Fetal Viability Research Articles

Adverse pregnancy outcome in fetuses with early increased nuchal translucency: prospective cohort study.

An increased nuchal translucency (NT) thickness of ≥ 3.5 mm is a well-established marker for congenital anomalies and adverse pregnancy outcome between 11 and 14 weeks' gestation, but little is known about its performance as a screening tool before 11 weeks. We aimed to investigate, in a prospective setting, whether fetuses with increased NT before 11 weeks are at risk for adverse pregnancy outcome. This was a prospective cohort study including pregnant women with a viable fetus with NT ≥ 2.5 mm and a crown-rump length (CRL) < 45 mm. All included women were referred to our fetal medicine unit (FMU) and scheduled for a follow-up scan where the NT was remeasured after 1 week when the CRL was > 45 mm. Two groups were evaluated: cases with a normalized NT (< 3.5 mm) and cases with persistently increased NT (≥ 3.5 mm). The cases were monitored until 4 weeks after delivery. The main outcome was a composite adverse outcome of aneuploidy, other genetic disorders, structural anomalies and pregnancy loss. We performed subgroup analyses of NT thickness at inclusion and normalized or persistently increased NT at follow-up. The study included 109 cases, of which 39 (35.8%) had an adverse pregnancy outcome. Of these, 64.1% (25/39) were aneuploid, corresponding to 22.9% (25/109) of the total study population. In the subgroups of NT thickness at inclusion of 2.5-3.4 mm, 3.5-4.4 mm and ≥ 4.5 mm, an adverse outcome was reported in 22.0% (9/41), 40.0% (18/45) and 52.2% (12/23), respectively. In fetuses with a normalized NT and without ultrasound abnormalities at the follow-up scan, the incidence of adverse outcome was 8.5% (5/59), of which 5.1% (3/59) cases were aneuploid. Fetuses with an early increased NT thickness are at considerable risk of an adverse pregnancy outcome, even if the NT normalizes after 11 weeks. Not all congenital anomalies can be diagnosed with routine first-trimester screening, such as non-invasive prenatal testing and/or a first-trimester anomaly scan. Therefore, expectant parents should always be referred to a FMU for detailed ultrasonography. Invasive prenatal testing should be offered if an increased NT of ≥ 2.5 mm is observed before 11 weeks' gestation. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Characterization of placentome vascular perfusion in relation to pregnancy associated glycoproteins throughout gestation in pregnant beef heifers

During pregnancy, blood flow to the uterus changes to support fetal demand. Placentomes serve as vascular attachment sites on the placenta for exchange of gases, nutrients, and metabolic products. Non-invasive methods of ultrasonography and biomarkers have been described to assess placental health and fetal viability. Pregnancy associated glycoproteins (PAGs) are produced by the ruminant placenta and are detected in maternal circulation. In cattle, changes in circulating PAG concentrations are associated with embryonic and fetal outcomes. The objective of this study was to determine the association between placentome blood perfusion and circulating PAG concentrations as they relate to the health of the developing fetus. We hypothesized that placentome perfusion and PAG concentration will be positively correlated and associated with neonatal outcome. A prospective, observational study was designed using 26 pregnant, nulliparous, Angus heifers in which PAG concentration and placentome blood perfusion were assessed throughout gestation, with assessment of calving characteristics following parturition. Placentome blood perfusion was visualized at 30-day intervals via transrectal Doppler ultrasonography with power flow function. Ultrasound images were analyzed using ImageJ software to determine the percent area of perfusion and integrated pixel densities. Venous blood was collected and PAG concentrations were determined via serum PAG enzyme-linked immunoassay. Mean placentome blood perfusion increased as gestation advanced. PAG concentrations demonstrated the expected temporal trend, increasing with gestation length, and were positively linearly correlated with placentome perfusion (P < 0.0001). The relationship identified between circulating PAG concentration and placentome blood perfusion suggests the use of transrectal power flow Doppler ultrasonography as a noninvasive technique to determine placental blood flow morphometrics to assess conceptus wellbeing throughout pregnancy.

