Weeks Of Gestation Period Research Articles

Understanding perspectives on neural tube defect management: insights from Jordanian parents

Introduction Neural tube defects (NTDs) represent a spectrum of heterogeneous birth anomalies characterized by the incomplete closure of the neural tube. In Jordan, NTDs are estimated to occur in approximately one out of every 1000 live births. Timely identification of NTDs during the 18–22 weeks of gestation period offers parents various management options, including intrauterine NTD repair and termination of pregnancy (TOP). This study aims to assess and compare parental knowledge and perceptions of these management modalities between parents of affected children and those with healthy offspring. Materials and methods This retrospective case-control study was conducted at Jordan University Hospital (JUH) using telephone-administered questionnaires. Categorical variables were summarized using counts and percentages, while continuous variables were analyzed using mean and standard deviation. The association between exposure variables and outcomes was explored using binary logistic regression. Data analysis was performed using SPSS for Windows version 26 (SPSS Inc., Chicago, IL). Results The study sample comprised 143 participants, with 49.7% being parents of children with NTDs. The majority of NTD cases were associated with unplanned pregnancies, lack of folic acid supplementation, and postnatal diagnosis. Concerning parental knowledge of TOP in Jordan, 86% believed it to be legally permissible in certain situations. However, there was no statistically significant difference between cases and controls regarding attitudes toward TOP. While the majority of parents with NTD-affected children (88.7%) expressed a willingness to consider intrauterine surgery, this percentage decreased significantly (to 77.6%) after receiving detailed information about the procedure’s risks and benefits (p = .013). Conclusions This study represents the first case-control investigational study in Jordan focusing on parental perspectives regarding TOP versus intrauterine repair of myelomeningocele following a diagnosis of an NTD-affected fetus. Based on our findings, we urge the implementation of a national and international surveillance program for NTDs, assessing the disease burden, facilitating resource allocation toward prevention strategies, and promoting early diagnosis initiatives either by using newly suggested diagnostic biomarkers or early Antenatal ultrasonography.

Amalgamation of Toll-Like Receptor and Hypoxic Signaling in Etiology of Preeclampsia.

Inflammation and oxidative stress are involved in the pathogenesis of preeclampsia. Therefore, the aim of this study was to investigate the expression of Toll-like receptor (TLR) (TLR-4, HMGB1, NFκB, IκBα) and hypoxic (HIF-1α, HIF-1β, PHD, pVHL) pathway proteins in the placenta of preeclamptic pregnant women after 28 weeks of gestational period. A possible association between these 2 pathways was also explored. A total of 194 placental tissues of preeclamptic as well as healthy pregnant women were analyzed by immunohistochemistry. On the basis of gestational age, the samples were divided into 2 groups, I (28-36wk) and II (36wk onwards), with 55 and 139 samples in the respective groups. The expression of both TLR (TLR-4, HMGB1, NFκB, IκBα) and hypoxic (HIF-1α, HIF-1β, PHD, pVHL) pathway proteins were significantly modulated in the placental tissues of preeclampsia as compared with control. The 2 pathways were interlinked in preeclampsia. This study highlights the intercorrelation of both TLR and hypoxic signalling pathways that may be a causative factor for the pathophysiology of preeclampsia.

Assessment of the Particularities of Thrombophilia in the Management of Pregnant Women in the Western Part of Romania.

Background and objectives: Thrombophilia in pregnant women is a condition whose incidence is constantly increasing worldwide, and, under these conditions, the development of preventive procedures is becoming essential. In this study, we aimed to evaluate thrombophilia in pregnant women in the western part of Romania and to establish anthropometric characteristics, socioeconomic features, and genetic and risk factors. Material and Methods: 178 pregnant women were divided into three study groups, according to the type of thrombophilia, aiming to carry out the genetic profile and the acquired one. Anthropometric measures and biological tests were performed. Results: The mixed type of thrombophilia predominates. The particularities of pregnant women diagnosed with thrombophilia are higher age, living in an urban environment, with normal BMI, approximately 36 weeks of gestational period, and having at least one miscarriage. Regarding the most frequent thrombophilic genetic markers, we obtained the MTFHR gene mutation C677T and A1298C, followed by the PAI-1 4G/5G gene mutation. Smoking represents an aggravating factor in the evolution of this pathology, manifested through the increase of D-dimers and the decrease in antithrombin values, simultaneously with the increase in therapeutic need. Conclusions: The predominance of MTHFR and PAI-1 4G/5G gene polymorphism is a particularity of pregnant women with thrombophilia from the western part of Romania. Smoking is confirmed as an important risk factor in spontaneous abortion.

