Post-term Research Articles

WPŁYW KRÓTSZEJ LUB DŁUŻSZEJ EKSPOZYCJI CIĘŻARNYCH NOREK NA SZTUCZNE DOŚWIETLANIE (NEOVISON VISON) NA ICH WSKAŹNIKI ROZRODU

The aim of this study was to analyze the influence of the length of the period of artificial lighting of mink on their reproductive performance. The experiment was carried out on a mink farm in West Pomerania, Poland. Reproduction data of 1068 one-year-old female mink of the silverblue strain were analyzed. All females were in selection classes 7 and 8 and were mated four times, first between the 1st and 10th of March. Females were illuminated during pregnancy with artificial light such that the light day was 17 hours per day. Females were divided into two groups – one group was illuminated from March 20 to April 17, and the other from March 20 to May 15. The following reproductive indices were analyzed in relation to the length of illumination: length of diapause and gestation, litter size, number of live-born and weaned young per litter, percentage of barren females, percentage of females dead during gestation and lactation, and average length of lactation in which females died. Artificially illuminated females were characterized by longer diapause, longer gestation, larger litters, but they had higher mortality of young during maternal nursing. It was also found that females with shorter lactation reared slightly more young, and were characterized by a lower percentage of barren females and females dying during pregnancy and lactation. The analysis conducted in this study confirmed the period of illumination of pregnant mink until April 17 is sufficient in terms of reproductive performance of the females.

P-606 Does trigger timing make a difference in oocyte donation?

Abstract Study question Is there optimal trigger timing in controlled ovarian stimulation (COS) for egg donors for better clinical outcome? Summary answer Different trigger timings may not affect oocyte maturity rate. 35 hour’s trigger may create optional timing for embryology to complete fertilization into a natural concept. What is known already Trigger exposure time is still a debatable clinical issue. Ovulation is triggered by administration of hCG or GnRH agonist, with retrieval taking place between 35th and 38th hour post triggering. There was a tendency to decrease post maturity risk for MII oocytes also early triggering will create optional timing for embryology laboratory for denudation, oocyte vitrification and fertilization process under oocyte cytoplasmic maturity (38 hours post trigger) and natural concept fertilization (till 40 hours post trigger) for better clinical outcome. Study design, size, duration This single center retrospective study included oocyte donors (n = 1289) with different timing of eggs retrieving. They were divided into two groups: group A, with exposure of the medicine trigger for 35 h and group B with timing which was 36 h before egg retrieval. We evaluated the concordance between the follicle-to-oocyte index (FOI), antral follicle count (AFC), number of MII oocytes, maturation rate (MR), utilization rate (UR) and the timing of triggering. Participants/materials, setting, methods The number of donors was 784 and 505 in A and B groups respectively. The mean age of the patients in this study was (SD) 26,2 (3,2) and 26,7 (3,3) years. Cycle characteristics were compared. Data was assessed using the Shapiro-Wilk test for the normality of the distribution of the variables. The association between COS cycle parameters and the differences in COS output was assessed by T-Student (parametric) or U-Mann-Whitney (non-parametric). Main results and the role of chance Donors in groups A and B had a similar mean number of oocytes retrieved (33,50±14,12 vs 30,44±13,00), in groups A and B respectively. The same tendency with no statistical difference was mentioned for values number of MII oocytes (SD): 25,16 (11,73) and 20,50 (10,19), for MR - 81% vs 80% and for AFC: 33,50 (14,18) and 30,44 (13,00) in groups A and B, respectively. Unexpectedly, values for UR and FOI (SD) were statistically significant different (p = <0.05): 94,1% (17,2) vs 89,1% (20,2) and 92,51 (11,43) vs 83,43 (15,63), accordingly, in group A and B respectively. Group A donor oocytes vitrified on 38 hours post trigger and fertilized on 40 hours from sibling oocytes. Group B donor oocytes vitrified on 39 hours and fertilized on 42 hours from sibling oocytes. Values for oocyte survival rate post warming were statistically non-significant different (p > 0.05): 96,64% (10,95) vs 95,08% (10,03). Cleavage arrest rate were statistically significant different; 8,01% vs 28,06% and used blastocysts rate were statistically significant different; 54,67% (5,02) vs 42,36% (4,08). Values for fertilization were statistically non-significant different; (p > 0.05): 98,64% (12,24) vs 97,08% (11.96) and used blastocysts rate were statistically significant different; 67,22% (6,18) vs 51,88%. (5,07) Limitations, reasons for caution This study is limited by its retrospective nature and the established strict time parameters of the study can be considered a limitation. Wider implications of the findings As we can see, the issue of the optimal period for oocyte retrieval after the administration of human chorionic gonadotropin should be considered very individually and in further studies it is possible to take into account wider time intervals in the design of trials. Trial registration number not applicable

