Pregnancy Scan Research Articles

OP06.08: Prediction of single and double fetal loss by discordancy in CRL, NT and AC at the 11+0–13+6 week scan in dichorionic and monochorionic twin pregnancies

OP06.08: Prediction of single and double fetal loss by discordancy in CRL, NT and AC at the 11⁺⁰–13⁺⁶ week scan in dichorionic and monochorionic twin pregnancies

VP01.17: Rare case of type‐2 Caesarean scar ectopic pregnancy

A Caesarean scar pregnancy (CSP) is implantation of blastocyst in the scarred or fibrosed uterine myometrium of a previous Caesarean delivery scar. Though CSP is rare, ectopic mindedness is very important while performing early pregnancy scans, specifically in women with previous Caesarean delivery. Timely diagnosis is of critical importance for quick intervention of this dangerous condition as undiagnosed CSP may progress to invasive placenta, uterine rupture, hemorrhage and possibly maternal death. Two different types of scar ectopic pregnancies are described. Type 1 is caused by implantation in the previous Caesarean scar with progression towards the cervicoisthmic space or the uterine cavity. This type of pregnancy may progress till term, but associated with complications like morbidly adherent placenta. Type 2 is caused by deep implantation into scar defect with trophoblastic infiltration into the uterine myometrium and to uterine serosal surface which may result into uterine rupture and massive hemorrhage in first trimester of pregnancy. We present an interesting case of type 2 CSP. The intact gestational sac was in the scar with extension beyond the serosa up to the anterior abdominal wall, with invasion of the abdominal muscle layer. The sac was also extending in the intrauterine cavity. The sac showed a demised embryo of 6 weeks. Extensive vascularity noted along the serosal breach as well as at abdominal wall invasion site. The findings were confirmed on laprohysterocopy. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

VP24.06: Unilateral microphthalmia and CNS‐associated anomalies: management and prognosis

We present the case of a fetus with a normal nuchal scan at 13 weeks with low risk for chromosomal abnormalities and then diagnosed with microphtalmia at the time of the anomaly scan at 22 weeks with no other cerebral or extracerebral abnormalities except one left ventricular hyperechogenic focus. After counselling about the future visual and esthetic disturbances and the possible association with several fetal syndromes the mother decided for continuation of the pregnancy and follow-up, the first step recommended being amniocentesis for arrayCGH. At 24 weeks we received the result of a normal karyiotype. In the 3rd trimester, at 28+5 weeks of pregnancy scan we noticed more cerebral anomalies: a much smaller left orbit with cataract and obvious facial dysmorphism, a nonlinear cerebral falx at the level of the anterior complex that was displaced towards left, high cerebral lateral ventricles inequality with the larger ventricle being the left (9.8mm), an appearance and suspicion of smooth cerebral surface and polyhydramnios with normal fetal growth and no other abnormalities. The mother declines other genetic tests (WES) and accepted to perform fetal cerebral MRI at 32 weeks that confirmed the US abnormalities described earlier plus gyration abnormalities and severe hypoplasia of the left frontal lobe and left ophthalmic nerve. Following this result she decided for TOP.

P–407 Early pregnancy in the Emergency Department; presentation, management, outcome and the effect of COVID–19

