Trimester Group Research Articles

Reference Intervals of Renal Function Set Established for Healthy Pregnant Women.

This cross-sectional study aimed to explore the variation trend of renal function for healthy pregnant women at different gestational ages and aimed to establish RIs for renal function set tests according to the trimester of pregnancy. A total of 120 healthy pregnant women and 40 healthy non-pregnant women were enrolled in this study and divided into early trimester (1 - 13 weeks of gestation, n = 40), second trimester (14 - 27 weeks of gestation, n = 40), third trimester (≥ 28 weeks of gestation, n = 40), and a non-pregnant women group (n = 40). Analytes of UA, BUN, Cr, β2-MG, Cys-C, RBP, NAG, CO2, HCY, C1q, and NGAL were measured by using the analytical systems of the Second Xiangya Hospital. The RIs were defined by using non-parametric 95% intervals. The RIs for UA, Cr, β2-MG, NAG, CO2, Hcy, and C1q were established for the first and second trimester group and the third trimester group. There were huge differences after pregnancy. The RIs for BUN were different for the 1 - 13 weeks group and the after 14 weeks group. There were significant differences for NGAL in pregnant and non-pregnant women, but not for Cys-C and RBP. The RIs for renal function tests in pregnant women were established, thus providing clinical reference intervals for the clinicians.

Self-Report and Performance-Based Measures for Pelvic Girdle Pain During Pregnancy

Purpose: The purpose of this cross-sectional study was to quantify functional mobility in pregnant individuals during the second and third trimesters, both with and with no pelvic girdle pain, using performance-based measures as compared with self-report tools. Methods: Study participants included 58 individuals between 18 and 45 years of age in the second or third trimesters of pregnancy who were categorized by pelvic girdle pain ratings and positive screening results. Participants completed the Pelvic Girdle Questionnaire (PGQ) and the Pelvic Floor Impact Questionnaire (PFIQ), and were evaluated by accelerometry during quiet standing, straight-line walking, and the Timed Up and Go (TUG) test. Results: The majority of performance measures captured using accelerometry were not statistically different between the Pain and Control groups. However, turning velocities were lower in the third trimester group during turning phases of the TUG (P < .006). Pain and No Pain groups differed in the distribution of PFIQ responses on Chores (P < .001), Exercise (P < .001), Travel (P = .012), and Frustration (P < .001). A statistical difference was present between the Pain and Control groups in PGQ total score (P < .001), and response distributions were statistically different on multiple PGQ items. Discussion: For pregnant individuals, accelerometry-based performance measures do not appear to detect difficulty with mobility, which may begin to be reported during the second trimester. Patient-report outcome tools may help clinicians capture movement difficulty and address biopsychosocial factors that impact pelvic girdle pain associated with pregnancy.

Serological Characteristics and Clinical Significance of Irregular Antibodies in Pregnant Women

To understand the serological characteristics of irregular antibodies in pregnant women and explore their clinical significance. From January 2017 to March 2022, 151 471 pregnant women in Women and Children's Hospital of Chongqing Medical University were enrolled in this study, microcolumn gel card test was used for irregular antibody screening, and antibody specificity identification was further performed in some antibody-positive subjects. The positive rate of irregular antibody screening in the enrolled pregnant women was 0.91% (1 375/151 471), 0.23% (355/151 471) was detected in the first trimester, 0.05% (71/151 471) in the second trimester, and 0.63% (949/151 471) in the third trimester. The positive rate of irregular antibody screening in the third trimester was significantly higher than that in the first and second trimester, and a significant increase in the number of positive cases was found in the third trimester than that in the second trimester. The analysis of agglutination intensity of 1 375 irregular antibody screening positive results showed that the weakly positive agglutination intensity accounted for 50.11% (689/ 1 375), which was the highest, the suspicious positive was 18.69% (257/1 375), and the positive was 31.20% (429/1 375). The significant difference in distribution of agglutination intensity was not observed between the first trimester group and the second trimester group, however, in the third trimester, the proportion of suspicious positive and weakly positive was lower than the first trimester, while, the proportion of positive was higher than the first trimester, and the difference was statistically significant (P < 0.001). Among the irregular antibody screening positive pregnant women, the proportion of pregnant women with pregnancy number ≥ 2 was significantly higher than that with pregnancy ≤ 1. Among 60 pregnant women who underwent antibody identification, the distributions of the antibodies were as follows: Rh blood group system accounted for 23.33% (14/60), Lewis system 43.33% (26/60), Kidd system 3.33% (2/60), MNS system 16.67% (10/60), P1PK system 1.67% (1/60), autoantibodies 1.67% (1/60), and 4 cases was unable to identify (6.67%, 4/60). Among specific antibodies, the anti-Lea was the most common (30.00%), followed by anti-E (16.67%) and anti-M (16.67%). The differences of irregular antibody serological characteristics exist in pregnant women from different regions with different genetic backgrounds, understanding the characteristics of irregular antibody in local pregnant women is of great significance for ensuring transfusion safety in pregnant women and preventing hemolytic disease of newborn.

