Prognosis Of Pregnancy Research Articles

Serum Neuropeptide FFR2 is increased in pregnant women with pre-eclampsia and associated with pregnancy outcomes

Objectives: NPFFR2 is a biomarker produced by the placenta during pregnancy and is thought to be associated with in various physiological processes, including pain modulation, opioid receptor regulation, and cardiovascular function. Pre-eclampsia (PE) is a major public health concern due to its links with cardiovascular disease (CVD), stroke and neonatal morbidity and mortality. Consequently, timely diagnosis and efficient management of PE are essential for both maternal and neonatal health. This study aimed to conduct a comparative analysis of neuropeptide FFR2 (NPFFR2), echocardiographic evaluation results, and pregnancy outcomes in pregnant women with and without PE. Methods: This is a prospective case-control study. It included 94 pregnant participants who applied to Manisa City Hospital between October 2021 to January 2023 and were grouped into women with PE (n = 47) and those without PE (n = 47). Biochemical and NPFFR2 analyses were performed using the blood samples collected from all participants, along with echocardiography and 24 hours. Ambulatory blood pressure monitoring (ABPM). A p-value <0.05 was considered statistically significant Results: The study group comprised 94 pregnant women with a mean age of 29.2 years and mean gestational age of 27.6 weeks. The preeclampsia group had a significantly higher NPFFR2 levels, lower gestational age at birth and higher all 24-hours ABPM findings. The left atrial-to-aortic ratio and right ventricle myocardial performance index were significantly higher and EA ratio was significantly lower in the preeclampsia group than in the control group. NPFFR2, gestational age at birth, LDL cholesterol, and body mass index were found to be independently associated with neonatal intensive care unit admission. Conclusions: The women with PE presented with increased serum NPFFR2 levels and the prognosis of pregnancy was associated with NPFFR2 levels. doi: https://doi.org/10.12669/pjms.41.2.10591 How to cite this: Tas U, Tas S, Kume T, Yilmaz O. Serum Neuropeptide FFR2 is increased in pregnant women with pre-eclampsia and associated with pregnancy outcomes. Pak J Med Sci. 2025;41(2):378-383. doi: https://doi.org/10.12669/pjms.41.2.10591 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Maternal and Perinatal Prognosis of Pregnancies in Women with Sickle Cell Disease at Chud-B/A from 2019 to 2023

Maternal and Perinatal Prognosis of Pregnancies in Women with Sickle Cell Disease at Chud-B/A from 2019 to 2023

Association between antinuclear antibodies and pregnancy prognosis in recurrent pregnancy loss patients.

