli population. In addition, the results were compared to the cohort from our previous study from 2010. ResultsA total of 20,796 deliveries took place at our labor and delivery department during the study period. Of these, 3% of all deliveries were of African refugees. Total rates of preterm deliveries <37 weeks was similar between groups, while rate of premature deliveries <34 week was higher among refugees. Rates of extreme prematurity <28 weeks were also similar between groups. Rate of meconium stained amniotic fluid, neonatal weight <2000 g as well as NICU admissions were significantly higher among refugees. ConclusionThough perinatal results have not substantially improved with the incorporation of a refugee population into a healthcare system, some progression has indeed been achieved in some perinatal parameters.

Birth during the moderate weather seasons is associated with early onset of type 1 diabetes in the Mediterranean area.

To assess the association of seasonal and perinatal parameters with early age of type 1 diabetes (T1D) onset. A cross-sectional review of all medical records of T1D patients born between the years 1990 and 2005, and diagnosed before/by the age of 10 years, from 13 university-affiliated paediatric medical centres in Israel, was performed. Data included: gender, ethnicity, seasons of birth and disease onset, birth gestational age and weight, and autoimmune diseases of the probands and their first-degree family members. Statistical analysis included the Chi-square test or Mann-Whitney test, as appropriate and multivariate regression analysis. Enrolled were 1571 T1D patients at a median age of T1D onset 6.9 years (IQR 4.4,8.4); 336 of them presented before 4 years of age. The median age of this group was 2.5 years (IQR 1.7,3.2), and of the 1235 patients who presented after 4 years of age, median presentation age was 7.5 years (IQR 6.1,8.8). Multivariate regression analysis demonstrated that a more recent birth year; OR = 1.06, 95% CI 1.02-1.1, P = 0.003, and birth during the moderate weather months (September, October, March, and April) were significantly associated with younger age at T1D onset; OR = 1.68, 95% CI 1.17-2.4, P = 0.005. Our novel finding demonstrates the association between younger than 4 years old age at presentation and birth during moderate weather months. The results also support previous reports, that there is a slight increase in the annual incidence of T1D in the youngest age groups.

Prognosis and Management of BRAF V600E-Mutated Pregnancy-Associated Melanoma.

Approximately one third of women who develop melanoma at childbearing age are diagnosed during gestation or the postpartum period, facing pregnancy-associated melanoma (PAM). However, only some retrospective studies with heterogeneous data have analyzed the impact of pregnancy on melanoma development, and no evidence exists about the behavior and the management of BRAF-mutated disease. In order to better describe the evolution of BRAF V600E-mutated PAM, we present here all consecutive cases diagnosed in our site during the last 7 years, recording oncological, obstetrical, and perinatal parameters, as well as the therapeutic decisions for both melanoma and gestation. Based on our institutional experience, we weigh the current published evidence and discuss upcoming clinical considerations about the prognosis of PAM, the role of BRAF status, and the possible treatment options during pregnancy in localized or advanced/metastatic disease. Five women were diagnosed with newly metastatic or relapsed BRAF V600E-mutated PAM (four during gestation and one in the 1st year postpartum) between 2012 and 2019. All of them developed extensive metastatic disease with multiple organ involvement, and four developed brain metastases. All cases experienced melanoma progression in less than 6 months under targeted therapy and died soon independently of the followed sequence of treatments. All the neonates were delivered alive and healthy, but one developed melanoma earlier than the second year of life. Reviewing the literature to confirm our unfavorable outcomes, no specific data on BRAF-mutated PAM were retrieved and current evidence still supports that the prognosis of PAM should be guided by the established risk factors, whereas the management of advanced/metastatic PAM should be evaluated on a case-by-case basis. More data are required to ascertain whether BRAF-mutated profile adversely affects PAM outcome, although the clinicians should be aware to detect any potential melanoma lesion during pregnancy as soon as possible, treating it locally, regardless of its BRAF status. The prognosis and management of pregnancy-associated melanoma whether BRAF-mutated or wild type, is currently guided by the same parameters as in the nonpregnant condition. In this special nontrial subpopulation, BRAF-mutated status seems to have a detrimental effect on disease outcome, independently of the following treatments. In early stage melanoma, wide local excision with or without sentinel lymph node dissection may be curative at any trimester of gestation, while in advanced/metastatic setting, therapeutic strategy including immune-checkpoint or BRAF/MEK inhibitors, is more challenging, regardless of BRAF status, and should be based on an individualized decision in each case at a multidisciplinary level.