HONOUR KILLING AND GENDER-BASED DOMESTIC VIOLENCE: A CASE STUDY OF QANDEEL BALOCH

Qandeel Baloch was a prominent social media star and feminist activist from Pakistan, who was brutally murdered by her brother Mr. Waseem in the name of honour killing. The incident of Qandeel Baloch is a subject of international scrutiny as it shed light on gender disparities, entrenched cultural norms, and social pressures. Honour killing and gender-based domestic violence reflect a negative impact on the country’s image. It is very important to analyze how such events are being portrayed in the foreign press and how people have reacted and shown their feedback in terms of posts/ comments. This research work is focused to analyze the foreign press (The Guardian) online stories/news and readers' posts about the murder case of Qandeel Baloch via content analysis. The documentary selected is "Qandeel - The Guardian". Even numbered 50 posts selected based on “Top Comments” are chosen. The results showed that the majority of posts are favorable as compared to un-favorable and neutral posts. Moreover, the favorable posts pertain to parental support, women supremacy, fatherly support, complimentary support, condemnation, motherly support, and sympathetic statements. A multi-faceted approach to underpin such violence is the need of the hour to cater to honour killing issues in Pakistan which encompass legal reforms, education, awareness, and collective action campaigns at all levels of society to ensure the rights and safety of women across the nation.

Comparison of Efficacy and Safety of Magnesium Sulphate Versus oral Nifedipine in Acute Tocolysis of Preterm Labour

Aim: To compare the efficacy and safety of magnesium sulphate and oral nifedipine in acute tocolysis of preterm labor. Study design: Randomized controlled trial. Place and duration of study: Department of Obstetrics & Gynecology, DHQ Hospital, Mirpur from 19th October 2019 to 18th April 2020. Methodology: This study included 178 pregnant women with singletons (18 to 40 years of age) assessed through ultrasonography and presented preterm labor. Pregnant women having fetal growth restriction, fetal death, severe preeclampsia, fetal distress, hyperthyroidism,any maternal contraindication for the use of tocolytic drugs, cardiovascular disease, abruptio placentae or placenta-previa were placed in the seclusion criteria of the study. In the group A, oral loading dose of nifedipine 20mg was given. While in group B, magnesium sulphate was injected intravenously with a loading dose of 4 grams over 15 minutes followed by maintenance dose of 2-3 grams/hr. All patients in both groups were evaluated by the researcher herself for prolongation of pregnancy at 48 hours after the start of treatment and efficacy and safety was noted. Results: Efficacy was seen in 80 (89.89%) in group A (Oral nifedipine) and 67 (75.28%) in group B (magnesium sulfate) with p0.019. Safety was seen in 72 (80.90%) in group B (magnesium sulfate) and 83 (93.26%) in group A (oral nifedipine) with p 0.014. Practical Implication: The administration of corticosteroids and also assist in reducing mortality and morbidity related with preterm labor events. Conclusion: This study concluded that oral nifedipine is efficacious and safe than magnesium sulphate for acute tocolysis of preterm labour. Keywords: Tocolytic Agents, Preterm Birth, Magnesium Sulphate.

Is sacral neuromodulation effective and safe in pregnancy? A systematic review.

