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To evaluate neonatal and maternal outcomes associated with detachment of non-metal vacuum cup during delivery and to identify risk factors for these detachments. This retrospective cohort study included women with singleton pregnancy, who underwent vacuum-assisted vaginal delivery with a non-metal vacuum cup in a single academic institution, January 2014–August 2019. Failed vacuum deliveries were excluded. Primary outcomes were defined as subgaleal hematoma (SGH) and cord blood pH 3700 g (14.1% vs, 10.3%, p = 0.006). Interestingly, there were more males in that group (60.6 vs. 54.6, p = 0.005). All these factors remained significant after controlling for potential confounders. Vacuum cup detachment has several predictive characteristics and is associated with adverse neonatal outcomes that should be incorporated into decisions made during the procedure.

Several studies were published about cervical pessary, with controversial results. These studies demonstrated that the patient follow-up after pessary insertion is very different between the study centers and the number of pessary insertions per center was often30 cases. This study aims to determine cervical pessary performance in singleton pregnancies with a short cervix based on a single center learning curve.Between 2011 and 2018, 128 singleton pregnancies between 18 and 24 gestational weeks with a short cervix (25 mm) were referred to our clinic. All cases were treated with progesterone, and when available in our supplies (due to low resources) cervical pessary was also offered. Three groups were created for statistical analysis: Group 1 (The learning curve was performed with all cases of pessary plus progesterone, and 30 patients were obtained as the number needed for learning, in our study with two operators. The PTB rate34 weeks was 27.3, 20, and 4.6% in groups 1, 2, and 3, respectively. There was no significant difference between Group 1 and 2 (OR 1.1; 95% CI 0.066 - 18.45;Learning curve and cumulative sum analysis determined that the application and surveillance of at least 30 patients is required to see significant improvements in the primary outcome of PTB34 weeks.

OBJECTIVE To evaluate the predictive role of the uterocervical angle and the cervical length in preterm birth. METHODS This was cross-sectional analytical study, recruiting 167 women at high-risk for preterm birth (delivery before 37 weeks of pregnancy). They had transvaginal ultrasound for evaluation of the uterocervical angle and the cervical length between at 30 and 32, 32+1 and 34, and 34+1 and 36+1 weeks of pregnancy. The primary outcome was to determine the predictive role of the uterocervical angle and the cervical length in preterm birth. RESULTS The mean uterocervical angle was significantly greater in those who delivered preterm (115.4° ± 9.1° versus 101.1° ± 8.3°, p

Objective: To assess the effects of oral fluids and intravenous fluids in terms of frequency of improving Amniotic Fluid Index during third trimester of pregnancy having oligohydramnios.Study Design: Comparative prospective survey. Place and Duration of Study: Obstetrics and Gynaecological Department of Fauji Foundation HospitalRawalpindi, from Apr 2018 to Oct 2018. Methodology: A total of 100 patients with singleton pregnancy (50 in each group) at gestational age of 28-37weeks and AFI of 5cm or less than 5cm were included. Non probability consecutive sampling technique wasused. Ethics approval from hospital ethical committee and research board was taken. Patients were randomizedinto 2 groups (50 patients each) by lottery method. Group A was instructed to drink 2 liters of water per day fora time period of seven days and patients in group B was given 2 liters of 5% D/W which was in addition to theirnormal fluids intake. Amniotic fluid index was measured pre hydration and post hydration in both groups. Datawas analyzed using SPSS-21. Results: Mean age of the patients was 33.62 ± 5.45 years and 34.70 ± 4.76 years for groups A and B respectively.In group A and group B mean gestational age was 34.28 ± 1.85 weeks vs 34.32 ± 1.82 weeks. In group A, 44 (88%)..............

