Maternal serum autotaxin levels in early- and late-onset preeclampsia

Purpose: We aimed to compare the serum autotaxin levels in early- and late- preeclamptic and healthy pregnant patients at a university hospital.

Methods: A total of 55 singleton preeclamptic women who delivered at Cerrahpasa Medical Faculty were included in the study. The patients were subdivided into two groups: early-onset preeclampsia (n = 31) and late-onset preeclampsia (n = 24). Demographic and clinical data were compared between early-onset and late-onset preeclamptic patients. The control group was composed of 32 healthy pregnant patients.

Results: The mean autotaxin levels were 1.16 ± 0.97 and 0.7 ± 0.35 ng/ml in the early- and late-onset preeclampsia groups, respectively. Autotaxin levels were significantly higher in early-onset preeclampsia group compared with late-onset preeclampsia group. Autotaxin levels were found to be significantly higher in preeclamptic patients compared with control group. Serum autotaxin levels showed a significant positive correlation with maternal systolic, diastolic blood pressures and uric acid levels.

Conclusion: Autotaxin might be a promising marker for detecting early-onset preeclampsia. However, further studies are necessary to confirm this hypothesis.     

Comparison of interleukin-6 levels in maternal and umbilical cord blood in early- and late-onset preeclampsia

Purpose: Increased inflammatory response and cytokines are claimed to play a significant role in the etiology of preeclampsia. Interleukin-6 (IL-6) is a proinflammatory cytokine. Limited number of studies evaluating IL-6 levels in preeclamptic patients have produced conflicting results. Therefore, the present study sought to compare maternal and umbilical cord serum levels of IL-6 in early- and late-onset preeclamptic pregnancies as well as in normal pregnancies. Materials and methods: A total of 69 participants were enrolled in the study. The control group consisted of 24 participants with normal pregnancies. Preeclampsia group consisted of 45 participants. The preeclampsia group was further classified into the subgroups of early- and late-onset preeclampsia. Late-onset preeclampsia group consisted of 24 women whereas early-onset preeclampsia group consisted of 21 women. Serum and umbilical cord samples of IL-6 were compared. Results: There was no significant difference between maternal and umbilical cord serum IL-6 concentrations between the preeclampsia and control group. No significant difference was observed in maternal and umbilical cord serum IL-6 levels between early- and late-onset preeclampsia groups. Conclusion: Our results do not support an increase in IL-6 levels in patients with early- and late-onset preeclampsia. The clinical relevance of our findings needs to be further investigated.     

Circulating Vascular Growth Factor (VEGF) Angiopoietin-1 (Angi-1) and Soluble Tie-2 Receptor in Pregnancy Complicated with Pre-eclampsia: A Prospective Study

Background

Preeclampsia is a leading cause of maternal and fetal/neonatal mortality and morbidity worldwide. Although the etiology of preeclampsia (PE) is still unclear, recent studies suggest that its major phenotypes, high blood pressure and proteinuria, are due in part to the disturbed angiogenic process.

Study Design

This study included the following groups: (1) women with normal pregnancies (n = 150), (2) patients with PE (n = 88), and (3) patients who delivered small growth for date (SGA) neonate (n = 50). Maternal serum concentrations of VEGF, Angi-1, and sTie-2 were measured by a sensitive immunoassay. Non-parametric statistics were used for analysis.

Results

The median maternal serum concentration of sVEGF and sAngi-1 was lower in normal pregnant women as compared to that in PE and SGA and the differences were statistically significant (P < 0.01). In contrast, there is a significant reduction in sTie-2 levels in PE and SGA groups as compared to that in normal pregnancy group (P < 0.01). Serum VEGF and Angi-1 were significantly higher in the late onset PE subgroup as compared to that in the early onset PE (P < 0.01), but sTie-2 was not significantly different in the 2 subgroups (P > 0.05). Serum VEGF, sAngi-1, and sTie-2 were significantly higher and Tie-2 was significantly lower in the severe PE subgroup as compared to that of the milder PE subgroup (P < 0.01 for all).