Study questionHas the COVID–19 pandemic and public health guidance impacted referrals, outcome and management of early pregnancy in the emergency room?Summary answerCOVID–19 changed the way in which women sought guidance and accessed services in early pregnancy.What is known alreadySpontaneous miscarriage is the most common complication of pregnancy1. Experiencing an early pregnancy loss is often an unexpected and difficult time that can be physically traumatising2. A previous study looking at the experience of a miscarriage from both the female and male point of view identified that long waiting times surrounded by other pregnant women in the Emergency Department (ED) was particularly difficult part of the experience2. The COVID–19 pandemic had a significant impact on both hospital and community services. Public health advice also changed the way women accessed healthcare.Study design, size, durationRetrospective audit was performed over two six-month periods – July to December 2019 and March to August 2020. Two groups of data were collected; women who contacted the ED with concerns related to early pregnancy (under thirteen weeks gestation) and those who attended the ED with the same complaints. Information was cross referenced to see how many women contacted the ED prior to arrival and what, if any advice was given.Participants/materials, setting, methodsAll women under thirteen weeks gestation with a complaint of bleeding per vaginum (PV) or pain related to early pregnancy who presented to the ED in a large tertiary maternity unit were included in the audit. All women meeting the same criteria who contacted the ED by telephone were also included.Main results and the role of chanceOver the twelve months of data collection, 1274 women had their first visit to the ED. There were 270 further visits within the early pregnancy period recorded for the same cohort of women. Additionally, 1452 phone calls were recorded. There was a 38% (n = 293) decrease in women attending the emergency room in early pregnancy in 2020 during the first wave of COVID–19. There was a 16% (n = 110) increase in women contacting the ED for advice in early pregnancy in the same period in 2020. Women were more like likely to have been referred to the ED by their General Practitioner (GP) (OR 0.62, 95%CI 0.48–0.80) and to have phoned in advance of arrival (OR 1.55, 95%CI 1.17–2.04) in 2020. They were also more likely to have already had a previous ultrasound scan in the current pregnancy (OR 0.64, 95%CI 0.48–0.93). There was a significantly shorter waiting time for an appointment in the early pregnancy clinic in 2020 compared with 2019 (3.5 days versus 2.4 days, p = 0.002). There was no change in the number of women admitted (OR 1.19, 95%CI 0.81–1.74).Limitations, reasons for cautionSingle centre audit. Pregnancies only followed to booking visit/dating scan and outcome noted at that stage.Wider implications of the findings: The COVID–19 pandemic highlighted the need for more education around early pregnancy. Easily accessible information about local early pregnancy services gives women autonomy. Phone triage allowing referral of women to appropriate services, reduces ED visits. Standard training in early pregnancy ultrasound could reduce follow up referrals and admission rates.Trial registration numberNot applicable

P–725 COVID–19: Fertility patients’ attitudes to pregnancy and implemented changes within fertility services during a pandemic

Study questionTo investigate the attitudes of male and female fertility patients to risk mitigation strategies and pregnancy advice during the first wave of the COVID–19 pandemic.Summary answerThe desire to conceive outweighed fears regarding infection. Patients felt fertility treatments should be classified as essential and were agreeable to most risk mitigation strategies.What is known alreadyThe effects of the COVID–19 global pandemic on fertility services became evident in early 2020. Because of possible impacts of the virus on gametes, embryos and patients and concerns over virus transmission and the ability of medical services to cope, fertility treatments were temporarily suspended, as advised by ESHRE, ASRM and others. Across Europe, services were paused for approximately 7 weeks. Patients have reported that they found this extremely stressful and in some cases, unfair. After the initial closures, many clinics re-opened but with new risk mitigation strategies regarding PPE, hygiene and reducing staff and patient footfall.Study design, size, durationMen and women with a scheduled appointment at a fertility clinic over a 7-week period during the first wave of the COVID–19 pandemic were asked to complete a questionnaire outlining their experience and how it affected them. Participants were recruited via email using a secure online patient portal. A standardised anonymous 25-item questionnaire was sent to 828 patients and a reminder was circulated seven days later. The questionnaire remained open for 28 days.Participants/materials, setting, methodsParticipants were invited to complete a questionnaire and assured that all data would remain anonymous. Three areas were assessed. Firstly, how the pandemic itself affected their attempts to conceive. Secondly, participant perceptions regarding the overall disruption to fertility services. Thirdly, how participants feel fertility services should be treated in the event of a future large scale global pandemic.Main results and the role of chance135 responses were received, giving a response rate of 16.3%. 80% of respondents were female and 20% male with no significant difference in responses between the sexes. Most participants (96%) had completed third level education and 90% were fully employed. Interestingly, 69% of participants continued trying to conceive during this time. This was despite 28% having concerns about contracting COVID–19 should they attend a clinic, 21% having concerns regarding the effect of the virus on pregnancy and 21% having concerns regarding an impact on the fetus. The majority surveyed (93%) stated that fertility treatment should be considered essential. 90% had their treatment disrupted or altered and, of these, 44% felt that this was justified, 23% disagreed and 33% were unsure. Regarding changes implemented within the clinic, 68% were satisfied with online video consultations and a further 16% would be content in certain circumstances. 92% felt privacy was maintained and 95% were happy to sign consent forms via video link. Many disagreed with the no partner policy at early pregnancy scans(57%) and embryo transfer(44%); however, they agreed with it for phlebotomy and treatment scans. In the event of a future pandemic, 79% felt fertility services should or probably should be continued.Limitations, reasons for cautionThis study focuses on the first wave of COVID–19. The long term, ongoing nature of the pandemic may influence participants’ perspectives on the areas investigated over time.Wider implications of the findings: It is estimated that the world will face a global pandemic approximately once every generation. Fertility stakeholders must learn from these events and studies such as ours are important to ascertain the views of service users. Some policies, such as video consultations, may be of benefit even in non-pandemic times.Trial registration numberNot applicable