We systematically assessed all available evidence on the efficacy and safety of sacral neuromodulation (SNM) in pregnancy. On September 2022, a thorough search was done on Ovid, PubMed, Scopus, ProQuest, Web of Science, and The Cochrane Library. We chose studies that included pregnant women who had SNM previously. Two authors independently evaluated the quality of the study using a standardized tool of JBI. Studies were given a risk of bias rating of low, moderate, or high. Given the descriptive nature of this study, we utilized descriptive statistics to report demographic and clinical features. For continuous variables, we used mean and standard deviation, and for dichotomous data, we used frequencies and percentages. Out of 991 abstracts screened, only 14 studies met our inclusion criteria and were included in the review. Overall, the quality of the evidence available from the literature is low based on the design of the included studies. Fifty-eight women, including 72 pregnancies, had SNM. The indication of SNM implantation was filling phase disorders in 18 cases (30.5%), voiding dysfunction in 35 women (59.3%), IC/BPS in two cases (3.5%), and fecal incontinence. In 38 pregnancies (58.5%), the SNM status was ON during pregnancy. Forty-nine cases delivered a full-term baby (75.4%), 12 cases had pre-term labor (18.5%), two miscarriages, and two postterm pregnancies happened. The most complications in patients with devices were urinary tract infection in 15 women (23.8%), urinary retention in six patients (9.5%), and pyelonephritis in two cases (3.2%). The findings revealed that when the device was deactivated, 11 cases out of the 23 patients (47.8%) had full-term pregnancies, while in ON status, 35 out of the 38 pregnant women (92.1%) had full-term pregnancies. Nine preterm labors in OFF (39.1%), and two in ON status (5.3%) were recorded. The results revealed that this difference was statistically significant (p = 0.002), and those who turned SNM of them off had more preterm labor. Although the studies reported all neonates had a healthy status, two children had chronic motor tic problems and a pilonidal sinus in a case with an active SNM in pregnancy. However, there was no association between the SNM status and pregnancy or neonatal complications (p = 0.057). SNM activation in pregnancy seems safe and effective. The choice of whether to activate or deactivate SNM should be made on an individual basis given the current SNM evidence.

The effects of sildenafil citrate on intrauterine growth restriction: a systematic review and meta-analysis

BackgroundAn increase in vascular resistance of uterine vessels is associated with intrauterine growth restriction (IUGR). Sildenafil citrate, a phosphodiesterase-5 inhibitor that stabilizes cyclic guanosine monophosphate (cGMP) and increases nitric oxide levels, improves placental perfusion by dilation of spiral arteries and is beneficial in managing IUGR. This study aims to determine the effectiveness of sildenafil citrate in improving perinatal outcomes in IUGR pregnancies.MethodsMeta-analysis was performed on data extracted from all studies specific to sildenafil citrate in IUGR management, searching relevant articles on PubMed, Medline, Google Scholar, Embase, and Cochrane databases. Publications identified by the manual search, based on references in reviews, were also included. Dichotomous results were presented as risk ratio (95% confidence interval), while continuous results were expressed as mean difference (MD); samples represented by the random effects model.ResultsNine trials were included where the sildenafil citrate effect was compared with a placebo or no intervention. A significant increase in birth weight [SMD (95% CI), 0.69 (0.31, 1.07)] was seen in IUGR pregnancies managed with sildenafil. However, gestational age (SMD (95% CI), 0.44 (-0.05, 0.94], fetal death rate [RR (95% CI), 0.56 (0.17, 1.79)] in IUGR pregnancies was not changed by sildenafil. Neonatal death [RR (95% CI), 0.93 (0.47, 1.86)] and neonatal intensive care unit (NICU) admissions [RR (95% CI), 0.76 (0.50, 1.17)] were not significantly different between sildenafil and control groups.ConclusionSildenafil citrate increases birth weight and prolonged pregnancies but did not affect stillbirth rate, neonatal death, and NICU admission.Trial registrationThe study was registered in PROSPERO on September 18, 2021 (CRD42021271992).

The Relationship of Preterm, Term, and Post-Term Births to Maternal Stress and Human Milk Cortisol Levels.

Introduction: Maternal stress can lead to changes in the composition of human breast milk. The present study evaluates cortisol levels in the breast milk of mothers after giving birth preterm, term, or post-term, and ascertains whether the levels are associated with maternal stress. Materials and Methods: Included in the study were mothers who gave birth vaginally after 32 weeks of gestation between January and April 2022. The breast milk was expressed with an electronic pump under the supervision of a nurse on day 7 following birth, and 2 mL samples of the milk were transferred into microtubes and stored at -80°C. Stress in the mothers was measured using the perceived stress scale developed by Cohen et al. The human breast milk cortisol levels were determined using an enzyme-linked immunoassay in a single session. Results: A total of 90 mothers, including 30 with preterm births, 38 with term births, and 22 with post-term births, were included in the study. The median stress scale score was 28 (17-50) and the median breast milk cortisol level was 0.49 ng/mL (0.1-1.96 ng/mL). A significant positive correlation was noted between the stress scale scores and breast milk cortisol levels (r = 0.56, p < 0.01). The breast milk cortisol levels and maternal stress scale scores were significantly higher in the preterm birth group than in the term birth group (p = 0.011 and p = 0.013, respectively). Conclusion: Although there is an association between maternal stress and preterm labor and milk cortisol levels, we believe that more studies are needed to establish a causal link.

