Weeks Of Gestation Research Articles

Cardiopulmonary bypass of acute type A aortic dissection during pregnancy at the 20th gestational week with maternal and foetal survival: A case report.

Type A acute aortic dissection, an aggressive and highly fatal disease, is particularly common among pregnant women and foetuses. This disease often occurs during the third trimester of pregnancy and the postpartum period. This case involves a female who was 20 weeks pregnant with type A acute aortic dissection. While maintaining pregnancy, the patient underwent Bentall surgery and Sun's procedure. The duration of circulatory arrest was a brief 4 min. The patient fully recovered 40 days after surgery and remained pregnant post-discharge. At the 38th gestational week, she delivered a healthy male infant via caesarean section. Gestational morbidity can have a serious impact on the safety of mothers and children. Currently, the shortest time reported for hypothermic circulatory arrest is 5 min. In this case, the lower body circulatory arrest was controlled to approximately 4 min during cardiopulmonary bypass while simultaneously safeguarding both individuals. Ideal strategies for cardiopulmonary bypass to reduce foetal risk include shorter cardiopulmonary bypass times, higher flow rates, and higher perfusion pressures. A reduction in the duration of hypothermic circulatory arrest further increases foetal survival rates. The development of a rational cardiopulmonary bypass plan should be tailored to the physiological characteristics of the pregnant woman to ensure the safety of both the pregnant woman and the foetus, reduce complications, and improve the success rate of the operation.

Fetus in the Abdominal Cavity After Uterine Rupture in a Primigravida Post-Adenomyosis Enucleation

A 35-year-old primigravida with a history of adenomyosis enucleation was diagnosed with abnormal fetal position at 25 weeks of gestation. The patient presented with normal vital signs and no symptoms. A cardiotocogram and transabdominal ultrasound revealed a healthy fetus, normal amniotic fluid volume, and no intra-abdominal bleeding. Pelvic magnetic resonance imaging (MRI) indicated a ruptured muscular layer of the uterine fundus, with the fetus completely prolapsed into the abdominal cavity. An emergency cesarean section was performed, during which the fetus was found wrapped within the amniotic membrane in the abdominal cavity. The uterus exhibited extensive tearing along the line of the previous surgical scar; however, no hemorrhage was observed. In this case, despite uterine rupture, blood flow through the umbilical cord from the placenta in the uterus resulted in the survival of the fetus. In addition, MRI was essential in determining the appropriate timing to save the fetus.

A Review on Machine Learning Deployment Patterns and Key Features in the Prediction of Preeclampsia

Previous reviews have investigated machine learning (ML) models used to predict the risk of developing preeclampsia. However, they have not addressed the intended deployment of these models throughout pregnancy, nor have they detailed feature performance. This study aims to provide an overview of existing ML models and their intended deployment patterns and performance, along with identified features of high importance. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The search was performed in January and February 2024. It included all papers published before March 2024 obtained from the scientific databases: PubMed, Engineering Village, the Association for Computing Machinery, Scopus, and Web of Science. Of a total of 198 identified studies, 18 met the inclusion criteria. Among these, 11 showed the intent to use the ML model as a single-use tool, two intended a dual-use, and two intended multiple-use. Ten studies listed the features of the highest importance, with systolic and diastolic blood pressure, mean arterial pressure, and hypertension frequently mentioned as critical predictors. Notably, three of the four studies proposing dual or multiple-use models were conducted in 2023 and 2024, while the remaining study is from 2009. No single ML model emerged as superior across the subgroups of PE. Incorporating body mass index alongside hypertension and either mean arterial pressure, diastolic blood pressure, or systolic blood pressure as features may enhance performance. The deployment patterns mainly focused on single use during gestational weeks 11+0 to 14+1.

Comparison of two proxies for the preconception weight using data from a pre-pregnancy cohort in Benin: Weight measured in the first trimester of pregnancy vs estimated by Thomas' formula.

Accurate determination of pre-pregnancy weight is essential for optimal pregnancy monitoring and antenatal care. Determining pre-pregnancy weight in limited-resources settings is challenging for both clinical practice and public health research. From a 2014-2017 pre-pregnancy cohort in Benin, we evaluated the agreement between the measured pre-pregnancy weight (MPPW) and two proxies: (i) the first trimester pregnancy weight (FTPW) and (ii) the estimated pre-pregnancy weight (EPPW) using Thomas & al. formula. We analysed data from 302 pregnant women with both pre-pregnancy weight measured within 3 months before conception and weight measured during the first trimester. Using segmented linear regression, we first assessed up to which gestational age the weight measured during the first trimester could reasonably estimate the MPPW. Then the Bland & Altman method was used to assess agreement between MPPW and the two proxies. Additional analyses were performed to assess the sensitivity of results to the timing of measurement of either MPPW or the two proxies. On average, FTPW did not feature significant difference with MPPW up to 13.03 (11.99-14.06) weeks of gestational age. FTPW, measured on average at 7 ± 2.4 weeks of gestation, and the EPPW showed similar Bland & Altman limits of agreement with the MPPW. However, while the FTPW slightly underestimated the MPPW by a mean of-0.16 (-0.08; +0.39) kg, the EPPW overestimated it by a mean of + 0.43 (+0.20; +0.66) kg. Minor differences in these results were observed when the MPPW was assessed earlier or within three months before pregnancy, or according to the gestational age at the time of the proxy's measurement. In conclusion, in Southern Benin and up to 12-14 weeks of pregnancy, the FTPW appeared to be a good proxy of the MPPW while using Thomas' formula did not enhance pre-pregnancy weight estimation.

