Fetal Growth Retardation Research Articles

PERINATAL ASPECTS OF MEDICAL CARE WITH COVID-19

Purpose. To determine perinatal aspects of medical care for COVID-19. Materials and methods. 200 patients with confirmed SARS-CoV-2 hospitalized at the Kiev City Center for Reproductive and Perinatal Medicine were comprehensively examined: group 1 - 50 pregnant women with severe Covid-19 and group 2 - 150 pregnant women with moderate severity of the disease. Research results. Severe Covid-19 disease is observed in 12.2% of pregnant women, critical condition - in 7.5% of patients. Severe disease directly or indirectly determined a significantly higher incidence of pregnancy complications. First of all, this is placental insufficiency in the vast majority of patients (72.0%), which was manifested by fetal growth retardation and distress (in 32.0% and 48.0%). Half of the women experience oligohydramnios (50.0%), 38.0% have a threat of premature birth, and a third (30.0%) have premature birth. 44.0% of children are born in a state of asphyxia, 36.0% of children have manifestations of respiratory failure, and 16.0% have bilateral pneumonia. High incidence of neurological disorders (56.0%), gastrointestinal (50.0%), hypoglycemic (34.0%) and hemorrhagic (32.0%) syndromes. Testing of newborns for COVID-19 was positive in 6.0% of cases. 22.0% of children required intensive care unit care. Perinatal mortality was 0.4%. Conclusions. The identified high frequency of perinatal disorders in women with COVID-19 indicates the need for careful care for this category of pregnant women and their newborns, constant monitoring of vital functions, follow-up observation, and the development of clear algorithms for the actions of medical personnel depending on the patients’ condition.

PECULIARITIES OF THE COURSE OF PREGNANCY IN WOMEN OF DIFFERENT POPULATION GROUPS BURDENED WITH ANEMIA AND HELICOBACTERIOSIS

Peculiarities of the course of pregnancy in women of different ethnic groups are burdened with anemia and helicobacteriosis in modern living conditions after the pandemic of coronavirus infection, the state of constant stress of the war in Ukraine. The purpose of the study was to determine the characteristics of the course of pregnancy in women of different population groups burdened with anemia and helicobacteriosis
 Materials and Methods. 30 pregnant women of reproductive age, burdened with anemia, residents of the city of Odesa (group I) and countries of Southeast Asia (group II) were under our observation. All women were registered at the women’s clinic. The monitoring algorithm included clinical and laboratory studies of Helicobacter pylori infection (total antibodies (IgG, IgM, IgA) to Helicobacter pylori antigens).
 Results. The presence of infectious processes in the body of women is one of the etiological factors of gestational complications, including the progression of the severity of anemia in pregnant women. The clinical severity of anemia in pregnant women was consistent with a high coefficient of positivity of total antibodies (IgG, IgM, IgA) to Helicobacter pylori antigens and a low level of hemoglobin, the level of ferritin, folic acid, cyanocobalamin, the vital trace element iron. Indicators of the clinical course of pregnancy in group I and group II had a significant difference (p<0.05), respectively: early toxicosis (mild, moderate, severe) – 20.0 %, 0 %, 0 % and 26.7 %, 20.0 %, 0 %; syndrome of the threat of early miscarriage - 13.3 % and 33.3 %; late miscarriage threat syndrome – 6.7 % and 20.0 %; secondary placental dysfunction – 0 % and 20.0 %; fetal growth retardation syndrome (FGRS) – 0 % and 6.7 %; intranatal fetal distress – 0 % and 6.7 %. The postpartum period in 13.3 % of women in the 2nd group had a lochiometer.
 Conclusions. Peculiarities of the course of pregnancy in women of different population groups burdened with anemia and helicobacteriosis consisted in the progression of the severity of the clinical and laboratory course of anemia and gestational complications during the trimesters. The clinical severity of anemia in pregnant women was consistent with a high ratio of total antibodies (IgG, IgM, IgA) to Helicobacter pylori antigens and a low level of hemoglobin, the level of ferritin, folic acid, cyanocobalamin, the vital trace element iron. It is recommended to determine the ratio of total antibodies (IgG, IgM, IgA) to Helicobacter pylori antigens in the blood of pregnant women with anemia and at the stage of pregnancy planning. Positive results are an indication for examination of all family members.

