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Thakur S, Singh C, Paliwal P, Appannagri V, Mohit N, Chawla GS, Bagga R. Revisiting Utility of Fetal Autopsy in Genomic Era. Fetal Pediatr Pathol 2024:1-11. [PMID: 39177267 DOI: 10.1080/15513815.2024.2393356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/02/2024] [Accepted: 08/08/2024] [Indexed: 08/24/2024]
Abstract
Background: Autopsy has been a gold standard in cases of antenatal detected anomalies or fetal demise. This helped clinicians in getting insights into the future management. In current times, ultrasound and genomic testing has become extremely powerful in further refining the etiological basis; however, fetal autopsy still has its role even now. Material and Methods: We have discussed the utility of fetal autopsy in current times by diving the cases in seven groups. Results: Case based discussions to discuss the utility of fetal autopsy. Conclusions: We suggest that fetal autopsy should be the standard of care in case of any abnormal fetal outcomes alongwith fetal genomic testing. Fetal autopsy is complementary to the ultrasound assessment and genomic investigations in reaching the final diagnosis and provides invaluable information regarding recurrence risk which may not be available when couple plans next pregnancy.
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Affiliation(s)
- Seema Thakur
- Fortis Hospital, AA Block, New Delhi, India
- Rainbow Children Hospital, New Delhi, India
| | | | - Preeti Paliwal
- Consultant Cytogenetics, Onquest Laboratories Limited, Gurugram, India
| | | | - N Mohit
- Rainbow Children Hospital, New Delhi, India
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Agaoglu Z, Tanacan A, Ipek G, Peker A, Ozturk Agaoglu M, Bastemur AG, Kara O, Sahin D. Utility of the cerebro-placental-uterine ratio in predicting composite adverse perinatal outcomes in pregestational diabetes: A prospective cohort study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:745-752. [PMID: 38655708 DOI: 10.1002/jcu.23700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To examine the cerebro-placental-uterine ratio (CPUR) in pregnant women with pregestational diabetes and determine its role in predicting adverse prenatal outcomes. METHODS This prospective, cohort study conducted at a tertiary hospital included 65 patients with pregestational diabetes (25 with type1 diabetes, 40 with type2 diabetes) and 130 low-risk patients in the control group. The cerebroplacental (CPR) ratio and the CPUR were calculated. Composite adverse perinatal outcome (CAPO) is defined as the presence of any of the following: (1) Neonatal intensive care unit (NICU) admission, (2) Apgar at 5 min <7, and (3) umbilical cord arterial pH <7.10. The relationship of CPR and CPUR with CAPO was investigated. RESULTS CPR and CPUR were significantly lower in the pregestational diabetes group than in the control group. The NICU admission was higher in the case group. In receiver operating characteristic analyses, the optimal cut-off value of CPUR was 1.46 (AUC = 0.72, p = 0.003, 80% sensitivity, and 69% specificity) to predict CAPO and the optimal cut-off value of CPUR was 1.50 for NICU admission (AUC = 0.70, p = 0.013, 77% sensitivity, and 66% specificity). CONCLUSION Low CPUR values were found to be associated with adverse perinatal outcomes in women with pregestational diabetes. With the increasing number of studies, CPUR is expected to be utilized more widely in routine obstetric practice.
