Predictor Of Pregnancy Outcome Research Articles

Significance of dynamically monitoring serum estrogen and β-human chorionic gonadotropin in early pregnancy assessment.

BackgroundSpontaneous abortion occurs in 15% ~ 25% of clinical pregnancy. β‐human chorionic gonadotropin (β‐HCG) and progesterone (P) have been widely used in early pregnancy assessment, but their clinical significances are still controversial. Estradiol (E2) has not been used as widely as β‐HCG and P, and its value in predicting pregnancy outcome is unclear.MethodsIn this retrospective study, two hundred early pregnancy women were divided into two groups according to their early pregnancy outcomes: the ongoing pregnancy group and inevitable abortion group. Serum E2 and β‐HCG levels and their growth rates were compared weekly.ResultsEstradiol and β‐HCG of the ongoing pregnancy group were significantly higher than that of the inevitable abortion group from the 5th to 10th week of pregnancy. Taking 489.5 pg/mL in the 5th and 6th week, 590.5 pg/mL in the 7th week, and 614.5 pg/mL in the 8th week as cutoff levels of E2, the sensitivity and specificity for E2 to predict bad pregnancy outcome were 91.7% and 41.5%, 82.9% and 71.1%, 84.8% and 84.7%, 75.0% and 95.7%, respectively (P < .05). Both E2 and β‐HCG increased much more rapidly in the ongoing pregnancy group. 80% of the normal pregnancy women showed continuously increasing E2 level. Meanwhile, the inevitable abortion group presented E2 variation types as slow increase or fluctuation, continuous decline, and sudden drop, which account for 54.0%, 34.0%, and 12.0%, respectively.ConclusionLow values and low growth rates of E2 and β‐HCG probably indicate bad pregnancy outcomes.

Value of endometrial thickness change after human chorionic gonadotrophin administration in predicting pregnancy outcome following fresh transfer in vitro fertilization cycles.

To study whether the change of endometrial thickness (EMT) between the day of human chorionic gonadotrophin (hCG) administration and the day of embryo transfer has any impact on pregnancy outcome in fresh in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. This single-center retrospective cohort study included 2620 patients undergoing their first consecutive autologous IVF/ICSI cycles from January 2003 to December 2012. Patients were categorized into three groups based on the percentage change of post-hCG EMT: > 10% decrease, ± 10% plateau and > 10% increase. The primary outcome was live birth rate. Live birth rates were similar in the EMT decrease, plateau and increase groups (27.4% [174/635], 29.7% [300/1010] and 27.6% [269/975]; P = 0.649). Compared with the plateau group, both EMT decrease (crude odds ratio [cOR] 0.89, 95% confidence interval [CI] 0.72-1.11) and increase (cOR 0.90, 95% CI 0.74-1.10) on the day of transfer did not affect the likelihood of live birth. The non-significant association was maintained after controlling for major confounding factors, with the adjusted OR being 0.92 (95% CI 0.73-1.16) and 0.92 (95% CI 0.75-1.13) for the decrease and increase groups, respectively. EMT change after hCG administration did not provide significant prognostic information for pregnancy outcome in fresh IVF/ICSI cycles. This finding should offer reassuring information for patients with decreased EMT on the day of embryo transfer while questioning the necessity of EMT re-measurement prior to transfer as a routine practice.

RATIO OF HUMAN MENOPAUSAL GONADOTROPIN (HMG) TO RECOMBINANT FOLLICLE STIMULATING HORMONE (RFSH) DOSAGE PREDICTS PREMATURE PROGESTERONE ELEVATION AND LIVE BIRTH RATE IN FRESH IVF CYCLES

Premature progesterone rise during IVF stimulation reduces endometrial receptivity and is associated with decreased pregnancy rates following embryo transfer (ET). To our knowledge, no data exists regarding the appropriate ratio of hMG (which has 1:1 LH:FSH activity) to rFSH (which has FSH activity alone) to improve pregnancy outcomes. Our objective is to determine if an optimal ratio of hMG:rFSH can be identified that best predicts a reduced risk of elevated serum progesterone levels and change in progesterone (ΔP) during IVF stimulation, and to determine whether this ratio can also predict pregnancy outcomes following fresh ET.

