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Sharma KA, Singh N, Hillman S, Mathur P, Yadav K, Garg A, Dadhwal V, Bhatla N. Seroprevalence of SARS-CoV-2 antibodies among first-trimester pregnant women during the second wave of the pandemic in India. Int J Gynaecol Obstet 2022; 160:74-78. [PMID: 35324007 PMCID: PMC9087646 DOI: 10.1002/ijgo.14189] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/18/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Data on the immune response to SARS-CoV-2 during pregnancy are lacking and the potential role and effect of SARS-CoV-2 vaccination in pregnancy is yet to be completely investigated. METHOD This is a cross-sectional observational study wherein pregnant women were tested for SARS-CoV-2 immunoglobulin M and immunoglobulin G levels, irrespective of their infective status or presence or symptomatology. RESULT Of the 220 pregnant women tested, 160 (72.7%) were SARS-CoV-2 IgG positive, 37 (16.8%) were SARS-CoV-2 IgM positive and 27 (16.9%) were both IgG and IgM positive. The average antibody titer found was 10.49 BAU/ml (±14.0) and 0.6 (±0.55) for anti-SARS-CoV-2 IgG and IgM non neutralizing antibodies respectively. ROC analysis for SARS-CoV-2 IgG positivity showed a cut-off value of 1.19 with a sensitivity of 99.3% (0.99 AUC, 95% CI) and specificity of 98.3% (0.99 AUC, 95% CI), respectively. Similarly, ROC analysis for SARS-CoV-2 IgM positivity showed a cut-off value of 1 with a sensitivity of 97.3% (0.99 AUC, 95% CI) and specificity of 98.9% (0.99 AUC, 95% CI), respectively. CONCLUSION First trimester sero-molecular screening suggests a high prevalence of COVID antibodies in the study population of pregnant women in the first trimester, without the patients being symptomatic.
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Affiliation(s)
- Kandala Aparna Sharma
- Department of Obstetrics and GynecologyAll India Institute of Medical SciencesDelhiIndia
| | - Nilanchali Singh
- Department of Obstetrics and GynecologyAll India Institute of Medical SciencesDelhiIndia
| | - Sara Hillman
- Department of Obstetrics and GynecologyUniversity College of LondonLondonUK
| | - Purva Mathur
- Department of Microbiology, Trauma CenterAll India Institute of Medical SciencesDelhiIndia
| | - Kapil Yadav
- Department of Community MedicineAll India Institute of Medical SciencesDelhiIndia
| | - Anapti Garg
- Department of Obstetrics and GynecologyAll India Institute of Medical SciencesDelhiIndia
| | - Vatsla Dadhwal
- Department of Obstetrics and GynecologyAll India Institute of Medical SciencesDelhiIndia
| | - Neerja Bhatla
- Department of Obstetrics and GynecologyAll India Institute of Medical SciencesDelhiIndia
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102
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Li X, Xuan Y, Wang J, Wang L, Papageorghiou AT, Wu Q. Crown-Rump Length Discordance, Increased Nuchal Translucency, and Detection of Fetal Structural Anomalies in Twin Pregnancies in the First Trimester: 5 Years of Experience in a Tertiary Hospital in China. J Ultrasound Med 2022; 41:971-982. [PMID: 34289155 DOI: 10.1002/jum.15784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/21/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the efficacy of the first-trimester ultrasound scan in the detection of fetal structural anomalies in twin pregnancies. To examine the association between increased nuchal translucency (NT) thickness, crown-rump length (CRL) or NT discordance, and detection of structural anomalies in a large twin series in China. METHODS We performed retrospective analysis of twin pregnancies who underwent 11-13+6 -week and second-trimester anomaly scan and booked at Beijing Obstetrics and Gynecology Hospital between January 2012 and December 2016. Measurement of fetal CRL/NT and assessment of fetal anatomic structures were based on standard (not detailed) protocols. Conjoined twins and twin-reversed arterial perfusion sequence (TRAPS) were excluded from structural anomalies. The diagnostic performance of first-trimester ultrasound in detection of fetal structural anomalies in twins was determined and compared with that of second trimester. The accuracy of independent variates associated with structural anomaly detection was calculated. RESULTS A total of 1442 women with twin pregnancies were included. In 40 women and 45 fetuses, structural anomalies were found. Fetal structural anomalies verified at delivery were detected in 42.5% (17/40) of affected pregnancies in the first trimester and 92.5% (37/40) of affected pregnancies when added second trimester (P = .13). The survival rate of pregnancies detected in second trimester was higher than that of pregnancies detected in first trimester (11.8% vs 65.2%). The mean value of intertwin CRL/NT discordance in cases with fetal structural anomalies was larger in monochorionic twins than dichorionic twins, but monochorionicity was not associated with structural anomalies. CRL discordance ≥10% (OR 3.1, 95%CI 1.5-6.3) and NT ≥95th centile (OR 20.0, 95%CI 9.0-44.2) were associated with fetal structural anomalies. In both dichorionic (DC) and monochorionic (MC) twins, the percentages of CRL discordance ≥10% was larger in twins with structural anomalies than those without structural anomalies (37.5% vs 13.4% in DC twins and 50.0% vs 12.5% in MC twins), and this was also true for NT ≥95th centile (31.3% vs 1.7% in DC twins and 37.5% vs 2.2% in MC twins). In the setting of CRL discordance ≥10%, 40.0% (16/40) of twins with structural anomalies were found, in which the predominant fetal structural anomalies were cardiovascular defects, abdominal wall defects, and central nervous system defects. The AUC for detecting structural anomalies by CRL discordance ≥10% was 0.63. In the setting of NT ≥95th centile, 32.5% (13/40) of twins with structural anomalies were found, in which the predominant fetal structural anomalies were cardiovascular defects, cystic hygroma, and abdominal wall defects. The AUC for detecting structural anomalies by NT ≥95th centile was 0.65. CONCLUSIONS The detection rate of twins with fetal structural anomalies was 42.5% per pregnancy in the first trimester. CRL discordance ≥10% and NT ≥95th centile may indicate higher risk of fetal structural anomalies in twins, but their efficacy was limited.
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Affiliation(s)
- Xiaofei Li
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yinghua Xuan
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jingjing Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Li Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, China
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103
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Karmegaraj B, Udhayakumar V, Selvan G. First Trimester Prenatal Diagnosis of a Conotruncal Anomaly Using Spatiotemporal Image Correlation Imaging Confirmed by Conventional Autopsy. Fetal Pediatr Pathol 2022; 41:346-350. [PMID: 32815432 DOI: 10.1080/15513815.2020.1806419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BackgroundFetal echocardiography continues to be the first line investigation for detecting congenital heart diseases (CHD). As accurate and complete diagnosis of complex heart disease is often difficult in the first trimester due to small size of the fetal heart, confirmation/expanded description by fetopsy provides the best information for accurate counseling for future pregnancies. Although non invasive fetal autopsy alternatives have been investigated with favorable results, conventional autopsy remains the gold standard procedure used to confirm the fetal abnormalities. Case report: We describe a conotruncal anomaly diagnosed at 12 weeks gestation using spatiotemporal image. The fetopsy confirmed the diagnosis of Type I Truncus arteriosus. Conclusion: Four-dimensional STIC imaging provides incremental benefits in evaluation of fetal cardiac anomalies, and confirmation by autopsy findings allows further refinement of the diagnosis.
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Affiliation(s)
- Balaganesh Karmegaraj
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Vani Udhayakumar
- Department of Fetal medicine, Annai Velankanni Multispeciality Hospital, Tirunelveli, Tamil Nadu, India
| | - Gigi Selvan
- Department of Fetal medicine, Annai Velankanni Multispeciality Hospital, Tirunelveli, Tamil Nadu, India
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Turan S, Asoglu MR, Ozdemir H, Seger L, Turan OM. Accuracy of the Standardized Early Fetal Heart Assessment in Excluding Major Congenital Heart Defects in High-Risk Population: A Single-Center Experience. J Ultrasound Med 2022; 41:961-969. [PMID: 34288033 DOI: 10.1002/jum.15782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/27/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the ability of standardized early fetal heart assessment (EFHA) that includes the 4-chamber view, outflow tract relationship (OTR), and transverse arches views (TAV) of the great arteries in excluding major congenital heart defects (CHDs) in high-risk populations. METHODS This retrospective study included high-risk pregnancies for CHDs undergoing EFHA at 11-14 weeks of gestation. Risk factors for CHDs were diabetes mellitus, a family history of CHDs, a history of a CHD use of teratogenic medications, seizure disorder, assisted reproductive treatment-conceived pregnancy, presence of at least one of the ultrasound markers: enlarged nuchal translucency (>95th percentile), tricuspid regurgitation, and reversed a-wave in the ductus venosus, presence of an extracardiac or a suspected cardiac anomaly, a high-risk first trimester combined screen result, and multiple pregnancies. EFHA consisted of visualization of 4ChV, OTR, and TAV, with and without power Doppler ultrasound. The primary outcome was the negative predictive value of EFHA in excluding major CHDs. RESULTS EFHA was performed on 1055 fetuses. Of these, 1024 were used for the final analysis. Of these, 94.9% (n = 923) were singleton. The most common indication for EFHA was maternal DM (n = 231, 22.6%). The sensitivity, specificity, false positive, false negative, and accuracy of EFHA were 93.2%, 99.9%, 1.4%, 0.4%, and 99.5% (P < .0001), respectively, in entire included cases. The performance of EFHA was 88%, 99.9%, 1.4%, 0.4%, and 99.5% (P < .0001) respectively when the terminated cases were excluded. CONCLUSION Early fetal heart assessment is feasible for screening for major CHDs in high-risk populations. This approach may be expanded to the general obstetric population.
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Affiliation(s)
- Sifa Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mehmet Resit Asoglu
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Halis Ozdemir
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lindsey Seger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ozhan Mehmet Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
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105
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Hata T, Koyanagi A, Kawahara T, Konishi M, Takayoshi R, Miyagi Y, Miyake T. HDlive Flow Silhouette with spatiotemporal image correlation for assessment of fetal cardiac structures at 12 to 14 + 6 weeks of gestation. J Perinat Med 2022; 50:313-318. [PMID: 34496162 DOI: 10.1515/jpm-2021-0252] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess fetal cardiac structures using HDlive Flow Silhouette with spatiotemporal image correlation (STIC) at 12 to 14 + 6 weeks of gestation, and verify the feasibility of obtaining five cardiac views in the late first and early second trimesters of pregnancy. The fetal cardiac shape and the aspect of the descending aorta were also evaluated. METHODS Eighty normal fetuses at 12 to 14 + 6 weeks of gestation were studied using trans-abdominal HDlive Flow Silhouette with STIC to assess the feasibility of five fetal cardiac views (frontal, spatial three-vessel, panoramic, posterior, and right lateral views). Target structures in each cardiac view were evaluated. 'Good' was assigned when all structures were noted, 'Fair' when only one structure was missed, and 'Poor' when two and more structures could not be detected. Frequencies of an elongated heart and those of a tortuous descending aorta were counted. RESULTS Forty-nine fetuses were effectively included in the analysis. Success rates of 'Good' and 'Fair' were significantly higher with spatial three-vessel (p<0.01) and panoramic views (p<0.05). Frequencies of "Elongated heart", "Elongated left ventricle", and "Spherical heart" were 12.2, 6.2, and 81.6%, respectively. Frequencies of "Tortuous descending aorta" and "Straight descending aorta" were 12.2 and 87.8%, respectively. CONCLUSIONS The feasibility of obtaining fetal five cardiac views using HDlive Flow Silhouette with STIC is good, and this technique provides useful information for evaluating fetal cardiac structures in the late first and early second trimesters of pregnancy.
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Affiliation(s)
- Toshiyuki Hata
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan.,Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Miki, Kagawa, Japan
| | - Aya Koyanagi
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
| | - Tomomi Kawahara
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
| | - Miyu Konishi
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
| | - Riko Takayoshi
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan.,Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Miki, Kagawa, Japan
| | - Yasunari Miyagi
- Department of Gynecology, Miyake Ofuku Clinic, Okayama, Japan
| | - Takahito Miyake
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan.,Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Miki, Kagawa, Japan
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Mendoza M, Bonacina E, Serrano B, Ricart M, Martin L, Lopez-Quesada E, Vives A, Maroto A, Garcia-Manau P, De Antonio C, Tusquets C, Moreano G, Armengol-Alsina M, Carreras E. Implementation of routine first-trimester combined screening for preeclampsia based on the Gaussian algorithm: A clinical effectiveness study. Int J Gynaecol Obstet 2022; 159:803-809. [PMID: 35332556 DOI: 10.1002/ijgo.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the clinical effectiveness of the routine first-trimester screening for preeclampsia (PE) after being implemented in six Catalan maternities. METHODS Participants in the reference group were recruited prospectively between October 2015 and September 2017. Participants in the study group were recruited retrospectively between November 2018 and May 2019, after implementing the screening program. PE risk was assessed between 11 + 0 and 13 + 6 weeks of gestation using the Gaussian algorithm combining maternal characteristics, mean arterial blood pressure, uterine artery pulsatility index, and maternal serum pregnancy-associated plasma protein-A. Women with a risk ≥1/137 were prescribed daily salicylic acid (150 mg) until 36 weeks of gestation. RESULTS Preterm PE occurred in 30 of 2641 participants (1.14%) in the reference group, as compared with 18 of 2848 participants (0.63%) in the study group (OR: 0.55; 95% CI, 0.31-0.99; P = 0.045). In the reference group, 37 participants (1.40%) were admitted to ICU, as compared with 23 participants (0.81%) in the study group (OR: 0.57; 95% CI, 0.34-0.96; P = 0.035). CONCLUSION The routine first-trimester PE screening can be implemented in a public healthcare setting, leading to a significant reduction in the incidence of preterm PE and of maternal ICU admission.
