Routine Antenatal Examination Research Articles

Evaluating fetal lung development at various gestational weeks using two-dimensional shear wave elastography.

Noninvasive evaluation of fetal lung development is a critical area of study. Two-dimensional shear-wave elastography (2D-SWE) provides valuable insights into tissue stiffness, potentially correlating with different stages of lung development. This study aims to explore the potential of the 2D-SWE technique for assessing the maturity of fetal lung development. This prospective cohort study included pregnant women undergoing routine antenatal ultrasound examinations at the Second Affiliated Hospital of Fujian Medical University and Quanzhou Women's and Children's Hospital from September 2022 to September 2023. The study consecutively recruited 300 pregnant women with normal pregnancies and 15 who opted for induced labor. Among those with normal pregnancies, the study assessed the differences in fetal pulmonary and hepatic elasticity measurements across different gestational weeks (GW) using one-way analysis of variance (ANOVA). Furthermore, regression analyses using linear, quadratic, and cubic equations were conducted to investigate the relationship between fetal parameters and GW. For those who opted for induced labor, elasticity measurements were taken before induction, and fetal lung tissue specimens were collected for post-induction observation. Fetal lung and liver elasticity values, along with the lung-to-liver elasticity ratio (LLE ratio), showed significant variations across different GW (P<0.05). Specifically, fetal lung elasticity values initially increased and then decreased as GW advanced (R2=0.41). Liver elasticity values continuously increased throughout GW, though the rate of increase diminished during the prenatal period (R2=0.37). The LLE ratio values increased and then decreased over GW, fluctuating overall between 0.8 and 0.9 (R2=0.14). A 71.4% concordance was observed between the predicted stage of lung development, based on lung elasticity values, and the histological stage of lung development in the induced fetuses. 2D-SWE can depict the maturation of fetal lung development at various stages.

Fetal weight estimation before delivery: comparison of ultrasound and Dare`s clinical assessment

Fetal weight assessment is a standardized component of both prenatal care and labor management. In addition, it is important for managing high-risk pregnancies and monitoring fetal growth. During childbirth it is important to accurately determine the weight of the fetus. Assessment of fetal weight has been included in the standard routine antenatal examination performed in high-risk pregnancies and deliveries for the past ten years.Scientific publications present data on the accuracy of fetal weight assessment methods based on ultrasound and clinical examinations, known as the Dare’s method.The objective: to compare the accuracy of fetal weight determination using ultrasound examination and the Dare’s fetal weight maneuver in developing countries and peripheral centers.Materials and methods. A cross-sectional comparative study was conducted at the Mosul obstetric hospital and outpatient clinic from March 2020 to January 2022. The study included 340 pregnant women with a gestational age of 35–42 weeks.All included pregnant women were over 18 years of age and expected to give birth in 7 days. Fetal weight was assessed using ultrasonography examination and the clinical Dare’s method. Both results were compared with the actual weight of the infant after birth.Results. All participants underwent Dare’s clinical examination and ultrasound examination, and their predicted fetal weight was compared with actual fetal weight. The mean value and standard deviation of the estimated fetal weight was 3154.22±552.31 g when assessed by the Dare’s method and 3238.76±495.28 g – by ultrasound examination, and the actual average birth weight of the infants was 3114.44± 582.59 g (P=0.07).Conclusions. The results of the study indicate that in conditions of lack of access to ultrasound examination for the purpose of assessing the weight of the fetus in medical institutions, the Dare’s method is acceptable.

Analysis of factors associated with the umbilical cord pitch value by ultrasound measurement in late pregnancy

