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First trimester bleeding is commonly encountered in pregnancy and can be potentially life-threatening. Simulation training provides an ideal opportunity for resident medical learners to improve clinical knowledge and gain confidence inmanaging life-threatening causes of first trimester bleeding in a realistic but safe clinical environment. The objective of this study was to assess the effectiveness of simulation in improving family medicine residents' confidence and knowledge in identifying and managing first trimester bleeding in the emergency department (ED). The intervention was a two-hour educational simulation focusing on management of unstable first trimester bleeding. Twenty-one family medicine residents (67% female) at the University of Toronto participated in the simulation and completed pre- and post-simulation questionnaires assessing their confidence and knowledge in management of first trimester bleeding. This study demonstrates that simulation training improves resident physicians' confidence in managing first trimester bleeding in the ED. Additionally, it improves their objective history taking skills. Post-graduate medical programs should consider developing structured simulation, particularly for high-yield clinical cases residents may not otherwise have acute exposure to and are required to be competent in managing. [ABSTRACT FROM AUTHOR]

Summary PHACE syndrome is a challenging but important prenatal diagnosis due to its protean clinical consequences. The ‘tilted telephone receiver’ sign (TTRS), consisting of asymmetric cerebellar volume reduction and marked counterclockwise, Dandy–Walker‐like upward vermis rotation on prenatal MRI and ultrasound has high specificity for PHACE. Recently, a case report of the prenatal imaging findings in an infant with PHACE described more mild upward vermis rotation and cerebellar clefting. It recommended consideration of expansion of the currently accepted phenotype to improve prenatal detection of the condition. We describe a case with imaging features essentially indistinguishable from the recently published case of PHACE with mild upward vermis rotation, asymmetric cerebellar hemispheric volume loss and a cerebellar hemispheric cleft. Our patient did not have PHACE postnatally at 1 year of follow up. Neurodevelopmental testing in infancy demonstrated mildly atypical development. Fetuses with asymmetric cerebellar hemispheric volume loss, a cleft in the smaller hemisphere and only mild upward vermis rotation, consistent with the proposed ‘expanded PHACE phenotype’ do not always have PHACE. Erroneously adverse prenatal prognostic counselling may result from such prenatal phenotypic expansion. [ABSTRACT FROM AUTHOR]

Introduction: Nausea and vomiting are common complaints in the first trimester of pregnancy. One treatment to reduce nausea and vomiting is non-pharmacological therapy by providing a mixture of lemon and lavender aromatherapy. In this study, there was only one group, namely the intervention group, which received blended lemon and lavender aromatherapy. Before carrying out the intervention, pregnant women in the first trimester are given a pre-test to find out how often pregnant women feel nauseous and vomit. Then the pregnant mother is taught how to use aromatherapy blended lemon and Lavender with Roll On which will be done in the morning and evening for 6 consecutive days. -continuously. Next, another post-test was carried out to determine the effectiveness of providing aromatherapy.Objectives: The aim of this study was to determine the effectiveness of giving a mixture of lemon and lavender aromatherapy against nausea and vomiting in first trimester pregnant women at PMB (Independent Midwife Practice) Entin Hartini, A.Md. Keb Mrebet District, Purbalingga Regency.Methods: The type of research used in this research is pre-experimental with a One Group Pre-Test and Post-Test design.Results: The Wilcoxon test results were obtained by Asymp. signature. 0.00 that there is an effect of giving a mixture of lemon and lavender aromatherapy in reducing nausea and vomiting (𝜌- value = 0.00).Conclusions: There is effectiveness of giving a mixture of lemon and lavender aromatherapy for nausea and vomiting in first trimester pregnant women at PMB Entin Hartini, A.Md.Keb.

Preeclampsia (PE) is a multisystem disorder that is an important cause of maternal and perinatal deaths. Currently, delivery is the only final treatment for PE. This practice is usually accompanied by premature birth, which inevitably increases neonatal morbidities. Aspirin is a non-selective non-steroidal anti-inflammatory drug that irreversibly inhibits cyclooxygenase enzymes involved in converting arachidonic acid to prostaglandins and thromboxane. Aspirin inhibits thromboxane A2 production via platelet aggregation, thereby increasing the prostacyclin/thromboxane A2 ratio and reducing platelet aggregation. Since the first case report of aspirin’s potential use during pregnancy was reported in 1978, many studies have attempted to confirm the effect of aspirin on PE, and the results have been controversial. However, this preventive strategy is generally accepted in clinical practice. As evidence for aspirin’s prevention of PE has been accumulating, a recent study investigated the effectiveness of aspirin at high doses of 150 mg, which is higher than before. However, there is an ongoing debate about how much aspirin should be used during pregnancy and when to start aspirin therapy. Guidelines for the use of prophylactic aspirin during pregnancy vary slightly among countries and groups. In this article, we review and summarize the evidence regarding the use of aspirin for PE prevention.

We aimed to evaluate the effectiveness of the first trimester's 50 g glucose loading as a screening test for gestational diabetes mellitus and to find a cut-off value for 50 g OGCT in the first trimester. This study was conducted on pregnant women at low risk for diabetes mellitus. A 50-g glucose load was done in the first trimester, and then pregnant women were followed up. A 100-gram diagnostic test for gestational diabetes mellitus was administered to all participants at 24-28 weeks of gestation. The sensitivity, specificity, and false-positive rate of the 50 g glucose challenge test were determined. A total of 454 pregnant women were assessed in this study. 34 women (7.5%) were diagnosed with gestational diabetes. 420 women have constituted the non-diabetic group. In patients with gestational diabetes, age, weight, polyhydramnios, and macrosomia rates were significantly higher than in the non-diabetic group. The discriminative power of the 50 g glucose test in the first trimester was found to be significant (p = 0.001) in gestational diabetic patients. The area under the ROC curve was 0.927. The best cut-off value was 143 mg/dl. In this value, the sensitivity and false-positive rate were 85% and 11%, respectively. A 50-g glucose challenge test done in the first trimester may contribute to the reduction of maternal and perinatal risks and prevent long-term consequences such as obesity, type 2 diabetes mellitus, and lipid profile disorders with early glycemic control and lifestyle changes. [ABSTRACT FROM AUTHOR]