The value of some indices of heart rate variability in the diagnosis of fetal growth retardation

Fetal growth retardation (FGR) is one of the most serious problems in current perinatology. This pathology leads not only to the deterioration of perinatal outcomes but also significantly increases morbidity during adult life. FGR is known to be featured by its delayed “neurological maturation”. This is manifested in a decrease in autonomic nervous regulation according to the fetal heart rate variability (HRV) scores and indices. The objective: to study HRV in fetuses with normal biometric indices compared to similar parameters of growth retarded fetuses. Materials and methods. The 47 pregnant women who had fetuses with normal biometric indices (I group) and 33 patients with fetal growth retardation (II group) were included in the study. The investigation of the fetal HRV was performed by processing the R–R intervals obtained via non-invasive electrocardiogram (ECG) and involved the following indices: STV (short term variations), LTV (long term variations), AC/DC (acceleration capacity/deceleration capacity), TP (total power), SI (stress index), SDNN (standard deviation of normal to normal intervals), EnRE (entropy of the time series), D2 (correlation dimension of the time series), Z (temporary irreversibility) і FL (measure of fuzzy logic, integrated measure of HRV). Results. The obtained data indicated that the indices of fetal HRV were reduced in the patients with FGR. These indices have utility in screening programs for the detection of fetal intrauterine nutrition and growth disturbances. The results of the study allow us to believe that the ability to accelerate heart rate patterns is partly preserved even during FGR. This may indicate a very ancient phylogenetic nature of the reaction of the heart system of the fetus to its motile activity. However, decelerations according to the DC were typical for FGR. A non-invasive fetal ECG could become a useful supplementary method in the current methods’ spectrum used in perinatal medicine. Conclusions. Therefore, the development of algorithms for the diagnosis of FGR requires the inclusion of the following HRV indices: STV, LTV, DC, TP, SI, SDNN, D2, Z, and FL. These biophysical markers of FGR can be used as a screening program in conditions of lack of access to high-quality ultrasound diagnostics or be a valuable addition to existing perinatal strategies.

The features of the prevention of preeclampsia in pregnant women with gestational endotheliopathy in the first trimester

The objective: to evaluate the clinical effectiveness of L-arginine in the prevention of preeclampsia and reduction of other perinatal risks in patients with preclinical gestational endotheliopathy (GE).Materials and methods. A comparative clinical study was performed at the clinical base of the Department of Obstetrics and Gynecology N. 1 of the Vinnytsya National Pirogov Memorial Medical University. 116 pregnant women with preclinical GE (main group), which was diagnosed by laboratory and instrumental research (microalbuminuria and endothelium-dependent vasodilatation), took part in the study. The patients of the main group were divided into clinical subgroups: 31 pregnant women with GE in subgroup A received acetylsalicylic acid (ASA) at a dose of 75 mg per or per day; 33 patients with preclinical GE from subgroup B received L-arginine at a dose of 4-4.2 g per or per day; 52 pregnant women with preclinical GE who refused prophylactic treatment were included in the subgroup C. The control group involved 58 pregnant women with a physiological gestation and without GE.The clinical effectiveness of the therapy was assessed by comparing the number of cases of perinatal pathology in the I, II and III trimesters.Results. The use of L-arginine as an alternative preventive therapy for the development of preeclampsia and other perinatal pathology made possible to reduce the rate of preeclampsia significantly (RR 0.19, 95% CI: 0.05-0.77; p=0.02) and placental hyperplasia/hypoplasia (RR 0.17, 95% CI: 0.04-0.68; p=0.01), compared to patients who did not receive any preventive treatment. In pregnant women with early-onset gestational endotheliopathy who received L-arginine, placental dysfunction was not diagnosed in the II and III trimesters of pregnancy and there were no cases of fetal growth retardation. The use of L-arginine was not associated with side effects and/or adverse reactions in the proposed dose and frequency of administration and can be considered beneficial for the mother and the fetus.Conclusions. Prescribing ASA and L-arginine drugs for pregnant women with a moderate degree of perinatal risk (preclinical GE) made possible not only to prolong pregnancy, but also to prevent the development of severe perinatal pathology. A more pronounced clinical effectiveness of the course prescription of solution of L-arginine per or (daily dose of L-arginine - 4.0-4.2 g) in pregnant women with preclinical form of GE may be associated with the endotheliotropic protective effect of the drug.The appropriateness of using L-arginine during pregnancy is still debated, and further researches are needed to determine the optimal dosage, initial period for using and duration for the best prophylactic or therapeutic effect.

