Umbilical Blood Research Articles

CGAS Deficiency Regulates the Phenotypic Polarization and Glycolysis of Microglia Through Lactylation in Hypoxic-Ischemic Encephalopathy Cell Model.

Promoting the M2 phenotype polarization of microglia is of great significance in alleviating hypoxic-ischemic encephalopathy (HIE). The umbilical artery blood sample was collected to evaluate the expression of cGAS, and the aberrant expressed cGAS was verified in the oxygen glucose deprivation (OGD) microglia which was established to mimic HIE in vitro. Then the regulating role of cGAS on the transformation of microglia M2 phenotype polarization and glycolysis was investigated. Moreover, the lactylation of cGAS in OGD treated microglia was evaluated by western blot. cGAS was found to be highly expressed in umbilical artery blood of HIE group, and OGD treated microglia. OGD interference activated microglia into M1 phenotype by enhancing CD86 and suppressing CD206 levels; meanwhile, the microglia in OGD group highly expressed IL-1β, iNOS and TNF-α, and lowly expressed IL-4, IL-10, and Arg-1. Inhibition of cGAS promotes the transformation of microglia from M1 to M2 phenotype. Meanwhile, OGD increased ECAR and decreased OCR to regulate glycolysis, cGAS deficiency inhibits glycolysis in OGD treated microglia. Moreover, the pan lysine lactylation (Pan-Kla) levels and lactated cGAS levels in microglia were upregulated in the OGD group. Lactate reversed the effects of cGAS knockdown on microglia polarization and glycolysis. The present study reveals that the cGAS-mediated neuron injury is associated with high level of cGAS lactylation. Inhibition of cGAS promotes the M2 phenotype polarization of microglia and suppress glycolysis. Thereby, targeting cGAS provides a new strategy for the development of therapeutic agents against HIE.

Neonatal Hematological Abnormalities Associated with Maternal Pre-eclampsia at Birth

Background: Pre-eclampsia (PE) can cause hematological abnormalities that can further exacerbate the existing morbidity in newborns. This study aimed to investigate neonatal hematological abnormalities associated with maternal pre-eclampsia at the time of birth. Methods: This cross-sectional was conducted from January 2023 to July 2023, involving 122 neonates born at the Department of Pediatric Medicine, Sohail Trust Hospital in Karachi, Pakistan. It analyzed neonates of either gender, aged from birth to 24 hours of life, and born to pre-eclamptic mothers, and their demographic details were recorded. At delivery, 2 ml of umbilical venous blood was collected by a trained pediatric nurse and then sent to the institutional laboratory. Hematological changes like leukopenia, thrombocytopenia, or neutropenia were noted. To assess the influence of various factors on hematological outcomes, chi-square tests were applied, with a significance threshold set at p<0.05. Results: In a total of 122 neonates, the mean age was 8.14±6.49 hours. The mean gestational age was 38.87±3.15 weeks. There were 68 (55.7%) neonates who were male. Low birth weight (LBW) was less than 2500 grams in 45 (36.9%) newborns. Thrombocytopenia, leukopenia, and neutropenia were identified in 32 (26.2%), 25 (20.5%), and 23 (18.9%) neonates respectively. Stratification of leukopenia concerning study variables revealed that gestational age and LBW had a significant association (p=0.0036, p=0.0072) with leukopenia. Moreover, neutropenia also had an association with LBW (p<0.0001). Conclusion: These findings underscore the importance of early hematological screening for neonates born to pre-eclamptic mothers to facilitate timely diagnosis and care.

Ultrasound blood flow characteristics changes in fetal umbilical artery thrombosis: A retrospective analysis.

