Risk Of Intrauterine Growth Restriction Research Articles

Neonatal Anthropometric Measurements: A Comparison of Neonates With 3-T Fetal MRI Exposure, With 1.5-T Fetal MRI Exposure, and Without In-Utero MRI Exposure.

Background: Fetal MRI is increasingly performed at 3 T. Nonetheless, safety concerns persist regarding potential increased risk of intrauterine growth restriction from in-utero 3-T MRI exposure. Objective: To compare neonatal anthropometric measurements between newborns who underwent 3-T fetal MRI, newborns who underwent 1.5-T fetal MRI, and newborns without in utero MRI exposure. Methods: This single-center retrospective study included gravid patients who underwent fetal ultrasound and possible 1.5-T or 3-T fetal MRI within 10 days from January 2017 to January 2022. For each included patient who also underwent 3-T fetal MRI, one matched patient who also underwent 1.5-T MRI and two matched patients without in-utero MRI exposure, were randomly selected. Matching was based on gestational age per the fetal ultrasound. Neonatal anthropometric characteristics were compared among groups. Results: The final sample included 416 patients (mean age, 32±5 years), 104 in the 3-T MRI group, 104 in the 1.5-T MRI group, and 208 in the MRI-unexposed group. Mean gestational age at the time of fetal ultrasound used for matching was 27 weeks 2 days in the 3-T group, 25 weeks 2 days in the 1.5-T group, and 26 weeks 0 days in the MRI-unexposed group (p=.07). The distribution of indications for fetal MRI was not significantly different between the 3-T and 1.5-T groups (p=.62). Mean gestational age at delivery was 37 weeks 5 days in the 3-T group, 38 weeks 0 day in the 1.5-T group, and 38 weeks 2 days in the unexposed group (p=.51). No significant difference (p=.09) was observed among groups in mean neonatal weight (3-T: 3120±753 g; 1.5-T: 3104±704 g; unexposed: 2967±614 g); neonatal weight percentile (3-T: 45±27; 1.5-T: 42±26; MRI: 41±24); neonatal head circumference (3-T: 34±3 cm; 1.5-T: 34±3 cm; unexposed: 34±2 cm), or neonatal head circumference percentile (3-T: 48±29; 1.5-T: 42±23; unexposed: 43±30). Conclusion: There were no significant differences in neonatal anthropometric measurements among newborns who underwent in-utero 3-T MRI, newborns who underwent in-utero 1.5-T MRI, and newborns without in-utero MRI exposure. Clinical Impact: The results support the safety of 3-T MRI with respect to growth of the developing fetus.

The impact of obesity surgery on newborn anthropometrics in women with and without polycystic ovary syndrome

PurposeObesity surgery and polycystic ovary syndrome (PCOS) are both associated with increased risk of intrauterine growth restriction. We investigated whether offspring of mothers with PCOS who underwent obesity surgery had an increased risk of deviating birth anthropometrics compared to offspring of mothers without PCOS.MethodsIn this observational study, data from two study databases (BAROBS and PregMet2) were supplemented with data from patient’s records from secondary and tertiary hospitals. In total, 162 offspring born to mothers with PCOS (n = 48) and without PCOS (n = 114) were included. Forty-nine offspring were born prior to, and 113 after obesity surgery.ResultsMean ± SD birthweight (BW), birth length (BL), and head circumference (HC) before and after surgery for offspring born to mothers with PCOS were 3987 ± 495 g vs 3396 ± 526 g (P = 0.001), 52.2 ± 1.6 cm vs 50.1 ± 2.2 cm (P = 0.010), and 36.3 ± 1.97 cm vs 35.3 ± 1.66 cm (P = 0.183), respectively. In the non-PCOS group BW, BL and HC before and after were 3859 ± 603 g vs 3490 ± 538 g (P = 0.001), 51.3 ± 2.0 cm vs 49.9 ± 2.5 cm (P = 0.013), and 36.4 ± 2.0 cm vs 35.3 ± 1.8 cm (P = 0.016), respectively. Post-surgery, we found no difference in z-score BW, (∆–0.08, P = 0.677), BL (∆0.21, P = 0.184), and HC (∆0.14, P = 0.476) between children of PCOS and non-PCOS mothers.ComclusionBabies born after obesity surgery were smaller and shorter in both the PCOS and non-PCOS group. Post-surgery anthropometrics were similar in babies born to mothers with and without PCOS.