The importance of professional responsibility and fetal viability in the management of abortion.

In June 2022, the Dobbs v. Jackson Women's Health Organization Supreme Court decision ended the constitutional right to the professional practice of abortion throughout the United States. The removal of the constitutional right to abortion has significantly altered the practice of obstetricians and gynecologists across the US. It potentially increases risks to pregnant patients, leads to profound changes in how physicians can provide care, especially in states with strict bans or gestational limits to abortion, and has introduced personal challenges, including moral distress and injury as well as legal risks for patients and clinicians alike. The professional responsibility model is based on the ethical concept of medicine as a profession and has been influential in shaping medical ethics in the field of obstetrics and gynecology. It provides the framework for the importance of ethical and professional conduct in obstetrics and gynecology. Viability marks a stage where the fetus is a patient with a claim to access to medical care. By allowing unrestricted abortions past this stage without adequate justifications, such as those concerning the life and health of the pregnant individual, or in instances of serious fetal anomalies, the states may not be upholding the equitable ethical consideration owed to the fetus as a patient. Using the professional responsibility model, we emphasize the need for nuanced, evidence-based policies that allow abortion management prior to viability without restrictions and allow abortion after viability to protect the pregnant patient's life and health, as well as permitting abortion for serious fetal anomalies.

The measurement of hypoxia-inducible factor-1α and interleukin-6 levels in pregnancies with threatened preterm labor

Background: Preterm birth has a significant impact on neonatal health and the healthcare system as it increases neonatal morbidities and mortality rates. Interleukin-6 is one of the pro-inflammatory cytokines that can trigger the production of chemokines and uterine activation proteins, consequently causing uterine contraction and subsequent cervical change. Hypoxia-inducible factor-1α plays a pivotal role in the hypoxic adaptive response of tissues. It has been suggested that hypoxia has a vital role in the initiating and/or strengthening of uterine contractions, proposing that hypoxia-inducible factor-1α could be involved in this process. Aim: Investigate whether serum concentrations of interleukin-6 and hypoxia-inducible factor-1α would differ between women with threatened preterm labor who deliver prematurely and those who continue their pregnancy till term. Patients and Methods: The case-control study was extended over 12 months, including women in their 28th to 35th weeks of gestation and with a single viable fetus. The women were divided into three groups: women with threatened preterm labor who delivered prematurely (27 women), women with threatened preterm labor who continued their pregnancy till term (23 women), and women with matching gestational age and uncomplicated pregnancies (the controls = 40 women). The serum levels of interleukin-6 and hypoxia-inducible factor-1α were measured by Enzyme-linked immunosorbent assay. Results: The mean values of interleukin-6 and hypoxia-inducible factor-1α were significantly different between the study groups (p-value &lt;0.001 by one-way ANOVA), where women with threatened preterm labor who delivered prematurely had higher serum values of interleukin-6 and hypoxia-inducible factor-1α (124.5 and 102.4, respectively) than the women with threatened preterm labor who continued their pregnancy till term (71.0 and 55.2, respectively), and than the women in the control group (55.3 and 50.0, respectively). There was a significant negative statistical correlation between the values of interleukin-6 and hypoxia-inducible factor-1α and the timing of delivery (R = -0.786 and -0.644, respectively, p-value &lt; 0.001). Conclusions: Both interleukin-6 and hypoxia-inducible factor-1α serum concentrations can help differentiate pregnant women who are genuinely in preterm labor from those who have preterm contractions but are not at risk of imminent delivery.

