Clinical significance of ptyalism gravidarum

Objective

The aim of this study was to identify the clinical significance associated with ptyalism gravidarum in Japanese singleton pregnancies.

Methods

Data were collected from 22 patients complicated by ptyalism gravidarum whose symptoms continued until delivery and from 7,743 unaffected controls.

Results

The incidence of ptyalism gravidarum in the Japanese pregnant women was about 0.3 %. Using multiple logistic regressions, ptyalism gravidarum was associated with history of hyperemesis gravidarum (p < 0.01), neonatal male sex (p = 0.02) and small for gestational age infants (p = 0.04).

Conclusions

Ptyalism gravidarum may be a distinctive condition leading to adverse perinatal outcomes.     

The differences in placental pathology and neonatal outcome in singleton vs. twin gestation complicated by small for gestational age

Objective

We aimed to compare placental histopathology and neonatal outcome between dichorionic diamniotic (DCDA) twins and singleton pregnancies complicated by small for gestational age (SGA).

Methods

Medical files and placental pathology reports from all deliveries between 2008 and 2017 of SGA neonates, (birthweight?<?10th percentile), were reviewed. Comparison was made between singleton pregnancies complicated with SGA (singletons SGA group) and DCDA twin pregnancies (Twins SGA group), in which only one of the neonates was SGA. Placental diameters were compared between the groups. Placental lesions were classified into maternal and fetal vascular malperfusion lesions (MVM and FVM), maternal (MIR) and fetal (FIR) inflammatory responses, and chronic villitis. Neonatal outcome parameters included composite of early neonatal complications.

Results

The twins SGA group (n?=?66) was characterized by a higher maternal age (p?=?0.011), lower gestational age at delivery (34.9?±?3.1 vs. 37.7?±?2.6 weeks, p?<?0.001), and a higher rate of preeclampsia (p?=?0.010), compared to the singletons SGA group (n?=?500). Adverse composite neonatal outcome was more common in the twins SGA group (p?<?0.001). Placental villous lesions related to MVM (p?<?0.001) and composite MVM lesions (p?=?0.04) were more common in the singletons SGA group. On multivariate logistic regression analysis, the singletons SGA group was independently associated with placental villous lesions (aOR 3.6, 95% CI 1.9–7.0, p?<?0.001) and placental MVM lesions (aOR 2.44, 95% CI 1.29–4.61, p?=?0.006).

Conclusion

Placentas from SGA singleton pregnancies have more MVM lesions as compared to placentas from SGA twin pregnancies, suggesting different mechanisms involved in abnormal fetal growth in singleton and twin gestations.

     

Maternal type 1collagen N-terminal telopeptide levels in severe hyperemesis gravidarum

Background

Nausea and vomiting occur 50–90% during the first trimester of pregnancy. However, patients with hyperemesis gravidarum (HG) may be hospitalized at an incidence rate of 0.8–2% before the 20th week of gestational age. The symptoms generally start during the 5–6th gestational weeks, reaching the highest degree during the 9th week, and decline after the 16–20th weeks of gestation. Clinical findings are proportional to the severity of the disease and severe HG is characterized with dehydration, electrolyte imbalance, and nutritional deficiency as a result of vomiting.

Methods

The study population consisted of two groups of pregnant volunteers at 5–12?weeks of gestation: a severe HG group and a control group. The HG severity was scored using the Pregnancy-Unique Quantification of Emesis (and nausea) (PUQE).The serum levels of the maternal Ca, parathyroid hormone (PTH), Na, K, blood urea nitrogen(BUN), creatinine, vitamin D(25OHD3), and the maternal urine NTx levels were compared between the groups.

