Trimester Of Pregnancy In Patients Research Articles

Androgen Levels in the Third Trimester of Pregnancy in Patients with Preeclampsia

Androgen Levels in the Third Trimester of Pregnancy in Patients with Preeclampsia

Comparative evaluation of fetal renal artery hemodynamics in normohydramnios, idiopathic oligohydramnios and polyhydramnios in third trimester pregnancy

AbstractObjectiveTo compare the renal artery (RA) flow indices (RI and PI) among normohydramnios, idiopathic oligohydramnios, and polyhydramnios and determine applicability of fetal RA Doppler indices in predicting the pregnancy outcome.MethodsTotal 106 3rd trimester pregnant patients were divided into cases and controls based on amniotic fluid index. Routine antenatal and color Doppler (including kidneys) ultrasound was performed for all patients in this study. The postnatal follow‐up was done, and the pregnancies having poor outcomes in terms of NICU admissions were assessed.ResultsStatistically significant differences were noted when comparing RI and PI values of normohydramnios (0.91 ± 0.04 and 2.38 ± 0.21, respectively) with oligohydramnios (1.02 ± 0.07 and 2.99 ± 0.38, respectively) and polyhydramnios (0.90 ± 0.12 and 2.7 ± 0.84, respectively) independently (p value < 0.05). Our study demonstrated an increase in NICU admissions in the fetus having raised values of RI and PI.ConclusionFetal RA RI and PI can be used as an antenatal predictor for the pregnancy outcome associated with idiopathic oligohydramnios; however, fetal RA PI was found to be a better predictor for the pregnancy outcome than fetal RA RI value in our study.

The Effect of Peppermint Aromatherapy on the Degree of Nausea and Vomiting in Pregnant Women in the First Trimester at the Independent Practice of Midwife (TPMB) Yusnita Purwasari, Karawang Regency, Indonesia

Pregnancy is a physiological condition that can be followed by pathological processes that will threaten the condition of the mother and fetus. During pregnancy, problems can occur that a mother does not want. Nausea and vomiting are complaints that are often experienced by pregnant women in the first trimester due to an increase in HCG in the pregnant woman's body. If this situation continues, it will have an impact on the pregnancy and fetal growth process. This study aimed to identify the effect of peppermint aromatherapy on reducing nausea and vomiting in pregnant women. The design of this research is experimental research pre-test and post-test one group. Sampling technique with purposive sampling where every first trimester pregnant woman who underwent a pregnancy check-up who met the inclusion criteria was included in this study. The results showed that there was a decrease in the degree of nausea and vomiting in research subjects before and after being given the intervention (2.12 ± 0.11 Vs 1.11 ± 0.13), p < 0.05. In conclusion, there is influence giving aromatherapy peppermint in reducing the degree of nausea and vomiting in first trimester pregnant patients at TPMB Yusnita Purwasari, Karawang Regency, Indonesia.

Quality of Life in the Third Trimester of Pregnancy in Patients with Gastroesophageal Reflux Disease

Quality of Life in the Third Trimester of Pregnancy in Patients with Gastroesophageal Reflux Disease

The Association of IL-17 and PlGF/sENG Ratio in Pre-Eclampsia and Adverse Pregnancy Outcomes

The aim of the study was to assess the role of concentrations of interleukin-17 (IL-17), placental growth factor (PlGF) and soluble endoglin (sENG), as well as the PlGF/sENG ratio in pregnancy complicated by pre-eclampsia (PE) and normal pregnancy. The concentrations of IL-17, PlGF and sENG were measured with the use of immunoenzymatic methods. The concentrations of IL-17 were significantly higher in PE patients when compared to control patients. In the group of patients with PE, the levels of IL-17 positively correlated with systolic blood pressure. On the other hand, IL-17 negatively correlated with neonatal birth weight. The concentrations of PLGF were significantly lower and sENG significantly higher in studied patients when compared to controls. The PlGF/sENG ratio in the PE group was significantly lower when compared to healthy third trimester pregnant patients. In the study group, negative correlations were observed between the sENG concentrations and thrombocyte levels. The higher concentrations of IL-17 in PE could suggest its role as an inflammatory agent in the pathogenesis of the syndrome. Moreover, the negative correlation between IL-17 and a neonatal birth weight could suggest the role of the cytokine in the development of fetal growth restriction (FGR) associated with PE. It seems possible that IL-17 can be a useful marker of the risk of FGR in pregnancy complicated by PE. Furthermore, the results suggested the potential role of sENG and the PlGF/sENG ratio in the prediction of adverse outcomes such as HELLP syndrome and DIC.