Respiratory Severity Score with Regard to Birthweight during the Early Days of Life for Predicting Pulmonary Hypertension in Preterm Infants.

The respiratory severity score (RSS) has been demonstrated to be associated with the oxygenation index in intubated newborn infants. We aimed to evaluate the usefulness of RSS with regard to birthweight (BW) in preterm infants for predicting an association with future pulmonary hypertension (PH). Preterm infants with <30 weeks' gestation and <1250 g BW were reviewed and grouped into two (PH vs. no PH). Basic perinatal characteristics, comorbidities and parameters reflecting lung condition, including duration of invasive mechanical ventilator care, were compared. Respiratory support parameters (FiO2, RSS and RSS/kg) during the first 5 days of birth (0-120 h) were compared between the groups, and receiver operating characteristics curves were produced to evaluate the association with PH. RSS/kg, of the three respiratory support parameters, demonstrated significantly higher values in the PH group in the early days of life. Particularly, RSS/kg at day 2 of life had the greatest area under the curve [0.762, 95% confidence interval (CI) 0.655-0.869, p < 0.001] and maintained statistical significance [odds ratio (OR) 1.352, 95% CI 1.055-1.732, p = 0.017] in the multivariable analysis for a potential association with PH, along with gestational age (OR 0.996, 95% CI 0.993-0.999, p = 0.015) and preterm premature rupture of membrane >18 h (OR 4.907, 95% CI 1.436-16.765, p = 0.011). RSS/kg is a potential marker associated with the development of PH. Future studies could verify its usefulness as a reliable surrogate for predicting respiratory morbidity in clinical settings.

Impact of Day 7 Blastocyst Transfer on Obstetric and Perinatal Outcome of Singletons Born After Vitrified-Warmed Embryo Transfer.

BackgroundExtended embryo culture has been reported to affect perinatal outcome regarding higher risks of large for gestational age (LGA) and preterm birth (PTB) yet decreased risk of small for gestational age (SGA). However, existing data about the obstetric outcome and the safety for offspring resulting from the transfer of day 7 blastocysts is rare.ObjectivesTo compare obstetric and perinatal outcome using embryos vitrified on day 7 with those vitrified on day 3, day 5, and day 6.MethodsData were collected from 4489 infertile women who gave birth to live-born singletons after vitrified-warmed embryo transfer cycles from January 1, 2006 to December 31, 2017. Singletons were compared depending on the age of embryos. Main perinatal outcome parameters included PTB (gestational age < 37 weeks), very PTB (VPTB, gestational age < 32 weeks), LGA (birthweights > 90th percentiles), and SGA (birthweights < 10th percentiles). Obstetric outcomes included gestational diabetes (GDM), pregnancy-induced hypertension (PIH), preterm premature rupture of membranes (PPROM), pre-eclampsia, placenta previa, placental abruption, and postpartum hemorrhage. Propensity score matching (PSM) was used to adjust the confounding factors across groups and then analyze the association between in vitro culture period and the outcome measures.ResultsAfter PSM, the transfer of day 7 blastocysts was associated with higher birth weight Z-scores and increased incidence of very large for gestational age (VLGA) compared with the transfer of day 3 cleavage-stage embryos while the incidence of PTB, low birth weight (LBW), SGA did not reach statistical significance. Moreover, comparable perinatal outcome was found in the comparison of day 7 vs. day 5 and day 7 vs. day 6. Day 7 blastocysts did not result in adverse obstetric outcome compared with day 3, day 5, and day 6 embryos, respectively.ConclusionIn vitrified-warmed transfer cycles, day 7 blastocysts were associated with adverse perinatal outcome regarding higher risk of VLGA compared with day 3 cleavage-stage embryo, while blastocysts with diverse growth rates embrace similar developmental viability regardless of blastocysts vitrified on day 5, day 6, or day 7.