CLARIFYING THE RELATIONSHIP BETWEEN TOTAL MOTILE SPERM COUNTS (TMSC) AND INTRAUTERINE INSEMINATION (IUI) PREGNANCY RATES

The use of post-wash TMSC in predicting pregnancy outcomes in IUI has been a subject of debate. Limitations of previous reports have been due to small sample sizes and attempts to identify clinically meaningful thresholds rather than define gradual pregnancy rate trends across a continuum of TMSC. To clarify the relationship between post-wash TMSC and IUI outcomes, we provide an updated evaluation of a large single institution sample.

Value of Middle Cerebral/Umbilical Artery Resistance Index Ratio in Neonatal Outcome in Patients with Intrauterine Growth Restriction (Prospective Study)

Background: Fetal growth disorders are usually associated with perinatal morbidity and mortality. Accurate assessment of intrauterine fetal growth is difficult, but recent advances have improved with positive implications for antenatal care.Aim of the work: The aim of this study was to assess the accuracy of the umbilical and middle cerebral artery resistance index in prediction of fetal outcome in pregnancies with intra-uterine growth restriction (IUGR).Patients and Methods: Forty-five pregnant females had been included in a prospective study. All had a confirmed diagnosis of intra-uterine growth restriction (IUGR). Doppler ultrasound had been performed to record fetal umbilical and middle cerebral artery (MCA) resistance indices every one week (from 32 weeks onwards). Post-delivery birth weight of the baby, Apgar score at 0 and 5 minutes had been documented and correlated with doppler indices. Results: One-fifth of the mothers participating in the study (20%) had pre-term birth and 6.7% missed the follow-up. Umbilical artery resistance index (RI) at a cut off value of (0.79) had a diagnostic accuracy of 93%. MCA RI best cut off value was 0.63 with diagnostic accuracy of 73.9%. Also, for C/U ratio had diagnostic accuracy of 92.9%. Finally, there was significant, proportional correlation between MCA RA and C/U ratio from one side and APGAR score at 0 and 5 minutes from the other side. However, the correlation between UARI and Apgar score was inverse and statistically significant. Conclusion: Doppler velocimetry of fetal circulation can provide important information regarding fetal well-being, with subsequent impact on fetal outcome.

Comparison of estimated fetal weight percentiles near term for predicting extremes of birthweight percentile

The INTERGROWTH-21st estimated fetal weight percentiles are recommended for predicting extremes of birthweight percentile, although evidence for their superiority over the widely employed Hadlock method is lacking. This study aimed to compare the ability of estimated fetal weight percentiles calculated using the Hadlock method and the INTERGROWTH-21st method to predict extremes of birthweight percentile. A prospective cohort study of blinded serial ultrasonography in nulliparous women with a singleton pregnancy, The Pregnancy Outcome Prediction study was conducted in Cambridge, United Kingdom. The study participants who had a research estimated fetal weight performed at 36 weeks' gestation were eligible for the analysis. Estimated fetal weight percentiles for gestational age calculated using (1) the Hadlock method or (2) the INTERGROWTH-21st method were used as exposures. Birthweight percentiles of <10th (small for gestational age) and >90th (large for gestational age) for gestational age and fetal sex using the United Kingdom 1990 reference or the INTERGROWTH-21st birthweight reference were analyzed as outcomes using receiver operating characteristic curve analysis. Screening statistics from 2×2 tables were calculated for dichotomized exposures and each outcome. The Hadlock estimated fetal weight percentile performed better than the INTERGROWTH-21st estimated fetal weight percentile at discriminating both small for gestational age birthweight (areas under the receiver operating characteristic curves, 0.87 vs 0.85; 95% confidence intervals, 0.85-0.89 vs 0.83-0.87, respectively; P<.0001) and large for gestational age birthweight (areas under the receiver operating characteristic curves, 0.87 vs 0.86; 95% confidence intervals, 0.85-0.90 vs 0.83-0.89, respectively; P=.005). When the estimated fetal weight percentiles were dichotomized and screen positive was defined at 90% specificity, the sensitivity for the Hadlock vs the INTERGROWTH-21st method was 58.6% vs 52.3%, respectively, for small for gestational age, and 71.0% vs 60.9%, respectively, for birthweight at less than the third percentile (United Kingdom 1990 reference). The results were similar when the birthweight percentile was defined using the INTERGROWTH-21st birthweight reference, when the estimated fetal weight was calculated without the inclusion of head measurements, or when the women who had clinically indicated scans and women who had their research scan result were excluded. Replacing the Hadlock method by the INTERGROWTH-21st method may lead to less effective screening for extremes of birthweight percentile.