The course of pregnancy and childbirth in women with fetal growth retardation syndrome

The course of pregnancy and childbirth in women with fetal growth retardation syndrome

NOVEL ULTRASOUND TECHNOLOGIES IN ASSESSING THE STATE OF THE MOTHER–PLACENTA–FETUS SYSTEM

The leading process in early pregnancy is forming the mother–placenta–fetus system. The central link of the mother–placenta–fetus system is the placenta. The structural features of the placenta reflect complex relationship between the mother's body and the fetus. Disorder in forming and functioning of the placenta underlies the development of complications such as early termination of pregnancy, placental insufficiency, fetal growth retardation syndrome, preeclampsia, premature birth. In this regard, an integrated approach in studying the hemodynamic system of mother–placenta–fetus is of particular importance. Ultrasound examination remains one of the most promising diagnostic methods. The aim of the study is to increase the effectiveness of diagnosis and prediction of gestational complications associated with violation of hemodynamic parameters in the mother–placenta–fetus system. Materials and methods. The study included 40 patients between the 30th and 32nd weeks of pregnancy with a singleton spontaneous pregnancy: 20 patients with normal course of pregnancy and 20 patients with a diagnosis of placental insufficiency. Ultrasound examination included standard echography in B-mode, color Doppler mapping and the use of modern techniques – three-dimensional imaging technology and innovative techniques of high-precision microvascular imaging SMI (Superb Micro-Vascular Imaging). Results and discussion. In patients with normal pregnancy, a variant of a three-dimensional model of the vascular network with a complex massive vascular network prevailed, whereas in the group with placental insufficiency, a three-dimensional vascular model looked simple: several intertwined vessels. Visual assessment of the placental vascular tree using SMI technology revealed the absence of a clear vascular pattern in the area of interest in patients with placental insufficiency, whereas active placental blood flow was determined in patients with normal pregnancy. Conclusions. The use of modern ultrasound technologies enables to obtain information about the state of placental blood flow, which gives the opportunity to diagnose the development of placental insufficiency in a timely manner.