Open Intrauterine Fetal Myelomeningocele Repair: Changes in the Surgical Procedure and Perinatal Complications during the First 8 Years of Experience at a Single Center

Introduction: Open fetal myelomeningocele (fMMC) repair is nowadays a therapeutic option in selected cases. We aimed to evaluate changes in maternal and fetal outcome after fMMC repair during the first 8 years of experience at a tertiary referral fetal medicine center in Switzerland. ­Materials and Methods: Between 2010 and 2018, fMMC repair and delivery of the neonate via planned cesarean section was performed in 67 cases. Cases were retrospectively stratified into 2 groups: a “training phase” (TP) with supervision from an external surgeon during 11 operations (2010–2014, 15 cases) followed by an “experienced phase” (EP, 2014–2018, 52 cases); each phase lasted about 4 years. Both phases were compared with regard to various maternal and fetal outcome parameters. Results: Analyses did not reveal differences between TP and EP in major outcome parameters such as gestational age at delivery, chorionic membrane separation, or the incidence of placental abruption. Although more complex surgical techniques were applied in EP (e.g., dermal closure using a rotational flap), surgery time was not different from TP. At the same time, surgical complications such as oligohydramnios (27 vs. 8%, p = 0.046) with MRI-confirmed leakage (13 vs. 4%, nonsignificant) and subchorionic hematoma (20 vs. 2%, p = 0.009) were less common in EP than TP. Conclusions: This study shows that the level of competence at our center with regard to major perinatal outcome parameters was already high in the first years of fMMC repair. However, more complex surgical techniques and significantly less minor complications were observed during the most recent years.

Perinatal lipocalin-2 profile at the extremes of fetal growth

Background Lipocalin-2 (LCN-2) has been identified as an osteoblast-secreted hormone regulating immunity, inflammation and metabolic homeostasis and has emerged as a diagnostic and prognostic biomarker for acute kidney injury in neonates. We investigated the impact of fetal growth on antepartum maternal serum, cord serum and breast milk LCN-2 concentrations and the associations of the latter with perinatal parameters. Methods Maternal serum, cord serum and breast milk LCN-2 concentrations were measured by ELISA in samples from 80 mothers who delivered 40 appropriate (AGA), 20 large for gestational age (LGA) and 20 intrauterine growth restricted (IUGR) neonates, classified by customized weight centiles. LCN-2 concentrations were associated with birth weight, customized centile, gender, maternal age and delivery mode. Results Antepartum maternal serum LCN-2 concentrations were significantly higher in women delivering AGA infants compared to the other two groups. Cord blood LCN-2 concentrations were significantly higher compared to maternal ones; furthermore, they were significantly elevated in the IUGR group compared to the LGA one (p = .019). Lowest concentrations were detected in breast milk, which did not differ between the three growth groups. A negative correlation was documented between cord blood LCN-2 concentrations and customized centiles (r: −0.304, p = .007). Conclusions The higher cord serum LCN-2 concentrations, compared to maternal ones, may point to its fetal origin and potential role in intrauterine growth. The negative correlation of cord LCN-2 concentrations with customized centiles, possibly implies reduced nephron endowment/subclinical kidney damage in IUGR neonates. The extremely low LCN-2 breast milk concentrations could imply that the secretion of LCN-2 from maternal circulation to breast milk is not influenced by factors leading to intrauterine growth pathology.

Left congenital diaphragmatic hernia-associated musculoskeletal deformities.

