Terms Of Gestational Age Research Articles

Ovarian ectopic pregnancy: clinical characteristics, ultrasound diagnosis and management.

To compare the clinical, ultrasound and biochemical characteristics of ovarian ectopic pregnancy (OEP) with those of tubal ectopic pregnancy (TEP). This was a retrospective case-control study of women with OEP and those with TEP seen at a single center between December 2010 and February 2021. OEP was defined as a pregnancy located completely or partially within the ovarian parenchyma, seen separately to a corpus luteum, if a corpus luteum was present within the ipsilateral ovary. We compared demographic features, risk factors, clinical presentation, ultrasound findings and outcomes, such as blood loss at surgery, need for blood transfusion, length of hospital stay, follow-up and future pregnancy outcome, between cases of OEP and TEP. Overall, 20 women with OEP were identified and compared to 100 women with TEP. A total of15/20(75%) OEPs were diagnosed correctly on the first ultrasound scan. There was no difference between the groups in terms of maternal age, gestational age, gravidity, parity or risk factors. Compared with TEP, OEP was more likely to present with abdominal pain without vaginal bleeding (12/20 (60%) vs 13/100 (13%); odds ratio (OR), 10.0 (95% CI, 3.45-29.20); P < 0.01), contain an embryo with cardiac activity (3/20 (15%) vs 2/100 (2%); OR, 8.7 (95% CI, 1.34-55.65); P = 0.02) and have severe hemoperitoneum on ultrasound (9/20 (45%) vs 8/100 (8%); OR, 9.4 (95% CI, 3.01-29.40); P < 0.01), and had a higher volume of blood loss at surgery (median, 700 mL vs 100 mL; P < 0.01). All surgically managed OEPs had successful laparoscopic treatment (18 excisions, one wedge resection) with preservation of the ovary. Only one (5%) case of OEP required a blood transfusion. OEP is more likely than TEP to contain an embryo and to present with severe hemoperitoneum. In a dedicated early pregnancy setting, the majority of OEPs were detected on an ultrasound scan at the initial visit, facilitating optimal minimally invasive surgical management, reducing the risk of blood transfusion and oophorectomy. Our findings can be used as a reference for clinicians who may not otherwise encounter this rare condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The effect of thyroid disorders on obstetric and perinatal outcomes: an observational retrospective study in a tertiary care center of north India

Background: The incidence of hypothyroidism in pregnancy is between 0.5-3.5%, hyperthyroidism occurs in about 0.2-0.4%. They are associated with various maternal-fetal complications. Methods: This retrospective observational cohort study was conducted in SMGS Hospital, Jammu, India after ethical clearance. Admitted patients were included over a period of 1 year from January to December 2021. Inclusion criteria was women belonging to any period of gestation admitted to the labour room and woman with established thyroid disorder. Exclusion criteria was women on drugs influencing thyroid functions. Results: 1641 (10.43%) of 15722 women had thyroid disorders. Hypothyroidism in 10.37% (8.99% subclinical and 1.37% overt) and hyperthyroidism in 0.06%. PPROM was seen in 5.9% subclinical, 2.7% overt hypothyroid, none of hyperthyroid group. 7% subclinical, 8.5% overt hypothyroid and 1/10 women in hyperthyroid group had GDM. Abruption seen in 2.5% subclinical, 1.7% overt hypothyroid and none in hyperthyroid. In subclinical group 3.2% had gestational hypertension, 5.2% had preeclampsia and 0.6% had eclampsia. In overt hypothyroid, 2.8% had gestational hypertension, 7.9% preeclampsia and 1.7% eclampsia. In hyperthyroid group, 1/10 had gestational hypertension, 1/10 had preeclampsia. 18.2% subclinical, 14.7% overt hypothyroid, 2/10 in hyperthyroid group had history of abortion. 7% subclinical, 9.6% overt hypothyroid and 0/10 hyperthyroid group had infertility. 25.8% babies born were abnormal in terms of less gestational age at birth, low birth weight, IUGR, low apgar and IUD. 16.5% babies that had low birth weight &lt;2.5 kg. Conclusions: The impact of thyroid disorders warrants routine screening for thyroid dysfunctions in all women in prenatal and antenatal period to predict and prevent adverse maternal-neonatal outcomes.

Challenges and perspectives of abdominal pregnancy in a resource-limited setting: A case series

Introduction and importanceAbdominal pregnancies, although rare, present unique challenges in both diagnosis and management. This case series reports on four cases of abdominal pregnancies diagnosed in a remote and underserved region of the Democratic Republic of Congo, highlighting the difficulties encountered in an under-equipped environment. Case presentationThe cases were documented in a remote village of DRC, which lacks specialized medical personnel and relies heavily on traditional healers. We report here 4 cases of abdominal pregnancies, their clinical presentations, diagnostic modalities, and surgical approaches. The cases varied in terms of clinical symptoms, gestational age, and placental implantation sites. Delayed diagnosis and presentation were common, resulting in significant hemoperitoneum and adverse fetal outcomes. All cases required laparotomy for both diagnosis and intervention. Clinical discussionAbdominal pregnancies can go undetected until advanced gestational age, with common physical findings including abdominal tenderness, abnormal fetal lie, fetal body parts readily palpable, and a displaced cervix. Laboratory tests may raise suspicion, but treatment options depend on intraoperative findings and gestational age. Advanced abdominal pregnancies are associated with high mortality rates for both the mother and the fetus. Laparotomy is typically required for diagnosis and intervention, with variations in placental implantation sites. Management of the placenta remains a debated topic, with partial or complete removal both viable options. ConclusionAbdominal pregnancies pose significant challenges in resource-poor settings, where limited healthcare resources and a shortage of specialized medical personnel can impede early diagnosis and appropriate management. Enhancing prenatal care, improving diagnostic capabilities, and increasing awareness among healthcare providers and communities are essential for optimizing outcomes in these complex obstetric cases.