Функціональний стан фетоплацентарного комплексу у вагітних із HCV-інфекцією

Purpose - to study the functional state of the fetoplacental complex (FPC) during pregnancy in women with hepatitis C virus (HCV infection). Materials and methods. A prospective clinical and statistical analysis of the functional state of the FP during pregnancy in 40 women (main group, MG) with HCV infection was conducted on the basis of the Kyiv City Center of Reproductive and Perinatal Medicine for the period 2020-2021. The control group (CG) consisted of 50 healthy pregnant women. Statistical processing of research results was carried out using standard programs Microsoft Excel 5.0 and Statistica 8.0. Results. The hormonal status of FPK in MG of pregnant women, starting from the 18th week, was characterised by a significant decrease in the secretion of progesterone (PG) (159.314.6 nmol/l in MG versus 205.44.8 nmol/l in CG; p<0.05) and human chorionic gonadotropin (39.24.6 mIU/mL versus 52.85.3 mIU/mL, respectively). Estradiol (E2) levels in MG of pregnant women from the 18th week of pregnancy were significantly lower (26.32.7 nmol/l) than in CG of pregnant women (33.71.4 nmol/l, p<0.05). A synchronous decrease in the level of PG and E2 was observed in the case of threatened abortion against the background of bloody discharge, which indicated clinical manifestations of placental dysfunction (PD). In MG of pregnant women, the level of placental lactogen (PL) at week 18 was almost the same (80.913.2 nmol/l) compared to CG of pregnant women (79.57.1 nmol/l; p>0.05). From the 29th week, the level of E2 in MG of pregnant women is significantly different from CG (25.61.3 nmol/l in MG versus 51.20.7 nmol/l in CG; p<0.05). The most pronounced difference was the level of estriol (E3) and cortisol (Cr) in blood serum relative to CG in MG of pregnant women, which was manifested by a decrease in the level of E3 (up to 86.4±5.2 nmol/l in MG versus 98.42.6 nmol/l in CG; p<0.05) against the background of a simultaneous increase in Cr content (up to 751.118.6 nmol/l in MG versus 625.618.4 nmol/l in CG; p<0.05). Endocrinological disorders also changed before delivery (39-40 weeks): the E2 level decreased (to 45.41.9 nmol/l in MG versus 65.30.6 nmol/l in CG; p<0.05), E3 (up to 28.32.0 nmol/l versus 57.81.8 nmol/l, respectively; p<0.01), PG (up to 499.4±11.6 nmol/l versus 604,216.3 nmol/l, respectively; p<0.05) and PL (up to 201.4±12.4 nmol/l versus 63.418.8 nmol/l, respectively; p<0.05) and the Cr content increased (up to 812.4±16.7 nmol/l versus 651.614.6 nmol/l, respectively; p<0.01). Conclusions. The functional state of the FPC in pregnant women with HCV infection, on the eve of delivery, is characterized by a high level of premature maturation of the placenta, changes in the volume of amniotic fluid, due to which significant hemodynamic and endocrinological subcompensated disorders appear, but in some cases they are decompensated, which causes disorders from the functional state of the fetus and the high frequency of development of fetal growth retardation syndrome in this group of women. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Особливості перебігу вагітності в жінок із передчасними пологами

Purpose - to determine the peculiarities of the course of pregnancy and childbirth in women who had complications from the group of major obstetric syndromes, clinically manifested by premature birth (PB). Materials and methods. A retrospective clinical-statistical analysis of the course of pregnancy and childbirth of n=69 pregnant women with spontaneous PB at a gestation period of 24-36 weeks and 6 days was carried out. Depending on the period of pregnancy, they were divided into groups: the Group I - 9 pregnant women 24-26 weeks 6 days, the Group II - 28 women 28-31 weeks 6 days, the Group III - pregnant women 32-36 weeks 6 days. The Control group (CG) consisted of 56 practically healthy pregnant women with a healthy reproductive history and an uncomplicated course of this pregnancy. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. Were received significant differences between the Group I and the CG (p=0.007), in the presence of signs of the threat of termination of pregnancy during the second “wave” of cytotrophoblast invasion, so the chance of giving birth in the early term is 4.2 times higher than at term. In the presence of isthmic-cervical insufficiency (ICN), the reliability of differences between the Groups I and II (p=0.0021), Groups I and III (p=0.012) is observed between the Group I and CG (p=0.00083) and the risk of very early PB is 2.6 times higher than the risk of premature, late premature - 2.2 times. Disturbances in uteroplacental blood circulation have the presence of significant differences between Groups I and II (р=0.0051). There is a direct relationship between the level of blood pressure and blood circulation in the uterine arteries. Therefore, the observed difference is not accidental: in the Group II, preeclampsia was observed significantly more often. Violation of feto-placental hemodynamics when comparing groups demonstrated the existence of statistically significant differences between the Groups I and II (p=0.048), as well as between the Group I and CG (p=0.02). In the presence of clinical signs of fetal growth retardation syndrome (GRS), there is a significant difference between the Groups I and II (р=0.033). Conclusions.The features of the course of pregnancy with premature birth include the threat of termination during the second “wave” of cytotrophoblast invasion; isthmic-cervical insufficiency, which can lead to very early premature birth; vaginal infectious-inflammatory and dysbiotic diseases. Severe forms of placental insufficiency and preeclampsia are more often an indication for termination of pregnancy at 28-33 weeks 6 days. The research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. A informed sonsennt was collected in order to carry out the research. No conflict of interests was declared by the author.