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Affiliation(s)
- Zahid Agaoglu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Goksun Ipek
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ayca Peker
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Merve Ozturk Agaoglu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ayse Gulcin Bastemur
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Ge T, Kong J. Clinical value of serum SIRT1 combined with uterine hemodynamics in predicting disease severity and fetal growth restriction in preeclampsia. J Med Biochem 2024; 43:350-362. [PMID: 39139170 PMCID: PMC11318065 DOI: 10.5937/jomb0-37645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/08/2023] [Indexed: 08/15/2024] Open
Abstract
Background To investigate the effect and correlation of serum SIRT1 combined with uterine hemodynamic parameters on disease severity and fetal uterine growth restriction in the progression of preeclampsia, and to evaluate its clinical value as potential markers. Methods A total of 100 patients with preeclampsia who were hospitalized in Qufu Normal University Hospital from June 2017 to June 2021 were selected as the research objects. According to the severity, they were divided into Mild group (62 cases) and Severe group (38 cases), and according to whether the fetal growth restriction was combined or not, they were divided into the Combined fetal growth restriction group (56 cases) and the Uncomplicated fetal growth restriction group (44 cases). Serum SIRT1 levels and uterine artery hemodynamic parameters were detected, and spearman analysis was used to evaluate the association of serum SIRT1 levels and uterine artery hemodynamic parameters (peak-to-trough ratio of arterial blood velocity, pulsatility index, resistance index) with disease severity (systolic blood pressure, diastolic blood pressure, and random urinary protein levels) and fetal growth restriction (femoral length, biparietal diameter, head circumference and neonatal weight); unsupervised PCA analysis, supervised PLS-DA analysis, Cluster heat map analysis, ROC curve and AUC analysis were used to evaluate the diagnostic value of serum SIRT1 levels combined with uterine artery hemodynamic parameters in the severity of disease and fetal growth restriction in patients with preeclampsia. Results Serum SIRT1 levels was decreased in patients with severe preeclampsia (p < 0.0001), arterial blood flow velocity peak-to-trough ratio, pulsatility index and resistance index were increased (p < 0.001; p < 0.0001), and serum SIRT1 levels and uterine artery hemodynamic parameters were closely related to disease severity (p < 0.001; p < 0.0001). In addition, the levels of serum SIRT1 in patients with preeclampsia combined with fetal growth restriction was decreased (p < 0.0001), the peak-to-trough ratio of arterial blood flow velocity, pulsatility index and resistance index were increased (p < 0.0001), and serum SIRT1 levels and uterine artery hemodynamics were closely related to fetal growth restriction (p < 0.0001). Unsupervised PCA analysis and supervised PLS-DA analysis showed that patients with different severity of disease and patients with or without fetal growth restriction were similar within groups, and there were significant differences between groups; cluster heat map analysis showed that mild and severe groups were stratified clustering, the combined fetal growth restriction group and the uncombined group were hierarchically clustered; ROC curve and AUC analysis showed that serum SIRT1 levels combined with uterine artery hemodynamic parameters had a significant effect on the severity of preeclampsia and whether combined with fetal growth restriction high diagnostic value. Conclusions Serum SIRT1 combined with uterine hemodynamic parameters in preeclampsia is closely related to disease severity and fetal growth restriction, and is expected to become potential biomarkers for early clinical intervention in patients.
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Affiliation(s)
- Tongjun Ge
- Qufu Normal University Hospital, Qufu City, China
| | - JianYing Kong
- Qufu Peopležs Hospital, Department of Imaging, Qufu City, China
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4
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Villar J, Cavoretto PI, Barros FC, Romero R, Papageorghiou AT, Kennedy SH. Etiologically Based Functional Taxonomy of the Preterm Birth Syndrome. Clin Perinatol 2024; 51:475-495. [PMID: 38705653 DOI: 10.1016/j.clp.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Preterm birth (PTB) is a complex syndrome traditionally defined by a single parameter, namely, gestational age at birth (ie, ˂37 weeks). This approach has limitations for clinical usefulness and may explain the lack of progress in identifying cause-specific effective interventions. The authors offer a framework for a functional taxonomy of PTB based on (1) conceptual principles established a priori; (2) known etiologic factors; (3) specific, prospectively identified obstetric and neonatal clinical phenotypes; and (4) postnatal follow-up of growth and development up to 2 years of age. This taxonomy includes maternal, placental, and fetal conditions routinely recorded in data collection systems.
