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Background: Pre-eclampsia contributes significantly to both maternal and perinatal morbidities and mortalities. One of the identified pathophysiologies of pre-eclampsia is the deranged serum lipid profile of which some components have been found to be elevated early in pregnancy in women destined to develop pre-eclampsia. Objective: To compare the serum fasting lipid profiles of pre-eclamptic primigravidas with normal primigravidas at week 20, 28, and 34. Methods: We conducted a nested case-control study at Obafemi Awolowo University, Ile-Ife between November 2016 and April 2018. A cohort of 290 primigravidas was recruited at week 20 and followed up until delivery. Serum fasting lipid profiles were quantified at weeks 20, 28 and 34 for all participants. Twenty four women that developed pre-eclampsia were compared with 48 women that had a normal pregnancy. Data were analyzed with SPSS version 22. We used a linear mixed-effect regression model with random intercept and slope. Significance was established using p Results: Serum lipid profiles showed an average weekly increase in both groups. Primigravidas that developed pre-eclampsia had a weekly increase of 0.2(SE0.14) mmol/l in serum total cholesterol more than those with normal pregnancies. (p Conclusion: The average weekly increase in serum total cholesterol and low density lipoprotein were higher significantly in primigravidas that developed pre-eclampsia when compared to the control group. These findings depicted an association between serum lipid profile and pre-eclampsia among the primigravidas.

Objectives The purpose of this study was to evaluate serum G protein-coupled estrogen receptor-1 (GPER1) levels in non-pregnant and pregnant with and without gestational diabetes mellitus (GDM). Methods The study comprised 40 pregnant women with (n=20) and without GDM (n=20) and 20 healthy non-pregnant women. Data as maternal age, gestational age, and body mass index (BMI) of participants were recorded and serum samples were collected. Serum GPER1 levels were measured by enzyme-linked immunosorbent assays. Results Serum GPER1 level was significantly higher in GDM (p=0.03) and non-pregnant women (p=0.005) than those of normal pregnancy. There was no significant correlation between the serum GPER1 levels age (r=0.18, p=0.34), gestational age (r=−0.22, p=0.47), and BMI (r=0.004, p=0.975). Conclusions Our results suggest that changes in serum GPER1 levels in pregnancy and GDM may be associated with estrogen. More detailed studies should be conducted to monitor the changes and their interactions in serum sex hormones and serum GPER1 levels during GDM.

Background: The severe form of nausea and vomiting of pregnancy called hyperemesis gravidarum (HG) that if left untreated may lead to significant maternal morbidity and adverse birth outcomes. Helicobacter pylori (H. pylori) is a prevalent gram-negative flagellated spiral bacterium that colonizes the stomach of half of the world’s population. Researchers have hypothesized that maternal hormonal and immunological changes during pregnancy that prevent allogenic rejection of fetus reactivates the bacterium. Aim of the work is to compare between patients with hyperemesis gravidarum and normal pregnancy regarding presence of Helicobacter pylori antibodies for proper management. Materials and Methods: A case-control study was carried out on ninety pregnant women at 5-15 weeks of gestation, thirty pregnant females with single living fetus complaining of HG (Group A), Thirty pregnant females who were multiple pregnancy and/or trophoblastic disorders complaining of HG (Group B) and Thirty pregnant females with normal pregnancy (Group C). Serum test for H. pylori IgG antibody titer was done for all patients and controls using enzyme immunoassay-based kit. Results: H. pylori were noted in 32 hyperemetic cases and 6 control subjects. The presence of H. pylori increased the risk of HG more than two fold (OR = 2.923, 95% CI: 1.326-6.446, P < 0.05). Conclusion: There is powerful correlation between H. pylori and hyperemesis gravidarum which proved in single, multiple pregnancy and/or trophoblastic disorders.

ABSTRAK Kehamilan adalah fertilisasi atau penyatuan dari spermatozoa dan ovum dilanjutkan dengan nidasi atau implantasi. Bisa dihitung dari saat fertilisasi hingga lahirnya bayi, kehamilan normal akan berlangsung dalam waktu 40 minggu. Tujuan penelitian ini untuk mengetahui Gambaran Pengetahuan Remaja Mengenai Bahaya Hamil Usia Dini Di SMA Sei Putih Kecamatan Tapung Kabupaten Kampar Tahun 2021. Menggunakan jenis penelitian deskriptif kuantitatif. Populasi dalan penelitian ini yaitu siswi SMA Sei Putih sebanyak 52 orang. Teknik pengambilan sampel pada penelitian ini dengan menggunakan teknik quota sampling dimana peneliti mengambil sampel sesuai dengan yang ditargetkan atau diinginkan. Instrumen penelitian menggunakan kuesioner skala Guttman yang terdiri dari 20 pertanyaan. Analisa data menggunakan analisa univariat. Diketahui tingkat pengetahuan pada penelitian ini yaitu cukup dengan jumlah 28 responden (53,84%). Kata Kunci : Kehamilan, Siswi, Bahaya Hamil Usia Dini

OBJECTIVE Endocan is a novel marker of endothelial inflammation. In this study, we aimed to show whether there was a significant difference between the endocan levels of pregnant women with and without preterm premature rupture of membranes (PPROM and non-PPROM). Also, we aimed to find a relation between endocan levels and the latent period. MATERIAL AND METHODS Pregnant women with PPROM between 28 and 34 weeks of gestation and those without PPROM with similar gestational weeks were included in the study. A total of 88 pregnant women, 44 with PROM and 44 healthy pregnancies, were evaluated. Demographic and obstetric features, leukocyte, and endocan levels of the study and control groups were compared. RESULTS The demographic features and obstetric history of both groups were similar. The mean leukocyte and endocan levels of the study group were higher than in the control group (p