Conclusion

Patients with PE and those with SGA fetuses have lower median serum concentrations of sTie-2 and higher sVEGF and sAngi-1 than women with normal pregnancies. These findings lend support to the hypothesis that circulating angiogenic proteins may have an important biologic role in PE.     

Comparison of angiogenic and anti-angiogenic factors in maternal and umbilical cord blood in early- and late-onset pre-eclampsia

Purpose: The aim of this study was to compare maternal and umbilical cord serum levels of the angiogenic and anti-angiogenic factors in early- and late-onset pre-eclamptic pregnancies as well as in normal pregnancies, which might have significant importance in the etiology of pre-eclampsia. Materials and Methods: This prospective case-control study was carried out with pre-eclamptic (early-onset, ≤?34 weeks and late-onset, >34 weeks) and normal pregnant women. VEGF, PIGF, sFlt-1 and sEng levels in maternal and umbilical cord serum were measured before delivery and the findings were compared. Results: The study was conducted with 15 early- and 15 late-onset pre-eclampsia patients, and 17 patients with normal pregnancies. It was found that sEng levels were higher in the umbilical cord serum in the early-onset and in the maternal serum in the late-onset pre-eclampsia group than the control group (p < 0.05). No significant difference in any factor was observed between the early- and late-onset pre-eclampsia groups. Conclusion: In this study, the results showed that angiogenic and anti-angiogenic factor levels in maternal serum and umbilical cord serum may not be related to the time of onset of pre-eclampsia.     

Comparison of clinical and perinatal outcomes in early- and late-onset preeclampsia

Purpose

To compare the clinical and laboratory findings and maternal–perinatal outcomes between women with early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE).

Methods

One hundred and fifty-four women with preeclampsia (PE) who delivered in our clinic were included in the study. Perinatal and obstetric outcomes were evaluated.

Results

The incidence of abnormal uterine artery (UtA) velocity waveform was significantly higher in the EO-PE group (71.4 vs 30.1 %) (p < 0.001). The incidences of small-for-gestational age, oligohydramnios, Apgar score <7 at 5 min, stillbirth and early neonatal death rates were significantly higher in women with EO-PE compared to LO-PE (p < 0.01). Maternal complications were only recorded in women with severe PE.

Conclusion

EO-PE, especially with abnormal UtA Doppler findings defines a placentation abnormality with higher perinatal adverse outcomes.     

Placental Growth Factor: As an Early Second Trimester Predictive Marker for Preeclampsia in Normal and High-Risk Pregnancies in a Turkish Population

Objective

Placental growth factor (PlGF) is an angiogenetic factor and inducts the development of preeclampsia in a hypoxic environment. In this study, we examined maternal blood PlGF levels in a pregnant population between 16 and 19 weeks of gestation for determining the prospective value for early diagnosis of preeclampsia as a screening test.

Materials and Methods

In this prospective cross-sectional study, 114 nulliparous normotensive pregnant women were selected for the control group and 34 patients who have chronic hypertension or had a medical history of hypertensive disorders in previous pregnancies were selected for the study group.

Results

In the study group, the risk of preeclampsia increased 3.2 times when compared with the control with a confidence interval of 95 %. The cut-off value for PlGF for discriminating preeclamptic and non-preeclamptic patients was found to be 62.5 pg/ml.

Conclusion

Patients with a medical history of hypertensive disorders and low PIGF levels in early second trimester have an increased risk for preeclampsia.     

Intrapartum fetal asphyxia: study of umbilical cord blood lactate in relation to fetal heart rate patterns

Purposes

To correlate between umbilical artery cord blood lactate and acid–base status with intrapartum fetal heart rate monitoring, and to measure the reliability of umbilical cord blood lactate for prediction of early neonatal outcome.

Methods

Sixty-six participants with intrapartum abnormal fetal heart rate monitoring and 60 participants with normal intrapartum recordings were recruited. The abnormal recordings included late onset, atypical variable and simple variable decelerations. After delivery, the arterial cord blood lactate, pH, actual base excess (ABE), and Apgar score were measured in all participants.