To compare pregnancy outcomes in grand-multiparous (GMP) women with and without one previous cesarean delivery (CD), and to evaluate the number of previous successful vaginal deliveries after a CD needed to reduce the complication rate of trials of labor after a previous CD. This is a retrospective cohort study of women with singleton pregnancy at term who had a trial of vaginal delivery between 2007 and 2014 at a tertiary medical center. We compared pregnancy outcomes in GMP women with and without one previous cesarean delivery. The primary outcome was mode of delivery and secondary outcomes were uterine rupture and composite maternal and neonatal morbidity. For the secondary objective, we compared pregnancy outcomes in women in TOLAC, stratified by the number of previous vaginal deliveries. Overall, 2815 GMP women met the study criteria, of which 310 (11%) had a previous cesarean delivery. The rate of a successful vaginal deliveries (VBAC) was similar, regardless of the presence of a previous cesarean delivery. No other differences in outcomes were found between the groups. In a secondary analysis, it was found that the presence of a single previous VBAC (compared to no previous VBACs) increased the odds of achieving a vaginal delivery in the next trial of labor after cesarean delivery (TOLAC) (aOR 5.66; 95% CI 3.73–8.60), and decreased the risk of maternal or neonatal adverse outcomes (aOR 0.62; 95% CI 0.39–0.97, and aOR 0.49; 95% CI 0.25–0.97, respectively). Multiple prior VBACs (as compared to a single prior VBAC) did not increase the odds of achieving another VBAC. Grand-multiparous women with and without previous uterine scar have comparable pregnancy outcomes. Additionally, after the first VBAC, additional successful VBACs do not improve the success rate in the next TOLAC.

Acute appendicitis during pregnancy may lead to increased maternal and fetal risks. Laparoscopic appendectomy is commonly performed during pregnancy. Compared with open appendectomy in pregnant women, laparoscopic appendectomy has shown non-inferior safety for pregnancy outcomes and superior safety for surgical outcomes. Over the last few decades, the occurrence of twin pregnancy has been increasing. Performing an operation on a patient with a twin pregnancy is more difficult than with a singleton pregnancy. Only a few operations of this kind have been reported. Here, we present a case of a 20-week twin pregnant woman who presented with acute appendicitis. Laparoscopic appendectomy was performed, and no maternal complications occurred. This report contributes to discussions on the safety of the laparoscopic approach for appendicitis during twin pregnancies.

Objectives: Significance of the crown-rump length (CRL) measurement criteria in the assessments of gestational age and actual precision in daily clinical practice. Material and methods: We recruited 806 pregnant women with singleton pregnancy and history of regular menstrual periods.We analysed retrospectively CRL measurements obtained during routine first trimester scan performed between 11 + 0 and 13 + 6 weeks gestation. Gestational age was calculated using both the last menstrual period (LMP) and the CRL. The images of the CRL measurements were assessed by the expert. The visual analysis of the images in terms of meeting the five criteria recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) was performed. Statistical analysis were used to assess how the above-mentioned criteria influenced calculation of the gestational age. Results: The study showed 323 out of 806 of the CRL measurements (40.1%) were qualified by a specialist as accurate, 279 (34.6%) as inaccurate, and 204 (25.3%) as inaccurate, but not changing the duration of a pregnancy. With the application in the assessment of the five criteria of the ISOUG 217 (26.9%), the following results of qualification were obtained: accurate — fulfilled ≥ 4, inaccurate 341 (42.3%) — fulfilled ≤ 2, whereas inaccurate, but not changing the duration of a pregnancy 248 (30.8%) — 3 criteria fulfilled. We found that only the neutralof the fetus demonstrated a significant corellation with the assessment of the duration of a gestation. Conclusions: a) the accurate audit of the CRL measurements is recommended; b) neutral position of the fetus is the most important criterion out of 5.

Objective: This study aimed to separately evaluate the prevalence of anemia and iron deficiency in nulliparous and multiparous women. Materials and methods: We retrospectively examined data of women who delivered in our clinic from January 2016 to December 2018. Inclusion criteria were delivery occurring at ≥36 weeks and singleton pregnancy. Pregnant women with severe medical disorders were excluded. We estimated complete blood count (CBC) and serum ferritin (SF) in the first trimester and only CBC in the late second trimester. Data of nulliparas and multiparas were analyzed separately. Statistically significance was set at p