The objective of this study was to evaluate the differences and predictive efficacy of circulating cell-free DNA (cfDNA) and human suppression of tumorigenesis 2 (ST2) among women with uncomplicated pregnancies and patients with gestational hypertension (GH) or preeclampsia (PE). This study included patients with GH (n = 41), patients with PE (n = 62), and women with uncomplicated pregnancies (n = 148). The cfDNA concentration was determined by qPCR, and the ST2 levels were measured by ELISA. A receiver operating characteristic curve was employed to measure the diagnostic performance of cfDNA and ST2. Our results showed that ST2 but not cfDNA was increased in the middle and third trimesters of normal pregnancy; ST2 and cfDNA were increased in GH and PE patients compared to women with uncomplicated pregnancies. More importantly, plasma cfDNA and ST2 served as diagnostic biomarkers for GH and PE, and the AUCs were 0.883 and 0.734 for GH and 0.838 and 0.816 for PE, respectively. Moreover, their combination significantly elevated the diagnostic efficiency for GH and PE, with AUCs of 0.906 and 0.916, respectively. Plasma cfDNA and ST2 could be used as parameters for GH and PE.

The purpose of this review article is to analyze current information on the molecular mechanisms of gestational diabetes and the prospects for their use in the further development of new effective treatments for this common pathology. Decreased ability of insulin to bind to its receptor, decreased IRS-1 expression and GLUT-4 translocation, and increased levels of p85α-PI-3 kinase subunits are involved in the development of insulin resistance during pregnancy. In gestational diabetes, there are not only more significant changes of the above mentioned indicators, but also increased levels of pro-inflammatory factors: TNF-α, IL-6, leptin and decreased insulin-sensitizing factors: adiponectin and PPAR-γ. Therapeutic measures aimed at normalizing the secretion of cytokines and adipokines reduce the risk of gestational diabetes mellitus and its complications and require further development

There is still controversy regarding the changes of ventricular-arterial coupling (VAC) during normal pregnancy. The possible influence of chest shape on VAC during normal pregnancy has never been investigated.Between October 2019 and June 2020, 59 healthy pregnant women (33.7 ± 4.4 years/old) were consecutively included. They underwent obstetric visit, modified Haller index (MHI) assessment, and complete echocardiographic evaluation with blood pressure measurement to assess arterial elastance (Ea), end-systolic elastance (Ees), and Ea/Ees as an index of VAC, at 12-14 weeks and 36-38 weeks gestation, then 6-9 weeks after delivery.VAC progressively increased from the first to the third trimester of pregnancy, then decreased in the postpartum (P 0.0001) in the whole study population. Women with concave-shaped chest wall (MHI2.5, n = 31) but not women with normal chest shape (MHI ≤2.5, n = 28) showed a progressive increase in VAC during normal pregnancy. Women with MHI2.5 showed a significantly less pronounced increase in stroke volume index (SVi) from the first to the third trimester of pregnancy. There was a strong linear correlation between third trimester MHI and VAC (r = 0.93).Anatomical and/or extrinsic mechanical factors rather than impaired arterial elastance or reduced left ventricular contractility may contribute to changes in VAC during normal pregnancy in women with concave-shaped chest wall.

There are various physiological and pharmacokinetic changes occur in pregnancy to nurture the developing foetus, avoid toxicities, resistance to infections and prepare the mother for labour and delivery. Some of these changes influence normal biochemical values while others may mimic symptoms of medical disease and alter the kinetic parameters of the drugs. It is important to differentiate between normal physiological changes and disease pathology. This article highlights the important changes that take place during normal pregnancy, development of common conditions and pharmacokinetic variations. This review also will describe basic concepts in pharmacokinetics and their clinical relevance and highlight the variations in pregnancy that may impact the pharmacokinetic properties of medications, different treatment approaches, contraindications and drugs used in pregnancy Key words: Physiological changes in pregnancy, Hypertension, pregnancy disorders.

Hofbauer cells are macrophages residing in the stroma of placental villi and play a number of roles during normal pregnancy, as well as pathological conditions. A morphometric analysis of Hofbauer cells, in particular to investigate the number of cells, their size and shape in samples of normal human placenta from 1st trimester, term and with chorioamnionitis was performed. Tissue samples were immunostained for CD206 antigen and evaluated using ImageJ software. We detected significant changes in number and morphology of HBCs between normal placenta and placenta with chorioamnionitis samples. In chorioamnionitis, the cells were unevenly distributed within the villi, generally present in higher numbers, larger and more elongated than those in normal 1st trimester and term placenta.

Introduction Compliance to routine antenatal medications increases a woman’s chances of achieving a normal pregnancy and having a healthy baby. However, noncompliance is a commonly encountered problem in developing countries including Nigeria. This study investigated compliance to routine antenatal medications as reported by pregnant women receiving antenatal care in a tertiary hospital in Enugu State, Nigeria. Methods A cross-sectional descriptive survey research design was adopted for the study while simple random sampling technique was used to select the 354 pregnant women at Enugu state teaching hospital. A validated structured questionnaire (α=0.72) was utilized for data collection. Analysis of data involved descriptive and inferential statistics. Results Only 32% of pregnant women had a good compliance to their routine antenatal drugs while forgetfulness (27.2%) and vomiting as a side effect of the drug (25.7%) were the major barriers to compliance with routine drugs. Furthermore, there was a statistically significant association between respondents’ compliance with antenatal drugs and number of children as well as level of income (p

Tumors of the ovaries in general and dermoids in particular do not particularly complicate a normal pregnancy, causing the last more or less inconvenience.All ovarian tumors, with the exception of dermoid tumors, differing in relatively large sizes, generally speaking and with the exception of very bulky tumors, lessen the development of pregnancy and especially the course of labor, since these tumors have a tendency to grow upward into the abdominal cavity, thus being removed from small pelvis.