BackgroundThis study aimed to investigate the factors associated with the antenatal umbilical cord pitch value by ultrasound measurement in late pregnancy. We investigated the factors associated with the umbilical cord pitch value under prenatal ultrasound measurement.MethodsThis study included 528 pregnant women who underwent routine antenatal ultrasound examinations in Ningbo Women and Children’s Hospital from December 2020 to August 2021. Their umbilical cord pitch values and diameter, Wharton’s jelly thickness, amniotic fluid indexes, umbilical artery blood flow parameters, and other relevant data, such as ages and gestational ages, were measured. Information about delivery methods, placenta, umbilical cord, and neonatal weight were recorded during follow-up. Statistical analysis was performed on the above data, and the factors associated with the pitch values were analyzed by linear regression.ResultsThis study revealed that cord torsion (p < 0.001, 95% confidence interval [CI]=-34.81 to -19.01), cord entanglement (p < 0.001, 95% CI = 10.71 to 20.11), thickening of Wharton’s jelly (p = 0.001, 95% CI = 5.39 to 20.24), and cord edema (p = 0.015, 95%CI = 2.09 to 19.44), gestational age (p = 0.024, 95%CI = 0.14 to 1.89), age of pregnant woman (p = 0.009, 95%CI= -1.15 to -0.16), and neonatal weight (p = 0.011, 95%CI = 0.002 to 0.012) were significantly correlated with the pitch values.ConclusionThe umbilical cord pitch value significantly correlated with cord entanglement, cord torsion, cord edema, Wharton’s jelly thickening, gestational age, age of the pregnant woman, and neonatal weight. Notably, the pitch value by prenatal ultrasound measurement is predictive of cord morphological abnormalities such as cord entanglement, cord torsion, cord edema, and Wharton’s jelly thickening.

Prenatal screening and diagnosis of pulmonary artery anomalies.

Congenital pulmonary artery anomalies are rare. Their antenatal diagnosis requires good knowledge of fetal cardiac anatomy because their clinical presentation varies depending on the type and severity of the underlying lesion. Screening of these vascular anomalies can be straightforward in some cases because of significant associated consequences that are detected easily on ultrasound, while other anomalies have considerably less obvious features. There may be an associated genetic syndrome. The aim of this review was to define anomalies of the main pulmonary artery and its branches and to propose, through the identification of suspicious findings during routine antenatal heart examination, an optimal screening method for the pulmonary artery pathway. We propose that pulmonary artery anomalies can be classified antenatally into four types of disorder. Herein we describe 14 cases subgrouped accordingly as: anomalies of the pulmonary valvular region, with stenosis or atresia of the valve (n = 4); conotruncal abnormalities (n = 4); anomalies associated with abnormal origin or course of the pulmonary artery (n = 4); and anomalies associated with abnormal growth of the pulmonary artery and its branches (n = 2). We highlight the need to differentiate the three-vessel view from the three-vessel-and-trachea view when assessing a fetus with a congenital pulmonary artery anomaly. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Fibrinogen to albumin ratio, a novel serum indicator for evaluating the severity of preeclampsia: A single-center retrospective study.

Preeclampsia (PE) is a disorder that affects approximately 5% to 10% of pregnant women. Timely and accurate identification of PE and assessment of its severity are crucial. Therefore, it is necessary to develop predictive indicators which are easily measured in routine antenatal examinations to enable the early detection of PE and assess its severity. We designed a single-center retrospective study in our daily work to assess whether the serum levels of fibrinogen to albumin ratio (FAR), fibrinogen (Fib), albumin (ALB), prothrombin time, calcium (Ca), activated partial thrombin time, creatinine (Cr), D-dimer(D-D), platelet, white blood cell, neutrophil, and lymphocyte counts could help in assessing PE and evaluating its severity. Our findings showed that the serum levels of FAR, Cr, Fib, and D-D were significantly higher in the severe preeclampsia group (sPE) compared with the control and mild preeclampsia groups, whereas the levels of ALB and Ca were significantly lower in sPE patients. In addition, no differences were found between the control and PE groups in terms of prothrombin time, activated partial thrombin time, platelet, white blood cell, neutrophils, and lymphocytes counts. Furthermore, FAR is a novel and better indicator for evaluating the severity of PE, which has not been reported before. And it is an independent risk factor for the development of sPE. In conclusion, the serum levels of FAR, Cr, D-D and Fib were positively correlated with PE, whereas ALB and Ca were negatively correlated with PE severity, which might be valuable in evaluating the severity of PE. FAR proved to be a feasible diagnostic marker for sPE with sensitivity and specificity comparable to those of ALB and Fib.

