Is there a correlation between birth weights and first-trimester crown-rump length growth velocity?

Objective: To test the hypothesis that small- or large-for-gestational-age (SGA or LGA) newborns have anomalous crown-rump length (CRL) growth rates in the first trimester. Methods: Prospective observational study. Women in the first trimester presenting to the Early Pregnancy Unit, between November 2006 and December 2010, underwent transvaginal scan. Women with viable singleton pregnancies in the first trimester who had at least two CRL measurements > 5 mm, recorded at least 2 weeks apart, and also had birth weight data available were included in the final analysis. Birth weight percentiles were calculated and adjusted for gestational age and gender. SGA was equivalent to < 10th centile and LGA was equivalent to > 90th centile. Correlation analysis was performed between birthweight percentiles and first-trimester CRL growth-rate coefficients. In addition, we estimated early fetal growth rates (EFGR) by calculating the Δ CRL/Δ time (mm/day) to see if these differed according to the birth-weight percentiles. Results: A total of 107 women had complete data. The mean maternal characteristics were age 27.5 ± 6 years, weight 87 ± 29 kg and height 163 ± 8 cm. The mean birth weight and gestational age at delivery were 3405 g (SD = 597) and 269 days (SD = 13), respectively. The proportions of SGA and LGA were 7.5% and 18.7%, respectively. There were no significant correlations between birth-weight percentiles and any of the CRL growth rates. There were also no significant differences in the mean CRL velocities when comparing the SGA and LGA newborns birth weights. EFGR for SGA and LGA newborns were 1.34 mm/day (SD = 0.17) and 1.32 mm/day (SD = 0.24), respectively (p > 0.05). Conclusions: Newborns who are found to be SGA or LGA at delivery do not appear to have anomalous CRL growth patterns in the first trimester. The EFGR also did not correlate with birth-weight percentiles.     

Is there a correlation between maternal serum TGF-β1 levels and fetal hydronephrosis?

Objective: We aimed to identify a noninvasive marker for clinically significant fetal uropathies. To achieve this aim, we detected TGF (transforming growth factor)-β1 serum level which rises in neonatal hydronephrosis, in pregnant patients with fetal hydronephrosis.

Materials and methods: We evaluated 44 patients, all of whom were pregnant and had a gestational age between 20 and 30 weeks. Twenty-two patients had normal maternal renal ultrasound imaging and had a fetus with fetal hydronephrosis (Group A). The remaining twenty-two patients had normal maternal and fetal renal ultrasound imaging (Group B). The maternal serum levels of TGF-β1 were measured with a sandwich enzyme-linked immunosorbent assay (ELISA) using a commercially available kit.

Results: The median value for the study group was 55.90?pg/mL (9.67?±?574.45) and for the control group was 59.49?pg/mL (12.49?±?402.04). There was no statistical difference in serum TGF-β1 levels between the groups (p?=?0.769 – Mann–Whitney U test). In the study group, the diameter of the right renal pelvis was 5.7?mm (5.1–8.9?mm), while the diameter of left renal pelvis was 5.75?mm (5.3–10.04?mm).

Conclusion: In our study, the circulating TGF-β1 levels were not statistically different in the fetal hydronephrosis group when compared to the controls. According to our study, TGF-β1 is not useful in the detection and follow-up of fetal hydronephrosis. We therefore require further studies involving larger groups with moderate or severe fetal hydronephrosis to detect the usefulness of the serum levels of TGF-β1 in pregnant women with fetal hydronephrosis.     

Is there any correlation between amh and obesity in premenopausal women?

Purpose

To evaluate the correlation between the levels of anti-mullerian hormone and body mass index between obese and non-obese premenopausal women.

Methods

Serum anti-mullerian hormone levels of women younger than 45?years admitted to our reproductive endocrinology clinic for investigation of infertility were examined in this cross-sectional study. Body mass indices were lower than 30?kg/m² in 222 patients and equal to or higher than 30?kg/m² in 37 patients. Levels of antimullerian hormone were analyzed in each group. Blood samples obtained from study subjects were assayed for levels of anti-mullerian hormone, follicle-stimulating hormone, luteinizing hormone, estradiol, prolactin and thyroid stimulating hormone.