Pharmacopoeia: Illness narratives.

Pharmacopoeia: Illness narratives.

Lying behaviour of housed and outdoor-managed pregnant sheep

Lying behaviour has been shown to be highly valuable in supporting the productivity and welfare of cattle. The aim of this experiment was to investigate the effect of biological and physical factors on the lying behaviour of sheep. Ninety-six Bluefaced Leicester x Welsh Mountain crossbred (Mule) ewes managed to lamb indoors, and 80 Welsh Mountain (WM) ewes managed to lamb at grass were used for the study. Acceleration values were collected for the two flocks from accelerometers fitted vertically to the outside of the rear right leg and set to record at 1-min intervals for at least 14 d prior to parturition. Ewes were simultaneously recorded using video equipment to identify lambing and to verify predictions of lying (total lying time, mean lying bout duration and total number of lying bouts) using data collected from 10 randomly selected ewes from the indoor flock on day -10 prior to lambing. Linear regression was used to evaluate predicted behaviours with video footage. Predictions of total lying time (R2 ≥ 0.99; P > 0.05 for slope = 1, intercept = 0), mean lying bout duration (R2 ≥ 0.99; P > 0.05 for slope = 1, intercept = 0) and total number of lying bouts (R2 ≥ 0.98; P > 0.05 for slope = 1, intercept = 0) were strongly associated with video footage (P < 0.001) demonstrating that a 1-min sampling interval provides reliable estimates of ewe lying behaviours. Measures of lying (mean daily lying time, mean lying bout duration and mean daily lying bouts) were calculated for all ewes using averages taken across days -10, -9 and -8 prior to lambing. Linear regression was used to test for effects of independent variables (pregnancy scan result (single- or twin-bearing), ewe age, ewe BCS, lambing ease, lamb sex and lamb birth weight) on each measure of lying. Significant associations (P < 0.05) were found between measures of lying and pregnancy scan result, ewe age, sex of singleton lambs and twin birth weight for housed, Mule ewes. Only ewe age and twin birth weight were significantly associated (P < 0.05) with measures of lying for WM ewes managed at grass. This information could help guide further research on sheep behaviour for management purposes (e.g., to optimise stocking densities and welfare for pregnant ewes). Further work should also consider evaluating measures of lying as proxies for imminent parturition.

Ultrasound screening for fetal anomalies in a single center: diagnostic performances twenty years after the Eurofetus Study