The evaluation of cardiovascular disease in pregnancy is challenging due to overlaps between cardiac and normal pregnancy symptomatology, as well as concerns about the potential impact, if any, of imaging studies on fetal development. We discuss here an approach to the evaluation of the pregnant cardiac patient and review the safety and utility of available diagnostic tests, including labs, electrocardiogram, echocardiography, stress testing, computed tomography, magnetic resonance imaging, and cardiac catheterization. Importantly, the majority of standard imaging studies can be safely performed in pregnancy, and a high index of suspicion must be maintained when evaluating pregnant patients, especially those with preexisting cardiovascular disease.

Fetal neurodevelopment in utero is profoundly shaped by both systemic maternal immunity and local processes at the maternal–fetal interface. Immune pathways are a critical participant in the normal physiology of pregnancy and perturbations of maternal immunity due to infections during this period have been increasingly linked to a diverse array of poor neurological outcomes, including diseases that manifest much later in postnatal life. While experimental models of maternal immune activation (MIA) have provided groundbreaking characterizations of the maternal pathways underlying pathogenesis, less commonly examined are the immune factors that serve pathogen-independent developmental functions in the embryo and fetus. In this review, we explore what is known about the in vivo role of immune factors in fetal neurodevelopment during normal pregnancy and provide an overview of how MIA perturbs the proper orchestration of this sequence of events. Finally, we discuss how the dysregulation of immune factors may contribute to the manifestation of a variety of neurological disorders.

Objective: Vitamin D levels have shown significant geographical distribution, therefore, this study was conducted to evaluate its relationship to a specific geographic area with a high prevalence of vitamin D deficiency to the important maternal manifestation of preeclampsia. This study established the association of vitamin D deficiency to preeclampsia among women of reproductive age. Method: It is a retrospective case-control study done to measure serum vitamin D levels in pregnant women receiving care at the King Fahad Medical City Riyadh with preeclampsia (n=100) and normal pregnancy (controls, n=200) from 2012 to 2014. Odds of developing preeclampsia with vitamin D deficiency were calculated using logistic regression analysis. Results: The mean serum vitamin D level was 25.35?ng/ml in controls and 15.95?ng/ml in pre-eclampsia women. Comparing to those who had a serum vitamin D level of ?50?ng/ml, the odds ratio of developing preeclampsia in women with vitamin D deficiency was 4.2 (95% CI=1.23-14.35) while adjusting for age, BMI and duration of pregnancy. Conclusion: The risk of developing preeclampsia might increase by up to 4-fold in women with vitamin D deficiency. Since preeclampsia could lead to maternal and neonatal complications, vitamin D could be added during pregnancy to decrease these adverse consequences. Keywords: Vitamin D deficiency; preeclampsia; BMI; hypertension. Continuous...

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.

BACKGROUND Gestational Diabetes Mellitus (GDM) is diabetes diagnosed for the first-time during pregnancy. Infants of diabetic mothers are prone to various neonatal adverse outcomes, including metabolic and hematologic disorders, respiratory distress, cardiac disorders, and neurologic impairment due to perinatal asphyxia and birth traumas, among others. METHODS This was a comparative study conducted in the Department of Obstetrics and Gynaecology, Institute of Maternal and Child Health, Medical College, Calicut. A total of 200 subjects were included in the study. The subjects were divided into two groups comprising of neonates of healthy 150 pregnant women with no history of GDM. The other group included neonates of 50 pregnant women with GDM. Cord blood sample was collected during delivery. Cord blood glucose was determined by the GOD/POD method. Birth weight of newborn was recorded following delivery. The obtained data was tabulated and analysed using appropriate statistical tests. RESULTS The mean birth weight of newborns of women with GDM was 2.96 Kg and mean birth weight of newborns of normal pregnant women was 2.81 Kg. Even though macrosomia was not observed in newborn of GDM in the present study, the birth weight is significantly higher in newborns of women with GDM (p-value

Soluble Fms like tyrosine kinase 1 (sFlt-1) is one of the markers that play a role in the pathogenesis of pregnancy induced hypertension. The aims of the research were to determine the relationship beteween sFlt-1 level and birth weight. The samples were preeclampsia inpartu consisting of 22 peopole,, and normal pregnancy women consisting of 18 people. Analytic observational study with cross sectional was conducted. The level of sFlt-1 was examined using ELISA. Statistic analysis used Kruskal Wallis test, One way Anova test and Pearson correlation test.The result indicate that the characteristics of research subject in preeclampsia group and control group do not have a significant difference (p>0.05).The negative linear relationship occured between sFlt-1 level with birth weight in preeclampsia (p=0,015). While, in the group of normal pregnancy was not available of the relationship either sFlt-1 level with birth weight (p>0.05).