Umbilical artery thrombosis (UAT) is extremely uncommon and leads to adverse perinatal outcomes. Hypercoagulation of blood in pregnant women is suspected to be an important risk for UAT. Ultrasound is an effective way to detect thrombosis. The mother can monitor her own fetal health using ultrasound, which enables her to take preventative action in case of emergency. To investigate ultrasonic blood signal after UAT in the umbilical artery, and evaluate the relationship between hypercoagulability and UAT. We described a case of a newly formed UAT with markedly altered ultrasonic indices of umbilical artery blood flow, and retrospectively studied it with 18 UAT patients confirmed by histopathology from October 2019 and March 2023 in Xiamen Women and Children's Hospital. Patients' information was collected from medical archives, including maternal clinical data, neonatal outcomes, pathological findings and ultrasonic indices of umbilical artery blood flow, such as systolic-diastolic duration ratio (S/D), resistance index (RI), pulsatility index (PI) and peak systolic velocity (PSV). Ultrasound and coagulation indices were analyzed with matched samples t-test and Wilcoxon rank sum test using the statistical packages in R (version 4.2.1) including car (version 3.1-0) and stats (version 4.2.1), and visualized by ggplot2 package (version 3.3.6). A patient with normal findings in second and third-trimester routine ultrasound scan developed UAT with severe changes in ultrasonic indices of umbilical artery blood flow (within 2.5th of reference ranges) in a short period of time. Statistical analysis of umbilical artery blood flow ultrasound indices for 19 patients with UAT showed that the decrease in S/D, RI, and PI and increase of PSV during the disease process was greater than that of non-UAT. All 18 patients delivered in our hospital showed characteristic manifestations of UAT on histological examination after delivery, most of which (16/18) showed umbilical cord abnormalities, with 15 umbilical cord torsion and 1 pseudoknot. Coagulation parameters were not significantly changed in UAT patients compared with normal pregnancy women. Significant changes in ultrasound indicators after UAT were demonstrated. PSV can play important roles in the diagnosis of UAT. Hypercoagulability alone is not sufficient for the occurrence of UAT.

Profiles and transplacental transfer of per- and polyfluoroalkyl substances in maternal and umbilical cord blood: A birth cohort study in Zhoushan, Zhejiang Province, China

Per- and polyfluoroalkyl substances (PFAS) can pass through the placental barrier and pose health risks to fetuses. However, exposure and transplacental transfer patterns of emerging PFAS remain unclear. Here, 24 PFAS were measured in paired maternal whole blood (n = 228), umbilical cord whole blood (n = 119) and serum (n = 120). Orthogonal partial least-squares discriminant analysis (OPLS-DA) was used to differentiate PFAS between different matrices. The transplacental transfer (TPT) of PFAS was calculated using cord to maternal whole blood concentration ratios. PFOS and PFOA were still the dominant PFAS in maternal samples. The emerging PFAS had higher TPT than PFOS and PFOA. Moreover, PFAS with the same chain length but different functional groups and C-F bonds showed different TPT, such as PFOS and PFOSA (C8, median: 0.090 vs. 0.305, p < 0.05) and PFHxS and 4:2 FTS (C6, median: 0.220 vs. 1.190, p < 0.05). A significant sex difference in 4:2 FTS (median: boys 1.250, girls 1.010, p < 0.05) were found. Furthermore, we observed a significant U-shaped trend for the TPT of carboxylates with increasing carbon chain length. PFAS showed a compound-specific transfer through placental barrier and a compound-specific distribution between different matrices in this study.

Novel cuproptosis-related prognostic gene profiles in preeclampsia

BackgroundPreeclampsia (PE) is a pregnancy-specific disorder with complex pathogenesis. Cuproptosis is a novel identified form of programmed cell death, however, the link between cuproptosis and clinical outcomes in PE is still not fully understood. In this study, we searched for cuproptosis-related genes (CRGs) in the placental tissues of normal and PE patients to clarify the importance of cuproptosis in the development of PE and provide potential predictive indicators for the occurrence of PE.MethodsUsing RNA sequencing data in the GEO database, we conducted functional enrichment analysis of Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Set Enrichment Analysis (GSEA), supported by linear regression model and operating characteristic curve (ROC) curve analysis, and summarized the role of CRGs in preeclampsia.ResultsA total of 2831 differentially expressed genes related to PE were screened through multiple database analyses. After further intersection with 19 reported CRGs, 5 CRGs have been closely associated with the pathogenesis of PE, including NFE2L2, PDHA1, PDHB, DLD and GLS. NFE2L2 was identified as a key central gene. Pearson correlation analysis showed that CRGs could be related to several maternal and fetal outcome factors, including the highest pregnancy blood pressure, placenta weight, umbilical blood flow pulsatility index (PI), and neonatal weight. Linear regression equation revealed that the expression of NFE2L2 is negatively correlated with the highest pregnancy blood pressure and umbilical blood flow PI but positively correlated with placental weight and neonatal weight. QRT-PCR showed that the expression of these CRGs was significantly lower in placental tissues.ConclusionsThis cuproptosis pattern may be a potential prognostic factor in patients with PE and could provide new insights into disease progression.

