Severe Intrauterine Growth Restriction Research Articles

Early Prophylactic Enoxaparin for the Prevention of Preeclampsia and Intrauterine Growth Restriction: A Randomized Trial

Background: Preeclampsia (PE) and intrauterine growth restriction (IUGR) are major causes of maternal and perinatal morbidity and mortality. Previous studies have shown that intervention with low-dose aspirin resulted in a reduction in the occurrence of preterm PE. However, no data are currently available on the effect of low-molecular-weight heparin (LMWH) for the prevention of pregnancy complications in women enrolled at first trimester screening. Objective: We aimed to assess the effectiveness of LMWH in the prevention of PE, IUGR, fetal death, and abruptio placentae in women classified as high risk based on their medical history and in women selected by first trimester screening of PE. Study ­Design: This was a multicenter, randomized, open-label, parallel controlled trial in women without thrombophilia between 6.0 and 15.6 weeks of gestation. Inclusion criteria were severe PE or IUGR before 34 weeks of gestation and/or abruptio placentae or unexplained intrauterine death in a previous pregnancy; uterine artery mean pulsatility index Doppler >95th percentile and/or positive first trimester screening for PE. Pregnant women were randomly assigned to receive no intervention or LMWH until the 36th week of gestation. The primary composite outcome consisted of 1 or more of the following: development of PE, IUGR, abruptio placentae, and intrauterine fetal death. Results: A total of 278 pregnant women were randomly allocated to receive LMWH (n = 134) or no intervention (n = 144). Overall, 115 (41%) women experienced placental insufficiency complications, with no significant differences between the 2 arms: 50/144 (34.7%) in the LMWH arm and 43/134 (32%) in the control arm (p = 0.64, OR: 1.13, 95% CI: 0.68–1.85). Conclusion: LMWH did not reduce the incidence of placenta-mediated complications either in women with previous adverse obstetric history without thrombophilia or in women selected by first trimester screening for PE. Based on these results, we cannot recommend the use of LMWH alone in women at risk of placental complications.

Survival Outcomes by Fetal Weight Discordance after Laser Surgery for Twin-Twin Transfusion Syndrome Complicated by Donor Fetal Growth Restriction

Introduction: Management options for treatment of twin-twin transfusion syndrome (TTTS) with severe donor intrauterine growth restriction (IUGR) include fetoscopic laser surgery and umbilical cord occlusion (UCO). We studied perinatal survival outcomes in this select group after laser surgery, stratifying patients by preoperative estimated fetal weight (EFW) discordance. Methods: In this retrospective study of monochorionic diamniotic twin gestations with TTTS and selective donor IUGR who underwent laser surgery (2006–2017), preoperative EFW discordance was calculated ([(larger twin – smaller twin)/(larger twin)] × 100) and cases were divided into discordance strata. Severe EFW discordance was defined as >35%. The primary outcome was 30-day donor twin neonatal survival. Results: The 371 cases were distributed by discordance strata: ≤20% (74 [19.9%]), 21–25% (49 [13.2%]), 26–30% (68 [18.3%]), 31–35% (53 [14.3%]), 36–40% (51 [13.7%]), 41–45% (38 [10.2%]), >45% (38 [10.2%]). Donor 30-day survival declined as the discordance strata increased: 86.5, 85.7, 83.8, 75.5, 64.7, 63.2, and 65.8% (p = 0.0046); 30-day survival was inversely associated with severe discordance (>35%) (64.6 vs. 83.2%, p < 0.0001). Discussion: In TTTS cases complicated by donor IUGR with severe growth discordance, laser surgery was associated with donor survivorship greater than 60% suggesting that, in this setting, laser surgery remains a reasonable alternative treatment to UCO.