Results

There was no significant difference in terms of mean age between the two groups. There was no statistically significant difference between these two groups in terms of FSH, LH, estradiol and prolactin levels. Anti-mullerian hormone levels were 3.46?±?2.79?ng/ml and 3.79?±?2.93?ng/ml in non-obese and obese participants, respectively. No statistically significant correlation was found between Anti Müllerian Hormone (AMH) levels and BMI levels in either group (P?>?0.05).

Conclusions

Body mass index does not have an effect on serum AMH levels in women of reproductive age. Obesity has no association with levels of serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin and thyroid stimulating hormone. Obesity is unlikely to affect ovarian reserve in the premenopausal age group.     

Is there a correlation between the vaginal colonization with group B streptococci and premature deliveries?

The study covered 110 pregnant females during the period from January 1, 2002 till April 30, 2003. Nine females (8.18%) delivered premature newborns. Samples were taken from the posterior vaginal fornix and canalis cervicalis in the 18th and 24th gestational week. The preparations stained after Gram were examined under light microscope. Microbial cultures on blood agar were examined, too. It was established that 18 or 16.36% of all the cases presented with cultures positive for group B streptococci (Str. agalactiae) and Ureaplasma urealythicum. Some other microbial flora representatives such as Chlamydia trachomatis, Neisseria gonorrhoea and Trichomonas vaginalis were additionally identified. The independent colonization with Str. agalactiae prior to the 18th gestational week does not relate to the spontaneous abortions and premature deliveries at all. On the other hand, the colonization with Group B streptococci or their symbiosis with other microorganisms after the 23rd-24th gestational week displays a certain correlation with the premature births.     

Is there a link between vulval cancer and blood group?

Risk factors for squamous cell vulval cancer (SCC) remain unclear though there have been associations with lichen sclerosis, smoking, and vulval intraepithelial neoplasia (VIN). We studied 191 patients who had been referred to the vulval clinic at the Royal Free Hospital and who had both blood group and histopathology results available. Seventy-two percent of patients with SCC and non-neoplastic epithelial disorders of the vulva (NNEDV) were found to be in blood group A with only 17% in blood group O. Those with SCC associated with VIN had only 30% in blood group A with 50% in blood group O. The control population showed that 38% of the population were in blood group A and 43% were in blood group O. Our results suggest that blood group A is prevalent in patients with SCC associated with NNEDV but not in those women with squamous vulval cancer and associated VIN.     

Is there a relationship between the grade of maternal hydronephrosis and birth weight of the babies?

Mild hydronephrosis may be present in upto 90% of pregnancies. The degree of hydronephrosis was determined by maximal calyceal diameter (MCD). The aim of this study is to investigate whether there is a relationship between grade of maternal hydronephrosis and birth weight of the babies. Subjects were examined in three groups: group 1 MCD of 5–10?mm (grade I), group 2 10–15?mm (grade II) and group 3 patients >15?mm (grade III). There were 45, 30, 13 patients in the groups, respectively. Estimated fetal weight (EFW) at the time that hydronephrosis was diagnosed, birth weight and duration of pregnancy were compared. The average birth weight of the babies was not statistically different in the three groups (p?>?0.05), but there was a statistically significant difference in fetal weights at the time of diagnosis (p?=?0.02). The grade of maternal hydronephrosis does not affect the duration of pregnancy.     

Is there an association between a history of placental abruption and long-term maternal renal complications?

Objective: To investigate whether patients with a history of placental abruption have an increased risk for subsequent maternal long-term morbidity.

Study design: A population-based study compared the incidence of long-term renal morbidity in cohort of women with and without a history of placental abruption. Deliveries occurred during a 25-year period, with a mean follow-up duration of 11.2 years. Renal morbidity included kidney transplantation, chronic renal failure, hypertensive renal disease, etc.

