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Introduction: Ultrasound elastography is a technique used to quantify biomechanical changes that occur in parenchymal tissue with disease. Recent research has applied the technique to the placenta in order to investigate changes associated with uteroplacental dysfunction. We performed a literature review to summarise the current available information regarding this novel technique. Methods: Pubmed, CINAHL and Embase were searched using the terms “placenta”, “ultrasound” and “elastography”. Only full text studies written in English and limited to placental sonoelastography were included. Results: Twenty-eight studies met the inclusion criteria and were included in this review. Publications were divided into in vivo and ex vivo groups, and further categorised into four subgroups: normal pregnancy, pregnancy-induced hypertension and pre-eclampsia, fetal growth restriction and other pregnancy complications. Conclusion: Ultrasound elastography can quantitatively assess biomechanical properties of the placenta in conditions where placental function is compromised.

Normal pregnancy is a complex and dynamic process that requires significant adaptation from the maternal system. Failure of this adaptive process in pregnancy contributes to many pregnancy related disorders, including the hypertensive disorders of pregnancy. This article discusses placental development and how abnormalities in the process of vascular remodeling contribute to the multisystem maternal and fetal disease that is preeclampsia and fetal growth restriction. We review some of the consequences of this condition on the mother and fetus, aspects of the clinical management of preeclampsia and how it can influence both mother and infant in the postnatal period and beyond.

Objective The purpose of this study was to analyze serum 25-hydroxyvitamin D levels in normal pregnant women, severe preeclampsia, and severe preeclampsia with complications. Method This research was a cross-sectional study; the sample was 86 third-trimester pregnant women consisting of 44 normal pregnant mothers, 30 severe preeclampsia and 12 people severe preeclampsia with complications. The diagnosis based on obstetrics and gynecology physicians who served at the research hospital. Serum levels of 25-hydroxyvitamin D are measured using VD (vitamin D) human Enzyme-Linked Immunosorbent Assay (ELISA) Kit. Results Serum levels of 25-hydroxyvitamin D showed that there were statistically significant differences in the normal pregnancy group, severe preeclampsia group, and severe preeclampsia group with complications. Low serum 25-hydroxyvitamin D levels were severe in severe preeclampsia, while the highest 25-hydroxyvitamin D serum levels were in complicated severe preeclampsia. Observation on medical records that the majority of severe preeclampsia has received treatment that increases serum levels 25-hydroxyvitamin D. Conclusion Our study found that serum 25-hydroxyvitamin D levels will decrease as preeclampsia worsens and will increase again after receiving treatment. Earlier treatment in the early period of preeclampsia will be better than if there had been severe preeclampsia.

Primary aldosteronism, the most common secondary cause of hypertension is likely to be significantly underdiagnosed in pregnancy and is associated with high rates of adverse maternal and fetal outcomes. Normal pregnancy is associated with a rise in aldosterone and renin levels early in pregnancy making the aldosterone:renin ratio which is normally used to screen for primary aldosteronism, difficult to interpret. Additionally, many laboratories have moved from performing plasma renin activity to measurements of direct renin. Aldosterone, direct renin and aldosterone: renin ratios were determined in 9 women with primary aldosteronism and compared to levels in 33 women with chronic hypertension. All women with primary aldosteronism had a direct renin levels of less than 20 mU/L together with aldosterone:renin ratio of greater than 40. Values for direct renin were significantly lower, and the aldosterone:renin ratio was significantly higher in pregnancy in women with primary aldosteronism compared to women with chronic hypertension. Pregnant women with chronic hypertension who have a direct renin level less than 20 mU/L and aldosterone:renin ratio of greater than 40 should have close surveillance for maternal and fetal complications, and follow-up postpartum should be ensured for definitive testing.

Pregnancy is characterized by marked alterations in the hypothalamic–pituitary–adrenal axis and in the function of the adrenal gland. Some of those alterations have clinical characteristics that are similar to those of adrenal gland disorders. While adrenal disorders are rare among pregnant women, they harbor the potential for significant morbidity if they remain unrecognized and untreated. As the majority of patients with adrenal disorders present with clinical features that are typical of normal pregnancy - diagnosis during pregnancy is not uncommonly delayed. A high index of suspicion must be practiced for these disorders as they might carry severe obstetrical negative outcomes. In this review we will survey the normal function of adrenal glands in pregnancy and the role of adrenal hormones in pregnancy. We will outline the adrenal disorders that commonly present during pregnancy and review the literature on treatment modalities.

Aim The purpose of the present study is to evaluate and understand the association of global and MTHFR gene specific methylation in the progression of a normal pregnancy. Methods The subjects comprised of normal pregnant women and non pregnant women. Fasting blood sample (~5 ml) was drawn from all the participants followed by DNA extraction, global DNA methylation and MTHFR gene specific methylation. Results Women with normal pregnancy were having relatively lower levels of global methylation in their first trimester as compared to non pregnant women. The trend of MTHFR gene specific methylation was exactly opposite of that of global methylation in the respective three trimesters and full term. Among normal pregnant women in the first trimester, a significant increase in MTHFR gene specific methylation is observed as compared to the non pregnant controls, followed with a relative decline in the second, third trimester and full term. Conclusion The present study speculates that pregnancy is associated with decrease in global methylation levels and increase in MTHFR gene specific methylation as compared to non pregnant state. There is an inverse relationship between global and MTHFR gene specific methylation.