Preeclampsia Screening Method Using MAP and ROT in Third Trimester Pregnant Women

Preeclampsia can contribute to a direct impact on the mother and fetus. Various problems that can threaten the life of a mother with preeclampsia. There is a need for routine antenatal care assistance and examinations by conducting Mean Artery Pressure (MAP) and Roll Over Test (ROT) examinations.&#x0D; The aim of this study was to identify two screening methods which one was more effective in detecting preeclampsia so that initial treatment of mothers with abnormally elevated blood pressure could minimize complications that might occur.&#x0D; Methods: The study was the prevalence ratio with cross sectional approach by assessing the association between Mean Artery Pressure and Roll Over Test as a preeclampsia screening method. The population were 62 respondents. The sample of 54 respondents were obtained in this study with accidental sampling technique. The instrument used an observation sheet. Univariate analysis was used for identifying frequency distribution and bivariate analysis with chi square test.&#x0D; Results: Less than half of preeclampsia screening with the MAP method in third trimester pregnant women with a positive result of 40.7%. Less than half of preeclampsia screening with the ROT method in third trimester pregnant women with a positive result of 38.9%. Less than half of third trimester pregnant women experience preeclampsia by 25.9%. There was a relationship between the MAP screening method and a p-value of 0.001 (&lt;0.05) and a prevalence ratio of 2.022. There was a relationship between the ROT screening method and a p-value of 0.004 (&lt;0.05) and a prevalence ratio of 1.152. The most influential screening method in detecting preeclampsia was the MAP method with an RR value of 11.694, meaning that the MAP method was 11.694 greater in detecting preeclampsia, while the ROT method was 5.067 in detecting preeclampsia.&#x0D; Conclusion: The most influential screening method in detecting preeclampsia was the MAP method

O-198 Fecundity – a marker of health and survival?

Abstract Study question Fecundity (the ability to conceive) may be declining in many high income countries. Does long time to pregnancy reflect a worse of health condition and survival potential in couples? Summary answer We find that time to pregnancy as a marker of fecundity to be a strong maker of both health and survival in couples. What is known already Women have postponed their childbearing with an increased risk of infertility with age and many young men have a low semen quality. The effect of reduced fecundity on the societal level is obvious; a contribution to the reduced fertility in the Western world. The health consequences for the individuals suffering from reduced fecundity themselves have been studied to a less extend and mostly for males. Most of the research done within the research area have been based on produced offspring. One intrinsic and less explored question is how the ability to conceive influence health and survival in the affected couples. Study design, size, duration We performed a registry-based cohort study on 18,359 mothers and fathers with information on time to pregnancy. The mothers in the study population were first time mothers who attended prophylactic antenatal care between 1977 and 1987 at the department of Gynecology and Obstetrics at Odense University Hospital, Denmark. The study participants were followed up for survival and hospitalizations until 2018. Participants/materials, setting, methods Information on reproduction (including TTP), medical, occupational, and lifestyle histories was collected as a part of the first routine antenatal examination. Nationwide registries were used for gathering more information: Biological fathers were identified in the Danish Medical Birth Registry, total and causes of death was retrieved from the Danish Causes of Death Registry, information on dates of migrations from the Danish Population Registry, and hospitalizations from the Danish Hospital Discharge Registry. Main results and the role of chance We find a strong association between time to pregnancy and survival. Mothers with more than 12 months waiting time to pregnancy had an adjusted higher instant risk of dying compared to mothers with less than 12 months of waiting time to pregnancy (HR: 1.3, 95%CI: 1.1-1.5). Similar results were found for fathers (HR:1.2, 95%CI: 1.1-1.3). A clear dose-response association between time to pregnancy and survival in mothers and fathers was found. E.g. more than 60 months of waiting-time to pregnancy resulted in HR: 2.0, 95%CI 1.6-2.6 (mothers) and HR: 2.4, 95%CI:2.0-2.8 (fathers). No specific causes of death explained the overall increased mortality as increased risks was observed for nearly all causes. Time to first hospitalization was shorter for both fathers and mothers with long time to pregnancy (e.g HR: 1.32 , 95% CI: 1.16-1.51 for mothers with more than 60 months of waiting time to pregnancy) and a clear dose-respond effect was observed (p-trend&amp;lt;0.001). No specific disease groups explained the overall higher hospitalization risk for persons with long waiting time to pregnancy as increased risks was observed for nearly all disease groups. Limitations, reasons for caution The study is comprised of couples conceiving a child and thus leave out those who fails. Thus, the found association between time to pregnancy and health and survival can only be inferred for mothers and fathers. We adjust for social-conditions, lifestyle and demographics but there may still be unknown confounders. Wider implications of the findings Our results suggest fecundity measured as time to pregnancy as an important marker of health and survival and may be a signal of increased environmental influence om reproductive and individual health. Trial registration number not applicable