Maternal Hemoglobin Concentration and Pregnancy Outcome: A Study of the Effects of Elevation in El Alto, Bolivia

Iron-defciency anemia is often under-diagnosed in developing coun- tries, specifcally in pregnant populations in regions of high altitude. Hemoglobin levels are not consistently adjusted for elevation, and therefore many anemic pa- tients are left undiagnosed. The purpose of this study was to incorporate current parameters for diagnosing anemia in pregnancy at high altitudes, and to evaluate the effects of appropriately adjusted hemoglobin concentrations on pregnancy out- come. A few studies have examined the effect of elevation on hemoglobin status, and other studies have considered the effects of anemia of pregnancy; however, there is a lack of data demonstrating that altitude-adjusted hemoglobin levels ac- curately predict pregnancy outcome. Using the Student t-Test, multiple linear re- gression, and ANOVA statistical analyses, various factors of pregnancy outcome were compared between anemic and non-anemic groups, as defned by hemoglobin cut-off levels adjusted for trimester of pregnancy and altitude. when appropriate adjustments were used, maternal anemia was associated with lower infant Apgar scores at both one minute and fve minutes after birth, as well as complication of labor, lower gestational age at birth, and higher parity. This study demonstrates the importance of altitude and trimester specifc adjustments to maternal hemoglobin levels in order to accurately diagnose anemia in pregnancy. In addition, a clear cor- relation is seen between maternal hemoglobin level and pregnancy outcome.

Is gross morphology of placenta, umbilical cord, and neonatal outcome in well-controlled gestational diabetes mellitus pregnancy different? A case-control study.

BackgroundThe relation of placental gross morphology and the outcome of pregnancies complicated with diabetes mellitus in comparison with healthy pregnancies is not known. Identifying significant differences in pregnancy outcomes in Gestational Diabetes Mellitus (GDM) and healthy pregnancies by the means of morphologic measurements can induce the use of antenatal ultrasonography of placental parameters to predict pregnancy outcomes.ObjectiveThis study aimed to evaluate the relationship between placental morphological parameters of the placenta and cord and the outcomes of pregnancies complicated with diabetes mellitus.Materials and MethodsIn this case-control study, which was conducted at two referral perinatology center in Tehran between March 2017 and November 2018, 60 pregnant women with GDM who were controlled with either diet or insulin as the case group and 60 pregnant women without GDM as the control group were enrolled. The study population were selected from patients who had their prenatal care and delivery in Mahdieh and Shohadaye Tajrish Hospital. The data was collected by taking sickness history, using data from patients files, and measuring of placental and newborn parameters after delivery. GDM was diagnosed either by 75 gr or 100 gr oral glucose tolerance tests. Placenta parameters, umbilical cord features, and newborn outcomes were compared between the two groups.Results Placental weight, diameter, number of lobes, thickness, placental weight to-newborn weight ratio, place of umbilical cord insertion, length, coiling, and diameter of the umbilical cord are similar in two groups. Newborn weight, NICU admission, ABG, and Apgar score are also the same in well-controlled GDM pregnancy and pregnancy without GDM.Conclusion Good controlled GDM causes no difference in placental gross morphology and pregnancy outcome compared to a healthy pregnancy.