Diagnostic efficiency of ultrasound diagnosis of venous catheters and venous catheter blood flow spectrum

BackgroundVenous catheter abnormalities are related to chromosomal abnormalities, in order to detect whether the fetus has congenital diseases as soon as possible. ObjectiveTo explore the image characteristics and diagnostic efficiency of ultrasound diagnosis of venous catheter abnormalities and venous catheter blood flow spectrum abnormalities. Method60 pregnant women were divided into a venous catheter abnormality group (n = 12) and a normal group (n = 48). Both groups underwent ultrasound examination. Collect abnormal fetal umbilical vein catheter and venous catheter blood flow spectrum parameters from the abnormal venous catheter group. Calculate the diagnostic efficiency and prognosis of two groups of patients. ResultIn this experiment, there were differences in peak atrial systolic velocity among participants, and the peak atrial systolic velocity in the group with abnormal venous catheters was lower than that in the normal group (P < 0.05). The positive detection rate of the normal group was 4.17%, and the negative detection rate was 95.83%. The positive detection rate of venous catheter abnormalities group was 66.67%, and the negative detection rate was 33.33%. The prognostic differences among participants in this experiment showed SSI (P<0.05). The proportion of abnormal prognosis of venous catheter abnormalities is higher than that of the normal group. ConclusionUltrasound diagnosis of fetal venous catheter abnormalities has high clinical value, which is beneficial for determining whether the fetus has congenital diseases through abnormal venous catheter blood flow spectrum.

Evaluating Practice Consistency: Complying with the Directive to Obtain Umbilical Cord Arterial and Venous Blood Gasses, and Hemoglobin Values, at High-risk Deliveries

Evaluating Practice Consistency: Complying with the Directive to Obtain Umbilical Cord Arterial and Venous Blood Gasses, and Hemoglobin Values, at High-risk Deliveries

Maternal exposure to polyethylene micro- and nanoplastics impairs umbilical blood flow but not fetal growth in pregnant mice

While microplastics have been recently detected in human blood and the placenta, their impact on human health is not well understood. Using a mouse model of environmental exposure during pregnancy, our group has previously reported that exposure to polystyrene micro- and nanoplastics throughout gestation results in fetal growth restriction. While polystyrene is environmentally relevant, polyethylene is the most widely produced plastic and amongst the most commonly detected microplastic in drinking water and human blood. In this study, we investigated the effect of maternal exposure to polyethylene micro- and nanoplastics on fetal growth and placental function. Healthy, pregnant CD-1 dams were divided into three groups: 106 ng/L of 740–4990 nm polyethylene with surfactant in drinking water (n = 12), surfactant alone in drinking water (n = 12) or regular filtered drinking water (n = 11). At embryonic day 17.5, high-frequency ultrasound was used to investigate the placental and fetal hemodynamic responses following exposure. While maternal exposure to polyethylene did not impact fetal growth, there was a significant effect on placental function with a 43% increase in umbilical artery blood flow in the polyethylene group compared to controls (p < 0.01). These results suggest polyethylene has the potential to cause adverse pregnancy outcomes through abnormal placental function.

Effect of intravenous esketamine in emergency cesarean deliveries: a retrospective analysis of maternal and neonatal outcomes