Abortion Indications According to Law Number 17 of 2023 concerning Health

This normative juridical research scrutinizes Indonesia's legal framework surrounding abortion, juxtaposing the criminalization of abortion with the nuanced provisions of Law Number 17 of 2023 concerning health. The study focuses on Article 42, which permits abortion under specific indications such as fetal viability challenges and pregnancies resulting from rape. The primary legal materials are sourced from statutory regulations, with a supplementary examination of secondary legal materials. The research reveals the legal complexities surrounding abortion in Indonesia, shedding light on the delicate balance between criminal sanctions and legal protections. The implications of the findings extend to the broader discourse on reproductive rights and the evolving legal landscape.&#x0D; Highlights:&#x0D; &#x0D; &#x0D; Abortion Legislation in Indonesia: Balancing criminal sanctions and legal protections under Health Law Number 17 of 2023.&#x0D; &#x0D; &#x0D; Indications and Protections: Analyzing specific indications like fetal viability challenges and rape pregnancies, shaping women's reproductive rights.&#x0D; &#x0D; &#x0D; Normative Juridical Research: Utilizing primary and secondary legal materials to navigate the intricate legal landscape surrounding abortion in Indonesia.&#x0D; &#x0D; &#x0D; Keywords: Abortion, Planning, Legal Protection

Harlequin Ichthyosis: Case series

Objective: Harlequin ichthyosis (HI) is an autosomal-recessive inherited disorder. The incidence is extremely rare and is reported to range from 1/300 000 to 1/1 000 000. Some risk factors include preterm births and consanguinity. Prenatal DNA testing for the ABCA12 mutation aids in diagnosis. Although ultrasonography helps the diagnosis, the diagnostic value of a single ultrasound is low. It is fatal for the affected newborn after the first few days after birth, but few long-term survivals have been recorded. The hallmark of with disease is severely keratinized skin. This study aims to evaluate the prenatal and postnatal outcomes of cases with HI. Study Design: The study includes instances of HI that were diagnosed at the clinic throughout 2018–2023. The week of diagnosis, ultrasonographic findings, week of birth, and findings at the time of delivery for all patients were acquired via electronic reports and archival data. Data regarding the condition of viable fetuses was acquired using telephonic means. Results: The study included a total of five patients. There were prenatal ultrasonography findings in three cases. There were no prenatal ultrasound findings in the remaining two patients. Cordocentesis was applied to a single case using prenatal ultrasound diagnosis, and a normal genetic result was obtained. The remaining two cases refused to opt for the option of prenatal invasive testing. The termination option was not accepted in three cases with an intrauterine diagnosis. Prenatal ultrasonography revealed features showing skin thickening, ectropion, eclabion, oligohydramnios, and fetal growth restriction (FGR). Histological examination results of fetal skin biopsies in three cases showed consistent findings of epidermolytic HI, thus confirming the diagnosis of HI. The histological diagnosis of the remaining two patients was inconclusive. All cases are alive. Conclusion: It is advisable to conduct a methodical evaluation based on the clinical manifestations of the condition during the third trimester of gestation to diagnose HI, particularly in instances where there is no familial predisposition.

Factors that influence the choice for neonatal resuscitation in periviable deliveries