Purpose To establish the accuracy of ultrasound in detecting fetal anomalies looking at the concordance between prenatal and postnatal diagnosis. Materials and methods Retrospective analysis of concordance between prenatal and postnatal/autoptic diagnosis of fetuses with congenital abnormalities. Data are from a single center (Policlinico di Modena); all fetuses included were born between 2017 and 2018 and with a follow-up of at least 6 months. We included all deliveries (including perinatal deaths) and termination of pregnancy (TOP) for fetal indication. We calculated sensibility, sensitivity, Positive and Negative Likelihood Ratio, positive and negative predictive value of ultrasound. Results During the study period 5920 deliveries, including perinatal deaths, and 28 TOP for fetal indication were registered at our center. The prevalence of congenital malformations was 2.6% (153/5920). At least one ultrasound was performed in our center in 1250 women delivering in our unit. All 28 TOP had the anomaly scan performed in our center. Among the total 1278 women scanned in our unit, there were 128 (10%) suspicious scans. In 5/128 (3.9%) cases we diagnosed a false alarm; in 8/128 (6.2%) cases an evolutive malformation with in-utero regression. The prenatal diagnosis was confirmed in 77 (60.2%) cases at birth and in 28/128 (21.9%) at postmortem analysis while there were 10/128 false positive (7.8%). Among the 153 congenital malformations diagnosed at birth, the anomaly scan was performed in our Prenatal Medicine Unit in 92 (60.1%) fetuses. Among these, there were 15 false negatives (9.8%) while in 77/92 (83.7%) the malformation at birth agreed with the sonographic diagnosis. Sensitivity and specificity of ultrasound were 87.5% (IC95 80.2–92.8%) and 99.1% (IC95 98.4–99.6%) respectively with a Positive Likelihood Ratio and Negative Likelihood Ratio of 101.3 (IC95 54.5–188.5) and 0.13 (IC95 0.08–0.2); Positive Predictive Value and Negative Predictive Value were 91.3% (IC95 85–95.1%) and 98.7(IC95 98–99.2%). Conclusion Anomaly scan in pregnancy allows the diagnosis of congenital malformations with a sensibility of 87.5% and specificity of 99.1%. The main limitations of this study are its retrospective design and that it was conducted in a single referral center.

P096 Pregnancy outcomes in women attending a joint obstetric and rheumatology clinic in a tertiary centre over a 2-year period

Abstract Background/Aims The Lupus in Pregnancy Scanning (LIPS) clinic, a joint obstetrics and rheumatology clinic was established in 2010 at Saint Mary’s Hospital, Manchester, UK for women with systemic lupus erythematosus (SLE) and other complex rheumatological conditions. We aimed to describe pregnancy outcomes of women attending this clinic to establish a baseline for future changes aimed at improving the service. Methods Data were collected retrospectively from electronic records of patients who attended the LIPS clinic at least once between 1st January 2018 and 31st December 2019. Results Pregnancy outcomes were available in 105/125 (84%) women (Table). The median age [inter-quartile range] was 30.6 years [IQR 27.7 - 33.6] and 40 (38%) were of non-Caucasian background. Sixty-one (58%) had a connective tissue disease (CTD) of whom 36 (59%) had SLE. Other rheumatological diagnoses included inflammatory arthritis, primary anti-phospholipid syndrome (APS) and systemic vasculitis. Anti-Ro was found in 32 (31%) and anti-phospholipid antibodies in 25 (24%). During pregnancy, 65 (62%) received aspirin and 40 (38%) had low molecular weight heparin (LMWH). In the antenatal period, 43 (41%) took steroids, 52 (50%) had conventional disease modifying anti-rheumatic drugs and 8 (8%) received biologics. Active disease in the antenatal period was noted in 14 (13%) women. Regarding pregnancy outcomes (Table), still-births were low (0.95%). The rate of C-sections (45%) and assisted deliveries (19.6%) was comparable to previously published data from similar clinics. P096 Table 1:Pregnancy outcomes over a 2-year period in women attending the LIPS clinic at St. Mary's HospitalPregnancy Outcomen (%)Miscarriage3 (2.9)Deliveries• Live101 (96.2)• Still-birth1 (0.95)Median Gestation (weeks) [inter-quartile range (IQR)]38 [37 - 39]Sex of Neonate• Female57 (56)• Male45 (44)Mode of Delivery• Normal vaginal36 (35.3)• Assisted20 (19.6)• Elective Caesarean Section15 (14.7)• Emergency Caesarean Section31 (30.4)Median Neonatal Birth Weight (grams) [IQR]3137 [2724 - 3428]• Low Birth Weight &amp;lt;2500g15 (15)Maternal Complications (Antenatal and Peri-Partum)• Infection22 (22)• Pre-Eclampsia1 (1)• Post-Partum Haemorrhage56 (55)Neonatal Intensive Care Admission7 (7)Neonatal Complications• Sepsis1 (1)• Congenital Heart Block2 (2)• Prematurity (&amp;lt;36 weeks)39 (38) Conclusion In this cohort we report a high live birth rate and comparable rates of assisted delivery to similar cohorts. Infection and post-partum haemorrhage are maternal complications that are common, and reflect the complex clinical presentations and therapeutic regimes in these conditions. Overall this specialist clinic achieves favourable maternal and foetal outcomes in this high-risk population. Disclosure T. David: None. R. Hum: None. Y. Lau: None. S. Thornber: None. L. Simcox: None. I. Bruce: None. C. Tower: None. P. Ho: None.