Study Of Thyroid Profile In Different Trimesters Of Pregnancy

Background: Thyroid disorders and dyslipidemia are frequent during pregnancy, which are associated with complications for both the mother and the fetus. Hence, this study aims to evaluate thyroid function test and its association with dyslipidemia in pregnancy. Method: This laboratory-based cross-sectional study was carried out in Manmohan Memorial Teaching Hospital, Kathmandu, Nepal. A total of 200 participants; where 100 pregnant and 100 non pregnant women were included in the study. Pregnant women were further subdivided into 1st, 2nd and 3rd trimester groups. Thyroid Profile and Lipid profile were estimated. Student t-test, one way ANOVA, and Pearson’s correlation were applied. Findings: The findings of the study revealed that the level of TSH was significantly (p&lt;0.001) lower, TG, TC and VLDL were significantly (p&lt;0.001) higher and HDL was significantly (p&lt;0.001) lower in pregnant women as compared to non-pregnant women. In different trimester of pregnancy TG (p&lt;0.001), TC (p&lt;0.05) and VLDL (p&lt;0.001) were found to be significantly increased with increasing trimester of pregnancy. Conclusion: In medical interventions, screening of thyroid hormones, lipid profile and adjustment of TSH level according to trimester specific range in different trimesters should be implemented to improve lipid indices to decrease pregnancy complications outcomes.

Elevated expression of Toll-like receptor 4 and cytokines in both serum and myometrium at term may serve as promising biomarkers for uterine activation preceding labor.

Increased inflammation and cytokine levels are considered risk factors and promoters of preterm birth (PTB). However, the regulatory mechanism of pregnancy-related inflammation remains unclear. Toll-like receptor 4 (TLR4) plays a critical role in inflammatory responses in various diseases. Therefore, our study aimed to investigate whether TLR4 is involved in the inflammatory responses during uterine activation for labor, with the goal of identifying potential biomarkers for uterine activation at term. We used flow cytometry to detect TLR4 expression on CD14+ maternal blood monocytes in the first, second, and third trimesters. ELISA was employed to measure TLR4 and cytokines levels in the maternal serum of term non-labor (TNL), term labor (TL) women and LPS induced preterm labor and PBS injected controls. TLR4siRNA was transfected into the human myometrial smooth muscle cells (HMSMCs), which were subsequently treated with IL-1β. The mRNA and protein levels of TLR4, uterine contraction-related protein connexin 43 (CX43), oxytocin receptor (OTR), MAPK/NF-κB signaling pathway, and cytokines were analyzed using qRT-PCR, western blotting, and immunohistochemistry. The study revealed TLR4 expression on CD14+ maternal blood monocytes was higher in the third trimester group compared to the first and second trimester groups (p<0.001). Maternal serum concentrations of TLR4 and cytokines were significantly higher in the TL group than the TNL group (p<0.001). TLR4, OTR, CX43, activated MAPK/NF-κB expression, and cytokines levels were upregulated in TL group, and similarly significantly higher in the LPS-induced preterm group than in the control group. Using the HMSMCs we demonstrated that TLR4siRNA transfection suppressed contractility. Interfering with TLR4 expression reduced the expression of OTR, CX43, cytokines, and MAPK/NF-κB activation. There was a significant positive relationship between TLR4 expression and the inflammatory status in the myometrium. ROC analysis indicated that TLR4 and cytokines may serve as potential biomarkers for predicting uterine activation for labor. Our data suggest that TLR4 and cytokines can act as stimulators of uterine activation for labor at term. Furthermore, the MAPK/NF-κB pathway appears to be one of the potential signaling pathways mediating TLR4's regulation of parturition initiation.

Middle Cerebral Artery Blood Flow Velocity During Normal Pregnancy.