The China birth cohort study (CBCS)

The China birth cohort study (CBCS) is a prospective longitudinal, mega-cohort study and the first national-based birth cohort study, aiming to establish a birth cohort covering representative geographical areas of the whole of China to investigate risk factors for birth defects and develop strategies for their reduction. Pregnant women who are of Chinese nationality, are 6–13+6 weeks of gestation, plan to attend the routine antenatal examination and deliver in the study site, and give their informed, written consent are eligible to participate in this study. All participants are followed-up through an in-person interview at 20–23+6 weeks and again at 28–33+6 weeks of gestation, and at delivery, respectively. CBCS has been divided into three phases from 20th November 2017 to 31st December 2021, and the first two phases have now been completed on 29th February 2020, enrolling 120 377 eligible pregnant women during this period. During the same period a total of 40 837 participants had been followed up to the end of pregnancy. Study recruitment will continue until December 2021 to achieve the target of 500 000 participants. Meanwhile, biological samples including peripheral blood, amniocytes, cord blood, placenta, or umbilical cord tissue have been collected from participants according to various conditions. The incidence of birth defects in this group is 2.5% and congenital heart disease is the most common type of birth defect seen so far. A website is in the advanced stages of planning, to allow seamless data transfer and facilitate collaboration with groups around the world.

Comparative Analysis to Assess Pregnancy Related Issues among Women over 35 Years of Age

Background and Aim: Advanced maternal age (AMA) is seen by patients and healthcare professionals, to be correlatedwith poorer outcomes to pregnancies. This is largely because of the higher incidence of chronic medical conditions amongolder women. The present study has been conducted to reckon the strength of the association between maternal age andobstetric issues pertaining to women.Material and Methods: The present study was conducted in the Department of Obstetrics and Gynecology, tertiary careinstitute of India. A total number of patients included in the study were 280 which were divided into two groups basedon age of patients. Group A consists of 200 pregnant women aged &lt; 35 years and group B consists of 80 pregnant patientsaged ≥35 years. Routine antenatal examination along with some additional lab investigations like KFT; LFT etc. wereperformed.Results: The difference in number of cesarean sections, assisted pregnancies and early pregnancy loss between group Aand group B was statistically significant. We found a significant difference between group A and group B with respect toearly pregnancy loss, C-section, antepartum, intrapartum and postpartum complications (p&lt;0.001).Conclusion: Advanced maternal age is linked with disastrous pregnancy issues. Without any doubt, extreme maternalage invites a catastrophe of pregnancy related complications that include antenatal, intrapartum and postpartumcomplications. Natural conception becomes all the more challenging and hence the role assisted pregnancies comes intoplay.

Ultrasonographic ovarian mass scoring system for predicting malignancy in pregnant women with ovarian mass.

During routine antenatal ultrasound examinations, an ovarian mass can be found incidentally. In clinical practice, the differential diagnosis between benign and malignant ovarian masses is essential for planning further management. Ultrasound imaging has become the most popular diagnostic tool during pregnancy, with the recent development of ultrasonography. In non-pregnant women, several methods have been used to predict malignant ovarian masses before surgery. The International Ovarian Tumor Analysis (IOTA) group reported several scoring systems, such as the IOTA simple rules, IOTA logistic regression models, and IOTA assessment of different NEoplasias in the adneXa. Other researchers have also evaluated the malignancy of ovarian masses before surgery using scoring systems such as the Sassone score, pelvic mass score, DePriest score, Lerner score, and Ovarian-Adnexal Reporting and Data System. These researchers suggested specific features of ovarian masses that can be used for differential diagnosis, including size, proportion of solid tissue, papillary projections, inner wall structure, locules, wall thickness, septa, echogenicity, acoustic shadows, and presence of ascites. Although these factors can also be measured in pregnant women using ultrasound, only a few studies have applied ovarian scoring systems in pregnant women. In this article, we reviewed various scoring systems for predicting malignant tumors of the ovary and determined whether they can be applied to pregnant women.