Can antinuclear antibodies (ANA) affect the subsequent live birth rate (LBR) in patients with unexplained recurrent pregnancy loss (RPL) in the absence of antiphospholipid antibodies (aPL)? Women with unexplained RPL have a high probability of live birth following a positive pregnancy test (>70%), being similar between those with positive and negative ANA testing, regardless of the cut-off value. The RPL guidelines of the ESHRE state that 'ANA testing can be considered for explanatory purposes'. However, there have been a limited number of studies on this issue and sample sizes have been small, and the impact of ANA on the pregnancy prognosis is unclear. A retrospective cohort study was conducted at Nagoya City University Hospital between 2006 and 2019. The study included 1021 women with RPL without known cause. Hysterosalpingography or 3D-ultrasound, chromosome analysis for both partners, blood tests for aPL, ANA, hypothyroidism, and diabetes mellitus were performed before a subsequent pregnancy. ANAs were measured by indirect immunofluorescence on Hep-2 cell slides. The cutoff dilution used was 1:40. In addition, patients were classified according to the ANA pattern on immunofluorescence staining: homogeneous, speckled, nucleolar, centromeric, peripheral, cytoplasmic, and others. LBRs were compared between ANA-positive and ANA-negative patients after excluding patients with antiphospholipid antibody syndrome, an abnormal chromosome in either partner and a uterine anomaly. Considering the cut-off value = 1:40 dilution, the subsequent LBRs were 72.5% (256/353) for the ANA-positive group and 73.2% (489/668) for the ANA-negative group; odds ratio (OR) = 0.97, 95% CI = 0.72-1.29. After excluding the miscarriages occurring from embryonic aneuploidy, the biochemical pregnancy losses, and the ectopic pregnancies, LBRs were 92.8% (256/276) for the ANA-positive group and 93.0% (489/526) for the ANA-negative group: OR = 0.97 (95% CI = 0.55-1.70). Considering the cut-off value = 1:80 dilution, the subsequent LBRs were 75.0% (87/116) for the ANA-positive group and 72.7% (658/905) for the ANA-negative group; OR = 1.13 (95% CI = 0.72-1.76). After excluding the miscarriages occurring from embryonic aneuploidy, the biochemical pregnancy losses, and the ectopic pregnancies, LBRs were 89.7% (87/97) for the ANA-positive group and 93.3% (658/705) for the ANA-negative group: OR = 0.62 (95% CI = 0.30-1.27). Considering the cut-off value = 1:160 dilution, the subsequent LBRs were 82.4% (28/34) for the ANA-positive group and 72.6% (717/987) for the ANA-negative group; OR = 1.76 (95% CI = 0.72-4.29). After excluding the miscarriages occurring from embryonic aneuploidy, the biochemical pregnancy losses, and the ectopic pregnancies, LBR were 93.3% (28/30) for the ANA-positive group and 92.9% (717/772) for the ANA-negative group: OR = 1.07 (95% CI = 0.25-4.63). There was no difference in LBR between the 2 groups before or after adjustment for age and BMI, but ANA-positive patients were significantly older than ANA-negative patients when using the 1:40 dilution, and ANA-positive patients had significantly lower BMIs than ANA-negative patients when using the 1:80 dilution. A healthy control group was not established, making it impossible to compare ANA positivity rates between healthy controls and RPL patients. There were significant differences in age (1:40 dilution) and BMI (1:160 dilution) between the ANA-positive and ANA-negative groups. Our results suggest that ANA testing is not useful to predict future pregnancy loss in women with RPL without known cause. This study was supported by MEXT Promotion of Distinctive Joint Research Center Program, Grant Number JPMXP0621467963 and used for English proofreading costs. There are no competing interests for all authors. N/A.

Maternal Death Due to Pulmonary Arterial Hypertension ― A Nationwide Survey in Japan ―

With advances in treatment, the prognosis for pregnancies complicated by pulmonary arterial hypertension (PAH) has been improving. However, PAH-related maternal mortality remains high compared with that due to other cardiovascular diseases. The specifics of PAH-related maternal deaths under advanced medical standards are not well understood. We used the maternal death registration system established by the Japan Association of Obstetricians and Gynecologists and reviewed 6 PAH-related maternal deaths from 2010 to 2022. All women were initially diagnosed with PAH during pregnancy or immediately after childbirth. The diagnosis of PAH tended to be delayed because symptoms were not reported to healthcare providers and/or a different disease was diagnosed. Cardiogenic shock occurred antepartum in 1 woman and during delivery or within 7 days after delivery in the other 5 women. Four women were resuscitated and started on extracorporeal membrane oxygenation. Pulmonary vasodilators were initiated in 4 women, with a median duration of 8 days from PAH diagnosis to starting medication. Right heart failure was the most common cause of maternal death, with a median duration of 16 days from PAH diagnosis to maternal death. All PAH-related maternal deaths occurred in women who were diagnosed with PAH after pregnancy. Diagnosing PAH and initiating pulmonary vasodilators takes considerable time, highlighting the importance of early diagnosis and early treatment.

Abstract 4114436: Feto-maternal outcomes of subsequent pregnancy among women with Peripartum Cardiomyopathy in Tanzania.

