Pregnancy Outcomes In Patients Research Articles

Evaluation of alanine aminotransferase/aspartate aminotransferase ratio and high-density lipoprotein for predicting neonatal adverse outcomes associated with intrahepatic cholestasis of pregnancy.

To determine the association between lipid metabolism and intrahepatic cholestasis of pregnancy (ICP), and explore the value of maternal alanine aminotransferase/aspartate aminotransferase (ALT/AST) and high-density lipoprotein (HDL) in predicting adverse neonatal outcomes in women with ICP. A total of 147 pregnant women with ICP admitted to The Fourth Hospital of Shijiazhuang and 120 normal pregnant women in the same period were selected in this study. The Mann-Whitney U test and Chi-square tests were used to compare the differences in clinical data. Multivariate logistic regression was used to analyze the relationship between ALT/AST and the occurrence of adverse pregnancy outcomes in patients with ICP. The combined predictive value of ALT/AST and HDL was determined by receiver operating characteristic (ROC) curve analysis. Among 147 women with ICP, 122 women had total bile acid (TBA) levels of 10-39.9 µmol/L, and 25 had TBA ≥ 40 µmol/L. There was significantly lower gestational age in patients with severe ICP than in those with mild and control groups (all p<0.05), and the weight of newborns in the maternal ICP group was significantly lower than in the control group (p<0.05). Increasing TBA levels was associated with higher AST, ALT, ALT/AST, and lower HDL level (all p<0.05). Meanwhile, higher levels of ALT/AST was positively associated with neonatal hyperbilirubinemia [adjusted odds ratio (AOR) = 4.019, 95% CI [1.757-9.194, p=0.001] and cardiac injury [AOR = 3.500, 95% CI [1.535-7.987], p=0.003]. HDL was a significant protective factor for neonatal hyperbilirubinemia and cardiac injury [AOR = 0.315, 95% CI [0.126-0.788], p=0.014; AOR = 0.134 (0.039-0.461), p=0.001]. The area under the ROC curve (AUC) for prediction of neonatal hyperbilirubinemia by ALT/AST combined with HDL was 0.668 [95% CI [56.3-77.3%], p = 0.002], and the sensitivity and specificity were 47.1% and 84.0%, respectively. To predict neonatal cardiac injury, the AUC value was 0.668 [95% CI [56.4-77.1%], p = 0.002], with sensitivity and specificity were 41.2% and 87.1%, respectively. The levels of higher ALT/AST and lower HDL were significantly associated with the risk of ICP-related adverse neonatal outcomes. Moreover, ALT/AST combined with HDL has moderate clinical value in predicting the adverse outcomes of neonatal hyperbilirubinemia and cardiac injury.

Nomogram to predict the probability of clinical pregnancy in women with poor ovarian response undergoing in vitro fertilization/ intracytoplasmic sperm injection cycles.

Poor ovarian response (POR) is associated with decreased clinical pregnancy rates, emphasizing the need for developing clinical prediction models. Such models can improve prognostic accuracy, personalize medical interventions, and ultimately enhance live birth rates among patients with POR. This study aims to develop and validate a prognostic model for predicting clinical pregnancy outcomes in individuals with POR undergoing in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles. A retrospective cohort of 969 patients with POR undergoing fresh embryo transfer cycles at the Reproductive Center of Fujian Maternal and Child Health Center from January 2018 to January 2022 was included. The cohort was randomly divided into model (n = 678) and validation (n = 291) groups in a 7:3 ratio. A single-factor analysis was performed on the model group to identify variables influencing clinical pregnancy. Optimal variables were selected using LASSO regression, and a clinical prediction model was constructed using multivariate logistic regression analysis. The model's calibration and discrimination were assessed using receiver operating characteristic (ROC) and calibration curves, while the clinical utility was evaluated using decision curve analysis. Multivariate logistic regression analysis revealed that the age of the women (odds ratio [OR] 0.936, 95% confidence interval [CI] 0.898-0.976, P = 0.002), body mass index (BMI) ≤ 24 (OR 2.748, 95% CI 1.724-4.492, P < 0.001), antral follicle count (AFC) (OR 1.232, 95% CI 1.073-1.416, P = 0.003), anti-Müllerian hormone (AMH) (OR 1.67, 95% CI 1.178-2.376, P = 0.004), number of mature oocytes (OR 1.227, 95% CI 1.075-1.403, P = 0.003), number of embryos transferred (OR 1.692, 95% CI 1.132-2.545, P = 0.011), and transfer of high-quality embryos (OR 3.452, 95% CI 1.548-8.842, P = 0.005) were independent predictors of clinical pregnancy in patients with POR. According to the receiver operating characteristic (ROC) analysis, the prediction model exhibited an area under the curve (AUC) of 0.752 (0.714, 0.789) in the model group and 0.765 (0.708, 0.821) in the validation group. The clinical decision curve demonstrated that the model held maximum clinical utility in both cohorts when the threshold probability of clinical pregnancy ranged from 6-81% to 12-82%, respectively. Clinical pregnancy outcomes in patients with POR who underwent IVF/ICSI treatment were influenced by several independent factors, including the age of the women, BMI, AFC, AMH, number of mature oocytes, number of embryos transferred, and transfer of high-quality embryos. A clinical prediction model based on these factors exhibited favorable clinical predictive and applicative value. Therefore, this model can serve as a valuable tool for clinical prognosis, intervention, and facilitating personalized medical treatment.