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Affiliation(s)
- Jose Villar
- Nuffield Department of Women's & Reproductive Health, Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford OX3 9DU, UK.
| | - Paolo Ivo Cavoretto
- Department of Obstetrics and Gynaecology, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Fernando C Barros
- Post-Graduate Program in Health in the Life Cycle, Catholic University of Pelotas, Rua Félix da Cunha, Pelotas, Rio Grande do Sul 96010-000, Brazil
| | - Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, USA; Department of Obstetrics and Gynecology, University of Michigan, L4001 Women's Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0276, USA; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford OX3 9DU, UK
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford OX3 9DU, UK
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Omaña-Guzmán I, Ortiz-Hernández L, Ancira-Moreno M, Godines-Enriquez M, O'Neill M, Vadillo-Ortega F. Association between maternal cardiometabolic markers and fetal growth in non-complicated pregnancies: a secondary analysis of the PRINCESA cohort. Sci Rep 2024; 14:9096. [PMID: 38643289 PMCID: PMC11032337 DOI: 10.1038/s41598-024-59940-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
The objective of this study was to evaluate the association of maternal cardiometabolic markers trajectories (glucose, triglycerides (TG), total cholesterol, systolic blood pressure (SBP) and diastolic blood pressure (DBP)) with estimated fetal weight trajectories and birth weight in Mexican pregnant women without medical complications. Cardiometabolic marker trajectories were characterized using group-based trajectory models. Mixed-effect and linear regression models were estimated to assess the association of maternal trajectories with estimated fetal weight and birth weight. The final sample comprised 606 mother-child dyads. Two trajectory groups of maternal cardiometabolic risk indicators during pregnancy were identified (high and low). Fetuses from women with higher values of TG had higher weight gain during pregnancy ( β ^ = 24.00 g; 95%CI: 12.9, 35.3), were heavier at the sixth month ( β ^ =48.24 g; 95%CI: 7.2, 89.7) and had higher birth weight ( β ^ = 89.08 g; 95%CI: 20.8, 157.4) than fetuses in the low values trajectory. Fetuses from mothers with high SBP and DBP had less weight in the sixth month of pregnancy ( β ^ = - 42.4 g; 95%CI: - 82.7, - 2.1 and β ^ = - 50.35 g; 95%CI: - 94.2, - 6.4), and a higher DBP trajectory was associated with lower birth weight ( β ^ = - 101.48 g; 95%CI: - 176.5, - 26.4). In conclusion, a longitudinal exposition to high values of TG and BP was associated with potentially adverse effects on fetal growth. These findings support the potential modulation of children's phenotype by maternal cardiometabolic conditions in pregnancies without medical complications.
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Affiliation(s)
- Isabel Omaña-Guzmán
- Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City, Mexico
- Unidad de Vinculación Científica de la Facultad de Medicina, Instituto Nacional de Medicina Genómica, Universidad Nacional Autónoma de México, Periférico Sur 4809, Arenal Tepepan, 14610, Mexico City, CDMX, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Luis Ortiz-Hernández
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | | | | | - Marie O'Neill
- Epidemiology and Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Felipe Vadillo-Ortega
- Unidad de Vinculación Científica de la Facultad de Medicina, Instituto Nacional de Medicina Genómica, Universidad Nacional Autónoma de México, Periférico Sur 4809, Arenal Tepepan, 14610, Mexico City, CDMX, Mexico.
- Epidemiology and Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Waller JA, Saade G. Stillbirth and the placenta. Semin Perinatol 2024; 48:151871. [PMID: 38199875 DOI: 10.1016/j.semperi.2023.151871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Stillbirth affects a large proportion of pregnancies world-wide annually and continues to be a major public health concern. Several causes of stillbirth have been identified and include obstetrical complications, placental abnormalities, fetal malformations, infections, and medical complications in pregnancy. Placental abnormalities such as placental abruption, chorioangioma, vasa previa, and umbilical cord abnormalities have been identified as causes of death for a significant proportion of stillbirths. In the absence of placental abnormalities, the gross and histologic changes in the placenta in stillbirth are found when secondary to other etiologies. Here we describe both gross and histologic changes of the placenta that are associated with stillbirth.