Early morbidity profile of late preterm neonates in a teaching hospital in South India

Background: Late preterm neonates although close to term neonates in weight and physical appearance, have a high risk for morbidities causing a significant health care cost. Objective: We undertook the study to analyze the morbidity pattern of late preterm infants to help in better management of these neonates. Materials and Methods: This was a retrospective analytical study conducted in a tertiary hospital of South India. The data were retrieved from admission, discharge registers, case records, and neonatal database. The rate of various morbidities during the hospital stay and subgroup analysis was performed. Results: About 936 late preterm neonates (32.8% of preterm deliveries) were admitted in neonatology ward for various morbidities. The mean gestational age was 35.32±0.76 (1 SD) and mean birth weight was 2.11±0.46 kg (1 SD). Male:female ratio was 1.12:1. About 50% of them were born at 36 weeks, 31% at 35 weeks, and 18% were born at 34 weeks. About 16.72% of admitted late preterm neonates were severe intrauterine growth restriction (IUGR). Neonatal jaundice requiring phototherapy 33.1%, sepsis 23.7%, birth asphyxia 8.3%, and respiratory distress syndrome 6.62%, were the most common morbidities. Around 14.2% of admitted neonates required some form of respiratory support. Sepsis occurred in a significant proportion (23.7%) and 18.7% of admitted neonates had hypoglycemia. The average duration of stay was 8.19±5.5 (SD) days. Conclusion: Late preterm neonates are at a high risk for various morbidities, neonatal jaundice, respiratory distress, asphyxia, sepsis, and required prolonged stay. A high proportion of severe IUGR was found in our study.

Twelve Weeks of Reversed Umbilical Flow in a Fetal Growth Restriction Case Associated with Severe Periconceptional Maternal Anemia

We present a case of a patient diagnosed with severe intrauterine growth restriction and periconceptional severe anemia, where the fetal well-being features, including reversal of umbilical artery end-diastolic flow and abnormal cerebroplacental ratio, remained stationary for 12 weeks. We are not aware of reports with similar findings, and the professionals should take into consideration the possibility of a "frozen" fetal well-being for a long time. Possibly, in our case, the evolution may be due to the prompt correction of the chronic severe maternal anemia. This approach may offer the opportunity to prolong the pregnancy, even in cases with apparently imminent delivery, as the association of reversal of umbilical artery end-diastolic flow.

SAT-219 OUTCOMES OF PREGNANCY AMONG CHRONIC HEMODIALYSIS PATIENTS

Pregnancy in end stage renal disease (ESRD) women is uncommon and the risk for maternal - fetal complications is high. The rate of successful pregnancies in chronic hemodialysis (HD) patients has improved over the last decade up to 80%. Multidisciplinary team care and intensified hemodialysis regimens contributed in this substantial impact. We are reporting the outcomes of pregnancy in hemodialysis patients from single hemodialysis center in United Arab Emirates. A retrospective chart review study was conducted at Tawam hospital hemodialysis unit (capacity of 380 patients) over 10 years (Jan 2009 – June 2019). We included all cases of female HD patients get pregnant during study period. Demographic, clinical and laboratory data were collected as well as pregnancy outcomes, maternal and fetal complications were analyzed using descriptive analysis. we identified a total of 5 female ESRD patients on HD, with a total of 7 pregnancies. The mean age was 35.5 years. Three patients were expatriates. The causes of ESRD were type 1 diabetes (2), type 2 diabetes (1), systemic lupus erythematosus (1) and adult polycystic kidney disease (1). Other comorbid conditions were anemia of renal disease (5), hypertension (4), dyslipidemia (4), obesity (2), history of ischemic heart disease (IHD) (1) and peripheral vascular disease (PVD) (1). The average duration on hemodialysis at time of pregnancy was ranging from 3 months to 7 years and two patients were initiated on HD in the first 10 weeks of pregnancy. Three patients were multiparous prior to ESRD, with total number of children (11) and abortion/ fetal death (7). All the 5 patients had spontaneous pregnancies. The frequency of HD increased to 5-6 times per week with 4 hours duration with average pre-dialysis urea levels of 10.5 to 12 mmol/L Qutaiba Hussain*,. The maternal complications during pregnancy in our cohort including: urinary tract infection (1), diabetic foot infection (1), anemia required blood transfusion (3), renal cyst rupture (1), recurrent arteriovenous graft thrombosis (1), preeclampsia (3), premature preterm rapture of membrane (PPROM) and abruptio placenta (2). The successful outcomes of pregnancies were three live births required c sections for preterm delivery at 30 – 34 weeks (2 emergency c/sections for preeclampsia and abruptio placenta). A patient had advanced diabetic type 1 complications with IHD, PVD had a total of 3 pregnancies with poor outcomes due to uteroplacental insufficiency (one fetal death at 25 weeks, one severe intrauterine growth restriction (IUGR)/preeclampsia, and one with PPROM/ IUGR). The fetal complications identified were preterm delivery (3), fetal death (1), post-delivery death (2), severe IUGR (3), abortion (1) and fetal anomalies (2) [anhydramnios (1), membranous ventricular septal defect VSD (1)]. Pregnancy in chronic hemodialysis patients with advanced comorbid conditions has high risk for complications and need comprehensive care. We had a total of 7 pregnancies over 10 years with successful outcomes in three patients (42.8%).