Background: Besides survival and recovery, women afflicted with peripartum cardiomyopathy (PPCM) harbor significant apprehension regarding the safety of future pregnancies. Current knowledge regarding the maternal and fetal outcomes in subsequent pregnancies among women with a history of PPCM is sparse. Likewise, there is insufficient medical evidence to provide guidance for women who opt to become pregnant again after experiencing PPCM. Research Questions: What is the feto-maternal prognosis of subsequent pregnancies following a history of PPCM? Aims: To describe the fetal and maternal outcomes of subsequent pregnancies following a history of PPCM. Methods: We included women from the Tanzania PPCM registry who had subsequent pregnancies after PPCM and assessed PPCM recurrence, maternal prognosis, and fetal outcomes. Results: Among the 870 survivors (286 of whom left ventricular function had returned to normal [group 1] and 584 with persistent left ventricular dysfunction [group 2]), subsequent pregnancies were observed in 121 (13.9%) women (78 in group 1 and 43 in group 2). Forty (51.3%) women in group 1 had PPCM relapse, and during a mean follow-up of 896 days, 34 (85.0%) had complete recovery, 3 (7.5%) had persistent heart failure, and 3 (7.5%) died. In group 2, four (9.3%) women had complete recovery, 32 (74.4%) had persistent heart failure, and 7 (16.3%) died. The infant mortality rate was 23.4%. Conclusions: After the initial pregnancy complicated by peripartum cardiomyopathy, subsequent pregnancies could lead to PPCM relapse and deleterious feto-maternal outcomes, including death.

Trisomy 16 mimicking hydatidiform mole.

The authors present a case of 1st trimester miscarriage where an early, complete hydatidiform mole was clinically suspected. Histopathological and immunohistochemical analyses excluded a complete mole, but the histomorphological profile was in concordance with a partial hydatidiform mole. Genetic analysis excluded a partial mole based on biparental genome composition, where further genetic analyses detected trisomy of chromosome 16. Trisomy of chromosome 16 is a frequent cause of 1st trimester abortions and may lead to highly abnormal placental histomorphology mimicking a partial mole. Genetic analyses are crucial for proper differential diagnosis and for the determination of adequate follow-up and prognosis for further pregnancies.

Early diagnosis, effective treatment: modern approaches to the management of ectopic pregnancies

Purpose of research: The aim of this article is to provide an overview of the diagnosis and management of atypical ectopic pregnancy, with particular reference to pregnancy in the cesarean scar. The importance of early detection and medical intervention will be described, as well as the impact of advanced diagnostic techniques and modern treatments on the curability of patients.This article aims to provide valuable insights into the development of effective strategies for the diagnosis, treatment and prognosis of ectopic pregnancy. State of knowledge: Ectopic pregnancies account for 1-2% of all pregnancies, with the majority (90%) occurring in the fallopian tube. Less commonly, they present as ovarian, cervical or abdominal pregnancies. Advances in diagnosis and treatment have made it possible to identify rare forms such as cesarean scar pregnancy (0.15% of all pregnancies), interstitial pregnancy and recurrent ectopic pregnancy on tubal remnants. Techniques such as transvaginal ultrasound (TVS), MRI and laparoscopy have the potential to improve diagnostic accuracy and treatment outcomes. Modern interventions such as transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and methotrexate have shown promise in terms of safety and efficacy. Conclusions: Ectopic pregnancy and its complications have a significant impact on the psycho-physical health of patients, requiring ongoing research to improve diagnostic and therapeutic methods. Future studies should focus on long-term outcomes and the coordination of multidisciplinary medical care to further improve diagnosis and treatment.

Umbilical Cord Hemangiomas: A Multi-Institutional Case Series With Literature Review.