Associations Between Trajectory of Different Blood Pressure Components in Pregnancy and Risk of Adverse Birth Outcomes - A Real World Study.

BackgroundHigh blood pressure during pregnancy has been suggested to be associated with adverse birth outcomes (ABO), but it is unclear how different blood pressure changes and the extent of the effect. Therefore, we aimed to investigate the association between blood pressure trajectories (systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP)) of pregnant women and ABO in a real-world study.Material and MethodsLeveraging 28,679 pregnant women and their fetuses from a register-based cohort from January 1, 2010, to December 31, 2019. Blood pressure trajectories were estimated by package “traj” in R software using real-world blood pressure data of routine antenatal care examinations. Logistic regression models were applied to examine the association between trajectories of different blood pressure components (SBP, DBP, MAP, and PP) during pregnancy and the risk of ABO.ResultsTrajectories of all blood pressure components were identically labeled as low-stable, moderate-increasing, moderate-decreasing and high-stable. After adjusting for confounding factors, compared with pregnant women with the low-stable pattern, pregnant women with a high-stable or moderate-increasing pattern had a significantly increased risk of developing adverse birth outcomes. Pregnant women with a moderate-decreasing pattern had no significant increased risk of ABO but had a lower risk of adverse birth outcomes than those with a moderate-increasing pattern. The trajectories crossed at 17–20 weeks of gestation for all blood pressure components.ConclusionOur study results indicated that reduction and maintenance of blood pressure to a low level of less than 110 mmHg for SBP and 65 mmHg for DBP after 20 weeks of gestation would benefit prevention of adverse birth outcomes, regardless of the level of blood pressure at early pregnancy.

10 cases of umbilical cord thrombosis in the third trimester

Thrombosis of umbilical vessels is a rare occurrence that is difficult to detect during routine antenatal examinations but can lead to poor perinatal outcomes. The aim of this study is to examine the association between meaningful clinical manifestations and features associated with thrombosis of umbilical vessels, and to evaluate optimal management options. A retrospective study of umbilical cord thrombi cases enrolled between 2015-2019 was carried out. Data were analyzed from the medical archives where the diagnosis of all cases was established by histopathology. Gross examination reported additional cord abnormalities (7/10), including the irregular length of the umbilical cord, narrowed cord with hyper-coiling, swollen cord with deficiency of Wharton's jelly, placenta velamentous and umbilical infarction. Pathological examination accounted for 10 cases of umbilical cord thrombosis including umbilical artery embolism (3/10), umbilical vein thrombi (5/10) and funisitis (2/10). Clinical findings depicted that the chief complaint was decreased fetal movement companied by nonreactive NST tests (5/10). With the exception of two stillbirths, the remaining pregnancies (8/10) were terminated by cesarean section. All neonates are alive, including one VLBW and three LBW cases. We have observedthat umbilical structural dysplasia, maternal coagulation disorder, vascular endothelial injury and elevated blood glucose may lead to the formation of thrombosis. Focus on specific signs during a prenatal ultrasound, EFM monitoring and counting fetal movements can help in early identification of umbilical cord thrombi. Our results support the more effective approach of emergency cesarean section during the third trimester.

Prevalence of hepatitis B virus infection and its associated factors among 15,461 pregnant women in Yunnan province, China

PurposeChina has the world's largest burden of hepatitis B virus (HBV) infection. However, there are few studies reported on the latest prevalence of hepatitis B surface antigen (HBsAg) among pregnant women in China. We aimed to assess the prevalence of HBV infection and its associated risk factors among pregnant women in Yunnan, which is a province with relatively high prevalence of blood-borne viruses. MethodsWe conducted a cross-sectional study of 15,641 pregnant women who underwent routine antenatal screening for HBsAg in Yunnan between 2013 and 2016. Logistic regression analyses were used to examine the associations between HBV infection and risk factors. ResultsOverall, 7.89% (95% confidence interval (CI), 7.47%–8.31%) of the 15,641 pregnant women tested positive for HBsAg. Multivariable logistic regression analysis showed that advanced age (≥35 years old; adjusted odds ratio [aOR], 2.43–2.59), Hani ethnicity (aOR, 1.97; 95% CI, 1.22–3.17), unemployed women (aOR, 1.88; 95% CI, 1.30–2.72), multigravidas (aOR, 1.21; 95% CI, 1.05–1.40), and multiparas (aOR, 1.28; 95% CI, 1.10–1.49) were more likely to be infected with HBV. HBV infection was associated with cesarean section and preterm birth, with aORs of 1.31 (1.17–1.48) and 1.23 (1.00–1.51), respectively. In the subgroup analysis, the association between Hani ethnicity and HBV infection was significantly higher in women aged 35 years or older (aOR = 5.15; 95% CI, 1.51–17.55) than in women younger than 35 years of age (aOR = 1.69; 95% CI, 1.00–2.86). ConclusionsHBV infection among 15,641 pregnant women was of high-intermediate endemicity in Yunnan, China. Advanced age, Hani ethnicity, unemployment, and multigravid and multiparous statuses were associated with an increased prevalence of HBV infection. High-risk pregnant women should be paid more attention during routine antenatal examination.