Vivax malaria in pregnancy and lactation: a long way to health equity

BackgroundThe Sustainable Development Goals (SDG) call for increased gender equity and reduction in malaria-related mortality and morbidity. Plasmodium vivax infections in pregnancy are associated with maternal anaemia and increased adverse perinatal outcomes. Providing radical cure for women with 8-aminoquinolines (e.g., primaquine) is hindered by gender-specific complexities.Case presentationA symptomatic episode of vivax malaria at 18 weeks of gestation in a primigravid woman was associated with maternal anaemia, a recurrent asymptomatic P. vivax episode, severe intra-uterine growth restriction with no other identifiable cause and induction to reduce the risk of stillbirth. At 5 months postpartum a qualitative glucose-6-phosphate dehydrogenase (G6PD) point-of-care test was normal and radical cure with primaquine was prescribed to the mother. A 33% fractional decrease in haematocrit on day 7 of primaquine led to further testing which showed intermediate phenotypic G6PD activity; the G6PD genotype could not be identified. Her infant daughter was well throughout maternal treatment and found to be heterozygous for Mahidol variant.ConclusionAdverse effects of vivax malaria in pregnancy, ineligibility of radical cure for pregnant and postpartum women, and difficulties in diagnosing intermediate levels of G6PD activity multiplied morbidity in this woman. Steps towards meeting the SDG include prevention of malaria in pregnancy, reducing unnecessary exclusion of women from radical cure, and accessible quantitative G6PD screening in P. vivax-endemic settings.

A Protocol for Nurse-Practitioner Led Cardiovascular Follow-Up After Pregnancy Complications in a Socioeconomically Disadvantaged Population.

Background: Women who experience pregnancy complications have an increased risk of future cardiovascular disease when compared to their healthy counterparts. Despite recommendations, there is no standardized cardiovascular follow-up in the postpartum period for these women, and the Australian follow-up protocols that have been previously described are research-based. This study proposes a new model of care for a nurse practitioner-led postpartum intervention clinic for women who experience severe hypertensive disorders of pregnancy, gestational diabetes mellitus requiring medication, severe intrauterine growth restriction, idiopathic preterm delivery, or placental abruption, in a socioeconomically disadvantaged population.Methods: All women receiving antenatal care or who deliver at the Lyell McEwin Hospital, a tertiary acute care facility located in the northern Adelaide metropolitan area, following a severe complication of pregnancy are referred to the intervention clinic for review at 6 months postpartum. A comprehensive assessment is conducted from demographics, medical history, diet and exercise habits, psychosocial information, health literacy, pathology results, and physical measurements. Subsequently, patient-specific education and clinical counseling are provided by a specialized nurse practitioner. Clinic appointments are repeated at 18 months and 5 years postpartum. All data is also collated into a registry, which aims to assess the efficacy of the intervention at improving modifiable cardiovascular risk factors and reducing cardiovascular risk.Discussion: There is limited information on the efficacy of postpartum intervention clinics in reducing cardiovascular risk in women who have experienced pregnancy complications. Analyses of the data collected in the registry will provide essential information about how best to reduce cardiovascular risk in women in socioeconomically disadvantaged and disease-burdened populations.