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Affiliation(s)
- Jerri A Waller
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School.
| | - George Saade
- Department Chair of Obstetrics and Gynecology, Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School
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Lv Y, Hu R, Liang Y, Zhou Y, Lian Y, He T. Effect of daily physical activity on ambulatory blood pressure in pregnant women with chronic hypertension: A prospective cohort study protocol. PLoS One 2024; 19:e0296023. [PMID: 38198464 PMCID: PMC10781089 DOI: 10.1371/journal.pone.0296023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/23/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Physical activity, a first-line approach for the treatment of non-gestational hypertension globally, has been shown to benefit most pregnant women in many respects. The benefits and risks of prenatal physical activity in complicated pregnancies, such as preeclampsia and chronic hypertension, require further investigation. It is worth conducting studies to address questions about physical activity during pregnancy in women with chronic hypertension, such as the benefits and risks, frequency, duration, and intensity. This prospective cohort study aims to investigate whether moderate-intensity daily physical activity reduces ambulatory blood pressure in pregnant women with chronic hypertension. METHODS Pregnant women with chronic hypertension at 11+0 to 13+6 gestational weeks will be recruited from the outpatient clinic and divided into moderate- and light-intensity physical activity groups according to the intensity of the 7-day physical activity monitored using the model wGT3X-BT accelerometer. 24-h ambulatory blood pressure monitoring will be performed at enrollment as a baseline and will be repeated in the second and third trimesters. The primary outcome is the difference in the change in 24-h ambulatory systolic blood pressure from the first to the third trimester between the groups. Secondary outcomes include the difference of change in other ambulatory (24-h diastolic, daytime, and nighttime) and office blood pressure variables from the first to the second and third trimesters, the incidence of severe hypertension (≥160/110 mmHg), and changes in the type and dosage of antihypertensive medication. The primary and secondary outcomes related to changes in blood pressure from baseline to the second and third trimesters between the groups will be analyzed using Student's independent t-test or the Mann-Whitney U test. DISCUSSION This cohort study will provide a basis for randomized controlled trials and verify an easily achieved, economical, and non-fetotoxic approach for adjuvant blood pressure management in pregnant women with chronic hypertension. REGISTRY This study is registered with the Chinese Clinical Trials Registry (NO. ChiCTR2200062094). Date Registered: 21/07/2022.
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Affiliation(s)
- Yanxiang Lv
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
| | - Rui Hu
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
| | - Yan Liang
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
| | - Ying Zhou
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
| | - Yanan Lian
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
| | - Tongqiang He
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
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Huang X, Xiang H, Bao J, Zhu J, Chen J, Zhou P, Zhou T, Xu Z. The effects of intrauterine growth on physical and intellectual development of one-year-old infants: a study on monochorionic twins with selective intrauterine growth restriction. J OBSTET GYNAECOL 2023; 43:2125300. [PMID: 36173191 DOI: 10.1080/01443615.2022.2125300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study aimed to evaluate physical and intellectual development of one-year-old infants of monochorionic twins with selective intrauterine growth restriction (sIUGR). A total of 31 pairs of sIUGR twins ageing 1 year old were included in the study. Each pair of sIUGR twins was divided into low birthweight-twin group (L-twin group) and high birthweight-twin group (H-twin group) according to twins' birthweight. The differences in height, weight, head circumstance and body mass index (BMI) in each stage were statistically significant for all measures from birth until 1 year old (p < .05), and there was a disappointed catch-up growth in lighter twins. Psychomotor development index (PDI) and mental development index (MDI) at 1 year old were significantly different between the two groups (p < .05). Stepwise regression analysis showed that the effects of weight on both PDI and MDI were statistically significant (p < .05). Intrauterine growth inconsistencies in monochorionic twins with sIUGR persist until the first year of life and affect low-birthweight infants' physical and intellectual development.Impact StatementWhat is already known on this subject? Selective intrauterine growth restriction in monochorionic twins increases the risks of intrauterine foetal demise, preterm birth, caesarean delivery and adverse neonatal outcomes, especially in the smaller foetus.What do the results of this study add? Previous studies have concentrated on the clinical management of sIUGR, while little attention has been paid to the growth and development of twins after birth. Given the adverse neurobiological effects of suboptimal nutrition on the brain development, it is important to determine whether IUGR causes long-term cognitive deficits and physical retardation. The current study has assessed the physical and intellectual development of one-year-old infants of monochorionic twins with sIUGR.What are the implications of these findings for clinical practice and/or further research? Intrauterine growth inconsistencies in monochorionic twins with sIUGR persist until the first year of life and affect low-birthweight infants' physical and intellectual development. Further research on the longer-term effects of sIUGR is needed.
