Prediction of PIH by Maternal Serum Beta HCG Levels in the Second Trimester (13–20?Weeks) of Pregnancy

Objective

To test the hypothesis that women with high serum beta-HCG levels in early pregnancy are at higher risk of developing PIH.

Methods

Serum beta-HCG estimation was done by CLIA method in 200 women between 13 and 20 weeks of gestation, selected randomly for this study from July 2008 to Aug 2009. Multiple of median (MOM) was calculated from charts of norms available for that week of pregnancy. They were followed till delivery for development of PIH and pregnancy outcome and results analysed statistically with Chi-square test and Z test.

Results

Out of 200 cases, 178 (89 %) were finally evaluated. Of whom 22 (12.36 %) cases developed PIH. Beta HCG levels were considered raised if the levels were >2MOM.20 (83.33 %) out of 24 cases with beta HCG levels >2MOM developed PIH against 2 (1.2 %) cases out of 154 having beta HCG levels ≤2 MOM (P value <0.001). Also, higher levels of beta HCG are associated with increased severity of PIH (P value <0.01). The sensitivity was 90.91 %, specificity was 97.44 % and positive predictive value was 83.33 %.

Conclusion

The study concluded that the serum beta HCG estimation at mid trimester (13–20 weeks) is a good predictor of PIH and higher levels of beta HCG are associated with increased severity of PIH.     

Transvaginal Sonography Post–Office Hysteroscopy as a Screening Tool for Tubal Patency: A Reliable and Feasible Technique in an Outpatient Setting

ObjectiveTo determine feasibility and accuracy of post-hysteroscopic transvaginal ultrasonography (TVUS) measurement of pelvic fluid accumulation as a screening method for tubal patency (TP).MethodsWe conducted a retrospective cohort study of 85 patients who underwent uterine cavity assessment by office hysteroscopy at our university-affiliated fertility centre from November 2019 to October 2020. During the study period, two-dimensional (2D) TVUS was performed pre- and post-hysteroscopy to evaluate TP. Patient records were reviewed for demographics, diagnosis, and prior/subsequent TP testing. Predictive values for TP were calculated.ResultsPelvic fluid accumulation post-hysteroscopy was found in 65.9% of patients (56). Accumulation of fluid was seen with the use of as little as 10–50 mL of saline. Using more fluid did not increase the likelihood of demonstrating TP (P = 0.17). A trend towards more false-negative results for TP was observed when less fluid was used (7.7% with 10–50 mL vs. 3.8% with 60–190 mL and 1.3% with 200–760 mL; P = 0.10). The positive predictive value (PPV) of TVUS post-hysteroscopy in comparison to known patency/occlusion was 100%; negative predictive value (NPV) was 33%; sensitivity was 82.8%; and specificity was 100%. Similar values were seen in a second analysis that included patients with highly suspected patent or occluded tubes (n = 60); presumed predictive values were: PPV 100%, NPV 42%, sensitivity 78.8%, and specificity 100%. The use of more fluid did not increase pain (P = 0.75). This finding remains after accounting for confounders (e.g., pre-medication, endometrial biopsy).ConclusionTVUS pre- and post-hysteroscopy is feasible in an outpatient setting, and can serve as a reliable screening tool for TP. When hysteroscopy is performed and TP is not known, TVUS can be added for screening, potentially omitting the need for more invasive examinations. With limited non-urgent ambulatory services, it is of upmost importance to maximize information from a single procedure.     

Cross-Cultural Adaptation and Psychometric Evaluation of the Neonatal Eating Assessment Tool–Breastfeeding Into Tamil

ObjectiveTo adapt the Neonatal Eating Assessment Tool–Breastfeeding (NeoEAT-Breastfeeding) into Tamil, a language spoken in several South Asian countries, to identify the tool’s factor structure, and to assess its psychometric properties.DesignCross-sectional.SettingTertiary care hospital in South India.ParticipantsA cohort of 323 mothers of infants ages 1 week to 7 months, including infants with and without feeding difficulties.MethodTo adapt the English tool to Tamil, we followed standard procedures specified by the tool developers and international guidelines for tool translation and adaptation, including pilot testing and personal interviews with participants who had infants younger than 7 months. Participants completed the NeoEAT-Breastfeeding (Tamil) after assessment of breastfeeding by professionals. The 62-item tool involves rating each item on a 6-point scale, and higher scores indicate increased feeding difficulties.ResultsAfter exploratory factor analysis, we divided the tool into five subscales in the Tamil version compared to the seven subscales in the original English version. The Tamil version demonstrated high internal consistency reliability (Cronbach’s α = 0.97) and test–retest reliability (intraclass correlation = 0.99) for the total scores. Infants with feeding concerns demonstrated significantly higher total and subscale scores on the NeoEAT-Breastfeeding (Tamil) than infants without feeding concerns (p = .000; construct validity).ConclusionThe NeoEAT-Breastfeeding (Tamil) holds promise as a culturally appropriate, clinically useful parent-report tool with evidence for initial reliability and validity for identifying feeding-related concerns among infants younger than 7 months in the Tamil-speaking population.     