Machine learning algorithms to predict early pregnancy loss after in vitro fertilization-embryo transfer with fetal heart rate as a strong predictor

Background and objectiveAccording to previous studies, after in vitro fertilization-embryo transfer (IVF-ET) there exist a high early pregnancy loss (EPL) rate. The objectives of this study were to construct a prediction model of embryonic development by using machine learning algorithms based on historical case data, in this way doctors can make more accurate suggestions on the number of patient follow-ups, and provide decision support for doctors who are relatively inexperienced in clinical practice. MethodsWe analyzed the significance of the same type of features between ongoing pregnancy samples and EPL samples. At the same time, by analyzing the correlation between days after embryo transfer (ETD) and fetal heart rate (FHR) of those normal embryo samples, a regression model between the two was established to obtain FHR model of normal development, and the residual analysis was used to further clarify the importance of FHR in predicting pregnancy outcome. Finally we applied six representative machine learning algorithms including Logistic Regression (LR), Support Vector Machine (SVM), Decision Tree (DT), Back Propagation Neural Network (BNN), XGBoost and Random Forest (RF) to build prediction models. Sensitivity was selected to evaluate prediction results, and accuracy of what each algorithm above predicted under both the conditions with and without FHR was compared as well. ResultsThere were statically significant differences in the same type of features between ongoing pregnancy samples and EPL samples, which could serve as predictors. FHR, of which the normal development showed a strong correlation with ETD, had great predictive value for embryonic development. Among the six predictive models the one predicted with the highest accuracy was Random Forest, of which recall ratio and F1 could reach 97%, and AUC could reach 0.97, FHR taken into account as a feature. In addition, Random Forest had a higher prediction accuracy rate for samples with longer ETD—its accuracy rate could reach 99% when predicting those at 10 weeks after embryo transfer. ConclusionIn this study, we established and compared six classification models to accurately predict EPL after the appearance of embryonic cardiac activity undergoing IVF-ET. Finally, Random Forest model outperformed the others. The implementation of Random Forest model in clinical environment can assist doctors to make clinical decisions.

Biallelic mutations of CFAP74 may cause human primary ciliary dyskinesia and MMAF phenotype.

Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterized by recurrent respiratory infections, nasosinusitis, tympanitis, and/or male infertility, all of which can severely impair the patient's quality of life. Multiple morphological abnormalities of the sperm flagella (MMAF) is one type of severe teratozoospermia and results from a variety of flagellar defects. In this study, we conducted whole-exome sequencing to identify and evaluate the genetic lesions in two patients with potential PCD and MMAF. Biallelic mutations in exon 10, c.983G>A; p.(Gly328Asp), and exon 29, c.3532G>A; p.(Asp1178Asn), of the CFAP74 (NM_001304360) gene were identified in patient 1 (P1), and biallelic mutations in exon 7, c.652C>T; p.(Arg218Trp), and exon 35, c. 4331G>C; p.(Ser1444Thr), of the same gene were identified in patient 2 (P2). Bioinformatic analysis suggested that these variants may be disease causing. Immunofluorescence confirmed that CFAP74 was absent in these patients' sperm samples. Intracytoplasmic sperm injection (ICSI) was carried out for P1, and his wife became pregnant after embryo transfer and gave birth to a healthy baby. To the best of our knowledge, this study is the first to identify the importance of CFAP74 in potential PCD and MMAF, contributing to the genetic diagnosis of these disorders and helping to predict pregnancy outcomes relevant in in vitro fertilization.

Elective Termination of Pregnancy in Autoimmune Rheumatic Diseases: Experience From Two Databases.