Previously reported haemostatic reference intervals in normal pregnancy displayed considerable contradictions to establish convince gestational age-related haemostatic reference values. 30 clinical reports were recruited to collect and assemble existing clinical reports from the database D-dimer levels increased progressively with gestational ages and exceeded conventional value of 1 mg/L after 29–36 weeks, and reached a peak at 24 h postpartum with mean value of 6.44 mg/L [95% confidence interval (CI): 5.84 to 7.05] and returned to 0.79 mg/L (95% CI: 0.43 to 1.16) at 1–8 weeks postpartum. Analogously, the level of fibrinogen gradually increased throughout the pregnancy, and peaked at 48–72 h after birth, with mean value of 9.05 g/L (95% CI: 2.22 to 15.89) and then returned to 3.62 g/L (95% CI: 3.03 to 4.20) at 1–8 weeks postpartum. However, in the middle trimester, asynchronously prothromb in fragments 1 + 2 (F1+2) level elevated and reached a peak at 28–36 weeks with mean value of 3.05 nmol/L (95% CI: 2.41 to 3.70), and then decreased in the later trimester, and reached 1.92 nmol/L (95% CI: 0.58 to 3.27) at 48–72 h post-partum, close to normal levels. Previously reported gestational age-related haemostatic reference intervals in pregnancy could not be used as a standard. Keywords: Coagulation markers, D-dimer, Fibrinogen, Normal reference values, Prothrombin fragments 1+2 (F1+2)

Spondyloarthritis (SpA) are a heterogeneous group of chronic inflammatory joint diseases that includes several clinical subgroups. SpA can affect women in the reproductive stage so pregnancy can influence the course of the disease and SpA can affect the maternal-fetal outcome. The treatment of SpA has changed dramatically in recent years and the use of targeted drugs is part of therapeutic armamentarium. The use of targeted drugs during pregnancy is controversial because the information available on safety during this period is still limited. Several cytokines have an important role in the normal development of pregnancy or other cytokines may play a role in certain maternal-fetal complications. Potentially targeted drugs can affect the function of these cytokines during pregnancy. The aim of this study is to review the interrelationship between SpA during pregnancy and lactation, the role of some cytokines during normal pregnancy and the development of maternal-fetal complications as well as to review recent information on targeted drugs during pregnancy and breastfeeding in these patients in order to maximize their use in these critical periods of life.

The current study is aimed at analyzing the correlation and differential expression of three entities namely, TIMP metallopeptidase inhibitor-1 (TIMP-1), a glycoprotein, serum adipokine (GBP-28), an amino acid protein and neuroendocrine basic polypeptide NBP-cystatin3 (NBP-Cyc 3) in HDP (Hypertensive Disorders complicating Pregnancy). A total of 63 patients, diagnosed with HDP at the study hospital during the study period, was placed under treatment (HDP) group. While healthy group had a total of 50 women with normal pregnancy during the same period. Both these groups were compared in terms of GBP-28, TIMP-1 and NBP-Cyc 3 levels. Further, the author also checked the correlation, diagnostic value and prognosis for the three factors and HDP. There was a significant increase observed in the expression levels of serum TIMP-1 and NBP-Cyc 3 in HDP during ELISA compared to GB. However, HDP group recorded low value of serum GBP-28 than healthy group (all P < 0.001). There is a relationship between the expressions of GBP-28, TIMP-1 and NBP-Cyc 3 and the abnormalities in lipid and glucose metabolisms, resulting in severe clinical conditions among HDP patients. The inference from spearman correlation analysis is that serum GBP-28 and the severity of HDP are negatively correlated. While Serum TIMP-1 and NBP-Cyc 3 had a positive correlation with the severity of HDP (all P < 0.001). When diagnosing HDP, the AUC values of both GBP-28 and NBP-Cyc 3 single diagnosis were above 0.8. Multivariate conditional logistic regression was deployed to assess the risk factors associated with HDP. The results listed the independent risk factors such as GBP-28, TIMP-1 and NBP-Cyc 3 and disease severity for the prognosis of HDP. Among HDP patients, upregulated expressions of serum TIMP-1and NBP-Cyc 3 were observed while in case of GBP-28, it was vice versa. The significant role, played by GBP-28, TIMP-1 and NBP-Cyc 3 in the progression of HDP, makes these entities potential serum biomarkers in diagnosis and assessment of HDP.

Outside of pregnancy excessive salt consumption is known to be harmful being linked to increased blood pressure and cardiovascular disease. However, pregnancy represents a major change to a woman's physiology resulting in an intimate adaptation to environmental conditions. It is now becoming apparent that salt is essential for a number of these changes during pregnancy including haematological, cardiac adaptations as well as directly influencing placental development and the uteroplacental immune environment. The present review discusses the important role that salt has during normal pregnancy and evidence will also be presented to show how the placenta may act as a salt sensing organ temporarily, yet substantially regulating maternal blood pressure., Highlights • The placenta may function as an extrarenal regulator of maternal blood pressure. • Na+handling in pregnancy is completely different to the non-pregnant situation. • Na+may actually lower blood pressure in pregnancy affected with pre-eclampsia. • Aldosterone is an important regulator of placental and fetal development. • Na+ may compensate for aldosterone deficiency in pregnancy.