Assessment of the fetal thymic-thoracic ratio in pregnant women with intrahepatic cholestasis: a prospective case-control study.

To examine the fetal thymic-thoracic ratio (TTR) in intrahepatic cholestasis of pregnancy (ICP). This prospective case-control study was conducted in a single tertiary center. The sample consisted of 86 pregnant women at 28-37 weeks of gestation, including 43 women with ICP and 43 healthy controls. TTR was calculated for each patient using the anterior-posterior measurements of the thymus and intrathoracic mediastinal measurements. The median TTR value was found to be smaller in the ICP group compared to the control group (0.32 vs. 0.36, p<0.001). The ICP group had a greater rate of admission to the neonatal intensive care unit (NICU) (p<0.001). Univariate regression analysis revealed that lower TTR values increased the possibility of NICU admission six times (95 % confidence interval: 0.26-0.39, p=0.01). A statistically significant negative correlation was detected between TTR and the NICU requirement (r:-0.435, p=0.004). As a result of the receiver operating characteristic analysis, in predicting NICU admission, the optimal cut-off value of TTR was determined to be 0.31 with 78 % sensitivity and 67 % specificity (area under the curve=0.819; p<0.001). We determined that the fetal TTR may be affected by the inflammatory process caused by the maternal-fetal immune system and increased serum bile acid levels in fetal organs in the presence of ICP. We consider that TTR can be used to predict adverse pregnancy outcomes in patients with ICP.

Diagnostic efficacy of virtual organ computer-assisted analysis in measuring the volume ratio of subchorionic hematoma with serum progesterone

BACKGROUND Subchorionic hematoma (SCH) is a common complication in early pregnancy characterized by the accumulation of blood between the uterine wall and the chorionic membrane. SCH can lead to adverse pregnancy outcomes such as miscarriage, preterm birth, and other complications. Early detection and accurate assessment of SCH are crucial for appropriate management and improved pregnancy outcomes. AIM To evaluate the diagnostic efficacy of virtual organ computer-assisted analysis (VOCAL) in measuring the volume ratio of SCH to gestational sac (GS) combined with serum progesterone on early pregnancy outcomes in patients with SCH. METHODS A total of 153 patients with SCH in their first-trimester pregnancies between 6 and 11 wk were enrolled. All patients were followed up until a gestational age of 20 wk. The parameters of transvaginal two-dimensional ultrasound, including the circumference of SCH (Cs), surface area of SCH (Ss), circumference of GS (Cg), and surface area of GS (Sg), and the parameters of VOCAL with transvaginal three-dimensional ultrasound, including the three-dimensional volume of SCH (3DVs) and GS (3DVg), were recorded. The size of the SCH and its ratio to the GS size (Cs/Cg, Ss/Sg, 3DVs/3DVg) were recorded and compared. RESULTS Compared with those in the normal pregnancy group, the adverse pregnancy group had higher Cs/Cg, Ss/Sg, and 3DVs/3DVg ratios (P &lt; 0.05). When 3DVs/3DVg was 0.220, the highest predictive performance predicted adverse pregnancy outcomes, resulting in an AUC of 0.767, and the sensitivity, specificity were 70.2%, 75% respectively. VOCAL measuring 3DVs/3DVg combined with serum progesterone gave a diagnostic AUC of 0.824 for early pregnancy outcome in SCH patients, with a high sensitivity of 82.1% and a specificity of 72.1%, which showed a significant difference between AUC. CONCLUSION VOCAL-measured 3DVs/3DVg effectively quantifies the severity of SCH, while combined serum progesterone better predicts adverse pregnancy outcomes.

Effect of Tiaojing Cuyun acupuncture therapy on pregnancy outcomes in women with diminished ovarian reserve undergoing IVF-ET: a cohort study