With the advancement in the treatment strategies of congenital diaphragmatic hernia (CDH), there is an increase in the survival rates. This fact leads to an increase in the morbidity and extrapulmonary complications in the long term such as failure to thrive, hernia recurrence, neurodevelopmental delay, gastrointestinal problems, and musculoskeletal anomalies. Herein, we aim to investigate the association between the long-term musculoskeletal complications in CDH patients regarding the defect size, repair type, and perinatal parameters. After Institutional Review Board approval was obtained (2017-6361), a retrospective chart review was performed on CDH patients from 2003 to 2016. Patients who were operated due to left-sided isolated congenital diaphragmatic hernia and survived to date were included in the study. Data were collected on demographics, preoperative characteristics, operative interventions, and postoperative outcomes. Statistical analysis was performed with IBM SPSS Statistics 20.0.0 (Chicago, IL). There were 98 patients with left CDH of whom 33 (33.7%) had primary repair, 25 (25.5%) had patch repair, and 40 (40.8%) had muscle flap repair. The median age of the patients was 6.00 ± 3.83years. 45 patients (45.9%) had large diaphragmatic defects, 28 patients (28.6%) had at least one type of musculoskeletal deformities, 2 of which were pectus carinatum, 16 were pectus excavatum, and 18 were scoliosis. CDH patients who had small diaphragmatic defects and repaired with a patch were less likely develop musculoskeletal deformities while who had primary abdominal closure after ventral hernia significantly have more pectus excavatum. Although there was a trend towards an increased risk of the pectus deformity and scoliosis in patients repaired with muscle flap, it did not reach statistical significance. There is a correlation between musculoskeletal deformities and the severity of the CDH.

Health and Disease After Assisted Reproductive Technology

Long-term health outcomes after ART have largely focused on offspring health and perinatal parameters. Longer-term health outcomes in female patients remain difficult to fully assess. Hypothetical concerns about the effects of endocrine manipulation on hormone-sensitive conditions, e.g. breast disease, are confounded by variable factors in patients and treatments. Obstetric and perinatal factors endow an additional layer of complexity to the overall analysis and more research is required to appreciate all aspects of ART. Notwithstanding the knowledge gap, clinicians must endeavour to individualise management plans, taking into account the pros and cons of ART in the context of immediate, maternity-related and long-term health risks for their patients.This review of recent literature examines current ART practice in terms of female health and disease as we strive for best practice in an ever-changing clinical and demographic fertility landscape.

Fraction of Inspired Oxygen as a Predictor of CPAP Failure in Preterm Infants with Respiratory Distress Syndrome: A Prospective Multicenter Study

Introduction: There are limited data available regarding the fraction of inspired oxygen (FiO₂) predictive of the failure of continuous positive airway pressure (CPAP) in preterm infants with respiratory distress syndrome (RDS). Therefore, we investigated factors predictive of CPAP failure in the first 72 h of life, with special attention to the prognostic role of FiO₂. Methods: This multicenter, prospective study enrolled infants <30 weeks gestation in whom CPAP was initiated within the first 15 min after birth. In the univariate and multivariate logistic regression models, demographic, perinatal, and respiratory parameters were analyzed. The FiO₂ threshold was determined with ROC curve analysis. Results: Of 389 recruited newborns, CPAP failure occurred in 108 infants (27.8%). In the univariate model, each gestational week reduced the odds of CPAP failure by 19%, and each 100 g of birth weight reduced the odds by 16% (both p < 0.05). The risk was increased by 4.2 and 7.5% for each 0.01 increase in FiO₂in the first and second hours of life, respectively. In the final multivariate model, birth weight and FiO₂ in the second hour of life were the predictive measures. The prognostic threshold was FiO₂ = 0.29 in the second hour of life (AUC 0.7; p < 0.0001), with a sensitivity of 73% and a specificity of 57%. CPAP failure implied a more than 20-fold higher risk of death and pneumothorax and a 2- to 5-fold higher risk of typical complications of prematurity, including bronchopulmonary dysplasia and severe intraventricular hemorrhage. Conclusion: FiO₂ in the second hour of life is a significantpredictor of CPAP failure. The threshold of 0.29 best discriminates the CPAP outcome. Nonresponders to CPAP have a remarkably higher incidence of complications and a higher mortality rate.