During pregnancy Nitric oxide is one of the most important relaxing factors for myometrium and also in the control of blood flow in uterus and placenta. Nitric oxide is generated by endothelial type II nitric oxide synthase (NOS) and acts as a vasodilator. Objective:To investigate the level of nitric oxide (NO) production in pregnancies complicated by preeclampsia and in normal pregnancy. Materials and Methods: A case control study was undertaken in Department of Gynaecology and Obstetrics of Bangabandhu Sheikh Mujib Medical University (BSMMU), from january to july 2014. The study population was pregnant women having preeclampsia and normal pregnancy who attended the OPD Department of Obstetrics and Gynecology in BSMMU between 29 to 40 weeks of gestation. As because of transient and volatile nature of nitric oxide, it was unsuitable to measure the nitric oxide level by conventional method. However, two stable break down product, nitrate (NO3 -) and nitrate (NO2 -) could be easily detected by sprectophototric means. Nitrate (NO2 -) was first converted to Nitrite (NO3 -) by reduction process using cadmium. Then concentration was measured by using Griess reagent in UV sprectophototric machine. This procedure was done in the Biochemistry Department, Dhaka University. Results: The mean nitrite level was found 18.37}3.64 mol/L in case group and 25.57}2.11mol/ L in control group, which was significantly (p

Extracellular vesicles (EVs) are nanosized, membranous vesicles released by almost all types of cells. Extracellular vesicles can be classified into distinct subtypes according to their sizes, origins and functions. Extracellular vesicles play important roles in intercellular communication through the transfer of a wide spectrum of bioactive molecules, contributing to the regulation of diverse physiological and pathological processes. Recently, it has been established that EVs mediate foetal‐maternal communication across gestation. Abnormal changes in EVs have been reported to be critically involved in pregnancy‐related diseases. Moreover, EVs have shown great potential to serve as biomarkers for the diagnosis of pregnancy‐related diseases. In this review, we discussed about the roles of EVs in normal pregnancy and how changes in EVs led to complicated pregnancy with an emphasis on their values in predicting and monitoring of pregnancy‐related diseases.

Recurrent molar pregnancy is very rare. In this case report, we highlight a case of a patient who experienced five recurrent molar pregnancies without an intervening normal pregnancy. A 22-year-old patient was admitted to our labour room with a fifth consecutive molar pregnancy. The patient underwent suction and evacuation and was followed up with serial serum human chorionic gonadotropin (beta-hCG) estimation. The patient did not require chemotherapy. Karyotype of the patient and her husband was normal. Nonetheless, the couple was counselled for adoption.

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.

This study presents the analysis and classification of maternal status during healthy pregnancy and postpartum using bispectral features of heart rate variability (HRV). Bispectral analysis is appl...

Hypothesis/aims of study. It is assumed that intestinal dysbiosis, as well as bacterial vaginosis, may be one of the risk factors, and in some cases, the direct cause of pregnancy complications. This study was aimed to assess the intestinal and vaginal microbiocenosis composition in women with threatened miscarriage and normal pregnancy. Study design, materials and methods. The study involved 68 women aged 18 to 35 years (mean age 27.6 0.7 years) in pregnancy from 6 to 18 weeks. The main group consisted of 38 women with threatened miscarriage. The control group included women (n = 30) with normal pregnancy. Patients of the main and control groups were examined in accordance with the requirements of the Ministry of Health order No. 572n. In addition, a qualitative and quantitative microbiological analysis of vaginal discharge and feces was performed using the real-time polymerase chain reaction method. Results. Vaginal dysbiosis was detected in 60.5% of pregnant women of the main group and only 13.3% of women of the control group. In the main group, grade II dysbiosis was found in 23.7% of cases, and grade I dysbiosis in 36.8% of cases, while in the control group, these grades were found only in 3.3% and 10% of cases, respectively. Intestinal dysbiosis was diagnosed in 100% of the examined pregnant women. In patients of the main group, intestinal dysbiosis was detected as follows: grade I in 29% of cases, grade II in 52.6% of cases, and grade III in 18.4% of cases. In patients of the control group, the disorders corresponded mainly to grade I (83.4%) and, to a lesser extent, grade II (16.6%) dysbiosis, there being no cases of severe dysbiosis revealed. Conclusion. Women with threatened miscarriage had the most pronounced dysbiotic changes in vaginal and intestinal microflora compared to the control group. Vaginal dysbiosis was combined with intestinal dysbiosis in 100% of cases in patients of the main and control groups, and the degree of dysbiotic changes in the vaginal microflora was directly proportional to the degree of intestinal dysbiosis.

We studied the intensity of respiratory burst of neutrophils in the venous blood of women at different stages of reproduction using the chemiluminescent method (BHL-07). The analysis of the of luminol-dependent latex-induced luminescence parameters demonstrated that the neutrophils of pregnant women are in the primed state and equally respond to latex-mediated induction during both normal pregnancy and in case of threatened miscarriage or premature birth. However, childbirth leads to the deactivation of neutrophils, while the intensity of active radical generation does not significantly differ from that in non-pregnant women.