Role of Placental laterality as a Predictive Tool for Preeclampsia

Objective: To study role of Ultrasound determined placental laterality as a predictor of preeclampsia Methods: This prospective study was conducted in the Department of Obstetrics and Gynaecology, VMMC &amp; Safdarjang Hospital, New Delhi from Feb 2019 to July 2019. Three hundred pregnant women attending antenatal clinic both OPD and IPD between 16 to 20 weeks of gestation without any high risk factor were subjected to ultrasound examination as a part of routine antenatal examination and placental location was determined. These cases were followed up for the development of preeclampsia. Results :Out of the 300 women studied 241 had central placenta (Group A) and 59 had laterally located placenta (group B).Out of 59 women with lateral placenta, 29 (49.2%) developed preeclampsia while out of the 241 women with central placenta only 19 (7.88%) developed preeclampsia. This was statistically significant (p value&lt;0.0001). The sensitivity, specificity, positive predictive value and negative predictive value of placental laterality as a predictor for preeclampsia was 64.18%, 83.19%, 53.16% and 88.64% respectively. Conclusion: Placental laterality by ultrasound d at 16-20 weeks; is a simple, cheap and effective method ,establishing its role as early predictor of pre-eclampsia.

GAMBARAN ANALISIS KEJADIAN BBLR DI RSUD H.A.SULTHAN DAENG RADJA KABUPATEN BULUKUMBA

Low birth weight babies (LBW) are babies born weighing less than 2500 grams regardless of gestational period (birth weight is the weight of the baby weighed within 1 hour after birth). LBW is a human individual who is due to weight, gestational age, and causes of birth are less than the standard birth of a normal baby. From the results of the study conducted by researchers on July 19, 2018 on 47 respondents, who experienced LBW as many as 29 babies while the normal number of 18 babies. The purpose of this study was to know the picture of the incidence of Low Birth Weight Babies (LBW) in HA Sulthan Hospital Daeng Radja Bulukumba District in 2018.The research method uses a descriptive design with a simple approach. Sampling is done by nonprobability sampling technique with incidental sampling approach. The population in this study were 307. The sample in this study were 30 respondents.The results showed that mothers who gave birth at age 20-35 years were 6 people 20.0%, and aged &lt;20 and&gt; 35 as many as 24 people 80.%, good nutritional status as many as 27 people 90.0%, nutritional status less than 3 people 10%, consumption Fe tablets are as much as 16 people 53.3%, consume less tablet fe as many as 14 people 46.7%, gestational periods are not as risky as 21 people70%, high risk 9 people 30%, paritasibu low risk as many as 22 people 73.3%, high risk 8 26.7% people. Routine antenatal care examination as many as 29 people 96.7%, non-routine 1 person 3.3%, the conclusion in this study was the infants who experienced LBW in H.Andi Sulthan Daeng Radja Hospital Bulukumba District in 2018 of 30 infants who experienced LBW caused by several factors, namely nutritional status, gestational period, age, parity and ANC examination. It is recommended for mothers to increase the source of information regarding LBW.

The Impact of Scientific and Technical Training on Improving Routine Collection of Antenatal Care Data for Maternal and Foetal Risk Assessment: A Case Study in the Province of South Kalimantan, Indonesia.