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Affiliation(s)
- Manel Mendoza
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Erika Bonacina
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Serrano
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Ricart
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Lourdes Martin
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari de Tarragona Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Eva Lopez-Quesada
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Angels Vives
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Consorci Sanitari de Terrassa, Universitat Internacional de Catalunya, Terrassa, Spain
| | - Anna Maroto
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari de Girona Doctor Josep Trueta, Universitat de Girona, Girona, Spain
| | - Pablo Garcia-Manau
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clementina De Antonio
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Tusquets
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriela Moreano
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Mireia Armengol-Alsina
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Carreras
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Kornanova E, Dugatova M, Vaclavova Z, Borovsky M. Fetal anatomy scan with integrated nuchal translucency and combination of PAPP-A and fβhCG for prediction of aneuploidy. BRATISL MED J 2022; 123:299-303. [PMID: 35294217 DOI: 10.4149/bll_2022_047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nuchal translucency (NT) is an important finding of early fetal anatomy scan because of the association with genetic and structural anomalies. Enlarged nuchal translucency can be easily detected even without measurement on fetal anatomy scan as a neck pathology. Because of demanding criteria for measurning NT in established prenatal aneuploidy screening we came with an idea of improvement and simplification with availabe methods. The aim of this study is to compare established screening methods with new model of screening composed of fetal anatomy scan with integrated nuchal translucency and combination of PAPP-A and fβhCG. METHODS A prospective one center study analyzed a total of 351 pregnancies between January 2017 and December 2020. Sonographic measurement of NT and fetal anatomy scan (FAS) were performend with biochemical testing from blood sample in the first trimester. Combined screening and fetal anatomy scan was performed. Patients with a pathological screening or with structural defects underwent an invasive procedure. In patient with positive screenining who missed the first trimester invasive procedure, amniocentesis was performed. Fetuses were divided into two groups according to positive or negative karyotype and to calculate sensitivity and specificity of screening methods. From statistical methods regression analysis, significance p of individual predictor, sensitivity and specificity with graphic drawing of ROC charts were used. Data were analyzed using statistical tools of Microsoft Excel 365 and BESH stat. RESULTS Four models for aneuploidy screening were tested. 1) Model of "Age at the time of diagnosis" was slightly significant predictor with insignificant odds ratio (P=0.04, OR=1). 2) Model of" First trimester biochemical screening" (age, free beta human chorionic gonadotropine - fβhCG and pregnancy associated plasmatic protein A - PAPP-A) were significant (P=0.0001; LR=21) with sensitivity of 87.5 % and specificity of 65.7 %. 3) Model of "First trimester combined test" (age of patients at the time of diagnosis, fβhCG, PAPP-A, NT) was significant (P=7.9 x10-14, LR=67, sensitivity 87 %, specificity 80 %). 4) Model of "Fetal anatomy scan with biochemistry" (structural abnormality finding with combination including age, fβhCG and PAPP-A) was significant (P=4.9x10-18, LR=87, sensitivity 95 %, specificity 80 %). CONCLUSION Fetal anatomy scan combined with age, fβhCG and PAPP-A has the highest sensitivity and specificity for both, the detection of fetal aneuploidies and structural abnormalities. Our study shows that fetal anatomy scan is the best possible option for first trimester diagnostics (Tab. 4, Fig. 5, Ref. 16).
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Wu M, Yan Y, Zou S, Wu S, Feng L, Liu Y, Guo W, Tang W, Liang K. Adverse pregnancy outcomes among pregnant women living with HIV in Hubei province, China: prevalence and risk factors. AIDS Care 2022; 35:351-358. [PMID: 35187997 DOI: 10.1080/09540121.2022.2039358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mother-to-child transmission of Human Immunodeficiency Virus (HIV) has been greatly reduced with the advance of intervention technology. However, adverse pregnancy outcomes (APOs) are still common, and little is known about the driving forces of APOs among pregnant women living with HIV in China. Between January 2004 and December 2020, a total of 638 pregnancies among pregnant women living with HIV were enrolled in this study, 84 (13.2%) pregnancies with 87 APOs were reported. Preterm birth (3.8%), ectopic pregnancy (3.4%), spontaneous abortion (2.0%), and embryo arrest (1.7%) were the most common APOs in pregnant women living with HIV. Exposure to antiretroviral drugs (ARVs) during the first trimester (RR = 4.077, 95% CI: 0.521, 1.484, P<0.001) and the first CD4+ T lymphocyte count (CD4 count)≤ 350/μl (RR = 2.227, 95% CI: 0.063, 0.991, P = 0.026) were risk factors of APOs. The age≤ 30 years (RR = -2.513, 95% CI: -1.067, -0.132, P = 0.012) was associated with the decreasing of APOs. Encouraging people to initiate combination antiretroviral therapy and reach a high CD4 count level before pregnancy would be helpful to prevent APOs. Pregnant women exposed to ARVs in the first trimester needed more attention for APOs.
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Affiliation(s)
- Mengmeng Wu
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Yajun Yan
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Shi Zou
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Songjie Wu
- Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Ling Feng
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Yanbin Liu
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wei Guo
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.,Department of Pathology, School of Basic Medical Sciences, Wuhan University, Wuhan, People's Republic of China
| | - Weiming Tang
- Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China.,University of North Carolina Project-China, Guangzhou, People's Republic of China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.,Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, People's Republic of China.,Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, People's Republic of China
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Ozgu-Erdinc AS, Sert UY, Kansu-Celik H, Moraloglu Tekin O, Engin-Ustun Y. Prediction of gestational diabetes mellitus in the first trimester by fasting plasma glucose which cutoff is better? Arch Physiol Biochem 2022; 128:195-199. [PMID: 31573373 DOI: 10.1080/13813455.2019.1671457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We aimed to predict subsequent gestational diabetes mellitus (GDM) by fasting plasma glucose (FPG) in the first trimester. METHODS Healthy pregnant women who were screened for GDM at 24-28 gestational weeks and had FPG levels calculated during their first antenatal visit and less than 14 gestational weeks were included in this study. RESULTS Of the 2605 women who were recruited for the study, 245 (9.4%) were diagnosed with GDM at weeks 24-28. The diagnostic accuracy for FPG predicting GDM was 66.5, 78.4, and 88.2 for the cutoff values of 87.5 mg/dl, 92 mg/dl, and 99.5 mg/dl, respectively. CONCLUSIONS FPG values which are within the normoglycaemic range constitute an independent risk factor for the development of GDM. The threshold for gestational diabetes diagnosis must be revised.
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Affiliation(s)
- A Seval Ozgu-Erdinc
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Umit Yasemin Sert
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hatice Kansu-Celik
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, University of Health Sciences, Ankara, Turkey
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Chaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening and prediction. Am J Obstet Gynecol 2022; 226:S1071-S1097.e2. [PMID: 32682859 DOI: 10.1016/j.ajog.2020.07.020] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022]
Abstract
Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Early-onset disease requiring preterm delivery is associated with a higher risk of complications in both mothers and babies. Evidence suggests that the administration of low-dose aspirin initiated before 16 weeks' gestation significantly reduces the rate of preterm preeclampsia. Therefore, it is important to identify pregnant women at risk of developing preeclampsia during the first trimester of pregnancy, thus allowing timely therapeutic intervention. Several professional organizations such as the American College of Obstetricians and Gynecologists (ACOG) and National Institute for Health and Care Excellence (NICE) have proposed screening for preeclampsia based on maternal risk factors. The approach recommended by ACOG and NICE essentially treats each risk factor as a separate screening test with additive detection rate and screen-positive rate. Evidence has shown that preeclampsia screening based on the NICE and ACOG approach has suboptimal performance, as the NICE recommendation only achieves detection rates of 41% and 34%, with a 10% false-positive rate, for preterm and term preeclampsia, respectively. Screening based on the 2013 ACOG recommendation can only achieve detection rates of 5% and 2% for preterm and term preeclampsia, respectively, with a 0.2% false-positive rate. Various first trimester prediction models have been developed. Most of them have not undergone or failed external validation. However, it is worthy of note that the Fetal Medicine Foundation (FMF) first trimester prediction model (namely the triple test), which consists of a combination of maternal factors and measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor, has undergone successful internal and external validation. The FMF triple test has detection rates of 90% and 75% for the prediction of early and preterm preeclampsia, respectively, with a 10% false-positive rate. Such performance of screening is superior to that of the traditional method by maternal risk factors alone. The use of the FMF prediction model, followed by the administration of low-dose aspirin, has been shown to reduce the rate of preterm preeclampsia by 62%. The number needed to screen to prevent 1 case of preterm preeclampsia by the FMF triple test is 250. The key to maintaining optimal screening performance is to establish standardized protocols for biomarker measurements and regular biomarker quality assessment, as inaccurate measurement can affect screening performance. Tools frequently used to assess quality control include the cumulative sum and target plot. Cumulative sum is a sensitive method to detect small shifts over time, and point of shift can be easily identified. Target plot is a tool to evaluate deviation from the expected multiple of median and the expected median of standard deviation. Target plot is easy to interpret and visualize. However, it is insensitive to detecting small deviations. Adherence to well-defined protocols for the measurements of mean arterial pressure, uterine artery pulsatility index, and placental growth factor is required. This article summarizes the existing literature on the different methods, recommendations by professional organizations, quality assessment of different components of risk assessment, and clinical implementation of the first trimester screening for preeclampsia.
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Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol 2022; 226:S1108-S1119. [PMID: 32835720 DOI: 10.1016/j.ajog.2020.08.045] [Citation(s) in RCA: 124] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/02/2023]
Abstract
Preeclampsia is defined as hypertension arising after 20 weeks of gestational age with proteinuria or other signs of end-organ damage and is an important cause of maternal and perinatal morbidity and mortality, particularly when of early onset. Although a significant amount of research has been dedicated in identifying preventive measures for preeclampsia, the incidence of the condition has been relatively unchanged in the last decades. This could be attributed to the fact that the underlying pathophysiology of preeclampsia is not entirely understood. There is increasing evidence suggesting that suboptimal trophoblastic invasion leads to an imbalance of angiogenic and antiangiogenic proteins, ultimately causing widespread inflammation and endothelial damage, increased platelet aggregation, and thrombotic events with placental infarcts. Aspirin at doses below 300 mg selectively and irreversibly inactivates the cyclooxygenase-1 enzyme, suppressing the production of prostaglandins and thromboxane and inhibiting inflammation and platelet aggregation. Such an effect has led to the hypothesis that aspirin could be useful for preventing preeclampsia. The first possible link between the use of aspirin and the prevention of preeclampsia was suggested by a case report published in 1978, followed by the first randomized controlled trial published in 1985. Since then, numerous randomized trials have been published, reporting the safety of the use of aspirin in pregnancy and the inconsistent effects of aspirin on the rates of preeclampsia. These inconsistencies, however, can be largely explained by a high degree of heterogeneity regarding the selection of trial participants, baseline risk of the included women, dosage of aspirin, gestational age of prophylaxis initiation, and preeclampsia definition. An individual patient data meta-analysis has indicated a modest 10% reduction in preeclampsia rates with the use of aspirin, but later meta-analyses of aggregate data have revealed a dose-response effect of aspirin on preeclampsia rates, which is maximized when the medication is initiated before 16 weeks of gestational age. Recently, the Aspirin for Evidence-Based Preeclampsia Prevention trial has revealed that aspirin at a daily dosage of 150 mg, initiated before 16 weeks of gestational age, and given at night to a high-risk population, identified by a combined first trimester screening test, reduces the incidence of preterm preeclampsia by 62%. A secondary analysis of the Aspirin for Evidence-Based Preeclampsia Prevention trial data also indicated a reduction in the length of stay in the neonatal intensive care unit by 68% compared with placebo, mainly because of a reduction in births before 32 weeks of gestational age with preeclampsia. The beneficial effect of aspirin has been found to be similar in subgroups according to different maternal characteristics, except for the presence of chronic hypertension, where no beneficial effect is evident. In addition, the effect size of aspirin has been found to be more pronounced in women with good compliance to treatment. In general, randomized trials are underpowered to investigate the treatment effect of aspirin on the rates of other placental-associated adverse outcomes such as fetal growth restriction and stillbirth. This article summarizes the evidence around aspirin for the prevention of preeclampsia and its complications.