Results

There was significant inverse correlation between cord lactate and pH and ABE in all participants (correlation coefficient = ?0.7, p < 0.0001). The cord lactate was significantly higher in the late onset and atypical variable decelerations groups compared to control (p < 0.0001). There was no significant correlation between the Apgar score and blood lactate in all groups; however, the sensitivity and specificity of cord lactate to predict low score at 5 min were higher in comparison to cord pH.

Conclusions

Umbilical cord blood lactate is a reliable marker for intrapartum fetal asphyxia compared to cord acid–base status with better prediction for newborns with low Apgar score.     

2-Methoxyoestradiol levels and placental catechol-O-methyltransferase expression in patients with late-onset preeclampsia

Purpose

Deficiencies in placental catechol-O-methyltransferase (COMT) and circulating 2-methoxyoestradiol (2-ME) have been shown to be related to early onset preeclampsia. The aim of this study was to investigate levels of 2-ME in the serum and urine of patients with late-onset preeclampsia and to compare those levels to those of normal pregnant women. In addition, we examined placental COMT expression in both groups.

Methods

Fifteen patients with preeclampsia and 15 normal pregnant women were enrolled. 2-ME levels were evaluated by ELISA and placental COMT expression was examined by Western blot analysis.

Results

2-ME levels in serum [median 181.1 pg/mL, interquartile range (IQR) 119.6–244.3 vs. 61.2 pg/mL, IQR 12.0–133.7, respectively, p = 0.004] and urine (median 143.3 pg/mL, IQR 35.0–328.2 vs. 0.5 pg/mL, IQR 0.4–4.6, respectively, p < 0.001) were significantly increased in patients with late-onset preeclampsia compared to those in normal pregnant women at term. There was no significant difference in placental COMT expression between the two groups.

Conclusion

Increased levels of 2-ME in patients with late-onset preeclampsia might be a product of a compensatory mechanism in patients with late-onset preeclampsia.     

Role of peripheral blood mononuclear cell transportation from mother to baby in HBV intrauterine infection

Purpose

We aimed to investigate the role of peripheral blood mononuclear cell transportation from mother to baby in hepatitis B virus (HBV) intrauterine infection.

Methods

Thirty HBsAg-positive pregnant women in the second trimester and their aborted fetuses were included in this study. Enzyme-linked-immunosorbent-assay was utilized to detect HBsAg in the peripheral blood of pregnant women and the femoral vein blood of their aborted fetuses. HBV-DNA in serum and peripheral blood mononuclear cells (PBMC) and GSTM1 alleles of pregnant women and their aborted fetuses were detected by nested polymerase chain reaction (PCR) and seminested PCR, respectively. We also examined the location of placenta HBsAg and HBcAb using immunohistochemical staining. The expression of placenta HBV-DNA was detected by in situ hybridization.

Results

For the 30 aborted fetuses, the HBV intrauterine infection rate was 43.33 %. The HBV-positive rates of HBsAg in peripheral blood, serum, and PBMC were 10 % (3/30), 23.33 % (7/30), and 33.33 % (10/30), respectively. Maternal–fetal PBMC transport was significantly positively correlated with fetal PBMC HBV-DNA (P = 0.004). Meanwhile, the rates of HBV infection gradually decreased from the maternal side to the fetus side of placenta (decidual cells > trophoblastic cells > villous mesenchymal cells > villous capillary endothelial cells). However, no significant correlation between placenta HBV infection and HBV intrauterine infection was observed (P = 0.410).

Conclusions

HBV intrauterine infection was primarily due to peripheral blood mononuclear cell maternal–fetal transportation in the second trimester in pregnant women.     

Vitamin D Status in Mothers and Their Newborns and Its Association with Pregnancy Outcomes: Experience from a Tertiary Care Center in Northern India

Objective

Study was planned to know vitamin D status in mothers and their newborns and effect of vitamin D deficiency on pregnancy outcome. Study design: Two hundred consecutive pregnant women with singleton pregnancy admitted to the labor ward of a tertiary care center were recruited for the study. Maternal and cord blood samples were taken and analyzed for 25(OH) D level. Maternal and fetal outcomes were studied.