Review of meta-analyses on the use of artificial intelligence in radiology

Introduction. Artificial intelligence (AI) is an effective tool for automating routine tasks in radiology. The diagnostic accuracy of AI in detecting various pathologies on medical images has generated considerable interest in the scientific community: the number of studies and meta-analyses has been constantly growing. The abundance of published evidence and the diversity of outcomes necessitate the need to systematize the available publications. The aim of this paper is to conduct an umbrella systematic review of contemporary meta-analyses on the use of AI in radiology.Materials and methods. PubMed was searched for studies published in the English language. Thirty-eight systematic reviews with meta-analyses published between 2021 and 2023 were selected for full-text analysis. The extracted data included the goal, study design, imaging modality, sample size, quality assessment of the included studies, AI diagnostic accuracy estimates, reference method parameters, and clinical efficacy metrics of AI implementation. The methodological quality of included systematic reviews was assessed using the AMSTAR-2 tool.Results. Nearly half (47%) of the included meta-analyses focused on the diagnosis, staging and segmentation of malignancies. Four meta-analyses were related to detection of maxillofacial structures in dentistry, while another four meta-analyses addressed the diagnosis of brain lesions. The diagnosis of COVID-19 and the diagnosis of bone fractures were each covered in three meta-analyses. One meta-analysis was reviewed for each of the following fields: colorectal polyps, pneumothorax, pulmonary embolism, osteoporosis, aneurysms, multiple sclerosis, acute cerebrovascular accident, intracranial hemorrhage, burns, and the risk of intrauterine growth restriction. Thirty-five (92%) meta-analyses assessed the risk of bias. Twenty-eight (80%) meta-analyses utilized QUADAS-2 to assess the risk of bias. 14 out of 28 papers reported low risk of bias (50%); 4 (14%) – moderate; 10 (36%) – high. The major risks were associated with samples that were unbalanced in terms of size and composition, a lack of details about the methods, a low number of prospective studies, and a lack of external validation of the outcomes. The overall results indicate that the diagnostic accuracy of AI is comparable to or even greater than that of radiologists. The mean sensitivity, specificity and area under the ROC curve for AI and radiologists were 85.2%, 89.5%, 93.5% and 84.4%, 90.0%, 92.8%, respectively. However, many studies that compared the diagnostic accuracy of AI and radiologists lack the data on the number and experience of the latter. Only one paper presented results of implementing AI into routine clinical diagnosis.Discussion. AI is capable of reducing the turnaround time for non-urgent examinations. When used to verify the primary interpretation, AI was effective in detecting false-negative results from radiologists. However, the efficacy of detecting false-positive results was inadequate. Our assessment of the quality of systematic reviews with AMSTAR-2 show that the methods of searching, selecting and analyzing literature must be improved and brought to a common standard. The development of a specialized tool for assessing the quality of systematic reviews in the AI implementation is also necessary. Due to high diagnostic accuracy, AI is currently considered a promising tool for optimizing the turnaround time. However, more evidence is needed to study the AI outcomes in routine clinical practice. Furthermore, it is necessary to standardize and improve the quality of research methodology.

Serum Ferritin Level as a Predictor for Intra Uterine Growth Restriction

Background: Maternal serum ferritin is being explored as a potential predictor for Intrauterine Growth Restriction (IUGR). Early detection of IUGR is crucial for improving perinatal outcomes and reducing associated mortality and morbidity. Objective: To evaluate the role of elevated maternal serum ferritin in predicting the risk of developing IUGR. Patients and Methods: A prospective case-control study was conducted at Al-Batool Teaching Hospital, Diyala, involving 51 pregnant women divided into two groups based on pregnancy status. Demographic data, obstetric history, and risk factors for IUGR were collected through a questionnaire, and blood samples were taken to measure hemoglobin and serum ferritin levels. Results: The study found that the mean serum ferritin level was significantly higher in the patient group (209.89±50.95 ng/ml) compared to the control group (66.91±37.49 ng/ml), with a p-value of <0.001. The mean birth weight was significantly lower in the patient group (1873.81±425.62 g) compared to the control group (3078.67±415.56 g), also with a p-value of <0.001. There were no significant differences in age and hemoglobin levels between the two groups. Conclusion: Elevated maternal serum ferritin levels may suggest an increased risk of IUGR, emphasizing the need for further research to validate its role as a predictive marker.