Results: During the study period 99?354 deliveries met the inclusion criteria; 1.8% (n?=?1807) occurred in patients with a diagnosis of placental abruption. Patients with placental abruption did not have higher cumulative incidence of renal related hospitalizations, using Kaplan–Meier survival curve. During the follow-up period patients with a history of placental abruption did not have higher rate of renal morbidity (0.2% versus 0.1%; OR 1.8; 95% CI 0.6–4.8; p?=?0.261). When performing a Cox proportional hazards model, adjusted for confounders such as parity and diabetes mellitus, a history of placental abruption was not associated with renal related hospitalizations (adjusted HR, 1.6; 95% CI, 0.6–4.2; p?=?0.381).

Conclusion: Placental abruption, even though considered a part of the “placental syndrome” with possible vascular etiology, is not a risk factor for long-term maternal renal complications.     

Is there a correlation between tumor marker panel and tumor size and histopathology in well staged patients with borderline ovarian tumors?

AIMS: To investigate whether there is a correlation between serum tumor markers panel (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well staged patients with borderline ovarian tumors (BOTs). METHODS: Four tumor markers (CA 125, CA 19-9, CA 15-3, and CEA) were analysed clinically in 60 well staged patients with borderline ovarian tumor, for this retrospective observational study. RESULTS: Most patients had serous histology and early stage disease, and the mean age at the time of diagnosis was 40.70 years (range: 19-73). Twenty-nine patients (48.3%) had high CA 125 levels (>35 U/l), 15 patients (25%) had high levels of CEA (>4 ng/ml), 12 patients (20%) had high levels of CA 19-9 (>37 U/ml), and 9 patients (15%) had high levels of CA 15-3 (>30 ng/ml) at the time of initial surgery. The positive rate of CA 125, CA 19-9, CA 15-3, and CEA in serous tumor were 57.9, 7.9, 7.9 and 15.8%, respectively. These figures were 31.8, 40.9, 27.3 and 40.9% in mucinous tumor. The positive rate of CA 125 in the serous group was statistically significantly higher than that in the mucinous group, while the positive rates for CA 19-9 and CEA in mucinous histology was significantly higher than those in serous tumors. In case of grouping the tumor size as <4, 4.1-10 and >10 cm, the mean serum levels of tumor markers had significantly increased by increasing tumor size (p<0.05 for CA 125, and CA 19-9, p>0.05 for CA 15-3, and CEA). CONCLUSION: The high levels of tumor markers, especially for CA 125 and CA 19-9, may indicate the larger tumor size. The elevation of serum CA 125 may suggest serous tumors, while the high level of serum CA 19-9 and CEA may indicate mucinous BOTs.     

Is human myometrial sampling at the time of cesarean delivery safe?

OBJECTIVE: The mechanism for the initiation of human labor remains unknown and is under extensive investigation. Myometrium from patients in labor and not in labor is the ideal tissue to study structural, cellular, and molecular changes that occur during parturition. This study was designed to determine whether myometrial sampling at the time of cesarean delivery increases maternal morbidity. STUDY DESIGN: This is a prospective cohort study including 118 study and 236 control patients. A full-thickness myometrial sample was obtained from the superior edge of a transverse uterine incision at the time of cesarean delivery. Demographics and standard surgical morbidity data were collected. Statistical methods used included univariate and multivariate analysis. RESULTS: The study and control groups did not differ significantly with respect to age, gravidity, parity, birth weight, and Apgar scores. The estimated intraoperative blood loss was greater in the control group (P <.02); however, the change in hematocrit level (preoperative vs postoperative values) was not different. There were no significant differences in the rates of endometritis, wound infection, and venous thrombosis up to 6 weeks post partum. When study and control patients were stratified into term in labor, term not in labor, preterm in labor, and preterm not in labor categories and compared for maternal morbidity, there were still no significant differences for any of the outcome measures evaluated. CONCLUSION: On the basis of our data, human myometrial sampling at cesarean delivery does not increase overall maternal morbidity, irrespective of gestational age and the presence or absence of labor.     

Is there a relationship between uterine activity and the length of the cervix in the second trimester?