Because pregnant women have an increased risk of venous thromboembolism (VTE) and at the same time normal pregnancy is associated with symptoms, mimicking those present in the setting of acute pulmonary embolism (PE), the latter diagnosis is frequently suspected in this patient category. Since imaging tests expose both mother and foetus to ionizing radiation, the ability to rule out PE based on non-radiological diagnostic tests is of paramount importance. However, clinical decision rules have only been scarcely evaluated in the pregnant population with suspected PE, while D-dimer levels lose diagnostic accuracy due to a physiological increase during normal pregnancy. Consequently, clinical guidelines provide contradicting and weak recommendations on this subject and the optimal diagnostic strategy remains highly debated. With this systematic review, we aimed to summarize current evidence on the safety and efficacy of clinical decision rules and biomarkers used in the diagnostic management of suspected acute PE in pregnant patients.

Background Neonatal intracranial pial arteriovenous fistulas (AVFs) are rare vascular malformations. The pathophysiology of hydrocephalus in cases of pial AVF remains to be fully understood. Here, authors report a case of pial AVF with a large venous varix, which rapidly expanded after cerebrospinal fluid (CSF) diversion. Case description A female neonate was born at full term following a normal pregnancy and delivery. A supracerebellar pial AVF with a large venous varix and the hydrocephalus due to complex mechanism were found on fetal imaging. She had no neurological deficits, but her head circumference was slightly larger than normal. The hydrocephalus was treated via CSF diversion, but this was followed by a remarkable expansion of the venous varix. Transarterial embolization of the AVF was subsequently performed, which resulted observable improvement of the hydrocephalus. Conclusion Hydrocephalus complicating pial AVFs with a venous varix should not be treated by CSF diversion first. Instead, the initial step in the treatment should be obliteration of the AVFs. This restores the hydrodynamic balance between the CSF and intracranial venous system, resulting in the gradual improvement of the hydrocephalus.

We evaluated the diagnostic accuracy of activin B in discriminating tubal ectopic pregnancy (tEP) from intrauterine miscarriages (IUM), and normal viable intrauterine pregnancy (IUP). We included 28 women with tEP, 31 women with IUM, and 29 normal IUP, confirmed both by clinical examination and ultrasonography. Serum activin B concentration was measured at the time of admission using the ELISA kit. The median serum activin B concentration was found to be significantly decreased in both tEP (p=0.004) and IUM (p=0.022) compared to normal IUP. When compared between tEP and IUM, activin B concentrations did not differ significantly. ROC analysis of activin B and free β-hCG demonstrated AUC of 0.722 and 0.805, respectively to discriminate tEP from viable IUP. The model including both activin B and free β-hCG improved the discriminating potential with greater AUC (0.824), and specificity (93%) than individual one. To discriminate tEP from IUM, activin B, free β-hCG and combination of both performed poorly. We conclude that serum activin B concentration is lower in tubal ectopic pregnancy, and can discriminate it from normal pregnancy with moderate accuracy. It also shows improved diagnostic potential along with free β-hCG, but cannot distinguish tEP from IUM reliably.

Spontaneous platelet aggregation has not been adequately assessed as a potential risk factor for adverse outcomes in pregnancy. Therefore the objective of this study was to assess spontaneous platelet aggregation (SPA), measured via a novel functional assay, as a risk factor for hypertensive disease and intra-uterine growth restriction (IUGR).This was a prospective longitudinal study. Spontaneous platelet aggregation was assessed as a marker of platelet reactivity using a modification of light transmission aggregometry. Platelet reactivity was assessed in four groups: non-pregnant healthy female volunteers (n=30), longitudinally in normal uncomplicated pregnancy (n=50), hypertensive disorder (n=40) and IUGR (n=30). The mean percentage SPA was plotted and compared across all groups.Spontaneous platelet aggregation was significantly reduced in the first trimester compared to the non-pregnant group (p-value=0.003). The mean aggregation for the hypertensive group was 1.9%, (95% CI -0.08 to 4.02) and for the IUGR group was 1.6%, (95% CI -0.6 to 3.72). Platelet aggregation in the hypertensive group was significantly reduced compared to the normal pregnant group (p0.05). Spontaneous platelet aggregation was also reduced in the IUGR group compared to normal pregnancy (p0.05).This study demonstrates that a reduction of spontaneous platelet aggregation may be a novel risk factor for adverse pregnancy outcomes such as pre-eclampsia and IUGR. The most clinically significant finding is that SPA is significantly lower in pregnancies complicated by hypertension and IUGR compared to those who had a normal pregnancy outcome. Further studies should be carried out to asses if spontaneous platelet aggregation may be a clinically useful tool for the prediction of pre-eclampsia and IUGR.

OBJECTIVES: Maternal plasma metabolites have been linked with pregnancy outcomes, and two studies reported that metabolite levels differ by trimester. However, dynamic metabolite trajectories in normal pregnancy have not been characterized. We examined metabolite trajectories and tested whether trajectories differed by maternal body mass index (BMI) or fetal sex. METHODS: We quantified 3 panels of targeted metabolites—37 amino acids, 37 phospholipid fatty acids and 28 acylcarnitines—in blood samples collected longitudinally from 214 pregnant women (at 10–14, 15–26, 26–31, and 33–39 weeks, staggered to sample most weeks of pregnancy). Participants were healthy controls in a nested case-control study in the Fetal Growth Studies—Singletons. We used linear mixed models to estimate metabolite trajectories and evaluate if trajectories varied by maternal BMI (