To provide reference data regarding the frequency and safety of elective termination of pregnancy in women with autoimmune rheumatic diseases followed up in 2 referral databases. Two large databases, one from an autoimmune rheumatic disease referral clinical practice with a known interest in pregnancy (the Barbara Volcker Center for Women and Rheumatic Disease [BVC]), and one from an observational study of systemic lupus erythematosus- and antiphospholipid antibody-associated pregnancies (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus [PROMISSE]), were interrogated for histories of prior elective termination of pregnancy and complications related to incident pregnancy termination. Of women who had had prior pregnancies, 21.7% of 1,307 in the BVC database and 25.3% of 297 in the PROMISSE database gave histories of 1-5 prior elective terminations of pregnancy; BVC patients reported no flares or hospitalizable complications due to pregnancy termination. Of 674 incident pregnancies, termination for fetal or maternal reasons was recommended for 15 (2%); of these, 2 fetuses died before the procedure was carried out and 1 woman declined termination and, though gravely ill, successfully delivered. She died of cardiomyopathy 3 years later. Many patients with autoimmune rheumatic disease undergo elective termination of pregnancy; few report complications. In medically indicated termination of pregnancy, there are no adverse signals of unusual complications or disease flare.

The potential use of urinary hCG measurements in the management of pregnancies of unknown location

Multiple measurements of serum human chorionic gonadotropin (hCG) are used to predict the final pregnancy outcome for women with a pregnancy of unknown location (PUL) and monitor the management of ectopic pregnancy (EP). Urine-based testing would be more convenient and economical. This prospective cohort study involving 80 women assessed the degree of correlation between serum and urine hCG levels and whether urine hCG levels have the potential to impact clinical decision making in the management of women with a PUL. Paired urine and serum hCG measurements differed quite widely but were well correlated and the degree of correlation improved after creatinine correction. Although serial serum hCG measurements appear to be better for the overall prediction of pregnancy outcome in PUL (AUC 0.77–0.94 compared to corrected urine AUC 0.69–0.84), serial urine hCG measurements may have a role in identifying subtypes of low-risk PUL (AUC 0.83–0.84).

Role of cerebro-placental ratio in prediction of perinatal outcome in high-risk pregnancies with intrauterine growth restriction

Introduction: Doppler ultrasound velocimetry of uteroplacental umbilical and fetal vessels has become established method of antenatal monitoring. Cerebroplacental ratio has been studied to predict neonatal outcomes. Aim of the work: Our aim was to assess role of cerebro-placental ratio in prediction of perinatal outcome in high-risk pregnancies with intrauterine growth restriction. Patients and Methods: In this study was held in Ain Shams university maternity hospital which included 60 high risk pregnant women divided in to two groups: Group I: study group: 30 high risk pregnant women with IUGR, Group II- control group: 30 high risk pregnant women without IUGR. Results: The current study showed that among patients with IUGR and low CPR, 17 (56.7%) had CS for fetal distress, 12 (40.0%) had neonate with low APGAR, 13 (43.3%) had neonatal meconium aspiration, 6 (20.0%) had neonatal Hypoxic ischemic Encephalopathy, 15 (50.0%) had neonate need NICU admission, 3 (10.0%) had neonatal death, 1 (3.3%) had neonatal still birth. The current study showed that among patients without IUGR and low CPR, 8 (26.7%) had CS for fetal distress, 5 (16.7%) had neonate with low APGAR, 4 (13.3%) had neonatal meconium aspiration, 1 (3.3%) had neonatal Hypoxic ischemic Encephalopathy, 5 (16.7%) had neonate need NICU admission, 1 (3.3%) had neonatal death, 0 (0.0%) had neonatal still birth. Conclusion: Cerebro -placental ratio has high predictive value of perinatal outcome in high risk pregnancy with intrauterine growth restriction.