To assess the effect of Tiaojing Cuyun acupuncture therapy (acupuncture for regulating menstruation and promoting pregnancy) on pregnancy outcomes in patients with diminished ovarian reserve (DOR) undergoing in vitro fertilization-embryo transfer (IVF-ET). Eighty women with DOR were divided into an observation group (40 cases, 1 case dropped out) and a control group (40 cases, 1 case dropped out) according to whether Tiaojing Cuyun acupuncture therapy was given or not. In the control group, IVF-ET was delivered. In the observation group, before IVF-ET, Tiaojing Cuyun acupuncture therapy was given. Two groups of acupoints were used alternatively, including Baihui (GV 20), Shenting (GV 24), Benshen (GB 13), Zhongwan (CV 12), Guanyuan (CV 4), and bilateral Tianshu (ST 25), Shenshu (BL 23), Ciliao (BL 32), etc. Acupuncture was operated once every other day, three interventions a week, for 12 weeks. The primary outcome was clinical pregnancy rate (CPR). Secondary outcomes included the total days and amount of gonadotropin (Gn) used, the number of oocytes retrieved, the number of oocytes in metaphase of second meiosis (MⅡ), the number of transferable embryos, the number of high-quality embryos, the cycle cancellation rate, the positive rate of human choriogonadotropin (HCG), the embryo implantation rate, live birth rate (LBR), the basal serum levels of sex hormones (follicular stimulating hormone [FSH], estradiol (E2), FSH/luteinizing hormone [LH]) and antral follicle count (AFC). CPR in the observation group was higher than that in the control group (53.8% [21/39] vs. 17.9% [7/39], P<0.05). The results of the number of oocytes retrieved, the number of oocytes in MⅡ, the number of transferable embryos, the number of high-quality embryos, the positive rate of HCG, the embryo implantation rate, and LBR in the observation group were higher than those in the control group (P<0.05). The serum level of FSH and FSH/LH in the observation group were lower thau those in the control group (P<0.05). The differences were not significant statistically in the total days and amount of Gn used, the cycle cancellation rate, serum level of E2 and AFC between the two groups (P>0.05). Logic regression analysis showed that CPR increased in the observation group when compared with that of the control group (OR = 5.33, 95%CI: 1.90-14.97, P = 0.001). Acupuncture can improve the pregnancy outcomes of DOR women undergoing IVF-ET.

Current research of Assisted Reproductive Technology for women with early endometrial cancer and atypical endometrial hyperplasia after conservative treatment.

As the incidence of endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) has been increasing, and has shown young trend. It is crucial to study the fertility-preserving treatment of endometrial lesions and fertility-promoting protocols. Age, obesity, and irregular ovulation are not only high-risk factors for endometrial lesions but also key factors affecting female fertility. Assisted reproductive technology (ART) can significantly improve pregnancy outcomes in patients with AEH and EC after conservative treatment. Based on the existing studies, this article reviews the progress of research on pregnancy outcomes of ART and its influencing factors in such patients. It helps physicians in providing optimal fertility guidance.

The Relationship Between Anti-Mullerian Hormone Levels and Pregnancy Outcomes in Patients with Recurrent Unexplained Miscarriage

Background: This study aimed to assess the correlation between serum levels of anti-Mullerian hormone (AMH), basal follicle-stimulating hormone (FSH), basal luteinizing hormone (LH), and basal estradiol with pregnancy outcomes. Methods: Conducted at Shariati Hospital in Tehran from 2020 to 2021, this prospective cohort study included women under 38 years old with idiopathic recurrent miscarriage (IRM). Individuals with AMH levels below 1 ng/mL were classified as the poor responder group. All participants with IRM received a daily combination of 20 mg prednisolone and 200 mg progesterone vaginal suppositories from the beginning of pregnancy until 12 weeks, along with aspirin and folic acid. Pregnancy was monitored until 36 weeks, and outcomes were evaluated over two years using univariate and multiple logistic regression, with P-values &lt; 0.05 considered significant. Results: The study comprised 128 individuals with a mean age of 36.4 ± 3.9 years. Of these, 80 became pregnant, while 48 did not. Among the pregnant individuals, 34 had terminations before 26 weeks (13 ongoing and 21 clinical), while 46 had pregnancies lasting 26 weeks or longer. Maternal age (RR = 1.23, 95% CI: 1.10 - 1.90, P = 0.001), history of abortion (RR = 1.262, 95% CI: 1.052 - 1.327, P = 0.008), and low serum AMH level (RR = 0.752, 95% CI: 0.227 - 0.934, P = 0.035) were significantly associated with the probability of subsequent pregnancies. Maternal age (RR = 1.108, 95% CI: 1.05 - 1.350, P = 0.025) and history of abortion (RR = 1.097, 95% CI: 1.02 - 1.161, P = 0.042) were the only factors associated with the risk of non-pregnancy. Conclusions: The study findings suggest that AMH levels in women with IRM significantly influence pregnancy outcomes, including abortion and live births at 26 weeks or more. The univariate analysis revealed significant correlations between age, serum AMH levels, previous history of abortion, and the risk of abortion. Additionally, AMH levels were found to relate to follicle storage rather than egg quality, indicating that AMH does not predict live birth after IVF. Overall, this prospective study underscores the importance of maternal age, AMH level, and previous abortion history in predicting pregnancy outcomes.

Diabetes Mellitus: Preconception management in primary care

Women with diabetes experience adverse risks to their health and the health of their foetuses during pregnancy. This article draws upon research to help primary care nurses advise and care for patients who fall into this category Diabetes mellitus is associated with adverse risks to both pregnant women and their foetuses. These risks include; congenital malformations, stillbirth and miscarriage. The infant is also at risk of developing diabetes mellitus and other health issues in the future. This article provides an overview of diabetes mellitus and pregnancy. Addressing the importance of preconception management and the role general practice nurses have in increasing favourable outcomes, through improving preconception management in primary care. Discussing integrating primary and secondary care to enable continuity of care. Analysing the research on the impact health care professionals conducting educational interventions has on patient's pregnancy outcomes. As well as the use of conventional and digital methods to provide health education on preconception care.