Peculiarities of organometric parameters of the coronary arteries in the perinatal period of ontogenesis

Formation of the structure and topography of the coronary arteries during the fetal and early neonatal periods of human ontogenesis is an essential constituent while making perinatal diagnosis and understanding real parameters of the norm and pathology. Objective of the study is to determine organometric parameters of the carotid arteries during the fetal and early neonatal periods of human ontogenesis. The study was conducted on 50 specimens of dead fetuses (from 4 to 10 months) and 9 neonates (5 isolated complexes of organs in particular) by means of adequate anatomical methods: macrodissection, injection of the blood vessels, making topographic-anatomical sections, morphometry, and statistical analysis. During perinatal period external diameters and lengths of the carotid arteries are found to be characterized by two periods of an accelerated development and the period of relatively slow development. For the external diameter of the right common carotid artery and the external diameter of the left internal carotid artery the periods from the 4th to 7th months of the intrauterine development and the period from the 9th month to the neonatal period are the periods of an accelerated development; the periods from the 7th to 9th months of development are the period of relatively slow development. The periods from the 4th to the 7th months of the intrauterine development and the period from the 10th month till neonatal period are the periods of an accelerated development for the external diameter of the left common carotid artery and external diameter of the right internal carotid artery; the period from the 7th to the 10th months of development is the period of relatively slow development. The periods from the 4th to the 7th months of the intrauterine development and from the 8th month of development till the neonatal period are the periods of an accelerated development for the external diameter of the right and left external carotid arteries; the period during 7-8th months is the period of relatively slow development. The length of the cervical part of the right and left carotid arteries is characterized by the two periods of an accelerated development – from the 4th to the 6th month and from the 7th month till the neonatal period; the period of relatively slow development is from the 6th to the 7th month of the intrauterine development. Comparison of the developmental periods of the carotid arteries with all the possible organometric parameters enables to affirm that practically similar enlargement of the external diameters of the common, external and internal carotid arteries both from the right and left sides is peculiar for the period of relatively slow development. The first period of an accelerated development of the carotid arteries is more specific for the external diameter and length of the left common and left external artery contrary to the second accelerated period of development of the carotid arteries. It is characterized by enlargement of the external diameters of the right common and right external carotid artery. A reliable difference of the mean values of the external diameters of the right and left common, external and internal carotid arteries is peculiar for the 4th, 7th, 10th months of development and for the neonatal period for the common carotid arteries; for the external carotid arteries – the 4th, 7th, 9th months of development and neonatal period; for the internal carotid arteries – for the whole months of development.

Peculiarities of organometric parameters of the hard palate in the second and third trimester of the intrauterine development and newborns

Finding anatomical variability of organs, structures and their parts at all the stages of human development is rather topical. Determination of organometric parameters of the hard palate in fetuses and newborns is an essential part for perinatal diagnostics and understanding real parameters of the norm and pathology. Purpose of the study is to find organometric parameters of the palatine maxillary process and horizontal lamina of the palatine bone during fetal and early neonatal periods of human ontogenesis. By means of adequate anatomical methods of examination the study was conducted on 53 specimens of dead fetuses from 4 to 10 months of fetal development (from 165.0 mm to 500.0 mm of the parietal-calcaneal length (PCL)) and 9 specimens of dead neonates. The length of the palatine maxillary process during the perinatal period was found to be characterized by the two periods of accelerated development (5-7 and 8-10 months), and the period of relatively slow development (7-8 months). Its width was found to be characterized by the two period of accelerated development (5-7 and 9-10 months), and relatively slow development (7-8 months). The length of the horizontal lamina of the palatine bone is characterized by the period of accelerated development from 8 to 10 months, and the period of relatively slow development from 7 to 8 months. Meanwhile 5-8 and 9-10 months were the periods of accelerated development for its width, and 8-9 months – the period of relatively slow development for it. During fetal and early neonatal periods of human ontogenesis the value of all the paired correlation coefficients between organometric parameters of the palatine maxillary process (hard palate) and horizontal lamina of the palatine bone are positive and rather close to 1 (&gt;0.84), which is indicative of a close positive correlation between all the organometric parameters. Very strong relation is found between the length of the hard palate and its width in the right and left (r=0.92), between the length of the hard palate and palatine bone (r=0.97), between the length of the palatine bone and the width of the hard palate in the right (r=0.91) and in the left (r=0.90). Therefore, by means of adequate anatomical methods of examination new scientifically substantiated data are obtained concerning organometric characteristics of anatomical structures of the hard palate at all the stages of perinatal period.