Serum Ferritin Level as a Predictor for Intra Uterine Growth Restriction

Background: Maternal serum ferritin is being explored as a potential predictor for Intrauterine Growth Restriction (IUGR). Early detection of IUGR is crucial for improving perinatal outcomes and reducing associated mortality and morbidity. Objective: To evaluate the role of elevated maternal serum ferritin in predicting the risk of developing IUGR. Patients and Methods: A prospective case-control study was conducted at Al-Batool Teaching Hospital, Diyala, involving 51 pregnant women divided into two groups based on pregnancy status. Demographic data, obstetric history, and risk factors for IUGR were collected through a questionnaire, and blood samples were taken to measure hemoglobin and serum ferritin levels. Results: The study found that the mean serum ferritin level was significantly higher in the patient group (209.89±50.95 ng/ml) compared to the control group (66.91±37.49 ng/ml), with a p-value of <0.001. The mean birth weight was significantly lower in the patient group (1873.81±425.62 g) compared to the control group (3078.67±415.56 g), also with a p-value of <0.001. There were no significant differences in age and hemoglobin levels between the two groups. Conclusion: Elevated maternal serum ferritin levels may suggest an increased risk of IUGR, emphasizing the need for further research to validate its role as a predictive marker. Keywords: Intrauterine Growth Restriction (IUGR), Serum Ferritin, Pregnancy, Predictive Marker, Perinatal Outcomes.

Relationship between increased maternal serum free human chorionic gonadotropin levels in the second trimester and adverse pregnancy outcomes: a retrospective cohort study

BackgroundA retrospective cohort study was conducted to collect the data of pregnant women who received hospital delivery in Hangzhou Women's Hospital from January 2018 to December 2020, and who participated in the second trimester (15–20+6 weeks) of free beta human chorionic gonadotropin (free β-hCG). And the study was conducted to explore the relationship between maternal serum free β-hCG and adverse pregnancy outcomes (APO).MethodsWe retrospectively analyzed the clinical data of 1,978 women in the elevated maternal serum free β-hCG group (free β-hCG ≥ 2.50 multiples of the median, MoM) and 20,767 women in the normal group (0.25 MoM ≤ free β-hCG < 2.50 MoM) from a total of 22,745 singleton pregnancies, and modified Poisson regression analysis was used to calculate risk ratios (RRs) and 95% confidence intervals (CI) of the two groups.ResultsThe gravidity and parity in the elevated free β-hCG group were lower, and the differences between the groups were statistically significant (all, P < 0.05). The risks of polyhydramnios, preeclampsia, and hyperlipidemia, were increased in women with elevated free β-hCG levels (RRs: 1.996, 95% CI: 1.322–3.014; 1.469, 95% CI: 1.130–1.911 and 1.257, 95% CI: 1.029–1.535, respectively, all P < 0.05), intrauterine growth restriction (IUGR) and female infants were also likely to happen (RRs = 1.641, 95% CI: 1.103–2.443 and 1.101, 95% CI: 1.011–1.198, both P < 0.05). Additionally, there was an association between elevated AFP and free β-hCG levels in second-trimester (RR = 1.211, 95% CI: 1.121–1.307, P < 0.001).ConclusionsAPOs, such as polyhydramnios, preeclampsia, and hyperlipidemia, were increased risks of elevated free β-hCG levels, IUGR and female infants were also likely to happen. Furthermore, there was an association between elevated AFP levels and elevated free β-hCG levels in second-trimester. We recommend prenatal monitoring according to the elevated maternal serum free β-hCG level and the occurrence of APO.

Respiratory syncytial virus vaccination during pregnancy for improving infant outcomes.

Respiratory syncytial virus vaccination during pregnancy for improving infant outcomes.

Decreased Sonographic Head Circumference Is Found in Buprenorphine-Exposed Fetuses [ID 2683396

INTRODUCTION: Neonates diagnosed with neonatal opioid withdrawal syndrome (NOWS) have decreased head circumference compared to non-exposed newborns. This is the first study to evaluate fetal head circumference over time in a group of fetuses with intrauterine buprenorphine exposure. METHODS: Fetal anatomic surveys are commonly performed at around 20 weeks of gestation. Patients treated with medication-assisted therapy (MAT) for opioid use disorder commonly receive estimated fetal weight scans at around 32 weeks of gestation due to the risk of intrauterine growth restriction. Retrospective review of ultrasound reports for three groups of patients were performed. Group 1 (75 patients) was low-dose MAT; group 2 (73 patients) was traditional higher-dose MAT. Group 3 (104 patients) was a control group. The IRB approval was 1220.9e-ETSU, entitled “Effect of Maternal Buprenorphine on Fetal Head Circumference.” RESULTS: At the time of the approximately 20-week scan, no statistical difference was found between the groups. At the approximately 32-week growth scan, however, a comparison of the two buprenorphine groups together versus control group showed a statistically significant difference (P=.018) in head circumference. Although the low-dose group had larger head circumferences than the higher-dose group in the 32-week scan, the difference was not significant. CONCLUSION: Previous studies have shown decreased head circumference in newborns in association with maternal MAT. This is the first study to provide ultrasound confirmation of decreased head circumference in fetuses exposed to buprenorphine. Effects are pronounced in the third trimester; the possibility exists that interventions during pregnancy might preserve fetal brain volume. Further research is needed.