Effects of the Number of Transferred and Implanted Embryos upon Serum β-hCG Level in Early Pregnancy

目的:探讨移植胚胎数和着床胚胎数与妊娠早期血清β-hCG值的关系.方法:回顾性分析IVF/ICSI新鲜胚胎移植后820个宫内妊娠周期,根据移植胚胎数及移植后35dB超显示的妊娠囊数分组,比较移植14d、18d血清β-hCG水平及其上升幅度.结果:不同移植胚胎数相同妊娠囊数组间比较血清β-hCG差异无统计学意义(P＞0.05);妊娠早期血清β-hCG水平:三妊娠囊组＞双妊娠囊组＞单妊娠囊组,差异有统计学意义(P＜0.05);血清β-hCG上升幅度各组比较无统计学意义(P＞0.05).结论:移植胚胎数对妊娠早期血清β-hCG无直接影响;着床胚胎数影响妊娠早期血清β-hCG水平.妊娠囊越多,其hCG水平就越高.     

Management of New-Onset Atrial Fibrillation in Pregnancy: When Should Early Delivery Be Considered?

BackgroundThe hemodynamic and physiological changes of pregnancy may predispose women to cardiac arrhythmias such as atrial fibrillation (AF). Nevertheless, new-onset AF in pregnancy remains rare, and treatment is challenging. Current recommendations are to treat pregnant women with AF as non-pregnant adults, by using pharmacological or synchronized electrical cardioversion, without mention of gestational age or possibility of delivery.CaseA 23-year-old nulliparous woman developed new-onset symptomatic AF at 36² weeks gestation, but presented to our hospital was delivered at 36⁴ weeks gestation. Beta-blockers were administered for heart rate control. After 48 hours, the decision was made to proceed with delivery rather than cardioversion. The patient's arrhythmia resolved spontaneously postpartum without further treatment.ConclusionIn pregnant patients near or at term, delivery should be considered in the management of new-onset AF after consultation with cardiology, anaesthesiology, and maternal-fetal medicine.     

The Urinary Protein-to-Creatinine Ratio in Canadian Women at Risk of Preeclampsia: Does the Time of Day of Testing Matter?

ObjectivesTo determine the performance of a protein-to-creatinine ratio threshold of 30 mg/mmol in pregnant women investigated for hypertension according to the time of day of the sampleMethodsThis prospective study included ambulatory pregnant women investigated for hypertensive disorders. A single voided random urine specimen was obtained to determine the protein-to-creatinine ratio, followed immediately by a 24-hour urine collection. Statistical analyses included Spearman correlation, sensitivity, specificity, predictive values, likelihood ratios, and receiver-operator characteristic curves with 95% confidence intervals. A P value < 0.05 was considered statistically significant.ResultsAmong the 91 specimens analyzed, 47.3% showed significant proteinuria in the 24-hour collection and 33% were first morning samples. The protein-to-creatinine ratio and 24-hour urinary protein excretion were highly correlated (r = 0.92, P < 0.001). The diagnostic accuracy of the protein-to-creatinine ratio threshold of 30 mg/mmol was lower in first morning samples than in samples obtained during the rest of the day, with sensitivity 58% and 90%, specificity 93% and 100%, positive predictive value 88% and 100%, negative predictive value 72% and 92%, positive likelihood ratio 8 and not calculable, and negative likelihood ratio 0.45 and 0.1, respectively. The receiver-operator characteristic area under the curve was 0.94 (95% CI 0.86 to 1) for first morning samples and 1.0 (95% CI 0.99 to 1) for other samples.ConclusionA protein-to-creatinine ratio threshold of 30 mg/mmol reliably identifies significant proteinuria, but its reliability is reduced in first morning samples. Consequently, such samples should not be used for this purpose.     