Umbilical cord hemangiomas are rare lesions, for which data on pregnancy outcome is lacking. This study combines a multi-institution 4-case series with a systematic literature search (n = 52) to determine possible pathologic lesion parameters which may have an effect on pregnancy outcome. Of all 56 pregnancies, lesion size ranged from 0.2 to 23.0 cm with pregnancy outcomes ranging from healthy liveborns (58.9%), liveborns with severe complications largely due to prematurity and/or fluid overload (12.5%), intrauterine/neonatal demise (25.0%), and pregnancy termination (3.6%). Of the 52 cases included for statistical analysis, there was no significant association between fetal outcome and vascular lesion location (P = .12) or fetal outcome and single umbilical artery involvement versus involvement of other vasculature (P = .29). The mean length of vascular lesions that resulted in healthy liveborns did not significantly differ from those resulting in severe fetal complications and/or demise (P = .72). Cases resulting in severe complications and/or demise were significantly earlier at delivery than those resulting in healthy liveborns (P < .001). Combined findings suggest that functional lesion characteristics, such as the degree of turbulent flow generated, have more significance than size, especially in early gestation losses. Moving forward, standardized reporting of pathologic lesion characteristics is paramount to better predict pregnancy prognosis.

Pregnancy conditions and outcomes of Chinese women with mild, moderate and severe pulmonary arterial hypertension.

Pregnancy is normally contraindicated in pulmonary arterial hypertension (PAH). Thanks to medical advances, the prognosis for pregnancy in patients with PAH has improved. The aim of our study was to investigate pregnancy conditions and outcomes in patients with mild, moderate and severe PAH. We searched PubMed, Embase, CNKI, Wanfang and Weipu databases for studies published before May 2024. Data from 29 included studies from 1898 references were pooled and analyzed. We calculated the rates for each group as well as the risk ratio (RR) and 95% confidence interval (CI) between pairwise. There was no statistical difference in maternal and neonatal survival between the mild and moderate groups. Maternal survival in the mild, moderate and severe groups was 100.0%, 99.7% and 88.8%, respectively, and neonatal survival was 100.0%, 99.7% and 96.0%, respectively. The incidence of NYHA class III-IV, pregnancy loss, intensive care unit (ICU) admission, fetal growth restriction, and neonatal asphyxia was lowest in patients with mild PAH and highest in patients with severe PAH (P < 0.001). The incidence of vaginal deliveries and term pregnancies was highest in the mild group and lowest in the severe group (P < 0.001). In conclusion, pregnant women with mild PAH can safely deliver a newborn. Given similar survival rates but greater economic and medical burdens, caution is advised in the moderate group. Pregnancy in the severe group is considered contraindicated.

Influence of surgical treatment of varicocele on the pathospermia and the level of sperm DNA fragmentation

Introduction. Varicocele is a varicose vein in the testicle caused by pathological venous reflux. Clinically, varicocele is found in 15% of the male population, with 35% of men with primary infertility and 70-81% of men with secondary infertility. Uncontrolled, excessive amounts of reactive oxygen species (ROS) can cause single- and/ or double-strand breaks in sperm DNA, commonly referred to as sperm DNA fragmentation. The purpose of the study was to determine the effect of surgical treatment of varicocele on the level of DNA fragmentation and to develop prognostic criteria for restoring the fertility of patients.Materials and methods. The study is based on a comparative analysis of the results of examination and treatment of 93 patients without concomitant pathology, with pathospermia, increased levels of DNA fragmentation and varicocele, who received surgical treatment. All patients were followed up for 3–9 months after surgery. The control group did not receive postoperative therapy – 34 people, the main group (59 patients) received drug rehabilitation – a complex of spermatoprotectors and antioxidants – for 3 months after surgical treatment.Results of the study and their discussion. In patients who received surgical treatment, there was a normalization of the level of DNA fragmentation after 3 months in the postoperative period, on average the positive dynamics was 21% (from an average fragmentation level of 22.82% to 15.84%, p &lt;0.05), the prognosis for pregnancy in the couple became favorable. An improvement in DNA fragmentation indicators was observed in parallel with an improvement in spermogram indicators in the postoperative period. Progression of left testicular hypotrophy in the postoperative period was not detected. No relapses or other complications were noted.Conclusions. Treatment of varicocele improves fertility in patients with pathospermia, increased levels of DNA fragmentation, which is consistent with research data from other authors, which confirmed the fact of a significant improvement in ejaculate parameters (sperm concentration, motility and morphology) However, the dynamics of normalization of sperm DNA fragmentation occurs, according to our data, more dynamically (within 3 months in the postoperative period) than the improvement of pathospermia (OAT syndrome) and does not depend on the presence of postoperative drug rehabilitation.