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Karim JN, Bradburn E, Roberts N, Papageorghiou AT. First-trimester ultrasound detection of fetal heart anomalies: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2022; 59:11-25. [PMID: 34369613 PMCID: PMC9305869 DOI: 10.1002/uog.23740] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To determine the diagnostic accuracy of ultrasound at 11-14 weeks' gestation in the detection of fetal cardiac abnormalities and to evaluate factors that impact the detection rate. METHODS This was a systematic review of studies evaluating the diagnostic accuracy of ultrasound in the detection of fetal cardiac anomalies at 11-14 weeks' gestation, performed by two independent reviewers. An electronic search of four databases (MEDLINE, EMBASE, Web of Science Core Collection and The Cochrane Library) was conducted for studies published between January 1998 and July 2020. Prospective and retrospective studies evaluating pregnancies at any prior level of risk and in any healthcare setting were eligible for inclusion. The reference standard used was the detection of a cardiac abnormality on postnatal or postmortem examination. Data were extracted from the included studies to populate 2 × 2 tables. Meta-analysis was performed using a random-effects model in order to determine the performance of first-trimester ultrasound in the detection of major cardiac abnormalities overall and of individual types of cardiac abnormality. Data were analyzed separately for high-risk and non-high-risk populations. Preplanned secondary analyses were conducted in order to assess factors that may impact screening performance, including the imaging protocol used for cardiac assessment (including the use of color-flow Doppler), ultrasound modality, year of publication and the index of sonographer suspicion at the time of the scan. Risk of bias and quality assessment were undertaken for all included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS The electronic search yielded 4108 citations. Following review of titles and abstracts, 223 publications underwent full-text review, of which 63 studies, reporting on 328 262 fetuses, were selected for inclusion in the meta-analysis. In the non-high-risk population (45 studies, 306 872 fetuses), 1445 major cardiac anomalies were identified (prevalence, 0.41% (95% CI, 0.39-0.43%)). Of these, 767 were detected on first-trimester ultrasound examination of the heart and 678 were not detected. First-trimester ultrasound had a pooled sensitivity of 55.80% (95% CI, 45.87-65.50%), specificity of 99.98% (95% CI, 99.97-99.99%) and positive predictive value of 94.85% (95% CI, 91.63-97.32%) in the non-high-risk population. The cases diagnosed in the first trimester represented 63.67% (95% CI, 54.35-72.49%) of all antenatally diagnosed major cardiac abnormalities in the non-high-risk population. In the high-risk population (18 studies, 21 390 fetuses), 480 major cardiac anomalies were identified (prevalence, 1.36% (95% CI, 1.20-1.52%)). Of these, 338 were detected on first-trimester ultrasound examination and 142 were not detected. First-trimester ultrasound had a pooled sensitivity of 67.74% (95% CI, 55.25-79.06%), specificity of 99.75% (95% CI, 99.47-99.92%) and positive predictive value of 94.22% (95% CI, 90.22-97.22%) in the high-risk population. The cases diagnosed in the first trimester represented 79.86% (95% CI, 69.89-88.25%) of all antenatally diagnosed major cardiac abnormalities in the high-risk population. The imaging protocol used for examination was found to have an important impact on screening performance in both populations (P < 0.0001), with a significantly higher detection rate observed in studies using at least one outflow-tract view or color-flow Doppler imaging (both P < 0.0001). Different types of cardiac anomaly were not equally amenable to detection on first-trimester ultrasound. CONCLUSIONS First-trimester ultrasound examination of the fetal heart allows identification of over half of fetuses affected by major cardiac pathology. Future first-trimester screening programs should follow structured anatomical assessment protocols and consider the introduction of outflow-tract views and color-flow Doppler imaging, as this would improve detection rates of fetal cardiac pathology. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. N. Karim
- Nuffield Department of Women's & Reproductive HealthUniversity of OxfordOxfordUK
| | - E. Bradburn
- Nuffield Department of Women's & Reproductive HealthUniversity of OxfordOxfordUK
| | - N. Roberts
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | - A. T. Papageorghiou
- Nuffield Department of Women's & Reproductive HealthUniversity of OxfordOxfordUK
- Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
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Guy GP, Leslie K, Diaz Gomez D, Forenc K, Buck E, Bhide A, Thilaganathan B. Effect of routine first-trimester combined screening for pre-eclampsia on small-for-gestational-age birth: secondary interrupted time series analysis. Ultrasound Obstet Gynecol 2022; 59:55-60. [PMID: 34319638 DOI: 10.1002/uog.23741] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the impact of a first-trimester combined screening program for pre-eclampsia, based on the Fetal Medicine Foundation (FMF) algorithm, on the rate of small-for-gestational age (SGA) at birth and adverse pregnancy outcome. METHODS This was a retrospective cohort study of data obtained from a London tertiary hospital between January 2017 and March 2019. The data were derived from a secondary analysis of the cohort evaluated in a clinical-effectiveness study on the implementation of a first-trimester screening program for pre-eclampsia. The cohort included 7720 women screened according to the UK National Institute for Health and Care Excellence (NICE) risk-based approach and 4841 women screened by the FMF multimodal approach, which combines maternal risk factors, blood pressure, pregnancy-associated plasma protein-A and uterine artery Doppler indices. The care package for the FMF-screened group included 150-mg aspirin prophylaxis, ultrasound scans at 28 and 36 weeks' gestation and scheduled delivery at 40 weeks. Outcome measures included the rates of SGA neonates at birth, admission to the neonatal unit, intrauterine demise, neonatal death and hypoxic-ischemic encephalopathy assessed by interrupted time series analysis (ITSA). RESULTS There was no significant difference in the rates of intrauterine demise, neonatal death and hypoxic-ischemic encephalopathy between the FMF-screened and NICE-screened cohorts. ITSA showed a significant reduction in the rate of term SGA birth < 10th percentile at 21 months following implementation of the FMF screening program, with a relative effect reduction of 45.1% (P = 0.004). However, there was no significant relative effect reduction in term SGA birth < 5th or < 3rd percentile. CONCLUSIONS First-trimester combined screening for pre-eclampsia based on the FMF algorithm accompanied by a care package including serial ultrasound scans for growth evaluation and elective birth from 40 weeks' gestation resulted in a significant 45% relative effect reduction in term SGA birth < 10th percentile but did not affect term SGA birth < 5th or < 3rd percentile. Further screening strategies to detect and improve the outcome of cases with SGA birth < 5th percentile need to be considered. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G P Guy
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - K Leslie
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Obstetrics and Gynaecology, Ashford and St Peter's NHS Foundation Trust, Lyne, Chertsey, UK
| | - D Diaz Gomez
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - K Forenc
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - E Buck
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Tommy's National Centre for Maternity Improvement, Royal College of Obstetricians and Gynaecologists, London, UK
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Liu WY, Zhu YT, Xu XM, Zhang JR, Gan XP, Cheng DC, Lu F, Lu C. Associations of Thyroid Function Tests with Lipid Levels and Adverse Pregnancy Outcomes During the First Trimester. Diabetes Metab Syndr Obes 2022; 15:973-981. [PMID: 35386588 PMCID: PMC8979751 DOI: 10.2147/dmso.s352073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The present study aims to evaluate the relationship of thyroid function during the first trimester of pregnancy with lipid levels and pregnancy outcomes. METHODS Women who delivered babies at the Shanghai General Hospital between March 2019 and December 2019 with a known pregnancy outcome and complete data were included in the present study (n = 1779). A retrospective cohort study of all subjects with available first-trimester thyroid function testing and lipid levels data was conducted, and the relationship of thyroid function with lipid levels and pregnancy outcomes was evaluated. The data were analyzed using the SPSS software for statistical correlation. RESULTS The proportion of caesarean sections was higher in women with hypothyroxinemia (HIA) and hypothyroidism than in women with euthyroidism. Hypothyroidism was shown to be related with polyhydramnios, preterm labor and hypertriglyceridemia. HIA was correlated with increased rates of gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension and hypertriglyceridemia. Compared with the euthyroidism group, the hypothyroidism group had a higher apolipoprotein A1 (Apo A1) level and apolipoprotein B level; the subclinical hypothyroidism group had a higher total cholesterol (TC) level and low-density lipoprotein cholesterol level; the HIA group had higher triglyceride, high-density lipoprotein cholesterol levels and lower TC, Apo A1 levels. TC levels were positively correlated with the thyroid-stimulating hormone level and negatively correlated with free thyroxine (FT4) level, and free triiodothyronine and FT4 levels were positively correlated with GDM occurrence. CONCLUSION Thyroid function in early pregnancy is associated with dyslipidemia and pregnancy outcomes; conventional screening of thyroid diseases in early pregnancy may help improve lipid levels and decrease adverse pregnancy outcomes.
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Affiliation(s)
- Wen-Yu Liu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
| | - Yu-Ting Zhu
- Department of Gynecology Maternal and Child Health Hospital of Jiading District, Shanghai, 201800, People’s Republic of China
| | - Xian-Ming Xu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
| | - Jia-Rong Zhang
- Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, 200030, People’s Republic of China
| | - Xu-Pei Gan
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
| | - De-Cui Cheng
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
| | - Feng Lu
- Department of Obstetrics and Gynecology, Songjiang Maternal and Child Health-Care Hospital, Shanghai, 201600, People’s Republic of China
- Feng Lu, Department of Obstetrics and Gynecology, Songjiang Maternal and Child Health-Care Hospital, No. 1010 of Xilin North Road, Songjiang District, Shanghai, 201600, People’s Republic of China, Tel +86-18918282005, Email
| | - Cong Lu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
- Correspondence: Cong Lu, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 of Xinsongjiang Road, Songjiang District, Shanghai, 201600, People’s Republic of China, Tel +86-021-37798537, Email
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Bhatia A, Palacio M, Wright AM, Yeo GSH. Lower uterine segment scar assessment at 11-14 weeks' gestation to screen for placenta accreta spectrum in women with prior Cesarean delivery. Ultrasound Obstet Gynecol 2022; 59:40-48. [PMID: 34254386 DOI: 10.1002/uog.23734] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To validate prospectively transvaginal ultrasound assessment of the lower uterine segment (LUS) scar at the time of first-trimester screening in women with previous Cesarean section (CS) and to determine its feasibility and accuracy in stratifying women according to the risk for placenta accreta spectrum (PAS) disorder. METHODS Women with a history of CS were recruited between 11 + 0 and 13 + 6 weeks' gestation and underwent LUS scar assessment using transvaginal ultrasound. A standardized midsagittal plane, which included the cervicoisthmic canal (CIC), the uterine scar and the placental site, was obtained. The scar was described in terms of its size (narrow or dehiscent) and its location in relation to the CIC (within or above), with each LUS scar classified into one of four groups based on these features. Placental location was assessed and classified as high- or low-lying. Women were stratified according to the risk of PAS, based on the relationship between the scar location and placental site. Women were considered high risk when the scar was above the CIC and the placenta was low-lying (i.e. when the placenta was overlying an exposed scar) and low risk when the scar was within the CIC and/or the placenta was high. High-risk patients were followed up at 20 weeks and 28-30 weeks for the development of PAS. Maternal demographics, detailed obstetric history and obstetric outcome were collected. RESULTS First-trimester transvaginal ultrasound was offered to 535 women with prior CS during the study period. A LUS scar was visualized in 79.9% (401/502) of those who agreed to undergo the examination. At this scan, the LUS scar was above the CIC in 9.0% (36/401) of women, but only 5.7% (23/401) additionally had a low-lying placenta overlying the scar. Of these 23 high-risk women, two were found to have PAS on the mid-trimester screening scan and one was noted to have placental adherence during evacuation following mid-trimester termination of pregnancy. On the first-trimester scan, 94.3% (378/401) of women were at low risk of PAS. This screening protocol yielded a positive likelihood ratio of 21.33 (95% CI, 13.02-34.96), sensitivity of 100% (95% CI, 29.24-100%), specificity of 95.31% (95% CI, 92.39-97.35%), positive predictive value of 16.7% (95% CI, 5.8-39.2%) and negative predictive value of 100% (95% CI, 98.4-100%). On multivariable regression analysis performed to identify confounding variables associated with a LUS scar above the CIC, only maternal body mass index ≥ 30 kg/m2 was significant (odds ratio (OR), 2.42 (95% CI, 1.04-5.39); P = 0.03). Although there was a trend towards an increased risk of a LUS scar above the CIC in women with prior elective prelabor CS (OR, 1.72 (95% CI, 0.80-3.68)), this association did not reach statistical significance. CONCLUSIONS Routine transvaginal ultrasound assessment of the location of the LUS scar and placenta at the time of first-trimester screening between 11 + 0 and 13 + 6 weeks' gestation in women with prior CS is a feasible and effective tool to identify those at risk of subsequent development of PAS disorder. A finding of placental implantation over an exposed LUS scar seems to be cardinal in predicting the risk of PAS disorder in women with prior CS, with an excellent negative predictive value. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Bhatia
- Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - M Palacio
- Hospital Clinic of Barcelona (BCNatal), IDIBAPS, University of Barcelona, CIBER-ER, Barcelona, Spain
| | - A M Wright
- Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - G S H Yeo
- Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
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Lu L, Li C, Deng J, Luo J, Huang C. Maternal serum NGAL in the first trimester of pregnancy is a potential biomarker for the prediction of gestational diabetes mellitus. Front Endocrinol (Lausanne) 2022; 13:977254. [PMID: 36465627 PMCID: PMC9708734 DOI: 10.3389/fendo.2022.977254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) has adverse effects on the health of mothers and their offspring. Currently, no known biomarker has been proven to have sufficient validity for the prediction of GDM in the first trimester of pregnancy. The aim of this study was to investigate the potential relationship between serum neutrophil gelatinase-associated lipocalin (NGAL) levels in the first trimester of pregnancy and later GDM risk and to evaluate the performance of serum NGAL as a biomarker for the prediction of GDM. METHODS The study was conducted by recruiting participants at 8-13 weeks of gestation from The First Affiliated Hospital of Chengdu Medical College between January and June 2021; participants were followed up for oral glucose tolerance test (OGTT) screening at 24-28 gestational weeks. We examined the serum NGAL levels of all subjects in the first trimester who met the inclusion and exclusion criteria. Anthropometric, clinical, and laboratory parameters of the study subjects were obtained during the same study period. A logistic regression model was carried out to investigate the potential relationship between serum NGAL levels in the first trimester of pregnancy and later GDM risk. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the discrimination and calibration of serum NGAL as a biomarker for the prediction of GDM in the first trimester of pregnancy. RESULTS Serum NGAL levels in the first trimester of pregnancy were significantly higher in women who later developed GDM than in those who did not develop GDM. Serum NGAL levels in the first trimester of pregnancy were positively associated with an increased risk of GDM after adjustment for potential confounding factors. The risk prediction model for GDM constructed by using serum NGAL levels in the first trimester of pregnancy achieved excellent performance. CONCLUSIONS Maternal serum NGAL in the first trimester of pregnancy is a potential biomarker for the prediction of GDM, which could help guide the clinical practice of antenatal care.
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Affiliation(s)
| | | | | | - Jianbo Luo
- *Correspondence: Chaolin Huang, ; Jianbo Luo,
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117
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Saito M, Tokunaka M, Goto M, Takita H, Arakaki T, Miyagami K, Hamada S, Oba T, Matsuoka R, Sekizawa A. The role of first-trimester ultrasound screening for women with positive noninvasive prenatal testing results. J Obstet Gynaecol Res 2021; 48:328-332. [PMID: 34918431 DOI: 10.1111/jog.15115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to assess the utility of ultrasound screening for pregnancies with positive noninvasive prenatal testing results for trisomy 21, trisomy 18, and trisomy 13. METHODS We performed a retrospective analysis of positive noninvasive prenatal testing results and first-trimester ultrasound screening at our department between 2013 and 2019. Invasive genetic testing was performed if the patient had positive noninvasive prenatal testing results. Fetal ultrasound and cytogenetic data were collected. Noninvasive prenatal testing was performed in the women for advanced maternal age, nuchal translucency thickness, or history of abnormality in the previous child or relative. RESULTS Forty-one pregnant women had positive noninvasive prenatal testing results for trisomy 21, trisomy 18, and trisomy 13. Twenty-three women had positive results for trisomy 21, 13 had positive results for trisomy 18, and 5 had positive results for trisomy 13 at 11 to 14 weeks of gestation. The positive predictive value of noninvasive prenatal testing was 100% for trisomy 21, 84.6% for trisomy 18, and 100% for trisomy 13. The positive predictive value of positive noninvasive prenatal testing results and fetal morphological abnormalities was 100% for trisomy 21, trisomy 18, and trisomy 13. CONCLUSION Combining an ultrasound examination with noninvasive prenatal testing resulted in a higher positive predictive value for trisomy 18. Normal ultrasound examination results can help alleviate stress caused by false-positive noninvasive prenatal testing results. In contrast, the positive predictive value and negative predictive value for trisomy 21 were not altered by adding an ultrasound examination to noninvasive prenatal testing.
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Affiliation(s)
- Mizue Saito
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Mayumi Tokunaka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Minako Goto
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroko Takita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Keiko Miyagami
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Shoko Hamada
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Oba
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Ryu Matsuoka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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Li H, Zhu Z. Ultrasonographic study of fetal mandibular markers during the first trimester in a Chinese population. J Obstet Gynaecol Res 2021; 48:333-339. [PMID: 34856646 DOI: 10.1111/jog.15121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
AIM To establish reference ranges for fetal mandibular markers in low-risk singleton pregnancies between 11 and 13 + 6 weeks of gestation in a Chinese population. METHODS The inferior facial angle (IFA), transverse, and anteroposterior diameters of the mandible, and mandibular length were measured at 11-13 + 6 weeks of gestation. The utility of these sonographic markers for detecting micrognathia was explored in seven fetuses. RESULTS In healthy fetuses at 11-13 + 6 weeks, there were linear correlations between gestational age and the transverse (Y = -15.615 + 1.987X, r = 0.718, p < 0.001) and anteroposterior (Y = -8.557 + 1.101X, r = 0.581, p < 0.001) diameters of the mandible; mean ratio of the anteroposterior: transverse diameters of the mandible decreased with gestational age (Y = 0.603-0.003X, r = 0.018, p = 0.755); there was a positive correlation between crown rump length and mandibular length (mandible length = 0.861 + 0.137*crown rump length; r = 0.723, p < 0.001); and there was a positive correlation between crown rump length and IFA (r = 0.234, p < 0.05). Reference ranges were: mean ratio of anteroposterior diameter: transverse diameter of the mandible 0.56; mean mandibular length 9.05 mm; and median IFA 66.5°. The values for these mandibular markers in seven cases of fetal micrognathia were outside the normal range. CONCLUSIONS Evaluations of fetal mandibular markers during first trimester ultrasound screening may contribute to the early detection and diagnosis of micrognathia. We recommend obtaining a subjective impression of the mandible on the mid-sagittal view routinely used to measured nuchal translucency, followed by targeted objective measurements on the mid-sagittal and axial views in suspected cases.