Safety of Monoclonal Antibodies as Treatment for Coronavirus Disease 2019 (COVID-19) During Pregnancy

OBJECTIVE: Pregnant patients are at increased risk of severe illness, in-hospital mortality, and preterm birth in the setting of coronavirus disease 2019 (COVID-19); however, they often are excluded from clinical trials that analyze improved therapeutics for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Thus, there are relatively few available data that examine the safety of monoclonal antibodies (mAbs) in pregnant patients with COVID-19, which we aimed to explore in this systematic review. DATA SOURCES: We searched PubMed, Cochrane, EMBASE, and Google Scholar on September 30, 2022. Included studies encompassed English-language case reports with at least five participants, cross-sectional studies, case–control studies, cohort studies, retrospective or prospective chart reviews, and randomized controlled trials that enrolled pregnant women who received SARS-CoV-2–targeted mAbs. Studies were screened for eligibility using Covidence according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines and were subsequently evaluated for risk of bias with the JBI critical appraisal checklist. TABULATION, INTEGRATION, AND RESULTS: Initial search yielded 616 studies; 13 publications were ultimately eligible. Pregnant patients were treated with SARS-CoV-2–neutralizing mAbs casirivimab-imdevimab, bamlanivimab, or bamlanivimab-etesevimab. A total of 365 patients were treated with casirivimab-imdevimab, 13 were treated with bamlanivimab, and 11 were treated with bamlanivimab-etesevimab. There were no cases of maternal mortality. Eighteen of the 389 patients had adverse effects related to mAb administration—all resolved. Of the patients treated with casirivimab-imdevimab, there were 35 preterm deliveries, two fetal deaths, one neonatal death due to sepsis, five cases of preterm prelabor rupture of membranes (PROM), one case of PROM, and 24 neonatal intensive care unit (NICU) admissions. Of the patients treated with bamlanivimab, there was one case of preterm PROM and one preterm delivery. There were no NICU admissions in the bamlanivimab or bamlanivimab-etesevimab cohorts. CONCLUSION: Preliminary data suggest that neutralizing mAb treatment for COVID-19 in pregnant patients is safe. However, treatment-associated events support the importance of clinical trials to determine the statistical significance of maternal and fetal outcomes in pregnant patients treated with SARS-CoV-2–targeted mAbs.

Comparison of HCG Trigger versus Dual Trigger in Improving Pregnancy Outcomes in Patients with Different Ovarian Responses: A Retrospective Study

Comparison of HCG Trigger versus Dual Trigger in Improving Pregnancy Outcomes in Patients with Different Ovarian Responses: A Retrospective Study

The impact of comprehensive treatment on pregnancy outcomes in patients with polycystic ovary syndrome

This study focuses on the impact of comprehensive treatment on pregnancy outcomes in patients with polycystic ovary syndrome (PCOS). In this research, 60 PCOS patients admitted to our hospital between January 2022 and April 2023 were selected and randomly divided into two groups. The control group (n=30) received conventional Western medical treatment, while the observation group (n=30) received integrated traditional Chinese and Western medicine treatment. The two groups were compared in terms of sex hormone levels, endometrial receptivity indices, pregnancy outcomes, incidence of adverse reactions, overall treatment efficacy, and Traditional Chinese Medicine (TCM) syndrome scores. The study found that before treatment, there were no significant differences between the two groups in terms of sex hormone levels, endometrial receptivity indices, and TCM syndrome scores (P&gt;0.05). After treatment, the observation group showed significantly better results than the control group in these indices (P&lt;0.05). The pregnancy outcomes in the observation group were superior to those in the control group (P&lt;0.05), the incidence of adverse reactions was lower in the observation group (P&lt;0.05), and the overall clinical efficacy was higher in the observation group (P&gt;0.05). In conclusion, comprehensive treatment combining traditional Chinese and Western medicine can improve pregnancy outcomes in PCOS patients and is worthy of promotion.

Efficacy of endometrial receptivity testing for recurrent implantation failure in patients with euploid embryo transfers: study protocol for a randomized controlled trial