Culdocentesis Followed by Saline Solution–Enhanced Ultrasonography: Technique for Evaluation of Suspected Ectopic Pregnancy

Study ObjectiveTo evaluate the use of a technique consisting of culdocentesis followed by saline solution–enhanced pelvic ultrasonography in cases suspect for ectopic pregnancy in which an accurate diagnosis could not be made using routine transvaginal ultrasound.DesignRetrospective clinical study (Canadian Task Force classification III).SettingAcademic medical center.PatientsTwenty patients with an initial diagnosis of pregnancy of unknown location.InterventionsIn 20 patients with symptoms of early pregnancy and serum quantitative human chorionic gonadotropin concentration, ectopic pregnancy could not be confirmed or ruled out. Transvaginal ultrasound-guided culdocentesis was performed, and 300 to 400 mL of normal saline solution was injected into the posterior cul-de-sac and pelvis. Transvaginal ultrasound was repeated with particular attention to the floating fallopian tubesMeasurements and Main ResultsUsing this technique, a tubal pregnancy was visualized in 15 of 20 patients, and ectopic pregnancy was ruled out in 5 patients. In all patients, appropriate management was provided according to the final diagnosis, and consisted of either methotrexate, laparoscopic salpingostomy or salpingectomy, or expectant management in patients with abnormal intrauterine pregnancies.ConclusionUltrasound-guided culdocentesis followed by saline solution–enhanced pelvic ultrasound can be considered as a diagnostic tool in patients with suspected ectopic pregnancy in whom other methods fail to demonstrate this diagnosis.     

Prenatal Diagnosis of Meckel–Gruber Syndrome in a Pregnancy Obtained With ICSI

The association of occipital encephalocele, cleft palate, postaxial polydactyly, polycystic kidneys, and hepatic cysts is well known as Meckel–Gruber syndrome (MGS). Nowadays, the diagnosis of MGS is usually performed prenatally by ultrasound findings. MGS was previously described following in vitro fertilization. We report a case of MGS diagnosed at 17 weeks in a pregnancy obtained with intra-cytoplasmic sperm injection (ICSI).     

Evaluation of neutrophil–lymphocyte ratio,platelet–lymphocyte ratio and red blood cell distribution width–platelet ratio as early predictor of acute pancreatitis in pregnancy

Objective: Acute pancreatitis (AP) is a state of inflammation. It has been widely known that neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and red blood cell distribution width (RDW) to platelet ratio (RPR) reflect systemic inflammation. The aim of this study is to investigate whether these inflammatory markers could be used as reliable markers in early prediction of AP in pregnancy and if there is a relationship between disease severity and these markers.

Methods: The study group consisted of 14 patients, who developed AP in ongoing pregnancy, and the control group consisted of 30 healthy pregnant women. NLR, PLR and RPR were calculated for both the groups.

Results: NLR was significantly elevated in the AP group when compared with the controls (p?=?0.00), but there was no statistically significant difference in terms of PLR and RPR (p?>?0.05). ROC curve analysis results for NLR showed that there was a significant prediction power of NLR for AP (R²?=?0.842; p?<?0.001). For NLR parameter, if cut-off value is chosen to be 4.1030, then sensitivity is 71.4% and specificity is 100.0%. There was statistically significant and positive correlation between C-reactive protein (CRP) and glucose with NLR (p?=?0.001, p?=?0.043). It was seen that Ranson was close to be significant (p?=?0.051).

Conclusion: NLR might be used as an early marker of AP and may have a role in prediction of disease severity.     

Isolation and Purification of an Early Pregnancy Factor–like Molecule from Culture Supernatants Obtained from Lymphocytes of Pregnant Women: II. Identification of the Molecule as a FC-Receptor–like Molecule: A Preliminary Report

Purpose: Early pregnancy factor (EPF)–like activity from culture supernatants obtained from stimulated lymphocytes of pregnant women was characterized and identified. Methods: The enzyme-linked immunosorbent assay depending on the presence of Fc receptors on bovine spermatozoa was used to identify the EPF-like molecule purified by gel filtration and reverse-phase high-performance liquid chromatography. Results: The results indicated that the crude lymphocyte culture supernatant, the EPF-positive G IV fraction obtained on gel filtration, and the EPF-positive reverse-phase high-performance liquid chromatography protein readily bound with the different concentrations of aggregated human -globulin in a manner similar to that in which the standard control of aggregated human -globulin binds to the bovine spermatozoa. Conclusions: EPF-like activity synthesized and secreted by lymphocytes during pregnancy may be a Fc-receptor–like molecule.     