The present study aimed to evaluate resting middle cerebral artery (MCA) blood flow velocities using transcranial Doppler ultrasound (TCD) in healthy women at different stages of pregnancy, and to compare these velocities with those of normal controls. A total of 105 healthy normotensive pregnant women and 25 non-pregnant healthy controls were included in the study. We formed 3 groups according to gestational age: first trimester (7 to 13wk pregnant), second trimester (14 to 28wk pregnant), and third trimester (29 to 42wk pregnant). Age, body mass index, heart rate, arterial blood pressure, and hematological data were recorded and TCD was performed on the subjects. Regarding TCD, we evaluated the mean cerebral blood flow velocity, the peak systolic velocity, the end-diastolic flow velocity, S/D ratio, the pulsatility Index (PI) and the resistance Index (RI). The MCA mean blood flow velocities differed significantly among the groups (P<0.001) and were higher in the controls than those of the first trimester, second trimester, and third trimester groups (P<0.01, P<0.001, P<0.001 respectively). The MCA mean and peak blood flow velocities, and the PI and RI decreased significantly with advancing gestation. TCD is a noninvasive and non-toxic method of monitoring the adaptation of the maternal cerebral blood flow in pregnancy. The progressive decreases in the MCA mean and peak blood flow velocities, PI, and RI during gestation may be the result of chemical and neuronal factors. This study supports the need for additional studies using TCD to establish normative cerebral blood flow volumes throughout pregnancy.

Biochemical Changes in Salivary pH and Its Correlation to Hemoglobin Levels, Calcium and Phosphate Ion Concentrations among Pregnant Women, Tanzania: A Cross-Sectional Study

Background: Surveys in Tanzania show that pregnant women have a significant burden of oral disease, although there is still little literature on the variation of their intraoral electrolytes. The present study investigated changes in salivary calcium (Ca2+), phosphate (PO43−), and hydrogen (H) ions during pregnancy and the correlation between salivary pH and hemoglobin levels. Methodology: A cross-sectional study involved sixty (60) pregnant women stratified by trimester and twenty (20) non-pregnant women attending an antenatal clinic at Mnazi Mmoja Hospital. Consecutive sampling was used, saliva was collected, and electrolyte levels were measured. Gestation age was the independent variable, whereas saliva pH and calcium and phosphate ion concentrations and hemoglobin levels were the dependent variables. Results: A difference in calcium concentration (z = −3.145, p = 0.001) and salivary pH (t = −2.49, p = 0.014) was observed between pregnant and non-pregnant women. Kruskal–Wallis tests for saliva Ca2+ and PO43− and ANOVA for saliva pH revealed differences in concentrations of saliva Ca2+, PO43−, and pH levels between trimester groups (saliva Ca2+ (H = 9.91, df = 3, p = 0.019), saliva PO43− (H = 12.36, df = 3, p = 0.006), saliva pH (F (3.76) = (16.42); p &lt; 0.001)). Pearson’s correlation tests showed no association between salivary pH and hemoglobin levels. Conclusions: Pregnancy is associated with a reduction in saliva pH and saliva calcium levels with a progressive increase in the magnitude of reduction from the first trimester to the third trimester. Saliva phosphate reduction was noticed during the third trimester only and saliva pH levels were independent of hemoglobin levels.

Association between intrapartum antibiotic prophylaxis for Group B Streptococcus colonization and clinical chorioamnionitis among patients undergoing induction of labor at term