Neurodevelopmental Outcome in Infants of Gestational Diabetic Mother in a Tertiary Care Hospital, Dhaka, Bangladesh

Background: Diabetes Mellitus (DM) is one of the most common metabolic complications of pregnancy, with negative influences on maternal and fetal health. Infants of Diabetic Mothers (IDMs) are prone to develop both early and late complications. Evidences shows that diabetes in pregnancy have strong association with long-term adverse effects on brain development in babies born to mothers with gestational diabetes mellitus. Very few studies were done in this subcontinent regarding association of gestational diabetes mellitus and infant’s neurodevelopmental outcome. This study will help to find out this associations and thus to reduce poor neurodevelopmental outcome in infants of diabetic mothers by early detection and providing proper early childhood stimulation. Objective: To assess the neurodevelopmental outcome of infants born to mother with gestational diabetes mellitus. Methodology: This prospective observational study was conducted in the department of Neonatology and Institute of Pediatric Neurodisorder and Autism (IPNA), BSMMU, from March 2022 to September 2023. Neonates (N= 52) born at or after 34 weeks of gestation and born to gestational diabetic mother were enrolled in this study. Consent was taken from guardians. The newborns fulfilling the inclusion criteria were followed up for neurodevelopmental assessment at their 9 months of age by clinical psychologists assigned from Institute of Pediatric Neurodisorder and Autism (IPNA), BSMMU, who were blinded about infant’s diagnosis. Bayley scales of infant and toddler development (BSID III) was used for developmental assessment. In the Bayley III, cognitive development, expressive and receptive language and fine and gross motor development all were evaluated at 9 months of age. All data were recorded in a preformed questionnaire and analyzed by Statistical Package for Social Sciences (SPSS), version 25. Results: According to inclusion and exclusion criteria 58 newborn were enrolled and their blood samples were sent at 24 to 48 hours of age to see the laboratory parameters of metabolic and hematological profile. Among them 6 patients lost to follow up, so 52 infants were followed up for neurodevelopmental outcome at 9 months of age. Among the baseline characteristics of mother and neonate 48% mother needed drugs for glycemic control, while others were on dietary modification and 75% of the mothers had good glycemic control. Most of the neonate were born at term and were age appropriate, 18 patients needed NICU admission. Among the neonatal laboratory parameters hyperbilirubinemia was most common (30.8%) and hypoglycemia was second most common found in 15.4% of newborns. The most common morbidity was sepsis (17.3%). Overall adverse neurodevelopmental outcome was found among 14 (26.9%) neonate and 38 (73.1%) neonates had favorable outcome. Use of drugs and poor maternal glycemic control were found statistically significant in between adverse and favorable groups. (p-value- 0.041 and 0.000). Among the neonatal clinical parameters only hypoglycemia was found statistically significant in between these two groups. (p-value- 0.014) Multivariate logistic regression among these predictive factors showed only maternal poor glycemic control was significantly associated with adverse neurodevelopmental outcome (p-value=0.001). Conclusion: Maternal gestational diabetes can adversely affect on their infants neurodevelopment. Among the adverse outcome of three domains language delay was most common. Neonatal hypoglycemia, maternal poor glycemic control and use of drugs for GDM are significant predictors of adverse neurodevelopmental outcome in infants of gestational diabetic mother. Among them maternal poor glycemic control was significantly associated with adverse neurodevelopmental outcome.

The effect of hereditary thrombophilia on recurrent pregnancy loss: a retrospective cohort study