Background Periviable preterm birth, defined as delivery between 20+0/7 to 25+6/7 weeks, represents less than 1% of all births but contributes to up to 40% of all infant deaths. Scenarios with high risks of morbidity and mortality to the maternal-neonatal dyad may result in periviable preterm delivery. These situations require shared decision making between healthcare teams and families to decide whether maternal and neonatal patients are candidates for obstetric interventions and neonatal resuscitation at delivery, respectively, and to determine the optimal mode of delivery at the cusp of fetal viability. Objective The primary objective is to describe the influence of patient demographics (i.e. maternal race) and societal factors (i.e. maternal religion) on the decision between neonatal resuscitation and comfort care in periviable deliveries. Our secondary goals are: 1. to quantify the use of obstetric interventions (antenatal steroids for fetal lung maturity, magnesium sulfate for fetal neuroprotection, tocolytics and GBS prophylaxis) at the threshold of viability and 2. to establish whether planned neonatal resuscitation versus comfort care influenced the choice of cesarean versus vaginal delivery. Methods This project is a retrospective cohort study; electronic medical records were queried for data at Ascension St. Vincent Women's Hospital of mothers and neonates delivered at 22 0/7 to 24 6/7 from January 1, 2016 to July 31, 2020. Study patients were separated to compare outcomes between those that received neonatal resuscitation and those for whom comfort care was provided at 22, 23, and 24 weeks gestational age. Results were further stratified by obstetric interventions, mode of delivery, and maternal race and maternal religion with statistical analysis utilizing Fisher's Exact Test. Results Of the 111 patient charts originally identified, 73 patients met inclusion criteria. For those patients that opted for obstetric interventions, the most likely intervention was antenatal steroids (86%), followed by magnesium for fetal neuroprotection (63%) and tocolytics (63%), with the least likely intervention being Group Beta Streptococcus antibiotic prophylaxis (43%). The overall cesarean delivery rate was 53%. Cesarean delivery was selected with increasing gestational age: 9.1%, 52%, and 67% at 22, 23, and 24 weeks respectively. While there was no significant difference in those that opted for comfort care versus neonatal resuscitation at 22 weeks, the majority of patients at 23 and 24 weeks overwhelmingly opted for resuscitation; 5 infants (45%) were resuscitated at 22 weeks, 24 infants (96%) at 23 weeks, and 36 infants (97%) at 24 weeks. Planned neonatal resuscitation increased by gestational age. Patients opting for comfort care were more likely to deliver vaginally (87%) versus those that opted for resuscitation (41%), (Fisher's Exact Test, p=0.02), with the most common diagnoses documented for cesarean delivery being malpresentation followed by fetal distress. As for the influence of maternal race, African American patients opted for resuscitation 100% of the time, regardless of gestational age, in comparison to Caucasian (87%) and "other" (62%) counterparts. As for maternal religion, there was no significant difference between patients that self-identified as Christian, Roman Catholic, Unaffiliated or Other and their decision for neonatal resuscitation at 22 weeks. However, at 23 and 24 weeks, the only patients to opt in favor of comfort care were patients that were Unaffiliated with an organized religion. Overall, our infant survival rates were 7.6%, 44%, 63%, at 22, 23, and 24 weeks respectively, with an overall survival rate of 41%. Conclusion While the decision to resuscitate periviable preterm infants is multifactorial, demographic and societal factors influence the decision for planned resuscitation for this vulnerable patient population. Planned neonatal resuscitation rates were higher among patients identified as African American than other demographics included in this study. Patients not affiliated with an organized religion are less likely to opt for resuscitation at later gestational ages. Regardless ofplans for resuscitation, the majority of patients received obstetric interventions including antenatal steroids and cesarean delivery. These findings may be used by clinicians for shared decision making during future antenatal counseling sessions.

Effect of Aromatase Inhibitor Letrozole on the Placenta of Adult Albino Rats: A Histopathological, Immunohistochemical, and Biochemical Study.

Letrozole, an aromatase inhibitor, has recently been introduced as the preferred treatment option for ectopic pregnancy. To date, no study has investigated the effect of letrozole alone on placental tissue. The present study aimed to evaluate the effect of different doses of letrozole on the placenta of rats and to clarify the underlying mechanism. Sixty pregnant female rats were equally divided into three groups, namely the control group (GI), low-dose (0.5 mg/Kg/day) letrozole group (GII), which is equivalent to the human daily dose (HED) of 5 mg, and high-dose (1 mg/Kg/day) letrozole group (GIII), equivalent to the HED of 10 mg. Letrozole was administered by oral gavage daily from day 6 to 16 of gestation. Data were analyzed using a one-way analysis of variance followed by Tukey's post hoc test and Chi square test. P<0.05 was considered statistically significant. Compared to the GI and GII groups, high-dose letrozole significantly increased embryonic mortality with a high post-implantation loss rate (P<0.001) and significantly reduced the number of viable fetuses (P<0.001) and placental weight (P<0.001) of pregnant rats. Moreover, it significantly reduced placental estrogen receptor (ER) and progesterone receptor (PR) (P<0.001) and the expression of vascular endothelial growth factor (P<0.001), while increasing the apoptotic index of cleaved caspase-3 (P<0.001). Letrozole inhibited the expression of ER and PR in rat placenta. It interrupted stimulatory vascular signals causing significant apoptosis and placental vascular dysfunction. Letrozole in an equivalent human daily dose of 10 mg caused a high post-implantation loss rate without imposing severe side effects.