Late Pregnancy Ultrasound to Screen for and Manage Potential Birth Complications in Nulliparous Women: A Cost-Effectiveness and Value of Information Analysis

BackgroundFetal growth restriction is a major risk factor for stillbirth. A routine late-pregnancy ultrasound scan could help detect this, allowing intervention to reduce the risk of stillbirth. Such a scan could also detect fetal presentation and predict macrosomia. A trial powered to detect stillbirth differences would be extremely large and expensive. ObjectivesIt is therefore critical to know whether this would be a good investment of public research funds. The aim of this study is to estimate the cost-effectiveness of various late-pregnancy screening and management strategies based on current information and predict the return on investment from further research. MethodsSynthesis of current evidence structured into a decision model reporting expected costs, quality-adjusted life-years, and net benefit over 20 years and value-of-information analysis reporting predicted return on investment from future clinical trials. ResultsGiven a willingness to pay of £20 000 per quality-adjusted life-year gained, the most cost-effective strategy is a routine presentation-only scan for all women. Universal ultrasound screening for fetal size is unlikely to be cost-effective. Research exploring the cost implications of induction of labor has the greatest predicted return on investment. A randomized, controlled trial with an endpoint of stillbirth is extremely unlikely to be a value for money investment. ConclusionGiven current value-for-money thresholds in the United Kingdom, the most cost-effective strategy is to offer all pregnant women a presentation-only scan in late pregnancy. A randomized, controlled trial of screening and intervention to reduce the risk of stillbirth following universal ultrasound to detect macrosomia or fetal growth restriction is unlikely to represent a value for money investment.

The effects of parasitism on ewes for prime lamb production in western Victoria

Context Internal parasites are estimated to cost the Australian sheep industry AUD436 million per annum (p.a.). Aims To assess the effects of parasitism in flocks producing prime lambs in the 500–700 mm p.a rainfall. area of Victoria. Methods Ewes on two farms that followed ‘best practice’ gastrointestinal parasite control programs (BP) and two farms that did not (regionally typical, TYP) were compared. Separate cohorts of ewes were monitored from pregnancy scanning to their subsequent joining each year for three consecutive seasons. Observations included worm egg count (WEC), bodyweight, condition score and presence of breech soiling (dag). These were compared between groups that were treated to suppress parasitism (SUP) and those treated according to the usual program used on that farm (NSUP). Data from individual ewes were analysed using a multivariable, mixed-effects regression model. Key results After adjusting for known confounders, SUP ewes were 1.2 (95% CI 0.80–1.6) kg heavier than NSUP ewes. Mature SUP ewes were significantly heavier than NSUP ewes at their next joining on 6 of 18 occasions, mostly following winters when ewes experienced nutritional stress. Ewe hoggets and Merino ewes were generally more susceptible to parasitism than mature non-Merino ewes; single-bearing ewes were less susceptible than those bearing twins. The effects of parasitism were reduced when peri-parturient ewes had an optimal condition score and grazed adequate pastures. Conclusions Ewes were more vulnerable to parasitism when immature, twin-bearing, or under nutritional stress. Some of the greatest differences between SUP and NSUP ewes occurred following periods of low feed availability and/or ewe condition score. The difference between the mean bodyweight of SUP and NSUP Merinos was not always greater than that of the non-Merinos. WECs are not a sole reliable indicator of the effects of parasitism in this class of sheep. Implications Immature or twin-bearing ewes, and those in suboptimal body condition, should be managed considering their increased vulnerability to parasitism, and WEC interpreted alongside other factors. Controlled release capsules were not cost effective in reducing production loss from gastrointestinal nematodes in most years but may be effective in reducing the effects of clinical parasitism in some cases.