Heart Rate Variability and Cold Pressor Test before Onset of Pre-eclampsia in Pregnant Women-A Longitudinal Study

Introduction: A major obstetric complication, that leads to severe maternal and foetal morbidity is Pre-eclampsia (PE). Studies evaluating the autonomic nervous activity in pregnant women with PE shows conflicting results. Previous studies are inadequate for the identification of the most useful tools to detect and monitor autonomic dysfunction prior to PE. The cold pressor test is a simple and validated test, in which the afferent sensory pathways are stimulated by the cold stimulus, resulting in an increase in Blood Pressure (BP). Aim: To evaluate the response to cold pressor test and Heart Rate Variability (HRV) to detect increased vascular reactivity and sympathetic activity prior to the clinical manifestation of PE in pregnant women. Materials and Methods: A longitudinal study was conducted in in the Department of Physiology at Hamdard Institute of Medical Sciences, HAHC Hospital, Jamia Hamdard, New Delhi, India. The duration of the study was 11 months, from December 2018 to November 2019. Subjects were 50 pregnant women, between age 18-40 years and of 12-14 weeks of gestation. Cold pressor test and HRV were parameters measured for the assessment of the autonomic functions during 12 and 21 weeks of gestational period. The Statistical Package for Social Sciences (SPSS) version 26.0 was used for analysis of the quantitative data. Paired t-test was done for comparison of all values. Results: The mean age of the study participants was 29±2.7 years. There was no hyper-reaction to cold pressor test at 12 weeks of gestation, nor the subjects showed any signs of PE. At 14 weeks of gestation, 2 (4%) showed hyper-reaction to cold pressor test. At 21 weeks of gestation, 3 (6%) subjects showed hyper-reactions to cold pressor test and out of them, 2 developed PE. Root Mean Square Standard Deviation (RMSSD) and difference between adjacent Standard Deviation of N-N intervals (SDNN) of HRV analysis were significantly higher in the first trimester as compared to 21 weeks of pregnancy. Conclusion: Response to cold pressor test showed increased vascular reactivity, as a sign before the development of PE. HRV analysis could not detect any significant features of increased sympathetic activity prior to the clinical manifestation of PE in pregnant women.

Cesarean delivery rates based on time and indication using the Robson Ten-Group Classification System: Assessment at a Turkish tertiary center.

This study aimed to evaluate increasing cesarean delivery (CD) rates, their causes, and changes over the years in a Turkish tertiary center using the Robson Ten-Group Classification System (RTGCS). Data of deliveries involving birth weight of ≥500 g or ≥24 weeks of gestation period from 2013 to 2020 were retrospectively collected and classified from the hospital digital record system using obstetric concepts and parameters described in the RTGCS. The overall CD rate for all births (69051) from 2013 to 2020 was 55.5%. Groups 3, 5, and 1 were the most represented groups (29.1%, 23.9%, and 19.4%, respectively). The major contributors to the overall CD rate were Groups 5, 2, and 10 (23.8%, 9.9%, and 5.6%, respectively). Groups 2 and 4 (nullipara, multipara, single cephalic at term) had high CD rates associated with high rates of pre-labor CD (88.9% and 73.3%, respectively). The CD rate was 99.7% in Group 5, which showed recurrent CD, and 67.2% in Group 10. The overall CD rate was 60.8% in 2020 owing to the significant increase in the contributions by Groups 5, 8, and 10. The most common indication for CD was previous CD (46.1%), fetal distress (13.2%), and cephalopelvic disproportion (CPD) (8%). Groups 1, 2, 5, and 10 were the major contributors to the overall CD rate at this tertiary center. To reduce overall CD rates, policies that reduce primary CD and support vaginal delivery after cesarean section should be established.

MANAJEMEN ASUHAN KEBIDANAN ANTENATAL PATOLOGI DENGAN HIPEREMESIS GRAVIDARUM TUNGKAT II (LITERATURE REVIEW)