Rectovaginal colonization with Group B Streptococcus during pregnancy has historically been shown to be associated with an increased risk of clinical chorioamnionitis and peripartum infectious morbidity. Newer observational data in the era of intrapartum antibiotic prophylaxis suggest a possible reversal of this association; however, it is unclear if this is related to differences in labor management for those with and without Group B Streptococcus colonization. We therefore sought to assess the association between intrapartum antibiotic prophylaxis for Group B Streptococcus colonization and clinical chorioamnionitis within the context of a randomized induction of labor trial with a standardized labor protocol. We performed an exploratory secondary analysis of a randomized trial of patients undergoing term induction at a tertiary care center. Patients received third trimester Group B Streptococcus screening and intrapartum antibiotic prophylaxis as routine care. Group B Streptococcus detection was performed using a carrot broth-enhanced subculture to Group B Streptococcus Detect approach (Hardy Diagnostics, Santa Maria, CA). Labor management was protocolized per the trial. Patients with unknown Group B Streptococcus status or who did not receive intrapartum antibiotic prophylaxis, if indicated, were excluded. The primary outcome was diagnosis of clinical chorioamnionitis, compared between patients who received intrapartum antibiotic prophylaxis for known Group B Streptococcus positive status (by culture, history, or Group B Streptococcus bacteriuria) and those who were Group B Streptococcus negative and did not receive intrapartum antibiotic prophylaxis. Secondary outcomes included postpartum endometritis, wound infection, a composite maternal peripartum infectious morbidity, and neonatal outcomes. A total of 491 patients were enrolled in the trial. Of these, 466 had a known Group B Streptococcus status and received or did not receive intrapartum antibiotic prophylaxis accordingly and were included in this analysis: 292 (62.7%) were Group B Streptococcus negative and did not receive intrapartum antibiotic prophylaxis, and 174 (37.3%) were Group B Streptococcus positive and received intrapartum antibiotic prophylaxis. The majority of patients were Non-Hispanic Black (78.1%) and nulliparous (59.7%). There were no differences in demographic, clinical, induction or labor characteristics between groups. Patients who were Group B Streptococcus positive had a 49% lower rate of clinical chorioamnionitis (8.1% vs 14.7%, odds ratio, 0.51; P=.03) and a lower rate of peripartum infectious morbidity (8.1% vs 15.8%, odds ratio, 0.47; P=.02) compared to those who were Group B Streptococcus negative. Infants born to patients who were Group B Streptococcus positive were significantly less likely to be admitted to the neonatal intensive care unit (3.4% vs 15.1%, P<.001). Although Group B Streptococcus colonization has historically been considered a risk factor for clinical chorioamnionitis, in the era of universal antibiotic prophylaxis for Group B Streptococcus positive patients, our findings support the point that intrapartum antibiotic prophylaxis for Group B Streptococcus positivity is associated with lower rates of clinical chorioamnionitis and peripartum infectious morbidity among patients undergoing induction with protocolized labor management. These findings demonstrate that intrapartum antibiotic prophylaxis for Group B Streptococcus may protect against perinatal infectious morbidity, a phenomenon that warrants further investigation.

Evaluation of mutans streptococci concerning oral health in the saliva of pregnant women

Pregnancy is a physiological condition that affects a woman's life, including susceptibility to oral disease. Increased levels of female hormones impact the growth of periodontal pathogenic bacteria. In several mutants, Streptococci levels are said to be greater during Pregnancy. Thus, the cariogenic bacteria predominating in plaque and saliva will develop more acids through fermentation, leading to dental caries. The present study aimed to assess (Decay and Decayed, Missing and Filled Surface) value and mutans streptococci counts in pregnant and non-pregnant women. The method was applied to 80 women, with an age range of 20 to 30 years. The study group comprised 60 pregnant women divided into three equal trimester groups (20 pregnant women in each trimester), while the control group consisted of 20 married non-pregnant. The salivary samples were collected under standardized conditions for microbiological analysis and oral examination done by caries experience (Decay and Decayed, Missing and Filled Surfaces). Results revealed that Decayed, Missing and Filled Surfaces value and mutans Streptococci count was higher in (study groups) in comparison to (control group) in addition to the correlation between the viable count of mutans streptococci (CFU×105 /ml) and DMF appeared positive significant result in this study. Keywords: Pregnant women, DMFs, mutans streptococci.

Measurement of cervical softness before cerclage placement with an aspiration-based device.

An abnormally soft cervix could contribute to the pathophysiology of cervical shortening and cervical insufficiency. Multiple techniques to measure cervical softness have been developed but none are used routinely in clinical practice. A clinically acceptable technique to measure cervical softness could improve identification of patients at risk for cervix-related preterm birth. This study aimed to measure cervical softness in patients with cervical insufficiency and in normal controls using a novel, aspiration-based device. We hypothesized that the cervix is softer in patients with cervical insufficiency. This was a cross-sectional study of patients presenting for cerclage at a single academic medical center. Cervical softness was measured using a noninvasive, aspiration-based device placed on the anterior lip of the cervix during a speculum examination. The device measured the aspiration pressure required to displace cervical tissue to a predefined deformation level. Stiff tissue required increased aspiration pressure, whereas soft tissue required lower pressure values. Cerclage patients were subdivided into 3 groups, namely history-indicated, ultrasound-indicated, and examination-indicated cerclage. Controls were healthy volunteers between 12+0 weeks and 23+6 weeks of gestation without a history of cervical insufficiency and were matched by gestational age to the patients in the cerclage groups. Women with a cerclage in place, multiple gestations, active genital infection, or previous cervical excision procedures were excluded. Delivery information was subsequently recorded as well. Data from 133 women were analyzed; of those, 54 patients were in the cerclage group (23 history-indicated, 12 ultrasound-indicated, and 19 examination-indicated participants) and 79 were controls (40 in the first trimester and 39 in the second trimester groups). Patients who presented for ultrasound-indicated cerclage had significantly softer cervices (median; interquartile range) than second trimester controls (62 mbar; 50.5-114 vs 81 mbar; 75-101; P=.042). The difference in cervical softness was not significantly different between the history-indicated and examination-indicated cerclage groups and their respective control groups. Patients presenting for ultrasound-indicated cerclage had significantly softer cervices than normal controls as measured by an aspiration-based device. Quantitative measurement of cervical softness with the aspiration-based device is a promising technique for objective measurement of cervical softness during pregnancy.