Preadipocyte factor-1 in maternal, umbilical cord serum and breast milk: The impact of fetal growth

Background/ObjectiveTo study the concentrations of preadipocyte factor-1 (Pref-1) -an inhibitor of adipocyte differentiation, implicated in adipose tissue metabolism, late metabolic disorders and fetal growth- in maternal and umbilical cord serum, as well as maternal milk and correlate above concentrations with intrauterine growth and other perinatal parameters. Material and methodsPref-1 concentrations were determined by ELISA in antepartum maternal and umbilical cord serum, as well as day 3 to 4 postpartum breast milk, deriving from 80 women, who delivered 40 appropriate (AGA), 20 large for gestational age (LGA) and 20 intrauterine growth restricted (IUGR) neonates, classified by the use of customized birth-weight standards adjusted for significant determinants of fetal growth. ResultsUmbilical cord serum Pref-1 concentrations were significantly higher than antepartum maternal ones (p < 0.001), while breast milk concentrations were the lowest (p < 0.001 concerning umbilical serum, p < 0.001 concerning maternal serum). Umbilical cord serum Pref-1 concentrations were significantly lower in the LGA group than in the AGA one (p = 0.044). Breast milk and maternal serum Pref-1 concentrations did not differ between the three intrauterine growth groups. Maternal serum and breast milk Pref-1 concentrations did not correlate with maternal age, body mass index before and after gestation, birth weight, body length, and customized centile. A positive weak correlation was recorded between maternal serum and milk Pref-1 concentrations (r = 0.238, p = 0.034). ConclusionsPref-1 concentrations in umbilical cord serum are higher than in antepartum maternal serum, probably pointing to its fetal origin and role in intrauterine growth. Breast milk concentrations, being extremely low, and possibly implying infant protection from metabolic disorders, positively correlate with maternal serum ones, conceivably suggesting a transfer of the substance from the circulation to the breast. Umbilical cord serum Pref-1 concentrations were lower in LGA fetuses/neonates, as compared to respective AGA ones.

Predicting attention deficit hyperactivity disorder using pregnancy and birth characteristics.

The aim of this study was to evaluate maternal, prenatal, perinatal, and postpartum parameters as risk factors for the later development of an attention deficit hyperactivity disorder (ADHD) in the child. Women who had given birth at Erlangen University Hospital between 1996 and 1999 were sent a questionnaire in 2009. The results of the questionnaire were correlated with the prospectively collected data for the births in 1996-1999. A total of 573 mother and child pairs were analyzed. Forty-four of the mothers reported that their child had ADHD (7.7%). No significant associations were found for the following parameters: mother's age; mother's educational level; number of the pregnancy; maternal weight before and at the end of pregnancy; mother's height; alcohol consumption during pregnancy; mode of delivery; gestational week; birthweight; umbilical artery blood values; Apgar score at 5 and 10min; or breastfeeding. The parameters of smoking in pregnancy and an Apgar score lower than 7 after 1min were significantly associated with a risk for later development of ADHD. This analysis of maternal, prenatal, perinatal, and postnatal parameters found that smoking in pregnancy and a low Apgar score 1min after birth are associated with a significantly greater risk for the development of ADHD. Beyond the question of the causal mechanism involved, this is a relevant finding, since smoking during pregnancy is a preventable risk factor.