Results

In total, 40 volunteers were enrolled in this study: 20 healthy pregnant volunteers and 20 with severe HG. There were no statistically significant differences between the maternal characteristics. The first trimester weight loss of ≥5?kg was significantly higher in the severe HG group (p?<?0.001), while the control group had a significantly higher sunlight exposure ratio than the severe HG group (p?=?0.021). The urine NTx levels were significantly higher in the severe HG group (39.22?±?11.68NTx/Cre) than in the control group(32.89?±?8.33NTx/Cre) (p?=?0.028).The serum Ca, PTH, Na, K, BUN, and creatinine levels were similar between the groups (p?=?0.738, p?=?0.886, p?=?0.841, p?=?0.957, p?=?0.892, and p?=?0.824, respectively). In the severe HG group, the serum 25OHD₃ levels were significantly lower than in the control group (p?<?0.001).

Conclusions

The data from this study indicated that severe HG is associated with increased urine NTx levels. However, large-scale studies are required to understand the clinical significance of this finding, as well as the long-term consequences of elevated urine NTx levels and the underlying mechanisms.

Trial registration

NCT02862496 Date of registration: 21/07/2016.

     

Do intrauterine growth restricted fetuses of the hypertensive and normotensive mothers differ from each other?

Purpose

To investigate if normotensive and hypertensive patients with intrauterine growth restricted (IUGR) fetuses were different with respect to maternal and fetal characteristics and Doppler flow.

Methods

The records of patients with IUGR fetuses who had to be delivered before 34th gestational week because of fetal distress were examined. Early Doppler abnormalities were defined as increased umbilical artery resistance and redistribution of blood flow in the middle cerebral artery while late Doppler abnormalities were defined as the absence or reversal of umbilical artery blood flow and Doppler flow changes in venous Doppler. t Test, Chi-square test and Mann–Whitney U test were used for the comparison of data as appropriate. p?<?0.05 was considered statistically significant.

Results

Thirty-six patients were hypertensive while 42 were normotensive. Gestational week at admission for hypertensive and normotensive groups (30.8?±?3.6 vs. 32.3?±?3.1) (p?=?0.057), time to delivery (7.1?±?12.6 vs. 4.3?±?9.1?days) (p?=?0.267) and gestational week at delivery (31.8?±?3.1 vs. 32.9?±?2.9) (p?=?0.117) were similar. Birth weight was significantly lower (1242?±?534 vs. 1516?±?504?g) (p?=?0.02) in the normotensive group. The frequency of having oligohydramnios (64.2?% for normotensive and 44.4?% for hypertensive patients) (p?=?0.079) was similar in both groups. Early Doppler abnormalities were more common in hypertensive group (75 vs. 40.5?%) (p?=?0.001) while late Doppler abnormalities were more common in normotensive group (25 vs. 59.5?%) (p?=?0.001).

Conclusion

Birth weight was lower and late Doppler abnormalities were more common in the normotensive group while early Doppler abnormalities were more common in hypertensive group.     

Pregnancy outcomes and superiorities of prophylactic cervical cerclage and therapeutic cervical cerclage in cervical insufficiency pregnant women

Purpose

To compare the clinical effect of prophylactic cervical cerclage and therapeutic cervical cerclage on pregnancy outcome and operative factors in cervical insufficiency pregnant women.

Methods

A retrospective study was conducted between June 2014 and September 2016 in a maternity ward, which included women who have had a single pregnancy and have been carried out a McDonald cerclage. All maternal medical records were reviewed. The efficacy of cerclage for preventing late foetal loss was assessed using multivariable logistic regression analysis.