Background This study investigates the effects of administering intravenous esketamine at a dose of 0.25 mg/kg to pregnant patients receiving epidural anesthesia for emergency cesarean section on both maternal and neonatal outcomes. Methods Medical records of pregnant patients transitioning from labor analgesia to epidural anesthesia for emergency cesarean sections between January 2020 and December 2022 were analyzed. The patients were categorized based on whether they received esketamine infusions during the incision-to-delivery interval. The variables compared between the groups included hemodynamic parameters, perioperative and postoperative adverse reactions, and neonatal outcomes (gender, weight, Apgar scores at 1 and 5 min, need for neonatal intensive care, and umbilical artery/vein blood gas analysis). Results For maternal outcomes, the systolic blood pressure (SBP) in the esketamine group showed a significant increase at 5 and 10 min’ post-administration, and the diastolic blood pressure (DBP) significantly increased at 5 min, compared to the control group (p < 0.01). No significant differences were observed in heart rate (HR) and oxygen saturation (SpO2) at any time point (p > 0.05). The esketamine group experienced a significant rise in the incidence of arrhythmias, dizziness, and nystagmus during the perioperative period, a notable decrease in hypotension incidence, and an increase in postoperative nausea and dizziness. Regarding neonatal outcomes, there were no significant differences in gender, weight, Apgar scores ≤7 at 1 and 5 min, and the need for neonatal intensive care. However, the pH level in the umbilical artery blood of the esketamine group was significantly higher. The levels of PCO2 and PO2 in umbilical artery and venous blood did not show significant differences between the groups. Conclusions In pregnant women undergoing emergency cesarean section, intravenous administration of 0.25 mg/kg esketamine is correlated with favorable maternal and neonatal outcomes.

Prenatal exposure to intra-amniotic infection with Ureaplasma species increases the prevalence of bronchopulmonary dysplasia

Objectives The present study investigated the relationship between bronchopulmonary dysplasia (BPD) and intra-amniotic infection with Ureaplasma species. Methods This was a single-center, retrospective cohort study. Patients with singleton pregnancies who underwent inpatient management at our department for preterm premature rupture of membranes (PPROM), preterm labor, cervical insufficiency, and asymptomatic cervical shortening at 22–33 gestational weeks were included. Amniocentesis was indicated for patients with PPROM or an elevated maternal C-reactive protein level (≥0.58 mg/dL). Patients with an amniotic fluid IL-6 concentration ≥3.0 ng/mL were diagnosed with intra-amniotic inflammation, while those with positive aerobic, anaerobic, M. hominis, and Ureaplasma spp. cultures were diagnosed with microbial invasion of the amniotic cavity (MIAC). Patients who tested positive for both intra-amniotic inflammation and MIAC were considered to have intra-amniotic infection. An umbilical vein blood IL-6 concentration >11.0 pg/mL indicated fetal inflammatory response syndrome (FIRS). The maternal inflammatory response (MIR) and fetal inflammatory response (FIR) were staged using the Amsterdam Placental Workshop Group Consensus Statement. Results Intra-amniotic infection with Ureaplasma spp. was diagnosed in 37 patients, intra-amniotic infection without Ureaplasma spp. in 28, intra-amniotic inflammation without MIAC in 58, and preterm birth without MIR/FIR and FIRS in 86 as controls. Following an adjustment for gestational age at birth, the risk of BPD was increased in patients with intra-amniotic infection with Ureaplasma spp. (adjusted odds ratio: 10.5; 95% confidence interval: 1.55–71.2), but not in those with intra-amniotic infection without Ureaplasma spp. or intra-amniotic inflammation without MIAC. Conclusion BPD was only associated with intra-amniotic infection with Ureaplasma species.

Umbilical cord arterial blood pH an indicator of rise in cesarean section rate due to false-positive indications by CTG

Background: Cesarean section rate is rising globally, now accounting for more than 1 in 5 (21%) of all childbirths. This number is set to continue increasing over the coming decade unless the factors which increase the rate of cesarean section are kept in check. Intrapartum cardiotocography (CTG) has shown a false-positive rate of cesarean section. This has been correlated with neonatal umbilical cord blood pH analysis. Aims and Objectives: (1) Correlation of non-reassuring CTG, resulting in cesarean section with umbilical cord arterial blood pH. (2) To find the false-positive indications of cesarean section due to CTG. Materials and Methods: This observational study was conducted in the Department of Obstetrics and Gynecology of SKIMS, Soura, from September 2020 to July 2022 over a period of 22 months. Women with a gestational age of more than 34 weeks with singleton pregnancy were included in the study. Those with CTG-documented fetal distress were subjected to umbilical cord arterial blood pH monitoring. Results: A total of 85 patients underwent cesarean sections in view of fetal distress documented by CTG, but only 45 neonates had actual distress as documented by umbilical cord blood sampling. Conclusion: Social and non-medical factors no doubt have caused an alarming rise in cesarean sections, but at the same time, there are some iatrogenic causes, namely CTG, which lead to the rise in the cesarean section rate due to false-positive indications. This has been further supported by the fact that the pH of the umbilical cord blood of neonates with intrapartum non-reassuring CTG does not correspond to fetal acidemia in all cases. Hence, a significant number of cesarean sections is being done for false-positive indications.