A Case of Complete Neu-Laxova Syndrome: Report and Literature Review

Neu-Laxova syndrome (NLS) is a rare autosomal recessive and early fatal disease. It is a complex entity that includes intrauterine growth retardation, abnormal facial structure, limb and skeletal abnormalities, and ichthyosis and severe malformations of the central nervous system. We report a rare case of recurrence of Neu-Laxova syndrome in a 32-year-old pauciparous woman, which occurred after a first cousin’s consanguineous marriage. Typical ultrasound findings included hydramnios, severe intrauterine growth restriction, craniofacial and central nervous system abnormalities such as ventriculomegaly. The newborn shows a terrible face with a usual craniofacial aspect, eyeball proptosis, puffy hands and feet, large bilateral cleft lip/palate, severe hall body ichthyosis. The overcome was fatal, the death occurred in less than one hour after birth. Consanguinity remains the most implicated cause which is high in developing countries. Prenatal serial ultrasound examinations with genetic counselling should be performed on high-risk pregnant women to terminate affected pregnancies.

1222 Conservative Management of Cesarean Scar Pregnancies with Systemic Multidose Methotrexate: Predictors of Treatment Failure and Reproductive Outcomes

Study Objective The role of conservative management of CSP has been previously reported with conflicting results reported. In this retrospective study, we aimed to further evaluate its role and better delineate the subsequent reproductive outcomes Design A retrospective cohort study. Setting A large university hospital (Hadassah Medical Center Hospitals, Israel, Jerusalem) between November 2014 to April 2017 Patients or Participants All patients diagnosed with a CSP and treated by intention of conservative management with systemic methotrexate (MTX). Interventions A comparison of maternal and gestation characteristics was performed between treatment success and failure groups Measurements and Main Results Thirty seven cases of CSP were encountered. Overall, 29/37 (78.3%) were treated by systemic injection of MTX while the other 21.7% had combined systemic and local (i.e. intra-sac) MTX treatment. Invasive intervention was needed in 5 (13.5%) cases (failure group). Cases who were converted to surgical treatment had higher number of previous cesarean deliveries (median 4 vs. 2, p=0.002). In logistic regression modeling, the number of prior cesarean deliveries in the past was the only factor found independently associated with conversion to surgical management Odds Ratio 2.02, 95 % Confidence Interval 1.03,3.94. Majority of future pregnancies had term pregnancy with one preterm delivery due to severe intrauterine growth restriction Conclusion Systemic MTX therapy is a safe and effective strategy for the treatment of CSP with favorable subsequent reproductive results and a low conversion rate for surgical management. Patients with high order of previous cesarean deliveries should be considered for early surgical treatment rather than a medical one.

Association of maternal Toll-like receptor-4 alleles with susceptibility to early-onset preeclampsia in central Greece.

Altered maternal inflammatory responses may play a role in the development of hypertensive disorders of pregnancy like preeclampsia, its more severe early-onset form and intrauterine growth restriction. We evaluated the relation of common allelic variants of Toll-like receptor 4 (TLR4), known to impair the inflammatory response, with the susceptibility to early-onset preeclampsia in Central Greece. We compared the occurrence of TLR4 (Asp299Gly and Thr399Ile) alleles in heterozygous (A/G, C/T) and homozygous (G/G, T/T) states in 84 women with a history of early-onset preeclampsia and 94 age matched controls with a history of only uneventful pregnancies, by direct sequencing. Heterozygous TLR4 allelic variants were more common in women with a history of early-onset preeclampsia than in controls (GA for Asp299Gly: 14.3% vs 6.4% (AA), p = 0.053 & CT for Thr399Ile: 16.7% vs. 6.4% (CC), p = 0.019) and a stronger association was obtained when homozygous allelic carriers were also included (GA/GG for Asp299Gly: 16.7% vs. 6.4% (AA), p = 0.03 & TC/TT for Thr399Ile: 19.0% vs. 6.4% (CC), p = 0.01). We recorded association between common TLR4 gene variants and early-onset preeclampsia. Our findings support the involvement of maternal innate immune system in severe hypertensive disorders of pregnancy and point to the potential value of maternal TLR4 polymorphisms as predictors-risk factors of susceptibility to early-onset preeclampsia in Central Greece.