Objectives First, to assess the impact of scientific and technical training on midwives' abilities in collecting and recording the results of routine antenatal care examinations. Second, to explore midwives' views with regard to factors affecting their abilities to successfully complete the data documentation tasks. Methods The study was conducted in South Kalimantan, Indonesia (April 2016-October 2017). Nineteen urban and rural midwives were selected. Access to antenatal care information on 4,946 women (retrospective cohort study) and 381 women (prospective cohort study) was granted. A descriptive and exploratory design was used to describe midwives' abilities and challenges pertaining to timely collection and recording of results concerning antenatal care examinations. Results Scientific and technical training has significantly improved the average amount of recorded antenatal care data (from 17.5% to 62.1%, p-value < 0.0005). Lack of awareness, high workload, and insufficient skills and facilities are the main reasons for the database gaps. Conclusions The training has equipped midwives with scientific knowledge and technical abilities to allow routine collection of antenatal care data. Provision and adequate use of this information during different stages of pregnancy is crucial as an evidence-based guideline to assess maternal and foetal risk factors to ending preventable mortality.

Application of non-invasive prenatal genetic testing in prenatal anomaly index screening

Objective To evaluate the value of non-invasive prenatal testing (NIPT) in pregnancies with anomaly in prenatal screening. Methods This was a retrospective study of 2 837 singleton pregnancies who performed NIPT indicated by isolated anomaly in prenatal screening at Guangdong Women and Children Hospital between November 2014 and August 2016. All pregnancies were divided into 3 groups by single indication: advanced maternal age ( AMA, ≥35), abnormal multiples of the median (MoM) in standard screening, increased nuchal translucency thickness (NT, 2.5-3.0 mm). High risk results were verified by prenatal diagnosis. Low risk cases were followed by a 22-26 week anatomical ultrasound examination. All of the cases were followed up and the performance of NIPT for every single indication was evaluated. Results There were total of 2 837 pregnant women who underwent NIPT. Twenty-five of 2 448 pregnancies indicated by AMA had high risk results, among which 17 were confirmed by invasive genetic testing, except 1 case rejecting prenatal diagnosis. In 351 pregnant women with abnormal MoM, NIPT found 3 cases of sex chromosome aneuploidies (SCA) and 2 of them were validated by invasive prenatal diagnosis. Increased NT group included 38 cases, NIPT found 1 case of trisomy 21 which was consistent with karyotype analysis. For common aneuploidies and SCA, the performance of NIPT in the pregnant women who indicated by AMA, abnormal MoM and increased NT were as the follows: the sensitivity were 17/17, 2/2 and 1/1 respectively, the specificity were 99.7% (2 423/2 431), 99.7% (348/349) and 100%(37/37), the positive predictive value were 68% (17/25), 2/3 and 1/1, the negative predictive value were 100% (2 423/2 423), 100% (348/348) and 100% (38/38), respectively. By follow-up survey, a total of 8 cases of abnormal fetus were recorded in NIPT low-risk women, including 5 cases of termination of pregnancy due to abnormal ultrasound findings, 2 cases of abortion as a result of severe obstetric complications and 1 case of stillbirth. Conclusions To the pregnant women who indicated by advanced maternal age, abnormal MoM and increased NT (2.5-3.0 mm), NIPT had satisfactory performance for common aneuploidies, and also had potential value for SCA, resulting in a significant reduction in diagnostic procedures. However, for NIPT low-risk pregnancies, routine antenatal examination and anatomical ultrasound detection would be highly necessary to avoid missing abnormal fetuses.(Chin J Lab Med, 2018, 41: 509-513) Key words: Aneuploidy; Prenatal diagnosis; Genetic testing; Nuchal translucency measurement

CKD-EPI is a Better Tool for Detecting Renal Dysfunction in Hypertensive Pregnancy: A Case-Control Study in Ghana