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Affiliation(s)
- Xianping Huang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Huiqiu Xiang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jiale Bao
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jing Zhu
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jiajia Chen
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Panpan Zhou
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Tong Zhou
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Zhangye Xu
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Ge TJ, Kong JY. Clinical Value of Serum SIRT1 Combined with Uterine Hemodynamics in Predicting Disease Severity and Fetal Growth Restriction in Preeclampsia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:1744625. [PMID: 37064953 PMCID: PMC10104738 DOI: 10.1155/2023/1744625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 04/18/2023]
Abstract
Objective The sirtuin regulator 1-related enzyme (SIRT1) has been shown to play an important role in various pathophysiological processes. Our aim was to investigate the effect and correlation of serum SIRT1 combined with uterine hemodynamic parameters on disease severity and fetal uterine growth restriction in the progression of preeclampsia and to evaluate its clinical value as a potential marker. Methods A total of 100 patients with preeclampsia who were hospitalized in Qufu Normal University Hospital from June 2017 to June 2021 were selected as the research objects. According to the severity, they were divided into the mild (62 cases) and severe groups (38 cases), and according to whether the fetal growth restriction was combined or not, they were divided into the combined fetal growth restriction group (56 cases) and the uncomplicated fetal growth restriction group (44 cases). Serum SIRT1 expression and uterine artery hemodynamic parameters were detected, and Spearman analysis was used to evaluate the association of serum SIRT1 expression and uterine artery hemodynamic parameters (the peak-to-trough ratio of arterial blood velocity, the pulsatility index, and the resistance index) with disease severity (systolic blood pressure, diastolic blood pressure, and random urinary protein levels) and fetal growth restriction (femoral length, biparietal diameter, head circumference, and neonatal weight); unsupervised principal component analysis (PCA), supervised partial least-squares discrimination analysis (PLS-DA), cluster heat map analysis, the receiver operating characteristic (ROC) curve, and the area under curve (AUC) were used to evaluate the diagnostic value of serum SIRT1 expression combined with uterine artery hemodynamic parameters in the severity of disease and fetal growth restriction in patients with preeclampsia. Results Compared with patients with mild preeclampsia, serum SIRT1 expression was lower in patients with severe preeclampsia (p < 0.0001), the arterial blood flow velocity peak-to-trough ratio, pulsatility index, and resistance index were higher (p < 0.001; p < 0.0001); and serum SIRT1 expression and uterine artery hemodynamic parameters were closely related to disease severity (p < 0.001; p < 0.0001). In addition, the expression of serum SIRT1 in patients with preeclampsia combined with fetal growth restriction was lower than patients without preeclampsia (p < 0.0001); the peak-to-trough ratio of arterial blood flow velocity, the pulsatility index, and the resistance index were higher (p < 0.0001); and serum SIRT1 expression and uterine artery hemodynamics were closely related to fetal growth restriction (p < 0.0001). Unsupervised PCA analysis and supervised PLS-DA analysis showed that patients with different severity of disease and patients with or without fetal growth restriction were similar within the groups, and there were significant differences between the groups; cluster heat map analysis showed that the mild and severe groups were stratified clustering, and the combined fetal growth restriction group and the uncombined group were hierarchically clustered; ROC curve showed that the AUC of serum SIRT1 expression combined with uterine artery hemodynamic parameters was 0.776 in identifying the severity of preeclampsia and 0.956 in identifying the preeclampsia complicated by fetal growth restriction. Conclusion Serum SIRT1 combined with uterine hemodynamic parameters in preeclampsia is closely related to disease severity and fetal growth restriction and is expected to become a potential biomarker for early clinical intervention in patients.