Results

The results showed that there were significant associations between cerclage operations and pregnancy outcomes in the duration of pregnancy prolongation in terms of live births, gestation age, live birth and cesarean section rate. In prophylactic cervical cerclage, compared with therapeutic cervical cerclage, cervical length before surgery was significantly longer (32.7?±?5.8 vs 19.9?±?7.3 mm, p?<?0.0001). Mean operative duration and postoperative length of hospital stay in prophylactic cervical cerclage were shorter than those in therapeutic cervical cerclage (22.1?±?10.3 vs 28.9?±?13.0 min, p?=?0.0241 and 5.6?±?1.8 vs 7.0?±?2.8 days, p?=?0.0354), respectively. Compared with therapeutic cerclage, prophylactic cerclage had more advantages in gestational age at delivery (35.2?±?5.5 and 31.7?±?6.5 weeks, p?=?0.0061), deliveries?<?37 gestational weeks (40 vs 69.2%, p?=?0.0159), live births (93.3 vs 69.2%, p?=?0.0143) and the duration of pregnancy prolongation in terms of live births (19.5?±?5.0 vs 12.0?±?8.2 weeks, p?=?0.0002). There was a higher cesarean section rate in prophylactic group than that in therapeutic group (50 vs 25.6%, p?=?0.0383). The logistic analysis showed that the cervical length before surgery was the only independent prognostic factor [OR 2.860 (1.425, 5.742) p?=?0.0031] for pregnancy outcome, and that is the cervical length before surgery affected late foetal loss.

Conclusions

Our study suggests that, both prophylactic cervical cerclage and therapeutic cervical cerclage reduce the incidence of recurrent abortion or preterm birth and efficiently extend the length of the pregnancy with live births. The prophylactic cervical cerclage has more advantages in operative time, length of hospital stay after surgery, gestational age at delivery, live births and preterm birth. The length of the cervical before surgery is an independent risk factor for pregnancy outcomes when pregnant women appear in the cervical shortening is less than normal. Cervical cerclage is an effective surgical technique to prevent recurrent abortion or late foetal loss.

     

Antihistamines and other prognostic factors for adverse outcome in hyperemesis gravidarum

Objective

The purpose of this study is to determine the frequency of adverse perinatal outcome in women with hyperemesis gravidarum and identify prognostic factors.

Study design

This is a case–control study in which outcomes of first pregnancies were compared between 254 women with hyperemesis gravidarum treated with intravenous fluids and 308 controls. Prognostic factors were identified by comparing the clinical profile of patients with hyperemesis gravidarum with a normal and an adverse pregnancy outcome. Binary responses were analyzed using either a Chi-square or Fisher exact test and continuous responses were analyzed using a t-test.

Results

Women with hyperemesis gravidarum have over a 4-fold increased risk of poor outcome including preterm birth and lower birth weight (p < 0.0001). Among maternal characteristics, only gestational hypertension had an influence on outcome (p < 0.0001). Treatment as an outpatient and/or by alternative medicine (acupuncture/acupressure/Bowen massage) was associated with a positive outcome (p < 0.0089). Poor outcomes were associated with early start of symptoms (p < 0.019), and treatment with methylprednisolone (p < 0.0217), promethazine (p < 0.0386), and other antihistamines [diphenhydramine (Benadryl), dimenhydrinate (Gravol), doxylamine (Unisom), hydroxyzine (Vistaril/Atarax), doxylamine and pyridoxine (Diclectin/Bendectin)] (p < 0.0151) independent of effectiveness. Among these medications, only the other antihistamines were prescribed independent of severity: they were effective in less than 20% of cases and were taken by almost 50% of patients with an adverse outcome.

Conclusion

Poor outcomes are significantly greater in women with HG and are associated with gestational hypertension, early symptoms, and antihistamine use. Given these results, there is an urgent need to address the safety and effectiveness of medications containing antihistamines in women with severe nausea of pregnancy.     

IVF/ICSI outcomes of the OCP plus GnRH agonist protocol versus the OCP plus GnRH antagonist fixed protocol in women with PCOS: a randomized trial

Objective

To compare the IVF/ICSI outcomes of the long GnRH agonist and the fixed GnRH antagonist protocol in women with PCOS.

Design

Randomized controlled trial.

Setting

Baskent University Department of Obstetrics and Gynecology.

Patients

Three hundred women with PCOS.

Interventions

IVF/ICSI following the long GnRH agonist down-regulation or the fixed GnRH antagonist protocols.