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Affiliation(s)
- Hezhou Li
- Zhengzhou University Third Hospital, and Henan Province Women and Children's Hospital, Zhengzhou, Henan, China
| | - Zhengfeng Zhu
- Zhengzhou University Third Hospital, and Henan Province Women and Children's Hospital, Zhengzhou, Henan, China
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Cordisco Md A, Lozza V, Filice ME, Chiappa E. First trimester prenatal diagnosis of a severe tricuspid valve regurgitation and pulmonary valve atresia. Echocardiography 2021; 38:2119-2121. [PMID: 34747067 DOI: 10.1111/echo.15242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022] Open
Abstract
Early diagnosis of congenital heart defect (CHD) increased in the last two decades, following technological evolution. A recent meta-analysis (Yu, 2020), on diagnostic accuracy in ultrasound detection of major CHD in the first trimester of pregnancy, reported an overall sensitivity of 75%. Ultrasound imaging of this case refers to a tricuspid valve dysplasia with right atriomegaly and pulmonary valve atresia diagnosed in a 13-week gestational-age fetus with low risk for chromosomal abnormalities. To our knowledge, this is the first case describing such features in the first trimester. We believe the precocity and severity of onset make this a case of diagnostic interest.
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Affiliation(s)
- Adalgisa Cordisco Md
- Division of Prenatal Diagnosis, Materno Infantile Department, Azienda USL Toscana Centro, San Giovanni di Dio Hospital, Firenze, Italy
| | - Virginia Lozza
- Division of Prenatal Diagnosis, Materno Infantile Department, Azienda USL Toscana Centro, San Giovanni di Dio Hospital, Firenze, Italy
| | - Maria Elena Filice
- Division of Anatomia Patologica 2, Department of Medicina di Laboratorio, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Enrico Chiappa
- Division of Pediatric Cardiology, National Research Center - Tuscany Region Foundation "G. Monasterio", Ospedale del Cuore, Massa, Italy
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Chaiyasit N, Sahota DS, Ma R, Choolani M, Wataganara T, Sim WS, Chaemsaithong P, Wah YMI, Hui SYA, Poon LC. Prospective Evaluation of International Prediction of Pregnancy Complications Collaborative Network Models for Prediction of Preeclampsia: Role of Serum sFlt-1 at 11-13 Weeks' Gestation. Hypertension 2021; 79:314-322. [PMID: 34689595 DOI: 10.1161/hypertensionaha.121.18021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The study aimed to investigate whether serum sFlt-1 (soluble fms-like tyrosine kinase-1) at 11-13 weeks' gestation in pregnancies that subsequently developed preeclampsia was different from those without preeclampsia and compare screening performance of the International Prediction of Pregnancy Complications (IPPIC) reported models, which include various combinations of maternal factors, systolic blood pressure, diastolic blood pressure, PlGF (placental growth factor) and sFlt-1 and the competing risk (CR) models, which include various combinations of maternal factors, mean arterial pressure (MAP) and PlGF for predicting any-onset, early-onset, and late-onset preeclampsia. This was a prospective multicenter study in 7877 singleton pregnancies. The differences of the predictive performance between the IPPIC and CR models were compared. There were 141 women (1.79%) who developed preeclampsia, including 13 cases (0.17%) of early-onset preeclampsia and 128 cases (1.62%) of late-onset preeclampsia. In pregnancies that developed preeclampsia compared to unaffected pregnancies, median serum sFlt-1 levels and its MoMs were not significantly different (p>0.05). There was no significant association between gestational age at delivery and log10 sFlt-1 and log10 sFlt-1 MoM (p>0.05). The areas under the curve of CR models were significantly higher than the IPPIC models for the prediction of any-onset and late-onset preeclampsia but not for early-onset preeclampsia. In conclusion, there are no significant differences in the maternal serum sFlt-1 levels at 11-131 weeks' gestation between women who subsequently develop preeclampsia and those who do not. Moreover, the CR models for the prediction of any-onset and late-onset preeclampsia perform better than the IPPIC reported model.
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Affiliation(s)
- Noppadol Chaiyasit
- From King Chulalongkorn Memorial Hospital, Bangkok, Thailand (Noppadol Chaiyasit)
| | - Daljit S Sahota
- The Chinese University of Hong Kong, Hong Kong SAR (D.S.S., Y.M.I.W., S.Y.A.H., L.C.P.)
| | - Runmei Ma
- First Affiliated Hospital of Kunming Medical University, Kunming, China (R.M.)
| | | | - Tuangsit Wataganara
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.W.)
| | - Wen Shan Sim
- KK Women's and Children's Hospital, Singapore (W.S.S.)
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.C.)
| | - Yi Man Isabella Wah
- The Chinese University of Hong Kong, Hong Kong SAR (D.S.S., Y.M.I.W., S.Y.A.H., L.C.P.)
| | - Shuk Yi Annie Hui
- The Chinese University of Hong Kong, Hong Kong SAR (D.S.S., Y.M.I.W., S.Y.A.H., L.C.P.)
| | - Liona C Poon
- The Chinese University of Hong Kong, Hong Kong SAR (D.S.S., Y.M.I.W., S.Y.A.H., L.C.P.)
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Alfuraih AM, Alotaiby SA, Alsaadi MJ, Bukhari HA, Aldhebaib AM, Mohtasib RS. Predictive value and reference ranges of anogenital distance for determining fetal gender in the first trimester: A retrospective cohort study. Saudi Med J 2021; 42:1057-1064. [PMID: 34610998 PMCID: PMC9129234 DOI: 10.15537/smj.2021.42.10.20210468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the usefulness of sonographically measured anogenital distance (AGD) in predicting fetal gender in Saudi fetuses during the first trimester and to provide normal reference centiles for AGD. METHODS A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia between November 2020 and May 2021. The ultrasound scans of 313 singleton pregnancies between 11-13 plus 6 gestational weeks and their gender-at-birth were collected. Anogenital distance was measured from the inferior base of the genital tubercle to the rump. Binominal logistic regression and receiver operating characteristic curves (ROC) evaluated the predictive performance of AGD for determining fetal gender. RESULTS There was a significant difference of approximately 15% in mean AGD between female (5.92 mm [95% CI= 6.70, 6.14]) and male (6.80 mm [95% CI= 6.61,7.00]) fetuses (p<0.001). Anogenital distance significantly correlated with gestational age (r=0.573, p<0.001) and crown-rump length (r=0.562, p<0.001). The logistic regression determined AGD as a significant predictor of fetal gender (p<0.001). However, ROC analysis showed that overall accuracies were low at 68% (p=0.001) for 11 weeks, 70% (p<0.001) for 12 weeks, and 64% (p=0.017), and for 13 weeks. The average AGD of our Saudi cohort was longer than what the literature reported from other populations. CONCLUSION The first-trimester ultrasound evaluation of AGD was feasible and reliable. It showed a difference between the genders but did not yield high predictive accuracy. Future research should consider racial factors when evaluating AGD.
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Affiliation(s)
- Abdulrahman M. Alfuraih
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Abdulrahman M. Alfuraih, Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-4655-7248
| | - Samiah A. Alotaiby
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed J. Alsaadi
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Hanifa A. Bukhari
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Ali M. Aldhebaib
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Rafat S. Mohtasib
- From the Radiology and Medical Imaging Department (Alfuraih, Alsaadi) College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj; from the Obstetrics and Gynecology Department (Alotaiby, Bukhari), from the Department of Biomedical Physics, Molecular and Functional Imaging (Mohtasib), King Faisal Specialist Hospital and Research Center; and from the Radiologic Sciences Department (Aldhebaib), College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
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Volpe P, De Robertis V, Volpe G, Boito S, Fanelli T, Olivieri C, Votino C, Persico N. Position of the choroid plexus of the fourth ventricle in first- and second-trimester fetuses: a novel approach to early diagnosis of cystic posterior fossa anomalies. Ultrasound Obstet Gynecol 2021; 58:568-575. [PMID: 33847428 DOI: 10.1002/uog.23651] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe the sonographic appearance and position of the choroid plexus of the fourth ventricle (4V-CP) between 12 and 21 weeks' gestation in normal fetuses and in fetuses with Dandy-Walker malformation (DWM) or Blake's pouch cyst (BPC). METHODS The study population comprised 90 prospectively recruited normal singleton pregnancies and 41 pregnancies identified retrospectively from our institutional database that had a suspected posterior fossa anomaly at 12-13 weeks' gestation based on the ultrasound finding of abnormal hindbrain spaces. In all cases the final diagnosis was confirmed by prenatal and/or postnatal magnetic resonance imaging or postmortem examination. All pregnancies underwent a detailed ultrasound assessment, including a dedicated examination of the posterior fossa, at 12-13 weeks, 15-16 weeks and 20-21 weeks of gestation. Two-dimensional ultrasound images of the midsagittal and coronal views of the brain through the posterior fontanelle and three-dimensional volume datasets were obtained. Multiplanar orthogonal image correlation with volume contrast imaging was used as the reference visualization mode. Two independent operators, blinded to the fetal outcome, were asked to classify the 4V-CP as visible or not visible in both normal and abnormal cases, and to assess if the 4V-CP was positioned inside or outside the cyst in fetuses with DWM and BPC. RESULTS Of the 41 fetuses with apparently isolated cystic posterior fossa anomaly in the first trimester, eight were diagnosed with DWM, 29 were diagnosed with BPC and four were found to be normal in the second trimester. The position of the 4V-CP differed between DWM, BPC and normal cases in the first- and second-trimester ultrasound examinations. In particular, in normal fetuses, no cyst was present and, in the midsagittal and coronal planes of the posterior fossa, the 4V-CP appeared as an echogenic oval-shaped structure located inside the 4V apparently attached to the cerebellar vermis. In fetuses with DWM, the 4V-CP was not visible in the midsagittal view because it was displaced inferolaterally by the cyst. In contrast, in the coronal view of the posterior brain, the 4V-CP was visualized in all cases with DWM at 12-13 weeks, with a moderate decrease in the visualization rate at 15-16 weeks (87.5%) and at 20-21 weeks (75%). In the coronal view, the 4V-CP was classified as being outside the cyst in all DWM cases at 12-13 weeks and in 87.5% and 75% of cases at 15-16 and 20-21 weeks, respectively. In fetuses with BPC, the 4V-CP was visualized in all cases in both the midsagittal and coronal views at 12-13 weeks and in 100% and 96.6% of cases, respectively, at 15-16 weeks. In the coronal view, the 4V-CP was classified as being inside the cyst in 28 (96.6%), 27 (93.1%) and 25 (86.2%) cases at 12-13, 15-16 and 20-21 weeks, respectively. The medial segment of the 4V-CP was visualized near the inferior part of the vermis. CONCLUSIONS Our study shows that longitudinal ultrasound assessment of the 4V-CP and its temporal changes from 12 to 21 weeks is feasible. The 4V-CP is located inside the cyst, just below the vermis, in BPC and outside the cyst, inferolaterally displaced and distant from the vermian margin, in DWM, consistent with the pathogenesis of the two conditions. The position of the 4V-CP is a useful sonographic marker that can help differentiate between DWM and BPC as early as in the first trimester of pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - V De Robertis
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - G Volpe
- Maternal Infant Department SC, Obstetrics and Gynecology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - S Boito
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - T Fanelli
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - C Olivieri
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - C Votino
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - N Persico
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Noël L, Guy GP, Jones S, Forenc K, Buck E, Papageorghiou AT, Thilaganathan B. Routine first-trimester combined screening for pre-eclampsia: pregnancy-associated plasma protein-A or placental growth factor? Ultrasound Obstet Gynecol 2021; 58:540-545. [PMID: 33998078 DOI: 10.1002/uog.23669] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the screening performance of serum pregnancy-associated plasma protein-A (PAPP-A) vs placental growth factor (PlGF) in routine first-trimester combined screening for pre-eclampsia (PE), small-for-gestational age (SGA) at birth and trisomy 21. METHODS This was a retrospective study nested in pregnancy cohorts undergoing first-trimester combined screening for PE and trisomy 21 using The Fetal Medicine Foundation (FMF) algorithm based on maternal characteristics, nuchal translucency thickness, PAPP-A, free beta-human chorionic gonadotropin, blood pressure and uterine artery Doppler. Women at high risk for preterm PE (≥ 1 in 50) received 150 mg of aspirin per day, underwent serial fetal growth scans at 28 and 36 weeks and were offered elective birth from 40 weeks of gestation. PlGF was quantified retrospectively from stored surplus first-trimester serum samples. The performance of combined first-trimester screening for PE and SGA using maternal history, blood pressure, uterine artery pulsatility index and either PAPP-A or PlGF was calculated. Similarly, the performance of combined first-trimester screening for trisomy 21 was calculated using either PAPP-A or PlGF in addition to maternal age, nuchal translucency thickness and free beta-human chorionic gonadotropin. RESULTS Maternal serum PAPP-A was assayed in 1094 women, including 82 with PE, 111 with SGA (birth weight < 10th centile), 53 with both PE and SGA and 94 with fetal trisomy 21. PlGF levels were obtained retrospectively from 1066/1094 women. Median serum PlGF multiples of the median was significantly lower in pregnancies with PE (1.0 (interquartile range (IQR), 0.8-1.4); P < 0.01), SGA (1.0 (IQR, 0.8-1.3); P < 0.001) and trisomy 21 (0.6 (IQR, 0.5-0.9); P < 0.0001) compared to in controls (1.2 (IQR, 0.9-1.5)). There was no significant difference in the performance of first-trimester screening using PAPP-A vs PlGF for either preterm PE (area under the receiver-operating-characteristics curve (AUC), 0.78 vs 0.79; P = 0.55) or term PE (AUC, 0.74 vs 0.74; P = 0.60). These findings persisted even after correction for the effect of targeted aspirin use on the prevalence of PE. Similarly, there were no significant differences in sensitivity and specificity of combined screening for SGA or trisomy 21 when using PAPP-A vs PlGF. CONCLUSIONS Using either PlGF or PAPP-A in routine first-trimester combined screening based on maternal characteristics, blood pressure and uterine artery Doppler does not make a significant clinical difference to the detection of PE or SGA. Depending on the setting, biomarkers should be chosen to achieve a good compromise between performance and measurement requirements. This pragmatic clinical-effectiveness study suggests that combined screening for PE can be implemented successfully in a public healthcare setting without changing current protocols for the assessment of PAPP-A in the first trimester. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Noël
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - G P Guy
- Fetal Medicine Unit, Medway NHS Foundation Trust, Gillingham, UK
| | - S Jones
- Prenatal Screening Unit, King George's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - K Forenc
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - E Buck
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Tommy's National Centre for Maternity Improvement, Royal College of Obstetricians and Gynaecologists, London, UK
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Ouyang Y, Chen H, Lin G, Xiang S, Qin J, Gong F, Li X. Heterotopic Cesarean Scar Pregnancy: An Analysis of 20 Cases Following in vitro Fertilization-Embryo Transfer. J Ultrasound Med 2021; 40:2239-2249. [PMID: 33470465 DOI: 10.1002/jum.15610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 11/27/2020] [Accepted: 12/12/2020] [Indexed: 06/12/2023]
Abstract
We report a series of 20 cases of heterotopic cesarean scar pregnancy in this study. The results show that transvaginal sonography offers highly accurate diagnoses of heterotopic cesarean scar pregnancy during the first trimester. Careful exclusion of cesarean scar pregnancy is of great clinical importance for patients with a history of cesarean section after in vitro fertilization-embryo transfer, even when an intrauterine pregnancy has been detected. We recommend single embryo transfer for patients with a history of cesarean section. Expectant management may provide the opportunity for a live cesarean scar pregnancy to develop, albeit at high risks of placenta accreta and hemorrhage, and this needs further verification in the future.