Introduction Hyperemesis gravidarum is a health issue often found during gestational period signified by a severe and excessive nausea and vomiting. Once a mother experiences an excessive nause and vomitting, she will probably lose her weight. In addition, a mother will also suffer from acetone and skin dryness. Nausea and vomiting in pregnancy usually begins in the 9th to 10th weeks of gestational period. It would mostly become worse in 11th to 13th weeks. In general, the issues would end in the 12th to 14th weeks. The data shows that rarely do pregnancy’ssymptoms persist to be more the 20th to 22nd week. The proportion has been only around 1-10%. For the cases of hyperemesis gravidarum, they were found on 0.3-2% of pregnancies in which patients should be well treated in a hospital. Method The methodological approach used in this research was literature review. The major purpose was to conduct research on the issue related to hyperemesis gravidarum. The research was conducted based on the 7-stages of Varney and SOAP documentation procedures. Result Based on the research data analysis from various different references, it could be noticed that the treatments that could be given to patients with hyperemesis gravidarum were in the forms of providing adequate parenteral fluids as well as administering protein electrolytes with 5% of glucose dissolved into 2 to 3 liters of physiologist saline. In addition, other important potions such as potassium depending on the conditon of patients. Initial fluid administration could also be given in the forms of 2L RL solvent for approximately 3-5 hours. The fluid should further be replaced with 5% of dextrose dissolved in 0.45% of saline. The RL dextrose ratio of 2:1 could be implemented with 40 drops per minute to be given to patients. Conclusion The findings of this research were the results of the analysis on 70 references. It could be concluded that with appropriate treatments and medication, patients with the case of hyperemesis gravidarum could be cured. The major examination that could be taken to confirm the status of patients is by checking the vital signs such as blood pressure, pulse, temperature and respiration

PREDICTIVE VALUE OF PLATELET INDICES IN DEVELOPMENT OF PREECLAMPSIA

Introduction: Preeclampsia (PE) is a multisystem hypertensive disorder that is a major contributor to maternal, neonatal morbidity and mortality. In modern obstetrics, identicaton of pregnant women with an increased PE risk is an objective of paramount importance. In preeclampsia, increased platelet indices may occur earlier than development of other recognized manifestations like hypertension and proteinuria. On the other hand, lowered platelet count and increased platelet indices in pregnant women during antenatal check may be considered as a risk factor for development of preeclampsia and eclampsia.This group of pregnant women may be considered for special attention to prevent the development of preeclampsia. So, the present study was conducted with an aim to assess the association between changes in platelet indices and development of pre-eclampsia. To estima Objectives: te the prevalence of preeclampsia among pregnant women and assess the changes occurring in platelet indices in pregnant women with duration of gestation. A Prospective Material And Methods: Observational study was carried out over a period of 6 months ie., from March to August 2022 in pregnant women with history of normal blood pressure before 24 weeks of gestational age. Institutional ethical committee clearance was obtained for the study. Data collected was entered into MS-Excel 2013 spreadsheet. The collected data was analysed using IBM statistical package for social sciences. Chi-square test and Unpaired t-test was used to nd the signicant difference between two groups. ROC analysis was done to nd out the cut-off values of platelet indices in diagnosing preeclampsia. The prevalence of preeclampsia in the pre Results: sent study was 6.5%. The mean age of the study population was 23.47 ± 2.68 Years. There was a statistical signicant association between platelet indices and preeclampsia (p<0.05) at various weeks of gestational period with high mean value in the preeclamptic women. At 24 – 28 Weeks of gestational age the cut-off > 9.5fL for MPV the sensitivity of detecting preeclampsia was 92.3% and specicity was 80.7%. At cut-off > 15.5% for PDW the sensitivity of detecting preeclampsia was 84.6% and specicity was 69.5%. At cut-off < 0.22% for PCT the sensitivity of detecting preeclampsia was 53.8% and specicity was 59.4%. Patients with preeclampsia are more likely to ha Conclusion: ve rapid and signicant decrease in platelet count and plateletcrit, increase in PDW and MPV in comparison to the normotensive counterparts. These signicant changes can be observed at an earlier gestational age than signicant rise in BP can be observed and changes are more signicant in patients who are destined to develop progressive preeclampsia. Thus estimation of platelet indices seems to be a reliable, rapid, easy and economical method for early detection of preeclampsia.

Anaesthetic Management of a Patient with Advanced Abdominal Pregnancy, Intrauterine Foetal Death and Celiac Disease

Abdominal pregnancy is a rare form of ectopic pregnancy where implantation of fertilised ovum occurs in the abdominal cavity. If diagnosed late maternal and foetal mortality is very high. The major cause of death in abdominal pregnancy is haemorrhage. The case report is about a 31-year-old gravida two with 36 weeks of gestation period with Intrauterine Foetal Death (IUFD) and celiac disease. Celiac disease is a chronic malabsorptive disease of the small intestine occurring due to hypersensitivity to gluten ingestion. Due to chronic malabsorption, the patient presented with calcium deficiency. She also had lesions of dermatitis herpetiformis over the whole body sparing only the face. It is a rare case of advanced abdominal pregnancy with the IUFD, with celiac disease. The patient was managed successfully under general anaesthesia with preparedness for difficult airway management, securing wide bore peripheral cannulas, central venous cannulation and invasive blood pressure monitoring. Massive haemorrhage intraoperatively was managed with crystalloids, colloids, blood products and tranexamic acid. The intraoperative period was uneventful. The patient was extubated at the end of the surgery, and followed-up in a high dependency unit.