Incidence and Types of Fetal Chromosomal Abnormalities in First Trimester of Thai Pregnant Women between Miscarriages and Intrauterine Survivals

Abortion is a common pregnancy complication. Fetuses with several types of chromosomal abnormalities are aborted during the first trimester, while others have a better chance of surviving. This research aims to study and compare the incidence and types of fetal chromosomal abnormalities during the first trimester of Thai pregnant women between miscarriages and intrauterine survivals. Cytogenetic and BACs-on-Beads™ assays were assessed from 2010 to 2020 in Ramathibodi Hospital using first trimester samples of 265 chorionic villi as a retrospective study. Chromosomal abnormalities were observed in 135 cases (50.94%) including 38.11% miscarriages and 12.83% intrauterine survivals. In total, 75.56% single autosomal trisomies, 18.52% sex chromosome aneuploidies, 5.19% double aneuploidies, and 0.74% structural abnormalities were detected. In miscarriages, all chromosomes were involved in abnormalities except chromosomes 1, 5, 8, 9, 11, and 17, while survivals had only trisomy 13, 18, 21, and sex chromosome aneuploidy. Trisomy 16 and 18 were the most common abnormalities in miscarriages and intrauterine survivals, respectively. The highest rate of chromosomal aberrations was demonstrated in 8–9⁺⁶ and 12–13⁺⁶ weeks of gestation in miscarriages and intrauterine survivals, respectively. Correlation between chromosomal abnormalities and maternal age <35 years and ≥35 years was significant (p < 0.05) in intrauterine survival and first trimester groups.

Establishing Trimester-Specific Haemoglobin A1c Reference Intervals in Pregnant Women: A retrospective study of healthy South Asian women with normal pregnancy outcomes.

This study aimed to define trimester-specific haemoglobin A1c (HbA1c) reference intervals in healthy, pregnant South Asian women. This retrospective study was conducted at St. Stephen's Hospital, Delhi, India, between January 2011 and December 2016. Healthy pregnant women were compared to a control group of healthy non-pregnant women. Pregnant participants had term deliveries of babies with appropriate gestational weights. The HbA1c levels were calculated in terms of non-parametric 2.5 and 97.5 percentiles for women in first (T1), second (T2) and third (T3) trimester groups. Statistical tests were used to obtain the normal HbA1c reference values and were considered significant when P <0.05. This study included a total of 1,357 healthy pregnant women and a control group of 67 healthy, non-pregnant women. Pregnant women had a median HbA1c of 4.8% (4-5.5%) or 32 mmol/mol (20-39 mmol/mol); non-pregnant women had a median HbA1c of 5.1% (4-5.7%) or 29 mmol/mol (20-37 mmol/mol; P <0.001). The HbA1c levels for the T1, T2 and T3 groups were 4.9% (4.1-5.5%) or 30 mmol/mol (21-37 mmol/mol), 4.8% (4.5-5.3%) or 29 mmol/mol (20-34 mmol/mol) and 4.8% (3.9-5.6%) or 29 mmol/mol (19-38 mmol/mol), respectively. The HbA1c values were significant when comparing T1 versus T2 (P <0.001), T1 versus T3 (P = 0.002) and T1 versus the non-pregnant group (P = 0.001). However, T2 versus T3 was not significant (P = 0.111). Compared to non-pregnant women, HbA1c levels were lower in pregnant women, despite women in the T2 and T3 groups having a higher body mass index than the women in the T1 and non-pregnant groups. Further research is recommended to understand the factors responsible and validate these findings.

Ultrasonographic Evaluation of Thyroid Gland Volume and Nodularity in Pregnant versus Non Pregnant Females: A Cross-sectional Study