Introduction: The Fetal Medicine Foundation (FMF) London developed a first trimester combined screening algorithm for preterm preeclampsia (pPE) that allows a significantly higher detection of pregnancies at risk compared to conventional screening by maternal risk factors only. The aim of this trial is to validate this screening model in the Swiss population in order to implement this screening into routine first trimester ultrasound and to prescribe low-dose aspirin 150 mg (LDA) in patients at risk for pPE. Therefore, a multicentre registry study collecting and screening pregnancy outcome data was initiated in 2020; these are the preliminary results. Methods: Between June 1, 2020, and May 31, 2021, we included all singleton pregnancies with pPE screening at the hospitals of Basel, Lucerne, and Bern. Multiple of medians of uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP), placental growth factor (PlGF), and pregnancy-associated plasma protein A (PAPP-A) as well as risks were analysed as calculated by each centre's software and recalculated on the FMF online calculator for comparative reasons. Statistical analyses were performed by GraphPad Version 9.1. Results: During the study period, 1,027 patients with singleton pregnancies were included. 174 (16.9%) had a risk >1:100 at first trimester combined screening. Combining the background risk, MAP, UtA-PI, and PlGF only, the cut-off to obtain a screen positive rate (SPR) of 11% is ≥1:75. Outcomes were available for 968/1,027 (94.3%) of all patients; 951 resulted in live birth. Fifteen (1.58%) developed classical preeclampsia (PE), 23 (2.42%) developed PE according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) definition. Conclusion: First trimester combined screening for PE and prevention with LDA results in a low prevalence of PE. The screening algorithm performs according to expectations; however, the cut-off of >1:100 results in a SPR above the accepted range and a cut-off of ≥1:75 should be considered for screening. More data are needed to evaluate, if these results are representative for the general Swiss population. [ABSTRACT FROM AUTHOR]

Abstract Objective To explore the risk factors including the difference between mean gestational sac diameter and crown-rump length for missed abortion. Methods Hospitalized patients with missed abortion and patients with continuing pregnancy to the second trimester from Chengdu Women's and Children's Central Hospital from June 2018 to June 2021 were retrospectively analyzed. The best cut-off value for age and difference between mean gestational sac diameter and crown-rump length (mGSD-CRL) were obtained by x-tile software. Univariate and multivariate logistic regression analysis were adopted to identify the possible risk factors for missed abortion. Results Age, gravidity, parity, history of cesarean section, history of recurrent abortion (≥ 3 spontaneous abortions), history of ectopic pregnancy and overweight or obesity (BMI > 24 kg/m2) were related to missed abortion in univariate analysis. However, only age (≥ 30 vs 24 vs ≤ 24 kg/m2: OR = 2.073, 95%CI = 1.056–4.068, P = 0.034, power = 81.3%) and mGSD-CRL (> 20.0vs ≤ 11.7 mm: OR = 2.960, 95% CI = 1.397–6.273, P = 0.005, power = 98.9%; 11.7 20.0 mm: OR = 0.341, 95%CI = 0.172–0.676, P = 0.002, power = 84.8%) were identified as independent risk factors for missed abortion in multivariate analysis. Conclusion Patients with age ≥ 30 years, BMI > 24 kg/m2 or mGSD-CRL > 20 mm had increasing risk for missed abortion, who should be more closely monitored and facilitated with necessary interventions at first trimester or even before conception to reduce the occurrence of missed abortion to have better clinical outcomes.

This case series is presented to illustrate the clinical value of identifying, sonographically, the type of cesarean scar ectopic pregnancy that may present, as this has become more frequently encountered. The choice of surgical treatment appears to be dependent on the sonographic typing, of this specific type of ectopic pregnancy. This case study illustrates the importance of this topic, given the rising incidence of cesarean deliveries coupled with the increase in first trimester sonograms being more commonly performed. The value of proper diagnostic detection is important, given the contemporary management of this new type of ectopic pregnancy. [ABSTRACT FROM AUTHOR]

Background and Objective: The most important concern associated with diagnosing congenital toxoplasmosis is to determine when the mother has been infected. The importance of using serological diagnostic tests such as IgG-avidity assay which can distinguish between recent and past infections has been proven. The present study aimed to diagnose acute toxoplasmosis in the first trimester of pregnancy using IgG-avidity testing. Materials and Methods: The present descriptive cross-sectional study was conducted in Hamadan, Iran in 2019. A total of 340 blood samples were collected from pregnant women in the first trimester of pregnancy and stored at -70 °C until experimenting. The IgG antibody titer was then determined. Also, IgM and IgG-avidity titers were measured for those samples with a positive IgG titer. Results: Out of 340 pregnant women, 106 (31.2%) had a positive and 2 (0.6%) had a suspected IgM test. Of the 106 pregnant mothers with positive IgG, 6 (5.66%) had low IgG-avidity indicating recent infection of toxoplasmosis in the past 3 to 4 months. IgG-avidity titer was moderate in 10 patients (9.43%) and high in 90 patients (84.9%). Conclusion: Using the IgG-avidity test and its improved methods along with other serological and molecular methods can be effective in determining and differentiating acute toxoplasmosis in pregnant women, especially in the first trimester of pregnancy, and preventing its irreversible complications in the fetus.

Abstract Background The incidence rates of obesity and gestational diabetes mellitus (GDM) are increasing in parallel. This study aimed to evaluate the relationship between different obesity indices, including prepregnancy body mass index (preBMI), the first-trimester abdominal circumference (AC), and first-trimester abdominal circumference/height ratio (ACHtR), and GDM, and the efficacy of these three indices in predicting GDM was assessed. Methods A total of 15,472 pregnant women gave birth to a singleton at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Prepregnancy weight was self-reported by study participants, body height and AC were measured by nurses at the first prenatal visit during weeks 11 to 13+6 of pregnancy. GDM was diagnosed through a 75-g oral glucose tolerance test at 24–28 gestational weeks. Using receiver operator characteristic (ROC) curve analysis, we evaluated the association between obesity indices and GDM. Results A total of 1912 women (12.4%) were diagnosed with GDM. Logistic regression analysis showed that AC, ACHtR, and preBMI (P

Background: The incidence rates of obesity and gestational diabetes mellitus (GDM) are increasing in parallel. This study aimed to evaluate the relationship between different obesity indices, including prepregnancy body mass index (preBMI), the first-trimester abdominal circumference (AC), and first-trimester abdominal circumference/height ratio (ACHtR), and GDM, and the efficacy of these three indices in predicting GDM was assessed. Methods: A total of 15,472 pregnant women gave birth to a singleton at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Prepregnancy weight was self-reported by study participants, body height and AC were measured by nurses at the first prenatal visit during weeks 11 to 13+6 of pregnancy. GDM was diagnosed through a 75-g oral glucose tolerance test at 24–28 gestational weeks. Using receiver operator characteristic (ROC) curve analysis, we evaluated the association between obesity indices and GDM. Results: A total of 1912 women (12.4%) were diagnosed with GDM. Logistic regression analysis showed that AC, ACHtR, and preBMI (P < 0.001) were all independent risk factors for the development of GDM. In the normal BMI population, the higher the AC or ACHtR was, the more likely the pregnant woman was to develop GDM. The area under the ROC curve (AUC) was 0.63 (95% CI: 0.62–0.64) for the AC, 0.64 (95% CI: 0.62–0.65) for the ACHtR and 0.63 (95% CI: 0.62–0.64) for the preBMI. An AC ≥ 80.3 cm (sensitivity: 61.6%; specificity: 57.9%), an ACHtR of ≥ 0.49 (sensitivity: 67.3%; specificity: 54.0%), and a preBMI ≥ 22.7 (sensitivity: 48.4%; specificity: 71.8%) were determined to be the best cut-off levels for identifying subjects with GDM. Conclusions: An increase in ACHtR may be an independent risk factor for GDM in the first trimester of pregnancy. Even in the normal BMI population, the higher the AC and ACHtR are, the more likely a pregnant woman is to develop GDM. AC, ACHtR in the first trimester and preBMI might be anthropometric indices for predicting GDM, but a single obesity index had limited predictive value for GDM. [ABSTRACT FROM AUTHOR]