Effectiveness of ginger tea on nausea, vomiting and retching among antenatal mothers residing in rural community of East Sikkim

Background: Nausea, vomiting and retching is a common medical condition in pregnancy affecting women worldwide which occur during the first trimester of pregnancy. Ginger, Zingiber officinale Roscoe, is recognized as a popular non-pharmacological treatment for nausea and vomiting of pregnancy (NVP). The present study examined the effectiveness of ginger tea on nausea, vomiting and retching among antenatal mothers residing in rural community of East Sikkim. Methods: This study was conducted in rural community of East Sikkim among 60 antenatal mothers having nausea, with or without vomiting or retching within 8th to 12th weeks of gestational period. True experimental pre-test post-test design was adopted, and the participants were selected using simple random sampling comprising 30 antenatal mothers each in experimental and control group. Demographic and obstetrical data were used to collect personal information and Rhodes Index of nausea, vomiting and retching scale was used to assess the level of symptoms. Experimental group was demonstrated to drink 500 mg of ginger tea twice a day and the control group did not receive any intervention. The post-test was conducted for both the groups after 4 days to assess the level of nausea, vomiting and retching.Result: The findings of the study showed that in the pre-test, majority 53.4% in experimental group had moderate symptoms, 33.3% had mild symptoms and 13.3% had severe symptoms whereas in control group majority 50% had mild symptoms, 36.6% had moderate symptoms, 6.7% had severe symptoms and 6.7% had no symptoms. After the administration of ginger tea to the experimental group, majority 63.3% were having mild symptoms, 20% had no symptoms and 16.7% had moderate symptoms whereas in control group majority 46.7% had moderate symptoms, 43.3% had mild symptoms, 6.7% had severe symptoms and remaining 3.3% had no symptoms in the post-test. There was a significant difference between the post-test level of nausea, vomiting and retching among antenatal mothers in experimental and control group (t= 3.762, p

Smart Incubator for Preterm Neonatal Using Kangaroo Mother Care

Kangaroo mother care is an apparatus that provides closed and controlled environmental for the preterm babies. A Preterm birth is commonly defined as any birth base 37 weeks completed weeks of gestation period. This paper deals with cost effective design of incubator that monitors parameters like pulse rate, temperature, humidity, child security and the readings will be continuously displayed In the LED screen and also monitoring the details to the corresponding doctor, nurse and parents by using GSM. The power failure problem is also eliminated by using solar panel. We also intimate the parents about feeding time, dressing time, ear check, eye check. But many of the existing system does not mentioned about above problem and have adopted only with humidity and temperature and also by manual control. So the main objective of this research is to overcome drawbacks and provide eco friendly service to all common people.

Evaluation of epicardial fat tissue thickness and aortic stiffness in patients with gestational diabetes mellitus

Objective We aimed to assess the relationship between gestational diabetes mellitus and coronary artery disease by measuring epicardial fat tissue thickness and aortic stiffness in pregnant women diagnosed with gestational diabetes mellitus. Methods 28 pregnant women diagnosed with gestational diabetes mellitus and 25 pregnant women without gestational diabetes mellitus were included in the research. Body mass index, laboratory values, blood pressure measurements and obstetric history findings of the study population were recorded. All participants of the study population were evaluated with transthoracic echocardiography between 24 and 28 weeks of gestational period. The measurement of epicardial fat tissue thickness was taken and aortic stiffness index was also calculated. Results The age, gravidity, parity and obstetric history of the two groups were similar. Epicardial fat tissue thickness was found significantly higher in gestational diabetes mellitus group than control group (0.416 cm and 0.336 cm, respectively; p<0.001). However, no significant difference was found in aortic stiffness measurements of the two groups (p=0.079). Conclusion According to the results of our study, epicardial fat tissue thickness was found to be statistically significantly higher in pregnant women with gestational diabetes mellitus compared to the control group. The fact that no difference was detected in other cardiovascular parameters suggests that measurement of epicardial fat tissue thickness in gestational period may be a beneficial adjunctive tool in early detection of gestational diabetes mellitus.