There is no consensus on how much and at what diameters the blood flow velocity changes in the female microcirculation during normal pregnancy.A non-contact, digital slit-lamp biomicroscopy system was used to measure axial blood velocity (Vax) and diameter (D) in the conjunctival microcirculation of 28 normal non-pregnant women (Control Group), 17 women in the first semester of their normal pregnancy (Group 1) and 16 women in the third trimester of their normal pregnancy (Group 2). Blood volume flow (Q) was estimated from Vax and D. Microvessels were classified as "capillaries" (CAP) with D 9 μm, "postcapillary venules of size 1" (PC1) with 9 ≤ D 14 μm and "postcapillary venules of size 2" (PC2) with 14 ≤ D ≤ 24 μm.The women groups did not differ significantly in age, diastolic and systolic pressure and diameter of each size. Taking as baseline the capillary Vax of 0.51 mm/s of the Control Group, there was a statistically significant (p 0.001) increase to 0.74 mm/s (45%) in Group 1 and to 0.95 mm/s (86%) in Group 2. This significant Vax increase in capillaries (CAP) was a consistent finding irrespective of the exact vessel size cut-off value for discriminating CAP from PC1. There was no statistical difference in Vax among groups at postcapillary venules of size 2 (PC2). Statistical conclusions for blood volume flows were similar to velocities.Normal pregnancy increases significantly axial blood velocity (Vax) in capillaries (CAP) with diameter9 μm.

Aim The purpose of the present study is to understand the association between global DNA methylation and cardiovascular adversities in light of Bad obstetric history. Methods The participants included women with normal pregnancy history and women with history of pregnancy complications. Fating blood sample (5 ml) was drawn from the participants followed by DNA extraction, lipid profile and global DNA methylation. Results Hypomethylation was observed among women with history of normal pregnancy and abnormal lipids and higher methylation levels were observed among women with Bad obstetric history and abnormal lipids. Conclusion The present study indicates an association between altered global methylation and dyslipidemia as well as pregnancy complications.

Introduction Women who have had pre-eclampsia (PE) have increased risk for future hypertension and cardiovascular disease; however, what defines normal blood pressure (BP) for healthy young non-pregnant women is unclear. Objective To determine: a) the normal BP range for healthy young women who have had a normal pregnancy (NP); b) the percentage of women with prior PE with BPs above this range. Methods The prospective P4 study examines BP, cardiovascular function and risk, mental health and paediatric assessment following PE and NP at 6 months, 2 yrs. and 5 yrs. post-partum. We measured routine sphygmomanometry BP, central BP (CBP) with applanation tonometry, and 24 h. ambulatory BP (ABPM) at 6 months (NP = 245, PE = 76) and, in the same women, at 2 years (NP = 66, PE = 27) post-partum. Results At 6 months PE women had higher: 1) routine BP (112/71 vs. 104/66 mmHg, p 0.001); 2) central BP (105/74 vs. 97/68 mmHg, p = 0.002); 3) ABPM (114/71 vs. 107/67 mmHg, p 0.001) than NP women. The upper normal BP at 6 months was 122/79 mmHg for routine BP (‘traditional’ = 140/90 mmHg), 115/81 mmHg for central BP (‘traditional’ = 120 mmHg systolic) and 120/77 mmHg for ABPM (‘traditional’ = 130/80 mmHg). Between group differences persisted at 2 years post-partum; there were no changes in any BP parameter within groups between 6 months and 2 years. Clinicians using traditional values would have considered up to 3% as hypertensive by routine BP, 8% by Central BP and 17% by ABPM; using these new limits hypertension detection rates were 15,13 and 20% respectively at 6 months and 22, 32 and 17% at 2 years. Discussion These new normal BP limits for defining hypertension in young women are lower than those used in the general community; using these values defines more formerly PE women as hypertensive than using traditional cut-off BP levels.

The aim of our study was to investigate whether the peripartum has any influence on platelet aggregation in the mare to characterize the role of platelets in mare's normal pregnancy. Ten healthy pregnant Italian Saddle broodmares were monitored during the peripartum (from 2 weeks before until 2 week after foaling). Blood samples were collected at 7-day intervals, except the first postfoaling sample collected within 24 ± 12 hours from parturition. A pool of 26 blood samples from nonpregnant, nonlactating mares was used as control. The obtained samples were tested for platelet aggregation using adenosine diphosphate as agonist. Significant differences ( P = .0002) were found between pregnant and control mares. The percentage of platelet aggregation increased significantly in pregnant mares starting 2 weeks before parturition. Our results support the hypothesis that a physiologically adaptive mechanism occurs in healthy periparturient broodmares to prevent excessive blood loss from damaged vessels at the time of delivery.

Introduction: Autophagy has not been studied extensively in the human placenta. This study was performed to determine whether autophagy is increased in the placentas of women with hypertensive disorders in pregnancy compared to normotensive pregnancies. Methods: LC3-II and p62 protein expression were examined by quantitative Western blotting analysis in 40 placentas from women not experiencing labor pains. The 40 placentas were from 13, 8, and 19 women with preeclampsia, gestational hypertension, and normal pregnancy, respectively. Hypertensive disorders in pregnancy included preeclampsia and gestational hypertension. Results: LC3-II expression was significantly increased, while that of p62 was significantly reduced in 21 placentas of women with hypertensive disorders compared to those with normal blood pressure irrespective of the presence or absence of fetal growth restriction (FGR). LC3-II expression was also significantly increased in 13 placentas of women with preeclampsia irrespective of the presence or absence of FGR. Discussion: The results of this study suggested that autophagy is active in the placenta of hypertensive disorders even in the absence of FGR. (C) 2014 Elsevier Ltd. All rights reserved.