Objective To estimate the prevalence and types of sexual dysfunction in pregnancy. Methods A cross-sectional facility-based descriptive study among pregnant women attending the prenatal clinic of the Greater Accra Regional Hospital, a large tertiary health facility in Accra, Ghana, from May to June 2018. The inclusion criteria were 18 years or older, singleton pregnancy of 8 gestational weeks or more, and residing with their partner for at least 4 weeks before the study. Face-to-face interviews were conducted among consecutively enrolled women by using the Female Sexual Function Index (FSFI) tool. Results Overall, 425 women were enrolled. The mean age was 30.8 ± 4.8 years. The mean gestational age was 32.3 ± 7.1weeks (range 9.7-42.0 weeks). The prevalence of sexual dysfunction in pregnancy was 64.9% (95% confidence interval [CI], 60.3%-69.4%) but only 32 (7.5%) women self-reported sexual problems. The predominant types of sexual disorder were desire disorder (377 [88.7%; 95% CI, 85.3%-91.4%] women) and arousal disorder (320 [75.3%; 95% CI, 71.0%-79.2%]). Conclusion Sexual dysfunction in pregnancy was found to be common, but most pregnant women were not aware that they had it.

Objective To compare the cervical shear wave elastography (SWE) by using transvaginal ultrasound (TVS) between twin and singleton pregnant women. Materials and Methods This was a prospective cohort study involving the twin and singleton pregnant women who attended the antenatal care at Ramathibodi Hospital, Bangkok, Thailand. The participants who met the inclusion criteria were serially measured the shear wave speed (SWS) by using TVS at early, mid-, and third trimester. The changes in SWS with advancing gestational age between twin and singleton pregnancies were evaluated. The gestational age at delivery and spontaneous preterm delivery rate were also analyzed. Results A total of 36 twin pregnancies and 38 singleton pregnancies were analyzed. No significant difference in baseline characteristics, except the age of participants (twin pregnancies 33.1±4.6 years, singleton pregnancies 29.9±5.4 years, p-value = 0.006) was observed. The cervical SWS decreased with advancing gestational age in both twin and singleton pregnancy, but there was a statistically significant difference of cervical SWS at the lower point in mid-trimester (twin pregnancies 2.27±0.4, singleton pregnancies 2.71±0.6 m/s, p-value = 0.001). However, no significant difference in cervical SWS at the upper point and the lower point in the early and third trimester was demonstrated. Even though the gestational age at delivery between both groups revealed a significant difference (twin pregnancies 35.9±2.8, singleton pregnancies 37.6±2.9 wk., p-value = 0.008) but the spontaneous preterm delivery rate did not differ significantly (twin pregnancies 22.2%, singleton pregnancies 15.8%, p-value = 0.483). Conclusion The mid-trimester cervical SWS measurement at the lower point detects the difference in cervical softness between twin pregnancies and singleton pregnancies. The cervical SWS might be an additional option for monitoring the change in cervical softness in twin pregnancies.

OBJECTIVE To determine whether maternal cardiac adaptation at term differs between women with, and those without, gestational diabetes mellitus (GDM). METHODS This was a prospective case-control study of pregnant women at term with or without GDM. For both cases and controls, only women without any comorbidity or form of pre-existing diabetes who had a singleton pregnancy without complication (such as pre-eclampsia or fetal growth restriction) were included. All women underwent conventional and speckle-tracking echocardiography to assess both the left- and right-heart geometry and function. RESULTS A total of 40 women with GDM and 40 healthy controls were enrolled. Women with GDM, compared with controls, had a significantly higher heart rate (83 ± 10 vs 75 ± 9 beats per min; P