Study on Serum Calcium, Magnesium and Uric acid Levels in Preeclamptic and Healthy Pregnant Women - A Comparative Study

Background &amp; Objective: Pre-eclampsia is the most common medical complication of pregnancy associated with increased maternal and infant mortality and morbidity. Various dietary deficiencies or excesses have previously been linked to preeclampsia. Many studies have documented that the changes in the concentration of minerals like calcium, magnesium, and uric acid have a link to the etiopathogenesis of preeclampsia. The present study was undertaken to find the associations of serum calcium, magnesium, and uric acid with preeclampsia. Methods: This cross-sectional comparative study was carried out in the Department of Physiology in collaboration with the Department of Biochemistry, Rajshahi Medical College, Rajshahi over a period of one year between July 2018 to June 2019. Pre-eclamptic and healthy pregnant women aged 18-35 years with single-tone pregnancies having agestational age of 28-32 weeks were the study population. While preeclamptic pregnant women were included as cases, healthy pregnant women were included as controls. A total of 100 cases (pre-eclamptic women) and an equalnumber of controls (healthy pregnant women) were included. Serum calcium, magnesium, and uric acid levels of the subjects were compared between the case and the control groups to evaluate their association with preeclampsia. Result: The findings of the study revealed that cases were older and heavier than the controls. However, both groups were alike in terms of gestational age. Both systolic and diastolic blood pressures were much higher in the case group than those in the control group. The serum calcium was significantly decreased in the case group than that in the control group (p &lt; 0.001). The serum magnesium was also significantly dropped in the case group compared to the control group (p &lt; 0.001). However, the serum uric acid was dramatically raised in the former group than that in the latter group (p &lt; 0.001). Conclusion: The study concluded that serum calcium and magnesium levels are significantly decreased and serum uricacid levels significantly increased in preeclamptic women. Ibrahim Card Med J 2022; 12 (2): 27-31

Elevated Serum Homocysteine Concentrations in Severe Preeclampsia and Eclampsia

Background &amp; objective: Preeclampsia, a pregnancy-specific syndrome, is a major cause of maternal and perinatalmorbidity and mortality all over the world. Several studies have indicated that homocysteine concentrations areincreased in women with preeclampsia. However, there is still conflicting evidence on the extent to which elevatedmaternal homocysteine contributes to this deadly complication of pregnancy. The present study was, therefore,intended to see the association between serum homocysteine and preeclampsia. Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology, Dhaka MedicalCollege Hospital, Dhaka over a period of 2 (two) years from July 2007 to June 2009. Pregnant women with gestationalage ranging between 24 – 40 weeks having preeclampsia or eclampsia were considered as cases, while gestationalage-matched pregnant women without preeclampsia and eclampsia were considered as controls. However, pregnancywith diabetes mellitus, known renal or hepatic disease, urinary tract infection, cardiovascular disease, and takinganti-epileptics were excluded from the study. A total of 100 pregnant women – 50 cases and 50 controls were selectedfor the study. Among the cases, 16 had mild preeclampsia, 17 had severe preeclampsia, and 17 had eclampsia. Result: Two-thirds of the cases and 60% of the controls were in their 3rd decade of life with no significant differencebetween the study groups (p = 0.651). There was no significant difference between the groups in terms of gravidityand gestational age. However, the past history of PE demonstrated its more significant presence in the case group thanthat in the control group (p = 0.030). Out of 50 cases, 30(60%) had severe proteinura (+++), 15(30%) had moderateproteinuria (++) and 5(10%) had mild proteinuria. The mean serum homocysteine level was significantly higher inmild PE (7.2±1.2 μmol/L) than that in normal pregnant women (5.3±1.0 μmol/L). The concentration of homocysteineincreases with the increase in severity of preeclampsia (p = 0.004) and turning preeclampsia into eclampsia (p =0.027). The data show as the grade of proteinuria increases progressively (from mild to severe) the concentrations ofhomocysteine level also increase progressively from 6.3 ± 1.6 μmol/L in mild proteinuria to 11.4 ± 3.7 μmol/L insevere proteinuria. Conclusion: The serum homocysteine level is significantly elevated in mild PE than that in normal pregnant women.The concentration of homocysteine increases further with the increase in the severity of preeclampsia and ineclampsia. Ibrahim Card Med J 2022; 12 (2): 10-14

Antenatal Corticosteroid Treatment During the Late-Preterm Period and Neonatal Outcomes for Twin Pregnancies