OBJECTIVE The aim: To find out typical pathomorphological differences in placenta of women with early and late preeclampsia. PATIENTS AND METHODS Materials and methods: Investigation includes 40 placentas from deliveries in women with preeclampsia (main group) and 40 placentas from physiological delivery in somatically healthy women, who had no complications during pregnancy (control group). Placentas in the main group were devided into two sub-groups (20 in each) - with early and late preeclampsia. Specialties of the blood vessels in normal pregnancy were investigated, and their structural transformation with the developement of preeclampsia, according to the appearence of perinatal pathology. Morphometrical data of the blood stream was investigated with the help of eyepiece and program Image Tools 3,6. RESULTS Results: Significant decrease of weight (p

Objective: to analyze the relationship between the length of marriage to pregnancy with the incidence of preeclampsia.Materials and Methods: This study was an observational analytic study with case control approach. Samples were 33 respondents with preeclampsia and 66 respondents with normal pregnancy, all were primigravida with age of 20-35 years old in Dr. M. Soewandhie Hospital, Surabaya, Indonesia, in January-June 2017. Data were taken from medical record.Results: This study found that the length of marriage until pregnancy was 0-4 months with percentage of 39.4% and 77.3% for case and control group respectively. Chi-square test resulted in p = 0.00 and contingency coefficient = 0.366, which meant there was relationship between the length of marriage to pregnancy and the incidence of preeclampsia in primigravida in Dr. M. Soewandhie Hospital Surabaya from January to June 2017 despite being in low level. The value of odd ratio (OR) was 0.191 (95% CI 0.077-0.473), which means there was a risk of protection for the length of marriage to pregnancy

Dyspnea in the postpartum period can be a symptom of a wide range of causes spanning normal pregnancy to life-threatening pathology. We describe a case of acute postpartum heart failure with preserved systolic function in the absence of pre-eclampsia or prior cardiovascular disease. (Level of Difficulty: Beginner.), Graphical abstract, Dyspnea in the postpartum period can be a symptom of a wide range of causes spanning normal pregnancy to life-threatening pathology…

COMPARATIVE MORPHOLOGICAL CHANGES IN SMOOTH MYOCYTES AND MACROFAGES CD16 IN PULMONARY ARTERY AND AORTA IN FETUSES AND NEWBORNS EXPOSED TO CHRONIC INTRAUTERINE HYPOXIASorokina I., Markovsky V., Kaluzhyna O., Pliten O., Hol’yeva N. Background. Oxygen deficiency, both acute and chronic, causes a variety of pathological changes in a number of organs and systems of fetuses and newborns. In particular, there are morphological changes in the vessels. Information in the available literature regarding the morphological state of smooth myocytes (SM) and cells expressing CD16 in the pulmonary artery (PA) and aorta of fetuses and newborns under such conditions of pregnancy is various and insufficient. Subjects and methods. The results of complex pathomorphological research of SM and macrophages CD16 of fetuses and newborns PA and aorta in chronic intrauterine hypoxia with the use of histological (staining with hematoxylin and eosin), immunohistochemical (MCA to Anti-Human Smooth Muscle Actin and MCA to CD16), morphometric, statistical methods are presented in the article. The investigation was performed on WAG line rats, observing all ethical norms and rules of handling of laboratory animals. The location of SM and macrophages CD16 in the wall of the PA and aorta in normal pregnancy and under oxygen deficiency, the density of their location in the field of vision (SM – ×1000, CD16 – ×600) was calculated. A comparative analysis of the morphological characteristics of the studied cells between mentioned vessels was also carried out. Results. The macroscopic examination of the wall of PA and aorta in the group of fetuses and newborns from mothers with physiological pregnancy with a magnifier (×3, 8 diopters) revealed that it was elastic, had a smooth ivorish intima. Smooth muscle cells in PA and aorta during immunohistochemical identification are determined in intima and media, as well as in the adventitial vessels of vessels. With hypoxic effect their number decreased in comparison with control group, and the number of macrophages – increased in both described vessels. Conclusions. The density of smooth myocytes (SM) location in the thickness of the wall of PA and aorta in the fetuses and newborns during the physiological course of pregnancy differs significantly from each other with dominance in the first vessel. Under the influence of experimental chronic intrauterine hypoxia in PA and aorta of fetuses and newborns a significant (p

Metabolomics has begun to revolutionize many fields of biomedicine. Indeed, various disease states can be reflected by changes in metabolite concentrations. Metabolomics allows the simultaneous measurement of a large number of biomolecules on a single biological sample. Metabolomics strategies have been increasingly exploited to understand the metabolic adaptations of the human organism in pregnancy and to characterize deviant behavior caused by prenatal complications. Several types of biomaterial can be collected and investigated. All of them enable the determination of the maternal and fetal state, but their biochemical interactions pose a number of challenges for the obstetric scientific world. The aim of our study was to collect evidences in metabolomics research and prenatal medicine, considering several pathological or physiological aspects of pregnancy. The development of new approaches to find reliable biomarkers is crucial to introduce new knowledge and panels for the diagnosis and classification of different diseases.

To investigate the expression of complement system's activation factors in patients with HELLP syndrome.A case-control study was performed. Sixteen HELLP syndrome patients, 32 severe preeclampsia patients, and 48 normal pregnancy women were involved in this studyELISA was used to test C1q, C4d, MBL, Bb, C3a, C5a, sC5b-9, s-Endoglin, and sflt-1 in the plasma.The levels of C5a (P 0.01) and sC5b-9 (P = 0.014) in HELLP syndrome were higher than those in severe preeclampsia patients.The abnormal activation of the complement system is more significant in the pathogenesis of HELLP syndrome than in severe preeclampsia.

The reproductive tract microbiota plays a crucial role in maintenance of normal pregnancy and influences reproductive outcomes. Microbe–host interactions in pregnancy remain poorly understood and their role in shaping immune modulation is still being uncovered. In this review, we describe the composition of vaginal microbial communities in the reproductive tract and their association with reproductive outcomes. We also consider strategies for manipulating microbiota composition by using live biotherapeutics, selective eradication of pathogenic bacteria with antibiotics and vaginal microbiota transplantation. Finally, future developments in this field and the need for mechanistic studies to explore the functional significance of reproductive tract microbial communities are highlighted.

