Viable Singleton Pregnancies Research Articles

Correlation of 24-hour urinary protein excretion and spot urine protein-creatinine ratio in women with preeclampsia: A cross sectional study

Objective: To examine the correlation between spot urine PCR and 24-hour urine protein excretion in patients being evaluated for preeclampsia. Material and Methods: A cross sectional study was conducted on 100 patients at the Department of Obstetrics and Gynecology at Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana State for a period from December 2019 to August 2020, with inclusion of singleton viable pregnancy, Gestational age between 24 and 38 weeks, Confirmed by last menstrual period and early ultrasound. Result: Among 100 patient’s patients having mean age of 25 ± 3.266 years, among the patients 19% percent of the patients had past history of preeclampsia. Mean gestational age for the patients was 32.39 ± 3.42 weeks. Study showed 62 % of moderate urinary protein levels. There was significant correlation between spot PCR and 24 hour urine protein collection (spearman’s rho=0.7, P<0.0001). Conclusion: Urine protein: creatine ratio is one of the important investigation in hypertensive disorder of the pregnancy. Spot Urine protein: creatine ratio can reliably be taken as a simple, accurate, and convenient replacement for tedious, time consuming 24 hour urine protein estimation, especially in countries like India where hospitals are flooded with a large number of in-patients. Therefore Urine protein: creatine ratio estimation should be introduced and adopted in practice in testing for proteinuria.

Poor sleep is associated with higher blood pressure and uterine artery pulsatility index in pregnancy: a prospective cohort study.

ObjectiveTo elucidate the association between sleep disturbances and blood pressure as well as uterine artery Doppler during pregnancy in women with no pre‐existing hypertension.DesignProspective cohort study.SettingOutpatient specialist clinics at KK Women’s and Children’s Hospital, Singapore.PopulationWomen with viable singleton pregnancies confirmed by ultrasonography at less than 14 weeks of amenorrhoea at first visit.MethodsIn all, 926 subjects were recruited for this study in the outpatient specialist clinics at KK Women’s and Children’s Hospital, Singapore, between 1 September 2010 and 31 August 2014. They were followed up throughout pregnancy with sleep quality, blood pressure and uterine artery Doppler assessed at each visit.Main outcome measuresSleep quality, blood pressure and uterine artery Doppler.ResultsSleep progressively worsened as pregnancy advanced. Shorter sleep duration and poorer sleep efficiency were associated with higher blood pressure, especially in the first trimester. Mixed model analysis demonstrated an overall positive association between sleep quality represented by Pittsburgh Sleep Quality Index (PSQI) score and diastolic blood pressure (DBP) (P < 0.001) and mean arterial pressure (MAP) (P = 0.005) during pregnancy after considering all trimesters. Sleep duration was found to be negatively associated with both systolic blood pressure (SBP) (P = 0.029) and DBP (P = 0.002), whereas sleep efficiency was negatively correlated with DBP (P = 0.002) only. Overall poor sleep during pregnancy was also found to be associated with a higher uterine artery pulsatility index.ConclusionOur prospective study demonstrated that poor sleep quality is significantly associated with higher blood pressure and uterine artery pulsatility index during pregnancy.Tweetable abstractPoor sleep quality is significantly associated with higher blood pressure and higher uterine artery pulsatility index during pregnancy.

Stratified risk of pregnancy loss for women with a viable singleton pregnancy in the first trimester

Objective Calculate the risk of miscarriage in women with a viable (defined as presence of fetal heart rate on ultrasound) first trimester singleton pregnancy and to create a model for stratified risk-assessment for pregnancy loss based on significant risk factors. Study Design Retrospective cohort study of unselected women with singleton pregnancies in a large obstetrical practice who presented for prenatal care prior to 14 weeks over a three-year period. All women underwent a formal first-trimester ultrasound, and we only included women with viable pregnancies with fetal heart activity seen on that ultrasound. Our primary outcome was pregnancy loss prior to 20 weeks. Statistical modeling was used to create a risk-assessment tool from adjusted likelihood ratios of pregnancy loss based on risk factors independently associated with this outcome. Results From January 2015-December 2017, 2,446 women met the inclusion criteria for the study and 132 (5.4%) had a pregnancy loss <20 weeks. On regression analysis, the independent risk factors for pregnancy loss were earlier gestational age (aOR 0.72, 95% CI 0.65–0.80) and increasing number of prior miscarriages (aOR 1.56, 95% CI 1.32–1.83). Using these risk factors, we calculated the stratified risk of pregnancy loss, which ranged from 0.8% in women at 13 weeks of gestation with no prior miscarriages to 33.7% in women at six weeks of gestation with three or more prior miscarriages. Conclusion In first trimester singleton pregnancies, the overall risk of pregnancy loss <20 weeks after confirmation of fetal heart activity is 5.4%, but can be stratified for each woman and ranges from 0.8% to 33.7% based on the gestational age and number of prior pregnancy losses.