P-231 How many blastocysts are necessary to reach pregnancy with preimplantation genetic testing?

Abstract Study question What is the influence of the number of blastocysts before biopsy on the prognosis of pregnancy in preimplantation genetic testing for aneuploidy (PGT-A) cycles? Summary answer The number of pre-biopsy blastocysts seems to be a parameter that can be used as a prognostic factor for the pregnancy chance in PGT-A cycles. What is known already Advances in embryo cryopreservation techniques have allowed for a greater use of PGT. Studies showed that PGT-A has improved live birth rates while reducing the number of embryos transferred. There is a lot of information about the role of the oocyte number as a predicting factor for pregnancy rate. However, little information is available about the influence of the number of blastocysts before performing PGT-A on the chance of achieving a pregnancy. Study design, size, duration Retrospective study performed in a reproductive medicine center using the first IVF cycle from 2016 to 2023, including 682 patients with at least one blastocyst before undergoing PGT-A. All patients performed a single embryo transfer in each procedure, in up to 4 transfers. Participants/materials, setting, methods The sample was divided into four groups according to the blastocyst number: G1, 1 to 2 blastocysts (n = 324); G2, 3 to 4 (n = 197); G3, 5 to 9 (n = 137); and G4, ≥ 10 blastocysts (n = 24); each group was divided according to female age (≤ 37 and &amp;gt; 37) Variables: female age, and euploidy, clinical pregnancy per transfer and cumulative clinical pregnancy rates. Data were compared between groups. Statistical analysis: Chi-square test (Bonferroni correction) and Anova (p &amp;lt; 0.05). Main results and the role of chance The results in G1, G2, G3 and G4 were, respectively: female age, yo (40 vs. 38.4 vs. 37.2 vs. 34.7, p &amp;lt; 0.01); euploidy rate (34.6 vs. 67.2 vs. 83.2 vs. 100.0, p &amp;lt; 0.0001), clinical pregnancy rate per transfer, % (45.5 vs. 58.6 vs. 72.8 vs. 95.8 p &amp;lt; 0.0001 ), cumulative clinical pregnancy rate, % (15,7 vs. 39.4 vs. 60.6 vs. 95,8% p &amp;lt; 0.0001). Women with 1 to 2 blastocysts before biopsy had a cumulative pregnancy rate more than 3-fold lower than those with 3 to 4 blastocysts (%, 39.6 vs. 15.3, p &amp;lt; 0.001, OR 3.59, CI 95% 2.32 to 5.57) and more than 8-fold lower than those with 5 to 9 blastocysts (%, 60,6 vs. 15.3, p &amp;lt; 0.001, OR 8.42, CI 95%: 5.20 to 13.64). The comparison in each group according to female age showed that until 9 blastocysts, the younger women had a pregnancy rate higher than the older, respectively (%): G1: 30.8 vs. 12.5, p = 0.001; OR 3.1, CI 95%: 1.44 to 6.48; G2: 57.4 vs. 30.2, p &amp;lt; 0.001; OR 3.10, CI 95%: 1.61 to 5.98; G3: 72.6 vs. 50.7, p = 0.009. OR 2.58; IC 95%: 1.19 to 5.67; and G4: 93.8 vs. 87.5, p = 0.268. Limitations, reasons for caution As a retrospective study, data collection and filling limitations should be considered. Wider implications of the findings The number of pre-biopsy blastocysts appears to be a parameter that can be used as a prognostic factor for the pregnancy chance in PGT-A cycles. Even transferring 1 embryo, the pregnancy rate/transfer was higher with more blastocysts. In patients with less than 10 blastocysts before PGT, age influences pregnancy rates. Trial registration number Not Applicable

The relationship between serum levels of epidermal growth factor and β-human chorionic gonadotropin and the type and prognosis of ectopic pregnancy.