Morbidities among Eclamptic Women of Lower Socioeconomic Community in a Selected Area of Bangladesh

Eclampsia is a serious obstetric emergency with new onset of grand mal seizure during pregnancy or postpartum women having signs symptoms of pre-eclampsia. The sequel of severe pre-eclampsia and eclampsia includes organ failure, loss of consciousness and finally loss of lives of both mother and fetus. This study aimed to evaluate morbidity of eclamptic women at lower socioeconomic community in a selected area of Bangladesh. This descriptive cross sectional study was conducted at Sheikh Hasina Medical College Hospital (SHMC.T) of Tangail district during the period of January to December 2019. During this period 7918 admitted patients from different sub-districts (Upazilas) of this district in obstetrics ward of SHMC.T were observed and 205 diagnosed eclamptic patients were selected as respondents for this study to detect morbidities. The prevalence rate of eclampsia among the obstetrics patients was 2.6%, where 81% of them were found during antepartum/ intrapartum and rest of them during postpartum period. The mean age of the eclamptic cases was 23.78±4.94 years and more than half of them were in age group 21-30 years. Most of the cases (84%) were from primary level or able to sign or illiterate and rest was secondary level of education. Mean age of marriage and first pregnancy were 17.81±SD2.19 and 19.39±SD2.5 years respectively, where majority of patients were primigravida. Among the multi gravida about one fourth had 2-4 children, 16.09% had 5-6 children, where 1.46% had ≥7 children and more than three-fourth of cases had 34-37 weeks of gestational period. Among cases 95.1% had hypertension, 94.6% edema, 83.9% convulsion, 39.5% headache with blurring of vision, 22.4% severe abdominal pain, 79.0% proteinuria and 9.76% unconsciousness. Incidence of maternal morbidity during study period was 14.36%, among them 9.4% pulmonary edema, 1.5% renal failure, 0.98% HELLP (Hemolysis, Elevated liver enzyme level and Low Platelet level) syndrome, 0.98% coma and 1.5% placental abruption. Caesarean delivery was 79.2% and 11.70% was detected as postpartum haemorrhage. Among fetal morbidity 19.5% intrauterine growth restriction, 48.8% low birth weight, 39.6% birth asphyxia, and 58.5% preterm baby. During follow up only persistent hypertension was found as morbidity of eclampsia, 19.5%, 9.8% and 7.32% at 2nd week, at 6th week and at 6th months respectively. Regarding health care services 93.7% had available facility and 41.5%, 47.8% and 10.7% lived in >10 kilometers (kms), 5-10 kms and less than 5 km distance respectively. Regarding MCH services; only 5.9% patient received antenatal care (ANC) ≥4 times; more than half of them incompletely received ANC <4 times and 42.0% never visited for ANC. This study reveals various matters of maternal and fetal morbidities commencing from eclamptic condition in lower socioeconomic community. Here important factors for morbidities in eclamptic women like lack of ANC/ PNC, availabilities of MCHC services and others. Pulmonary edema, renal failure, HELLP syndrome, coma and placental abruption are important maternal morbidities. Prematurity, low birth weight, intrauterine growth restriction and birth asphyxia are foremost fetal morbidities. Availabilities of MCH services, complete visit for ANC/ PNC and early diagnosis and management of eclamptic women positively reduce morbidity and will prevent eclampsia.
 Bangladesh Med J. 2020 Jan; 49 (1): 7-13

Association of Apgar Score With Meconium Staining of Amniotic Fluid in Labor.

ObjectiveThis study aimed to determine the association of Apgar score with meconium staining of amniotic fluid in labor.MethodologyA retrospective observational study was carried out through the non-probability convenient sampling technique at the Department of Obstetrics and Gynecology for a duration of six months. Only those women were selected who had more than 24 weeks of gestation period. The women were excluded on the basis of risk factors for fetal distress and breech in late labor.ResultsA total of 216 pregnant women were selected from the labor room in this study. The mean age of the women was 26.57±4.28 years. The gestational age of the women was 36.09±4.11 weeks. Moreover, the mean parity of pregnant women was 1.68±2.53. It has been observed that the women who had meconium staining, the neonates of 144(77.4%) women showed the Apgar score of less than six at one minute. However, for the women without meconium staining, the neonates of only 15(50%) women showed the Apgar score of less than six at the one-minute interval with a significant association (p=0.02). With respect to age groups, a significant association of meconium staining with Apgar score was noted in the 21-30 years age group, whereas, no significant association was seen in other age groups. Similarly, a significant association of meconium staining and Apgar score was noted in primiparous women, whereas, no significant association was noted in multiparous women. No significant association of Apgar score and meconium staining was seen with respect to the mode of delivery.ConclusionThe study has found a relation between the Apgar score and meconium staining of amniotic fluid and reported that the Apgar score of less than six at one minute was significantly associated with meconium staining of amniotic fluid.

