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Purpose: This study investigated interobserver agreement in lung ultrasonography (LUS) in pregnant women performed by obstetricians with different levels of expertise, with confirmation by an expert radiologist., Methods: This prospective study was conducted at a tertiary "Coronavirus Pandemic Hospital" in April 2020. Pregnant women suspected to have coronavirus disease 2019 (COVID-19) were included. Two blinded experienced obstetricians performed LUS on pregnant women separately and noted their scores for 14 lung zones. Following a theoretical and hands-on practical course, one experienced obstetrician, two novice obstetric residents, and an experienced radiologist blindly evaluated anonymized and randomized still images and videoclips retrospectively. Weighted Cohen's kappa and Krippendorff's alpha tests were used to assess the interobserver agreement., Results: Fifty-two pregnant women were included, with confirmed COVID-19 diagnosis rate of 82.7%. In total, 336 eligible still images and 115 videoclips were included in the final analysis. The overall weighted Cohen's kappa values ranged from 0.706 to 0.912 for the 14 lung zones. There were only seven instances of major disagreement (>1 point) in the evaluation of 14 lung zones of 52 patients (n=728). The overall agreement between the radiologist and obstetricians for the still images (Krippendorff's α=0.856, 95% confidence interval [CI], 0.797 to 0.915) and videoclips (Krippendorff's α=0.785; 95% CI, 0.709 to 0.861) was good., Conclusion: The interobserver agreement between obstetricians with different levels of experience on still images and videoclips of LUS was good. Following a brief theoretical course, obstetricians' performance of LUS in pregnant women and interpretation of pre-acquired LUS images can be considered consistent.

Objective: Evidence for the use of lung ultrasound scan (LUS) examinations in coronavirus 2019 pneumonia is rapidly growing. The safe and non-ionizing nature of LUS drew attention, particularly for pregnant women. This study aimed to contribute to the interpretation of LUS findings in pregnant women for the obstetricians., Materials and Methods: LUS was performed to pregnant women suspected of or diagnosed as having Severe Acute Respiratory syndrome coronavirus-2 (SARS-CoV-2) in the first 24 hours of admission. Fourteen areas (3 posterior, 2 lateral, and 2 anterior) were scanned per patient for at least 10 seconds along the indicated anatomical landmarks. The scan was performed in supine, right-sided and left-sided positions, respectively. Each area was given a score between 0 and 3 according to the specific pattern., Results: In this study, 21 still images and 21 videoclips that enabled dynamic and real-time evaluation were provided. Pleural line assessment, physiologic A-lines, pathologic B-lines, light beam pattern, white lung pattern, and specific patterns for quick recognition and evaluation are described., Conclusion: The potential advantages and limitations of LUS and its areas of use for obstetricians are discussed. LUS is a promising supplementary imaging tool during the SARS-CoV-2 pandemic. It is easy to perform and may be feasible in the hands of obstetricians after a brief didactic course. It may be a firstline imaging modality for pregnant women., Competing Interests: Conflict of Interest: The authors report no conflict of interest., (©Copyright 2020 by Turkish Society of Obstetrics and Gynecology | Turkish Journal of Obstetrics and Gynecology published by Galenos Publishing House.)

This study aims to elicit the validation performance of different diagnostic criteria and to evaluate the disease course and perinatal outcomes of pregnancies complicated by twin anemia polycythemia sequence (TAPS). Monochorionic diamniotic (MCDA) twin pregnancies who received serial middle cerebral artery (MCA) peak systolic velocity (PSV) measurements without non-TAPS-related demise or major anomalies were included. Course of disease, antenatal intervention, additional ultrasound features, and perinatal outcomes were compared between each criteria and onset. Forty-nine cases of TAPS and 203 non-TAPS controls were identified. The incidence of TAPS was 19.2%, 15.7%, 7.8%, and 6.3% for ΔPSV MoM > 0.373, ΔPSV MoM > 0.5, traditional, and Delphi consensus criteria, respectively ( p < 0.001). The incidence of antenatal intervention was 55.1, 62.5, 75.0, and 87.5%, respectively. Furthermore, cases detected according to the Delphi consensus criteria had a higher rate of progression or intervention compared to cases detected with ΔPSV MoM > 0.373 (87.0 vs. 59.0%, p = 0.037). TAPS had a significantly higher birth weight discordance than uncomplicated MCDA twins (25.3 vs. 7.3%, p < 0.001). Application of four different diagnostic criteria for TAPS leads to significant differences in the incidence, severity, and antenatal intervention. The Delphi criteria identified more severe cases likely to require intervention, and the delta PSV > 0.373 criteria identified milder cases, without a significant impact on neonatal outcomes.

Objective: To compare the rates of fetal growth restriction (FGR) in singleton and twin pregnancies using singleton and twin-specific birthweight standards., Methods: The study included liveborn twin and singleton pregnancies between January 2000 and January 2019. Hypertensive disorders of pregnancy (HDP) included gestational hypertension and pre-eclampsia. The study outcomes were FGR or small-for-gestational-age (SGA) at birth as assessed using singleton and twin reference charts., Results: The analysis included 1473 twin and 62,432 singleton pregnancies. In singleton pregnancies the risk of PTB <34 weeks without HDP (OR 2.82, p < 0.001), delivery ≥34 weeks with HDP (OR 2.38, p < 0.001), and PTB <34 weeks with HDP (OR 13.65, p < 0.001) were significantly higher in the pregnancies complicated by FGR compared to those without. When selective fetal growth restriction (sFGR) was assessed using the singleton standard, the risk of PTB <34 weeks without HDP (OR 1.03, p = 0.872), delivery ≥34 weeks with HDP (OR 1.36, p = 0.160) were similar in the pregnancies complicated by sFGR compared to those without, while the risk of PTB <34 weeks with HDP (OR 2.41, p = 0.025) was significantly higher in the pregnancies complicated by sFGR compared to those without. When sFGR was assessed using the twin-specific chart, the risk of PTB <34 weeks without HDP (OR 3.55, p < 0.001), delivery ≥34 weeks with HDP (OR 3.17, p = 0.004), and PTB <34 weeks with HDP (OR 5.69, p < 0.001) were significantly higher in the pregnancies complicated by sFGR compared to those without. The stronger and more consistent association persisted in the subgroup analyses according to chorionicity. The strength of association in dichorionic twin pregnancies resembles that of the singletons more closely and consistently when the FGR was diagnosed using the twin-specific charts., Conclusion: FGR in twin pregnancies has a stronger and more consistent association with HDP and PTB when using twin-specific rather than singleton charts. This study provides further evidence supporting the use of twin-specific charts when assessing fetal growth in twin pregnancies.