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Affiliation(s)
- Yan Ouyang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- College of Life Science, Hunan Normal University, Changsha, China
- Clinical Research Center For Reproduction and Genetics in Hunan Province, Changsha, China
| | - Hui Chen
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center For Reproduction and Genetics in Hunan Province, Changsha, China
| | - Ge Lin
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center For Reproduction and Genetics in Hunan Province, Changsha, China
| | - Shuanglin Xiang
- College of Life Science, Hunan Normal University, Changsha, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Fei Gong
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center For Reproduction and Genetics in Hunan Province, Changsha, China
| | - Xihong Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center For Reproduction and Genetics in Hunan Province, Changsha, China
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Kriengtuntiwong T, Zaw YH, Taneepanichskul N. Brain-Derived Neurotrophic Factor (BDNF) Depression and Subjective Sleep Quality in the First Trimester of Pregnancy Among Migrant Workers in Thailand. J Multidiscip Healthc 2021; 14:2549-2556. [PMID: 34552333 PMCID: PMC8450157 DOI: 10.2147/jmdh.s322355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/03/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Brain-derived neurotrophic factor (BDNF) influences neurodevelopment during pregnancy. Maternal sleep quality and depression are suggested to influence BDNF levels. The objective of this study was to assess the association between depression, sleep quality, and BDNF levels among Myanmar migrant pregnancies. Methods A cross-sectional study was conducted at Krathum Baen Hospital, Samut Sakhon province, from June to October 2018. A total of 108 first-trimester women were recruited into our study. Maternal blood was collected to analyze BDNF. Depression levels were assessed using the Patient Health Questionnaire (PHQ-9) instrument. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was applied to evaluate subjective sleep quality. Because BDNF was skewed, binary logistic regression was analyzed. Results We found that 28.7% of pregnant women reported poor sleep quality, and 33.4% were classified as having mild to moderate depression. After adjusting for covariate variables, pregnant women with depression had higher BDNF levels than those without depression (OR = 2.972, 95% CI = [1.111, 7.949], p = 0.030). Pregnant women with poor sleep quality had lower BDNF levels than those who had good sleep quality (OR = 0.359, 95% CI = [0.132, 0.972], p = 0.044). Discussion The results suggested that BDNF might be an alternative tool to assess sleep quality in pregnant women.
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Affiliation(s)
- Thuvachit Kriengtuntiwong
- College of Public Health Science, Chulalongkorn University, Bangkok, Thailand.,Department of Mental Health, Srithanya Hospital, Nonthaburi, Thailand
| | - Ye Htet Zaw
- Defense Services Medical Academy, Yangon, Myanmar
| | - Nutta Taneepanichskul
- College of Public Health Science, Chulalongkorn University, Bangkok, Thailand.,HAUS IAQ Research Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Romero Infante XC, Uriel M, Rincón Franco S, Ibáñez Pinilla EA, Rojas NA. First trimester placental growth factor in maternal blood and placenta related disorders. J Matern Fetal Neonatal Med 2021; 35:7668-7675. [PMID: 34470124 DOI: 10.1080/14767058.2021.1960966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe and compare the placental growth factor levels at first trimester in patients that developed preeclampsia, gestational hypertension, IUGR and in those patients without impaired placentation diseases. METHODS Observational study based on a prospective cohort of 422 pregnant women. PlGF values were compared between the different groups (preeclampsia, intrauterine growth restriction (IUGR), gestational hypertension or normal group-patients without impaired placentation diseases). RESULTS The 85.3% (n = 360, 95% CI = 81.9-88.7) had a normal pregnancy, 7.6% (n = 32, 95% CI = 5.1-10.1) had preeclampsia, 3.8% (n = 16, 95% CI = 2.0-5.6) had IUGR and 3.3% (n = 14, 95% CI = 1.6-5.0) had gestational hypertension. The median level of PlGF for preeclampsia (0.76) and IUGR (0.75) were lower than gestational hypertension (0.82) and normal group (1.02). The groups of preeclampsia >34 weeks (0.76), preeclampsia <37 weeks (0.73), and preeclampsia ≥37 weeks (0.77), were significantly lower than the normal group. The sensitivity and specificity of PlGF for impaired placentation diseases is 65% and 64.9%, respectively. CONCLUSION It was found in this study that PlGF has significantly lower levels in gestational hypertension than normal pregnancies, in concordance with the other impaired placentation diseases. Additionally, a better comparison of the PlGF values was obtained when separating early onset of preeclampsia <37 weeks and late-onset of preeclampsia 37≥ weeks of gestations.
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Affiliation(s)
- Ximena Carolina Romero Infante
- El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Universidad El Bosque, Ecodiagnóstico El Bosque S.A.S, Los Cobos Medical Center, Bogotá, Colombia
| | - Montserrat Uriel
- El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Universidad El Bosque, Ecodiagnóstico El Bosque S.A.S, Los Cobos Medical Center, Bogotá, Colombia
| | - Sara Rincón Franco
- El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Universidad El Bosque, Ecodiagnóstico El Bosque S.A.S, Los Cobos Medical Center, Bogotá, Colombia
| | | | - Nydia Alexandra Rojas
- El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Universidad El Bosque, Ecodiagnóstico El Bosque S.A.S, Los Cobos Medical Center, Bogotá, Colombia
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Reid CN, Fryer K, Cabral N, Marshall J. Health care system barriers and facilitators to early prenatal care among diverse women in Florida. Birth 2021; 48:416-427. [PMID: 33950567 DOI: 10.1111/birt.12551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Worldwide, women continue to experience barriers to accessing early prenatal care. Given the unique nature of the United States health care system, this study aimed to identify barriers and facilitators to early prenatal care reported by women in Florida. METHODS A mixed-methods study of postpartum women with entry to care after 14 weeks' gestation was conducted at a tertiary care hospital in Florida. First, eligible women completed a survey including demographic characteristics and open-ended questions on prenatal care barriers. Second, a semi-structured interview was conducted to contextualize the conditions of access. The qualitative analysis was based on the combined theoretical frameworks of Phillippi and Khan. RESULTS The majority of the 55 participants self-identified as Hispanic (n = 28, 51%), non-Hispanic White (n = 12, 22%), or non-Hispanic Black (n = 9, 16%). Quantitative analysis identified frequent barriers, including the following: "couldn't get an appointment when wanted one" (n = 24, 47%); "didn't have insurance" (n = 21, 41%); and "not aware of pregnancy" (n = 21, 41%). From the combined quantitative and qualitative analyses, three major themes emerged that help to explain barriers faced by birthing people in Florida: personal factors (mental health, awareness of pregnancy, considering abortion, tumultuous life), community conditions (transportation, stigma/fear, social support), and health care system (language barriers, delay at clinic level, cost of care). DISCUSSION Barriers to early prenatal care are multifaceted and operate at personal, societal, and health care systems levels. Prenatal care practitioners have multiple potential targets for interventions at the clinic level to help mitigate barriers to early prenatal care. Strategies should include health care policy reforms to Medicaid access and interventions at the clinic level aimed at fast-tracking access to care.
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Affiliation(s)
- Chinyere N Reid
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Kimberly Fryer
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Naciely Cabral
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Jennifer Marshall
- Chiles Center, Sunshine Education and Research Center, University of South Florida College of Public Health, Tampa, FL, USA
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Wang Y, Dai X, Liu H, Li Y, Li L, Chen J. Anal atresia as the diagnostic clue in VACTERL association: A first-trimester case report. J Obstet Gynaecol Res 2021; 47:3702-3706. [PMID: 34365700 DOI: 10.1111/jog.14974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/24/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
Anal atresia is the most common malformation occurring in VACTERL association, but it is difficult to diagnose antenatally. We herein present a case of fetal anal atresia in VACTERL association diagnosed by ultrasonography and supported by autopsy. This case emphasizes the clues to ultrasonographic diagnosis of anal atresia at 11-13+6 weeks of gestation, promoting increased awareness of VACTERL association during first-trimester screening.
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Affiliation(s)
- Yu Wang
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaohui Dai
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hanmin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.,Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Yiping Li
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Lei Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.,Department of Pathology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Jiao Chen
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Sridhar A, Shiliang Z, Woodson R, Kwan L. Non-pharmacological anxiety reduction with immersive virtual reality for first-trimester dilation and curettage: a pilot study. EUR J CONTRACEP REPR 2021; 25:480-483. [PMID: 33140989 DOI: 10.1080/13625187.2020.1836146] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Most women experience moderate to severe pain during first-trimester surgical termination of pregnancy despite the application of various analgesic techniques. Studies have shown that virtual reality (VR) is effective in reducing anxiety among a range of women in differing circumstances. Our study objectives were to assess the feasibility of using VR during first-trimester dilation and curettage under local anaesthesia and understand the effect of VR on procedure-related anxiety during first-trimester dilation and curettage. METHODS A pilot feasibility study was conducted in a convenience sample of 30 women (15 in the intervention group and 15 in the control group). Anxiety scores were recorded before, during and after the procedure. In-depth interviews were conducted after the procedure. RESULTS Participants reported that VR was either very effective (53%) or somewhat effective (40%) in relieving anxiety during and after the procedure. Eleven participants used the VR device for the entire procedure and four participants removed it during the procedure. The anxiety scores before the procedure were not significantly different between the groups. The intervention group had a median five point post-procedure decrease in anxiety score rated on a visual analogue scale, which was significantly different from that of the control group. Overall, participants had a positive experience but there were some technological frustrations. CONCLUSION Women undergoing dilation and curettage in the first trimester were able to use a VR device during the procedure. VR-induced distraction and relaxation helped to reduce anxiety in some participants both during and after the procedure.
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Affiliation(s)
- Aparna Sridhar
- Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Zhang Shiliang
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ryan Woodson
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, University of California, Los Angeles, CA, USA
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130
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Nzelu D, Nicolaides KH, Kametas NA. First trimester angiogenic and inflammatory factors in women with chronic hypertension and impact of blood pressure control: a case-control study. BJOG 2021; 128:2171-2179. [PMID: 34245653 DOI: 10.1111/1471-0528.16835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess first trimester serum placental growth factor (PLGF), soluble fms-like tyrosine kinase-1 (sFLT-1), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), endothelin and vascular cell adhesion molecule (VCAM) in women with chronic hypertension (CH) stratified according to blood pressure (BP) control. DESIGN Case-control. SETTING Tertiary referral centre. POPULATION 650 women with CH, 142 normotensive controls. METHODS In the first trimester, patients with CH were subdivided into four groups. Group 1 included women without pre-pregnancy CH presenting with BP ≥140/90 mmHg. Groups 2-4 had pre-pregnancy CH; in group 2 the BP was <140/90 mmHg without antihypertensive medication, in group 3 the BP was <140/90 mmHg with antihypertensive medication, and in group 4 the BP was ≥140/90 mmHg despite antihypertensive medication. PLGF, sFLT-1, IL-6, TNF-α, endothelin and VCAM were measured at 11+0 -13+6 weeks' gestation and converted into multiples of the expected median (MoM) using multivariate regression analysis in the controls. MAIN OUTCOME MEASURE Comparisons of MoM values of PLGF, sFLT-1, endothelin, IL-6, TNF-α and VCAM between the entire cohort of women with CH and the control group were made using Student's t-test or Mann-Whitney U-test. Comparisons between the four CH groups were made using analysis of variance or Kruskal-Wallis tests. RESULTS Compared with the control group, women with CH had significantly lower MoM of PLGF, sFLT-1 and IL-6 and a significantly higher MoM of endothelin. Between the four groups of women with CH, there were no significant differences in the MoM of sFLT-1, PLGF, sFLT-1/PLGF ratio, endothelin, IL-6 or VCAM, or in the levels of TNF- α. CONCLUSION In women with CH, differences exist in first trimester angiogenic and inflammatory profiles when compared with normotensive pregnancies. However, these differences do not assist in the stratification of women with CH to identify those with more severe underlying disease and worse pregnancy outcomes. TWEETABLE ABSTRACT First trimester blood pressure control impacts on serum PLGF, sFLT-1, endothelin and IL-6 in women with chronic hypertension.
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Affiliation(s)
- D Nzelu
- Fetal Medicine Research Institute, King's College Hospital, London, UK.,King's College London, London, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - N A Kametas
- Fetal Medicine Research Institute, King's College Hospital, London, UK.,King's College London, London, UK
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131
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Mohaghegh F, Galehdari H, Rezaie M. Pustular psoriasis of pregnancy in early first trimester: A case report. Clin Case Rep 2021; 9:e04438. [PMID: 34306683 PMCID: PMC8294136 DOI: 10.1002/ccr3.4438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022] Open
Abstract
Pustular psoriasis of pregnancy is a rare skin condition which mostly affects women in the third trimester and is sometimes followed by adverse outcomes for the mother and the fetus.