Prevalence of Renal Pathologies in Fetuses Detected on Ultrasound in the Second Trimester of Pregnancy in Females with Oligohydramnios

Background: Common fetal renal abnormalities due to oligohydramnios are deficiency in the renal tissue congenitally, obstruction in the flow of urine, and reduced perfusion of renal tissue can also cause pathologies. Oligohydramnios is responsible for causing various serious fetal complications. Due to this reason, ultrasound screening in the second trimester of pregnancy is a common practice to rule out these complications. Objective: Assessment of fetal renal pathologies on ultrasound in the second trimester of pregnancy in patients with oligohydramnios Methodology: The current study is a descriptive study that was conducted in Gilani Ultrasound Centre, Ferozpur Road, Lahore from August 12, 2021, to December 14, 2021. The duration of the study was four months. A total of 149 participants were considered as a sample in the study. All the participants were in their second trimester of pregnancy and all of them were detected with oligohydramnios. According to the exclusion criteria, the patients with already present renal pathology were excluded from the study. Transabdominal ultrasound was done in all the patients with a 2-5MHz concave probe. The parameters considered for the assessment of the outcomes were gestational age (GA), estimated fetal weight (EFW), amniotic fluid index (AFI), umbilical artery Systolic/Diastolic (S/D) ratio, and findings of the fetal renal system on ultrasound. Results: A total of 149 patients in the second trimester of pregnancy, having oligohydramnios, underwent transabdominal ultrasound. 123 (82.55%) patients were not found with any fetal renal abnormalities. The remaining 26 (17.45%) had different renal pathologies such as hydronephrosis in 9 (6.04%) and infantile polycystic kidneys (PKD) in 17 (11.41%). Conclusion: The present study suggests that most of the patients with oligohydramnios had normal fetuses. Only 17.4% were detected with fetuses with renal pathologies. The most common abnormality seen was PKD and then hydronephrosis. Keywords: Second Trimester, Oligohydramnios, Infantile Polycystic Kidneys, Hydronephrosis

562. Tocilizumab Use in the Second Trimester Pregnant Patients with Severe Covid-19 Pneumonia and their Maternal and Fetal Outcomes: Two Case Reports

BackgroundTocilizumab is an interleukin-6 monoclonal antibody with widespread use in rheumatologic conditions. Observational studies have shown a promising role of Tocilizumab in severe COVID-19 patients with cytokine storm syndrome. Data about tocilizumab use in pregnant patients is limited. We report two outcomes of two pregnant patients with COVID-19 in the second trimester who received tocilizumabMethodsA 24-year-old 20 weeks pregnant lady with a history of asthma and gestational diabetes mellitus presented with three days history of fever, cough and shortness of breath (Figure 1). She was clinically stable but later developed ARDS and developed increased oxygen demand up to 10 liters/min. She received Tocilizumab on. Patient was observed in a high dependency unit but did not require mechanical ventilation. Patient was discharged home with full recovery and later delivered a healthy baby. Timeline of medicines used during hospital (Figure 2). Case 2: 39-year-old 23 weeks pregnant lady presented with seven days history of fever cough and shortness of breath (Figure 1). On presentation, she had progressive worsening hypoxic respiratory failure and was intubated. Patient had her nasopharyngeal swab for CODI-19 RT PCR was positive. The patient had severe ARDS requiring ECMO (extracorporeal membrane oxygenation) for respiratory support. Tocilizumab 400 mg was given on the presentation, along with other medications (Figure 3). Patient had regular monitoring of fetus; however, she had intrauterine fetal demise on day 14. Patient It is unclear if IUFD was due to using of tocilizumab or severity of COVID19 itself. The patient stayed in ICU for 20 days and was discharged after full recovery. Figure 1. Case 1 treatment timeline. Abberviations: Azithro: Azithromycin, HCQ: Hydroxychloroquine, CQ: Chloroquine, LPV/r: lopinavir/Ritonavir, Osel: Oseltamivir, MP: Methylprednisolone, Ampi-sulb: Ampicillin-sulbactam, TCZ: tocilizumabFigure 2. Case 2 treatment timeline ResultsLearning points: Tocilizumab use in pregnant patients with severe COVID-19 pneumonia during the second trimester improved maternal outcomes in our cases. Tocilizumab use may be associated with worse fetal outcomes, including intrauterine fetal demise (IUFD). Figure 3. Table of clinical characteristics, pregnant outcomes. Abbreviations: LRTI: lower respiratory tract infection, HCQ: Hydroxychloroquine, CQ: chloroquine, Osel: Oseltamivir, Cef: Ceftrixone, Ampi-Sulb: ampicillin-sulbactam, Azithro: Azithromycin, TCZ: tocilizumab, MP: methylpredinisolone, H/O: History of, LSCS: C-section, NA: not available. Pip-tazo: Piperacillin-tazobactam, Mero: Meropenem, Sulfa-trim: Sulfamethoxazole-Trimethoprim, IUFD: Intrauterine fetal death.ConclusionThe pharmacological management of pregnant patients with severe COVID-19 pneumonia poses significant challenges. The use of Tocilizumab may improve maternal outcomes but may also increase the risk of worse fetal outcomes. Caution should be exercised in using this agent, and risks and benefits should be discussed with the patients.Disclosures All Authors: No reported disclosures