Introduction: Increased fetal nuchal translucency (NT) thickness is defined as a transient subcutaneous accumulation of fluid behind the fetal neck that can be seen with the help of ultrasound. The thickness of fetal NT is a diagnostic criterion in genetic syndromes. The aim of this study was to investigate the relationship between exogenous progesterone administration in the first trimester of pregnancy and fetal NT thickness. Materials and Methods: This retrospective cohort study was conducted on 200 pregnant women aged 18 to 45 years including 100 pregnant women receiving exogenous progesterone and 100 pregnant women who did not receive exogenous progesterone in 2020-2021. The NT thickness of their fetal was measured at 11 to 12 weeks-6 days of gestation. Data were analyzed using Stata software version 14 using independent t-test, Chi-square, Fisher, and Pearson correlation coefficient. The statistical significance level was determined as less than 0.05 (P <0.05). Results: Mean of age, body mass index (BMI), gestational age, crown-rump length (CRL), pregnancy-associated plasma protein-A (PAPPA), free beta-human chorionic gonadotropin (FβHCG) and βHCG median and multiple of median (MOM) levels were not statistically significant in the two groups (p<0.05).The mean of NT thickness in the group receiving exogenous progesterone was higher than the group non-receiving exogenous progesterone and there was a significant difference between the two groups (p<0.05). Frequency distribution of Gravida, parity, previous live births, previous abortion, and history of abnormalities were not significant in the two groups (p<0.05). Conclusion: The findings of the present study showed that external progesterone consumption increased the thickness of the fetal nuchal translucency thickness. Since in some studies, no significant association has been reported between NT thickness and exogenous progesterone intake further studies are recommended. [ABSTRACT FROM AUTHOR]

Uterine fibroids are the most common benign tumors in women in the reproductive age group. The incidence of fibroids during pregnancy varies between 1.6 and 10.7%. In 10% of these cases, fibroids lead to complications. The management in symptomatic patients is conservative, and the surgical treatment is delayed until after birth due to its risks. In the last two decades, it has been shown that myomectomy can be an alternative treatment in selected cases, especially in second-trimester pregnancies. However, the data on the success of myomectomies performed earlier in pregnancy are limited. In this case report, we present two cases who were admitted to our clinic during the first trimester of pregnancy and had complicated fibroids. The diagnosis, the follow up and the treatment are presented with the review of the literature.

Objective: To explore the risk factors including the difference between mean gestational sac diameter and crown-rump length for missed abortion. Methods: Hospitalized patients with missed abortion and patients with continuing pregnancy to the second trimester from Chengdu Women's and Children's Central Hospital from June 2018 to June 2021 were retrospectively analyzed. The best cut-off value for age and difference between mean gestational sac diameter and crown-rump length (mGSD-CRL) were obtained by x-tile software. Univariate and multivariate logistic regression analysis were adopted to identify the possible risk factors for missed abortion. Results: Age, gravidity, parity, history of cesarean section, history of recurrent abortion (≥ 3 spontaneous abortions), history of ectopic pregnancy and overweight or obesity (BMI > 24 kg/m2) were related to missed abortion in univariate analysis. However, only age (≥ 30 vs < 30 years: OR = 1.683, 95%CI = 1.017–2.785, P = 0.043, power = 54.4%), BMI (> 24 vs ≤ 24 kg/m2: OR = 2.073, 95%CI = 1.056–4.068, P = 0.034, power = 81.3%) and mGSD-CRL (> 20.0vs ≤ 11.7 mm: OR = 2.960, 95% CI = 1.397–6.273, P = 0.005, power = 98.9%; 11.7 < mGSD-CRL ≤ 20.0vs > 20.0 mm: OR = 0.341, 95%CI = 0.172–0.676, P = 0.002, power = 84.8%) were identified as independent risk factors for missed abortion in multivariate analysis. Conclusion: Patients with age ≥ 30 years, BMI > 24 kg/m2 or mGSD-CRL > 20 mm had increasing risk for missed abortion, who should be more closely monitored and facilitated with necessary interventions at first trimester or even before conception to reduce the occurrence of missed abortion to have better clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: This study was designed and performed to investigate the relationship between fetal chromosome aberrations and screening markers in the first trimester of pregnancy in order to prevent the birth of infants with chromosome aberrations with early prenatal diagnosis. Methods: We conducted an analytic cross-sectional study on result of chromosomal culture of 762 pregnant women with high-risk combined screening test from December 2018 to June 2020 and analyzed by SPSS program. Results: There was a significant relationship between chromosome structural abnormalities with free beta-human chorionic gonadotropin (free β-hCG) values equal to and higher than 1.5 multiples of the median (MoM) (P: 0.05). The highest incidence of disorder in number of chromosomes with abnormal nuchal translucency (NT) percentiles (≥99%) was seen (P < 0.001). It also shows that the cumulative number of chromosome aberrations of 25 (78.12%) occurred in individuals with a NT less than 99th percentile and at the same time a risk of 1/50≤ risk <1/10. Discussion: According to the results, Comparative Genomic Hybridization (CGH) array method is recommended to detect structural abnormalities in chromosomes in samples with NT ≥3.5. In addition, it is noteworthy that chromosomal structural abnormalities occur in free β-hCG ≥1.5 MoM. Conclusion: Due to the frequency of chromosomal structural disorders and its effect on the incidence of fetal abnormalities, the study of chromosomal structural disorders is recommended. [ABSTRACT FROM AUTHOR]

Amaç: Gebelerdeki vitamin takviyesi obstetrik sonuçlar açısından önemlidir. Beslenme alışkanlıkları et ağırlıklı olan ve bol güneşli ilimizdeki gebelerin ulusal kılavuzlarda önerilen takviyelere olan gerçek ihtiyacı bilinmemektedir. Bu yüzden çalışmamızda, ilimizdeki gebelerin hemoglobin, ferritin, B12, folat ve D vitamini seviyeleri ve desteğe olan ihtiyaçları araştırıldı.Gereç ve Yöntem: Haziran 2018 ve Aralık 2018 tarihleri arasında kadın doğum polikliniğine başvuran 17845 gebenin verisi incelendi. Hastalardan takviye ilaç kullanmayan ve birinci trimesterde hemoglobin, ferritin, B12, folat ve D vitamini istenen 200 gebe çalışmaya dahil edildi. Gebelerin demografik özellikleri tanımlayıcı istatistiksel yöntemlerle belirlendi. Çalışma grubumuzdaki gebeler iki doğum arasındaki süreye göre ve hemoglobin, ferritin, B12, folat ve D vitamini konsantrasyonlarının seviyelerine göre gruplandırılarak sonuçları incelendi.Bulgular: Hastaların hemogram, ferritin, vitamin B12 ve folat konsantrasyonları normal sınırlarda iken, çalışmaya dahil edilen tüm gebelerde bir önceki gebeliği ile mevcut gebeliği arasındaki süre dikkate alınmadan D vitamini düzeyleri ciddi düşük 20 ng/mL’nin altında bulundu. İlaveten yaşı 26’nın altında olan gebelerde B12 seviyeleri anlamlı olarak daha düşüktü. Sonuç: D Vitamini eksikliği ilimizde sık görülen bir sağlık sorunudur ve güneşli günlerin yaygın olduğu bölgemizde yaşayan gebeler için gizli bir risk faktörüdür. İlaveten nöral tüp defekti etiyolojisinde rol oynadığından özellikle daha genç hasta grubunda B12 vitamini takviyesi, hayvansal temelli diyetin yaygın olduğu yerlerde bile prekonsepsiyonel olarak değerlendirilmelidir