Antenatal corticosteroid treatment of individuals with singletons at risk for delivery during the late-preterm period has been academically recommended. However, the evidence on the use of antenatal corticosteroid treatment for twins at risk for delivery during the late-preterm period is still lacking. To evaluate whether antenatal corticosteroid treatment during the late-preterm period in twin pregnancies was associated with a lower risk of newborn morbidity. This retrospective cohort study of twin pregnancies delivered from February 1, 2013, to September 30, 2020, in a university-affiliated hospital in China included 1974 individuals with twin pregnancies who were at risk for late preterm birth (34 weeks and 0 days to 36 weeks and 6 days of gestation). Data were analyzed from June 30 to July 13, 2023. Antenatal corticosteroid treatment during the late-preterm period. The primary outcome measure was composite neonatal respiratory morbidity, defined as at least 1 of the following postnatal occurrences in at least 1 neonate of the twins: respiratory distress syndrome, mechanical ventilation, surfactant administration, transferred with respiratory complications, or neonatal death. Propensity score overlap weighting was used to analyze the association between antenatal corticosteroid treatment and the risk of neonatal outcomes. The study population consisted of 1974 individuals with twin pregnancies, including 303 (15.3%; mean [SD] maternal age, 30.8 [4.2] years) who received antenatal corticosteroid treatment and 1671 (84.7%; mean [SD] maternal age, 31.2 [4.0] years) who did not receive antenatal corticosteroid treatment. The propensity score overlap weighting showed no significant differences between the antenatal corticosteroid treatment group and the no-antenatal corticosteroid treatment group in the risk of neonatal primary outcome (29 of 303 [9.6%] vs 41 of 1671 [2.5%]; weighted odds ratio, 1.27 [95% CI, 0.60-2.76]). None of the subgroup interaction tests were significant for the neonatal primary outcome in terms of gestational age at delivery, year of delivery, chorionicity, at least 1 infant small for gestational age, intertwin growth discordance, and infant sex, and neither was the sensitivity analysis of using propensity score matching and a different administration-to-birth interval and treating twin infants as individuals. This cohort study found insufficient evidence that antenatal corticosteroid treatment during the late-preterm period in twin pregnancies could be associated with a lower risk of newborn morbidity. This new finding can provide a reference for clinical practice.

Impact of 2.5 mg versus 5 mg letrozole co-treatment in an antagonist protocol for IVF: a retrospective study.

The present study aimed to compare the effectiveness of two different doses of letrozole (2.5 mg and 5 mg daily) in an antagonist protocol for infertile women with normal ovarian reserve. This retrospective cohort study included infertile women who underwent in vitro fertilization treatment with letrozole co-treatment at doses of 2.5 mg and 5 mg from 2007 - 2021 at Shanghai Ninth People's Hospital (Shanghai, China). The control group comprised infertile women who received gonadotropin-releasing hormone antagonist alone. The primary outcome was the cumulative live birth rate, while secondary outcomes included follicular phase endocrine parameters, ovarian stimulation outcomes, pregnancy outcomes, and the incidences of maternal and neonatal complications. Baseline and follow-up data were compared between the groups using ANOVA for normally distributed variables, the Kruskal-Wallis test for non-normally distributed variables, and the Chi-square test for categorical variables. A total of 422 participants were enrolled in the study, with 211 women in the antagonist group, 109 women in the 2.5 mg letrozole co-treatment group, and 102 women in the 5 mg letrozole co-treatment group. Letrozole co-treatment significantly suppressed oestradiol and follicle-stimulating hormone concentrations from stimulation day 5 and onwards, while increasing luteinizing hormone levels on stimulation day 5 and trigger day. The effect was more pronounced with a 5 mg dose of letrozole compared to a 2.5 mg dose (P < 0.05). Administration of 5 mg letrozole reduced the gonadotropin dose (P < 0.05) without negatively affecting the number of oocytes retrieved and subsequent embryo parameters (P > 0.05). The analysis of cumulative live birth rates showed rates of 29.4% in the letrozole 5 mg group, 27.5% in the letrozole 2.5 mg group, and 33.6% in the control group, with no statistically significant difference (P > 0.05). There were no reported pregnancy complications in the two letrozole groups. Additionally, there were no significant differences among the three groups in terms of gestational age and birth weight for both singleton and twin births. This study indicates that the administration of letrozole in an antagonist protocol, at both 2.5 mg and 5 mg dosages, results in comparable clinical outcomes.

Expression of inhibitory receptors on peripheral blood T cells in pregnant women with preeclampsia