Morbidity associated with the use of Foley balloon for cervical ripening in women with prior cesarean delivery

Objective We evaluated the morbidity of Foley balloon for cervical ripening in comparison to oxytocin alone in women with a prior cesarean delivery. Study design A four-hospital retrospective review of all women with viable singleton pregnancies and history of a single prior cesarean delivery presenting for cervical ripening between 1994 and 2015. Exposure groups were either Foley balloon or oxytocin, at the treating physician’s discretion. The primary outcome was defined as maternal morbidity, evaluated by a composite that included hemorrhage, and/or uterine infection, and/or uterine rupture. We defined two secondary outcomes: neonatal morbidity, and vaginal delivery rate. Neonatal morbidity was evaluated by a composite that included five-minute APGAR score <7 and/or NICU admission. We adjusted results for potential confounding variables, including hospital site, maternal age and race, initial cervical dilation, and gestational age at delivery. Results We identified 688 patients who received ripening, 276 by Foley balloon and 412 by oxytocin. There was no significant difference in the primary outcome of maternal morbidity between groups: 38 (13.8%) in the Foley balloon group and 79 (19.2%) in the oxytocin group (aOR 1.43; 95% CI, 0.90–2.27). There was no significant difference in the secondary outcome of neonatal morbidity: 31 (11.3%) in the Foley balloon group and 51 (12.4%) in the oxytocin group (aOR 1.02; 95% CI, 0.57–1.80). The rate of vaginal delivery was significantly less in the Foley balloon group compared to the oxytocin group: 56.2% vs 64.1%, p = .037. Conclusion When cervical ripening with either Foley balloon or oxytocin was utilized at the physician’s discretion in women with prior cesarean, there was no identified difference in maternal and neonatal morbidity, but the rate of successful vaginal delivery was lower.

Preimplantation Genetic Testing for a Chinese Family With X-Linked Lymphoproliferative Syndrome Type 1.

BackgroundX-linked lymphoproliferative disease (XLP) is a rare primary immunodeficiency disorder. We performed experiments based on two strategies of preimplantation genetic testing (PGT) for a family with XLP caused by a mutation in SH2D1A (c.191G > A).MethodsFirst, a single-cell polymerase chain reaction (PCR) protocol was established using single lymphocytes. A nested PCR experiment was performed with direct sequencing after whole genome amplification of single cells to assess the accuracy of the genetic diagnosis. Embryos obtained after intracytoplasmic sperm injection were biopsied on day 3 and detected using the established single-cell PCR protocol. In the second PGT cycle, targeted next generation sequencing (NGS) was performed and the single nucleotide polymorphism (SNP) markers flanking SH2D1A were selected to determine the disease-carrying haplotype phase in each embryo.ResultIn the first PGT cycle, six embryos were biopsied. Discounting an embryo from a single failed PCR experiment, five embryos were identified, including three unaffected and two hemizygous. After PCR, one normal embryo was transferred when it was developing into an early blastocyst. Although the ultrasound images indicated a viable singleton pregnancy, the implantation was on the cesarean scar. Therefore, an artificial abortion was performed. In the haplotyping cycle, six embryos were identified to have inherited a haplotype without pathogenic mutations. After the embryo implantation process failed twice, a successful singleton pregnancy was established, and subsequently, a healthy female child was born.ConclusionTargeted NGS with haplotyping analysis circumvents the laborious process of multiplex PCR and is more likely to ensure diagnostic accuracy. However, when a genetic recombination occurs close to the site of mutation, confirmed identification using selected SNP markers can be challenging.

Prospective longitudinal cohort study of uterine arteries Doppler in singleton pregnancies obtained by IVF/ICSI with oocyte donation or natural conception.