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Affiliation(s)
- Fatemeh Mohaghegh
- Dermatology DepartmentSchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Hamid Galehdari
- Dermatology DepartmentSchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Mina Rezaie
- School of MedicineIsfahan University of Medical SciencesIsfahanIran
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132
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Yong HY, Mohd Shariff Z, Mohd Yusof BN, Rejali Z, Tee YYS, Bindels J, van der Beek EM. Beverage Intake and the Risk of Gestational Diabetes Mellitus: The SECOST. Nutrients 2021; 13:2208. [PMID: 34199062 DOI: 10.3390/nu13072208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/28/2022] Open
Abstract
The contribution and impact of beverage intake to total nutrient and energy intake may be substantial. Given the link between lifestyle, diet, and the risk of pregnancy complications, this study investigated the association between the quantity and types of beverages with gestational diabetes mellitus (GDM) risk. The study included 452 women from the Seremban Cohort Study (SECOST). The mean energy by beverage intake was 273 ± 23.83 kcal/day (pre-pregnancy), 349 ± 69.46 kcal/day (first trimester) and 361 ± 64.24 kcal/day (second trimester). Women significantly increased intake of maternal milks and malted drinks, but significantly reduced the intake of carbonated drinks and other drinks from before until the second trimester of pregnancy. For chocolate drinks, carbonated drinks, and soy milk, women increased intake from pre-conception to the first trimester, but reduced their intake from the first to the second trimester. While higher intake of cultured-milk drinks was associated with an increased risk of GDM, higher fruit juice intake was associated with a lower risk of GDM. However, these associations were only observed for intake prior to pregnancy and during the first trimester. Further research is needed to corroborate these findings and investigate the contributions of different beverages to overall diet quality as well as adverse health outcomes during pregnancy.
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133
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Adibi JJ, Layden AJ, Birru RL, Miragaia A, Xun X, Smith MC, Yin Q, Millenson ME, O’Connor TG, Barrett ES, Snyder NW, Peddada S, Mitchell RT. First trimester mechanisms of gestational sac placental and foetal teratogenicity: a framework for birth cohort studies. Hum Reprod Update 2021; 27:747-770. [PMID: 33675653 PMCID: PMC8222765 DOI: 10.1093/humupd/dmaa063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The function of the gestational sac (GS) and the placenta in the closely related processes of embryogenesis and teratogenicity in the first trimester has been minimally described. The prevailing assumption is that direct teratogenic effects are mediated by the critical extraembryonic organ, the placenta, which either blocks or transfers exposures to the foetus. Placental transfer is a dominant mechanism, but there are other paradigms by which the placenta can mediate teratogenic effects. Knowledge of these paradigms and first trimester human developmental biology can be useful to the epidemiologist in the conduct of biomarker-based studies of both maternal and child health. OBJECTIVE AND RATIONALE Our aim is to provide a causal framework for modelling the teratogenic effects of first trimester exposures on child health outcomes mediated by the GS and placenta using biomarker data collected in the first trimester. We initially present first trimester human developmental biology for the sake of informing and strengthening epidemiologic approaches. We then propose analytic approaches of modelling placental mechanisms by way of causal diagrams using classical non-embryolethal teratogens (diethylstilboestrol [DES], folic acid deficiency and cytomegalovirus [CMV]) as illustrative examples. We extend this framework to two chronic exposures of particular current interest, phthalates and maternal adiposity. SEARCH METHODS Information on teratogens was identified by a non-systematic, narrative review. For each teratogen, we included papers that answered the five following questions: (i) why were these exposures declared teratogens? (ii) is there a consensus on biologic mechanism? (iii) is there reported evidence of a placental mechanism? (iv) can we construct a theoretical model of a placental mechanism? and (v) can this knowledge inform future work on measurement and modelling of placental-foetal teratogenesis? We prioritized literature specific to human development, the organogenesis window in the first trimester and non-embryolethal mechanisms. OUTCOMES As a result of our review of the literature on five exposures considered harmful in the first trimester, we developed four analytic strategies to address first trimester placental mechanisms in birth cohort studies: placental transfer and direct effects on the foetus (DES and maternal adiposity), indirect effects through targeted placental molecular pathways (DES and phthalates), pre-placental effects through disruptions in embryonic and extraembryonic tissue layer differentiation (folic acid deficiency), and multi-step mechanisms that involve maternal, placental and foetal immune function and inflammation (DES and CMV). WIDER IMPLICATIONS The significance of this review is to offer a causal approach to classify the large number of potentially harmful exposures in pregnancy when the exposure occurs in the first trimester. Our review will facilitate future research by advancing knowledge of the first trimester mechanisms necessary for researchers to effectively associate environmental exposures with child health outcomes.
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Affiliation(s)
- Jennifer J Adibi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexander J Layden
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rahel L Birru
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexandra Miragaia
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xiaoshuang Xun
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Megan C Smith
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qing Yin
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Thomas G O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Nathaniel W Snyder
- Department of Microbiology and Immunology, Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Shyamal Peddada
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, The University of Edinburgh, Queens Medical Research Institute, Edinburgh, UK
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Herghelegiu CĂG, NeacȘu A, Chircurescu R, Herghelegiu D, Voinea SC, Diaconu C, Stiru O, Savu C, Filipescu A, Balescu I, Bacalbasa N, Suciu N. Pathological Examination of the Late Embryonic Heart Using the Same 4-chamber and 3-vessel Planes Used in Fetal Echocardiography. In Vivo 2021; 35:533-539. [PMID: 33402506 DOI: 10.21873/invivo.12288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIM The incidence of early pregnancy loss widely varies according to age, being considerably higher in older women. Severe congenital malformations play an important role in pregnancy loss, having a high risk of recurrence. Congenital heart defects are the most common congenital abnormalities, thus the diagnosis of such malformations in aborted embryos is important for establishing both a possible cause for pregnancy loss and for correctly counseling the parents. Pathologic examination of the heart that is only a few millimeters in size, is very challenging. PATIENTS AND METHODS A pathologic examination protocol using transverse microscopic sections at the level of the 4-chamber and 3-vessel planes is proposed for heart evaluation. RESULTS Two 9-10 gestational weeks embryos were microscopically examined using transverse slides of the thorax. The 4-chamber and 3-vessel slides were analyzed and compared to 11-13 weeks ultrasound images of the 4-chamber and 3-vessel views from 10 cases. The pathologic examination provided a detailed view of the ventricles, atria and great vessels, sometime surpassing even the ultrasound examination that was performed at a later gestational age. CONCLUSION We consider our proposed pathologic examination protocol feasible for evaluating normal heart structures and ruling out severe congenital heart disease.
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Affiliation(s)
- CĂtĂlin Gabriel Herghelegiu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Adrian NeacȘu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Raluca Chircurescu
- Department of Pathology, "Polizu" Clinical Hospital, INSMC "Alessandrescu-Rusescu", Bucharest, Romania
| | - Doru Herghelegiu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Silviu Cristian Voinea
- Department of Surgical Oncology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Ovidiu Stiru
- Department of Cardiovascular Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Cardiovascular Surgery, "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Cornel Savu
- Department of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Alexandru Filipescu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, "Elias" Emergency Hospital, Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, "Ponderas" Academic Hospital, Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; .,Department of Visceral Surgery, Center of Excellence in Translational Medicine, "Fundeni" Clinical Institute, Bucharest, Romania.,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Nicolae Suciu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, "Polizu" Clinical Hospital, INSMC "Alessandrescu-Rusescu", Bucharest, Romania
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135
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Laing SP, Guzek JM, Rassam DM, Ceesay IS, N'Dow JMO. Determinants of compliance with the World Health Organisation recommendations for pregnant women in an urban health centre in The Gambia. Afr J Reprod Health 2021; 24:24-32. [PMID: 34077124 DOI: 10.29063/ajrh2020/v24i3.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In 2001 the World Health Organization drew up recommendations for pregnant women in order to reduce maternal mortality: the first visit to the antenatal clinic to be in the first trimester, at least four visits in total and delivery with a trained birth attendant. This study reports the extent to which pregnant women attending a health centre in The Gambia complied with the recommendations. A cohort of 1611 consecutive pregnant women was recruited. Only 384 (23.9%) women first attended in the first trimester and 568 (41.6%) attended at least four times. Only 15.8% of the women complied with all recommendations. Following multivariate analysis the educational level of the partner was the sole factor associated with both recommendations regarding attendance. This level of compliance reflects widespread ignorance of the value of early antenatal care and frequent visits. Public health programmes require a basic level of education to be effective.
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Affiliation(s)
- Susan P Laing
- Department of Global Health and Infection, Brighton and Sussex Medical School, UK
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136
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Zhu X, Zhao S, Yang X, Feng Q, Zhang X, Yang F, Chen X. First-Trimester Cranial Ultrasound Markers of Open Spina Bifida. J Ultrasound Med 2021; 40:1155-1162. [PMID: 32951226 DOI: 10.1002/jum.15496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/21/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate cranial ultrasound markers during a first-trimester routine ultrasound examination for screening for open spina bifida (OSB). METHODS Midsagittal and axial images of the fetal head obtained from fetuses with spina bifida and unaffected control fetuses at 11 weeks to 13 weeks 6 days were analyzed retrospectively. The observed markers of the posterior brain included the 4- versus 3-line view, the brain stem (BS)-to-brain stem-occipital bone (BSOB) distance ratio (BS/BSOB), the position relationship between the maxillo-occipital (MO) line and the midbrain-BS junction, and the crash sign status. RESULTS This study included 9 OSB cases, 2 closed spina bifida (CSB) cases, and 200 unaffected controls. Eight of 9 OSB cases had informative midsagittal views of the head. The 3-line view (abnormal) and BS/BSOB greater than 1 (abnormal) were observed in 87.5% (7 of 8) and 100% (8 of 8), respectively. The midbrain-BS junction was below or nearly on the MO line (abnormal) in 100% (8 of 8). Seven of the cases had informative axial views of the head. The crash sign (abnormal) was observed in 85.7% (6 of 7). A 3-line view was seen in all of the cases that had a positive crash sign. Neither of the 2 cases of CSB and none of the controls had any of the 4 first-trimester intracranial ultrasound markers of OSB. CONCLUSIONS The 4 first-trimester intracranial ultrasound markers investigated in this study appear to be very good markers of OSB, especially a BS/BSOB greater than 1 and an abnormal MO line. The crash sign and 3-line view were observed in the same fetus. In our study, these ultrasound findings were not helpful in CSB.
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Affiliation(s)
- Xia Zhu
- Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Sheng Zhao
- Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Xiaohong Yang
- Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Qian Feng
- Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Xiaoyan Zhang
- Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Fan Yang
- Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Xinlin Chen
- Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
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Wiertsema CJ, Erkamp JS, Mulders AGMGJ, Steegers EAP, Duijts L, Koning AHJ, Gaillard R, Jaddoe VWV. First trimester fetal proportion volumetric measurements using a Virtual Reality approach. Prenat Diagn 2021; 41:868-876. [PMID: 33811672 PMCID: PMC8251560 DOI: 10.1002/pd.5947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/15/2021] [Accepted: 03/27/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To establish feasibility and reproducibility of fetal proportion volumetric measurements, using three-dimensional (3D) ultrasound and a Virtual Reality (VR) system. METHODS Within a population-based prospective birth cohort, 3D ultrasound datasets of 50 fetuses in the late first trimester were collected by three ultrasonographers in a single research center. V-scope software was used for volumetric measurements of total fetus, extremities, head-trunk, head, trunk, thorax, and abdomen. All measurements were performed independently by two researchers. Intraobserver and interobserver reproducibility were analyzed using Bland and Altman methods. RESULTS Intraobserver and interobserver analyses of volumetric measurements of total fetus, head-trunk, head, trunk, thorax and abdomen showed intraclass correlation coefficients above 0.979, coefficients of variation below 7.51% and mean difference below 3.44%. The interobserver limits of agreement were within the ±10% range for volumetric measurements of total fetus, head-trunk, head and trunk. The interobserver limits of agreement for extremities, thorax and abdomen were -26.09% to 4.77%, -14.14% to 10.00% and -14.47% to 8.83%, respectively. CONCLUSION First trimester fetal proportion volumetric measurements using 3D ultrasound and VR are feasible and reproducible, except volumetric measurements of the fetal extremities. These novel volumetric measurements may be used in future research to enable detailed studies on first trimester fetal development and growth.
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Affiliation(s)
- Clarissa J. Wiertsema
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
| | - Jan S. Erkamp
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
| | | | - Eric A. P. Steegers
- Departments of Obstetrics and GynecologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Liesbeth Duijts
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsDivision of Respiratory Medicine and AllergologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Anton H. J. Koning
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Clinical Bioinformatics UnitDepartment of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Romy Gaillard
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
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Chan DMK, Cheung KW, Ko JKY, Yung SSF, Lai SF, Lam MT, Ng DYT, Lee VCY, Li RHW, Ng EHY. Use of oral progestogen in women with threatened miscarriage in the first trimester: a randomized double-blind controlled trial. Hum Reprod 2021; 36:587-595. [PMID: 33331637 DOI: 10.1093/humrep/deaa327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/19/2020] [Indexed: 01/14/2023] Open
Abstract
STUDY QUESTION Will use of oral progestogen in women with threatened miscarriage in the first trimester reduce the miscarriage rate when compared with placebo? SUMMARY ANSWER Use of oral progestogen in women with threatened miscarriage in the first trimester did not reduce miscarriage before 20 weeks when compared with placebo. WHAT IS KNOWN ALREADY Miscarriage is a common complication of pregnancy and occurs in 15-20% of clinically recognized pregnancies. Use of vaginal progestogens is not effective in reducing miscarriage but there is still no good evidence to support use of oral progestogen for the treatment of threatened miscarriage. STUDY DESIGN, SIZE, DURATION This was a randomized double-blind controlled trial. A total of 406 women presenting with threatened miscarriage in the first trimester were recruited from 30 March 2016 to May 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Women attending Early Pregnancy Assessment Clinics because of vaginal bleeding during the first trimester were recruited and randomly assigned to use dydrogesterone 40 mg orally, followed by 10 mg orally three times a day or placebo until 12 completed weeks of gestation or 1 week after the bleeding stopped, whichever was later. The primary outcome was the miscarriage rate before 20 weeks of gestation. MAIN RESULTS AND THE ROLE OF CHANCE The two groups of women had comparable age, BMI, number of previous miscarriages, gestation and ultrasound findings at presentation. The miscarriage rate before 20 weeks of gestation was similar in both groups, being 12.8% (26/203) in the progestogen group and 14.3% (29/203) in the placebo group (relative risk 0.897, 95% CI 0.548-1.467; P = 0.772). The live birth rate was 81.3% in the progestogen group versus 83.3% in the placebo group (P = 0.697). No significant differences were found between the two groups in terms of obstetric outcomes and side effects. LIMITATIONS, REASONS FOR CAUTION The primary outcome was the miscarriage rate, rather than the live birth rate. Women were recruited from Early Pregnancy Assessment Clinics and those with heavy vaginal bleeding might be admitted into wards directly instead of attending Early Pregnancy Assessment Clinic. The severity of vaginal bleeding was subjectively graded by women themselves. The sample size was not adequate to demonstrate a smaller difference in the miscarriage rate between the progestogen and placebo groups. We did not exclude women with multiple pregnancy, which increased the risk of miscarriage although there was only one set of twin pregnancy in the placebo group. WIDER IMPLICATIONS OF THE FINDINGS Use of oral progestogen is not recommended in women with threatened miscarriage in the first trimester. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Health and Medical Research Fund, HKSAR (reference number 12132341). All authors declared no conflict of interest. TRIAL REGISTRATION NUMBER ClinicalTrials.gov with an identifier NCT02128685. TRIAL REGISTRATION DATE 1 May 2014. DATE OF FIRST PATIENT'S ENROLMENT 30 March 2016.