Maternal adaptation of the immune system aimed at limiting the immune response to fetal antigens is a necessary condition for a successful pregnancy. It involves various mechanisms (Th1/Th2 switching, Treg expansion, induction of anergy and apoptosis of T lymphocytes, development of T cell depletion) that are induced through the ligation of inhibitory receptors. Accordingly, the expression of inhibitory receptors on T cells, including PD-1, CTLA-4, and Tim-3 molecules, may reflect the effectiveness of immune adaptation and its impairment in pregnancy pathology. Preeclampsia (PE), the pathogenesis of which is associated with the impairments of immunological tolerance is a major complication of pregnancy. Accordingly, changes in the expression of inhibitory receptors on T cells may be biomarkers of abnormal gestation and potential therapeutic targets. The aim of this work was to study the expression of inhibitory molecules on peripheral blood T cells in women with PE. The study recruited 29 pregnant women with PE and 36 women with uncomplicated pregnancies in the second half of pregnancy. Pregnant women of the study groups were comparable in terms of gestational age, number of pregnancies and parity of childbirth. The control group consisted of 28 fertile women with children. Relative content of CD8+PD-1+, CD8+CTLA-4+, CD8+TIM-3+, CD8+PD-1+TIM-3+, CD4+PD-1+, CD4+CTLA-4+, CD4+TIM-3+, CD4+PD-1+TIM-3+T cells in blood were analyzed by flow cytometry. It has been shown that uncomplicated pregnancy is associated with increased expression of PD-1 and Tim-3 T cells, which is manifested by an increase in the relative content of CD4+Tim-3+, CD8+PD-1+ and PD-1+Tim-3+T lymphocytes . In PE, on the contrary, there is a reduction in the expression of PD-1 and Tim-3 by T cells, in particular, a decrease in the proportion of CD4+Tim-3+ and CD8+PD-1+ cells; the absence of elevated levels in PD-1+Tim-3+ cells (compared to uncomplicated gestation) and an increase in CTLA-4+ cells within CD4+ lymphocytes. Changes in the expression of inhibitory receptors are associated with the severity of PE. A decrease in CD4+Tim-3+ and CD8+PD-1+T cells is most typical for patients with moderate PE, and an increase in CD4+CTLA-4T cells for pregnant women with severe PE. The relationship between changes in the expression of inhibitory molecules and the onset of PE has also been demonstrated. A distinctive feature of early PE is a decrease in the proportion of CD8+CTLA-4+ cells and a more pronounced increase in CD4+CTLA-4+ cells, while late PE is associated with a decrease in CD4+PD-1+ cells and a more pronounced decrease in CD4+Tim-3+ cells. The results obtained indicate a changes in the expression of CTLA-4, PD-1 and Tim-3 molecules on circulating T cells in pregnant women with PE and the association of these changes with the severity and the onset of PE manifestation.

Granulocyte Colony-Stimulating Factor (G-CSF): Is It Effective for Feeding Tolerance in Very Low Birth Weight Infants?

Background: Feeding intolerance is one of the most common problems in very low birth weight infants. Granulocyte colony-stimulating factor (G-CSF), one of the cytokines in amniotic fluid and human milk, plays an important role in gut maturation. Objectives: The aim of this study was to evaluate the effect of oral administration of G-CSF on feeding tolerance in preterm infants weighing ≤ 1200 g. Methods: This randomized, single-blind, placebo-controlled clinical study was conducted between September 2018 and June 2019 on preterm infants (≤ 32 weeks) weighing ≤ 1200 g and matched in terms of gestational age, birth weight, and umbilical cord pH. The intervention group received G-CSF by gavage simultaneously with the start of enteral feeding stopped after 10 days. The primary outcome was the duration of infant milk that reached 50, 75, and 100 mL/kg/day, and the secondary outcomes were the onset of weight gain and the length of hospital stay. Results: Out of 68 eligible infants, 31 infants in each group completed the study. There was no significant difference between the two groups in terms of the length of hospital stay and the duration of reaching a feeding volume of 50 and 75 mL/kg/day; nonetheless, the duration of reaching a feeding volume of 100 mL/kg/day and the time to start gaining weight in the case group were significantly shorter than those of the control group (P = 0.029 and P = 0.002, respectively). Conclusions: The oral administration of G-CSF in preterm infants ≤ 1200 g improves feeding tolerance and can further shorten the time to reach full enteral feeding.

Effect of Tranexamic Acid in Prevention of Post-Partum Haemorrhage: A Prospective Observational Study

Background: Treatment of Post partum haemorrhage relies primarily on uterotonics, but early use of Tranexamic Acid (TXA) has become part of several recommended algorithms. Recent data has demonstrated that Tranexamic Acid (TXA), an antifibrinolytic agent, reduces death due to bleeding when used as a treatment for PPH. This study was conducted with an objective to see the role of tranexamic acid along with uterotonic agent (oxytocin) in prevention of postpartum hemorrhage. Materials and Methods: The present prospective observational study carried out at the Maternal and Child Health (MCH) wing Department of a rural tertiary care hospital and medical college situated in the central India during January 2021 to December 2022. A total sample size of 1640 patients attending labour room for vaginal birth or caesarean section in 3rd stage of labour were included in the study. Total 1640 women were further divided into two groups, Group A (receiving both tranexamic acid along with oxytocin) and Group B (receiving only oxytocin). Blood loss in each group was measured by visual method and Gravimetric (measurement by weight) method. They were followed till delivery; maternal and neonatal outcome was studied. Statistical analysis was done by using SPSS 27.0 version and GraphPad Prism 7.0 version and p&lt;0.05 considered as level of significance. Results: The majority of patients in Group A and Group B were between 26-30 years of age group. There was no significant difference between the groups in terms of maternal age, gestational age, gravida and booking status. The mean foetal birth weight among Group A was 2421.28 ± 626.91 and Group B was 2381.38 ± 721.20 with no significant difference between the groups. There was significant reduction in blood loss in study group A as compared to control group in both vaginal and LSCS birth with statistically significant difference. Conclusion: Tranexamic acid injection, an antifibrinolytic agent when given prophylactically after delivery of placenta along with oxytocin appears to reduce the blood loss during normal labour as well as caesarean sections effectively.