Comparison between conventional-dose and high-dose rocuronium use in general anesthesia for Cesarean section.

Background: There have been few studies comparing the effects of high- and low-dose rocuronium during cesarean section by directly measuring the concentration. Therefore, we conducted a study to examine the blood concentrations and clinical effects of both doses of rocuronium on mothers and fetuses. Methods: Eighteen patients were randomly assigned to two groups: C Group (0.6 mg/kg), and H Group, (1.0 mg/kg). The primary outcome was the comparison of umbilical vein rocuronium concentration between two groups. We assessed ease of intubation, time from rocuronium administration to some TOF points, post-anesthesia care unit (PACU) stay time, infused remifentanil dose, maternal rocuronium concentration, and Apgar scores. Results: No differences were observed in demographic data, ease of intubation, PACU stay time, 1 min Apgar scores, umbilical venous blood gas analysis between both groups. However, the time from rocuronium administration to T3 disappearance was shorter (p=0.009) and time to T1 and T2 reappearance were longer (p=0.003, p=0.009) in H group than that in C group. The administered remifentanil dose (p=0.042) was lower in the H group than in the C group. Rocuronium concentrations in the umbilical vein (p=0.004) and maternal vein before cord clamping (p=0.002) and at discharge (p<0.001) were also found to be higher in the H group than in the C group. Conclusions: We observed no prolongation of PACU stay, and no differences in Apgar scores in H group compared to C group. It suggests that 1.0 mg/kg of rocuronium has no negative effects on the fetus and mother in cesarean section.

Comparison of the efficacy of phloroglucinol versus ritodrine hydrochloride in preventing miscarriage and adverse reactions.

To analyze the efficacy of phloroglucinol versus ritodrine hydrochloride in preventing miscarriage and adverse reactions (ARs). A retrospective analysis was conducted on 211 patients with threatened abortion or premature birth who were admitted to the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine between July 2019 and July 2021. The control group (n=57) received ritodrine hydrochloride, while the observation group (n=154) was treated with phloroglucinol. We compared the overall therapeutic efficacy, time to symptom resolution, cessation of uterine contractions, success rate of miscarriage prevention, and full-term pregnancy rate between the two groups. Estrogen levels, including serum progesterone (P), estradiol (E2), and human chorionic gonadotropin (hCG), were measured and compared before and after treatment using ELISA. Additionally, neonatal outcomes, such as birth weight, Apgar scores, and umbilical arterial blood gas parameters [pH value, partial pressure of oxygen (PaO2), and partial pressure of carbon dioxide (PaCO2)], were evaluated and compared between the groups. Finally, the incidence of ARs during treatment was assessed and compared. Compared to the control group, the observation group had higher effective rate of treatment, success rate of miscarriage prevention, and a full-term pregnancy rate (all P<0.05). The times to symptom resolution and cessation of uterine contractions were markedly shorter in the observation group than those in the control group (both P<0.05). After treatment, levels of serum P, E2, and hCG in the observation group were significantly higher than those of the control group (all P<0.05). Additionally, the body weight, Apgar scores, pH value, and PaO2 of the neonates in the observation group were higher, while PaCO2 and the incidence of ARs were lower compared to the control group (all P<0.05). For threatened abortion or threatened premature labor, phloroglucinol is more effective than ritodrine hydrochloride for clinical intervention and treatment.

Ethanol foam: a novel type of foam sclerosant for treating venous malformations.