Predicting pregnancy outcome by Doppler study evaluation of fetal middle cerebral artery, umbilical artery and ductus venosus

Objective: To investigate the sensitivity and specify of MCA, UA and DV Doppler pulsatility index as a diagnostic value for antepartum assessment of fetal wellbeing and prediction of adverse perinatal out come in both low and high-risk pregnancies. Patients and methods: Aprospective observational case control study conducted at Mansoura university hospitals from February 2018 through march 2019 and involved 100 pregnant ladies with a singleton pregnan- cy divided into two equal groups, G1 cases with high risk pregnancy, and G2 cases with low risk pregnancy as a control group. Both groups were matched for age, parity and gestational age. Results: The basic socio-demographic characteristics of the studied cases and controls were similar in age, gravidity, parity and body mass index (p> 0.05) but in G1 cases had significantly higher frequencies of mean systolic blood pressure, gestational hypertension, gestational DM, mild or severe PET, oligo- hydraminions, IUGR (p <0.001). De- spite there was no significant difference among cases and control as regard mean (SD) of gestational age in weeks, BPD (mm), UA PI (p >0.05), but there is a highly significant difference as regard FL (mm), AC (mm), MCA PI, DV PI (p values < 0.05). Also; there is a signif- icant difference regarding the reactivity of NST being more reactive in control than cases (35 vs 2, p <0.001). Again; there is a significant difference between cases and control regarding mean (SD) of gestation- al age at delivery (34±2 vs 39±1 in G2, p <0.001), Fetal weight (gm) (2255±1047 vs 2944±976, p <0.001), Agar score at 5 minutes (4.9±1.1 vs 8.3±1.4, p <0.001), occurrence of hypoxia (68% vs 2%, p <0.001), need for NICU admission (66% vs 2% p <0.001) and acidotic cord blood with PH < 7.2 (33 cases vs 1 case only, p <0.001). Logistic re- gression analysis revealed the cut off value MCA PI (1.62) had high sensitivity (82%), specificity (78%), PV(79%), NPV (81%) and a diag- nostic accuracy of (80%). Also, UA PI cut off value was found (1.12) with sensitivity (60%), specificity (68%), PPV(65%), NPV (63%) with a diagnostic accuracy of (64%). Regarding the best cut off value of DV study by the same method, DVPI cut off value was(0.77), with sensi- tivity (84%), specificity (80%), PPV(80%), NPV(83%) with diagnostic accuracy (82%). Conclusions: Doppler velocimetry studies of placental and fetal circu- lation can provide important information regarding fetal well-being thus yielding an opportunity to improve fetal and neonatal outcome

ROLE OF ULTRASOUND IN PREDICTION OF PREGNANCY OUT COME IN THREATENED ABORTION

Background: Threatened miscarriage constitutes 15–20% of pregnancies and is one of the commonest gynecological emergencies. Previously, the volume of an intrauterine hematoma (IUH) or on the presence of vaginal bleeding was considered but not the location of the hemorrhage. Objective: To predicted pregnancy outcome through sonographic finding in women presenting with symptoms of threatened abortion. Subjects and methods: This was a prospective study held on 300 patients who attended the out-patient clinic or the causality department of Obstetrics &Gynecology, in Tahta general hospital. Patients were with clinical diagnosis of threatened abortion in their 1st trimester of pregnancy, attended to outpatient clinic or causality department, giving a history of bloody vaginal discharge or vaginal bleeding. Results: there were statistically significant difference of mean values of sub trophoblastic arteries RI for the continued group and aborted group in all gestational age. There were statistically significant difference of mean values of sub trophoblastic arteries PI for the continued group and aborted group in all gestational age. Conclusion: CRL and FHR are good sonographic indicators for the prediction of outcome in women with threatened miscarriage. Color Doppler of subtrophoblastic arteries is useful in prediction of pregnancy outcome in threatened abortion .The incidence of maternal and fetal complications increased in cases with threatened miscarriage that completed the pregnancy.