306EMF Defining the Learning Curve for First Trimester Ultrasound Image Interpretation Skills for Emergency Physicians

First trimester pregnancy ultrasound is an oft-used, high-stakes skill for emergency physicians (EPs). Performing bedside ultrasound for symptomatic first trimester pregnant patients requires the skill of image acquisition, image interpretation and integration of interpretation in clinical decision-making. Learning curves for EPs' skills in ultrasound applications have been shown to vary considerably. Some have advocated for a “mastery-based” competency evaluation in which trainees practice until they reach a pre-defined level of performance. However, clinical practice alone may not be sufficient in achieving this standard since opportunities for immediate feedback at the bedside may be limited by the number of patient encounters and the frequency of pathology. Little is known about the development of the skill of image interpretation over time among EPs engaged in deliberate practice of image review. The objective of this study is develop an educational innovation to teach first trimester pregnancy ultrasound image assessment using an online learning platform and assess learners’ skill acquisition for this critical emergency medicine skill. This is a multicenter prospective cohort study. First trimester ultrasound examinations from two academic medical centers’ ultrasound image archival systems were reviewed to identify 400 high-quality studies with complete imaging and a specified case mix. An online experience was developed for each case and integrated into an online learning platform. Images, case-specific information and education for each case were developed and reviewed by emergency ultrasound specialists. EPs will be recruited to complete an education experience using the online learning platform which presents cases and images to physicians whose interpretations are then evaluated. 400 cases of early first trimester ultrasound examinations have been reviewed and cataloged, including 200 transvaginal and 200 transabdominal ultrasound examinations. Of these, 195 include an intrauterine pregnancy (IUP), 205 do not include an IUP, 132 are viable, and 43 are confirmed ectopic pregnancies. Classification of findings of each case has been reviewed by one expert reviewer. Development of an online learning intervention is underway. Data acquisition of 135 EPs’ performance with this intervention, rate of skill acquisition and learning curves is forthcoming. We will determine changes in accuracy, sensitivity and specificity, and the effect size of the learning intervention. We will determine the item reliability and interpretation difficulty for each case. We will determine the time it took to complete the course and evaluate the participant experience. We will examine the rate of learning for first trimester TVUS and TAUS measured by deriving learning curves and determining the median number of cases required to reach the following performance benchmarks: 80%, 85%, 90%, and 95% accuracy. EPs frequently evaluate symptomatic first trimester pregnant patients. Patients experience high morbidity and mortality if an ectopic pregnancy is missed and ultrasound is the imaging modality of choice to evaluate for the presence or absence of an IUP. We have developed an online learning platform with an image bank of 400 cases and plan to evaluate 135 physician’ learning with the platform.

Pregnancy-Induced Changes in microRNA Expression in Multiple Sclerosis.