Noninvasive Prenatal Testing (NIPT) has advanced the detection of fetal chromosomal aneuploidy by analyzing cell-free DNA in peripheral maternal blood. The statistic Z-test that it utilizes, which measures the deviation of each chromosome dosage from its negative control, is now widely accepted in clinical practice. However, when a chromosome has loss and gain regions which offset each other in the z-score calculation, merely using the Z-test for the result tends to be erroneous. To improve the performance of NIPT in this aspect, a novel graphic-aided algorithm (gNIPT) that requires no extra experiment procedures is reported in this study. In addition to the Z-test, this method provides a detailed analysis of each chromosome by dividing each chromosome into multiple 2 Mb size windows, calculating the z-score and copy number variation of each window, and visualizing the z-scores for each chromosome in a line chart. Data from 13537 singleton pregnancy women were analyzed and compared using both the normal NIPT (nNIPT) analysis and the gNIPT method. The gNIPT method had significantly improved the overall positive predictive value (PPV) of nNIPT (88.14% vs. 68.00%, p=0.0041) and the PPV for trisomy 21 (T21) detection (93.02% vs. 71.43%, p=0.0037). There were no significant differences between gNIPT and nNIPT in PPV for trisomy 18 (T18) detection (88.89% vs. 63.64%, p=0.1974) and in PPV for trisomy 13 (T13) detection (57.14% vs. 50.00%, p=0.8004). One false-negative T18 case in nNIPT was detected by gNIPT, which demonstrates the potency of gNIPT in discerning chromosomes that have variation in multiple regions with an offsetting effect in z-score calculation. The gNIPT was also able to detect copy number variation (CNV) in chromosomes, and one case with pathogenic CNV was detected during the study. With no additional test requirement, gNIPT presents a reasonable solution in improving the accuracy of normal NIPT.

The purpose of this study was to explore the association of fibrin/fibrinogen degradation products (FDP) levels with the risk of macrosomia, and determine whether FDP, either alone or combined with traditional factors in late pregnancy, could be used to predict macrosomia at birth in healthy pregnancies.A total of 9464 health pregnant women with singleton pregnancy were recruited in this retrospective cohort study. Maternal plasma FDP levels at hospital admission and birth outcomes were obtained from laboratory system and hospital records, respectively.FDP levels in late pregnancy were significant higher in women who delivered macrosomia than those who delivered infants with normal weight [median (interquartile range, IQR): 8.2 (5.8-11.9) vs. 6.6 (4.7-9.6) mg/L; P 0.001]. Multivariable logistic regression analysis demonstrated that FDP levels were independently associated with macrosomia risk. Pregnant women in the highest quartile of FDP had a 2.99-fold higher risk of delivering macrosomia compared with those in the lowest (adjusted OR: 2.99; 95% CI: 2.27-3.93). In addition, the incorporation of FDP into the crude prediction model significantly improved the area under curve (AUC) for predicting macrosomia (0.774 vs. 0.787; P 0.001).Our findings suggest that maternal plasma FDP levels in late pregnancy are independently and significantly associated with risk of macrosomia. Combination of FDP levels and traditional risk factors could promote the prediction of macrosomia.

OBJECTIVE To assess the efficacy and safety of outpatient administration of oral hyoscine for cervical ripening. METHODS In a randomized controlled trial at a university hospital in Tehran between September 2017 and December 2018, 100 primiparous women with singleton pregnancy at 380 -400 gestational weeks and Bishop score of 5 or less were randomized to either routine expectant management (control group) or 10 mg of oral hyoscine twice daily for 1 week, followed by once daily for 1 week (hyoscine group). RESULTS Mean ± SD Bishop score in the hyoscine and control groups was, respectively, 1.19 ± 1.38 and 1.08 ± 1.70 at baseline, and 4.56 ± 2.87 and 2.76 ± 2.14 on admission for delivery (P=0.001). Duration of the first stage was 4.10 ± 5.49 hours in the hyoscine and 5.29 ± 6.48 hours in the control group (P=0.03). Duration of the second and third stages was, respectively, 0.52 ± 0.53 and 0.14 ± 0.25 hours in the hyoscine, and 0.59 ± 1.08 and 0.12 ± 0.15 hours in the control group. No adverse effects were reported. CONCLUSION Administration of oral hyoscine in an outpatient setting was found to ripen the cervix with no clinically significant adverse drug reaction. IRANIAN REGISTRY OF CLINICAL TRIALS (IRCT20180819040830N1).

When a caesarean section is performed on a singleton pregnancy when there is no clinical indication, this is deemed a maternal request caesarean section (CSMR). The procedure contributes to the ever rising rates of caesarean sections in the UK, as well as the rates associated risks and subsequent financial burden to the NHS. The ethics of exposing these otherwise healthy women to the risks of surgery and the increasing financial strain on our healthcare system becomes complicated with the importance of assessing and managing the patients’ psychological well-being and the demand to promote patient choice and autonomy. This article considers the main reasons behind why we encounter CSMRs, while exploring the ethical dilemmas we as obstetricians face. We will also look at ways to manage these women, with suggestions of support and evidence to provide in order for them to make an informed decision.