Results

High prevalence of hypovitaminosis D was found among pregnant women. Eighty-six percentage had vitamin D deficiency, 9.5% had insufficiency, and only 4.5% had sufficient vitamin D level. Women with preeclampsia had statistically significant vitamin D deficiency and insufficiency as compared to patients who had normal blood pressure levels (p = 0.04). Cesarean section rate was significantly higher in patients with vitamin D deficiency and insufficiency compared to sufficient group (p = 0.004). Cord blood 25(OH) D levels strongly correlated with maternal serum 25 (OH) D levels (p = 0.001, correlation coefficient r = 0.84).

Conclusions

This study showed a very high prevalence of hypovitaminosis D among pregnant women and excellent correlation between maternal and fetal 25(OH) D levels. Hypovitaminosis D was associated with preeclampsia, increased Cesarean rate, and low birth weight babies.

     

Maternal and neonatal omentin-1 levels in gestational diabetes

Purpose

To evaluate the effect of gestational diabetes on omentin-1 in maternal and cord plasma. As a potent mediator of insulin resistance, Omentin-1, an adipokine derived from human adipose and placental tissue, may be an important player in the pathophysiology of gestational diabetes.

Methods

This was a prospective case–control study. The study included 96 women with gestational diabetes and 96 pregnant women without. Omentin-1 was measured at the time of the oral glucose tolerance test, at 32 weeks in maternal plasma and right after delivery in umbilical cord blood by ELISA assay.

Results

Over a period of 2 years, 200 patients were enrolled. Omentin-1 levels did not significantly differ between both groups throughout the pregnancy: omentin-1 levels were 157 ± 83 ng/ml in women with gestational diabetes and 158 ± 93 ng/ml in women without gestational diabetes (p = 0.94) at time of the oral glucose tolerance test and 118 ± 77 ng/ml in women with diabetes and 150 ± 89 ng/ml in women without (p = 0.12) at 32 weeks, respectively. Both groups showed a decrease in omentin-1 levels throughout pregnancy, with a more pronounced decrease in diabetic women (13 ± 53 versus 4 ± 48 ng/ml; p = 0.5). Neonatal omentin-1 levels were significantly lower in offspring of diabetic mothers: 106 ± 61 versus 134 ± 45 ng/ml (p = 0.03).

Conclusions

There was no significant difference in omentin-1 levels between healthy and diabetic mothers throughout the pregnancy. However, we found significantly lower omentin-1 levels in offspring of diabetic mothers. This may indicate a risk for the development of insulin resistance in later life.

     

Circadian Pattern of Blood Pressure in Normal Pregnancy and Preeclampsia

Aims &; Objective

To find out the circadian pattern of blood pressure in normotensive pregnant women and in women with preeclampsia.

Method

A cross-sectional prospective observational case control study. Blood pressure was sampled in thirty-five normotensive pregnant women (control) and thirty five preeclamptic women (study group) by using non-invasive automatic ambulatory blood pressure monitoring machine for 72 h.

Results

Blood pressure (BP) was not constant over 24 h period and it oscillated from time to time in control group. BP was maximum during early part of afternoon. However, in preeclampsia besides quantitative increase in BP, circadian BP oscillations were less pronounced and in around 50% subjects BP was maximum during evening and night hours.

Conclusion

Both systolic and diastolic BP showed definite reproducible circadian pattern in both preeclamptic and normotensive pregnant women. This pattern both quantitatively and qualitatively was different in preeclamptic women. Standardized 24 h BP monitoring allows quantitative and qualitative evaluation of hypertensive status and is important for timing and dosing of antihypertensive medications.     