Maternal and Neonatal Outcomes of Sub-clinical Hypothyroidism Treated With Levothyroxine in Pregnancy: A Retrospective Cohort Study.

The effect of sub-clinical hypothyroidism (SCH) in pregnancy has been controversial. Furthermore, the impact of levothyroxine replacement on improving outcomes in pregnant women with SCH is unknown. This study aimed to assess the maternal and neonatal outcomes of pregnant women with SCH who were treated with levothyroxine replacement. This retrospective chart review was conducted at a tertiary hospital in Iran between 2020 and 2022. All pregnant women who had given birth during the study period were recruited. Those who did not have thyroid function test results within 10-12 weeks, as well as those with SCH who did not have levothyroxine replacement, were excluded. The subjects were divided into two groups based on the 2017 American Thyroid Association (ATA) criteria: non-SCH (TSH values 0.27-2.5 mIU/L) and SCH (TSH values more than 4.0 mIU/L). The demographic, obstetric, maternal, and neonatal outcomes of both groups were compared. The Chi-square test was used to compare the categorical variables. Binary logistic regression was used to assess differences in categorical variables. With a frequency of 10.5%, 935 women out of 8888 were diagnosed with SCH. In terms of age, educational level, living residency, medical insurance, access to prenatal care, and smoking status, there were no differences between the two groups. In terms of gestational age, parity, onset of labor, history of infertility, hypertension, cardiovascular disease, anemia, and overt diabetes, there were no differences between the two groups; however, gestational diabetes was more common in those with SCH. Compared with the non-SCH group, the prevalence and risks of gestational diabetes [19.8 vs. 14.2, odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.72-3.95] were significantly higher in the SCH group after controlling for confounding factors. There were no differences in neonatal outcomes between the two groups. Except for gestational diabetes, we found no significant adverse events in terms of maternal and neonatal outcomes among women with SCH who were treated with levothyroxine.

Yenidoğan Yoğun Bakım Ünitesinde İzlenen Çok Düşük Doğum Ağırlıklı Bebeklerde Morbidite Ve Mortalite Sonuçları: 15 Yıl Arayla İki Beş Yıllık Dönemin Karşılaştırılması

Introduction and methods: &#x0D; Thanks to developments in perinatal and neonatal care, the survival rate of premature babies has increased. Depending on the development level of countries and units, some of the morbidity rates may increase, while others may decrease. In this retrospective cross-sectional study; the morbidity and mortality results of very low birth weight (VLBW) infants were evaluated by comparing the results of the infants in our previous study and the data of developed countries.&#x0D; Results: &#x0D; 203 infants were included in the last group. The mean birth weight of these babies was 976±308 g and the mean gestational age was 27.8±2.5 weeks. The rate of babies with a gestational age of 28 weeks and above were significantly lower than the first group containing 173 infants. Regarding major morbidities, the rates of bronchopulmonary dysplasia (moderate to severe) and necrotizing enterocolitis (&gt;stage 2) were significantly higher in the last group; while the rates of retinopathy of prematurity (&gt;grade 2), intraventricular hemorrhage (&gt;grade 2) and periventricular leukomalacia were also similar among the two groups. While survival rates were found to be similar, the survival rate without major morbidity was significantly lower in the last group.&#x0D; Conclusion: &#x0D; While the survival rates remained unchanged despite the observation of smaller babies in terms of birth weight and gestational age in the last period when mortality and morbidity data were compared with developed countries, the study demonstrated a need for improvement in mortality rates especially in small gestational weeks, while major morbidity rates were generally encouraging.

Application of jejunal turnover and bowel plication technique in neonatal high intestinal atresia: a retrospective study.

To evaluate the outcomes of jejunal turnover and bowel plication (JTBP) in high jejunal atresia of neonates. The clinical data of neonates met the criteria were retrospectively analyzed from January 2012 to December 2021.The neonates were divided into the JTBP group and control group according to the surgical procedure.Demographics, postoperative morphology of the duodenum and proximal jejunum,intestinal recovery time and complications were compared. 75 patients were allocated to the JTBP (n=30) and control (n=45) groups, respectively. There was no significant difference between the two groups in terms of gestational age, birth weight, age at surgery,the pathological classification,and concomitant disease. UGCS showed that the diameter of the proximal bowel of the anastomotic stoma was normal and the duodenum and proximal jejunumin streamline shape in the JTBP group.While the duodenum dilated, and the shape of Trojan angle was classified into sharp angle and blunt round angle in the control group.The duration of total parenteral nutrition, postoperative oral feeding time and oral feeding time of 40 mL/3 h was significantly different between the JTBP group and control group(sharp and blunt round type): 9.0±3.5d,7.0±2.1d and 11.0±6.0d vs 16.9±4.2 d, 14.0±5.0 d and 19.0±7.4 d vs 11.9±8.3 d, 8.2±3.9d and 15.8±3.6d(P<0.05). JTBP for neonatal high jejunal atresia can significantly change the diameter of the proximal bowel and the course of duodenum jejunum flexure. Postoperative bowel movement was more in line with fluid dynamics, which was conducive to the recovery of the intestinal function and resulted in fewer complications.