Association Between Preconception Maternal Mental Health-Related Hospitalisation (MHrH) and Outcomes During Pregnancy: A Population-Based Cohort Study in the Northern Territory, Australia

AbstractComprehensive studies investigating the link between maternal hospitalisation for mental health conditions prior to pregnancy and adverse outcomes in pregnancy are scarce in Australia. We aimed to fill this gap by using 18 years of administratively linked data to inform early interventions. We linked the perinatal data from the year 1999 to 2017 to the hospital hospitalisation data to create a cohort of pregnant women aged 15 to 44 years who gave birth in the Northern Territory (NT). We used the International Classification of Disease 10th revision (ICD-AM-10) codes to locate women with mental health-related hospitalisation (MHrH) (exposure of interest) and the perinatal data to access pregnancy outcomes. We used the modified Poisson regression with robust standard error to estimate the risk of pregnancy outcomes associated with maternal MHrH in the 5 years prior to pregnancy. We calculated the adjusted population attributable fraction (aPAF) for valid associations. We used the E-value to assess the effect of potential confounding bias. Out of 69,890 pregnancies, ~ 67,518 were eligible and included in the analysis. We found a significant variation in the incidence of substance use and complications between Aboriginal and non-Aboriginal women and women with and without MHrH in the 5 years prior to pregnancy. After adjusting, 5 years of preconception hospitalisation for substance misuse was associated with a 31% (95%CI, 1.05, 1.63) increased risk of Intrauterine Growth Restriction (IUGR), a 60% (CI, 1.37, 1.86) increased risk of smoking and a 2.21 (CI, 1.98, 2.47) times increased risk of drinking during pregnancy in Aboriginal women; and a 17% increased risk of drinking (CI, 1.11, 1.23) in pregnancy in non-Aboriginal women. A significant proportion of smoking (aPAF = 14.7 to 37.4%), alcohol consumption (aPAF = 46.0 to 66.7%), and IUGR (aPAF = 23.6 to 38.5%) are attributed to maternal MHrH 5 years prior to pregnancy. Our findings are a ‘wake-up’ call for strengthening preconception care to reduce adverse outcomes of maternal MHrH prior to pregnancy.

Levels of serum β-human chorionic gonadotropin after embryo transfer and subsequent miscarriage, pre-eclampsia, and intrauterine growth restriction.

This study aimed to examine maternal serum concentration of β-human chorionic gonadotropin(β-hCG) on Day 16 after embryo transfer and risk of miscarriage, pre-eclampsia, and intrauterine growth restriction (IUGR). In this study, we evaluated 125 pregnancies following in vitro fertilization (IVF). β-hCG concentrations were measured on the morning of Day 16 after embryo transfer. Baseline characteristics of the study participants were also recorded. Concentrations of β-hCG on Day 16 after embryo transfer were inversely associated with the higher risk of miscarriage (p < 0.001), but did not with pre-eclampsia and IUGR (p > 0.05). Spearman's correlation coefficient showed a reverse and significant association between β-hCG and higher risk of miscarriage (σ = 0.531andp < 0.001). There was a significant association between frozen embryo transfer and the risk of IUGR and pre-eclampsia (p = 0.005and p = 0.023, respectively). Maternal serum concentrations of β-hCG on Day 16 after IVF/embryo transfer were associated with the higher risk of miscarriage, but not pre-eclampsia and IUGR.

Overt hypothyroidism in pregnancy and language development in offspring: is there an association?

PurposeOvert hypothyroidism during pregnancy is linked to various obstetric complications, such as premature birth and fetal death. While some studies have shown that maternal hypothyroidism can impact a child's Intelligence Quotient (IQ) and language development, findings are controversial. The aim of this study was to explore the connection between treated maternal hypothyroidism during pregnancy and offspring neurodevelopment, focusing on learning and language and examining related maternal obstetric complications.MethodsGroup 1 included 31 hypothyroid women with elevated thyroid stimulating hormone (TSH) (> 10 mU/L, > 10 µIU/mL) during pregnancy, and Group 2 had 21 euthyroid women with normal TSH levels (0.5–2.5 mU/L, 0.5–2.5 µIU/mL). Children underwent neuropsycological assessments using the Griffiths-II scale.ResultsPregnancy outcome showed an average gestational age at delivery of 38.2 weeks for hypothyroid women, compared to 40 weeks for controls, and average birth weight of 2855.6 g versus 3285 g for controls, with hypothyroid women having children with higher intrauterine growth restriction (IUGR) prevalence and more caesarean sections. The 1-min APGAR score was lower for the hypothyroid group's children, at 8.85 versus 9.52. Neuropsychological outcomes showed children of hypothyroid mothers scored lower in neurocognitive development, particularly in the learning and language subscale (subscale C), with a notable correlation between higher maternal TSH levels and lower subscale scores.ConclusionFetuses born to hypothyroid mothers appeared to be at higher risk of IUGR and reduced APGAR score at birth. Neurocognitive development seemed to affect language performance more than the developmental quotient. This alteration appeared to correlate with the severity of hypothyroidism and its duration.

Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

BackgroundThere is a high prevalence of autoimmune conditions in women specially in the reproductive years; thus, the association with adverse pregnancy outcomes has been widely studied. However, few autoimmune conditions/adverse outcomes have been studied more than others, and this umbrella review aims to consolidate existing knowledge in this area with the aim to provide new knowledge and also identify gaps in this research area.MethodsMedline, Embase, and Cochrane databases were searched from inception to December 2023. Screening, data extraction, and quality appraisal (AMSTAR 2) were done by two independent reviewers. Data were synthesised narratively and quantitatively. Relative risks (RR)/odds ratio (OR) with 95% confidence intervals were reported.ResultsThirty-two reviews were included consisting of 709 primary studies. The review reported the association between 12 autoimmune conditions and 16 adverse pregnancy outcomes. Higher risk of miscarriage is reported in women with Sjögren’s syndrome RR 8.85 (95% CI 3.10–25.26) and systemic lupus erythematosus (SLE) OR 4.90 (3.10–7.69). Pre-eclampsia was reported higher in women with type 1 diabetes mellitus (T1DM) OR 4.19 (3.08–5.71) and SLE OR 3.20 (2.54–4.20). Women reported higher risk of diabetes during pregnancy with inflammatory bowel disease (IBD) OR 2.96 (1.47–5.98). There was an increased risk of intrauterine growth restriction in women with systemic sclerosis OR 3.20 (2.21–4.53) and coeliac disease OR 1.71 (1.36–2.14). Preterm birth was associated with T1DM OR 4.36 (3.72–5.12) and SLE OR 2.79 (2.07–3.77). Low birth weight babies were reported in women with women with SLE or systemic sclerosis OR 5.95 (4.54–7.80) and OR 3.80 (2.16–6.56), respectively. There was a higher risk of stillbirth in women with T1DM OR 3.97 (3.44–4.58), IBD OR 1.57 (1.03–2.38), and coeliac disease OR 1.57 (1.17–2.10). T1DM in women was associated with 32% lower odds of small for gestational age baby OR 0.68 (0.56–0.83).ConclusionsPregnant women with autoimmune conditions are at a greater risk of developing adverse pregnancy outcomes. Further research is required to develop better preconception to postnatal care for women with autoimmune conditions.

Study on Types of Umbilical Cord Insertion in Normal and Intrauterine Growth Restriction

Background: Intrauterine growth restriction (IUGR) is said to be in neonates whose birth weight is less thantenth percentile of the average for gestational age. IUGR is associated with short and long-term complicationswhich can severely impact quality of life. Placental size, weight and shape may vary within wide extreme values.Ability to transfer nutrients is related to placental size. Decreased placental surface area and size are associatedwith increased risk of IUGR. Umbilical cord is the key marker for intrauterine complications. It is one of the mostimportant part of fetoplacental unit that transfer vital nutrients to fetus. This current study was taken to find outthe difference in placental morphometric features and to find the correlation between placental and neonatalweight.Materials and methods: This study included 100 samples which were equally divided into cases and controls.Placenta was collected after delivery and the data is measured quantitatively.Results: Central insertion of umbilical cord observed in IUGR in our study was 40%, eccentric was 20%, marginalwas 38%, velamentous insertion was 2% while furcate insertion observed was nil in our study.Conclusion: Central and marginal insertion was prevalent in IUGR in our study. Types of cord insertion plays alsoplays role in transfer of nutrients. Vasculature being the most important factor the growth of fetus, any imbalancein it will alter the growth.