Main outcome measures

Ongoing pregnancy rates.

Results

Ongoing pregnancy rates were 36.4?% in the OCP?+?GnRH agonist group and 35.9?% in the OCP?+?GnRH antagonist group (p?>?0.05). Progesterone levels on the day of hCG (0.76?±?0.71 vs. 0.58?±?0.50), endometrial thickness on the day of hCG (11.57?±?2.50 vs. 10.50?±?2.01), total gonadotropin used (1388.71?±?482.39 vs. 1253.25?±?415.81), and duration of COH (9.07?±?1.96 vs. 8.39?±?1.75) were significantly lower in the OCP?+?GnRH antagonist group.

Conclusion

The OCP?+?long GnRH agonist and the OCP?+?fixed GnRH antagonist protocols yield similar ongoing pregnancy rates in women with PCOS. Although this study consisting three hundred patients, seems to be large enough in a single center, we were not able to reach to the actual size of power analysis which was approximately 3,000.     

The impact of severe hyperemesis gravidarum on the triple test screening results

Objective: we aimed to determine the influence of severe hyperemesis gravidarum on the interpretation of the triple test screen results. Methods: A retrospective, case control study. The study group included 73 women who were hospitalized due to severe hyperemesis gravidarum and data regarding triple screening test was available. Data was compared with a control group consisting of low-risk patients without hyperemesis gravidarum, who underwent the triple screening test in the same laboratory and matched to the study group by maternal age and gestational age at the time of screening in a 2:1 ratio. Results: Overall, 219 gravid patients were included in the study, of whom 73 were diagnosed with severe hyperemesis gravidarum. Patients in the control group were characterized by higher weight at the time of triple test screen (53.7?±?10.9 vs. 59.7?±?14.3 years, p?=?0.043). No difference was found in the level of Alpha-fetoprotein or unconjugated estriol (uE3) between the groups; however the level of hCG was significantly increased in women with severe hyperemesis gravidarum (1.2977?±?0.82 vs. 1.0662?±?0.53 MoM, p?=?0.013). Conclusion: Increase in the level of hCG in women with severe hyperemesis gravidarum alter the results of triple test screen. This data should be incorporated when counseling patients regarding overall risk for chromosomal abnormalities.     

The effects of gestational transient thyrotoxicosis on the perinatal outcomes: a case–control study

Purpose

To study the effects of gestational transient thyrotoxicosis (GTT) on pregnancy outcomes.

Methods

This case–control study retrospectively analyzed 7976 women with singleton pregnancies whose thyroid function was measured before 16 weeks of gestation and who delivered at ≥22 weeks of pregnancy. GTT was defined as hyperthyroidism (free thyroxine [FT4] level: ≥95th percentile) in the early pregnancy, which normalized in mid-pregnancy without thyroid-stimulating hormone receptor antibodies. Using data extracted from electronic records, we examined the association between GTT and the pregnancy outcomes (preterm delivery, gestational age at delivery, pregnancy induced hypertension (PIH), preeclampsia, placental abruption, caesarian section, birth weight, low birth weight, Apgar score, cord pH, stillbirth at gestational week ≥22, and neonatal death). We classified the cases into quartiles according to their FT4 values during the early pregnancy and investigated the association with the gestational age at delivery.

Results

Two hundred and eight cases of GTT and 6317 cases with normal thyroid assessments were reviewed. GTT was associated with hyperemesis gravidarum, but not with stillbirth, preterm delivery, PIH, preeclampsia, placental abruption, or low birth weight. The gestation period was shorter in patients with GTT than in those with a normal thyroid function (38.69 ± 1.79 vs. 39.07 ± 1.64 weeks, p < 0.01). Higher FT4 levels during the early pregnancy were associated with earlier delivery (p = 0.02).

Conclusions

GTT was associated with a lower gestational age at delivery but not with adverse pregnancy outcomes. There was a negative correlation between the FT4 values in the early pregnancy and the gestational period.