Umbilical Vein and Maternal Serum Inhibin A, Activin A, and Follistatin Concentrations in IUGR due to Placental Dysfunction Pregnancies

Objective

The objective of this study were to (1) quantify the concentrations of inhibin A, activin A, and follistatin in maternal serum and umbilical vein (inhibin A, activin A) in IUGR due to placental dysfunction pregnancies and control group, (2) determine the concentration differences of these factors in maternal and umbilical vein serum in control and subject group, and (3) examine the relationship between fetal growth and placental function.

Method

Sandwich ELISA was used to measure the concentrations in control (n = 40) and subject groups (n = 30).

Results

Umbilical vein serum inhibin A, activin A concentrations were increased in subject group compared with controls (inhibin A regression coefficient, 0.7647, P < 0.001, activin A P < 0.0005). Maternal serum inhibin A, activin A were significantly increased in subject group compared with controls (inhibin A regression coefficient, 0.7614, P < 0.001, activin A P < 0.0005). Maternal serum activin: follistatin ratio was significantly increased in subject group compared with controls (P < 0.0005). Maternal serum inhibin A, activin A concentrations were more when compared to the umbilical vein inhibin A, activin A concentrations in subject group.

Conclusion

The present study strengthens the evidence of using inhibin A, activin A, and follistatin as serum markers in routine screening for early detection of IUGR. But large prospective studies are needed to further define their role in clinical practice.     

Elevated hyaluronan and extracellular matrix metalloproteinase inducer levels in women with preeclampsia

Purpose

Preeclampsia (PE) is a specific syndrome of pregnancy clinically identified by hypertension and proteinuria from the 20th week of gestation associated with a systemic inflammatory response and oxidative stress. While pro-inflammatory cytokines have been extensively studied in PE, other factors in the circulation that also influence the magnitude of inflammation have received much less attention. The present study compared serum concentrations of five immune-regulatory compounds in normotensive pregnant women and in women with gestational hypertension (GH) or PE.

Methods

Sixty women with PE, 53 with GH and 40 normotensive women paired by gestational age were evaluated. Sera were evaluated for concentrations of extracellular matrix metalloproteinase inducer (EMMPRIN), hyaluronan, gelsolin, visfatin and histone 2B by ELISA. Differences between groups were analyzed by nonparametric tests, with a significance level of 5 %.

Results

Increased levels of EMMPRIN and hyaluronan were present in preeclamptic women as compared to the GH and normotensive groups. There was no difference between groups in gelsolin, visfatin or histone 2B.

Conclusion

Increased release of EMMPRIN and hyaluronan may contribute to an elevated pro-inflammatory response and tissue damage in women with PE.     

Placental Thickness: Its Correlation with Ultrasonographic Gestational Age in Normal and Intrauterine Growth-Retarded Pregnancies in the Late Second and Third Trimester

Objective

The aim was to study the correlation of placental thickness, measured at the level of the umbilical cord insertion, with the ultrasonographic gestational age in normal and IUGR pregnancies in the late second and third trimester.

Materials and Methods

A total of 498 patients were observed for correlation of the placental thickness with ultrasonographic gestational age and their outcomes by dividing them into Group A (outcome fetal weight < 2,500 g, n = 122) and Group B (fetal weight > 2,500 g, n = 376). The mean placental thickness was calculated at the umbilical cord insertion in both groups along with ultrasonographic fetal age and estimated fetal weight. The mean values of placental thickness along with respective standard deviation were calculated from the 24th to 39th week of gestational age.

Results

A positive correlation was observed between placental thickness and ultrasonographic gestational age in both groups (p value of 0.01), with Pearson’s correlation coefficient (“r”) values of 0.325 in Group A and 0.135 in Group B. Regression analysis yielded linear equations of relationship with placental thickness and gestational age in both groups. The placental thickness was also found to be lower in Group A between 26 and 27 weeks and 30 and 31 weeks, having mean values of 2.48 ± 0.063 cm (p value of 0.042) and 2.76 ± 0.552 (p value of 0.05) in Group A as compared to 3.04 ± 0.25 and 3.13 ± 0.183 cm in Group B.