Effectiveness of P6 Acupressure on Reduction of Nausea, Vomiting & Retching among Antenatal Women attending Antenatal Clinic at District Hospitals of Sikkim

Background: Nausea vomiting and retching are troublesome symptoms, which occur during the first trimester of pregnancy. Considering the adverse effects caused by most drugs used during pregnancy to control these symptoms, alternative treatments such as acupressure have been suggested in various studies. The present study examined the effectiveness of acupressure wristband at P6 point on nausea, vomiting and retching during pregnancy among Sikkimese women. Methods: A non-blinded randomized clinical trial conducted in outpatient department of District Hospitals of Sikkim in 2017 among 80 antenatal women having mild nausea, with or without vomiting or retching within 8th to 12th weeks of gestational period. After consecutive sampling, participants were randomly assigned to experimental and control groups comprising 40 women in each group. The experimental group applied the acupressure wrist band and self-assessed symptoms were recorded twice a day as per Rhodes Index Scale. The control group did not receive any intervention but was asked to record the self-assessed symptoms as per Rhodes Index Scale.Data analysis was conducted using SPSS version 15 applying descriptive, and inferential statistical methods. Result: A significant difference was observed on 5th, 6th and 7th day after performing the intervention in experimental group as compared to control group. Further, the mean duration, discomfort and frequency of nausea, vomiting and retching scores in experimental group showed significant decrease as compared to the control group (p <0.001). Conclusion: Acupressure on P6 point has proved to be effective to reduce the duration, discomfort and frequency of nausea, vomiting and retching. How to cite this article:Lepcha K, Devi B, Das M. Effectiveness of P6 Acupressure on Reduction of Nausea, Vomiting & Retching among Antenatal Women attending Antenatal Clinic at District Hospitals of Sikkim. Int J Nurs Midwif Res 2020; 7(1): 24-30. DOI: https://doi.org/10.24321/2455.9318.202005

Prenatal diagnosis of anencephaly and acrania in pregnant females - Report series of eight cases

Acrania and anencephaly are characterized by the partial or complete absence of skull and brain tissue. Due to this, the neural tissue is exposed and it leads to non-function of few parts of the hemispheres. A total of eight cases of acrania and anencephaly were included in the report. Five cases were acrania and three cases were anencephaly. Both cases were diagnosed between 15 and 24 weeks of gestation period. In the present report, all the pregnant women carry fetuses with neural tube defects. Out of five acrania cases, there is a partial or complete absence of cranium in all the cases, and in one case, there is a twin intrauterine gestational sac that was noted. However, out of twin sac, the first one is having a good heart rate (155 bpm) and the second fetus is having no cardiac activity, i.e., early fetal demise. On the other hand, out of three anencephaly cases, two anencephaly cases were diagnosed with partial absence of the fetal brain and the complete absence of the cranium, and in one case, there is a partial absence of cerebral parenchymal tissue above the orbit with the absence of cranial vault. By the use of ultrasonography, we can diagnose the anencephaly and acrania at a very early stage without any side effects. The cause of anencephaly and acrania is dependent on the number of factors one of which is a folic acid deficiency. Sentence is reviewed and corrected): It is always better to consume the folic acid supplements that are advised by the physician during the planning of pregnancy to avoid the congenital anomalies of the fetus like anencephaly and acrania. The ultimate focus of the study is to evaluate the morphology of the fetus in case of anencephaly and acrania which could lead to the early detection of abnormalities and also to create awareness among people to take folic acid supplements to eschew such abnormalities.