Objectives: Small-for-gestational-age fetuses (SGA) are at high risk of intrapartum fetal compromise requiring operative delivery. In a recent study, we developed a model using a combination of three antenatal (gestational age at delivery, parity, cerebroplacental ratio) and three intrapartum (epidural use, labor induction and augmentation using oxytocin) variables for the prediction of operative delivery due to presumed fetal compromise in SGA fetuses - the Individual RIsk aSsessment (IRIS) prediction model. The aim of this study was to test the predictive accuracy of the IRIS prediction model in an external cohort of singleton pregnancies complicated by SGA. Methods: This was an external validation study using a cohort of pregnancies from two tertiary referral centers in Spain and England. The inclusion criteria were singleton pregnancies diagnosed with an SGA fetus, defined as estimated fetal weight (EFW) below the 10th centile for gestational age at 36 weeks or beyond, which had fetal Doppler assessment and available data on their intrapartum care and pregnancy outcomes. The main outcome in this study was the operative delivery for presumed fetal compromise. External validation was performed using the coefficients obtained in the original development cohort. The predictive accuracies of models were investigated with receiver operating characteristics (ROC) curves. The Hosmer-Lemeshow test was used to test the goodness-of-fit of models and calibration plots were also obtained for visual assessment. A mobile application using the combined model algorithm was developed to facilitate clinical use. Results: Four hundred twelve singleton pregnancies with an antenatal diagnosis of SGA were included in the study. The operative delivery rate was 22.8% ( n  = 94). The group which required operative delivery for presumed fetal compromise had significantly fewer multiparous women (19.1 versus 47.8%, p  < .001 in the total study population; 19.0 versus 43.5 and 19.2 versus 49.6%, UK and Spain cohort, respectively), lower cerebroplacental ratio (CPR) multiples of median (MoM) (median: 0.77 versus 0.92, p  < .001 in the total study population; 0.77 versus 0.92 and 0.77 versus 0.92, UK and Spain cohort, respectively), more inductions of labor (74.5 versus 60.1%, p  = .010 in the total study population; 85.7 versus 77.2 and 71.2% and 53.1, UK and Spain cohort, respectively) and more use of oxytocin augmentation (57.4 versus 39.3%, p  = .002 in the total study population; 19.0 versus 12.0 and 68.5 and 50.4%, UK and Spain cohort, respectively) compared to those who did not require operative delivery due to presumed fetal compromise. When the original antenatal model was applied to the present cohort, we observed moderate predictive accuracy (AUC: 0.70, 95% CI: 0.64-0.76), and no signs of poor fit ( p  = .464). The original combined model, when applied to the external cohort, had moderate predictive accuracy (AUC: 0.72, 95% CI: 0.67-0.77) and also no signs of poor fit ( p  = .268) without the need for refitting. A statistically significant increase in the predictive accuracy was not achieved via refitting of the combined model (AUC 0.76 versus 0.72, p  = .060). Conclusions: Using our recently published model, the predictive accuracy for fetal compromise requiring operative delivery in term fetuses thought to be SGA was modest and showed no signs of poor fit in an external cohort. The IRIS tool for mobile devices has been developed to facilitate wide clinical use of this prediction model. Brief rationale Objective : To determine the external validity of an intrapartum risk prediction model for suspected small-for-gestational age fetuses.What is already known: Small-for-gestational age fetuses are at increased risk of intrapartum compromise. Fetal weight alone is a poor marker for adverse outcomes and a comprehensive prediction model has been previously suggested.What this study adds: Multivariable prediction model showed good accuracy and calibration in this external validation study. The significance of some variables was different between the original and external validation cohort and there was a small margin for improvement with model refitting. A mobile application has been developed to facilitate clinical use.

This study aimed to assess the prognostic value of cardiovascular assessment in women with gestational hypertension or chronic hypertension for the risk of preeclampsia and need for closer antenatal surveillance. This was a prospective study of pregnancies complicated by gestational hypertension or chronic hypertension presenting to St George's Hospital, between January 2015 and May 2018. A noninvasive ultrasonic cardiac output monitor was used to obtain cardiovascular variables of cardiac output (CO) and systemic vascular resistance (SVR) and weight-adjusted indices. The primary outcome was the time to development of preeclampsia in women with gestational hypertension or chronic hypertension. In women with gestational hypertension or chronic hypertension (n=149), cox-proportional hazards analysis showed that mean arterial pressure ( P =0.006), Afro-Caribbean ethnicity ( P =0.045), and gestational age at the time of diagnosis above 34 weeks ( P <0.001) were significantly associated with increased risk of earlier preeclampsia. Women with high SVR and normal CO (adjusted hazard ratio, 2.32 [95% CI, 1.06-5.08]; P =0.035) and high SVR and low CO (adjusted hazard ratio, 7.79 [95% CI, 1.94-31.24]; P =0.003) cardiovascular profiles had significantly higher risk of earlier preeclampsia compared with women with normal SVR and normal CO. The findings of this study demonstrate that hypertensive women with increased SVR and low CO had a higher risk of developing preeclampsia sooner.

Background: Perform a systematic review and meta-analysis of SARS-CoV-2 infection and pregnancy., Methods: Databases (Medline, Embase, Clinicaltrials.gov, Cochrane Library) were searched electronically on 6th April and updated regularly until 8th June 2020. Reports of pregnant women with reverse transcription PCR (RT-PCR) confirmed COVID-19 were included. Meta-analytical proportion summaries and meta-regression analyses for key clinical outcomes are provided., Findings: 86 studies were included, 17 studies (2567 pregnancies) in the quantitative synthesis; other small case series and case reports were used to extract rarely-reported events and outcome. Most women (73.9%) were in the third trimester; 52.4% have delivered, half by caesarean section (48.3%). The proportion of Black, Asian or minority ethnic group membership (50.8%); obesity (38.2%), and chronic co-morbidities (32.5%) were high. The most commonly reported clinical symptoms were fever (63.3%), cough (71.4%) and dyspnoea (34.4%). The commonest laboratory abnormalities were raised CRP or procalcitonin (54.0%), lymphopenia (34.2%) and elevated transaminases (16.0%). Preterm birth before 37 weeks' gestation was common (21.8%), usually medically-indicated (18.4%). Maternal intensive care unit admission was required in 7.0%, with intubation in 3.4%. Maternal mortality was uncommon (~1%). Maternal intensive care admission was higher in cohorts with higher rates of co-morbidities (beta=0.007, p<0.05) and maternal age over 35 years (beta=0.007, p<0.01). Maternal mortality was higher in cohorts with higher rates of antiviral drug use (beta=0.03, p<0.001), likely due to residual confounding. Neonatal nasopharyngeal swab RT-PCR was positive in 1.4%., Interpretation: The risk of iatrogenic preterm birth and caesarean delivery was increased. The available evidence is reassuring, suggesting that maternal morbidity is similar to that of women of reproductive age. Vertical transmission of the virus probably occurs, albeit in a small proportion of cases., Funding: N/A., Competing Interests: Dr. Morris is the President and Trustee of the Royal College of Obstetricians and Gynaecologists. He is a Trustee of the British Menopause Society and the Chairman of the Baby Lifeline Multiprofessional Advisory Panel., (© 2020 The Author(s).)