Introduction: Continuous stimulation of thyroid gland occurs during pregnancy in order to meet the demands of growing foetus. This might result in variations in thyroid gland morphology which may be misdiagnosed if not assessed accurately. Ultrasonography can measure these variations during pregnancy in the form of change in volume, echotexture, nodularity etc. Aim: To compare the thyroid volume and nodules using ultrasound, amongst different trimesters of pregnancy and with non pregnant women of similar age and find the correlation with different factors. Materials and Methods: A time-bound, hospital-based, crosssectional observational study was done in the Department of Radiodiagnosis, Maharaja Yeshwantrao (MY) Hospital, Indore, Madhya Pradesh, India, from April 2021 to August 2022 on 240 patients. All subjects were divided into groups of 60 women each, which included non pregnant women in group 1 and pregnant women during each trimester in rest three groups, as group 2, 3 and 4, respectively. Thyroid volume and nodules were measured in each group. The descriptive data was calculated using mean and standard deviation and then compared using Analysis of Variance (ANOVA) test. Linear regression analysis was also used to assess the correlation. Results: Most 125 (52%) of the women belonged to the younger age group i.e., 21-25 years. Majority i.e., 114 (47.5%) of pregnant women were primigravida. Mean total thyroid volume in non pregnant group, 1st trimester group, 2nd trimester group and in 3rd trimester group were 5.44±0.82 mL, 5.85±0.64 mL, 6.25±0.67 mL and 7.24±1.16 mL, respectively, with up to 24% increase of thyroid volume during the course of pregnancy (p-value=0.001). Thyroid nodule incidence was 12.2% in pregnant women and 5% in non pregnant women. Conclusion: With pregnancy, there is an increase in thyroid gland size along with a small increase in thyroid nodularity. Also, the interplay of a few factors such as Body Mass Index (BMI), parity, age etc., was noted.

Refusal of the hospitalization: a distressed dilemma in obstetric practice.

Pregnant women are a special population in which hospitalizations are more recommended due to physiological changes mimicking pathologies and medico-legal concerns. We aimed to assess the obstetric outcomes of expectant mothers who were admitted to the obstetrics emergency outpatient clinic and declined the hospitalization advised by doctors. Additionally, we examined the appropriateness of physicians' recommendations. We have retrospectively evaluated the patients admitted to the 'Obstetric Emergency Outpatient Clinic' and refused hospitalization between 1 January 2019 and 31 December 2019. Cases were classified into three groups based on the trimester, considering the substantial variation between complaints and complications in each trimester. The complaints of pregnant women were categorized as psychosocial causes, obstetric complications, maternal systemic complaints, and suspicion of labor. We evaluated the compatibility of the hospitalization decision with the pregnancy outcome of patients. A total of 958 pregnant women were included in the study. Leading causes for admissions were obstetric complications, maternal systemic complaints, and suspicion of labor in first, second, and third trimesters, respectively. Psychosocial causes were mostly observed in the second trimester. Readmission to the hospital within a week was highest in the third trimester group. According to pregnancy outcomes, 12.5% (94/753) of our recommendations were appropriate in all trimesters. Obstetricians seem overcautious in managing obstetric patients and willing to offer hospitalization more often than the actual requirements.

EVALUATION OF THE FRONTAL-PLANE QRS-T ANGLE IN PREGNANCY

Objective: Our aim in this study was to evaluate changes in the frontal QRS–T (fQRS-T) angle, which is an important indicator of repolarisation defects and arrhythmogenic predisposition, in pregnant women relative to non-pregnant women and between trimester groups. Material and Methods: One hundred fifty-seven pregnant women with no history of cardiac or chronic disease and 150 healthy non-pregnant women as a control group were included in this study. PR, QRS, QT, corrected QT and fQRS-T angles were calculated manually. Subgroup analysis was performed to investigate the effects of changes in trimester on ECG of 58 pregnant women, whose ECG data of all three trimesters could be accessed. Result: The mean age of study participants was 31±7 years. The heart rates of pregnant women and the control group were 83±12 bpm and 76±14 bpm respectively (p&amp;lt;0.001), while fQRS–T angles measured 27.6°±17.7° and 20.7°±6.6° respectively (p&amp;lt;0.001). The frontal QRS-T angle was also detected significantly decrease in the progression from the first trimester (34.4±15.4) to the second (26.5±14.8) and third (23.3±20.3) trimesters (p=0.003). Gestational week had a statistically significant negative correlation with fQRS-T angle (r = −0.233; p=0.003). Conclusion: The fQRS-T angle, even if remained within the normal range was larger in pregnant women than in non-pregnant women and also larger in first trimester pregnant women relative to those in the second or third trimester.