BackgroundEmbryo implantation remains a critical barrier in assisted reproductive technologies. One of the main causes of unsuccessful embryo implantation is window of implantation (WOI) displacement, particularly in patients with recurrent implantation failure (RIF). Therefore, a reliable diagnostic tool for identifying the optimal WOI is essential. Previous data has suggested that a novel RNA-Seq-based endometrial receptivity testing (ERT) can diagnose WOI, guide personalized embryo transfer (pET), and improve pregnancy outcomes in patients with RIF compared to standard embryo transfer (sET). However, there is still a lack of evidence from randomized controlled trials (RCT) with sufficient power to determine whether pET based on ERT can increase the rate of live births as the primary outcome.MethodsThis trial is a prospective, single-blind, parallel-group RCT (1:1 ratio of pET versus sET). Infertile women with RIF who intend to undergo frozen-thawed embryo transfer (FET) after preimplantation genetic testing for aneuploidy (PGT-A) with the availability of at least one euploid blastocyst for transfer will be enrolled and assigned into two parallel groups randomly. Participants in the intervention group will undergo ERT and then pET based on the results of ERT, while those in the control group will undergo sET. The primary outcome is live birth rate.DiscussionThe findings of this study will provide evidence for the effect of pET guided by ERT on pregnancy outcomes in patients with RIF.Trial registrationChinese Clinical Trial Registry ChiCTR2100049041. Registered on 20 July 2021.

Pregnancy outcomes of patients with positive anticentromere antibodies receiving in vitro fertilization-embryo transfer.

To analyze the pregnancy outcomes in patients with positive anti-centromere antibodies (ACA) receiving in vitro fertilization (IVF)-embryo transfer (ET) and natural conception. A case-control study was used to retrospectively analyze the clinical data of 3955 patients who received IVF-ET therapy and had the results of antinuclear antibody (ANA) spectrum at Zhejiang Provincial People's Hospital from June 2016 to June 2023. Patients with positive ACA and negative ACA were matched at a ratio of 1∶3 using propensity score matching. Embryo outcomes of IVF were compared between the two groups, and the impact of different fertilization methods and the use of immunosuppressants on pregnancy outcomes were analyzed using self-matching. The natural conception and disease progress were followed up for ACA-positive patients after IVF failure. The ACA-positive patients accounted for 0.86% of all IVF patients (34/3955) and 2.51% of total ANA-positive IVF patients. Regardless of whether patients received conventional IVF (c-IVF) or intracytoplasmic sperm injection (ICSI), the ACA-positive group exhibited significant differences in oocyte maturity and fertilization compared to the ACA-negative group (both P<0.01). Moreover, the ACA-positive group had a decreased number of D3 suboptimal embryos and D3 optimal embryos (both P<0.05). In 5 cases of ACA-positive patients who underwent ICSI cycles, the two pronucleus (2PN) rate did not increase compared to c-IVF cycles (P>0.05), and there was a decrease in the number of D3 high-quality embryos and D3 suboptimal embryos (both P<0.05). After 1-2 months of immuno-suppressant treatment, 12 ACA-positive patients underwent c-IVF/ICSI again, and there were no changes in egg retrieval and fertilization before and after medication (both P>0.05), but there was an improvement in the 2PN embryo cleavage rate (P<0.05). The number of embryos transferred was similar between the ACA-positive and negative groups, but the ACA-positive group had significantly lower embryo implantation rate and clinical pregnancy rate compared to the ACA-negative group (both P<0.05), with no significant differences in the miscarriage rate between the two groups (P>0.05). Twenty-seven ACA-positive patients attempted natural conception or artificial insemination after IVF failure, resulting in a total of 7 cases of clinical pregnancy. Serum ACA positivity may disrupt oocyte maturation and normal fertilization processes, with no improvement observed with ICSI and immunosuppressant use. However, ACA-positive patients may still achieve natural pregnancy.

Endometrial compaction to predict pregnancy outcomes in patients undergoing assisted reproductive technologies: a systematic review and meta-analysis.

Does endometrial compaction (EC) help predict pregnancy outcomes in those undergoing ART? EC is associated with a significantly higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR), but this does not translate to live birth rate (LBR). EC describes the progesterone-induced decrease in endometrial thickness, which may be observed following the end of the proliferative phase, prior to embryo transfer. EC is proposed as a non-invasive tool to help predict pregnancy outcome in those undergoing ART, however, published data is conflicting. A literature search was carried out by two independent authors using PubMed, Cochrane Library, MEDLINE, Embase, Science Direct, Scopus, and Web of Science from inception of databases to May 2023. All peer-reviewed studies reporting EC and pregnancy outcomes in patients undergoing IVF/ICSI treatment were included. The primary outcome is LBR. Secondary outcomes included other pregnancy metrics (positive pregnancy test (PPT), CPR, OPR, miscarriage rate (MR)) and rate of EC. Comparative meta-analyses comparing EC and no EC were conducted for each outcome using a random-effects model if I 2 > 50%. The Mantel-Haenszel method was applied for pooling dichotomous data. Results are presented as odds ratios (OR) with 95% CI. Out of 4030 screened articles, 21 cohort studies were included in the final analysis (n = 27 857). No significant difference was found between LBR in the EC versus the no EC group (OR 0.95; 95% CI 0.87-1.04). OPR was significantly higher within the EC group (OR 1.61; 95% CI 1.09-2.38), particularly when EC ≥ 15% compared to no EC (OR 3.52; 95% CI 2.36-5.23). CPR was inconsistently defined across the studies, affecting the findings. When defined as a viable intrauterine pregnancy <12 weeks, the EC group had significantly higher CPR than no EC (OR 1.83; 95% CI 1.15-2.92). No significant differences were found between EC and no EC for PPT (OR 1.54; 95% CI 0.97-2.45) or MR (OR 1.06; 95% CI 0.92-1.56). The pooled weighted incidence of EC across all studies was 32% (95% CI 26-38%). Heterogeneity due to differences between reported pregnancy outcomes, definition of EC, method of ultrasound, and cycle protocol may account for the lack of translation between CPR/OPR and LBR findings; thus, all pooled data should be viewed with an element of caution. In this dataset, the significantly higher CPR/OPR with EC does not translate to LBR. Although stratification of women according to EC cannot currently be recommended in clinical practice, a large and well-designed clinical trial to rigorously assess EC as a non-invasive predictor of a successful pregnancy is warranted. We urge for consistent outcome reporting to be mandated for ART trials so that data can be pooled, compared, and concluded on. H.A. was supported by the Hewitt Fertility Centre. S.G.P. and J.W. were supported by the Liverpool University Hospital NHS Foundation Trust. D.K.H. was supported by a Wellbeing of Women project grant (RG2137) and MRC clinical research training fellowship (MR/V007238/1). N.T. was supported by the National Institute for Health and Care Research. D.K.H. had received honoraria for consultancy for Theramex and has received payment for presentations from Theramex and Gideon Richter. The remaining authors have no conflicts of interest to report. PROSPERO CRD42022378464.