Pregnancy is the fertilization or fusion of spermatozoa and ovum which is followed by bullying. Normal pregnancy lasts in 9 to 10 months. Complaints and discomfort can arise from the beginning of pregnancy to the end of pregnancy which can affect the physical and psychological condition of the mother. Pregnant women often complain in the third trimester and 96.7% experience complaints of frequent urination. The case study method used is observational (COC) Continuity of Care. From data collection and inspection there were no gaps and problem found, so no further special handling was needed.

У здоровой женщины при нормально протекающей беременности структурно-функциональные изменения сердца носят адаптивный характер, выражены незначительно и полностью нормализуются после родов. У беременной с теми или иными заболеваниями сердца адаптационные возможности снижены, поэтому на любом этапе беременности могут возникать патологические изменения, осложняющие ее течение и приводящие к неблагоприятным исходам. Кроме того, при любой беременности возможно развитие новых заболеваний сердца, которые могут быть фатальными. Вот почему эхокардиографическая оценка структурно-функциональных изменений сердца является необходимой как при нормальной беременности, так и на фоне сопутствующих сердечно-сосудистых заболеваний. In a healthy woman with a normal pregnancy, structural and functional changes in the heart are adaptive in nature, are slight and are completely normalized after childbirth. A pregnant woman with heart diseases has reduced adaptive capacity, therefore, at any stage of pregnancy, pathological changes can occur that complicate its course and lead to adverse outcomes. In addition, any pregnancy may develop new heart diseases, which can be fatal. That is why an echocardiographic assessment of structural and functional changes in the heart is necessary both during normal pregnancy and in the background of concomitant cardiovascular diseases.

Study question Is there an association between serum oestradiol, vaginal microbial composition and pregnancy outcome in the early first trimester? Summary answer In women with a vaginal microbiome deplete of Lactobacillus species at the time of Pregnancy of Uncertain Viability (IPUV), higher serum oestradiol associates with livebirth. What is known already During pregnancy, oestradiol mediates vaginal mucosal properties and increases glycogen deposition in epithelial cells which is thought to support colonisation of Lactobacillus species. Low levels of Lactobacillus associates with adverse outcomes such as miscarriage and preterm birth. The direct relationship between systemic oestradiol and the vaginal microbiome has never been studied in pregnancy. However studies have shown a positive correlation between serum oestrone, vaginal glycogen and Lactobacillus abundance in menopausal women. Study design, size, duration This was a prospective cohort study where one-hundred women were recruited in early pregnancy at the time of IPUV and donated paired blood and vaginal samples. 40 women had an eventual miscarriage, 58 had a livebirth and two pregnancies were terminated. All 100 women donated one paired serum and vaginal sample at this time point, and 22 women with Lactobacillus depletion at the time of IPUV donated further longitudinal vaginal samples. Participants/materials, setting, methods Participants were recruited from an Early Pregnancy Unit and underwent transvaginal ultrasound assessment of their pregnancy. Serum samples were analysed with an immunoassay on a ROCHE COBAS E411 analyser for Oestradiol (pg/ml) and Progesterone (ng/ml). Bacterial DNA was extracted from paired vaginal swabs and sequenced using Illumina MiSeq sequencing of 16S rRNA gene amplicons. Main results and the role of chance Lactobacillus dominance of the vagina was associated with higher serum levels of E2 and progesterone compared to depletion (E2=398pg/ml vs 302pg/ml(p = 0.02), P4=23.1ng/ml vs 17ng/ml(p = 0.02)). E2 and P4 were positively correlated (r = 0.6, p Limitations, reasons for caution In this study, serum oestradiol levels were compared to the local vaginal bacterial environment. The ideal would be to study local vaginal oestradiol, glycogen and the bacterial composition. Wider implications of the findings: In contrast to previous studies in menopause where low oestrogen levels associate with the vaginal microbial composition, this study uses the high oestradiol environment of early pregnancy to study the mechanistic relationship between oestradiol and vaginal Lactobacillus abundance. Trial registration number NA