Do uterine arteries Doppler studies show different pulsatility index (UtA-PI) measurements in IVF/ICSI pregnancies with oocyte donation (OD) as compared to natural conceptions? In IVF/ICSI pregnancies with OD, UtA-PI is reduced by an average of about 40% as compared to pregnancies with natural conception. OD pregnancies present worse pregnancy outcomes as compared to natural conception, particularly for increased incidence of pre-eclampsia (PE). Recent evidence shows that IVF/ICSI pregnancies with frozen blastocyst transfer also present higher prevalence of PE and 15% lower UtA-PI as compared to pregnancies after fresh blastocyst transfers. Prospective, longitudinal matched cohort study performed in the Fetal Medicine and Obstetric Departments of San Raffaele Hospital in Milan, between 2013 and 2018. The analysis is based on 584 Doppler observations collected from 296 women with different method of conception (OD n = 122; natural conception n = 174). IVF/ICSI viable singleton pregnancies with OD and natural conception control pregnancies matched for BMI and smoking, performing repeated UtA-PI measurements at 11-34 weeks. Miscarriages, abnormalities, twins, significant maternal diseases and other types of ARTs were excluded. Log mean left-right UtA-PI was used for analysis with linear mixed model (LMM) and correction for significant confounders. Pregnancy outcome was also analyzed. Participants after OD were older and more frequently nulliparous (mean age: OD 43.4, 95% CI from 42.3 to 44.6; natural conception 35.1, 95% CI from 34.5 to 35.7; P-value < 0.001; nulliparous: OD 96.6%; natural conception 56.2%; P-value < 0.001). Mean pulsatility index was lower in OD (UtA-PI: natural conception 1.22; 95% CI from 1.11 to 1.28; OD 1.04; 95% CI from 0.96 to 1.12; P-value < 0.001). A significant effect of parity, gestational age (GA) modeled with a cubic polynomial and BMI was described in the LMM. The mean Log UtA-PI was on average 37% lower in OD as compared to natural conception pregnancies at LMM (P-value < 0.001). We also found a significant interaction between longitudinal UtA-PI Doppler and GA. Therefore, at 11 weeks' gestation the Log UtA-PI was 42% lower and, at 34 weeks, the differences reduced to 32%. GA at delivery and birth weight were statistically lower in OD group; however, birthweight centile was not statistically different. Preeclampsia was 11-fold more common in the OD group (0.6% and 6.6%, P-value = 0.003). No other significant difference in pregnancy outcome was shown in the study groups (gestational diabetes mellitus, small or large for GA). It was not possible to properly match for maternal age and to blind the assessment given the major differences between cohorts; however, we did not find significant within-groups effects related to maternal age. Future research is needed to reassess outcomes and correct them for maternal characteristics (e.g. cardiovascular function). This finding reproduces our previous discovery of lower UtA-PI in frozen as compared to fresh blastocyst transfer. The vast majority of OD is obtained by the use of cryopreservation. We speculate that increased uterine perfusion may be the physiological response to compensate dysfunctions both in the mother and in the placenta. This is a non-funded study. The authors do not declare competing interest. N/A.

THE EFFECT OF CARBETOCIN COMPARED TO RECTAL MISOPROSTOL IN THE MANAGEMENT OF BLOOD LOSS DURING THE THIRD STAGE OF VAGINAL DELIVERY IN LOW RISK PATIENTS FOR POSTPARTUM HEMORRHAGE

Background: Postpartum hemorrhage (PPH) or excessive bleeding at or after childbirth is a potentially life-threatening complication and is one of the major contributors to maternal mortality and morbidity worldwide. Objective: To compare the effect of IV Carbetocin and Rectal Misoprostol to decrease blood loss in third stage of vaginal delivery in low risk patients for postpartum hemorrhage. Patients and Methods: A randomized controlled trial was performed at Beni Suef Specialized Hospital in Obstetric Unit. The study included 160 healthy women with viable normal singleton pregnancy achieving normal vaginal delivery at or beyond 37 gestations from March 2019 till August 2019. Women were randomized to receive either a single dose Of Carbetocin 100 mcg following delivery of the anterior shoulder of baby or rectal misoprostol 800 mcg (4 tabs) at the crowning in the second stage of labor. Results: There was non-statistically significant difference in the estimated mean blood loss between the carbetocin and misoprostol groups with blood loss of 203 ml higher in misoprostol group. The mean drop of hemoglobin concentration 12h after delivery was 0.63g/dl in carbetocin group and 1.1g/dl in misoprostol group and drop in hematocrit value was 1.9% in carbetocin group and 3.3% in misoprostol group. These differences were statistically non-significant in both groups. Women in the carbetocin group were more likely to experience abdominal pain than misoprostol group. Headache and tachycardia were predominate in carbetocin group, women needed other uterotonic drugs more in misoprostol group. Blood transfusion was needed in some misoprostol group cases. Conclusion: Single dose of carbetocin 100 mcg was with the same effect to 800 mcg (4 tablets) misoprostol to decrease blood loss in third stage of normal vaginal delivery of low risk patients for postpartum hemorrhage, with no significant drop in hemoglobin and hematocrit in two groups but with more side effects and more cost in carbetocin group than misoprostol group.

THE EFFECT OF CARBETOCIN COMPARED TO RECTAL MISOPROSTOL IN THE MANAGEMENT OF BLOOD LOSS DURING THE THIRD STAGE OF VAGINAL DELIVERY IN LOW RISK PATIENTS FOR POSTPARTUM HEMORRHAGE

Background: Postpartum hemorrhage (PPH) or excessive bleeding at or after childbirth is a potentially life-threatening complication and is one of the major contributors to maternal mortality and morbidity worldwide. Objective: To compare the effect of IV Carbetocin and Rectal Misoprostol to decrease blood loss in third stage of vaginal delivery in low risk patients for postpartum hemorrhage. Patients and Methods: A randomized controlled trial was performed at Beni Suef Specialized Hospital in Obstetric Unit. The study included 160 healthy women with viable normal singleton pregnancy achieving normal vaginal delivery at or beyond 37 gestations from March 2019 till August 2019. Women were randomized to receive either a single dose Of Carbetocin 100 mcg following delivery of the anterior shoulder of baby or rectal misoprostol 800 mcg (4 tabs) at the crowning in the second stage of labor. Results: There was non-statistically significant difference in the estimated mean blood loss between the carbetocin and misoprostol groups with blood loss of 203 ml higher in misoprostol group. The mean drop of hemoglobin concentration 12h after delivery was 0.63g/dl in carbetocin group and 1.1g/dl in misoprostol group and drop in hematocrit value was 1.9% in carbetocin group and 3.3% in misoprostol group. These differences were statistically non-significant in both groups. Women in the carbetocin group were more likely to experience abdominal pain than misoprostol group. Headache and tachycardia were predominate in carbetocin group, women needed other uterotonic drugs more in misoprostol group. Blood transfusion was needed in some misoprostol group cases. Conclusion: Single dose of carbetocin 100 mcg was with the same effect to 800 mcg (4 tablets) misoprostol to decrease blood loss in third stage of normal vaginal delivery of low risk patients for postpartum hemorrhage, with no significant drop in hemoglobin and hematocrit in two groups but with more side effects and more cost in carbetocin group than misoprostol group.

Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomised, placebo-controlled trial

Summary Background Although metformin is increasingly being used in women with type 2 diabetes during pregnancy, little data exist on the benefits and harms of metformin use on pregnancy outcomes in these women. We aimed to investigate the effects of the addition of metformin to a standard regimen of insulin on neonatal morbidity and mortality in pregnant women with type 2 diabetes. Methods In this prospective, multicentre, international, randomised, parallel, double-masked, placebo-controlled trial, women with type 2 diabetes during pregnancy were randomly assigned from 25 centres in Canada and four in Australia to receive either metformin 1000 mg twice daily or placebo, added to insulin. Randomisation was done via a web-based computerised randomisation service and stratified by centre and pre-pregnancy BMI ( ClinicalTrials.gov , NCT01353391 . Findings Between May 25, 2011, and Oct 11, 2018, we randomly assigned 502 women, 253 (50%) to metformin and 249 (50%) to placebo. Complete data were available for 233 (92%) participants in the metformin group and 240 (96%) in the placebo group for the primary outcome. We found no significant difference in the primary composite neonatal outcome between the two groups (40% vs 40%; p=0·86; relative risk [RR] 1·02 [0·83 to 1·26]). Compared with women in the placebo group, metformin-treated women achieved better glycaemic control (HbA1c at 34 weeks' gestation 41·0 mmol/mol [SD 8·5] vs 43·2 mmol/mol [–10]; 5·90% vs 6·10%; p=0·015; mean glucose 6·05 [0·93] vs 6·27 [0·90]; difference −0·2 [–0·4 to 0·0]), required less insulin (1·1 units per kg per day vs 1·5 units per kg per day; difference −0·4 [95% CI −0·5 to −0·2]; p Interpretation We found several maternal glycaemic and neonatal adiposity benefits in the metformin group. Along with reduced maternal weight gain and insulin dosage and improved glycaemic control, the lower adiposity and infant size measurements resulted in fewer large infants but a higher proportion of small-for-gestational-age infants. Understanding the implications of these effects on infants will be important to properly advise patients who are contemplating the use of metformin during pregnancy. Funding Canadian Institutes of Health Research, Lunenfeld-Tanenbaum Research Institute, University of Toronto.

TROPHECTODERM BIOPSY PRIOR TO AUTOLOGOUS FROZEN BLASTOCYST TRANSFER IS NOT ASSOCIATED WITH ADVERSE OBSTETRICAL OUTCOMES

To determine if trophectoderm biopsy prior to autologous frozen blastocyst transfer is associated with gestational age at delivery, birth weight, or cesarean rate in ongoing singleton gestations. retrospective cohort study We identified all patients at a university-affiliated center that had viable singleton gestations after autologous frozen blastocyst transfers from January 2016 through December 2018. Obstetrical outcomes of 67 viable singleton pregnancies after blastocyst trophectoderm biopsy for preimplantation genetic testing (PGT) with next generation sequencing were compared to 78 viable singleton pregnancies from unbiopsied frozen blastocysts. All transfers occurred in programmed frozen transfer cycles. Cycles that utilized a gestational carrier, donor oocytes, or frozen oocytes were excluded. Primary outcomes included gestational age at delivery, birth weight, and cesarean rate. The study had 80% power at a significance level of 0.05 to detect a 4-day difference in median gestational age at delivery, 300-gram difference in median birth weight, and 20% difference in cesarean rate. Secondary outcomes included preterm delivery, low birth weight, and birth weight over 4000 grams. There were no significant differences between the two groups in terms of maternal age, BMI, or ethnicity. There were no differences in the PGT cohort compared to the reference cohort for median gestational age at delivery, median birth weight, cesarean rate, preterm delivery rate, rate of low birth weight, or rate of birth weight over 4000 grams (Table). There were no differences in the primary outcomes for subgroup analysis based on fetal sex, single embryo transfer, nulligravid, and no history of prior term birth. Trophectoderm biopsy prior to frozen blastocyst transfer is not associated with adverse obstetrical outcomes related to gestational age at delivery, birth weight, or cesarean rate.Tabled 1No PGT (ref) n = 78PGT n = 67RR (95% CI)P valueDemographics and baseline characteristicsMaternal age (SD)35.6 (4.3)35.8 (3.7)0.77Maternal BMI kg/m2 (SD)24.5 (5.4)24.0 (5.2)0.59Number of embryos transferred1.6 (0.6)1.2 (0.4)< 0.01Prior preterm birth4 (5%)2 (3%)0.69OutcomesCesarean delivery34 (44%)34 (51%)1.16 (0.82-1.64)0.41Birth weight in grams3430 [3033, 3714]3420 [3050, 3799]0.97Birth weight >4000g6 (8%)9 (13%)1.75 (0.66-4.65)0.29Low birth weight, <2500g7 (9%)8 (12%)1.33 (0.51-3.48)0.59Gestational age in weeks39.4 [39.0, 40.4]39.4 [39.0, 40.3]0.80Delivery prior to 37 weeks6 (8%)8 (12%)1.55 (0.57-4.25)0.41Delivery prior to 34 weeks1 (1%)1 (1%)1.16 (0.07-18.3)1.00Data are reported as mean (SD), median [IQR] or n (%). Open table in a new tab