Objective: The aim of the objective was to compare the detection rate for trisomy 21 of universal cell free DNA (cfDNA) screening with contingent screening.Methods: Retrospective study was carried out at 3 German centers. The study included euploid and trisomy 21 pregnancies where cfDNA and first trimester (FT) screening assessment was carried out. The FT risk for trisomy 21 was computed based on combined screening and stratified into the following classes: high risk ≥1:10, intermediate risk 1:11-1,000, low risk ≤1,001. For universal cfDNA screening, the cfDNA test results were examined. For the contingent screening model, the result of the cfDNA test was taken into account in case of an intermediate FT risk. Different strategies combining maternal age, nuchal translucency, nasal bone, beta-hCG, and PAPP-A were evaluated. Screen positivity was defined as either a high risk after FT screening or a cfDNA test indicating a high-risk result. An inconclusive cfDNA test was also considered as screen positive.Results: The search of the database identified 2,255 euploid and 163 affected pregnancies. All affected fetuses were identified by universal cfDNA screening. 1.3% of the euploid fetuses were classified as screen positive due to final inconclusive cfDNA test result. The detection and false-positive rate of a contingent approach that is based on combined screening and cfDNA screening in the intermediate group would be 98.4% and 0.7%, respectively. With this approach, cfDNA screening would be necessary in only about 27% of all pregnancies.Conclusion: This study demonstrates that a contingent approach provides similar detection rates for trisomy 21 as universal cfDNA screening, by a reduction of 73% the number of cfDNA tests. [ABSTRACT FROM AUTHOR]

Abstract Pregnancy‐associated ischemic stroke is rare. The degree of the risk is the highest in the third trimester, but clinicians should be also wary from the beginning of the pregnancy as the risk still exists like demonstrated by our case.

Pregnancy‐associated ischemic stroke is rare. The degree of the risk is the highest in the third trimester, but clinicians should be also wary from the beginning of the pregnancy as the risk still exists like demonstrated by our case. [ABSTRACT FROM AUTHOR]

Abstract Background The use of alternative medicines and dietary supplements is constantly changing, as are dietary habits. One example of this phenomenon is the current popularity of ginger products as an everyday health boost. Ginger and licorice has also been shown to ameliorate nausea a common complaint in early pregnancy. Alternative medicines are often regarded as safe. However, they might affect fetal development, such as through alterations of hormone metabolism and cytochrome P450 function. Health care professionals may be unaware of the supplementation habits of pregnant women, which may allow adverse exposures to go unnoticed, especially if the rates of use in pregnancy are not known. We therefore investigated the use of alternative medicines and licorice among pregnant Danish women. Methods A total of 225 pregnant women were included in a prospective cohort when attending the national prenatal screening program at gestational weeks 10–16. Participants were asked to complete a questionnaire regarding their socio-economic status and lifestyle habits, including their intake of alternative medicine and licorice. Results We found that 22.7% of women reported taking alternative medicines, with 14.7% reporting daily consumption. Ginger supplements were consumed by 11.1%, mainly as health boost and 87.1% reported consumption of licorice. Regular or daily licorice consumption was reported by 38.2 and 7.1%, respectively. Notably, the use of licorice was reflected by an increase in blood pressure of the pregnant women. Conclusions The use of licorice and alternative medicines appears to be common in pregnant Danish women, supporting the need for further investigations into the safety of alternative medicine use during pregnancy and the importance of up-to-date personalized counseling regarding popular health trends and lifestyle habits.

Goals: Our aim in this study was to determine if the maternal neck and waist circumference measured in the first three months of pregnancy were effective in prediction of fetal macrosomia. Material and methods In this retrospective cohort study; body mass index, neck circumference (NC) and waist circumference (WC) was measured in low risk pregnant women at 11–13+6th weeks of pregnancy. Results Among the 361 women, 8% of newborns were over 4000 grams. The rate of fetal macrosomia increased with the increased NC and WC. In ROC analysis, optimum cutoff value of NC was >36.5 cm to predict fetal macrosomia with 68.97% sensitivity and 66.97% specifity and for WC it was >88 cm with 62.07% sensitivity and 61.26% specifity. Conclusion Risk of fetal macrosomia increased with the increased maternal NC and WC. [ABSTRACT FROM AUTHOR]

AbstractsBackground and Objectives: This study aimed to investigate whether mild fetal tricuspid regurgitation (TR) at 11+ 0 to 13+ 6 weeks of gestation affects perinatal outcomes. Since fetal right ventricular load is associated with placental resistance, we hypothesized that fetal mild TR would be associated with perinatal outcomes as a consequence of abnormal placentation. Materials and Methods: We retrospectively evaluated 435 women with first-trimester scan data. Blood flow across the tricuspid valve was examined in singleton pregnancies between 11+ 0 and 13+ 6 weeks of gestation. Women were categorized according to the presence or absence of fetal mild TR, and the maternal and pregnancy characteristics and perinatal outcomes were compared. Multiple linear and logistic regression analyses were conducted to identify independent predictors of perinatal outcome. Results: In the group with mild TR, there were more cases of borderline amniotic fluid index, including oligohydramnios (p = 0.031), and gestational age- and sex-specific birth weights were lower (p = 0.012). There were no significant differences in other perinatal outcomes, including preeclampsia, gestational hypertension and small for gestational age. Gestational diabetes (adjusted odds ratio (OR) 0.514, 95% confidence interval (CI) 0.312–0.947) and fetal mild TR (adjusted OR 1.602, 95% CI 1.080–2.384) were identified as factors associated with below borderline amniotic fluid index before birth. The factors that affected gestational age and sex-specific birth weight were also gestational diabetes (adjusted beta coefficient 9.673, p = 0.008) and the presence of fetal mild TR (adjusted beta coefficient -6.593, p = 0.007). Conclusions: Mild fetal TR observed in the first trimester is negatively associated with fetal growth and the amniotic fluid index at term but not with other adverse pregnancy or perinatal outcomes due to abnormal placentation. [ABSTRACT FROM AUTHOR]