Investigation of serum afamin concentration in pregnant women diagnosed with late fetal growth restriction or small for gestational age fetus

Objective To investigate the afamin concentration in the serum of pregnant women diagnosed with late fetal growth restriction (FGR) or small for gestational age (SGA) in the third trimester. Methods This prospective case-control study was conducted on 126 pregnant women, 42 of whom were diagnosed with late FGR in the third trimester, 43 were SGA, and 41 were healthy controls. The groups were compared in terms of maternal serum afamin concentrations. Results Three groups were similar in terms of demographic characteristics and gestational age at blood sampling for afamin (p < .05). The median afamin concentration was determined as 199 ng/mL in the late FGR group, 153 ng/mL in the SGA group, and 108 ng/mL in the control group (p = .000). In the post-hoc analysis, while maternal serum afamin concentrations were found to be significantly higher in the late FGR group and SGA group compared to the control group but, this significance could not be shown between the FGR group and the SGA group (p = .00001, p = .005, p = .137, respectively). In the ROC analysis, the optimal cutoff value of serum afamin concentration to predict late FGR was determined as 141 ng/mL, with a sensitivity of 66.6% and a specificity of 85.3%. Conclusions The serum afamin concentration in the third trimester was found to be higher in pregnant women with late FGR compared to the SGA and control groups. Although afamin is seen as a promising molecule in the clinical prediction of late FGR, this needs to be supported by large series of studies.

A Comparison of Nifedipine Versus a Combination of Nifedipine and Sildenafil Citrate in the Management of Preterm Labour.

Background Preterm delivery is a significant contributor to neonatal and infant morbidity and mortality. Preventive methods are preferable to treatment protocols for reducing perinatal mortality and morbidity. The calcium channel blocker nifedipine has the potential to be employed as a tocolytic, whereas the phosphodiesterase inhibitor sildenafil citrate promotes smooth muscle relaxation. Objective This study aims to examine the tocolytic effect of nifedipine in combination with sildenafil citrate in managing preterm labour (PTL). Methods After approval from the ethical board, 160 patients fulfilling the selection criteria were enrolled in the study from the outpatient and emergency department of obstetrics and gynaecology, University of Lahore, Pakistan. After taking written informed consent, their demographic profile, i.e., name, age, gestational age at presentation, parity, and expected date of delivery was noted. Patients were randomly assigned in a 1:1 ratio to two study groups (Group A: sildenafil citrate + nifedipine) and (Group B: nifedipine) using a computer-generated random number table to obtain a trial sequence. In group A, each patient was given nifedipine 20 mg orally, followed by 10 mg orally every eight hours for 48 hours and vaginal administration of sildenafil citrate, 25 mg at eight-hour intervals, for 48 hours. In group B, females were given nifedipine 20 mg orally, followed by 10 mg orally every 8 hours for 48 hours. They were kept admitted for 72 hours.SPSS Statistics version 21.0 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) was used to enter and analyse the collected data. Mean and standard deviation was calculated for quantitative variables like age, gestational age at presentation, gestational age at delivery, and BMI. Frequency and percentage were calculated for parity and preterm delivery. Results The study involved 160 patients, with the average age in Group A being 29.60±4.9 years and in Group B being 30.96±4.98 years. In terms of gestational age at delivery, Group A had an average of 34.16±1.7 weeks, while Group B had an average of 33.5±1.8 weeks (p-value<0.05). Preterm delivery was observed in 68.5% of Group A and 41.3% of Group B, with a significant p-value of 0.001. The study also discovered that the duration of prolonged pregnancy was significantly higher in Group A compared to Group B, with averages of 14.96±10.37 days and 10.24±8.97 days, respectively (p-value=0.002). Conclusion The results of this study suggest that the combination of sildenafil citrate and nifedipine may offer a promising new approach to improving pregnancy outcomes in cases of PTL. In the present study, sildenafil citrate plus nifedipine showed a significant effect in the management of PTL and prolongation in mean gestational age at delivery.

P-496 The effect of adding letrozole to the combined treatment of caesarean scar pregnancy with methotrexate followed by hysteroscopic evacuation of products of conception