This work aimed to explore the relationship between epidermal growth factor (EGF) and β-human chorionic gonadotropin (β-HCG) and ectopic pregnancy types and impact on prognosis. Twenty women with normal pregnancies (NPs) were recruited as control group, and twenty women each with tubal pregnancy (TP) and cervical pregnancy (CP) were recruited. Blood samples were collected to detect EGF and β-HCG. Data on length of hospital stay and incidence of complications were collected. The differences in serum EGF and β-HCG levels were compared among groups and within various types of ectopic pregnancy using analysis of variance and Pearson correlation analysis. Serum EGF and β-HCG were notably lower in TP and CP group vs. controls (P < 0.05). In subgroup analysis within the types of ectopic pregnancy, serum EGF levels were drastically higher in TP group vs. CP group (P < 0.05). Serum EGF levels were negatively correlated with pregnancy outcomes and incidence of complications (P < 0.05). In patients with TP and CP, serum EGF and β-HCG recovery time and hospital stay differed drastically (P < 0.05). Serum EGF and β-HCG levels showed optimal cutoff values identified at 2.65μg/L and 11,745.35IU/L, respectively. The corresponding area under the curve (AUC) values were 0.885 and 0.841. Elevated levels of EGF may be associated with the occurrence of ectopic pregnancy and may impact the type of ectopic pregnancy, pregnancy outcomes, and the incidence of complications. Further clinical research is warranted to investigate these findings.

What is the materno-fetal prognosis of adrenal insufficiency and pregnancy in low ressource setting ? A case report

Introduction and importance: Adrenal insufficiency is a rare chronic disease with a prevalence of 39 to 60 cases per million peoples in Europe. However, the prevalence is higher in sub-saharian Africa. The occurrence of pregnancy in adrenal insufficiency is rare but associated with high maternal and perinatal morbidity and mortality. For this reason, the management of pregnancy in adrenal insufficiency patient must be provided by a multidisciplinary team. Case presentation: We report the case of a 34-year-old pregnant woman followed for adrenal insufficiency secondary to prolonged corticosteroid therapy. Treatment consisted to an obstetrical and endocrinological follow-up and corticosteroid replacement therapy with hydrocortisone. A prophylactic caesarean section at 38 weeks resulted in the birth of a newborn male weighing 3395g. Maternal and perinatal prognosis was good. Clinical discussion: Pregnancy in adrenal insufficiency is a therepeutic challange in developing countries. Through this case, we discuss the therapeutic and prognostic aspects of adrenal insufficiency in our setting. Conclusion: With the introduction of gluco-corticosteroid replacement therapy, pregnancy in adrenal insufficiency can progress normally.

Prognosis of subsequent pregnancy in uterine necrosis after uterine artery embolization.

In an 8-year period at two medical center, 138 patients underwent uterine artery embolization, and 11 of them were diagnosed with uterine necrosis. Among them, three were successfully conceived. However, one of them developed an arteriovenous malformation after an artificial abortion, and another experienced complications, including placenta previa and placenta accreta spectrum, which resulted in early preterm delivery and recurrent postpartum hemorrhage, necessitating subtotal hysterectomy. Therefore, it is crucial to prepare for potential adverse pregnancy outcomes in subsequent pregnancies for patients with a history of uterine necrosis.

Externally validated nomogram for predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction (FGR)

ObjectiveThis study aimed at developing an available predictive model of singleton pregnancies with fetal growth restriction (FGR) for accurate and individualised prognosis assessment.MethodsThe prediction nomogram was developed by using multivariable...