Prevalence and economic losses associated with foetal wastage in abattoir.

Both male and female food animals are slaughtered for meat. Some cows, ewes and does slaughtered are found with viable foetuses resulting in foetal wastage and loss of future replacement stock. Foetal wastage accounts for about 20%-25% of the decline in livestock numbers in sub-Saharan Africa. Slaughter of pregnant cows, ewes and does results in economic losses and threatens food security with consequent decrease in available animal proteins to the fast growing human population. Protein requirement for healthy human development is inadequate in most developing countries including Uganda. The prevalence and economic losses associated with foetal wastage were assessed in an abattoir. The study was cnducted to assess the prevalence of feotal wastage at the study abattoir and estimate the associated economic losses. The researchers supported by abattoir resident meat inspectors examined all slaughtered female animals during the study period. Gravid uteri obtained from slaughtered animals after dressing of carcasses were eviscerated using a sharp knife across the long axis to recover foetuses. The crown rump lengths (CRLs) of the recovered foetuses were measured using a tape measure, weighed on a scale and categorised into first, second and third trimesters. Prevalence of pregnant animals slaughtered was determined by calculating the percentage of pregnant animals over the total number of female animals slaughtered. Economic losses were estimated based on the monetary losses at birth, weaning, maturity, and carcass loss at weaning and maturity. The aggregate slaughters were bovine 604 (73.6%), caprine 169 (20.6%) and ovine 48 (5.9%). The overall prevalence of foetal wastage was 21.9%. The aggregate prevalence of foetal wastage by species include 160 (88.9%) cows, 8 (4.4%) heifers, 4 (2.2%) does and 8 (4.4%) ewes. Foetal wastage of cows by trimester included 62 (38.8%), 26 (16.25%) and 72 (45.0%) in first, second and third trimesters, respectively, translating into loss of US$13,055. Foetal wastage was high and the associated economic losses were substantial which undermines sustainability of the national herd. Farmers should be sensitised about the economic losses and long-term impact associated with foetal wastage and dissuaded from this practice. A policy is needed to deter farmers from selling pregnant animals for slaughter. A total of 168 bovine, 8 caprine and 12 ovine foetuses were wasted within 60 days study period. These foetal wastages translated to US$ 13,224 monetary losses at birth, US$ 31,849 monetary loss at weaning and US$ 57,0896 monetary loss at maturity.

Obstetric interventionism and maternalization ofwomen in childbirth care in Uruguay, 1920-1940

This article analyzes the speeches of leading doctors in the creation of the specialty in childbirth care: gynecotology. Between 1920 and 1940, under the influence of eugenic and maternalist thinking, in a context of valuing the well-being of children, medicine built a new obstetric interventionism under the foundation of improving fetal viability. The supposed female "maternal instinct" was, thus, appealed to improve acceptance of the medical mandate. At the same time, doctors recognized their difficulties in providing adequate care. They did not wait long enough and tended to intervene in unnecessary physiological processes.

Aerobic Brain Metabolism, Body Temperature, Oxygen, Fetal Oxygen Supply and Fetal Movement Dynamics as Factors in Stillbirth and Neonatal Encephalopathy: Invention Review