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Affiliation(s)
- Tong Jun Ge
- Qufu Normal University Hospital, Qufu 273165, Shandong, China
| | - Jian Ying Kong
- Department of Imaging, Qufu People's Hospital, Qufu 273100, Shandong, China
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10
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Reichman O, Rottenstreich M, Sela HY, Michaelson-Cohen R, Ehrlich Z, Rotem R, Grisaru-Granovsky S. Repeat low order caesarean delivery, risk factors for complications: A retrospective, longitudinal study. PLoS One 2023; 18:e0276869. [PMID: 36753477 PMCID: PMC9907808 DOI: 10.1371/journal.pone.0276869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/16/2022] [Indexed: 02/09/2023] Open
Abstract
One-third of cesarean deliveries (CDs) are repeat operations, of which the majority are low-order, second (CD2) and third (CD3). The study objectives were to identify risk factors for a complicated maternal CD among women undergoing a repeat low-order CD and to develop a predictive model for at-risk women. A retrospective longitudinal follow-up study was conducted in a single medical center, during 2005-2016. Women who underwent both CD2 and CD3 at the site were included. Those with placenta accreta or a caesarean hysterectomy were excluded. A composite complicated maternal CD was defined by either uterine rupture/dehiscence, blood transfusion, relaparotomy, admission to the intensive care unit or prolonged operative time >90th percentile. Data was analyzed comparing between CD2 to CD3, each woman served as her own control. Univariate analysis followed by a multivariate logistic regression modeling were performed with an OR of 95% CI defining significance. The study group comprised of 1,331 women. A complicated CD occurred in 159 (12%) vs. 226 (17%) of CD2 vs. CD3 respectively, (p<0.001). Women with a complicated CD2 were at higher risk for complications in CD3, aOR 2.3 (95% CI 1.5, 3.3). Sub-Saharan African origin and preterm delivery at CD3 were both risk factors for a complicated CD3, aOR 3.7 (95% CI 1.9, 7.3) and aOR 1.7 (95% CI 1.1, 2.7), respectively. The multivariate regression model included 1328 cases, was statistically significant, χ2(7) = 50.760, p <0.001, explained 6.3% of the variance of composite complicated maternal CD3 and correctly classified 82.9% of cases. Although a complicated CD2, Sub-Saharan African origin and preterm delivery are risk factors for maternal complications in CD3, it is hard to predict which specific women will experience complications. Sensitivity, specificity, positive and negative predictive value of a complicated CD2 for detecting complications in CD3 were 21%, 90%, 30% and 85% respectively.
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Affiliation(s)
- Orna Reichman
- Faculty of Medicine, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
- * E-mail:
| | - Misgav Rottenstreich
- Faculty of Medicine, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hen Y. Sela
- Faculty of Medicine, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Michaelson-Cohen
- Faculty of Medicine, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zvi Ehrlich
- Faculty of Medicine, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reut Rotem
- Faculty of Medicine, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Faculty of Medicine, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Andreasen LA, Feragen A, Christensen AN, Thybo JK, Svendsen MBS, Zepf K, Lekadir K, Tolsgaard MG. Multi-centre deep learning for placenta segmentation in obstetric ultrasound with multi-observer and cross-country generalization. Sci Rep 2023; 13:2221. [PMID: 36755050 PMCID: PMC9908915 DOI: 10.1038/s41598-023-29105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
The placenta is crucial to fetal well-being and it plays a significant role in the pathogenesis of hypertensive pregnancy disorders. Moreover, a timely diagnosis of placenta previa may save lives. Ultrasound is the primary imaging modality in pregnancy, but high-quality imaging depends on the access to equipment and staff, which is not possible in all settings. Convolutional neural networks may help standardize the acquisition of images for fetal diagnostics. Our aim was to develop a deep learning based model for classification and segmentation of the placenta in ultrasound images. We trained a model based on manual annotations of 7,500 ultrasound images to identify and segment the placenta. The model's performance was compared to annotations made by 25 clinicians (experts, trainees, midwives). The overall image classification accuracy was 81%. The average intersection over union score (IoU) reached 0.78. The model's accuracy was lower than experts' and trainees', but it outperformed all clinicians at delineating the placenta, IoU = 0.75 vs 0.69, 0.66, 0.59. The model was cross validated on 100 2nd trimester images from Barcelona, yielding an accuracy of 76%, IoU 0.68. In conclusion, we developed a model for automatic classification and segmentation of the placenta with consistent performance across different patient populations. It may be used for automated detection of placenta previa and enable future deep learning research in placental dysfunction.