Study question Can a novel embryo culture method that artificially removes the ZP at the pronuclear stage yield successful pregnancy in patients with poor-quality embryos and/or blastocysts? Summary answer A blastocyst transfer after ZP-free culture can result in pregnancy for patients who cannot obtain good quality blastocysts from conventional culture methods. What is known already Perivitelline threads are been associated with the formation of cytoplasmic fragments. We had previously observed perivitelline threads in the adhesive region between the ooplasm and the ZP at the first cleavage in human embryos. We removed the ZP at the pronuclear stage in 71 abnormally fertilized oocytes (zygotes with three pronuclei), donated after conventional IVF (c-IVF), and termed them ZP-free 3PN. We found ZP-free 3PN embryos could be cultured without losing blastomere adhesions. Furthermore, the rate of good quality embryos was significantly higher in ZP-free 3PN embryos compared with ZP-intact embryos (ZP-intact 2PN/2PB and 3PN embryos; P Study design, size, duration This study was conducted in two cases selected among patients who underwent ART treatment in our clinic between 2018 and 2019. Cases were selected if they lacked good quality blastocysts in previous c-IVF/Intracytoplasmic Sperm Injection (ICSI) cycles due to massive cytoplasmic fragmentation at the first and second cleavage. We performed a clinical trial of ZP-free culture from December 2019 to March 2020. Participants/materials, setting, methods Two cases were selected for this trial. Normally fertilized oocytes were grouped as ZP-free or ZP-intact. For the ZP-free group, 2PN embryos were placed in 0.125M sucrose-containing HEPES to reduce ooplasm size, then ooplasms were completely separated from ZPs by a laser and pipetting. ZP-free and ZP-intact embryos were cultured with time-lapse imaging for up to seven days. Resultant blastocysts were either transferred into uterus or cryopreserved on Day5/6/7 for future embryo transfer cycles. Main results and the role of chance The ZP-free culture method was applied to two patients (patient A and B) with recurrent failure of ART in our clinic due to poor-quality embryos and/or difficulties in obtaining good quality blastocysts. In both cases, blastocysts were successfully obtained and cryopreserved for all ZP-free culture cycles. In patient A, one good quality ZP-free blastocyst was freshly transferred five days after oocyte retrieval, and a live male baby (2925g) was delivered at 40 weeks of gestation by caesarean section). In patient B, a frozen/thawed ZP-free blastocyst transfer was conducted, and a live female baby (3225g) was delivered at 39 weeks of gestation by vaginal delivery. This shows ZP-free culturing may help obtain viable embryos in patients for which conventional in vitro culturing methods result in embryos characterized with severe cytoplasmic fragmentation and poor quality in the early cleavage stage. Limitations, reasons for caution Although successful pregnancies and deliveries were confirmed in two cases, postnatal evaluations will be absolutely necessary for infants derived from ZP-free culture. In addition, the number of trial cases needs to be expanded, however careful selection of suitable patients is necessary for this novel culture method. Wider implications of the findings: We found removing the ZP at the pronuclear stage improved embryo development and led to successful pregnancies and deliveries after blastocyst transfer. This indicates ZP-free culturing may be an effective method for decreasing cytoplasmic fragmentation caused by perivitelline threads or adhesion between the ooplasm and the zona pellucida. Trial registration number Not applicable

Pregnancy is a complicated and insidious state with various aspects to consider, including the well-being of the mother and child. Developing better non-invasive tests that cover a broader range of disorders with lower false-positive rates is a fundamental necessity in the prenatal medicine field, and, in this sense, the application of metabolomics could be extremely useful. Metabolomics measures and analyses the products of cellular biochemistry. As a biomarker discovery tool, the integrated holistic approach of metabolomics can yield new diagnostic or therapeutic approaches. In this review, we identify and summarize prenatal metabolomics studies and identify themes and controversies. We conducted a comprehensive search of PubMed and Google Scholar for all publications through January 2020 using combinations of the following keywords: nuclear magnetic resonance, mass spectrometry, metabolic profiling, prenatal diagnosis, pregnancy, chromosomal or aneuploidy, pre-eclampsia, fetal growth restriction, pre-term labor, and congenital defect. Metabolite detection with high throughput systems aided by advanced bioinformatics and network analysis allowed for the identification of new potential prenatal biomarkers and therapeutic targets. We took into consideration the scientific papers issued between the years 2000–2020, thus observing that the larger number of them were mainly published in the last 10 years. Initial small metabolomics studies in perinatology suggest that previously unidentified biochemical pathways and predictive biomarkers may be clinically useful. Although the scientific community is considering metabolomics with increasing attention for the study of prenatal medicine as well, more in-depth studies would be useful in order to advance toward the clinic world as the obtained results appear to be still preliminary. Employing metabolomics approaches to understand fetal and perinatal pathophysiology requires further research with larger sample sizes and rigorous testing of pilot studies using various omics and traditional hypothesis-driven experimental approaches.

Obesity is prevalent among women of reproductive age and is associated with increased risk of developing multiple pregnancy disorders. Pregnancy must induce immune tolerance to avoid fetal rejection, while obesity can cause chronic inflammation through activating the immune system. Impaired maternal immuno-tolerance leads to pregnancy failure, such as recurrent spontaneous abortion (RSA), one of the most common complications during early pregnancy. How does maternal immune response change under obesity stress in normal pregnancy and RSA? In turn, is obesity affected by different gestational statuses? Limited information is presently available now. Our study investigated pregnancy outcomes and maternal immune responses in two murine models (normal pregnancy and spontaneous abortion models) after obesity challenge with a high-fat diet (HFD). Abortion-prone mice fed HFD had significantly higher weight gains during pregnancy than normal pregnant mice with HFD feeding. Nonetheless, the embryo implantation and resorption rates were comparable between HFD and normal chow diet (NCD)-fed mice in each model. Evaluation of immune cell subsets showed HFD-induced obesity drove the upregulation of activated NK cell-activating receptor (NKp46)+ NK cells and pro-inflammatory macrophages (MHCIIhigh Mφ) as well as CD4+ and CD8+ T cells in the normal pregnancy group. However, in the abortion-prone group, relative more immature NK cells with decreased activity phenotypes were found in obese mice. Moreover, there were increased DCreg (CD11bhigh DC) cells and decreased CD4+ and CD8+ T cells detected in the HFD abortion-prone mice relative to those fed the NCD diet. Our findings reveal how pregnancy obesity and maternal immune regulation are mutually influenced. It is worth noting that the abortion-prone model where active maternal immune status was intensified by obesity, in turn stimulated an overcompensation response, leading to an over-tolerized immune status, and predisposing to potential risks of perinatal complications.