MicroRNAs in combined spent culture media and sperm are associated with embryo quality and pregnancy outcome

To identify differentially abundant miRNAs in sperm samples and spent culture media (SCM) of embryos of different grade toward a prediction of pregnancy outcome. Array-based reverse-transcription quantitative polymerase chain reaction profiling and validation. University research institute and invitro fertilization center. Couples (n = 61) undergoing infertility treatment with the use of intracytoplasmic sperm injection. None. Abundance levels of miRNAs in combined SCM of embryos of different quality and in sperm samples associated with pregnancy outcome. Out of 372 screened miRNAs, miR-19b-3p and let-7a-5p were detected consistently in all SCM and sperm samples. The abundance levels of miRNAs were significantly altered between SCM of embryos with different quality (G1, G2, and G3 grades). Specifically, miR-320a and miR-15a-5p were differentially abundant in G1 vs. G2, miR-21-5p in G1 vs. G3, and miR-20a-5p in G2 vs. G3. The abundance levels of combined SCM and sperm derived miRNAs were also significantly altered between different pregnancy outcomes. MiR-19b-3p showed the highest area under the receiver operating characteristic curve values between positive and negative outcomes, with lower abundance levels in both combined SCM and sperm samples associated with a positive pregnancy outcome. MiR-320a, miR-15a-5p, miR-21-5p, and miR-20a-5p showed similar results in combined SCM samples. miRNA abundance levels in combined SCM and sperm differed significantly depending on embryo quality and pregnancy outcome. MiR-19b-3p may serve as a potential biomarker to predict pregnancy outcome.

Low frequency of flares during pregnancy and post-partum in stable lupus patients

BackgroundLupus patients are at risk for pregnancy loss, and it has been generally accepted that women with SLE should have low disease activity prior to conception. However, there are conflicting results regarding the effect of pregnancy on SLE flares. This study aims to identify predictors of flares during and after pregnancy in SLE patients with inactive or stable disease activity during the first trimester and to characterize and estimate the frequency of post-partum flares in these patients.MethodsSLE patients in the multicenter, prospective PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study were evaluated for flares during and after pregnancy using the SELENA-SLEDAI Flare Index. Flares during pregnancy were assessed in all 384 patients and post-partum flares in 234 patients with study visits 2–6 months post-partum. Logistic regression models were fit to the data to identify independent risk factors for flare.ResultsDuring pregnancy, 20.8% of patients had mild/moderate flares and 6.25% had severe. Post-partum, 27.7% of patients had mild/moderate flares and 1.7% had severe. The mild flares rarely required treatment. Younger age, low C4 and higher PGA at baseline were independently associated with higher risk of having at least one mild/moderate or severe flare during pregnancy. Older patients were at decreased risk of flare, as well as those with quiescent disease at baseline. No variables evaluated at baseline or the visit most proximal to delivery was significantly associated with risk of flare post-partum. Medications were not associated with flare during or after pregnancy.ConclusionIn patients with inactive or stable mild disease activity at the time of conception, lupus disease flares during and after pregnancy are typically mild and occur at similar rates. Flares during pregnancy are predicted by the patients’ age and clinical and serological activity at baseline.

Sensitivity Analysis of the Quadratic Discriminant Function for Predicting Pregnancy Outcomes

The prevalence rate of stillbirth is ten times higher in developing countries relative to developed countries with a 2016 rate of 18 percent in Ghana. This study employed the Quadratic Discriminant Function for discriminating and classifying of pregnancy outcomes based on some predictors. The study further examined the sensitivity of the Quadratic Discriminant Function in predicting pregnancy outcomes with variations in the training and test samples of deliveries recorded in a hospital in Accra, Ghana. The study considered the scenarios; 50:50, 60:40, 70:30 and 75:25 ratios of training sets to testing sets. Predictor variables on both maternal factors (maternal age, parity and gravida) and fetus variables (weight at birth and gestational period) were all statistically significant (P &lt; .01) in discriminating between live birth and stillbirth. Results showed that maternal age had a negative effect on the live birth outcomes, while parity, gravida, gestational period and fetus weight recorded positive effects on live birth outcomes. The 75:25 ratio outperformed the other ratios in discriminating between live and stillbirth based on the Actual Error Rate of 7.28% compared to 7.81%, 12.14% and 13.79% for the 50:50, 70:30 and 60:40 ratios respectively whereas, the receiver operating characteristic curve shows the 70:30 (AUC= 0.9233) ratio outperformed the others. The study recommend the use of either the 70:30 or 75:25 training to test ratios for classification and discrimination related problems. Moreover, further research to establish the power of the respective training to test sample ratios with other statistical classification tools and more socio-economic variables can be considered.