Objective(s): To develop a multivariable model using both clinical examination findings and validated questionnaires' scores for predicting the presence of detrusor overactivity observed during ambulatory urodynamic monitoring in women with urinary incontinence., Study Design: The study population was chosen from a registry of women evaluated with urodynamics for urinary incontinence retrospectively. Data for baseline characteristics, clinical findings, and ambulatory urodynamic records were evaluated for all women included to the study. Urodynamic data were obtained by retrospective review of urodynamic traces with a standardized protocol during single voiding cycle, compatible to the standards of International Continence Society (ICS) for ambulatory urodynamic monitoring., Results: A total of 395 women with urinary incontinence were included in the study. Detrusor overactivity was diagnosed in 57.1% of women included to the study. Clinical factors positively associated with detrusor overactivity were higher body-mass index (OR = 1.10; 95% CI 1.03-1.15, p < 0.001), higher OAB-V8 (Overactive bladder awareness tool - version 8) scores (OR = 1.04; 95% CI 1.01-1.06, p < 0.001) and presence of urgency urinary incontinence (OR = 2.39; 95% CI 1.47-3.81, p < 0.001). The presence of postural urinary incontinence (OR = 0.51; 95%CI 0.28-0.90, p = 0.021) and insensible loss of urine (OR = 0.33; 95%CI 0.27-0.93, p = 0.005) had negative associations with detrusor overactivity in the final multivariate logistic regression analysis., Conclusion(s): BMI, OAB-V8 scores, urgency urinary incontinence, postural urinary incontinence and insensible loss of urine were associated with the presence of detrusor overactivity according to our prediction model. However, the overall model accuracy suggests urodynamic studies are still needed for a definitive diagnosis. Nevertheless, the prediction may be beneficial for selecting a subgroup of women who are unlikely to benefit from ambulatory urodynamic monitoring for the diagnosis of detrusor overactivity., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective(s): To assess the association between the ultrasonographic presence of adenomyosis and recurrent miscarriage (RM)., Study Design: A prospective matched case-control study was conducted between March 2018 and December 2018 at Ankara University Hospital. A total of 132 women were assessed with transvaginal ultrasonography for the presence of adenomyosis markers. The case group consisted of 66 women with RM. The control group consisted of 66 women without RM or any other gynaecologic conditions. The rates of ultrasonographic adenomyosis, using strict criteria, were compared between the groups. Other etiologic factors for RM were described in the case group. The primary outcome was the ultrasonographic diagnosis of adenomyosis., Results: The ultrasonographic diagnosis of adenomyosis, using diagnostic criteria of at least two markers, was significantly higher in the RM group when compared to the control group (19.7% vs. 6.1%, respectively; P = 0.035). The most common ultrasonographic finding in the RM group was heterogeneous myometrium (18.2%). In the RM group, there was at least one possible risk factor (including adenomyosis) for RM in 42 women (63.6%). The prevalence of adenomyosis in nine women with unexplained RM was 13.6%., Conclusion(s): The prevalence of adenomyosis was significantly increased in women with RM compared to healthy controls. Adenomyosis and uterine anomalies were the most common risk factors associated with RM., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The sFlt-1 (soluble fms-like tyrosine kinase-1), PlGF (placental growth factor), and their ratio are useful for predicting delivery because of preeclampsia in singleton pregnancies. Evidence on the utility of sFlt-1/PlGF ratio in twin pregnancies is lacking. We aimed to evaluate the predictive value of sFlt-1/PlGF ratio for delivery because of preeclampsia in twins. A retrospective data analysis of 164 twin pregnancies with suspected preeclampsia was performed. The sFlt-1/PlGF ratio, which was known to clinicians, was significantly higher in women who delivered within 1 and 2 weeks compared with those who did not (median: 98.9 and 84.2 versus 23.5 pg/mL, respectively; P <0.001). The area under the curve values sFlt-1/PlGF ratio levels were 0.88 (95% CI, 0.83-0.84) and 0.88 (95% CI, 0.83-0.93) for predicting delivery because of preeclampsia within 1 and 2 weeks of blood sampling, respectively. The predictive accuracy of sFlt-1/PlGF was independent of gestational age at sampling and chorionicity ( P >0.100 for interaction). The area under the curve values of sFlt-1/PlGF were significantly higher than for PlGF alone (mean 0.88 and 0.88 versus 0.81 and 0.80) for predicting delivery because of preeclampsia within 1 and 2 weeks of blood sampling ( P =0.055 and 0.001, respectively). sFlt-1/PlGF ratio lower than 38 was able to rule-out delivery within 1 and 2 weeks with a negative predictive value of 98.8% and 96.4% for delivery because of preeclampsia within 1 and 2 weeks, respectively. A cutoff of 38 is applicable for ruling out delivery because of preeclampsia in twin pregnancies.

The aim of this meta-analysis is to investigate whether white-coat hypertension (WCH) has an adverse effect on maternal, fetal, and neonatal outcomes. Medline, EMBASE, www.Clinicaltrials.gov, and Cochrane Library databases were searched electronically in December 2019. The outcomes were compared between pregnant women with WCH and normotensive controls, women with chronic hypertension, gestational hypertension or any hypertensive disorder of pregnancy. Twelve studies were eligible for inclusion in the systematic review. Women with WCH enrolled below 20 weeks had a significantly increased risk of preeclampsia (pooled risk ratio [RR], 5.43 [95% CI, 2.00-14.71]). Furthermore, women with WCH had increased risk of delivering a small-for-gestational-age newborn (RR, 2.47 [95% CI, 1.21-5.05], P =0.013) and preterm birth (RR, 2.86 [95% CI, 1.44-5.68], P =0.002). The risk of preeclampsia (risk ratio, 0.43 [95% CI, 0.23-0.78], P =0.005), small-for-gestational-age (RR, 0.46 [95% CI, 0.26-0.82], P =0.008), preterm birth (RR, 0.47 [95% CI, 0.31-0.71], P <0.001) were significantly lower with WCH compared with women with gestational hypertension. Women with WCH delivered ≈1 week later compared with women with chronic hypertension (mean difference, 1.06 weeks [95% CI, 0.44-1.67 weeks]; P <0.001). WCH is associated with a worse perinatal and maternal outcome than normotension, but better outcomes than gestational hypertension and chronic hypertension. Therefore, diagnosis of WCH should be ascertained in pregnant women presenting with hypertension. When the diagnosis is confirmed, these women require monitoring for developing preeclampsia, small-for-gestational-age and preterm birth.