     

Pre-pregnancy body mass index moderates the effect of maternal depressive symptoms on small-for-gestational-age infants

Purpose

We aimed to investigate whether the negative effects of maternal depressive symptoms on Small for gestational age (SGA) was moderated by pre-pregnancy body mass index.

Methods

A total of 9,851 women provided self-reported height and pre-pregnancy weight at their first prenatal visit. Pre-pregnancy BMI was categorized according to the BMI cut point ranges for Chinese adults. Depression during pregnancy was assessed by using standardized questionnaires. Demographic characteristics and birth outcomes, including gestational age at birth and birth weight, were collected through the interviews and case history. Multiple regression analysis was used to estimate the relationship between depressive symptoms and SGA among various pre-pregnancy BMI groups.

Results

The relationship between depressive symptoms and SGA was inconsistent among three pre-pregnancy BMI groups. The incidence of SGA was positively related with depressive symptoms only among women with pre-pregnancy underweight [odds ratio (OR) 1.89, 95 % confidence interval (CI) 1.12–3.21].

Conclusions

The negative effect of depressive symptoms during pregnancy on SGA depends on pre-pregnancy BMI.     

Emergency cervical cerclage after miscarriage of the first fetus in dichorionic twin pregnancies: obstetric and neonatal outcomes of delayed delivery interval

Purpose

To study the effectiveness of emergency cervical cerclage in order to delay the delivery interval after miscarriage of the first fetus in dichorionic twin pregnancies.

Methods

Dichorionic twin pregnancies after miscarriage of the first fetus (<24?weeks) were exclusively included in the present analysis. Prolongation of delivery interval was managed with additional emergency cervical cerclage in the already initiated tocolytic therapy. Obstetric outcomes (cervical dilatation, gestational age at delivery of the first twin, interval between miscarriage and delivery of the second fetus) and neonatal outcomes [neonatal birth weight, Apgar score in the first and fifth minute, admission to Neonatal Intensive Care Unit (NICU)] of the second twin were analyzed.

Results

Five cases of dichorionic twin pregnancies were included in our study. Cervical dilatation (mean?±?SD) at admission time was 3.7?±?1.4?cm. The gestational week at delivery of the first twin was 20.6?±?2.6. The median delivery interval was 72?days and the maximum 121?days. Mean gestational age at delivery of the second twin was 28.8?±?7.2?weeks and mean birth weight 1,772.5?±?742?g. The rate of live birth was 80?%, while NICU admission was demanded in 75?% of the live births. All neonates discharged from NICU remained alive after 1?month of life.

Conclusion

The present study demonstrated beneficial effect concerning obstetric and neonatal outcomes of the second twin after performing emergency cervical cerclage to postpone the delivery interval in premature dichorionic twin pregnancies.     

Nifedipine versus labetalol in the treatment of hypertensive disorders of pregnancy

Purpose

To assess the maternal and fetal outcomes of pregnancies affected by hypertensive disorders treated with nifedipine versus labetalol.

Methods

A retrospective study in hypertensive patients treated during pregnancy with nifedipine or labetalol was conducted. After the charts review the patients were divided in the four groups: gestational hypertension (113 patients); mild preeclampsia (77 patients); severe preeclampsia (31 patients); HELLP syndrome (21 patients). The pregnancy and neonatal records were analyzed by paired and unpaired t test.

Results

We found that there was an higher rate of intrauterine growth restriction infants among women treated with labetalol compared with those treated with nifedipine (38.8 vs. 15.5?%; p?p?Conclusions Antihypertensive therapy in pregnancy with Labetalol may have the potential to impair fetal behavior in low degrees hypertensive diseases of pregnancy. Optimal care must balance the potentially conflicting risks and benefits to mother and fetus.     