Clinical observation of delivery in a COVID-19-convalescent woman with preeclampsia developing fetal distress during preterm labor

The course of the pandemic revealed that despite the general populational risks for developing novel coronavirus infection (NCI) COVID-19, pregnant women are more susceptible to its severe course and unfavorable perinatal outcomes. Currently, NCI is associated with a high risk of spontaneous miscarriages, premature rupture of fetal membranes, preterm delivery, development of fetoplacental insufficiency, fetal growth retardation, fetal distress, exacerbation of chronic somatic pathology, and postpartum bleeding. A brief literature review and the described clinical case demonstrate a need to thoroughly examine puerperal women with preterm delivery.

Endothelial Dysfunction and Pregnant COVID-19 Patients with Thrombophilia: A Narrative Review.

Pregnancy with SARS-CoV-2 infection can raise the risk of many complications, including severe COVID-19 and maternal-fetal adverse outcomes. Additionally, endothelial damage occurs as a result of direct SARS-CoV-2 infection, as well as immune system, cardiovascular, and thrombo-inflammatory reactions. In this narrative review, we focus on endothelial dysfunction (ED) in pregnancy, associated with obstetric complications, such as preeclampsia, fetal growth retardation, gestational diabetes, etc., and SARS-CoV-2 infection in pregnant women that can cause ED itself and overlap with other pregnancy complications. We also discuss some shared mechanisms of SARS-CoV-2 pathophysiology and ED.

Sirtuin 1 (SIRT1) is a potential therapeutic candidate gene for fetal growth retardation

Sirtuin 1 (SIRT1) is a potential therapeutic candidate gene for fetal growth retardation

Диагностическая значимость определения экспрессии генов энергетического метаболизма при задержке роста плода

Диагностическая значимость определения экспрессии генов энергетического метаболизма при задержке роста плода

Restrição de Crescimento Intrauterino e os fatores de risco associados no Brasil

Introduction: Intrauterine Growth Restriction is defined as the inability of the fetus to reach its growth potential and can be caused by maternal, placental and fetal factors. Objective: The study aims to make a major social contribution, in order to help the health sectors develop actions aimed at improving the quality of life of pregnant women, promoting changes in behaviors that are harmful to the fetus and thus contributing to reducing infant morbidity and mortality. Methodology: A bibliographic survey was carried out in the Scielo, PubMed and VHL databases, between 2010-2020, with the descriptors and their combinations in Portuguese and English, using the Boolean operators: "fetal growth retardation" OR "intrauterine growth retardation" OR "intrauterine growth restriction" AND "risk factors" AND "intrauterine growth restriction" AND "Brazil". After applying inclusion and exclusion criteria, 10 articles were selected. Results: Analysis of the articles showed that Intrauterine Growth Restriction is strictly related to five themes: evolution in prenatal treatment; socioeconomic factor; low birth weight; fetal mortality and serum leptin concentration, eclampsia and HIV. Conclusion: The analyses available on the main categories related to IUGR showed that lack of prenatal care, poor socioeconomic situation, low leptin concentration during pregnancy, pre-eclampsia and viral infections such as HIV are risk factors for IUGR in Brazil.

Adverse associations between maternal deoxynivalenol exposure and birth outcomes: a prospective cohort study in China