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Structural coronary artery remodelling in the rabbit fetus as a result of intrauterine growth restriction

Intrauterine growth restriction (IUGR) is a fetal condition that affects up to 10% of all pregnancies and is associated with cardiovascular structural and functional remodelling that persists postnatally. Some studies have reported an increase in myocardial coronary blood flow in severe IUGR fetuses which has been directly associated to the dilatation of the coronary arteries. However, a direct measurement of the coronaries’ lumen diameter in IUGR has not been reported before. The aim of this paper is to perform, for the first time, a quantitative analysis of the effects of IUGR in cardiac geometry and coronary vessel size in a well-known rabbit model of IUGR using synchrotron-based X-ray Phase Contrast Tomography Imaging (X-PCI). Eight rabbit fetal hearts were imaged non-destructively with X-PCI. 3D reconstructions of the coronary arterial tree were obtained after semi-automatic image segmentation. Different morphometric features including vessel lumen diameter of the three main coronaries were automatically quantified. IUGR fetuses had more globular hearts and dilated coronary arteries as compared to controls. We have quantitatively shown that IUGR leads to structural coronary vascular tree remodelling and enlargement as an adaptation mechanism in response to an adverse environment of restricted oxygen and nutrients and increased perfusion pressure.

SWATH-MS quantitative proteomic investigation of intrauterine growth restriction in a porcine model reveals sex differences in hippocampus development

Intrauterine growth restriction (IUGR) is characterized by reduced growth and weight of the foetus, mainly due to the lack of nutrients and oxygen. Animals affected by IUGR show changes in specific brain areas and several neuronal processes. Female offspring affected by IUGR show increased survival and development compared to males. The objective of this study was to analyse changes in the hippocampus proteome in male and female piglets affected by IUGR. Seven pregnant Iberian sows were fed from Day 35 of pregnancy onwards at 50% of their requirements. At Day 100 of pregnancy, foetuses were obtained and classified by sex and weight, as mild IUGR (Normal Body Weight) versus severe IUGR (Low Body Weight). Hippocampi were dissected and the proteomes analysed by SWATH-MS DIA. In this study, 1497 proteins were identified of which 260 were quantitatively analysed. All differential proteins were more abundant in females versus males and were involved in protein synthesis, neuronal development, metabolism, antiapoptotic signalling and vesicular transport. Our findings support that female foetuses tolerate nutrient limitation better than males, especially under mild IUGR. Under severe IUGR, females still seems to maintain normal lipid metabolism and antiapoptotic signalling, which may be related to the increased female survival. SignificanceIn the last years, proteomics have been used to evidence differences related to sex in non-reproductive organs. Intrauterine Growth Restriction (IUGR) can affect female and male offspring differently. Female offspring has stronger protective strategies compared to males, enhancing growth and postnatal survival. Most studies regarding this issue have focused on metabolic organs (i.e. liver). However, the predominance of neurodevelopmental disorders in males suggests that the central nervous system in female offspring adapt better to nutritional stress conditions than that of males. Based on the differential protein expression in hippocampal samples, our work demonstrates that female foetuses indeed adapt better to IUGR than males, especially under mild IUGR conditions. In severe IUGR conditions, differences between males and females were not so evident, but even in this case, the remaining differences suggest increased survival in females than in males.

Does Chorionic Villus Sampling Increase the Risk of Preeclampsia or Gestational Hypertension?

Background:Chorionic villus sampling (CVS) and amniocentesis are two methods for prenatal diagnosis. The goal of this study was to compare amniocentesis and CVS-related complications in a large sample of Iranian women.Methods:Medical records of 1624 women who underwent amniocentesis or CVS due to medical indications between 2008 and 2016 were reviewed. Data regarding age, gravidity, parity, gestational age, type of procedure, neonatal weight (and percentile), trisomia, abortion, intrauterine growth restriction (IUGR), severe IUGR, preeclampsia, and gestational hypertension were recorded.Results:Finally, 1215 cases were evaluated. Mean maternal age, gravidity, and gestational age were significantly different between two groups. Preeclampsia, gestational hypertension, IUGR, severe IUGR, and intrauterine fetal death were not significantly different between two groups. Trisomy 18 and 21 were common in cases underwent amniocentesis.Conclusions:Women who underwent CVS are not at higher risk for developing hypertensive disorders than women underwent amniocentesis.