OBJECTIVE: The purpose of this study was to determine if a relationship could be detected between uterine activity and cervical change in the second trimester. METHODS: Ten women with evidence of cervical change and 10 women with no cervical change (controls) were studied between 20 and 28 weeks gestation. Uterine activity was recorded using home uterine activity monitoring units. Cervical assessment was performed using transvaginal ultrasound. RESULTS: There was no statistically significant difference in the contractions per hour in the cervical change group (1.26 +/- 0.38; mean +/- SEM) compared to the controls (1.13 +/- 0.48) (p 0.48; Mann-Whitney U test). There were significant differences in closed endocervical length (p < 0.001) and internal os dilatation (p 0.004), the cervical change group demonstrating a shorter closed endocervical length and greater internal os dilatation. CONCLUSIONS: This preliminary study shows no evidence of a relationship between uterine activity and endocervical canal length in the second trimester.     

Is there an association between maternal hypotension and poor pregnancy outcome?: a review of contemporary literature

This literature review highlights that research about the effect of maternal hypotension in pregnancy has either concentrated on an acute hypotensive episode, or looked at the influence of persistent maternal hypotension on fetal growth and/or premature birth. Whilst there is some German literature no published English study has specifically examined the possible significance of chronic maternal hypotension on the risk of stillbirth. There is, therefore, a significant gap in the research in this area.     

Is there a relationship between endometrial polyps and obesity,diabetes mellitus,hypertension?

Objective

The purpose of our study was to evaluate the relationship between endometrial polyps and obesity, diabetes mellitus (DM) and hypertension (HT).

Materials and methods

202 patients who applied to our gynecology clinic with complaints of infertility, recurrent pregnancy loss and abnormal uterine bleeding, diagnosed to have endometrial polyps by hysteroscopy, were compared with 79 patients without polyps, retrospectively. The relationships between risk factors and presence of a polyp and polyp size were analyzed.

Results

The mean age of cases with endometrial polyps was significantly greater than the controls. The mean body mass index (BMI) of the cases with polyps was also significantly greater than the controls. There was no significant difference between groups with respect to prevalence of DM or HT.

Conclusion

This study suggests that obesity is an independent risk factor in the development of endometrial polyps. Clinicians should be aware in terms of endometrial polyps in the assessment of patients with BMI ≥30. There was no relationship between HT or DM with presence of polyps.     

Manipulation of the follicular phase: Uterodomes and pregnancy - is there a correlation?

Background  

Manipulation of the follicular phase uterine epithelium in women undergoing infertility treatment, has not generally shown differing morphological effects on uterine epithelial characteristics using Scanning Electron Microscopy (SEM) and resultant pregnancy rates have remained suboptimal utilising these manipulations. The present study observed manipulation of the proliferative epithelium, with either 7 or 14 days of sequential oestrogen (E) therapy followed by progesterone (P) and assessed the appearance of pinopods (now called uterodomes) for their usefulness as potential implantation markers in seven women who subsequently became pregnant. Three endometrial biopsies per patient were taken during consecutive cycles: day 19 of a natural cycle - (group 1), days 11/12 of a second cycle after 7 days E then P - (group 2), and days 19/22 of a third cycle after 14 days E then P - (group 3). Embryo transfer (ET) was performed in a subsequent long treatment cycle (as per Group 3).     

Uterine electrical activity at labor: is there a correlation between labor stages?

Objective: To determine the association between the myometrial electrical activity in the active and second stages of labor at term using electrical uterine myography (EUM).

Methods: A prospective observational study of 47 singleton deliveries at term in a tertiary hospital. All women were assessed using noninvasive 9-channel surface electrodes of the EUM during labor. EUM index (EUMi) was calculated as the mean electrical activity during a 30?min monitoring period and expressed as microjouls (MJ). Mean EUMi of the active and second stages of labor were compared accordingly.

Results: Mean EUMi during the active phase was 3.53?±?0.43?MJ, whereas mean EUMi in the second stage was 3.66?±?0.48?MJ (p?=?0.02). Correlation analysis between mean EUMi of the active and second stages of labor produced r^2?=^?0.68 (p?r^2?=^?0.73, p?Conclusion: A positive correlation of myometrial electrical activity exists between active phase and second stage of labor. However, while EUMi was associated with the duration of the active phase, no correlation was found between EUMi and the duration of the second stage.     