Predictive Value of New Onset Versus Primary Meconium-Stained Amniotic Fluid

(Abstracted from Birth 2022;49:805–811 Meconium-stained amniotic fluid (MSAF) occurs in up to 52% of postterm pregnancies, 25% of term pregnancies, and 5% of pregnancies &lt;37 weeks of gestation. As a sign of fetal maturity, MFAS may also help signal fetal distress.

A Study of the Literature on Intrauterine Treatment Options for Chronic Placental Insufficiency with Intrauterine Growth Restriction Using Intrauterine Intravascular Amino Acid Supplementation.

Intrauterine growth retardation (IUGR) is a very serious prenatal condition with 3-5% incidence of all pregnancies. It results from numerous factors, including chronic placental insufficiency. IUGR is associated with an increased risk of mortality and morbidity and is considered a major cause of fetal mortality. Currently, treatment options are significantly limited and often result in preterm delivery. Postpartum, IUGR infants also have higher risks of disease and neurological abnormalities. The PubMed database was searched using the keywords "IUGR", "fetal growth restriction", "treatment", "management" and "placental insufficiency" for the period between 1975 and 2023. These terms were also combined together. There were 4160 papers, reviews and articles dealing with the topic of IUGR. In total, only 15 papers directly dealt with a prepartum therapy of IUGR; 10 of these were based on an animal model. Overall, the main focus was on maternal intravenous therapy with amino acids or intraamniotic infusion. Treatment methods have been tested since the 1970s to supplement the fetuses with nutrients lacking due to chronic placental insufficiency in various ways. In some studies, pregnant women were implanted with a subcutaneous intravascular perinatal port system, thus infusing the fetuses with a continuous amino acid solution. Prolongation of pregnancy was achieved, as well as improvement in fetal growth. However, insufficient benefit was observed in infusion with commercial amino acid solution in fetuses below 28 weeks' gestation. The authors attribute this primarily to the enormous variation in amino acid concentrations of the commercially available solutions compared with those observed in the plasma of preterm infants. These different concentrations are particularly important because differences in the fetal brain caused by metabolic changes have been demonstrated in the rabbit model. Several brain metabolites and amino acids were significantly decreased in IUGR brain tissue samples, resulting in abnormal neurodevelopment with decreased brain volume. There are currently only a few studies and case reports with correspondingly low case numbers. Most of the studies refer to prenatal treatment by supplementation of amino acids and nutrients to prolong pregnancy and support fetal growth. However, there is no infusion solution that matches the amino acid concentrations found in fetal plasma. The commercially available solutions have mismatched amino acid concentrations and have not shown sufficient benefit in fetuses below 28 weeks' gestation. More treatment avenues need to be explored and existing ones improved to better treat multifactorial IUGR fetuses.

The Effect of Maternal Race, Ethnicity, and Nativity on Macrosomia Among Infants Born in the United States.

This study aims to elucidate the influence of race, ethnicity, and nativity on macrosomia rates, hypothesizing that higher rates are observed among White non-Latina mothers and United States (US)-born mothers. We analyzed data from 1,791,718 US births sourced from the National Center for Health Statistics of the Centers for Disease Control and Prevention. Logistic regression analyses were conducted to examine the associations between macrosomia rates and maternal race, ethnicity, and nativity. After excluding non-singleton, preterm, post-term births, and those with missing data, six maternal cohorts were identified: White non-Latina US-born (1,147,096) and foreign-born (75,542), Black non-Latina US-born (174,540) and foreign-born (32,200), and Latina US-born (223,968) and foreign-born (137,515). White non-Latina US-born mothers had the highest rates of excessive gestational weight gain (58.9%). Black non-Latina US-born mothers exhibited the highest rates of pre-pregnancy diabetes (0.7%) and obesity (29.5%). Macrosomia rates were highest among White non-Latina US-born mothers (10.7%) compared to other cohorts. After adjusting for socioeconomic and health-related factors, this group maintained the highest odds of macrosomia (OR: 1.876; 95%CI 1.832-1.922, P<0.001). Our findings reveal that White non-Latina US-born mothers experience the highest macrosomia rates, which persist after adjusting for known confounders. These results have significant implications for the development of gestational surveillance tools and targeted public health interventions aimed at improving pregnancy outcomes among high-risk cohorts.