This study aims to evaluate the natural history, disease progression, and outcomes in dichorionic twins with selective fetal growth restriction (sFGR) according to different diagnostic criteria and time of onset. Dichorionic twins seen from the first trimester were included. sFGR was classified according to the Delphi consensus, and was compared to the outcomes of those classified by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) diagnostic criteria. Early sFGR occurred before 32-weeks, and late sFGR after 32-weeks. Disease progression, neonatal outcomes such as gestation at delivery, birthweight, neonatal unit (NNU) admission, and morbidities were compared. One-hundred twenty-three of 1053 dichorionic twins had sFGR, where 8.4% were classified as early sFGR, and 3.3% were late sFGR. Disease progression was seen in 36%, with a longer progression time (5 vs. 1 week) and higher progression rate (40% vs. 26%) in early sFGR. Perinatal death was significantly higher in the sFGR than the non-sFGR group (24 vs. 16 per 1000 births, p = 0.018), and those with early sFGR had more NNU admissions than late sFGR ( p = 0.005). The ISUOG diagnostic criteria yielded a higher number of sFGR than the Delphi criteria, but similar outcomes. sFGR have worse perinatal outcomes, with early onset being more prevalent. Use of the Delphi diagnostic criteria can reduce over-diagnosis of sFGR and avoid unnecessary intervention.

Angiogenic markers such as PlGF (placental growth factor) and sFlt-1 (soluble Fms-like tyrosine kinase-1) have been shown to be useful for predicting adverse outcome in women suspected of having preeclampsia. The aim of the current study was to evaluate the prognostic value of angiogenic markers and maternal risk factors in pregnant women with hypertension. This was a prospective study of pregnancies complicated by preeclampsia, gestational hypertension, or chronic hypertension presenting to 1 of 2 tertiary referral hospitals between May 2013 and May 2018. Maternal characteristics along with blood samples for angiogenic marker analysis were obtained from participants. The primary outcome was delivery related to preeclampsia within 1 and 2 weeks. In total, 302 women with hypertension were included in the study cohort. The baseline model included maternal body mass index, mean arterial pressure, and clinical diagnosis at the time of assessment. The use of sFlt-1/PIGF ratio combined with the baseline model significantly improved the area under the curve values for predicting delivery within a week (0.83 versus 0.88; P =0.025) or in 2 weeks (0.86 versus 0.93; P =0.001) due to preeclampsia-related events in gestational ages <35 weeks. The magnitude of increase in accuracy was 7.9% (-0.5% to 16.4%, posterior probability of increase: 96.7%) for sFlt-1/PlGF ratio. Our results emphasize the additive value of angiogenic biomarkers and the superior performance of a continuous scale of sFlt-1/PlGF ratio in the model. The added utility of angiogenic markers diminishes after 35 weeks' gestation.

Aims: Fetuses affected by congenital heart defects (CHD) are considered to be at increased risk of fetal growth restriction and intrauterine demise. Whether these risks are a direct consequence of fetal CHD or a result of associated uteroplacental dysfunction is not evident from the data of recent studies. The aim of this study was to investigate the prevalence of uteroplacental dysfunction reflected by abnormal uterine artery Doppler indices and reduced fetal growth in CHD pregnancies., Methods: This is a retrospective case-control study including singleton pregnancies referred for detailed fetal cardiac assessment subsequently diagnosed with or without CHD. Mid-trimester uterine artery Doppler assessment at 20-24 weeks as well as third trimester fetal biometry and arterial Doppler pulsatility indices (PI) were performed. All fetal biometry were converted into centiles and Doppler values to multiples of median (MoM) to adjust for physiological changes with gestation., Results: The study included 811 pregnancies including 153 cases where the fetus was diagnosed with CHD. Mid-pregnancy uterine artery PI was significantly higher in women with fetal CHD compared to controls (0.90MoM vs 0.83MoM; p = 0.006). In the third trimester, median centiles for fetal head circumference (45.4 vs 57.07; p<0.001), abdominal circumference (51.17 vs 55.71; p = 0.014), estimated fetal weight (33.6 vs 56.7; p<0.001) and cerebroplacental ratio (CPR: 0.84MoM vs 0.95MoM; p<0.001) were significantly lower in fetuses with CHD compared to controls. The percentage of small for gestational age births <10th centile (24.0% vs 10.7%; <0.001) and low CPR <0.6MoM (11.7% vs 2.5%; p<0.001) were significantly higher in the fetal CHD cohort., Conclusions: Mid-pregnancy uterine artery resistance is increased and subsequent fetal biometry reduced in pregnancies with CHD fetuses. These findings suggest that fetal CHD are associated with uteroplacental dysfunction, secondary to impaired maternal uteroplacental perfusion resulting in relative fetal hypoxaemia and reduced fetal growth., Competing Interests: The authors have declared that no competing interests exist.

Recent evidence suggests that home blood pressure monitoring (HBPM) is an effective way of managing women with hypertensive disorders of pregnancy (HDP) without increasing adverse outcomes. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of HBPM during pregnancy. Medline, EMBASE and the Cochrane library databases were searched electronically in November 2018. Studies were included from which data could be extracted on the pregnancy outcomes and included pregnancies with HDP or at increased risk of developing HDP. Data from nine studies were included in the meta-analysis. The use of HBPM during the antenatal period was associated with reduced risk of induction of labor (OR: 0.55, 95% CI: 0.36-0.82, 444 women, I 2  = 0%), prenatal hospital admissions (OR: 0.31, 95% CI: 0.19-0.49, 416 women, I 2  = 0%) and diagnosis of preeclampsia (OR: 0.50, 95% CI: 0.31-0.81, 725 women, I 2  = 37%). The number of antenatal visits was significantly less in the HBPM group (standard mean difference: -0.49, 95% CI: -0.82 to -0.16, 738 women, I 2  = 75%). There were no significant differences between HBPM and conventional care regarding composite maternal, fetal or neonatal outcomes when used during the antenatal period. There were no significant differences between the groups who had HBPM compared to those who had conventional care regarding postpartum readmissions and obtaining a blood pressure measurement within 10 days of delivery after discharge. The significant clinical heterogeneity and low quality of evidence are the main limitations, and therefore, more high quality studies are needed., (Copyright © 2019 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.)

Objectives: To assess the safety and efficacy of home blood pressure monitoring (HBPM) and office (traditional) blood pressure measurements in a cohort of pregnant women with gestational hypertension (GH)., Study Design: This was a cohort study at St. George's Hospital, University of London conducted between December 2013 and August 2018. The inclusion criteria was pregnant women with a diagnosis of GH. Eligible patients were counseled and trained by a specialist midwife and were provided with an automated Microlife® "WatchBP Home" BP machine. Each patient followed an individualised schedule of hospital visits and BP measurements based on the HBPM pathway or standard hospital protocol which was based on the National Institute of Health and Care Excellence (NICE) guideline., Main Outcome Measures: Adverse fetal, neonatal and maternal outcomes as well as number of antenatal hospital visits were recorded and compared between HBPM and office (traditional) pathways., Results: 143 women with GH were included in the study (80 HBPM vs 63 standard care). There were no significant difference between the two groups in maternal high-dependency unit admission (P = 0.999), birth weight centile (P = 0.803), fetal growth restriction (p = 0.999), neonatal intensive care unit admissions (p = 0.507) and composite neonatal (p = 0.654), maternal (p = 0.999) or fetal adverse outcomes (p = 0.999). The number of Day Assessment Unit (DAU) visits was significantly lower in the HBPM group than the traditional pathway (median 4.0 vs. 5.0, P = 0.009). The difference was greater when the number of visits were adjusted for the duration of monitoring in weeks (median: 1.0 vs 1.5, P < 0.001). There were no significant difference between the two groups in the total number of outpatient (P = 0.357) and triage visits (p = 0.237). However, the total number of antenatal visits adjusted for the duration of monitoring was significantly lower for the HBPM group compared to the traditional pathway (median 1.4 vs 1.8, P = 0.020)., Conclusions: HBPM in women with GH results in significantly less antenatal visits compared to women on a standard pathway of care. The two groups had comparable fetal, neonatal and maternal adverse outcomes. Large multicentre studies are needed to ascertain the safety of rare adverse pregnancy outcomes., (Copyright © 2019. Published by Elsevier B.V.)