Sclerotherapy is a commonly utilized treatment approach for venous malformations. Absolute ethanol is renowned for its remarkable efficacy as a potent sclerosants, but it is potentially associated with severe complications. Foam sclerotherapy is considered superior to liquid sclerotherapy owing to its heightened efficacy and diminished incidence of complications. Thus, our objective was to devise an ethanol foam sclerosant that delivers exceptional efficacy while mitigating complications. In the first set of experiments, we identified the suitable range of ethanol concentrations for sclerotherapy through human umbilical vein endothelial cell proliferation assays and blood clotting experiments. Next, the surfactants polysorbate 80, egg yolk lecithin, and hyaluronic acid were added to create stable ethanol foam, with their ratios meticulously optimized. The optimal concentration range of ethanol was determined to be 30-60%. Eventually, a 48% ethanol foam was successfully produced with excellent stability. Other than ethanol, the formulation included 5 × 10-3 g/mL polysorbate 80, 10-2 g/mL egg yolk lecithin, and 0.04 mL/mL hyaluronic acid. The novel ethanol foam produced here could be a promising candidate for the treatment of venous malformations.

An investigation of the umbilical artery N-terminal proBrain natriuretic peptide levels of fetuses due to fetal distress in term pregnancies.

This study aimed to investigate umbilical artery N-terminal proBrain natriuretic peptide (NT-proBNP) in fetuses delivered by cesarean section due to fetal distress in term pregnancies. This prospective case-control study was conducted at the Antalya Training and Research Hospital Obstetric Department, Turkiye. A total of 140 pregnant women, 70 underwent elective cesarean sections between weeks 37 and 40 of gestation (Group 1, the control group) and 70 underwent cesarean sections due to fetal distress (Group 2, the study group), were included. The participants' sociodemographic and obstetric data and fetal umbilical blood NT-proBNP levels were recorded in a database. Age, body mass index, gestational age, prenatal diagnostic tests, fetal anatomical scanning, and baby gender ratios were comparable between the groups (p>0.05), while statistically significant differences were observed in terms of gravidity (3.0 vs. 1.0, p≤0.001) and parity numbers (2 vs. 0, p≤0.001), baby height (50.36±0.88 vs. 49.80±0.86, p≤0.001) and weight (3422.43±409.16 vs. 3239.86±293.74, p=0.003), 1-min Apgar (9.0±0.1 vs. 8.5±1.3, p≤0.001) and 5-min Apgar (10.0±0.1 vs. 9.8±0.4, p=0.026) scores, umbilical artery pH (7.32±0.05 vs. 7.25±0.07, p≤0.001), umbilical artery base deficit (-2.48±1.23 vs. -4.36±1.09. p≤0.001), and NT-proBNP levels [8.77 (7.72-9.39) vs. 12.35 (9.69-12.92), p<0.001]. This study showed that NT-proBNP can be used as an important marker in the diagnosis of fetal distress. Prospective studies with more participants are now needed to confirm the accuracy of our results.

Application of Dexmedetomidine in Epidural Labor Analgesia: A Systematic Review and Meta-Analysis on Randomized Controlled Trials.

To summarize and appraise the use of dexmedetomidine in epidural labor analgesia, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We conducted the literature search about the RCTs of epidural labor analgesia with or without dexmedetomidine from inception until Nov 1,2022 in the following databases: PubMed, the Cochrane Library and Embase. The primary outcome was visual analogue scale(VAS) within 2h after epidural intubation. The secondary outcomes included the duration of the first and second labor stage, Apgar score, umbilical blood pH, dosage of analgesics, and side effects. 8 RCTs including 846 parturients were included. The VAS score of dexmedetomidine group was significantly lower than that of the control group at the time of 15min(MD -1.41,95%CI -2.23,-0.59)、30min(MD -1.02,95%CI -1.70,-0.33)、60min(MD -0.90,95%CI -1.36,-0.44)、90min(MD -0.70,95%CI -1.16,-0.23). The incidence of pruritus in dexmedetomidine group was lower than that of control group（MD 0.28,95%CI 0.11,0.74）but the incidence of maternal bradycardia was higher (MD 6.41,95%CI 1.64,25.04). There were no significant difference in other outcomes. Dexmedetomidine combined with local anesthetic for epidural labor analgesia can improve the VAS score of parturients. Except for the increased incidence of maternal bradycardia, it seems to be safe for the parturients and fetuses.