D.6 Neurological care and outcomes of pregnant patients with epilepsy in a Canadian tertiary care center (2014-2020)

Background: Limited data exists on neurological care and outcomes of Canadian pregnant patients with epilepsy (PPWE). This study provides Canadian data to inform practice patterns and observed outcomes for PPWE at a tertiary care center. Methods: PPWE receiving care at the University Health Network (Toronto, Canada) epilepsy clinic from January 1, 2014 to November 20 2020 were retrospectively identified with demographics and neurological data and outcomes collected. Results: A total of 195 cases were identified, with a median maternal age of 32 years (SD 4.58), a median age at first seizure of 17 years (range 1 month – 36 years old), 52% were diagnosed with genetic generalized epilepsy and 50% endorsed 6 months of seizure freedom prior to conception. In pregnancy, 93% took ASM(s) with 77% receiving therapeutic drug monitoring (TDM) and drug dose adjustments reported in 69%. Most cases (73%) maintained a stable seizure frequency. Conclusions: This study provides new Canadian data on PPWE at a tertiary care center. PPWE are overall well controlled, more likely to have young adult onset, genetic generalized epilepsy with nearly all taking ASM(s) during pregnancy. While high rates of TDM and drug dose adjustments were observed, most experienced seizure stability in pregnancy.

#2740 Pregnancy outcomes in patients with IgA nephropathy and the impact of pregnancy on the renal disease

Abstract Background and Aims IgA nephropathy (IgAN), the predominant primary glomerulonephritis in adults,, frequently affects women in childbearing age. There is a dearth of information about the impact of pregnancy on the outcome in IgAN especially in the Indian population where it is known to have an aggressive disease phenotype. This retrospective cohort study examines pregnancy outcomes in women with biopsy-proven IgAN and the impact on renal outcome. Method In a retrospective cohort study, we assessed the medical records of women in child bearing age (18-40 years) diagnosed with biopsy proven primary IgAN from 2012-2022. Patients with end stage kidney disease (ESKD) at the time of biopsy and/or at time of conception and those who had undergone kidney transplantation were excluded. Maternal (pre-eclampsia, relapse, renal disease progression, etc.) and fetal outcomes (neonatal death, preterm delivery, intra-uterine growth retardation-IUGR, etc.) were recorded. Relapse was defined as increase in proteinuria to ≥1 g/day during pregnancy and renal disease progression as &amp;gt;40% sustained decline in eGFR and/or ESKD. Results Of 75 women assessed, 25 were lost to follow up. 34 did not conceive after biopsy. 20 pregnancies were documented in 14 patients. Three (15%) were medically terminated, 7 (35%) resulted in spontaneous abortions, and 10 (50%) culminated in live births. There was one neonatal death. 6/20(30%) pregnancies occurred while the patient was on ACEi/ARBs of which 5 pregnancies resulted in live births. 7/10 (70%) births were premature, 5 being moderate preterm (34-37 weeks) and 2 late preterm (32-34 weeks). IUGR below the 5th percentile affected 7/10(70%) of births. The mode of delivery was evenly split between vaginal (5, 50%) and Caesarian (5, 50%). From a maternal perspective, preeclampsia affected 3/10 (30%) patients. 5/10(50%) patients who delivered had a relapse during pregnancy with 2 developing nephrotic range proteinuria. 4 of them receiving steroids during pregnancy. All relapsed patients had persistent proteinuria &amp;gt;1 g/day postpartum. In 2 (20%) pregnancies, relapse developed during immediate post-partum period. In 4 patients, eGFR decreased by &amp;gt; 40 percent compared to their baseline (at biopsy) following the pregnancy. Conclusion Pregnancy is associated with adverse maternal and fetal outcomes in women with IgA nephropathy. eGFR, estimated glomerular filtration rate. IUGR, Intra-uterine growth restriction (based on birth weight percentile, adjusted for gender and gestational age). *Serum creatine of one patient during pregnancy is not available, analysis is done using values of other 9 patients. **Urine Protein of one patient is not available at the latest follow-up, analysis is done using values of 9 other patients.