Altered Placental Chorionic Arterial Biomechanical Properties During Intrauterine Growth Restriction

Intrauterine growth restriction (IUGR) is a pregnancy complication due to placental dysfunction that prevents the fetus from obtaining enough oxygen and nutrients, leading to serious mortality and morbidity risks. There is no treatment for IUGR despite having a prevalence of 3% in developed countries, giving rise to an urgency to improve our understanding of the disease. Applying biomechanics investigation on IUGR placental tissues can give important new insights. We performed pressure-diameter mechanical testing of placental chorionic arteries and found that in severe IUGR cases (RI > 90th centile) but not in IUGR cases (RI < 90th centile), vascular distensibility was significantly increased from normal. Constitutive modeling demonstrated that a simplified Fung-type hyperelastic model was able to describe the mechanical properties well, and histology showed that severe IUGR had the lowest collagen to elastin ratio. To demonstrate that the increased distensibility in the severe IUGR group was related to their elevated umbilical resistance and pulsatility indices, we modelled the placental circulation using a Windkessel model, and demonstrated that vascular compliance (and not just vascular resistance) directly affected blood flow pulsatility, suggesting that it is an important parameter for the disease. Our study showed that biomechanics study on placenta could extend our understanding on placenta physiology.

Addition of sildenafil citrate for treatment of severe intrauterine growth restriction: a double blind randomized placebo controlled trial

Background: Severe intrauterine growth restriction complicates approximately 0.4% of the pregnancies. It increases the risk of perinatal morbidity and mortality.Subjects and methods: A double blind placebo controlled trial was conducted in Beni Suef University hospitals during 2017. It included 46 pregnant women with severe intrauterine growth restriction. Women were randomly allocated into two groups each included 23 patients. Intervention group received sildenafil citrate 20 mg orally three times a day, in addition to fish oil and zinc supplementation. Control group received tablets similar to sildenafil and the same treatment as intervention group. Primary outcomes included improvement in umbilical and middle cerebral arteries pulsatility indices and abdominal circumference.Results: Umbilical and middle cerebral arteries Doppler indices showed significant difference between groups after intake of sildenafil. Umbilical artery pulsatility index decreased significantly (p value = .001) while middle cerebral artery pulsatility index increased significantly in intervention group (p value0.001). Moreover, abdominal circumference growth velocity improved after two weeks of sildenafil intake (p value = .001).Conclusions: Sildenafil citrate may improve uteroplacental and fetal cerebral perfusion in pregnancies complicated by severe intrauterine growth restriction. It also improves abdominal circumference growth velocity. A wide scale randomized trials are needed for evaluation of neonatal and long term morbidity and mortality outcomes of pregnancies treated by sildenafil citrate.

Pregnancy in patient with X-linked hypophosphatemic rickets – management and outcome

Introduction: X-linked hypophosphatemia (XLH) is a genetically determined disorder inherited as a dominant trait associated with mutation within the PHEX gene. Phenotypic presentation of XLH ranges from isolated hypophosphatemia to severe lower-extremity bowing. Case Report: Preterm hypotrophic infant was born to a mother with a history of XLH, arterial hypertension, and aortic valve insufficiency. The course of pregnancy was complicated by severe symmetric intrauterine growth restriction (IUGR), abnormal umbilical artery flow, and fetal heart rate decelerations during the non-stress test. Discussion: Occurrence of IUGR was most probably due to severe maternal disorders, as no data suggesting association between XLH in mother and symmetric IUGR is available. XLH, treatment side effects, and secondary hyperparathyroidism may manifest by variety of medical conditions including nephrocalcinosis, hypertension or heart disease. Proper management of pregnancy in this group of patients requires appropriate preconception counseling and multidisciplinary approach during pregnancy and after delivery.