Growing evidence suggests that galectins, an evolutionarily conserved family of glycan-binding proteins, fulfill key roles in pregnancy including blastocyst implantation, maternal-fetal immune tolerance, placental development, and maternal vascular expansion, thereby establishing a healthy environment for the growing fetus. In this review, we comprehensively present the function of galectins in shaping cellular circuits that characterize a healthy pregnancy. We describe the current understanding of galectins in term and preterm labor and discuss how the galectin-glycan circuits contribute to key immunological pathways sustaining maternal tolerance and preventing microbial infections. A deeper understanding of the glycoimmune pathways regulating early events in preterm birth could offer the broader translational potential for the treatment of this devastating syndrome.

Background: Elevated maternal homocysteine concentration has been described as a consequence of disruptions in methionine and/or folate metabolism which is associated with adverse outcomes and several obstetric complications inclusive of neural tube defects in offspring such as spina bifida, preeclampsia and spontaneous abortion. Aims and Objectives: The current study investigated the influence of maternal homocysteine metabolism in singleton pregnant women on the prevalence of Spina bifida in Osun State. Materials and Methods: Sixty (60) subjects attending Ladoke Akintola University of Technology Teaching Hospital and State Specialist Hospital in Osogbo, Osun State were randomly recruited for the study which spanned from January 2018 through April 2018 involving 30 apparently healthy singleton pregnant women classified according to gestational age and 30 apparently healthy age- and socio-economic status-matched non-pregnant women as controls. Haematocrit, haemoglobin concentration, total white cell count as well as the levels of homocysteine concentration were assessed. Results: Haematocrit and haemoglobin concentration in all three trimesters were significantly (p< 0.05) decreased when compared with their non-pregnant counterparts. There was however a significant (p< 0.05) increase in the expression of circulating homocysteine in all three trimesters compared to the control group, and an observed steady decline in the second trimester through the third trimester. Conclusion: These findings therefore imply that gestational perturbation of homocysteine metabolism may contribute to reduced risk of spina bifida in Osun State, Nigeria.

Objective: Episiotomy is associated with an increased risk of postpartum pain, bleeding, and dyspareunia. The hypothesis of this trial was that in women with singleton pregnancy, and spontaneous labor at term, use of calendula ointment would reduce pain after episiotomy. Methods: This was a single-center parallel group randomized trial of women with singleton pregnancies and spontaneous labor at term who were randomized to either use of calendula ointment (i.e. intervention group) or standard care (i.e. control group) after episiotomy. Eligible women were those with singleton gestations in spontaneous labor and vertex presentation at term. Women with premature rupture of membranes were excluded from the study. Women in the intervention group were recommended use of calendula ointment 4 h after the episiotomy and then every 8 h for 10 days. The primary outcome was the pain level. Pain level was self-reported and recorded using the verbal rating scale (VRS). The effect of the calendula ointment was quantified as mean difference (MD) with 95% confidence interval (CI). Results: During the study, 100 women agreed to take part in the study, underwent randomization, and were enrolled in this trial. Of the 100 randomized women, 50 were randomized to the calendula ointment group, and 50 to the control group. No women were excluded after randomization or lost to follow up.Women who received calendula ointment after episiotomy compared to standard care had a significantly lower pain level starting from day two and during all the follow-up. Calendula ointment also improve wound healing in terms of redness and edema. Conclusions: Use of calendula ointment significantly reduce pain after episiotomy.