Accuracy of the fetal cerebroplacental ratio for the detection of intrapartum compromise in nonsmall fetuses

Objective: To study the accuracy of the cerebroplacental ratio (CPR) for the detection of intrapartum fetal compromise (IFC) in fetuses growing over the 10th centile.Methods: This was a prospective study of 569 nonsmall fetuses attending the day hospital unit of a tertiary hospital that underwent an ultrasound examination at 36–40 weeks, and were delivered within 4 weeks of examination. IFC was defined as a composite of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH <7.20 requiring cesarean section, neonatal umbilical cord pH <7.20, 5 min Apgar score <7 and postpartum admission to neonatal or pediatric intensive care units. The accuracy of CPR for the prediction of IFC was calculated alone and in combination with other perinatal parameters using univariate and multivariate logistic regression models, which alternatively included the onset of labor to evaluate the influence of induction of labor (IOL) on IFC, and a brief composite adverse outcome of two parameters to prove the strength of the approach.Results: The incidence of IFC was 17.9%. CPR sensitivity was 30.4% for a false positive rate (FFR) of 10 and 14.7% for an FPP of 5% (AUC = 0.62, p < .001). The multivariate analysis showed that only fetal gender and parity increased the predictive accuracy of CPR alone, although the improvement was poor (AUC = 0.67, p < .001). No differences were observed using any of the alternative models. Finally, IOL had no influence on IFC.Conclusions: Despite their apparent normality, a proportion of fetuses growing over the 10th centile suffer IFC. Some of them are suitable for detection by means of CPR.

Sonographic evaluation of adrenal size in neonates (23 to 41\xa0weeks of gestation)

BackgroundFetal adrenal gland size is known to have a positive correlation with both gestational age and estimated body weight. In contrast, some clinical observations suggest that maturation of the adrenal stress response occurs after 30 weeks of gestation. In this study, adrenal gland size at birth in extremely preterm to term neonates was investigated using ultrasonography to evaluate the adrenal developmental pattern and the impact of prematurity and perinatal factors.MethodsThe area of the right adrenal gland was measured in the first 3 h of life in 350 neonates and corrected for birth weight (BW) to determine the corrected adrenal area index (cAI). The neonates were subdivided into three groups: group 1 (before 30 weeks of gestation), group 2 (30 to 36 weeks), and group 3 (after 37 weeks). Differences in the cAI among the 3 groups were compared to estimate the impact of perinatal factors.ResultsThe adrenal gland size was measurable in all neonates with gestational age ranging from 23 to 41 weeks. Right adrenal gland area was highly correlated with BW (r = 0.75, p < 0.01). cAI showed a significant negative correlation with gestational age in group 1 (r = − 0.67, p < 0.01), whereas it showed no correlation with gestational age in both groups 2 and 3. As for the impact of perinatal parameters on cAI, only gestational age in group 1 and only fetal distress in group 2 were correlated with cAI. In group 3, perinatal parameters such as fetal distress and low Apgar score were correlated with cAI.ConclusionsThe present study demonstrated that the developmental pattern of fetal adrenal gland was different before and after 30 weeks of gestation, suggesting that the magnitude of adrenal stress response might mature after 30 weeks of gestation.

Fetal cardiac remodeling in twin pregnancy conceived by assisted reproductive technology.