During pregnancy, a woman may notice the development of a number of new symptoms. Many of these are widely accepted as a normal part of uncomplicated pregnancy but others may be of more concern. The anatomical and physiological changes that accompany normal pregnancy are profound, and it is therefore not surprising that as the various systems adapt, which can result in changes that overlap with those seen in disease. Additionally, sub-clinical disease can be unmasked during pregnancy, when the physiological adaptation to pregnancy provides an additional stress test. Common symptoms may include palpitations, dyspnoea, peripheral oedema, nausea, vomiting and pruritus. Underlying alterations in major organs can explain a large number of symptoms and signs, which are benign. It is prudent that clinicians are aware of those symptoms and signs that warrant further investigation and that may be associated with disease. Furthermore, biochemical and haematological variables may also be altered in pregnancy, and this should be taken into account when interpreting blood results.

INTRODUCTION: Preeclampsia affects about 3% of pregnancies and the placenta is believed to play a major role in its pathophysiology. Lately, the role of the placenta has been hypothesised to be mor ...

Food intake increases to a varying extent during pregnancy to provide extra energy for the growing fetus. Measuring the respiratory quotient (RQ) during the course of pregnancy (by quantifying O2 consumption and CO2 production with indirect calorimetry) could be potentially useful since it gives an insight into the evolution of the proportion of carbohydrate vs. fat oxidized during pregnancy and thus allows recommendations on macronutrients for achieving a balanced (or slightly positive) substrate intake. A systematic search of the literature for papers reporting RQ changes during normal pregnancy identified 10 papers reporting original research. The existing evidence supports an increased RQ of varying magnitude in the third trimester of pregnancy, while the discrepant results reported for the first and second trimesters (i.e. no increase in RQ), explained by limited statistical power (small sample size) or fragmentary data, preclude safe conclusions about the evolution of RQ during early pregnancy. From a clinical point of view, measuring RQ during pregnancy requires not only sophisticated and costly indirect calorimeters but appears of limited value outside pure research projects, because of several confounding variables: (1) spontaneous changes in food intake and food composition during the course of pregnancy (which influence RQ); (2) inter-individual differences in weight gain and composition of tissue growth; (3) technical factors, notwithstanding the relatively small contribution of fetal metabolism per se (RQ close to 1.0) to overall metabolism of the pregnant mother.

Members of the galectin family are expressed within the female reproductive tract and have been shown to be involved in multiple biological functions that support the progression of pregnancy. Specific expression patterns of different members of this family have been identified at the maternal decidua and on the placental side. In some cases, mechanisms by which galectins exert their functions have been delineated in adverse pregnancy outcomes. This review summarizes studies on galectins that have been documented to be important for pregnancy maintenance, either supporting the maternal adaptation to pregnancy or the placentation process. In addition, we focus our discussion on the role of galectins in preeclampsia, a specific life-threatening pregnancy disorder. Fil: Blois, Sandra M.. Universitätsmedizin Berlin; Alemania Fil: Barrientos, Gabriela Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina

To study the effect of integrated yoga on Pregnancy experience, anxiety, and depression in normal pregnancy.This Prospective Randomized control study recruited 96 women in 20th week of normal pregnancy. Yoga group (n = 51) practiced integrated yoga and control group (n = 45) did standard antenatal exercises, one hour daily, from 20th to 36th week of gestation. Mann-Whitney and Wilcoxon's tests were used for statistical analysis.There was significant difference between groups (Mann-Whitney p0.001) in all variables. There were significant changes within groups (Wilcoxon's p0.001) in both groups. Pregnancy related experience (PEQ) reduced in yoga by 26.86%, State (STAI I) anxiety (decreased 15.65% in yoga, increased 13.76% in control), Trait (STAI II) anxiety (decreased 8.97% in yoga, increased 5.02% in control) and Depression (HADS) (decreased 30.67% in yoga, increased 3.57% in control).Yoga reduces anxiety, depression and pregnancy related uncomfortable experiences.

Introduction In women with hereditary angioedema (HAE) due to C1-inhibitor (C1-INH) deficiency, pregnancy can have a variable effect on disease activity. C1-INH concentrate is recommended as first-line therapy for pregnant patients with HAE. Subcutaneous C1-INH (HAEGARDA®, CSL Behring) is indicated for routine prophylaxis to prevent HAE attacks in adolescents and adults. This analysis examines outcomes in patients who became pregnant during C1-INH (SC) treatment in an open-label safety study. Methods Per study protocol, patients who became pregnant during treatment were required to discontinue the study. These patients were assessed during exposure to C1-INH in the open-label study and followed post-discontinuation to assess pregnancy outcomes. Results Four patients discontinued the study due to pregnancy as mandated by the protocol. C1-INH (SC) exposure after the last menstrual period ranged from 4 to 8 weeks (9, 10, 10, and 15 doses). Pregnancy was normal in all cases, with no related complications. All 4 women delivered live healthy infants, 1 by vaginal delivery and 3 by caesarean section at 36 to 40 weeks gestation. No congenital abnormalities were reported. With twice-weekly C1-INH (SC) treatment in the open-label study (total exposure: 25.3-43.1 weeks), 3 women had ≥50% reduction in HAE attacks relative to the number used to qualify for study entry. Three patients had Conclusions In this study, patients with HAE who were exposed to C1-INH (SC) during the first trimester of pregnancy had normal pregnancy outcomes, and all delivered healthy newborns.

Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal morbidity and mortality worldwide. Pre-eclampsia has recently emerged as an independent risk factor for future cardiovascular diseases. Modifications of cardiac structure and function have been described during normal and hypertensive pregnancies. Cardiovascular changes in pregnant women with HDP include increased peripheral resistance, left ventricular remodelling, diastolic dysfunction and, for some of them but still debated, a decreased in left ventricular systolic function. The aim of this systematic review and meta-analysis is to summarize evidence of sustained modifications of cardiac structure and function at least 3 months after delivery. Studies included were observational, with HDP as the main exposure and outcome measured by echocardiography (TTE) or cardiac magnetic resonance. We pooled results of modalities reported in >3 studies using a random effects model. Of 2733 potentially relevant studies, 22 were included in the meta-analysis and all of them used TTE. Women with prior HDP had a tendency to have lower LV ejection fraction, larger left atria, a higher E/A ratio and, interestingly, a higher 2D strain when compared with women with prior normal pregnancy. In conclusion, preliminary pooled data from studies evaluating post-partum cardiac structure and function by TTE suggest that echocardiographic indices of early diastolic dysfunction persist after HDP as compared with women with prior normal pregnancy.

Background: There is worldwide recognition that midwives are specialists in normal pregnancy, labour and birth and the postnatal period and that they should be educated to be primary providers of maternity care. In Jordan midwives currently have limited opportunities to fulfil this role. Since the mid-1980s, two public community colleges have offered three-year diploma midwifery education programmes in two major cities in Jordan. In 2002 the first and only four-year bachelor of midwifery education programme was established in one public university. Aim: A review to describe the design and content of midwifery education programmes in Jordan and address the question: Does the design of midwifery education programmes in Jordan encourage confidence that graduates will be competent to practise to the full capacity of the internationally defined role and scope of practice of the midwife and undertake the role of primary maternity care providers for women with low-risk pregnancies? Design: A review of Jordanian midwifery education curriculum documents was undertaken using information and documents provided by midwifery programme coordinators. Participants: Programme coordinators in all institutions in Jordan providing midwifery education programmes. Findings: The curriculum documents reflected a medical model, with an emphasis on illness and intervention rather than preparation for the internationally defined full role and scope of practice of the midwife. Implications for practice: This study provides a profile of midwifery education curriculum documents in Jordan with recommendations for changes that would position midwives as potential primary maternity care providers for women in Jordan who have uncomplicated pregnancies. © 2011 Australian College of Midwives.

To determine concurrent changes in corneal thickness, intraocular pressure (IOP), and corneal topography measurements during normal pregnancy.Prospective cohort study.We studied 50 eyes from 25 healthy women whose ages ranged from 21 to 35 years and who were first seen during the 10th week of pregnancy.Measurements included IOP (noncontact tonometry); corneal thickness (ultrasound pachymetry); and corneal topography (TMS 2N, TOMEY, Nagoya, Japan). Changes in IOP, central corneal thickness (CCT), and corneal power were calculated at 4 time periods: first trimester, second trimester, third trimester, and 3 months postpartum.The mean IOPs in the second and third trimesters of pregnancy were found to be lower than those in the first trimester and at 3 months postpartum (p = 0.001). The mean CCT in the second and third trimester of pregnancy was measured to be higher than in the first trimester and at 3 months postpartum (p0.001). Both IOP and CCT returned to first-trimester levels following delivery. In the third trimester, a 3.1% increase in CCT was associated with a 9.5 % decrease in IOP. Topographic measurements did not show statistically significant changes throughout the trimesters or after pregnancy.An increase in CCT was accompanied by a decrease in IOP in the second and third trimesters. Physiologic changes occurring in CCT and IOP should be considered in the management of glaucoma during pregnancy.

Considerable evidence indicates that one third of early pregnancy failures, spontaneous abortions and biochemical pregnancies, are due to chromosomal abnormalities, and two thirds are due to inappropriate implantation. These findings led us to investigate the role of hyperglycosylated hCG, an important pregnancy implantation signal, in pregnancy failures. We used urinary hCG determinations to evaluate a total of 127 pregnancies on the day of implantation, as marked by a positive urinary hCG. These included 81 normal term pregnancies, 18 spontaneous abortion pregnancies, and 28 biochemical pregnancies. Of the normal term pregnancies, the mean ± standard deviation concentration of hyperglycosylated hCG was 5.4 ± 4.3 mIU/ml equivalents, and the percentage of hyperglycosylated hCG was 88 ± 17%. All term pregnancies produced hyperglycosylated hCG > 51%. Of the 18 cases that spontaneously aborted, both the mean hyperglycosylated hCG (1.9 ± 2.0 mIU/ml equivalents) and the percentage of hyperglycosylated hCG (41 ± 33%) were significantly lower than in the normal pregnancy group. Only 4/18 spontaneously aborting pregnancies produced more than 51% hyperglycosylated hCG on the day of implantation. Similarly, of the 28 biochemical pregnancies, both the mean hyperglycosylated hCG (0.63 ± 1.3 mIU/ml equivalents) and the percentage of hyperglycosylated hCG (21 ± 29%) were significantly lower than in the normal pregnancy group. Only 4/28 pregnancies produced more than 51% hyperglycosylated hCG. Low hyperglycosylated hCG concentrations are associated with pregnancy failure. Whether this association is a primary cause of pregnancy failure or is simply a marker for an abnormal conceptus requires further investigation.