Comparison of uterine artery Doppler in pregnant women with thrombophilia treated by LMWHs and without thrombophilia

Objective

The aim of this study was to use uterine artery Doppler ultrasonography to investigate the cases of women with thrombophilia who used LMWH during the 18?C22-week period of gestation.

Methods

This retrospective study was conducted at our university between January 2005 and July 2010. 64 patients were treated with low-dose LMWHs (enoxaparine 40?mg) from the beginning of pregnancy until 36?weeks of gestation. Fifty control subjects were also included in this study. Transabdominal ultrasound examination and bilateral uterine artery Doppler measurements pulsatility index (PI), resistive index (RI), and systole/diastole measurement (S/D) were performed during the 18?C22-weeks period of gestation.

Results

No significant differences were found between the groups with respect to maternal age or gestational age at the time of uterine artery Doppler. However, the mean PI (1.07?±?0.46 for LMWH group and 0.91?±?0.31 for control, p?=?0.036) and the mean RI (0.59?±?0.12 for LMWH group and 0.54?±?0.10 for control, p?=?0.021) were significantly higher in the trombophilia group.

Conclusion

Women with trombophilia still have an increased mean PI and RI, as determined by uterine artery Doppler ultrasonography during the 18-22-week period of gestation, even if they use LMWH.     

Association of Helicobacter pylori positivity with the symptoms in patients with hyperemesis gravidarum

Purpose

To investigate the relationship between Helicobacter pylori (Hp) positivity and the severity of symptoms of nausea and vomiting in patients diagnosed with hyperemesis gravidarum (HG).

Design

Prospective controlled.

Methods

Ninety patients with the diagnosis of HG below the 20th week gestation, who had no additional disease and 50 pregnant women with no complaints were enrolled in the study. According to the severity of symptoms, the patients were divided into three groups as group I, II and III (mild, moderate and severe, respectively). The Rhode's scoring system was used to determine the severity of HG symptoms. HpIgG and IgM levels were determined in the blood samples and Hp DNA positivity with PCR was investigated in the saliva.

Results

In accordance with the Rhode's scoring system, 15.5 % of the pregnant women had mild, 58.9 % had moderate, and 25.6 % had severe symptoms (group I, II and III, respectively). HpIgG was determined as positive in 78.6, 84.9 and 82.6 % in groups I, II and III, respectively. HpIgM positivity was determined as 26.1 % only in group III (p = 0.847). HpDNA was determined as 7.2, 3.8, and 91.3 % in group I, II, and III, respectively (p<0.01). While HpIgG was positive in 60 %, HpDNA was found to be positive in 2 % and HpIgM was found to be negative in all the pregnant women in the control group.

Conclusion

A positive relationship between the symptoms of HG and Hp positivity was determined using PCR.     

The underestimation of immaturity in late preterm infants

Purpose

Late preterm infants with gestational ages between $ 34\frac{0}{7} $ and $ 36\frac{6}{7} $ weeks are known to be at higher risk of mortality and morbidity than term newborns. This study aims to investigate the nature and frequency of neonatological complications in the late preterm population resulting in neonatal intensive care unit admissions as well as to draw obstetrical conclusions from the results.

Methods

Neonatological outcomes of 893 consecutively born late preterm infants were evaluated and classified by the frequency of occurrence in relation to potential maternal or fetal risk factors.

Results

Out of 893 late preterm infants, 528 (59.1?%) required intensive neonatal care. The incidence of apnea and bradycardia, the occurrence of feeding difficulties and the requirement of continuous positive airway pressure (CPAP) were inversely proportional to gestational age (p?p?p?p?p?p?p?p?p?Conclusions The high risk of a problematic neonatological outcome in late preterms requires fundamental reconsideration. All efforts to prolong a pregnancy should be made beyond the 34th week of gestation.     

Postnatal neuro-development of fetuses with absent end-diastolic flow in the umbilical artery and/or fetal descending aorta

Objective

To determine whether absence of end-diastolic flow in the umbilical artery and/or fetal aorta impacts postnatal neuro-development in preterm-born children.