Objective: To investigate whether assessment of longitudinal change in Doppler variables in small-for-gestational-age (SGA) fetuses improves the prediction of those at risk of stillbirth., Methods: This was a longitudinal study of two cohorts of singleton pregnancies, which included SGA and appropriate-for-gestational-age (AGA) fetuses, respectively. The inclusion criteria for the SGA cohort were singleton pregnancy at ≥ 20 weeks' gestation, classified as SGA (estimated fetal weight < 10 th centile). The AGA cohort consisted of singleton pregnancies deemed at high risk of being SGA, which were followed up longitudinally but remained AGA. Fetal middle cerebral artery (MCA) pulsatility index (PI) and umbilical artery (UA)-PI were measured longitudinally and cerebroplacental ratio (CPR) was calculated, and values were converted to multiples of the median. The last two measurements prior to delivery were included in the analysis. Longitudinal models for Doppler variables were developed using linear-mixed models and their accuracy in the prediction of stillbirth was tested using generalized linear models. A Bayesian framework was employed to compare the accuracy of longitudinal and standard (last-scan measurement) models., Results: In total, 1549 AGA and 941 SGA pregnancies were included in the analysis. There were 30 (3.2%) and no stillbirth cases in the SGA and AGA groups, respectively. Change in MCA-PI, UA-PI and CPR with advancing gestation was significantly different between liveborn AGA and SGA fetuses, with a less pronounced difference with advancing gestation. Using the last measurement, the best models for the prediction of stillbirth in SGA pregnancies were those based on CPR (accuracy, 75.0%; 95% CI, 72.6-77.2%) and UA-PI (accuracy, 71.0%; 95% CI, 68.6-73.4%). The posterior probability of the standard CPR model having a higher accuracy compared with the UA-PI model was 97.2% (magnitude of change (MC), 3.9%; 95% credible interval (CrI), 0.5-7.3%). The accuracies of the standard, compared with the longitudinal, models for UA-PI (71.0% vs 72.8%), MCA-PI (64.6% vs 63.8%) and CPR (75.0% vs 74.9%) in the prediction of stillbirth were not significantly different. The posterior probabilities for improvement in accuracy using longitudinal, compared with standard, assessment were 50.1% (MC, < 0.1%; 95% CrI, -3.3 to 3.3%), 35.2% (MC, -0.1%; 95% CrI, -4.5 to 2.8%) and 82.2% (MC, 1.9%; 95% CrI, -1.5 to 5.3%) for CPR, MCA-PI and UA-PI models, respectively. Therefore, change in Doppler parameters did not improve the accuracy of the prediction of stillbirth, compared with that of the last-scan measurement., Conclusion: Longitudinal assessment of Doppler parameters was not useful in improving the detection of stillbirth in SGA pregnancies, as compared with a single-point assessment. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.)

Objective: Small for gestational age (SGA) fetuses are at increased risk of admission to the neonatal unit, even at term. We aimed to develop and validate a predictive model for the risk of prolonged neonatal unit admission in suspected SGA fetuses at term., Methods: A single-center cohort study of singleton pregnancies with SGA fetus, defined as estimated fetal weight (EFW) less than the 10th centile, at term. The variables included known risk factors for neonatal unit admissions: maternal characteristics, EFW, abdominal circumference (AC), fetal Dopplers, gestational age (GA) at delivery, and intrapartum risk factors (meconium, pyrexia). Logistic regression analysis was used for model building and the prediction models were validated internally using bootstrapping., Results: Seven hundred and one SGA pregnancies at term were included; 5.9% had prolonged neonatal unit admission (>48 h). The multivariable model (AUC 0.71; 95% CI: 0.63-0.79) included GA at delivery <39 weeks (OR 2.76; 95% CI 1.23-6.04, p = .011), cerebroplacental ratio (CPR) multiples of median (MoM) (OR 0.21; 95% CI 0.05-0.79, p = .023), and EFW below the third centile (OR 2.43; 95% CI 1.26-4.68, p < .007). The combined model showed a sensitivity 30.9% (95% CI: 16.6-45.2%) for a fixed 10% false positive rate., Conclusion: The prediction model shows good accuracy and good calibration for assessing the risk of neonatal unit admission in suspected SGA fetuses. It has the potential to be used for patient counseling, determining the timing of delivery and the individual risk. Brief rationale Objective: The objective of this study is to determine the factors associated with prolonged neonatal unit admissions in small for gestational age fetuses at term. What is already known: Fetal weight and Doppler parameters are associated with adverse outcome in small for gestational age fetuses. However, most studies use composite outcome criteria by combining neonatal unit admission with adverse delivery outcomes. A comprehensive model combining antenatal and intrapartum variables is also lacking., What This Study Adds: Our model describes the association of antenatal and intrapartum variables with prolonged neonatal unit admission without using a composite adverse outcome measure. Estimated fetal weight, gestational age at delivery, and the cerebroplacental ratio can be used to estimate the risk of prolonged neonatal unit admission. The risk estimation can be useful for patient counseling and to determine the time of delivery.