Clinical characteristics of hepatic flare and efficacy of antiviral therapy in pregnant women with chronic hepatitis B virus infection

Objective: To analyze the clinical characteristics of hepatic flare and evaluate efficacy of antiviral treatment in pregnant women with chronic HBV infection. Methods: A single-center, open-label, prospective study was conducted, and pregnant women with chronic HBV infection were enrolled. Liver function, HBV serum markers and HBV DNA of pregnant women with chronic HBV infection were reviewed during every 4 to 12 weeks of gestation period. The proportion and clinical characteristics of hepatitis flare during pregnancy were observed. Logistic regression analysis was used to predict hepatic flare in pregnant women with chronic HBV infection. Antiviral therapy with telbivudine (LdT) or tenofovir dipivoxil (TDF) was used to treat hepatic flare during pregnancy. Sequential entecavir (ETV) or TDF was applied after the delivery. Treatment course and drug withdrawal in pregnant women with hepatic flare was the same as those of the general patients with chronic hepatitis B. Liver function, HBV serum markers and HBV DNA were measured in pregnant women with hepatic flare at different time points (4, 12, 24 and 52 weeks). A t-test was used to compare the hepatic flare in pregnant women with and without hepatitis group. HBsAg and HBeAg were used to quantify the receiver operating characteristic (ROC) curve of pregnant women with hepatic flare during pregnancy. Area under the ROC curve was used to calculate the optimal cut-off value corresponding to the maximum sensitivity and specificity of the ROC curve. Results: Of the 220 pregnant women with chronic HBV infection, 55 (25%) had hepatitis flare during pregnancy and received antiviral treatment. Among the 55 women with hepatic flare during gestation, 47 (85.46%) had hepatic flare in the mid-second trimester (12-24 weeks); average peak value of alanine aminotransferase (ALT) was 220.62 U/L, and the average peak value of ALT in 32 cases (58.18%) of pregnant women with hepatic flare was between 2-5 × ULN. HBsAg and HBeAg quantification were significantly lower in pregnant women with hepatic flare during pregnancy than with non-hepatitis (t = -3.745, P < 0.001; t = -2.186, P = 0.030). Multivariate logistic regression analysis showed that pregnant women with HBeAg < 3.065 log10 s/co were 7.576 times more likely to have hepatic flare during pregnancy (95% confidence interval: 3.779-15.190). ALT normalization, undetectable HBV DNA levels, HBeAg loss and HBeAg seroconversion in 55 pregnant women with hepatic flare at 52-week treatment was 100% (55/55), 74.55% (41/55), 47.27% (26/55) and 41.82% (23/55), respectively. HBsAg quantification at 52 weeks was significantly lower than baseline HBsAg quantification (3.32 + 0.37) log(10) IU/ml and (3.95 + 0.40) log(10) IU/ml; t = 8.465, P < 0.001). Conclusion: Hepatic flare often occurs in the second trimester of pregnancy in pregnant women with chronic HBV infection and baseline HBeAg quantification is an independent predictor of hepatic flare. HBeAg seroconversion rate increased at 52 weeks after antiviral therapy.

Central corneal thickness and corneal diameter in preterm and term newborns and preterm neonates at term.

Purpose:To record central corneal thickness and corneal diameter in preterm and term newborns within first week of their birth and in preterm neonates at term age.Methods:Babies born at ≤34 weeks of gestation period (n = 100), term babies who have a gestation period of >37 weeks (n = 100) and preterm neonates at term age (38-42 weeks) who were born at ≤34 weeks (n = 100) were included in this hospital based observational descriptive study. Corneal diameter was taken by Castroviejo Calipers. Central corneal thickness was measured using portable ultrasonic pachymeter (Pachette 3). Refractive status of the eyes was measured using streak Wellch Allyn retinoscope under cyclopentolate cycloplegia.Results:Measure of central corneal thickness and corneal diameter in preterm newborns was found to be 633.5 ± 2.8 μm and 8.1 ± 0.6 mm, in full term newborns it was 555.1 ± 2.7 μm and 9.5 ± 0.6 mm, and in preterm neonates at term age, it was 563.5 ± 2.5 μm and 9.6 ± 0.5 mm, respectively. Mean central corneal thickness was found to be more in preterm newborns 633.5 um then term newborns 555.1 um and the difference was statistically significant (P =0.001). Mean corneal diameter was found to be maximum (9.6 mm) in preterm neonates at term age.Conclusion:Preterm babies have thick corneas and small corneal diameters. This study is useful with respect to the analysis of glaucoma in children and using preterm corneas as donor corneas in penetrating keratoplasty.