BackgroundMaternal exposures to traffic-related air pollution have been associated with adverse pregnancy outcomes. Exposures to traffic-related air pollutants are strongly influenced by time spent near traffic. However, little is known about women’s travel activities during pregnancy and whether questionnaire-based data can provide reliable information on travel patterns during pregnancy.ObjectivesExamine women’s in-vehicle travel behavior during pregnancy and examine the difference in travel data collected by questionnaire and global positioning system (GPS) and their potential for exposure error.MethodsWe measured work-related travel patterns in 56 pregnant women using a questionnaire and one-week GPS tracking three times during pregnancy (30 weeks of gestation). We compared self-reported activities with GPS-derived trip distance and duration, and examined potentially influential factors that may contribute to differences. We also described in-vehicle travel behavior by pregnancy periods and influences of demographic and personal factors on daily travel times. Finally, we estimated personal exposure to particle-bound polycyclic aromatic hydrocarbon (PB-PAH) and examined the magnitude of exposure misclassification using self-reported vs. GPS travel data.ResultsSubjects overestimated both trip duration and trip distance compared to the GPS data. We observed moderately high correlations between self-reported and GPS-recorded travel distance (home to work trips: r = 0.88; work to home trips: r = 0.80). Better agreement was observed between the GPS and the self-reported travel time for home to work trips (r = 0.77) than work to home trips (r = 0.64). The subjects on average spent 69 and 93 minutes traveling in vehicles daily based on the GPS and self-reported data, respectively. Longer daily travel time was observed among participants in early pregnancy, and during certain pregnancy periods in women with higher education attainment, higher income, and no children. When comparing self-reported vs. GPS data, we found that estimated personal exposure to PB-PAH did not differ remarkably at the population level, but the difference was large at an individual level.ConclusionSelf-reported home-to-work data overestimated both trip duration and trip distance compared to GPS data. Significant differences in PAH exposure estimates were observed at individual level using self-reported vs. GPS data, which has important implications in air pollution epidemiological studies.

International guidelines recommend screening for overt diabetes in early pregnancy. Women in their first trimester with fasting plasma glucose (FPG) levels that would be diagnostic of gestational diabetes mellitus (GDM) in later pregnancy are being identified and treated despite uncertainty regarding the risks and benefits. The evidence for the current diagnostic criteria and management recommendations in early GDM are reviewed. The results of a prospective observational study assessing the progression to GDM and prespecified maternal‐fetal outcomes in women with mild fasting hyperglycaemia in the first trimester suggest that women with FPG 5.1–5.6 mmol/L may warrant proactive management in early pregnancy. [ABSTRACT FROM AUTHOR]

Purpose This retrospective study aims to determine whether the maxilla‐mandible‐nasion (MMN) angle can be reliably measured in the first trimester, to describe normal ranges, and to determine if significant changes occur in foetuses with aneuploidies. Methods: The MMN angle was measured in stored 2D‐ultrasound images of 200 normal fetal profiles between 11+0 and 13+6 weeks of gestation. Each image was analyzed by two observers at two independent time points. Bland‐Altmann analysis was performed to evaluate the reliability of the measurements. Additionally, the MMN angle was measured on sonograms from 140 aneuploid foetuses. Results: The mean MMN angle in normal foetuses from 11 to 14 weeks of gestation was 15.4°. Reliability of the measurement was high when repeatedly measured by the same observer (ICC = 0.92 and 0.82) and between two observers (ICC = 0.77 and 0.63). Average MMN values in foetuses with trisomy 21, 13, and Turner syndrome were significantly higher than those measured in normal foetuses. The highest differences were observed in foetuses with trisomy 13. Among those, 62% had an MMN angle above the 95th percentile and 92% above the normal mean. Conclusion: The MMN angle can be reliably measured in early pregnancy and is abnormal in about 60% of foetuses with trisomy 13. [ABSTRACT FROM AUTHOR]

Objective: Vitamin supplementation in pregnant women is important for obstetric outcomes. In our province, meat is commonly consumed and our city has plenty of sunny days. So, we do not know how much these pregnant women need the supplementary foods recommended in the national guidelines. Therefore, in our study we investigated the hemoglobin, ferritin, B12, folate and vitamin D levels and their need for support of pregnant women in our province. Material and Methods: Data of 17845 pregnant women who applied to Obstetrics and Gynecology Clinic of between June 2018 and December 2018 were analyzed. The study included 200 pregnant women who did not use supplementary drugs and who required hemoglobin, ferritin, B12, folate and vitamin D in the first trimester. Demographic characteristics of pregnant women were determined by descriptive statistical methods. Pregnant women were grouped according to the time interval between two births and hemoglobin, ferritin, B12, folate and vitamin D concentrations. Results: While hemogram, ferritin, vitamin B12 and folate concentrations were within normal limits, vitamin D levels were significantly lower (below 20 ng / mL) in all pregnants included in the study regardless of the previous pregnancy. In addition, B12 levels were significantly lower in pregnant women under 26 years of age. Conclusion: Vitamin D deficiency is a common health problem in our province and it is a hidden risk factor for pregnant women living in our region where sunny days are common. In addition, vitamin B12 supplementation should be evaluated preconceptively even in areas where animal based diet is common, especially in the younger patient group, as it plays a role in the etiology of neural tube defect. [ABSTRACT FROM AUTHOR]

Background: Family support is one of the determinants of lifestyle habits and relevant health behavior for pregnancy outcomes. In India, the joint family system is still practiced. Due to education, urbanization, and industrialization, the family institution continues to play a central role in people's lives. Pregnancy is a crucial period in women's lives. Good care during pregnancy is important for the health of the mother and the newborn baby. During this period, hormonal changes are complex and involve multiple hormones working together to support the developing fetus and prepare the mother's body for labor, delivery, and breastfeeding. To avoid maternal and fetal complications, she needs support from her family throughout pregnancy and the postnatal period., Aim and Objectives: This study aims to evaluate the influence of the level and quality of family support during pregnancy on maternal and fetal outcomes and to identify any association between the sociodemographic variables and the impact of the level and quality of family support during the first trimester., Material and Methods: This study used a quantitative approach with a survey research design. Data were collected from four Primary Health Centers at Karad, Maharashtra, India, i.e., Rethare, Vadgaon, Kale, and Supane. A consecutive sampling technique was used to select the 344 subjects from the Rethare, Vadgaon, Kale, and Supane areas of Karad Taluka. Data were collected before the completion of the first three months of pregnancy, then during the second trimester and after delivery. Upon evaluation, the tool was validated by experts representing a range of specialties, including community health nursing, mental health nursing, obstetric gynecology, and pediatric care. A pilot study was conducted on 30 samples. The data collected were analyzed by using descriptive and inferential statistics., Result: The findings of the study show a significant association between the psychosocial support received in the first trimester and the total gestational weeks completed at the time of delivery (p < 0.05). The study suggests the need for psychosocial support during the first trimester for better maternal and fetal outcomes., Conclusion: Psychosocial family support is needed by pregnant women during the first trimester to achieve maternal and fetal outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethical committee issued approval KIMSDU/IEC/01/2020. All participants in this study have either provided consent or had it waived. The Institutional Ethics Committee (IEC) of Krishna Institute of Medical Sciences (Deemed to be University), Karad, issued an approval letter dated December 01, 2020, with reference number KIMSDU/IEC/01/2020 and permitted to start this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mane et al.)