Conclusions

Placental thickness measured at the level of umbilical cord insertion can be used as an accurate sonographic indicator in assessment of gestational age in singleton pregnancies because of its linear correlation.     

Placental and cord blood brain derived neurotrophic factor levels are decreased in nondiabetic macrosomia

Purpose

To measure levels of placental brain derived neurotrophic factor (BDNF) gene expression and umbilical cord blood BDNF in neonates with nondiabetic macrosomia and determine associations between these levels and macrosomia.

Methods

This case–control study included 58 nondiabetic macrosomic and 59 normal birth weight mother-infant pairs. Data were collected from interviews and our hospital’s database. BDNF gene expression was quantified in placental tissues using quantitative real-time polymerase chain reaction (n = 117). Umbilical cord blood BDNF levels were measured by enzyme-linked immunosorbent assay (n = 90). Multivariate logistic regression models were used to evaluate associations between BDNF levels and macrosomia.

Results

Placental BDNF gene expression (P = 0.026) and cord blood BDNF (P = 0.008) were lower in neonates with nondiabetic macrosomia than in normal birth weight controls. Cord blood BDNF was significantly lower in vaginally delivered macrosomic neonates than vaginally delivered controls (P = 0.014), but cord BDNF did not differ between vaginal and cesarean section delivery modes in macrosomic neonates. Cord blood BDNF was positively associated with gestational age in control neonates (r = 0.496, P < 0.001), but not in macrosomic neonates. Cord blood BDNF was positively associated with placental BDNF relative expression (r _s = 0.245, P = 0.02) in the total group. Higher cord blood BDNF levels were independently associated with protection against nondiabetic macrosomia (adjusted odds ratio 0.992; 95% confidence interval 0.986–0.998).

Conclusions

Both placental BDNF gene expression and cord blood BDNF were downregulated in neonates with nondiabetic macrosomia compared with normal birth weight neonates. Cord BDNF may partly derive from BDNF secreted by the placenta. Higher cord plasma BDNF levels protected against nondiabetic macrosomia.

     

Hypotension due to spinal anesthesia influences fetal circulation in primary caesarean sections

Purpose

Hypotension due to spinal anesthesia is a well-known side effect in pregnant women receiving caesarean section. Little is known about its impact on fetal blood circulation.

Methods

40 women with uncomplicated singleton term pregnancies prepared for caesarean section were prospectively evaluated by Doppler sonography before and immediately after spinal anesthesia.

Results

In 90% of the women, blood pressure significantly decreased after spinal anesthesia and 42.5% of the patients suffered from severe hypotension. We found a significant negative correlation between maternal blood pressure change and the resistant index (RI) of the umbilical artery (r_s = ? 0.376, p = 0.017) and a significant positive correlation between maternal blood pressure and fetal middle cerebral artery.

Conclusion

Healthy fetuses seem to compensate well in situations with decreased uteroplacental blood flow due to maternal hypotension measured by means of RI changes in the fetal umbilical and middle cerebral artery. This raises the question if growth-restricted and/or preterm fetuses are able to compensate similarly or if general anesthesia would be a method of choice.

     

Echocardiographic Assessment of Cardiovascular Hemodynamics in Preeclampsia

Objective

To assess maternal cardiovascular function using echocardiography in normal and preeclamptic women in the third trimester of pregnancy.

Methods

40 subjects, 20 with preeclampsia and 20 normotensive controls with >34 weeks gestation and singleton pregnancy were recruited. Baseline characteristics, maternal and fetal outcome were studied with systolic and diastolic parameters on echocardiography.

Results

The following parameters were higher in preeclamptic subjects as compared to normotensive controls–mean cardiac output (66.85 ± 4.56 ml/min vs. 56.1 ± 1.77 ml/min); mean LV diastolic mass (131.15 ± 16.85 vs. 104.90 ± 23.17 g); systolic mass (88.5 ± 7.34 vs. 83.33 ± 23.84 g); total vascular resistance (1396.85 ± 150.2 vs. 1204.5 ± 71.182 dyne, s cm⁵). Women with preeclampsia delivered smaller babies (2410 ± 426.16 g) as compared to normotensive controls (2895 ± 276.20 g). Student ‘t’ test was used as a test of significance.