Introduction: To date, there is no systematic review dedicated to the study of inventions that have not yet been introduced into clinical practice, but are devoted to the diagnosis, prevention, modeling and treatment of fetal intrauterine hypoxia. Hypoxic damage to fetal brain cells still remains an unsolved problem of obstetrics and gynecology. Methods: 27 inventions were found from the beginning of the 21st century to 26.08.2023 in databases such as EAPATIS, BYPATENTS, DWPI, DEPATISnet, PATENTSCOPE, Espacenet, RUPTO, USPTO, CIPO, CNIPA, KIPRIS, PatSearch, J-PlatPat, Google Patents and TPO. Due to the small number of inventions, methodological heterogeneity, and differences in the content of their claims, a quantitative meta-analysis could not be performed. Results: Prospects for innovative obstetric care proposals aimed at improving fetal viability in hypoxia during pregnancy and delivery were analyzed. Results of the included studies were presented only qualitatively (descriptively). Conclusion: Fetal resistance to impending labor hypoxia has not been previously investigated, so values of low fetal resistance to intrauterine hypoxia are still not among the indications for the use of excess oxygen and the choice of Cesarean section to exclude stillbirth and neonatal encephalopathy. The first systematic review of published inventions shows innovative ways of assessing fetal adaptive reserves to hypoxia, oxygen and apnea administration, and selecting the optimal timing and type of delivery to prevent stillbirth and neonatal encephalopathy.

"I don't have a telephone to the fetus": Clinicians' conceptions of fetal patienthood in maternal-fetal surgery counseling

RationaleMaternal fetal surgery (MFS) has developed rapidly since the 1960s and centers for fetal diagnosis and therapy (CFDT) have proliferated. As a result, CFDT clinicians have intervened with fetuses through pregnant bodies for decades, yet the patienthood status of the fetus and its implications for the pregnant person's autonomy have been relatively unexamined. ObjectiveOur overall research aims were threefold: (1) to explore how clinicians train for and provide counseling for MFS; (2) to examine how clinicians assess fetal patienthood and its implications; and (3) to understand clinicians’ professed needs and their recommendations for education and training for the provision of MFS counseling. This focuses on aim two. MethodIn this qualitative study, conducted using in-depth interviews, we examined how 20 clinicians from 17 different sites understood fetal patienthood, how that affected their counseling of pregnant patients, and whether they drew on extant ethical frameworks for guidelines. ResultsWe identified three major themes: 1) Clinicians entered fetal surgery consultations with assumptions about fetal patienthood (frequently informed by beliefs about fetal viability, maternal attachment, and disciplinary perspectives); 2) they consciously assessed their pregnant patients' connections to their fetus to inform or re-calibrate their own understandings of fetal patienthood; and 3) they used a threshold -based conceptualization whereby the fetus achieved patienthood after crossing a symbolic boundary, often related to the clinician's ability to intervene. ConclusionsFew clinicians invoked an extant ethical framework to determine fetal patienthood; most asserted that they did not view directive counseling toward MFS as appropriate, instead working diligently to protect pregnant patients’ autonomy and rights to self-determination.

Determinants of neural tube defects among women who gave birth in hospitals in Eastern Ethiopia: evidence from a matched case control study

IntroductionNeural tube defects (NTDs) are severe birth defects caused by nutritional, genetic or environmental factors. Because NTDs continue to have a significant health and economic impact on children and community at large, it is crucial to investigate potential risk factors in order to develop novel approaches to NTDs prevention. Determinants for the development of NTDs differ by country, region as well as within the country. The objective of this study was to identify the determinants of NTDs among newborns delivered in three hospitals found in eastern Ethiopia.MethodsA hospital-based matched case-control study was conducted among 138 cases and 138 control women who delivered in three teaching hospitals in Eastern Ethiopia in 2021. Data were collected using a structured and pre-tested interviewer-administered questionnaire. Cases were mothers who delivered a neonate with any type of NTDs regardless of gestational age or fetal viability, whereas controls were mothers who delivered an apparently healthy newborn. Chi-square was used to assess the significant difference between the two groups. Conditional logistic regression model was used to generate adjusted odds ratio with its corresponding 95% confidence intervals and compare the two groups.ResultsAnencephaly (51.4%) and spinal bifida (34.1%) were the most frequently observed NTDs. None of study participants took preconception folic acid supplementation. Being a non-formal mothers (AOR = 0.34, 95% CI: 0.12–0.92, P = 0.034), rural residence, (AOR = 3.4, 95% CI: 1.18–9.78, P = 0.023), history of spontaneous abortion (AOR = 2.95, 95% CI: 1.15–7.55, P = 0.023), having severe anemia (AOR = 3.4, 95% CI: 1.17–9.87, P = 0.024), history of fever or cold (AOR = 2.75; 95% CI: 1.05–7.15, P = 0.038), and an exposure to various agro-chemicals (AOR = 3.39, 95% CI: 1.11–10.3, P = 0.032) were independent determinants of NTDs.Conclusion and RecommendationIn this study, NTDs were associated to several determinant factors in the area, including residential area, history of spontaneous abortion, severe anemia, fever/cold, antibiotic use before or during early pregnancy, and exposure to agrochemicals. Addressing the identified determinants is critical in averting the incidence of NTDs in the study area. Moreover, more research is needed to investigate women’s dietary practices as well as the practice of preconception folic acid supplementation for pregnant women in Ethiopia’s current health care system.