BACKGROUND Women who achieve pregnancy by ART show an increased risk of obstetric and perinatal complications compared with those with spontaneous conception (SC). OBJECTIVE AND RATIONALE The purpose of this systematic review and meta-analysis was to synthesize the best available evidence regarding the association between ART and gestational diabetes mellitus (GDM) in women with singleton pregnancies. The research question asked was whether the risk of GDM is higher in women achieving singleton pregnancy by ART compared with those achieving singleton pregnancy spontaneously. SEARCH METHODS A literature search, in MEDLINE, Scopus and Cochrane databases, covering the period 1978–2019, was performed aiming to identify studies comparing the risk of GDM in singleton pregnancies after ART versus after SC. Both matched and unmatched studies were considered eligible. Meta-analysis of weighted data was performed using the random effects model. Results were reported as risk ratio (RR) with 95% CI. Heterogeneity was quantified with the I2 index. OUTCOMES The study reports on 63 760 women who achieved a singleton pregnancy after ART (GDM was present in 4776) and 1 870 734 women who achieved a singleton pregnancy spontaneously (GDM in 158 526). Women with singleton pregnancy achieved by ART showed a higher risk of GDM compared with those with singleton pregnancy achieved spontaneously (RR 1.53, 95% CI 1.39–1.69; I2 78.6%, n = 37, 1 893 599 women). The direction or the magnitude of the effect observed did not change in subgroup analysis based on whether the study was matched (n = 17) or unmatched (n = 20) (matched: RR 1.42, 95% CI 1.17–1.72; I2 61.5%—unmatched: RR 1.58, 95% CI 1.40–1.78; I2 84.1%) or whether it was prospective (n = 12) or retrospective (n = 25) (prospective studies: RR 1.52, 95% CI 1.27–1.83, I2 62.2%—retrospective studies: RR 1.53, 95% CI 1.36–1.72, I2 82.5%). Regarding the method of fertilization, a higher risk of GDM after ART versus SC was observed after IVF (n = 7), but not after ICSI (n = 6), (IVF: RR 1.95, 95% CI 1.56–2.44, I2 43.1%—ICSI: RR 1.42, 95% CI 0.94–2.15, I2 73.5%). Moreover, regarding the type of embryo transfer (ET), a higher risk of GDM after ART versus SC was observed after fresh (n = 14) but not after frozen (n = 3) ET (fresh ET: RR 1.38, 95% CI 1.03–1.85, I2 75.4%—frozen ET: RR 0.46, 95% CI 0.10–2.19; I2 73.1%). A higher risk of GDM was observed after ART regardless of whether the eligible studies included patients with polycystic ovary syndrome (RR 1.49, 95% CI 1.33–1.66, I2 75.0%) or not (RR 4.12, 95% CI 2.63–6.45, I2 0%), or whether this information was unclear (RR 1.46, 95% CI 1.22–1.75, I2 77.7%). WIDER IMPLICATIONS The present systematic review and meta-analysis, by analysing 1 893 599 women, showed a higher risk of GDM in women achieving singleton pregnancy by ART compared with those achieving singleton pregnancy spontaneously. This finding highlights the importance of early detection of GDM in women treated by ART that could lead to timely and effective interventions, prior to ART as well as during early pregnancy.

Objective: To assess the delivery outcome in nulliparous women at term and to compare the outcomes among induced versus spontaneous labor. Methods: A descriptive study was conducted at Obstetrics and Gynecology department of Patel Hospital, Karachi from April to October 2019. All women with age between 20-40 years, gestational age between 37-42 weeks, and singleton pregnancy were consecutively included. Mode of delivery and Apgar score at 5 minutes were noted. Results: Of 172 women, the mean age of the women was 29.9±4.64. Vaginal delivery was reported in 102 (59.3%) and cesarean section in 70 (40.7%) women. Cesarean delivery was found to be significantly higher among women with >29 years of age (pvalue 0.006), >38 weeks of gestational age (p-value