Background and objective: The maternal glucose-insulin axis is central for metabolic adaptations required for a healthy pregnancy. Metabolic changes in obese mothers in early pregnancy have been scantly described. Here we characterized the glucose-insulin axis in the first trimester of human pregnancy and assessed the effect of maternal obesity and fat mass.Methods: In this cross-sectional study, maternal blood samples (N = 323) were collected during voluntary pregnancy termination (gestational age 4+0–11+6 weeks) after overnight fasting. Smokers (N = 198) were identified by self-report and serum cotinine levels (ELISA). Maternal BMI (kg/m2) and serum leptin (ELISA) were used as proxy measures of obesity and maternal fat mass, respectively. BMI was categorized into under-/normal weight (BMI < 25.0 kg/m2), overweight (BMI 25.0–29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2), and leptin in tertiles (1st tertile: leptin < 6.80 ng/ml, 2nd tertile: leptin 6.80–12.89 ng/ml, 3rd tertile: leptin > 12.89 ng/ml). ISHOMA insulin sensitivity index was calculated from glucose and C-peptide (ELISA) serum concentrations. Analyses of covariance including multiple confounders were performed to test for differences in glucose, C-peptide and ISHOMA between gestational age periods, BMI and leptin groups. C-peptide and ISHOMA were log-transformed before analyses.Results: At weeks 7–9, fasting glucose and C-peptide levels were lower (P < 0.01 and P < 0.001, respectively) and insulin sensitivity higher (P < 0.001) than at weeks 4–6. Glucose levels were not significantly different between BMI or leptin categories. In contrast, C-peptide increased by 19% (P < 0.01) between the normal weight and the overweight group and by 39% (P < 0.001) between the overweight and obese group. In the leptin groups, C-peptide increased by 25% (P < 0.001) between the 1st and 2nd leptin tertile and by 15% (P < 0.05) between the 2nd and 3rd leptin tertile. ISHOMA decreased with higher BMI and fat mass. ISHOMA decreased by 18% (P < 0.01) between the normal weight and the overweight group and by 30% (P < 0.01) between the overweight and the obese group. In the leptin groups, ISHOMA decreased by 22% (P < 0.001) between the 1st and 2nd leptin tertile and by 14% (P < 0.05) between the 2nd and 3rd leptin tertile.Conclusions: At the group level, fasting glucose, C-peptide and insulin sensitivity dynamically change in the first trimester of human pregnancy. Maternal obesity is associated with higher C-peptide and lower insulin sensitivity at all periods in the first trimester of human pregnancy, while glucose is unaltered. These findings have implications for the timing of early gestational diabetes mellitus risk screening.

Background and objective: The maternal glucose-insulin axis is central for metabolic adaptations required for a healthy pregnancy. Metabolic changes in obese mothers in early pregnancy have been scantly described. Here we characterized the glucose-insulin axis in the first trimester of human pregnancy and assessed the effect of maternal obesity and fat mass. Methods: In this cross-sectional study, maternal blood samples (N = 323) were collected during voluntary pregnancy termination (gestational age 4+0–11+6 weeks) after overnight fasting. Smokers (N = 198) were identified by self-report and serum cotinine levels (ELISA). Maternal BMI (kg/m2) and serum leptin (ELISA) were used as proxy measures of obesity and maternal fat mass, respectively. BMI was categorized into under-/normal weight (BMI < 25.0 kg/m2), overweight (BMI 25.0–29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2), and leptin in tertiles (1st tertile: leptin < 6.80 ng/ml, 2nd tertile: leptin 6.80–12.89 ng/ml, 3rd tertile: leptin > 12.89 ng/ml). ISHOMA insulin sensitivity index was calculated from glucose and C-peptide (ELISA) serum concentrations. Analyses of covariance including multiple confounders were performed to test for differences in glucose, C-peptide and ISHOMA between gestational age periods, BMI and leptin groups. C-peptide and ISHOMA were log-transformed before analyses. Results: At weeks 7–9, fasting glucose and C-peptide levels were lower (P < 0.01 and P < 0.001, respectively) and insulin sensitivity higher (P < 0.001) than at weeks 4–6. Glucose levels were not significantly different between BMI or leptin categories. In contrast, C-peptide increased by 19% (P < 0.01) between the normal weight and the overweight group and by 39% (P < 0.001) between the overweight and obese group. In the leptin groups, C-peptide increased by 25% (P < 0.001) between the 1st and 2nd leptin tertile and by 15% (P < 0.05) between the 2nd and 3rd leptin tertile. ISHOMA decreased with higher BMI and fat mass. ISHOMA decreased by 18% (P < 0.01) between the normal weight and the overweight group and by 30% (P < 0.01) between the overweight and the obese group. In the leptin groups, ISHOMA decreased by 22% (P < 0.001) between the 1st and 2nd leptin tertile and by 14% (P < 0.05) between the 2nd and 3rd leptin tertile. Conclusions: At the group level, fasting glucose, C-peptide and insulin sensitivity dynamically change in the first trimester of human pregnancy. Maternal obesity is associated with higher C-peptide and lower insulin sensitivity at all periods in the first trimester of human pregnancy, while glucose is unaltered. These findings have implications for the timing of early gestational diabetes mellitus risk screening. [ABSTRACT FROM AUTHOR]

Objective: The aim of this work was to investigate the association between maternal and fetal characteristics and the fetal fraction at 8-14 weeks' gestation, with emphasis on the change in the fetal fraction upon repeat sampling.Method: One sample for cell-free DNA (cfDNA) testing was collected at the same time as the biochemical markers for combined first trimester screening (visit 1) and another at the nuchal translucency scan (visit 2). Chromosome-selective cfDNA analysis was performed on frozen plasma.Results: Overall, 321 women were included at visit 1, and 307 had a repeat blood sampling. A fetal fraction was obtained in 532 samples (238 samples with repeat fetal fraction). The fetal fraction decreased with maternal BMI (p < 0.001), was lower in Asian women (p = 0.03), and increased with β-hCG levels (p < 0.001) and gestational age (p = 0.04). Before 10 weeks' gestation, the fetal fraction was lower (p = 0.02), as was the probability of a sufficient fetal fraction (p = 0.03) after adjustment for maternal BMI. Asian women had a higher increase in fetal fraction upon repeat sampling (p < 0.001).Conclusion: Before 10 weeks' gestation, the fetal fraction is significantly lower but seems to increase more rapidly compared to later gestations. Presently, combined first trimester screening with cfDNA testing should not include samples before 10 weeks' gestation. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate sonographic detectable abnormalities of the posterior fossa in fetuses with a crown-rump length of 45-84 mm in high-risk pregnancies.Methods: This was a prospective, observational study including 47 fetuses with known outcome, whose mothers attended our centers for first trimester tests and showed an abnormal first trimester ultrasound scan. In these fetuses, we examined transvaginal acquired three-dimensional volume blocks for abnormalities of the fetal posterior fossa. In these fetuses, the measurements of the cerebellar vermis (VE) and of the anterior membranous area (AMA) were compared with published reference ranges.Results: There were 8 fetuses with a ver-mian length below the 5th centile. In 5 of these fetuses, the AMA was also elongated and in 4 of these fetuses, pathology was confirmed. One case with a normal vermian length and normal AMA had a hypoplastic VE later on in the confirmatory test.Conclusion: Pathology of the posterior fossa can be directly diagnosed by assessing the VE and the AMA at the first trimester scan by examining transvaginal acquired volume blocks. [ABSTRACT FROM AUTHOR]