BackgroundDeoxynivalenol (DON), one of the most prevalent mycotoxins, has been found to cause fetal growth retardation in animals. However, limited evidence exists regarding its effects on pregnant women.MethodsMaternal urinary concentration of total DON (tDON) and free DON (fDON) in the second trimester was measured using liquid chromatography with tandem mass spectrometry. Provisional daily intake (PDI) of DON was calculated based on tDON concentration. Linear and logistic regression models were used to evaluate the association between DON exposure levels and birth weight, birth length, and the risk of small for gestational age (SGA).ResultsAmong 1538 subjects, the median concentrations of tDON and fDON were 12.1 ng/mL and 5.1 ng/mL, respectively. The PDI values revealed that the median DON intake was 0.7 µg/kg bw, and 35.9% of the total population exceeded the provisional maximum tolerable daily intake (PMTDI) of 1 µg/kg bw. Compared with the lowest tertile, birth weight decreased by 81.11 g (95% CI: -127.00, -35.23) for tDON (P-trend < 0.001) and 63.02 g (95% CI: -108.72, -17.32) for fDON (P-trend = 0.004) in the highest tertile. Each unit increase in Ln-tDON and Ln-fDON was also inversely associated with birth weight. Furthermore, compared to those who did not exceed PMTDI, pregnant women whose PDI exceeded PMTDI had lower birth weight (β = -79.79 g; 95% CI: -119.09, -40.49) and birth length (β = -0.21 cm; 95% CI: -0.34, -0.07), and a higher risk of SGA (OR = 1.48; 95% CI: 1.02, 2.15) in their offspring. Similar associations with birth weight, birth length, and SGA were found when comparing the highest tertile of PDI to the lowest tertile (all P-trend < 0.05).ConclusionsMaternal DON exposure is related to decreased birth weight. Our findings implicate that DON exposure during pregnancy may cause fetal growth faltering, and measures should be taken to reduce DON exposure in pregnant women.

Features of the course of pregnancy and health of newborns with intrauterine growth restriction

Introduction. The development of intrauterine growth restriction (IUGR) begins with fertilization and trophoblast invasion. IUGR is manifested in a decrease in fetal growth rate. However, data on risk factors for fetal growth retardation, their combination with various chronic diseases in a pregnant woman are contradictory.Objective. To study the features of the course of pregnancy, childbirth, the health status of newborns with IUGR. Materials and methods. The study was a retrospective cohort study. At the first stage, we analyzed 1574 birth histories with a diagnosis of IUGR, placental insufficiency, women with normal pregnancy who gave birth (2016–2021). According to the inclusion and exclusion criteria, 408 women were included in the study. The women were divided into 2 groups. The first group included 202 pregnant women with a diagnosis of IUGR. In the second Group – 206 pregnant women with normal pregnancy, without IUGR, delivered at the time corresponding to the terms in the main group.Results. We have clarified the risk factors and premorbid conditions involved in the development of IUGR (somatic and gynecological morbidity, pregnancy course). Their analysis is necessary to predict IUGR. The analysis of the timing and method of delivery in the studied groups was carried out. A higher incidence of complications in the early neonatal period was revealed when assessing the health status of newborns with IUGR.Conclusion. Thus, the study of the mechanisms of IUGR formation in the future will allow the development of modern pathogenetic approaches to prevention and treatment.

Correlation of Neutrophil Lymphocyte Ration (NLR) Values with Severe Preeclampsia, HELLP Syndrome, and Eclampsia

Background: Preeclampsia (PE) is the leading cause of maternal and fetal morbidity and mortality. The disease is characterized by hypertension (≥140/90 mmHg), proteinuria, thrombocytopenia, renal failure, neurological complications, liver involvement, and fetal growth retardation. HELLP syndrome is a variant of preeclampsia that causes an increase in liver enzymes and a low platelet count. Eclampsia is the heaviest complication of preeclampsia. Neutrophil lymphocyte ratio (NLR) is part of the leukocyte type count examination which is an easy, available examination parameter and can be used as an index of the severity of systemic inflammation. This study aimed to determine the relationship of neutrophil-lymphocyte ratio (NLR) values with severe Preeclampsia, HELLP syndrome, and eclampsia.Method: This research is a comparative analytical study with a case control study approach. This research was conducted from April-November 2022. This study was conducted at the emergency room (ER) and inpatient department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Andalas – RSUP Dr. M. Djamil Padang. The study sample was part of the population that met the inclusion and exclusion criteria. The study required 108 samples, namely 27 from the severe preeclampsia group, 27 from the eclampsia group, 27 from the HELLP syndrome group, and 27 from the control group. Bivariate statistical analysis using Independent T-Test. Samples were taken by the method of consecutive sampling. The data were analyzed at a 95% confidence interval, if obtained p value&lt;0.05 then there is a significant relationship. The Data was analyzed by the SPSS computer program.Results: The results of this study obtained neutrophil-lymphocyte ratio in eclampsia has the highest average value compared with HELLP syndrome, severe preeclampsia, and control. While HELLP syndrome has a higher mean value than severe preeclampsia and control and subsequently severe preeclampsia also has a higher mean value NLR than control. This study found a significant relationship between neutrophil-lymphocyte ratio (NLR) with severe Preeclampsia, HELLP syndrome, and eclampsia (all p values=0.000).Conclusion: This study proves that neutrophil-lymphocyte ratio (NLR) has a significant relationship with severe Preeclampsia, HELLP syndrome, and eclampsia so further research can develop this study by analyzing other factors that affect preeclampsia. For clinicians can make this study as a reference in monitoring the progression of inflammation that occurs in severe preeclampsia, HELLP syndrome, and eclampsia.