Methods

The study group, consisting of 43 fetuses with absent end-diastolic flow in the umbilical artery and/or fetal aorta, was compared with a control group, consisting of 30 fetuses, matching for gestational age but with normal doppler-flow results. The children’s neuro-developmental status was assessed using the ‘Munich functional developmental diagnostics’ (MFDD), between the 2nd and 3rd year of life.

Results

Gestational age at birth was 33?+?6?weeks in the study group and 34?+?4?weeks in the control group. A brain-sparing effect was observed in 37.3% of fetuses in the study group compared with 10.0% in the control group (p?=?0.014). For all seven MFDD domains, the number of children with deficiencies was higher in the study group. For the domains perception, active speech and comprehension this effect was statistically significant (p?<?0.05). Overall, 30.2% of children in the study group and 16.7% of the control group had pathologic test results (p?<?0.013).

Conclusion

Pathological doppler-flow in the umbilical artery and/or fetal descending aorta in preterm born children is associated with neuro-developmental deficiencies. Intensive pediatric care is recommended to mitigate these deficiencies during early childhood.     

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.     

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.     

The Misgav-Ladach method of cesarean section: a step forward in operative technique in obstetrics

Objective

The objective of this study is to compare the intraoperative and short-term outcomes of two cesarean techniques: the modified Misgav-Ladach and the Pfannenstiel–Kerr.

Methods

We performed a prospective observational cohort study of women undergoing a primary cesarean at the Clinic for Obstetric and Gynecology Tuzla, Bosnia and Herzegovina, between January 2003 and December 2011. The two cesarean techniques were compared for intraoperative and short terms outcomes.

Results

A total of 4,944 women were included in this study, 4,336 allocated to the modified Misgav-Ladach and 608 to the Pfannenstiel–Kerr techniques. The rate of modified Misgav-Ladach increased from 74?% in 2003 to 99?% in 2011. The modified Misgav-Ladach technique was associated with a shorter operative time (13.3?min?±?7.4 vs. 19.1?min?±?6.8, p?<?0.05), as well as significantly less surgical material (3.5?±?2.5 vs. 7.9?±?2.1, p?<?0.05). The modified Misgav-Ladach technique was also associated with lower analgesic requirements, lower rates of febrile morbidity and wound infection compared to the Pfannenstiel–Kerr technique (p?<?0.05). No significant differences were observed in the incidence of endometritis, wound dehiscence, bowel restitution, postoperative antibiotic use, and hospital stay.

Conclusion

The modified Misgav-Ladach technique is associated with a shorter operative time than Pfannenstiel–Kerr and might lead to better postoperative outcomes.     

First trimester pregnancy volumes and subsequent small for gestational age fetuses

Objective

To examine whether in the first trimester, placental, gestational sac and fetal volumes are different in pregnancies that result in small for gestational age (SGA) compared to average for gestational age (AGA) neonates.

Methods

Case–control study comparing first trimester 3D volumes of the placenta, the fetus and the gestational sac between SGA and AGA pregnancies. 3D volumes were acquired for quality assurance and documentation. Pregnancy volumes were calculated by the virtual organ computer-aided analysis technique. Linear regression analysis was used to compute a normal range for the placental, gestational sac and fetal volume based on the crown rump length (CRL) in AGA pregnancies. Multiple regression analysis was used to examine significant influencing covariates. A Student’s t test was used to compare the difference between the SGA and AGA group.

Results

The study population consisted of 19 first trimester pregnancies with subsequent SGA neonates and 105 control pregnancies. In the AGA group, all pregnancy volumes were significantly dependent on the CRL. After controlling the CRL effect, the placental, gestational sac and fetal volumes were not significantly different between the SGA and AGA group.

Conclusion

First trimester 3D pregnancy volume measurements are not different in SGA or AGA pregnancies.