Dentition can predict maturity in young Merino sheep

Context A unique population of Merino sheep recorded for a range of production and reproduction traits presented an opportunity to calculate sire variation in dentition which may indicate maturity and influence marketing and selection decisions. A change in the definition of ‘lamb’ in the Australian sheep industry warranted an investigation of the relationship between production, reproduction and dentition. Aims To assess the variation in timing of dentition changes in Merino sheep and determine whether there are associations with key production and reproduction traits. Methods A population of 2150 pedigree-recorded Merino sheep were studied to analyse the sire variation in progeny for a range of dentition changes and production and reproduction traits. Dentition phenotypes included the age animals started to lose the deciduous lamb teeth, the age when one permanent incisor was in wear and the amount of time between these two events. Production records included bodyweight, fat and muscle traits. Reproduction records from the female progeny included the outcome of pregnancy scanning after the first joining opportunity. Sire variation for the age dentition changed was analysed. The effect of progeny age at hogget categorisation on production and reproduction was analysed. Key results Progeny that were heavier, fatter and with higher muscle measurements matured earlier. Female progeny were more likely to be pregnant if classed as hoggets earlier in life. Conclusions Dentition records provided useful indicators of maturity in Merino sheep in this study and can be used to inform decisions regarding the timing of marketing options and the likelihood of success when assessing female progeny for suitability to join at ~18 months of age. Implications Merino sires can exhibit a wide range of variation with respect to the age at which their progeny will mature, as indicated by their dentition. If animals are heavier at an earlier age, they are more likely to mature earlier, which has to be considered when planning nutritional requirements for growing out young male progeny, and females could be more successful as young breeders. Dentition is a useful tool to indicate maturity in young Merino sheep.

A Rare Coincidence-a Second Trimester Ectopic Pregnancy Following Early Medical Abortion: a Case Report.

We describe a case of a woman in her mid-30s who presented to a tertiary level maternity hospital 17 days following early medical abortion with a positive pregnancy test. On the ultrasound examination, it was discovered that she had a second trimester ectopic pregnancy which was treated surgically with a unilateral salpingectomy. We discuss in depth factors related to this woman’s care, such as appropriate assessment and evaluation of early medical abortion cases, the diagnostic challenges of early pregnancy scanning as well as the implications of the COVID-19 pandemic on the provision of care in these scenarios, and how this affected this woman’s care.

Evaluation of the Scan Duration and Mechanical and Thermal Indices Applied for the Diagnostic Ultrasound Examinations.

Although epidemiological studies have failed to show the harmful effects of ultrasound in humans, as a form of energy, ultrasound has the potential to cause bio-effects in tissues. Therefore, clinical guidelines have been established for ultrasound technology related to human safety, which include Thermal (TI) and mechanical (MI) indices. The appropriate TI and MI ranges for embryonic examinations are between 0-1.0 and 0-0.4, respectively. The accepted TI and MI ranges are 0-2.0 and 0-1.9, respectively, for general ultrasound examinations. In addition, the scan duration should be kept as low as possible. Therefore, the present study aimed at evaluating the scan duration, TI, and MI as measures of acoustic output during ultrasound studies. A cross-sectional descriptive study was conducted for patients undergoing pregnancy checkups, routine checkups, and initial diagnosis ultrasound examinations. Samples were selected from imaging departments of 4 educational hospitals based on convenience sampling and 321 checklists completed by direct observation of ultrasound examinations. For pregnancy scans, the mean TI and MI were obtained as 0.32 ± 0.27 and 1.15 ± 0.13, respectively. For non-pregnancy examinations, the mean value of TI and MI were 0.30 ± 0.29 and 1.07 ± 0.35, respectively. Therefore, mean TI for pregnancy and non-pregnancy examinations and mean MI for non-pregnancy studies obtained lower than the permitted values, while the mean MI was higher than the permitted level for first trimester of pregnancy. Also, relatively suitable scan durations were seen in reviewed studies. From this study, it may be concluded that the reported ultrasound scans were safe.