Distribution of uterocervical angles in singleton pregnancy at gestational age 16 - 24 weeks

The uterocervical angle (UCA) has recently been studied as a parameter to identify women at risk for spontaneous preterm birth (PTB). Objective: This study aimed to investigate the distribution of UCA values by transvaginal sonography (TVS) at gestational age (GA) 16 - 24 weeks of singleton pregnancy. Study design: TVS was performed in 1.039 singleton pregnancies, viable fetuses at gestational age (GA) 16 - 24 weeks, at the Department of Pregnancy Management &amp; Prenatal Diagnosis, Hai Phong Obstetric and Gynecology Hospital from September 2019 to June 2020. The UCA distribution by GA was visualized using a scatter plot. The range of UCA values and their relationship with GA were assessed using quantile regression analysis. P &lt; 0.05 was considered statistically significant. Results: The normal range of UCA (5th and 95th percentiles) was from 46.99 degrees (95% CI: 35.45o - 44.31o) to 125.38 degrees (95% CI: 128.92o – 139.32o) with significant changes during this GA period (2.0 degrees per week, p &lt; 0.001). Conclusion: The value of the UCA increases significantly with gestational age from 16-24 weeks, so it is advisable to monitor and evaluate the UCA, especially in pregnant women at high risk for PTB. Key words: uterocervical angle, preterm birth, singleton pregnancy

Molar pregnancy with a coexisting viable fetus: a rare case report

Molar pregnancy with a coexisting viable fetus: a rare case report

Long-lasting developmental effects in rat offspring after maternal exposure to acetamiprid in the drinking water during gestation.

Neonicotinoids (NNTs) are a class of insecticides proposed to be safe for pest control in urban, suburban, and agricultural applications. However, little is known about their developmental effects after repeated low-dose exposures during gestation. Here, we tested a dose considered subthreshold for maternal toxicity in rats (6 mg/kg/day) by assessing several morphological, biochemical, and neurobehavioral features in preterm fetuses and developing pups after maternal administration of the NTT acetamiprid (ACP) dissolved in the drinking water during gestational days (GD) 2-19. The exploratory evaluation included monitoring maternal body weight gain, fetal viability, body weight and sex ratio, cephalic length, neonatal body weight and sex ratio, metabolic enzymes in the placenta, maternal blood and fetal liver, and anogenital distance and surface righting response during infancy. We also used the circling training test to study the integrity of the associative-spatial-motor response in adolescence. Results showed no consistent findings indicating maternal, reproductive or developmental toxicity. However, we found ACP effects on maternal body weight gain, placental butyrylcholinesterase activity, and neurobehavioral responses, suggestive of a mild toxic action. Thus, our study showed a trend for developmental susceptibility at a dose so far considered subtoxic. Although the ACP concentration in environmental samples of surface water and groundwater has been mostly reported to be much lower than that used in our study, our results suggest that the ACP point of departure used in current guidelines aimed to prevent developmental effects may need to be verified by complementary sensitive multiple-endpoint testing in the offspring.