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Affiliation(s)
- Diana Man Ka Chan
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, Hong Kong SAR
| | - Ka Wang Cheung
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, Hong Kong SAR
| | - Jennifer Ka Yee Ko
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, Hong Kong SAR
| | | | - Shui Fan Lai
- Department of Obstetrics & Gynaecology, Kwong Wah Hospital, Hong Kong SAR
| | - Mei Ting Lam
- Department of Obstetrics & Gynaecology, Kwong Wah Hospital, Hong Kong SAR
| | - Dorothy Yuet Tao Ng
- Department of Obstetrics & Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
| | - Vivian Chi Yan Lee
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, Hong Kong SAR
| | | | - Ernest Hung Yu Ng
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, Hong Kong SAR
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Kesrouani A, Abdallah W, Kharrat R, Choueiry E, Daou L, Nasr B. Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound. J Perinat Med 2021; 49:496-499. [PMID: 33470962 DOI: 10.1515/jpm-2020-0457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To report the normal fetal cardiac axis (CA) values at the time of the first trimester screening ultrasound. METHODS Standardized images and measurement of the CA were obtained from 100 healthy fetuses between 11+0 and 13+6 weeks of gestation along with the nucal thichkness (NT), Crown-rump length (CRL) and other measurements. We excluded cases with abnormal NT, later diagnosis of abnormalities, and suspected fetal cardiopathy during the pregnancy follow-up. Data analysis was performed after all the patients delivered and cardiopathy was excluded. RESULTS CA was measurable in all the cases. Higher CRL was associated with a decrease in the CA. The mean ± SD embryonic/fetal CA was 48±5,2°, ranging from 39 to 60°, The 2.5 percentile was defined at 40° and the 97.5 percentile at 59°. The Pearson test resulted in a significant correlation between CA and CRL with a coefficient R of 70% and p-value <0.01. CONCLUSIONS CA tends to decrease at the 11 to 13+6 gestational ages. We defined 2.5 and 97.5% curves for the normal values of CA in our Middle Eastern population. A larger study will be required to differentiate normal and abnormal values for the early detection of heart abnormalities.
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Affiliation(s)
- Assaad Kesrouani
- Obstetrics and Gynecology Department, St Joseph University, Beirut, Lebanon.,Bellevue Medical Center Hospital, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Wael Abdallah
- Obstetrics and Gynecology Department, St Joseph University, Beirut, Lebanon.,Bellevue Medical Center Hospital, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Roland Kharrat
- Faculty of Medicine, St Joseph University, Beirut, Lebanon.,Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Elie Choueiry
- Hotel-Dieu de France Hospital, Beirut, Lebanon.,Pediatrics Department, St Joseph University, Beirut, Lebanon
| | - Linda Daou
- Hotel-Dieu de France Hospital, Beirut, Lebanon.,Pediatrics Department, St Joseph University, Beirut, Lebanon
| | - Bernard Nasr
- Bellevue Medical Center Hospital, Beirut, Lebanon
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Valdespino-Vázquez MY, Helguera-Repetto CA, León-Juárez M, Villavicencio-Carrisoza O, Flores-Pliego A, Moreno-Verduzco ER, Díaz-Pérez DL, Villegas-Mota I, Carrasco-Ramírez E, López-Martínez IE, Giraldo-Gómez DM, Lira R, Yocupicio-Monroy M, Rodríguez-Bosch M, Sevilla-Reyes EE, Cortés-Bonilla M, Acevedo-Gallegos S, Merchant-Larios H, Cardona-Pérez JA, Irles C. Fetal and placental infection with SARS-CoV-2 in early pregnancy. J Med Virol 2021; 93:4480-4487. [PMID: 33764543 PMCID: PMC8250563 DOI: 10.1002/jmv.26965] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023]
Abstract
To date, mother‐to‐fetus transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), responsible for the coronavirus disease 2019 (COVID‐19) pandemic, remains controversial. Although placental COVID‐19 infection has been documented in some cases during the second‐ and third‐trimesters, no reports are available for the first trimester of pregnancy, and no SARS‐CoV‐2 protein has been found in fetal tissues. We studied the placenta and fetal organs from an early pregnancy miscarriage in a COVID‐19 maternal infection by immunohistochemical, reverse transcription quantitative real‐time polymerase chain reaction, immunofluorescence, and electron microscopy methods. SARS‐CoV‐2 nucleocapsid protein, viral RNA, and particles consistent with coronavirus were found in the placenta and fetal tissues, accompanied by RNA replication revealed by double‐stranded RNA (dsRNA) positive immunostain. Prominent damage of the placenta and fetal organs were associated with a hyperinflammatory process identified by histological examination and immunohistochemistry. The findings provided in this study document that congenital SARS‐CoV‐2 infection is possible during the first trimester of pregnancy and that fetal organs, such as lung and kidney, are targets for coronavirus. The infection and multi‐organic fetal inflammation produced by SARS‐CoV‐2 during early pregnancy should alert clinicians in the assessment and management of pregnant women for possible fetal consequences and adverse perinatal outcomes.
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Affiliation(s)
- María Y Valdespino-Vázquez
- Departamento de Patología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Cecilia A Helguera-Repetto
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Moises León-Juárez
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Oscar Villavicencio-Carrisoza
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Arturo Flores-Pliego
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Elsa R Moreno-Verduzco
- Subdirección de Servicios auxiliares de Diagnóstico, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Diana L Díaz-Pérez
- Departamento de Patología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Isabel Villegas-Mota
- Departamento de Epidemiología e Infectología Clínica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Elba Carrasco-Ramírez
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Unidad de Microscopía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Irma E López-Martínez
- Unidad de Microscopía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - David M Giraldo-Gómez
- Unidad de Microscopía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Rosalia Lira
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Martha Yocupicio-Monroy
- Posgrado en Ciencias Genómicas, Universidad Autónoma de la Ciudad de México, Mexico City, Mexico
| | - Mario Rodríguez-Bosch
- Subdirección de Ginecología y Obstetricia, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Edgar E Sevilla-Reyes
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Manuel Cortés-Bonilla
- Dirección Médica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Sandra Acevedo-Gallegos
- Departamento de Medicina Materno-Fetal, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Horacio Merchant-Larios
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Jorge Arturo Cardona-Pérez
- Dirección General, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Claudine Irles
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
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Liao Y, Wen H, Ouyang S, Yuan Y, Bi J, Guan Y, Fu Q, Yang X, Guo W, Huang Y, Zeng Q, Qin Y, Xiang H, Li S. Routine first-trimester ultrasound screening using a standardized anatomical protocol. Am J Obstet Gynecol 2021; 224:396.e1-396.e15. [PMID: 33127430 DOI: 10.1016/j.ajog.2020.10.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/30/2020] [Accepted: 10/22/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND First-trimester ultrasound scans were introduced to China for nearly 20 years. The ability of first-trimester ultrasound screening to detect different malformations was variable. A recent systematic review concluded that the use of a standardized anatomic protocol was the most crucial factor to improve the sensitivity of first-trimester ultrasound screening for anomalies. Standardized sectional scans have long been used for routine anatomy screening during the second trimester. However, during the first trimester, most of the previous studies have described the observation of anatomic structures but have not specified clearly the standard sectional views. OBJECTIVE We aimed to determine the performance of routine first-trimester scans using a standardized anatomic protocol for detecting structural abnormalities in China. STUDY DESIGN This was a large retrospective study involving 59,063 sequential unselected pregnancies. Scans at 11 to 13+6 weeks were performed in a single center during a 7-year span. All fetuses were examined following a predefined protocol for standardized views. RESULTS From October 2008 to December 2015, first-trimester scans were performed in 53,349 pregnant women with available outcome. Of these, there were 1578 (3%) pregnancies that presented with at least 1 fetal structural abnormality. The detection rate for first-trimester screening was 43.1% (95% confidence interval, 40.6%-45.5%). Routine first-trimester scans detected 95.6% of abdominal wall defects, 66.3% of nervous system defects, 33.8% of limbs and skeleton malformations, 30.8% of facial abnormalities, 21.2% of urogenital abnormalities, 18.4% of thoracic and lung abnormalities, and 4.1% of gastrointestinal tract abnormalities. During the first trimester, 37.7% of cardiac defects were identified and included 57.9% of major cardiac defects and 2.6% of mild cardiac defects. A robust high detection rate for anencephaly, exencephaly, cephalocele, holoprosencephaly, exomphalos, gastroschisis, Pentalogy of Cantrell, sirenomelia, and body stalk anomaly was achieved during routine first-trimester scans. CONCLUSION A standardized anatomic protocol is advised when performing routine first-trimester ultrasound screening. It is recommended that screening for severe structural abnormalities should be extended to the first trimester.
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Cosma S, Carosso AR, Cusato J, Borella F, Carosso M, Bovetti M, Filippini C, D'Avolio A, Ghisetti V, Di Perri G, Benedetto C. Coronavirus disease 2019 and first-trimester spontaneous abortion: a case-control study of 225 pregnant patients. Am J Obstet Gynecol 2021; 224:391.e1-391.e7. [PMID: 33039396 PMCID: PMC7543983 DOI: 10.1016/j.ajog.2020.10.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/16/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022]
Abstract
Background The disease caused by the severe acute respiratory syndrome coronavirus 2 was named coronavirus disease 2019 and classified as a global public health emergency. The evidence related to the impact of coronavirus disease 2019 on pregnancy is limited to the second and third trimester of pregnancy, whereas data on the first trimester are scant. Many viral infections can be harmful to the fetus during the first trimester of pregnancy, and whether severe acute respiratory syndrome coronavirus 2 is one of them is still unknown. Objective With this study, we evaluated severe acute respiratory syndrome coronavirus 2 infection as a risk factor for early pregnancy loss in the first trimester of pregnancy. Furthermore, coronavirus disease 2019 course in the first trimester was assessed. Study Design Between February 22 and May 21, 2020, we conducted a case-control study at S. Anna Hospital, Turin, among pregnant women in their first trimester, paired for last menstruation. The cumulative incidence of coronavirus disease 2019 was compared between women with spontaneous abortion (case group, n=100) and those with ongoing pregnancy (control group, n=125). Current or past infection was determined by the detection of severe acute respiratory syndrome coronavirus 2 from nasopharyngeal swab and severe acute respiratory syndrome coronavirus 2 immunoglobulin G and immunoglobulin M antibodies in a blood sample. Patient demographics, coronavirus disease 2019–related symptoms, and the main risk factors for abortion were collected. Results Of 225 women, 23 (10.2%) had a positive test result for coronavirus disease 2019. There was no difference in the cumulative incidence of coronavirus disease 2019 between the cases (11/100, 11%) and the controls (12/125, 9.6%) (P=.73). Logistic regression analysis confirmed that coronavirus disease 2019 was not an independent predictor of early pregnancy loss (odds ratio, 1.28; confidence interval, 0.53–3.08). Coronavirus disease 2019–related symptoms in the first trimester were fever, anosmia, ageusia, cough, arthralgia, and diarrhea; no cases of pneumonia or hospital admission owing to coronavirus disease 2019–related symptoms were recorded. No difference in the incidence of symptoms was noted between the 2 groups. Conclusion Severe acute respiratory syndrome coronavirus 2 infection during the first trimester of pregnancy does not seem to predispose to early pregnancy loss; its cumulative incidence did not differ between women with spontaneous abortion and women with ongoing pregnancy. Coronavirus disease 2019 appears to have a favorable maternal course at the beginning of pregnancy, consistent with what has been observed during the second and third trimesters.
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Affiliation(s)
- Stefano Cosma
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Andrea R Carosso
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy.
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fulvio Borella
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Marco Carosso
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Marialuisa Bovetti
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Claudia Filippini
- Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Antonio D'Avolio
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valeria Ghisetti
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
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Feng Q, Duan H, Ju X, Appiah K, Yip KM, Tai YY, Sun Q, Chaemsaithong P, Poon LC. Prediction of spontaneous preterm birth by cervical length in the first trimester of pregnancy: Comparison of two measurement methods. Acta Obstet Gynecol Scand 2021; 100:1305-1312. [PMID: 33683725 DOI: 10.1111/aogs.14138] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our objectives were to compare the single-line and two-line methods of cervical length measurement in the first trimester of pregnancy and to evaluate the potential value of the first trimester cervical length measured by the two methods in predicting spontaneous preterm birth. MATERIAL AND METHODS This was a prospective study in singleton pregnancies at 11+0 to 13+6 weeks of gestation. Cervical length was measured by two methods: (i) a linear distance between the two ends of the glandular area around the endocervical canal (single-line method) and (ii) a sum of a linear distance from the internal os to the greatest cervical curvature and a linear distance from this point of the cervix to the external os (two-line method). The screening performance of the first trimester cervical length measured by the two different methods for the prediction of spontaneous preterm delivery was assessed by receiver-operating characteristics (ROC) curve analysis. The areas under the ROC (AUROC) were compared by De Long test. RESULTS A total of 1484 consecutive singleton pregnancies were included in this study. Spontaneous preterm delivery at <37 and <32 weeks occurred in 75 cases (5.1%) and 12 cases (0.8%), respectively. The median cervical length measured by the single-line method was significantly shorter than that by the two-line method (33.5 vs 36.5 mm, p < .001). Compared with the term delivery group, the median cervical length measured by the two-line method was shorter in women with spontaneous delivery at <32 weeks of gestation (36.5 vs 33.6 mm, p < .01). No significant difference in the median cervical length measured by the single-line method was detected between the spontaneous preterm delivery and term delivery groups. Receiver-operating-characteristic curves demonstrated that cervical length measured by the two-line method achieved better performance in predicting spontaneous delivery at <32 weeks compared with the single-line method (AUROC: 0.72 vs 0.61, p < .01). CONCLUSIONS We have demonstrated that the first trimester cervical length, measured by the two-line approach, holds promise as a potential screening tool for early spontaneous preterm delivery.