Impact of change in body condition score in mid-late pregnancy in ewes fed a mixed diet on lamb survival and performance

The objective of this study was to evaluate the effect that body condition score of pregnant ewes fed on turnip and swede crops during mid-late gestation had on offspring survival and performance. Data were collected from 755 multiparous mixed-age ewes carrying 1–4 fetuses. Ewes grazed a turnip crop for 1 month prior to pregnancy scanning with supplementary ryegrass/clover baleage (~75 days gestation) followed by a swede crop with supplementary Lucerne baleage for 1 month following pregnancy scanning (to ~120 days gestation). Ewe body condition score (BCS) at mating, pregnancy scanning and pre-lambing, along with lamb survival and growth rates to weaning were recorded. Lamb survival from pregnancy scanning to tailing differed by litter size (P&lt;0.001) with lower survival in litters with 3 or more lambs compared to singles and twins which did not differ. Improving BCS from pregnancy scanning to 120 days gestation had a positive effect on lamb survival irrespective of litter size and ewe age (P&lt;0.001). Lamb survival in ewes ≥5 years of age, irrespective of litter size, was lower (P&lt;0.001) compared to 2 or 3–4-year-old ewes, which in turn did not differ from each other. The key finding of the study was that loss in BCS from pregnancy scanning to 120 days gestation, negatively impacted on lamb survival, especially in ewes carrying 3 or more fetuses and in ewes &gt;5 years of age irrespective of the number of fetuses carried. Furthermore, there was high variation in BCS change observed in both early and mid-pregnancy.&#x0D;

Effect of clindamycin and a live biotherapeutic on the reproductive outcomes of IVF patients with abnormal vaginal microbiota: protocol for a double-blind, placebo-controlled multicentre trial

IntroductionRecent studies in in vitro fertilisation (IVF) patients have associated abnormal vaginal microbiota (AVM) with poor clinical pregnancy rates of 6%–9% per embryo transfer. The biological plausibility for this finding...

Developing an Animal Welfare Assessment Protocol for Cows in Extensive Beef Cow-Calf Systems in New Zealand. Part 1: Assessing the Feasibility of Identified Animal Welfare Assessment Measures.

Simple SummaryIt is not feasible to transfer animal welfare assessment protocols developed for intensive systems to extensive systems or from rangeland- to pasture-based cattle because each system needs a different protocol. In a previous study, we combined selected measures from the Welfare Quality protocol for beef cattle and the UC Davis Cow-Calf Health and Handling protocol with additional measures specific to New Zealand to create a welfare assessment protocol for pasture-based cow–calf systems that had 50 measures. In this study, the feasibility of this protocol was assessed during routine yardings of cows and a questionnaire. Individual measures that were deemed unsuitable were eliminated or modified. At the end of the process, a robust, achievable protocol with 32 measures for use on pasture-based extensive cow–calf farms was created.Potential measures suitable for assessing welfare in pasture-based beef cow–calf systems in New Zealand were identified from Welfare Quality and UC Davis Cow-Calf protocols. These were trialled on a single farm and a potential protocol of 50 measures created. The aim of this study was to assess the feasibility of the measures included in this protocol on multiple farms in order, to develop a credible animal welfare assessment protocol for pasture-based cow–calf farms systems in New Zealand. The assessment protocol was trialled on 25 farms over two visits and took a total of 2.5 h over both visits for a 100-cow herd. The first visit in autumn included an animal welfare assessment of 3366 cows during pregnancy scanning, while the second visit in winter included a questionnaire-guided interview to assess cattle management and health, and a farm resource evaluation. Through a process of eliminating unsuitable measures, adjustments of modifiable measures and retaining feasible measures, a protocol with 32 measures was created. The application of the protocol on the farms showed that not all measures are feasible for on-farm assessment, and categorisation of identified animal welfare measures into scores that indicate a threshold of acceptable and non-acceptable welfare standards is necessary.