Objective: Twin pregnancy is associated with a 2-3-fold increased risk of stillbirth compared with singleton pregnancy. Despite the fact that the growth pattern in twins has been shown to be different from that in singletons, it is controversial whether twin-specific growth charts should be used routinely. A major goal of prenatal ultrasound is to identify fetuses with growth restriction at risk of stillbirth. The main aim of this study was to compare the performance of chorionicity-specific twin charts with singleton charts, both customized and non-customized, in the antenatal prediction of small-for-gestational-age (SGA) stillborn and liveborn fetuses., Methods: This was a multicenter cohort study analyzing data from the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort (2000-2009) and a second cohort of twin pregnancies at St George's University Hospital (SGH) (2011-2016). The STORK cohort was used to compare the performance of the twin charts and non-customized singleton charts of Poon et al. and the SGH cohort was used to validate the twin-specific charts and compare their performance against customized (Gestation Related Optimal Weight (GROW)) and non-customized (Poon) singleton charts. The primary outcome was the prediction of SGA cases that were stillborn and those that were liveborn in twin pregnancies. Estimated fetal weight (EFW) available from the last examination (24 weeks' gestation and onwards) before delivery or demise was used to classify the fetuses as SGA (EFW < 10 th centile or < 3 rd centile) or appropriate for gestational age. The proportions of predicted SGA stillbirths and SGA live births were calculated using the three different charts., Results: The STORK cohort consisted of 1850 dichorionic (DC) and 300 monochorionic (MC) twin pregnancies. The SGH cohort consisted of 579 DC and 180 MC twin pregnancies. The stillbirth rates in the STORK and SGH cohorts were 1.1% and 1.3%, respectively. In those liveborn in the STORK cohort, using a 10 th -centile cut-off to define SGA, the non-customized singleton chart classified a significantly greater proportion as SGA than did the twin chart, regardless of chorionicity (P < 0.001). However, there was no significant difference between the twin and the non-customized singleton charts with regard to the proportion of stillbirth cases that were classified as SGA (P = 0.479). In the SGH cohort, the non-customized singleton chart classified 8.5% of all liveborn fetuses as SGA (EFW < 10 th centile) compared with 12.8% using the customized singleton chart and 7.1% using the twin chart (P < 0.001 and P = 0.005, respectively). However, there was no significant difference among the three charts in the proportion of stillbirths classified as SGA, regardless of chorionicity (P = 0.999). Similar results were obtained when the third centile cut-off was used to define SGA., Conclusions: Compared with the STORK chorionicity-specific twin charts, the customized and non-customized singleton charts classified prenatally as SGA more liveborn fetuses. However, the three charts classified as SGA a similar proportion of stillborn cases. Our preliminary results suggest that these twin charts could safely reduce unnecessary medical intervention in twin pregnancies. Further research on the topic is needed before clinical recommendations can be made. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.)

Purpose of Review: Two-thirds of the pregnancies complicated by stillbirth demonstrate growth restriction. Identification of the foetus at risk of growth restriction is essential to reduce the risk of stillbirth. The aim of this review is to critically appraise the current evidence regarding clinical utility of cerebroplacental ratio (CPR) in antenatal surveillance., Recent Findings: The CPR has emerged as an assessment tool for foetuses at increased risk of growth disorders. CPR is a better predictor of adverse events compared with middle-cerebral artery or umbilical artery Doppler alone. The predictive value of CPR for adverse perinatal outcomes is better for suspected small-for-gestational age foetuses compared with appropriate-for-gestational age (AGA) foetuses. CPR could be useful for the risk stratification of small-for-gestational age foetuses to determine the timing of delivery and also to calculate the risk of intrapartum compromise or prolonged admission to the neonatal care unit. Although there are many proposed cut-offs for an abnormal CPR value, evidence is currently lacking to suggest the use of one cut-off over another. CPR appears to be associated with increased risk of intrapartum foetal compromise, abnormal growth velocity, and lower birthweight in AGA foetuses as well. Moreover, birthweight differences are better explained with CPR compared to other factors such as ethnicity. However, the role of CPR in predicting adverse perinatal outcomes such as acidosis or low Apgar scores in AGA foetuses is yet to be determined., Summary: CPR appears to be a useful surrogate of suboptimal foetal growth and intrauterine hypoxia and it is associated with a variety of perinatal adverse events.

Objectives: During mid-trimester, it is necessary to terminate pregnancy due to some fetal anomalies and intrauterine death. Therefore, in this study, we aimed to compare abortion induction methods and combined use retrospectively., Methods: About 112 out of 223 pregnant patients were included in the study. The groups were determined as follows: Group 1 including pregnant patients who were administered misoprostol only (50 patients), Group 2 including pregnant patients who were administered single dose misoprostol (according to FIGO) and subsequently received cervical Foley catheter (30 patients), and Group 3 including pregnant patients who received Foley catheter only (32 patients). These three groups were compared in terms of effectiveness of the method, side effects, and complications as well as their characteristics., Results: In terms of characteristic of the groups, the average age of the women in the Group 1 was significantly higher than other two groups ( p  < 0.001). In terms of effectiveness of the method, the termination period in Groups 1 and 2 was significantly lower than Group 3 ( p  < 0.001). However, in terms of complications, it was observed that uterine rupture was developed in Group 1., Conclusions: Although medical methods may seem to be more effective in the process of termination, mechanical methods seem more reliable in terms of reliability. Especially combined methods can be used to increase effectiveness and also to reduce complications.

Background: Small-for-gestational-age fetuses are at an increased risk of intrapartum fetal compromise requiring operative delivery. Factors associated with the risk of intrapartum fetal compromise are yet to be established, and a comprehensive model accounting for both the antenatal and intrapartum variables is lacking., Objective: We aimed to develop and validate a predictive model for the risk of operative delivery for presumed intrapartum fetal compromise in fetuses suspected to be small for gestational age at term., Study Design: This was a single-center cohort study of small-for-gestational-age fetuses, defined as estimated fetal weight below the 10th centile in singleton pregnancies at term. The variables included known risk factors for operative delivery because of fetal compromise: maternal characteristics, estimated fetal weight, abdominal circumference, Doppler parameters, gestational age at delivery, induction of labor, and intrapartum risk factors (presence of meconium, augmentation of labor using oxytocin, the use of epidural analgesia, intrapartum pyrexia, and hemorrhage). The receiver-operating characteristics curve analysis was used to investigate the predictive accuracy. Internal validation of the models was performed with bootstrapped data sets., Results: A total of 927 term pregnancies with 18.7% operative deliveries were included. The antenatal model (area under the curve, 0.69; 95% confidence interval, 0.65-0.73) using only the antenatal risk factors included parity, abdominal circumference centile, gestational age at delivery beyond 39 weeks' gestation, and the cerebroplacental ratio multiples of median. The combined model (area under the curve, 0.76; 95% confidence interval, 0.72-0.80), using both the antenatal and intrapartum risk factors, included the gestational age at delivery beyond 39 weeks' gestation (odds ratio, 1.62; 95% confidence interval, 1.14-2.56), the cerebroplacental ratio multiples of median (odds ratio, 0.38; 95% confidence interval, 0.18-0.79), parity (odds ratio 0.35; 95% confidence interval, 0.22-0.54), induction of labor (odds ratio 1.63; 95% confidence interval, 1.11-2.40), augmentation using oxytocin (odds ratio, 1.84; 95% confidence interval, 1.23-2.73) and the use of epidural analgesia (odds ratio, 2.80; 95% confidence interval, 1.94-4.04). The results indicate that the model has good discrimination and, according to the Hosmer-Lemeshow test, has good fit (P = .591)., Conclusion: The prediction model demonstrates 6 important risk factors that are associated with the risk of operative delivery for fetal compromise in small-for-gestational-age fetuses at term. The model shows good discrimination and fit and has the potential to be used for clinical decision making and to counsel women about their individual intrapartum risk., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose of Review: To review the current data on maternal cardiovascular adaptation in normal pregnancy and preeclampsia., Recent Findings: Defective placentation causes early-onset preeclampsia, a disease entity that is considered more or less distinct from late-onset preeclampsia. The latter has been attributed as 'maternal' preeclampsia. There are inconsistencies with the placental origins hypothesis, especially when considering the lack of a causative association with abnormal placental histology or impaired fetal growth. An alternative explanation is that placental dysfunction is secondary to maternal cardiovascular maladaptation in pregnancy. The concept that placental dysfunction is secondary to a maternal disorder is not new when one considers the clinical similarities between preeclampsia and gestational diabetes - both pregnancy-specific conditions that are cured by birth. It is accepted that gestational diabetes develops when the maternal pancreas is unable to manage the increasing glucose load of pregnancy. It is now apparent that pregnancy presents a substantial cardiovascular load on the maternal heart, and that cardiovascular dysfunction precedes the disorder, predominates in the clinical syndrome and persists for several decades postpartum. It is time to consider the evidence that failure of the maternal cardiovascular system to adapt to pregnancy may well be the primary mechanism leading to secondary placental dysfunction in preeclampsia., Summary: Many of the existing paradoxes of preeclampsia challenge the placental origin hypothesis and are explained if one considered preeclampsia to be a cardiovascular syndrome.