Pregnancy affects the disease course in multiple sclerosis (MS), particularly in the third trimester, where the relapse rate is reduced by as much as two thirds. This study aimed at identifying changes in microRNA (miRNA) and immune cell phenotypes in pregnant MS patients. Discovery and validation studies to detect differentially expressed miRNAs were performed with quantitative real-time PCR on peripheral blood mononuclear cells (PBMC). Flow cytometry analysis was performed on PBMC stained with antibodies directed against surface markers of antigen presenting cells (APCs), NK-cells, NKT cells, CD4+ and CD8+ T cells and subsets of these cell types, including PDL1 and PDL2 expressing subsets. RNA was extracted from whole blood, monocytes, and NK-cells to investigate expression and correlation between regulated miRNAs and mRNAs. In total, 15 miRNAs were validated to be differentially expressed between third trimester pregnant and postpartum MS patients (Benjamini-Hochberg false discovery rate from p = 0.03–0.00004). Of these, 12 miRNAs were downregulated in pregnancy and 6 of the 15 miRNAs were altered by more than ±2-fold (+2.99- to -6.38-fold). Pregnant MS patients had a highly significant increase in the percentage of monocytes and a decrease of NK-cells and myeloid dendritic cells compared to non-pregnant MS patients. We confirm previous reports of a relative increase in CD56-bright NK-cells and a decrease in CD56-dim NK-cells in third trimester of pregnancy and report an increase in non-committed follicular helper cells. PDL1 and PDL2 expression was increased in pregnant patients together with IL10. Also, in monocytes IL10, PDL1, and PDL2 were upregulated whereas miR-1, miR-20a, miR-28, miR-95, miR-146a, miR-335, and miR-625 were downregulated between pregnant and untreated MS patients. IL10, PDL1, and PDL2 were predicted targets of MS pregnancy-changed miRNAs, further supported by their negative correlations. Additionally, previously identified pregnancy-regulated mRNAs were identified as predicted targets of the miRNAs. PDL1 and PDL2 bind PD-1 expressed on T cells with an inhibitory effect on T-cell proliferation and increase in IL10 production. These results indicate that some of the effects behind the disease-ameliorating third trimester of pregnancy might be caused by changed expression of miRNAs and immunoregulatory molecules in monocytes.

Гепатопротекторная терапия препаратом низкомолекулярных сахаров беременных с функциональными расстройствами печени на фоне раннего токсикоза и лекарственной гепатопатии

Objective. To assess the efficacy and safety of low molecular weight sugar solution as a hepatoprotector in the first trimester of pregnancy in patients with liver functional disorders against the background of early toxicosis and / or hepatotoxicity. Patients and methods. The study included 70 patients: the main group (n = 30) – pregnant women with functional hepatopathies who received therapy with drug Heptrong; the control group (n = 30) – pregnant women who received standard treatment, of which 15 patients had hepatotoxicity (essential phospholipid therapy) and 15 patients with early toxicosis (intravenous saline fluid therapy, Cerucal), as well as 10 pregnant women with early toxicosis who were treated without drugs (the placebo group). Results. Pregnant women with early toxicosis noted a decrease in its clinical manifestations against the use of the drug Heptrong after 2.3 ± 0.8 days from the onset of therapy; by the end of therapy, all patients had no vomiting, and nausea stopped in 80%, which was not observed in comparison groups. The normalization of alanine aminotransferase (≤40 U/L) occurred in 80% of pregnant women in the main group (p < 0.01) and in 66% (p < 0.01) when treating with essential phospholipids. The normalization of alanine aminotransferase (≤40 U/L) occurred in 90% (p < 0.01) and 33.3% (p = 0.03), respectively. A significant decrease in the level of bile acids (from 8.49 ± 2.1 μmol/L to 2.74 ± 1.1 μmol/L; p < 0.05) and improvement in the indicators of the antioxidant system – an increase in total antiradical activity (from 804.0.0 ± 10.5 μmol/L to 839.0 ± 11.0 μmol/L; p < 0.05) and a decrease in the level of conjugated dienes (from 3.77 ± 0.2 μmol/L to 3.26 ± ± 0.1 μmol/L; p < 0.05) – were observed only in the main group. A number of other indicators of the “liver panel” tended to improve only in the main group. Conclusion. Heptrong is an effective hepatoprotective drug, which considerably improves the state of pregnant women during early toxicosis and helps to reduce liver transaminases and bile acids in pregnant women with hepatotoxicity. Due to the antiinflammatory and pronounced antioxidant effect, which is not observed in standard pharmacological treatment, Heptrong can be used to prevent late obstetric complications. Key words: Heptrong, drug-induced hepatopathies, “liver panel” indicators, early toxicosis