Obstetrics and fetal outcomes in pregnant women with beta-blocker treatment in maternal arrhythmia

Aim: The aim of this study was to investigate the pregnancy prognosis of patients taking beta-blockers for the treatment of cardiac arrhythmias.&#x0D; Materials and Method: This study was a retrospective observational study involving 50 pregnant women with cardiac arrhythmias and 55 healthy pregnant women, admitted between January 1, 2020 and January 1, 2022, to Ankara City Hospital. Beta-blockers were classified into three groups: metaprolol, propranolol, and bisoprolol. The use of beta-blockers was examined in two groups: high-dose and low-dose. For pregnancy outcome, birth week, birth weight and birth weight Z-score, the bHCG MoM and PAPP-A MoM, neonatal APGAR score, and neonatal intensive care unit admission rates were determined. Statistical analysis was performed using IBM SPSS Statistics 26.0 (IBM Corp, Armonk, NY, USA). Shapiro-Wilk and Kolmogorov-Smirnov tests were both used to evaluate normality of variables. Groups were compared using the Student t-test and the Mann-Whitney U test. P-values &lt; 0.05 were considered as statistically significant.&#x0D; Results: The patient group taking beta-blockers had a statistically significant earlier delivery week than the group without beta-blocker use (p=0.000). The rate of primary cesarean deliveries was higher in the study group (p=0.007). Birth weight and APGAR score at the fifth minute was significantly lower in the study group, and NICU admission rate was significantly higher (p=0.006, p=0.000 and p=0.000, respectively). &#x0D; Conclusion: Beta-blockers, a first-line therapy for maternal arrhythmias, may affect fetal development and pregnancy outcomes. İt is recommended that these drugs to be administered are meticulously selected for appropriate subgroups, with lowest effective doses

Features of the state of extraembryonic structures in miscarriage early terms of pregnancy

Background. Despite the modern achievements of medicine, miscarriage remains the main problem of obstetrics and gynecology science and practice. Purpose – to assess the features of the state of extraembryonic structures in case of miscarriage in the early stages of gestation. Materials and Methods. Under observation were 32 patients (main group) with a verified threat of pregnancy termination with bleeding in the embryonic period of gestation (up to 10 weeks) and 20 women (control group) with a physiological course of early pregnancy. The exclusion criteria from the study were patients with induced pregnancy, multiple pregnancies, anomalies of the development of female genital organs. All patients underwent a standard clinical and laboratory examination. During the ultrasound examination, both the state of the embryo and the state of extraembryonic structures were evaluated: the volume of the fertilized egg (V f/e), the average internal diameter of the yolk sac, the nature of vascularization of the corpus luteum, the state of hemodynamics in the myometrium. During transvaginal ultrasound, the chorionic volume (Vc) was calculated and its vascularization index (VI) was evaluated using a special three-dimensional VOCAL program. Results. Analysis of embryo biometrics in the studied groups did not reveal any significant difference. When assessing the state of extra-embryonic structures, we found that the volume of the fertilized egg and the average internal diameter of the yolk sac in women with miscarriage in the embryonic period of gestation was significantly lower. The volume of the corpus luteum of the ovary in the main group was equal to 3.0±0.3 cm3 in the control group – 5.3±0.61 cm3 , (p &lt; 0.05). Vascularization of the corpus luteum in patients with bleeding in early pregnancy was also reduced. In patients with threatened termination of pregnancy with bleeding, Vc was 32.5±2.08 cm3 in control 71.6±2.4 cm3 . The vascularization index of the chorion in pregnant women of the main group was equal to 9.5±1.2, while in women with a physiological course of gestation it was 19.1±1.7 (p&lt;0.05). When evaluating the hemodynamics in the myometrium, it was also established that the resistance index in the uterine and spiral arteries in the patients of the main group was significantly higher compared to the pregnant women of the control group. Conclusions. When there is a threat of pregnancy termination with bleeding in the embryonic period of intrauterine development of the child, significant changes occur in extraembryonic structures. A decrease in the volume of the fertilized egg, the average internal diameter of the yolk sac, blood flow disorders in the corpus luteum and myometrium, a decrease in vascularization of the chorion and its hypoplasia create a high risk of developing placental dysfunction and worsen the prognosis of pregnancy.

Quantitative proteomics reveals pregnancy prognosis signature of polycystic ovary syndrome women based on machine learning.