Study of Feto-Maternal Outcome in Pregnancy with Subclinical Hypothyroidism

Background: Hypothyroidism has a great impact on pregnancy. But there is a controversy about the maternal and perinatal outcomes of subclinical hypothyroidism (SCH). This study was placed to know the significant effects. Methods and Materials: A descriptive longitudinal study was held in Z. H. Sikder Women’s Medical College &amp; Hospital, Dhaka, Bangladesh. 400 pregnant women were included in this study with purposive sampling. All antenatal patients from booking visit at 1st trimester to delivery were monitored by serum TSH and serum FT4 levels in each trimester and fetal outcomes were also monitored. 200 pregnant women were diagnosed as subclinical hypothyroidism (SCH) with random screening of initial thyroid function tests. Another 200 pregnant women were euthyroid. The study period was 3 years, from January 2020 to December 2022. To evaluate the thyroid status, maternal serum samples were collected in each trimester, total three times. Maternal outcomes, which we studied, were gestational hypertension, gestational diabetes mellitus, maternal anemia, antepartum hemorrhage, postpartum hemorrhage, placental abruption, preterm delivery, premature rupture of membranes (PROM), caesarean deliveries; perinatal outcomes were low birth weight (LBW), intrauterine growth restriction (IUGR), low Apgar score, stillbirth, congenital anomaly and NICU admission. Result: This study includes 400 pregnant women, among which 200 were euthyroid and 200 were with SCH. The mean age was 27.12 ± 0.05 years in pregnancy with euthyroid group and 26.31 ± 0.25 in pregnancy with SCH group. Among the pregnancy with euthyroid group, 141 women were nullipara and 59 women were nullipara. Among the pregnancy with SCH group, 87 women were nullipara and 113 women were nullipara. Serum TSH level was 4.44 ± 0.11 in 1st trimester, 4.74 ± 0.19 in 2nd trimester, 5.45 ± 0.17 in 3rd trimester. Serum free T4 level was 8.29 ± 0.13 in 1st trimester, 6.65 ± 0.15 in 2nd trimester, 6.67 ± 0.34 in 3rd trimester. In pregnancy with SCH group gestational hypertension, miscarriage, placental abruption and premature rupture of membranes (PROM) were significantly higher (p&lt;0.001). Antepartum hemorrhage (APH), preterm delivery and Caesarian deliveries were also higher in this group (p&lt;0.05). Among the neonatal outcomes, low birth weight and intrauterine growth restriction (IUGR) babies were more born in pregnancy with SCH group. Anti TPO antibody titer was significantly higher in pregnant women with SCH. Conclusion: Subclinical hypothyroidism (SCH) is associated with increased risk of gestational hypertension, premature rupture of membranes (PROM), abruptio placentae and fetuses have more risk of IUGR and LBW. Therefore, routine maternal thyroid function test should be done to protect from adverse maternal and fetal outcome.

Surgical Conservative Management of a Retained Placenta after Angular Pregnancy, a Case Report and Literature Review

Angular pregnancies are rare and difficult to diagnose. Evidence suggests they are associated with a higher risk of intrauterine growth restriction and abnormal third stage of labor due to a retained placenta. The lack of standardized AP diagnostic criteria impacts on their correct identification and makes the treatment of potential complications challenging. We present a case of the successful conservative surgical management of a retained placenta after a term AP also complicated by intrauterine growth restriction. Moreover, to identify the best evidence regarding AP diagnostic criteria and retained placenta therapeutic approaches, we have realized an expert literature review.

Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

BackgroundThe prevalence of autoimmune conditions is two-fold higher in women than in men, especially during the reproductive years. Autoimmune conditions have been associated with a greater risk of adverse pregnancy outcomes, and some conditions have been studied more than others with inconsistent findings. The objective of this umbrella review was to identify, appraise, synthesise, and consolidate findings from published systematic reviews of autoimmune conditions and adverse pregnancy outcomes. MethodsIn this umbrella review, we searched Medline, Embase, and Cochrane databases for systematic reviews from inception to Sept 30, 2022, without language restrictions. We used the Medical Subject Headings and free text search for autoimmune conditions and pregnancy outcomes. Screening, data extraction, and quality appraisal (AMSTAR 2) were done by two independent reviewers. Data was extracted using a standardised form, which was piloted before use. Data were synthesised narratively and quantitatively. Odds ratios (ORs) with 95% CIs were reported. The protocol has been registered to PROSPERO (CRD42022334992). FindingsWe selected 33 reviews, which included 709 primary studies. Pregnant women with autoimmune conditions were at high risk of both adverse maternal and fetal outcomes. The risk of miscarriage was increased in pregnant women with Sjögren's syndrome (relative risk [RR] 8·85, 95% CI 3·10–25·26), systemic lupus erythematosus (SLE; OR 4·90, 95% CI 3·10–7·69), thyroid autoimmunity (OR 2·77, 2·10–3·65), systemic sclerosis (OR 1·60, 1·29–2·22), and coeliac disease (OR 1·38, 1·12–1·69). The risk of pre-eclampsia was increased in pregnant women with type 1 diabetes (T1DM; OR 4·19, 3·08–5·71) and SLE (OR 3·20, 2·54 – 4·20). The risk of gestational diabetes was increased in pregnant women with inflammatory bowel disease (IBD; OR 2·96, 1·47–5·98) and thyroid autoimmunity (OR 1·49, 1·07–2·07). The risk of intrauterine growth restriction (IUGR) was increased in pregnant women with systemic sclerosis (OR 3·20, 2·21–4·53) and coeliac disease (OR 1·71, 1·36–2·14). The risk of delivering a small-for-gestational age baby was increased in pregnant women with SLE (OR 2·49, 1·88–3·31) and rheumatoid arthritis (OR 1·49, 1·22–1·82). The risks of other fetal outcomes such as stillbirth, preterm birth, and low birthweight were also increased in pregnant women with autoimmune disorders. T1DM in women was associated with lower odds of small-for-gestational-age outcome (OR 0·68, 0·56–0·83). InterpretationPregnant women with autoimmune conditions are at greater risk of developing adverse pregnancy outcomes. Further research is required to develop better preconception to post-natal care for women with autoimmune conditions. FundingMedical Research Council (MRC) and the National Institute for Health and Care Research (NIHR).