Myomectomy: surgical tactics, reproductive outcomes

The article highlights modern approaches to the surgical treatment of uterine fibroids in patients of reproductive age, depending on the size and type of localization of the node in the uterus in accordance with the FIGO classification. It has been established that submucosal uterine fibroids of types 0, 1, 2 are subject to hysteroscopic removal, since their effect on the onset, prolongation of pregnancy and reproductive outcomes has been proven. Intramural uterine leiomyomas are subject to removal if the node size is more than 5 cm or other unidentified causes of infertility in patients with reproductive plans. Subserous uterine leiomyomas do not affect fertility and do not require removal.

A Comparative Study of the Effectiveness of Transdermal Nitroglycerine Patches and Oral Nifedipine in Prolongation of Pregnancy in Women With Preterm Labour.

Backgrounds A significant contributor to newborn morbidity and mortality is preterm birth. Several techniques have been employed to identify patients at risk of premature labour. However, these predictors are not always effective because of their multifactorial aetiology. Preterm labour can be suppressed largely through tocolysis. This study compared the effectiveness and safety of transdermal nitroglycerine and oral nifedipine in preventing premature labour. Methods This study was done at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, from December 2020 to November 2022, on 130 women presenting with preterm labour pains between 28 and 37 weeks of gestational age. All the women selected were randomized into two equal groups by using the envelope method. Sixty-five women were given a nitroglycerine patch (Group A), and the rest (65 women) were given an oral nifedipine tablet (group B). The variables studied were mean days of prolongation of pregnancy, treatment outcome, steroid coverage, along with feto-maternal outcomes among both groups. Results The percentage of women whose pregnancy was prolonged for at least 48 hours in the nitroglycerine group was 75.3%, and in the nifedipine group it was 93.8%. Failure to achieve tocolysis, defined as delivery within 48 hours, was seen significantly more in the nitroglycerine group (24.6%) than in the nifedipine group (6.1%). The overall foetal outcomes were comparable in both groups. Conclusion Oral nifedipine was found to be superior to transdermal nifedipine patches in terms of efficacy and safety in the management of preterm labour, with a better side effect profile.

Associations of Prenatal Agricultural Farm Work with Fetal Overgrowth and Pregnancy Complications in State of Arizona Birth Records.

The purpose of this study is to examine fetal growth outcomes from agricultural worker households. Using Arizona 2006 to 2013 birth certificates with parental occupation, we identified N = 623,185 live births by agricultural household status. Logistic regression models estimated adjusted odds ratios (aORs) for macrosomia (>4000 g), postterm birth (>41 weeks), low birth weight (<2500 g), preterm birth (<37 weeks), large for GA, small for GA, and 5-minute APGAR (<7). Newborns of agricultural households (n = 6371) had a higher risk of macrosomia (aOR, 1.15; 95% CI, 1.05-1.26), large for GA (aOR, 1.12; 95% CI, 1.03-1.22), postterm birth (aOR, 1.20; 95% CI, 1.09-1.33), and low 5-minute APGAR (aOR, 1.39; 95% CI, 1.07-1.81), whereas low birth weight (aOR, 0.85; 95% CI, 0.76-0.96) and preterm birth (aOR, 0.82; 95% CI, 0.74-0.92) were inversely related. Having an agriculture working parent increased the likelihood of fetal overgrowth and low APGAR.

A Multichannel Convolutional Neural Network for Multilabel Sentiment Classification Using Abilify Oral User Reviews

Nowadays, patients and caregivers have become very active in social media. They are sharing a lot of information about their medication and drugs in terms of posts or comments. Therefore, sentiment analysis plays an active role to compute those posts or comments. However, each post is associated with multilabel such as ease of use, effectiveness, and satisfaction. To solve this kind of problem, we propose a multichannel convolution neural network for multilabel sentiment classification using Abilify oral user comments. The multichannel represents the multiple versions of the standard model with different strides. Specifically, we use the pre-trained model to generate word vectors. The proposed model is evaluated with multilabel metrics. The results indicate that the proposed multichannel convolutional network model outperforms the traditional machine learning algorithms.