ObjectiveThrombophilia screening has been performed in patients with conditions such as previous fetal death, (fetal growth restriction) FGR, preeclampsia, (hemolysis. elevated liver enzyme, low platelet count) HELLP Syndrome, previous abruptio placentae, previous thrombosis in pregnancy, and abnormal placental histology. The actual role of hereditary thrombophilia in recurrent pregnancy loss (RPL) is still debated. This study was intended to determine the incidence of specific gene defects for hereditary thrombophilia and to ascertain their impact on RPL in central Anatolia in Turkey.MethodsThis retrospective cohort study was performed between January 2012 and December 2022. All pregnant women with a complete hereditary screening profile were included. The investigated gene polymorphisms were methylenetetrahydrofolate reductase (MTHFR) C677T, MTHFR A1298C, Factor V Leiden G1691A, and Factor II prothrombin G20210A. Cases of pregnant women at least two or more consecutive pregnancy losses before 22 weeks of gestation were defined as RPL. The rates of genetic screening and their association with RPL were analyzed.ResultsRPL was identified in 224 (27.58%) of the 812 pregnant women with complete genetic screening. Although there was no difference in terms of age, body mass index, numbers of ectopic pregnancies, molar pregnancies, or dilatation & curettage (p > 0.05), gravity (2.0 [2.0–3.0] vs. 4.0 [3.0–5.0]), parity (1.0 [1.0–2.0] vs. 1.0 [0–1.0]), live birth (1.0 [1.0–2.0] vs. 1.0 [0–1.0]), anembryonic pregnancy (0 [0–0] vs. 0 [0–0]), miscarriage (0 [0–1.0] vs. 3.0 [2.0–3.0]), and stillbirth (0 [0–0] vs. 0 [0–0]) numbers differed significantly between the groups (p < 0.05). While no significant differences were determined in MTHFR A1298C, Factor V Leiden, factor II prothrombin G20210A, or homocysteine levels (p > 0.05), the homozygous MTHFR C677T positivity rates differed significantly (6.3% in the non-RPL group vs. 11.6% in the RPL group, p = 0.027) .ConclusionThe homozygous MTHFR C677T polymorphisms was found to be more frequent in women with RPL. Further studies with larger cohorts are needed to confirm our results.

Fetal growth ultrasound in obese patients for the detection of growth abnormalities.

To examine the impact of maternal obesity on fetal growth abnormalities including fetal growth restriction (FGR) and large for gestational age (LGA) fetuses. Secondary analysis from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The study excluded individuals with pregestational or gestational diabetes, chronic hypertension, and other major maternal medical conditions. Ultrasound assessments were performed at 16 - 21 and 22 - 29 weeks of gestation. Our exposure was the presence of pre-pregnancy obesity. Our primary outcome was rates of fetal growth abnormalities identified by ultrasound, defined as FGR (estimated fetal weight [EFW] or abdominal circumference < 10th percentile) or LGA (EFW > 90 th percentile) among obese compared to non-obese women. A secondary analysis was performed after limiting ultrasound performed from 28-29 weeks. To estimate adjusted relative risks (aRR) with 95% confidence intervals (95%CIs), we used generalized linear models with Poisson distribution and log link using robust error variance, adjusting for the predefined covariates. Of 7,354 participants, 1,443 (19.6%) had pre-pregnancy obesity while 5,911 (80.4%) did not. Pre-pregnancy obesity compared with normal weight was associated with an increased risk of fetal growth abnormalities both at 16-21 weeks (16.0% vs. 13.2%; aRR 1.23; 95%CI 1.06-1.42) and 22-29 weeks (16.0% vs. 12.1%; aRR 1.33; 95%CI 1.14-1.54). Furthermore, pre-pregnancy obesity compared with normal weight was associated with an increased risk of LGA both at 16-21 weeks (12.5% vs. 10.3%; aRR 1.24; 95%CI 1.05-1.47) and 22-29 weeks (10.6% vs. 6.9%; aRR 1.66; 95%CI 1.38-2.01). In a secondary analysis limited to the ultrasound 28-29 weeks, both fetal growth abnormalities and LGA were associated with the presence of obesity. In any of the analyses, pre-pregnancy obesity was not associated with FGR compared to normal weight. Maternal obesity is associated with an increased risk of fetal growth abnormalities and LGA fetuses.

Development and validation of an ultrasound-based estimated fetal weight reference for Chinese twin pregnancy: a retrospective cohort study

BackgroundFetal growth monitoring is important for twin pregnancies. However, there has been no clinically validated tool for monitoring fetal growth of twin pregnancies in China. This study aims to develop and validate a chorionicity-specific growth chart of ultrasound estimated fetal weight (EFW) for Chinese twin pregnancies.MethodsThis retrospective cohort study included all twin pregnancies who delivered two live fetuses with gestational age ≥ 34 weeks without severe obstetric complications at a tertiary hospital from January 2007 to March 2021. The participants were divided into a development set (delivered in or before December 2017) and a validation set (delivered in or after January 2018). Chorionicity-specific growth charts were created using the generalized additive models for location, scale, and shape (GAMLSS) based on the development set. The fetuses from the validation set were classified into three groups based on the last EFW: small-for-gestational-age (SGA) indicated by both the newly established twin charts and the Hadlock singleton chart currently used for twin pregnancies in China, suspected SGA indicated by only the singleton chart, and no SGA indicated by either chart. The incidence of neonatal outcomes among the three groups was then compared accordingly, including intensive care unit (NICU) stay length, respiratory diseases, and neurological disorders.ResultsThe development set included 883 twin pregnancies and a total of 6374 EFW measurements between 16 and 38 weeks of gestation, and the validation set included 801 twin pregnancies and 7630 EFW measurements. In the development set, monochorionic diamniotic (MCDA) twins had a significantly lower EFW compared to dichorionic diamniotic (DCDA) twins beginning at 26 weeks, with the difference gradually increasing thereafter, supporting the establishment of chorionicity-specific growth charts. Of the 1,602 twin neonates in the validation set, 103 (6.4%) were classified into the SGA group, 164 (10.2%) into the suspected SGA group, and 1335 (83.3%) into the no SGA group. The incidence of respiratory diseases and neurological disorders was comparable between the suspected SGA group and the no SGA group, but apparently higher in the SGA group. Meanwhile, NICU stay lengths were consistently longer for twins in the SGA group compared to the no SGA group (difference: 0.57, 95% CI: 0.31–0.83), with no significant differences observed between the suspected SGA and no SGA groups.ConclusionsThe fetal growth trajectories differed by chorionicity, with a lower EFW for MCDA twins beginning at 26 weeks. The establishment of chorionicity-specific growth chart could reduce overdiagnosis of SGA and improve fetal growth monitoring of twin pregnancies.