Four Markers Useful for the Distinction of Intrauterine Growth Restriction in Sheep.

Intrauterine growth restriction (IUGR) is a common perinatal complication in animal reproduction, with long-lasting negative effects on neonates and postnatal animals, which seriously negatively affects livestock production. In this study, we aimed to identify potential genes associated with the diagnosis of IUGR through bioinformatics analysis. Based on the 73 differentially expressed related genes obtained by differential analysis and weighted gene co-expression network analysis, we used three machine learning algorithms to identify 4 IUGR-related hub genes (IUGR-HGs), namely, ADAM9, CRYL1, NDP52, and SERPINA7, whose ROC curves showed that they are a good diagnostic target for IUGR. Next, we identified two molecular subtypes of IUGR through consensus clustering analysis and constructed a gene scoring system based on the IUGR-HGs. The results showed that the IUGR score was positively correlated with the risk of IUGR. The AUC value of IUGR scoring accuracy was 0.970. Finally, we constructed a new artificial neural network model based on the four IUGR-HGs to diagnose sheep IUGR, and its accuracy reached 0.956. In conclusion, the IUGR-HGs we identified provide new potential molecular markers and models for the diagnosis of IUGR in sheep; they can better diagnose whether sheep have IUGR. The present findings provide new perspectives on the diagnosis of IUGR.

Syncope in pregnancy, immediate pregnancy outcomes, and offspring long-term neurologic health

There are limited data regarding the perinatal consequences of maternal syncope during pregnancy, and even less is known about the potential long-term effect on offspring health. This study aimed to examine perinatal outcomes as well as long-term offspring neurologic morbidity associated with prenatal maternal syncope, and the possible differential effect by trimester of first syncope episode. A retrospective cohort study was conducted, including all singleton deliveries occurring between 1991 and 2021 at a large tertiary medical center. Multivariable analyses were applied to study the associations between prenatal maternal syncope and various perinatal outcomes as well as offspring neurologic morbidity up to the age of 18 years, while adjusting for clinically relevant factors. Analyses were further conducted by trimester of first syncope episode. The study population included 232,475 pregnancies, 774 (0.3%) were affected by maternal syncope, which most frequently first occurred during the second trimester (44.5%), followed by the first trimester (31.8%) and finally the third trimester (27.7%). Maternal syncope was independently associated with increased risk for intrauterine growth restriction (adjusted odds ratio, 1.52; 95% confidence interval, 1.01-2.29), which appeared to be mainly driven by first trimester syncope occurrence; as well as with increased risk for cesarean delivery (adjusted odds ratio, 1.33; 95% confidence interval, 1.10-1.61), and for long-term offspring neurologic morbidity (adjusted hazard ratio, 1.79; 95% confidence interval, 1.65-2.08), regardless of the trimester of syncope occurrence. Prenatal maternal syncope is an independent risk factor for intrauterine growth restriction, cesarean delivery, and for long-term offspring neurologic morbidity.