A Retrospective Assessment of Thrombophilia in Pregnant Women with First and Second Trimester Pregnancy Loss

Recurrent Pregnancy Loss (RPL) affects between 1% to 5% of women of reproductive age. It is widely believed that RPL is a complex disorder that is influenced by chromosomal abnormalities, genetic mutations, uterine anatomic deformity, endocrine dysfunction, immunologic factors, infections, and the environment. Thrombotic disorders are a frequent cause of RPL, accounting for almost half of all cases; however, in the rest of the cases, the cause of RPL remains unclear. Therefore, in this study, it was planned to determine the genetic mutations involved in RPL during the first and second trimester of pregnancy. An observational retrospective cohort study was conducted in 2021, collecting data from 157 first trimester miscarriages and 54 s trimester pregnancies. All patients with a panel of laboratory and genetic analysis for thrombophilia were included for data analysis. It was observed that four factors were significantly more prevalent in one of the groups. Factor V Leiden (FVL) homozygosity and antiphospholipid syndrome (APS) antibodies were statistically significantly more common in pregnant women who suffered first trimester pregnancy losses. On the other hand, Protein C deficiency and Glycoprotein Ia polymorphism were statistically significantly more frequent in the second trimester group. The strongest independent risk factors for first trimester pregnancy loss were FVL and prothrombin (PT) compound mutations (OR = 3.11), followed by FVL homozygous mutation (OR = 3.66), and APS antibodies (OR = 4.47). Regarding second trimester pregnancy loss risk factors, the strongest were FVL and PT compound (OR = 3.24), followed by Glycoprotein Ia polymorphism (OR = 3.61), and respectively, APS antibodies (OR = 3.85). Numerous thrombophilic risk factors for early and late pregnancy loss have been found, including several mutations that seem to occur more often either during the first or the second trimester. Even though we are aware of risk-free and efficient diagnostics for thrombophilia abnormalities, no intervention has been proved to be clearly successful after the detection of these variables.

Comparison of insulin requirements across gestation in women with hyperglycemia in pregnancy: A prospective cohort study.

The aim of this study is to explore the daily insulin dose and the percentage change in preprandial and basal insulin dosage of women with different types of hyperglycemia in pregnancy (HIP) during the whole gestation and postpartum period. A total of 121 subjects with HIP requiring insulin therapy were enrolled from a prospective cohort consisted of 436 pregnant women with hyperglycemia. The subjects were divided into three groups: Group 1 [type 1 diabetes mellitus (T1DM) and maturity onset diabetes of the young (MODY)], Group 2 [type 1 diabetes mellitus (T2DM)], and Group 3 [gestation diabetes mellitus (GDM)]. The primary study measurements included daily dose and percentage of different types of exogenous insulin requirements across gestation in different groups. Insulin total daily dosage of Group 1 was highest among the three groups and increased significantly from the first to the second/third trimester. Percentage of preprandial insulin increased from 53.8% (46.7, 60.0) and 54.5% (42.3, 62.9) in the first trimester to 63.6% (54.9, 75.0) and 67.2% (51.8, 73.7) in the second/third trimester in Group 1 and Group 2. All subjects with T1DM and 18.6% of subjects with T2DM still required insulin administration after delivery, with a 26.9% (19.0, 46.0) and 36.7% (26.9, 52.6) decrease in total insulin dose, respectively, whereas subjects with GDM and MODY weaned off insulin completely. The insulin requirements for pregnancy complicated with T1DM and MODY were higher than those for T2DM and GDM. In the subjects with PGDM, the insulin requirement and percentage of preprandial insulin increased gradually from early to mid- and late pregnancy.

Changes of new coagulation markers in healthy pregnant women and establishment of reference intervals in Changsha.