Triptorelin 0.2 mg and leuprolide 1 mg subcutaneous injections for triggering final follicular maturation were compared in patients with a high risk for ovarian hyperstimulation syndrome (OHSS). Infertile patients treated with GnRH antagonist protocol between January 2014 and March 2016 were recruited. Patients with high serum oestradiol levels on HCG day (>3000 pg/ml) indicating a risk of OHSS consisted of the study groups (A and B). Patients with serum oestradiol levels less than 3000 pg/ml consisted of the control group (C). A single injection of 0.2 mg triptorelin, 1 mg leuprolide and 10000 IU HCG were administered for final oocyte triggering in groups A (n = 63), B (n = 74) and C (n = 131), respectively. Demographic parameters were comparable between the groups. No cases of severe or moderate OHSS occurred in any group. The clinical pregnancy rates were 31.7%, 37.8% and 32.8% in groups A, B and C, respectively. Both injections had comparable efficacy in clinical outcome and OHSS risk. Regardless of preferred drug, GnRH agonist trigger for final oocyte maturation seems to be safe for patients with high OHSS risk, and can be safely used in fresh embryo transfer cycles., (Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: The objective of this study is to evaluate diagnostic accuracy of transperineal ultrasound assessment compared to speculum examination by using placental alfa-microglobulin (PAMG)-1 tests as reference., Methods: This was a prospective observational study conducted in Ankara University Hospital. Women with early and late preterm pregnancies with suspected rupture of membranes, i.e. women with a complaint of fluid leakage (105 in total) were enrolled. Prior to speculum examination, sagittal and transverse plane views of the fornices and cervix were obtained via transperineal ultrasonography and images were stored. Then the speculum examination for amniotic fluid pooling was performed. Definite diagnoses were made with PAGM-1 assays. After collection of the data, ultrasound images were analyzed by an observer blind to physical examination findings. Hypoechogenic fluid appearance around the cervix and in the fornices was considered positive for preterm premature rupture of membranes (PPROM). Results of physical and ultrasound examination were compared with PAMG-1 test as a reference method. The diagnostic performance of transperineal ultrasound was tested with accuracy parameters and receiver-operating characteristics (ROC) curves. Inter-rater reliability was analyzed with Cohen's kappa., Results: In total, 103 pregnant women were evaluated. The prevalence of PPROM in our study population was 43.14%. At a 5 mm diagnostic threshold, the sensitivity and specificity values of transperineal assessment were 95.45% (95% CI: 84.50-99.31%) and 96.55% (95% CI: 88.07-99.48%), respectively, and they were comparable with speculum examination in a population of preterm pregnant women with suspected PPROM (p > 0.05). Interobserver reliability analysis with Cohen's kappa has shown good very good agreement with the kappa value of 0.93 (95% CI 0.87-1.00)., Conclusions: Transperineal ultrasonography is a novel method that can be used to assess vaginal pooling of amniotic fluid. Ultrasonography offers similar sensitivity and specificity compared with speculum examination and it is non-invasive.

Objective: To evaluate the relevant thoughts of nulliparous pregnant women in the second trimester without an absolute indication for cesarean on delivery preferences., Materials and Methods: This study was conducted on pregnant women who presented to the Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology Pregnant Outpatients Department for antenatal follow-up between May 2014 and February 2015. A total of 237 nulliparous patients voluntarily completed the survey form and the data were evaluated using various parameters. Parameters consistent with normal distribution were evaluated using the t-test, and parameters that were not normally distributed were evaluated using the Mann-Whitney U test. Parameters with a p value <0.05 were considered significant., Results: We found that 221 (93.2%) of the 237 nulliparous pregnant women preferred vaginal delivery and the remaining 16 (6.8%) preferred delivery by cesarean section., Conclusion: Women should be informed on the type of birth and both methods should be explained in a realistic and scientific manner in terms of benefit and risk. An effort is being made to increase vaginal birth rates worldwide and the same effort should be made in Turkey., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Objective: To investigate the association of first trimester serum uric acid levels with the development of gestational diabetes mellitus (GDM) in low-risk pregnant women., Materials and Methods: In this retrospective data analysis, the results of pregnant women who completed both first trimester biochemical panel and two-step GDM screening were compared with an age-, body mass index, and gestational age-matched control group. The women were grouped as either GDM or impaired glucose tolerance (IGT) according to 100-g oral glucose challenge results. Uric acid levels were compared between the groups and diagnostic utility was tested with receiver-operating characteristics curves., Results: Sixty-six women in GDM group and 358 women in the IGT group were compared against 202 healthy pregnant women. The groups did not differ significantly in terms of parity, pre-gestational body mass index and gestational age. Serum samples for uric acid levels were obtained. The mean serum uric acid levels were significantly higher in the GDM and IGT groups (5.95 mg/dL (±0.97 mg/dL) and 4.76 mg/dL (±1.51 mg/dL), respectively) compared with the control group (3.76 mg/dL (±1.07 mg/dL) (p<0.001). The area under the curve for uric acid levels was 0.92 (95% confidence interval 0.88-0.95) for diagnosis of GDM. At a diagnostic threshold of 3.95 mg/dL, uric acid levels predicted development of GDM with 60% specificity and 100% sensitivity., Conclusion: First trimester serum uric acid has a linear association with the development of GDM and IGT., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

The purpose of this case series is to provide preliminary evidence on the efficacy of pessary application in women with short cervix and at risk for preterm labor. Between May 2015 and July 2015, four pregnant women were followed-up with Arabin pessaries. The gestational age at the time of diagnosis was between the 23(th) and 29(th) weeks. Pessary application was associated with a prolongation of pregnancy lasting between 28 and 98 days. The gestational age at the time of delivery was between the 33rd and 39th weeks. Pessary use is non-invasive for the prolongation of pregnancy in pregnant women with shortened cervix. The major advantage of pessary use is its easy application without requiring anesthesia.