#2289 Pregnancy outcomes in patients with congenital abnormality of the urinary tract: experience of a tertiary Portuguese center

Abstract Background and Aims Congenital abnormalities of the urinary tract (CAKUT) represent a broad range of disorders that occur due to abnormal kidney development. Maternal, obstetric, and perinatal outcome in pregnant woman with CAKUT have not been extensively evaluated, although small series report an increased incidence of urinary tract infections (UTI) and obstructive uropathy. Method Retrospective analysis of maternal, obstetric, and perinatal outcomes in pregnant patients with CAKUT (including genetic cystic kidney disease) that were surveilled in our tertiary center by a nephro-obstetric team between 2011 and June 2023. Information was obtained from medical records. Results We evaluated 47 gestations in 41 patients, with mean age of 31 ± 5 years [17-40], 89% were Caucasian, 11% black; 40% were nulliparous, 36% had hypertension (HT) and 42% a previous history of UTI. Regarding CAKUT specificity, 17/41 patients had genetic cystic diseases, 10/41 ureteropelvic junction obstruction (UPJ), 4/41 duplicate collecting system, 5/41 vesicourethral reflux, 2/41 ectopic kidney, 3/41 renal hypoplasia. Genetic testing was done before, during or after pregnancy in 2/4/4 patients, respectively. Teratogenic therapy exposure occurred in 25% of gestations. Most patients were CKD stage 1 (33/41), with 2/4/1/1 with patients in CKD stage 2/3/4/5, respectively. Mean baseline SCr was 0.99 ± 0.8 mg/dL [0.4-4.6] and mean proteinuria was 194 ± 357 mg/g [22-1500]. Renal function (RF) deterioration occurred in 9/47 (19%) women due to pre-eclampsia (PE), pregnancy hyperfiltration (PH) and hydronephrosis in 3/3/3 patients, respectively. Urologic intervention was needed in 2 patients due to hydronephrosis, and one of the patients required transient dialysis. All patients fully recovered RF except for the 1 CKD stage 3 patients that had partial RF recovery. De novo and worsening proteinuria occurred in 7/47 gestations due to PE (3/7) and PH (4/7). De novo or aggravation of HTN occurred in 25% gestations, UTI in 19% and PE in 6% gestations. Regarding fetal outcomes, mean duration of gestation was 38 ± 2 weeks [32-41] and mean birth weight 2910 ± 634 g [1360-4600]. There was 1 miscarriage and 1 medical termination of pregnancy at 17 weeks (neural tube defect). Cesarean was performed in (8/47, 17%) gestations and 10/47 (17%) newborns were admitted to the neonatal care unit (NICU) mainly due to prematurity, sepsis and feeding intolerance. Conclusion Our cohort of CAKUT patients was very heterogenous and only 19.5% had CKD stage 2-5. Still, we found a significant incidence of maternal, obstetric, and perinatal complications, namely HT UTI, PE, and the need for NICU. UPJ obstruction can evolve with RF deterioration and the need for intervention during pregnancy. This study underlines the importance of the management of these patients by a multidisciplinary team.

A new insight on evaluation of the fertility and pregnancy outcome in patients with primary Sjögren syndrome: a propensity score matched study in multi-IVF centers

BackgroundPrimary Sjögren syndrome (pSS) is often related to adverse neonatal outcomes. But it’s currently controversial whether pSS has an adverse effect on female fertility and clinical pregnancy condition. More importantly, it’s unclear regarding the role of pSS in oocyte and embryonic development. There is a lack of comprehensive understanding and evaluation of fertility in pSS patients.ObjectiveThis study aimed to investigate oocyte and embryonic development, ovarian reserve, and clinical pregnancy outcomes in Primary Sjögren syndrome (pSS) patients during in vitro fertilization (IVF) treatment from multi-IVF centers.MethodsWe performed a muti-central retrospective cohort study overall evaluating the baseline characteristics, ovarian reserve, IVF laboratory outcomes, and clinical pregnancy outcomes between the pSS patients and control patients who were matched by Propensity Score Matching.ResultsFollowing PSM matching, baseline characteristics generally coincided between the two groups. Ovarian reserve including anti-müllerian hormone (AMH) and antral follicle counting (AFC) were significantly lower in the pSS group vs comparison (0.8 vs. 2.9 ng/mL, P < 0.001; 6.0 vs. 10.0, P < 0.001, respectively). The pSS group performed significant reductions in numbers of large follicles, oocytes retrieved and MII oocytes. Additionally, pSS patients exhibited obviously deteriorate rates of oocyte maturation, 2PN cleavage, D3 good-quality embryo, and blastocyst formation compared to comparison. As for clinical pregnancy, notable decrease was found in implantation rate (37.9% vs. 54.9%, P = 0.022). The cumulative live birth rate (CLBR) following every embryo-transfer procedure was distinctly lower in the pSS group, and the conservative and optimal CLBRs following every complete cycle procedure were also significantly reduced in the pSS group. Lastly, the gestational weeks of the newborns in pSS group were distinctly early vs comparison.ConclusionPatients with pSS exhibit worse conditions in terms of female fertility and clinical pregnancy, notably accompanied with deteriorate oocyte and embryo development. Individualized fertility evaluation and early fertility guidance are essential for these special patients.