To determine whether there is pathogenetic link between red cells sodium-lithium counter-transport activity and digoxin-like immunoreactive substances (DLIS) in plasma of insulin-dependent diabetic (IDDM) and non-diabetic women with preexisting preeclampsia (PE).We studied Na(+)/Li(+) CT activity in red cells and plasma levels of DLIS in 11 IDDM women with preexisting PE (Group 1), 13 IDDM without preexisting PE (Group 2) 23 non-diabetic women with preexisting PE (Group 3) and 12 non-diabetic women with normal pregnancy (Group 4) at least 4 months after delivery.Na(+)/Li(+) CT activity was higher in Group 1 compared to Group 2 (mean ± SEM 0.316 ± 0.05 vs 0.190 ± 0.02 mmol/LRBC/hr p0.05) and in Group 3 compared to Group 4 (0.365 ± 0.004 vs 0.168 ± 0.01 mmol/LRBC/hr, p0.01). Plasma levels of DLIS were higher in Group 3 compared to Group 4 (0.727 ± 0.189 vs 0.295 ± 0.066 ng/ml; p0.05); there was no statistically significant difference between the two diabetic groups. In Groups 1 and 3, Na(+)/Li(+) CT activity was correlated to the plasma levels of DLIS (r = 0.927; p0.001 and r = 0.485; p0.05 respectively).Increased Na(+)/Li(+) CT activity and increased plasma levels of DLIS may contribute to PE in IDDM and non-diabetic women.

Basal values of fetal heart rate (FHR) and amplitude of the accelerations were determined in pregnant adolescents and compared with those of a control group. The study design was open, prospective, comparative and exploratory. The sample consisted of 40 patients divided into two groups. Group 1 (the problem group) was composed of 20 pregnant adolescents. Group 2 (the control group) consisted of 20 patients with a normal pregnancy. Ultrasound was used to determine the biparietal diameters of the fetuses. FHR and uterine contractility were measured for 2 h. An HP cardiotocograph, model 1350, series 50 XM was used. All these studies were longitudinal. Basal FHR and the amplitude of the accelerations of the two groups were compared. In group 1, FHR was 4 beats higher and this difference was highly significant. Amplitude was 1 beat lower. In two FHR recordings, Type II Dips of moderate and large amplitude were registered during a reactive pattern. A dispersion diagram was drawn and the linear regression of the biparietal diameter values of group 1 fetuses was calculated. The linear regression was y=2.5053x−1.3545. The correlation coefficient was very good (R2=0.9579). In group 2 (normal distribution) the linear regression equation was y=2.0344x+12.944. The correlation coefficient was excellent (R2=0.9981). The means of the biparietal diameters of the two groups were also compared. In group 1 the mean was 9 mm lower but this difference was non-significant. The means of uterine height and abdominal perimeter were 33.95 and 95.95 cm, respectively. The physical status of the newborns was evaluated using the Apgar test at 1 and 5 min. Eleven neonates were not tested. One neonate was born depressed. Eight other neonates showed a score in the range of 7–8. At 5 min, their score was between 8 and 9. The weight and height of the neonates in the two groups were compared. In group 1, weight was 16 g higher and weight was also higher but these differences were non-significant.

Trophoblast deportation was first described before the turn of the 20th Century by the German Scientist Schmorl and is now considered a normal physiological process during human pregnancy. Increased shedding and deportation of placental trophoblast is well documented in preeclampsia, one of the most common diseases of pregnancy. This review summarises the seminal historical and contemporary publications that have contributed to our knowledge of trophoblast deportation to the maternal lungs, their presence and quantity in the maternal circulation during normal pregnancy and during preeclampsia, and the range of morphologies deported trophoblasts display. Finally, the contentious nature of the deported multinucleated trophoblasts' current nomenclature (syncytial knots vs. sprouts) is considered.

The aim of this study was to investigate anti-fibrillin-1 autoantibody in patients with a history of recurrent pregnancy loss (RPL) and during normal pregnancy. Method of Study: Anti-fibrillin-1 IgG and IgM antibodies were measured by a home made ELISA in serum samples of 48 medically and obstetrically normal pregnant women, classified to three trimester groups, 15 female patients with RPL and 26 healthy non-pregnant women classified to two control subgroups: (a) women who had already had at least one previous successful pregnancy and (b) women who had never been pregnant. Differences in anti-fibrillin-1 autoantibodies between the groups were analyzed for statistical significance (Pb0.05) with one-way analysis of variance (ANOVA) and multiple comparison test — Post Hoc test, Least Significant Difference method. Results: Anti-fibrillin-1 IgM autoantibodies were significantly decreased in the second and third trimester pregnant women compared to the nulligravida controls. RPL patients had significantly increased anti-fibrillin1 IgM antibody compared to control group (a) Conclusion: Fibrillin-1 degradation seems to be decreased during the second and third trimester of normal pregnancy. Increased anti-fibrillin-1 IgM antibodies in RPL patients may be a secondary phenomenon of increased fibrillin-1 degradation and contribute to the pathogenesis of pregnancy losses.

In the latest Confidential Enquiry into Maternal and Child Health, cardiac disease remains the leading cause of maternal death in the UK. Increasing maternal age and extended survival of patients with complex congenital disease are partly responsible for a rising number of patients with cardiac disease in pregnancy. Another large proportion consists of patients with rheumatic disease (often previously undiagnosed) who present for the first time in pregnancy. Furthermore, maternal obesity and diabetes predispose to a rising number of deaths related to coronary artery disease. In all cases, early referral to a specialist centre (ideally before conception) and management by a multidisciplinary team are essential. It is important to be vigilant for new cardiovascular disease developing during pregnancy or in the postpartum period. Equally important is awareness of physiological changes of the cardiovascular system occurring during normal pregnancy.