Outcomes of in vitro fertilization pregnancies complicated by subchorionic hematoma detected on first-trimester ultrasound

ObjectiveTo estimate the association between subchorionic hematoma (SCH) on ultrasound and pregnancy outcomes in in vitro fertilization (IVF) pregnancies.DesignInstitutional Review Board–approved, retrospective cohort study.SettingTertiary care university-based facility.Patient(s)In this study, 1,004 patients who underwent IVF with a viable singleton pregnancy from January 1, 2009 through December 31, 2017.Intervention(s)Subchorionic hematoma versus no hematoma diagnosed on first-trimester ultrasound.Main Outcome Measure(s)Live birth, preterm birth, and spontaneous abortion.Result(s)We found that 1,004 women met the criteria and 187 (18.6%) had an SCH. In bivariate and multivariate regression models, there were no associations between SCH and the outcomes of live birth, preterm birth, or birth weight.Conclusion(s)Subchorionic hematoma detected on first-trimester ultrasound after IVF is not associated with probability of live birth, probability of preterm birth, or infant birth weight in this patient population.

How often do we incidentally find a fetal abnormality at the routine third-trimester growth scan? A population-based study

Third-trimester scans are increasingly used to try to prevent adverse outcomes associated with abnormalities of fetal growth. Unexpected fetal malformations detected at third-trimester growth scans are rarely reported. To determine the incidence and type of fetal malformations detected in women attending a routine third-trimester growth scan. This was a population-based study of all women with singleton pregnancy attending antenatal care over a 2-year period in Oxfordshire, UK. Women who had a viable singleton pregnancy at dating scan were included. Women had standard obstetrical care including the offer of a routine dating scan and combined screening for trisomies; a routine anomaly scan at 18 to 22 weeks; and a routine third-trimester growth scan at 36 weeks. The third-trimester scan comprises assessment of fetal presentation, amniotic fluid, biometry, umbilical and middle cerebral artery Dopplers, but no formal anatomic assessment is undertaken. Scans are performed by certified sonographers or clinical fellows (n=54), and any suspected abnormalities are evaluated by a team of fetal medicine specialists. We assessed the frequency and type of incidental congenital malformations identified for the first time at this third-trimester scan. All babies were followed-up after birth for a minimum of 6 months. There were 15,244 women attending routine antenatal care. Anomalies were detected in 474 (3.1%) fetuses as follows: 103 (21.7%) were detected before the anomaly scan, 174 (36.7%) at the anomaly scan, 11 (2.3%) after the anomaly scan and before the third-trimester scan, 43 (9.1%) at the third-trimester scan and 143 (30.2%) after birth. The 43 abnormalities were found in a total of 13,023 women who had a 36 weeks scan, suggesting that in 1 out of 303 (95% confidence interval, 233-432) women attending such a scan, a new malformation was detected. Anomalies detected at the routine third-trimester scan were of the urinary tract (n=30), central nervous system (5), simple ovarian cysts (4), chromosomal (1), splenic cyst (1), skeletal dysplasia (1), and cutaneous lymphangioma (1). Most urinary tract anomalies were renal pelvic dilatation, which showed spontaneous resolution in 57% of the cases. When undertaking a program of routine third-trimester growth scans in women who have had previous screening scans, an unexpected congenital malformation is detected in approximately 1 in 300 women.

Standard care informed by the result of a placental growth factor blood test versus standard care alone in women with reduced fetal movement at or after 36+0 weeks\u2019 gestation: a pilot randomised controlled trial