Objective: To assess effects of in utero cord blood collection on postoperative hemoglobin, hematocrit levels., Study Design: Elective cesarean deliveries in which cord blood was collected were compared with match paired elective cesarean deliveries without cord blood collection. Pre-post-operative hemoglobin and hematocrit level differences were compared between study groups with Student's t test. Multivariate regression models were used to address confounders. Correlation between volume of collected UCB and mean decrease in blood count parameters was analyzed., Results: A total of 399 cesarean deliveries during a 12 months period were included in the analysis. Mean decrease in hemoglobin levels was 1.08g/dL (SD=1.0) in UCB collected group compared to 0.84g/dL (SD=1.0) in control group (p=0.002). Mean decrease in hematocrit levels was 3.1% (SD=3.4) in cord blood collected cesarean delivery group compared to 1.9% (SD=2.4) in control group (p=0.002). Univariate analysis has shown the collected UCB volume to be uncorrelated with the change in hemoglobin levels (r=0.013). Multivariate regression models, after adjusting for birth weight, age and number of prior cesarean, have shown the UCB collection to be significantly associated with the mean decrease in blood count parameters (estimate=0.23g/dL, t=-2.23, p=0.02)., Conclusion: In utero UCB collection is associated with a small increase in bleeding of little clinical importance. Amount of UCB is not associated with amount of change in hemoglobin and hematocrit levels. In utero UCB collection seems to be safe for expectant mothers scheduled for low-risk cesarean delivery., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: The present study aims to determine the effects of a history of adolescent pregnancy (AP) on the bone mineral density (BMD) of perimenopausal women., Methods: Overall, 240 women aged between 40 and 55 years, with a complaint of oligomenorrhea or amenorrhea not exceeding 1 year in duration, were evaluated. Evaluation included a DEXA scan and a detailed demographic survey for bone health. Comparison was made between women with a history of AP and those without., Results: In total, 87 women who had a history of AP were compared with 153 women who did not have a history of AP. The study groups did not differ significantly for most of the evaluated demographic factors. Women with a history of AP had higher gravidity and parity. Comparison of T-scores revealed lumbar BMD to be unaffected by AP (P=0.184), whereas femoral BMD was positively influenced by a history of AP (0.78±0.65 vs -1.06±0.67; P=0.042). In covariance regression models, after adjusting for parity and age of first menarche, AP still positively influenced femoral BMD. Without a history of AP, women were at increased risk for osteoporosis of femoral neck (odds ratio, 2.8, 95% CI 1.75-4.8)., Conclusions: The effects of AP on BMD are not well elucidated. Women with a history of AP had better femoral BMD scores, indicating a possible protective influence of AP on bone health., Brief Summary: Pregnancy during adolescence is associated with a better femoral bone mineral density than pregnancy at an older age. However, the effects did not extend to lumbar spine bone mineral density., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: We performed a retrospective study to evaluate adolescent pregnancies as for gestational complications, and prinatal outcomes., Methods: We evaluated 341 pregnants whose data we could reach regarding gestational, and perinatal complications., Results: In our study group anemia (35.4%), preeclampsia/eclampsia (1.45%), premature membrane rupture (1.4%), intrauterine growth retardation (3.81%), and instrumental delivery (0.3%) were seen in indicated incidence rates., Conclusion: In our retrospective study, we found lower our complication rates in adolescent age group when compared with the adult age group, and other studies performed in adolescents. Since our hospital is a tertiary health care institute, and we monitorized our patients closely, our incidence rates can be better than those cited in the literature. As long as proper antenatal surveillance is employed, adolescent mothers do not seem to have increased risk for most of obstetric complications., Competing Interests: No conflict of interest was declared by the authors.

Objective: To compare ultrasound measurements and clinical assessments of cervical dilatation, fetal head station and fetal head position., Design: Prospective, observational study., Setting: Tertiary care center (Ankara University Hospital), labor ward., Population: Forty-three women in labor., Methods: Women were prospectively evaluated through simultaneous examinations (79 in total). Dilatation, head station, and position were recorded via digital examination whenever possible and were compared with ultrasonographic measurements of dilatation, angle of progression, head-perineum distance, and head position by two independent operators. Operators were blinded to each other's findings., Main Outcome Measures: Agreement between sonographic measurements and digital examinations., Results: Ultrasonographic assessment of dilatation correlated significantly with digital examination. The interclass correlation coefficient of the two methods was 0.82 (95% confidence interval 0.73-0.88). Ultrasonography showed a mean lower cervical dilatation of 10 mm (95% limits of agreement: -36 to 16 mm) compared with digital examination. The angle of progression and head-perineum distances correlated moderately with the palpated head station (Pearson's correlation coefficients: 0.55 and -0.42, respectively; p < 0.001). Position could only be assessed in 40 of 79 examinations by digital examinations and the results showed low agreement with ultrasound findings., Conclusion: We observed good agreement between clinical and ultrasound assessment of dilatation, moderate agreement in assessing fetal station and low agreement assessing head position., (© 2015 Nordic Federation of Societies of Obstetrics and Gynecology.)

Cell-free fetal DNA has received significant attention for the purposes of prenatal genetic testing in the past decade. Fetal DNA testing is a new method and promising for many applications such as aneuploidy screening, prenatal diagnosis, prediction of preeclampsia and more. A 37-year-old primigravida, with a pregnancy conceived by intracytoplasmic sperm injection (ICSI), was offered non-invasive prenatal testing (NIPT) due to advanced maternal age. NIPT performed at 23 weeks' gestation reported a diagnosis of monosomy X. She was offered an amniocentesis, which revealed a euploid fetus with no sex chromosome abnormalities. Even with single nucleotide polymorphism-based NIPT, positive predictive value for detection of sex chromosome abnormalities is around 50%. Positive results of NIPT should be heeded with caution and an invasive diagnostic procedure should be performed, especially for rare chromosomal abnormalities and sex chromosome abnormalities where NIPT performs subpar compared to its performance for detection of trisomy 21., (2015 BMJ Publishing Group Ltd.)

The objective of this study was to investigate the determining effects of diagnosis time on pregnancy outcomes in a population of pregnant women with idiopathic thrombocytopenic purpura (ITP). Records of all the pregnant women with thrombocytopenia were evaluated. Those with a confirmed diagnosis of ITP were included in the study. Main outcome measures were antenatal thrombocyte count, postpartum haemorrhage rate, and route of delivery. Foetal outcomes such as foetal thrombocyte count, haemorrhage, and birth weight were also reported as secondary outcome measures. Time of diagnosis either antenatal or preconception did not significantly alter the investigated parameters. Delivery route had no impact on complication rates. Time of diagnosis also did not affect treatment modality. ITP is rare disorder accounting for less than 5 % of all pregnant thrombocytopenias. Time of diagnosis does not affect maternal-foetal outcomes or treatment modality unless diagnosis is made during labour. Compared to gestational thrombocytopenia, treatment rates may differ but treatment modalities remain the same and the effort put into making the differential should be weighed against maternal stress factors for lengthy laboratory evaluation as long as the thrombocytopenia is of pure nature without any systemic involvement.