Abstract Study question Does adding letrozole to combined cesarean scar pregnancy (CSP) treatment cause a greater decrease in B-human chorionic gonadotropin (B-hCG) concentrations and less blood loss? Summary answer The addition of letrozole to the combined CSP treatment does not result in a greater decrease in B-hCG concentrations or less blood loss. What is known already There is no reference treatment for CSP as the limited number of cases precludes the extrapolation of results. In our center we successfully use two-step treatment with methotrexate followed by hysteroscopic removal of products of conception (POC). The time in between is needed to achieve a decrease in the trophoblast's vital potential (B-hCG fall) and its vascularization. The suppression of estradiol production by letrozole may interfere with the physiological effect of progesterone, which is essential for the maintenance of pregnancy. Additional administration of letrozole could further reduce the vital potential of the pregnancy, resulting in a lower rate of complications. Study design, size, duration A prospective cohort tertiary single-center study (consent no. 1072.6120.321.2020) was conducted among women with CSP from January 2021 to December 2022. Only women with increasing concentrations of B-hCG and consent of the Bioethics Committee for termination of pregnancy were included. Women with decreasing B-hCG concentrations were excluded. All enrolled women gave informed written consent to participate in the study. Participants/materials, setting, methods All women received a single dose of 100 mg MTX intravenously and 50 mg MTX in intra-amniotic injection (day 0), along with 30 mg potassium chloride in case of positive fetal heartbeat (FH). Women who consented were additionally given letrozole 5 mg orally (day 0) for 10 days. B-hCG concentration was measured on day 0,4,7. After obtaining satisfactory decrease in B-hCG and POC vascularization, women underwent hysteroscopic evacuation of POC. Blood loss parameters were measured. Main results and the role of chance The study included 28 women aged 27-41, with a gestational age of 6-12 weeks. FH was present in 17/28 (60.7%) women. Of the 28 women, 16 (57.1%) received additional letrozole (arm 1). There was no significant difference between arm 1 vs. arm 2 (without letrozole) in terms of gestational age (7.69±1.54 vs. 8.00±2.09 weeks, p = 0.85), FH positivity (10/16, 62.5% vs. 7/12, 58.33%; p = 1), BMI (25.39±5.08 vs. 26.24±6.51; p = 0.82), day 0 B-hCG (47656.89± 37747.87 vs. 51870.83± 45838.87 mIU/ml; p = 0.89) and day 0 hemoglobin (Hb) (12.98±0.74 vs. 12.74±1.26 g/dl; p = 0.57). Timing of hysteroscopy was not significantly different between arm 1 vs. arm 2 (day 22.19± 14.44 vs. 31.42± 25.83; p = 0.42). The dynamics of B-hCG decline in arm 1 vs. arm 2 between days 4-0 (-3295.67± 15133.13 vs. −6883.00± 20029.88 mIU/ml; p = 0.71) and 7-4 (-13137.82± 13765.14 vs. −19145.75± 23526.70 mIU/ml; p = 0.68) was not significantly different. There were no differences between arm 1 vs. arm 2, in decrease in Hb concentration on day 1 post-hysteroscopy (-1.79± 1.67 vs. −2.19± 1.68 g/dl, p = 0.53), blood loss volume (318.75± 437.37 vs. 591.67 ± 744.02 ml; p = 0.29) and rate of hemorrhage (4/16, 25% vs. 3/12, 25% cases, p = 1). Limitations, reasons for caution The limitations of the study are the small sample size, the single-center nature of the study, and the arbitrarily set dosing regimen of letrozole. Wider implications of the findings The results do not support the use of letrozole in the above regimen as an adjunct to combined CSP treatment. Trials with a larger sample size and with a different letrozole dosing regimen are needed to confront the results. Trial registration number 072.6120.321.2020

Cultural considerations and beliefs surrounding preterm birth in Kenya and South Africa

BackgroundPreterm birth (PTB) is a global health epidemic, sub-Saharan Africa is severely impacted due to its limited healthcare resources. Pregnancy knowledge, cultural beliefs and practices play a role in the identification of risk and management of PTB. This study explored knowledge, understandings, cultural beliefs and attitudes to pregnancy and PTB, as well as cultural considerations for the introduction of an intravaginal device which could be used to identify PTB risk.MethodsQualitative research was conducted in South Africa and Kenya. In-depth interviews were conducted using semi-structured guides with women with a history of PTB (n = 10), healthcare providers (n = 16) and health systems experts (n = 10); and 26 focus group discussions with pregnant women seeking antenatal care (n = 132) and community male partners/fathers (n = 54). Interviews/discussions were transcribed, translated, and analysed thematically.ResultsPregnancy knowledge, especially for first time pregnancies was poor, with many reporting late entry to antenatal care. Knowledge about PTB was understood in terms of gestational age, weight or small size of baby, with concerns about long term health and stigma. Various risk factors for PTB were described, including those related to traditions and beliefs of witchcraft/curses. Cultural practices, such as the use of traditional medicines and pica, and religion and its impact on health seeking behaviour were also viewed as risk factors. Although insertion of intravaginal devices was not widely acceptable in traditional communities, especially during pregnancy, it was felt that the use of one to detect risk of PTB would be accepted if proven effective in reducing PTB risk.ConclusionsVarious culturally-informed beliefs exist which explain understandings of and attitudes toward pregnancy, pregnancy risk, and PTB. An inclusive exploratory process is critical to facilitate an understanding of the beliefs and traditions which could impact the introduction and design of a product to detect the risk of PTB.

The thicker the endometrium, the better the neonatal outcomes?