Non-monotonic effects of Bisphenol A Dimethacrylate on male mouse reproductive system and fertility leads to impaired conceptive performance

As an estrogenic agent, Bisphenol A Dimethacrylate (Bis-DMA) may incite alterations in both the reproductive tract and the neuroendocrine axis, and thus have the potential to affect the proper development, maturity and conceptive performance in animals. We investigated the consequences of 14 weeks of exposure to different concentrations of Bis-DMA on male mouse conceptive performance. Male mice were exposed to Bis-DMA (0, 0.1 mg/L, 1.0 mg/L or 10 mg/L) via drinking water, and the effects on fertility, reproductive organ weights, reproductive hormone levels, sperm counts and testicular histology were assessed. We clearly demonstrate that prolonged exposure of male mice to Bis-DMA negatively affects fertility and reproduction causing significant reductions in sperm counts, non-monotonic effects on serum LH and testosterone levels, increased seminal vesicle weights, lower number of embryonic implantations and viable fetuses, as well as, increased embryonal resorptions in females mated by Bis-DMA treated males. Furthermore, Bis-DMA caused abnormalities in testicular infrastructure with atrophic seminiferous tubules exhibiting intraepithelial vacuolization and disorganization, loss and shedding of germ cells into the lumen, and presence of apoptotic cells. Our data collectively suggest that Bis-DMA adversely affects male fertility and reproduction by interference with normal hormone signaling in the testis, inducing changes in testicular infrastructure and ultimately leading to impaired reproductive function and fertility.

Successful Management of An Advanced Abdominal Pregnancy With A Viable Fetus: A Case Report

Successful Management of An Advanced Abdominal Pregnancy With A Viable Fetus: A Case Report

Do prospective parents have a right to bury their deceased previable foetuses? A discussion of how the Constitutional Court has created great legal uncertainty

The Constitutional Court, in Voice of the Unborn Baby NPC v Minister of Home Affairs, was faced with a request to recognise a constitutionally protected right to bury a deceased previable foetus. This is a sensitive topic, since many persons who lose a foetus in utero wish to bury the remains for personal or religious purposes. Prior to this case, the general understanding was that such burials were prohibited in terms of the Births and Deaths Registration Act (BADRA), which allows the burial only of viable foetuses. The case, therefore, turned on whether BADRA permits the burial of a deceased previable foetus and, if not, whether this is unconstitutional. The applicants requested that the court declare that prospective parents have a right to bury their previable foetuses. The High Court found that BADRA does not allow such burials, and that this is unconstitutional. The Constitutional Court, however, found that BADRA does not prohibit such burials, since such deaths are not covered by the Act at all. This article discusses the lacuna that the Constitutional Court's decision created. It specifically considers whether such a right is protected in the Bill of Rights, and what the current law is regarding the burial ofpreviable foetuses, given the finding that this matter is not covered by BADRA.

Scar Ectopic: Diagnostic and Management Challenge

Scar ectopic pregnancy is the rarest form of ectopic pregnancy and has been increasingly diagnosed all over the world. Usually when a blastocyst implants on the fibrous tissue of the previous Caesarean scar is called scar ectopic. This type of abnormal implantation of embryo can occur following hysterotomy, dilatation and curettage ,abnormal placentation surgery on uterus like myomectomy ,hysteroscopy and manual removal of placenta. The incidence is increased due to increase in number of Caesarean deliveries. Trans vaginal Sonography helps in early diagnosis. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility. Excision of trophoblastic tissues using laparotomy or laparoscopy, systemically administered methotrexate, and more recently uterine artery embolization are the treatment options for scar ectopic. When TVS is inconclusive, MRI can be recommended. We are reporting here a case of first trimester caesarean scar pregnancy with viable fetus in the process of rupture, where uterine repair could be done to preserve the future fertility. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 154-156