BackgroundBiomarkers of placental function can potentially aid the diagnosis and prediction of pregnancy complications. This randomised controlled pilot trial assessed whether for women with reduced fetal movement (RFM), intervention directed by the measurement of a placental biomarker in addition to standard care was feasible and improved pregnancy outcome compared with standard care alone.MethodsWomen aged 16–50 years presenting at eight UK maternity units with RFM between 36+0 and 41+0 weeks’ gestation with a viable singleton pregnancy and no indication for immediate delivery were eligible. Participants were randomised 1:1 in an unblinded manner to standard care and a biomarker blood test result revealed and acted on (intervention arm) or standard care where the biomarker result was not available (control arm). The objectives were to determine the feasibility of a main trial by recruiting 175–225 participants over 9 months and to provide proof of concept that informing care by measurement of placental biomarkers may improve outcome. Feasibility was assessed via the number of potentially eligible women, number recruited, reasons for non-recruitment and compliance. Proof of concept outcomes included the rates of the induction of labour and caesarean birth, and a composite adverse pregnancy outcome.ResultsOverall, 2917 women presented with RFM ≥ 36 weeks, 352 were approached to participate and 216 (61%) were randomised (intervention n = 109, control n = 107). The main reason for not approaching women was resource/staff issues (n = 1510). Ninety-seven women declined the trial, mainly due to not liking blood tests (n = 24) or not wanting to be in a trial (n = 21). Compliance with the trial interventions was 100% in both arms. Labour was induced in 97 (45%) participants (intervention n = 49, control n = 48), while 17 (9%) had planned caesarean sections (intervention n = 9, control n = 8). Overall, 9 (8%) babies in the intervention arm had the composite adverse pregnancy outcome versus 4 (4%) in the control arm.ConclusionsA main trial using a placental biomarker in combination with delivery, as indicated by the biomarker, in women with RFM is feasible. The frequency of adverse outcomes in this population is low, hence, a large sample size would be required along with consideration of the most appropriate outcome measures.Trial registrationISRCTN, ISRCTN12067514; registered 8 September 2017.

Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial

Preterm birth remains a common cause of neonatal mortality, with a disproportionately high burden in low-income and middle-income countries. Meta-analyses of low-dose aspirin to prevent pre-eclampsia suggest that the incidence of preterm birth might also be decreased, particularly if initiated before 16 weeks of gestation. ASPIRIN was a randomised, multicountry, double-masked, placebo-controlled trial of low-dose aspirin (81 mg daily) initiated between 6 weeks and 0 days of pregnancy, and 13 weeks and 6 days of pregnancy, in nulliparous women with an ultrasound confirming gestational age and a singleton viable pregnancy. Participants were enrolled at seven community sites in six countries (two sites in India and one site each in the Democratic Republic of the Congo, Guatemala, Kenya, Pakistan, and Zambia). Participants were randomly assigned (1:1, stratified by site) to receive aspirin or placebo tablets of identical appearance, via a sequence generated centrally by the data coordinating centre at Research Triangle Institute International (Research Triangle Park, NC, USA). Treatment was masked to research staff, health providers, and patients, and continued until 36 weeks and 7 days of gestation or delivery. The primary outcome of incidence of preterm birth, defined as the number of deliveries before 37 weeks' gestational age, was analysed in randomly assigned women with pregnancy outcomes at or after 20 weeks, according to a modified intention-to-treat (mITT) protocol. Analyses of our binary primary outcome involved a Cochran-Mantel-Haenszel test stratified by site, and generalised linear models to obtain relative risk (RR) estimates and associated confidence intervals. Serious adverse events were assessed in all women who received at least one dose of drug or placebo. This study is registered with ClinicalTrials.gov, NCT02409680, and the Clinical Trial Registry-India, CTRI/2016/05/006970. From March 23, 2016 to June 30, 2018, 14 361 women were screened for inclusion and 11 976 women aged 14-40 years were randomly assigned to receive low-dose aspirin (5990 women) or placebo (5986 women). 5780 women in the aspirin group and 5764 in the placebo group were evaluable for the primary outcome. Preterm birth before 37 weeks occurred in 668 (11·6%) of the women who took aspirin and 754 (13·1%) of those who took placebo (RR 0·89 [95% CI 0·81 to 0·98], p=0·012). In women taking aspirin, we also observed significant reductions in perinatal mortality (0·86 [0·73-1·00], p=0·048), fetal loss (infant death after 16 weeks' gestation and before 7 days post partum; 0·86 [0·74-1·00], p=0·039), early preterm delivery (<34 weeks; 0·75 [0·61-0·93], p=0·039), and the incidence of women who delivered before 34 weeks with hypertensive disorders of pregnancy (0·38 [0·17-0·85], p=0·015). Other adverse maternal and neonatal events were similar between the two groups. In populations of nulliparous women with singleton pregnancies from low-income and middle-income countries, low-dose aspirin initiated between 6 weeks and 0 days of gestation and 13 weeks and 6 days of gestation resulted in a reduced incidence of preterm delivery before 37 weeks, and reduced perinatal mortality. Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Role of Pregnancy-Associated Plasma Protein-A and Uterine Artery Doppler in Early Detection of Preeclampsia