Serum βhCG and Lipid Profile in Early Second Trimester as Predictors of Pregnancy-Induced Hypertension

Objectives

A variety of biological, biochemical, and biophysical markers implicated in the pathophysiology of pre-eclampsia during the last two decades have instigated the growing interest in this study to include both βhCG and lipid profile studies in the early second trimester as early predictors of pregnancy-induced hypertension. Early identification of at-risk women may help in taking timely preventive and curative management to prevent or delay complications associated with pregnancy-induced hypertension.

Method

A prospective study was performed on 120 patients attending the outpatient department of the Obstetrics and Gynaecology of the Maharaja Agrasen Hospital. All the patients were screened for serum βhCG and serum lipid profile in their early second trimester (14–20 weeks) and followed up till their delivery. Comparative studies of serum βhCG and serum lipid profile were performed between those who remain normotensive (group I) and those who developed pregnancy-induced hypertension (group II).

Results

TG, total cholesterol, VLDL, and LDL values for those women who developed PIH (group II) were significantly higher than those who remain normotensive (group I), with p value of <0.05 which is statistically significant. HDL and βhCG values for group II were not higher than those in group I with p value >0.05 which is statistically insignificant.

Conclusion

Maternal lipid profile in second trimester is very good noninvasive test which can be used for prediction of pregnancy-induced hypertension before its clinical onset. However, there is no correlation between maternal serum βhCG and pregnancy-induced hypertension.     

Evaluation of ovarian function in 35–40-year-old women with polycystic ovary syndrome

Objective

To assess gonadotrophin secretion, ovarian steroid production and ovarian reserve in PCOS women during the onset of reproductive decline, in order to characterize their ovarian function at this age.

Study design

Forty PCOS patients and 35 healthy women (35–40 years of age) were included. Clinical history, anthropometry, transvaginal ultrasound and a leuprolide acetate test (10 μg/kg s.c.) were performed. Gonadotrophins, steroid hormones, SHBG, inhibin B and AMH were determined.

Results

Basal and peak LH levels were similar in both groups. Basal and peak FSH levels were significantly higher in the control group. Androgens, peak oestradiol, ovarian volume, antral follicle count and AMH levels were significantly higher in PCOS patients.

Conclusion

These observations suggest that during late reproductive age, gonadotrophin secretion in women with PCOS is clearly different from that observed in control women and may also differ from that of younger PCOS patients. New features like normal LH and lower FSH levels associated with a higher ovarian reserve may give a different reproductive profile to these women.     

Early prediction of the success of methotrexate treatment success by 24–hour pretreatment increment in HCG and day 1–4 change in HCG

Research questionSeveral studies have tried to identify early markers of treatment outcome after methotrexate (MTX) treatment for ectopic pregnancy, including pretreatment and day 4 human chorionic gonadotrophin (HCG) concentrations and their corresponding changes, and the increment in HCG during the initial 24 h after treatment. There have, however, been conflicting results. This study aimed to re-evaluate the role of these markers in the earlier identification of treatment success in a large cohort of women.DesignThis was a retrospective cohort study including women diagnosed with an ectopic pregnancy and treated with a regimen of a single dose of MTX. A comparison of maternal and gestation characteristics was made between groups in whom treatment was successful or failed.ResultsA total of 292 women treated with single-dose intramuscular MTX for ectopic pregnancy were included in this study. In the overall cohort, the treatment success rate with a single dose of MTX was 62.7% (183/292). Only two independent determinants were significantly associated with treatment success: the initial 24-h percentage increase in HCG (adjusted odds ratio [OR] 1.82, 95% confidence interval [CI] 1.26–2.63; P < 0.001) and the percentage change in HCG from day 1 to day 4 (adjusted OR 1.12, 95% CI 1.04–1.21; P < 0.001). The optimal cut-off points for prediction of treatment success were an increment of less than 17% in the 24 h before treatment and a decrease of more than 22% between the day 1 and day 4 HCG concentrations.ConclusionsA small increase in HCG concentration 24 h before treatment with MTX, alongside a decline in HCG concentration from day 1 to day 4, may predict the success of medical treatment for an ectopic pregnancy.     