Frequency of puerperal pyrexia with meconium stained amniotic fluid.

Objective: To determine the association of meconium stained amniotic fluid with puerperal pyrexia. Study Design: Cohort Study. Setting: Department of Obstetrics &amp; Gynecology, Nishtar Hospital, Multan. Period: 1st January 2018 to 31st December 2018. Material &amp; Methods: A total of 66 women with singleton pregnancy, gestational age 37-40 weeks of any parity undergoing elective caesarean section were eligible for study. Patients with rupture of membranes (≥18 hours), preterm delivery and postdate pregnancy were excluded. During elective caesarean section, after rupture of membranes, women were divided in two equal groups. Thirty three patients with meconium stained liquor group (MSAF) and 33 patients with clear liquor group. Puerperal pyrexia was defined as temperature of ³ 38°C on any two occasions was reported during first ten days postpartum excluding first 24 hours. Frequency, percentage and mean ±SD were presented for variables. Chi-square test was applied to compare puerperal infection in both groups taken p £ 0.05 as significant. Results: Age range in this study was from 15 to 45 years with mean age 15 to 45 years with mean of 29.5± 2.5 years in MSAF group while 28.5 ± 3.5 years in clear liqour group. Mean gestational age was 39.1±1.0 weeks in MSAF group while 38.5±1.10 weeks. Puerperal pyrexia was seen in 45.5% patients in MSAF group as compare to 10% in clear liqour group (p=0.005). Conclusion: There is strong correlation between meconium stained amniotic fluid and postpartum febrile illness.

The effect of vaginal administration of isosorbide mononitrate on cervical ripening and induction of labour in term and post term pregnancy

The effect of vaginal administration of isosorbide mononitrate on cervical ripening and induction of labour in term and post term pregnancy

Equid nutritional physiology and behavior: an evolutionary perspective.

Like other members of the even-toed ungulates (the perissodactyls), equids once had a higher species diversity in the fossil record than they have today. This is generally explained in comparison to the enormous diversity of bovid ruminants. Theories on putative competitive disadvantages of equids include the use of a single toe as opposed to two toes per leg, the lack of a specific brain cooling (and hence water-saving) mechanism, longer gestation periods that delay reproductive output, and in particular digestive physiology. To date, there is no empirical support for the theory that equids fare better on low-quality forage than ruminants. In contrast to the traditional juxtaposition of hindgut and foregut fermenters, we suggest that it is more insightful to sketch the evolution of equid and ruminant digestive physiology as a case of convergence: both evolved a particularly high chewing efficacy in their respective groups, which facilitates comparatively high feed and hence energy intakes. But because the ruminant system, less based on tooth anatomy but more on a forestomach sorting mechanism, is more effective, equids depend more on high feed intakes than ruminants and may well be more susceptible to feed shortages. Arguably, the most under-emphasized characteristic of equids may be that in contrast to many other herbivores including ruminants and coprophageous hindgut fermenters, equids do not use the microbial biomass growing in their gastrointestinal tract. Equids display behavioral and morphophysiological adaptations to high feed intakes, and their cranial anatomy that facilitates the cropping of forage while performing grinding chewing at the same time might be unique. Rather than looking for explanations how equids are better adapted to their present niches than other organisms, considering them remnants of a different morphophysiological solution may be more appropriate.

Quantitative cervicovaginal fetal fibronectin as a predictor of cervical ripening and induced labour duration in late-term pregnancy