Autoimmune diseases comprise a group of about 85 heterogeneous conditions that can affect virtually any organ and tissue in the body. Many autoimmune diseases change significantly during pregnancy: some ameliorate, some worsen, and others are unaffected. Two autoimmune diseases present prominently in relation to pregnancy: postpartum autoimmune thyroiditis and autoimmune hypophysitis. This article will review the current state of knowledge of the immunological changes that occur during normal pregnancy, and will explore the striking temporal association with pregnancy observed in thyroiditis and hypophysitis.

Objective to explore women's experiences of referral to tertiary care on the basis of uncertain ultrasound findings. Design a qualitative method using Rice and Ezzy's thematic analysis approach. Data were gathered through two in-depth interviews over a six to eight-month period. Participants a total of 20 interviews were conducted among pregnant women, purposively recruited at a tertiary facility. Inclusion criteria were based on detection of an isolated soft marker in an otherwise normal pregnancy. Data analysis interview data were transcribed and data were subjected to thematic analysis. Findings mothers journeyed through a temporal sequence of adjustment following referral to specialist services. Four distinct phases were identified: realisation; making sense of events; anxious waiting; and having no clear resolution. Conclusion trends of increasing prenatal surveillance together with advancing technology make this study timely and of global interest. Findings suggest that women identified as ‘at risk' before being discharged uneventfully may be prone to attachment issues and a host of other difficulties. The complexities inherent in this experience should be of interest to a broad range of health professionals. An appreciation of this experience may assist midwives and other health professionals to provide more meaningful maternal support to women identified as ‘at risk'.

Alpha-1-antitrpsin (AAT) is the main antiprotease of plasma. Concentration of serum alpha-1-antitrypsin (AAT) may not be delegate of the functional capacity of this antiprotease. To our knowledge there is not any report regarding the functional level of AAT in gestational diabetes mellitus (GDM). The aim of the present study was to determine serum trypsin inhibitory capacity (sTIC) in gestational diabetes mellitus.This case-control study was performed in 41 GDM and 40 healthy pregnant women. sTIC was measured by enzymatic assay.The serum trypsin inhibitory capacity was significantly lower (p0.001) in GDM (5.84+/-2.27 micromol/min/ml) than healthy pregnant women (7.24+/-1.91 micromol/min/ml).In gestational diabetes mellitus reduction of serum trypsin inhibitory capacity may be due to non-enzymatic glycosylation of alpha-1-antitrypsin or oxidation of methionin in the active site of alpha-1-antitrypsin which remains to be cleared.

We evaluated the correlation between brain natriuretic peptide (BNP) in umbilical cord blood after normal pregnancy, in blood samples of twenty-nine Italian healthy newborns and paired echocardiographic parameters. Plasma BNP was evaluated in UCB (T0) and in blood on day 3 (T1), 30 (T2) of life. Echocardiographic parameters were recorded at T1 and T2. Median of BNP concentrations in cord blood was 8.6 pg/ml. Median BNP concentrations on T1 was 59.2 pg/ml, on T2 was 8.7 pg/ml. Significantly higher BNP concentrations were reported on T1 than T0 and T2 (p0.0001), while no significant difference resulted between T0 and T2. Plasma BNP at T2 was significantly correlated with mVTI (p=0.006), E wave (p=0.004), LA (p=0.047), LVPW (p=0.004), M (p=0.025). No correlation was found with SF% and E/A. Our results confirm that in healthy and term neonates the cord blood BNP concentrations are low. On T1 BNP values are high with wide ranges because of physiological adjustment to postnatal circulation. When echocardiographic parameters are in normal ranges, BNP concentrations return to low levels on day 30. In healthy newborns left ventricular filling, LA size and M seem to influence BNP levels rather than left ventricular systolic and diastolic function.

Introduction Protein S (PS) activity has been shown to decrease during normal pregnancy. The aim of this study was to determine any correlation between decreased maternal PS activity and fetal growth restriction (FGR). Methods We carried out a retrospective study of maternal PS activity and complement 4b-binding protein (C4BP) concentration in 102 patients with FGR and 58 patients with fetuses that had normal growth. Among pregnancies affected by FGR, 14 diagnoses were made in the second trimester and 88 in the third trimester. Patients whose fetuses had normal growth were matched with FGR subjects for maternal age and gestational age at sampling (29 cases each in the second and third trimester). Results Mean PS activity of the control group in the third trimester was significantly lower than in the second trimester (56.5 ± 16.5% vs 35.8 ± 13.8%). PS activity in women with FGR was significantly decreased in both the second trimester (36.6 ± 13.2%) and third trimester (30.2 ± 12.2%) compared with control group levels. Plasma concentrations of C4BP for the control group were significantly higher in the third trimester than in the second trimester (90.5 ± 17.5% vs 81.1 ± 13.6%). However, in women with FGR, plasma C4BP concentrations in both the second trimester (84.0 ± 14.8%) and the third trimester (86.0 ± 17.7%) were comparable with concentrations of the control group. Conclusions Maternal PS activity decreased as normal pregnancies progressed but decreased over time in cases with FGR. Excessive decreases in PS activity during pregnancy could contribute to development of FGR.

An appreciation of the maternal physiologic adaptations that occur in the renal system during pregnancy is fundamental to the understanding and proper clinical management of normal pregnancy, renal disorders in the gravid patient, and pregnancy-specific conditions such as pre-eclampsia. In this article, the authors first address the anatomic changes that occur in the upper urinary tract in normal pregnancy, followed by the dramatic alterations in maternal renal hemodynamics and glomerular filtration. They also briefly discuss renal handling of various substrates in pregnancy, including protein, uric acid, and glucose. An understanding of these changes is important and relevant to the clinician caring for pregnant women.