Electromyographic parameters for treatment of pelvic floor disorders in pregnant and postpartum women: A review protocol.

Electromyography is a widely used instrument in clinical practice to evaluate and treat pelvic floor disorders in pregnant and postpartum women. The objective of this study is to analyze the scientific evidence on the electromyography parameters used for treatment of pelvic floor disorders in pregnant women in any gestational week and postpartum women up to 12 months after delivery. A systematic review of randomized controlled experimental studies (clinical trials) and quasi-experimental studies in English, Portuguese or Spanish, which used electromyography as an intervention for treatment of pelvic floor disorders in pregnant or postpartum women up to 12 months after delivery will be performed in online databases (Scopus, Medline, Pedro, Scielo and Pubmed),. Risk of bias assessment will be performed using Cochrane group tools. The Rob 2.0 tool will be used for experimental studies and the Robins-I tool for non-experimental studies. The protocol was registered in PROSPERO (no.433510). The quality of the evidence will be analyzed using the GRADE System Methodological Guide and the systematic review structure will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Molecular Lineages and Spatial Distributions of Subplate Neurons in the Human Fetal Cerebral Cortex.

The expansion of neural progenitors and production of distinct neurons are crucial for architectural assembly and formation of connectivity in human brains. Subplate neurons (SPNs) are among the firstborn neurons in the human fetal cerebral cortex, and play a critical role in establishing intra- and extracortical connections. However, little is known about SPN origin and developmental lineages. In this study, spatial landscapes and molecular trajectories of SPNs in the human fetal cortices from gestational weeks (GW) 10 to 25 are created by performing spatial transcriptomics and single-cell RNA sequencing. Genes known to be evolutionarily human-specific and genes associated with extracellular matrices (ECMs) are found to maintain stable proportions of subplate neurons among other neuronal types. Enriched ECM gene expression in SPNs varies in distinct cortical regions, with the highest level in the frontal lobe of human fetal brains. This study reveals molecular origin and lineage specification of subplate neurons in the human fetal cerebral cortices, and highlights underpinnings of SPNs to cortical neurogenesis and early structural folding.

Serum oxidative markers and delta neutrophil index in hyperemesis gravidarum

Objectives: To evaluate the relationship between different serum oxidative markers and the delta neutrophil index and hyperemesis gravidarum. Methods: One hundred pregnant women were enrolled in the study and divided into two groups. Group 1 included 50 women with hyperemesis gravidarum, while Group 2 (control group) included 50 pregnant women similar in age, gestational week, and body mass index. Serum oxidative markers and complete blood count inflammatory markers were compared. Results: Native thiol and total thiol were significantly lower in the Group 1 when compared with the control group (P=0.029 for native thiol; P=0.035 for total thiol). Moreover, ischemia-modified albumin (IMA) and catalase values were significantly higher in the Group 1 than in the control group (P=0.023 for IMA; P=0.021 for catalase). Index1% shows the disulfide/native thiol percent ratio and means that the Group 1 oxidant load is increased but not statistically significant. Myeloperoxidase, ferroxidase, and the delta neutrophil index did not differ significantly between the two groups (P=0.591, P=0.793, and P=0.52; respectively). Conclusions: According to our study, contrary to the literature, although there are differences in some values, when evaluated individually hyperemesis gravidarum does not impose an extra burden on maternal oxidant-antioxidant balance.

The use of complementary and alternative medicine (CAM) during pregnancy.