Recent data suggest that singleton fetuses conceived by assisted reproductive technology (ART) present cardiovascular remodeling that may persist postnatally. Twin pregnancies are more frequent in the ART population and are associated with increased adverse perinatal outcomes, such as hypertensive disorders, gestational diabetes and preterm birth. However, it is unknown whether cardiac remodeling is also present in twin pregnancies conceived by ART. Our aim was to assess the presence of fetal cardiac remodeling and dysfunction in twin pregnancies conceived by ART as compared with those conceived spontaneously (SC). This was a prospective cohort study including 50 dichorionic twin fetuses conceived by ART and 50 SC twin fetuses. The study protocol included collection of baseline/perinatal data and a fetal ultrasound examination at 28-30 weeks' gestation, including assessment of estimated fetal weight, fetoplacental Doppler and fetal echocardiography. Measurements of atrial area, atrial/heart ratio, ventricular sphericity index, free wall thickness, mitral and tricuspid annular plane systolic excursions, and systolic and early diastolic peak velocities were assessed. Multilevel analyses were used to compare perinatal and ultrasonographic parameters. Comparisons of echocardiographic variables were adjusted for parental age, paternal body mass index and incidence of pre-eclampsia. Compared with SC twins, ART twin fetuses showed significant cardiac changes, predominantly affecting the right heart, such as dilated atria (right atrial/heart area: 15.7 ± 3.1 vs 18.4 ± 3.2, P< 0.001), more globular ventricles (right ventricular sphericity index: 1.57 ± 0.25 vs 1.41 ± 0.23, P = 0.001) and thicker myocardial walls (septal wall thickness: 2.57 ± 0.45 mm vs 2.84 ± 0.41 mm, P = 0.034) together with reduced longitudinal motion (tricuspid annular plane systolic excursion: 6.36 ± 0.89 mm vs 5.18 ± 0.93 mm, P< 0.001). ART twin fetuses present signs of cardiac remodeling and dysfunction. These changes are similar to those observed in ART singletons and reinforce the concept of fetal cardiac programing in ART. These results open opportunities for early detection and intervention in infants conceived by ART. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Shared motherhood IVF: high delivery rates in a large study of treatments for lesbian couples using partner-donated eggs.

Shared motherhood IVF treatment is becoming increasingly accepted among assisted reproductive techique practitioners and patients in Europe, although data on its overall efficiency remain scarce. This 6-year retrospective study from a single, private, UK HFEA-regulated centre included consecutive lesbian couples (n = 121) undergoing shared motherhood IVF treatment (141 cycles). Recipients were more parous and had undergone more previous intrauterine insemination and IVF treatments than donor partners, who had slightly higher ovarian reserve markers than recipients. Indications in most cycles (60%) were non-medical. Most (79%) egg-providers were stimulated with gonadotrophin releasing hormone antagonist protocol, and no moderate or severe cases of ovarian hyperstimulation syndrome (OHSS) arose. A total of 172 fresh and vitrified-warmed embryo transfers were carried out: 70% at the blastocyst-stage and 58% involved a single embryo. Cumulative live birth rate per receiver was 60% (72/120), and twin delivery rate was 14% (10/72). Perinatal outcome parameters were better for singleton than twin pregnancies, although the latter also achieved generally favourable outcomes. No significant difference in cumulative outcomes were found between synchronized and non-synchronized cycles. Shared motherhood IVF combines ovarian stimulation with single blastocyst transfer to provide a safe and effective treatment modality offering reassuring obstetrical and perinatal outcomes.

A preliminary evaluation of glial cell line-derived neurotrophic factor (GDNF) levels in cerebrospinal fluid across various gestational ages and clinical conditions of the neonate

BackgroundThis study aims to investigate glial cell derived neurotrophic factor (GDNF) levels in newborns’ umbilical cord blood and cerebrospinal fluid across various perinatal growth parameters and clinical conditions. MethodsCord blood from 20 newborns and 58 residual CSF samples (stored after completion of clinical testing) were collected. GDNF levels were determined using GDNF ELISA kits from R&D Systems in triplicates with appropriate controls to eliminate background. ResultsCord blood GDNF levels were significantly higher (p=0.004) in preterm newborns (n=6) (115.05±57.17,pg/ml) when compared to term newborns (n=14) (19.67±10.67,pg/ml). GDNF levels in CSF trended (p=0.07) higher in term newborns (n=10) (19.56±9.11,pg/ml) when compared to preterm newborns at term or post term corrected gestational ages (n=5) (14.49±3.53,pg/ml). ConclusionsGDNF levels in preterm newborns were higher in cord blood and lower in CSF as compared to term newborns. It is important to further study circulating and CSF-GDNF levels in newborns at different gestational ages and clinical conditions.