FEATURES OF THE FUNCTIONAL STATE OF PLATELETS AT THE PRE-CLINICAL STAGE OF PREECLAMPSIA

The only effective method of treating pregnant women with developed preeclampsia is timely delivery, so it is an urgent task to establish predictors of preeclampsia in order to predict its development.The aim of the work is to evaluate the platelet link of the hemostasis system in the 2nd trimester of pregnancy in patients with preeclampsia that developed after 34 weeks of pregnancy, to establish informative markers for predicting the development of preeclampsia after 34 weeks of pregnancy A survey of 210 apparently healthy women of active reproductive age (18-34 years) was carried out. Patients with multiple pregnancies, autoimmune pathology, arterial hypertension, heart defects, varicose veins, diabetes mellitus, hereditary thrombophilia were excluded from the study. All patients received voluntary informed consent to use the survey data for scientific purposes. In 20 patients, the course of pregnancy was complicated by the development of moderate preeclampsia after 34 weeks of pregnancy, these patients constituted the main group. 190 women with physiological pregnancy made up the comparison group. The study of the state of the platelet link of the hemostasis system was carried out using a VS-3000 + hematological analyzer, the number of platelets, their average volume, the root-mean-square value of the spread of platelet sizes, and the percentage of megalothrombocytes were determined. At the preclinical stage of development of preeclampsia (at 20-22 weeks), a decrease in the number of platelets and an increase in functional activity in the form of an increase in the rate of platelet anisocytosis, the average volume of platelets and the number of megalothrombocytes were found in pregnant women of the main group. Determination of indicators of the state of the platelet hemostasis at 20-22 weeks of gestation can be used to predict the development of moderate preeclampsia after 34 weeks of gestation.

The possible role of endocrine dysfunction of adipose tissue in gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is diabetes that is first diagnosed in the second or third trimester of pregnancy in patients who did not have a history of diabetes before pregnancy. Consequences of GDM include increased risk of macrosomia and birth complications in the infant and an increased risk of maternal type 2 diabetes mellitus (T2DM) after pregnancy. There is also a longer-term risk of obesity, T2DM, and cardiovascular diseases in the child. GDM is the result of impaired glucose tolerance due to pancreatic β-cell dysfunction on a background of insulin resistance that physiologically increases during pregnancy. The strongest clinical predictors of GDM are overweight and obesity. The fact that women with GDM are more likely to be overweight or obese suggests that adipose tissue dysfunction may be involved in the pathogenesis of GDM, similarly to T2DM. Adipose tissue is not only involved in energy storage but also functions as an active endocrine organ secreting adipokines (specific hormones and cytokines) with the ability to alter insulin sensitivity. Recent evidence points to a crucial role of numerous adipokines produced by fat in the development of GDM. The following text summarizes the current knowledge about a possible role of selected adipokines in the development of GDM.

Cortisol and DHEA-S levels in pregnant women with severe anxiety

BackgroundA complex interaction between cortisol and dehydroepiandrosterone-sulphate (DHEA-S) is crucial in the stress system balance; several studies have reported increased cortisol levels during chronic stress and a weak counter-regulation by DHEA-S. During pregnancy, scarce information about this system is available, although cortisol and DHEA-S play an important role in the initiation and acceleration of labor. We conducted the present study in order to determine both cortisol and DHEA-S levels during the last trimester of pregnancy in patients exhibiting severe anxiety.MethodsPregnant women during the 3rd trimester of pregnancy were evaluated by using the self-reported version of the Hamilton Anxiety Rating Scale (HARS). According to the scores obtained from the psychometric scale, participants were divided into two groups: 1) patients exhibiting a cutoff score > 15 were considered with severe anxiety (ANX) (n = 101), and control pregnant subjects (CTRL) (n = 44) with a cutoff score < 5. Morning cortisol, DHEA-S and Cortisol/DHEA-S index were measured in all participants. Comparisons between groups were performed; additionally, correlations between clinical variables, biochemical data and HARS were calculated.ResultsCortisol levels were significantly higher in the ANX group (p < 0.001), whereas those of DHEA-S were significantly lower in the same group (p < 0.01) when compared to healthy pregnant subjects. An increased cortisol/DHEA-S index was observed in the ANX group (p < 0.05). A significant association between cortisol and HARS scores (p = 0.03), was observed even after adjusting by gestational weeks (p = 0.004).ConclusionsOur data support that the cortisol/DHEA-S index is higher in pregnant women with high anxiety levels as compared with healthy pregnant women.