Conclusion

Women with preeclampsia have significant systolic and diastolic dysfunction compared to normotensive controls. Blood pressure monitoring alone is insufficient to identify effectively, risk of cardiovascular complications in these subjects.     

Study of Length of Umbilical Cord and Fetal Outcome: A Study of 1,000 Deliveries

Objective

To study the correlation of umbilical cord length with fetal parameters like Apgar score, sex, weight, and length, and its effect on labor outcome.

Design

Prospective study of 1,000 cases.

Setting

Government Hospital

Material and Method

Examination of umbilical cord was done for any loop around neck, trunk, etc; no. of loops of cord and positions; Knots of cord (True or false), any cord abnormalities. Fetal parameters recorded were sex, weight, and length of the newborn. Fetal outcome studied by Apgar score at 1 and 5 min.

Results

In our study, the cord length varied from 24 to 124 cm. The mean cord length was 63.86 cm (±15.69 cm). Maximum cases seen were in the group of cord length between 51 and 60 cm. Lower 5th percentile was considered as short cord and upper 5th percentile was considered as long cord. Short-cord group was associated with significantly higher (p < 0.05) incidence of LSCS cases. Cord length did not vary according to the weight, length, and sex of the baby. The incidence of all types of cord complications increases as the cord length increases (p < 0.001*). Nuchal cords had higher mean cord length than in cases without nuchal cords (p < 0.001). As the number of loops in a nuchal cord increases to more than two loops, the operative interference increases. The significance was tested by using a Chi-square test, and it was found to be statistically significant (p < 0.05). Nuchal cords were seen to be associated with more cases of fetal heart abnormalities (p < 0.001). There is higher incidence of variability in fetal heart rate with extremes of cord length (p < 0.001). The incidence of birth asphyxia was significantly more in long and short cords as compared to cords with normal cord length (p < 0.001).

Conclusion

The present study showed that the length of umbilical cord is variable; however, maximum number of cases had normal cord length. Cases which had short and long cords constituted abnormal cord length. These cases had higher incidence of cord complications, increased incidence of operative interference, intrapartum complications, increased fetal heart rate abnormalities, and more chances of birth asphyxia. But cord length did not vary according to the weight, length, and sex of the baby.     

Ghrelin and motilin levels in hyperemesis gravidarum

Purpose

Ghrelin, an endogenous ligand for the growth hormone secratogogue receptor, and its receptors are found in the reproductive organs and placenta. Motilin is produced from the endocrine cells of the duodeno jejunal mucosa and considered to be a regulator of interdigestive migrating contractions. Aim of this study is to investigate ghrelin and motilin levels in patients with hyperemesis gravidarum.

Methods

A total of 56 patients with singleton pregnancies in the first trimester were recruited in the study, 39 with hyperemezis gravidarum and 17 normal pregnant women. Patients with medical complications and body mass index <18 or >25 were excluded. Fasting plasma ghrelin and motilin concentrations were measured. Fasting blood glucose, liver enzymes, blood urea nitrogen, creatinin, estradiol, progesterone, human chorionic gonadotropin, and thyroid function tests were also investigated.

Results

Ghrelin levels were significantly higher in patients with hyperemesis group than the normal pregnant women (p = 0.025). Serum estradiol levels were also higher in the hyperemesis group (p = 0.001). No significant difference was observed in plasma motilin levels between the two groups. In correlation analyses, maternal ghrelin was positively correlated with estradiol (r = 0.29, p = 0.029) in the whole cohort.

Conclusion

There are a few studies about the course of circulating ghrelin levels during human pregnancy. Ghrelin administration increases food intake through central mechanisms but its effects on appetite in relation to human pregnancy is unknown. The increased levels of ghrelin in hyperemesis gravidarum might be a compensatory mechanism to restore the energy metabolism of the pregnant women.