Zinc-nanoparticles alleviate the ovarian damage induced by bacterial lipopolysaccharide (LPS) in pregnant rats and their fetuses

Lipopolysaccharide (LPS) is an endotoxin derived from the cell wall of Gram-negative bacteria. LPS exposure during early gestation is associated with adverse effects on the placenta as well as on developmental outcomes, including embryonic resorption, fetal death, congenital teratogenesis, and fetal growth retardation. This work aimed to explore the adverse effects of LPS injected at an early stage of gestation on the gonads of pregnant rats and the ovaries of their pups and the role of zinc nanoparticles (Zn-NPs) against these adverse effects. Twenty-four pregnant rats were used in this study. They were divided at gestation day 4 into four groups (n = 6): control, Zn-NPs (20 mg/kg orally from gestation day E14 till the end of weaning), LPS (50 µg/kg at gestation days E7 and E9), and LPS + Zn-NPs group. The body weight and placenta weight were recorded at gestational day 16. At postnatal day 21 (weaning), the mothers rats and their offspring were sacrificed and immediately dissected to remove the ovaries and uteri from the mothers and the ovaries from their offspring for subsequent biochemical, histological, and immunohistochemical investigations. The obtained results revealed that LPS exposure during early gestation caused severe histopathological alterations in the placenta, uterus, and ovaries of mothers, as well as in the ovaries of their pups. Also, the uterine and ovarian sections displayed a positive reaction for caspase-3 antibody and a negative reaction for Bcl-2 antibody, which reflects the apoptotic effect of LPS. Additionally, remarkable reductions in the levels of antioxidants (superoxide dismutase and catalase) and significant increases in malondialdehyde (MDA) levels were recorded in the serum of LPS-treated mothers and in the ovarian tissues of their offspring. Further biochemical analysis of the ovarian tissues from LPS-maternally treated offspring showed a significant increase in the levels of caspase-3, TNF-α, and TGF-β1, but a significant decrease in the level of IGF-1. On the other hand, treatment of mothers with Zn-NPs from day 14 of gestation until the weaning day (21st day postnatal) successfully ameliorated most of the deleterious histopathological, immunohistochemical, and biochemical changes induced by LPS.Graphical abstract