Antral follicular count has limited impact in the selection of more fertile beef heifers

The selection of replacements using applications such as reproductive tract scores and antral follicle count may be useful to eliminate less fertile animals before breeding. Previously, we reported that heifers with increased numbers of follicles achieved puberty earlier than heifers with diminished numbers of follicles. We, therefore, hypothesized that heifers that achieved a reproductive tract score ≥4 earlier in the breeding season would have greater numbers of follicles than heifers that achieved a reproductive tract score ≥4 later in the breeding season. The uterus and ovaries of three hundred and fifty beef heifers from a commercial farm were evaluated by transrectal ultrasonography 20 days before breeding and parameters of growth and development were recorded. The antral follicle count (AFC) of both ovaries was recorded and the heifers assigned a reproductive tract score (1 to 5). Only heifers with a reproductive tract score ≥4 entered to two fixed timed artificial insemination (FTAI) programs. The first group (FTAI1,n = 269) started the day of the beginning of the breeding period and the second group (FTAI2, n = 61) one month later. The rest were naturally mated (no FTAI, n = 20). Serial pregnancy scanning was performed throughout the breeding season and 45 days after bull removal to estimate the day of conception. Data indicative of growth and development were analysed using the REG and GLM procedures of SAS with FTAI (0, 1 and 2), AFC (low, medium and high), and the interaction as the independent variables. Reproductive tract development was negatively associated to AFC (P>0.0001). There was no interaction between FTAI and AFC (P>0.11). Heifers inseminated at FTAI1 were heavier and taller, had greater deposition of fat and muscle, and conceived earlier than those inseminated at FTAI2 (P<0.05); however, there was no difference in AFC between heifers inseminated in FTAI1 and FTAI2 (15.6 ± 0.4 vs. 16.7 ± 0.9 follicles, respectively; P = 0.3). Furthermore, conception rates did not differ statistically between heifers in FTAI1 and FTAI2 (P = 0.12). Antral follicle count influenced growth and carcass traits (P>0.05) and heifers in the High AFC class conceived approximately 1 week earlier than heifers in the Low and Medium AFC class (P<0.05). We conclude that pubertal heifers have less AFC, thus similar numbers were observed for heifers in both FTAI programs and no differences in pregnancy rate. Antral follicle count may allow for the selection of heifers that conceive earlier, but may result in a lower pregnancy rate.

Publics, technologies and interventions in reproduction and early life in South Africa

Despite successful clinical interventions and maternal and child health monitoring for over a century, low and middle-income countries, including South Africa, continue to experience the quadruple burden of disease of high maternal mortality rates and poor infant and child health, non-communicable diseases, infectious diseases, and violence and injury. In this article, we focus on how different kinds of technologies in South Africa are implemented in the ‘first 1000 days’ from conception to early childhood. Some of these interventions, as we discuss, are lifesaving; others are conceptualised as preventing early and longer-term health problems, including cardiometabolic conditions into adulthood and in future generations. Here, we consider the use of routine and specialist technologies in reproduction and early life: scanning and monitoring in pregnancy, caesarean section, extracorporeal membrane oxygenation (ECMO) for very low birth weight infants, and the Road to Health Booklet. Through this focus, we illustrate how ‘publics’ are constituted such that foetal and infant health outcomes are privileged over women’s health, reproductive rights, and public health safety.

Low lying gestation sac in early pregnancy-an algorithmic approach with ultrasound markers

The differential diagnosis of low lying gestational sac in ultrasound at early pregnancy scan varies from benign entities like cervical stage of miscarriage to morbid conditions like caesarean scar pregnancy and cervical pregnancy. Abnormal placental invasive pregnancies also manifest as low lying gestational sac at cervico-isthmic junction. Early diagnosis using simple ultrasound criteria can prevent severe life-threatening complications. Various clues on ultrasonography can easily differentiate between a caesarean scar pregnancy, cervical pregnancy, cervical stage of miscarriage or a low implanted sac which may be a precursor for morbidly adherent placenta. In this article we have reviewed the ultrasound markers in a case of inevitable abortion, a case of cervical pregnancy, 3 cases of caesarean scar pregnancy and 2 cases of morbidly adherent placenta. Comparison of anterior myometrial thickness in a low implantation of sac and caesarean scar pregnancy has been demonstrated. Sometimes a small cervical polyp can mimic a low lying gestation sac and the differential diagnosis with ultrasound has been discussed. Three dimensional ultrasound examinations for spatial location of the sac provide additional information for further management and aids in precise diagnosis. Though other investigations like MRI may also be beneficial in arriving at a diagnosis, its routine usage may be limited due to the cost and availability. Hence defining ultrasound markers in a low lying gestational sac helps in early diagnosis which can prevent fertility losses incurred due to inadvertent management