Is endometrial thickness (EMT) on the hCG trigger day related to the neonatal outcome of a single birth after fresh embryo transfer (ET)? An EMT ≤7.8 mm was an independent predictor for greater odds of preterm delivery (PTD) of singletons born after fresh ET. There may be a positive association between live birth rates and EMT after fresh ET. It is still unknown whether a similar association is seen for the neonatal outcomes of singletons in fresh cycles. This retrospective study involved singleton live births in women undergoing autologous IVF cycles during the period from 1 October 2016 to 31 July 2021. A total of 2010 women who fulfilled the inclusion criteria were included. A multivariable regression analysis was performed to detect the relationship between EMT and neonatal outcomes after controlling for potential confounders. Smooth curve fitting and threshold effect analysis were used to evaluate the accurate cutoff value of EMT. The results of the multivariate regression analyses showed that the odds of PTD were reduced by 45% with an EMT of 9.00-9.90 mm (adjusted odds ratio (OR): 0.55, 95% CI: 0.13 to 0.98; P = 0.0451), reduced by 58% with an EMT of 10.00-10.90 mm (adjusted OR: 0.42, 95% CI: 0.06 to 0.87; P = 0.0211) and reduced by 75% with an EMT >11 mm (adjusted OR: 0.25, 95% CI: 0.04 to 0.66; P = 0.0034), compared to the group with an EMT of 6.00-8.90 mm. It could also be seen from the adjusted smooth curves that the odds of PTD decreased and gestational age (GA) increased with increasing EMT. Combined with the analysis of threshold effects, the results indicated that when the EMT was ≤7.6 mm, the incidence of PTD decreased as the EMT gradually increased (adjusted OR: 0.47, 95% CI: 0.03 to 0.99; P = 0.0107), and when the EMT was ≤7.8 mm, the GA increased (adjusted β: 1.94, 95% CI: 1.26 to 2.63; P < 0.0001) as the EMT gradually increased. The main limitation of our study is its retrospective design. Although we found a significant decrease in PTD as the EMT increased, in terms of GA, the magnitude of the differences was modest, which may limit the clinical relevance of the findings. Our data provide new insight into the relationship between EMT and neonatal outcomes by indicating that a thin endometrium of ≤7.8 mm is associated with an increased odds of PTD of singletons after fresh ET. This study was supported by the National Natural Science Foundation of China (grant no. 82071717). There are no conflicts of interest.

Early Treatment of Gestational Diabetes Mellitus and Prediabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials [ID: 1377137

INTRODUCTION: This meta-analysis aims to determine whether early treatment of hyperglycemia in gestational diabetes mellitus (GDM) and prediabetic pregnancies improve perinatal outcomes. METHODS: PubMed/Medline, EMBASE, ClinicalTrials.gov and Web of Science were systematically searched up to June 30, 2022. Randomized clinical trials (RCTs) of early treatment for gestational diabetes mellitus (International Association of the Diabetes and Pregnancy Study Groups [IADPSG] or Carpenter and Coustan [C&amp;C] criteria) and prediabetes (HbA1c 5.7–6.4%) before 20 weeks of gestation were considered eligible. Random-effects model meta-analysis was used to pool the odds ratios (OR) and/or mean differences (MD) with 95% CI. Furthermore, subgroup analysis was performed stratifying by indication for intervention (GDM versus prediabetic). RESULTS: Seven RCTs including 2,757 pregnant individuals, of whom 647 had positive screening before 20 weeks of gestation, were included. Of 647 individuals, 346 were allocated to early treatment and 301 to the routine treatment. There was no significant difference in terms of gestational age at delivery (MD –0.21 [95% CI: −0.44, 0.02], P=.089), rate of cesarean delivery (OR 0.93 [95% CI: 0.64, 1.34], P=.394), hypertensive disorder of pregnancy (OR 1.19 [95% CI: 0.59, 2.39], P=.341), any diabetic medication use (OR 1.31 [95% CI: 0.89, 1.93], P=.177), and neonatal hypoglycemia (OR 1.02 [95% CI: 0.50, 2.08], P=.952). However, there was a decreased risk of macrosomia (OR 0.42 [95% CI: 0.19, 0.92], P=.031) and increased need for insulin use (OR 2.23 [95% CI: 1.30, 3.84], P=.004) for early treatment group. After separate analyses on GDM and prediabetics as distinct groups, the risk of macrosomia was not decreased for GDM and prediabetic subgroups after early treatment. CONCLUSION: Treatment in early pregnancy for GDM or prediabetes does not appear to improve the maternal or neonatal outcomes.

THE EFFECT OF DELIVERY MODE ON NT-PROBNP LEVELS IN NEWBORNS

Objective: Reference values of NT-proBNP levels in newborns may vary depending on gestational age, postnatal age and Apgar scores. However, the effect of the mode of delivery has been less investigated, and the results are contradictory. In this study, it was aimed to compare NT-proBNP levels in healthy term newborns born through vaginal delivery and cesarean (C/S) and to investigate whether delivery method had an effect on it.&#x0D; &#x0D; Material and Methods: Healthy newborns born in our hospital and with a gestational age of ≥38 weeks were included in the study. Cases (n=56) were grouped according to delivery type. Both groups were similar in terms of gender, gestational age, body weight and Apgar scores. NT-proBNP levels, hematological parameters, LDH and CPK levels were studied in blood samples taken in the first hours after birth. The two groups were compared in terms of these parameters and it was investigated whether there was a relationship between the parameters.&#x0D; &#x0D; Results: NT-proBNP levels were 3145 (372-7231) pg/ml in newborns born vaginally and 783 (401-6563) pg/ml in newborns born by cesarean section (p