We evaluated quantitative cervicovaginal foetal-fibronectin as a predictor of cervical ripening and labour duration in late-term pregnant women with an unfavourable cervix. This was an analytical cross-sectional study wherein 152 women, with late-term pregnancy and unfavourable cervix, at 41weeks3days gestational age, had pre-induction quantitative cervicovaginal foetal-fibronectin determined using ELISA. Data were compared in nulliparas and multiparas at a significance level < 0.05. The mean age of late-term pregnant women was 30.4 ± 4.3 years. Median cervicovaginal foetal-fibronectin levels in nulliparous and multiparous women were 45.35 ng/ml and 46.93 ng/ml respectively(p = 0.289). The correlation between foetal-fibronectin levels and cervical ripening duration was poor in nulliparous(r = 0.014) and multiparous(r = 0.024) women. The Youden’s foetal-fibronectin cut-off level had a sensitivity of 53.5% and specificity of 71.6% in predicting cervical ripening duration of > 12 hours in late-term pregnancy with an area under the ROC curve of 0.634. Quantitative cervicovaginal foetal-fibronectin is a poor correlate and predictor of cervical ripening and induced labour duration in late-term pregnancy. IMPACT STATEMENT What is already known on this subject? Cervicovaginal foetal fibronectin is useful in the prediction of preterm delivery but its role in prolonged pregnancy is unclear. What the results of this study add? Cervicovaginal foetal fibronectin is a poor correlate and predictor of cervical ripening and induced labour duration in late-term pregnancy What the implications are of these findings for clinical practice and/or further research? Cervicovaginal fibronectin should not be used to predict ease and success of cervical ripening and induction of labour in women with late-term pregnancy.

Pre- and Post-Sexual Maturity Liver-specific ERα Knockout Does Not Impact Hepatic Mitochondrial Function.

Compared with males, premenopausal women and female rodents are protected against hepatic steatosis and present with higher functioning mitochondria (greater hepatic mitochondrial respiration and reduced H2O2 emission). Despite evidence that estrogen action mediates female protection against steatosis, mechanisms remain unknown. Here we validated a mouse model with inducible reduction of liver estrogen receptor alpha (ERα) (LERKO) via adeno-associated virus (AAV) Cre. We phenotyped the liver health and mitochondrial function of LERKO mice (n = 10-12 per group) on a short-term high-fat diet (HFD), and then tested whether timing of LERKO induction at 2 timepoints (sexually immature: 4 weeks old [n = 11 per group] vs sexually mature: 8-10 weeks old [n = 8 per group]) would impact HFD-induced outcomes. We opted for an inducible LERKO model due to known estrogen-mediated developmental programming, and we reported both receptor and tissue specificity with our model. Control mice were ERαfl/fl receiving AAV with green fluorescent protein (GFP) only. Results show that there were no differences in body weight/composition or hepatic steatosis in LERKO mice with either short-term (4-week) or chronic (8-week) high-fat feeding. Similarly, LERKO genotype nor timing of LERKO induction (pre vs post sexual maturity) did not alter hepatic mitochondrial O2 and H2O2 flux, coupling, or OXPHOS protein. Transcriptomic analysis showed that hepatic gene expression in LERKO was significantly influenced by developmental stage. Together, these studies suggest that hepatic ERα is not required in female protection against HFD-induced hepatic steatosis nor does it mediate sexual dimorphism in liver mitochondria function.

The Use of Off-label and Unlicensed Drugs for Neonates: A Report from a Teaching Hospital in Baghdad

Background: Neonates who are admitted to hospitals will need various drugs. The use of unlicensed or off-label drugs without scientific evidence makes this exposure unsafe. Aim of study: We aimed to assess the use of drugs for neonates based on the British National Formulary for Children and IBM Micromedex Neofax. Patients and methods: This is a descriptive study which reviewed the clinical files of enrolled neonates who have stayed in the hospital for more than 24 hours and received at least one drug. It was conducted in the neonatal care unit of the Children Welfare Teaching Hospital/ Medical City Complex in Baghdad during the period from 1st of January to 30th of June/2018. The data was entered on a predesigned format and analyzed by using the appropriate statistical methods. Results: A total number of 1079 neonates were admitted to the NCU during the study period, of whom 967 were included in the current study with 597 (61.7%) males and 370 (38.3%) females. There were 424 (43.8%) preterm, 496 (51.3%) term and post term neonates, and 47 (4.9%) neonates with unknown gestational age. Different classes of drugs were used with a total of 56 drugs, of which 33.9% were unlicensed and 66.1% were off-label. Accordingly, 42.5% of the neonates received unlicensed drugs and almost all patients received at least one off-label drug. Major risk factors for such use include mechanical ventilation, male sex and prolonged hospitalization. Conclusions: In hospitalized neonates, drugs were more frequently prescribed as an off-label rather than unlicensed. Almost all neonates were exposed to off-label formulations.