Pregnancy Outcomes in Diabetes Subtypes: How Do They Compare? A Province-based Study of Ontario, 2005–2006

ObjectiveTo ascertain differences in pregnancy outcomes between women with diabetes subtypes (type 1 [DM1], type 2 [DM2], women with gestational [GDM])] and non-diabetic women within a large Canadian population.MethodsWe performed a retrospective multi-cohort analysis of all obstetrical deliveries that occurred in the province of Ontario between April 1, 2005, and March 31, 2006. Data were extracted from the Ontario Niday Perinatal Database.ResultsIncreased rates of major negative maternal and perinatal outcomes (i.e. preterm delivery, Caesarean section, pregnancy-induced hypertension/preeclampsia) occurred in women with DM1. Both DM1 and GDM subtypes were associated with the greatest risk of macrosomia, shoulder dystocia, and congenital anomalies. DM2 did not demonstrate an association with an increased risk of congenital malformations and stillbirth.ConclusionDiabetes in pregnancy, irrespective of subtype, predisposes women to poorer outcomes than those of the general obstetric population. However, this large population analysis is consistent with previous studies in showing that the adversity remains greatest for women with type 1 diabetes.     

Urinary 6-sulfatoxymelatonin excretion in hyperandrogenic women with polycystic ovary syndrome: the effect of ethinyl estradiol–cyproterone acetate treatment

The role of melatonin in human reproduction is still unknown. Data obtained in patients with hypogonadism and precocious puberty suggest that melatonin and the reproductive hormones are interrelated.The aim of this study was to determine melatonin production in hyperandrogenic women. We studied 12 women with polycystic ovary syndrome (PCOS) and 10 women with idiopathic hirsutism (IH). Patients were treated with cyproterone acetate–ethinyl estradiol (Diane 35) for 4 months. Fasting blood samples for the determination of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone and dehydroepiandrosterone sulfate (DHEAS) and 24-h urine collections for the determination of 6-sulfatoxymelatonin (αMT6s) excretion were obtained from all patients at baseline and after 4 months of treatment. The results were compared with those obtained in 15 control women. At baseline, women with PCOS had significantly higher LH and testosterone levels than those with IH and controls. Their αMT6s values (52.6?±?20.3?µg/24?h) were significantly higher than the values in women with IH (34.3?±?7.1) and controls (30.5?±?6.5) (p?<?0.001). Diane 35 treatment significantly decreased LH, FSH, testosterone and αMT6s values in PCOS (28.0?±?13.9?µg/24?h) (p?<?0.0001). These results indicate that women with PCOS have increased melatonin production. The normalization of αMT6s and testosterone values during Diane 35 treatment suggests that sex steroids modulate melatonin secretion in these patients either directly or through the suppression of gonadotropin.     

Prediction of birth weight discordance from fetal weight estimations at 21–24 weeks' scans in monochorionic and dichorionic twins

Objective: To evaluate if inter-twin estimated fetal weight (EFW) differences at 21–24 weeks’ scans predict birth weight discordance in monochorionic and dichorionic twins born at three gestational age periods.

Methods: We counted the number of pairs with discordant EFWs (EFWs greater than the mean?+?1SD; i.e. a difference above 12% in dichorionic and 21% in monochorionic twins) derived during a 21–24 weeks’ scan as compared to actual discordant birth weight (>25%) in monochorionic and dichorionic pairs born at ≤32, 33–36 and >36 weeks.

Results: We studied 416 dichorionic and 244 monochorionic twins. The frequency of EFWs discordance at 21–24 weeks was the same for dichorionic and monochorionic twins but the total number of birth weight discordant pairs was significantly smaller among dichorionic twins (OR 0.2, 95% CI 0.1, 0.6). Generally, the positive predictive values for birth weight discordance by using the EFWs difference were quite poor, but always better in monochorionic than in dichorionic twins. Whereas the negative predictive value and hence the sensitivity for monochorionic twins was 100% irrespective of gestational age at birth, it was much lower in the dichorionic pairs.

Conclusion: Concordant EFWs at 21–24 weeks exclude discordant birth weight in monochorionic twins whereas discordant EFWs are poor predictors of birth weight discordance especially in dichorionic twins irrespective when the twins were born.