Objective History of prior preterm birth (PTB) represents one of the strongest risk factors for recurrent PTB. Nevertheless, whether the occurrence of PTB in multifetal gestation is associated with increased risk of PTB in subsequent pregnancies remains unclear. We aimed to determine the recurrence risk of PTB in a subsequent singleton pregnancy after a previous spontaneous preterm triplet delivery. Study design A retrospective matched case-control study. The study group comprised all women with spontaneous preterm trichorionic triplet delivery who had a subsequent singleton pregnancy during 2006–2017 at two university hospitals. A control group of women with spontaneous preterm dichorionic twin delivery and a subsequent singleton pregnancy, was established by matching, four-to-one, according to maternal age, parity, gestational age at delivery, and delivery year. Results Data from 170 women were analyzed, 34 with preterm triplet delivery and 136 matched control women with preterm twin delivery. Gestational age at the subsequent singleton delivery was higher in those with preterm triplet delivery than in those with preterm twin delivery (median 39 vs 38 weeks, P = 0.02). Women with prior triplet PTB had a significantly lower rate of recurrent PTB as compared with women with prior twin PTB (5.9 % vs. 25.0 %; OR [95 % CI]: 0.19 (0.04, 0.82), P = 0.02) with lower proportions of low-birth weight infants ( Conclusions The risk of recurrent PTB following spontaneous PTB in triplet pregnancy was low compared to preterm twin delivery. These data provide reassurance for those who experienced preterm triplet delivery and suggest the need for further studies to understand the mechanisms contributing to PTB in multifetal pregnancies.

Aim We hypothesized that elevated vaginal levels of matrix metalloproteinase-8 (MMP-8), interleukin-8 (IL-8) and the 70kDa heat shock protein (hsp70), compounds involved in inflammatory responses, correlated with a short cervix in pregnant women. Methods This prospective cohort study used a convenience sample of 64 women in their early third trimester with a singleton pregnancy. A short cervical length was present in 35 women (54.7 %). Vaginal fluid was tested for levels of MMP-8, IL-8 and hsp70 by enzyme-linked immunosorbent assay (ELISA). A receiver operating charasteristic (ROC) analysis was used to calculate the area under the curve (AUC) for each mediator in predicting short cervical length. Results MMP-8 (109 vs 29.6 ng/ml, p=0.014), IL-8 (689 vs 330 pg/ml, p=0.007) and hsp70 (4.4 vs 2.9 ng/ml, p=0.036) were all elevated in vaginal samples from women with a short cervix. In addition, there was a negative association between the concentration of each compound in vaginal fluid and cervical length p≤0.026). The vaginal IL-8 concentration had the highest negative correlation with a short cervix (AUC=0.7, p=0.007). Conclusion MMP-8, hsp70 and IL-8 contribute to a pro-inflammatory cervico-vaginal milieu that weakens cervical integrity and leads to a shortening in cervical length (Tab. 4, Fig. 1, Ref. 27).

Objective: To determine the efficacy of urine dipstick in Pre-eclamplasia. Study Design and Setting: This was a cross-sectional study conducted at the department of obstetrics & gynecology of a tertiary care hospital from May-2017 to September-2018. Methods: All the pregnant women of age 15-45 years, BP=140/90 mmHg on two occasions 4 hours apart or single diastolic value of 100 mmHg, gestational age >20 weeks, singleton pregnancy, booked in first trimester of pregnancy were included in the study. Statistical package SPSS 22 was used for the analysis of data chi-square tests were applied for the diagnostic accuracy of urine dipstick in detection of Pre-eclampsia in pregnant women. P-value was

This study aimed to evaluate the differences in the impact on maternal renal function between singleton and twin pregnancies in the second half of pregnancy. It retrospectively enrolled 1711 pregnant women consisting of 1547 singleton pregnancies and 164 twin pregnancies from Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital from January 2019 to June 2021. Patients underwent renal function tests (serum blood urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR)) at least one month before delivery. The main outcome measure was maternal renal dysfunction, defined as a serum creatinine level above 0.8 mg/dL. The serum creatinine level was significantly higher and the eGFR was significantly lower in twin than in singleton pregnancies (p < 0.001). In addition, the rate of renal dysfunction was significantly higher in twin than in singleton pregnancies (7.9% vs. 2.6%; p < 0.01). Multivariate analysis revealed that twin pregnancy (odds ratio (OR) 3.38), nulliparity (OR 2.31), and preeclampsia (OR 3.64) were significant risk factors for maternal renal dysfunction. Maternal renal dysfunction was observed in 13 twin pregnancies, all of which recovered to within normal limits during the early months of the postpartum period. Twin pregnancy is a significant risk factor for maternal renal dysfunction; renal function should be carefully monitored in twin pregnancies.