The purpose of this study was to evaluate the role of pregnancy-associated plasma protein-A and uterine artery Doppler in early detection of preeclampsia. Subjects of this prospective cohort study included (120) pregnant women with viable singleton pregnancies in the first trimester between (11- 13+6 ) weeks of gestation, were recruited during the period from March 2018 to January 2020 and who came for ante natal clinic, in the Department of Obstetrics and Gynecology at Benha University Hospital. Consideration criteria were Pregnant ladies going to antenatal forethought toward Benha outpatient facility for singleton feasible pregnancy In 11-13+6 weeks gestation (Fetal crown-rump length (CRL) might have been 45-84 mm for typical fetal morphology). For each tolerant we measure uterine corridor doppler and pregnancy cohorted plasma protein and the outcomes were Pregnancy copartnered plasma protein (PAPP-A) indicated profoundly noteworthy Contrast between instances for preeclampsia What's more instances that don’t create preeclampsia (p quality 0. 004) same time both uterine corridor pulstality list (UTPI) Furthermore uterine corridor imperviousness list (UTRI ) are stastically critical. We closed that mix for uterine corridor stream indices Also pregnancy connected plasma protein from the beginning trimester needed progressed early identification about preeclampsia.

138: Congenital malformations detected during routine third-trimester growth scan: a population-based study

Routine third-trimester fetal growth scans are increasingly recommended. Our aim was to evaluate the number and nature of congenital malformations detected in the third trimester in women attending a universal late growth scan. Population-based study of women receiving care in Oxfordshire, UK over 2 years. Eligible women had a viable singleton pregnancy and an estimated due date between October 2016 and September 2018. Standard care included sonographer performed and reported nuchal translucency scan at 11-13 weeks, combined biochemical testing, an anomaly scan at 19-21 weeks, and a growth scan at 35-37 weeks. The fetal growth scan consisted of biometry, amniotic fluid volume, and Doppler measurements, but not formal reassessment of anatomy. Suspected fetal malformations were referred for fetal medicine evaluation. Prenatal ultrasound data and postnatal diagnoses were collected for all pregnancies. We assessed the rate and timing of prenatal detection of fetal congenital malformations in the cohort. There were 15,244 women attending routine antenatal care. Malformations were detected prenatally in 332: 104 (31%) were detected before the anomaly scan, 176 (53%) at the anomaly scan, 9 (3%) after but before the third-trimester scan, and 43 (13%) at the third-trimester scan (Table). In a further 150 neonates, an anomaly was detected postnatally. Of major malformations, 68% were detected before the third-trimester growth scan, 3% at the third-trimester growth scan, and 29% after birth. The malformations detected at the routine third-trimester growth scan were most commonly urinary tract dilatation, ventriculomegaly, and abdominal cysts. Of the third-trimester malformations, 33 (77%) were confirmed postnatally; 21 (49%) were minor renal abnormalities, 2 (5%) were chromosomal and none were cardiac. A universal third-trimester growth scan in a previously screened population will incidentally identify a congenital malformation in about 1 in 350 pregnancies, however, detection rates of major malformations are affected very little.

Impact of Childbirth Policy Changes on Obstetric Workload Over a 13-Year Period in a Regional Referral Center in China — Implications on Service Provision Planning

Background: To appraise the impact of the changing national childbirth policy since 2002, currently allowing two children per family, on obstetric workload in a regional referral center in China. Methods: In a retrospective cohort study, temporal changes in maternal demographics, incidence of high-risk pregnancies, and resource statistics in our hospital in managing singleton viable pregnancies (birth at ≥28 weeks gestation) for the period 2005-2017 were examined. Findings During this 13-year period, there were 49,479 singletons live-born infants delivered at ≥28 weeks gestation, the annual delivery increasing from 1,941 in 2005 to 5,777 in 2017(p<0.001). There were concomitant and significant (p<0.001) increases in the incidence of parturients of multiparity status (10.6% to 50.8%), of age ≥35 years (6.5% to 24.3%), with prior CS (2.6% to 23.6%), and with ≥3 previous pregnancy terminations (1.0% to 4.9%). There were associated increases in beds and staff complement, and reduced average hospital stay. Nevertheless, while medical staff maintained a stable service efficacy, that for nursing and midwifery staff increased 1.7 fold from 194.1% to 320.9% (p<0.001). Interpretation In our hospital, there has been progressively increasing total annual births and especially incidence of high risk pregnancies following the revised national childbirth policy. Only the increase in medical but not nursing/midwifery staff was commensurate with workload. Our experience is likely a reflection of other tertiary centres in China as well. Remedial measures are urgently required before the anticipated progressive increase in service demand would overwhelm the obstetric service with potentially disastrous consequences. Funding Statement: The research grants of the Key Science and Technology projects (2018ZF009, 2015FA003) from the Department of Yunnan Science and Technology, the National Natural Science Founding of China (grant number 81760274), and a Ph.D. Research and Development of Kunming Medical University (2015BS018). Declaration of Interests: The authors stated: None declared. Ethics Approval Statement: The study was approved by the Health Administrative Departments of Yunnan Province, and the Medical Ethics Committee of the 1st Affiliated Hospital of Kunming Medical University.

Risk of miscarriage in women conceiving after medically assisted reproduction with an ultrasound-verified viable pregnancy at 6-8 weeks' gestation.