Case 3: A Term Newborn with Intrauterine Growth Restriction and Severe Fetal Brain Anomalies

A 29-year-old gravida 4, para 3 woman is seen by the maternal-fetal medicine team because of abnormal ultrasonographic findings at 34 weeks of gestation. The fetus has severe intrauterine growth restriction (IUGR) (<1st percentile) and multiple organ abnormalities, including microcephaly, small forebrain, scalloped parietal bones, bilateral ventriculomegaly, dilated third ventricle, splayed thalami, irregular falx, scattered intracranial calcifications, and a small, flattened forehead. Fetal echocardiography shows levorotation of the cardiac axis, tortuous ductus arteriosus, and tricuspid valve thickening. Her prenatal history is notable for travel to the Dominican Republic until 12 weeks of gestation. She denies any fever, insect bites, rash, conjunctivitis, or arthralgia. Findings on other prenatal laboratory screening are reassuring. After the induction of labor for IUGR, a male infant is delivered at 37 2/7 weeks of gestation via normal spontaneous vaginal delivery. Brief positive pressure ventilation is given in the delivery room for an initial low heart rate. The heart rate quickly recovers, but respiratory distress develops, requiring continuous positive airway pressure (CPAP). The infant is transferred to the NICU with the administration of CPAP. Upon admission, physical examination shows a boy with a birthweight of 2,140 g (2.8th percentile), length of 40.5 cm (<1st percentile), and head circumference of 29 cm (<1st percentile). Pertinent findings include microcephaly and global hypertonia, along with contractures of the upper and lower extremities (Fig 1). Figure 1. Contractures of upper and lower extremities. …

Self-Renewing Trophoblast Organoids Recapitulate the Developmental Program of the Early Human Placenta.

SummaryDefective placentation is the underlying cause of various pregnancy complications, such as severe intrauterine growth restriction and preeclampsia. However, studies on human placental development are hampered by the lack of a self-renewing in vitro model that would recapitulate formation of trophoblast progenitors and differentiated subtypes, syncytiotrophoblast (STB) and invasive extravillous trophoblast (EVT), in a 3D orientation. Hence, we established long-term expanding organoid cultures from purified first-trimester cytotrophoblasts (CTBs). Molecular analyses revealed that the CTB organoid cultures (CTB-ORGs) express markers of trophoblast stemness and proliferation and are highly similar to primary CTBs at the level of global gene expression. Whereas CTB-ORGs spontaneously generated STBs, withdrawal of factors for self-renewal induced trophoblast outgrowth, expressing the EVT progenitor marker NOTCH1, and provoked formation of adjacent, distally located HLA-G+ EVTs. In summary, we established human CTB-ORGs that grow and differentiate under defined culture conditions, allowing future human placental disease modeling.

An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

Background. A systematic review concluded that a caesarean section (CS) performed for medical indications will save lives; however, it is associated with short- and long-term complications. The CS rate at Chris Hani Baragwanath Academic Hospital (CHBAH) was 39.78% in 2015. Objectives. To evaluate the indications for CSs at CHBAH. Methods. This was a cross-sectional study conducted on the data collected in the week of 23 June to 29 June 2015. Each file was evaluated for the correctness of the decision by at least two researchers. Each reviewer could state that he/she absolutely agreed, partially agreed, did not agree or could not make an assessment. Results. The mean (standard deviation (SD)) age of the women was 27.01 (6.35) (range 15 - 44) years. The median (interquartile range (IQR)) parity was 1 (0 - 2) (range 0 - 4). No co-morbidities were found in 13.6% ( n =20) of the reviewed cases. Complications were found to have occurred in 17% ( n =25) of women who gave birth over the week reviewed. The median (IQR) gestational age at delivery was 38.14 (36.39 - 40.14) (range 28.0 - 42.4) weeks. The median (IQR) Apgar (5 minutes) was 10 (9 - 10) (range 0 - 10). The median (IQR) birth weight was 3 040 (2 530 - 3 440) (range 825 - 4 575) g. The most common indications were fetal distress ( n =73; 49.66%) and dystocia ( n =42; 28.57%). There was absolute agreement between the two reviewers in the following: retained second twin, antepartum haemorrhage (APH) of unknown origin, placenta previa, severe intrauterine growth restriction, multiple pregnancy, abnormal presentation, eclampsia and two previous CSs. When the indication was fetal distress, dystocia, second-stage CS, or one previous CS, the absolute agreement was between 73.85% and 90.24%. Conclusion. There were few absolute disagreements with the indication cited. Methods used to diagnose fetal distress and dystocia must be evaluated