Blood lead levels in pregnant women and their newborn infants at an Indian teaching hospital.

With the growth of the world's economy and industrialization, lead (Pb) contamination in the environment has become a major issue on a global scale. Lead is typically linked to unfavorable pregnancy outcomes such as stillbirth, low birth weight preterm, and spontaneous abortion. In this study, we evaluated the blood lead levels of pregnant women and their birth outcomes attending an Indian tertiary care teaching hospital, those who were not exposed to any lead-associated industry or shops. A descriptive study was undertaken to evaluate blood lead estimation in pregnant women and umbilical blood lead levels in a community hospital. Blood samples from 104 mothers during the 1st trimester, 90 mothers during 3rd trimester, and from the umbilical cord were collected. Self-administered questionnaires were used to collect information on demographics, medical history, and concerns linked to pregnancy. Following acid digestion, the levels of lead in whole blood were determined by an atomic absorption spectrometer. The DNA damage in high blood lead-concentrated pregnant women was evaluated by comet assay methods. Among 194 blood samples of pregnant women, 31 (15.98%) samples revealed ≥5 μg/dL blood lead levels. High lead concentration (≥5 µg/dL) in 1st trimester pregnant women, end of 3rd trimester and cord blood were detected 20.19%, 11.11% and 1.11% respectively. The mean blood lead levels in 1st trimester, 3rd trimester, and cord blood were 3.88 ± 3.19, 2.66 ± 1.82, and 1.53 ± 1.06 mg/dL, respectively. The blood lead concentrations were significantly higher in the 1st trimester of pregnancy than in the 3rd trimester of pregnancy (P < 0.0017). A positive correlation between maternal and infant blood lead levels was revealed (P < 0.0001). When the comet assay was used to assess the genotoxic consequences of elevated blood lead levels during pregnancy, higher amounts of DNA damage were found in the samples (P < 0.01). In this descriptive study, there was a significant amount of lead transferred from mother to baby through the placenta. All mothers were not exposed to lead-associated industry and most were housewives. This article may be viewed as an eye-opener for understanding the blood lead concentration during pregnancy to avoid abnormal birth outcomes. To minimize exposure to environmental lead, all possible measures should be undertaken.

Clinical Outcome of Monochorionic Diamniotic Twins with Intrauterine Growth Restriction.

This study investigated the clinical outcome of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR). International Peace Maternal and Child Health Hospital of Shanghai ultrasound database was investigated to identify all MCDA delivered from January 2013 to December 2017. After identifying 43 pairs of MCDA twins with sIUGR and 282 pairs of normal MCDA twins, we compared clinical outcomes between the two groups. Compared with normal twins, sIUGR fetuses had significantly shorter gestational age at delivery, smaller average birth weight of both twins, more significant intertwin difference in birth weight, lower Apgar scores, and higher intrauterine fetal demise (IUFD) rate, and smaller placental weight. The rate of abnormal umbilical cord insertions and abnormal blood flow in the ductus venosus (DV) and middle cerebral artery (MCA) is significantly higher in the sIUGR group. In addition, the subtype analysis of sIUGR groups indicated the poorest outcomes in type II with no significant difference between type I and III. MCDA twins with sIUGR generally exhibited limited clinical outcomes than normal MCDA twins. These limitations are mainly associated with abnormal umbilical cord insertions and blood flow in the DV and MCA. Clinical outcomes differed among the three types of sIUGR, with type II having the worst prognosis and the highest IUFD rate. · sIUGR generally exhibited limited clinical outcomes than normal MCDA twins.. · These limitations are mainly associated with blood flow of the DV and MCA.. · sIUGR with type II has the worst prognosis and the highest IUFD rate..

Accuracy of Umbilical Cord Complete Blood Count in Detecting Early-Onset Neonatal Thrombocytopenia.