What is the risk of miscarriage after a viable fetus verified on ultrasound at 6-8 weeks' gestation among women who conceive with medically assisted reproduction (MAR), stratified by type of fertility treatment? A nationwide register-based cohort study of women identified in the Danish ART-Registry with a viable singleton pregnancy at 6-8 weeks' gestation between 2007 and 2010 (n = 10,011). Women were identified from The Danish Fetal Medicine Database (DFMD), which holds information on early (between 6-8 and 11-14 weeks) and late (between 11-14 and 22 weeks) miscarriages. The late miscarriage rate was compared with a control group of naturally conceived pregnancies with a viable fetus at 11-14 weeks' gestation from 2008 to 2010, identified in the DFMD (n = 146,932). In the MAR1 cohort, the overall miscarriage rate was 11.8% (1091/9261) after an ultrasound verified viable pregnancy at 6-8 weeks' gestation. Most miscarriages occurred before the 11-14-week scan (1035/1091 [94.9%]). The early miscarriage rate was slightly higher in women who conceived with frozen embryo transfer compared with intrauterine insemination (IUI), corresponding to an adjusted OR of 1.31 (1.02 to 1.68). We found no significant risk associated with IVF and intracytoplasmic sperm injection compared with IUI pregnancies. The late miscarriage rate was 0.8% in women conceiving with MAR and 0.6% among controls (P = 0.013). After adjustment for maternal characteristics, none of the fertility treatment types were associated with an increased risk of miscarriage compared with naturally conceiving women.

Effects of mares' age and day of gestation on efficacy of transvaginal ultrasound-guided twin reduction.

Transvaginal ultrasound-guided aspiration (TUA) is a procedure which can be used for the reduction of twins post-fixation in the mare. The aim of this study was to evaluate the effect of the age of mares and the day of gestation on the outcome of TUA treatment. In 88 mares, diagnosed pregnant with twins, TUA of the yolk sac or allantoic fluid was performed between day 30 and 62 of gestation. Mares were aged 3-22 years. Ultrasonographic examination for a viable singleton pregnancy was performed by referring veterinarians 5-7 days and 4 weeks after TUA. Based on reported findings, effects of age and day of gestation on pregnancy rates were evaluated. Four weeks after TUA, 67% of the cases resulted in a viable singleton pregnancy. Five to 7 days after TUA treatment, the success rate was 74%. The gestational period did not affect the outcome, irrespective of the age of the mare. In contrast, success rates decreased with increasing age of the mares (84% ≤ 7 years vs. 67% 8-14 years vs. 57% ≥ 15 years). In mares aged 8-14 years, a decrease in singleton pregnancies was observed, if TUA was performed after day 35 of gestation. Success rates were slightly higher, if twin vesicles were localized within separate uterine horns (73%) as compared to the same horn (66%). Differences in singleton pregnancy rates were not statistically significant (p > 0.05). TUA was found to be an effective procedure for reduction of twin pregnancies performed at days 30-62 of gestation. Success rates for singleton pregnancies were high for young mares ≤ 7 years old (84%) and middle aged mares treated before day 36 of pregnancy (74%). Duration of pregnancy at the time of TUA did not have a major impact on the outcome. Nevertheless, the procedure should optimally be performed around days 32-35 of pregnancy to allow for the possibility of natural reduction before treatment and rebreeding in case of a total pregnancy loss after TUA.

Prospective assessment of INTERGROWTH-21st and World Health Organization estimated fetal weight reference curves.

To assess the suitability of the new INTERGROWTH-21st and World Health Organization (WHO) estimated fetal weight (EFW) references in a Southern Chinese population. A secondary aim was to determine the accuracy of EFW by assessing the difference between EFW and actual birth weight. This was a prospective cross-sectional cohort study. Viable singleton pregnancies at 11-13 weeks' gestation were recruited to undergo a single standardized fetal biometric scan after 20 weeks. The gestational age at which the scan was performed was allocated randomly at the time of recruitment. EFW was predicted using both the Hadlock and INTERGROWTH-21st weight estimation model formulae. Population-specific EFW references were constructed. Z-scores were used to compare these references against the INTERGROWTH-21st and WHO international size references. Gestational-age-adjusted projection was used to assess the difference between EFW on the day of delivery and birth weight for fetuses having biometry scans ≥ 34 weeks. Fetuses of 970 participants had biometry scans. The median number of scans per gestational week was 48 (interquartile range, 43-53). Z-score comparison indicated that the WHO 10th , 50th and 90th centiles of the EFW reference were consistently higher than the corresponding local centiles, whilst the INTERGROWTH-21st 10th centile was lower. Fewer than 2% of fetuses scanned at or after 34 weeks would be considered as potentially large-for-gestational age, irrespective of which model was used to predict weight. Adopting the WHO international reference would result in approximately one in six fetuses being regarded as potentially small-for-gestational age, 50% more than the number determined using a population-specific reference. Systematic errors of extrapolated EFW were similar, ranging from 5.5% to 7.4%. Centers seeking to use new references, such as the INTERGROWTH-21st and/or WHO international references, as a means of determining whether a fetus is small- or large-for-gestational age, would be advised to assess the suitability of these references within their own population using standardized methodology. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.