LO46: Prognostic value of single serum progesterone in the evaluation of symptomatic pregnant patients: a systematic review and meta-analysis

Introduction: Pain and bleeding complicate 30% of pregnancies threatening viability. The objective of this systematic review is to evaluate the role of a single progesterone level in predicting viability. Methods: We comprehensively searched MEDLINE, Embase (OVID), CINAHL and Cochrane databases from inception to July 2019. We included English language studies that enrolled symptomatic first trimester pregnant patients, measured progesterone and reported viability (miscarriage, ectopic or viable). We excluded studies with patients who had progesterone treatment, or conception after induced ovulation/invitro fertilization. We extracted patient characteristics, study setting, mean progesterone, the cut off value and outcome (viability). The quality of the included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We extracted data for 2X2 tables and report mean, standard deviation (SD), sensitivity, specificity, positive and negative predictive values (PPV, NPV). Results: Of the 689 studies screened, 51 studies with 15783 patients were included (1 randomized control trial, 36 prospective, 9 retrospective, 5 prospective case control studies) and 7553 were viable pregnancies. Of the 31 studies (n = 10998) that reported ectopic, 1661 patients were diagnosed with ectopic pregnancy. In 35 studies (n = 6003) that reported mean and SD, the levels were higher in viable (26.7 ± 11.2ng/ml) than non-viable (9.5 ± 5.9ng/ml; p &lt; 0.001) or ectopic pregnancy 9.5 ± 6.8ng/ml (p &lt; 0.001). The pooled diagnostic characteristics at different cut-off values were: &lt;6.3ng/mL (9 studies; N = 6033) sensitivity 65.0% (95%CI 63.5,66.5), specificity 97.3% (95%CI 95.5, 98.5), PPV 99.4% (95%CI 99.1,99.7) and NPV 27.4 (95%CI 26.6,28.4); &lt;10 ng/mL (12 studies with 5743 participants) sensitivity 65.0% (95% CI 63.5, 66.5), specificity of 97.3% (95%CI 95.5, 98.5), PPV 99.4% (95% CI 99.1, 99.7) and NPV 27.4% [95% CI 26.5, 29.4); 11-20 ng/mL (24 studies with 7141 participants) sensitivity 77.3% (95% CI 76.2,78.4), specificity 64.6% (95% CI 63.2, 65.9), PPV 73.2% [95% CI 72.3, 73.9) and NPV 69.5% (95% CI 70.7, 72.5). There was low risk of bias for patient selection, index test and low concern regarding applicability. The highest risk (82% of studies) was due to outcome ascertainment bias due to non-blinding of index and additional tests. Conclusion: A single progesterone value is useful in predicting viability of pregnancy among symptomatic patients.

Serum Magnesium Levels in Second and Third Trimesters of Pregnancy in Patients That Developed Pre-Eclampsia and Feto-Maternal Outcome

Introduction: Pregnancy is a physiological process that may be complicated by a number of clinical conditions. Gestational diabetes and pre-eclampsia are known complications in pregnancy. Pre-eclampsia is a disease of hypothesis in which the pathogenesis is yet to be fully explained. The role of magnesium in the pathogenesis of pre-eclampsia has been suggested by studies and it is being investigated all over the world. The study aimed to compare serum magnesium levels in pre-eclampsia and control groups from second trimester of pregnancy and assessed maternofetal outcome. Materials and Methods: This was a nested case control study in which consenting three hundred and sixty (360) normal pregnant women were enrolled. These women were recruited in their second trimester of pregnancy. Blood samples for serum magnesium estimation were obtained from subjects and controls at recruitment and after development of pre-eclampsia. Results: Thirty seven pregnant women that developed pre-eclampsia were nested as cases and were matched with 37 controls (apparently healthy pregnant women). The mean serum magnesium at recruitment was 0.75 ± 0.028 mmol/l (cases) and 0.76 ± 0.036 mmol/l (controls) (P = 0.123); this became significant when diagnosis of pre-eclampsia were made with mean of 0.53 ± 0.06 mmol/l (cases) and 0.69 ± 0.08 mmol/l (controls), (P 0.001). There was significant statistical relationship between preterm delivery, low birth weight and need for special care baby unit (SCBU) admission in newborn of mothers with low serum magnesium level (P = 0.001, 0.002 and 0.035 respectively). Conclusion: Findings from this study revealed that hypomagnesaemia appears to be a complication of pre-eclampsia. Serum levels of magnesium were normal until the development of the disease. Serum level of this biomarker affects maternofetal outcome significantly.