Approximately one-third of the global population uses complementary medicine, as yoga and meditation, not endorsed by evidence-based conventional medicine and, with more difficulties in case of pregnancy. Our study investigates the prevalence of Complementary and Alternative Medicine (CAM) usage in Novara (Italy) and its province through a survey to pregnant women at 36 gestational weeks. The sample consisted of 70 women, average age of 33 years, most Caucasian, highly educated, mostly employed, under private gynecological care, with a prevalence of CAM use of 24.3 % [95 % CI 14.83; 36.01]. Six women (35.3 %) did not inform their healthcare provider of using these medicines, 15 women (88.2 %) express willingness to use complementary medicine in their next pregnancy, while 2 (11.8 %) are uncertain. The study found a significant association between higher education and CAM usage among pregnant women. Other factors, including nationality, occupation, choice of private practice, parity, physical activity, diet, smoking, pregnancy complications, and vaccination status, did not show significant relationships with CAM usage. Our objective is to delineate the characteristics of CAM users, explore the methodologies and motivations of their usage, and ascertain any correlations with the rejection of conventional vaccination practices. The analyzed population consists of 70 women aged 32.9 years in mean, mostly Caucasian, with a high level of education. Most women are under private gynecological care (84.3 %), half of the participants are experiencing their first pregnancy. Physical activity levels vary, with 34.3 % reporting high activity levels. Regarding diet, 77.1 % consider their eating habits moderately healthy, with a notable portion of smokers women (24.3 %); 20.0 % have experienced pregnancy complications. 17 participants utilized non-conventional or alternative medicine, with a prevalence of 24.3 [95 % CI 14.83; 36.01]. Six women (35.3 %) did not inform their healthcare provider about using CAM. Seven women (46.7 %) claim significant beneficial effects in most cases, while 8 (53.3 %) state this occasionally. Based on their experiences, 15 women (88.2 %) express willingness to use complementary alternative medicine in their subsequent pregnancy, while 2 (11.8 %) are uncertain. Only one person (11.1 %) used this type of therapy as a substitute for conventional treatment, but they informed their attending physician. The study seeks to enhance our understanding of CAM utilization in pregnancy, informing more comprehensive and evidence-based healthcare practices for expectant mothers.

Surgical management of delivery with placenta accreta spectrum from the perspective of perinatal obstetrics

Introduction. This article raises the issue of planning the timing and method of operative delivery in pregnant women with placenta accreta spectrum. Placenta accreta spectrum is one of the most formidable complications of pregnancy, the delivery of pregnant women with this pathology is accompanied by massive blood loss, and programmed late premature birth leads to an increase in perinatal morbidity.The objective was to evaluate the possibility of prolonging pregnancy to full term in patients with pathology of placenta accreta spectrum.Methods and materials. 94 histories of pregnant women with placenta accreta spectrum, delivered from 2017 to 2023, were analyzed. All patients were divided into 4 groups according to the topography of placenta accreta. According to the assessment of perinatal outcomes, pregnant women were divided into 2 groups: group 1 – pregnant women who delivered at 34–36 weeks of pregnancy (n=82; 87 %); group 2 – patients operated on from 37 to 39 weeks of gestation (n=12; 13 %). The statistical analysis was performed using the program StatTech v. 4.2.7.Results. Among pregnant women whose delivery ended with hysterectomy (n=32, 100 %), the largest proportion of patients had placenta accreta in the area of the parametrium and cervix (n=12, 43.75 %). The average score of newborns in group 1 was 7 points on the Apgar scale at 1 minute after extraction and 8 points on the Apgar scale at 5 minutes; in group2, the average score on the Apgar scale was 8 and 8 points at 1 and 5 minutes.Conclusion. If placenta accreta is suspected and involves the cervix, parametrium, and lower part of the posterior wall of the bladder, a hysterectomy is most likely to be performed. For such pregnant women, it is possible to shift the timing of surgical intervention to 37/38 weeks of gestation in order to improve neonatal outcomes.

Association between adenomyosis volume and adverse perinatal outcomes: multicenter cohort study.

To assess the association between adenomyosis volume, as a reflection of its severity, and the risk of adverse perinatal outcomes. This multicenter retrospective cohort study was conducted at a comprehensive tertiary care institution and a tertiary maternal and child healthcare hospital, which are the main types of hospital providing maternal medical care in China. The study included pregnant women without adenomyosis (non-AD cohort) who delivered between 1 January 2021 and 31 December 2021, and women with pregnancy complicated by adenomyosis (AD cohort) who delivered between 1 January 2020 and 31 December 2022. Adenomyosis was diagnosed and measured using transvaginal or transabdominal ultrasound up to 14 weeks of gestation. The adenomyosis volume (V) was calculated based on the sonographic measurement of three dimensions, using the formula V = (length × width × thickness) × 4/3π. Univariate and multivariate logistic regression analyses were conducted to assess the association between adenomyosis and the risk of pregnancy complications. We also performed a sensitivity analysis among 226 pregnancies complicated by adenomyosis that had volume measurements available and 10 507 pregnancies without adenomyosis, using as a threshold for severe adenomyosis the 3rd quartile of adenomyosis volume. The study group included 10 507 pregnant women in the non-AD cohort and 321 in the AD cohort. Pregnancies complicated by adenomyosis had an increased risk of preterm birth < 37 weeks of gestation (adjusted odds ratio (aOR), 2.39 (95% CI, 1.65-3.48)), spontaneous preterm birth < 37 weeks of gestation (aOR, 2.57 (95% CI, 1.54-4.28)), placenta previa (aOR, 2.57 (95% CI, 1.41-4.67)), cervical incompetence (aOR, 9.70 (95% CI, 4.00-23.55)) and abnormal fetal presentation (aOR, 2.04 (95% CI, 1.39-3.00)), and there was also a non-significant trend toward increased risk of pre-eclampsia (aOR, 1.64 (95% CI, 0.94-2.85)). Sensitivity analysis revealed there was a greater risk in pregnancies with severe (≥ 757.5 cm3) vs mild adenomyosis of preterm birth < 37 weeks of gestation (aOR, 5.50 (95% CI, 2.80-10.82) vs aOR, 1.73 (95% CI, 0.98-3.05)), pre-eclampsia (aOR, 4.94 (95% CI, 2.11-11.58) vs aOR, 1.03 (95% CI, 0.41-2.58)), placenta previa (aOR, 6.37 (95% CI, 2.39-17.04) vs aOR, 1.58 (95% CI, 0.60-4.19)) and cervical incompetence (aOR, 12.79 (95% CI, 2.87-56.93) vs aOR, 4.97 (95% CI, 1.25-19.77)) compared to pregnancies without adenomyosis. The risk of spontaneous preterm birth < 37 weeks and the risk of abnormal fetal presentation was similar between the two subgroups. Pregnancies complicated by adenomyosis, particularly those with severe adenomyosis, have an increased risk of pregnancy complications, including preterm birth, spontaneous preterm birth, placenta previa, cervical incompetence and abnormal fetal presentation. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Disease Activity in Pregnant and Postpartum Women With Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies.