Background: Pregnant women with hypertension are at an increased risk of renal impairment. This study assessed the use of CKD-EPI and 4v-MDRD for early diagnosis of renal impairment in pregnant women with hypertension. Methods: This case-control study was conducted at Suntreso Government Hospital Kumasi, Ghana. In all, 220 pregnant women were recruited, 84 had Gestational Hypertension, 36 had Preeclampsia, with 100 normotensive pregnant women as controls. Structured Questionnaires were used to obtain socio-demographic and clinical information. 4 mL of venous blood was collected for estimation of electrolytes, urea, creatinine and uric acid; urine was collected for estimation of protein using dipstick. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD-4) equations were used to assess and classify renal impairments. Results: Prevalence of renal impairment using CKD-EPI and MDRD-4 was 4.1% and 0.5% respectively. CKDEPI identified 22.2% of women with preeclampsia as having renal impairment whereas MDRD-4 identified 2.8%. Using CKD-EPI and MDRD-4, eGFR was significantly higher in the controls compared to the cases, (p<0.001). Sodium, chloride, urea, creatinine, uric acid was significantly increased in the hypertensive women. Conclusion: Renal impairment is common in hypertensive pregnant women. CKD-EPI is better equation in early detection of renal impairment in pregnant women and should be adopted as the tool for assessing renal dysfunction during routine antenatal examinations to prevent end-stage renal diseases.

EP01.06: Isolated absence of septum pellucidum: a report of two cases

Agenesis of the septum pellucidum (ASP) is a rare cerebral anomaly which can appear in a partial or a complete form and agenesis may occur in an isolated or in an association with various congenital brain malformations. We report two cases with isolated agenesis of septum pellucidum which were suspected prenatally with 2D ultrasound and fetal MRI. A-32-year-old G1P0 woman first visited Cheil General Hospital at 12weeks of gestation. During routine antenatal examination in 28 gestational weeks, CSP was not seen and the fusion between the frontal horns of lateral ventricle in fetal brain was found. Cerebral developmental anomalies related to the ASP were suspected. Fetal MRI was performed at 29 weeks and 4 days of gestation. Septum pellucidum was still not seen but the corpus callosum and the fornix were intact and no definite fusion in brain parenchyme was found. Due to fetal movement, measurement of the optic nerves were not possible. As a result, isolated ASP was suspected with possibility of septo-optic dysplasia. A full-term 3,245 gram female was born after a normal delivery. Postnatal evaluation with brain ultrasound was performed 3 days after birth and isolated ASP was suspected. The newborn was discharged afterward and no definite sign of focal neurologic deficit was found by this time. A-37-year-old G1P0 woman was referred at 17 weeks and 6 days of gestation due to increased risk of Trisomy 21 and neural tube defect in Quad test. Fetal karyotype was normal. In the mid-trimester ultrasound, estimated fetal weight was 3 percentile and small cystic lesion in fetal head posterior fossa was noted. She was hospitalised at 27 weeks due to symptoms of pre-eclampsia. In follow up ultrasound at 32 weeks and 1 day of gestation, estimated fetal weight was below 1 percentile and cystic lesion in posterior fetal head was still seen. The day after Caesarean section was performed due to fetal distress. A preterm 1,220 gram male was born. Brain ultrasound and MRI was performed 48 days after birth and isolated ASP with well visualised both optic nerves were noticed.

A simple point of care test can indicate the need for periodontal therapy to reduce the risk for adverse pregnancy outcomes in mothers attending antenatal clinics

Introduction: Although the association between periodontal disease (PD) and adverse pregnancy outcomes has gained recognition amongst antenatal healthcare workers, not much has changed in practice to address it. This prospective study tested the hypothesis that BANA (N-benzoyl-DL-arginine-2-naphthylamide), a diagnostic test for PD, may inform obstetricians and other antenatal healthcare practitioners, of the risk of adverse pregnancy outcomes in mothers attending antenatal clinics.Methods: At first visit, the presence of suspected periodontopathogens was assessed by BANA testing of dental plaque from 443 mothers attending antenatal clinics in KwaZulu-Natal, South Africa and an association later sought with pregnancy outcomes. The accuracy of BANA to predict adverse pregnancy outcomes was evaluated by the calculation of likelihood ratios. The study complied with the Declaration of Helsinki.Results: Significant differences were found between pregnancy outcomes of BANA-negative and BANA-positive mothers (p < 0.0001). BANA showed sensitivity and negative predictive values of 87% and 91%; 75% and 78%; 87% and 94% in detecting low birth weight, preterm delivery, and preterm low birth weight delivery respectively.Conclusion: This study confirms that BANA may indicate the need for periodontal therapy to reduce the risk of adverse pregnancy outcomes and could form part of the routine antenatal examination.