To report the case of pregnant woman with Guillain-Barré syndrome (GBS) presenting as the Miller Fisher variant, and to review the literature on the diagnosis, treatment and prognosis of this GBS variant during gestation.Pregnant woman presenting at 27 weeks of gestation with Miller Fisher syndrome (MFS), treated in a military referral hospital with a satisfactory course after 15 days, continuation of normal pregnancy and delivery of a healthy neonate at 38 weeks. A search of the literature was conducted in the Medline via PubMed, Lilacs, SciELO, ScienceDirect and Ovid databases using the terms “Pregnancy,” “Miller Fisher syndrome,” “Guillain-Barré syndrome”. Cohorts, case series and case reports of pregnant women with MFS were included. Data on diagnostic methods, treatment and maternal and perinatal prognosis were extracted. The search was made on June 2020, with no restriction by date, but restriction by language (Spanish and English).Overall, 423 titles were identified, three studies met the inclusion criteria, the three of them corresponding to case reports. All cases were found to be seropositive for anti-GQ1b ganglioside antibodies. No imaging abnormalities were found in any of the cases. Two patients received IV immunoglobulin and the third patient was kept under observation. No obstetric complications have be documented so far.There are few cases of MFS reported during pregnancy. Intravenous immunoglobulin is the most frequently used treatment option. Plasmapheresis was used in the case presented here. The impact of the Miller Fisher variant on the normal course of gestation and on long-term perinatal outcomes is unknown. Further studies that look into the diagnosis, treatment and prognosis of this condition are required.reportar el caso de una paciente gestante con síndrome de Guillain-Barré (SGB) presentado en la variante denominada síndrome de Miller Fisher (SMF), y realizar una revisión en torno al diagnóstico, tratamiento y pronóstico de esta variedad de SGB durante la gestación.se presenta el caso de una gestante de 27 semanas con síndrome de Miller Fisher, quien fue tratada con plasmaféresis en un hospital militar de referencia, con evolución satisfactoria a los 15 días y continuación normal del embarazo, parto a las 38 semanas con recién nacido sano. Se realizó una búsqueda bibliográfica en bases de datos electrónicas: Medline vía PubMed, Lilacs, SciELO, ScienceDirect, Ovid, con los términos “Embarazo”, “Síndrome de Miller Fisher”, “Síndrome de Guillain-Barré”. Se incluyeron cohortes, series y reportes de casos de mujeres gestantes con síndrome de Miller Fisher; se extrajo información sobre los métodos diagnósticos, el tratamiento utilizado y el pronóstico materno y perinatal. La búsqueda se hizo en junio de 2020, sin restricción por fecha, pero sí por tipo de idioma (español e inglés).se identificaron 423 títulos, tres estudios cumplieron los criterios de inclusión, los tres correspondieron a reportes de caso. Todos los casos mostraron seropositividad para antigangliósidos GQ1b positivos; en ningún caso hubo alteración imagenológica. Dos pacientes recibieron inmunoglobulina intravenosa y la tercera paciente se dejó en observación. Hasta el momento no se documentan complicaciones obstétricas.existen pocos casos reportados de SMF durante la gestación, el diagnóstico se basa en el examen clínico; el tratamiento con inmunoglobulina IV representa la alternativa utilizada con mayor frecuencia. En el caso presentado se utilizó la plasmaféresis. Se desconoce el impacto de la variedad del síndrome de Miller Fisher sobre el curso normal de la gestación y sobre los resultados perinatales a largo plazo. Se requieren más estudios que aborden el diagnóstico, el tratamiento y el pronóstico de esta entidad.

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.

Management of preeclampsia is limited to blood pressure control and symptom relief in combination with close maternal/ fetal surveillance. Until recently, very little attention has been paid to preeclampsia's psychological consequences, especially maternal anxiety. Anxiety disorders can be identified using questionnaires instrument determining anxiety level, the Taylor Minnesota Anxiety Scale (TMAS) questionnaires is one among them. This study aimed to determine the TMAS maternal anxiety score difference between preeclampsia and normal pregnancy. This was an analytical study with a cross-sectional design conducted from March-August 2014 in 40 subjects, consisting of 20 women with preeclampsia and 20 women with normal pregnancy who met the inclusion and exclusion criteria. Anxiety was measured with the TMAS questionnaire. Statistical analysis to determine the TMAS maternal anxiety score difference between preeclampsia and normal pregnancy was t-test. In preeclampsia group, the mean of TMAS maternal anxiety score was 30,45 ± 9,65. While in the normal pregnancy group, the mean of TMAS maternal anxiety score was 18,50 ± 7,62. There was a significant TMAS maternal anxiety score difference between preeclampsia and normal pregnancy (p = 0,000).Keywords: TMAS maternal anxiety score, preeclampsia

Abortion is the termination of pregnancy before fetus can survive in the outside world, regardless of the cause. One cause of spontaneous abortion due to maternal nutritional factors, such as folic acid defi-ciency, lead to disruption of cell function and ends with apoptosis as well as continuing with fetal death. The study was conducted to determine differences in the levels of folic acid serum between patients with normal pregnancy and spontaneous abortion in some hospitals in West Sumatra. The study was con-ducted by the method of analytic observational comparative cross-sectional design. This research was carried out on pregnant women who come to the clinic and emergency obstetric Dr.M.Djamil hospital Padang, Batusangkar Hospital, Reksodiwiryo Hospital Padang and examinations conducted in biomed-ical laboratory medical faculty Andalas University the period August-December 2014. The total number of women included in the statistical calculation after the inclusion and exclusion criteria are met is 54 people, statistical analysis was done afterwards. The mean levels of serum folic acid is lower in sponta-neous abortion patients compared with average levels of folic acid in normal. Results of statistical anal-ysis using t-test found significant differences in the mean serum levels of folic acid group of spontaneous abortion patients with normal pregnancy group, it can be seen from p-value 0.001 (p

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.