Women with multiple sclerosis (MS) are at risk of disease reactivation in the early postpartum period. Ocrelizumab (OCR) is an anti-CD20 therapy highly effective at reducing MS disease activity. Data remain limited regarding use of disease-modifying therapies (DMTs), including OCR, and disease activity during peripregnancy periods. We performed a retrospective cohort study using data from the MSBase Registry including pregnancies conceived after December 31, 2010, from women aged 18 years and older, with relapsing-remitting MS or clinically isolated syndrome. Women were classified by preconception exposure to DMTs, including OCR, rituximab (RTX), natalizumab (NAT), stratified into active (NAT-A; continued ≥28 weeks of gestation, restarted ≤1 month postpartum) or conservative (NAT-C; continued ≤4 weeks of gestation, restarted >1 month postpartum) strategies, dimethyl fumarate (DMF) or low-efficacy DMTs (interferon-beta, glatiramer acetate). Annualized relapse rates (ARRs) were calculated for 12-month prepregnancy, pregnancy, and 6-month postpartum periods. A total of 2,009 live births from 1,744 women were analyzed, including 73 live births from 69 women treated with preconception OCR. For OCR, no within-pregnancy relapse was observed and 3 women (4.1%) experienced 1 relapse in the postpartum period (ARR 0.09 [95% CI 0.02-0.27]). For NAT-A, 3 (3.7%) of 82 women relapsed during pregnancy (0.05 [0.01-0.15]) and 4 (4.9%) relapsed during postpartum (0.10 [0.03-0.26]). However, for NAT-C, 13 (15.9%) of 82 women relapsed within pregnancy (0.32 [0.20-0.51]) and 25 (30.5%) relapsed during postpartum (0.74 [0.50-1.06]). In the low-efficacy DMT group, 101 (7.6%) of 1,329 women experienced within-pregnancy relapse (0.12 [0.10-0.14]), followed by an increase in postpartum relapse activity with 234 women (17.6%) relapsing (0.43 [0.38-0.48]). This was similarly seen in the DMF group with 13 (7.9%) of 164 women experiencing within-pregnancy relapse (0.12 [0.06-0.20]) and 25 (15.2%) of 164 relapsing postpartum (0.39 [0.26-0.57]). Our RTX cohort had 0 of 24 women experiencing within-pregnancy relapse and 3 (12.5%) of 24 experiencing postpartum relapse. Women treated with OCR or NAT-A were observed to have low relapse rates during pregnancy and postpartum. NAT-C was associated with increased risk of relapses. There was no within-pregnancy relapse in our RTX cohort, although we caution overinterpretation due to our sample size. An effective DMT strategy with a favorable safety profile for the mother and infant should be discussed and implemented well in advance of planning a family. This study provides Class III evidence that for women with relapsing-remitting MS or clinically isolated syndrome who become pregnant, ocrelizumab, rituximab, and natalizumab (continued ≥28 weeks of gestation and restarted ≤1 month postpartum) were associated with reduced risk of relapses, compared with other therapeutic strategies.