Association between prenatal exposure to perfluoroalkyl substance mixtures and intrauterine growth restriction risk: A large, nested case–control study in Guangxi, China

Intrauterine growth restriction (IUGR) is an abnormal fetal growth pattern that can lead to neonatal morbidity and mortality. IUGR may be affected by prenatal exposure to environmental pollutants, including perfluoroalkyl substances (PFASs). However, research linking PFAS exposure to IUGR is limited, with inconsistent results. We aimed to investigate the association between PFAS exposure and IUGR by using nested casecontrol study based on Guangxi Zhuang Birth Cohort (GZBC), in Guangxi, China. A total of 200 IUGR cases and 600 controls were enrolled in this study. The maternal serum concentrations of nine PFASs were measured using ultrahigh-performance liquid chromatography-tandem mass spectrometry (UPLCMS). The associations single and mixed effects of prenatal PFAS exposure on IUGR risk were assessed using conditional logistic regression (single-exposure), Bayesian kernel machine regression (BKMR) and quantile g-computation (qgcomp) models. In the conditional logistic regression models, the log10-transformed concentrations of perfluoroheptanoic acid (PFHpA, adjusted OR: 4.41, 95% CI: 3.03–6.41), perfluorododecanoic acid (PFDoA, adjusted OR: 1.94, 95% CI: 1.14–3.32), and perfluorohexanesulfonate (PFHxS, adjusted OR: 1.83, 95% CI: 1.15–2.91) were positively associated with risk of IUGR. In the BKMR models, the combined effect of PFASs was positively associated with IUGR risk. In the qgcomp models, we also found an increased IUGR risk (OR=5.92, 95% CI: 2.33–15.06) when all nine PFASs increased by one tertile as a whole, and PFHpA (43.9%) contributed the largest positive weights. These findings suggested prenatal exposure to single and mixtures of PFASs may increase IUGR risk, with the effect being largely driven by the PFHpA concentration.

O-050 The impact of embryo biopsy on obstetric and neonatal outcomes

Abstract Background Preimplantation genetic testing of embryos (PGT) was performed first in 1990 to prevent the transmission of X-linked disease. Since then, the technique has improved to include couples who are both carriers of the same autosomal recessive disorder, to those with balanced translocations having recurrent pregnancy loss, and to women with advanced maternal age who are at higher risk for having aneuploid embryos. Originally, PGT involved biopsy of the polar body or of one blastomere of a cleavage stage embryo for diagnosis. The contemporary practice of PGT involves the culture of embryos to the blastocyst stage (5-7 days after fertilization), with biopsy of several trophectoderm cells that would become the placenta, transport of biopsy tissue off-site for genetic analysis, and cryopreservation of blastocysts until biopsy results are available. A single euploid embryo is then transferred into the uterus as a frozen embryo transfer. Objective We sought to determine if removal of these cells for preimplantation genetic testing was associated with adverse obstetrical or neonatal outcomes after frozen-thawed single embryo transfer compared to frozen-thawed single embryo transfer without biopsy. Further, we review other studies of contemporary practice of PGT to draw conclusions about the safety of the practice. Study design We linked assisted reproductive technology surveillance data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System to birth certificates and maternal and neonatal hospitalization discharge diagnoses in Massachusetts, USA, from 2014-2017, considering singleton births after frozen-thawed single embryo transfer. We compared outcomes of cycles having embryo biopsy (n = 585) to those having no biopsy (n = 2,191), adjusting for mother’s age, race, education, parity, body mass index, birth year, insurance, and all infertility diagnoses (Sites CK et al, Am J Obstet Gynecol 2021;225:285.e1-7). Results With no biopsy used as the reference, we found no differences between no biopsy and biopsy groups with respect to preeclampsia, pregnancy-induced hypertension, placental disorders (placental abruption, placenta previa, placenta accreta, placenta increta, and placenta percreta), preterm birth, low birthweight, cesarean delivery, gestational diabetes mellitus, or maternal or infant length of stay after delivery. Comparing our outcomes to 4 other studies of contemporary PGT practice of frozen-thawed embryo transfers (Zhang WY Fertil Steril 2019, Li M Am J Obstet Gynecol 2020, Makhijani R Hum Reprod 2021, He H Fertil Steril 2019), our data are consistent with no effect of biopsy on low birth weight, pregnancy-induced hypertension, gestational diabetes, placenta previa, and placenta accreta. A slight decrease in preterm delivery (RR 1.10, CI 1.02-1.18), slight reduction in cesarean section (RR 0.90, CI 0.82-0.99), and increase in intrauterine growth restriction (RR 1.21, CI 1.06-1.38) are reported with biopsy in a systematic review (Hou W, Fertil Steril 2021). The increase in risk for intrauterine growth restriction with biopsy was influenced by one study (Li M Am J Obstet Gynecol 2020). Conclusion Embryo biopsy of trophectoderm cells for PGT in contemporary practice appears to be safe generally with respect to maternal and neonatal outcomes. There is no clear increase in diagnoses related to placentation (preeclampsia, pregnancy-induced hypertension, placental disorders, preterm birth, low birthweight), cesarean delivery, gestational diabetes mellitus, or maternal or infant length of stay after delivery. Further study of a possible increase in intrauterine growth restriction with biopsy is indicated.