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Affiliation(s)
- Qiaoli Feng
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Honglei Duan
- Department of Obstetrics and Gynecology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaoqing Ju
- Department of Obstetrics and Gynecology, Suzhou Municipal Hospital, Suzhou, China
| | - Kubi Appiah
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ka Man Yip
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yi-Yun Tai
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Qian Sun
- Department of Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Liona C Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Lemon LS, Bodnar LM, Garrard W, Venkataramanan R, Platt RW, Marroquin OC, Caritis SN. Ondansetron use in the first trimester of pregnancy and the risk of neonatal ventricular septal defect. Int J Epidemiol 2021; 49:648-656. [PMID: 31860078 DOI: 10.1093/ije/dyz255] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Literature is divided regarding the risk of neonatal ventricular septal defect (VSD) associated with first trimester ondansetron use in pregnancy. METHODS We evaluated the risk of VSD associated with first trimester exposure to intravenous or oral ondansetron in 33 677 deliveries at Magee-Womens Hospital in Pittsburgh, PA (2006-2014). Using log-binomial regression, we evaluated the risk: (1) in the full cohort, (2) using propensity score designs with both matching and inverse probability weighting and (3) utilizing clustered trajectory analysis evaluating the role of dose. Sensitivity analyses assessed the association between ondansetron and all recorded birth defects in aggregate. RESULTS A total of 3733 (11%) pregnancies were exposed to ondansetron in the first trimester (dose range: 2.4-1008 mg). Ondansetron was associated with increased risk of VSD with risk ratios ranging from 1.7 [95% confidence interval (CI) 1.0-2.9] to 2.1 (95% CI 1.1-4.0) across methods. Risks correspond to one additional VSD for approximately every 330 pregnancies exposed in the first trimester. The association was dose-dependent with increased risk in women receiving highest cumulative doses compared with lowest doses [adjusted risk ratio: 3.2 (95% CI 1.0-9.9)]. The association between ondansetron and congenital malformations was diluted as the outcome included additional birth defects. CONCLUSIONS First trimester ondansetron use is associated with an increased risk of neonatal VSD potentially driven by higher doses. This risk should be viewed in the context of risks attributable to severe untreated nausea and vomiting of pregnancy.
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Affiliation(s)
- Lara S Lemon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, PA, USA.,Department of Clinical Analytics, University of Pittsburgh Medical Centers, PA, USA
| | - Lisa M Bodnar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, PA, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - William Garrard
- Department of Clinical Analytics, University of Pittsburgh Medical Centers, PA, USA
| | - Raman Venkataramanan
- Department of Pharmaceutical Science, School of Pharmacy, University of Pittsburgh, PA, USA.,Department of Pathology, University of Pittsburgh, PA, USA
| | - Robert W Platt
- Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
| | - Oscar C Marroquin
- Department of Clinical Analytics, University of Pittsburgh Medical Centers, PA, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Steve N Caritis
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, PA, USA
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145
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Liu S, Yu L, Wu Q, Cui H, Lin X, Wang W. Study on the correlation between vaginal bleeding in first trimester and preterm birth: A birth cohort study in Lanzhou, China. J Obstet Gynaecol Res 2021; 47:1997-2004. [PMID: 33749042 DOI: 10.1111/jog.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/08/2021] [Accepted: 03/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTS To investigate the correlation between first trimester vaginal bleeding and preterm birth (PB), and to offer suggestions on the perinatal health care and preterm birth prevention. METHODS A birth cohort study was conducted on 10 179 pregnant women. Unconditional logistic regression model was used to evaluate the associations between vaginal bleeding and preterm birth in sub-preterm groups. RESULTS Of the 10 179 pregnant women included, a total of 1001 women suffered from vaginal bleeding during the first trimester, of which 119 suffered from PB. Any vaginal bleeding increased the risk of PB. Severe bleeding was a high-risk factor of PB, associated with 4.8-fold risk of very PB, 2.7-fold risk of spontaneous PB without PROM (premature rupture of membrane) and 4.6-fold risk of medical induced PB. Bleeding prolonged more than 1 week increased 66% risk of PB and 36% risk of PB on initial episode happened in 5-12 weeks of gestation age, especially in moderate PB, in medical-induced PB and in spontaneous PB with PPROM (preterm premature rupture of membrane which is one cause of PB). Mild bleeding or bleeding within 1 week or initial episode happened within 4 weeks of gestation age possibly had no influence on PB. CONCLUSION Vaginal bleeding in the first-trimester was an independent risk factor for PB. The severity, duration and initial time of vaginal bleeding had different effects on different subtypes of PB.
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Affiliation(s)
- Sufen Liu
- Aviation General Hospital, Beijing, China
| | - Liqun Yu
- Aviation General Hospital, Beijing, China
| | | | - Hongmei Cui
- Gansu Provincial Maternity & Child Care Hospital, Lanzhou, China
| | - Xiaojuan Lin
- Gansu Provincial Maternity & Child Care Hospital, Lanzhou, China
| | - Wendi Wang
- Gansu Provincial Maternity & Child Care Hospital, Lanzhou, China
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146
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Abu-Amara J, Szpecht D, Al-Saad SR, Karbowski LM. Contracting COVID-19 in the first and second trimester of pregnancy: what we know - a concise qualitative systematic review. Arch Med Sci 2021; 17:1548-1557. [PMID: 34900033 PMCID: PMC8641503 DOI: 10.5114/aoms/133121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Recent medical literature has drawn attention to the possible influence of COVID-19 on the course of pregnancies. As the coherence of results seems to vary, especially in relation to first and second trimester pregnancies, a concise qualitative systematic review can shed light on the most recent data. MATERIAL AND METHODS A structured systematic search was performed to collect all COVID-19 pregnancy-related articles published between January 1 and September 16, 2020. Two independent reviewers evaluated studies using the STROBE statement in combination with the CERQual quality assessment of findings. RESULTS In total 1387 articles were screened and finally 22 studies were evaluated (179 1st/2nd trimesters of pregnant women with COVID-19). The majority of reported mothers who contracted COVID-19 during 1st/2nd trimesters are yet to complete their pregnancy. CONCLUSIONS Evidently a limited amount of data is available. Usually, mothers and newborns are discharged from the hospital without any serious complications. Further observations are imperative.
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Affiliation(s)
| | - Dawid Szpecht
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
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147
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Mendoza M, Serrano B, Bonacina E, Capote S, Garcia-Manau P, Regincós L, Murcia MT, Barberan L, Míguez M, Carreras E. Diagnostic accuracy of the Gaussian first-trimester combined screening for pre-eclampsia to predict small-for-gestational-age neonates. Int J Gynaecol Obstet 2021; 156:322-330. [PMID: 33724448 DOI: 10.1002/ijgo.13673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Pre-eclampsia and delivery of small-for-gestational-age (SGA) neonates can be predicted from the first trimester. A Gaussian model for prediction of PE has recently been described, although its capacity to predict SGA is still unknown. METHODS This was a secondary analysis of a prospective cohort study conducted at Vall d'Hebron University Hospital (Barcelona) in 2483 single pregnancies from October 2015 to September 2017. Mean arterial blood pressure and mean uterine artery pulsatility index were recorded at the first-trimester scan. Serum concentrations of placental growth factor and pregnancy-associated plasma protein-A were assessed between 8+0 and 13+6 weeks. The predictive capacities of early (<32 weeks) and preterm (<37 weeks) SGA were tested. RESULTS For SGA without pre-eclampsia, detection rates of 25.0% (95% confidence interval [CI] 0-75.0) for early SGA and 14.3% (95% CI 3.6-28.6) for preterm SGA were achieved. For SGA with pre-eclampsia, the algorithm showed detection rates of 100.0% (95% CI 25.0-100.0) for early SGA and 56.3% (95% CI 31.3-81.3) for preterm SGA. CONCLUSION This algorithm identifies 62.5% of early SGA and 27.3% of preterm SGA. Combined screening for predicting both pre-eclampsia and SGA by using the Gaussian algorithm is feasible and would simplify clinical practice.
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Affiliation(s)
- Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Serrano
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Erika Bonacina
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sira Capote
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo Garcia-Manau
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Regincós
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Teresa Murcia
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lidia Barberan
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Míguez
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Carreras
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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148
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Liu Z, Shi Z, Wei Y, Dai Q, Liu X. Lacunar-like changes of the chorion: can it be a first-trimester ultrasound sign in predicting worse clinical outcome in cesarean scar pregnancy termination? J Matern Fetal Neonatal Med 2021; 34:2355-2362. [PMID: 33685328 DOI: 10.1080/14767058.2021.1888914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To observe the lacunar-like changes in cesarean scar pregnancy (CSP) ultrasonography in first trimester and to explore its relationship with clinical outcome in early pregnancy termination. METHODS This is a retrospective case-control study. Patients who were diagnosed as CSP and chose to terminate pregnancy from January 2017 to April 2020 were enrolled. According to occurrence of lacunar-like change in chorion membrane, patients were divided into case and control group. The clinical manifestation, laboratory test, ultrasound data, and outcome were compared. RESULTS Fifty-five CSP patients were enrolled with 20 (36.4%) in case group and 35 (63.6%) in control group. As for ultrasound features, the maximum outer diameter of gestational mass (5.6 ± 2.5 cm vs. 3.9 ± 1.5 cm), the maximum thickness of the chorion membrane (median number 1.1 cm vs. 0.7 cm), the longitudinal diameter of the implanting part of gestational mass in uterine lower segment (3.3 ± 1.8 cm vs. 1.2 ± 0.5 cm), uterine lower segment protrusion incidence (12, 60% vs. 2, 5.7%), and the crown-rump length of fetus (median number 1.7 cm vs. 0.7 cm) were bigger or higher in case group than that of the control group; the minimum thickness of the uterine lower segment myometrium (median number 0.08 cm vs. 0.20 cm) was significantly thinner in case group. CDFI grading of case group was different from control group with more cases in higher grades. As for clinical outcome, the patients of case group showed more frequency of CSP lesion resection under open surgery or laparoscopy (7, 35% vs. 1, 2.86%) rather than suction curettage, more blood loss in surgery (median number 35 ml vs. 20 ml) and more hospitalization days (median number 7.5 d vs. 3.5 d) than control group. CONCLUSIONS Lacunar-like change of chorion can be detected in early gestation and may act as a predictor of complicated and worse clinical outcome.
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Affiliation(s)
- Zhenzhen Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhimin Shi
- Department of Ultrasound, Haidian Women and Children's Health Care Hospital, Beijing, China
| | - Yao Wei
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qing Dai
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xinyan Liu
- Department of Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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149
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Speake HA, Pereira G, Regan AK. Risk of adverse maternal and foetal outcomes associated with inactivated influenza vaccination in first trimester of pregnancy. Paediatr Perinat Epidemiol 2021; 35:196-205. [PMID: 33155331 DOI: 10.1111/ppe.12715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND In many countries, influenza vaccination is routinely recommended during any stage of pregnancy, yet uptake remains low, particularly in the first trimester. This is thought to be due to maternal concerns regarding vaccine safety. OBJECTIVE To evaluate the safety of influenza vaccination in the first trimester of pregnancy. METHODS In a 4-year retrospective cohort study using probabilistic record linkage of administrative health data, we established a population-based cohort of 2391 women vaccinated in first trimester and 68 447 never vaccinated women with a date of conception between 2012 and 2015 in Western Australia. We estimated the relative risk (RR) of perinatal health outcomes among first trimester vaccinated women as compared to never vaccinated women using log-binomial logistic regression following a propensity score matched (PSM) analyses (2391 vaccinated women matched with 9564 never vaccinated women). RESULTS First trimester vaccination was not associated with increased risk of stillbirth (RR 1.18, 95% confidence interval [CI] 0.64, 2.19), small for gestational age (RR 0.96, 95% CI 0.83, 1.11) or preeclampsia (RR 0.97, 95% CI 0.74, 1.28). The risk of spontaneous birth at 32-36 weeks was higher in first trimester vaccinated women compared with never vaccinated women (RR 1.40, 95% CI 1.11, 1.77). Vaccination was associated with a 10-19% increase in the risk of gestational diabetes (RR 1.18, 95% CI 0.94, 1.49), premature rupture of membranes (RR 1.10, 95% CI 0.82, 1.48), and threatened preterm labour (RR 1.19, 95% CI 0.90, 1.59). CONCLUSIONS With exception to spontaneous preterm birth, findings suggest that first trimester vaccination is not associated with adverse maternal and foetal outcomes. Results can be used to support patient and provider-level vaccine decision making during first trimester.
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Affiliation(s)
- Hollie A Speake
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, WA, Australia.,Telethon Kids Institute, Nedlands, WA, Australia.,Centre for Fertility and Health, Norwegian Public Health Institute, Oslo, Norway
| | - Annette K Regan
- School of Public Health, Curtin University, Perth, WA, Australia.,School of Public Health, Texas A&M University, College Station, TX, USA.,UCLA Fielding School of Public Health, Los Angeles, CA, USA
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150
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Kalafat E, Ting L, Thilaganathan B, Papageorghiou AT, Khalil A. Diagnostic accuracy of fetal choroid plexus length to head biometry ratio at 11 to 13 weeks for open spina bifida. Am J Obstet Gynecol 2021; 224:294.e1-294.e14. [PMID: 32841630 DOI: 10.1016/j.ajog.2020.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Open spina bifida is a major congenital anomaly with an estimated incidence of <1 in 1000. The diagnosis of open spina bifida is usually made during the second trimester, but first-trimester detection rate of spina bifida is increasingly reported. Recently, the mean choroid plexus length to occipitofrontal diameter ratio was reported to be increased in fetuses with open spina bifida. The ratio reflects the so-called dry brain effect caused by cerebrospinal fluid leakage and expansion of the choroid plexus into the lateral ventricles. The mean choroid plexus length to occipitofrontal diameter ratio appears to be a promising tool for early detection of open spina bifida, but its diagnostic accuracy is yet to be determined in a large cohort. OBJECTIVE This study aimed to assess the predictive accuracy of mean choroid plexus length to occipitofrontal diameter ratio recorded at 11 to 13 weeks' gestation for the detection of open spina bifida. STUDY DESIGN This was a retrospective cohort of patients treated in a tertiary referral center. Fetuses in which open spina bifida was detected at 16 to 24 weeks' gestation and normal fetuses were included in the cohort. Biparietal diameter and occipitofrontal diameter were measured in an axial view. The length of choroid plexus was measured along its longest diameter in the same plane. Ultrasound images were examined offline, and the operator was blinded to the clinical diagnosis. The predictive accuracy was evaluated using the area under the curve and positive and negative predictive values. RESULTS We included 3300 pregnant women, of whom 24 (0.73%) had the fetuses affected by open spina bifida. The area under the curve values were 0.921 for mean choroid plexus length to occipitofrontal diameter ratio and 0.933 for its multiple of the median. Mean choroid plexus length to biparietal diameter ratio indicated similar results, with area under the curve values of 0.928 and 0.931 for raw ratio and multiple of the median ratio models, respectively. The optimal cutoffs of the mean choroid plexus to occipitofrontal diameter ratio and multiple of the median ratios were 0.662 and 1.263, respectively. The optimal mean choroid plexus to occipitofrontal diameter ratio and multiple of the median ratio cutoffs provided a positive predictive value of 90.9% and a negative predictive value of 99.6%. The number of affected spinal segments was significantly higher in fetuses with a ratio above 0.662 (P=.022). CONCLUSION The mean choroid plexus length to occipitofrontal diameter ratio at 11 to 13 weeks' gestation is a promising tool for the prenatal detection of open spina bifida.
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Affiliation(s)
- Erkan Kalafat
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom; Department of Statistics, Faculty of Arts and Sciences, Middle East Technical University, Ankara, Turkey; Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Lei Ting
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Aris T Papageorghiou
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom.
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