There is a high coagulation state in pregnant women, which is prone to coagulation and fibrinolysis system dysfunction. This study aims to explore the latest coagulation markers-thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), and tissue plasminogen activator/plasminogen activator inhibitor compound (tPAI-C) in different stages of pregnancy, establish reference intervals (RIs) for healthy pregnant women of Chinese population, and to provide an effective and reliable reference for clinicians. A total of 492 healthy pregnant women, who underwent pregnancy examination and delivery in the Department of Obstetrics, Second Xiangya Hospital of Central South University from October 2019 to October 2020, were enrolled for this study. They were assigned into the first trimester group, the second trimester group, the third trimester group, and the puerperium group according to the pregnancy period, and 123 healthy non-pregnant women were selected as the controls. Plasma levels of TM, TAT, PIC and tPAI-C were analyzed by automatic chemiluminescence immunoassay analyzer. The RIs for TM, TAT, PIC, and tPAI-C were defined using non-parametric 95% intervals, determined following Clinical and Laboratory Standards Institute Document C28-A3c (CLSI C28-A3c), and Formulation of Reference Intervals for the Clinical Laboratory Test Items (WS/T402-2012). TM and TAT levels increased gradually in the first, second, and third trimester women and decreased in the puerperium women (P<0.05 or P<0.01). PIC level of healthy non-pregnant women was lower than that of pregnant women (P<0.05 or P<0.01), but PIC level of pregnant and puerperium women did not differ significantly (P>0.05). tPAI-C level in healthy non-pregnant women was lower than that of pregnant women (P<0.05 or P<0.01), and tPAI-C level was significantly decreases in the puerperium women (P<0.01). The RIs for TM were as follows: Healthy non-pregnant women at 3.20-4.60 TU/mL, the first and second trimester at 3.12-7.90 TU/mL, the third trimester at 3.42-8.29 TU/mL, puerperium at 2.70-6.40 TU/mL. The RIs for TAT were as follows: Healthy non-pregnant women at 0.50-1.64 ng/mL, the first and second trimester at 0.52-6.91 ng/mL, the third trimester at 0.96-12.92 ng/mL, puerperium at 0.82-3.75 ng/mL. The RIs for PIC were as follows: Healthy non-pregnant women at 0.160-0.519 ng/mL, pregnant women at 0.162-0.770 μg/mL. The RIs for tPAI-C were as follows: Healthy non-pregnant women at 1.90-4.80 ng/mL, the first and second trimester at 2.03-9.33 ng/mL, the third trimester at 2.80-14.20 ng/mL, puerperium at 1.10-8.40 ng/mL. The levels of 4 new coagulation markers TM, TAT, PIC, and tPAI-C in pregnant women are increased significantly during pregnancy and gradually return to normal after delivery. The RIs for TM, TAT, PIC, and tPAI-C in pregnant women by trimester are established according to CLSI C28-A3c, thus providing a clinical reference for clinician in judgement of thrombotic risk.

Evaluation of Cardiovascular Markers in Normotensive Pregnant Women

Pregnancy is associated with series of biochemical changes such as changes in cardiovascular markers. These changes may contribute to risk of developing cardiovascular disease among this group of people. Therefore, this work was aimed at evaluating changes in cardiovascular biochemical markers in pregnancy. This research was a cross-sectional study with 150 female subjects divided into three groups; control (non-pregnant women), 2nd trimester and 3rd trimester. Each of the group had 50 subjects each. Subjects were selected randomly from Rivers State University and Rivers State University Teaching Hospital. Fasting blood was collected using venipuncture technique (WHO, 2010). The collected blood was carefully dispensed into plain vacutainer tubes and assayed for uric acid, Apo A1 and B, CRP, TG, HDL and TC while VLDL and LDL were calculated. The data obtained from the study were analyzed using GraphPad Prism Version 8.0.2.263. ANOVA results revealed that there were significant differences in TC, TG, LDL, HDL, VLDL, CRP, ApoA1, and ApoB levels among non-pregnant, 2nd trimester and 3rd trimester groups of normotensive pregnant women (P&lt;0.05) except for uric acid (UA) that showed no significant difference. Post hoc analysis revealed significant difference in studied parameters between groups except in HDL, TG and VLDL in non-pregnant and 2nd trimester group while UA remained non-significant between compared groups. This study has shown that pregnancy causes significant changes in cardiovascular risk markers in healthy pregnant women.

Surgically confirmed adnexal torsion during pregnancy: Does the trimester make a difference?

To investigate the clinical and the sonographic characteristics of adnexal torsion (AT) during pregnancy and to underline differences in AT manifestation between pregnancy trimesters. This is a retrospective cohort study in a tertiary medical center. The study included all pregnant women with surgically confirmed AT between March 2011 and April 2020. The patients were divided into three groups according to pregnancy trimesters, and the clinical and sonographic characteristics were compared between the groups. The study cohort included 140 cases of AT. Ninety-nine (70.7%) of the cases occurred during the 1st trimester, and 31 (22.1%) and 10 (7.1%) occurred during the 2nd and the 3rd trimesters, respectively. Conception by assisted-reproductive technologies (ART), nausea, and finding of enlarged ovary on ultrasound scan were all more common among patients in the 1st trimester group as compared to the 3rd trimester group (p=0.001, 0.015, and 0.024, respectively). The mean time from admission to surgery was significantly shorter in the 1st trimester group as compared to late pregnancy (p=0.001). The majority of cases were right-sided. There was a significant difference in the organs involved in every trimester of pregnancy-ovary only, ovary and fallopian tube, and fallopian tube only (p=0.023). Most AT cases during pregnancy occurred during the 1st trimester. Conception by ART and enlarged ovary on ultrasound scan were also more common in AT cases during early pregnancy. Time from admission to surgery was longer as pregnancy progressed and organs involved differed between trimesters. Understanding the difference in manifestation of AT in every trimester might improve the preoperative evaluation of AT in pregnancy.