Neonatal thrombocytopenia (NTCP) is a common hematological disorder whose platelet count falls below the normal limitof 150 x 109/L. NTCP can causelate complications if left untreated. The current study aimed to evaluate the accuracy of the umbilical cord complete blood count (UC CBC) in detecting early-onsetneonatal thrombocytopenia(EO-NTCP). Further, the prevalence of NTCP was also investigated. Methods: A cross-sectional study with a matched control was conducted on all newborns delivered at a tertiary care center in Jeddah, Saudi Arabia, between May 2016 and 2019. After exclusions, 40 neonateswith EO-NTCP (cases) and 80 without EO-NTCP (controls) were included. The case-to-control ratio was 1:2. The results of UC CBC were compared with those of follow-up CBC, performed within 72 hours.A p-value of <0.05 was considered statistically significant. All data were analyzed using IBM SPSS version 28 for Windows (IBM Corp., Armonk, NY). The prevalence of NTCP was approximately 1.02% (111/10,936). Lack of antenatal care was found in12 (30%) neonates with EO-NTCP vs. 10 (12.5%)neonates without EO-NTCP (p = 0.02). Neonates with EO-NTCP were more likely to have experiencedintrauterine growth restriction (5 (37.5%) vs. 5 (6.3%), p < 0.001)and oligohydramnios (5 (12.5%) vs. 0 (0%), p = 0.003). Neonates who developed EO-NTCP were more likely to be admitted to the NICU (34 (85%) vs. 35 (43.8%), p < 0.001) and receiveantibiotics (22 (55%) vs. 25 (31.3%), p = 0.012). Also, neonates with EO-NTCP were more frequently diagnosed with neonatal sepsis (7 (17.5%) vs. 3 (3.8%), p = 0.015)and more likely to receiveplatelet transfusions (15 (37.5% vs. 1 (1.3%), p < 0.001). They also had a higher median length of hospital stay(13 (interquartile range (IQR) 3-28) vs. 4(IQR 2-9) days, p = 0.006). The mortality rates of neonates with EO-NTCP and those without were 6 (15%) vs. 2 (2.5%) neonates (p = 0.016). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of UC CBC were 62.50%, 97.50%, 20.40%, and 99.61%, respectively. The prevalence of EO-NTCP in King Abdulaziz Medical City is comparable to international and national figures, and itis associated with preceding maternal comorbidities, serious neonatal morbidity, and even mortality. Therefore, proper antenatal care is vital in preventing maternal and neonatal morbidities, including the risks of NTCP and itsrelatedcomplications. With high NPV, using UC CBC as a universal screening method could assist in safely discharging newborns. However, because of its low sensitivity, a comprehensive clinical examination with confirmatory laboratory tests are stillthe cornerstone in diagnosing EO-NTCP. Future trials should aim to study the cost-effectiveness of universal UC CBC and the long-term outcomes of infants diagnosed with EO-NTCP.

The comparison of umbilical cord artery pH in newborns with and without thick meconium stained amniotic fluid

Meconium-stained amniotic fluid (MSAF) affects 15-20% of term pregnancies. Recent studies have shown that MSAF has adverse effects on neonatal outcomes. There is no scientific consensus on the incidence of fetal distress in MSAF neonates, and most cesarean sections due to MSAF are unnecessary. The present study was conducted to assess umbilical artery blood pH in neonates with MSAF and to examine whether there is a relationship between MSAF and fetal distress. A clinical survey case-control was conducted on the neonates of 200 pregnant women admitted to a delivery unit of the obstetrics and Gynecology center in Amir al-Momenin Hospital, Zabol in 2014. Neonates born with MSAF made up the case group, and the control group consisted of neonates born with clear amniotic fluid. Umbilical cord arterial pH, gestational age, gender, mode of delivery, and one and five-minute Apgar scores were considered in both groups. The mean pH of the umbilical cord artery blood in the infants of the case group was 7.25, and the mean pH of the umbilical cord artery in the infants of the control group was 7.29 (P = 0.93). The mean gestational age in the case and control groups was 40.08 weeks and 38.32 weeks, respectively (P= 0.03). In this study, a cesarean delivery (P=0.001) and female gender (P= 0.016) were higher in the case group than in the control group. MSAF does not necessarily imply fetal distress, so urgent cesarean sections are unnecessary. This study showed that based on the acidity variables of the umbilical cord artery, there is no statistically significant correlation between the Apgar score at the 1st and 5th minute. While a significant difference has been observed between the type of delivery, gestational age and baby's gender.