Evaluation of fetal biometric indices for fetal growth restriction diagnosis

BACKGROUND: Fetal Growth Restriction occurs when a fetus does not reach its intrauterine growth potential due to genetic and/or environmental factors; it is associated with increased perinatal mortality and morbidity and also predisposes to the development of chronic disorders in adulthood. The aim of this study was to evaluate the accuracy of the Biometric Indices: Femur Length/Abdominal Circumference (FL/AC); Transverse Cerebellar Diameter/Abdominal Circumference (TCD/AC) and Humerus, Cerebellum, Femur/Abdominal Circumference Equation (HCF/AC); in predicting fetal growth retardation. METHODS: Diagnostic tests validation study, with a universe of pregnant patients who attended the outpatient clinic of Hospital General Machala, El Oro-Ecuador, for prenatal control, between 32 and 38 weeks of gestation. The following variables were obtained: gestational dating; ultrasound fetal biometry of all the necessary parameters for the described indices calculation; fetal weight estimated by ultrasound, with cut-off point ≤ P° 10. The LH/CA and TCD/CA Indices were calculated, with cut-off points for fetal growth retardation diagnosis of ≥ 23.5 and ≥16.1 respectively. The index proposed by the authors HCF/CA was also applied, taking as cut-off point the 90th percentile: ≥ 1.063. RESULTS: The prevalence of fetal weight less P° 10 in the present study was 12.22%. The biometric index with the highest sensitivity was the HCF CA index with 70.3%; however, the highest specificity was obtained for the LF CA index with 84%. The positive predictive value of the DTC CA index was 24.7%, of the LF CA index: 27.9%, and of the HCF CA index: 31.1%. The negative predictive values found were, DTC CA: 93.9%; LF CA: 91.6% and HCF CA: 95.0%. The positive likelihood ratios obtained were: DTC CA: 2.352; LF CA: 2.781 and HCF CA: 3.25. The negative likelihood ratios were, HCF CA: 0.378, DTC CA: 0.465, LF CA: 0.661. CONCLUSION:The biometric indices for prediction of fetal growth retardation have limited positive predictive accuracy. All indices have high negative predictive accuracy. To confirm the presence of condition disease the HCF CA index has better results, as well as to confirm the absence of the condition disease; the addition of the HCF CA Index increases the predictive results; the Odds Rate obtained indicates that there is 8.595 times higher probability of a positive response, when the condition"fetus in percentile ≤ 10" is present.

Assessment of Thyroid Dysfunction During Different Trimester of Pregnancy.

Thyroid dysfunction is frequently seen in pregnant women and is associated with complications like miscarriage, gestational hypertension, placental abruption, pre mature delivery and fetal growth retardation and even causes impaired neuropsychological development of fetus. This study is carried out to assess the prevalence of thyroid disorder during different trimester of pregnancy. Serum samples were collected from 124pregnant women attending Patan Academy of Health Science for ante natal visit. Free thyroxine free triiodothyronine and thyroid stimulating hormone were performed by chemiluminescent assay. Out of 124 pregnant women, euthyroidism was seen in 79% (n =98) followed by subclinical hypothyroidism (10%, n=13) and primary hypothyroidism (8%, n=10). Subclinical hyperthyroidism and primary hyperthyroidism accounts for 1% (n=1), and 2% (n=2) respectively. Although, thyroid disorder was found to be more prevalent in third trimester (38.4%, n=10) but the distribution in first and second trimester (34.6%, n= 9, 27%, n= 7 respectively) were also significant. Mean fT3 and fT4 level were found to be negatively correlated with trimester (r=-0.19, p=0.027 and r=-0.29, p=0.001 respectively) whereas positive correlation of trimester was seen with TSH (r=0.08, p=0.35). Hypothyroidism is more common in pregnant women visiting tertiary care hospital. Different complication can be minimized if diagnosis is done early.

Expression profile of plasma microRNAs and target genes in patients with complicated pregnancy

Aim: to assess features of placental transcriptome in patients with complicated pregnancy course and outcome.Materials and Methods. A prospective observational comparative study in parallel groups was carried out by examining 44 patients divided into three groups: group 1 included 13 pregnant women with moderate and severe preeclampsia (PE), group 2 consisted of 12 patients with fetal growth retardation (FGR), control group included 19 clinically healthy women with uncomplicated pregnancy and delivery. All women enrolled to the study underwent a comprehensive examination, including history collection, general and obstetric-gynecological examination, laboratory and instrumental studies. Special research methods were used during the study, which included placental tissue sampling followed by analyzed expression profile of 12 microRNAs using real-time polymerase chain reaction (PCR).Results. The PCR data indicated about lack of expression for analyzed miR-210-3p, miR-320-3p, miR-1304-5p and miR-375-5p in placental tissue samples in FGR patients. No significant differences in placental miRNA levels were observed in FGR vs. PE and control group. Analysis of placenta-specific microRNAs in women with PE vs. control group showed a significantly down modulated expression level for miR-517a-3p (p = 0.025), miR-517c-3p (p = 0.036), miR-574-5p (p = 0.015) along with upregulated expression of miR-20a-5p (p = 0.046).Conclusion. The data obtained evidence that pregnancy-related complications are characterized by specific molecular changes at placental transcriptome level.