Study Question: Does maternal smoking in early pregnancy affect metallothionein 1 and 2 (MT1 and MT2) mRNA and protein expression in first trimester placenta or embryonic/fetal liver?Summary Answer: In the first trimester, MT protein expression is seen only in liver, where smoking is associated with a significantly reduced expression.What Is Known Already: Zinc homeostasis is altered by smoking. Smoking induces MT in the blood of smokers properly as a result of the cadmium binding capacities of MT. In term placenta MT is present and smoking induces gene and protein expression (MT2 in particular), but the MT presence and response to smoking have never been examined in first trimester placenta or embryonic/fetal tissues.Study Design, Size, Duration: Cross sectional study where the presence of MT mRNA and protein was examined at the time of the abortion. The material was collected with informed consent after surgical intervention and frozen immediately. For protein expression analysis, liver tissue originating from smoking exposed n = 10 and unexposed n = 12 pregnancies was used. For mRNA expression analyses, placental tissue originating from smokers n = 19 and non-smokers n = 23 and fetal liver tissue from smoking exposed n = 16 and smoking unexposed pregnancies n = 13, respectively, were used.Participants/materials, Setting, Methods: Tissues were obtained from women who voluntarily and legally chose to terminate their pregnancy between gestational week 6 and 12. Western blot was used to determine the protein expression of MT, and real-time PCR was used to quantify the mRNA expression of MT2A and eight MT1 genes alongside the expression of key placental zinc transporters: zinc transporter protein-1 (ZNT1), Zrt-, Irt-related protein-8 and -14 (ZIP8 and ZIP14).Main Results and the Role Of Chance: A significant reduction in the protein expression of MT1/2 in liver tissue (P = 0.023) was found by western blot using antibodies detecting both MT forms. Overall, a similar tendency was observed on the mRNA level although not statistically significant. Protein expression was not present in placenta, but the mRNA regulation suggested a down regulation of MT as well. A suggested mechanism based on the known role of MT in zinc homeostasis could be that the findings reflect reduced levels of easily accessible zinc in the blood of pregnant smokers and hence a reduced MT response in smoking exposed fetal/embryonic tissues.Limitations and Reasons For Caution: Smoking was based on self-reports; however, our previous studies have shown high consistency regarding cotinine residues and smoking status. Passive smoking could interfere but was found mainly among smokers. The number of fetuses was limited, and other factors such as medication and alcohol might affect the findings. Information on alcohol was not consistently obtained, and we cannot exclude that it was more readily obtained from non-users. In the study, alcohol consumption was reported by a limited number (less than 1 out of 5) of women but with more smokers consuming alcohol. However, the alcohol consumption reported was typically limited to one or few times low doses. The interaction between alcohol and smoking is discussed in the paper. Notably we would have liked to measure zinc status to test our hypothesis, but maternal blood samples were not available.Wider Implications Of the Findings: Zinc deficiency-in particular severe zinc deficiency-can affect pregnancy outcome and growth. Our findings indicate that zinc homeostasis is also affected in early pregnancy of smokers, and we know from pilot studies that even among women who want to keep their babies, the zinc status is low. Our findings support that zinc supplements should be considered in particular to women who smoke.Study Funding/competing Interest(s): We thank the Department of Biomedicine for providing laboratory facilities and laboratory technicians and the Lundbeck Foundation and Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis Legat for financial support. The authors have no competing interests to declare.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Background: While being prepared for abortions, some women experience decisional ambivalence during their encounters with health personnel at the hospital. Women's experiences with these encounters have rarely been examined. Objective: The objective of this study was to explore ambivalent abortion-seeking women's experiences of their encounters with health personnel. Research design: The data were collected in individual interviews and analysed with dialogical narrative analyses. Participants and research context: A total of 13 women (aged 18–36 years), who were uncertain of whether to terminate their pregnancies during the first trimester, were interviewed before and after they made their decisions. The participants were recruited at six Norwegian outpatient clinics. Ethical considerations: Approval was granted by the Regional Committee for Medical and Health Research Ethics. Findings: The ambivalent pregnant women sought to make autonomous decisions while simultaneously involving their closest confidants and health personnel in the process. The following three types of narratives of women's experiences with encounters with health personnel were identified: the respected women; the identified women; and the abandoned women. Discussion: The findings are discussed in terms of the ambivalent pregnant woman's autonomous responsibility in considering an abortion and how her autonomy can be enabled or impaired during encounters with health personnel. Conclusion and implication: Although the women considered themselves autonomous and responsible for their final decisions, they wished health personnel were involved in their situations. The health personnel contributed by enabling or disabling the possibility of decision-making in accordance with the women's values. The findings indicate that health personnel who care for women considering abortions must be trained in dialogical competence. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV) is a polymicrobial clinical syndrome characterized by changes in vaginal flora, with replacement of normally abundant Lactobacillus species by high concentrations of anaerobic bacteria among reproductive age women. Studies have different aspects on the effect of vitamin D on BV. Objective: To find out the prevalence of BV, vitamin D deficiency in early pregnancy and to examine association between BV and vitamin D deficiency. Patients and Methods: A cross-sectional study was carried out during July 2017 till October 2018 among 100 pregnant women at first trimester pregnancy, aged 18-35 years old at Erbil Maternity Hospital. Results: At enrollment the prevalence of BV was (53%), about (73%) of our clients suffering from homogenous white greyish vaginal discharge, (57%) were with elevated vaginal PH and fishy odor, clue cells was found among (53%) of them. Vitamin D deficiency, defined as 25 (OH) D concentration below 20 ng/ml, was found in (67%) of women. Insufficiency of the vitamin D 25(OH) D concentration between 20-30ng/ml was present in (29%) of the women. Sufficient level of 25 (OH) over (30 ng/ml) was found in (4%). The incidence of Vitamin D pattern among women with BV were (49.3%), (62.1%) and (50%) respectively for each vitamin D deficiency, Insufficiency and sufficient vitamin D. No significant association was found between Vitamin D deficiency and BV. Conclusion: High occurrence of BV and vitamin D deficiency were found. Vitamin D was not associated significantly with increased BV incidence. We suggested that pregnant women should check and manage their level of vitamin D and BV additionally they must not depend only on vitamin D for curing BV. [ABSTRACT FROM AUTHOR]