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Affiliation(s)
- Lisbeth Anita Andreasen
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark.
| | - Aasa Feragen
- Technical University of Denmark (DTU) Compute, Lyngby, Denmark
| | | | | | - Morten Bo S Svendsen
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark
| | - Kilian Zepf
- Technical University of Denmark (DTU) Compute, Lyngby, Denmark
| | - Karim Lekadir
- Artificial Intelligence in Medicine Lab (BCN-AIM), Universitat de Barcelona, Barcelona, Spain
| | - Martin Grønnebæk Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark.,Department of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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12
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Sadlecki P, Walentowicz-Sadlecka M. Prenatal diagnosis of fetal defects and its implications on the delivery mode. Open Med (Wars) 2023; 18:20230704. [PMID: 37197356 PMCID: PMC10183726 DOI: 10.1515/med-2023-0704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/19/2023] Open
Abstract
Congenital malformations are defined as single or multiple defects of the morphogenesis of organs or body parts, identifiable during intrauterine life or at birth. With recent advances in prenatal detection of congenital malformations, many of these disorders can be identified early on a routine fetal ultrasound. The aim of the present systematic review is to systematize the current knowledge about the mode of delivery in pregnancies complicated by fetal anomalies. The databases Medline and Ebsco were searched from 2002 to 2022. The inclusion criteria were prenatally diagnosed fetal malformation, singleton pregnancy, and known delivery mode. After the first round of research, 546 studies were found. For further analysis, studies with full text available concerning human single pregnancy with known neonatal outcomes were considered. Publications were divided into six groups: congenital heart defects, neural tube defects, gastroschisis, fetal tumors, microcephaly, and lung and thorax malformations. Eighteen articles with a descripted delivery mode and neonatal outcome were chosen for further analysis. In most pregnancies complicated by the presence of fetal anomalies, spontaneous vaginal delivery should be a primary option, as it is associated with lower maternal morbidity and mortality. Cesarean delivery is generally indicated if a fetal anomaly is associated with the risk of dystocia, bleeding, or disruption of a protective sac; examples of such anomalies include giant omphaloceles, severe hydrocephalus, and large myelomeningocele and teratomas. Fetal anatomy ultrasound should be carried out early, leaving enough time to familiarize parents with all available options, including pregnancy termination, if an anomaly is detected.
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Affiliation(s)
- Pawel Sadlecki
- Department of Obstetrics and Gynecology, Regional Polyclinical HospitalGrudziadz, Poland
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13
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Agrawal S, Parks WT, Kingdom JC. Uterine and umbilical artery Doppler combined with placental growth factor assay for placental function expertise in the assessment of fetal growth restriction: a response. Am J Obstet Gynecol 2023; 228:108-109. [PMID: 36108730 DOI: 10.1016/j.ajog.2022.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/06/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Swati Agrawal
- Division of Maternal-Fetal Medicine (Placenta Program), Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - W Tony Parks
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - John C Kingdom
- Division of Maternal-Fetal Medicine (Placenta Program), Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 600 University Ave., Ontario, Canada M5G 1X5.