Personalized embryo transfer guided by rsERT improves pregnancy outcomes in patients with repeated implantation failure.

Embryo implantation requires synchronous communication between the embryo and maternal endometrium. Inadequate maternal endometrial receptivity is one of the principal causes for embryo implantation failure [especially repeated implantation failure (RIF)] when biopsied good-quality euploid embryos are transferred. An RNA-seq-based endometrial receptivity test (rsERT) was previously established to precisely guide successful embryo implantation. In this study, we aimed to evaluate the effect of personalized embryo transfer (pET) via rsERT on the clinical outcomes in patients with RIF. A total of 155 patients with RIF were included in the present retrospective study and were divided into two groups: 60 patients who underwent rsERT and pET (Group rsERT) and 95 patients who underwent standard frozen embryo transfer (FET) without rsERT (Group FET). Reproductive outcomes were compared for patients who underwent rsERT-guided pET and standard FET. Forty percent (24/60) of the patients who underwent rsERT were receptive, and the remaining 60% (36/60) were non-receptive. The positive human chorionic gonadotropin (β-hCG) rate (56.3% vs. 30.5%, P = 0.003) and clinical pregnancy rate (43.8% vs. 24.2%, P = 0.017) were significantly higher in Group rsERT patients than in FET group patients. Additionally, Group rsERT patients also showed a higher implantation rate (32.1% vs. 22.1%, P = 0.104) and live birth rate (35.4% vs. 21.1%, P = 0.064) when compared with FET patients, although without significance. For subpopulation analysis, the positive β-hCG rate, clinical pregnancy rate, implantation rate, and live birth rate of receptive patients were not statistically significant different from those of non-receptive patients. The rsERT can significantly improve the pregnancy outcomes of RIF patients, indicating the clinical potential of rsERT-guided pET.

Autologous platelet-rich plasma as a potential new approach in the endometrial response during in vitro fertilization cycle: A pilot study

Objectives: Infertility is a global health concern, affecting ~13% of couples. Despite assisted reproductive technology (ART) attempts, implantation failure occurs due to inadequate growth of the endometrium. Increasing endometrial thickness (ET) can be increased to improve the rate of pregnancy; implantation necessitates a minimum thickness of 7 mm. Platelet-rich plasma (PRP) is a recommended treatment approach for endometrium and ovarian infertility. This approach minimizes the potential of immunogenic reactions and disease transmission because PRP comes from an autologous source. The purpose of this study was to evaluate the efficacy of PRP intrauterine infusions during the in vitro fertilization (IVF) cycle in patients with thin endometrium. Material and Methods: Ten patients with primary infertility (age: 28–40 years) were chosen for intrauterine PRP infusion at the RiSSA IVF Center, Delhi. This study was carried out between June 2020 and January 2022 over a span of 18-month period. Intrauterine infusion of PRP was an additional procedure to hormone replacement therapy (HRT) treatment cycle. PRP was prepared by centrifugation process from autologous blood. On the 10th day of HRT cycle, 2 mL of PRP was infused into the uterine cavity. In each cycle, PRP infusion was administered 1–3 times if there was no increase in ET 72 hours later. Out of ten patients, four patients received a single infusion, two patients received two infusions, and four patients received three infusions. The embryos were transferred when the ET reached ≥7 mm. ET was measured at the uterine longitudinal axis at the thickest point. To determine ET, three measurements were made, and the average of those measures was noted. The primary outcome measure was ET, determined by transvaginal sonography, and the secondary outcome measure was clinical pregnancy following embryo transfer. Results: The mean increase in ET was 1.8–2.25 mm. In 8 (80%) patients, there was an increase of 7–7.5 mm in ET. ET thickness did not improve in 2 patients (20%), and it was &lt;6 mm after three infusions of PRP. Further, of the eight patients who had embryo transfer and became pregnant, six patients had a clinical pregnancy with visible cardiac activity at 6 weeks, while two patients had a missed abortion in the first trimester. Six patients had a successful delivery. Conclusion: This study revealed that PRP could support endometrial growth, improving pregnancy outcomes in patients who have thin endometrium. PRP is a novel treatment option for endometrial thinning and poor response to IVF. The findings of the current pilot study support the need for large-scale, randomized, controlled trials in this field.