Background: The use of alternative medicines and dietary supplements is constantly changing, as are dietary habits. One example of this phenomenon is the current popularity of ginger products as an everyday health boost. Ginger and licorice has also been shown to ameliorate nausea a common complaint in early pregnancy. Alternative medicines are often regarded as safe. However, they might affect fetal development, such as through alterations of hormone metabolism and cytochrome P450 function. Health care professionals may be unaware of the supplementation habits of pregnant women, which may allow adverse exposures to go unnoticed, especially if the rates of use in pregnancy are not known. We therefore investigated the use of alternative medicines and licorice among pregnant Danish women. Methods: A total of 225 pregnant women were included in a prospective cohort when attending the national prenatal screening program at gestational weeks 10–16. Participants were asked to complete a questionnaire regarding their socio-economic status and lifestyle habits, including their intake of alternative medicine and licorice. Results: We found that 22.7% of women reported taking alternative medicines, with 14.7% reporting daily consumption. Ginger supplements were consumed by 11.1%, mainly as health boost and 87.1% reported consumption of licorice. Regular or daily licorice consumption was reported by 38.2 and 7.1%, respectively. Notably, the use of licorice was reflected by an increase in blood pressure of the pregnant women. Conclusions: The use of licorice and alternative medicines appears to be common in pregnant Danish women, supporting the need for further investigations into the safety of alternative medicine use during pregnancy and the importance of up-to-date personalized counseling regarding popular health trends and lifestyle habits. [ABSTRACT FROM AUTHOR]

Objectives: Non-invasive methods of inducing a miscarriage are now considered an effective alternative to surgical evacuation (dilatation and curettage). This study aimed to evaluate the effectiveness of misoprostol in the termination of first-trimester miscarriages. Methods: This prospective study was conducted between October 2009 and September 2010 and assessed all patients admitted to the Royal Hospital in Muscat, Oman, for the termination of first-trimester miscarriages during the study period. All patients received misoprostol and the rates of successful termination were measured. Patient satisfaction was assessed using a short questionnaire. Results: A total of 290 women were included in the study. Termination with misoprostol was successful in 61.38% of the subjects. Of the remaining subjects requiring additional surgical evacuation (n = 112), 58.93% required evacuation due to failed termination with misoprostol and 65.18% underwent early evacuation (≤24 hours since their last misoprostol dose). The majority of patients experienced no side-effects due to misoprostol (89.66%). Pain was controlled with simple analgesics in 70.00% of the subjects. A high satisfaction rate (94.83%) with the misoprostol treatment was reported. Conclusion: Misoprostol was a well-tolerated drug which reduced the rate of surgical evacuation among the study subjects. This medication can therefore be used safely in the management of incomplete miscarriages.

Objective: To compare a new simple algorithm for preeclampsia (PE) prediction among Brazilian women with two international guidelines - National Institute for Clinical Excellence (NICE) and American College of Obstetricians and Gynecologists (ACOG).Methods: We performed a secondary analysis of two prospective cohort studies to predict PE between 11 and 13+6weeks of gestation, developed between August 2009 and January 2014. Outcomes measured were total PE, early PE (<34weeks), preterm PE (<37weeks), and term PE (≥37weeks). The predictive accuracy of the models was assessed using the area under the receiver operator characteristic curve (AUC-ROC) and via calculation of sensitivity and specificity for each outcome.Results: Of a total of 733 patients, 55 patients developed PE, 12 at early, 21 at preterm and 34 at term. The AUC-ROC values were low, which compromised the accuracy of NICE (AUC-ROC: 0.657) and ACOG (AUC-ROC: 0.562) algorithms for preterm PE prediction in the Brazilian population. The best predictive model for preterm PE included maternal factors (MF) and mean arterial pressure (MAP) (AUC-ROC: 0.842), with a statistically significant difference compared with ACOG (p<0.0001) and NICE (p=0.0002) guidelines.Conclusion: The predictive accuracies of NICE and ACOG guidelines to predict preterm PE were low and a simple algorithm involving maternal factors and MAP performed better for the Brazilian population. [ABSTRACT FROM AUTHOR]

Purpose: To determine if and when fetal structures are identifiable during first trimester pregnancy on magnetic resonance imaging (MRI) in women with acute abdominopelvic pain. Methods: Sixty-four first trimester MRI examinations performed for evaluation of abdominopelvic pain were reviewed retrospectively. T2-weighted images were assessed independently by three radiologists for the presence of gestational sac, yolk sac, fetal pole, and limb buds. Mean sac diameter and sac volume were determined, and logistic regression analyses were performed. Criterion values for fetal structures and gestational sac size were calculated using receiver operating characteristic analysis. Results: A gestational sac is present in all but two cases. The yolk sac is never identified. A fetal pole is identified at a gestational age (GA), mean sac diameter (MSD), and gestational sac volume (GSV) of greater than 6.4 weeks, 1.7 cm, and 8.9 mL, respectively. Limb buds are identified at a GA, MSD, and GSV of greater than 8.1 weeks, 3.4 cm, and 27.1 mL, respectively. There is a significant correlation between GA and gestational sac size, including the MSD ( r = 0.85, P < 0.01) and GSV ( r = 0.86, P < 0.01). Conclusions: The gestational sac is readily demonstrated on T2-weighted images, but the yolk sac is not identified on routine MRI. The fetal pole and limb buds are seen on MRI at a similar GA and MSD as with published values using transvaginal sonography. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study is to evaluate if pregestational diabetes affects fetal heart rate (FHR) readings at 11-14 weeks of pregnancy.Study Design: For each patient, we recorded age, body mass index (BMI), presence of pregestational diabetes, nuchal translucency (NT), FHR, crown-rump length (CRL), biparietal diameter (BPD) and gestational age. Pregnancies were grouped according to the presence or absence of pregestational diabetes and maternal and fetal variables were compared. Ordinal regression analysis was performed to assess the influence of maternal and fetal variables on the FHR.Results: We included 994 pregnancies from 2009 to 2016. Kruskal-Wallis test showed that median FHR was higher in women with pregestational diabetes than in controls (161; IQR 11 vs. 158; IQR 10, χ2 = 5.13, p = 0.02). Ordinal regression analysis showed that differences in FHR were significantly correlated with the presence of pregestational diabetes (p = 0.007) and the CRL (p = 0.042) but not with the maternal BMI, maternal age, gestational age, BPD and NT.Conclusions: First trimester FHR is higher in diabetic pregnancies than in non-diabetic pregnancies. Therefore, further research is needed to assess whether these pregnancies may benefit from a correction of FHR for a better estimation of the chromosomal abnormalities risk. [ABSTRACT FROM AUTHOR]