We aimed to screen and construct a predictive model for pregnancy loss in polycystic ovary syndrome (PCOS) patients through machine learning methods. We obtained the endometrial samples from 33 PCOS patients and 7 healthy controls at the Reproductive Center of the Second Hospital of Lanzhou University from September 2019 to September 2020. Liquid chromatography tandem mass spectrometry (LCMS/MS) was conducted to identify the differentially expressed proteins (DEPs) of the two groups. Gene Ontology (GO) as well as Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed to analyze the related pathways and functions of the DEPs. Then, we used machine learning methods to screen the feature proteins. Multivariate Cox regression analysis was also conducted to establish the prognostic models. The performance of the prognostic model was then evaluated by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). In addition, the Bootstrap method was conducted to verify the generalization ability of the model. Finally, linear correlation analysis was performed to figure out the correlation between the feature proteins and clinical data. Four hundred and fifty DEPs in PCOS and controls were screened out, and we obtained some pathways and functions. A prognostic model for the pregnancy loss of PCOS was established, which has good discrimination and generalization ability based on two feature proteins (TIA1, COL5A1). Strong correlation between clinical data and proteins were identified to predict the reproductive outcome in PCOS. The model based on the TIA1 and COL5A1 protein could effectively predict the occurrence of pregnancy loss in PCOS patients and provide a good theoretical foundation for subsequent research.

Pregnancy and cardiac maternal outcomes in women with inherited cardiomyopathy: interest of the CARPREG II risk score.

Inherited cardiomyopathies are relatively rare but carry a high risk of cardiac maternal morbidity and mortality during pregnancy and postpartum. However, data for risk stratification are scarce. The new CARPREG II score improves prediction of prognosis in pregnancies associated with heart disease, though its role in inherited cardiomyopathies is unclear. We aim to describe characteristics and cardiac maternal outcomes in patients with inherited cardiomyopathy during pregnancy, and to evaluate the interest of the CARPREG II risk score in this population. In this retrospective single-centre study, 90 consecutive pregnancies in 74 patients were included (mean age 32±5years), including 28 cases of dilated cardiomyopathy (DCM), 46 of hypertrophic cardiomyopathy, 11 of arrhythmogenic right ventricular cardiomyopathy and 5 of left ventricular noncompaction, excluding peripartum cardiomyopathy. The discriminatory power of several risk scores was assessed by the area under the receiver-operating characteristic curve (AUC). Median CARPREG II score was 2 [0;3] and was higher in the DCM subgroup. A severe cardiac maternal complication was observed in 18 (20%) pregnancies, mainly driven by arrhythmia and heart failure (each event in 10 pregnancies), with 3 cardiovascular deaths. Forty-three pregnancies (48%) presented foetal/neonatal complications (18 premature delivery, 3 foetal/neonatal death). CARPREG II was significantly associated with cardiac maternal complications (P<0.05 for all) and showed a higher AUC (0.782) than CARPREG (0.755), mWHO (0.697) and ZAHARA (0.604). Pregnancy in women with inherited cardiomyopathy carries a high risk of maternal cardiovascular complications. CARPREG II is the most efficient predictor of cardiovascular complications in this population.

Fetal Death in Utero Associated with a Double Circular Umbilical Cord Tight on Full-Term Pregnancy about a Case at the Lac Tele De Bamako Clinic

Introduction: The circular umbilical cord corresponds to a winding of it in one or more turns of the whorl around the fetal neck. Case observation: She is a 25-year-old primigeste, married, a nurse by profession with no known medical-surgical history, who consulted for painful uterine contractions on pregnancy of 38 weeks of amenorrhea (AS). This is a pregnancy well followed by a gynecological-obstetrician with 06 quality antenatal consultations. The clinical and biological monitoring parameters were well documented in the antenatal diary and show no abnormalities. Conclusion: Fetal death in utero is a common pathology but association with umbilical cord circulars is rare. When the umbilical cord circular is double and tightened around the neck like a knot of the cord. It could be the cause of unexplained fetal death. It is always a tragedy for the parents and a failure for the obstetrician. It is necessary to reassure the woman and her family about the prognosis of subsequent pregnancies.