OA07 Upadacitinib exposure during pregnancy in seronegative Rheumatoid arthritis

Abstract Introduction Targeted therapies have become increasingly prevalent in the management of rheumatoid arthritis (RA), with Janus kinase inhibitors (JAK inhibitors) gaining traction in clinical practice. Upadacitinib, a selective JAK1 inhibitor, is widely used for its efficacy in controlling RA. However, preclinical studies have demonstrated teratogenic effects associated with JAK inhibitors, raising concerns about their safety during pregnancy. Given the limited data on human exposure, current guidelines recommend the immediate discontinuation of JAK inhibitors upon pregnancy detection. This case report details an instance of Upadacitinib exposure during pregnancy. Case description A 36-year-old woman was diagnosed with seronegative RA in January 2020. Her medical history is otherwise unremarkable. She has two children, aged four and two, both of whom were born after uneventful pregnancies. She has no history of spontaneous abortions. At the time of her RA diagnosis, the patient was considering pregnancy and was initially started on sulfasalazine. However, due to the development of a rash, her treatment was switched to certolizumab injections. Despite this treatment, she exhibited only a partial response with ongoing disease activity, leading to a change to etanercept in August 2021. When etanercept proved ineffective, adalimumab was considered in January 2022. Unfortunately, her response to adalimumab was limited. Consequently, she was started on Upadacitinib in July 2022. The patient responded well to Upadacitinib, achieving remission with normal inflammatory markers. In April 2024, the patient reported being six weeks pregnant while on Upadacitinib. Upon confirmation of her pregnancy, Upadacitinib was discontinued at approximately four weeks of gestational age. The parents were informed about the potential risks of teratogenicity. After a detailed discussion with the high-risk pregnancy team, who provided reassurance, the patient decided to continue the pregnancy. She was subsequently started on certolizumab. Unfortunately, the patient experienced a miscarriage at 11 weeks of gestation. Discussion Currently, there are no published human studies available in the literature regarding the effects of upadacitinib during pregnancy. It is crucial to encourage adequate contraception for women of childbearing potential and to verify a negative pregnancy status before initiating therapy. Women with reproductive potential should be advised to use effective contraception during upadacitinib therapy and for at least four weeks after discontinuation. If a patient becomes pregnant while on the drug, they should be informed of the potential risks to the foetus. According to the 2019 product information on upadacitinib, animal studies have shown that the drug, when administered at exposures equal to or greater than approximately 1.6 to 15 times the maximum recommended human dose, resulted in dose-related increases in skeletal and cardiovascular malformations, increased post-implantation loss, and decreased foetal body weights. There are no controlled data on upadacitinib use during human pregnancy, and it is unknown whether the drug can cause foetal harm or adversely affect reproductive capacity in humans. Data about pregnancy while on upadacitinib is limited. There are some unpublished data from the clinical trials and it was noted most of the patients had live births without congenital anomaly. Spontaneous abortions, elective terminations and ectopic pregnancies were among the other outcomes noted. Key learning points • Due to issues such as primary or secondary treatment failures, hypersensitivity reactions, and adverse events, patients often require sequential trials of different agents in management of Rheumatoid Arthritis (RA). Janus kinase inhibitors (JAK inhibitors) have shown remarkable efficacy in managing RA over the last decade. Despite their widespread use, there is limited literature on the safety of upadacitinib exposure during pregnancy in humans. Most of the available data come from unexpected pregnancies documented during clinical trials. • Animal studies indicate that upadacitinib can be harmful to a developing foetus. Furthermore, data suggest that women with RA who experience increased disease activity are at a heightened risk for adverse pregnancy outcomes, including preterm delivery, low birth weight, and infants who are small for gestational age. • It is crucial to emphasize pregnancy contraindications during follow-up appointments for patients on these medications. Access to a medical obstetrician team is invaluable in managing such cases. • While some case reports have documented positive pregnancy outcomes with other JAK inhibitors, such as tofacitinib and baricitinib, there remains a significant gap in knowledge regarding upadacitinib. This case report adds to the limited data on the potential risks associated with upadacitinib exposure during pregnancy. Comprehensive and targeted studies are necessary to better understand the safety of this class of drugs during pregnancy and lactation.

HELLP Syndrome Developing at 14 Weeks of Gestation: An Extremely Rare Case Report and a Literature Review

Introduction: Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a disease of pregnancy that occurs very rarely before 20 weeks of gestation. We report a case of HELLP syndrome developing at 14 weeks and 2 days of gestation. Case Presentation: A 33-year-old Asian primipara at 14 weeks and 2 days of gestation visited the emergency room with a fever and headache. Initial blood pressure was 140/70 mm Hg, temperature 38.5°C, heart rate 130 beats/min with tachycardia. Her prenatal examination has been unremarkable, and fetal ultrasonography was within normal range. The laboratory results showed low platelet count with elevated liver enzymes, D-dimer, and fibrinogen but no sign of jaundice. Her WBC differential suggested a bacterial infection. Thus, we diagnosed early HELLP syndrome and immediately started conservative treatments. One day after admission, symptoms and laboratory results showed aggravation of the disease. We performed termination, followed by dilation and curettage for retained placenta. Her general condition improved rapidly after the operation. Placental biopsy showed both acute and chronic inflammation. She also had anticardiolipin antibody IgM, and after discharge, she was referred to a rheumatology specialist to address the antiphospholipid syndrome issue. Discussion: Although the triggers of HELLP syndrome are unclear, a recent inflammatory hypothesis suggests that placenta-derived inflammatory cytokines are involved. In our case, the anti-cardiolipin antibody may have triggered microangiopathy of the placenta. Our analysis of published HELLP cases revealed that, apart from the three diagnostic criteria, the most common abnormal laboratory finding was antiphospholipid antibodies. Therefore, despite its rarity, if a sign of inflammation is present in a patient, it is important to consider HELLP syndrome regardless of gestational age