Adolescents: Is there an association between knowledge of oral contraceptives and profession of provider?

Knowledge about oral contraceptives (OCs) was investigated among young users of OCs by profession of provider, namely, physician or public health nurse. A 44-item questionnaire designed to assess communication about contraception and knowledge of OCs was distributed to students in 11 of 13 high schools in Trondheim, Norway. Data from 688 OC users were eligible for analyses. Knowledge about OCs was measured by means of 15 questions, from which scores on three separate indices and a total index were determined. Separate indices included knowledge about physical changes during OC use (index I), knowledge about the pill's relative efficacy (index II) and knowledge about risks of cancer/thromboembolism (index III). Logistic regression analyses showed that high scores with regard to knowledge indices were predicted by sexual activity and communication about contraception with peers and/or parents. Profession of provider was not associated with high knowledge scores. Information given during brief and annual discussions with health professionals appears to have an insignificant impact as compared with information from other sources. Our results plead for an over-the-counter practice.     

Is nuchal cord justified as a cause of obstetrician anxiety?

Purpose

Birth asphyxia leading to acidosis comprises 20–60 % of perinatal mortality. Nuchal cord (NC) is one of the possible causes of birth asphyxia. Majority of fetuses who are antenatally detected to have nuchal cord are able to achieve successful vaginal birth. The purpose of this study was to analyze the effect of nuchal cord on fetal acid base status and perinatal outcome in vaginal deliveries.

Study design

150 parturients were equally divided into three groups after vaginal delivery based on no NC, single and multiple loops. Umbilical cord arterial blood was analyzed for biochemical markers i.e. pH, PO₂, SPO₂, PCO₂, HCO₃ ^?, standard base excess and lactate for acidosis. Labor complications like abnormal FHR, meconium-stained liquor, prolonged second stage, instrumental vaginal delivery, third stage complications were compared. In neonates, birth weight, Apgar score ≤7 at 5 min, NICU admission and other morbidity and mortality during hospital stay were compared among groups using suitable statistical tests. Above parameters were also compared between tight and loose loops.

Result

Nuchal cord groups had significantly higher frequency of labor complications than no NC group, especially tight loops. Neonates with NC had significantly higher frequency of meconium-stained liquor, Apgar score ≤7 at 5 min, deranged biochemical markers, NICU transfer. However, none of the neonate had pH in acidosis range and majority were discharged in healthy condition.

Conclusion

Patients with NC are likely to have uneventful labor and delivery as cord compression is transient and most fetuses are able to compensate for reduce umbilical blood flow. Routine antenatal ultrasound scan is not advisable, as mode of delivery and labor management does not change with detection of NC antenatally. Therefore, vaginal delivery with routine labor protocol can be allowed in cases of nuchal cord.     

Postmenopausal endometrial cancer screening: is there a correlation between transvaginal sonographic measurement of endometrial thickness and body mass index?

OBJECTIVE: The aim of this study was to correlate the body mass index with transvaginal sonographic measurement of endometrial thickness in a cohort of postmenopausal women who were admitted for endometrial cancer surveillance. MATERIAL AND METHODS: Transvaginal sonographic measurement of endometrial thickness was performed in 97 postmenopausal women who attended the gynecology clinic for endometrial cancer screening with no history of hormone replacement therapy and correlated with body mass index. Baseline characteristics including age, years since menopause and body mass index were recorded for each subject. The relationship between transvaginal sonographic endometrial thickness and baseline characteristics was assessed in each. RESULTS: Body mass index was significantly correlated with years since menopause (r = 0.292, p = 0.004) and age (r = 0.243, p = 0.01) but not with endometrial thickness (r = -0.07, p = 0.454). Endometrial thickness versus time since menopause correlation was found to be significant (r = 0.274, p = 0.03) in patients with a body mass index lower than 30. CONCLUSION: The present findings indicate that endometrial thickness does not differ with body mass index in the screening of postmenopausal women for endometrial cancer.