Functional Status of Maternal Thyroid Gland in Eclampsia

Marked changes in maternal thyroid activity occur in pregnancy. During pregnancy bodily hormonal changes and metabolic demands result in complex alteration in the bio-chemical parameters of thyroid activities. Besides these, thyroid enlargement, increased thyroid capability for iodine uptake and increase in basal metabolic rate are evidential though these findings are not usually associated with symptoms of hyperthyroidism in pregnancy. Serum concentration of thyroid hormone thyroxine and triiodothyronine in complicated pregnancy like eclamptic toxemia is another field of controversy. To evaluate the changes in thyroid function in normal pregnancy and eclamptic toxemia, a study was undertaken in Rajshahi Medical College Hospital. We collected serum specimens from non pregnant but married women, normal 3rd trimester pregnant women and patients with eclampsia at 3rd trimester of pregnancy and measured serum concentrations of total and free thyroxine (TT4 &amp; FT4) and total and free triiodothyronine (TT3 &amp; FT3 ) by using RIA. Among the study subjects, 10 women were married but non pregnant, 12 women were in their 3rd trimester of normal pregnancy and 32 patients of eclamptic toxemia with 3rd trimester of pregnancy. In normal pregnancy, FT4 and FT3 levels remained normal while TT4 and TT3 levels were elevated. In patients with toxemia of pregnancy, the mean serum TT3 concentration was significantly lower than that of normal pregnancy and the serum FT3 concentrations were below the normal pregnancy range. The mean serum TT4 and FT4 concentrations in patients with eclampsia were however, significantly higher than those in normal pregnant women.&#x0D; TAJ 2018; 31(1): 9-14

Vaginal microbiota in the first trimester of pregnancy in women with a history of miscarriage

Hypothesis/aims of study. Dysbiotic disorders of the vagina are one of the main risk factors of miscarriage. The analysis of vaginal microbiota during pregnancy in women having a history of miscarriage may contribute to understanding the importance of specific types of vaginal flora in the development of processes resulting in spontaneous abortion or preterm birth. This study was undertaken to evaluate the vaginal flora in the 1st trimester of pregnancy in women having a history of miscarriage.&#x0D; Study design, materials, and methods. To participate in the study, 160 individuals in the 1st trimester of pregnancy with and without a history of miscarriage were invited. Group 1 included 100 women with a history of miscarriage, group 2 consisted of 60 women without a history of miscarriage. The vaginal flora was analyzed with microscopic, bacteriological, and quantitative real-time PCR methods.&#x0D; Results. In patients with a history of miscarriage, the frequency of dysbiotic disorders of the vaginal flora was three times higher (11.0% and 3.3%) and pH value of the vaginal fluid was significantly higher. Along with a significant reduction of the proportion of the Lactobacillus flora in the 1st trimester of pregnancy in patients having a history of miscarriage, there was a significant increase in the abundance of opportunistic microorganisms, mostly aerobic flora, such as Enterobacteriaceae, Streptococcus spp., and Staphylococcus spp. Furthermore, there was a significant predominance of Ureaplasma spp. and Candida spp. in women with a miscarriage history.&#x0D; Conclusion. The vaginal microbiota in the 1st trimester of pregnancy in women having a history of miscarriage is characterized by higher pH values of the vaginal fluid, the prevalence of opportunistic microorganisms, a decrease in the abundance of the Lactobacillus flora, and a higher concentration of aerobic bacteria, Ureaplasma spp., and Candida spp. These findings indicate dysbiotic disorders of the vaginal microbiocenosis in women having a history of miscarriage, which can lead to late miscarriage and pretem birth.