The value of intelligent ultrasound sensor used in the measurement of fetal hemodynamics and evaluation of health factors

ObjectiveThe purpose is to discuss the application of intelligent ultrasound sensor in the measurement of fetal hemodynamics and the evaluation of health factors. Methods: 237 pregnant women who were hospitalized in the fourth people's hospital of Jinan from June 2016 to May 2018 were selected as the study objects. According to the situation of pregnant women, they were divided into pre-pregnancy diabetes group (Group IB, 19 cases), gestational diabetes group (Group IA, 93 cases), and normal control group (Group II, 125 cases). In order to evaluate the health status of pregnant women and infants, intelligent ultrasound sensor was used for pregnant women measurement in each group, including ultrasonic parameters, hemodynamic parameters, and body weight. ResultsThere was no significant difference in age, height, weight, and gestational weeks between Group IA, Group IB, and Group II (P > 0.05). Pregnant women in each group showed that the blood glucose content of Group IB and Group IA increased significantly after fasting and glucose tolerance test, compared with the control group (P < 0.05), and the blood glucose content of Group IB was always higher than that of Group IA (P < 0.05). Compared with the control group, fetal ultrasound parameters and body weight were significantly increased in Group IB and Group IA (P < 0.05). The hemodynamic parameters of MCA (Middle Cerebral Artery), UA (Umbilical Artery), and Ut-A (Uterine Artery) in Group IB and Group IA were significantly different from that of the control group (P < 0.05). Furthermore, the area under ROC (Receiver Operating Characteristic) curve of MCA-PI was the largest, and the effect of predicting pregnancy outcome was the most obvious. ConclusionThrough the study, it was found that the measurement of hemodynamic parameters in the later period of pregnancy with intelligent ultrasound sensor could predict the outcome of pregnancy, especially the adverse pregnancy outcome of patients with abnormal glucose metabolism. It could provide experimental basis for the prediction of the outcome of pregnancy and the evaluation of health status of patients with abnormal glucose metabolism in the later period of pregnancy.

A maternal serum metabolite ratio predicts fetal growth restriction at term.

Fetal growth restriction (FGR) is the major single cause of stillbirth1 and is also associated with neonatal morbidity and mortality2,3, impaired health and educational achievement in childhood4,5 and with a range of diseases in later life6. Effective screening and intervention for FGR is an unmet clinical need. Here, we performed ultrahigh performance liquid chromatography-tandem mass spectroscopy (UPLC-MS/MS) metabolomics on maternal serum at 12, 20 and 28 weeks of gestational age (wkGA) using 175 cases of term FGR and 299 controls from the Pregnancy Outcome Prediction (POP) study, conducted in Cambridge, UK, to identify predictive metabolites. Internal validation using 36 wkGA samples demonstrated that a ratio of the products of the relative concentrations of two positively associated metabolites (1-(1-enyl-stearoyl)-2-oleoyl-GPC (P-18:0/18:1) and 1,5-anhydroglucitol) to the product of the relative concentrations of two negatively associated metabolites (5α-androstan-3α,17α-diol disulfate and N1,N12-diacetylspermine) predicted FGR at term. The ratio had approximately double the discrimination as compared to a previously developed angiogenic biomarker7, the soluble fms-like tyrosine kinase 1:placental growth factor (sFLT1:PlGF) ratio (AUC 0.78 versus 0.64, P = 0.0001). We validated the predictive performance of the metabolite ratio in two sub-samples of a demographically dissimilar cohort, Born in Bradford (BiB), conducted in Bradford, UK (P = 0.0002). Screening and intervention using this metabolite ratio in conjunction with ultrasonic imaging at around 36 wkGA could plausibly prevent adverse events through enhanced fetal monitoring and targeted induction of labor.