Glycated albumin in pregnancy correlates negatively with body mass index and contributes to the risk of gestational diabetes mellitus

ObjectivesThe aims of our study were to establish a reference interval for glycated albumin (GA) in gestational week 30, to investigate whether GA can replace or reduce the need for oral glucose tolerance test (OGTT) in pregnancy, and to reassess the usefulness of body mass-index (BMI), age and fasting glucose in detection of gestational diabetes (GDM). Designand methods: We measured GA in 486 healthy pregnant women. Reference interval was calculated using the central 95% of the results. ROC curves were created to assess the ability of GA, fasting glucose and BMI separately to detect GDM, and logistic regression analysis was used to estimate risk of developing GDM given the level of the same markers. Finally, multiple logistic regression analysis based on GA, fasting glucose and BMI was used to find a strategy of predicting a patient’s risk of GDM. ResultsThe reference interval for GA at week 30 of gestation is 6.8-10.3%. The analysis has a low AUC (0.53) with respect to detecting GDM. It increases slightly to 0.64 when corrected for BMI, as GA is inversely correlated to BMI. Combining GA with fasting glucose and BMI at gestational weeks 16-20 could raise the AUC to 0.80. ConclusionGA cannot be recommended to replace OGTT for the diagnosis of GDM. Nor can it be used to identify women at risk of developing GDM. GA combined with fasting glucose and BMI in early pregnancy could be a useful model to estimate risk of GDM.

Electrokinetic indices of erythrocytes as diagnostic criteria for preeclampsia

Objective. To evaluate the features of changes in the morphofunctional status of peripheral blood erythrocytes during normal pregnancy and in preeclampsia based on rapid analysis of biophysical parameters of cells.Materials and methods. A total of 136 pregnant women were examined at 22–24 and 34–35 weeks of gestation. The comparison groups included: 40 pregnant women with moderate preeclampsia (PE), 30 pregnant women with severe preeclampsia, 30 pregnant women with chronic arterial hypertension (CAH), 36 women with normal pregnancy who do not have signs of hypertensive disorders. Electrokinetic features of peripheral blood erythrocytes were studied using cellular microelectrophoresis, the average value of the amplitude of oscillations of mobile erythrocytes (μm) and the proportion of mobile cells (%) were analyzed.Results. At 22–24 weeks, the percentage of immobile erythrocytes in pregnant women with moderate PE increased by 2.8 times (p&lt;0.05), the amplitude of oscillations of mobile cells decreased by 21% (p&lt;0.05). In pregnant women with severe PE, the proportion of immobile erythrocytes increased by 3.2 times (p&lt;0.05), the amplitude decreased by 30% (p&lt;0.05). In pregnant women with CAH, a slight increase in the percentage of immobile cells (8.2 vs 6.8%) and a tendency to a decrease in the average amplitude (21.5 vs 23.2 μm) were noted. At 34–35 weeks in the group with moderate PE, the% of immobile erythrocytes exceeded the corresponding indicator in women with physiological pregnancy by 3.3 times (p&lt;0.05), the average amplitude decreased by 28% (p&lt;0.05), in pregnant women with severe PE, the% of immobile erythrocytes increased by 3.7 times (p&lt;0.05), the amplitude decreased by 36% (p&lt;0.05). In pregnant women with CAH, there was a tendency for a slight increase in the proportion of immobile erythrocytes.Conclusion. The functional and morphological usefulness of erythrocytes as active participants in the pathogenesis of preeclampsia can be objectively assessed using indicators of electrokinetic activity of cells, and erythrocytes can be considered as biomarkers of the disease and a promising tool for stratifying patients for early detection of high-risk pregnancies.

Impact of aortic and pulmonary artery wall histology on radicular dilatation during the Ross procedure

ObjectiveIn our study, we aim to explore the structural differences between the aortic root and the pulmonary artery to better understand the process of pulmonary autograft dilatation during the Ross procedure.Materials and methodsWe studied twenty human fetuses (aged 14–36 weeks of gestation) and four adults (one female and three males, aged 30–45 years, mean age = 37 ± 16 years). Samples of aortic root and pulmonary artery were obtained through dissection. Histological examinations, including hematoxylin–eosin, Masson’s trichrome, and orcein staining, as well as immunohistochemical technique with caldesmon staining, were performed. Microscopic counting was conducted to assess the number of elastic laminae and smooth muscle cells in each arterial wall. Statistical analyses were performed using R software. Means and standard deviations were used to present central tendencies and data dispersion for elastic laminae and smooth muscle.ResultsSignificant histological differences were observed between the aortic root and pulmonary artery in both adults and fetuses. In fetuses, no difference was found between the two vessels in terms of elastic laminae (p = 0.26) and smooth muscle cells (p = 0.69). However, in adults, significant differences were found for elastic laminae (p < 0.001) and smooth muscle cells (p < 0.001) between the aorta and pulmonary artery.ConclusionsThe microscopic vascular structure impacts the mechanical properties of the pulmonary autograft wall and explains its observed dilatation remote from the Ross procedure due to wall stresses related to systemic pressure.