High-Sensitivity Cardiac Troponin I Levels in Normal and Hypertensive Pregnancy

PurposeThe purpose of this study was to examine the association of circulating concentrations of high-sensitivity cardiac troponin I (hs-cTn) in the various trimesters of pregnancy in patients with and without hypertension. MethodsThis was a prospective cross-sectional study of pregnant and postnatal women aged between 18-35 years with no coexisting diseases. Serum samples were analysed for hs-TnI. ResultsA total of 880 women (mean age = 29.1 years [standard deviation = 5.1 years]) were recruited with 129 (14%), 207 (24%), and 416 (47%) patients in the first, second, and third trimesters, respectively. Ninety (10%) participants were recruited in the postnatal period. During pregnancy 28 (3%) patients were classified as having pregnancy-induced hypertension and 10 (1%) as preeclampsia. High-sensitivity cardiac troponin I was measurable in 546 (62%) participants with a median of 1 ng/L (range 0 to 783 ng/L). Troponin concentrations were above the 99th percentile in 19 (2%) individuals. Patients with pregnancy-induced hypertension and preeclampsia had higher concentrations of hs-TnI (median 11 ng/L [interquartile range (IQR) 6 to 22 ng/L] vs 12ng/L [IQR 3 to 98 ng/L] vs 1 ng/L [IQR 0 to 1 ng/L]). In logistic regression modeling hs-cTnI concentration remained an independent predictor of pregnancy-induced hypertension or preeclampsia in both unadjusted and adjusted models (odds ratio 9.3 [95% confidence interval 5.8 to 16.3] and 11.5 [95% confidence interval 6.3 to 24.1], respectively, per doubling of hs-TnI concentrations). ConclusionsCardiac troponin measured using a high-sensitivity assay is quantifiable in the majority of young pregnant women with 2% of individuals having concentration above the 99th percentile sex-specific threshold. Patients with pregnancy-induced hypertension or preeclampsia had higher cardiac troponin concentrations. Cardiac troponin was a strong independent predictor of pregnancy-induced hypertension or preeclampsia in pregnant and postnatal women.

THE FIRST HALF OF PREGNANCY IN WOMEN WITH SEVERE FORMS OF PREECLAMPSIA (RETROSPECTIVE ANALYSIS)

The article presents the results of the clinical and statistical analysis of the birth stories of the childbearing with severe forms of preeclampsia in view of the traditional risk factors - excess body weight, age, number of pregnancies and childbirth, as well as the features of the course of the first trimester of pregnancy.Purpose of the study. To study the features of the first trimester of pregnancy in patients with severe forms of preeclampsia.Material and methods of investigation. The history of childbirth and questionnaires of 129 pregnant women with severe and moderate severity of preeclampsia (main group) and 120 infants with a physiological course of the second half of pregnancy and childbirth (control group) were studied.Results and discussion. Analysis of 129 childbirth histories in pregnant women with severe forms of preeclampsia did not show prevalence among women of a certain age group, as well as women with a primary overweight, concomitant somatic diseases, thrombophilia in particular. Nulliparas were dominating among them. At the same time, for women with severe forms of preeclampsia the uncomplicated course of the first pregnancy trimester was proper, in particular – significantly decreased frequency of nausea and vomiting, comparing with control group.ConclusionsClinical and statistical analysis of the labour stories of the patients with severe forms of preeclampsia did not reveal an increase in the risk of the disease with age, but the prevalence among them among the first-breeders has been shown.Most part of the mothers with severe forms of preeclampsia had no complaints in the first trimester of pregnancy, while the women with uncomplicated flow of the second half of pregnancy and labour were more likely to have nausea and vomiting in the first half of it.

The role of obesity and adipose tissue dysfunction in gestational diabetes mellitus.

Gestational diabetes mellitus is defined as diabetes diagnosed in the second or third trimester of pregnancy in patients with no history of diabetes prior to gestation. It is the most common complication of pregnancy. The underlying pathophysiology shares some common features with type 2 diabetes mellitus (T2DM) combining relatively insufficient insulin secretion with increased peripheral insulin resistance. While a certain degree of insulin resistance is the physiological characteristics of the second half of pregnancy, it is significantly more pronounced in patients with gestational diabetes. Adipose tissue dysfunction and subclinical inflammation in obesity are well-described causes of increased insulin resistance in non-pregnant subjects and are often observed in individuals with T2DM. Emerging evidence of altered adipokine expression and local inflammation in adipose tissue in patients with gestational diabetes suggests an important involvement of adipose tissue in its etiopathogenesis. This review aims to summarize current knowledge of adipose tissue dysfunction and its role in the development of gestational diabetes. We specifically focus on the significance of alterations of adipokines and immunocompetent cells number and phenotype in fat. Detailed understanding of the role of adipose tissue in gestational diabetes may provide new insights into its pathophysiology and open new possibilities of its prevention and treatment.