Association between single nucleotide polymorphism of immunoregulatory genes and preterm premature rupture of membranes in preterm labour

Aim. Investigation of the association between SNP genes of IL4 (rs2243250), IL10 (rs1800896 and rs1800872) and RLN2 (rs4742076 and rs3758239) and preterm premature rupture of membranes in 26–34 weeks of gestation in Zaporizhzhia population. Materials and methods. W e have investigated markers of cytokines genes in 50 women with PPROM in 26–34 weeks of gestation period and 50 pregnant women with physiological pregnancy and term labour without complications. The genotyping using TaqMan tests was done on amplifier CFX96™ Real-Time PCR Detection Systems (Bio-Rad Laboratories, Inc., USA. The combined effect of the studied locus of the analyzed genes on the appearance of PPROM, PTL in the population was initiated using the Multifactory Dimensionality Reduction (MDR) method (software MDR ver. 3.0.2). Results. The distribution of the rs2243250 gene polymorphism alleles of the IL4 gene of the main study group – TT homozygotes were determined in 4 % cases, CT heterozygotes were found in 22 %, CC homozygotes – in 74 % cases. We have got statistically significant differences of rs4742076 polymorphisms (TT, CT, and CC) of the RLN2 gene in the study groups. We also detected statistically significant differences in all the alleles of rs3758239 polymorphism (AA, GG and AG) of the gene RLN2 – χ 2 = 23.86, OR( AA ) = 12.57; 95 % CI: 3.68–42.98; OR( GG )= 0.08; 95 % CI: 0.02–0.27; and OR( AG )= 0.11; 95 % CI: 0.03–0.42, respectively, P < 0.05, indicating the reliability of the received prognostic markers. The nature of interlocal interaction between the genes is at the level of “independent effects” of influence (IL4-IL10 rs1800896 = -23.08 %, IL10 rs1800896 – IL10 rs1800872 = -19.94 %, IL10 rs1800872-IL-4 = -19.34 %). The percentage of entropy of the investigated polymorphism of each gene for the case-control status was 14.15 % for the IL4 gene, 23.08 % for the IL10 rs1800896 gene and 9.34 % for the IL10 rs1800872 gene. Conclusions. Combination of IL4 rs2243250, IL10 rs1800896 and rs1800872 supports the role for functional polymorphisms in immunoregulatory genes in the development of PPROM and PTL. Reliable clinical association of rs4742076 and rs3758239 gene RLN2 was established with the PPROM in 26–34 weeks’ gestation in Zaporizhzhia population.

The Use of Pulse Wave Velocity in Predicting Pre-Eclampsia in High-Risk Women

In this study, we evaluated the diagnostic utility of pulls wave velocity (PWV) alone or in combination with other diagnostic markers in predicting pre-eclampsia (PE) on high-risk women. Pregnant women at high risk for PE were recruited between 32 and 36 weeks of gestation period. This study is the first in Romanian and shows that PWV may be a potentially promising predictor of early-onset PE in women at high risk for PE. All these patients were treated and were instructed according to the ESC/ESH guidelines regarding hypertensive patients. Statistical analysis was performed using the Chi-square, a Mann-Whitney test, Pearson correlation, and linear regression tests.After we ran several test the main conclusions are that there is a positive correlation between the para-clinics data (creatinine, Esbach proteinuria) and the pulls wave velocity for aorta (PWVao). The risk for preeclampsia is increasing if the body mass index (BMI) of the patients is higher than the average value (BMI]26) or if the patient is a smoker.

Labour induction with gestational hypertension: A great obstetric challenge.

Objective:To observe the fetomaternal morbidity and mortality with induction of labour in pregnant women with gestational hypertension.Methods:The subjected study population included was 138 pregnant women with gestational hypertension. These pregnant women were between 34-40 weeks of gestational period in whom labour was induced, while the pregnant women who had labour induction for other reasons were excluded. These women were registered on the predesigned proforma. The data was collected and analyzed on SPSS version 21.Result:Out of the 138 cases, mean age of the women was 25.93±5.037, prim gravid women were 78(56.5%), gestational period in majority of these women 71(51.4%) varied between 35-38 weeks. The common presenting symptoms were oedema 119(86.23%), headache 90(65.21%). Labour induction in majority of the cases 81(58.7%) was carried with prosten pessary. The Caesarean section was needed in 39(28.3%) women in emergency due to maternal and fetal reasons or due to failed induction. Maternal complications were uncontrolled hypertension 23(16.7%), intensive care unit admission 21(15.2%), fits 15(10.9%), post partum haemorrhage 13(9.4%). Fetal complications were birth asphyxia 49(35.5%), neonatal intensive care unit admission 17(12.3%), neonatal death 14(10.1%).Conclusion:The emergency Caesarean section rate was quite high with induction of labour in pregnant women with gestational diabetes. The maternal morbidity as well as fetal morbidity and mortality rate was also high.