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14
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Carbillon L, Benbara A, Fermaut M. High second-trimester uterine artery impedance correlates to maternal vascular malperfusion and related-complications. Acta Obstet Gynecol Scand 2022; 102:398-399. [PMID: 36825667 PMCID: PMC9951323 DOI: 10.1111/aogs.14486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Lionel Carbillon
- Department of Obstetrics and GynecologyHôpital Jean Verdier, Assistance Publique—Hôpitaux de ParisBondyFrance,Université Sorbonne Paris NordBobignyÎle‐de‐FranceFrance
| | - Amélie Benbara
- Department of Obstetrics and GynecologyHôpital Jean Verdier, Assistance Publique—Hôpitaux de ParisBondyFrance
| | - Marion Fermaut
- Department of Obstetrics and GynecologyHôpital Jean Verdier, Assistance Publique—Hôpitaux de ParisBondyFrance
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15
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Mazza GR, Youssefzadeh AC, Klar M, Kunze M, Matsuzaki S, Mandelbaum RS, Ouzounian JG, Matsuo K. Association of Pregnancy Characteristics and Maternal Mortality With Amniotic Fluid Embolism. JAMA Netw Open 2022; 5:e2242842. [PMID: 36399343 PMCID: PMC9675004 DOI: 10.1001/jamanetworkopen.2022.42842] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE Amniotic fluid embolism (AFE) is an uncommon pregnancy complication but is associated with high maternal mortality. Because of the rarity of AFE, associated risks factors and maternal outcomes have been relatively understudied. OBJECTIVE To examine the clinical, pregnancy, and delivery characteristics and the maternal outcomes related to AFE in a recent period in the US. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined hospital deliveries from January 1, 2016, to December 31, 2019, from the Healthcare Cost and Utilization Project's National Inpatient Sample. MAIN OUTCOMES AND MEASURES The primary outcome was clinical, pregnancy, and delivery characteristics of AFE, assessed with a multivariable binary logistic regression model. The coprimary outcome was failure to rescue, defined as maternal mortality after AFE. Associations with other severe maternal morbidity indicators and failure to rescue per clinical and pregnancy characteristics were also assessed. RESULTS A total of 14 684 135 deliveries were examined, with AFE diagnosed in 880 women, corresponding to an incidence rate of 6.0 per 100 000 deliveries. The cohort-level median patient age was 29 years (IQR, 25-33 years). In a multivariable analysis, (1) patient factors of older age, Asian and Black race, Western US region, pregestational hypertension, asthma, illicit substance use, and grand multiparity; (2) pregnancy factors of placental accreta spectrum (PAS), placental abruption, uterine rupture, polyhydramnios, chorioamnionitis, preeclampsia, fetal growth restriction, and fetal demise; and (3) delivery factors of early gestational age, cervical ripening, cesarean delivery, operative delivery, and manual removal were associated with AFE. Among these characteristics, PAS had the largest association with AFE (adjusted odds ratio [aOR], 10.01; 95% CI, 7.03-14.24). When stratified by the PAS subtypes, more severe forms of PAS had a greater association with AFE (aOR for increta and percreta, 17.35; 95% CI, 10.21-28.48; and aOR for accreta, 7.62; 95% CI, 4.83-12.01). Patients who had AFE were more likely to have coagulopathy (aOR, 24.68; 95% CI, 19.38-31.44), cardiac arrest (aOR, 24.56; 95% CI, 17.84-33.81), and adult respiratory distress syndrome (aOR, 10.72; 95% CI, 8.09-14.20). The failure-to-rescue rate after AFE was 17.0% overall. However, the failure-to-rescue rate exceeded 30% when AFE co-occurred with other severe maternal morbidity indicators: 45.8% for AFE, cardiac arrest, and coagulopathy; 43.2% for AFE, shock, and cardiac rhythm conversion; and 38.6% for AFE, cardiac arrest, coagulopathy, and shock. The failure-to-rescue rate after AFE also exceeded 30% when AFE occurred in the setting of placental pathology: 42.9% for AFE and PAS and 31.3% for AFE and placental abruption. CONCLUSIONS AND RELEVANCE This contemporaneous, national-level analysis validated previously known risk factors for AFE and confirmed the dismal outcomes of pregnancy complicated by AFE. The association between PAS and AFE, which was not previously reported, warrants further investigation.
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Affiliation(s)
- Genevieve R. Mazza
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Ariane C. Youssefzadeh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Rachel S. Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Joseph G. Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
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